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  1. 76 FR 59167 - Siemens Medical Solutions USA, Inc., Oncology Care Systems Division, Concord, CA; Siemens Medical...

    Science.gov (United States)

    2011-09-23

    ... Medical Solutions USA, Inc., Oncology Care Systems Division, Concord, CA; Siemens Medical Solutions USA... Solutions USA, Inc. (Siemens), Oncology Care Systems Division, Concord, California (subject firm). The...., Oncology Care Systems Division, Concord, California (TA-W-73,158) and Siemens Medical Solutions USA, Inc...

  2. A Comparison of Self-reported Medication Adherence to Concordance Between Part D Claims and Medication Possession.

    Science.gov (United States)

    Savitz, Samuel T; Stearns, Sally C; Zhou, Lei; Thudium, Emily; Alburikan, Khalid A; Tran, Richard; Rodgers, Jo E

    2017-05-01

    Medicare Part D claims indicate medication purchased, but people who are not fully adherent may extend prescription use beyond the interval prescribed. This study assessed concordance between Part D claims and medication possession at a study visit in relation to self-reported medication adherence. We matched Part D claims for 6 common medications to medications brought to a study visit in 2011-2013 for the Atherosclerosis Risk in Communities study. The combined data consisted of 3027 medication events (claims, medications possessed, or both) for 2099 Atherosclerosis Risk in Communities study participants. Multinomial logistic regression estimated the association of concordance (visit only, Part D only, or both) with self-reported medication adherence while controlling for sociodemographic characteristics, veteran status, and availability under Generic Drug Discount Programs. Relative to participants with high adherence, medication events for participants with low adherence were approximately 25 percentage points less likely to match and more likely to be visit only (PDiscount Programs were 3 percentage points more likely to be visit only. Part D claims were substantially less likely to be concordant with medications possessed at study visit for participants with low self-reported adherence. This result supports the construction of adherence proxies such as proportion days covered using Part D claims.

  3. The concordance between self-reported medication use and pharmacy records in pregnant women.

    Science.gov (United States)

    Cheung, K; El Marroun, H; Elfrink, M E; Jaddoe, V W V; Visser, L E; Stricker, B H Ch

    2017-09-01

    Several studies have been conducted to assess determinants affecting the performance or accuracy of self-reports. These studies are often not focused on pregnant women, or medical records were used as a data source where it is unclear if medications have been dispensed. Therefore, our objective was to evaluate the concordance between self-reported medication data and pharmacy records among pregnant women and its determinants. We conducted a population-based cohort study within the Generation R study, in 2637 pregnant women. The concordance between self-reported medication data and pharmacy records was calculated for different therapeutic classes using Yule's Y. We evaluated a number of variables as determinant of discordance between both sources through univariate and multivariate logistic regression analysis. The concordance between self-reports and pharmacy records was moderate to good for medications used for chronic conditions, such as selective serotonin reuptake inhibitors or anti-asthmatic medications (0.88 and 0.68, respectively). Medications that are used occasionally, such as antibiotics, had a lower concordance (0.51). Women with a Turkish or other non-Western background were more likely to demonstrate discordance between pharmacy records and self-reported data compared with women with a Dutch background (Turkish: odds ratio, 1.63; 95% confidence interval, 1.16-2.29; other non-Western: odds ratio, 1.33; 95% confidence interval, 1.03-1.71). Further research is needed to assess how the cultural or ethnic differences may affect the concordance or discordance between both medication sources. The results of this study showed that the use of multiple sources is needed to have a good estimation of the medication use during pregnancy. Copyright © 2017 John Wiley & Sons, Ltd.

  4. Adherence to Cardiovascular Disease Medications: Does Patient-Provider Race/Ethnicity and Language Concordance Matter?

    OpenAIRE

    Traylor, Ana H.; Schmittdiel, Julie A.; Uratsu, Connie S.; Mangione, Carol M.; Subramanian, Usha

    2010-01-01

    BACKGROUND: Patient-physician race/ethnicity and language concordance may improve medication adherence and reduce disparities in cardiovascular disease (CVD) by fostering trust and improved patient-physician communication. OBJECTIVE: To examine the association of patient race/ethnicity and language and patient-physician race/ethnicity and language concordance on medication adherence rates for a large cohort of diabetes patients in an integrated delivery system. DESIGN: We studied 131,277 adul...

  5. Concordance between Self and Standardized Patient Ratings of Medical Students' Communication Skills.

    Science.gov (United States)

    Je, Min Ji; Lee, Su Hyun; Lee, Chang Hyung; Kim, Sung Soo

    2013-03-01

    The purpose of this study was to examine the concordance between self and standardized patient (SP) ratings of medical students' communication skills. Forty-three students interviewed SPs. The students were asked to complete a communication skills questionnaire that comprised 2 measures (empathy and interpersonal communication) before the interview. After each student's interview with the SP, the latter completed the same questionnaire as the students. Based on Lin's concordance coefficient, there was strong disconcordance between students' self-ratings and the SPs' ratings. With regard to empathic communication, more than 50% of students who considered themselves higher than middle level were regarded by SP as low level. On interpersonal communication, 39% of students who assessed themselves as higher than middle level were scored low level by SPs. There was strong disconcordance between students' self-ratings and the SPs' ratings-students tended to overevaluate themselves regarding their communication skills. These differences might result in patient dissatisfaction and noncompliance. Further, it could become a serious hindrance to the development of a good doctor-patient relationship. Medical educators should make sincere efforts to reduce this gap by teaching medical students the importance of the patients' perception of his doctors' communication skills.

  6. Concordance of self-reported and medical chart information on cancer diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Shu Xiao Ou

    2011-05-01

    Full Text Available Abstract Background Self-reported information is an important tool for collecting clinical information for epidemiologic studies and in clinical settings where electronic medical records are not employed and shared. Methods Using data collected from the Shanghai Breast Cancer Survival Study (SBCSS, a population-based, prospective cohort study of 5,042 women diagnosed with breast cancer in Shanghai, China, we compared the concordance of patient questionnaire responses to a survey administered approximately 6 months after cancer diagnosis with medical chart information obtained from the diagnostic hospitals for several disease and treatment-related variables. Results Of 5,042 SBCSS participants, medical chart information was available for 4,948 women (98.1%. Concordance between patient self-reported and medical chart information was high for the majority of disease-related variables, including: diagnosing hospital (agreement: 98.7%, kappa: 0.99, type of surgery conducted (94.0%, 0.53, ER/PR status (94.5%, 0.91, and tumor position (98.2%, 0.97, as well as for important calendar dates, such as date of diagnosis, surgery, and first chemotherapy treatment. The 10 most commonly used chemotherapeutic drugs were all reported with agreement rates of at least 82%, with associated kappa values that ranged from 0.41 for calcium folinate to 0.76 for vinorelbine. Conclusions Our study found high validity for patient self-reported information for a variety of disease and treatment-related variables, suggesting the utility of self-reports as an important source of clinical information for both epidemiological research and patient care.

  7. Influence knowledge and behavior of TB medical personnels’ concordance principle based communications skill at primary healthcare, Medan, Indonesia

    Science.gov (United States)

    Wahyuni, A. S.; Soeroso, N. N.; Alona, I.; Yunanda, Y.; Siregar, I.

    2018-03-01

    Concordance behavior of TB management is a form of collaboration among doctors, personnel, and patients in treating TB. Approvalamong them could be achieved if credibility and policy occur. This study is aimed to analyze the influence of TB medical personnel’s concordance behaviour principle to patient obedience at primary health care in Medan.The design of this study was quasi experimental, focusing on interventional primary health care, which is those who applied concordance behaviour principle to non-interventionalprimary health care. The population is TB patients, starting from 18 years old, TB category I with positive Acid Fast Bacilli Smear Test (AFBST), and taking TB regimens at Medan. Seventy- four patients were selected to be samples. They had undergone interview based on validated concordance principle, knowledge, behavior, and treatment. Data were analyzed using chi- square. The percentage of knowledge, behavior of TB patient to the treatment is higher on interventional primary health care than noninterventional ones. Treatment awareness based on concordance principle is expected to planish DOTS-based TB programs.

  8. Decision-Making in Pediatric Transport Team Dispatch Using Script Concordance Testing.

    Science.gov (United States)

    Rajapreyar, Prakadeshwari; Marcdante, Karen; Zhang, Liyun; Simpson, Pippa; Meyer, Michael T

    2017-11-01

    Our objective was to compare decision-making in dispatching pediatric transport teams by Medical Directors of pediatric transport teams (serving as experts) to that of Pediatric Intensivists and Critical Care fellows who often serve as Medical Control physicians. Understanding decision-making around team composition and dispatch could impact clinical management, cost effectiveness, and educational needs. Survey was developed using Script Concordance Testing guidelines. The survey contained 15 transport case vignettes covering 20 scenarios (45 questions). Eleven scenarios assessed impact of intrinsic patient factors (e.g., procedural needs), whereas nine assessed extrinsic factors (e.g., weather). Pediatric Critical Care programs accredited by the Accreditation Council for Graduate Medical Education (the United States). Pediatric Intensivists and senior Critical Care fellows at Pediatric Critical Care programs were the target population with Transport Medical Directors serving as the expert panel. None. Survey results were scored per Script Concordance Testing guidelines. Concordance within groups was assessed using simple percentage agreement. There was little concordance in decision-making by Transport Medical Directors (median Script Concordance Testing percentage score [interquartile range] of 33.9 [30.4-37.3]). In addition, there was no statistically significant difference between the median Script Concordance Testing scores among the senior fellows and Pediatric Intensivists (31.1 [29.6-33.2] vs 29.7 [28.3-32.3], respectively; p = 0.12). Transport Medical Directors were more concordant on reasoning involving intrinsic patient factors rather than extrinsic factors (10/21 vs 4/24). Our study demonstrates pediatric transport team dispatch decision-making discordance by pediatric critical care physicians of varying levels of expertise and experience. Script Concordance Testing at a local level may better elucidate standards in medical decision-making within

  9. Impact of Patient-Provider Race, Ethnicity, and Gender Concordance on Cancer Screening: Findings from Medical Expenditure Panel Survey.

    Science.gov (United States)

    Malhotra, Jyoti; Rotter, David; Tsui, Jennifer; Llanos, Adana A M; Balasubramanian, Bijal A; Demissie, Kitaw

    2017-12-01

    Background: Racial and ethnic minorities experience lower rates of cancer screening compared with non-Hispanic whites (NHWs). Previous studies evaluating the role of patient-provider race, ethnicity, or gender concordance in cancer screening have been inconclusive. Methods: In a cross-sectional analysis using the Medical Expenditure Panel Survey (MEPS), data from 2003 to 2010 were assessed for associations between patient-provider race, ethnicity, and/or gender concordance and, screening (American Cancer Society guidelines) for breast, cervical, and colorectal cancer. Multivariable logistic analyses were conducted to examine associations of interest. Results: Of the 32,041 patient-provider pairs in our analysis, more than 60% of the patients were NHW, 15% were non-Hispanic black (NHB), and 15% were Hispanic. Overall, patients adherent to cancer screening were more likely to be non-Hispanic, better educated, married, wealthier, and privately insured. Patient-provider gender discordance was associated with lower rates of breast [OR, 0.83; 95% confidence interval (CI), 0.76-0.90], cervical (OR, 0.83; 95% CI, 0.76-0.91), and colorectal cancer (OR, 0.84; 95% CI, 0.79-0.90) screening in all patients. This association was also significant after adjusting for racial and/or ethnic concordance. Conversely, among NHWs and NHBs, patient-provider racial and/or ethnic concordance was not associated with screening. Among Hispanics, patient-provider ethnic discordant pairs had higher breast (58% vs. 52%) and colorectal cancer (45% vs. 39%) screening rates compared with concordant pairs. Conclusions: Patient-provider gender concordance positively affected cancer screening. Patient-provider ethnic concordance was inversely associated with receipt of cancer screening among Hispanics. This counter-intuitive finding requires further study. Impact: Our findings highlight the importance of gender concordance in improving cancer screening rates. Cancer Epidemiol Biomarkers Prev; 26

  10. Concorde

    CERN Multimedia

    Bernard

    1971-01-01

    Concorde -volera, volera pas et comment volera-t-il? Film: les Concordes de vol Le Commandant Bernard présente le Concorde, "né" en 1962, et commente l'appareil qui est d'actualité- commentaires techniques à l'aide d'une maquette et présentation des dias

  11. The evaluation of an intervention based on the application of patient self-completion concordance forms in Dutch community pharmacies and the effect on adherence to chronic medication

    NARCIS (Netherlands)

    Geurts, Marlies M. E.; Pot, Johan L. W.; Schepers, Emiel H.; Tromp, Chris; Colijn, Corine G.; Dijkstra, Arie; de Gier, Johan J.

    Objective: To evaluate the use of patient self-completion concordance forms and to determine the effect of patient counselling by using concordance forms on adherence to chronic medication. Methods: Patients with a prescription for new chronic treatment were randomised in an intervention or control

  12. Availability of Care Concordant With Patient-centered Medical Home Principles Among Those With Chronic Conditions: Measuring Care Outcomes.

    Science.gov (United States)

    Pourat, Nadereh; Charles, Shana A; Snyder, Sophie

    2016-03-01

    Care delivery redesign in the form of patient-centered medical home (PCMH) is considered as a potential solution to improve patient outcomes and reduce costs, particularly for patients with chronic conditions. But studies of prevalence or impact at the population level are rare. We aimed to assess whether desired outcomes indicating better care delivery and patient-centeredness were associated with receipt of care according to 3 important PCMH principles. We analyzed data from a representative population survey in California in 2009, focusing on a population with chronic condition who had a usual source of care. We used bivariate, logistic, and negative-binomial regressions. The indicators of PCMH concordant care included continuity of care (personal doctor), care coordination, and care management (individual treatment plan). Outcomes included flu shots, count of outpatient visits, any emergency department visit, timely provider communication, and confidence in self-care. We found that patients whose care was concordant with all 3 PCMH principles were more likely to receive flu shots, more outpatient care, and timely response from providers. Concordance with 2 principles led to some desired outcomes. Concordance with only 1 principle was not associated with desired outcomes. Patients who received care that met 3 key aspects of PCMH: coordination, continuity, and management, had better quality of care and more efficient use of the health care system.

  13. Concordance: Design Ideal for Facilitating Situated Negotiations in Out-of-clinic Healthcare

    DEFF Research Database (Denmark)

    Bagalkot, Naveen L.; Gronvall, Erik; Sokoler, Tomas

    2014-01-01

    Healthcare HCI research has explored various designs that encourage people to follow prescribed treatments, mostly adopting compliance and adherence as design ideals. However, within the medical sciences the notion of concordance also exists. Concordance promotes negotiation between the patient...... and healthcare professional for forging a therapeutic alliance. However, the HCI community has still not adopted concordance as a design ideal. This paper revisits four old design-cases to explore the role of concordance in out-of-clinic healthcare. We argue that concordance, as a design ideal, can guide new...... designs that promote a more active patient-role both at the clinic and beyond....

  14. The script concordance test as a tool to evaluate clinical reasoning in neonatology.

    Science.gov (United States)

    Ben Hamida, Emira; Ayadi, Imen; Marrakchi, Zahra; Quinton, André

    2017-05-01

    Script concordance test aims to evaluate knowledge organization, which represents an essential component of the clinical competence. To build a script concordance test and demonstrate its relevance in the evaluation of Neonatology skills. A script concordance test including 20 vignettes and 20 items, was provided to 52 fourth year medical students and 11 family medicine interns. Script concordance test scores obtained by experts were higher then those obtained by students and family medicine interns. The scores (out of 100) were 82.52 ± 7.35 CI95% [77.26-87.78] for the experts, 58.52 ± 9.72 CI95% [55.82-61.23] for the students, and 63.17±11.36 IC95%  [55.53-70.81] (p<0.0001) for the interns. Our data suggest that script concordance tests could be used to assess the acquisition of clinical reasoning among fourth year medical students in neonatolgy.

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

    Science.gov (United States)

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

    2011-01-01

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

  16. The Royal Naval Medical Services: delivering medical operational capability. the 'black art' of Medical Operational Planning.

    Science.gov (United States)

    Faye, M

    2013-01-01

    This article looks to dispel the mysteries of the 'black art' of Medical Operational Planning whilst giving an overview of activity within the Medical Operational Capability area of Medical Division (Med Div) within Navy Command Headquarters (NCHQ) during a period when the Royal Naval Medical Services (RNMS) have been preparing and reconfiguring medical capability for the future contingent battle spaces. The rolling exercise program has been used to illustrate the ongoing preparations taken by the Medical Operational Capability (Med Op Cap) and the Medical Force Elements to deliver medical capability in the littoral and maritime environments.

  17. Concorde Re-visited

    Science.gov (United States)

    Horton, Peter; Moore, Peter

    This year marks the twentieth anniversary of the introduction of Concorde into commercial airline service. The first commercial flights were on 21 January 1976 - British Airways from Heathrow to Bahrain and Air France from Paris to Rio via Dakar. Later in that year commercial flights to Washington/Dulles began on 24 May. Services to New York were delayed until 22 November 1977. The first flight of Concorde was some seven years earlier. The prototype took off out of Toulouse on 2 March 1969 and this was followed by 002 from Filton to Fairford on 9 April. At the time it was anticipated that this was the beginning of an era when supersonic flight would be the normal way to travel long distances. Now, in 1996, Concorde is still the world's only supersonic commercial passenger airliner in airline service. This is an extraordinary achievement. The Boeing SST proved to be too ambitious and the programme was halted in 1971 after the United States Government withdrew support, while the Russian TU 144 was beset with problems. One TU 144 crashed at the Paris Air Show in 1973. The aircraft entered internal airline service in December 1975, flying supersonically between Moscow and Alma-Ata, capital of Kazakhstan, carrying mail and freight, but it did not have the range to operate viable intercontinental passenger serives. Certainly by 1985, if not many years before, the TU 144 was out of service.

  18. The Stable Concordance Genus

    OpenAIRE

    Kearney, M. Kate

    2013-01-01

    The concordance genus of a knot is the least genus of any knot in its concordance class. Although difficult to compute, it is a useful invariant that highlights the distinction between the three-genus and four-genus. In this paper we define and discuss the stable concordance genus of a knot, which describes the behavior of the concordance genus under connected sum.

  19. A valoração de traços de concordância dentro do DP Concord features valuing within DP

    Directory of Open Access Journals (Sweden)

    Telma M.V. Magalhães

    2004-06-01

    Full Text Available Este trabalho argumenta em favor da valoração dos traços de concordância dentro do DP em termos da operação Agree (Chomsky, 1999 sem a necessidade de estipular nenhum outro mecanismo para tanto. Mostro que Agree dá conta da valoração de traços tanto no nível da sentença quanto no nível do DP, contra a sugestão de Chomsky (1999 de que concordância no DP envolveria algum outro mecanismo de checagem.This paper argues in favor of a concord features valuing within the DP in terms of the Agree operation (Chomsky, 1999, with no recourse to any other mechanism. I show that Agree accounts for feature valuing both in the sentence level as well as in the DP, contrary to Chomsky's (1999 suggestion that concord in DP should involve some other checking mechanism.

  20. Are physicians and patients in agreement? Exploring dyadic concordance.

    Science.gov (United States)

    Coran, Justin J; Koropeckyj-Cox, Tanya; Arnold, Christa L

    2013-10-01

    Dyadic concordance in physician-patient interactions can be defined as the extent of agreement between physicians and patients in their perceptions of the clinical encounter. The current research specifically examined two types of concordance: informational concordance-the extent of agreement in physician and patient responses regarding patient information (education, self-rated health, pain); and interactional concordance-the extent of physician-patient agreement regarding the patient's level of confidence and trust in the physician and the perceived quality of explanations concerning diagnosis and treatment. Using a convenience sample of physicians and patients (N = 50 dyads), a paired survey method was tested, which measured and compared physician and patient reports to identify informational and interactional concordances. Factors potentially related to dyadic concordance were also measured, including demographic characteristics (patient race, gender, age, and education) and clinical factors (whether this was a first visit and physician specialty in family medicine or oncology). The paired survey showed informational discordances, as physicians tended to underestimate patients' pain and overestimate patient education. Interactional discordances included overestimating patients' understanding of diagnosis and treatment explanations and patients' level of confidence and trust. Discordances were linked to patient dissatisfaction with physician listening, having unanswered questions, and feeling the physician had not spent enough time. The paired survey method effectively identified physician-patient discordances that may interfere with effective medical practice; this method may be used in various settings to identify potential areas of improvement in health communication and education.

  1. Learning-by-Concordance (LbC): introducing undergraduate students to the complexity and uncertainty of clinical practice.

    Science.gov (United States)

    Fernandez, Nicolas; Foucault, Amélie; Dubé, Serge; Robert, Diane; Lafond, Chantal; Vincent, Anne-Marie; Kassis, Jeannine; Kazitani, Driss; Charlin, Bernard

    2016-10-01

    A current challenge in medical education is the steep exposure to the complexity and uncertainty of clinical practice in early clerkship. The gap between pre-clinical courses and the reality of clinical decision-making can be overwhelming for undergraduate students. The Learning-by-Concordance (LbC) approach aims to bridge this gap by embedding complexity and uncertainty by relying on real-life situations and exposure to expert reasoning processes to support learning. LbC provides three forms of support: 1) expert responses that students compare with their own, 2) expert explanations and 3) recognized scholars' key-messages. Three different LbC inspired learning tools were used by 900 undergraduate medical students in three courses: Concordance-of-Reasoning in a 1 st -year hematology course; Concordance-of-Perception in a 2nd-year pulmonary physio-pathology course, and; Concordance-of-Professional-Judgment with 3rd-year clerkship students. Thematic analysis was conducted on freely volunteered qualitative comments provided by 404 students. Absence of a right answer was challenging for 1 st year concordance-of-reasoning group; the 2 nd year visual concordance group found radiology images initially difficult and unnerving and the 3 rd year concordance-of-judgment group recognized the importance of divergent expert opinion. Expert panel answers and explanations constitute an example of "cognitive apprenticeship" that could contribute to the development of appropriate professional reasoning processes.

  2. Concordance measures and second order stochastic dominance-portfolio efficiency analysis

    Czech Academy of Sciences Publication Activity Database

    Kopa, Miloš; Tichý, T.

    2012-01-01

    Roč. 15, č. 4 (2012), s. 110-120 ISSN 1212-3609 R&D Projects: GA ČR(CZ) GBP402/12/G097 Institutional support: RVO:67985556 Keywords : dependency * concordance * portfolio selection * second order stochastic dominance Subject RIV: BB - Applied Statistics, Operational Research Impact factor: 0.633, year: 2012 http://library.utia.cas.cz/separaty/2013/E/kopa-concordance measures and second order stochastic dominance- portfolio efficiency analysis.pdf

  3. Concordance of Barthel Index, ECOG-PS, and Palliative Performance Scale in the assessment of functional status in patients with advanced medical diseases.

    Science.gov (United States)

    Hernández-Quiles, C; Bernabeu-Wittel, M; Pérez-Belmonte, L M; Macías-Mir, P; Camacho-González, D; Massa, B; Maiz-Jiménez, M; Ollero-Baturone, M

    2017-09-01

    Analysing most relevant clinical features and concordance between different functional scales in patients with advanced medical diseases (PAMD). Cross-sectional multicentre study that included PAMD (heart, lung, kidney, liver, and neurological diseases) in hospital settings from February 2009 to October 2010. We analysed clinical, biological and functional features in performing activities of daily living (ADL) by medians of Barthel Index (BI); additionally we assessed their performance status by medians of Eastern Cooperative Oncology Group-Performance Status (ECOG-PS) and Palliative Performance Scale (PPS) scores. We evaluated the concordance of these instruments in assessing functional impairment by κ and intraclass correlation coefficient tests. 1847 patients were included (average age 79 years, 50.1% men). Most common symptoms were dyspnoea (62.31%), asthenia (23%) and delirium (20.14%). Functional assessment showed a high prevalence of severe or total impairment in performing basic ADL by medians of used instruments (BI median=35 (IQR=70), and 52.1% of patients with severe-total impairment; ECOG-PS median=2 (IQR 30), and 44% of patients with severe-total impairment; and PPS median=50 (IQR 30), and 32% of patients with severe-total impairment). Concordance among these instruments was acceptably good ( κ indexes ranging from 0.653 to 0.745 (pmanagement. Assessment of functional ability in this population by BI, ECOG-PS, and PPS showed good concordance. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  4. Concordance between maternal recall of birth complications and data from obstetrical records.

    Science.gov (United States)

    Keenan, Kate; Hipwell, Alison; McAloon, Rose; Hoffmann, Amy; Mohanty, Arpita; Magee, Kelsey

    2017-02-01

    Prenatal complications are associated with poor outcomes in the offspring. Access to medical records is limited in the United States and investigators often rely on maternal report of prenatal complications. We tested concordance between maternal recall and birth records in a community-based sample of mothers participating in a longitudinal study in order to determine the accuracy of maternal recall of perinatal complications. Participants were 151 biological mothers, who were interviewed about gestational age at birth, birthweight, and the most commonly occurring birth complications: nuchal cord and meconium aspiration when the female child was on average 6years old, and for whom birth records were obtained. Concordance between reports was assessed using one-way random intra-class coefficients for continuous measures and kappa coefficients for dichotomous outcomes. Associations between maternal demographic and psychological factors and discrepancies also were tested. Concordance was excellent for continuously measured birthweight (ICC=0.85, pbirth record and absence according to maternal recall. Receipt of public assistance was associated with a decrease in discrepancy in report of nuchal cord. Concordance between maternal retrospective report and medical birth records varies across different types of perinatal events. There was little evidence that demographic or psychological factors increased the risk of discrepancies. Maternal recall based on continuous measures of perinatal factors may yield more valid data than dichotomous outcomes. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  5. Concorde noise-induced building vibrations: International Airport Dulles. [studies by Langley Research Center

    Science.gov (United States)

    Mayes, W. H.; Scholl, H. F.; Stephens, D. G.; Holliday, B. G.; Deloach, R.; Finley, T. D.; Holmes, H. K.; Lewis, R. B.; Lynch, J. W.

    1977-01-01

    A series of studies were conducted to assess the noise-induced building vibrations associated with Concorde operations. The vibration levels of windows, walls, and floors were measured along with the associated noise levels of Concorde, subsonic aircraft and some nonaircraft events. Test sites included Sully Plantation which is adjacent to Dulles International Airport and three residential homes located in Montgomery County, Maryland. The measured vibration response levels due to Concorde operations were found to be: (1) higher than the levels due to other aircraft, (2) less than the levels due to certain household events which involve direct impulsive loading such as door and window closing, (3) less than criteria levels for building damage, and (4) comparable to levels which are perceptible to people.

  6. Attitudes toward concordance and self-efficacy in decision making: a cross-sectional study on pharmacist-patient consultations.

    Science.gov (United States)

    Ng, Yew Keong; Shah, Noraida Mohamed; Loong, Ly Sia; Pee, Lay Ting; Hidzir, Sarina Anim M; Chong, Wei Wen

    2018-01-01

    This study investigated patients' and pharmacists' attitudes toward concordance in a pharmacist-patient consultation and how patients' attitudes toward concordance relate to their involvement and self-efficacy in decision making associated with medication use. A cross-sectional study was conducted among patients with chronic diseases and pharmacists from three public hospitals in Malaysia. The Revised United States Leeds Attitudes toward Concordance (RUS-LATCon) was used to measure attitudes toward concordance in both patients and pharmacists. Patients also rated their perceived level of involvement in decision making and completed the Decision Self-Efficacy scale. One-way analysis of variance (ANOVA) and independent t -test were used to determine significant differences between different subgroups on attitudes toward concordance, and multiple linear regression was performed to find the predictors of patients' self-efficacy in decision making. A total of 389 patients and 93 pharmacists participated in the study. Pharmacists and patients scored M=3.92 (SD=0.37) and M=3.84 (SD=0.46) on the RUS-LATCon scale, respectively. Seven items were found to be significantly different between pharmacists and patients on the subscale level. Patients who felt fully involved in decision making (M=3.94, SD=0.462) scored significantly higher on attitudes toward concordance than those who felt partially involved (M=3.82, SD=0.478) and not involved at all (M=3.68, SD=0.471; p Decision Self-Efficacy scale. In multiple linear regression analysis, ethnicity, number of medications taken by patients, patients' perceived level of involvement, and attitudes toward concordance are significant predictors of patients' self-efficacy in decision making ( p making an informed decision. Further study is recommended on interventions involving pharmacists in supporting patients' involvement in medication-related decision making.

  7. Patient factors associated with guideline-concordant treatment of anxiety and depression in primary care.

    Science.gov (United States)

    Prins, Marijn A; Verhaak, Peter F M; Smolders, Mirrian; Laurant, Miranda G H; van der Meer, Klaas; Spreeuwenberg, Peter; van Marwijk, Harm W J; Penninx, Brenda W J H; Bensing, Jozien M

    2010-07-01

    To identify associations of patient characteristics (predisposing, enabling and need factors) with guideline-concordant care for anxiety and depression in primary care. Analysis of data from the Netherlands Study of Depression and Anxiety (NESDA). Seven hundred and twenty-one patients with a current anxiety or depressive disorder, recruited from 67 general practitioners (GPs), were included. Diagnoses according to the Diagnostic and Statistic Manual of Mental Disorders, fourth edition (DSM-IV) were made using a structured and widely validated assessment. Socio-demographic and enabling characteristics, severity of symptoms, disability, (under treatment for) chronic somatic conditions, perceived need for care, beliefs and evaluations of care were measured by questionnaires. Actual care data were derived from electronic medical records. Criteria for guideline-concordant care were based on general practice guidelines, issued by the Dutch College of General Practitioners. Two hundred and eighty-one (39%) patients received guideline-concordant care. High education level, accessibility of care, comorbidity of anxiety and depression, and severity and disability scores were positively associated with receiving guideline-concordant care in univariate analyses. In multivariate multi-level logistic regression models, significant associations with the clinical need factors disappeared. Positive evaluations of accessibility of care increased the chance (OR = 1.31; 95%-CI = 1.05-1.65; p = 0.02) of receiving guideline-concordant care, as well as perceiving any need for medication (OR = 2.99; 95%-CI = 1.84-4.85; p depression than clinical need factors. Initiatives to improve GPs' communication skills around mental health issues, and to improve recognition of people suffering from anxiety disorders, could increase the number of patients receiving treatment for depression and anxiety in primary care.

  8. Concordance of sleep and pain outcomes of diverse interventions: an umbrella review.

    Directory of Open Access Journals (Sweden)

    Anthony G Doufas

    Full Text Available BACKGROUND/OBJECTIVE: Pain influences sleep and vice versa. We performed an umbrella review of meta-analyses on treatments for diverse conditions in order to examine whether diverse medical treatments for different conditions have similar or divergent effects on pain and sleep. METHODS: We searched published systematic reviews with meta-analyses in the Cochrane Database of Systematic Reviews until October 20, 2011. We identified randomized trials (or meta-analyses thereof, when >1 trial was available where both pain and sleep outcomes were examined. Pain outcomes were categorized as headache, musculoskeletal, abdominal, pelvic, generic or other pain. Sleep outcomes included insomnia, sleep disruption, and sleep disturbance. We estimated odds ratios for all outcomes and evaluated the concordance in the direction of effects between sleep and various types of pain and the correlation of treatment effects between sleep and pain outcomes. RESULTS: 151 comparisons with 385 different trials met our eligibility criteria. 96 comparisons had concordant direction of effects between each pain outcome and sleep, while in 55 the effect estimates were in opposite directions (P<0.0001. In the 20 comparisons with largest amount of evidence, the experimental drug always had worse sleep outcomes and tended to have worse pain outcomes in 17/20 cases. For headache and musculoskeletal pain, 69 comparisons showed concordant direction of effects with sleep outcomes and 36 showed discordant direction (P<0.0001. For the other 4 pain types there were overall 27 vs. 19 pairs with concordant vs. discordant direction of effects (P = 0.095. There was a weak correlation of the treatment effect sizes for sleep vs. headache/musculoskeletal pain (r = 0.17, P = 0.092. CONCLUSIONS: Medical interventions tend to have effects in the same direction for pain and sleep outcomes, but exceptions occur. Concordance is primarily seen for sleep and headache or musculoskeletal

  9. 78 FR 5717 - Safety Zone; Military Ocean Terminal Concord Safety Zone, Suisun Bay, Military Ocean Terminal...

    Science.gov (United States)

    2013-01-28

    ...-AA00 Safety Zone; Military Ocean Terminal Concord Safety Zone, Suisun Bay, Military Ocean Terminal... Guard is establishing a safety zone in the navigable waters of Suisun Bay near Military Ocean Terminal Concord, CA in support of military onload and offload operations. This safety zone is established to...

  10. Patient-provider concordance with behavioral change goals drives measures of motivational interviewing consistency.

    Science.gov (United States)

    Laws, Michael Barton; Rose, Gary S; Beach, Mary Catherine; Lee, Yoojin; Rogers, William S; Velasco, Alyssa Bianca; Wilson, Ira B

    2015-06-01

    Motivational Interviewing (MI) consistent talk by a counselor is thought to produce "change talk" in clients. However, it is possible that client resistance to behavior change can produce MI inconsistent counselor behavior. We applied a coding scheme which identifies all of the behavioral counseling about a given issue during a visit ("episodes"), assesses patient concordance with the behavioral goal, and labels providers' counseling style as facilitative or directive, to a corpus of routine outpatient visits by people with HIV. Using a different data set of comparable encounters, we applied the concepts of episode and concordance, and coded using the Motivational Interviewing Treatment Integrity system. Patient concordance/discordance was not observed to change during any episode. Provider directiveness was strongly associated with patient discordance in the first study, and MI inconsistency was strongly associated with discordance in the second. Observations that MI-consistent behavior by medical providers is associated with patient change talk or outcomes should be evaluated cautiously, as patient resistance may provoke MI-inconsistency. Counseling episodes in routine medical visits are typically too brief for client talk to evolve toward change. Providers with limited training may have particular difficulty maintaining MI consistency with resistant clients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. On the concordance genus of topologically slice knots

    OpenAIRE

    Hom, Jennifer

    2012-01-01

    The concordance genus of a knot K is the minimum Seifert genus of all knots smoothly concordant to K. Concordance genus is bounded below by the 4-ball genus and above by the Seifert genus. We give a lower bound for the concordance genus of K coming from the knot Floer complex of K. As an application, we prove that there are topologically slice knots with 4-ball genus equal to one and arbitrarily large concordance genus.

  12. Spousal Concordance of Diabetes Mellitus among Women in Ajman, United Arab Emirates.

    Science.gov (United States)

    Al-Sharbatti, Shatha S; Abed, Yasmeen I; Al-Heety, Lujain M; Basha, Shaikh A

    2016-05-01

    Spousal concordance is defined as similar behaviours and associated health statuses between spouses. This study aimed to identify the concordance of diabetes mellitus (DM) and related variables among genetically unrelated couples in Ajman, United Arab Emirates (UAE). This cross-sectional study included 270 married women attending either the Mushairef Health Center or the Gulf Medical College Hospital in Ajman between May and November 2012. A validated questionnaire was designed to determine sociodemographic characteristics and a history or family history of DM, hypertension, coronary artery disease or dyslipidaemia among the women and their husbands. The weight, height, body mass index, waist circumference, fasting blood sugar and glycated haemoglobin (HbA1c) levels of all women were measured. Of the women, 39.3% of those with diabetic husbands and 39.9% of those with non-diabetic husbands were diabetic themselves (P >0.050). The prevalence of DM spousal concordance was 17.8%. A history of hypertension, coronary artery disease and dyslipidaemia was significantly more frequent among women whose husbands had a history of the same conditions (P = 0.001, 0.040 and 0.002, respectively). Spousal concordance of abnormal glycaemia among non-diabetic women with diabetic husbands was significant (P = 0.001). Having a diabetic husband (P = 0.006) and being obese (P = 0.009) were the only significant predictors of hyperglycaemia among non-diabetic women after controlling for confounding factors. There was significant concordance of abnormal glycaemia among non-diabetic women with diabetic husbands. The spouses of diabetic patients may therefore be a target population for regular hyperglycaemia and DM screening.

  13. Medical supply on contingency military operations: experience from Operation GRITROCK.

    Science.gov (United States)

    Robinson, J P; Reeves, P

    2015-01-01

    Medical supply during military operations has the ability to affect the efficacy of the operation being undertaken, either negatively or positively. An appropriately-managed maritime platform with a robust medical supply chain during transit and on arrival in theatre is the main aim. A secure supply chain will reduce any implications that logistics may have with regard to capability, and negate the effects of deficiencies of short shelf life items occurring over time and during use in high tempo operations.

  14. Guideline concordance of treatment for depressive disorders in Canada.

    Science.gov (United States)

    Duhoux, Arnaud; Fournier, Louise; Nguyen, Cat Tuong; Roberge, Pasquale; Beveridge, Rachelle

    2009-05-01

    Depression is one of the most prevalent mental health problems worldwide with considerable social and economic burdens. While practice guidelines exist, their adherence is inconsistent in clinical practice. To provide up-to-date national estimates of the adequacy of treatment received by Canadians having suffered a major depressive disorder (MDD) and examine factors associated with this adequacy. To evaluate the impact of different definitions of guideline-concordant treatment on the results. Data were drawn from the Canadian Community Health Survey, cycle 1.2: Mental Health and Well-Being (CCHS 1.2), a nationally representative survey conducted in 2002 and targetting persons aged 15 years or older living in private dwellings. In order to calculate the prevalence of treatment adequacy, we used a sample of 1,563 individuals meeting the criteria for MDD in the 12 months preceding the survey. A subset of 831 subjects who reported having used health services for mental health purposes at least once during that time served to identify the factors associated with treatment adequacy. Four definitions of minimally adequate treatment were considered and covariates were selected according to a well-known behavioral model. The analyses consisted of prevalence estimates and logistic regression models. Among selected subjects, 55% received guideline-concordant treatment according to the Canadian guidelines. Inadequacy was more prevalent in rural settings, for less complex cases, and in the general medical sector. Depending on the definition, prevalence of guideline-concordant treatment ranged between 48 and 71%, and factors associated with guideline-concordant treatment were mainly need factors and sector of care. A large proportion of people with a depressive disorder do not receive minimally adequate treatment. Improved access to and quality of treatment is required, especially in primary care settings.

  15. Negative ... concord?

    NARCIS (Netherlands)

    Giannakidou, A

    The main claim of this paper is that a general theory of negative concord (NC) should allow for the possibility of NC involving scoping of a universal quantifier above negation. I propose that Greek NC instantiates this option. Greek n-words will be analyzed as polarity sensitive universal

  16. The Doctrinal Basis for Medical Stability Operations

    Science.gov (United States)

    2010-01-01

    lead actor, preferably a HN agency, but sometimes the military must take the lead in medical stability operations when overwhelming violence prevents...34 Assessment Tasks Administration of hospital Communications Obstetrics , Pediatrics, Emergency room. Operating room Nursing procedures Medical supply

  17. Consanguinity and spousal concordance in Kuwait.

    Science.gov (United States)

    al-Kandari, Y; Crews, D E; Poirier, F E

    2002-12-01

    Consanguineous marriage is favored in Kuwait. This research focuses on the relationship of physical and cultural traits to marriage types in Kuwait and examines concordance as a function of consanguinity and marriage duration. In a nonrandom opportunistic sample of 242 couples anthropometric and blood pressure data have been collected as well as data on acculturation, religiosity, Farsi proficiency, level of education, occupation, and attitudes regarding fertility. Significant concordances occur in cultural characteristics among couples in all three types of marriages with respect to the degree of religiosity, acculturation, language similarity, education, and occupation. Non-consanguineous spouses have the highest concordance in educational level, occupation, and degree of acculturation, but the lowest for religiosity and Farsi proficiency. Nonkin marriages seem to be based on personal preferences. In the wider potential nonkin marriage pool spouses show more concordance in stature and education indicating the positive assortative mating for those traits. Non-consanguineous spouses show a significant association for triceps and subscapular skinfold thicknesses hip and waist circumferences, and body fat distribution. Unrelated spouses exhibit more concordance for physical traits than do related spouses. There is a significant correlation between spouses in first and double cousin marriages as well as in spouses in second and less than second cousin unions for systolic and diastolic blood pressure, while non-consanguineous spouses show a significant association in diastolic blood pressure only.

  18. Achieving Goal-Concordant Care: A Conceptual Model and Approach to Measuring Serious Illness Communication and Its Impact

    Science.gov (United States)

    Curtis, J. Randall; Tulsky, James A.

    2018-01-01

    Abstract Background: High-quality care for seriously ill patients aligns treatment with their goals and values. Failure to achieve “goal-concordant” care is a medical error that can harm patients and families. Because communication between clinicians and patients enables goal concordance and also affects the illness experience in its own right, healthcare systems should endeavor to measure communication and its outcomes as a quality assessment. Yet, little consensus exists on what should be measured and by which methods. Objectives: To propose measurement priorities for serious illness communication and its anticipated outcomes, including goal-concordant care. Methods: We completed a narrative review of the literature to identify links between serious illness communication, goal-concordant care, and other outcomes. We used this review to identify gaps and opportunities for quality measurement in serious illness communication. Results: Our conceptual model describes the relationship between communication, goal-concordant care, and other relevant outcomes. Implementation-ready measures to assess the quality of serious illness communication and care include (1) the timing and setting of serious illness communication, (2) patient experience of communication and care, and (3) caregiver bereavement surveys that include assessment of perceived goal concordance of care. Future measurement priorities include direct assessment of communication quality, prospective patient or family assessment of care concordance with goals, and assessment of the bereaved caregiver experience. Conclusion: Improving serious illness care necessitates ensuring that high-quality communication has occurred and measuring its impact. Measuring patient experience and receipt of goal-concordant care should be our highest priority. We have the tools to measure both. PMID:29091522

  19. TERRAIN, Concord, Massachusetts

    Data.gov (United States)

    Federal Emergency Management Agency, Department of Homeland Security — The Concord AOI consists of one area. Ground Control is collected throughout the AOI for use in the processing of LiDAR data to ensure data accurately represents the...

  20. Patient-provider language concordance and colorectal cancer screening.

    Science.gov (United States)

    Linsky, Amy; McIntosh, Nathalie; Cabral, Howard; Kazis, Lewis E

    2011-02-01

    Patient-provider language barriers may play a role in health-care disparities, including obtaining colorectal cancer (CRC) screening. Professional interpreters and language-concordant providers may mitigate these disparities. DESIGN, SUBJECTS, AND MAIN MEASURES: We performed a retrospective cohort study of individuals age 50 years and older who were categorized as English-Concordant (spoke English at home, n = 21,594); Other Language-Concordant (did not speak English at home but someone at their provider's office spoke their language, n = 1,463); or Other Language-Discordant (did not speak English at home and no one at their provider's spoke their language, n = 240). Multivariate logistic regression assessed the association of language concordance with colorectal cancer screening. Compared to English speakers, non-English speakers had lower use of colorectal cancer screening (30.7% vs 50.8%; OR, 0.63; 95% CI, 0.51-0.76). Compared to the English-Concordant group, the Language-Discordant group had similar screening (adjusted OR, 0.84; 95% CI, 0.58-1.21), while the Language-Concordant group had lower screening (adjusted OR, 0.57; 95% CI, 0.46-0.71). Rates of CRC screening are lower in individuals who do not speak English at home compared to those who do. However, the Language-Discordant cohort had similar rates to those with English concordance, while the Language-Concordant cohort had lower rates of CRC screening. This may be due to unmeasured differences among the cohorts in patient, provider, and health care system characteristics. These results suggest that providers should especially promote the importance of CRC screening to non-English speaking patients, but that language barriers do not fully account for CRC screening rate disparities in these populations.

  1. Disease-Concordant Twins Empower Genetic Association Studies

    DEFF Research Database (Denmark)

    Tan, Qihua; Li, Weilong; Vandin, Fabio

    2017-01-01

    and ordinary healthy samples as controls. We examined the power gain of the twin-based design for various scenarios (i.e., cases from monozygotic and dizygotic twin pairs concordant for a disease) and compared the power with the ordinary case-control design with cases collected from the unrelated patient...... concordant for a disease, should confer increased power in genetic association analysis because of their genetic relatedness. We conducted a computer simulation study to explore the power advantage of the disease-concordant twin design, which uses singletons from disease-concordant twin pairs as cases...... population. Simulation was done by assigning various allele frequencies and allelic relative risks for different mode of genetic inheritance. In general, for achieving a power estimate of 80%, the sample sizes needed for dizygotic and monozygotic twin cases were one half and one fourth of the sample size...

  2. Moderators of Implicit-Explicit Exercise Cognition Concordance.

    Science.gov (United States)

    Berry, Tanya R; Rodgers, Wendy M; Markland, David; Hall, Craig R

    2016-12-01

    Investigating implicit-explicit concordance can aid in understanding underlying mechanisms and possible intervention effects. This research examined the concordance between implicit associations of exercise with health or appearance and related explicit motives. Variables considered as possible moderators were behavioral regulations, explicit attitudes, and social desirability. Participants (N = 454) completed measures of implicit associations of exercise with health and appearance and questionnaire measures of health and appearance motives, attitudes, social desirability, and behavioral regulations. Attitudes significantly moderated the relationship between implicit associations of exercise with health and health motives. Identified regulations significantly moderated implicit-explicit concordance with respect to associations with appearance. These results suggest that implicit and explicit exercise-related cognitions are not necessarily independent and their relationship to each other may be moderated by attitudes or some forms of behavioral regulation. Future research that takes a dual-processing approach to exercise behavior should consider potential theoretical moderators of concordance.

  3. Concordance for prognostic models with competing risks

    DEFF Research Database (Denmark)

    Wolbers, Marcel; Blanche, Paul; Koller, Michael T

    2014-01-01

    The concordance probability is a widely used measure to assess discrimination of prognostic models with binary and survival endpoints. We formally define the concordance probability for a prognostic model of the absolute risk of an event of interest in the presence of competing risks and relate i...

  4. Civic Friendship in Aristotle: Concord and Fraternity

    Directory of Open Access Journals (Sweden)

    Oriol Farrés Juste

    2015-05-01

    Full Text Available the article shows the importance of friendship in the context of Aristotelian political philosophy. this importance is verified in its specific weight compared with justice. As it is known, Aristotle argues that the pursuit of friendship outranks the pursuit of justice in the polis. Particularly, the article focuses on the role of concord, as a special type of civic friendship, in terms of preserving the unity and stability of the polis. to grasp its significance, we have to consider the role of concord as a supplement of the political condition of the human being. Concord is necessary in the light of the trend to the struggle between the parts of the city, between the demos and the oligarchs. Since this fight endangers the continuity of the polis, concord among citizens becomes a privileged background of early republican fraternity, which has not enjoyed sufficient attention in the field of history of political philosophy.

  5. Electronic Procedures for Medical Operations

    Science.gov (United States)

    2015-01-01

    Electronic procedures are replacing text-based documents for recording the steps in performing medical operations aboard the International Space Station. S&K Aerospace, LLC, has developed a content-based electronic system-based on the Extensible Markup Language (XML) standard-that separates text from formatting standards and tags items contained in procedures so they can be recognized by other electronic systems. For example, to change a standard format, electronic procedures are changed in a single batch process, and the entire body of procedures will have the new format. Procedures can be quickly searched to determine which are affected by software and hardware changes. Similarly, procedures are easily shared with other electronic systems. The system also enables real-time data capture and automatic bookmarking of current procedure steps. In Phase II of the project, S&K Aerospace developed a Procedure Representation Language (PRL) and tools to support the creation and maintenance of electronic procedures for medical operations. The goal is to develop these tools in such a way that new advances can be inserted easily, leading to an eventual medical decision support system.

  6. [Assessment of venous thromboembolism risk in hospitalized medical patients. Concordance between PRETEMED guide and the recommendations of the viii conference of the American College of Chest Physicians].

    Science.gov (United States)

    Gallardo Jiménez, Patricia; Guijarro Merino, Ricardo; Vallejo Herrera, Verónica; Sánchez Morales, David; Villalobos Sánchez, Aurora; Perelló González-Moreno, Juan Ignacio; Gómez-Huelgas, Ricardo

    2012-11-03

    The aim of this study is to evaluate the use of venous thromboembolism prophylaxis in hospitalized medical patients using 2 clinical practice guidelines and to analyze the agreement between them. Cross-sectional study of medical services in a third level hospital. We calculated the thromboembolic risk and the thromboprophylaxis adequacy by implementing the recommendations of viii conference of the American College of Chest Physicians (ACCP) and PRETEMED guide as well as their agreement. One hundred and twenty eight patients were included in the study. According to the PRETEMED guide, 34.4% of patients were low risk, 6.3% moderate and 59.4% high, with appropriate prophylaxis in 72.7% of patients (CI95%: 64.4-79.9), 18.8% (CI95%: 12.7-26.2) were undertreated and 8.6% (CI95%: 4.6-14.4) overtreated. According to ACCP recommendations, 50% of patients were low risk and 50% high, with appropriate prophylaxis in 74.2% of patients (CI95%: 66.1-81.2), 10.9% (CI95%: 6.4-17.3) were undertreated and 14.8% (CI95%: 9.4-21.8) overtreated. When PRETEMED risk was classified into low or moderate-high group versus ACCP risk low or high, the grade of concordance between both guides was 0.68 (CI95%: 0.56-0.81). When PRETEMED risk was classified into low-moderate or high group versus ACCP risk low or high, the grade of concordance between both guides was 0.81 (CI95%: 0.71-0.91). About a quarter of hospitalized medical patients did not receive adequate prophylaxis, showing an important room for improvement. PRETEMED guide and ACCP recommendations differ in risk assessment mainly because PRETEMED guide overestimates the risk of venous thromboembolism since it includes more risk factors. Copyright © 2011 Elsevier España, S.L. All rights reserved.

  7. Cosmonauts and astronauts during medical operations training

    Science.gov (United States)

    1994-01-01

    Cosmonaut Alexandr F. Poleshchuk (right) inventories medical supplies with Ezra D. Kucharz, medical operations trainer for Krug Life Sciences, Incorporated. Poleshchuk, a Mir reserve crew member, and a number of other cosmonauts and astronauts participati

  8. Behavioral and neural concordance in parent-child dyadic sleep patterns.

    Science.gov (United States)

    Lee, Tae-Ho; Miernicki, Michelle E; Telzer, Eva H

    2017-08-01

    Sleep habits developed in adolescence shape long-term trajectories of psychological, educational, and physiological well-being. Adolescents' sleep behaviors are shaped by their parents' sleep at both the behavioral and biological levels. In the current study, we sought to examine how neural concordance in resting-state functional connectivity between parent-child dyads is associated with dyadic concordance in sleep duration and adolescents' sleep quality. To this end, we scanned both parents and their child (N=28 parent-child dyads; parent M age =42.8years; adolescent M age =14.9years; 14.3% father; 46.4% female adolescent) as they each underwent a resting-state scan. Using daily diaries, we also assessed dyadic concordance in sleep duration across two weeks. Our results show that greater daily concordance in sleep behavior is associated with greater neural concordance in default-mode network connectivity between parents and children. Moreover, greater neural and behavioral concordances in sleep is associated with more optimal sleep quality in adolescents. The current findings expand our understanding of dyadic concordance by providing a neurobiological mechanism by which parents and children share daily sleep behaviors. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  9. Estimating twin concordance for bivariate competing risks twin data

    DEFF Research Database (Denmark)

    Scheike, Thomas; Holst, Klaus K.; Hjelmborg, Jacob B.

    2014-01-01

    For twin time-to-event data, we consider different concordance probabilities, such as the casewise concordance that are routinely computed as a measure of the lifetime dependence/correlation for specific diseases. The concordance probability here is the probability that both twins have experience...... events with the competing risk death. We thus aim to quantify the degree of dependence through the casewise concordance function and show a significant genetic component...... the event of interest. Under the assumption that both twins are censored at the same time, we show how to estimate this probability in the presence of right censoring, and as a consequence, we can then estimate the casewise twin concordance. In addition, we can model the magnitude of within pair dependence...... over time, and covariates may be further influential on the marginal risk and dependence structure. We establish the estimators large sample properties and suggest various tests, for example, for inferring familial influence. The method is demonstrated and motivated by specific twin data on cancer...

  10. Models and methods of emotional concordance.

    Science.gov (United States)

    Hollenstein, Tom; Lanteigne, Dianna

    2014-04-01

    Theories of emotion generally posit the synchronized, coordinated, and/or emergent combination of psychophysiological, cognitive, and behavioral components of the emotion system--emotional concordance--as a functional definition of emotion. However, the empirical support for this claim has been weak or inconsistent. As an introduction to this special issue on emotional concordance, we consider three domains of explanations as to why this theory-data gap might exist. First, theory may need to be revised to more accurately reflect past research. Second, there may be moderating factors such as emotion regulation, context, or individual differences that have obscured concordance. Finally, the methods typically used to test theory may be inadequate. In particular, we review a variety of potential issues: intensity of emotions elicited in the laboratory, nonlinearity, between- versus within-subject associations, the relative timing of components, bivariate versus multivariate approaches, and diversity of physiological processes. Copyright © 2013 Elsevier B.V. All rights reserved.

  11. Estimating Twin Pair Concordance for Age of Onset

    DEFF Research Database (Denmark)

    Scheike, Thomas H; Hjelmborg, Jacob B; Holst, Klaus K

    2015-01-01

    that they will develop the disease. The aim of this contribution is to show that the standard casewise concordance and standard prevalence estimators do not work in general for age-of-onset data. We show how one can in fact do something easy and simple even with censored data. The key is to take age into account when......Twin and family data provide a key source for evaluating inheritance of specific diseases. A standard analysis of such data typically involves the computation of prevalences and different concordance measures such as the casewise concordance, that is the probability that one twin has the disease...

  12. Utility of an Algorithm to Increase the Accuracy of Medication History in an Obstetrical Setting.

    Science.gov (United States)

    Corbel, Aline; Baud, David; Chaouch, Aziz; Beney, Johnny; Csajka, Chantal; Panchaud, Alice

    2016-01-01

    In an obstetrical setting, inaccurate medication histories at hospital admission may result in failure to identify potentially harmful treatments for patients and/or their fetus(es). This prospective study was conducted to assess average concordance rates between (1) a medication list obtained with a one-page structured medication history algorithm developed for the obstetrical setting and (2) the medication list reported in medical records and obtained by open-ended questions based on standard procedures. Both lists were converted into concordance rate using a best possible medication history approach as the reference (information obtained by patients, prescribers and community pharmacists' interviews). The algorithm-based method obtained a higher average concordance rate than the standard method, with respectively 90.2% [CI95% 85.8-94.3] versus 24.6% [CI95%15.3-34.4] concordance rates (phistory in our obstetric population, without using substantial resources. Its implementation is an effective first step to the medication reconciliation process, which has been recognized as a very important component of patients' drug safety.

  13. Assessing clinical reasoning in optometry using the script concordance test.

    Science.gov (United States)

    Faucher, Caroline; Dufour-Guindon, Marie-Pier; Lapointe, Gabrielle; Gagnon, Robert; Charlin, Bernard

    2016-05-01

    Clinical reasoning is central to any health profession but its development among learners is difficult to assess. Over the last few decades, the script concordance test (SCT) has been developed to solve this dilemma and has been used in many health professions; however, no study has been published on the use of the script concordance test in optometry. The purpose of this study was to develop and validate a script concordance test for the field of optometry. A 101-question script concordance test (27 short clinical scenarios) was developed and administered online to a convenience sample of 23 second-year and 19 fourth-year students of optometry. It was also administered to a reference panel of 12 experienced optometrists to develop the scoring key. An item-total correlation was calculated for each question. Cronbach's alpha coefficient was used to evaluate the script concordance test reliability and a t-test compared the two groups. A final 77-question script concordance test was created by eliminating questions with low item-total correlation. Cronbach's alpha for this optimised 77-question script concordance test was 0.80. A group comparison revealed that the second-year students' scores (n = 23; mean score = 66.4 ± 7.87 per cent) were statistically lower (t = -4.141; p Optometry © 2016 Optometry Australia.

  14. Concordance between clinical and histopathologic diagnoses of oral mucosal lesions.

    Science.gov (United States)

    Patel, Kush J; De Silva, Harsha L; Tong, Darryl C; Love, Robert M

    2011-01-01

    To study the epidemiology of oral soft tissue lesions in New Zealand from 2002 to 2006 and to determine the concordance between the clinical diagnosis and the definitive histopathologic diagnosis achieved by general dental practitioners and by specialists. The details from biopsy referrals and the corresponding histopathologic reports of oral soft tissue lesions were recorded into a statistical software package, and the concordance between the clinical diagnosis and histopathologic diagnosis was determined for all the lesions. Most biopsies were benign lesions, and both clinician groups achieved a high diagnostic concordance for these lesions. However, when considering all lesion types, the overall concordance for both groups was a moderate 50.6%, with little difference between specialists and general dental practitioners, although specialists were more accurate in diagnosing a malignant or premalignant lesion. The clinical and histopathologic concordance achieved by oral health practitioners in New Zealand appears to be moderate. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  15. Prediction future asset price which is non-concordant with the historical distribution

    Science.gov (United States)

    Seong, Ng Yew; Hin, Pooi Ah

    2015-12-01

    This paper attempts to predict the major characteristics of the future asset price which is non-concordant with the distribution estimated from the price today and the prices on a large number of previous days. The three major characteristics of the i-th non-concordant asset price are the length of the interval between the occurrence time of the previous non-concordant asset price and that of the present non-concordant asset price, the indicator which denotes that the non-concordant price is extremely small or large by its values -1 and 1 respectively, and the degree of non-concordance given by the negative logarithm of the probability of the left tail or right tail of which one of the end points is given by the observed future price. The vector of three major characteristics of the next non-concordant price is modelled to be dependent on the vectors corresponding to the present and l - 1 previous non-concordant prices via a 3-dimensional conditional distribution which is derived from a 3(l + 1)-dimensional power-normal mixture distribution. The marginal distribution for each of the three major characteristics can then be derived from the conditional distribution. The mean of the j-th marginal distribution is an estimate of the value of the j-th characteristics of the next non-concordant price. Meanwhile, the 100(α/2) % and 100(1 - α/2) % points of the j-th marginal distribution can be used to form a prediction interval for the j-th characteristic of the next non-concordant price. The performance measures of the above estimates and prediction intervals indicate that the fitted conditional distribution is satisfactory. Thus the incorporation of the distribution of the characteristics of the next non-concordant price in the model for asset price has a good potential of yielding a more realistic model.

  16. Medical Logistics Lessons Observed During Operations Enduring Freedom and Iraqi Freedom.

    Science.gov (United States)

    Dole, Mark J; Kissane, Jonathan M

    2016-01-01

    Medical Logistics (MEDLOG) is a function of the Army's integrated System for Health that provides the medical products and specialized logistics services required to deliver health protection and care under all operational conditions. In unified land operations, MEDLOG is an inherent function of Health Service Support (HSS), which also includes casualty care and medical evacuation. This paper focuses on a few key lessons observed during Operations Enduring Freedom and Iraqi Freedom with direct implications for the support of HSS in future operations as envisioned in the Army Operating Concept and the Joint Concept for Health Services. It also examines a few key enablers that helped mitigate these challenges that are not yet fully acknowledged in Army Medical Department doctrine, policy, and planning.

  17. Investigating spousal concordance of diabetes through statistical analysis and data mining.

    Directory of Open Access Journals (Sweden)

    Jong-Yi Wang

    Full Text Available Spousal clustering of diabetes merits attention. Whether old-age vulnerability or a shared family environment determines the concordance of diabetes is also uncertain. This study investigated the spousal concordance of diabetes and compared the risk of diabetes concordance between couples and noncouples by using nationally representative data.A total of 22,572 individuals identified from the 2002-2013 National Health Insurance Research Database of Taiwan constituted 5,643 couples and 5,643 noncouples through 1:1 dual propensity score matching (PSM. Factors associated with concordance in both spouses with diabetes were analyzed at the individual level. The risk of diabetes concordance between couples and noncouples was compared at the couple level. Logistic regression was the main statistical method. Statistical data were analyzed using SAS 9.4. C&RT and Apriori of data mining conducted in IBM SPSS Modeler 13 served as a supplement to statistics.High odds of the spousal concordance of diabetes were associated with old age, middle levels of urbanization, and high comorbidities (all P < 0.05. The dual PSM analysis revealed that the risk of diabetes concordance was significantly higher in couples (5.19% than in noncouples (0.09%; OR = 61.743, P < 0.0001.A high concordance rate of diabetes in couples may indicate the influences of assortative mating and shared environment. Diabetes in a spouse implicates its risk in the partner. Family-based diabetes care that emphasizes the screening of couples at risk of diabetes by using the identified risk factors is suggested in prospective clinical practice interventions.

  18. Medical support for law enforcement-extended operations incidents.

    Science.gov (United States)

    Levy, Matthew J; Tang, Nelson

    2014-01-01

    As the complexity and frequency of law enforcement-extended operations incidents continue to increase, so do the opportunities for adverse health and well-being impacts on the responding officers. These types of clinical encounters have not been well characterized nor have the medical response strategies which have been developed to effectively manage these encounters been well described. The purpose of this article is to provide a descriptive epidemiology of the clinical encounters reported during extended law enforcement operations, as well as to describe a best practices approach for their effective management. This study retrospectively examined the clinical encounters of the Maryland State Police (MSP) Tactical Medical Unit (TMU) during law enforcement extended operations incidents lasting 8 or more hours. In addition, a qualitative analysis was performed on clinical data collected by federal law enforcement agencies during their extended operations. Forty-four percent of missions (455/1,047) supported by the MSP TMU lasted 8 or more hours. Twenty-six percent of these missions (117/455) resulted in at least one patient encounter. Nineteen percent of patient chief complaints (45/238) were related to heat illness/ dehydration. Fifteen percent of encounters (36/238) were for musculoskeletal injury/pain. Eight percent of patients (19/238) had nonspecific sick call (minor illness) complaints. The next most common occurring complaints were cold-related injuries, headache, sinus congestion, and wound/laceration, each of which accounted for 7 percent of patients (16/238), respectively. Analysis of federal law enforcement agencies' response to such events yielded similar clinical encounters. A wide range of health problems are reported by extended law enforcement operations personnel. Timely and effective treatment of these problems can help ensure that the broader operations mission is not compromised. An appropriate operational strategy for managing health complaints

  19. Receipt of Guideline-Concordant Treatment in Elderly Prostate Cancer Patients

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Ronald C., E-mail: Ronald_chen@med.unc.edu [Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Carpenter, William R. [Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Hendrix, Laura H. [Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Bainbridge, John [Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Wang, Andrew Z. [Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Nielsen, Matthew E. [Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); and others

    2014-02-01

    Purpose: To examine the proportion of elderly prostate cancer patients receiving guideline-concordant treatment, using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Methods and Materials: A total of 29,001 men diagnosed in 2004-2007 with localized prostate cancer, aged 66 to 79 years, were included. We characterized the proportion of men who received treatment concordant with the National Comprehensive Cancer Network guidelines, stratified by risk group and age. Logistic regression was used to examine covariates associated with receipt of guideline-concordant management. Results: Guideline concordance was 79%-89% for patients with low- or intermediate-risk disease. Among high-risk patients, 66.6% of those aged 66-69 years received guideline-concordant management, compared with 51.9% of those aged 75-79 years. Discordance was mainly due to conservative management—no treatment or hormone therapy alone. Among the subgroup of patients aged ≤76 years with no measured comorbidity, findings were similar. On multivariable analysis, older age (75-79 vs 66-69 years, odds ratio 0.51, 95% confidence interval 0.50-0.57) was associated with a lower likelihood of guideline concordance for high-risk prostate cancer, but comorbidity was not. Conclusions: There is undertreatment of elderly but healthy patients with high-risk prostate cancer, the most aggressive form of this disease.

  20. The impact of health coaching on medication adherence in patients with poorly controlled diabetes, hypertension, and/or hyperlipidemia: a randomized controlled trial.

    Science.gov (United States)

    Thom, David H; Willard-Grace, Rachel; Hessler, Danielle; DeVore, Denise; Prado, Camille; Bodenheimer, Thomas; Chen, Ellen

    2015-01-01

    Lack of concordance between medications listed in the medical record and taken by the patient contributes to poor outcomes. We sought to determine whether patients who received health coaching by medical assistants improved their medication concordance and adherence. This was a nonblinded, randomized, controlled, pragmatic intervention trial. English- or Spanish-speaking patients, age 18 to 75 years, with poorly controlled type 2 diabetes, hypertension, and/or hyperlipidemia were enrolled from 2 urban safety net clinics and randomized to receive 12 months of health coaching versus usual care. Outcomes included concordance between medications documented in the medical record and those reported by the patient and adherence based on the patient-reported number of days (of the last 7) on which patient took all prescribed medications. The proportion of medications completely concordant increased in the coached group versus the usual care group (difference in change, 10%; P = .05). The proportion of medications listed in the chart but not taken significantly decreased in the coached group compared with the usual care group (difference in change, 17%; P = .013). The mean number of adherent days increased in the coached but not in the usual care group (difference in change, 1.08; P coaching by medical assistants significantly increases medication concordance and adherence. © Copyright 2015 by the American Board of Family Medicine.

  1. Towards automated assistance for operating home medical devices.

    Science.gov (United States)

    Gao, Zan; Detyniecki, Marcin; Chen, Ming-Yu; Wu, Wen; Hauptmann, Alexander G; Wactlar, Howard D

    2010-01-01

    To detect errors when subjects operate a home medical device, we observe them with multiple cameras. We then perform action recognition with a robust approach to recognize action information based on explicitly encoding motion information. This algorithm detects interest points and encodes not only their local appearance but also explicitly models local motion. Our goal is to recognize individual human actions in the operations of a home medical device to see if the patient has correctly performed the required actions in the prescribed sequence. Using a specific infusion pump as a test case, requiring 22 operation steps from 6 action classes, our best classifier selects high likelihood action estimates from 4 available cameras, to obtain an average class recognition rate of 69%.

  2. Quality Assessment of Process Measures in Antimicrobial Stewardship: Concordance of Valacyclovir Indication and Automatic Prospective Approval in Computerized Provider Order Entry

    Science.gov (United States)

    Lee, Tiffany; McCoy, Christopher; Mahoney, Monica V

    2017-01-01

    Abstract Background The Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) recommend computerized decision support at the time of prescribing as an antimicrobial stewardship (AST) tool. Providing antimicrobial indications during prescribing can optimize infection-specific therapy through appropriate antimicrobial selection, dosing, and frequency. The Leapfrog group identifies this as a quality measure for their report card system. At Beth Israel Deaconess Medical Center (BIDMC), indication-based dosing has been incorporated in the computerized provider order entry (CPOE) system since 2006. At BIDMC, valacyclovir is only approved for the treatment of varicella zoster (VZV) infection or prophylaxis of solid organ transplant (SOT) patients at low risk for cytomegalovirus. These indications bypass the need for AST approval. Accuracy validation of the selected indications has not been formally performed. Methods A retrospective chart review was performed in patients prescribed valacyclovir during an 8-month period in 2016. Electronic medical records, laboratory reports, and pharmacy records were reviewed to identify the suspected/confirmed infection. The primary outcome was the concordance rate of selected CPOE valacyclovir indication compared with suspected/confirmed infection at the time of ordering. The secondary outcome was the proportion of valacyclovir use per institutional protocol. Results Overall, 117 patients were included, with a median age of 57.9 years, 51 (43.6%) were male, and 4 (3.4%) were located in an intensive care unit. Fifty-nine orders (50.4%) selected VZV as the indication, followed by 21 orders (17.9%) for SOT prophylaxis. Of orders with any CPOE indication, only 59/101 (58.4%) were concordant with suspected/confirmed infection. Of the valacyclovir orders with a VZV indication, 37 (62.7%) were concordant. Of the orders with SOT prophylaxis indications, 5 (23.8%) were concordant

  3. Genotype-Specific Concordance of Chlamydia trachomatis Genital Infection Within Heterosexual Partnerships.

    Science.gov (United States)

    Schillinger, Julia A; Katz, Barry P; Markowitz, Lauri E; Braslins, Phillip G; Shrier, Lydia A; Madico, Guillermo; Van Der Pol, Barbara; Orr, Donald P; Rice, Peter A; Batteiger, Byron E

    2016-12-01

    Sexual transmission rates of Chlamydia trachomatis (Ct) cannot be measured directly; however, the study of concordance of Ct infection in sexual partnerships (dyads) can help to illuminate factors influencing Ct transmission. Heterosexual men and women with Ct infection and their sex partners were enrolled and partner-specific coital and behavioral data collected for the prior 30 days. Microbiological data included Ct culture, and nucleic acid amplification testing (NAAT), quantitative Ct polymerase chain reaction, and ompA genotyping. We measured Ct concordance in dyads and factors (correlates) associated with concordance. One hundred twenty-one women and 125 men formed 128 dyads. Overall, 72.9% of male partners of NAAT-positive women and 68.6% of female partners of NAAT-positive men were Ct-infected. Concordance was more common in dyads with culture-positive members (78.6% of male partners, 77% of female partners). Partners of women and men who were NAAT-positive only had lower concordance (33.3%, 46.4%, respectively). Women in concordant dyads had significantly higher median endocervical quantitative Ct polymerase chain reaction values (3,032) compared with CT-infected women in discordant dyads (1013 inclusion forming units DNA equivalents per mL; P model coitus-specific transmission probabilities.

  4. Electronic Procedures for Medical Operations, Phase II

    Data.gov (United States)

    National Aeronautics and Space Administration — Electronic procedures are currently being used to document the steps in performing medical operations for the Space Shuttle and/or the International Space Station...

  5. Concordance between Stages of Behavior Change Questionnaire and IPAQ

    Directory of Open Access Journals (Sweden)

    Priscila Missaki Nakamura

    2013-12-01

    Full Text Available A low rate of physical activity (PA participation is observed worldwide. The identification of feasible and reliable instruments able to accurately measuring PA and help in the development of interventions to promote PA are necessary. This study aimed to analyze the concordance between the Stages of Behavior Change Questionnaire (SBCQ and the International Physical Activity Questionnaire (IPAQ long-version in assessing adult leisure-time physical activity (LTPA. A total of 1.588 adults completed the IPAQ to assess LTPA and the participants who performed more than 10 min/week were classified in active individuals. Using the SBCQ, active individuals were those classified in the action or maintenance stage and inactive individuals were those classified in the precontemplation, contemplation or preparation stage. The concordance between SBCQ and IPAQ was found to be 0.80. Separated by gender, it was observed a concordance between the two instruments of 0.82 for women, and 0.77 for men. Regarding age group, it was found to be 0.81 for young and middle-aged adults, and 0.77 for older people. The SBCQ presented a very good concordance with IPAQ to assess LTPA.

  6. Concordance with prescribing information dosage recommendations for dipeptidyl-peptidase-4 inhibitors among type 2 diabetes mellitus patients with moderate to severe chronic kidney disease.

    Science.gov (United States)

    Huang, Huan; Shetty, Sharash; Bauer, Elise; Lang, Kathleen

    2018-06-01

    To estimate the proportion of patients with moderate to severe chronic kidney disease (CKD) whose initial dipeptidyl-peptidase-4 inhibitor (DPP4-i) dosage was concordant with prescribing information (label) recommendations in the United States. Adult patients with type 2 diabetes mellitus (T2DM) who initiated a DPP4-i (linagliptin, sitagliptin, saxagliptin) between 1 January 2011 and 30 June 2014 were identified using electronic medical records and administrative claims, with index date being the date of first observed DPP4-i treatment. Patients were required to have chronic kidney disease (CKD) stage 3b, 4 or 5 (estimated Glomerular Filtration Rate [eGFR] value <45 ml/min/1.73 m 2 ) during the 12 month pre-index period. Patients were classified as concordant or not concordant based on whether the first prescribed dose was consistent with label recommendations. Demographics, clinical characteristics, resource use and costs during pre-index were evaluated by DPP4-i concordance status. Of the 492 patients (323 sitagliptin, 57 saxagliptin, 112 linagliptin), 36.2% were prescribed doses that were not concordant with label recommendations (44.9% for sitagliptin, 57.9% for saxagliptin and 0% for linagliptin [which does not require dosage adjustment]). Concordant patients were slightly older (mean age 71 years vs. 68, p = .01) but had similar gender distribution (55% vs. 60% female, p = .31) compared to those who were not concordant. They had lower general health status (Charlson Comorbidity Score 2.6 vs. 2.2, p = .03), and had similar pre-index all-cause total costs ($25,245 vs. $21,972, p = .68) and lower pre-index T2DM-related costs ($1618 vs. $1922, p = .05). More than a third of DPP4-i patients with CKD stage 3b or higher were prescribed doses not concordant with DPP4-i label dosage recommendations.

  7. Language, literacy, and communication regarding medication in an anticoagulation clinic: a comparison of verbal vs. visual assessment.

    Science.gov (United States)

    Schillinger, Dean; Machtinger, Edward L; Wang, Frances; Palacios, Jorge; Rodriguez, Maytrella; Bindman, Andrew

    2006-01-01

    Despite the importance of clinician-patient communication, little is known about rates and predictors of medication miscommunication. Measuring rates of miscommunication, as well as differences between verbal and visual modes of assessment, can inform efforts to more effectively communicate about medications. We studied 220 diverse patients in an anticoagulation clinic to assess concordance between patient and clinician reports of warfarin regimens. Bilingual research assistants asked patients to (1) verbalize their prescribed weekly warfarin regimen and (2) identify this regimen from a digitized color menu of warfarin pills. We obtained clinician reports of patient regimens from chart review. Patients were categorized as having regimen concordance if there were no patient-clinician discrepancies in total weekly dosage. We then examined whether verbal and visual concordance rates varied with patient's language and health literacy. Fifty percent of patients achieved verbal concordance and 66% achieved visual concordance with clinicians regarding the weekly warfarin regimen (P visual discordance. Shifting from verbal to visual modes was associated with greater patient-provider concordance across all patient subgroups, but especially for those with communication barriers.Clinician-patient discordance regarding patients' warfarin regimen was common but occurred less frequently when patients used a visual aid. Visual aids may improve the accuracy of medication assessment, especially for patients with communication barriers.

  8. Language-concordant automated telephone queries to assess medication adherence in a diverse population: a cross-sectional analysis of convergent validity with pharmacy claims.

    Science.gov (United States)

    Ratanawongsa, Neda; Quan, Judy; Handley, Margaret A; Sarkar, Urmimala; Schillinger, Dean

    2018-04-06

    Clinicians have difficulty accurately assessing medication non-adherence within chronic disease care settings. Health information technology (HIT) could offer novel tools to assess medication adherence in diverse populations outside of usual health care settings. In a multilingual urban safety net population, we examined the validity of assessing adherence using automated telephone self-management (ATSM) queries, when compared with non-adherence using continuous medication gap (CMG) on pharmacy claims. We hypothesized that patients reporting greater days of missed pills to ATSM queries would have higher rates of non-adherence as measured by CMG, and that ATSM adherence assessments would perform as well as structured interview assessments. As part of an ATSM-facilitated diabetes self-management program, low-income health plan members typed numeric responses to rotating weekly ATSM queries: "In the last 7 days, how many days did you MISS taking your …" diabetes, blood pressure, or cholesterol pill. Research assistants asked similar questions in computer-assisted structured telephone interviews. We measured continuous medication gap (CMG) by claims over 12 preceding months. To evaluate convergent validity, we compared rates of optimal adherence (CMG ≤ 20%) across respondents reporting 0, 1, and ≥ 2 missed pill days on ATSM and on structured interview. Among 210 participants, 46% had limited health literacy, 57% spoke Cantonese, and 19% Spanish. ATSM respondents reported ≥1 missed day for diabetes (33%), blood pressure (19%), and cholesterol (36%) pills. Interview respondents reported ≥1 missed day for diabetes (28%), blood pressure (21%), and cholesterol (26%) pills. Optimal adherence rates by CMG were lower among ATSM respondents reporting more missed days for blood pressure (p = 0.02) and cholesterol (p < 0.01); by interview, differences were significant for cholesterol (p = 0.01). Language-concordant ATSM demonstrated modest potential

  9. SPACE MEDICINE and Medical Operations Overview

    Science.gov (United States)

    Dervay, Joe

    2009-01-01

    This presentation is an overview of the function of the work of the Space Medicine & Health Care Systems Office. The objective of the medical operations is to ensure the health, safety and well being of the astronaut corps and ground support team during all phases of space flight. There are many issues that impact the health of the astronauts. Some of them are physiological, and others relate to behavior, psychological issues and issues of the environment of space itself. Reviews of the medical events that have affected both Russian, and Americans while in space are included. Some views of shuttle liftoff, and ascent, the medical training aboard NASA's KC-135 and training in weightlessness, the Shuttle Orbiter Medical system (SOMS), and some of the medical equipment are included. Also included are a graphs showing Fluid loading countermeasures, and vertical pursuit tracking with head and eye. The final views are representations of the future crew exploration vehicle (CEV) approaching the International Space Station, and the moon, and a series of perspective representations of the earth in comparison to the other planets and the Sun, the Sun in relation to other stars, and a view of where in the galaxy the Sun is.

