[Pain care in Austrian health care centers: Questionnaire study on the current status of Austrian pain clinics].

Science.gov (United States)

Szilagyi, I-S; Bornemann-Cimenti, H; Messerer, B; Vittinghoff, M; Sandner-Kiesling, A

2015-12-01

Pain clinics provide interdisciplinary therapy to treat chronic pain patients and to increase the return-to-work rate. In recent years and due to increased economic pressure in health care, a change in the management of pain in Austrian health care centers has been observed. For the analysis of the current situation, two surveys addressing all Austrian pain clinics were performed. In total, 133 heads of Austrian Anesthesia Departments were interviewed online and personally. The data from the first interview were confirmed by an additional telephone survey that was performed by one anesthetist per Austrian state (n = 9). Currently, 44 Austrian pain clinics are active. During the last 5 years, 9 pain clinics closed. Adding the current active pain clinics together, they represent a total of 17.5 full-time-operated clinics. The most common reasons for closing the pain clinics were lack of personnel (47%), lack of time resources (26%), lack of space resources (11%), and financial difficulties (11%). A reduction of >50% of operating hours during the last 3 years was reported by 9 hospitals. The reasons for not running a pain clinic were lack of personnel (36%), lack of time (25%) and department too small (16%). Estimates between actual and required clinics indicate that 49.5 full-time-operating pain clinics are lacking in Austria, resulting in 74% of the Austrian chronic pain patients not receiving interdisciplinary pain management. Our survey confirmed the closure of 9 pain clinics during the last 5 years due to lack of personnel and time. Pain clinics appear to provide the simplest economic saving potential. This development is a major concern. Although running a pain clinic seems to be expensive at the first sight, it reduces pain, sick leave, complications, and potential legal issues against health care centers, while simultaneously increasing the hospital's competitiveness. Our results show that 74% of Austrian chronic pain patients do not have access to an

Transient and steady-state currents in epoxy resin

International Nuclear Information System (INIS)

Guillermin, Christophe; Rain, Pascal; Rowe, Stephen W

2006-01-01

Charging and discharging currents have been measured in a diglycidyl ether of bisphenol-A epoxy resin with and without silica fillers, below and above its glass transition temperature T g = 65 deg. C. Both transient and steady-state current densities have been analysed. The average applied fields ranged from 3 to 35 kV mm -1 with a sample thickness of 0.5 mm. Above T g , transient currents suggested a phenomenon of charge injection forming trapped space charges even at low fields. Steady-state currents confirmed that the behaviour was not Ohmic and suggested Schottky-type injection. Below T g , the current is not controlled by the metal-dielectric interface but by the conduction in the volume: the current is Ohmic at low fields and both transient and steady-state currents suggest a phenomenon of space-charge limited currents at high fields. The field threshold is similar in the filler-free and the filled resin. Values in the range 12-17 kV mm -1 have been measured

Transient and steady-state currents in epoxy resin

Energy Technology Data Exchange (ETDEWEB)

Guillermin, Christophe [Schneider Electric Industries S.A.S., 37 quai Paul-Louis Merlin, 38050 Grenoble Cedex 9 (France); Rain, Pascal [Laboratoire d' Electrostatique et de Materiaux Dielectriques (LEMD), CNRS, 25 avenue des Martyrs, 38042 Grenoble Cedex 9 (France); Rowe, Stephen W [Schneider Electric Industries S.A.S., 37 quai Paul-Louis Merlin, 38050 Grenoble Cedex 9 (France)

2006-02-07

Charging and discharging currents have been measured in a diglycidyl ether of bisphenol-A epoxy resin with and without silica fillers, below and above its glass transition temperature T{sub g} = 65 deg. C. Both transient and steady-state current densities have been analysed. The average applied fields ranged from 3 to 35 kV mm{sup -1} with a sample thickness of 0.5 mm. Above T{sub g}, transient currents suggested a phenomenon of charge injection forming trapped space charges even at low fields. Steady-state currents confirmed that the behaviour was not Ohmic and suggested Schottky-type injection. Below T{sub g}, the current is not controlled by the metal-dielectric interface but by the conduction in the volume: the current is Ohmic at low fields and both transient and steady-state currents suggest a phenomenon of space-charge limited currents at high fields. The field threshold is similar in the filler-free and the filled resin. Values in the range 12-17 kV mm{sup -1} have been measured.

The current state of serum biomarkers of hepatotoxicity.

Science.gov (United States)

Ozer, Josef; Ratner, Marcia; Shaw, Martin; Bailey, Wendy; Schomaker, Shelli

2008-03-20

The level of serum alanine aminotransferase (ALT) activity reflects damage to hepatocytes and is considered to be a highly sensitive and fairly specific preclinical and clinical biomarker of hepatotoxicity. However, an increase in serum ALT activity level has also been associated with other organ toxicities, thus, indicating that the enzyme has specificity beyond liver in the absence of correlative histomorphologic alteration in liver. Thus, unidentified non-hepatic sources of serum ALT activity may inadvertently influence the decision of whether to continue development of a novel pharmaceutical compound. To assess the risk of false positives due to extraneous sources of serum ALT activity, additional biomarkers are sought with improved specificity for liver function compared to serum ALT activity alone. Current published biomarker candidates are reviewed herein and compared with ALT performance in preclinical and on occasion, clinical studies. An examination of the current state of hepatotoxic biomarkers indicates that serum F protein, arginase I, and glutathione-S-transferase alpha (GSTalpha) levels, all measured by ELISA, may show utility, however, antibody availability and high cost per run may present limitations to widespread applicability in preclinical safety studies. In contrast, the enzymatic markers sorbitol dehydrogenase, glutamate dehydrogenase, paraxonase, malate dehydrogenase, and purine nucleoside phosphorylase are all readily measured by photometric methods and use reagents that work across preclinical species and humans and are commercially available. The published literature suggests that these markers, once examined collectively in a large qualification study, could provide additional information relative to serum ALT and aspartate aminotransferase (AST) values. Since these biomarkers are found in the serum/plasma of treated humans and rats, they have potential to be utilized as bridging markers to monitor acute drug-induced liver injury in

The current state of serum biomarkers of hepatotoxicity

International Nuclear Information System (INIS)

Ozer, Josef; Ratner, Marcia; Shaw, Martin; Bailey, Wendy; Schomaker, Shelli

2008-01-01

The level of serum alanine aminotransferase (ALT) activity reflects damage to hepatocytes and is considered to be a highly sensitive and fairly specific preclinical and clinical biomarker of hepatotoxicity. However, an increase in serum ALT activity level has also been associated with other organ toxicities, thus, indicating that the enzyme has specificity beyond liver in the absence of correlative histomorphologic alteration in liver. Thus, unidentified non-hepatic sources of serum ALT activity may inadvertently influence the decision of whether to continue development of a novel pharmaceutical compound. To assess the risk of false positives due to extraneous sources of serum ALT activity, additional biomarkers are sought with improved specificity for liver function compared to serum ALT activity alone. Current published biomarker candidates are reviewed herein and compared with ALT performance in preclinical and on occasion, clinical studies. An examination of the current state of hepatotoxic biomarkers indicates that serum F protein, arginase I, and glutathione-S-transferase alpha (GSTα) levels, all measured by ELISA, may show utility, however, antibody availability and high cost per run may present limitations to widespread applicability in preclinical safety studies. In contrast, the enzymatic markers sorbitol dehydrogenase, glutamate dehydrogenase, paraxonase, malate dehydrogenase, and purine nucleoside phosphorylase are all readily measured by photometric methods and use reagents that work across preclinical species and humans and are commercially available. The published literature suggests that these markers, once examined collectively in a large qualification study, could provide additional information relative to serum ALT and aspartate aminotransferase (AST) values. Since these biomarkers are found in the serum/plasma of treated humans and rats, they have potential to be utilized as bridging markers to monitor acute drug-induced liver injury in early

Cognition in epilepsy: current clinical issues of interest.

Science.gov (United States)

Witt, Juri-Alexander; Helmstaedter, Christoph

2017-04-01

This review provides an update and summary of recent neuropsychological findings in epilepsy focusing on three major clinical topics among the many developments in the field. We will critically outline the current state with regard to cognition in new-onset epilepsies, social cognition in epilepsy, and the long-term outcome of epilepsy surgery and the cognitive outcomes of superselective surgical procedures. Current studies indicate that neuropsychological impairments are prevalent already at the onset of epilepsy and even before, social cognition (i.e., emotion recognition and theory of mind) is impaired in different epilepsy populations, the long-term outcome of epilepsy surgery is mostly characterized by a stable or even improved cognitive status, and superselective epilepsy surgeries are associated with a promising neuropsychological outcome. The high prevalence of cognitive deficits around epilepsy onset challenges the assumption that epilepsy is the major cause of cognitive problems and calls for early neuropsychological diagnostics. Social cognition seems to be a relevant domain that is not yet routinely considered in epilepsy. The cognitive long-term outcome of epilepsy surgery is mostly positive. Stereotactic thermocoagulation and gamma knife surgery appear to be cognitively safe procedures.

Deep Venous Thrombosis Prophylaxis in Anterior Cruciate Ligament Reconstructive Surgery: What Is the Current State of Practice?

Science.gov (United States)

Keller, Robert A; Moutzouros, Vasilios; Dines, Joshua S; Bush-Joseph, Charles A; Limpisvasti, Orr

Venous thromboembolism (VTE) is a significant perioperative risk with many common orthopaedic procedures. Currently, there is no standardized recommendation for the use of VTE prophylaxis during anterior cruciate ligament (ACL) reconstruction. This study sought to evaluate the current prophylactic practices of fellowship-trained sports medicine orthopaedic surgeons in the United States. Very few surgeons use perioperative VTE prophylaxis for ACL reconstructive surgery. Survey. Surveys were emailed to the alumni networks of 4 large ACGME-accredited sports medicine fellowship programs. Questions were focused on their current use of chemical and nonchemical VTE prophylaxis. Surveys were completed by 142 surgeons in the United States, yielding a response rate of 32%. Of those who responded, 50.7% stated that they routinely use chemical prophylaxis, with 95.5% of those using aspirin (acetylsalicylic acid [ASA]). There was no standardized dosing protocol, with respondents using ASA 325 mg once (46%) or twice daily (26%) or ASA 81 mg once (18%) or twice (10%) daily. The most common reason for not including chemical prophylaxis within the reconstruction procedure was that it is unnecessary given the low risk of VTE. Physicians also based their prophylaxis regimen more on their own clinical experience than concern for litigation. Half of all sports medicine fellowship-trained surgeons surveyed routinely use chemical VTE prophylaxis after ACL reconstruction, with more than 90% of those using ASA. Of those using ASA, there was no prevailing dosing protocol. For those not using chemical prophylaxis, the most important reason was that it was felt to be unnecessary due to the risks outweighing the benefits. Those who do not regularly use chemical prophylaxis would be willing to, however, if a patient had a personal or family history of clotting disorder or is currently on birth control. Additionally, clinical experience was the primary driver for a current prophylaxis protocol

Current management of obsessive and phobic states

Directory of Open Access Journals (Sweden)

Goljevscek S

2011-09-01

Full Text Available Serena Goljevscek1, Livia A Carvalho21Psychiatric Clinic, University of Udine, Udine, Italy; 2Health Science Research Centre, Department of Life Sciences, Roehampton University, London, UKAbstract: Obsessional states show an average point prevalence of 1%–3% and a lifetime prevalence of 2%–2.5%. Most treatment-seeking patients with obsessions continue to experience significant symptoms after 2 years of prospective follow-up. A significant burden of impairment, distress, and comorbidity characterize the course of the illness, leading to an increased need for a better understanding of the nature and management of this condition. This review aims to give a representation of the current pharmacological and psychotherapeutic strategies used in the treatment of obsessive-compulsive disorder. Antidepressants (clomipramine and selective serotonin reuptake inhibitors are generally the first-line choice used to handle obsessional states, showing good response rates and long-term positive outcomes. About 40% of patients fail to respond to selective serotonin reuptake inhibitors. So far, additional pharmacological treatment strategies have been shown to be effective, ie, administration of high doses of selective serotonin reuptake inhibitors, as well as combinations of different drugs, such as dopamine antagonists, are considered efficacious and well tolerated strategies in terms of symptom remission and side effects. Psychotherapy also plays an important role in the management of obsessive-compulsive disorder, being effective for a wide range of symptoms, and many studies have assessed its long-term efficacy, especially when added to appropriate pharmacotherapy. In this paper, we also give a description of the clinical and psychological features likely to characterize patients refractory to treatment for this illness, with the aim of highlighting the need for greater attention to more patient-oriented management of the disease.Keywords: obsessive

Radiopharmaceuticals - current state and trends

International Nuclear Information System (INIS)

Muenze, R.

1981-07-01

The current state as well as the tendencies of modern radiopharmaceutical development and application is reviewed. After an evaluation of the fundamental preconditions of decay characteristics and pharmaceutical properties the problems concerning sup(99m)Tc-radiopharmaceuticals, metabolizable compounds and the use of specific biological interactions are discussed. (author)

Historical Trust Levels Predict Current Welfare State Design

DEFF Research Database (Denmark)

Bergh, Andreas; Bjørnskov, Christian

Using cross-sectional data for 76 countries, we apply instrumental variable techniques based on pronoun drop, temperature and monarchies to demonstrate that historical trust levels predict several indicators of current welfare state design, including universalism and high levels of regulatory...... freedom. We argue that high levels of trust and trustworthiness are necessary, but not sufficient, conditions for societies to develop successful universal welfare states that would otherwise be highly vulnerable to free riding and fraudulent behavior. Our results do not exclude positive feedback from...... welfare state universalism to individual trust, although we claim that the important causal link runs from historically trust levels to current welfare state design....

Current perceptions of the term Clinical Pharmacy and its relationship to Pharmaceutical Care: a survey of members of the European Society of Clinical Pharmacy.

Science.gov (United States)

Dreischulte, Tobias; Fernandez-Llimos, Fernando

2016-12-01

Background The definitions that are being used for the terms 'clinical pharmacy' and 'pharmaceutical care' seem to have a certain overlap. Responsibility for therapy outcomes seems to be especially linked to the latter term. Both terms need clarification before a proper definition of clinical pharmacy can be drafted. Objective To identify current disagreements regarding the term 'Clinical Pharmacy' and its relationship to 'Pharmaceutical Care' and to assess to which extent pharmacists with an interest in Clinical Pharmacy are willing to accept responsibility for drug therapy outcomes. Setting The membership of the European Society of Clinical Pharmacy. Methods A total of 1,285 individuals affiliated with the European Society of Clinical Pharmacy were invited by email to participate in an online survey asking participants to state whether certain professional activities, providers, settings, aims and general descriptors constituted (a) 'Clinical Pharmacy only', (b) 'Pharmaceutical Care only', (c) 'both' or (d) 'neither'. Further questions examined pharmacists' willingness to accept ethical or legal responsibility for drug therapy outcomes, under current and ideal working conditions. Main outcome measures Level of agreement with a number of statements. Results There was disagreement (responsibility under current/ideal working conditions were: safety (32.7%/64.3%), effectiveness (17.9%/49.2%), patient-centeredness (17.1%/46.2%), cost-effectiveness (20.3%/44.0%). Conclusions The survey identified key disagreements around the term 'Clinical Pharmacy' and its relationship to 'Pharmaceutical Care', which future discussions around a harmonised definition of 'Clinical Pharmacy' should aim to resolve. Further research is required to understand barriers and facilitators to pharmacists accepting responsibility for drug therapy outcomes.

Stemless shoulder arthroplasty: current status.

Science.gov (United States)

Churchill, R Sean

2014-09-01

Since the original Neer humeral replacement in the 1950s, the standard primary anatomic total shoulder arthroplasty design has slowly evolved. Most recently, the humeral stem has become progressively shorter to help combat stem-related complications. Currently, there are several companies who have developed and marketed a stemless humeral arthroplasty component. Manufacturers' data for 5 stemless shoulder arthroplasty components currently on the market were analyzed and reviewed. A literature review of short-term results for stemless shoulder arthroplasty was completed. Of the stemless shoulder arthroplasty systems available on the market, 3 are currently undergoing clinical trials in the United States. The Tornier Simpliciti (Tornier, Edina, MN, USA) clinical trial began in 2011. The study with 2-year minimum follow-up results is scheduled for completion in November 2014. The Arthrex Eclipse (Arthrex, Naples, FL, USA) clinical trial was started in January 2013. The tentative study completion date is 2017. The Biomet Nano (Biomet, Warsaw, IN, USA) clinical trial began in October 2013 and also has a tentative completion date of 2017. No other clinical trial is currently under way in the United States. Early results for stemless shoulder arthroplasty indicate clinical results similar to standard stemmed shoulder arthroplasty. Radiographic analysis indicates implant stability without migration or subsidence at 2- to 3-year minimum follow-up.. Several stemless shoulder arthroplasty implants are available outside the United States. Early clinical and radiographic results are promising, but well-designed clinical studies and midterm results are lacking. Three clinical trials are currently under way in the United States with initial availability for use anticipated in 2015. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

A review of the current state of digital plate reading of cultures in clinical microbiology.

Science.gov (United States)

Rhoads, Daniel D; Novak, Susan M; Pantanowitz, Liron

2015-01-01

Digital plate reading (DPR) is increasingly being adopted as a means to facilitate the analysis and improve the quality and efficiency within the clinical microbiology laboratory. This review discusses the role of DPR in the context of total laboratory automation and explores some of the platforms currently available or in development for digital image capturing of microbial growth on media. The review focuses on the advantages and challenges of DPR. Peer-reviewed studies describing the utility and quality of these novel DPR systems are largely lacking, and professional guidelines for DPR implementation and quality management are needed. Further development and more widespread adoption of DPR is anticipated.

WE-D-BRB-03: Current State of Volumetric Image Guidance for Proton Therapy

Energy Technology Data Exchange (ETDEWEB)

Hua, C. [St. Jude Children’s Research Hospital (United States)

2016-06-15

The goal of this session is to review the physics of proton therapy, treatment planning techniques, and the use of volumetric imaging in proton therapy. The course material covers the physics of proton interaction with matter and physical characteristics of clinical proton beams. It will provide information on proton delivery systems and beam delivery techniques for double scattering (DS), uniform scanning (US), and pencil beam scanning (PBS). The session covers the treatment planning strategies used in DS, US, and PBS for various anatomical sites, methods to address uncertainties in proton therapy and uncertainty mitigation to generate robust treatment plans. It introduces the audience to the current status of image guided proton therapy and clinical applications of CBCT for proton therapy. It outlines the importance of volumetric imaging in proton therapy. Learning Objectives: Gain knowledge in proton therapy physics, and treatment planning for proton therapy including intensity modulated proton therapy. The current state of volumetric image guidance equipment in proton therapy. Clinical applications of CBCT and its advantage over orthogonal imaging for proton therapy. B. Teo, B.K Teo had received travel funds from IBA in 2015.

WE-D-BRB-03: Current State of Volumetric Image Guidance for Proton Therapy

International Nuclear Information System (INIS)

Hua, C.

2016-01-01

The goal of this session is to review the physics of proton therapy, treatment planning techniques, and the use of volumetric imaging in proton therapy. The course material covers the physics of proton interaction with matter and physical characteristics of clinical proton beams. It will provide information on proton delivery systems and beam delivery techniques for double scattering (DS), uniform scanning (US), and pencil beam scanning (PBS). The session covers the treatment planning strategies used in DS, US, and PBS for various anatomical sites, methods to address uncertainties in proton therapy and uncertainty mitigation to generate robust treatment plans. It introduces the audience to the current status of image guided proton therapy and clinical applications of CBCT for proton therapy. It outlines the importance of volumetric imaging in proton therapy. Learning Objectives: Gain knowledge in proton therapy physics, and treatment planning for proton therapy including intensity modulated proton therapy. The current state of volumetric image guidance equipment in proton therapy. Clinical applications of CBCT and its advantage over orthogonal imaging for proton therapy. B. Teo, B.K Teo had received travel funds from IBA in 2015.

Ten years since the discovery of iPS cells: The current state of their clinical application.

Science.gov (United States)

Aznar, J; Tudela, J

On the 10-year anniversary of the discovery of induced pluripotent stem cells, we review the main results from their various fields of application, the obstacles encountered during experimentation and the potential applications in clinical practice. The efficacy of induced pluripotent cells in clinical experimentation can be equated to that of human embryonic stem cells; however, unlike stem cells, induced pluripotent cells do not involve the severe ethical difficulties entailed by the need to destroy human embryos to obtain them. The finding of these cells, which was in its day a true scientific milestone worthy of a Nobel Prize in Medicine, is currently enveloped by light and shadow: high hopes for regenerative medicine versus the, as of yet, poorly controlled risks of unpredictable reactions, both in the processes of dedifferentiation and subsequent differentiation to the cell strains employed for therapeutic or experimentation goals. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

Current State of Craniofacial Prosthetic Rehabilitation

NARCIS (Netherlands)

Ariani, Nina; Visser, Anita; van Oort, Robert P.; Kusdhany, Lindawati; Rahardjo, Tri Budi W.; Krom, Bastiaan P.; van der Mei, Henny C.; Vissink, Arjan

2013-01-01

Purpose: This study aimed to review the current state of the techniques and materials used to rehabilitate maxillofacial defects. Materials and Methods: The MEDLINE and EMBASE databases were searched for articles pertinent to maxillofacial prostheses published from January 1990 to July 2011. The

Rufinamide from clinical trials to clinical practice in the United States and Europe.

Science.gov (United States)

Resnick, Trevor; Arzimanoglou, Alexis; Brown, Lawrence W; Flamini, Robert; Kerr, Michael; Kluger, Gerhard; Kothare, Sanjeev; Philip, Sunny; Harrison, Miranda; Narurkar, Milind

2011-05-01

Rufinamide is a triazole derivative structurally unrelated to other antiepileptic drugs that is indicated for the adjunctive treatment of seizures associated with Lennox-Gastaut syndrome (LGS) in patients aged ≥4 years. Originally granted orphan drug status, marketing authorisation was obtained on the basis of a randomised, double-blind, placebo-controlled trial conducted in 138 LGS patients. An open-label extension study subsequently demonstrated that rufinamide's efficacy and tolerability were maintained over the longer term (median duration of treatment, 432 days). Recently published reports from Europe and the United States have described the use of adjunctive rufinamide to treat LGS in clinical practice. These data complement the clinical trial results, by providing information on the efficacy and tolerability of rufinamide when used on an individualised basis in real-world practice, under less tightly restricted conditions in terms of patient population and dosing strategies. A comparison of the data reveals that a "lower and slower" dosing strategy tends to be adopted in clinical practice, in comparison with the clinical trial, which does not appear to compromise efficacy, but may provide improvements in tolerability. Individual case reports provide additional valuable information on how rufinamide is being used to treat different seizure types associated with LGS. Since clinical experience with rufinamide is currently at an early stage, there are still unanswered questions relating to its use, and it is likely that its place in the adjunctive treatment of LGS will evolve as further data emerge.

Current Guidelines, Common Clinical Pitfalls, and Future Directions for Laboratory Diagnosis of Lyme Disease, United States.

Science.gov (United States)

Moore, Andrew; Nelson, Christina; Molins, Claudia; Mead, Paul; Schriefer, Martin

2016-07-01

In the United States, Lyme disease is caused by Borrelia burgdorferi and transmitted to humans by blacklegged ticks. Patients with an erythema migrans lesion and epidemiologic risk can receive a diagnosis without laboratory testing. For all other patients, laboratory testing is necessary to confirm the diagnosis, but proper interpretation depends on symptoms and timing of illness. The recommended laboratory test in the United States is 2-tiered serologic analysis consisting of an enzyme-linked immunoassay or immunofluorescence assay, followed by reflexive immunoblotting. Sensitivity of 2-tiered testing is low (30%-40%) during early infection while the antibody response is developing (window period). For disseminated Lyme disease, sensitivity is 70%-100%. Specificity is high (>95%) during all stages of disease. Use of other diagnostic tests for Lyme disease is limited. We review the rationale behind current US testing guidelines, appropriate use and interpretation of tests, and recent developments in Lyme disease diagnostics.

Cervical spondylotic myelopathy: the clinical phenomenon and the current pathobiology of an increasingly prevalent and devastating disorder.

Science.gov (United States)

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

2013-08-01

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

High-voltage, high-current, solid-state closing switch

Science.gov (United States)

Focia, Ronald Jeffrey

2017-08-22

A high-voltage, high-current, solid-state closing switch uses a field-effect transistor (e.g., a MOSFET) to trigger a high-voltage stack of thyristors. The switch can have a high hold-off voltage, high current carrying capacity, and high time-rate-of-change of current, di/dt. The fast closing switch can be used in pulsed power applications.

[Current clinical significance of anaerobic bacteremia].

Science.gov (United States)

Jirsa, Roman; Marešová, Veronika; Brož, Zdeněk

2010-10-01

to estimate tje current clinical significance of anaerobic bacteremia in a group of Czech hospitals. this retrospective analysis comprised 8 444 anaerobic blood cultures in patients admitted to four Czech hospitals between 2004 and 2007. in 16 patients, blood cultures yielded significant anaerobic bacteria. Thus, anaerobic bacteremia accounted for less than 2 % of clinically significant bacteremia. Four patients (18 %) died but none of the deaths could be clearly attributable to anaerobic bacteria in the bloodstream. The most common comorbidities predisposing to anaerobic bacteremia and the most frequent sources of infection were similar to those reported by other authors. The majority of anaerobic bacteremia cases were due to gram-negative bacteria, followed by Clostridium perfringens and, surprisingly, Eubacterium spp. (particularly Eubacterium lentum). anaerobic bacteremia remains rare. The comparison of our data with those by other authors suggests that (despite the reported high mortality) the actual clinical significance of anaerobic bacteremia is rather controversial and that the anaerobic bacteremia might not correspond to more serious pathogenic role of the anaerobic bacteria as the source of infection.

Cranial MRI: Current clinical applications

International Nuclear Information System (INIS)

Bradley, W.G. Jr.; Kortman, K.E.

1987-01-01

Human MR images were first published by the Nottingham group in 1980. Since that time, there have been steady improvements in image quality and significant reductions in imaging time. After initial studies by the Hammersmith group in London, investigators at UCSF published studies comparing CT with MR, clearly demonstrating the higher sensitivity of MR to pathologic intracranial processes. Since that time, several investigators have demonstrated the efficacy of MR in the evaluation of a wide range of intracranial pathologic processes, including neoplasms, demyelinating disease, trauma, and congenital abnormalities. In the authors' studies comparing MR with CT in 400 consecutive cases of suspected CNS pathology, MR detected abnormalities which were not seen on CT in 30 percent of these cases. MR has become established as the imaging modality of choice in the evaluation of a broad range of CNS abnormalities and is rapidly being implemented not only at university medical centers but also in community hospitals and free-standing clinics. This chapter deals with fundamental principles of MR image interpretation and provides insight into current clinical indications for MR in intracranial disorders

Customized oligonucleotide microarray gene expression-based classification of neuroblastoma patients outperforms current clinical risk stratification.

Science.gov (United States)

Oberthuer, André; Berthold, Frank; Warnat, Patrick; Hero, Barbara; Kahlert, Yvonne; Spitz, Rüdiger; Ernestus, Karen; König, Rainer; Haas, Stefan; Eils, Roland; Schwab, Manfred; Brors, Benedikt; Westermann, Frank; Fischer, Matthias

2006-11-01

To develop a gene expression-based classifier for neuroblastoma patients that reliably predicts courses of the disease. Two hundred fifty-one neuroblastoma specimens were analyzed using a customized oligonucleotide microarray comprising 10,163 probes for transcripts with differential expression in clinical subgroups of the disease. Subsequently, the prediction analysis for microarrays (PAM) was applied to a first set of patients with maximally divergent clinical courses (n = 77). The classification accuracy was estimated by a complete 10-times-repeated 10-fold cross validation, and a 144-gene predictor was constructed from this set. This classifier's predictive power was evaluated in an independent second set (n = 174) by comparing results of the gene expression-based classification with those of risk stratification systems of current trials from Germany, Japan, and the United States. The first set of patients was accurately predicted by PAM (cross-validated accuracy, 99%). Within the second set, the PAM classifier significantly separated cohorts with distinct courses (3-year event-free survival [EFS] 0.86 +/- 0.03 [favorable; n = 115] v 0.52 +/- 0.07 [unfavorable; n = 59] and 3-year overall survival 0.99 +/- 0.01 v 0.84 +/- 0.05; both P model, the PAM predictor classified patients of the second set more accurately than risk stratification of current trials from Germany, Japan, and the United States (P < .001; hazard ratio, 4.756 [95% CI, 2.544 to 8.893]). Integration of gene expression-based class prediction of neuroblastoma patients may improve risk estimation of current neuroblastoma trials.

Veterinarian-Client Communication Skills: Current State, Relevance, and Opportunities for Improvement.

Science.gov (United States)

McDermott, Michael P; Tischler, Victoria A; Cobb, Malcolm A; Robbé, Iain J; Dean, Rachel S

2015-01-01

Communication is increasingly recognized as a core skill for veterinary practitioners, and in recent years, attention to communication competency and skills training has increased. To gain an up-to-date assessment of the current state of veterinary communication skills and training, we conducted a survey among veterinary practitioners in the United Kingdom and United States in 2012/2013. The questionnaire was used to assess the current state, relevance, and adequacy of veterinary communication skills among veterinary practitioners, to assess interest in further training, and to understand perceived challenges in communicating with clients. There was an overall response rate of 29.6% (1,774 of 6,000 recipients), with a higher response rate for UK-based practitioners (39.7%) than practitioners in the US (19.5%). Ninety-eight percent of respondents agreed that communication skills were as important as or more important than clinical knowledge. Forty-one percent of respondents had received formal veterinary communication skills training during veterinary school, and 47% had received training post-graduation. Thirty-five percent said their veterinary communication skills training during veterinary school prepared them well or very well for communicating with clients about the health of their pets, compared to 61% of those receiving post-graduate training. Forty percent said they would be interested in further veterinary communication skills training, with the preferred methods being simulated consultations and online training. While there has been increased emphasis on communication skills training during and after veterinary school, there is a need for more relevant and accessible training.

[Mixed affective states in the juvenile age (historical aspects, current state of the problem, psychopathology)].

Science.gov (United States)

Kopeĭko, G I

2011-01-01

The author analyzed the problem in historical, diagnostic and psychopathological aspects and presented the results of his own study. The aim was to study the structure and dynamics of endogenous juvenile mixed states in order to work out the psychopathological typology and to clarify the criteria of diagnosis, differential treatment and clinical-social prognosis. The study included 174 patients, 118 men and 56 women, aged from 17 to 25 years (mean age 20, 4 years). Depressive states were found in 65%, mania in 16% and mixed in 19% of patients. The clinical differentiation of mixed states was carried out basing on the dominating pole of affective disorders and the following types were singled out and described: mania type (dysphoria-like mania)--34%, depressive type (association-driven depression)--38%; alternating type of mixed states--28%. The preference of the formation of alternating and atypical variants of mixed states in the juvenile age demonstrated in the study may reflect the pathogenetic and pathoplastic effect of biological features characteristic of this age--lability and polymorphism of clinical presentations as well as immaturity of emotional and cognitive spheres.

Tri-State Current Source Inverter With Improved Dynamic Performance

DEFF Research Database (Denmark)

Blaabjerg, Frede; Loh, Poh Chiang; Wong, Chow Pang

2008-01-01

Traditional dc-ac current source inverter (CSI) has a right-half-plane (RHP) zero in its control-to-output transfer function. This RHP zero causes the inverter output to fall before rising when a step increase in command reference is required (commonly known as non-minimum-phase effect). To achieve...... a better dynamic response, this paper proposes the design of a tri-state CSI using only an additional semiconductor switch for introducing unique freewheeling states to the traditional six active and three null states of a CSI. With the freewheeling states inserted appropriately within the inverter state...... sequence, the inductive boosting and discharging intervals can be decoupled, allowing the RHP zero to be eliminated with only minor circuit modifications (high level control schemes like predictive and multiloop voltage/current control remain unchanged). The designed inverter can be controlled using...

Current clinical evidence on pioglitazone pharmacogenomics

Directory of Open Access Journals (Sweden)

Marina eKawaguchi-Suzuki

2013-11-01

Full Text Available Pioglitazone is the most widely used thiazolidinedione and acts as an insulin-sensitizer through activation of the Peroxisome Proliferator-Activated Receptor-γ (PPARγ. Pioglitazone is approved for use in the management of type 2 diabetes mellitus, but its use in other therapeutic areas is increasing due to pleiotropic effects. In this hypothesis article, the current clinical evidence on pioglitazone pharmacogenomics is summarized and related to variability in pioglitazone response. How genetic variation in the human genome affects the pharmacokinetics and pharmacodynamics of pioglitazone was examined. For pharmacodynamic effects, hypoglycemic and anti-atherosclerotic effects, risks of fracture or edema, and the increase in body mass index in response to pioglitazone based on genotype were examined. The genes CYP2C8 and PPARG are the most extensively studied to date and selected polymorphisms contribute to respective variability in pioglitazone pharmacokinetics and pharmacodynamics. We hypothesized that genetic variation in pioglitazone pathway genes contributes meaningfully to the clinically observed variability in drug response. To test the hypothesis that genetic variation in PPARG associates with variability in pioglitazone response, we conducted a meta-analysis to synthesize the currently available data on the PPARG p.Pro12Ala polymorphism. The results showed that PPARG 12Ala carriers had a more favorable change in fasting blood glucose from baseline as compared to patients with the wild-type Pro12Pro genotype (p=0.018. Unfortunately, findings for many other genes lack replication in independent cohorts to confirm association; further studies are needed. Also, the biological functionality of these polymorphisms is unknown. Based on current evidence, we propose that pharmacogenomics may provide an important tool to individualize pioglitazone therapy and better optimize therapy in patients with T2DM or other conditions for which pioglitazone

Current clinical approach to patients with disorders of consciousness

Directory of Open Access Journals (Sweden)

Robson Luis Oliveira de Amorim

Full Text Available Summary In clinical practice, hospital admission of patients with altered level of consciousness, sleepy or in a non-responsive state is extremely common. This clinical condition requires an effective investigation and early treatment. Performing a focused and objective evaluation is critical, with quality history taking and physical examination capable to locate the lesion and define conducts. Imaging and laboratory exams have played an increasingly important role in supporting clinical research. In this review, the main types of changes in consciousness are discussed as well as the essential points that should be evaluated in the clinical management of these patients.

Is current clinical practice modified about intraoperative breast irradiation?

Science.gov (United States)

Massa, Michela; Franchelli, Simonetta; Panizza, Renzo; Massa, Tiberio

2016-04-01

After the results obtained in the two randomized clinical trial, the ELIOT trial and the TARGIT-A trial, a heated debate is going on concerning the question of applying intraoperative radiotherapy (IORT) instead of postoperative whole breast irradiation (WBI) after breast conservative treatment. Currently, many centers are applying the IORT following the strict selection criteria dictated by the working groups American Society for Radiation Oncology (ASTRO) and Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) and monitoring the oncological outcome together with radiation toxicity on breast tissue. The clinical experience of the Geneva University Hospital regarding the use of the Intrabeam system is evaluated and compared with current evidences.

Licensed pertussis vaccines in the United States: History and current state

OpenAIRE

Klein, Nicola P

2014-01-01

The United States switched from whole cell to acellular pertussis vaccines in the 1990s following global concerns with the safety of the whole cell vaccines. Despite high levels of acellular pertussis vaccine coverage, the United States and other countries are experiencing large pertussis outbreaks. The aim of this article is to describe the historical context which led to acellular pertussis vaccine development, focusing on vaccines currently licensed in the US, and to review evidence that w...

Preparing nursing students for enhanced roles in primary care: The current state of prelicensure and RN-to-BSN education.

Science.gov (United States)

Wojnar, Danuta M; Whelan, Ellen Marie

With the current emphasis on including registered nurses (RNs) on the primary care teams, it is essential that nursing programs prepare students for employment in these settings. This study explored the current state of prelicensure and RN-to-Bachelor of Science in Nursing (BSN) online education regarding the implementation of primary care content in the curricula. A sample of 1,409 schools and/or colleges from across the United States was invited to participate in an online survey. About 529 surveys were returned for an overall response rate of 37.5%. Summative content analysis was used to analyze survey data. Although most respondents have implemented some primary care content, some found it challenging and others have demurred from incorporating primary care content altogether. Nursing leaders and faculty in academia must collaborate with clinical partners to design and expand didactic and clinical learning experiences that emphasize primary care content in the prelicensure and RN-to-BSN education. Copyright © 2016 Elsevier Inc. All rights reserved.

Current therapeutic interventions in the glycation pathway: evidence from clinical studies.

Science.gov (United States)

Engelen, L; Stehouwer, C D A; Schalkwijk, C G

2013-08-01

The increased formation of advanced glycation endproducts (AGEs) constitutes a potential mechanism of hyperglycaemia-induced micro- and macrovascular disease in diabetes. In vitro and animal experiments have shown that various interventions can inhibit formation and/or actions of AGEs, in particular the specific AGE inhibitor aminoguanidine and the AGEs crosslink breaker alagebrium, and the B vitamins pyridoxamine and thiamine, and the latter's synthetic derivative, benfotiamine. The potential clinical value of these interventions, however, remains to be established. The present review provides, from the clinical point of view, an overview of current evidence on interventions in the glycation pathway relating to (i) the clinical benefits of specific AGE inhibitors and AGE breakers and (ii) the potential AGE-inhibiting effects of therapies developed for purposes unrelated to the glycation pathway. We found that safety and/or efficacy in clinical studies with the specific AGE inhibitor, aminoguanidine and the AGE breaker, alagebrium, appeared to be a concern. The clinical evidence on the potential AGE-inhibiting effects of B vitamins is still limited. Finally, current evidence for AGE inhibition by therapies developed for purposes unrelated to glycation is limited due to a large heterogeneity in study designs and/or measurement techniques, which have often been sub-optimal. We conclude that, clinical evidence on interventions to inhibit formation and/or action of AGEs is currently weak and unconvincing. © 2012 Blackwell Publishing Ltd.

Limiting stable states of high-Tc superconductors in the alternating current modes

International Nuclear Information System (INIS)

Romanovskii, V.R.; Watanabe, K.; Awaji, S.

2014-01-01

The limiting current-carrying capacity of high-T c superconductor and superconducting tape has been studied in the alternating current states. The features that are responsible for their stable formation have been investigated under the conduction-cooled conditions when the operating peak values of the electric field and the current may essentially exceed the corresponding critical values of superconductor. Besides, it has been proved that these peak values are higher than the values of the electric field and the current, which lead to the thermal runaway phenomenon when the current instability onset occurs in the operating modes with direct current. As a result, the stable extremely high heat generation exists in these operating states, which can be called as overloaded states. The limiting stable peak values of charged currents and stability conditions have been determined taking into account the flux creep states of superconductors. The analysis performed has revealed that there exist characteristic times defining the corresponding time windows in the stable development of overloaded states of the alternating current. In order to explain their existence, the basic thermo-electrodynamics mechanisms have been formulated, which have allowed to explain the high stable values of the temperature and the induced electric field before the onset of alternating current instability. In general, it has been shown that the high-T c superconductors may stably operate in the overloaded alternating current states even under the not intensive cooling conditions at a very high level of heat generation, which is not considered in the existing theory of losses. (authors)

Mineralized Collagen: Rationale, Current Status, and Clinical Applications

Directory of Open Access Journals (Sweden)

Zhi-Ye Qiu

2015-07-01

Full Text Available This paper presents a review of the rationale for the in vitro mineralization process, preparation methods, and clinical applications of mineralized collagen. The rationale for natural mineralized collagen and the related mineralization process has been investigated for decades. Based on the understanding of natural mineralized collagen and its formation process, many attempts have been made to prepare biomimetic materials that resemble natural mineralized collagen in both composition and structure. To date, a number of bone substitute materials have been developed based on the principles of mineralized collagen, and some of them have been commercialized and approved by regulatory agencies. The clinical outcomes of mineralized collagen are of significance to advance the evaluation and improvement of related medical device products. Some representative clinical cases have been reported, and there are more clinical applications and long-term follow-ups that currently being performed by many research groups.

Introducing nuclear power into currently non-nuclear states

International Nuclear Information System (INIS)

Claassen, Gert

2007-01-01

As the nuclear renaissance gains momentum, many countries that currently have no nuclear power plants will begin to consider introducing them. It is anticipated that smaller reactors such as the Pebble Bed Modulator Reactor (PBMR) will not only be sold to current nuclear states to also to states where there is currently no nuclear experience. A range of issues would have to be considered for nuclear plants to be solid to non-nuclear states, such as the appropriate regulatory environment, standardization and codes, non-proliferation, security of supply, obtaining experienced merchant operators, appropriate financial structures and education and training. The paper considers nine major issues that need to be addressed by governments and vendors alike. International cooperation by organisations such as the IAEA, financial institutions and international suppliers will be required to ensure that developing countries as well as developed ones share the benefits of the nuclear renaissance. The opportunities that the nuclear industry affords to develop local skills, create job opportunities and to develop local manufacturing industries are among the important reasons that the South African Government has decided to support and fund the development of the Pebble Bed Modular Reactor project. These considerations are included in the paper. (author)

Licensed pertussis vaccines in the United States. History and current state.

Science.gov (United States)

Klein, Nicola P

2014-01-01

The United States switched from whole cell to acellular pertussis vaccines in the 1990s following global concerns with the safety of the whole cell vaccines. Despite high levels of acellular pertussis vaccine coverage, the United States and other countries are experiencing large pertussis outbreaks. The aim of this article is to describe the historical context which led to acellular pertussis vaccine development, focusing on vaccines currently licensed in the US, and to review evidence that waning protection following licensed acellular pertussis vaccines have been significant factors in the widespread reappearance of pertussis.

RETAIL BANKING BUSINESS: CURRENT STATE ANDSPECIFIC FEATURES

Directory of Open Access Journals (Sweden)

Гузель Рефкадовна Фаизова

2013-04-01

Full Text Available The role and importance of the retail banking business in the banking sector continueto grow. The current state of the retail banking business is considered and specific features of this area in the face of growing demand for banking products and services by the public and interest from lending institutions are identified by the article.Purpose: Research of current state of retail banking business and detection specific features of this area.Methodology: In the process of analysis and researchof the question the methods of economical and statistical analysis, methods of comparison and generalizationwereused.Results: The conclusion is that interest in the retail banking business continues to grow.There were revealed the role and the importance of standardized service processes and standardized products and services delivering as one of the main line of development in the segment of retail business.DOI: http://dx.doi.org/10.12731/2218-7405-2013-3-2

CpG Methylation Analysis—Current Status of Clinical Assays and Potential Applications in Molecular Diagnostics

Science.gov (United States)

Sepulveda, Antonia R.; Jones, Dan; Ogino, Shuji; Samowitz, Wade; Gulley, Margaret L.; Edwards, Robin; Levenson, Victor; Pratt, Victoria M.; Yang, Bin; Nafa, Khedoudja; Yan, Liying; Vitazka, Patrick

2009-01-01

Methylation of CpG islands in gene promoter regions is a major molecular mechanism of gene silencing and underlies both cancer development and progression. In molecular oncology, testing for the CpG methylation of tissue DNA has emerged as a clinically useful tool for tumor detection, outcome prediction, and treatment selection, as well as for assessing the efficacy of treatment with the use of demethylating agents and monitoring for tumor recurrence. In addition, because CpG methylation occurs early in pre-neoplastic tissues, methylation tests may be useful as markers of cancer risk in patients with either infectious or inflammatory conditions. The Methylation Working Group of the Clinical Practice Committee of the Association of Molecular Pathology has reviewed the current state of clinical testing in this area. We report here our summary of both the advantages and disadvantages of various methods, as well as the needs for standardization and reporting. We then conclude by summarizing the most promising areas for future clinical testing in cancer molecular diagnostics. PMID:19541921

Clinical exome sequencing reports: current informatics practice and future opportunities.

Science.gov (United States)

Swaminathan, Rajeswari; Huang, Yungui; Astbury, Caroline; Fitzgerald-Butt, Sara; Miller, Katherine; Cole, Justin; Bartlett, Christopher; Lin, Simon

2017-11-01

The increased adoption of clinical whole exome sequencing (WES) has improved the diagnostic yield for patients with complex genetic conditions. However, the informatics practice for handling information contained in whole exome reports is still in its infancy, as evidenced by the lack of a common vocabulary within clinical sequencing reports generated across genetic laboratories. Genetic testing results are mostly transmitted using portable document format, which can make secondary analysis and data extraction challenging. This paper reviews a sample of clinical exome reports generated by Clinical Laboratory Improvement Amendments-certified genetic testing laboratories at tertiary-care facilities to assess and identify common data elements. Like structured radiology reports, which enable faster information retrieval and reuse, structuring genetic information within clinical WES reports would help facilitate integration of genetic information into electronic health records and enable retrospective research on the clinical utility of WES. We identify elements listed as mandatory according to practice guidelines but are currently missing from some of the clinical reports, which might help to organize the data when stored within structured databases. We also highlight elements, such as patient consent, that, although they do not appear within any of the current reports, may help in interpreting some of the information within the reports. Integrating genetic and clinical information would assist the adoption of personalized medicine for improved patient care and outcomes. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Introducing nuclear power into currently non-nuclear states

International Nuclear Information System (INIS)

Gert, Claassen

2007-01-01

As the nuclear renaissance gains momentum, many countries that currently have no nuclear power plants will begin to consider introducing them. It is anticipated that smaller reactors such as the Pebble Bed Modular Reactor (PBMR) will not only be sold to current nuclear states to also to states where there is currently no nuclear experience. A range of issues would have to be considered for nuclear plants to be sold to non-nuclear states, such as the appropriate regulatory environment, standardization and codes, non-proliferation, security of supply, obtaining experienced merchant operators, appropriate financial structures and education and training. The paper considers nine major issues that need to be addressed by governments and vendors alike: 1) political enabling framework, 2) regulatory framework, 3) responsible owner, 4) responsible operator, 5) finance, 6) contact management, 7) fuel supply and waste management framework, 8) training and education, and 9) industrial infrastructure. International cooperation by organisations such as the IAEA, financial institutions and international suppliers will be required to ensure that developing countries as well as developed ones share the benefits of the nuclear renaissance. The opportunities that the nuclear industry affords to develop local skills, create job opportunities and to develop local manufacturing industries are among the important reasons that the South African Government has decided to support and fund the development of the Pebble Bed Modular Reactor project. (author)

Current Status of Operation and Management of Dental School Clinics.

Science.gov (United States)

Reinhardt, John W

2017-08-01

This article summarizes the current status of the operation and management of dental school clinics as schools strive to provide excellent patient-centered care in an environment that is educationally sound, efficient, and financially strong. Clinical education is a large component of dental education and an area in which many dental schools have an opportunity to enhance revenue. Clinical efficiencies and alternative models of clinical education are evolving in U.S. dental schools, and this article describes some of those evolutionary changes. This article was written as part of the project "Advancing Dental Education in the 21 st Century."

Rectocele repair using biomaterial augmentation: current documentation and clinical experience.

Science.gov (United States)

Altman, Daniel; Mellgren, Anders; Zetterström, Jan

2005-11-01

Although the etiology of rectocele remains debated, surgical innovations are currently promoted to improve anatomic outcome while avoiding dyspareunia and alleviating rectal emptying difficulties following rectocele surgery. Use of biomaterials in rectocele repair has become widespread in a short time, but the clinical documentation of their effectiveness and complications is limited. Medline and the Cochrane database were searched electronically from 1964 to May 2005 using the Pubmed and Ovid search engines. All English language publications including any of the search terms "rectocele," "implant," "mesh," "biomaterial," "prolapse," "synthetical," "pelvic floor," "biological," and "compatibility" were reviewed. This review outlines the basic principles for use of biomaterials in pelvic reconstructive surgery and provides a condensation of peer-reviewed articles describing clinical use of biomaterials in rectocele surgery. Historical and new concepts in rectocele surgery are discussed. Factors of importance for human in vivo biomaterial compatibility are presented together with current knowledge from clinical studies. Potential risks and problems associated with the use of biomaterials in rectocele and pelvic reconstructive surgery in general are described. Although use of biomaterials in rectocele and other pelvic organ prolapse surgery offers exciting possibilities, it raises treatment costs and may be associated with unknown and potentially severe complications at short and long term. Clinical benefits are currently unknown and need to be proven in clinical studies. Obstetricians & Gynecologists, Family Physicians After completion of this article, the reader should be able to explain that the objective of surgical treatment is to improve anatomic outcome and alleviate rectal emptying difficulties, describe the efficacy of biomaterials in rectocele repair, and summarize the potential risks and problems associated with use of biomaterials in rectocele and pelvic

Single-electron states near a current-carrying core

International Nuclear Information System (INIS)

Masale, M.

2004-01-01

The energy spectrum of an electron confined near a current-carrying core is obtained as a function of the azimuthal applied magnetic field within the effective-mass approximation. The double degeneracy of the non-zero electron's axial wave number (k z ) states is lifted by the current-induced magnetic field while that of the non-zero azimuthal quantum number (m) states is preserved. A further analysis is the evaluations of the oscillator strengths for optical transitions involving the lowest-order pair of the electron's energy subbands within the dipole approximation. The radiation field is taken as that of elliptically polarized light incident along the core axis. In this polarization and within the dipole approximation, the allowed transitions are only those governed by the following specific selection rules. The azimuthal quantum numbers of the initial and final states must differ by unity while the electron's axial wave number is conserved. The azimuthal magnetic field is also found to lift the multiple degeneracies of the k z ≠0 interaction integrals as well as those of the oscillator strengths for optical transitions

Tuning of tunneling current noise spectra singularities by localized states charging

OpenAIRE

Mantsevich, V. N.; Maslova, N. S.

2008-01-01

We report the results of theoretical investigations of tunneling current noise spectra in a wide range of applied bias voltage. Localized states of individual impurity atoms play an important role in tunneling current noise formation. It was found that switching "on" and "off" of Coulomb interaction of conduction electrons with two charged localized states results in power law singularity of low-frequency tunneling current noise spectrum ($1/f^{\\alpha}$) and also results on high frequency com...

Current state about the cuaternary knowledge of Uruguay

International Nuclear Information System (INIS)

Anton, D; Goso, H.

1974-01-01

This work is about current state of cuaternary knowledge Uruguayan. It is considered that the cuaternary presented a change from the hot and dry weather of the Pliocene to more humid and colder weather in Uruguay.

Treatment of sepsis: current status of clinical immunotherapy.

LENUS (Irish Health Repository)

O'Callaghan, A

2012-02-03

While antibiotics address the root cause of sepsis--that of pathogen infection--they fail to provide an adequate cure for the condition. Currently, 30% to 50% of septic patients die, and this figure is likely to increase in line with the proliferation of multi-drug resistant bacteria. With an increased understanding of the immune response, it has been proposed that modulation of this defence mechanism offers the best hope of cure. Many entry-points in the immune system have been identified and targeted therapies have been developed,but why are these not in routine clinical practice? This review examines the latest evidence for the use of immuno-modulating drugs, obtained from human clinical trials. We discuss cytokine-based therapies, steroids and anti-coagulants. Finally, consideration is given as to why successful therapies in the laboratory, and in vivo models, do not automatically translate into clinical benefit

Translating state-of-the-art spinal cord MRI techniques to clinical use: A systematic review of clinical studies utilizing DTI, MT, MWF, MRS, and fMRI

Directory of Open Access Journals (Sweden)

Allan R. Martin

2016-01-01

Conclusions: State-of-the-art spinal cord MRI techniques are emerging with great potential to improve the diagnosis and management of various spinal pathologies, but the current body of evidence has only showed limited clinical utility to date. Among these imaging tools DTI is the most mature, but further work is necessary to standardize and validate its use before it will be adopted in the clinical realm. Large, well-designed studies with a priori hypotheses, standardized acquisition methods, detailed clinical data collection, and robust automated analysis techniques are needed to fully demonstrate the potential of these rapidly evolving techniques.

Challenges of implementing fibromyalgia treatment guidelines in current clinical practice.

Science.gov (United States)

Arnold, Lesley M; Clauw, Daniel J

2017-09-01

The current diagnostic and treatment pathway for patients with fibromyalgia (FM) is lengthy, complex, and characterized by multiple physician visits with an average 2-year wait until diagnosis. It is clear that effective identification and appropriate treatment of FM remain a challenge in current clinical practice. Ideally, FM management involves a multidisciplinary approach with the preferable patient pathway originating in primary care but supported by a range of health care providers, including referral to specialist care when necessary. After the publication of individual clinical studies, high-quality reviews, and meta-analyses, recently published FM treatment guidelines have transitioned from an expert consensus to an evidence-based approach. Evidence-based guidelines provide a framework for ensuring early diagnosis and timely adoption of appropriate treatment. However, for successful outcomes, FM treatments must adopt a more holistic approach, which addresses more than just pain. Impact on the associated symptoms of fatigue and cognitive problems, sleep and mood disturbances, and lowered functional status are also important in judging the success of FM therapy. Recently published guidelines recommend the adoption of a symptom-based approach to guide pharmacologic treatment. Emerging treatment options for FM may be best differentiated on the basis of their effect on comorbid symptoms that are often associated with pain (e.g. sleep disturbance, mood, fatigue). The current review discusses the most recently published Canadian guidelines and the implications of the recent European League Against Rheumatism (EULAR) recommendations, with a focus on the challenges of implementing these guidelines in current clinical practice.

Application of radiotherapy for hepatocellular carcinoma in current clinical practice guidelines

Energy Technology Data Exchange (ETDEWEB)

Rim, Chai Hong; Seong, Jin Sil [Dept. of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (Korea, Republic of)

2016-09-15

In oncologic practice, treatment guidelines provide appropriate treatment strategies based on evidence. Currently, many guidelines are used, including those of the European Association for the Study of the Liver and European Organization for Research and Treatment of Cancer (EASL-EORTC), National Comprehensive Cancer Network (NCCN), Asia-Pacific Primary Liver Cancer Expert (APPLE), and Korean Liver Cancer Study Group and National Cancer Centre (KLCSG-NCC). Although radiotherapy is commonly used in clinical practice, some guidelines do not accept it as a standard treatment modality. In this review, we will investigate the clinical practice guidelines currently used, and discuss the application of radiotherapy.

Application of radiotherapy for hepatocellular carcinoma in current clinical practice guidelines

International Nuclear Information System (INIS)

Rim, Chai Hong; Seong, Jin Sil

2016-01-01

In oncologic practice, treatment guidelines provide appropriate treatment strategies based on evidence. Currently, many guidelines are used, including those of the European Association for the Study of the Liver and European Organization for Research and Treatment of Cancer (EASL-EORTC), National Comprehensive Cancer Network (NCCN), Asia-Pacific Primary Liver Cancer Expert (APPLE), and Korean Liver Cancer Study Group and National Cancer Centre (KLCSG-NCC). Although radiotherapy is commonly used in clinical practice, some guidelines do not accept it as a standard treatment modality. In this review, we will investigate the clinical practice guidelines currently used, and discuss the application of radiotherapy

Consensus of best current management: the starting point for clinical quality assessment

International Nuclear Information System (INIS)

Hanks, G.E.; Kramer, S.

1984-01-01

Consensus of best current management developed by a rational and deliberative process can provide the basis for clinical quality assessment. When it is possible to arrive at consensus in a specific disease, this consensus should detail appropriate pretreatment evaluation and the details of the treatment. Committees of experts for each specific disease site can formulate the consensus and must document their decision based on information from the current world literature. The authors have observed that individuals formulating consensus of best current management do not strictly follow their own criteria, and that compliance in various strata of practice throughout the United States shows a greater deviation from consensus than anticipated and indeed this deviation crosses all types of practice. The authors have observed quite different outcomes for two groups of patients with Hodgkin's disease treated with the same processes (i.e., mantle field technology and adequate radiation dose, etc.). They were unable to identify the reason for an increased failure rate in one group of these patients until they looked at each individual mantle port film from the two groups of patients. They identified that one facility was not including the Hodgkin's disease in the treatment portal due to poor technical performance. This program of process verification may be important in evaluating quality for any disease site

Standardization of calibration of clinic dosemeters using electric currents and charges

International Nuclear Information System (INIS)

Peres, Marcos Antonio de Lima

1999-09-01

Clinical dosimeters used in radiotherapy are calibrated in Latin American countries, including Brazil, as a complete 'system, i.e., ionization chamber and electrometer together. Some countries, as European ones, and USA calibrate them by component, i.e., ionisation chamber apart from electrometer. This method is more advantageous than the previous one, since it makes possible the automation of the calibration process, allowing the acquisition of data related to the chamber and the electrometer measurements independently, as well as the substitution of one of the components, in case of failure. This work proposes a method for standardisation of low intensity electric charge and currents in order to implement electric calibration of electrometers. This will make possible the implementation of a by components calibration technique, by components, of clinical dosimeters in Brazil. The results obtained with the calibration by components prove that the proposed method of standardisation of low electric charges and currents is viable. The difficulties found for the generation and measurement of low intensity electric charges and currents and the procedures adopted for the calibration by components are presented. Additionally, a current source was built to yield reference electric charges that will make possible the quality control clinical dosimeters. This source will also allow the user to identify the defective components of the dosimeters, through a simple verification test. (author)

Adherence to clinic recommendations among patients with phenylketonuria in the United States.

