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Sample records for early goal-directed therapy

  1. EARLY GOAL DIRECTED THERAPY AT SEPTIC SYOK

    Directory of Open Access Journals (Sweden)

    Ayu Widyanti

    2013-04-01

    Full Text Available Sepsis is the most commom cause of death in children with critically ill. Using WHO criteria (severe sepsis defined as sepsis with acidosis, hypotension or both, it was determined that in 1995 there were more than 42.000 cases of severe sepsis in children in the United States with mortality rate was 10.3%. To answer that finding, evicende based protocol was made, it called early goal directed therapy (EGDT. EGDT is a comprehensive strategy to evaluate patient with septic shock include, challenge of fluid, antibiotic, vasopressor, measurement of central vein oxygen saturation, PRC transfusion, administering inotropic dan mechanic ventilation. All of these must be done in the first 6 hours since sepsis or septic shock was found, because if there is a delay of resuscitation, anything we do to increase oxygenation level of the cell will be useless.

  2. Early management of sepsis with emphasis on early goal directed therapy: AME evidence series 002

    OpenAIRE

    Zhang, Zhongheng; Hong, Yucai; Smischney, Nathan J.; Kuo, Han-Pin; Tsirigotis, Panagiotis; Rello, Jordi; Kuan, Win Sen; Jung, Christian; Robba, Chiara; Taccone, Fabio Silvio; Leone, Marc; Spapen, Herbert; Grimaldi, David; Van Poucke, Sven; Simpson, Steven Q.

    2017-01-01

    Severe sepsis and septic shock are major causes of morbidity and mortality in patients entering the emergency department (ED) or intensive care unit (ICU). Despite substantial efforts to improve patient outcome, treatment of sepsis remains challenging to clinicians. In this context, early goal directed therapy (EGDT) represents an important concept emphasizing both early recognition of sepsis and prompt initiation of a structured treatment algorithm. As part of the AME evidence series on seps...

  3. Monitoring of peri-operative fluid administration by individualized goal-directed therapy

    DEFF Research Database (Denmark)

    Bundgaard-Nielsen, M; Holte, Kathrine; Secher, N H

    2007-01-01

    (n = 725) found a reduced hospital stay. Post-operative nausea and vomiting (PONV) and ileus were reduced in three studies and complications were reduced in four studies. Of the monitors that may be applied for goal-directed therapy, only oesophageal Doppler has been tested adequately; however......, several other options exist. CONCLUSION: Goal-directed therapy with the maximization of flow-related haemodynamic variables reduces hospital stay, PONV and complications, and facilitates faster gastrointestinal functional recovery. So far, oesophageal Doppler is recommended, but other monitors...

  4. Early, Goal-Directed Therapy for Septic Shock - A Patient-Level Meta-Analysis.

    Science.gov (United States)

    Rowan, Kathryn M; Angus, Derek C; Bailey, Michael; Barnato, Amber E; Bellomo, Rinaldo; Canter, Ruth R; Coats, Timothy J; Delaney, Anthony; Gimbel, Elizabeth; Grieve, Richard D; Harrison, David A; Higgins, Alisa M; Howe, Belinda; Huang, David T; Kellum, John A; Mouncey, Paul R; Music, Edvin; Peake, Sandra L; Pike, Francis; Reade, Michael C; Sadique, M Zia; Singer, Mervyn; Yealy, Donald M

    2017-06-08

    After a single-center trial and observational studies suggesting that early, goal-directed therapy (EGDT) reduced mortality from septic shock, three multicenter trials (ProCESS, ARISE, and ProMISe) showed no benefit. This meta-analysis of individual patient data from the three recent trials was designed prospectively to improve statistical power and explore heterogeneity of treatment effect of EGDT. We harmonized entry criteria, intervention protocols, outcomes, resource-use measures, and data collection across the trials and specified all analyses before unblinding. After completion of the trials, we pooled data, excluding the protocol-based standard-therapy group from the ProCESS trial, and resolved residual differences. The primary outcome was 90-day mortality. Secondary outcomes included 1-year survival, organ support, and hospitalization costs. We tested for treatment-by-subgroup interactions for 16 patient characteristics and 6 care-delivery characteristics. We studied 3723 patients at 138 hospitals in seven countries. Mortality at 90 days was similar for EGDT (462 of 1852 patients [24.9%]) and usual care (475 of 1871 patients [25.4%]); the adjusted odds ratio was 0.97 (95% confidence interval, 0.82 to 1.14; P=0.68). EGDT was associated with greater mean (±SD) use of intensive care (5.3±7.1 vs. 4.9±7.0 days, P=0.04) and cardiovascular support (1.9±3.7 vs. 1.6±2.9 days, P=0.01) than was usual care; other outcomes did not differ significantly, although average costs were higher with EGDT. Subgroup analyses showed no benefit from EGDT for patients with worse shock (higher serum lactate level, combined hypotension and hyperlactatemia, or higher predicted risk of death) or for hospitals with a lower propensity to use vasopressors or fluids during usual resuscitation. In this meta-analysis of individual patient data, EGDT did not result in better outcomes than usual care and was associated with higher hospitalization costs across a broad range of patient and

  5. Monitoring of peri-operative fluid administration by individualized goal-directed therapy

    DEFF Research Database (Denmark)

    Bundgaard-Nielsen, M; Holte, Kathrine; Secher, N H

    2007-01-01

    BACKGROUND: In order to avoid peri-operative hypovolaemia or fluid overload, goal-directed therapy with individual maximization of flow-related haemodynamic parameters has been introduced. The objectives of this review are to update research in the area, evaluate the effects on outcome and assess...

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

    Science.gov (United States)

    Guralnick, Michael J.; Bruder, Mary Beth

    2016-01-01

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

  7. Impairments in goal-directed actions predict treatment response to cognitive-behavioral therapy in social anxiety disorder.

    Directory of Open Access Journals (Sweden)

    Gail A Alvares

    Full Text Available Social anxiety disorder is characterized by excessive fear and habitual avoidance of social situations. Decision-making models suggest that patients with anxiety disorders may fail to exhibit goal-directed control over actions. We therefore investigated whether such biases may also be associated with social anxiety and to examine the relationship between such behavior with outcomes from cognitive-behavioral therapy. Patients diagnosed with social anxiety and controls completed an instrumental learning task in which two actions were performed to earn food outcomes. After outcome devaluation, where one outcome was consumed to satiety, participants were re-tested in extinction. Results indicated that, as expected, controls were goal-directed, selectively reducing responding on the action that previously delivered the devalued outcome. Patients with social anxiety, however, exhibited no difference in responding on either action. This loss of a devaluation effect was associated with greater symptom severity and poorer response to therapy. These findings indicate that variations in goal-directed control in social anxiety may represent both a behavioral endophenotype and may be used to predict individuals who will respond to learning-based therapies.

  8. Goal-directed fluid therapy: stroke volume optimisation and cardiac dimensions in supine healthy humans

    DEFF Research Database (Denmark)

    Jans, O.; Tollund, C.; Bundgaard-Nielsen, M.

    2008-01-01

    BACKGROUND: Based on maximisation of cardiac stroke volume (SV), peri-operative individualised goal-directed fluid therapy improves patient outcome. It remains, however, unknown how fluid therapy by this strategy relates to filling of the heart during supine rest as reference for the anaesthetised...... by thoracic electrical admittance, central venous oxygenation and pressure, and arterial plasma atrial natriuretic peptide. Also, muscle and brain oxygenation were assessed by near infrared spectroscopy (n=7). RESULTS: The HUT reduced the mentioned indices of CBV, the end-diastolic dimensions of the heart...... therapy is that when a maximal SV is established for patients, cardiac pre-load is comparable to that of supine healthy subjects Udgivelsesdato: 2008/4...

  9. Early goal-directed nutrition in icU patients (EAT-ICU)

    DEFF Research Database (Denmark)

    Allingstrup, Matilde Jo; Kondrup, Jens; Wiis, Jørgen

    2016-01-01

    -energy nutrition based on measured requirements on short-term clinical outcomes and long-term physical quality of life in ICU patients. METHODS: The EAT-ICU trial is a single-centre, randomised, parallel-group trial with concealed allocation and blinded outcome assessment. A total of 200 consecutive, acutely...... admitted, mechanically ventilated intensive care patients will be randomised 1:1 to early goal-directed nutrition versus standard of care to show a potential 15% relative risk reduction in the primary outcome measure (physical function) at six months (two-sided significance level α = 0.05; power β = 80......%). Secondary outcomes include energy- and protein balances, metabolic control, new organ failure, use of life support, nosocomial infections, ICU- and hospital length of stay, mortality and cost analyses. CONCLUSION: The optimal nutrition strategy for ICU patients remains unsettled. The EAT-ICU trial...

  10. Predictors of Unattempted Central Venous Catheterization in Septic Patients Eligible for Early Goal-directed Therapy

    Directory of Open Access Journals (Sweden)

    David R. Vinson

    2014-02-01

    Full Text Available Introduction: Central venous catheterization (CVC can be an important component of the management of patients with severe sepsis and septic shock. CVC, however, is a time- and resource-intensive procedure associated with serious complications. The effects of the absence of shock or the presence of relative contraindications on undertaking central line placement in septic emergency department (ED patients eligible for early goal-directed therapy (EGDT have not been well described. We sought to determine the association of relative normotension (sustained systolic blood pressure >90 mmHg independent of or in response to an initial crystalloid resuscitation of 20 mL/kg, obesity (body mass index [BMI] ≥30, moderate thrombocytopenia (platelet count <50,000 per μL, and coagulopathy (international normalized ratio ≥2.0 with unattempted CVC in EGDT-eligible patients. Methods: This was a retrospective cohort study of 421 adults who met EGDT criteria in 5 community EDs over a period of 13 months. We compared patients with attempted thoracic (internal jugular or subclavian CVC with those who did not undergo an attempted thoracic line. We also compared patients with any attempted CVC (either thoracic or femoral with those who did not undergo any attempted central line. We used multivariate logistic regression analysis to calculate adjusted odd ratios (AORs. Results: In our study, 364 (86.5% patients underwent attempted thoracic CVC and 57 (13.5% did not. Relative normotension was significantly associated with unattempted thoracic CVC (AOR 2.6 95% confidence interval [CI], 1.6-4.3, as were moderate thrombocytopenia (AOR 3.9; 95% CI, 1.5-10.1 and coagulopathy (AOR 2.7; 95% CI, 1.3-5.6. When assessing for attempted catheterization of any central venous site (thoracic or femoral, 382 (90.7% patients underwent attempted catheterization and 39 (9.3% patients did not. Relative normotension (AOR 2.3; 95% CI, 1.2-4.5 and moderate thrombocytopenia (AOR 3.9; 95

  11. Neutrophil gelatinase-associated lipocalin and albuminuria as predictors of acute kidney injury in patients treated with goal-directed haemodynamic therapy after major abdominal surgery.

    LENUS (Irish Health Repository)

    Cullen, Mr

    2013-10-11

    Neutrophil gelatinase-associated lipocalin (NGAL) is emerging as a new biomarker for the early identification of acute kidney injury (AKI). There is also increasing evidence of an association between urinary albumin\\/creatinine ratio (ACR) and AKI. The primary aim of this study was to evaluate the clinical utility of these biomarkers to predict AKI in a population of perioperative patients treated with goal-directed haemodynamic therapy (GDHT). Secondary aims were to examine NGAL and ACR as sensitive biomarkers to detect the effects of GDHT and to investigate the association of these biomarkers with secondary outcomes.

  12. A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators.

    Science.gov (United States)

    Angus, D C; Barnato, A E; Bell, D; Bellomo, R; Chong, C-R; Coats, T J; Davies, A; Delaney, A; Harrison, D A; Holdgate, A; Howe, B; Huang, D T; Iwashyna, T; Kellum, J A; Peake, S L; Pike, F; Reade, M C; Rowan, K M; Singer, M; Webb, S A R; Weissfeld, L A; Yealy, D M; Young, J D

    2015-09-01

    To determine whether early goal-directed therapy (EGDT) reduces mortality compared with other resuscitation strategies for patients presenting to the emergency department (ED) with septic shock. Using a search strategy of PubMed, EmBase and CENTRAL, we selected all relevant randomised clinical trials published from January 2000 to January 2015. We translated non-English papers and contacted authors as necessary. Our primary analysis generated a pooled odds ratio (OR) from a fixed-effect model. Sensitivity analyses explored the effect of including non-ED studies, adjusting for study quality, and conducting a random-effects model. Secondary outcomes included organ support and hospital and ICU length of stay. From 2395 initially eligible abstracts, five randomised clinical trials (n = 4735 patients) met all criteria and generally scored high for quality except for lack of blinding. There was no effect on the primary mortality outcome (EGDT: 23.2% [495/2134] versus control: 22.4% [582/2601]; pooled OR 1.01 [95% CI 0.88-1.16], P = 0.9, with heterogeneity [I(2) = 57%; P = 0.055]). The pooled estimate of 90-day mortality from the three recent multicentre studies (n = 4063) also showed no difference [pooled OR 0.99 (95% CI 0.86-1.15), P = 0.93] with no heterogeneity (I(2) = 0.0%; P = 0.97). EGDT increased vasopressor use (OR 1.25 [95% CI 1.10-1.41]; P < 0.001) and ICU admission [OR 2.19 (95% CI 1.82-2.65); P < 0.001]. Including six non-ED randomised trials increased heterogeneity (I(2) = 71%; P < 0.001) but did not change overall results [pooled OR 0.94 (95% CI 0.82 to 1.07); P = 0.33]. EGDT is not superior to usual care for ED patients with septic shock but is associated with increased utilisation of ICU resources.

  13. Combination of brain-computer interface training and goal-directed physical therapy in chronic stroke: a case report.

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    Broetz, Doris; Braun, Christoph; Weber, Cornelia; Soekadar, Surjo R; Caria, Andrea; Birbaumer, Niels

    2010-09-01

    There is no accepted and efficient rehabilitation strategy to reduce focal impairments for patients with chronic stroke who lack residual movements. A 67-year-old hemiplegic patient with no active finger extension was trained with a brain-computer interface (BCI) combined with a specific daily life-oriented physiotherapy. The BCI used electrical brain activity (EEG) and magnetic brain activity (MEG) to drive an orthosis and a robot affixed to the patient's affected upper extremity, which enabled him to move the paralyzed arm and hand driven by voluntary modulation of micro-rhythm activity. In addition, the patient practiced goal-directed physiotherapy training. Over 1 year, he completed 3 training blocks. Arm motor function, gait capacities (using Fugl-Meyer Assessment, Wolf Motor Function Test, Modified Ashworth Scale, 10-m walk speed, and goal attainment score), and brain reorganization (functional MRI, MEG) were repeatedly assessed. The ability of hand and arm movements as well as speed and safety of gait improved significantly (mean 46.6%). Improvement of motor function was associated with increased micro-oscillations in the ipsilesional motor cortex. This proof-of-principle study suggests that the combination of BCI training with goal-directed, active physical therapy may improve the motor abilities of chronic stroke patients despite apparent initial paralysis.

  14. Early goal-directed nutrition versus standard of care in adult intensive care patients

    DEFF Research Database (Denmark)

    Allingstrup, Matilde Jo; Kondrup, Jens; Wiis, Jørgen

    2017-01-01

    Purpose: We assessed the effects of early goal-directed nutrition (EGDN) vs. standard nutritional care in adult intensive care unit (ICU) patients. Methods: We randomised acutely admitted, mechanically ventilated ICU patients expected to stay longer than 3 days in the ICU. In the EGDN group we...... estimated nutritional requirements by indirect calorimetry and 24-h urinary urea aiming at covering 100% of requirements from the first full trial day using enteral and parenteral nutrition. In the standard of care group we aimed at providing 25 kcal/kg/day by enteral nutrition. If this was not met by day 7......, patients were supplemented with parenteral nutrition. The primary outcome was physical component summary (PCS) score of SF-36 at 6 months. We performed multiple imputation for data of the non-responders. Results: We randomised 203 patients and included 199 in the intention-to-treat analyses; baseline...

  15. Object-based processes in the planning of goal-directed hand movements

    NARCIS (Netherlands)

    Bekkering, H.; Pratt, J.

    2004-01-01

    Theories in motor control suggest that the parameters specified during the planning of goal-directed hand movements to a visual target are defined in spatial parameters like direction and amplitude. Recent findings in the visual attention literature, however, argue widely for early object-based

  16. Early haemorrhage control and management of trauma-induced coagulopathy

    DEFF Research Database (Denmark)

    Stensballe, Jakob; Henriksen, Hanne H; Johansson, Pär I

    2017-01-01

    of trauma resuscitation using a ratio-driven strategy aiming at 1:1:1 of red blood cells, plasma and platelets while applying goal-directed therapy early and repeatedly to control trauma-induced coagulopathy. SUMMARY: Trauma resuscitation should focus on early goal-directed therapy with use of viscoelastic...... haemostatic assays while initially applying a ratio 1:1:1 driven transfusion therapy (with red blood cells, plasma and platelets) in order to sustain normal haemostasis and control further bleeding....

  17. Early development of de novo hepatocellular carcinoma after direct-acting agent therapy: Comparison with pegylated interferon-based therapy in chronic hepatitis C patients.

    Science.gov (United States)

    Yoo, S H; Kwon, J H; Nam, S W; Kim, H Y; Kim, C W; You, C R; Choi, S W; Cho, S H; Han, J-Y; Song, D S; Chang, U I; Yang, J M; Lee, H L; Lee, S W; Han, N I; Kim, S-H; Song, M J; Hwang, S; Sung, P S; Jang, J W; Bae, S H; Choi, J Y; Yoon, S K

    2018-04-16

    Patients with chronic hepatitis C who achieve a sustained viral response after pegylated interferon therapy have a reduced risk of hepatocellular carcinoma, but the risk after treatment with direct-acting antivirals is unclear. We compared the rates of early development of hepatocellular carcinoma after direct-acting antivirals and after pegylated interferon therapy. We retrospectively analysed 785 patients with chronic hepatitis C who had no history of hepatocellular carcinoma (211 treated with pegylated interferon, 574 with direct-acting antivirals) and were followed up for at least 24 weeks after antiviral treatment. De novo hepatocellular carcinoma developed in 6 of 574 patients receiving direct-acting antivirals and in 1 of 211 patients receiving pegylated interferon. The cumulative incidence of early hepatocellular carcinoma development did not differ between the treatment groups either for the whole cohort (1.05% vs 0.47%, P = .298) or for those patients with Child-Pugh Class A cirrhosis (3.73% vs 2.94%, P = .827). Multivariate analysis indicated that alpha-fetoprotein level >9.5 ng/mL at the time of end-of-treatment response was the only independent risk factor for early development of hepatocellular carcinoma in all patients (P hepatocellular carcinoma did not differ between patients treated with pegylated interferon and those treated with direct-acting antivirals and was associated with the serum alpha-fetoprotein level at the time of end-of-treatment response. © 2018 John Wiley & Sons Ltd.