  10. Concordance between European and US case definitions of healthcare-associated infections

    Science.gov (United States)

    2012-01-01

    Background Surveillance of healthcare-associated infections (HAI) is a valuable measure to decrease infection rates. Across Europe, inter-country comparisons of HAI rates seem limited because some countries use US definitions from the US Centers for Disease Control and Prevention (CDC/NHSN) while other countries use European definitions from the Hospitals in Europe Link for Infection Control through Surveillance (HELICS/IPSE) project. In this study, we analyzed the concordance between US and European definitions of HAI. Methods An international working group of experts from seven European countries was set up to identify differences between US and European definitions and then conduct surveillance using both sets of definitions during a three-month period (March 1st -May 31st, 2010). Concordance between case definitions was estimated with Cohen’s kappa statistic (κ). Results Differences in HAI definitions were found for bloodstream infection (BSI), pneumonia (PN), urinary tract infection (UTI) and the two key terms “intensive care unit (ICU)-acquired infection” and “mechanical ventilation”. Concordance was analyzed for these definitions and key terms with the exception of UTI. Surveillance was performed in 47 ICUs and 6,506 patients were assessed. One hundred and eighty PN and 123 BSI cases were identified. When all PN cases were considered, concordance for PN was κ = 0.99 [CI 95%: 0.98-1.00]. When PN cases were divided into subgroups, concordance was κ = 0.90 (CI 95%: 0.86-0.94) for clinically defined PN and κ = 0.72 (CI 95%: 0.63-0.82) for microbiologically defined PN. Concordance for BSI was κ = 0.73 [CI 95%: 0.66-0.80]. However, BSI cases secondary to another infection site (42% of all BSI cases) are excluded when using US definitions and concordance for BSI was κ = 1.00 when only primary BSI cases, i.e. Europe-defined BSI with ”catheter” or “unknown” origin and US-defined laboratory-confirmed BSI (LCBI), were

  11. Concordance between European and US case definitions of healthcare-associated infections

    Directory of Open Access Journals (Sweden)

    Hansen Sonja

    2012-08-01

    Full Text Available Abstract Background Surveillance of healthcare-associated infections (HAI is a valuable measure to decrease infection rates. Across Europe, inter-country comparisons of HAI rates seem limited because some countries use US definitions from the US Centers for Disease Control and Prevention (CDC/NHSN while other countries use European definitions from the Hospitals in Europe Link for Infection Control through Surveillance (HELICS/IPSE project. In this study, we analyzed the concordance between US and European definitions of HAI. Methods An international working group of experts from seven European countries was set up to identify differences between US and European definitions and then conduct surveillance using both sets of definitions during a three-month period (March 1st -May 31st, 2010. Concordance between case definitions was estimated with Cohen’s kappa statistic (κ. Results Differences in HAI definitions were found for bloodstream infection (BSI, pneumonia (PN, urinary tract infection (UTI and the two key terms “intensive care unit (ICU-acquired infection” and “mechanical ventilation”. Concordance was analyzed for these definitions and key terms with the exception of UTI. Surveillance was performed in 47 ICUs and 6,506 patients were assessed. One hundred and eighty PN and 123 BSI cases were identified. When all PN cases were considered, concordance for PN was κ = 0.99 [CI 95%: 0.98-1.00]. When PN cases were divided into subgroups, concordance was κ = 0.90 (CI 95%: 0.86-0.94 for clinically defined PN and κ = 0.72 (CI 95%: 0.63-0.82 for microbiologically defined PN. Concordance for BSI was κ = 0.73 [CI 95%: 0.66-0.80]. However, BSI cases secondary to another infection site (42% of all BSI cases are excluded when using US definitions and concordance for BSI was κ = 1.00 when only primary BSI cases, i.e. Europe-defined BSI with ”catheter” or “unknown” origin and US-defined laboratory-confirmed BSI

  12. Concordance of Beta-papillomavirus across anogenital and oral anatomic sites of men: The HIM Study.

    Science.gov (United States)

    Nunes, Emily M; López, Rossana V M; Sudenga, Staci L; Gheit, Tarik; Tommasino, Massimo; Baggio, Maria L; Ferreira, Silvaneide; Galan, Lenice; Silva, Roberto C; Lazcano-Ponce, Eduardo; Giuliano, Anna R; Villa, Luisa L; Sichero, Laura

    2017-10-01

    We evaluated the concordance between β-HPVs detected in external genital skin, anal canal, and oral cavity specimens collected simultaneously from 717 men that were participating in the multinational HIM Study. Viral genotyping was performed using the Luminex technology. Species- and type-specific concordance was measured using kappa statistics for agreement. Overall, concordance of β-HPVs across sites was low and mainly observed among paired genital/anal canal samples. When grouped by species, solely β-4 HPVs showed moderate concordance in genital/anal pairs (κ = 0.457), which could be attributed to the substantial concordance of HPV-92 in men from Brazil and Mexico (κ > 0.610). β-HPV type concordance was higher in Mexico, where HPV-19 was consistently concordant in all anatomic site combinations. Our analysis indicates that type-specific concordance across sites is limited to few viral types; however, these infections seem to occur more often than would be expected by chance, suggesting that although rare, there is agreement among sites. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Organization, Management and Function of International Space Station (ISS) Multilateral Medical Operations

    Science.gov (United States)

    Duncan, James M.; Bogomolov, V. V.; Castrucci, F.; Koike, Y.; Comtois, J. M.; Sargsyan, A. E.

    2007-01-01

    Long duration crews have inhabited the ISS since November of 2000. The favorable medical outcomes of its missions can be largely attributed to sustained collective efforts of all ISS Partners medical organizations. In-flight medical monitoring and support, although crucial, is just a component of the ISS system of Joint Medical Operations. The goal of this work is to review the principles, design, and function of the multilateral medical support of the ISS Program. The governing documents, which describe the relationships among all ISS partner medical organizations, were evaluated, followed by analysis of the roles, responsibilities, and decision-making processes of the ISS medical boards, panels, and working groups. The degree of integration of the medical support system was evaluated by reviewing the multiple levels of the status reviews and mission assurance activities carried out throughout the last six years. The Integrated Medical Group, consisting of physicians and other essential personnel in the mission control centers represents the front-line medical support of the ISS. Data from their day-to-day activities are presented weekly at the Space Medicine Operations Team (SMOT), where known or potential concerns are addressed by an international group of physicians. A broader status review is conducted monthly to project the state of crew health and medical support for the following month, and to determine measures to return to nominal state. Finally, a comprehensive readiness review is conducted during preparations for each ISS mission. The Multilateral Medical Policy Board (MMPB) issues medical policy decisions and oversees all health and medical matters. The Multilateral Space Medicine Board (MSMB) certifies crewmembers and visitors for training and space flight to the Station, and physicians to practice space medicine for the ISS. The Multilateral Medical Operations Panel (MMOP) develops medical requirements, defines and supervises implementation of

  14. Genetic analysis of rare disorders: Bayesian estimation of twin concordance rates

    NARCIS (Netherlands)

    van den Berg, Stéphanie Martine; Hjelmborg, J.

    2012-01-01

    Twin concordance rates provide insight into the possibility of a genetic background for a disease. These concordance rates are usually estimated within a frequentistic framework. Here we take a Bayesian approach. For rare diseases, estimation methods based on asymptotic theory cannot be applied due

  15. The application of digital medical 3D printing technology on tumor operation

    Science.gov (United States)

    Chen, Jimin; Jiang, Yijian; Li, Yangsheng

    2016-04-01

    Digital medical 3D printing technology is a new hi-tech which combines traditional medical and digital design, computer science, bio technology and 3D print technology. At the present time there are four levels application: The printed 3D model is the first and simple application. The surgery makes use of the model to plan the processing before operation. The second is customized operation tools such as implant guide. It helps doctor to operate with special tools rather than the normal medical tools. The third level application of 3D printing in medical area is to print artificial bones or teeth to implant into human body. The big challenge is the fourth level which is to print organs with 3D printing technology. In this paper we introduced an application of 3D printing technology in tumor operation. We use 3D printing to print guide for invasion operation. Puncture needles were guided by printed guide in face tumors operation. It is concluded that this new type guide is dominantly advantageous.

  16. Habitat Demonstration Unit Medical Operations Workstation Upgrades

    Science.gov (United States)

    Trageser, Katherine H.

    2011-01-01

    This paper provides an overview of the design and fabrication associated with upgrades for the Medical Operations Workstation in the Habitat Demonstration Unit. The work spanned a ten week period. The upgrades will be used during the 2011 Desert Research and Technology Studies (Desert RATS) field campaign. Upgrades include a deployable privacy curtain system, a deployable tray table, an easily accessible biological waste container, reorganization and labeling of the medical supplies, and installation of a retractable camera. All of the items were completed within the ten week period.

  17. Work happiness among teachers: a day reconstruction study on the role of self-concordance.

    Science.gov (United States)

    Tadić, Maja; Bakker, Arnold B; Oerlemans, Wido G M

    2013-12-01

    Self-concordant work motivation arises from one's authentic choices, personal values, and interests. In the present study, we investigated whether self-concordant motivation may fluctuate from one work-related task to the next. On the basis of self-determination theory, we hypothesized that momentary self-concordance buffers the negative impact of momentary work demands on momentary happiness. We developed a modified version of the day reconstruction method to investigate self-concordance, work demands, and happiness during specific work-related tasks on a within-person and within-day level. In total, 132 teachers completed a daily diary on three consecutive work days as well as a background questionnaire. The daily diary resulted in 792 reported work activities and activity-related work demands, self-concordance, and happiness scores. Multilevel analysis showed that-for most work activities-state self-concordant motivation buffered the negative association of work demands with happiness. These findings add to the literature on motivation and well-being by showing that the levels of self-concordance and happiness experienced by employees vary significantly on a within-day level and show a predictable pattern. We discuss theoretical and practical implications of the findings to increase employees' well-being. © 2013.

  18. In-flight medical emergencies during airline operations: a survey of physicians on the incidence, nature, and available medical equipment

    Directory of Open Access Journals (Sweden)

    Hinkelbein J

    2017-02-01

    Full Text Available Jochen Hinkelbein,1,2 Christopher Neuhaus,2,3 Lennert Böhm,1 Steffen Kalina,1 Stefan Braunecker1,2 1Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, 2Working group “Emergency Medicine and Air Rescue”, German Society for Aviation and Space Medicine (DGLRM, Munich, 3Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany Background: Data on the incidence of in-flight medical emergencies on-board civil aircraft are uncommon and rarely published. Such data could provide information regarding required medical equipment on-board aircraft and requisite training for cabin crew. The aim of the present study was to gather data on the incidences, nature, and medical equipment for in-flight medical emergencies by way of a survey of physician members of a German aerospace medical society.Materials and methods: Using unipark.de (QuestBack GmbH, Cologne, Germany, an online survey was developed and used to gather specific information. Members of the German Society for Aviation and Space Medicine (Deutsche Gesellschaft für Luft- und Raumfahrtmedizin e.V.; DGLRM were invited to participate in the survey during a 4-week period (21 March 2015 to 20 April 2015. Chi-square test was used for statistical analysis (p<0.05 was considered significant.Results: Altogether, 121 members of the society responded to the survey (n=335 sent out. Of the 121 respondents, n=54 (44.6% of the participants (89.9% male and 10.1% female; mean age, 54.1 years; n=121 were involved in at least one in-flight medical emergency. Demographic parameters in this survey were in concordance with the society members’ demographics. The mean duration of flights was 5.7 hours and the respondents performed 7.1 airline flights per year (median. Cardiovascular (40.0% and neurological disorders (17.8% were the most frequent diagnoses. The medical equipment (78.7% provided was sufficient. An emergency diversion was

  19. Biometrics in support of special forces medical operations.

    Science.gov (United States)

    Kershner, Michael R

    2012-01-01

    Recommendations on ways in which the ODA can leverage biometrics in medical operations to improve their security, improve relations with indigenous personnel, and contribute to the larger theater biometrics program. 2012.

  20. Concordance Between Clinical Practice and Published Evidence: Findings From Virginia Commonwealth University School of Dentistry.

    Science.gov (United States)

    Chiang, Harmeet K; Best, Al M; Sarrett, David C

    2017-09-01

    To evaluate the concordance between clinical practice and published evidence by dental faculty and graduating students of the Virginia Commonwealth University School of Dentistry. A questionnaire previously developed by the National Dental Practice-Based Research Network with 12 clinical scenarios was administered to VCU faculty and graduating students. Responses were scored as either consistent or inconsistent with published evidence and then analyzed for differences between dental faculty, graduating students, and the national results. There were 43 dental faculty members with at least half-time student contact who responded to the survey. Faculty concordance ranged from 33% to 100%, and general practice faculty had the highest concordance (82%). Eighty-five of the graduating class of 98 responded to the survey, and student concordance ranged from 18% to 92% and averaged 67%. General practice faculty had higher concordance with published evidence than recently graduated dental students. Graduating students and dental faculty demonstrated higher concordance with evidence-based practice than practitioners in the National Dental Practice-Based Research Network. General practice dental faculty demonstrated adequate concordance, but students demonstrated only a medium-level concordance. Practitioners involved in teaching dental students are better able to keep up with evolving evidence and are better able to demonstrate evidence-based practice. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Association of pre-operative medication use with post-operative delirium in surgical oncology patients receiving comprehensive geriatric assessment.

    Science.gov (United States)

    Jeong, Young Mi; Lee, Eunsook; Kim, Kwang-Il; Chung, Jee Eun; In Park, Hae; Lee, Byung Koo; Gwak, Hye Sun

    2016-07-07

    Older patients undergoing surgery tend to have a higher frequency of delirium. Delirium is strongly associated with poor surgical outcomes. This study evaluated the association between pre-operative medication use and post-operative delirium (POD) in surgical oncology patients receiving comprehensive geriatric assessment (CGA). A total of 475 patients who were scheduled for cancer surgery and received CGA from January 2014 to June 2015 were included. Pre-operative medication review through CGA was conducted on polypharmacy (≥5 medications), delirium-inducing medications (DIMs), fall-inducing medications (FIMs), and potentially inappropriate medications (PIMs). POD was confirmed by psychiatric consultation, and DSM-V criteria were used for diagnosing delirium. The model fit of the prediction model was assessed by computing the Hosmer-Lemeshow goodness-of-fit test. Effect size was measured using the Nagelkerke R(2). Discrimination of the model was assessed by an analysis of the area under receiver operating curve (AUROC). Two models were constructed for multivariate analysis based on univariate analysis; model I included dementia and DIM in addition to age and sex, and model II included PIM instead of DIM of model I. Every one year increase of age increased the risk of POD by about 1.1-fold. DIM was a significant factor for POD after adjusting for confounders (AOR 12.78, 95 % CI 2.83-57.74). PIM was also a significant factor for POD (AOR 5.53, 95 % CI 2.03-15.05). The Hosmer-Lemeshow test results revealed good fits for both models (χ(2) = 3.842, p = 0.871 for model I and χ(2) = 8.130, p = 0.421 for model II). The Nagelkerke R(2) effect size and AUROC for model I was 0.215 and 0.833, respectively. Model II had the Nagelkerke R(2)effect size of 0.174 and AUROC of 0.819. These results suggest that pharmacists' comprehensive review for pre-operative medication use is critical for the post-operative outcomes like delirium in older patients.

  2. Psychiatric patients' preferences and experiences in clinical decision-making: examining concordance and correlates of patients' preferences.

    Science.gov (United States)

    De las Cuevas, Carlos; Peñate, Wenceslao; de Rivera, Luis

    2014-08-01

    To assess the concordance between patients' preferred role in clinical decision-making and the role they usually experience in their psychiatric consultations and to analyze the influence of socio-demographic, clinical and personality characteristics on patients' preferences. 677 consecutive psychiatric outpatients were invited to participate in a cross-sectional survey and 507 accepted. Patients completed Control Preference Scale twice consecutively before consultation, one for their preferences of participation and another for the style they usually experienced until then, and locus of control and self-efficacy scales. Sixty-three percent of psychiatric outpatients preferred a collaborative role in decision-making, 35% preferred a passive role and only a 2% an active one. A low concordance for preferred and experienced participation in medical decision-making was registered, with more than a half of patients wanting a more active role than they actually had. Age and doctors' health locus of control orientation were found to be the best correlates for participation preferences, while age and gender were for experienced. Psychiatric diagnoses registered significant differences in patients' preferences of participation but no concerning experiences. The limited concordance between preferred and experienced roles in psychiatric patients is indicative that clinicians need to raise their sensitivity regarding patient's participation. The assessment of patient's attribution style should be useful for psychiatrist to set objectives and priority in the communication with their patients. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  3. Sociodemographic Correlates of HIV Discordant and Concordant ...

    African Journals Online (AJOL)

    AIDS is significant. An understanding of the characteristics of HIV- affected couples will help modify preventive strategies. The aim of this study was to compare the HIV discordant and concordant partnerships for sociodemographic ...

  4. Transitions from hospital to community care: the role of patient-provider language concordance.

    Science.gov (United States)

    Rayan, Nosaiba; Admi, Hanna; Shadmi, Efrat

    2014-01-01

    Cultural and language discordance between patients and providers constitutes a significant challenge to provision of quality healthcare. This study aims to evaluate minority patients' discharge from hospital to community care, specifically examining the relationship between patient-provider language concordance and the quality of transitional care. This was a multi-method prospective study of care transitions of 92 patients: native Hebrew, Russian or Arabic speakers, with a pre-discharge questionnaire and structured observations examining discharge preparation from a large Israeli teaching hospital. Two weeks post-discharge patients were surveyed by phone, on the transition from hospital to community care (the Care Transition Measure (CTM-15, 0-100 scale)) and on the primary-care post-discharge visit. Overall, ratings on the CTM indicated fair quality of the transition process (scores of 51.8 to 58.8). Patient-provider language concordance was present in 49% of minority patients' discharge briefings. Language concordance was associated with higher CTM scores among minority groups (64.1 in language-concordant versus 49.8 in non-language-concordant discharges, P Language-concordant care, coupled with extensive discharge briefings and post-discharge explanations for ongoing care, are important contributors to the quality of care transitions of ethnic minority patients.

  5. Organization and Management of the International Space Station (ISS) Multilateral Medical Operations

    Science.gov (United States)

    Duncan, J. M.; Bogomolov, V. V.; Castrucci, F.; Koike, Y.; Comtois, J. M.; Sargsyan, A. E.

    2007-01-01

    The goal of this work is to review the principles, design, and function of the ISS multilateral medical authority and the medical support system of the ISS Program. Multilateral boards and panels provide operational framework, direct, and supervise the ISS joint medical operational activities. The Integrated Medical Group (IMG) provides front-line medical support of the crews. Results of ongoing activities are reviewed weekly by physician managers. A broader status review is conducted monthly to project the state of crew health and medical support for the following month. All boards, panels, and groups function effectively and without interruptions. Consensus prevails as the primary nature of decisions made by all ISS medical groups, including the ISS medical certification board. The sustained efforts of all partners have resulted in favorable medical outcomes of the initial fourteen long-duration expeditions. The medical support system appears to be mature and ready for further expansion of the roles of all Partners, and for the anticipated increase in the size of ISS crews.

  6. [Inter-rater concordance of the "Nursing Activities Score" in intensive care].

    Science.gov (United States)

    Valls-Matarín, Josefa; Salamero-Amorós, Maria; Roldán-Gil, Carmen; Quintana-Riera, Salvador

    2015-01-01

    To evaluate inter-rater concordance in the valuation of the "Nursing Activities Score". Cross-sectional descriptive study conducted from December 2012 until June 2013 in a general intensive care unit with twelve beds. Three evaluator nurses, simultaneously and independently, through the patient daily charts, scored the nursing workload using Nursing Activities Score scale in all patients admitted over 18 years old. Three hundreds and thirty-nine records were collected. The intra-class correlation coefficient (ICC) between evaluators was 0.92 (0.89-0.94). A perfect concordance was obtained in 39.1% of the items, with 52.2% having a high, and 8.7% having lower concordance, corresponding to two of the items with multiple scoring options. Significant differences between two of the evaluators (P=.049) were found. Although the inter-rater concordance was high, more accurate records are needed to reduce the variability of the items with multiple options and to allow more accuracy in the interpretation and measurement of the data regarding nursing workload. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  7. Operation of medical accelerator PATRO at Hyogo Ion Beam Medical Center

    International Nuclear Information System (INIS)

    Itano, A.; Akagi, T.; Higashi, A.; Fukushima, S.; Fujita, A.; Honda, Y.; Isa, H.; Nishikigouri, K.

    2004-01-01

    PATRO (Particle Accelerator for Therapy, Radiology and Oncology) is a medical accelerator facility for hadrontherapy of cancer at Hyogo Ion Beam Medical Center (HIBMC). Beam particles are proton (230 MeV) and carbon (320 MeV/u). After the beam commissioning and the tuning of irradiation system in 2000, we performed the clinical trials with proton and carbon beams from May 2001 until July 2002. We operated the accelerator for about 11,000 hours since the beginning of the beam tuning until the end of the clinical trials and for about 5,000 hours during the clinical trials. No serious troubles happened during the clinical trials. The stability and the reproducibility of the beams were well proved. (author)

  8. Estimating the concordance probability in a survival analysis with a discrete number of risk groups.

    Science.gov (United States)

    Heller, Glenn; Mo, Qianxing

    2016-04-01

    A clinical risk classification system is an important component of a treatment decision algorithm. A measure used to assess the strength of a risk classification system is discrimination, and when the outcome is survival time, the most commonly applied global measure of discrimination is the concordance probability. The concordance probability represents the pairwise probability of lower patient risk given longer survival time. The c-index and the concordance probability estimate have been used to estimate the concordance probability when patient-specific risk scores are continuous. In the current paper, the concordance probability estimate and an inverse probability censoring weighted c-index are modified to account for discrete risk scores. Simulations are generated to assess the finite sample properties of the concordance probability estimate and the weighted c-index. An application of these measures of discriminatory power to a metastatic prostate cancer risk classification system is examined.

  9. Task force St. Bernard: operational issues and medical management of a National Guard disaster response operation.

    Science.gov (United States)

    Bonnett, Carl J; Schock, Tony R; McVaney, Kevin E; Colwell, Christopher B; Depass, Christopher

    2007-01-01

    After Hurricane Katrina struck the Gulf Coast of the United States on 29 August 2005, it became obvious that the country was facing an enormous national emergency. With local resources overwhelmed, governors across the US responded by deploying thousands of National Guard soldiers and airmen. The National Guard has responded to domestic disasters due to natural hazards since its inception, but an event with the magnitude of Hurricane Katrina was unprecedented. The deployment of >900 Army National Guard soldiers to St. Bernard Parish, Louisiana in the aftermath of the Hurricane was studied to present some of the operational issues involved with providing medical support for this type of operation. In doing so, the authors attempt to address some of the larger issues of how the National Guard can be incorporated into domestic disaster response efforts. A number of unforeseen issues with regards to medical operations, medical supply, communication, preventive medicine, legal issues, and interactions with civilians were encountered and are reviewed. A better understanding of the National Guard and how it can be utilized more effectively in future disaster response operations can be developed.

  10. Medical support to military airborne training and operations.

    Science.gov (United States)

    Starkey, Kerry J; Lyon, J; Sigman, E; Pynn, H J; Nordmann, G

    2018-05-01

    Airborne operations enable large numbers of military forces to deploy on the ground in the shortest possible time. This however must be balanced by an increased risk of injury. The aim of this paper is to review the current UK military drop zone medical estimate process, which may help to predict the risk of potential injury and assist in planning appropriate levels of medical support. In spring 2015, a British Airborne Battlegroup (UKBG) deployed on a 7-week overseas interoperability training exercise in the USA with their American counterparts (USBG). This culminated in a 7-day Combined Joint Operations Access Exercise, which began with an airborne Joint Forcible Entry (JFE) of approximately 2100 paratroopers.The predicted number of jump-related injuries was estimated using Parachute Order Number 8 (PO No 8). Such injuries were defined as injuries occurring from the time the paratrooper exited the aircraft until they released their parachute harness on the ground. Overall, a total of 53 (2.5%) casualties occurred in the JFE phase of the exercise, lower than the predicted number of 168 (8%) using the PO No 8 tool. There was a higher incidence of back (30% actual vs 20% estimated) and head injuries (21% actual vs 5% estimated) than predicted with PO No 8. The current method for predicting the incidence of medical injuries after a parachute drop using the PO No 8 tool is potentially not accurate enough for current requirements. Further research into injury rate, influencing factors and injury type are urgently required in order to provide an evidence base to ensure optimal medical logistical and clinical planning for airborne training and operations in the future. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  11. Concordance of Adherence Measurement Using Self-Reported Adherence Questionnaires and Medication Monitoring Devices: An Updated Review.

    Science.gov (United States)

    Monnette, Alisha; Zhang, Yichen; Shao, Hui; Shi, Lizheng

    2018-01-01

    (MEMS) operating together continue to emerge as the preferred effective method for measuring medication adherence.

  12. Concordance Between Administrator and Clinician Ratings of Organizational Culture and Climate.

    Science.gov (United States)

    Beidas, Rinad S; Williams, Nathaniel J; Green, Philip D; Aarons, Gregory A; Becker-Haimes, Emily M; Evans, Arthur C; Rubin, Ronnie; Adams, Danielle R; Marcus, Steven C

    2018-01-01

    Organizational culture and climate are important determinants of behavioral health service delivery for youth. The Organizational Social Context measure is a well validated assessment of organizational culture and climate that has been developed and extensively used in public sector behavioral health service settings. The degree of concordance between administrators and clinicians in their reports of organizational culture and climate may have implications for research design, inferences, and organizational intervention. However, the extent to which administrators' and clinicians' reports demonstrate concordance is just beginning to garner attention in public behavioral health settings in the United States. We investigated the concordance between 73 administrators (i.e., supervisors, clinical directors, and executive directors) and 247 clinicians in 28 child-serving programs in a public behavioral health system. Findings suggest that administrators, compared to clinicians, reported more positive cultures and climates. Organizational size moderated this relationship such that administrators in small programs (climate in contrast to administrators in large programs (≥466 youth clients served annually) who reported more positive cultures and climates than clinicians. We propose a research agenda that examines the effect of concordance between administrators and clinicians on organizational outcomes in public behavioral health service settings.

  13. The concordance of directly and indirectly measured built environment attributes and physical activity adoption

    Directory of Open Access Journals (Sweden)

    O'Connor Daniel P

    2011-07-01

    Full Text Available Background Physical activity (PA adoption is essential for obesity prevention and control, yet ethnic minority women report lower levels of PA and are at higher risk for obesity and its comorbidities compared to Caucasians. Epidemiological studies and ecologic models of health behavior suggest that built environmental factors are associated with health behaviors like PA, but few studies have examined the association between built environment attribute concordance and PA, and no known studies have examined attribute concordance and PA adoption. Purpose The purpose of this study was to associate the degree of concordance between directly and indirectly measured built environment attributes with changes in PA over time among African American and Hispanic Latina women participating in a PA intervention. Method Women (N = 410 completed measures of PA at Time 1 (T1 and Time 2 (T2; environmental data collected at T1 were used to compute concordance between directly and indirectly measured built environment attributes. The association between changes in PA and the degree of concordance between each directly and indirectly measured environmental attribute was assessed using repeated measures analyses. Results There were no significant associations between built environment attribute concordance values and change in self-reported or objectively measured PA. Self-reported PA significantly increased over time (F(1,184 = 7.82, p = .006, but this increase did not vary by ethnicity or any built environment attribute concordance variable. Conclusions Built environment attribute concordance may not be associated with PA changes over time among minority women. In an effort to promote PA, investigators should clarify specific built environment attributes that are important for PA adoption and whether accurate perceptions of these attributes are necessary, particularly among the vulnerable population of minority women.

  14. Medical capability team: the clinical microsystem for combat healthcare delivery in counterinsurgency operations.

    Science.gov (United States)

    Clark, Susz; Van Steenvort, Jon K

    2008-01-01

    Today's operational environment in the support of counterinsurgency operations requires greater tactical and operational flexibility and diverse medical capabilities. The skills and organizations required for full spectrum medical operations are different from those of the past. Combat healthcare demands agility and the capacity for rapid change in clinical systems and processes to better support the counterinsurgency environment. This article proposes the Army Medical Department (AMEDD) develop and implement the medical capability team (MCT) for combat healthcare delivery. It discusses using the concept of the brigade combat team to develop medical capability teams as the unit of effectiveness to transform frontline care; provides a theoretical overview of the MCT as a "clinical microsystem"; discusses MCT leadership, training, and organizational support, and the deployment and employment of the MCT in a counterinsurgency environment. Additionally, this article proposes that the AMEDD initiate the development of an AMEDD Combat Training Center of Excellence to train and validate the MCTs. The complexity of combat healthcare demands an agile and campaign quality AMEDD with joint expeditionary capability in order to promote the best patient outcomes in a counterinsurgency environment.

  15. Prostate cancer: concordance between "1"8F-choline PET and CT in biochemical relapse

    International Nuclear Information System (INIS)

    Herández Pinzón, J.; Ferrarotti, C.; Ferrari, L.; Larrañaga, N.; Gallo, J.C.; Mena, D.; Bastianello, M.

    2016-01-01

    Objective: To establish the concordance between 18-fluor choline positron emission tomography (PET) and computed tomography (CT) for re-staging patients with biochemical relapse of prostate cancer according to the TNM system. Materials and methods: The medical records of the Molecular Imaging Section were retrospectively reviewed. The TNM classification was established by us for each method, and the Kappa concordance statistic was used to classify the results according to the Landis and Koch proposal. Results: The PET-choline reported 19 (59.4%) patients N0 and 13 (40.6%) N1, while CT reported 28 (87.5%) N0 and 4 (12.5%) N1. In metastasis classification PET-choline established M0 in 17 (53.1%) patients, M1a in 1 (3.1%), M1b in 5 (15.6%), M1c in 1 (3.1%), M1a + M1b in 7 (21.9%), and M1b + M1c in 1 (3.1%). On the other hand, CT was M0 in 23 (71.9%) patients, M1a in 2 (6.25%), M1a + M1b in 2 (6.25%), and M1b + M1c in 5 (15.6%). The correlation between PET-choline and CT in the TNM lymph node and metastasis classifications was 71.88%, with a Kappa of 0.3455 (standard error 0.1336; P=.0049) and 62.5% with Kappa 0.3725 (standard error 0.0847; P=.0001), respectively. Discussion: Several studies have shown a high diagnostic accuracy of PET-choline detecting the spread of the disease compared to conventional methods. Conclusion: There is poor concordance for metastatic and lymph node classifications according to the TNM system between choline-PET and CT. (authors) [es

  16. A concordance-based study to assess doctors’ and nurses’ mental models in Internal Medicine

    Science.gov (United States)

    Chan, K. C. Gary; Muller-Juge, Virginie; Cullati, Stéphane; Hudelson, Patricia; Maître, Fabienne; Vu, Nu V.; Savoldelli, Georges L.; Nendaz, Mathieu R.

    2017-01-01

    Interprofessional collaboration between doctors and nurses is based on team mental models, in particular for each professional’s roles. Our objective was to identify factors influencing concordance on the expectations of doctors’ and nurses’ roles and responsibilities in an Internal Medicine ward. Using a dataset of 196 doctor-nurse pairs (14x14 = 196), we analyzed choices and prioritized management actions of 14 doctors and 14 nurses in six clinical nurse role scenarios, and in five doctor role scenarios (6 options per scenario). In logistic regression models with a non-nested correlation structure, we evaluated concordance among doctors and nurses, and adjusted for potential confounders (including prior experience in Internal Medicine, acuteness of case and gender). Concordance was associated with number of female professionals (adjusted OR 1.32, 95% CI 1.02 to 1.73), for acute situations (adjusted OR 2.02, 95% CI 1.13 to 3.62), and in doctor role scenarios (adjusted OR 2.19, 95% CI 1.32 to 3.65). Prior experience and country of training were not significant predictors of concordance. In conclusion, our concordance-based approach helped us identify areas of lower concordance in expected doctor-nurse roles and responsibilities, particularly in non-acute situations, which can be targeted by future interprofessional, educational interventions. PMID:28792524

  17. A concordance-based study to assess doctors' and nurses' mental models in Internal Medicine.

    Directory of Open Access Journals (Sweden)

    Katherine S Blondon

    Full Text Available Interprofessional collaboration between doctors and nurses is based on team mental models, in particular for each professional's roles. Our objective was to identify factors influencing concordance on the expectations of doctors' and nurses' roles and responsibilities in an Internal Medicine ward. Using a dataset of 196 doctor-nurse pairs (14x14 = 196, we analyzed choices and prioritized management actions of 14 doctors and 14 nurses in six clinical nurse role scenarios, and in five doctor role scenarios (6 options per scenario. In logistic regression models with a non-nested correlation structure, we evaluated concordance among doctors and nurses, and adjusted for potential confounders (including prior experience in Internal Medicine, acuteness of case and gender. Concordance was associated with number of female professionals (adjusted OR 1.32, 95% CI 1.02 to 1.73, for acute situations (adjusted OR 2.02, 95% CI 1.13 to 3.62, and in doctor role scenarios (adjusted OR 2.19, 95% CI 1.32 to 3.65. Prior experience and country of training were not significant predictors of concordance. In conclusion, our concordance-based approach helped us identify areas of lower concordance in expected doctor-nurse roles and responsibilities, particularly in non-acute situations, which can be targeted by future interprofessional, educational interventions.

  18. Phenotypic concordance in familial inflammatory bowel disease (IBD). Results of a nationwide IBD Spanish database.

    Science.gov (United States)

    Cabré, Eduard; Mañosa, Míriam; García-Sánchez, Valle; Gutiérrez, Ana; Ricart, Elena; Esteve, Maria; Guardiola, Jordi; Aguas, Mariam; Merino, Olga; Ponferrada, Angel; Gisbert, Javier P; Garcia-Planella, Esther; Ceña, Gloria; Cabriada, José L; Montoro, Miguel; Domènech, Eugeni

    2014-07-01

    Disease outcome has been found to be poorer in familial inflammatory bowel disease (IBD) than in sporadic forms, but assessment of phenotypic concordance in familial IBD provided controversial results. We assessed the concordance for disease type and phenotypic features in IBD families. Patients with familial IBD were identified from the IBD Spanish database ENEIDA. Families in whom at least two members were in the database were selected for concordance analysis (κ index). Concordance for type of IBD [Crohn's disease (CD) vs. ulcerative colitis (UC)], as well as for disease extent, localization and behaviour, perianal disease, extraintestinal manifestations, and indicators of severe disease (i.e., need for immunosuppressors, biological agents, and surgery) for those pairs concordant for IBD type, were analyzed. 798 out of 11,905 IBD patients (7%) in ENEIDA had familial history of IBD. Complete data of 107 families (231 patients and 144 consanguineous pairs) were available for concordance analyses. The youngest members of the pairs were diagnosed with IBD at a significantly younger age (p<0.001) than the oldest ones. Seventy-six percent of pairs matched up for the IBD type (κ=0.58; 95%CI: 0.42-0.73, moderate concordance). There was no relevant concordance for any of the phenotypic items assessed in both diseases. Familial IBD is associated with diagnostic anticipation in younger individuals. Familial history does not allow predicting any phenotypic feature other than IBD type. Copyright © 2013 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

  19. Concordance of attachment representations in preschool siblings assessed by the attachment story completion task

    OpenAIRE

    Werner, Helene; Zahn, Salome; Titze, Karl; Walitza, Susanne; Zulauf Logoz, Marina

    2015-01-01

    Several studies have indicated only a modest concordance of attachment security in siblings in infancy. Until now, very little was known about the concordance of siblings’ attachment security beyond infancy, as assessed by the attachment story completion task. This cross-sectional study aims to examine the concordance of attachment representations of 38 first-born (4–7 years) and 38 second-born (3–5 years) siblings living in middle-class two-parent families. Personality factors and the level ...

  20. Concordance between prenatal ultrasound and autopsy findings in a tertiary center.

    Science.gov (United States)

    Rodriguez, M Angeles; Prats, Pilar; Rodríguez, Ignacio; Cusí, Victoria; Comas, Carmina

    2014-08-01

    The aim of this study was to evaluate the ultrasound (US)/autopsy concordance in elective termination of pregnancies (TOP) due to fetal causes. We performed a retrospective evaluation of elective TOP from 2004 to 2012. Inclusion criteria were gestational age at termination autopsy data. Based on the US-autopsy concordance, cases were divided into four groups: Group 1: agreement; Group 2: autopsy confirmed all US findings but provided additional information; Group 3: autopsy didn't confirm all US findings; Group 4: disagreement. One hundred and fifty-one patients fulfilled the inclusion criteria during the study period. Central nervous system malformations (91.5%), cardiovascular anomalies (90.2%) and renal system malformations (91.3%) were confirmed by autopsy. We found less concordance in the abdominal and musculoskeletal anomalies (61.5% and 66.7%, respectively). There were 130 (86%) fetuses in group 1, 7 in group 2 (4.6%), 3 in group 3 (1.9%) and 11 in group 4 (7.2%). In 5.29% of cases, the autopsy added relevant information to the diagnosis and counselling. Diagnosis concordance between US and necropsy is achieved in almost 90% of cases. An autopsy may help to adjust the diagnosis and help in counselling the parents for a future pregnancy. © 2014 John Wiley & Sons, Ltd.

  1. Characterization of the medical department of pharmaceutical companies operating in Portugal

    Directory of Open Access Journals (Sweden)

    Acílio Gala

    2017-04-01

    Full Text Available In a context of strong regulatory demands and high economic pressures and constraints, medical departments within pharmaceutical companies, have demonstrated its strategic relevance even though the functions to embrace are not globally consensual. In this context, a study that intended to analyse the management of medical activities, in pharmaceutical companies operating in Portugal, including allocated human resources and investment trends, was implemented. Quantitative information was collected through an electronic survey, in pharmaceutical companies with activity in Portugal. The analysis of the results supported the conclusion that the majority of the companies are affiliates of international companies and that 79% of them have formalized medical departments. The human resources of the medical departments of the participant companies include several professional classes, with predominance of pharmacists. Globally, the number of employees of the medical area has registered a systematic growth in the last years. It was also possible to conclude that the majority of the companies are increasing the investment in medical affairs activities. This study enables the understanding of these activities in pharmaceutical companies operating in Portugal, within the international panorama of pharmaceutical industry. It contributes to improve the knowledge about the relevance of medical departments while enabling the definition of novel pathways to increase the competiveness and sustainability of the companies.

  2. Radiation safety and operational health physics of hospital based medical cyclotrons

    International Nuclear Information System (INIS)

    Mukherjee, B.

    2002-01-01

    Full text: Compact, low energy, high current Medical Cyclotrons are now primarily used to produce large activities of short lived, neutron deficient, positron- emitting radioisotopes. These isotopes constitute the key ingredients of important PET (Positron Emission Tomography) radiopharmaceuticals used in diagnostic nuclear medicine. The PET-radioisotope producing Medical Cyclotrons are now increasingly installed in modern urban hospitals in many countries of the world. Modern Medical Cyclotrons run at a very high beam current (∼100-200 micro Amp) level and thereby produce intense fields of parasitic gamma rays and neutrons, causing the activation of cyclotron components, ambient air and radiation exposure to patients and members of the public. This report highlights the important operational aspects and the characteristics of the radiation fields produced by Medical Cyclotrons. The pathways of personnel radiation exposure are also analyzed. The above information constitutes the scientific basis of a sound operational health physics service, which is manifested in an effective dose reduction and an enhanced radiological safety of the Medical Cyclotron facility within the framework of ALARA

  3. Environmental assessment proposed license renewal of Nuclear Metals, Inc. Concord, Massachusetts

    International Nuclear Information System (INIS)

    Miller, R.L.; Easterly, C.E.; Lombardi, C.E.; Treitler, I.E.; Winbow, R.T.; Zimmerman, G.P.

    1997-02-01

    The US Nuclear Regulatory Commission (NRC) has prepared this Environmental Assessment (EA) to evaluate environmental issues associated with the renewal of licenses issued by NRC for facilities operated by Nuclear Metals, Inc. (NMI) in Concord, Massachusetts. By renewing the licenses, NRC proposes to allow the continuation of ongoing operations involving radioactive materials at NMI's facilities. This EA focuses on the potential impacts related to air emissions at NMI during normal (incident-free) operations and accidental releases. Findings indicate that there are only two areas of potential concern. First, modeling results for sulfur dioxide (SO 2 ) emissions from the boilers during normal operations indicate that the potential exists for exceeding the short-term National Ambient Air Quality Standards (NAAQS). NMI is prepared to undertake mitigative action to prevent potential exceedances of the short-term SO 2 NAAQS, and the Massachusetts Department of Environmental Protection is prepared to resolve the issue via a permit/approval change or through a Consent Order. Second, in the unlikely event of a severe fire, predicted sulfuric acid (H 2 SO 4 ) concentrations based on conservative (upper bound) modeling exceed the Emergency Response Planning Guideline (ERPG) levels. NMI has committed to NRC to give a briefing for local emergency response officials regarding the potential for an accidental H 2 SO 4 release

  4. Labtracker+, a medical smartphone app for the interpretation of consecutive laboratory results: an external validation study.

    Science.gov (United States)

    Hilderink, Judith M; Rennenberg, Roger J M W; Vanmolkot, Floris H M; Bekers, Otto; Koopmans, Richard P; Meex, Steven J R

    2017-09-01

    When monitoring patients over time, clinicians may struggle to distinguish 'real changes' in consecutive blood parameters from so-called natural fluctuations. In practice, they have to do so by relying on their clinical experience and intuition. We developed Labtracker+ , a medical app that calculates the probability that an increase or decrease over time in a specific blood parameter is real, given the time between measurements. We presented patient cases to 135 participants to examine whether there is a difference between medical students, residents and experienced clinicians when it comes to interpreting changes between consecutive laboratory results. Participants were asked to interpret if changes in consecutive laboratory values were likely to be 'real' or rather due to natural fluctuations. The answers of the study participants were compared with the calculated probabilities by the app Labtracker+ and the concordance rates were assessed. Medical students (n=92), medical residents from the department of internal medicine (n=19) and internists (n=24) at a Dutch University Medical Centre. Concordance rates between the study participants and the calculated probabilities by the app Labtracker+ were compared. Besides, we tested whether physicians with clinical experience scored better concordance rates with the app Labtracker+ than inexperienced clinicians. Medical residents and internists showed significantly better concordance rates with the calculated probabilities by the app Labtracker+ than medical students, regarding their interpretation of differences between consecutive laboratory results (p=0.009 and p<0.001, respectively). The app Labtracker+ could serve as a clinical decision tool in the interpretation of consecutive laboratory test results and could contribute to rapid recognition of parameter changes by physicians. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial

  5. Medical Support for Aircraft Disaster Search and Recovery Operations at Sea: the RSN Experience.

    Science.gov (United States)

    Teo, Kok Ann Colin; Chong, Tse Feng Gabriel; Liow, Min Han Lincoln; Tang, Kong Choong

    2016-06-01

    The maritime environment presents a unique set of challenges to search and recovery (SAR) operations. There is a paucity of information available to guide provision of medical support for SAR operations for aircraft disasters at sea. The Republic of Singapore Navy (RSN) took part in two such SAR operations in 2014 which showcased the value of a military organization in these operations. Key considerations in medical support for similar operations include the resultant casualty profile and challenges specific to the maritime environment, such as large distances of area of operations from land, variable sea states, and space limitations. Medical support planning can be approached using well-established disaster management life cycle phases of preparedness, mitigation, response, and recovery, which all are described in detail. This includes key areas of dedicated training and exercises, force protection, availability of air assets and chamber support, psychological care, and the forensic handling of human remains. Relevant lessons learned by RSN from the Air Asia QZ8501 search operation are also included in the description of these key areas. Teo KAC , Chong TFG , Liow MHL , Tang KC . Medical support for aircraft disaster search and recovery operations at sea: the RSN experience. Prehosp Disaster Med. 2016; 31(3):294-299.

  6. Negative concord and the scope of universals

    NARCIS (Netherlands)

    Giannakidou, A

    2000-01-01

    In this paper, I propose an analysis of Greek negative concord (NC) in terms of quantifier scope. It is shown that there is no evidence that Greek NC n-words are indefinites or negative quantifiers, NC n-words are analysed as universal quantifiers, which are sensitive to negative polarity, and which

  7. Concord Grape Juice Supplementation Improves Memory Function In Older Adults with Mild Cognitive Impairment

    Science.gov (United States)

    Concord grape juice contains flavonoid polyphenol compounds, which have antioxidant and anti-inflammatory properties and influence neuronal signaling. Concord grape juice supplementation has been shown to reduce inflammation, blood pressure, and vascular pathology in individuals with cardiovascular...

  8. Grading of Cerebral Glioma with Multiparametric MR Imaging and {sup 18}F-FDG-PET: Concordance and Accuracy

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Jeong Hee; Kim, Ji-hoon; Sohn, Chul-Ho; Choi, Seung Hong; Yun, Tae Jin; Song, Yong Sub [Seoul National University Hospital, Department of Radiology, Seoul (Korea, Republic of); Kang, Won Jun [Seoul National University Hospital, Department of Nuclear Medicine, Seoul (Korea, Republic of); Yonsei University College of Medicine, Department of Nuclear Medicine, Seoul (Korea, Republic of); Eun, Yong [Seoul National University, College of Medicine, Seoul (Korea, Republic of); Chang, Kee-Hyun [Seoul National University Hospital, Department of Radiology, Seoul (Korea, Republic of); Soonchunhyang University Bucheon Hospital, Department of Radiology, Bucheon (Korea, Republic of)

    2014-02-15

    To retrospectively evaluate concordance rates and predictive values in concordant cases among multiparametric MR techniques and FDG-PET to grade cerebral gliomas. Multiparametric MR imaging and FDG-PET were performed in 60 consecutive patients with cerebral gliomas (12 low-grade and 48 high-grade gliomas). As the dichotomic variables, conventional MRI, minimum apparent diffusion coefficient in diffusion-weighted imaging, maximum relative cerebral blood volume ratio in perfusion-weighted imaging, choline/creatine ratio and (lipid and lactate)/creatine ratio in MR spectroscopy, and maximum standardised uptake value ratio in FDG-PET in low- and high-grade gliomas were compared. Their concordance rates and positive/negative predictive values (PPV/NPV) in concordant cases were obtained for the various combinations of multiparametric MR techniques and FDG-PET. There were significant differences between low- and high-grade gliomas in all techniques. Combinations of two, three, four, and five out of the five techniques showed concordance rates of 77.0 ± 4.8 %, 65.5 ± 4.0 %, 58.3 ± 2.6 % and 53.3 %, PPV in high-grade concordant cases of 97.3 ± 1.7 %, 99.1 ± 1.4 %, 100.0 ± 0 % and 100.0 % and NPV in low-grade concordant cases of 70.2 ± 7.5 %, 78.0 ± 6.0 %, 80.3 ± 3.4 % and 80.0 %, respectively. Multiparametric MR techniques and FDG-PET have a concordant tendency in a two-tiered classification for the grading of cerebral glioma. If at least two examinations concordantly indicated high-grade gliomas, the PPV was about 95 %. (orig.)

  9. A community study of language concordance in Russian patients with diabetes.

    Science.gov (United States)

    Mehler, Philip S; Lundgren, Rita A; Pines, Irina; Doll, Katherine

    2004-01-01

    Unique challenges exist in the provision of culturally and linguistically appropriate health care to ethnically diverse populations. The purpose of this study was to improve the metabolic control of Russian patients with diabetes through increased attention to language and cultural concordance between the provider and patient. This is a retrospective cohort study of 55 Russian immigrant type 2 patients with diabetes to assess levels of glycemic, lipid, and blood pressure control before and after the arrival of a bilingual Russian internist trained in both the United States and Russia. Paired t test was used to compare these parameters before and after the bilingual Russian provider joined our practice. Overall, the mean low density lipoprotein (LDL) level decreased by 20% from 126 mg/dL to 102 mg/dL (P=.0002) respectively before and after the Russian provider began treating these patients. Mean hemoglobin A1c decreased from 8.4% to 8.0% (P=.007), and diastolic blood pressure was reduced from 82.7 mm Hg to 76.3 mm Hg (P=.0002). Systolic blood pressure also improved from 143.2 mm Hg to 140.6 mm Hg (P=.3). At the end of the study period more than 90% of the patients with diabetes were appropriately taking lipid-lowering medications and an angiotensin converting enzyme (ACE) inhibitor. Our findings suggest that it is important to facilitate the health care of ethnically diverse minority populations in a manner that attempts to maximize language and cultural concordance. These potential benefits will assume an even greater importance with the expansive growth of ethnic minorities in the United States and their unique healthcare needs.

  10. Space Technology - Game Changing Development NASA Facts: Autonomous Medical Operations

    Science.gov (United States)

    Thompson, David E.

    2018-01-01

    The AMO (Autonomous Medical Operations) Project is working extensively to train medical models on the reliability and confidence of computer-aided interpretation of ultrasound images in various clinical settings, and of various anatomical structures. AI (Artificial Intelligence) algorithms recognize and classify features in the ultrasound images, and these are compared to those features that clinicians use to diagnose diseases. The acquisition of clinically validated image assessment and the use of the AI algorithms constitutes fundamental baseline for a Medical Decision Support System that will advise crew on long-duration, remote missions.

  11. Hand trauma: A prospective observational study reporting diagnostic concordance in emergency hand trauma which supports centralised service improvements.

    Science.gov (United States)

    Miranda, B H; Spilsbury, Z P; Rosala-Hallas, A; Cerovac, S

    2016-10-01

    Hand injuries are common, contributing up to 30% of accident and emergency (A&E) attendances. The aim of this study was to prospectively analyse the pathological demographics of hand injuries in a level 1 trauma centre with a Hand Trauma Unit and direct A&E links, and compare clinical and intra-operative findings. The null hypothesis was that there would be no differences between clinical and intra-operative findings (100% diagnostic concordance). Data were prospectively collected for referrals during 2012. Referral diagnosis, additional pathologies found on clinical assessment and intra-operative findings were documented on a live database accessible from both the Hand Unit and associated operating theatres. Odds ratios were calculated using SAS. Injuries (1526) were identified in 1308 patients included in the study. Diagnostic concordance between Hand Unit clinical examination and intra-operative findings was 92.5% ± 2.85% (mean ± SEM); this was lower for flexor tendon injuries (56.3%) because a greater number of additional pathologies were found intra-operatively (2.25 ± 0.10). This 'trend' was noted across multiple referral pathologies including phalangeal fractures (1.28 ± 0.02; 82.9%), lacerations (1.33 ± 0.04; 79.1%), extensor tendon injuries (1.30 ± 0.05; 87.8%) and dislocations (1.18 ± 0.05; 87.8%). Odds ratio analysis indicated a relationship between primary referral diagnoses that were more or less likely to be associated with additional injuries (p management of hand trauma. Our findings, coupled with the presented relevant literature reports, lead us to advocate that A&E departments should move towards a system wherein links to specialist hand trauma services are in place; we hereby present useful data for hospitals implementing such services. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

  12. The validity and reliability of script concordance test in otolaryngology residency training.

    Science.gov (United States)

    Iravani, Kamyar; Amini, Mitra; Doostkam, Aida; Dehbozorgian, Mahnaz

    2016-04-01

    The script concordance test (SCT) is one the best tools used to evaluate clinical reasoning in ill-defined clinical situations. The aim of this study was to demonstrate SCT application in otolaryngology residency training. A 20 item otolaryngology SCT containing 60 questions was administered to 26 otolaryngology residents. The test was prepared by two otolaryngologists familiar to medical education. These questions have been validated by otolaryngology experts. The panel consisted of 9 academic staff in the field of otolaryngology. Pearson correlation test was used to assess the reliability of the test. The obtained mean scores were 68.4±5.8 (out of 100) for residents and 78.2±6.4(out of 100) for experts. There was a significant difference between the two scores (preliable tool to evaluate clinical reasoning in otolaryngology residents. It should be included in otolaryngology residency training.

  13. A Place Called Home: Educational Reform in a Concord, Massachusetts School, 1897-1914

    Science.gov (United States)

    Morice, Linda C.

    2012-01-01

    This paper examines the role of place in the reform efforts of two teachers who established Miss White's Home School in Concord, Massachusetts (USA). Flora and Mary White rebelled against the prevailing industrial model of instruction in tax-supported schools where they taught. As a solution, they moved to Concord--a nonconformist town with a…

  14. Corpus-aided language pedagogy : the use of concordance lines in vocabulary instruction

    OpenAIRE

    Kazaz, İlknur

    2015-01-01

    Ankara : The Program of Teaching English as a Foreign Language Bilkent University, 2015. Thesis (Master's) -- Bilkent University, 2015. Includes bibliographical references leaves 83-91. This study investigated the effectiveness of the use of a concordance software and concordance lines as a pedagogical tool to learn the target vocabulary of a text book. The purpose of the study was to compare the effects of corpus-aided vocabulary instruction with traditional vocabulary teac...

  15. Where Do Self-Concordant Goals Come From? The Role of Domain-Specific Psychological Need Satisfaction.

    Science.gov (United States)

    Milyavskaya, Marina; Nadolny, Daniel; Koestner, Richard

    2014-06-01

    Previous research has shown that self-concordant goals are more likely to be attained. But what leads someone to adopt a self-concordant goal in the first place? The present research addresses this question by looking at the domains in which goals are set, focusing on the amount of psychological need satisfaction experienced in these domains. Across three experimental studies, we demonstrate that domain-related need satisfaction predicts the extent to which people adopt self-concordant goals in a given domain, laying the foundation for successful goal pursuit. In addition, we show that need satisfaction influences goal self-concordance because in need-satisfying domains people are both more likely to choose the most self-concordant goal (among a set of comparable choices), and are more likely to internalize the possible goals. The implications of this research for goal setting and pursuit as well as for the importance of examining goals within their broader motivational framework are discussed. © 2014 by the Society for Personality and Social Psychology, Inc.

  16. The script concordance test in radiation oncology: validation study of a new tool to assess clinical reasoning

    International Nuclear Information System (INIS)

    Lambert, Carole; Gagnon, Robert; Nguyen, David; Charlin, Bernard

    2009-01-01

    The Script Concordance test (SCT) is a reliable and valid tool to evaluate clinical reasoning in complex situations where experts' opinions may be divided. Scores reflect the degree of concordance between the performance of examinees and that of a reference panel of experienced physicians. The purpose of this study is to demonstrate SCT's usefulness in radiation oncology. A 90 items radiation oncology SCT was administered to 155 participants. Three levels of experience were tested: medical students (n = 70), radiation oncology residents (n = 38) and radiation oncologists (n = 47). Statistical tests were performed to assess reliability and to document validity. After item optimization, the test comprised 30 cases and 70 questions. Cronbach alpha was 0.90. Mean scores were 51.62 (± 8.19) for students, 71.20 (± 9.45) for residents and 76.67 (± 6.14) for radiation oncologists. The difference between the three groups was statistically significant when compared by the Kruskall-Wallis test (p < 0.001). The SCT is reliable and useful to discriminate among participants according to their level of experience in radiation oncology. It appears as a useful tool to document the progression of reasoning during residency training

  17. Concord, Convergence and Accommodation in Bilingual Children

    Science.gov (United States)

    Radford, Andrew; Kupisch, Tanja; Koppe, Regina; Azzaro, Gabriele

    2007-01-01

    This paper examines the syntax of "GENDER CONCORD" in mixed utterances where bilingual children switch between a modifier in one language and a noun in another. Particular attention is paid to how children deal with potential gender mismatches between modifier and noun, i.e., if one of the languages has grammatical gender but the other does not,…

  18. Correlates of and couples' concordance in reports of recent sexual behavior and contraceptive use.

    Science.gov (United States)

    Koffi, Alain K; Adjiwanou, Visseho D; Becker, Stan; Olaolorun, Funmilola; Tsui, Amy O

    2012-03-01

    This study uses couple-level data to measure couples' concordance of self-reported time since last coitus and of condom and other contraceptive use at last sexual intercourse among monogamous couples in Liberia (N = 1,673), Madagascar (N = 4,138), and Namibia (N = 588). The study also examines the characteristics associated with sexual behavior and contraceptive use occurring in the 28 days prior to the interviews among couples whose reports are concordant. Overall, our study finds less than 75 percent concordance in reporting of time since last coitus. Use of condoms and other contraceptives yielded fair (0.27) to substantial (0.67) agreement on the kappa index. Factors predicting a shorter time since last coitus among concordant couples in at least two of the countries included wealth, spousal age difference, education, and both partners wanting another child. The discordant reports of recent sexual behavior and contraceptive use suggest that caution should be exercised when inferring couples' behavior from the report of one spouse, that concordant reports should be examined when possible, that methodological changes to improve the validity of spousal reports should be pursued, and that family planning and HIV-prevention programs should target those groups found to be using condoms and other contraceptives less frequently, particularly poorer couples.

  19. The concordance of ultrasound technique versus X-ray to confirm endotracheal tube position in neonates.

    Science.gov (United States)

    Chowdhry, R; Dangman, B; Pinheiro, J M B

    2015-07-01

    Given the distressingly high incidence of ETT malposition in the neonatal population, patients are exposed to ionizing radiation to confirm endotracheal tube (ETT) position. Our objective is to determine if ultrasound technique is concordant with X-ray in determining whether an ETT is deeply positioned or not. Prospective observational clinical trial. After obtaining informed consent, patients with an ETT who required X-ray for clinical reasons underwent sonographic evaluation of the ETT by an ultrasound technologist or pediatric radiologist, usually within the hour. A total of 56 image pairs were obtained from 29 patients. Ninety-eight percent of the ultrasound/X-ray image pairs were suitable for analysis. The concordance of ultrasound with X-ray to identify deeply and not deeply positioned ETTs was 95% (53/56). The sensitivity of ultrasound to detect deeply positioned ETTs on X-ray was 86% (6/7). The specificity of ultrasound to detect ETTs that were not deeply positioned on X-ray was 96% (47/49). As the largest clinical trial of its kind to date, with the greatest number of ultrasound operators, we have further established US as a feasible imaging modality to determine whether an ETT is deeply positioned or not.

  20. Concordance and interchangeability of biometric measurements of ocular axial length in patients awaiting cataract surgery.

    Science.gov (United States)

    Martín-Serrano, María José; Roman-Ortiz, Carmen; Villa-Sáez, M Luz; Labrador-Castellanos, M Purificación; Blanco-Carrasco, Rosario; Lozano-Ballesteros, Felicidad; Pedraza-Martín, Carmen; José-Herrero, M Teresa San; López-Ropero, Ana M; Tenías Burillo, José María

    2014-01-01

    To estimate in patients awaiting cataract surgery the concordance and interchangeability of axial eye length measurements performed with the aid of various biometric methods (optical or ultrasonic) by different operators (nurses) at different times during the period prior to surgery. We selected 182 consecutive eyes from 91 patients.Ocular axial length was measured with the aid of 2 methods (IOLMaster® and Ocuscan®) by 9 randomly allocated technicians at 2 different times during the waiting period. The concordance between measurements was evaluated by means of the intraclass correlation coefficient (ICC); the interchangeability of the results was assessed with Bland Altman plots and Passing and Bablok regression. The measurements were consistent between biometric methods (ICC 0.975, 95% confidence interval [CI] 0.968 to 0.980) and measurement dates (ICC 0.996, 95% CI 0.995 to 0.997). Interobserver agreement was more heterogeneous (ICC range 0.844 to 0.998). No systematic errors were observed among the various biometric methods and measurement dates. Because measurement of axial length in phakic patients may be technician-dependent, the technician's experience should be noted in the protocols of ophthalmology services.

  1. Environmental assessment proposed license renewal of Nuclear Metals, Inc. Concord, Massachusetts

    Energy Technology Data Exchange (ETDEWEB)

    Miller, R.L.; Easterly, C.E.; Lombardi, C.E.; Treitler, I.E.; Winbow, R.T.; Zimmerman, G.P. [Oak Ridge National Lab., TN (United States)

    1997-02-01

    The US Nuclear Regulatory Commission (NRC) has prepared this Environmental Assessment (EA) to evaluate environmental issues associated with the renewal of licenses issued by NRC for facilities operated by Nuclear Metals, Inc. (NMI) in Concord, Massachusetts. By renewing the licenses, NRC proposes to allow the continuation of ongoing operations involving radioactive materials at NMI`s facilities. This EA focuses on the potential impacts related to air emissions at NMI during normal (incident-free) operations and accidental releases. Findings indicate that there are only two areas of potential concern. First, modeling results for sulfur dioxide (SO{sub 2}) emissions from the boilers during normal operations indicate that the potential exists for exceeding the short-term National Ambient Air Quality Standards (NAAQS). NMI is prepared to undertake mitigative action to prevent potential exceedances of the short-term SO{sub 2} NAAQS, and the Massachusetts Department of Environmental Protection is prepared to resolve the issue via a permit/approval change or through a Consent Order. Second, in the unlikely event of a severe fire, predicted sulfuric acid (H{sub 2}SO{sub 4}) concentrations based on conservative (upper bound) modeling exceed the Emergency Response Planning Guideline (ERPG) levels. NMI has committed to NRC to give a briefing for local emergency response officials regarding the potential for an accidental H{sub 2}SO{sub 4} release.

  2. Fault Severity Evaluation and Improvement Design for Mechanical Systems Using the Fault Injection Technique and Gini Concordance Measure

    Directory of Open Access Journals (Sweden)

    Jianing Wu

    2014-01-01

    Full Text Available A new fault injection and Gini concordance based method has been developed for fault severity analysis for multibody mechanical systems concerning their dynamic properties. The fault tree analysis (FTA is employed to roughly identify the faults needed to be considered. According to constitution of the mechanical system, the dynamic properties can be achieved by solving the equations that include many types of faults which are injected by using the fault injection technique. Then, the Gini concordance is used to measure the correspondence between the performance with faults and under normal operation thereby providing useful hints of severity ranking in subsystems for reliability design. One numerical example and a series of experiments are provided to illustrate the application of the new method. The results indicate that the proposed method can accurately model the faults and receive the correct information of fault severity. Some strategies are also proposed for reliability improvement of the spacecraft solar array.

  3. Concordance of autoimmune disease in a nationwide Danish systemic lupus erythematosus twin cohort

    DEFF Research Database (Denmark)

    Ulff-Møller, Constance Jensina; Svendsen, Anders Jørgen; Viemose, Louise Nørgaard

    2018-01-01

    OBJECTIVE: To determine the concordance of systemic lupus erythematosus (SLE) and co-aggregating autoimmune diseases among Danish twins. METHODS: SLE-affected twins were ascertained by record linkage between the National Patient Register (NPR) and the Danish Twin Registry (DTR). Registered SLE....... Another four co-twins had other autoimmune disease, corresponding to a probandwise concordance of any autoimmune disease of 50.0% in MZ (95% CI: 21.5-78.5) and 23.1% in DZ twins (95% CI: 8.18-50.3). CONCLUSION: Population-based Danish data suggest that SLE twin concordance is lower than previously...... reported, but still point to the importance of both genetic and environmental factors, and indicate a substantial co-aggregation of other autoimmune diseases in SLE twins....

  4. Improvisation versus guideline concordance in surgical antibiotic prophylaxis: a qualitative study.

    Science.gov (United States)

    Broom, Jennifer; Broom, Alex; Kirby, Emma; Post, Jeffrey J

    2018-05-28

    Surgical antibiotic prophylaxis (SAP) is a common area of antimicrobial misuse. The aim of this study was to explore the social dynamics that influence the use of SAP. 20 surgeons and anaesthetists from a tertiary referral hospital in Australia participated in semi-structured interviews focusing on experiences and perspectives on SAP prescribing. Interview data were analysed using the framework approach. Systematic analysis of the participants' account of the social factors influencing SAP revealed four themes. First, antibiotic prophylaxis is treated as a low priority with the competing demands of the operating theatre environment. Second, whilst guidelines have increased in prominence in recent years, there exists a lack of confidence in their ability to protect the surgeon from responsibility for infectious complications (thus driving SAP over-prescribing). Third, non-concordance prolonged duration of SAP is perceived to be driven by benevolence for the individual patient. Finally, improvisation with novel SAP strategies is reported as ubiquitous, and acknowledged to confer a sense of reassurance to the surgeon despite potential non-concordance with guidelines or clinical efficacy. Surgical-specific concerns have thus far not been meaningfully integrated into antimicrobial stewardship (AMS) programmes, including important dynamics of confidence, trust and mitigating fear of adverse infective events. Surgeons require specific forms of AMS support to enact optimisation, including support for strong collaborative ownership of the surgical risk of infection, and intra-specialty (within surgical specialties) and inter-specialty (between surgery, anaesthetics and infectious diseases) intervention strategies to establish endorsement of and address barriers to guideline implementation.

  5. Modeling Concordance Correlation Coefficient for Longitudinal Study Data

    Science.gov (United States)

    Ma, Yan; Tang, Wan; Yu, Qin; Tu, X. M.

    2010-01-01

    Measures of agreement are used in a wide range of behavioral, biomedical, psychosocial, and health-care related research to assess reliability of diagnostic test, psychometric properties of instrument, fidelity of psychosocial intervention, and accuracy of proxy outcome. The concordance correlation coefficient (CCC) is a popular measure of…

  6. Dioxins from medical waste incineration: Normal operation and transient conditions.

    Science.gov (United States)

    Chen, Tong; Zhan, Ming-xiu; Yan, Mi; Fu, Jian-ying; Lu, Sheng-yong; Li, Xiao-dong; Yan, Jian-hua; Buekens, Alfons

    2015-07-01

    Polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs) are key pollutants in waste incineration. At present, incinerator managers and official supervisors focus only on emissions evolving during steady-state operation. Yet, these emissions may considerably be raised during periods of poor combustion, plant shutdown, and especially when starting-up from cold. Until now there were no data on transient emissions from medical (or hospital) waste incineration (MWI). However, MWI is reputed to engender higher emissions than those from municipal solid waste incineration (MSWI). The emission levels in this study recorded for shutdown and start-up, however, were significantly higher: 483 ± 184 ng Nm(-3) (1.47 ± 0.17 ng I-TEQ Nm(-3)) for shutdown and 735 ng Nm(-3) (7.73 ng I-TEQ Nm(-3)) for start-up conditions, respectively. Thus, the average (I-TEQ) concentration during shutdown is 2.6 (3.8) times higher than the average concentration during normal operation, and the average (I-TEQ) concentration during start-up is 4.0 (almost 20) times higher. So monitoring should cover the entire incineration cycle, including start-up, operation and shutdown, rather than optimised operation only. This suggestion is important for medical waste incinerators, as these facilities frequently start up and shut down, because of their small size, or of lacking waste supply. Forthcoming operation should shift towards much longer operating cycles, i.e., a single weekly start-up and shutdown. © The Author(s) 2015.

  7. Army Medical Department Leaders in Military Operations Other Than War

    National Research Council Canada - National Science Library

    Sadlon, Gary

    2000-01-01

    .... Likewise, the Army Medical Department (AMEDD) must insure its leaders, specifically those selected to deploy world-wide, have a more diverse skill set that enables them to fully operate within the full spectrum of scenarios...

  8. SUPERVISED AUTOMATIC HISTOGRAM CLUSTERING AND WATERSHED SEGMENTATION. APPLICATION TO MICROSCOPIC MEDICAL COLOR IMAGES

    Directory of Open Access Journals (Sweden)

    Olivier Lezoray

    2011-05-01

    Full Text Available In this paper, an approach to the segmentation of microscopic color images is addressed, and applied to medical images. The approach combines a clustering method and a region growing method. Each color plane is segmented independently relying on a watershed based clustering of the plane histogram. The marginal segmentation maps intersect in a label concordance map. The latter map is simplified based on the assumption that the color planes are correlated. This produces a simplified label concordance map containing labeled and unlabeled pixels. The formers are used as an image of seeds for a color watershed. This fast and robust segmentation scheme is applied to several types of medical images.

  9. A quality control study on cytotechnologist-cytopathologist concordance and its relationship to the number of dots on the slide.

    Science.gov (United States)

    Bongiovanni, Massimo; De Saussure, Barbara; Kumar, Neeta; Pache, Jean-Claude; Cibas, Edmund S

    2009-01-01

    To study cytotechnologist (CT)-cytopathologist (CP) concordance for evaluating individual CTs' performance and for quality assurance and educational feedback. The interpretations of individual CTs were compared with the final interpretations (according to the 2001 Bethesda System) of the CP. Concordance percentages and kappa values were calculated for each CT and correlated with the numbers of dots on each slide, years of experience and percentage of work hours devoted to cytology. A total of 10,453 Pap tests were screened by 9 CTs during one year, out of which 993 (9.5%) were referred to one CP for a final interpretation. Mean concordance between the aggregate CT interpretations and those of the CP was 65.5%. Five CTs had good concordance, 3 had moderately good concordance, and one had surprisingly poor concordance that contrasted with good subjective impressions. No correlation was found between concordance and the average number of dots per slide, screening experience in cervicovaginal cytology or percentage of work hours devoted to cytology. Monitoring CT-CP concordance rates can unveil performance issues not detected by subjective impressions. An excessive number of dots per slide may not reflect poor diagnostic precision so much as a lack of confidence in interpretation.

  10. Reasons for medical evacuations of soldiers serving in International Security Assistance Force (ISAF) operation in Afghanistan.

    Science.gov (United States)

    Korzeniewski, Krzysztof; Gregulski, Robert

    2014-01-01

    The article presents the results of a research study into the reasons for medical evacuations of Polish military personnel taking part in the International Security Assistance Force (ISAF) operation in Afghanistan from 2007 to 2013. The authors have analysed medical records of 485 soldiers who were medically evacuated out of a combat zone in Afghanistan for battle injuries, non-battle injuries and diseases. Each medically evacuated Polish soldier was subjected to statistical analysis. The study population comprised 25,974 soldiers assigned to the Polish Military Contingent Afghanistan in the given period. From 2007 to 2013, 1.9% of the Polish military personnel (n = 485) participating in the ISAF operation in Afghanistan were evacuated for medical reasons before the scheduled termination of their contract. 40.6% of all medical evacuations were due to battle injuries, 32.4% due to non-battle injuries, and 27.0% due to diseases. ISAF is an example of a combat operation, in which battle injuries remain the leading health problem in mission participants. 3 of 4 Polish soldiers who were medically evacuated from Afghanistan were no longer fit for military service in the area of operations due to the traumas they had suffered.

  11. Personal, family and social functioning among older couples concordant and discordant for high-risk alcohol consumption.

    Science.gov (United States)

    Moos, Rudolf H; Schutte, Kathleen K; Brennan, Penny L; Moos, Bernice S

    2011-02-01

    This study compares the personal, family and social functioning of older husbands and wives concordant or discordant for high-risk alcohol consumption and identifies predictors of changes in concordance and high-risk consumption. Three groups of couples were identified at baseline and followed 10 years later: (i) concordant couples in which husbands and wives engaged in low-risk alcohol consumption (n = 54); (ii) concordant couples in which husbands and wives engaged in high-risk alcohol consumption (n = 38); and (iii) discordant couples in which one partner engaged in high-risk alcohol consumption and the other partner did not (n = 75). At each follow-up, husbands and wives completed an inventory that assessed their personal, family and social functioning. Compared to the low-risk concordant group, husbands and wives in the high-risk concordant group were more likely to rely on tension-reduction coping, reported more friend approval of drinking, and were less involved in religious activities; however, they did not differ in the quality of the spousal relationship. The frequency of alcohol consumption declined among husbands in discordant couples, but not among husbands in concordant couples. Predictors of high-risk drinking included tension-reduction coping, friend approval of drinking and, for husbands, their wives' level of drinking. High-risk and discordant alcohol consumption do not seem to be linked to decrements in family functioning among older couples in long-term stable marriages. The predictors of heavy alcohol consumption among older husbands and wives identify points of intervention that may help to reduce their high-risk drinking. © 2010 Society for the Study of Addiction. No claim to US government works.

  12. Building a Smooth Medical Service for Operating Room Using RFID Technologies

    Directory of Open Access Journals (Sweden)

    Lun-Ping Hung

    2014-01-01

    Full Text Available Due to the information technology advancement, the feasibility for the establishment of mobile medical environments has been strengthened. Using RFID to facilitate the tracing of patients’ mobile position in hospital has attracted more attentions from researchers due to the demand on advanced features. Traditionally, the management of surgical treatment is generally manually operated and there is no consistent operating procedure for patients transferring among wards, surgery waiting rooms, operating rooms, and recovery rooms, resulting in panicky and urgent transferring work among departments and, thus, leading to delays and errors. In this paper, we propose a new framework using radio frequency identification (RFID technology for a mobilized surgical process monitoring system. Through the active tag, an application management system used before, during, and after the surgical processes has been proposed. The concept of signal level matrix, SLM, was proposed to accurately identify patients and dynamically track patients’ location. By updating patient’s information real-time, the preprocessing time needed for various tasks and incomplete transfers among departments can be reduced, the medical resources can be effectively used, unnecessary medical disputes can be reduced, and more comprehensive health care environment can be provided. The feasibility and effectiveness of our proposed system are demonstrated with a number of experimental results.

  13. Concordance among remission and admission diagnoses at intensive care unit, Hospital Universitario San José, Popayán, 2011

    Directory of Open Access Journals (Sweden)

    Victor Daniel Montenegro

    2012-03-01

    Full Text Available There are few published studies about diagnostic concordance in hospital services. The objective of this study was to calculate the concordance among remission and admission diagnoses from Hospital Universitario San José adult intensive care unit (I.C.U. of Popayán, 2011. Methods: Descriptive and retrospective study about concordance between the main remission and admission diagnoses from patients admitted in the Hospital adult intensive care unit; 914 patients were studied from the intensive care unit database, months January to December 2011. Statistical analysis about sociodemographic variables was performed, and Kappa index according to Landis and Koch scale among remission and admission diagnoses defined as priority was calculated. Results: It was found al almost perfect level of concordance in the diagnoses pancreatitis and intoxication, a substantial level of concordance in the diagnoses acute coronary syndrome, convulsive status, gastric cancer and eclampsia, a moderate level of concordance in the diagnoses stroke, head trauma, politraumatism and cardiac failure, and a fair level of concordance in the diagnoses sepsis, pneumonia, chronic obstructive pulmonary disease (COPD, gastrointestinal bleeding, acute respiratory infection and acute respiratory distress syndrome. Conclusion: Six of the seventeen studied diagnoses presented an outstanding concordance level; this can be related to factors such as: physicians’, diagnostic ability, provenance of the patients remitted to the I.C.U. and diagnostic coding made by health staff.

  14. Can Confirmation Measures Reflect Statistically Sound Dependencies in Data? The Concordance-based Assessment

    Directory of Open Access Journals (Sweden)

    Susmaga Robert

    2018-03-01

    Full Text Available The paper considers particular interestingness measures, called confirmation measures (also known as Bayesian confirmation measures, used for the evaluation of “if evidence, then hypothesis” rules. The agreement of such measures with a statistically sound (significant dependency between the evidence and the hypothesis in data is thoroughly investigated. The popular confirmation measures were not defined to possess such form of agreement. However, in error-prone environments, potential lack of agreement may lead to undesired effects, e.g. when a measure indicates either strong confirmation or strong disconfirmation, while in fact there is only weak dependency between the evidence and the hypothesis. In order to detect and prevent such situations, the paper employs a coefficient allowing to assess the level of dependency between the evidence and the hypothesis in data, and introduces a method of quantifying the level of agreement (referred to as a concordance between this coefficient and the measure being analysed. The concordance is characterized and visualised using specialized histograms, scatter-plots, etc. Moreover, risk-related interpretations of the concordance are introduced. Using a set of 12 confirmation measures, the paper presents experiments designed to establish the actual concordance as well as other useful characteristics of the measures.

  15. Concordance of mother-daughter diurnal cortisol production: Understanding the intergenerational transmission of risk for depression.

    Science.gov (United States)

    LeMoult, Joelle; Chen, Michael C; Foland-Ross, Lara C; Burley, Hannah W; Gotlib, Ian H

    2015-05-01

    A growing body of research is demonstrating concordance between mother and child diurnal cortisol production. In the context of maternal history of depression, intergenerational concordance of cortisol production could contribute to hypercortisolemia in children of depressed mothers, which has been shown to increase risk for MDD. The current study is the first to examine concordance in diurnal cortisol production between mothers with a history of depression and their never-depressed, but high-risk, children. We collected salivary cortisol across 2 days from mothers with (remitted; RMD) and without (CTL) a history of recurrent episodes of depression and their never-depressed daughters. As expected, RMD mothers and their daughters both exhibited higher cortisol production than did their CTL counterparts. Moreover, both across and within groups, mothers' and daughters' cortisol production were directly coupled. These findings suggest that there is an intergenerational concordance in cortisol dysregulation that may contribute to hypercortisolemia in girls at familial risk for depression. Copyright © 2015 Elsevier B.V. All rights reserved.

  16. Price squeezes in electric power: The new Battle of Concord

    International Nuclear Information System (INIS)

    Kwoka, J.E. Jr.