Science.gov (United States)

Jurecki, E R; Cederbaum, S; Kopesky, J; Perry, K; Rohr, F; Sanchez-Valle, A; Viau, K S; Sheinin, M Y; Cohen-Pfeffer, J L

2017-03-01

Assess current management practices of phenylketonuria (PKU) clinics across the United States (US) based on the key treatment metrics of blood phenylalanine (Phe) concentrations and blood Phe testing frequency, as well as patient adherence to their clinic's management practice recommendations. An online survey was conducted with medical professionals from PKU clinics across the US from July to September 2015. Forty-four clinics participated in the survey and account for approximately half of PKU patients currently followed in clinics in the US (Berry et al., 2013). The majority of PKU clinics recommended target blood Phe concentrations to be between 120 and 360μM for all patients; the upper threshold was relaxed by some clinics for adult patients (from 360 to 600μM) and tightened for patients who are pregnant/planning to become pregnant (to 240μM). Patient adherence to these recommendations (percentage of patients with blood Phe below the upper recommended threshold) was age-dependent, decreasing from 88% in the 0-4years age group to 33% in adults 30+ years. Patient adherence to recommendations for blood testing frequency followed a similar trend. Higher staffing intensity (specialists per 100 PKU patients) was associated with better patient adherence to clinics' blood Phe concentrations recommendations. Clinic recommendations of target blood Phe concentrations in the US are now stricter compared to prior years, and largely reflect recent guidelines by the American College of Medical Genetics and Genomics (Vockley et al., 2014). Adherence to recommended Phe concentrations remains suboptimal, especially in older patients. However, despite remaining above the guidelines, actual blood Phe concentrations in adolescents and adults are lower than those reported in the past (Walter et al., 2002; Freehauf et al., 2013). Continued education and support for PKU patients by healthcare professionals, including adequate clinic staffing, are needed to improve adherence

A Systematic Review of Wearable Systems for Cancer Detection: Current State and Challenges.

Science.gov (United States)

Ray, Partha Pratim; Dash, Dinesh; De, Debashis

2017-10-02

Rapid growth of sensor and computing platforms have introduced the wearable systems. In recent years, wearable systems have led to new applications across all medical fields. The aim of this review is to present current state-of-the-art approach in the field of wearable system based cancer detection and identify key challenges that resist it from clinical adoption. A total of 472 records were screened and 11 were finally included in this study. Two types of records were studied in this context that includes 45% research articles and 55% manufactured products. The review was performed per PRISMA guidelines where considerations was given to records that were published or reported between 2009 and 2017. The identified records included 4 cancer detecting wearable systems such as breast cancer (36.3%), skin cancer (36.3%), prostate cancer (18.1%), and multi-type cancer (9%). Most works involved sensor based smart systems comprising of microcontroller, Bluetooth module, and smart phone. Few demonstrated Ultra-Wide Band (i.e. UWB) antenna based wearable systems. Skin cancer detecting wearable systems were most comprehensible ones. The current works are gradually progressing with seamless integration of sensory units along with smart networking. However, they lack in cloud computing and long-range communication paradigms. Artificial intelligence and machine learning are key ports that need to be attached with current wearable systems. Further, clinical inertia, lack of awareness, and high cost are altogether pulling back the actual growth of such system. It is well comprehended that upon sincere orientation of all identified challenges, wearable systems would emerge as vital alternative to futuristic cancer detection.

The current state of science in radiation protection

International Nuclear Information System (INIS)

Kaul, A.

1985-01-01

The qualification 'according to the current state of science and technology' is regularly found in radiation protection laws. It is assumed that the state of science and technology is codified in the publications of ICRP and ICRU, the International Comissions on Radiological Protection and - Units respectively, and in the UN publication USCEAR. An investigation is made on the extent the regulations of FRD comply with this requirement. Stochastic and non-stochastic damages are differentiated and the problem of assigning equivalent whole-body doses to exposures of specific body organs is considered. (G.Q.)

Possession States: Approaches to Clinical Evaluation and Classification

Directory of Open Access Journals (Sweden)

S. McCormick

1992-01-01

Full Text Available The fields of anthropology and sociology have produced a large quantity of literature on possession states, physicians however rarely report on such phenomena. As a result clinical description of possession states has suffered, even though these states may be more common and less deviant than supposed. Both ICD-10 and DSM-IV may include specific criteria for possession disorders. The authors briefly review Western notions about possession and kindred states and present guidelines for evaluation and classification.

Finite element model predicts current density distribution for clinical applications of tDCS and tACS

Directory of Open Access Journals (Sweden)

Toralf eNeuling

2012-09-01

Full Text Available Transcranial direct current stimulation (tDCS has been applied in numerous scientific studies over the past decade. However, the possibility to apply tDCS in therapy of neuropsychiatric disorders is still debated. While transcranial magnetic stimulation (TMS has been approved for treatment of major depression in the United States by the Food and Drug Administration (FDA, tDCS is not as widely accepted. One of the criticisms against tDCS is the lack of spatial specificity. Focality is limited by the electrode size (35 cm2 are commonly used and the bipolar arrangement. However, a current flow through the head directly from anode to cathode is an outdated view. Finite element (FE models have recently been used to predict the exact current flow during tDCS. These simulations have demonstrated that the current flow depends on tissue shape and conductivity. Toface the challenge to predict the location, magnitude and direction of the current flow induced by tDCS and transcranial alternating current stimulation (tACS, we used a refined realistic FE modeling approach. With respect to the literature on clinical tDCS and tACS, we analyzed two common setups for the location of the stimulation electrodes which target the frontal lobe and the occipital lobe, respectively. We compared lateral and medial electrode configuration with regard to theirusability. We were able to demonstrate that the lateral configurations yielded more focused stimulation areas as well as higher current intensities in the target areas. The high resolution of our simulation allows one to combine the modeled current flow with the knowledge of neuronal orientation to predict the consequences of tDCS and tACS. Our results not only offer a basis for a deeper understanding of the stimulation sites currently in use for clinical applications but also offer a better interpretation of observed effects.

The Current Mental State of School Students in Online Learning Conditions

Directory of Open Access Journals (Sweden)

Kovalevskaya E.V.,

2015-08-01

Full Text Available This article discusses the results of a study of actual mental state of high school students who are active subjects of career self-determination in terms of interactive learning. There are four groups of methods of interactive training: psychological training, art therapy, cognitive, and game training. The main task, which is solved by a researcher in a formative experiment with the use of each of these methods, is to establish significant differences in health, activity and mood as the indicators of current mental state of students in the classroom. As a result, we found that the most significant improvements in the current mental state takes place when using art and game therapy, so these techniques should be used in groups of students with low motivation to work, as well as in the adverse psychological climate. Less significant was the improvement of the current mental state after psychological training due to the fact that this method allow to update and seek solutions to the most important intrapersonal issues and require the implementation of a deeper reflection

Current educational issues in the clinical neurosciences.

Science.gov (United States)

Desbiens, R; Elleker, M G; Goldsand, G; Hugenholtz, H; Puddester, D; Toyota, B; Findlay, J M

2001-11-01

Canadian training in the clinical neurosciences, neurology and neurosurgery, faces significant challenges. New balances are being set by residents, their associations and the Royal College of Physicians and Surgeons of Canada between clinical service, education and personal time. The nature of hospital-provided medical service has changed significantly over the past decade, impacting importantly on resident training. Finally, future manpower needs are of concern, especially in the field of neurosurgery, where it appears that soon more specialists will be trained than can be absorbed into the Canadian health care system. A special symposium on current challenges in clinical neuroscience training was held at the Canadian Congress of Neurological Sciences in June 2000. Representatives from the Canadian Association of Interns and Residents, the Royal College of Physicians and Surgeons of Canada and English and French neurology and neurosurgery training programs made presentations, which are summarized in this report. Residency training has become less service-oriented, and this trend will continue. In order to manage the increasingly sophisticated hospital services of neurology and neurosurgery, resident-alternatives in the form of physician "moonlighters" or more permanent hospital-based clinicians or "hospitalists" will be necessary in order to operate major neuroclinical units. Health authorities and hospitals will need to recognize and assume this responsibility. As clinical experience diminishes during residency training, inevitably so will the concept of the fully competent "generalist" at the end of specialty training. Additional subspecialty training is being increasingly sought by graduates, particularly in neurosurgery. Training in neurology and neurosurgery, as in all medical specialties, has changed significantly in recent years and continues to change. Programs and hospitals need to adapt to these changes in order to ensure the production of fully

Ebola hemorrhagic Fever and the current state of vaccine development.

Science.gov (United States)

Hong, Joo Eun; Hong, Kee-Jong; Choi, Woo Young; Lee, Won-Ja; Choi, Yeon Hwa; Jeong, Chung-Hyeon; Cho, Kwang-Il

2014-12-01

Current Ebola virus outbreak in West Africa already reached the total number of 1,323 including 729 deaths by July 31st. the fatality is around 55% in the southeastern area of Guinea, Sierra Leone, Liberia, and Nigeria. The number of patients with Ebola Hemorrhagic Fever (EHF) was continuously increasing even though the any effective therapeutics or vaccines has not been developed yet. The Ebola virus in Guinea showed 98% homology with Zaire Ebola Virus. Study of the pathogenesis of Ebola virus infection and assess of the various candidates of vaccine have been tried for a long time, especially in United States and some European countries. Even though the attenuated live vaccine and DNA vaccine containing Ebola viral genes were tested and showed efficacy in chimpanzees, those candidates still need clinical tests requiring much longer time than the preclinical development to be approved for the practical treatment. It can be expected to eradicate Ebola virus by a safe and efficient vaccine development similar to the case of smallpox virus which was extinguished from the world by the variola vaccine.

Current irritability robustly related to current and prior anxiety in bipolar disorder.

Science.gov (United States)

Yuen, Laura D; Miller, Shefali; Wang, Po W; Hooshmand, Farnaz; Holtzman, Jessica N; Goffin, Kathryn C; Shah, Saloni; Ketter, Terence A

2016-08-01

Although current irritability and current/prior anxiety have been associated in unipolar depression, these relationships are less well understood in bipolar disorder (BD). We investigated relationships between current irritability and current/prior anxiety as well as other current emotions and BD illness characteristics. Outpatients referred to the Stanford Bipolar Disorders Clinic during 2000-2011 were assessed with the Systematic Treatment Enhancement Program for BD (STEP-BD) Affective Disorders Evaluation. Prevalence and clinical correlates of current irritability and current/prior anxiety and other illness characteristics were examined. Among 497 BD outpatients (239 Type I, 258 Type II; 58.1% female; mean ± SD age 35.6 ± 13.1 years), 301 (60.6%) had baseline current irritability. Patients with versus without current irritability had significantly higher rates of current anxiety (77.1% versus 42.9%, p anxiety disorder (73.1% versus 52.6%, p anxiety than to current anhedonia, sadness, or euphoria (all p anxiety associations persisted across current predominant mood states. Current irritability was more robustly related to past anxiety than to all other assessed illness characteristics, including 1° family history of mood disorder, history of alcohol/substance use disorder, bipolar subtype, and current syndromal/subsyndromal depression (all p anxiety. Further studies are warranted to assess longitudinal clinical implications of relationships between irritability and anxiety in BD. Copyright © 2016 Elsevier Ltd. All rights reserved.

The Current State of Predicting Furrow Irrigation Erosion

Science.gov (United States)

There continues to be a need to predict furrow irrigation erosion to estimate on- and off-site impacts of irrigation management. The objective of this paper is to review the current state of furrow erosion prediction technology considering four models: SISL, WEPP, WinSRFR and APEX. SISL is an empiri...

Coherent current states in mesoscopic four-terminal Josephson junction

International Nuclear Information System (INIS)

Zareyan, M.; Omelyanchouk, A.N.

1999-01-01

A theory is offered for the ballistic 4-terminal Josephson junction. The studied system consist of a mesoscopic two-dimensional normal rectangular layer which is attached on each side to the bulk superconducting banks (terminals). A relation is obtained between the currents through the different terminals, that is valid for arbitrary temperatures and junction sizes. The nonlocal coupling of the supercurrent leads to a new effect, specific for the mesoscopic weak link between two superconducting rings; an applied magnetic flux through one of the rings produces a magnetic flux in the other ring even in the absence of an external flux through the other one. The phase dependent distributions of the local density of Andreev states, of the supercurrents and of the induced order parameter are obtained. The 'interference pattern' for the anomalous average inside the two-dimensional region cam be regulated by the applied magnetic fluxes or the transport currents. For some values of the phase differences between the terminals, the current vortex state and two-dimensional phase slip center appear

A Review of Clinical Data for Currently Approved Hysteroscopic Sterilization Procedures

Science.gov (United States)

Basinski, Cindy M

2010-01-01

Two hysteroscopic permanent sterilization procedures are approved for use in the United States: Essure® Permanent Birth Control System (Conceptus Incorporated, Mountain View, CA) and Adiana® Permanent Contraception (Hologic, Inc., Bedford, MA). This review compares the clinical trial data for these procedures. A notable difference is the resultant clinical pregnancy risk. The clinical trials for the Essure procedure have reported no pregnancies in 643 relying women in the 9 years since initiation of the studies. The clinical trial for the Adiana procedure has reported 12 pregnancies in 570 relying women in nearly 5 years of collected data. Other clinical outcome parameters concerning Essure and Adiana are examined in this review. PMID:21364861

The influence of current mood state, number of previous affective episodes and predominant polarity on insight in bipolar disorder.

Science.gov (United States)

de Assis da Silva, Rafael; Mograbi, Daniel C; Camelo, Evelyn Vieira Miranda; Peixoto, Ursula; Santana, Cristina Maria Teixeira; Landeira-Fernandez, Jesus; Morris, Robin G; Cheniaux, Elie

2017-11-01

Although many studies have explored the effect of current affective episodes on insight into bipolar disorder, the potential interaction between current mood state and previous affective episodes has not been consistently investigated. To explore the influence of dominant polarity, number of previous affective episodes and current affective state on insight in bipolar disorder patients in euthymia or mania. A total of 101 patients with bipolar disorder were recruited for the study, including 58 patients in euthymia (30 with no defined predominant polarity and 28 with manic predominant polarity) and 43 in mania (26 with no defined predominant polarity and 17 with manic predominant polarity). Patients underwent a clinical assessment and insight was evaluated through the Insight Scale for Affective Disorders. Bipolar disorder patients in mania had worse insight than those in euthymia, with no effect of dominant polarity. In addition, positive psychotic symptoms showed a significant effect on insight and its inclusion as a covariate eliminated differences related to mood state. Finally, the number of previous manic or depressive episodes did not correlate with insight level. Mania is a predictor of loss of insight into bipolar disorder. However, it is possible that its contribution is linked to the more frequent presence of psychotic symptoms in this state. Dominant polarity and number/type of previous affective episodes have a limited impact on insight.

42 CFR 457.80 - Current State child health insurance coverage and coordination.

Science.gov (United States)

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Current State child health insurance coverage and... HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES Introduction; State Plans for Child Health Insurance Programs and Outreach Strategies...

The Path to Advanced Practice Licensure for Clinical Nurse Specialists in Washington State.

Science.gov (United States)

Schoonover, Heather

The aim of this study was to provide a review of the history and process to obtaining advanced practice licensure for clinical nurse specialists in Washington State. Before 2016, Washington State licensed certified nurse practitioners, certified nurse midwives, and certified nurse anesthetists under the designation of an advanced registered nurse practitioner; however, the state did not recognize clinical nurse specialists as advanced practice nurses. The work to drive the rule change began in 2007. The Washington Affiliate of the National Association of Clinical Nurse Specialists used the Power Elite Theory to guide advocacy activities, building coalitions and support for the desired rule changes. On January 8, 2016, the Washington State Nursing Care Quality Assurance Commission voted to amend the state's advanced practice rules, including clinical nurse specialists in the designation of an advanced practice nurse. Since the rule revision, clinical nurse specialists in Washington State have been granted advanced registered nurse practitioner licenses. Driving changes in state regulatory rules requires diligent advocacy, partnership, and a deep understanding of the state's rule-making processes. To be successful in changing rules, clinical nurse specialists must build strong partnerships with key influencers and understand the steps in practice required to make the desired changes.

Physical therapists' perceptions of sexual boundaries in clinical practice in the United States.

Science.gov (United States)

Roush, Susan E; Cox, Kenneth; Garlick, John; Kane, Molly; Marchand, Lauren

2015-07-01

Physical therapists' perceptions of sexual boundaries in clinic settings in the United States have not been studied. Given the magnitude of potential consequences of sexual boundary violations, examination of this topic is imperative. The purpose of this study was to describe the perceptions of sexual boundaries among licensed physical therapists in the United States. Licensed physical therapists from Arkansas, Kansas, Maine, Ohio, and Oregon were contacted by email and asked to complete a sexual boundaries questionnaire via Survey Monkey™; 967 surveys (7.3%) were returned. While most physical therapists practice within the profession's Code of Ethics, there are practitioners who date current and former patients, and condone patients' sexual banter in the clinic. Almost half (42%) of the participants acknowledged feeling sexually attracted to a patient. While gender differences were seen throughout the analyses, generally, the demographic and professional variables did not account for meaningful variance. Results were similar to previous research on physiotherapists in other countries. Sexuality is part of the physical therapy practice environment and physical therapists' understanding of sexual boundaries is ambiguous. These data can inform professional conversation on sexual boundaries in physical therapy practice leading to greater understanding and decreased potential for violations.

Clinical Research with Transcranial Direct Current Stimulation (tDCS): Challenges and Future Directions

Science.gov (United States)

Brunoni, Andre Russowsky; Nitsche, Michael A.; Bolognini, Nadia; Bikson, Marom; Wagner, Tim; Merabet, Lotfi; Edwards, Dylan J.; Valero-Cabre, Antoni; Rotenberg, Alexander; Pascual-Leone, Alvaro; Ferrucci, Roberta; Priori, Alberto; Boggio, Paulo; Fregni, Felipe

2011-01-01

Background Transcranial direct current stimulation (tDCS) is a neuromodulatory technique that delivers low-intensity, direct current to cortical areas facilitating or inhibiting spontaneous neuronal activity. In the past ten years, tDCS physiological mechanisms of action have been intensively investigated giving support for the investigation of its applications in clinical neuropsychiatry and rehabilitation. However, new methodological, ethical, and regulatory issues emerge when translating the findings of preclinical and phase I studies into phase II and III clinical studies. The aim of this comprehensive review is to discuss the key challenges of this process and possible methods to address them. Methods We convened a workgroup of researchers in the field to review, discuss and provide updates and key challenges of neuromodulation use for clinical research. Main Findings/Discussion We reviewed several basic and clinical studies in the field and identified potential limitations, taking into account the particularities of the technique. We review and discuss the findings into four topics: (i) mechanisms of action of tDCS, parameters of use and computer-based human brain modeling investigating electric current fields and magnitude induced by tDCS; (ii) methodological aspects related to the clinical research of tDCS as divided according to study phase (i.e., preclinical, phase I, phase II and phase III studies); (iii) ethical and regulatory concerns; (iv) future directions regarding novel approaches, novel devices, and future studies involving tDCS. Finally, we propose some alternative methods to facilitate clinical research on tDCS. PMID:22037126

THE CURRENT STATE OF CLOTHING TRADE IN THE BALKAN COUNTRIES

OpenAIRE

TRIPA Simona; CUC Sunhilde; YALDIZ Suleyman

2017-01-01

The study presented here is aimed at analysing the current state of clothing trade in the Balkan states. The dynamics of change over a 15‐year period following economic reforms are revealed. The clothing industries play a significant role and continue to contribute to the economic prosperity of countries with an inexpensive labour force. For most Balkan States clothing’s export plays an important role in promoting economic growth and development – for example, exports of garments Albania was ...

Islet cell transplant: Update on current clinical trials

Science.gov (United States)

Schuetz, Christian; Markmann, James F.

2016-01-01

In the last 15 years clinical islet transplantation has made the leap from experimental procedure to standard of care for a highly selective group of patients. Due to a risk-benefit calculation involving the required systemic immunosuppression the procedure is only considered in patients with type 1 diabetes, complicated by severe hypoglycemia or end stage renal disease. In this review we summarize current outcomes of the procedure and take a look at ongoing and future improvements and refinements of beta cell therapy. PMID:28451515

Developing genomic knowledge bases and databases to support clinical management: current perspectives.

Science.gov (United States)

Huser, Vojtech; Sincan, Murat; Cimino, James J

2014-01-01

Personalized medicine, the ability to tailor diagnostic and treatment decisions for individual patients, is seen as the evolution of modern medicine. We characterize here the informatics resources available today or envisioned in the near future that can support clinical interpretation of genomic test results. We assume a clinical sequencing scenario (germline whole-exome sequencing) in which a clinical specialist, such as an endocrinologist, needs to tailor patient management decisions within his or her specialty (targeted findings) but relies on a genetic counselor to interpret off-target incidental findings. We characterize the genomic input data and list various types of knowledge bases that provide genomic knowledge for generating clinical decision support. We highlight the need for patient-level databases with detailed lifelong phenotype content in addition to genotype data and provide a list of recommendations for personalized medicine knowledge bases and databases. We conclude that no single knowledge base can currently support all aspects of personalized recommendations and that consolidation of several current resources into larger, more dynamic and collaborative knowledge bases may offer a future path forward.

Multiday Transcranial Direct Current Stimulation Causes Clinically Insignificant Changes in Childhood Dystonia: A Pilot Study.

Science.gov (United States)

Bhanpuri, Nasir H; Bertucco, Matteo; Young, Scott J; Lee, Annie A; Sanger, Terence D

2015-10-01

Abnormal motor cortex activity is common in dystonia. Cathodal transcranial direct current stimulation may alter cortical activity by decreasing excitability while anodal stimulation may increase motor learning. Previous results showed that a single session of cathodal transcranial direct current stimulation can improve symptoms in childhood dystonia. Here we performed a 5-day, sham-controlled, double-blind, crossover study, where we measured tracking and muscle overflow in a myocontrol-based task. We applied cathodal and anodal transcranial direct current stimulation (2 mA, 9 minutes per day). For cathodal transcranial direct current stimulation (7 participants), 3 subjects showed improvements whereas 2 showed worsening in overflow or tracking error. The effect size was small (about 1% of maximum voluntary contraction) and not clinically meaningful. For anodal transcranial direct current stimulation (6 participants), none showed improvement, whereas 5 showed worsening. Thus, multiday cathodal transcranial direct current stimulation reduced symptoms in some children but not to a clinically meaningful extent, whereas anodal transcranial direct current stimulation worsened symptoms. Our results do not support transcranial direct current stimulation as clinically viable for treating childhood dystonia. © The Author(s) 2015.

A cross-cultural comparison of clinical supervision in South Korea and the United States.

Science.gov (United States)

Son, Eunjung; Ellis, Michael V

2013-06-01

We investigated similarities and differences in clinical supervision in two cultures: South Korea and the United States The study had two parts: (1) a test of the cross-cultural equivalence of four supervision measures; and (2) a test of two competing models of cultural differences in the relations among supervisory style, role difficulties, supervisory working alliance, and satisfaction with supervision. Participants were 191 South Korean and 187 U.S. supervisees currently engaged in clinical supervision. The U.S. measures demonstrated sufficient measurement equivalence for use in South Korea. Cultural differences moderated the relations among supervisory styles, role difficulties, supervisory working alliance, and supervision satisfaction. Specifically, the relations among these variables were significantly stronger for U.S. than for South Korean supervisees. Implications for theory, research, and practice were discussed.

[Pathological gambling and computergame-addiction. Current state of research regarding two subtypes of behavioural addiction].

Science.gov (United States)

Wölfling, K; Müller, K W

2010-04-01

Behavioral addictions, like pathological gambling and computer game addiction (or internet addiction), have become a growing concern in research and public interest. Currently similarities between behavioral addictions and substance dependency are controversially discussed in the scientific community. Unfortunately a mismatch exists between the large number of people seeking treatment and the small number of scientific studies on pathological gambling and computer game addiction. Prevalence of pathological gambling among the German population is estimated to be 0.2-0.5%. These estimations are comparable to prevalence rates reported for drug dependency. Latest research states that about 3% of German adolescents and young adults are believed to suffer from computer game addiction. Therefore, it is important to enhance investigations regarding the clinical and neuroscientific basis of computer game addiction. This review offers a summary of current results of research regarding pathological gambling and internet addiction. The phenomenological description of these two disorders is meant to allow a deeper understanding of behavioral addictions.

The Development and Current State of Translation Process Research

DEFF Research Database (Denmark)

Lykke Jakobsen, Arnt

2014-01-01

The development and current state of translation process research ch Arnt Lykke Jakobsen Copenhagen Business School lInterest in process-oriented translation studies has been intense for the past almost half a century. Translation process research (TPR) is the label we have used to refer to a spe...... itself, into regions like cognitive psychology, psycho- and neurolinguistics, and neuroscience, where the interest in what goes on in our heads is also very strong.......The development and current state of translation process research ch Arnt Lykke Jakobsen Copenhagen Business School lInterest in process-oriented translation studies has been intense for the past almost half a century. Translation process research (TPR) is the label we have used to refer...... which simultaneously tracks the translator’s eye movements across a screen displaying both a source text and the translator’s emerging translation. This research method was developed as a means of qualifying and strengthening translation process hypotheses based on verbal reports by providing additional...

Clinical proteomics-driven precision medicine for targeted cancer therapy: current overview and future perspectives.

Science.gov (United States)

Zhou, Li; Wang, Kui; Li, Qifu; Nice, Edouard C; Zhang, Haiyuan; Huang, Canhua

2016-01-01

Cancer is a common disease that is a leading cause of death worldwide. Currently, early detection and novel therapeutic strategies are urgently needed for more effective management of cancer. Importantly, protein profiling using clinical proteomic strategies, with spectacular sensitivity and precision, offer excellent promise for the identification of potential biomarkers that would direct the development of targeted therapeutic anticancer drugs for precision medicine. In particular, clinical sample sources, including tumor tissues and body fluids (blood, feces, urine and saliva), have been widely investigated using modern high-throughput mass spectrometry-based proteomic approaches combined with bioinformatic analysis, to pursue the possibilities of precision medicine for targeted cancer therapy. Discussed in this review are the current advantages and limitations of clinical proteomics, the available strategies of clinical proteomics for the management of precision medicine, as well as the challenges and future perspectives of clinical proteomics-driven precision medicine for targeted cancer therapy.

OSTEOARTHRITIS: CURRENT CLINICAL CONCEPT AND SOME PROMISING THERAPEUTIC APPROACHES

Directory of Open Access Journals (Sweden)

A. E. Karateev

2018-01-01

Full Text Available In recent years, there has been a trend toward changing the clinical concept of osteoarthritis (OA. This disease has been considered as an age-related disease and the long-term result of a current pathological process for a very long time. However, many experts are now inclined to consider it necessary to identify the early, pre-X-ray stage of OA, when adequate treatment may not only halt the progression, but also achieve the regression of joint structural changes. This review deals with a number of pathogenetic and clinical aspects of the early stages of OA, which are important for timely diagnosis and pathogenetic therapy choice. It also considers some therapeutic approaches, both a "classic" and recently actively discussed methods for using platelet-rich plasma and autologous chondrocyte transplantation.

[The current state and prospectives of military endocrinology].

Science.gov (United States)

Nagibovich, O A; Golota, A S; Krassiĭ, A B

2014-10-01

The article is dedicated to the current state and prospectives of military endocrinology demonstrated on the examples of the endocrinology services of armed forces of Serbia, Poland, France, and USA. It is shown that this branch of military healthcare receives much attention abroad. The prospectives of military endocrinology are demonstrated in the context of two nosological forms which dominate in this section of military medicine, namely, primary hypothyroidism an diabetes mellitus.

Effectiveness of the current method of calculating member states' contributions

CERN Document Server

2002-01-01

At its Two-hundred and eighty-sixth Meeting of 19 September 2001, the Finance Committee requested the Management to re-assess the effectiveness of the current method of forecasting Net National Income (NNI) for the purposes of calculating the Member States' contributions by comparing the results of the current weighted average method with a method based on a simple arithmetic average. The Finance Committee is invited to take note of this information.

High ion charge states in a high-current, short-pulse, vacuum ARC ion sources

International Nuclear Information System (INIS)

Anders, A.; Brown, I.; MacGill, R.; Dickinson, M.

1996-01-01

Ions of the cathode material are formed at vacuum arc cathode spots and extracted by a grid system. The ion charge states (typically 1-4) depend on the cathode material and only little on the discharge current as long as the current is low. Here the authors report on experiments with short pulses (several μs) and high currents (several kA); this regime of operation is thus approaching a more vacuum spark-like regime. Mean ion charge states of up to 6.2 for tungsten and 3.7 for titanium have been measured, with the corresponding maximum charge states of up to 8+ and 6+, respectively. The results are discussed in terms of Saha calculations and freezing of the charge state distribution

High ion charge states in a high-current, short-pulse, vacuum arc ion source

International Nuclear Information System (INIS)

Anders, A.; Brown, I.; MacGill, R.; Dickinson, M.

1995-09-01

Ions of the cathode material are formed at vacuum arc cathode spots and extracted by a grid system. The ion charge states (typically 1--4) depend on the cathode material and only little on the discharge current as long as the current is low. Here the authors report on experiments with short pulses (several micros) and high currents (several kA); this regime of operation is thus approaching a more vacuum spark-like regime. Mean ion charge states of up to 6.2 for tungsten and 3.7 for titanium have been measured, with the corresponding maximum charge states of up to 8+ and 6+, respectively. The results are discussed in terms of Saha calculations and freezing of the charge state distribution

Tetracritical point and current circulations in superconducting state

International Nuclear Information System (INIS)

Belyavskij, V.I.; Kopaev, Yu.V.; Smirnov, M.Yu.

2005-01-01

Phase diagram reflecting the key peculiar features of the standard diagram of the cuprate superconductors was studied in terms of the Ginzburg-Landau phenomenology near the tetracritical point resulting from the competition of superconducting and dielectric channels of pairing. Two-component parameter of order the relative phase of which is associated with antiferromagnetic dielectric ordering corresponds to the superconducting pairing at repulsion. In case of slight doping the dielectric order coexists with superconductivity below the temperature of superconducting phase transition and manifests itself as a slight pseudoslit above the mentioned temperature. A segment of pseudoslit region adjacent to the superconducting state corresponds to the matured fluctuations of the order parameter in the form of quasi-stationary states of noncoherent superconducting pairs and may be interpreted as a region of a strong pseudoslit. At increase of doping one observes a phase transition from the coexistence region and the orbital antiferromagnetism to the conventional superconducting state covering the region of matured fluctuations of the order parameter in the form of quasi-stationary states of the noncorrelated orbital circulation currents adjacent to the line of phase transition [ru

Smartphone use in dermatology for clinical photography and consultation: Current practice and the law.

Science.gov (United States)

Abbott, Lisa M; Magnusson, Roger S; Gibbs, Emma; Smith, Saxon D

2018-05-01

Smartphones are rapidly changing the way doctors capture and communicate clinical information, particularly in highly visual specialties such as dermatology. An understanding of how and why smartphones are currently used in clinical practice is critical in order to evaluate professional and legal risks, and to formulate policies that enable safe use of mobile technologies for the maximal benefit of practitioners and patients. Australian dermatologists and dermatology trainees were surveyed on their current practices relating to clinical smartphone use. Of the 105 respondents, 101 provided useable results. The data show clinical smartphone use is common and frequent, with more than 50% of respondents sending and receiving images on their smartphones at least weekly. Clinical photographs were usually sent via multimedia message or email and were commonly stored on smartphones (46%). Security measures adopted to protect data were limited. There was inadequate documentation of consent for transmission of photographs and advice provided. Only 22% of respondents were aware of clear policies in their workplace regarding smartphone use, and a majority desired further education on digital image management. Given the frequency of use and the degree of importance placed on the ability to send and receive clinical images, clinical smartphone use will persist and will likely increase over time. Current practices are insufficient to comply with professional and legal obligations, and increase practitioners' vulnerability to civil and disciplinary proceedings. Further education, realistic policies and adequate software resources are critical to ensure protection of patients, practitioners and the reputation of the dermatological profession. © 2017 The Australasian College of Dermatologists.

Obtaining patient test results from clinical laboratories: a survey of state law for pharmacists.

Science.gov (United States)

Witry, Matthew J; Doucette, William R

2009-01-01

To identify states with laws that restrict to whom clinical laboratories may release copies of laboratory test results and to describe how these laws may affect pharmacists' ability to obtain patient laboratory test results. Researchers examined state statutes and administrative codes for all 50 states and the District of Columbia at the University of Iowa Law Library between June and July 2007. Researchers also consulted with lawyers, state Clinical Laboratory Improvement Amendments officers, and law librarians. Laws relating to the study objective were analyzed. 34 jurisdictions do not restrict the release of laboratory test results, while 17 states have laws that restrict to whom clinical laboratories can send copies of test results. In these states, pharmacists will have to use alternative sources, such as physician offices, to obtain test results. Pharmacists must consider state law before requesting copies of laboratory test results from clinical laboratories. This may be an issue that state pharmacy associations can address to increase pharmacist access to important patient information.

Detection of defect states responsible for leakage current in ultrathin tantalum pentoxide (Ta2O5) films by zero-bias thermally stimulated current spectroscopy

International Nuclear Information System (INIS)

Lau, W.S.; Zhong, L.; Lee, A.; See, C.H.; Han, T.; Sandler, N.P.; Chong, T.C.

1997-01-01

Defect states responsible for leakage current in ultrathin (physical thickness 2 O 5 ) films were measured with a novel zero-bias thermally stimulated current technique. It was found that defect states A, whose activation energy was estimated to be about 0.2 eV, can be more efficiently suppressed by using N 2 O rapid thermal annealing (RTA) instead of using O 2 RTA for postdeposition annealing. The leakage current was also smaller for samples with N 2 O RTA than those with O 2 RTA for postdeposition annealing. Hence, defect states A are quite likely to be important in causing leakage current. copyright 1997 American Institute of Physics

Heating and current drive requirements towards steady state operation in ITER

Energy Technology Data Exchange (ETDEWEB)

Poli, F. M.; Kessel, C. E.; Gorelenkova, M. [Princeton Plasma Physics Laboratory, Princeton, NJ 08543 (United States); Bonoli, P. T. [MIT Plasma Science and Fusion Center, Cambridge, MA 02139 (United States); Batchelor, D. B. [Oak Ridge National Laboratory, Oak Ridge, TN 37831-6169 (United States); Harvey, B.; Petrov, Y. [CompX, Box 2672, Del Mar, CA 92014 (United States)

2014-02-12

Steady state scenarios envisaged for ITER aim at optimizing the bootstrap current, while maintaining sufficient confinement and stability to provide the necessary fusion yield. Non-inductive scenarios will need to operate with Internal Transport Barriers (ITBs) in order to reach adequate fusion gain at typical currents of 9 MA. However, the large pressure gradients associated with ITBs in regions of weak or negative magnetic shear can be conducive to ideal MHD instabilities, reducing the no-wall limit. The E × B flow shear from toroidal plasma rotation is expected to be low in ITER, with a major role in the ITB dynamics being played by magnetic geometry. Combinations of H/CD sources that maintain weakly reversed magnetic shear profiles throughout the discharge are the focus of this work. Time-dependent transport simulations indicate that, with a trade-off of the EC equatorial and upper launcher, the formation and sustainment of quasi-steady state ITBs could be demonstrated in ITER with the baseline heating configuration. However, with proper constraints from peeling-ballooning theory on the pedestal width and height, the fusion gain and the maximum non-inductive current are below the ITER target. Upgrades of the heating and current drive system in ITER, like the use of Lower Hybrid current drive, could overcome these limitations, sustaining higher non-inductive current and confinement, more expanded ITBs which are ideal MHD stable.

Heating and current drive requirements towards steady state operation in ITER

Science.gov (United States)

Poli, F. M.; Bonoli, P. T.; Kessel, C. E.; Batchelor, D. B.; Gorelenkova, M.; Harvey, B.; Petrov, Y.

2014-02-01

Steady state scenarios envisaged for ITER aim at optimizing the bootstrap current, while maintaining sufficient confinement and stability to provide the necessary fusion yield. Non-inductive scenarios will need to operate with Internal Transport Barriers (ITBs) in order to reach adequate fusion gain at typical currents of 9 MA. However, the large pressure gradients associated with ITBs in regions of weak or negative magnetic shear can be conducive to ideal MHD instabilities, reducing the no-wall limit. The E × B flow shear from toroidal plasma rotation is expected to be low in ITER, with a major role in the ITB dynamics being played by magnetic geometry. Combinations of H/CD sources that maintain weakly reversed magnetic shear profiles throughout the discharge are the focus of this work. Time-dependent transport simulations indicate that, with a trade-off of the EC equatorial and upper launcher, the formation and sustainment of quasi-steady state ITBs could be demonstrated in ITER with the baseline heating configuration. However, with proper constraints from peeling-ballooning theory on the pedestal width and height, the fusion gain and the maximum non-inductive current are below the ITER target. Upgrades of the heating and current drive system in ITER, like the use of Lower Hybrid current drive, could overcome these limitations, sustaining higher non-inductive current and confinement, more expanded ITBs which are ideal MHD stable.

Qualitative ergonomics/human factors research in health care: Current state and future directions.

Science.gov (United States)

Valdez, Rupa Sheth; McGuire, Kerry Margaret; Rivera, A Joy

2017-07-01

The objective of this systematic review was to understand the current state of Ergonomics/Human Factors (E/HF) qualitative research in health care and to draw implications for future efforts. This systematic review identified 98 qualitative research papers published between January 2005 and August 2015 in the seven journals endorsed by the International Ergonomics Association with an impact factor over 1.0. The majority of the studies were conducted in hospitals and outpatient clinics, were focused on the work of formal health care professionals, and were classified as cognitive or organizational ergonomics. Interviews, focus groups, and observations were the most prevalent forms of data collection. Triangulation and data archiving were the dominant approaches to ensuring rigor. Few studies employed a formal approach to qualitative inquiry. Significant opportunities remain to enhance the use of qualitative research to advance systems thinking within health care. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Current state of competence assessment in nursing].

Science.gov (United States)

Darmann-Finck, Ingrid; Reuschenbach, Bernd

2013-01-01

Competency measurement is central to the optimisation of outcome oriented educational processes in nursing, similar to the concept of evidence based practice. The classification of measurement tools provides the basis for describing the current state of research and development in relation to competence measurement in nursing science, and any gaps are identified. The article concludes with questioning the importance of outcome oriented quality orientation in order to achieve an increase in quality during training. Further methodological developments and qualitative studies are needed to examine the context specific processes of interaction and learning, beyond competence diagnostics. Copyright © 2012. Published by Elsevier GmbH.

Isavuconazole for the treatment of invasive aspergillosis and mucormycosis: current evidence, safety, efficacy, and clinical recommendations

Directory of Open Access Journals (Sweden)

Natesan SK

2016-12-01

Full Text Available Suganthini Krishnan Natesan,1,2 Pranatharthi H Chandrasekar1 1Division of Infectious Diseases, Department of Internal Medicine, Wayne State University, 2John D Dingell VA Medical Center, Detroit, MI, USA Abstract: The majority of invasive mold infections diagnosed in immunocompromised cancer patients include invasive aspergillosis (IA and mucormycosis. Despite timely and effective therapy, mortality remains considerable. Antifungal agents currently available for the management of these serious infections include triazoles, polyenes, and echinocandins. Until recently, posaconazole has been the only triazole with a broad spectrum of anti-mold activity against both Aspergillus sp. and mucorales. Other clinically available triazoles voriconazole and itraconazole, with poor activity against mucorales, have significant drug interactions in addition to a side effect profile inherent for all triazoles. Polyenes including lipid formulations pose a problem with infusion-related side effects, electrolyte imbalance, and nephrotoxicity. Echinocandins are ineffective against mucorales and are approved as salvage therapy for refractory IA. Given that all available antifungal agents have limitations, there has been an unmet need for a broad-spectrum anti-mold agent with a favorable profile. Following phase III clinical trials that started in 2006, isavuconazole (ISZ seems to fit this profile. It is the first novel triazole agent recently approved by the United States Food and Drug Administration (FDA for the treatment of both IA and mucormycosis. This review provides a brief overview of the salient features of ISZ, its favorable profile with regard to spectrum of antifungal activity, pharmacokinetic and pharmacodynamic parameters, drug interactions and tolerability, clinical efficacy, and side effects. Keywords: isavuconazole, aspergillosis, mucormycosis, efficacy, antifungal therapy, novel azole, tolerability, drug interactions

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

Science.gov (United States)

Paramore, James E.

1982-01-01

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

Translating ocular biomechanics into clinical practice: current state and future prospects.

Science.gov (United States)

Girard, Michaël J A; Dupps, William J; Baskaran, Mani; Scarcelli, Giuliano; Yun, Seok H; Quigley, Harry A; Sigal, Ian A; Strouthidis, Nicholas G

2015-01-01

Biomechanics is the study of the relationship between forces and function in living organisms and is thought to play a critical role in a significant number of ophthalmic disorders. This is not surprising, as the eye is a pressure vessel that requires a delicate balance of forces to maintain its homeostasis. Over the past few decades, basic science research in ophthalmology mostly confirmed that ocular biomechanics could explain in part the mechanisms involved in almost all major ophthalmic disorders such as optic nerve head neuropathies, angle closure, ametropia, presbyopia, cataract, corneal pathologies, retinal detachment and macular degeneration. Translational biomechanics in ophthalmology, however, is still in its infancy. It is believed that its use could make significant advances in diagnosis and treatment. Several translational biomechanics strategies are already emerging, such as corneal stiffening for the treatment of keratoconus, and more are likely to follow. This review aims to cultivate the idea that biomechanics plays a major role in ophthalmology and that the clinical translation, lead by collaborative teams of clinicians and biomedical engineers, will benefit our patients. Specifically, recent advances and future prospects in corneal, iris, trabecular meshwork, crystalline lens, scleral and lamina cribrosa biomechanics are discussed.

Analysis of transient state in HTS tapes under ripple DC load current

Science.gov (United States)

Stepien, M.; Grzesik, B.

2014-05-01

The paper concerns the analysis of transient state (quench transition) in HTS tapes loaded with the current having DC component together with a ripple component. Two shapes of the ripple were taken into account: sinusoidal and triangular. Very often HTS tape connected to a power electronic current supply (i.e. superconducting coil for SMES) that delivers DC current with ripples and it needs to be examined under such conditions. Additionally, measurements of electrical (and thermal) parameters under such ripple excitation is useful to tape characterization in broad range of load currents. The results presented in the paper were obtained using test bench which contains programmable DC supply and National Instruments data acquisition system. Voltage drops and load currents were measured vs. time. Analysis of measured parameters as a function of the current was used to tape description with quench dynamics taken into account. Results of measurements were also used to comparison with the results of numerical modelling based on FEM. Presented provisional results show possibility to use results of measurements in transient state to prepare inverse models of superconductors and their detailed numerical modelling.

Radiotherapy for pediatric brain tumors: Standard of care, current clinical trials, and new directions

International Nuclear Information System (INIS)

Kun, Larry E.

1996-01-01

Objectives: To review the clinical characteristics of childhood brain tumors, including neurologic signs, neuroimaging and neuropathology. To critically assess indications for therapy relevant to presenting characteristics, age, and disease status. To discuss current management strategies including neurosurgery, radiation therapy, and chemotherapy. To analyze current clinical trials and future directions of clinical research. Brain tumors account for 20% of neoplastic diseases in children. The most common tumors include astrocytoma and malignant gliomas, medulloblastoma and supratentorial PNET's, ependymoma, craniopharyngioma, and intracranial germ cell tumors. Tumor type and clinical course are often correlated with age at presentation and anatomic site. The clinical characteristics and disease extent largely determine the relative merits of available 'standard' and investigational therapeutic approaches. Treatment outcome, including disease control and functional integrity, is dependent upon age at presentation, tumor type, and disease extent. An understanding of the clinical, neuroimaging, and histologic characteristics as they relate to decisions regarding therapy is critical to the radiation oncologist. Appropriate radiation therapy is central to curative therapy for a majority of pediatric brain tumor presentations. Technical advances in neurosurgery provide greater safety for 'gross total resection' in a majority of hemispheric astrocytomas and medulloblastomas. The relative roles of 'standard' radiation therapy and evolving chemotherapy for centrally located astrocytomas (e.g., diencephalic, optic pathway) need to be analyzed in the context of initial and overall disease control, neurotoxicities, and potential modifications in the risk:benefit ratio apparent in the introduction of precision radiation techniques. Modifications in radiation delivery are fundamental to current investigations in medulloblastoma; the rationale for contemporary and projected

Biomarkers in prostate cancer - Current clinical utility and future perspectives.

Science.gov (United States)

Kretschmer, Alexander; Tilki, Derya

2017-12-01

Current tendencies in the treatment course of prostate cancer patients increase the need for reliable biomarkers that help in decision-making in a challenging clinical setting. Within the last decade, several novel biomarkers have been introduced. In the following comprehensive review article, we focus on diagnostic (PHI ® , 4K score, SelectMDx ® , ConfirmMDx ® , PCA3, MiPS, ExoDX ® , mpMRI) and prognostic (OncotypeDX GPS ® , Prolaris ® , ProMark ® , DNA-ploidy, Decipher ® ) biomarkers that are in widespread clinical use and are supported by evidence. Hereby, we focus on multiple clinical situations in which innovative biomarkers may guide decision-making in prostate cancer therapy. In addition, we describe novel liquid biopsy approaches (circulating tumor cells, cell-free DNA) that have been described as predictive biomarkers in metastatic castration-resistant prostate cancer and might support an individual patient-centred oncological approach in the nearer future. Copyright © 2017 Elsevier B.V. All rights reserved.

Assessment of Energy Production Potential from Ocean Currents along the United States Coastline

Energy Technology Data Exchange (ETDEWEB)

Haas, Kevin A. [Georgia Inst. of Technology, Atlanta, GA (United States)

2013-10-03

Increasing energy consumption and depleting reserves of fossil fuels have resulted in growing interest in alternative renewable energy from the ocean. Ocean currents are an alternative source of clean energy due to their inherent reliability, persistence and sustainability. General ocean circulations exist in the form of large rotating ocean gyres, and feature extremely rapid current flow in the western boundaries due to the Coriolis Effect. The Gulf Stream system is formed by the western boundary current of the North Atlantic Ocean that flows along the east coastline of the United States, and therefore is of particular interest as a potential energy resource for the United States.

Current drive efficiency requirements for an attractive steady-state reactor

Energy Technology Data Exchange (ETDEWEB)

Tonon, G

1994-12-31

The expected values of the figure of merit and the electrical efficiency of various non-inductive current drive methods are considered. The main experimental results achieved today with neutral beams and radiofrequency systems are summarized. Taking into account the simplified energy flow diagram of a steady state reactor, the figure of merit and the electrical efficiency values which are necessary in order to envisage an attractive steady-state reactor are determined. These values are compared to the theoretical predictions. (author). 16 refs., 11 figs., 2 tabs.

Current drive efficiency requirements for an attractive steady-state reactor

International Nuclear Information System (INIS)

Tonon, G.

1994-01-01

The expected values of the figure of merit and the electrical efficiency of various non-inductive current drive methods are considered. The main experimental results achieved today with neutral beams and radiofrequency systems are summarized. Taking into account the simplified energy flow diagram of a steady state reactor, the figure of merit and the electrical efficiency values which are necessary in order to envisage an attractive steady-state reactor are determined. These values are compared to the theoretical predictions. (author). 16 refs., 11 figs., 2 tabs

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

Science.gov (United States)

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

2015-01-01

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

State Higher Education Funding Models: An Assessment of Current and Emerging Approaches

Science.gov (United States)

Layzell, Daniel T.

2007-01-01

This article provides an assessment of the current and emerging approaches used by state governments in allocating funding for higher education institutions and programs. It reviews a number of desired characteristics or outcomes for state higher education funding models, including equity, adequacy, stability, and flexibility. Although there is…

Advanced robotics for medical rehabilitation current state of the art and recent advances

CERN Document Server

Xie, Shane

2016-01-01

Focussing on the key technologies in developing robots for a wide range of medical rehabilitation activities – which will include robotics basics, modelling and control, biomechanics modelling, rehabilitation strategies, robot assistance, clinical setup/implementation as well as neural and muscular interfaces for rehabilitation robot control – this book is split into two parts; a review of the current state of the art, and recent advances in robotics for medical rehabilitation. Both parts will include five sections for the five key areas in rehabilitation robotics: (i) the upper limb; (ii) lower limb for gait rehabilitation (iii) hand, finger and wrist; (iv) ankle for strains and sprains; and (v) the use of EEG and EMG to create interfaces between the neurological and muscular functions of the patients and the rehabilitation robots. Each chapter provides a description of the design of the device, the control system used, and the implementation and testing to show how it fulfils the needs of that specific ...

Clinical and Laboratory Features of the Nocardia spp. Based on Current Molecular Taxonomy

Science.gov (United States)

Brown-Elliott, Barbara A.; Brown, June M.; Conville, Patricia S.; Wallace, Richard J.

2006-01-01

The recent explosion of newly described species of Nocardia results from the impact in the last decade of newer molecular technology, including PCR restriction enzyme analysis and 16S rRNA sequencing. These molecular techniques have revolutionized the identification of the nocardiae by providing rapid and accurate identification of recognized nocardiae and, at the same time, revealing new species and a number of yet-to-be-described species. There are currently more than 30 species of nocardiae of human clinical significance, with the majority of isolates being N. nova complex, N. abscessus, N. transvalensis complex, N. farcinica, N. asteroides type VI (N. cyriacigeorgica), and N. brasiliensis. These species cause a wide variety of diseases and have variable drug susceptibilities. Accurate identification often requires referral to a reference laboratory with molecular capabilities, as many newer species are genetically distinct from established species yet have few or no distinguishing phenotypic characteristics. Correct identification is important in deciding the clinical relevance of a species and in the clinical management and treatment of patients with nocardial disease. This review characterizes the currently known pathogenic species of Nocardia, including clinical disease, drug susceptibility, and methods of identification. PMID:16614249

Fertility Preservation for Pediatric Patients: Current State and Future Possibilities.

Science.gov (United States)

Johnson, Emilie K; Finlayson, Courtney; Rowell, Erin E; Gosiengfiao, Yasmin; Pavone, Mary Ellen; Lockart, Barbara; Orwig, Kyle E; Brannigan, Robert E; Woodruff, Teresa K

2017-07-01

This review provides an overview of pediatric fertility preservation. Topics covered include the patient populations who could benefit, the current state of fertility preservation options and research, and considerations related to ethics and program development. A broad Embase® and PubMed® search was performed to identify publications discussing investigational, clinical, ethical and health care delivery issues related to pediatric fertility preservation. Relevant publications were reviewed and summarized. Populations who could benefit from fertility preservation in childhood/adolescence include oncology patients, patients with nononcologic conditions requiring gonadotoxic chemotherapy, patients with differences/disorders of sex development and transgender individuals. Peripubertal and postpubertal fertility preservation options are well established and include cryopreservation of oocytes, embryos or sperm. Prepubertal fertility preservation is experimental. Multiple lines of active research aim to develop technologies that will enable immature eggs and sperm to be matured and used to produce a biological child in the future. Ethical challenges include the need for parental proxy decision making and the fact that fertility preservation procedures can be considered not medically necessary. Successful multidisciplinary fertility preservation care teams emphasize partnerships with adult colleagues, prioritize timely consultations and use standardized referral processes. Some aspects of fertility preservation are not covered by insurance and out-of-pocket costs can be prohibitive. Pediatric fertility preservation is an emerging, evolving field. Fertility preservation options for prepubertal patients with fertility altering conditions such as cancer and differences/disorders of sex development are currently limited. However, multiple lines of active research hold promise for the future. Key considerations include establishing a multidisciplinary team to provide

Risk factors, pre-presentation management and clinical state of ...

African Journals Online (AJOL)

2017-08-23

Aug 23, 2017 ... based on provision of clean water sources, basic hygiene. CC –BY ... clinical state at presentation, management, and outcome were documented. Data was entered ... WHBPF = Washes hands before preparing food. WHBF =.

Atopic Dermatitis in Children: Current Clinical Guidelines for Diagnosis and Therapy

Directory of Open Access Journals (Sweden)

Leyla S. Namazova-Baranova

2016-01-01

Full Text Available Atopic dermatitis is a chronic multifactorial skin disease that is common enough in childhood. The article presents the current data on epidemiology and dynamics of incidence of pathological symptoms, pathogenesis basics, and key factors of the disease development, shows the current classification of the disease. The authors consider in detail the key principles of the diagnosis and peculiarities of a clinical aspect depending on age. Algorithms of a therapeutic approach, as well as basics of an individual hypoallergenic diet are proposed. General recommendations and possible prognosis for pediatric patients with atopic dermatitis are given.

Determination of the Steady State Leakage Current in Structures with Ferroelectric Ceramic Films

Science.gov (United States)

Podgornyi, Yu. V.; Vorotilov, K. A.; Sigov, A. S.

2018-03-01

Steady state leakage currents have been investigated in capacitor structures with ferroelectric solgel films of lead zirconate titanate (PZT) formed on silicon substrates with a lower Pt electrode. It is established that Pt/PZT/Hg structures, regardless of the PZT film thickness, are characterized by the presence of a rectifying contact similar to p-n junction. The steady state leakage current in the forward direction increases with a decrease in the film thickness and is determined by the ferroelectric bulk conductivity.

Current computational modelling trends in craniomandibular biomechanics and their clinical implications.

Science.gov (United States)

Hannam, A G

2011-03-01

Computational models of interactions in the craniomandibular apparatus are used with increasing frequency to study biomechanics in normal and abnormal masticatory systems. Methods and assumptions in these models can be difficult to assess by those unfamiliar with current practices in this field; health professionals are often faced with evaluating the appropriateness, validity and significance of models which are perhaps more familiar to the engineering community. This selective review offers a foundation for assessing the strength and implications of a craniomandibular modelling study. It explores different models used in general science and engineering and focuses on current best practices in biomechanics. The problem of validation is considered at some length, because this is not always fully realisable in living subjects. Rigid-body, finite element and combined approaches are discussed, with examples of their application to basic and clinically relevant problems. Some advanced software platforms currently available for modelling craniomandibular systems are mentioned. Recent studies of the face, masticatory muscles, tongue, craniomandibular skeleton, temporomandibular joint, dentition and dental implants are reviewed, and the significance of non-linear and non-isotropic material properties is emphasised. The unique challenges in clinical application are discussed, and the review concludes by posing some questions which one might reasonably expect to find answered in plausible modelling studies of the masticatory apparatus. © 2010 Blackwell Publishing Ltd.

On the structure of intermediate state created by the direct current

International Nuclear Information System (INIS)

Kan, Ya.S.; Frolov, V.A.

1974-01-01

Observations were made of the structure of an intermediate state formed at the destruction of superconductivity of a cylindrical tin sample by an electric current through it. For this purpose, there was determined the nature of the dependence of the magnetic permeability averaged over a section normal with the sample axis on the position of this section relative to the axis. the quantity actually measured was the inductance of a short (0.5 mm) superconductive probe coil embracing the sample and moving along the axis of the latter. In order the inductance were representatative of the magnetic permeability in the depth of a thick (5 mm in diameter) sample, measurements were made with a direct current by means of the device specially designed for this purpose; the operating principle and method for checking of this device being briefly described in the paper. The curves of oscillations of the inductance of the probe with the latter being moved along the sample suggested a conclusion that the structure of the intermediate state had a periodic nature (of the London type) with a period of 1.3 mm. The reduction of the oscillation amplitude and the increase of their average level while an increase of the current passing through the sample above the critical value (at constant temperature) indicated the reduction of the diameter of the core, being in the intermediate state, and an increase of the thickness of a normal layer. Measurements were made at temperatures (13-17)x10 -3 deg K below Tsub(k) with a current of 2-3 A in the sample

Radiotherapy for pediatric brain tumors: Standard of care, current clinical trials and new directions

International Nuclear Information System (INIS)

Kun, Larry E.

1997-01-01

Objectives: To review the clinical characteristics of childhood brain tumors, including neurologic signs, neuroimaging and neuropathology. To critically assess indications for therapy relevant to presenting characteristics, age, and disease status. To discuss current management strategies including neurosurgery, radiation therapy, and chemotherapy. To analyze current clinical trials and future directions of clinical research. Brain tumors account for 20% of neoplastic diseases in children. The most common tumors include astrocytoma and malignant gliomas, medulloblastoma and supratentorial PNET's, ependymoma, craniopharyngioma, and intracranial germ cell tumors. The clinical characteristics and disease extent largely determine the relative merits of available 'standard' and investigational therapeutic approaches. Treatment outcome, including disease control and functional integrity, is dependent upon tumor type and site, age at presentation, and disease extent. An understanding of the clinical, neuroimaging, and histologic characteristics as they relate to decisions regarding therapy is critical to the radiation oncologist. Appropriate radiation therapy is central to curative therapy for a majority of pediatric brain tumor presentations. Technical advances in neurosurgery provide greater safety for 'gross total resection' in a majority of hemispheric astrocytomas and medulloblastomas. The relative roles of radiation therapy and chemotherapy for centrally located astrocytomas (e.g., diencephalic, optic pathway) need to be analyzed in the context of initial and overall disease control, neurotoxicities, and potential modifications in the risk:benefit ratio apparent in the introduction of 3-dimensional radiation techniques. Modifications in radiation delivery are important components of current investigations in medulloblastoma; the rationale for contemporary cooperative group trials will be presented as well as the background data re surgical, radiotherapeutic, and

Representing delayed force feedback as a combination of current and delayed states.