  18. [Theraplay--a direct communication play therapy].

    Science.gov (United States)

    Franke, U

    1990-01-01

    This paper introduces the basic concepts and the application of the directive short-term play therapy called Theraplay. Goals and methods are illustrated by examples from the assessment (Marschak Interaction Method) and by sessions with a 6 year old regressive noncompliant mutistic twin.

  19. Goal-Directed and Goal-Less Imitation in Autism Spectrum Disorder

    Science.gov (United States)

    Wild, Kelly S.; Poliakoff, Ellen; Jerrison, Andrew; Gowen, Emma

    2012-01-01

    To investigate how people with Autism are affected by the presence of goals during imitation, we conducted a study to measure movement kinematics and eye movements during the imitation of goal-directed and goal-less hand movements. Our results showed that a control group imitated changes in movement kinematics and increased the level that they…

  20. Infants Show Stability of Goal-Directed Imitation

    Science.gov (United States)

    Sakkalou, Elena; Ellis-Davies, Kate; Fowler, Nia C.; Hilbrink, Elma E.; Gattis, Merideth

    2013-01-01

    Previous studies have reported that infants selectively reproduce observed actions and have argued that this selectivity reflects understanding of intentions and goals, or goal-directed imitation. We reasoned that if selective imitation of goal-directed actions reflects understanding of intentions, infants should demonstrate stability across…

  1. Interpersonal processes affecting early alliance formation in experiential therapy for depression.

    Science.gov (United States)

    Wong, Karen; Pos, Alberta E

    2014-01-01

    This study examined the effects of in-session interpersonal process and pre-therapy interpersonal problems on session-one alliance formation for 32 clients who received short-term experiential therapy for depression. Interpersonal behavior measured by the Structural Analysis of Social Behavior, as well as clients' pre-therapy reports of interpersonal problems significantly related to session-one alliance scores. Greater client disclosure independently predicted a stronger session-one bond with the therapist. Both greater client disclosure (positively) and pre-therapy Social Inhibition (negatively) independently predicted early goal agreement. Findings suggest that client disclosure is a marker of early engagement in experiential therapy, as well as support this model's mandate to form interpersonally safe therapeutic environments from the first moments of therapy.

  2. Treatment goals and treatment in exercise therapy.

    NARCIS (Netherlands)

    Zuijderduin, W.M.; Dekker, J.

    1994-01-01

    In the present study a quantitative description is given of treatment in exercise therapy according to Cesar and according to Mensendieck. Information was gathered from saurvey on exercise therapy in the Netherlands. Characteristics of treatment are described including treatment goals, emphasis of

  3. Goal-directed fluid optimization based on stroke volume variation and cardiac index during one-lung ventilation in patients undergoing thoracoscopy lobectomy operations: a pilot study

    Directory of Open Access Journals (Sweden)

    Jian Zhang

    2013-07-01

    Full Text Available OBJECTIVES: This pilot study was designed to utilize stroke volume variation and cardiac index to ensure fluid optimization during one-lung ventilation in patients undergoing thoracoscopic lobectomies. METHODS: Eighty patients undergoing thoracoscopic lobectomy were randomized into either a goal-directed therapy group or a control group. In the goal-directed therapy group, the stroke volume variation was controlled at 10%±1%, and the cardiac index was controlled at a minimum of 2.5 L.min-1.m-2. In the control group, the MAP was maintained at between 65 mm Hg and 90 mm Hg, heart rate was maintained at between 60 BPM and 100 BPM, and urinary output was greater than 0.5 mL/kg-1/h-1. The hemodynamic variables, arterial blood gas analyses, total administered fluid volume and side effects were recorded. RESULTS: The PaO2/FiO2-ratio before the end of one-lung ventilation in the goal-directed therapy group was significantly higher than that of the control group, but there were no differences between the goal-directed therapy group and the control group for the PaO2/FiO2-ratio or other arterial blood gas analysis indices prior to anesthesia. The extubation time was significantly earlier in the goal-directed therapy group, but there was no difference in the length of hospital stay. Patients in the control group had greater urine volumes, and they were given greater colloid and overall fluid volumes. Nausea and vomiting were significantly reduced in the goal-directed therapy group. CONCLUSION: The results of this study demonstrated that an optimization protocol, based on stroke volume variation and cardiac index obtained with a FloTrac/Vigileo device, increased the PaO2/FiO2-ratio and reduced the overall fluid volume, intubation time and postoperative complications (nausea and vomiting in thoracic surgery patients requiring one-lung ventilation.

  4. Impaired cognitive plasticity and goal-directed control in adolescent obsessive-compulsive disorder.

    Science.gov (United States)

    Gottwald, Julia; de Wit, Sanne; Apergis-Schoute, Annemieke M; Morein-Zamir, Sharon; Kaser, Muzaffer; Cormack, Francesca; Sule, Akeem; Limmer, Winifred; Morris, Anna Conway; Robbins, Trevor W; Sahakian, Barbara J

    2018-01-22

    Youths with obsessive-compulsive disorder (OCD) experience severe distress and impaired functioning at school and at home. Critical cognitive domains for daily functioning and academic success are learning, memory, cognitive flexibility and goal-directed behavioural control. Performance in these important domains among teenagers with OCD was therefore investigated in this study. A total of 36 youths with OCD and 36 healthy comparison subjects completed two memory tasks: Pattern Recognition Memory (PRM) and Paired Associates Learning (PAL); as well as the Intra-Extra Dimensional Set Shift (IED) task to quantitatively gauge learning as well as cognitive flexibility. A subset of 30 participants of each group also completed a Differential-Outcome Effect (DOE) task followed by a Slips-of-Action Task, designed to assess the balance of goal-directed and habitual behavioural control. Adolescent OCD patients showed a significant learning and memory impairment. Compared with healthy comparison subjects, they made more errors on PRM and PAL and in the first stages of IED involving discrimination and reversal learning. Patients were also slower to learn about contingencies in the DOE task and were less sensitive to outcome devaluation, suggesting an impairment in goal-directed control. This study advances the characterization of juvenile OCD. Patients demonstrated impairments in all learning and memory tasks. We also provide the first experimental evidence of impaired goal-directed control and lack of cognitive plasticity early in the development of OCD. The extent to which the impairments in these cognitive domains impact academic performance and symptom development warrants further investigation.

  5. Habitual versus goal-directed action control in Parkinson disease.

    Science.gov (United States)

    de Wit, Sanne; Barker, Roger A; Dickinson, Anthony D; Cools, Roshan

    2011-05-01

    This study presents the first direct investigation of the hypothesis that dopamine depletion of the dorsal striatum in mild Parkinson disease leads to impaired stimulus-response habit formation, thereby rendering behavior slow and effortful. However, using an instrumental conflict task, we show that patients are able to rely on direct stimulus-response associations when a goal-directed strategy causes response conflict, suggesting that habit formation is not impaired. If anything our results suggest a disease severity-dependent deficit in goal-directed behavior. These results are discussed in the context of Parkinson disease and the neurobiology of habitual and goal-directed behavior.

  6. Goal-Directed Decision Making with Spiking Neurons.

    Science.gov (United States)

    Friedrich, Johannes; Lengyel, Máté

    2016-02-03

    Behavioral and neuroscientific data on reward-based decision making point to a fundamental distinction between habitual and goal-directed action selection. The formation of habits, which requires simple updating of cached values, has been studied in great detail, and the reward prediction error theory of dopamine function has enjoyed prominent success in accounting for its neural bases. In contrast, the neural circuit mechanisms of goal-directed decision making, requiring extended iterative computations to estimate values online, are still unknown. Here we present a spiking neural network that provably solves the difficult online value estimation problem underlying goal-directed decision making in a near-optimal way and reproduces behavioral as well as neurophysiological experimental data on tasks ranging from simple binary choice to sequential decision making. Our model uses local plasticity rules to learn the synaptic weights of a simple neural network to achieve optimal performance and solves one-step decision-making tasks, commonly considered in neuroeconomics, as well as more challenging sequential decision-making tasks within 1 s. These decision times, and their parametric dependence on task parameters, as well as the final choice probabilities match behavioral data, whereas the evolution of neural activities in the network closely mimics neural responses recorded in frontal cortices during the execution of such tasks. Our theory provides a principled framework to understand the neural underpinning of goal-directed decision making and makes novel predictions for sequential decision-making tasks with multiple rewards. Goal-directed actions requiring prospective planning pervade decision making, but their circuit-level mechanisms remain elusive. We show how a model circuit of biologically realistic spiking neurons can solve this computationally challenging problem in a novel way. The synaptic weights of our network can be learned using local plasticity rules

  7. Aggressive treatment of early rheumatoid arthritis: recognizing the window of opportunity and treating to target goals.

    Science.gov (United States)

    Resman-Targoff, Beth H; Cicero, Marco P

    2010-11-01

    Evidence supports the use of aggressive therapy for patients with early rheumatoid arthritis (RA). Clinical outcomes in patients with early RA can improve with a treat-to-target approach that sets the goal at disease remission. The current selection of antirheumatic therapies, including conventional and biologic disease-modifying antirheumatic drugs (DMARDs), has made disease remission a realistic target for patients with early RA. The challenge is selecting the optimal antirheumatic drug or combination of drugs for initial and subsequent therapy to balance the clinical benefits, risks, and economic considerations. In some cases, the use of biologic agents as part of the treatment regimen has shown superior results compared with conventional DMARDs alone in halting the progression of disease, especially in reducing radiographic damage. However, the use of biologic agents as initial therapy is challenged by cost-effectiveness analyses, which favor the use of conventional DMARDs. The use of biologic agents may be justified in certain patients with poor prognostic factors or those who experience an inadequate response to conventional DMARDs as a means to slow or halt disease progression and its associated disability. In these cases, the higher cost of treatment with biologic agents may be offset by decreased societal costs, such as lost work productivity, and increased health-related quality of life. Further research is needed to understand optimal strategies for balancing costs, benefits, and risks of antirheumatic drugs. Some key questions are (1) when biologic agents are appropriate for initial therapy, and (2) when to conclude that response to conventional DMARDs is inadequate and biologic agents should be initiated.

  8. Speed/accuracy trade-off between the habitual and the goal-directed processes.

    Directory of Open Access Journals (Sweden)

    Mehdi Keramati

    2011-05-01

    Full Text Available Instrumental responses are hypothesized to be of two kinds: habitual and goal-directed, mediated by the sensorimotor and the associative cortico-basal ganglia circuits, respectively. The existence of the two heterogeneous associative learning mechanisms can be hypothesized to arise from the comparative advantages that they have at different stages of learning. In this paper, we assume that the goal-directed system is behaviourally flexible, but slow in choice selection. The habitual system, in contrast, is fast in responding, but inflexible in adapting its behavioural strategy to new conditions. Based on these assumptions and using the computational theory of reinforcement learning, we propose a normative model for arbitration between the two processes that makes an approximately optimal balance between search-time and accuracy in decision making. Behaviourally, the model can explain experimental evidence on behavioural sensitivity to outcome at the early stages of learning, but insensitivity at the later stages. It also explains that when two choices with equal incentive values are available concurrently, the behaviour remains outcome-sensitive, even after extensive training. Moreover, the model can explain choice reaction time variations during the course of learning, as well as the experimental observation that as the number of choices increases, the reaction time also increases. Neurobiologically, by assuming that phasic and tonic activities of midbrain dopamine neurons carry the reward prediction error and the average reward signals used by the model, respectively, the model predicts that whereas phasic dopamine indirectly affects behaviour through reinforcing stimulus-response associations, tonic dopamine can directly affect behaviour through manipulating the competition between the habitual and the goal-directed systems and thus, affect reaction time.

  9. Goal-directed learning and obsessive–compulsive disorder

    Science.gov (United States)

    Gillan, Claire M.; Robbins, Trevor W.

    2014-01-01

    Obsessive–compulsive disorder (OCD) has become a paradigmatic case of goal-directed dysfunction in psychiatry. In this article, we review the neurobiological evidence, historical and recent, that originally led to this supposition and continues to support a habit hypothesis of OCD. We will then discuss a number of recent studies that have directly tested this hypothesis, using behavioural experiments in patient populations. Based on this research evidence, which suggests that rather than goal-directed avoidance behaviours, compulsions in OCD may derive from manifestations of excessive habit formation, we present the details of a novel account of the functional relationship between these habits and the full symptom profile of the disorder. Borrowing from a cognitive dissonance framework, we propose that the irrational threat beliefs (obsessions) characteristic of OCD may be a consequence, rather than an instigator, of compulsive behaviour in these patients. This lays the foundation for a potential shift in both clinical and neuropsychological conceptualization of OCD and related disorders. This model may also prove relevant to other putative disorders of compulsivity, such as substance dependence, where the experience of ‘wanting’ drugs may be better understood as post hoc rationalizations of otherwise goal-insensitive, stimulus-driven behaviour. PMID:25267818

  10. Music as therapy in early history.

    Science.gov (United States)

    Thaut, Michael H

    2015-01-01

    The notion of music as therapy is based on ancient cross-cultural beliefs that music can have a "healing" effect on mind and body. Explanations for the therapeutic mechanisms in music have almost always included cultural and social science-based causalities about the uses and functions of music in society. However, it is also important to note that the view of music as "therapy" was also always strongly influenced by the view and understanding of the concepts and causes of disease. Magical/mystical concepts of illness and "rational" medicine probably lived side by side for thousands of years. Not until the late-nineteenth and early-twentieth centuries were the scientific foundations of medicine established, which allowed the foundations of music in therapy to progress from no science to soft science and most recently to actual brain science. Evidence for "early music therapy" will be discussed in four broad historical-cultural divisions: preliterate cultures; early civilizations in Mesopotamia, Egypt, Israel; Greek Antiquity; Middle Ages, Renaissance, and Baroque. In reviewing "early music therapy" practice, from mostly unknown periods of early history (using preliterate cultures as a window) to increasingly better documented times, including preserved notation samples of actual "healing" music, five theories and applications of early music therapy can be differentiated. © 2015 Elsevier B.V. All rights reserved.

  11. [Early diagnosis and therapy in pulmonary hypertension--aspects of a vision].

    Science.gov (United States)

    Ewert, R; Olschewski, H; Ghofrani, H A; Opitz, C F

    2013-07-01

    In patients with pulmonary hypertension progressive vascular changes in the lung precede the clinical and hemodynamic manifestations of the disease. Therefore, early diagnosis and timely treatment of the disease are crucial. This has been the topic of an expert meeting in Greifswald, Germany in June 2012. The current definition of pulmonary hypertension requires a mean pulmonary artery pressure ≥ 25 mmHg at rest, a hemodynamic abnormality already reflecting pulmonary vascular changes beyond early disease. There is increasing evidence supporting the concept that a lower pressure threshold at rest or an abnormal pressure response with exercise better characterize early disease. While right heart catheterization at rest remains the diagnostic gold standard other methods for detecting early disease are explored with echocardiography being the most frequently used technique. Targeted therapy has been approved for patients with pulmonary arterial hypertension (PAH, WHO-group I) in functional class II-IV. Preliminary data in functional class I patients suggest therapeutic potential of theses drugs in early disease as well. Current guidelines propose therapeutic goals based on parameters with prognostic importance. However, these recommendations are based on mostly retrospective analyses of pre-treatment data obtained in patients with pulmonary hypertension in functional class II-IV. Therefore, evidence-based therapeutic goals for early interventions in functional class I patients are lacking. © Georg Thieme Verlag KG Stuttgart · New York.

  12. Early cessation of pressure garment therapy results in scar contraction and thickening.

    Science.gov (United States)

    DeBruler, Danielle M; Zbinden, Jacob C; Baumann, Molly E; Blackstone, Britani N; Malara, Megan M; Bailey, J Kevin; Supp, Dorothy M; Powell, Heather M

    2018-01-01

    Pressure garment therapy is often prescribed to improve scar properties following full-thickness burn injuries. Pressure garment therapy is generally recommended for long periods of time following injury (1-2 years), though it is plagued by extremely low patient compliance. The goal of this study was to examine the effects of early cessation of pressure garment therapy on scar properties. Full-thickness burn injuries were created along the dorsum of red Duroc pigs. The burn eschar was excised and wound sites autografted with split-thickness skin. Scars were treated with pressure garments within 1 week of injury and pressure was maintained for either 29 weeks (continuous pressure) or for 17 weeks followed by cessation of pressure for an additional 12 weeks (pressure released); scars receiving no treatment served as controls. Scars that underwent pressure garment therapy were significantly smoother and less contracted with decreased scar height compared to control scars at 17 weeks. These benefits were maintained in the continuous pressure group until week 29. In the pressure released group, grafts significantly contracted and became more raised, harder and rougher after the therapy was discontinued. Pressure cessation also resulted in large changes in collagen fiber orientation and increases in collagen fiber thickness. The results suggest that pressure garment therapy effectively improves scar properties following severe burn injury; however, early cessation of the therapy results in substantial loss of these improvements.

  13. Outcomes of implementation of enhanced goal directed therapy in high-risk patients undergoing abdominal surgery

    Directory of Open Access Journals (Sweden)

    Lakshmi Kumar

    2015-01-01

    Full Text Available Background and Aims: Advanced monitoring targeting haemodynamic and oxygenation variables can improve outcomes of surgery in high-risk patients. We aimed to assess the impact of goal directed therapy (GDT targeting cardiac index (CI and oxygen extraction ratio (O 2 ER on outcomes of high-risk patients undergoing abdominal surgery. Methods: In a prospective randomised trial, forty patients (American Society of Anaesthesiologists II and III undergoing major abdominal surgeries were randomised into two groups. In-Group A mean arterial pressure ≥ 65 mmHg, central venous pressure ≥ 8-10 mmHg, urine output ≥ 0.5 mL/kg/h and central venous oxygen saturation ≥ 70% were targeted intra-operatively and 12 h postoperatively. In-Group-B (enhanced GDT, in addition to the monitoring in-Group-A, CI ≥ 2.5 L/min/m 2 and O 2 ER ≤ 27% were targeted. The end-points were lactate levels and base deficit during and after surgery. The secondary end points were length of Intensive Care Unit (ICU and hospital stay and postoperative complications. Wilcoxon Mann Whitney and Chi-square tests were used for statistical assessment. Results: Lactate levels postoperatively at 4 and 8 h were lower in-Group-B (P < 0.05. The mean base deficit at 3, 4, 5 and 6 h intra-operatively and postoperatively after 4, 8 and 12 h were lower in-Group-B (P < 0.05. There were no significant differences in ICU stay (2.10 ± 1.52 vs. 2.90 ± 2.51 days or hospital stay (10.85 + 4.39 vs. 13.35 + 6.77 days between Group A and B. Conclusions: Implementation of enhanced GDT targeting CI and OER was associated with improved tissue oxygenation.