    1992-01-01

    The US Court of Appeals opinion in Town of Concord v. Boston Edison offers a vigorous statement of the position that in a regulated market, what may appear to be a price squeeze almost certainly cannot harm the competitive process and therefore should not be held to violate the antitrust laws. While not disputing the possibility of self-serving claims of price squeezes, this article shows that truly anticompetitive price squeezes may indeed occur in the electric power industry and cannot be so readily dismissed. This analysis begins with a brief factual and economic background on price squeezes, then addresses arguments made in Concord and elsewhere seeking to disprove their possibility, and demonstrate that sound economics and good policy require a more balanced approach

  17. [Beginners' operations and medical specialist standards : Avoidance of criminal liability and civil liability].

    Science.gov (United States)

    Schneider, H

    2018-05-16

    In all phases, patients are entitled to receive medical treatment according to medical specialist standards. This does not mean that patients necessarily have to be treated by a medical specialist. Operations performed by "beginners", e. g. assistant physicians, are permitted. However, there are increased liability risks, both for the specialist and the assistant physician. Furthermore, there are risks of criminal responsibility for causing bodily harm by negligence or negligent manslaughter. This article portrays the requirements of civil liability and criminal responsibility concerning beginners' operations on the basis of cases and judgments of the Federal Court and the Higher Regional Courts in Germany. Additionally, the reception of the jurisprudence by the relevant legal literature will be discussed. Jurisprudence and legal literature categorize breaches of duty of care. Assistant physicians can be subject to contributory negligence liabilities, while specialists can bear liabilities for negligent selection, organization or supervision. Responsible specialist and assistant physicians can protect themselves (and the patient) and avoid legal risks by only performing operations adequate to their educational level or by delegating operations to beginners and ensuring intervention by a specialist by supervision of the operation which is suitable to the assistant physician's level of education.

  18. Particulate Matter Resuspension in Mississippi Bight Evaluated with CONCORDE's Synthesis Model

    Science.gov (United States)

    O'Brien, S. J.; Quas, L. M.; Miles, T. N.; Pan, C.; Cambazoglu, M. K.; Soto Ramos, I. M.; Greer, A. T.; Church, I.; Wiggert, J. D.

    2017-12-01

    The CONsortium for oil spill exposure pathways in COastal River-Dominated Ecosystems (CONCORDE) was established to investigate the complex fine-scale biological, chemical and physical interactions in a marine system controlled by pulsed-river plume dynamics. During CONCORDE's spring 2016 field campaign, the In Situ Ichthyoplankton Imaging System (ISIIS) on the R/V Point Sur and the Scanfish on the R/V Pelican comprehensively characterized the physical and biological structure in the region. Increased suspended particulate matter was observed by the ISIIS, with concentrations at depth sufficient to completely occlude the in situ images of planktonic organisms. Data was also collected on the continental shelf during the spring cruise by the RU31 glider in the proximity of the Mississippi River Delta, east of the ISIIS / Scanfish transects. Backscatter and salinity observed by the Scanfish and glider showed elevated suspended particulate matter and increased salinity, suggesting a linkage to shoreward advection from the continental shelf of oceanic waters that are sufficiently energetic to drive sediment resuspension. As part of the CONCORDE research effort, a four-dimensional biogeochemical/lower trophic level synthesis model for Mississippi Sound and Bight has been developed, based on the Coupled Ocean-Atmosphere-Wave-Sediment Transport (COAWST) Modeling System. This study utilizes CONCORDE's synthesis model to investigate the physical forcing mechanisms affecting the increased suspended particulate matter concentration observed in the Mississippi Bight during spring 2016, and advection pathways between estuarine and shelf waters in the northern Gulf of Mexico. The results show that episodic, advection-driven resuspension is a critical aspect controlling suspended sediment distributions in Mississippi Bight, which has implications for observed spatio-temporal patterns of planktonic species.

  19. Is There Concordance in Attitudes and Beliefs between Parents and Scientists about Autism Spectrum Disorder?

    Science.gov (United States)

    Fischbach, Ruth L.; Harris, Mark J.; Ballan, Michelle S.; Fischbach, Gerald D.; Link, Bruce G.

    2016-01-01

    There is no reported investigation comparing concordance in attitudes and beliefs about autism spectrum disorder between parents of children with autism spectrum disorder and scientists who research autism spectrum disorder. To investigate the level of concordance between these groups on causes of autism, priorities of research, perceived stigma,…

  20. Common Ground? The Concordance of Sarcopenia and Frailty Definitions

    NARCIS (Netherlands)

    Reijnierse, Esmee M.; Trappenburg, Marijke C.; Blauw, Gerard Jan; Verlaan, Sjors; de van der Schueren, Marian A.E.; Meskers, Carel G.M.; Maier, Andrea B.

    2016-01-01

    Objectives: This study aimed to explore the concordance between definitions of sarcopenia and frailty in a clinically relevant population of geriatric outpatients. Design: Data were retrieved from a cross-sectional study. Setting: The study was performed in a geriatric outpatient clinic of a

  1. Evaluating imaging-pathology concordance and discordance after ultrasound-guided breast biopsy

    Science.gov (United States)

    2018-01-01

    Ultrasound (US)-guided breast biopsy has become the main method for diagnosing breast pathology, and it has a high diagnostic accuracy, approaching that of open surgical biopsy. However, methods for confirming adequate lesion retrieval after US-guided biopsy are relatively limited and false-negative results are unavoidable. Determining imaging-pathology concordance after US-guided biopsy is essential for validating the biopsy result and providing appropriate management. In this review article, we briefly present the results of US-guided breast biopsy; describe general aspects to consider when establishing imaging-pathology concordance; and review the various categories of imaging-pathology correlations and corresponding management strategies. PMID:29169231

  2. Medical Operational Challenges in the Expedition 16 Landing and Recovery

    Science.gov (United States)

    Moynihan, S.; Johnston, S. L.; Ilcus, L. S.; Shevchenko, V.

    2009-01-01

    On April 19, 2008 the crew of Expedition 16 left the International Space Station and returned to earth via their Soyuz TMA-11 capsule after 192 days on orbit. Their capsule experienced the second consecutive and third ballistic reentry in the last 10 TMA recoveries and landed approximately 260 miles (420 km) from the prime landing site. Issues: The purpose of this presentation will be to describe, not only the typical medical operational challenges faced by Flight Surgeons recovering a long duration crew from space, but also address the unique challenges that existed with the Expedition 16 landing and crew recovery. Nominal Soyuz recovery challenges include remote recovery sites with crew exposures to sleep shifting and fatigue, dehydration, hypothermia and hyperthermia, and rotational, sustained, and impact g-forces. These environmental factors coupled with the patho-physiologic neuro-vestibular and orthostatic intolerance changes that occur secondary to the crews reintroduction into the earth s gravity field will be detailed. Additional challenges that were unique to this expedition included a ballistic reentry with higher g-loads, the presence of fire outside of the capsule on landing, a contingency medical event of a ground support personnel, and loss of communications with the crew just prior to landing and during recovery operations. Conclusions: In spite of these unique challenges the Russian Search and Rescue Forces and Medical Support personnel along with U.S. Medical Support performed well together. Possible improvements in training and coordination will be discussed.

  3. Closed-loop approach for situation awareness of medical devices and operating room infrastructure

    Directory of Open Access Journals (Sweden)

    Rockstroh Max

    2015-09-01

    Full Text Available In recent years, approaches for information and control integration in the digital operating room have emerged. A major step towards an intelligent operating room and a cooperative technical environment would be autonomous adaptation of medical devices and systems to the surgical workflow. The OR staff should be freed from information seeking and maintenance tasks. We propose a closed-loop concept integrating workflow monitoring, processing and (semi-automatic interaction to bridge the gap between OR integration of medical devices and workflow-related information management.

  4. A Comparison of Total Antioxidant Capacities of Concord, Purple, Red, and Green Grapes Using the CUPRAC Assay

    Directory of Open Access Journals (Sweden)

    Connor M. Callaghan

    2013-10-01

    Full Text Available Considering how popular grapes are in terms of their antioxidant benefits, we compared concord, purple, red, and green grapes for total antioxidant capacity (TAC and carbohydrate concentration. All grapes were acquired from commercial sources and samples of each were separated into skinned and not skinned groups. Each whole grape and the skins were individually homogenized and then separated into pulp and supernatant fractions. Each fraction was analyzed for total TAC and carbohydrates. The concord grapes and purple grapes had significantly higher TAC in the homogenates than did the red or green grapes. The concord grapes and green grapes had significantly higher TAC in the pulp than in the cytosol whereas the red and purple grapes had approximately the same amount. The majority of the TAC of the purple and red grapes was in the skin whereas the concord and green grapes had approximately the same TAC in the skin and pulp. The concord and purple grapes had the highest TAC when compared to the red and green grapes, whereas the red and green grapes had approximately the same total TAC.

  5. [Design and Implementation of a Mobile Operating Room Information Management System Based on Electronic Medical Record].

    Science.gov (United States)

    Liu, Baozhen; Liu, Zhiguo; Wang, Xianwen

    2015-06-01

    A mobile operating room information management system with electronic medical record (EMR) is designed to improve work efficiency and to enhance the patient information sharing. In the operating room, this system acquires the information from various medical devices through the Client/Server (C/S) pattern, and automatically generates XML-based EMR. Outside the operating room, this system provides information access service by using the Browser/Server (B/S) pattern. Software test shows that this system can correctly collect medical information from equipment and clearly display the real-time waveform. By achieving surgery records with higher quality and sharing the information among mobile medical units, this system can effectively reduce doctors' workload and promote the information construction of the field hospital.

  6. Variables influencing medical student learning in the operating room.

    Science.gov (United States)

    Schwind, Cathy J; Boehler, Margaret L; Rogers, David A; Williams, Reed G; Dunnington, Gary; Folse, Roland; Markwell, Stephen J

    2004-02-01

    The operating room (OR) is an important venue where surgeons do much of medical student teaching and yet there has been little work evaluating variables that influence learning in this unique environment. We designed this study to identify variables that affected medical student learning in the OR. We developed a questionnaire based on surgery faculty observations of learning in the OR. The medical students completed the questionnaire on 114 learning episodes in the OR. Pearson correlation coefficient was used to establish the strength of association between various variables and the student's overall perception of learning. The students evaluated 27 variables that might impact their learning in the OR. Strong correlations were identified between the attending physician's attitude, interactions and teaching ability in the OR and the environment being conducive to learning. Surgical faculty behavior is a powerful determinant of student perceptions of what provides for a favorable learning environment in the OR.

  7. [Reliability of Primary Care computerised medication records].

    Science.gov (United States)

    García-Molina Sáez, Celia; Urbieta Sanz, Elena; Madrigal de Torres, Manuel; Piñera Salmerón, Pascual; Pérez Cárceles, María D

    2016-03-01

    To quantify and to evaluate the reliability of Primary Care (PC) computerised medication records of as an information source of patient chronic medications, and to identify associated factors with the presence of discrepancies. A descriptive cross-sectional study. General Referral Hospital in Murcia. Patients admitted to the cardiology-chest diseases unit, during the months of February to April 2013, on home treatment, who agreed to participate in the study. Evaluation of the reliability of Primary Care computerised medication records by analysing the concordance, by identifying discrepancies, between the active medication in these records and that recorded in pharmacist interview with the patient/caregiver. Identification of associated factors with the presence of discrepancies was analysed using a multivariate logistic regression. The study included a total of 308 patients with a mean of 70.9 years (13.0 SD). The concordance of active ingredients was 83.7%, and this decreased to 34.7% when taking the dosage into account. Discrepancies were found in 97.1% of patients. The most frequent discrepancy was omission of frequency (35.6%), commission (drug added unjustifiably) (14.6%), and drug omission (12.7%). Age older than 65 years (1.98 [1.08 to 3.64]), multiple chronic diseases (1.89 [1.04 to 3.42]), and have a narcotic or psychotropic drug prescribed (2.22 [1.16 to 4.24]), were the factors associated with the presence of discrepancies. Primary Care computerised medication records, although of undoubted interest, are not be reliable enough to be used as the sole source of information on patient chronic medications when admitted to hospital. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  8. Concordance between macrophytes and macroinvertebrates in a Mediterranean river of central Apennine region.

    Science.gov (United States)

    Traversetti, Lorenzo; Scalici, Massimiliano; Ginepri, Valeria; Manfrin, Alessandro; Ceschin, Simona

    2014-05-01

    The main aim of this study was to improve the knowledge about the concordance among macrophytes and macroinvertebrates to provide complementary information and facilitate the procedures for quality assessment of river ecosystems. Macrophytes and macroinvertebrates were collected in 11 sampling sites along a central Apennine calcareous river in October 2008 and June 2009. The concordance between the two biomonitoring groups was tested according to several environmental parameters. The comparison of data matrix similarities by Mantel test showed differences in the assemblage of macrophytes and macroinvertebrates along the river since correlation values were 0.04, p > 0.05 in October 2008 and 0.39, p > 0.05 in June 2009. The study revealed lack of concordance between the two groups, emphasizing that the information provided by macrophytes and macroinvertebrates does not overlap in terms of response to environmental parameters. Indeed, the two different biological groups resulted useful descriptors of different parameters. Together, they could represent a complementary tool to reflect the river environmental quality.

  9. Correlates of non-concordance between perceived and objective measures of walkability.

    Science.gov (United States)

    Gebel, Klaus; Bauman, Adrian; Owen, Neville

    2009-04-01

    Objective and self-reported physical environmental attributes have been related to physical activity. We examined the characteristics of adults who are resident in objectively identified high walkable neighborhoods but whose perceptions of neighborhood attributes are not concordant with objective attributes relating to high walkability. Neighborhood built-environment attributes relating to walkability (dwelling density, intersection density, land use mix, and net retail area) were determined objectively, using Geographic Information System databases; data on corresponding perceptions of local environment attributes (from the Neighborhood Environment Walkability Scale) were derived from a self-completion survey of a socially diverse sample of 2,650 adults aged 19 to 65. Objective and perceived walkability attributes were categorized using median splits, and correlates of non-concordance were determined using multiple logistic regression models. There was a fair overall agreement between objectively determined walkability and perceived walkability (Kappa = 0.35, 95% CI = 0.31-0.39). Among those resident in objectively assessed high walkable areas (n = 1,063), 32.1% perceived them to be low walkable; conversely, 32.7% (n = 1,021) resident in objectively determined low walkability areas perceived them to be high. For residents of objectively determined high walkable areas, the characteristics that differentiated those with perceptions of low walkability (non-concordant perceptions) from those with concordant perceptions of high walkability were: not being university-educated (OR = 1.47, 95% CI = 1.06-2.04); having lower household incomes (OR = 1.54, 95% CI = 1.09-2.17); being overweight (OR = 1.46, 95% CI = 1.03-2.07); and walking fewer days per week for transport (OR = 1.75, 95% CI = 1.11-2.70). Higher walking times and more positive cognitive variables were noted among participants who lived in a neighborhood with low walkability that was perceived as high compared

  10. A JURIDICAL-ADMINISTRATIVE COMPARISON BETWEEN THE MILITARY AND THE MEDICAL OPERATION

    Directory of Open Access Journals (Sweden)

    Georgel RUSU

    2016-03-01

    Full Text Available To bring together the word operation and opera and/or accomplishing an opera is not at all improper. Defining a (military operation as ”the total amount of the military actions performed by large operative and strategic units, according to an unique plan, for attaining an operative or strategic objective....”[1], coldly and exhaustively developed along almost two pages, may provide sufficient arguments for correctly anchoring the action within the domain of military practice, in spite of the shortcoming of not having a more synthetic form, with valid landmarks for other disciplines, as well. Frequently, both the medical and the military operations exceed their routine, deserving artistic appreciations. It is not accidental that analysis and preparation of any military combat includes the field of military art, defined as ”a compounding part of the military science, a specialized domain of organization and management of armed conflicts. It includes both the principles, methods, procedures and rules for the preparation and development of military actions, and the personal endowments (talent, mastership, skill expected from the part of leaders and troops for attaining success in the battle...”[2] More than that, the operative art is defined as ”a component of military art ... created and developed as an intermediary domain between strategy and tactics...”[3]. Continuing to lay stress on the parallelism to which the study is devoted, the author considers that actions that may be related to or may be appreciated as possessing artistic characteristics occur even beyond the field of aesthetic or reparatory surgery. The definitions provided by medical dictionaries do not eliminate, yet encourage similarities. The operation is ”s.f./operation, (Lat. operatio, -onis = work, operation, derived from operari = to work, and opus, operis = labour, work, a medical act performed by the surgeon with his hands, by means of adequate instruments, for

  11. Assessing the Readability of Medical Documents: A Ranking Approach.

    Science.gov (United States)

    Zheng, Jiaping; Yu, Hong

    2018-03-23

    The use of electronic health record (EHR) systems with patient engagement capabilities, including viewing, downloading, and transmitting health information, has recently grown tremendously. However, using these resources to engage patients in managing their own health remains challenging due to the complex and technical nature of the EHR narratives. Our objective was to develop a machine learning-based system to assess readability levels of complex documents such as EHR notes. We collected difficulty ratings of EHR notes and Wikipedia articles using crowdsourcing from 90 readers. We built a supervised model to assess readability based on relative orders of text difficulty using both surface text features and word embeddings. We evaluated system performance using the Kendall coefficient of concordance against human ratings. Our system achieved significantly higher concordance (.734) with human annotators than did a baseline using the Flesch-Kincaid Grade Level, a widely adopted readability formula (.531). The improvement was also consistent across different disease topics. This method's concordance with an individual human user's ratings was also higher than the concordance between different human annotators (.658). We explored methods to automatically assess the readability levels of clinical narratives. Our ranking-based system using simple textual features and easy-to-learn word embeddings outperformed a widely used readability formula. Our ranking-based method can predict relative difficulties of medical documents. It is not constrained to a predefined set of readability levels, a common design in many machine learning-based systems. Furthermore, the feature set does not rely on complex processing of the documents. One potential application of our readability ranking is personalization, allowing patients to better accommodate their own background knowledge. ©Jiaping Zheng, Hong Yu. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 23.03.2018.

  12. Which factors influence MRI-pathology concordance of tumour size measurements in breast cancer?

    Energy Technology Data Exchange (ETDEWEB)

    Rominger, M.; Frauenfelder, T. [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); Berg, D. [Urbankrankenhaus Berlin, Anesthesiology, Berlin (Germany); Ramaswamy, A. [University Hospital Marburg, Pathology, Marburg (Germany); Timmesfeld, N. [Philipps University Marburg, Institute for Medical Biometry and Epidemiology, Marburg (Germany)

    2016-05-15

    To assess MRI-pathology concordance and factors influencing tumour size measurement in breast cancer. MRI tumour size (greatest diameter in anatomical planes (MRI-In-Plane) and greatest diameter along main tumour axis (MRI-MPR)) of 115 consecutive breast lesions (59 invasive lobular carcinoma, 46 invasive ductal carcinoma, and 10 ductal carcinoma in situ) was retrospectively compared to size measured at histopathology (pT size (Path-TNM) and greatest tumour diameter as relevant for excision (Path-Diameter; reference standard)). Histopathological tumour types, preoperative palpability, surgical management, additional high-risk lesions, and BI-RADS lesion type (mass versus non-mass enhancements) were assessed as possible influencing factors. Systematic errors were most pronounced between MRI-MPR and Path-TNM (7.1 mm, limits of agreement (LoA) [-21.7; 35.9]), and were lowest between MRI-In-Plane and Path-Diameter (0.2 mm, LoA [-19.7; 20.1]). Concordance rate of MRI-In-Plane with Path-Diameter was 86 % (97/113), overestimation 9 % (10/113) and underestimation 5 % (6/113); BI-RADS mass lesions were overestimated in 7 % (6/81) versus 41 % (13/32) for non-mass enhancements. On multivariate analysis only BI-RADS lesion type significantly influenced MRI-pathology concordance (p < 0.001). 2/59 (3 %) ILC did not enhance. Concordance rate varies according to the execution of MRI and histopathological measurements. Beyond this only non-mass enhancement significantly predicted discordance. (orig.)

  13. IFOP's survey for the Concorde foundation. Business leaders worry about the energy policy

    International Nuclear Information System (INIS)

    2012-03-01

    In partnership with the French public opinion institute (IFOP), the Concorde foundation has conducted a survey among 600 business leaders. Electricity appears as a fundamental element for companies and industry competitiveness and for French people's buying power. In the coming years, France must hedge against an excessive rise in the electricity price. Therefore, the next energy mix choice will be essential as a too costly kWh would greatly reduce our chances to revitalise our economy. As a conclusion, the Concorde foundation stresses on the importance of not losing one of our few competitive advantages

  14. Avaliação da concordância da sialometria e cintilografia de glândulas salivares em pacientes com boca seca Evaluation of the concordance of sialometry and salivary glands scintigraphy in dry mouth patients

    Directory of Open Access Journals (Sweden)

    Bianca Maria Liquidato

    2006-02-01

    Full Text Available INTRODUÇÃO: São utilizados vários exames para avaliar os pacientes com queixa de boca seca e, especialmente, os pacientes com Síndrome de Sjögren, em que estes exames fazem parte de critérios de classificação para estudos científicos. OBJETIVO: Desta maneira, procurou-se avaliar se haveria concordância entre os resultados da sialometria e da cintilografia de glândulas salivares para, se esta concordância estiver presente, optar por apenas um dos dois exames. CASUÍSTICA E MÉTODO: Foram avaliados 72 pacientes com boca seca, divididos em grupos não-Síndrome de Sjögren, com Síndrome de Sjögren primária e com Síndrome de Sjögren secundária. Os resultados de sialometria e cintilografia de glândulas salivares foram estudados, procurando-se dimensionar a concordância existente entre eles, através do teste de Kappa. RESULTADOS: Observou-se concordância igual ou próxima de zero entre os dois testes. CONCLUSÃO: Pelos resultados observados, não é possível fazer a opção por um ou outro exame, devendo ambos serem realizados.INTRODUCTION: Many diagnostic tests are used to evaluate dry mouth patients, especially the ones with Sjögren’s Syndrome, to whom these tests are part of classification criteria for scientific studies. AIM: Thus, the concordance between results of sialometry and salivary glands scintigraphy was evaluated; if positive, it would enable the choice of one or the other for diagnosis. PATIENTS AND METHOD: Seventy-two dry mouth patients were divided into non-Sjögren’s Syndrome group, primary Sjögren’s Syndrome group and secondary Sjögren’s Syndrome group. The concordance among sialometry and scintigraphy results was evaluated by Kappa test. RESULTS: It was observed that their concordance was equal or near to zero. CONCLUSION: It is not possible to make a choice between these tests and both should be performed.

  15. 47 CFR 95.1119 - Specific requirements for wireless medical telemetry devices operating in the 608-614 MHz band.

    Science.gov (United States)

    2010-10-01

    ... devices operating in the 608-614 MHz band. For a wireless medical telemetry device operating within the... 47 Telecommunication 5 2010-10-01 2010-10-01 false Specific requirements for wireless medical telemetry devices operating in the 608-614 MHz band. 95.1119 Section 95.1119 Telecommunication FEDERAL...

  16. Modifying Post-Operative Medical Care after EBV Implant May Reduce Pneumothorax Incidence.

    Directory of Open Access Journals (Sweden)

    Dominik Herzog

    Full Text Available Endoscopic lung volume reduction (ELVR with valves has been shown to improve COPD patients with severe emphysema. However, a major complication is pneumothoraces, occurring typically soon after valve implantation, with severe consequences if not managed promptly. Based on the knowledge that strain activity is related to a higher risk of pneumothoraces, we asked whether modifying post-operative medical care with the inclusion of strict short-term limitation of strain activity is associated with a lower incidence of pneumothorax.Seventy-two (72 emphysematous patients without collateral ventilation were treated with bronchial valves and included in the study. Thirty-two (32 patients received standard post-implantation medical management (Standard Medical Care (SMC, and 40 patients received a modified medical care that included an additional bed rest for 48 hours and cough suppression, as needed (Modified Medical Care (MMC.The baseline characteristics were similar for the two groups, except there were more males in the SMC cohort. Overall, ten pneumothoraces occurred up to four days after ELVR, eight pneumothoraces in the SMC, and only two in the MMC cohorts (p=0.02. Complicated pneumothoraces and pneumothoraces after upper lobe treatment were significantly lower in MMC (p=0.02. Major clinical outcomes showed no significant differences between the two cohorts.In conclusion, modifying post-operative medical care to include bed rest for 48 hours after ELVR and cough suppression, if needed, might reduce the incidence of pneumothoraces. Prospective randomized studies with larger numbers of well-matched patients are needed to confirm the data.

  17. Spousal concordance and reliability of the 'Prudence Score' as a summary of diet and lifestyle.

    Science.gov (United States)

    Parekh, Sanjoti; King, David; Owen, Neville; Jamrozik, Konrad

    2009-08-01

    This paper describes a composite 'Prudence Score' summarising self-reported behavioural risk factors for non-communicable diseases. If proved robust, the 'Prudence score' might be used widely to encourage large numbers of individuals to adopt and maintain simple, healthy changes in their lifestyle. We calculated the 'Prudence Score' based on responses collected in late 2006 to a postal questionnaire sent to 225 adult patients aged 25 to 75 years identified from the records of two general medical practices in Brisbane, Australia. Participants completed the behavioural, dietary and lifestyle items in relation to their spouse as well as themselves. The spouse or partner of each addressee completed their own copy of the study questionnaire. Kappa scores for spousal concordance with probands' reports (n = 45 pairs) on diet-related items varied between 0.35 (for vegetable intake) to 0.77 (for usual type of milk consumed). Spousal concordance values for other behaviours were 0.67 (physical activity), 0.82 (alcohol intake) and 1.0 (smoking habits). Kappa scores for test-retest reliability (n = 53) varied between 0.47 (vegetable intake) and 0.98 (smoking habits). The veracity of self-reported data is a challenge for studies of behavioural change. Our results indicate moderate to substantial agreement from life partners regarding individuals' self-reports for most of the behavioural risk items included in the 'Prudence Score'. This increases confidence that key aspects of diet and lifestyle can be assessed by self-report. The 'Prudence Score' potentially has wide application as a simple and robust tool for health promotion programs.

  18. The Concordance of Multilingual Legal Texts at the WTO

    Science.gov (United States)

    Condon, Bradly J.

    2012-01-01

    Multilingualism is a sensitive and complex subject in a global organisation such as the World Trade Organization (WTO). In the WTO legal texts, there is a need for full concordance, not simply translation. This article begins with an overview of the issues raised by multilingual processes at the WTO in the negotiation, drafting, translation,…

  19. Skylab IMSS checklist application study for emergency medical care. [emergency medical care operations involving the use and operation of the portable ambulance module

    Science.gov (United States)

    Carl, J. G.; Furukawa, S.

    1975-01-01

    A manual is presented that provides basic technical documentation to support the operation and utilization of the Portable Ambulance Module (PAM) in the field. The PAM is designed to be used for emergency resuscitation and victim monitoring. The functions of all the controls, displays, and stowed equipment of the unit are defined. Supportive medical and physiological data in those areas directly related to the uses of the PAM unit are presented.

  20. Cluster infall in the concordance LCDM model

    OpenAIRE

    Pivato, Maximiliano C.; Padilla, Nelson D.; Lambas, Diego G.

    2005-01-01

    We perform statistical analyses of the infall of dark-matter onto clusters in numerical simulations within the concordance LCDM model. By studying the infall profile around clusters of different mass, we find a linear relation between the maximum infall velocity and mass which reach 900km/s for the most massive groups. The maximum infall velocity and the group mass follow a suitable power law fit of the form, V_{inf}^{max} = (M/m_0)^{gamma}. By comparing the measured infall velocity to the li...

  1. Operational health and physics service during the maintenance of the Australian National Medical Cyclotron

    International Nuclear Information System (INIS)

    Mukherjee, B.

    1994-01-01

    Modern Medical Cyclotrons use intense beams of high energy protons or deuterons to produce large activities of short and medium lived radionuclides. After continuous operation for prolonged periods the Cyclotron components become activated through various nuclear interactions therefore, the risk of personal radiation hazard while handling such activated cyclotron components is high. This paper describes all operational aspects of the Health Physics service evolved during the first preventative maintenance program of the Australian National Medical Cyclotron, which took place in June 1993. 5 refs., 3 tabs., 2 figs

  2. Can magnetic resonance imaging accurately predict concordant pain provocation during provocative disc injection?

    International Nuclear Information System (INIS)

    Kang, Chang Ho; Kim, Yun Hwan; Kim, Jung Hyuk; Chung, Kyoo Byung; Sung, Deuk Jae; Lee, Sang-Heon; Derby, Richard

    2009-01-01

    To correlate magnetic resonance (MR) image findings with pain response by provocation discography in patients with discogenic low back pain, with an emphasis on the combination analysis of a high intensity zone (HIZ) and disc contour abnormalities. Sixty-two patients (aged 17-68 years) with axial low back pain that was likely to be disc related underwent lumbar discography (178 discs tested). The MR images were evaluated for disc degeneration, disc contour abnormalities, HIZ, and endplate abnormalities. Based on the combination of an HIZ and disc contour abnormalities, four classes were determined: (1) normal or bulging disc without HIZ; (2) normal or bulging disc with HIZ; (3) disc protrusion without HIZ; (4) disc protrusion with HIZ. These MR image findings and a new combined MR classification were analyzed in the base of concordant pain determined by discography. Disc protrusion with HIZ [sensitivity 45.5%; specificity 97.8%; positive predictive value (PPV), 87.0%] correlated significantly with concordant pain provocation (P < 0.01). A normal or bulging disc with HIZ was not associated with reproduction of pain. Disc degeneration (sensitivity 95.4%; specificity 38.8%; PPV 33.9%), disc protrusion (sensitivity 68.2%; specificity 80.6%; PPV 53.6%), and HIZ (sensitivity 56.8%; specificity 83.6%; PPV 53.2%) were not helpful in the identification of a disc with concordant pain. The proposed MR classification is useful to predict a disc with concordant pain. Disc protrusion with HIZ on MR imaging predicted positive discography in patients with discogenic low back pain. (orig.)

  3. [Correlation and concordance between the national test of medicine (ENAM) and the grade point average (GPA): analysis of the peruvian experience in the period 2007 - 2009].

    Science.gov (United States)

    Huamaní, Charles; Gutiérrez, César; Mezones-Holguín, Edward

    2011-03-01

    To evaluate the correlation and concordance between the 'Peruvian National Exam of Medicine' (ENAM) and the Mean Grade Point Average (GPA) in recently graduated medical students in the period 2007 to 2009. We carried out a secondary data analysis, using the records of the physicians applying to the Rural and Urban Marginal Service in Health of Peru (SERUMS) processes for the years 2008 to 2010. We extracted from these registers, the grades obtained in the ENAM and GPA. We performed a descriptive analysis using medians and 1st and 3rd quartiles (q1/q3); we calculated the correlation between both scores using the Spearman correlation coefficient, additionally, we conducted a lineal regression analysis, and the concordance was measured using the Bland and Altman coefficient. A total of 6 117 physicians were included, the overall median for the GPA was 13.4 (12.7/14.2) and for the ENAM was 11.6 (10.2/13.0).Of the total assessed, 36.8% failed the TEST. We observed an increase in annual median of ENAM scores, with the consequent decrease in the difference between both grades. The correlation between ENAM and PPU is direct and moderate (0.582), independent from the year, type of university management (Public or Private) and location. However, the concordance between both ratings is regular, with a global coefficient of 0.272 (CI 95%: 0.260 to 0.284). Independently of the year, location or type of university management, there is a moderate correlation between the ENAM and the PPU; however, there is only a regular concordance between both grades.

  4. Ancient-modern concordance in Ayurvedic plants: some examples.

    Science.gov (United States)

    Dev, S

    1999-10-01

    Ayurveda is the ancient (before 2500 b.c.) Indian system of health care and longevity. It involves a holistic view of man, his health, and illness. Ayurvedic treatment of a disease consists of salubrious use of drugs, diets, and certain practices. Medicinal preparations are invariably complex mixtures, based mostly on plant products. Around 1,250 plants are currently used in various Ayurvedic preparations. Many Indian medicinal plants have come under scientific scrutiny since the middle of the nineteenth century, although in a sporadic fashion. The first significant contribution from Ayurvedic materia medica came with the isolation of the hypertensive alkaloid from the sarpagandha plant (Rouwolfia serpentina), valued in Ayurveda for the treatment of hypertension, insomnia, and insanity. This was the first important ancient-modern concordance in Ayurvedic plants. With the gradual coming of age of chemistry and biology, disciplines central to the study of biologic activities of natural products, many Ayurvedic plants have been reinvestigated. Our work on Commiphora wightti gum-resin, valued in Ayurveda for correcting lipid disorders, has been described in some detail; based on these investigations, a modern antihyperlipoproteinemic drug is on the market in India and some other countries. There has also been concordance for a few other Ayurvedic crude drugs such as Asparagus racemosus, Cedrus deodara, and Psoralea corylifolia.

  5. Medical student electives in wilderness medicine: curriculum guidelines.

    Science.gov (United States)

    Lareau, Stephanie A; Caudell, Michael J; Pandit, Kiran B; Hiestand, Brian C

    2014-12-01

    Wilderness medicine has been a part of medical student education for many years and is becoming more popular. To help standardize and improve the student experience, we surveyed current elective directors to gain an understanding of what experts in the field thought were priority elements in a wilderness medicine elective. Although there is a diversity of opinion among leaders in the field, there are multiple topics on which there is concordance on inclusion or exclusion. Copyright © 2014 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

  6. Emotion dysregulation and dyadic conflict in depressed and typical adolescents: Evaluating concordance across psychophysiological and observational measures

    Science.gov (United States)

    Crowell, Sheila E.; Baucom, Brian R.; Yaptangco, Mona; Bride, Daniel; Hsiao, Ray; McCauley, Elizabeth; Beauchaine, Theodore P.

    2014-01-01

    Many depressed adolescents experience difficulty regulating their emotions. These emotion regulation difficulties appear to emerge in part from socialization processes within families and then generalize to other contexts. However, emotion dysregulation is typically assessed within the individual, rather than in the social relationships that shape and maintain dysregulation. In this study, we evaluated concordance of physiological and observational measures of emotion dysregulation during interpersonal conflict, using a multilevel actor-partner interdependence model (APIM). Participants were 75 mother-daughter dyads, including 50 depressed adolescents with or without a history of self-injury, and 25 typically developing controls. Behavior dysregulation was operationalized as observed aversiveness during a conflict discussion, and physiological dysregulation was indexed by respiratory sinus arrhythmia (RSA). Results revealed different patterns of concordance for control versus depressed participants. Controls evidenced a concordant partner (between-person) effect, and showed increased physiological regulation during minutes when their partner was more aversive. In contrast, clinical dyad members displayed a concordant actor (within-person) effect, becoming simultaneously physiologically and behaviorally dysregulated. Results inform current understanding of emotion dysregulation across multiple levels of analysis. PMID:24607894

  7. Reactor operations Brookhaven medical research reactor, Brookhaven high flux beam reactor informal monthly report

    International Nuclear Information System (INIS)

    Hauptman, H.M.; Petro, J.N.; Jacobi, O.

    1995-04-01

    This document is the April 1995 summary report on reactor operations at the Brookhaven Medical Research Reactor and the Brookhaven High Flux Beam Reactor. Ongoing experiments/irradiations in each are listed, and other significant operations functions are also noted. The HFBR surveillance testing schedule is also listed

  8. Insomnia From Drug Treatments: Evidence From Meta-analyses of Randomized Trials and Concordance With Prescribing Information.

    Science.gov (United States)

    Doufas, Anthony G; Panagiotou, Orestis A; Panousis, Periklis; Wong, Shane Shucheng; Ioannidis, John P A

    2017-01-01

    To determine whether drugs used to treat diverse conditions cause insomnia symptoms and whether their prescription information is concordant with this evidence. We conducted a survey of meta-analyses (Cochrane Database of Systematic Reviews) and comparisons with package inserts compiled in the Physicians' Desk Reference (PDR). We identified randomized controlled trials (RCTs) in which any drug had been evaluated vs placebo and sleep had been assessed. We collectively referred to insomnia-related outcomes as sleep disturbance. We also searched the PDR to identify any insomnia symptoms listed for drugs with RCT evidence available. Seventy-four Cochrane systematic reviews corresponding to 274 RCTs assessed 88 drugs in 27 different conditions, providing evidence on 109 drug-condition pairs. Of these 88 drugs, 5 decreased sleep problems and 19 increased sleep problems; 64 drugs had no nominally statistically significant effect on sleep. Acetylcholinesterase inhibitors, dopamine agonists, and selective serotonin reuptake inhibitors were the drug classes most importantly associated with sleep disturbance. Of 35 drugs that included disturbed sleep as an adverse effect in the PDR, only 14 had RCT evidence supporting such effect, and 2 had evidence of increasing and decreasing sleep problems in RCTs, although this was not shown in the PDR. We identified weak concordance between the PDR and RCTs (weighted κ=0.31; P<.001). The RCTs offer substantial evidence about the common effects of drugs on the risk of sleep disturbance; currently, prescription information only partially agrees with the available randomized evidence. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  9. Concordance Between Veterans' Self-Report and Documentation of Surrogate Decision Makers: Implications for Quality Measurement.

    Science.gov (United States)

    Garner, Kimberly K; Dubbert, Patricia; Lensing, Shelly; Sullivan, Dennis H

    2017-01-01

    The Measuring What Matters initiative of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association identified documentation of a surrogate decision maker as one of the top 10 quality indicators in the acute hospital and hospice settings. To better understand the potential implementation of this Measuring What Matters quality measure #8, Documentation of Surrogate in outpatient primary care settings by describing primary care patients' self-reported identification and documentation of a surrogate decision maker. Examination of patient responses to self-assessment questions from advance health care planning educational groups conducted in one medical center primary care clinic and seven community-based outpatient primary care clinics. We assessed the concordance between patient reports of identifying and naming a surrogate decision maker and having completed an advance directive (AD) with presence of an AD in the electronic medical record. Of veterans without a documented AD on file, more than half (66%) reported that they had talked with someone they trusted and nearly half (52%) reported that they had named someone to communicate their preferences. Our clinical project data suggest that many more veterans may have initiated communications with surrogate decision makers than is evident in the electronic medical record. System changes are needed to close the gap between veterans' plans for a surrogate decision maker and the documentation available to acute care health care providers. Published by Elsevier Inc.

  10. Core self-evaluations and job and life satisfaction: the role of self-concordance and goal attainment.

    Science.gov (United States)

    Judge, Timothy A; Bono, Joyce E; Erez, Amir; Locke, Edwin A

    2005-03-01

    The present study tested a model explaining how the core self-evaluations (i.e., positive self-regard) concept is linked to job and life satisfaction. The self-concordance model, which focuses on motives underlying goal pursuit, was used as an explanatory framework. Data were collected from 2 samples: (a) 183 university students (longitudinal measures of goal attainment and life satisfaction were used) and (b) 251 employees (longitudinal measures of goal attainment and job satisfaction were utilized). In both studies, the core self-evaluations concept was positively related to goal self-concordance, meaning that individuals with positive self-regard were more likely to pursue goals for intrinsic and identified (value-congruent) reasons. Furthermore, in both studies, goal self-concordance was related to satisfaction (job satisfaction in Study 1 and life satisfaction in Study 2).

  11. Estimating HPV DNA Deposition Between Sexual Partners Using HPV Concordance, Y Chromosome DNA Detection, and Self-reported Sexual Behaviors.

    Science.gov (United States)

    Malagón, Talía; Burchell, Ann N; El-Zein, Mariam; Guénoun, Julie; Tellier, Pierre-Paul; Coutlée, François; Franco, Eduardo L

    2017-12-05

    Detection of human papillomavirus (HPV) DNA in genital samples may not always represent true infections but may be depositions from infected sexual partners. We examined whether sexual risk factors and a biomarker (Y chromosome DNA) were associated with genital HPV partner concordance and estimated the fraction of HPV detections potentially attributable to partner deposition. The HITCH study enrolled young women attending a university or college in Montréal, Canada, and their male partners, from 2005 to 2010. We tested baseline genital samples for Y chromosome DNA and HPV DNA using polymerase chain reaction. Type-specific HPV concordance was 42.4% in partnerships where at least one partner was HPV DNA positive. Y chromosome DNA predicted type-specific HPV concordance in univariate analyses, but in multivariable models the independent predictors of concordance were days since last vaginal sex (26.5% higher concordance 0-1 vs 8-14 days after last vaginal sex) and condom use (22.6% higher concordance in never vs always users). We estimated that 14.1% (95% confidence interval [CI], 6.3-21.9%) of HPV DNA detections in genital samples were attributable to vaginal sex in the past week. A substantial proportion of HPV DNA detections may be depositions due to recent unprotected vaginal sex. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

  12. Scalable whole-exome sequencing of cell-free DNA reveals high concordance with metastatic tumors.

    Science.gov (United States)

    Adalsteinsson, Viktor A; Ha, Gavin; Freeman, Samuel S; Choudhury, Atish D; Stover, Daniel G; Parsons, Heather A; Gydush, Gregory; Reed, Sarah C; Rotem, Denisse; Rhoades, Justin; Loginov, Denis; Livitz, Dimitri; Rosebrock, Daniel; Leshchiner, Ignaty; Kim, Jaegil; Stewart, Chip; Rosenberg, Mara; Francis, Joshua M; Zhang, Cheng-Zhong; Cohen, Ofir; Oh, Coyin; Ding, Huiming; Polak, Paz; Lloyd, Max; Mahmud, Sairah; Helvie, Karla; Merrill, Margaret S; Santiago, Rebecca A; O'Connor, Edward P; Jeong, Seong H; Leeson, Rachel; Barry, Rachel M; Kramkowski, Joseph F; Zhang, Zhenwei; Polacek, Laura; Lohr, Jens G; Schleicher, Molly; Lipscomb, Emily; Saltzman, Andrea; Oliver, Nelly M; Marini, Lori; Waks, Adrienne G; Harshman, Lauren C; Tolaney, Sara M; Van Allen, Eliezer M; Winer, Eric P; Lin, Nancy U; Nakabayashi, Mari; Taplin, Mary-Ellen; Johannessen, Cory M; Garraway, Levi A; Golub, Todd R; Boehm, Jesse S; Wagle, Nikhil; Getz, Gad; Love, J Christopher; Meyerson, Matthew

    2017-11-06

    Whole-exome sequencing of cell-free DNA (cfDNA) could enable comprehensive profiling of tumors from blood but the genome-wide concordance between cfDNA and tumor biopsies is uncertain. Here we report ichorCNA, software that quantifies tumor content in cfDNA from 0.1× coverage whole-genome sequencing data without prior knowledge of tumor mutations. We apply ichorCNA to 1439 blood samples from 520 patients with metastatic prostate or breast cancers. In the earliest tested sample for each patient, 34% of patients have ≥10% tumor-derived cfDNA, sufficient for standard coverage whole-exome sequencing. Using whole-exome sequencing, we validate the concordance of clonal somatic mutations (88%), copy number alterations (80%), mutational signatures, and neoantigens between cfDNA and matched tumor biopsies from 41 patients with ≥10% cfDNA tumor content. In summary, we provide methods to identify patients eligible for comprehensive cfDNA profiling, revealing its applicability to many patients, and demonstrate high concordance of cfDNA and metastatic tumor whole-exome sequencing.

  13. Concordance between fine-needle aspiration and core biopsies for osseous lesions by lesion imaging appearance and CT attenuation.

    Science.gov (United States)

    Li, John; Weissberg, Zoe; Bevilacqua, Thomas A; Yu, Gordon; Weber, Kristy; Sebro, Ronnie

    2018-04-01

    To compare the concordance between fine-needle aspiration and core biopsies for osseous lesions by lesion imaging appearance and CT attenuation. Retrospective review of 215 FNAs of osseous lesions performed in conjunction with core biopsy at our institution over a 6-year period (2011-2016). FNAs were interpreted independently of core biopsies. We assessed if FNA in conjunction with core biopsy increased diagnostic accuracy compared to core biopsy alone. We also calculated the concordance between FNA and core biopsy by lesion appearance, lesion CT attenuation, lesion histology, lesion location and FNA needle gauge size. Core biopsy alone provided the diagnosis in 207/215 cases (96.3%), however, the FNA provided the diagnosis in the remaining 8/215 cases (3.7%) where the core biopsy was non-diagnostic. There were 154 (71.6%) lytic lesions, 21 (9.8%) blastic lesions, 25 (11.6%) mixed lytic and blastic lesions and 15 (7.0%) lesions that were neither lytic nor blastic. The concordance between FNA and core biopsy for lytic osseous lesions (136/154 cases, 88.3%) was statistically significantly higher than that for blastic osseous lesions (13/21 cases, 61.9%) [P = 4.2 × 10 -3 ; 95% CI (0.02, 0.50)]. The concordance between FNA and core biopsy was higher for low-attenuation- (110/126) than high-attenuation (58/77) lesions (P = 0.028). The concordance between FNA and core biopsy was also higher for metastases (102/119 cases, 85.7%) than non-metastases (78/96, 81.3%) [P = 0.487; 95% CI (- 0.15, 0.065)]. There was no difference in the rate of concordance between FNA and core biopsy by lesion location or FNA needle gauge size (P > 0.05). FNA with core biopsy increases diagnostic rate compared to core biopsy alone or FNA alone. The concordance between FNA and core biopsy is higher for lytic lesions than for blastic lesions; and higher for low-attenuation lesions than for high-attenuation lesions.

  14. Study of concord in the examination scripts of students of Ghana ...

    African Journals Online (AJOL)

    This paper investigates grammatical concord in undergraduate students' examination scripts in Ghana Technology University College (GTUC), a private university college in Ghana. Purposeful and critical discourse analytical methods are employed to analyse thirty (30) Communication Skills scripts of level 200 students of ...

  15. A Medical Logistics Officer Training Needs Assessment Utilizing Feedback from Operation Iraqi Freedom

    National Research Council Canada - National Science Library

    Waddick, James L

    2004-01-01

    ... their missions during the initial Operation Iraqi Freedom deployment (OIF 1). Additionally, the study sought to identify the potential benefit of additional training on key medical logistics tasks and training events...

  16. Embodied simulation as part of affective evaluation processes: task dependence of valence concordant EMG activity.

    Science.gov (United States)

    Weinreich, André; Funcke, Jakob Maria

    2014-01-01

    Drawing on recent findings, this study examines whether valence concordant electromyography (EMG) responses can be explained as an unconditional effect of mere stimulus processing or as somatosensory simulation driven by task-dependent processing strategies. While facial EMG over the Corrugator supercilii and the Zygomaticus major was measured, each participant performed two tasks with pictures of album covers. One task was an affective evaluation task and the other was to attribute the album covers to one of five decades. The Embodied Emotion Account predicts that valence concordant EMG is more likely to occur if the task necessitates a somatosensory simulation of the evaluative meaning of stimuli. Results support this prediction with regard to Corrugator supercilii in that valence concordant EMG activity was only present in the affective evaluation task but not in the non-evaluative task. Results for the Zygomaticus major were ambiguous. Our findings are in line with the view that EMG activity is an embodied part of the evaluation process and not a mere physical outcome.

  17. Dry Eye Disease: Concordance Between the Diagnostic Tests in African Eyes.

    Science.gov (United States)

    Onwubiko, Stella N; Eze, Boniface I; Udeh, Nnenma N; Onwasigwe, Ernest N; Umeh, Rich E

    2016-11-01

    To assess the concordance between the diagnostic tests for dry eye disease (DED) in a Nigerian hospital population. The study was a hospital-based cross-sectional survey of adults (≥18 years) presenting at the eye clinic of the University of Nigeria Teaching Hospital (UNTH), Enugu; September-December, 2011. Participants' socio-demographic data were collected. Each subject was assessed for DED using the "Ocular Surface Disease Index" (OSDI) questionnaire, tear-film breakup time (TBUT), and Schirmer test. The intertest concordance was assessed using kappa statistic, correlation, and regression coefficients. The participants (n=402; men: 193) were aged 50.1±19.1 standard deviation years (range: 18-94 years). Dry eye disease was diagnosed in 203 by TBUT, 170 by Schirmer test, and 295 by OSDI; the concordance between the tests were OSDI versus TBUT (Kappa, κ=-0.194); OSDI versus Schirmer (κ=-0.276); and TBUT versus Schirmer (κ=0.082). Ocular Surface Disease Index was inversely correlated with Schirmer test (Spearman ρ=-0.231, P<0.001) and TBUT (ρ=-0.237, P<0.001). In the linear regression model, OSDI was poorly predicted by TBUT (β=-0.09; 95% confidence interval (CI): -0.26 to -0.03, P=0.14) and Schirmer test (β=-0.35, 95% CI: -0.53 to -0.18, P=0.18). At UNTH, there is poor agreement, and almost equal correlation, between the subjective and objective tests for DED. Therefore, the selection of diagnostic test for DED should be informed by cost-effectiveness and diagnostic resource availability, not diagnostic efficiency or utility.

  18. Analysis of the concordance rates between core needle biopsy and surgical excision in patients with breast cancer Análise das taxas de concordância entre a biópsia com agulha grossa e a excisão cirúrgica em pacientes com câncer de mama

    Directory of Open Access Journals (Sweden)

    Marcos Desidério Ricci

    2012-10-01

    Full Text Available OBJECTIVE: To evaluate whether immunohistochemical marker studies performed on core needle biopsy (CNB specimens accurately reflect the marker status of the tumor obtained from final surgical specimen. METHODS: This was a retrospective study that used the database of the Division of Mastology of the Hospital das Clínicas, São Paulo, Brazil. Sixty-nine patients submitted to ultrasound-guided CNB diagnosed with breast cancer were retrospectively analyzed. Immunohistochemistry (IHC on core biopsy specimens was compared to that of excisional biopsy regarding estrogen receptor (ER, progesterone receptor (PR, human epidermal gowth factor receptor 2 gene (HER2, p53, and Ki67. The analysis of the concordance between CNB and surgical biopsy was performed using the kappa (k coefficient (95% CI. RESULTS: A perfect concordance between the labeling in the surgical specimens and the preoperative biopsies in p53 (k = 1.0; 95% CI: 0.76-1.0 was identified. There was an almost perfect concordance for ER (k = 0.89; 95% CI: 0.65-1.0 and a substantial concordance for PR (k = 0.70; 95% CI: 0.46-0.93. HER2 (k = 0.61; 95% CI: 0.38-0.84 and Ki-67 (k = 0.74; 95% CI: 0.58-0.98 obtained a substantial concordance this analysis. CONCLUSION: The results of this study indicate that the immunohistochemical analysis of ER, PR, Ki-67, and p53 from core biopsy specimens provided results that accurately reflect the marker status of the tumor. The concordance rate of HER2 was less consistent; although it produced substantial concordance, values were very close to moderate concordance.OBJETIVO: Avaliar se a análise dos marcadores imunoistoquímicos obtidos por meio de espécimes de core biopsy (CB refletem com precisão o perfil dos marcadores tumorais obtidos por biópsia cirúrgica excisional (BCE. MÉTODOS: Estudo retrospectivo usando dados da Divisão de Mastologia do Hospital das Clínicas de São Paulo. Sessenta e nove pacientes submetidas à CB guiada por ultrassom com

  19. 47 CFR 95.1121 - Specific requirements for wireless medical telemetry devices operating in the 1395-1400 and 1427...

    Science.gov (United States)

    2010-10-01

    ... wireless medical telemetry devices operating in the 1395-1400 and 1427-1432 MHz bands. Due to the critical... 47 Telecommunication 5 2010-10-01 2010-10-01 false Specific requirements for wireless medical telemetry devices operating in the 1395-1400 and 1427-1432 MHz bands. 95.1121 Section 95.1121...

  20. Deployment of field hospitals to disaster regions: Insights from ten medical relief operations spanning three decades.

    Science.gov (United States)

    Naor, Michael; Heyman, Samuel N; Bader, Tarif; Merin, Ofer

    2017-01-01

    The Israeli Defense Force (IDF) Medical Corps developed a model of airborne field hospital. This model was structured to deal with disaster settings, requiring self-sufficiency, innovation and flexible operative mode in the setup of large margins of uncertainty regarding the disaster environment. The current study is aimed to critically analyze the experience, gathered in ten such missions worldwide. Interviews with physicians who actively participated in the missions from 1988 until 2015 as chief medical officers combined with literature review of principal medical and auxiliary publications in order to assess and integrate information about the assembly of these missions. A body of knowledge was accumulated over the years by the IDF Medical Corps from deploying numerous relief missions to both natural (earthquake, typhoon, and tsunami), and man-made disasters, occurring in nine countries (Armenia, Rwanda, Kosovo, Turkey, India, Haiti, Japan, Philippines, and Nepal). This study shows an evolutionary pattern with improvements implemented from one mission to the other, with special adaptations (creativity and improvisation) to accommodate logistics barriers. The principals and operative function for deploying medical relief system, proposed over 20 years ago, were challenged and validated in the subsequent missions of IDF outlined in the current study. These principals, with the advantage of the military infrastructure and the expertise of drafted civilian medical professionals enable the rapid assembly and allocation of highly competent medical facilities in disaster settings. This structure model is to large extent self-sufficient with a substantial operative flexibility that permits early deployment upon request while the disaster assessment and definition of needs are preliminary.

  1. Super Memory Bros.: going from mirror patterns to concordant patterns via similarity enhancements.

    Science.gov (United States)

    Ozubko, Jason D; Joordens, Steve

    2008-12-01

    When memory is contrasted for stimuli belonging to distinct stimulus classes, one of two patterns is observed: a mirror pattern, in which one stimulus gives rise to higher hits but lower false alarms (e.g., the frequency-based mirror effect) or a concordant pattern, in which one stimulus class gives rise both to higher hits and to higher false alarms (e.g., the pseudoword effect). On the basis of the dual-process account proposed by Joordens and Hockley (2000), we predict that mirror patterns occur when one stimulus class is more familiar and less distinctive than another, whereas concordant patterns occur when one stimulus class is more familiar than another. We tested these assumptions within a video game paradigm using novel stimuli that allow manipulations in terms of distinctiveness and familiarity (via similarity). When more distinctive, less familiar items are contrasted with less distinctive, more familiar items, a mirror pattern is observed. Systematically enhancing the familiarity of stimuli transforms the mirror pattern to a concordant pattern as predicted. Although our stimuli differ considerably from those used in examinations of the frequency-based mirror effect and the pseudoword effect, the implications of our findings with respect to those phenomena are also discussed.

  2. Familial concordance for age at natural menopause: results from the Breakthrough Generations Study.

    Science.gov (United States)

    Morris, Danielle H; Jones, Michael E; Schoemaker, Minouk J; Ashworth, Alan; Swerdlow, Anthony J

    2011-09-01

    Existing estimates of the heritability of menopause age have a wide range. Furthermore, few studies have analyzed to what extent familial similarities might reflect shared environment, rather than shared genes. We therefore analyzed familial concordance for age at natural menopause and the effects of shared genetic and environmental factors on this concordance. Participants were 2,060 individuals comprising first-degree relatives, aged 31 to 90 years, and participating in the UK Breakthrough Generations Study. Menopause data were collected using a self-administered questionnaire and analyzed using logistic regression and variance-components models. Women were at an increased risk of early menopause (≤45 y) if their mother (odds ratio, 6.2; P menopause. Likewise, women had an increased risk of late menopause (≥54 y) if their relative had had a late menopause (mother: odds ratio, 6.1; P menopause age attributed to environmental factors shared by sisters. We confirm that early menopause aggregates within families and show, for the first time, that there is also strong familial concordance for late menopause. Both genes and shared environment were the source of variation in menopause age. Past heritability estimates have not accounted for shared environment, and thus, the effect of genetic variants on menopause age may previously have been overestimated.

  3. Emotion dysregulation and dyadic conflict in depressed and typical adolescents: evaluating concordance across psychophysiological and observational measures.

    Science.gov (United States)

    Crowell, Sheila E; Baucom, Brian R; Yaptangco, Mona; Bride, Daniel; Hsiao, Ray; McCauley, Elizabeth; Beauchaine, Theodore P

    2014-04-01

    Many depressed adolescents experience difficulty in regulating their emotions. These emotion regulation difficulties appear to emerge in part from socialization processes within families and then generalize to other contexts. However, emotion dysregulation is typically assessed within the individual, rather than in the social relationships that shape and maintain dysregulation. In this study, we evaluated concordance of physiological and observational measures of emotion dysregulation during interpersonal conflict, using a multilevel actor-partner interdependence model (APIM). Participants were 75 mother-daughter dyads, including 50 depressed adolescents with or without a history of self-injury, and 25 typically developing controls. Behavior dysregulation was operationalized as observed aversiveness during a conflict discussion, and physiological dysregulation was indexed by respiratory sinus arrhythmia (RSA). Results revealed different patterns of concordance for control versus depressed participants. Controls evidenced a concordant partner (between-person) effect, and showed increased physiological regulation during minutes when their partner was more aversive. In contrast, clinical dyad members displayed a concordant actor (within-person) effect, becoming simultaneously physiologically and behaviorally dysregulated. Results inform current understanding of emotion dysregulation across multiple levels of analysis. Copyright © 2014 Elsevier B.V. All rights reserved.

  4. Evaluation of concordance among three cardiac output measurement techniques in adult patients during cardiovascular surgery postoperative care.

    Science.gov (United States)

    Muñoz, L; Velandia, A; Reyes, L E; Arevalo-Rodríguez, I; Mejía, C; Asprilla, D; Uribe, D V; Arevalo, J J

    2017-12-01

    The standard method for cardiac output measuring is thermodilution although it is an invasive technique. Transesophageal Echocardiography (TEE) offers a dynamic and functional alternative to thermodilution. Analyze concordance between two TEE methods and thermodilution for cardiac output assessment. Observational concordance study in cardiovascular surgery patients that required pulmonary artery catheter. TEE cardiac output measurement at both mitral annulus (MA) and left ventricle outflow tract (LVOT) were performed. Results were compared with thermodilution. Correlation was evaluated by Lin's concordance correlation coefficient and Bland-Altman analysis. Statistical analysis was undertaken in STATA 13.0. Twenty-five patients were enrolled. Fifty two percent of patients were male, median age and ejection fraction was 63 years and 35% respectively. Median thermodilution, LVOT and MA -measured cardiac output was 3.25 L/min, 3.46 L/min and 8.4 L/min respectively. Different values between thermodilution and MA measurements were found (Lin concordance=0.071; Confidence Interval 95%=-0.009 to 0.151; Spearman's correlation=0.22) as values between thermodilution and LVOT (Lin concordance=0.232; Confidence Interval 95%=-0.12 a 0.537; Spearman's correlation 0.28). Bland-Altman analysis showed greater difference between MA measurements and thermodilution (DM=-0.408; Bland-Altman Limits=-0.809 to -0.007), than the other echocardiographic findings (DM=0.007; Bland-Altman Limits=-0.441 to 0.428). Results from cardiac output measurement by doppler and 2D-TEE on both MA and LVOT do not correlate with those obtained by thermodilution. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  5. Intimate Partner Aggression Reporting Concordance and Correlates of Agreement among Men with Alcohol Use Disorders and Their Female Partners

    Science.gov (United States)

    Panuzio, Jillian; O'Farrell, Timothy J.; Marshall, Amy D.; Murphy, Christopher M.; Murphy, Marie; Taft, Casey T.

    2006-01-01

    This study examined relationship aggression reporting concordance among 303 men with alcohol use disorders and their female partners enrolled in couples-based alcohol abuse treatment. Agreement for physical and psychological aggression was generally consistent with, or higher than, concordance rates reported among other populations. Men's…

  6. 2010 Federal Emergency Management Agency (FEMA) Topographic Lidar: Concord River Watershed, Massachusetts

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Concord AOI consists of one area. Ground Control is collected throughout the AOI for use in the processing of LiDAR data to ensure data accurately represents the...

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

    Science.gov (United States)

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

    2011-01-01

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

  8. A Descriptive Enquiry into Subject-Verb Concord in English Existential Constructions

    Science.gov (United States)

    Tsuchida, Takehiro

    2011-01-01

    Subject-verb concord in English existential constructions is often viewed as problematic from both prescriptive and descriptive approaches to grammar and causes considerable confusion among teachers and learners of English as a second language (ESL). This paper aims to disentangle debates over the curious usage of the "there" + plural noun phrase…

  9. Concordance between preoperative and postoperative assessments of primary caries lesion depth: results from the Dental PBRN

    DEFF Research Database (Denmark)

    Nascimento, Marcelle M; Bader, James D; Qvist, Vibeke

    2010-01-01

    depths were recorded as being in the outer half (E1) or inner half (E2) of enamel, or in the outer third (D1), middle third (D2) or inner third (D3) of dentin. Most restorations were placed to treat lesions that were preoperatively assessed as extending to the D1 (53%) and D2 (25%) depths....... Of the restored caries lesions, 10% were preoperatively assessed as being limited to E2 depth and 3% to E1 depth. The majority of the restored enamel lesions were located on occlusal surfaces. Preoperative estimates of caries lesion depth were more concordant with postoperative depths when the lesion...... was at an advanced stage: 88% concordance at the D3 depth, compared to 54% concordance at the E1 depth. DPBRN dentists can discriminate caries lesions at different depths, but the accuracy of their depth assessments was higher for dentin than for enamel lesions. In general, DPBRN dentists were more likely...

  10. Lessons from the organisation of the UK medical services deployed in support of Operation TELIC (Iraq) and Operation HERRICK (Afghanistan).

    Science.gov (United States)

    Bricknell, Martin C M; Nadin, M

    2017-08-01

    This paper provides the definitive record of the UK Defence Medical Services (DMS) lessons from the organisation of medical services in support of Operation (Op) TELIC (Iraq) and Op HERRICK (Afghanistan). The analysis involved a detailed review of the published academic literature, internal post-operational tour reports and post-tour interviews. The list of lessons was reviewed through three Military Judgement Panel cycles producing the single synthesis ' the golden thread ' and eight ' silver bullets ' as themes to institutionalise the learning to deliver the golden thread. One additional theme, mentoring indigenous healthcare systems and providers, emerged as a completely new capability requirement. The DMS has established a programme of work to implement these lessons. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  11. Concordance of Motion Sensor and Clinician-Rated Fall Risk Scores in Older Adults.

    Science.gov (United States)

    Elledge, Julie

    2017-12-01

    As the older adult population in the United States continues to grow, developing reliable, valid, and practical methods for identifying fall risk is a high priority. Falls are prevalent in older adults and contribute significantly to morbidity and mortality rates and rising health costs. Identifying at-risk older adults and intervening in a timely manner can reduce falls. Conventional fall risk assessment tools require a health professional trained in the use of each tool for administration and interpretation. Motion sensor technology, which uses three-dimensional cameras to measure patient movements, is promising for assessing older adults' fall risk because it could eliminate or reduce the need for provider oversight. The purpose of this study was to assess the concordance of fall risk scores as measured by a motion sensor device, the OmniVR Virtual Rehabilitation System, with clinician-rated fall risk scores in older adult outpatients undergoing physical rehabilitation. Three standardized fall risk assessments were administered by the OmniVR and by a clinician. Validity of the OmniVR was assessed by measuring the concordance between the two assessment methods. Stability of the OmniVR fall risk ratings was assessed by measuring test-retest reliability. The OmniVR scores showed high concordance with the clinician-rated scores and high stability over time, demonstrating comparability with provider measurements.

  12. Concordance of vitamin D peripheral levels in infertile couples' partners.

    Science.gov (United States)

    Paffoni, Alessio; Ferrari, Stefania; Mangiarini, Alice; Noli, Stefania; Bulfoni, Alessandro; Vigano, Paola; Parazzini, Fabio; Somigliana, Edgardo

    2017-08-01

    A large number of evidence supports the role of vitamin D insufficiency in both women and men infertility. However, no studies have evaluated the rate of concordance of vitamin D status between the partners. This finding might open new scenarios in the interpretation of the available data linking vitamin D insufficiency and infertility. In the present cross-sectional study, 103 consecutive infertile couples were recruited between April and May 2014. Both partners concomitantly provided a serum sample for the assessment of 25-hydroxy-vitamin D [25-(OH)-D]. Vitamin D insufficiency was defined as serum 25-(OH)-D D insufficient, corresponding to a rate of 73%. Overall, concordance was observed in 73 couples (71%), thus higher than the expected 61% (0.732 + 0.272) based on chance (p = 0.007). The Pearson coefficient of correlation R2 between the partners of the couples was 0.52 (p D insufficiency according to the causes of infertility. Serum 25-(OH)-D correlates within the partners of infertile couples. Further evidence is warranted to determine the clinical relevance and possible clinical applications of this finding.

  13. Your Lung Operation: After Your Operation

    Medline Plus

    Full Text Available ... Medical Student Core Curriculum ACS/ASE Medical Student Simulation-Based Surgical Skills Curriculum Cancer Education Cancer Education ... Surgeons Education Patients and Family Skills Programs Your Lung Operation Your Lung Operation DVD After Your Operation ...

  14. Modelação computacional de padrões variáveis de concordância em português

    Directory of Open Access Journals (Sweden)

    Leonel Figueiredo de Alencar

    2014-03-01

    Full Text Available Este trabalho descreve a implementação de um parser para um fragmento do português no XLE, sistema que constitui o estado da arte para o desenvolvimento de gramáticas computacionais baseadas no modelo gerativo da LFG. O fragmento abrange os seguintes aspectos da concordância verbal,sujeitos à variação dialetal: (i concordância sintática do chamado pronome a gente, com formas verbais de terceira pessoa do singular e semântica coma primeira e terceira do plural; (ii concordância do pronome tu, com a segunda e a terceira do singular e do pronome vocês, com a segunda e terceira do plural; (iii concordância semântica de um DP definido no plural, com a primeira pessoa do plural. Para derivar os diferentes padrões de concordância nesse domínio, constatados no português padrão e em alguns dialetos não padrão tanto do português do Brasil quanto do português europeu, são propostas estruturas de traços para os DPs e flexões verbais em que se distingue entre traços sintático-formais e traços semântico-discursivos. Mostra-se que as diferenças entre os dialetos investigados em relação a (i – (iiipodem ser derivadas por meio da ativação ou desativação desses traços.

  15. The CpG island methylator phenotype is concordant between primary colorectal carcinoma and matched distant metastases.

    Science.gov (United States)

    Cohen, Stacey A; Yu, Ming; Baker, Kelsey; Redman, Mary; Wu, Chen; Heinzerling, Tai J; Wirtz, Ralph M; Charalambous, Elpida; Pentheroudakis, George; Kotoula, Vassiliki; Kalogeras, Konstantine T; Fountzilas, George; Grady, William M

    2017-01-01

    The CpG island methylator phenotype (CIMP) in stage III colon cancer (CRC) has been associated with improved survival after treatment with adjuvant irinotecan-based chemotherapy. In this analysis, we determine whether CIMP status in the primary CRC is concordant with the CIMP status of matched metastases in order to determine if assessment of CIMP status in the primary tumor can be used to predict CIMP status of metastatic disease, which is relevant for patient management as well as for understanding the biology of CIMP CRCs. We assessed the CIMP status of 70 pairs of primary CRC and matched metastases using a CRC-specific panel of five markers ( CACNA1G , IGF2 , NEUROG1 , RUNX3 , and SOCS1 ) where CIMP positive was defined as 3/5 positive markers at a percent methylated reference threshold of ≥10%. Concordance was compared using the Fisher's exact test and P  CIMP status in the primary tumor and matched metastasis; five (7.0%) of the pairs were concordantly CIMP positive. Only one pair (1.4%) had divergent CIMP status, demonstrating CIMP positivity (4/5 markers positive) in the primary tumor, while the matched metastasis was CIMP negative (0 markers positive). CIMP status is generally concordant between primary CRCs and matched metastases. Thus, CIMP status in the primary tumor is maintained in matched metastases and can be used to inform CIMP-based therapy options for the metastases.

  16. Continuously Operating Biosensor and Its Integration into a Hermetically Sealed Medical Implant

    Directory of Open Access Journals (Sweden)

    Mario Birkholz

    2016-10-01

    Full Text Available An integration concept for an implantable biosensor for the continuous monitoring of blood sugar levels is presented. The system architecture is based on technical modules used in cardiovascular implants in order to minimize legal certification efforts for its perspective usage in medical applications. The sensor chip operates via the principle of affinity viscometry, which is realized by a fully embedded biomedical microelectromechanical systems (BioMEMS prepared in 0.25-µm complementary metal–oxide–semiconductor (CMOS/BiCMOS technology. Communication with a base station is established in the 402–405 MHz band used for medical implant communication services (MICS. The implant shall operate within the interstitial tissue, and the hermetical sealing of the electronic system against interaction with the body fluid is established using titanium housing. Only the sensor chip and the antenna are encapsulated in an epoxy header closely connected to the metallic housing. The study demonstrates that biosensor implants for the sensing of low-molecular-weight metabolites in the interstitial may successfully rely on components already established in cardiovascular implantology.

  17. Air quality monitoring of the post-operative recovery room and locations surrounding operating theaters in a medical center in Taiwan.

    Directory of Open Access Journals (Sweden)

    Chin-Sheng Tang

    Full Text Available To prevent surgical site infection (SSI, the airborne microbial concentration in operating theaters must be reduced. The air quality in operating theaters and nearby areas is also important to healthcare workers. Therefore, this study assessed air quality in the post-operative recovery room, locations surrounding the operating theater area, and operating theaters in a medical center. Temperature, relative humidity (RH, and carbon dioxide (CO2, suspended particulate matter (PM, and bacterial concentrations were monitored weekly over one year. Measurement results reveal clear differences in air quality in different operating theater areas. The post-operative recovery room had significantly higher CO2 and bacterial concentrations than other locations. Bacillus spp., Micrococcus spp., and Staphylococcus spp. bacteria often existed in the operating theater area. Furthermore, Acinetobacter spp. was the main pathogen in the post-operative recovery room (18% and traumatic surgery room (8%. The mixed effect models reveal a strong correlation between number of people in a space and high CO2 concentration after adjusting for sampling locations. In conclusion, air quality in the post-operative recovery room and operating theaters warrants attention, and merits long-term surveillance to protect both surgical patients and healthcare workers.

  18. Air quality monitoring of the post-operative recovery room and locations surrounding operating theaters in a medical center in Taiwan.

    Science.gov (United States)

    Tang, Chin-Sheng; Wan, Gwo-Hwa

    2013-01-01

    To prevent surgical site infection (SSI), the airborne microbial concentration in operating theaters must be reduced. The air quality in operating theaters and nearby areas is also important to healthcare workers. Therefore, this study assessed air quality in the post-operative recovery room, locations surrounding the operating theater area, and operating theaters in a medical center. Temperature, relative humidity (RH), and carbon dioxide (CO2), suspended particulate matter (PM), and bacterial concentrations were monitored weekly over one year. Measurement results reveal clear differences in air quality in different operating theater areas. The post-operative recovery room had significantly higher CO2 and bacterial concentrations than other locations. Bacillus spp., Micrococcus spp., and Staphylococcus spp. bacteria often existed in the operating theater area. Furthermore, Acinetobacter spp. was the main pathogen in the post-operative recovery room (18%) and traumatic surgery room (8%). The mixed effect models reveal a strong correlation between number of people in a space and high CO2 concentration after adjusting for sampling locations. In conclusion, air quality in the post-operative recovery room and operating theaters warrants attention, and merits long-term surveillance to protect both surgical patients and healthcare workers.

  19. Concordance and predictive value of two adverse drug event data sets.

    Science.gov (United States)

    Cami, Aurel; Reis, Ben Y

    2014-08-22

    Accurate prediction of adverse drug events (ADEs) is an important means of controlling and reducing drug-related morbidity and mortality. Since no single "gold standard" ADE data set exists, a range of different drug safety data sets are currently used for developing ADE prediction models. There is a critical need to assess the degree of concordance between these various ADE data sets and to validate ADE prediction models against multiple reference standards. We systematically evaluated the concordance of two widely used ADE data sets - Lexi-comp from 2010 and SIDER from 2012. The strength of the association between ADE (drug) counts in Lexi-comp and SIDER was assessed using Spearman rank correlation, while the differences between the two data sets were characterized in terms of drug categories, ADE categories and ADE frequencies. We also performed a comparative validation of the Predictive Pharmacosafety Networks (PPN) model using both ADE data sets. The predictive power of PPN using each of the two validation sets was assessed using the area under Receiver Operating Characteristic curve (AUROC). The correlations between the counts of ADEs and drugs in the two data sets were 0.84 (95% CI: 0.82-0.86) and 0.92 (95% CI: 0.91-0.93), respectively. Relative to an earlier snapshot of Lexi-comp from 2005, Lexi-comp 2010 and SIDER 2012 introduced a mean of 1,973 and 4,810 new drug-ADE associations per year, respectively. The difference between these two data sets was most pronounced for Nervous System and Anti-infective drugs, Gastrointestinal and Nervous System ADEs, and postmarketing ADEs. A minor difference of 1.1% was found in the AUROC of PPN when SIDER 2012 was used for validation instead of Lexi-comp 2010. In conclusion, the ADE and drug counts in Lexi-comp and SIDER data sets were highly correlated and the choice of validation set did not greatly affect the overall prediction performance of PPN. Our results also suggest that it is important to be aware of the

  20. Transjugular Intrahepatic Portosystemic Shunt Dysfunction: Concordance of Clinical Findings, Doppler Ultrasound Examination, and Shunt Venography.

    Science.gov (United States)

    Owen, Joshua M; Gaba, Ron Charles

    2016-01-01

    The objective of this study was to evaluate the concordance between clinical symptoms, Doppler ultrasound (US), and shunt venography for the detection of stent-graft transjugular intrahepatic portosystemic shunt (TIPS) dysfunction. Forty-one patients (M:F 30:11, median age 55 years) who underwent contemporaneous clinical exam, Doppler US, and TIPS venography between 2003 and 2014 were retrospectively studied. Clinical symptoms (recurrent ascites or variceal bleeding) were dichotomously classified as present/absent, and US and TIPS venograms were categorized in a binary fashion as normal/abnormal. US abnormalities included high/low (>190 or 50 cm/s), absent flow, and return of antegrade intra-hepatic portal flow. Venographic abnormalities included shunt stenosis/occlusion and/or pressure gradient elevation. Clinical and imaging concordance rates were calculated. Fifty-two corresponding US examinations and venograms were assessed. The median time between studies was 3 days. Forty of 52 (77%) patients were symptomatic, 33/52 (64%) US examinations were abnormal, and 20/52 (38%) TIPS venograms were abnormal. Concordance between clinical symptoms and TIPS venography was 48% (25/52), while the agreement between US and shunt venography was 65% (34/52). Clinical symptoms and the US concurred in 60% (31/52) of the patients. The sensitivity of clinical symptoms and US for the detection of venographically abnormal shunts was 80% (16/20) and 85% (17/20), respectively. Both clinical symptoms and the US had low specificity (25%, 8/32 and 50%, 16/32) for venographically abnormal shunts. Clinical findings and the US had low concordance rates with TIPS venography, with acceptable sensitivity but poor specificity. These findings suggest the need for improved noninvasive imaging methods for stent-graft TIPS surveillance.

  1. Development of a National Consensus for Tactical Emergency Medical Support (TEMS) Training Programs--Operators and Medical Providers.

    Science.gov (United States)

    Schwartz, Richard; Lerner, Brooke; Llwewllyn, Craig; Pennardt, Andre; Wedmore, Ian; Callaway, David; Wightman, John; Casillas, Raymond; Eastman, Alex; Gerold, Kevin; Giebner, Stephen; Davidson, Robert; Kamin, Richard; Piazza, Gina; Bollard, Glenn; Carmona, Phillip; Sonstrom, Ben; Seifarth, William; Nicely, Barbara; Croushorn, John; Carmona, Richard

    2014-01-01

    Tactical teams are at high risk of sustaining injuries. Caring for these casualties in the field involves unique requirements beyond what is provided by traditional civilian emergency medical services (EMS) systems. Despite this need, the training objectives and competencies are not uniformly agreed to or taught. An expert panel was convened that included members from the Departments of Defense, Homeland Security, Justice, and Health and Human Services, as well as federal, state, and local law-enforcement officers who were recruited through requests to stakeholder agencies and open invitations to individuals involved in Tactical Emergency Medical Services (TEMS) or its oversight. Two face-to-face meetings took place. Using a modified Delphi technique, previously published TEMS competencies were reviewed and updated. The original 17 competency domains were modified and the most significant changes were the addition of Tactical Emergency Casualty Care (TECC), Tactical Familiarization, Legal Aspects of TEMS, and Mass Casualty Triage to the competency domains. Additionally, enabling and terminal learning objectives were developed for each competency domain. This project has developed a minimum set of medical competencies and learning objectives for both tactical medical providers and operators. This work should serve as a platform for ensuring minimum knowledge among providers, which will serve enhance team interoperability and improve the health and safety of tactical teams and the public. 2014.

  2. [Concordance in the registry of dementia among the main sources of clinical information].

