WorldWideScience

Sample records for depression breakthrough collaborative

  1. Breakthrough seizures after starting vilazodone for depression.

    Science.gov (United States)

    McKean, James; Watts, Hannah; Mokszycki, Robert

    2015-03-01

    Vilazodone is a new selective serotonin reuptake inhibitor (SSRI) and serotonin 5-HT1a partial agonist that is approved by the United States Food and Drug Administration to treat major depression. SSRI-induced seizures are rare and are more likely to be associated with larger doses and severe symptoms such as those present in serotonin syndrome. Several case reports have implicated SSRIs, buspirone, or the combination of these agents as the cause of seizures, but these reports were confounded with either coingestions or doses that exceeded FDA recommendations. We describe a 22-year-old woman with a history of seizure disorder who had been seizure free for the previous 8 years and experienced two breakthrough seizures shortly after starting vilazodone. Her dose of vilazodone had recently been titrated to 40 mg/day when she experienced the first seizure. She was instructed to taper vilazodone over the next several days, then discontinue the drug, and then follow up with her neurologist. Based on the patient's history, physical examination, and recent dose increase, it was plausible that vilazodone was the cause of the seizures. Use of the Naranjo adverse drug reaction probability scale indicated a possible relationship (score of 4) between her development of seizures and vilazodone therapy. The pharmacodynamics of this particular class of SSRI has both proconvulsive and anticonvulsive mechanisms. This is of particular concern in patients with a history of seizure disorder who are starting antidepressive therapy. In persons with epilepsy who are taking vilazodone and experience breakthrough seizures, practitioners should consider this drug as a potential cause of these seizures. Thus, until future research and experience with vilazodone can provide a definitive answer, clinicians should be cautious when prescribing this medication to treat depression in patients with a history of seizure disorder. © 2015 Pharmacotherapy Publications, Inc.

  2. Hand Hygiene Improvement and Sustainability: Assessing a Breakthrough Collaborative in Western Switzerland.

    Science.gov (United States)

    Staines, Anthony; Amherdt, Isabelle; Lécureux, Estelle; Petignat, Christiane; Eggimann, Philippe; Schwab, Marcos; Pittet, Didier

    2017-12-01

    OBJECTIVE To assess hand hygiene improvement and sustainability associated with a Breakthrough Collaborative. DESIGN Multicenter analysis of hand hygiene compliance through direct observation by trained observers. SETTING A total of 5 publicly funded hospitals in 14 locations, with a total of 1,152 beds, in the County of Vaud, Switzerland. PARTICIPANTS Clinical staff. INTERVENTIONS In total, 59,272 opportunities for hand hygiene were monitored for the duration of the study, for an average of 5,921 per audit (range, 5,449-6,852). An 18-month Hand Hygiene Breakthrough Collaborative was conducted to implement the WHO multimodal promotional strategy including improved access to alcohol-based hand rub, education, performance measurement and feedback, reminders and communication, leadership engagement, and safety culture. RESULTS Overall hand hygiene compliance improved from 61.9% to 88.3% (Pstrategy for content and measurement was associated with significant and substantial improvement in compliance across all professions, all hand hygiene indications, and all participating hospitals. Infect Control Hosp Epidemiol 2017;38:1420-1427.

  3. Treatment of Premenstrual Breakthrough of Depression With Adjunctive Oral Contraceptive Pills Compared With Placebo.

    Science.gov (United States)

    Peters, Whitney; Freeman, Marlene P; Kim, Semmie; Cohen, Lee S; Joffe, Hadine

    2017-10-01

    Two-thirds of women with depressive disorders report reemergence of depression premenstrually, or premenstrual exacerbation (PME), despite effective treatment of the underlying mood disorder during the remainder of the cycle. There is a paucity of studies that rigorously assess treatments targeting PME. Open-label data suggest that augmentation of antidepressants with the oral contraceptive pill (OCP) drospirenone and ethinyl estradiol (DRSP/EE) improves depressive symptoms that break through treatment premenstrually. We now report results of a randomized placebo-controlled OCP augmentation trial. Women with unipolar depressive disorders in remission on stable antidepressant doses with a 30% increase in Montgomery-Åsberg Depression Rating Scale (MADRS) scores from the follicular to luteal phase were randomized to double-blind augmentation of antidepressant with either DRSP/EE or placebo for 2 months. The MADRS and Daily Record of Severity of Problems (DRSP) measures were anchored to the menstrual cycle phase. Of 32 women randomized, 25 (n = 12 DRSP/EE, n = 13 placebo) completed the trial. Premenstrual MADRS scores declined by a median of 43.6% and 38.9% (P = 0.59), and premenstrual DRSP scores declined by a median of 23.5% and 20.9% (P = 0.62) in the DRSP/EE and placebo groups, respectively. There was a trend toward greater improvement in premenstrual DRSP scores for women with fewer lifetime depressive episodes (r = -0.40, P = 0.06). Findings from this small randomized trial suggest that OCP augmentation of antidepressants may not be effective for treating premenstrual breakthrough of depression. Future studies should target women established to have hormonal sensitivity prior to antidepressant therapy and those with fewer lifetime depressive episodes.

  4. Collaborative care for depression in general practice

    DEFF Research Database (Denmark)

    Brinck-Claussen, Ursula Ødum; Curth, Nadja Kehler; Davidsen, Annette Sofie

    2017-01-01

    Background: Depression is a common illness with great human costs and a significant burden on the public economy. Previous studies have indicated that collaborative care (CC) has a positive effect on symptoms when provided to people with depression, but CC has not yet been applied in a Danish...... in the Capital Region of Denmark. The primary outcome is depression symptoms (Beck’s Depression Inventory (BDI-II)) after 6 months. Secondary outcomes include depression symptoms (BDI-II) after 15 months, anxiety symptoms (Beck’s Anxiety Inventory (BAI)), level of functioning (Global Assessment of Function (GAF...

  5. Integrated care for patients with a stroke in the Netherlands: results and experiences from a national Breakthrough Collaborative Improvement project

    Directory of Open Access Journals (Sweden)

    M.M.N. Minkman

    2005-03-01

    Full Text Available Purpose: This article considers the question if measurable improvements are achieved in the quality of care in stroke services by using a Breakthrough collaborative quality improvement model. Context of case: Despite the availability of explicit criteria, evidence based guidelines, national protocols and examples of best practices; stroke care in the Netherlands did not improve substantially yet. For that reason a national collaborative started in 2002 to improve integrated stroke care in 23 self selected stroke services. Data sources: Characteristics of sites, teams, aims and changes were assessed by using a questionnaire and monthly self-reports of teams. Progress in achieving significant quality improvement has been assessed on a five point Likert scale (IHI score. Case description: The stroke services (n=23 formed multidisciplinary teams, which worked together in a collaborative based on the IHI Breakthrough Series Model. Teams received instruction in quality improvement, reviewed self reported performance data, identified bottlenecks and improvement goals, and implemented “potentially better practices” based on criteria from the Edisse study, evidence based guidelines, own ideas and expert opinion. Conclusion and discussion: Quality of care has been improved in most participating stroke services. Eighty-seven percent of the teams have improved their care significantly on at least one topic. About 34% of the teams have achieved significant improvement on all aims within the time frame of the project. The project has contributed to the further development and spread of integrated stroke care in the Netherlands.

  6. Using a virtual breakthrough series collaborative to reduce postoperative respiratory failure in 16 Veterans Health Administration hospitals.

    Science.gov (United States)

    Zubkoff, Lisa; Neily, Julia; Mills, Peter D; Borzecki, Ann; Shin, Marlena; Lynn, Marilyn M; Gunnar, William; Rosen, Amy

    2014-01-01

    The Institute for Healthcare Improvement (IHI) Virtual Breakthrough Series (VBTS) process was used in an eight-month (June 2011-January 2012) quality improvement (QI) project to improve care related to reducing postoperative respiratory failure. The VBTS collaborative drew on Patient Safety Indicator 11: Postoperative Respiratory Failure Rate to guide changes in care at the bedside. Sixteen Veterans Health Administration hospitals, each representing a regional Veterans Integrated Service Network, participated in the QI project. During the prework phase (initial two months), hospitals formed multidisciplinary teams, selected measures related to their goals, and collected baseline data. The six-month action phase included group conference calls in which the faculty presented clinical background on the topic, discussed evidence-based processes of care, and/or presented content regarding reducing postoperative respiratory failure. During a final, six-month continuous improvement and spread phase, teams were to continue implementing changes as part of their usual processes. The six most commonly reported interventions to reduce postoperative respiratory failure focused on improving incentive spirometer use, documenting implementation of targeted interventions, oral care, standardized orders, early ambulation, and provider education. A few teams reported reduced ICU readmissions for respiratory failure. The VBTS collaborative helped teams implement process changes to help reduce postoperative respiratory complications. Teams reported initial success at implementing site-specific improvements using real-time data. The VBTS model shows promise for knowledge sharing and efficient multifacility improvement efforts, although long-term sustainability and testing in these and other settings need to be examined.

  7. The Breakthrough Series Collaborative on Service Integration: A Mixed Methods Study of a Strengths-Based Initiative

    Directory of Open Access Journals (Sweden)

    Cynthia A. Lietz

    2010-11-01

    Full Text Available Arizona’s Department of Economic Security (DES engaged in a strengths-based initiative to increase quality and integration of human services. Twenty teams including employees from state agencies, community leaders, and families were brought together to discuss and implement improvements to a variety of social services. A mixed methods study was conducted to explore the complex process of forming diverse teams to strengthen social services. Specifically, the research team conducted focus groups to collect qualitative data from a purposive sample of the teams to explore their experiences in greater depth. Analysis of the data led to the development of an online survey instrument that allowed all collaborative members an opportunity to participate in the study. Findings suggest that while the teams faced many challenges, a commitment to the process brought perseverance, communication, and creativity allowing this collaborative to initiate 105 activities to bring about positive changes in social services within their communities.

  8. Collaborative Care for Depressed Patients With Chronic Medical Conditions: A Randomized Trial in Puerto Rico

    Science.gov (United States)

    Vera, Mildred; Perez-Pedrogo, Coralee; Huertas, Sarah Enid; Reyes-Rabanillo, Maria Leticia; Juarbe, Deborah; Huertas, Aracelis; Reyes-Rodriguez, Mae Lynn; Chaplin, William

    2010-01-01

    Objective This study examined whether a collaborative care model for depression would improve clinical and functional outcomes for depressed patients with chronic general medical conditions in primary care practices in Puerto Rico. Methods A total of 179 primary care patients with major depression and chronic general medical conditions were randomly assigned to receive collaborative care or usual care. The collaborative care intervention involved enhanced collaboration among physicians, mental health specialists, and care managers paired with depression-specific treatment guidelines, patient education, and follow-up. In usual care, study personnel informed the patient and provider of the diagnosis and encouraged patients to discuss treatment options with their provider. Depression severity was assessed with the Hopkins Symptom Checklist; social functioning was assessed with the 36-item Short Form. Results Compared with usual care, collaborative care significantly reduced depressive symptoms and improved social functioning in the six months after randomization. Integration of collaborative care in primary care practices considerably increased depressed patients' use of mental health services. Conclusions Collaborative care significantly improved clinical symptoms and functional status of depressed patients with coexisting chronic general medical conditions receiving treatment for depression in primary care practices in Puerto Rico. These findings highlight the promise of the collaborative care model for strengthening the relationship between mental health and primary care services in Puerto Rico. PMID:20123819

  9. Breakthrough Drugs and Turtle Soup

    OpenAIRE

    Chabner, Bruce A.

    2015-01-01

    The U.S. Food and Drug Administration (FDA) category of Breakthrough Therapy drugs was established in 2012, fostered by collaboration between legislators, researchers, industry representatives, and cancer research advocates. This category allows the FDA to designate certain lifesaving drugs for expedited review, and it has been successful in speeding the approval of several new drugs.

  10. Randomized, proof-of-concept trial of low dose naltrexone for patients with breakthrough symptoms of major depressive disorder on antidepressants.

    Science.gov (United States)

    Mischoulon, David; Hylek, Lindsay; Yeung, Albert S; Clain, Alisabet J; Baer, Lee; Cusin, Cristina; Ionescu, Dawn Flosnik; Alpert, Jonathan E; Soskin, David P; Fava, Maurizio

    2017-01-15

    Given the proposed dopaminergic mechanism of low-dose naltrexone (LDN), we examined its efficacy as augmentation for depressive breakthrough on pro-dopaminergic antidepressant regimens. 12 adults (67% female, mean age = 45±12) with recurrent DSM-IV major depressive disorder (MDD) on dopaminergic antidepressant regimens (stimulants, dopamine agonists, bupropion [≥300mg/day], aripiprazole [≤2.5mg/day], or sertraline [≥150mg/day]) were randomized to naltrexone 1mg b.i.d. (n=6) or placebo (n=6) augmentation for 3 weeks. All subjects completed the trial. Hamilton Depression Rating Scale (HAM-D-17) scores (primary outcome measure) decreased from 21.2±2.0 to 11.7±7.7 for LDN, from 23.7±2.3 to 17.8±5.9 for placebo (Cohen's d=0.62; p=0.3 between treatment groups). HAM-D-28 scores decreased from 26.2±4.0 to 12.0±9.8 for LDN, from 26.3±2.6 to 19.8±6.6 for placebo (d=1.15; p=0.097). Montgomery-Asberg Depression Rating Scale (MADRS-10 item) scores decreased from 30.4±4.9 to 12.2±8.4 for LDN, from 30.7±4.3 to 22.8±8.5) for placebo (d=1.45; p=0.035). MADRS-15 item scores decreased from 36.6±6.2 to 13.2±8.8 for LDN, from 36.7±4.2 to 26.0±10.0 for placebo (d=1.49; p=0.035). Clinical Global Improvement Scale-Severity (CGI-S) scores decreased from 4.3±0.5 to 3.0±1.1 for LDN, from 4.3±0.5 to 4.0±0.6 for placebo (d=1.22; p=0.064). Small study; restrictions on allowed antidepressants. LDN augmentation showed some benefit for MDD relapse on dopaminergic agents. Confirmation in larger studies is needed. Copyright © 2016 Elsevier B.V. All rights reserved.

  11. The Depression Inventory Development Workgroup: A Collaborative, Empirically Driven Initiative to Develop a New Assessment Tool for Major Depressive Disorder.

    Science.gov (United States)

    Vaccarino, Anthony L; Evans, Kenneth R; Kalali, Amir H; Kennedy, Sidney H; Engelhardt, Nina; Frey, Benicio N; Greist, John H; Kobak, Kenneth A; Lam, Raymond W; MacQueen, Glenda; Milev, Roumen; Placenza, Franca M; Ravindran, Arun V; Sheehan, David V; Sills, Terrence; Williams, Janet B W

    2016-01-01

    The Depression Inventory Development project is an initiative of the International Society for CNS Drug Development whose goal is to develop a comprehensive and psychometrically sound measurement tool to be utilized as a primary endpoint in clinical trials for major depressive disorder. Using an iterative process between field testing and psychometric analysis and drawing upon expertise of international researchers in depression, the Depression Inventory Development team has established an empirically driven and collaborative protocol for the creation of items to assess symptoms in major depressive disorder. Depression-relevant symptom clusters were identified based on expert clinical and patient input. In addition, as an aid for symptom identification and item construction, the psychometric properties of existing clinical scales (assessing depression and related indications) were evaluated using blinded datasets from pharmaceutical antidepressant drug trials. A series of field tests in patients with major depressive disorder provided the team with data to inform the iterative process of scale development. We report here an overview of the Depression Inventory Development initiative, including results of the third iteration of items assessing symptoms related to anhedonia, cognition, fatigue, general malaise, motivation, anxiety, negative thinking, pain and appetite. The strategies adopted from the Depression Inventory Development program, as an empirically driven and collaborative process for scale development, have provided the foundation to develop and validate measurement tools in other therapeutic areas as well.

  12. The Depression Initiative. Description of a collaborative care model for depression and of the factors influencing its implementation in the primary care setting in the Netherlands

    NARCIS (Netherlands)

    Jong, de F.J.; Steenbergen-Weijenburg, van K.M.; Huijbregts, K.M.L.; Vlasveld, M.C.; Marwijk, van H.W.J.; Beekman, A.T.F.; Feltz - Cornelis, van der C.M.

    2009-01-01

    BACKGROUND: In the Depression Initiative, a promising collaborative care model for depression that was developed in the US was adapted for implementation in the Netherlands. AIM: Description of a collaborative care model for major depressive disorder (MDD) and of the factors influencing its

  13. A High School Depression and Suicide Prevention Program: A Collaboration between Health Education and Psychological Services.

    Science.gov (United States)

    Moilanen, Donna L.; Bradbury, Susan

    2002-01-01

    Examined a collaboration between health education and psychological services in generating a high school depression and suicide prevention program. The five-component program raised awareness of teen depression and suicide, increased communication about these issues within the school and community, and provided information about available…

  14. Developing an evaluation framework for consumer-centred collaborative care of depression using input from stakeholders.

    Science.gov (United States)

    McCusker, Jane; Yaffe, Mark; Sussman, Tamara; Kates, Nick; Mulvale, Gillian; Jayabarathan, Ajantha; Law, Susan; Haggerty, Jeannie

    2013-03-01

    To develop a framework for research and evaluation of collaborative mental health care for depression, which includes attributes or domains of care that are important to consumers. A literature review on collaborative mental health care for depression was completed and used to guide discussion at an interactive workshop with pan-Canadian participants comprising people treated for depression with collaborative mental health care, as well as their family members; primary care and mental health practitioners; decision makers; and researchers. Thematic analysis of qualitative data from the workshop identified key attributes of collaborative care that are important to consumers and family members, as well as factors that may contribute to improved consumer experiences. The workshop identified an overarching theme of partnership between consumers and practitioners involved in collaborative care. Eight attributes of collaborative care were considered to be essential or very important to consumers and family members: respectfulness; involvement of consumers in treatment decisions; accessibility; provision of information; coordination; whole-person care; responsiveness to changing needs; and comprehensiveness. Three inter-related groups of factors may affect the consumer experience of collaborative care, namely, organizational aspects of care; consumer characteristics and personal resources; and community resources. A preliminary evaluation framework was developed and is presented here to guide further evaluation and research on consumer-centred collaborative mental health care for depression.

  15. Breakthrough cancer pain – still a challenge

    Science.gov (United States)

    Margarit, Cesar; Juliá, Joaquim; López, Rafael; Anton, Antonio; Escobar, Yolanda; Casas, Ana; Cruz, Juan Jesús; Galvez, Rafael; Mañas, Ana; Zaragozá, Francisco

    2012-01-01

    Breakthrough cancer pain is defined as transient pain exacerbation in patients with stable and controlled basal pain. Although variable, the prevalence of breakthrough cancer pain is high (33%–95%). According to the American Pain Foundation, breakthrough pain is observed in 50%–90% of all hospitalized cancer patients, in 89% of all patients admitted to homes for the elderly and terminal-patient care centers, and in 35% of all ambulatory care cancer patients. The management of breakthrough cancer pain should involve an interdisciplinary and multimodal approach. The introduction of new fentanyl formulations has represented a great advance and has notably improved treatment. Among these, the pectin-based intranasal formulation adjusts very well to the profile of breakthrough pain attacks, is effective, has a good toxicity profile, and allows for convenient dosing – affording rapid and effective analgesia with the added advantage of being easily administered by caregivers when patients are unable to collaborate. PMID:23204865

  16. Clinical effectiveness of collaborative care for depression in UK primary care (CADET): cluster randomised controlled trial.

    Science.gov (United States)

    Richards, David A; Hill, Jacqueline J; Gask, Linda; Lovell, Karina; Chew-Graham, Carolyn; Bower, Peter; Cape, John; Pilling, Stephen; Araya, Ricardo; Kessler, David; Bland, J Martin; Green, Colin; Gilbody, Simon; Lewis, Glyn; Manning, Chris; Hughes-Morley, Adwoa; Barkham, Michael

    2013-08-19

    To compare the clinical effectiveness of collaborative care with usual care in the management of patients with moderate to severe depression. Cluster randomised controlled trial. 51 primary care practices in three primary care districts in the United Kingdom. 581 adults aged 18 years and older who met ICD-10 (international classification of diseases, 10th revision) criteria for a depressive episode on the revised Clinical Interview Schedule. We excluded acutely suicidal patients and those with psychosis, or with type I or type II bipolar disorder; patients whose low mood was associated with bereavement or whose primary presenting problem was alcohol or drug abuse; and patients receiving psychological treatment for their depression by specialist mental health services. We identified potentially eligible participants by searching computerised case records in general practices for patients with depression. Collaborative care, including depression education, drug management, behavioural activation, relapse prevention, and primary care liaison, was delivered by care managers. Collaborative care involved six to 12 contacts with participants over 14 weeks, supervised by mental health specialists. Usual care was family doctors' standard clinical practice. Depression symptoms (patient health questionnaire 9; PHQ-9), anxiety (generalised anxiety disorder 7; GAD-7), and quality of life (short form 36 questionnaire; SF-36) at four and 12 months; satisfaction with service quality (client satisfaction questionnaire; CSQ-8) at four months. 276 participants were allocated to collaborative care and 305 allocated to usual care. At four months, mean depression score was 11.1 (standard deviation 7.3) for the collaborative care group and 12.7 (6.8) for the usual care group. After adjustment for baseline depression, mean depression score was 1.33 PHQ-9 points lower (95% confidence interval 0.35 to 2.31, P=0.009) in participants receiving collaborative care than in those receiving usual

  17. Collaborative care for sick-listed workers with major depressive disorder: a randomised controlled trial from the Netherlands Depression Initiative aimed at return to work and depressive symptoms.

    Science.gov (United States)

    Vlasveld, Moniek C; van der Feltz-Cornelis, Christina M; Adèr, Herman J; Anema, Johannes R; Hoedeman, Rob; van Mechelen, Willem; Beekman, Aartjan T F

    2013-04-01

    Major depressive disorder (MDD) is associated with absenteeism. In this study, the effectiveness of collaborative care, with a focus on return to work (RTW), was evaluated in its effect on depressive symptoms and the duration until RTW in sick-listed workers with MDD in the occupational health setting. In this randomised controlled trial, 126 sick-listed workers with MDD were randomised to usual care (N=61) or collaborative care (N=65). Collaborative care was applied by the occupational physician care manager, supported by a web-based tracking system and a consultant psychiatrist. Primary outcome measure was time to response. Secondary outcome measures were time to remission, depressive symptoms as continuous measure and the duration until full RTW. Collaborative care participants had a shorter time to response, with a difference of 2.8 months. However, no difference was found on time to remission or depressive symptoms as continuous measure. With a mean of 190 days in the collaborative care group, and 210 days in the usual care group, the groups did not differ significantly from each other in the duration until full RTW. Adherence to the collaborative care intervention was low. These results do not justify a widespread implementation of collaborative care in occupational healthcare, as it was operationalised in this study. However, since the study might have been underpowered for RTW and because treatment integrity was low, further research, with larger sample sizes, is needed to develop the best fitting (collaborative care) model for addressing RTW in depressed sick-listed workers. : ISRCTN78462860.

  18. Effectiveness of Collaborative Care for Depression in Public-Sector Primary Care Clinics Serving Latinos.

    Science.gov (United States)

    Lagomasino, Isabel T; Dwight-Johnson, Megan; Green, Jennifer M; Tang, Lingqi; Zhang, Lily; Duan, Naihua; Miranda, Jeanne

    2017-04-01

    Quality improvement interventions for depression care have been shown to be effective for improving quality of care and depression outcomes in settings with primarily insured patients. The aim of this study was to determine the impact of a collaborative care intervention for depression that was tailored for low-income Latino patients seen in public-sector clinics. A total of 400 depressed patients from three public-sector primary care clinics were enrolled in a randomized controlled trial of a tailored collaborative care intervention versus enhanced usual care. Social workers without previous mental health experience served as depression care specialists for the intervention patients (N=196). Depending on patient preference, they delivered a cognitive-behavioral therapy (CBT) intervention or facilitated antidepressant medication given by primary care providers or both. In enhanced usual care, patients (N=204) received a pamphlet about depression, a letter for their primary care provider stating that they had a positive depression screen, and a list of local mental health resources. Intent-to-treat analyses examined clinical and process-of-care outcomes at 16 weeks. Compared with patients in the enhanced usual care group, patients in the intervention group had significantly improved depression, quality of life, and satisfaction outcomes (pclinics. Social workers without prior mental health experience can effectively provide CBT and manage depression care.

  19. Impact of Collaborative Care on Absenteeism for Depressed Employees Seen in Primary Care Practices: A Retrospective Cohort Study.

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    Adaji, Akuh; Newcomb, Richard D; Wang, Zhen; Williams, Mark

    2018-01-01

    The impact of "real world" collaborative care on depression and absenteeism for depressed employees seen in primary care practices using objective employer absence data. A retrospective cohort study comparing depressed employees seen in primary care practices who enrolled for a "real world" collaborative care program to practice as usual (PAU) on objective absence days and depression response and remission at 6, and 12-month time periods. Absence days were more in the collaborative care group compared with the PAU group at 3 and 6 months but at 12 months the difference was no longer statistically significant. Collaborative care led to better response and remission depression scores compared with PAU at 12 months. Collaborative care led to faster improvement in depression symptoms but did not translate to less time away from work.

  20. Moving beyond Depression: A Collaborative Approach to Treating Depressed Mothers in Home Visiting Programs

    Science.gov (United States)

    Ammerman, Robert T.; Putnam, Frank W.; Teeters, Angelique R.; Van Ginkel, Judith B.

    2014-01-01

    Research indicates that up to half of mothers in home visiting experience clinically significant levels of depression during their participation in services. Depression alters maternal life course, negatively impacts child development, and contributes to poorer home visiting outcomes. This article describes the Moving Beyond Depression (MBD)…

  1. Collaborative care for depression symptoms in an outpatient cardiology setting: A randomized clinical trial.

    Science.gov (United States)

    Carney, Robert M; Freedland, Kenneth E; Steinmeyer, Brian C; Rubin, Eugene H; Ewald, Gregory

    2016-09-15

    Depression is a risk factor for morbidity and mortality in patients with coronary heart disease. Finding effective methods for identifying and treating depression in these patients is a high priority. The purpose of this study was to determine whether collaborative care (CC) for patients who screen positive for depression during an outpatient cardiology visit results in greater improvement in depression symptoms and better medical outcomes than seen in patients who screen positive for depression but receive only usual care (UC). Two hundred-one patients seen in an outpatient cardiology clinic who screened positive for depression during an outpatient visit were randomized to receive either CC or UC. Recommendations for depression treatment and ongoing support and monitoring of depression symptoms were provided to CC patients and their primary care physicians (PCPs) for up to 6months. There were no differences between the arms in mean Beck Depression Inventory-II scores(CC, 15.9; UC, 17.4; p=.45) or in depression remission rates(CC, 32.5%; UC, 26.2%; p=0.34) after 6months, or in the number of hospitalizations after 12months (p=0.73). There were fewer deaths among the CC (1/100) than UC patients (8/101) (p=0.03). This trial did not show that CC produces better depression outcomes than UC. Screening led to a higher rate of depression treatment than was expected in the UC group, and delays in obtaining depression treatment from PCPs may have reduced treatment effectiveness for the CC patients. A different strategy for depression treatment following screening in outpatient cardiology services is needed. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  2. Breakthrough cancer pain

    DEFF Research Database (Denmark)

    Davies, Andrew; Buchanan, Alison; Zeppetella, Giovambattista

    2013-01-01

    Breakthrough pain is common in patients with cancer and is a significant cause of morbidity in this group of patients.......Breakthrough pain is common in patients with cancer and is a significant cause of morbidity in this group of patients....

  3. Comparative Studies of Collaborative Team Depression Care Adoption in Safety Net Clinics

    Science.gov (United States)

    Ell, Kathleen; Wu, Shinyi; Guterman, Jeffrey; Schulman, Sandra-Gross; Sklaroff, Laura; Lee, Pey-Jiuan

    2018-01-01

    Purpose: To evaluate three approaches adopting collaborative depression care model in Los Angeles County safety net clinics with predominantly Latino type 2 diabetes patients. Methods: Pre-post differences in treatment rates and symptom reductions were compared between baseline, 6-month, and 12-month follow-ups for each approach: (a) Multifaceted…

  4. Enablers and barriers to implementing collaborative care for anxiety and depression

    DEFF Research Database (Denmark)

    Overbeck, Gritt; Davidsen, Annette Sofie; Kousgaard, Marius Brostrøm

    2016-01-01

    collaborative care interventions: effective educational programs, especially for care managers; issues of reimbursement in relation to primary care providers; good systems for communication and monitoring; and promoting face-to-face interaction between care managers and physicians, preferably through co......BACKGROUND: Collaborative care is an increasingly popular approach for improving quality of care for people with mental health problems through an intensified and structured collaboration between primary care providers and health professionals with specialized psychiatric expertise. Trials have...... shown significant positive effects for patients suffering from depression, but since collaborative care is a complex intervention, it is important to understand the factors which affect its implementation. We present a qualitative systematic review of the enablers and barriers to implementing...

  5. The cost-effectiveness of PHQ screening and collaborative care for depression in New York City.

    Directory of Open Access Journals (Sweden)

    Boshen Jiao

    Full Text Available Depression is under-diagnosed and under-treated in most areas of the US. New York City is currently looking to close gaps in identifying and treating depression through the adoption of a screening and collaborative care model deployed throughout the city.We examine the cost-effectiveness of universal two-stage screening with the 2- and 9-item Patient Health Questionnaires (PHQ-2 and PHQ-9 in New York City followed by collaborative care for those who screen positive. We conducted microsimulations on hypothetical adult participants between ages 20 and 70.The incremental cost-effectiveness of the interventions over the average lifespan of a 20-year-old adult in NYC is approximately $1,726/QALY gained (95% plausible interval: cost-saving, $10,594/QALY gained.Two-stage screening coupled with collaborative care for depression in the clinical setting appears to be significantly less expensive than most clinical preventive interventions, such as HIV screening in high-risk patients. However, effectiveness is dependent on the city's ability to manage scale up of collaborative care models.

  6. Understanding temporal relationships between depression, falls, and physical activity in a cohort of post-hospitalized older adults - a breakthrough or a conundrum?

    Science.gov (United States)

    Lee, Den-Ching A; Lalor, Aislinn F; Russell, Grant; Stolwyk, Rene; Brown, Ted; McDermott, Fiona; Haines, Terry P

    2017-10-01

    Clinical depression affects approximately 15% of community-dwelling older adults, of which half of these cases present in later life. Falls and depressive symptoms are thought to co-exist, while physical activity may protect an older adult from developing depressive symptoms. This study investigates the temporal relationships between depressive symptoms, falls, and participation in physical activities amongst older adults recently discharged following extended hospitalization. A prospective cohort study in which 311 older adults surveyed prior to hospital discharge were assessed monthly post-discharge for six months. N = 218 completed the six-month follow-up. Participants were recruited from hospitals in Melbourne, Australia. The survey instrument used was designed based on Fiske's behavioral model depicting onset and maintenance of depression. The baseline survey collected data on self-reported falls, physical activity levels, and depressive symptoms. The monthly follow-up surveys repeated measurement of these outcomes. At any assessment point, falls were positively associated with depressive symptoms; depressive symptoms were negatively associated with physical activity levels; and, physical activity levels were negatively associated with falls. When compared with data in the subsequent assessment point, depressive symptoms were positively associated with falls reported over the next month (unadjusted OR: 1.20 (1.12, 1.28)), and physical activity levels were negatively associated with falls reported over the next month (unadjusted OR: 0.97 (0.96, 0.99) household and recreational), both indicating a temporal relationship. Falls, physical activity, and depressive symptoms were inter-associated, and depressive symptoms and low physical activity levels preceded falls. Clear strategies for management of these interconnected problems remain elusive.

  7. Developing a national dissemination plan for collaborative care for depression: QUERI Series

    Directory of Open Access Journals (Sweden)

    Rubenstein Lisa V

    2008-12-01

    Full Text Available Abstract Background Little is known about effective strategies for disseminating and implementing complex clinical innovations across large healthcare systems. This paper describes processes undertaken and tools developed by the U.S. Department of Veterans Affairs (VA Mental Health Quality Enhancement Research Initiative (MH-QUERI to guide its efforts to partner with clinical leaders to prepare for national dissemination and implementation of collaborative care for depression. Methods An evidence-based quality improvement (EBQI process was used to develop an initial set of goals to prepare the VA for national dissemination and implementation of collaborative care. The resulting product of the EBQI process is referred to herein as a "National Dissemination Plan" (NDP. EBQI participants included: a researchers with expertise on the collaborative care model for depression, clinical quality improvement, and implementation science, and b VA clinical and administrative leaders with experience and expertise on how to adapt research evidence to organizational needs, resources and capacity. Based on EBQI participant feedback, drafts of the NDP were revised and refined over multiple iterations before a final version was approved by MH-QUERI leadership. 'Action Teams' were created to address each goal. A formative evaluation framework and related tools were developed to document processes, monitor progress, and identify and act upon barriers and facilitators in addressing NDP goals. Results The National Dissemination Plan suggests that effectively disseminating collaborative care for depression in the VA will likely require attention to: Guidelines and Quality Indicators (4 goals, Training in Clinical Processes and Evidence-based Quality Improvement (6 goals, Marketing (7 goals, and Informatics Support (1 goal. Action Teams are using the NDP as a blueprint for developing infrastructure to support system-wide adoption and sustained implementation of

  8. [Primary care and mental health care collaboration in patients with depression: Evaluation of a pilot experience].

    Science.gov (United States)

    Calderón, Carlos; Balagué, Laura; Iruin, Álvaro; Retolaza, Ander; Belaunzaran, Jon; Basterrechea, Javier; Mosquera, Isabel

    2016-01-01

    To implement and assess a collaborative experience between Primary Care (PC) and Mental Health (MH) in order to improve the care of patients with depression. Pilot collaborative project from a participatory action research approach during 2013. Basque Country. Osakidetza (Basque Health Service). Bizkaia and Gipuzkoa. The study included 207 professionals from general practice, nursing, psychiatry, psychiatric nursing, psychology and social work of 9 health centres and 6 mental health centres of Osakidetza. Shared design and development of four axes of intervention: 1) Communication and knowledge between PC and MH professionals, 2) Improvement of diagnostic coding and referral of patients, 3) Training programmes with meetings and common Clinical Practice Guidelines, and 4) Evaluation. Intervention and control questionnaires to professionals of the centres on the knowledge and satisfaction in the PC-MH relationship, joint training activities, and assessment of the experience. Osakidetza registers of prevalences, referrals and treatments. Follow-up meetings. Improvement in the 4 axes of intervention in the participant centres compared with the controls. Identification of factors to be considered in the development and sustainability of PC-MH collaborative care. The pilot experience confirms that collaborative projects promoted by PC and MH can improve depression care and the satisfaction of professionals. They are complex projects that need simultaneous interventions adjusted to the particularities of the health services. Multidisciplinary and continuous participation and management and information system support are necessary for their implementation. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  9. The Depression Initiative. Description of a collaborative care model for depression and of the factors influencing its implementation in the primary care setting in the Netherlands

    Directory of Open Access Journals (Sweden)

    Fransina J. de Jong

    2009-06-01

    Full Text Available Background: In the Depression Initiative, a promising collaborative care model for depression that was developed in the US was adapted for implementation in the Netherlands. Aim: Description of a collaborative care model for major depressive disorder (MDD and of the factors influencing its implementation in the primary care setting in the Netherlands. Data sources: Data collected during the preparation phase of the CC:DIP trial of the Depression Initiative, literature, policy documents, information sheets from professional associations. Results: Factors facilitating the implementation of the collaborative care model are continuous supervision of the care managers by the consultant psychiatrist and the trainers, a supportive web-based tracking system and the new reimbursement system that allows for introduction of a mental health care-practice nurse (MHC-PN in the general practices and coverage of the treatment costs. Impeding factors might be the relatively high percentage of solo-primary care practices, the small percentage of professionals that are located in the same building, unfamiliarity with the concept of collaboration as required for collaborative care, the reimbursement system that demands regular negotiations between each health care provider and the insurance companies and the reluctance general practitioners might feel to expand their responsibility for their depressed patients. Conclusion: Implementation of the collaborative care model in the Netherlands requires extensive training and supervision on micro level, facilitation of reimbursement on meso- and macro level and structural effort to change the treatment culture for chronic mental disorders in the primary care setting.

  10. The Depression Initiative. Description of a collaborative care model for depression and of the factors influencing its implementation in the primary care setting in the Netherlands.

    Science.gov (United States)

    de Jong, Fransina J; van Steenbergen-Weijenburg, Kirsten M; Huijbregts, Klaas M L; Vlasveld, Moniek C; Van Marwijk, Harm W J; Beekman, Aartjan T F; van der Feltz-Cornelis, Christina M

    2009-06-15

    In the Depression Initiative, a promising collaborative care model for depression that was developed in the US was adapted for implementation in the Netherlands. Description of a collaborative care model for major depressive disorder (MDD) and of the factors influencing its implementation in the primary care setting in the Netherlands. Data collected during the preparation phase of the CC:DIP trial of the Depression Initiative, literature, policy documents, information sheets from professional associations. Factors facilitating the implementation of the collaborative care model are continuous supervision of the care managers by the consultant psychiatrist and the trainers, a supportive web-based tracking system and the new reimbursement system that allows for introduction of a mental health care-practice nurse (MHC-PN) in the general practices and coverage of the treatment costs. Impeding factors might be the relatively high percentage of solo-primary care practices, the small percentage of professionals that are located in the same building, unfamiliarity with the concept of collaboration as required for collaborative care, the reimbursement system that demands regular negotiations between each health care provider and the insurance companies and the reluctance general practitioners might feel to expand their responsibility for their depressed patients. Implementation of the collaborative care model in the Netherlands requires extensive training and supervision on micro level, facilitation of reimbursement on meso- and macro level and structural effort to change the treatment culture for chronic mental disorders in the primary care setting.

  11. An Academic-Marketing Collaborative to Promote Depression Care: A Tale of Two Cultures

    Science.gov (United States)

    Kravitz, Richard L.; Epstein, Ronald M.; Bell, Robert A.; Rochlen, Aaron B.; Duberstein, Paul; Riby, Caroline H.; Caccamo, Anthony F.; Slee, Christina K.; Cipri, Camille S.; Paterniti, Debora A.

    2011-01-01

    Objectives Commercial advertising and patient education have separate theoretical underpinnings, approaches, and practitioners. This paper aims to describe a collaboration between academic researchers and a marketing firm working to produce demographically targeted public service anouncements (PSAs) designed to enhance depression care-seeking in primary care. Methods An interdisciplinary group of academic researcherss contracted with a marketing firm in Rochester, NY to produce PSAs that would help patients with depressive symptoms engage more effectively with their primary care physicians (PCPs). The researchers brought perspectives derived from clinical experience and the social sciences and conducted empirical research using focus groups, conjoint analysis, and a population-based survey. Results were shared with the marketing firm, which produced four PSA variants targeted to gender and socioeconomic position. Results There was no simple, one-to-one relationship between research results and the form, content, or style of the PSAs. Instead, empirical findings served as a springboard for discussion and kept the creative process tethered to the experiences, attitudes, and opinions of actual patients. Reflecting research findings highlighting patients’ struggles to recognize, label, and disclose depressive symptoms, the marketing firm generated communication objectives that emphasized: a) educating the patient to consider and investigate the possibility of depression; b) creating the belief that the PCP is interested in discussing depression and capable of offering helpful treatment; and c) modelling different ways of communicating with physicians about depression. Before production, PSA prototypes were vetted with additional focus groups. The winning prototype, “Faces,” involved a multi-ethnic montage of formerly depressed persons talking about how depression affected them and how they improved with treatment, punctuated by a physician who provided clinical

  12. An academic-marketing collaborative to promote depression care: a tale of two cultures.

    Science.gov (United States)

    Kravitz, Richard L; Epstein, Ronald M; Bell, Robert A; Rochlen, Aaron B; Duberstein, Paul; Riby, Caroline H; Caccamo, Anthony F; Slee, Christina K; Cipri, Camille S; Paterniti, Debora A

    2013-03-01

    Commercial advertising and patient education have separate theoretical underpinnings, approaches, and practitioners. This paper aims to describe a collaboration between academic researchers and a marketing firm working to produce demographically targeted public service anouncements (PSAs) designed to enhance depression care-seeking in primary care. An interdisciplinary group of academic researchers contracted with a marketing firm in Rochester, NY to produce PSAs that would help patients with depressive symptoms engage more effectively with their primary care physicians (PCPs). The researchers brought perspectives derived from clinical experience and the social sciences and conducted empirical research using focus groups, conjoint analysis, and a population-based survey. Results were shared with the marketing firm, which produced four PSA variants targeted to gender and socioeconomic position. There was no simple, one-to-one relationship between research results and the form, content, or style of the PSAs. Instead, empirical findings served as a springboard for discussion and kept the creative process tethered to the experiences, attitudes, and opinions of actual patients. Reflecting research findings highlighting patients' struggles to recognize, label, and disclose depressive symptoms, the marketing firm generated communication objectives that emphasized: (a) educating the patient to consider and investigate the possibility of depression; (b) creating the belief that the PCP is interested in discussing depression and capable of offering helpful treatment; and (c) modelling different ways of communicating with physicians about depression. Before production, PSA prototypes were vetted with additional focus groups. The winning prototype, "Faces," involved a multi-ethnic montage of formerly depressed persons talking about how depression affected them and how they improved with treatment, punctuated by a physician who provided clinical information. A member of the

  13. Developing Standards for Breakthrough Therapy Designation in Oncology

    Science.gov (United States)

    Horning, Sandra J.; Haber, Daniel A.; Selig, Wendy K.D.; Ivy, S. Percy; Roberts, Samantha A.; Allen, Jeff D.; Sigal, Ellen V.; Sawyers, Charles L.

    2013-01-01

    In July 2012, Congress passed the Food and Drug Administration Safety and Innovation Act (FDASIA). The Advancing Breakthrough Therapies for Patients Act was incorporated into a Title of FDASIA to expedite clinical development of new, potential “breakthrough” drugs or treatments that show dramatic responses in early phase studies. Using this regulatory pathway, once a promising new drug candidate is designated as a “Breakthrough Therapy”, the FDA and sponsor would collaborate to determine the best path forward to abbreviate the traditional three-phase approach to drug development. The breakthrough legislation requires that an FDA Guidance be drafted that details specific requirements of the bill to aid FDA in implementing requirements of the Act. In this article, we have proposed criteria to define a product as a Breakthrough Therapy, and discussed critical components of the development process that would require flexibility in order to enable expedited development of a Breakthrough Therapy. PMID:23719260

  14. Parents' experiences of collaboration between welfare professionals regarding children with anxiety or depression - an explorative study

    Directory of Open Access Journals (Sweden)

    Catharina Widmark

    2013-10-01

    Full Text Available Introduction: Well-functioning collaboration between professionals in the welfare sector has a strong influence on the contact with parents of children and adolescents with mental illness, and it is a precondition for the availability of support for these parents. This paper reports how such parents experience collaboration between professionals in mental health care, social services, and schools.Methods: Data were collected by in-depth interviews with seven parents of children and adolescents diagnosed with anxiety and depression. The families were selected from the Child and Adolescent Mental Health (CAMH patient records kept by the Stockholm County Council (Sweden, and they all lived in a catchment area for CAMH outpatient services in Stockholm.Results and discussion: We conclude that when the encounter between parents and professionals is characterized by structure and trust, it is supportive and serves as a holding environment. Coordination and communication links are needed in the collaboration between the professionals, along with appropriately scheduled and well-performed network meetings to create structure in the parent-professional encounter. Indeed, establishment of trust in this interaction is promoted if individual professionals are available, provide the parents with adequate information, are skilled, and show empathy and commitment. 

  15. Breakthroughs in statistics

    CERN Document Server

    Johnson, Norman

    This is author-approved bcc: This is the third volume of a collection of seminal papers in the statistical sciences written during the past 110 years. These papers have each had an outstanding influence on the development of statistical theory and practice over the last century. Each paper is preceded by an introduction written by an authority in the field providing background information and assessing its influence. Volume III concerntrates on articles from the 1980's while including some earlier articles not included in Volume I and II. Samuel Kotz is Professor of Statistics in the College of Business and Management at the University of Maryland. Norman L. Johnson is Professor Emeritus of Statistics at the University of North Carolina. Also available: Breakthroughs in Statistics Volume I: Foundations and Basic Theory Samuel Kotz and Norman L. Johnson, Editors 1993. 631 pp. Softcover. ISBN 0-387-94037-5 Breakthroughs in Statistics Volume II: Methodology and Distribution Samuel Kotz and Norman L. Johnson, Edi...

  16. Reconsidering the definition of Major Depression based on Collaborative Psychiatric Epidemiology Surveys.

    Science.gov (United States)

    Rosenström, Tom; Jokela, Markus

    2017-01-01

    Diagnostic definitions for depressive disorders remain a debated topic, despite their central role in clinical practice and research. We use both recent evidence and nationally representative data to derive an empirically-based modification of DSM-IV/-5 Major Depressive Disorder (MDD). A modified MDD diagnosis was derived by analyzing data from Collaborative Psychiatric Epidemiology Surveys, a multistage probability sample of adults (n=20 013; age ≥ 18 years) in coterminous USA, Alaska and Hawaii. The old and the newly suggested MDD definitions were compared for their associated disability (WHO Disability Assessment Schedule and number of disability days in past month), suicide attempt, and other covariates. Our data-driven definition for major depression was "lack of interest to all or most things" plus four other symptoms from the set {weight gain, weight loss, insomnia, psychomotor retardation, fatigue, feelings of worthlessness, diminished ability to think/concentrate, suicidal ideation/attempt}. The new definition captured all the disability implied by MDD and excluded cases that showed no greater disability than the general population nor increased risk of suicide attempts. The lifetime prevalence of the new diagnosis was 14.7% (95% CI=14-15.4%) of the population, slightly less than for the old definition (16.4%; CI=15.4-17.3%). Only conservative modifications of MDD could be studied, because of restrictions in the symptom data. With only small adjusting, the new definition for major depression may be more clinically relevant than the old one, and could serve as a conservative replacement for the old definition. Copyright © 2016 Elsevier B.V. All rights reserved.

  17. Breakthrough cancer pain – still a challenge

    Directory of Open Access Journals (Sweden)

    Mañas A

    2012-11-01

    Full Text Available Cesar Margarit,1 Joaquim Juliá,2 Rafael López,3 Antonio Anton,4 Yolanda Escobar,5 Ana Casas,6 Juan Jesús Cruz,7 Rafael Galvez,8 Ana Mañas,9 Francisco Zaragozá101Pain Unit, Alicante University General Hospital, Alicante, Spain; 2Department of Integral Support-Palliative Care, Catalan Institute of Oncology (ICO, Germans Trias i Pujol University Hospital, Badalona, Spain; 3Department of Clinical Oncology, University Hospital Complex, Santiago de Compostela, Spain; 4Department of Clinical Oncology, Miguel Servet Hospital, Zaragoza, Spain; 5Department of Clinical Oncology, Gregorio Marañón Hospital, Madrid, Spain; 6Department of Oncology, Virgen Macarena Hospital, Seville, Spain; 7Department of Clinical Oncology, Salamanca Hospital, Salamanca, Spain; 8Pain and Palliative Care Unit, Virgen de las Nieves Hospital, Granada, Spain; 9Department of Oncology–Radiotherapy, La Paz Hospital, Madrid, Spain; 10Department of Pharmacology, University of Alcalá de Henares, SpainAbstract: Breakthrough cancer pain is defined as transient pain exacerbation in patients with stable and controlled basal pain. Although variable, the prevalence of breakthrough cancer pain is high (33%–95%. According to the American Pain Foundation, breakthrough pain is observed in 50%–90% of all hospitalized cancer patients, in 89% of all patients admitted to homes for the elderly and terminal-patient care centers, and in 35% of all ambulatory care cancer patients. The management of breakthrough cancer pain should involve an interdisciplinary and multimodal approach. The introduction of new fentanyl formulations has represented a great advance and has notably improved treatment. Among these, the pectin-based intranasal formulation adjusts very well to the profile of breakthrough pain attacks, is effective, has a good toxicity profile, and allows for convenient dosing – affording rapid and effective analgesia with the added advantage of being easily administered by

  18. A Remote Collaborative Care Program for Patients with Depression Living in Rural Areas: Open-Label Trial.

    Science.gov (United States)

    Rojas, Graciela; Guajardo, Viviana; Martínez, Pablo; Castro, Ariel; Fritsch, Rosemarie; Moessner, Markus; Bauer, Stephanie

    2018-04-30

    In the treatment of depression, primary care teams have an essential role, but they are most effective when inserted into a collaborative care model for disease management. In rural areas, the shortage of specialized mental health resources may hamper management of depressed patients. The aim was to test the feasibility, acceptability, and effectiveness of a remote collaborative care program for patients with depression living in rural areas. In a nonrandomized, open-label (blinded outcome assessor), two-arm clinical trial, physicians from 15 rural community hospitals recruited 250 patients aged 18 to 70 years with a major depressive episode (DSM-IV criteria). Patients were assigned to the remote collaborative care program (n=111) or to usual care (n=139). The remote collaborative care program used Web-based shared clinical records between rural primary care teams and a specialized/centralized mental health team, telephone monitoring of patients, and remote supervision by psychiatrists through the Web-based shared clinical records and/or telephone. Depressive symptoms, health-related quality of life, service use, and patient satisfaction were measured 3 and 6 months after baseline assessment. Six-month follow-up assessments were completed by 84.4% (221/250) of patients. The remote collaborative care program achieved higher user satisfaction (odds ratio [OR] 1.94, 95% CI 1.25-3.00) and better treatment adherence rates (OR 1.81, 95% CI 1.02-3.19) at 6 months compared to usual care. There were no statically significant differences in depressive symptoms between the remote collaborative care program and usual care. Significant differences between groups in favor of remote collaborative care program were observed at 3 months for mental health-related quality of life (beta 3.11, 95% CI 0.19-6.02). Higher rates of treatment adherence in the remote collaborative care program suggest that technology-assisted interventions may help rural primary care teams in the management

  19. Impact of collaborative care for depression on clinical, functional, and work outcomes: a practice-based evaluation.

    Science.gov (United States)

    Shippee, Nathan D; Shah, Nilay D; Angstman, Kurt B; DeJesus, Ramona S; Wilkinson, John M; Bruce, Steven M; Williams, Mark D

    2013-01-01

    The impact of collaborative care (CC) on depression and work productivity in routine, nonresearch primary care settings remains unclear due to limited evidence. This prospective study examined depression and work outcomes (eg, absenteeism, presenteeism) for 165 individuals in CC for depression versus 211 patients in practice as usual in a multisite primary care practice. CC predicted greater adjusted 6-month improvements in treatment response, remission, and absenteeism versus practice as usual. Response/remission increased productivity overall. CC increased clinical and work improvements in a nonresearch care setting. Insurers and employers should consider CC's work benefits in developing payment structures.

  20. Collaborative Interventions for Circulation and Depression (COINCIDE): study protocol for a cluster randomized controlled trial of collaborative care for depression in people with diabetes and/or coronary heart disease.

    Science.gov (United States)

    Coventry, Peter A; Lovell, Karina; Dickens, Chris; Bower, Peter; Chew-Graham, Carolyn; Cherrington, Andrea; Garrett, Charlotte; Gibbons, Chris J; Baguley, Clare; Roughley, Kate; Adeyemi, Isabel; Keyworth, Chris; Waheed, Waquas; Hann, Mark; Davies, Linda; Jeeva, Farheen; Roberts, Chris; Knowles, Sarah; Gask, Linda

    2012-08-20

    Depression is up to two to three times as common in people with long-term conditions. It negatively affects medical management of disease and self-care behaviors, and leads to poorer quality of life and high costs in primary care. Screening and treatment of depression is increasingly prioritized, but despite initiatives to improve access and quality of care, depression remains under-detected and under-treated, especially in people with long-term conditions. Collaborative care is known to positively affect the process and outcome of care for people with depression and long-term conditions, but its effectiveness outside the USA is still relatively unknown. Furthermore, collaborative care has yet to be tested in settings that resemble more naturalistic settings that include patient choice and the usual care providers. The aim of this study was to test the effectiveness of a collaborative-care intervention, for people with depression and diabetes/coronary heart disease in National Health Service (NHS) primary care, in which low-intensity psychological treatment services are delivered by the usual care provider - Increasing Access to Psychological Therapies (IAPT) services. The study also aimed to evaluate the cost-effectiveness of the intervention over 6 months, and to assess qualitatively the extent to which collaborative care was implemented in the intervention general practices. This is a cluster randomized controlled trial of 30 general practices allocated to either collaborative care or usual care. Fifteen patients per practice will be recruited after a screening exercise to detect patients with recognized depression (≥10 on the nine-symptom Patient Health Questionnaire; PHQ-9). Patients in the collaborative-care arm with recognized depression will be offered a choice of evidence-based low-intensity psychological treatments based on cognitive and behavioral approaches. Patients will be case managed by psychological well-being practitioners employed by IAPT in

  1. Collaborative Interventions for Circulation and Depression (COINCIDE: study protocol for a cluster randomized controlled trial of collaborative care for depression in people with diabetes and/or coronary heart disease

    Directory of Open Access Journals (Sweden)

    Coventry Peter A

    2012-08-01

    Full Text Available Abstract Background Depression is up to two to three times as common in people with long-term conditions. It negatively affects medical management of disease and self-care behaviors, and leads to poorer quality of life and high costs in primary care. Screening and treatment of depression is increasingly prioritized, but despite initiatives to improve access and quality of care, depression remains under-detected and under-treated, especially in people with long-term conditions. Collaborative care is known to positively affect the process and outcome of care for people with depression and long-term conditions, but its effectiveness outside the USA is still relatively unknown. Furthermore, collaborative care has yet to be tested in settings that resemble more naturalistic settings that include patient choice and the usual care providers. The aim of this study was to test the effectiveness of a collaborative-care intervention, for people with depression and diabetes/coronary heart disease in National Health Service (NHS primary care, in which low-intensity psychological treatment services are delivered by the usual care provider - Increasing Access to Psychological Therapies (IAPT services. The study also aimed to evaluate the cost-effectiveness of the intervention over 6 months, and to assess qualitatively the extent to which collaborative care was implemented in the intervention general practices. Methods This is a cluster randomized controlled trial of 30 general practices allocated to either collaborative care or usual care. Fifteen patients per practice will be recruited after a screening exercise to detect patients with recognized depression (≥10 on the nine-symptom Patient Health Questionnaire; PHQ-9. Patients in the collaborative-care arm with recognized depression will be offered a choice of evidence-based low-intensity psychological treatments based on cognitive and behavioral approaches. Patients will be case managed by psychological

  2. A social marketing approach to implementing evidence-based practice in VHA QUERI: the TIDES depression collaborative care model

    Science.gov (United States)

    2009-01-01

    Abstract Collaborative care models for depression in primary care are effective and cost-effective, but difficult to spread to new sites. Translating Initiatives for Depression into Effective Solutions (TIDES) is an initiative to promote evidence-based collaborative care in the U.S. Veterans Health Administration (VHA). Social marketing applies marketing techniques to promote positive behavior change. Described in this paper, TIDES used a social marketing approach to foster national spread of collaborative care models. TIDES social marketing approach The approach relied on a sequential model of behavior change and explicit attention to audience segmentation. Segments included VHA national leadership, Veterans Integrated Service Network (VISN) regional leadership, facility managers, frontline providers, and veterans. TIDES communications, materials and messages targeted each segment, guided by an overall marketing plan. Results Depression collaborative care based on the TIDES model was adopted by VHA as part of the new Primary Care Mental Health Initiative and associated policies. It is currently in use in more than 50 primary care practices across the United States, and continues to spread, suggesting success for its social marketing-based dissemination strategy. Discussion and conclusion Development, execution and evaluation of the TIDES marketing effort shows that social marketing is a promising approach for promoting implementation of evidence-based interventions in integrated healthcare systems. PMID:19785754

  3. A social marketing approach to implementing evidence-based practice in VHA QUERI: the TIDES depression collaborative care model.

    Science.gov (United States)

    Luck, Jeff; Hagigi, Fred; Parker, Louise E; Yano, Elizabeth M; Rubenstein, Lisa V; Kirchner, JoAnn E

    2009-09-28

    Collaborative care models for depression in primary care are effective and cost-effective, but difficult to spread to new sites. Translating Initiatives for Depression into Effective Solutions (TIDES) is an initiative to promote evidence-based collaborative care in the U.S. Veterans Health Administration (VHA). Social marketing applies marketing techniques to promote positive behavior change. Described in this paper, TIDES used a social marketing approach to foster national spread of collaborative care models. The approach relied on a sequential model of behavior change and explicit attention to audience segmentation. Segments included VHA national leadership, Veterans Integrated Service Network (VISN) regional leadership, facility managers, frontline providers, and veterans. TIDES communications, materials and messages targeted each segment, guided by an overall marketing plan. Depression collaborative care based on the TIDES model was adopted by VHA as part of the new Primary Care Mental Health Initiative and associated policies. It is currently in use in more than 50 primary care practices across the United States, and continues to spread, suggesting success for its social marketing-based dissemination strategy. Development, execution and evaluation of the TIDES marketing effort shows that social marketing is a promising approach for promoting implementation of evidence-based interventions in integrated healthcare systems.

  4. Cost-effectiveness of collaborative care for the treatment of depressive disorders in primary care: a systematic review.

    Science.gov (United States)

    Grochtdreis, Thomas; Brettschneider, Christian; Wegener, Annemarie; Watzke, Birgit; Riedel-Heller, Steffi; Härter, Martin; König, Hans-Helmut

    2015-01-01

    For the treatment of depressive disorders, the framework of collaborative care has been recommended, which showed improved outcomes in the primary care sector. Yet, an earlier literature review did not find sufficient evidence to draw robust conclusions on the cost-effectiveness of collaborative care. To systematically review studies on the cost-effectiveness of collaborative care, compared with usual care for the treatment of patients with depressive disorders in primary care. A systematic literature search in major databases was conducted. Risk of bias was assessed using the Cochrane Collaboration's tool. Methodological quality of the articles was assessed using the Consensus on Health Economic Criteria (CHEC) list. To ensure comparability across studies, cost data were inflated to the year 2012 using country-specific gross domestic product inflation rates, and were adjusted to international dollars using purchasing power parities (PPP). In total, 19 cost-effectiveness analyses were reviewed. The included studies had sample sizes between n = 65 to n = 1,801, and time horizons between six to 24 months. Between 42% and 89% of the CHEC quality criteria were fulfilled, and in only one study no risk of bias was identified. A societal perspective was used by five studies. Incremental costs per depression-free day ranged from dominance to US$PPP 64.89, and incremental costs per QALY from dominance to US$PPP 874,562. Despite our review improved the comparability of study results, cost-effectiveness of collaborative care compared with usual care for the treatment of patients with depressive disorders in primary care is ambiguous depending on willingness to pay. A still considerable uncertainty, due to inconsistent methodological quality and results among included studies, suggests further cost-effectiveness analyses using QALYs as effect measures and a time horizon of at least 1 year.

  5. Cost-effectiveness of collaborative care for the treatment of depressive disorders in primary care: a systematic review.

    Directory of Open Access Journals (Sweden)

    Thomas Grochtdreis

    Full Text Available For the treatment of depressive disorders, the framework of collaborative care has been recommended, which showed improved outcomes in the primary care sector. Yet, an earlier literature review did not find sufficient evidence to draw robust conclusions on the cost-effectiveness of collaborative care.To systematically review studies on the cost-effectiveness of collaborative care, compared with usual care for the treatment of patients with depressive disorders in primary care.A systematic literature search in major databases was conducted. Risk of bias was assessed using the Cochrane Collaboration's tool. Methodological quality of the articles was assessed using the Consensus on Health Economic Criteria (CHEC list. To ensure comparability across studies, cost data were inflated to the year 2012 using country-specific gross domestic product inflation rates, and were adjusted to international dollars using purchasing power parities (PPP.In total, 19 cost-effectiveness analyses were reviewed. The included studies had sample sizes between n = 65 to n = 1,801, and time horizons between six to 24 months. Between 42% and 89% of the CHEC quality criteria were fulfilled, and in only one study no risk of bias was identified. A societal perspective was used by five studies. Incremental costs per depression-free day ranged from dominance to US$PPP 64.89, and incremental costs per QALY from dominance to US$PPP 874,562.Despite our review improved the comparability of study results, cost-effectiveness of collaborative care compared with usual care for the treatment of patients with depressive disorders in primary care is ambiguous depending on willingness to pay. A still considerable uncertainty, due to inconsistent methodological quality and results among included studies, suggests further cost-effectiveness analyses using QALYs as effect measures and a time horizon of at least 1 year.