  14. Goal-Directed Fluid Therapy Based on Stroke Volume Variation in Patients Undergoing Major Spine Surgery in the Prone Position: A Cohort Study.

    Science.gov (United States)

    Bacchin, Maria Renata; Ceria, Chiara Marta; Giannone, Sandra; Ghisi, Daniela; Stagni, Gaetano; Greggi, Tiziana; Bonarelli, Stefano

    2016-09-15

    A retrospective observational study. The aim of this study was to test whether a goal-directed fluid therapy (GDFT) protocol, based on stroke volume variation (SVV), applied in major spine surgery performed in the prone position, would be effective in reducing peri-operative red blood cells transfusions. Recent literature shows that optimizing perioperative fluid therapy is associated with lower complication rates and faster recovery. Data from 23 patients who underwent posterior spine arthrodesis surgery and whose intraoperative fluid administration were managed with the GDFT protocol were retrospectively collected and compared with data from 23 matched controls who underwent the same surgical procedure in the same timeframe, and who received a liberal intraoperative fluid therapy. Patients in the GDFT group received less units of transfused red blood cells (primary endpoint) in the intra (0 vs. 2.0, P = 0.0 4) and postoperative period (2.0 vs. 4.0, P = 0.003). They also received a lower amount of intraoperative crystalloids, had fewer blood losses, and lower intraoperative peak lactate. In the postoperative period, patients in the GDFT group had fewer pulmonary complications and blood losses from surgical drains, needed less blood product transfusions, had a shorter intensive care unit stay, and a faster return of bowel function. We found no difference in the total length of stay among the two groups. Our study shows that application of a GDFT based on SVV in major spine surgery is feasible and can lead to reduced blood losses and transfusions, better postoperative respiratory performance, shorter ICU stay, and faster return of bowel function. 3.

  15. Hope and self-regulatory goals applied to an advertising context : promoting prevention stimulates goal-directed behavior.

    NARCIS (Netherlands)

    Poels, K.; Dewitte, S.

    2008-01-01

    This article proposes the existence of two types of hope which differ in terms of self-regulatory goals: prevention hope and promotion hope. Consistent with the functional emotion approach and regulatory focus theory, we show that prevention hope generates more goal-directed behavior compared to

  16. Hope and self regulatory goals applied to an advertising context : promoting prevention stimulates goal-directed behavior

    NARCIS (Netherlands)

    Poels, K.; Dewitte, S.; Astregaard, S.; Dwight, M.

    2007-01-01

    This article proposes the existence of two types of hope which differ in terms of self-regulatory goals: prevention hope and promotion hope. Consistent with the functional emotion approach and regulatory focus theory, we show that prevention hope generates more goal-directed behavior compared to

  17. Mirroring "meaningful" actions: sensorimotor learning modulates imitation of goal-directed actions.

    Science.gov (United States)

    Catmur, Caroline; Heyes, Cecilia

    2017-06-19

    Imitation is important in the development of social and technological skills throughout the lifespan. Experiments investigating the acquisition and modulation of imitation (and of its proposed neural substrate, the mirror neuron system) have produced evidence that the capacity for imitation depends on associative learning in which connections are formed between sensory and motor representations of actions. However, evidence that the development of imitation depends on associative learning has been found only for non-goal-directed actions. One reason for the lack of research on goal-directed actions is that imitation of such actions is commonly confounded with the tendency to respond in a spatially compatible manner. However, since the most prominent account of mirror neuron function, and hence of imitation, suggests that these cells encode goal-directed actions, it is important to establish whether sensorimotor learning can also modulate imitation of goal-directed actions. Experiment 1 demonstrated that imitation of goal-directed grasping can be measured while controlling for spatial compatibility, and Experiment 2 showed that this imitation effect can be modulated by sensorimotor training. Together these data support the hypothesis that the capacity for behavioural imitation, and the properties of the mirror neuron system, are constructed in the course of development through associative learning.

  18. 'Finding a balance' in involving patients in goal setting early after stroke: a physiotherapy perspective.

    Science.gov (United States)

    Lloyd, A; Roberts, A R; Freeman, J A

    2014-09-01

    Collaborative goal setting (between patient and professional) confers benefits within stroke and neurological rehabilitation, and is recommended in clinical guidelines. However, evidence suggests that patient participation in rehabilitation goal setting is not maximized, particularly within the hospital setting. The purpose of this study was to investigate physiotherapists' perceptions about their experiences of collaborative goal setting with patients in the sub-acute stages after stroke, in the hospital setting. This qualitative study employed constructivist grounded theory methodology. Nine physiotherapists, of varying experience, were selected using purposive then theoretical sampling from three National Health Service hospital stroke units in England. Semi-structured interviews were conducted, audio-recorded and transcribed. Transcripts were coded and analysed using the constant comparative method of grounded theory to find common themes. Three themes emerged from the data: 1) 'coming to terms with stroke' - the individual patient journey; 2) the evolution of goal setting skill - the individual physiotherapist journey; and 3) 'finding a balance' - managing expectations and negotiating interactions. A provisional grounded theory was constructed, which highlighted that, from the physiotherapists' perspective, collaboration with patients within goal setting early after stroke involved finding a balance between numerous different drivers, which have the potential to compete. Patient-directed and therapist-directed goal setting approaches could be viewed as opposite ends of a continuum, along which patient-centred goal setting is possible. Physiotherapists perceived that collaborating with patients in goal setting was important but challenging. Goal setting interactions with other professionals, patients and families were perceived as complex, difficult and requiring significant effort. The importance of individuality and temporality were recognized suggesting that

  19. A Unifying Approach to Goal-Directed Evaluation

    DEFF Research Database (Denmark)

    Danvy, Olivier; Rhiger, Morten; Grobauer, Bernd

    2001-01-01

    Goal-directed evaluation, as embodied in Icon and Snobol, is built on the notions of backtracking and of generating successive results, and therefore it has always been something of a challenge to specify and implement. In this article, we address this challenge using computational monads and par...

  20. Early cessation of pressure garment therapy results in scar contraction and thickening.

    Directory of Open Access Journals (Sweden)

    Danielle M DeBruler

    Full Text Available Pressure garment therapy is often prescribed to improve scar properties following full-thickness burn injuries. Pressure garment therapy is generally recommended for long periods of time following injury (1-2 years, though it is plagued by extremely low patient compliance. The goal of this study was to examine the effects of early cessation of pressure garment therapy on scar properties. Full-thickness burn injuries were created along the dorsum of red Duroc pigs. The burn eschar was excised and wound sites autografted with split-thickness skin. Scars were treated with pressure garments within 1 week of injury and pressure was maintained for either 29 weeks (continuous pressure or for 17 weeks followed by cessation of pressure for an additional 12 weeks (pressure released; scars receiving no treatment served as controls. Scars that underwent pressure garment therapy were significantly smoother and less contracted with decreased scar height compared to control scars at 17 weeks. These benefits were maintained in the continuous pressure group until week 29. In the pressure released group, grafts significantly contracted and became more raised, harder and rougher after the therapy was discontinued. Pressure cessation also resulted in large changes in collagen fiber orientation and increases in collagen fiber thickness. The results suggest that pressure garment therapy effectively improves scar properties following severe burn injury; however, early cessation of the therapy results in substantial loss of these improvements.

  1. Advanced Parkinson’s disease effect on goal-directed and habitual processes involved in visuomotor associative learning

    Directory of Open Access Journals (Sweden)

    Fadila eHadj-Bouziane

    2013-01-01

    Full Text Available The present behavioral study readdresses the question of habit learning in Parkinson's disease. Patients were early onset, non-demented, dopa-responsive, candidates for surgical treatment, similar to those we found earlier as suffering greater dopamine depletion in the putamen than in the caudate nucleus. The task was the same conditional associative learning task as that used previously in monkeys and healthy humans to unveil the striatum involvement in habit learning. Sixteen patients and 20 age- and education-matched healthy control subjects learned sets of 3 visuo-motor associations between complex patterns and joystick displacements during two testing sessions separated by a few hours. We distinguished errors preceding versus following the first correct response to compare patients' performance during the earliest phase of learning dominated by goal-directed actions with that observed later on, when responses start to become habitual. The disease significantly retarded both learning phases, especially in patients under sixty years of age. However, only the late phase deficit was disease severity-dependent and persisted on the second testing session. These findings provide the first corroboration in Parkinson patients of two ideas well-established in the animal literature. The first is the idea that associating visual stimuli to motor acts is a form of habit learning that engages the striatum. It is confirmed here by the global impairment in visuo-motor learning induced by Parkinson's disease. The second idea is that goal-directed behaviors are predominantly caudate-dependent whereas habitual responses are primarily putamen-dependent. At the advanced Parkinson's disease stages tested here, dopamine depletion is greater in the putamen than in the caudate nucleus. Accordingly, the late phase of learning corresponding to the emergence of habitual responses was more vulnerable to the disease than the early phase dominated by goal-directed

  2. Sleep Deprivation Promotes Habitual Control over Goal-Directed Control: Behavioral and Neuroimaging Evidence.

    Science.gov (United States)

    Chen, Jie; Liang, Jie; Lin, Xiao; Zhang, Yang; Zhang, Yan; Lu, Lin; Shi, Jie

    2017-12-06

    Sleep is one of the most fundamental processes of life, playing an important role in the regulation of brain function. The long-term lack of sleep can cause memory impairments, declines in learning ability, and executive dysfunction. In the present study, we evaluated the effects of sleep deprivation on instrumental learning behavior, particularly goal-directed and habitual actions in humans, and investigated the underlying neural mechanisms. Healthy college students of either gender were enrolled and randomly divided into sleep deprivation group and sleep control group. fMRI data were collected. We found that one night of sleep deprivation led to greater responsiveness to stimuli that were associated with devalued outcomes in the slips-of-action test, indicating a deficit in the formation of goal-directed control and an overreliance on habits. Furthermore, sleep deprivation had no effect on the expression of acquired goal-directed action. The level of goal-directed action after sleep deprivation was positively correlated with baseline working memory capacity. The neuroimaging data indicated that goal-directed learning mainly recruited the ventromedial PFC (vmPFC), the activation of which was less pronounced during goal-directed learning after sleep deprivation. Activation of the vmPFC during goal-directed learning during training was positively correlated with the level of goal-directed action performance. The present study suggests that people rely predominantly on habits at the expense of goal-directed control after sleep deprivation, and this process involves the vmPFC. These results contribute to a better understanding of the effects of sleep loss on decision-making. SIGNIFICANCE STATEMENT Understanding the cognitive consequences of sleep deprivation has become extremely important over the past half century, given the continued decline in sleep duration in industrialized societies. Our results provide novel evidence that goal-directed action may be

  3. Using shared goal setting to improve access and equity: a mixed methods study of the Good Goals intervention in children’s occupational therapy

    Directory of Open Access Journals (Sweden)

    Kolehmainen Niina

    2012-08-01

    Full Text Available Abstract Background Access and equity in children’s therapy services may be improved by directing clinicians’ use of resources toward specific goals that are important to patients. A practice-change intervention (titled ‘Good Goals’ was designed to achieve this. This study investigated uptake, adoption, and possible effects of that intervention in children’s occupational therapy services. Methods Mixed methods case studies (n = 3 services, including 46 therapists and 558 children were conducted. The intervention was delivered over 25 weeks through face-to-face training, team workbooks, and ‘tools for change’. Data were collected before, during, and after the intervention on a range of factors using interviews, a focus group, case note analysis, routine data, document analysis, and researchers’ observations. Results Factors related to uptake and adoptions were: mode of intervention delivery, competing demands on therapists’ time, and leadership by service manager. Service managers and therapists reported that the intervention: helped therapists establish a shared rationale for clinical decisions; increased clarity in service provision; and improved interactions with families and schools. During the study period, therapists’ behaviours changed: identifying goals, odds ratio 2.4 (95% CI 1.5 to 3.8; agreeing goals, 3.5 (2.4 to 5.1; evaluating progress, 2.0 (1.1 to 3.5. Children’s LoT decreased by two months [95% CI −8 to +4 months] across the services. Cost per therapist trained ranged from £1,003 to £1,277, depending upon service size and therapists’ salary bands. Conclusions Good Goals is a promising quality improvement intervention that can be delivered and adopted in practice and may have benefits. Further research is required to evaluate its: (i impact on patient outcomes, effectiveness, cost-effectiveness, and (ii transferability to other clinical contexts.

  4. Intensity and direction of competitive anxiety as a function of goal attainment expectation and competition goal generation.

    Science.gov (United States)

    O'Brien, M; Hanton, S; Mellalieu, S D

    2005-12-01

    Jones's control model was adopted to investigate differences in the labelling of symptoms associated with pre-competition anxiety and self-confidence as a function of goal attainment expectation and competition goal generation. Team sport performers (N = 96) were divided into outcome, performance and process goal groups. Anxiety intensity and direction, and self-confidence were then examined as a function of goal expectancy (positive or negative) and perceived input into goal production (input or no input). MANOVA and follow-up ANOVA supported the study predictions. Specifically, participants who reported positive expectations of goal achievement and indicated some input into the goal generation process experienced the most facilitative interpretations of cognitive symptoms and greater self-confidence. The results highlight the need to consider how goals are generated when attempting to foster a sense of control and help athletes cope with the psychological demands of competition.

  5. Perioperative utility of goal-directed therapy in high-risk cardiac patients undergoing coronary artery bypass grafting: “A clinical outcome and biomarker-based study”

    Directory of Open Access Journals (Sweden)

    Poonam Malhotra Kapoor

    2016-01-01

    Full Text Available Goal-directed therapy (GDT encompasses guidance of intravenous (IV fluid and vasopressor/inotropic therapy by cardiac output or similar parameters to help in early recognition and management of high-risk cardiac surgical patients. With the aim of establishing the utility of perioperative GDT using robust clinical and biochemical outcomes, we conducted the present study. This multicenter randomized controlled study included 130 patients of either sex, with European system for cardiac operative risk evaluation ≥3 undergoing coronary artery bypass grafting on cardiopulmonary bypass. The patients were randomly divided into the control and GDT group. All the participants received standardized care; arterial pressure monitored through radial artery, central venous pressure (CVP through a triple lumen in the right internal jugular vein, electrocardiogram, oxygen saturation, temperature, urine output per hour, and frequent arterial blood gas (ABG analysis. In addition, cardiac index (CI monitoring using FloTrac™ and continuous central venous oxygen saturation (ScVO2 using PreSep™ were used in patients in the GDT group. Our aim was to maintain the CI at 2.5–4.2 L/min/m2, stroke volume index 30–65 ml/beat/m2, systemic vascular resistance index 1500–2500 dynes/s/cm5/m2, oxygen delivery index 450–600 ml/min/m2, continuous ScVO2 >70%, and stroke volume variation 30%, and urine output >1 ml/kg/h. The aims were achieved by altering the administration of IV fluids and doses of inotropes or vasodilators. The data of sixty patients in each group were analyzed in view of ten exclusions. The average duration of ventilation (19.89 ± 3.96 vs. 18.05 ± 4.53 h, P = 0.025, hospital stay (7.94 ± 1.64 vs. 7.17 ± 1.93 days, P = 0.025, and Intensive Care Unit (ICU stay (3.74 ± 0.59 vs. 3.41 ± 0.75 days, P = 0.012 was significantly less in the GDT group, compared to the control group. The extra volume added and the number of inotropic dose adjustments were

  6. The Effects of Methylphenidate on Goal-Directed Behavior in a Rat Model of ADHD

    Directory of Open Access Journals (Sweden)

    Joman Y. Natsheh

    2015-11-01

    Full Text Available Although attentional and motor alterations in Attention Deficit Hyperactivity Disorder (ADHD have been well characterized, less is known about how this disorder impacts goal-directed behavior. To investigate whether there is a misbalance between goal-directed and habitual behaviors in an animal model of ADHD, we tested adult [P75-P105] Spontaneously Hypertensive Rats (SHR (ADHD rat model and Wistar-Kyoto rats (WKY, the normotensive control strain, on an instrumental conditioning paradigm with two phases: a free-operant training phase in which rats separately acquired two distinct action-outcome contingencies, and a choice test conducted in extinction prior to which one of the food outcomes was devalued through specific satiety. To assess the effects of Methylphenidate, a commonly used ADHD medication, on goal-directed behavior, we injected rats with either Methylphenidate or saline prior to the choice test. Both rat strains acquired an instrumental response, with SHR responding at greater rates over the course of training. During the choice test WKY demonstrated goal-directed behavior, responding more frequently on the lever that delivered, during training, the still-valued outcome. In contrast, SHR showed no goal-directed behavior, responding equally on both levers. However, methylphenidate administration prior to the choice test restored goal-directed behavior in SHR, and disrupted this behavior in WKY rats. This study provides the first experimental evidence for selective impairment in goal-directed behavior in rat models of ADHD, and how methylphenidate acts differently on SHR and WKY animals to restore or impair this behavior, respectively.

  7. When Preferences Are in the Way: Children's Predictions of Goal-Directed Behaviors.

    Science.gov (United States)

    Yang, Fan; Frye, Douglas

    2017-12-18

    Across three studies, we examined 4- to 7-year-olds' predictions of goal-directed behaviors when goals conflict with preferences. In Study 1, when presented with stories in which a character had to act against basic preferences to achieve an interpersonal goal (e.g., playing with a partner), 6- and 7-year-olds were more likely than 4- and 5-year-olds to predict the actor would act in accordance with the goal to play with the partner, instead of fulfilling the basic preference of playing a favored activity. Similar results were obtained in Study 2 with scenarios that each involved a single individual pursuing intrapersonal goals that conflicted with his or her basic preferences. In Study 3, younger children's predictions of goal-directed behaviors did not increase for novel goals and preferences, when the influences of their own preferences, future thinking, or a lack of impulse control were minimized. The results suggest that between ages 4 and 7, children increasingly integrate and give more weight to other sources of motivational information (e.g., goals) in addition to preferences when predicting people's behaviors. This increasing awareness may have implications for children's self-regulatory and goal pursuit behaviors. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  8. A Unifying Approach to Goal-Directed Evaluation

    DEFF Research Database (Denmark)

    Danvy, Olivier; Grobauer, Bernd; Rhiger, Morten

    2001-01-01

    semantics coincides with Gudeman’s continuation semantics of Icon. We then compile Icon programs by specializing their interpreter (i.e., by using the first Futamura projection), using type-directed partial evaluation. Through various back ends, including a run-time code generator, we generate ML code, C......Goal-directed evaluation, as embodied in Icon and Snobol, is built on the notions of backtracking and of generating successive results, and therefore it has always been something of a challenge to specify and implement. In this article, we address this challenge using computational monads...... code, and OCaml byte code. Binding-time analysis and partial evaluation of the continuation-based interpreter automatically give rise to C programs that coincide with the result of Proebsting’s optimized compiler....