    Science.gov (United States)

    Marta-Moreno, Javier; Obón-Azuara, Blanca; Gimeno-Felíu, Luis; Achkar-Tuglaman, Nesib Nicolás; Poblador-Plou, Beatriz; Calderón-Larrañaga, Amaia; Prados-Torres, Alexandra

    2016-01-01

    The objective of this work was to analyse the concordance in the registry of dementia among the main sources of clinical information, with the aim of determining their usefulness for epidemiological and clinical research. Descriptive study of patients assigned to the Aragon Health Service in 2010 (n=1,344,891). (i)the pharmacy billing database (n=9,392); (ii)Primary Care electronic health records (EHR) (n=9,471), and (iii)the hospital minimum basic data set (n=3,289). When studying the concordance of the databases, the group of patients with a specific treatment for dementia (i.e., acetylcholinesterase inhibitors and/or memantine) was taken as the reference. The diagnosis in Primary Care was missing for 47.3% of patients taking anti-dementia drugs. The same occurred with 38.3% of dementia patients admitted to hospital during the study year. Among patients with a diagnosis of dementia in the EHR, only half (52.3%) was under treatment for this condition. This percentage decreased to 34.4% in patients with the diagnosis registered in the hospital database. The weak concordance in the registry of the dementia diagnosis between the main health information systems makes their use and analysis more complex, and supports the need to include all available health data sources in order to gain a global picture of the epidemiological and clinical reality of this health condition. Copyright © 2015 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. A Review of Supplementary Medical Aspects of Post-Cold War UN Peacekeeping Operations: Trends, Lessons Learned, Courses of Action, and Recommendations.

    Science.gov (United States)

    Johnson, Ralph J

    2015-01-01

    Post-Cold War United Nations Peace Keeping Operations (UN PKOs) have been increasingly involved in dangerous areas with ill-defined boundaries, harsh and remote geographies, simmering internecine armed conflict, and disregard on the part of some local parties for peacekeepers' security and role. In the interest of force protection and optimizing operations, a key component of UN PKOs is healthcare and medical treatment. The expectation is that UN PKO medical support will adjust to the general intent and structure of UN PKOs. To do so requires effective policies and planning informed by a review of all medical aspects of UN PKO operations, including those considered supplementary, that is, less crucial but contributing nonetheless. Medical aspects considered paramount and key to UN PKOs have received relatively thorough treatment elsewhere. The intent of this article is to report on ancillary and supplemental medical aspects practical to post-Cold War UN PKO operations assembled through an iterative inquiry of open-source articles. Recommendations are made about possible courses of action in terms of addressing trends found in such medical aspects of PKOs and relevance of US/NATO/European Union models and research.

  4. English Collocation Learning through Corpus Data: On-Line Concordance and Statistical Information

    Science.gov (United States)

    Ohtake, Hiroshi; Fujita, Nobuyuki; Kawamoto, Takeshi; Morren, Brian; Ugawa, Yoshihiro; Kaneko, Shuji

    2012-01-01

    We developed an English Collocations On Demand system offering on-line corpus and concordance information to help Japanese researchers acquire a better command of English collocation patterns. The Life Science Dictionary Corpus consists of approximately 90,000,000 words collected from life science related research papers published in academic…

  5. Concordance between VDU-users' ratings of comfort and perceived exertion with experts' observations of workplace layout and working postures.

    Science.gov (United States)

    Lindegård, A; Karlberg, C; Wigaeus Tornqvist, E; Toomingas, A; Hagberg, M

    2005-05-01

    The aim of the present study was to evaluate the concordance (agreement) between VDU-users' ratings of comfort and ergonomists' observations of workplace layout, and the concordance between VDU-users' ratings of perceived exertion and ergonomists' observations of working postures during VDU-work. The study population consisted of 853 symptom free subjects. Data on perceived comfort in different dimensions and data regarding perceived exertion in different body locations were collected by means of a questionnaire. Data concerning workplace layout and working postures were collected with an observation protocol, by an ergonomist. Concordance between ratings of comfort and observations of workplace layout was reasonably good for the chair and the keyboard (0.60, 0.58) and good regarding the screen and the input device (0.72, 0.61). Concordance between ratings of perceived exertion and observations of working postures indicated good agreement (0.63-0.77) for all measured body locations (neck, shoulder, wrist and trunk). In conclusion ratings of comfort and perceived exertion could be used as cost-efficient and user-friendly methods for practitioners to identify high exposure to poor workplace layout and poor working postures.

  6. Concordant testing results between various Human Papillomavirus assays in primary cervical cancer screening

    DEFF Research Database (Denmark)

    de Thurah, Lena; Bonde, Jesper; Hoa Lam, Janni Uyen

    2018-01-01

    OBJECTIVES: Human Papillomavirus (HPV) assays are increasingly used for primary cervical screening and HPV vaccination effect monitoring. We undertook a systematic literature review to determine the concordance in positive test results (i.e., detection of HPV infections) between Hybrid Capture 2 ...

  7. Brief Report: On the Concordance Percentages for Autistic Spectrum Disorder of Twins

    Science.gov (United States)

    Bohm, Henry V.; Stewart, Melbourne G.

    2009-01-01

    In the development of genetic theories of Autistic Spectrum Disorder (ASD) various characteristics of monozygotic (MZ) and dizygotic (DZ) twins are often considered. This paper sets forth a possible refinement in the interpretation of the MZ twin concordance percentages for ASD underlying such genetic theories, and, drawing the consequences from…

  8. The Establishment and operation of Longjing Medical College - The History of Longjing Medical College as Frontier History: Focusing on its ‘Disconnection’ and ‘Continuity’ -

    Directory of Open Access Journals (Sweden)

    Mira MOON

    2017-08-01

    Full Text Available Longjing Medial College, established in Longjing, Yanbian, China on September 12, 1945, existed for about 1 year and 6 months until it was renamed as the Medical Department of Dongbei Junzheng Daxue Jilin Fenxiao in April 1947. However, there are only few records and studies on Longjing Medical College in Yanbian as well as in Korea. In order to fill the gap, this study attempted to restore the history of Longjing Medical College built in Yanbian, China immediately after the liberation. In particular, it analyzed how and why the Longjing Medical College was founded and operated, and which relations the college had with the post-war medical educational institutions, focusing on the ‘disconnection’ and ‘continuity’ in the historical sense. Since the establishment of Manchukuo, the Japanese colonial government had made it a major “frontier” and actively promoted the mass migration of Japanese and Koreans. For them, the government also set up three Exploitation Medical Schools in 1940. As a part of these three institutions, Longjing Exploitation Medical School educated more than 150 students by 1945, of which about one third was Korean. After the liberation, the Longjing Educational Alliance decided to pursue the return-movement of the Longjing Exploitation Medical School and took over the institution. On September 12, 1945, Longjing Medical College opened at the school site of Longjing Exploitation Medical School. Longjing Medical College was founded by people who had ‘the perspective of Korean nationality’ in an atmosphere where the ‘ethnicity’ of the Koreans exercised considerable power. Nevertheless, in 1946, when the Chinese Civil War began and the Yanbian region became an important base of the Chinese Communist Party, the Party began to expand and strengthen their influences in the region. Accordingly, the operation rights of Longjing Medical College were transferred to the Yanbian Administrative offices of Supervision and

  9. Transjugular Intrahepatic Portosystemic Shunt Dysfunction: Concordance of Clinical Findings, Doppler Ultrasound Examination, and Shunt Venography

    Directory of Open Access Journals (Sweden)

    Joshua M Owen

    2016-01-01

    Full Text Available Objectives: The objective of this study was to evaluate the concordance between clinical symptoms, Doppler ultrasound (US, and shunt venography for the detection of stent-graft transjugular intrahepatic portosystemic shunt (TIPS dysfunction. Materials and Methods: Forty-one patients (M:F 30:11, median age 55 years who underwent contemporaneous clinical exam, Doppler US, and TIPS venography between 2003 and 2014 were retrospectively studied. Clinical symptoms (recurrent ascites or variceal bleeding were dichotomously classified as present/absent, and US and TIPS venograms were categorized in a binary fashion as normal/abnormal. US abnormalities included high/low (>190 or 50 cm/s, absent flow, and return of antegrade intra-hepatic portal flow. Venographic abnormalities included shunt stenosis/occlusion and/or pressure gradient elevation. Clinical and imaging concordance rates were calculated. Results: Fifty-two corresponding US examinations and venograms were assessed. The median time between studies was 3 days. Forty of 52 (77% patients were symptomatic, 33/52 (64% US examinations were abnormal, and 20/52 (38% TIPS venograms were abnormal. Concordance between clinical symptoms and TIPS venography was 48% (25/52, while the agreement between US and shunt venography was 65% (34/52. Clinical symptoms and the US concurred in 60% (31/52 of the patients. The sensitivity of clinical symptoms and US for the detection of venographically abnormal shunts was 80% (16/20 and 85% (17/20, respectively. Both clinical symptoms and the US had low specificity (25%, 8/32 and 50%, 16/32 for venographically abnormal shunts. Conclusion: Clinical findings and the US had low concordance rates with TIPS venography, with acceptable sensitivity but poor specificity. These findings suggest the need for improved noninvasive imaging methods for stent-graft TIPS surveillance.

  10. Exploring the Circulation Dynamics of Mississippi Sound and Bight Using the CONCORDE Synthesis Model

    Science.gov (United States)

    Pan, C.; Dinniman, M. S.; Fitzpatrick, P. J.; Lau, Y.; Cambazoglu, M. K.; Parra, S. M.; Hofmann, E. E.; Dzwonkowski, B.; Warner, S. J.; O'Brien, S. J.; Dykstra, S. L.; Wiggert, J. D.

    2017-12-01

    As part of the modeling effort of the GOMRI (Gulf of Mexico Research Initiative)-funded CONCORDE consortium, a high resolution ( 400 m) regional ocean model is implemented for the Mississippi (MS) Sound and Bight. The model is based on the Coupled Ocean Atmosphere Wave Sediment Transport Modeling System (COAWST), with initial and lateral boundary conditions drawn from data assimilative 3-day forecasts of the 1km-resolution Gulf of Mexico Navy Coastal Ocean Model (GOM-NCOM). The model initiates on 01/01/2014 and runs for 3 years. The model results are validated with available remote sensing data and with CONCORDE's moored and ship-based in-situ observations. Results from a three-year simulation (2014-2016) show that ocean circulation and water properties of the MS Sound and Bight are sensitive to meteorological forcing. A low resolution surface forcing, drawn from the North America Regional Reanalysis (NARR), and a high resolution forcing, called CONCORDE Meteorological Analysis (CMA) ) that resolves the diurnal sea breeze, are used to drive the model to examine the sensitivity of the circulation to surface forcing. The model responses to the low resolution NARR forcing and to the high resolution CMA are compared in detail for the CONCORDE Fall and Spring field campaigns when contemporaneous in situ data are available, with a focus on how simulated exchanges between MS Sound and MS Bight are impacted. In most cases, the model shows higher simulation skill when it is driven by CMA. Freshwater plumes of the MS River, MS Sound and Mobile Bay influence the shelf waters of the MS Bight in terms of material budget and dynamics. Drifters and dye experiments near Mobile Bay demonstrate that material exchanges between Mobile Bay and the Sound, and between the Sound and Bight, are sensitive to the wind strength and direction. A model - data comparison targeting the Mobile Bay plume suggests that under both northerly and southerly wind conditions the model is capable of

  11. A short note on jackknifing the concordance correlation coefficient.

    Science.gov (United States)

    Feng, Dai; Baumgartner, Richard; Svetnik, Vladimir

    2014-02-10

    Lin's concordance correlation coefficient (CCC) is a very popular scaled index of agreement used in applied statistics. To obtain a confidence interval (CI) for the estimate of CCC, jackknifing was proposed and shown to perform well in simulation as well as in applications. However, a theoretical proof of the validity of the jackknife CI for the CCC has not been presented yet. In this note, we establish a sufficient condition for using the jackknife method to construct the CI for the CCC. Copyright © 2013 John Wiley & Sons, Ltd.

  12. Concordance Between Different Amyloid Immunoassays and Visual Amyloid Positron Emission Tomographic Assessment.

    Science.gov (United States)

    Janelidze, Shorena; Pannee, Josef; Mikulskis, Alvydas; Chiao, Ping; Zetterberg, Henrik; Blennow, Kaj; Hansson, Oskar

    2017-12-01

    Visual assessment of amyloid positron emission tomographic (PET) images has been approved by regulatory authorities for clinical use. Several immunoassays have been developed to measure β-amyloid (Aβ) 42 in cerebrospinal fluid (CSF). The agreement between CSF Aβ42 measures from different immunoassays and visual PET readings may influence the use of CSF biomarkers and/or amyloid PET assessment in clinical practice and trials. To determine the concordance between CSF Aβ42 levels measured using 5 different immunoassays and visual amyloid PET analysis. The study included 262 patients with mild cognitive impairment or subjective cognitive decline from the Swedish BioFINDER (Biomarkers for Identifying Neurodegenerative Disorders Early and Reliably) cohort (recruited from September 1, 2010, through December 31, 2014) who had undergone flutemetamol F 18 ([18F]flutemetamol)-labeled PET. Levels of CSF Aβ42 were analyzed using the classic INNOTEST and the newer modified INNOTEST, fully automated Lumipulse (FL), EUROIMMUN (EI), and Meso Scale Discovery (MSD) assays. Concentrations of CSF Aβ were assessed using an antibody-independent mass spectrometry-based reference measurement procedure. The concordance of CSF Aβ42 levels and Aβ42:Aβ40 and Aβ42:tau ratios with visual [18F]flutemetamol PET status. Of 262 participants (mean [SD] age, 70.9 [5.5] years), 108 were women (41.2%) and 154 were men (58.8%). The mass spectrometry-derived Aβ42 values showed higher correlations with the modified Aβ42-INNOTEST (r = 0.97), Aβ42-FL (r = 0.93), Aβ42-EI (r = 0.93), and Aβ42-MSD (r = 0.95) assays compared with the classic Aβ42-INNOTEST assay (r = 0.88; P ≤ .01). The signal in the classic Aβ42-INNOTEST assay was partly quenched by recombinant Aβ1-40 peptide. However, the classic Aβ42-INNOTEST assay showed better concordance with visual [18F]flutemetamol PET status (area under the receiver operating characteristic curve [AUC], 0.92) compared with the

  13. Concordance of In-Home "Smart" Scale Measurement with Body Weight Measured In-Person.

    Science.gov (United States)

    Ross, Kathryn M; Wing, Rena R

    2016-06-01

    Newer "smart" scales that transmit participants' body weights directly to data collection centers offer the opportunity to simplify weight assessment in weight management research; however, little data exist on the concordance of these data compared to weights measured at in-person assessments. We compared the weights of 58 participants (mean±SD BMI = 31.6±4.8, age = 52.1±9.7 years, 86.2% White, 65.5% Female) measured by study staff at an in-person assessment visit to weights measured on the same day at home using BodyTrace "smart" scales. These measures occurred after 3 months of an internet-based weight management intervention. Weight (mean±SD) measured at the 3-month in-person assessment visit was 81.5±14.7kg compared to 80.4±14.5kg measured on the same day using in-home body weight scales; mean bias =1.1±0.8kg, 95% limits of agreement = -0.5 to 2.6. Two outliers in the data suggest that there may be greater variability between measurements for participants weighing above 110 kg. Results suggest good concordance between the measurements and support the use of the BodyTrace smart scale in weight management research. Future trials using BodyTrace scales for outcome assessment should clearly define protocols for measurement and associated instructions to participants (e.g., instruct individuals to weigh at the same time of day, similarly clothed). Finally, measure concordance should be investigated in a group of individuals weighing more than 110kg.

  14. Three-dimensional ultrasound in the diagnosis of Müllerian duct anomalies and concordance with magnetic resonance imaging.

    Science.gov (United States)

    Bermejo, C; Martínez Ten, P; Cantarero, R; Diaz, D; Pérez Pedregosa, J; Barrón, E; Labrador, E; Ruiz López, L

    2010-05-01

    To demonstrate the value of three-dimensional (3D) ultrasound in the diagnosis of uterine malformations and its concordance with magnetic resonance imaging (MRI). This study included 286 women diagnosed with uterine malformation by 3D ultrasound, having been referred to our clinics on suspicion of uterine malformation following clinical and/or conventional two-dimensional ultrasound examination. With the exception of three with intact hymen, patients underwent both bimanual examination and speculoscopy before and/or after sonography. MRI was performed in 65 cases. We analyzed the diagnostic concordance between the techniques in the study of uterine malformations. Using 3D ultrasound we diagnosed: one case with uterine agenesis; 10 with unicornuate uterus, four of which also underwent MRI; six with didelphic uterus, one of which had MRI; 45 with bicornuate uterus, 12 of which had MRI; 125 with septate uterus (18 with two cervices), 42 of which had MRI (six with two cervices); 96 with arcuate uterus, three of which had MRI; and three with diethylstilbestrol (DES) iatrogenic uterine malformations, all of which had MRI. Among the 65 which underwent MRI, the diagnosis was: four cases with unicornuate uterus, 10 with bicornuate uterus (two with two cervices), 45 with septate uterus (five with two cervices), three with arcuate uterus and three with DES-related uterine malformations. The concordance between 3D ultrasound and MRI was very good (kappa index, 0.880 (95% CI, 0.769-0.993)). Discrepancies in diagnosis between the two techniques occurred in four cases. There was very good concordance in the diagnosis of associated findings (kappa index, 0.878 (95% CI, 0.775-0.980)), this analysis identifying differences in two cases. There is a high degree of concordance between 3D ultrasound and MRI in the diagnosis of uterine malformations, the relationship between cavity and fundus being visualized equally well with both techniques. 3D ultrasound should be complemented by

  15. Public health surveillance of cancer survival in the United States and worldwide: The contribution of the CONCORD programme.

    Science.gov (United States)

    Allemani, Claudia; Coleman, Michel P

    2017-12-15

    CONCORD is a programme for the global surveillance of cancer survival. In 2015, the second cycle of the program (CONCORD-2) established long-term surveillance of cancer survival worldwide, for the first time, in the largest cancer survival study published to date. CONCORD-2 provided cancer survival trends for 25,676,887 patients diagnosed during the 15-year period between 1995 and 2009 with 1 of 10 common cancers that collectively represented 63% of the global cancer burden in 2009. Herein, the authors summarize the past, describe the present, and outline the future of the CONCORD programme. They discuss the difference between population-based studies and clinical trials, and review the importance of international comparisons of population-based cancer survival. This study will focus on the United States. The authors explain why population-based survival estimates are crucial for driving effective cancer control strategies to reduce the wide and persistent disparities in cancer survival between white and black patients, which are likely to be attributable to differences in access to early diagnosis and optimal treatment. Cancer 2017;123:4977-81. Published 2017. This article is a U.S. Government work and is in the public domain in the USA. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

  16. Sources of variation influencing concordance between functional MRI and direct cortical stimulation in brain tumor surgery

    Directory of Open Access Journals (Sweden)

    Melanie A Morrison

    2016-10-01

    Full Text Available Object: Preoperative functional magnetic resonance imaging (fMRI remains a promising method to aid in the surgical management of patients diagnosed with brain tumors. For patients that are candidates for awake craniotomies, surgical decisions can potentially be improved by fMRI but this depends on the level of concordance between preoperative brain maps and the maps provided by the gold standard intraoperative method, direct cortical stimulation (DCS. There have been numerous studies of the concordance between fMRI and DCS using sensitivity and specificity measures, however the results are variable across studies and the key factors influencing variability are not well understood. Thus, the present work addresses the influence of technical factors on fMRI and DCS concordance. Methods: Motor and language mapping data were collected for a group of glioma patients (n = 14 who underwent both preoperative fMRI and intraoperative DCS in an awake craniotomy procedure for tumor removal. Normative fMRI data were also acquired in a healthy control group (n = 12. The fMRI and DCS mapping data were co-registered; true positive (TP, true negative (TN, false positive (FP and false negative (FN occurrences were tabulated over the exposed brain surface. Sensitivity and specificity were measured for the total group, and the motor and language sub-groups. The influence of grid placement, fMRI statistical thresholding, and task standardization were assessed. Correlations between proportions of agreement and error were carefully scrutinized to evaluate concordance more in-depth. Results: Concordance was significantly better for motor versus language mapping. There was an inverse relationship between TP and TN with increasing statistical threshold, and FP dominated the total error. Sensitivity and specificity were reduced when tasks were not standardized across fMRI and DCS. Conclusions: Although the agreement between fMRI and DCS is good, variability is introduced

  17. Complex antithrombotic therapy: determinants of patient preference and impact on medication adherence

    Directory of Open Access Journals (Sweden)

    Abraham NS

    2015-11-01

    Full Text Available Neena S Abraham,1,2 Aanand D Naik,3,4 Richard L Street Jr,3–5 Diana L Castillo,3 Anita Deswal,6 Peter A Richardson,3,4 Christine M Hartman,3 George Shelton Jr,3,4 Liana Fraenkel7,8 1Division of Gastroenterology, Mayo Clinic, Scottsdale, AZ, USA; 2Divison of Healthcare Policy and Research, Department of Health Services Research, Rochester, MN, USA; 3Center for Innovations in Quality, Effectiveness, and Safety at the Michael E DeBakey VA Medical Center, Houston, TX, USA; 4Department of Medicine, Baylor College of Medicine, Houston, TX, USA; 5Department of Communication, Texas A&M University, College Station, TX, USA; 6Cardiology, Michael E DeBakey VAMC, Houston, TX, USA; 7Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA; 8Department of Medicine, Yale University, New Haven, CT, USA Purpose: For years, older patients have been prescribed multiple blood-thinning medications (complex antithrombotic therapy [CAT] to decrease their risk of cardiovascular events. These therapies, however, increase risk of adverse bleeding events. We assessed patient-reported trade-offs between cardioprotective benefit, gastrointestinal bleeding risk, and burden of self-management using adaptive conjoint analysis (ACA. As ACA could be a clinically useful tool to obtain patient preferences and guide future patient-centered care, we examined the clinical application of ACA to obtain patient preferences and the impact of ACA on medication adherence.Patients and methods: An electronic ACA survey led 201 respondents through medication risk–benefit trade-offs, revealing patients’ preferences for the CAT risk/benefit profile they valued most. The post-ACA prescription regimen was categorized as concordant or discordant with elicited preferences. Adherence was measured using VA pharmacy refill data to measure persistence of use prior to and 1 year following preference-elicitation. Additionally, we analyzed qualitative interviews of 56 respondents

  18. Detection of Parathyroid Autofluorescence Using Near-Infrared Imaging: A Multicenter Analysis of Concordance Between Different Surgeons.

    Science.gov (United States)

    Kahramangil, Bora; Dip, Fernando; Benmiloud, Fares; Falco, Jorge; de La Fuente, Martin; Verna, Silvina; Rosenthal, Raul; Berber, Eren

    2018-04-01

    Parathyroid glands (PGs) exhibit autofluorescence (AF) when excited by near-infrared laser. This multicenter study aims to analyze how this imaging could facilitate the detection of PGs during thyroidectomy and parathyroidectomy procedures. This was a retrospective Institutional Review Board-approved analysis of prospectively collected data at three centers. Near-infrared fluorescence imaging (NIFI) was used to detect AF from PGs during thyroidectomy and parathyroidectomy procedures. Logistic regression analysis was performed to assess the utility of NIFI to identify PGs and concordance at these centers. Overall, 210 patients underwent total thyroidectomy (n = 95), thyroid lobectomy (n = 41), and parathyroidectomy (n = 74) (n = 70 per center). Using NIFI, AF was detected from 98% of visually identified PGs. Upon initial exploration, 46% of PGs were not visible to the naked eye due to coverage by soft tissue, but AF from these glands could be detected by NIFI without any further dissection. Overall, a median of one PG per patient was detected by NIFI in this fashion before being identified visually (p = nonsignificant between centers). On logistic regression, smaller PGs were more likely to be missed visually, but localized by AF on NIFI (odds ratio with increasing size, 0.91; p = 0.02). In our experience, NIFI facilitated PG identification by detecting their AF, before conventional recognition by the surgeon, in 37-67% of the time. Despite the variability in this rate across centers, there was a concordance in detecting AF from 97 to 99% of the PGs using NIFI. We suggest the incorporation of AF on NIFI alongside conventional visual cues to aid identification of PGs during neck operations.

  19. Genetic determinants of LDL, lipoprotein(a), triglyceride-rich lipoproteins and HDL: concordance and discordance with cardiovascular disease risk

    DEFF Research Database (Denmark)

    Nordestgaard, Børge G; Tybjærg-Hansen, Anne

    2011-01-01

    To evaluate whether new and known genetic determinants of plasma levels of LDL cholesterol, lipoprotein(a), triglyceride-rich lipoproteins, and HDL cholesterol associate with the risk of cardiovascular disease expected from the effect on lipoprotein levels. Concordance or discordance of such gene......To evaluate whether new and known genetic determinants of plasma levels of LDL cholesterol, lipoprotein(a), triglyceride-rich lipoproteins, and HDL cholesterol associate with the risk of cardiovascular disease expected from the effect on lipoprotein levels. Concordance or discordance...

  20. Inter and intra-observer concordance for the diagnosis of portal hypertension gastropathy.

    Science.gov (United States)

    Casas, Meritxell; Vergara, Mercedes; Brullet, Enric; Junquera, Félix; Martínez-Bauer, Eva; Miquel, Mireia; Sánchez-Delgado, Jordi; Dalmau, Blai; Campo, Rafael; Calvet, Xavier

    2018-03-01

    At present there is no fully accepted endoscopic classification for the assessment of the severity of portal hypertensive gastropathy (PHG). Few studies have evaluated inter and intra-observer concordance or the degree of concordance between different endoscopic classifications. To evaluate inter and intra-observer agreement for the presence of portal hypertensive gastropathy and enteropathy using different endoscopic classifications. Patients with liver cirrhosis were included into the study. Enteroscopy was performed under sedation. The location of lesions and their severity was recorded. Images were videotaped and subsequently evaluated independently by three different endoscopists, one of whom was the initial endoscopist. The agreement between observations was assessed using the kappa index. Seventy-four patients (mean age 63.2 years, 53 males and 21 females) were included. The agreement between the three endoscopists regarding the presence or absence of PHG using the Tanoue and McCormack classifications was very low (kappa scores = 0.16 and 0.27, respectively). The current classifications of portal hypertensive gastropathy have a very low degree of intra and inter-observer agreement for the diagnosis and assessment of gastropathy severity.

  1. Assessing the concordance between illicit drug laws on the books and drug law enforcement: Comparison of three states on the continuum from "decriminalised" to "punitive".

    Science.gov (United States)

    Belackova, Vendula; Ritter, Alison; Shanahan, Marian; Hughes, Caitlin E

    2017-03-01

    Variations in drug laws, as well as variations in enforcement practice, exist across jurisdictions. This study explored the feasibility of categorising drug laws "on the books" in terms of their punitiveness, and the extent of their concordance with "laws in practice" in a cross-national comparison. "Law on the books", classified with respect to both cannabis and other drug offences in the Czech Republic, NSW (AU) and Florida (USA) were analysed in order to establish an ordinal relationship between the three states. Indicators to assess the "laws in practice" covered both police (arrests) and court (sentencing) activity between 2002 and 2013. Parametric and non-parametric tests of equality of means, tests of stationarity and correlation analysis were used to examine the concordance between the ordinal categorisation of "laws on the books" and "laws in practice", as well as trends over time. The Czech Republic had the most lenient drug laws; Florida had the most punitive and NSW was in-between. Examining the indicators of "laws in practice", we found that the population adjusted number of individuals sentenced to prison ranked across the three states was concordant with categorisation of "laws on the books", but the average sentence length and percentage of court cases sentenced to prison were not. Also, the de jure decriminalisation of drug possession in the Czech Republic yielded a far greater share of administrative offenses than the de facto decriminalisation of cannabis use / possession in NSW. Finally, the mean value of most "laws in practice" indicators changed significantly over time although the "laws on the books" didn't change. While some indicators of "laws in practice" were concordant with the ordinal categorisation of drug laws, several indicators of "laws in practice" appeared to operate independently from the drug laws as stated. This has significant implications for drug policy analysis and means that research should not assume they are

  2. Coming close to the ideal alternative: The concordant-ranks strategy

    Directory of Open Access Journals (Sweden)

    Neda Kerimi

    2011-04-01

    Full Text Available We present the Concordant-Ranks (CR strategy that decision makers use to quickly find an alternative that is proximate to an ideal alternative in a multi-attribute decision space. CR implies that decision makers prefer alternatives that exhibit concordant ranks between attribute values and attribute weights. We show that, in situations where the alternatives are equal in multi-attribute utility (MAU, minimization of the weighted Euclidean distance (WED to an ideal alternative implies the choice of a CR alternative. In two experiments, participants chose among, as well as evaluated, alternatives that were constructed to be equal in MAU. In Experiment 1, four alternatives were designed in such a way that the choice of each alternative would be consistent with one particular choice strategy, one of which was the CR strategy. In Experiment 2, participants were presented with a CR alternative and a number of arbitrary alternatives. In both experiments, participants tended to choose the CR alternative. The CR alternative was on average evaluated as more attractive than other alternatives. In addition, measures of WED, between given alternatives and the ideal alternative, by and large agreed with the preference order for choices and attractiveness evaluations of the different types of alternatives. These findings indicate that both choices and attractiveness evaluations are guided by proximity of alternatives to an ideal alternative.

  3. A avaliação da concordância verbal com o pronome tu em Florianópolis

    Directory of Open Access Journals (Sweden)

    Christiane Maria Nunes de Souza

    2015-09-01

    Full Text Available http://dx.doi.org/10.5007/1984-8420.2015v16n1p170 Neste artigo, com base nos pressupostos da Sociolinguística Variacionista (WEINREICH, LABOV, HERZOG, 1968; LABOV, 1972, 1982, 1994, 2001, 2010, buscamos indícios de como o fenômeno variável de concordância verbal com o pronome tu (tu/Ø falas ~ tu/Ø fala, tu/Ø  falaste ~ tu/Ø falasse ~ tu/Ø falou é avaliado na cidade de Florianópolis. Com essa finalidade, aplicamos um teste de avaliação a 22 alunos do curso de Economia da Universidade Federal de Santa Catarina (UFSC. Os resultados evidenciam uma correlação entre a diminuição das taxas percentuais de concordância verificada em Florianópolis (LOREGIAN-PENKAL, 2004; DAVET, 2013 e uma avaliação positiva/neutra da não marcação da concordância.

  4. Morbidities, concordance, and predictors of preterm premature rupture of membranes among pregnant women at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria.

    Science.gov (United States)

    Okeke, T C; Enwereji, J O; Adiri, C O; Onwuka, C I; Iferikigwe, E S

    2016-01-01

    Preterm premature rupture of membranes (PPROM) is a challenging complication of pregnancies and an important cause of perinatal morbidity and mortality. Management of morbidities associated with PPROM is fraught with controversy. However, women should be informed of these complications. This article aimed to review the morbidities, concordance, and predictors of PPROM over a 10-year period. This was a retrospective review of morbidities, concordance, and predictors of PPROM among pregnant women at the University of Nigeria Teaching Hospital, Enugu, Nigeria between January 1, 1999, and December 31, 2008. The morbidities, concordance, and predictors of PPROM were expressed by regression analysis output for PPROM. Primigravidae had the highest occurrence of PPROM. Increasing parity does not significantly influence the incidence of PPROM. The concordance and predictors of PPROM are maternal age (P women should be informed of these complications.

  5. Latitudinal variation of European freshwater diversity is not concordant across habitat types

    DEFF Research Database (Denmark)

    Hof, Christian; Brändle, Martin; Brandl, Roland

    of species richness with latitude, but a peak in central Europe. The regions differ in size, but the peak was not due to an area effect. However, the relationship between species richness and latitude was not concordant across the three basic habitat types: Species living in groundwater and running water...... biogeographic regions corroborates this line of arguments....

  6. Numerical modelling of the Concorde wake during ZEBRE

    Energy Technology Data Exchange (ETDEWEB)

    Gierens, K. [Deutsche Forschungsanstalt fuer Luft- und Raumfahrt e.V. (DLR), Oberpfaffenhofen (Germany). Inst. fuer Physik der Atmosphaere

    1997-12-31

    Numerical simulations of the Concorde contrail during the ZEBRE experiment have been performed. The main goal of the simulations is to reproduce the fast vanishing of the contrail which disappeared 20-30 s after exhaust. It is difficult to evaporate ice crystals during the jet and vortex phase of the aircraft wake, when the exhaust products are trapped in the vortex cores. The trapping also excludes spatial dispersion of the ice crystals as an explanation of the short contrail lifetime. The disappearance of the contrail within 20-30 s requires that a substantial part of the exhaust gases escapes from the region that is later on trapped in the vortex cores. (author) 10 refs.

  7. Numerical modelling of the Concorde wake during ZEBRE

    Energy Technology Data Exchange (ETDEWEB)

    Gierens, K [Deutsche Forschungsanstalt fuer Luft- und Raumfahrt e.V. (DLR), Oberpfaffenhofen (Germany). Inst. fuer Physik der Atmosphaere

    1998-12-31

    Numerical simulations of the Concorde contrail during the ZEBRE experiment have been performed. The main goal of the simulations is to reproduce the fast vanishing of the contrail which disappeared 20-30 s after exhaust. It is difficult to evaporate ice crystals during the jet and vortex phase of the aircraft wake, when the exhaust products are trapped in the vortex cores. The trapping also excludes spatial dispersion of the ice crystals as an explanation of the short contrail lifetime. The disappearance of the contrail within 20-30 s requires that a substantial part of the exhaust gases escapes from the region that is later on trapped in the vortex cores. (author) 10 refs.

  8. Young Learners and Lexical Awareness: Children's Engagement with Wordlists and Concordances

    Science.gov (United States)

    MacGregor, Alex

    2014-01-01

    Sinclair (1991) found that lexical analysis can be overcomplicated, yet Johns (1994) called for investigation into whether corpus analysis can motivate beginners and near-beginners. The findings of this research suggest that young EFL learners can enjoy using corpus analysis tools (wordlists and concordances) to identify, classify, and generalize…

  9. Clinical skills-related learning goals of senior medical students after performance feedback.

    Science.gov (United States)

    Chang, Anna; Chou, Calvin L; Teherani, Arianne; Hauer, Karen E

    2011-09-01

    Lifelong learning is essential for doctors to maintain competence in clinical skills. With performance feedback, learners should be able to formulate specific and achievable learning goals in areas of need. We aimed to determine: (i) the type and specificity of medical student learning goals after a required clinical performance examination; (ii) differences in goal setting among low, average and high performers, and (iii) whether low performers articulate learning goals that are concordant with their learning needs. We conducted a single-site, multi-year, descriptive comparison study. Senior medical students were given performance benchmarks, individual feedback and guidelines on learning goals; each student was subsequently instructed to write two clinical skills learning goals. Investigators coded the learning goals for specificity, categorised the goals, and performed statistical analyses to determine their concordance with student performance level (low, average or high) in data gathering (history taking and physical examination) or communication skills. All 208 students each wrote two learning goals and most (n=200, 96%) wrote two specific learning goals. Nearly two-thirds of low performers in data gathering wrote at least one learning goal that referred to history taking or physical examination; one-third wrote learning goals pertaining to the organisation of the encounter. High performers in data gathering wrote significantly more patient education goals and significantly fewer history-taking goals than average or low performers. Only 50% of low performers in communication wrote learning goals related to communication skills. Low performers in communication were significantly more likely than average or high performers to identify learning goals related to improving performance in future examinations. The provision of performance benchmarking, individual feedback and brief written guidelines helped most senior medical students in our study to write specific

  10. Patient factors associated with guideline-concordant treatment of anxiety and depression in primary care.

    NARCIS (Netherlands)

    Prins, M.A.; Verhaak, P.F.; Smolders, M.; Laurant, M.G.H.; Meer, K. de; Spreeuwenberg, P.; Marwijk, H.W.J. van; Penninx, B.W.J.H.; Bensing, J.M.

    2010-01-01

    OBJECTIVE: To identify associations of patient characteristics (predisposing, enabling and need factors) with guideline-concordant care for anxiety and depression in primary care. DESIGN: Analysis of data from the Netherlands Study of Depression and Anxiety (NESDA). PARTICIPANTS: Seven hundred and

  11. Patient factors associated with guideline-concordant treatment of anxiety and depression in primary care

    NARCIS (Netherlands)

    Prins, M.A.; Verhaak, P.; Smolders, M.; Laurant, M.G.H.; van der Meer, K; Spreeuwenberg, P.; van Marwijk, H.W.J.; Penninx, B.W.J.H.; Bensing, J.M.

    2010-01-01

    Objective: To identify associations of patient characteristics (predisposing, enabling and need factors) with guideline-concordant care for anxiety and depression in primary care. Design: Analysis of data from the Netherlands Study of Depression and Anxiety (NESDA). Participants: Seven hundred and

  12. Concordance between a simpler definition of major depressive disorder and Diagnostic and statistical manual of mental disorders, fourth edition: an independent replication in an outpatient sample.

    Science.gov (United States)

    Zimmerman, Mark; Emmert-Aronson, Benjamin O; Brown, Timothy A

    2011-01-01

    The diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV) symptom criteria for major depressive disorder (MDD) are somewhat lengthy with several studies showing that clinicians have difficulty recalling all 9 symptoms. Moreover, the criteria include somatic symptoms that are difficult to apply in patients with medical illnesses. To address these problems, a simpler definition of MDD was developed that did not include the somatic symptoms. Previous reports found high levels of agreement between the simplified and full DSM-IV definition of MDD. However, the same research group has conducted all previous studies of psychiatric patients. The goal of the present study was to determine if a high level of concordance between the 2 definitions would be replicated in an independent setting. We interviewed 2907 psychiatric outpatients presenting for treatment at the Boston University Center for Anxiety and Related Disorders. A trained diagnostic rater administered a semistructured interview and inquired about all symptoms of depression for all patients. A high level of agreement was found between the DSM-IV and the simpler definition of MDD. The absolute level of agreement between the 2 definitions was 95.5% and the κ coefficient was 0.88. Thus, consistent with previous studies, a high level of concordance was found between a simpler definition of MDD and the DSM-IV definition. This new definition offers 2 advantages over the current DSM-IV definition-it is briefer, and it is easier to apply with medically ill patients because it is free of somatic symptoms. Implications of these findings for DSM-5 are discussed. Copyright © 2011 Elsevier Inc. All rights reserved.

  13. Gender Differences in Depressive Symptoms Among HIV-Positive Concordant and Discordant Heterosexual Couples in China.

    Science.gov (United States)

    Li, Li; Liang, Li-Jung; Lin, Chunqing; Ji, Guoping; Xiao, Yongkang

    2017-03-01

    HIV seropositive individuals and their heterosexual partners/spouses, either seropositive or seronegative, are facing several mental health challenges. The objective of this study was to examine gender differences in depressive symptoms among HIV-positive concordant and HIV-discordant couples. We identified heterosexual couples from participants of a randomized controlled trial conducted in Anhui province, China. A total of 265 couples, comprising 129 HIV+ male/HIV- female couples, 98 HIV- male/HIV+ female couples, and 38 HIV-positive concordant couples, were included in the analyses. We collected data using the computer-assisted personal interview method. We used a linear mixed-effects regression model to assess whether gender differences in depressive symptoms varied across couple types. HIV-positive women reported a significantly higher level of depressive symptoms than their partners/spouses. HIV-positive women with HIV-positive partners had higher depressive symptoms than those with HIV-negative partners, whereas HIV-positive men reported similar levels of depressive symptoms regardless of their partners' serostatus. Among the concordant couples, those with the highest annual family income showed the greatest gender differences in depressive symptoms. We suggest that family interventions should be gender- and couple-type specific and that mental health counseling is warranted not only for HIV-positive women but also for HIV-negative women in an HIV-affected relationship.

  14. Giant-cell arteritis. Concordance study between aortic CT angiography and FDG-PET/CT in detection of large-vessel involvement

    International Nuclear Information System (INIS)

    Boysson, Hubert de; Dumont, Anael; Boutemy, Jonathan; Maigne, Gwenola; Martin Silva, Nicolas; Sultan, Audrey; Bienvenu, Boris; Aouba, Achille; Liozon, Eric; Ly, Kim Heang; Lambert, Marc; Aide, Nicolas; Manrique, Alain

    2017-01-01

    The purpose of our study was to assess the concordance of aortic CT angiography (CTA) and FDG-PET/CT in the detection of large-vessel involvement at diagnosis in patients with giant-cell arteritis (GCA). We created a multicenter cohort of patients with GCA diagnosed between 2010 and 2015, and who underwent both FDG-PET/CT and aortic CTA before or in the first ten days following treatment introduction. Eight vascular segments were studied on each procedure. We calculated concordance between both imaging techniques in a per-patient and a per-segment analysis, using Cohen's kappa concordance index. We included 28 patients (21/7 women/men, median age 67 [56-82]). Nineteen patients had large-vessel involvement on PET/CT and 18 of these patients also presented positive findings on CTA. In a per-segment analysis, a median of 5 [1-7] and 3 [1-6] vascular territories were involved on positive PET/CT and CTA, respectively (p = 0.03). In qualitative analysis, i.e., positivity of the procedure suggesting a large-vessel involvement, the concordance rate between both procedures was 0.85 [0.64-1]. In quantitative analysis, i.e., per-segment analysis in both procedures, the global concordance rate was 0.64 [0.54-0.75]. Using FDG-PET/CT as a reference, CTA showed excellent sensitivity (95%) and specificity (100%) in a per-patient analysis. In a per-segment analysis, sensitivity and specificity were 61% and 97.9%, respectively. CTA and FDG-PET/CT were both able to detect large-vessel involvement in GCA with comparable results in a per-patient analysis. However, PET/CT showed higher performance in a per-segment analysis, especially in the detection of inflammation of the aorta's branches. (orig.)

  15. Giant-cell arteritis. Concordance study between aortic CT angiography and FDG-PET/CT in detection of large-vessel involvement

    Energy Technology Data Exchange (ETDEWEB)

    Boysson, Hubert de; Dumont, Anael; Boutemy, Jonathan; Maigne, Gwenola; Martin Silva, Nicolas; Sultan, Audrey; Bienvenu, Boris; Aouba, Achille [Caen University Hospital, Department of Internal Medicine, Caen (France); Liozon, Eric; Ly, Kim Heang [Limoges University Hospital, Department of Internal Medicine, Limoges (France); Lambert, Marc [Lille University Hospital, Department of Internal Medicine, Lille (France); Aide, Nicolas [Caen University Hospital, Department of Nuclear Medicine, Caen (France); INSERM U1086 ' ' ANTICIPE' ' , Francois Baclesse Cancer Centre, Caen (France); Manrique, Alain [Caen University Hospital, Department of Nuclear Medicine, Caen (France); Normandy University, Caen (France)

    2017-12-15

    The purpose of our study was to assess the concordance of aortic CT angiography (CTA) and FDG-PET/CT in the detection of large-vessel involvement at diagnosis in patients with giant-cell arteritis (GCA). We created a multicenter cohort of patients with GCA diagnosed between 2010 and 2015, and who underwent both FDG-PET/CT and aortic CTA before or in the first ten days following treatment introduction. Eight vascular segments were studied on each procedure. We calculated concordance between both imaging techniques in a per-patient and a per-segment analysis, using Cohen's kappa concordance index. We included 28 patients (21/7 women/men, median age 67 [56-82]). Nineteen patients had large-vessel involvement on PET/CT and 18 of these patients also presented positive findings on CTA. In a per-segment analysis, a median of 5 [1-7] and 3 [1-6] vascular territories were involved on positive PET/CT and CTA, respectively (p = 0.03). In qualitative analysis, i.e., positivity of the procedure suggesting a large-vessel involvement, the concordance rate between both procedures was 0.85 [0.64-1]. In quantitative analysis, i.e., per-segment analysis in both procedures, the global concordance rate was 0.64 [0.54-0.75]. Using FDG-PET/CT as a reference, CTA showed excellent sensitivity (95%) and specificity (100%) in a per-patient analysis. In a per-segment analysis, sensitivity and specificity were 61% and 97.9%, respectively. CTA and FDG-PET/CT were both able to detect large-vessel involvement in GCA with comparable results in a per-patient analysis. However, PET/CT showed higher performance in a per-segment analysis, especially in the detection of inflammation of the aorta's branches. (orig.)

  16. Concept of Operations Evaluation for Mitigating Space Flight-Relevant Medical Issues in a Planetary Habitat

    Science.gov (United States)

    Barsten, Kristina; Hurst, Victor, IV; Scheuring, Richard; Baumann, David K.; Johnson-Throop, Kathy

    2010-01-01

    Introduction: Analogue environments assist the NASA Human Research Program (HRP) in developing capabilities to mitigate high risk issues to crew health and performance for space exploration. The Habitat Demonstration Unit (HDU) is an analogue habitat used to assess space-related products for planetary missions. The Exploration Medical Capability (ExMC) element at the NASA Johnson Space Center (JSC) was tasked with developing planetary-relevant medical scenarios to evaluate the concept of operations for mitigating medical issues in such an environment. Methods: Two medical scenarios were conducted within the simulated planetary habitat with the crew executing two space flight-relevant procedures: Eye Examination with a corneal injury and Skin Laceration. Remote guidance for the crew was provided by a flight surgeon (FS) stationed at a console outside of the habitat. Audio and video data were collected to capture the communication between the crew and the FS, as well as the movements of the crew executing the procedures. Questionnaire data regarding procedure content and remote guidance performance also were collected from the crew immediately after the sessions. Results: Preliminary review of the audio, video, and questionnaire data from the two scenarios conducted within the HDU indicate that remote guidance techniques from an FS on console can help crew members within a planetary habitat mitigate planetary-relevant medical issues. The content and format of the procedures were considered concise and intuitive, respectively. Discussion: Overall, the preliminary data from the evaluation suggest that use of remote guidance techniques by a FS can help HDU crew execute space exploration-relevant medical procedures within a habitat relevant to planetary missions, however further evaluations will be needed to implement this strategy into the complete concept of operations for conducting general space medicine within similar environments

  17. Concord Grape Juice Polyphenols and Cardiovascular Risk Factors: Dose-Response Relationships

    Science.gov (United States)

    Blumberg, Jeffrey B.; Vita, Joseph A.; Chen, C. -Y. Oliver

    2015-01-01

    Pure fruit juices provide nutritional value with evidence suggesting some of their benefits on biomarkers of cardiovascular disease risk may be derived from their constituent polyphenols, particularly flavonoids. However, few data from clinical trials are available on the dose-response relationship of fruit juice flavonoids to these outcomes. Utilizing the results of clinical trials testing single doses, we have analyzed data from studies of 100% Concord grape juice by placing its flavonoid content in the context of results from randomized clinical trials of other polyphenol-rich foods and beverages describing the same outcomes but covering a broader range of intake. We selected established biomarkers determined by similar methods for measuring flow-mediated vasodilation (FMD), blood pressure, platelet aggregation, and the resistance of low density lipoprotein cholesterol (LDL) to oxidation. Despite differences among the clinical trials in the treatment, subjects, and duration, correlations were observed between the dose and FMD. Inverse dose-response relationships, albeit with lower correlation coefficients, were also noted for the other outcomes. These results suggest a clear relationship between consumption of even modest serving sizes of Concord grape juice, flavonoid intake, and effects on risk factors for cardiovascular disease. This approach to dose-response relationships may prove useful for testing other individual foods and beverages. PMID:26633488

  18. Concordant pressure paresthesia during interlaminar lumbar epidural steroid injections correlates with pain relief in patients with unilateral radicular pain.

    Science.gov (United States)

    Candido, Kenneth D; Rana, Maunak V; Sauer, Ruben; Chupatanakul, Lalida; Tharian, Antony; Vasic, Vladimir; Knezevic, Nebojsa Nick

    2013-01-01

    Transforaminal and interlaminar epidural steroid injections are commonly used interventional pain management procedures in the treatment of radicular low back pain. Even though several studies have shown that transforaminal injections provide enhanced short-term outcomes in patients with radicular and low back pain, they have also been associated with a higher incidence of unintentional intravascular injection and often dire consequences than have interlaminar injections. We compared 2 different approaches, midline and lateral parasagittal, of lumbar interlaminar epidural steroid injection (LESI) in patients with unilateral lumbosacral radiculopathic pain. We also tested the role of concordant pressure paresthesia occurring during LESI as a prognostic factor in determining the efficacy of LESI. Prospective, randomized, blinded study. Pain management center, part of a teaching-community hospital in a major metropolitan US city. After Institutional Review Board approval, 106 patients undergoing LESI for radicular low back pain were randomly assigned to one of 2 groups (53 patients each) based on approach: midline interlaminar (MIL) and lateral parasagittal interlaminar (PIL). Patients were asked to grade any pressure paresthesia as occurring ipsilaterally or contralaterally to their "usual and customary pain," or in a distribution atypical of their daily pain. Other variables such as: the Oswestry Disability Index questionnaire, pain scores at rest and during movement, use of pain medications, etc. were recorded 20 minutes before the procedure, and on days 1, 7, 14, 21, 28, 60, 120, 180 and 365 after the injection. Results of this study showed statistically and clinically significant pain relief in patients undergoing LESI by both the MIL and PIL approaches. Patients receiving LESI using the lateral parasagittal approach had statistically and clinically longer pain relief then patients receiving LESI via a midline approach. They also had slightly better quality of

  19. Parent and Teacher Concordance of Child Outcomes for Youth with Autism Spectrum Disorder

    Science.gov (United States)

    Dickson, Kelsey S.; Suhrheinrich, Jessica; Rieth, Sarah R.; Stahmer, Aubyn C.

    2018-01-01

    Cross-informant ratings of are considered gold standard for child behavioral assessment. To date, little work has examined informant ratings of adaptive functioning for youth with autism spectrum disorder (ASD). In a large, diverse sample of youth with ASD, this study evaluated parent-teacher concordance of ratings of adaptive functioning and…

  20. Patient Factors Associated with Guideline-concordant Treatment of Anxiety and Depression in Primary Care

    NARCIS (Netherlands)

    Prins, Marijn A.; Verhaak, Peter F. M.; Smolders, Mirrian; Laurant, Miranda G. H.; van der Meer, Klaas; Spreeuwenberg, Peter; van Marwijk, Harm W. J.; Penninx, Brenda W. J. H.; Bensing, Jozien M.

    To identify associations of patient characteristics (predisposing, enabling and need factors) with guideline-concordant care for anxiety and depression in primary care. Analysis of data from the Netherlands Study of Depression and Anxiety (NESDA). Seven hundred and twenty-one patients with a current

  1. Concordance-based Kendall's Correlation for Computationally-Light vs. Computationally-Heavy Centrality Metrics: Lower Bound for Correlation

    Directory of Open Access Journals (Sweden)

    Natarajan Meghanathan

    2017-01-01

    Full Text Available We identify three different levels of correlation (pair-wise relative ordering, network-wide ranking and linear regression that could be assessed between a computationally-light centrality metric and a computationally-heavy centrality metric for real-world networks. The Kendall's concordance-based correlation measure could be used to quantitatively assess how well we could consider the relative ordering of two vertices vi and vj with respect to a computationally-light centrality metric as the relative ordering of the same two vertices with respect to a computationally-heavy centrality metric. We hypothesize that the pair-wise relative ordering (concordance-based assessment of the correlation between centrality metrics is the most strictest of all the three levels of correlation and claim that the Kendall's concordance-based correlation coefficient will be lower than the correlation coefficient observed with the more relaxed levels of correlation measures (linear regression-based Pearson's product-moment correlation coefficient and the network wide ranking-based Spearman's correlation coefficient. We validate our hypothesis by evaluating the three correlation coefficients between two sets of centrality metrics: the computationally-light degree and local clustering coefficient complement-based degree centrality metrics and the computationally-heavy eigenvector centrality, betweenness centrality and closeness centrality metrics for a diverse collection of 50 real-world networks.

  2. Surgical site infections among high-risk patients in clean-contaminated head and neck reconstructive surgery: concordance with preoperative oral flora.

    Science.gov (United States)

    Yang, Ching-Hsiang; Chew, Khong-Yik; Solomkin, Joseph S; Lin, Pao-Yuan; Chiang, Yuan-Cheng; Kuo, Yur-Ren

    2013-12-01

    Salivary contamination of surgical wounds in clean-contaminated head and neck surgery with free flap reconstruction remains a major cause of infection and leads to significant morbidity. This study investigates the correlation between intraoral flora and surgical site infections (SSIs) among high-risk head and neck cancer patients undergoing resection and free flap reconstruction. One hundred twenty-nine patients were identified as being at high risk for infective complications based on cancer stage, tumor size, comorbid factors, and extent of reconstruction. All patients had intraoral swab cultures before surgery. Patients with culture-confirmed SSI after surgery were chosen for analysis, using the κ index and its 95% confidence interval for concordance analysis. All patients received clindamycin and gentamicin for antibiotic prophylaxis for 5 days. Antibiotic susceptibility testing of all isolates was obtained and analyzed. Thirty-seven patients experienced SSI, or an infection rate of 28.3%, occurring at a mean of 9.3 postoperative days. The overall concordance between oral flora and SSI was fair to moderate (κ index of 0.25), but detailed analysis shows a higher concordance for known and opportunistic pathogens, such as Pseudomonas aeruginosa and Enterococcus faecalis, compared to typical oral commensals. Antibiotic susceptibility tests show rapid and significant increases in resistance to clindamycin, indicating a need for a more effective alternative. Predicting pathogens in SSI using preoperative oral swabs did not demonstrate a good concordance in general for patients undergoing clean-contaminated head and neck surgery, although concordance for certain pathogenic species seem to be higher than for typical intraoral commensals. The rapid development of resistance to clindamycin precludes its use as a prophylactic agent.

  3. [Concordance of glomerular filtration rate with creatinine clearance in 24-hour urine and Schwartz and Schwartz updated].

    Science.gov (United States)

    Salazar-Gutiérrez, María Luisa; Ochoa-Ponce, Cristina; Lona-Reyes, Juan Carlos; Gutiérrez-Íñiguez, Sara Ivonne

    Reference methods for the quantification of the glomerular filtration rate (GFR) are difficult to use in clinical practice; formulas for evaluating GFR based on serum creatinine (SCr) and/or creatinine clearance are used. The aim of this study was to quantify the correlation and concordance of GFR with creatinine clearance in 24-hour urine (GFR24) and Schwartz and Schwartz updated formulas. Cross-sectional study involving healthy pediatric patients and with chronic kidney disease (CKD) from 5 to 16.9 years. Linear correlation between GFR 24 and two formulas was evaluated with the Pearson correlation coefficient (r) and intraclass correlation coefficient (ICC). We studied 134 patients, of which 59.7% were male. Mean age was 10.8 years. The average GFR24 was 140.34ml/min/1.73m 2 ; 34.3% (n=46) had GFR <90ml/min/1.73m 2 . Moderate linear correlation between GFR24 and Schwartz (r= 0.63) and Schwartz updated (r= 0.65) formulas was observed. There was good concordance between the GFR24 and Schwartz (ICC= 0.77) and updated Schwartz (ICC= 0.77) formulas. Schwartz classical formula in patients with GFR24 ≥ 90ml/min/1.73m 2 estimated higher values, while Schwartz updated underestimated values. There is moderate correlation and good concordance between the GFR24 and Schwartz and Schwartz updated formulas. The concordance was better in patients with obesity and lower in women, patients with hyperfiltration and normal weight. Copyright © 2016 Hospital Infantil de México Federico Gómez. Publicado por Masson Doyma México S.A. All rights reserved.

  4. CHRONIC MEDICAL CONDITIONS AND REPRODUCIBILITY OF SELF-REPORTED AGE AT MENOPAUSE AMONG COMMUNITY DWELLING WOMEN

    Science.gov (United States)

    de Vries, Heather F.; Northington, Gina M.; Kaye, Elise M.; Bogner, Hillary R.

    2011-01-01

    OBJECTIVE To examine the association between chronic medical conditions and reproducibility of self-reported age at menopause among community-dwelling women. METHOD Age at menopause was assessed in a population-based longitudinal survey of 240 women twice, in 1993 and 2004. Women who recalled age at menopause in 2004 within one year or less of the age at menopause recalled in 1993 (concordant) were compared with women who did not recall of age at menopause in 2004 within 1 year of age at menopause recalled in 1993 (discordant). Type of menopause (surgical or natural) and chronic medical conditions were assessed by self-report. RESULTS One hundred and forty three women (59.6%) reported surgical menopause and 97 (40.4%) reported natural menopause. In all, 130 (54.2%) of women recalled age at menopause in 2004 within one year or less of recalled age at menopause in 1994 while 110 (45.8%) women did not recall age at menopause in 2004 within one year or less of recalled age at menopause in 1994. Among women with surgical menopause, women with three or more medical conditions were less likely to have concordant recall of age at menopause than women with less than three chronic medical conditions (adjusted odds ratio (OR) = 0.36, 95% confidence interval (CI) [0.15, 0.91]) in multivariate models controlling for potentially influential characteristics including cognition and years from menopause. CONCLUSIONS Among women who underwent surgical menopause, the presence of three or more medical conditions is associated with decreased reproducibility of self-reported age at menopause. PMID:21971208

  5. Chronic medical conditions and reproducibility of self-reported age at menopause among community-dwelling women.

    Science.gov (United States)

    de Vries, Heather F; Northington, Gina M; Kaye, Elise M; Bogner, Hillary R

    2011-12-01

    The aim of this study was to examine the association between chronic medical conditions and reproducibility of self-reported age at menopause among community-dwelling women. Age at menopause was assessed in a population-based longitudinal survey of 240 women twice, in 1993 and 2004. Women who recalled age at menopause in 2004 within 1 year or less of age at menopause recalled in 1993 (concordant) were compared with women who did not recall age at menopause in 2004 within 1 year of age at menopause recalled in 1993 (discordant). Type of menopause (surgical or natural) and chronic medical conditions were assessed by self-report. One hundred forty-three women (59.6%) reported surgical menopause, and 97 (40.4%) reported natural menopause. In all, 130 (54.2%) women recalled age at menopause in 2004 within 1 year or less of recalled age at menopause in 1994, whereas 110 (45.8%) women did not recall age at menopause in 2004 within 1 year or less of recalled age at menopause in 1994. Among the women with surgical menopause, the women with three or more medical conditions were less likely to have concordant recall of age at menopause than the women with less than three chronic medical conditions (adjusted odds ratio, 0.36; 95% CI, 0.15-0.91) in multivariate models controlling for potentially influential characteristics including cognition and years since menopause. Among women who underwent surgical menopause, the presence of three or more medical conditions is associated with decreased reproducibility of self-reported age at menopause.

  6. Intergeracionalidade de estilos educativos parentais : continuidade ou mudança? : concordância ou discordância?

    OpenAIRE

    Marques, Joana Isabel Correia

    2012-01-01

    Tese de mestrado, Psicologia (Secção de Psicologia Clínica e da Saúde - Núcleo de Psicologia Clínica Sistémica), Universidade de Lisboa, Faculdade de Psicologia, 2012 O presente estudo exploratório, baseado numa abordagem qualitativa, tem como objectivo estudar a continuidade e concordância entre os Estilos Educativos Parentais dos Avós (Geração 1 – G1) e dos Pais (Geração 2 - G2), e a concordância e discordância na percepção dos Estilos Educativos Parentais (EEP) entre os Pais (G2) e Filh...

  7. Clinical, mammographic, and pathologic concordance in breast cancer

    International Nuclear Information System (INIS)

    Rodriguez Cascaret, Argenis; Martin Rodriguez, Andres; Hernandez Castellanos, Kirenia

    2011-01-01

    An observational descriptive and cross-sectional study was carried out in 100 patients with breast cancer, who attended the Breast Care Department at 'Conrado Benitez' Teaching Oncology Hospital in Santiago de Cuba from August 2009 to July 2010, to characterize them according to imaging, pathological, clinical, and general variables. Percentage as summary measure to statically validate the results and Kappa index to determine diagnostic concordance were used. Women between 40-49 years with history of fibrocystic breast disease and palpable lesions, as well as lump in the right breast, upper outer quadrant and periphery of the breast, tumor greater than one centimeter in diameter and infiltrating ductal carcinoma in the stages III-b and IV prevailed in the case material.(author)

  8. Performance Support Tools for Space Medical Operations

    Science.gov (United States)

    Byrne, Vicky E.; Schmidt, Josef; Barshi, Immanuel

    2009-01-01

    The early Constellation space missions are expected to have medical capabilities very similar to those currently on the Space Shuttle and International Space Station (ISS). For Crew Exploration Vehicle (CEV) missions to ISS, medical equipment will be located on ISS, and carried into CEV in the event of an emergency. Flight Surgeons (FS) on the ground in Mission Control will be expected to direct the Crew Medical Officer (CMO) during medical situations. If there is a loss of signal and the crew is unable to communicate with the ground, a CMO would be expected to carry out medical procedures without the aid of a FS. In these situations, performance support tools can be used to reduce errors and time to perform emergency medical tasks. Human factors personnel at Johnson Space Center have recently investigated medical performance support tools for CMOs on-orbit, and FSs on the ground. This area of research involved the feasibility of Just-in-time (JIT) training techniques and concepts for real-time medical procedures. In Phase 1, preliminary feasibility data was gathered for two types of prototype display technologies: a hand-held PDA, and a Head Mounted Display (HMD). The PDA and HMD were compared while performing a simulated medical procedure using ISS flight-like medical equipment. Based on the outcome of Phase 1, including data on user preferences, further testing was completed using the PDA only. Phase 2 explored a wrist-mounted PDA, and compared it to a paper cue card. For each phase, time to complete procedures, errors, and user satisfaction were captured. Information needed by the FS during ISS mission support, especially for an emergency situation (e.g. fire onboard ISS), may be located in many different places around the FS s console. A performance support tool prototype is being developed to address this issue by bringing all of the relevant information together in one place. The tool is designed to include procedures and other information needed by a FS

  9. Beyond concordance cosmology with magnification of gravitational-wave standard sirens.

    Science.gov (United States)

    Camera, Stefano; Nishizawa, Atsushi

    2013-04-12

    We show how future gravitational-wave detectors would be able to discriminate between the concordance Λ cold dark matter cosmological model and up-to-date competing alternatives, e.g., dynamical dark energy (DE) models or modified gravity (MG) theories. Our method consists of using the weak-lensing magnification effect that affects a standard-siren signal because of its traveling through the Universe's large scale structure. As a demonstration, we present constraints on DE and MG from proposed gravitational-wave detectors, namely Einstein Telescope and DECI-Hertz Interferometer Gravitational-Wave Observatory and Big-Bang Observer.

  10. Integrated cosmological probes: concordance quantified

    Energy Technology Data Exchange (ETDEWEB)

    Nicola, Andrina; Amara, Adam; Refregier, Alexandre, E-mail: andrina.nicola@phys.ethz.ch, E-mail: adam.amara@phys.ethz.ch, E-mail: alexandre.refregier@phys.ethz.ch [Department of Physics, ETH Zürich, Wolfgang-Pauli-Strasse 27, CH-8093 Zürich (Switzerland)

    2017-10-01

    Assessing the consistency of parameter constraints derived from different cosmological probes is an important way to test the validity of the underlying cosmological model. In an earlier work [1], we computed constraints on cosmological parameters for ΛCDM from an integrated analysis of CMB temperature anisotropies and CMB lensing from Planck, galaxy clustering and weak lensing from SDSS, weak lensing from DES SV as well as Type Ia supernovae and Hubble parameter measurements. In this work, we extend this analysis and quantify the concordance between the derived constraints and those derived by the Planck Collaboration as well as WMAP9, SPT and ACT. As a measure for consistency, we use the Surprise statistic [2], which is based on the relative entropy. In the framework of a flat ΛCDM cosmological model, we find all data sets to be consistent with one another at a level of less than 1σ. We highlight that the relative entropy is sensitive to inconsistencies in the models that are used in different parts of the analysis. In particular, inconsistent assumptions for the neutrino mass break its invariance on the parameter choice. When consistent model assumptions are used, the data sets considered in this work all agree with each other and ΛCDM, without evidence for tensions.

  11. Concordancia entre el diagnóstico clínico y el patológico por necropsias Clinico-pathological concordance at autopsies

    Directory of Open Access Journals (Sweden)

    EDITH VALDEZ-MARTÍNEZ

    1998-01-01

    Full Text Available Objetivo. Determinar la concordancia entre diagnósticos clínicos y patológicos con base en los resultados de necropsias. Material y métodos. Se revisaron 67 protocolos de necropsia y expedientes clínicos de niños y adultos del servicio de patología del Centro de Especialidades Médicas del Estado de Veracruz Doctor Rafael Lucio, durante 1995 y 1996. Se obtuvieron las frecuencias simples de las variables de estudio, y la concordancia se calculó con el estadístico kappa simple. Resultados. En general la cifra de necropsias fue de 10.5%. Correspondió a la población infantil la mayor frecuencia (17.5%. El 59% de diagnósticos clínicos en niños y el 57% en adultos presentaron algún tipo de error La concordancia del diagnóstico principal ante y postmortem fue de 26% (infantes y 41% (adultos. Conclusiones. La alta cifra de errores diagnósticos y la consecuente baja concordancia clínicopatológica apoyan el hecho de que, a pesar del avance tecnológico en los procedimientos diagnósticos, es necesario realizar necropsias con el fin de documentar de manera más definitiva el control de calidad del ejercicio de la medicina.Objective. To determine the degree of concordance between clinical and autopsy diagnosis. Material and methods. The records of 67 autopsies and clinical files of children and adults, comprising the years 1995 to 1996, from a third level hospital in the State of Veracruz, Mexico, were revised. The concordance score was calculated with the statistical kappa. Results. In general, the rate of autopsy was 10.5%, with higher frequency for children (17.5%. In children, 59% of clinical diagnoses revealed mistakes and in adults, 57%. The degree of agreement in the underlying cause ante and postmortem was 6% in children and 41% in adults. Conclusions The high rate of diagnostic error and low concordance score between clinical and autopsy diagnosis strongly suggests that, in spite of increased availability of modern diagnostic

  12. Assessing Concordance of Drug-Induced Transcriptional Response in Rodent Liver and Cultured Hepatocytes.

    Directory of Open Access Journals (Sweden)

    Jeffrey J Sutherland

    2016-03-01

    Full Text Available The effect of drugs, disease and other perturbations on mRNA levels are studied using gene expression microarrays or RNA-seq, with the goal of understanding molecular effects arising from the perturbation. Previous comparisons of reproducibility across laboratories have been limited in scale and focused on a single model. The use of model systems, such as cultured primary cells or cancer cell lines, assumes that mechanistic insights derived from the models would have been observed via in vivo studies. We examined the concordance of compound-induced transcriptional changes using data from several sources: rat liver and rat primary hepatocytes (RPH from Drug Matrix (DM and open TG-GATEs (TG, human primary hepatocytes (HPH from TG, and mouse liver/HepG2 results from the Gene Expression Omnibus (GEO repository. Gene expression changes for treatments were normalized to controls and analyzed with three methods: 1 gene level for 9071 high expression genes in rat liver, 2 gene set analysis (GSA using canonical pathways and gene ontology sets, 3 weighted gene co-expression network analysis (WGCNA. Co-expression networks performed better than genes or GSA when comparing treatment effects within rat liver and rat vs. mouse liver. Genes and modules performed similarly at Connectivity Map-style analyses, where success at identifying similar treatments among a collection of reference profiles is the goal. Comparisons between rat liver and RPH, and those between RPH, HPH and HepG2 cells reveal lower concordance for all methods. We observe that the baseline state of untreated cultured cells relative to untreated rat liver shows striking similarity with toxicant-exposed cells in vivo, indicating that gross systems level perturbation in the underlying networks in culture may contribute to the low concordance.

  13. Justify Your Answer: The Role of Written Think Aloud in Script Concordance Testing.

    Science.gov (United States)

    Power, Alyssa; Lemay, Jean-Francois; Cooke, Suzette

    2017-01-01

    Construct: Clinical reasoning assessment is a growing area of interest in the medical education literature. Script concordance testing (SCT) evaluates clinical reasoning in conditions of uncertainty and has emerged as an innovative tool in the domain of clinical reasoning assessment. SCT quantifies the degree of concordance between a learner and an experienced clinician and attempts to capture the breadth of responses of expert clinicians, acknowledging the significant yet acceptable variation in practice under situations of uncertainty. SCT has been shown to be a valid and reliable clinical reasoning assessment tool. However, as SCT provides only quantitative information, it may not provide a complete assessment of clinical reasoning. Think aloud (TA) is a qualitative research tool used in clinical reasoning assessment in which learners verbalize their thought process around an assigned task. This study explores the use of TA, in the form of written reflection, in SCT to assess resident clinical reasoning, hypothesizing that the information obtained from the written TA would enrich the quantitative data obtained through SCT. Ninety-one pediatric postgraduate trainees and 21 pediatricians from 4 Canadian training centers completed an online test consisting of 24 SCT cases immediately followed by retrospective written TA. Six of 24 cases were selected to gather TA data. These cases were chosen to allow all phases of clinical decision making (diagnosis, investigation, and treatment) to be represented in the TA data. Inductive thematic analysis was employed when systematically reviewing TA responses. Three main benefits of adding written TA to SCT were identified: (a) uncovering instances of incorrect clinical reasoning despite a correct SCT response, (b) revealing sound clinical reasoning in the context of a suboptimal SCT response, and (c) detecting question misinterpretation. Written TA can optimize SCT by demonstrating when correct examinee responses are based on

  14. Concordance analysis for QTL detection in dairy cattle: a case study of leg morphology

    DEFF Research Database (Denmark)

    van den Berg, Irene; Rodrigue; Fritz, Sebastien

    2014-01-01

    The present availability of sequence data gives new opportunities to narrow down from QTL (quantitative trait locus) regions to causative mutations. Our objective was to decrease the number of candidate causative mutations in a QTL region. For this, a concordance analysis was applied for a leg co...

  15. Analysis of reliability of professor recommendation letters based on concordance with self-introduction letter.

    Science.gov (United States)

    Kim, Sang Hyun

    2013-12-01

    The purpose of this study was to examine the concordance between a checklist's categories of professor recommendation letters and characteristics of the self-introduction letter. Checklists of professor recommendation letters were analyzed and classified into cognitive, social, and affective domains. Simple correlation was performed to determine whether the characteristics of the checklists were concordant with those of the self-introduction letter. The difference in ratings of the checklists by pass or fail grades was analyzed by independent sample t-test. Logistic regression analysis was performed to determine whether a pass or fail grade was influenced by ratings on the checklists. The Cronbach alpha value of the checklists was 0.854. Initiative, as an affective domain, in the professor's recommendation letter was highly ranked among the six checklist categories. Self-directed learning in the self-introduction letter was influenced by a pass or fail grade by logistic regression analysis (pprofessor recommendation letters and the sum of all characteristics in the self-introduction letter.

  16. MEDIC: medical embedded device for individualized care.

    Science.gov (United States)

    Wu, Winston H; Bui, Alex A T; Batalin, Maxim A; Au, Lawrence K; Binney, Jonathan D; Kaiser, William J

    2008-02-01

    Presented work highlights the development and initial validation of a medical embedded device for individualized care (MEDIC), which is based on a novel software architecture, enabling sensor management and disease prediction capabilities, and commercially available microelectronic components, sensors and conventional personal digital assistant (PDA) (or a cell phone). In this paper, we present a general architecture for a wearable sensor system that can be customized to an individual patient's needs. This architecture is based on embedded artificial intelligence that permits autonomous operation, sensor management and inference, and may be applied to a general purpose wearable medical diagnostics. A prototype of the system has been developed based on a standard PDA and wireless sensor nodes equipped with commercially available Bluetooth radio components, permitting real-time streaming of high-bandwidth data from various physiological and contextual sensors. We also present the results of abnormal gait diagnosis using the complete system from our evaluation, and illustrate how the wearable system and its operation can be remotely configured and managed by either enterprise systems or medical personnel at centralized locations. By using commercially available hardware components and software architecture presented in this paper, the MEDIC system can be rapidly configured, providing medical researchers with broadband sensor data from remote patients and platform access to best adapt operation for diagnostic operation objectives.

  17. Concordance of Time-of-Flight MRA and Digital Subtraction Angiography in Adult Primary Central Nervous System Vasculitis.

    Science.gov (United States)

    de Boysson, H; Boulouis, G; Parienti, J-J; Touzé, E; Zuber, M; Arquizan, C; Dequatre, N; Detante, O; Bienvenu, B; Aouba, A; Guillevin, L; Pagnoux, C; Naggara, O

    2017-10-01

    3D-TOF-MRA and DSA are 2 available tools to demonstrate neurovascular involvement in primary central nervous system vasculitis. We aimed to compare the diagnostic concordance of vessel imaging using 3D-TOF-MRA and DSA in patients with primary central nervous system vasculitis. We retrospectively identified all patients included in the French primary central nervous system vasculitis cohort of 85 patients who underwent, at baseline, both intracranial 3D-TOF-MRA and DSA in an interval of no more than 2 weeks and before treatment initiation. Two neuroradiologists independently reviewed all 3D-TOF-MRA and DSA imaging. Brain vasculature was divided into 25 arterial segments. Concordance between 3D-TOF-MRA and DSA for the identification of arterial stenosis was assessed by the Cohen κ Index. Thirty-one patients met the inclusion criteria, including 20 imaged with a 1.5T MR unit and 11 with a 3T MR unit. Among the 25 patients (81%) with abnormal DSA findings, 24 demonstrated abnormal 3D-TOF-MRA findings, whereas all 6 remaining patients with normal DSA findings had normal 3D-TOF-MRA findings. In the per-segment analysis, concordance between 1.5T 3D-TOF-MRA and DSA was 0.82 (95% CI, 0.75-0.93), and between 3T 3D-TOF-MRA and DSA, it was 0.87 (95% CI, 0.78-0.91). 3D-TOF-MRA shows a high concordance with DSA in diagnostic performance when analyzing brain vasculature in patients with primary central nervous system vasculitis. In patients with negative 3T 3D-TOF-MRA findings, the added diagnostic value of DSA is limited. © 2017 by American Journal of Neuroradiology.

  18. Concordance of the late night salivary cortisol in patients with Cushing's syndrome and elevated urine-free cortisol.

    Science.gov (United States)

    Doi, Suhail A R; Clark, Justin; Russell, Anthony W

    2013-04-01

    The concordance of the late night salivary cortisol (LNSC) results with the 24-h urine-free cortisol (UFC) results in the biochemical screening for Cushing's syndrome is unknown. We investigated this in a population of Cushing's syndrome subjects. We used meta-analytic methods to pool proportions of LNSC-positive subjects from diagnostic evaluations of Cushing's syndrome subjects where both tests were performed and the UFC was elevated (any level). Cushing's syndrome was confirmed in all subjects by two out of three conventional tests. LNSC was collected between 22:00 to 24:00 h and measured around the same time period as the UFC. Minimum cutoffs of ≥4 and ≥10 nmol/L were used to determine concordance with the UFC and studies were limited to those that used radioimmunoassays or electrochemiluminiscence immunoassays for LNSC. The concordance of LNSC ≥4 nmol/L was 97 % (95 % CI 95-99 %) and studies were homogeneous. With LNSC ≥10 nmol/L, there was heterogeneity and two groups were discernible with a pooled concordance of 69 % (95 % CI 60-77 %) and 95 % (95 % CI 92-97 %). Within these sub-groups, studies were homogeneous and there was no difference between them in collection methods, assays used, geographic location, year of publication, or the quality of the underlying studies. The LNSC at a very specific cutoff detects at best 95 % of cases and at worst 69 % of cases of Cushing's syndrome that are UFC positive. The two tests become equivalent at the more sensitive cutoff (>4 nmol/L). We conclude that, given its many benefits and the currently documented equivalence to the UFC, the LNSC should replace the conventional 24-h UFC as the frontline test when screening for Cushing's syndrome.

  19. The Role of Medication in Supporting Emotional Wellbeing in Young People with Long-Term Needs

    Directory of Open Access Journals (Sweden)

    Nicola J. Gray

    2017-11-01

    Full Text Available Young people frequently use and access prescribed medications for a range of health problems. Medications aimed at treating both common health problems and long-term physical and mental health needs in adolescence can have a significant effect on a young person’s emotional well-being. We use a series of case studies to illustrate the challenges for healthcare professionals supporting young people with medication use. The studies illustrate the efficacy and limitations of medication on improving emotional well-being by alleviating illness and distress, and how this efficacy must be balanced against both the adverse effects and the burden of treatment. There are specific challenges for medication management during adolescence including issues of adherence/concordance, facilitating autonomy and participation in decision making, and promoting independence.

  20. The lifesaving potential of specialized on-scene medical support for urban tactical operations.

    Science.gov (United States)

    Metzger, Jeffery C; Eastman, Alexander L; Benitez, Fernando L; Pepe, Paul E

    2009-01-01

    Since the 1980s, the specialized field of tactical medicine has evolved with growing support from numerous law-enforcement and medical organizations. On-scene backup from tactical emergency medical support (TEMS) providers has not only permitted more immediate advanced medical aid to injured officers, victims, bystanders, and suspects, but also allows for rapid after-incident medical screening or minor treatments that can obviate an unnecessary transport to an emergency department. The purpose of this report is to document one very explicit benefit of TEMS deployment, namely, a situation in which a police officer's life was saved by the routine on-scene presence of specialized TEMS physicians. In this specific case, a police officer was shot in the anterior neck during a law-enforcement operation and became moribund with massive hemorrhage and compromised airway. Two TEMS physicians, who had been integrated into the tactical law-enforcement team, were on scene, controlled the hemorrhage, and provided a surgical airway. By the time of arrival at the hospital, the patient had begun purposeful movements and, within 12 hours, was alert and oriented. Considering the rapid decline in the patient's condition, it was later deemed by quality assurance reviewers that the on-scene presence of these TEMS providers was lifesaving.