  6. Breakthrough Propulsion Physics Research Program

    Science.gov (United States)

    Millis, Marc G.

    1996-01-01

    In 1996, a team of government, university and industry researchers proposed a program to seek the ultimate breakthroughs in space transportation: propulsion that requires no propellant mass, propulsion that can approach and, if possible, circumvent light speed, and breakthrough methods of energy production to power such devices. This Breakthrough Propulsion Physics program, managed by Lewis Research Center, is one part of a comprehensive, long range Advanced Space Transportation Plan managed by Marshall Space Flight Center. Because the breakthrough goals are beyond existing science, a main emphasis of this program is to establish metrics and ground rules to produce near-term credible progress toward these incredible possibilities. An introduction to the emerging scientific possibilities from which such solutions can be sought is also presented.

  7. NASA Breakthrough Propulsion Physics Program

    Science.gov (United States)

    Millis, Marc G.

    1998-01-01

    In 1996, NASA established the Breakthrough Propulsion Physics program to seek the ultimate breakthroughs in space transportation: propulsion that requires no propellant mass, propulsion that attains the maximum transit speeds physically possible, and breakthrough methods of energy production to power such devices. Topics of interest include experiments and theories regarding the coupling of gravity and electromagnetism, vacuum fluctuation energy, warp drives and worm-holes, and superluminal quantum effects. Because these propulsion goals are presumably far from fruition, a special emphasis is to identify affordable, near-term, and credible research that could make measurable progress toward these propulsion goals. The methods of the program and the results of the 1997 workshop are presented. This Breakthrough Propulsion Physics program, managed by Lewis Research Center, is one part of a comprehensive, long range Advanced Space Transportation Plan managed by Marshall Space Flight Center.

  8. Symptom specificity in the acute treatment of Major Depressive Disorder: a re-analysis of the treatment of depression collaborative research program.

    Science.gov (United States)

    Stewart, Jeremy G; Harkness, Kate L

    2012-03-01

    Antidepressant medications, Cognitive-Behavioral Therapy (CBT) and Interpersonal Psychotherapy (IPT) are equally efficacious in the acute treatment of Major Depressive Disorder (MDD). Nevertheless, remission rates remain unacceptably low. Examining the differential time course of remission of specific symptom clusters across treatments may provide a basis for assigning patients to treatments that have the highest chance of being effective. This study re-analyzed data from the NIMH Treatment of Depression Collaborative Research Project (TDCRP), which included 250 adult outpatients with MDD randomized to 16 weeks of CBT, IPT, imipramine+clinical management (IMI-CM), or pill placebo (PLA-CM). We derived four symptom factors from the 23-item Hamilton Depression Rating Scale, and three symptom factors from the Beck Depression Inventory. Within-subject hierarchical regression models were specified to examine the linear and quadratic patterns of symptom remission over five assessment points. IMI-CM produced a more rapid rate of remission than CBT or IPT for both the somatic/vegetative and cognitive-affective symptoms of MDD. There were no statistically significant differences in the rates of improvement of any of the symptom factors between the IMI-CM and PLA-CM groups. Some core symptoms of depression were excluded due to low factor loadings. Past research has argued that the CBT arm in the TDCRP may have been weak. We failed to find evidence that treatments act preferentially on specific symptom clusters. Therefore, the symptoms of MDD may be inter-dependent when it comes to their courses of remission in treatment. Copyright © 2011 Elsevier B.V. All rights reserved.

  9. RESPECT-Mil: feasibility of a systems-level collaborative care approach to depression and post-traumatic stress disorder in military primary care.

    Science.gov (United States)

    Engel, Charles C; Oxman, Thomas; Yamamoto, Christopher; Gould, Darin; Barry, Sheila; Stewart, Patrice; Kroenke, Kurt; Williams, John W; Dietrich, Allen J

    2008-10-01

    U.S. military ground forces report high rates of war-related traumatic stressors, posttraumatic stress disorder (PTSD), and depression following deployment in support of recent armed conflicts in Iraq and Afghanistan. Affected service members do not receive needed mental health services in most cases, and they frequently report stigma and significant structural barriers to mental health services. Improvements in primary care may help address these issues, and evidence supports the effectiveness of a systems-level collaborative care approach. To test the feasibility of systems-level collaborative care for PTSD and depression in military primary care. We named our collaborative care model "Re-Engineering Systems of Primary Care for PTSD and Depression in the Military" (RESPECT-Mil). Key elements of RESPECT-Mil care include universal primary care screening for PTSD and depression, brief standardized primary care diagnostic assessment for those who screen positive, and use of a nurse "care facilitator" to ensure continuity of care for those with unmet depression and PTSD treatment needs. The care facilitator assists primary care providers with follow-up, symptom monitoring, and treatment adjustment and enhances the primary care interface with specialty mental health services. We report assessments of feasibility of RESPECT-Mil implementation in a busy primary care clinic supporting Army units undergoing frequent Iraq, Afghanistan, and other deployments. Thirty primary care providers (family physicians, physician assistants, and nurse practitioners) were trained in the model and in the care of depression and PTSD. The clinic screened 4,159 primary care active duty patient visits: 404 screens (9.7%) were positive for depression, PTSD, or both. Sixty-nine patients participated in collaborative care for 6 weeks or longer, and the majority of these patients experienced clinically important improvement in PTSD and depression. Even although RESPECT-Mil participation was

  10. Cost-effectiveness of collaborative care for chronically ill patients with comorbid depressive disorder in the general hospital setting, a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Beekman Aartjan TF

    2007-02-01

    Full Text Available Abstract Background Depressive disorder is one of the most common disorders, and is highly prevalent in chronically ill patients. The presence of comorbid depression has a negative influence on quality of life, health care costs, self-care, morbidity, and mortality. Early diagnosis and well-organized treatment of depression has a positive influence on these aspects. Earlier research in the USA has reported good results with regard to the treatment of depression with a collaborative care approach and an antidepressant algorithm. In the UK 'Problem Solving Treatment' has proved to be feasible. However, in the general hospital setting this approach has not yet been evaluated. Methods/Design CC: DIM (Collaborative Care: Depression Initiative in the Medical setting is a two-armed randomised controlled trial with randomisation at patient level. The aim of the trial is to evaluate the treatment of depressive disorder in general hospitals in the Netherlands based on a collaborative care framework, including contracting, 'Problem Solving Treatment', antidepressant algorithm, and manual-guided self-help. 126 outpatients with diabetes mellitus, chronic obstructive pulmonary disease, or cardiovascular diseases will be randomised to either the intervention group or the control group. Patients will be included if they have been diagnosed with moderate to severe depression, based on the DSM-IV criteria in a two-step screening method. The intervention group will receive treatment based on the collaborative care approach; the control group will receive 'care as usual'. Baseline and follow-up measurements (after 3, 6, 9, and 12 months will be performed by means of questionnaires. The primary outcome measure is severity of depressive symptoms, as measured with the PHQ-9. The secondary outcome measure is the cost-effectiveness of these treatments according to the TiC-P, the EuroQol and the SF-36. Discussion Earlier research has indicated that depressive disorder is

  11. Depression

    DEFF Research Database (Denmark)

    Kessing, Lars Veddel; Bukh, Jens Otto Drachmann

    2014-01-01

    , that these diagnostic criteria represent an oversimplification, which has blurred the concept of depression. We suggest a greater emphasis on the depressed mood as the core symptom of depression, which may increase the specificity of the diagnosis. Furthermore, basic principles for the treatment of depression......The prevalence of depression is not clearly established, but estimated to 3-4% in a Danish questionnaire study. Lifetime's prevalences of 12-17% are reported in other community samples. In the current diagnostic system depression is defined categorically and operationally. It has been argued...

  12. Depression

    DEFF Research Database (Denmark)

    Kessing, Lars Veddel; Bukh, Jens Drachmann

    2014-01-01

    The prevalence of depression is not clearly established, but estimated to 3-4% in a Danish questionnaire study. Lifetime's prevalences of 12-17% are reported in other community samples. In the current diagnostic system depression is defined categorically and operationally. It has been argued......, that these diagnostic criteria represent an oversimplification, which has blurred the concept of depression. We suggest a greater emphasis on the depressed mood as the core symptom of depression, which may increase the specificity of the diagnosis. Furthermore, basic principles for the treatment of depression...

  13. Therapeutic collaboration and the assimilation of problematic experiences in emotion-focused therapy for depression: Comparison of two cases.

    Science.gov (United States)

    Ribeiro, Eugénia; Cunha, Carla; Teixeira, Ana Sofia; Stiles, William B; Pires, Nuno; Santos, Beatriz; Basto, Isabel; Salgado, João

    2016-11-01

    The Assimilation model argues that therapists should work responsively within the client's therapeutic zone of proximal development (TZPD). This study analyzed the association between the collaborative processes assessed by the Therapeutic Collaboration Coding System (TCCS) and advances in assimilation, as assessed by the Assimilation of Problematic Experiences Scale (APES). Sessions 1, 4, 8, 12, and 16 of two contrasting cases, Julia and Afonso (pseudonyms), drawn from a clinical trial of 16-sessions emotion-focused therapy (EFT) for depression, were coded according to the APES and the TCCS. Julia met criteria for reliable and clinically significant improvement, whereas Afonso did not. As expected, Julia advanced farther along the APES than did Afonso. Both therapists worked mainly within their client's TZPD. However, Julia's therapist used a balance of supporting and challenging interventions, whereas Afonso's therapist used mainly supporting interventions. Setbacks were common in both cases. This study supports the theoretical expectation that EFT therapists work mainly within their client's TZPD. Therapeutic exchanges involving challenging interventions may foster client change if they occur in an overall climate of safety.

  14. Clinical effectiveness and cost-effectiveness of collaborative care for depression in UK primary care (CADET): a cluster randomised controlled trial.

    Science.gov (United States)

    Richards, David A; Bower, Peter; Chew-Graham, Carolyn; Gask, Linda; Lovell, Karina; Cape, John; Pilling, Stephen; Araya, Ricardo; Kessler, David; Barkham, Michael; Bland, J Martin; Gilbody, Simon; Green, Colin; Lewis, Glyn; Manning, Chris; Kontopantelis, Evangelos; Hill, Jacqueline J; Hughes-Morley, Adwoa; Russell, Abigail

    2016-02-01

    Collaborative care is effective for depression management in the USA. There is little UK evidence on its clinical effectiveness and cost-effectiveness. To determine the clinical effectiveness and cost-effectiveness of collaborative care compared with usual care in the management of patients with moderate to severe depression. Cluster randomised controlled trial. UK primary care practices (n = 51) in three UK primary care districts. A total of 581 adults aged ≥ 18 years in general practice with a current International Classification of Diseases, Tenth Edition depressive episode, excluding acutely suicidal people, those with psychosis, bipolar disorder or low mood associated with bereavement, those whose primary presentation was substance abuse and those receiving psychological treatment. Collaborative care: 14 weeks of 6-12 telephone contacts by care managers; mental health specialist supervision, including depression education, medication management, behavioural activation, relapse prevention and primary care liaison. Usual care was general practitioner standard practice. Blinded researchers collected depression [Patient Health Questionnaire-9 (PHQ-9)], anxiety (General Anxiety Disorder-7) and quality of life (European Quality of Life-5 Dimensions three-level version), Short Form questionnaire-36 items) outcomes at 4, 12 and 36 months, satisfaction (Client Satisfaction Questionnaire-8) outcomes at 4 months and treatment and service use costs at 12 months. In total, 276 and 305 participants were randomised to collaborative care and usual care respectively. Collaborative care participants had a mean depression score that was 1.33 PHQ-9 points lower [n = 230; 95% confidence interval (CI) 0.35 to 2.31; p = 0.009] than that of participants in usual care at 4 months and 1.36 PHQ-9 points lower (n = 275; 95% CI 0.07 to 2.64; p = 0.04) at 12 months after adjustment for baseline depression (effect size 0.28, 95% CI 0.01 to 0.52; odds ratio for

  15. Recurring Utterances - Targeting a Breakthrough

    Directory of Open Access Journals (Sweden)

    Jacqueline Stark

    2014-05-01

    The most interesting phenomenon is KB’s production of words from former sessions indicating that they are still ‘active’ and the production of completely novel incorrect words. The observable features indicate that immediate auditory processing is possible in the form of repeating target words. However, as soon as KB must retrieve information from the (semantic lexicon, even after being able to correctly ‘repeat’ the target word several times, he responds with a RU, perseveration, or paraphasia. Several of his productions can be characterized as aphasic confabulations which stem from a memory gap. Thus, although KB’s language impairment is severe, his responses across time indicate that step-by-step a breakthrough is being made.

  16. Better together? a naturalistic qualitative study of inter-professional working in collaborative care for co-morbid depression and physical health problems.

    Science.gov (United States)

    Knowles, Sarah E; Chew-Graham, Carolyn; Coupe, Nia; Adeyemi, Isabel; Keyworth, Chris; Thampy, Harish; Coventry, Peter A

    2013-09-20

    Mental-physical multi-morbidities pose challenges for primary care services that traditionally focus on single diseases. Collaborative care models encourage inter-professional working to deliver better care for patients with multiple chronic conditions, such as depression and long-term physical health problems. Successive trials from the United States have shown that collaborative care effectively improves depression outcomes, even in people with long-term conditions (LTCs), but little is known about how to implement collaborative care in the United Kingdom. The aim of the study was to explore the extent to which collaborative care was implemented in a naturalistic National Health Service setting. A naturalistic pilot study of collaborative care was undertaken in North West England. Primary care mental health professionals from IAPT (Increasing Access to Psychological Therapies) services and general practice nurses were trained to collaboratively identify and manage patients with co-morbid depression and long-term conditions. Qualitative interviews were performed with health professionals at the beginning and end of the pilot phase. Normalization Process Theory guided analysis. Health professionals adopted limited elements of the collaborative care model in practice. Although benefits of co-location in primary care practices were reported, including reduced stigma of accessing mental health treatment and greater ease of disposal for identified patients, existing norms around the division of mental and physical health work in primary care were maintained, limiting integration of the mental health practitioners into the practice setting. Neither the mental health practitioners nor the practice nurses perceived benefits to joint management of patients. Established divisions between mental and physical health may pose particular challenges for multi-morbidity service delivery models such as collaborative care. Future work should explore patient perspectives about

  17. Depressants

    Science.gov (United States)

    ... system. Doctors use them to treat things like insomnia or anxiety . But if depressant drugs (like sedatives, tranquilizers, or barbiturates) are abused, they can cause addiction , serious injury, or death. Depressants are usually ...

  18. Remote Collaborative Depression Care Program for Adolescents in Araucanía Region, Chile: Randomized Controlled Trial

    Science.gov (United States)

    Martínez, Pablo; Zitko, Pedro; Irarrázaval, Matías; Luttges, Carolina; Araya, Ricardo

    2018-01-01

    Background Despite evidence on efficacious interventions, a great proportion of depressed adolescents do not receive evidence-based treatment and have no access to specialized mental health care. Remote collaborative depression care (RCDC) may help to reduce the gap between needs and specialized mental health services. Objective The objective of this study was to assess the feasibility, acceptability, and effectiveness of an RCDC intervention for adolescents with major depressive disorder (MDD) living in the Araucanía Region, Chile. Methods A cluster randomized, assessor-blind trial was carried out at 16 primary care centers in the Araucanía Region, Chile. Before randomization, all participating primary care teams were trained in clinical guidelines for the treatment of adolescent depression. Adolescents (N=143; 13-19 years) with MDD were recruited. The intervention group (RCDC, N=65) received a 3-month RCDC treatment that included continuous remote supervision by psychiatrists located in Santiago, Chile’s capital city, through shared electronic health records (SEHR) and phone patient monitoring. The control group (enhanced usual care or EUC; N=78) received EUC by clinicians who were encouraged to follow clinical guidelines. Recruitment and response rates and the use of the SEHR system were registered; patient adherence and satisfaction with the treatment and clinician satisfaction with RCDC were assessed at 12-week follow-up; and depressive symptoms and health-related quality of life (HRQoL) were evaluated at baseline and 12-weeks follow-up. Results More than 60.3% (143/237) of the original estimated sample size was recruited, and a response rate of 90.9% (130/143) was achieved at 12-week follow-up. A mean (SD) of 3.5 (4.0) messages per patient were written on the SEHR system by primary care teams. A third of the patients showed an optimal adherence to psychopharmacological treatment, and adolescents in the RCDC intervention group were more satisfied with

  19. Remote Collaborative Depression Care Program for Adolescents in Araucanía Region, Chile: Randomized Controlled Trial.

    Science.gov (United States)

    Martínez, Vania; Rojas, Graciela; Martínez, Pablo; Zitko, Pedro; Irarrázaval, Matías; Luttges, Carolina; Araya, Ricardo

    2018-01-31

    Despite evidence on efficacious interventions, a great proportion of depressed adolescents do not receive evidence-based treatment and have no access to specialized mental health care. Remote collaborative depression care (RCDC) may help to reduce the gap between needs and specialized mental health services. The objective of this study was to assess the feasibility, acceptability, and effectiveness of an RCDC intervention for adolescents with major depressive disorder (MDD) living in the Araucanía Region, Chile. A cluster randomized, assessor-blind trial was carried out at 16 primary care centers in the Araucanía Region, Chile. Before randomization, all participating primary care teams were trained in clinical guidelines for the treatment of adolescent depression. Adolescents (N=143; 13-19 years) with MDD were recruited. The intervention group (RCDC, N=65) received a 3-month RCDC treatment that included continuous remote supervision by psychiatrists located in Santiago, Chile's capital city, through shared electronic health records (SEHR) and phone patient monitoring. The control group (enhanced usual care or EUC; N=78) received EUC by clinicians who were encouraged to follow clinical guidelines. Recruitment and response rates and the use of the SEHR system were registered; patient adherence and satisfaction with the treatment and clinician satisfaction with RCDC were assessed at 12-week follow-up; and depressive symptoms and health-related quality of life (HRQoL) were evaluated at baseline and 12-weeks follow-up. More than 60.3% (143/237) of the original estimated sample size was recruited, and a response rate of 90.9% (130/143) was achieved at 12-week follow-up. A mean (SD) of 3.5 (4.0) messages per patient were written on the SEHR system by primary care teams. A third of the patients showed an optimal adherence to psychopharmacological treatment, and adolescents in the RCDC intervention group were more satisfied with psychological assistance than those in EUC

  20. Depression

    DEFF Research Database (Denmark)

    Pouwer, Frans

    2017-01-01

    There is ample evidence that depression is000  a common comorbid health issue in people with type 1 or type 2 diabetes. Reviews have also concluded that depression in diabetes is associated with higher HbA1c levels, less optimal self-care behaviours, lower quality of life, incident vascular...... complications and higher mortality rates. However, longitudinal studies into the course of depression in people with type 1 diabetes remain scarce. In this issue of Diabetologia, Kampling and colleagues (doi: 10.1007/s00125-016-4123-0 ) report the 5 year trajectories of depression in adults with newly diagnosed...... type 1 diabetes (mean age, 28 years). Their baseline results showed that shortly after the diagnosis of type 1 diabetes a major depressive episode was diagnosed in approximately 6% of participants, while 8% suffered from an anxiety disorder. The longitudinal depression data showed that, in a 5 year...

  1. Tsetse Fly Genome Breakthrough Brings Hope for African Farmers

    International Nuclear Information System (INIS)

    2014-01-01

    Scientists have cracked the genetic code of the bloodsucking tsetse fly, prompting hope that the breakthrough will help future efforts to control one of the most devastating livestock diseases in sub-Saharan Africa spread by the insect. The tsetse genome was sequenced and annotated during a 10-year international collaborative effort that involved the Insect Pest Control Laboratory run jointly by the United Nations Food and Agriculture Organization (FAO) and the International Atomic Energy Agency (IAEA) in Vienna. The achievement allows scientists to better study the fly's genes and their functions, knowledge that should open the door for researching ways to control the insect

  2. Depression

    Science.gov (United States)

    ... and insomnia References American Psychiatric Association. Depressive disorders. Diagnostic and Statistical Manual of Mental Disorders . 5th ed. Arlington, VA: American Psychiatric Publishing; 2013: ...

  3. CASPER plus (CollAborative care in Screen-Positive EldeRs with major depressive disorder): study protocol for a randomised controlled trial.

    Science.gov (United States)

    Overend, Karen; Lewis, Helen; Bailey, Della; Bosanquet, Kate; Chew-Graham, Carolyn; Ekers, David; Gascoyne, Samantha; Hems, Deborah; Holmes, John; Keding, Ada; McMillan, Dean; Meer, Shaista; Meredith, Jodi; Mitchell, Natasha; Nutbrown, Sarah; Parrott, Steve; Richards, David; Traviss, Gemma; Trépel, Dominic; Woodhouse, Rebecca; Gilbody, Simon

    2014-11-19

    Depression accounts for the greatest disease burden of all mental health disorders, contributes heavily to healthcare costs, and by 2020 is set to become the second largest cause of global disability. Although 10% to 16% of people aged 65 years and over are likely to experience depressive symptoms, the condition is under-diagnosed and often inadequately treated in primary care. Later-life depression is associated with chronic illness and disability, cognitive impairment and social isolation. With a progressively ageing population it becomes increasingly important to refine strategies to identity and manage depression in older people. Currently, management may be limited to the prescription of antidepressants where there may be poor concordance; older people may lack awareness of psychosocial interventions and general practitioners may neglect to offer this treatment option. CASPER Plus is a multi-centre, randomised controlled trial of a collaborative care intervention for individuals aged 65 years and over experiencing moderate to severe depression. Selected practices in the North of England identify potentially eligible patients and invite them to participate in the study. A diagnostic interview is carried out and participants with major depressive disorder are randomised to either collaborative care or usual care. The recruitment target is 450 participants. The intervention, behavioural activation and medication management in a collaborative care framework, has been adapted to meet the complex needs of older people. It is delivered over eight to 10 weekly sessions by a case manager liaising with general practitioners. The trial aims to evaluate the clinical and cost effectiveness of collaborative care in addition to usual GP care versus usual GP care alone. The primary clinical outcome, depression severity, will be measured with the Patient Health Questionnaire-9 (PHQ-9) at baseline, 4, 12 and 18 months. Cost effectiveness analysis will assess health

  4. Depression

    DEFF Research Database (Denmark)

    Cizza, G; Ravn, Pernille; Chrousos, G P

    2001-01-01

    Existing studies of the relationship between depression and osteoporosis have been heterogeneous in their design and use of diagnostic instruments for depression, which might have contributed to the different results on the comorbidity of these two conditions. Nevertheless, these studies reveal a...

  5. Depression

    DEFF Research Database (Denmark)

    Johansen, Jon O. J.

    2013-01-01

    Nyhederne er fulde af historier om depression. Overskrifter som: ’Danskerne propper sig med lykkepiller’ eller ‘depression er stadigvæk tabu’ går tit igen i dagspressen. Men hvor er nuancerne, og hvorfor gider vi læse de samme historier igen og igen? Måske er det fordi, vores egne forestillinger er...

  6. Cost-effectiveness of collaborative care including PST and an antidepressant treatment algorithm for the treatment of major depressive disorder in primary care; a randomised clinical trial

    Directory of Open Access Journals (Sweden)

    Beekman Aartjan TF

    2007-03-01

    Full Text Available Abstract Background Depressive disorder is currently one of the most burdensome disorders worldwide. Evidence-based treatments for depressive disorder are already available, but these are used insufficiently, and with less positive results than possible. Earlier research in the USA has shown good results in the treatment of depressive disorder based on a collaborative care approach with Problem Solving Treatment and an antidepressant treatment algorithm, and research in the UK has also shown good results with Problem Solving Treatment. These treatment strategies may also work very well in the Netherlands too, even though health care systems differ between countries. Methods/design This study is a two-armed randomised clinical trial, with randomization on patient-level. The aim of the trial is to evaluate the treatment of depressive disorder in primary care in the Netherlands by means of an adapted collaborative care framework, including contracting and adherence-improving strategies, combined with Problem Solving Treatment and antidepressant medication according to a treatment algorithm. Forty general practices will be randomised to either the intervention group or the control group. Included will be patients who are diagnosed with moderate to severe depression, based on DSM-IV criteria, and stratified according to comorbid chronic physical illness. Patients in the intervention group will receive treatment based on the collaborative care approach, and patients in the control group will receive care as usual. Baseline measurements and follow up measures (3, 6, 9 and 12 months are assessed using questionnaires and an interview. The primary outcome measure is severity of depressive symptoms, according to the PHQ9. Secondary outcome measures are remission as measured with the PHQ9 and the IDS-SR, and cost-effectiveness measured with the TiC-P, the EQ-5D and the SF-36. Discussion In this study, an American model to enhance care for patients with a

  7. CollAborative care for Screen-Positive EldeRs with major depression (CASPER plus): a multicentred randomised controlled trial of clinical effectiveness and cost-effectiveness.

    Science.gov (United States)

    Bosanquet, Katharine; Adamson, Joy; Atherton, Katie; Bailey, Della; Baxter, Catherine; Beresford-Dent, Jules; Birtwistle, Jacqueline; Chew-Graham, Carolyn; Clare, Emily; Delgadillo, Jaime; Ekers, David; Foster, Deborah; Gabe, Rhian; Gascoyne, Samantha; Haley, Lesley; Hamilton, Jahnese; Hargate, Rebecca; Hewitt, Catherine; Holmes, John; Keding, Ada; Lewis, Helen; McMillan, Dean; Meer, Shaista; Mitchell, Natasha; Nutbrown, Sarah; Overend, Karen; Parrott, Steve; Pervin, Jodi; Richards, David A; Spilsbury, Karen; Torgerson, David; Traviss-Turner, Gemma; Trépel, Dominic; Woodhouse, Rebecca; Gilbody, Simon

    2017-11-01

    Depression in older adults is common and is associated with poor quality of life, increased morbidity and early mortality, and increased health and social care use. Collaborative care, a low-intensity intervention for depression that is shown to be effective in working-age adults, has not yet been evaluated in older people with depression who are managed in UK primary care. The CollAborative care for Screen-Positive EldeRs (CASPER) plus trial fills the evidence gap identified by the most recent guidelines on depression management. To establish the clinical effectiveness and cost-effectiveness of collaborative care for older adults with major depressive disorder in primary care. A pragmatic, multicentred, two-arm, parallel, individually randomised controlled trial with embedded qualitative study. Participants were automatically randomised by computer, by the York Trials Unit Randomisation Service, on a 1 : 1 basis using simple unstratified randomisation after informed consent and baseline measures were collected. Blinding was not possible. Sixty-nine general practices in the north of England. A total of 485 participants aged ≥ 65 years with major depressive disorder. A low-intensity intervention of collaborative care, including behavioural activation, delivered by a case manager for an average of six sessions over 7-8 weeks, alongside usual general practitioner (GP) care. The control arm received only usual GP care. The primary outcome measure was Patient Health Questionnaire-9 items score at 4 months post randomisation. Secondary outcome measures included depression severity and caseness at 12 and 18 months, the EuroQol-5 Dimensions, Short Form questionnaire-12 items, Patient Health Questionnaire-15 items, Generalised Anxiety Disorder-7 items, Connor-Davidson Resilience Scale-2 items, a medication questionnaire, objective data and adverse events. Participants were followed up at 12 and 18 months. In total, 485 participants were randomised (collaborative

  8. The Breakthrough Behind the Chevy Volt Battery

    Science.gov (United States)

    Lerner, Louise

    2011-03-28

    A revolutionary breakthrough cathode for lithium-ion batteries—the kind in your cell phone, laptop and new hybrid cars—makes them last longer, run more safely and perform better than batteries currently on the market.

  9. Researchers Realize Major Breakthrough in Understanding Endometriosis

    Science.gov (United States)

    ... 16, 2014 Researchers Realize Major Breakthrough in Understanding Endometriosis For a disease that affects an estimated 6 ... 10% of women, surprisingly little is known about endometriosis — a disorder that causes uterine tissue to grow ...

  10. Breakthrough Listen: Searching for Signatures of Technology

    Science.gov (United States)

    Isaacson, H. T.; Siemion, A. P. V.

    2017-11-01

    Breakthrough Listen is searching for signals of extra-terrestrial technologies using radio and optical telescopes. Very nearby stars of all types. Stars across the HR diagram and galaxies are all of interest in the search for techno-signatures.

  11. Innovation Impact: Breakthrough Research Results (Brochure)

    Energy Technology Data Exchange (ETDEWEB)

    2013-07-01

    The Innovation Impact brochure captures key breakthrough results across NREL's primary areas of renewable energy and energy efficiency research: solar, wind, bioenergy, transportation, buildings, analysis, and manufacturing technologies.

  12. How to revive breakthrough innovation in the pharmaceutical industry.

    Science.gov (United States)

    Munos, Bernard H; Chin, William W

    2011-06-29

    Over the past 20 years, pharmaceutical companies have implemented conservative management practices to improve the predictability of therapeutics discovery and success rates of drug candidates. This approach has often yielded compounds that are only marginally better than existing therapies, yet require larger, longer, and more complex trials. To fund them, companies have shifted resources away from drug discovery to late clinical development; this has hurt innovation and amplified the crisis brought by the expiration of patents on many best-selling drugs. Here, we argue that more breakthrough therapeutics will reach patients only if the industry ceases to pursue "safe" incremental innovation, re-engages in high-risk discovery research, and adopts collaborative innovation models that allow sharing of knowledge and costs among collaborators.

  13. Depression

    Science.gov (United States)

    ... don't have the right balance of chemicals. Hormonal factors – Menstrual cycle changes, pregnancy, miscarriage, postpartum period, perimenopause, and menopause may all cause a woman to develop depression. ...

  14. Creative Management as a Strategy for Breakthrough Innovation. Lessons from Basic Research Projects of Japanese Companies.

    Science.gov (United States)

    Lee, K. T.

    1997-01-01

    Japanese science/technology policies emphasize creative research management for strengthening breakthrough innovation. Key lessons include the following: cultivation of creative researchers, clear strategic directions, systematic teamwork and collaboration, focus on strategic industrial relevance, balance between autonomy and control, and the need…

  15. Controlled trial of a collaborative primary care team model for patients with diabetes and depression: Rationale and design for a comprehensive evaluation

    Directory of Open Access Journals (Sweden)

    Johnson Jeffrey A

    2012-08-01

    Full Text Available Abstract Background When depression accompanies diabetes, it complicates treatment, portends worse outcomes and increases health care costs. A collaborative care case-management model, previously tested in an urban managed care organization in the US, achieved significant reduction of depressive symptoms, improved diabetes disease control and patient-reported outcomes, and saved money. While impressive, these findings need to be replicated and extended to other healthcare settings. Our objective is to comprehensively evaluate a collaborative care model for comorbid depression and type 2 diabetes within a Canadian primary care setting. Methods/design We initiated the TeamCare model in four Primary Care Networks in Northern Alberta. The intervention involves a nurse care manager guiding patient-centered care with family physicians and consultant physician specialists to monitor progress and develop tailored care plans. Patients eligible for the intervention will be identified using the Patient Health Questionnaire-9 as a screen for depressive symptoms. Care managers will then guide patients through three phases: 1 improving depressive symptoms, 2 improving blood glucose, blood pressure and cholesterol, and 3 improving lifestyle behaviors. We will employ the RE-AIM framework for a comprehensive and mixed-methods approach to our evaluation. Effectiveness will be assessed using a controlled “on-off” trial design, whereby eligible patients would be alternately enrolled in the TeamCare intervention or usual care on a monthly basis. All patients will be assessed at baseline, 6 and 12 months. Our primary analyses will be based on changes in two outcomes: depressive symptoms, and a multivariable, scaled marginal model for the combined outcome of global disease control (i.e., A1c, systolic blood pressure, LDL cholesterol. Our planned enrolment of 168 patients will provide greater than 80% power to observe clinically important improvements in all

  16. Rapid learning: a breakthrough agenda.

    Science.gov (United States)

    Etheredge, Lynn M

    2014-07-01

    A "rapid-learning health system" was proposed in a 2007 thematic issue of Health Affairs. The system was envisioned as one that uses evidence-based medicine to quickly determine the best possible treatments for patients. It does so by drawing on electronic health records and the power of big data to access large volumes of information from a variety of sources at high speed. The foundation for a rapid-learning health system was laid during 2007-13 by workshops, policy papers, large public investments in databases and research programs, and developing learning systems. Challenges now include implementing a new clinical research system with several hundred million patients, modernizing clinical trials and registries, devising and funding research on national priorities, and analyzing genetic and other factors that influence diseases and responses to treatment. Next steps also should aim to improve comparative effectiveness research; build on investments in health information technology to standardize handling of genetic information and support information exchange through apps and software modules; and develop new tools, data, and information for clinical decision support. Further advances will require commitment, leadership, and public-private and global collaboration. Project HOPE—The People-to-People Health Foundation, Inc.

  17. What work has to be done to implement collaborative care for depression? Process evaluation of a trial utilizing the Normalization Process Model.

    Science.gov (United States)

    Gask, Linda; Bower, Peter; Lovell, Karina; Escott, Diane; Archer, Janine; Gilbody, Simon; Lankshear, Annette J; Simpson, Angela E; Richards, David A

    2010-02-10

    There is a considerable evidence base for 'collaborative care' as a method to improve quality of care for depression, but an acknowledged gap between efficacy and implementation. This study utilises the Normalisation Process Model (NPM) to inform the process of implementation of collaborative care in both a future full-scale trial, and the wider health economy. Application of the NPM to qualitative data collected in both focus groups and one-to-one interviews before and after an exploratory randomised controlled trial of a collaborative model of care for depression. Findings are presented as they relate to the four factors of the NPM (interactional workability, relational integration, skill-set workability, and contextual integration) and a number of necessary tasks are identified. Using the model, it was possible to observe that predictions about necessary work to implement collaborative care that could be made from analysis of the pre-trial data relating to the four different factors of the NPM were indeed borne out in the post-trial data. However, additional insights were gained from the post-trial interview participants who, unlike those interviewed before the trial, had direct experience of a novel intervention. The professional freedom enjoyed by more senior mental health workers may work both for and against normalisation of collaborative care as those who wish to adopt new ways of working have the freedom to change their practice but are not obliged to do so. The NPM provides a useful structure for both guiding and analysing the process by which an intervention is optimized for testing in a larger scale trial or for subsequent full-scale implementation.

  18. NASA Breakthrough Propulsion Physics Workshop Proceedings

    Science.gov (United States)

    Millis, Marc G. (Editor); Williamson, Gary Scott (Editor)

    1999-01-01

    In August 1997, NASA sponsored a 3-day workshop to assess the prospects emerging from physics that may eventually lead to creating propulsion breakthroughs -the kind of breakthroughs that could revolutionize space flight and enable human voyages to other star systems. Experiments and theories were discussed regarding the coupling of gravity and electromagnetism, vacuum fluctuation energy, warp drives and wormholes, and superluminal quantum tunneling. Because the propulsion goals are presumably far from fruition, a special emphasis was to identify affordable, near-term, and credible research tasks that could make measurable progress toward these grand ambitions. This workshop was one of the first steps for the new NASA Breakthrough Propulsion Physics program led by the NASA Lewis Research Center.

  19. Breakthrough Propulsion Physics Workshop Preliminary Results

    Science.gov (United States)

    Millis, Marc G.

    1997-01-01

    In August, 1997, a NASA workshop was held to assess the prospects emerging from physics that might lead to creating the ultimate breakthroughs in space transportation: propulsion that requires no propellant mass, attaining the maximum transit speeds physically possible, and breakthrough methods of energy production to power such devices. Because these propulsion goals are presumably far from fruition, a special emphasis was to identify affordable, near-term, and credible research that could make measurable progress toward these propulsion goals. Experiments and theories were discussed regarding the coupling of gravity and electromagnetism, vacuum fluctuation energy, warp drives and wormholes, and superluminal quantum tunneling. Preliminary results of this workshop are presented, along with the status of the Breakthrough Propulsion Physics program that conducted this workshop.

  20. Initial Severity and Differential Treatment Outcome in the National Institute of Mental Health Treatment of Depression Collaborative Research Program.

    Science.gov (United States)

    Elkin, Irene; And Others

    1995-01-01

    Random regression models were used to investigate the role of initial severity in the outcome of four treatments for major depression: cognitive behavioral therapy, interpersonal psychotherapy, imipramine plus clinical management, and placebo plus clinical management. Initial severity of depression and impairment of functioning significantly…

  1. Exploration of the Pathways to Delinquency for Female Adolescents with Depression: Implications for Cross-Systems Collaboration and Counseling

    Science.gov (United States)

    Mellin, Elizabeth A.; Fang, Hong-Ning

    2010-01-01

    This study found that lack of involvement in prosocial institutions, affiliation with other troubled youth, and indifference regarding personal safety partially mediate the relationship between depression and delinquency among justice-involved female adolescents. The results suggest that depression may not be the primary conduit to delinquency.…

  2. Religion as a Cross-cultural Determinant of Depression in Elderly Europeans: Results from the EURODEP Collaboration

    NARCIS (Netherlands)

    Braam, A.W.; van den Eeden, P.; Prince, M.J.; Beekman, A.T.F.; Kivela, S.L.; Lawlor, B.A.; Birkhofer, A.; Fuhrer, R.; Lobo, A.; Magnusson, H.; Mann, A.H.; Meller, I.; Roelands, M.; Skoog, I.; Turrina, C.; Copeland, J.R.M.

    2001-01-01

    Background. The protective effects of religion against late life depression may depend on the broader sociocultural environment. This paper examines whether the prevailing religious climate is related to cross-cultural differences of depression in elderly Europeans. Methods. Two approaches were

  3. Clinical effectiveness of care managers in collaborative care for patients with depression in Swedish primary health care: a pragmatic cluster randomized controlled trial.

    Science.gov (United States)

    Björkelund, Cecilia; Svenningsson, Irene; Hange, Dominique; Udo, Camilla; Petersson, Eva-Lisa; Ariai, Nashmil; Nejati, Shabnam; Wessman, Catrin; Wikberg, Carl; André, Malin; Wallin, Lars; Westman, Jeanette

    2018-02-09

    Depression is one of the leading causes of disability and affects 10-15% of the population. The majority of people with depressive symptoms seek care and are treated in primary care. Evidence internationally for high quality care supports collaborative care with a care manager. Our aim was to study clinical effectiveness of a care manager intervention in management of primary care patients with depression in Sweden. In a pragmatic cluster randomized controlled trial 23 primary care centers (PCCs), urban and rural, included patients aged ≥ 18 years with a new (Care management including continuous contact between care manager and patient, a structured management plan, and behavioral activation, altogether around 6-7 contacts over 12 weeks. Control condition was care as usual (CAU). Depression symptoms (measured by Mongomery-Asberg depression score-self (MADRS-S) and BDI-II), quality of life (QoL) (EQ-5D), return to work and sick leave, service satisfaction, and antidepressant medication. Data were analyzed with the intention-to-treat principle. One hundred ninety two patients with depression at PCCs with care managers were allocated to the intervention group, and 184 patients at control PCCs were allocated to the control group. Mean depression score measured by MADRS-S was 2.17 lower in the intervention vs. the control group (95% CI [0.56; 3.79], p = 0.009) at 3 months and 2.27 lower (95% CI [0.59; 3.95], p = 0.008) at 6 months; corresponding BDI-II scores were 1.96 lower (95% CI [- 0.19; 4.11], p = 0.07) in the intervention vs. control group at 6 months. Remission was significantly higher in the intervention group at 6 months (61% vs. 47%, p = 0.006). QoL showed a steeper increase in the intervention group at 3 months (p = 0.01). During the first 3 months, return to work was significantly higher in the intervention vs. the control group. Patients in the intervention group were more consistently on antidepressant medication than

  4. The Breakthrough Listen Search for Intelligent Life

    Science.gov (United States)

    Croft, Steve; Siemion, Andrew; De Boer, David; Enriquez, J. Emilio; Foster, Griffin; Gajjar, Vishal; Hellbourg, Greg; Hickish, Jack; Isaacson, Howard; Lebofsky, Matt; MacMahon, David; Price, Daniel; Werthimer, Dan

    2018-01-01

    The $100M, 10-year philanthropic "Breakthrough Listen" project is driving an unprecedented expansion of the search for intelligent life beyond Earth. Modern instruments allow ever larger regions of parameter space (luminosity function, duty cycle, beaming fraction, frequency coverage) to be explored, which is enabling us to place meaningful physical limits on the prevalence of transmitting civilizations. Data volumes are huge, and preclude long-term storage of the raw data products, so real-time and machine learning processing techniques must be employed to identify candidate signals as well as simultaneously classifying interfering sources. However, the Galaxy is now known to be a target-rich environment, teeming with habitable planets.Data from Breakthrough Listen can also be used by researchers in other areas of astronomy to study pulsars, fast radio bursts, and a range of other science targets. Breakthrough Listen is already underway in the optical and radio bands, and is also engaging with facilities across the world, including Square Kilometer Array precursors and pathfinders. I will give an overview of the technology, science goals, data products, and roadmap of Breakthrough Listen, as we attempt to answer one of humanity's oldest questions: Are we alone?

  5. Breakthroughs in Action Research through Poetry

    Science.gov (United States)

    Barrett, Terry

    2011-01-01

    This paper discusses how major breakthroughs in generating, analysing and disseminating action research about problem-based learning were made through the medium of poetry. I used poetry in three ways: as data, as an interpretive device and as a reflective medium. Poetry helped me to disseminate my research in provocative, memorable and…

  6. Information and Announcements The Breakthrough Prize

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 19; Issue 10. Breakthrough Prize. B Sury Rajaram Nityananda Dipshikha Chakravortty. Information and Announcements Volume 19 Issue 10 October 2014 pp 966-969. Fulltext. Click here to view fulltext PDF. Permanent link:

  7. Exploring the Market for Breakthrough Technologies

    NARCIS (Netherlands)

    Ortt, J. Roland; Langley, David J.; Pals, Nico

    2007-01-01

    In this article, the gap between futures research (long term) and market research (short term) is closed in two ways. Firstly, by describing methods of market exploration that can be used earlier on in the process of development and diffusion of breakthrough technologies, so market research can be

  8. Depression

    DEFF Research Database (Denmark)

    Eriksen, Stine Aistrup

    2017-01-01

    Use of antidepressants is associated with an increased risk of fractures, and may be a result of both negative effects on the skeleton as well as increased risk of falling; however, the specific mechanisms are not yet known. Vitamin D play important roles for bone and muscle, and has previously...... shown positive effects in lowering the risk of osteoporosis and risk of falling. In addition, vitamin D may improve mental health, and deficiency of vitamin D is a common condition among patients suffering from depression. This thesis investigates bone and factors related to fall risk (including muscle...

  9. Multidisciplinary Collaborative Care for Depressive Disorder in the Occupational Health Setting: design of a randomised controlled trial and cost-effectiveness study

    Directory of Open Access Journals (Sweden)

    Beekman Aartjan TF

    2008-05-01

    Full Text Available Abstract Background Major depressive disorder (MDD has major consequences for both patients and society, particularly in terms of needlessly long sick leave and reduced functioning. Although evidence-based treatments for MDD are available, they show disappointing results when implemented in daily practice. A focus on work is also lacking in the treatment of depressive disorder as well as communication of general practitioners (GPs and other health care professionals with occupational physicians (OPs. The OP may play a more important role in the recovery of patients with MDD. Purpose of the present study is to tackle these obstacles by applying a collaborative care model, which has proven to be effective in the USA, with a focus on return to work (RTW. From a societal perspective, the (costeffectiveness of this collaborative care treatment, as a way of transmural care, will be evaluated in depressed patients on sick leave in the occupational health setting. Methods/Design A randomised controlled trial in which the treatment of MDD in the occupational health setting will be evaluated in the Netherlands. A transmural collaborative care model, including Problem Solving Treatment (PST, a workplace intervention, antidepressant medication and manual guided self-help will be compared with care as usual (CAU. 126 Patients with MDD on sick leave between 4 and 12 weeks will be included in the study. Care in the intervention group will be provided by a multidisciplinary team of a trained OP-care manager and a consultant psychiatrist. The treatment is separated from the sickness certification. Data will be collected by means of questionnaires at baseline and at 3, 6, 9 and 12 months after baseline. Primary outcome measure is reduction of depressive symptoms, secondary outcome measure is time to RTW, tertiary outcome measure is the cost effectiveness. Discussion The high burden of MDD and the high level of sickness absence among people with MDD contribute to

  10. Prospects for Breakthrough Propulsion From Physics

    Science.gov (United States)

    Millis, Marc G.

    2004-01-01

    "Space drives", "Warp drives", and "Wormholes:" these concepts may sound like science fiction, but they are being written about in reputable journals. To assess the implications of these emerging prospects for future spaceflight, NASA supported the Breakthrough Propulsion Physics Project from 1996 through 2002. This Project has three grand challenges: (1) Discover propulsion that eliminates the need for propellant; (2) Discover methods to achieve hyper-fast travel; and (3) Discover breakthrough methods to power spacecraft. Because these challenges are presumably far from fruition, and perhaps even impossible, a special emphasis is placed on selecting incremental and affordable research that addresses the critical issues behind these challenges. Of 16 incremental research tasks completed by the project and from other sponsors, about a third were found not to be viable, a quarter have clear opportunities for sequels, and the rest remain unresolved.

  11. Implementation of a collaborative care model for the treatment of depression and anxiety in a community health center: results from a qualitative case study

    Directory of Open Access Journals (Sweden)

    Eghaneyan BH

    2014-11-01

    Full Text Available Brittany H Eghaneyan,1 Katherine Sanchez,2 Diane B Mitschke2 1Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA; 2School of Social Work, The University of Texas at Arlington, Arlington, TX, USA Background: The collaborative care model is a systematic approach to the treatment of depression and anxiety in primary care settings that involves the integration of care managers and consultant psychiatrists, with primary care physician oversight, to more proactively manage mental disorders as chronic diseases, rather than treating acute symptoms. While collaborative care has been shown to be more effective than usual primary care in improving depression outcomes in a number of studies, less is known about the factors that support the translation of this evidence-based intervention to real-world program implementation. The purpose of this case study was to examine the implementation of a collaborative care model in a community based primary care clinic that primarily serves a low-income, uninsured Latino population, in order to better understand the interdisciplinary relationships and the specific elements that might facilitate broader implementation. Methods: An embedded single-case study design was chosen in order to thoroughly examine the components of one of several programs within a single organization. The main unit of analysis was semi-structured interviews that were conducted with seven clinical and administrative staff members. A grounded theory approach was used to analyze the interviews. Line-by-line initial coding resulted in over 150 initial codes, which were clustered together to rebuild the data into preliminary categories and then divided into four final categories, or main themes. Results: Four unique themes about how the implementation of a collaborative care model worked in this setting emerged from the interviews: organizational change, communication, processes and outcomes of the program, and barriers to

  12. How to use analogies for breakthrough innovations

    OpenAIRE

    Schild, Katharina; Herstatt, Cornelius; Lüthje, Christian

    2004-01-01

    Analogies can trigger breakthrough ideas in new product development. Numerous examples demonstrate that substantial innovations often result from transferring problem solutions from one industry or domain to another. For instance, the designers of the new running shoe generation of Nike, “Nike SHOX”, use the same suspension concept like the technologies applied for Formula 1 racing cars, or the biological Lotus-effect led to the development of various self-cleaning surfaces. Academic resea...

  13. Breakthrough Propulsion Physics Project: Project Management Methods

    Science.gov (United States)

    Millis, Marc G.

    2004-01-01

    To leap past the limitations of existing propulsion, the NASA Breakthrough Propulsion Physics (BPP) Project seeks further advancements in physics from which new propulsion methods can eventually be derived. Three visionary breakthroughs are sought: (1) propulsion that requires no propellant, (2) propulsion that circumvents existing speed limits, and (3) breakthrough methods of energy production to power such devices. Because these propulsion goals are presumably far from fruition, a special emphasis is to identify credible research that will make measurable progress toward these goals in the near-term. The management techniques to address this challenge are presented, with a special emphasis on the process used to review, prioritize, and select research tasks. This selection process includes these key features: (a) research tasks are constrained to only address the immediate unknowns, curious effects or critical issues, (b) reliability of assertions is more important than the implications of the assertions, which includes the practice where the reviewers judge credibility rather than feasibility, and (c) total scores are obtained by multiplying the criteria scores rather than by adding. Lessons learned and revisions planned are discussed.

  14. Collaborative nurse-led self-management support for primary care patients with anxiety, depressive or somatic symptoms: Cluster-randomised controlled trial (findings of the SMADS study).

    Science.gov (United States)

    Zimmermann, Thomas; Puschmann, Egina; van den Bussche, Hendrik; Wiese, Birgitt; Ernst, Annette; Porzelt, Sarah; Daubmann, Anne; Scherer, Martin

    2016-11-01

    Collaborative, nurse-led care is a well-established model of ambulatory care in many healthcare systems. Nurses play a key role in managing patients' conditions as well as in enhancing symptom- and self-management skills. The SMADS trial evaluated the effectiveness of a primary care-based, nurse-led, complex intervention to promote self-management in patients with anxiety, depressive or somatic symptoms. Change in self-efficacy 12 months post baseline was used as the primary outcome. The SMADS trial set up a two-arm, cluster randomised controlled trial in the city of Hamburg, a large metropolitan area in the North West of Germany. We randomly allocated participating primary care practices to either the intervention group (IG), implementing a nurse-led collaborative care model, or to the control group (CG), where patients with the above psychosomatic symptoms received routine treatment. Patients from 18 to 65 years of age, regularly consulting a participating primary care practice, scoring≥5 on the anxiety, depressive or somatic symptom scales of the Patient Health Questionnaire (PHQ-D), German version. A mixed model regression approach was used to analyse the outcome data. Analyses were based on the intention-to-treat population: All enrolled patients were analysed at their follow-up. Additionally, we reported results as effect sizes. The robustness of the results was investigated by performing an observed cases analysis. 325 participants (IG N=134, CG N=191) from ten practices in each study arm consented to take part and completed a baseline assessment. The mean group difference (ITT-LOCF, IG vs. CG) in self-efficacy at the post baseline follow-up (median 406days) was 1.65 points (95% CI 0.50-2.8) in favour of IG (p=0.004). This amounts to a small Cohen's d effect size of 0.33. An observed cases analysis (168 participants, IG=56, CG=105) resulted in a mean difference of 3.13 (95% CI 1.07-5.18, p=0.003) between the groups, amounting to a moderate effect size of d

  15. Development and assessment of an active strategy for the implementation of a collaborative care approach for depression in primary care (the INDI·i project).

    Science.gov (United States)

    Aragonès, Enric; Palao, Diego; López-Cortacans, Germán; Caballero, Antonia; Cardoner, Narcís; Casaus, Pilar; Cavero, Myriam; Monreal, José Antonio; Pérez-Sola, Víctor; Cirera, Miquel; Loren, Maite; Bellerino, Eva; Tomé-Pires, Catarina; Palacios, Laura

    2017-12-13

    Primary care is the principal clinical setting for the management of depression. However, significant shortcomings have been detected in its diagnosis and clinical management, as well as in patient outcomes. We developed the INDI collaborative care model to improve the management of depression in primary care. This intervention has been favorably evaluated in terms of clinical efficacy and cost-effectiveness in a clinical trial. Our aim is to bring this intervention from the scientific context into clinical practice. Objective: To test for the feasibility and impact of a strategy for implementing the INDI model for depression in primary care. A quasi-experiment conducted in primary care. Several areas will be established to implement the new program and other, comparable areas will serve as control group. The study constitutes the preliminary phase preceding generalization of the model in the Catalan public healthcare system. The target population of the intervention are patients with major depression. The implementation strategy will also involve healthcare professionals, primary care centers, as well as management departments and the healthcare organization itself in the geographical areas where the study will be conducted: Camp de Tarragona and Vallès Occidental (Catalonia). The INDI model is a program for improving the management of depression involving clinical, instructional, and organizational interventions including the participation of nurses as care managers, the efficacy and efficiency of which has been proven in a clinical trial. We will design an active implementation strategy for this model based on the PARIHS (Promoting Action on Research Implementation in Health Services) framework. Qualitative and quantitative measures will be used to evaluate variables related to the successful implementation of the model: acceptability, utility, penetration, sustainability, and clinical impact. This project tests the transferability of a healthcare intervention

  16. Breakthrough at NIF 'unlikely' in 2010

    Science.gov (United States)

    Harris, Margaret

    2010-05-01

    Hopes of reaching a milestone in fusion research by the end of 2010 have dimmed following a US government report that plays down the chances of an early breakthrough and sharply criticizes management of the 4bn National Ignition Facility (NIF). In the report, officials from the Government Accountability Office (GAO) state that ignition - fusion's "break-even" point - is "unlikely" to occur at the laser-fusion lab this year and that "significant scientific and technical challenges" could delay or even prevent the facility from achieving ignition by 2012.

  17. The management of breakthrough pain during labour.

    Science.gov (United States)

    Akerman, Nicholas; Dresner, Martin

    2009-08-01

    There is a long history of attempts to alleviate the pain of childbirth, particularly in Asian and Middle Eastern civilisations. In the UK, it was the administration of chloroform to Queen Victoria by John Snow in 1853 that is widely credited with popularizing the idea that labour pain should and could be treated. Medical analgesia is now well established around the globe with a wealth of research evidence describing methods, efficacy and complications. In this article, we define 'primary breakthrough pain' as the moment when a woman first requests analgesia during labour. The management of this can include simple emotional support, inhaled analgesics, parenteral opioids and epidural analgesia. 'Secondary breakthrough pain' can be defined as the moment when previously used analgesia becomes ineffective. We concentrate our discussion of this phenomenon on the situation when epidural analgesia begins to fail. Only epidural analgesia offers the potential for complete analgesia, so when this effect is lost the recipient can experience significant distress and dissatisfaction. The best strategy to avert this problem is prevention by using the best techniques for epidural catheterisation and the most effective drug combinations. Even then, epidurals can lose their efficacy for a variety of reasons, and management is hampered by the fact that each rescue manoeuvre takes about 30 minutes to be effective. If the rescue protocol is too cautious, analgesia may not be successfully restored before delivery, leading to patient dissatisfaction. We therefore propose an aggressive response to epidural breakthrough pain using appropriate drug supplementation and, if necessary, the placement of a new epidural catheter. Combined spinal epidural techniques offer several advantages in this situation. The goal is to re-establish analgesia within 1 hour. The primary aim of pain management during labour and delivery is to provide the level of comfort determined as acceptable to each

  18. Creating breakthrough products from hidden needs

    OpenAIRE

    Goffin, Keith

    2011-01-01

    Many managers want their organizations to develop breakthrough products and ask their R&D departments to come up with the equivalent of the iPod or iPhone. Unfortunately, the reality is very different-most organizations struggle to come up with novel product concepts, and of the thousands of new products introduced worldwide each year, product failure is more common than success. What are the reasons for product failure and what steps can companies take to avoid it? In this ...

  19. Breakthrough curve moments scaling in hyporheic exchange

    Science.gov (United States)

    Bellin, A.; Tonina, D.; Marzadri, A.

    2015-02-01

    The interaction between stream flow and bed forms creates an uneven distribution of near-bed energy heads, which is the driving force of hyporheic exchange. Owing to the large disparity of advection characteristic times in the stream and within the hyporheic zone, solute mass exchange is often modeled by considering the latter as an immobile region. In a recent contribution Gónzalez-Pinzón et al. (2013) showed that existing models employing this hypothesis are structurally inconsistent with the scaling revealed by the analysis of 384 breakthrough curves collected in 44 streams across five continents. Motivated by this result, we analyze the scaling characteristics of a model that we recently developed by combining the analytical solution of the advective flow within the hyporheic zone with a Lagrangian solute transport model. Results show that similarly to the experimental data our model predicts breakthrough curves with a constant skewness, irrespective of the stream size, and that the scaling of the first three moments observed by Gónzalez-Pinzón et al. (2013) is also respected. Moreover, we propose regression curves that relate the first three moments of the residence time distribution with the alternate bar dimensionless depth (YBM*), a quantity that is easily measurable in the field. The connection between BTC moments and YBM* opens new possibilities for modeling transport processes at the catchment scale.

  20. Cost-utility of collaborative care for the treatment of comorbid major depressive disorder in outpatients with chronic physical conditions. : A randomized controlled trial in the general hospital setting (CC-DIM)

    NARCIS (Netherlands)

    M. Goorden (Maartje); C.M. van der Feltz-Cornelis (Christina); K.M. van Steenbergen-Weijenburg (Kirsten); E.K. Horn (Eva); A.T.F. Beekman (Aartjan); L. van Hakkaart-van Roijen (Leona)

    2017-01-01

    markdownabstract__Purpose:__ Major depressive disorder (MDD) is highly prevalent in patients with a chronic physical condition, and this comorbidity has a negative influence on quality of life, health care costs, self-care, morbidity, and mortality. Research has shown that collaborative care (CC)

  1. Controlled Nucleosynthesis Breakthroughs in Experiment and Theory

    CERN Document Server

    Adamenko, Stanislav; Merwe, Alwyn

    2007-01-01

    This book ushers in a new era of experimental and theoretical investigations into collective processes, structure formation, and self-organization of nuclear matter. It reports the results of experiments wherein for the first time the nuclei constituting our world (those displayed in Mendeleev's table as well as the super-heavy ones) have been artificially created. Pioneering breakthroughs are described, achieved at the "Proton-21" Laboratory, Kiev, Ukraine, in a variety of new physical and technological directions. A detailed description of the main experiments, their analyses, and the interpretation of copious experimental data are given, along with the methodology governing key measurements and the processing algorithms of the data that empirically confirm the occurrence of macroscopic self-organizing processes leading to the nuclear transformations of various materials. The basic concepts underlying the initiation of self-sustaining collective processes that result in the formation of nuclear structures a...

  2. Effectiveness and cost-effectiveness of transmural collaborative care with consultation letter (TCCCL) and duloxetine for major depressive disorder (MDD) and (sub)chronic pain in collaboration with primary care: design of a randomized placebo-controlled multi-Centre trial: TCC:PAINDIP.

    Science.gov (United States)

    de Heer, Eric W; Dekker, Jack; van Eck van der Sluijs, Jonna F; Beekman, Aartjan Tf; van Marwijk, Harm Wj; Holwerda, Tjalling J; Bet, Pierre M; Roth, Joost; Hakkaart-Van Roijen, Leona; Ringoir, Lianne; Kat, Fiona; van der Feltz-Cornelis, Christina M

    2013-05-24

    The comorbidity of pain and depression is associated with high disease burden for patients in terms of disability, wellbeing, and use of medical care. Patients with major and minor depression often present themselves with pain to a general practitioner and recognition of depression in such cases is low, but evolving. Also, physical symptoms, including pain, in major depressive disorder, predict a poorer response to treatment. A multi-faceted, patient-tailored treatment programme, like collaborative care, is promising. However, treatment of chronic pain conditions in depressive patients has, so far, received limited attention in research. Cost effectiveness of an integrated approach of pain in depressed patients has not been studied. This study is a placebo controlled double blind, three armed randomized multi centre trial. Patients with (sub)chronic pain and a depressive disorder are randomized to either a) collaborative care with duloxetine, b) collaborative care with placebo or c) duloxetine alone. 189 completers are needed to attain sufficient power to show a clinically significant effect of 0.6 SD on the primary outcome measures (PHQ-9 score). Data on depression, anxiety, mental and physical health, medication adherence, medication tolerability, quality of life, patient-doctor relationship, coping, health resource use and productivity will be collected at baseline and after three, six, nine and twelve months. This study enables us to show the value of a closely monitored integrated treatment model above usual pharmacological treatment. Furthermore, a comparison with a placebo arm enables us to evaluate effectiveness of duloxetine in this population in a real life setting. Also, this study will provide evidence-based treatments and tools for their implementation in practice. This will facilitate generalization and implementation of results of this study. Moreover, patients included in this study are screened for pain symptoms, differentiating between nociceptive

  3. Breakthrough Listen - A New Search for Life in the Universe

    Science.gov (United States)

    Worden, Pete

    On July 20, 2015 Yuri Milner and Stephen Hawking announced a new set of scientific initiatives - a SETI search called Breakthrough Listen and a contest to devise potential messages in response to a detection entitled Breakthrough Message. These are the first of several privately-funded Breakthrough Initiatives, designed to answer the fundamental science questions surrounding the origin, extent and nature of life in the universe. The initiatives are managed by the Breakthrough Prize Foundation. With Breakthrough Listen, Radio SETI observations have begun at the Green Bank Radio Telescope (GBT) and optical SETI at the Lick Observatory Automated Planet Finder (APF). Observations will soon commence at the CSIRO Parkes Radio Telescope. Other SETI instruments and observations are under consideration. In addition, several other initiatives are under development including an expanded search for life in the universe.