Science.gov (United States)

Avraham, Guy; Mawase, Firas; Karniel, Amir; Shmuelof, Lior; Donchin, Opher; Mussa-Ivaldi, Ferdinando A; Nisky, Ilana

2017-10-01

To adapt to deterministic force perturbations that depend on the current state of the hand, internal representations are formed to capture the relationships between forces experienced and motion. However, information from multiple modalities travels at different rates, resulting in intermodal delays that require compensation for these internal representations to develop. To understand how these delays are represented by the brain, we presented participants with delayed velocity-dependent force fields, i.e., forces that depend on hand velocity either 70 or 100 ms beforehand. We probed the internal representation of these delayed forces by examining the forces the participants applied to cope with the perturbations. The findings showed that for both delayed forces, the best model of internal representation consisted of a delayed velocity and current position and velocity. We show that participants relied initially on the current state, but with adaptation, the contribution of the delayed representation to adaptation increased. After adaptation, when the participants were asked to make movements with a higher velocity for which they had not previously experienced with the delayed force field, they applied forces that were consistent with current position and velocity as well as delayed velocity representations. This suggests that the sensorimotor system represents delayed force feedback using current and delayed state information and that it uses this representation when generalizing to faster movements. NEW & NOTEWORTHY The brain compensates for forces in the body and the environment to control movements, but it is unclear how it does so given the inherent delays in information transmission and processing. We examined how participants cope with delayed forces that depend on their arm velocity 70 or 100 ms beforehand. After adaptation, participants applied opposing forces that revealed a partially correct representation of the perturbation using the current and the

Clinical features and pathophysiology of Complex Regional Pain Syndrome – current state of the art

Science.gov (United States)

Marinus, Johan; Moseley, G. Lorimer; Birklein, Frank; Baron, Ralf; Maihöfner, Christian; Kingery, Wade S.; van Hilten, Jacobus J.

2017-01-01

That a minor injury can trigger a complex regional pain syndrome (CRPS) - multiple system dysfunction, severe and often chronic pain and disability - has fascinated scientists and perplexed clinicians for decades. However, substantial advances across several medical disciplines have recently increased our understanding of CRPS. Compelling evidence implicates biological pathways that underlie aberrant inflammation, vasomotor dysfunction, and maladaptive neuroplasticity in the clinical features of CRPS. Collectively, the evidence points to CRPS being a multifactorial disorder that is associated with an aberrant host response to tissue injury. Varying susceptibility to perturbed regulation of any of the underlying biological pathways probably accounts for the clinical heterogeneity of CRPS. PMID:21683929

Enceladus: three-act play and current state

Science.gov (United States)

Luan, J.; Goldreich, P.

2017-12-01

Eccentricity (e) growth as Enceladus migrates deeper into mean motion resonance with Dione results in increased tidal heating. As the bottom of the ice shell melts, the rate of tidal heating jumps and runaway melting ensues. At the end of run-away melting, the shell's thickness has fallen below the value at which the frequency of free libration equals the orbital mean motion and e has damped to well below its current value. Subsequently, both the shell thickness and e partake in a limit cycle. As e damps toward its minimum value, the shell's thickness asymptotically approaches its resonant value from below. After minimum e, the shell thickens quickly and e grows even faster. This cycle is likely to have been repeated multiple times in the past. Currently, e is much smaller than its equilibrium value corresponding to the shell thickness. Physical libration resonance resolves this mystery, it ensures that the low-e and medium-thickness state is present for most of the time between consecutive limit cycles. It is a robust scenario that avoids fine tuning or extreme parameter choice, and naturally produces episodic stages of high heating, consistent with softening of topographical features on Enceladus.

High magnetic field science and its application in the United States current status and future directions

CERN Document Server

National Research Council of the National Academies

2013-01-01

The Committee to Assess the Current Status and Future Direction of High Magnetic Field Science in the United States was convened by the National Research Council in response to a request by the National Science Foundation. This report answers three questions: (1) What is the current state of high-field magnet science, engineering, and technology in the United States, and are there any conspicuous needs to be addressed? (2) What are the current science drivers and which scientific opportunities and challenges can be anticipated over the next ten years? (3) What are the principal existing and planned high magnetic field facilities outside of the United States, what roles have U.S. high field magnet development efforts played in developing those facilities, and what potentials exist for further international collaboration in this area? A magnetic field is produced by an electrical current in a metal coil. This current exerts an expansive force on the coil, and a magnetic field is "high" if it challenges the str...

Critical-state model for the determination of critical currents in disk-shaped superconductors

International Nuclear Information System (INIS)

Frankel, D.J.

1979-01-01

A series of experiments has been carried out on the flux trapping and shielding capabilities of a flat strip of Nb-Ti/Cu composite material. A circular piece of material from the strip was tested in a uniform field directed perpendicularly to the surface of the sample. Profiles of the normal component of the field along the sample diameter were measured. The critical-state model was adapted for this geometry and proved capable of reproducing the measured field profiles. Model curves agreed well with experimental field profiles generated when the full sample was in the critical state, when only a portion of the sample was in the critical state, and when profiles were obtained after the direction of the rate change of the magnetic field was reversed. The adaption of the critical-state model to disk geometry provides a possible method either to derive values of the critical current from measurements of field profiles above thin flat samples, or to predict the trapping and shielding behavior of such samples if the critical current is already known. This method of determining critical currents does not require that samples be formed into narrow strips or wires, as is required for direct measurements of J/sub c/, or into tubes or cylinders, as is usually required for magnetization-type measurements. Only a relatively small approximately circular piece of material is needed. The method relies on induced currents, so there is no need to pass large currents into the sample. The field-profile measurements are easily performed with expensive Hall probes and do not require detection of the resistive transition of the superconductor

Limitations Of The Current State Space Modelling Approach In Multistage Machining Processes Due To Operation Variations

Science.gov (United States)

Abellán-Nebot, J. V.; Liu, J.; Romero, F.

2009-11-01

The State Space modelling approach has been recently proposed as an engineering-driven technique for part quality prediction in Multistage Machining Processes (MMP). Current State Space models incorporate fixture and datum variations in the multi-stage variation propagation, without explicitly considering common operation variations such as machine-tool thermal distortions, cutting-tool wear, cutting-tool deflections, etc. This paper shows the limitations of the current State Space model through an experimental case study where the effect of the spindle thermal expansion, cutting-tool flank wear and locator errors are introduced. The paper also discusses the extension of the current State Space model to include operation variations and its potential benefits.

[Atypical epithelial hyperplasia of the breast: current state of knowledge and clinical practice].

Science.gov (United States)

Lavoué, V; Bertel, C; Tas, P; Bendavid, C; Rouquette, S; Foucher, F; Audrain, O; Bouriel, C; Levêque, J

2010-02-01

The diagnosis of atypical epithelial hyperplasia (AEH) increases with breast cancer screening. AEH is divided in three groups: atypical ductal hyperplasia, columnar cell lesions with atypia, lobular neoplasia. The management of women with AEH is not consensual because of uncertainty about their diagnosis related to the type of the biopsy sampling (core needle biopsy or surgical excision) and their controversial clinical signification between risk marker and true precursor of breast cancer. A systematic review of published studies was performed. Medline baseline interrogation was performed with the following keywords: atypical ductal hyperplasia, columnar cell lesions with atypia, lobular neoplasia, core needle biopsy, breast cancer, precursor lesion, hormonal replacement therapy. For each breast lesion, identified publications (English or French) were assessed for clinical practise in epidemiology, diagnosis and patient management. With immunohistochemistry and molecular studies, AEH seems to be precursor of breast cancer. But, epidemiological studies show low rate of breast cancer in women with AEH. AEH were still classified as risk factor of breast cancer. Because of high rate of breast cancer underestimation, surgical excision is necessary after the diagnosis of AEH at core needle biopsy. Surgical oncology rules and collaboration with radiologist are required for this surgery. A second operation was not required due to involved margins by AEH (except with pleiomorphic lobular neoplasia) because local control of breast cancer seems to be unchanged. Besides, hormonal replacement therapy for patient with AEH is not recommended because of lack of studies about this subject. Copyright 2009 Elsevier Masson SAS. All rights reserved.

Policies for patient access to clinical data via PHRs: current state and recommendations.

Science.gov (United States)

Collins, Sarah A; Vawdrey, David K; Kukafka, Rita; Kuperman, Gilad J

2011-12-01

Healthcare delivery organizations are increasingly using online personal health records (PHRs) to provide patients with direct access to their clinical information; however, there may be a lack of consistency in the data made available. We aimed to understand the general use and functionality of PHRs and the organizational policies and decision-making structures for making data available to patients. A cross-sectional survey was administered by telephone structured interview to 21 organizations to determine the types of data made available to patients through PHRs and the presence of explicit governance for PHR data release. Organizations were identified based on a review of the literature, PHR experts, and snowball sampling. Organizations that did not provide patients with electronic access to their data via a PHR were excluded. Interviews were conducted with 17 organizations for a response rate of 81%. Half of the organizations had explicit governance in the form of a written policy that outlined the data types made available to patients. Overall, 88% of the organizations used a committee structure for the decision-making process and included senior management and information services. All organizations sought input from clinicians. Discussion There was considerable variability in the types of clinical data and the time frame for releasing these data to patients. Variability in data release policies may have implications for PHR use and adoption. Future policy activities, such as requirement specification for the latter stages of Meaningful Use, should be leveraged as an opportunity to encourage standardization of functionality and broad deployment of PHRs.

Evaluation of current state of amplification-based DDoS attacks

NARCIS (Netherlands)

Bohte, Edgar; Stamatogiannakis, Manolis; Bos, Herbert

2018-01-01

Amplification-based DDoS attacks are still a big threat to the availability of the internet. In quite some time there is no new paper published that gave an update on the current state of amplification DDoS attacks, taken into consideration it was a huge problem a few years ago. We performed

CURRENT STATE AND DEVELOPMENT OF THE FISHERIES SECTOR OF UKRAINE IN THE CRISIS

Directory of Open Access Journals (Sweden)

І. Hrytsyniak

2015-03-01

Full Text Available Purpose. Fisheries has a strategic importance for supplying the population with food, while the sectors of the national economy with raw materials, for strengthening the country’s position in the international arena, for preserving spatial and national integrity of Ukraine, plays an important role in the restoration of natural resources and in the increase in employment. In recent years, fisheries sector of Ukraine is in a severe, protracted economic crisis. Considering its socio-economic and strategic importance for the state, there is a task for developing an effective policy for fisheries development in Ukraine that defines the relevance of the research and practical importance of its results. Thus, a compilation and analysis of the existing information on the current state and development of fisheries sector in the crisis period will allow a deeper understanding of problems in the fisheries sector in Ukraine and finding quick solutions. The main goal of the state policy in the field of fisheries in Ukraine has to be meeting the needs of the population in fish and fish products by creating conditions for effective operations and development of aquaculture and fishing enterprises. Findings. The article reviews the current state of the development of fisheries sector in Ukraine, consumption, catch, processing of fish and seafood, dynamics of fish product exports and imports, legislative and regulatory framework of fisheries sector, state of the implementation of WTO and EU requirements, as well as finding ways for the fisheries sector out from the crisis. Originality. This work is a compilation of the information on the current state of fisheries sector development in Ukraine. The information is provided in the form of a coherent presentation of information on the current state of fisheries sector in Ukraine, both in the domestic and foreign markets. Practical Value. The fact that the fisheries sector of Ukraine is still in a depressive state

Steady-state configurations of Dzyaloshinskii domain walls driven by field and current

Energy Technology Data Exchange (ETDEWEB)

Sánchez-Tejerina, L., E-mail: luis.st@ee.uva.es [Departamento de Electricidad y Electrónica, Facultad de Ciencias, Universidad de Valladolid, 47011 Valladolid (Spain); Departamento de Física Aplicada, Facultad de Ciencias, Universidad de Salamanca, 37011 Salamanca (Spain); Alejos, O. [Departamento de Electricidad y Electrónica, Facultad de Ciencias, Universidad de Valladolid, 47011 Valladolid (Spain); Martínez, E. [Departamento de Física Aplicada, Facultad de Ciencias, Universidad de Salamanca, 37011 Salamanca (Spain)

2017-02-01

The dynamics of Dzyaloshinskii domain walls (DDW) in ultrathin ferromagnetic strips with perpendicular magnetic anisotropy, for different values of both perpendicular field and longitudinal current excitation associated to the Spin-Hall effect, has been studied, taking into account different values of the interfacial Dzyaloshinskii-Moriya interaction (DMI). This study has been carried out with the help of the q-Φ one-dimensional model and micromagnetic simulations. We have found that Walker breakdown may be avoided by applying a certain threshold current, even though the inverse effect is also possible. We have also found that, for particular values of field and current, the magnetization within the DDW experiences an abrupt change of orientation, which provokes a change on the contribution of current to the terminal DDW velocity. This effect disappears for sufficiently strong DMI, as it is expected from the model. - Highlights: • Steady-state configurations of Dzyaloshinskii domain walls driven by field and current have been reported. • Field-like torques and Slonczewskii-like torques due to spin-orbit interactions have been considered. • The response is associated with the rotation of the domain wall inner magnetization. • An asymmetric behavior arising from the existence of degenerate states is shown. • The asymmetry results in different travelled distances and/or terminal speeds.

Steady-state configurations of Dzyaloshinskii domain walls driven by field and current

International Nuclear Information System (INIS)

Sánchez-Tejerina, L.; Alejos, O.; Martínez, E.

2017-01-01

The dynamics of Dzyaloshinskii domain walls (DDW) in ultrathin ferromagnetic strips with perpendicular magnetic anisotropy, for different values of both perpendicular field and longitudinal current excitation associated to the Spin-Hall effect, has been studied, taking into account different values of the interfacial Dzyaloshinskii-Moriya interaction (DMI). This study has been carried out with the help of the q-Φ one-dimensional model and micromagnetic simulations. We have found that Walker breakdown may be avoided by applying a certain threshold current, even though the inverse effect is also possible. We have also found that, for particular values of field and current, the magnetization within the DDW experiences an abrupt change of orientation, which provokes a change on the contribution of current to the terminal DDW velocity. This effect disappears for sufficiently strong DMI, as it is expected from the model. - Highlights: • Steady-state configurations of Dzyaloshinskii domain walls driven by field and current have been reported. • Field-like torques and Slonczewskii-like torques due to spin-orbit interactions have been considered. • The response is associated with the rotation of the domain wall inner magnetization. • An asymmetric behavior arising from the existence of degenerate states is shown. • The asymmetry results in different travelled distances and/or terminal speeds.

Sulfonylureas in type 2 diabetes mellitus: current evidence, conflicts ...

African Journals Online (AJOL)

Introduction: We sought to explore the current state of evidence on sulfonylurea therapy in type 2 diabetes mellitus (T2DM) and critically examine the recommendations of major practice guidelines,and the overall ramifications of the issues thereof in current clinical practice. Method: We searched PUBMED, MEDLINE and ...

Inhaled therapies in patients with moderate COPD in clinical practice: current thinking

Science.gov (United States)

Ariel, Amnon; Altraja, Alan; Belevskiy, Andrey; Boros, Piotr W; Danila, Edvardas; Fležar, Matjaz; Koblizek, Vladimir; Fridlender, Zvi G; Kostov, Kosta; Krams, Alvils; Milenkovic, Branislava; Somfay, Attila; Tkacova, Ruzena; Tudoric, Neven; Ulmeanu, Ruxandra; Valipour, Arschang

2018-01-01

COPD is a complex, heterogeneous condition. Even in the early clinical stages, COPD carries a significant burden, with breathlessness frequently leading to a reduction in exercise capacity and changes that correlate with long-term patient outcomes and mortality. Implementation of an effective management strategy is required to reduce symptoms, preserve lung function, quality of life, and exercise capacity, and prevent exacerbations. However, current clinical practice frequently differs from published guidelines on the management of COPD. This review focuses on the current scientific evidence and expert opinion on the management of moderate COPD: the symptoms arising from moderate airflow obstruction and the burden these symptoms impose, how physical activity can improve disease outcomes, the benefits of dual bronchodilation in COPD, and the limited evidence for the benefits of inhaled corticosteroids in this disease. We emphasize the importance of maximizing bronchodilation in COPD with inhaled dual-bronchodilator treatment, enhancing patient-related outcomes, and enabling the withdrawal of inhaled corticosteroids in COPD in well-defined patient groups. PMID:29317810

Radiation-induced off-state leakage current in commercial power MOSFETs

International Nuclear Information System (INIS)

Dodd, Paul Emerson; Shaneyfelt, Marty Ray; Draper, Bruce Leroy; Felix, James Andrew; Schwank, James Ralph; Dalton, Scott Matthew

2005-01-01

The total dose hardness of several commercial power MOSFET technologies is examined. After exposure to 20 krad(SiO 2 ) most of the n- and p-channel devices examined in this work show substantial (2 to 6 orders of magnitude) increases in off-state leakage current. For the n-channel devices, the increase in radiation-induced leakage current follows standard behavior for moderately thick gate oxides, i.e., the increase in leakage current is dominated by large negative threshold voltage shifts, which cause the transistor to be partially on even when no bias is applied to the gate electrode. N-channel devices biased during irradiation show a significantly larger leakage current increase than grounded devices. The increase in leakage current for the p-channel devices, however, was unexpected. For the p-channel devices, it is shown using electrical characterization and simulation that the radiation-induced leakage current increase is related to an increase in the reverse bias leakage characteristics of the gated diode which is formed by the drain epitaxial layer and the body. This mechanism does not significantly contribute to radiation-induced leakage current in typical p-channel MOS transistors. The p-channel leakage current increase is nearly identical for both biased and grounded irradiations and therefore has serious implications for long duration missions since even devices which are usually powered off could show significant degradation and potentially fail.

[Current state of blood transfusion in Yugoslavia and its perspectives].

Science.gov (United States)

Bosković, S

1975-01-01

The current situation of the transfusion service in this country has been characterised by small-scale operational level, the lack of regional system and basic components of a single service. There is a great variety in the medical and expert point of view starting from the lack of elementary hygienic and technical conditions, down to developed institutions of the European level. This activity has been characterised for the last ten years or so by an effort to win blood-givers at all cost, to enhance production of intravenous solutions which in some factories have obtained factory production volume, to determine basic blood groups and a very modest diagnostics for haemolitic diseases of newly born children. A large number of doctors--transfusiologists have obtained specialists' titles, but without any prospects to change the present status of their work: blood conservation, efforts to win blood-givers and determine blood groups. The differentiation between transfusiologists and clinic-engaged personnel has been increasing, thus making the transfusiologists to be far from the problems of modern haematology and clinical therapy. Observing the situation and status of transfusiology in the developed countries of Western Europe, it is possible to state that the transfusiology is developing in the direction of cooperation and team-work with doctors engaged in clinics. Therefore, cooperation with doctors engaged in clinics should be cultivated and organise team work. The intermediary role of doctors-transfusiologist in the cycle of health improvement should be avoided by all means. 90% of packed blood in this country is consumed in the form of full blood or dry plasma and only 10% in the form of desired derivatives, instead of the contrary case, since the precisely set therapy using new haemostatic medicaments is an economical imperative. The electronic data processing of blood-givers enables doctors-transfusiologists to deal with these problems since this is much cheaper

Lower bounds for ballistic current and noise in non-equilibrium quantum steady states

Directory of Open Access Journals (Sweden)

Benjamin Doyon

2015-03-01

Full Text Available Let an infinite, homogeneous, many-body quantum system be unitarily evolved for a long time from a state where two halves are independently thermalized. One says that a non-equilibrium steady state emerges if there are nonzero steady currents in the central region. In particular, their presence is a signature of ballistic transport. We analyze the consequences of the current observable being a conserved density; near equilibrium this is known to give rise to linear wave propagation and a nonzero Drude peak. Using the Lieb–Robinson bound, we derive, under a certain regularity condition, a lower bound for the non-equilibrium steady-state current determined by equilibrium averages. This shows and quantifies the presence of ballistic transport far from equilibrium. The inequality suggests the definition of “nonlinear sound velocities”, which specialize to the sound velocity near equilibrium in non-integrable models, and “generalized sound velocities”, which encode generalized Gibbs thermalization in integrable models. These are bounded by the Lieb–Robinson velocity. The inequality also gives rise to a bound on the energy current noise in the case of pure energy transport. We show that the inequality is satisfied in many models where exact results are available, and that it is saturated at one-dimensional criticality.

Voltage and Current Regulators Design of Power Converters in Islanded Microgrids based on State Feedback Decoupling

DEFF Research Database (Denmark)

Federico, de Bosio; de Sousa Ribeiro, Luiz Antonio; Freijedo Fernandez, Francisco Daniel

2016-01-01

In stand-alone microgrids based on voltage source inverters state feedback coupling between the capacitor voltage and inductor current degrades significantly the dynamics performance of voltage and current regulators. The decoupling of the controlled states is proposed, considering the limitations...

Topical steroids in the current clinical practice

Directory of Open Access Journals (Sweden)

T. A. Belousova

2014-01-01

Full Text Available The article discusses issues related to current criteria for selection of glucocorticosteroids for external use as the basic therapy for a great number of allergic and inflammatory skin diseases. The authors emphasize that non-fluorinated GCSs having the best efficacy-to-safety ratio must be the drugs of first choice. The article provides data on a positive clinical experience of using a non-halogenated glucocorticosteroid for external use - hydrocortisone 17-butyrate (Laticort - for treatment of steroid-sensitive dermatoses in children and adults. The drug has a high anti-inflammatory action and minimum risk of the development of side effects, which is sufficient for using it in sensitive areas of skin (face, neck, folds, genitals both in children and in adults. The availability of three forms of the drug (solution, cream and ointment ensures the expedience and convenience of its application at any stage of the inflammatory process and for any localization.

Regulations in the United States for cell transplantation clinical trials in neurological diseases

Institute of Scientific and Technical Information of China (English)

He Zhu; Yuanqing Tan; Qi Gu; Weifang Han; Zhongwen Li; Jason S Meyer; Baoyang Hu

2015-01-01

Objective: This study aimed to use a systematic approach to evaluate the current utilization, safety, and effectiveness of cell therapies for neurological diseases in human. And review the present regulations, considering United States (US) as a representative country, for cell transplantation in neurological disease and discuss the challenges facing the field of neurology in the coming decades. Methods:A detailed search was performed in systematic literature reviews of cellular‐based therapies in neurological diseases, using PubMed, web of science, and clinical trials. Regulations of cell therapy products used for clinical trials were searched from the Food and Drug Administration (FDA) and the National Institutes of Health (NIH). Results: Seven most common types of cell therapies for neurological diseases have been reported to be relatively safe with varying degrees of neurological recovery. And a series of regulations in US for cellular therapy was summarized including preclinical evaluations, sourcing material, stem cell manufacturing and characterization, cell therapy product, and clinical trials. Conclusions:Stem cell‐based therapy holds great promise for a cure of such diseases and will value a growing population of patients. However, regulatory permitting activity of the US in the sphere of stem cells, technologies of regenerative medicine and substitutive cell therapy are selective, theoretical and does not fit the existing norm and rules. Compiled well‐defined regulations to guide the application of stem cell products for clinical trials should be formulated.

Quantum decay of metastable current states in rf squids

International Nuclear Information System (INIS)

Dmitrenko, I.M.; Khlus, V.A.; Tsoj, C.M.; Shnyrkov, V.I.

1985-01-01

Quantum decay of metastable current states in a rf SQUID superconducting ring of a hysteresis mode are considered. Point contacts are used as a Josephson weak link. The first derivative of rf IVC, dVsub(T)/dIsub(RF), is measured which gives the dependence of the density of decay probability on the amplitude of magnetic flux oscillations in the ring. The temperature dependence of probability distribution width between 4.2 and 0.5 K suggests that for most of high-ohmic contacts Nb-Nb, Nb-Ag-Nb the quantum mechanisms of decay become dominant beginning with the temperature of about 2 K. The experimental parameters of distribution of decay probability in the quantum limit are compared to those calculated by the theory of macroscopic quantum tunneling in the limit of high and low dissipation. The experimental values of probability density distribution width and characteristic quantum temperature are higher than the theoretical ones, the fact can be attributed to the deviation of current-phase relation of contact from a sinusoidal one. Besides, some contacts seem to correspond to the case of an intermediate value of dissipation. As the frequency of rf oscillations varies from 30 to 6 MHz, the distribution width remains unchanged in accordance with the theory of quantum tunneling decay of metastable current state in the ring in the limit of high damping. At low temperatures (T approximately 0.5 K), and rather small damping coefficient, the density of probability displays anomalous peaks when the amplitude of rf oscillations is lower considerably than the critical vaiue of magnetic flux in the ring

The Current State of Poison Control Centers in Pakistan and the Need for Capacity Building

Directory of Open Access Journals (Sweden)

Nadeem Khan

2014-03-01

Full Text Available Background: Chemical exposure is a major health problem globally. Poison control centers (PCCs play a leading role both in developed and developing countries in the prevention and control of poisonous chemical exposures. In this study, we aimed to assess the current state of PCCs in Pakistan and highlight capacity building needs in these centers. Methods: A cross-sectional survey of the two registered PCCs was done during August – December 2011. Necessary services of the PCCs were evaluated and the data were recorded on a predesigned checklist. Results: Both PCCs are affiliated to a tertiary care hospital. Clinical services to poisoned patients were available 24 hours a day / 7 days a week. Information on common local products was available to poison center staff. Both centers were involved in undergraduate and post graduate teaching. Telephone poison information service was not available in either of centers. There was a limited capacity for qualitative and analytical toxicology. Common antidotes were available. There were limited surveillance activities to capture toxic risks existing in the community and also a deficiency was observed in chemical disaster planning. Conclusion: PCCs in Pakistan need capacity building for specialized training in toxicology, toxicovigilance, chemical disaster planning, analytical laboratory tests and telephone service for consultation in poisoning cases.   How to cite this article: Khan NU, Mir MU, Khan UR, Khan AR, Ara J, Raja K, et al. The Current State of Poison Control Centers in Pakistan and the Need for Capacity Building. Asia Pac J Med Toxicol 2014;3:31-5.

SSAT State-of-the-Art Conference: Current Surgical Management of Gastric Tumors.

Science.gov (United States)

Norton, Jeffrey A; Kim, Teresa; Kim, Joseph; McCarter, Martin D; Kelly, Kaitlyn J; Wong, Joyce; Sicklick, Jason K

2018-01-01

The current era of gastric surgery is marked by low morbidity and mortality rates, innovative strategies to approach resections with a minimally invasive fashion or hyperthermic intraperitoneal chemotherapy (HIPEC), as well as improved understanding of the biology of sporadic and hereditary stromal, neuroendocrine, and epithelial malignancies. In 2017, the Society for Surgery of the Alimentary Tract convened a State-of-the-Art Conference on Current Surgical Management of Gastric Tumors with both international experts and emerging leaders in the field of gastric surgery. Martin D. McCarter, MD of the University of Colorado discussed the current management of gastric gastrointestinal stromal tumors (GIST). Kaitlyn J. Kelly, MD of the University of California, San Diego discussed the management of gastric carcinoid tumors. Jeffrey A. Norton of Stanford University discussed recent advances in the management of gastric adenocarcinoma including a focus on hereditary diffuse gastric cancer (HDGC). Joseph Kim, MD of Stony Brook University discussed a systematic approach to minimally invasive gastrectomy for cancer. Joyce Wong, MD of Pennsylvania State University discussed the role for cytoreductive surgery (CRS) and HIPEC for gastric adenocarcinoma. This review provides gastrointestinal surgeons with a concise update on the current surgical management of gastric tumors.

A simulation study on burning profile tailoring of steady state, high bootstrap current tokamaks

International Nuclear Information System (INIS)

Nakamura, Y.; Takei, N.; Tobita, K.; Sakamoto, Y.; Fujita, T.; Fukuyama, A.; Jardin, S.C.

2007-01-01

From the aspect of fusion burn control in steady state DEMO plant, the significant challenges are to maintain its high power burning state of ∝3-5 GW without burning instability, hitherto well-known as ''thermal stability'', and also to keep its desired burning profile relevant with internal transport barrier (ITB) that generates high bootstrap current. The paper presents a simulation modeling of the burning stability coupled with the self-ignited fusion burn and the structure-formation of the ITB. A self-consistent simulation, including a model for improved core energy confinement, has pointed out that in the high power fusion DEMO plant there is a close, nonlinear interplay between the fusion burnup and the current source of non-inductive, ITB-generated bootstrap current. Consequently, as much distinct from usual plasma controls under simulated burning conditions with lower power (<<1 GW), the selfignited fusion burn at a high power burning state of ∝3-5 GW becomes so strongly selforganized that any of external means except fuelling can not provide the effective control of the stable fusion burn.It is also demonstrated that externally applied, inductive current perturbations can be used to control both the location and strength of ITB in a fully noninductive tokamak discharge. We find that ITB structures formed with broad noninductive current sources such as LHCD are more readily controlled than those formed by localized sources such as ECCD. The physics of the inductive current is well known. Consequently, we believe that the controllability of the ITB is generic, and does not depend on the details of the transport model (as long as they can form an ITB for sufficiently reversed magnetic shear q-profile). Through this external control of the magnetic shear profile, we can maintain the ITB strength that is otherwise prone to deteriorate when the bootstrap current increases. These distinguishing capabilities of inductive current perturbation provide steady

Neoplastic stem cells: current concepts and clinical perspectives.

Science.gov (United States)

Schulenburg, Axel; Brämswig, Kira; Herrmann, Harald; Karlic, Heidrun; Mirkina, Irina; Hubmann, Rainer; Laffer, Sylvia; Marian, Brigitte; Shehata, Medhat; Krepler, Clemens; Pehamberger, Hubert; Grunt, Thomas; Jäger, Ulrich; Zielinski, Christoph C; Valent, Peter

2010-11-01

Neoplastic stem cells have initially been characterized in myeloid leukemias where NOD/SCID mouse-repopulating progenitors supposedly reside within a CD34+/Lin- subset of the malignant clone. These progenitors are considered to be self-renewing cells responsible for the in vivo long-term growth of neoplastic cells in leukemic patients. Therefore, these cells represent an attractive target of therapy. In some lymphoid leukemias, NOD/SCID mouse-repopulating cells were also reported to reside within the CD34+/Lin- subfraction of the clone. More recently, several attempts have been made to transfer the cancer stem cell concept to solid tumors and other non-hematopoietic neoplasms. In several of these tumors, the cell surface antigens AC133 (CD133) and CD44 are considered to indicate the potential of a cell to initiate permanent tumor formation in vivo. However, several questions concerning the phenotype, self-renewal capacity, stroma-dependence, and other properties of cancer- or leukemia-initiating cells remain to be solved. The current article provides a summary of our current knowledge on neoplastic (cancer) stem cells, with special emphasis on clinical implications and therapeutic options as well as a discussion about conceptual and technical limitations. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Effect of localized states on the current-voltage characteristics of metal-semiconductor contacts with thin interfacial layer

Science.gov (United States)

Chattopadhyay, P.

1994-10-01

The role of discrete localized states on the current-voltage characteristics of metal-semiconductor contact is examined. It is seen that, because of these localized states, the logarithmic current vs voltage characteristics become nonlinear. Such nonlinearity is found sensitive to the temperature, and the energy and density of the localized states. The predicted temperature dependence of barrier height and the current-voltage characteristics are in agreement with the experimental results of Aboelfotoh [ Phys. Rev. B39, 5070 (1989)].

Pain clinic definitions in the medical literature and U.S. state laws: an integrative systematic review and comparison.

Science.gov (United States)

Andraka-Christou, Barbara; Rager, Joshua B; Brown-Podgorski, Brittany; Silverman, Ross D; Watson, Dennis P

2018-05-22

In response to widespread opioid misuse, ten U.S. states have implemented regulations for facilities that primarily manage and treat chronic pain, called "pain clinics." Whether a clinic falls into a state's pain clinic definition determines the extent to which it is subject to oversight. It is unclear whether state pain clinic definitions model those found in the medical literature, and potential differences lead to discrepancies between scientific and professionally guided advice found in the medical literature and actual pain clinic practice. Identifying discrepancies could assist states to design laws that are more compatible with best practices suggested in the medical literature. We conducted an integrative systematic review to create a taxonomy of pain clinic definitions using academic medical literature. We then identified existing U.S. state pain clinic statutes and regulations and compared the developed taxonomy using a content analysis approach to understand the extent to which medical literature definitions are reflected in state policy. In the medical literature, we identified eight categories of pain clinic definitions: 1) patient case mix; 2) single-modality treatment; 3) multidisciplinary treatment; 4) interdisciplinary treatment; 5) provider supervision; 6) provider composition; 7) marketing; and 8) outcome. We identified ten states with pain clinic laws. State laws primarily include the following definitional categories: patient case mix; single-modality treatment, and marketing. Some definitional categories commonly found in the medical literature, such as multidisciplinary treatment and interdisciplinary treatment, rarely appear in state law definitions. This is the first study to our knowledge to develop a taxonomy of pain clinic definitions and to identify differences between pain clinic definitions in U.S. state law and medical literature. Future work should explore the impact of different legal pain clinic definitions on provider decision

Current drive studies for the ARIES steady-state tokamak reactors

International Nuclear Information System (INIS)

Mau, T.K.; Ehst, D.A.; Mandrekas, J.

1994-01-01

Steady-state plasma operating scenarios are designed for three versions of the ARIES reactor, using non-inductive current drive techniques that have an established database. R.f. waves, including fast and lower hybrid waves, are the reference drivers for the D-T burning ARIES-I and ARIES-II/IV, while neutral beam injection is employed for ARIES-III which burns D- 3 He. Plasma equilibria with a high bootstrap-current component have been used, in order to minimize the recirculating power fraction and cost of electricity. To maintain plasma stability, the driven current profile has been aligned with that of equilibrium by proper choices of the plasma profiles and power launch parameters. Except for ARIES-III, the current-drive power requirements and the relevant technology developments are found to be quite reasonable. The wave-power spectrum and launch requirements are also considered achievable with a modest development effort. Issues such as an improved database for fast-wave current drive, lower-hybrid power coupling to the plasma edge, profile control in the plasma core, and access to the design point of operation remain to be addressed. ((orig.))

Endoscopic Ultrasound Elastography: Current Clinical Use in Pancreas.

Science.gov (United States)

Mondal, Utpal; Henkes, Nichole; Patel, Sandeep; Rosenkranz, Laura

2016-08-01

Elastography is a newer technique for the assessment of tissue elasticity using ultrasound. Cancerous tissue is known to be stiffer (hence, less elastic) than corresponding healthy tissue, and as a result, could be identified in an elasticity-based imaging. Ultrasound elastography has been used in the breast, thyroid, and cervix to differentiate malignant from benign neoplasms and to guide or avoid unnecessary biopsies. In the liver, elastography has enabled a noninvasive and reliable estimate of fibrosis. Endoscopic ultrasound has become a robust diagnostic and therapeutic tool for the management of pancreatic diseases. The addition of elastography to endoscopic ultrasound enabled further characterization of pancreas lesions, and several European and Asian studies have reported encouraging results. The current clinical role of endoscopic ultrasound elastography in the management of pancreas disorders and related literature are reviewed.

Hyperthermia: Clinical promise and current challenges

International Nuclear Information System (INIS)

Kapp, D.S.

1987-01-01

Local-regional hyperthermia (HT) when used in conjunction with radiation therapy (XRT), has been shown in numerous clinical trials to result in considerable improvement in response rates and local tumor control rates when compared with treatment by XRT alone. Although considerable progress has been made in understanding the biological basis for hyperthermia induced cytotoxicity and radiosensitization, additional research remains in establishing the optimal treatment schedules for the clinical utilization of HT-XRT. The number of HT treatments; the sequencing of HT and XRT; the frequency of administration of HT; and the ideal temperature-time parameters all remain to be better defined for the clinical setting. The role of tumor blood flow on the thermal distributions also warrants further investigation. In addition, considerable effort is needed to improve hyperthermia equipment in order to provide more uniform therapeutic temperature distributions (temperatures ≥42.5%C). Better heating equipment is particularly needed for the treatment of deep seeted tumors. Pertinent clinical literature will be presented summarizing the clinical promise of hyperthermia and the above mentioned clinical challenges

Cryptography in the Cloud Computing: the Current State and Logical Tasks

OpenAIRE

Sergey Nikolaevich Kyazhin; Andrey Vladimirovich Moiseev

2013-01-01

The current state of the cloud computing (CC) information security is analysed and logical problems of storage and data transmission security at CC are allocated. Cryptographic methods of data security in CC, in particular, lightweight cryptography and the cryptography based on bilinear pairings are described.

Pancreatic cancer clinical trials and accrual in the United States.

Science.gov (United States)

Hoos, William A; James, Porsha M; Rahib, Lola; Talley, Anitra W; Fleshman, Julie M; Matrisian, Lynn M

2013-09-20

Pancreatic cancer clinical trials open in the United States and their accrual were examined to identify opportunities to accelerate progress in the treatment of pancreatic cancer. Pancreatic cancer-specific clinical trials open in the United States in the years 2011 and 2012 were obtained from the Pancreatic Cancer Action Network database. Accrual information was obtained from trial sponsors. The portfolio of pancreatic cancer clinical trials identified by type (adenocarcinoma or neuroendocrine), phase, disease stage, and treatment approach is reported. More than half of trials for patients with pancreatic ductal adenocarcinoma applied biologic insights to new therapeutic approaches, and 38% focused on optimization of radiation or chemotherapy delivery or regimens. In 2011, pancreatic cancer trials required total enrollment of 11,786 patients. Actual accrual to 93.2% of trials was 1,804 patients, an estimated 4.57% of the patients with pancreatic cancer alive in that year. The greatest need was for patients with resectable cancer. Trials open in 2011 enrolled an average of 15% of their total target accrual. Physician recommendations greatly influenced patients' decision to enroll or not enroll onto a clinical trial. Matching to a clinical trial within a 50-mile radius and identifying trials for recurrent/refractory disease were documented as challenges for patient accrual. Overall trial enrollment indicates that pancreatic cancer trials open in 2011 would require 6.7 years on average to complete accrual. These results suggest that harmonizing patient supply and demand for clinical trials is required to accelerate progress toward improving survival in pancreatic cancer.

Current concepts of severe asthma

Science.gov (United States)

Raundhal, Mahesh; Oriss, Timothy B.; Ray, Prabir; Wenzel, Sally E.

2016-01-01

The term asthma encompasses a disease spectrum with mild to very severe disease phenotypes whose traditional common characteristic is reversible airflow limitation. Unlike milder disease, severe asthma is poorly controlled by the current standard of care. Ongoing studies using advanced molecular and immunological tools along with improved clinical classification show that severe asthma does not identify a specific patient phenotype, but rather includes patients with constant medical needs, whose pathobiologic and clinical characteristics vary widely. Accordingly, in recent clinical trials, therapies guided by specific patient characteristics have had better outcomes than previous therapies directed to any subject with a diagnosis of severe asthma. However, there are still significant gaps in our understanding of the full scope of this disease that hinder the development of effective treatments for all severe asthmatics. In this Review, we discuss our current state of knowledge regarding severe asthma, highlighting different molecular and immunological pathways that can be targeted for future therapeutic development. PMID:27367183

Current clinical magnetoencephalography practice across Europe: Are we closer to use MEG as an established clinical tool?

Science.gov (United States)

De Tiège, Xavier; Lundqvist, Daniel; Beniczky, Sándor; Seri, Stefano; Paetau, Ritva

2017-08-01

This comprehensive survey aims at characterizing the current clinical use of magnetoencephalography (MEG) across European MEG centres. Forty-four MEG centres across Europe were contacted in May 2015 via personalized e-mail to contribute to survey. The web-based survey was available on-line for 1 month and the MEG centres that did not respond were further contacted to maximize participation. Among the 57% of responders, 12 centres from 10 different countries reported to use MEG for clinical applications. A total of 524 MEG investigations were performed in 2014 for the pre-surgical evaluation of epilepsy, while in the same period 244 MEG investigations were performed for pre-surgical functional brain mapping. Seven MEG centres located in different European countries performed ≥50 MEG investigations for epilepsy mapping in 2014, both in children and adults. In those centres, time from patient preparation to MEG data reporting tends to be lower than those investigating a lower annual number of patients. This survey demonstrates that there is in Europe an increasing and widespread expertise in the field of clinical MEG. These findings should serve as a basis to harmonize clinical MEG procedures and promote the clinical added value of MEG across Europe. MEG should now be considered in Europe as a mature clinical neurophysiological technique that should be used routinely in two specific clinical indications, i.e, the pre-surgical evaluation of refractory focal epilepsy and functional brain mapping. Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Rapid Detection Strategies for the Global Threat of Zika Virus: Current State, New Hypotheses and Limitations

Directory of Open Access Journals (Sweden)

Shruti Shukla

2016-10-01

Full Text Available The current scenario regarding the widespread Zika virus (ZIKV has resulted in numerous diagnostic studies, specifically in South America and in locations where there is frequent entry of travelers returning from ZIKV-affected areas, including pregnant women with or without clinical symptoms of ZIKV infection. The World Health Organization, WHO, announced that millions of cases of ZIKV are likely to occur in the United States of America in the near future. This situation has created an alarming public health emergency of international concern requiring the detection of this life-threatening viral candidate due to increased cases of newborn microcephaly associated with ZIKV infection. Hence, this review reports possible methods and strategies for the fast and reliable detection of ZIKV with particular emphasis on current updates, knowledge and new hypotheses that might be helpful for medical professionals in poor and developing countries that urgently need to address this problem. In particular, we emphasize liposome-based biosensors. Although these biosensors are currently among the less popular tools for human disease detection, they have become useful tools for the screening and detection of pathogenic bacteria, fungi and viruses because of their versatile advantageous features compared to other sensing devices. This review summarizes the currently available methods employed for the rapid detection of ZIKV and suggests an innovative approach involving the application of a liposome-based hypothesis for the development of new strategies for ZIKV detection and their use as effective biomedicinal tools.

Exploration of one-dimensional plasma current density profile for K-DEMO steady-state operation

Energy Technology Data Exchange (ETDEWEB)

Kang, J.S. [Seoul National University, Seoul 151-742 (Korea, Republic of); Jung, L. [National Fusion Research Institute, Daejeon (Korea, Republic of); Byun, C.-S.; Na, D.H.; Na, Y.-S. [Seoul National University, Seoul 151-742 (Korea, Republic of); Hwang, Y.S., E-mail: yhwang@snu.ac.kr [Seoul National University, Seoul 151-742 (Korea, Republic of)

2016-11-01

Highlights: • One-dimensional current density and its optimization for the K-DEMO are explored. • Plasma current density profile is calculated with an integrated simulation code. • The impact of self and external heating profiles is considered self-consistently. • Current density is identified as a reference profile by minimizing heating power. - Abstract: Concept study for Korean demonstration fusion reactor (K-DEMO) is in progress, and basic design parameters are proposed by targeting high magnetic field operation with ITER-sized machine. High magnetic field operation is a favorable approach to enlarge relative plasma performance without increasing normalized beta or plasma current. Exploration of one-dimensional current density profile and its optimization process for the K-DEMO steady-state operation are reported in this paper. Numerical analysis is conducted with an integrated plasma simulation code package incorporating a transport code with equilibrium and current drive modules. Operation regimes are addressed with zero-dimensional system analysis. One-dimensional plasma current density profile is calculated based on equilibrium, bootstrap current analysis, and thermal transport analysis. The impact of self and external heating profiles on those parameters is considered self-consistently, where thermal power balance and 100% non-inductive current drive are the main constraints during the whole exploration procedure. Current and pressure profiles are identified as a reference steady-state profile by minimizing the external heating power with desired fusion power.

Mixed-state bipolar I and II depression: time to remission and clinical characteristics.

Science.gov (United States)

Shim, In Hee; Woo, Young Sup; Jun, Tae-Youn; Bahk, Won-Myong

2014-01-01

We compared the time to achieve remission and the clinical characteristics of patients with bipolar depressive mixed state and those with bipolar depressive non-mixed state. The subjects (N=131) were inpatients diagnosed between 2006 and 2012 with bipolar I or II disorder, depression and were classified into the following three groups: "pure depressive state" (PD, n=70), "sub-threshold mixed state" (SMX, n=38), and "depressive mixed state" (DMX, n=23). Diagnosis of a DMX was in accordance with Benazzi's definition: three or more manic symptoms in a depressive episode. The subjects' charts were retrospectively reviewed to ascertain the time to achieve remission from the index episode and to identify other factors, such as demographic and clinical characteristics, specific manic symptoms, and pharmacological treatment, that may have contributed to remission. The time to achieve remission was significantly longer in the DMX (p=0.022) and SMX (p=0.035) groups than in the PD group. Adjustment for covariates using a Cox proportional hazards model did not change these results. Clinically, subjects with a DMX were more likely to have manic symptoms in the index episode, especially inflated self-esteem and psychomotor agitation than those in the PD. We investigated only inpatients and therefore could not comment on outpatients. These findings showed that sub-syndromal manic symptoms in bipolar depression had different clinical characteristics and a more severe illness course, including a longer time to achieve remission, than did a pure depressive state. © 2013 Elsevier B.V. All rights reserved.

A Review of Current Clinical Applications of Three-Dimensional Printing in Spine Surgery.

Science.gov (United States)

Cho, Woojin; Job, Alan Varkey; Chen, Jing; Baek, Jung Hwan

2018-02-01

Three-dimensional (3D) printing is a transformative technology with a potentially wide range of applications in the field of orthopaedic spine surgery. This article aims to review the current applications, limitations, and future developments of 3D printing technology in orthopaedic spine surgery. Current preoperative applications of 3D printing include construction of complex 3D anatomic models for improved visual understanding, preoperative surgical planning, and surgical simulations for resident education. Intraoperatively, 3D printers have been successfully used in surgical guidance systems and in the creation of patient specific implantable devices. Furthermore, 3D printing is revolutionizing the field of regenerative medicine and tissue engineering, allowing construction of biocompatible scaffolds suitable for cell growth and vasculature. Advances in printing technology and evidence of positive clinical outcomes are needed before there is an expansion of 3D printing applied to the clinical setting.

Clinical effectiveness of primary and secondary headache treatment by transcranial direct current stimulation

Directory of Open Access Journals (Sweden)

Dmitry ePinchuk

2013-03-01

Full Text Available The clinical effectiveness of headache treatment by transcranial direct current stimulation with various locations of stimulating electrodes on the scalp was analyzed retrospectively. The results of the treatment were analyzed in 90 patients aged from 19 to 54 years (48 patients had migraine without aura, 32 – frequent episodic tension-type headaches, 10 – chronic tension-type headaches and in 44 adolescents aged 11 – 16 years with chronic posttraumatic headaches after a mild head injury. Clinical effectiveness of tDCS with 70 – 150 µA current for 30 – 45 minutes via 6.25 cm2 stimulating electrodes is comparable to that of modern pharmacological drugs, with no negative side effects. The obtained result has been maintained on average from 5 to 9 months. It has been demonstrated that effectiveness depends on localization of stimulating electrodes used for different types of headaches.

Current globalization of drug interventional clinical trials: characteristics and associated factors, 2011-2013.

Science.gov (United States)

Jeong, Sohyun; Sohn, Minji; Kim, Jae Hyun; Ko, Minoh; Seo, Hee-Won; Song, Yun-Kyoung; Choi, Boyoon; Han, Nayoung; Na, Han-Sung; Lee, Jong Gu; Kim, In-Wha; Oh, Jung Mi; Lee, Euni

2017-06-21

Clinical trial globalization is a major trend for industry-sponsored clinical trials. There has been a shift in clinical trial sites towards emerging regions of Eastern Europe, Latin America, Asia, the Middle East, and Africa. Our study objectives were to evaluate the current characteristics of clinical trials and to find out the associated multiple factors which could explain clinical trial globalization and its implications for clinical trial globalization in 2011-2013. The data elements of "phase," "recruitment status," "type of sponsor," "age groups," and "design of trial" from 30 countries were extracted from the ClinicalTrials.gov website. Ten continental representative countries including the USA were selected and the design elements were compared to those of the USA. Factors associated with trial site distribution were chosen for a multilinear regression analysis. The USA, Germany, France, Canada, and United Kingdom were the "top five" countries which frequently held clinical trials. The design elements from nine continental representative countries were quite different from those of the USA; phase 1 trials were more prevalent in India (OR 1.517, p globalization of clinical trials in the emerging regions of Asia, South Africa, and Eastern Europe developed in parallel with the factors of economic drive, population for recruitment, and regulatory constraints.

Cryptography in the Cloud Computing: the Current State and Logical Tasks

Directory of Open Access Journals (Sweden)

Sergey Nikolaevich Kyazhin

2013-09-01

Full Text Available The current state of the cloud computing (CC information security is analysed and logical problems of storage and data transmission security at CC are allocated. Cryptographic methods of data security in CC, in particular, lightweight cryptography and the cryptography based on bilinear pairings are described.

Fundamentals of functional imaging I: current clinical techniques.

Science.gov (United States)

Luna, A; Martín Noguerol, T; Mata, L Alcalá

2018-05-01

Imaging techniques can establish a structural, physiological, and molecular phenotype for cancer, which helps enable accurate diagnosis and personalized treatment. In recent years, various imaging techniques that make it possible to study the functional characteristics of tumors quantitatively and reproducibly have been introduced and have become established in routine clinical practice. Perfusion studies enable us to estimate the microcirculation as well as tumor angiogenesis and permeability using ultrafast dynamic acquisitions with ultrasound, computed tomography, or magnetic resonance (MR) imaging. Diffusion-weighted sequences now form part of state-of-the-art MR imaging protocols to evaluate oncologic lesions in any anatomic location. Diffusion-weighted imaging provides information about the occupation of the extracellular and extravascular space and indirectly estimates the cellularity and apoptosis of tumors, having demonstrated its relation with biologic aggressiveness in various tumor lines and its usefulness in the evaluation of the early response to systemic and local targeted therapies. Another tool is hydrogen proton MR spectroscopy, which is used mainly in the study of the metabolic characteristics of brain tumors. However, the complexity of the technique and its lack of reproducibility have limited its clinical use in other anatomic areas, although much experience with the use of this technique in the assessment of prostate and breast cancers as well as liver lesions has also accumulated. This review analyzes the imaging techniques that make it possible to evaluate the physiological and molecular characteristics of cancer that have already been introduced into clinical practice, such as techniques that evaluate angiogenesis through dynamic acquisitions after the administration of contrast material, diffusion-weighted imaging, or hydrogen proton MR spectroscopy, as well as their principal applications in oncology. Copyright © 2018 SERAM. Publicado

Clinical Engeneering Experience at the Hospital of the State University of Londrina

Directory of Open Access Journals (Sweden)

Ernesto Fernando Ferreyra Ramírez

2002-01-01

Full Text Available This paper describes the four-year experience of implementation of Clinical Engineering services at the Hospital of the State University of Londrina (HURNP/UEL. It was performed by the Electrical Engineering Department (DEEL, through a project involving lecturers and students from the Electrical and Civil Engineering Courses of the same university. The main objectives were the formation of human resources in the Clinical Engineering area and a positive contribution to the healthcare services offered by the HURNP for the community in the surroundings of Londrina – Paraná State – Brazil.

Single cell analysis contemporary research and clinical applications

CERN Document Server

Cossarizza, Andrea

2017-01-01

This book highlights the current state of the art in single cell analysis, an area that involves many fields of science – from clinical hematology, functional analysis and drug screening, to platelet and microparticle analysis, marine biology and fundamental cancer research. This book brings together an eclectic group of current applications, all of which have a significant impact on our current state of knowledge. The authors of these chapters are all pioneering researchers in the field of single cell analysis. The book will not only appeal to those readers more focused on clinical applications, but also those interested in highly technical aspects of the technologies. All of the technologies identified utilize unique applications of photon detection systems.

Including Alternative Resources in State Renewable Portfolio Standards: Current Design and Implementation Experience

Energy Technology Data Exchange (ETDEWEB)

Heeter, J.; Bird, L.

2012-11-01

Currently, 29 states, the District of Columbia, and Puerto Rico have instituted a renewable portfolio standard (RPS). An RPS sets a minimum threshold for how much renewable energy must be generated in a given year. Each state policy is unique, varying in percentage targets, timetables, and eligible resources. This paper examines state experience with implementing renewable portfolio standards that include energy efficiency, thermal resources, and non-renewable energy and explores compliance experience, costs, and how states evaluate, measure, and verify energy efficiency and convert thermal energy. It aims to gain insights from the experience of states for possible federal clean energy policy as well as to share experience and lessons for state RPS implementation.

Implications of rf current drive theory for next step steady-state tokamak design

International Nuclear Information System (INIS)

Schultz, J.H.

1985-06-01

Two missions have been identified for a next-step tokamak experiment in the United States. The more ambitious Mission II device would be a superconducting tokamak, capable of doing long-pulse ignition demonstrations, and hopefully capable of also being able to achieve steady-state burn. A few interesting lines of approach have been identified, using a combination of logical design criteria and parametric system scans [SC85]. These include: (1) TIBER: A point-design suggested by Lawrence Livermore, that proposes a machine with the capability of demonstrating ignition, high beta (10%) and high Q (=10), using high frequency, fast-wave current drive. The TIBER topology uses moderate aspect ratio and high triangularity to achieve high beta. (2) JET Scale-up. (3) Magic5: It is argued here that an aspect ratio of 5 is a magic number for a good steady-state current drive experiment. A moderately-sized machine that achieves ignition and is capable of high Q, using either fast wave or slow wave current drive is described. (4) ET-II: The concept of a highly elongated tokamak (ET) was first proposed as a low-cost approach to Mission I, because of the possibility of achieving ohmic ignition with low-stress copper magnets. We propose that its best application is really for commercial tokamaks, using fast-wave current drive, and suggest a Mission II experiment that would be prototypical of such a reactor

Addressing unwarranted clinical variation: A rapid review of current evidence.

Science.gov (United States)

Harrison, Reema; Manias, Elizabeth; Mears, Stephen; Heslop, David; Hinchcliff, Reece; Hay, Liz

2018-05-15

Unwarranted clinical variation (UCV) can be described as variation that can only be explained by differences in health system performance. There is a lack of clarity regarding how to define and identify UCV and, once identified, to determine whether it is sufficiently problematic to warrant action. As such, the implementation of systemic approaches to reducing UCV is challenging. A review of approaches to understand, identify, and address UCV was undertaken to determine how conceptual and theoretical frameworks currently attempt to define UCV, the approaches used to identify UCV, and the evidence of their effectiveness. Rapid evidence assessment (REA) methodology was used. A range of text words, synonyms, and subject headings were developed for the major concepts of unwarranted clinical variation, standards (and deviation from these standards), and health care environment. Two electronic databases (Medline and Pubmed) were searched from January 2006 to April 2017, in addition to hand searching of relevant journals, reference lists, and grey literature. Results were merged using reference-management software (Endnote) and duplicates removed. Inclusion criteria were independently applied to potentially relevant articles by 3 reviewers. Findings were presented in a narrative synthesis to highlight key concepts addressed in the published literature. A total of 48 relevant publications were included in the review; 21 articles were identified as eligible from the database search, 4 from hand searching published work and 23 from the grey literature. The search process highlighted the voluminous literature reporting clinical variation internationally; yet, there is a dearth of evidence regarding systematic approaches to identifying or addressing UCV. Wennberg's classification framework is commonly cited in relation to classifying variation, but no single approach is agreed upon to systematically explore and address UCV. The instances of UCV that warrant investigation and

Clinical Risk Assessment in the Antiphospholipid Syndrome: Current Landscape and Emerging Biomarkers.

Science.gov (United States)

Chaturvedi, Shruti; McCrae, Keith R

2017-07-01

Laboratory criteria for the classification of antiphospholipid syndrome include the detection of a lupus anticoagulant and/or anticardiolipin and anti-β2-glycoprotein I antibodies. However, the majority of patients who test positive in these assays do not have thrombosis. Current risk-stratification tools are largely limited to the antiphospholipid antibody profile and traditional thrombotic risk factors. Novel biomarkers that correlate with disease activity and potentially provide insight into future clinical events include domain 1 specific anti-β 2 GPI antibodies, antibodies to other phospholipids or phospholipid/protein antigens (such as anti-PS/PT), and functional/biological assays such as thrombin generation, complement activation, levels of circulating microparticles, and annexin A5 resistance. Clinical risk scores may also have value in predicting clinical events. Biomarkers that predict thrombosis risk in patients with antiphospholipid antibodies have been long sought, and several biomarkers have been proposed. Ultimately, integration of biomarkers with established assays and clinical characteristics may offer the best chance of identifying patients at highest risk of APS-related complications.

Landscape of current and emerging cell therapy clinical trials in the UK: current status, comparison to global trends and future perspectives.

Science.gov (United States)

Bisson, Isabelle; Green, Emma; Sharpe, Michaela; Herbert, Chris; Hyllner, Johan; Mount, Natalie

2015-01-01

Cell Therapy Clinical Trial and Preclinical Research databases have been established by the Cell Therapy Catapult to document current and future cell therapy clinical trials in the UK. We identified 41 ongoing trials in April 2014, an increase of seven trials from April 2013. In addition, we identified 45 late-stage preclinical research projects. The majority of the clinical trials are early phase, primarily led by academic groups. The leading therapeutic areas are cancer, cardiology and neurology. The trends in the UK are also seen globally. As the field matures, more later phase and commercial studies will emerge and the challenges will likely evolve into how to manufacture sufficient cell quantities, manage complex logistics for multi-center trials and control cost.