  9. Evaluation of financial burden following complications after major surgery in France: Potential return after perioperative goal-directed therapy.

    Science.gov (United States)

    Landais, Alain; Morel, Morgane; Goldstein, Jacques; Loriau, Jerôme; Fresnel, Annie; Chevalier, Corinne; Rejasse, Gilles; Alfonsi, Pascal; Ecoffey, Claude

    2017-06-01

    Perioperative goal-directed therapy (PGDT) has been demonstrated to improve postoperative outcomes and reduce the length of hospital stays. The objective of our analysis was to evaluate the cost of complications, derived from French hospital payments, and calculate the potential cost savings and length of hospital stay reductions. The billing of 2388 patients who underwent scheduled high-risk surgery (i.e. major abdominal, gynaecologic, urological, vascular, and orthopaedic interventions) over three years was retrospectively collected from three French hospitals (one public-teaching, one public, and one private hospital). A relationship between mortality, length of hospital stays, cost/patient, and severity scores, based mainly on postoperative complications but also on preoperative clinical status, were analysed. Statistical analysis was performed using Student's t-tests or Wilcoxon tests. Our analyses determined that a severity score of 3 or 4 was associated with complications in 90% of cases and this represented 36% of patients who, compared with those with a score of 1 or 2, were associated with significantly increased costs (€ 8205±3335 to € 22,081±16,090; Prisk surgeries per year), the potential financial savings ranged from € 40M to € 68M, not including the costs of PGDT and its implementation. Our analysis demonstrates that patients with complications are significantly more expensive to care for than those without complications. In our model, it was projected that implementing PGDT during high-risk surgery may significantly reduce healthcare costs and the length of hospital stays in France while probably improving patient access to care and reducing waiting times for procedures. Copyright © 2017. Published by Elsevier Masson SAS.

  10. Multimodality multiparametric imaging of early tumor response to a novel antiangiogenic therapy based on anticalins.

    Directory of Open Access Journals (Sweden)

    Reinhard Meier

    Full Text Available Anticalins are a novel class of targeted protein therapeutics. The PEGylated Anticalin Angiocal (PRS-050-PEG40 is directed against VEGF-A. The purpose of our study was to compare the performance of diffusion weighted imaging (DWI, dynamic contrast enhanced magnetic resonance imaging (DCE-MRI and positron emission tomography with the tracer [18F]fluorodeoxyglucose (FDG-PET for monitoring early response to antiangiogenic therapy with PRS-050-PEG40. 31 mice were implanted subcutaneously with A673 rhabdomyosarcoma xenografts and underwent DWI, DCE-MRI and FDG-PET before and 2 days after i.p. injection of PRS-050-PEG40 (n = 13, Avastin (n = 6 or PBS (n = 12. Tumor size was measured manually with a caliper. Imaging results were correlated with histopathology. In the results, the tumor size was not significantly different in the treatment groups when compared to the control group on day 2 after therapy onset (P = 0.09. In contrast the imaging modalities DWI, DCE-MRI and FDG-PET showed significant differences between the therapeutic compared to the control group as early as 2 days after therapy onset (P<0.001. There was a strong correlation of the early changes in DWI, DCE-MRI and FDG-PET at day 2 after therapy onset and the change in tumor size at the end of therapy (r = -0.58, 0.71 and 0.67 respectively. The imaging results were confirmed by histopathology, showing early necrosis and necroptosis in the tumors. Thus multimodality multiparametric imaging was able to predict therapeutic success of PRS-050-PEG40 and Avastin as early as 2 days after onset of therapy and thus promising for monitoring early response of antiangiogenic therapy.

  11. Proton Beam Therapy for Non-Small Cell Lung Cancer: Current Clinical Evidence and Future Directions

    International Nuclear Information System (INIS)

    Berman, Abigail T.; James, Sara St.; Rengan, Ramesh

    2015-01-01

    Lung cancer is the leading cancer cause of death in the United States. Radiotherapy is an essential component of the definitive treatment of early-stage and locally-advanced lung cancer, and the palliative treatment of metastatic lung cancer. Proton beam therapy (PBT), through its characteristic Bragg peak, has the potential to decrease the toxicity of radiotherapy, and, subsequently improve the therapeutic ratio. Herein, we provide a primer on the physics of proton beam therapy for lung cancer, present the existing data in early-stage and locally-advanced non-small cell lung cancer (NSCLC), as well as in special situations such as re-irradiation and post-operative radiation therapy. We then present the technical challenges, such as anatomic changes and motion management, and future directions for PBT in lung cancer, including pencil beam scanning

  12. Impaired acquisition of goal-directed action in healthy aging

    NARCIS (Netherlands)

    de Wit, S.; van de Vijver, I.; Ridderinkhof, K.R.

    2014-01-01

    According to dual-system theories, instrumental learning is supported by dissociable goal-directed and habitual systems. Previous investigations of the dual-system balance in healthy aging have yielded mixed results. To further investigate this issue, we compared performance of young (17-24 years)

  13. The hemodynamic "target": a visual tool of goal-directed therapy for septic patients Alvo hemodinâmico: uma ferramenta visual de terapia "goal-directed" para pacientes sépticos

    Directory of Open Access Journals (Sweden)

    Fabrice Vallée

    2007-01-01

    Full Text Available OBJECTIVE: To improve understanding of the hemodynamic status of patients with sepsis by nursing teams through the attainment of hemodynamic parameters using a pentaxial "target" diagram as a clinical tool. Parameters include cardiac index (CI, arterial oxygen saturation (SaO2, mean arterial pressure (MAP, arterial blood lactate, and central venous oxygen saturation (ScvO2. METHODS: Design: Prospective descriptive study. Setting: The intensive care unit of a university hospital. Patients: During a 6-month period, 38 intubated septic shock patients were included in the study. Survivors and nonsurvivors were compared. Interventions: MAP, CI, SaO2, ScvO2 and lactate were measured at 0, 6, 12, 24, 36, and 48 h. Measurements were recorded on the target diagram along with the norepinephrine infusion rate and the hemoglobin (Hb level. The number of lactate and ScvO2 measurements achieved during the target period were compared to a 6-month retrospective control period just before starting the protocol. We assessed the nurse knowledge status prior to the introduction of target diagram. We then performed a post-test after implementing the new recording technique. MEASUREMENTS AND RESULTS: The nursing team expressed a positive attitude toward the target concept. The mean number of lactate and ScvO2 measurements performed for each patient during the control period was significantly lower than during the target period, and those values were rarely used as goal values before the introduction of the target diagram. At 24 hours, 46% of the survivors had achieved all the goal parameter values of the target diagram, compared to only 10% of nonsurvivors (P = .01. CONCLUSION: The target diagram is a visual multiparametric tool involving all the medical and nursing team that helps achieve goal-directed therapy for septic patients. The number of goal values reached at each time point during the first 48 hours was closely linked to mortality.OBJETIVO: Melhorar a

  14. Which goal for fluid therapy during colorectal surgery is followed by the best outcome

    DEFF Research Database (Denmark)

    Brandstrup, B; Svendsen, P E; Rasmussen, M

    2012-01-01

    /st> We aimed to investigate whether fluid therapy with a goal of near-maximal stroke volume (SV) guided by oesophageal Doppler (ED) monitoring result in a better outcome than that with a goal of maintaining bodyweight (BW) and zero fluid balance in patients undergoing colorectal surgery....

  15. Proton Beam Therapy for Non-Small Cell Lung Cancer: Current Clinical Evidence and Future Directions

    Directory of Open Access Journals (Sweden)

    Abigail T. Berman

    2015-07-01

    Full Text Available Lung cancer is the leading cancer cause of death in the United States. Radiotherapy is an essential component of the definitive treatment of early-stage and locally-advanced lung cancer, and the palliative treatment of metastatic lung cancer. Proton beam therapy (PBT, through its characteristic Bragg peak, has the potential to decrease the toxicity of radiotherapy, and, subsequently improve the therapeutic ratio. Herein, we provide a primer on the physics of proton beam therapy for lung cancer, present the existing data in early-stage and locally-advanced non-small cell lung cancer (NSCLC, as well as in special situations such as re-irradiation and post-operative radiation therapy. We then present the technical challenges, such as anatomic changes and motion management, and future directions for PBT in lung cancer, including pencil beam scanning.

  16. Resolution of conflict between goal-directed actions: outcome encoding and neural control processes.

    Science.gov (United States)

    de Wit, Sanne; Ostlund, Sean B; Balleine, Bernard W; Dickinson, Anthony

    2009-07-01

    According to O-R theory of instrumental learning, incongruent biconditional discriminations should be impossible to solve in a goal-directed manner because the event acting as the outcome of one response also acts as a discriminative stimulus for an opposite response. Each event should therefore be associated with two competing responses. However, Dickinson and de Wit (2003) have presented evidence that rats can learn incongruent discriminations. The present study investigated whether rats were able to engage additional processes to solve incongruent discriminations in a goal-directed manner. Experiment 1 provides evidence that rats resolve the response conflict that arises in the incongruent discrimination by differentially encoding events in their roles as discriminative stimulus and as outcome. Furthermore, Experiment 2 shows that once goal-directed control has been established the dorsomedial prefrontal cortex is not directly involved in its maintenance but rather plays a central role in conflict resolution processes.

  17. Music and Video Gaming during Breaks: Influence on Habitual versus Goal-Directed Decision Making.

    Science.gov (United States)

    Liu, Shuyan; Schad, Daniel J; Kuschpel, Maxim S; Rapp, Michael A; Heinz, Andreas

    2016-01-01

    Different systems for habitual versus goal-directed control are thought to underlie human decision-making. Working memory is known to shape these decision-making systems and their interplay, and is known to support goal-directed decision making even under stress. Here, we investigated if and how decision systems are differentially influenced by breaks filled with diverse everyday life activities known to modulate working memory performance. We used a within-subject design where young adults listened to music and played a video game during breaks interleaved with trials of a sequential two-step Markov decision task, designed to assess habitual as well as goal-directed decision making. Based on a neurocomputational model of task performance, we observed that for individuals with a rather limited working memory capacity video gaming as compared to music reduced reliance on the goal-directed decision-making system, while a rather large working memory capacity prevented such a decline. Our findings suggest differential effects of everyday activities on key decision-making processes.

  18. Is goal-directed attentional guidance just intertrial priming? A review.

    Science.gov (United States)

    Lamy, Dominique F; Kristjánsson, Arni

    2013-07-01

    According to most models of selective visual attention, our goals at any given moment and saliency in the visual field determine attentional priority. But selection is not carried out in isolation--we typically track objects through space and time. This is not well captured within the distinction between goal-directed and saliency-based attentional guidance. Recent studies have shown that selection is strongly facilitated when the characteristics of the objects to be attended and of those to be ignored remain constant between consecutive selections. These studies have generated the proposal that goal-directed or top-down effects are best understood as intertrial priming effects. Here, we provide a detailed overview and critical appraisal of the arguments, experimental strategies, and findings that have been used to promote this idea, along with a review of studies providing potential counterarguments. We divide this review according to different types of attentional control settings that observers are thought to adopt during visual search: feature-based settings, dimension-based settings, and singleton detection mode. We conclude that priming accounts for considerable portions of effects attributed to top-down guidance, but that top-down guidance can be independent of intertrial priming.

  19. The Use of Personal Projects Analysis to Enhance Occupational Therapy Goal Identification

    Directory of Open Access Journals (Sweden)

    Mary Egan

    2016-01-01

    Full Text Available Background: Client-centered occupational therapy begins with the identification of personally-relevant patient goals. This study aimed to determine whether the elicitation module of Personal Projects Analysis (PPA could help patients in an acquired brain injury day hospital program identify more meaningful goals than those identified using the Canadian Occupational Performance Measure (COPM alone. Method: Ten patients completed the COPM. They rated the importance of each goal and their confidence that they could attain each goal. During the next session, using the elicitation module of PPA, they identified personal projects just prior to their brain injuries, current personal projects, and future desired personal projects. They were then invited to revise their COPM goals and re-rate them for importance and confidence. Results: Following completion of the elicitation module of PPA, seven participants changed at least one goal. Of the goals that were changed, half were revised to include the mention of another person. There were no significant changes in average goal importance or perceived attainability. Occupational therapists reported that the elicitation module of PPA helped them get to know their patients better and identify potential therapeutic occupations. Discussion: The elicitation module of PPA may help people develop goals that are more embedded in their social contexts.

  20. Towards host-directed therapies for tuberculosis.

    Science.gov (United States)

    Zumla, Alimuddin; Maeurer, Markus; Chakaya, Jeremiah; Hoelscher, Michael; Ntoumi, Francine; Rustomjee, Roxana; Vilaplana, Cristina; Yeboah-Manu, Dorothy; Rasolof, Voahangy; Munderi, Paula; Singh, Nalini; Aklillu, Eleni; Padayatchi, Nesri; Macete, Eusebio; Kapata, Nathan; Mulenga, Modest; Kibiki, Gibson; Mfinanga, Sayoki; Nyirenda, Thomas; Maboko, Leonard; Garcia-Basteiro, Alberto; Rakotosamimanana, Niaina; Bates, Matthew; Mwaba, Peter; Reither, Klaus; Gagneux, Sebastien; Edwards, Sarah; Mfinanga, Elirehema; Abdulla, Salim; Cardona, Pere-Joan; Russell, James B W; Gant, Vanya; Noursadeghi, Mahdad; Elkington, Paul; Bonnet, Maryline; Menendez, Clara; Dieye, Tandakha N; Diarra, Bassirou; Maiga, Almoustapha; Aseffa, Abraham; Parida, Shreemanta; Wejse, Christian; Petersen, Eskild; Kaleebu, Pontiano; Oliver, Matt; Craig, Gill; Corrah, Tumena; Tientcheu, Leopold; Antonio, Martin; Rao, Martin; McHugh, Timothy D; Sheikh, Aziz; Ippolito, Giuseppe; Ramjee, Gita; Kaufmann, Stefan H E; Churchyard, Gavin; Steyn, Andrie; Grobusch, Martin; Sanne, Ian; Martinson, Neil; Madansein, Rajhmun; Wilkinson, Robert J; Mayosi, Bongani; Schito, Marco; Wallis, Robert S

    2015-08-01

    The treatment of tuberculosis is based on combinations of drugs that directly target Mycobacterium tuberculosis. A new global initiative is now focusing on a complementary approach of developing adjunct host-directed therapies.

  1. [Individual therapy goals: on outcome documentation of inpatient psychotherapy from the patient and therapist viewpoint].

    Science.gov (United States)

    Heuft, G; Senf, W; Wagener, R; Pintelon, C; Lorenzen, J

    1996-01-01

    The results of a study evaluation in practicability of two newly developed documentation forms are presented. Examined are 82 inpatient treatment episodes in an already published clinical concept with different treatment settings. Parallel versions of the forms were completed by patients and therapists. The 'Erge-Doku-A-Form' allows for the naming of up to five therapy goals determined at the beginning of therapy and evaluated in relation to their achieved quality at the end of therapy. The 'Erge-Doku-B-Form' describes a variety of problem areas as well as questions related to medication and changes induced by therapy. Surprising there were a high number of 230 Individual Therapy Goals (ITG) by patients and 262 ITG by therapists which could be arranged into 89 content categories and 5 main categories. Outcome measurement shows different results. There was a significant relationship between the 'well-being', the impression of 'satisfying treatment' at the end of the inpatient period and 'success in the main ITG'. The documentation forms presented here allow an outcome-measurement depending on differential indications.

  2. Music and Video Gaming during Breaks: Influence on Habitual versus Goal-Directed Decision Making.

    Directory of Open Access Journals (Sweden)

    Shuyan Liu

    Full Text Available Different systems for habitual versus goal-directed control are thought to underlie human decision-making. Working memory is known to shape these decision-making systems and their interplay, and is known to support goal-directed decision making even under stress. Here, we investigated if and how decision systems are differentially influenced by breaks filled with diverse everyday life activities known to modulate working memory performance. We used a within-subject design where young adults listened to music and played a video game during breaks interleaved with trials of a sequential two-step Markov decision task, designed to assess habitual as well as goal-directed decision making. Based on a neurocomputational model of task performance, we observed that for individuals with a rather limited working memory capacity video gaming as compared to music reduced reliance on the goal-directed decision-making system, while a rather large working memory capacity prevented such a decline. Our findings suggest differential effects of everyday activities on key decision-making processes.

  3. Dynamical Intention: Integrated Intelligence Modeling for Goal-directed Embodied Agents

    Directory of Open Access Journals (Sweden)

    Eric Aaron

    2016-11-01

    Full Text Available Intelligent embodied robots are integrated systems: As they move continuously through their environments, executing behaviors and carrying out tasks, components for low-level and high-level intelligence are integrated in the robot's cognitive system, and cognitive and physical processes combine to create their behavior. For a modeling framework to enable the design and analysis of such integrated intelligence, the underlying representations in the design of the robot should be dynamically sensitive, capable of reflecting both continuous motion and micro-cognitive influences, while also directly representing the necessary beliefs and intentions for goal-directed behavior. In this paper, a dynamical intention-based modeling framework is presented that satisfies these criteria, along with a hybrid dynamical cognitive agent (HDCA framework for employing dynamical intentions in embodied agents. This dynamical intention-HDCA (DI-HDCA modeling framework is a fusion of concepts from spreading activation networks, hybrid dynamical system models, and the BDI (belief-desire-intention theory of goal-directed reasoning, adapted and employed unconventionally to meet entailments of environment and embodiment. The paper presents two kinds of autonomous agent learning results that demonstrate dynamical intentions and the multi-faceted integration they enable in embodied robots: with a simulated service robot in a grid-world office environment, reactive-level learning minimizes reliance on deliberative-level intelligence, enabling task sequencing and action selection to be distributed over both deliberative and reactive levels; and with a simulated game of Tag, the cognitive-physical integration of an autonomous agent enables the straightforward learning of a user-specified strategy during gameplay, without interruption to the game. In addition, the paper argues that dynamical intentions are consistent with cognitive theory underlying goal-directed behavior, and

  4. Goal-directed action control in children with autism spectrum disorders

    NARCIS (Netherlands)

    Geurts, H.M.; de Wit, S.