  4. Inertial frames and breakthrough propulsion physics

    Science.gov (United States)

    Millis, Marc G.

    2017-09-01

    The term ;Breakthrough Propulsion Physics; comes from the NASA project by that name which examined non-rocket space drives, gravity control, and faster-than-light travel. The focus here is on space drives and the related unsolved physics of inertial frames. A ;space drive; is a generic term encompassing any concept for using as-yet undiscovered physics to move a spacecraft instead of existing rockets, sails, or tethers. The collective state of the art spans mostly steps 1-3 of the scientific method: defining the problem, collecting data, and forming hypotheses. The key issues include (1) conservation of momentum, (2) absence of obvious reaction mass, and (3) the net-external thrusting requirement. Relevant open problems in physics include: (1) the sources and mechanisms of inertial frames, (2) coupling of gravitation to the other fundamental forces, and (3) the nature of the quantum vacuum. Rather than following the assumption that inertial frames are an immutable, intrinsic property of space, this paper revisits Mach's Principle, where it is posited that inertia is relative to the distant surrounding matter. This perspective allows conjectures that a space drive could impart reaction forces to that matter, via some as-yet undiscovered interaction with the inertial frame properties of space. Thought experiments are offered to begin a process to derive new hypotheses. It is unknown if this line of inquiry will be fruitful, but it is hoped that, by revisiting unsolved physics from a propulsion point of view, new insights will be gained.

  5. Clinical characterization of breakthrough bacteraemia: a survey of 392 episodes.

    Science.gov (United States)

    López Dupla, M; Martinez, J A; Vidal, F; Almela, M; López, J; Marco, F; Soriano, A; Richart, C; Mensa, J

    2005-08-01

    Few data are available on the clinical features of patients who develop breakthrough bacteraemia, understood as positive blood cultures despite appropriate antibiotic therapy. To determine the clinical significance and outcome of a large series of breakthrough bacteraemia. Retrospective analysis of a prospectively collected database. Two university-affiliated hospitals in Catalonia, Spain. A total of 392 individuals who suffered an episode of breakthrough bacteraemia recorded between 1997 and 2002. Demographic characteristics, underlying diseases, origin of infection, sources of infection, microorganisms isolated, McCabe and Jackson prognostic criteria, and mortality were analysed. Breakthrough bacteraemia was detected in 392 of 6324 (6.1%) episodes of bacteraemia. Eighty per cent of episodes were nosocomial. The most frequent source of infection in breakthrough bacteraemia was endovascular (70%). Coagulase-negative staphylococci, Staphylococcus aureus, and Pseudomonas aeruginosa were the most significant microorganisms involved. Nosocomial acquisition together with selected sources (central venous catheter, endocarditis and other endovascular foci), underlying conditions (neutropenia, polytraumatism, allogenic bone marrow and kidney transplantation), and particular microbial aetiologies (S. aureus, P. aeruginosa and polymicrobial) were independently associated with increased risk for developing breakthrough bacteraemia. Crude mortality rate was greater in patients with breakthrough bacteraemia (16% vs. 12.3%; P<0.05), and this condition was an independent predictor of death (OR 1.4, 95% CI, 1-1.9; P=0.04). In view of a case of breakthrough bacteraemia it is mandatory to search for an endovascular focus. Empiric treatment should be directed to cover S. aureus, coagulase-negative staphylococci and nonfermentative Gram-negative bacilli. Breakthrough bacteraemia is an independent predictor of death.

  6. Attention-deficit/hyperactivity disorder in adults with bipolar disorder or major depressive disorder: results from the international mood disorders collaborative project.

    Science.gov (United States)

    McIntyre, Roger S; Kennedy, Sidney H; Soczynska, Joanna K; Nguyen, Ha T T; Bilkey, Timothy S; Woldeyohannes, Hanna O; Nathanson, Jay A; Joshi, Shikha; Cheng, Jenny S H; Benson, Kathleen M; Muzina, David J

    2010-01-01

    Relatively few studies have evaluated the clinical implications of lifetime attention-deficit/hyperactivity disorder (ADHD) in adults with bipolar disorder or major depressive disorder (MDD). Herein, we sought to determine the prevalence as well as the demographic and clinical correlates of lifetime ADHD in persons with a mood disorder. The first 399 patients enrolled in the International Mood Disorders Collaborative Project (IMDCP) were evaluated for lifetime ADHD using the Mini-International Neuropsychiatric Interview-Plus (MINI-Plus) as the primary instrument to derive current and lifetime DSM-IV diagnoses. All analyses of variables of interest were conducted utilizing the MINI-Plus, the Adult ADHD Self-Report Scale-v1.1, and the Wender Utah Rating Scale-Short Form. The effect of ADHD on clinical presentation, course of illness variables, comorbidity, anamnesis, treatment, and outcome are reported. The IMDCP is a joint initiative of the Mood Disorders Psychopharmacology Unit at the University Health Network, University of Toronto, Toronto, Ontario, Canada, and the Cleveland Clinic Center for Mood Disorders Treatment and Research at Lutheran Hospital, Cleveland, Ohio. All data for this study were procured between January 2008 and January 2009. The percentages of subjects with MDD or bipolar disorder meeting the DSM-IV criteria for lifetime adult ADHD were 5.4% and 17.6% (P disorder populations was associated with earlier age at illness onset (MDD, P = .049; bipolar disorder, P = .005), a higher number of psychiatric comorbidities (eg, MDD and current panic disorder with agoraphobia [P = .002]; bipolar disorder and social phobia [P = .012]), and decreased quality of life (MDD, P = .018). The overarching findings herein are that the adult ADHD phenotype is commonly reported by individuals with MDD or bipolar disorder and is associated with a greater illness burden and complexity.

  7. Collaborative Lab Reports with Google Docs

    Science.gov (United States)

    Wood, Michael

    2011-01-01

    Science is a collaborative endeavor. The solitary genius working on the next great scientific breakthrough is a myth not seen much today. Instead, most physicists have worked in a group at one point in their careers, whether as a graduate student, faculty member, staff scientist, or industrial researcher. As an experimental nuclear physicist with…

  8. A Blueprint for Collaborative Lawmaking

    Directory of Open Access Journals (Sweden)

    Miki Kashtan

    2016-03-01

    Full Text Available Miki Kashtan, a consultant at the Center for Efficient Collaboration, describes how her Convergent Facilitation method of collaborative decision-making brought together contentiously divided stakeholders in an effort to redraft child custody legislation in Minnesota, resulting in a near-unanimous new bill that completely changes the approach to child custody. This breakthrough surprised many. It depended on reframing the goals of the legislative effort to find legislation that all could wholeheartedly embrace, based on what mattered to all parties. A commitment to those goals carried the group through two years of an intensive and yet non-adversarial process.

  9. PREFACE: Inverse Problems in Applied Sciences—towards breakthrough

    Science.gov (United States)

    Cheng, Jin; Iso, Yuusuke; Nakamura, Gen; Yamamoto, Masahiro

    2007-06-01

    These are the proceedings of the international conference `Inverse Problems in Applied Sciences—towards breakthrough' which was held at Hokkaido University, Sapporo, Japan on 3-7 July 2006 (http://coe.math.sci.hokudai.ac.jp/sympo/inverse/). There were 88 presentations and more than 100 participants, and we are proud to say that the conference was very successful. Nowadays, many new activities on inverse problems are flourishing at many centers of research around the world, and the conference has successfully gathered a world-wide variety of researchers. We believe that this volume contains not only main papers, but also conveys the general status of current research into inverse problems. This conference was the third biennial international conference on inverse problems, the core of which is the Pan-Pacific Asian area. The purpose of this series of conferences is to establish and develop constant international collaboration, especially among the Pan-Pacific Asian countries, and to lead the organization of activities concerning inverse problems centered in East Asia. The first conference was held at City University of Hong Kong in January 2002 and the second was held at Fudan University in June 2004. Following the preceding two successes, the third conference was organized in order to extend the scope of activities and build useful bridges to the next conference in Seoul in 2008. Therefore this third biennial conference was intended not only to establish collaboration and links between researchers in Asia and leading researchers worldwide in inverse problems but also to nurture interdisciplinary collaboration in theoretical fields such as mathematics, applied fields and evolving aspects of inverse problems. For these purposes, we organized tutorial lectures, serial lectures and a panel discussion as well as conference research presentations. This volume contains three lecture notes from the tutorial and serial lectures, and 22 papers. Especially at this

  10. Aldosterone breakthrough during aliskiren, valsartan, and combination (aliskiren + valsartan) therapy.

    Science.gov (United States)

    Bomback, Andrew S; Rekhtman, Yelena; Klemmer, Philip J; Canetta, Pietro A; Radhakrishnan, Jai; Appel, Gerald B

    2012-01-01

    Aldosterone levels increase in 30%-40% of patients on angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers over the long term. This "aldosterone breakthrough" may carry important clinical consequences given aldosterone's nonepithelial, pro-fibrotic actions. The renin inhibitor, aliskiren, by suppressing the renin-angiotensin-aldosterone system (RAAS) proximally, may limit breakthrough compared to conventional RAAS blockade. This open-label study (NCT01129557) randomized subjects to aliskiren 300 mg daily (A), valsartan 320 mg daily (V), or aliskiren 150 mg + valsartan 160 mg daily (A+V) for 9 months. Eligible subjects had proteinuria >300 mg/day, estimated glomerular filtration rate (eGFR) >45 mL/min/1.73 m(2), and systolic blood pressure (BP) >130 or diastolic BP >80 mm Hg. Serum and 24-hour urine aldosterone (indexed to 24-hour urine Na) were checked before initiation of therapy and at 3, 6, and 9 months. Aldosterone breakthrough was defined as a sustained increase from baseline aldosterone by study end. The study was intended to enroll 120 subjects but was terminated early by the sponsor. We present here the results of 33 subjects who completed the protocol, of which 12 were randomized to A, 11 were randomized to V, and 10 were randomized to A+V. Mean baseline eGFR was 75.5 (±23.3) mL/min/1.73 m(2); baseline proteinuria was 3104 (±2943) mg/day; and baseline BP was 134.7 (±10.5)/84.8 (±8.4) mm Hg. Three (27%) subjects on V, three (25%) subjects on A, and three (30%) subjects on A+V had aldosterone breakthrough. Mean proteinuria reduction was 31% from baseline in all subjects: 30% in subjects with breakthrough vs. 32% in subjects without breakthrough. Mean BP reduction was 11.0/8.8 mm Hg in all subjects: 8.4/6.1 mm Hg in subjects with breakthrough vs. 12.0/9.8 mm Hg in subjects without breakthrough. Aliskiren, alone or in combination with valsartan, did not reduce the incidence of aldosterone breakthrough in subjects with hypertension

  11. Foreknowledge of breakthroughs science and technology foresight, and the early identification of areas of breakthrough

    International Nuclear Information System (INIS)

    Papon, P.

    2010-01-01

    The progress of science and technology has been so rapid in the last few decades that it receives especial attention in forecasting and foresight exercises. But, because they are too greatly in thrall to the dominant paradigms and hence favour a linear perspective, the experts who deal with these questions pay more attention to the future of technologies than to scientific advances and revolutions. The bulk of their work consists, then, in anticipating, by various different methods (Delphi surveys, Road-maps, etc.), at what date a particular technology might be available (without, however, always correctly gauging the conditions for its social appropriation or the applications to which it might be put). In this article, Pierre Papon expounds a much more original and promising approach for attempting to anticipate the discoveries that are likely radically to transform the fields of scientific knowledge by investigating the phenomena that may potentially lead to fundamental revolutions. After reminding us of the premonitory thinking of a number of authors - in the fields, for example, of genetics and computer science -, he endeavors to describe some of the dominant paradigms, particularly in quantum physics and molecular biology. In this way, he shows the advances they have made possible, and also their limitations, and explores what new scientific leaps forward might occur, bringing radically new technological breakthroughs between now and 2050. Papon reminds us, at the same time that, 'as science is not something isolated within society'; it has a duty to contribute to meeting the great challenges that face us - of work, health, nutrition and sustainable development, particularly where energy and climate are concerned. He therefore examines the ways in which future scientific and technological advances might provide solutions and how important it might be to 'translate the questions society poses into scientific questions'. He thus argues implicitly for strategic

  12. Application of the rainfall infiltration breakthrough (RIB) model for ...

    African Journals Online (AJOL)

    Application of the rainfall infiltration breakthrough (RIB) model for groundwater recharge estimation in west coastal South Africa. ... the data from Oudebosch with different rainfall and groundwater abstraction inputs are simulated to explore individual effects on water levels as well as recharge rate estimated on a daily basis.

  13. Technical Breakthroughs in the Wearable Artificial Kidney (WAK)

    OpenAIRE

    Gura, Victor; Macy, Alexandra S.; Beizai, Masoud; Ezon, Carlos; Golper, Thomas A.

    2009-01-01

    Background: The wearable artificial kidney (WAK) has been a holy grail in kidney failure for decades. Described herein are the breakthroughs that made possible the creation of the WAK V1.0 and its advanced versions V 1.1 and 1.2.

  14. Back to the future, current trends in breakthrough pain treatments

    Directory of Open Access Journals (Sweden)

    Max Watson

    2011-01-01

    Full Text Available The importance of effectively managing breakthrough pain for patients on long term background analgesia has recently lead to the development of a range of new products aimed at filling this need. This review article looks at the reasons behind these developments and their implications for clinical practice in resource limited situations.

  15. Breakthrough VZV infection after immunization, presenting as herpes zoster.

    NARCIS (Netherlands)

    Schade, R.P.; Bakkers, J.; Cornelissen, M.; Koster-Kamphuis, L.; Melchers, W.J.G.; Galama, J.M.D.

    2008-01-01

    An immunocompromized, VZV-vaccinated child had a breakthrough infection with VZV, acquired at a day-care centre during a chickenpox outbreak. Interestingly, the infection manifested as herpes zoster of 1 dermatome. Typing showed wild-type virus, which suggests that exogenous reinfection with a new

  16. Dissolved CO2Increases Breakthrough Porosity in Natural Porous Materials.

    Science.gov (United States)

    Yang, Y; Bruns, S; Stipp, S L S; Sørensen, H O

    2017-07-18

    When reactive fluids flow through a dissolving porous medium, conductive channels form, leading to fluid breakthrough. This phenomenon is caused by the reactive infiltration instability and is important in geologic carbon storage where the dissolution of CO 2 in flowing water increases fluid acidity. Using numerical simulations with high resolution digital models of North Sea chalk, we show that the breakthrough porosity is an important indicator of dissolution pattern. Dissolution patterns reflect the balance between the demand and supply of cumulative surface. The demand is determined by the reactive fluid composition while the supply relies on the flow field and the rock's microstructure. We tested three model scenarios and found that aqueous CO 2 dissolves porous media homogeneously, leading to large breakthrough porosity. In contrast, solutions without CO 2 develop elongated convective channels known as wormholes, with low breakthrough porosity. These different patterns are explained by the different apparent solubility of calcite in free drift systems. Our results indicate that CO 2 increases the reactive subvolume of porous media and reduces the amount of solid residual before reactive fluid can be fully channelized. Consequently, dissolved CO 2 may enhance contaminant mobilization near injection wellbores, undermine the mechanical sustainability of formation rocks and increase the likelihood of buoyance driven leakage through carbonate rich caprocks.

  17. Technology breakthrough and clinic application of gemstone CT

    International Nuclear Information System (INIS)

    Wang Jian

    2009-01-01

    Gemstone CT breaks through the conventional CT development model of expending detector's width over the past decade. By gemstone detector and spectral imaging technology, it could provide higher diagnostic accuracy, quicker diagnosis speed and higher definition of imaging, and better meet comprehensive clinical needs than conventional CT. To summarize technical breakthrough and clinical application of Gemstone CT. (authors)

  18. Breakthrough supplies young fish to a hungry industry | IDRC ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2010-10-28

    Oct 28, 2010 ... The technological breakthrough made the industry's growth possible in Southeast Asia. At the time, the Philippines produced about 200,000 tonnes of milkfish. ... for about half of the farmed fish production in the Philippines. An important source of animal protein, it is vital to the country's food security.

  19. Do It Yourself (DIY) Earth Science Collaboratories Using Best Practices and Breakthrough Technologies

    Science.gov (United States)

    Stephan, E.

    2017-12-01

    The objective of published earth science study data results and literature on the Web should be to provide a means to integrate discoverable science resources through an open collaborative-Web. At the core of any open science collaborative infrastructure is the ability to discover, manage and ultimately use relevant data accessible to the collaboration. Equally important are the relationships between people, applications, services, and publications, which capture critical contextual knowledge that enable their effective use. While contributions of either irreproducible or costly data can be a great asset the inability of users being able to use the data intelligently or make sense of it, makes these investments not usable. An ability to describe ad-hoc discoverable usage methodologies, provide feedback to data producers, and identify and cite data in a systematic way by leveraging existing Web-enabled off the shelf technology is needed. Fortunately many break-through advancements in data publication best practices and government, open source, and commercial investments support consumers who can provide feedback, share experiences, and contribute back to the earth science ecosystem.

  20. The prevalence and illness characteristics of DSM-5-defined "mixed feature specifier" in adults with major depressive disorder and bipolar disorder: Results from the International Mood Disorders Collaborative Project.

    Science.gov (United States)

    McIntyre, Roger S; Soczynska, Joanna K; Cha, Danielle S; Woldeyohannes, Hanna O; Dale, Roman S; Alsuwaidan, Mohammad T; Gallaugher, Laura Ashley; Mansur, Rodrigo B; Muzina, David J; Carvalho, Andre; Kennedy, Sidney H

    2015-02-01

    A substantial proportion of individuals with mood disorders present with sub-syndromal hypo/manic features. The objective of this analysis was to evaluate the prevalence and illness characteristics of the Diagnostic and Statistical Manual Version-5 (DSM-5) - defined mixed features specifier (MFS) in adults with major depressive disorder (MDD) and bipolar disorder (BD). Data from participants who met criteria for a current mood episode as part of MDD (n=506) or BD (BD-I: n=216, BD-II: n=130) were included in this post-hoc analysis. All participants were enrolled in the International Mood Disorders Collaborative Project (IMDCP): a collaborative research platform at the Mood Disorders Psychopharmacology Unit, University of Toronto and the Cleveland Clinic, Cleveland, Ohio. Mixed features specifier was operationalized as a score ≥ 1 on 3 or more select items on the Young Mania Rating Scale (YMRS) or ≥ 1 on 3 select items of the Montgomery Åsberg Depression Rating Scale (MADRS) or Hamilton Depression Rating Scale (HAMD-17) during an index major depressive episode (MDE) or hypo/manic episode, respectively. A total of 26.0% (n=149), 34.0% (n=65), and 33.8% (n=49) of individuals met criteria for MFS during an index MDE as part of MDD, BD-I and BD-II, respectively. Mixed features specifier during a hypo/manic episode was identified in 20.4% (n=52) and 5.1% (n=8) in BD-I and BD-II participants, respectively. Individuals with MDE-MFS as part of BD or MDD exhibited a more severe depressive phenotype (p=0.0002 and pdefined MFS is common during an MDE as part of MDD and BD. The presence of MFS identifies a subgroup of individuals with greater illness complexity and possibly a higher rate of cardiovascular comorbidity. The results herein underscore the common occurrence of MFS in adults with either BD or MDD. Moreover, the results of our analysis indicate that adults with mood disorders and MFS have distinct clinical characteristics and comorbidity patterns. Copyright

  1. Multidisciplinary collaborative care for depressive disorder in the occupational health setting: design of a randomised controlled trial and cost-effectiveness study

    NARCIS (Netherlands)

    Vlasveld, M.C.; Anema, J.R.; Beekman, A.T.F.; van Mechelen, W.; Hoedeman, R.; van Marwijk, H.W.J.; Rutten, F.F.H.; Hakkaart-van Roijen, L.H.; van der Feltz-Cornelis, C.M.

    2008-01-01

    Background. Major depressive disorder (MDD) has major consequences for both patients and society, particularly in terms of needlessly long sick leave and reduced functioning. Although evidence-based treatments for MDD are available, they show disappointing results when implemented in daily practice.

  2. Breakthrough candidemia in children: clinical and microbiological characteristics, therapeutic strategies and impact on outcomes.

    Science.gov (United States)

    Lai, Mei-Yin; Hsu, Jen-Fu; Chu, Shih-Ming; Wu, I-Hsyuan; Huang, Hsuan-Rong; Lin, Chun-Chih; Lee, I-Ta; Chiang, Ming-Chou; Fu, Ren-Huei; Tsai, Ming-Horng

    2017-06-01

    To assess the characteristics, treatments, risk factors and outcomes of breakthrough candidemia in children. Episodes of breakthrough candidemia in children were compared with the remaining episodes in a 13-year cohort study. Out of 319 episodes, 45 (14.1%) were breakthrough candidemia. Breakthrough candidemia occurred in patients with more acutely ill conditions, and the majority was caused by non-albicans Candida species (73.3%; 33 episodes). A total of 79.1% of breakthrough candidemia were caused by antifungal-susceptible Candida isolates and emergence of resistance was the mechanism in five cases of patients receiving fluconazole. Episodes of breakthrough candidemia had significantly higher illness severity and higher rates of fungemia-attributable mortality. Breakthrough candidemia independently contributed to unfavorable outcomes, and more aggressive treatment strategies are warranted when breakthrough candidemia is encountered.

  3. Methodology for Examining Potential Technology Breakthroughs for Mitigating CO2 and Application to Centralized Solar Photovoltaics

    Science.gov (United States)

    Aggressive reductions in US greenhouse gas emissions will require radical changes in how society generates and uses energy. Technological breakthroughs will be necessary if we are to make this transition cost effectively. With limited resources, understanding the breakthrough pot...

  4. Management of breakthrough pain in patients with cancer.

    Science.gov (United States)

    William, Leeroy; Macleod, Rod

    2008-01-01

    Breakthrough pain (BTP) in patients with cancer lacks a consensus definition and is subsequently inadequately diagnosed and assessed, therefore making it more challenging to manage. Cancer pain is generally moderate to severe in intensity and persistent in nature. Despite the problematic definition of BTP, it is generally described as having similar intensity, but may also be transitory and variable in predictability. Most breakthrough analgesia fails to be effective in the time required for BTP. No useful analgesia is therefore provided but drug adverse effects escalate. Cancer pain management relies on the WHO analgesic ladder. The frequency of BTP and its inadequate management means that it has significant adverse effects on patients, their families and those involved in their care. This article outlines a systematic, clinical and evidence-based approach to managing BTP in patients with cancer that emphasizes a holistic approach and an understanding of multidimensional 'total pain'. Guidelines for managing BTP are presented and areas of developing research are identified.

  5. Breakthroughs In Low-Profile Leaky-Wave HPM Antennas

    Science.gov (United States)

    2014-09-18

    YYYY) 18-09-2014 2. REPORT TYPE Quarterly 3. DATES COVERED (From - To) 19 Jun 2014 – 18 Sep 2014 4. TITLE AND SUBTITLE Breakthroughs in Low...Table 1. Types of low-profile, forward-traveling, fast-wave, leaky-wave, HPM antennas Acronym Full Name Identifying Geometry / Feature(s) FAWSEA...more parallel waveguides (aka, channels), with a radiated plane wave that exits the overall aperture at a well-defined angle. Since the FAWSEA aper

  6. Breakthroughs in Photonics 2013: Photoacoustic Tomography in Biomedicine

    OpenAIRE

    Yao, Junjie; Wang, Lihong V.

    2014-01-01

    Photoacoustic tomography (PAT) is one of the fastest growing biomedical imaging modalities in the last decade. Building on its high scalability and complementary imaging contrast to other mainstream modalities, PAT has gained substantial momentum in both preclinical and clinical studies. In 2013, PAT has grown markedly in both its technological capabilities and biomedical applications. In particular, breakthroughs have been made in super-resolution imaging, deep blood flow measurement, small ...

  7. New AIDA-2020 call for breakthrough detector technologies

    CERN Multimedia

    2016-01-01

    Physicists, engineers, and industry will be interested in a new proof-of-concept fund for breakthrough projects from the general field of detector development and testing.   Launched in the framework of the European project AIDA-2020, this open call will provide up to 200k€ of seed funding to support innovative and societal applications with a focus on industry-oriented applications. The deadline for applying is 20 October 2016. More information here.

  8. Collaboration and E-collaboration

    DEFF Research Database (Denmark)

    Razmerita, Liana; Kirchner, Kathrin

    2015-01-01

    Understanding student’s perception of collaboration and how collaboration is supported by ICT is important for its efficient use in the classroom. This article aims to investigate how students perceive collaboration and how they use new technologies in collaborative group work. Furthermore, it tr...

  9. Collaborative Economy

    DEFF Research Database (Denmark)

    that are emerging from them, and how governments are responding to these new challenges. In doing so, the book provides both theoretical and practical insights into the future of tourism in a world that is, paradoxically, becoming both increasingly collaborative and individualized. Table of Contents Preface 1.The...... collaborative economy and tourism Dianne Dredge and Szilvia Gyimóthy PART I - Theoretical explorations 2.Definitions and mapping the landscape in the collaborative economy Szilvia Gyimóthy and Dianne Dredge 3.Business models of the collaborative economy Szilvia Gyimóthy 4.Responsibility and care...... in the collaborative economy Dianne Dredge 5.Networked cultures in the collaborative economy Szilvia Gyimóthy 6.Policy and regulatory perspectives in the collaborative economy Dianne Dredge PART II - Disruptions, innovations and transformations 7.Regulating innovation in the collaborative economy: An examination...

  10. Generating breakthrough new product ideas feeding the innovation funnel

    CERN Document Server

    Cooper, Robert

    2007-01-01

    Senior executives are experiencing a shortage of game-changing ideas that drive growth. This book explains how to feed the innovation funnel with a steady stream of breakthrough new product ideas, providing numerous examples of the methods, approaches and techniques used by leading companies such as Motorola and Procter & Gamble. Learn more about the impact you can make by leveraging an innovation strategy, voice-of-customer research, external ideas via open innovation, employees? creative talent and fundamental research. Establish a proactive Discovery Stage that focuses on the drivers of innovation performance to transform your organization into an innovation machine.

  11. Daratumumab – breakthrough drug in multiple myeloma therapy

    Directory of Open Access Journals (Sweden)

    Artur Jurczyszyn

    2014-11-01

    Full Text Available Multiple myeloma (MM remains incurable despite important recent advances in treatment. Over the last 2 years, an anti-CD38 monoclonal antibody daratumumab (DARA has emerged as a breakthrough targeted therapy for patients with MM. Early-stage clinical trials have found DARA to be safe and to have encouraging clinical activity as a single agent and in combination with lenalidomide in heavily pretreated, relapsed patients in whom other novel agents (such as bortezomib, thalidomide and lenalidomide as well as stem cell transplant has already failed. This review discusses the preclinical and clinical development of DARA, its pathophysiological basis, and its prospects for future use in MM.

  12. Mini-columns for Conducting Breakthrough Experiments. Design and Construction

    Energy Technology Data Exchange (ETDEWEB)

    Dittrich, Timothy M. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Reimus, Paul William [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Ware, Stuart Douglas [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2015-06-11

    Experiments with moderately and strongly sorbing radionuclides (i.e., U, Cs, Am) have shown that sorption between experimental solutions and traditional column materials must be accounted for to accurately determine stationary phase or porous media sorption properties (i.e., sorption site density, sorption site reaction rate coefficients, and partition coefficients or Kd values). This report details the materials and construction of mini-columns for use in breakthrough columns to allow for accurate measurement and modeling of sorption parameters. Material selection, construction techniques, wet packing of columns, tubing connections, and lessons learned are addressed.

  13. Collaborative Economy

    DEFF Research Database (Denmark)

    collaborative economy and tourism Dianne Dredge and Szilvia Gyimóthy PART I - Theoretical explorations 2.Definitions and mapping the landscape in the collaborative economy Szilvia Gyimóthy and Dianne Dredge 3.Business models of the collaborative economy Szilvia Gyimóthy 4.Responsibility and care...... in the collaborative economy Dianne Dredge 5.Networked cultures in the collaborative economy Szilvia Gyimóthy 6.Policy and regulatory perspectives in the collaborative economy Dianne Dredge PART II - Disruptions, innovations and transformations 7.Regulating innovation in the collaborative economy: An examination...... of Airbnb’s early legal issues Daniel Guttentag 8.Free walking tour enterprises in Europe: An evolutionary economic approach Maria del Pilar Leal and L. Xavier Medina, 9.Cultural capitalism: Manipulation and control in Airbnb’s intersection with tourism Michael O' Reganand Jaeyeon Choe 10.Sharing the new...

  14. Comparative Effect of Collaborative Care, Pain Medication, and Duloxetine in the Treatment of Major Depressive Disorder and Comorbid (SubChronic Pain: Results of an Exploratory Randomized, Placebo-Controlled, Multicenter Trial (CC:PAINDIP

    Directory of Open Access Journals (Sweden)

    Eric W. de Heer

    2018-04-01

    Full Text Available ObjectiveEvidence exists for the efficacy of collaborative care (CC for major depressive disorder (MDD, for the efficacy of the consequent use of pain medication against pain, and for the efficacy of duloxetine against both MDD and neuropathic pain. Their relative effectiveness in comorbid MDD and pain has never been established so far. This study explores the effectiveness of CC with pain medication and duloxetine, and CC with pain medication and placebo, compared with duloxetine alone, on depressive and pain symptoms. This study was prematurely terminated because of massive reorganizations and reimbursement changes in mental health care in the Netherlands during the study period and is therefore of exploratory nature.MethodsThree-armed, randomized, multicenter, placebo-controlled trial at three specialized mental health outpatient clinics with patients who screened positive for MDD. Interventions lasted 12 weeks. Pain medication was administered according to an algorithm that avoids opiate prescription as much as possible, where paracetamol, COX inhibitors, and pregabalin are offered as steps before opiates are considered. Patients who did not show up for three or more sessions were registered as non-compliant. Explorative, intention-to-treat and per protocol, multilevel regression analyses were performed. The trial is listed in the trial registration (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1089; NTR number: NTR1089.ResultsSixty patients completed the study. Patients in all treatment groups reported significantly less depressive and pain symptoms after 12 weeks. CC with placebo condition showed the fastest decrease in depressive symptoms compared with the duloxetine alone group (b = −0.78; p = 0.01. Non-compliant patients (n = 31 did not improve over the 12-week period, in contrast to compliant patients (n = 29. Pain outcomes did not differ between the three groups.ConclusionIn MDD and pain, patient

  15. (Mis)understanding Science: The Problem with Scientific Breakthroughs.

    Science.gov (United States)

    Evans, James P

    2016-09-01

    On Saturday morning, February 28, 1953, the mystery of heredity appeared secure. Humans hadn't the faintest idea of how genetic information was transmitted-how the uncanny resemblance between mother and daughter, grandfather and grandson was conveyed across generations. Yet, by that Saturday afternoon, two individuals, James Watson and Francis Crick, had glimpsed the solution to these mysteries. The story of Watson and Crick's great triumph has been told and retold and has rightly entered the pantheon of scientific legend. But Watson and Crick's breakthrough was just that: a rupture and dramatic discontinuity in human knowledge that solved a deep mystery, the likes of which occurs, perhaps, a couple of times each century. And that's the problem. The story is just so good and so irresistible that it has misled generations of scientists about what to expect regarding a life in science. And more damaging, the resulting breakthrough mentality misleads the public, the media, and society's decision-makers about how science really works, all to the detriment of scientific progress and our society's well-being. © 2016 The Hastings Center.

  16. Turning Regenerative Medicine Breakthrough Ideas and Innovations into Commercial Products.

    Science.gov (United States)

    Bayon, Yves; Vertès, Alain A; Ronfard, Vincent; Culme-Seymour, Emily; Mason, Chris; Stroemer, Paul; Najimi, Mustapha; Sokal, Etienne; Wilson, Clayton; Barone, Joe; Aras, Rahul; Chiesi, Andrea

    2015-12-01

    The TERMIS-Europe (EU) Industry committee intended to address the two main critical issues in the clinical/commercial translation of Advanced Therapeutic Medicine Products (ATMP): (1) entrepreneurial exploitation of breakthrough ideas and innovations, and (2) regulatory market approval. Since January 2012, more than 12,000 publications related to regenerative medicine and tissue engineering have been accepted for publications, reflecting the intense academic research activity in this field. The TERMIS-EU 2014 Industry Symposium provided a reflection on the management of innovation and technological breakthroughs in biotechnology first proposed to contextualize the key development milestones and constraints of allocation of financial resources, in the development life-cycle of radical innovation projects. This was illustrated with the biofuels story, sharing similarities with regenerative medicine. The transition was then ensured by an overview of the key identified challenges facing the commercialization of cell therapy products as ATMP examples. Real cases and testimonies were then provided by a palette of medical technologies and regenerative medicine companies from their commercial development of cell and gene therapy products. Although the commercial development of ATMP is still at the proof-of-concept stage due to technology risks, changing policies, changing markets, and management changes, the sector is highly dynamic with a number of explored therapeutic approaches, developed by using a large diversity of business models, both proposed by the experience, pitfalls, and successes of regenerative medicine pioneers, and adapted to the constraint resource allocation and environment in radical innovation projects.

  17. Expedited Programs for Serious Conditions: An Update on Breakthrough Therapy Designation.

    Science.gov (United States)

    Kwok, Martin; Foster, Theresa; Steinberg, Michael

    2015-09-01

    Our aim was to describe the regulatory pathways made available by the US Food and Drug Administration (FDA) to expedite the drug development and approval process, with a focus on the benefits and limitations of the Breakthrough Therapy Designation (BTD) pathway. Published materials consisting of journal articles, press releases, government documents, and news articles from pharmaceutical publishers were identified through online databases (ie, Medline and Scopus), the FDA website, and Internet search engines (eg, Google). To encourage pharmaceutical innovation and increase the number of products being approved each year, the FDA has introduced 4 expedited regulatory pathways to accelerate the drug development and approval process. The most recent program, enacted in July 2012, was BTD that is given to drugs that treat a serious or life-threatening disease or condition; and preliminary clinical evidence suggests the potential for these drugs to provide a substantial improvement over the current standard of care. The primary basis for the creation of BTD is to provide patients with serious conditions with earlier access to FDA-approved medications. In 2014, 22% of the new molecular entities approved within the Center for Drug Evaluation and Research had BTD status, as opposed to only 11% in 2013, which indicates both the popularity and success of this expedited pathway. Additionally, the creation of BTD has produced a more collaborative working relationship between the pharmaceutical industry and the FDA because both parties have a vested interest in the drug's success. Some of the more notable concerns surrounding these approved breakthrough therapies have been the abbreviated tolerability and efficacy evidence available from accelerated clinical development programs, ensuring the manufacturing aspects keep pace with these accelerated clinical programs, and finally, managing the strain on resources for both the pharmaceutical companies and the FDA. BTD has already

  18. Collaborative Attack vs. Collaborative Defense

    Science.gov (United States)

    Xu, Shouhuai

    We have witnessed many attacks in the cyberspace. However, most attacks are launched by individual attackers even though an attack may involve many compromised computers. In this paper, we envision what we believe to be the next generation cyber attacks — collaborative attacks. Collaborative attacks can be launched by multiple attackers (i.e., human attackers or criminal organizations), each of which may have some specialized expertise. This is possible because cyber attacks can become very sophisticated and specialization of attack expertise naturally becomes relevant. To counter collaborative attacks, we might need collaborative defense because each “chain” in a collaborative attack may be only adequately dealt with by a different defender. In order to understand collaborative attack and collaborative defense, we present a high-level abstracted framework for evaluating the effectiveness of collaborative defense against collaborative attacks. As a first step towards realizing and instantiating the framework, we explore a characterization of collaborative attacks and collaborative defense from the relevant perspectives.

  19. What is depression?

    DEFF Research Database (Denmark)

    Davidsen, Annette Sofie; Fosgerau, Christina Fogtmann

    2014-01-01

    The diagnosis of depression is defined by psychiatrists, and guidelines for treatment of patients with depression are created in psychiatry. However, most patients with depression are treated exclusively in general practice. Psychiatrists point out that general practitioners' (GPs') treatment...... of depression is insufficient and a collaborative care (CC) model between general practice and psychiatry has been proposed to overcome this. However, for successful implementation, a CC model demands shared agreement about the concept of depression and the diagnostic process in the two sectors. We aimed...... to explore how depression is understood by GPs and clinical psychiatrists. We carried out qualitative in-depth interviews with 11 psychiatrists and 12 GPs. Analysis was made by Interpretative Phenomenological Analysis. We found that the two groups of physicians differed considerably in their views...

  20. Working Collaboratively

    DEFF Research Database (Denmark)

    Holder, Anna; Lovett, George

    2009-01-01

    Working collaboratively is arguably an essential skill in architectural practice as the complexity of contemporary projects involves multiple agents in the conception, construction and use of architecture. This has been emphasised by recent government rhetoric. Mass collaboration has been...... identified as a transformative global force of the last decade, most notably in knowledge and information publishing, communication and creation. This paper presents a structured conversation on changing understandings of collaboration, and the realities of collaborative methodology in architectural work....... Ideas of the platforms and structures necessary to support ‘creative’ collaborations are advanced and tested, and a vocabulary of key terms is developed. The conversation extends to reflect on the role of the architecture profession in supporting or enabling collaboration in architectural works....

  1. Collaborative experience

    DEFF Research Database (Denmark)

    Mortensen, Thomas Bøtker

    Literature review: Collaborative experience has been shown to have a positive effect on the collaborative outcome in general (Anand & Khanna, 2000; Kale, Dyer & Singh, 2002). Furthermore, it has been linked to the ability to exploit the network of the firm for learning (Powell, Koput and Smith...... experience was largest the higher the hypothesized ambiguity. Theoretically contribution: This research project aims at contributing to existing literature by arguing, that collaborative experience is a moderating variable which moderates the effects on collaborative outcome from the level of complexity......, that the largest effects from collaborative experience is from recent collaborative experience, since knowledge depreciates when it is not used. Methodologically contribution: The research project studies the dyad and aims at introducing, to this field of research, an established way of collecting data, a new...

  2. Depression - resources

    Science.gov (United States)

    Resources - depression ... Depression is a medical condition. If you think you may be depressed, see a health care provider. ... following organizations are good sources of information on depression : American Psychological Association -- www.apa.org/topics/depression/ ...

  3. Symptoms and Treatment of Depression

    Medline Plus

    Full Text Available ... Principal Investigators Administrative Oversight & Support Collaborations & Partnerships Join A Study News & Events News & Events Home Science News ... for myself. NARRATOR : Depression is more than just a feeling of being down in the dumps or ...

  4. Depression (Major Depressive Disorder)

    Science.gov (United States)

    ... your mood. Chronic pain causes a number of problems that can lead to depression, such as trouble sleeping and stress. Disabling pain can cause low self-esteem due to work, legal or financial issues. Depression ...

  5. Is a Breakthrough on Climate Change Governance on the Horizon?

    DEFF Research Database (Denmark)

    Figueroa, Maria Josefina

    The recently released Fifth Assessment report of the IPCC has highlighted again with unprecedented scope and insight the urgency of addressing climate change. The international community has pledged to devise the next international agreement on climate change by 2015, while the EU and in particular...... the Scandinavian countries have forged ahead advancing a variety of policies to respond to climate change. Similarly, regions, municipalities, and private actors across the world are also contributing to climate governance. This paper asks whether the world is reaching a tipping point where a breakthrough...... on climate change governance is near?. The answer is approached by contrasting the governance model within which the IPCC operates and the conditions of policy and governance interaction toward the more scientific foundations laid out by IPCC, with the range of multilateral climate governance...

  6. Islet transplantation: lessons learned since the Edmonton breakthrough.

    Science.gov (United States)

    Langer, R M

    2010-06-01

    This work sought to summarize the main issues of the last decade in the field of clinical islet transplantation. Ten years ago in Edmonton, a new protocol initiated for islet transplantation brought a breakthrough to the field. The earlier, rather poor results were in a sharp contrast to the first published results of 100% insulin freedom at 1 year. However, later it became clear that the promising initial results decline with time; at around 5 years, only about 10% of the patients maintain freedom from external insulin. Despite that fact, a milestone was set and intensive research started worldwide. New hopes were raised for patients. Modifications of the original protocol have been implemented to improve clinical results; however, islet transplantation remains an experimental procedure to date.

  7. Serum (1,3)-beta-D-glucan is an inefficient marker of breakthrough candidemia.

    Science.gov (United States)

    Abe, Masahiro; Kimura, Muneyoshi; Araoka, Hideki; Taniguchi, Shuichi; Yoneyama, Akiko

    2014-11-01

    The aim of this study was to evaluate the usefulness of serum (1,3)-beta-D-glucan (BDG) for earlier detection of breakthrough candidemia. We reviewed the medical records of patients with candidemia from January 2008 to March 2013. Serum BDG was measured by Wako turbidimetric assay. During the study period, a total of 147 cases of candidemia were identified, and 31 patients met the criteria for breakthrough candidemia. Serum BDG levels were measured in 25 patients with breakthrough candidemia and 67 patients with nonbreakthrough candidemia. Almost all of the patients with breakthrough candidemia had hematological malignancies. More candidemia were caused by non-C. albicans Candida in the breakthrough group than in the nonbreakthrough group (92.0% vs. 61.8%, p = .005). The median BDG value was significantly lower in breakthrough episodes than in non-breakthrough episodes (18.5 pg/ml vs. 90.4 pg/ml, p = .01). Moreover, BDG values under the cutoff was significantly higher in patients with breakthrough candidemia than in those with nonbreakthrough candidemia (44% vs. 19%, p = .03). In summary, BDG alone was insufficient to detect breakthrough candidemia, and candidemia could occur in patients being treated with antifungal agents, even when the BDG value was under the cutoff value. © The Author 2014. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  8. Single-dose fentanyl sublingual spray for breakthrough cancer pain

    Directory of Open Access Journals (Sweden)

    Taylor DR

    2013-07-01

    Full Text Available Donald R Taylor Comprehensive Pain Care PC, Marietta, GA, USA Abstract: Breakthrough cancer pain (BTCP is defined as a transient exacerbation of pain that arises in patients with otherwise controlled persistent pain. BTCP typically has a rapid onset and relatively short duration, but it causes a significant amount of physical and psychological distress for patients. Several rapid-onset fentanyl formulations have been introduced in the USA to replace traditional oral opioids for the treatment of BTCP: a transmucosal lozenge, a sublingual orally disintegrating tablet, a buccal tablet, a buccal soluble film, a pectin nasal spray and, the newest formulation to enter the market, a sublingual spray. This article reviews the six rapid-onset formulations of fentanyl approved in the USA for the management of BTCP with emphasis on describing the published literature on fentanyl sublingual spray. The different fentanyl formulations vary in pharmacokinetic properties and ease of use, but all have a rapid onset and a relatively short duration of analgesia. Fentanyl sublingual spray has demonstrated absorption within 5 minutes of administration, with fentanyl plasma concentrations increasing over the first 30 minutes and remaining elevated for 60–90 minutes in pharmacokinetic studies in healthy subjects. Fentanyl sublingual spray shows linear dose proportionality, and changes in the temperature or acidity of the oral cavity do not alter its pharmacokinetic properties. In patients with BTCP, statistically significant pain relief is measurable at 5 minutes after administration of fentanyl sublingual spray, when compared with placebo, with significant pain relief lasting at least 60 minutes after administration. Adverse events are typical of opioid treatment and are considered mild to moderate in intensity. In summary, fentanyl sublingual spray provides rapid onset of analgesia and is a tolerable and effective treatment for BTCP. Keywords: breakthrough pain

  9. The Breakthrough Listen Initiative and the Future of the Search for Intelligent Life

    Science.gov (United States)

    Enriquez, J. Emilio; Siemion, Andrew; Croft, Steve; Hellbourg, Greg; Lebofsky, Matt; MacMahon, David; Price, Danny; DeBoer, David; Werthimer, Dan

    2017-05-01

    Unprecedented recent results in the fields of exoplanets and astrobiology have dramatically increased the interest in the potential existence of intelligent life elsewhere in the galaxy. Additionally, the capabilities of modern Searches for Extraterrestrial Intelligence (SETI) have increased tremendously. Much of this improvement is due to the ongoing development of wide bandwidth radio instruments and the Moore's Law increase in computing power over the previous decades. Together, these instrumentation improvements allow for narrow band signal searches of billions of frequency channels at once.The Breakthrough Listen Initiative (BL) was launched on July 20, 2015 at the Royal Society in London, UK with the goal to conduct the most comprehensive and sensitive search for advanced life in humanity's history. Here we detail important milestones achieved during the first year and a half of the program. We describe the key BL SETI surveys and briefly describe current facilities, including the Green Bank Telescope, the Automated Planet Finder and the Parkes Observatory. We also mention the ongoing and potential collaborations focused on complementary sciences, these include pulse searches of pulsars and FRBs, as well as astrophysically powered radio emission from stars targeted by our program.We conclude with a brief view towards future SETI searches with upcoming next-generation radio facilities such as SKA and ngVLA.

  10. Collaborative Prototyping

    DEFF Research Database (Denmark)

    Bogers, Marcel; Horst, Willem

    2014-01-01

    changes, and it detects emerging usability problems through active engagement and experimentation. As such, the collaborative prototype acts as a boundary object to represent, understand, and transform knowledge across functional, hierarchical, and organizational boundaries. Our study also identifies some......This paper presents an inductive study that shows how collaborative prototyping across functional, hierarchical, and organizational boundaries can improve the overall prototyping process. Our combined action research and case study approach provides new insights into how collaborative prototyping...... can provide a platform for prototype-driven problem solving in early new product development (NPD). Our findings have important implications for how to facilitate multistakeholder collaboration in prototyping and problem solving, and more generally for how to organize collaborative and open innovation...

  11. THE ARTHRITIS AND MUSCULOSKELETAL QUALITY IMPROVEMENT PROGRAM (AMQUIP: A BREAKTHROUGH SERIES METHODOLOGY PROJECT

    Directory of Open Access Journals (Sweden)

    MASTURA I

    2008-01-01

    Full Text Available The Australian government had funded the National Primary Care Collaborative (NPCC program with funding of $14.6 million over three years. One of the pilots project was the Arthritis and Musculoskeletal Quality Improvement Program (AMQuIP.The study aims to optimize general practitioners (GPs management of patients with osteoarthritis (OA of the hip and knee by identifying gaps between their current practice and best practice. The Breakthrough Series Collaborative methodology with several Plan-Do-Study-Act (PDSA cycles was employed. Participants comprises of 12 GPs/practices from two Victorian Divisions of general Practice (one rural, one metropolitan with 10 patients per GP/practice. GPs/practices attended an orientation and three learning workshops and a videoconference. GPs/practices completed PDSA cycles between workshop and reported results at workshops. GPs/practices reported use of guidelines, change in patient management and change in practice management/systems. All recruited patients completed the SF-12v2 Health Survey and WOMAC OA Index Questionnaire twice. Follow up activities including focus groups and face-to-face interviews were held six months after the final workshop. All GPs/practices used the guidelines/key messages, introduced “new” management strategies to patients, and made positive changes to their practice management/systems. Patient reported positive changes and outcomes. By using a structured methodology and evidence-based guidelines/key messages; GPs can introduce new patient management strategies, and by identifying gaps in practice management systems, positive changes can be achieved.

  12. 75 Breakthroughs by the U.S. Department of Energy's National Laboratories; Breakthroughs 2017

    Energy Technology Data Exchange (ETDEWEB)

    None

    2017-01-01

    Born at a time when the world faced a dire threat, the National Laboratory System protects America through science and technology. For more than 75 years, the Department of Energy’s national laboratories have solved important problems in science, energy and national security. Partnering with industry and academia, the laboratories also drive innovation to advance economic competitiveness and ensure our nation’s future prosperity. Over the years, America's National Laboratories have been changing and improving the lives of millions of people and this expertise continues to keep our nation at the forefront of science and technology in a rapidly changing world. This network of Department of Energy Laboratories has grown into 17 facilities across the country. As this list of breakthroughs attests, Laboratory discoveries have spawned industries, saved lives, generated new products, fired the imagination and helped to reveal the secrets of the universe.

  13. Postpartum Depression

    Science.gov (United States)

    ... Patients Search FAQs Postpartum Depression Page Navigation ▼ ACOG Pregnancy Book Postpartum Depression Patient Education FAQs Postpartum Depression Patient Education Pamphlets - Spanish Postpartum ...

  14. Calculation of Breakthrough Time in Oil Recovery by the Use of ...

    African Journals Online (AJOL)

    Recent studies indicate that percolation models may be be used to predict breakthrough time by the use of the fractal dimension of the shortest path. The paper shows that better predictions can be made about the breakthrough time when the actual fractal dimension of the boundaries of the oil reservoirs are calculated.

  15. Alternative sample-introduction technique to avoid breakthrough in gradient-elution liquid chromatography of polymers

    NARCIS (Netherlands)

    Reingruber, E.; Bedani, F.; Buchberger, W.; Schoenmakers, P.

    2010-01-01

    Gradient-elution liquid chromatography (GELC) is a powerful tool for the characterization of synthetic polymers. However, gradient-elution chromatograms often suffer from breakthrough phenomena. Breakthrough can be averted by using a sample solvent as weak as the mobile phase. However, this approach

  16. The New Three Rs: Research, Reading, and Results. Breakthrough to Literacy[TM].

    Science.gov (United States)

    McGraw-Hill Companies, New York, NY. Educational and Professional Publishing Group.

    Research in school districts throughout the United States shows that children who use "Breakthrough to Literacy" achieve significant and lasting improvement in their reading skills. At virtually every site studied where implementation criteria were met, children who participated in "Breakthrough" demonstrated marked increases…

  17. Differences in characteristics between first and breakthrough neutropenic fever after chemotherapy in patients with hematologic disease

    Directory of Open Access Journals (Sweden)

    Eun Young Nam

    2016-03-01

    Conclusion: It is concluded that the epidemiological profile of breakthrough neutropenic fever is different from that of first episode fever. These data reinforce the view that pooled reporting of neutropenic fever may be misleading, and that clinicians should approach breakthrough fever as a distinct entity.

  18. Collaborative Appropriation

    DEFF Research Database (Denmark)

    Muller, Michael; Neureiter, Katja; Verdezoto, Nervo

    2016-01-01

    Previous workshops and papers have examined how individual users adopt and adapt technologies to meet their own local needs, by “completing design through use.” However, there has been little systematic study of how groups of people engage collaboratively in these activities. This workshop opens...... a discussion for these under-studied forms of collaborative appropriation, using a broad range of perspectives including empirical data, design explorations, research, and critique....

  19. From Islamicizing the Sciences to Strategizing for Muslims’ Scientific Breakthrough

    Directory of Open Access Journals (Sweden)

    RAFIU IBRAHIM ADEBAYO

    2015-06-01

    Full Text Available At inception, science and religion were seen as poles apart and so science was vehemently kicked against by religious leaders. Islam later came to bridge the gap between religion and science only to be later hijacked by the Western world and so science was rewritten from a purely materialist point of view; hence, experts in modern science became over-confident and arrogant to have relegated religion to the lowest ebb and looked down upon any knowledge which could not be scientifically proved. However attempts are being made to reconcile religion and science by Muslim reformers. These attempts are not without their shortcomings, hence the need for Islamization of the sciences for them to conform to the Islamic principle of unity of knowledge. However, the present researcher feels that there should be a step forward from the contemporary approaches to Islamicizing the sciences in form of colouring the Western scientific discoveries Islam, to making their own scientific breakthroughs, the type which immortalized Muslim scientists of the Islam’s golden ages. Without this, Muslims will continue to be mere consumers of the Western products. The strategy for the Ummah to achieve this is suggested in this paper.

  20. Structural mechanism of GPCR-arrestin interaction: recent breakthroughs.

    Science.gov (United States)

    Park, Ji Young; Lee, Su Youn; Kim, Hee Ryung; Seo, Min-Duk; Chung, Ka Young

    2016-03-01

    G protein-coupled receptors (GPCRs) are a major membrane receptor family with important physiological and pathological functions. In the classical signaling pathway, ligand-activated GPCRs couple to G proteins, thereby inducing G protein-dependent signaling pathways and phosphorylation by G protein-coupled receptor kinases (GRKs). This leads to an interaction with arrestins, which results in GPCR desensitization. Recently, non-classical GPCR signaling pathways, mediated by GPCR-bound arrestins, have been identified. Consequently, arrestins play important roles in GPCR signaling not only with respect to desensitization but also in relation to G protein-independent signal transduction. These findings have led to efforts to develop functionally biased (i.e. signal transduction biased) GPCR-targeting drugs. One of these efforts is aimed at understanding the structural mechanism of functionally biased GPCR signaling, which includes understanding the G protein-selectivity or arrestin-selectivity of GPCRs. This goal has not yet been achieved; however, great progress has been made during the last 3 years toward understanding the structural mechanism of GPCR-mediated arrestin activation. This review will discuss the recent breakthroughs in the conformational understanding of GPCR-arrestin interaction.

  1. Clean Energy Innovation: Sources of Technical and Commercial Breakthroughs

    Energy Technology Data Exchange (ETDEWEB)

    Perry, T. D., IV; Miller, M.; Fleming, L.; Younge, K.; Newcomb, J.

    2011-03-01

    Low-carbon energy innovation is essential to combat climate change, promote economic competitiveness, and achieve energy security. Using U.S. patent data and additional patent-relevant data collected from the Internet, we map the landscape of low-carbon energy innovation in the United States since 1975. We isolate 10,603 renewable and 10,442 traditional energy patents and develop a database that characterizes proxy measures for technical and commercial impact, as measured by patent citations and Web presence, respectively. Regression models and multivariate simulations are used to compare the social, institutional, and geographic drivers of breakthrough clean energy innovation. Results indicate statistically significant effects of social, institutional, and geographic variables on technical and commercial impacts of patents and unique innovation trends between different energy technologies. We observe important differences between patent citations and Web presence of licensed and unlicensed patents, indicating the potential utility of using screened Web hits as a measure of commercial importance. We offer hypotheses for these revealed differences and suggest a research agenda with which to test these hypotheses. These preliminary findings indicate that leveraging empirical insights to better target research expenditures would augment the speed and scale of innovation and deployment of clean energy technologies.

  2. Recent breakthroughs on C-2U: Norman’s legacy

    Energy Technology Data Exchange (ETDEWEB)

    Binderbauer, M. W.; Tajima, T.; Tuszewski, M.; Smirnov, A.; Gota, H.; Garate, E.; Barnes, D.; Deng, B. H.; Trask, E.; Yang, X.; Putvinski, S.; Andow, R.; Bolte, N.; Bui, D. Q.; Ceccherini, F.; Clary, R.; Cheung, A. H.; Conroy, K. D.; Dettrick, S. A.; Douglass, J. D. [Tri Alpha Energy, Inc., P.O. Box 7010, Rancho Santa Margarita, CA 92688 (United States); and others

    2016-03-25

    Conventional field-reversed configurations (FRC) face notable stability and confinement concerns, which can be ameliorated by introducing and maintaining a significant fast ion population in the system. This is the conjecture first introduced by Norman Rostoker multiple decades ago and adopted as the central design tenet in Tri Alpha Energy’s advanced beam driven FRC concept. In fact, studying the physics of such neutral beam (NB) driven FRCs over the past decade, considerable improvements were made in confinement and stability. Next to NB injection, the addition of axially streaming plasma guns, magnetic end plugs, as well as advanced surface conditioning lead to dramatic reductions in turbulence driven losses and greatly improved stability. In turn, fast ion confinement improved significantly and allowed for the build-up of a dominant fast particle population. This recently led to the breakthrough of sustaining an advanced beam driven FRC, thereby demonstrating successful maintenance of trapped magnetic flux, plasma dimensions and total pressure inventory for times much longer than all characteristic system time scales and only limited by hardware and electric supply constraints.

  3. Parameterizing the Spatial Markov Model From Breakthrough Curve Data Alone

    Science.gov (United States)

    Sherman, Thomas; Fakhari, Abbas; Miller, Savannah; Singha, Kamini; Bolster, Diogo

    2017-12-01

    The spatial Markov model (SMM) is an upscaled Lagrangian model that effectively captures anomalous transport across a diverse range of hydrologic systems. The distinct feature of the SMM relative to other random walk models is that successive steps are correlated. To date, with some notable exceptions, the model has primarily been applied to data from high-resolution numerical simulations and correlation effects have been measured from simulated particle trajectories. In real systems such knowledge is practically unattainable and the best one might hope for is breakthrough curves (BTCs) at successive downstream locations. We introduce a novel methodology to quantify velocity correlation from BTC data alone. By discretizing two measured BTCs into a set of arrival times and developing an inverse model, we estimate velocity correlation, thereby enabling parameterization of the SMM in studies where detailed Lagrangian velocity statistics are unavailable. The proposed methodology is applied to two synthetic numerical problems, where we measure all details and thus test the veracity of the approach by comparison of estimated parameters with known simulated values. Our results suggest that our estimated transition probabilities agree with simulated values and using the SMM with this estimated parameterization accurately predicts BTCs downstream. Our methodology naturally allows for estimates of uncertainty by calculating lower and upper bounds of velocity correlation, enabling prediction of a range of BTCs. The measured BTCs fall within the range of predicted BTCs. This novel method to parameterize the SMM from BTC data alone is quite parsimonious, thereby widening the SMM's practical applicability.

  4. Breakthrough characteristics of gas absorption in a packed column

    International Nuclear Information System (INIS)

    Shitanda, Shoji; Fukada, Satoshi; Koto, Kenji; Mitsuishi, Nobuo

    1979-01-01

    In nuclear industries, the operations to collect or recover various radioactive and non-radioactive gases with a number of absorption or adsorption reagents are practically utilized or planned. Specifically in the operations of recovering hydrogen isotopes, the direct collecting method with active metals such as uranium, zirconium (Zr) and yttrium is watched with keen interest. In this study, the capability of recovering hydrogen by means of Zr was investigated through the estimation of rate-determining step, by flowing the gas mixture of hydrogen and argon after activating metallic Zr under the condition of high temperature and high vacuum, and by determining overall mass transfer coefficient from the absorption breakthrough curves. The details of a packed column and the flowsheet are also described, and the deterioration of Zr powder is considered. That is, the diffusion speed and absorbing reaction speed of hydrogen in Zr particles are supposed to be slow and dominant in mass transfer speed. Further, since gas mixture does not simply diffuse in Zr particles, but the reaction plane seems to move toward the center from the surface in the case of Zr, different from general adsorbents, the moving speed seems to give large effect on the rate-determining step. It is ensured that the hydrogen absorption with Zr powder is so active that hydrogen in gas flow can easily be recovered, and its separation from other gases can be effectively carried out by the desorption of hydrogen from Zr powder by heating it in vacuum. (Wakatsuki, Y.)