Solid state dye-sensitized solar cells. Current state of the art. Challenges and opportunities

Energy Technology Data Exchange (ETDEWEB)

Lenzmann, F.O.; Olson, C.L.; Goris, M.J.A.A.; Kroon, J.M. [ECN Solar Energy, Petten (Netherlands)

2008-09-15

The first generation of dye-sensitized solar cell technology is based on a liquid electrolyte component. Today, this technology is on the verge of commercialization. The step towards the market and real applications is supported by the prospect of low manufacturing costs, good efficiency as well as the expectation that the current stability level of this technology is at least sufficient for applications in mobile electronics. These favorable developments may be reinforced and accelerated even further, if the corrosive liquid electrolyte could be replaced by a non-corrosive solid, since this would ease a number of stringent requirements in the production process. A successful exchange of the liquid electrolyte by a solid-state holeconductor requires to at least maintain, preferably improve, the most relevant technical parameters of the solar cell (efficiency, stability, cost). First pioneering work with solid-state hole conductors was carried out 10 years ago with an initial efficiency level below 1%. Until 2007, the record efficiency could be improved to 5%. This paper gives an overview of the solid-state concept as an early stage approach with good perspectives for the mid-term future (5-10 years)

Complex state variable- and disturbance observer-based current controllers for AC drives

DEFF Research Database (Denmark)

Dal, Mehmet; Teodorescu, Remus; Blaabjerg, Frede

2013-01-01

In vector-controlled AC drives, the design of current controller is usually based on a machine model defined in synchronous frame coordinate, where the drive performance may be degraded by both the variation of the machine parameters and the cross-coupling between the d- and q-axes components...... of the stator current. In order to improve the current control performance an alternative current control strategy was proposed previously aiming to avoid the undesired cross-coupling and non-linearities between the state variables. These effects are assumed as disturbances arisen in the closed-loop path...... of the parameter and the cross-coupling effect. Moreover, it provides a better performance, smooth and low noisy operation with respect to the complex variable controller....

Comment on: "Current-voltage characteristics and zero-resistance state in 2DEG"

OpenAIRE

Cheremisin, M. V.

2003-01-01

We demonstrate that N(S)-shape current-voltage characteristics proposed to explain zero-resistance state in Corbino(Hall bar) geometry 2DEG (cond-mat/0302063, cond-mat/0303530) cannot account essential features of radiation-induced magnetoresistance oscillations experiments.

The Role of Clinical Cardiac Magnetic Resonance Imaging in China: Current Status and the Future

Directory of Open Access Journals (Sweden)

Shi Chen, MD

2016-12-01

Full Text Available Cardiac magnetic resonance (CMR imaging plays an important role in the diagnosis and management of cardiovascular diseases. The state-of-the-art CMR imaging has many advantages in cardiac imaging, including excellent spatial and temporal resolution, unrestricted imaging field, no exposure to ionizing radiation, excellent tissue contrast, and unique myocardial tissue characterization. Clinical CMR imaging is used during the cardiovascular diagnostic workup in the United States and some European countries. Use of CMR imaging is emerging in hospitals in China and has a promising future. This review briefly describes the real-world clinical application of CMR imaging in China and discuss obstacles for its future development.

On the Current Thermal State of Mars.

Science.gov (United States)

Grott, M.; Breuer, D.

2008-09-01

Introduction: The current thermal state of Mars is a fundamental unknown in Mars science. Although is has a huge influence on the planet's current geodynamic activity and controls the possibility for basal melting at the polar caps [1], constraints on this quantities are very scarce. This situation has lately been improved by the study of lithospheric deformation at the north polar cap [2] which constrained the current Martian elastic lithosphere thickness Te, an indirect measure of the temperatures in the planetary interior. Using radar sounding data obtained bySHARAD, the shallow radar onboard the Mars Reconnaissance Orbiter, [2] found that the current Martian lithosphere is extremely stiff and Te is larger than 300 km today. This is surprising as this value is almost twice as large as previously estimated from theoretical considerations and flexure studies [3][1]. In order to be consistent with the planets thermal evolution, [2] argue that the amount of radioactive elements in the Martian interior needs to be subchondritic. This appears to be problematic as geochemical analysis of the SNC meteorites implies higher concentrations of radioactive elements [4]. Furthermore, if the concentration of heat producing elements is indeed reduced, the resulting low interior temperatures will inhibit partial mantle melting and magmatism. However, geological evidence suggests that Mars has been volcanically active in the recent past [5]. In order to address these inconsistencies, we reinvestigate the thermal evolution of Mars and examine its current thermal state for a wide range of initial condition using the current elastic thickness Te and the potential for partial mantle melting to constrain our models. Modeling: We investigate the thermal evolution of Mars by solving the energy balance equations for the core and mantle, treating the mantle energy transport by parametrized convection models. This is done using scaling laws for stagnant lid convection and our model is

The Current State of Silicone-Based Dielectric Elastomer Transducers

DEFF Research Database (Denmark)

Madsen, Frederikke Bahrt; Daugaard, Anders Egede; Hvilsted, Søren

2016-01-01

class of transducer due to their inherent lightweight and potentially large strains. For the field to progress towards industrial implementation, a leap in material devel- opment is required, specifically targeting longer lifetime and higher energy densities to provide more efficient transduction at lower...... driving voltages. In this review, the current state of sili- cone elastomers for DETs is summarised and critically discussed, including commercial elastomers, composites, polymer blends, grafted elastomers and complex network structures. For future developments in the field it is essential that all aspects...

The current state and trends of the development of universities in Ukraine

Directory of Open Access Journals (Sweden)

O.B. Morhulets

2015-09-01

Full Text Available Education is the basis of social, political, economic, spiritual, and cultural development. Therefore, the study of the current state and trends of the development of Ukrainian universities is a significant factor of social and economic progress of the country.The paper reflects the general state of universities in Ukraine, in particular, the trends in dynamics: the number of students in terms of entry/graduation, sources of financing, education fields; the number of universities in the context of accreditation, types and forms of ownership; the number of outbound Ukrainian and inbound foreign students; quantitative and qualitative characteristics of teaching staff; spending on higher education and the cost of funding per student compared with other countries. The purpose of the study is the assessment of economic activity of higher educational establishments in Ukraine, the identification of problems and tendencies of their development in the context of national transformational processes in education and formation of the society of knowledge. The methodical base used in the study is analysis and synthesis, methods of comparison and generalization, extrapolation, index and graphical methods. The practical value of the study is based on the results of a thorough analysis of university activities. Such results reveal the current state and trends of the development of universities under conditions of higher education transformation in Ukraine and its integration into the European educational area. The results of research improve understanding of the state and problems of the universities and provide the foundations for further research in the field of the national education system development and for improving of the quality of young professionals’ training. The trends of the university development indicate that the reorganization of higher education which is being currently taken place, already results in the emergence of new competencies of

[Clinical research outside of teaching hospitals: Current situation in north-eastern France].

Science.gov (United States)

Goetz, C; Dupoux, A; Déloy, L; Hertz, C; Jeanmaire, T; Parneix, N

2015-04-01

Most clinical research in France takes place in teaching hospitals. There are, however, many advantages to developing it in other hospitals: access to innovative treatments, improvement in healthcare quality, attractiveness of hospitals, increased trial inclusion rates and reduced selection bias. The objectives of our study were to report on the current situation of clinical research outside teaching hospitals. A three-stage survey was conducted between January 2012 and May 2013 in non-teaching hospitals of north-eastern France. First, questionnaires were sent to administrative and medical boards of all hospitals with more than 100 beds, then to head doctors of every department in hospitals with more than 300 beds and finally meetings were organized with members of 20 selected hospitals. The administrative and medical boards of 85 hospitals participated in the first stage of the survey; half of these hospitals were engaged in clinical research activities and for 10 the internal structuring was cross-disciplinary. Answers from 178 departments were obtained during the second stage; 47% reported a clinical research activity. Meetings with research teams in 20 hospitals allowed us to identify difficulties concerning research funding, transversal organization and sponsoring. Clinical research existed in more than half of the respondent non-teaching hospitals. Obstacles to its development can be grouped in three categories: 1) internal structuring of clinical research, 2) access to information and knowledge of how clinical research functions and to interlocutors outside the hospital and 3) access to skills necessary to sponsor clinical research. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Clinical and evoked pain, personality traits, and emotional states: can familial confounding explain the associations?

Science.gov (United States)

Strachan, Eric; Poeschla, Brian; Dansie, Elizabeth; Succop, Annemarie; Chopko, Laura; Afari, Niloofar

2015-01-01

Pain is a complex phenomenon influenced by context and person-specific factors. Affective dimensions of pain involve both enduring personality traits and fleeting emotional states. We examined how personality traits and emotional states are linked with clinical and evoked pain in a twin sample. 99 female twin pairs were evaluated for clinical and evoked pain using the McGill Pain Questionnaire (MPQ) and dolorimetry, and completed the 120-item International Personality Item Pool (IPIP), the Positive and Negative Affect Scale (PANAS), and ratings of stress and mood. Using a co-twin control design we examined a) the relationship of personality traits and emotional states with clinical and evoked pain and b) whether genetics and common environment (i.e. familial factors) may account for the associations. Neuroticism was associated with the sensory component of the MPQ; this relationship was not confounded by familial factors. None of the emotional state measures was associated with the MPQ. PANAS negative affect was associated with lower evoked pressure pain threshold and tolerance; these associations were confounded by familial factors. There were no associations between IPIP traits and evoked pain. A relationship exists between neuroticism and clinical pain that is not confounded by familial factors. There is no similar relationship between negative emotional states and clinical pain. In contrast, the relationship between negative emotional states and evoked pain is strong while the relationship with enduring personality traits is weak. The relationship between negative emotional states and evoked pain appears to be non-causal and due to familial factors. Copyright © 2014 Elsevier Inc. All rights reserved.

Gravity currents in rotating channels. Part 1. Steady-state theory

Science.gov (United States)

Hacker, J. N.; Linden, P. F.

2002-04-01

A theory is developed for the speed and structure of steady-state non-dissipative gravity currents in rotating channels. The theory is an extension of that of Benjamin (1968) for non-rotating gravity currents, and in a similar way makes use of the steady-state and perfect-fluid (incompressible, inviscid and immiscible) approximations, and supposes the existence of a hydrostatic ‘control point’ in the current some distance away from the nose. The model allows for fully non-hydrostatic and ageostrophic motion in a control volume V ahead of the control point, with the solution being determined by the requirements, consistent with the perfect-fluid approximation, of energy and momentum conservation in V, as expressed by Bernoulli's theorem and a generalized flow-force balance. The governing parameter in the problem, which expresses the strength of the background rotation, is the ratio W = B/R, where B is the channel width and R = (g[prime prime or minute]H)1/2/f is the internal Rossby radius of deformation based on the total depth of the ambient fluid H. Analytic solutions are determined for the particular case of zero front-relative flow within the gravity current. For each value of W there is a unique non-dissipative two-layer solution, and a non-dissipative one-layer solution which is specified by the value of the wall-depth h0. In the two-layer case, the non-dimensional propagation speed c = cf(g[prime prime or minute]H)[minus sign]1/2 increases smoothly from the non-rotating value of 0.5 as W increases, asymptoting to unity for W [rightward arrow] [infty infinity]. The gravity current separates from the left-hand wall of the channel at W = 0.67 and thereafter has decreasing width. The depth of the current at the right-hand wall, h0, increases, reaching the full depth at W = 1.90, after which point the interface outcrops on both the upper and lower boundaries, with the distance over which the interface slopes being 0.881R. In the one-layer case, the wall

The effect of social exclusion on state paranoia and explicit and implicit self-esteem in a non-clinical sample.

Science.gov (United States)

Stewart, C; Rogers, F; Pilch, M; Stewart, I; Barnes-Holmes, Y; Westermann, S

2017-12-01

The relationship between self-esteem and paranoia may be influenced by social stress. This study aimed to replicate previous research on the impact ofsocial exclusion on paranoia and self-esteem in a non-clinical sample and to extend this work by examining the effect of exclusion on self-esteem at the 'implicit' level. Non-clinical participants (N = 85) were randomly allocated to the Inclusion or Exclusion condition of a virtual ball-toss game ('Cyberball'). They completed self-reportmeasures of state paranoia and self-esteem, and two implicit measures of self-esteem - theImplicit Association Task (IAT) and Implicit Relational Assessment Procedure (IRAP) -prior to and after exposure to Cyberball. Social exclusion increased state paranoia. This effect was moderated by distress associated with trait paranoia. Exclusion was also associated with decreased self-reported self-esteem, as well as reduced implicit self-esteem on the IAT. Changes in self-reported self-esteem were associated with state paranoia at post-Cyberball. The IRAP indicated that reductions in implicit self-esteem may be due to increases in 'Me-Negative' and 'Others-Positive' biases (rather than reductions in 'Me-Positive' bias). The current study involved a non-clinical sample and so findings cannot be generalized to clinical paranoia. These findings are consistent with previous evidence that paranoia is associated with negative self-evaluations, whereas positive self-evaluations can persist in paranoia. They also provide support for the suggestion that investigations of self-esteem in paranoia should extend beyond global self-esteem and might benefit from a distinction between positive and negative components. Copyright © 2017 Elsevier Ltd. All rights reserved.

Mobile Healthcare and People with Disabilities: Current State and Future Needs

Directory of Open Access Journals (Sweden)

Michael Jones

2018-03-01

Full Text Available Significant health disparities exist between the general population and people with disabilities, particularly with respect to chronic health conditions. Mobile healthcare—the delivery of healthcare via mobile communication devices—is witnessing tremendous growth and has been touted as an important new approach for management of chronic health conditions. At present, little is known about the current state of mobile healthcare for people with disabilities. Early evidence suggests they are not well represented in the growth of mobile healthcare, and particularly the proliferation of mobile health software applications (mHealth apps for smartphones. Their omission in mHealth could lead to further health disparities. This article describes our research investigating the current state of mHealth apps targeting people with disabilities. Based on a multi-modal approach (literature review, Internet search, survey of disabled smartphone users, we confirm that people with disabilities are under-represented in the growth of mHealth. We identify several areas of future research and development needed to support the inclusion of people with disabilities in the mHealth revolution.

Mobile Healthcare and People with Disabilities: Current State and Future Needs.

Science.gov (United States)

Jones, Michael; Morris, John; Deruyter, Frank

2018-03-14

Significant health disparities exist between the general population and people with disabilities, particularly with respect to chronic health conditions. Mobile healthcare-the delivery of healthcare via mobile communication devices-is witnessing tremendous growth and has been touted as an important new approach for management of chronic health conditions. At present, little is known about the current state of mobile healthcare for people with disabilities. Early evidence suggests they are not well represented in the growth of mobile healthcare, and particularly the proliferation of mobile health software applications (mHealth apps) for smartphones. Their omission in mHealth could lead to further health disparities. This article describes our research investigating the current state of mHealth apps targeting people with disabilities. Based on a multi-modal approach (literature review, Internet search, survey of disabled smartphone users), we confirm that people with disabilities are under-represented in the growth of mHealth. We identify several areas of future research and development needed to support the inclusion of people with disabilities in the mHealth revolution.

Negative velocity fluctuations and non-equilibrium fluctuation relation for a driven high critical current vortex state.

Science.gov (United States)

Bag, Biplab; Shaw, Gorky; Banerjee, S S; Majumdar, Sayantan; Sood, A K; Grover, A K

2017-07-17

Under the influence of a constant drive the moving vortex state in 2H-NbS 2 superconductor exhibits a negative differential resistance (NDR) transition from a steady flow to an immobile state. This state possesses a high depinning current threshold ([Formula: see text]) with unconventional depinning characteristics. At currents well above [Formula: see text], the moving vortex state exhibits a multimodal velocity distribution which is characteristic of vortex flow instabilities in the NDR regime. However at lower currents which are just above [Formula: see text], the velocity distribution is non-Gaussian with a tail extending to significant negative velocity values. These unusual negative velocity events correspond to vortices drifting opposite to the driving force direction. We show that this distribution obeys the Gallavotti-Cohen Non-Equilibrium Fluctuation Relation (GC-NEFR). Just above [Formula: see text], we also find a high vortex density fluctuating driven state not obeying the conventional GC-NEFR. The GC-NEFR analysis provides a measure of an effective energy scale (E eff ) associated with the driven vortex state. The E eff corresponds to the average energy dissipated by the fluctuating vortex state above [Formula: see text]. We propose the high E eff value corresponds to the onset of high energy dynamic instabilities in this driven vortex state just above [Formula: see text].

The Implementation Of Solid State Switches In A Parallel Configuration To Gain Output Current Capacity In A High Current Capacitive Discharge Unit (CDU).

Energy Technology Data Exchange (ETDEWEB)

Chaves, Mario Paul [Univ. of New Mexico, Albuquerque, NM (United States)

2017-07-01

For my project I have selected to research and design a high current pulse system, which will be externally triggered from a 5V pulse. The research will be conducted in the region of paralleling the solid state switches for a higher current output, as well as to see if there will be any other advantages in doing so. The end use of the paralleled solid state switches will be used on a Capacitive Discharge Unit (CDU). For the first part of my project, I have set my focus on the design of the circuit, selection of components, and simulation of the circuit.

[Application of the International Classification of Functioning, Disability and Health (ICF) in Psychosomatic Rehabilitation and Addiction Rehabilitation in Germany - The Current State].

Science.gov (United States)

Spies, M; Brütt, A L; Freitag, M; Buchholz, A

2015-10-01

The aim of this study was to gather information on the current state of the implementation of the International Classification of Functioning, Disability and Health (ICF) in psychosomatic and addiction rehabilitation. In the summer of 2013, rehabilitation clinics in Germany were surveyed online on their ICF utilization. The questionnaire covered scope and purpose of ICF use, application of ICF core sets and assessments as well as barriers to the use of ICF. Of 359 clinics invited, 104 (30%) participated in the survey. Of those surveyed, 60 (61.9%) claimed to have taken measures to implement the ICF in their clinic; only 37 (38.5%), however, reported using the ICF in their daily work. The main barriers identified were complexity of the ICF, time management issues and training deficits. Approaches to ICF use are not uniform. There is a need for training programs, and guidance from health care insurance providers could help towards uniform implementation of the ICF. © Georg Thieme Verlag KG Stuttgart · New York.

Constructive interference in steady-state/FIESTA-C clinical applications in neuroimaging

International Nuclear Information System (INIS)

Kulkami, Makarand

2011-01-01

Full text: High spatial resolution is one of the major problems in neuroimaging, par ticularly in cranial and spinal nerve imaging. Constructive interference in steady-state/fast imaging employing steady-state acquisition with phase cycling is a robust sequence in imaging the cranial and spinal nerve patholo gies. This pictorial review is a concise article about the applications of this sequence in neuroimaging with clinical examples.

Compliance of clinical microbiology laboratories in the United States with current recommendations for processing respiratory tract specimens from patients with cystic fibrosis.

Science.gov (United States)

Zhou, Juyan; Garber, Elizabeth; Desai, Manisha; Saiman, Lisa

2006-04-01

Respiratory tract specimens from patients with cystic fibrosis (CF) require unique processing by clinical microbiology laboratories to ensure detection of all potential pathogens. The present study sought to determine the compliance of microbiology laboratories in the United States with recently published recommendations for CF respiratory specimens. Microbiology laboratory protocols from 150 of 190 (79%) CF care sites were reviewed. Most described the use of selective media for Burkholderia cepacia complex (99%), Staphylococcus aureus (82%), and Haemophilus influenzae (89%) and identified the species of all gram-negative bacilli (87%). Only 52% delineated the use of agar diffusion assays for susceptibility testing of Pseudomonas aeruginosa. Standardizing laboratory practices will improve treatment, infection control, and our understanding of the changing epidemiology of CF microbiology.

REMOTE DIAGNOSTICS OF TURNOUTS STATE ON TIMING AND SPECTRAL COMPOSITION IN CURRENT CURVE

Directory of Open Access Journals (Sweden)

S. Yu. Buryak

2015-03-01

Full Text Available Purpose. Development and implementation the points system diagnostics that would allow determining remotely the current state of turnout with all possible faults, gradual and sudden failures, damages, and in real time to report about their appearance. Methodology. State diagnostics on the values analysis of turnout main parameters is proposed to carry out with the help of a computer and analog-to-digital converter (ADC. Connecting measurements performance is advisable to produce to a shunt ammeter, installed in the working circuit of the point feed panel. ADC converts the analog signal of lost volts at the shunt into digital form and transmits it to a computer which stores the received data on its own recording medium for their further processing and storage. There is special software that is capable to reconnect signal and construct its temporal characteristic as well as decompose it on the spectral components. Using it one can analyze the obtained data, which allows diagnosing state of points upon change the nature, values and composition of the current curve. Findings. The computer diagnosis method was confirmed in practice for possible indications of problems that are associated with both the mechanical part of the turnout and the electrical part of it, while controlling parameters such as the amount of current normal transition, when working on frictions, the duration of the transition, properly adjusted headset and attachment points, the state of the motor. Originality. The use of computer technology in the diagnosis of the state of turnouts during their operation to monitor the current values of technical indicators, analysis and storage for all types of electric switches with different types of engines both DC and AC occurs through digitization and recording signal from measuring shunt of point feeder panel. Practical value. The proposed method enables timely, still in the early stages of defect parts, damages or failures of nodes

Delivering Communication Strategy Training for People with Aphasia: What Is Current Clinical Practice?

Science.gov (United States)

Beckley, Firle; Best, Wendy; Beeke, Suzanne

2017-01-01

Background: Communication strategy training (CST) is a recognized part of UK speech and language therapists' (SLTs) role when working with a person with aphasia. Multiple CST interventions have been published but, to date, there are no published studies exploring clinical practice in this area. Aims: To investigate UK SLTs' current CST practices.…

Pediatric endocrine society survey of diabetes practices in the United States: What is the current state?

Science.gov (United States)

Guttmann-Bauman, I; Thornton, P; Adhikari, S; Reifschneider, K; Wood, M A; Hamby, T; Rubin, K

2018-03-26

The Practice Management Committee (PMC) of the Pediatric Endocrine Society (PES) conducted a survey of its membership in February/March, 2016 to assess the current state of pediatric diabetes care delivery across multiple practice types in the United States. The PES distributed an anonymous electronic survey (Survey Monkey) via email to its membership and requested that only one survey be completed for each practice. Ninety-three unique entries from the US were entered into analysis. Care is predominantly delivered by multidisciplinary teams, based at academic institutions (65.6%), with >85% of the provider types being physicians. Each 1.0 full time equivalent certified diabetes educators serves on average 367 diabetic youth. Fee-for-service remains the standard method of reimbursement with 57% of practices reporting financial loss. Survey respondents identified under-reimbursement as a major barrier to improving patient outcomes and lack of behavioral health (BH) providers as a key gap in services provided. Our survey reveals wide variation in all aspects of pediatric diabetes care delivery in the United States. Pediatric Endocrinologists responding to the survey identified a lack of resources and the current fee for service payment model as a major impediment to practice and the lack of integrated BH staff as a key gap in service. The respondents strongly support its organizations' involvement in the dissemination of standards for care delivery and advocacy for a national payment model aligned with chronic diabetes care in the context of our emerging value-based healthcare system. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Research on State-of-Charge (SOC) estimation using current integration based on temperature compensation

Science.gov (United States)

Yin, J.; Shen, Y.; Liu, X. T.; Zeng, G. J.; Liu, D. C.

2017-11-01

The traditional current integral method for the state-of-charge (SOC) estimation has an unusable estimation accuracy because of the current measuring error. This paper proposed a closed-loop temperature compensation method to improve the SOC estimation accuracy of current integral method by eliminating temperature drift. Through circuit simulation result in Multisim, the stability of current measuring accuracy is improved by more than 10 times. In a designed 70 charge-discharge experimental circle, the SOC estimation error with temperature compensation had 30 times less than error in normal situation without compensation.

Education technology with continuous real time monitoring of the current functional and emotional students' states

Science.gov (United States)

Alyushin, M. V.; Kolobashkina, L. V.

2017-01-01

The education technology with continuous monitoring of the current functional and emotional students' states is suggested. The application of this technology allows one to increase the effectiveness of practice through informed planning of the training load. For monitoring the current functional and emotional students' states non-contact remote technologies of person bioparameters registration are encouraged to use. These technologies are based on recording and processing in real time the main person bioparameters in a purely passive mode. Experimental testing of this technology has confirmed its effectiveness.

Status and current spent fuel storage practices in the United States

International Nuclear Information System (INIS)

Lake, W.H.

1999-01-01

Brief discussions are presented on the history and state of spent fuel generation by utilities that comprise the United States commercial nuclear power industry, the current situation regarding the Federal government's nuclear waste policy, and evolving spent fuel storage practices. These evolving spent fuel storage practices are the result of private sector initiatives, but appear to be influenced by various external factors. The paper is not intended to provide a comprehensive appraisal of the storage initiatives being conducted by the private sector. The focus, instead, is on the Federal government's role and activities related to spent fuel management. Although the Federal government has adopted a policy calling for deep geological disposal of spent fuel, the US Congress has recently begun to consider expanding that policy to include a centralized interim storage facility. In the absence of such an expanded policy, the Department of Energy has performed some preliminary activities that would expedite development of a centralized interim storage facility, if Congress were to enact such a policy. The Department's current activities with regard to developing a centralized interim storage facility, which are consistent with the current policy, are described in the paper. The paper also describes two important technical development activities that have been conducted by the Department of Energy to support improved efficiency in spent fuel management. The Department's activities regarding development of a burnup credit methodology, and a dry transfer system are summarized. (author)

A clinical trial with combined transcranial direct current stimulation and alcohol approach bias retraining

NARCIS (Netherlands)

den Uyl, T.E.; Gladwin, T.E.; Rinck, M.; Lindenmeyer, J.; Wiers, R.W.

2017-01-01

Two studies showed an improvement in clinical outcomes after alcohol approach bias retraining, a form of Cognitive Bias Modification (CBM). We investigated whether transcranial direct current stimulation (tDCS) could enhance effects of CBM. TDCS is a neuromodulation technique that can increase

Medical Student Education in State Psychiatric Hospitals: A Survey of US State Hospitals.

Science.gov (United States)

Nurenberg, Jeffry R; Schleifer, Steven J; Kennedy, Cheryl; Walker, Mary O; Mayerhoff, David

2016-04-01

State hospitals may be underutilized in medical education. US state psychiatric hospitals were surveyed on current and potential psychiatry medical student education. A 10-item questionnaire, with multiple response formats, was sent to identified hospitals in late 2012. Ninety-seven of 221 hospitals contacted responded. Fifty-three (55%) reported current medical student education programs, including 27 clinical clerkship rotations. Education and training in other disciplines was prevalent in hospitals both with and without medical students. The large majority of responders expressed enthusiasm about medical education. The most frequent reported barrier to new programs was geographic distance from the school. Limited resources were limiting factors for hospitals with and without current programs. Only a minority of US state hospitals may be involved in medical student education. While barriers such as geographic distance may be difficult to overcome, responses suggest opportunities for expanding medical education in the state psychiatric hospitals.

Investigation of unstable periodic space-time states in distributed active system with supercritical current

International Nuclear Information System (INIS)

Koronovskij, A.A.; Rempen, I.S.; Khramov, A.E.

2003-01-01

The set of the unstable periodic space-time states, characterizing the chaotic space-time dynamics of the electron beam with the supercritical current in the Pierce diode is discussed. The Lyapunov indicators of the revealed instable space-time states of the chaotic dynamics of the distributed self-excited system are calculated. It is shown that change in the set of the unstable periodic states in dependence on the Pierce parameter is determined by change in the various orbits stability, which is demonstrated by the values of senior Lyapunov unstable state index [ru

Critical current, pinning and resistive state of superconducting single-crystal niobium with different types of defect structure

International Nuclear Information System (INIS)

Sokolenko, V.I.; Starodubov, Ya.D.

2005-01-01

Critical current pinning and resistive state of single crystal niobium of texture orientation are studied for different structural states obtained by rolling at 20 K by 42% and polishing the surface layers. It is found that the heterogeneous structures typical of the strained sample even after its thinning down to approx 10% display a lower current-carrying capability due to an increase of the thermomagnetic instability within the fragmented structure sections in the near-surface layers. For a homogeneous defect structure of the sample core with the density of equilibrium distributed dislocations of 1.3 centre dot 10 11 cm -2 , a correlation between the normal current density and the critical current density in the resistive state is found, in agreement with the concepts of flux creep due to the scatter of local values of J c

Embedded Ag Grid Electrodes as Current Collector for Ultraflexible Transparent Solid-State Supercapacitor.

Science.gov (United States)

Xu, Jian-Long; Liu, Yan-Hua; Gao, Xu; Sun, Yilin; Shen, Su; Cai, Xinlei; Chen, Linsen; Wang, Sui-Dong

2017-08-23

Flexible transparent solid-state supercapacitors have attracted immerse attention for the power supply of next-generation flexible "see-through" or "invisible" electronics. For fabrication of such devices, high-performance flexible transparent current collectors are highly desired. In this paper, the utilization of embedded Ag grid transparent conductive electrodes (TCEs) fabricated by a facile soft ultraviolet imprinting lithography method combined with scrap techniques, as the current collector for flexible transparent solid-state supercapacitors, is demonstrated. The embedded Ag grid TCEs exhibit not only excellent optoelectronic properties (R S ∼ 2.0 Ω sq -1 and T ∼ 89.74%) but also robust mechanical properties, which could meet the conductivity, transparency, and flexibility needs of current collectors for flexible transparent supercapacitors. The obtained supercapacitor exhibits large specific capacitance, long cycling life, high optical transparency (T ∼ 80.58% at 550 nm), high flexibility, and high stability. Owing to the embedded Ag grid TCE structure, the device shows a slight capacitance loss of 2.6% even after 1000 cycles of repetitive bending for a bending radius of up to 2.0 mm. This paves the way for developing high-performance current collectors and thus flexible transparent energy storage devices, and their general applicability opens up opportunities for flexible transparent electronics.

CURRENT STATE OF WATER BIORESOURCES OF THE VOLGA AND CASPIAN SEA BASIN

Directory of Open Access Journals (Sweden)

L. M. Vasileva

2012-01-01

Full Text Available The article considers the issues of current degraded state of aquatic biological resources of the Volga-Caspian Sea basin and provides specific data on commercial stocks of fish. The main reasons for decrease in natural stocks of ichthyofauna are regulation and pollution of the spawning rivers, adverse hydrological conditions, injudicious hunting, poaching pressure. To improve the state of natural stocks of fish it is necessary to increase their reproduction and implement measures to restore and rational exploitation of aquatic bioresources of the Volga- Caspian Sea basin.

Examination of the Current Approaches to State-Level Nuclear Security Evaluation

International Nuclear Information System (INIS)

Kim, Chan; Yim, Mansung; Kim, So Young

2014-01-01

An effective global nuclear materials security system will cover all materials, employ international standards and best practices, and reduce risks by reducing weapons-usable nuclear material stocks and the number of locations where they are found. Such a system must also encourage states to accept peer reviews by outside experts in order to demonstrate that effective security is in place. It is thus critically important to create an integrative framework of state-level evaluation of nuclear security as a basis for measuring the level and progress of international effort to secure and control all nuclear materials. There have been studies to represent state-level nuclear security with a quantitative metric. A prime example is the Nuclear Materials Security Index (NMSI) by the Nuclear Threat Initiative (NTI). Another comprehensive study is the State Level Risk Metric by Texas A and M University (TAMU). This paper examines the current methods with respect to their strengths and weaknesses and identifies the directions for future research to improve upon the existing approaches

The role of hybrid SPECT-CT in oncology: current and emerging clinical applications

International Nuclear Information System (INIS)

Chowdhury, F.U.; Scarsbrook, A.F.

2008-01-01

Single photon emission computed tomography - computed tomography (SPECT-CT) is an emerging dual-modality imaging technique with many established and potential clinical applications in the field of oncology. To date, there has been a considerable emphasis on the benefits of integrated positron emission tomography - computed tomography (PET-CT) in oncology, but relatively little focus on the clinical utility of SPECT-CT. As with PET-CT, accurate co-registration of anatomical and functional data from a combined SPECT-CT camera often provides complementary diagnostic information. Both sensitivity (superior disease localization) and specificity (exclusion of false-positives due to physiological tracer uptake) are improved, and the functional significance of indeterminate lesions detected on cross-sectional imaging can be defined. This article will review the scope of hybrid SPECT-CT in oncology and illustrate both current and emerging clinical applications

Radiomics and its emerging role in lung cancer research, imaging biomarkers and clinical management: State of the art

International Nuclear Information System (INIS)

Lee, Geewon; Lee, Ho Yun; Park, Hyunjin; Schiebler, Mark L.; Beek, Edwin J.R. van; Ohno, Yoshiharu; Seo, Joon Beom; Leung, Ann

2017-01-01

Highlights: • Radiomics is the post-processing and analysis of large amounts of quantitative imaging features that can be derived from medical images. • Radiomics features can reflect the spatial complexity, genomic heterogeneity, and subregional identification of lung cancer. • Currently available radiomic features can be divided into four major categories. • The major challenge is to integrate radiomic data with clinical, pathological, and genomic information. - Abstract: With the development of functional imaging modalities we now have the ability to study the microenvironment of lung cancer and its genomic instability. Radiomics is defined as the use of automated or semi-automated post-processing and analysis of large amounts of quantitative imaging features that can be derived from medical images. The automated generation of these analytical features helps to quantify a number of variables in the imaging assessment of lung malignancy. These imaging features include: tumor spatial complexity, elucidation of the tumor genomic heterogeneity and composition, subregional identification in terms of tumor viability or aggressiveness, and response to chemotherapy and/or radiation. Therefore, a radiomic approach can help to reveal unique information about tumor behavior. Currently available radiomic features can be divided into four major classes: (a) morphological, (b) statistical, (c) regional, and (d) model-based. Each category yields quantitative parameters that reflect specific aspects of a tumor. The major challenge is to integrate radiomic data with clinical, pathological, and genomic information to decode the different types of tissue biology. There are many currently available radiomic studies on lung cancer for which there is a need to summarize the current state of the art.

Radiomics and its emerging role in lung cancer research, imaging biomarkers and clinical management: State of the art

Energy Technology Data Exchange (ETDEWEB)

Lee, Geewon [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Department of Radiology and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan (Korea, Republic of); Lee, Ho Yun, E-mail: hoyunlee96@gmail.com [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Park, Hyunjin [School of Electronic and Electrical Engineering and Center for Neuroscience Imaging Research, Sungkyunkwan University, Suwon (Korea, Republic of); Schiebler, Mark L. [Department of Radiology, UW-Madison School of Medicine and Public Health, Madison, WI (United States); Beek, Edwin J.R. van [Clinical Research Imaging Centre, Edinburgh Imaging, Queen' s Medical Research Institute, University of Edinburgh, Edinburgh (United Kingdom); Ohno, Yoshiharu [Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe-shi 650-0017 (Japan); Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe-shi 650-0017 (Japan); Seo, Joon Beom [Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Leung, Ann [Department of Radiology, Stanford University, Palo Alto, CA (United States)

2017-01-15

Highlights: • Radiomics is the post-processing and analysis of large amounts of quantitative imaging features that can be derived from medical images. • Radiomics features can reflect the spatial complexity, genomic heterogeneity, and subregional identification of lung cancer. • Currently available radiomic features can be divided into four major categories. • The major challenge is to integrate radiomic data with clinical, pathological, and genomic information. - Abstract: With the development of functional imaging modalities we now have the ability to study the microenvironment of lung cancer and its genomic instability. Radiomics is defined as the use of automated or semi-automated post-processing and analysis of large amounts of quantitative imaging features that can be derived from medical images. The automated generation of these analytical features helps to quantify a number of variables in the imaging assessment of lung malignancy. These imaging features include: tumor spatial complexity, elucidation of the tumor genomic heterogeneity and composition, subregional identification in terms of tumor viability or aggressiveness, and response to chemotherapy and/or radiation. Therefore, a radiomic approach can help to reveal unique information about tumor behavior. Currently available radiomic features can be divided into four major classes: (a) morphological, (b) statistical, (c) regional, and (d) model-based. Each category yields quantitative parameters that reflect specific aspects of a tumor. The major challenge is to integrate radiomic data with clinical, pathological, and genomic information to decode the different types of tissue biology. There are many currently available radiomic studies on lung cancer for which there is a need to summarize the current state of the art.

Fueling Requirements for Steady State high butane current fraction discharges

International Nuclear Information System (INIS)

R.Raman

2003-01-01

The CT injector originally used for injecting CTs into 1T toroidal field discharges in the TdeV tokamak was shipped PPPL from the Affiliated Customs Brokers storage facility in Montreal during November 2002. All components were transported safely, without damage, and are currently in storage at PPPL, waiting for further funding in order to begin advanced fueling experiments on NSTX. The components are currently insured through the University of Washington. Several technical presentations were made to investigate the feasibility of the CT injector installation on NSTX. These technical presentations, attached to this document, were: (1) Motivation for Compact Toroida Injection in NSTX; (2) Assessment of the Engineering Feasibility of Installing CTF-II on NSTX; (3) Assessment of the Cost for CT Installation on NSTX--A Peer Review; and (4) CT Fueling for NSTX FY 04-08 steady-state operation needs

Film-induced Tourism in Finland : Its Current State and Opportunities

OpenAIRE

Anul, Kezban

2013-01-01

The goal of this paper was to evaluate the current state of film-induced tourism in Finland and to create suggestions for further development in the context of international markets. To the knowledge of the author, a comprehensive study about film-induced tourism in Finland has not been undertaken yet. Therefore, the thesis was designed in the form of an exploratory research with the aim to deliver some initial insights and key issues for the broad topic. The paper starts with a general ...

MRI for solitary pulmonary nodule and mass assessment: Current state of the art.

Science.gov (United States)

Ohno, Yoshiharu; Kauczor, Hans-Ulrich; Hatabu, Hiroto; Seo, Joon Beom; van Beek, Edwin J R

2018-03-23

Since the clinical introduction of magnetic resonance imaging (MRI), the chest has been one of its most challenging applications, and many physicists and radiologists have tried since the 1980s to use MR for assessment of different lung diseases as well as mediastinal and pleural diseases. Since then, however, technical advances in sequencing, scanners, and coils, adaptation of parallel imaging techniques, utilization of contrast media, and development of postprocessing tools have been reported by many basic and clinical researchers. As a result, state-of-the-art thoracic MRI is now substituted for traditional imaging techniques and/or plays a complementary role in the management of patients with various chest diseases, and especially in the detection of pulmonary nodules and in thoracic oncology. In addition, MRI has continued to be developed to help overcome the limitations of computed tomography (CT) and nuclear medicine examinations. It can currently provide not only morphological, but also functional, physiological, pathophysiological, and molecular information at 1.5T with a gradual shift from 1.5T to 3T MR systems. In this review, we focus on these recent advances in MRI for pulmonary nodule detection and pulmonary nodule and mass evaluation by using noncontrast-enhanced and contrast-enhanced techniques as well as new molecular imaging methods such as chemical exchange saturation transfer imaging for a comparison with other modalities such as single or multidetector row CT, 18F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET), and/or PET/CT. 4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018. © 2018 International Society for Magnetic Resonance in Medicine.

Clinical Characteristics and Current Treatment of Age-Related Macular Degeneration

Science.gov (United States)

Yonekawa, Yoshihiro; Kim, Ivana K.

2015-01-01

Age-related macular degeneration (AMD) is a multifactorial degeneration of photoreceptors and retinal pigment epithelium. The societal impact is significant, with more than 2 million individuals in the United States alone affected by advanced stages of AMD. Recent progress in our understanding of this complex disease and parallel developments in therapeutics and imaging have translated into new management paradigms in recent years. However, there are many unanswered questions, and diagnostic and prognostic precision and treatment outcomes can still be improved. In this article, we discuss the clinical features of AMD, provide correlations with modern imaging and histopathology, and present an overview of treatment strategies. PMID:25280900

External heating and current drive source requirements towards steady-state operation in ITER

Science.gov (United States)

Poli, F. M.; Kessel, C. E.; Bonoli, P. T.; Batchelor, D. B.; Harvey, R. W.; Snyder, P. B.

2014-07-01

Steady state scenarios envisaged for ITER aim at optimizing the bootstrap current, while maintaining sufficient confinement and stability to provide the necessary fusion yield. Non-inductive scenarios will need to operate with internal transport barriers (ITBs) in order to reach adequate fusion gain at typical currents of 9 MA. However, the large pressure gradients associated with ITBs in regions of weak or negative magnetic shear can be conducive to ideal MHD instabilities, reducing the no-wall limit. The E × B flow shear from toroidal plasma rotation is expected to be low in ITER, with a major role in the ITB dynamics being played by magnetic geometry. Combinations of heating and current drive (H/CD) sources that sustain reversed magnetic shear profiles throughout the discharge are the focus of this work. Time-dependent transport simulations indicate that a combination of electron cyclotron (EC) and lower hybrid (LH) waves is a promising route towards steady state operation in ITER. The LH forms and sustains expanded barriers and the EC deposition at mid-radius freezes the bootstrap current profile stabilizing the barrier and leading to confinement levels 50% higher than typical H-mode energy confinement times. Using LH spectra with spectrum centred on parallel refractive index of 1.75-1.85, the performance of these plasma scenarios is close to the ITER target of 9 MA non-inductive current, global confinement gain H98 = 1.6 and fusion gain Q = 5.

Step Up-Not On-The Step 2 Clinical Skills Exam: Directors of Clinical Skills Courses (DOCS) Oppose Ending Step 2 CS.

Science.gov (United States)

Ecker, David J; Milan, Felise B; Cassese, Todd; Farnan, Jeanne M; Madigosky, Wendy S; Massie, F Stanford; Mendez, Paul; Obadia, Sharon; Ovitsh, Robin K; Silvestri, Ronald; Uchida, Toshiko; Daniel, Michelle

2018-05-01

Recently, a student-initiated movement to end the United States Medical Licensing Examination Step 2 Clinical Skills and the Comprehensive Osteopathic Medical Licensing Examination Level 2-Performance Evaluation has gained momentum. These are the only national licensing examinations designed to assess clinical skills competence in the stepwise process through which physicians gain licensure and certification. Therefore, the movement to end these examinations and the ensuing debate merit careful consideration. The authors, elected representatives of the Directors of Clinical Skills Courses, an organization comprising clinical skills educators in the United States and beyond, believe abolishing the national clinical skills examinations would have a major negative impact on the clinical skills training of medical students, and that forfeiting a national clinical skills competency standard has the potential to diminish the quality of care provided to patients. In this Perspective, the authors offer important additional background information, outline key concerns regarding the consequences of ending these national clinical skills examinations, and provide recommendations for moving forward: reducing the costs for students, exploring alternatives, increasing the value and transparency of the current examinations, recognizing and enhancing the strengths of the current examinations, and engaging in a national dialogue about the issue.

Development and current state of dosimetry in Cuba

International Nuclear Information System (INIS)

Prieto Miranda, E.F.; Cuesta Fuente, G.; Chavez Ardanza, A.

1999-01-01

In Cuba, the application of the radiation technologies has been growing in the last years, and at present there are several dosimetry systems with different ranges of absorbed dose. Diverse researches were carried out on high dose dosimetry with the following dosimetry systems: Fricke, ceric-cerous sulfate, ethanol-chlorobenzene, cupric sulfate and Perspex (Red 4034 AE and Clear HX). In this paper the development achieved during the last 15 years in the high dose dosimetry for radiation processing in Cuba is presented, as well as, the current state of different dosimetry systems employed for standardization and for process control. The paper also reports the results of dosimetry intercomparison studies that were performed with the Ezeiza Atomic Center of Argentine and the International Dose Assurance Service (IDAS) of IAEA. (author)

Nicotine at clinically relevant concentrations affects atrial inward rectifier potassium current sensitive to acetylcholine.

Science.gov (United States)

Bébarová, Markéta; Matejovič, Peter; Švecová, Olga; Kula, Roman; Šimurdová, Milena; Šimurda, Jiří

2017-05-01

Nicotine abuse is associated with variety of diseases including arrhythmias, most often atrial fibrillation (AF). Altered inward rectifier potassium currents including acetylcholine-sensitive current I K(Ach) are known to be related to AF pathogenesis. Since relevant data are missing, we aimed to investigate I K(Ach) changes at clinically relevant concentrations of nicotine. Experiments were performed by the whole cell patch clamp technique at 23 ± 1 °C on isolated rat atrial myocytes. Nicotine was applied at following concentrations: 4, 40 and 400 nM; ethanol at 20 mM (∼0.09%). Nicotine at 40 and 400 nM significantly activated constitutively active component of I K(Ach) with the maximum effect at 40 nM (an increase by ∼100%); similar effect was observed at -110 and -50 mV. Changes at 4 nM nicotine were negligible on average. Coapplication of 40 nM nicotine and 20 mM ethanol (which is also known to activate this current) did not show cumulative effect. In the case of acetylcholine-induced component of I K(Ach) , a dual effect of nicotine and its correlation with the current magnitude in control were apparent: the current was increased by nicotine in the cells showing small current in control and vice versa. The effect of 40 and 400 nM nicotine on acetylcholine-induced component of I K(Ach) was significantly different at -110 and -50 mV. We conclude that nicotine at clinically relevant concentrations significantly increased constitutively active component of I K(Ach) and showed a dual effect on its acetylcholine-induced component, similarly as ethanol. Synchronous application of nicotine and ethanol did not cause additive effect.

Current-State Constrained Filter Bank for Wald Testing of Spacecraft Conjunctions

Science.gov (United States)

Carpenter, J. Russell; Markley, F. Landis

2012-01-01

We propose a filter bank consisting of an ordinary current-state extended Kalman filter, and two similar but constrained filters: one is constrained by a null hypothesis that the miss distance between two conjuncting spacecraft is inside their combined hard body radius at the predicted time of closest approach, and one is constrained by an alternative complementary hypothesis. The unconstrained filter is the basis of an initial screening for close approaches of interest. Once the initial screening detects a possibly risky conjunction, the unconstrained filter also governs measurement editing for all three filters, and predicts the time of closest approach. The constrained filters operate only when conjunctions of interest occur. The computed likelihoods of the innovations of the two constrained filters form a ratio for a Wald sequential probability ratio test. The Wald test guides risk mitigation maneuver decisions based on explicit false alarm and missed detection criteria. Since only current-state Kalman filtering is required to compute the innovations for the likelihood ratio, the present approach does not require the mapping of probability density forward to the time of closest approach. Instead, the hard-body constraint manifold is mapped to the filter update time by applying a sigma-point transformation to a projection function. Although many projectors are available, we choose one based on Lambert-style differential correction of the current-state velocity. We have tested our method using a scenario based on the Magnetospheric Multi-Scale mission, scheduled for launch in late 2014. This mission involves formation flight in highly elliptical orbits of four spinning spacecraft equipped with antennas extending 120 meters tip-to-tip. Eccentricities range from 0.82 to 0.91, and close approaches generally occur in the vicinity of perigee, where rapid changes in geometry may occur. Testing the method using two 12,000-case Monte Carlo simulations, we found the

Doctors currently in jobs with academic content and their future intentions to pursue clinical academic careers: questionnaire surveys.

Science.gov (United States)

Lambert, Trevor W; Smith, Fay; Goldacre, Michael J

2015-02-01

Our aim was to report on doctors' descriptions of their current post at about 12 years after qualification, in respect of academic content, and to compare this with their long-term intentions. By academic content, we mean posts that are designated as clinical academic posts or clinical service posts that include research and/or teaching commitments. Questionnaire survey. All UK medical graduates of 1996 contacted in 2007, graduates of 1999 in 2012, and graduates of 2000 in 2012. UK. Responses about current posts and future intentions. Postal and email questionnaires. The response rate was 61.9% (6713/10844). Twenty eight per cent were working in posts with academic content (3.3% as clinical academics, 25% in clinical posts with some academic content). Seventeen per cent of women were working in clinical posts with some teaching and research, compared with 29% of men. A higher percentage of men than women intended to be clinical academics as their eventual career choice (3.9% overall, 5.4% of men, 2.7% of women). More doctors wished to move to a job with an academic component than away from one (N = 824 compared with 236). This was true for both men (433 compared with 118) and women (391 compared with 118). Women are under-represented both in holding posts with academic content and in aspirations to do so. It is noteworthy that many more doctors hoped to move into an academic role than to move out of one. Policy should facilitate this wish in order to address current shortfalls in clinical academic medicine.

Cooper pairs versus Bose condensed molecules: The ground-state current in superfluid 3He-A

International Nuclear Information System (INIS)

Mermin, N.D.; Muzikar, P.

1980-01-01

We present a new calculation of the current g flowing in a ground state of the Bardeen-Cooper-Schrieffer (BCS) form for a weakly inhomogeneous superfluid with the symmetry of 3 He-A. When the structure of the order parameter not determined by symmetry is appropriate to 3 He-A and when the mass density rho of the helium is essentially uniform, our current reduces to that calculated by Cross. If the mass density is allowed to vary, we find a generalization of the Cross current which shows that when v/sub s/=0 and the anisotropy axis l is uniform, then the current is simply (h/4M) del-arrow-rightrho x l. We show that this property of the BCS ground state, which taken with the Cross definition leads to an ''intrinsic angular momentum density'' of rhoh/2M at zero temperature, also follows directly from the Gor'kov equations. If the range of the order parameter is taken to be small compared with the interatomic separation, then the ground state does not describe 3 He-A, but a Bose-Einstein condensate of tightly bound diatomic molecules. In this limit our current reduces to the form calculated by Ishikawa et al. We indicate why their analysis is only valid in this limit, and offer some rather more general remarks on the differences between Cooper pairing and the Bose-Einstein condensation of diatomic molecules

PUBLIC ADMINISTRATION: MODERNIZING THE CURRENT MODEL OF STATE MANAGEMENT

Directory of Open Access Journals (Sweden)

Evgenii V. Ohotskii

2014-01-01

Full Text Available Applying the method of retrospective analysis the article deals with the process of forming the scientific fundamentals and the search by the international community of effective and adequate to the current stage of social development public administration system. The author attempts to analyze, in a number of cases in terms of models, features of public administration systems at different stages of historical development, drawing attention to reasons why the Soviet model of public administration did not manage to meet competition, did not provide the required social effect and as a natural result suffered a defeat in the global confrontation between the two social systems. Current models and theoretical concepts of public administration, especially the "new public administration", which became scientific basis for administrative reforms implemented in many countries, are the particular subject of scientific analysis. The author draws attention to major comprehensive characteristics of modern state public administration: making it impossible to absolutize principles of traditional hierarchy system of forced administration; globalization - gradual destruction of boundaries between national and international levels of administration, the growing role of supranational subjects of administration relations; informatization - increasing importance of information and communication technologies and of political networks: development of civil society, especially political parties and non-governmental organizations, growing public involvement in discussion and adoption of the most important administrative decisions; making the state policy more pluralistic and which will result in the formation of nonlinear - humanistic social consciousness as the intellectual basis of modern social governance. The author's position is that Russia is yet to solve the issue of choosing a public administration model that would be effective for further administrative

The Current State and Path Forward For Enterprise Image Viewing: HIMSS-SIIM Collaborative White Paper.

Science.gov (United States)

Roth, Christopher J; Lannum, Louis M; Dennison, Donald K; Towbin, Alexander J

2016-10-01

Clinical specialties have widely varied needs for diagnostic image interpretation, and clinical image and video image consumption. Enterprise viewers are being deployed as part of electronic health record implementations to present the broad spectrum of clinical imaging and multimedia content created in routine medical practice today. This white paper will describe the enterprise viewer use cases, drivers of recent growth, technical considerations, functionality differences between enterprise and specialty viewers, and likely future states. This white paper is aimed at CMIOs and CIOs interested in optimizing the image-enablement of their electronic health record or those who may be struggling with the many clinical image viewers their enterprises may employ today.

Current Role for Biomarkers in Clinical Diagnosis of Alzheimer Disease and Frontotemporal Dementia.

Science.gov (United States)

Sheikh-Bahaei, Nasim; Sajjadi, Seyed Ahmad; Pierce, Aimee L

2017-11-14

Purpose of review Alzheimer's disease (AD) and frontotemporal dementia can often be diagnosed accurately with careful clinical history, cognitive testing, neurological examination, and structural brain MRI. However, there are certain circumstances wherein detection of specific biomarkers of neurodegeneration or underlying AD pathology will impact the clinical diagnosis or treatment plan. We will review the currently available biomarkers for AD and frontotemporal dementia (FTD) and discuss their clinical importance. Recent findings With the advent of 18 F-labeled tracers that bind amyloid plaques, amyloid PET is now clinically available for the detection of amyloid pathology and to aid in a biomarker-supported diagnosis of AD or mild cognitive impairment (MCI) due to AD. It is not yet possible to test for the specific FTD pathologies (tau or TDP-43); however, a diagnosis of FTD may be "imaging supported" based upon specific MRI or FDG-PET findings. Cerebrospinal fluid measures of amyloid-beta, total-tau, and phospho-tau are clinically available and allow detection of both of the cardinal pathologies of AD: amyloid and tau pathology. Summary It is appropriate to pursue biomarker testing in cases of MCI and dementia when there remains diagnostic uncertainty and the result will impact diagnosis or treatment. Practically speaking, due to the rising prevalence of amyloid positivity with advancing age, measurement of biomarkers in cases of MCI and dementia is most helpful in early-onset patients, patients with atypical clinical presentations, or when considering referral for AD clinical trials.

Microbial production of hyaluronic acid: current state, challenges, and perspectives

Directory of Open Access Journals (Sweden)

Liu Long

2011-11-01

Full Text Available Abstract Hyaluronic acid (HA is a natural and linear polymer composed of repeating disaccharide units of β-1, 3-N-acetyl glucosamine and β-1, 4-glucuronic acid with a molecular weight up to 6 million Daltons. With excellent viscoelasticity, high moisture retention capacity, and high biocompatibility, HA finds a wide-range of applications in medicine, cosmetics, and nutraceuticals. Traditionally HA was extracted from rooster combs, and now it is mainly produced via streptococcal fermentation. Recently the production of HA via recombinant systems has received increasing interest due to the avoidance of potential toxins. This work summarizes the research history and current commercial market of HA, and then deeply analyzes the current state of microbial production of HA by Streptococcus zooepidemicus and recombinant systems, and finally discusses the challenges facing microbial HA production and proposes several research outlines to meet the challenges.

Shallow Lunar Seismic Activity and the Current Stress State of the Moon

Science.gov (United States)

Watters, Thomas R.; Weber, Renee C.; Collins, Geoffrey C.; Johnson, Catherine L.

2017-01-01

A vast, global network of more than 3200 lobate thrust fault scarps has been revealed in high resolution Lunar Reconnaissance Orbiter Camera (LROC) images. The fault scarps are very young, less than 50 Ma, based on their small scale and crisp appearance, crosscutting relations with small-diameter impact craters, and rates of infilling of associated small, shallow graben and may be actively forming today. The population of young thrust fault scarps provides a window into the recent stress state of the Moon and offers insight into the origin of global lunar stresses. The distribution of orientations of the fault scarps is non-random, inconsistent with isotropic stresses from late-stage global contraction as the sole source of stress. Modeling shows that tidal stresses contribute significantly to the current stress state of the lunar crust. Tidal stresses (orbital recession and diurnal tides) superimposed on stresses from global contraction result in non-isotropic compressional stress and may produce thrust faults consistent with lobate scarp orientations. At any particular point on the lunar surface, peak compressive stress will be reached at a certain time in the diurnal cycle. Coseismic slip events on currently active thrust faults are expected to be triggered when peak stresses are reached. Analysis of the timing of the 28 the shallow moonquakes recorded by the Apollo seismic network shows that 19 indeed occur when the Moon is closer to apogee, while only 9 shallow events occur when the Moon is closer to perigee. Here we report efforts to refine the model for the current stress state of the Moon by investigating the contribution of polar wander. Progress on relocating the epicentral locations of the shallow moonquakes using an algorithm designed for sparse networks is also reported.

Important configurations in six-quark N-N states. II. Current quark model

International Nuclear Information System (INIS)

Stancu, F.; Wilets, L.

1989-01-01

Quark basis states constructed from molecular-type orbitals were shown previously to be more convenient to use than cluster model states for N-N processes. The usual cluster model representation omits configurations which emerge naturally in a molecular basis which contains the same number of spatial functions. The importance of the omitted states was demonstrated for a constituent quark model. The present work extends the study to the prototypical current quark model, namely the MIT bag. In order to test the expansion for short-range N-N interactions, the eigenstates and eigenenergies of six quarks in a spherical bag, including one-gluon exchange, are calculated. The lowest eigenenergies are lowered significantly with respect to the usual cluster model. This reaffirms the importance of dynamics for obtaining the needed short-range repulsion

Mentoring and New Teacher Induction in the United States: A Review and Analysis of Current Practices

Science.gov (United States)

Bullough, Robert V., Jr.