  1. Sexual violence and associated factors among women in HIV discordant and concordant relationships in Uganda.

    Science.gov (United States)

    Shuaib, Faisal M B; Ehiri, John E; Jolly, Pauline; Zhang, Qionghui; Emusu, Donath; Ngu, Julius; Foushee, Herman; Katongole, Drake; Kirby, Russell; Wabwire-Mangen, Fred

    2012-01-01

    HIV serodiscordance is a sexual partnership in which one partner is infected with HIV while the other is not. Managing emotional and sexual intimacy in HIV serodiscordant unions can be difficult due to concerns about HIV transmission and the challenge of initiating and maintaining safe sex. In situations where couples are jointly aware of their HIV status, women in serodiscordant unions may face increased risk of partner violence. We conducted an investigation to assess risk factors for HIV serodiscordance and determine if HIV serodiscordance is associated with incident sexual violence among a cohort of women attending HIV post-test club services at three AIDS Information Centers (AICs) in Uganda. Using a prospective study of 250 women, we elicited information about sexual violence using structured face-to-face interviews. Sexual violence and risk factors were assessed and compared among HIV positive women in HIV discordant unions, HIV negative women in discordant unions, and HIV negative women in negative concordant unions. Multivariable logistic regression was used to assess the association between participants' serostatus and sexual violence. HIV negative women in serodiscordant relationships (36.1±11.1 years, range: 19-65 years) were significantly older than either HIV positive women in serodiscordant relationships (32.2±9.0 years, range: 18-56 years), or HIV negative women in concordant relationships (32.3±11.0 years, range: 18-62), (p=0.033). Early age at sexual debut was associated with a 2.4-fold increased risk of experiencing sexual violence (OR 2.4, 95% CI 1.27-4.65). Based on unadjusted analysis, HIV positive women in discordant relationship were at highest risk for sexual violence compared to HIV negative women in discordant unions, and HIV negative women in negative concordant unions. HIV negative women in discordant relationships and those in concordant negative relationships showed no increased risk for sexual violence. However, couples' HIV

  2. Statistical analysis of operating efficiency and failures of a medical linear accelerator for ten years

    International Nuclear Information System (INIS)

    Ju, Sang Gyu; Huh, Seung Jae; Han, Young Yih

    2005-01-01

    To improve the management of a medical linear accelerator, the records of operational failures of a Varian CL2100C over a ten year period were retrospectively analyzed. The failures were classified according to the involved functional subunits, with each class rated into one of three levels depending on the operational conditions. The relationships between the failure rate and working ratio and between the failure rate and outside temperature were investigated. In addition, the average life time of the main part and the operating efficiency over the last 4 years were analyzed. Among the recorded failures (total 587 failures), the most frequent failure was observed in the parts related with the collimation system, including the monitor chamber, which accounted for 20% of all failures. With regard to the operational conditions, 2nd level of failures, which temporally interrupted treatments, were the most frequent. Third level of failures, which interrupted treatment for more than several hours, were mostly caused by the accelerating subunit. The number of failures was increased with number of treatments and operating time. The average life-times of the Klystron and Thyratron became shorter as the working ratio increased, and were 42 and 83% of the expected values, respectively. The operating efficiency was maintained at 95% or higher, but this value slightly decreased. There was no significant correlation between the number of failures and the outside temperature. The maintenance of detailed equipment problems and failures records over a long period of time can provide good knowledge of equipment function as well as the capability of predicting future failure. More rigorous equipment maintenance is required for old medical linear accelerators for the advanced avoidance of serious failure and to improve the quality of patient treatment

  3. [Discussion on Quality Evaluation Method of Medical Device During Life-Cycle in Operation Based on the Analytic Hierarchy Process].

    Science.gov (United States)

    Zheng, Caixian; Zheng, Kun; Shen, Yunming; Wu, Yunyun

    2016-01-01

    The content related to the quality during life-cycle in operation of medical device includes daily use, repair volume, preventive maintenance, quality control and adverse event monitoring. In view of this, the article aims at discussion on the quality evaluation method of medical devices during their life cycle in operation based on the Analytic Hierarchy Process (AHP). The presented method is proved to be effective by evaluating patient monitors as example. The method presented in can promote and guide the device quality control work, and it can provide valuable inputs to decisions about purchase of new device.

  4. Parent/Child Concordance about Bullying Involvement and Family Characteristics Related to Bullying and Peer Victimization

    Science.gov (United States)

    Holt, Melissa K.; Kaufman Kantor, Glenda; Finkelhor, David

    2009-01-01

    This study examined parent perspectives on bullying, parent/child concordance about bullying involvement, and family characteristics associated with bullying perpetration and peer victimization. Participants were 205 fifth-grade students and their parents. Students attended an urban, ethnically diverse school district in the Northeast. Youth…

  5. Perceptions around concordance – focus groups and semi‐structured interviews conducted with consumers, pharmacists and general practitioners

    OpenAIRE

    Bajramovic, Jasmina; Emmerton, Lynne; Tett, Susan E.

    2004-01-01

    Background  Achieving concordance by identifying beliefs about illness, treatment and medicine‐taking should impact positively on behaviour and consumer satisfaction with respect to treatment, and health outcomes may be improved.

  6. Prudent layperson definition of an emergent pediatric medical condition.

    Science.gov (United States)

    Huang, Craig J; Poirier, Michael P; Cantwell, John R; Ermis, Peter R; Isaacman, Daniel J

    2006-03-01

    This study was designed to assess how well parents rated pediatric medical conditions based on their perceived degree of urgency so as to determine if the "Prudent Layperson Standard'' is reasonable. A self-administered, supervised survey was given to a convenience sample of 340 caregivers in the emergency department of an urban children's hospital. Respondents were asked to rank the urgency of 15 scenarios. A caregiver response within 1 point of the physician score was considered concordant with medical opinion. A 2-week-old infant with a rectal temperature of 103.7 degrees F was the only emergent scenario underestimated by caregivers. A 1 1/2-yr-old child with an upper respiratory tract infection, a 7-year-old child with ringworm, an 8-month-old infant with a simple forehead contusion, and a 4-year-old child with conjunctivitis were the non-urgent scenarios overestimated by caregivers. Laypeople are able to identify cases constructed to represent obvious pediatric medical emergencies. Several patient subgroups frequently overestimate medical urgency.

  7. Aligning conservation goals: are patterns of species richness and endemism concordant at regional scales?

    Directory of Open Access Journals (Sweden)

    Ricketts, T. H.

    2001-01-01

    Full Text Available Biodiversity conservation strategies commonly target areas of high species richness and/or high endemism. However, the correlation between richness and endemism at scales relevant to conservation is unclear; these two common goals of conservation plans may therefore be in conflict. Here the spatial concordance between richness and endemism is tested using five taxa in North America: butterflies, birds, mammals, amphibians, and reptiles. This concordance is also tested using overall indices of richness and endemism (incorporating all five taxa. For all taxa except birds, richness and endemism were significantly correlated, with amphibians, reptiles, and the overall indices showing the highest correlations (rs = 0.527-0.676. However, 'priority sets' of ecoregions (i.e., the top 10% of ecoregions based on richness generally overlapped poorly with those based on endemism (< 50% overlap for all but reptiles. These results offer only limited support for the idea that richness and endemism are correlated at broad scales and indicate that land managers will need to balance these dual, and often conflicting, goals of biodiversity conservation.

  8. Equivalent dose measurements on board an Armenian Airline flight and Concord (9-17 km)

    International Nuclear Information System (INIS)

    Akopova, A.B.; Melkonyan, A.A.; Tatikyan, S.Sh.; Capdevielle, J-N.

    2002-01-01

    The results of investigations of the neutron component (E=1-10 MeV) of cosmic radiation on board the 'Armenian Airlines' aircrafts using nuclear photoemulsion are presented. The emulsions were exposed on the flights from Yerevan to Moscow, St.-Petersburg, Beirut, Athens, Frankfurt, Amsterdam, Paris and Sofia, and on Concord supersonic flights from Paris to New York. The dependence of the neutron fluxes, and on absorbed and equivalent doses on the flight parameters were investigated. On the flights of the supersonic Concord, with an altitude of 17 km, the neutron fluxes were essentially higher in comparison to those measured on Armenian airliners. It is interesting to note, that the neutron flux and equivalent dose rate decrease with altitude up to 470 km in space, for example, on board the STS-57. The shape of the differential energy spectrum for fast neutrons is the same on all Armenian airlines flights, but significantly different at 17 km altitude, where the flux in the energy region above 3 MeV is increasing

  9. Equivalent dose measurements on board an Armenian Airline flight and Concord (9-17 km)

    Energy Technology Data Exchange (ETDEWEB)

    Akopova, A.B. E-mail: akopova@lx2.yerphi.am; Melkonyan, A.A.; Tatikyan, S.Sh.; Capdevielle, J-N

    2002-12-01

    The results of investigations of the neutron component (E=1-10 MeV) of cosmic radiation on board the 'Armenian Airlines' aircrafts using nuclear photoemulsion are presented. The emulsions were exposed on the flights from Yerevan to Moscow, St.-Petersburg, Beirut, Athens, Frankfurt, Amsterdam, Paris and Sofia, and on Concord supersonic flights from Paris to New York. The dependence of the neutron fluxes, and on absorbed and equivalent doses on the flight parameters were investigated. On the flights of the supersonic Concord, with an altitude of 17 km, the neutron fluxes were essentially higher in comparison to those measured on Armenian airliners. It is interesting to note, that the neutron flux and equivalent dose rate decrease with altitude up to 470 km in space, for example, on board the STS-57. The shape of the differential energy spectrum for fast neutrons is the same on all Armenian airlines flights, but significantly different at 17 km altitude, where the flux in the energy region above 3 MeV is increasing.

  10. Post-cold war United Nations peacekeeping operations: a review of the case for a hybrid level 2+ medical treatment facility.

    Science.gov (United States)

    Johnson, Ralph Jay

    2015-01-01

    Post-Cold War, UN peacekeeping operations (UN PKOs) have become larger, more mobile, multi-faceted and conducted over vast areas of remote, rugged, and harsh geography. They have been increasingly involved in dangerous areas with ill-defined boundaries, simmering internecine armed conflict, and disregard on the part of some local parties for peacekeepers' security and role. Yet progressively there have been expectations of financial restraint and austerity. Additionally, UN PKOs have become more "robust," that is, engaged in preemptive, assertive operations. A statistically positive and significant relationship exists between missions' size, complexity, remoteness, and aggressive tenor and a higher probability of trauma or death, especially as a result of hostile actions or disease. Therefore, in the interest of "force protection" and optimizing operations, a key component of UN PKOs is health care and medical treatment. The expectation is that UN PKO medical support must conform to the general intent and structure of current UN PKOs to become more streamlined, portable, mobile, compartmentalized, and specialized, but also more varied and complex to address the medical aspects of these missions cost-efficiently. This article contends that establishing a hybrid level 2-a level 2 with level 3 modules and components (i.e., level 2+)-is a viable course of action when considering trends in the medical aspects of Post-Cold War UN PKOs. A level 2 medical treatment facility has the potential to provide needed forward mobile medical treatment, especially trauma care, for extended, complex, large-scale, and comprehensive UN PKOs. This is particularly the case for missions that include humanitarian outreach, preventive medicine, and psychiatry. The level 2 treatment facility is flexible enough to expand into a hybrid level 2+ with augmentation of modules based on changes in mission requirements and variation in medical aspects.

  11. Concordance between phylogeographical and biogeographical patterns in the Brazilian Cerrado: diversification of the endemic tree Dalbergia miscolobium (Fabaceae).

    Science.gov (United States)

    Novaes, Renan Milagres Lage; Ribeiro, Renata Acácio; Lemos-Filho, José Pires; Lovato, Maria Bernadete

    2013-01-01

    Few studies have addressed the phylogeography of species of the Cerrado, the largest savanna biome of South America. Here we aimed to investigate the phylogeographical structure of Dalbergia miscolobium, a widespread tree from the Cerrado, and to verify its concordance with plant phylogeographical and biogeographical patterns so far described. A total of 287 individuals from 32 populations were analyzed by sequencing the trnL intron of the chloroplast DNA and the internal transcribed spacer of the nuclear ribosomal DNA. Analysis of population structure and tests of population expansion were performed and the time of divergence of haplotypes was estimated. Twelve and 27 haplotypes were identified in the cpDNA and nrDNA data, respectively. The star-like network configuration and the mismatch distributions indicated a recent spatial and demographic expansion of the species. Consistent with previous tree phylogeographical studies of Cerrado trees, the cpDNA also suggested a recent expansion towards the southern Cerrado. The diversity of D. miscolobium was widespread but high levels of genetic diversity were found in the Central Eastern and in the southern portion of Central Western Cerrado. The combined analysis of cpDNA and nrDNA supported a phylogeographic structure into seven groups. The phylogeographical pattern showed many concordances with biogeographical and phylogeographical studies in the Cerrado, mainly with the Cerrado phytogeographic provinces superimposed to our sampling area. The data reinforced the uniqueness of Northeastern and Southeastern Cerrados and the differentiation between Eastern and Western Central Cerrados. The recent diversification of the species (estimated between the Pliocene and the Pleistocene) and the 'genealogical concordances' suggest that a shared and persistent pattern of species diversification might have been present in the Cerrado over time. This is the first time that an extensive 'genealogical concordance' between

  12. Concordance between otic cytology and culture in diagnosis of external otitis canine by Malassezia spp

    Directory of Open Access Journals (Sweden)

    Adriana Pulido-Villamarín

    2015-09-01

    Full Text Available Objective. To determine the correlation between microbiological culture and otic cytology for diagnoses of external otitis by Malassezia in dogs. Materials and methods. 158 ear swabs of dogs with clinical diagnosis of external otitis were analyzed by cytology, mycological culture and metabolic tests. Results. Were obtained a positive results by cytology of 62% and 75.3% by culture. The 31.1% of isolates were identified as M. pachydermatis, 12.6% as M. furfur and 56.3% were classified as Malassezia spp., because was not possible to define the species. We found a positive concordance between cytology and culture for Malassezia spp., of 0.76 with a kappa index of 0.448 (95% CI 0.30 to 0.60 which represents a moderate strength of concordance between the two techniques, without regard the identified species. Conclusions. The use of a diagnostic test is not enough to establish the participation of Malassezia spp., as a causal disease agent.

  13. Molecular classification of endometrial carcinoma on diagnostic specimens is highly concordant with final hysterectomy: Earlier prognostic information to guide treatment.

    Science.gov (United States)

    Talhouk, Aline; Hoang, Lien N; McConechy, Melissa K; Nakonechny, Quentin; Leo, Joyce; Cheng, Angela; Leung, Samuel; Yang, Winnie; Lum, Amy; Köbel, Martin; Lee, Cheng-Han; Soslow, Robert A; Huntsman, David G; Gilks, C Blake; McAlpine, Jessica N

    2016-10-01

    Categorization and risk stratification of endometrial carcinomas is inadequate; histomorphologic assessment shows considerable interobserver variability, and risk of metastases and recurrence can only be derived after surgical staging. We have developed a Proactive Molecular Risk classification tool for Endometrial cancers (ProMisE) that identifies four distinct prognostic subgroups. Our objective was to assess whether molecular classification could be performed on diagnostic endometrial specimens obtained prior to surgical staging and its concordance with molecular classification performed on the subsequent hysterectomy specimen. Sequencing of tumors for exonuclease domain mutations (EDMs) in POLE and immunohistochemistry for mismatch repair (MMR) proteins and p53 were applied to both pre- and post-staging archival specimens from 60 individuals to identify four molecular subgroups: MMR-D, POLE EDM, p53 wild type, p53 abn (abnormal). Three gynecologic subspecialty pathologists assigned histotype and grade to a subset of samples. Concordance of molecular and clinicopathologic subgroup assignments were determined, comparing biopsy/curetting to hysterectomy specimens. Complete molecular and pathologic categorization was achieved in 57 cases. Concordance metrics for pre- vs. post-staging endometrial samples categorized by ProMisE were highly favorable; average per ProMisE class sensitivity(0.9), specificity(0.96), PPV(0.9), NPV(0.96) and kappa statistic 0.86(95%CI, 0.72-0.93), indicating excellent agreement. We observed the highest level of concordance for 'p53 abn' tumors, the group associated with the worst prognosis. In contrast, grade and histotype assignment from original pathology reports pre- vs. post-staging showed only moderate levels of agreement (kappa=0.55 and 0.44 respectively); even with subspecialty pathology review only moderate levels of agreement were observed. Molecular classification can be achieved on diagnostic endometrial samples and accurately

  14. Guidelines concordance of maintenance treatment in euthymic patients with bipolar disorder: Data from the national bipolar mania pathway survey (BIPAS) in mainland China.

    Science.gov (United States)

    Wang, Zuowei; Chen, Jun; Zhang, Chen; Gao, Keming; Hong, Wu; Xing, Mengjuan; Wu, Zhiguo; Yuan, Chengmei; Huang, Jia; Peng, Daihui; Wang, Yong; Lu, Weihong; Yi, Zhenghui; Yu, Xin; Zhao, Jingping; Fang, Yiru

    2015-08-15

    Although the treatment guidelines of bipolar disorders (BPD) have spread more than a decade, the concordance with evidence-based guidelines was typically low in routine clinical practice. This study is to present the data on the maintenance treatment of BPD in mainland China. One thousand and twenty-three patients who had experienced a euthymia were eligible for entry into this survey on the maintenance treatment of BPD. Guidelines disconcordance was determined by comparing the medication(s) that patients were prescribed with the recommendations in the guidelines of the Canadian Network for Mood and Anxiety Treatments. Three hundred and sixty-four patients (35.6%) had not been prescribed with the maintenance treatment as guidelines recommendations, and 208 patients (20.3%) were prescribed with the antidepressants. A longer duration of BPD, a depressive episode at first onset, and a recent depressive or mixed episode significantly increased the risk for guidelines disconcordance and prescribing antidepressant. In contrast, a hospitalization history due to manic episode was associated with a significant decrease in the risk for guidelines disconcordance and prescribing antidepressant. This study was a cross-sectional and retrospective investigation based on medical records. Considering the potentially hazardous effects of inappropriate treatment, individualized psychoeducational strategies for subjects with BPD are necessary to enhance treatment adherence and close the gap between guidelines and clinical practice in mainland China. Copyright © 2015 Elsevier B.V. All rights reserved.

  15. Flipping the Classroom in Medical Student Education: Does Priming Work?

    Directory of Open Access Journals (Sweden)

    Emily Rose

    2017-12-01

    Full Text Available Introduction The emergency medicine (EM clerkship curriculum at Los Angeles County + University of Southern California Medical Center includes monthly lectures on pediatric fever and shortness of breath (SOB. This educational innovation evaluated if learning could be enhanced by “priming” the students with educational online videos prior to an in-class session. Factors that impacted completion rates were also evaluated (planned specialty and time given for video viewing. Methods Twenty-minute videos were to be viewed prior to the didactic session. Students were assigned to either the fever or SOB group and received links to those respective videos. All participating students took a pre-test prior to viewing the online lectures. For analysis, test scores were placed into concordant groups (test results on fever questions in the group assigned the fever video and test results on SOB questions in the group assigned the SOB video and discordant groups (crossover between video assigned and topic tested. Each subject contributed one set of concordant results and one set of discordant results. Descriptive statistics were performed with the Mann-Whitney U test. Lecture links were distributed to students two weeks prior to the in-class session for seven months and three days prior to the in-class session for eight months (in which both groups included both EM-bound and non-EM bound students. Results In the fifteen-month study period, 64% of students rotating through the EM elective prepared for the in class session by watching the videos. During ten months where exclusively EM-bound students were rotating (n=144, 71.5% of students viewed the lectures. In four months where students were not EM-bound (n=54, 55.6% of students viewed the lectures (p=0.033. Participation was 60.2% when lecture links were given three days in advance and 68.7% when links were given two weeks in advance (p=0.197. In the analysis of concordant scores, the pre-test averaged 56

  16. A robust bayesian estimate of the concordance correlation coefficient.

    Science.gov (United States)

    Feng, Dai; Baumgartner, Richard; Svetnik, Vladimir

    2015-01-01

    A need for assessment of agreement arises in many situations including statistical biomarker qualification or assay or method validation. Concordance correlation coefficient (CCC) is one of the most popular scaled indices reported in evaluation of agreement. Robust methods for CCC estimation currently present an important statistical challenge. Here, we propose a novel Bayesian method of robust estimation of CCC based on multivariate Student's t-distribution and compare it with its alternatives. Furthermore, we extend the method to practically relevant settings, enabling incorporation of confounding covariates and replications. The superiority of the new approach is demonstrated using simulation as well as real datasets from biomarker application in electroencephalography (EEG). This biomarker is relevant in neuroscience for development of treatments for insomnia.

  17. Molecular Concordance Between Primary Breast Cancer and Matched Metastases

    DEFF Research Database (Denmark)

    Krøigård, Anne Bruun; Larsen, Martin Jakob; Thomassen, Mads

    2016-01-01

    Clinical management of breast cancer is increasingly personalized and based on molecular profiling. Often, primary tumors are used as proxies for systemic disease at the time of recurrence. However, recent studies have revealed substantial discordances between primary tumors and metastases, both....... The purpose of this review is to illuminate the extent of cancer genome evolution through disease progression and the degree of molecular concordance between primary breast cancers and matched metastases. We present an overview of the most prominent studies investigating the expression of endocrine receptors......, transcriptomics, and genome aberrations in primary tumors and metastases. In conclusion, biopsy of metastatic lesions at recurrence of breast cancer is encouraged to provide optimal treatment of the disease. Furthermore, molecular profiling of metastatic tissue provides invaluable mechanistic insight...

  18. CDX2 expression is concordant between primary colorectal cancer lesions and corresponding liver metastases independent of chemotherapy: a single-center retrospective study in Japan.

    Science.gov (United States)

    Shigematsu, Yasuyuki; Inamura, Kentaro; Mise, Yoshihiro; Saiura, Akio; Rehnberg, Emil; Yamamoto, Noriko; Ishikawa, Yuichi; Takahashi, Shunji; Kanda, Hiroaki

    2018-03-30

    Loss of caudal-type homeobox transcription factor 2 (CDX2) expression in colorectal cancers (CRCs) has recently been proposed as a promising predictive biomarker for not only prognosis but also response to chemotherapy. However, the relationship between alterations in CDX2 expression during cancer progression and response to chemotherapy remains unclear. We herein aimed to determine the concordance of CDX2 expression between primary CRCs and corresponding liver metastases, in association with chemotherapy. Primary CRCs exhibited heterogeneous CDX2 expression. Seven of the 144 CRCs in the cohort (4.9%, 95% confidential interval, 2.0%-9.8%) were CDX2-negative. The concordance rate of the CDX2 expression status in patients who did not receive chemotherapy was 100% ( P = 0.041), whereas the concordance rate among patients who received chemotherapy only after primary resection was 96.3% ( P = 0.005). Moreover, the concordance rate in patients who received chemotherapy before both primary resection and liver metastasectomy was 100% ( P < 0.001). CDX2 expression status was highly concordant between primary CRCs and corresponding liver metastases, independent of chemotherapy, suggesting that the CDX2 expression status in CRCs was not affected by metastasis or chemotherapy. A total of 144 consecutive patients with CRC who were treated at a single center in Japan between 2006 and 2014 were included. Formalin-fixed paraffin-embedded whole sections of surgically resected primary CRCs and corresponding liver metastases were assessed for CDX2 expression by immunohistochemistry.

  19. Is There a Concordance Between the Gleason Scores of Needle Biopsy and Radical Prostatectomy Specimens in Prostatic Carsinoma?

    Directory of Open Access Journals (Sweden)

    Faruk Özgör

    2016-03-01

    Full Text Available Aim: To evaluate the concordance between the Gleason Scores (GS of prostate biopsy and radical prostatectomy specimens. Methods: Prostate biopsy was performed in 1135 patients with the suspicion of prostate cancer in our clinic between 2008 and 2012. A total of 366 patients were diagnosed with prostate cancer. Radical prostatectomy was performed in 73 of these patients and GS of pathology specimens were included in this study for comparison. The patients were divided into three groups (low intermediate- and high-risk patients according to the D’amico risk classification for prostate cancer. Results: The median age of the patients was 64.2±6.1 years (54- 73. The mean prostate specific antigen level was 20.34 ng/mL and the mean biopsy core number was 12±0.58. A statistically significant concordance was detected between the GS of biopsy specimens and radical prostatectomy materials in 65.7% of patients (p<0.01. There were 40 patients in the low-risk group, however, 8 (20% of them were identified to be intermediate-risk patients and one (2.5% was found to be a high-risk patient after radical prostatectomy. Conclusion: Concordance between the GS of prostate biopsy and radical prostatectomy materials are important for selection of the appropriate treatment

  20. Prescribing and using self-injectable antiretrovirals: How concordant are physician and patient perspectives?

    OpenAIRE

    Cohen Calvin; Fisher Martin; Youle Michael; Kulasegaram Ranjababu; Fumaz Carmina R; Clotet Bonaventura; Katlama Christine; Kovacs Colin; Horne Robert; Slim Jihad; Shalit Peter; Cooper Vanessa; Tsoukas Christos

    2009-01-01

    Abstract Background The selection of agents for any treatment regimen is in part influenced by physician and patient attitudes. This study investigated attitudinal motivators and barriers to the use of self-injectable antiretroviral agents among physicians and patients and measured the degree of concordance between physician and patient perspectives. Methods Attitudes toward prescribing and usage of self-injectable antiretroviral therapy (SIAT) were assessed by structured interview in 2 cohor...

  1. Why OR.NET? Requirements and perspectives from a medical user's, clinical operator's and device manufacturer's points of view.

    Science.gov (United States)

    Czaplik, Michael; Voigt, Verena; Kenngott, Hannes; Clusmann, Hans; Hoffmann, Rüdiger; Will, Armin

    2018-02-23

    In the past decades, modern medicine has been undergoing a change in the direction of digitalisation and automation. Not only the integration of new digital technologies, but also the interconnection of all components can simplify clinical processes and allow progress and development of new innovations. The integration and interconnection of medical devices with each other and with information technology (IT) systems was addressed within the framework of the Federal Ministry of Education and Research (BMBF)-funded lighthouse project OR.NET ("Secure dynamic networking in the operating room and clinic".) (OR.net-Forschungskonsortium (OR.net Research Syndicate.) OR.net - Sichere dynamische Vernetzung in Operationssaal und Klinik [Online]. Available: www.ornet.org. [last accessed 22 March 2017]). In this project the standards and concepts for interdisciplinary networking in the operating room (OR) were developed. In this paper, the diverse advantages of the OR.NET concept are presented and explained by the OR.NET "Medical Board". This board represents the forum of clinical users and includes clinicians and experts from various specialties. Furthermore, the opinion from the viewpoint of operators is presented. In a concluding comment of the "Operator Board", clinical user needs are aligned with technical requirements.

  2. Predictors of Success in Bariatric Surgery: the Role of BMI and Pre-operative Comorbidities.

    Science.gov (United States)

    da Cruz, Magda Rosa Ramos; Branco-Filho, Alcides José; Zaparolli, Marília Rizzon; Wagner, Nathalia Farinha; de Paula Pinto, José Simão; Campos, Antônio Carlos Ligocki; Taconeli, Cesar Augusto

    2017-11-10

    This is a retrospective review of 204 patients who underwent bariatric surgery. The impact of weight regain (WR), pre-operative comorbidities and BMI values on the recurrence of comorbidities was evaluated, and an equation was elaborated to estimate BMI at 5 years of bariatric surgery. Pre-operative data, after 1 year and after 5 years, was collected from the medical records. Descriptive analyses and bivariate hypothesis tests were performed first, and then, a generalised linear regression model with Tweedie distribution was adjusted. The hit rate and the Kendall coefficient of concordance (Kendall's W) of the equation were calculated. At the end, the Mann-Whitney test was performed between the BMI, WR and the presence of comorbidities, after a post-operative period of 5 years. The adjustment of the model resulted in an equation that estimates the mean value of BMI 5 years after surgery. The hit rate was 82.35% and the value of Kendall's W was 0.85 for the equation. It was found that patients with comorbidities presented a higher median WR (10.13%) and a higher mean BMI (30.09 kg/m 2 ) 5 years after the surgery. It is concluded that the equation is useful for estimating the mean BMI at 5 years of surgery and that patients with low pre-operative HDL and folic acid levels, with depression and/or anxiety and a higher BMI, have a higher BMI at 5 years of surgery and higher incidence of comorbid return and dissatisfaction with post-operative results.

  3. A Prospective Study of the Concordance of DSM-IV and DSM-5 Diagnostic Criteria for Autism Spectrum Disorder.

    Science.gov (United States)

    Mazurek, Micah O; Lu, Frances; Symecko, Heather; Butter, Eric; Bing, Nicole M; Hundley, Rachel J; Poulsen, Marie; Kanne, Stephen M; Macklin, Eric A; Handen, Benjamin L

    2017-09-01

    The transition from DSM-IV to DSM-5 criteria for autism spectrum disorder (ASD) sparked considerable concern about the potential implications of these changes. This study was designed to address limitations of prior studies by prospectively examining the concordance of DSM-IV and final DSM-5 criteria on a consecutive sample of 439 children referred for autism diagnostic evaluations. Concordance and discordance were assessed using a consistent diagnostic battery. DSM-5 criteria demonstrated excellent overall specificity and good sensitivity relative to DSM-IV criteria. Sensitivity and specificity were strongest for children meeting DSM-IV criteria for autistic disorder, but poor for those meeting criteria for Asperger's disorder and pervasive developmental disorder. Higher IQ, older age, female sex, and less pronounced ASD symptoms were associated with greater discordance.

  4. The value of nuclear medical examinations in paediatrics

    International Nuclear Information System (INIS)

    Sixthofer, A.

    1991-02-01

    In 1988 155 children were nuclear medically examined at the university clinic in Innsbruck. The first separations to be made were sex and age. A more precise organization concerning the clinically allocated diagnosis of the patients showed, that nephrological and urological questions were asked in 2/3 of the cases. The second point was the cure of inflammation and tumourous cases of the skeletal system (osteomyelitis, osteosarcoma) followed by the assessment of the practical and morphological disturbances to the thyroid glands. Nuclear medical examinations also, occasionally, used questions from the fields of neurology, gastroenterology, cardiology and pulmonology. Analysis regarding the concordance of nuclear medicine with the clinic expresses the diagnostical precision of nuclear medicine well. Nuclear medical diagnosis corresponded to conclusive clinical diagnosis in 73.75 % of the cases. The classification concerning with clinical relevance of the nuclear medical findings for treatment showed that, in only 7.5 % of all cases there was no influence of the nuclear medical diagnosis on the treatment. The investigation of radiation was done in three age groups (0 to 5 years, 5 to 10 years, 10 to 15 years). The calculations, especially with the kidney examinations, produced definite results, it could be illustrated that the nuclear medical examinations show a smaller amount of radiation as a radiological alternative, on intravenous urogram, for example. (author)

  5. Islam and the four principles of medical ethics.

    Science.gov (United States)

    Mustafa, Yassar

    2014-07-01

    The principles underpinning Islam's ethical framework applied to routine clinical scenarios remain insufficiently understood by many clinicians, thereby unfortunately permitting the delivery of culturally insensitive healthcare.This paper summarises the foundations of the Islamic ethical theory, elucidating the principles and methodology employed by the Muslim jurist in deriving rulings in the field of medical ethics. The four-principles approach, as espoused by Beauchamp and Childress, is also interpreted through the prism of Islamic ethical theory. Each of the four principles (beneficence, nonmaleficence,justice and autonomy) is investigated in turn, looking in particular at the extent to which each is rooted in the Islamic paradigm. This will provide an important insight into Islamic medical ethics, enabling the clinician to have a better informed discussion with the Muslim patient. It will also allow for a higher degree of concordance in consultations and consequently optimise culturally sensitive healthcare delivery.

  6. Concordances and discrepancies between ICD-10 and DSM-IV criteria for anxiety disorders in childhood and adolescence

    Science.gov (United States)

    2012-01-01

    Background Mental disorders are classified by two major nosological systems, the ICD-10 and the DSM-IV-TR, consisting of different diagnostic criteria. The present study investigated the diagnostic concordance between the two systems for anxiety disorders in childhood and adolescence, in particular for separation anxiety disorder (SAD), specific phobia, social phobia, and generalized anxiety disorder (GAD). Methods A structured clinical interview, the Kinder-DIPS, was administered to 210 children and 258 parents. The percentage of agreement, kappa, and Yule’s Y coefficients were calculated for all diagnoses. Specific criteria causing discrepancies between the two classification systems were identified. Results DSM-IV-TR consistently classified more children than ICD-10 with an anxiety disorder, with a higher concordance between DSM-IV-TR and the ICD-10 child section (F9) than with the adult section (F4) of the ICD-10. This result was found for all four investigated anxiety disorders. The results revealed low to high levels of concordance and poor to good agreement between the classification systems, depending on the anxiety disorder. Conclusions The two classification systems identify different children with an anxiety disorder. However, it remains an open question, whether the research results can be generalized to clinical practice since DSM-IV-TR is mainly used in research while ICD-10 is widely established in clinical practice in Europe. Therefore, the population investigated by the DSM (research population) is not identical with the population examined using the ICD (clinical population). PMID:23267678

  7. Does patient-provider gender concordance affect mental health care received by primary care patients with major depression?

    Science.gov (United States)

    Chan, Kitty S; Bird, Chloe E; Weiss, Robert; Duan, Naihua; Meredith, Lisa S; Sherbourne, Cathy D

    2006-01-01

    We sought to determine whether patient-provider gender concordance influences the detection and care of depression and comorbid anxiety and substance use in patients with major depression Cross-sectional analyses of baseline patient survey data linked with provider data were performed. Data based on routine primary care visits in clinics from a variety of health systems serving diverse patient populations across the United States. Participants all had major depression. Depression care was examined in the Quality Improvement for Depression (QID) Collaboration sample (n patients = 1,428, n providers = 389). In a subanalysis of data solely from 714 patients and 157 providers from Partners-In-Care, one of the projects participating in QID, we also examined detection of anxiety disorder and alcohol or drug problems. Rates of detection and care of mental health problems in primary care were low even among patients with major depression. Except for anxiety counseling in female patients, patient-provider gender concordance did not improve care as hypothesized. However, female providers were more likely to counsel on anxiety and less likely to counsel on alcohol or drug use than male providers. Female patients were less likely to be counseled on alcohol or drug use compared with male patients. Detection and care of mental health and substance use problems for patients with major depression is not influenced by patient-provider gender concordance. However, depressed female patients may have greater unmet needs for alcohol and drug use counseling than their male counterparts.

  8. Concordances and discrepancies between ICD-10 and DSM-IV criteria for anxiety disorders in childhood and adolescence

    Directory of Open Access Journals (Sweden)

    Adornetto Carmen

    2012-12-01

    Full Text Available Abstract Background Mental disorders are classified by two major nosological systems, the ICD-10 and the DSM-IV-TR, consisting of different diagnostic criteria. The present study investigated the diagnostic concordance between the two systems for anxiety disorders in childhood and adolescence, in particular for separation anxiety disorder (SAD, specific phobia, social phobia, and generalized anxiety disorder (GAD. Methods A structured clinical interview, the Kinder-DIPS, was administered to 210 children and 258 parents. The percentage of agreement, kappa, and Yule’s Y coefficients were calculated for all diagnoses. Specific criteria causing discrepancies between the two classification systems were identified. Results DSM-IV-TR consistently classified more children than ICD-10 with an anxiety disorder, with a higher concordance between DSM-IV-TR and the ICD-10 child section (F9 than with the adult section (F4 of the ICD-10. This result was found for all four investigated anxiety disorders. The results revealed low to high levels of concordance and poor to good agreement between the classification systems, depending on the anxiety disorder. Conclusions The two classification systems identify different children with an anxiety disorder. However, it remains an open question, whether the research results can be generalized to clinical practice since DSM-IV-TR is mainly used in research while ICD-10 is widely established in clinical practice in Europe. Therefore, the population investigated by the DSM (research population is not identical with the population examined using the ICD (clinical population.

  9. Army Medical Support for Peace Operations and Humanitarian Assistance,

    Science.gov (United States)

    1996-01-01

    or contractors. Some coalition troops may uti - lize the theater medical system in ways it was not intended. Coalition partners’ own medical assets...agencies, and the State Depart- ment often urge the Army to expand medical services and to uti - lize any excess capacity for purposes other than the...Psychologists (new 67D). Similar concerns involved comptrollers and preventive medicine officers, field medical pharmacists , and personnel managers

  10. The diagnostic concordance of endoanal ultrasonography and endoanal MRI in cases of anorectal fistula

    International Nuclear Information System (INIS)

    Kim, Wan Tae; Yoo, Weon Young; Moon, Hee Jung; Shin, Hyun Ja; Joo, Jae Sik

    2000-01-01

    To evaluate the preoperative diagnostic concordance of morphologic classification of anorectal fistula by endoanal ultrasonography (EUSG) and endoanal magnetic resonance imaging (EMRI). Between January 1998 and March 1999, 17 patients with anorectal fistula underwent endoanal ultrasonography and magnetic resonance imaging for preoperative assessment. The types of fistula and abscess formation were evaluated, and the findings compared with those obtained during surgery. The overall accordance of anorectal fistula was 76% (13 of 17 cases) on ultrasonography and 94% (16 of 17 cases) on magnetic resonance imaging. According to the findings of EUSG, the accordance of each type of anorectal fistula was as follows: transphineteric, 92% (11 of 12 cases); suprasphinteric, 33% (1 of 3); and extrasphincteric, 50% (1 of 2), while for EMRI, the respective figures were 100% (12 of 12 cases), 67% (2 of 3), and 100% (2 of 2). An analysis of reproducibility using kappa value showed that overall concordance between endoanal ultrasonography and surgery (κ=0.820) as well as between endoanal MRI and surgery (κ=0.866), was very close. For the evaluation of anorectal fistula, preoperative endoanal magnetic resonance imaging was more accurate and informative than endoanal ultrasonography

  11. Concordance between brain 18F-FDG PET and cerebrospinal fluid biomarkers in diagnosing Alzheimer's disease.

    Science.gov (United States)

    Rubí, S; Noguera, A; Tarongí, S; Oporto, M; García, A; Vico, H; Espino, A; Picado, M J; Mas, A; Peña, C; Amer, G

    Cortical posterior hypometabolism on PET imaging with 18 F-FDG (FDG-PET), and altered levels of Aß 1-42 peptide, total Tau (tTau) and phosphorylated Tau (pTau) proteins in cerebrospinal fluid (CSF) are established diagnostic biomarkers in Alzheimer's disease (AD). An evaluation has been made of the concordance and relationship between the results of FDG-PET and CSF biomarkers in symptomatic patients with suspected AD. A retrospective review was carried out on 120 patients with cognitive impairment referred to our Cognitive Neurology Unit, and who were evaluated by brain FDG-PET and a lumbar puncture for CSF biomarkers. In order to calculate their Kappa coefficient of concordance, the result of the FDG-PET and the set of the three CSF biomarkers in each patient was classified as normal, inconclusive, or AD-compatible. The relationship between the results of both methods was further assessed using logistic regression analysis, including the Aß 1-42 , tTau and pTau levels as quantitative predictors, and the FDG-PET result as the dependent variable. The weighted Kappa coefficient between FDG-PET and CSF biomarkers was 0.46 (95% CI: 0.35-0.57). Logistic regression analysis showed that the Aß 1-42 and tTau values together were capable of discriminating an FDG-PET result metabolically suggestive of AD from one non-suggestive of AD, with a 91% sensitivity and 93% specificity at the cut-off line Aß 1-42 =44+1.3×tTau. The level of concordance between FDG-PET and CSF biomarkers was moderate, indicating their complementary value in diagnosing AD. The Aß 1-42 and tTau levels in CSF help to predict the patient FDG-PET cortical metabolic status. Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

  12. Goal striving, goal attainment, and well-being: adapting and testing the self-concordance model in sport.

    Science.gov (United States)

    Smith, Alison; Ntoumanis, Nikos; Duda, Joan

    2007-12-01

    Grounded in self-determination theory (Deci & Ryan, 1985) and the self-concordance model (Sheldon & Elliot, 1999), this study examined the motivational processes underlying goal striving in sport as well as the role of perceived coach autonomy support in the goal process. Structural equation modeling with a sample of 210 British athletes showed that autonomous goal motives positively predicted effort, which, in turn, predicted goal attainment. Goal attainment was positively linked to need satisfaction, which, in turn, predicted psychological well-being. Effort and need satisfaction were found to mediate the associations between autonomous motives and goal attainment and between attainment and well-being, respectively. Controlled motives negatively predicted well-being, and coach autonomy support positively predicted both autonomous motives and need satisfaction. Associations of autonomous motives with effort were not reducible to goal difficulty, goal specificity, or goal efficacy. These findings support the self-concordance model as a framework for further research on goal setting in sport.

  13. Operational experience and recent developments at the National Medical Cyclotron, Sydney

    International Nuclear Information System (INIS)

    Conard, E.M.; Arnott, D.W.

    1996-01-01

    The National Medical Cyclotron, Sydney, Australia commenced operation in mid 1991, with a mission to provide PET and SPECT radionuclides throughout Australia. The realization of the present production capacity has been synonymous with the development of the facility's industrial cyclotron (IBA Cyclone 30). The choice of cyclotron was based on the Cyclone 30's virtues as a compact, user-friendly, energy efficient cyclotron, offering the beam quality characteristic of negative ion technology. Development of the cyclotron has improved reliability and increased beam capacity, while improvements to targetry have increased production reliability. More recently, the installation and commissioning of a new solid target irradiation facility has provided much needed redundancy. This paper describes the major cyclotron and targetry developments carried out to date. (orig.)

  14. Breast Intraductal Papillomas without Atypia in Radiologic-Pathologic Concordant Core Needle Biopsies: Predictors of Upgrade to Carcinoma at Excision

    Science.gov (United States)

    Pareja, Fresia; Corben, Adriana; Brennan, Sandra; Murray, Melissa P.; Bowser, Zenica; Jakate, Kiran; Sebastiano, Christopher; Morrow, Monica; Morris, Elizabeth; Brogi, Edi

    2016-01-01

    Background The surgical management of breast intraductal papilloma without atypia (IDP) identified at core needle biopsy (CNB) is controversial. We assessed the rate of upgrade to carcinoma at surgical excision, and identified parameters predictive of upgrade. Methods We identified women with CNB diagnosis of intraductal papilloma without atypia or carcinoma at our center between 2003 and 2013. Radiologic-pathologic concordance was assessed for all cases, and discordant cases were excluded. We correlated the radiologic and clinicopathologic features of patients with CNB diagnosis of IDP with upgrade to carcinoma at surgical excision. Results Our study population consists of 189 women with 196 IDPs; 166 women (171 IDPs) underwent excision. The upgrade rate was 2.3% (4/171). The upgrade lesions were 2 invasive lobular carcinomas and 2 cases of ductal carcinoma in situ (DCIS). One case of DCIS involved the residual IDP, whereas the other 3 carcinomas were ≥8 mm away. Twenty-four women (25 IDPs) did not undergo excision, and had stable imaging at follow-up (median of 23.5 months). Conclusions The upgrade rate at excision of IDP diagnosed at CNB with radiologic-pathologic concordance is 2.3%. Our findings suggest that observation is appropriate for patients with radiologic-pathologic concordant CNB yielding IDP, regardless of its size. PMID:27315013

  15. Concordância entre citologia, colposcopia e histopatologia cervical Agreement between cytology, colposcopy and cervical histopathology

    Directory of Open Access Journals (Sweden)

    Letícia Maria Correia Katz

    2010-08-01

    Full Text Available OBJETIVO: avaliar a concordância da citologia convencional por Papanicolaou repetida no momento da colposcopia com os achados colposcópicos e a histopatologia. MÉTODOS: o estudo foi realizado no Laboratório Central de Saúde Pública do Estado de Pernambuco (LACEN, de janeiro a julho de 2008, em 397 mulheres com exame citopatológico alterado encaminhadas para avaliação colposcópica. No momento da colposcopia, repetiu-se a citologia em meio convencional, pesquisando-se os achados colposcópicos anormais. A nomenclatura citológica utilizada foi a de Bethesda e a histopatológica, da Organização Mundial de Saúde. A citologia no momento da colposcopia e a colposcopia foram comparadas entre si e com o resultado do histopatológico obtido por biópsia dirigida. A concordância entre os métodos foi avaliada pelo coeficiente Kappa (K, além do teste χ2 a um nível de significância de 5%. RESULTADOS: foi encontrada uma concordância fraca entre a citologia realizada no momento da colposcopia e a colposcopia, K=0,33 (IC95%=0,21-0,45 e entre a colposcopia e a histopatologia, K=0,35 (IC95%=0,39-0,51. Para a concordância entre citologia no momento da colposcopia e histopatologia, o Kappa foi de 0,41 (IC95%=0,29-0,530, considerado moderado. CONCLUSÕES: houve melhor concordância entre citologia e histopatologia do que entre colposcopia e citologia ou colposcopia e histopatologia.PURPOSE: to evaluate the agreement between conventional cytology using the Papanicolaou test, repeated at the time of colposcopy, with colposcopic and histopathological findings. METHODS: the study was carried out at the central public health laboratory of the state of Pernambuco between January and July, 2008, involving 397 women referred for colposcopic evaluation following an abnormal cervical smear test. Cytology was repeated at the time of colposcopy using conventional method, with particular attention being paid to the presence of abnormal colposcopic findings

  16. Importance of prostate-specific antigen (PSA as a predictive factor for concordance between the Gleason scores of prostate biopsies and RADICAL prostatectomy specimens

    Directory of Open Access Journals (Sweden)

    Nelson Gianni de Lima

    2013-06-01

    Full Text Available OBJECTIVE: To evaluate the concordance between the Gleason scores of prostate biopsies and radical prostatectomy specimens, thereby highlighting the importance of the prostate-specific antigen (PSA level as a predictive factor of concordance. METHODS: We retrospectively analyzed 253 radical prostatectomy cases performed between 2006 and 2011. The patients were divided into 4 groups for the data analysis and dichotomized according to the preoperative PSA, <10 ng/mL and ≥10 ng/mL. A p-score <0.05 was considered significant. RESULTS: The average patient age was 63.3±7.8 years. The median PSA level was 9.3±4.9 ng/mL. The overall concordance between the Gleason scores was 52%. Patients presented preoperative PSA levels <10 ng/mL in 153 of 235 cases (65% and ≥10 ng/mL in 82 of 235 cases (35%. The Gleason scores were identical in 86 of 153 cases (56% in the <10 ng/mL group and 36 of 82 (44% cases in the ≥10 ng/mL group (p = 0.017. The biopsy underestimated the Gleason score in 45 (30% patients in the <10 ng/mL group and 38 (46% patients in the ≥10 ng/mL (p = 0.243. Specifically, the patients with Gleason 3 + 3 scores according to the biopsies demonstrated global concordance in 56 of 110 cases (51%. In this group, the patients with preoperative PSA levels <10 ng/dL had higher concordance than those with preoperative PSA levels ≥10 ng/dL (61% x 23%, p = 0.023, which resulted in 77% upgrading after surgery in those patients with PSA levels ≥10 ng/dl. CONCLUSION: The Gleason scores of needle prostate biopsies and those of the surgical specimens were concordant in approximately half of the global sample. The preoperative PSA level was a strong predictor of discrepancy and might improve the identification of those patients who tended to be upgraded after surgery, particularly in patients with Gleason scores of 3 + 3 in the prostate biopsy and preoperative PSA levels ≥10 ng/mL.

  17. Attention problems and Attention-Deficit/Hyperactivity Disorder in discordant and concordant monozygotic twins: Evidence of environmental mediators.

    NARCIS (Netherlands)

    Lehn, H.; Derks, E.M.; Hudziak, J.; Heutink, P.; van Beijsterveldt, C.E.M.; Boomsma, D.I.

    2007-01-01

    OBJECTIVE: To study familial and nonfamilial environmental influences on attention problems and attention-deficit/hyperactivity disorder (ADHD) in monozygotic twins discordant and concordant-high and low for these traits. METHOD: Ninety-five twin pairs from The Netherlands Twin Register were

  18. Fine Needle Aspiration Using Improved Agar Microbiopsy is Highly Concordant With Renal Mass Final Diagnosis and Subclassification

    NARCIS (Netherlands)

    Schieven, Louise W.; Smedts, Frank; Hopman, Anton H.; van der Wijk, Jan; Nijman, Rien J.; de Jong, Igle J.

    2009-01-01

    Purpose: Computerized tomography and ultrasound are usually sufficient for preoperative evaluation of renal masses greater than 5 cm. For renal masses less than 5 cm additional histological evaluation could improve diagnosis and treatment decisions. We investigated the concordance between an

  19. Active implantable medical device EMI assessment for wireless power transfer operating in LF and HF bands.

    Science.gov (United States)

    Hikage, Takashi; Nojima, Toshio; Fujimoto, Hiroshi

    2016-06-21

    The electromagnetic interference (EMI) imposed on active implantable medical devices by wireless power transfer systems (WPTSs) is discussed based upon results of in vitro experiments. The purpose of this study is to present comprehensive EMI test results gathered from implantable-cardiac pacemakers and implantable cardioverter defibrillators exposed to the electromagnetic field generated by several WPTSs operating in low-frequency (70 kHz-460 kHz) and high-frequency (6.78 MHz) bands. The constructed in vitro experimental test system based upon an Irnich's flat torso phantom was applied. EMI test experiments are conducted on 14 types of WPTSs including Qi-compliant system and EV-charging WPT system mounted on current production EVs. In addition, a numerical simulation model for active implantable medical device (AIMD) EMI estimation based on the experimental test system is newly proposed. The experimental results demonstrate the risk of WPTSs emitting intermittent signal to affect the correct behavior of AIMDs when operating at very short distances. The proposed numerical simulation model is applicable to obtain basically the EMI characteristics of various types of WPTSs.

  20. Lesion concordance, image quality and artefacts in PET/CT. Results of a multicenter study

    International Nuclear Information System (INIS)

    Stergar, H.; Bockisch, A.; Krause, B.J.; Eschmann, S.M.; Juergens, K.U.; Kuehl, H.; Pfannenberg, A.C.; Stollfuss, J.; Weckesser, M.

    2010-01-01

    This study had three major objectives: (1.) to record the number of concordant (both in PET and CT) pathological lesions in different body regions/organs, (2.) to evaluate the image quality and (3.) to determine both, the quantity and the quality of artefacts in whole body FDG PET/CT scans. Routine whole body scans of 353 patients referred to FDG-PET/CT exams at 4 university hospitals were employed. All potentially malignant lesions in 13 different body regions/organs were classified as either concordant or suspicious in FDG-PET or CT only. In the latter case the diagnostic relevance of this disparity was judged. The image quality in PET and CT was rated as a whole and separately in 5 different body regions. Furthermore we investigated the frequency and site of artefacts caused by metal implants and oral or intravenous contrast media as well as the subjective co-registration quality (in 4 body regions) and the diagnostic impact of such artefacts or misalignment. In addition, the readers rated the diagnostic gain of adding the information from the other tomographic method. In total 1941 lesions (5.5 per patient) were identified, 1094 (56%) out of which were concordant. 602 (71%) out of the 847 remaining lesions were detected only with CT, 245 (29%) were only PET-positive. As expected, CT particularly depicted the majority of lesions in the lungs and abdominal organs. However, the diagnostic relevance was greater with PET-only positive lesions. Most of the PET/CT scans were performed with full diagnostic CT including administration of oral and intravenous contast media (> 80%). The image quality in PET and CT was rated excellent. Artefacts occurred in more than 60% of the scans and were mainly due to (dental) metal implants and contrast agent. Nevertheless there was almost no impact on diagnostic confidence if reading of the non attenuation corrected PET was included. The co-registration quality in general was also rated as excellent. Misalignment mostly occurred due

  1. Age of Onset in Concordant Twins and Other Relative Pairs With Multiple Sclerosis

    OpenAIRE

    Sadovnick, A. Dessa; Yee, Irene M.; Guimond, Colleen; Reis, Jacques; Dyment, David A.; Ebers, George C.

    2009-01-01

    The ages of onset in multiple sclerosis cases span more than 7 decades. Data are presented for affected relative pairs from a Canadian population base of 30,000 multiple sclerosis index cases (1993?2008). The effects of genetic sharing, parent of origin, intergenerational versus collinear differences, and gender on the ages of onset were evaluated in the following concordant pairs: monozygotic twins (n?=?29), dizygotic twins (n?=?10), siblings (n?=?614), first cousins (n?=?405), half siblings...

  2. Incidence, characteristics and management of pain in one operational area of medical emergency teams.

    Science.gov (United States)

    Kosiński, Sylweriusz; Bryja, Magdalena; Wojtaszowicz, Rafał; Górka, Andrzej

    2014-01-01

    Experience of pain associated with both chronic as well as acute medical conditions is a main cause for call for ambulance. The aim of this study was to establish both frequency and characteristics of pain reported by patients treated in pre-hospital environment in a single operational area. The supplementary goal was an analysis of methods of pain alleviation applied by medical personnel in the above described scenario. The written documentation of 6 months of year 2009 provided by doctor-manned as well as paramedic-only ambulances operating in Tatra county, Małopolska, Poland was analyzed. Medical personnel inquired about pain experienced in 57.4% of cases, 10-point numerical rating scale was used in 22.3% of patients. Pain was reported by 43.8% of patients, the most frequent reasons of experienced pain were trauma and cardiovascular diseases. In almost half of the cases pain was referred to the areas of chest and abdomen. Non-traumatic pain was reported by 47.7% of patients, post-traumatic in 41.3% of cases, 11% of subjects reported ischemic chest pain. 42.3% of pain-reporting patients received some form of analgesia, yet only 3% of subjects in this group received opiates. Personnel of paramedic-only ambulances tended to use pain intensity scale more often (P < 0.01), yet administered pain alleviating drugs noticeably less often than the doctor-manned teams (P < 0.01). The use of pain alleviating drugs, opiates especially, was inadequate in proportion to frequency and intensity of pain reported by patients. General, nation-wide standards of pain measurement and treatment in pre-hospital rescue are suggested as a means to improve the efficacy of pain reduction treatment.

  3. Merger of Multiple Accreting Black Holes Concordant with Gravitational-wave Events

    Science.gov (United States)

    Tagawa, Hiromichi; Umemura, Masayuki

    2018-03-01

    Recently, the advanced Laser Interferometer Gravitational-Wave Observatory (aLIGO) has detected black hole (BH) merger events, most of which are sourced by BHs more massive than 30 M ⊙. Especially, the observation of GW170104 suggests dynamically assembled binaries favoring a distribution of misaligned spins. It has been argued that mergers of unassociated BHs can be engendered through a chance meeting in a multiple BH system under gas-rich environments. In this paper, we consider the merger of unassociated BHs, concordant with the massive BH merger events. To that end, we simulate a multiple BH system with a post-Newtonian N-body code incorporating gas accretion and general relativistic effects. As a result, we find that gas dynamical friction effectively promotes a three-body interaction of BHs in dense gas of n gas ≳ 106 cm‑3, so that BH mergers can take place within 30 Myr. This scenario predicts an isotropic distribution of spin tilts. In the concordant models with GW150914, the masses of seed BHs are required to be ≳25 M ⊙. The potential sites of such chance meeting BH mergers are active galactic nucleus (AGN) disks and dense interstellar clouds. Assuming the LIGO O1, we roughly estimate the event rates for PopI BHs and PopIII BHs in AGN disks to be ≃1–2 yr‑1 and ≃1 yr‑1, respectively. Multiple episodes of AGNs may enhance the rates by roughly an order of magnitude. For massive PopI BHs in dense interstellar clouds the rate is ≃0.02 yr‑1. Hence, high-density AGN disks are a more plausible site for mergers of chance meeting BHs.

  4. Concordance of mutation detection in circulating tumor DNA in early clinical trials using different blood collection protocols

    DEFF Research Database (Denmark)

    Ahlborn, Lise B.; Madsen, Mette; Jonson, Lars

    2017-01-01

    in a clinical setting. Here we investigate the concordance between standard blood collection for molecular analysis using immediate separation of plasma, compared to the use of collection tubes allowing for delayed processing. Methods: In this study, we measured the fractional abundance of tumor specific...... patients with advanced solid cancers enrolled in early clinical trials. Results: Concordance in the fractional abundance of mutations in ctDNA isolated from blood collected in either K3EDTA or BCT tubes from patients with different solid cancers was observed. Conclusions: This study indicates that BCT...... mutations (BRAF p.V600E and PIK3CA p.H1047R) in ctDNA isolated from blood samples collected in either cell-stabilizing Cell-Free DNA BCT tubes (delayed processing within 72 hours) or standard K3EDTA tubes (immediate processing within 15 minutes). Twenty-five blood sample pairs (EDTA/BCT) were collected from...

  5. Concordance of Interests in Dynamic Models of Social Partnership in the System of Continuing Professional Education

    Science.gov (United States)

    Tarasenko, Larissa V.; Ougolnitsky, Guennady A.; Usov, Anatoly B.; Vaskov, Maksim A.; Kirik, Vladimir A.; Astoyanz, Margarita S.; Angel, Olga Y.

    2016-01-01

    A dynamic game theoretic model of concordance of interests in the process of social partnership in the system of continuing professional education is proposed. Non-cooperative, cooperative, and hierarchical setups are examined. Analytical solution for a linear state version of the model is provided. Nash equilibrium algorithms (for non-cooperative…

  6. Your Lung Operation: After Your Operation

    Medline Plus

    Full Text Available ... to Participate Resources Webinars for Young Surgeons YFA E-News YFA Advocacy Essay Contest Resident and Associate ... ACS Leader International Exchange Scholar Program Resources RAS E-News Medical Students Operation Giving Back Operation Giving ...

  7. Electronic health records and online medical records: an asset or a liability under current conditions?

    Science.gov (United States)

    Allen-Graham, Judith; Mitchell, Lauren; Heriot, Natalie; Armani, Roksana; Langton, David; Levinson, Michele; Young, Alan; Smith, Julian A; Kotsimbos, Tom; Wilson, John W

    2018-02-01

    Objective The aim of the present study was to audit the current use of medical records to determine completeness and concordance with other sources of medical information. Methods Medical records for 40 patients from each of five Melbourne major metropolitan hospitals were randomly selected (n=200). A quantitative audit was performed for detailed patient information and medical record keeping, as well as data collection, storage and utilisation. Using each hospital's current online clinical database, scanned files and paperwork available for each patient audited, the reviewers sourced as much relevant information as possible within a 30-min time allocation from both the record and the discharge summary. Results Of all medical records audited, 82% contained medical and surgical history, allergy information and patient demographics. All audited discharge summaries lacked at least one of the following: demographics, medication allergies, medical and surgical history, medications and adverse drug event information. Only 49% of records audited showed evidence the discharge summary was sent outside the institution. Conclusions The quality of medical data captured and information management is variable across hospitals. It is recommended that medical history documentation guidelines and standardised discharge summaries be implemented in Australian healthcare services. What is known about this topic? Australia has a complex health system, the government has approved funding to develop a universal online electronic medical record system and is currently trialling this in an opt-out style in the Napean Blue Mountains (NSW) and in Northern Queensland. The system was originally named the personally controlled electronic health record but has since been changed to MyHealth Record (2016). In Victoria, there exists a wide range of electronic health records used to varying degrees, with some hospitals still relying on paper-based records and many using scanned medical records

  8. Increased concordance of severe respiratory syncytial virus infection in identical twins

    DEFF Research Database (Denmark)

    Thomsen, Simon Francis; Stensballe, Lone Graff; Skytthe, Axel

    2008-01-01

    (concordance rate: 0.66 vs 0.53), which suggests genetic influences on disease severity. Genetic factors accounted for 16%, family environment for 73%, and nonshared environment for 11% of the individual susceptibility to develop severe respiratory syncytial virus infection. CONCLUSIONS: The severity...... of respiratory syncytial virus infection is determined partly by genetic factors. This result should stimulate the search for genetic markers of disease severity.......OBJECTIVE: We estimated differences in the severity of respiratory syncytial virus infection attributable to genetic and environmental factors. METHODS: Record linkage data on hospitalizations attributable to respiratory syncytial virus infection were gathered on all twins (12,346 pairs) born...

  9. Filtration of the classical knot concordance group and Casson-Gordon invariants

    Science.gov (United States)

    Kim, Taehee

    2004-09-01

    It is known that if every prime power branched cyclic cover of a knot in S(3) is a homology sphere, then the knot has vanishing Casson-Gordon invariants. We construct infinitely many examples of (topologically) non-slice knots in S(3) whose prime power branched cyclic covers are homology spheres. We show that these knots generate an infinite rank subgroup of scrf_{(1.0)}/scrf_{(1.5)} for which Casson-Gordon invariants vanish in Cochran-Orr-Teichner's filtration of the classical knot concordance group. As a corollary, it follows that Casson-Gordon invariants are not a complete set of obstructions to a second layer of Whitney disks.

  10. Co-operation of medical and chemical services to provide radiation safety in special zone during Chernobyl' accident response

    International Nuclear Information System (INIS)

    Terent'ev, V.I.

    1990-01-01

    Cooperation of medical and chemical services of the operation group in the special zone during intensive decontamination of the site and neighboring herritories at the Chernobyl NPP are considered. Responsibilities of medical and chemical services, their relations with civie and millitary organizations within the ChNPP region and 30-km zone are reviewed. Cooperation of the services mentioned above consisted in information exchange aimed at overall comprehension of the situation, cooperative activities in the commision and at elaboration of recommendations with an account of radiation safety measures

  11. Investigation of the effects of radiolytic-gas bubbles on the long-term operation of solution reactors for medical-isotope production

    Science.gov (United States)

    Souto Mantecon, Francisco Javier

    One of the most common and important medical radioisotopes is 99Mo, which is currently produced using the target irradiation technology in heterogeneous nuclear reactors. The medical isotope 99Mo can also be produced from uranium fission using aqueous homogeneous solution reactors. In solution reactors, 99Mo is generated directly in the fuel solution, resulting in potential advantages when compared with the target irradiation process in heterogeneous reactors, such as lower reactor power, less waste heat, and reduction by a factor of about 100 in the generation of spent fuel. The commercial production of medical isotopes in solution reactors requires steady-state operation at about 200 kW. At this power regime, the formation of radiolytic-gas bubbles creates a void volume in the fuel solution that introduces a negative coefficient of reactivity, resulting in power reduction and instabilities that may impede reactor operation for medical-isotope production. A model has been developed considering that reactivity effects are due to the increase in the fuel-solution temperature and the formation of radiolytic-gas bubbles. The model has been validated against experimental results from the Los Alamos National Laboratory uranyl fluoride Solution High-Energy Burst Assembly (SHEBA), and the SILENE uranyl nitrate solution reactor, commissioned at the Commissariat a l'Energie Atomique, in Valduc, France. The model shows the feasibility of solution reactors for the commercial production of medical isotopes and reveals some of the important parameters to consider in their design, including the fuel-solution type, 235U enrichment, uranium concentration, reactor vessel geometry, and neutron reflectors surrounding the reactor vessel. The work presented herein indicates that steady-state operation at 200 kW can be achieved with a solution reactor consisting of 120 L of uranyl nitrate solution enriched up to 20% with 235U and a uranium concentration of 145 kg/m3 in a graphite

  12. The Parenting to Reduce Adolescent Depression and Anxiety Scale: Assessing parental concordance with parenting guidelines for the prevention of adolescent depression and anxiety disorders

    Directory of Open Access Journals (Sweden)

    Mairead C. Cardamone-Breen

    2017-09-01

    Full Text Available Background Despite substantial evidence demonstrating numerous parental risk and protective factors for the development of adolescent depression and anxiety disorders, there is currently no single measure that assesses these parenting factors. To address this gap, we developed the Parenting to Reduce Adolescent Depression and Anxiety Scale (PRADAS as a criterion-referenced measure of parental concordance with a set of evidence-based parenting guidelines for the prevention of adolescent depression and anxiety disorders. In this paper, we used a sample of Australian parents of adolescents to: (1 validate the PRADAS as a criterion-referenced measure; (2 examine parental concordance with the guidelines in the sample; and (3 examine correlates of parental concordance with the guidelines. Methods Seven hundred eleven parents completed the PRADAS, as well as two established parenting measures, and parent-report measures of adolescent depression and anxiety symptoms. Six hundred sixty adolescent participants (aged 12–15 also completed the symptom measures. Concordance with the guidelines was assessed via nine subscale scores and a total score. Reliability of the scores was assessed with an estimate of the agreement coefficient, as well as 1-month test-retest reliability. Convergent validity was examined via correlations between the scale and two established parenting measures. Results One proposed subscale was removed from the final version of the scale, resulting in a total of eight subscales. Reliability was high for the total score, and acceptable to high for seven of the eight subscales. One-month test-retest reliability was acceptable to high for the total score. Convergent validity was supported by moderate to high correlations with two established measures of parenting. Overall, rates of parental concordance with the guidelines were low in our sample. Higher scores were associated with being female and higher levels of parental education

  13. Breast intraductal papillomas without atypia in radiologic-pathologic concordant core-needle biopsies: Rate of upgrade to carcinoma at excision.

    Science.gov (United States)

    Pareja, Fresia; Corben, Adriana D; Brennan, Sandra B; Murray, Melissa P; Bowser, Zenica L; Jakate, Kiran; Sebastiano, Christopher; Morrow, Monica; Morris, Elizabeth A; Brogi, Edi

    2016-09-15

    The surgical management of mammary intraductal papilloma without atypia (IDP) identified at core-needle biopsy (CNB) is controversial. This study assessed the rate of upgrade to carcinoma at surgical excision (EXC). This study identified women with a CNB diagnosis of intraductal papilloma without atypia or carcinoma at a cancer center between 2003 and 2013. Radiologic-pathologic concordance was assessed for all cases, and discordant cases were excluded. The radiologic and clinicopathologic features of patients with a CNB diagnosis of IDP were correlated with an upgrade to carcinoma at EXC. The study population consists of 189 women with 196 IDPs; 166 women (171 IDPs) underwent EXC. The upgrade rate was 2.3% (4 of 171). The upgraded lesions were 2 invasive lobular carcinomas and 2 cases of ductal carcinoma in situ (DCIS). One case of DCIS involved the residual IDP, whereas the other 3 carcinomas were ≥ 8 mm away. Twenty-four women (25 IDPs) did not undergo EXC and had stable imaging on follow-up (median, 23.5 months). The upgrade rate at EXC for IDPs diagnosed at CNB with radiologic-pathologic concordance was 2.3%. These findings suggest that observation is appropriate for patients with radiologic-pathologic concordant CNB yielding IDP, regardless of its size. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2819-2827. © 2016 American Cancer Society. © 2016 American Cancer Society.

  14. Concordance between myocardial perfusion scan assessed by SPECT and fractional flow reserve findings for detection of significant ischemia

    Directory of Open Access Journals (Sweden)

    Morteza Safi

    2016-09-01

    Conclusion: FFR and MPI with SPECT techniques showed significant concordance for detection of myocardial ischemia, regardless of the type of diseased coronary arteries. In this context, SPECT has high sensitivity and NPV for detection of ischemia compared with FFR.

  15. Systems-based biological concordance and predictive reproducibility of gene set discovery methods in cardiovascular disease.

    Science.gov (United States)

    Azuaje, Francisco; Zheng, Huiru; Camargo, Anyela; Wang, Haiying

    2011-08-01

    The discovery of novel disease biomarkers is a crucial challenge for translational bioinformatics. Demonstration of both their classification power and reproducibility across independent datasets are essential requirements to assess their potential clinical relevance. Small datasets and multiplicity of putative biomarker sets may explain lack of predictive reproducibility. Studies based on pathway-driven discovery approaches have suggested that, despite such discrepancies, the resulting putative biomarkers tend to be implicated in common biological processes. Investigations of this problem have been mainly focused on datasets derived from cancer research. We investigated the predictive and functional concordance of five methods for discovering putative biomarkers in four independently-generated datasets from the cardiovascular disease domain. A diversity of biosignatures was identified by the different methods. However, we found strong biological process concordance between them, especially in the case of methods based on gene set analysis. With a few exceptions, we observed lack of classification reproducibility using independent datasets. Partial overlaps between our putative sets of biomarkers and the primary studies exist. Despite the observed limitations, pathway-driven or gene set analysis can predict potentially novel biomarkers and can jointly point to biomedically-relevant underlying molecular mechanisms. Copyright © 2011 Elsevier Inc. All rights reserved.

  16. Medical x-ray

    International Nuclear Information System (INIS)

    Abd Aziz Mhd Ramli; Gui Ah Auu; Husaini Salleh; Idris Besar; Mohd Ashhar Khalid; Muhammad Jamal Md Isa; Shaharuddin Mohd; Siti Najila Mohd Janib; Mohamed Ali Abdul Khader; Mahalatchimi Dave; Mohd Fazly Abdul Rahim; Ng Chee Moon; Ram Piari; Teoh Hoon Heng; Lee Peter

    2004-01-01

    This book describes the fundamental subject about medical radiography. It is a multidisciplinary field that requires cross professional input from scientists, engineers and medical doctors. However, it is presented in simple language to suit different levels of readers from x-ray operators and radiographers to physists, general practitioners and radiology specialists.The book is written in accordance to the requirements of the standard syllabus approved by the Ministry of Health Malaysia for the training of medical x-ray operator and general practitioners. In general, the content is not only designed to provide relevant and essential subject for related professionals in medical radiological services such as x-ray operator, radiographer and radiologists, but also to address those in associated radiological services including nurses, medical technologists and physicists.The book is organized and arranged sequentially into 3 parts for easy reference: Radiation safety; X-ray equipment and associated facilities; Radiography practices. With proper grasping of all these parts, the radiological services could be provided with confident and the highest professional standard. Thus, medical imaging with highest quality that can provide useful diagnostic information at minimum doses and at cost effective could be assured

  17. Correction of technical bias in clinical microarray data improves concordance with known biological information

    DEFF Research Database (Denmark)

    Eklund, Aron Charles; Szallasi, Zoltan Imre

    2008-01-01

    The performance of gene expression microarrays has been well characterized using controlled reference samples, but the performance on clinical samples remains less clear. We identified sources of technical bias affecting many genes in concert, thus causing spurious correlations in clinical data...... sets and false associations between genes and clinical variables. We developed a method to correct for technical bias in clinical microarray data, which increased concordance with known biological relationships in multiple data sets....

  18. Analysis of Forensic Autopsy in 120 Cases of Medical Disputes Among Different Levels of Institutional Settings.

    Science.gov (United States)

    Yu, Lin-Sheng; Ye, Guang-Hua; Fan, Yan-Yan; Li, Xing-Biao; Feng, Xiang-Ping; Han, Jun-Ge; Lin, Ke-Zhi; Deng, Miao-Wu; Li, Feng

    2015-09-01

    Despite advances in medical science, the causes of death can sometimes only be determined by pathologists after a complete autopsy. Few studies have investigated the importance of forensic autopsy in medically disputed cases among different levels of institutional settings. Our study aimed to analyze forensic autopsy in 120 cases of medical disputes among five levels of institutional settings between 2001 and 2012 in Wenzhou, China. The results showed an overall concordance rate of 55%. Of the 39% of clinically missed diagnosis, cardiovascular pathology comprises 55.32%, while respiratory pathology accounts for the remaining 44. 68%. Factors that increase the likelihood of missed diagnoses were private clinics, community settings, and county hospitals. These results support that autopsy remains an important tool in establishing causes of death in medically disputed case, which may directly determine or exclude the fault of medical care and therefore in helping in resolving these cases. © 2015 American Academy of Forensic Sciences.

  19. Pre-diagnostic concordance with the WCRF/AICR guidelines and survival in European colorectal cancer patients : A cohort study

    NARCIS (Netherlands)

    Romaguera, Dora; Ward, Heather; Wark, Petra A.; Vergnaud, Anne Claire; Peeters, Petra H.; van Gils, Carla H.; Ferrari, Pietro; Fedirko, Veronika; Jenab, Mazda; Boutron-Ruault, Marie Christine; Dossus, Laure; Dartois, Laureen; Hansen, Camilla Plambeck; Dahm, Christina Catherine; Buckland, Genevieve; Sánchez, María José; Dorronsoro, Miren; Navarro, Carmen; Barricarte, Aurelio; Key, Timothy J.; Trichopoulou, Antonia; Tsironis, Christos; Lagiou, Pagona; Masala, Giovanna; Pala, Valeria; Tumino, Rosario; Vineis, Paolo; Panico, Salvatore; Bueno-de-Mesquita, H. Bas; Siersema, PD; Ohlsson, Bodil; Jirström, Karin; Wennberg, Maria; Nilsson, Lena M.; Weiderpass, Elisabete; Kühn, Tilman; Katzke, Verena; Khaw, Kay Tee; Wareham, Nick J.; Tjønneland, Anne; Boeing, Heiner; Quirós, José R.; Gunter, Marc J.; Riboli, Elio; Norat, Teresa

    2015-01-01

    Background: Cancer survivors are advised to follow lifestyle recommendations on diet, physical activity, and body fatness proposed by the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) for cancer prevention. Previous studies have demonstrated that higher concordance

  20. Pre-diagnostic concordance with the WCRF/AICR guidelines and survival in European colorectal cancer patients: a cohort study

    NARCIS (Netherlands)

    Romaguera, D.; Ward, H.; Wark, P.A.; Vergnaud, A.C.; Peeters, P.H.M.; Gils, C.H. van; Ferrari, P.; Fedirko, V.; Jenab, M.; Boutron-Ruault, M.C.; Dossus, L.; Dartois, L.; Hansen, C.P.; Dahm, C.C.; Buckland, G.; Sanchez, M.J.; Dorronsoro, M.; Navarro, C; Barricarte, A.; Key, T.J.; Trichopoulou, A.; Tsironis, C.; Lagiou, P.; Masala, G.; Pala, V.; Tumino, R.; Vineis, P.; Panico, S.; Bueno-de-Mesquita, H.B.; Siersema, P.D.; Ohlsson, B.; Jirstrom, K.; Wennberg, M.; Nilsson, L.M.; Weiderpass, E.; Kuhn, T.; Katzke, V.; Khaw, K.T.; Wareham, N.J.; Tjonneland, A.; Boeing, H.; Quiros, J.R.; Gunter, M.J.; Riboli, E.; Norat, T.

    2015-01-01

    BACKGROUND: Cancer survivors are advised to follow lifestyle recommendations on diet, physical activity, and body fatness proposed by the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) for cancer prevention. Previous studies have demonstrated that higher concordance

  1. Racing the Moon’s shadow with Concorde 001

    CERN Document Server

    Léna, Pierre

    2015-01-01

    This is the unique story of  observing a total solar exlipse for no less than 74 consecutive minutes. On the summer morning of June 30, 1973, the Sun rises on the Canary Islands. But it is strangely indented by the Moon. The eclipse of the century has just begun. From the west, the lunar shadow rushes to the African coast at a velocity of over 2000 kilometers per hour. Astronomers on the ground will enjoy seven short minutes of total eclipse to study the solar corona - too short for Pierre Lena and seven scientists who board the Concorde 001 prototype, an extraordinary plane to become the first commercial supersonic aircraft. With André Turcat as chief pilot and a crew of five, at 17000 m altitude, the aircraft remains in the lunar shadow for 74 minutes, a record time of scientific observations not yet beaten and allowing for exceptional measurements. Science, technology, aviation and history combine in the story of a unique human adventure aboard a legendary aircraft, illustrated with a rich and original ...

  2. Concordance with the New American Plate guidelines of the American Institute for Cancer Research in Guatemalan children

    NARCIS (Netherlands)

    Solomons, N.W.; Montenegro-Bethancourt, G.; Vasquez, C.; Vossenaar, M.; Doak, C.M.

    2009-01-01

    Objective: To determine concordance with the New American Plate guideline that no more than one-third of one's plate be covered with foods of animal origin in Guatemalan schoolchildren. Methods: Dietary intake data collected with a 24-h pictorial diary in a convenience sample of 449 third- and

  3. Effects of concord grape juice on appetite, diet, body weight, lipid profile, and antioxidant status of adults

    Science.gov (United States)

    Concord grape juice (CGJ) is a rich source of phenolic antioxidants with a range of putative health benefits. However, high beverage energy and fructose intake may lead to weight gain and insulin resistance, respectively. This study assessed the effects of CGJ consumption for 12-wk on appetite, di...

  4. Operational measurements in radioprotection in the industrial and medical environments

    International Nuclear Information System (INIS)

    Rodde, S.; Vial, Th.; Truffert, H.; Kramar, R.; Batalla, A.; Roine, Ph.; Pin, A.; Lahaye, Th.; Rodde, S.; Bordy, J.M.; Paquet, F.; Veres, A.; Cadiou, A.; Branthonne, J.Y.; Noel, A.; Laloubere, L.; Moreau, St.; Gensdarmes, F.; Marques, S.; Lestang, M.; Valendru, N.; Tranchant, Ph.; Martel, P.; Bernhard, S.; Chareyre, P.; Gardin, I.; Casanova, Ph.; De Vita, A.; Tenailleau, L.; Masson, B.; Feret, B.; Guerin, M.; Guillot, L.; Gaultier, E.