  5. Funding breakthrough therapies: A systematic review and recommendation.

    Science.gov (United States)

    Hanna, E; Toumi, M; Dussart, C; Borissov, B; Dabbous, O; Badora, K; Auquier, P

    2018-03-01

    Advanced therapy medicinal products (ATMPs) are innovative therapies likely associated with high prices. Payers need guidance to create a balance between ensuring patient access to breakthrough therapies and maintaining the financial sustainability of the healthcare system. The aims of this study were to identify, define, classify and compare the approaches to funding high-cost medicines proposed in the literature, to analyze their appropriateness for ATMP funding and to suggest an optimal funding model for ATMPs. Forty-eight articles suggesting new funding models for innovative high-cost therapies were identified. The models were classified into 3 groups: financial agreement, health outcomes-based agreement and healthcoin. Financial agreement encompassed: discounts, rebates, price and volume caps, price-volume agreements, loans, cost-plus price, intellectual-based payment and fund-based payment. Health outcomes-based agreements were defined as agreements between manufacturers and payers based on drug performance, and were divided into performance-based payment and coverage with evidence development. Healthcoin described a new suggested tradeable currency used to assign monetary value to incremental outcomes. With a large number of ATMPs in development, it is time for stakeholders to start thinking about new pathways and funding strategies for these innovative high-cost therapies. An "ATMP-specific fund" may constitute a reasonable solution to ensure rapid patient access to innovation without threatening the sustainability of the health care system. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Cost-utility of collaborative care for the treatment of comorbid major depressive disorder in outpatients with chronic physical conditions. A randomized controlled trial in the general hospital setting (CC-DIM

    Directory of Open Access Journals (Sweden)

    Goorden M

    2017-07-01

    Full Text Available Maartje Goorden,1 Christina M van der Feltz-Cornelis,2,3 Kirsten M van Steenbergen-Weijenburg,4 Eva K Horn,5 Aartjan TF Beekman,6,7 Leona Hakkaart-van Roijen1 1Institute of Health Policy and Management (iBMG/Institute for Medical Technology Assessment (iMTA, Erasmus University Rotterdam, Rotterdam, 2Tranzo Department, Tilburg University, 3Clinical Centre of Excellence for Body, Mind and Health, GGzBreburg, Tilburg, 4Trimbos Instituut, Utrecht, 5Viersprong Institute for Studies on Personality Disorders, Halsteren, 6Department of Psychiatry, 7EMGO+ Research Institute VUmc, VU University Medical Centre, Amsterdam, the Netherlands Purpose: Major depressive disorder (MDD is highly prevalent in patients with a chronic physical condition, and this comorbidity has a negative influence on quality of life, health care costs, self-care, morbidity, and mortality. Research has shown that collaborative care (CC may be a cost-effective treatment. However, its cost-effectiveness in this patient group has not yet been established. Therefore, the aim of this study was to evaluate the cost-utility of CC for the treatment of comorbid MDD in chronically ill patients in the outpatient general hospital setting. The study was conducted from a health care and societal perspective.Patients and methods: In this randomized controlled trial, 81 patients with moderate-to-severe MDD were included; 42 were randomly assigned to the CC group and 39 to the care as usual (CAU group. We applied the TiC-P, short-form Health-Related Quality of Life questionnaire, and EuroQol EQ-5D 3 level version, measuring the use of health care, informal care, and household work, respectively, at baseline and at 3, 6, 9, and 12 months follow-up.Results: The mean annual direct medical costs in the CC group were €6,718 (95% confidence interval [CI]: 3,541 to 10,680 compared to €4,582 (95% CI: 2,782 to 6,740 in the CAU group. The average quality-adjusted life years (QALYs gained were 0.07 higher

  7. Collaborative Consumption

    DEFF Research Database (Denmark)

    Gjerdrum Pedersen, Esben Rahbek; Netter, Sarah

    Purpose: The purpose of this paper is to explore barriers and opportunities for business models based on the ideas of collaborative consumption within the fashion industry. Design/methodology/approach: The analysis is based on a multiple-­‐‑case study of Scandinavian fashion libraries – a new...... to the new phenomenon of fashion libraries and does not cover other types of collaborative consumption within the fashion industry (Swap-­‐‑parties, etc.). Originality/value: The paper is one of the first attempts to examine new business models of collaborative consumption in general and the fashion library......, clothes-­‐‑sharing concept that has emerged as a fashion niche within the last decade. Findings: It is concluded that fashion libraries offers interesting perspectives, e.g. by allowing people to experiment with styles without having to pay the full cost and becoming a meeting place for young designers...

  8. Collaborative Consumption

    DEFF Research Database (Denmark)

    Gjerdrum Pedersen, Esben Rahbek; Netter, Sarah

    2015-01-01

    Purpose – The purpose of this paper is to explore barriers and opportunities for business models based on the ideas of collaborative consumption within the fashion industry. Design/methodology/approach – The analysis is based on a multiple-case study of Scandinavian fashion libraries – a new...... to the new phenomenon of fashion libraries and does not cover other types of collaborative consumption within the fashion industry (Swap-parties, etc.). Originality/value – The paper is one of the first attempts to examine new business models of collaborative consumption in general and the fashion library......, clothes-sharing concept that has emerged as a fashion niche within the last decade. Findings – It is concluded that fashion libraries offers interesting perspectives, e.g. by allowing people to experiment with styles without having to pay the full cost and becoming a meeting place for young designers...

  9. Collaborative Moments

    DEFF Research Database (Denmark)

    Hastrup, Kirsten Blinkenberg

    2017-01-01

    as an experiment in real time, where insights gained intersubjectively gradually shape up as knowledge through analysis. This line of thought is brought to bear on a discussion of collaboration between anthropologists, archaeologists, and biologists in North West Greenland. Through actual experiences from...... the field, this article shows how knowledge generated on the edge of one’s familiar disciplinary territory may both expand and intensify the anthropological field. Collaborative moments are seen to make new anthropological insights emerge through the co-presence of several analytical perspectives...

  10. Collaborative Improvement

    DEFF Research Database (Denmark)

    Kaltoft, Rasmus

    -organisational continuous improvement of their performance, relative to that of other EMEs. Developing a collaborative improvement relationship between companies is a protracted and complex process and, according to some surveys, the failure rate is as low as one to three. This failure rate is affected by a whole range...... of factors. The research presented in this thesis was aimed at identifying these factors and investigating their interplay and influence on the progress and success of the development of the collaborative improvement. This thesis presents our findings regarding the factors found, their interplay...

  11. A European survey of oncology nurse breakthrough cancer pain practices.

    Science.gov (United States)

    Rustøen, Tone; Geerling, Jenske I; Pappa, Theodora; Rundström, Carina; Weisse, Isolde; Williams, Sian C; Zavratnik, Bostjan; Kongsgaard, Ulf E; Wengström, Yvonne

    2013-02-01

    Breakthrough cancer pain (BTCP) is a prevalent type of pain in which the nurse can play an important role in improving patients' pain symptoms and overall well-being. Nurses' experience with BTCP (number of patients, and estimates of severity and frequency), the treatment of BTCP (pharmacological and nonpharmacological treatments normally used), ratings of the importance of treatment factors, and reasons given for not advising patients to take strong painkillers are presented in the present paper. Nurses from 12 European countries, who cared for patients with cancer, took part in a survey. In total 1618 nurses were recruited and 1241 completed the survey questionnaire. Almost 90% of the nurses were female, and 50.4% had >9 years of experience in oncology nursing. The majority of the nurses (47%) said that a patient typically suffered from BTCP 2-3 times a day, and the severity of the pain for the patients was described as severe by 75.5%. In all, 38.4% of the nurses were unaware that medications specifically intended for treatment of BTCP exist, and 57% reported that oral opioids were normally prescribed for BTCP at their workplace. While 38% said they did not use nonpharmacological treatments for BTCP, the most common treatment approach was positional change (used by 76.6%). The treatment varied between the European countries. Patients do not receive the appropriate medical treatment for their BTCP. Nurses need better training about BTCP in general, and BTCP assessment and management specifically. Copyright © 2012 Elsevier Ltd. All rights reserved.

  12. Technical breakthroughs in the wearable artificial kidney (WAK).

    Science.gov (United States)

    Gura, Victor; Macy, Alexandra S; Beizai, Masoud; Ezon, Carlos; Golper, Thomas A

    2009-09-01

    The wearable artificial kidney (WAK) has been a holy grail in kidney failure for decades. Described herein are the breakthroughs that made possible the creation of the WAK V1.0 and its advanced versions V 1.1 and 1.2. The battery-powered WAK pump has a double channel pulsatile counter phase flow. This study clarifies the role of pulsatile blood and dialysate flow, a high-flux membrane with a larger surface area, and the optimization of the dialysate pH. Flows and clearances from the WAK pump were compared with conventional pumps and with gravity steady flow. Raising dialysate pH to 7.4 increased adsorption of ammonia. Clearances were higher with pulsatile flow as compared with steady flow. The light WAK pump, geometrically suitable for wearability, delivered the same clearances as larger and heavier pumps that cannot be battery operated. Beta(2) microglobulin (beta(2)M) was removed from human blood in vitro. Activated charcoal adsorbed most beta(2)M in the dialysate. The WAK V1.0 delivered an effective creatinine clearance of 18.5 +/- 3.2 ml/min and the WAK V1.1 27.0 +/- 4.0 ml/min in uremic pigs. Half-cycle differences between blood and dialysate, alternating transmembrane pressures (TMP), higher amplitude pulsations, and a push-pull flow increased convective transport. This creates a yet undescribed type of hemodiafiltration. Further improvements were achieved with a larger surface area high-flux dialyzer and a higher dialysate pH. The data suggest that the WAK might be an efficient way of providing daily dialysis and optimizing end stage renal disease (ESRD) treatment.

  13. Enabling Breakthrough Kinetic Simulations of the Magnetosphere Using Petascale Computing

    Science.gov (United States)

    Vu, H. X.; Karimabadi, H.; Omelchenko, Y.; Tatineni, M.; Majumdar, A.; Krauss-Varban, D.; Dorelli, J.

    2009-12-01

    Currently global magnetospheric simulations are predominantly based on single-fluid magnetohydrodynamics (MHD). MHD simulations have proven useful in studies of the global dynamics of the magnetosphere with the goal of predicting eminent features of substorms and other global events. But it is well known that the magnetosphere is dominated by ion kinetic effects, which is ignored in MHD simulations, and many key aspects of the magnetosphere relating to transport and structure of boundaries await global kinetic simulations. We are using our recent innovations in hybrid (electron fluid, kinetic ions) simulations, as being developed in our Hybrid3D (H3D) code, and the power of massively parallel machines to make, breakthrough 3D global kinetic simulations of the magnetosphere. The innovations include (i) multi-zone (asynchronous) algorithm, (ii) dynamic load balancing, and (iii) code adaptation and optimization to large number of processors. In this presentation we will show preliminary results of our progress to date using from 512 to over 8192 cores. In particular, we focus on what we believe to be the first demonstration of the formation of a flux rope in 3D global hybrid simulations. As in the MHD simulations, the resulting flux rope has a very complex structure, wrapping up field lines from different regions and appears to be connected on at least one end to Earth. Magnetic topology of the FTE is examined to reveal the existence of several separators (3D X-lines). The formation and growth of this structure will be discussed and spatial profile of the magnetic and plasma variables will be compared with those from MHD simulations.

  14. Breakthrough cancer pain: twenty-five years of study.

    Science.gov (United States)

    Mercadante, Sebastiano; Portenoy, Russell K

    2016-12-01

    Breakthrough cancer pain (BTcP) is an episode of severe pain that "breaks through" a period of persistent pain at least partly controlled by a stable opioid regimen. Although mentioned in the literature decades ago, it has been only 25 years since the first effort to define and measure it. Controversy about the definition of BTcP continues despite an international effort to achieve consensus. Nevertheless, common approaches to measurement of BTcP have led to a robust literature, including many surveys that have described prevalence, characteristics, and association with adverse outcomes. Measurement also has been important for clinical trials of new drug formulations specifically designed for BTcP. Several approaches have been reported in the literature, although most of them have never been substantiated with appropriate studies. Administration of an opioid as needed is the most common treatment. Twenty-five years of research has produced a more refined understanding of the safety and efficacy of oral opioids in this context, and provided the clinical trials data necessary to attain regulatory approval of multiple new formulations specifically developed for BTcP. Transmucosal formulations of fentanyl may provide meaningful analgesia within 5 to 15 minutes. Given the difference in cost, transmucosal formulations should be considered in a subset of patients with BTcP, including those with pain that are not adequately controlled with an oral drug and those with distress associated with the rapid pain onset. The long-term use of opioids for BTcP remains to be clarified. Future studies should assess the potential of personalized treatment of BTcP.

  15. [Future directions of neurology - breakthrough to the next stage ].

    Science.gov (United States)

    Tsuji, Shoji

    2010-11-01

    The 51st Annual Meeting of the Japanese Society of Neurology was held in Tokyo (Tokyo International Forum) from Thursday, May 20 to Saturday, May 22, 2010 with as many as 5,471 attendants. Our Society has been celebrating its 50th anniversary during the period from 2009 through 2010. At the 51st Annual Meeting in 2010, we looked toward the future, as we celebrate our 50th anniversary together with distinguished guests closely related to our Society. The theme for the 51st Annual Meeting was set as "Future of Neurology-Breakthrough to the next stage-." As represented in the theme, I hope that the Annual Meeting provided an excellent opportunity for all of us to look ahead to the future of Neurology and our Society in the next half-century. We have achieved tremendous advances in better understanding neurological diseases and developing more efficacious treatment over the last half century. Great strides have been made in all areas, of which diagnostic imaging, molecular genetics, immunology and physiology are just a few examples, and understanding of diseases has similarly taken a great leap forward. In Japan, the aging of society coupled with the declining birthrate has placed ever-increasing expectations on neurologists to provide better care for dementia, cerebrovascular disorders and neurodegenerative diseases. Given this situation our Society is required to provide outstanding education in both the pre- and post-graduate context, and, furthermore, to ensure that excellent training programs are available for young neurologists preparing for Board certification. Looking towards the future of neurology, we should continue to anticipate new, ground-breaking achievements for better understanding neurological diseases and establishing more effective treatment through our ongoing endeavors.

  16. Collaborative Design

    Science.gov (United States)

    Broderick, Debora

    2014-01-01

    This practitioner research study investigates the power of multimodal texts within a real-world context and argues that a participatory culture focused on literary arts offers marginalized high school students opportunities for collaborative design and authoring. Additionally, this article invites educators to rethink the at-risk label. This…

  17. Risk Factors for Breakthrough Pneumocystis carinii Pneumonia on Aerosol Pentamidine Prophylaxis

    Directory of Open Access Journals (Sweden)

    RA McIvor

    1995-01-01

    Full Text Available OBJECTIVE: To identify baseline characteristics of human immunodeficiency virus (HIV-infected individuals on aerosol pentamidine for Pneumocystis carinii prophylaxis that are predictive of subsequent breakthrough Pneumocystis carinii pneumonia (PCP.

  18. Breakthroughs in Medicinal Chemistry: New Targets and Mechanisms, New Drugs, New Hopes–2

    Directory of Open Access Journals (Sweden)

    Diego Muñoz-Torrero

    2017-12-01

    Full Text Available Breakthroughs in Medicinal Chemistry: New Targets and Mechanisms, New Drugs, New Hopes is a series of Editorials, which are published on a biannual basis by the Editorial Board of the Medicinal Chemistry section of the journal Molecules [...

  19. Depression Screening

    Science.gov (United States)

    ... Depression Screening Substance Abuse Screening Alcohol Use Screening Depression Screening (PHQ-9) - Instructions The following questions are ... this tool, there is also text-only version . Depression Screening - Manual Instructions The following questions are a ...

  20. Caregiver Depression

    Science.gov (United States)

    ... will not sell or share your name. Caregiver Depression Tweet Bookmark this page | Email | Print Many caregivers ... depression See your doctor Treatment Coping Symptoms of depression Caregiving is hard — and can lead to feelings ...

  1. Depression FAQs

    Science.gov (United States)

    Depression affects about 15 million American adults every year. Women are more likely to get depression than men. In general, about one out of every four women will get depression at some point in her life.

  2. Breakthrough disease during interferon-[beta] therapy in MS: No signs of impaired biologic response

    DEFF Research Database (Denmark)

    Hesse, D; Krakauer, M; Lund, H

    2010-01-01

    Disease activity is highly variable in patients with multiple sclerosis (MS), both untreated and during interferon (IFN)-beta therapy. Breakthrough disease is often regarded as treatment failure; however, apart from neutralizing antibodies (NAbs), no blood biomarkers have been established...... as reliable indicators of treatment response, despite substantial, biologically measurable effects. We studied the biologic response to treatment in a cohort of NAb-negative patients to test whether difference in responsiveness could segregate patients with and without breakthrough disease during therapy....

  3. Statistical characteristics of breakthrough discoveries in science using the metaphor of black and white swans

    Science.gov (United States)

    Zeng, Carl J.; Qi, Eric P.; Li, Simon S.; Stanley, H. Eugene; Ye, Fred Y.

    2017-12-01

    A publication that reports a breakthrough discovery in a particular scientific field is referred to as a ;black swan;, and the most highly-cited papers previously published in the same field ;white swans;. Important scientific progress occurs when ;white swans; meet a ;black swan;, and the citation patterns of the ;white swans; change. This metaphor combines scientific discoveries and scientometric data and suggests that breakthrough scientific discoveries are either ;black swans; or ;grey-black swans;.

  4. Treatment of Breakthrough and Refractory Chemotherapy-Induced Nausea and Vomiting

    OpenAIRE

    Navari, Rudolph M.

    2015-01-01

    Despite significant progress in the prevention of chemotherapy-induced nausea and vomiting (CINV) with the introduction of new antiemetic agents, 30–50% of patients receiving moderately or highly emetogenic chemotherapy (MEC or HEC) and guideline directed prophylactic antiemetics develop breakthrough CINV. International guidelines recommend the treatment of breakthrough CINV with an agent from a drug class that was not used in the prophylactic antiemetic regimen and recommend using the breakt...

  5. The management of breakthrough cancer pain--educational needs a European nursing survey.

    Science.gov (United States)

    Wengström, Y; Rundström, C; Geerling, J; Pappa, T; Weisse, I; Williams, S C; Zavratnik, B; Rustøen, T

    2014-01-01

    Poorly managed cancer pain is well known to profoundly impact the patient's daily life and interfere with quality of life. Nurses who cared for patients with cancer from 12 European countries participated in a survey of breakthrough cancer pain practice. The purpose was to investigate how nurses assess breakthrough cancer pain, use of standardised tools, confidence in supporting patients and awareness of medications. Responses from 1241 participants showed country variations. The majority of the sample was female, Germany had the highest proportion of male nurses (21.0%), followed by Greece (15.8%). A significantly larger proportion of nurses with longer experience and more education (78.8%) used a comprehensive definition of breakthrough cancer pain. Significant variations in training were found; 71% of Finnish nurses had received training compared with 6% of Greek nurses. Training and using a standardised assessment tool was associated with a significant increase in the nurses' perceived ability to distinguish between breakthrough and background pain. Nurses in countries with the highest proportion of training were most confident in supporting patients. In conclusion, there still exists problems with effective management of patients' breakthrough cancer pain, continuing inability to define the difference between background and breakthrough cancer pain leads to poor treatment. © 2013 John Wiley & Sons Ltd.

  6. Prediction of ion-exchange column breakthrough curves by constant-pattern wave approach.

    Science.gov (United States)

    Lee, I-Hsien; Kuan, Yu-Chung; Chern, Jia-Ming

    2008-03-21

    The release of heavy metals from industrial wastewaters represents one of major threats to environment. Compared with chemical precipitation method, fixed-bed ion-exchange process can effectively remove heavy metals from wastewaters and generate no hazardous sludge. In order to design and operate fixed-bed ion-exchange processes successfully, it is very important to understand the column dynamics. In this study, the column experiments for Cu2+/H+, Zn2+/H+, and Cd2+/H+ systems using Amberlite IR-120 were performed to measure the breakthrough curves under varying operating conditions. The experimental results showed that total cation concentration in the mobile-phase played a key role on the breakthrough curves; a higher feed concentration resulted in an earlier breakthrough. Furthermore, the column dynamics was also predicted by self-sharpening and constant-pattern wave models. The self-sharpening wave model assuming local ion-exchange equilibrium could provide a simple and quick estimation for the breakthrough volume, but the predicted breakthrough curves did not match the experimental data very well. On the contrary, the constant-pattern wave model using a constant driving force model for finite ion-exchange rate provided a better fit to the experimental data. The obtained liquid-phase mass transfer coefficient was correlated to the flow velocity and other operating parameters; the breakthrough curves under varying operating conditions could thus be predicted by the constant-pattern wave model using the correlation.

  7. The solarPACES strategy for the solar thermal breakthrough

    International Nuclear Information System (INIS)

    Burch, G.D.; Grasse, W.

    1997-01-01

    IEA(International Energy Agency)/SolarPACES(Solar Power and Chemical Energy systems)represents a world wide coalition for information sharing and collaboration on applications of concentrated solar energy. The current SolarPACES community has built up solar thermal system know-how over 15 years, is operating the three main solar test centres in the world. Its main activities are in the following four fields: solar thermal electric power systems, solar chemistry, solar technology and advanced applications and non-technical activities. The article presents the talk on the strategy of solarPACES given at the International Workshop on applied solar energy held in Tashkent(Uzbekistan) in June 1997. (A.A.D.)

  8. Sex differences in the prevalence and detection of depressive and anxiety disorders in general health care settings - Report from the World Health Organization collaborative study on Psychological Problems in General Health Care

    NARCIS (Netherlands)

    Gater, R; Tansella, M; Korten, A; Tiemens, BG; Mavreas, VG; Olatawura, MO

    Background: Understanding the relevance of biological and social factors to sex differences in the prevalence and detection of depressive and anxiety disorders has been impaired by the lack of standardized research methods across cultures. Method: Prevalence rates of depressive and anxiety disorders

  9. Oral Contraceptives, Depression, and Libido

    Science.gov (United States)

    Herzberg, Brenda N.; Draper, Katharine C.; Johnson, Anthony L.; Nicol, Gillian C.

    1971-01-01

    Depression, headaches, and libido were rated in 272 women before starting a contraceptive method and at intervals during the first year of use—54 were fitted with an intrauterine device (I.U.D.) and 218 used one of three oral contraceptives. Side effects caused 25% of the oral contraceptive group and 13% of the I.U.D. group to stop the method. Depression, headaches, and loss of libido were the most common reasons for stopping oral contraceptives and breakthrough bleeding was the most common reason for stopping the I.U.D. The group of women who stopped or changed their oral contraceptives during the survey were compared with the group who remained on the same oral contraceptive throughout. The former had higher mean depression and neuroticism scores at the first clinic visit and contained more women with a history of premenstrual weepiness, depression during pregnancy, outpatient psychiatric treatment, and treatment with antidepressants. Changes in the depression, headache, and libido ratings throughout the survey are presented. PMID:5565516

  10. Collaborative Improvement

    DEFF Research Database (Denmark)

    Kaltoft, Rasmus

    (Denmark, Italy and The Netherlands) each with three to five suppliers were involved. The CO-IMPROVE project and the thesis is based on “action research” and “action learning”. The main aim of the whole project is through actual involvement and actions make the researchers, companies and selected suppliers......The thesis data have been collected in the EU-sponsored project: Collaborative Improvement Tool for the Extended Manufacturing Enterprise, CO-IMPROVE. In this project four universities (Denmark, Ireland, Italy, and The Netherlands), two software vendors (Greece and Sweden) and three companies...

  11. Contested collaboration

    DEFF Research Database (Denmark)

    Sonnenwald, Diane H.

    1995-01-01

    to design outcomes. Through a qualitative analysis of a house, expert system, and telecommunications network architecture and management system design situations, a descriptive model of design that characterizes communication among users, designers, and developers as they create an artifact was developed....... The model describes design phases, roles, themes, and intergroup communication networks as they evolve throughout the design process and characterizes design as a process of "contested collaboration". It is a first step towards a predictive design model that suggests strategies which may help participants...

  12. Collaborative Care

    OpenAIRE

    Schuyler, Dean

    2005-01-01

    本書を著したHornbyは英国のソーシャルワーカーである。彼女は1983年に「Collaboration in social work(Journal of social work practice,1.1)」を発表し、ソーシャルワークでの職種間の連携の重要性について報告している。さらに1993年に発刊した本書では、同一機関内の人間関係 ...

  13. Predicting the Risk of Breakthrough Urinary Tract Infections: Primary Vesicoureteral Reflux.

    Science.gov (United States)

    Hidas, Guy; Billimek, John; Nam, Alexander; Soltani, Tandis; Kelly, Maryellen S; Selby, Blake; Dorgalli, Crystal; Wehbi, Elias; McAleer, Irene; McLorie, Gordon; Greenfield, Sheldon; Kaplan, Sherrie H; Khoury, Antoine E

    2015-11-01

    We constructed a risk prediction instrument stratifying patients with primary vesicoureteral reflux into groups according to their 2-year probability of breakthrough urinary tract infection. Demographic and clinical information was retrospectively collected in children diagnosed with primary vesicoureteral reflux and followed for 2 years. Bivariate and binary logistic regression analyses were performed to identify factors associated with breakthrough urinary tract infection. The final regression model was used to compute an estimation of the 2-year probability of breakthrough urinary tract infection for each subject. Accuracy of the binary classifier for breakthrough urinary tract infection was evaluated using receiver operator curve analysis. Three distinct risk groups were identified. The model was then validated in a prospective cohort. A total of 252 bivariate analyses showed that high grade (IV or V) vesicoureteral reflux (OR 9.4, 95% CI 3.8-23.5, p urinary tract infection (OR 5.3, 95% CI 1.1-24.7, p = 0.034) and female gender (OR 2.6, 95% CI 0.097-7.11, p urinary tract infection. Subgroup analysis revealed bladder and bowel dysfunction was a significant risk factor more pronounced in low grade (I to III) vesicoureteral reflux (OR 2.8, p = 0.018). The estimation model was applied for prospective validation, which demonstrated predicted vs actual 2-year breakthrough urinary tract infection rates of 19% vs 21%. Stratifying the patients into 3 risk groups based on parameters in the risk model showed 2-year risk for breakthrough urinary tract infection was 8.6%, 26.0% and 62.5% in the low, intermediate and high risk groups, respectively. This proposed risk stratification and probability model allows prediction of 2-year risk of patient breakthrough urinary tract infection to better inform parents of possible outcomes and treatment strategies. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights

  14. Collaborative Environments. Considerations Concerning Some Collaborative Systems

    Directory of Open Access Journals (Sweden)

    Mihaela I. MUNTEAN

    2009-01-01

    Full Text Available It is obvious, that all collaborative environments (workgroups, communities of practice, collaborative enterprises are based on knowledge and between collaboration and knowledge management there is a strong interdependence. The evolution of information systems in these collaborative environments led to the sudden necessity to adopt, for maintaining the virtual activities and processes, the latest technologies/systems, which are capable to support integrated collaboration in business services. In these environments, portal-based IT platforms will integrate multi-agent collaborative systems, collaborative tools, different enterprise applications and other useful information systems.

  15. Using Collaborative Engineering to Inform Collaboration Engineering

    Science.gov (United States)

    Cooper, Lynne P.

    2012-01-01

    Collaboration is a critical competency for modern organizations as they struggle to compete in an increasingly complex, global environment. A large body of research on collaboration in the workplace focuses both on teams, investigating how groups use teamwork to perform their task work, and on the use of information systems to support team processes ("collaboration engineering"). This research essay presents collaboration from an engineering perspective ("collaborative engineering"). It uses examples from professional and student engineering teams to illustrate key differences in collaborative versus collaboration engineering and investigates how challenges in the former can inform opportunities for the latter.

  16. The Breakthrough Listen Search for Intelligent Life: the first SETI results and other future science.

    Science.gov (United States)

    Enriquez, J. Emilio; Breakthrough Listen Team

    2018-01-01

    The Breakthrough Listen (BL) Initiative is the largest campaign in human history on the search for extraterrestrial intelligence. The work presented here is the first BL search for engineered signals. This comprises a sample of 692 nearby stars within 50 pc. We used the Green Bank Telescope (GBT) to conduct observations over 1.1-1.9 GHz (L-band). Our observing strategy allows us to reject most of the detected signals as terrestrial interference. During the analysis, eleven stars show events that passed our thresholding algorithm, but detailed analysis of their properties indicates they are consistent with known examples of anthropogenic radio frequency interference. This small number of false positives and their understood properties give confidence on the techniques used for this search. We conclude that, at the time of our observations none of the observed systems host high-duty-cycle radio transmitters emitting at the observed frequencies with an EIRP of 10^13 W, readily achievable by our own civilization.We can place limits on the presence of engineered signals from putative extraterrestrial civilizations inhabiting the environs of the target stars. Our results suggest that fewer than ~0.1% of the stellar systems within 50 pc possess the type of transmitters searched in this survey. This work provides the most stringent limit on the number of low power radio transmitters around nearby stars to date. We explored several metics to compare our results to previous SETI efforts. We developed a new figure-of-merit that can encompass a wider set of parameters and can be used on future SETI experiments for a meaningful comparison.We note that the current BL state-of-the-art digital backend installed at the Green Bank Observatory is the fastest ever used for a SETI experiment by a factor of a few. Here we will describe the potential use of the BL backend by other groups on complementary science, as well as a mention the ongoing and potential collaborations focused in

  17. Alternative sample-introduction technique to avoid breakthrough in gradient-elution liquid chromatography of polymers.

    Science.gov (United States)

    Reingruber, Eva; Bedani, Filippo; Buchberger, Wolfgang; Schoenmakers, Peter

    2010-10-15

    Gradient-elution liquid chromatography (GELC) is a powerful tool for the characterization of synthetic polymers. However, gradient-elution chromatograms often suffer from breakthrough phenomena. Breakthrough can be averted by using a sample solvent as weak as the mobile phase. However, this approach is only applicable to polymers for which a sufficiently strong solvent exists which is at the same time a weak eluent. Finding such a solvent for a given polymer can be laborious or may even be impossible. Besides, when working with comprehensive two-dimensional LC the effluent of the first dimension is the injection solvent of the second dimension. In this case, it is not possible to avoid breakthrough by adjusting the eluent strength of the second-dimension injection solvent. Therefore, another strategy to avert breakthrough has to be implemented. In this work, we successfully avoided breakthrough in GELC by mixing the mobile phase not before, but after the autosampler. This was demonstrated measuring a blend of poly(methyl methacrylate) standards with different molecular-weights as model mixture with comprehensive two-dimensional GELC×size-exclusion chromatography. The strategy is thought to be applicable to all substances with a sufficiently strong dependence of retention on mobile-phase composition. This typically applies to large molecules (synthetic and natural polymers) and allows efficient refocusing. Unretained and barely retained substances are not refocused and therefore suffer in the proposed setup from peak broadening. Copyright © 2010 Elsevier B.V. All rights reserved.

  18. Treatment of Breakthrough and Refractory Chemotherapy-Induced Nausea and Vomiting

    Science.gov (United States)

    Navari, Rudolph M.

    2015-01-01

    Despite significant progress in the prevention of chemotherapy-induced nausea and vomiting (CINV) with the introduction of new antiemetic agents, 30–50% of patients receiving moderately or highly emetogenic chemotherapy (MEC or HEC) and guideline directed prophylactic antiemetics develop breakthrough CINV. International guidelines recommend the treatment of breakthrough CINV with an agent from a drug class that was not used in the prophylactic antiemetic regimen and recommend using the breakthrough medication continuously rather than using it on an as needed basis. There have been very few studies on the treatment of breakthrough CINV. A recent double-blind, randomized, phase III study suggested that olanzapine may be an effective agent for the treatment of breakthrough CINV. Refractory CINV occurs when patients develop CINV during subsequent cycles of chemotherapy when antiemetic prophylaxis has not been successful in controlling CINV in earlier cycles. Patients who develop refractory CINV should be considered for a change in their prophylactic antiemetic regimen. If significant anxiety exists, a benzodiazepine may be added to the prophylactic regimen. If a refractory patient is receiving HEC, olanzapine may be added to the prophylactic regimen. If the patient is receiving MEC, olanzapine or an NK-1 receptor antagonist may be added to the prophylactic regimen. PMID:26421294

  19. Treatment of Breakthrough and Refractory Chemotherapy-Induced Nausea and Vomiting

    Directory of Open Access Journals (Sweden)

    Rudolph M. Navari

    2015-01-01

    Full Text Available Despite significant progress in the prevention of chemotherapy-induced nausea and vomiting (CINV with the introduction of new antiemetic agents, 30–50% of patients receiving moderately or highly emetogenic chemotherapy (MEC or HEC and guideline directed prophylactic antiemetics develop breakthrough CINV. International guidelines recommend the treatment of breakthrough CINV with an agent from a drug class that was not used in the prophylactic antiemetic regimen and recommend using the breakthrough medication continuously rather than using it on an as needed basis. There have been very few studies on the treatment of breakthrough CINV. A recent double-blind, randomized, phase III study suggested that olanzapine may be an effective agent for the treatment of breakthrough CINV. Refractory CINV occurs when patients develop CINV during subsequent cycles of chemotherapy when antiemetic prophylaxis has not been successful in controlling CINV in earlier cycles. Patients who develop refractory CINV should be considered for a change in their prophylactic antiemetic regimen. If significant anxiety exists, a benzodiazepine may be added to the prophylactic regimen. If a refractory patient is receiving HEC, olanzapine may be added to the prophylactic regimen. If the patient is receiving MEC, olanzapine or an NK-1 receptor antagonist may be added to the prophylactic regimen.

  20. Technology collaboration

    Energy Technology Data Exchange (ETDEWEB)

    Thomas, Jacob [Halliburton (Brazil)

    2011-07-01

    The aim of this paper is to present Halliburton's Brazilian technology center. Halliburton has technology centers in the United States, Saudi Arabia, India, Singapore and Brazil, all of which aim at delivering accelerated innovation in the oil sector. The technology centers engage in research and development activities with the help of various universities and in collaboration with the customer or supplier. The Halliburton Brazil technology center provides its customers with timely research and development solutions for enhancing recovery and mitigating reservoir uncertainty; they are specialized in finding solutions for pre- and post-salt carbonate drilling and in the enhancement of production from mature fields. This presentation showcased the work carried out by the Halliburton Brazil technology center to help customers develop their deepwater field activities.

  1. Collaborative Economy

    DEFF Research Database (Denmark)

    Meged, Jane Widtfeldt; Christensen, Mathilde Dissing

    2017-01-01

    This book employs an interdisciplinary, cross-sectoral lens to explore the collaborative dynamics that are currently disrupting, re-creating and transforming the production and consumption of tourism. House swapping, ridesharing, voluntourism, couchsurfing, dinner hosting, social enterprise...... of Airbnb’s early legal issues Daniel Guttentag 8.Free walking tour enterprises in Europe: An evolutionary economic approach Maria del Pilar Leal and L. Xavier Medina, 9.Cultural capitalism: Manipulation and control in Airbnb’s intersection with tourism Michael O' Reganand Jaeyeon Choe 10.Sharing the new...... and similar phenomena are among these collective innovations in tourism that are shaking the very bedrock of an industrial system that has been traditionally sustained along commercial value chains. To date there has been very little investigation of these trends, which have been inspired by, amongst other...

  2. How do nurses in specialist palliative care assess and manage breakthrough cancer pain? A multicentre study.

    Science.gov (United States)

    Soden, Katie; Ali, Simone; Alloway, Lara; Barclay, David; Barker, Stephanie; Bird, Lydia; Hall, Lesley; Perkins, Paul

    2013-11-01

    To gain a better understanding of how registered nurses working in specialist palliative care assess and manage breakthrough cancer pain. A mixed-methodology study was undertaken in two stages-this paper reports findings from stage two. Anonymous postal questionnaires, designed based on themes identified in interviews undertaken during stage one, were sent to trained nurses working in ten specialist palliative care services in England. A total of 104 questionnaires were returned. Respondents were experienced nurses mainly working in inpatient settings. Some 82% of the nurses wanted more training on the assessment of breakthrough cancer pain. Although there were inconsistencies around the use of terminology, pain management appeared to be good. The use of terminology in the field of breakthrough cancer pain remains variable. However, this does not appear to have a negative impact on patient management, which was broadly in line with recently published consensus recommendations. There is a desire for more education within this area of practice.

  3. Breakthrough properties of chloride ions in columns of lead phosphate hydroxide

    International Nuclear Information System (INIS)

    Akiba, Kenichi; Hashimoto, Hiroyuki; Mimura, Hitoshi; Shindo, Manabu.

    1994-01-01

    Breakthrough properties of chloride ion (Cl - ) have been studied by using columns packed with a granular anion-exchanger of lead phosphate hydroxide (Pb 10 (PO 4 ) 6 (OH) 2 , IXE-1000G). The column utilization of the ratio of breakthrough capacity to total capacity increased with decreasing particle size and increasing temperature. The collection of Cl - from a simulated waste solution was improved by the addition of cation-exchange to IXE-1000G; the adsorption capacity of the column of IXE-1000G/IXE-300G (Sb type cation-exchanger) was over 0.16 mmol Cl - /g, yielding a relatively high column utilization of 75%. (author)

  4. Coupling gravity, electromagnetism and space-time for space propulsion breakthroughs

    Science.gov (United States)

    Millis, Marc G.

    1994-01-01

    spaceflight would be revolutionized if it were possible to propel a spacecraft without rockets using the coupling between gravity, electromagnetism, and space-time (hence called 'space coupling propulsion'). New theories and observations about the properties of space are emerging which offer new approaches to consider this breakthrough possibility. To guide the search, evaluation, and application of these emerging possibilities, a variety of hypothetical space coupling propulsion mechanisms are presented to highlight the issues that would have to be satisfied to enable such breakthroughs. A brief introduction of the emerging opportunities is also presented.

  5. Efficacy and Safety of Sublingual Fentanyl Tablets in Breakthrough Cancer Pain Management According to Cancer Stage and Background Opioid Medication.

    Science.gov (United States)

    Guitart, Jordi; Vargas, María Isabel; De Sanctis, Vicente; Folch, Jordi; Salazar, Rafael; Fuentes, José; Coma, Joan; Ferreras, Julia; Moya, Jordi; Tomás, Albert; Estivill, Pere; Rodelas, Francisco; Jiménez, Antonio Javier; Sanz, Almudena

    2018-03-23

    Our objective was to assess the effect of sublingual fentanyl tablets (SFTs) on pain relief, quality of life, and adverse effects in patients with cancer pain, according to cancer stage and background opioid regimen. Subgroup analyses from a recently completed study were performed according to cancer stage (locally advanced cancer [LAC] vs. metastatic cancer) and most frequent background opioid medication (fentanyl vs. oxycodone/naloxone). The efficacy and safety of SFTs were evaluated, recording pain intensity (PI), onset of pain relief, and adverse events (AEs). Health status was assessed with the Short Form 12, version 2 (SF-12v2) questionnaire and the Hospital Anxiety and Depression Scale (anxiety subscale [HADS-A] and depression subscale [HADS-D]). In total, 54 (67.5%) patients had LAC and 26 (32.5%) had metastatic cancer. The oxycodone/naloxone group included 39 patients (48.1%) and the fentanyl group 29 (35.8%). In all subgroups, pain relief was achieved within 5 min in an increasing number of individuals over time; at the end of the study, PI values decreased (PI-end: 44.4% for LAC vs. 57.9% for metastatic cancer; 44.4% for fentanyl vs. 38.6% for oxycodone/naloxone). HADS and mental component summary (MCS) SF-12v2 scores significantly improved in the LAC group (HADS-A 9.44-8.04; HADS-D 10.46-8.15; MCS 44.69-45.94) and in the fentanyl group (HADS-A 10.05-8.33; HADS-D 11.95-8.76; MCS 44.38-47.19). AEs were reported in few patients and were mostly mild. Exploratory subgroup analyses show the efficacy and safety of SFTs for the treatment of breakthrough pain in patients with cancer, regardless of their cancer stage and background opioid medication.

  6. Collaborative information seeking

    DEFF Research Database (Denmark)

    Hertzum, Morten

    2008-01-01

    , the activities involved in information seeking are often performed by varying subgroups of actors. Consequently, collaborative grounding is necessary to share information among collaborating actors and, thereby, establish and maintain the common ground necessary for their collaborative work. By focusing......Since common ground is pivotal to collaboration, this paper proposes to define collaborative information seeking as the combined activity of information seeking and collaborative grounding. While information-seeking activities are necessary for collaborating actors to acquire new information...... on the collaborative level, collaborative information seeking aims to avoid both individual reductionism and group reductionism, while at the same time recognizing that only some information and understanding need be shared....

  7. Depression Treatment

    Science.gov (United States)

    ... Health Infertility White Paper CDC Programs and Activities Assisted Reproductive Technology (ART) Depression Among Women Depression Treatment ... department for emergency medical treatment. Call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), ...

  8. Postpartum Depression

    Science.gov (United States)

    ... do not need treatment. The symptoms of postpartum depression last longer and are more severe. You may ... treatment right away, often in the hospital. Postpartum depression can begin anytime within the first year after ...

  9. Collaboration rules.

    Science.gov (United States)

    Evans, Philip; Wolf, Bob

    2005-01-01

    Corporate leaders seeking to boost growth, learning, and innovation may find the answer in a surprising place: the Linux open-source software community. Linux is developed by an essentially volunteer, self-organizing community of thousands of programmers. Most leaders would sell their grandmothers for workforces that collaborate as efficiently, frictionlessly, and creatively as the self-styled Linux hackers. But Linux is software, and software is hardly a model for mainstream business. The authors have, nonetheless, found surprising parallels between the anarchistic, caffeinated, hirsute world of Linux hackers and the disciplined, tea-sipping, clean-cut world of Toyota engineering. Specifically, Toyota and Linux operate by rules that blend the self-organizing advantages of markets with the low transaction costs of hierarchies. In place of markets' cash and contracts and hierarchies' authority are rules about how individuals and groups work together (with rigorous discipline); how they communicate (widely and with granularity); and how leaders guide them toward a common goal (through example). Those rules, augmented by simple communication technologies and a lack of legal barriers to sharing information, create rich common knowledge, the ability to organize teams modularly, extraordinary motivation, and high levels of trust, which radically lowers transaction costs. Low transaction costs, in turn, make it profitable for organizations to perform more and smaller transactions--and so increase the pace and flexibility typical of high-performance organizations. Once the system achieves critical mass, it feeds on itself. The larger the system, the more broadly shared the knowledge, language, and work style. The greater individuals' reputational capital, the louder the applause and the stronger the motivation. The success of Linux is evidence of the power of that virtuous circle. Toyota's success is evidence that it is also powerful in conventional companies.

  10. Drivers of Collaborative Advantage

    DEFF Research Database (Denmark)

    Weihe, Gudrid

    , the antecedents of collaborative advantage are theoretically examined, and the organizational competences contributing to collaborative success are identified. The conclusion is that operational processes and social dynamics are vital drivers of collaborative advantage. Another significant conclusion...

  11. Breakthrough disease during interferon-[beta] therapy in MS: No signs of impaired biologic response

    DEFF Research Database (Denmark)

    Hesse, D; Krakauer, M; Lund, H

    2010-01-01

    as reliable indicators of treatment response, despite substantial, biologically measurable effects. We studied the biologic response to treatment in a cohort of NAb-negative patients to test whether difference in responsiveness could segregate patients with and without breakthrough disease during therapy....

  12. The breakthrough curve combination for xenon sampling dynamics in a carbon molecular sieve column.

    Science.gov (United States)

    Shu-jiang, Liu; Zhan-ying, Chen; Yin-zhong, Chang; Shi-lian, Wang; Qi, Li; Yuan-qing, Fan; Huai-mao, Jia; Xin-jun, Zhang; Yun-gang, Zhao

    2015-01-21

    In the research of xenon sampling and xenon measurements, the xenon breakthrough curve plays a significant role in the xenon concentrating dynamics. In order to improve the theoretical comprehension of the xenon concentrating procedure from the atmosphere, the method of the breakthrough curve combination for sampling techniques should be developed and investigated under pulse injection conditions. In this paper, we describe a xenon breakthrough curve in a carbon molecular sieve column, the combination curve method for five conditions is shown and debated in detail; the fitting curves and the prediction equations are derived in theory and verified by the designed experiments. As a consequence, the curves of the derived equations are in good agreement with the fitting curves by tested. The retention times of the xenon in the column are 61.2, 42.2 and 23.5 at the flow rate of 1200, 1600 and 2000 mL min(-1), respectively, but the breakthrough times are 51.4, 38.6 and 35.1 min.

  13. Chemokine receptors and their crucial role in human immunodeficiency virus infection: major breakthroughs in HIV research

    DEFF Research Database (Denmark)

    Kristiansen, T B; Knudsen, T B; Eugen-Olsen, J

    1998-01-01

    to a series of breakthroughs in HIV research and knowledge. These include an increased understanding of viral entry, a connection of viral phenotype to specific coreceptor use, and an unequivocal linkage of a single human gene to host susceptibility. All in all these achievements provide a number of promising...... new strategies for combating HIV....

  14. Behind "AIDS breakthrough" headlines, December 2004: important research, not so new.

    Science.gov (United States)

    James, John S

    2004-01-01

    The mid-December press reports about an AIDS drug breakthrough were exaggerated, but the research described is important. It concerns the development of a class of related experimental drugs that work like efavirenz or nevirapine, but appear to be more powerful and much less subject to resistance.

  15. FRB 121102: Detection at 4 - 8 GHz band with Breakthrough Listen backend at Green Bank

    Science.gov (United States)

    Gajjar, Vishal,; Siemion, Andrew P. V.; MacMahon, David H. E.; Croft, Steve; Hellbourg, Gregory; Isaacson, Howard; Enriquez, J. Emilio; Price, Danny C.; Lebofsky, Matthew; DeBoer, David; Werthimer, Dan; Hickish, Jack; Brinkman, Casey; Chatterjee, Shami; Ransom, Scott

    2017-08-01

    On Saturday, August 26 at 13:51:44 UTC we initiated observations of the well-known repeating fast radio burst FRB 121102 [Spitler et al., Nature, 531, 7593 202-205, 2016] using the Breakthrough Listen Digital Backend with the C-band receiver at the Green Bank Telescope.

  16. Collaborative Service Arrangements

    DEFF Research Database (Denmark)

    J. May, Peter; Winter, Søren

    While much of prior research on collaboration addresses the service delivery network as a whole, we address collaborative relationships between one type of organization—municipal employment services—and a range of governmental and non-governmental partners for employment services in Denmark...... with collaborators. In short, collaboration requires a healthy and active relationship to foster improved outcomes. These findings have implications for future research about collaborative service delivery concerning the measurement of collaboration, different bases for it, and potential impacts....

  17. Collaborative Service Arrangements

    DEFF Research Database (Denmark)

    Winter, Søren; J. May, Peter

    2007-01-01

    While much of prior research on collaboration addresses the service delivery network as a whole, we address collaborative relationships between one type of organization—municipal employment services—and a range of governmental and non-governmental partners for employment services in Denmark...... with collaborators. In short, collaboration requires a healthy and active relationship to foster improved outcomes. These findings have implications for future research about collaborative service delivery concerning the measurement of collaboration, different bases for it, and potential impacts....

  18. Distal Ureteral Diameter Ratio is Predictive of Breakthrough Febrile Urinary Tract Infection.

    Science.gov (United States)

    Arlen, Angela M; Leong, Traci; Guidos, P Joseph; Alexander, Siobhan E; Cooper, Christopher S

    2017-12-01

    Distal ureteral diameter ratio is an objective measure that is prognostic of spontaneous resolution of vesicoureteral reflux. Along with likelihood of resolution, improved identification of children at risk for recurrent febrile urinary tract infections may impact management decisions. We evaluated the usefulness of ureteral diameter ratio as a predictive factor for breakthrough febrile urinary tract infections. Children with primary vesicoureteral reflux and detailed voiding cystourethrogram were identified. Ureteral diameter ratio was computed by measuring largest ureteral diameter within the pelvis and dividing by the distance between L1 and L3 vertebral bodies. Demographics, vesicoureteral reflux grade, laterality, presence/absence of bladder-bowel dysfunction, and ureteral diameter ratio were tested in univariate and multivariable analyses. Primary outcome was breakthrough febrile urinary tract infections. We analyzed 112 girls and 28 boys with a mean ± SD age of 2.5 ± 2.3 years at diagnosis. Vesicoureteral reflux was grade 1 to 2 in 64 patients (45.7%), grade 3 in 50 (35.7%), grade 4 in 16 (11.4%) and grade 5 in 10 (7.2%). Mean ± SD followup was 3.2 ± 2.7 years. A total of 40 children (28.6%) experienced breakthrough febrile urinary tract infections. Ureteral diameter ratio was significantly greater in children with (0.36) vs without (0.25) breakthrough febrile infections (p = 0.004). Controlling for vesicoureteral reflux grade, every 0.1 U increase in ureteral diameter ratio resulted in 1.7 times increased odds of breakthrough infection (95% CI 1.24 to 2.26, p urinary tract infections independent of reflux grade. Ureteral diameter ratio provides valuable prognostic information about risk of recurrent pyelonephritis and may assist with clinical decision-making. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  19. Offering Global Collaboration Services beyond CERN and HEP

    CERN Document Server

    Fernandes, J; Baron, T

    2015-01-01

    The CERN IT department has built over the years a performant and integrated ecosystem of collaboration tools, from videoconference and webcast services to event management software. These services have been designed and evolved in very close collaboration with the various communities surrounding the laboratory and have been massively adopted by CERN users. To cope with this very heavy usage, global infrastructures have been deployed which take full advantage of CERN's international and global nature. If these services and tools are instrumental in enabling the worldwide collaboration which generates major HEP breakthroughs, they would certainly also benefit other sectors of science in which globalization has already taken place. Some of these services are driven by commercial software (Vidyo or Wowza for example), some others have been developed internally and have already been made available to the world as Open Source Software in line with CERN's spirit and mission. Indico for example is now installed in 10...

  20. Onset of disability in depressed and non-depressed primary care patients

    NARCIS (Netherlands)

    Ormel, J; Vonkorff, M; Oldehinkel, AJ; Simon, G; Tiemens, BG; Ustun, TB

    Background. While cross-sectional and longitudinal studies have consistently found depressive illness and disability to be related, understanding whether depression leads to subsequent onset of disability is limited. Methods. In the context of the multi-centre international WHO Collaborative Study

  1. Collaboration: The Next Steps

    Science.gov (United States)

    Bacon, Pamela S.

    2008-01-01

    School media specialists collaborate with many teachers every day. They are so good that sometimes they even collaborate without realizing it. Sometimes, however, a more formal type of collaboration is needed. Not only does formal collaboration give them a chance to shine as the instructional leader, it also allows them to collect data to show…

  2. Collaborative Systems Testing

    Science.gov (United States)

    Pocatilu, Paul; Ciurea, Cristian

    2009-01-01

    Collaborative systems are widely used today in various activity fields. Their complexity is high and the development involves numerous resources and costs. Testing collaborative systems has a very important role for the systems' success. In this paper we present taxonomy of collaborative systems. The collaborative systems are classified in many…

  3. Gas breakthrough and emission through unsaturated compacted clay in landfill final cover

    International Nuclear Information System (INIS)

    Ng, C.W.W.; Chen, Z.K.; Coo, J.L.; Chen, R.; Zhou, C.

    2015-01-01

    Highlights: • Explore feasibility of unsaturated clay as a gas barrier in landfill cover. • Gas breakthrough pressure increases with clay thickness and degree of saturation. • Gas emission rate decreases with clay thickness and degree of saturation. • A 0.6 m-thick clay layer may be sufficient to meet gas emission rate limit. - Abstract: Determination of gas transport parameters in compacted clay plays a vital role for evaluating the effectiveness of soil barriers. The gas breakthrough pressure has been widely studied for saturated swelling clay buffer commonly used in high-level radioactive waste disposal facility where the generated gas pressure is very high (in the order of MPa). However, compacted clay in landfill cover is usually unsaturated and the generated landfill gas pressure is normally low (typically less than 10 kPa). Furthermore, effects of clay thickness and degree of saturation on gas breakthrough and emission rate in the context of unsaturated landfill cover has not been quantitatively investigated in previous studies. The feasibility of using unsaturated compacted clay as gas barrier in landfill covers is thus worthwhile to be explored over a wide range of landfill gas pressures under various degrees of saturation and clay thicknesses. In this study, to evaluate the effectiveness of unsaturated compacted clay to minimize gas emission, one-dimensional soil column tests were carried out on unsaturated compacted clay to determine gas breakthrough pressures at ultimate limit state (high pressure range) and gas emission rates at serviceability limit state (low pressure range). Various degrees of saturation and thicknesses of unsaturated clay sample were considered. Moreover, numerical simulations were carried out using a coupled gas–water flow finite element program (CODE-BRIGHT) to better understand the experimental results by extending the clay thickness and varying the degree of saturation to a broader range that is typical at different

  4. Collaboration enhances later individual memory for emotional material.

    Science.gov (United States)

    Bärthel, Gwennis A; Wessel, Ineke; Huntjens, Rafaële J C; Verwoerd, Johan

    2017-05-01

    Research on collaborative remembering suggests that collaboration hampers group memory (i.e., collaborative inhibition), yet enhances later individual memory. Studies examining collaborative effects on memory for emotional stimuli are scarce, especially concerning later individual memory. In the present study, female undergraduates watched an emotional movie and recalled it either collaboratively (n = 60) or individually (n = 60), followed by an individual free recall test and a recognition test. We replicated the standard collaborative inhibition effect. Further, in line with the literature, the collaborative condition displayed better post-collaborative individual memory. More importantly, in post-collaborative free recall, the centrality of the information to the movie plot did not play an important role. Recognition rendered slightly different results. Although collaboration rendered more correct recognition for more central details, it did not enhance recognition of background details. Secondly, the collaborative and individual conditions did not differ with respect to overlap of unique correct items in free recall. Yet, during recognition former collaborators more unanimously endorsed correct answers, as well as errors. Finally, extraversion, neuroticism, social anxiety, and depressive symptoms did not moderate the influence of collaboration on memory. Implications for the fields of forensic and clinical psychology are discussed.

  5. Breakthrough on technical and vocational education of Taiwan: Take Oriental Institute of Technology as an example

    Science.gov (United States)

    Chang, Horng-jinh; Wang, Whe-min

    2017-06-01

    Taiwan's economic strength has changed drastically in the past decade because of political and economic reasons; however, in order to cope with international environment, higher education must increase its breakthrough to meet the needs of enterprises. School curriculum also has to be timely changes and adjustments. This study will analyze school learning in several directions, use questionnaire to investigate students' learning stress, to find out where students' pressure lie. Also, outsourcing employers' satisfaction survey to find out what do enterprises wants to solve with the drop problem between school and enterprise. Taking Oriental Institute of Technology (OIT) as an example; over the past ten years, OIT has used overseas internships to help students overcome learning difficulties. Overseas practice courses include Penang Malaysia and Suzhou China had gained tremendous breakthrough.

  6. Heat Sweep Analysis of Thermal Breakthrough at Los Humeros and La Primavera Fields, Mexico

    Energy Technology Data Exchange (ETDEWEB)

    Kruger, P.; Lam, S.; Molinar, R.; Aragon, A.

    1987-01-20

    Early evaluation of the potential for geothermal breakthrough of reinjected fluids in newly developed geothermal fields can be obtained with the SGP one-dimensional heat sweep model. The model was used to estimate fluid cooldown from wells selected for the first wellhead generating units to be installed at the Los Humeros and La Primavera geothermal fields in Mexico, based on staff-compiled geometric and geologic data, thermal properties of the reservoir rock, and expected production conditions. Geometric considerations were evaluated with respect to known and postulated fault zones and return flow angle of the reinjected fluid. The results show the range of parameter values that affect the rate of thermal breakthrough to an abandonment temperature of 170 ºC corresponding to the minimum inlet pressure to the CFE 5-MW wellhead generator units. 9 figs., 4 tabs., 11 refs.

  7. Breakthrough of toluene vapours in granular activated carbon filled packed bed reactor

    International Nuclear Information System (INIS)

    Mohan, N.; Kannan, G.K.; Upendra, S.; Subha, R.; Kumar, N.S.

    2009-01-01

    The objective of this research was to determine the toluene removal efficiency and breakthrough time using commercially available coconut shell-based granular activated carbon in packed bed reactor. To study the effect of toluene removal and break point time of the granular activated carbon (GAC), the parameters studied were bed lengths (2, 3, and 4 cm), concentrations (5, 10, and 15 mg l -1 ) and flow rates (20, 40, and 60 ml/min). The maximum percentage removal of 90% was achieved and the maximum carbon capacity for 5 mg l -1 of toluene, 60 ml/min flow rate and 3 cm bed length shows 607.14 mg/g. The results of dynamic adsorption in a packed bed were consistent with those of equilibrium adsorption by gravimetric method. The breakthrough time and quantity shows that GAC with appropriate surface area can be utilized for air cleaning filters. The result shows that the physisorption plays main role in toluene removal.

  8. Breakthrough attacks in patients with hereditary angioedema receiving long-term prophylaxis are responsive to icatibant

    DEFF Research Database (Denmark)

    Aberer, Werner; Maurer, Marcus; Bouillet, Laurence

    2017-01-01

    BACKGROUND: Patients with hereditary angioedema (HAE) due to C1-inhibitor deficiency (C1-INH-HAE) experience recurrent attacks of cutaneous or submucosal edema that may be frequent and severe; prophylactic treatments can be prescribed to prevent attacks. However, despite the use of long......-term prophylaxis (LTP), breakthrough attacks are known to occur. We used data from the Icatibant Outcome Survey (IOS) to evaluate the characteristics of breakthrough attacks and the effectiveness of icatibant as a treatment option. METHODS: Data on LTP use, attacks, and treatments were recorded. Attack...... characteristics, treatment characteristics, and outcomes (time to treatment, time to resolution, and duration of attack) were compared for attacks that occurred with versus without LTP. RESULTS: Data on 3228 icatibant-treated attacks from 448 patients with C1-INH-HAE were analyzed; 30.1% of attacks occurred while...

  9. Electrical breakthrough effect for end pointing in 90 and 45 nm node circuit edit

    International Nuclear Information System (INIS)

    Liu, Kun; Soskov, Alex; Scipioni, Larry; Bassom, Neil; Sijbrandij, Sybren; Smith, Gerald

    2006-01-01

    The interaction between high-energy Ga + ions and condensed matter is studied for circuit edit applications. A new 'electrical breakthrough effect' due to charging of, and Ga + penetration/doping into, dielectrics is discovered. This new effect is proposed for end pointing in 90 and 45 nm node circuit edits where integrated circuit device dimensions are of a few hundred nanometers. This new end point approach is very sensitive, reliable, and precise. Most importantly, it is not sensitive to device dimensions. A series of circuit edits involving milling holes of high aspect ratio (5-30) and small cross-section area (0.01-0.25 μm 2 ) on real chips has been successfully performed using the electrical breakthrough effect as the end point method

  10. Ordovician gas exploration breakthrough in the Gucheng lower uplift of the Tarim Basin and its enlightenment

    Directory of Open Access Journals (Sweden)

    Wang Zhaoming

    2014-10-01

    Full Text Available A steady high yield natural gas flow was tapped in the Ordovician strata of Well Gucheng 6 drilled in the Gucheng lower uplift in the Tarim Basin in 2012, marking the discovery of another carbonate gas exploration field after the other two fields in the middle and northern Tarim Basin (the so called Tazhong and Tabei in the industry. The exploration in the Gucheng lower uplift has experienced three stages: the first stage, marine facies clastic exploration from 1995 to 2003, focusing on the Devonian Donghe sandstone lithologic traps, the Silurian overlapping lithologic traps, and the Upper Ordovician shelf slope turbidites; the second stage focusing on the reef shoal carbonate reservoirs from 2003 to 2006, during which oil and gas were first discovered in Well Gucheng 4; the third stage can be divided into two periods, in the first period, deeper insight into interbed karstification reservoir exploration, intense research on tricky seismic issues, selection of favorable zones, and 3D seismic deployment in advance laid a robust foundation for breakthroughs in oil and gas exploration; and during 2009–2012, through an in-depth investigation, Well Gucheng 6 was drilled, bringing about the major breakthrough in oil and gas exploration in this study area. This success proves that the Lower Paleozoic carbonate rocks in the Gucheng area have good geological conditions and broad prospect for oil and gas exploration, which give us enlightenment in three aspects: a. new insight into geologic understanding is the prerequisite of exploration breakthrough; b. addressing bottleneck technologies, and acquiring 3D seismic data are the guarantees of exploration breakthrough; and c. emancipation of mind and persistent exploration are key to the findings in new domains.

  11. Developing technology pushed breakthroughs:defining and assessing success factors in ICT industry

    OpenAIRE

    Sarja, J. (Jari)

    2016-01-01

    Abstract The main task for most development-intensive organisations is to create, develop and commercialise new products and services. The technology push (TP) concept is considered an important competitive advantage for companies trying to create breakthrough products. Because development processes are risky and failure rates are high, especially in the case of technology pushed projects, defined success factors are valuable knowledge for the management of development-intensive firms. ...

  12. The reading-science learning-writing connection: Breakthroughs, barriers, and promises

    Science.gov (United States)

    Holliday, William G.; Yore, Larry D.; Alvermann, Donna E.

    This article establishes a broad framework from which to interpret and evaluate the reading-science learning-writing connection. The presentation of breakthroughs, barriers, and promises is intended to outline the established links between, to identify current bottlenecks in thinking about, and to highlight productive inquiries into, print-based languages and scientific understanding. The ideas presented come from various disciplines connected to science education. The ideas are meant to be informative, provocative, integrative, supportive, and without hidden agenda.