2012-01-01

In this article, current practices were reviewed in mentoring and induction across three large states--New York, Texas, and California--and one small state, Utah. Patterns and trends are described in the United States, program results and evolving views of mentoring are discussed, gaps in the research literature are identified, and the future of…

Current concepts in maxillofacial imaging

Energy Technology Data Exchange (ETDEWEB)

Boeddinghaus, Rudolf [Perth Radiological Clinic, 127 Hamersley Road, Subiaco, Western Australia 6008 (Australia)], E-mail: rboeddinghaus@perthradclinic.com.au; Whyte, Andy [Perth Radiological Clinic, 127 Hamersley Road, Subiaco, Western Australia 6008 (Australia)], E-mail: awhyte@perthradclinic.com.au

2008-06-15

A review of state-of-the-art maxillofacial imaging is presented. Current imaging techniques include intra-oral radiographs, dental panoramic tomography, multidetector helical computed tomography, cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI). The commonest conditions encountered in clinical radiological practice are reviewed, including maxillofacial deformities, complicated dental impactions, maxillofacial trauma, jaw lesions (cysts, neoplasms, fibro-osseous lesions (FOLs) and infections), and temporomandibular joint pathology. Pre-operative assessment for dental implant placement is also briefly reviewed.

The association between current unemployment and clinically determined poor oral health.

Science.gov (United States)

Al-Sudani, Fouad Y H; Vehkalahti, Miira M; Suominen, Anna L

2015-08-01

The aim of this study was to assess whether current unemployment was associated with poor oral health and whether there was a difference in oral health according to the duration of the current unemployment. As part of the Health 2000 Survey in Finland (a nationwide comprehensive health examination survey), we used its data based on interviews, questionnaires, and clinical oral examinations of the 30- to 63-year-old respondents (n = 4773). Current employment status was measured in its dichotomous form, employed versus unemployed, and length of current unemployment was classified into four categories. We measured oral health in terms of numbers of missing teeth, of sound teeth, of filled teeth, of decayed teeth, and of teeth with deepened periodontal pockets (≥4 mm, ≥6 mm). Poisson regression models were fitted for all oral health outcomes except number of decayed teeth, for which negative binomial regression model was used. Oral health-related behaviors and sociodemographic and socioeconomic factors were added to the analyses. The unemployed subjects had higher numbers of missing teeth, of decayed teeth, and of teeth with periodontal pockets than the employed ones. The association remained consistent even after adjustments. Oral health-related behaviors seemed to mediate the association. We found no association between unemployment and number of sound teeth. Current long-term unemployment showed stronger association with poor oral health than short-term among women. The unemployed can be considered as a risk group for poor oral health. Oral healthcare should be reoriented toward those who are unemployed. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

There is an app for that! The current state of mobile applications (apps) for DSM-5 obsessive-compulsive disorder, posttraumatic stress disorder, anxiety and mood disorders.

Science.gov (United States)

Van Ameringen, Michael; Turna, Jasmine; Khalesi, Zahra; Pullia, Katrina; Patterson, Beth

2017-06-01

Mental health apps are viewed as a promising modality to extend the reach of mental health care beyond the clinic. They do so by providing a means of assessment, tracking, and treatment through a smartphone. Given that nearly 2/3 of the American population owns a smartphone, mental health apps offer the possibility of overcoming treatment barriers such as geographic location or financial barriers. Unfortunately, the excitement surrounding mental health apps may be premature as the current supporting literature regarding their efficacy is limited. The app marketplace is littered with apps claiming to treat or assess symptoms, but even those created by reputable organizations or those incorporating components of evidence-based treatments have not yet been validated in terms of their efficacy. This review aims to provide a comprehensive review of the current state of the mental health app literature by examining published reports of apps designed for DSM-5 anxiety and mood disorders, OCD, and PTSD. The breadth of apps reviewed includes those oriented around assessment, symptom tracking, and treatment as well as "multipurpose" apps, which incorporate several of these components. This review will also present some of the most popular mental health apps which may have clinical utility and could be prescribed to clients. While we discuss many potential benefits of mental health apps, we focus on a number of issues that the current state of the app literature presents. Overall there is a significant disconnect between app developers, the scientific community and health care, leaving the utility of existing apps questionable. © 2017 Wiley Periodicals, Inc.

Regulatory Considerations for the Clinical and Research Use of Transcranial Direct Current Stimulation (tDCS): review and recommendations from an expert panel

Science.gov (United States)

Fregni, F; Nitsche, MA; Loo, C.K.; Brunoni, AR; Marangolo, P; Leite, J; Carvalho, S; Bolognini, N; Caumo, W; Paik, NJ; Simis, M; Ueda, K; Ekhitari, H; Luu, P; Tucker, DM; Tyler, WJ; Brunelin, J; Datta, A; Juan, CH; Venkatasubramanian, G; Boggio, PS; Bikson, M

2014-01-01

The field of transcranial electrical stimulation (tES) has experienced significant growth in the past 15 years. One of the tES techniques leading this increased interest is transcranial direct current stimulation (tDCS). Significant research efforts have been devoted to determining the clinical potential of tDCS in humans. Despite the promising results obtained with tDCS in basic and clinical neuroscience, further progress has been impeded by a lack of clarity on international regulatory pathways. We therefore convened a group of research and clinician experts on tDCS to review the research and clinical use of tDCS. In this report, we review the regulatory status of tDCS, and we summarize the results according to research, off-label and compassionate use of tDCS in the following countries: Australia, Brazil, France, Germany, India, Iran, Italy, Portugal, South Korea, Taiwan and United States. Research use, off label treatment and compassionate use of tDCS are employed in most of the countries reviewed in this study. It is critical that a global or local effort is organized to pursue definite evidence to either approve and regulate or restrict the use of tDCS in clinical practice on the basis of adequate randomized controlled treatment trials. PMID:25983531

New Way of Characterizing the State of the Ring Current

Science.gov (United States)

Wolf, R.; Bao, S.; Gkioulidou, M.; Yang, J.; Toffoletto, F.

2017-12-01

The flux tube entropy S is invariant in ideal MHD and is a good way to characterize the degree to which a closed flux tube is loaded with particle energy. Flux tube entropy generally increases with increasing geocentric distance. A flux tube that is injected from the plasma sheet into the ring current tends to be a bubble that has a lower S value than typical plasma sheet flux tubes, and it tends to penetrate to a position where the surroundings matches its S. From this point of view, a good way to characterize the state of the ring current is through the function dF/dS, which specifies how much magnetic flux is occupied by tubes with different degrees of loading. By displaying dF/dS curves before and during storm main phases simulated with the RCM-E code, we determine that, in the model, the injection of the stormtime ring current consists of replacing pre-storm low-S flux tubes with tubes from the plasma sheet that have a certain limited range of S, which is well below typical plasma-sheet values. We also display dF/dS curves for passes by the Van Allen Probes before and during storm main phases, and compare with the RCM-E-derived curves, to gain insight into the nature of the flux tubes that are injected to form the real storm-time ring current.

Current status and future prospects of the development of clinical Pharmacy in China: A SWOT analysis.

Science.gov (United States)

Rao, Yuefeng; Zhao, Qingwei; Zhang, Xiangyi; Yang, Hongyu; Lou, Yan; Zhang, Xingguo

2016-03-01

In many industrialized countries, clinical pharmacy has developed into a separate discipline and become a vital part of inpatient care in hospitals. However, as compared to many established branches of medicine, clinical pharmacy is still in its infancy, with much room for growth, improvement, and recognition by both the medical community and patients. In this study, a widely-recognized development strategy analysis tool, Strength, Weakness, Opportunity and Threat (SWOT), was used to systematically address several key issues to the development of clinical pharmacy in China. This analysis aims to provide feasible recommendations for the development of clinical pharmacy in China by identifying current problems and growth opportunities. Full development of clinical pharmacy as a mature clinical discipline will help promote the rational use of drugs by both clinicians and patients and lead to enhanced drug efficacy and safety.

Early Childhood Inclusion in the United States: Goals, Current Status, and Future Directions

Science.gov (United States)

Guralnick, Michael J.; Bruder, Mary Beth

2016-01-01

The current status and future directions of early childhood inclusion in the United States are discussed from the perspective of 4 key goals: access, accommodations and feasibility, developmental progress, and social integration. Recommendations are put forward to promote inclusion goals emphasizing administrative structures, personnel…

Current opportunities and challenges in skeletal muscle tissue engineering

NARCIS (Netherlands)

Koning, Merel; Harmsen, Martin C; van Luyn, Marja J A; Werker, Paul M N

The purpose of this article is to give a concise review of the current state of the art in tissue engineering (TE) of skeletal muscle and the opportunities and challenges for future clinical applicability. The endogenous progenitor cells of skeletal muscle, i.e. satellite cells, show a high

[Nostalgia as a state of mind and as a clinical form].

Science.gov (United States)

Borgna, E

2001-01-01

Psychiatry, as human science, necessarily concerns emotions too and, among these, nostalgia. Nostalgia is not only a mind condition but also a psychopathological and clinical state which can be defined nostalgic depression form. At the beginning of this work, on the base of a clinical case-report, we describe the phenomenological and space-temporal aspects of nostalgia, we analyse some psychopathological situations that, marked by nostalgic emotions, come from moving house, exile and rooting out. Each of these situations go with depression models thematically different, that are explained in the work.

Current status and clinical association of beta-catenin with juvenile nasopharyngeal angiofibroma.

Science.gov (United States)

Mishra, A; Singh, V; Verma, V; Pandey, S; Trivedi, R; Singh, H P; Kumar, S; Dwivedi, R C; Mishra, S C

2016-10-01

A possible role of the APC/beta-catenin pathway in the pathogenesis of sporadic juvenile nasopharyngeal angiofibroma has been suggested. This paper presents its current status and clinical association in our patients. A prospective observational study was conducted at King George Medical University and Central Drug Research Institute, in Lucknow, India. Western blot analysis was undertaken in 16 cases to examine beta-catenin expression. The clinical details were recorded along with follow up observations, to determine associations. Up-regulation of beta-catenin expression was seen in 69 per cent of cases. The clinical variables did not reveal significant differences between patients with extremes of expression (extreme under- vs over-expression). However, absent expression was shown exclusively in young adults aged over 18 years, while enhanced expression was associated with an altered facial profile. Although a beta-catenin association was seen in a subset of our sporadic juvenile nasopharyngeal angiofibroma cases, its expression was not homogeneous. This is in contrast to the Western literature that suggests a universal (homogenous) enhanced expression in the majority. Hence, further research is required to better define its molecular cascade.

Tidal Stream Generators, current state and potential opportunities for condition monitoring

DEFF Research Database (Denmark)

Kappatos, Vassilios; Georgoulas, George; Avdelidis, Nicolas

2016-01-01

Tidal power industry has made significant progress towards commercialization over the past decade. Significant investments from sector leaders, strong technical progress and positive media coverage have established the credibility of this specific renewable energy source. However, its progress...... is being retarded by operation and maintenance problems, which results in very low operational availability times, as low as 25 %. This paper presents a literature review of the current state of tidal device operators as well as some commercial tidal turbine condition monitoring solutions. Furthermore......, an overview is given of the global tidal activity status (tidal energy market size and geography), the key industry activity and the regulations-standards related with tidal energy industry. Therefore, the main goal of this paper is to provide a bird’s view of the current status of the tidal power industry...

THE ATTITUDE TOWARDS TREATMENT OF CARDIOVASCULAR DISEASES: A SURVEY OF PATIENTS OF STATE OUTPATIENT CLINICS AND PRIVATE MEDICAL CENTERS

Directory of Open Access Journals (Sweden)

O. N. Semenova

2015-01-01

Full Text Available Aim. To study the differences in views on treatment among patients with cardiovascular diseases in state and private outpatient clinics, as well as the motivation for choosing one of these outpatient clinics.Material and methods. Anonymous and voluntary survey of cardiology patients (n=90 in 2 state (57.7% and 3 private outpatient clinics (42.2% was conducted in Saratov.Results. 33.3% of respondents were men; the median age was 65 years. Patients of state outpatient clinics were more likely to have retirement age (p=0.0008, low income (p=0.0006, history of hypertensive crises (p=0.0129 and chronic heart failure (p=0.0001. Patients of private outpatient clinics were more likely to have mental work (p=0.0001, higher education (p=0.0001, moderate income (p=0.0006. The difference in views on the disease and the attitude towards a doctor among patients of state and private clinics was shown.Conclusion. Patients of private outpatient clinics were more active, young, aimed at continuation of life. They are more likely to have higher education, mental work and moderate income. Patients of state outpatient clinics are "infatuated with their illness"; it is their “lifestyle”. Paternalistic model of communication with doctors is expressed in all the patients.

Current role of liquid chromatography coupled to mass spectrometry in clinical toxicology screening methods.

Science.gov (United States)

Viette, Véronique; Fathi, Marc; Rudaz, Serge; Hochstrasser, Denis; Veuthey, Jean-Luc

2011-07-01

Abstract Toxicological screening is the analysis of a biological specimen to detect and identify compounds in patients admitted to the hospital with acute intoxication of unknown origin. The screening of a wide range of toxicologically relevant compounds in biological samples is a serious challenge for clinical laboratories. The high selectivity and sensitivity of liquid chromatography coupled to mass spectrometry or tandem mass spectrometry technology provides an attractive alternative to the current methods. For these reasons, an increasing number of applications for multi-target screening or general screening of unknown compounds in biological matrices are being published. This paper is an overview of sample clean-up, chromatographic separation and mass spectrometry detection procedures which can be combined to obtain screening methods adapted to the constraints and needs of various laboratories, and none specifically in clinical toxicology. Currently the techniques are in the hands of specialists, principally in academic institutes. However, the evolution in technology should allow application of the techniques as a tool in toxicology laboratories and thus more widespread exploitation of their potential.

Clinical decision support systems in hospital care using ubiquitous devices: Current issues and challenges.

Science.gov (United States)

Baig, Mirza Mansoor; GholamHosseini, Hamid; Moqeem, Aasia A; Mirza, Farhaan; Lindén, Maria

2017-11-01

Supporting clinicians in decision making using advanced technologies has been an active research area in biomedical engineering during the past years. Among a wide range of ubiquitous systems, smartphone applications have been increasingly developed in healthcare settings to help clinicians as well as patients. Today, many smartphone applications, from basic data analysis to advanced patient monitoring, are available to clinicians and patients. Such applications are now increasingly integrating into healthcare for clinical decision support, and therefore, concerns around accuracy, stability, and dependency of these applications are rising. In addition, lack of attention to the clinicians' acceptability, as well as the low impact on the medical professionals' decision making, are posing more serious issues on the acceptability of smartphone applications. This article reviews smartphone-based decision support applications, focusing on hospital care settings and their overall impact of these applications on the wider clinical workflow. Additionally, key challenges and barriers of the current ubiquitous device-based healthcare applications are identified. Finally, this article addresses current challenges, future directions, and the adoption of mobile healthcare applications.

Clinical Engeneering Experience at the Hospital of the State University of Londrina

OpenAIRE

Ernesto Fernando Ferreyra Ramírez

2002-01-01

This paper describes the four-year experience of implementation of Clinical Engineering services at the Hospital of the State University of Londrina (HURNP/UEL). It was performed by the Electrical Engineering Department (DEEL), through a project involving lecturers and students from the Electrical and Civil Engineering Courses of the same university. The main objectives were the formation of human resources in the Clinical Engineering area and a positive contribution to the healthcare service...

The US Opioid Crisis: Current Federal and State Legal Issues.

Science.gov (United States)

Soelberg, Cobin D; Brown, Raeford E; Du Vivier, Derick; Meyer, John E; Ramachandran, Banu K

2017-11-01

The United States is in the midst of a devastating opioid misuse epidemic leading to over 33,000 deaths per year from both prescription and illegal opioids. Roughly half of these deaths are attributable to prescription opioids. Federal and state governments have only recently begun to grasp the magnitude of this public health crisis. In 2016, the Centers for Disease Control and Prevention released their Guidelines for Prescribing Opioids for Chronic Pain. While not comprehensive in scope, these guidelines attempt to control and regulate opioid prescribing. Other federal agencies involved with the federal regulatory effort include the Food and Drug Administration (FDA), the Drug Enforcement Agency (DEA), and the Department of Justice. Each federal agency has a unique role in helping to stem the burgeoning opioid misuse epidemic. The DEA, working with the Department of Justice, has enforcement power to prosecute pill mills and physicians for illegal prescribing. The DEA could also implement use of prescription drug monitoring programs (PDMPs), currently administered at the state level, and use of electronic prescribing for schedule II and III medications. The FDA has authority to approve new and safer formulations of immediate- and long-acting opioid medications. More importantly, the FDA can also ask pharmaceutical companies to cease manufacturing a drug. Additionally, state agencies play a critical role in reducing overdose deaths, protecting the public safety, and promoting the medically appropriate treatment of pain. One of the states' primary roles is the regulation of practice of medicine and the insurance industry within their borders. Utilizing this authority, states can both educate physicians about the dangers of opioids and make physician licensure dependent on registering and using PDMPs when prescribing controlled substances. Almost every state has implemented a PDMP to some degree; however, in addition to mandating their use, increased interstate

Dominant male song performance reflects current immune state in a cooperatively breeding songbird

NARCIS (Netherlands)

York, Jenny E.; Radford, Andrew N.; Groothuis, Ton G.; Young, Andrew J.

Conspicuous displays are thought to have evolved as signals of individual quality, though precisely what they encode remains a focus of debate. While high quality signals may be produced by high quality individuals due to good genes or favourable early-life conditions, whether current immune state

Prehospital Ultrasound in Trauma: A Review of Current and Potential Future Clinical Applications

Directory of Open Access Journals (Sweden)

Tharwat El Zahran

2018-01-01

Full Text Available Ultrasound (US is an essential tool for evaluating trauma patients in the hospital setting. Many previous in-hospital studies have been extrapolated to out of hospital setting to improve diagnostic accuracy in prehospital and austere environments. This review article presents the role of prehospital US in blunt and penetrating trauma management with emphasis on its current clinical applications, challenges, and future implications of such use.

Evolution of Clinical Proteomics and its Role in Medicine | Office of Cancer Clinical Proteomics Research

Science.gov (United States)

NCI's Office of Cancer Clinical Proteomics Research authored a review of the current state of clinical proteomics in the peer-reviewed Journal of Proteome Research. The review highlights outcomes from the CPTC program and also provides a thorough overview of the different technologies that have pushed the field forward. Additionally, the review provides a vision for moving the field forward through linking advances in genomic and proteomic analysis to develop new, molecularly targeted interventions.

["Good dying"--definition and current state of research].

Science.gov (United States)

Hutter, Nico; Stößel, Ulrich; Meffert, Cornelia; Körner, Mirjam; Bozzaro, Claudia; Becker, Gerhild; Baumeister, Harald

2015-08-01

The advances of modern medicine did not only result in prolongation of life expectancy, but also led to a shift from dying at home to dying in public institutions. In western countries most people die at advanced age in medical facilities. Hence, the question regarding the conditions, which should be provided by society and especially medicine, to allow terminally ill people to experience "good dying" is substantial. For this purpose, an examination of patients', family members' and health care providers' understanding of the term " good dying" is required. The present paper aims at shedding light on the term "good dying" and to summarize the current state of research. Therefore, the attributes of "good dying" will be described from the perspectives of patients, family members and health care providers, which are discussed and examined in current medical-sociological research. These attributes can be illustrated on three dimensions: Quality of life at the end of life (e. g. pain relief, mental well-being), quality of dying (e. g. avoiding prolonged dying, autonomy, presence of relatives) and quality of health care at the end of life (e. g. patient-oriented health care, positive communication between health care providers and patients, availability of guidelines). Although the attributes of "good dying" are described in detail in the existing literature, further studies have to clarify the relevance and impact of these attributes as predictors of "good dying". © Georg Thieme Verlag KG Stuttgart · New York.

Clinical Social Work. State Laws Governing Independent Practice and Reimbursement of Services. Fact Sheet for the Honorable Daniel K. Inouye, United States Senate.

Science.gov (United States)

General Accounting Office, Washington, DC. Div. of Human Resources.

This fact sheet on state laws governing the independent practice and reimbursement of services for clinical social workers contains information from questionnaires sent to the state agencies responsible for health insurance regulations and Medicaid and licensing activities. Information on Ohio, the only state which did not respond, is not…

The State of Knowledge of Outdoor Orientation Programs: Current Practices, Research, and Theory

Science.gov (United States)

Bell, Brent J.; Gass, Michael A.; Nafziger, Christopher S.; Starbuck, J. David

2014-01-01

Outdoor orientation programs represent a prominent area of experiential education with over 25,000 participants annually. More than 191 outdoor orientation programs currently operate in the United States and Canada. The research examining outdoor orientation programs consists of 25 peer-reviewed published studies and 11 dissertations. A new theory…

Patient centric approach for clinical trials: Current trend and new opportunities.

Science.gov (United States)

Sharma, Neha Shankar

2015-01-01

The clinical research industry today is undergoing a major facelift. Companies are continuously looking to adopt and implement effective and innovative ways to accelerate drug launches in the market. Companies today are more open and do not view patients as mere "subjects" who generate data, - but as informed collaborators whose participation is "core" to the overall success of trials leading to the emergence of the concept of "patient-centric trials." This paper is intended to highlight the current trends and new opportunities that can be seen in industry -indicative of crucial role patients today play in their own health care using technology, social media and self education.

Patient centric approach for clinical trials: Current trend and new opportunities

Directory of Open Access Journals (Sweden)

Neha Shankar Sharma

2015-01-01

Full Text Available The clinical research industry today is undergoing a major facelift. Companies are continuously looking to adopt and implement effective and innovative ways to accelerate drug launches in the market. Companies today are more open and do not view patients as mere "subjects" who generate data, - but as informed collaborators whose participation is "core" to the overall success of trials leading to the emergence of the concept of "patient-centric trials." This paper is intended to highlight the current trends and new opportunities that can be seen in industry -indicative of crucial role patients today play in their own health care using technology, social media and self education.

Uncertainty quantification of fast sodium current steady-state inactivation for multi-scale models of cardiac electrophysiology.

Science.gov (United States)

Pathmanathan, Pras; Shotwell, Matthew S; Gavaghan, David J; Cordeiro, Jonathan M; Gray, Richard A

2015-01-01

Perhaps the most mature area of multi-scale systems biology is the modelling of the heart. Current models are grounded in over fifty years of research in the development of biophysically detailed models of the electrophysiology (EP) of cardiac cells, but one aspect which is inadequately addressed is the incorporation of uncertainty and physiological variability. Uncertainty quantification (UQ) is the identification and characterisation of the uncertainty in model parameters derived from experimental data, and the computation of the resultant uncertainty in model outputs. It is a necessary tool for establishing the credibility of computational models, and will likely be expected of EP models for future safety-critical clinical applications. The focus of this paper is formal UQ of one major sub-component of cardiac EP models, the steady-state inactivation of the fast sodium current, INa. To better capture average behaviour and quantify variability across cells, we have applied for the first time an 'individual-based' statistical methodology to assess voltage clamp data. Advantages of this approach over a more traditional 'population-averaged' approach are highlighted. The method was used to characterise variability amongst cells isolated from canine epi and endocardium, and this variability was then 'propagated forward' through a canine model to determine the resultant uncertainty in model predictions at different scales, such as of upstroke velocity and spiral wave dynamics. Statistically significant differences between epi and endocardial cells (greater half-inactivation and less steep slope of steady state inactivation curve for endo) was observed, and the forward propagation revealed a lack of robustness of the model to underlying variability, but also surprising robustness to variability at the tissue scale. Overall, the methodology can be used to: (i) better analyse voltage clamp data; (ii) characterise underlying population variability; (iii) investigate

The Immunology of Neuromyelitis Optica-Current Knowledge, Clinical Implications, Controversies and Future Perspectives.

Science.gov (United States)

Jasiak-Zatonska, Michalina; Kalinowska-Lyszczarz, Alicja; Michalak, Slawomir; Kozubski, Wojciech

2016-03-02

Neuromyelitis optica (NMO) is an autoimmune, demyelinating disorder of the central nervous system (CNS) with typical clinical manifestations of optic neuritis and acute transverse myelitis attacks. Previously believed to be a variant of multiple sclerosis (MS), it is now considered an independent disorder which needs to be differentiated from MS. The discovery of autoantibodies against aquaporin-4 (AQP4-IgGs) changed our understanding of NMO immunopathogenesis and revolutionized the diagnostic process. AQP4-IgG is currently regarded as a specific biomarker of NMO and NMO spectrum disorders (NMOsd) and a key factor in its pathogenesis. Nevertheless, AQP4-IgG seronegativity in 10%-25% of NMO patients suggests that there are several other factors involved in NMO immunopathogenesis, i.e., autoantibodies against aquaporin-1 (AQP1-Abs) and antibodies against myelin oligodendrocyte glycoprotein (MOG-IgGs). This manuscript reviews current knowledge about NMO immunopathogenesis, pointing out the controversial issues and showing potential directions for future research. Further efforts should be made to broaden our knowledge of NMO immunology which could have important implications for clinical practice, including the use of potential novel biomarkers to facilitate an early and accurate diagnosis, and modern treatment strategies improving long-term outcome of NMO patients.

The Immunology of Neuromyelitis Optica—Current Knowledge, Clinical Implications, Controversies and Future Perspectives

Science.gov (United States)

Jasiak-Zatonska, Michalina; Kalinowska-Lyszczarz, Alicja; Michalak, Slawomir; Kozubski, Wojciech

2016-01-01

Neuromyelitis optica (NMO) is an autoimmune, demyelinating disorder of the central nervous system (CNS) with typical clinical manifestations of optic neuritis and acute transverse myelitis attacks. Previously believed to be a variant of multiple sclerosis (MS), it is now considered an independent disorder which needs to be differentiated from MS. The discovery of autoantibodies against aquaporin-4 (AQP4-IgGs) changed our understanding of NMO immunopathogenesis and revolutionized the diagnostic process. AQP4-IgG is currently regarded as a specific biomarker of NMO and NMO spectrum disorders (NMOsd) and a key factor in its pathogenesis. Nevertheless, AQP4-IgG seronegativity in 10%–25% of NMO patients suggests that there are several other factors involved in NMO immunopathogenesis, i.e., autoantibodies against aquaporin-1 (AQP1-Abs) and antibodies against myelin oligodendrocyte glycoprotein (MOG-IgGs). This manuscript reviews current knowledge about NMO immunopathogenesis, pointing out the controversial issues and showing potential directions for future research. Further efforts should be made to broaden our knowledge of NMO immunology which could have important implications for clinical practice, including the use of potential novel biomarkers to facilitate an early and accurate diagnosis, and modern treatment strategies improving long-term outcome of NMO patients. PMID:26950113

Current Research Studies

Science.gov (United States)

... Success Home > Explore Research > Current Research Studies Current Research Studies Email Print + Share The Crohn’s & Colitis Foundation ... conducted online. Learn more about IBD Partners. Clinical Research Alliance The Clinical Research Alliance is a network ...

Clinical data management: Current status, challenges, and future directions from industry perspectives

Directory of Open Access Journals (Sweden)

Zhengwu Lu

2010-06-01

Full Text Available Zhengwu Lu1, Jing Su21Smith Hanley Consulting, Houston, Texas; 2Department of Chemical Engineering, University of Massachusetts, Amherst, MA, USAAbstract: To maintain a competitive position, the biopharmaceutical industry has been facing the challenge of increasing productivity both internally and externally. As the product of the clinical development process, clinical data are recognized to be the key corporate asset and provide critical evidence of a medicine’s efficacy and safety and of its potential economic value to the market. It is also well recognized that using effective technology-enabled methods to manage clinical data can enhance the speed with which the drug is developed and commercialized, hence enhancing the competitive advantage. The effective use of data-capture tools may ensure that high-quality data are available for early review and rapid decision-making. A well-designed, protocol-driven, standardized, site workflow-oriented and documented database, populated via efficient data feed mechanisms, will ensure regulatory and commercial questions receive rapid responses. When information from a sponsor’s clinical database or data warehouse develops into corporate knowledge, the value of the medicine can be realized. Moreover, regulators, payer groups, patients, activist groups, patient advocacy groups, and employers are becoming more educated consumers of medicine, requiring monetary value and quality, and seeking out up-todate medical information supplied by biopharmaceutical companies. All these developments in the current biopharmaceutical arena demand that clinical data management (CDM is at the forefront, leading change, influencing direction, and providing objective evidence. Sustaining an integrated database or data repository for initial product registration and subsequent postmarketing uses is a long-term process to maximize return on investment for organizations. CDM should be the owner of driving clinical data

Assessment of Energy Production Potential from Ocean Currents along the United States Coastline

Energy Technology Data Exchange (ETDEWEB)

Haas, Kevin

2013-09-15

Increasing energy consumption and depleting reserves of fossil fuels have resulted in growing interest in alternative renewable energy from the ocean. Ocean currents are an alternative source of clean energy due to their inherent reliability, persistence and sustainability. General ocean circulations exist in the form of large rotating ocean gyres, and feature extremely rapid current flow in the western boundaries due to the Coriolis Effect. The Gulf Stream system is formed by the western boundary current of the North Atlantic Ocean that flows along the east coastline of the United States, and therefore is of particular interest as a potential energy resource for the United States. This project created a national database of ocean current energy resources to help advance awareness and market penetration in ocean current energy resource assessment. The database, consisting of joint velocity magnitude and direction probability histograms, was created from data created by seven years of numerical model simulations. The accuracy of the database was evaluated by ORNL?s independent validation effort documented in a separate report. Estimates of the total theoretical power resource contained in the ocean currents were calculated utilizing two separate approaches. Firstly, the theoretical energy balance in the Gulf Stream system was examined using the two-dimensional ocean circulation equations based on the assumptions of the Stommel model for subtropical gyres with the quasi-geostrophic balance between pressure gradient, Coriolis force, wind stress and friction driving the circulation. Parameters including water depth, natural dissipation rate and wind stress are calibrated in the model so that the model can reproduce reasonable flow properties including volume flux and energy flux. To represent flow dissipation due to turbines additional turbine drag coefficient is formulated and included in the model. Secondly, to determine the reasonableness of the total power

Current developments in clinical multiphoton tomography

Science.gov (United States)

König, Karsten; Weinigel, Martin; Breunig, Hans Georg; Gregory, Axel; Fischer, Peter; Kellner-Höfer, Marcel; Bückle, Rainer

2010-02-01

Two-photon microscopy has been introduced in 1990 [1]. 13 years later, CE-marked clinical multiphoton systems for 3D imaging of human skin with subcellular resolution have been launched by the JenLab company with the tomograph DermaInspectTM. In 2010, the second generation of clinical multiphoton tomographs was introduced. The novel mobile multiphoton tomograph MPTflexTM, equipped with a flexible articulated optical arm, provides an increased flexibility and accessibility especially for clinical and cosmetical examinations. The multiphoton excitation of fluorescent biomolecules like NAD(P)H, flavins, porphyrins, elastin, and melanin as well as the second harmonic generation of collagen is induced by picojoule femtosecond laser pulses from an tunable turn-key near infrared laser system. The ability for rapid highquality image acquisition, the user-friendly operation of the system, and the compact and flexible design qualifies this system to be used for melanoma detection, diagnostics of dermatological disorders, cosmetic research, and skin aging measurements as well as in situ drug monitoring and animal research. So far, more than 1,000 patients and volunteers have been investigated with the multiphoton tomographs in Europe, Asia, and Australia.

The Current State of Empirical Support for the Pharmacological Treatment of Selective Mutism

Science.gov (United States)

Carlson, John S.; Mitchell, Angela D.; Segool, Natasha

2008-01-01

This article reviews the current state of evidence for the psychopharmacological treatment of children diagnosed with selective mutism within the context of its link to social anxiety disorder. An increased focus on potential medication treatment for this disorder has resulted from significant monetary and resource limitations in typical practice,…

The state of multiple sclerosis: current insight into the patient/health care provider relationship, treatment challenges, and satisfaction

Science.gov (United States)

Tintoré, Mar; Alexander, Maggie; Costello, Kathleen; Duddy, Martin; Jones, David E; Law, Nancy; O’Neill, Gilmore; Uccelli, Antonio; Weissert, Robert; Wray, Sibyl

2017-01-01

Background Managing multiple sclerosis (MS) treatment presents challenges for both patients and health care professionals. Effective communication between patients with MS and their neurologist is important for improving clinical outcomes and quality of life. Methods A closed-ended online market research survey was used to assess the current state of MS care from the perspective of both patients with MS (≥18 years of age) and neurologists who treat MS from Europe and the US and to gain insight into perceptions of treatment expectations/goals, treatment decisions, treatment challenges, communication, and satisfaction with care, based on current clinical practice. Results A total of 900 neurologists and 982 patients completed the survey, of whom 46% self-identified as having remitting-relapsing MS, 29% secondary progressive MS, and 11% primary progressive MS. Overall, patients felt satisfied with their disease-modifying therapy (DMT); satisfaction related to comfort in speaking with their neurologist and participation in their DMT decision-making process. Patients who self-identified as having relapsing-remitting MS were more likely to be very satisfied with their treatment. Top challenges identified by patients in managing their DMT were cost, side effects/tolerability of treatment, and uncertainty if treatment was working. Half of the patients reported skipping doses, but only 68% told their health care provider that they did so. Conclusion Several important differences in perception were identified between patients and neurologists concerning treatment selection, satisfaction, expectations, goals, and comfort discussing symptoms, as well as treatment challenges and skipped doses. The study results emphasize that patient/neurologist communication and patient input into the treatment decision-making process likely influence patient satisfaction with treatment. PMID:28053511

The state of multiple sclerosis: current insight into the patient/health care provider relationship, treatment challenges, and satisfaction.

Science.gov (United States)

Tintoré, Mar; Alexander, Maggie; Costello, Kathleen; Duddy, Martin; Jones, David E; Law, Nancy; O'Neill, Gilmore; Uccelli, Antonio; Weissert, Robert; Wray, Sibyl

2017-01-01

Managing multiple sclerosis (MS) treatment presents challenges for both patients and health care professionals. Effective communication between patients with MS and their neurologist is important for improving clinical outcomes and quality of life. A closed-ended online market research survey was used to assess the current state of MS care from the perspective of both patients with MS (≥18 years of age) and neurologists who treat MS from Europe and the US and to gain insight into perceptions of treatment expectations/goals, treatment decisions, treatment challenges, communication, and satisfaction with care, based on current clinical practice. A total of 900 neurologists and 982 patients completed the survey, of whom 46% self-identified as having remitting-relapsing MS, 29% secondary progressive MS, and 11% primary progressive MS. Overall, patients felt satisfied with their disease-modifying therapy (DMT); satisfaction related to comfort in speaking with their neurologist and participation in their DMT decision-making process. Patients who self-identified as having relapsing-remitting MS were more likely to be very satisfied with their treatment. Top challenges identified by patients in managing their DMT were cost, side effects/tolerability of treatment, and uncertainty if treatment was working. Half of the patients reported skipping doses, but only 68% told their health care provider that they did so. Several important differences in perception were identified between patients and neurologists concerning treatment selection, satisfaction, expectations, goals, and comfort discussing symptoms, as well as treatment challenges and skipped doses. The study results emphasize that patient/neurologist communication and patient input into the treatment decision-making process likely influence patient satisfaction with treatment.

THE CURRENT STATE OF CLOTHING TRADE IN THE BALKAN COUNTRIES

Directory of Open Access Journals (Sweden)

TRIPA Simona

2017-05-01

Full Text Available The study presented here is aimed at analysing the current state of clothing trade in the Balkan states. The dynamics of change over a 15‐year period following economic reforms are revealed. The clothing industries play a significant role and continue to contribute to the economic prosperity of countries with an inexpensive labour force. For most Balkan States clothing’s export plays an important role in promoting economic growth and development – for example, exports of garments Albania was in 2015, 16.81% of its exports, Republic of Macedonia 11.75% of its exports, in Turkey10.51% etc. The main factors which influence the level of competitiveness of clothing products from the Balkans are the gross value added per employee and wages. When the producers of the Balkan countries will create products with higher added value in garment industry the competitiveness of these countries will decrease. Also rising wages in this industry, as a result of trade union pressure or government policy, will lead to decreasing competitiveness of these products on the EU market and implicitly to the decrease of exports of garments from these countries. The main challenges that must face the Balkan States are related to restructuring of economic system, changing trade markets and patterns, declining of domestic demand of most merchandise, reduction of competitive ability, narrow export base, and lower economies of scale. The main opportunities that most of these countries can exploit are related to their geographical position, membership of the EU market, infrastructure in garment sector, and highly skilled workforce.

The current role of on-line extraction approaches in clinical and forensic toxicology.

Science.gov (United States)

Mueller, Daniel M

2014-08-01

In today's clinical and forensic toxicological laboratories, automation is of interest because of its ability to optimize processes, to reduce manual workload and handling errors and to minimize exposition to potentially infectious samples. Extraction is usually the most time-consuming step; therefore, automation of this step is reasonable. Currently, from the field of clinical and forensic toxicology, methods using the following on-line extraction techniques have been published: on-line solid-phase extraction, turbulent flow chromatography, solid-phase microextraction, microextraction by packed sorbent, single-drop microextraction and on-line desorption of dried blood spots. Most of these published methods are either single-analyte or multicomponent procedures; methods intended for systematic toxicological analysis are relatively scarce. However, the use of on-line extraction will certainly increase in the near future.

The scope and impact of mobile health clinics in the United States: a literature review.

Science.gov (United States)

Yu, Stephanie W Y; Hill, Caterina; Ricks, Mariesa L; Bennet, Jennifer; Oriol, Nancy E

2017-10-05

As the U.S. healthcare system transforms its care delivery model to increase healthcare accessibility and improve health outcomes, it is undergoing changes in the context of ever-increasing chronic disease burdens and healthcare costs. Many illnesses disproportionately affect certain populations, due to disparities in healthcare access and social determinants of health. These disparities represent a key area to target in order to better our nation's overall health and decrease healthcare expenditures. It is thus imperative for policymakers and health professionals to develop innovative interventions that sustainably manage chronic diseases, promote preventative health, and improve outcomes among communities disenfranchised from traditional healthcare as well as among the general population. This article examines the available literature on Mobile Health Clinics (MHCs) and the role that they currently play in the U.S. healthcare system. Based on a search in the PubMed database and data from the online collaborative research network of mobile clinics MobileHealthMap.org , the authors evaluated 51 articles with evidence on the strengths and weaknesses of the mobile health sector in the United States. Current literature supports that MHCs are successful in reaching vulnerable populations, by delivering services directly at the curbside in communities of need and flexibly adapting their services based on the changing needs of the target community. As a link between clinical and community settings, MHCs address both medical and social determinants of health, tackling health issues on a community-wide level. Furthermore, evidence suggest that MHCs produce significant cost savings and represent a cost-effective care delivery model that improves health outcomes in underserved groups. Even though MHCs can fulfill many goals and mandates in alignment with our national priorities and have the potential to help combat some of the largest healthcare challenges of this era, there

Human iPS Cell-Derived Germ Cells: Current Status and Clinical Potential

Directory of Open Access Journals (Sweden)

Tetsuya Ishii

2014-10-01

Full Text Available Recently, fertile spermatozoa and oocytes were generated from mouse induced pluripotent (iPS cells using a combined in vitro and in vivo induction system. With regard to germ cell induction from human iPS cells, progress has been made particularly in the male germline, demonstrating in vitro generation of haploid, round spermatids. Although iPS-derived germ cells are expected to be developed to yield a form of assisted reproductive technology (ART that can address unmet reproductive needs, genetic and/or epigenetic instabilities abound in iPS cell generation and germ cell induction. In addition, there is still room to improve the induction protocol in the female germline. However, rapid advances in stem cell research are likely to make such obstacles surmountable, potentially translating induced germ cells into the clinical setting in the immediate future. This review examines the current status of the induction of germ cells from human iPS cells and discusses the clinical potential, as well as future directions.

Hypertrophic pachymeningitis: Current criteria for diagnosis and differentiation (Clinical case and review of literature

Directory of Open Access Journals (Sweden)

E. G. Mendelevich

2015-01-01

Full Text Available The paper describes a 44-year-old male patient with an about 6-year history of hypertrophic pachymeningitis. The major clinical symptoms were characterized by headache, exophthalmos, and blindness in one eye. The data for differential diagnosis of the disease are given. The current literature on the clinical manifestations of hypertrophic pachymeningitis, its differential diagnosis, and the results of magnetic resonance imaging (MRI is reviewed. Diagnostic difficulties at the stage of a clinical observation are due to the nonspecificity of neurological manifestations and the need for a comprehensive examination to detect a somatic disease. MRI can diagnose the disease-specific phenomenon of damage to the meninges, which calls for further careful differentiation. Clinicians must be familiar with alternative differential diagnosis, as a rapid specific therapeutic approach will help avoid long-term or irreversible neurological complications.

Helical system. History and current state of helical research

International Nuclear Information System (INIS)

Yokoyama, Masayuki

2017-01-01

This paper described the following: (1) history of nuclear fusion research of Japan's original heliotron method, (2) worldwide development of nuclear fusion research based on helical system such as stellarator, and (3) worldwide meaning of large helical device (LHD) aiming to demonstrate the steady-state performance of heliotron type in the parameter area extrapolable to the core plasma, and research results of LHD. LHD demonstrated that the helical system is excellent in steady operation performance at the world's most advanced level. In an experiment using deuterium gas in 2017, LHD achieved to reach 120 million degrees of ion temperature, which is one index of nuclear fusion condition, demonstrated the realization of high-performance plasma capable of extrapolating to future nuclear fusion reactors, and established the foundation for full-scale research toward the realization of nuclear fusion reactor. Besides experimental research, this paper also described the helical-type stationary nuclear fusion prototype reactor, FFHR-d1, which was based on progress of large-scale simulation at the world's most advanced level. A large-scale superconducting stellarator experimental device, W7-X, with the same scale as LHD, started experiment in December 2015, whose current state is also touched on here. (A.O.)

Aerobic-Strength Exercise Improves Metabolism and Clinical State in Parkinson’s Disease Patients

Directory of Open Access Journals (Sweden)

Patrik Krumpolec

2017-12-01

Full Text Available Regular exercise ameliorates motor symptoms in Parkinson’s disease (PD. Here, we aimed to provide evidence that exercise brings additional benefits to the whole-body metabolism and skeletal muscle molecular and functional characteristics, which might help to explain exercise-induced improvements in the clinical state. 3-months supervised endurance/strength training was performed in early/mid-stage PD patients and age/gender-matched individuals (n = 11/11. The effects of exercise on resting energy expenditure (REE, glucose metabolism, adiposity, and muscle energy metabolism (31P-MRS were evaluated and compared to non-exercising PD patients. Two muscle biopsies were taken to determine intervention-induced changes in fiber type, mitochondrial content, and expression of genes related to muscle energy metabolism, as well as proliferative and regenerative capacity. Exercise improved the clinical disability score (MDS-UPDRS, bradykinesia, balance, walking speed, REE, and glucose metabolism and increased muscle expression of energy sensors (AMPK. However, the exercise-induced increase in muscle mass/strength, mitochondrial content, type II fiber size, and postexercise phosphocreatine (PCr recovery (31P-MRS were found only in controls. Nevertheless, MDS-UPDRS was associated with muscle AMPK and mechano-growth factor (MGF expression. Improvements in fasting glycemia were positively associated with muscle function and the expression of Sirt1 and Cox7a1, and the parameters of fitness/strength were positively associated with the expression of MyHC2, MyHC7, and MGF. Moreover, reduced bradykinesia was associated with better muscle metabolism (maximal oxidative capacity and postexercise PCr recovery; 31P-MRS. Exercise training improved the clinical state in early/mid-stage Parkinson’s disease patients, including motor functions and whole-body metabolism. Although the adaptive response to exercise in PD was different from that of controls, exercise

Study of the nonequilibrium state of superconductors by large quasiparticle injection from an external current source

International Nuclear Information System (INIS)

Iguchi, I.

1977-01-01

We have studied the nonequilibrium state of superconductors by injecting large numbers of quasiparticles from an external current source into a superconducting film of a tunnel junction with low tunnel resistance (typically 0.1--1 Ω for junction area approx. = 10 -4 cm 2 ). It was observed that there was a critical tunnel current density at which a voltage appeared locally in the part of a superconducting film confined to the junction area. Its values ranged from 10 2 to 10 3 A/cm 2 for bath temperatures well below T/sub c/. Followed by this voltage onset, a transition region corresponding to the nonequilibrium intermediate resistive state was also observed. For further increase of the tunnel current, the local film resistance developed beyond the value of its normal resistance, suggesting that the nonequilibrium state extends far beyond the voltage onset point. A theory based on the modified Rothwarf-Taylor equations and Parker's T* model is presented to compare with the experimental results. The calculated critical current density yielded almost the same order of magnitude as those found experimentally. The detailed behavior, however, deviates from the theoretical predictions although the film makes a second-order transition in the broad range of temperatures. It is also shown using four-terminal analysis that our observations and those by Wong, Yeh, and Langenberg are essentially the same

MHz repetition rate solid-state driver for high current induction accelerators

International Nuclear Information System (INIS)

Brooksby, C; Caporaso, G; Goerz, D; Hanks, R; Hickman, B; Kirbie, H; Lee, B; Saethre, R.

1999-01-01

A research team from the Lawrence Livermore National Laboratory and Bechtel Nevada Corporation is developing an all solid-state power source for high current induction accelerators. The original power system design, developed for heavy-ion fusion accelerators, is based on the simple idea of using an array of field effect transistors to switch energy from a pre-charged capacitor bank to an induction accelerator cell. Recently, that idea has been expanded to accommodate the greater power needs of a new class of high-current electron accelerators for advanced radiography. For this purpose, we developed a 3-stage induction adder that uses over 4,000 field effect transistors to switch peak voltages of 45 kV at currents up to 4.8 kA with pulse repetition rates of up to 2 MHz. This radically advanced power system can generate a burst of five or more pulses that vary from 200 ns to 2 ampersand micro;s at a duty cycle of up to 25%. Our new source is precise, robust, flexible, and exceeds all previous drivers for induction machines by a factor of 400 in repetition rate and a factor of 1000 in duty cycle

Existence of non-unique steady state solutions to the RMF current drive equations

Energy Technology Data Exchange (ETDEWEB)

Hugrass, W N [Flinders Univ. of South Australia, Bedford Park. School of Physical Sciences

1985-05-04

It is shown that the value of the d.c. current driven in a plasma cylinder by means of a rotating magnetic field (RMF) is not unique for R/delta >= 6 and eBsub(..omega..)/..nu..sub(ei)m approx.R/delta, where R is the radius of the plasma cylinder, delta is the classical skin depth, ..nu..sub(ei) is the electron-ion momentum transfer collision frequency, Bsub(..omega..) is the magnitude of the rotating magnetic field, e is the electron charge and m is the electron mass. This effect is predicted using three distinct approaches: (i) a steady state anaysis which ignores the second and higher harmonics of the fields and currents; (ii) a qualitative model which utilizes the analogy between the RMF current drive technique and the operation of the induction motor; (iii) a solution of the initial boundary value equations describing the RMF current drive in cylindrical plasmas.

Progress in clinical research and application of resting state functional brain imaging

International Nuclear Information System (INIS)

Long Miaomiao; Ni Hongyan

2013-01-01

Resting state functional brain imaging experimental design is free of stimulus task and offers various parametric maps through different data-driven post processing methods with endogenous BOLD signal changes as the source of imaging. Mechanism of resting state brain activities could be extensively studied with improved patient compliance and clinical application compared with task related functional brain imaging. Also resting state functional brain imaging can be used as a method of data acquisition, with implicit neuronal activity as a kind of experimental design, to reveal characteristic brain activities of epileptic patient. Even resting state functional brain imaging data processing method can be used to analyze task related functional MRI data, opening new horizons of task related functional MRI study. (authors)

Establishment of the European College of Veterinary Clinical Pathology (ECVCP) and the current status of veterinary clinical pathology in Europe

DEFF Research Database (Denmark)

O'Brien, P.J.; Fournel-Fleury, C.; Bolliger, Adrian Marc

2007-01-01

congresses and a joint journal (with the American Society for Veterinary Clinical Pathology) for communication of scientific research and information; the College also maintains a website, a joint listserv, and a newsletter; 6) collaboration in training and continuing education with relevant colleges......After 5 years of development, the European College of Veterinary Clinical Pathology (ECVCP)was formally recognized and approved on July 4, 2007 by the European Board of Veterinary Specialisation (EBVS), the European regulatory body that oversees specialization in veterinary medicine and which has......; currently there are 18 resident trainingprograms inEurope; 3) administration of 3 annual board-certifying examinations thus far,with an overall pass rate of 70%; 4) European consensus criteria for assessing the continuing education of specialists every 5 ears; 5) organization of 8 annual scientific...

The use of psychometrists in clinical neuropsychology: history, current status, and future directions.

Science.gov (United States)

Malek-Ahmadi, Michael; Erickson, Tom; Puente, Antonio E; Pliskin, Neil; Rock, Rachel

2012-01-01

In recent years, the National Academy of Neuropsychology and other professional neuropsychological organizations have published a number of articles and position papers regarding the use, education, and training of psychometrists ("technicians"). Although these documents provide guidelines for the suggested qualifications and training procedures of psychometrists, none make any mention of the need for a standardized credentialing process, which is commonly required of technicians in similar fields, especially in medical settings. Given the recent changes in current procedural Terminology codes used to bill for neuropsychological services and the interpretation of legislation disallowing the use of psychometrists in New York, the need for a standard credential for psychometrists is apparent. This article will review the history and current use of psychometrists in clinical neuropsychology and highlight the need and rationale for the credentialing of psychometrists.

Clinical Utilisation and Usefullness of the Rating Scale of Mixed States, ("Gt-Msrs"): a Multicenter Study.

Science.gov (United States)

Tavormina, Giuseppe; Franza, Francesco; Stranieri, Giuseppe; Juli, Luigi; Juli, Maria Rosaria

2017-09-01

The rating scale "G.T. MSRS" has been designed to improve the clinical effectiveness of the clinician psychiatrists, by enabling them to make an early "general" diagnosis of mixed states. The knowledge of the clinical features of the mixed states and of the symptoms of the "mixity" of mood disorders is crucial: to mis-diagnose or mis-treat patients with these symptoms may increase the suicide risk and make worse the evolution of mood disorders going to the dysphoric state. This study is the second validation study of the "G.T. MSRS" rating scale, in order to demonstrate its usefullness.

The current state of the California biomass energy industry

International Nuclear Information System (INIS)

Morris, G.P.

1994-01-01

During the decade of the 1980s the California biomass energy industry grew from a few isolated facilities located mostly at pulp mills into the largest biomass energy industry in the world. Currently, more than fifty biomass powered electricity generating facilities provide the state with some 850 Megawatts (MW) of generating capacity, most of it interconnected to the state's electric utility systems. Each year, more than ten million tons of wood and agricultural wastes in the state are converted into fuel, rather than being disposed of using conventional, environmentally costly methods like open burning and landfill burial. As the 1980s began, the California biomass energy industry was in a nascent state. Optimism was blooming within the wood-products and agricultural sectors of California, who foresaw an opportunity to turn costly wastes into profits. At the same time, the independent energy industry itself was being launched. Interest in biomass energy development was spreading to the engineering and construction industries and the financial community as well. A great variety of firms and individuals were engaged in the development of biomass power plants and biomass fuel sources. The second half of the 1980s saw the fruits of the developmental activity that began in the first half of the decade. Biomass energy facilities were entering construction and coming on-line in increasing numbers, and the demand for biomass fuels was increasing in step. As the decade was coming to an end, biomass fuel supplies were hard put to meet the demand, yet a huge number of new facilities entered operation in 1990. This extreme growth spurt of new generating capacity caused a fuel crisis and a shake-out in the industry just as it was entering full-scale operation. The Crisis of Success had been reached. More recently an equilibrium has been achieved in which fuel prices are at levels that produce adequate supplies, while allowing profitable operations at the power plants

Short-rotation coppicing in France. Current state of research and prospects for future development

Energy Technology Data Exchange (ETDEWEB)

Bonduelle, P. (Association Foret Cellulose, Trelaze (France)); Bouvarel, L. (Institut National de la Recherche Agronomique, Olivet (France). Unite Experimentale Biomasse, Forestiere et Foret Paysanne); Petit, H. (Association pour la Rationalisation et la Mecanisation de l' Exploitation Forestiere, Fontainebleau (France)); Pierson, J. (Cellulose des Ardennes, Montemedy (France)); Savanne, D. (Agence de l' Environnement et de la Maitrise de l' Energie, 75 - Paris (France)); Sourie, J.C. (Institut National de la Recherche Agronomique, Grignon (France). Station d' Economie et de Sociologie Rurales)

1992-01-01

This article analyzes the current context and the prospects for crop development as well as offering a number of examples of short rotation coppicing projects. The industrial outlets created through state aid remain the primary driving force behind plantations at this time. (author)

Levitation of current carrying states in the lattice model for the integer quantum Hall effect.

Science.gov (United States)

Koschny, T; Potempa, H; Schweitzer, L

2001-04-23

The disorder driven quantum Hall to insulator transition is investigated for a two-dimensional lattice model. The Hall conductivity and the localization length are calculated numerically near the transition. For uncorrelated and weakly correlated disorder potentials the current carrying states are annihilated by the negative Chern states originating from the band center. In the presence of correlated disorder potentials with correlation length larger than approximately half the lattice constant the floating up of the critical states in energy without merging is observed. This behavior is similar to the levitation scenario proposed for the continuum model.

State-Specific Prevalence of Tobacco Product Use Among Adults - United States, 2014-2015.

Science.gov (United States)

Odani, Satomi; Armour, Brian S; Graffunder, Corinne M; Willis, Gordon; Hartman, Anne M; Agaku, Israel T

2018-01-26

Despite recent declines in cigarette smoking prevalence, the tobacco product landscape has shifted to include emerging tobacco products* (1,2). Previous research has documented adult use of smokeless tobacco and cigarettes by state (3); however, state-specific data on other tobacco products are limited. To assess tobacco product use in the 50 U.S. states and the District of Columbia (DC), CDC and the National Cancer Institute analyzed self-reported use of six tobacco product types: cigarettes, cigars, regular pipes, water pipes, electronic cigarettes (e-cigarettes), and smokeless tobacco products among adults aged ≥18 years using data from the 2014-2015 Tobacco Use Supplement to the Current Population Survey (TUS-CPS). Prevalence of ever-use of any tobacco product ranged from 27.0% (Utah) to 55.4% (Wyoming). Current (every day or some days) use of any tobacco product ranged from 10.2% (California) to 27.7% (Wyoming). Cigarettes were the most common currently used tobacco product in all states and DC. Among current cigarette smokers, the proportion who currently used one or more other tobacco products ranged from 11.5% (Delaware) to 32.3% (Oregon). Differences in tobacco product use across states underscore the importance of implementing proven population-level strategies to reduce tobacco use and expanding these strategies to cover all forms of tobacco marketed in the United States. Such strategies could include comprehensive smoke-free policies, tobacco product price increases, anti-tobacco mass media campaigns, and barrier-free access to clinical smoking cessation resources (1,4).

Development of a prototype solid state fault current limiting and interrupting device for low voltage distribution networks.

OpenAIRE

Ahmed, M.; Putrus, G. A.; Ran, L.; Penlington, R.

2006-01-01

This paper describes the development of a solid-state Fault Current Limiting and Interrupting Device (FCLID) suitable for low voltage distribution networks. The main components of the FCLID are a bidirectional semiconductor switch that can disrupt the short-circuit current, and a voltage clamping element that helps in controlling the current and absorbing the inductive energy stored in the network during current interruption. Using a hysteresis type control algorithm, the short-circuit curren...

Otolaryngology in the medical school curriculum: Current trends in the United States.

Science.gov (United States)

Boscoe, Elizabeth F; Cabrera-Muffly, Cristina

2017-02-01

To identify trends in medical school otolaryngology curriculum requirements. Survey of United States allopathic medical schools. A survey was sent to deans of curriculum at allopathic medical schools. We identified opportunities for medical students to learn basic concepts in otolaryngology during their undergraduate medical training. The opportunities were classified into preclinical and clinical as well as elective and mandatory rotations. Of the schools surveyed, 60% responded. Mean class size was 149 students. Sixty-eight percent of surveyed schools noted that 75% to 100% of their students participated in preclinical otolaryngology experiences, with 59% reporting a mandatory preclinical otolaryngology module for all students. Eighty-nine percent of schools offered otolaryngology as a clinical elective rotation, with a mean of 12 students participating yearly. Only 7% of schools required a mandatory otolaryngology clinical rotation. Our data suggest that medical students do not receive sufficient exposure to otolaryngology during medical school. Increased requirements for otolaryngology curriculum may be beneficial to all medical students, regardless of their specialty choice. NA. Laryngoscope, 00:000-000, 2016 127:346-348, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Current nonclinical testing paradigm enables safe entry to First-In-Human clinical trials: The IQ consortium nonclinical to clinical translational database.