    2014-01-01

    Repetitive behavior is a key characteristic of autism spectrum disorders. Our aim was to investigate the hypothesis that this abnormal behavioral repetition results from a tendency to over-rely on habits at the expense of flexible, goal-directed action. Twenty-four children with autism spectrum

  5. Young Children Help Others to Achieve Their Social Goals

    Science.gov (United States)

    Beier, Jonathan S.; Over, Harriet; Carpenter, Malinda

    2014-01-01

    From early in development, humans have strong prosocial tendencies. Much research has documented young children's propensity to help others achieve their unfulfilled goals toward physical objects. Yet many of our most common and important goals are social--directed toward other people. Here we demonstrate that children are also inclined, and able,…

  6. Collaborating with Parents to Establish Behavioral Goals in Child-Centered Play Therapy

    Science.gov (United States)

    Post, Phyllis B.; Ceballos, Peggy L.; Penn, Saundra L.

    2012-01-01

    The purpose of this article is to provide specific guidelines for child-centered play therapists to set behavioral outcome goals to effectively work with families and to meet the demands for accountability in the managed care environment. The child-centered play therapy orientation is the most widely practiced approach among play therapists who…

  7. Directive and Non-Directive Movement in Child Therapy.

    Science.gov (United States)

    Krason, Katarzyna; Szafraniec, Grazyna

    1999-01-01

    Presents a new authorship method of child therapy based on visualization through motion. Maintains that this method stimulates motor development and musical receptiveness, and promotes personality development. Suggests that improvised movement to music facilitates the projection mechanism and that directed movement starts the channeling phase.…

  8. Emotion, Intent and Voluntary Movement in Children with Autism. an Example: The Goal Directed Locomotion

    Science.gov (United States)

    Longuet, Sophie; Ferrel-Chapus, Carole; Oreve, Marie-Joelle; Chamot, Jean-Marc; Vernazza-Martin, Sylvie

    2012-01-01

    This article focuses on the impact of intentionality on goal directed locomotion in healthy and autistic children. Closely linked with emotions and motivation, it is directly connected with movement planning. Is planning only preserved when the goal of the action appears motivating for healthy and autistic children? Is movement programming similar…

  9. Drunk decisions: Alcohol shifts choice from habitual towards goal-directed control in adolescent intermediate-risk drinkers.

    Science.gov (United States)

    Obst, Elisabeth; Schad, Daniel J; Huys, Quentin Jm; Sebold, Miriam; Nebe, Stephan; Sommer, Christian; Smolka, Michael N; Zimmermann, Ulrich S

    2018-05-01

    Studies in humans and animals suggest a shift from goal-directed to habitual decision-making in addiction. We therefore tested whether acute alcohol administration reduces goal-directed and promotes habitual decision-making, and whether these effects are moderated by self-reported drinking problems. Fifty-three socially drinking males completed the two-step task in a randomised crossover design while receiving an intravenous infusion of ethanol (blood alcohol level=80 mg%), or placebo. To minimise potential bias by long-standing heavy drinking and subsequent neuropsychological impairment, we tested 18- to 19-year-old adolescents. Alcohol administration consistently reduced habitual, model-free decisions, while its effects on goal-directed, model-based behaviour varied as a function of drinking problems measured with the Alcohol Use Disorders Identification Test. While adolescents with low risk for drinking problems (scoring towards goal-directed decision-making, such that alcohol possibly even improved their performance. We assume that alcohol disrupted basic cognitive functions underlying habitual and goal-directed decisions in low-risk drinkers, thereby enhancing hasty choices. Further, we speculate that intermediate-risk drinkers benefited from alcohol as a negative reinforcer that reduced unpleasant emotional states, possibly displaying a novel risk factor for drinking in adolescence.

  10. Associative theories of goal-directed behaviour: a case for animal-human translational models

    NARCIS (Netherlands)

    de Wit, S.; Dickinson, A.

    2009-01-01

    Associative accounts of goal-directed action, developed in the fields of human ideomotor action and that of animal learning, can capture cognitive belief-desire psychology of human decision-making. Whereas outcome-response accounts can account for the fact that the thought of a goal can call to mind

  11. Goal-Directed Action Control in Children with Autism Spectrum Disorders

    Science.gov (United States)

    Geurts, Hilde M; de Wit, Sanne

    2014-01-01

    Repetitive behavior is a key characteristic of autism spectrum disorders. Our aim was to investigate the hypothesis that this abnormal behavioral repetition results from a tendency to over-rely on habits at the expense of flexible, goal-directed action. Twenty-four children with autism spectrum disorders and 24 age- and gender-matched controls…

  12. Goal Direction and Effectiveness, Emotional Maturity, and Nuclear Family Functioning

    Science.gov (United States)

    Klever, Phillip

    2009-01-01

    Differentiation of self, a cornerstone concept in Bowen theory, has a profound influence over time on the functioning of the individual and his or her family unit. This 5-year longitudinal study tested this hypothesis with 50 developing nuclear families. The dimensions of differentiation of self that were examined were goal direction and…

  13. Early intranasal insulin therapy halts progression of neurodegeneration: progress in Alzheimer's disease therapeutics.

    Science.gov (United States)

    de la Monte, Suzanne M

    Evaluation of Craft S, Baker LD, Montine TJ, Minoshima S, Watson GS, Claxton A, et al. Intranasal Insulin Therapy for Alzheimer Disease and Amnestic Mild Cognitive Impairment: A Pilot Clinical Trial. Arch Neurol . 2011 Sep 12. Alzheimer's disease is associated with brain insulin deficiency and insulin resistance, similar to the problems in diabetes. If insulin could be supplied to the brain in the early stages of Alzheimer's, subsequent neurodegeneration might be prevented. Administering systemic insulin to elderly non-diabetics poses unacceptable risks of inadvertant hypoglycemia. However, intranasal delivery directs the insulin into the brain, avoiding systemic side-effects. This pilot study demonstrates both efficacy and safety of using intranasal insulin to treat early Alzheimer's and mild cognitive impairment, i.e. the precursor to Alzheimer's. Significant improvements in learning, memory, and cognition occured within a few months, but without intranasal insulin, brain function continued to deteriorate in measurable degrees. Intranasal insulin therapy holds promise for halting progression of Alzheimer's disease.

  14. Outcome producing potential influences twelve-month-olds' interpretation of a novel action as goal-directed.

    Science.gov (United States)

    Biro, Szilvia; Verschoor, Stephan; Coalter, Esther; Leslie, Alan M

    2014-11-01

    Learning about a novel, goal-directed action is a complex process. It requires identifying the outcome of the action and linking the action to its outcome for later use in new situations to predict the action or to anticipate its outcome. We investigated the hypothesis that linking a novel action to a salient change in the environment is critical for infants to assign a goal to the novel action. We report a study in which we show that 12-month-old infants, who were provided with prior experience with a novel action accompanied with a salient visible outcome in one context, can interpret the same action as goal-directed even in the absence of the outcome in another context. Our control condition shows that prior experience with the action, but without the salient effect, does not lead to goal-directed interpretation of the novel action. We also found that, for the case of 9-month-olds infants, prior experience with the outcome producing potential of the novel action does not facilitate a goal-directed interpretation of the action. However, this failure was possibly due to difficulties with generalizing the learnt association to another context rather than with linking the action to its outcome. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Neural systems analysis of decision making during goal-directed navigation.

    Science.gov (United States)

    Penner, Marsha R; Mizumori, Sheri J Y

    2012-01-01

    The ability to make adaptive decisions during goal-directed navigation is a fundamental and highly evolved behavior that requires continual coordination of perceptions, learning and memory processes, and the planning of behaviors. Here, a neurobiological account for such coordination is provided by integrating current literatures on spatial context analysis and decision-making. This integration includes discussions of our current understanding of the role of the hippocampal system in experience-dependent navigation, how hippocampal information comes to impact midbrain and striatal decision making systems, and finally the role of the striatum in the implementation of behaviors based on recent decisions. These discussions extend across cellular to neural systems levels of analysis. Not only are key findings described, but also fundamental organizing principles within and across neural systems, as well as between neural systems functions and behavior, are emphasized. It is suggested that studying decision making during goal-directed navigation is a powerful model for studying interactive brain systems and their mediation of complex behaviors. Copyright © 2011. Published by Elsevier Ltd.

  16. Loss of lateral prefrontal cortex control in food-directed attention and goal-directed food choice in obesity.

    Science.gov (United States)

    Janssen, Lieneke K; Duif, Iris; van Loon, Ilke; Wegman, Joost; de Vries, Jeanne H M; Cools, Roshan; Aarts, Esther

    2017-02-01

    Loss of lateral prefrontal cortex (lPFC)-mediated attentional control may explain the automatic tendency to eat in the face of food. Here, we investigate the neurocognitive mechanism underlying attentional bias to food words and its association with obesity using a food Stroop task. We tested 76 healthy human subjects with a wide body mass index (BMI) range (19-35kg/m 2 ) using fMRI. As a measure of obesity we calculated individual obesity scores based on BMI, waist circumference and waist-to-hip ratio using principal component analyses. To investigate the automatic tendency to overeat directly, the same subjects performed a separate behavioral outcome devaluation task measuring the degree of goal-directed versus automatic food choices. We observed that increased obesity scores were associated with diminished lPFC responses during food attentional bias. This was accompanied by decreased goal-directed control of food choices following outcome devaluation. Together these findings suggest that deficient control of both food-directed attention and choice may contribute to obesity, particularly given our obesogenic environment with food cues everywhere, and the choice to ignore or indulge despite satiety. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Interpersonal Circumplex Profiles Of Persistent Depression: Goals, Self-Efficacy, Problems, And Effects Of Group Therapy.

    Science.gov (United States)

    Locke, Kenneth D; Sayegh, Liliane; Penberthy, J Kim; Weber, Charlotte; Haentjens, Katherine; Turecki, Gustavo

    2017-06-01

    We assessed severely and persistently depressed patients' interpersonal self-efficacy, problems, and goals, plus changes in interpersonal functioning and depression during 20 weeks of group therapy. Outpatients (32 female, 26 male, mean age = 45 years) completed interpersonal circumplex measures of goals, efficacy, and problems before completing 20 weeks of manualized group therapy, during which we regularly assessed depression and interpersonal style. Compared to normative samples, patients lacked interpersonal agency, including less self-efficacy for expressive/assertive actions; stronger motives to avoid conflict, scorn, and humiliation; and more problems with being too submissive, inhibited, and accommodating. Behavioral Activation and especially Cognitive Behavioral Analysis System of Psychotherapy interventions produced improvements in depression and interpersonal agency, with increases in "agentic and communal" efficacy predicting subsequent decreases in depression. While severely and persistently depressed patients were prone to express maladaptive interpersonal dispositions, over the course of group therapy, they showed increasingly agentic and beneficial patterns of cognitions, motives, and behaviors. © 2016 Wiley Periodicals, Inc.

  18. Reliance on habits at the expense of goal-directed control following dopamine precursor depletion

    OpenAIRE

    de Wit, Sanne; Standing, Holly R.; DeVito, Elise E.; Robinson, Oliver J.; Ridderinkhof, K. Richard; Robbins, Trevor W.; Sahakian, Barbara J.

    2011-01-01

    Rationale Dopamine is well known to play an important role in learning and motivation. Recent animal studies have implicated dopamine in the reinforcement of stimulus?response habits, as well as in flexible, goal-directed action. However, the role of dopamine in human action control is still not well understood. Objectives We present the first investigation of the effect of reducing dopamine function in healthy volunteers on the balance between habitual and goal-directed action control. Metho...

  19. Neuronal activity in primate prefrontal cortex related to goal-directed behavior during auditory working memory tasks.

    Science.gov (United States)

    Huang, Ying; Brosch, Michael

    2016-06-01

    Prefrontal cortex (PFC) has been documented to play critical roles in goal-directed behaviors, like representing goal-relevant events and working memory (WM). However, neurophysiological evidence for such roles of PFC has been obtained mainly with visual tasks but rarely with auditory tasks. In the present study, we tested roles of PFC in auditory goal-directed behaviors by recording local field potentials in the auditory region of left ventrolateral PFC while a monkey performed auditory WM tasks. The tasks consisted of multiple events and required the monkey to change its mental states to achieve the reward. The events were auditory and visual stimuli, as well as specific actions. Mental states were engaging in the tasks and holding task-relevant information in auditory WM. We found that, although based on recordings from one hemisphere in one monkey only, PFC represented multiple events that were important for achieving reward, including auditory and visual stimuli like turning on and off an LED, as well as bar touch. The responses to auditory events depended on the tasks and on the context of the tasks. This provides support for the idea that neuronal representations in PFC are flexible and can be related to the behavioral meaning of stimuli. We also found that engaging in the tasks and holding information in auditory WM were associated with persistent changes of slow potentials, both of which are essential for auditory goal-directed behaviors. Our study, on a single hemisphere in a single monkey, reveals roles of PFC in auditory goal-directed behaviors similar to those in visual goal-directed behaviors, suggesting that functions of PFC in goal-directed behaviors are probably common across the auditory and visual modality. This article is part of a Special Issue entitled SI: Auditory working memory. Copyright © 2016 Elsevier B.V. All rights reserved.

  20. Future directions in lipid therapies.

    Science.gov (United States)

    Ansell, Benjamin

    2002-01-01

    Cholesterol management to reduce the burden of cardiovascular disease is a major public health concern. Despite widespread recognition of lipid abnormalities as cardiovascular risk factors, significant cardiovascular event reductions with cholesterol-lowering therapies, and dissemination of treatment guidelines, most high-risk patients are not at target lipid levels. In addition to lifestyle changes, four major drug classes are available to modify lipid levels: fibrates, niacin, resins, and statins. High efficacy and tolerability in clinical trials make statins the most widely prescribed of these agents. Newer, more potent members of this class and novel formulations of niacin and resins may provide more effective therapy for dyslipidemia with fewer side effects. Several agents in development (cholesterol-absorption inhibitors and ACAT inhibitors) exploit mechanisms of action complementary to those of current treatments and combined with statins may produce greater improvements in lipid profiles than are now possible. These innovations should enable a greater number of patients to achieve more aggressive cholesterol goals, thereby reducing the risk of cardiovascular events.

  1. Six-and-a-Half-Month-Old Children Positively Attribute Goals to Human Action and to Humanoid-Robot Motion

    Science.gov (United States)

    Kamewari, K.; Kato, M.; Kanda, T.; Ishiguro, H.; Hiraki, K.

    2005-01-01

    Recent infant studies indicate that goal attribution (understanding of goal-directed action) is present very early in infancy. We examined whether 6.5-month-olds attribute goals to agents and whether infants change the interpretation of goal-directed action according to the kind of agent. We conducted three experiments using the visual habituation…

  2. Framing the frame: How task goals determine the likelihood and direction of framing effects

    OpenAIRE

    Todd McElroy; John J. Seta

    2007-01-01

    We examined how the goal of a decision task influences the perceived positive, negative valence of the alternatives and thereby the likelihood and direction of framing effects. In Study 1 we manipulated the goal to increase, decrease or maintain the commodity in question and found that when the goal of the task was to increase the commodity, a framing effect consistent with those typically observed in the literature was found. When the goal was to decrease, a framing effect opposite to the ty...

  3. Reliance on habits at the expense of goal-directed control following dopamine precursor depletion.

    Science.gov (United States)

    de Wit, Sanne; Standing, Holly R; Devito, Elise E; Robinson, Oliver J; Ridderinkhof, K Richard; Robbins, Trevor W; Sahakian, Barbara J

    2012-01-01

    Dopamine is well known to play an important role in learning and motivation. Recent animal studies have implicated dopamine in the reinforcement of stimulus-response habits, as well as in flexible, goal-directed action. However, the role of dopamine in human action control is still not well understood. We present the first investigation of the effect of reducing dopamine function in healthy volunteers on the balance between habitual and goal-directed action control. The dietary intervention of acute dietary phenylalanine and tyrosine depletion (APTD) was adopted to study the effects of reduced global dopamine function on action control. Participants were randomly assigned to either the APTD or placebo group (ns = 14) to allow for a between-subjects comparison of performance on a novel three-stage experimental paradigm. In the initial learning phase, participants learned to respond to different stimuli in order to gain rewarding outcomes. Subsequently, an outcome-devaluation test and a slips-of-action test were conducted to assess whether participants were able to flexibly adjust their behaviour to changes in the desirability of the outcomes. APTD did not prevent stimulus-response learning, nor did we find evidence for impaired response-outcome learning in the subsequent outcome-devaluation test. However, when goal-directed and habitual systems competed for control in the slips-of-action test, APTD tipped the balance towards habitual control. These findings were restricted to female volunteers. We provide direct evidence that the balance between goal-directed and habitual control in humans is dopamine dependent. The results are discussed in light of gender differences in dopamine function and psychopathologies.

  4. The influence of goal-directed fluid therapy on the prognosis of elderly patients with hypertension and gastric cancer surgery

    Directory of Open Access Journals (Sweden)

    Zeng K

    2014-10-01

    Full Text Available Kai Zeng,* Yanzhen Li,* Min Liang, Youguang Gao, Hongda Cai, Caizhu LinDepartment of Anesthesia, the First Affiliated Hospital, Fujian Medical University, Fuzhou, People’s Republic of China*These authors contributed equally to this workPurpose: We aimed to investigate the influence of perioperative goal-directed fluid therapy (GDFT on the prognosis of elderly patients with gastric cancer and hypertension. Methods: Sixty elderly patients (>60 years old with primary hypertension who received gastric cancer radical surgery and who were American Society of Anesthesiologists (ASA class II or III were enrolled in the current study. Selected patients were divided randomly into two arms, comprising a conventional intraoperative fluid management arm (arm C, n=30 and a GDFT arm (arm G, n=30. Patients in arm C were infused with crystalloids or colloids according to the methods of Miller’s Anesthesia (6th edition, while those in arm G were infused with 200 mL hydroxyethyl starch over 15 minutes under the FloTrac/Vigileo monitoring system, with stroke volume variation between 8% and 13%. Hemodynamics and tissue perfusion laboratory indicators in patients were recorded continuously from 30 minutes before the operation to 24 hours after the operation. Results: Compared with arm C, the average intraoperative intravenous infusion quantity in arm G was significantly reduced (2,732±488 mL versus 3,135±346 mL, P<0.05, whereas average colloid fluid volume was significantly increased (1,235±360 mL versus 760±280 mL, P<0.05. In addition, there were more patients exhibiting intraoperatively and postoperatively stable hemodynamics and less patients with low blood pressure in arm G. Postoperative complications were less frequent, and the time of postoperative hospital stay shorter, in arm G. No significant differences were observed in mortality between the two arms.Conclusion: Our research showed that GDFT stabilized perioperative hemodynamics and reduced the

  5. Goal-Directed Visual Attention Drives Health Goal Priming: An Eye-Tracking Experiment

    NARCIS (Netherlands)

    Laan, van der Laura N.; Hooge, I.T.C.; Smeets, P.A.M.