    2009-01-01

    This document gathers the slides of the available presentations given during these conference days. Thirty presentations are assembled in the document and deal with: 1 - enforcement circular of the labor code dispositions relative to workers protection against ionizing radiation hazards (T. Lahaye); 2 - context and regulatory evolutions - public health code (S. Rodde); 3 - references and perspectives in external dosimetry (J.M. Bordy); 4 - CIPR's Committee 2 works (F. Paquet); 5 - from protection data to measurement data (A. Pin); 6 - dosimetric control in radiotherapy (A. Veres); 7 - calibration of irradiation measurement devices in industrial environment (A. Cadiou); 8 - calibration and verification of nuclear measurement devices (J.Y. Branthonne); 9 - calibration of measurement devices in medical environment (J.M. Bordy); 10 - quality control in radiotherapy (A. Batalla); 11 - in-vivo dosimetry in radiotherapy (A. Noel); 12 - calibration metrology of fixed post irradiation sensors (L. Laloubere); 13 - design requirements for the radiological zoning and the wastes cleanliness of Flamanville 3 EPR reactor (S. Moreau); 14 - efficiency of aerosol capture systems used in CNPE EDF (F. Gensdarmes); 15 - mobile surveillance means of the atmospheric contamination of CNPE EDF's reactor building (S. Marques and M. Lestang); 16 - experience feedback about the security gates at EDF's nuclear facilities (N. Valendru); 17 - metrology needs for radioprotection technical controls (P. Tranchant); 18 - technical evaluation of a flowmeter/dosemeter in the framework of the regulatory control of X-ray electric generators used in radio-diagnosis (P. Martel); 19 - reinforced natural radioactivity - the case of radon measurement (S. Bernhard); 20 - fires during radioactive materials transport (P. Chareyre); 21 - measurement in the framework of medical examinations: radiology service (A. Noel); 22 - operational measurements in nuclear medicine (I. Gardin); 23 - from the operational

  5. Power Estimation for Gene-Longevity Association Analysis Using Concordant Twins

    DEFF Research Database (Denmark)

    Tan, Qihua; Zhao, Jing Hua; Kruse, Torben A

    2014-01-01

    Statistical power is one of the major concerns in genetic association studies. Related individuals such as twins are valuable samples for genetic studies because of their genetic relatedness. Phenotype similarity in twin pairs provides evidence of genetic control over the phenotype variation...... in a population. The genetic association study on human longevity, a complex trait that is under control of both genetic and environmental factors, has been confronted by the small sample sizes of longevity subjects which limit statistical power. Twin pairs concordant for longevity have increased probability...... an approximate of 2- to 3-fold increase in sample sizes needed for longevity cutoff at age 90 as compared with that at age 95. Overall, our results showed high value of twins in genetic association studies on human longevity....

  6. Concordance between nurse-reported quality of care and quality of care as publicly reported by nurse-sensitive indicators

    NARCIS (Netherlands)

    D. Stalpers (Dewi); R.A.M.M. Kieft (Renate A. M. M.); D. van der Linden (Dimitri); M.J. Kaljouw (Marian J.); M.J. Schuurmans (Marieke )

    2016-01-01

    textabstractBackground: Nurse-sensitive indicators and nurses' satisfaction with the quality of care are two commonly used ways to measure quality of nursing care. However, little is known about the relationship between these kinds of measures. This study aimed to examine concordance between

  7. Whipple Resection: Concordance Between Frozen Section And Permanent Section Diagnosis Of Surgical Margins.

    Science.gov (United States)

    Bilal, Muhammad; Tariq, Hina; Mamoon, Nadira

    2018-01-01

    Margin assessment is done in Whipple procedures which are usually performed to resect tumours of head of pancreas and ampullary/periampullary region. Aims and objective of the study are to determine the concordance between frozen sections (FS) and permanent sections (PS) of surgical margins in Whipple resections. It is a retrospective study, from January 2008 to January 2015 (07 years). It includes the specimen with malignancy in final report and for which FS of pancreatic and/or CBD margin(s) were requested. Data was retrieved from Laboratory information system (LIS) database. Of the 41 bile duct margins in cases of ampullary tumours, 03 were positive on FS as well as PS, 35 were negative on FS as well as on PS. Results showed 100% sensitivity, 92.1% specificity, 50% PPV and 100% NPV. Results of 36 pancreatic margins in cases of ampullary showed 100% sensitivity, 97.1% specificity, 50% PPV and 100% NPV. In pancreatic carcinoma cases, none of CBD margins were reported as positive on FS, 02 margins reported as negative were found positive on PS, while 17 were negative on FS as well as PS. Results showed 100% specificity and 89.5% NPV. Of the 27 pancreatic margins tested in pancreatic tumours 100% sensitivity, 94.1% specificity, 88.9% PPV and 100% NPV was found. Factors such as absent prior tissue diagnosis and/or inflammatory processes make margin diagnosis difficult. However, a high concordance was observed between our FS and PS diagnosis.

  8. Accreditation Council for Graduate Medical Education (ACGME) Surgery Resident Operative Logs: The Last Quarter Century.

    Science.gov (United States)

    Drake, Frederick Thurston; Aarabi, Shahram; Garland, Brandon T; Huntington, Ciara R; McAteer, Jarod P; Richards, Morgan K; Zern, Nicole Kansier; Gow, Kenneth W

    2017-05-01

    To describe secular trends in operative experience for surgical trainees across an extended period using the most comprehensive data available, the Accreditation Council for Graduate Medical Education (ACGME) case logs. Some experts have expressed concern that current trainees are inadequately prepared for independent practice. One frequently mentioned factor is whether duty hours' restrictions (DHR) implemented in 2003 and 2004 contributed by reducing time spent in the operating room. A dataset was generated from annual ACGME reports. Operative volume for total major cases (TMC), defined categories, and four index laparoscopic procedures was evaluated. TMC dropped after implementation of DHR but rebounded after a transition period (949 vs 946 cases, P = nonsignificance). Abdominal cases increased from 22% of overall cases to 31%. Alimentary cases increased from 21% to 26%. Trauma and vascular surgery substantially decreased. For trauma, this drop took place well before DHR. The decrease in vascular surgery also began before DHR but continued afterward as well: 148 cases/resident in the late 1990s to 107 currently. Although total operative volume rebounded after implementation of DHR, diversity of operative experienced narrowed. The combined increase in alimentary and abdominal cases is nearly 13%, over a half-year's worth of operating in 5-year training programs. Bedrock general surgery cases-trauma, vascular, pediatrics, and breast-decreased. Laparoscopic operations have steadily increased. If the competence of current graduates has, in fact, diminished. Our analysis suggests that operative volume is not the problem. Rather, changing disease processes, subspecialization, reductions in resident autonomy, and technical innovation challenge how today's general surgeons are trained.

  9. Concordance analysis of methylation biomarkers detection in self-collected and physician-collected samples in cervical neoplasm

    International Nuclear Information System (INIS)

    Chang, Cheng-Chang; Huang, Rui-Lan; Liao, Yu-Ping; Su, Po-Hsuan; Hsu, Yaw-Wen; Wang, Hui-Chen; Tien, Chau-Yang; Yu, Mu-Hsien; Lin, Ya-Wen; Lai, Hung-Cheng

    2015-01-01

    Non-attendance at gynecological clinics is a major limitation of cervical cancer screening and self-collection of samples may improve this situation. Although HPV testing of self-collected vaginal samples is acceptable, the specificity is inadequate. The current focus is increasing self-collection of vaginal samples to minimize clinic visits. In this study, we analyzed the concordance and clinical performance of DNA methylation biomarker (PAX1, SOX1, and ZNF582) detection in self-collected vaginal samples and physician-collected cervical samples for the identification of cervical neoplasm. We enrolled 136 cases with paired methylation data identified from abnormal Pap smears (n = 126) and normal controls (n = 10) regardless of HPV status at gynecological clinics. The study group comprised 37 cervical intraepithelial neoplasm I (CIN1), 23 cervical intraepithelial neoplasm II (CIN2), 16 cervical intraepithelial neoplasm III (CIN3), 30 carcinoma in situ (CIS), 13 squamous cell carcinomas (SCCs) and seven adenocarcinomas (ACs)/adenosquamous carcinomas (ASCs). PAX1, SOX1 and ZNF582 methylation in study samples was assessed by real-time quantitative methylation-specific polymerase chain reaction analysis. We generated methylation index cutoff values for the detection of CIN3+ in physician-collected cervical samples for analysis of the self-collected group. Concordance between the physician-collected and self-collected groups was evaluated by Cohen’s Kappa. Sensitivity, specificity and area under curve (AUC) were calculated for detection of CIN3+ lesions. Finally, we produced an optimal cutoff value with the best sensitivity from the self-collected groups. We generated a methylation index cutoff value from physician-collected samples for detection of CIN3+. There were no significant differences in sensitivity, specificity of PAX1, SOX1 and ZNF582 between the self-collected and physician-collected groups. The methylation status of all three genes in the normal control

  10. Estrogen and progesterone receptor testing in breast carcinoma: concordance of results between local and reference laboratories in Brazil

    Directory of Open Access Journals (Sweden)

    Sheila Cristina Lordelo Wludarski

    Full Text Available CONTEXT AND OBJECTIVE: Breast cancer accounts for approximately one quarter of all cancers in females. Estrogen and progesterone receptor testing has become an essential part of the clinical evaluation of breast carcinoma patients, and accurate results are critical in identifying patients who may benefit from hormone therapy. The present study had the aim of investigating the concordance of the results from hormone receptor tests between a reference laboratory and local (or community laboratories in Brazil. DESIGN AND SETTING: Retrospective study at a reference pathology laboratory. METHODS: The concordance in the results from hormone receptor tests between a reference laboratory and 146 local laboratories in Brazil was compared in relation to 500 invasive breast carcinoma cases, using immunohistochemistry. RESULTS: There was concordance in 89.4% (447/500 cases and 85.0% (425/500 cases of the results from estrogen (κ = 0.744, P < 0.001 and progesterone (κ = 0.688, P < 0.001 receptor tests, respectively, between local and reference laboratories. This was similar to findings in other countries. The false negative rates from estrogen and progesterone receptor tests in local laboratories were 8.7% and 14.4%, respectively. The false positive rates from estrogen and progesterone receptor tests in local laboratories were 15.5% and 16.0%, respectively. CONCLUSION: Technical and result interpretation issues may explain most of the discordances in hormone receptor testing in local laboratories. Validation of estrogen and progesterone receptor tests at local laboratories, with rigorous quality control measures, is strongly recommended in order to avoid erroneous treatment of breast cancer patients.

  11. A "Marked Success": Physical Activity at Miss White's School

    Science.gov (United States)

    Morice, Linda C.

    2008-01-01

    This article examines the career of Flora White, who operated a school for girls in Concord, Massachusetts (USA) from 1897 to 1914. The school promoted individualised learning and physical activity for young women. Its programme of female exercise and sports ran counter to prevailing scholarly, medical, and popular opinion in the US. White faced…

  12. Concordance between nurse-reported quality of care and quality of care as publicly reported by nurse-sensitive indicators

    NARCIS (Netherlands)

    Stalpers, Dewi; Kieft, Renate A M M; Van Der Linden, Dimitri; Kaljouw, Marian J.; Schuurmans, Marieke J.

    2016-01-01

    Background: Nurse-sensitive indicators and nurses' satisfaction with the quality of care are two commonly used ways to measure quality of nursing care. However, little is known about the relationship between these kinds of measures. This study aimed to examine concordance between nurse-sensitive

  13. Medical Operations Decision Support System, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — Determining the probability of specific medical events on a given space mission is difficult. Yet, it is important to have reasonable estimates of these...

  14. Gender Differences in Depressive Symptoms Among HIV-Positive Concordant and Discordant Heterosexual Couples in China

    OpenAIRE

    Li, Li; Liang, Li-Jung; Lin, Chunqing; Ji, Guoping; Xiao, Yongkang

    2016-01-01

    HIV seropositive individuals and their heterosexual partners/spouses, either seropositive or seronegative, are facing several mental health challenges. The objective of this study was to examine gender differences in depressive symptoms among HIV-positive concordant and HIV-discordant couples. We identified heterosexual couples from participants of a randomized controlled trial conducted in Anhui province, China. A total of 265 couples, comprising 129 HIV+ male/HIV− female couples, 98 HIV− ma...

  15. A literature review of medical aspects of post-cold war UN peacekeeping operations: trends, lessons learnt, courses of action and recommendations.

    Science.gov (United States)

    Johnson, Ralph Jay

    2016-08-01

    Post-Cold War United Nations Peace Keeping Operations (UN PKOs) have been increasingly involved in dangerous areas with ill-defined boundaries, harsh and remote geographies, simmering internecine armed conflict and disregard on the part of some local parties for peacekeepers' security and role. In the interest of 'force protection' and optimising operations, a key component of UN PKOs is healthcare and medical treatment. The expectation is that UN PKO medical support will conform to the general intent and structure of UN PKOs. To do so requires effective policies and planning informed by a review of medical aspects crucial to UN PKOs. The intent of this article is to report on a review of principal medical aspects practical to post-Cold War UN PKOs. This review was assembled through a comprehensive, grounded, systematic iterative inquiry of open-source articles. This inquiry revealed that the principal medical aspects in post-Cold War UN missions were the following: (1) the changed nature of UN PKOs, (2) new challenges in terms of proximity and distance to medical care, (3) expanded need for preventive medicine and disease contagion prevention and (4) increased propensity for psychological morbidity and need for intervention. Post Cold War, the dramatically changed nature of UN PKOs has resulted in new challenges mainly in terms of medical logistics, preventive medicine and psychiatry. The changed nature of post-Cold War UN PKOs altered the character of medical support most notably regarding (1) a need for emphasis on immediate response proximate to medical events and rapid transport over long distances and traversing barriers to higher levels of care, (2) proactive contagion and hazard identification and prevention and (3) interventions designed to reduce psychological morbidity. Recommendations are offered about possible courses of action in terms of addressing trends found in identified medical aspects of PKOs. Published by the BMJ Publishing Group Limited. For

  16. [Prospective assessment of medication errors in critically ill patients in a university hospital].

    Science.gov (United States)

    Salazar L, Nicole; Jirón A, Marcela; Escobar O, Leslie; Tobar, Eduardo; Romero, Carlos

    2011-11-01

    Critically ill patients are especially vulnerable to medication errors (ME) due to their severe clinical situation and the complexities of their management. To determine the frequency and characteristics of ME and identify shortcomings in the processes of medication management in an Intensive Care Unit. During a 3 months period, an observational prospective and randomized study was carried out in the ICU of a university hospital. Every step of patient's medication management (prescription, transcription, dispensation, preparation and administration) was evaluated by an external trained professional. Steps with higher frequency of ME and their therapeutic groups involved were identified. Medications errors were classified according to the National Coordinating Council for Medication Error Reporting and Prevention. In 52 of 124 patients evaluated, 66 ME were found in 194 drugs prescribed. In 34% of prescribed drugs, there was at least 1 ME during its use. Half of ME occurred during medication administration, mainly due to problems in infusion rates and schedule times. Antibacterial drugs had the highest rate of ME. We found a 34% rate of ME per drug prescribed, which is in concordance with international reports. The identification of those steps more prone to ME in the ICU, will allow the implementation of an intervention program to improve the quality and security of medication management.

  17. Code of practice for the design and safe operation of non-medical irradiation facilities (1988)

    International Nuclear Information System (INIS)

    1988-01-01

    This Code establishes requirements for the design and operation of irradiation facilities which use X-rays, electrons or gamma radiation for non-medical purposes such as the sterilisation of therapeutic goods. These requirements aim to ensure that exposure of workers and members of the public to ionizing and non-ionizing radiation as well as to noxious gases and radioactive contamination of the environment and facilities are controlled through the design of engineering safety features, approved administrative controls and appropriate radiation monitoring [fr

  18. Comparison of equations for dosing of medications in renal impairment.

    Science.gov (United States)

    Khanal, Aarati; Peterson, Gregory M; Jose, Matthew D; Castelino, Ronald L

    2017-06-01

    The aim of this study is to determine the concordance among the Cockcroft-Gault, the Modification of Diet in Renal Disease and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in hypothetical dosing of renally cleared medications. A total of 2163 patients prescribed at least one of the 31 renally cleared drugs under review were included in the study. Kidney function was estimated using the three equations. We compared actual prescribed dosages of the same drug with recommended dosages based on the kidney function as calculated by each of the equations and applying dosing recommendations in the Australian Medicines Handbook. There was a significant difference in the kidney function values estimated from the three equations (P < 0.001). Despite the good overall agreement in renal drug dosing, we found selected but potentially important discrepancies among the doses rendered from the equations. The CKD-EPI equation non-normalized for body surface area had a greater rate of concordance with the Cockcroft-Gault equation than the Modification of Diet in Renal Disease equation for renal drug dosing. There is need for a long-term multi-centre study in a diverse population to define the clinical effects of the discrepancies among the equations for drug dosing. Given the greater concordance of the non-normalized CKD-EPI equation with the Cockcroft-Gault equation for dosing, the recommendation by Kidney Health Australia and the United States National Kidney Disease Education Program that 'dosing based on either eCrCl or an eGFR with body surface area normalization removed are acceptable' seems suitable and practicable for the purpose of dosing of non-critical drugs in the primary care setting. © 2016 Asian Pacific Society of Nephrology.

  19. National Comorbidity Survey Replication Adolescent Supplement (NCS-A): III. Concordance of DSM-IV/CIDI Diagnoses with Clinical Reassessments

    Science.gov (United States)

    Kessler, Ronald C.; Avenevoli, Shelli; Green, Jennifer; Gruber, Michael J.; Guyer, Margaret; He, Yulei; Jin, Robert; Kaufman, Joan; Sampson, Nancy A.; Zaslavsky, Alan M.; Merikangas, Kathleen R.

    2009-01-01

    The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnoses that was based on the World Health Organization's Composite International Diagnostic Interview (CIDI) and implemented in the National comorbidity survey replication adolescent supplement is found to have good individual-level concordance with diagnosis based on blinded…

  20. Measuring Medical Housestaff Teamwork Performance Using Multiple Direct Observation Instruments: Comparing Apples and Apples.

    Science.gov (United States)

    Weingart, Saul N; Yaghi, Omar; Wetherell, Matthew; Sweeney, Megan

    2018-04-10

    To examine the composition and concordance of existing instruments used to assess medical teams' performance. A trained observer joined 20 internal medicine housestaff teams for morning work rounds at Tufts Medical Center, a 415-bed Boston teaching hospital, from October through December 2015. The observer rated each team's performance using 9 teamwork observation instruments that examined domains including team structure, leadership, situation monitoring, mutual support, and communication. Observations recorded on paper forms were stored electronically. Scores were normalized from 1 (low) to 5 (high) to account for different rating scales. Overall mean scores were calculated and graphed; weighted scores adjusted for the number of items in each teamwork domain. Teamwork scores were analyzed using t-tests, pair-wise correlations, and the Kruskal-Wallis statistic, and team performance was compared across instruments by domain. The 9 tools incorporated 5 major domains, with 5-35 items per instrument for a total of 161 items per observation session. In weighted and unweighted analyses, the overall teamwork performance score for a given team on a given day varied by instrument. While all of the tools identified the same low outlier, high performers on some instruments were low performers on others. Inconsistent scores for a given team across instruments persisted in domain-level analyses. There was substantial variation in the rating of individual teams assessed concurrently by a single observer using multiple instruments. Since existing teamwork observation tools do not yield concordant assessments, researchers should create better tools for measuring teamwork performance.

  1. Accuracy of pre-operative hysteroscopic guided biopsy for predicting final pathology in uterine malignancies.

    Science.gov (United States)

    Martinelli, Fabio; Ditto, Antonino; Bogani, Giorgio; Signorelli, Mauro; Chiappa, Valentina; Lorusso, Domenica; Haeusler, Edward; Raspagliesi, Francesco

    2017-07-01

    To evaluate concordance (C) between pre-operative hysteroscopic-directed sampling and final pathology in uterine cancers. A retrospective cross-sectional evaluation of prospectively collected data of women who underwent hysterectomy for uterine malignancies and a previous hysteroscopic-guided biopsy was performed. Diagnostic concordance between pre-operative (hysteroscopic biopsy) and postoperative (uterine specimen) histology was evaluated. In endometrioid-endometrial cancers cases Kappa (k) statistics was applied to evaluate agreement for grading (G) between the preoperative and final pathology. A total 101 hysterectomies for uterine malignancies were evaluated. There were 23 non-endometrioid cancers: 7 serous (C:5/7, 71.4%); 10 carcinosarcomas (C:7/10, 70%, remaining 3 cases only epithelial component diagnosed); 3 clear cell (C:3/3, 100%); 3 sarcomas (C:3/3, 100%). In 78 cases an endometrioid endometrial cancer was found. In 63 cases there was a histological C (63/78, 80.8%) between hysteroscopic-guided biopsy and final pathology, while in 15 cases (19.2%) only hyperplasia (with/without atypia) was found preoperatively. Overall accuracy to detect endometrial cancer was 80.2%. In 50 out of 63 endometrial cancers (79.4%) grading was concordant. The overall level of agreement between preoperative and postoperative grading was "substantial" according to Kappa (k) statistics (k 0.64; 95% CI: 0.449-0.83; p < 0.001), as well as for G1 (0.679; 95% CI: 0.432-0.926; p < 0.001) and G3 (0.774; 94% CI: 0.534-1; p < 0.001), while for G2 (0.531; 95% CI: 0.286-0.777; p < 0.001) it was moderate. In our series we found an 80% C between pre-operative hysteroscopic-guided biopsy and final pathology, in uterine malignancies. Moreover, hysteroscopic biopsy accurately predicted endometrial cancer in 80% of cases and "substantially" predicted histological grading. Hysteroscopic-guided uterine sampling could be a useful tool to tailor treatment in patients with uterine

  2. Concordance négative optionnelle : contrastes forts et faibles entre picard et québécois

    Directory of Open Access Journals (Sweden)

    Dagnac Anne

    2016-01-01

    Full Text Available Cet article, basédeux études decorpus,comparele phénomène de la concordance négative(CNenpicard et enfrançais montréalais. Après avoir défini les phénomènes étudiés, il présenterapidement lefonctionnement de la négation et de la concordance négative en picard, et leurressemblances avec le système montréalais.La concordance entre marqueur négatifet mot-N y est à la fois possible et optionnelle: j’n’in sais (mie rien ‘je n’en sais rien’ (picard, j’ai (pasrien contre la loi cent un ‘je n’ai rien contre la loi cent un’ (québécois. Les contrastes en termes de contextes syntaxiques permettant ou non la CNoptionnelle, conduisent à poser ces deux dialectes commetypologiquement distinctssur des points considérés comme théoriquement cruciaux, comme la possibilité de la CNentre un marqueur denégation et un mot-N préverbalou dans des énoncés fragmentaires. Néanmoins, onmontre qu’une prise en compte plus fine des propriétéslexicalesdes items en jeuet de leurs fréquences d’emploi relativesmodifiece schéma typologique:elle montred’étonnantes convergences entre les deux systèmes, qui invitent à repenser la manière d’aborder la microvariation syntaxique. L’article défend enfin l’hypothèse que les différences entre les deux dialectes reposent sur l’existence d’un marqueur secondaire en picard, occupant une position syntaxique distinctedu marqueur pas ou point.

  3. Family history assessment of personality disorders: I. Concordance with direct interview and between pairs of informants.

    Science.gov (United States)

    Ferro, T; Klein, D N

    1997-01-01

    The present study examined the concordance of the Family History Interview for Personality Disorders (FHIPD) with diagnoses based on direct interviews and between pairs of informants. Subjects were 224 probands participating in a series of studies of the familial transmission of mood and personality disorders and their first-degree relatives. Proband informants and relatives provided information about themselves on the Structured Clinical Interview for DSM-III-R (SCID), Personality Disorder Examination (PDE), and Eysenck Personality Questionnaire (EPQ). Information from informants about relatives was collected with the FHIPD. All assessments were made blindly and independently. Using Kappa, concordance between proband informants' family histories and relative direct reports on specific personality disorders was low, ranging from -.01 to .28, with a median of .10. Kappa for a diagnosis of any personality disorder was .16. When two independent informant reports were compared, Kappas for specific Axis II disorders ranged from .10 to .72, with a median of .28. Kappa for a diagnosis of any personality disorder was .36. These data suggest that subjects and informants provide different perspectives on Axis II psychopathology, and support the use of both sources of information whenever possible.

  4. Considering "Nonlinearity" Across the Continuum in Medical Education Assessment: Supporting Theory, Practice, and Future Research Directions.

    Science.gov (United States)

    Durning, Steven J; Lubarsky, Stuart; Torre, Dario; Dory, Valérie; Holmboe, Eric

    2015-01-01

    The purpose of this article is to propose new approaches to assessment that are grounded in educational theory and the concept of "nonlinearity." The new approaches take into account related phenomena such as "uncertainty," "ambiguity," and "chaos." To illustrate these approaches, we will use the example of assessment of clinical reasoning, although the principles we outline may apply equally well to assessment of other constructs in medical education. Theoretical perspectives include a discussion of script theory, assimilation theory, self-regulated learning theory, and situated cognition. Assessment examples to include script concordance testing, concept maps, self-regulated learning microanalytic technique, and work-based assessment, which parallel the above-stated theories, respectively, are also highlighted. We conclude with some practical suggestions for approaching nonlinearity. © 2015 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.

  5. Caregiver-Teacher Concordance of Challenging Behaviors in Children with Autism Spectrum Disorder Served in Community Mental Health Settings

    Science.gov (United States)

    Stadnick, Nicole; Chlebowski, Colby; Brookman-Frazee, Lauren

    2017-01-01

    Children with autism spectrum disorder (ASD) exhibit high rates of challenging behaviors that impair functioning and represent the primary presenting problem in mental health (MH) services. Obtaining symptom reports from multiple informants is critical for treatment planning. This study evaluated caregiver-teacher concordance of ratings of the…

  6. USE OF ELECTRONIC CASE HISTORIES IN OPERATION OF MEDICAL UNITS

    Directory of Open Access Journals (Sweden)

    I. B. Boltenkova

    2016-01-01

    Full Text Available Introduction of electronic case histories to medical units including TB units is one of the factors allowing enhancing quality of medical care provision. Use of the electronic case histories provides conditions for information transparency improvement in a medical unit: financial, statistic and medico-technological. Information contained in the electronic case history is important and required both for internal and external use. Use of electronic case histories contributes to reduction of labor costs of workers in medical units, provides fast access of medical personnel to information, formalizes data, provides preservation, invariance and reliability of the information entered into electronic case history during the whole period of storage, regulates the access rights and confidentiality, personifies data and allows unifying health data of all Russian population into one pool.

  7. Concordance between local, institutional, and central pathology review in glioblastoma: implications for research and practice: a pilot study.

    Science.gov (United States)

    Gupta, Tejpal; Nair, Vimoj; Epari, Sridhar; Pietsch, Torsten; Jalali, Rakesh

    2012-01-01

    There is significant inter-observer variation amongst the neuro-pathologists in the typing, subtyping, and grading of glial neoplasms for diagnosis. Centralized pathology review has been proposed to minimize this inter-observer variation and is now almost mandatory for accrual into multicentric trials. We sought to assess the concordance between neuro-pathologists on histopathological diagnosis of glioblastoma. Comparison of local, institutional, and central neuro-oncopathology reporting in a cohort of 34 patients with newly diagnosed supratentorial glioblastoma accrued consecutively at a tertiary-care institution on a prospective trial testing the addition of a new agent to standard chemo-radiation regimen. Concordance was sub-optimal between local histological diagnosis and central review, fair between local diagnosis and institutional review, and good between institutional and central review, with respect to histological typing/subtyping. Twelve (39%) of 31 patients with local histological diagnosis had identical tumor type, subtype and grade on central review. Overall agreement was modestly better (52%) between local diagnosis and institutional review. In contrast, 28 (83%) of 34 patients had completely concordant histopathologic diagnosis between institutional and central review. The inter-observer reliability test showed poor agreement between local and central review (kappa statistic=0.12, 95% confidence interval (CI): -0.03-0.32, P=0.043), but moderate agreement between institutional and central review (kappa statistic=0.51, 95%CI: 0.17-0.84, P=0.00003). Agreement between local diagnosis and institutional review was fair. There exists significant inter-observer variation regarding histopathological diagnosis of glioblastoma with significant implications for clinical research and practice. There is a need for more objective, quantitative, robust, and reproducible criteria for better subtyping for accurate diagnosis.

  8. [Intelligent operating room suite : From passive medical devices to the self-thinking cognitive surgical assistant].

    Science.gov (United States)

    Kenngott, H G; Wagner, M; Preukschas, A A; Müller-Stich, B P

    2016-12-01

    Modern operating room (OR) suites are mostly digitally connected but until now the primary focus was on the presentation, transfer and distribution of images. Device information and processes within the operating theaters are barely considered. Cognitive assistance systems have triggered a fundamental rethinking in the automotive industry as well as in logistics. In principle, tasks in the OR, some of which are highly repetitive, also have great potential to be supported by automated cognitive assistance via a self-thinking system. This includes the coordination of the entire workflow in the perioperative process in both the operating theater and the whole hospital. With corresponding data from hospital information systems, medical devices and appropriate models of the surgical process, intelligent systems could optimize the workflow in the operating theater in the near future and support the surgeon. Preliminary results on the use of device information and automatically controlled OR suites are already available. Such systems include, for example the guidance of laparoscopic camera systems. Nevertheless, cognitive assistance systems that make use of knowledge about patients, processes and other pieces of information to improve surgical treatment are not yet available in the clinical routine but are urgently needed in order to automatically assist the surgeon in situation-related activities and thus substantially improve patient care.

  9. Differences in knowledge, attitudes and behaviors of Israeli HIV-uninfected gay men in HIV-discordant vs. concordant steady relationships.

    Science.gov (United States)

    Tairy, Daniel; Levy, Itzchak; Turner, Dan; Livnat, Yuval; Mor, Zohar

    2018-06-01

    HIV-discordant gay male couples may play an important role in HIV-transmissions. This cross-sectional study compared the knowledge, attitudes and sexual behaviors of HIV-uninfected gay men, between those in HIV-discordant and those in HIV-concordant steady relationships. Anonymous questionnaires were distributed electronically in designated gay-related internet sites and in AIDS-clinics in 2015. The dependent variable was defined as a steady relationship of an HIV-uninfected man with an HIV-infected partner. Risky sexual behavior was defined as unprotected anal intercourse (UAI) with a sex partner whose HIV-status was either positive or unknown. Of 2,319 responders, 460 (20%) were HIV-uninfected gay men in steady relationships, of whom 72 were in HIV-discordant relationships and 388 were in HIV-concordant relationships. Those in HIV-discordant relationships presented better established knowledge regarding HIV-transmission, more lenient attitudes regarding UAI, and reported being involved in riskier sexual behavior, both within and outside their steady relationship compared to men in HIV-concordant relationships. UAI was performed by 48% of the HIV-discordant couples and was associated with the use of sero-positioning strategy and with achieving undetectable viral-load. These findings reflect the complexity of constant use of condoms during long-term sero-discordant relationships. Targeted interventions for HIV-prevention in HIV-discordant couples should be employed for balancing the partners' desire for intimacy and sexual pleasure in the relationship, while reducing the risk for acquiring HIV. ART: Antiretroviral therapy; PEP: Post exposure prophylaxis; PrEP: Pre exposure prophylaxis; STI: Sexually transmitted infections; UAI: Unprotected anal intercourse.

  10. Applying Amide Proton Transfer MR Imaging to Hybrid Brain PET/MR: Concordance with Gadolinium Enhancement and Added Value to [18F]FDG PET.

    Science.gov (United States)

    Sun, Hongzan; Xin, Jun; Zhou, Jinyuan; Lu, Zaiming; Guo, Qiyong

    2018-06-01

    The purpose of this study is to evaluate the diagnostic concordance and metric correlations of amide proton transfer (APT) imaging with gadolinium-enhanced magnetic resonance imaging (MRI) and 2-deoxy-2-[ 18 F-]fluoro-D-glucose ([ 18 F]FDG) positron emission tomography (PET), using hybrid brain PET/MRI. Twenty-one subjects underwent brain gadolinium-enhanced [ 18 F]FDG PET/MRI prospectively. Imaging accuracy was compared between unenhanced MRI, MRI with enhancement, APT-weighted (APTW) images, and PET based on six diagnostic criteria. Among tumors, the McNemar test was further used for concordance assessment between gadolinium-enhanced imaging, APT imaging, and [ 18 F]FDG PET. As well, the relation of metrics between APT imaging and PET was analyzed by the Pearson correlation analysis. APT imaging and gadolinium-enhanced MRI showed superior and similar diagnostic accuracy. APTW signal intensity and gadolinium enhancement were concordant in 19 tumors (100 %), while high [ 18 F]FDG avidity was shown in only 12 (63.2 %). For the metrics from APT imaging and PET, there was significant correlation for 13 hypermetabolic tumors (P PET in the evaluation of tumor metabolic activity during brain PET/MR studies.

  11. Attention-Deficit/Hyperactivity Disorder (ADHD) in Adulthood: Concordance and Differences between Self- and Informant Perspectives on Symptoms and Functional Impairment.

    Science.gov (United States)

    Mörstedt, Beatrice; Corbisiero, Salvatore; Bitto, Hannes; Stieglitz, Rolf-Dieter

    2015-01-01

    Attention-deficit/hyperactivity disorder (ADHD) is a severe mental illness, associated with major impairment and a high comorbidity rate. Particularly undiagnosed ADHD in adulthood has serious consequences. Thus, a valid diagnosis is important. In adulthood, the diagnostic process for ADHD is complicated: symptoms may overlap with comorbid disorders, and the onset and progression of the disorder must be reconstructed retrospectively. Guidelines for the diagnostic process recommend the inclusion of additional informant ratings. Research into the relation between self- and informant ratings shows extremely heterogeneous results. The levels of agreement range from low to high. The focus of this study is the concordance and differences between self- and informant ratings on ADHD symptoms and impairments. In this regard, two possible influencing factors (gender and relationship type) are also examined. 114 people participated in this study, 77 with an ADHD diagnosis and 37 without a diagnosis. For all participants, either parents or partners also rated ADHD symptoms and impairments. Small to moderate concordance was found between self- and informant ratings, with females being slightly more concordant than males, particularly for ratings of problems with self-concept. Examination of the consistency within a particular perspective showed that people with ADHD seemed to be unaware of the causal relation between ADHD symptoms and their impairments. A close investigation found almost no influence of gender and relationship type on differences within perspectives. Based on these results, the implications for the diagnostic process are that additional informant information is clearly necessary and helpful.

  12. Adrenal vein sampling in primary aldosteronism: concordance of simultaneous vs sequential sampling.

    Science.gov (United States)

    Almarzooqi, Mohamed-Karji; Chagnon, Miguel; Soulez, Gilles; Giroux, Marie-France; Gilbert, Patrick; Oliva, Vincent L; Perreault, Pierre; Bouchard, Louis; Bourdeau, Isabelle; Lacroix, André; Therasse, Eric

    2017-02-01

    Many investigators believe that basal adrenal venous sampling (AVS) should be done simultaneously, whereas others opt for sequential AVS for simplicity and reduced cost. This study aimed to evaluate the concordance of sequential and simultaneous AVS methods. Between 1989 and 2015, bilateral simultaneous sets of basal AVS were obtained twice within 5 min, in 188 consecutive patients (59 women and 129 men; mean age: 53.4 years). Selectivity was defined by adrenal-to-peripheral cortisol ratio ≥2, and lateralization was defined as an adrenal aldosterone-to-cortisol ratio ≥2, the contralateral side. Sequential AVS was simulated using right sampling at -5 min (t = -5) and left sampling at 0 min (t = 0). There was no significant difference in mean selectivity ratio (P = 0.12 and P = 0.42 for the right and left sides respectively) and in mean lateralization ratio (P = 0.93) between t = -5 and t = 0. Kappa for selectivity between 2 simultaneous AVS was 0.71 (95% CI: 0.60-0.82), whereas it was 0.84 (95% CI: 0.76-0.92) and 0.85 (95% CI: 0.77-0.93) between sequential and simultaneous AVS at respectively -5 min and at 0 min. Kappa for lateralization between 2 simultaneous AVS was 0.84 (95% CI: 0.75-0.93), whereas it was 0.86 (95% CI: 0.78-0.94) and 0.80 (95% CI: 0.71-0.90) between sequential AVS and simultaneous AVS at respectively -5 min at 0 min. Concordance between simultaneous and sequential AVS was not different than that between 2 repeated simultaneous AVS in the same patient. Therefore, a better diagnostic performance is not a good argument to select the AVS method. © 2017 European Society of Endocrinology.

  13. An astronomical age for the Bishop Tuff and concordance with radioisotopic dates

    DEFF Research Database (Denmark)

    Rivera, Tiffany; Zeeden, Christian; Storey, Michael

    2014-01-01

    The Bishop Tuff forms a key stratigraphic horizon for synchronization of Quaternary sedimentary records in North America. The unit stratigraphically overlies the Matuyama-Brunhes geomagnetic polarity reversal by several thousand years; high-precision dating of this tuff may be valuable for regional...... and global correlation of records. The Quaternary time scale is anchored by 40Ar/39Ar ages on lava flows and ash layers where available, with stage boundaries and geomagnetic reversals including astronomically tuned records. However, astronomical dating has not yet validated the high-precision 238U/206Pb...... ages, including new single crystal 40Ar/39Ar sanidine fusion analyses presented here, which demonstrates that concordance through multiple dating techniques is achievable within the Quaternary...

  14. Diagnostic accuracy of gadoxetic acid-enhanced MR for small hypervascular hepatocellular carcinoma and the concordance rate of Liver Imaging Reporting and Data System (LI-RADS).

    Science.gov (United States)

    Bae, Jae Seok; Kim, Jung Hoon; Yu, Mi Hye; Lee, Dong Ho; Kim, Hyo-Cheol; Chung, Jin Wook; Han, Joon Koo

    2017-01-01

    To assess diagnostic accuracy of gadoxetic acid-enhanced MR for small hypervascular hepatocellular carcinoma (HCC) detected by C-arm CT and concordance rate of Liver Imaging Reporting and Data System (LI-RADS). In this retrospective study, we recruited 4,544 patients suspected of having HCC underwent C-arm CT from November 2008 to May 2013. Among these patients, gadoxetic acid-enhanced MR was performed in 167 patients with HCC (n = 379; 257 > 1 cm, 122 ≤ 1 cm). HCC was confirmed by MR, CT, or follow-up images. Two radiologists graded likelihood of HCC and assessed MR features. Jackknife alternative free-response receiver operating characteristic (JAFROC) analysis was performed. All HCCs were evaluated concordance rate of LI-RADS. Mean JAFROC figure of merit for large (>1-cm) HCC was 0.948, while that for small HCC was 0.787 with fair agreement (κ = 0.409). Mean sensitivity and positive predictive value (PPV) were 91% and 90% for large HCC versus 63.0% and 79% for small HCC, respectively. Seventeen of 122 small HCCs (13.9%) were not visible on MR. Among 379 HCCs, 99 met LR-5, and 259 met LR-4. Common features for small HCC included arterial enhancement (81.9%), hepatobiliary phase hypointensity (80.3%), and delayed washout (72.9%). Diagnostic accuracy of gadoxetic acid-enhanced MR imaging for small, hypervascular HCCs (Mean figure of merit = 0.787) was still low compared with large HCC (Mean figure of merit = 0.948). LR-5 and LR-4 covered 94% (358/379) of the HCCs.

  15. Operational experience and recent developments at the National Medical Cyclotron

    International Nuclear Information System (INIS)

    Conard, E.; Pac, B.; Arnott, D.W.

    1994-01-01

    The National Medical Cyclotron is a radioisotope production facility run by ANSTO and located on the grounds of the Royal Prince Alfred Hospital in Sydney, Australia. A CYCLONE 30 (IBA) cyclotron is used in the production of short-lived PET radiopharmaceuticals required by the hospital's PET Scanner and also to produce a number of bulk radiochemicals for processing and distribution throughout Australasia. Following commissioning of the cyclotron and beam lines in October 1991, and the overcoming of a number of early open-quote teething close-quote problems especially relating to the reliability of the r.f. and solid target transport systems, a steady program of improvements has been pursued. These improvements have included development of new beam diagnostics and the design and installation of a new beam line for SPECT radioisotope production. The current operations schedule includes the production of 18 FDG, 13 NH 3 , 15 O 2 and 201 Tl, 67 Ga and 123 I. This paper will discuss the process of development of the cyclotron to ably meet the present demands on it, and the problems resolved in the pursuit of this goal

  16. A Prospective Study of the Concordance of DSM-IV and DSM-5 Diagnostic Criteria for Autism Spectrum Disorder

    Science.gov (United States)

    Mazurek, Micah O.; Lu, Frances; Symecko, Heather; Butter, Eric; Bing, Nicole M.; Hundley, Rachel J.; Poulsen, Marie; Kanne, Stephen M.; Macklin, Eric A.; Handen, Benjamin L.

    2017-01-01

    The transition from DSM-IV to DSM-5 criteria for autism spectrum disorder (ASD) sparked considerable concern about the potential implications of these changes. This study was designed to address limitations of prior studies by prospectively examining the concordance of DSM-IV and final DSM-5 criteria on a consecutive sample of 439 children…

  17. [Concordance among analysts from Latin-American laboratories for rice grain appearance determination using a gallery of digital images].

    Science.gov (United States)

    Avila, Manuel; Graterol, Eduardo; Alezones, Jesús; Criollo, Beisy; Castillo, Dámaso; Kuri, Victoria; Oviedo, Norman; Moquete, Cesar; Romero, Marbella; Hanley, Zaida; Taylor, Margie

    2012-06-01

    The appearance of rice grain is a key aspect in quality determination. Mainly, this analysis is performed by expert analysts through visual observation; however, due to the subjective nature of the analysis, the results may vary among analysts. In order to evaluate the concordance between analysts from Latin-American rice quality laboratories for rice grain appearance through digital images, an inter-laboratory test was performed with ten analysts and images of 90 grains captured with a high resolution scanner. Rice grains were classified in four categories including translucent, chalky, white belly, and damaged grain. Data was categorized using statistic parameters like mode and its frequency, the relative concordance, and the reproducibility parameter kappa. Additionally, a referential image gallery of typical grain for each category was constructed based on mode frequency. Results showed a Kappa value of 0.49, corresponding to a moderate reproducibility, attributable to subjectivity in the visual analysis of grain images. These results reveal the need for standardize the evaluation criteria among analysts to improve the confidence of the determination of rice grain appearance.

  18. Real external predictivity of QSAR models: how to evaluate it? Comparison of different validation criteria and proposal of using the concordance correlation coefficient.

    Science.gov (United States)

    Chirico, Nicola; Gramatica, Paola

    2011-09-26

    The main utility of QSAR models is their ability to predict activities/properties for new chemicals, and this external prediction ability is evaluated by means of various validation criteria. As a measure for such evaluation the OECD guidelines have proposed the predictive squared correlation coefficient Q(2)(F1) (Shi et al.). However, other validation criteria have been proposed by other authors: the Golbraikh-Tropsha method, r(2)(m) (Roy), Q(2)(F2) (Schüürmann et al.), Q(2)(F3) (Consonni et al.). In QSAR studies these measures are usually in accordance, though this is not always the case, thus doubts can arise when contradictory results are obtained. It is likely that none of the aforementioned criteria is the best in every situation, so a comparative study using simulated data sets is proposed here, using threshold values suggested by the proponents or those widely used in QSAR modeling. In addition, a different and simple external validation measure, the concordance correlation coefficient (CCC), is proposed and compared with other criteria. Huge data sets were used to study the general behavior of validation measures, and the concordance correlation coefficient was shown to be the most restrictive. On using simulated data sets of a more realistic size, it was found that CCC was broadly in agreement, about 96% of the time, with other validation measures in accepting models as predictive, and in almost all the examples it was the most precautionary. The proposed concordance correlation coefficient also works well on real data sets, where it seems to be more stable, and helps in making decisions when the validation measures are in conflict. Since it is conceptually simple, and given its stability and restrictiveness, we propose the concordance correlation coefficient as a complementary, or alternative, more prudent measure of a QSAR model to be externally predictive.

  19. Concordance in the Health Behaviors of Couples by Age: A Cross-sectional Study

    Directory of Open Access Journals (Sweden)

    Seungmin Jeong

    2018-01-01

    Full Text Available Objectives To investigate concordance in the health behaviors of women and their partners according to age and to investigate whether there was a stronger correlation between the health behaviors of housewives and those of their partners than between the health behaviors of non-housewives and those of their partners. Methods We used data obtained from women participants in the 2015 Korea Community Health Survey who were living with their partners. The outcome variables were 4 health behaviors: smoking, drinking, eating salty food, and physical activity. The main independent variables were the partners’ corresponding health behaviors. We categorized age into 4 groups (19-29, 30-49, 50-64, and ≥ 65 years and utilized multivariate logistic regression analysis, stratifying by age group. Another logistic regression analysis was stratified by whether the participant identified as a housewife. Results Data from 64 971 women older than 18 years of age were analyzed. Of the 4 health behaviors, the risk of smoking (adjusted odds ratio [aOR], 4.65; 95% confidence interval [CI], 3.93 to 5.49 was highest when the participant’s partner was also a smoker. Similar results were found for an inactive lifestyle (aOR, 2.56; 95% CI, 2.45 to 2.66, eating salty food (aOR, 2.48; 95% CI, 2.36 to 2.62; and excessive drinking (aOR, 1.89; 95% CI, 1.80 to 1.98. In comparison to non-housewives, housewives had higher odds of eating salty food. Conclusions The health behaviors of women were positively correlated with those of their partners. The magnitude of the concordance differed by age group.

  20. Special Forces Medical Sergeants' perceptions and beliefs regarding their current medical sustainment program: implications for the field.

    Science.gov (United States)

    Wilson, Ramey L; DeZee, Kent J

    2014-01-01

    Special Forces Medical Sergeants (SFMS) are trained to provide trauma and medical care in support of military operations and diplomatic missions throughout the world with indirect physician oversight. This study assessed their perceptions of the current program designed to sustain their medical skills. An Internet-based survey was developed using the constructs of the Theory of Reasoned Action/Planned Behavior and validated through survey best practices. Of the 334 respondents, 92.8% had deployed at least once as an SFMS. Respondents reported spending 4 hours per week sustaining their medical skills and were highly confident that they could perform their duties on a no-notice deployment. On a 5-point, Likert-type response scale, SFMS felt that only slight change is needed to the Special Operations Medical Skills Sustainment Course (mean: 2.17; standard deviation [SD]: 1.05), while moderate change is needed to the Medical Proficiency Training (mean: 2.82; SD: 1.21) and nontrauma modules (mean: 3.02; SD: 1.22). Respondents desire a medical sustainment program that is provided by subject matter experts, involves actual patient care, incorporates new technology, uses hands-on simulation, and is always available. SFMS are challenged to sustain their medical skills in the current operational environment, and barriers to medical training should be minimized to facilitate sustainment training. Changes to the current medical sustainment program should incorporate operator-level perspectives to ensure acceptability and utility but must be balanced with organizational realities. Improving the medical sustainment program will prepare SFMS for the challenges of future missions. 2014.

  1. medical journal Banda

    African Journals Online (AJOL)

    USER

    Information System (HMIS) records from three clinical practice there must be concordance .... Knowledge of parts of the body using anatomical terms. Average = 3. All of above AND ? ... respiratory tract infections, meningitis, pneumonia.

  2. A Bayesian Framework for Estimating the Concordance Correlation Coefficient Using Skew-elliptical Distributions.

    Science.gov (United States)

    Feng, Dai; Baumgartner, Richard; Svetnik, Vladimir

    2018-04-05

    The concordance correlation coefficient (CCC) is a widely used scaled index in the study of agreement. In this article, we propose estimating the CCC by a unified Bayesian framework that can (1) accommodate symmetric or asymmetric and light- or heavy-tailed data; (2) select model from several candidates; and (3) address other issues frequently encountered in practice such as confounding covariates and missing data. The performance of the proposal was studied and demonstrated using simulated as well as real-life biomarker data from a clinical study of an insomnia drug. The implementation of the proposal is accessible through a package in the Comprehensive R Archive Network.

  3. Telementoring systems in the operating room: a new approach in medical training.

    Science.gov (United States)

    Wachs, Juan P; Gomez, Gerardo

    2013-01-01

    This paper discusses the challenges and innovations related to the use of telementoring systems in the operating room. Most of the systems presented leverage on three types of interaction channels: audio, visual and physical. The audio channel enables the mentor to verbally instruct the trainee, and allows the trainee to ask questions. The visual channel is used to deliver annotations, alerts and other messages graphically to the trainee during the surgery. These visual representations are often displayed through a telestrator. The physical channel has been used in laparoscopic procedures by partially controlling the laparoscope through force-feedback. While in face to face instruction, the mentor produces gestures to convey certain aspects of the surgical instruction, there is not equivalent of this form of physical interaction between the mentor and trainee in open surgical procedures in telementoring systems. Even that the trend is to perform more minimally invasive surgery (MIS), trauma surgeries are still necessary, where initial resuscitation and stabilization of the patient in a timely manner is crucial. This paper presents a preliminary study conducted at the Indiana University Medical School and Purdue University, where initial lexicons of surgical instructive gestures (SIGs) were determined through systematic observation when mentor and trainee operate together. The paper concludes with potential ways to convey gestural information through surgical robots.

  4. Telementoring systems in the operating room: a new approach in medical training

    Directory of Open Access Journals (Sweden)

    Juan P. Wachs

    2013-12-01

    Full Text Available This paper discusses the challenges and innovations related to the use of telementoring systems in the operating room. Most of the systems presented leverage on three types of interaction channels: audio, visual and physical. The audio channel enables the mentor to verbally instruct the trainee, and allows the trainee to ask questions. The visual channel is used to deliver annotations, alerts and other messages graphically to the trainee during the surgery. These visual representations are often displayed through a telestrator. The physical channel has been used in laparoscopic procedures by partially controlling the laparoscope through force-feedback. While in face to face instruction, the mentor produces gestures to convey certain aspects of the surgical instruction, there is not equivalent of this form of physical interaction between the mentor and trainee in open surgical procedures in telementoring systems. Even that the trend is to perform more minimally invasive surgery (MIS, trauma surgeries are still necessary, where initial resuscitation and stabilization of the patient in a timely manner is crucial. This paper presents a preliminary study conducted at the Indiana University Medical School and Purdue University, where initial lexicons of surgical instructive gestures (SIGs were determined through systematic observation when mentor and trainee operate together. The paper concludes with potential ways to convey gestural information through surgical robots.

  5. An Explication of Concordance between Man's Mental Structure and the Narrative Structure in the Light of Vygotsky's SCT

    Science.gov (United States)

    Azabdaftari, Behrooz

    2013-01-01

    This paper seeks to throw light on the concordance between man's mental structure and the structure of narrative with regard to Vygotsky's sociocultural theory. In so doing, the author first provides the backdrop of the literature on the topic by first explaining Vygotsky's approach to the genesis of mind, and then gives a synoptic account of the…

  6. Molecular testing guidelines for lung adenocarcinoma: Utility of cell blocks and concordance between fine-needle aspiration cytology and histology samples

    Science.gov (United States)

    Heymann, Jonas J.; Bulman, William A.; Maxfield, Roger A.; Powell, Charles A.; Halmos, Balazs; Sonett, Joshua; Beaubier, Nike T.; Crapanzano, John P.; Mansukhani, Mahesh M.; Saqi, Anjali

    2014-01-01

    Background: Lung cancer is a leading cause of mortality, and patients often present at a late stage. More recently, advances in screening, diagnosing, and treating lung cancer have been made. For instance, greater numbers of minimally invasive procedures are being performed, and identification of lung adenocarcinoma driver mutations has led to the implementation of targeted therapies. Advances in molecular techniques enable use of scant tissue, including cytology specimens. In addition, per recently published consensus guidelines, cytology-derived cell blocks (CBs) are preferred over direct smears. Yet, limited comparison of molecular testing of fine-needle aspiration (FNA) CBs and corresponding histology specimens has been performed. This study aimed to establish concordance of epidermal growth factor receptor (EGFR) and Kirsten rat sarcoma (KRAS) virus homolog testing between FNA CBs and histology samples from the same patients. Materials and Methods: Patients for whom molecular testing for EGFR or KRAS was performed on both FNA CBs and histology samples containing lung adenocarcinoma were identified retrospectively. Following microdissection, when necessary, concordance of EGFR and KRAS molecular testing results between FNA CBs and histology samples was evaluated. Results: EGFR and/or KRAS testing was performed on samples obtained from 26 patients. Concordant results were obtained for all EGFR (22/22) and KRAS (17/17) mutation analyses performed. Conclusions: Identification of mutations in lung adenocarcinomas affects clinical decision-making, and it is important that results from small samples be accurate. This study demonstrates that molecular testing on cytology CBs is as sensitive and specific as that on histology. PMID:24987443

  7. Attention-Deficit/Hyperactivity Disorder (ADHD in Adulthood: Concordance and Differences between Self- and Informant Perspectives on Symptoms and Functional Impairment.

    Directory of Open Access Journals (Sweden)

    Beatrice Mörstedt

    Full Text Available Attention-deficit/hyperactivity disorder (ADHD is a severe mental illness, associated with major impairment and a high comorbidity rate. Particularly undiagnosed ADHD in adulthood has serious consequences. Thus, a valid diagnosis is important. In adulthood, the diagnostic process for ADHD is complicated: symptoms may overlap with comorbid disorders, and the onset and progression of the disorder must be reconstructed retrospectively. Guidelines for the diagnostic process recommend the inclusion of additional informant ratings. Research into the relation between self- and informant ratings shows extremely heterogeneous results. The levels of agreement range from low to high. The focus of this study is the concordance and differences between self- and informant ratings on ADHD symptoms and impairments. In this regard, two possible influencing factors (gender and relationship type are also examined. 114 people participated in this study, 77 with an ADHD diagnosis and 37 without a diagnosis. For all participants, either parents or partners also rated ADHD symptoms and impairments. Small to moderate concordance was found between self- and informant ratings, with females being slightly more concordant than males, particularly for ratings of problems with self-concept. Examination of the consistency within a particular perspective showed that people with ADHD seemed to be unaware of the causal relation between ADHD symptoms and their impairments. A close investigation found almost no influence of gender and relationship type on differences within perspectives. Based on these results, the implications for the diagnostic process are that additional informant information is clearly necessary and helpful.

  8. Molecular testing guidelines for lung adenocarcinoma: Utility of cell blocks and concordance between fine-needle aspiration cytology and histology samples

    Directory of Open Access Journals (Sweden)

    Jonas J. Heymann

    2014-01-01

    Full Text Available Background: Lung cancer is a leading cause of mortality, and patients often present at a late stage. More recently, advances in screening, diagnosing, and treating lung cancer have been made. For instance, greater numbers of minimally invasive procedures are being performed, and identification of lung adenocarcinoma driver mutations has led to the implementation of targeted therapies. Advances in molecular techniques enable use of scant tissue, including cytology specimens. In addition, per recently published consensus guidelines, cytology-derived cell blocks (CBs are preferred over direct smears. Yet, limited comparison of molecular testing of fine-needle aspiration (FNA CBs and corresponding histology specimens has been performed. This study aimed to establish concordance of epidermal growth factor receptor (EGFR and Kirsten rat sarcoma (KRAS virus homolog testing between FNA CBs and histology samples from the same patients. Materials and Methods: Patients for whom molecular testing for EGFR or KRAS was performed on both FNA CBs and histology samples containing lung adenocarcinoma were identified retrospectively. Following microdissection, when necessary, concordance of EGFR and KRAS molecular testing results between FNA CBs and histology samples was evaluated. Results: EGFR and/or KRAS testing was performed on samples obtained from 26 patients. Concordant results were obtained for all EGFR (22/22 and KRAS (17/17 mutation analyses performed. Conclusions: Identification of mutations in lung adenocarcinomas affects clinical decision-making, and it is important that results from small samples be accurate. This study demonstrates that molecular testing on cytology CBs is as sensitive and specific as that on histology.

  9. Ciclo de produção e demanda térmica de clones da videira 'Concord' sobre diferentes porta-enxertos

    Directory of Open Access Journals (Sweden)

    Rogério de Sá Borges

    2014-12-01

    Full Text Available O objetivo do trabalho foi determinar a duração do ciclo de produção e a necessidade térmica de seis clones de 'Concord' sobre três porta-enxertos no norte do Paraná. Foram avaliados os clones '22', '28', '49', '202', '211' e '225', obtidos pela Embrapa Uva e Vinho, e enxertados sobre os porta-enxertos 'IAC 766', 'IAC 572' e '420-A'. O trabalho foi realizado em área experimental pertencente ao Centro Tecnológico da COROL - Cooperativa Agroindustrial, localizado no município de Rolândia-PR. O experimento foi realizado em esquema fatorial (6 clones x 3 porta-enxertos, em delineamento inteiramente casualizado, com cinco repetições. As plantas foram conduzidas em sistema de latada, no espaçamento de 4,0 m x 2,0 m, e as avaliações foram realizadas nas safras de 2009/2010 e 2010/2011. Verificou-se que dentre os clones de 'Concord' avaliados, o '202' apresenta a menor duração do ciclo entre a poda e a colheita, sendo portanto o mais precoce. Dentre os porta-enxertos, o '420-A' induz a maior taxa de acúmulo diário de sólidos solúveis do mosto, proporcionando redução do ciclo total e da demanda térmica dos clones de 'Concord', enquanto o 'IAC 572' induz a menor taxa, promovendo aumento do ciclo e da demanda térmica dos clones.

  10. A critical evaluation of the Beckman Coulter Access hsTnI: Analytical performance, reference interval and concordance.

    Science.gov (United States)

    Pretorius, Carel J; Tate, Jillian R; Wilgen, Urs; Cullen, Louise; Ungerer, Jacobus P J

    2018-05-01

    We investigated the analytical performance, outlier rate, carryover and reference interval of the Beckman Coulter Access hsTnI in detail and compared it with historical and other commercial assays. We compared the imprecision, detection capability, analytical sensitivity, outlier rate and carryover against two previous Access AccuTnI assay versions. We established the reference interval with stored samples from a previous study and compared the concordances and variances with the Access AccuTnI+3 as well as with two commercial assays. The Access hsTnI had excellent analytical sensitivity with the calibration slope 5.6 times steeper than the Access AccuTnI+3. The detection capability was markedly improved with the SD of the blank 0.18-0.20 ng/L, LoB 0.29-0.33 ng/L and LoD 0.58-0.69 ng/L. All the reference interval samples had a result above the LoB value. At a mean concentration of 2.83 ng/L the SD was 0.28 ng/L (CV 9.8%). Carryover (0.005%) and outlier (0.046%) rates were similar to the Access AccuTnI+3. The combined male and female 99th percentile reference interval was 18.2 ng/L (90% CI 13.2-21.1 ng/L). Concordance amongst the assays was poor with only 16.7%, 19.6% and 15.2% of samples identified by all 4 assays as above the 99th, 97.5th and 95th percentiles. Analytical imprecision was a minor contributor to the observed variances between assays. The Beckman Coulter Access hsTnI assay has excellent analytical sensitivity and precision characteristics close to zero. This allows cTnI measurement in all healthy individuals and the capability to identify numerically small differences between serial samples as statistically significant. Concordance in healthy individuals remains poor amongst assays. Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.

  11. Medication deserts: survey of neighborhood disparities in availability of prescription medications

    Science.gov (United States)

    2012-01-01

    Background Only a small amount of research has focused on the relationship between socio-economic status (SES) and geographic access to prescription medications at community pharmacies in North America and Europe. To examine the relationship between a community’s socio-economic context and its residents’ geographic access to common medications in pharmacies, we hypothesized that differences are present in access to pharmacies across communities with different socio-economic environments, and in availability of commonly prescribed medications within pharmacies located in communities with different socio-economic status. Methods We visited 408 pharmacies located in 168 socio-economically diverse communities to assess the availability of commonly prescribed medications. We collected the following information at each pharmacy visited: hours of operation, pharmacy type, in-store medication availability, and the cash price of the 13 most commonly prescribed medications. We calculated descriptive statistics for the sample and fitted a series of hierarchical linear models to test our hypothesis that the in-stock availability of medications differs by the socio-economic conditions of the community. This was accomplished by modeling medication availability in pharmacies on the socio-economic factors operating at the community level in a socio-economically devise urban area. Results Pharmacies in poor communities had significantly higher odds of medications being out of stock, OR=1.24, 95% CI [1.02, 1.52]. There was also a significant difference in density of smaller, independent pharmacies with very limited stock and hours of operation, and larger, chain pharmacies in poor communities as compared to the middle and low-poverty communities. Conclusions The findings suggest that geographic access to a neighborhood pharmacy, the type of pharmacy, and availability of commonly prescribed medications varies significantly across communities. In extreme cases, entire communities

  12. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY DISEASE STATE CLINICAL REVIEW: MANAGEMENT OF ACROMEGALY PATIENTS: WHAT IS THE ROLE OF PRE-OPERATIVE MEDICAL THERAPY?

    Science.gov (United States)

    Fleseriu, Maria; Hoffman, Andrew R; Katznelson, Laurence

    2015-06-01

    Acromegaly is a complex disease characterized by growth hormone (GH) excess originating in most cases from a pituitary tumor. The goals of treatment include removing the tumor or reducing tumor burden, normalizing GH secretion and insulin-like growth factor 1 levels, and preserving normal pituitary function if possible. Surgery by an experienced neurosurgeon is still considered first-line therapy, especially in cases with small tumors. In the last few decades, significant progress in the development of selective pharmacologic agents has greatly facilitated the management of active acromegaly, with agents such as somatostatin-receptor ligands (SRLs), GH-receptor antagonists, and dopamine agonists. In addition to adjuvant treatment, pre-operative medical therapy and primary therapy in de novo patients are increasingly employed. A United States National Library of Medicine PubMed search (through July 2014) was conducted for the following terms: acromegaly, pre-operative medical therapy, somatostatin-receptor ligands, and somatostatin analogs. Articles not in English and those not in peer-reviewed journals were excluded. In reviewing pertinent articles, focus was placed on biochemical and other postoperative outcomes of medical therapy. An analysis of the full effect of pre-operative use of SRLs on surgical outcomes (remission rates and peri-operative complications) is limited by heterogeneity of methodology, low overall surgical cure rates, and different study designs. The assumption that SRL use prior to surgery reduces peri-operative surgical risk has yet to be proven. A variable degree of tumor shrinkage with preoperative SRLs is observed. Likewise, SRL treatment 3 months before surgery may improve surgical remission rates in the short term; however, positive results do not persist in the long term. We consider that medical therapy before surgery could play a role in carefully selected patients, but treatment should be individualized. Primary medical therapy with a

  13. Concordance Rates of Adolescent Idiopathic Scoliosis in a Danish Twin Population

    DEFF Research Database (Denmark)

    Simony, Ane; Carreon, Leah Y; Højmark, Karen

    2016-01-01

    STUDY DESIGN: Clinical, radiological and genetic determination of zygosity of twin pairs from the Danish Twin Registry who self-reported having Adolescent Idiopathic Scoliosis (AIS). OBJECTIVE: To establish concordance rates of AIS. SUMMARY OF BACKGROUND DATA: The aetiology of and the true mode...... reported. METHODS: All 46,418 twins registered in the Danish Twin Registry born from 1931 to 1982 were sent a survey, which included questions about scoliosis. The survey was returned by 34,944 individuals (75.3%) representing 23,204 pairs. From this study, 548 individuals representing 274 complete twin...... pairs where at least one twin self-reported having scoliosis were invited to a clinical and radiological examination. Zygosity was established by genetic testing. RESULTS: 182 individuals (33.2%) of the original cohort agreed to participate, 128 of whom had scoliosis by self-report. There were 91 twin...

  14. Inflation with primordial broken power law spectrum as an alternative to the concordance cosmological model

    International Nuclear Information System (INIS)

    Pandolfi, Stefania; Giusarma, Elena; Lattanzi, Massimiliano; Melchiorri, Alessandro

    2010-01-01

    We consider cosmological models with a non-scale-invariant spectrum of primordial perturbations and assess whether they represent a viable alternative to the concordance ΛCDM model. We find that in the framework of a model selection analysis, the WMAP and 2dF data do not provide any conclusive evidence in favor of one or the other kind of model. However, when a marginalization over the entire space of nuisance parameters is performed, models with a modified primordial spectrum and Ω Λ =0 are strongly disfavored.

  15. Verfügbarkeit elektronischer Lehr- und Lernmodule für die Aus- und Weiterbildung in der Humanmedizin [Availability of learning objects for graduate and continuing medical education

    Directory of Open Access Journals (Sweden)

    Stausberg, Jürgen

    2008-11-01

    Full Text Available [english] A great number of learning objects is available for graduate and continuing medical education. Nevertheless, it is not known how well the range of available learning objects covers the needs of the various medical fields. To get an idea of this, the content of two catalogs of learning objects (LRSMed and KELDAmed was compared with the study regulations of the medical faculty of the University of Duisburg-Essen on the one hand and with the 2006 directory of certified medical specialists on the other hand. Spearman’s rank correlation coefficient was used as concordance measure in addition to a qualitative assessment. Correlation coefficients of 0.495 (LRSMed and 0.510 (KELDAmed show a relevant concordance with study regulations, while correlation coefficients of 0.300 and –0.182 reveal a worse concordance with continuing medical education. Therefore, the offers for graduate medical education correspond well with the medical fields, based on number of hours per semester per course. The absolute number of 1,822 learning objects from LRSMed and 1,769 from KELDAmed is excellent as well. The gap for continuing medical education can now be closed by means of funding from professional organizations and medical faculties and through healthcare policies. The quality of the learning objects offered by LRSMed and KELDAmed remains unknown, as there is yet no reliable and valid approach for assessing their quality. [german] Elektronische Lehr- und Lernmodule stehen inzwischen in großer Zahl für Aus- und Weiterbildung in der Humanmedizin zur Verfügung. Ob das Angebot die Fachgebiete in der erforderlichen Breite abdeckt ist unbekannt. Für eine erste Einschätzung wurden die Ressourcen von zwei umfassenden Katalogen, dem Learning Resource Server Medizin (LRSMed und der Kommentierten E-Learning Datenbank Medizin (KELDAmed, der Studienordnung der Medizinischen Fakultät der Universität Duisburg-Essen sowie der Ärztestatistik 2006 zu

  16. Regulatory Compliance to Assure the Safety of the Operation of a Medical Cyclotron

    International Nuclear Information System (INIS)

    Dela Cruz, Joselito

    2015-01-01

    Khealth Corporation, in Partnership with the National Kidney and Transplant Institute, has established a medical cyclotron facility to accommodate the up-and-coming needs of tracers for PET/CT in different centers and hospitals all over the country. This facility houses a 16.5 MeV GE PET trace 880 particle accelerator that can produce 14 Ci (518 GBq) of Fluorine-18. Its structure has adopted global standard designs in meeting the safety during its use, radiopharmaceutical production and distribution. Compliances were remarkably fulfilled from the building construction, machine acquisition, commissioning, operations up to the quality control and assurance. Furthermore, various regulatory challenges during the current standardization of radiopharmaceutical utilization were encountered however time dedication and efforts were wielded until all have been successfully justified and acquired. (author)

  17. [Prevention of medical device-related adverse events in hospitals: Specifying the recommendations of the German Coalition for Patient Safety (APS) for users and operators of anaesthesia equipment].

    Science.gov (United States)

    Bohnet-Joschko, Sabine; Zippel, Claus; Siebert, Hartmut

    2015-01-01

    The use and organisation of medical technology has an important role to play for patient and user safety in anaesthesia. Specification of the recommendations of the German Coalition for Patient Safety (APS) for users and operators of anaesthesia equipment, explore opportunities and challenges for the safe use and organisation of anaesthesia devices. We conducted a literature search in Medline/PubMed for studies dealing with the APS recommendations for the prevention of medical device-related risks in the context of anaesthesia. In addition, we performed an internet search for reports and recommendations focusing on the use and organisation of medical devices in anaesthesia. Identified studies were grouped and assigned to the recommendations. The division into users and operators was maintained. Instruction and training in anaesthesia machines is sometimes of minor importance. Failure to perform functional testing seems to be a common cause of critical incidents in anaesthesia. There is a potential for reporting to the federal authority. Starting points for the safe operation of anaesthetic devices can be identified, in particular, at the interface of staff, organisation, and (anaesthesia) technology. The APS recommendations provide valuable information on promoting the safe use of medical devices and organisation in anaesthesia. The focus will be on risks relating to the application as well as on principles and materials for the safe operation of anaesthesia equipment. Copyright © 2015. Published by Elsevier GmbH.

  18. Biomedical programs operations plans

    Science.gov (United States)

    Walbrecher, H. F.

    1974-01-01

    Operational guidelines for the space shuttle life sciences payloads are presented. An operational assessment of the medical experimental altitude test for Skylab, and Skylab life sciences documentation are discussed along with the operations posture and collection of space shuttle operational planning data.

  19. Evaluation of Randomly Selected Completed Medical Records Sheets in Teaching Hospitals of Jahrom University of Medical Sciences, 2009

    Directory of Open Access Journals (Sweden)

    Mohammad Parsa Mahjob

    2011-06-01

    Full Text Available Background and objective: Medical record documentation, often use to protect the patients legal rights, also providing information for medical researchers, general studies, education of health care staff and qualitative surveys is used. There is a need to control the amount of data entered in the medical record sheets of patients, considering the completion of these sheets is often carried out after completion of service delivery to the patients. Therefore, in this study the prevalence of completeness of medical history, operation reports, and physician order sheets by different documentaries in Jahrom teaching hospitals during year 2009 was analyzed. Methods and Materials: In this descriptive / retrospective study, the 400 medical record sheets of the patients from two teaching hospitals affiliated to Jahrom medical university was randomly selected. The tool of data collection was a checklist based on the content of medical history sheet, operation report and physician order sheets. The data were analyzed by SPSS (Version10 software and Microsoft Office Excel 2003. Results: Average of personal (Demography data entered in medical history, physician order and operation report sheets which is done by department's secretaries were 32.9, 35.8 and 40.18 percent. Average of clinical data entered by physician in medical history sheet is 38 percent. Surgical data entered by the surgeon in operation report sheet was 94.77 percent. Average of data entered by operation room's nurse in operation report sheet was 36.78 percent; Average of physician order data in physician order sheet entered by physician was 99.3 percent. Conclusion: According to this study, the rate of completed record papers reviewed by documentary in Jahrom teaching hospitals were not desirable and in some cases were very weak and incomplete. This deficiency was due to different reason such as medical record documentaries negligence, lack of adequate education for documentaries, High work

  20. Genetic determinants of LDL, lipoprotein(a), triglyceride-rich lipoproteins and HDL: concordance and discordance with cardiovascular disease risk

    DEFF Research Database (Denmark)

    Nordestgaard, Børge G; Tybjærg-Hansen, Anne

    2011-01-01

    To evaluate whether new and known genetic determinants of plasma levels of LDL cholesterol, lipoprotein(a), triglyceride-rich lipoproteins, and HDL cholesterol associate with the risk of cardiovascular disease expected from the effect on lipoprotein levels. Concordance or discordance...... of such genetic determinants with cardiovascular disease risk will either favor or disfavor that these lipoproteins are causally related to cardiovascular disease....

  1. Concordant Patterns of Brain Structure in Mothers with Recurrent Depression and Their Never-Depressed Daughters.

    Science.gov (United States)

    Foland-Ross, Lara C; Behzadian, Negin; LeMoult, Joelle; Gotlib, Ian H

    2016-01-01

    A growing body of research has demonstrated that having a mother with a history of major depressive disorder (MDD) is one of the strongest predictors of depression in adolescent offspring. Few studies, however, have assessed neural markers of this increased risk for depression, or examined whether risk-related anomalies in adolescents at maternal risk for depression are related to neural abnormalities in their depressed mothers. We addressed these questions by examining concordance in brain structure in two groups of participants: mothers with a history of depression and their never-depressed daughters, and never-depressed mothers and their never-depressed daughters. We scanned mothers with (remitted; RMD) and without (control; CTL) a history of recurrent episodes of depression and their never-depressed daughters, computed cortical gray matter thickness, and tested whether mothers' thickness predicted daughters' thickness. Both RMD mothers and their high-risk daughters exhibited focal areas of thinner cortical gray matter compared with their CTL/low-risk counterparts. Importantly, the extent of thickness anomalies in RMD mothers predicted analogous abnormalities in their daughters; this pattern was not present in CTL/low-risk dyads. We identified neuroanatomical risk factors that may underlie the intergenerational transmission of risk for MDD. Our findings suggest that there is concordance in brain structure in dyads that is affected by maternal depression, and that the location, direction, and extent of neural anomalies in high-risk offspring mirror those of their recurrent depressed mothers. © 2016 S. Karger AG, Basel.

  2. Concordance of DNA methylation profiles between breast core biopsy and surgical excision specimens containing ductal carcinoma in situ (DCIS).

    Science.gov (United States)

    Chen, Youdinghuan; Marotti, Jonathan D; Jenson, Erik G; Onega, Tracy L; Johnson, Kevin C; Christensen, Brock C

    2017-08-01

    The utility and reliability of assessing molecular biomarkers for translational applications on pre-operative core biopsy specimens assume consistency of molecular profiles with larger surgical specimens. Whether DNA methylation in ductal carcinoma in situ (DCIS), measured in core biopsy and surgical specimens are similar, remains unclear. Here, we compared genome-scale DNA methylation measured in matched core biopsy and surgical specimens from DCIS, including specific DNA methylation biomarkers of subsequent invasive cancer. DNA was extracted from guided 2mm cores of formalin fixed paraffin embedded (FFPE) specimens, bisulfite-modified, and measured on the Illumina HumanMethylation450 BeadChip. DNA methylation profiles of core biopsies exhibited high concordance with matched surgical specimens. Within-subject variability in DNA methylation was significantly lower than between-subject variability (all Pcore biopsy and surgical specimens, 15%, and a pathway analysis of these CpGs indicated enrichment for genes related with wound healing. Our results indicate that DNA methylation measured in core biopsies are representative of the matched surgical specimens and suggest that DCIS biomarkers measured in core biopsies can inform clinical decision-making. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  3. Mosquito and Fly Surveillance and Control Research at the USDA-ARS Center for Medical, Agricultural and Veterinary Entomology: Solving Operational Challenges

    Science.gov (United States)

    The Mosquito and Fly Research Unit of the USDA-ARS Center for Medical, Agricultural and Veterinary Entomology located in Gainesville Florida is the largest Federal laboratory devoted to specifically solving operational mosquito and fly surveillance and control challenges in the U.S. and internationa...

  4. Familial concordance of phenotype and microbial variation among siblings with CF.

    Science.gov (United States)

    Picard, Elie; Aviram, Micha; Yahav, Yaakov; Rivlin, Joseph; Blau, Hanna; Bentur, Lea; Avital, Avraham; Villa, Yael; Schwartz, Shepard; Kerem, Batsheva; Kerem, Eitan

    2004-10-01

    The clinical spectrum of cystic fibrosis (CF) is influenced by the cystic fibrosis transmembrane conductance regulator (CFTR) genotype. However, variable courses of the disease were demonstrated among patients with identical genotypes. Since siblings share identical CFTR mutations and environmental factors, they can serve as a model to assess the effect of modifier genes on disease expression, and also to evaluate cross-infection. The aim of this study was to compare disease expression among siblings with CF. All sibling pairs treated at 7 CF centers in Israel were included in the study. Data were collected from patients' medical charts. Fifty families with at least 2 siblings were identified. As expected, the second-born sibling was diagnosed at an earlier age compared to the first-born. The mode of CF presentation at diagnosis showed significant familial concordance. In the families where the first sibling presented with gastrointestinal manifestations, 79% of the second siblings also presented with gastrointestinal manifestations. When gastrointestinal manifestations were absent in the first sibling, only 12% of the second siblings presented with gastrointestinal manifestations (P sibling presented with respiratory symptoms, 60% of the second siblings presented with the similar symptoms. However, when the first sibling presented without respiratory symptoms, only 12% of the second siblings presented with respiratory symptoms (P sibling had MI, 8 (80%) of the subsequent siblings had MI. On the other hand, in the 39 families where the first-born sibling did not have MI, only 2 (5%) subsequent siblings had MI (P siblings. P. aeruginosa grew from sputum in 89% of our study patients. When P. aeruginosa was isolated from the first-born patient, 91% of the second siblings were also positive for P. aeruginosa, whereas when the initial sibling was not a carrier of P. aeruginosa, only 50% of subsequent siblings were positive (P sibling than in the first for the two

  5. Familial concordance of metabolic syndrome in Korean population--Korean National Health and Nutrition Examination Survey 2005.