Science.gov (United States)

Monticello, Thomas M; Jones, Thomas W; Dambach, Donna M; Potter, David M; Bolt, Michael W; Liu, Maggie; Keller, Douglas A; Hart, Timothy K; Kadambi, Vivek J

2017-11-01

The contribution of animal testing in drug development has been widely debated and challenged. An industry-wide nonclinical to clinical translational database was created to determine how safety assessments in animal models translate to First-In-Human clinical risk. The blinded database was composed of 182 molecules and contained animal toxicology data coupled with clinical observations from phase I human studies. Animal and clinical data were categorized by organ system and correlations determined. The 2×2 contingency table (true positive, false positive, true negative, false negative) was used for statistical analysis. Sensitivity was 48% with a 43% positive predictive value (PPV). The nonhuman primate had the strongest performance in predicting adverse effects, especially for gastrointestinal and nervous system categories. When the same target organ was identified in both the rodent and nonrodent, the PPV increased. Specificity was 84% with an 86% negative predictive value (NPV). The beagle dog had the strongest performance in predicting an absence of clinical adverse effects. If no target organ toxicity was observed in either test species, the NPV increased. While nonclinical studies can demonstrate great value in the PPV for certain species and organ categories, the NPV was the stronger predictive performance measure across test species and target organs indicating that an absence of toxicity in animal studies strongly predicts a similar outcome in the clinic. These results support the current regulatory paradigm of animal testing in supporting safe entry to clinical trials and provide context for emerging alternate models. Copyright © 2017 Elsevier Inc. All rights reserved.

What is the current state of scientific knowledge with regard to seasonal and decadal forecasting?

International Nuclear Information System (INIS)

Smith, Doug M; Scaife, Adam A; Kirtman, Ben P

2012-01-01

Environmental factors, such as the frequency, intensity and duration of extreme weather events, are important drivers of migration and displacement of people. There is therefore a growing need for regional climate predictions for the coming seasons to decades. This paper reviews the current state of the art of seasonal to decadal climate prediction, focusing on the potential sources of skill, forecasting techniques, current capability and future prospects. (letter)

A contact-less method to evaluate the state of charge of nickel batteries using Foucault's eddy currents

Science.gov (United States)

Mancier, V.; Metrot, A.; Willmann, P.

A nickel hydroxide electrode and a commercial battery have been studied by a new and contact-less impedance method, based on Foucault's eddy currents, with the aim of determining their state of charge. Four different current line distributions have been employed and the impedance versus time graphs obtained show a linear variation of this impedance during charge and discharge for all configurations. This new method allows the determination of the state of charge and, furthermore some "artifacts" obvious on these graphs may be useful to detect a deterioration of the studied material.

Malignancies in HIV/AIDS patients attending an outpatient clinic in Vitória, State of Espírito Santo, Brazil

Directory of Open Access Journals (Sweden)

Lauro Ferreira da Silva Pinto Neto

2012-12-01

Full Text Available INTRODUCTION: The present study investigated cancer prevalence and associated factors among HIV-infected individuals attending an AIDS outpatient clinic in Vitória, State of Espírito Santo, Brazil. METHODS: A sectional study was conducted among HIV infected adults attending an AIDS outpatient clinic in Vitória, State of Espírito Santo, Brazil. Demographic, epidemiological and clinical data were abstracted from medical records, including cancer diagnoses; nadir and current CD4 cell count, HIV viral load, time on antiretroviral treatment (ART, type of ART and smoking status. RESULTS: A total of 730 (91.3% patients were included in the study. Median age was 44.0 [interquartile range (IQR: 35-50.3] years; median time since HIV diagnosis was 5.5 years (IQR: 2-10; 60% were male; and 59% were white. Thirty (4.1% cases of cancer were identified of which 16 (53% were AIDS defining cancers and 14 (47% were non-AIDS defining malignancies. Patients diagnosed with cancer presented higher chance of being tobacco users [OR 2.2 (95% CI: 1.04-6.24]; having nadir CD4 ≤200 cells/mm³ [OR 3.0 (95% CI: 1.19-7.81] and higher lethality [OR 13,3 (95% CI: 4,57-38,72]. CONCLUSIONS: These results corroborate the importance of screening for and prevention of non-AIDS defining cancers focus in HIV-infected population, as these cancers presented with similar frequency as AIDS defining cancers.

Current State of Agile Methodologies Worldwide and in the Czech Republic

Directory of Open Access Journals (Sweden)

Martin Tománek

2015-06-01

Full Text Available The objective of this research paper is to compare the current state of agile methodologies in the world and in the Czech Republic. The comparison is executed as the comparative analysis of two publicly available researches conducted in 2013 and published in 2014. The comparison is further enriched by the results of the unpublished survey in the global logistics company which was conducted also in 2013. The potential trend for agile methodologies in the Czech Republic is also discussed with regard to the worldwide trend.

Nanomedicine applications in the treatment of breast cancer: current state of the art.

Science.gov (United States)

Wu, Di; Si, Mengjie; Xue, Hui-Yi; Wong, Ho-Lun

2017-01-01

Breast cancer is the most common malignant disease in women worldwide, but the current drug therapy is far from optimal as indicated by the high death rate of breast cancer patients. Nanomedicine is a promising alternative for breast cancer treatment. Nanomedicine products such as Doxil ® and Abraxane ® have already been extensively used for breast cancer adjuvant therapy with favorable clinical outcomes. However, these products were originally designed for generic anticancer purpose and not specifically for breast cancer treatment. With better understanding of the molecular biology of breast cancer, a number of novel promising nanotherapeutic strategies and devices have been developed in recent years. In this review, we will first give an overview of the current breast cancer treatment and the updated status of nanomedicine use in clinical setting, then discuss the latest important trends in designing breast cancer nanomedicine, including passive and active cancer cell targeting, breast cancer stem cell targeting, tumor microenvironment-based nanotherapy and combination nanotherapy of drug-resistant breast cancer. Researchers may get insight from these strategies to design and develop nanomedicine that is more tailored for breast cancer to achieve further improvements in cancer specificity, antitumorigenic effect, antimetastasis effect and drug resistance reversal effect.

Lymphoma: current status of clinical and preclinical imaging with radiolabeled antibodies

Energy Technology Data Exchange (ETDEWEB)

England, Christopher G. [University of Wisconsin School of Medicine and Public Health, Department of Medical Physics, Madison, WI (United States); Rui, Lixin [University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, WI (United States); University of Wisconsin School of Medicine and Public Health, Carbone Cancer Center, Madison, WI (United States); Cai, Weibo [University of Wisconsin School of Medicine and Public Health, Department of Medical Physics, Madison, WI (United States); University of Wisconsin School of Medicine and Public Health, Carbone Cancer Center, Madison, WI (United States); University of Wisconsin School of Medicine and Public Health, Department of Radiology, Madison, WI (United States)

2017-03-15

Lymphoma is a complex disease that arises from cells of the immune system with an intricate pathology. While lymphoma may be classified as Hodgkin or non-Hodgkin, each type of tumor is genetically and phenotypically different and highly invasive tissue biopsies are the only method to investigate these differences. Noninvasive imaging strategies, such as immunoPET, can provide a vital insight into disease staging, monitoring treatment response in patients, and dose planning in radioimmunotherapy. ImmunoPET imaging with radiolabeled antibody-based tracers may also assist physicians in optimizing treatment strategies and enhancing patient stratification. Currently, there are two common biomarkers for molecular imaging of lymphoma, CD20 and CD30, both of which have been considered for investigation in preclinical imaging studies. In this review, we examine the current status of both preclinical and clinical imaging of lymphoma using radiolabeled antibodies. Additionally, we briefly investigate the role of radiolabeled antibodies in lymphoma therapy. As radiolabeled antibodies play critical roles in both imaging and therapy of lymphoma, the development of novel antibodies and the discovery of new biomarkers may greatly affect lymphoma imaging and therapy in the future. (orig.)

Lymphoma: current status of clinical and preclinical imaging with radiolabeled antibodies

International Nuclear Information System (INIS)

England, Christopher G.; Rui, Lixin; Cai, Weibo

2017-01-01

Lymphoma is a complex disease that arises from cells of the immune system with an intricate pathology. While lymphoma may be classified as Hodgkin or non-Hodgkin, each type of tumor is genetically and phenotypically different and highly invasive tissue biopsies are the only method to investigate these differences. Noninvasive imaging strategies, such as immunoPET, can provide a vital insight into disease staging, monitoring treatment response in patients, and dose planning in radioimmunotherapy. ImmunoPET imaging with radiolabeled antibody-based tracers may also assist physicians in optimizing treatment strategies and enhancing patient stratification. Currently, there are two common biomarkers for molecular imaging of lymphoma, CD20 and CD30, both of which have been considered for investigation in preclinical imaging studies. In this review, we examine the current status of both preclinical and clinical imaging of lymphoma using radiolabeled antibodies. Additionally, we briefly investigate the role of radiolabeled antibodies in lymphoma therapy. As radiolabeled antibodies play critical roles in both imaging and therapy of lymphoma, the development of novel antibodies and the discovery of new biomarkers may greatly affect lymphoma imaging and therapy in the future. (orig.)

Progress Toward Steady State Tokamak Operation Exploiting the high bootstrap current fraction regime

Science.gov (United States)

Ren, Q.

2015-11-01

Recent DIII-D experiments have advanced the normalized fusion performance of the high bootstrap current fraction tokamak regime toward reactor-relevant steady state operation. The experiments, conducted by a joint team of researchers from the DIII-D and EAST tokamaks, developed a fully noninductive scenario that could be extended on EAST to a demonstration of long pulse steady-state tokamak operation. Fully noninductive plasmas with extremely high values of the poloidal beta, βp >= 4 , have been sustained at βT >= 2 % for long durations with excellent energy confinement quality (H98y,2 >= 1 . 5) and internal transport barriers (ITBs) generated at large minor radius (>= 0 . 6) in all channels (Te, Ti, ne, VTf). Large bootstrap fraction (fBS ~ 80 %) has been obtained with high βp. ITBs have been shown to be compatible with steady state operation. Because of the unusually large ITB radius, normalized pressure is not limited to low βN values by internal ITB-driven modes. βN up to ~4.3 has been obtained by optimizing the plasma-wall distance. The scenario is robust against several variations, including replacing some on-axis with off-axis neutral beam injection (NBI), adding electron cyclotron (EC) heating, and reducing the NBI torque by a factor of 2. This latter observation is particularly promising for extension of the scenario to EAST, where maximum power is obtained with balanced NBI injection, and to a reactor, expected to have low rotation. However, modeling of this regime has provided new challenges to state-of-the-art modeling capabilities: quasilinear models can dramatically underpredict the electron transport, and the Sauter bootstrap current can be insufficient. The analysis shows first-principle NEO is in good agreement with experiments for the bootstrap current calculation and ETG modes with a larger saturated amplitude or EM modes may provide the missing electron transport. Work supported in part by the US DOE under DE-FC02-04ER54698, DE-AC52-07NA

Mass transport and the bootstrap current from Ohm's law in steady-state tokamaks

International Nuclear Information System (INIS)

Kim, J.-S.; Greene, J.M.

1989-01-01

The consequences of mass conservation and Ohm's law are examined for steady state Tokamaks. In a Tokamak, magnetofluid-dynamic waves rapidly equilibrate pressure and toroidal field along magnetic surfaces. As a result, the detailed current distribution is determined by the flux surface averaged poloidal and toroidal currents. The electrons that carry the plasma current are impeded in their motion by interactions with ions, which is resistivity and its generalizations, and by interactions with electrons, which is viscosity and its generalizations. The important viscous terms arise from the interaction between trapped and untrapped electrons, and so viscosity acts by impeding poloidal current. properly chosen, the results of neoclassical theory are The neoclassical viscous coefficient is here regarded as less likely than Spitzer conductivity to be experimentally relevant in a turbulent Tokamak. Thus, the toroidal Ohm's law is regarded as being more reliable than the poloidal Ohm's law. A combination of toroidal and poloidal Ohm's law, namely the component parallel to the magnetic field, eliminates the influence of plasma fueling, and directly relates the bootstrap current and the pressure gradient. The latter is the usual relation, but, since i

Proton Therapy Expansion Under Current United States Reimbursement Models

Energy Technology Data Exchange (ETDEWEB)

Kerstiens, John [Indiana University Health Proton Therapy Center, Bloomington, Indiana (United States); Johnstone, Peter A.S., E-mail: pajohnst@iupui.edu [Indiana University Health Proton Therapy Center, Bloomington, Indiana (United States); Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana (United States)

2014-06-01

Purpose: To determine whether all the existing and planned proton beam therapy (PBT) centers in the United States can survive on a local patient mix that is dictated by insurers, not by number of patients. Methods and Materials: We determined current and projected cancer rates for 10 major US metropolitan areas. Using published utilization rates, we calculated patient percentages who are candidates for PBT. Then, on the basis of current published insurer coverage policies, we applied our experience of what would be covered to determine the net number of patients for whom reimbursement is expected. Having determined the net number of covered patients, we applied our average beam delivery times to determine the total number of minutes needed to treat that patient over the course of their treatment. We then calculated our expected annual patient capacity per treatment room to determine the appropriate number of treatment rooms for the area. Results: The population of patients who will be both PBT candidates and will have treatments reimbursed by insurance is significantly smaller than the population who should receive PBT. Coverage decisions made by insurers reduce the number of PBT rooms that are economically viable. Conclusions: The expansion of PBT centers in the US is not sustainable under the current reimbursement model. Viability of new centers will be limited to those operating in larger regional metropolitan areas, and few metropolitan areas in the US can support multiple centers. In general, 1-room centers require captive (non–PBT-served) populations of approximately 1,000,000 lives to be economically viable, and a large center will require a population of >4,000,000 lives. In areas with smaller populations or where or a PBT center already exists, new centers require subsidy.

System and method for generating steady state confining current for a toroidal plasma fusion reactor

International Nuclear Information System (INIS)

Bers, A.

1981-01-01

A system for generating steady state confining current for a toroidal plasma fusion reactor providing steady-state generation of the thermonuclear power. A dense, hot toroidal plasma is initially prepared with a confining magnetic field with toroidal and poloidal components. Continuous wave rf energy is injected into said plasma to estalish a spectrum of traveling waves in the plasma, where the traveling waves have momentum components substantially either all parallel, or all anti-parallel to the confining magnetic field. The injected rf energy is phased to couple to said traveling waves with both a phase velocity component and a wave momentum component in the direction of the plasma traveling wave components. The injected rf energy has a predetermined spectrum selected so that said traveling waves couple to plasma electrons having velocities in a predetermined range delta . The velocities in the range are substantially greater than the thermal electron velocity of the plasma. In addition, the range is sufficiently broad to produce a raised plateau having width delta in the plasma electron velocity distribution so that the plateau electrons provide steady-state current to generate a poloidal magnetic field component sufficient for confining the plasma. In steady state operation of the fusion reactor, the fusion power density in the plasma exceeds the power dissipated inthe plasma

Cutaneous leishmaniasis in Syria: clinical features, current status and the effects of war.

Science.gov (United States)

Hayani, Kinan; Dandashli, Anwar; Weisshaar, Elke

2015-01-01

Cutaneous leishmaniasis (CL) is a worldwide disease caused by an infection with the protozoan parasite Leishmania transmitted via sand flies. It is endemic in many of the poorest countries of all continents. "Aleppo boil" is one of the recognised names given to this disease in the medical literature. Although CL used to be well-controlled and well-documented in Syria, its incidence has dramatically increased since the beginning of the war; however, there is lack of documentation. Here, we present the past and current epidemiological situation of the disease in Syria. We also draw attention to gross and highly unusual clinical variants of CL presented to the Department of Dermatology in Aleppo covering the important differential clinical diagnoses, since this disease is already known to mimic other conditions. Diagnostic procedures and treatment as well as prevention are summarised. Due to the increased ability to travel, and especially the flight of Syrians to neighbouring countries, as well as to Europe, CL may become a new threat in formerly unaffected regions. Through this account, we hope to give weight to the aspiration that CL does not remain a neglected and often clinically overlooked tropical dermatosis.

Current Strategies in Cardiovascular Biomaterial Functionalization

Directory of Open Access Journals (Sweden)

Karla Lehle

2010-01-01

Full Text Available Prevention of the coagulation cascade and platelet activation is the foremost demand for biomaterials in contact with blood. In this review we describe the underlying mechanisms of these processes and offer the current state of antithrombotic strategies. We give an overview of methods to prevent protein and platelet adhesion, as well as techniques to immobilize biochemically active molecules on biomaterial surfaces. Finally, recent strategies in biofunctionalization by endothelial cell seeding as well as their possible clinical applications are discussed.

Current issues in allogeneic islet transplantation.

Science.gov (United States)

Chang, Charles A; Lawrence, Michael C; Naziruddin, Bashoo

2017-10-01

Transplantation of allogenic pancreatic islets is a minimally invasive treatment option to control severe hypoglycemia and dependence on exogenous insulin among type 1 diabetes (T1D) patients. This overview summarizes the current issues and progress in islet transplantation outcomes and research. Several clinical trials from North America and other countries have documented the safety and efficacy of clinical islet transplantation for T1D patients with impaired hypoglycemia awareness. A recently completed phase 3 clinical trial allows centres in the United States to apply for a Food and Drug Administration Biologics License for the procedure. Introduction of anti-inflammatory drugs along with T-cell depleting induction therapy has significantly improved long-term function of transplanted islets. Research into islet biomarkers, immunosuppression, extrahepatic transplant sites and potential alternative beta cell sources is driving further progress. Allogeneic islet transplantation has vastly improved over the past two decades. Success in restoration of glycemic control and hypoglycemic awareness after islet transplantation has been further highlighted by clinical trials. However, lack of effective strategies to maintain long-term islet function and insufficient sources of donor tissue still impose limitations to the widespread use of islet transplantation. In the United States, wide adoption of this technology still awaits regulatory approval and, importantly, a financial mechanism to support the use of this technology.

Screening mammography among nursing home residents in the United States: Current guidelines and practice.

Science.gov (United States)

Mack, Deborah S; Epstein, Mara M; Dubé, Catherine; Clark, Robin E; Lapane, Kate L

2018-06-04

United States (US) guidelines regarding when to stop routine breast cancer screening remain unclear. No national studies to-date have evaluated the use of screening mammography among US long-stay nursing home residents. This cross-sectional study was designed to identify prevalence, predictors, and geographic variation of screening mammography among that population in the context of current US guidelines. Screening mammography prevalence, identified with Physician/Supplier Part B claims and stratified by guideline age classification (65-74, ≥75 years), was estimated for all women aged ≥65 years residing in US Medicare- and Medicaid- certified nursing homes (≥1 year) with an annual Minimum Data Set (MDS) 3.0 assessment, continuous Medicare Part B enrollment, and no clinical indication for screening mammography as of 2011 (n = 389,821). The associations between resident- and regional- level factors, and screening mammography, were estimated by crude and adjusted prevalence ratios from robust Poisson regressions clustered by facility. Women on average were 85.4 (standard deviation ±8.1) years old, 77.9% were disabled, and 76.3% cognitively impaired. Screening mammography prevalence was 7.1% among those aged 65-74 years (95% Confidence Interval (CI): 6.8%-7.3%) and 1.7% among those ≥75 years (95% CI, 1.7%-1.8%), with geographic variation observed. Predictors of screening in both age groups included race, cognitive impairment, frailty, hospice, and some comorbidities. These results shed light on the current screening mammography practices in US nursing homes. Thoughtful consideration about individual screening recommendations and the implementation of more clear guidelines for this special population are warranted to prevent overscreening. Copyright © 2018 Elsevier Inc. All rights reserved.

Imaging of Mucosal Inflammation: Current Technological Developments, Clinical Implications, and Future Perspectives

Directory of Open Access Journals (Sweden)

Maximilian J. Waldner

2017-10-01

Full Text Available In recent years, various technological developments markedly improved imaging of mucosal inflammation in patients with inflammatory bowel diseases. Although technological developments such as high-definition-, chromo-, and autofluorescence-endoscopy led to a more precise and detailed assessment of mucosal inflammation during wide-field endoscopy, probe-based and stationary confocal laser microscopy enabled in vivo real-time microscopic imaging of mucosal surfaces within the gastrointestinal tract. Through the use of fluorochromes with specificity against a defined molecular target combined with endoscopic techniques that allow ultrastructural resolution, molecular imaging enables in vivo visualization of single molecules or receptors during endoscopy. Molecular imaging has therefore greatly expanded the clinical utility and applications of modern innovative endoscopy, which include the diagnosis, surveillance, and treatment of disease as well as the prediction of the therapeutic response of individual patients. Furthermore, non-invasive imaging techniques such as computed tomography, magnetic resonance imaging, scintigraphy, and ultrasound provide helpful information as supplement to invasive endoscopic procedures. In this review, we provide an overview on the current status of advanced imaging technologies for the clinical non-invasive and endoscopic evaluation of mucosal inflammation. Furthermore, the value of novel methods such as multiphoton microscopy, optoacoustics, and optical coherence tomography and their possible future implementation into clinical diagnosis and evaluation of mucosal inflammation will be discussed.

[Security Management in Clinical Laboratory Departments and Facilities: Current Status and Issues].

Science.gov (United States)

Ishida, Haku; Nakamura, Junji; Yoshida, Hiroshi; Koike, Masaru; Inoue, Yuji

2014-11-01

We conducted a questionnaire survey regarding the current activities for protecting patients' privacy and the security of information systems (IS) related to the clinical laboratory departments of university hospitals, certified training facilities for clinical laboratories, and general hospitals in Yamaguchi Prefecture. The response rate was 47% from 215 medical institutions, including three commercial clinical laboratory centers. The results showed that there were some differences in management activities among facilities with respect to continuing education, the documentation or regulation of operational management for paper records, electronic information, remaining samples, genetic testing, and laboratory information for secondary use. They were suggested to be caused by differences in functions between university and general hospitals, differences in the scale of hospitals, or whether or not hospitals have received accreditation or ISO 15189. Regarding the IS, although the majority of facilities had sufficiently employed the access control to IS, there was some room for improvement in the management of special cases such as VIPs and patients with HIV infection. Furthermore, there were issues regarding the login method for computers shared by multiple staff, the showing of the names of personnel in charge of reports, and the risks associated with direct connections to systems and the Internet and the use of portable media such as USB memory sticks. These results indicated that further efforts are necessary for each facility to continue self-assessment and make improvements.

The current state of industry development in Ukraine: advance perspective

Directory of Open Access Journals (Sweden)

Skyba Maryna Valeriyivna

2015-02-01

Full Text Available The current state of the industry of Ukraine are considered at the article. The author determined that the stabilization of the situation and further development of the industry need first of all cessation of hostilities. It is necessary to implement effective measures to combat corruption, the development of consistent, constructive and concerted action on the formation of institutions guaranteeing stability, predictability and transparency of the market rules and procedures that minimize the impact of shadow factors, and implementation of professional privatization and limitation of monopoly at the markets, forming a transparent, competitive business environment, the introduction of new energy saving technologies. These measures will help attract investment, increase production and improve enterprise profitability.

Current state of methodological and decisions for radiation treatment of blood, its components and products

OpenAIRE

Gordeev A.V.; Naumova L.A.; Kharitonov S.V.

2014-01-01

This article presents currently used blood transfusion media — components and blood products, therapeutic effects, reactions and complications of blood transfusion, use of radiation treatment for blood transfusion fluids. There had been discussed in detail the practice of radiation processing of blood components and for the prevention of reaction "graft versus host" and studies of plasma radiation treatment for its infectious safety. There was presented the current state of techniques and tec...

Transcatheter Pulmonary Valve Replacement: Current State of Art.

Science.gov (United States)

Alkashkari, Wail; Alsubei, Amani; Hijazi, Ziyad M

2018-03-15

The past couple of decades have brought tremendous advances to the field of pediatric and adult congenital heart disease (CHD). Percutaneous valve interventions are now a cornerstone of not just the congenital cardiologist treating patients with congenital heart disease, but also-and numerically more importantly-for adult interventional cardiologists treating patients with acquired heart valve disease. Transcatheter pulmonary valve replacement (tPVR) is one of the most exciting recent developments in the treatment of CHD and has evolved to become an attractive alternative to surgery in patients with right ventricular outflow tract (RVOT) dysfunction. This review aims to summarize (1) the current state of the art for tPVR, (2) the expanding indications, and (3) the technological obstacles to optimizing tPVR. Since its introduction in 2000, more than ten thousands tPVR procedures have been performed worldwide. Although the indications for tPVR have been adapted earlier from those accepted for surgical intervention, they remain incompletely defined. The new imaging modalities give better assessment of cardiac anatomy and function and determine candidacy for the procedure. The procedure has been shown to be feasible and safe when performed in patients who received pulmonary conduit and or bioprosthetic valves between the right ventricle and the pulmonary artery. Fewer selected patients post trans-annular patch repair for tetralogy of Fallot may also be candidates for this technology. Size restrictions of the currently available valves limit deployment in the majority of patients post trans-annular patch repair. Newer valves and techniques are being developed that may help such patients. Refinements and further developments of this procedure hold promise for the extension of this technology to other patient populations.

Clinical Microbiology Laboratories' Adoption of Culture-Independent Diagnostic Tests Is a Threat to Foodborne-Disease Surveillance in the United States.

Science.gov (United States)

Shea, Shari; Kubota, Kristy A; Maguire, Hugh; Gladbach, Stephen; Woron, Amy; Atkinson-Dunn, Robyn; Couturier, Marc Roger; Miller, Melissa B

2017-01-01

INTRODUCTIONIn November 2015, the Centers for Disease Control and Prevention (CDC) sent a letter to state and territorial epidemiologists, state and territorial public health laboratory directors, and state and territorial health officials. In this letter, culture-independent diagnostic tests (CIDTs) for detection of enteric pathogens were characterized as "a serious and current threat to public health surveillance, particularly for Shiga toxin-producing Escherichia coli (STEC) and Salmonella" The document says CDC and its public health partners are approaching this issue, in part, by "reviewing regulatory authority in public health agencies to require culture isolates or specimen submission if CIDTs are used." Large-scale foodborne outbreaks are a continuing threat to public health, and tracking these outbreaks is an important tool in shortening them and developing strategies to prevent them. It is clear that the use of CIDTs for enteric pathogen detection, including both antigen detection and multiplex nucleic acid amplification techniques, is becoming more widespread. Furthermore, some clinical microbiology laboratories will resist the mandate to require submission of culture isolates, since it will likely not improve patient outcomes but may add significant costs. Specimen submission would be less expensive and time-consuming for clinical laboratories; however, this approach would be burdensome for public health laboratories, since those laboratories would need to perform culture isolation prior to typing. Shari Shea and Kristy Kubota from the Association of Public Health Laboratories, along with state public health laboratory officials from Colorado, Missouri, Tennessee, and Utah, will explain the public health laboratories' perspective on why having access to isolates of enteric pathogens is essential for public health surveillance, detection, and tracking of outbreaks and offer potential workable solutions which will allow them to do this. Marc Couturier of

Current Epidemiology of Revision Total Knee Arthroplasty in the United States.

Science.gov (United States)

Delanois, Ronald E; Mistry, Jaydev B; Gwam, Chukwuweike U; Mohamed, Nequesha S; Choksi, Ujval S; Mont, Michael A

2017-09-01

Revision surgery for failed total knee arthroplasty (TKA) continues to pose a substantial burden for the United States healthcare system. The predominant etiology of TKA failure has changed over time and may vary between studies. This report aims to update the current literature on this topic by using a large national database. Specifically, we analyzed: (1) etiologies for revision TKA; (2) frequencies of revision TKA procedures; (3) various demographics including payer type and region; and (4) the length of stay (LOS) and total charges based on type of revision TKA procedure. The Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) database was used to identify all revision TKA procedures performed between 2009 and 2013. Clinical, economic, and demographic data were collected and analyzed for 337,597 procedures. Patients were stratified according to etiology of failure, age, sex, race, US census region, and primary payor class. The mean LOS and total charges were also calculated. Infection was the most common etiology for revision TKA (20.4%), closely followed by mechanical loosening (20.3%). The most common revision TKA procedure performed was all component revision (31.3%). Medicare was the primary payor for the greatest proportion of revisions (57.7%). The South census region performed the most revision TKAs (33.2%). The overall mean LOS was 4.5 days, with arthrotomy for removal of prosthesis without replacement procedures accounting for the longest stays (7.8 days). The mean total charge for revision TKAs was $75,028.07. Without appropriate measures in place, the burden of revision TKAs may become overwhelming and pose a strain on providers and institutions. Continued insight into the etiology and epidemiology of revision TKAs may be the principle step towards improving outcomes and mitigating the need for future revisions. Copyright © 2017 Elsevier Inc. All rights reserved.

Figures in clinical trial reports: current practice & scope for improvement.

Science.gov (United States)

Pocock, Stuart J; Travison, Thomas G; Wruck, Lisa M

2007-11-19

Most clinical trial publications include figures, but there is little guidance on what results should be displayed as figures and how. To evaluate the current use of figures in Trial reports, and to make constructive suggestions for future practice. We surveyed all 77 reports of randomised controlled trials in five general medical journals during November 2006 to January 2007. The numbers and types of figures were determined, and then each Figure was assessed for its style, content, clarity and suitability. As a consequence, guidelines are developed for presenting figures, both in general and for each specific common type of Figure. Most trial reports contained one to three figures, mean 2.3 per article. The four main types were flow diagram, Kaplan Meier plot, Forest plot (for subgroup analyses) and repeated measures over time: these accounted for 92% of all figures published. For each type of figure there is a considerable diversity of practice in both style and content which we illustrate with selected examples of both good and bad practice. Some pointers on what to do, and what to avoid, are derived from our critical evaluation of these articles' use of figures. There is considerable scope for authors to improve their use of figures in clinical trial reports, as regards which figures to choose, their style of presentation and labelling, and their specific content. Particular improvements are needed for the four main types of figures commonly used.

Figures in clinical trial reports: current practice & scope for improvement

Directory of Open Access Journals (Sweden)

Travison Thomas G

2007-11-01

Full Text Available Abstract Background Most clinical trial publications include figures, but there is little guidance on what results should be displayed as figures and how. Purpose To evaluate the current use of figures in Trial reports, and to make constructive suggestions for future practice. Methods We surveyed all 77 reports of randomised controlled trials in five general medical journals during November 2006 to January 2007. The numbers and types of figures were determined, and then each Figure was assessed for its style, content, clarity and suitability. As a consequence, guidelines are developed for presenting figures, both in general and for each specific common type of Figure. Results Most trial reports contained one to three figures, mean 2.3 per article. The four main types were flow diagram, Kaplan Meier plot, Forest plot (for subgroup analyses and repeated measures over time: these accounted for 92% of all figures published. For each type of figure there is a considerable diversity of practice in both style and content which we illustrate with selected examples of both good and bad practice. Some pointers on what to do, and what to avoid, are derived from our critical evaluation of these articles' use of figures. Conclusion There is considerable scope for authors to improve their use of figures in clinical trial reports, as regards which figures to choose, their style of presentation and labelling, and their specific content. Particular improvements are needed for the four main types of figures commonly used.

Clinical Endocannabinoid Deficiency Reconsidered: Current Research Supports the Theory in Migraine, Fibromyalgia, Irritable Bowel, and Other Treatment-Resistant Syndromes.

Science.gov (United States)

Russo, Ethan B

2016-01-01

Medicine continues to struggle in its approaches to numerous common subjective pain syndromes that lack objective signs and remain treatment resistant. Foremost among these are migraine, fibromyalgia, and irritable bowel syndrome, disorders that may overlap in their affected populations and whose sufferers have all endured the stigma of a psychosomatic label, as well as the failure of endless pharmacotherapeutic interventions with substandard benefit. The commonality in symptomatology in these conditions displaying hyperalgesia and central sensitization with possible common underlying pathophysiology suggests that a clinical endocannabinoid deficiency might characterize their origin. Its base hypothesis is that all humans have an underlying endocannabinoid tone that is a reflection of levels of the endocannabinoids, anandamide (arachidonylethanolamide), and 2-arachidonoylglycerol, their production, metabolism, and the relative abundance and state of cannabinoid receptors. Its theory is that in certain conditions, whether congenital or acquired, endocannabinoid tone becomes deficient and productive of pathophysiological syndromes. When first proposed in 2001 and subsequently, this theory was based on genetic overlap and comorbidity, patterns of symptomatology that could be mediated by the endocannabinoid system (ECS), and the fact that exogenous cannabinoid treatment frequently provided symptomatic benefit. However, objective proof and formal clinical trial data were lacking. Currently, however, statistically significant differences in cerebrospinal fluid anandamide levels have been documented in migraineurs, and advanced imaging studies have demonstrated ECS hypofunction in post-traumatic stress disorder. Additional studies have provided a firmer foundation for the theory, while clinical data have also produced evidence for decreased pain, improved sleep, and other benefits to cannabinoid treatment and adjunctive lifestyle approaches affecting the ECS.

Current Status of Immunomodulatory and Cellular Therapies in Preclinical and Clinical Islet Transplantation

Directory of Open Access Journals (Sweden)

Preeti Chhabra

2011-01-01

Full Text Available Clinical islet transplantation is a -cell replacement strategy that represents a possible definitive intervention for patients with type 1 diabetes, offering substantial benefits in terms of lowering daily insulin requirements and reducing incidences of debilitating hypoglycemic episodes and unawareness. Despite impressive advances in this field, a limiting supply of islets, inadequate means for preventing islet rejection, and the deleterious diabetogenic and nephrotoxic side effects associated with chronic immunosuppressive therapy preclude its wide-spread applicability. Islet transplantation however allows a window of opportunity for attempting various therapeutic manipulations of islets prior to transplantation aimed at achieving superior transplant outcomes. In this paper, we will focus on the current status of various immunosuppressive and cellular therapies that promote graft function and survival in preclinical and clinical islet transplantation with special emphasis on the tolerance-inducing capacity of regulatory T cells as well as the -cells regenerative capacity of stem cells.

An In-Rush Current Suppression Technique for the Solid-State Transfer Switch System

Science.gov (United States)

Cheng, Po-Tai; Chen, Yu-Hsing

More and more utility companies provide dual power feeders as a premier service of high power quality and reliability. To take advantage of this, the solid-state transfer switch (STS) is adopted to protect the sensitive load against the voltage sag. However, the fast transfer process may cause in-rush current on the load-side transformer due to the resulting DC-offset in its magnetic flux as the load-transfer is completed. The in-rush current can reach 2∼6 p.u. and it may trigger the over-current protections on the power feeder. This paper develops a flux estimation scheme and a thyristor gating scheme based on the impulse commutation bridge STS (ICBSTS) to minimize the DC-offset on the magnetic flux. By sensing the line voltages of both feeders, the flux estimator can predict the peak transient flux linkage at the moment of load-transfer and evaluate a suitable moment for the transfer to minimize the in-rush current. Laboratory test results are presented to validate the performance of the proposed system.

Current state and controversies in fertility preservation in women with breast cancer

OpenAIRE

Taylan, Enes; Oktay, Kutluk H

2017-01-01

On average, over 25000 women are diagnosed with breast cancer under the age of 45 annually in the United States. Because an increasing number of young women delay childbearing to later life for various reasons, a growing population of women experience breast cancer before completing childbearing. In this context, preservation of fertility potential of breast cancer survivors has become an essential concept in modern cancer care. In this review, we will outline the currently available fertilit...

High Charge State Ions Extracted from Metal Plasmas in the Transition Regime from Vacuum Spark to High Current Vacuum Arc

International Nuclear Information System (INIS)

Yushkov, Georgy Yu.; Anders, A.

2008-01-01

Metal ions were extracted from pulsed discharge plasmas operating in the transition region between vacuum spark (transient high voltage of kV) and vacuum arc (arc voltage ∼ 20 V). At a peak current of about 4 kA, and with a pulse duration of 8 (micro)s, we observed mean ion charges states of about 6 for several cathode materials. In the case of platinum, the highest average charge state was 6.74 with ions of charge states as high as 10 present. For gold we found traces of charge state 11, with the highest average charge state of 7.25. At currents higher than 5 kA, non-metallic contaminations started to dominate the ion beam, preventing further enhancement of the metal charge states

Evidence of a New Current-Induced Magnetoelectric Effect in a Toroidal Magnetic Ordered State of UNi4B

Science.gov (United States)

Saito, Hiraku; Uenishi, Kenta; Miura, Naoyuki; Tabata, Chihiro; Hidaka, Hiroyuki; Yanagisawa, Tatsuya; Amitsuka, Hiroshi

2018-03-01

Magnetization measurements under direct electric current were performed in a toroidal magnetic ordered state of UNi4B to test a recent theoretical prediction of current-induced magnetization in a metallic system lacking local-inversion symmetry. We found that electric current parallel to [2\\bar{1}\\bar{1}0] and [0001] in the hexagonal 4-index notation induces a uniform magnetization along the [01\\bar{1}0] direction. The observed behavior of the induced magnetization is essentially consistent with the theoretical prediction; however, it also shows an inconsistency suggesting that the antiferromagnetic state of UNi4B could not be simply regarded as a uniform toroidal order in the ideal honeycomb layered structure.

Operating tokamaks with steady-state toroidal current

International Nuclear Information System (INIS)

Fisch, N.J.

1981-04-01

Continuous operation of a tokamak requires, among other things, a means of continuously providing the toroidal current. Various methods have been proposed to provide this current including methods which utilize radio-frequency waves in any of several frequency regimes. Here we elaborate on the prospects of incorporating these current-drive techniques in tokamak reactors, concentrating on the theoretical minimization of the power requirements

System and method for generating steady state confining current for a toroidal plasma fusion reactor

International Nuclear Information System (INIS)

Fisch, N.J.

1981-01-01

A system for generating steady state confining current for a toroidal plasma fusion reactor providing steady-state generation of the thermonuclear power. A dense, hot toroidal plasma is initially prepared with a confining magnetic field with toroidal and poloidal components. Continuous wave rf energy is injected into said plasma to establish a spectrum of traveling waves in the plasma, where the traveling waves have momentum components substantially either all parallel, or all anti-parallel to the confining magnetic field. The injected rf energy is phased to couple to said traveling waves with both a phase velocity component and a wave momentum component in the direction of the plasma traveling wave components. The injected rf energy has a predetermined spectrum selected so that said traveling waves couple to plasma electrons having velocities in a predetermined range delta . The velocities in the range are substantially greater than the thermal electron velocity of the plasma. In addition, the range is sufficiently broad to produce a raised plateau having width delta in the plasma electron velocity distribution so that the plateau electrons provide steady-state current to generate a poloidal magnetic field component sufficient for confining the plasma. In steady state operation of the fusion reactor, the fusion power density in the plasma exceeds the power dissipated in the plasma

Current reversals and metastable states in the infinite Bose-Hubbard chain with local particle loss

Science.gov (United States)

Kiefer-Emmanouilidis, M.; Sirker, J.

2017-12-01

We present an algorithm which combines the quantum trajectory approach to open quantum systems with a density-matrix renormalization-group scheme for infinite one-dimensional lattice systems. We apply this method to investigate the long-time dynamics in the Bose-Hubbard model with local particle loss starting from a Mott-insulating initial state with one boson per site. While the short-time dynamics can be described even quantitatively by an equation of motion (EOM) approach at the mean-field level, many-body interactions lead to unexpected effects at intermediate and long times: local particle currents far away from the dissipative site start to reverse direction ultimately leading to a metastable state with a total particle current pointing away from the lossy site. An alternative EOM approach based on an effective fermion model shows that the reversal of currents can be understood qualitatively by the creation of holon-doublon pairs at the edge of the region of reduced particle density. The doublons are then able to escape while the holes move towards the dissipative site, a process reminiscent—in a loose sense—of Hawking radiation.

Current Status of Immunomodulatory and Cellular Therapies in Preclinical and Clinical Islet Transplantation

Science.gov (United States)

Chhabra, Preeti; Brayman, Kenneth L.

2011-01-01

Clinical islet transplantation is a β-cell replacement strategy that represents a possible definitive intervention for patients with type 1 diabetes, offering substantial benefits in terms of lowering daily insulin requirements and reducing incidences of debilitating hypoglycemic episodes and unawareness. Despite impressive advances in this field, a limiting supply of islets, inadequate means for preventing islet rejection, and the deleterious diabetogenic and nephrotoxic side effects associated with chronic immunosuppressive therapy preclude its wide-spread applicability. Islet transplantation however allows a window of opportunity for attempting various therapeutic manipulations of islets prior to transplantation aimed at achieving superior transplant outcomes. In this paper, we will focus on the current status of various immunosuppressive and cellular therapies that promote graft function and survival in preclinical and clinical islet transplantation with special emphasis on the tolerance-inducing capacity of regulatory T cells as well as the β-cells regenerative capacity of stem cells. PMID:22046502

Recent developments and current concepts in medulloblastoma.

Science.gov (United States)

Gerber, N U; Mynarek, M; von Hoff, K; Friedrich, C; Resch, A; Rutkowski, S

2014-04-01

Medulloblastoma is the most common malignant brain tumor of childhood. While prognosis has significantly improved in the last decades with multimodal therapy including surgery, radiotherapy, and chemotherapy, one third of patients still succumb to their disease. Further research is needed to find more efficient treatment strategies for prognostically unfavorable patient groups and to minimize long-term sequelae of tumor treatment. This review gives a summary of the current state of treatment concepts including an outlook on the near future. We describe recent advances in the understanding of molecular mechanisms, their potential impact on risk stratification in upcoming clinical trials, and perspectives for the clinical implementation of targeted therapies. Copyright © 2013 Elsevier Ltd. All rights reserved.

Current State-of-the-Art MRI for Comprehensive Evaluation of Potential Living Liver Donors.

Science.gov (United States)

Jhaveri, Kartik S; Guo, Lijun; Guimarães, Luís

2017-07-01

This review focuses on the role of state-of-the-art MRI-based techniques for comprehensive evaluation of living donors providing single-visit assessment of the liver vasculature via MR angiography, of the biliary tract via conventional T2-weighted MR cholangiography and T1-weighted gadoxetate disodium-enhanced MR cholangiography, and of hepatic steatosis via T2*-corrected multiecho chemical shift-based water-fat separation MRI and high-speed T2-corrected multiecho MR spectroscopy. By using current state-of-the-art techniques, MRI can provide a one-stop-shop method for evaluation of the potential living liver donors.

Macroscopic quantum effects in the zero voltage state of the current biased Josephson junction

International Nuclear Information System (INIS)

Clarke, J.; Devoret, M.H.; Martinis, J.; Esteve, D.

1985-05-01

When a weak microwave current is applied to a current-biased Josephson tunnel junction in the thermal limit the escape rate from the zero voltage state is enhanced when the microwave frequency is near the plasma frequency of the junction. The resonance curve is markedly asymmetric because of the anharmonic properties of the potential well: this behavior is well explained by a computer simulation using a resistively shunted junction model. This phenomenon of resonant activation enables one to make in situ measurements of the capacitance and resistance shunting the junction, including contributions from the complex impedance presented by the current leads. For the relatively large area junctions studied in these experiments, the external capacitive loading was relatively unimportant, but the damping was entirely dominated by the external resistance

[Is the structure of surgical clinics in Germany changing? A current investigation into the structure of surgical clinics in the Federal Republic of Germany].

Science.gov (United States)

Lob, G; Lob, T; Bauer, H; Niethard, F; Polonius, J; Siebert, H

2009-04-01

Medical developments have led to extensive specialization in the field of surgery. This has already been reflected for many years in altered structure and organization forms of surgical clinics. Indispensable quality standards, statutory general conditions, increasing competition in service providers and health insurance with transparency of the service procedure all intensify this trend. The aim of this investigation was, therefore, to determine how far this differentiation of service supply in the field of surgery is also reflected in the area and in surgical departments and clinics of basic and routine supply. To achieve this, all available published information on the structure and organization of surgical clinics in the Federal Republic of Germany was classified according to current departmentalization into "undivided" or general/visceral surgery facilities compared to orthopedic/trauma surgery departments.

Modulation of Brain Activity with Noninvasive Transcranial Direct Current Stimulation (tDCS): Clinical Applications and Safety Concerns

Science.gov (United States)

Zhao, Haichao; Qiao, Lei; Fan, Dongqiong; Zhang, Shuyue; Turel, Ofir; Li, Yonghui; Li, Jun; Xue, Gui; Chen, Antao; He, Qinghua

2017-01-01

Transcranial direct current stimulation (tDCS) is a widely-used tool to induce neuroplasticity and modulate cortical function by applying weak direct current over the scalp. In this review, we first introduce the underlying mechanism of action, the brief history from discovery to clinical scientific research, electrode positioning and montages, and parameter setup of tDCS. Then, we review tDCS application in clinical samples including people with drug addiction, major depression disorder, Alzheimer's disease, as well as in children. This review covers the typical characteristics and the underlying neural mechanisms of tDCS treatment in such studies. This is followed by a discussion of safety, especially when the current intensity is increased or the stimulation duration is prolonged. Given such concerns, we provide detailed suggestions regarding safety procedures for tDCS operation. Lastly, future research directions are discussed. They include foci on the development of multi-tech combination with tDCS such as with TMS and fMRI; long-term behavioral and morphological changes; possible applications in other research domains, and more animal research to deepen the understanding of the biological and physiological mechanisms of tDCS stimulation. PMID:28539894

Fed-state gastric media and drug analysis techniques: Current status and points to consider.

Science.gov (United States)

Baxevanis, Fotios; Kuiper, Jesse; Fotaki, Nikoletta

2016-10-01

Gastric fed state conditions can have a significant effect on drug dissolution and absorption. In vitro dissolution tests with simple aqueous media cannot usually predict drugs' in vivo response, as several factors such as the meal content, the gastric emptying and possible interactions between food and drug formulations can affect drug's pharmacokinetics. Good understanding of the effect of the in vivo fed gastric conditions on the drug is essential for the development of biorelevant dissolution media simulating the gastric environment after the administration of the standard high fat meal proposed by the FDA and the EMA in bioavailability/bioequivalence (BA/BE) studies. The analysis of drugs in fed state media can be quite challenging as most analytical protocols currently employed are time consuming and labour intensive. In this review, an overview of the in vivo gastric conditions and the biorelevant media used for their in vitro simulation are described. Furthermore an analysis of the physicochemical properties of the drugs and the formulations related to food effect is given. In terms of drug analysis, the protocols currently used for the fed state media sample treatment and analysis and the analytical challenges and needs emerging for more efficient and time saving techniques for a broad spectrum of compounds are being discussed. Copyright © 2016 Elsevier B.V. All rights reserved.

Sub-bandgap photonic base current method for characterization of interface states at heterointerfaces in heterojunction bipolar transistors

International Nuclear Information System (INIS)

Shin, H. T.; Kim, K. H.; Kim, K. S.

2004-01-01

In this paper, we propose a novel photonic base current analysis method to characterize the interface states in heterojunction bipolar transistors (HBTs) by using the photonic I-V characteristics under sub-bandgap photonic excitation. For the photonic current-voltage characterization of HBTs, an optical source with a photon energy less than the bandgap energy of Al 0.3 Ga 0.7 As and GaAs (E ph = 0.95 eV g,AlGaAs = 1.79 eV, E g,GaAs = 1.45 eV) is employed for the characterization of the interface states distributed in the photo-responsive energy band (E C - 0.95 ≤ E it ≤ E C ) in emitter-base heterojunction at HBTs. The proposed novel method, which is applied to bipolar junction transistors for the first time, is simple, and an accurate analysis of interface traps in HBTs is possible. By using the photonic base-current and the dark-base-current, we qualitatively analyze the interface trap at the Al 0.3 Ga 0.7 As/GaAs heterojunction interface in HBTs.

[Current status of job burnout in clinical nurses in a grade A tertiary hospital and related influencing factors].

Science.gov (United States)

Ye, L Y; Fan, C L; Wang, L G; Tao, T; Gao, W B; Li, Y H

2017-10-20

Objective: To investigate the current status of job burnout in clinical nurses in a grade A tertiary hospitalin Shaoxing,China and related influencing factors. Methods: In October 2016, the Nursing Burnout Scale (NBS)was used for the investigation of 304 clinical nurses in a grade A tertiary hospital.The contents of the investigation included general data(including age,education background,working years,marital status, frequency of night shifts,professional title, and way of employment), characteristics of working environment,burnout, personality characteristics,coping strategy,and psychosomatic symptoms.SPSS 18.0 was used to conduct Pearson correlation analysis of the scores of each dimension of NBS. A multivariate regression analysis was performed with the demographic features of clinical nurses as the independent variable and the scores of each dimension of NBS as the dependent variable. Results: Among the clinical nurses in this grade A tertiary hospital, the incidence rate of severe burnout was 74%.The Pearson correlation analysis showed that burnout,pessimistic personality,negative coping,and psychosomatic symptoms were positively correlated with working environment( r =0.530,0.316,0.116,and 0.502); pessimistic personality and psychosomatic symptoms were positively correlated with burnout( r =0.618 and 0.675); psychosomatic symptoms were positively correlated withpessimistic personality( r =0.540); negative coping was negatively correlated with pessimistic personality( r =-0.145).The multivariate linear regression analysis showed that department(Department of Internal Medicine or Department of Surgery, B =-0.364 and -0.428)and frequency of night shifts(burnout; 1 - 3 working years( B =-0.238)was an influencing factor for the score of pessimistic personality; married state,1 - 3 working years,and department (Department of Internal Medicine or Department of Surgery)were influencing factors for the score of psychosomatic symptoms( B =0.263,-0.301,-0.322,and -0

Current and future perspectives in clinical management

International Nuclear Information System (INIS)

Willett, Christopher

1996-01-01

In the past several years, there has been significant progress and controversy in the clinical management of patients with rectal cancer as well as important advances in the understanding the biology of these tumors. The panel will highlight relevant biologic and clinical developments. One of major advances has been in the understanding of the molecular basis for the development of colon and rectal cancer with many of the events leading to cancer development having been determined. Although there is much to be learned, there is now a much improved understanding of colon and rectal carcinogenesis with the prospect of being able to define high risk patient populations and the possibility of early detection (before cancer formation) now a real possibility. In addition, the identification of favorable or unfavorable subsets of patients wit rectal cancer based on molecular markers is under active investigation. These exciting developments will be summarized. In the clinical arena, there are a number of controversial issues in the management of patients with rectal cancer. For patients with distal rectal cancer, the goals of therapy have evolved from cure to cure with sphincter preservation. The role of resection with coloanal anastomosis as an alternative to an abdominoperineal resection is also being defined. A wide array of treatment programs of radiation therapy and chemotherapy and sphincter sparing surgery are under active investigation. The relative merits of preoperative chemo-irradiation versus postoperative chemo-irradiation continues to be debated. The utility of total mesorectal excision is being evaluated and the need for adjuvant therapy is being questioned. These clinical issues will be highlighted

The cost of implementing rapid HIV testing in sexually transmitted disease clinics in the United States.

Science.gov (United States)

Eggman, Ashley A; Feaster, Daniel J; Leff, Jared A; Golden, Matthew R; Castellon, Pedro C; Gooden, Lauren; Matheson, Tim; Colfax, Grant N; Metsch, Lisa R; Schackman, Bruce R

2014-09-01

Rapid HIV testing in high-risk populations can increase the number of persons who learn their HIV status and avoid spending clinic resources to locate persons identified as HIV infected. We determined the cost to sexually transmitted disease (STD) clinics of point-of-care rapid HIV testing using data from 7 public clinics that participated in a randomized trial of rapid testing with and without brief patient-centered risk reduction counseling in 2010. Costs included counselor and trainer time, supplies, and clinic overhead. We applied national labor rates and test costs. We calculated median clinic start-up costs and mean cost per patient tested, and projected incremental annual costs of implementing universal rapid HIV testing compared with current testing practices. Criteria for offering rapid HIV testing and methods for delivering nonrapid test results varied among clinics before the trial. Rapid HIV testing cost an average of US $22/patient without brief risk reduction counseling and US $46/patient with counseling in these 7 clinics. Median start-up costs per clinic were US $1100 and US $16,100 without and with counseling, respectively. Estimated incremental annual costs per clinic of implementing universal rapid HIV testing varied by whether or not brief counseling is conducted and by current clinic testing practices, ranging from a savings of US $19,500 to a cost of US $40,700 without counseling and a cost of US $98,000 to US $153,900 with counseling. Universal rapid HIV testing in STD clinics with same-day results can be implemented at relatively low cost to STD clinics, if brief risk reduction counseling is not offered.

Clinical management of achalasia: current state of the art

Science.gov (United States)

Krill, Joseph T; Naik, Rishi D; Vaezi, Michael F

2016-01-01

Achalasia is a primary disorder of esophageal motility. It classically presents with dysphagia to both solids and liquids but may be accompanied by regurgitation and chest pain. The gold standard for the diagnosis of achalasia is esophageal motility testing with manometry, which often reveals aperistalsis of the esophageal body and incomplete lower esophageal sphincter relaxation. The diagnosis is aided by complimentary tests, such as esophagogastroduodenoscopy and contrast radiography. Esophagogastroduodenoscopy is indicated to rule out mimickers of the disease known as “pseudoachalasia” (eg, malignancy). Endoscopic appearance of a dilated esophagus with retained food or saliva and a puckered lower esophageal sphincter should raise suspicion for achalasia. Additionally, barium esophagography may reveal a dilated esophagus with a distal tapering giving it a “bird’s beak” appearance. Multiple therapeutic modalities aid in the management of achalasia, the decision of which depends on operative risk factors. Conventional treatments include medical therapy, botulinum toxin injection, pneumatic dilation, and Heller myotomy. The last two are defined as the most definitive treatment options. New emerging therapies include peroral endoscopic myotomy, placement of self-expanding metallic stents, and endoscopic sclerotherapy. PMID:27110134

Clinical management of achalasia: current state of the art

Directory of Open Access Journals (Sweden)

Krill JT

2016-04-01

Full Text Available Joseph T Krill, Rishi D Naik, Michael F Vaezi Division of Gastroenterology, Hepatology, and Nutrition, Center for Swallowing and Esophageal Disorders, Vanderbilt University Medical Center, Nashville, TN, USA Abstract: Achalasia is a primary disorder of esophageal motility. It classically presents with dysphagia to both solids and liquids but may be accompanied by regurgitation and chest pain. The gold standard for the diagnosis of achalasia is esophageal motility testing with manometry, which often reveals aperistalsis of the esophageal body and incomplete lower esophageal sphincter relaxation. The diagnosis is aided by complimentary tests, such as esophagogastroduodenoscopy and contrast radiography. Esophagogastroduodenoscopy is indicated to rule out mimickers of the disease known as “pseudoachalasia” (eg, malignancy. Endoscopic appearance of a dilated esophagus with retained food or saliva and a puckered lower esophageal sphincter should raise suspicion for achalasia. Additionally, barium esophagography may reveal a dilated esophagus with a distal tapering giving it a “bird’s beak” appearance. Multiple therapeutic modalities aid in the management of achalasia, the decision of which depends on operative risk factors. Conventional treatments include medical therapy, botulinum toxin injection, pneumatic dilation, and Heller myotomy. The last two are defined as the most definitive treatment options. New emerging therapies include peroral endoscopic myotomy, placement of self-expanding metallic stents, and endoscopic sclerotherapy. Keywords: achalasia, pseudoachalasia, pneumatic dilation, Heller myotomy, botulinum toxin injection, peroral endoscopic myotomy

Combination injuries - current state of pathology and clinical practice

International Nuclear Information System (INIS)

Messerschmidt, O.

1987-01-01

Study of the literature reveals that most animal-experimental investigations are concerned with the combination of radiation plus burn. As it seems, this form of injury is also the most dangerous type of combination injury. Investigations have shown fatality from irradiation injury plus burns to be not merely additive. Rather, the lethal effects of the combined factors of harm are raised to a power of each other's potential. On other combinations of injuries, the literature presents far less findings. Nor do the prospects for their healing seem to be as unfavourable as in the case of burns. There seems to be a time factor according to which healing prospects depend on whether a trauma was sustained before or after whole-body irradiation and on the lapse of time between the two traumas. Transfer of the results obtained from experimental animals, mostly rodents, to man carries problems. Knowledge of how to treat combination injuries in a nuclear catastrophe is inadequate, too. Some treatment proposals are put up for discussion. (orig./MG) [de

Computed tomography: acquisition process, technology and current state

Directory of Open Access Journals (Sweden)

Óscar Javier Espitia Mendoza

2016-02-01

Full Text Available Computed tomography is a noninvasive scan technique widely applied in areas such as medicine, industry, and geology. This technique allows the three-dimensional reconstruction of the internal structure of an object which is lighted with an X-rays source. The reconstruction is formed with two-dimensional cross-sectional images of the object. Each cross-sectional is obtained from measurements of physical phenomena, such as attenuation, dispersion, and diffraction of X-rays, as result of their interaction with the object. In general, measurements acquisition is performed with methods based on any of these phenomena and according to various architectures classified in generations. Furthermore, in response to the need to simulate acquisition systems for CT, software dedicated to this task has been developed. The objective of this research is to determine the current state of CT techniques, for this, a review of methods, different architectures used for the acquisition and some of its applications is presented. Additionally, results of simulations are presented. The main contributions of this work are the detailed description of acquisition methods and the presentation of the possible trends of the technique.

Current state of commercial radiation detection equipment for homeland security applications

International Nuclear Information System (INIS)

Klann, R.T.; Shergur, J.; Mattesich, G.

2009-01-01

With the creation of the U.S. Department of Homeland Security (DHS) came the increased concern that terrorist groups would attempt to manufacture and use an improvised nuclear device or radiological dispersal device. As such, a primary mission of DHS is to protect the public against the use of these devices and to assist state and local responders in finding, locating, and identifying these types of devices and materials used to manufacture these devices. This assistance from DHS to state and local responders comes in the form of grant money to procure radiation detection equipment. In addition to this grant program, DHS has supported the development of American National Standards Institute standards for radiation detection equipment and has conducted testing of commercially available instruments. This paper identifies the types and kinds of commercially available equipment that can be used to detect and identify radiological material - for use in traditional search applications as well as primary and secondary screening of personnel, vehicles, and cargo containers. In doing so, key considerations for the conduct of operations are described as well as critical features of the instruments for specific applications. The current state of commercial instruments is described for different categories of detection equipment including personal radiation detectors, radioisotope identifiers, man-portable detection equipment, and radiation portal monitors. In addition, emerging technologies are also discussed, such as spectroscopic detectors and advanced spectroscopic portal monitors

Current State and Future Perspectives of Energy Sources for Totally Implantable Cardiac Devices.