  13. The Effect of Velocity Correlation on the Spatial Evolution of Breakthrough Curves in Heterogeneous Media

    Science.gov (United States)

    Massoudieh, A.; Dentz, M.; Le Borgne, T.

    2017-12-01

    In heterogeneous media, the velocity distribution and the spatial correlation structure of velocity for solute particles determine the breakthrough curves and how they evolve as one moves away from the solute source. The ability to predict such evolution can help relating the spatio-statistical hydraulic properties of the media to the transport behavior and travel time distributions. While commonly used non-local transport models such as anomalous dispersion and classical continuous time random walk (CTRW) can reproduce breakthrough curve successfully by adjusting the model parameter values, they lack the ability to relate model parameters to the spatio-statistical properties of the media. This in turns limits the transferability of these models. In the research to be presented, we express concentration or flux of solutes as a distribution over their velocity. We then derive an integrodifferential equation that governs the evolution of the particle distribution over velocity at given times and locations for a particle ensemble, based on a presumed velocity correlation structure and an ergodic cross-sectional velocity distribution. This way, the spatial evolution of breakthrough curves away from the source is predicted based on cross-sectional velocity distribution and the connectivity, which is expressed by the velocity transition probability density. The transition probability is specified via a copula function that can help construct a joint distribution with a given correlation and given marginal velocities. Using this approach, we analyze the breakthrough curves depending on the velocity distribution and correlation properties. The model shows how the solute transport behavior evolves from ballistic transport at small spatial scales to Fickian dispersion at large length scales relative to the velocity correlation length.

  14. Depressive Disorders

    Science.gov (United States)

    Brown, Jacqueline A.; Russell, Samantha; Rasor, Kaitlin

    2017-01-01

    Depression is among the most common mental disorders in the United States. Its diagnosis is often related to impairment of functioning across several domains, including how an individual thinks, feels, and participates in daily activities. Although depression has a relatively high prevalence among adults, the rate is alarmingly higher among…

  15. Postpartum Depression

    Science.gov (United States)

    ... first. The risk increases if: You have a history of depression, either during pregnancy or at other times You have bipolar disorder ... common as well. Prevention If you have a history of depression — ... pregnant. During pregnancy, your doctor can monitor you closely for signs ...

  16. Compacted artificially cemented soil-acid leachate contaminant interactions: breakthrough curves and transport parameters.

    Science.gov (United States)

    Knop, Alexandre; VanGulck, Jamie; Heineck, Karla Salvagni; Consoli, Nilo Cesar

    2008-06-30

    The transport of contaminants through compacted artificially cemented soil subjected to acid leachate contaminant percolation was analyzed by means of laboratory column tests. The effect of cement content, degree of acidity and hydraulic gradient were evaluated after permeation of several pore volumes of acid leachate contaminant flow through the soil. The pH, electric conductivity and solute breakthrough curves were considered throughout the study. The results showed that the increase of cement content increases the solute pore volumes needed before breakthrough occurred. An increase of the degree of acidity of the percolate and of the hydraulic gradient cause a reduction in the pore volumes needed before breakthrough occurred. The larger the soil cement content, the longer the time required to reach maximum effluent solute concentration. The hydraulic conductivity slightly increased due to cement addition and reduced with increasing degree of acidity of the percolate. Finally, it is possible to state that cement addition to the soil was responsible for increasing retardation coefficient (R) and distribution coefficient (kd) values, meaning that the artificially cemented soils have higher capability to retard the propagation of the contamination and amplified affinity with dissolved acid contaminant.

  17. Carbon dioxide adsorption on polyacrylamide-impregnated silica gel and breakthrough modeling

    Science.gov (United States)

    Zhao, Yi; Shen, Yanmei; Bai, Lu; Ni, Shiqing

    2012-11-01

    Polyacrylamide-impregnated silica gel was prepared to capture CO2 from flue gas. The polymerization of acrylamide was carried out in AN solvent using AIBN as initiator and EGDMA as crosslinker. The adsorbents were characterized by N2 adsorption, FTIR analysis, SEM analysis, and thermal gravimetric analysis. The results showed that the polymer was not only occupying the porosity of the silica, but necessarily surrounding silica particles, and the amide groups was successfully loaded on the support silica. The impregnated silica displayed good thermal-stability at 250 °C. The CO2 adsorption isotherms were measured to examine CO2 adsorption on adsorbents, and the results showed that the capacity was increased significantly after modification. The CO2 isosteric adsorption heats calculated from the isotherms showed that the adsorption interaction of CO2 with the functionalized material may be mainly an intermolecular force or hydrogen bond. Fixed-bed breakthrough model of CO2 adsorption on functionalized silica was successfully developed to describe the breakthrough curves under different adsorption temperature, CO2 concentration, and gas flow rate. The mass transfer coefficients of CO2 were calculated from the breakthrough model, the results showed that adsorption rate could be promoted by increasing temperature, flow rate and CO2 concentration, among which the effect of gas flow rate is the most obvious.

  18. Breakthrough revisited: investigating the requirements for growth of dust beyond the bouncing barrier

    Science.gov (United States)

    Booth, Richard A.; Meru, Farzana; Lee, Man Hoi; Clarke, Cathie J.

    2018-03-01

    For grain growth to proceed effectively and lead to planet formation, a number of barriers to growth must be overcome. One such barrier, relevant for compact grains in the inner regions of the disc, is the `bouncing barrier' in which large grains (˜mm size) tend to bounce off each other rather than sticking. However, by maintaining a population of small grains, it has been suggested that cm-size particles may grow rapidly by sweeping up these small grains. We present the first numerically resolved investigation into the conditions under which grains may be lucky enough to grow beyond the bouncing barrier by a series of rare collisions leading to growth (so-called `breakthrough'). Our models support previous results, and show that in simple models breakthrough requires the mass ratio at which high-velocity collisions transition to growth instead of causing fragmentation to be low, ϕ ≲ 50. However, in models that take into account the dependence of the fragmentation threshold on mass ratio, we find that breakthrough occurs more readily, even if mass transfer is relatively inefficient. This suggests that bouncing may only slow down growth, rather than preventing growth beyond a threshold barrier. However, even when growth beyond the bouncing barrier is possible, radial drift will usually prevent growth to arbitrarily large sizes.

  19. Using Mobile Devices to Support Online Collaborative Learning

    Directory of Open Access Journals (Sweden)

    Santi Caballé

    2010-01-01

    Full Text Available Mobile collaborative learning is considered the next step of on-line collaborative learning by incorporating mobility as a key and breakthrough requirement. Indeed, the current wide spread of mobile devices and wireless technologies brings an enormous potential to e-learning, in terms of ubiquity, pervasiveness, personalization, flexibility, and so on. For this reason, Mobile Computer-Supported Collaborative Learning has recently grown from a minor research field to significant research projects covering a fairly variety of formal and specially informal learning settings, from schools and universities to workplaces, museums, cities and rural areas. Much of this research has shown how mobile technology can offer new opportunities for groups of learners to collaborate inside and beyond the traditional instructor-oriented educational paradigm. However, mobile technologies, when specifically applied to collaborative learning activities, are still in its infancy and many challenges arise. In addition, current research in this domain points to highly specialized study cases, uses, and experiences in specific educational settings and thus the issues addressed in the literature are found dispersed and disconnected from each other. To this end, this paper attempts to bridge relevant aspects of mobile technologies in support for collaborative learning and provides a tighter view by means of a multidimensional approach.

  20. Developing international open science collaborations: Funder reflections on the Open Science Prize.

    Science.gov (United States)

    Kittrie, Elizabeth; Atienza, Audie A; Kiley, Robert; Carr, David; MacFarlane, Aki; Pai, Vinay; Couch, Jennifer; Bajkowski, Jared; Bonner, Joseph F; Mietchen, Daniel; Bourne, Philip E

    2017-08-01

    The Open Science Prize was established with the following objectives: first, to encourage the crowdsourcing of open data to make breakthroughs that are of biomedical significance; second, to illustrate that funders can indeed work together when scientific interests are aligned; and finally, to encourage international collaboration between investigators with the intent of achieving important innovations that would not be possible otherwise. The process for running the competition and the successes and challenges that arose are presented.

  1. The involvement of glutamate in the pathophysiology of depression.

    Science.gov (United States)

    Palucha, A; Pilc, A

    2005-05-01

    In spite of more than 40 years of thorough studies, conventional antidepressants still have many limitations that hinder the effective treatment of depression. It seems that a breakthrough in the therapy of depression will require going beyond a monoamine-based theory of depression. Converging lines of evidence indicate that the glutamatergic system might be a promising target for a novel antidepressant therapy. Both ionotropic glutamate receptor ligands (functional NMDA receptor antagonists and AMPA receptor potentiators) and compounds acting at metabotropic glutamate receptors (mGluRs; group I mGluR antagonists, group II antagonists and group III agonists) produce antidepressant-like activity in several preclinical and some clinical studies. In this review, current knowledge and crucial hypotheses concerning the role of glutamate in the pathophysiology of depression are discussed. 2005 Prous Science. All rights reserved

  2. Genetics Home Reference: depression

    Science.gov (United States)

    ... Share: Email Facebook Twitter Home Health Conditions Depression Depression Printable PDF Open All Close All Enable Javascript to view the expand/collapse boxes. Description Depression (also known as major depression or major depressive ...

  3. Global Collaborative STEM Education

    Science.gov (United States)

    Meabh Kelly, Susan; Smith, Walter

    2016-04-01

    Global Collaborative STEM Education, as the name suggests, simultaneously supports two sets of knowledge and skills. The first set is STEM -- science, technology, engineering and math. The other set of content knowledge and skills is that of global collaboration. Successful global partnerships require awareness of one's own culture, the biases embedded within that culture, as well as developing awareness of the collaborators' culture. Workforce skills fostered include open-mindedness, perseverance when faced with obstacles, and resourceful use of technological "bridges" to facilitate and sustain communication. In respect for the 2016 GIFT Workshop focus, Global Collaborative STEM Education projects dedicated to astronomy research will be presented. The projects represent different benchmarks within the Global Collaborative STEM Education continuum, culminating in an astronomy research experience that fully reflects how the global STEM workforce collaborates. To facilitate wider engagement in Global Collaborative STEM Education, project summaries, classroom resources and contact information for established international collaborative astronomy research projects will be disseminated.

  4. Collaborative Contracting in Projects

    NARCIS (Netherlands)

    Suprapto, M.

    2016-01-01

    Project practitioners have increasingly recognized the importance of collaborative relationships to ensure successful executions of projects. However, the ability to sustain and consistenly drive real collaborative attitudes and behavior for achieving the desired outcomes remains of enduring

  5. Designing collaborative policy innovation

    DEFF Research Database (Denmark)

    Agger, Annika; Sørensen, Eva

    2014-01-01

    , the chapter investigates the extent to which and how collaboration between politicians and relevant stakeholders can spur the formulation, implementation and diffusion of new innovative policies. A case study of a process of collaborative policy innovation in a Danish municipality shows that collaborative...

  6. Making synthetic mudstone: Parametric resedimentation studies at high effective stress to determine controls on breakthrough pressure and permeability

    Science.gov (United States)

    Guiltinan, E. J.; Cardenas, M. B.; Cockrell, L.; Espinoza, N.

    2017-12-01

    The geologic sequestration of CO2 is widely considered a potential solution for decreasing anthropogenic atmospheric CO2 emissions. As CO2 rises buoyantly within a reservoir it pools beneath a caprock and a pressure is exerted upon the pores of the caprock proportionally to the height of the pool. The breakthrough pressure is the point at which CO2 begins to flow freely across the caprock. Understanding the mineralogical and grain size controls on breakthrough pressure is important for screening the security of CO2 sequestration sites. However, breakthrough pressure and permeability measurements on caprocks are difficult to conduct in a systematic manner given the variability in and heterogeneity of naturally occurring mudstones and shales causing significant noise and scatter in the literature. Recent work has even revealed the ability for CO2 to pass through thin shale beds at relatively low pressures. To broaden the understanding of shale breakthrough and permeability, we developed an approach that allows for the creation of resedimented mudstones at high effective stresses. Resedimented samples also include calcium carbonate cement. Using this technique, we explore the controls on entry pressure, breakthrough pressure, and permeability of synthetic mudstones. Understanding the effect of mineralogy and grain size on the permeability and breakthrough pressure of mudstones at reservoir stresses will help in the selection and uncertainty quantification of secure CO2 storage sites.

  7. Postpartum Depression

    Science.gov (United States)

    ... develop after childbirth. Postpartum depression isn't a character flaw or a weakness. Sometimes it's simply a ... eating difficulties, excessive crying, and attention-deficit/hyperactivity disorder (ADHD). Delays in language development are more common as well. Prevention If ...

  8. Teen Depression

    Science.gov (United States)

    ... t you just ‘snap out’ of depression? Well-meaning friends or family members may try to tell ... in ways that will jeopardize the integrity and “brand” when using the publication. The addition of non- ...

  9. Postpartum depression

    Science.gov (United States)

    ... the pregnancy Had depression, bipolar disorder , or an anxiety disorder before your pregnancy, or with a past pregnancy Had a stressful event during the pregnancy or delivery, including personal illness, death or illness of a loved one, a ...

  10. Comprehensive sieve analysis of breakthrough HIV-1 sequences in the RV144 vaccine efficacy trial.

    Directory of Open Access Journals (Sweden)

    Paul T Edlefsen

    2015-02-01

    Full Text Available The RV144 clinical trial showed the partial efficacy of a vaccine regimen with an estimated vaccine efficacy (VE of 31% for protecting low-risk Thai volunteers against acquisition of HIV-1. The impact of vaccine-induced immune responses can be investigated through sieve analysis of HIV-1 breakthrough infections (infected vaccine and placebo recipients. A V1/V2-targeted comparison of the genomes of HIV-1 breakthrough viruses identified two V2 amino acid sites that differed between the vaccine and placebo groups. Here we extended the V1/V2 analysis to the entire HIV-1 genome using an array of methods based on individual sites, k-mers and genes/proteins. We identified 56 amino acid sites or "signatures" and 119 k-mers that differed between the vaccine and placebo groups. Of those, 19 sites and 38 k-mers were located in the regions comprising the RV144 vaccine (Env-gp120, Gag, and Pro. The nine signature sites in Env-gp120 were significantly enriched for known antibody-associated sites (p = 0.0021. In particular, site 317 in the third variable loop (V3 overlapped with a hotspot of antibody recognition, and sites 369 and 424 were linked to CD4 binding site neutralization. The identified signature sites significantly covaried with other sites across the genome (mean = 32.1 more than did non-signature sites (mean = 0.9 (p < 0.0001, suggesting functional and/or structural relevance of the signature sites. Since signature sites were not preferentially restricted to the vaccine immunogens and because most of the associations were insignificant following correction for multiple testing, we predict that few of the genetic differences are strongly linked to the RV144 vaccine-induced immune pressure. In addition to presenting results of the first complete-genome analysis of the breakthrough infections in the RV144 trial, this work describes a set of statistical methods and tools applicable to analysis of breakthrough infection genomes in general vaccine

  11. Determination of hydrogeologic parameters and media nonhomogeneity from nuclear tracer breakthrough curve data

    International Nuclear Information System (INIS)

    Yu, C.; Jester, W.A.; Jarrett, A.R.

    1984-01-01

    A group transfer model has been developed for the determination of hydrogeologic parameters and medium nonhomogeneity from experimental breakthrough curves. The model is designed to handle the migration of tracers through heterogeneous and homogeneous soil systems under saturated and unsaturated conditions. It divides the medium into groups according to the water velocity in each group. Each group is evaluated in its response to the tracer in terms of flow path distance, pore-water velocity, dispersion coefficient, retardation factor, volumetric water content and mass transfer coefficients. 17 references, 3 figures

  12. Comprehensive Sieve Analysis of Breakthrough HIV-1 Sequences in the RV144 Vaccine Efficacy Trial

    Science.gov (United States)

    Edlefsen, Paul T.; Rolland, Morgane; Hertz, Tomer; Tovanabutra, Sodsai; Gartland, Andrew J.; deCamp, Allan C.; Magaret, Craig A.; Ahmed, Hasan; Gottardo, Raphael; Juraska, Michal; McCoy, Connor; Larsen, Brendan B.; Sanders-Buell, Eric; Carrico, Chris; Menis, Sergey; Bose, Meera; Arroyo, Miguel A.; O’Connell, Robert J.; Nitayaphan, Sorachai; Pitisuttithum, Punnee; Kaewkungwal, Jaranit; Rerks-Ngarm, Supachai; Robb, Merlin L.; Kirys, Tatsiana; Georgiev, Ivelin S.; Kwong, Peter D.; Scheffler, Konrad; Pond, Sergei L. Kosakovsky; Carlson, Jonathan M.; Michael, Nelson L.; Schief, William R.; Mullins, James I.; Kim, Jerome H.; Gilbert, Peter B.

    2015-01-01

    The RV144 clinical trial showed the partial efficacy of a vaccine regimen with an estimated vaccine efficacy (VE) of 31% for protecting low-risk Thai volunteers against acquisition of HIV-1. The impact of vaccine-induced immune responses can be investigated through sieve analysis of HIV-1 breakthrough infections (infected vaccine and placebo recipients). A V1/V2-targeted comparison of the genomes of HIV-1 breakthrough viruses identified two V2 amino acid sites that differed between the vaccine and placebo groups. Here we extended the V1/V2 analysis to the entire HIV-1 genome using an array of methods based on individual sites, k-mers and genes/proteins. We identified 56 amino acid sites or “signatures” and 119 k-mers that differed between the vaccine and placebo groups. Of those, 19 sites and 38 k-mers were located in the regions comprising the RV144 vaccine (Env-gp120, Gag, and Pro). The nine signature sites in Env-gp120 were significantly enriched for known antibody-associated sites (p = 0.0021). In particular, site 317 in the third variable loop (V3) overlapped with a hotspot of antibody recognition, and sites 369 and 424 were linked to CD4 binding site neutralization. The identified signature sites significantly covaried with other sites across the genome (mean = 32.1) more than did non-signature sites (mean = 0.9) (p < 0.0001), suggesting functional and/or structural relevance of the signature sites. Since signature sites were not preferentially restricted to the vaccine immunogens and because most of the associations were insignificant following correction for multiple testing, we predict that few of the genetic differences are strongly linked to the RV144 vaccine-induced immune pressure. In addition to presenting results of the first complete-genome analysis of the breakthrough infections in the RV144 trial, this work describes a set of statistical methods and tools applicable to analysis of breakthrough infection genomes in general vaccine efficacy

  13. Considerations of breakthrough orientation on prospecting uranium resources in southwestern China

    International Nuclear Information System (INIS)

    Sun Zexuan; Kang Youchun

    2010-01-01

    Based on the study of metallogenic environment, ore control factors, and metallogenic genesis of uranium deposits, combining with regional geological background, 5 uranium metallogenic belts including Gangdise-Tengchong, Sanjiang, northwest of Sichuan, north of Sichuan, middle of Guizhou and 4 uranium metallogenic prospective belts including Gangdise, Changdu, Changtai-Daocheng and Xikang-Yunnan Axis can be classified in southwestern China. The thought of prospecting uranium resources should aim at strengthening regional geological investigation, selecting favorable metallogenic areas, accelerating regional evaluation and implementing uranium resources survey gradually. The breakthrough orientation includes expanding old mining areas, opening up new bases, prospecting new types, and raising comprehensive value for unconventional uranium resources. (authors)

  14. Accelerated approval and breakthrough therapy designation: oncology drug development on speed?

    Science.gov (United States)

    Yao, James C; Meric-Bernstam, Funda; Lee, J Jack; Eckhardt, S Gail

    2013-08-15

    Recent advances in biotechnology have led to discoveries resulting in major improvements in the therapy of refractory malignancies, although most advanced cancers remain incurable. Thus, there is global consensus around the need to streamline the drug approval process for effective agents. Accelerated Approval and Breakthrough Therapy Designation hold the promise of making new treatments available sooner through the use of smaller studies using intermediate endpoints. Here, we consider the inherent limitations of smaller studies and discuss the strategies for hastening oncology drug development while maintaining high-efficacy standards. ©2013 AACR.

  15. Successful pregnancy outcome in paroxysmal nocturnal hemoglobinuria (PNH following escalated eculizumab dosing to control breakthrough hemolysis

    Directory of Open Access Journals (Sweden)

    Ruby Sharma

    2015-01-01

    Full Text Available Pregnancy in women with paroxysmal nocturnal hemoglobinuria (PNH is associated with increased maternal and fetal morbidity and mortality. There is limited published experience regarding therapy of PNH during pregnancy. We describe a case of a 30 year old female with hypoplastic myelodysplastic syndrome and PNH. After two years of treatment with eculizumab, she became pregnant. She developed breakthrough hemolysis at 20 weeks gestation. Pharmacokinetic and pharmacodynamic studies demonstrated a subtherapeutic eculizumab level with absence of complement blockade. Escalation of her eculizumab dose successfully controlled hemolysis and restored therapeutic eculizumab level and activity. She delivered a healthy baby at 36 weeks.

  16. So That's How! 2007 Microsoft® Office System Timesavers, Breakthroughs, & Everyday Genius

    CERN Document Server

    Archilla, Evan

    2009-01-01

    Turn your productivity drains into productivity gains! With this practical (and fun) guide, you'll discover the best ways to tackle your daily work with the 2007 Microsoft Office system. The authors have taught thousands of people to get better results with less effort. Now these efficiency experts let you steal from their "tip jar" full of timesaving shortcuts and other brilliant ideas. You'll explore what's new in your favorite Microsoft Office programs-and transform the way you work. Get timesavers, breakthroughs, & everyday genius to: Take control of your inbox, calendar, and everyday in

  17. Collaborative research: accomplishments & potential.

    Science.gov (United States)

    Katsouyanni, Klea

    2008-01-21

    Although a substantial part of scientific research is collaborative and increasing globalization will probably lead to its increase, very few studies actually investigate the advantages, disadvantages, experiences and lessons learned from collaboration. In environmental epidemiology interdisciplinary collaboration is essential and the contrasting geographical patterns in exposure and disease make multi-location projects essential. This paper is based on a presentation given at the Annual Conference of the International Society for Environmental Epidemiology, Paris 2006, and is attempting to initiate a discussion on a framework for studying collaborative research. A review of the relevant literature showed that indeed collaborative research is rising, in some countries with impressive rates. However, there are substantial differences between countries in their outlook, need and respect for collaboration. In many situations collaborative publications receive more citations than those based on national authorship. The European Union is the most important host of collaborative research, mainly driven by the European Commission through the Framework Programmes. A critical assessment of the tools and trends of collaborative networks under FP6, showed that there was a need for a critical revision, which led to changes in FP7. In conclusion, it is useful to study the characteristics of collaborative research and set targets for the future. The added value for science and for the researchers involved may be assessed. The motivation for collaboration could be increased in the more developed countries. Particular ways to increase the efficiency and interaction in interdisciplinary and intercultural collaboration may be developed. We can work towards "the principles of collaborative research" in Environmental Epidemiology.

  18. Collaborative research: Accomplishments & potential

    Science.gov (United States)

    Katsouyanni, Klea

    2008-01-01

    Although a substantial part of scientific research is collaborative and increasing globalization will probably lead to its increase, very few studies actually investigate the advantages, disadvantages, experiences and lessons learned from collaboration. In environmental epidemiology interdisciplinary collaboration is essential and the contrasting geographical patterns in exposure and disease make multi-location projects essential. This paper is based on a presentation given at the Annual Conference of the International Society for Environmental Epidemiology, Paris 2006, and is attempting to initiate a discussion on a framework for studying collaborative research. A review of the relevant literature showed that indeed collaborative research is rising, in some countries with impressive rates. However, there are substantial differences between countries in their outlook, need and respect for collaboration. In many situations collaborative publications receive more citations than those based on national authorship. The European Union is the most important host of collaborative research, mainly driven by the European Commission through the Framework Programmes. A critical assessment of the tools and trends of collaborative networks under FP6, showed that there was a need for a critical revision, which led to changes in FP7. In conclusion, it is useful to study the characteristics of collaborative research and set targets for the future. The added value for science and for the researchers involved may be assessed. The motivation for collaboration could be increased in the more developed countries. Particular ways to increase the efficiency and interaction in interdisciplinary and intercultural collaboration may be developed. We can work towards "the principles of collaborative research" in Environmental Epidemiology. PMID:18208596

  19. Collaborative research: Accomplishments & potential

    Directory of Open Access Journals (Sweden)

    Katsouyanni Klea

    2008-01-01

    Full Text Available Abstract Although a substantial part of scientific research is collaborative and increasing globalization will probably lead to its increase, very few studies actually investigate the advantages, disadvantages, experiences and lessons learned from collaboration. In environmental epidemiology interdisciplinary collaboration is essential and the contrasting geographical patterns in exposure and disease make multi-location projects essential. This paper is based on a presentation given at the Annual Conference of the International Society for Environmental Epidemiology, Paris 2006, and is attempting to initiate a discussion on a framework for studying collaborative research. A review of the relevant literature showed that indeed collaborative research is rising, in some countries with impressive rates. However, there are substantial differences between countries in their outlook, need and respect for collaboration. In many situations collaborative publications receive more citations than those based on national authorship. The European Union is the most important host of collaborative research, mainly driven by the European Commission through the Framework Programmes. A critical assessment of the tools and trends of collaborative networks under FP6, showed that there was a need for a critical revision, which led to changes in FP7. In conclusion, it is useful to study the characteristics of collaborative research and set targets for the future. The added value for science and for the researchers involved may be assessed. The motivation for collaboration could be increased in the more developed countries. Particular ways to increase the efficiency and interaction in interdisciplinary and intercultural collaboration may be developed. We can work towards "the principles of collaborative research" in Environmental Epidemiology.

  20. Effect of Relative Humidity on Adsorption Breakthrough of CO2 on Activated Carbon Fibers

    Directory of Open Access Journals (Sweden)

    Yu-Chun Chiang

    2017-11-01

    Full Text Available Microporous activated carbon fibers (ACFs were developed for CO2 capture based on potassium hydroxide (KOH activation and tetraethylenepentamine (TEPA amination. The material properties of the modified ACFs were characterized using several techniques. The adsorption breakthrough curves of CO2 were measured and the effect of relative humidity in the carrier gas was determined. The KOH activation at high temperature generated additional pore networks and the intercalation of metallic K into the carbon matrix, leading to the production of mesopore and micropore volumes and providing access to the active sites in the micropores. However, this treatment also resulted in the loss of nitrogen functionalities. The TEPA amination has successfully introduced nitrogen functionalities onto the fiber surface, but its long-chain structure blocked parts of the micropores and, thus, made the available surface area and pore volume limited. Introduction of the power of time into the Wheeler equation was required to fit the data well. The relative humidity within the studied range had almost no effects on the breakthrough curves. It was expected that the concentration of CO2 was high enough so that the impact on CO2 adsorption capacity lessened due to increased relative humidity.

  1. Design and optimization of a chronotherapeutic dosage form for treatment of nocturnal acid breakthrough.

    Science.gov (United States)

    Agarwal, Vaibhav; Bansal, Mayank

    2012-11-01

    Present work focuses on the use of tamarind gum to develop a drug delivery system making combined use of floating and pulsatile principles, for the chrono-prevention of nocturnal acid breakthrough. The desired aim was achieved by fabricating a floating delivery system bearing time - lagged coating of Tamarindus indica seed polymer for the programmed release of Famotidine. Response Surface METHODology was the statistical tool that was employed for experiment designing, mathematical model generation and optimization study. A 32 full factorial design was used in designing the experiment. % weight ratio of tamarind gum to ethyl cellulose in the coating combination and the coating weight were the independent variables, whereas the lag time for drug release and the cumulative % drug release in 330 minutes were the observed responses. Results revealed that both the coating composition and the coating weight significantly affected the release of drug from the dosage form. The optimized formulation prepared according to the computer generated software, Design-Expert® deciphered response which were in close proximity with the experimental responses, thus confirming the robustness and accuracy of the predicted model for the utilization of natural polymer like tamarind gum for the chronotherapeutic treatment of nocturnal acid breakthrough.

  2. Proposal to realize a cost breakthrough in carbon-13 production by photochemical separation

    International Nuclear Information System (INIS)

    Marling, J.B.

    1979-10-01

    A cost breakthrough can now be made in photochemical production of the rare stable isotope carbon-13. This cost breakthrough is achieved by CO 2 laser infrared multiple-photon dissociation of any of several halocarbons (Freon derivatives) such as CF 3 Cl, CF 3 Br, or CF 2 Cl 2 . The single-step carbon-13 enrichment factor for this process is approximately 50, yielding 30% pure C-13 in one step, or up to 97% pure C-13 in two steps. A three-fold carbon-13 cost reduction to below $20/gram is expected to be achieved in a small laboratory-scale demonstration facility capable of producing 4 to 8 kg/year of carbon-13, using presently available pulsed CO 2 TEA lasers at an average power level of 50 watts. Personnel costs dominate the attainable C-13 production costs in a small photochemical enrichment facility. A price reduction to $2/gm carbon-13 is feasible at carbon-13 production levels of 100 to 1000 kg/year, dominated by the Freon raw material costs

  3. First Breakthrough for Future Air-Breathing Magneto-Plasma Propulsion Systems

    Science.gov (United States)

    Göksel, B.; Mashek, I. Ch

    2017-04-01

    A new breakthrough in jet propulsion technology since the invention of the jet engine is achieved. The first critical tests for future air-breathing magneto-plasma propulsion systems have been successfully completed. In this regard, it is also the first time that a pinching dense plasma focus discharge could be ignited at one atmosphere and driven in pulse mode using very fast, nanosecond electrostatic excitations to induce self-organized plasma channels for ignition of the propulsive main discharge. Depending on the capacitor voltage (200-600 V) the energy input at one atmosphere varies from 52-320 J/pulse corresponding to impulse bits from 1.2-8.0 mNs. Such a new pulsed plasma propulsion system driven with one thousand pulses per second would already have thrust-to-area ratios (50-150 kN/m²) of modern jet engines. An array of thrusters could enable future aircrafts and airships to start from ground and reach altitudes up to 50km and beyond. The needed high power could be provided by future compact plasma fusion reactors already in development by aerospace companies. The magneto-plasma compressor itself was originally developed by Russian scientists as plasma fusion device and was later miniaturized for supersonic flow control applications. So the first breakthrough is based on a spin-off plasma fusion technology.

  4. Postpartum Depression

    DEFF Research Database (Denmark)

    Smith-Nielsen, Johanne

    not only buffer or amplify effects , but which may also increase the risk of recurrent or persistent depression in the mother. These findings are also important in terms of providing appropriate help with the aim of preventing adverse developmental outcomes in the child. For a large group of PPD mothers......Background: In three academic articles, this PhD thesis investigates maternal postpartum depression (PPD) as a risk factor for the infant-mother attachment and infant development. Previous studies have been contradictory with respect to the question of whether PPD can have long term effects...... months with the Bayley Scales of Infant and Toddler Development, third edition. Additionally, at 13 months infant-mother attachment security was assessed using Strange Situation Procedure. Results: We found that even in a well-functioned sample, symptoms of depression in the postpartum period...

  5. The Collaborative Future

    Directory of Open Access Journals (Sweden)

    Thomas Marlowe

    2011-10-01

    Full Text Available Collaboration has become an important goal in modern ventures, across the spectrum of commercial, social, and intellectual activities, sometimes as a mediating factor, and sometimes as a driving, foundational principle. Research, development, social programs, and ongoing ventures of all sorts benefit from interactions between teams, groups, and organizations, across intellectual disciplines and across facets and features of the inquiry, product, entity, or activity under consideration. We present a survey of the state of collaboration and collaborative enterprise, in the context of papers and presentations at the International Symposium on Collaborative Enterprises 2011 (CENT 2011, and the extended papers appearing in this special issue.

  6. Staging Collaborative Innovation Processes

    DEFF Research Database (Denmark)

    Pedersen, Signe; Clausen, Christian

    Organisations are currently challenged by demands for increased collaborative innovation internally as well as with external and new entities - e.g. across the value chain. The authors seek to develop new approaches to managing collaborative innovative processes in the context of open innovation...... and public private innovation partnerships. Based on a case study of a collaborative design process in a large electronics company the paper points to the key importance of staging and navigation of collaborative innovation process. Staging and navigation is presented as a combined activity: 1) to translate...

  7. Depression and African Americans

    Science.gov (United States)

    ... You are here Home » Depression And African Americans Depression And African Americans Not “Just the Blues” Clinical ... or spiritual communities. Commonly Asked Questions about Clinical Depression How do I get help for clinical depression? ...

  8. Older Adults and Depression

    Science.gov (United States)

    ... find more information? Reprints Share Older Adults and Depression Download PDF Download ePub Order a free hardcopy ... depression need treatment to feel better. Types of Depression There are several types of depression. The most ...

  9. Major Depression Among Adults

    Science.gov (United States)

    ... Depressive Episode Among Adolescents Data Sources Share Major Depression Definitions Major depression is one of the most common mental disorders in the United States. For some individuals, major depression can result in severe impairments that interfere with ...

  10. Collaborating with Rising Stars

    DEFF Research Database (Denmark)

    Andersen, Kristina Vaarst; Mors, Marie Louise; Jeppesen, Jacob

    2018-01-01

    Status provides preferential access to resources, as well as favorable judgment, which in turn may lead to increases in performance. Prior work has established that such benefits even spill over between collaboration partners, thus allowing collaboration partners of high status individuals to bas...

  11. Negotiating Collaborative Governance Designs

    DEFF Research Database (Denmark)

    Plotnikof, Mie

    2017-01-01

    This chapter addresses the design and implementation issues of collaborative governance, a public management practice aimed at involving stakeholders in problem-solving and public innovation.......This chapter addresses the design and implementation issues of collaborative governance, a public management practice aimed at involving stakeholders in problem-solving and public innovation....

  12. Enabling distributed collaborative science

    DEFF Research Database (Denmark)

    Hudson, T.; Sonnenwald, Diane H.; Maglaughlin, K.

    2000-01-01

    To enable collaboration over distance, a collaborative environment that uses a specialized scientific instrument called a nanoManipulator is evaluated. The nanoManipulator incorporates visualization and force feedback technology to allow scientists to see, feel, and modify biological samples being...

  13. Emergent Collaboration on Twitter

    DEFF Research Database (Denmark)

    Lundgaard, Daniel; Razmerita, Liana; Tan, Chee-Wee

    2018-01-01

    This paper explores the organizing elements that foster emergent collaboration within large-scale communities on online social platforms like Twitter. This study is based on a case study of the #BlackLivesMatter social movement and draws on organizing dynamics and online social network literature...... foster emergent collaboration in social movements using Twitter....

  14. Solo Librarians Working Collaboratively

    Science.gov (United States)

    Nickel, Robbie

    2011-01-01

    The Elko County School District in Nevada has elementary school librarians that are "solo" librarians. Over the last several years they have worked to collaborate on meeting monthly--even though the district covers 17,100 square miles--and on providing professional development face to face and online. Sharing and collaboration help them…

  15. Advances in Collaborative Evaluation

    Science.gov (United States)

    Rodriguez-Campos, Liliana

    2012-01-01

    Collaborative evaluation is an approach that offers, among others, many advantages in terms of access to information, quality of information gathered, opportunities for creative problem-solving, and receptivity to findings. In the last decade, collaborative evaluation has grown in popularity along with similar participatory, empowerment, and…

  16. Collaboration in teacher teams

    NARCIS (Netherlands)

    Brouwer, P.|info:eu-repo/dai/nl/30482285X

    2011-01-01

    In order to deal with innovations and the associated complexity of work, ongoing collaboration between teachers has become more important in secondary education. Teacher collaboration is one of the factors that contribute to the successful implementation of innovations in secondary schools. However,

  17. Trust repertoires for collaboration

    DEFF Research Database (Denmark)

    Fuglsang, Lars

    This case study analyses the role of trust in a public private innovation network that involved a private consultancy company as a facilitator. We know that collaboration is a important for innovation, and that collaboration across organizational boundaries is not a trivial issue. But we know very...

  18. Collaborative Car Pooling System

    OpenAIRE

    João Ferreira; Paulo Trigo; Porfírio Filipe

    2009-01-01

    This paper describes the architecture for a collaborative Car Pooling System based on a credits mechanism to motivate the cooperation among users. Users can spend the accumulated credits on parking facilities. For this, we propose a business model to support the collaboration between a car pooling system and parking facilities. The Portuguese Lisbon-s Metropolitan area is used as application scenario.

  19. Beyond Collaborative Services

    DEFF Research Database (Denmark)

    Seravalli, Anna; Agger Eriksen, Mette

    2017-01-01

    The notion of collaborative service was rst used by Jegou and Manzini in 2008 to discuss how services based on a tight collaboration between providers and users and based on the sharing of material resources, knowledge and competences, could support the transition towards more environmental and s...

  20. Fentanyl sublingual spray for breakthrough cancer pain in patients receiving transdermal fentanyl.

    Science.gov (United States)

    Alberts, David S; Smith, Christina Cognata; Parikh, Neha; Rauck, Richard L

    2016-10-01

    To investigate the relationship between effective fentanyl sublingual spray (FSS) doses for breakthrough cancer pain (BTCP) and around-the-clock (ATC) transdermal fentanyl patch (TFP). Adults tolerating ATC opioids received open-label FSS for 26 days, followed by a 26-day double-blind phase for patients achieving an effective dose (100-1600 µg). Out of 50 patients on ATC TFP at baseline, 32 (64%) achieved an effective dose. FSS effective dose moderately correlated with mean TFP dose (r = 0.4; p = 0.03). Patient satisfaction increased during the study. Common adverse event included nausea (9%) and peripheral edema (9%). FSS can be safely titrated to an effective dose for BTCP in patients receiving ATC TFP as chronic cancer pain medication. ClinicalTrials.gov identifier: NCT00538850.

  1. Ovarian stem cells and neo-oogenesis: A breakthrough in reproductive biology research

    Directory of Open Access Journals (Sweden)

    S Mooyottu1

    2011-04-01

    Full Text Available The concept of ovarian stem cells which can replenish the ovarian reserve in postnatal mammalian females is a revolutionary breakthrough in reproductive biology. This idea overturned the central dogma existed in female reproductive physiology. Contradicting the popular belief that oogenesis does not occur in post natal life, researchers proved the existence of putative stem cells in ovary, which can supply functional follicles in post natal ovaries. Even though the idea of neo-oogenesis in postnatal ovaries in normal conditions is controversial, the isolation and manipulation of ovarian stem cells have got tremendous application in medical, veterinary and animal production fields. [Veterinary World 2011; 4(2.000: 89-91

  2. Marketization of Collective-owned Rural Land: A Breakthrough in Shenzhen, China

    Directory of Open Access Journals (Sweden)

    Yonghua Zou

    2014-12-01

    Full Text Available This study focuses on analyzing the ongoing land policy reform that allows collective-owned rural land transactions in the open market in Shenzhen, China. Employing a case study method, we investigate this land policy evolution through description and contextual analysis. We argue that the existing dual-track land administration system, within which the state administers market transactions, has contributed to numerous social problems, such as urban land scarcity, inefficiency of land resource allocation, and exacerbated social injustice. Following the recent actions of the central government, a collective-owned rural land parcel in Shenzhen was officially transferred in November 2013, an action viewed as a landmark step in reforming the current dual-track land system. Though the generalization of Shenzhen’s experiment nationwide faces significant barriers, Shenzhen’s breakthrough in liberalization of the rural land market indicates that China is moving toward a potential new round of land policy revolution.

  3. Breakthrough Pain Associated with a Reduction in Serum Buprenorphine Concentration during Dialysis.

    Science.gov (United States)

    Salili, Ali Reza; Müller, Daniel; Skendaj, Roswitha; Jehle, Andreas W; Taegtmeyer, Anne B

    2016-01-01

    To describe a case of breakthrough pain associated with a reduction in serum buprenorphine concentration during dialysis. Pharmacokinetic sampling of total and free buprenorphine and norbuprenorphine in an 80 year old male undergoing haemodialysis three times per week who received 5760 µg oral and transdermal buprenorphine daily was performed. The patient's serum albumin concentration was 23g/l (reference range: 35-52 g/l). Pharmacokinetic sampling revealed a free buprenorphine fraction of 32% (consistent with the hypoalbuminaemia), which was markedly reduced at the end of dialysis (free buprenorphine concentration 2.4 µg/l before vs. buprenorphine doses during dialysis to prevent significant falls in the concentration of active drug. Copyright © 2016 Elsevier HS Journals, Inc. All rights reserved.

  4. [Human Primordial Germ Cell Specification--Breakthrough In Culture and Hopes for Therapeutic Utilization].

    Science.gov (United States)

    Magnúsdóttir, Erna

    2015-10-01

    Germ cells are the precursors to the gametes that carry genetic and epigenetic information between human generations and generate a new individual. Because germ cells are specified early during embryogenesis, at the time of embryo implantation, they are inaccessible for research. Our understanding of their biology has therefore developed slowly since their identification over one hundred years ago. As a result of research into the properties of human and mouse embryonic stem cells and primordial germ cells, scientists have now succeeded in efficiently generating human primordial germ cells in culture by embryonic stem cell and induced pluripotent stem cell culture. In this review we will discuss the state of our knowledge of human primordial germ cells and how research into the pluripotent properties of human and mouse embryonic germ cells has led to this breakthrough. In addition we will discuss the possible utilization of a cell culture system of human primordial germ cells for research into and treatment of germ cell related abnormalities.

  5. Solar Spicules: Prospects for Breakthroughs in Understanding with Solar-B

    Science.gov (United States)

    Sterling, A. C.

    2004-01-01

    Spicules densely populate the lower solar atmosphere; any image or movie of the chromosphere shows a plethora of them or their "cousins," such as mottles or fibrils. Yet despite several decades of effort we still do not know the mechanism that generates them, or how important their contribution is to the material and energy balance of the overall solar atmosphere. Solar-B will provide exciting new chromospheric observations at high time- and spatial-resolution, along with associated quality magnetic field data, that promise to open doors to revolutionary breakthroughs in spicule research. In this presentation we will review the current observational and theoretical status of spicule studies, and discuss prospects for advances in spicule understanding during the Solar-B era.

  6. Trial Design and Efficacy Thresholds for Granting Breakthrough Therapy Designation in Oncology.

    Science.gov (United States)

    Kern, Kenneth A

    2016-08-01

    Breakthrough therapy designation (BTD) is a new approach created by the US Congress and the US Food and Drug Administration (FDA) as part of the FDA Innovation and Safety Act of 2012 to expedite the drug development process for serious illness, including cancer. By law, to qualify for BTD, a new molecular entity must demonstrate substantial clinical improvement over existing therapies. Although the administrative requirements for granting BTD have been made available by the FDA, the actual trial designs, end points, and quantitative therapeutic thresholds involved in the granting process have not been made public. This literature review evaluates nine oncology new molecular entities granted BTD involved in 10 accelerated approvals and summarizes the key factors in clinical trial design leading to successful BTD applications. This information can be used by oncology research teams to set goals for BTD when developing clinical trial designs and thresholds in expedited drug development programs. Copyright © 2016 by American Society of Clinical Oncology.

  7. Central Hyperexcitability in Chronic Musculoskeletal Pain: A Conceptual Breakthrough with Multiple Clinical Implications

    Directory of Open Access Journals (Sweden)

    Jan Lidbeck

    2002-01-01

    Full Text Available Recent investigations of dysfunctional pain processing in the central nervous system have contributed much knowledge about the development of chronic musculoskeletal pain. Many common chronic musculoskeletal pain syndromes - including regional myofascial pain syndromes, whiplash pain syndromes, refractory work-related neck-shoulder pain, certain types of chronic low back pain, fibromyalgia and others - may essentially be explained by abnormalities in central pain modulation. The growing awareness of dysfunctional central pain modulation may be a conceptual breakthrough leading to a better understanding of common chronic pain disorders. A new paradigm will have multiple clinical implications, including re-evaluation of clinical practice routines and rehabilitation methods, and will focus on controversial issues of medicolegal concern. The concept of dysfunctional central pain processing will also necessitate a mechanism-based classification of pain for the selection of individual treatment and rehabilitation programs for subgroups of patients with chronic musculoskeletal pain due to different pathophysiological mechanisms.

  8. Posterior reversible encephalopathy syndrome and acute post-streptococcal glomerulonephritis mimicking breakthrough seizures

    Directory of Open Access Journals (Sweden)

    Kamille Abdool

    2015-05-01

    Full Text Available We report the case of a 14-year-old boy with a past history of primary generalized seizures, who had been seizure-free for 2 years on sodium valproate and presented with generalized tonic clonic seizures suggestive of breakthrough seizures. Examination revealed hypertension, impetiginous lesions of the lower limbs, microscopic hematuria, elevated antistreptolysin O titre and low complement levels consistent with acute post-streptococcal glomerulonephritis. Cranial magnetic resonance imaging (MRI demonstrated changes consistent with posterior reversible encephalopathy syndrome. Hypertension was controlled with intravenous nitroglycerin followed by oral captopril and amlodipine. Brain MRI changes returned normal within 2 weeks. The nephritis went in to remission within 2 months and after 8 months the patient has been seizure free again. Posterior reversible encephalopathy syndrome appeared to have neither short nor intermediate effect on seizure control in this patient. The relationship between posterior reversible encephalopathy syndrome and seizures is reviewed.

  9. Break-through of Mass Integration in Textile Industry through Development of Generic Water Recycle Schemes

    DEFF Research Database (Denmark)

    Wenzel, Henrik

    2003-01-01

    processing is one of the largest and oldest industries world-wide and responsible for a substantial resource consumption and pollution. Especially the wet processing part of the industry, i.e. pre-treatment, dyeing, printing and finishing, is polluting and resource consuming in terms of both water, energy......As a result of a long term South African – Danish research co-operation on Cleaner Production in textile industry, a number of generic and widely applicable water recycle schemes for textile wet processing has been developed, and the first break-through of water recycling has been achieved. Textile...... and chemicals. It entails a vast variety of water consuming processes, and like in most industries, fresh water is used in all processes with almost no exceptions. Between researchers, it was known for many years that fresh water is not needed by all processes taking place in textile wet treatment. But sound...

  10. Posterior Reversible Encephalopathy Syndrome and Acute Post-Streptococcal Glomerulonephritis Mimicking Breakthrough Seizures.

    Science.gov (United States)

    Abdool, Kamille; Ramcharan, Kanterpersad; Bhagwandass, Neal; Persad, Navindra; Temull, Vasant; Seegobin, Karan; Mike, Cassie

    2015-03-23

    We report the case of a 14-year-old boy with a past history of primary generalized seizures, who had been seizure-free for 2 years on sodium valproate and presented with generalized tonic clonic seizures suggestive of breakthrough seizures. Examination revealed hypertension, impetiginous lesions of the lower limbs, microscopic hematuria, elevated anti-streptolysin O titre and low complement levels consistent with acute post-streptococcal glomerulonephritis. Cranial magnetic resonance imaging (MRI) demonstrated changes consistent with posterior reversible encephalopathy syndrome. Hypertension was controlled with intravenous nitroglycerin followed by oral captopril and amlodipine. Brain MRI changes returned normal within 2 weeks. The nephritis went in to remission within 2 months and after 8 months the patient has been seizure free again. Posterior reversible encephalopathy syndrome appeared to have neither short nor intermediate effect on seizure control in this patient. The relationship between posterior reversible encephalopathy syndrome and seizures is reviewed.

  11. Supply chain optimization: a practitioner's perspective on the next logistics breakthrough.

    Science.gov (United States)

    Schlegel, G L

    2000-08-01

    The objective of this paper is to profile a practitioner's perspective on supply chain optimization and highlight the critical elements of this potential new logistics breakthrough idea. The introduction will briefly describe the existing distribution network, and business environment. This will include operational statistics, manufacturing software, and hardware configurations. The first segment will cover the critical success factors or foundations elements that are prerequisites for success. The second segment will give you a glimpse of a "working game plan" for successful migration to supply chain optimization. The final segment will briefly profile "bottom-line" benefits to be derived from the use of supply chain optimization as a strategy, tactical tool, and competitive advantage.

  12. Chemical beam epitaxy as a breakthrough technology for photovoltaic solar energy applications

    Science.gov (United States)

    Yamaguchi, Masafumi; Warabisako, Terunori; Sugiura, Hideo

    1994-03-01

    Chemical beam epitaxy (CBE) is a possible breakthrough technology for photovoltaic (PV) solar energy applications. This paper reviews the present status of epitaxial technologies for high-efficiency III-V compound semiconductor solar cells. It also discusses the advantages of CBE technology over metalorganic chemical vapor deposition (MOCVD) and molecular beam epitaxy (MBE) for III-V compound solar cell fabrication. CBE and related growth technologies can effectively produce high-efficiency and low-cost multi-junction III-V compound solar cells. Moreover, CBE may possibly reduce solar cell fabrication costs in the future because it utilizes source materials more efficiently than MBE and MOCVD. The cost of solar cell fabrication using CBE are estimated and compared with those using MOCVD and MBE.

  13. Managing collaborative innovation networks

    DEFF Research Database (Denmark)

    Stevens, Vidar; Agger, Annika

    2017-01-01

    . Empirical research on the management of collaborative policy innovation processes is, however, scarce. Therefore, we review in this article a case to add new insights to the causal link between collaboration, management, and innovation. Specifically, we examine the management strategies which helped......Collaborative innovation networks are increasingly used as vehicles for fostering innovative policy solutions. However, scholars have noted that the extent to which collaborative networks can actually contribute to the development of innovative policy solutions depends on how they are managed...... a Flemish administrative network to develop a radical new Spatial Planning Policy Plan. This study shows that the best way to manage collaborative innovation networks is not to press directly for results, but take the time to invest in relationship-building and together agree on a planning and clear process...

  14. Writing as collaborative inquiry

    DEFF Research Database (Denmark)

    Frølunde, Lisbeth; Pedersen, Christina Hee; Novak, Martin

    2015-01-01

    involved in collaborative knowledge production across difference (including age, professional position, life situation, nation). We tell about our experiences with how collaboration can lead toward re-invention of our research practices and methods, as well as our own subjectivities, through involvement......In our presentation we strive to disturb and unravel the romantic discourses of collaboration, dialogue and empowerment in relation to qualitative inquiry. For more than two years we (five Danish and Czech researchers) have been exploring the complex obstructions, difficulties and potentials...... in the not-yet-known. Over the years, we have shared and analyzed personal stories about our collaborative experiences in an on-going reflective learning process. We draw on writing methodologies, including memory-work (Haug, Davies) and collaborative writing such as by Wyatt, Gale, Gannon & Davies. Our...

  15. Writing as collaborative inquiry

    DEFF Research Database (Denmark)

    Frølunde, Lisbeth; Pedersen, Christina Hee; Novak, Martin

    2015-01-01

    in the not-yet-known. Over the years, we have shared and analyzed personal stories about our collaborative experiences in an on-going reflective learning process. We draw on writing methodologies, including memory-work (Haug, Davies) and collaborative writing such as by Wyatt, Gale, Gannon & Davies. Our......In our presentation we strive to disturb and unravel the romantic discourses of collaboration, dialogue and empowerment in relation to qualitative inquiry. For more than two years we (five Danish and Czech researchers) have been exploring the complex obstructions, difficulties and potentials...... involved in collaborative knowledge production across difference (including age, professional position, life situation, nation). We tell about our experiences with how collaboration can lead toward re-invention of our research practices and methods, as well as our own subjectivities, through involvement...

  16. Collaborative Policy Innovation

    DEFF Research Database (Denmark)

    Sørensen, Eva; Waldorff, Susanne Boch

    2014-01-01

    and policy ideas produced in collaborative governance arenas are not diffused to the formal political institutions of representative democracy because the participating politicians only to a limited extent function as boundary spanners between the collaborative governance arena and the decision making arenas......Governments all over the Western world currently face wicked problems that call for policy innovation. A new strand of research in public innovation points to collaboration between public authorities and relevant and affected stakeholders as an important driver of public innovation. A case study...... of collaborative policy innovation in the area of mental health care in Denmark indicates that collaboration can contribute to qualify the politicians’ understanding of wicked policy problems, and to fostering new creative policy solutions. The study also shows, however, that the new problem understandings...

  17. On the late-time behavior of tracer test breakthrough curves

    Energy Technology Data Exchange (ETDEWEB)

    HAGGERTY, ROY; MCKENNA, SEAN A; MEIGS, LUCY C

    2000-06-12

    The authors investigated the late-time (asymptotic) behavior of tracer test breakthrough curves (BTCs) with rate-limited mass transfer (e.g., in dual or multi-porosity systems) and found that the late-time concentration, c, is given by the simple expression: c = t{sub ad} (c{sub 0}g {minus} m{sub 0}{partial_derivative}g/{partial_derivative}t), for t >> t{sub ad} and t{sub a} >> t{sub ad} where t{sub ad} is the advection time, c{sub 0} is the initial concentration in the medium, m{sub 0} is the 0th moment of the injection pulse; and t{sub a} is the mean residence time in the immobile domain (i.e., the characteristic mass transfer time). The function g is proportional to the residence time distribution in the immobile domain, the authors tabulate g for many geometries, including several distributed (multirate) models of mass transfer. Using this expression they examine the behavior of late-time concentration for a number of mass transfer models. One key results is that if rate-limited mass transfer causes the BTC to behave as a power-law at late-time (i.e., c {approximately} t{sup {minus}k}), then the underlying density function of rate coefficients must also be a power-law with the form a{sup k{minus}}, as a {r_arrow}0. This is true for both density functions of first-order and diffusion rate coefficients. BTCs with k < 3 persisting to the end of the experiment indicate a mean residence time longer than the experiment and possibly infinite, and also suggest an effective rate coefficient that is either undefined or changes as a function of observation time. They apply their analysis to breakthrough curves from Single-Well Injection-Withdrawal tests at the Waste Isolation Pilot Plant, New Mexico.

  18. Accord on “Fire and Building Safety in Bangladesh”: A Breakthrough Agreement?

    Directory of Open Access Journals (Sweden)

    Zillur Rahman

    2014-03-01

    Full Text Available This discussion aims to review the emergence of the “Accord on Fire and Building Safety in Bangladesh” signed on May 13, 2013, and evaluate if it is an international agreement “breakthrough”. The Accord is signed not only by the global clothing brands and national garment unions but also by international trade union organizations, which is a new development. This raises a question: could this agreement set a new international negotiating precedence in industrial relations between transnational corporations and international trade union organizations? In Bangladesh, globalization has played an important role for booming garment industries. Yet, lack of workers’ rights, weak safety situations, and poor working conditions have continuously been reported. Local and international solidarity movements and garment workers’ welfare associations have been emphasizing workers’ rights and better and safer working environments in workplaces since the beginning of the 1990s. However, their voices were not highly considered even there were some initiatives. Following the ‘Rana Plaza’ garment factory building collapse in April 2013, one of the world’s worst industrial accidents, with more than 1,100 dead workers, some strong measures have been taken—one of these, signing the ‘Accord on Fire and Building Safety in Bangladesh’. This is a strong achievement of a long struggle to take collective action for improving the safety in garment factories in Bangladesh. Although the Accord is understood as a game changer or breakthrough in relation to national and international agreements, do we really know yet if it is a breakthrough or not when it comes to its implementation?

  19. The Breakthrough Listen Search for Intelligent Life: L-Band Data Recovery and Analysis

    Science.gov (United States)

    Lifset, Noah

    2018-01-01

    Breakthrough Listen is a next generation SETI project conducted under the leadership of UC Berkeley. In January 2016, it began collecting data with the Green Bank Telescope in West Virginia. It started a targeted campaign of stars within 50 pc with the L-band receiver (1.1-1.9 GHz). Enriquez et al. (2017) analyzed two thirds of this data comprising an homogeneous sample. The remaining one third of the L-band data taken since then is incomplete in some way, and thus required a different analysis. This project identified all possible issues with this data, and classified it based on its ability to be analyzed. Seven issues were found, and six are able to be accounted for with adapted analysis techniques. The data set consisted of observations of 366 stars within 50 pc, with 297 able to be analyzed and 69 needing to be re-observed. The Breakthrough Listen observation strategy uses 6 five minute observations per target star alternating between ON-target and OFF-target in the form ABACAD, which allows for easier radio-frequency interference identification. The analysis techniques, called turboSETI, search for a narrowband signal with a drifting doppler shift. For this data, a maximum drift rate of 4 Hz/s was chosen, which corresponds to an ET emitter on a planet three times the size of earth rotating three times as fast. An SNR threshold for signal detection of 15 was chosen, which allows for detection of signals with an EIRP (Equivalent Isotropic Radiated Power) of 9.72 x109 W for an emitter at a distance of 10 Ly. A total of 10 candidates signals were found, which were all determined to be either a satellite or another type of RFI. We can infer an upper limit of ~ 5 x108 stars in the milky way transmitting continuously towards earth in the L-band with a EIRP of 1012 W or greater.

  20. Photogravimagnetic assists of light sails: a mixed blessing for Breakthrough Starshot?

    Science.gov (United States)

    Forgan, Duncan H.; Heller, René; Hippke, Michael

    2018-03-01

    Upon entering a star system, light sails are subject to both gravitational forces and radiation pressure, and can use both in concert to modify their trajectory. Moreover, stars possess significant magnetic fields, and if the sail is in any way charged, it will feel the Lorentz force also. We investigate the dynamics of so-called `photogravimagnetic assists' of sailcraft around α Centauri A, a potential first destination en route to Proxima Centauri (the goal of the Breakthrough Starshot programme). We find that a 10-m2 sail with a charge-to-mass ratio of around 10 μC g-1 or higher will need to take account of magnetic field effects during orbital manoeuvres. The magnetic field can provide an extra source of deceleration and deflection, and allow capture on to closer orbits around a target star. However, flipping the sign of the sailcraft's charge can radically change resulting trajectories, resulting in complex loop-de-loops around magnetic field lines and essentially random ejection from the star system. Even on well-behaved trajectories, the field can generate off-axis deflections at α Centauri that, while minor, can result in very poor targeting of the final destination (Proxima) post-assist. Fortunately for Breakthrough Starshot, nanosails are less prone to charging en route than their heavier counterparts, but can still accrue relatively high charge at both the origin and destination, when travelling at low speeds. Photogravimagnetic assists are highly non-trivial, and require careful course correction to mitigate against unwanted changes in trajectory.

  1. Accuracy of a Diagnostic Algorithm to Diagnose Breakthrough Cancer Pain as Compared With Clinical Assessment.

    Science.gov (United States)

    Webber, Katherine; Davies, Andrew N; Cowie, Martin R

    2015-10-01

    Breakthrough cancer pain (BTCP) is a heterogeneous condition, and there are no internationally agreed standardized criteria to diagnose it. There are published algorithms to assist with diagnosis, but these differ in content. There are no comparative data to support use. To compare the diagnostic ability of a simple algorithm against a comprehensive clinical assessment to diagnose BTCP and to assess if verbal rating descriptors can adequately discriminate controlled background pain. Patients with cancer pain completed a three-step algorithm with a researcher to determine if they had controlled background pain and BTCP. This was followed by a detailed pain consultation with a clinical specialist who was blinded to the algorithm results and determined an independent pain diagnosis. The sensitivity, specificity, and positive and negative predictive values were calculated for the condition of BTCP. Further analysis determined which verbal pain severity descriptors corresponded with the condition of controlled background pain. The algorithm had a sensitivity of 0.54 and a specificity of 0.76 in the identification of BTCP. The positive predictive value was 0.7, and the negative predictive value was 0.62. The sensitivity of a background pain severity rating of mild or less to accurately categorize controlled background pain was 0.69 compared with 0.97 for severity of moderate or less; however, this was balanced by a higher specificity rating for mild or less, 0.78 compared with 0.2. The diagnostic breakthrough pain algorithm had a good positive predictive value but limited sensitivity using a cutoff score of "mild" to define controlled background pain. When the cutoff level was changed to moderate, the sensitivity increased, but specificity reduced. A comprehensive clinical assessment remains the preferred method to diagnose BTCP. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  2. Tsetse Fly Genome Breakthrough: The FAO and IAEA Crack the Code

    International Nuclear Information System (INIS)

    Dixit, Aabha

    2014-01-01

    With the breakthrough in sequencing the genome of the tsetse fly species Glossina morsitans in April 2014, another milestone has been achieved in helping to solve a problem that has had horrendous ramifications for Africa. Finding a solution to the havoc created by tsetse flies to livestock has been a major challenge for the combined scientific efforts of the IAEA and the Food and Agriculture Organization of the United Nations (FAO), as well as for the World Health Organization (WHO), which has focused on combating human sleeping sickness. Joint research over the past decades to block the spread of severe infection from tsetse flies resulted in the introduction by the FAO and IAEA of the environmentally friendly sterile insect technique (SIT), a biologically-based method for the management of key insect pests of agricultural, medical and veterinary importance. A form of insect birth control, the SIT involves releasing mass-bred male flies that have been sterilized by low doses of radiation into infested areas, where they mate with wild females. These do not produce offspring and, as a result, the technique can suppress and, if applied systematically on an area-wide basis, eventually eradicate populations of wild flies. The newly acquired knowledge of the tsetse fly genome provides a wealth of information for the improvement of the entire SIT package and can help unravel interactions between tsetse flies, symbionts and trypanosomes. The decoding of the genome was detailed in a press release issued by the IAEA on 24 April 2014 entitled Tsetse Fly Genome Breakthrough Brings Hope for African Farmers. Tsetse flies were successfully eradicated in 1997 from the Tanzanian island of Zanzibar using the SIT. Ethiopia and Senegal are making significant progress in infested areas with the same method. The FAO and IAEA are helping 14 countries control tsetse populations through applying area-wide integrated pest management approaches

  3. Often Difficult--But Worth It. Collaboration among Professionals.

    Science.gov (United States)

    Walker, Joyce A.