    Science.gov (United States)

    Lee, Myung Ha; Kim, Hyeon Chang; Thomas, G Neil; Ahn, Song Vogue; Hur, Nam Wook; Choi, Dong Phil; Suh, Il

    2011-09-01

    To investigate the familial concordance of metabolic syndrome and its components in a nationally representative survey in Korean. We used data from the Korean National Health and Nutrition Examination Survey (KNHANES), a nationwide survey examining the general health and nutritional status of the Korean people. We enrolled 1641 married couples and 1527 parents-1342 offspring. Prevalence of the metabolic syndrome was 17.1% for husbands, 11.7% for wives, 14.3% for parents, and 7.2% for offspring. After adjustment for age, there were strong positive correlations between family members for the metabolic variables. Compared with husbands whose wives did not have metabolic syndrome, adjusted odds ratio in husbands whose wives had metabolic syndrome was 1.43 (95% CI: 1.10-1.87) for the risk of having metabolic syndrome. Similarly, wives whose husbands had metabolic syndrome had 1.41 (95% CI: 1.08-1.84) times higher risk of having metabolic syndrome. Compared with children whose parents did not have metabolic syndrome, adjusted odds ratio in children with at least one parent with the metabolic syndrome was 2.56 (95% CI: 1.09-5.98) for the metabolic syndrome. Our study revealed that there is significant familial concordance for metabolic syndrome and its components in Korean families. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  6. [Concordance between the zinc sulphate flotation and centrifugal sedimentation methods for the diagnosis of intestinal parasites].

    Science.gov (United States)

    Inês, Elizabete De Jesus; Pacheco, Flavia Thamiris Figueiredo; Pinto, Milena Carneiro; Mendes, Patrícia Silva de Almeida; Da Costa-Ribeiro, Hugo; Soares, Neci Matos; Teixeira, Márcia Cristina Aquino

    2016-12-01

    The diagnosis of intestinal parasitic infections depends on the parasite load, the specific gravity density of the parasite eggs, oocysts or cysts, and the density and viscosity of flotation or sedimentation medium where faeces are processed. To evaluate the concordance between zinc sulphate flotation and centrifugal sedimentation in the recovery of parasites in faecal samples of children. Faecal samples of 330 children from day care centers were evaluated by zinc sulphate flotation and centrifugal sedimentation techniques. The frequencies of detection of parasites by each method were determined and the agreement between the diagnostic techniques was evaluated using the kappa index, with 95% confidence intervals. The faecal flotation in zinc sulphate diagnosed significantly more cases of Trichuris trichiura infection when compared to centrifugal sedimentation (39/330; 11.8% vs. 13/330; 3.9%, p<0.001), with low diagnostic concordance between methods (kappa=0.264; 95% CI: 0.102-0.427). Moreover, all positive samples for Enterobius vermicularis eggs (n=5) and Strongyloides stercoralis larvae (n=3) were diagnosed only by zinc sulphate. No statistical differences were observed between methods for protozoa identification. The results showed that centrifugal flotation in zinc sulphate solution was significantly more likely to detect light helminths eggs such as those of T. trichiura and E. vermicularis in faeces than the centrifugal sedimentation process.

  7. Guideline-Concordant Cancer Care and Survival Among American Indian/Alaskan Native Patients

    Science.gov (United States)

    Javid, Sara H.; Varghese, Thomas K.; Morris, Arden M.; Porter, Michael P.; He, Hao; Buchwald, Dedra; Flum, David R.

    2014-01-01

    BACKGROUND American Indians/Alaskan Natives (AI/ANs) have the worst 5-year cancer survival of all racial/ethnic groups in the United States. Causes for this disparity are unknown. The authors of this report examined the receipt of cancer treatment among AI/AN patients compared with white patients. METHODS This was a retrospective cohort study of 338,204 patients who were diagnosed at age ≥65 years with breast, colon, lung, or prostate cancer between 1996 and 2005 in the Surveillance, Epidemiology, and End Results-Medicare database. Nationally accepted guidelines for surgical and adjuvant therapy and surveillance were selected as metrics of optimal, guideline-concordant care. Treatment analyses compared AI/ANs with matched whites. RESULTS Across cancer types, AI/ANs were less likely to receive optimal cancer treatment and were less likely to undergo surgery (P ≤ .025 for all cancers). Adjuvant therapy rates were significantly lower for AI/AN patients with breast cancer (P <.001) and colon cancer (P = .001). Rates of post-treatment surveillance also were lower among AI/ANs and were statistically significantly lower for AI/AN patients with breast cancer (P = .002) and prostate cancer (P <.001). Nonreceipt of optimal cancer treatment was associated with significantly worse survival across cancer types. Disease-specific survival for those who did not undergo surgery was significantly lower for patients with breast cancer (hazard ratio [HR], 0.62), colon cancer (HR, 0.74), prostate cancer (HR, 0.52), and lung cancer (HR, 0.36). Survival rates also were significantly lower for those patients who did not receive adjuvant therapy for breast cancer (HR, 0.56), colon cancer (HR, 0.59), or prostate cancer (HR, 0.81; all 95% confidence intervals were <1.0). CONCLUSIONS Fewer AI/AN patients than white patients received guideline-concordant cancer treatment across the 4 most common cancers. Efforts to explain these differences are critical to improving cancer care and

  8. Concordance of parent proxy report and child self-report of posttraumatic stress in children with cancer and healthy children: influence of parental posttraumatic stress.

    Science.gov (United States)

    Clawson, Ashley H; Jurbergs, Niki; Lindwall, Jennifer; Phipps, Sean

    2013-11-01

    This study examined the relationships between parental posttraumatic stress symptoms (PTSS), child PTSS, and parent-child concordance for child PTSS. Participants were children with cancer (n = 199), and healthy children (n = 108) and their parents. Children self-reported on PTSS and parents completed measures of child and parent PTSS. In the cancer group, child and parent reports of child PTSS were significantly correlated with no mean differences between reporters. In contrast, correlations were non-significant in the control group, and parents reported significantly lower levels of child PTSS than children. Increased parental PTSS was associated with better concordance in the cancer group but not in the control group. In fact, in the cancer group, parent-child concordance was strongest at the highest level of parental PTSS. Parents of children with cancer were found to be accurate reporters of their children's distress, even with high levels of reported personal distress. In contrast, parents of healthy children appear primarily influenced by personal distress when reporting child PTSS. Although multiple informant assessments are always desirable, it appears that utilization of a single informant may be reasonable in the cancer setting when access to informants is limited. Copyright © 2013 John Wiley & Sons, Ltd.

  9. Integrated Medical Model Overview

    Science.gov (United States)

    Myers, J.; Boley, L.; Foy, M.; Goodenow, D.; Griffin, D.; Keenan, A.; Kerstman, E.; Melton, S.; McGuire, K.; Saile, L.; hide

    2015-01-01

    The Integrated Medical Model (IMM) Project represents one aspect of NASA's Human Research Program (HRP) to quantitatively assess medical risks to astronauts for existing operational missions as well as missions associated with future exploration and commercial space flight ventures. The IMM takes a probabilistic approach to assessing the likelihood and specific outcomes of one hundred medical conditions within the envelope of accepted space flight standards of care over a selectable range of mission capabilities. A specially developed Integrated Medical Evidence Database (iMED) maintains evidence-based, organizational knowledge across a variety of data sources. Since becoming operational in 2011, version 3.0 of the IMM, the supporting iMED, and the expertise of the IMM project team have contributed to a wide range of decision and informational processes for the space medical and human research community. This presentation provides an overview of the IMM conceptual architecture and range of application through examples of actual space flight community questions posed to the IMM project.

  10. STS-3 medical report

    Science.gov (United States)

    Pool, S. L. (Editor); Johnson, P. C., Jr. (Editor); Mason, J. A. (Editor)

    1982-01-01

    The medical operations report for STS-3, which includes a review of the health of the crew before, during, and immediately after the third Shuttle orbital flight is presented. Areas reviewed include: health evaluation, medical debriefing of crewmembers, health stabilization program, medical training, medical 'kit' carried in flight, tests and countermeasures for space motion sickness, cardiovascular profile, biochemistry and endocrinology results, hematology and immunology analyses, medical microbiology, food and nutrition, potable water, shuttle toxicology, radiological health, and cabin acoustic noise. Environmental effects of shuttle launch and landing medical information management, and management, planning, and implementation of the medical program are also dicussed.

  11. Interobserver reproducibility of the histological diagnosis of cervical dysplasia, Hospital San Juan de Dios, from January to December 2010

    International Nuclear Information System (INIS)

    Morales Navarro, Karla Andrea

    2013-01-01

    The reproducibility of the histological diagnosis of cervix specimens processed by the Pathology Service of the San Juan de Dios Hospital from January to December 2010 was determined. When operational failures were detected, possible improvement processes were proposed, guided by the study's findings. A moderate concordance for the Bethesda System and poor to moderate for the classification of Cervical Intraepithelial Neoplasia, was obtained after analyzing the diagnoses issued by the observers when comparing the pairs of pathologists. The concordance was moderate when comparing each pathologist with the standard for both classifications. The correlation was excellent when comparing the Classification Cervical Intraepithelial Neoplasia versus the Bethesda System. The categories with highest concordance were high-grade intraepithelial lesion and cervical intraepithelial neoplasia 3 and minor agreement were low-grade intraepithelial lesion and cervical intraepithelial neoplasia 2. The results agree and in some cases the results exceed the reproduction noted in the literature world medical [es

  12. [Molecular typing of Leishmania (Leishmania) amazonensis and species of the subgenus Viannia associated with cutaneous and mucosal leishmaniasis in Colombia: A concordance study].

    Science.gov (United States)

    Ovalle-Bracho, Clemencia; Camargo, Carolina; Díaz-Toro, Yira; Parra-Muñoz, Marcela

    2018-03-15

    Multilocus enzyme electrophoresis (MLEE) is the reference standard for the characterization of Leishmania species. The test is restricted to specialized laboratories due to its technical complexity, cost, and time required to obtain results. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) is used to identify Leishmania species. To establish the concordance between the two tests as identifying methods for circulating species in Colombia. A total of 96 isolates from patients with cutaneous or mucosal leishmaniasis were selected and identified by MLEE and PCR-RFLP with miniexon and hsp70 as the molecular targets, which were used sequentially. Restriction enzymes HaeIII and BccI were similarly applied. Cohen's kappa coefficient and the 95% confidence interval (CI) were calculated. The kappa coefficient and the 95% CI between MLEE and PCR-RFLP displayed "very good" concordance with a coefficient of 0.98 (CI95%: 0.98 to 1.00). The identified species were Leishmania Viannia braziliensis, Leishmania Viannia panamensis, Leishmania Viannia guyanensis and Leishmania Leishmania amazonensis. A total of 80 of the 96 isolates were sequenced and the results obtained by PCR-RFLP were confirmed. Due to the concordance obtained between tests results with the amplification of the genes miniexon and hsp70, PCR-RFLP is proposed as an alternative for identifying circulating Leishmania species in Colombia.

  13. Concordance of self-report and measured height and weight of college students.

    Science.gov (United States)

    Quick, Virginia; Byrd-Bredbenner, Carol; Shoff, Suzanne; White, Adrienne A; Lohse, Barbara; Horacek, Tanya; Kattelmann, Kendra; Phillips, Beatrice; Hoerr, Sharon L; Greene, Geoffrey

    2015-01-01

    This study examined associations between college students' self-report and measured height and weight. Participants (N = 1,686) were 77% white, 62% female, aged 18-24 years (mean ± SD, 19.1 ± 1.1 years), and enrolled at 8 US universities. Body mass index (BMI) was calculated for self-report (via online survey); trained researchers measured height and weight and categorized them as normal (18.5 to obese (30 to obese (≥ 35). Concordance of self-report vs objectively measured BMI groups using chi-square revealed that 93% were accurate, 4% were underestimated, and 2.7% were overestimated. Pearson correlations and adjusted linear regression revealed significant associations between self-report and measured BMI (r = .97; P students. Copyright © 2015 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

  14. The Concordance of Parent and Child Immunization.

    Science.gov (United States)

    Robison, Steve G; Osborn, Andrew W

    2017-05-01

    A substantial body of work has related survey-based parental vaccine hesitancy to noncompliant childhood immunization. However little attention has been paid to the connection between parents' own immunization behavior and the immunizations their children receive. Using the Oregon ALERT Immunization Information System, we identified adult caregiver-child pairs for children between 9 months and 17 years of age. The likelihood of adult-child concordance of influenza immunization per influenza season from 2010-2011 through 2014-2015 was assessed. The utility of adult immunization as a predictor was also assessed for other, noninfluenza recommended immunizations for children and adolescents. A total of 450 687 matched adult caregiver-child pairs were included in the study. The children of immunizing adults were 2.77 times more likely to also be immunized for seasonal influenza across all seasons (95% confidence interval, 2.74-2.79), with similar results applying within each season. Adult immunization status was also significantly associated with the likelihood of children and adolescents getting other noninfluenza immunizations, such as the human papillomavirus vaccine (HPV). When adults improved their own behavior from nonimmunizing to immunizing across influenza seasons, their children if not immunized in the previous season were 5.44 times (95% confidence interval, 5.35-5.53) more likely to become immunized for influenza. Children's likelihood of following immunization recommendations is associated with the immunization behavior of their parents. Encouraging parental immunization is a potential tool for increasing children's immunization rates. Copyright © 2017 by the American Academy of Pediatrics.

  15. 10 CFR 55.21 - Medical examination.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 2 2010-01-01 2010-01-01 false Medical examination. 55.21 Section 55.21 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) OPERATORS' LICENSES Medical Requirements § 55.21 Medical examination. An applicant for a license shall have a medical examination by a physician. A licensee shall have a medical...

  16. Reliability and validity of the self-report version of the apathy evaluation scale in first-episode Psychosis: Concordance with the clinical version at baseline and 12 months follow-up.

    Science.gov (United States)

    Faerden, Ann; Lyngstad, Siv Hege; Simonsen, Carmen; Ringen, Petter Andreas; Papsuev, Oleg; Dieset, Ingrid; Andreassen, Ole A; Agartz, Ingrid; Marder, Stephen R; Melle, Ingrid

    2018-05-31

    Negative symptoms have traditionally been assessed based on clinicians' observations. The subjective experience of negative symptoms in people with psychosis may bring new insight. The Apathy Evaluation Scale (AES) is commonly used to study apathy in psychosis and has corresponding self-rated (AES-S) and clinician-rated (AES-C) versions. The aim of the present study was to determine the validity and reliability of the AES-S by investigating its concordance with the AES-C. Eighty-four first-episode (FEP) patients completed the shortened 12-item AES-S and AES-C at baseline (T1) and 12 months (T2). Concordance was studied by degree of correlation, comparison of mean scores, and change and difference between diagnostic groups. The Positive and Negative Symptom Scale (PANSS) was used to study convergent and discriminative properties. High concordance was found between AES-S and AES-C at both T1 and T2 regarding mean values, change from T1 to T2, and the proportion with high levels of apathy. Both versions indicated high levels of apathy in FEP, while associations with PANSS negative symptoms were weaker for AES-S than AES-C. Controlling for depression did not significantly alter results. We concluded that self-rated apathy in FEP patients is in concordance with clinician ratings, but in need of further study. Copyright © 2018. Published by Elsevier B.V.

  17. Vaginal and anal human papillomavirus infection and seropositivity among female sex workers in amsterdam, the Netherlands: prevalence, concordance and risk factors

    NARCIS (Netherlands)

    Marra, E.; Kroone, N.; Freriks, E.; van Dam, C. L.; Alberts, C. J.; Hogewoning, A. A.; Bruisten, S.; van Dijk, A.; Kroone, M. M.; Waterboer, T.; Schim van der Loeff, M. F.

    2017-01-01

    We studied prevalence, risk factors and concordance of vaginal and anal HPV infection and L1 seropositivity among female sex workers (FSW) in Amsterdam. In 2016, FSW aged ≥18 years having a sexually transmitted infections (STI) consultation were invited to participate. Participation entailed taking

  18. A SNP panel and online tool for checking genotype concordance through comparing QR codes.

    Directory of Open Access Journals (Sweden)

    Yonghong Du

    Full Text Available In the current precision medicine era, more and more samples get genotyped and sequenced. Both researchers and commercial companies expend significant time and resources to reduce the error rate. However, it has been reported that there is a sample mix-up rate of between 0.1% and 1%, not to mention the possibly higher mix-up rate during the down-stream genetic reporting processes. Even on the low end of this estimate, this translates to a significant number of mislabeled samples, especially over the projected one billion people that will be sequenced within the next decade. Here, we first describe a method to identify a small set of Single nucleotide polymorphisms (SNPs that can uniquely identify a personal genome, which utilizes allele frequencies of five major continental populations reported in the 1000 genomes project and the ExAC Consortium. To make this panel more informative, we added four SNPs that are commonly used to predict ABO blood type, and another two SNPs that are capable of predicting sex. We then implement a web interface (http://qrcme.tech, nicknamed QRC (for QR code based Concordance check, which is capable of extracting the relevant ID SNPs from a raw genetic data, coding its genotype as a quick response (QR code, and comparing QR codes to report the concordance of underlying genetic datasets. The resulting 80 fingerprinting SNPs represent a significant decrease in complexity and the number of markers used for genetic data labelling and tracking. Our method and web tool is easily accessible to both researchers and the general public who consider the accuracy of complex genetic data as a prerequisite towards precision medicine.

  19. A SNP panel and online tool for checking genotype concordance through comparing QR codes.

    Science.gov (United States)

    Du, Yonghong; Martin, Joshua S; McGee, John; Yang, Yuchen; Liu, Eric Yi; Sun, Yingrui; Geihs, Matthias; Kong, Xuejun; Zhou, Eric Lingfeng; Li, Yun; Huang, Jie

    2017-01-01

    In the current precision medicine era, more and more samples get genotyped and sequenced. Both researchers and commercial companies expend significant time and resources to reduce the error rate. However, it has been reported that there is a sample mix-up rate of between 0.1% and 1%, not to mention the possibly higher mix-up rate during the down-stream genetic reporting processes. Even on the low end of this estimate, this translates to a significant number of mislabeled samples, especially over the projected one billion people that will be sequenced within the next decade. Here, we first describe a method to identify a small set of Single nucleotide polymorphisms (SNPs) that can uniquely identify a personal genome, which utilizes allele frequencies of five major continental populations reported in the 1000 genomes project and the ExAC Consortium. To make this panel more informative, we added four SNPs that are commonly used to predict ABO blood type, and another two SNPs that are capable of predicting sex. We then implement a web interface (http://qrcme.tech), nicknamed QRC (for QR code based Concordance check), which is capable of extracting the relevant ID SNPs from a raw genetic data, coding its genotype as a quick response (QR) code, and comparing QR codes to report the concordance of underlying genetic datasets. The resulting 80 fingerprinting SNPs represent a significant decrease in complexity and the number of markers used for genetic data labelling and tracking. Our method and web tool is easily accessible to both researchers and the general public who consider the accuracy of complex genetic data as a prerequisite towards precision medicine.

  20. Anatomical and functional volume concordance between FDG PET, and T2 and diffusion-weighted MRI for cervical cancer: a hybrid PET/MR study

    Energy Technology Data Exchange (ETDEWEB)

    Sun, Hongzan; Xin, Jun; Zhang, Shaomin; Guo, Qiyong; Lu, Yueyue; Zhai, Wei; Zhao, Long [Shengjing Hospital of China Medical University, Department of Radiology, Shenyang, Liaoning (China); Peng, Weiai [NM Marketing, Great China, Philips Healthcare, Guangzhou (China); Wang, Baijun [Philips China Investment Co. Ltd. Shenyang Office, Shenyang, Liaoning (China)

    2014-05-15

    To evaluate the concordance among {sup 18}F-FDG PET imaging, MR T2-weighted (T2-W) imaging and apparent diffusion coefficient (ADC) maps with diffusion-weighted (DW) imaging in cervical cancer using hybrid whole-body PET/MR. This study prospectively included 35 patients with cervical cancer who underwent pretreatment {sup 18}F-FDG PET/MR imaging. {sup 18}F-FDG PET and MR images were fused using standard software. The percent of the maximum standardized uptake values (SUV{sub max}) was used to contour tumours on PET images, and volumes were calculated automatically. Tumour volumes measured on T2-W and DW images were calculated with standard techniques of tumour area multiplied by the slice profile. Parametric statistics were used for data analysis. FDG PET tumour volumes calculated using SUV{sub max} (14.30 ± 4.70) and T2-W imaging volume (33.81 ± 27.32 cm{sup 3}) were similar (P > 0.05) at 35 % and 40 % of SUV{sub max} (32.91 ± 18.90 cm{sup 3} and 27.56 ± 17.19 cm{sup 3} respectively) and significantly correlated (P < 0.001; r = 0.735 and 0.766). The mean DW volume was 30.48 ± 22.41 cm{sup 3}. DW volumes were not significantly different from FDG PET volumes at either 35 % SUV{sub max} or 40 % SUV{sub max} or from T2-W imaging volumes (P > 0.05). PET subvolumes with increasing SUV{sub max} cut-off percentage showed an inverse change in mean ADC values on DW imaging (P < 0.001, ANOVA). Hybrid PET/MR showed strong volume concordance between FDG PET, and T2-W and DW imaging in cervical cancer. Cut-off at 35 % or 40 % of SUV{sub max} is recommended for {sup 18}F-FDG PET/MR SUV-based tumour volume estimation. The linear tumour subvolume concordance between FDG PET and DW imaging demonstrates individual regional concordance of metabolic activity and cell density. (orig.)

  1. Oral human papillomavirus (HPV) infection in men who have sex with men: prevalence and lack of anogenital concordance

    Science.gov (United States)

    King, Eleanor M; Gilson, Richard; Beddows, Simon; Soldan, Kate; Panwar, Kavita; Young, Carmel; Jit, Mark; Edmunds, W John; Sonnenberg, Pam

    2015-01-01

    Objectives To estimate the prevalence of oral detectable human papillomavirus (HPV) DNA in HIV-negative men who have sex with men (MSM) attending a sexual health clinic in London and concordance with anogenital HPV infection. Such data are important to improve our understanding of the epidemiology of oral HPV and the potential use of vaccines to prevent oropharyngeal cancers. Methods Paired oral rinse samples and anogenital samples were available from 151 HIV-negative MSM within a larger cross-sectional survey. All samples were tested in parallel for 21 types of HPV DNA using an in-house assay. Results The median age of participants was 30 (IQR 25–35). The prevalence of any oral HPV and of high-risk HPV (HR-HPV) was 13.7% (n=21; 95% CI 8.7 to 20.2) and 5.9% (n=9; 95% CI 2.7 to 10.9) compared with 64.9% (n=98; 95% CI 56.7 to 72.5) and 34.4% (n=52; 95% CI 26.9 to 42.6) in any anogenital sample, respectively. The prevalence of types prevented by the bivalent (HPV16/18), quadrivalent (HPV6/11/16/18) and nonavalent (HPV6/11/16/18/31/33/45/52/58) vaccines was 1.3% (95% CI 0.2 to 4.7), 2.6% (95% CI 0.7 to 6.6) and 4.6% (95% CI 1.9 to 9.3), respectively. There was no concordance between HPV genotypes detected in oral and anogenital sites. Conclusions HR-HPV DNA, including HPV 16/18, was detected in oral specimens from HIV-negative MSM attending sexual health clinics, suggesting a potential role for vaccination, but is far less common than anogenital infection. How this relates to the risk and natural history of HPV-related head and neck cancers warrants further study. Lack of concordance with anogenital infection also suggests that oral HPV infection should be considered separately when estimating potential vaccine impact. PMID:25887283

  2. Factors Affecting Concordance between Radiological and Histological Findings in Invasive Lobular Carcinoma - Experience from a National Cancer Centre.

    Science.gov (United States)

    Abu-Sinn, Duaa; O'Driscoll, Donal; Murphy, Maurice

    2017-05-01

    Invasive lobular carcinoma (ILC) is characterized by an infiltrative discohesive growth pattern, making it difficult to accurately assess both clinically and by imaging studies. Despite favourable biological characteristics, challenges remain in the surgical treatment of ILC. We aimed to evaluate radiology/histology concordance and identify histological and biological parameters on core biopsies that may predict final tumour histology and guide surgical treatment decisions. The radiology and histology reports for all newly diagnosed cases of ILC were analysed. The biopsy and resection histological slides for all the surgical cases were reviewed. 75 new cases of ILC were diagnosed over a 2-year period. 48 patients underwent surgery of whom 25% had 2 or more operations. There was discordance between radiological and histological tumour focality and tumour size in 35 and 40%, respectively. The correlation between radiology/histology discordance and E-cadherin expression was statistically significant. However, the correlation between radiology/histology discordance and menopausal status, breast density, pattern of invasion, presence of lobular intraepithelial neoplasia (LIN), hormonal status, and Ki67 were not statistically significant. Histological and biological factors in ILC, with the exception of E-cadherin expression, do not seem to play a significant role in radiology/histology discordance. However, larger studies are needed to further corroborate these findings.

  3. [New possibilities in emergency medical transportation and emergency services of Polish Medical Air Rescue].

    Science.gov (United States)

    Gałazkowski, Robert

    2010-01-01

    In Poland, two types of medical services are accomplished by the Medical Air Rescue (MAR) operating all over the country: emergency transport from the incident scene to hospital and inter-hospital transport. Helicopters or planes are used for this purpose. In 2009, helicopters performed 4359 flights to incidents and 1537 inter-hospital transports whereas planes performed 589 inter-hospital ambulance and 196 rescue flights. MAR operates from 17 bases of the Helicopter Emergency Medical Service (HEMS) and one airbase. Helicopters are mainly used when medical transport is emergent, within the operational region of a given base whereas planes when the distance between the present and target airports exceeds 250 km. In 2008, new modern aircraft were introduced to HEMS-helicopters EC 135. They fulfil all requirements of air transport regulations and are adjusted to visual (VFR) and instrumental (IFR) flights rules, at day and night. The medical cabin of EC 135 is ergonomic and functional considering the majority of rescue activities under life-saving circumstances. It is equipped with ventilator, defibrillator, infusion pumps etc. Defibrillators have 12-lead ECG, E(T)CO2, SpO2, NIBP, and IBP modules. Transport ventilators can work in a variety of ventilation modes including CMV, SIMV, SVV, BILEVEL, PCV, ASB, PPV and CPAP. The purchase of helicopters with modern avionic and medical configuration ensures high quality services of MAR for many years to come.

  4. Improving diagnostic sensitivity of combined dermoscopy and reflectance confocal microscopy imaging through double reader concordance evaluation in telemedicine settings: A retrospective study of 1000 equivocal cases.

    Directory of Open Access Journals (Sweden)

    A M Witkowski

    Full Text Available Reflectance confocal microscopy (RCM is an imaging device that permits non-invasive visualization of cellular morphology and has been shown to improve diagnostic accuracy of dermoscopically equivocal cutaneous lesions. The application of double reader concordance evaluation of dermoscopy-RCM image sets in retrospective settings and its potential application to telemedicine evaluation has not been tested in a large study population.To improve diagnostic sensitivity of RCM image diagnosis using a double reader concordance evaluation approach; to reduce mismanagement of equivocal cutaneous lesions in retrospective consultation and telemedicine settings.1000 combined dermoscopy-RCM image sets were evaluated in blind by 10 readers with advanced training and internship in dermoscopy and RCM evaluation. We compared sensitivity and specificity of single reader evaluation versus double reader concordance evaluation as well as the effect of diagnostic confidence on lesion management in a retrospective setting.Single reader evaluation resulted in an overall sensitivity of 95.2% and specificity of 76.3%, with misdiagnosis of 8 melanomas, 4 basal cell carcinomas and 2 squamous cell carcinomas. Combined double reader evaluation resulted in an overall sensitivity of 98.3% and specificity of 65.5%, with misdiagnosis of 1 in-situ melanoma and 2 basal cell carcinomas.Evaluation of dermoscopy-RCM image sets of cutaneous lesions by single reader evaluation in retrospective settings is limited by sensitivity levels that may result in potential mismanagement of malignant lesions. Double reader blind concordance evaluation may improve the sensitivity of diagnosis and management safety. The use of a second check can be implemented in telemedicine settings where expert consultation and second opinions may be required.

  5. The text of the Agreement establishing the Asian Regional Co-operative Project on Medical and Biological Applications of Nuclear Techniques

    International Nuclear Information System (INIS)

    1987-04-01

    The full text of the Agreement establishing the Asian Regional Co-operative Project on Medical and Biological Applications of Nuclear Techniques between the Agency and Member States is reproduced. The Agreement entered into force on 20 May 1986 after the Governments of Japan, Bangladesh and the Philippines had notified the Agency of their acceptance of the Agreement

  6. Do you think it's a disease? a survey of medical students

    Directory of Open Access Journals (Sweden)

    Erueti Chrissy

    2012-04-01

    Full Text Available Abstract Background The management of medical conditions is influenced by whether clinicians regard them as "disease" or "not a disease". The aim of the survey was to determine how medical students classify a range of conditions they might encounter in their professional lives and whether a different name for a condition would influence their decision in the categorisation of the condition as a 'disease' or 'not a disease'. Methods We surveyed 3 concurrent years of medical students to classify 36 candidate conditions into "disease" and "non-disease". The conditions were given a 'medical' label and a (lay label and positioned where possible in alternate columns of the survey. Results The response rate was 96% (183 of 190 students attending a lecture: 80% of students concurred on 16 conditions as "disease" (eg diabetes, tuberculosis, and 4 as "non-disease" (eg baldness, menopause, fractured skull and heat stroke. The remaining 16 conditions (with 21-79% agreement were more contentious (especially obesity, infertility, hay fever, alcoholism, and restless leg syndrome. Three pairs of conditions had both a more, and a less, medical label: the more medical labels (myalgic encephalomyelitis, hypertension, and erectile dysfunction were more frequently classified as 'disease' than the less medical (chronic fatigue syndrome, high blood pressure, and impotence, respectively, significantly different for the first two pairs. Conclusions Some conditions excluded from the classification of "disease" were unexpected (eg fractured skull and heat stroke. Students were mostly concordant on what conditions should be classified as "disease". They were more likely to classify synonyms as 'disease' if the label was medical. The findings indicate there is still a problem 30 years on in the concept of 'what is a disease'. Our findings suggest that we should be addressing such concepts to medical students.

  7. In vitro versus in vivo concordance: a case study of the replacement of an animal potency test with an immunochemical assay.

    Science.gov (United States)

    Schofield, T

    2002-01-01

    Early in its development, the potency of Merck's recombinant hepatitis B vaccine, RECOMBIVAX HB, was monitored using an assay performed in mice. A specification was determined to be the lowest potency which induced acceptable response in clinical trials. As a post-licensing commitment, Merck was asked to replace its mouse potency assay with an in vitro procedure for product release in the US market. Early studies with a commercial enzyme immunoassay (EIA) yielded highly variable results. That assay, combined with a sample pretreatment step, proved more dependable and predictive of potency in the mouse assay. Based on measurements made on manufactured materials, combined with experiments contrived to yield a wide range of reactivity in the two assays, concordance was established between the EIA and the mouse potency assay. This concordance was used to calibrate a specification for the in vitro assay that is predictive of a satisfactory response in vivo. Data from clinical trials established a correspondence between human immunogenicity and these potency markers.

  8. Hair analysis and its concordance with self-report for drug users presenting in emergency department.

    Science.gov (United States)

    Sharma, Gaurav; Oden, Neal; VanVeldhuisen, Paul C; Bogenschutz, Michael P

    2016-10-01

    Secondary analysis using data from the National Drug Abuse Treatment Clinical Trials Network randomized trial (NCT # 01207791), in which 1285 adult ED patients endorsing moderate to severe problems related to drug use were recruited from 6 US academic hospitals. To investigate the utility of hair analysis in drug use disorder trials with infrequent visits, and its concordance with Timeline Follow Back (TLFB). This study compared the self-reported drug use on the TLFB instrument with the biological measure of drug use from hair analysis for four major drug classes (Cannabis, Cocaine, Prescribed Opioids and Street Opioids). Both hair analysis and TLFB were conducted at 3, 6 and 12 month follow-up visit and each covered a 90-day recall period prior to the visit. The concordance between the hair sample results and the TLFB was high for cannabis and street opioids, but was low to moderate for cocaine and prescribed opioids. Under-reporting of drug use given the positive hair sample was always significantly lower for the drug the study participant noted as their primary drug of choice compared with other drugs the participant reported taking, irrespective of whether the drug of choice was cannabis, cocaine, street opioids and prescribed opioids. Over-reporting of drug use given the negative hair sample was always significantly higher for the drug of choice, except for cocaine. This study extends the literature on hair analysis supporting its use as a secondary outcome measure in clinical trials. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. Agreement between questionnaire and medical records on some health and socioeconomic problems among poisoning cases

    Directory of Open Access Journals (Sweden)

    Fathelrahman Ahmed I

    2009-09-01

    Full Text Available Abstract Background The main objective of the present study was to evaluate the agreement between questionnaire and medical records on some health and socioeconomic problems among poisoning cases. Methods Cross-sectional sample of 100 poisoning cases consecutively admitted to the Hospital Pulau Pinang, Malaysia during the period from September 2003 to February 2004 were studied. Data on health and socioeconomic problems were collected both by self-administered questionnaire and from medical records. Agreement between the two sets of data was assessed by calculating the concordance rate, Kappa (k and PABAK. McNemar statistic was used to test differences between categories. Results Data collected by questionnaire and medical records showed excellent agreement on the "marital status"; good agreements on "chronic illness", "psychiatric illness", and "previous history of poisoning"; and fair agreements on "at least one health problem", and "boy-girl friends problem". PABAK values suggest better agreements' measures. Conclusion There were excellent to good agreements between questionnaire and medical records on the marital status and most of the health problems and fair to poor agreements on the majority of socioeconomic problems. The implications of those findings were discussed.

  10. Medical Applications

    OpenAIRE

    Biscari, C.; Falbo, L.

    2016-01-01

    The use of accelerators for medical applications has evolved from initial experimentation to turn-key devices commonly operating in hospitals. New applications are continuously being developed around the world, and the hadrontherapy facilities of the newest generation are placed at the frontier between industrial production and advanced R&D. An introduction to the different medical application accelerators is followed by a description of the hadrontherapy facilities, with special emphasis on ...

  11. Concordant bone marrow involvement of diffuse large B-cell lymphoma represents a distinct clinical and biological entity in the era of immunotherapy

    DEFF Research Database (Denmark)

    Yao, Zhilei; Deng, Lijuan; Xu-Monette, Z Y

    2018-01-01

    In diffuse large B-cell lymphoma (DLBCL), the clinical and biological significance of concordant and discordant bone marrow (BM) involvement have not been well investigated. We evaluated 712 de novo DLBCL patients with front-line rituximab-containing treatment, including 263 patients with positiv...

  12. Converting Radiology Operations in a Six-Hospital Healthcare System from Film-Based to Digital: Another Leadership Role for the Diagnostic Medical Physicist

    International Nuclear Information System (INIS)

    Arreola, Manuel M.; Rill, Lynn N.

    2004-01-01

    As medical facilities across the United States continue to convert their radiology operations from film-based to digital environments, partially accomplished and failed endeavors are frequent because of the lack of competent and knowledgeable leadership. The diagnostic medical physicist is, without a doubt, in a privileged position to take such a leadership role, not only because of her/his understanding of the basics principles of new imaging modalities, but also because of her/his inherent participation in workflow design and educational/training activities. A well-structured approach by the physicist will certainly lead the project to a successful completion, opening, in turn, new opportunities for the medical physicist to become an active participant in the decision-making process for an institution

  13. Converting Radiology Operations in a Six-Hospital Healthcare System from Film-Based to Digital: Another Leadership Role for the Diagnostic Medical Physicist

    Science.gov (United States)

    Arreola, Manuel M.; Rill, Lynn N.

    2004-09-01

    As medical facilities across the United States continue to convert their radiology operations from film-based to digital environments, partially accomplished and failed endeavors are frequent because of the lack of competent and knowledgeable leadership. The diagnostic medical physicist is, without a doubt, in a privileged position to take such a leadership role, not only because of her/his understanding of the basics principles of new imaging modalities, but also because of her/his inherent participation in workflow design and educational/training activities. A well-structured approach by the physicist will certainly lead the project to a successful completion, opening, in turn, new opportunities for the medical physicist to become an active participant in the decision-making process for an institution.

  14. Medical Simulations for Exploration Medicine

    Science.gov (United States)

    Reyes, David; Suresh, Rahul; Pavela, James; Urbina, Michelle; Mindock, Jennifer; Antonsen, Erik

    2018-01-01

    Medical simulation is a useful tool that can be used to train personnel, develop medical processes, and assist cross-disciplinary communication. Medical simulations have been used in the past at NASA for these purposes, however they are usually created ad hoc. A stepwise approach to scenario development has not previously been used. The NASA Exploration Medical Capability (ExMC) created a medical scenario development tool to test medical procedures, technologies, concepts of operation and for use in systems engineering (SE) processes.

  15. Effects of Stimulant Medication under Varied Motivational Operations

    Science.gov (United States)

    Mace, F. Charles; Prager, Kevin L.; Thomas, Karen; Kochy, Jane; Dyer, Tim J.; Perry, Lora; Pritchard, Duncan

    2009-01-01

    We evaluated the evocative effects of four conditions (high- and low-preference activities, low and divided attention) and stimulant medication on the behavior of a 16-year-old boy with attention deficit hyperactivity disorder and moderate mental retardation. All behavior (activity engagement, activity changes, inappropriate touching, rude…

  16. Important radiation protection aspects of the operation of a commercial medical cyclotron

    International Nuclear Information System (INIS)

    Mukherjee, B.

    1997-01-01

    Since July 1991 the Radiopharmaceutical Division of the Australian Nuclear Science and Technology Organisation (ANSTO) operates a 30 MeV H'- ion Medical Cyclotron (Model; CYCLONE 30, Manufacturer: Ion Beam Applications, Louvain La Neuve, Belgium). During routine isotope production operations at the cyclotron a thick copper substrate plate electroplated with thin layer of selected enriched target material are bombarded with 30 MeV proton beam current up to 450 μA. The nuclear reaction of protons with the copper atoms result in the reduction of prompt evaporation neutrons with a peak energy of ∼ 1.8 MeV. These evaporation neutrons slow down via multiple collisions with the concrete shielding walls of the target cave, bounce back to the,interior space of the cave activating the cyclotron parts, beam tube components and other utilities installed in the irradiation cave. After the completion of 60 hour isotope production run, gamma dose equivalent rates of ∼10 5 μSvh -1 were measured at contact with the target irradiation stations and beam collimators. Evidently, these gamma rays emitted from the activated cyclotron components impose crucial radiation exposure hazard problems for the cyclotron maintenance technicians. Experiments had been carried out in order to identify the specific pathways of cyclotron component activation and to assess the probable personnel radiation exposure during handling of the activated cyclotron parts. The cool-down (radioactive decay) of the activated cyclotron components was estimated experimentally at different target bombardment conditions using the wall mounted gamma area monitors interfaced to the Health Physics Data Acquisition System. The gamma dose equivalent rates at contact with various locations of interest at the target irradiation station and at the typical work areas of the maintenance personnel were carefully recorded with a radiation (gamma) survey instrument during the three years operation period of the cyclotron. A

  17. Radiation protection in the operating room

    International Nuclear Information System (INIS)

    Kunz, B.; Stargardt, A.

    1978-01-01

    On the basis of legally provided area dose measurements and time records of fluoroscopic examinations during the operation, radiation doses to medical personnel and patients are evaluated. Adequate radiation protection measures and a careful behaviour in the operating room keep the radiation exposure to the personnel below the maximum permissible exposure. Taking into account the continuous personnel radiation monitoring and medical supervision, radiation hazards in the operating room can be considered low

  18. The readiness of German GPs to recommend and conduct cancer screening is associated with patient-physician gender concordance. Results of a survey.

    Science.gov (United States)

    Engler, Jennifer; Dahlhaus, Anne; Güthlin, Corina

    2017-12-01

    Cancer screening participation rates in Germany differ depending on patients' gender. International studies have found that patient-physician gender concordance fosters recommendation and conducting of cancer screening, and especially cancer screening for women. We aimed to ascertain whether gender concordance influences general practitioners' (GPs') rating of the usefulness of cancer screening, as well as their recommendations and readiness to conduct cancer screening in general practice in Germany. For an exploratory cross-sectional survey, 500 randomly selected GPs from all over Germany were asked to fill in a questionnaire on cancer screening in general practice between March and June 2015. We asked them to rate the usefulness of each cancer screening examination, how frequently they recommended and conducted them and whether they viewed GPs or specialists as responsible for carrying them out. We used multiple logistic regression to analyse gender effect size by calculating odds ratios. Our study sample consisted of 139 GPs of which 65% were male. Male and female GPs did not differ significantly in their rating of the general usefulness of any of the specified cancer screening examinations. Male GPs were 2.9 to 6.8 times as likely to consider GPs responsible for recommending and conducting PSA testing and digital rectal examinations and were 3.7 to 7.9 times as likely to recommend and conduct these examinations on a regular basis. Patient-physician gender concordance made it more likely that male-specific cancer screenings would be recommended and conducted, but not female-specific screenings. [Box: see text].

  19. Concordance of patient and caregiver reports in evaluating quality of life in patients with malignant gliomas and an assessment of caregiver burden

    Science.gov (United States)

    Jacobs, Daniel I.; Kumthekar, Priya; Stell, Becky V.; Grimm, Sean A.; Rademaker, Alfred W.; Rice, Laurie; Chandler, James P.; Muro, Kenji; Marymont, MaryAnne; Helenowski, Irene B.; Wagner, Lynne I.; Raizer, Jeffrey J.

    2014-01-01

    Background Given the neurocognitive impairment experienced by many patients with malignant gliomas, caregiver reports can be critical in assessing the quality of life (QOL) of these patients. In this study, we explored whether assessment of patient QOL by the primary caregiver shows concordance with the patient's self-reported QOL, and we quantified the burden faced by caregivers. Methods QOL of 45 patients was evaluated by both the patient and primary caregiver on 3 or more separate occasions using the Functional Assessment of Cancer Therapy-Brain (FACT-Br) instrument, and concordance between the 2 reports was evaluated. Caregiver burden was measured using the Caregiver Quality of Life Index-Cancer (CQOL-C) instrument. Results Overall, good concordance was observed between the patient and caregiver FACT-Br reports (intraclass correlation coefficient = 0.74). Patient-reported FACT-Br scores were 4.75 (95% CI, 1.44–8.05) points higher than paired caregiver reports on the 200-point scale (P = .008); however, this difference did not achieve clinical significance. Caregiver burden, as measured by the CQOL-C, was significantly greater among caregivers in this study than those previously reported for caregivers of patients with lung, breast, or prostate cancer (P < .001). Conclusions Despite minor discrepancies in caregiver assessments of patient QOL relative to patient self-reports, our results suggest that the caregiver assessments can serve as adequate proxies for patient reports. Our results also illustrate the particularly heavy burden faced by caregivers of patients with malignant glioma. Further research into both of these areas is warranted. PMID:26034616

  20. Concordance between the chang and the International Society of Pediatric Oncology (SIOP) ototoxicity grading scales in patients treated with cisplatin for medulloblastoma.

    Science.gov (United States)

    Bass, Johnnie K; Huang, Jie; Onar-Thomas, Arzu; Chang, Kay W; Bhagat, Shaum P; Chintagumpala, Murali; Bartels, Ute; Gururangan, Sridharan; Hassall, Tim; Heath, John A; McCowage, Geoffrey; Cohn, Richard J; Fisher, Michael J; Robinson, Giles; Broniscer, Alberto; Gajjar, Amar; Gurney, James G

    2014-04-01

    Reporting ototoxicity is frequently complicated by use of various ototoxicity criteria. The International Society of Pediatric Oncology (SIOP) ototoxicity grading scale was recently proposed for standardized use in reporting hearing loss outcomes across institutions. The aim of this study was to evaluate the concordance between the Chang and SIOP ototoxicity grading scales. Differences between the two scales were identified and the implications these differences may have in the clinical setting were discussed. Audiological evaluations were reviewed for 379 patients with newly diagnosed medulloblastoma (ages 3-21 years). Each patient was enrolled on one of two St. Jude clinical protocols that included craniospinal radiation therapy and four courses of 75 mg/m(2) cisplatin chemotherapy. The latest audiogram conducted 5.5-24.5 months post-protocol treatment initiation was graded using the Chang and SIOP ototoxicity criteria. Clinically significant hearing loss was defined as Chang grade ≥2a and SIOP ≥2. Hearing loss was considered serious (requiring a hearing aid) at the level of Chang grade ≥2b and SIOP ≥3. A strong concordance was observed between the Chang and SIOP ototoxicity scales (Stuart's tau-c statistic = 0.89, 95% CI: 0.86, 0.91). Among those patients diagnosed with serious hearing loss, the two scales were in good agreement. However, the scales deviated from one another in classifying patients with less serious or no hearing loss. Although discrepancies between the Chang and SIOP ototoxicity scales exist primarily for patients with no or minimal hearing loss, the scales share a strong concordance overall. © 2013 Wiley Periodicals, Inc.

  1. Concordance of the ForenSeq™ system and characterisation of sequence-specific autosomal STR alleles across two major population groups.

    Science.gov (United States)

    Devesse, Laurence; Ballard, David; Davenport, Lucinda; Riethorst, Immy; Mason-Buck, Gabriella; Syndercombe Court, Denise

    2018-05-01

    By using sequencing technology to genotype loci of forensic interest it is possible to simultaneously target autosomal, X and Y STRs as well as identity, ancestry and phenotypic informative SNPs, resulting in a breadth of data obtained from a single run that is considerable when compared to that generated with standard technologies. It is important however that this information aligns with the genotype data currently obtained using commercially available kits for CE-based investigations such that results are compatible with existing databases and hence can be of use to the forensic community. In this work, 400 samples were typed using commercially available STR kits and CE, as well as using the Ilumina ForenSeq™ DNA Signature Prep Kit and MiSeq ® FGx to assess concordance of autosomal STRs and population variability. Results show a concordance rate between the two technologies exceeding 99.98% while numerous novel sequence based alleles are described. In order to make use of the sequence variation observed, sequence specific allele frequencies were generated for White British and British Chinese populations. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Short interval follow-up after a benign concordant MR-guided vacuum assisted breast biopsy - is it worthwhile?

    Energy Technology Data Exchange (ETDEWEB)

    Shaylor, Sara D.; Melsaether, Amy N.; Gupta, Avani; Babb, James; Moy, Linda [NYU School of Medicine, Department of Radiology, New York, NY (United States); Heller, Samantha L. [St. George' s Healthcare Trust, Department of Radiology, London (United Kingdom); Gupta, Dipti [Northwestern Memorial Hospital, Breast and Women' s Imaging Center, Chicago, IL (United States)

    2014-06-15

    To determine the utility of short-interval follow-up after benign concordant MRI-guided breast biopsy. Institutional review board approved, retrospective review of consecutive biopsies performed over 3 years (2007-10) yielded 170 women with 188 lesions that were considered benign concordant. Indication for original study, biopsy results, follow-up recommendations, compliance and outcomes of subsequent MRI and mammography examinations were reviewed. The most common indication for breast MRI was high-risk screening 119/170 (70 %). Overall, 59 % of lesions (113/188) had follow-up MRI. Of those lesions (n = 113), 43 % (49/113) presented within 7 months, 26 % (29/113) presented within 8-13 months, 11.5 % (13/113) presented within 14-22 months, and 19 % (22/113) presented after 23 months. At initial follow-up, 37 % of lesions were stable and 61 % were decreased in size. Three lesions were recommended for excision based on follow-up imaging with one malignancy diagnosed 2 years following biopsy. One additional patient had MRI-detected bilateral cancers remote from the biopsy site 3 years after biopsy. Overall cancer yield of lesions with follow-up MRI was 0.9 % (1/113); no cancers were detected at 6 months. Our data suggests that 6-month follow-up may not be required and that annual screening MRI would be acceptable to maintain a reasonable cancer detection rate. (orig.)

  3. [Concordance between a head circumference growth function and intellectual disability in relation with the cause of microcephaly].

    Science.gov (United States)

    Coronado, R; Macaya Ruíz, A; Giraldo Arjonilla, J; Roig-Quilis, M

    2015-08-01

    Our aim was to investigate the correlations between patterns of head growth and intellectual disability among distinct aetiological presentations of microcephaly. 3,269 head circumference (HC) charts of patients from a tertiary neuropediatric unit were reviewed and 136 microcephalic participants selected. Using the Z-scores of registered HC measurements we defined the variables: HC Minimum, HC Drop and HC Catch-up. We classified patients according to the presence or absence of intellectual disability (IQ below 71) and according to the cause of microcephaly (idiopathic, familial, syndromic, symptomatic and mixed). Using Discriminant Analysis a C-function was defined as C=HC Minimum + HC Drop with a cut-off level of C=-4.32 Z-score. In our sample 95% of patients scoring below this level, severe microcephaly, were classified in the disabled group while the overall concordance was 66%. In the symptomatic-mixed group the concordance between HC function and outcome reached 82% in contrast to only 54% in the idiopathic-syndromic group (P-value=0.0002). We defined a HC growth function which discriminates intellectual disability of microcephalic patients better than isolated HC measurements, especially for those with secondary and mixed aetiologies. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  4. Short interval follow-up after a benign concordant MR-guided vacuum assisted breast biopsy - is it worthwhile?

    International Nuclear Information System (INIS)

    Shaylor, Sara D.; Melsaether, Amy N.; Gupta, Avani; Babb, James; Moy, Linda; Heller, Samantha L.; Gupta, Dipti

    2014-01-01

    To determine the utility of short-interval follow-up after benign concordant MRI-guided breast biopsy. Institutional review board approved, retrospective review of consecutive biopsies performed over 3 years (2007-10) yielded 170 women with 188 lesions that were considered benign concordant. Indication for original study, biopsy results, follow-up recommendations, compliance and outcomes of subsequent MRI and mammography examinations were reviewed. The most common indication for breast MRI was high-risk screening 119/170 (70 %). Overall, 59 % of lesions (113/188) had follow-up MRI. Of those lesions (n = 113), 43 % (49/113) presented within 7 months, 26 % (29/113) presented within 8-13 months, 11.5 % (13/113) presented within 14-22 months, and 19 % (22/113) presented after 23 months. At initial follow-up, 37 % of lesions were stable and 61 % were decreased in size. Three lesions were recommended for excision based on follow-up imaging with one malignancy diagnosed 2 years following biopsy. One additional patient had MRI-detected bilateral cancers remote from the biopsy site 3 years after biopsy. Overall cancer yield of lesions with follow-up MRI was 0.9 % (1/113); no cancers were detected at 6 months. Our data suggests that 6-month follow-up may not be required and that annual screening MRI would be acceptable to maintain a reasonable cancer detection rate. (orig.)

  5. Dual-energy CT perfusion and angiography in chronic thromboembolic pulmonary hypertension: diagnostic accuracy and concordance with radionuclide scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Dournes, Gael; Verdier, Damien; Montaudon, Michel; Laurent, Francois; Lederlin, Mathieu [Hopital Haut-Leveque, CHU Bordeaux, Department of Medical Imaging, Pessac (France); University Bordeaux Segalen, Bordeaux Cedex (France); Bullier, Eric; Riviere, Annalisa [Hopital Haut-Leveque, CHU Bordeaux, Department of Nuclear Medicine, Pessac (France); Dromer, Claire [Hopital Haut-Leveque, CHU Bordeaux, Department of Respiratory Diseases, Pessac (France); Picard, Francois [Hopital Haut-Leveque, CHU Bordeaux, Department of Cardiology, Pessac (France); Billes, Marc-Alain [Hopital Haut-Leveque, CHU Bordeaux, Department of Cardiac Surgery, Pessac (France); Corneloup, Olivier [Hopital Haut-Leveque, CHU Bordeaux, Department of Medical Imaging, Pessac (France)

    2014-01-15

    To evaluate the diagnostic accuracy of dual-energy computed tomography (DECT) perfusion and angiography versus ventilation/perfusion (V/Q) scintigraphy in chronic thromboembolic pulmonary hypertension (CTEPH), and to assess the per-segment concordance rate of DECT and scintigraphy. Forty consecutive patients with proven pulmonary hypertension underwent V/Q scintigraphy and DECT perfusion and angiography. Each imaging technique was assessed for the location of segmental defects. Diagnosis of CTEPH was established when at least one segmental perfusion defect was detected by scintigraphy. Diagnostic accuracy of DECT perfusion and angiography was assessed and compared with scintigraphy. In CTEPH patients, the per-segment concordance between scintigraphy and DECT perfusion/angiography was calculated. Fourteen patients were diagnosed with CTEPH and 26 with other aetiologies. DECT perfusion and angiography correctly identified all CTEPH patients with sensitivity/specificity values of 1/0.92 and 1/0.93, respectively. At a segmental level, DECT perfusion showed moderate agreement (κ = 0.44) with scintigraphy. Agreement between CT angiography and scintigraphy ranged from fair (κ = 0.31) to slight (κ = 0.09) depending on whether completely or partially occlusive patterns were considered, respectively. Both DECT perfusion and angiography show satisfactory performance for the diagnosis of CTEPH. DECT perfusion is more accurate than angiography at identifying the segmental location of abnormalities. (orig.)

  6. Dual-energy CT perfusion and angiography in chronic thromboembolic pulmonary hypertension: diagnostic accuracy and concordance with radionuclide scintigraphy

    International Nuclear Information System (INIS)

    Dournes, Gael; Verdier, Damien; Montaudon, Michel; Laurent, Francois; Lederlin, Mathieu; Bullier, Eric; Riviere, Annalisa; Dromer, Claire; Picard, Francois; Billes, Marc-Alain; Corneloup, Olivier

    2014-01-01

    To evaluate the diagnostic accuracy of dual-energy computed tomography (DECT) perfusion and angiography versus ventilation/perfusion (V/Q) scintigraphy in chronic thromboembolic pulmonary hypertension (CTEPH), and to assess the per-segment concordance rate of DECT and scintigraphy. Forty consecutive patients with proven pulmonary hypertension underwent V/Q scintigraphy and DECT perfusion and angiography. Each imaging technique was assessed for the location of segmental defects. Diagnosis of CTEPH was established when at least one segmental perfusion defect was detected by scintigraphy. Diagnostic accuracy of DECT perfusion and angiography was assessed and compared with scintigraphy. In CTEPH patients, the per-segment concordance between scintigraphy and DECT perfusion/angiography was calculated. Fourteen patients were diagnosed with CTEPH and 26 with other aetiologies. DECT perfusion and angiography correctly identified all CTEPH patients with sensitivity/specificity values of 1/0.92 and 1/0.93, respectively. At a segmental level, DECT perfusion showed moderate agreement (κ = 0.44) with scintigraphy. Agreement between CT angiography and scintigraphy ranged from fair (κ = 0.31) to slight (κ = 0.09) depending on whether completely or partially occlusive patterns were considered, respectively. Both DECT perfusion and angiography show satisfactory performance for the diagnosis of CTEPH. DECT perfusion is more accurate than angiography at identifying the segmental location of abnormalities. (orig.)

  7. Exclusive double outlet right ventricle with atrioventricular concordance and pulmonary stenosis. Results of reconstructive surgery.

    Science.gov (United States)

    Busquet, J; Fontan, F; Choussat, A; Caianiello, G; Fernandez, G

    1988-01-01

    Double outlet right ventricle associated with atrioventricular concordance, pulmonary stenosis and situs solitus of the atria is a subset of double outlet right ventricle related through the surgical treatment. From 1974 to 1985, 14 patients, 5 males, 9 females (mean age 8.9 years, range 13 months-22 years) were operated upon. All patients had infundibular stenosis and normal or large pulmonary arteries. The apex of the heart was to the right in 2 patients, the right and left ventricles were superior and inferior in 2 patients and 1 patient had both anomalies. The ventricular septal defect was subaortic in 11 patients (aorto-mitral discontinuity in 5) and non-committed in 3 patients. Three patients had 2 ventricular septal defects. The aorta was anterior in 3 patients and to the right of the pulmonary artery in 11 patients. All patients, through a transventricular and transatrial approach, had a reconstructive surgery. In 3 patients, an aortic homograft valved conduit was used. One patient had the ventricular septal defect enlarged. There was one early death (7.1%) from high residual right ventricle pressure and no late death. One patient had a transient atrioventricular block. One patient was reoperated upon for a residual ventricular septal defect. All survivors had a good clinical result. Re-evaluation in 8 patients confirmed excellent haemodynamics: the right ventricle to pulmonary artery pressure gradient decreased from 80 mm Hg (range 60-95) preoperatively to 24 mm Hg (range 3-32) postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

  8. Remediation in Canadian medical residency programs: Established and emerging best practices.

    Science.gov (United States)

    Shearer, Cindy; Bosma, Mark; Bergin, Fiona; Sargeant, Joan; Warren, Andrew

    2018-02-23

    Policies to guide remediation in postgraduate medical education exist in all Canadian medical schools. This study examines concordance between these policies and processes, and published "best practices" in remediation. We conducted a literature review to identify best practices in the area of remediation. We then reviewed remediation policies from all 13 English medical schools in Canada other than our own and conducted interviews with key informants from each institution. Each policy and interview transcript pair was then reviewed for evidence of pre-defined "best practices." Team members also noted additional potential policy or process enablers of successful remediation. Most policies and processes aligned with some but not all published best practices. For instance, all participating schools tailored remediation strategies to individual resident needs, and a majority encouraged faculty-student relationships during remediation. Conversely, few required the teaching of goal-setting, strategic planning, self-monitoring, and self-awareness. In addition, we identified avoidance of automatic training extension and the use of an educational review board to support the remediation process as enablers for success. Remediation policies and practices in Canada align well with published best practices in this area. Based on key informant opinions, flexibility to avoid training extension and use of an educational review board may also support optimal remediation outcomes.

  9. Human Factors and Medical Devices

    International Nuclear Information System (INIS)

    Dick Sawyer

    1998-01-01

    Medical device hardware- and software-driven user interfaces should be designed to minimize the likelihood of use-related errors and their consequences. The role of design-induced errors in medical device incidents is attracting widespread attention. The U.S. Food and Drug Administration (FDA) is fully cognizant that human factors engineering is critical to the design of safe medical devices, and user interface design is receiving substantial attention by the agency. Companies are paying more attention to the impact of device design, including user instructions, upon the performance of those health professionals and lay users who operate medical devices. Concurrently, the FDA is monitoring human factors issues in its site inspections, premarket device approvals, and postmarket incident evaluations. Overall, the outlook for improved designs and safer device operation is bright

  10. Effects of Concord grape juice on ambulatory blood pressure in prehypertension and stage 1 hypertension.

    Science.gov (United States)

    Dohadwala, Mustali M; Hamburg, Naomi M; Holbrook, Monika; Kim, Brian H; Duess, Mai-Ann; Levit, Aaron; Titas, Megan; Chung, William B; Vincent, Felix B; Caiano, Tara L; Frame, Alissa A; Keaney, John F; Vita, Joseph A

    2010-11-01

    Consumption of flavonoid-containing foods may be useful for the management of hypertension. We investigated whether 100% Concord grape juice lowers blood pressure in patients with prehypertension and stage 1 hypertension. We conducted a double-blind crossover study to compare the effects of grape juice (7 mL · kg⁻¹ · d⁻¹) and matched placebo beverage on 24-h ambulatory blood pressure, stress-induced changes in blood pressure, and biochemical profile. Participants consumed each beverage for 8 wk with a 4-wk rest period between beverages. They ceased consumption of grapes and other flavonoid-containing beverages throughout the study. We enrolled 64 otherwise healthy patients taking no antihypertensive medications (31% women, 42% black, age 43 ± 12 y). Baseline mean (± SD) cuff blood pressure was 138 ± 7 (systolic)/82 ± 7 (diastolic) mm Hg. No effects on the primary endpoint of 24-h mean systolic blood pressure, diastolic blood pressure, or stress-induced changes in blood pressure were observed. A secondary endpoint was nocturnal dip in systolic pressure. At baseline, nocturnal pressure was 8.3 ± 7.1% lower at night than during daytime. The mean nocturnal dip increased 1.4 percentage points after grape juice and decreased 2.3 percentage points after placebo (P = 0.005). Fasting blood glucose was 91 ± 10 mg/dL at baseline for the entire cohort. Glucose decreased 2 mg/dL after consumption of grape juice and increased 1 mg/dL after consuming the placebo (P = 0.03). We observed no effect of grape juice on ambulatory blood pressure in this cohort of relatively healthy individuals with modestly elevated blood pressure. Secondary analyses suggested favorable effects on nocturnal dip and glucose homeostasis that may merit further investigation. This trial was registered at clinicaltrials.gov as NCT00302809.

  11. Aeromedical Hazard Comparison of FAA Medically Certified Third-Class and Medically Uncertified Pilots.

    Science.gov (United States)

    Ricaurte, Eduard M; Mills, William D; DeJohn, Charles A; Laverde-Lopez, Maria C; Porras-Sanchez, Daniel F

    2016-07-01

    Since 2004, in the United States, light sport aircraft (LSA) and some aircraft with standard airworthiness certificates can be operated for recreational purposes with a valid state driver's license rather than a Federal Aviation Administration (FAA)-issued aeromedical certificate. There have been recent efforts to allow operation of much larger, heavier, faster, and more complex aircraft without requiring a medical certificate. The primary objective of this research was to compare hazards to flight safety identified in fatally injured pilots required to possess a valid FAA third-class medical certificate to hazards in fatally injured pilots who were not required to possess a valid medical certificate. A search of all fatal U.S. aircraft accidents in the FAA Medical ANalysis and TRAcking (MANTRA) registry between January 1, 2011, and April 30, 2014, identified 1084 individuals. A review of accident pilots' medical, autopsy, and toxicological data was conducted. After applying exclusion criteria, 467 pilots remained, including 403 medically certified and 64 medically uncertified pilots. A significant difference was found in a surrogate measure for risk between medically certified and uncertified pilots (25% vs. 59%). This difference remained significant after adjustment for age. No significant difference was found in the proportions of hazards identified on toxicological review. The results of this study suggest that the risk of an adverse medical event is reduced in pilots required to possess a valid medical certificate. Ricaurte EM, Mills WD, DeJohn CA, Laverde-Lopez MC, Porras-Sanchez DF. Aeromedical hazard comparison of FAA medically certified third-class and medically uncertified pilots. Aerosp Med Hum Perform. 2016; 87(7):618-621.

  12. Medical results of the Skylab program

    Science.gov (United States)

    Johnston, R. S.; Dietlein, L. F.

    1974-01-01

    The Skylab food system, waste management system, operational bioinstrumentation, personal hygiene provisions, in-flight medical support system, and the cardiovascular counterpressure garment worn during reentry are described. The medical experiments program provided scientific data and also served as the basis for real-time decisions on flight duration. Premission support, in-flight operational support, and postflight medical activities are surveyed. Measures devised to deal with possible food spoilage, medical instrument damage, and toxic atmosphere caused by the initial failures on the Orbital Workshop (OWS) are discussed. The major medical experiments performed in flight allowed the study of physiological changes as a function of exposure to weightless flight. The experiments included studies of the cardiovascular system, musculoskeletal and fluid/electrolyte balance, sleep, blood, vestibular system, and time and motion studies.

  13. Medical Information Technology in Support of the Operational Commander

    National Research Council Canada - National Science Library

    Mitchell, James

    1999-01-01

    .... DoD is aggressively pursuing a unified force health protection strategy to protect service members from medical hazards associated with their military service from accession through retirement...

  14. Lung cancer survival in the United States by race and stage (2001-2009): Findings from the CONCORD-2 study.

    Science.gov (United States)

    Richards, Thomas B; Henley, S Jane; Puckett, Mary C; Weir, Hannah K; Huang, Bin; Tucker, Thomas C; Allemani, Claudia

    2017-12-15

    Results from the second CONCORD study (CONCORD-2) indicated that 5-year net survival for lung cancer was low (range, 10%-20%) between 1995 and 2009 in most countries, including the United States, which was at the higher end of this range. Data from CONCORD-2 were used to analyze net survival among patients with lung cancer (aged 15-99 years) who were diagnosed in 37 states covering 80% of the US population. Survival was corrected for background mortality using state-specific and race-specific life tables and age-standardized using International Cancer Survival Standard weights. Net survival was estimated for patients diagnosed between 2001 and 2003 and between 2004 and 2009 at 1, 3, and 5 years after diagnosis by race (all races, black, and white); Surveillance, Epidemiology, and End Results Summary Stage 2000; and US state. Five-year net survival increased from 16.4% (95% confidence interval, 16.3%-16.5%) for patients diagnosed 2001-2003 to 19.0% (18.8%-19.1%) for those diagnosed 2004-2009, with increases in most states and among both blacks and whites. Between 2004 and 2009, 5-year survival was lower among blacks (14.9%) than among whites (19.4%) and ranged by state from 14.5% to 25.2%. Lung cancer survival improved slightly between the periods 2001-2003 and 2004-2009 but was still low, with variation between states, and persistently lower survival among blacks than whites. Efforts to control well established risk factors would be expected to have the greatest impact on reducing the burden of lung cancer, and efforts to ensure that all patients receive timely and appropriate treatment should reduce the differences in survival by race and state. Cancer 2017;123:5079-99. Published 2017. This article is a U.S. Government work and is in the public domain in the USA. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

  15. Exploration Medical Cap Ability System Engineering Overview

    Science.gov (United States)

    McGuire, K.; Mindock, J.

    2018-01-01

    Deep Space Gateway and Transport missions will change the way NASA currently practices medicine. The missions will require more autonomous capability compared to current low Earth orbit operations. For the medical system, lack of consumable resupply, evacuation opportunities, and real-time ground support are key drivers toward greater autonomy. Recognition of the limited mission and vehicle resources available to carry out exploration missions motivates the Exploration Medical Capability (ExMC) Element's approach to enabling the necessary autonomy. The ExMC Systems Engineering team's mission is to "Define, develop, validate, and manage the technical system design needed to implement exploration medical capabilities for Mars and test the design in a progression of proving grounds." The Element's work must integrate with the overall exploration mission and vehicle design efforts to successfully provide exploration medical capabilities. ExMC is using Model-Based System Engineering (MBSE) to accomplish its integrative goals. The MBSE approach to medical system design offers a paradigm shift toward greater integration between vehicle and the medical system, and directly supports the transition of Earth-reliant ISS operations to the Earth-independent operations envisioned for Mars. This talk will discuss how ExMC is using MBSE to define operational needs, decompose requirements and architecture, and identify medical capabilities needed to support human exploration. How MBSE is being used to integrate across disciplines and NASA Centers will also be described. The medical system being discussed in this talk is one system within larger habitat systems. Data generated within the medical system will be inputs to other systems and vice versa. This talk will also describe the next steps in model development that include: modeling the different systems that comprise the larger system and interact with the medical system, understanding how the various systems work together, and

  16. Operational measurements in radioprotection in the industrial and medical environments; Mesures operationnelles en radioprotection dans les milieux industriel et medical

    Energy Technology Data Exchange (ETDEWEB)

    Rodde, S.; Vial, Th.; Truffert, H.; Kramar, R.; Batalla, A.; Roine, Ph.; Pin, A.; Lahaye, Th.; Rodde, S.; Bordy, J.M.; Paquet, F.; Veres, A.; Cadiou, A.; Branthonne, J.Y.; Noel, A.; Laloubere, L.; Moreau, St.; Gensdarmes, F.; Marques, S.; Lestang, M.; Valendru, N.; Tranchant, Ph.; Martel, P.; Bernhard, S.; Chareyre, P.; Gardin, I.; Casanova, Ph.; De Vita, A.; Tenailleau, L.; Masson, B.; Feret, B.; Guerin, M.; Guillot, L.; Gaultier, E.

    2009-07-01

    This document gathers the slides of the available presentations given during these conference days. Thirty presentations are assembled in the document and deal with: 1 - enforcement circular of the labor code dispositions relative to workers protection against ionizing radiation hazards (T. Lahaye); 2 - context and regulatory evolutions - public health code (S. Rodde); 3 - references and perspectives in external dosimetry (J.M. Bordy); 4 - CIPR's Committee 2 works (F. Paquet); 5 - from protection data to measurement data (A. Pin); 6 - dosimetric control in radiotherapy (A. Veres); 7 - calibration of irradiation measurement devices in industrial environment (A. Cadiou); 8 - calibration and verification of nuclear measurement devices (J.Y. Branthonne); 9 - calibration of measurement devices in medical environment (J.M. Bordy); 10 - quality control in radiotherapy (A. Batalla); 11 - in-vivo dosimetry in radiotherapy (A. Noel); 12 - calibration metrology of fixed post irradiation sensors (L. Laloubere); 13 - design requirements for the radiological zoning and the wastes cleanliness of Flamanville 3 EPR reactor (S. Moreau); 14 - efficiency of aerosol capture systems used in CNPE EDF (F. Gensdarmes); 15 - mobile surveillance means of the atmospheric contamination of CNPE EDF's reactor building (S. Marques and M. Lestang); 16 - experience feedback about the security gates at EDF's nuclear facilities (N. Valendru); 17 - metrology needs for radioprotection technical controls (P. Tranchant); 18 - technical evaluation of a flowmeter/dosemeter in the framework of the regulatory control of X-ray electric generators used in radio-diagnosis (P. Martel); 19 - reinforced natural radioactivity - the case of radon measurement (S. Bernhard); 20 - fires during radioactive materials transport (P. Chareyre); 21 - measurement in the framework of medical examinations: radiology service (A. Noel); 22 - operational measurements in nuclear medicine (I. Gardin); 23 - from the

  17. CSF biomarkers of Alzheimer's disease concord with amyloid-β PET and predict clinical progression: A study of fully automated immunoassays in BioFINDER and ADNI cohorts.

    Science.gov (United States)

    Hansson, Oskar; Seibyl, John; Stomrud, Erik; Zetterberg, Henrik; Trojanowski, John Q; Bittner, Tobias; Lifke, Valeria; Corradini, Veronika; Eichenlaub, Udo; Batrla, Richard; Buck, Katharina; Zink, Katharina; Rabe, Christina; Blennow, Kaj; Shaw, Leslie M

    2018-03-01

    We studied whether fully automated Elecsys cerebrospinal fluid (CSF) immunoassay results were concordant with positron emission tomography (PET) and predicted clinical progression, even with cutoffs established in an independent cohort. Cutoffs for Elecsys amyloid-β 1-42 (Aβ), total tau/Aβ(1-42), and phosphorylated tau/Aβ(1-42) were defined against [ 18 F]flutemetamol PET in Swedish BioFINDER (n = 277) and validated against [ 18 F]florbetapir PET in Alzheimer's Disease Neuroimaging Initiative (n = 646). Clinical progression in patients with mild cognitive impairment (n = 619) was studied. CSF total tau/Aβ(1-42) and phosphorylated tau/Aβ(1-42) ratios were highly concordant with PET classification in BioFINDER (overall percent agreement: 90%; area under the curve: 94%). The CSF biomarker statuses established by predefined cutoffs were highly concordant with PET classification in Alzheimer's Disease Neuroimaging Initiative (overall percent agreement: 89%-90%; area under the curves: 96%) and predicted greater 2-year clinical decline in patients with mild cognitive impairment. Strikingly, tau/Aβ ratios were as accurate as semiquantitative PET image assessment in predicting visual read-based outcomes. Elecsys CSF biomarker assays may provide reliable alternatives to PET in Alzheimer's disease diagnosis. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

  18. Cosmic microwave background and supernova constraints on quintessence: Concordance regions and target models

    International Nuclear Information System (INIS)

    Caldwell, Robert R.; Doran, Michael

    2004-01-01

    We perform a detailed comparison of the Wilkinson Microwave Anisotropy Probe measurements of the cosmic microwave background (CMB) temperature and polarization anisotropy with the predictions of quintessence cosmological models of dark energy. We consider a wide range of quintessence models, including a constant equation of state, a simply parametrized, time-evolving equation of state, a class of models of early quintessence, and scalar fields with an inverse-power law potential. We also provide a joint fit to the Cosmic Background Imager (CBI) and Arcminute Cosmology Bolometer Array Receiver (ACBAR) CMB data, and the type 1a supernovae. Using these select constraints we identify viable, target models which should prove useful for numerical studies of large scale structure formation, and to rapidly estimate the impact to the concordance region when new or improved observations become available

  19. Guide of good practices in medical physics - French Society of Medical Physics

    International Nuclear Information System (INIS)

    Rosenwald, Jean-Claude; Aventin, Christophe; Coste, Frederic; Francois, Pascal; Ginestet, Chantal; Perrin, Benedicte; Salvat, Cecile; Caselles, Olivier; Dedieu, Veronique; Dejean, Catherine; Batalla, Alain; Guillaume, Bonniaud; Le Du, Dominique; Lisbona, Albert; Marchesi, Vincent; Sarrazin, Thierry; Mazeron, Jean-Jacques; Lipinski, Francis; Vera, Pierre; Vermandel, Maximilien; Ducou le Pointe, Hubert; Vidal, Vincent; Henry, Cecile; Mazeau-Woynar, Valerie; Prot, Camille; Valero, Marc; Aubert, Bernard; Etard, Cecile; Jimonet, Christine; Roue, Amelie; Sage, Julie; Bardies, Manuel; Beauvais, Helene; Bey, Pierre; Costa, Andre; Desblancs, Claire; Eudaldo, Teresa; Farman, Bardia; Ferrand, Regis; Garcia, Robin; Giraud, Jean-Yves; Husson, Francois; Koulibaly, Malick; Carlan, Loic de; Manens, Jean-Pierre; Naudy, Suzanne; Noel, Alain; Pilette, Pierre; Verdun, Francis; Bouette, Aurelien; Breen, Stephen; Bridier, Andre; Chauvenet, Bruno; Chavaudra, Jean; Gardin, Isabelle; Herlevin, Karine

    2012-01-01

    After a presentation of the methodological approach used to write this book, the first chapter addresses the profession of medical physicist: medical physics in France (history, evolution of the profession, of the education and of regulation), legal framework (related to the medical use of ionizing radiations, legal texts directly concerning medical physics, regulations impacting the professional practice of medical physicists), scopes of intervention of the medical physicist (context, missions, dose management, image quality, quality management and safety, relationship with the patient, education, training and research, relationships with industry, cost management), operating conditions, and good professional practices. The second chapter addresses the principles of management of quality and safety: quality management in medical physics, safety management, quality and safety in health care facilities. The third part addresses good practices in medical physics: general principles of working methods, equipment management, participation to clinic activities

  20. The sound of operation and the acoustic attenuation of the Ohmeda Medical Giraffe OmniBed™.

    Science.gov (United States)

    Wubben, Stephanie M; Brueggeman, Paul M; Stevens, Dennis C; Helseth, Carol C; Blaschke, Kristen

    2011-01-01

    The neonatal intensive care unit (NICU) is an environment that provides premature and fragile infants with health provisions needed to make a complete recovery. Premature infants are often born before their auditory systems have had an opportunity to fully mature. Research has shown that the ambient acoustic environment in the NICU exceeds the maximum noise level recommended by the American Academy of Pediatrics, even after measures have been taken to decrease noise levels. The purpose of this study is to evaluate noise levels inside an Ohmeda Medical Giraffe™ OmniBed™, the natural attenuation of the incubator, and the effects of modifications on attenuation and reverberation within the Giraffe TM OmniBed™. The normal operation of the Giraffe™ OmniBed™ is 41.7 dBA which indicates a lower noise of operation than previous studies. The Giraffe™ OmniBed™ naturally attenuates 12 dBA. Leaving an access latch or portal door open causes a statistically significant (P=.001) increase in sound within the bassinet. All modifications in the no-noise and the noise conditions showed a statistically significant (P=.001) drop in L(eq) when compared to baseline.

  1. Quality assurance in medical radiation applications. The medical and dental appointment

    International Nuclear Information System (INIS)

    Ernst-Elz, Andreas

    2017-01-01

    Medical radiation applications cause averaged over the German population an annual exposure of almost 2 mSv. Medical authorities have the assignment to assure and control the diagnostic and therapeutic quality of these applications and to provide recommendations for operators with respect to dose reductions and radiation protection, including guidance for radiotherapy planning aimed to questions of dose and therapy optimization.

  2. Record completeness and data concordance in an anesthesia information management system using context-sensitive mandatory data-entry fields.

    Science.gov (United States)

    Avidan, Alexander; Weissman, Charles

    2012-03-01

    Use of an anesthesia information management system (AIMS) does not insure record completeness and data accuracy. Mandatory data-entry fields can be used to assure data completeness. However, they are not suited for data that is mandatory depending on the clinical situation (context sensitive). For example, information on equal breath sounds should be mandatory with tracheal intubation, but not with mask ventilation. It was hypothesized that employing context-sensitive mandatory data-entry fields can insure high data-completeness and accuracy while maintaining usability. A commercial off-the-shelf AIMS was enhanced using its built-in VBScript programming tool to build event-driven forms with context-sensitive mandatory data-entry fields. One year after introduction of the system, all anesthesia records were reviewed for data completeness. Data concordance, used as a proxy for accuracy, was evaluated using verifiable age-related data. Additionally, an anonymous satisfaction survey on general acceptance and usability of the AIMS was performed. During the initial 12 months of AIMS use, 12,241 (99.6%) of 12,290 anesthesia records had complete data. Concordances of entered data (weight, size of tracheal tubes, laryngoscopy blades and intravenous catheters) with patients' ages were 98.7-99.9%. The AIMS implementation was deemed successful by 98% of the anesthesiologists. Users rated the AIMS usability in general as very good and the data-entry forms in particular as comfortable. Due to the complexity and the high costs of implementation of an anesthesia information management system it was not possible to compare various system designs (for example with or without context-sensitive mandatory data entry-fields). Therefore, it is possible that a different or simpler design would have yielded the same or even better results. This refers also to the evaluation of usability, since users did not have the opportunity to work with different design approaches or even different

  3. The medical story. [of Skylab

    Science.gov (United States)

    Johnston, R. S.; Dietlein, L. F.; Michel, E. L.