Science.gov (United States)

Bleszynski, Peter A; Luc, Jessica G Y; Schade, Peter; PhilLips, Steven J; Tchantchaleishvili, Vakhtang

There is a large population of patients with end-stage congestive heart failure who cannot be treated by means of conventional cardiac surgery, cardiac transplantation, or chronic catecholamine infusions. Implantable cardiac devices, many designated as destination therapy, have revolutionized patient care and outcomes, although infection and complications related to external power sources or routine battery exchange remain a substantial risk. Complications from repeat battery replacement, power failure, and infections ultimately endanger the original objectives of implantable biomedical device therapy - eliminating the intended patient autonomy, affecting patient quality of life and survival. We sought to review the limitations of current cardiac biomedical device energy sources and discuss the current state and trends of future potential energy sources in pursuit of a lifelong fully implantable biomedical device.

The Current State of Music Therapy Theory?

DEFF Research Database (Denmark)

Bonde, Lars Ole

2015-01-01

An essay on themes from Ken Aigen (2014): "The Study of Music Therapy. Current Issues and Concepts"......An essay on themes from Ken Aigen (2014): "The Study of Music Therapy. Current Issues and Concepts"...

Current State of Agile User-Centered Design: A Survey

Science.gov (United States)

Hussain, Zahid; Slany, Wolfgang; Holzinger, Andreas

Agile software development methods are quite popular nowadays and are being adopted at an increasing rate in the industry every year. However, these methods are still lacking usability awareness in their development lifecycle, and the integration of usability/User-Centered Design (UCD) into agile methods is not adequately addressed. This paper presents the preliminary results of a recently conducted online survey regarding the current state of the integration of agile methods and usability/UCD. A world wide response of 92 practitioners was received. The results show that the majority of practitioners perceive that the integration of agile methods with usability/UCD has added value to their adopted processes and to their teams; has resulted in the improvement of usability and quality of the product developed; and has increased the satisfaction of the end-users of the product developed. The top most used HCI techniques are low-fidelity prototyping, conceptual designs, observational studies of users, usability expert evaluations, field studies, personas, rapid iterative testing, and laboratory usability testing.

Heating and current drive requirements for ideal MHD stability and ITB sustainment in ITER steady state scenarios

Science.gov (United States)

Poli, Francesca

2012-10-01

Steady state scenarios envisaged for ITER aim at optimizing the bootstrap current, while maintaining sufficient confinement and stability to provide the necessary fusion yield. Non-inductive scenarios will need to operate with Internal Transport Barriers (ITBs) in order to reach adequate fusion gain at typical currents of 9 MA. However, the large pressure gradients associated with ITBs in regions of weak or negative magnetic shear can be conducive to ideal MHD instabilities in a wide range of βN, reducing the no-wall limit. Scenarios are established as relaxed flattop states with time-dependent transport simulations with TSC [1]. Fully non-inductive configurations with current in the range of 7-10 MA and various heating mixes (NB, EC, IC and LH) have been studied against variations of the pressure profile peaking and of the Greenwald fraction. It is found that stable equilibria have qmin> 2 and moderate ITBs at 2/3 of the minor radius [2]. The ExB flow shear from toroidal plasma rotation is expected to be low in ITER, with a major role in the ITB dynamics being played by magnetic geometry. Combinations of H&CD sources that maintain reverse or weak magnetic shear profiles throughout the discharge and ρ(qmin)>=0.5 are the focus of this work. The ITER EC upper launcher, designed for NTM control, can provide enough current drive off-axis to sustain moderate ITBs at mid-radius and maintain a non-inductive current of 8-9MA and H98>=1.5 with the day one heating mix. LH heating and current drive is effective in modifying the current profile off-axis, facilitating the formation of stronger ITBs in the rampup phase, their sustainment at larger radii and larger bootstrap fraction. The implications for steady state operation and fusion performance are discussed.[4pt] [1] Jardin S.C. et al, J. Comput. Phys. 66 (1986) 481[0pt] [2] Poli F.M. et al, Nucl. Fusion 52 (2012) 063027.

SHORT OVERVIEW OF CLINICAL TRIALS WITH CURRENT IMMUNOTHERAPEUTIC TOOLS FOR CANCER TREATMENT

Directory of Open Access Journals (Sweden)

T. S. Nepomnyashchikh

2017-01-01

Full Text Available Over last decade, a substantial progress has been made, with respect to understanding of cancer biology and its interplay with the host immune system. Different immunotherapeutic drugs based on recombinant cytokines and monoclonal antibodies are widely used in cancer therapy, and a large number of experimental cancer treatments have been developed, many of which are currently undergoing various stages of clinical trials. Recent endorsement of a recombinant oncolytic herpesvirus T-VEC for the treatment of melanoma was an important step towards a more safe and efficient anticancer therapeutics. In this review, we shall mention only some of the most promising cancer immunotherapy strategies, namely, immune checkpoint inhibitors, cellular therapy and oncolytic viruses. 

Cost-Effective Screening for Breast Cancer Worldwide: Current State and Future Directions

Directory of Open Access Journals (Sweden)

A. Sarvazyan

2008-01-01

Full Text Available Affordability of healthcare is highly limited by its skyrocketing cost. Access to screening and diagnostic medical equipment and medicine in developing countries is inadequate for the majority of the population. There is a tremendous worldwide need to detect breast cancer at its earliest stage. These needs must be balanced by the ability of countries to provide breast cancer screening technology to their populations. We reviewed the diagnostic accuracy, procedure cost and cost-effectiveness of currently available technique for breast screening and diagnosis including clinical breast examination, mammography, ultrasound, magnetic resonance imaging, biopsy and a new modality for cancer diagnostics termed elasticity imaging that has emerged in the last decade. Clinical results demonstrate that elasticity imaging even in its simplest and least sophisticated versions, like tactile imaging, has significant diagnostic potential comparable and exceeding that of conventional imaging techniques. In view of many countries with limited resources, effective yet less expensive modes of screening must be considered worldwide. The tactile imaging is one method that has the potential to provide cost-effective breast cancer screening and diagnostics.

The Current Status of The Clinical Application of Radioisotope in Korea

International Nuclear Information System (INIS)

Lee, Myung Chul

1987-01-01

The medical application of radioisotope started in the western countries in the 1920's but the first successful clinical use of Nuclear Medicine in Korea was made in June, 1959, through the treatment of a patient with hyperthyroidism using radioactive iodine. However, keeping pace with the brilliant international development of nuclear medicine, nuclear medicine in Korea has remarkably grown scientifically; The Korean Society of Nuclear Medicine was organized in 1961, The Radiology Science Institute attached to the Korea Atomic Energy Research Institute, the predecessor of the Korea Cancer Center Hospital, was established in 1963, and The Korean Journal of Nuclear Medicine published its first issue in 1967. Furthermore, the active studies using radioisotopes and the vigorous interchanges of information with foreign countries had increased so steadily and remarkably that we could hold the 3rd Asia and Oceania Congress of Nuclear Medicine in 1984. In Korea, Nuclear Medicine has now settled as a field of a science which interests lots of medical doctors and scientists. However, I cannot deny the fact that the progress of the development of Nuclear Medicine in Korea tends to defer relatively to that of the western countries, which is naturally a very active one, in many respects. I here would like to analyze the current status of clinical application of radioisotope in Korea, find the problems and present their solutions

The Current Status of the State Financial Audit in Ukraine and Prospects of its Development

Directory of Open Access Journals (Sweden)

Dolbneva Deniza V.

2017-11-01

Full Text Available The article is aimed at studying the current status and determining the main results of conducting the State financial audit by the State audit service in Ukraine, as well as developing proposals as to ways of its improvement in view of the experience of the world’s leading countries and the requirements of international standards in this sphere of relations. The main indicators and results, which characterize the status of conducting by bodies of the State Audit Service of the State financial audit on key directions, were considered. The obtained data indicate that the State financial audit is taking place in the direction corresponding to international practice. Today, however, because of a number of problems and declarative provisions related to the organization and conduct of the State financial audit, it cannot fully implement all its functional capabilities and tasks. Directions of improvement and transformation of the State financial audit have been proposed. The prospect for further research is development of a holistic mechanism for the functioning of the State financial audit, which will unite all its directions at different levels and its participants.

PRESCRIBING OF ANTIHYPERTENSIVE AGENTS IN PUBLIC PRIMARY CARE CLINICS – IS IT IN ACCORDANCE WITH CURRENT EVIDENCE?

Directory of Open Access Journals (Sweden)

SAJARI J

2010-01-01

Full Text Available Background: Large population surveys in Malaysia have consistently shown minimal improvement of blood pressure control rates over the last 10 years. Poor adherence to antihypertensive medication has been recognized as a major reason for poor control of hypertension. This study aimed to describe the prescribing pattern of antihypertensive agents in 2 public primary care clinics and assess its appropriateness in relation to current evidence and guidelines. Methods: A cross-sectional survey to describe the prescribing pattern of antihypertensive agents was carried out in 2 publicprimary care clinics in Selangor from May to June 2009. Hypertensive patients on pharmacological treatment for ≥1 year who attended the clinics within the study period of 7 weeks were selected. Appropriate use of antihypertensive agents was defined based on current evidence and the recommendations by the Malaysian Clinical Practice Guidelines (CPG on the Management of Hypertension, 2008. Data were obtained from patients’ medical records and were analysed using the SPSS software version 16.0. Results: A total of 400 hypertensive patients on treatment were included. Mean age was 59.5 years (SD ±10.9, range 28 to91 years, of which 52.8% were females and 47.2% were males. With regards to pharmacotherapy, 45.7% were on monotherapy,43.3% were on 2 agents and 11.0% were on ≥3 agents. Target blood pressure of <140/90mmHg was achieved in 51.4% of patients on monotherapy, and 33.2% of patients on combination of ≥2 agents. The commonest monotherapy agents being prescribed were β-blockers (atenolol or propranolol, followed by the short-acting calcium channel blocker (nifedipine. The commonest combination of 2-drug therapy prescribed was β-blockers and short-acting calcium channel blocker. Conclusion: This study shows that the prescribing pattern of antihypertensive agents in the 2 primary care clinics was not in accordance with current evidence and guidelines. �

The rare and undiagnosed diseases diagnostic service - application of massively parallel sequencing in a state-wide clinical service.

Science.gov (United States)

Baynam, Gareth; Pachter, Nicholas; McKenzie, Fiona; Townshend, Sharon; Slee, Jennie; Kiraly-Borri, Cathy; Vasudevan, Anand; Hawkins, Anne; Broley, Stephanie; Schofield, Lyn; Verhoef, Hedwig; Walker, Caroline E; Molster, Caron; Blackwell, Jenefer M; Jamieson, Sarra; Tang, Dave; Lassmann, Timo; Mina, Kym; Beilby, John; Davis, Mark; Laing, Nigel; Murphy, Lesley; Weeramanthri, Tarun; Dawkins, Hugh; Goldblatt, Jack

2016-06-11

The Rare and Undiagnosed Diseases Diagnostic Service (RUDDS) refers to a genomic diagnostic platform operating within the Western Australian Government clinical services delivered through Genetic Services of Western Australia (GSWA). GSWA has provided a state-wide service for clinical genetic care for 28 years and it serves a population of 2.5 million people across a geographical area of 2.5milion Km(2). Within this context, GSWA has established a clinically integrated genomic diagnostic platform in partnership with other public health system managers and service providers, including but not limited to the Office of Population Health Genomics, Diagnostic Genomics (PathWest Laboratories) and with executive level support from the Department of Health. Herein we describe report presents the components of this service that are most relevant to the heterogeneity of paediatric clinical genetic care. Briefly the platform : i) offers multiple options including non-genetic testing; monogenic and genomic (targeted in silico filtered and whole exome) analysis; and matchmaking; ii) is delivered in a patient-centric manner that is resonant with the patient journey, it has multiple points for entry, exit and re-entry to allow people access to information they can use, when they want to receive it; iii) is synchronous with precision phenotyping methods; iv) captures new knowledge, including multiple expert review; v) is integrated with current translational genomic research activities and best practice; and vi) is designed for flexibility for interactive generation of, and integration with, clinical research for diagnostics, community engagement, policy and models of care. The RUDDS has been established as part of routine clinical genetic services and is thus sustainable, equitably managed and seeks to translate new knowledge into efficient diagnostics and improved health for the whole community.

A HIGH CURRENT, HIGH VOLTAGE SOLID-STATE PULSE GENERATOR FOR THE NIF PLASMA ELECTRODE POCKELS CELL

International Nuclear Information System (INIS)

Arnold, P A; Barbosa, F; Cook, E G; Hickman, B C; Akana, G L; Brooksby, C A

2007-01-01

A high current, high voltage, all solid-state pulse modulator has been developed for use in the Plasma Electrode Pockels Cell (PEPC) subsystem in the National Ignition Facility. The MOSFET-switched pulse generator, designed to be a more capable plug-in replacement for the thyratron-switched units currently deployed in NIF, offers unprecedented capabilities including burst-mode operation, pulse width agility and a steady-state pulse repetition frequency exceeding 1 Hz. Capable of delivering requisite fast risetime, 17 kV flattop pulses into a 6 (Omega) load, the pulser employs a modular architecture characteristic of the inductive adder technology, pioneered at LLNL for use in acceleration applications, which keeps primary voltages low (and well within the capabilities of existing FET technology), reduces fabrication costs and is amenable to rapid assembly and quick field repairs

Minimal invasive single-site surgery in colorectal procedures: Current state of the art

Directory of Open Access Journals (Sweden)

Diana Michele

2011-01-01

Full Text Available Background: Minimally invasive single-site (MISS surgery has recently been applied to colorectal surgery. We aimed to assess the current state of the art and the adequacy of preliminary oncological results. Methods: We performed a systematic review of the literature using Pubmed, Medline, SCOPUS and Web of Science databases. Keywords used were "Single Port" or "Single-Incision" or "LaparoEndoscopic Single Site" or "SILS™" and "Colon" or "Colorectal" and "Surgery". Results: Twenty-nine articles on colorectal MISS surgery have been published from July 2008 to July 2010, presenting data on 149 patients. One study reported analgesic requirement. The final incision length ranged from 2.5 to 8 cm. Only two studies reported fascial incision length. There were two port site hernias in a series of 13 patients (15.38%. Two "fully laparoscopic" MISS procedures with preparation and achievement of the anastomosis completely intracorporeally are reported. Future site of ileostomy was used as the sole access for the procedures in three studies. Lymph node harvesting, resection margins and length of specimen were sufficient in oncological cases. Conclusions: MISS colorectal surgery is a challenging procedure that seems to be safe and feasible, but the existing clinical evidence is limited. In selected cases, and especially when an ileostomy is planned, colorectal surgery may be an ideal indication for MISS surgery leading to a no-scar surgery. Despite preliminary oncological results showing the feasibility of MISS surgery, we want to stress the need to standardize the technique and carefully evaluate its application in oncosurgery under ethical committee control.

History and current state of immunotherapy in glioma and brain metastasis.

Science.gov (United States)

McGranahan, Tresa; Li, Gordon; Nagpal, Seema

2017-05-01

Malignant brain tumors such as glioblastoma (GBM) and brain metastasis have poor prognosis despite conventional therapies. Successful use of vaccines and checkpoint inhibitors in systemic malignancy has increased the hope that immune therapies could improve survival in patients with brain tumors. Manipulating the immune system to fight malignancy has a long history of both modest breakthroughs and pitfalls that should be considered when applying the current immunotherapy approaches to patients with brain tumors. Therapeutic vaccine trials for GBM date back to the mid 1900s and have taken many forms; from irradiated tumor lysate to cell transfer therapies and peptide vaccines. These therapies were generally well tolerated without significant autoimmune toxicity, however also did not demonstrate significant clinical benefit. In contrast, the newer checkpoint inhibitors have demonstrated durable benefit in some metastatic malignancies, accompanied by significant autoimmune toxicity. While this toxicity was not unexpected, it exceeded what was predicted from pre-clinical studies and in many ways was similar to the prior trials of immunostimulants. This review will discuss the history of these studies and demonstrate that the future use of immune therapy for brain tumors will likely need a personalized approach that balances autoimmune toxicity with the opportunity for significant survival benefit.

Fontan Surgical Planning: Previous Accomplishments, Current Challenges, and Future Directions.

Science.gov (United States)

Trusty, Phillip M; Slesnick, Timothy C; Wei, Zhenglun Alan; Rossignac, Jarek; Kanter, Kirk R; Fogel, Mark A; Yoganathan, Ajit P

2018-04-01

The ultimate goal of Fontan surgical planning is to provide additional insights into the clinical decision-making process. In its current state, surgical planning offers an accurate hemodynamic assessment of the pre-operative condition, provides anatomical constraints for potential surgical options, and produces decent post-operative predictions if boundary conditions are similar enough between the pre-operative and post-operative states. Moving forward, validation with post-operative data is a necessary step in order to assess the accuracy of surgical planning and determine which methodological improvements are needed. Future efforts to automate the surgical planning process will reduce the individual expertise needed and encourage use in the clinic by clinicians. As post-operative physiologic predictions improve, Fontan surgical planning will become an more effective tool to accurately model patient-specific hemodynamics.

Planning for Development in the Arab Gulf States: A content Analysis of Current Development Plans

DEFF Research Database (Denmark)

Hvidt, Martin

2012-01-01

Abstract: This paper analyses current development plans published by the GCC states (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates) in order to explore the region’s future growth trajectory: what barriers to growth are foreseen and how can they be anticipated; what...

Nanomedicine applications in the treatment of breast cancer: current state of the art

Directory of Open Access Journals (Sweden)

Wu D

2017-08-01

Full Text Available Di Wu, Mengjie Si, Hui-Yi Xue, Ho-Lun Wong Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, PA, USA Abstract: Breast cancer is the most common malignant disease in women worldwide, but the current drug therapy is far from optimal as indicated by the high death rate of breast cancer patients. Nanomedicine is a promising alternative for breast cancer treatment. Nanomedicine products such as Doxil® and Abraxane® have already been extensively used for breast cancer adjuvant therapy with favorable clinical outcomes. However, these products were originally designed for generic anticancer purpose and not specifically for breast cancer treatment. With better understanding of the molecular biology of breast cancer, a number of novel promising nanotherapeutic strategies and devices have been developed in recent years. In this review, we will first give an overview of the current breast cancer treatment and the updated status of nanomedicine use in clinical setting, then discuss the latest important trends in designing breast cancer nanomedicine, including passive and active cancer cell targeting, breast cancer stem cell targeting, tumor microenvironment-based nanotherapy and combination nanotherapy of drug-resistant breast cancer. Researchers may get insight from these strategies to design and develop nanomedicine that is more tailored for breast cancer to achieve further improvements in cancer specificity, antitumorigenic effect, antimetastasis effect and drug resistance reversal effect. Keywords: nanomedicine, breast cancer, targeted delivery, drug therapy, drug resistance, tumor microenvironment 

Current state of methodological and decisions for radiation treatment of blood, its components and products

Directory of Open Access Journals (Sweden)

Gordeev A.V.

2014-12-01

Full Text Available This article presents currently used blood transfusion media — components and blood products, therapeutic effects, reactions and complications of blood transfusion, use of radiation treatment for blood transfusion fluids. There had been discussed in detail the practice of radiation processing of blood components and for the prevention of reaction "graft versus host" and studies of plasma radiation treatment for its infectious safety. There was presented the current state of techniques and technical solutions of radiation treatment of transfusion-transmissible environments. There were also considered an alternative to radiation treatment of blood.

[Classification of results of studying blood plasma with laser correlation spectroscopy based on semiotics of preclinical and clinical states].

Science.gov (United States)

Ternovoĭ, K S; Kryzhanovskiĭ, G N; Musiĭchuk, Iu I; Noskin, L A; Klopov, N V; Noskin, V A; Starodub, N F

1998-01-01

The usage of laser correlation spectroscopy for verification of preclinical and clinical states is substantiated. Developed "semiotic" classifier for solving the problems of preclinical and clinical states is presented. The substantiation of biological algorithms as well as the mathematical support and software for the proposed classifier for the data of laser correlation spectroscopy of blood plasma are presented.

Clinical utilisation of the "G.T. MSRS", the rating scale for mixed states: 35 cases report.

Science.gov (United States)

Tavormina, Giuseppe

2015-09-01

The knowledge of the clinical features of the mixed states and of the symptoms of the "mixity" of mood disorders is crucial: to mis-diagnose or mis-treat patients with these symptoms may increase the suicide risk and make worse the evolution of mood disorders. The rating scale "G.T. MSRS" has been designed to improve the clinical effectiveness of both psychiatrists and GPs by enabling them to make an early "general" diagnosis of mixed states. This study presents some cases in which the "G.T. MSRS" scale has been used, in order to demonstrate its usefullness.

Analysis of Steady-State Error in Torque Current Component Control of PMSM Drive

Directory of Open Access Journals (Sweden)

BRANDSTETTER, P.

2017-05-01

Full Text Available The paper presents dynamic properties of a vector controlled permanent magnet synchronous motor drive supplied by a voltage source inverter. The paper deals with a control loop for the torque producing stator current. There is shown fundamental mathematical description for the vector control structure of the permanent magnet synchronous motor drive with respect to the current control for d-axis and q-axis of the rotor rotating coordinate system. The derivations of steady-state deviation for schemes with and without decoupling circuits are described for q-axis. The properties of both schemes are verified by MATLAB-SIMULINK program considering a lower and a higher value of inertia and by experimental measurements in our laboratory. The simulation and experimental results are presented and discussed at the end of the paper.

The current status of artisanal cannabis for the treatment of epilepsy in the United States.

Science.gov (United States)

Sulak, Dustin; Saneto, Russell; Goldstein, Bonni

2017-05-01

The widespread patient use of artisanal cannabis preparations has preceded quality validation of cannabis use for epilepsy. Neurologists and cannabinoid specialists are increasingly in a position to monitor and guide the use of herbal cannabis in epilepsy patients. We report the retrospective data on efficacy and adverse effects of artisanal cannabis in Patients with medically refractory epilepsy with mixed etiologies in Washington State, California, and Maine. Clinical considerations, including potential risks and benefits, challenges related to artisanal preparations, and cannabinoid dosing, are discussed. Of 272 combined patients from Washington State and California, 37 (14%) found cannabis ineffective at reducing seizures, 29 (15%) experienced a 1-25% reduction in seizures, 60 (18%) experienced a 26-50% reduction in seizures, 45 (17%) experienced a 51-75% reduction in seizures, 75 (28%) experienced a 76-99% reduction in seizures, and 26 (10%) experienced a complete clinical response. Overall, adverse effects were mild and infrequent, and beneficial side effects such as increased alertness were reported. The majority of patients used cannabidiol (CBD)-enriched artisanal formulas, some with the addition of delta-9-tetrahydrocannabinol (THC) and tetrahydrocannabinolic acid (THCA). Four case reports are included that illustrate clinical responses at doses prevention, the use of THC for seizure rescue, and the synergy of cannabinoids and terpenoids in artisanal preparations. This article is part of a Special Issue entitled "Cannabinoids and Epilepsy". Copyright © 2017 Elsevier Inc. All rights reserved.

[Latest development in mass spectrometry for clinical application].

Science.gov (United States)

Takino, Masahiko

2013-09-01

Liquid chromatography-tandem mass spectrometry (LC-MS/MS) has seen enormous growth in special clinical chemistry laboratories. It significantly increases the analytic potential in clinical chemistry, especially in the field of low molecular weight biomarker analysis. This review summarizes the state of the art in mass spectrometry and related techniques for clinical application with a main focus on recent developments in LC-MS. Current trends in ionization techniques, automated online sample preparation techniques coupled with LC-MS, and ion mobility spectrometry are discussed. Emerging mass spectrometric approaches complementary to LC-MS are discussed as well.

Clinical proteomics: Current status, challenges, and future perspectives

Directory of Open Access Journals (Sweden)

Shyh-Horng Chiou

2011-01-01

Full Text Available This account will give an overview and evaluation of the current advances in mass spectrometry (MS-based proteomics platforms and technology. A general review of some background information concerning the application of these methods in the characterization of molecular sizes and related protein expression profiles associated with different types of cells under varied experimental conditions will be presented. It is intended to provide a concise and succinct overview to those clinical researchers first exposed to this foremost powerful methodology in modern life sciences of postgenomic era. Proteomic characterization using highly sophisticated and expensive instrumentation of MS has been used to characterize biological samples of complex protein mixtures with vastly different protein structure and composition. These systems are then used to highlight the versatility and potential of the MS-based proteomic strategies for facilitating protein expression analysis of various disease-related organisms or tissues of interest. Major MS-based strategies reviewed herein include (1 matrix-assisted laser desorption ionization-MS and electron-spray ionization proteomics; (2 one-dimensional or two-dimensional gel-based proteomics; (3 gel-free shotgun proteomics in conjunction with liquid chromatography/tandem MS; (4 Multiple reaction monitoring coupled tandem MS quantitative proteomics and; (5 Phosphoproteomics based on immobilized metal affinity chromatography and liquid chromatography-MS/MS.

Consumer Mobile Health Apps: Current State, Barriers, and Future Directions.

Science.gov (United States)

Kao, Cheng-Kai; Liebovitz, David M

2017-05-01

This paper discusses the current state, barriers, and future directions of consumer-facing applications (apps). There are currently more than 165,000 mobile health apps publicly available in major app stores, the vast majority of which are designed for patients. The top 2 categories are wellness management and disease management apps, whereas other categories include self-diagnosis, medication reminder, and electronic patient portal apps. Apps specific to physical medicine and rehabilitation also are reviewed. These apps have the potential to provide low-cost, around-the-clock access to high-quality, evidence-based health information to end users on a global scale. However, they have not yet lived up to their potential due to multiple barriers, including lack of regulatory oversight, limited evidence-based literature, and concerns of privacy and security. The future directions may consist of improving data integration into the health care system, an interoperable app platform allowing access to electronic health record data, cloud-based personal health record across health care networks, and increasing app prescription by health care providers. For consumer mobile health apps to fully contribute value to health care delivery and chronic disease management, all stakeholders within the ecosystem must collaborate to overcome the significant barriers. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Movement of Genetic Counselors from Clinical to Non-clinical Positions: Identifying Driving Forces.

Science.gov (United States)

Cohen, Stephanie A; Tucker, Megan E

2018-03-05

A previous study of genetic counselors (GCs) in the state of Indiana identified movement out of clinical positions within the past 2 years. The aims of this study were to determine if this trend is nationwide and identify reasons why GCs are leaving their positions and factors that might help employers attract and retain GCs. An email was sent to members of the American Board of Genetic Counseling with a link to an online confidential survey. There were 939 responses (23.5% response rate). Overall, 52% of GCs report being highly satisfied in their current position, although almost two thirds think about leaving and one third had changed jobs within the past 2 years. Of those who had changed jobs (n = 295), 74.9% had been working in a hospital/clinic setting but only 46.3% currently do, demonstrating a major shift out of the clinic (p < 0.001). The top three reasons cited for leaving a position were work environment/institutional climate, salary/benefits, and a lack of feeling valued/recognized as a professional. These results confirm that GCs are moving out of clinical positions and document elements of job satisfaction. We suggest points for employers to consider when trying to recruit or retain GCs.

LHCD current profile control experiments towards steady state improved confinement on JT-60U

International Nuclear Information System (INIS)

Ide, S.; Naito, O.; Oikawa, T.; Fujita, T.; Kondoh, T.; Seki, M.; Ushigusa, K.

2001-01-01

In JT-60U lower hybrid current drive (LHCD) experiments, a reversed magnetic shear configuration that was accompanied by the internal transport barriers was successfully maintained by means of LHCD almost in the full current drive quasi-steady state for 4.7 s. The normalized beta was kept near 1 and the neutron emission rate was almost steady as well indicating no accumulation of impurities into the plasma. Diagnostics data showed that all the profiles of the electron and ion temperatures, the electron density and the current profile were almost unchanged during the LHCD phase. Moreover, capability of LHCD in H-mode plasmas has been also investigated. It was found that the lower hybrid waves can be coupled to an H-mode edge plasma even with the plasma wall distance of about 14 cm. The maximum coupling distance was found to depend on the edge recycling. (author)

Current State of History of Psychology Teaching and Education in Argentina: An Empirical Bibliometric Investigation

Science.gov (United States)

Fierro, Catriel; Ostrovsky, Ana Elisa; Di Doménico, María Cristina

2018-01-01

This study is an empirical analysis of the field's current state in Argentinian universities. Bibliometric parameters were used to retrieve the total listed texts (N = 797) of eight undergraduate history courses' syllabi from Argentina's most populated public university psychology programs. Then, professors in charge of the selected courses (N =…

Imaging of lumbar degenerative disk disease: history and current state

International Nuclear Information System (INIS)

Emch, Todd M.; Modic, Michael T.

2011-01-01

One of the most common indications for performing magnetic resonance (MR) imaging of the lumbar spine is the symptom complex thought to originate as a result of degenerative disk disease. MR imaging, which has emerged as perhaps the modality of choice for imaging degenerative disk disease, can readily demonstrate disk pathology, degenerative endplate changes, facet and ligamentous hypertrophic changes, and the sequelae of instability. Its role in terms of predicting natural history of low back pain, identifying causality, or offering prognostic information is unclear. As available modalities for imaging the spine have progressed from radiography, myelography, and computed tomography to MR imaging, there have also been advances in spine surgery for degenerative disk disease. These advances are described in a temporal context for historical purposes with a focus on MR imaging's history and current state. (orig.)

Management of adenovirus infection in patients after haematopoietic stem cell transplantation: State-of-the-art and real-life current approach: A position statement on behalf of the Infectious Diseases Working Party of the European Society of Blood and Marrow Transplantation.

Science.gov (United States)

Hiwarkar, Prashant; Kosulin, Karin; Cesaro, Simone; Mikulska, Malgorzata; Styczynski, Jan; Wynn, Robert; Lion, Thomas

2018-05-01

The important insights gained over the past years in diagnosis and treatment of invasive adenoviral infections provide new paradigms for the monitoring and clinical management of these life-threatening complications. A meeting was held to discuss and subsequently disseminate the current advances in our understanding of the aetiology/pathogenesis and future treatment options facilitating effective control or prevention of adenovirus-related diseases in the allogeneic haematopoietic stem cell transplant setting. Invited experts in the field discussed recent progress with leading members of the Infectious Diseases Working Party of the European Society of Blood and Marrow Transplantation at the "State-of-the-art" Meeting in Poznan, Poland, in October 2017. In this review article, the panel of experts presents a concise summary of the current evidence based on published data from the last 15 years and on recent achievements resulting from real-life practice. The present position statement reflects an expert opinion on current approaches to clinical management of adenovirus infections in patients undergoing allogeneic haematopoietic stem cell transplant and provides graded recommendations of the panel for diagnostic approaches and preemptive therapy reflecting the present state of knowledge. Copyright © 2018 John Wiley & Sons, Ltd.

Proton therapy for head and neck cancer: Rationale, potential indications, practical considerations, and current clinical evidence

International Nuclear Information System (INIS)

Mendenhall, Nancy P.; Malyapa, Robert S.; Su, Zhong; Yeung, Daniel; Mendenhall, William M.; Li, Zuofeng

2011-01-01

There is a strong rationale for potential benefits from proton therapy (PT) for selected cancers of the head and neck because of the opportunity to improve the therapeutic ratio by improving radiation dose distributions and because of the significant differences in radiation dose distribution achievable with x-ray-based radiation therapy (RT) and PT. Comparisons of dose distributions between x-ray-based and PT plans in selected cases show specific benefits in dose distribution likely to translate into improved clinical outcomes. However, the use of PT in head and neck cancers requires special considerations in the simulation and treatment planning process, and currently available PT technology may not permit realization of the maximum potential benefits of PT. To date, few clinical data are available, but early clinical experiences in sinonasal tumors in particular suggest significant improvements in both disease control and radiation-related toxicity

Proton therapy for head and neck cancer: Rationale, potential indications, practical considerations, and current clinical evidence

Energy Technology Data Exchange (ETDEWEB)

Mendenhall, Nancy P.; Malyapa, Robert S.; Su, Zhong; Yeung, Daniel; Mendenhall, William M.; Li, Zuofeng (Univ. of Florida Proton Therapy Inst., Jacksonville, Florida (United States)), e-mail: menden@shands.ufl.edu

2011-08-15

There is a strong rationale for potential benefits from proton therapy (PT) for selected cancers of the head and neck because of the opportunity to improve the therapeutic ratio by improving radiation dose distributions and because of the significant differences in radiation dose distribution achievable with x-ray-based radiation therapy (RT) and PT. Comparisons of dose distributions between x-ray-based and PT plans in selected cases show specific benefits in dose distribution likely to translate into improved clinical outcomes. However, the use of PT in head and neck cancers requires special considerations in the simulation and treatment planning process, and currently available PT technology may not permit realization of the maximum potential benefits of PT. To date, few clinical data are available, but early clinical experiences in sinonasal tumors in particular suggest significant improvements in both disease control and radiation-related toxicity

Cost-benefit assessment of using electronic health records data for clinical research versus current practices: Contribution of the Electronic Health Records for Clinical Research (EHR4CR) European Project.

Science.gov (United States)

Beresniak, Ariel; Schmidt, Andreas; Proeve, Johann; Bolanos, Elena; Patel, Neelam; Ammour, Nadir; Sundgren, Mats; Ericson, Mats; Karakoyun, Töresin; Coorevits, Pascal; Kalra, Dipak; De Moor, Georges; Dupont, Danielle

2016-01-01

The widespread adoption of electronic health records (EHR) provides a new opportunity to improve the efficiency of clinical research. The European EHR4CR (Electronic Health Records for Clinical Research) 4-year project has developed an innovative technological platform to enable the re-use of EHR data for clinical research. The objective of this cost-benefit assessment (CBA) is to assess the value of EHR4CR solutions compared to current practices, from the perspective of sponsors of clinical trials. A CBA model was developed using an advanced modeling approach. The costs of performing three clinical research scenarios (S) applied to a hypothetical Phase II or III oncology clinical trial workflow (reference case) were estimated under current and EHR4CR conditions, namely protocol feasibility assessment (S1), patient identification for recruitment (S2), and clinical study execution (S3). The potential benefits were calculated considering that the estimated reduction in actual person-time and costs for performing EHR4CR S1, S2, and S3 would accelerate time to market (TTM). Probabilistic sensitivity analyses using Monte Carlo simulations were conducted to manage uncertainty. Should the estimated efficiency gains achieved with the EHR4CR platform translate into faster TTM, the expected benefits for the global pharmaceutical oncology sector were estimated at €161.5m (S1), €45.7m (S2), €204.5m (S1+S2), €1906m (S3), and up to €2121.8m (S1+S2+S3) when the scenarios were used sequentially. The results suggest that optimizing clinical trial design and execution with the EHR4CR platform would generate substantial added value for pharmaceutical industry, as main sponsors of clinical trials in Europe, and beyond. Copyright © 2015 Elsevier Inc. All rights reserved.

Establishing a clinical pharmacy technician at a United States Army military treatment facility.

Science.gov (United States)

Evans, Jennifer L; Gladd, Ellen M; Gonzalez, Alicia C; Tranam, Salman; Larrabee, Joni M; Lipphardt, Sarah E; Chen, Tina T; Ronn, Michael D; Spain, John

2016-01-01

To describe the creation of a clinical pharmacy technician position within the U.S. Army and to identify the personal skills and characteristics required to meet the demands of this role. An outpatient military treatment facility located in Maryland. The clinical pharmacy technician position was designed to support clinical pharmacy services within a patient-centered medical home. Funding and a position description were established to hire a clinical pharmacy technician. Expected duties included administrative (45%), patient education (30%), and dispensing (25%). Local policy, in accordance with federal law and U.S. Army regulations, was developed to define the expanded technician responsibility to deliver patient medication education. In the initial 3 months, the clinical pharmacy technician spent 24 hours per week on clinical activities, affording an additional 10-15 hours per week for clinical pharmacists to provide patient care. Completed consults increased from 41% to 56%, and patient-pharmacist encounters increased from 240 to 290 per month. The technician, acting as a clinical pharmacist extender, also completed an average of 90 patient encounters independently each month. As a result of these improvements, the decision was made to hire a second technician. Currently, the technicians spend 28-40 hours per week on clinical activities, offsetting an average of 26 hours per week for the clinical pharmacists. A patient-centered medical home clinical pharmacy technician can reduce the administrative workload for clinical pharmacists, improve their efficiency, and enhance the use of clinical pharmacy services. Several characteristics, particularly medication knowledge, make pharmacy technicians particularly suited for this role. The results from the implementation of a clinical pharmacy technician at this military treatment facility resulted in an Army-wide expansion of the position and suggested applicability in other practice sites, particularly in federal

[Materials/Biomaterials in Clinical Practice - a Short Review and Current Trends].

Science.gov (United States)

Bolle, T; Meyer, F; Walcher, F; Lohmann, C; Jockenhövel, S; Gries, T; Hoffmann, W

2017-04-01

Biomaterials play a major role in interventional medicine and surgery. However, the development of biomaterials is still in its early phases in spite of the huge progress made within the last decades. On the one hand, this is because our knowledge of the molecular and cellular processes associated with biomaterials is still increasing exponentially. On the other hand, a wide variety of advanced materials with highly interesting properties is being developed currently. This review provides a short introduction into the variety of materials in use as well as their application in interventional medicine and surgery. Also the importance of biomaterials for tissue engineering in the field of regenerative medicine and the functionalisation of biomaterials, including sterilisation methods are discussed. For the future, an even broader interdisciplinary scientific collaboration is necessary in order to develop novel biomaterials and facilitate their translation into clinical practice. Georg Thieme Verlag KG Stuttgart · New York.

The current and ideal state of anatomic pathology patient safety.

Science.gov (United States)

Raab, Stephen Spencer

2014-01-01

An anatomic pathology diagnostic error may be secondary to a number of active and latent technical and/or cognitive components, which may occur anywhere along the total testing process in clinical and/or laboratory domains. For the pathologist interpretive steps of diagnosis, we examine Kahneman's framework of slow and fast thinking to explain different causes of error in precision (agreement) and in accuracy (truth). The pathologist cognitive diagnostic process involves image pattern recognition and a slow thinking error may be caused by the application of different rationally-constructed mental maps of image criteria/patterns by different pathologists. This type of error is partly related to a system failure in standardizing the application of these maps. A fast thinking error involves the flawed leap from image pattern to incorrect diagnosis. In the ideal state, anatomic pathology systems would target these cognitive error causes as well as the technical latent factors that lead to error.

Current State of Technology of Fuel Cell Power Systems for Autonomous Underwater Vehicles

Directory of Open Access Journals (Sweden)

Alejandro Mendez

2014-07-01

Full Text Available Autonomous Underwater Vehicles (AUVs are vehicles that are primarily used to accomplish oceanographic research data collection and auxiliary offshore tasks. At the present time, they are usually powered by lithium-ion secondary batteries, which have insufficient specific energies. In order for this technology to achieve a mature state, increased endurance is required. Fuel cell power systems have been identified as an effective means to achieve this endurance but no implementation in a commercial device has yet been realized. This paper summarizes the current state of development of the technology in this field of research. First, the most adequate type of fuel cell for this application is discussed. The prototypes and design concepts of AUVs powered by fuel cells which have been developed in the last few years are described. Possible commercial and experimental fuel cell stack options are analyzed, examining solutions adopted in the analogous aerial vehicle applications, as well as the underwater ones, to see if integration in an AUV is feasible. Current solutions in oxygen and hydrogen storage systems are overviewed and energy density is objectively compared between battery power systems and fuel cell power systems for AUVs. A couple of system configuration solutions are described including the necessary lithium-ion battery hybrid system. Finally, some closing remarks on the future of this technology are given.

The clinical endocrinology workforce: current status and future projections of supply and demand.

Science.gov (United States)

Vigersky, Robert A; Fish, Lisa; Hogan, Paul; Stewart, Andrew; Kutler, Stephanie; Ladenson, Paul W; McDermott, Michael; Hupart, Kenneth H

2014-09-01

Many changes in health care delivery, health legislation, and the physician workforce that affect the supply and demand for endocrinology services have occurred since the first published workforce study of adult endocrinologists in 2003. The objective of the study was to assess the current adult endocrinology workforce data and provide the first analysis of the pediatric endocrinology workforce and to project the supply of and demand for endocrinologists through 2025. A workforce model was developed from an analysis of proprietary and publicly available databases, consultation with a technical expert panel, and the results of an online survey of board-certified endocrinologists. The Endocrine Society commissioned The Lewin Group to estimate current supply and to project gaps between supply and demand for endocrinologists. A technical expert panel of senior endocrinologists provided context, clinical information, and direction. The following were measured: 1) the current adult and pediatric endocrinology workforce and the supply of and demand for endocrinologists through 2025 and 2) the number of additional entrants into the endocrinology work pool that would be required to close the gap between supply and demand. Currently there is a shortage of approximately 1500 adult and 100 pediatric full-time equivalent endocrinologists. The gap for adult endocrinologists will expand to 2700 without an increase in the number of fellows trained. An increase in the prevalence of diabetes mellitus further expands the demand for adult endocrinologists. The gap can be closed in 5 and 10 years by increasing the number of fellowship positions by 14.4% and 5.5% per year, respectively. The gap between supply and demand for pediatric endocrinologists will close by 2016, and thereafter an excess supply over demand will develop at the current rate of new entrants into the work force. There are insufficient adult endocrinologists to satisfy current and future demand. A number of proactive

Educational Attainment in the United States: 2015. Population Characteristics. Current Population Reports. P20-578

Science.gov (United States)

Ryan, Camille L.; Bauman, Kurt

2016-01-01

This report provides a portrait of educational attainment in the United States based on data collected from the Current Population Survey (CPS). The report examines educational attainment of the adult population by demographic and social characteristics such as age, sex, race and Hispanic origin, and disability status, as well as differences in…

Atlas of current and potential future distributions of common trees of the eastern United States

Science.gov (United States)

Louis R. Iverson; Anantha M. Prasad; Betsy J. Hale; Elaine Kennedy Sutherland

1999-01-01

This atlas documents the current and possible future distribution of 80 common tree species in the Eastern United States and gives detailed information on environmental characteristics defining these distributions. Also included are outlines of life history characteristics and summary statistics for these species. Much of the data are derived from Forest Inventory and...

Ex vivo lung perfusion in clinical lung transplantation--state of the art.

Science.gov (United States)

Andreasson, Anders S I; Dark, John H; Fisher, Andrew J

2014-11-01

Ex vivo lung perfusion (EVLP) has emerged as a new technique for assessing and potentially reconditioning human donor lungs previously unacceptable for clinical transplantation with the potential to dramatically push the limits of organ acceptability. With the recent introduction of portable EVLP, a new era in lung preservation may be upon us with the opportunity to also limit organ ischaemic times and potentially improve the outcome of donor lungs already deemed acceptable for transplantation. It took over half a century for the technique to evolve from basic theory to semi-automated circuits fit for clinical use that are now rapidly being adopted in transplant centres across the globe. With this field in constant evolution and many unanswered questions remaining, our review serves as an update on the state of the art of EVLP in clinical lung transplantation. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Flux nucleation in the current-induced resistive state of a constricted type I superconductor

International Nuclear Information System (INIS)

Selig, K.P.; Huebener, R.P.

1981-01-01

The current-induced resistive state in a constricted type I superconductor is characterized by a train of flux tubes traversing the sample perpendicular to the direction of the applied current following its nucleation at the sample edge. The temporal structure of the nucleation process can be investigated by attempting to synchronize this process with small periodic current pulses superimposed on the direct bias current. The resistive dc voltage is then to be measured as a function of the pulse parameters such as frequency and width. We have performed such experiments at 4.2 K on constricted Pb films of 6--8 μm thickness and 100 μm width. Simultaneously with the electrical measurements the dynamic behavior of the flux tubes was directly observed using a stroboscopic magnetooptical method for magnetic flux detection. Our electrical measurements clearly show how the size of the nucleated flux tubes varies with the direct bias current and the nucleation frequency. The positive wall energy in the Pb films results in a lower limit for this size as expected. The influence of the preceding flux tubes still existing within the constriction upon the flux nucleation process is revealed in detail. All observations can be understood from a consideration of the energy balance during the flux nucleation process

The current state of water resources of Transcarpathia

Directory of Open Access Journals (Sweden)

V. І. Nikolaichuk

2015-07-01

sanitary rules and regulations by the most of indicators of general health and specific indices. 19.0% of total water supply systems fail to meet the sanitary norms and regulations, in particular: 14.2% for the lack of sanitary protection zones; 1.9% because of unavailability of the necessary integrated treatment facilities, and 7.6% by the reason of absence of disinfecting plants. Possible ways of avoiding the depletion of water bodies are preventive water protection measures aimed at preventing or limiting pollution, water contamination and depletion; besides, it is necessary to educate people explaning them the current state and possible consequences of thoughtless water consumption.

THE CURRENT STATE OF LEGAL INSTITUTIONS PROTECTING THE RIGHTS OF JUVENILES IN RUSSIA

OpenAIRE

Yulia Hafizovna DAVYDOVA

2015-01-01

The article highlights the current state of the legislation on protection of the rights of under-aged. Much attention is paid to the formation of the juvenile justice system in the Russian Federation. We present problems related to law infringements by teenagers in various fields and their solutions, highlight the work and the development of juvenile courts in Russia, sum up the results of the implementation of juvenile technologies and their significance, gives the definition of the term «co...

State of Corporate Social Responsibility in India – Current scenario, Approach and Drivers

OpenAIRE

Nagpal, Kshitij

2016-01-01

Purpose – The aim of the study is to examine the state of Corporate Social Responsibility (CSR)in India. The report attempts to investigate the current scenario of CSR ctivities and examine how corporations in India interpret CSR. The study also seeks to identify the reported driving forces behind implementation of CSR practices by firms in India. Methodology – CSR personnel from 3O companies that are obligated to spend on CSR activities under the Companies Act, 2013 were surveyed. To cr...

The current situation and related problems of percutaneous vertebroplasty in clinical treatment of osteoporosis vertebral compression fracture

International Nuclear Information System (INIS)

Wang Luchang; Wu Chungen; Cheng Yongde

2011-01-01

As an effective, safe and less-invasive technique in interventional radiology, percutaneous vertebroplasty has satisfactory therapeutic results with fewer complications in treating osteoporosis vertebral compression fracture. This paper aims to make a comprehensive review of the current situation and related problems of percutaneous vertebroplasty in clinical treatment of osteoporosis vertebral compression fracture. (authors)

Current status of matrix-assisted laser desorption ionisation-time of flight mass spectrometry in the clinical microbiology laboratory.

Science.gov (United States)

Kok, Jen; Chen, Sharon C A; Dwyer, Dominic E; Iredell, Jonathan R

2013-01-01

The integration of matrix-assisted laser desorption ionisation-time of flight mass spectrometry (MALDI-TOF MS) into many clinical microbiology laboratories has revolutionised routine pathogen identification. MALDI-TOF MS complements and has good potential to replace existing phenotypic identification methods. Results are available in a more clinically relevant timeframe, particularly in bacteraemic septic shock. Novel applications include strain typing and the detection of antimicrobial resistance, but these are not widely used. This review discusses the technical aspects, current applications, and limitations of MALDI-TOF MS.

Misophonia: current perspectives

Directory of Open Access Journals (Sweden)

Cavanna AE

2015-08-01

Full Text Available Andrea E Cavanna,1–3 Stefano Seri3,4 1Department of Neuropsychiatry, Birmingham and Solihull Mental Health NHS Foundation Trust and University of Birmingham, Birmingham, 2Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, 3School of Life and Health Sciences, Aston Brain Centre, Wellcome Trust Laboratory for MEG Studies, Aston University, 4Children’s Epilepsy Surgery Programme, The Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK Abstract: Misophonia is characterized by a negative reaction to a sound with a specific pattern and meaning to a given individual. In this paper, we review the clinical features of this relatively common yet underinvestigated condition, with focus on co-occurring neurodevelopmental disorders. Currently available data on the putative pathophysiology of the condition can inform our understanding and guide the diagnostic process and treatment approach. Tinnitus retraining therapy and cognitive behavior therapy have been proposed as the most effective treatment strategies for reducing symptoms; however, current treatment algorithms should be validated in large population studies. At the present stage, competing paradigms see misophonia as a physiological state potentially inducible in any subject, an idiopathic condition (which can present with comorbid psychiatric disorders, or a symptomatic manifestation of an underlying psychiatric disorder. Agreement on the use of standardized diagnostic criteria would be an important step forward in terms of both clinical practice and scientific inquiry. Areas for future research include phenomenology, epidemiology, modulating factors, neurophysiological underpinnings, and treatment trials. Keywords: misophonia, selective sound sensitivity syndrome, hyperacusis, neurodevelopmental disorders, Tourette syndrome, obsessive-compulsive spectrum

Evaluation of a clinic-based cholinesterase test kit for the Washington State Cholinesterase Monitoring Program.

Science.gov (United States)

Hofmann, Jonathan N; Carden, Angela; Fenske, Richard A; Ruark, Harold E; Keifer, Matthew C

2008-07-01

The Washington State Cholinesterase Monitoring Program for pesticide handlers requires blood draws at local clinics, with samples tested at a central laboratory. At present, workers with inhibited cholinesterase activity may be re-exposed before they can be removed from work. In this study we explored the option of on-site testing at local clinics using the EQM Test-mate Kittrade mark, a portable cholinesterase test kit. Test kit cholinesterase activity measurements were performed on 50 blood samples by our research staff, and compared to measurements on the same samples by the Washington State Public Health Laboratory. Another set of samples was also analyzed with the test kit by medical staff at an eastern Washington clinic. Triplicate measurements with the test kit had a 3.3% average coefficient of variation (CV) for plasma cholinesterase (PChE), and a 3.5% average CV for erythrocyte cholinesterase (AChE) measurements. The kit's PChE measurements were similar to PHL measurements (average ratio of 0.98) when performed in the laboratory, but had a tendency to underestimate activity when used in the clinic setting (average ratio of 0.87). The kit systematically overestimated AChE activity by 42-48% relative to the PHL measurements, regardless of where the samples were analyzed. This easy-to-use test kit appeared to be a viable method for clinic-based PChE measurements, but was less consistent for AChE measurements performed in the clinic. Absolute measurements with the kit need to be evaluated carefully relative to standardized methods. (c) 2008 Wiley-Liss, Inc.

Continuum of depressive and manic mixed states in patients with bipolar disorder: quantitative measurement and clinical features

OpenAIRE

SWANN, ALAN C.; STEINBERG, JOEL L.; LIJFFIJT, MARIJN; MOELLER, GERARD F.

2009-01-01

Bipolar mixed states combine depressive and manic features, presenting diagnostic and treatment challenges and reflecting a severe form of the illness. DSM-IV criteria for a mixed state require combined depressive and manic syndromes, but a range of mixed states has been described clinically. A unified definition of mixed states would be valuable in understanding their diagnosis, mechanism and treatment implications. We investigated the manner in which depressive and manic features combine to...

Current status of investigations in the field of solid state science in central Kazakstan region

International Nuclear Information System (INIS)

Kuketaev, T.A.

1999-01-01

Investigations in the field of solid state science were initiated together with foundation of University in Karaganda. Historically general investigations in this field were conducted for scientific directions related to optical, luminescent and radiation properties of wide gap insulator. This activity was carried out according to appropriate plans of coordination counsels en-gaged in the physics of insulators, luminescent and radiation physics at the Academy of Science USSR and in the Committee on sciences and engineering of the Counsel of Ministers of the USSR. A number of works were coordinated by the Academy of Sciences of Kazakhstan Republic. Investigations in the field of solid state science, con-ducted in the Central Kazakstan and coordinated by the Institute of Physics and Engineering of Kazakhstan National Academy of Sciences, can be currently distinguished according to scientific directions. Currently, the following scientific directions in the field of solid state science exist in the Central Kazakstan: influence of polymorph phase transitions on electron excitation in wide-gap crystals, radiation malformation and recombination, dielectric spectroscopy of crystals with hydrogen link, spectral and luminescent properties and energy migration processes in disordered and partly ordered systems of organic molecules. It is necessary to note that all investigated objects, described in this report, were recovered by investigators. That is, the relevant hardware is available

Current status, challenges and the way forward for clinical pharmacy service in Ethiopian public hospitals.

Science.gov (United States)

Bilal, Arebu Issa; Tilahun, Zelalem; Gebretekle, Gebremedhin Beedemariam; Ayalneh, Belete; Hailemeskel, Bisrat; Engidawork, Ephrem

2017-05-19

Clinical pharmacy service has evolved steadily over the past few decades and is now contributing to the 'patient care journey' at all stages. It is improving the safety and effectiveness of medicines and has made a significant contribution to the avoidance of medication errors. In Ethiopia, clinical pharmacy service is in its initial phase, being started in July 2013. This study therefore aimed at assessing the status, challenges and way forward of clinical pharmacy service in the country. A cross-sectional survey was conducted in six regional states and one city- administration in September 2014. A total of 51 hospitals were included in the study. Both qualitative and quantitative methods were employed for data collection. A total of 160 pharmacy graduates, and 51 pharmacy heads participated in the study. Internal Medicine and Pediatric wards were the major wards where the graduates provide clinical pharmacy service. Almost 94% of the new graduates were found to be involved in clinical pharmacy service, but 47% of them rated their service as poor. The overall satisfaction of the graduates was close to 36%. Thirteen hospitals discontinued and two hospitals not even initiated the service largely due to shortage of pharmacists and lack of management support. About 44% of the surveyed hospitals documented the clinical pharmacy service provided using either developed or adopted formats. Lack of awareness by the medical fraternity, high attrition rate, lack of support from the management as well as from the health care team, readiness of the graduates to deliver the service, and shortage of pharmacists were identified by the key informants as the major stumbling block to deliver clinical pharmacy service. Clinical pharmacy service is initiated in most of the surveyed hospitals and a large proportion of the graduates were involved in the service. Although there is a great enthusiasm to promote clinical pharmacy service in the surveyed hospitals, efforts made to

Clinical symptoms, signs and tests for identification of impending and current water-loss dehydration in older people.

Science.gov (United States)

Hooper, Lee; Abdelhamid, Asmaa; Attreed, Natalie J; Campbell, Wayne W; Channell, Adam M; Chassagne, Philippe; Culp, Kennith R; Fletcher, Stephen J; Fortes, Matthew B; Fuller, Nigel; Gaspar, Phyllis M; Gilbert, Daniel J; Heathcote, Adam C; Kafri, Mohannad W; Kajii, Fumiko; Lindner, Gregor; Mack, Gary W; Mentes, Janet C; Merlani, Paolo; Needham, Rowan A; Olde Rikkert, Marcel G M; Perren, Andreas; Powers, James; Ranson, Sheila C; Ritz, Patrick; Rowat, Anne M; Sjöstrand, Fredrik; Smith, Alexandra C; Stookey, Jodi J D; Stotts, Nancy A; Thomas, David R; Vivanti, Angela; Wakefield, Bonnie J; Waldréus, Nana; Walsh, Neil P; Ward, Sean; Potter, John F; Hunter, Paul

2015-04-30

There is evidence that water-loss dehydration is common in older people and associated with many causes of morbidity and mortality. However, it is unclear what clinical symptoms, signs and tests may be used to identify early dehydration in older people, so that support can be mobilised to improve hydration before health and well-being are compromised. To determine the diagnostic accuracy of state (one time), minimally invasive clinical symptoms, signs and tests to be used as screening tests for detecting water-loss dehydration in older people by systematically reviewing studies that have measured a reference standard and at least one index test in people aged 65 years and over. Water-loss dehydration was defined primarily as including everyone with either impending or current water-loss dehydration (including all those with serum osmolality ≥ 295 mOsm/kg as being dehydrated). Structured search strategies were developed for MEDLINE (OvidSP), EMBASE (OvidSP), CINAHL, LILACS, DARE and HTA databases (The Cochrane Library), and the International Clinical Trials Registry Platform (ICTRP). Reference lists of included studies and identified relevant reviews were checked. Authors of included studies were contacted for details of further studies. Titles and abstracts were scanned and all potentially relevant studies obtained in full text. Inclusion of full text studies was assessed independently in duplicate, and disagreements resolved by a third author. We wrote to authors of all studies that appeared to have collected data on at least one reference standard and at least one index test, and in at least 10 people aged ≥ 65 years, even where no comparative analysis has been published, requesting original dataset so we could create 2 x 2 tables. Diagnostic accuracy of each test was assessed against the best available reference standard for water-loss dehydration (serum or plasma osmolality cut-off ≥ 295 mOsm/kg, serum osmolarity or weight change) within each study. For

Current technological clinical practice in breast radiotherapy; results of a survey in EORTC-Radiation Oncology Group affiliated institutions

NARCIS (Netherlands)

van der Laan, Hans Paul; Hurkmans, Coen W; Kuten, Abraham; Westenberg, Helen A

PURPOSE: To evaluate the current technological clinical practice of radiation therapy of the breast in institutions participating in the EORTC-Radiation Oncology Group (EORTC-ROG). MATERIALS AND METHODS: A survey was conducted between August 2008 and January 2009 on behalf of the Breast Working

Public health services and systems research: current state of finance research.