    1988-01-01

    A joint effort between the Minnesota Extension Service and University of Minnesota School of Medicine produced a community-based research and educational program on stress, depression, and suicide prevention. The Teens in Distress program represents a successful collaborative effort and illustrates the potential problems when Extension…

  4. Virtual Breakthrough Series, Part 1: Preventing Catheter-Associated Urinary Tract Infection and Hospital-Acquired Pressure Ulcers in the Veterans Health Administration.

    Science.gov (United States)

    Zubkoff, Lisa; Neily, Julia; King, Beth J; Dellefield, Mary Ellen; Krein, Sarah; Young-Xu, Yinong; Boar, Shoshana; Mills, Peter D

    2016-11-01

    In 2014 the Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) implemented a Virtual Breakthrough Series (VBTS) collaborative to help VHA facilities prevent hospital-acquired conditions: catheter-associated urinary tract infection (CAUTI) and hospital-acquired pressure ulcers (HAPUs). During the prework phase, participating facilities assembled a multidisciplinary team, assessed their current system for CAUTI or HAPU prevention, and examined baseline data to set improvement aims. The action phase consisted of educational conference calls, coaching, and monthly team reports. Learning was conducted via phone, web-based options, and e-mail. The CAUTI bundle focused on four key principles: (1) avoidance of indwelling urinary catheters, (2) proper insertion technique, (3) proper catheter maintenance, and (4) timely removal of the indwelling catheter. The HAPU bundle focused on assessment and inspection, pressure-relieving surfaces, turning and repositioning, incontinence management, and nutrition/hydration assessment and intervention. For the 18 participating units, the mean aggregated CAUTI rate decreased from 2.37 during the prework phase to 1.06 per 1,000 catheter-days during the action (implementation) phase (p model for implementing a virtual model for improvement. Copyright 2016 The Joint Commission.

  5. Collaborative quality improvement.

    Science.gov (United States)

    Luckenbaugh, Amy N; Miller, David C; Ghani, Khurshid R

    2017-07-01

    Quality improvement collaboratives were developed in many medical and surgical disciplines with the goal of measuring and improving the quality of care provided to patients. The aim of this review is to provide an overview of surgical quality improvement collaboratives, and in particular those aimed at improving urological care. Quality improvement collaboratives collect high-quality data using standardized methodologies, and use the data to provide feedback to physicians and practices, and then implement processes to improve patient outcomes. The largest regional collaborative in urology is the Michigan Urological Surgery Improvement Collaborative (MUSIC). Recent efforts by this group have been focused at understanding variation in care, improving patient selection for treatment, reducing treatment morbidity and measuring and optimizing technical skill. The American Urological Association has also recently launched a national quality registry (AQUA), with an initial focus on prostate cancer care. By understanding factors that result in exemplary performance, quality improvement collaboratives are able to develop best practices around areas of care with high variation that have the potential to improve outcomes and reduce costs. These developments have been made possible by the unique model offered by the collaborative structure with the goal of improving patient care at a population level.

  6. Energy Efficiency Collaboratives

    Energy Technology Data Exchange (ETDEWEB)

    Li, Michael [US Department of Energy, Washington, DC (United States); Bryson, Joe [US Environmental Protection Agency, Washington, DC (United States)

    2015-09-01

    Collaboratives for energy efficiency have a long and successful history and are currently used, in some form, in more than half of the states. Historically, many state utility commissions have used some form of collaborative group process to resolve complex issues that emerge during a rate proceeding. Rather than debate the issues through the formality of a commission proceeding, disagreeing parties are sent to discuss issues in a less-formal setting and bring back resolutions to the commission. Energy efficiency collaboratives take this concept and apply it specifically to energy efficiency programs—often in anticipation of future issues as opposed to reacting to a present disagreement. Energy efficiency collaboratives can operate long term and can address the full suite of issues associated with designing, implementing, and improving energy efficiency programs. Collaboratives can be useful to gather stakeholder input on changing program budgets and program changes in response to performance or market shifts, as well as to provide continuity while regulators come and go, identify additional energy efficiency opportunities and innovations, assess the role of energy efficiency in new regulatory contexts, and draw on lessons learned and best practices from a diverse group. Details about specific collaboratives in the United States are in the appendix to this guide. Collectively, they demonstrate the value of collaborative stakeholder processes in producing successful energy efficiency programs.

  7. Collaborative Video Sketching

    DEFF Research Database (Denmark)

    Henningsen, Birgitte; Gundersen, Peter Bukovica; Hautopp, Heidi

    2017-01-01

    This paper introduces to what we define as a collaborative video sketching process. This process links various sketching techniques with digital storytelling approaches and creative reflection processes in video productions. Traditionally, sketching has been used by designers across various...... findings: 1) They are based on a collaborative approach. 2) The sketches act as a mean to externalizing hypotheses and assumptions among the participants. Based on our analysis we present an overview of factors involved in collaborative video sketching and shows how the factors relate to steps, where...... the participants: shape, record, review and edit their work, leading the participants to new insights about their work....

  8. Collaborative Video Sketching

    DEFF Research Database (Denmark)

    Gundersen, Peter; Ørngreen, Rikke; Hautopp, Heidi

    2017-01-01

    This paper introduces to what we define as a collaborative video sketching process. This process links various sketching techniques with digital storytelling approaches and creative reflection processes in video productions. The empirical data is based on workshop sessions with researchers...... common features are important findings: 1) They are based on a collaborative approach. 2) The sketches act as a mean to externalizing hypotheses and assumptions among the participants. Based on our analysis we present an overview of factors involved in collaborative video sketching and shows how...... the factors relate to steps, where the participants: shape, record, review and edit their work, leading the participants to new insights about their work...

  9. Collaborative Policy Innovation

    DEFF Research Database (Denmark)

    Sørensen, Eva; Waldorff, Susanne Boch

    2014-01-01

    Governments all over the Western world currently face wicked problems that call for policy innovation. A new strand of research in public innovation points to collaboration between public authorities and relevant and affected stakeholders as an important driver of public innovation. A case study...... of collaborative policy innovation in the area of mental health care in Denmark indicates that collaboration can contribute to qualify the politicians’ understanding of wicked policy problems, and to fostering new creative policy solutions. The study also shows, however, that the new problem understandings...

  10. Collaboration in experiential therapy.

    Science.gov (United States)

    Berdondini, Lucia; Elliott, Robert; Shearer, Joan

    2012-02-01

    We offer a view of the nature and role of client-therapist collaboration in experiential psychotherapy, focusing on Gestalt and emotion-focused therapy (EFT). We distinguish between the necessary condition of mutual trust (the emotional bond between client and therapist) and effective collaboration (regarding the goals and tasks of therapy). Using a case study of experiential therapy for social anxiety, we illustrate how the development of collaboration can be both complex and pivotal for therapeutic success, and how it can involve client and therapist encountering one another through taking risks by openly and nonjudgementally disclosing difficult experiences in order to enrich and advance the work. © 2012 Wiley Periodicals, Inc.

  11. Multi-centre European study of breakthrough cancer pain: pain characteristics and patient perceptions of current and potential management strategies

    DEFF Research Database (Denmark)

    Davies, Andrew; Zeppetella, Giovambattista; Andersen, Steen

    2011-01-01

    This study involved 320 cancer patients from four Northern European countries. Patients with breakthrough pain were questioned about the characteristics of their pain, the current management of their pain, and the acceptability/utility of alternative routes of administration. The median number of...

  12. Geopolitics of Quantum Buddhism: Our Pre-Hydrocarbon Tao Future (No Breakthrough at the Rio+20 Summit)

    Science.gov (United States)

    Bajrektarevic, Anis

    2013-01-01

    From Rio to Rio with Kyoto, Copenhagen and Durban in between, the conclusion remains the same: we fundamentally disagree on realities of this planet and the ways we can address them. A decisive breakthrough would necessitate both wider contexts and a larger participatory base so as to identify problems, formulate policies, and broaden and…

  13. Parameterizing the Leaching Surface by Combining Curve-Fitting for Solute Breakthrough and for Spatial Solute Distribution

    NARCIS (Netherlands)

    Bloem, E.; Gee, de M.; Rooij, de G.H.

    2012-01-01

    Multi-compartment samplers (MCSs) measure unsaturated solute transport in space and time at a given depth. Sorting the breakthrough curves (BTCs) for individual compartments in descending order of total solute amount and plotting in 3D produces the leaching surface. The leaching surface is a useful

  14. Application of the rainfall infiltration breakthrough (RIB) model for groundwater recharge estimation in west coastal South Africa

    CSIR Research Space (South Africa)

    Sun, X

    2013-04-01

    Full Text Available level fluctuations (WLF) on a monthly basis was proposed in the rainfall infiltration breakthrough (RIB) model for the purpose of groundwater recharge estimation. In this paper, the physical meaning of parameters in the CRD and previous RIB models...

  15. Prediction of Breakthrough Curves for Conservative and Reactive Transport from the Structural Parameters of Highly Heterogeneous Media

    Energy Technology Data Exchange (ETDEWEB)

    Hansen, Scott [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Haslauer, Claus P. [Univ. of Tubingen (Germany); Cirpka, Olaf A. [Univ. of Tubingen (Germany); Vesselinov, Velimir Valentinov [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2017-01-05

    The key points of this presentation were to approach the problem of linking breakthrough curve shape (RP-CTRW transition distribution) to structural parameters from a Monte Carlo approach and to use the Monte Carlo analysis to determine any empirical error

  16. Collaborative software development

    NARCIS (Netherlands)

    M. de Jonge (Merijn); E. Visser; J.M.W. Visser (Joost)

    2001-01-01

    textabstractWe present an approach to collaborative software development where obtaining components and contributing components across organizational boundaries are explicit phases in the development process. A lightweight generative infrastructure supports this approach with an online package base,

  17. Collaborative Procurement Initiative

    Science.gov (United States)

    GPP's Clean Energy Collaborative Procurement Initiative provides a platform for deploying clean energy technologies across multiple government and educational organizations for maximum impact on installed solar system capacity and local economic activity.

  18. Collaborative Learning through Teletutorials.

    Science.gov (United States)

    Idrus, Rozhan

    1993-01-01

    Describes the use of audiographic teleconferencing for distance education courses for adult higher education at the Universiti Sains Malaysia. Telecommunications is discussed, and a collaborative learning strategy is explained that emphasizes the student-teacher relationship. (Contains 18 references.) (LRW)

  19. Indico: CERN Collaboration Hub

    CERN Multimedia

    CERN. Geneva

    2012-01-01

    Indico development is also moving towards a broader collaboration where other institutes, hosting their own Indico instance, can contribute to the project in order make it a better and more complete tool.

  20. CMS Collaboration Board Meeting

    CERN Multimedia

    Hoch, Michael

    2013-01-01

    The first CMS Collaboration Board meeting of the year (2013) provided an opportunity to thank Teresa Rodrigo, Matthias Kasemann and Randy Ruchti, the 2011-12 CB Chair, Deputy Chair and Secretary, respectively.

  1. Providers’ perspectives on collaboration

    Directory of Open Access Journals (Sweden)

    Patricia Bruner

    2011-08-01

    Full Text Available Objective: Changes in models of health care are required to better meet the needs of diverse, underserved patient populations. Collaboration among providers is one way to promote accessible, comprehensive and continuous care in healthcare organizations. This paper describes the quantitative findings from two time points that examined providers' views of collaboration among a sample of diverse personnel (e.g. clinical nurses, social workers, dental providers, mental health providers, clerical staff, medical assistants, public health staff, and administrators within a federally qualified nurse managed health care centre in the United States. Methods: The quantitative arm of a mixed-method study is presented in this paper. Two instruments, the Collaboration and Satisfaction About Care Decisions Scale and the University of the West of England Interprofessional Questionnaire (comprised of 4 subscales-Communication and Teamwork Scale, Interprofessional Learning Scale, Interprofessional Interaction Scale, and Interprofessional Relationships Scale were administered to providers at baseline and three to eight months following six same discipline focus group discussions on collaboration, in order to evaluate whether participating in the focus group discussions changed providers' views of collaboration. A summary of the focus group data which were published elsewhere is additionally summarized to help provide insight to the quantitative findings. Thirty-nine staff participated. Results: Paired t-tests revealed that only one scale out of the five, Collaboration and Satisfaction About Care Decisions Scale (33.97 at time one and 37.45 at time two, significantly and positively changed after the focus group discussion (p=0.046. Providers' views on collaboration ranged from positive to moderate views of collaboration; most measures revealed a non-significant improvement after the focus group discussions. Staff with some graduate school reported the greatest

  2. Providers’ perspectives on collaboration

    Directory of Open Access Journals (Sweden)

    Patricia Bruner

    2011-08-01

    Full Text Available Objective: Changes in models of health care are required to better meet the needs of diverse, underserved patient populations. Collaboration among providers is one way to promote accessible, comprehensive and continuous care in healthcare organizations. This paper describes the quantitative findings from two time points that examined providers' views of collaboration among a sample of diverse personnel (e.g. clinical nurses, social workers, dental providers, mental health providers, clerical staff, medical assistants, public health staff, and administrators within a federally qualified nurse managed health care centre in the United States.Methods: The quantitative arm of a mixed-method study is presented in this paper. Two instruments, the Collaboration and Satisfaction About Care Decisions Scale and the University of the West of England Interprofessional Questionnaire (comprised of 4 subscales-Communication and Teamwork Scale, Interprofessional Learning Scale, Interprofessional Interaction Scale, and Interprofessional Relationships Scale were administered to providers at baseline and three to eight months following six same discipline focus group discussions on collaboration, in order to evaluate whether participating in the focus group discussions changed providers' views of collaboration. A summary of the focus group data which were published elsewhere is additionally summarized to help provide insight to the quantitative findings. Thirty-nine staff participated.Results: Paired t-tests revealed that only one scale out of the five, Collaboration and Satisfaction About Care Decisions Scale (33.97 at time one and 37.45 at time two, significantly and positively changed after the focus group discussion (p=0.046. Providers' views on collaboration ranged from positive to moderate views of collaboration; most measures revealed a non-significant improvement after the focus group discussions. Staff with some graduate school reported the greatest

  3. Staging Collaborative Innovation Processes

    DEFF Research Database (Denmark)

    Pedersen, Signe; Clausen, Christian

    Organisations are currently challenged by demands for increased collaborative innovation internally as well as with external and new entities - e.g. across the value chain. The authors seek to develop new approaches to managing collaborative innovative processes in the context of open innovation...... and public private innovation partnerships. Based on a case study of a collaborative design process in a large electronics company the paper points to the key importance of staging and navigation of collaborative innovation process. Staging and navigation is presented as a combined activity: 1) to translate...... the diverse matters of concern into a coherent product or service concept, and 2) in the same process move these diverse holders of the matters of concern into a translated actor network which carry or support the concept....

  4. Collaborative Transportation Systems

    OpenAIRE

    Piorkowski, Michal

    2010-01-01

    We propose a new class of applications for Intelligent Transportation Systems (ITSs), called collaborative transportation applications that aim at solving transportation problems such as congestion and parking. Specifically, we define two applications: SmartPark and SmartRide that leverage shortrange wireless communication. We quantify the potential benefits these collaborative transportation applications can offer to an individual and to the public. To this extent, we conduct both the realis...

  5. Collaboration Between Multistakeholder Standards

    DEFF Research Database (Denmark)

    Rasche, Andreas; Maclean, Camilla

    Public interest in corporate social responsibility (CSR) has resulted in a wide variety of multistakeholder CSR standards in which companies can choose to participate. While such standards reflect collaborative governance arrangements between public and private actors, the market for corporate...... responsibility is unlikely to support a great variety of partly competing and overlapping standards. Increased collaboration between these standards would enhance both their impact and their adoption by firms. This report examines the nature, benefits, and shortcomings of existing multistakeholder standards...

  6. Providers? perspectives on collaboration

    OpenAIRE

    Bruner, Patricia; Waite, Roberta; Davey, Maureen P

    2011-01-01

    Objective: Changes in models of health care are required to better meet the needs of diverse, underserved patient populations. Collaboration among providers is one way to promote accessible, comprehensive and continuous care in healthcare organizations. This paper describes the quantitative findings from two time points that examined providers' views of collaboration among a sample of diverse personnel (e.g. clinical nurses, social workers, dental providers, mental health providers, clerical ...

  7. Electronic Collaboration Logbook

    CERN Multimedia

    CERN. Geneva

    2012-01-01

    At FNAL, we developed an Electronic Collaboration Logbook (ECL) application which is used by about 20 different collaborations, experiments and groups at FNAL. ECL is the latest iteration of the project formerly known as Control Room Logbook (CRL). We have been working on mobile (IOS and Android) clients for ECL. We will present history, current status and future plans of the project, as well as design, implementation and support solutions made by the project.

  8. Comparing Adoption of Breakthrough and "Me-too" Drugs among Medicare Beneficiaries: A Case Study of Dipeptidyl Peptidase-4 Inhibitors.

    Science.gov (United States)

    Hernandez, Inmaculada; Zhang, Yuting

    2017-06-01

    "Me-too" drugs are new pharmaceuticals with the mechanism of action of an existing drug and are considered less innovative than breakthrough drugs. The objective of this study was to evaluate whether the adoption patterns of the breakthrough drug sitagliptin and the "me-too" drug saxagliptin differed; and to assess whether the patterns differed between Medicare stand-alone (PDP) and Medicare-Advantage Part D (MA-PD) plans. Pharmacy claims from a 5% random sample of Medicare Part D beneficiaries were used to identify all prescriptions filled for sitagliptin (breakthrough drug) and saxagliptin ("me-too" drug) between October 1, 2006 and December 31, 2011. The number of new sitagliptin and saxagliptin users by month and type of plan were plotted, and Bass diffusion models were constructed to estimate the rate of diffusion. Sitagliptin had a longer adoption life than saxagliptin, and its adoption was quicker among MA-PD than PDP beneficiaries: it peaked at 51 and 66.7 months after its approval, respectively. However, the adoption of saxagliptin did not differ by type of plan: it peaked at 20.5 months in PDP and 22.9 months in MA-PD. At the end of our study, the market share of the innovative drug sitagliptin measured as the cumulative number of users since market entry was almost nine times higher than the "me-too" drug, saxagliptin. The breakthrough drug sitagliptin had a much longer adoption life compared to the "me-too" drug saxagliptin, and the breakthrough drug sitagliptin was adopted quicker among managed care plans compared to PDP plans.

  9. Collaborations in fusion research

    International Nuclear Information System (INIS)

    Barnes, D.; Davis, S.; Roney, P.

    1995-01-01

    This paper reviews current experimental collaborative efforts in the fusion community and extrapolates to operational scenarios for the Tokamak Physics Experiment (TPX) and the International Thermonuclear Experimental Reactor (ITER). Current requirements, available technologies and tools, and problems, issues and concerns are discussed. This paper specifically focuses on the issues that apply to experimental operational collaborations. Special requirements for other types of collaborations, such as theoretical or design and construction efforts, will not be addressed. Our current collaborative efforts have been highly successful, even though the tools in use will be viewed as primitive by tomorrow's standards. An overview of the tools and technologies in today's collaborations can be found in the first section of this paper. The next generation of fusion devices will not be primarily institutionally based, but will be national (TPX) and international (ITER) in funding, management, operation and in ownership of scientific results. The TPX will present the initial challenge of real-time remotely distributed experimental data analysis for a steady state device. The ITER will present new challenges with the possibility of several remote control rooms all participating in the real-time operation of the experimental device. A view to the future of remote collaborations is provided in the second section of this paper

  10. Serotonin & Depression

    OpenAIRE

    Axholm, Ida; Haxgart, Nina; Ranum, Kasper; Svendsen, Astrid Helmer

    2014-01-01

    350.000.000 people worldwide have a depression and 150.000 Danes are affected every year. Depresion is defined by WHO from it’s syptoms. The diagnose is given from a point system for the patient’s symptoms, for instance HAM-D scale and MADRS scale Serotonin in the brain is synthesized from L-tryptophan in the presynaptic parts of the neuron and is released into the synapse as a transmitter drug. According to the serotonin theory, the concentration of serotonin in the brain is low in depressio...

  11. Nutritional interventions in depression and perinatal depression.

    Science.gov (United States)

    Rechenberg, Kaitlyn; Humphries, Debbie

    2013-06-01

    Depression is the leading cause of mental disability worldwide. Women who are depressed during pregnancy are at a higher risk for preterm delivery, preeclampsia, birth difficulties, and postpartum depression. The treatment of depression in conventional medicine has focused on physiological factors that lead to impaired neurotransmitter function and treatments to improve neurotransmitter function. Pharmaceutical substances pose risks for pregnant and lactating women, and lower risk options are preferred. Micronutrients, including certain B vitamins, folate, and docosahexaenoic acid (DHA), play a role in the synthesis and absorption of neurotransmitters. Experimental studies suggest that supplementation with specific micronutrients may alleviate depressive symptoms and improve birth outcomes in patients with perinatal depression. Alternative treatments for depression, including nutritional supplements, are an important treatment option for depressive symptoms while limiting potential side effects and treatment costs. This article explores the biological basis of perinatal depression and reviews the potential benefits of non-pharmacological interventions.

  12. Recent breakthroughs and themes in hydrology, from climate to the water-food-energy nexus

    Science.gov (United States)

    Montanari, A.

    2017-12-01

    The last decades marked a significant change in geosciences. Increasing communication, observations, computing capabilities and opportunities to make dissemination stimulated a rapid increase of the number of publications and scientific forums. On the one hand this development is undoubtedly positive. In fact, it provides more and more opportunities to young and experienced scientists to elaborate innovative ideas and to establish cooperation. On the other hand, the proliferation of information, communication and publications makes the identification of key ideas and contributions definitely more challenging. Notwithstanding the above development, Water Resources Research (WRR) provides an ideal perspective to elaborate a picture of recent breakthroughs in hydrology. In fact, despite the increasing number of submissions and the progress of time, WRR kept a rigorous attitude to assess manuscripts by evaluating their relevance to emerging environmental and societal challenges.To get a long term perspective of breakthroughs in hydrology, it is interesting to compare the two anniversary special sections published so far in WRR, namely, the 50th anniversary special section "Legacy and perspectives for the science of hydrology", and "Trends and Directions in Hydrology", that was edited by Steven Burges in 1986 to celebrate the 20th anniversary of the journal. The above comparison highlights that the traditional break-up of hydrology into sub-disciplines, each focusing on separate components of the water cycle, has given way to a more interconnected, interdisciplinary research on a wide range of spatial and temporal scales, and interactions between water, society, earth and biological systems.This talk will present a voyage through the WRR history to highlight recent advances and topical themes. An attempt to develop a vision for the future of WRR and hydrology will be presented. Water will become more and more the regulator of social dynamics, including economy, politics

  13. Pharmacogenetic evaluation to assess breakthrough psychosis with aripiprazole long-acting injection: a case report.

    Science.gov (United States)

    Eum, Seenae; Schneiderhan, Mark E; Brown, Jacob T; Lee, Adam M; Bishop, Jeffrey R

    2017-07-03

    Given the complex nature of symptom presentation and medication regimens, psychiatric clinics may benefit from additional tools to personalize treatments. Utilizing pharmacogenetic information may be helpful in assessing unique responses to therapy. We report herein a case of wearing-off phenomena during treatment with aripiprazole long-acting injectable (LAI) and a proof of concept strategy of how pharmacogenetic information may be used to assess possible genetic factors and also hypothesize potential mechanisms for further study. A 51-year-old African American male with schizoaffective disorder was referred to a psychiatric clinic for medication management. After unsuccessful trials of multiple antipsychotics, oral aripiprazole was initiated (up to 30 mg/day) and transitioned to aripiprazole LAI with symptom improvement. At a high dose of aripiprazole LAI (400 mg Q3wks), the patient experienced breakthrough symptoms approximately 3 days prior to his next injection. Various considerations were examined to explain his atypical dose requirements, including but not limited to pharmacogenetic influences. Pharmacogenetic testing ruled out genetic influences on drug metabolism but noted a -141C Del variant in the dopamine-D2 receptor (DRD2) gene associated in prior studies of poor-response to antipsychotics. At this time, a new formulation, aripiprazole lauroxil, was explored due to its availability in higher dose options. Transition to the new formulation (882 mg Q4wks) greatly improved and stabilized the patient's symptoms with no breakthrough psychosis. Comparable daily dose equivalents were achieved with two different formulations due to the Q3wks vs Q4wks dosing strategies, although the two agents have some differences in pharmacokinetic profiles. We report a case of a patient experiencing wearing-off symptoms with aripiprazole LAI who benefited from switching to aripiprazole lauroxil. Pharmacogenetic testing revealed normal activity for relevant metabolism

  14. Solute breakthrough during repeated ponded infiltration into columns of repacked sand and heterogeneous soil

    Science.gov (United States)

    Sobotkova, M.; Snehota, M.; Cislerova, M.

    2010-12-01

    Water flow during recurrent ponded infiltration may be affected by presence of entrapped air in heterogeneous soils. It is likely that presence of entrapped air influences also the solute transport. The aim of this contribution is to experimentally investigate the effect of entrapped air on tracer breakthrough by means of experiments conducted on two large samples in laboratory. A modified recurrent ponded infiltration, conducted on each soil sample consisted of three infiltration runs. The same level of ponding was maintained during each infiltration run at the top of the sample. Water drained freely through the perforated plate at the bottom of the sample. First infiltration run was done into naturally dry soil while two subsequent runs were conducted into wetter soil. It is assumed that infiltration in wet media causes more air trapping and reduced effective saturated hydraulic conductivity in some heterogeneous soils. In order to demonstrate effect of entrapped air dissolution the third infiltration was conducted with partly de-aerated water. The experiments were conducted using an automated set-up with frequent monitoring of pressure heads in three tensiometers, water contents in three TDR probes, cumulative infiltration and outflow, weight of the sample monitored by load cell and concentration of oxygen in the effluent. During each infiltration run the concentration pulse of bromide tracer was applied at the top of the soil core during steady state flow. Bromide breakthrough curve was acquired by electrochemical in-line analysis of bromide ions in the effluent. The results of the experiment conducted on repacked sand show that the steady state outflow rates measured during the first and second infiltration run were similar, while the outflow rates during third infiltration runs were steadily increasing. The shapes of all three BTC’s plotted against the cumulative outflow were nearly identical. In contrast to the repacked sand, steady state outflow rates

  15. Tamoxifen for the treatment of breakthrough bleeding with the etonogestrel implant: a randomized controlled trial.

    Science.gov (United States)

    Simmons, Katharine B; Edelman, Alison B; Fu, Rongwei; Jensen, Jeffrey T

    2017-02-01

    The etonogestrel (ENG) subdermal implant can cause frequent breakthrough bleeding in some users. The objective of this study was to evaluate whether a short course of tamoxifen reduces bleeding/spotting days compared to placebo in ENG implant users. In this double-blind trial, we randomized ENG implant users with frequent or prolonged bleeding or spotting to tamoxifen 10 mg or placebo twice daily for 7 days, to be started after 3 consecutive days of bleeding/spotting. Treatment was repeated as needed up to three times in 180 days. Subjects completed a daily text message bleeding diary. A sample size of 56 provided 80% power to detect a difference of 6 days of bleeding/spotting per 30 days by two-sample t test. Ovulation was monitored by urinary metabolites of progesterone. From March 2014 to February 2015, 56 women enrolled. Fifty-one completed at least 30 days of follow up, and 34 completed 180 days. Compared to women randomized to placebo, women randomized to tamoxifen reported 5 fewer days of bleeding/spotting over 30 days (95% confidence interval [CI] -9.9 to -0.05, p=.05), and 15.2 more continuous bleeding-free days (95% CI 2.8-27.5 days, p=.02) after first use of study drug. Conclusions could not be drawn after 30 days due to higher-than-expected dropout. No ovulation was detected. First use of tamoxifen by ENG implant users reduces bleeding/spotting days and provides a longer cessation of bleeding/spotting than placebo, without compromising ovulation suppression. Further study is needed to determine whether this effect is maintained with repeat use. Women with frequent ENG implant-related breakthrough bleeding may experience a reduction in bleeding/spotting days and an increase in continuous bleeding-free days in the month following first use of tamoxifen. This short course of tamoxifen was well tolerated with bleeding cessation noted within a median of 5 days. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. FRB121102: First detection across 5 - 8 GHz and spectral properties from the Breakthrough Listen instrument

    Science.gov (United States)

    Gajjar, Vishal; Siemion, Andrew; MacMohan, David; Croft, Steve; Hellbourg, Greg; Isaacson, Howard; Enriquez, J. Emilio; Price, Daniel; Lebofsky, Matt; De Boer, David; Werthimer, Dan; Hickish, Jack; Brinkman, Casey; Chatterjee, Shami; Ransom, Scott M.; Law, Casey; Hessels, Jason W. T.; Cordes, Jim; Spitler, Laura; Lynch, Ryan; McLaughlin, Maura; Scholz, Paul; Marcote, Benito; Bower, Geoffrey C.; Tendulkar, Shriharsh

    2018-01-01

    Fast Radio Bursts (FRBs) are some of the most energetic and enigmatic events in the Universe. The origin of these sources is among the most challenging questions of modern-day astrophysics. Thus, it is imperative to understand the properties of these bursts across a range of radio frequencies. Among the known FRBs, FRB121102 is the only source known to show repeated bursts [Spitler et al., Nature, 531, 7593 202-205, 2016], which can allow a detailed investigation of various origin models. In August 2017, we initiated a campaign observing FRB 121102 using the Breakthrough Listen Digital Backend with the C-band receiver at the Robert C. Byrd Green Bank Telescope (GBT). We recorded baseband voltage data across 5.4 GHz of bandwidth, completely covering the C-band receiver's nominal 4-8 GHz band [MacMahon et al. arXiv:1707.06024v2]. The recorded data were searched for dispersed pulses consistent with the known dispersion measure of FRB 121102 (557 pc cm-3) using high-speed GPU software tools. We detected 21 bursts above our detection threshold of 6 sigmas in the first 60-minutes, out of which 18 occurred in the first 30-minutes only. To our knowledge, this is the highest event rate seen for FRB121102 at any observing frequency. These observations are the highest frequency and widest bandwidth detection of bursts from FRB 121102 (or any other FRB) obtained to-date. We note that individual bursts show marked changes in spectral extent ranging from hundreds of MHz to several GHz. We have used high frequency dynamic spectra of these bursts to estimate the characteristic scintillation bandwidth and correlation time-scale. We also found distinctive temporal structures, separated by a few milliseconds, in three of the strongest bursts, with each sub-structure exhibiting varied spectral features. We will discuss our findings and how these detections of FRB 121102 around 8 GHz opens up a new regime in scrutinizing various origin models. We will also highlight the unique

  17. TU-E-211-01: Establishing Multidisciplinary Collaboration as a Medical Physicist.

    Science.gov (United States)

    Xing, L; Fraass, B; Ford, E; Chang, S

    2012-06-01

    Many medical physicists are scientists at heart and their career fulfillment includes a balance of clinical service and research development. Multidisciplinary collaboration is a great way for the medical physicists to advance science and technology of our fields and the fields of our collaborators. Cross-pollination among scientists of different fields has been the key for some of the most significant breakthroughs in science and medicine and produced some of the most rewarding experiences for the individuals involved. However, medical physicists face unique challenges in establishing multidisciplinary collaboration because our time and resources for research are often quite limited compared to basic scientists. Yet we medical physicists are uniquely positioned and have a tremendous opportunity to create/contribute to multidisciplinary research: our fields are already multidisciplinary in nature and hospital environment is problem rich. How do we establish and carry out research collaboration with scientists of other fields? How to balance research with your higher priority clinical service? How do you find the right multidisciplinary collaboration in your own environment? We will discuss the challenges, provide real exemplary solutions to the above questions, and offer advise to medical physicists who are interested in starting or improving their multidisciplinary collaboration. There are different kinds of multidisciplinary collaborations a medical physicist can create and participate at different involvement levels. Multidisciplinary collaboration is not for every medical physicist but for those who seek and devote time to it, the experience can be truly rewarding and the impact can be enormous. 1. Learn the types of multidisciplinary collaboration medical physicists can created/participated 2. Learn the approaches and strategies to develop collaborations with scientists and professional of other fields3. Understand the challenges and different approaches to

  18. Alcoholism & depression.

    Science.gov (United States)

    Hall, Mellisa

    2012-10-01

    One out of 2 Americans report drinking on a routine basis, making the excessive consumption of alcohol the third leading cause of preventable death in America (). Alcoholism and depression are common comorbidities that home healthcare professionals frequently encounter. To achieve the best patient outcomes, alcoholism should be addressed initially. Although all age groups are at risk, alcoholism and depression occur in more than 8 percent of older adults. Prevention through identifying alcohol use early in adolescence is vital to reduce the likelihood of alcohol dependence. This article provides an overview of the long-term effects of alcohol abuse, including alcoholic cirrhosis and hepatic encephalopathy. The diagnostic criteria for substance dependence and ideas for nonthreatening screening questions to use with patients who are adolescent or older are discussed. While providing patient care, home healthcare nurses share the patient's intimate home environment. This environment is perceived as a safe haven by the patient and home care nurses can take advantage of counseling and treatment opportunities in this nonthreatening environment.

  19. Sadness and Depression

    Science.gov (United States)

    ... Videos for Educators Search English Español Sadness and Depression KidsHealth / For Kids / Sadness and Depression Print en ... big difference in your life. When Sadness Is Depression When you're in a sad mood, it ...

  20. Breakthrough invasive fungal diseases during voriconazole treatment for aspergillosis: A 5-year retrospective cohort study.

    Science.gov (United States)

    Kim, Sun Bean; Cho, Sung-Yeon; Lee, Dong-Gun; Choi, Jae-Ki; Lee, Hyo-Jin; Kim, Si-Hyun; Park, Sun Hee; Choi, Su-Mi; Choi, Jung-Hyun; Yoo, Jin-Hong; Lee, Jong-Wook

    2017-04-01

    Breakthrough invasive fungal diseases (bIFDs) during voriconazole treatment are concerning, as they are associated with high rates of mortality and pathogen distribution. To evaluate the prevalence, incidence, patient characteristics, including IFD events, and overall mortality of bIFDs during voriconazole treatment for invasive aspergillosis (IA). We retrospectively analyzed the medical records of consecutive patients who had undergone voriconazole treatment for IA and who had bIFD events between January 2011 and December 2015. Eleven bIFD events occurred in 9 patients. The prevalence and incidence of bIFDs were 2.25% (9/368) and 0.22 cases per year, respectively. Overall mortality was 44.4% (4/9). The severity of the illness and persistence of immunodeficiency, mixed infection, and low concentration of the treatment drug at the site of infection were identified as possible causes of bIFDs. Seven of 11 events (63.6%) required continued voriconazole treatment with drug level monitoring. In 4 (36.3%) cases, the treatment was changed to liposomal amphotericin B. Two cases resulted in surgical resection (18.2%). Clinicians should be aware that bIFDs during voriconazole treatment for IA can occur, and active therapeutic approaches are required in these cases. © The Author 2016. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology.

  1. Tracking tracer breakthrough in the hyporheic zone using time‐lapse DC resistivity, Crabby Creek, Pennsylvania

    Science.gov (United States)

    Nyquist, Jonathan E.; Toran, Laura; Fang, Allison C.; Ryan, Robert J.; Rosenberry, Donald O.

    2010-01-01

    Characterization of the hyporheic zone is of critical importance for understanding stream ecology, contaminant transport, and groundwater‐surface water interaction. A salt water tracer test was used to probe the hyporheic zone of a recently re‐engineered portion of Crabby Creek, a stream located near Philadelphia, PA. The tracer solution was tracked through a 13.5 meter segment of the stream using both a network of 25 wells sampled every 5–15 minutes and time‐lapse electrical resistivity tomographs collected every 11 minutes for six hours, with additional tomographs collected every 100 minutes for an additional 16 hours. The comparison of tracer monitoring methods is of keen interest because tracer tests are one of the few techniques available for characterizing this dynamic zone, and logistically it is far easier to collect resistivity tomographs than to install and monitor a dense network of wells. Our results show that resistivity monitoring captured the essential shape of the breakthrough curve and may indicate portions of the stream where the tracer lingered in the hyporheic zone. Time‐lapse resistivity measurements, however, represent time averages over the period required to collect a tomographic data set, and spatial averages over a volume larger than captured by a well sample. Smoothing by the resistivity data inversion algorithm further blurs the resulting tomograph; consequently resistivity monitoring underestimates the degree of fine‐scale heterogeneity in the hyporheic zone.

  2. Making Breakthroughs in the Turbulent Decade: China's Space Technology During the Cultural Revolution.

    Science.gov (United States)

    Li, Chengzhi; Zhang, Dehui; Hu, Danian

    2017-09-01

    This article discusses why Chinese space programs were able to develop to the extent they did during the turbulent decade of the Cultural Revolution (1966-1976). It first introduces briefly what China had accomplished in rocket and missile technology before the Cultural Revolution, including the establishment of a system for research and manufacturing, breakthroughs in rocket technology, and programs for future development. It then analyzes the harmful impacts of the Cultural Revolution on Chinese space programs by examining activities of contemporary mass factions in the Seventh Ministry of Machinery Industry. In the third section, this article presents the important developments of Chinese space programs during the Cultural Revolution and explores briefly the significance of these developments for the future and overall progress in space technology. Finally, it discusses the reasons for the series of developments of Chinese space technology during the Cultural Revolution. This article concludes that, although the Cultural Revolution generated certain harmful impacts on the development of Chinese space technology, the Chinese essentially accomplished their scheduled objectives in their space program, both because of the great support of top Chinese leaders, including the officially disgraced Lin Biao and the Gang of Four, and due to the implementation of many effective special measures. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Point Climat no. 33 'International Climate Negotiations - COP 19: do not underestimate the MRV breakthrough'

    International Nuclear Information System (INIS)

    Dupont, Marion; Morel, Romain; Bellassen, Valentin; Deheza, Mariana

    2013-01-01

    Among the publications of CDC Climat Research, 'Climate Briefs' presents, in a few pages, hot topics in climate change policy. This issue addresses the following points: For those who expect 'binding' emission reductions targets in the future international climate agreement to be signed in Paris in 2015, the Warsaw Conference (November 11 to 23, 2013) yielded as much progress as it could. That means little beyond a timetable. However, for those who consider the UNFCCC as the depository of common tools on the monitoring, reporting and verification (MRV) of emissions, actions and financing, Warsaw represents a major breakthrough. For the first time, developing countries - at least those wishing to access climate finance for forests - will abide by MRV procedures similar to those governing the greenhouse gas inventories of industrialized countries. Forestry may be seen as a first sectoral NAMA, and it would be difficult to ignore the Warsaw decisions for the future definition of MRV procedures of NAMAs. In spite of the establishment of the Warsaw International Mechanism for Loss and Damage, low outputs on other issues show that achieving an agreement at COP 21 will require significant political progress during the next 15 months

  4. Breakthrough reactions of iodinated and gadolinium contrast media after oral steroid premedication protocol.

    Science.gov (United States)

    Jingu, Akiko; Fukuda, Junya; Taketomi-Takahashi, Ayako; Tsushima, Yoshito

    2014-10-06

    Adverse reactions to iodinated and gadolinium contrast media are an important clinical issue. Although some guidelines have proposed oral steroid premedication protocols to prevent adverse reactions, some patients may have reactions to contrast media in spite of premedication (breakthrough reaction; BTR).The purpose of this study was to assess the frequency, type and severity of BTR when following an oral steroid premedication protocol. All iodinated and gadolinium contrast-enhanced radiologic examinations between August 2011 and February 2013 for which the premedication protocol was applied in our institution were assessed for BTRs. The protocol was applied to a total of 252 examinations (153 patients, ages 15-87 years; 63 males, 90 females). Of these, 152 were for prior acute adverse reactions to contrast media, 85 were for a history of bronchial asthma, and 15 were for other reasons. There were 198 contrast enhanced CTs and 54 contrast enhanced MRIs. There were nine BTR (4.5%) for iodinated contrast media, and only one BTR (1.9%) for gadolinium contrast media: eight were mild and one was moderate. No patient who had a mild index reaction (IR) had a severe BTR. Incidence of BTRs when following the premedication protocol was low. This study by no means proves the efficacy of premedication, but provides some support for following a premedication protocol to improve safety of contrast-enhanced examinations when prior adverse reactions are mild, or when there is a history of asthma.

  5. Breakthrough reactions of iodinated and gadolinium contrast media after oral steroid premedication protocol

    International Nuclear Information System (INIS)

    Jingu, Akiko; Fukuda, Junya; Taketomi-Takahashi, Ayako; Tsushima, Yoshito

    2014-01-01

    Adverse reactions to iodinated and gadolinium contrast media are an important clinical issue. Although some guidelines have proposed oral steroid premedication protocols to prevent adverse reactions, some patients may have reactions to contrast media in spite of premedication (breakthrough reaction; BTR). The purpose of this study was to assess the frequency, type and severity of BTR when following an oral steroid premedication protocol. All iodinated and gadolinium contrast-enhanced radiologic examinations between August 2011 and February 2013 for which the premedication protocol was applied in our institution were assessed for BTRs. The protocol was applied to a total of 252 examinations (153 patients, ages 15–87 years; 63 males, 90 females). Of these, 152 were for prior acute adverse reactions to contrast media, 85 were for a history of bronchial asthma, and 15 were for other reasons. There were 198 contrast enhanced CTs and 54 contrast enhanced MRIs. There were nine BTR (4.5%) for iodinated contrast media, and only one BTR (1.9%) for gadolinium contrast media: eight were mild and one was moderate. No patient who had a mild index reaction (IR) had a severe BTR. Incidence of BTRs when following the premedication protocol was low. This study by no means proves the efficacy of premedication, but provides some support for following a premedication protocol to improve safety of contrast-enhanced examinations when prior adverse reactions are mild, or when there is a history of asthma

  6. The development of new analgesics over the past 50 years: a lack of real breakthrough drugs.

    Science.gov (United States)

    Kissin, Igor

    2010-03-01

    Fifty-nine drugs identified as analgesics were introduced from 1960 to 2009 and remain in use. Seven can be regarded as having novel molecular targets; however, only one, sumatriptan, was sufficiently effective to motivate the introduction of many similar drugs acting at the same target (triptans). Publication productivity in the area of pain grew exponentially during this period. Pain-related publications on morphine were dominant among other analgesics. Very intensive research efforts directed at diverse molecular targets related to pain mechanisms produced thousands of publications, but those efforts have not yet yielded new analgesics with sufficient effectiveness to change the share of publications on opioids or nonsteroidal antiinflammatory drugs. Morphine and aspirin, introduced for the treatment of pain more than a century ago, continue to dominate biomedical publications despite their limited effectiveness in many areas (e.g., neuropathic pain) and multiple serious adverse effects. The present assessment reveals the lack of real breakthroughs in analgesic drug development despite intense research efforts. Possible factors contributing to the apparent drought of novel analgesics are discussed.

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

    Science.gov (United States)

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

    2011-09-01

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

  8. A BREAKTHROUGH VARICELLA: WILL A NEW VACCINATION SCHEDULE CHANGE THE SITUATION?

    Directory of Open Access Journals (Sweden)

    E.A. Vishneva

    2011-01-01

    Full Text Available Varicella — is a common viral infection that can cause complications and adverse outcome not only in children at risk, but also in healthy children and adults. Socio-economic burden of disease due to both-direct health care, costs — to seek medical care and treatment,  and indirect — social. The introduction of immunization after the development of live attenuated vaccine has shown impressive results provided high coverage of morbidity and mortality associated with chickenpox declined sharply. However, the development of infection in vaccinated patients — a breakthrough varicella may be related with the deterioration of post-vaccinal immunity with time,  and the primary tolerance and inability to induce an effective immune response. Despite the undeniable progress in the prevention of chicken pox since the early 2000s. the world’s a discussion about the need to move to the two-dose vaccination scheme in national immunization programs has been started. Key words: vaccination, children, chickenpox, varicella, breakout. (Pediatric pharmacology. — 2011; 8 (6: 18–22.

  9. EGOLOGY: psychological spatial breakthrough for social redirection--multidisciplinary spatial focus for individuals/humankind

    Science.gov (United States)

    Thompson, Robert A.

    1991-08-01

    Every age is marked by its physical tools. But today''s Space Age is unique because it is the spatial vantage itself which becomes a tool. It is a mental breakthrough, permitting us to contrast our outward-looking dreams with an inward-focused reality that can psychologically redirect the future for humankind. As the spatial perspective moves our eye from the surface of the earth to a remote point above its surface, our earth-based myopia disappears. We see all former parameters simultaneously, far out as well as close up. Physical differences are minimized, only natural demarcations remain, while similarities and interconnections abound. With the evolution of the Space Age this new awareness stimulated first the ecological movement, raising public consciousness about the physical environment, and then socially about human rights worldwide. From this intellectual quantum jump we realized that planetary interconnections permeated earth''s biosphere and on into the physical-chemical core. Like the ecological shell that identified ecology as the dynamic balance of all organisms interacting with their thermodynamic energy environment, a new outer shell, an egological one, or egoshell, is now needed to deal with multidisciplinary informational dynamics socially (acquisition for educational dissemination and perceptual workplace use). Individuals within their total spatial environment--the conceptual energy/human resource balance identified as EGOLOGY--would then be able to network society, inspiring mental fitness for an individual enlightenment to occur.

  10. Engineering excellence in breakthrough biomedical technologies: bioengineering at the University of California, Riverside.

    Science.gov (United States)

    Schultz, Jane S; Rodgers, V G J

    2012-07-01

    The Department of Bioengineering at the University of California, Riverside (UCR), was established in 2006 and is the youngest department in the Bourns College of Engineering. It is an interdisciplinary research engine that builds strength from highly recognized experts in biochemistry, biophysics, biology, and engineering, focusing on common critical themes. The range of faculty research interests is notable for its diversity, from the basic cell biology through cell function to the physiology of the whole organism, each directed at breakthroughs in biomedical devices for measurement and therapy. The department forges future leaders in bioengineering, mirroring the field in being energetic, interdisciplinary, and fast moving at the frontiers of biomedical discoveries. Our educational programs combine a solid foundation in bio logical sciences and engineering, diverse communication skills, and training in the most advanced quantitative bioengineering research. Bioengineering at UCR also includes the Bioengineering Interdepartmental Graduate (BIG) program. With its slogan Start-Grow-Be-BIG, it is already recognized for its many accomplishments, including being third in the nation in 2011 for bioengineering students receiving National Science Foundation graduate research fellowships as well as being one of the most ethnically inclusive programs in the nation.

  11. Computational tools for Breakthrough Propulsion Physics: State of the art and future prospects

    International Nuclear Information System (INIS)

    Maccone, Claudio

    2000-01-01

    To address problems in Breakthrough Propulsion Physics (BPP) one needs sheer computing capabilities. This is because General Relativity and Quantum Field Theory are so mathematically sophisticated that the amount of analytical calculations is prohibitive and one can hardly do all of them by hand. In this paper we make a comparative review of the main tensor calculus capabilities of the three most advanced and commercially available 'symbolic manipulator' codes: Macsyma, Maple V and Mathematica. We also point out that currently one faces such a variety of different conventions in tensor calculus that it is difficult or impossible to compare results obtained by different scholars in General Relativity and Quantum Field Theory. Mathematical physicists, experimental physicists and engineers have each their own way of customizing tensors, especially by using the different metric signatures, different metric determinant signs, different definitions of the basic Riemann and Ricci tensors, and by adopting different systems of physical units. This chaos greatly hampers progress toward the chief NASA BPP goal: the design of the NASA Warp Drive. It is thus concluded that NASA should put order by establishing international standards in symbolic tensor calculus and enforcing anyone working in BPP to adopt these NASA BPP Standards

  12. Breakthrough during air sampling with polyurethane foam: What do PUF 2/PUF 1 ratios mean?

    Science.gov (United States)

    Bidleman, Terry F; Tysklind, Mats

    2018-02-01

    Frontal chromatography theory is applied to describe movement of gaseous semivolatile organic compounds (SVOCs) through a column of polyurethane foam (PUF). Collected mass fractions (F C ) are predicted for sample volume/breakthrough volume ratios (τ = V S /V B ) up to 6.0 and PUF bed theoretical plate numbers (N) from 2 to 16. The predictions assume constant air concentrations and temperatures. Extension of the calculations is done to relate the collection efficiency of a 2-PUF train (F C1+2 ) to the PUF 2/PUF 1 ratio. F C1+2 exceeds 0.9 for PUF 2/PUF 1 ≤ 0.5 and lengths of PUF commonly used in air samplers. As the PUF 2/PUF 1 ratio approaches unity, confidence in these predictions is limited by the analytical ability to distinguish residues on the two PUFs. Field data should not be arbitrarily discarded because some analytes broke through to the backup PUF trap. The fractional collection efficiencies can be used to estimate air concentrations from quantities retained on the PUF trap when sampling is not quantitative. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. Reputational Information and Strategic Collaboration

    DEFF Research Database (Denmark)

    Andersen, Poul Houman; Bendix, Henrik B.

    1998-01-01

    What types of information do decision-makers use when deciding on collaboration? What are the role of reputational information in relation to decisions on collaboration......What types of information do decision-makers use when deciding on collaboration? What are the role of reputational information in relation to decisions on collaboration...

  14. COLLABORATION BOARD (CB55)

    CERN Multimedia

    B. Cousins

    Open Access Publication Policy ATLAS had recently issued a short statement in support of open access publishing. The mood of the discussions in the December CMS Collaboration Board had appeared to be in favour and so it was being proposed that CMS issue the same statement as that made by ATLAS (the statement is attached to the agenda of this meeting). The Collaboration Board agreed. Election of the Chair of the Collaboration Board Following the agreement to shorten the terms of both the Spokesperson and the Collaboration Board Chair, and to introduce a longer overlap period between the election and the start of the term, the election for the next Collaboration Board Chair was due in December 2007. If the old standard schedule specified in the Constitution were adapted to this date, then the Board should be informed at the present meeting that the election was being prepared. However, it was felt that the experience of the previous year's election of the Spokesperson had shown that it would be desirable to...

  15. Distance collaborations with industry

    Energy Technology Data Exchange (ETDEWEB)

    Peskin, A.; Swyler, K.

    1998-06-01

    The college industry relationship has been identified as a key policy issue in Engineering Education. Collaborations between academic institutions and the industrial sector have a long history and a bright future. For Engineering and Engineering Technology programs in particular, industry has played a crucial role in many areas including advisement, financial support, and practical training of both faculty and students. Among the most important and intimate interactions are collaborative projects and formal cooperative education arrangements. Most recently, such collaborations have taken on a new dimension, as advances in technology have made possible meaningful technical collaboration at a distance. There are several obvious technology areas that have contributed significantly to this trend. Foremost is the ubiquitous presence of the Internet. Perhaps almost as important are advances in computer based imaging. Because visual images offer a compelling user experience, it affords greater knowledge transfer efficiency than other modes of delivery. Furthermore, the quality of the image appears to have a strongly correlated effect on insight. A good visualization facility offers both a means for communication and a shared information space for the subjects, which are among the essential features of both peer collaboration and distance learning.

  16. Drivers of Collaborative Advantage

    DEFF Research Database (Denmark)

    Weihe, Gudrid

    Drawing upon extant alliance literature, this article substantiates the argument that we need to look beyond mere structural and formative aspects of cooperation in order to fully understand the performance antecedents of public-private partnerships. Currently, scholarly work on operational......, the antecedents of collaborative advantage are theoretically examined, and the organizational competences contributing to collaborative success are identified. The conclusion is that operational processes and social dynamics are vital drivers of collaborative advantage. Another significant conclusion...... is that public management research can benefit from drawing upon existing alliance research. Alliance scholars have during the past couple of decades accumulated an impressive amount of knowledge on different aspects of inter-firm cooperation, and therefore the learning potential for public management scholars...

  17. Collaborative Economy and Tourism

    DEFF Research Database (Denmark)

    Dredge, Dianne; Gyimóthy, Szilvia

    2017-01-01

    The digital collaborative economy is one of the most fascinating developments to have claimed our attention in the last decade. Not only does it defy clear definition, but its historical links back to non-monetised sharing and gift economies and its contemporary foundations in monetising idling...... or spare capacity make it difficult to theorise. In this chapter, we lay the foundation for a social science approach to the exploration of the collaborative economy and its relationship with tourism. We argue that “collaborative” and “economy” should be conceptualised in a broad and inclusive manner...... in order to avoid narrow theorisations and blinkered accounts that focus only on digitally-mediated, monetised transactions. A balance between individual and collective dimensions of the collaborative economy is also necessary if we are to understand its societal implications....

  18. The collaboration imperative.

    Science.gov (United States)

    Nidumolu, Ram; Ellison, Jib; Whalen, John; Billman, Erin

    2014-04-01

    Addressing global sustainability challenges--including climate change, resource depletion, and ecosystem loss--is beyond the individual capabilities of even the largest companies. To tackle these threats, and unleash new value, companies and other stakeholders must collaborate in new ways that treat fragile and complex ecosystems as a whole. In this article, the authors draw on cases including the Latin American Water Funds Partnership, the Sustainable Apparel Coalition (led by Nike, Patagonia, and Walmart), and Action to Accelerate Recycling (a partnership between Alcoa, consumer packaged goods companies, and local governments, among others) to describe four new collaboration models that create shared value and address environmental protection across the value stream. Optimal collaborations focus on improving either business processes or outcomes. They start with a small group of key organizations, bring in project management expertise, link self-interest to shared interest, encourage productive competition, create quick wins, and, above all, build and maintain trust.

  19. Toward Collaborative Information Seeking (CIS)

    OpenAIRE

    Shah, Chirag

    2009-01-01

    It is natural for humans to collaborate while dealing with complex problems. In this article I consider this process of collaboration in the context of information seeking. The study and discussion presented here are driven by two dissatisfactions: (1) the majority of IR systems today do not facilitate collaboration directly, and (2) the concept of collaboration itself is not well-understood. I begin by probing the notion of collaboration and propose a model that helps us understand the requi...

  20. Sensemaking in collaborative networks

    DEFF Research Database (Denmark)

    Peronard, Jean-Paul; Brix, Jacob

    2018-01-01

    The purpose of the study is to advance research on open business models as activity systems (Zott and Amit, 2010) in collaborative networks. We utilize Bradley’s (1995) theory of exchange behavior to discuss how new joint activities can be explored as well as how existing activities can...... be redesigned to strengthen the collaboration between companies. To enable this discussion we delve into the sensemaking literature and theory from loosely coupled systems. Our discussion leads to the development of the Balanced Activity System (BAS) model. The paper’s key contribution is the prescriptive BAS...

  1. Collaborative Knowledge Production

    DEFF Research Database (Denmark)

    Olesen, Birgitte Ravn

    2014-01-01

    In this article, the author reflects on the conditions for working with collaborative research in current academic settings. On the basis of reflections on goals, challenges and results of earlier projects, the author looks into how economic and political shifts and transformations in work have...... activities and other working practices and the identities of academics and other professionals who are inscribed as subjects in these regimes. The conclusion is, that we have to look for cracks in the wall and insist on collaborative research because it is it the process of “being in relation that forms...

  2. Nurse-patient collaboration

    DEFF Research Database (Denmark)

    Sørensen, Dorthe; Frederiksen, Kirsten; Groefte, Thorbjoern

    2013-01-01

    a huge challenge. Nurse-patient collaboration may be vital for treatment tolerance and success. A better understanding of how nurses and patients collaborate during non-invasive ventilation may therefore contribute to improvement in treatment success. Design: A constant comparative classical grounded...... theory. Method: The data comprised sessions of qualitative participant observation during the treatment of 21 patients with non-invasive ventilation that included informal conversations with the nurses and semi-structured interviews with 11 patients after treatment completion. Data were collected...

  3. Interpersonal processes in depression.

    Science.gov (United States)

    Hames, Jennifer L; Hagan, Christopher R; Joiner, Thomas E

    2013-01-01

    Humans have an intrinsic need for social connection; thus, it is crucial to understand depression in an interpersonal context. Interpersonal theories of depression posit that depressed individuals tend to interact with others in a way that elicits rejection, which increases their risk for future depression. In this review, we summarize the interpersonal characteristics, risk factors, and consequences of depression in the context of the relevant theories that address the role of interpersonal processes in the onset, maintenance, and chronicity of depression. Topics reviewed include social skills, behavioral features, communication behaviors, interpersonal feedback seeking, and interpersonal styles as they relate to depression. Treatment implications are discussed in light of the current research on interpersonal processes in depression, and the following future directions are discussed: developing integrative models of depression, improving measurement of interpersonal constructs, examining the association between interpersonal processes in depression and suicide, and tailoring interventions to target interpersonal processes in depression.

  4. Strategies for managing depression complicated by bipolar disorder, suicidal ideation, or psychotic features.

    Science.gov (United States)

    Hartmann, P M

    1996-01-01

    Major depression, a common clinical problem that, if recognized early and treated vigorously, is often highly responsive to antidepressants and can be complicated by such features as mania, suicidal thoughts and actions, and psychosis. Suicide is one of the most serious complications of major depression. An online search of the medical literature was used to select English-language articles addressing depression using, but not limited to, the following specific terms: "primary care," "depressive disorders," "bipolar disorder," "suicide," "psychosis," and "antidepressants." Treatment of the manic phases of bipolar disorder includes lithium or anticonvulsants. Breakthrough depression can be particularly resistant to treatment in bipolar patients, and the tricyclic antidepressants can cause patients to cycle more rapidly into the manic phase. The selective serotonin reuptake inhibitors (SSRIs) and bupropion are less likely to cause rapid cycling in bipolar disorder. Depressed patients with suicidal tendencies should be closely monitored and given full doses of antidepressant medications. The SSRIs lessen suicidal tendencies and, importantly, are markedly safer than the tricyclic antidepressants when taken in an overdose. Depressed patients can also become psychotic, exhibiting mood-congruent delusions. Combination therapy with antidepressant and antipsychotic medications is often necessary. Some physicians prefer to hospitalize patients with psychotic depression. Depression can be a complex and multifaceted disorder that requires careful diagnosis and treatment plans.

  5. Pore-scale analysis on the effects of compound-specific dilution on transient transport and solute breakthrough

    DEFF Research Database (Denmark)

    Rolle, Massimo; Kitanidis, Peter

    , a transient flux-related dilution index that allows quantifying the evolution of solute dilution at a given position along the main flow direction. For the different solute transport scenarios we obtained dilution breakthrough curves that complement and add important information to traditional solute......Compound-specific diffusivities significantly impact solute transport and mixing at different scales. Although diffusive processes occur at the small pore scale, their effects propagate and remain important at larger macroscopic scales [1]. In this pore-scale modeling study in saturated porous...... media we show that compound-specific effects are important not only at steady-state and for the lateral displacement of solutes with different diffusivities but also for transient transport and solute breakthrough [2]. We performed flow and transport simulations in two-dimensional pore-scale domains...

  6. Significant interaction between activated charcoal and antiretroviral therapy leading to subtherapeutic drug concentrations, virological breakthrough and development of resistance.