    2017-01-01

    Objective: Several lab and field experiments have shown that goal priming interventions can be highly effective in promoting healthy food choices. Less is known, however, about the mechanisms by which goal priming affects food choice. This experiment tested the hypothesis that goal priming affects

  6. Flexible goal attribution in early mindreading.

    Science.gov (United States)

    Michael, John; Christensen, Wayne

    2016-03-01

    The 2-systems theory developed by Apperly and Butterfill (2009; Butterfill & Apperly, 2013) is an influential approach to explaining the success of infants and young children on implicit false-belief tasks. There is extensive empirical and theoretical work examining many aspects of this theory, but little attention has been paid to the way in which it characterizes goal attribution. We argue here that this aspect of the theory is inadequate. Butterfill and Apperly's characterization of goal attribution is designed to show how goals could be ascribed by infants without representing them as related to other psychological states, and the minimal mindreading system is supposed to operate without employing flexible semantic-executive cognitive processes. But research on infant goal attribution reveals that infants exhibit a high degree of situational awareness that is strongly suggestive of flexible semantic-executive cognitive processing, and infants appear moreover to be sensitive to interrelations between goals, preferences, and beliefs. Further, close attention to the structure of implicit mindreading tasks--for which the theory was specifically designed--indicates that flexible goal attribution is required to succeed. We conclude by suggesting 2 approaches to resolving these problems. (c) 2016 APA, all rights reserved).

  7. Executive control of stimulus-driven and goal-directed attention in visual working memory.

    Science.gov (United States)

    Hu, Yanmei; Allen, Richard J; Baddeley, Alan D; Hitch, Graham J

    2016-10-01

    We examined the role of executive control in stimulus-driven and goal-directed attention in visual working memory using probed recall of a series of objects, a task that allows study of the dynamics of storage through analysis of serial position data. Experiment 1 examined whether executive control underlies goal-directed prioritization of certain items within the sequence. Instructing participants to prioritize either the first or final item resulted in improved recall for these items, and an increase in concurrent task difficulty reduced or abolished these gains, consistent with their dependence on executive control. Experiment 2 examined whether executive control is also involved in the disruption caused by a post-series visual distractor (suffix). A demanding concurrent task disrupted memory for all items except the most recent, whereas a suffix disrupted only the most recent items. There was no interaction when concurrent load and suffix were combined, suggesting that deploying selective attention to ignore the distractor did not draw upon executive resources. A final experiment replicated the independent interfering effects of suffix and concurrent load while ruling out possible artifacts. We discuss the results in terms of a domain-general episodic buffer in which information is retained in a transient, limited capacity privileged state, influenced by both stimulus-driven and goal-directed processes. The privileged state contains the most recent environmental input together with goal-relevant representations being actively maintained using executive resources.

  8. Directly observed therapy for treating tuberculosis

    OpenAIRE

    Karumbi, Jamlick; Garner, Paul

    2015-01-01

    Background Tuberculosis (TB) requires at least six months of treatment. If treatment is incomplete, patients may not be cured and drug resistance may develop. Directly Observed Therapy (DOT) is a specific strategy, endorsed by the World Health Organization, to improve adherence by requiring health workers, community volunteers or family members to observe and record patients taking each dose. Objectives To evaluate DOT compared to self-administered therapy in people on treatment for active TB...

  9. Four Weeks of Goal-Directed Learning in Primary Physical Education Classes

    NARCIS (Netherlands)

    Platvoet, Sebastiaan W. J.; Elferink-Gemser, Marije T.; Kannekens, Rianne; de Niet, Mark; Visscher, Chris

    Relatively little is known about how practice relates to children's improvement in gross motor skill performance. The aim of this study is to determine to what extent 6- and 7-year-old children improve their gross motor skill performance in a four-week period, in which goal-directed learning is

  10. Setting goals in psychotherapy

    DEFF Research Database (Denmark)

    Emiliussen, Jakob; Wagoner, Brady

    2013-01-01

    The present study is concerned with the ethical dilemmas of setting goals in therapy. The main questions that it aims to answer are: who is to set the goals for therapy and who is to decide when they have been reached? The study is based on four semi-­‐structured, phenomenological interviews...

  11. Early response in cognitive-behavior therapy for syndromes of medically unexplained symptoms.

    Science.gov (United States)

    Kleinstäuber, Maria; Lambert, Michael J; Hiller, Wolfgang

    2017-05-25

    Early dramatic treatment response suggests a subset of patients who respond to treatment before most of it has been offered. These early responders tend to be over represented among those who are well at termination and at follow-up. Early response patterns in psychotherapy have been investigated only for a few of mental disorders so far. The main aim of the current study was to examine early response after five therapy-preparing sessions of a cognitive behavior therapy (CBT) for syndromes of medically unexplained symptoms (MUS). In the context of a randomized, waiting-list controlled trial 48 patients who suffered from ≥3 MUS over ≥6 months received 5 therapy-preparing sessions and 20 sessions of CBT for somatoform disorders. They completed self-report scales of somatic symptom severity (SOMS-7 T), depression (BDI-II), anxiety (BSI), illness anxiety and behavior (IAS) at pre-treatment, after 5 therapy-preparing sessions (FU-5P) and at therapy termination (FU-20 T). The current analyses are based on data from the treatment arm only. Repeated measure ANOVAs revealed a significant decrease of depression (d = 0.34), anxiety (d = 0.60), illness anxiety (d = 0.38) and illness behavior (d = 0.42), but no change of somatic symptom severity (d = -0.03) between pre-treatment and FU-5P. Hierarchical linear multiple regression analyses showed that symptom improvements between pre-treatment and FU-5P predict a better outcome at therapy termination for depression and illness anxiety, after controlling for pre-treatment scores. Mixed-effect ANOVAs revealed significant group*time interaction effects indicating differences in the course of symptom improvement over the therapy between patients who fulfilled a reliable change (i.e., early response) during the 5 therapy-preparing sessions and patients who did not reach an early reliable change. Demographic or clinical variables at pre-treatment were not significantly correlated with differential scores between pre

  12. Goal-Directed Fluid Resuscitation Protocol Based on Arterial Waveform Analysis of Major Burn Patients in a Mass Burn Casualty.

    Science.gov (United States)

    Chiao, Hao-Yu; Chou, Chang-Yi; Tzeng, Yuan-Sheng; Wang, Chih-Hsin; Chen, Shyi-Gen; Dai, Niann-Tzyy

    2018-02-01

    Adequate fluid titration during the initial resuscitation period of major burn patients is crucial. This study aimed to evaluate the feasibility and efficacy of a goal-directed fluid resuscitation protocol that used hourly urine output plus the arterial waveform analysis FloTrac (Edwards LifeSciences, Irvine, Calif) system for major burns to avoid fluid overload. We conducted a retrospective cohort study of 43 major burn patients at the Tri-Service General Hospital after the Formosa Fun Coast Dust Explosion on June 27, 2015. Because of the limited capacity of intensive care units (ICUs), 23 intubated patients were transferred from the burn wards or emergency department to the ICU within 24 hours. Fluid administration was adjusted to achieve a urine output of 30 to 50 mL/h, cardiac index greater than 2.5 L/min/m, and stroke volume variation (SVV) less than 12%. The hourly crystalloid fluid infusion rate was titrated based on SVV and hourly urine output. Of the 23 critically burned patients admitted to the ICU, 13 patients who followed the goal-directed fluid resuscitation protocol within 12 hours postburn were included in the analysis. The mean age (years) was 21.8, and the mean total body surface area (TBSA) burned (%) was 68.0. The mean Revised Baux score was 106.8. All patients sustained inhalation injury. The fluid volumes administered to patients in the first 24 hours and the second 24 hours (mL/kg/% total body surface area) were 3.62 ± 1.23 and 2.89 ± 0.79, respectively. The urine outputs in the first 24 hours and the second 24 hours (mL/kg/h) were 1.13 ± 0.66 and 1.53 ± 0.87, respectively. All patients achieved the established goals within 32 hours postburn. In-hospital mortality rate was 0%. The SVV-based goal-directed fluid resuscitation protocol leads to less unnecessary fluid administration during the early resuscitation phase. Clinicians can efficaciously manage the dynamic body fluid changes in major burn patients under the guidance of the protocol.

  13. Factors affecting osteoarthritis patients' self-reported goal-directed drug information-seeking behaviors after exposure to direct-to-consumer advertising from physicians and the internet.

    Science.gov (United States)

    Liu, Yifei; Farris, Karen B; Doucette, William R

    2011-10-01

    The objective of this study was to investigate appraisal of means (ie, self-efficacy, outcome expectancy, and affect) in predicting patients' goal-directed behaviors of direct-to-consumer advertising (DTCA)-prompted drug-information search from physicians and the internet. One thousand patients were randomly selected from a nationwide sample frame of 3000 osteoarthritis patients. A self-administered survey assessed exposure to DTCA, drug-information search as goal, self-efficacy, outcome expectancy, affect, and osteoarthritis pain. After 6 weeks, another survey measured the behavior of drug-information search for respondents to the first survey. Study subjects were those who were exposed to DTCA in the previous month, and who set drug-information search as their goal. For each information source, a multiple regression analysis was conducted in which drug-information search was the dependent variable, and self-efficacy, outcome expectancy, affect, and osteoarthritis pain were the independent variables. Among 454 patients who were exposed to DTCA, 174 patients set drug-information search as their goal and were the study subjects. The regression for physicians was not statistically significant. The regression for the internet was significant, accounting for 15% of behavior variance. Self-efficacy was a strong predictor of goal-directed drug-information search from the internet. Appraisal of means was useful to predict the goal-directed behavior of DTCA-prompted drug-information search from the internet. For patients who set drug-information search as a goal, actions to promote drug-information search from the internet need to focus on self-efficacy.

  14. Key goals and indicators for successful aging of adults with early-onset disability.

    Science.gov (United States)

    LaPlante, Mitchell P

    2014-01-01

    Substantial improvements have occurred in the longevity of several groups of individuals with early-onset disabilities, with many now surviving to advanced ages. This paper estimates the population of adults aging with early-onset disabilities at 12-15 million persons. Key goals for the successful aging of adults with early-onset disabilities are discussed, emphasizing reduction in risks for aging-related chronic disease and secondary conditions, while promoting social participation and independence. However, indicators suggest that elevated risk factors for aging-related chronic diseases, including smoking, obesity, and inactivity, as well as barriers to prevention and the diminished social and economic situation of adults with disabilities are continuing impediments to successful aging that must be addressed. Increased provider awareness that people with early-onset disabilities are aging and can age successfully and the integration of disability and aging services systems are transformative steps that will help adults with early-onset disability to age more successfully. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Maximizing the probability of satisfying the clinical goals in radiation therapy treatment planning under setup uncertainty

    International Nuclear Information System (INIS)

    Fredriksson, Albin; Hårdemark, Björn; Forsgren, Anders

    2015-01-01

    Purpose: This paper introduces a method that maximizes the probability of satisfying the clinical goals in intensity-modulated radiation therapy treatments subject to setup uncertainty. Methods: The authors perform robust optimization in which the clinical goals are constrained to be satisfied whenever the setup error falls within an uncertainty set. The shape of the uncertainty set is included as a variable in the optimization. The goal of the optimization is to modify the shape of the uncertainty set in order to maximize the probability that the setup error will fall within the modified set. Because the constraints enforce the clinical goals to be satisfied under all setup errors within the uncertainty set, this is equivalent to maximizing the probability of satisfying the clinical goals. This type of robust optimization is studied with respect to photon and proton therapy applied to a prostate case and compared to robust optimization using an a priori defined uncertainty set. Results: Slight reductions of the uncertainty sets resulted in plans that satisfied a larger number of clinical goals than optimization with respect to a priori defined uncertainty sets, both within the reduced uncertainty sets and within the a priori, nonreduced, uncertainty sets. For the prostate case, the plans taking reduced uncertainty sets into account satisfied 1.4 (photons) and 1.5 (protons) times as many clinical goals over the scenarios as the method taking a priori uncertainty sets into account. Conclusions: Reducing the uncertainty sets enabled the optimization to find better solutions with respect to the errors within the reduced as well as the nonreduced uncertainty sets and thereby achieve higher probability of satisfying the clinical goals. This shows that asking for a little less in the optimization sometimes leads to better overall plan quality

  16. Antiretroviral therapy in a community clinic - early lessons from a ...

    African Journals Online (AJOL)

    Antiretroviral therapy in a community clinic - early lessons from a pilot project. ... The HIV Research Unit, University of Cape Town, supplied training and ... Attention must be given to the diagnosis of tuberculosis during screening and early ART ...

  17. Social Goal Orientations, Interpersonal Stress, and Depressive Symptoms among Early Adolescents in Japan: A Test of the Diathesis-Stress Model Using the Trichotomous Framework of Social Goal Orientations

    Science.gov (United States)

    Kuroda, Yuji; Sakurai, Shigeo

    2011-01-01

    This longitudinal study investigated whether depression among early adolescents (aged 12-14 years, N = 116; 65 girls) can be predicted by interactions between social goal orientations and interpersonal stress. Based on Kuroda and Sakurai (2001), this study applied Elliot and Harackiewicz's (1996) trichotomous framework of achievement goals to…

  18. Occupational Needs and Goals of Survivors of Domestic Violence.

    Science.gov (United States)

    Javaherian-Dysinger, Heather; Krpalek, Dragana; Huecker, Esther; Hewitt, Liane; Cabrera, Michelle; Brown, Canique; Francis, Jason; Rogers, Katie; Server, Sage

    2016-01-01

    This study's purpose was to describe the occupational needs and goals of women residing in a domestic violence shelter and their self-perceived changes in satisfaction and occupational performance. Using a retrospective design, data from 68 occupational therapy evaluations from two domestic violence shelter settings were examined. Data were analyzed by coding problem areas and occupational goals and calculating frequencies for these variables. Where data were available, we also analyzed changes in pre- and postscores for self-perceived satisfaction and occupational performance (n = 25). The most common problem areas were leisure, education, work, child rearing, and health management. The most common goals were in the areas of education, work, health management, child rearing, and home management. Retrospective pre- and postchange scores in performance and satisfaction for 25 women were statistically significant. Findings provide direction for, and highlight the importance of occupational therapy services within domestic violence shelters as women regain their life skills.

  19. Tryptophan Depletion Promotes Habitual over Goal-Directed Control of Appetitive Responding in Humans.

    Science.gov (United States)

    Worbe, Yulia; Savulich, George; de Wit, Sanne; Fernandez-Egea, Emilio; Robbins, Trevor W

    2015-02-05

    Optimal behavioral performance results from a balance between goal-directed and habitual systems of behavioral control, which are modulated by ascending monoaminergic projections. While the role of the dopaminergic system in behavioral control has been recently addressed, the extent to which changes in global serotonin neurotransmission could influence these 2 systems is still poorly understood. We employed the dietary acute tryptophan depletion procedure to reduce serotonin neurotransmission in 18 healthy volunteers and 18 matched controls. We used a 3-stage instrumental learning paradigm that includes an initial instrumental learning stage, a subsequent outcome-devaluation test, and a slip-of-action stage, which directly tests the balance between hypothetical goal-directed and habitual systems. We also employed a separate response inhibition control test to assess the behavioral specificity of the results. Acute tryptophan depletion produced a shift of behavioral performance towards habitual responding as indexed by performance on the slip-of-action test. Moreover, greater habitual responding in the acute tryptophan depletion group was predicted by a steeper decline in plasma tryptophan levels. In contrast, acute tryptophan depletion left intact the ability to use discriminative stimuli to guide instrumental choice as indexed by the instrumental learning stage and did not impair inhibitory response control. The major implication of this study is that serotonin modulates the balance between goal-directed and stimulus-response habitual systems of behavioral control. Our findings thus imply that diminished serotonin neurotransmission shifts behavioral control towards habitual responding. © The Author 2015. Published by Oxford University Press on behalf of CINP.

  20. Progress toward cell-directed therapy for phenylketonuria

    Science.gov (United States)

    Harding, CO

    2009-01-01

    Phenylketonuria (PKU) is one of the most common inborn errors of metabolism with an annual incidence of approximately 1:16,000 live births in North America. Contemporary therapy relies upon lifelong dietary protein restriction and supplementation with phenylalanine-free medical foods. This therapy is expensive and unpalatable; dietary compliance is difficult to maintain throughout life. Non-adherence to the diet is associated with learning disabilities, adult-onset neurodegenerative disease, and maternal PKU syndrome. The fervent dream of many individuals with PKU is a more permanent cure for this disease. This paper will review ongoing efforts to develop viable cell-directed therapies, in particular cell transplantation and gene therapy, for the treatment of PKU. PMID:18498375

  1. How to Build an Intentional Android: Infants' Imitation of a Robot's Goal-Directed Actions

    Science.gov (United States)

    Itakura, Shoji; Ishida, Hiraku; Kanda, Takayuki; Shimada, Yohko; Ishiguro, Hiroshi; Lee, Kang

    2008-01-01

    This study examined whether young children are able to imitate a robot's goal-directed actions. Children (24-35 months old) viewed videos showing a robot attempting to manipulate an object (e.g., putting beads inside a cup) but failing to achieve its goal (e.g., beads fell outside the cup). In 1 video, the robot made eye contact with a human…

  2. Enhancing Recognition of High Quality, Functional IEP Goals: A Training Activity for Early Childhood Special Education Staff

    Science.gov (United States)

    Lucas, Anne; Gillaspy, Kathi; Peters, Mary Louise; Hurth, Joicey

    2014-01-01

    This training activity was created to support participants' understanding of the criteria needed to develop and write high quality, participation-based Individualized Education Program (IEP) goals. The term "functional" is often used to describe what goals ought to be, yet many Early Childhood Special Education (ECSE) staff (e.g.,…

  3. Is gaze following purely reflexive or goal-directed instead? Revisiting the automaticity of orienting attention by gaze cues.

    Science.gov (United States)

    Ricciardelli, Paola; Carcagno, Samuele; Vallar, Giuseppe; Bricolo, Emanuela

    2013-01-01

    Distracting gaze has been shown to elicit automatic gaze following. However, it is still debated whether the effects of perceived gaze are a simple automatic spatial orienting response or are instead sensitive to the context (i.e. goals and task demands). In three experiments, we investigated the conditions under which gaze following occurs. Participants were instructed to saccade towards one of two lateral targets. A face distracter, always present in the background, could gaze towards: (a) a task-relevant target--("matching" goal-directed gaze shift)--congruent or incongruent with the instructed direction, (b) a task-irrelevant target, orthogonal to the one instructed ("non-matching" goal-directed gaze shift), or (c) an empty spatial location (no-goal-directed gaze shift). Eye movement recordings showed faster saccadic latencies in correct trials in congruent conditions especially when the distracting gaze shift occurred before the instruction to make a saccade. Interestingly, while participants made a higher proportion of gaze-following errors (i.e. errors in the direction of the distracting gaze) in the incongruent conditions when the distracter's gaze shift preceded the instruction onset indicating an automatic gaze following, they never followed the distracting gaze when it was directed towards an empty location or a stimulus that was never the target. Taken together, these findings suggest that gaze following is likely to be a product of both automatic and goal-driven orienting mechanisms.