Science.gov (United States)

Ingram, Richard C; Bernet, Patrick M; Costich, Julia F

2012-11-01

There is a growing recognition that the US public health system should strive for efficiency-that it should determine the optimal ways to utilize limited resources to improve and protect public health. The field of public health finance research is a critical part of efforts to understand the most efficient ways to use resources. This article discusses the current state of public health finance research through a review of public health finance literature, chronicles important lessons learned from public health finance research to date, discusses the challenges faced by those seeking to conduct financial research on the public health system, and discusses the role of public health finance research in relation to the broader endeavor of Public Health Services and Systems Research.

Chiral tunneling of topological states: towards the efficient generation of spin current using spin-momentum locking.

Science.gov (United States)

Habib, K M Masum; Sajjad, Redwan N; Ghosh, Avik W

2015-05-01

We show that the interplay between chiral tunneling and spin-momentum locking of helical surface states leads to spin amplification and filtering in a 3D topological insulator (TI). Our calculations show that the chiral tunneling across a TI pn junction allows normally incident electrons to transmit, while the rest are reflected with their spins flipped due to spin-momentum locking. The net result is that the spin current is enhanced while the dissipative charge current is simultaneously suppressed, leading to an extremely large, gate-tunable spin-to-charge current ratio (∼20) at the reflected end. At the transmitted end, the ratio stays close to 1 and the electrons are completely spin polarized.

The History of Liquid Ear Acupuncture and the Current Scientific State of the Art

Directory of Open Access Journals (Sweden)

Daniela Litscher

2016-06-01

Full Text Available This short review article presents a current overview of existing publications and scientific results regarding liquid (ear acupuncture. The injection of liquids into defined acupuncture points of the ear is not a method commonly used in the Western world. The term liquid acupuncture has different definitions, which makes understanding each definition and differentiating one from the other difficult. General terms like pharmacopuncture, homeosiniatry, and liquid acupuncture, which all describe the method of injecting different kinds of drugs into a defined body acupuncture point, are used. This article presents the history of liquid acupuncture, as well as the current scientific state of the art, from the point of view of two European researchers. Some articles are discussed and a few practical examples are presented.

Educational Attainment in the United States: 2009. Population Characteristics. Current Population Reports. P20-566

Science.gov (United States)

Ryan, Camille L.; Siebens, Julie

2012-01-01

This report provides a portrait of educational attainment in the United States based on data collected in the 2009 American Community Survey (ACS) and the 2005-2009 ACS 5-year estimates. It also uses data from the Annual Social and Economic Supplement (ASEC) to the Current Population Survey (CPS) collected in 2009 and earlier, as well as monthly…

Nursing, occupational therapy, and physical therapy preparation in rheumatology in the United States and Canada.

Science.gov (United States)

Jette, A M; Becker, M C

1980-11-01

Directors of undergraduate programs in nursing, physical therapy, and occupational therapy in the United States and Canada were surveyed to determine the amount and perceived adequacy of the current degree of classroom and clinical exposure to the rheumatic diseases. One hundred ninety-one (73%) of the 262 mailed questionnaires were returned. Results indicate that regardless of the actual degree of rheumatologic classroom exposure, directors in all three disciplines view current amounts as adequate. A larger proportion views levels of clinical exposure as inadequate. In general, the Canadian programs had a greater emphasis on rheumatology than their United States counterparts.

Determining the Impact of Steady-State PV Fault Current Injections on Distribution Protection

Energy Technology Data Exchange (ETDEWEB)

Seuss, John [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Reno, Matthew J. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Broderick, Robert Joseph [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Grijalva, Santiago [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

2017-05-01

This report investigates the fault current contribution from a single large PV system and the impact it has on existing distribution overcurrent protection devices. Assumptions are made about the modeling of the PV system under fault to perform exhaustive steady - state fault analyses throughout distribution feeder models. Each PV interconnection location is tested to determine how the size of the PV system affects the fault current measured by each protection device. This data is then searched for logical conditions that indicate whether a protection device has operated in a manner that will cause more customer outages due to the addition of the PV system. This is referred to as a protection issue , and there are four unique types of issues that have been identified in the study. The PV system size at which any issues occur are recorded to determine the feeder's PV hosting capacity limitations due to interference with protection settings. The analysis is carried out on six feeder models. The report concludes with a discussion of the prevalence and cause of each protection issue caused by PV system fault current.

Current Perspectives on Desmoid Tumors: The Mayo Clinic Approach

International Nuclear Information System (INIS)

Joglekar, Siddharth B.; Rose, Peter S.; Sim, Franklin; Okuno, Scott; Petersen, Ivy

2011-01-01

Desmoid tumors are a rare group of locally aggressive, non malignant tumors of fibroblastic origin that can lead to significant morbidity due to local invasion. Despite advances in the understanding of these tumors, their natural history is incompletely understood and the optimal treatment is still a matter of debate. Local control is the main goal of treatment and there has been a change in philosophy regarding the management of these tumors from aggressive surgical resection to function preservation. A multidisciplinary approach is essential to plan local control with acceptable morbidity. The current Mayo Clinic algorithm for the treatment of these tumors is based on institutional experience and the available evidence in the literature: asymptomatic/non progressive lesions away from vital structures are managed with observation and regular imaging; primary or recurrent desmoid tumors which are symptomatic or progressive or near vital structures are managed with wide surgical resection when wide surgical margins are possible with minimal functional and cosmetic loss. When positive or close surgical margins are likely, surgical resection with adjuvant radiotherapy or definitive radiotherapy is preferred. If likely functional or cosmetic deficit is unacceptable, radiotherapy is the treatment of choice. Unresectable lesions are considered for radiotherapy, chemotherapy or newer modalities however an unresectable lesion associated with a painful, functionless, infected extremity is managed with an amputation

Current Perspectives on Desmoid Tumors: The Mayo Clinic Approach

Directory of Open Access Journals (Sweden)

Scott Okuno

2011-08-01

Full Text Available Desmoid tumors are a rare group of locally aggressive, non malignant tumors of fibroblastic origin that can lead to significant morbidity due to local invasion. Despite advances in the understanding of these tumors, their natural history is incompletely understood and the optimal treatment is still a matter of debate. Local control is the main goal of treatment and there has been a change in philosophy regarding the management of these tumors from aggressive surgical resection to function preservation. A multidisciplinary approach is essential to plan local control with acceptable morbidity. The current Mayo Clinic algorithm for the treatment of these tumors is based on institutional experience and the available evidence in the literature: asymptomatic/non progressive lesions away from vital structures are managed with observation and regular imaging; primary or recurrent desmoid tumors which are symptomatic or progressive or near vital structures are managed with wide surgical resection when wide surgical margins are possible with minimal functional and cosmetic loss. When positive or close surgical margins are likely, surgical resection with adjuvant radiotherapy or definitive radiotherapy is preferred. If likely functional or cosmetic deficit is unacceptable, radiotherapy is the treatment of choice. Unresectable lesions are considered for radiotherapy, chemotherapy or newer modalities however an unresectable lesion associated with a painful, functionless, infected extremity is managed with an amputation.

Method for measuring the resistive transition and critical current in superconductors using pulsed current

International Nuclear Information System (INIS)

McGinnis, W.C.; Jones, T.E.

1993-01-01

A method is described for measuring the intragranular critical current of a granular superconductive material, comprising the steps of: conducting a substantially rectangular electronic pulse through said material so as to conduct a current through said material such that when said intragranular critical current of said material is exceeded, any grains present in said material are in a superconducting state when said current is less than said intragranular critical current, said material having a critical temperature; measuring said current through said material while conducting said pulse; measuring a voltage difference across said material while conducting said pulse; and determining said intragranular critical current through said material by varying said current to discern a current level at which an electrical resistance of said material increases to that of a non-superconducting state as the grains of said material transition from said superconducting to said non-superconducting state

Target volume definition for external beam partial breast radiotherapy: Clinical, pathological and technical studies informing current approaches

International Nuclear Information System (INIS)

Kirby, Anna M.; Coles, Charlotte E.; Yarnold, John R.

2010-01-01

Partial breast irradiation (PBI) is currently under investigation in several phase III trials and, following a recent consensus statement, its use off-study may increase despite ongoing uncertainty regarding optimal target volume definition. We review the clinical, pathological and technical evidence for target volume definition in external beam partial breast irradiation (EB-PBI). The optimal method of tumour bed (TB) delineation requires X-ray CT imaging of implanted excision cavity wall markers. The definition of clinical target volume (CTV) as TB plus concentric 15 mm margins is based on the anatomical distribution of multifocal and multicentric disease around the primary tumour in mastectomy specimens, and the clinical locations of local tumour relapse (LR) after breast conservation surgery. If the majority of LR originate from foci of residual invasive and/or intraduct disease in the vicinity of the TB after complete microscopic resection, CTV margin logically takes account of the position of primary tumour within the surgical resection specimen. The uncertain significance of independent primary tumours as sources of preventable LR, and of wound healing responses in stimulating LR, increases the difficulties in defining optimal CTV. These uncertainties may resolve after long-term follow-up of current PBI trials. By contrast, a commonly used 10 mm clinical to planning target volume (PTV) margin has a stronger evidence base, although departmental set-up errors need to be confirmed locally. A CTV-PTV margin >10 mm may be required in women with larger breasts and/or large seromas, whilst the role of image-guided radiotherapy with or without TB markers in reducing CTV-PTV margins needs to be explored.

Current and potential sustainable corn stover feedstock for biofuel production in the United States

Science.gov (United States)

Tan, Zhengxi; Liu, Shu-Guang; Tieszen, Larry L.; Bliss, Norman

2012-01-01

Increased demand for corn (Zea mays L.) stover as a feedstock for cellulosic ethanol raises concerns about agricultural sustainability. Excessive corn stover harvesting could have long-term impacts on soil quality. We estimated current and future stover production and evaluated the potential harvestable stover amount (HSA) that could be used for biofuel feedstock in the United States by defining the minimum stover requirement (MSR) associated with the current soil organic carbon (SOC) content, tillage practices, and crop rotation systems. Here we show that the magnitude of the current HSA is limited (31 Tg y−1, dry matter) due to the high MSR for maintaining the current SOC content levels of soils that have a high carbon content. An alternative definition of MSR for soils with a moderate level of SOC content could significantly elevate the annual HSA to 68.7 Tg, or even to 132.2 Tg if the amount of currently applied manure is counted to partially offset the MSR. In the future, a greater potential for stover feedstock could come from an increase in stover yield, areal harvest index, and/or the total planted area. These results suggest that further field experiments on MSR should be designed to identify differences in MSR magnitude between maintaining SOC content and preventing soil erosion, and to understand the role of current SOC content level in determining MSR from soils with a wide range of carbon contents and climatic conditions.

Current Limitations of Surgical Robotics in Reconstructive Plastic Microsurgery

Directory of Open Access Journals (Sweden)

Youri P. A. Tan

2018-03-01

Full Text Available Surgical robots have the potential to provide surgeons with increased capabilities, such as removing physiologic tremor, scaling motion and increasing manual dexterity. Several surgical specialties have subsequently integrated robotic surgery into common clinical practice. Plastic and reconstructive microsurgical procedures have not yet  benefitted significantly from technical developments observed over the last two decades. Several studies have successfully demonstrated the feasibility of utilising surgical robots in plastic surgery procedures, yet limited work has been done to identify and analyse current barriers that have prevented wide-scale adaptation of surgical robots for microsurgery. Therefore, a systematic review using PubMed, MEDLINE, Embase and Web of Science databases was performed, in order to evaluate current state of surgical robotics within the field of reconstructive microsurgery and their limitations. Despite the theoretical potential of surgical robots, current commercially available robotic systems are suboptimal for plastic or reconstructive microsurgery. Absence of bespoke microsurgical instruments, increases in operating time, and high costs associated with robotic-assisted provide a barrier to using such systems effectively for reconstructive microsurgery. Consequently, surgical robots provide currently little overall advantage over conventional microsurgery. Nevertheless, if current barriers can be addressed and systems are specifically designed for microsurgery, surgical robots may have the potential of meaningful impact on clinical outcomes within  this surgical subspeciality.

Current Limitations of Surgical Robotics in Reconstructive Plastic Microsurgery

Science.gov (United States)

Tan, Youri P. A.; Liverneaux, Philippe; Wong, Jason K. F.

2018-01-01

Surgical robots have the potential to provide surgeons with increased capabilities, such as removing physiologic tremor, scaling motion and increasing manual dexterity. Several surgical specialties have subsequently integrated robotic surgery into common clinical practice. Plastic and reconstructive microsurgical procedures have not yet  benefitted significantly from technical developments observed over the last two decades. Several studies have successfully demonstrated the feasibility of utilising surgical robots in plastic surgery procedures, yet limited work has been done to identify and analyse current barriers that have prevented wide-scale adaptation of surgical robots for microsurgery. Therefore, a systematic review using PubMed, MEDLINE, Embase and Web of Science databases was performed, in order to evaluate current state of surgical robotics within the field of reconstructive microsurgery and their limitations. Despite the theoretical potential of surgical robots, current commercially available robotic systems are suboptimal for plastic or reconstructive microsurgery. Absence of bespoke microsurgical instruments, increases in operating time, and high costs associated with robotic-assisted provide a barrier to using such systems effectively for reconstructive microsurgery. Consequently, surgical robots provide currently little overall advantage over conventional microsurgery. Nevertheless, if current barriers can be addressed and systems are specifically designed for microsurgery, surgical robots may have the potential of meaningful impact on clinical outcomes within  this surgical subspeciality. PMID:29740585

Current state about the cuaternary knowledge of Uruguay; Estado actual sobre los conocimientos del cuaternario en Uruguay

Energy Technology Data Exchange (ETDEWEB)

Anton, D; Goso, H

1974-07-01

This work is about current state of cuaternary knowledge Uruguayan. It is considered that the cuaternary presented a change from the hot and dry weather of the Pliocene to more humid and colder weather in Uruguay.

Current status and prospect of plasma control system for steady-state operation on QUEST

International Nuclear Information System (INIS)

Hasegawa, Makoto; Nakamura, Kazuo; Zushi, Hideki; Hanada, Kazuaki; Fujisawa, Akihide; Tokunaga, Kazutoshi; Idei, Hiroshi; Nagashima, Yoshihiko; Kawasaki, Shoji; Nakashima, Hisatoshi; Higashijima, Aki

2016-01-01

Highlights: • Overall configuration of plasma control system on QUEST are presented. • Multi core system and reflective memories are used for the real-time control. • Hall sensors are used for the identification of plasma current and its position. • Repetitive gas fueling with the feed-back control of Hα signal is implemented. - Abstract: The plasma control system (PCS) of QUEST is developed according to the progress of QUEST project. Since one of the critical goals of the project is to achieve the steady-state operation with high temperature vacuum vessel wall, the PCS is also required to have the capability to control the plasma for a long period. For the increase of the loads to processing power of the PCS, the PCS is decentralized with the use of reflective memories (RFMs). The PCS controls the plasma edge position with the real-time identification of plasma current and its position. This identification is done with not only flux loops but also hall sensors. The gas fueling method by piezo valve with monitoring the Hα signal filtered by a digital low-pass filter are proposed and suitable for the steady-state operation on QUEST. The present status and prospect of the PCS are presented with recent topics.

Current status and prospect of plasma control system for steady-state operation on QUEST

Energy Technology Data Exchange (ETDEWEB)

Hasegawa, Makoto, E-mail: hasegawa@triam.kyushu-u.ac.jp; Nakamura, Kazuo; Zushi, Hideki; Hanada, Kazuaki; Fujisawa, Akihide; Tokunaga, Kazutoshi; Idei, Hiroshi; Nagashima, Yoshihiko; Kawasaki, Shoji; Nakashima, Hisatoshi; Higashijima, Aki

2016-11-15

Highlights: • Overall configuration of plasma control system on QUEST are presented. • Multi core system and reflective memories are used for the real-time control. • Hall sensors are used for the identification of plasma current and its position. • Repetitive gas fueling with the feed-back control of Hα signal is implemented. - Abstract: The plasma control system (PCS) of QUEST is developed according to the progress of QUEST project. Since one of the critical goals of the project is to achieve the steady-state operation with high temperature vacuum vessel wall, the PCS is also required to have the capability to control the plasma for a long period. For the increase of the loads to processing power of the PCS, the PCS is decentralized with the use of reflective memories (RFMs). The PCS controls the plasma edge position with the real-time identification of plasma current and its position. This identification is done with not only flux loops but also hall sensors. The gas fueling method by piezo valve with monitoring the Hα signal filtered by a digital low-pass filter are proposed and suitable for the steady-state operation on QUEST. The present status and prospect of the PCS are presented with recent topics.

Usage of Bone Replacement Grafts in Periodontics and Oral Implantology and Their Current Levels of Clinical Evidence - A Systematic Assessment.

Science.gov (United States)

Salem, Daliah; Natto, Zuhair; Elangovan, Satheesh; Karimbux, Nadeem

2016-08-01

The aim of this review is to evaluate the levels of clinical evidence for bone replacement grafts available in the United States for periodontics and oral implantology purposes. A search was performed using PubMed, the Cochrane Library, and Google Scholar for articles relating to the use of bone replacement grafts in implant and/or periodontics by two independent reviewers. Articles unrelated to the topic, not involving patients, not including abstracts, or in languages other than English were excluded. Selected articles were graded according to "levels of evidence" based on guidelines originally introduced by Wright et al. (2003). There was limited published peer-reviewed clinical literature available regarding US commercially available bone replacement grafts in periodontics and oral implantology. Of 144 bone replacement grafts available in the United States according to Avila-Ortiz et al. (2013), only 52 met the inclusion criteria. The majority of materials used were allografts (26 of 93 available in the United States), followed by alloplasts (15 of 30) and xenografts (11 of 21). Dental providers should be aware of the limited evidence that qualified for a strong rating supporting the clinical efficacy of these materials for periodontics and oral implantology purposes using the inclusion criteria selected in this study.

Current referral practices and adolescent transition to Adult clinic ...

African Journals Online (AJOL)

2016-02-02

Feb 2, 2016 ... of adolescent transition from child to adult care ... from paediatric to adult clinics. Adolescent ... The fate of older adolescent patients in paediatric clinics is either one of ..... fer depends on physical and psychological factors and.

AACE/ACE Disease State Clinical Review: Medical Management of Cushing Disease.

Science.gov (United States)

Hamrahian, Amir H; Yuen, Kevin C J; Hoffman, Andrew R

2014-07-01

To review available medical therapies for patients with Cushing disease and to provide a roadmap for their use in clinical practice. PubMed searches were performed to identify all of the available published data on medical management of Cushing disease. Medical therapy is usually not the first-line treatment for patients with Cushing disease but may be used to improve clinical manifestations of Cushing disease in patients who are not suitable candidates for surgery, following unsuccessful surgery or recurrence, or as a "bridge therapy" in those who have undergone radiotherapy. Medical therapy may also be used in preoperative preparation of patients with severe disease. Current available medical options for patients with Cushing disease include centrally acting agents, steroidogenesis inhibitors, and a glucocorticoid receptor antagonists. At present, there are no head-to-head studies comparing the efficacy, tolerability, and safety of different U.S. Food and Drug Administration (FDA)- and non-FDA-approved drugs in patients with Cushing disease. With the initiation of new studies and the completion of ongoing clinical trials, the number of FDA-approved drugs for medical treatment of Cushing disease is expected to increase. Medical therapy has an important adjunctive role in the management of patients with Cushing disease. The decision to initiate medical treatment depends on many factors, including patient characteristics and preference. Long-term studies are needed to better define the clinical efficacy, safety, and tolerability of medical treatment of Cushing disease, including the role of combination therapies.

Current Therapeutic Cannabis Controversies and Clinical Trial Design Issues

Science.gov (United States)

Russo, Ethan B.

2016-01-01

This overview covers a wide range of cannabis topics, initially examining issues in dispensaries and self-administration, plus regulatory requirements for production of cannabis-based medicines, particularly the Food and Drug Administration “Botanical Guidance.” The remainder pertains to various cannabis controversies that certainly require closer examination if the scientific, consumer, and governmental stakeholders are ever to reach consensus on safety issues, specifically: whether botanical cannabis displays herbal synergy of its components, pharmacokinetics of cannabis and dose titration, whether cannabis medicines produce cyclo-oxygenase inhibition, cannabis-drug interactions, and cytochrome P450 issues, whether cannabis randomized clinical trials are properly blinded, combatting the placebo effect in those trials via new approaches, the drug abuse liability (DAL) of cannabis-based medicines and their regulatory scheduling, their effects on cognitive function and psychiatric sequelae, immunological effects, cannabis and driving safety, youth usage, issues related to cannabis smoking and vaporization, cannabis concentrates and vape-pens, and laboratory analysis for contamination with bacteria and heavy metals. Finally, the issue of pesticide usage on cannabis crops is addressed. New and disturbing data on pesticide residues in legal cannabis products in Washington State are presented with the observation of an 84.6% contamination rate including potentially neurotoxic and carcinogenic agents. With ongoing developments in legalization of cannabis in medical and recreational settings, numerous scientific, safety, and public health issues remain. PMID:27683558

Current Therapeutic Cannabis Controversies and Clinical Trial Design Issues.

Directory of Open Access Journals (Sweden)

Ethan Budd Russo

2016-09-01

Full Text Available This overview covers a wide range of cannabis topics, initially examining issue in dispensaries and self-administration, plus regulatory requirement for production of cannabis-based medicines, particularly the Food and Drug Administration Botanical Guidance. The remainder pertains to various cannabis controversies that certainly require closer examination if the scientific, consumer and governmental stakeholders are ever to reach consensus on safety issues, specifically: whether botanical cannabis displays herbal synergy of its components, pharmacokinetics of cannabis and dose titration, whether cannabis medicines produce cyclo-oxygenase inhibition, cannabis-drug interactions and cytochrome P450 issues, whether cannabis randomized clinical trials are properly blinded, combatting the placebo effect in those trials via new approaches, the drug abuse liability of cannabis-based medicines and their regulatory scheduling, their effects on cognitive function and psychiatric sequelae, immunological effects, cannabis and driving safety, youth usage, issues related to cannabis smoking and vaporization, cannabis concentrates and vape-pens, and laboratory analysis for contamination with bacteria and heavy metals. Finally, the issue of pesticide usage on cannabis crops is addressed. New and disturbing data on pesticide residues in legal cannabis products in Washington State are presented with the observation of an 84.6% contamination rate including potentially neurotoxic and carcinogenic agents. With ongoing developments in legalization of cannabis in medical and recreational settings, numerous scientific, safety and public health issues remain.

Current state and controversies in fertility preservation in women with breast cancer.

Science.gov (United States)

Taylan, Enes; Oktay, Kutluk H

2017-06-10

On average, over 25000 women are diagnosed with breast cancer under the age of 45 annually in the United States. Because an increasing number of young women delay childbearing to later life for various reasons, a growing population of women experience breast cancer before completing childbearing. In this context, preservation of fertility potential of breast cancer survivors has become an essential concept in modern cancer care. In this review, we will outline the currently available fertility preservation options for women with breast cancer of reproductive age, discuss the controversy behind hormonal suppression for gonadal protection against chemotherapy and highlight the importance of timely referral by cancer care providers.

[Literature survey on botanical origin and clinical application of traditional Tibetan medicine "Shengdeng"].

Science.gov (United States)

Chen, De-Dao; Meng, Xian-Hua; Zhang, Ying-Shan; Chen, Gen-Ping; Huang, Yu-Lan

2012-10-01

"Shengdeng" is its Tibetan transliteration referring to many medicines. Tibetan doctors and pharmacists in different areas use different drugs in formulation and clinical application, which are easily confused. In order to grasp the formula and clinical application accurately, we conduct a literature survey on history and current state of botanical origin and clinical application of "Shengdeng", making clear the application of various herbs named "Shengdeng" and providing reference to all Tibetan researchers and clinical workers in formulation and clinical application.

Bipolar disorder and complementary medicine: current evidence, safety issues, and clinical considerations.

Science.gov (United States)

Sarris, Jerome; Lake, James; Hoenders, Rogier

2011-10-01

Bipolar disorder (BD) is a debilitating syndrome that is often undiagnosed and undertreated. Population surveys show that persons with BD often self-medicate with complementary and alternative medicine (CAM) or integrative therapies in spite of limited research evidence supporting their use. To date, no review has focused specifically on nonconventional treatments of BD. The study objectives were to present a review of nonconventional (complementary and integrative) interventions examined in clinical trials on BD, and to offer provisional guidelines for the judicious integrative use of CAM in the management of BD. PubMed, CINAHL,(®) Web of Science, and Cochrane Library databases were searched for human clinical trials in English during mid-2010 using Bipolar Disorder and CAM therapy and CAM medicine search terms. Effect sizes (Cohen's d) were also calculated where data were available. Several positive high-quality studies on nutrients in combination with conventional mood stabilizers and antipsychotic medications in BD depression were identified, while branched-chain amino acids and magnesium were effective (small studies) in attenuating mania in BD. In the treatment of bipolar depression, evidence was mixed regarding omega-3, while isolated studies provide provisional support for a multinutrient formula, n-acetylcysteine, and l-tryptophan. In one study, acupuncture was found to have favorable but nonsignificant effects on mania and depression outcomes. Current evidence supports the integrative treatment of BD using combinations of mood stabilizers and select nutrients. Other CAM or integrative modalities used to treat BD have not been adequately explored to date; however, some early findings are promising. Select CAM and integrative interventions add to established conventional treatment of BD and may be considered when formulating a treatment plan. It is hoped that the safety issues and clinical considerations addressed in this article may encourage the practice

The state of the systems of information in the companies prioritized according to the current requirementstized according to the current requirements

Directory of Open Access Journals (Sweden)

Grisel Castillo Almeida

2017-04-01

Full Text Available The necessity to maintain efficient systems of information in the prioritized companies of the territory of Pinar del Rio, Cuba, took us to carry out a diagnosis to determine the current state of the same ones and to propose group actions that congratulate the taking of decisions and the identification of the useful flows of information, to favor the organizational acting. The results of the study evidenced among other that alone 12% has an organized system of information and implemented according to the current requirements, what indicates that 88% is wasting the opportunities that offer the systems of information, also stands out the necessity to implement good practices to assure the security of the information according to the effective norms. The execution of a group of activities was approved to rise in first term the efficiency of the informative system of the study sample, with a view to continuing deepening toward the managerial intelligence.

Current limiter circuit system

Science.gov (United States)

Witcher, Joseph Brandon; Bredemann, Michael V.

2017-09-05

An apparatus comprising a steady state sensing circuit, a switching circuit, and a detection circuit. The steady state sensing circuit is connected to a first, a second and a third node. The first node is connected to a first device, the second node is connected to a second device, and the steady state sensing circuit causes a scaled current to flow at the third node. The scaled current is proportional to a voltage difference between the first and second node. The switching circuit limits an amount of current that flows between the first and second device. The detection circuit is connected to the third node and the switching circuit. The detection circuit monitors the scaled current at the third node and controls the switching circuit to limit the amount of the current that flows between the first and second device when the scaled current is greater than a desired level.

Current status of palliative care--clinical implementation, education, and research.

Science.gov (United States)

Grant, Marcia; Elk, Ronit; Ferrell, Betty; Morrison, R Sean; von Gunten, Charles F

2009-01-01

Palliative and end-of-life care is changing in the United States. This dynamic field is improving care for patients with serious and life-threatening cancer through creation of national guidelines for quality care, multidisciplinary educational offerings, research endeavors, and resources made available to clinicians. Barriers to implementing quality palliative care across cancer populations include a rapidly expanding population of older adults who will need cancer care and a decrease in the workforce available to give care. Methods of integrating current palliative care knowledge into care of patients include multidisciplinary national education and research endeavors, and clinician resources. Acceptance of palliative care as a recognized medical specialty provides a valuable resource for improvement of care. Although compilation of evidence for the importance of palliative care specialities is in its initial stages, national research grants have provided support to build the knowledge necessary for appropriate palliative care. Opportunities are available to clinicians for understanding and applying appropriate palliative and end-of-life care to patients with serious and life-threatening cancers. (c) 2009 American Cancer Society, Inc.

The glenoid track: a review of the clinical relevance, method of calculation and current evidence behind this method

Energy Technology Data Exchange (ETDEWEB)

Younan, Yara; Wong, Philip K.; Umpierrez, Monica; Gonzalez, Felix; Singer, Adam Daniel [Emory University Hospital, Department of Radiology and Imaging Sciences, Section of Musculoskeletal Imaging, Atlanta, GA (United States); Karas, Spero [Emory University Hospital, Department of Orthopedic Surgery, Atlanta, GA (United States); Jose, Jean [University of Miami, Department of Radiology, Miami, FL (United States)

2017-12-15

In the setting of bipolar bone injury, orthopedic surgeons are currently making use of the glenoid track method to guide surgical management. Using preoperative CT or MR imaging, this method allows the identification of patients who are more likely to fail a primary capsuloligamentous Bankart repair. As the glenoid track method becomes increasingly used in preoperative planning, it is important for the radiologist to become familiar with its concept and method of calculation. This review article aims to concisely summarize the current literature and the clinical implications of the glenoid track method. (orig.)

Globalization of Gerontology Education: Current Practices and Perceptions for Graduate Gerontology Education in the United States

Science.gov (United States)

Mwangi, Samuel M.; Yamashita, Takashi; Ewen, Heidi H.; Manning, Lydia K.; Kunkel, Suzanne R.

2012-01-01

The purpose of this study is to document current practices and understandings about globalization of gerontology education in the United States. Better understanding of aging requires international perspectives in global communities. However, little is known about how globalization of gerontology education is practiced in U.S. graduate-level…

Clinical applications of Gallium-68

International Nuclear Information System (INIS)

Banerjee, Sangeeta Ray; Pomper, Martin G.

2013-01-01

Gallium-68 is a positron-emitting radioisotope that is produced from a 68 Ge/ 68 Ga generator. As such it is conveniently used, decoupling radiopharmacies from the need for a cyclotron on site. Gallium-68-labeled peptides have been recognized as a new class of radiopharmaceuticals showing fast target localization and blood clearance. 68 Ga-DOTATOC, 8 Ga-DOTATATE, 68 Ga-DOTANOC, are the most prominent radiopharmaceuticals currently in use for imaging and differentiating lesions of various somatostatin receptor subtypes, overexpressed in many neuroendocrine tumors. There has been a tremendous increase in the number of clinical studies with 68 Ga over the past few years around the world, including within the United States. An estimated ∼10,000 scans are being performed yearly in Europe at about 100 centers utilizing 68 Ga-labeled somatostatin analogs within clinical trials. Two academic sites within the US have also begun to undertake human studies. This review will focus on the clinical experience of selected, well-established and recently applied 68 Ga-labeled imaging agents used in nuclear medicine. - Highlights: ► A summary of the emerging clinical uses of 68 Ga-based radiopharmaceuticals is provided. ► 68 Ga-PET may prove as or more clinically robust than the corresponding 18 F-labeled agents. ► 68 Ga-radiopeptides were studied for targeting of somatostatin receptors subtypes. ► 68 Ga-DOTATOC, 68 Ga-DOTATATE, 68 Ga-DOTANOC, are currently in clinical trials

Electroconvulsive Therapy: A Current Review

Directory of Open Access Journals (Sweden)

Gokben Hizli Sayar

2014-06-01

Full Text Available Most of the electroconvulsive therapy guidelines state that severe major depression with psychotic features, manic delirium, or catatonia are conditions where there is a clear consensus favoring early electroconvulsive therapy. The decision to administer electroconvulsive therapy is based on an evaluation of the risks and benefits for the individual patient and involves a combination of factors, including psychiatric diagnosis, type and severity of symptoms, prior treatment history and response, identification of possible alternative treatment options, and consumer preference. In this review history, mechanisms of action, side effects that have been referenced in the literature and clinical experience are discussed. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2014; 6(2.000: 107-125

COAGULOPATHY IN BETA-THALASSEMIA: CURRENT UNDERSTANDING AND FUTURE PERSPECTIVES

Directory of Open Access Journals (Sweden)

M. Domenica Cappellini

2009-12-01

Full Text Available As the life expectancy of β-thalassemia patients has markedly improved over the last decade, several new complications are being recognized. The presence of a high incidence of thromboembolic events, mainly in thalassemia intermedia patients, has led to the identification of a hypercoagulable state in thalassemia. In this review, the molecular and cellular mechanisms leading to hypercoagulability in thalassemia are highlighted, and the current clinical experience is summarized. Recommendations for thrombosis prophylaxis are also discussed.

Effects of state and trait anxiety on selective attention to threatening stimuli in a non-clinical sample of school children

Directory of Open Access Journals (Sweden)

Jeniffer Ortega Marín

2015-01-01

Full Text Available Attentional biases, consisting of a preferential processing of threatening stimuli, have been found in anxious adults as predicted by several cognitive models. However, studies with non-clinical samples of children have provided mixed results. therefore, the aim of this research was to determine the effects of state and trait anxiety on the selective attention towards threatening stimuli in a non-clinical sample of school children (age: 8 to 13, n = 110 using the dot-probe task. This study did not reveal an effect of trait anxiety on selective attention towards threatening stimuli. However, a significant difference was found between participants with low state anxiety and high state anxiety. Nevertheless, the effect size was small. Specifically, participants with low state anxiety showed a bias towards threatening stimuli. Overall, the findings of this research with a non-clinical sample of school children suggest that attentional biases towards threatening information, which has been repeatedly found in anxious adults, are not necessarily inherent to non-clinical anxiety in children and on the other hand, the relationship between attentional biases and anxiety in this population might be moderated by other cognitive processes.

Small Bowel Transplantation: Current Clinical Status

Directory of Open Access Journals (Sweden)

David Sigalet

1991-01-01

Full Text Available With recent refinements in immunosuppression techniques, the first successful reports of small bowel transplantation in humans have now been made, increasing interest in bowel transplantation among clinicians and patients alike. This article reviews recent developments in understanding of the functional capabilities and requirements for effective immune suppression in bowel transplantation. Both experimental and clinical experience with transplantation are discussed, as are the areas which appear to offer the most promise for future developments. Finally guidelines for consideration of patient selection for this procedure are reviewed.

Role of the community pharmacist in emergency contraception counseling and delivery in the United States: current trends and future prospects

Directory of Open Access Journals (Sweden)

Rafie S

2017-03-01

Full Text Available Sally Rafie,1 Rebecca H Stone,2 Tracey A Wilkinson,3 Laura M Borgelt,4,5 Shareen Y El-Ibiary,6 Denise Ragland7 1Department of Pharmacy, UC San Diego Health, San Diego, CA, 2Department of Clinical and Administrative Pharmacy, University of Georgia, College of Pharmacy, Athens, GA, 3Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, 4Department of Clinical Pharmacy, 5Department of Family Medicine, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, 6Department of Pharmacy Practice, College of Pharmacy, Midwestern University, Glendale, AZ, 7Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA Abstract: Women and couples continue to experience unintended pregnancies at high rates. In the US, 45% of all pregnancies are either mistimed or unwanted. Mishaps with contraceptives, such as condom breakage, missed pills, incorrect timing of patch or vaginal ring application, contraceptive nonuse, forced intercourse, and other circumstances, place women at risk of unintended pregnancy. There is a critical role for emergency contraception (EC in preventing those pregnancies. There are currently three methods of EC available in the US. Levonorgestrel EC pills have been available with a prescription for over 15 years and over-the-counter since 2013. In 2010, ulipristal acetate EC pills became available with a prescription. Finally, the copper intrauterine device remains the most effective form of EC. Use of EC is increasing over time, due to wider availability and accessibility of EC methods. One strategy to expand access for both prescription and nonprescription EC products is to include pharmacies as a point of access and allow pharmacist prescribing. In eight states, pharmacists are able to prescribe and provide EC directly to women: levonorgestrel EC in eight states and ulipristal

Current state of low energy EB devices and its application technology

International Nuclear Information System (INIS)

Kinoshita, Shinobu

2000-01-01

This paper introduced the current state of low energy type EB (electron beam) devices with an acceleration voltage of 300 kV or below and specific application examples. As for EB devices, it introduced the ultra-compact new EB device (microbeam LV), experimental devices, and the pilot/production devices which have been recently developed by the manufacturer to which the author belongs. As the applications of low energy EB devices, it specifically introduced curing, graft polymerization, crosslinking, and sterilization/disinfection with soft electrons: (1) examples of EB curing; antistatic agents in antibacterial/antifungal property imparting processing, hard coat, printing and topcoat, high gloss/pattern transfer processing, and metal vapor deposition film, (2) example of graft polymerization; barrier imparting films, and (3) examples of crosslinking; shrinking films/tubes and foamed sheets. (A.O.)

Engineering Ethics Education : Its Necessity, Objectives, Methods, Current State, and Challenges

Science.gov (United States)

Fudano, Jun

The importance of engineering ethics education has become widely recognized in the industrialized countries including Japan. This paper examines the background against which engineering ethics education is required, and reviews its objectives, methods, and challenges, as well as its current state. In pointing out important issues associated with the apparent acceptance and quantitative development of ethics education, especially after the establishment of the Japan Accreditation Board for Engineering Education in 1999, the author stresses that the most serious problem is the lack of common understanding on the objectives of engineering ethics education. As a strategy to improve the situation, the so-called “Ethics-across-the-Curriculum” approach is introduced. The author also claims that business/organization ethics which is consistent with engineering ethics should be promoted in Japan.

State of the art of superconducting fault current limiters and their application to the electric power system

International Nuclear Information System (INIS)

Morandi, Antonio

2013-01-01

Highlights: ► The state of the art of superconducting fault current limiters is reviewed. ► An innovative concept of FCL is discussed and the potential of MgB 2 is outlined. ► The use of FCL to allow more interconnection of MV bus-bar is discussed. ► The use of FCL to increase the immunity from voltage dips is discussed. ► The use of FCL to integrate more distributed generation is pointed out. -- Abstract: Modern electric power systems are becoming more and more complex in order to meet new needs. Nowadays a high power quality is mandatory and there is the need to integrate increasing amounts of on-site generation. All this translates in more sophisticated electric network with intrinsically high short circuit rate. This network is vulnerable in case of fault and special protection apparatus and procedures needs to be developed in order to avoid costly or even irreversible damage. A superconducting fault current limiter (SFCL) is a device with a negligible impedance in normal operating conditions that reliably switches to a high impedance state in case of extra-current. Such a device is able to increase the short circuit power of an electric network and to contemporarily eliminate the hazard during the fault. It can be regarded as a key component for future electric power systems. In this paper the state of the art of superconducting fault current limiters mature for applications is briefly resumed and the potential impact of this device on the paradigm of design and operation of power systems is analyzed. In particular the use of the FCL as a mean to allow more interconnection of MV bus-bars as well an increased immunity with respect to the voltage disturbances induced by critical customer is discussed. The possibility to integrate more distributed generation in the distribution grid is also considered

Lithium monotherapy associated clinical improvement effects on amygdala-ventromedial prefrontal cortex resting state connectivity in bipolar disorder.

Science.gov (United States)

Altinay, Murat; Karne, Harish; Anand, Amit

2018-01-01

This study, for the first time, investigated lithium monotherapy associated effects on amygdala- ventromedial prefrontal cortex (vMPFC) resting-state functional connectivity and correlation with clinical improvement in bipolar disorder (BP) METHODS: Thirty-six medication-free subjects - 24 BP (12 hypomanic BPM) and 12 depressed (BPD)) and 12 closely matched healthy controls (HC), were included. BP subjects were treated with lithium and scanned at baseline, after 2 weeks and 8 weeks. HC were scanned at same time points but were not treated. The effect of lithium was studied for the BP group as a whole using two way (group, time) ANOVA while regressing out effects of state. Next, correlation between changes in amygdala-vMPFC resting-state connectivity and clinical global impression (CGI) of severity and improvement scale scores for overall BP illness was calculated. An exploratory analysis was also conducted for the BPD and BPM subgroups separately. Group by time interaction revealed that lithium monotherapy in patients was associated with increase in amygdala-medial OFC connectivity after 8 weeks of treatment (p = 0.05 (cluster-wise corrected)) compared to repeat testing in healthy controls. Increased amygdala-vMPFC connectivity correlated with clinical improvement at week 2 and week 8 as measured with the CGI-I scale. The results pertain to open-label treatment and do not account for non-treatment related improvement effects. Only functional connectivity was measured which does not give information regarding one regions effect on the other. Lithium monotherapy in BP is associated with modulation of amygdala-vMPFC connectivity which correlates with state-independent global clinical improvement. Copyright © 2017. Published by Elsevier B.V.

Current State of Pediatric Sarcoma Biology and Opportunities for Future Discovery: A Report from the Sarcoma Translational Research Workshop

Science.gov (United States)

Hingorani, Pooja; Janeway, Katherine; Crompton, Brian D.; Kadoch, Cigall; Mackall, Crystal L.; Khan, Javed; Shern, Jack F.; Schiffman, Joshua; Mirabello, Lisa; Savage, Sharon A.; Ladanyi, Marc; Meltzer, Paul; Bult, Carol J.; Adamson, Peter C.; Lupo, Philip J.; Mody, Rajen; DuBois, Steven G.; Parsons, D. Williams; Khanna, Chand; Lau, Ching; Hawkins, Douglas S.; Randall, R. Lor; Smith, Malcolm; Sorensen, Poul H.; Plon, Sharon E.; Skapek, Stephen X.; Lessnick, Stephen; Gorlick, Richard; Reed, Damon R.

2017-01-01

Sarcomas are a rare subgroup of pediatric cancers comprised of a variety of bone and soft-tissue tumors. While significant advances have been made in improving outcomes of patients with localized pediatric sarcomas since the addition of systemic chemotherapy to local control many decades ago, outcomes for patients with metastatic and relapsed sarcoma remain poor with few novel therapeutics identified to date. With the advent of new technologies to study cancer genomes, transcriptomes and epigenomes, our understanding of sarcoma biology has improved tremendously in a relatively short period of time. However, much remains to be accomplished in this arena especially with regard to translating all of this new knowledge to the bedside. To this end, a meeting was convened in Philadelphia, PA on April 18, 2015 sponsored by the QuadW foundation, Children’s Oncology Group and CureSearch for Children’s Cancer that brought together sarcoma clinicians and scientists from North America to review the current state of pediatric sarcoma biology and ongoing/planned genomics based clinical trials in an effort to identify and bridge knowledge gaps that continue to exist at the current time. At the conclusion of the workshop, three key objectives that would significantly further our understanding of sarcoma were identified and a proposal was put forward to develop an all-encompassing pediatric sarcoma biology protocol that would address these specific needs. This review summarizes the proceedings of the workshop. PMID:27132463

Academic versus Clinical Productivity of Cardiac Surgeons in the State of New York: Who Publishes More and Who Operates More.

Science.gov (United States)

Rosati, Carlo Maria; Gaudino, Mario; Vardas, Panos N; Weber, Daniel J; Blitzer, David; Hameedi, Fawad; Koniaris, Leonidas G; Girardi, Leonard N

2018-01-01

We investigated whether/how cardiac surgeons can be productive both academically and clinically. Using online resources (New York State Adult Cardiac Surgery database, SCOPUS), we collected individual clinical volumes (operations performed/year), academic metrics (ongoing publications, role as author), practice setting, and seniority for all cardiac surgeons in the State of New York from 1994 to 2011. Over time, individual clinical volumes decreased (median operations/year: 193 in 1995 vs 126 in 2010; P published more worked at hospitals with higher clinical volumes (Spearman's correlation coefficient: 0.16; P publishing at all; ∼45 per cent operating less, but publishing a little; ∼15 per cent clinically very productive (operating as much as the nonpublishers) and publishing a lot; and ∼1 per cent operating the least, but publishing the most.

Overview of steady-state tokamak operation and current drive experiments in TRIAM-1M

International Nuclear Information System (INIS)

Zushi, H.; Nakamura, K.; Hanada, K.

2005-01-01

Experiments aiming at 'day long operation at high performance' have been carried out. The record value of the discharge duration was updated to 5 h and 16 min. Steady-state tokamak operation (SSTO) is studied under the localized PWI conditions. The distributions of the heat load, the particle recycling flux and impurity source are investigated to understand the co-deposition and wall pumping. Formation and sustainment of an internal transport barrier ITB in enhanced current drive mode (ECD) has been investigated by controlling the lower hybrid driven current profile by changing the phase spectrum. An ITER relevant remote steering antenna for electron cyclotron wave ECW injection was installed and a relativistic Doppler resonance of the oblique propagating extraordinary wave with energetic electrons driven by lower hybrid waves was studied. (author)

Transforming the Primary Care Training Clinic: New York State's Hospital Medical Home Demonstration Pilot.

Science.gov (United States)

Angelotti, Marietta; Bliss, Kathryn; Schiffman, Dana; Weaver, Erin; Graham, Laura; Lemme, Thomas; Pryor, Veronica; Gesten, Foster C

2015-06-01

Training in patient-centered medical home (PCMH) settings may prepare new physicians to measure quality of care, manage the health of populations, work in teams, and include cost information in decision making. Transforming resident clinics to PCMHs requires funding for additional staff, electronic health records, training, and other resources not typically available to residency programs. Describe how a 1115 Medicaid waiver was used to transform the majority of primary care training sites in New York State to the PCMH model and improve the quality of care provided. The 2013-2014 Hospital Medical Home Program provided awards to 60 hospitals and 118 affiliated residency programs (training more than 5000 residents) to transform outpatient sites into PCMHs and provide high-quality, coordinated care. Site visits, coaching calls, resident surveys, data reporting, and feedback were used to promote and monitor change in resident continuity and quality of care. Descriptive analyses measured improvements in these areas. A total of 156 participating outpatient sites (100%) received PCMH recognition. All sites enhanced resident education using PCMH principles through patient empanelment, development of quality dashboards, and transforming resident scheduling and training. Clinical quality outcomes showed improvement across the demonstration, including better performance on colorectal and breast cancer screening rates (rate increases of 13%, P≤.001, and 11%, P=.011, respectively). A 1115 Medicaid waiver is a viable mechanism for states to transform residency clinics to reflect new primary care models. The PCMH transformation of 156 sites led to improvements in resident continuity and clinical outcomes.

Welfare state: Milestones of development and the current status

Directory of Open Access Journals (Sweden)

D A Zakharyan

2016-12-01

Full Text Available The article describes the evolution of ideas about the social state as a fair state based on the concept of the social contract. L. von Stein argues that the purpose of the welfare state was not changing the class structure of society and the elimination of the contradictions between the classes, but rather balancing and minimizing conflicts with the help of property transformations allowing a person to change one’s class affiliation. The main condition for the existence of the welfare state is its policies compliance with the interests of citizens, which provides political stability and social security. The central idea of the welfare constitutional state is that the rights of citizens are guaranteed by the state. The functions of the state and its social responsibilities were transforming over time mainly due to the erosion of state, private and corporate responsibility for providing social services. In most cases, the social programs are developed by the state, but they can also be provided by commercial organizations in the “consumer society”, in which all things and services have a material value and benefit. The welfare state is based on the principle of social justice in the distribution of wealth among the population, thus, every democratic state seeks to become a welfare state, which implies a high level of confidence in the government.

Clinical Management of Ebola Virus Disease in the United States and Europe.

Science.gov (United States)

Uyeki, Timothy M; Mehta, Aneesh K; Davey, Richard T; Liddell, Allison M; Wolf, Timo; Vetter, Pauline; Schmiedel, Stefan; Grünewald, Thomas; Jacobs, Michael; Arribas, Jose R; Evans, Laura; Hewlett, Angela L; Brantsaeter, Arne B; Ippolito, Giuseppe; Rapp, Christophe; Hoepelman, Andy I M; Gutman, Julie

2016-02-18

Available data on the characteristics of patients with Ebola virus disease (EVD) and clinical management of EVD in settings outside West Africa, as well as the complications observed in those patients, are limited. We reviewed available clinical, laboratory, and virologic data from all patients with laboratory-confirmed Ebola virus infection who received care in U.S. and European hospitals from August 2014 through December 2015. A total of 27 patients (median age, 36 years [range, 25 to 75]) with EVD received care; 19 patients (70%) were male, 9 of 26 patients (35%) had coexisting conditions, and 22 (81%) were health care personnel. Of the 27 patients, 24 (89%) were medically evacuated from West Africa or were exposed to and infected with Ebola virus in West Africa and had onset of illness and laboratory confirmation of Ebola virus infection in Europe or the United States, and 3 (11%) acquired EVD in the United States or Europe. At the onset of illness, the most common signs and symptoms were fatigue (20 patients [80%]) and fever or feverishness (17 patients [68%]). During the clinical course, the predominant findings included diarrhea, hypoalbuminemia, hyponatremia, hypokalemia, hypocalcemia, and hypomagnesemia; 14 patients (52%) had hypoxemia, and 9 (33%) had oliguria, of whom 5 had anuria. Aminotransferase levels peaked at a median of 9 days after the onset of illness. Nearly all the patients received intravenous fluids and electrolyte supplementation; 9 (33%) received noninvasive or invasive mechanical ventilation; 5 (19%) received continuous renal-replacement therapy; 22 (81%) received empirical antibiotics; and 23 (85%) received investigational therapies (19 [70%] received at least two experimental interventions). Ebola viral RNA levels in blood peaked at a median of 7 days after the onset of illness, and the median time from the onset of symptoms to clearance of viremia was 17.5 days. A total of 5 patients died, including 3 who had respiratory and renal

Electronic money in russia: current state and problems of development

Directory of Open Access Journals (Sweden)

T. G. Bondarenko

2016-01-01

Full Text Available Article is devoted to urgent problems of non-cash methods of calculation development by using electronic money – as one of the modern economically developed state strategic tasks. On modern economic science strong influence appears informatization process. The control expansion tendency, influence and distribution of commerce due to informatization of society led to emergence of the new phenomenon – information economy. Information economy brought new economic events which owing to their novelty are insufficiently studied to life. It is possible to carry electronic money to such phenomena of modern network economy Relevance and, in our opinion, timeliness of this scientific work, consisting in novelty of this non-cash payment method, its prospects and innovation within non-cash methods of calculations. Authors set as the purpose – studying of problems and the prospects of development of electronic money in the Russian Federation. In article theoretical bases of electronic money functioning are described. Determinations and classifications dismissed non-cash a method, and also the principles of electronic money functioning are considered, the questions of their historical development are raised.Authors analyzed statistical data on development of electronic services and channels of their using. Features, benefits and shortcomings of the current state of the market of electronic money are studied. The emphasis on that fact that in modern conditions considerable number of economic actors perform the activities, both in the real environment of economy, and within the virtual environment that promotes expansion of methods of their customer interaction by means of technical devices of personal computers, mobile phones is placed. In article common problems and tendencies of payments with using an electronic money are designated, the research on assessment of the current state and the prospects of electronic money

Current status and future prospects of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) clinical trials in ovarian cancer.

Science.gov (United States)

Cowan, Renee A; O'Cearbhaill, Roisin E; Zivanovic, Oliver; Chi, Dennis S

2017-08-01

The natural history of advanced-stage epithelial ovarian cancer is one of clinical remission after surgery and platinum/taxane-based intravenous (IV) and/or intraperitoneal (IP) chemotherapy followed by early or late recurrence in the majority of patients. Prevention of progression and recurrence remains a major hurdle in the management of ovarian cancer. Recently, many investigators have evaluated the use of normothermic and hyperthermic intraoperative IP drug delivery as a management strategy. This is a narrative review of the current status of clinical trials of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) in ovarian cancer and the future directions for this treatment strategy. The existing studies on HIPEC in patients with epithelial ovarian cancer are mostly retrospective in nature, are heterogeneous with regards to combined inclusion of primary and recurrent disease and lack unbiased data. Until data are available from evidence-based trials, it is reasonable to conclude that surgical cytoreduction and HIPEC is a rational and interesting, though still investigative, approach in the management of epithelial ovarian cancer, whose use should be employed within prospective clinical trials.

Learning Styles of Pilots Currently Qualified in United States Air Force Aircraft

Science.gov (United States)

Kanske, Craig A.

2001-01-01

Kolb's Learning Style Inventory was used to identify the predominant learning styles of pilots currently qualified in United States Air Force aircraft. The results indicate that these pilots show a significant preference for facts and things over people and feelings. By understanding the preferred learning styles of the target population, course material can be developed that take advantage of the strengths of these learning styles. This information can be especially useful in the future design of cockpit resource management training. The training program can be developed to demonstrate both that there are different learning styles and that it is possible to take advantage of the relative strengths of each of these learning styles.

CAEP 2015 Academic Symposium: Current State and Recommendations to Achieve Adequate and Sustainable Funding for Emergency Medicine Academic Units.

Science.gov (United States)

Lang, Eddy S; Artz, Jennifer D; Wilkie, Ryan D; Stiell, Ian G; Topping, Claude; Belanger, François P; Afilalo, Marc; Renouf, Tia; Crocco, Anthony; Wyatt, Kelly; Christenson, Jim

2016-05-01

To describe the current state of academic emergency medicine (EM) funding in Canada and develop recommendations to grow and establish sustainable funding. A panel of eight leaders from different EM academic units was assembled. Using mixed methods (including a literature review, sharing of professional experiences, a survey of current EM academic heads, and data previously collected from an environmental scan), 10 recommendations were drafted and presented at an academic symposium. Attendee feedback was incorporated, and the second set of draft recommendations was further distributed to the Canadian Association Emergency Physicians (CAEP) Academic Section for additional comments before being finalized. Recommendations were developed around the funding challenges identified and solutions developed by academic EM university-based units across Canada. A strategic plan was seen as integral to achieving strong funding of an EM unit, especially when it aligned with departmental and institutional priorities. A business plan, although occasionally overlooked, was deemed an important component for planning and sustaining the academic mission. A number of recommendations surrounding philanthropy consisted of creating partnerships with existing foundations and engaging multiple stakeholders and communities. Synergy between academic and clinical EM departments was also viewed as an opportunity to ensure integration of common missions. Education and networking for current and future leaders were also viewed as invaluable to ensure that opportunities are optimized through strong leadership development and shared experiences to further the EM academic missions across the country. These recommendations were designed to improve the financial circumstances for many Canadian EM units. There is a considerable wealth of resources that can contribute to financial stability for an academic unit, and an annual networking meeting and continuing education on these issues will facilitate

Clinical predictors of acute response to transcranial direct current stimulation (tDCS) in major depression.

Science.gov (United States)

D'Urso, Giordano; Dell'Osso, Bernardo; Rossi, Rodolfo; Brunoni, Andre Russowsky; Bortolomasi, Marco; Ferrucci, Roberta; Priori, Alberto; de Bartolomeis, Andrea; Altamura, Alfredo Carlo

2017-09-01

Transcranial direct current stimulation (tDCS) is a promising neuromodulation intervention for poor-responding or refractory depressed patients. However, little is known about predictors of response to this therapy. The present study aimed to analyze clinical predictors of response to tDCS in depressed patients. Clinical data from 3 independent tDCS trials on 171 depressed patients (including unipolar and bipolar depression), were pooled and analyzed to assess predictors of response. Depression severity and the underlying clinical dimensions were measured using the Hamilton Depression Rating Scale (HDRS) at baseline and after the tDCS treatment. Age, gender and diagnosis (bipolar/unipolar depression) were also investigated as predictors of response. Linear mixed models were fitted in order to ascertain which HDRS factors were associated with response to tDCS. Age, gender and diagnosis did not show any association with response to treatment. The reduction in HDRS scores after tDCS was strongly associated with the baseline values of "Cognitive Disturbances" and "Retardation" factors, whilst the "Anxiety/Somatization" factor showed a mild association with the response. Open-label design, the lack of control group, and minor differences in stimulation protocols. No differences in response to tDCS were found between unipolar and bipolar patients, suggesting that tDCS is effective for both conditions. "Cognitive disturbance", "Retardation", and "Anxiety/Somatization", were identified as potential clinical predictors of response to tDCS. These findings point to the pre-selection of the potential responders to tDCS, therefore optimizing the clinical use of this technique and the overall cost-effectiveness of the psychiatric intervention for depressed patients. Copyright © 2017 Elsevier B.V. All rights reserved.

BIOBANKS ARE AN ESSENTIAL TOOL FOR TRANSPLANTATION. HISTORY, CURRENT STATE, PERSPECTIVES

Directory of Open Access Journals (Sweden)

O. N. Reznik

2016-01-01

Full Text Available Organ shortage remains to be a crucial issue in transplantation. However, it’s not the only challenge that modern transplantation is facing. There are critical issues to be solved, such as, choosing optimal patient-specific immunosuppressive regimen, preventing or coping effectively with graft rejection and improving graft and patient survival rates. There are still a number of ongoing studies on ischemia-reperfusion injury mechanisms. It is also unknown what the true limitations of organ viability are and what mechanisms actually regulate it. The upcoming era of personalized medicine dictates the necessity for individualized approach to these issues. The creation of transplant biobanks followed by different studies on their base may be the key option to resolve problems of modern transplantation. Biobanks are an essential basis of personalized medicine, which allows largescale population studies, discovery of new biomarkers and therapy targets as well as new drugs development. The importance of this relatively new fi eld has increased over last decades making its way from small collections of samples to large national and international biorepositories. There are biobanks of different types and purposes. In this article a systematic review is given covering historical reference, term definition, and classifi cation variants. Furthermore, the current state of the industry is highlighted along with current issues and perspectives with respect to transplantation.