    Science.gov (United States)

    Tseng, Alice L; la Porte, Charles; Salit, Irving E

    2013-01-01

    A 42-year-old, treatment-experienced woman, virologically suppressed on tenofovir/emtricitabine and boosted atazanavir, experienced virological breakthrough, drop in CD4(+) T-cell count and undetectable drug concentrations. Adherence to treatment was confirmed, but repeat testing yielded similar results. After 2 months, the patient stated that she had been taking activated charcoal to manage gastrointestinal symptoms associated with her combination antiretroviral therapy, but she had recently discontinued the charcoal. Atazanavir concentrations were therapeutic but the patient's viral load rebounded and genotype testing revealed new reverse transcriptase mutations. The patient was changed to zidovudine, lamivudine, and boosted darunavir and achieved viral suppression. At 1 year follow-up, her viral load remained activated charcoal and atazanavir/ritonavir leading to virological breakthrough and development of resistance.

  7. Budget impact analysis of the fentanyl buccal tablet for treatment of breakthrough cancer pain

    Directory of Open Access Journals (Sweden)

    Darbà J

    2013-12-01

    Full Text Available Josep Darbà,1 Lisette Kaskens,2 Rainel Sánchez-de la Rosa31University of Barcelona, Barcelona, 2BCN Health Economics and Outcomes Research SL, Barcelona, 3Medical and HEOR Department, TEVA Pharmaceutical Industries Ltd, Madrid, SpainBackground: The purpose of this study was to assess the economic impact of the fentanyl buccal tablet for the management of breakthrough cancer pain (BTcP in Spain.Methods: A 4-year budget impact model was developed for the period 2012–2015 for patients with BTcP from the perspective of the Spanish National Health System. BTcP products included in this model were rapid-onset opioids containing fentanyl (buccal, sublingual, or nasal transmucosal. Prevalence data on cancer, BTcP, opioid use, and number of BTcP episodes were obtained from the literature. Input data on health care resources associated with opioid use and opioid-induced side effects were obtained by consulting experts in oncology from different Spanish hospitals. Resources used included drugs, medical and emergency visits, other nonpharmacologic treatments, and treatment of opioid-induced side effects. Unit costs were obtained from the literature, and a 3% discount rate was applied to costs. Based on the unit costs for drugs and health care resources, the annual BTcP treatment costs per patient associated with each fentanyl product were determined to estimate the overall budget impact based on the total treatment population and the percentage of drug utilization associated with each product. One-way sensitivity analyses were conducted to test the robustness of the model.Results: Patients treated with oral opioids for BTcP were estimated at 23,291 in 2012, with an increase up to 23,413 in 2015. The average annual budget savings, with an increase of fentanyl buccal tablets, fentanyl sublingual tablets, and intranasal fentanyl spray, and a decrease in oral transmucosal fentanyl citrate, was estimated at €2.6 million, which represents a 0.5% decrease in

  8. Efficacy, safety, and tolerability of fentanyl pectin nasal spray in patients with breakthrough cancer pain

    Directory of Open Access Journals (Sweden)

    Ueberall MA

    2016-08-01

    Full Text Available Michael A Ueberall,1 Stefan Lorenzl,2 Eberhard A Lux,3,4 Raymond Voltz,5 Michael Perelman6 1Institute of Neurological Sciences, Nuremberg, Germany; 2Institute of Nursing Science and Practice, Paracelsus Private Medical University of Salzburg, Salzburg, Austria; 3Faculty of Medicine, Witten/Herdecke University, Witten, Germany; 4Clinic for Pain and Palliative Care Medicine, St.- Marien-Hospital, Luenen, Germany; 5Department of Palliative Medicine, University Hospital Cologne, Cologne, Germany; 6Archimedes Development Ltd., Nottingham, United Kingdom Objective: Assessment of analgesic effectiveness, safety, and tolerability of fentanyl pectin nasal spray (FPNS in the treatment of breakthrough cancer pain (BTcP in routine clinical practice.Methods: A prospective, open-label, noninterventional study (4-week observation period, 3 month follow-up of opioid-tolerant adults with BTcP in 41 pain and palliative care centers in Germany. Standardized BTcP questionnaires and patient diaries were used. Evaluation was made of patient-reported outcomes with respect to “time to first effect”, “time to maximum effect”, BTcP relief, as well as changes in BTcP-related impairment of daily life activities, ­quality-of-life restrictions, and health care resource utilization.Results: A total of 235 patients were recruited of whom 220 completed all questionnaires and reported on 1,569 BTcP episodes. Patients reported a significant reduction of maximum BTcP intensity (11-stage numerical rating scale [0= no pain, 10= worst pain conceivable] with FPNS (mean ± standard deviation = 2.8±2.3 compared with either that reported at baseline (8.5±1.5, experienced immediately before FPNS application (7.4±1.7, or that achieved with previous BTcP medication (6.0±2.0; P<0.001 for each comparison. In 12.3% of BTcP episodes, onset of pain relief occurred ≤2 minutes and in 48.4% ≤5 minutes; maximum effects were reported within 10 minutes for 37.9% and within 15 minutes

  9. Cost-effectiveness analysis of oral fentanyl formulations for breakthrough cancer pain treatment.

    Science.gov (United States)

    Cortesi, Paolo Angelo; D'Angiolella, Lucia Sara; Vellucci, Renato; Allegri, Massimo; Casale, Giuseppe; Favaretti, Carlo; Kheiraoui, Flavia; Cesana, Giancarlo; Mantovani, Lorenzo Giovanni

    2017-01-01

    Breakthrough cancer Pain (BTcP) has a high prevalence in cancer population. Patients with BTcP reported relevant health care costs and poor quality of life. The study assessed the cost-effectiveness of the available Oral Fentanyl Formulations (OFFs) for BTcP in Italy. A decision-analytical model was developed to estimate costs and benefits associated with treatments, from the Italian NHS perspective. Expected reductions in pain intensity per BTcP episodes were translated into, percentage of BTcP reduction, resource use and Quality-Adjusted-Life-Years (QALYs). Relative efficacy, resources used and unit costs data were derived from the literature and validated by clinical experts. Probabilistic and deterministic sensitivity analyses were performed. At base-case analysis, Sublingual Fentanyl Citrate (FCSL) compared to other oral formulations reported a lower patient's cost (€1,960.8) and a higher efficacy (18.7% of BTcP avoided and 0.0507 QALYs gained). The sensitivity analyses confirmed the main results in all tested scenarios, with the highest impact reported by BTcP duration and health care resources consumption parameters. Between OFFs, FCSL is the cost-effective option due to faster reduction of pain intensity. However, new research is needed to better understand the economic and epidemiologic impact of BTcP, and to collect more robust data on economic and quality of life impact of the different fentanyl formulations. Different fentanyl formulations are available to manage BTcP in cancer population. The study is the first that assesses the different impact in terms of cost and effectiveness of OFFs, providing new information to better allocate the resources available to treat BTcP and highlighting the need of better data.

  10. The Breakthrough Listen Search for Intelligent Life: Target Selection of Nearby Stars and Galaxies

    Science.gov (United States)

    Isaacson, Howard; Siemion, Andrew P. V.; Marcy, Geoffrey W.; Lebofsky, Matt; Price, Danny C.; MacMahon, David; Croft, Steve; DeBoer, David; Hickish, Jack; Werthimer, Dan; Sheikh, Sofia; Hellbourg, Greg; Enriquez, J. Emilio

    2017-05-01

    We present the target selection for the Breakthrough Listen search for extraterrestrial intelligence during the first year of observations at the Green Bank Telescope, Parkes Telescope, and Automated Planet Finder. On the way to observing 1,000,000 nearby stars in search of technological signals, we present three main sets of objects we plan to observe in addition to a smaller sample of exotica. We chose the 60 nearest stars, all within 5.1 pc from the Sun. Such nearby stars offer the potential to observe faint radio signals from transmitters that have a power similar to those on Earth. We add a list of 1649 stars drawn from the Hipparcos catalog that span the Hertzprung-Russell diagram, including all spectral types along the main sequence, subgiants, and giant stars. This sample offers diversity and inclusion of all stellar types, but with thoughtful limits and due attention to main sequence stars. Our targets also include 123 nearby galaxies composed of a “morphological-type-complete” sample of the nearest spirals, ellipticals, dwarf spherioidals, and irregulars. While their great distances hamper the detection of technological electromagnetic radiation, galaxies offer the opportunity to observe billions of stars simultaneously and to sample the bright end of the technological luminosity function. We will also use the Green Bank and Parkes telescopes to survey the plane and central bulge of the Milky Way. Finally, the complete target list includes several classes of exotica, including white dwarfs, brown dwarfs, black holes, neutron stars, and asteroids in our solar system.

  11. Ionic Liquids: Breakthrough Absorption Technology for Post-Combustion CO{sub 2} Capture

    Energy Technology Data Exchange (ETDEWEB)

    Maginn, Edward

    2012-09-30

    This is the final report for DE-FC26-07NT43091 Ionic Liquids: Breakthrough Absorption Technology for Post-Combustion CO{sub 2} Capture. A detailed summary is provided of the ionic liquid (IL) discovery process, synthesis and testing results, process / systems modeling, lab-scale operational testing, corrosion testing and commercialization possibilities. The work resulted in the discovery of a new class of ionic liquids (ILs) that efficiently react with CO{sub 2} in a 1:1 stoichiometry with no water present and no increase in viscosity. The enthalpy of reaction was tuned to optimize process economics. The IL was found to have excellent corrosion behavior with and without CO{sub 2} present. In lab-scale tests, the IL was able to effectively remove CO{sub 2} from a simulated flue gas stream, although mass transfer was slower than with aqueous monoethanolamine (MEA) due to higher viscosities. The non-volatile nature of the solvent and its high thermal stability, however, make it an intriguing option. An independent systems analysis indicates that the economics of using the best IL discovered to date (NDIL0157), are at least comparable to and potentially slightly better than - the Fluor Econamine FG PlusTM process (DOE Case 12). Further work should be directed at improving mass transfer / lowering viscosity and developing commercial synthesis routes to make these ILs at scale in an inexpensive manner. Demonstration of the process at larger scales is also warranted, as is the exploration of other process configurations that leverage the anhydrous nature of the solvent and its extremely low volatility.

  12. Watch out for the blue circle: a breakthrough in family planning promotional strategy.

    Science.gov (United States)

    Sumarsono

    1989-07-01

    Realizing the potential of commercial marketing in changing the attitude and behavior of the target audience in the early years of the 4th 5-year development plan, the National Family Planning Program tried to develop new ventures in communicating the concept of the small family norm to the people. The condom was chosen as the 1st product to be sold through the social marketing project because male awareness about family planning was still low. Based on audience research, the pricing, packaging, and branding of the product was developed. The most accepted brand name was Dua Lima because it has a neutral meaning, is easily remembered, and can be described in sign language. The last reason is very important because most consumers have difficulty communicating about condoms in the sales outlet. Social marketing has proved effective because of strong public relations activities and the involvement of formal and informal leaders. This experiment has convinced family planning management that social marketing is workable for promoting the small family norm. In 1987, under the new program of self-sufficiency in family planning, the private sector is invited to participate by providing family planning services for target audiences, using the principles of self-sufficiency and self-support. There are 2 principal activities; 1) the IEC campaign, and 2) product (contraceptive) selling. IEC activities include a media campaign public relations work. Product selling is done through commercial channels such as pharmaceutical firms, drug stores, private doctors, and midwives. It was decided that the campaign would be aided by a name and logo. The blue circle was chosen because it is unique, communicative, and simple. The social marketing of contraceptives in Indonesia can be considered a breakthrough in communication strategy for a national development program.

  13. Relativistic generalization of the incentive trap of interstellar travel with application to Breakthrough Starshot

    Science.gov (United States)

    Heller, René

    2017-09-01

    As new concepts of sending interstellar spacecraft to the nearest stars are now being investigated by various research teams, crucial questions about the timing of such a vast financial and labour investment arise. If humanity could build high-speed interstellar lightsails and reach α Centauri 20 yr after launch, would it be better to wait a few years, then take advantage of further technology improvements and arrive earlier despite waiting? The risk of being overtaken by a future, faster probe has been described earlier as the incentive trap. Based on 211 yr of historical data, we find that the speed growth of artificial vehicles, from steam-driven locomotives to Voyager 1, is much faster than previously believed, about 4.72 per cent annually or a doubling every 15 yr. We derive the mathematical framework to calculate the minimum of the wait time to launch t plus travel time τ(t) and extend it into the relativistic regime. We show that the t + τ(t) minimum disappears for nearby targets. There is no use of waiting once we can reach an object within about 20 yr of travel, irrespective of the actual speed. In terms of speed, the t + τ(t) minimum for a travel to α Centauri occurs at 19.6 per cent the speed of light (c), in agreement with the 20 per cent c proposed by the Breakthrough Starshot initiative. If interstellar travel at 20 per cent c could be achieved within 45 yr from today and the kinetic energy be increased at a rate consistent with the historical record, then humans can reach the 10 most nearby stars within 100 yr from today.

  14. A new transmucosal drug delivery system for patients with breakthrough cancer pain: the fentanyl effervescent buccal tablet

    OpenAIRE

    Freye, Enno

    2008-01-01

    Enno FreyeCenter of Ambulatory Pain Medicine, Neuss-Uedesheim, GermanyAbstract: Breakthrough pain, a transitory severe pain with the background of otherwise controlled persistent pain has a prevalence between 52% and 67% in outpatients with cancer. Medications for such sudden-onset pain require non-invasive delivery of a potent and short-acting opioid for rapid pain relief. Although oral transmucosal delivery of fentanyl citrate (OTFC) has been shown to provide better pain relief than a typic...

  15. Stanford test called a net breakthrough - data sent at 3,500 times the speed of broadband

    CERN Multimedia

    2003-01-01

    Researchers at a Stanford University-affiliated research center have found a way to send data across the Internet more than 3,500 times faster than the typical broadband connection. The technical breakthrough set an Internet speed record too fast to be of use with present-day computers but could open the way for scientists to share and ship massive databases around the world, according to the researchers.

  16. Closed-flow column experiments—Insights into solute transport provided by a damped oscillating breakthrough behavior

    Science.gov (United States)

    Ritschel, Thomas; Totsche, Kai Uwe

    2016-03-01

    Transport studies that employ column experiments in closed-flow mode complement classical approaches by providing new characteristic features observed in the solute breakthrough and equilibrium between liquid and solid phase. Specific to the closed-flow mode is the recirculation of the effluent to the inflow via a mixing vessel. Depending on the ratio of volumes of mixing vessel and water-filled pore space, a damped oscillating solute concentration emerges in the effluent and mixing vessel. The oscillation characteristics, e.g., frequency, amplitude, and damping, allow for the investigation of solute transport in a similar fashion as known for classical open-flow column experiments. However, the closed loop conserves substances released during transport within the system. In this way, solute and porous medium can equilibrate with respect to physicochemical conditions. With this paper, the features emerging in the breakthrough curves of saturated column experiments run in closed-flow mode and methods of evaluation are illustrated under experimental boundary conditions forcing the appearance of oscillations. We demonstrate that the effective pore water volume and the pumping rate can be determined from a conservative tracer breakthrough curve uniquely. In this way, external preconditioning of the material, e.g., drying, can be avoided. A reactive breakthrough experiment revealed a significant increase in the pore water pH value as a consequence of the closed loop. These results highlight the specific impact of the closed mass balance. Furthermore, the basis for the modeling of closed-flow experiments is given by the derivation of constitutive equations and numerical implementation, validated with the presented experiments.

  17. Innovation and network collaboration

    DEFF Research Database (Denmark)

    Kesting, Peter; Müller, Sabine; Jørgensen, Frances

    2011-01-01

    and their inherent shortage of resources. In this paper, we propose that human resource management (HRM) practices may provide a means by which SMEs can increase their innovation capacity through network collaboration. Following a brief presentation of the relevant literature on networks, and innovation in networks...

  18. Team Collaboration Software

    Science.gov (United States)

    Wang, Yeou-Fang; Schrock, Mitchell; Baldwin, John R.; Borden, Charles S.

    2010-01-01

    The Ground Resource Allocation and Planning Environment (GRAPE 1.0) is a Web-based, collaborative team environment based on the Microsoft SharePoint platform, which provides Deep Space Network (DSN) resource planners tools and services for sharing information and performing analysis.

  19. Learning Music from Collaboration

    Science.gov (United States)

    Sawyer, R. Keith

    2008-01-01

    I draw on two traditions of research: the social psychology of collaborative groups, and the ethnographic study of improvisational performance. I outline a general model of group creativity derived from these traditions. I show how the model can be used to better understand musical competence and performance, and I provide recommendations for how…

  20. Collaboration in Augmented Reality

    NARCIS (Netherlands)

    Lukosch, S.; Billinghurst, M.; Alem, L.; Kiyokawa, K.

    2015-01-01

    Augmented Reality (AR) is a technology that allows users to view and interact in real time with virtual images seamlessly superimposed over the real world. AR systems can be used to create unique collaborative experiences. For example, co-located users can see shared 3D virtual objects that they

  1. Understanding collaborative design

    NARCIS (Netherlands)

    Kleinsmann, M.S.

    2006-01-01

    Fast product follow-ups and increasing customer demands have changed product design from a rather unstructured process, into a systematic activity. Nowadays, both companies and researchers have developed the organizational aspects of integrated product design. However, attention to the collaborative

  2. Towards the collaborative hospital

    DEFF Research Database (Denmark)

    Prætorius, Thim; Hasle, Peter; Edwards, Kasper

    2015-01-01

    Hospitals are increasingly faced with conflicting demands as they have to respond to increasing patient demands as well as financial, clinical and quality challenges. To handle these demands the hospital need to reconfigure its organization, and we propose to build on a concept for the collaborat......Hospitals are increasingly faced with conflicting demands as they have to respond to increasing patient demands as well as financial, clinical and quality challenges. To handle these demands the hospital need to reconfigure its organization, and we propose to build on a concept...... for the collaborative hospital as new organizational form which is better equipped to respond to the challenges facing modern hospitals. The collaborative hospital is an ambidextrous organization that opens for pursuing both exploration and exploitation within the same organizational structure. The basic principles...... of the collaborative hospital concern the creation of an appropriate balance between standardization and local autonomy, shared purpose centred around providing the best possible care, and use of enabling structures that sustain the new ways of collaborative work. The chapter builds on the theoretical framework...

  3. Strategic importance of collaboration

    Energy Technology Data Exchange (ETDEWEB)

    Miller, K.A. [NB Power, Fredericton, New Brunswick (Canada)

    2015-07-01

    In the nuclear industry there is a need to collaborate because of aging equipment, aging people that contribute to dilution of expertise, obsolesce and advances in codes and standards. In the longer term there is a need to focus on operational issues, sustain our suppliers and expertise as well as improve and sustain performance.

  4. PCORnet's Collaborative Research Groups.

    Science.gov (United States)

    Pletcher, Mark J; Forrest, Christopher B; Carton, Thomas W

    2018-01-01

    The Patient-Centered Outcomes Research Institute (PCORI) launched a multi-institutional "network of networks" in 2013 - Patient-Centered Clinical Research Network (PCORnet) - that is designed to conduct clinical research that is faster, less expensive, and more responsive to the information needs of patients and clinicians. To enhance cross-network and cross-institutional collaboration and catalyze the use of PCORnet, PCORI has supported formation of 11 Collaborative Research Groups focusing on specific disease types (e.g., cardiovascular health and cancer) or particular patient populations (e.g., pediatrics and health disparities). PCORnet's Collaborative Research Groups are establishing research priorities within these focus areas, establishing relationships with potential funders, and supporting development of specific research projects that will use PCORnet resources. PCORnet remains a complex, multilevel, and heterogeneous network that is still maturing and building a diverse portfolio of observational and interventional people-centered research; engaging with PCORnet can be daunting, particularly for outside investigators. We believe the Collaborative Research Groups are stimulating interest and helping investigators navigate the complexity, but only time will tell if these efforts will bear fruit in terms of funded multicenter PCORnet projects.

  5. Collaboration and Networking

    NARCIS (Netherlands)

    Husson, O.; Manten-Horst, E.; Graaf, W.T.A. van der

    2016-01-01

    Awareness of the need for collaboration across pediatric and adult cancer to care for adolescents and young adults (AYAs) arose from the recognition of the unique characteristics of AYAs with cancer. Neither pediatric nor adult oncology hospital departments are able to provide age-appropriate care

  6. Collaborative enterprise system implementation

    NARCIS (Netherlands)

    Wognum, P.M.; Mensink, G.J.; Bühl, H.; Ma, X.; Sedmak-Wells, M.; Fan, I.S.; Sobolewski, M.; Cha, J.

    2004-01-01

    Implementation of enterprise systems in companies is a complex and dynamic process, requiring collaboration between many different roles within and across organisational borders. Current research on implementation of enterprise systems consists of the major part of large-scale studies aimed at

  7. Collaboration in Print

    DEFF Research Database (Denmark)

    Lund, Joachim

    2012-01-01

    During the Second World War, Germany's National Socialist regime mobilized German universities in order to support the war efforts through academic collaboration and a number of publications that were meant to legitimize Germany's territorial ambitions. The rector of the University of Kiel, Dr Paul...

  8. Collaborative Learning in Practice

    International Development Research Centre (IDRC) Digital Library (Canada)

    This book is about collaborative learning for participatory rural development with a focus on community-based natural resource management approaches. Although informed and inspired by capacity development and learning theory, the emphasis of the three in-depth, Asian case studies highlighted here is on rural ...

  9. Playful Collaboration (Or Not)

    DEFF Research Database (Denmark)

    Bogers, Marcel; Sproedt, Henrik

    2012-01-01

    This article explores how playing games can be used to teach intangible social interaction across boundaries, in particular within open collaborative innovation. We present an exploratory case study of how students learned from playing a board game in a graduate course of the international...

  10. Cultivating Labor Management Collaboration

    Science.gov (United States)

    Spector, Stacy

    2013-01-01

    In many districts, the notion of labor groups and district administration working together conjures descriptions of war and battle rather than cooperation and collaboration. However, in San Juan Unified School District, the headline, "Union and District Exhibit Positive Partnership" exemplifies the changing relationship between teacher…

  11. Ketamine Metabolites for the Treatment of Depression and Pain | NCI Technology Transfer Center | TTC

    Science.gov (United States)

    The National Institute on Aging, Laboratory of Clinical Investigation, is seeking parties interested in collaborative research to co-develop ketamine metabolites for the treatment of different forms of depression and for alleviating pain.

  12. Biosorption of uranium(VI) from aqueous solutions by Ca-pretreated Cystoseira indica alga: breakthrough curves studies and modeling.

    Science.gov (United States)

    Ghasemi, Morteza; Keshtkar, Ali Reza; Dabbagh, Reza; Jaber Safdari, S

    2011-05-15

    Uranium(VI) biosorption from aqueous solutions containing 60 mg l(-1) metal concentration by Ca-pretreated Cystoseira indica alga was studied in a packed bed column with 1.5 cm internal diameter. The effect of bed height and flow rate on biosorption process was investigated and the experimental breakthrough curves were obtained. Results showed that by increasing the bed height, the breakthrough and exhaustion times increased and the slope of breakthrough curves decreased. Also, it was observed that the controlled-rate step shifted from external to internal mass transfer limitations, as the flow rate increased. The maximum uptake capacity, 318.15 mg g(-1), and total metal removal, 59.32%, were obtained at flow rate of 2.3 ml min(-1) and bed height of 6 cm. The column was regenerated using 0.1M HCl solution and sorption-desorption studies were carried out for three cycles. The obtained results confirmed that reusability of this biosorbent is possible. The results obtained agreed well with the bed depth service time model. In addition, for estimations of the parameters necessary for the design of a large-scale packed bed column, the experimental data were also fitted to the Thomas, Yan and Belter models and were found to agree with the experimental data fairly well. Copyright © 2011 Elsevier B.V. All rights reserved.

  13. Biosorption of uranium(VI) from aqueous solutions by Ca-pretreated Cystoseira indica alga: Breakthrough curves studies and modeling

    Energy Technology Data Exchange (ETDEWEB)

    Ghasemi, Morteza [Faculty of Nuclear Engineering, Shahid Beheshti University, Tehran (Iran, Islamic Republic of); Keshtkar, Ali Reza, E-mail: akeshtkar@aeoi.org.ir [Nuclear Fuel Cycle School, Nuclear Science and Technology Research Institute, Tehran (Iran, Islamic Republic of); Dabbagh, Reza [Nuclear Science Research School, Nuclear Science and Technology Research Institute, Tehran (Iran, Islamic Republic of); Jaber Safdari, S. [Nuclear Fuel Cycle School, Nuclear Science and Technology Research Institute, Tehran (Iran, Islamic Republic of)

    2011-05-15

    Uranium(VI) biosorption from aqueous solutions containing 60 mg l{sup -1} metal concentration by Ca-pretreated Cystoseira indica alga was studied in a packed bed column with 1.5 cm internal diameter. The effect of bed height and flow rate on biosorption process was investigated and the experimental breakthrough curves were obtained. Results showed that by increasing the bed height, the breakthrough and exhaustion times increased and the slope of breakthrough curves decreased. Also, it was observed that the controlled-rate step shifted from external to internal mass transfer limitations, as the flow rate increased. The maximum uptake capacity, 318.15 mg g{sup -1}, and total metal removal, 59.32%, were obtained at flow rate of 2.3 ml min{sup -1} and bed height of 6 cm. The column was regenerated using 0.1 M HCl solution and sorption-desorption studies were carried out for three cycles. The obtained results confirmed that reusability of this biosorbent is possible. The results obtained agreed well with the bed depth service time model. In addition, for estimations of the parameters necessary for the design of a large-scale packed bed column, the experimental data were also fitted to the Thomas, Yan and Belter models and were found to agree with the experimental data fairly well.

  14. Parkinson's disease and depression.

    Science.gov (United States)

    Rihmer, Zoltán; Seregi, Krisztina; Rihmer, Annamária

    2004-06-01

    The prevalence of depression in Parkinson's disease is around 40%, but, unfortunately, such depression is frequently unrecognized and untreated. However, recognition and appropriate treatment of depression in patients with Parkinson's disease is essential for clinical practice. This review focuses on the epidemiology, pathophysiology and treatment of depression associated with Parkinson's disease.

  15. Development of the breastfeeding quality improvement in hospitals learning collaborative in New York state.

    Science.gov (United States)

    Fitzpatrick, Eileen; Dennison, Barbara A; Welge, Sara Bonam; Hisgen, Stephanie; Boyce, Patricia Simino; Waniewski, Patricia A

    2013-06-01

    Exclusive breastfeeding is a public health priority. A strong body of evidence links maternity care practices, based on the Ten Steps to Successful Breastfeeding, to increased breastfeeding initiation, duration and exclusivity. Despite having written breastfeeding policies, New York (NY) hospitals vary widely in reported maternity care practices and in prevalence rates of breastfeeding, especially exclusive breastfeeding, during the birth hospitalization. To improve hospital maternity care practices, breastfeeding support, and the percentage of infants exclusively breastfeeding, the NY State Department of Health developed the Breastfeeding Quality Improvement in Hospitals (BQIH) Learning Collaborative. The BQIH Learning Collaborative was the first to use the Institute for Health Care Improvement's Breakthrough Series methodology to specifically focus on increasing hospital breastfeeding support. The evidence-based maternity care practices from the Ten Steps to Successful Breastfeeding provided the basis for the Change Package and Data Measurement Plan. The present article describes the development of the BQIH Learning Collaborative. The engagement of breastfeeding experts, partners, and stakeholders in refining the Learning Collaborative design and content, in defining the strategies and interventions (Change Package) that drive hospital systems change, and in developing the Data Measurement Plan to assess progress in meeting the Learning Collaborative goals and hospital aims is illustrated. The BQIH Learning Collaborative is a model program that was implemented in a group of NY hospitals with plans to spread to additional hospitals in NY and across the country.

  16. Bladder volume at onset of vesicoureteral reflux is an independent risk factor for breakthrough febrile urinary tract infection.

    Science.gov (United States)

    Alexander, Siobhan E; Arlen, Angela M; Storm, Douglas W; Kieran, Kathleen; Cooper, Christopher S

    2015-04-01

    Improved identification of children with vesicoureteral reflux at risk for recurrent febrile urinary tract infection may impact management decisions. We hypothesized that reflux occurring earlier during bladder filling increases the duration of exposure of the kidneys to bacteria, and, therefore, increases the risk of pyelonephritis. Children with vesicoureteral reflux and detailed voiding cystourethrogram data were identified. Bladder volume at onset of reflux was normalized for age. Demographics, reflux grade, laterality, presence/absence of bladder-bowel dysfunction and breakthrough febrile urinary tract infections were assessed. Median followup was 24 months (IQR 12 to 52). A total of 208 girls and 47 boys were analyzed with a mean ± SD age at diagnosis of 3.1 ± 2.6 years. On univariate analysis history of febrile urinary tract infection (HR 2.17, 95% CI 1.33-2.85, p = 0.01), dilating vesicoureteral reflux (HR 1.6, 95% CI 1.05-2.42, p = 0.03) and bladder-bowel dysfunction (HR 1.66, 95% CI 0.99-2.75, p = 0.05) were associated with an increased risk of breakthrough febrile urinary tract infection. Median bladder volume at onset of reflux in children with breakthrough febrile urinary tract infection was significantly less (33.1%) than in those without infection (49.5%, p = 0.003). Reflux onset at 35% predicted bladder capacity or less was associated with a significantly increased risk of breakthrough febrile urinary tract infection on multivariate analysis (HR 1.58, 95% CI 1.05-2.38, p = 0.03). Children with early filling vesicoureteral reflux are at increased risk for breakthrough febrile urinary tract infection independent of reflux grade. Bladder volume at onset of reflux should be recorded during cystograms since it provides additional prognostic information about the risk of pyelonephritis and resolution, and may assist with counseling and clinical decision making. Copyright © 2015 American Urological Association Education and Research, Inc. Published by

  17. Vitamin D and depression: A case series

    Directory of Open Access Journals (Sweden)

    Pallavi S Nadkarni

    2014-12-01

    Full Text Available Introduction: Over two-thirds of Canadians are deficient in vitamin D. Clinical overlap can compound diagnosis of depression in vitamin D deficient individuals. Citing high costs, the Ministry of Health has restricted routine vitamin D screening and hence is not feasible. Objectives: The current case series is an attempt to recognise the clinical overlap between depression and vitamin D deficiency in order to avoid unnecessary antidepressant prescriptions and to demonstrate the role of collaborative care in such patients. Method: After appropriate ethics approval 62 patients from an outpatient clinic were screened for the diagnosis of treatment resistant depression. Those who had predominant somatic complaints were further screened for organic factors and those with inadequate vitamin D levels were referred to family physicians for supplementation with vitamin D. Results: More than 50% were detected deficient in vitamin D after our evaluation. They showed subjective improvement with vitamin D supplements. No modification of antidepressants was needed. Conclusion: Vitamin D deficiency should be suspected in depressed patients with prominent somatic symptoms and their treatment resistance should be reconsidered to avoid unnecessary exposure to mood stabilisers. Collaborating with primary care is advocated. Limitation: Co-prescription of an antidepressant is a confounder in our case series, and we propose more organised studies with objective rating scales.

  18. Collaborative Affordances of Medical Records

    DEFF Research Database (Denmark)

    Bardram, Jakob Eyvind; Houben, Steven

    2017-01-01

    This article proposes the concept of Collaborative Affordances to describe physical and digital properties (i.e., affordances) of an artifact, which affords coordination and collaboration in work. Collaborative Affordances build directly on Gibson (1977)’s affordance concept and extends the work...... by Sellen and Harper (2003) on the affordances of physical paper. Sellen and Harper describe how the physical properties of paper affords easy reading, navigation, mark-up, and writing, but focuses, we argue, mainly on individual use of paper and digital technology. As an extension to this, Collaborative...... Affordances focusses on the properties of physical and digital artifacts that affords collaborative activities. We apply the concept of Collaborative Affordances to the study of paper-based and electronic patient records in hospitals and detail how they afford collaboration through four types of Collaborative...

  19. Collaborations in Open Learning Environments

    NARCIS (Netherlands)

    Spoelstra, Howard

    2015-01-01

    This thesis researches automated services for professionals aiming at starting collaborative learning projects in open learning environments, such as MOOCs. It investigates the theoretical backgrounds of team formation for collaborative learning. Based on the outcomes, a model is developed

  20. Collaborative argumentation in academic education

    NARCIS (Netherlands)

    Veerman, A.; Andriessen, J.; Kanselaar, G.

    2002-01-01

    The general purpose of this research is to discover principles for the design of educational tasks that provoke collaborative argumentation. The specific research question concentrates on the relationship between question asking and argumentation and is examined in three different collaborative

  1. Reproducing tailing in breakthrough curves: Are statistical models equally representative and predictive?

    Science.gov (United States)

    Pedretti, Daniele; Bianchi, Marco

    2018-03-01

    Breakthrough curves (BTCs) observed during tracer tests in highly heterogeneous aquifers display strong tailing. Power laws are popular models for both the empirical fitting of these curves, and the prediction of transport using upscaling models based on best-fitted estimated parameters (e.g. the power law slope or exponent). The predictive capacity of power law based upscaling models can be however questioned due to the difficulties to link model parameters with the aquifers' physical properties. This work analyzes two aspects that can limit the use of power laws as effective predictive tools: (a) the implication of statistical subsampling, which often renders power laws undistinguishable from other heavily tailed distributions, such as the logarithmic (LOG); (b) the difficulties to reconcile fitting parameters obtained from models with different formulations, such as the presence of a late-time cutoff in the power law model. Two rigorous and systematic stochastic analyses, one based on benchmark distributions and the other on BTCs obtained from transport simulations, are considered. It is found that a power law model without cutoff (PL) results in best-fitted exponents (αPL) falling in the range of typical experimental values reported in the literature (1.5 constant αCO ≈ 1. In the PLCO model, the cutoff rate (λ) is the parameter that fully reproduces the persistence of the tailing and is shown to be inversely correlated to the LOG scale parameter (i.e. with the skewness of the distribution). The theoretical results are consistent with the fitting analysis of a tracer test performed during the MADE-5 experiment. It is shown that a simple mechanistic upscaling model based on the PLCO formulation is able to predict the ensemble of BTCs from the stochastic transport simulations without the need of any fitted parameters. The model embeds the constant αCO = 1 and relies on a stratified description of the transport mechanisms to estimate λ. The PL fails to

  2. Correlations between plasma endothelin-1 levels and breakthrough pain in patients with cancer

    Directory of Open Access Journals (Sweden)

    Yan XB

    2015-12-01

    Full Text Available Xue-bin Yan, Tuo-chao Peng, Dong Huang Department of Anesthesiologist, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, People’s Republic of China Abstract: Endothelin-1 (ET-1 may be involved in driving pain in patients with advanced cancer. However, a few studies focus on the role of ET-1 in breakthrough pain (BP. The aim of this pivotal study was to explore the correlation between the plasma (ET-1 level and BP intensity. A total of 40 patients were enrolled in the study, and they were divided into two groups: BP group and non-BP group. Moreover, 20 healthy adults were used as the normal control group. Pain intensity was measured using visual analog scale (VAS scores of 1–10. Plasma ET-1 levels were detected by an ET radioimmunoassay kit. Subsequently, the correlation of ET-1 level with the VAS score and cancer types was analyzed by Pearson’s correlation coefficient. The plasma ET-1 level in the BP group (35.31±8.02 pg/mL was higher than that in the non-BP group (29.51±6.78 pg/mL and the normal control group (24.77±10.10 pg/mL, P<0.05. In addition, the VAS score in the BP group (7.45±0.82 was higher than that in the non-BP group (2.80±1.23, P<0.05. The plasma ET-1 level was positively correlated with the VAS score of the BP group (Pearson’s r=0.42. There was no significant correlation between the plasma ET-1 level and VAS score of the non-BP group (Pearson’s r=–0.22 or/and cancer types (P>0.05. The elevated plasma ET-1 levels were positively related to BP, and targeting ET-1 may provide a novel pain-reducing therapeutic treatment in BP. Keywords: visual analog scale, correlation, cancer types, background pain

  3. Esophageal Acidification During Nocturnal Acid-breakthrough with Ilaprazole Versus Omeprazole in Gastroesophageal Reflux Disease.

    Science.gov (United States)

    Karyampudi, Arun; Ghoshal, Uday C; Singh, Rajan; Verma, Abhai; Misra, Asha; Saraswat, Vivek A

    2017-04-30

    Though nocturnal acid-breakthrough (NAB) is common in gastroesophageal reflux disease (GERD) patients, its clinical importance results from esophageal acidification, which has been shown to be uncommon. Ilaprazole, a long-acting proton pump inhibitor, may cause NAB infrequently. Accordingly, we studied prospectively, (1) frequency and degree of esophageal acidification during NAB, and (2) frequency and severity of NAB while on ilaprazole versus omeprazole. Fifty-eight consecutive patients with GERD on once daily ilaprazole, 10 mg (n = 28) or omeprazole, 20 mg (n = 30) for > one month underwent 24-hour impedance-pH monitoring prospectively. NAB was defined as intra-gastric pH one hour during night, and esophageal acidification as pH < 4 for any duration. Nocturnal symptoms (heartburn, regurgitation, and chest pain) were also recorded. Of the 58 patients (age 35.5 [inter-quartile range 26.5-46.0] years, 38 [65.5%], 42 (72.4%) had NAB. Though patients with NAB had lower nocturnal intra-gastric pH than without (2.8 [1.9-4.1] vs 5.7 [4.6-6.8], P < 0.001), frequency and duration of nocturnal esophageal acidification (17/42 vs 4/16, P = 0.360 and 0.0 [0.0-1.0] vs 0.0 [0.0-0.3] minutes, P = 0.260, respectively) and symptoms were comparable (13/42 vs 6/16, P = 0.750). Though ilaprazole was associated with less NABs (1 [range 1-2, n = 19] vs 1 [range 1-3, n = 23], P = 0.010) than omeprazole, the frequency, duration, and mean intra-gastric pH during NAB were comparable (19/28 vs 23/30, P = 0.560; 117 [0-315] vs 159 [69-287] minutes, P = 0.500; 1.02 [0.7-1.4] vs 1.04 [0.44-1.3], P = 0.620, respectively). Though NAB was common while patients were on a proton pump inhibitor, esophageal acidification was uncommon. Frequency and severity of NAB were comparable among patients on ilaprazole and omeprazole, except for the lesser number of NABs with ilaprazole.

  4. Aldosterone breakthrough in dogs with naturally occurring myxomatous mitral valve disease.

    Science.gov (United States)

    Ames, M K; Atkins, C E; Eriksson, A; Hess, A M

    2017-06-01

    Aldosterone breakthrough (ABT) is the condition in which angiotensin converting enzyme inhibitors (ACEIs) and/or angiotensin receptor blockers fail to effectively suppress the activity of the renin angiotensin aldosterone system. The objective of this study was to determine if ABT occurs in dogs with naturally occurring myxomatous mitral valve disease receiving an ACEI, using the urine aldosterone to creatinine ratio (UAldo:C) as a measure of renin angiotensin aldosterone system activation. This study includes 39 dogs with myxomatous mitral valve disease. A UAldo:C cut-off definition (derived from a normal population of healthy, adult, and client-owned dogs) was used to determine the prevalence of ABT in this population. Spearman analysis and univariate logistic regression were used to evaluate the relationship between UAldo:C and ABT (yes/no) and eight variables (age, serum K + concentration, serum creatinine concentration, ACEI therapy duration and ACEI dosage, furosemide therapy duration and furosemide dosage, and urine sample storage time). Finally, the UAldo:C in dogs receiving spironolactone, as part congestive heart failure (CHF) therapy, was compared to dogs with CHF that were not receiving spironolactone. The prevalence of ABT was 32% in dogs with CHF and 30% in dogs without CHF. There was no relationship between either the UAldo:C or the likelihood of ABT and the eight variables. Therapy with spironolactone lead to a significant elevation of the UAldo:C. Using the UAldo:C and a relatively stringent definition of ABT, it appears that incomplete RAAS blockade is common in dogs with MMVD receiving an ACEI. The prevalence of ABT in this canine population mirrors that reported in humans. While the mechanism of ABT is likely multifactorial and still poorly understood, the proven existence of ABT in dogs offers the potential to improve the prognosis for MMVD with the addition of a mineralocorticoid receptor blocker to current therapeutic regimens

  5. Collaboration in scientific practice

    DEFF Research Database (Denmark)

    Wagenknecht, Susann

    2014-01-01

    This monograph investigates the collaborative creation of scientific knowledge in research groups. To do so, I combine philosophical analysis with a first-hand comparative case study of two research groups in experimental science. Qualitative data are gained through observation and interviews......, and I combine empirical insights with existing approaches to knowledge creation in philosophy of science and social epistemology. On the basis of my empirically-grounded analysis I make several conceptual contributions. I study scientific collaboration as the interaction of scientists within research...... groups. Thereby, I argue that research groups and their role in scientific practice deserve more philosophical attention than they have hitherto received. In contemporary natural science, research groups are key to the formulation and corroboration of scientific knowledge claims prior...

  6. A Holographic Collaboration

    Science.gov (United States)

    Nicholson, Ana Maria

    2013-02-01

    In the Fall of '87 Rudie Berkhout and myself started a very intense and fruitful collaboration producing a series of holographic art pieces that were experimental but that reflected our different artistic sensibilities. The masters were made in my portrait studio in the Museum of Holography in New York using a pulse laser and later transferred in my Long Island City Studio. These pieces were shown at the Holocenter in 2009 and poignantly, it was the last show that Rudie had while he was alive. My paper details the process of an artistic collaboration, its pitfalls and advantages, its conflicts and compromises. It will illuminate the creative process that from two separate and very different streams melded into beautiful and evocative art.

  7. The Collaborative Economy

    DEFF Research Database (Denmark)

    Avital, Michel; Andersson, Magnus; Nickerson, Jeffrey

    2014-01-01

    An economy based on the exchange of capital, assets and services between individuals has grown significantly, spurred by proliferation of internet-based platforms that allow people to share underutilized resources and trade with reasonably low transaction costs. The movement toward this economy...... of “sharing” translates into market efficiencies that bear new products, reframe established services, have positive environmental effects, and may generate overall economic growth. This emerging paradigm, entitled the collaborative economy, is disruptive to the conventional company-driven economic paradigm...... as evidenced by the large number of peer-to-peer based services that have captured impressive market shares sectors ranging from transportation and hospitality to banking and risk capital. The panel explores economic, social, and technological implications of the collaborative economy, how digital technologies...

  8. Offering Global Collaboration Services beyond CERN and HEP

    Science.gov (United States)

    Fernandes, J.; Ferreira, P.; Baron, T.

    2015-12-01

    The CERN IT department has built over the years a performant and integrated ecosystem of collaboration tools, from videoconference and webcast services to event management software. These services have been designed and evolved in very close collaboration with the various communities surrounding the laboratory and have been massively adopted by CERN users. To cope with this very heavy usage, global infrastructures have been deployed which take full advantage of CERN's international and global nature. If these services and tools are instrumental in enabling the worldwide collaboration which generates major HEP breakthroughs, they would certainly also benefit other sectors of science in which globalization has already taken place. Some of these services are driven by commercial software (Vidyo or Wowza for example), some others have been developed internally and have already been made available to the world as Open Source Software in line with CERN's spirit and mission. Indico for example is now installed in 100+ institutes worldwide. But providing the software is often not enough and institutes, collaborations and project teams do not always possess the expertise, or human or material resources that are needed to set up and maintain such services. Regional and national institutions have to answer needs, which are growingly global and often contradict their operational capabilities or organizational mandate and so are looking at existing worldwide service offers such as CERN's. We believe that the accumulated experience obtained through the operation of a large scale worldwide collaboration service combined with CERN's global network and its recently- deployed Agile Infrastructure would allow the Organization to set up and operate collaborative services, such as Indico and Vidyo, at a much larger scale and on behalf of worldwide research and education institutions and thus answer these pressing demands while optimizing resources at a global level. Such services would

  9. Schumpeterian Patterns of Innovation and the Sources of Breakthrough Inventions: Evidence from a Data-Set of R&D Awards

    OpenAIRE

    Roberto Fontana; Alessandro Nuvolari; Hiroshi Shimitzu; Andrea Vezzulli

    2012-01-01

    This paper examines the relationship between Schumpeterian patterns of innovation and the generation of breakthrough inventions. Our data source for breakthrough inventions is the “R&D 100 awards” competition organized each year by the magazine Research & Development. Since 1963, this magazine has been awarding this prize to 100 most technologically significant new products available for sale or licensing in the year preceding the judgment. We use instead USPTO patent data to measure the r...

  10. Security for ICT collaboration tools

    NARCIS (Netherlands)

    Broenink, E.G.; Kleinhuis, G.; Fransen, F.

    2010-01-01

    In order for collaboration tools to be productive in an operational setting, an information base that is shared across the collaborating parties is needed. Therefore, a lot of research is done for tooling to create such a common information base in a collaboration tool. However, security is often

  11. Security for ICT collaboration tools

    NARCIS (Netherlands)

    Broenink, E.G.; Kleinhuis, G.; Fransen, F.

    2011-01-01

    In order for collaboration tools to be productive in an operational setting, an information base that is shared across the collaborating parties is needed. Therefore, a lot of research is done for tooling to create such a common information base in a collaboration tool. However, security is often

  12. Collaborative Learning in the Cloud

    DEFF Research Database (Denmark)

    Kirchner, Kathrin; Razmerita, Liana

    2015-01-01

    This present study aims to investigate how students perceive collaboration and identifies associated technologies used to collaborate. In particular we aim to address the following research questions: What are the factors that impact satisfaction with collaboration? How do these factors differ in...

  13. Understanding Nomadic Collaborative Learning Groups

    Science.gov (United States)

    Ryberg, Thomas; Davidsen, Jacob; Hodgson, Vivien

    2018-01-01

    The paper builds on the work of Rossitto "et al." on collaborative nomadic work to develop three categories of practice of nomadic collaborative learning groups. Our study is based on interviews, workshops and observations of two undergraduate student's group practices engaged in self-organised, long-term collaborations within the frame…

  14. Realities of Supply Chain Collaboration

    NARCIS (Netherlands)

    Kampstra, R.P.; Ashayeri, J.; Gattorna, J.

    2006-01-01

    Successful supply chain collaboration (SCC) practices are rather exceptional, yet collaboration is believed to be the single most pressing need in supply chain management.In this paper we discuss the realities of SCC, present prerequisites for the collaboration process, indicate where the process

  15. MMI: Increasing Community Collaboration

    Science.gov (United States)

    Galbraith, N. R.; Stocks, K.; Neiswender, C.; Maffei, A.; Bermudez, L.

    2007-12-01

    Building community requires a collaborative environment and guidance to help move members towards a common goal. An effective environment for community collaboration is a workspace that fosters participation and cooperation; effective guidance furthers common understanding and promotes best practices. The Marine Metadata Interoperability (MMI) project has developed a community web site to provide a collaborative environment for scientists, technologists, and data managers from around the world to learn about metadata and exchange ideas. Workshops, demonstration projects, and presentations also provide community-building opportunities for MMI. MMI has developed comprehensive online guides to help users understand and work with metadata standards, ontologies, and other controlled vocabularies. Documents such as "The Importance of Metadata Standards", "Usage vs. Discovery Vocabularies" and "Developing Controlled Vocabularies" guide scientists and data managers through a variety of metadata-related concepts. Members from eight organizations involved in marine science and informatics collaborated on this effort. The MMI web site has moved from Plone to Drupal, two content management systems which provide different opportunities for community-based work. Drupal's "organic groups" feature will be used to provide workspace for future teams tasked with content development, outreach, and other MMI mission-critical work. The new site is designed to enable members to easily create working areas, to build communities dedicated to developing consensus on metadata and other interoperability issues. Controlled-vocabulary-driven menus, integrated mailing-lists, member-based content creation and review tools are facets of the new web site architecture. This move provided the challenge of developing a hierarchical vocabulary to describe the resources presented on the site; consistent and logical tagging of web pages is the basis of Drupal site navigation. The new MMI web site

  16. Strategic Nuclear Research Collaboration - FY99 Annual Report

    Energy Technology Data Exchange (ETDEWEB)

    T. J. Leahy

    1999-07-01

    The Idaho National Engineering and Environmental Laboratory (INEEL) has created the Strategic Nuclear Research Collaboration. The SNRC brings together some of America's finest laboratory and university nuclear researchers in a carefully focused research program intended to produce ''breakthrough'' solutions to the difficult issues of nuclear economics, safety, non-proliferation, and nuclear waste. This integrated program aims to address obstacles that stand in the way of nuclear power development in the US These include fuel cycle concerns related to waste and proliferation, the need for more efficient regulatory practices, and the high cost of constructing and operating nuclear power plants. Funded at an FY99 level of $2.58M, the SNRC is focusing the efforts of scientists and engineers from the INEEL and the Massachusetts Institute of Technology to solve complex nuclear energy challenges in a carefully chosen, integrated portfolio of research topics. The result of this collaboration will be research that serves as a catalyst for future direct-funded nuclear research and technology development and which preserves and enhances the INEEL's role as America's leading national laboratory for nuclear power research. In its first year, the SNRC has focused on four research projects each of which address one or more of the four issues facing further nuclear power development (economics, safety, waste disposition and proliferation-resistance). This Annual Report describes technical work and accomplishments during the first year of the SNRC's existence.

  17. Collaborative exams: Cheating? Or learning?

    Science.gov (United States)

    Jang, Hyewon; Lasry, Nathaniel; Miller, Kelly; Mazur, Eric

    2017-03-01

    Virtually all human activity involves collaboration, and yet, collaboration during an examination is typically considered cheating. Collaborative assessments have not been widely adopted because of the perceived lack of individual accountability and the notion that collaboration during assessments simply causes propagation of correct answers. Hence, collaboration could help weaker students without providing much benefit to stronger students. In this paper, we examine student performance in open-ended, two-stage collaborative assessments comprised of an individually accountable round followed by an automatically scored, collaborative round. We show that collaboration entails more than just propagation of correct answers. We find greater rates of correct answers after collaboration for all students, including the strongest members of a team. We also find that half of teams that begin without a correct answer to propagate still obtain the correct answer in the collaborative round. Our findings, combined with the convenience of automatic feedback and grading of open-ended questions, provide a strong argument for adopting collaborative assessments as an integral part of education.

  18. Breakdowns in collaborative information seeking

    DEFF Research Database (Denmark)

    Hertzum, Morten

    2010-01-01

    Collaborative information seeking is integral to many professional activities. In hospital work, the medication process encompasses continual seeking for information and collaborative grounding of information. This study investigates breakdowns in collaborative information seeking through analyses...... introduced risks of new kinds of breakdown in collaborative information seeking. In working to prevent and recover from breakdowns in the seeking and sharing of information a focus on collaborative information seeking will point toward collaborative, organizational, and systemic reasons for breakdown...... of the use of the electronic medication record adopted in a Danish healthcare region and of the reports of five years of medication incidents at Danish hospitals. The results show that breakdowns in collaborative information seeking is a major source of medication incidents, that most of these breakdowns...

  19. Clinical and Microbiological Characteristics of Breakthrough Candidemia in Allogeneic Hematopoietic Stem Cell Transplant Recipients in a Japanese Hospital.

    Science.gov (United States)

    Kimura, Muneyoshi; Araoka, Hideki; Yamamoto, Hisashi; Asano-Mori, Yuki; Nakamura, Shigeki; Yamagoe, Satoshi; Ohno, Hideaki; Miyazaki, Yoshitsugu; Abe, Masahiro; Yuasa, Mitsuhiro; Kaji, Daisuke; Kageyama, Kosei; Nishida, Aya; Ishiwata, Kazuya; Takagi, Shinsuke; Yamamoto, Go; Uchida, Naoyuki; Izutsu, Koji; Wake, Atsushi; Taniguchi, Shuichi; Yoneyama, Akiko

    2017-04-01

    Few data on breakthrough candidemia (BC), defined as candidemia that develops on administration of antifungal agents (AFAs), in allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients are available. The medical and microbiological records of recipients of an allo-HSCT obtained between December 2008 and December 2014 were reviewed. Of 768 allo-HSCT cases, 26 developed BC. Among the 26 causative strains, 22 strains were stored and identified by sequencing. The following species were isolated: Candida parapsilosis (9 strains), C. glabrata (4 strains), C. guilliermondii (3 strains), and other Candida species (6 strains). The AFAs being used when BC developed were micafungin (17 cases), liposomal amphotericin B (5 cases), itraconazole (2 cases), and voriconazole (2 cases). All 17 cases who developed BC during micafungin administration were administered 150 mg/day of micafungin. The susceptibilities of the causative Candida species to the administered AFAs when breakthrough occurred ranged from susceptible to resistant. Especially, 85% of the Candida species that caused BC during micafungin administration were susceptible to micafungin. Additionally, 75% of the strains were wild type for susceptibility to the administered AFAs when breakthrough occurred. Systemic steroid administration and a longer severe neutropenic phase (≥5 days) were independent risk factors for BC ( P = 0.016 and P = 0.015, respectively). BC developed in allo-HSCT recipients even when they received a sufficient dose of AFA, including micafungin, to which the causative Candida species were susceptible and/or had wild-type susceptibility in vitro Systemic steroid administration and a longer severe neutropenic phase were host-based factors associated with BC. Copyright © 2017 American Society for Microbiology.

  20. Experimental investigation of the impact of compound-specific dispersion and electrostatic interactions on transient transport and solute breakthrough

    Science.gov (United States)

    Muniruzzaman, Muhammad; Rolle, Massimo

    2017-02-01

    This study investigates the effects of compound-specific diffusion/dispersion and electrochemical migration on transient solute transport in saturated porous media. We conducted laboratory bench-scale experiments, under advection-dominated regimes (seepage velocity: 0.5, 5, 25 m/d), in a quasi two-dimensional flow-through setup using pulse injection of multiple tracers (both uncharged and ionic species). Extensive sampling and measurement of solutes' concentrations (˜1500 samples; >3000 measurements) were performed at the outlet of the flow-through setup, at high spatial and temporal resolution. The experimental results show that compound-specific effects and charge-induced Coulombic interactions are important not only at low velocities and/or for steady state plumes but also for transient transport under high flow velocities. Such effects can lead to a remarkably different behavior of measured breakthrough curves also at very high Péclet numbers. To quantitatively interpret the experimental results, we used four modeling approaches: classical advection-dispersion equation (ADE), continuous time random walk (CTRW), dual-domain mass transfer model (DDMT), and a multicomponent ionic dispersion model. The latter is based on the multicomponent formulation of coupled diffusive/dispersive fluxes and was used to describe and explain the electrostatic effects of charged species. Furthermore, we determined experimentally the temporal profiles of the flux-related dilution index. This metric of mixing, used in connection with the traditional solute breakthrough curves, proved to be useful to correctly distinguish between plume spreading and mixing, particularly for the cases in which the sole analysis of integrated concentration breakthrough curves may lead to erroneous interpretation of plume dilution.

  1. Highly efficient inactivation of bacteria found in drinking water using chitosan-bentonite composites: Modelling and breakthrough curve analysis.

    Science.gov (United States)

    Motshekga, Sarah C; Ray, Suprakas Sinha

    2017-03-15

    Disinfection of bacterially-contaminated drinking water requires a robust and effective technique and can be achieved by using an appropriate disinfectant material. The advanced use of nanomaterials is observed as an alternative and effective way for the disinfection process and water treatment as a whole. Hence, the inactivation of Escherichia coli (E. coli) using chitosan-Bentonite (Cts-Bent) composites was studied in a fixed bed column. Cts-Bent composites were synthesized using in situ cross-linking method using Bent-supported silver and zinc oxide nanoparticles. These composites were characterized by Fourier transform infrared spectroscopy, X-ray diffraction, scanning electron microscopy, and energy dispersive spectroscopy. The effect of the composite bed mass, initial concentration of bacteria, and flow rate on the bacterial inactivation was investigated. The characterization results revealed that the composites were successfully prepared and confirmed the presence of both silver and zinc oxide nanoparticles in the chitosan matrix. The growth curves of E. coli were expressed as breakthrough curves, based on the logistic, Gompertz, and Boltzmann models. The breakthrough time and processed volume of treated water at breakthrough were used as performance indicators, which revealed that the composites performed best at low bacterial concentration and flow rate and with substantial bed mass. The chitosan composites were found to be highly effective, which was demonstrated when no bacteria were observed in the effluent sample within the first 27 h of analysing river water. All the models were suitable for adequately describing and reproducing the experimental data with a sigmoidal pattern. Therefore, the prepared composite is showing potential to work as a disinfectant and provide an alternative solution for water disinfection; hence this study should propel further research of the same or similar materials. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. CD8+ and CD4+ cytotoxic T cell escape mutations precede breakthrough SIVmac239 viremia in an elite controller

    Directory of Open Access Journals (Sweden)

    Burwitz Benjamin J

    2012-11-01

    Full Text Available Abstract Background Virus-specific T cells are critical components in the containment of immunodeficiency virus infections. While the protective role of CD8+ T cells is well established by studies of CD8+ T cell-mediated viral escape, it remains unknown if CD4+ T cells can also impose sufficient selective pressure on replicating virus to drive the emergence of high-frequency escape variants. Identifying a high frequency CD4+ T cell driven escape mutation would provide compelling evidence of direct immunological pressure mediated by these cells. Results Here, we studied a SIVmac239-infected elite controller rhesus macaque with a 1,000-fold spontaneous increase in plasma viral load that preceded disease progression and death from AIDS-related complications. We sequenced the viral genome pre- and post-breakthrough and demonstrate that CD8+ T cells drove the majority of the amino acid substitutions outside of Env. However, within a region of Gag p27CA targeted only by CD4+ T cells, we identified a unique post-breakthrough mutation, Gag D205E, which abrogated CD4+ T cell recognition. Further, we demonstrate that the Gag p27CA-specific CD4+ T cells exhibited cytolytic activity and that SIV bearing the Gag D205E mutation escapes this CD4+ T cell effector function ex vivo. Conclusions Cumulatively, these results confirm the importance of virus specific CD8+ T cells and demonstrate that CD4+ T cells can also exert significant selective pressure on immunodeficiency viruses in vivo during low-level viral replication. These results also suggest that further studies of CD4+ T cell escape should focus on cases of elite control with spontaneous viral breakthrough.

  3. Capacitive Sensors and Breakthrough Curves in Automated Irrigation for Water and Soil Conservation

    Science.gov (United States)

    Fahmy Hussein, Mohamed

    2016-04-01

    when such sensors are used in farmers' fields. The second procedure was Breakthrough Curve (BTC) lab-method to follow the fate of chemical composition of water draining out of Ca-saturated soil columns and Exchangeable Sodium Percent, ESP, in soil materials under saturated-flow. The work was run on five packed soil-columns under hydraulic-gradient of about 6 in fine-grained soil materials (Nile clay-sediments) wetted with five NaCl aqueous solutions (10, 25, 50, 75 and 100 mEq/l). The results revealed the removal of 40 to 80% of sodium from irrigation water after 6 to 8 pore volumes flowed out in about 12 hours with the highest removal from the most dilute solution. Rapid increase of ESP was observed when the inlet solution had moderate to high TDS whereas the dilute solution (10 mEq/l) has resulted in no soil chemical degradation. The results were extrapolated to field situation and showed that Nile clayey soil would never get sodic (ESP>15) when wetted with high quality water regardless the water application duration whereas only 1-4 year of irrigation with moderate to poor-quality water (as takes place under perennial irrigation) would result in ESP increase to 15 and much higher values. A secondary but important outcome of BTC experiments was that marginal sediments could be used in multi-column cells (6 to 8 columns) to improve water-quality through removal of Na+ ions from water, whereas anions could be removed by positively-charged resins and the cells could be recycled in a proposed prototype scheme.