    1975-01-01

    The paper discusses the medical program of the Skylab missions. The major medical systems discussed include the food system, the waste-management system, the personal-hygiene system, and the inflight medical support system. The life-sciences experiments conducted on Skylab are reviewed. These dealt with the cardiovascular system, mineral balance and bioassay of fluids, sleep, blood, metabolic activity, vestibular function, and time and motion studies. The medical operations were accomplished with only minor problems.

  4. White matter differences in monozygotic twins discordant or concordant for obsessive-compulsive symptoms: a combined diffusion tensor imaging/voxel-based morphometry study.

    Science.gov (United States)

    den Braber, Anouk; van 't Ent, Dennis; Boomsma, Dorret I; Cath, Danielle C; Veltman, Dick J; Thompson, Paul M; de Geus, Eco J C

    2011-11-15

    Neuroimaging studies of obsessive-compulsive disorder (OCD) patients point to deficits in cortico-striato-thalamo-cortical circuits that might include changes in white matter. The contribution of environmental and genetic factors to the various OCD-related changes in brain structures remains to be established. White matter structures were analyzed in 140 subjects with both diffusion tensor imaging and voxel-based morphometry. We studied 20 monozygotic twin pairs discordant for obsessive-compulsive symptoms (OCS) to detect the effects of environmental risk factors for obsessive-compulsive (OC) symptomatology. Furthermore, we compared 28 monozygotic twin pairs concordant for low OCS scores with 23 twin pairs concordant for high OCS scores to detect the effects of genetic risk factors for OC symptomatology. Discordant pair analysis showed that the environmental risk was associated with an increase in dorsolateral-prefrontal white matter. Analysis of concordant pairs showed that the genetic risk was associated with a decrease in inferior frontal white matter. Various white matter tracts showed opposite effects of environmental and genetic risk factors (e.g., right medial frontal, left parietal, and right middle temporal), illustrating the need for designs that separate these classes of risk factors. Different white matter regions were affected by environmental and genetic risk factors for OC symptomatology, but both classes of risk factors might, in aggregate, create an imbalance between the indirect loop of the cortico-striato-thalamo-cortical network (to the dorsolateral-prefrontal region)-important for inhibition and switching between behaviors-and the direct loop (involving the inferior frontal region) that contributes to the initiation and continuation of behaviors. Copyright © 2011 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

  5. Concordance Between FISH Analysis of Her-2/Neu Gene in Breast Duct Carcinoma and Corresponding Axillary Nodal Metastases: Egyptian National Cancer Institute Experience.

    Science.gov (United States)

    Badawy, Omnia M; Hassan, Hannan; ELBakey, Heba A; Mosaad, Maha

    2018-05-10

    Breast cancer is a major health problem in Egypt. Her-2/Neu gene is routinely assessed for all breast cancer patients primarily by immunohistochemistry. At National Cancer Institute (NCI), Cairo University, Flourescence In Situ hybridization (FISH) analysis of Her-2/Neu gene is carried out for Her-2/Neu score 2 and for some cases of score 3 (particularly those assessed outside NCI). The test is performed essentially on the primary tumor. However, some situations require testing on corresponding lymph node metastases. There is a debate about the concordance between Her-2/Neu status in the primary tumor and synchronous lymph node metastases in various studies. The aim of this study was to test for the concordance between Her-2/Neu status in the primary breast tumor and corresponding axillary nodal metastases. This is a retrospective study in which FISH analysis of Her-2/Neu was carried out simultaneously on archived material of 50 cases previously diagnosed as invasive duct carcinoma and the corresponding nodal metastases from the Pathology Department, NCI. There was complete concordance between Her-2 status in the primary tumor and the corresponding axillary lymph node metastatic deposits in which Her-2 was amplified in 44% of the studied cohort of Egyptian patients. Her-2/Neu gene assessed by FISH analysis on synchronous lymph node metastases is strongly correlated with the primary tumor. Hence, it is justified to carry out the Her-2/Neu test on synchronous lymph nodes to decide on whether to carry out anti-Her-2/Neu target therapy. Further studies on other metastatic sites is recommended.

  6. Maternal mood and concordant maternal and infant salivary cortisol during heel lance while in kangaroo care.

    Science.gov (United States)

    Castral, T C; Warnock, F; Dos Santos, C B; Daré, M F; Moreira, A C; Antonini, S R R; Scochi, C G S

    2015-03-01

    Maternal kangaroo care (MKC) is a naturalistic intervention that alleviates neonatal pain, and mothers are assumed to play a stress regulatory role in MKC. Yet, no MKC infant pain study has examined relationship between maternal and infant stress reactivity concurrently, or whether post-partum depression and/or anxiety (PPDA) alters maternal and neonatal stress response and the regulatory effects of MKC. To examine the concordance of salivary cortisol reactivity between 42 mothers and their stable preterm infants during routine infant heel lance (HL) while in MKC and to compare salivary cortisol between groups of mothers with and without PPDA and their infants. Maternal and infant salivary cortisol samples were collected pre-HL and 20 min post-HL with two additional maternal samples at night and in the morning. Mothers and infants were allocated to with PPDA versus without PPDA study groups on the basis of maternal post-natal mental health assessment scores. Higher mothers' cortisol pre-HL was weakly associated with higher infants' salivary cortisol in response to the HL procedure. Maternal depression and/or anxiety were not associated with infants' cortisol. During HL, both groups of mothers and infants showed no change in salivary cortisol. Concordance between mother and infant salivary cortisol supports the maternal stress regulatory role in MKC. MKC may have stress regulatory benefits for mothers and their preterm infants during HL independent of PPDA. Future MKC studies that target mothers with altered mood will help to build on these findings. © 2014 European Pain Federation - EFIC®

  7. MRI follow-up after concordant, histologically benign diagnosis of breast lesions sampled by MRI-guided biopsy.

    Science.gov (United States)

    Li, Jie; Dershaw, D David; Lee, Carol H; Kaplan, Jennifer; Morris, Elizabeth A

    2009-09-01

    Follow-up MRI can be useful to confirm a benign diagnosis after MRI-guided breast biopsy. This retrospective study was undertaken to evaluate appropriate timing and imaging interpretation for the initial follow-up MRI when a benign, concordant histology is obtained using MRI-guided breast biopsy. Retrospective review was performed of 177 lesions visualized only by MRI in 172 women who underwent 9-gauge, vacuum-assisted core biopsy and marker placement with imaging-concordant benign histology. All underwent follow-up MRI within 12 months. Timing of the follow-up study, change in size, results of second biopsy if performed, and distance of localizing marker to the lesion on the follow-up study were recorded. At initial follow-up, 155 lesions were decreased or gone, 14 lesions were stable, and eight were enlarged. Seventeen (9.6%, 17/177) lesions underwent a second biopsy, including six enlarging, 10 stable, and one decreasing. Of these, four were malignant. Enlargement was seen in two carcinomas at 6 and 12 months. Two carcinomas, one stable at 2 months and another stable at 3 and 11 months, were rebiopsied because of suspicion of a missed lesion in the former and worrisome mammographic and sonographic changes in the latter. The distance of the marker from the lesion on follow-up did not correlate with biopsy accuracy. Follow-up MRI did not detect missed cancers because of lesion enlargement before 6 months after biopsy; two of four missed cancers were stable. The localizing marker can deploy away from the target despite successful sampling.

  8. Medical Data Architecture Project Status

    Science.gov (United States)

    Krihak, M.; Middour, C.; Lindsey, A.; Marker, N.; Wolfe, S.; Winther, S.; Ronzano, K.; Bolles, D.; Toscano, W.; Shaw, T.

    2017-01-01

    The Medical Data Architecture (MDA) project supports the Exploration Medical Capability (ExMC) risk to minimize or reduce the risk of adverse health outcomes and decrements in performance due to in-flight medical capabilities on human exploration missions. To mitigate this risk, the ExMC MDA project addresses the technical limitations identified in ExMC Gap Med 07: We do not have the capability to comprehensively process medically-relevant information to support medical operations during exploration missions. This gap identifies that the current International Space Station (ISS) medical data management includes a combination of data collection and distribution methods that are minimally integrated with on-board medical devices and systems. Furthermore, there are variety of data sources and methods of data collection. For an exploration mission, the seamless management of such data will enable an increasingly autonomous crew than the current ISS paradigm. The MDA will develop capabilities that support automated data collection, and the necessary functionality and challenges in executing a self-contained medical system that approaches crew health care delivery without assistance from ground support. To attain this goal, the first year of the MDA project focused on reducing technical risk, developing documentation and instituting iterative development processes that established the basis for the first version of MDA software (or Test Bed 1). Test Bed 1 is based on a nominal operations scenario authored by the ExMC Element Scientist. This narrative was decomposed into a Concept of Operations that formed the basis for Test Bed 1 requirements. These requirements were successfully vetted through the MDA Test Bed 1 System Requirements Review, which permitted the MDA project to begin software code development and component integration. This paper highlights the MDA objectives, development processes, and accomplishments, and identifies the fiscal year 2017 milestones and

  9. 47 CFR 15.513 - Technical requirements for medical imaging systems.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 1 2010-10-01 2010-10-01 false Technical requirements for medical imaging... DEVICES Ultra-Wideband Operation § 15.513 Technical requirements for medical imaging systems. (a) The UWB... MHz and 10,600 MHz. (b) Operation under the provisions of this section is limited to medical imaging...

  10. Molecular cloning and biochemical characterization of the UDP-glucose: flavonoid 3-O-glucosyltransferase from Concord grape (Vitis labrusca).

    Science.gov (United States)

    Hall, Dawn; Yuan, Xiao Xin; Murata, Jun; De Luca, Vincenzo

    2012-02-01

    Glucosylation of anthocyanidin substrates at the 3-O-position is crucial for the red pigmentation of grape berries and wine. The gene that encodes the enzyme involved in this reaction has been cloned from Vitis labrusca cv. Concord, heterologously expressed, and the recombinant enzyme (rVL3GT) was characterized. VL3GT has 96% amino acid sequence identity with Vitis vinifera VV3GT and groups phylogenetically with several other flavonoid 3-O-glycosyltransferases. In vitro substrate specificity studies and kinetic analyses of rVL3GT indicate that this enzyme preferentially glucosylates cyanidin as compared with quercetin. Crude protein extracts from several Concord grape tissues were assayed for glucosyltransferase activity with cyanidin and quercetin as acceptor substrates. A comparison of the VL3GT activities toward with these substrates showed that the 3GT enzyme activity is consistent with the expression of VL3GT in these tissues and is coincident with the biosynthesis of anthocyanins in both location and developmental stages. Enzyme activities in grape mesocarp, pre-veraison exocarp, leaf, flower bud, and flower tissues glucosylated quercetin but not cyanidin at high rates, suggesting the presence of additional enzymes which are able to glucosylate the 3-O-position of flavonols with higher specificity than anthocyanidins. Copyright © 2011 Elsevier Ltd. All rights reserved.

  11. Writing otorhinolaryngology head & neck surgery operative reports.

    Science.gov (United States)

    Laccourreye, O; Rubin, F; Villeneuve, A; Bonfils, P

    2017-09-01

    Only about ten articles devoted to operative reports have been published in the medical literature, but this document is essential, both medically and legally, to ensure optimal management of operated patients. In this technical note, based on published studies on this subject, the authors describe the key features of operating reports after otorhinolaryngology head & neck surgery and emphasize the need to write this document during the minutes after the end of the operation, the importance of standardization and its teaching role during surgical training. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  12. Conceptual Drivers for an Exploration Medical System

    Science.gov (United States)

    Antonsen, Erik; Hanson, Andrea; Shah, Ronak; Reed, Rebekah; Canga, Michael

    2016-01-01

    Interplanetary spaceflight, such as NASA's proposed three-year mission to Mars, provides unique and novel challenges when compared with human spaceflight to date. Extended distance and multi-year missions introduce new elements of operational complexity and additional risk. These elements include: inability to resupply medications and consumables, inability to evacuate injured or ill crew, uncharted psychosocial conditions, and communication delays that create a requirement for some level of autonomous medical capability. Because of these unique challenges, the approaches used in prior programs have limited application to a Mars mission. On a Mars mission, resource limitations will significantly constrain available medical capabilities, and require a paradigm shift in the approach to medical system design and risk mitigation for crew health. To respond to this need for a new paradigm, the Exploration Medical Capability (ExMC) Element is assessing each Mars mission phase-transit, surface stay, rendezvous, extravehicular activity, and return-to identify and prioritize medical needs for the journey beyond low Earth orbit (LEO). ExMC is addressing both planned medical operations, and unplanned contingency medical operations that meld clinical needs and research needs into a single system. This assessment is being used to derive a gap analysis and studies to support meaningful medical capabilities trades. These trades, in turn, allow the exploration medical system design to proceed from both a mission centric and ethics-based approach, and to manage the risks associated with the medical limitations inherent in an exploration class mission. This paper outlines the conceptual drivers used to derive medical system and vehicle needs from an integrated vision of how medical care will be provided within this paradigm. Keywords: (Max 6 keywords: exploration, medicine, spaceflight, Mars, research, NASA)

  13. A guide for good practices in medical physics - French Society of Medical Physics

    International Nuclear Information System (INIS)

    Rosenwald, Jean-Claude; Aventin, Christophe; Coste, Frederic; Francois, Pascal; Ginestet, Chantal; Perrin, Benedicte; Salvat, Cecile; Caselles, Olivier; Dedieu, Veronique; Dejean, Catherine; Batalla, Alain; Guillaume, Bonniaud; LeDu, Dominique; Lisbona, Albert; Marchesi, Vincent; Sarrazin, Thierry; Mazeron, Jean-Jacques; Lipinski, Francis; Vera, Pierre; Maximilien Vermandel; Ducou le Pointe, Hubert; Vidal, Vincent; Henry, Cecile; Mazeau-Woynar, Valerie; Prot, Camille; Valero, Marc; Aubert, Bernard; Etard, Cecile; Jimonet, Christine; Roue, Amelie; Sage, Julie; Bardies, Manuel; Beauvais, Helene; Bey, Pierre; Costa, Andre; Desblancs, Claire; Eudaldo, Teresa; Farman, Bardia; Ferrand, Regis; Garcia, Robin; Giraud, Jean-Yves; Husson, Francois; Koulibaly, Malick; Carlan, Loic de; Manens, Jean-Pierre; Naudy, Suzanne; Noel, Alain; Pilette, Pierre; Verdun, Francis

    2012-12-01

    After a presentation of the methodological approach used to write this book, the first chapter addresses the profession of medical physicist: medical physics in France (history, evolution of the profession, of the education and of regulation), legal framework (related to the medical use of ionizing radiations, legal texts directly concerning medical physics, regulations impacting the professional practice of medical physicists), scopes of intervention of the medical physicist (context, missions, dose management, image quality, quality management and safety, relationship with the patient, education, training and research, relationships with industry, cost management), operating conditions, and good professional practices. The second chapter addresses the principles of management of quality and safety: quality management in medical physics, safety management, quality and safety in health care facilities. The third part addresses good practices in medical physics: general principles of working methods, equipment management, participation to clinic activities

  14. Prevalence and concordance of high-risk papillomavirus infection in male sexual partners of women diagnosed with high grade cervical lesions.

    Science.gov (United States)

    López Diez, Elena; Pérez, Sonia; Iñarrea, Amparo; de la Orden, Angel; Castro, Máximo; Almuster, Sheila; Tortolero, Leonardo; Rodríguez, Moises; Montero, Ruben; Ojea, Antonio

    2017-05-01

    Little is known about the characteristics of high-risk papillomavirus (HR-HPV) infection in men. The aims of this cross-sectional study were: (a) to investigate HR-HPV prevalence and genotype distribution in men, sexual partners of women presenting with high-grade cervical intraepithelial neoplasia (HG-CIN), according to epidemiological characteristics, and (b) to assess type-specific concordance between partners. A total of 125 men were recruited within the first 6 months after HG-CIN diagnosis of their partner. Samples from the coronal sulcus, glans penis shaft, and scrotum were tested with linear array HPV genotyping assay (Roche Diagnostics, Mannheim, Germany). Type-specific concordance within 120 couples was studied. Epidemiological factors were evaluated by multivariate logistic regression analysis. SPSS 19 (IBM, Chicago, USA). The prevalence of HR-HPV infection in males was 50.4% (63/125). HPV16/53/52/51/66/31 were the most frequent genotypes (24/10.4/9.6/8.8/8/7.2%, respectively). Current smoking was associated with an increased risk for HR-HPV infection in men (38.2% (21/55) vs 60% (42/70), OR 2.4, p=0.025). Among 60 infected couples, 62% shared at least one genotype: 41.7% couples were concordantly HPV16 positive and 18.3% were HPV16 negative (kappa value: 0.21). The proportion of women with the same genotype as their male partner was higher than the proportion of men sharing the same genotype as their female partner: 58.7% (37/63) vs 30.8% (37/120), p<0.0001. Sexual partners of women with HG-CIN are a significant reservoir and vector of HPV infection, a fact that could contribute to making viral clearance more difficult to achieve in their partners after treatment of their HG-CIN lesions. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  15. Medical Applications

    CERN Document Server

    Biscari, C.

    2014-12-19

    The use of accelerators for medical applications has evolved from initial experimentation to turn-key devices commonly operating in hospitals. New applications are continuously being developed around the world, and the hadrontherapy facilities of the newest generation are placed at the frontier between industrial production and advanced R&D. An introduction to the different medical application accelerators is followed by a description of the hadrontherapy facilities, with special emphasis on CNAO, and the report closes with a brief outlook on the future of this field.

  16. Medical Applications

    International Nuclear Information System (INIS)

    Biscari, C; Falbo, L

    2014-01-01

    The use of accelerators for medical applications has evolved from initial experimentation to turn-key devices commonly operating in hospitals. New applications are continuously being developed around the world, and the hadrontherapy facilities of the newest generation are placed at the frontier between industrial production and advanced R&D. An introduction to the different medical application accelerators is followed by a description of the hadrontherapy facilities, with special emphasis on CNAO, and the report closes with a brief outlook on the future of this field

  17. Do radio frequencies of medical instruments common in the operating room interfere with near-infrared spectroscopy signals?

    Science.gov (United States)

    Shadgan, Babak; Molavi, Behnam; Reid, W. D.; Dumont, Guy; Macnab, Andrew J.

    2010-02-01

    Background: Medical and diagnostic applications of near infrared spectroscopy (NIRS) are increasing, especially in operating rooms (OR). Since NIRS is an optical technique, radio frequency (RF) interference from other instruments is unlikely to affect the raw optical data, however, NIRS data processing and signal output could be affected. Methods: We investigated the potential for three common OR instruments: an electrical cautery, an orthopaedic drill and an imaging system, to generate electromagnetic interference (EMI) that could potentially influence NIRS signals. The time of onset and duration of every operation of each device was recorded during surgery. To remove the effects of slow changing physiological variables, we first used a lowpass filter and then selected 2 windows with variable lengths around the moment of device onset. For each instant, variances (energy) and means of the signals in the 2 windows were compared. Results: Twenty patients were studied during ankle surgery. Analysis shows no statistically significant difference in the means and variance of the NIRS signals (p < 0.01) during operation of any of the three devices for all surgeries. Conclusion: This method confirms the instruments evaluated caused no significant interference. NIRS can potentially be used without EMI in clinical environments such as the OR.

  18. Effects of Concord grape juice on ambulatory blood pressure in prehypertension and stage 1 hypertension123

    Science.gov (United States)

    Dohadwala, Mustali M; Hamburg, Naomi M; Holbrook, Monika; Kim, Brian H; Duess, Mai-Ann; Levit, Aaron; Titas, Megan; Chung, William B; Vincent, Felix B; Caiano, Tara L; Frame, Alissa A; Keaney, John F

    2010-01-01

    Background: Consumption of flavonoid-containing foods may be useful for the management of hypertension. Objective: We investigated whether 100% Concord grape juice lowers blood pressure in patients with prehypertension and stage 1 hypertension. Design: We conducted a double-blind crossover study to compare the effects of grape juice (7 mL · kg−1 · d−1) and matched placebo beverage on 24-h ambulatory blood pressure, stress-induced changes in blood pressure, and biochemical profile. Participants consumed each beverage for 8 wk with a 4-wk rest period between beverages. They ceased consumption of grapes and other flavonoid-containing beverages throughout the study. Results: We enrolled 64 otherwise healthy patients taking no antihypertensive medications (31% women, 42% black, age 43 ± 12 y). Baseline mean (±SD) cuff blood pressure was 138 ± 7 (systolic)/82 ± 7 (diastolic) mm Hg. No effects on the primary endpoint of 24-h mean systolic blood pressure, diastolic blood pressure, or stress-induced changes in blood pressure were observed. A secondary endpoint was nocturnal dip in systolic pressure. At baseline, nocturnal pressure was 8.3 ± 7.1% lower at night than during daytime. The mean nocturnal dip increased 1.4 percentage points after grape juice and decreased 2.3 percentage points after placebo (P = 0.005). Fasting blood glucose was 91 ± 10 mg/dL at baseline for the entire cohort. Glucose decreased 2 mg/dL after consumption of grape juice and increased 1 mg/dL after consuming the placebo (P = 0.03). Conclusions: We observed no effect of grape juice on ambulatory blood pressure in this cohort of relatively healthy individuals with modestly elevated blood pressure. Secondary analyses suggested favorable effects on nocturnal dip and glucose homeostasis that may merit further investigation. This trial was registered at clinicaltrials.gov as NCT00302809. PMID:20844075

  19. Medical Diplomacy: A Tool for Enabling National Security Strategy Objectives

    Science.gov (United States)

    2012-04-06

    USGs global health portfolio includes a diverse set of programs and investments in...cultural linguistic competency, expertise in regional medical initiatives, and knowledge of joint coordination in the ability foster medical goodwill...operates medical research units in Egypt and Peru . Additionally, the Navy has operated facilities in Indonesia and maintains research capabilities

  20. Radiation shielding and health physics instrumentation for PET medical cyclotrons

    International Nuclear Information System (INIS)

    Mukherjee, B.

    2002-01-01

    Full text: Modern Medical Cyclotrons produce a variety of short-lived positron emitting PET radioisotopes, and as a result are the source of intense neutron and gamma radiations. Since such cyclotrons are housed within hospitals or medical clinics, there is significant potential for un-intentional exposure to staff or patients in proximity to cyclotron facilities. Consequently, the radiological hazards associated with Cyclotrons provide the impetus for an effective radiological shielding and continuous monitoring of various radiation levels in the cyclotron environment. Management of radiological hazards is of paramount importance for the safe operation of a Medical Cyclotron facility. This work summarised the methods of shielding calculations for a compact hospital based Medical Cyclotron currently operating in Canada, USA and Australia. The design principle and operational history of a real-time health physics monitoring system (Watchdog) operating at a large multi-energy Medical Cyclotron is also highlighted

  1. Skylab medical technology utilization

    Science.gov (United States)

    Stonesifer, J. C.

    1974-01-01

    To perform the extensive medical experimentation on man in a long-term, zero-g environment, new medical measuring and monitoring equipment had to be developed, new techniques in training and operations were required, and new methods of collecting and analyzing the great amounts of medical data were developed. Examples of technology transfers to the public sector resulted from the development of new equipment, methods, techniques, and data. This paper describes several of the examples that stemmed directly from Skylab technology.

  2. Centralization vs. Decentralization in Medical School Libraries

    Science.gov (United States)

    Crawford, Helen

    1966-01-01

    Does the medical school library in the United States operate more commonly under the university library or the medical school administration? University-connected medical school libraries were asked to indicate (a) the source of their budgets, whether from the central library or the medical school, and (b) the responsibility for their acquisitions and cataloging. Returns received from sixtyeight of the seventy eligible institutions showed decentralization to be much the most common: 71 percent of the libraries are funded by their medical schools; 79 percent are responsible for their own acquisitions and processing. The factor most often associated with centralization of both budget and operation is public ownership. Decentralization is associated with service to one or two rather than three or more professional schools. Location of the medical school in a different city from the university is highly favorable to autonomy. Other factors associated with these trends are discussed. PMID:5945568

  3. Centralization vs. decentralization in medical school libraries.

    Science.gov (United States)

    Crawford, H

    1966-07-01

    Does the medical school library in the United States operate more commonly under the university library or the medical school administration? University-connected medical school libraries were asked to indicate (a) the source of their budgets, whether from the central library or the medical school, and (b) the responsibility for their acquisitions and cataloging. Returns received from sixtyeight of the seventy eligible institutions showed decentralization to be much the most common: 71 percent of the libraries are funded by their medical schools; 79 percent are responsible for their own acquisitions and processing. The factor most often associated with centralization of both budget and operation is public ownership. Decentralization is associated with service to one or two rather than three or more professional schools. Location of the medical school in a different city from the university is highly favorable to autonomy. Other factors associated with these trends are discussed.

  4. Characterizing the Relationship Between Surgical Resident and Faculty Perceptions of Autonomy in the Operating Room.

    Science.gov (United States)

    Young, Katelyn A; Lane, Samantha M; Widger, John E; Neuhaus, Nina M; Dove, James T; Fluck, Marcus; Hunsinger, Marie A; Blansfield, Joseph A; Shabahang, Mohsen M

    Characterize the concordance among faculty and resident perceptions of surgical case complexity, resident technical performance, and autonomy in a diverse sample of general surgery procedures using case-specific evaluations. A prospective study was conducted in which a faculty surgeon and surgical resident independently completed a postoperative assessment examining case complexity, resident operative performance (Milestone assessment) and autonomy (Zwisch model). Pearson correlation coefficients (r) reaching statistical significance (p autonomy demonstrated a moderate correlation (r = 0.56, p autonomy and operative performance, respectively. General surgery residents generally demonstrated high correlations with faculty perceptions of case complexity, technical performance, and operative autonomy. This generalized accord supports the use of the Milestone and Zwisch assessments in residency programs. However, discordance among perceptions of midlevel resident autonomy and chief resident operative performance suggests that these trainees may need more direct communication from the faculty. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  5. [The organizational characteristics of the medical support for the troops in the first operations at the start of a war (based on the experience of exercises)].

    Science.gov (United States)

    Iziumtsev, I S

    1995-03-01

    The article summarized the experience of an explorative tactical-special exercise on medical support of Mobile Forces in first military operations of the initial period of war which has studied the following questions: the organic structure and organization of work of the medical service of a motorized infantry brigade in defense; joint direction of organic hospital facilities and field traumatological hospital. The author also studies the deployment peculiarities of a military multipurpose hospital on the basis of a garrison hospital. The experience of these exercises has proved the necessity to update the organic structure and principles of the employment of medical assets in accordance with the requirements of new military doctrine, as well as realize the technical re-equipment of medical service.

  6. Recommendations of the International Medical Informatics Association (IMIA) on Education in Health and Medical Informatics

    Czech Academy of Sciences Publication Activity Database

    Arokiasamy, J.; Ball, M.; Barnett, D.; Bearman, M.; Bemmel van, J.; Douglas, J.; Fisher, P.; Garrie, R.; Gatewood, L.; Goossen, W.; Grant, A.; Hales, J.; Hasman, A.; Haux, R.; Hovenga, E.; Johns, M.; Knaup, P.; Leven, F. J.; Lorenzi, N.; Murray, P.; Neame, R.; Protti, D.; Power, M.; Richard, J.; Schuster, E.; Swinkels, W.; Yang, J.; Zelmer, L.; Zvárová, Jana

    2001-01-01

    Roč. 40, č. 5 (2001), s. 267-277 ISSN 0026-1270 Institutional research plan: AV0Z1030915 Keywords : health informatics * medical informatics * education * recommendations * International Medical Informatics Association * IMIA Subject RIV: BB - Applied Statistics, Operational Research Impact factor: 1.254, year: 2001

  7. Leadership challenges in multinational medical peacekeeping operations: Lessons from UNIFIL Hospital.

    Science.gov (United States)

    Datta, Rakesh; Khanna, Sangeeta

    2017-10-01

    Commanding a military multinational and multilingual healthcare facility can be a formidable task with very little margin for error. The authors were in leadership positions of UNIFIL Hospital, unique in its diversity of both staff and clientele. Experience about the challenges faced and methods adopted to overcome them will be shared. Troops from diverse backgrounds differ in their competency, and also in their attitudinal approach to situations. It is imperative for the medical commanders to identify these differences, and work towards harnessing individual strengths to form a cohesive unit. Frequent rotation of team members and thereby difficulty in adapting to new environment makes the tasks more challenging. Challenges can be broadly categorized in those dealing with functional roles (providing medical support) and command and control issues. Linguistic challenges especially in situations where professionals have to work as a coordinated unit remains a major challenge. The threat of medical errors arising out of misunderstandings is very real. Gender sensitization is essential to avoid potential unpleasant situations. Interpersonal conflict can easily go out of hand. The leadership has to be more direct and deliberate relying less on hierarchy and more on direct communication. A strict enforcement of UN standards for equipment and competence, frequent joint medical drills help to overcome interoperability issues and develop mutual confidence. Leadership in multinational UN hospitals is a demanding task with its peculiar set of challenges. A systematic and deliberate approach focused on mutual respect, flexibility and direct leadership can help medical commanders in such situations.

  8. A Systematic Review Comparing the Acceptability, Validity and Concordance of Discrete Choice Experiments and Best-Worst Scaling for Eliciting Preferences in Healthcare.

    Science.gov (United States)

    Whitty, Jennifer A; Oliveira Gonçalves, Ana Sofia

    2018-06-01

    The aim of this study was to compare the acceptability, validity and concordance of discrete choice experiment (DCE) and best-worst scaling (BWS) stated preference approaches in health. A systematic search of EMBASE, Medline, AMED, PubMed, CINAHL, Cochrane Library and EconLit databases was undertaken in October to December 2016 without date restriction. Studies were included if they were published in English, presented empirical data related to the administration or findings of traditional format DCE and object-, profile- or multiprofile-case BWS, and were related to health. Study quality was assessed using the PREFS checklist. Fourteen articles describing 12 studies were included, comparing DCE with profile-case BWS (9 studies), DCE and multiprofile-case BWS (1 study), and profile- and multiprofile-case BWS (2 studies). Although limited and inconsistent, the balance of evidence suggests that preferences derived from DCE and profile-case BWS may not be concordant, regardless of the decision context. Preferences estimated from DCE and multiprofile-case BWS may be concordant (single study). Profile- and multiprofile-case BWS appear more statistically efficient than DCE, but no evidence is available to suggest they have a greater response efficiency. Little evidence suggests superior validity for one format over another. Participant acceptability may favour DCE, which had a lower self-reported task difficulty and was preferred over profile-case BWS in a priority setting but not necessarily in other decision contexts. DCE and profile-case BWS may be of equal validity but give different preference estimates regardless of the health context; thus, they may be measuring different constructs. Therefore, choice between methods is likely to be based on normative considerations related to coherence with theoretical frameworks and on pragmatic considerations related to ease of data collection.

  9. Medical records and issues in negligence

    Directory of Open Access Journals (Sweden)

    Joseph Thomas

    2009-01-01

    Full Text Available It is very important for the treating doctor to properly document the management of a patient under his care. Medical record keeping has evolved into a science of itself. This will be the only way for the doctor to prove that the treatment was carried out properly. Moreover, it will also be of immense help in the scientific evaluation and review of patient management issues. Medical records form an important part of the management of a patient. It is important for the doctors and medical establishments to properly maintain the records of patients for two important reasons. The first one is that it will help them in the scientific evaluation of their patient profile, helping in analyzing the treatment results, and to plan treatment protocols. It also helps in planning governmental strategies for future medical care. But of equal importance in the present setting is in the issue of alleged medical negligence. The legal system relies mainly on documentary evidence in a situation where medical negligence is alleged by the patient or the relatives. In an accusation of negligence, this is very often the most important evidence deciding on the sentencing or acquittal of the doctor. With the increasing use of medical insurance for treatment, the insurance companies also require proper record keeping to prove the patient′s demand for medical expenses. Improper record keeping can result in declining medical claims. It is disheartening to note that inspite of knowing the importance of proper record keeping it is still in a nascent stage in India. It is wise to remember that "Poor records mean poor defense, no records mean no defense". Medical records include a variety of documentation of patient′s history, clinical findings, diagnostic test results, preoperative care, operation notes, post operative care, and daily notes of a patient′s progress and medications. A properly obtained consent will go a long way in proving that the procedures were

  10. Splicing analysis for exonic and intronic mismatch repair gene variants associated with Lynch syndrome confirms high concordance between minigene assays and patient RNA analyses

    Science.gov (United States)

    van der Klift, Heleen M; Jansen, Anne M L; van der Steenstraten, Niki; Bik, Elsa C; Tops, Carli M J; Devilee, Peter; Wijnen, Juul T

    2015-01-01

    A subset of DNA variants causes genetic disease through aberrant splicing. Experimental splicing assays, either RT-PCR analyses of patient RNA or functional splicing reporter minigene assays, are required to evaluate the molecular nature of the splice defect. Here, we present minigene assays performed for 17 variants in the consensus splice site regions, 14 exonic variants outside these regions, and two deep intronic variants, all in the DNA mismatch-repair (MMR) genes MLH1, MSH2, MSH6, and PMS2, associated with Lynch syndrome. We also included two deep intronic variants in APC and PKD2. For one variant (MLH1 c.122A>G), our minigene assay and patient RNA analysis could not confirm the previously reported aberrant splicing. The aim of our study was to further investigate the concordance between minigene splicing assays and patient RNA analyses. For 30 variants results from patient RNA analyses were available, either performed by our laboratory or presented in literature. Some variants were deliberately included in this study because they resulted in multiple aberrant transcripts in patient RNA analysis, or caused a splice effect other than the prevalent exon skip. While both methods were completely concordant in the assessment of splice effects, four variants exhibited major differences in aberrant splice patterns. Based on the present and earlier studies, together showing an almost 100% concordance of minigene assays with patient RNA analyses, we discuss the weight given to minigene splicing assays in the current criteria proposed by InSiGHT for clinical classification of MMR variants. PMID:26247049

  11. Anatomical and functional volume concordance between FDG PET, and T2 and diffusion-weighted MRI for cervical cancer: a hybrid PET/MR study

    International Nuclear Information System (INIS)

    Sun, Hongzan; Xin, Jun; Zhang, Shaomin; Guo, Qiyong; Lu, Yueyue; Zhai, Wei; Zhao, Long; Peng, Weiai; Wang, Baijun

    2014-01-01

    To evaluate the concordance among 18 F-FDG PET imaging, MR T2-weighted (T2-W) imaging and apparent diffusion coefficient (ADC) maps with diffusion-weighted (DW) imaging in cervical cancer using hybrid whole-body PET/MR. This study prospectively included 35 patients with cervical cancer who underwent pretreatment 18 F-FDG PET/MR imaging. 18 F-FDG PET and MR images were fused using standard software. The percent of the maximum standardized uptake values (SUV max ) was used to contour tumours on PET images, and volumes were calculated automatically. Tumour volumes measured on T2-W and DW images were calculated with standard techniques of tumour area multiplied by the slice profile. Parametric statistics were used for data analysis. FDG PET tumour volumes calculated using SUV max (14.30 ± 4.70) and T2-W imaging volume (33.81 ± 27.32 cm 3 ) were similar (P > 0.05) at 35 % and 40 % of SUV max (32.91 ± 18.90 cm 3 and 27.56 ± 17.19 cm 3 respectively) and significantly correlated (P 3 . DW volumes were not significantly different from FDG PET volumes at either 35 % SUV max or 40 % SUV max or from T2-W imaging volumes (P > 0.05). PET subvolumes with increasing SUV max cut-off percentage showed an inverse change in mean ADC values on DW imaging (P max is recommended for 18 F-FDG PET/MR SUV-based tumour volume estimation. The linear tumour subvolume concordance between FDG PET and DW imaging demonstrates individual regional concordance of metabolic activity and cell density. (orig.)

  12. Eliminating US hospital medical errors.

    Science.gov (United States)

    Kumar, Sameer; Steinebach, Marc

    2008-01-01

    Healthcare costs in the USA have continued to rise steadily since the 1980s. Medical errors are one of the major causes of deaths and injuries of thousands of patients every year, contributing to soaring healthcare costs. The purpose of this study is to examine what has been done to deal with the medical-error problem in the last two decades and present a closed-loop mistake-proof operation system for surgery processes that would likely eliminate preventable medical errors. The design method used is a combination of creating a service blueprint, implementing the six sigma DMAIC cycle, developing cause-and-effect diagrams as well as devising poka-yokes in order to develop a robust surgery operation process for a typical US hospital. In the improve phase of the six sigma DMAIC cycle, a number of poka-yoke techniques are introduced to prevent typical medical errors (identified through cause-and-effect diagrams) that may occur in surgery operation processes in US hospitals. It is the authors' assertion that implementing the new service blueprint along with the poka-yokes, will likely result in the current medical error rate to significantly improve to the six-sigma level. Additionally, designing as many redundancies as possible in the delivery of care will help reduce medical errors. Primary healthcare providers should strongly consider investing in adequate doctor and nurse staffing, and improving their education related to the quality of service delivery to minimize clinical errors. This will lead to an increase in higher fixed costs, especially in the shorter time frame. This paper focuses additional attention needed to make a sound technical and business case for implementing six sigma tools to eliminate medical errors that will enable hospital managers to increase their hospital's profitability in the long run and also ensure patient safety.

  13. Avaliação da concordância interobservadores na análise da polipose nasossinusal por meio da tomografia computadorizada Evaluation of the concordance between observers in sinunasal polyposis through computed tomographic analysis

    Directory of Open Access Journals (Sweden)

    Elaine A. Mendes

    2004-08-01

    Full Text Available Polipose nasossinusal (PNS é uma entidade de etiologia controversa, caracterizada por uma condição inflamatória da superfície mucosa das fossas nasais e seios paranasais, bilateralmente. A queixa principal do paciente consiste na obstrução nasal e, ao exame físico, observam-se freqüentemente massas polipóides ocupando as cavidades nasais em extensões variáveis. Além da rinoscopia anterior e da endoscopia nasal, o uso da tomografia computadorizada (TC torna-se necessário para avaliação das fossas nasais e da presença ou não do acometimento dos seios paranasais por essas massas, bem como a sua extensão. Este trabalho tem como objetivo avaliar a concordância interobservadores, por meio da análise da tomografia computadorizada, de 32 casos de PNS. FORMA DE ESTUDO: Clínico prospectivo. CASUÍSTICA E MÉTODOS: Foram avaliadas 32 TC de pacientes portadores PNS por dois observadores experientes, separadamente, em relação à presença ou não de 3 sinais tomográficos sugestivos dessa doença: (1 alargamento infundibular do complexo ostiomeatal, (2 abaulamento lateral da lâmina papirácea e (3 apagamento do trabeculado ósseo etmoidal. RESULTADOS: Observou-se Qui-quadrado não significante para o primeiro e segundo sinais (p=0,7055 e p=0,2057 e significante para o terceiro (p=0,0040. Contudo, o coeficiente de correlação de Kendall entre os dois observadores foi significante para os três sinais tomográficos acima citados (pSinonasal polyposis (SNP is a condition with a controversial aethiology, known by bilaterally inflammatory mucous membranes of nasal and paranasal sinuses. The major patient's complaint is nasal obstruction, and polypoid masses in different sizes can be found during nasal cavity examination. Beyond anterior rhinoscophy and nasal endoscopy, screening sinus computed tomography (SSCT is necessary to measure the size and the extent of the polyps into nasal cavities and paranasal sinuses. The purpose of this

  14. The Relationship Between Ants and Lycaeides melissa samuelis (Lepidoptera: Lycaenidae) at Concord Pine Barrens, NH, USA.

    Science.gov (United States)

    Pascale, Elizabeth G; Thiet, Rachel K

    2016-04-22

    The Karner blue butterfly (Lycaeides melissa samuelis Nabokov) (Lepidoptera: Lycaenidae) is a federally listed, endangered species that has experienced dramatic decline over its historic range. In surviving populations, Karner blue butterflies have a facultative mutualism with ants that could be critically important to their survival where their populations are threatened by habitat loss or disturbance. In this study, we investigated the effects of ants, wild blue lupine population status (native or restored), and fire on adult Karner blue butterfly abundance at the Concord Pine Barrens, NH, USA. Ant frequency (the number of times we collected each ant species in our pitfall traps) was higher in restored than native lupine treatments regardless of burn status during both Karner blue butterfly broods, and the trend was statistically significant during the second brood. We observed a positive relationship between adult Karner blue butterfly abundance and ant frequency during the first brood, particularly on native lupine, regardless of burn treatment. During the second brood, adult Karner blue butterfly abundance and ant frequency were not significantly correlated in any treatments or their combinations. Our findings suggest that a combination of native and restored lupine is important for supporting both Karner blue butterflies and ants at the Concord Pine Barrens, and that burning does not affect the mutualism. Thus, scientists and managers at the site may wish to target their habitat management activities to best support both Karner blue butterflies and the particular ant species that provide the greatest benefit to their survival. © The Authors 2016. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  15. Endometrial cancer with cervical extension mimicking dual concordant endometrial and cervical malignancy by F18 FDG PET and MRI

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Seok Nam [Kwandong Univ. College of Medicine, Seoul (Korea, Republic of)

    2012-09-15

    A 35 year old woman with endometrial cancer and cervical extension underwent F18 FDG PET CT and MRI studies after resection of a cervical mass presumed to be cervical myoma. The patient underwent cervical myomectomy and the histopathologic report revealed poorly differentiated invasive carcinoma. Cervical cancer was ruled out because the patient had no history of sexual intercourse and was negative for human papilloma virus infection. The patient underwent radical hysterectomy, bilateral salpingo oophorectomy, pelvic and para aortic lymph node dissection, and multiple biopsies. F18 FDG PET CT showed intense FDG uptake along the cervix wall. T2 weighted MRI also revealed a mass lesion with high SI involving the anterior and posterior lips of the uterine cervix. Another area of focal increased uptake above the endometrial lesion in the left pelvic cavity was observed on PET CT and MRI, possibly due to a functioning ovary. PET CT and MRI were interpreted as showing a dual concordant malignant lesion due to separated FDG uptakes and high SI without any connection between the cervical and endometrial lesions. F18 FDG PET CT showed intense FDG uptake along the endometrium. Given the patient's history and the fact that she was not menstruating at the time of imaging, this intense uptake was interpreted as another pathologic lesion, suggesting dual primary lesions. A suspected heterogeneous mass lesion along the endometrium suggesting concordant endometrial cancer was found on MRI. Endometrial cancer with cervical extension is sometimes difficult to differentiate from primary cervical cancer. The final histopathologic report showed poorly differentiated endometrial adenocarcinoma with cervical extension, although the FDG PET CT and MRI findings were suggestive of concordant cervical and endometrial cancer. Although histopathologic confirmation is necessary for final diagnosis, MRI and FDG PET CT studies may aid in the differential diagnosis. A metastatic cervical mass

  16. Endometrial cancer with cervical extension mimicking dual concordant endometrial and cervical malignancy by F18 FDG PET and MRI

    International Nuclear Information System (INIS)

    Yoon, Seok Nam

    2012-01-01

    A 35 year old woman with endometrial cancer and cervical extension underwent F18 FDG PET CT and MRI studies after resection of a cervical mass presumed to be cervical myoma. The patient underwent cervical myomectomy and the histopathologic report revealed poorly differentiated invasive carcinoma. Cervical cancer was ruled out because the patient had no history of sexual intercourse and was negative for human papilloma virus infection. The patient underwent radical hysterectomy, bilateral salpingo oophorectomy, pelvic and para aortic lymph node dissection, and multiple biopsies. F18 FDG PET CT showed intense FDG uptake along the cervix wall. T2 weighted MRI also revealed a mass lesion with high SI involving the anterior and posterior lips of the uterine cervix. Another area of focal increased uptake above the endometrial lesion in the left pelvic cavity was observed on PET CT and MRI, possibly due to a functioning ovary. PET CT and MRI were interpreted as showing a dual concordant malignant lesion due to separated FDG uptakes and high SI without any connection between the cervical and endometrial lesions. F18 FDG PET CT showed intense FDG uptake along the endometrium. Given the patient's history and the fact that she was not menstruating at the time of imaging, this intense uptake was interpreted as another pathologic lesion, suggesting dual primary lesions. A suspected heterogeneous mass lesion along the endometrium suggesting concordant endometrial cancer was found on MRI. Endometrial cancer with cervical extension is sometimes difficult to differentiate from primary cervical cancer. The final histopathologic report showed poorly differentiated endometrial adenocarcinoma with cervical extension, although the FDG PET CT and MRI findings were suggestive of concordant cervical and endometrial cancer. Although histopathologic confirmation is necessary for final diagnosis, MRI and FDG PET CT studies may aid in the differential diagnosis. A metastatic cervical mass from

  17. Modelling spatial concordance between Rocky Mountain spotted fever disease incidence and habitat probability of its vector Dermacentor variabilis (American dog tick).

    Science.gov (United States)

    Atkinson, Samuel F; Sarkar, Sahotra; Aviña, Aldo; Schuermann, Jim A; Williamson, Phillip

    2012-11-01

    The spatial distribution of Dermacentor variabilis, the most commonly identified vector of the bacterium Rickettsia rickettsii which causes Rocky Mountain spotted fever (RMSF) in humans, and the spatial distribution of RMSF, have not been previously studied in the south central United States of America, particularly in Texas. From an epidemiological perspective, one would tend to hypothesise that there would be a high degree of spatial concordance between the habitat suitability for the tick and the incidence of the disease. Both maximum-entropy modelling of the tick's habitat suitability and spatially adaptive filters modelling of the human incidence of RMSF disease provide reliable portrayals of the spatial distributions of these phenomenons. Even though rates of human cases of RMSF in Texas and rates of Dermacentor ticks infected with Rickettsia bacteria are both relatively low in Texas, the best data currently available allows a preliminary indication that the assumption of high levels of spatial concordance would not be correct in Texas (Kappa coefficient of agreement = 0.17). It will take substantially more data to provide conclusive findings, and to understand the results reported here, but this study provides an approach to begin understanding the discrepancy.

  18. Modelling spatial concordance between Rocky Mountain spotted fever disease incidence and habitat probability of its vector Dermacentor variabilis (American dog tick

    Directory of Open Access Journals (Sweden)

    Samuel F. Atkinson

    2012-11-01

    Full Text Available The spatial distribution of Dermacentor variabilis, the most commonly identified vector of the bacterium Rickettsia rickettsii which causes Rocky Mountain spotted fever (RMSF in humans, and the spatial distribution of RMSF, have not been previously studied in the south central United States of America, particularly in Texas. From an epidemiological perspective, one would tend to hypothesise that there would be a high degree of spatial concordance between the habitat suitability for the tick and the incidence of the disease. Both maximum-entropy modelling of the tick’s habitat suitability and spatially adaptive filters modelling of the human incidence of RMSF disease provide reliable portrayals of the spatial distributions of these phenomenons. Even though rates of human cases of RMSF in Texas and rates of Dermacentor ticks infected with Rickettsia bacteria are both relatively low in Texas, the best data currently available allows a preliminary indication that the assumption of high levels of spatial concordance would not be correct in Texas (Kappa coefficient of agreement = 0.17. It will take substantially more data to provide conclusive findings, and to understand the results reported here, but this study provides an approach to begin understanding the discrepancy.

  19. Just say "I don't": lack of concordance between teen report and biological measures of drug use.

    Science.gov (United States)

    Delaney-Black, Virginia; Chiodo, Lisa M; Hannigan, John H; Greenwald, Mark K; Janisse, James; Patterson, Grace; Huestis, Marilyn A; Ager, Joel; Sokol, Robert J

    2010-11-01

    Prevalence estimates of illicit drug use by teens are typically generated from confidential or anonymous self-report. While data comparing teen self-report with biological measures are limited, adult studies identify varying degrees of under-reporting. Hair analyses for cocaine, opiates and marijuana were compared to confidential teen self- and parent-reported teen drug use in a longitudinal cohort of >400 high-risk urban teens and parents. Both teens and parents substantially underreported recent teen cocaine and opiate use. However, compared with parents, teens were more likely to deny biomarker-verified cocaine use. Teen specimens (hair) were 52 times more likely to identify cocaine use compared with self-report. Parent hair analyses for cocaine and opiate use were 6.5 times and 5.5 times, respectively, more likely to indicate drug use than were parental self-report. The lack of concordance between self-report and bioassay occurred despite participant's knowledge that a "certificate of confidentiality" protected both teen and adult participants, and that the biological specimens would be tested for drugs. These findings confirm prior reports of adult under-reporting of their own drug use while extending our understanding of teen's self-admitted drug use. The lack of concordance between teen self- or parent-reported teen drug use and biomarkers confirm our concerns that both teen- and parent-reported teen drug use is limited, at least for youth in high-risk urban settings. Methods of ascertainment other than self- or parent-report must be considered when health care providers, researchers and public health agencies attempt to estimate teen drug-use prevalence.

  20. On the heritability of psoriatic arthritis. Disease concordance among monozygotic and dizygotic twins

    DEFF Research Database (Denmark)

    Pedersen, Ole Birger; Svendsen, Anders Jørgen; Ejstrup, Leif

    2008-01-01

    OBJECTIVE: In a nationwide unselected twin population to estimate the relative importance of genetic and environmental effectors in the etiopathogenesis of psoriatic arthritis (PsA). METHODS: The study comprised three Danish nationwide twin cohorts. In 1994 and 2002 a total of 37,388 and 46......,418 Danish twin individuals respectively were asked by questionnaire if they had PsA. Twins reporting PsA were invited to participate in a clinical examination. Patients were classified according to the Moll and Wright (M&W) and the CASPAR criteria. Heritability was estimated by probandwise concordance rates...... and variance component analysis. RESULTS: 228 twin individuals reported PsA. Following diagnostic validation in 184 (81%), 50 probands were diagnosed with PsA according to the M&W criteria. Five of their co-twins were either dead, had emigrated, or did not participate in the twin study and nine did not respond...

  1. Boleslas Matuszewski: Pioneer of medical film-making

    Directory of Open Access Journals (Sweden)

    Matanović Dragana

    2005-01-01

    Full Text Available Boleslas Matuszewski, born in 1856, was a pioneer in medical film-making. He worked simultaneously on improving his movie camera, film-making, collecting film documentation, and the idea of establishing an archive of medical films. Although his first attempts at filming and showing surgical operations didn't gain widespread approval, he was not discouraged, and succeeded in garnering support from a number of French doctors, who realized the importance of his ideas, not only in filming and forming medical film documentation, but also in the use of film for educative purposes. His visionary ideas gained acceptance when Dr. Doyen, on the occasion of the 66th Convention of the British Medical Society, in 1898, used film material as part of his lecture. Shortly afterwards, the Medical Academy took steps to show certain operative techniques, which represented both the confirmation and fruition of Matuszewski's ideas about filmmaking and the establishment of an archive of medical films.

  2. AN IMPACT OF THE EFFICIENT FUNCTIONING OF THE VENTILATION AND AIR-CONDITIONING SYSTEM ON THERMAL COMFORT OF THE MEDICAL STAFF IN THE OPERATING ROOM

    Directory of Open Access Journals (Sweden)

    Tomasz Jankowski

    2016-11-01

    Full Text Available Ventilation and air conditioning systems are necessary for developing proper parameters of indoor envi-ronment in operating rooms. The main task of ventilation and air conditioning in those specific areas consists in creating desirable temperature, reducing the number of microorganisms and the concen-trations of hazardous gases and substances in the air, as well as ensuring the proper direction of airflow. In Poland, indoor environment in operating rooms has to comply with the requirements set out in three regulations (Journal of Laws of 2002 No. 75, item 690, as amended, Journal of Laws of 2002 No. 217, item 1833, Journal of Laws of 2011 No. 31, item 158, as amended and the document entitled "Guidelines for the design of general hospitals". Given insufficient accuracy of the abovementioned national documents, it is a common practice to use foreign standards, i.e. ASHRAE Standard 170-2013, DIN 1946-4: 2008 and FprCEN TR 16244: 2011. When considering the conditions for thermal comfort, it is important to bear in mind a close link between air flow velocity and air temperature. Air in the zone occupied by patients and medical staff must not cause the sensation of draft. Furthermore, air velocity should be sufficient to eliminate interference caused by the presence of people and other sources of heat. It should also reduce the turbulence level in the air in the operating room. Efficient functioning of ventilation and air conditioning was tested during treatments and operations carried out on three wards of a Warsaw hospital. Tests were performed with the participation of medical staff from various surgical units. They were asked to perform minor manual tasks to simulate work on the op-erating table, and to complete a questionnaire on subjective thermal sensation. The applied methodology is widely used during testing of general and local ventilation in public buildings. Air temperature, relative humidity, air flow supply and exhaust air from the

  3. [Clinical usefulness of IDEA and CARS: concordance with DSM-IV-TR in children and adolescents with suspicion of PDD].

    Science.gov (United States)

    García-López, C; Narbona, J

    2014-02-01

    Observational scales are useful to estimate the severity of symptoms in PDD as well as to monitor their evolution. a) To analyze the concordance between diagnoses based on the Autism Spectrum Inventory (Inventario del Espectro Autista, IDEA)) and the Childhood Autism Rating Scale (CARS), compared to DSM-IV-TR criteria, in subjects with a suspicion of pervasive developmental disorders (PDD), and b) to study the discrimination power of both scales to differentiate between a clinical diagnosis situated in the autism spectrum. Fifty-six children and adolescents, between 2 and 20 years-old, who attended our Neuropediatric Unit due to suspicion of PDD. Independently, two clinicians evaluated the presence of PDD symptoms; one of them according to DSM-IV-TR criteria and the other one based on the application of IDEA and CARS. The concordance of IDEA and CARS when compared to DSM-IV-TR classification was 73 and 82%, respectively, with a sensitivity of 1 and 0,83 and a specificity of 0,61 and 0,82, respectively. Both scales correctly discriminated between autistic disorder and other clinical diagnoses. Both IDEA and CARS are useful instruments to detect and monitor autism symptoms in the context of routine clinical practice. Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  4. Concordant association validates MGMT methylation and protein expression as favorable prognostic factors in glioma patients on alkylating chemotherapy (Temozolomide).

    Science.gov (United States)

    Pandith, Arshad A; Qasim, Iqbal; Zahoor, Wani; Shah, Parveen; Bhat, Abdul R; Sanadhya, Dheera; Shah, Zafar A; Naikoo, Niyaz A

    2018-04-30

    O 6 -methylguanine-DNA methyltransferase (MGMT) promoter methylation and its subsequent loss of protein expression has been identified to have a variable impact on clinical outcome of glioma patients indicated for chemotherapy with alkylating agents (Temozolomide). This study investigated methylation status of MGMT gene along with in situ protein expression in malignant glioma patients of different histological types to evaluate the associated clinical outcome vis-a-vis use of alkylating drugs and radiotherapy. Sixty three cases of glioma were evaluated for MGMT promoter methylation by methylation-specific PCR (MS-PCR) and protein expression by immunostaining (IHC). Methylation status of MGMT and loss of protein expression showed a very high concordant association with better survival and progression free survival (PFS) (p < 0.0001). Multivariate Cox regression analysis showed both MGMT methylation and loss of protein as significant independent prognostic factors in glioma patients with respect to lower Hazard Ratio (HR) for better OS and PFS) [p < 0.05]. Interestingly concordant MGMT methylation and lack of protein showed better response in TMZ therapy treated patient subgroups with HR of 2.02 and 0.76 (p < 0.05). We found the merits of prognostication of MGMT parameters, methylation as well as loss of its protein as predictive factors for favorable outcome in terms of better survival for TMZ therapy.

  5. Use of Preclinical Drug vs. Food Choice Procedures to Evaluate Candidate Medications for Cocaine Addiction.

    Science.gov (United States)

    Banks, Matthew L; Hutsell, Blake A; Schwienteck, Kathryn L; Negus, S Stevens

    2015-06-01

    Drug addiction is a disease that manifests as an inappropriate allocation of behavior towards the procurement and use of the abused substance and away from other behaviors that produce more adaptive reinforcers (e.g. exercise, work, family and social relationships). The goal of treating drug addiction is not only to decrease drug-maintained behaviors, but also to promote a reallocation of behavior towards alternative, nondrug reinforcers. Experimental procedures that offer concurrent access to both a drug reinforcer and an alternative, nondrug reinforcer provide a research tool for assessment of medication effects on drug choice and behavioral allocation. Choice procedures are currently the standard in human laboratory research on medications development. Preclinical choice procedures have been utilized in biomedical research since the early 1940's, and during the last 10-15 years, their use for evaluation of medications to treat drug addiction has increased. We propose here that parallel use of choice procedures in preclinical and clinical studies will facilitate translational research on development of medications to treat cocaine addiction. In support of this proposition, a review of the literature suggests strong concordance between preclinical effectiveness of candidate medications to modify cocaine choice in nonhuman primates and rodents and clinical effectiveness of these medications to modify either cocaine choice in human laboratory studies or metrics of cocaine abuse in patients with cocaine use disorder. The strongest evidence for medication effectiveness in preclinical choice studies has been obtained with maintenance on the monoamine releaser d -amphetamine, a candidate agonist medication for cocaine use analogous to use of methadone to treat heroin abuse or nicotine formulations to treat tobacco dependence.

  6. 77 FR 4252 - Additional Spectrum for the Medical Device Radiocommunication Service

    Science.gov (United States)

    2012-01-27

    ... licensed users in these frequency bands to continue providing service. Medical Micro-Power Networks (MMNs...). Under this approach, medical devices would operate in the band on a shared, non-exclusive basis with...Radio Service rules for devices operating in the 413-457 MHz band. These definitions were for a Medical...

  7. [Concordance between hospital prescriptions and recommendations in the treatment of mania].

    Science.gov (United States)

    Laforgue, Edouard-Jules; Bulteau, Samuel; Cholet, Jennyfer; Victorri-Vigneau, Caroline; Guitteny, Marie; Mauduit, Nicolas; Vanelle, Jean-Marie; Sauvaget, Anne

    2017-06-01

    There are differences between recommendations and practice in the pharmacological treatment of acute mania. The objective was to assess conformity of the anti-manic prescription between national recommendations (Haute Autorité de santé [French health authority, HAS] and "résumé des caractéristiques du produit" [product characteristics, RCP]) and clinical practice. We observed the drug prescriptions of in-patients for a manic episode. The main outcome measure was the concordance rate with the recommendations of the drugs prescriptions at the 48th hour. The secondary outcome repeated the same process with the hospital discharge statement of switches, associations, the presence of symptomatic and antidepressant treatments. Sixty-six episodes were included, 40 patients (60%) had a prescription complies with RCP recommendations H48 and 46 patients (70%) to HAS. These rates fall at hospital discharge. Off-label prescriptions, drug combinations and choices of not listed molecules are the most common reasons for non-conformity. Copyright © 2016 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.

  8. A Bayesian estimate of the concordance correlation coefficient with skewed data.

    Science.gov (United States)

    Feng, Dai; Baumgartner, Richard; Svetnik, Vladimir

    2015-01-01

    Concordance correlation coefficient (CCC) is one of the most popular scaled indices used to evaluate agreement. Most commonly, it is used under the assumption that data is normally distributed. This assumption, however, does not apply to skewed data sets. While methods for the estimation of the CCC of skewed data sets have been introduced and studied, the Bayesian approach and its comparison with the previous methods has been lacking. In this study, we propose a Bayesian method for the estimation of the CCC of skewed data sets and compare it with the best method previously investigated. The proposed method has certain advantages. It tends to outperform the best method studied before when the variation of the data is mainly from the random subject effect instead of error. Furthermore, it allows for greater flexibility in application by enabling incorporation of missing data, confounding covariates, and replications, which was not considered previously. The superiority of this new approach is demonstrated using simulation as well as real-life biomarker data sets used in an electroencephalography clinical study. The implementation of the Bayesian method is accessible through the Comprehensive R Archive Network. Copyright © 2015 John Wiley & Sons, Ltd.

  9. Geohydrology and limnology of Walden Pond, Concord, Massachusetts

    Science.gov (United States)

    Colman, John A.; Friesz, Paul J.

    2001-01-01

    The trophic ecology and ground-water contributing area of Walden Pond, in Concord and Lincoln, Mass., were investigated by the U.S. Geological Survey in cooperation with the Massachusetts Department of Environmental Management from April 1997 to July 2000. Bathymetric investigation indicated that Walden Pond (24.88 hectares), a glacial kettle-hole lake with no surface inlet or outlet, has three deep areas. The maximum depth (30.5 meters) essentially was unchanged from measurements made by Henry David Thoreau in 1846. The groundwater contributing area (621,000 square meters) to Walden Pond was determined from water-table contours in areas of stratified glacial deposits and from land-surface contours in areas of bedrock highs. Walden Pond is a flow-through lake: Walden Pond gains water from the aquifer along its eastern perimeter and loses water to the aquifer along its western perimeter. Walden Pond contributing area also includes Goose Pond and its contributing area. A water budget calculated for Walden Pond, expressed as depth of water over the lake surface, indicated that 45 percent of the inflow to the lake was from precipitation (1.215 meters per year) and 55 percent from ground water (1.47 meters per year). The groundwater inflow estimate was based on the average of two different approaches including an isotope mass-balance approach. Evaporation accounted for 26 percent of the outflow from the lake (0.71 meters per year) whereas lake-water seepage to the groundwater system contributed 74 percent of the outflow (1.97 meters per year). The water-residence time of Walden Pond is approximately 5 years. Potential point sources of nutrients to ground water, the Concord municipal landfill and a trailer park, were determined to be outside the Walden Pond groundwater contributing area. A third source, the septic leach field for the Walden Pond State Reservation facilities, was within the groundwater contributing area. Nutrient budgets for the lake indicated that

  10. Medical Imaging Informatics in Nuclear Medicine

    NARCIS (Netherlands)

    van Ooijen, Peter; Glaudemans, Andor W.J.M.; Medema, Jitze; van Zanten, Annie K.; Dierckx, Rudi A.J.O.; Ahaus, C.T.B. (Kees)

    2016-01-01

    Medical imaging informatics is gaining importance in medicine both in clinical practice and in scientific research. Besides radiology, nuclear medicine is also a major stakeholder in medical imaging informatics because of the variety of available imaging modalities and the imaging-oriented operation

  11. Translation, adaptation and validation the contents of the Diabetes Medical Management Plan for the Brazilian context.

    Science.gov (United States)

    Torres, Heloísa de Carvalho; Chaves, Fernanda Figueredo; Silva, Daniel Dutra Romualdo da; Bosco, Adriana Aparecida; Gabriel, Beatriz Diniz; Reis, Ilka Afonso; Rodrigues, Júlia Santos Nunes; Pagano, Adriana Silvina

    2016-08-08

    to translate, adapt and validate the contents of the Diabetes Medical Management Plan for the Brazilian context. This protocol was developed by the American Diabetes Association and guides the procedure of educators for the care of children and adolescents with diabetes in schools. this methodological study was conducted in four stages: initial translation, synthesis of initial translation, back translation and content validation by an expert committee, composed of 94 specialists (29 applied linguists and 65 health professionals), for evaluation of the translated version through an online questionnaire. The concordance level of the judges was calculated based on the Content Validity Index. Data were exported into the R program for statistical analysis. the evaluation of the instrument showed good concordance between the judges of the Health and Applied Linguistics areas, with a mean content validity index of 0.9 and 0.89, respectively, and slight variability of the index between groups (difference of less than 0.01). The items in the translated version, evaluated as unsatisfactory by the judges, were reformulated based on the considerations of the professionals of each group. a Brazilian version of Diabetes Medical Management Plan was constructed, called the Plano de Manejo do Diabetes na Escola. traduzir, adaptar e validar o conteúdo do Diabetes Medical Management Plan para o contexto brasileiro, protocolo elaborado pela Associação Americana de Diabetes, que orienta a conduta dos educadores para o cuidado das crianças e adolescentes com diabetes mellitus nas escolas. trata-se de estudo metodológico, realizado em quatro etapas: tradução inicial, síntese da tradução inicial, retrotradução e validação de conteúdo por um Comitê de Juízes, composto por 94 especialistas (29 linguistas aplicados e 65 profissionais da área da Saúde), para avaliação da versão traduzida por meio de um questionário online. O nível de concordância dos juízes foi

  12. Now and Then: Combat Casualty Care Policies for Operation Iraqi Freedom and Operation Enduring Freedom Compared With Those of Vietnam

    National Research Council Canada - National Science Library

    Cordts, Paul R; Brosch, Laura A; Holcomb, John B

    2008-01-01

    Between December 2004 and June 2007, 13 key Operation Iraqi Freedom/ Operation Enduring Freedom combat casualty care policies were published to inform medical practice in the combat theater of operations...

  13. Diagnoses accuracy in the detection of abnormalities in the thorax x-ray: Teleradiology vs. conventional radiology

    International Nuclear Information System (INIS)

    Moron, Fanny Emilia; Melendez, Patricia; Martinez, Carlos Eli

    1998-01-01

    Background: introduction of teleradiology in Colombia is very recent and its operative characteristics and reliability are unknown. Objective: to evaluate intra and interobserver concordance in the interpretation of digitized chest x-ray films and to compare diagnostic Accuracy of teleradiology and film screen interpretation. Design: cross-sectional study for evaluation or concordance and operative characteristics of a diagnostic test. Patients and methods: convenience sample of 40 chest films. Independent lecture of digitized images for each radiologist to evaluate interobserver concordance: second lecture of digitized images for evaluation of intraobserver concordance. Generation of a gold standard diagnosis with a consensus interpretation of film screens, comparison of operative characteristics of teleradiology and conventional interpretation, using as a reference the gold standard (consensus lectures) and comparison of diagnostic precision using receiver operating characteristics curves (ROC curves). Results: agreements and concordance were significant higher than expected in both evaluations (inter and intraobserver). Sensitivity of teleradiology was similar to sensitivity of film screen interpretation and areas under ROC curves were not statistically different. Conclusions: concordance in the interpretation of chest radiological studies are significant in a teleradiology system and diagnostic utility of teleradiology is the same as conventional film screen interpretation. Accuracy and reliability of teleradiology are optimal

  14. Concordance of health states in couples: Analysis of self-reported, nurse administered and blood-based biomarker data in the UK Understanding Society panel.

    Science.gov (United States)

    Davillas, Apostolos; Pudney, Stephen

    2017-12-01

    We use self-reported health measures, nurse-administered measurements and blood-based biomarkers to examine the concordance between health states of partners in marital/cohabiting relationships in the UK. A model of cumulative health exposures is used to interpret the empirical pattern of between-partner health correlation in relation to elapsed relationship duration, allowing us to distinguish non-causal correlation due to assortative mating from potentially causal effects of shared lifestyle and environmental factors. We find important differences between the results for different health indicators, with strongest homogamy correlations observed for adiposity, followed by blood pressure, heart rate, inflammatory markers and cholesterol, and also self-assessed general health and functional difficulties. We find no evidence of a "dose-response relationship" for marriage duration, and show that this suggests - perhaps counterintuitively - that shared lifestyle factors and homogamous partner selection make roughly equal contributions to the concordance we observe in most of the health measures we examine. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  15. Method for appraising model validity of randomised controlled trials of homeopathic treatment: multi-rater concordance study

    Science.gov (United States)

    2012-01-01

    Background A method for assessing the model validity of randomised controlled trials of homeopathy is needed. To date, only conventional standards for assessing intrinsic bias (internal validity) of trials have been invoked, with little recognition of the special characteristics of homeopathy. We aimed to identify relevant judgmental domains to use in assessing the model validity of homeopathic treatment (MVHT). We define MVHT as the extent to which a homeopathic intervention and the main measure of its outcome, as implemented in a randomised controlled trial (RCT), reflect 'state-of-the-art' homeopathic practice. Methods Using an iterative process, an international group of experts developed a set of six judgmental domains, with associated descriptive criteria. The domains address: (I) the rationale for the choice of the particular homeopathic intervention; (II) the homeopathic principles reflected in the intervention; (III) the extent of homeopathic practitioner input; (IV) the nature of the main outcome measure; (V) the capability of the main outcome measure to detect change; (VI) the length of follow-up to the endpoint of the study. Six papers reporting RCTs of homeopathy of varying design were randomly selected from the literature. A standard form was used to record each assessor's independent response per domain, using the optional verdicts 'Yes', 'Unclear', 'No'. Concordance among the eight verdicts per domain, across all six papers, was evaluated using the kappa (κ) statistic. Results The six judgmental domains enabled MVHT to be assessed with 'fair' to 'almost perfect' concordance in each case. For the six RCTs examined, the method allowed MVHT to be classified overall as 'acceptable' in three, 'unclear' in two, and 'inadequate' in one. Conclusion Future systematic reviews of RCTs in homeopathy should adopt the MVHT method as part of a complete appraisal of trial validity. PMID:22510227

  16. HER2 testing on core needle biopsy specimens from primary breast cancers: interobserver reproducibility and concordance with surgically resected specimens

    International Nuclear Information System (INIS)

    Tsuda, Hitoshi; Kurosumi, Masafumi; Umemura, Shinobu; Yamamoto, Sohei; Kobayashi, Takayuki; Osamura, Robert Yoshiyuki

    2010-01-01

    Accurate evaluation of human epidermal growth factor receptor type-2 (HER2) status based on core needle biopsy (CNB) specimens is mandatory for identification of patients with primary breast cancer who will benefit from primary systemic therapy with trastuzumab. The aim of the present study was to validate the application of HER2 testing with CNB specimens from primary breast cancers in terms of interobserver reproducibility and comparison with surgically resected specimens. A total of 100 pairs of archival formalin-fixed paraffin-embedded CNB and surgically resected specimens of invasive breast carcinomas were cut into sections. All 100 paired sections were subjected to HER2 testing by immunohistochemistry (IHC) and 27 paired sections were subjected to that by fluorescence in situ hybridization (FISH), the results being evaluated by three and two observers, respectively. Interobserver agreement levels in terms of judgment and the concordance of consensus scores between CNB samples and the corresponding surgically resected specimens were estimated as the percentage agreement and κ statistic. In CNB specimens, the percentage interobserver agreement of HER2 scoring by IHC was 76% (κ = 0.71) for 3 × 3 categories (0-1+ versus 2+ versus 3+) and 90% (κ = 0.80) for 2 × 2 categories (0-2+ versus 3+). These levels were close to the corresponding ones for the surgically resected specimens: 80% (κ = 0.77) for 3 × 3 categories and 92% (κ = 0.88) for 2 × 2 categories. Concordance of consensus for HER2 scores determined by IHC between CNB and the corresponding surgical specimens was 87% (κ = 0.77) for 3 × 3 categories, and 94% (κ = 0.83) for 2 × 2 categories. Among the 13 tumors showing discordance in the mean IHC scores between the CNB and surgical specimens, the results of consensus for FISH results were concordant in 11. The rate of successful FISH analysis and the FISH positivity rate in cases with a HER2 IHC score of 2+ differed among specimens processed at

  17. HER2 testing on core needle biopsy specimens from primary breast cancers: interobserver reproducibility and concordance with surgically resected specimens

    Directory of Open Access Journals (Sweden)

    Yamamoto Sohei

    2010-10-01

    Full Text Available Abstract Background Accurate evaluation of human epidermal growth factor receptor type-2 (HER2 status based on core needle biopsy (CNB specimens is mandatory for identification of patients with primary breast cancer who will benefit from primary systemic therapy with trastuzumab. The aim of the present study was to validate the application of HER2 testing with CNB specimens from primary breast cancers in terms of interobserver reproducibility and comparison with surgically resected specimens. Methods A total of 100 pairs of archival formalin-fixed paraffin-embedded CNB and surgically resected specimens of invasive breast carcinomas were cut into sections. All 100 paired sections were subjected to HER2 testing by immunohistochemistry (IHC and 27 paired sections were subjected to that by fluorescence in situ hybridization (FISH, the results being evaluated by three and two observers, respectively. Interobserver agreement levels in terms of judgment and the concordance of consensus scores between CNB samples and the corresponding surgically resected specimens were estimated as the percentage agreement and κ statistic. Results In CNB specimens, the percentage interobserver agreement of HER2 scoring by IHC was 76% (κ = 0.71 for 3 × 3 categories (0-1+ versus 2+ versus 3+ and 90% (κ = 0.80 for 2 × 2 categories (0-2+ versus 3+. These levels were close to the corresponding ones for the surgically resected specimens: 80% (κ = 0.77 for 3 × 3 categories and 92% (κ = 0.88 for 2 × 2 categories. Concordance of consensus for HER2 scores determined by IHC between CNB and the corresponding surgical specimens was 87% (κ = 0.77 for 3 × 3 categories, and 94% (κ = 0.83 for 2 × 2 categories. Among the 13 tumors showing discordance in the mean IHC scores between the CNB and surgical specimens, the results of consensus for FISH results were concordant in 11. The rate of successful FISH analysis and the FISH positivity rate in cases with a HER2 IHC score of

  18. A plea to control medical tourism.

    Science.gov (United States)

    Niechajev, Igor; Frame, James

    2012-02-01

    The growing phenomenon of patients seeking medical procedures abroad (MPA), formerly known as a medical tourism, is discussed. The dark side of the trend is exemplified by the tragic case of a 31-year-old Swedish woman who upon seeing a web advertisement went to Gdansk, Poland, to have breast augmentation. The operation was performed in an old hospital quite different from the modern hospital depicted in the ad. As a result of the grave mistakes in anesthetic care and lack of a postoperative recovery routine, the patient sustained severe brain injury because of prolonged hypoxia. Now, 6 months after the fateful operation, the patient is decorticated and has only vegetative functioning of the left side of the brain. Firm managers, who do not have any medical training, entice patients to believe that the doctors and the facilities abroad have the same technical and safety standards as at home. We question the gap in the law that allows a lay person to screen the candidates for surgery and decide who will operate and in what kind of environment. The trade in human organs is internationally banned but brokering operations on organs goes uncontrolled. Twenty other patients were operated on abroad at different facilities, but all told the same story: lack of adequate postoperative care, unfriendly nursing staff, and the feeling of abandonment upon the return home. The four facets of the ISAPS Patient Safety Diamond--the patient, the procedure, the facility, and the surgeon--are described. ISAPS decided to support the MPA policy with prescreening of the prospective patient, travel and medical insurance for the patient, and surgery abroad, but only if the surgeon is an ISAPS member in a fully accredited facility. This policy will be available first for UK residents who travel abroad for surgery, and later for patients and ISAPS surgeons worldwide. Many plastic surgeons have seen or heard of various tragedies or disasters following medical treatments in foreign countries

  19. INTERFACE ELECTRONIC MEDICAL CARD ON MOBILE DEVICE

    Directory of Open Access Journals (Sweden)

    Y. L. Nechyporenko

    2013-05-01

    Full Text Available The concept designed by electronic medical card for heterogeneous environment of medical information systems at various levels. Appropriate model and technical solution. Done evaluating operating systems for mobile devices. Designed and produced by the project mobile application on Android OS as an electronic medical record on a Tablet PC Acer.

  20. Effective Crew Operations: An Analysis of Technologies for Improving Crew Activities and Medical Procedures

    Science.gov (United States)

    Harvey, Craig

    2005-01-01

    NASA's vision for space exploration (February 2004) calls for development of a new crew exploration vehicle, sustained lunar operations, and human exploration of Mars. To meet the challenges of planned sustained operations as well as the limited communications between Earth and the crew (e.g., Mars exploration), many systems will require crews to operate in an autonomous environment. It has been estimated that once every 2.4 years a major medical issue will occur while in space. NASA's future travels, especially to Mars, will begin to push this timeframe. Therefore, now is the time for investigating technologies and systems that will support crews in these environments. Therefore, this summer two studies were conducted to evaluate the technology and systems that may be used by crews in future missions. The first study evaluated three commercial Indoor Positioning Systems (IPS) (Versus, Ekahau, and Radianse) that can track equipment and people within a facility. While similar to Global Positioning Systems (GPS), the specific technology used is different. Several conclusions can be drawn from the evaluation conducted, but in summary it is clear that none of the systems provides a complete solution in meeting the tracking and technology integration requirements of NASA. From a functional performance (e.g., system meets user needs) evaluation perspective, Versus performed fairly well on all performance measures as compared to Ekahau and Radianse. However, the system only provides tracking at the room level. Thus, Versus does not provide the level of fidelity required for tracking assets or people for NASA requirements. From an engineering implementation perspective, Ekahau is far simpler to implement that the other two systems because of its wi-fi design (e.g., no required runs of cable). By looking at these two perspectives, one finds there was no clear system that met NASA requirements. Thus it would be premature to suggest that any of these systems are ready for