  4. Image-guided conformation arc therapy for prostate cancer: Early side effects

    International Nuclear Information System (INIS)

    Soete, Guy; Verellen, Dirk; Michielsen, Dirk; Rappe, Bernard; Keuppen, Frans; Storme, Guy

    2006-01-01

    Purpose: To evaluate early side effects in prostate cancer patients treated with image-guided conformation arc therapy (IGCAT) using a minimultileaf collimator and daily X-ray-assisted patient positioning. Methods and Materials: Between May 2000 and November 2004, 238 cT1-T3N0M0 tumors were treated with doses of 70 or 78 Gy. Seventy patients also received neoadjuvant or concurrent hormonal treatment. Median follow-up is 18 months (range, 4-55 months). Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer toxicity scoring system was used to evaluate early side effects. Results: Grade 1, 2, and >2 acute side effects occurred in 19, 6, and 0% (gastrointestinal) and 37, 16, and 0% (genitourinary) of the patients. No relation between radiation dose and early side effects was observed. Conclusion: Patients treated with image-guided conformation arc therapy experience a low rate of Grade 2 (i.e., requiring medication) early side effects. The definitive evaluation of late side effects and biochemical control requires further follow-up

  5. Slips of action and sequential decisions: a cross-validation study of tasks assessing habitual and goal-directed action control

    Directory of Open Access Journals (Sweden)

    Zsuzsika Sjoerds

    2016-12-01

    Full Text Available Instrumental learning and decision-making rely on two parallel systems: a goal-directed and a habitual system. In the past decade, several paradigms have been developed to study these systems in animals and humans by means of e.g. overtraining, devaluation procedures and sequential decision-making. These different paradigms are thought to measure the same constructs, but cross-validation has rarely been investigated. In this study we compared two widely used paradigms that assess aspects of goal-directed and habitual behavior. We correlated parameters from a two-step sequential decision-making task that assesses model-based and model-free learning with a slips-of-action paradigm that assesses the ability to suppress cue-triggered, learnt responses when the outcome has been devalued and is therefore no longer desirable. Model-based control during the two-step task showed a very moderately positive correlation with goal-directed devaluation sensitivity, whereas model-free control did not. Interestingly, parameter estimates of model-based and goal-directed behavior in the two tasks were positively correlated with higher-order cognitive measures (e.g. visual short-term memory. These cognitive measures seemed to (at least partly mediate the association between model-based control during sequential decision-making and goal-directed behavior after instructed devaluation. This study provides moderate support for a common framework to describe the propensity towards goal-directed behavior as measured with two frequently used tasks. However, we have to caution that the amount of shared variance between the goal-directed and model-based system in both tasks was rather low, suggesting that each task does also pick up distinct aspects of goal-directed behavior. Further investigation of the commonalities and differences between the model-free and habit systems as measured with these, and other, tasks is needed. Also, a follow-up cross-validation on the neural

  6. Early Child Care Teachers' Socialization Goals and Preferred Behavioral Strategies: A Cross-Cultural Comparison

    Science.gov (United States)

    Gernhardt, Ariane; Lamm, Bettina; Keller, Heidi; Döge, Paula

    2014-01-01

    This study investigated early child care teachers' culturally shaped socialization goals and preferred behavioral strategies. The participants were 183 female teachers and trainees, 93 from Osnabrück, Germany, representing an urban Western context, which can be characterized by a primary cultural orientation toward psychological autonomy and a…

  7. [Mexican adolescentes' goals as determinants in the prevention of early pregnancies].

    Science.gov (United States)

    Atienzo, Erika E; Campero, Lourdes; Lozada, Ana Lilia; Herrera, Cristina

    2014-01-01

    This study aims to explore adolescents' intentions related to the early formation of a family. We administered a survey to students in eight schools in Morelos and Mexico City, in 2010. We analyzed intentions of marrying or having a child and fitted an exploratory path model to assess predictors of the intentions of having a child before the age of 20 (n=2974). Around 77% of adolescents expect to have their first child at 20 years or later; 21% show ambivalence or incongruence regarding this, whereas 2% expect to have a child before the age of 20. Parents' expectations for their child's education influence the importance that adolescents give to education. The latter promotes the idea of postponing childbearing until 20 years or later (β=0.13). In order to prevent early pregnancies, interventions and programs should encourage the construction of personal and professional goals.

  8. Early Studies of Binocular and Binaural Directions

    Directory of Open Access Journals (Sweden)

    Nicholas J. Wade

    2018-03-01

    Full Text Available Understanding how the eyes work together to determine the direction of objects provided the impetus for examining integration of signals from the ears to locate sounds. However, the advantages of having two eyes were recorded long before those for two ears were appreciated. In part, this reflects the marked differences in how we can compare perception with one or two organs. It is easier to close one eye and examine monocular vision than to “close” one ear and study monaural hearing. Moreover, we can move our eyes either in the same or in opposite directions, but humans have no equivalent means of moving the ears in unison. Studies of binocular single vision can be traced back over two thousand years and they were implicitly concerned with visual directions from each eye. The location of any point in visual or auditory space can be described by specifying its direction and distance, from the vantage point of an observer. From the late 18th century experiments indicated that binocular direction involved an eye movement component and experimental studies of binaural direction commenced slightly later. However, these early binocular and binaural experiments were not incorporated into theoretical accounts until almost a century later. The early history of research on visual direction with two eyes is contrasted to that on auditory direction with two ears.

  9. Early transition to oral antibiotic therapy for community-acquired pneumonia: duration of therapy, clinical outcomes, and cost analysis.

    Science.gov (United States)

    Omidvari, K; de Boisblanc, B P; Karam, G; Nelson, S; Haponik, E; Summer, W

    1998-08-01

    Our objective was to compare therapeutic outcome and analyse cost-benefit of a 'conventional' (7-day course of i.v. antibiotic therapy) vs. an abbreviated (2-day i.v. antibiotic course followed by 'switch' to oral antibiotics) therapy for in-patients with community-acquired pneumonia (CAP). We used a multicenter prospective, randomized, parallel group with a 28 day follow-up, at the University-based teaching hospitals: The Medical Center of Louisiana in New Orleans, LA and hospitals listed in the acknowledgement. Ninety-five patients were randomized to receive either a 'conventional' course of intravenous antibiotic therapy with cefamandole 1 g i.v. every 6 h for 7 days (n = 37), or an abbreviated course of intravenous therapy with cefamandole (1 g i.v. every 6 h for 2 days) followed by oral therapy with cefaclor (500 mg every 8 h for 5 days). No difference was found in the clinical courses, cure rates, survival or the resolution of the chest radiograph abnormalities among the two groups. The mean duration of therapy (6.88 days for the conventional group compared to 7-30 days for the early oral therapy group) and the frequencies of overall symptomatic improvement (97% vs. 95%, respectively) were similar in both groups. Patients who received early oral therapy had shorter hospital stays (7.3 vs. 9.71 days, P = 0.01), and a lower total cost of care ($2953 vs. $5002, P < 0.05). It was concluded that early transition to an oral antibiotic after an abbreviated course of intravenous therapy in CAP is substantially less expensive and has comparable efficacy to conventional intravenous therapy. Altering physicians' customary management of hospitalized patients with CAP can reduce costs with no appreciable additional risk of adverse patient outcome.

  10. The role of play themes in non-directive play therapy.

    Science.gov (United States)

    Ryan, Virginia; Edge, Andrew

    2012-07-01

    Describing the processes underlying play therapy is important for evidence based practice in child therapy. Employing play themes to describe children's play session contents is in widespread use by practitioners, but an adequate classification of these themes for non-directive play therapy practice has not yet been established. This article sets out to fill this gap by first describing how themes can be distinguished and distilled from the contents of play therapy contents. Second, a classification of main themes and sub-themes with exemplars to illustrate these concepts which is compatible with non-directive play therapy practice is set out. Finally a pilot project with experienced play therapists to test this classification in practice is suggested, along with the research questions that will need to be investigated in the shorter and longer terms.

  11. Fronto-parietal coding of goal-directed actions performed by artificial agents.

    Science.gov (United States)

    Kupferberg, Aleksandra; Iacoboni, Marco; Flanagin, Virginia; Huber, Markus; Kasparbauer, Anna; Baumgartner, Thomas; Hasler, Gregor; Schmidt, Florian; Borst, Christoph; Glasauer, Stefan

    2018-03-01

    With advances in technology, artificial agents such as humanoid robots will soon become a part of our daily lives. For safe and intuitive collaboration, it is important to understand the goals behind their motor actions. In humans, this process is mediated by changes in activity in fronto-parietal brain areas. The extent to which these areas are activated when observing artificial agents indicates the naturalness and easiness of interaction. Previous studies indicated that fronto-parietal activity does not depend on whether the agent is human or artificial. However, it is unknown whether this activity is modulated by observing grasping (self-related action) and pointing actions (other-related action) performed by an artificial agent depending on the action goal. Therefore, we designed an experiment in which subjects observed human and artificial agents perform pointing and grasping actions aimed at two different object categories suggesting different goals. We found a signal increase in the bilateral inferior parietal lobule and the premotor cortex when tool versus food items were pointed to or grasped by both agents, probably reflecting the association of hand actions with the functional use of tools. Our results show that goal attribution engages the fronto-parietal network not only for observing a human but also a robotic agent for both self-related and social actions. The debriefing after the experiment has shown that actions of human-like artificial agents can be perceived as being goal-directed. Therefore, humans will be able to interact with service robots intuitively in various domains such as education, healthcare, public service, and entertainment. © 2017 Wiley Periodicals, Inc.

  12. External radiation therapy in early stage prostate cancer

    International Nuclear Information System (INIS)

    Sandler, Howard M.

    1996-01-01

    Optimal therapy for adenocarcinoma of the prostate is controversial. Numerous options are available, however, comparison of results is difficult in view of the insufficiency of phase III randomized trials comparing alternative treatment strategies. These options include such strategies as no curative therapy (so-called watchful waiting), radiotherapy (external and/or internal), cryotherapy, or radical prostatectomy. Clearly, a broad spectrum of clinical approaches. When reported experiences involving radiation therapy and radical prostatectomy are compared, surgical patients tend to be younger, of earlier stage, of higher performance status, and have lower pre-therapy PSA. These prognostic factors influence the probability of disease control, and since patient selection can have a profound impact on results reporting, these issues need to be carefully controlled. A review of patients who are potentially candidates for surgery at the University of Michigan treated with conformal therapy external beam treatment, indicates that these relatively early patients are doing well. These issues will be elaborated upon further during the presentation

  13. Direct Molecular Detection and Genotyping of Borrelia burgdorferi from Whole Blood of Patients with Early Lyme Disease

    Science.gov (United States)

    Eshoo, Mark W.; Crowder, Christopher C.; Rebman, Alison W.; Rounds, Megan A.; Matthews, Heather E.; Picuri, John M.; Soloski, Mark J.; Ecker, David J.; Schutzer, Steven E.; Aucott, John N.

    2012-01-01

    Direct molecular tests in blood for early Lyme disease can be insensitive due to low amount of circulating Borrelia burgdorferi DNA. To address this challenge, we have developed a sensitive strategy to both detect and genotype B. burgdorferi directly from whole blood collected during the initial patient visit. This strategy improved sensitivity by employing 1.25 mL of whole blood, a novel pre-enrichment of the entire specimen extract for Borrelia DNA prior to a multi-locus PCR and electrospray ionization mass spectrometry detection assay. We evaluated the assay on blood collected at the initial presentation from 21 endemic area patients who had both physician-diagnosed erythema migrans (EM) and positive two-tiered serology either at the initial visit or at a follow-up visit after three weeks of antibiotic therapy. Results of this DNA analysis showed detection of B. burgdorferi in 13 of 21 patients (62%). In most cases the new assay also provided the B. burgdorferi genotype. The combined results of our direct detection assay with initial physician visit serology resulted in the detection of early Lyme disease in 19 of 21 (90%) of patients at the initial visit. In 5 of 21 cases we demonstrate the ability to detect B. burgdorferi in early Lyme disease directly from whole blood specimens prior to seroconversion. PMID:22590620

  14. The Neural Representation of Goal-Directed Actions and Outcomes in the Ventral Striatum's Olfactory Tubercle

    Science.gov (United States)

    Gadziola, Marie A.

    2016-01-01

    The ventral striatum is critical for evaluating reward information and the initiation of goal-directed behaviors. The many cellular, afferent, and efferent similarities between the ventral striatum's nucleus accumbens and olfactory tubercle (OT) suggests the distributed involvement of neurons within the ventral striatopallidal complex in motivated behaviors. Although the nucleus accumbens has an established role in representing goal-directed actions and their outcomes, it is not known whether this function is localized within the nucleus accumbens or distributed also within the OT. Answering such a fundamental question will expand our understanding of the neural mechanisms underlying motivated behaviors. Here we address whether the OT encodes natural reinforcers and serves as a substrate for motivational information processing. In recordings from mice engaged in a novel water-motivated instrumental task, we report that OT neurons modulate their firing rate during initiation and progression of the instrumental licking behavior, with some activity being internally generated and preceding the first lick. We further found that as motivational drive decreases throughout a session, the activity of OT neurons is enhanced earlier relative to the behavioral action. Additionally, OT neurons discriminate the types and magnitudes of fluid reinforcers. Together, these data suggest that the processing of reward information and the orchestration of goal-directed behaviors is a global principle of the ventral striatum and have important implications for understanding the neural systems subserving addiction and mood disorders. SIGNIFICANCE STATEMENT Goal-directed behaviors are widespread among animals and underlie complex behaviors ranging from food intake, social behavior, and even pathological conditions, such as gambling and drug addiction. The ventral striatum is a neural system critical for evaluating reward information and the initiation of goal-directed behaviors. Here we

  15. A Comparison of Aphasia Therapy Outcomes before and after a Very Early Rehabilitation Programme Following Stroke

    Science.gov (United States)

    Godecke, Erin; Ciccone, Natalie A.; Granger, Andrew S.; Rai, Tapan; West, Deborah; Cream, Angela; Cartwright, Jade; Hankey, Graeme J.

    2014-01-01

    Background: Very early aphasia rehabilitation studies have shown mixed results. Differences in therapy intensity and therapy type contribute significantly to the equivocal results. Aims: To compare a standardized, prescribed very early aphasia therapy regimen with a historical usual care control group at therapy completion (4-5 weeks post-stroke)…

  16. Interaction of Instrumental and Goal-Directed Learning Modulates Prediction Error Representations in the Ventral Striatum.

    Science.gov (United States)

    Guo, Rong; Böhmer, Wendelin; Hebart, Martin; Chien, Samson; Sommer, Tobias; Obermayer, Klaus; Gläscher, Jan

    2016-12-14

    Goal-directed and instrumental learning are both important controllers of human behavior. Learning about which stimulus event occurs in the environment and the reward associated with them allows humans to seek out the most valuable stimulus and move through the environment in a goal-directed manner. Stimulus-response associations are characteristic of instrumental learning, whereas response-outcome associations are the hallmark of goal-directed learning. Here we provide behavioral, computational, and neuroimaging results from a novel task in which stimulus-response and response-outcome associations are learned simultaneously but dominate behavior at different stages of the experiment. We found that prediction error representations in the ventral striatum depend on which type of learning dominates. Furthermore, the amygdala tracks the time-dependent weighting of stimulus-response versus response-outcome learning. Our findings suggest that the goal-directed and instrumental controllers dynamically engage the ventral striatum in representing prediction errors whenever one of them is dominating choice behavior. Converging evidence in human neuroimaging studies has shown that the reward prediction errors are correlated with activity in the ventral striatum. Our results demonstrate that this region is simultaneously correlated with a stimulus prediction error. Furthermore, the learning system that is currently dominating behavioral choice dynamically engages the ventral striatum for computing its prediction errors. This demonstrates that the prediction error representations are highly dynamic and influenced by various experimental context. This finding points to a general role of the ventral striatum in detecting expectancy violations and encoding error signals regardless of the specific nature of the reinforcer itself. Copyright © 2016 the authors 0270-6474/16/3612650-11$15.00/0.

  17. Goal directed fluid therapy decreases postoperative morbidity but not mortality in major non-cardiac surgery: a meta-analysis and trial sequential analysis of randomized controlled trials.

    Science.gov (United States)

    Som, Anirban; Maitra, Souvik; Bhattacharjee, Sulagna; Baidya, Dalim K

    2017-02-01

    Optimum perioperative fluid administration may improve postoperative outcome after major surgery. This meta-analysis and systematic review has been aimed to determine the effect of dynamic goal directed fluid therapy (GDFT) on postoperative morbidity and mortality in non-cardiac surgical patients. Meta-analysis of published prospective randomized controlled trials where GDFT based on non-invasive flow based hemodynamic measurement has been compared with a standard care. Data from 41 prospective randomized trials have been included in this study. Use of GDFT in major surgical patients does not decrease postoperative hospital/30-day mortality (OR 0.70, 95 % CI 0.46-1.08, p = 0.11) length of post-operative hospital stay (SMD -0.14; 95 % CI -0.28, 0.00; p = 0.05) and length of ICU stay (SMD -0.12; 95 % CI -0.28, 0.04; p = 0.14). However, number of patients having at least one postoperative complication is significantly lower with use of GDFT (OR 0.57; 95 % CI 0.43, 0.75; p infection (p = 0.002) and postoperative hypotension (p = 0.04) are also decreased with used of GDFT as opposed to a standard care. Though patients who received GDFT were infused more colloid (p infection, abdominal complications and postoperative hypotension is reduced.

  18. Past, present and future of cyanide antagonism research: From the early remedies to the current therapies.

    Science.gov (United States)

    Petrikovics, Ilona; Budai, Marianna; Kovacs, Kristof; Thompson, David E

    2015-06-26

    This paper reviews milestones in antidotal therapies for cyanide (CN) spanning early remedies, current antidotal systems and research towards next generation therapies. CN has been a part of plant defense mechanisms for millions of years. It became industrially important in the nineteenth century with the advent of CN assisted gold mining and the use of CN as a pest control agent. The biochemical basis of CN poisoning was actively studied and key mechanisms were understood as early as 1929. These fundamental studies led to a variety of antidotes, including indirect CN binders that generate methemoglobin, direct CN binders such as hydroxocobalamin, and sulfur donors that convert CN to the less toxic thiocyanate. Research on blood gases at the end of the twentieth century shed new light on the role of nitric oxide (NO) in the body. The discovery of NO's ability to compete with CN for enzymatic binding sites provided a previously missed explanation for the rapid efficacy of NO generating antidotes such as the nitrites. Presently used CN therapies include: methemoglobin/NO generators (e.g., sodium nitrite, amyl nitrite, and dimethyl aminophenol), sulfur donors (e.g., sodium thiosulfate and glutathione), and direct binding agents [(e.g., hydroxocobalamin and dicobalt salt of ethylenediaminetetraacetic acid (dicobalt edetate)]. A strong effort is being made to explore novel antidotal systems and to formulate them for rapid administration at the point of intoxication in mass casualty scenarios. New antidotes, formulations, and delivery systems are enhancing bioavailability and efficacy and hold promise for a new generation of improved CN countermeasures.