  4. On the formation of localized peaks and non-monotonic tailing of breakthrough curves

    Science.gov (United States)

    Siirila, Erica R.; Sanchez-Vila, Xavier; Fernàndez-Garcia, Daniel

    2014-05-01

    While breakthrough curve (BTC) analysis is a traditional tool in hydrogeology to obtain hydraulic parameters, in recent years emphasis has been placed on analyzing the shape of the receding portion of the curve. A number of field and laboratory observations have found a constant BTC slope in log-log space, and thus it has been hypothesized that a power law behavior is representative of real aquifers. Usually, monotonicity of the late-time BTC slope is just assumed, meaning that local peaks in the BTC are not considered, and that a local (in time) increase or decrease of BTC slope is also not considered. We contend that local peaks may exist but are sometimes not reported for a number of reasons. For example, when BTCs are obtained from actual measurements, sub-sampling may mask non-monotonicity, or small peaks may be reported as measurement errors and thus smoothed out or removed. When numerical analyses of synthetic aquifers are performed, the simulation method may yield artificially monotonous curves as a consequence of the methods used. For example, Eulerian methods may suffer from numerical dispersion, where curves tend to become over-smoothed while Lagrangian methods may suffer from artificial BTC oscillations stemming from the reconstruction of concentrations from a limited number of particles. A paradigm shift in terms of the BTC shape must also accompany two major advancements within the hydrogeology field: 1) the increase of high frequency data and progression of data collection techniques that diminish the problems of under-sampling BTCs and 2) advancements in supercomputing and numerical simulation allowing for higher resolution of flow and transport problems. As more information is incorporated into BTCs and/or they are obtained in more spatial locations, it is likely that classical definitions of BTC shapes will no longer be adequate descriptors for future treatment of contaminant transport problems. For example, the presence of localized peaks in BTCs

  5. Use of the maximum entropy method to correct for acoustic ringing and pulse breakthrough in 17O NMR spectra

    Science.gov (United States)

    Laue, Ernest D.; Pollard, Konrad O. B.; Skilling, John; Staunton, James; Sutkowski, Andrew C.

    The maximum entropy method (MEM) is shown to be capable of producing spectra of improved clarity from FIDs in which the early points are corrupted by ring-down (which may be caused by acoustic ringing or by pulse breakthrough). The method is evaluated using 17O NMR data. The distortion arising from the ring-down signal is suppressed by ignoring the severely corrupted early points in the FID when evaluating trial MEM spectra. The areas of peaks are best recovered (within 10%) when a suitable degree of line narrowing (equivalent in effect to a matched filter) is used in the MEM spectrum.

  6. Breakthrough viridans streptococcal bacteremia in allogeneic hematopoietic stem cell transplant recipients receiving levofloxacin prophylaxis in a Japanese hospital.

    Science.gov (United States)

    Kimura, Muneyoshi; Araoka, Hideki; Yoshida, Atsushi; Yamamoto, Hisashi; Abe, Masahiro; Okamoto, Yuki; Yuasa, Mitsuhiro; Kaji, Daisuke; Kageyama, Kosei; Nishida, Aya; Ishiwata, Kazuya; Takagi, Shinsuke; Yamamoto, Go; Asano-Mori, Yuki; Uchida, Naoyuki; Hishinuma, Akira; Izutsu, Koji; Wake, Atsushi; Taniguchi, Shuichi; Yoneyama, Akiko

    2016-08-05

    Breakthrough viridans streptococcal bacteremia (VSB) in patients with hematological malignancy receiving levofloxacin prophylaxis is a major blood stream infection (BSI) occurring during febrile neutropenia. However, clinical data focused on VSB in allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients are lacking. The medical records of allo-HSCT recipients who received oral levofloxacin prophylaxis between January 2011 and August 2013 at Toranomon Hospital were reviewed to evaluate breakthrough VSB. Stored viridans streptococcal (VGS) species were identified by using sodA gene sequencing, and were assessed for drug susceptibility. Among the 184 allo-HSCT recipients on levofloxacin prophylaxis, 28 (15.2 %) experienced breakthrough VSB. All of the 28 recipients with VSB were treated with a cefepime-based or piperacillin/tazobactam-based regimen. The susceptibility rates of the VGS strains for levofloxacin, cefepime, piperacillin/tazobactam, meropenem, and vancomycin were 0 %, 95 %, 100 %, 100 %, and 100 %, respectively. Both the MIC50 (minimum inhibitory concentration) and the MIC90 of ceftazidim (0.5 μg/mL and 2 μg/mL, respectively) were higher than the MIC90 of all the other anti-pseudomonal beta-lactams (APBLs). Only 1 VGS strain had a penicillin MIC ≥ 2 μg/mL by the Etest (3.6 %). There were no cases with acute respiratory distress syndrome (ARDS) that was associated with VSB, although the rate of viridans group streptococcal shock syndrome was high (26 %). The crude 30-day mortality rate in the VSB group (10.7 %) did not differ significantly from that in the BSI without VSB group (9.3 %) or non-BSI group (7.0 %) (P = 0.77). Also, VSB was not a risk factor for all-cause mortality up to 60 days following allo-HSCT (P = 0.43). APBL with increased anti-VGS activity (APBL-VA) monotherapy would typically be optimal for treating the VGS strains in this setting. Indication of adding an empiric anti-gram-positive agent to

  7. Breakthrough of the Nordic Bronze Age: Transcultural warriorhood and a Carpathian crossroad in the 16th century BC

    DEFF Research Database (Denmark)

    Vandkilde, Helle

    2014-01-01

    The breakthrough of the Nordic Bronze Age (NBA) c. 1600 bc as a koiné within Bronze Age Europe can be historically linked to the Carpathian Basin. Nordic distinctiveness entailed an entanglement of cosmology and warriorhood, albeit represented through different media in the hotspot zone (bronze) ...... momentous creativity that drew upon Carpathian originals, contacts and a pool of Carpathian ideas, but ultimately drawing on emergent Mycenaean hegemonies in the Aegean. This provided the incentive for a cosmology-rooted resource from which the NBA could take its starting point....

  8. State Technologies Advancement Collaborative

    Energy Technology Data Exchange (ETDEWEB)

    David S. Terry

    2012-01-30

    The U. S. Department of Energy (DOE), National Association of State Energy Officials (NASEO), and Association of State Energy Research and Technology Transfer Institutions (ASERTTI) signed an intergovernmental agreement on November 14, 2002, that allowed states and territories and the Federal Government to better collaborate on energy research, development, demonstration and deployment (RDD&D) projects. The agreement established the State Technologies Advancement Collaborative (STAC) which allowed the states and DOE to move RDD&D forward using an innovative competitive project selection and funding process. A cooperative agreement between DOE and NASEO served as the contracting instrument for this innovative federal-state partnership obligating funds from DOE's Office of Energy Efficiency and Renewable Energy and Office of Fossil Energy to plan, fund, and implement RDD&D projects that were consistent with the common priorities of the states and DOE. DOE's Golden Field Office provided Federal oversight and guidance for the STAC cooperative agreement. The STAC program was built on the foundation of prior Federal-State efforts to collaborate on and engage in joint planning for RDD&D. Although STAC builds on existing, successful programs, it is important to note that it was not intended to replace other successful joint DOE/State initiatives such as the State Energy Program or EERE Special Projects. Overall the STAC process was used to fund, through three competitive solicitations, 35 successful multi-state research, development, deployment, and demonstration projects with an overall average non-federal cost share of 43%. Twenty-two states were awarded at least one prime contract, and organizations in all 50 states and some territories were involved as subcontractors in at least one STAC project. Projects were funded in seven program areas: (1) Building Technologies, (2) Industrial Technologies, (3) Transportation Technologies, (4) Distributed Energy

  9. Effect of CH4 on the CO2 breakthrough pressure and permeability of partially saturated low-permeability sandstone in the Ordos Basin, China

    Science.gov (United States)

    Zhao, Yan; Yu, Qingchun

    2018-01-01

    The behavior of CO2 that coexists with CH4 and the effect of CH4 on the CO2 stream need to be deeply analyzed and studied, especially in the presence of water. Our previous studies investigated the breakthrough pressure and permeability of pure CO2 in five partially saturated low-permeability sandstone core samples from the Ordos Basin, and we concluded that rocks with a small pore size and low permeability show considerable sealing capacity even under unsaturated conditions. In this paper, we selected three of these samples for CO2-CH4 gas-mixture breakthrough experiments under various degrees of water saturation. The breakthrough experiments were performed by increasing the gas pressure step by step until breakthrough occurred. Then, the effluent gas mixture was collected for chromatographic partitioning analysis. The results indicate that CH4 significantly affects the breakthrough pressure and permeability of CO2. The presence of CH4 in the gas mixture increases the interfacial tension and, thus, the breakthrough pressure. Therefore, the injected gas mixture that contains the highest (lowest) mole fraction of CH4 results in the largest (smallest) breakthrough pressure. The permeability of the gas mixture is greater than that for pure CO2 because of CH4, and the effective permeability decreases with increased breakthrough pressure. Chromatographic partitioning of the effluent mixture gases indicates that CH4 breaks through ahead of CO2 as a result of its weaker solubility in water. Correlations are established between (1) the breakthrough pressure and water saturation, (2) the effective permeability and water saturation, (3) the breakthrough pressure and effective permeability, and (4) the mole fraction of CO2/CH4 in the effluent mixture gases and water saturation. These results deepen our understanding of the multi-phase flow behavior in the porous media under unsaturated conditions, which have implications for formulating emergency response plans for gas

  10. The best news for LPG in Denmark is diesel conversion breakthrough

    Energy Technology Data Exchange (ETDEWEB)

    1992-12-01

    Throughout Scandanavia, taxes seem to drive the marketplace. Governments do not want to encourage consumption of alcoholic beverages, so they tax them heavily, thereby actually discouraging their use. Using the same means, they dictate the fate of the various fuels. Taxes have depressed propane's use to a large extent; today it is priced at three times natural gas, with the result that it accounts for only 0.5%-0.7% of total energy consumption. But, this paper reports on a potential new star that has appeared on the horizon, as participants in the People-to-People sojourn to Scandanavia last August learned. It's a program of converting diesel buses to propane, and officials of the company that is marketing it, Skibby Motor A/S, are so confident of its success that they have already begun a campaign of introducing it to the U.S.

  11. Depression and College Students

    Science.gov (United States)

    ... on thoughts, behaviors, and feelings related to depression Interpersonal psychotherapy , or IPT, which focuses on working on relationships Dialectical behavior therapy , or DBT, which is especially useful when depression ...

  12. Men and Depression

    Science.gov (United States)

    ... or making it worse. Cognitive behavioral therapy (CBT), interpersonal therapy (IPT), and problem-solving therapy are examples of evidence-based talk therapy treatments for depression. Treatment for depression should be personalized. Some men, ...

  13. Depression - older adults

    Science.gov (United States)

    ... active and engaged. The most worrisome complication of depression is suicide. Men make up most suicides among older adults. ... such as 911) if you are thinking about suicide (taking your own ... and think they may have depression, contact their provider.

  14. Postpartum Depression - Multiple Languages

    Science.gov (United States)

    ... Are Here: Home → Multiple Languages → All Health Topics → Postpartum Depression URL of this page: https://medlineplus.gov/languages/ ... V W XYZ List of All Topics All Postpartum Depression - Multiple Languages To use the sharing features on ...

  15. Screening for Depression

    Science.gov (United States)

    Depression and Bipolar Support Alliance Crisis Hotline Information Coping with a Crisis Suicide Prevention Information Psychiatric Hospitalization ... sign-up Education info, training, events Mood Disorders Depression Bipolar Disorder Anxiety Screening Center Co-occurring Illnesses/ ...

  16. Help With Depression

    Science.gov (United States)

    ... a Psychiatrist Addiction and Substance Use Disorders ADHD Anxiety Disorders Autism ... Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way ...

  17. Behandlingsresistent depression kan behandles

    DEFF Research Database (Denmark)

    Vinberg, Maj; Levinsen, Mette Frandsen; Kessing, Lars Vedel

    2011-01-01

    Depression is considered resistant when two treatment attempts with antidepressants from different classes fail to produce significant clinical improvement. In cases of treatment-resistant depression, it is recommended to reevaluate the diagnosis, clarify comorbidity, substance abuse and lack of ...

  18. Recognizing teen depression

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000648.htm Recognizing teen depression To use the sharing features on this ... teen's life. Be Aware of the Risk for Teen Depression Your teen is more at risk for ...

  19. Learning about depression

    Science.gov (United States)

    ... medlineplus.gov/ency/patientinstructions/000325.htm Learning about depression To use the sharing features on this page, ... trigger or reason. What are the Signs of Depression? You may notice some or all of the ...

  20. Depression - stopping your medicines

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000570.htm Depression - stopping your medicines To use the sharing features ... prescription medicines you may take to help with depression, anxiety, or pain. Like any medicine, there are ...

  1. Depression and Pregnancy

    Science.gov (United States)

    ... best live chat Live Help Fact Sheets Share Depression Thursday, 01 September 2016 In every pregnancy, a ... risk. This sheet talks about whether exposure to depression may increase the risk for birth defects over ...

  2. Signs of Depression

    Science.gov (United States)

    Everyone has down days and times when they feel sad. But depression is more than feeling sad or having a bad day. You may have depression if you feel sad every day (or most days) for at least two weeks.

  3. Heart disease and depression

    Science.gov (United States)

    ... gov/ency/patientinstructions/000790.htm Heart disease and depression To use the sharing features on this page, ... a heart attack or heart surgery Signs of Depression It is pretty common to feel down or ...

  4. The Efficient Windows Collaborative

    Energy Technology Data Exchange (ETDEWEB)

    Petermann, Nils

    2006-03-31

    The Efficient Windows Collaborative (EWC) is a coalition of manufacturers, component suppliers, government agencies, research institutions, and others who partner to expand the market for energy efficient window products. Funded through a cooperative agreement with the U.S. Department of Energy, the EWC provides education, communication and outreach in order to transform the residential window market to 70% energy efficient products by 2005. Implementation of the EWC is managed by the Alliance to Save Energy, with support from the University of Minnesota and Lawrence Berkeley National Laboratory.

  5. Collaborative form(s)

    DEFF Research Database (Denmark)

    Gunn, Wendy

    anthropology engages groups of people within collaborative, interdisciplinary, inter-organizational design processes and co-analytic activities vs. the individual anthropologist conducting studies of people. In doing anthropology by means of design as Gatt and Ingold (2013) have shown, design is considered...... the process of research rather than its object. In its temporal orientation, anthropology by means of design moves, ‘…forward with people in tandem with their desires and aspirations rather than going back over times passed’ (ibid 2013: 141). Doing design by means of anthropology takes as its most fundamental...

  6. Playful Collaboration (or Not)

    DEFF Research Database (Denmark)

    Bogers, Marcel; Sproedt, Henrik

    2011-01-01

    This paper explores how games and play, which are deeply rooted in human beings as a way to learn and interact, can be used to teach certain concepts and practices related to open collaborative innovation. We discuss how playing games can be a source of creativity, imagination and fun, while it can...... related to open and distributed innovation models. From this experience, we induce that a game can be useful to teach certain open innovation concepts and practices. We also highlight some possible caveats of using the game and of actual open innovation practices alike, such as a tendency towards too much...

  7. Collaborative Communities of Firms

    DEFF Research Database (Denmark)

    Bøllingtoft, Anne; Müller, Sabine; Ulhøi, John Parm

    2011-01-01

    and developing strategic initiatives that aid the community as a whole. We discuss the facilitator role of the shared services provider, contrasting it with the coordinator role found in other multi-firm organizations, and we show how shared services providers function by describing three examples...... of collaborative communities of firms from different sectors: the U.S.-based Blade.org and two Denmark-based communities, the Kalundborg Industrial Symbiosis and MG50. Implications for the theory and practice of organization design are discussed....

  8. Blade reliability collaborative :

    Energy Technology Data Exchange (ETDEWEB)

    Ashwill, Thomas D.; Ogilvie, Alistair B.; Paquette, Joshua A.

    2013-04-01

    The Blade Reliability Collaborative (BRC) was started by the Wind Energy Technologies Department of Sandia National Laboratories and DOE in 2010 with the goal of gaining insight into planned and unplanned O&M issues associated with wind turbine blades. A significant part of BRC is the Blade Defect, Damage and Repair Survey task, which will gather data from blade manufacturers, service companies, operators and prior studies to determine details about the largest sources of blade unreliability. This report summarizes the initial findings from this work.

  9. Making Collaborative Innovation Accountable

    DEFF Research Database (Denmark)

    Sørensen, Eva

    The public sector is increasingly expected to be innovative, but the prize for a more innovative public sector might be that it becomes difficult to hold public authorities to account for their actions. The article explores the tensions between innovative and accountable governance, describes the...... the foundation for these tensions in different accountability models, and suggest directions to take in analyzing the accountability of collaborative innovation processes.......The public sector is increasingly expected to be innovative, but the prize for a more innovative public sector might be that it becomes difficult to hold public authorities to account for their actions. The article explores the tensions between innovative and accountable governance, describes...

  10. Collaboratively Constructed Contradictory Accounts

    DEFF Research Database (Denmark)

    Tunby Gulbrandsen, Ib; Just, Sine Nørholm

    2013-01-01

    Based on a mixed-method case study of online communication about the Danish pharmaceutical company Novo Nordisk, this article argues that online communication plays out as a centrifugal narration process with centripetal consequences. Through a content analysis of communication about Novo Nordisk...... the theoretical and methodological implications of the empirical findings. It is argued that although the findings are not in themselves surprising, they adequately reflect that online meaning formation is, indeed, a collaborative process in which centrifugal forces have centripetal consequences. Furthermore...

  11. Collaboration or contestation?

    DEFF Research Database (Denmark)

    Middleton, Geoff; Evans, Adam Brian; Henderson, Hannah

    2016-01-01

    -agency approach. The strength of health promotion initiatives relies on formed ‘coalitions’ or partnerships and the subsequent collaboration in the design, delivery and administration of the programme’s multiple components. Advantages of partnership are the pooling of resources, avoiding duplication...... to the development, implementation and evaluation of such programmes (Middleton et al., 2014, Kleij et al., 2015). This includes leadership issues, competing agendas and priorities, the unwieldy nature of large multi-agency networks and the complexities around making a sustained impact. Those involved...

  12. Advances in Collaborative Filtering

    Science.gov (United States)

    Koren, Yehuda; Bell, Robert

    The collaborative filtering (CF) approach to recommenders has recently enjoyed much interest and progress. The fact that it played a central role within the recently completed Netflix competition has contributed to its popularity. This chapter surveys the recent progress in the field. Matrix factorization techniques, which became a first choice for implementing CF, are described together with recent innovations. We also describe several extensions that bring competitive accuracy into neighborhood methods, which used to dominate the field. The chapter demonstrates how to utilize temporal models and implicit feedback to extend models accuracy. In passing, we include detailed descriptions of some the central methods developed for tackling the challenge of the Netflix Prize competition.

  13. Preventing Depression in Adults With Subthreshold Depression

    DEFF Research Database (Denmark)

    Buntrock, Claudia; Berking, Matthias; Smit, Filip

    2017-01-01

    BACKGROUND: Psychological interventions for the prevention of depression might be a cost-effective way to reduce the burden associated with depressive disorders. OBJECTIVE: To evaluate the cost-effectiveness of a Web-based guided self-help intervention to prevent major depressive disorder (MDD......) in people with subthreshold depression (sD). METHODS: A pragmatic randomized controlled trial was conducted with follow-up at 12 months. Participants were recruited from the general population via a large statutory health insurance company and an open access website. Participants were randomized to a Web......-based guided self-help intervention (ie, cognitive-behavioral therapy and problem-solving therapy assisted by supervised graduate students or health care professionals) in addition to usual care or to usual care supplemented with Web-based psycho-education (enhanced usual care). Depression-free years (DFYs...

  14. Genetic biomarkers of depression

    OpenAIRE

    Anand Tamatam; Farhath Khanum; Amarinder Singh Bawa

    2012-01-01

    Depression is a term that has been used to describe a variety of ailments, ranging from minor to incapacitating. Clinically significant depression, termed as major depression, is a serious condition characterized not only by depressed mood but also by a cluster of somatic, cognitive, and motivational symptoms. Significant research efforts are aimed to understand the neurobiological as well as psychiatric disorders, and the evaluation of treatment of these disorders is still based solely on th...

  15. Depression in cerebrovascular diseases

    OpenAIRE

    Voskresenskaya, Tatyana

    2009-01-01

    The paper discusses the topical problem of depression in cerebrovascular diseases. It shows its possible causes, mechanisms of occurrence, clinical picture and negative impact on the course of cerebrovascular disease and recovery of neurological functions. There is a bilateral association between stroke and depression: on the one hand, stroke is a risk factor for the development of depression and, on the other, depression is a both direct and indirect risk factor for the development of stroke...

  16. Method of treating depression

    Science.gov (United States)

    Henn, Fritz [East Patchogue, NY

    2012-01-24

    Methods for treatment of depression-related mood disorders in mammals, particularly humans are disclosed. The methods of the invention include administration of compounds capable of enhancing glutamate transporter activity in the brain of mammals suffering from depression. ATP-sensitive K.sup.+ channel openers and .beta.-lactam antibiotics are used to enhance glutamate transport and to treat depression-related mood disorders and depressive symptoms.

  17. Collaborative editing within the pervasive collaborative computing environment

    Energy Technology Data Exchange (ETDEWEB)

    Perry, Marcia [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Agarwal, Deb [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2003-09-11

    Scientific collaborations are established for a wide variety of tasks for which several communication modes are necessary, including messaging, file-sharing, and collaborative editing. In this position paper, we describe our work on the Pervasive Collaborative Computing Environment (PCCE) which aims to facilitate scientific collaboration within widely distributed environments. The PCCE provides a persistent space in which collaborators can locate each other, exchange messages synchronously and asynchronously and archive conversations. Our current interest is in exploring research and development of shared editing systems with the goal of integrating this technology into the PCCE. We hope to inspire discussion of technology solutions for an integrated approach to synchronous and asynchronous communication and collaborative editing.

  18. Therapeutics of postpartum depression.

    Science.gov (United States)

    Thomson, Michael; Sharma, Verinder

    2017-05-01

    Postpartum depression is a prevalent disorder affecting many women of reproductive age. Despite increasing public awareness, it is frequently underdiagnosed and undertreated leading to significant maternal morbidity and adverse child outcomes. When identified, postpartum depression is usually treated as major depressive disorder. Many studies have identified the postpartum as a period of high risk for first presentations and relapses of bipolar disorder. Areas covered: This article reviews the acute and prophylactic treatment of postpartum major depressive disorder, bipolar depression and major depressive disorder with mixed features. The safety of antidepressant and mood stabilizing medications in pregnancy and breastfeeding will also be reviewed. Expert commentary: Differentiating postpartum major depressive disorder and postpartum bipolar depression can be difficult given their clinical similarities but accurate identification is vital for initiating proper treatment. Antidepressants are the mainstay of drug treatment for postpartum major depressive disorder, yet randomized controlled trials have shown conflicting results. A paucity of evidence exists for the effectiveness of antidepressant prophylaxis in the prevention of recurrences of major depressive disorder. Mood stabilizing medications reduce the risk of postpartum bipolar depression relapse but no randomized controlled trials have examined their use in the acute or prophylactic treatment of postpartum bipolar depression.

  19. Vision in depressive disorder

    DEFF Research Database (Denmark)

    Bubl, E.; Tebartz Van Elst, L.; Ebert, D.

    2009-01-01

    plays a role in major depression we measured contrast sensitivity in patients with major depression and in healthy control subjects. Methods. Twenty-eight patients diagnosed with major depressive disorder were compared to 21 age-matched control subjects on their ability to detect a Gabor target...

  20. Depression (For Parents)

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Depression KidsHealth / For Parents / Depression What's in this article? ... Ways to Help Print en español Depresión About Depression It's normal for kids to feel sad, down, ...

  1. Handling Depression | Smokefree 60+

    Science.gov (United States)

    Everyone feels blue now and then. It's a part of life. But if your feelings last more than few days and interfere with your normal daily activities, you may be suffering from depression. On this page: Symptoms of depression Who gets depressed and why?

  2. Measuring psychotic depression

    DEFF Research Database (Denmark)

    Østergaard, Søren Dinesen; Meyers, B S; Flint, A J

    Psychotic depression (PD) is a highly debilitating condition, which needs intensive monitoring. However, there is no established rating scale for evaluating the severity of PD. The aim of this analysis was to assess the psychometric properties of established depression rating scales and a number...... of new composite rating scales, covering both depressive and psychotic symptoms, in relation to PD....

  3. A collaborative adventure

    CERN Multimedia

    2014-01-01

    At the start of a new year, I’d like to wish all of you and your families a happy, successful and peaceful 2014. It’s a year that holds particular significance for CERN, as on 29 September it will be 60 years since the Organization was founded.   As CERN turns 60, it is still going strong, maintaining its underlying attraction of international collaboration for basic science. Since its foundation in 1954, it has grown steadily and this year begins well as we welcome a new Member State, Israel. CERN and Israel already have a long history of mutual collaboration and now we can look forward to increasingly fruitful scientific cooperation. Israel’s accession brings the total number of Member States to 21, and other countries are in the stages leading up to becoming Members or Associates, while still others are expressing interest. CERN is becoming a global success, while retaining its original, European flavour. This year’s events for the 60th anniversary ...

  4. Globally Collaborative Experiential Learning

    Directory of Open Access Journals (Sweden)

    Takeshi UTSUMI

    2005-07-01

    Full Text Available ABSTRACT The Global University System (GUS [Utsumi, et al, 2003] is a worldwide initiative to create advanced telecommunications infrastructure for access to educational resources across national and cultural boundaries for global peace. GUS aims to create a worldwide consortium of universities to provide the underdeveloped world with access to 21st Century education via broadband Internet technologies. The aim is to achieve “education and healthcare for all,” anywhere, anytime and at any pace. The GUS works in the major regions of the globe with partnerships of higher education and healthcare institutions. Learners in these regions will be able to take their courses from member institutions around the world to receive a GUS degree. These learners and their professors from partner institutions will also form a global forum for exchange of ideas and information and for conducting collaborative research and development with emerging global GRID computer network technology. Globally Collaborative Environmental Peace Gaming (GCEPG project [Utsumi, 2003] with a globally distributed computer simulation system, focusing on the issue of environment and sustainable development in developing countries, is to train would-be decision-makers in crisis management, conflict resolution, and negotiation techniques basing on “facts and figures.” The GUS will supply game players from around the world.

  5. A neighbourly collaboration

    CERN Multimedia

    Corinne Pralavorio

    2014-01-01

    CERN and its host territories in France have created a new partnership aimed at reinforcing and making permanent numerous projects for the people who live in the region.   Over the last four years, CERN has developed a number of initiatives with its partners in Geneva and neighbouring France. To formalise and improve the structure of this collaboration, CERN, the French government, the Conseil général de l’Ain and the Communauté de communes du Pays de Gex have recently formed a quadripartite partnership. The CERN Director-General has been appointed Chair of the committee leading the partnership for this year. “Due to its geographical location, activities and aims, CERN has always placed great emphasis on dialogue with its neighbours,” explains Friedemann Eder, Head of the Relations with the Host States Service.  “The current Director-General wanted to boost dialogue and collaboration – an aim that the auth...

  6. The Alberta Breakthrough Pain Assessment Tool for cancer patients: a validation study using a delphi process and patient think-aloud interviews.

    Science.gov (United States)

    Hagen, Neil A; Stiles, Carla; Nekolaichuk, Cheryl; Biondo, Patricia; Carlson, Linda E; Fisher, Kim; Fainsinger, Robin

    2008-02-01

    Breakthrough pain is a prevalent cancer pain syndrome, and research is needed to identify more effective interventions to manage it. A validated tool to assess breakthrough pain in a standard and reliable manner is urgently needed to support the conduct of clinical trials in breakthrough pain. To address this need, we developed a breakthrough pain assessment tool for research purposes. The current study was undertaken to gather validity evidence for this breakthrough pain assessment tool, using a Delphi process involving an expert panel review, followed by a think-aloud process involving patients with cancer-related breakthrough pain. Two expert panels were formed: a national panel (within Canada; n=16) and an international panel (including experts from North America, UK, Europe, the Middle East, Australia, and New Zealand; n=22). Each panel participated in one anonymous survey round. Response rates were 56% (national panel) and 73% (international panel). The Delphi process revealed substantial consensus on the content of the tool, which increased between rounds of review. The overall level of agreement with the tool, averaged over the four evaluated aspects of all items, was 80% among national panelists and 88% among international panelists. Nine patients completed the think-aloud study. They were able to understand and complete the tool and provided specific direction on its improvement. The validity evidence gathered in this study suggests the Alberta Breakthrough Pain Assessment Tool is conceptually grounded and is understandable by patients and clinicians. Further validation of this tool as an assessment measure within clinical trials research is warranted.

  7. Cross-cultural aspects of depression management in primary care.

    Science.gov (United States)

    Hails, Katherine; Brill, Charlotte D; Chang, Trina; Yeung, Albert; Fava, Maurizio; Trinh, Nhi-Ha

    2012-08-01

    Major depressive disorder (MDD) is a prevalent illness in minority populations. Minority patients with MDD are often unrecognized and untreated. This review examines promising interventions to address MDD in primary care settings, where minority groups are more likely to seek care. Since 2010, eleven interventions have been developed to address patient-specific and provider-specific barriers, many of which are adaptations of the collaborative care model. Other promising interventions include cultural tailoring of the collaborative care model, as well as the addition of telepsychiatry, motivational interviewing, cultural consultation, and innovations in interpreting. Overall, collaborative care was found feasible and improved satisfaction and treatment engagement of depressed minority patients in primary care. It remains inconclusive whether these newer intervention models improve MDD treatment outcomes. Future research will be needed to establish the effectiveness of these intervention models in improving the treatment outcomes of minority populations with MDD.

  8. The Breakthrough Listen Search for Intelligent Life: A Wideband Data Recorder System for the Robert C. Byrd Green Bank Telescope

    Science.gov (United States)

    MacMahon, David H. E.; Price, Danny C.; Lebofsky, Matthew; Siemion, Andrew P. V.; Croft, Steve; DeBoer, David; Enriquez, J. Emilio; Gajjar, Vishal; Hellbourg, Gregory; Isaacson, Howard; Werthimer, Dan; Abdurashidova, Zuhra; Bloss, Marty; Brandt, Joe; Creager, Ramon; Ford, John; Lynch, Ryan S.; Maddalena, Ronald J.; McCullough, Randy; Ray, Jason; Whitehead, Mark; Woody, Dave

    2018-04-01

    The Breakthrough Listen Initiative is undertaking a comprehensive search for radio and optical signatures from extraterrestrial civilizations. An integral component of the project is the design and implementation of wide-bandwidth data recorder and signal processing systems. The capabilities of these systems, particularly at radio frequencies, directly determine survey speed; further, given a fixed observing time and spectral coverage, they determine sensitivity as well. Here, we detail the Breakthrough Listen wide-bandwidth data recording system deployed at the 100 m aperture Robert C. Byrd Green Bank Telescope. The system digitizes up to 6 GHz of bandwidth at 8 bits for both polarizations, storing the resultant 24 GB s‑1 of data to disk. This system is among the highest data rate baseband recording systems in use in radio astronomy. A future system expansion will double recording capacity, to achieve a total Nyquist bandwidth of 12 GHz in two polarizations. In this paper, we present details of the system architecture, along with salient configuration and disk-write optimizations used to achieve high-throughput data capture on commodity compute servers and consumer-class hard disk drives.

  9. The anomaly in a breakthrough curve of a single well "push-pull" tracer test: A density driven effect?

    Science.gov (United States)

    Zeilfelder, Sarah; Hebig, Klaus; Ito, Narimitsu; Machida, Isao; Scheytt, Traugott; Marui, Atsunao

    2013-04-01

    What method is appropriate to investigate an aquifer when there is only one well available? A single well "push-pull" tracer test (PP Test) may be a suitable method in order to characterize an aquifer and to obtain information about the hydraulic and chemical properties when only one well is available for the investigations. In a PP test, a test solution that contains a known amount of solutes and a conservative tracer is injected into the aquifer ("push") and extracted afterwards ("pull"). Optionally, the test solution is flushed out of the well and the casing with untreated test solution with a so called "chaser" before being extracted. Also between the injection and the extraction phase a drifting time may be included. The breakthrough of the tracer during the extraction phase is measured and used for analyses and interpretation. In the last three years, several PP Test campaigns were conducted at two different test sites in Japan (Hebig et al. 2011, Zeilfelder et al. 2012). The aim was to investigate the applicability of the PP Test method in different geological settings and in different types of aquifers. The latest field campaign thus focussed on the question how variations of the setup are influencing the breakthrough curve of the PP Test in order to develop and enhance this method. Also the standardization of the PP Test was an aim of this study. During the campaign, a total of seven PP Tests were performed, while only single aspects of the setup were varied from test to test. The tests differed in injection and extraction rate, in the salinity of the injected test solution and in the use of a chaser solution. The general shapes of the breakthrough curves were similar and conclusions about the repeatability of the PP Test could be drawn. However, a sharp anomaly was observed in the breakthrough curve of one specific setup type. By repeating this PP test under the same boundary conditions, we were able to recreate the anomaly and could exclude any technical

  10. The collaborative Economy and Tourism

    DEFF Research Database (Denmark)

    Dredge, Dianne; Gyimóthy, Szilvia

    2015-01-01

    House swapping, ridesharing, voluntourism, couchsurfing, dinner hosting and similar innovations epitomize the collaborative economy. The rise of the collaborative economy, also known as collaborative consumption, the sharing economy and peer-to-peer consumption, has been fuelled by a range...... experiences; and higher levels of consumer risk-taking balanced against mechanisms such as peer-to-peer feedback designed to engender trust between producers and consumers. This paper explores and critically assesses the collaborative economy and its implications for tourism industrial systems. It achieves...... this by mapping out the current knowledge dynamics characterising tourism and the collaborative economy, paying particular attention to the asymmetries of knowledge that are emerging. The paper then identifies and critically discusses five pervasive claims being made about the collaborative economy, arguing...

  11. Coordination theory and collaboration technology

    CERN Document Server

    Olson, Gary M; Smith, John B

    2001-01-01

    The National Science Foundation funded the first Coordination Theory and Collaboration Technology initiative to look at systems that support collaborations in business and elsewhere. This book explores the global revolution in human interconnectedness. It will discuss the various collaborative workgroups and their use in technology. The initiative focuses on processes of coordination and cooperation among autonomous units in human systems, in computer and communication systems, and in hybrid organizations of both systems. This initiative is motivated by three scientific issues which have been

  12. Depression in adolescence

    Science.gov (United States)

    Thapar, Anita; Collishaw, Stephan; Pine, Daniel S; Thapar, Ajay K

    2012-01-01

    Unipolar depressive disorder in adolescence is common worldwide but often unrecognised. The incidence, notably in girls, rises sharply after puberty and, by the end of adolescence, the 1 year prevalence rate exceeds 4%. The burden is highest in low-income and middle-income countries. Depression is associated with sub stantial present and future morbidity, and heightens suicide risk. The strongest risk factors for depression in adolescents are a family history of depression and exposure to psychosocial stress. Inherited risks, developmental factors, sex hormones, and psychosocial adversity interact to increase risk through hormonal factors and associated perturbed neural pathways. Although many similarities between depression in adolescence and depression in adulthood exist, in adolescents the use of antidepressants is of concern and opinions about clinical management are divided. Effective treatments are available, but choices are dependent on depression severity and available resources. Prevention strategies targeted at high-risk groups are promising. PMID:22305766

  13. Teacher and Student Perceptions on High School Science Flipped Classrooms: Educational Breakthrough or Media Hype?

    Science.gov (United States)

    Hunley, Rebecca C.

    For years educators have struggled to ensure students meet the rigors of state mandated tests. Challenges that often impede student success are student absences, school closings due to weather, and remediation for students who need additional help while advanced students can move ahead. Many educators, especially secondary math and science teachers, have responded to these issues by implementing a teaching strategy called the flipped classroom where students view lectures, power points, or podcasts outside of school and class time shifts to allow opportunities for collaborative learning. The purpose of this research was to evaluate teacher and student perceptions of high school flipped science classrooms. A qualitative phenomenological study was conducted to observe 3 high school science teachers from Georgia, North Carolina, and Tennessee selected through purposeful sampling who have used the flipped classroom method for a minimum of 2 years. Analysis of data from an online survey, direct observation, teacher interviews, and student focus groups helped to identify challenges and benefits of this teaching and learning strategy. Findings indicated that teachers find the flipped classroom beneficial to build student relationships but requires a significant amount of time to develop. Mixed student reactions revealed benefits of a flipped classroom as a successful learning tool for current and future endeavors for college or career preparation.

  14. Collaborative Communities of Firms

    DEFF Research Database (Denmark)

    2011-01-01

    and developing strategic initiatives that aid the community as a whole. We discuss the facilitator role of the shared services provider, contrasting it with the coordinator role found in other multi-firm organizations, and we show how shared services providers function by describing three examples...... of collaborative communities of firms from different sectors: the U.S.-based Blade.org and two Denmark-based communities, the Kalundborg Industrial Symbiosis and MG50. Implications for the theory and practice of organization design are discussed.......Both small and medium-size entrepreneurial firms face liabilities such as resource scarcity and scale diseconomies, making it difficult for them to innovate on a continuous basis. In response, experimentation with new ways of organizing for innovation has increased. One successful result...

  15. Collaborative Tax Regulation

    DEFF Research Database (Denmark)

    Boll, Karen

    2016-01-01

    This article shows a new form of regulation within a tax administration where tax administrators abate tax evasion by nudging and motivating consumers to only purchase services from tax compliant businesses. This indirectly closes or forces tax evading businesses to change their practices, because...... their customer bases decline to commercially non-viable levels. The analysis is framed by public governance literature and argues that the regulation is an example of collaborative or interactive governance, because the tax administrators do not regulate non-compliance directly, but activate external...... stakeholders, i.e. the consumers, in the regulatory craft. The study is based on a qualitative methodology and draws on a unique case of regulation in the cleaning sector. This sector is at high risk of tax evasion and human exploitation of vulnerable workers operating in the informal economy. The article has...

  16. International collaborative donor project.

    Science.gov (United States)

    Ríos Zambudio, Antonio

    2018-02-01

    The International Donor Collaborative Project (PCID) research group was created in 1996 in Spain with the aim of promoting research in the field of organ donation and transplantation, led by Spanish surgeons. During this period they have developed the questionnaires of the PCID, both the attitude towards cadaver and live donation, which are the most used questionnaires in publications in indexed journals. They have been the driving group of stratified studies representative of the populations under study, and of the performance of multivariate statistical analyzes in the field of psycho-social research in organ donation and transplantation. The main contributions of the group focus on the analysis of health center professionals and emerging migrant groups. In recent years, studies have been extended to the United States, Latin America (mainly Mexico) and Europe. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Boston Collaborative Drug Surveillance Program

    Science.gov (United States)

    The Boston Collaborative Drug Surveillance Program started in 1966 and conducted epidemiologic research to quantify the potential adverse effects of prescription drugs, utilizing in-hospital monitoring.

  18. Information handling in collaborative research

    Directory of Open Access Journals (Sweden)

    Ellen Collins

    2013-02-01

    Full Text Available UK public policy makers have a growing interest in collaborative research, where academics work with public, private or third sector partners on a joint project which supports the partner’s aims. This paper reports on the findings of five case studies, looking at how information is sourced, managed, used and shared within collaborative research projects. It finds that researchers within collaborative projects have similar information management issues as are known to exist within academia more broadly, but that the specific conditions which govern research collaborations mean that interventions to improve or support information management must be carefully tailored.

  19. Supporting collaborative computing and interaction

    Energy Technology Data Exchange (ETDEWEB)

    Agarwal, Deborah [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); McParland, Charles [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Perry, Marcia [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2002-05-22

    To enable collaboration on the daily tasks involved in scientific research, collaborative frameworks should provide lightweight and ubiquitous components that support a wide variety of interaction modes. We envision a collaborative environment as one that provides a persistent space within which participants can locate each other, exchange synchronous and asynchronous messages, share documents and applications, share workflow, and hold videoconferences. We are developing the Pervasive Collaborative Computing Environment (PCCE) as such an environment. The PCCE will provide integrated tools to support shared computing and task control and monitoring. This paper describes the PCCE and the rationale for its design.

  20. Collaborative Legal Pluralism

    Directory of Open Access Journals (Sweden)

    Wim Decock

    2017-01-01

    Full Text Available Legal pluralism calls into question the monopoly of the modern state when it comes to the production and the enforcement of norms. It rests on the assumption that juridical normativity and state organization can be dissociated. From an early modern historian’s perspective, such an assumption makes perfect sense, the plural nature of the legal order being the natural state of affairs in imperial spaces across the globe in the sixteenth and seventeenth centuries. This article will provide a case study of the collaborative nature of the interaction between spiritual and temporal legal orders in Spain and its overseas territories as conceived by Tomás de Mercado (ca. 1520–1575, a major theologian from the School of Salamanca. His treatise on trade and contracts (1571 contained an extended discussion of the government’s attempt to regulate the grain market by imposing a maximum price. It will be argued that Mercado’s view on the bindingness of economic regulations in conscience allowed for the internalization of the regulatory power of the nascent state. He called upon confessors to be strict enforcers of state law, considering them as fathers of the republic as much as fathers of faith. This is illustrative of the »collaborative form of legal pluralism« typical of the osmotic relationship between Church and State in the early modern Spanish empire. It contributed to the moral justification of state jurisdictions, while at the same time, guaranteeing a privileged role for theologians and religious leaders in running the affairs of the state.

  1. Safety and Efficacy of Oral Transmucosal Fentanyl Citrate Compared to Morphine Sulphate Immediate Release Tablet in Management of Breakthrough Cancer Pain

    Science.gov (United States)

    Bhatnagar, Sushma; Devi, Saraswathi; Vinod, NK; Jain, PN; Durgaprasad, G; Maroo, Sanjaykumar H; Patel, Ketan R

    2014-01-01

    Aim: To compare the efficacy and safety of oral transmucosal fentanyl citrate (OTFC) and oral morphine in Indian patients with breakthrough episodes of cancer pain. Materials and Methods: In this randomized, open label, active controlled, clinical study, total 186 patients who regularly experienced 1-4 episodes of breakthrough cancer pain (BTCP) daily, over the persistent pain controlled by taking oral morphine 60 mg/day or its equivalent were randomized to receive either OTFC 200 mcg or oral morphine 10 mg for the treatment of BTCP for 3 days. Improvement in pain as determined by numerical rating scale (NRS) at 5, 15, 30, and 60 minutes of drug administration and percentage of BTCP episodes showing reduction in pain intensity by >33% at 15 minutes were primary efficacy endpoints. Secondary efficacy endpoints were requirement for rescue analgesia and global assessment by physician and patient. Data of both treatment groups were analysed by appropriate statistical test using software, STATISTICA, version 11. Results: Patients treated with OTFC experienced significantly greater improvement in pain intensity of breakthrough episodes compared to those treated with oral morphine at all assessment time points (P breakthrough pain episodes treated with OTFC showed a greater than 33% reduction in pain intensity from baseline at 15 minutes compared to 39% episodes treated with oral morphine (P 0.05). Both study drugs were well tolerated. Conclusions: OTFC was found to provide faster onset of analgesic effect than immediate release oral morphine in management of breakthrough cancer pain. PMID:25191003

  2. Project-based learning with international collaboration for training biomedical engineers.

    Science.gov (United States)

    Krishnan, Shankar

    2011-01-01

    Training biomedical engineers while effectively keeping up with the fast paced scientific breakthroughs and the growth in technical innovations poses arduous challenges for educators. Traditional pedagogical methods are employed for coping with the increasing demands in biomedical engineering (BME) training and continuous improvements have been attempted with some success. Project-based learning (PBL) is an academic effort that challenges students by making them carry out interdisciplinary projects aimed at accomplishing a wide range of student learning outcomes. PBL has been shown to be effective in the medical field and has been adopted by other fields including engineering. The impact of globalization in healthcare appears to be steadily increasing which necessitates the inclusion of awareness of relevant international activities in the curriculum. Numerous difficulties are encountered when the formation of a collaborative team is tried, and additional difficulties occur as the collaboration team is extended to international partners. Understanding and agreement of responsibilities becomes somewhat complex and hence the collaborative project has to be planned and executed with clear understanding by all partners and participants. A model for training BME students by adopting PBL with international collaboration is proposed. The results of previous BME project work with international collaboration fit partially into the model. There were many logistic issues and constraints; however, the collaborative projects themselves greatly enhanced the student learning outcomes. This PBL type of learning experience tends to promote long term retention of multidisciplinary material and foster high-order cognitive activities such as analysis, synthesis and evaluation. In addition to introducing the students to experiences encountered in the real-life workforce, the proposed approach enhances developing professional contracts and global networking. In conclusion, despite

  3. Exploiting Publication Contents and Collaboration Networks for Collaborator Recommendation.

    Directory of Open Access Journals (Sweden)

    Xiangjie Kong

    Full Text Available Thanks to the proliferation of online social networks, it has become conventional for researchers to communicate and collaborate with each other. Meanwhile, one critical challenge arises, that is, how to find the most relevant and potential collaborators for each researcher? In this work, we propose a novel collaborator recommendation model called CCRec, which combines the information on researchers' publications and collaboration network to generate better recommendation. In order to effectively identify the most potential collaborators for researchers, we adopt a topic clustering model to identify the academic domains, as well as a random walk model to compute researchers' feature vectors. Using DBLP datasets, we conduct benchmarking experiments to examine the performance of CCRec. The experimental results show that CCRec outperforms other state-of-the-art methods in terms of precision, recall and F1 score.

  4. Collaborative Windows – A User Interface Concept for Distributed Collaboration

    DEFF Research Database (Denmark)

    Esbensen, Morten

    2016-01-01

    of software development where the production of software is carried out by geographically dispersed people. Such work however, is challenged by the distance between people and a strategy for handling the complex dependencies that exists in distributed software development is to engage in closely coupled work......Distributed collaboration is the work arrangement in which people distributed across different locations collaborate on achieving a common goal. One particular domain of work that has embraced distributed collaboration is software development. Global software development is the special kind...... of collaboration technologies. In this dissertation, I explore how novel collaboration technologies can support closely coupled distributed work such as that in distributed Scrum. This research is based on three different studies: an ethnographic field study of distributed Scrum between Danish and Indian software...

  5. Significant breakthroughs in monitoring networks of the volcanological and seismological French observatories

    Science.gov (United States)

    Lemarchand, Arnaud; Anglade, andré; Saurel, jean-marie

    2014-05-01

    In the last few years, French West Indies observatories, in collaboration with the Seismic Research Center (University of West Indies-Trinidad), have modernized the Lesser Antilles Arc seismic and deformation monitoring network. 16 new permanent stations have been installed to strengthen and expand its detection capabilities. The global network of the IPGP-SRC consortium is now composed of 21 modernized stations, all equipped with broadband seismometers, strong motion sensors, GNSS sensors and satellite communication for real-time data transfer to the observatories of Trinidad (SRC), Guadeloupe (OVSG), Martinique (OVSM). To improve the sensitivity and reduce ambient noise, special efforts were made to enhance the design of the seismic vault and the original Stuttgart shielding (D. Kurrle R. Widmer-Schnidrig, 2005) of the broadband seismometers (240 and 120 sec). Several months of tests have been performed in order to get the maximum performance level out of the seismometers with different types of shields. This renewed network feeds the Caribbean Tsunami Warning System supported by UNESCO and establishes a monitoring tool that produces high quality data for studying subduction and volcanism interactions in the Lesser Antilles arc. The project has been an opportunity to migrate the seismic data processing to SeisComP3 with new developed plugins to compute the duration magnitude and locate (modified HYPO71PC ) ever small events such as volcanic ones. The new plugins are integrated in Seiscomp3 releases. Several tools for data management and treatment (Earthworm and WebObs [Beauducel et al., 2004]) are also continuously improved. GPS data, real-time and validated seismic data (only broadband) are now available at the IPGP data center.

  6. Collision Welding of Dissimilar Materials by Vaporizing Foil Actuator: A Breakthrough Technology for Dissimilar Metal Joining

    Energy Technology Data Exchange (ETDEWEB)

    Daehn, Glenn S. [The Ohio State Univ., Columbus, OH (United States). Dept. of Materials Science and Engineering; Vivek, Anupam [The Ohio State Univ., Columbus, OH (United States). Dept. of Materials Science and Engineering; Liu, Bert C. [The Ohio State Univ., Columbus, OH (United States). Dept. of Materials Science and Engineering

    2016-09-30

    This work demonstrated and further developed Vaporizing Foil Actuator Welding (VFAW) as a viable technique for dissimilar-metal joining for automotive lightweighting applications. VFAW is a novel impact welding technology, which uses the pressure developed from electrically-assisted rapid vaporization of a thin aluminum foil (the consumable) to launch and ultimately collide two of more pieces of metal to create a solid-state bond between them. 18 dissimilar combinations of automotive alloys from the steel, aluminum and magnesium alloy classes were screened for weldability and characterized by metallography of weld cross sections, corrosion testing, and mechanical testing. Most combinations, especially a good number of Al/Fe pairs, were welded successfully. VFAW was even able to weld combinations of very high strength materials such as 5000 and 6000 series aluminum alloys to boron and dual phase steels, which is difficult to impossible by other joining techniques such as resistance spot welding, friction stir welding, or riveting. When mechanically tested, the samples routinely failed in a base metal rather than along the weld interface, showing that the weld was stronger than either of the base metals. As for corrosion performance, a polymer-based protective coating was used to successfully combat galvanic corrosion of 5 Al/Fe pairs through a month-long exposure to warm salt fog. In addition to the technical capabilities, VFAW also consumes little energy compared to conventional welding techniques and requires relatively light, flexible tooling. Given the technical and economic advantages, VFAW can be a very competitive joining technology for automotive lightweighting. The success of this project and related activities has resulted in substantial interest not only within the research community but also various levels of automotive supply chain, which are collaborating to bring this technology to commercial use.

  7. Virologic breakthrough in a patient with chronic hepatitis B by combination treatment with tenofovir disoproxil fumarate and entecavir

    Directory of Open Access Journals (Sweden)

    Suzuki F

    2014-06-01

    Full Text Available Fumitaka Suzuki,1,2 Hitomi Sezaki,1 Norio Akuta,1 Yoshiyuki Suzuki,1 Yusuke Kawamura,1 Tetsuya Hosaka,1 Masahiro Kobayashi,1 Satoshi Saitoh,1 Yasuji Arase,1 Kenji Ikeda,1 Mariko Kobayashi,3 Sachiyo Watahiki,3 Rie Mineta,3 Yukiko Suzuki,3 Hiromitsu Kumada1 1Department of Hepatology, Toranomon Hospital, Tokyo, Japan; 2Okinaka Memorial Institute for Medical Research, Tokyo, Japan; 3Research Institute for Hepatology, Toranomon Branch Hospital, Kawasaki, Japan Abstract: Tenofovir disoproxil fumarate (TDF is widely used to treat hepatitis B virus (HBV patients in the USA and Europe. No confirmed report of resistance selection during treatment with TDF in treatment-naïve and nucleoside/nucleotide analog-treated chronic hepatitis B patients has yet been reported. Here, we report for the first time a patient with chronic hepatitis B and cirrhosis who emerged with virologic breakthrough during combination therapy with TDF and entecavir (ETV, against ETV-resistant virus. A 51-year-old Japanese woman with hepatitis B e-antigen (HBeAg, whose genotype was C, received ETV monotherapy continuously followed by TDF and ETV combination therapy, because her HBV DNA levels had been >3.5 log copies/mL. At the start of combination therapy, amino acid substitutions of the reverse transcriptase (rt gene, rtL180M, rtT184I/M, and rtM204V, were detected. After this, serum HBV DNA decreased to less than 2.1 log copies/mL and remained at this level until 31 months of combination therapy, when it again began to increase. Amino acid substitutions of rtL180M, rtS202G, and rtM204V emerged and were associated with an increase in serum HBV DNA at virologic breakthrough. Long-term therapy with TDF against the ETV-resistant virus has the potential to induce virologic breakthrough and resistance, and careful follow-up should be carried out. Keywords: hepatitis B virus, resistant

  8. Collaboration at FNAL, USA

    Indian Academy of Sciences (India)

    Home; Journals; Pramana – Journal of Physics. DØ Collaboration at FNAL, USA. Articles written in Pramana – Journal of Physics. Volume 62 Issue 3 March 2004 pp 561-563 Experimental Particle Physics. Search for narrow-width t t ¯ resonances in p p ¯ collisons at ( s ) = 1.8 TeV · Supriya Jain DØ Collaboration at FNAL, ...

  9. Collaborative interactive visualization: exploratory concept

    Science.gov (United States)

    Mokhtari, Marielle; Lavigne, Valérie; Drolet, Frédéric

    2015-05-01

    Dealing with an ever increasing amount of data is a challenge that military intelligence analysts or team of analysts face day to day. Increased individual and collective comprehension goes through collaboration between people. Better is the collaboration, better will be the comprehension. Nowadays, various technologies support and enhance collaboration by allowing people to connect and collaborate in settings as varied as across mobile devices, over networked computers, display walls, tabletop surfaces, to name just a few. A powerful collaboration system includes traditional and multimodal visualization features to achieve effective human communication. Interactive visualization strengthens collaboration because this approach is conducive to incrementally building a mental assessment of the data meaning. The purpose of this paper is to present an overview of the envisioned collaboration architecture and the interactive visualization concepts underlying the Sensemaking Support System prototype developed to support analysts in the context of the Joint Intelligence Collection and Analysis Capability project at DRDC Valcartier. It presents the current version of the architecture, discusses future capabilities to help analyst(s) in the accomplishment of their tasks and finally recommends collaboration and visualization technologies allowing to go a step further both as individual and as a team.

  10. A Model of Transformative Collaboration

    Science.gov (United States)

    Swartz, Ann L.; Triscari, Jacqlyn S.

    2011-01-01

    Two collaborative writing partners sought to deepen their understanding of transformative learning by conducting several spirals of grounded theory research on their own collaborative relationship. Drawing from adult education, business, and social science literature and including descriptive analysis of their records of activity and interaction…

  11. Accounting Experiences in Collaborative Learning

    Science.gov (United States)

    Edmond, Tracie; Tiggeman, Theresa

    2009-01-01

    This paper discusses incorporating collaborative learning into accounting classes as a response to the Accounting Education Change Commission's call to install a more active student learner in the classroom. Collaborative learning requires the students to interact with each other and with the material within the classroom setting. It is a…

  12. Facilitating Collaboration through Design Games

    DEFF Research Database (Denmark)

    Brandt, Eva; Messeter, Jørn

    2004-01-01

    In recent years both companies and research communities call for collaborative work practices and user-centered approaches in various design fields. There are several challenges and issues to take into consideration. For instance there is a need to find ways of collaborating across various compet...

  13. Collaborative on-line teaching

    DEFF Research Database (Denmark)

    Levinsen, Karin

    2007-01-01

      It is often stressed that the pedagogic models and approaches of Collaborative Online Learning support learners' shared knowledge building within collaborating groups of learners, the individual construction of knowledge as well as the formation of an ongoing learning Community of Practice. Wit...

  14. Job Migration: A Collaborative Effort

    Science.gov (United States)

    Wagoner, Cynthia L.

    2012-01-01

    Music teachers often change jobs several times during their careers. Reasons for job changes vary, but regardless, these changes bring a different set of challenges. Sharing knowledge and learning are part and parcel of collaboration. So what if, as education professionals, music teachers decided to collaborate during job migrations? For all music…

  15. International Collaboration: Challenges for Researchers.

    Science.gov (United States)

    Martin, David S.; Craft, Anna R.; Tillema, Harm

    2002-01-01

    Reseachers collaborating with international colleagues should consider cultural, structural, and interpersonal/interprofessional factors that impinge on the process. Before embarking on collaboration, researchers should understand each other's interests, seek funding for face-to-face meetings, and learn about each other's culture. (SK)

  16. Worldwide esophageal cancer collaboration.

    Science.gov (United States)

    Rice, T W; Rusch, V W; Apperson-Hansen, C; Allen, M S; Chen, L-Q; Hunter, J G; Kesler, K A; Law, S; Lerut, T E M R; Reed, C E; Salo, J A; Scott, W J; Swisher, S G; Watson, T J; Blackstone, E H

    2009-01-01

    The aim of this study is to report assemblage of a large multi-institutional international database of esophageal cancer patients, patient and tumor characteristics, and survival of patients undergoing esophagectomy alone and its correlates. Forty-eight institutions were approached and agreed to participate in a worldwide esophageal cancer collaboration (WECC), and 13 (Asia, 2; Europe, 2; North America, 9) submitted data as of July 1, 2007. These were used to construct a de-identified database of 7884 esophageal cancer patients who underwent esophagectomy. Four thousand six hundred and twenty-seven esophagectomy patients had no induction or adjuvant therapy. Mean age was 62 +/- 11 years, 77% were men, and 33% were Asian. Mean tumor length was 3.3 +/- 2.5 cm, and esophageal location was upper in 4.1%, middle in 27%, and lower in 69%. Histopathologic cell type was adenocarcinoma in 60% and squamous cell in 40%. Histologic grade was G1 in 32%, G2 in 33%, G3 in 35%, and G4 in 0.18%. pT classification was pTis in 7.3%, pT1 in 23%, pT2 in 16%, pT3 in 51%, and pT4 in 3.3%. pN classification was pN0 in 56% and pN1 in 44%. The number of lymph nodes positive for cancer was 1 in 12%, 2 in 8%, 3 in 5%, and >3 in 18%. Resection was R0 in 87%, R1 in 11%, and R2 in 3%. Overall survival was 78, 42, and 31% at 1, 5, and 10 years, respectively. Unlike single-institution studies, in this worldwide collaboration, survival progressively decreases and is distinctively stratified by all variables except region of the world. A worldwide esophageal cancer database has been assembled that overcomes problems of rarity of this cancer. It reveals that survival progressively (monotonically) decreased and was distinctively stratified by all variables except region of the world. Thus, it forms the basis for data-driven esophageal cancer staging. More centers are needed and encouraged to join WECC.

  17. Does Telecare Improve Interorganisational Collaboration?

    DEFF Research Database (Denmark)

    Christensen, Jannie Kristine Bang

    2016-01-01

    Introduction: Previous studies have suggested that telecare can improve interorganisational collaboration within fragmented health care systems, yet this outcome has not been examined in a large-scale setting. This study explores the effects of a large-scale interorganisational telecare programme...... in Denmark based on home-monitoring on collaboration in a telecare network between municipalities, hospitals, and general practitioners. Methodology: Semi-structured interviews and observations of collaborating health professionals from the municipalities, hospitals, and general practitioners were undertaken...... and then repeated a year later. Collaboration was analysed both at the interorganisational network level and within each part of the network, including its interrelations. Results: Collaboration between municipalities and general practitioners was initially intensified as a result of implementing telecare, though...

  18. Understanding nomadic collaborative learning groups

    DEFF Research Database (Denmark)

    Ryberg, Thomas; Davidsen, Jacob; Hodgson, Vivien

    2018-01-01

    -term collaborations within the frame of Problem and Project Based Learning. By analysing the patterns of nomadic collaborative learning we identify and discuss how the two groups of students incorporate mobile and digital technologies as well as physical and/or non-digital technologies into their group work......The paper builds on the work of Rossitto et al. on collaborative nomadic work to develop three categories of practice of nomadic collaborative learning groups. Our study is based on interviews, workshops and observations of two undergraduate student's group practices engaged in self-organised, long....... Specifically, we identify the following categories of nomadic collaborative learning practices: “orchestration of work phases, spaces and activities,” “the orchestration of multiple technologies” and “orchestration of togetherness.” We found that for both groups of students there was a fluidity, situatedness...

  19. Male depression and suicide.

    Science.gov (United States)

    Wålinder, J; Rutzt, W

    2001-03-01

    Based on the experiences of the Gotland Study that education of general practitioners about depressive illness resulted in a statistically significant reduction in the number of female suicides, leaving the rate of male suicides almost unaffected, we propose the concept of a male depressive syndrome. This syndrome comprises a low stress tolerance, an acting-out behavior, a low impulse control, substance abuse and a hereditary loading of depressive illness, alcoholism and suicide. This notion is supported by data from The Amish study as well as the concept of van Praag of a stress-precipitated, cortisol-induced, serotonin-related and anxiety-driven depressive illness most often seen in males. In order to identify depressed males, the Gotland Male Depression Scale has been developed. Some preliminary data using the scale in a group of alcohol-dependant patients are presented.

  20. Experiences of depression

    DEFF Research Database (Denmark)

    Rønberg, Mette

    In this thesis, I examine the complex experiences of what we call depression in everyday life, the multifaceted and ambiguous experiences of getting a depression diagnosis, and the in-depth processes involved in learning to live under the description of depression. The thesis is based...... on ethnographic fieldwork among adults diagnosed with depression in Denmark, and consists of three articles that provide glimpses into experiences of depression and diagnostic processes. The articles deal with creativity, variability and resistance in diagnostic processes and illustrates how these not are once......-and-for-all-dealt-with matters but rather messy and complicated processes, that involve several actors and multiple relations to the diagnosis. The thesis furthermore challenges the dominant diagnostic understanding depression as a neurobiological, and individual disorder in present-day diagnostic cultures, by arguing...