  19. Mexican adolescents’ goals as determinants in the prevention of early pregnancies

    Directory of Open Access Journals (Sweden)

    Erika E Atienzo

    2014-05-01

    Full Text Available Objective. This study aims to explore adolescents’ intentions related to the early formation of a family. Materials and methods. We administered a survey to students in eight schools in Morelos and Mexico City, in 2010. We analyzed intentions of marrying or having a child and fitted an exploratory path model to assess predictors of the intentions of having a child before the age of 20 (n=2974. Results. Around 77% of adolescents expect to have their first child at 20 years or later; 21% show ambivalence or incongruence regarding this, whereas 2% expect to have a child before the age of 20. Parents’ expectations for their child’s education influence the importance that adolescents give to education. The latter promotes the idea of postponing childbearing until 20 years or later (β=0.13. Conclusions. In order to prevent early pregnancies, interventions and programs should encourage the construction of personal and professional goals.

  20. Original Research: Metabolic alterations from early life thyroxine replacement therapy in male Ames dwarf mice are transient.

    Science.gov (United States)

    Darcy, Justin; Fang, Yimin; Hill, Cristal M; McFadden, Sam; Sun, Liou Y; Bartke, Andrzej

    2016-10-01

    Ames dwarf mice are exceptionally long-lived due to a Prop1 loss of function mutation resulting in deficiency of growth hormone, thyroid-stimulating hormone and prolactin. Deficiency in thyroid-stimulating hormone and growth hormone leads to greatly reduced levels of circulating thyroid hormones and insulin-like growth factor 1, as well as a reduction in insulin secretion. Early life growth hormone replacement therapy in Ames dwarf mice significantly shortens their longevity, while early life thyroxine (T4) replacement therapy does not. Possible mechanisms by which early life growth hormone replacement therapy shortens longevity include deleterious effects on glucose homeostasis and energy metabolism, which are long lasting. A mechanism explaining why early life T4 replacement therapy does not shorten longevity remains elusive. Here, we look for a possible explanation as to why early life T4 replacement therapy does not impact longevity of Ames dwarf mice. We found that early life T4 replacement therapy increased body weight and advanced the age of sexual maturation. We also find that early life T4 replacement therapy does not impact glucose tolerance or insulin sensitivity, and any deleterious effects on oxygen consumption, respiratory quotient and heat production are transient. Lastly, we find that early life T4 replacement therapy has long-lasting effects on bone mineral density and bone mineral content. We suggest that the transient effects on energy metabolism and lack of effects on glucose homeostasis are the reasons why there is no shortening of longevity after early life T4 replacement therapy in Ames dwarf mice. © 2016 by the Society for Experimental Biology and Medicine.

  1. Early versus delayed initiation of antiretroviral therapy for Indian HIV-Infected individuals with tuberculosis on antituberculosis treatment.

    Science.gov (United States)

    Sinha, Sanjeev; Shekhar, Rahul C; Singh, Gurjeet; Shah, Nipam; Ahmad, Hafiz; Kumar, Narendra; Sharma, Surendra K; Samantaray, J C; Ranjan, Sanjai; Ekka, Meera; Sreenivas, Vishnu; Mitsuyasu, Ronald T

    2012-07-31

    For antiretroviral therapy (ART) naive human immunodeficiency virus (HIV) infected adults suffering from tuberculosis (TB), there is uncertainty about the optimal time to initiate highly active antiretroviral therapy (HAART) after starting antituberculosis treatment (ATT), in order to minimize mortality, HIV disease progression, and adverse events. In a randomized, open label trial at All India Institute of Medical Sciences, New Delhi, India, eligible HIV positive individuals with a diagnosis of TB were randomly assigned to receive HAART after 2-4 or 8-12 weeks of starting ATT, and were followed for 12 months after HAART initiation. Participants received directly observed therapy short course (DOTS) for TB, and an antiretroviral regimen comprising stavudine or zidovudine, lamivudine, and efavirenz. Primary end points were death from any cause, and progression of HIV disease marked by failure of ART. A total of 150 patients with HIV and TB were initiated on HAART: 88 received it after 2-4 weeks (early ART) and 62 after 8-12 weeks (delayed ART) of starting ATT. There was no significant difference in mortality between the groups after the introduction of HAART. However, incidence of ART failure was 31% in delayed versus 16% in early ART arm (p = 0.045). Kaplan Meier disease progression free survival at 12 months was 79% for early versus 64% for the delayed ART arm (p = 0.05). Rates of adverse events were similar. Early initiation of HAART for patients with HIV and TB significantly decreases incidence of HIV disease progression and has good tolerability. CTRI/2011/12/002260.

  2. Feasibility and safety of early combined cognitive and physical therapy for critically ill medical and surgical patients: the Activity and Cognitive Therapy in ICU (ACT-ICU) trial

    Science.gov (United States)

    Brummel, N.E.; Girard, T.D.; Ely, E.W.; Pandharipande, P.P.; Morandi, A.; Hughes, C.G.; Graves, A.J.; Shintani, A.K.; Murphy, E.; Work, B.; Pun, B.T.; Boehm, L.; Gill, T.M.; Dittus, R.S.; Jackson, J.C.

    2013-01-01

    PURPOSE Cognitive impairment after critical illness is common and debilitating. We developed a cognitive therapy program for critically ill patients and assessed the feasibility and safety of administering combined cognitive and physical therapy early during a critical illness. METHODS We randomized 87 medical and surgical ICU patients with respiratory failure and/or shock in a 1:1:2 manner to three groups: usual care, early once-daily physical therapy, or early once-daily physical therapy plus a novel, progressive, twice-daily cognitive therapy protocol. Cognitive therapy included orientation, memory, attention, and problem solving exercises, and other activities. We assessed feasibility outcomes of the early cognitive plus physical therapy intervention. At 3-months, we also assessed cognitive, functional and health-related quality of life outcomes. Data are presented as median [interquartile range] or frequency (%). RESULTS Early cognitive therapy was a delivered to 41/43 (95%) of cognitive plus physical therapy patients on 100% [92–100%] of study days beginning 1.0 [1.0–1.0] day following enrollment. Physical therapy was received by 17/22 (77%) of usual care patients, by 21/22 (95%) of physical therapy only patients and 42/43 (98%) of cognitive plus physical therapy patients on 17% [10–26%], 67% [46–87%] and 75% [59–88%] of study days, respectively. Cognitive, functional and health-related quality of life outcomes did not differ between groups at 3-month follow-up. CONCLUSIONS This pilot study demonstrates that early rehabilitation can be extended beyond physical therapy to include cognitive therapy. Future work to determine optimal patient selection, intensity of treatment and benefits of cognitive therapy in the critically ill is needed. PMID:24257969

  3. Application of the linear-quadratic model with incomplete repair to radionuclide directed therapy

    International Nuclear Information System (INIS)

    Millar, W.T.; Glasgow Univ.

    1991-01-01

    The LQ model has now been extended to include a general time varying dose rate profile, and the equations can be readily evaluated if an exponential radiation damage repair process is assumed. These equations are applicable to radionuclide directed therapy, including brachytherapy. Kinetic uptake data obtained during radionuclide directed therapy may therefore be used to determine the radiobiological dosimetry of the target and non-target tissues. Also, preliminary tracer studies may be used to pre-plan the radionuclide directed therapy, provided that tracer and therapeutic amounts of the radionuclide carrier are identically processed by the tissues. It is also shown that continuous radionuclide therapy will induce less damage in late-responding tissues than 2 Gy/fraction external beam therapy if the ratio of the maximum dose rate and the sublethal damage repair half-life in the tissue is less than 1.0 Gy. Similar inequalities may be derived for β-particle radionuclide directed therapy. (author)

  4. Radiation therapy planning for early-stage Hodgkin lymphoma

    DEFF Research Database (Denmark)

    Maraldo, Maja V; Dabaja, Bouthaina S; Filippi, Andrea R

    2015-01-01

    PURPOSE: Early-stage Hodgkin lymphoma (HL) is a rare disease, and the location of lymphoma varies considerably between patients. Here, we evaluate the variability of radiation therapy (RT) plans among 5 International Lymphoma Radiation Oncology Group (ILROG) centers with regard to beam arrangements...... axillary disease, and 1 had disease in the neck only. The median age at diagnosis was 34 years (range, 21-74 years), and 5 patients were male. Of the resulting 50 treatment plans, 15 were planned with volumetric modulated arc therapy (1-4 arcs), 16 with intensity modulated RT (3-9 fields), and 19 with 3...

  5. Goal-directed, habitual and Pavlovian prosocial behavior

    Directory of Open Access Journals (Sweden)

    Filip eGęsiarz

    2015-05-01

    Full Text Available Although prosocial behaviors have been widely studied across disciplines, the mechanisms underlying them are not fully understood. Evidence from psychology, biology and economics suggests that prosocial behaviors can be driven by a variety of seemingly opposing factors: altruism or egoism, intuition or deliberation, inborn instincts or learned dispositions, and utility derived from actions or their outcomes. Here we propose a framework inspired by research on reinforcement learning and decision making that links these processes and explains characteristics of prosocial behaviors in different contexts. More specifically, we suggest that prosocial behaviors inherit features of up to three decision-making systems employed to choose between self- and other- regarding acts: a goal-directed system that selects actions based on their predicted consequences, a habitual system that selects actions based on their reinforcement history, and a Pavlovian system that emits reflexive responses based on evolutionarily prescribed priors. This framework, initially described in the field of cognitive neuroscience and machine learning, provides insight into the potential neural circuits and computations shaping prosocial behaviors. Furthermore, it identifies specific conditions in which each of these three systems should dominate and promote other- or self- regarding behavior.

  6. SHOULD I STAY OR SHOULD I GO? CONCEPTUAL UNDERPINNINGS OF GOAL-DIRECTED ACTIONS

    Directory of Open Access Journals (Sweden)

    GIOVANNI eMIRABELLA

    2014-11-01

    Full Text Available All actions, even the simplest like moving an arm to grasp a pen, are associated with energy costs. Thus all mobile organisms possess the ability to evaluate resources and select those behaviours that are most likely to lead to the greatest accrual of valuable items (rewards in the near or, especially in the case of humans, distant future. The evaluation process is performed at all possible stages of the series of decisions that lead to the building of a goal-directed action or to its suppression. This is because all animals have a limited amount of energy and resources; to survive and be able to reproduce they have to minimize the costs and maximize the outcomes of their actions. These computations are at the root of behavioral flexibility. Two executive functions play a major role in generating flexible behaviors: i the ability to predict future outcomes of goal-directed actions; and ii the ability to cancel them when they are unlikely to accomplish valuable results. These two processes operate continuously during the entire course of a movement: during its genesis, its planning and even its execution, so that the motor output can be modulated or suppressed at any time before its execution.In this review, functional interactions of the extended neural network subserving generation and inhibition of goal-directed movements will be outlined, leading to the intriguing hypothesis that the performance of actions and their suppression are not specified by independent sets of brain regions. Rather, it will be proposed that acting and stopping are functions emerging from specific interactions between largely overlapping brain regions, whose activity is intimately linked (directly or indirectly to the evaluations of pros and cons of an action. Such mechanism would allow the brain to perform as a highly efficient and flexible system, as different functions could be computed exploiting the same components operating in different configurations.

  7. Indication for and frequency of early orthodontic therapy or interceptive measures.

    Science.gov (United States)

    Schopf, Peter

    2003-05-01

    The early treatment of nonskeletal and skeletal orthodontic anomalies in the deciduous and early mixed dentition is intended to prevent the development of pronounced anomalies in the late mixed and permanent dentition with the ultimate aim of reducing or even eliminating the need for later orthodontic treatment. There is a general consensus in the international literature that early therapy is indicated in cases of anterior and lateral crossbite and Class III malocclusion, and possibly for extreme forms of mandibular retrognathism (overjet > or =10 mm) and of open bite. However, evidence of the efficiency of early orthodontic measures is just as rare as studies providing serviceable information on the incidence of tooth malalignments and malocclusions in the deciduous and early mixed dentition, some of whose findings are in any case highly divergent. This makes it substantially more difficult to draw conclusions on the extent to which early orthodontic therapy may be indicated. In order to obtain information on the incidence of nonskeletal and skeletal orthodontic problems constituting a treatment need, 2326 first-year schoolchildren aged between 6 and 7 years were examined in Frankfurt am Main and in the Rural District of Offenbach. In only 14.7% of the children were no relevant orthodontic findings recorded. 77.2% displayed mild to severe dysgnathic symptoms, though without early orthodontic therapy being considered indicated. Treatment with orthodontic appliances was considered urgent for 187 of the children (8.04%). With 8.3% and 7.9% respectively, lateral and anterior crossbite were top of the list of anomalies with an urgent treatment need. Among the patients with lateral crossbite, the prognostically less favorable unilateral form was recorded approximately four times more often than the bilateral form. Markedly increased sagittal overjet > or =10 mm) was registered in only 1.4% of the children, and negative overjet (Class III) (with the exception of edge

  8. Achievement Goal Orientations and Adolescents’ Subjective Well-Being in School: The Mediating Roles of Academic Social Comparison Directions

    OpenAIRE

    Tian, Lili; Yu, Tingting; Huebner, E. Scott

    2017-01-01

    The purpose of this study was to examine the multiple mediational roles of academic social comparison directions (upward academic social comparison and downward academic social comparison) on the relationships between achievement goal orientations (i.e., mastery goals, performance-approach goals, and performance-avoidance goals) and subjective well-being (SWB) in school (school satisfaction, school affect) in adolescent students in China. A total of 883 Chinese adolescent students (430 males;...

  9. The impact of early symptom change and therapeutic alliance on treatment outcome in cognitive-behavioural therapy for eating disorders.

    Science.gov (United States)

    Turner, Hannah; Bryant-Waugh, Rachel; Marshall, Emily

    2015-10-01

    The present study explored the impact of early symptom change (cognitive and behavioural) and the early therapeutic alliance on treatment outcome in cognitive-behavioural therapy (CBT) for the eating disorders. Participants were 94 adults with diagnosed eating disorders who completed a course of CBT in an out-patient community eating disorders service in the UK. Patients completed a measure of eating disorder psychopathology at the start of treatment, following the 6th session and at the end of treatment. They also completed a measure of therapeutic alliance following the 6th session. Greater early reduction in dietary restraint and eating concerns, and smaller levels of change in shape concern, significantly predicted later reduction in global eating pathology. The early therapeutic alliance was strong across the three domains of tasks, goals and bond. Early symptom reduction was a stronger predictor of later reduction in eating pathology than early therapeutic alliance. The early therapeutic alliance did not mediate the relationship between early symptom reduction and later reduction in global eating pathology. Instead, greater early symptom reduction predicted a strong early therapeutic alliance. Early clinical change was the strongest predictor of treatment outcome and this also facilitated the development of a strong early alliance. Clinicians should be encouraged to deliver all aspects of evidence-based CBT, including behavioural change. The findings suggest that this will have a positive impact on both the early therapeutic alliance and later change in eating pathology. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Wearable Therapy - Detecting Information from Wearables and Mobiles that are Relevant to Clinical and Self-directed Therapy.

    Science.gov (United States)

    Arnrich, Bert; Ersoy, Cem; Mayora, Oscar; Dey, Anind; Berthouze, Nadia; Kunze, Kai

    2017-01-09

    This accompanying editorial provides a brief introduction into the focus theme "Wearable Therapy". The focus theme "Wearable Therapy" aims to present contributions which target wearable and mobile technologies to support clinical and self-directed therapy. A call for papers was announced to all participants of the "9th International Conference on Pervasive Computing Technologies for Healthcare" and was published in November 2015. A peer review process was conducted to select the papers for the focus theme. Six papers were selected to be included in this focus theme. The paper topics cover a broad range including an approach to build a health informatics research program, a comprehensive literature review of self-quantification for health self-management, methods for affective state detection of informal care givers, social-aware handling of falls, smart shoes for supporting self-directed therapy of alcohol addicts, and reference information model for pervasive health systems. More empirical evidence is needed that confirms sustainable effects of employing wearable and mobile technology for clinical and self-directed therapy. Inconsistencies between different conceptual approaches need to be revealed in order to enable more systematic investigations and comparisons.

  11. Early Change in Stroke Size Performs Best in Predicting Response to Therapy.

    Science.gov (United States)

    Simpkins, Alexis Nétis; Dias, Christian; Norato, Gina; Kim, Eunhee; Leigh, Richard

    2017-01-01

    Reliable imaging biomarkers of response to therapy in acute stroke are needed. The final infarct volume and percent of early reperfusion have been used for this purpose. Early fluctuation in stroke size is a recognized phenomenon, but its utility as a biomarker for response to therapy has not been established. This study examined the clinical relevance of early change in stroke volume and compared it with the final infarct volume and percent of early reperfusion in identifying early neurologic improvement (ENI). Acute stroke patients, enrolled between 2013 and 2014 with serial magnetic resonance imaging (MRI) scans (pretreatment baseline, 2 h post, and 24 h post), who received thrombolysis were included in the analysis. Early change in stroke volume, infarct volume at 24 h on diffusion, and percent of early reperfusion were calculated from the baseline and 2 h MRI scans were compared. ENI was defined as ≥4 point decrease in National Institutes of Health Stroke Scales within 24 h. Logistic regression models and receiver operator characteristics analysis were used to compare the efficacy of 3 imaging biomarkers. Serial MRIs of 58 acute stroke patients were analyzed. Early change in stroke volume was significantly associated with ENI by logistic regression analysis (OR 0.93, p = 0.048) and remained significant after controlling for stroke size and severity (OR 0.90, p = 0.032). Thus, for every 1 mL increase in stroke volume, there was a 10% decrease in the odds of ENI, while for every 1 mL decrease in stroke volume, there was a 10% increase in the odds of ENI. Neither infarct volume at 24 h nor percent of early reperfusion were significantly associated with ENI by logistic regression. Receiver-operator characteristic analysis identified early change in stroke volume as the only biomarker of the 3 that performed significantly different than chance (p = 0.03). Early fluctuations in stroke size may represent a more reliable biomarker for response to therapy than the

  12. Effects of psychosocial stress on the goal-directed and habit memory systems during learning and later execution.

    Science.gov (United States)

    Fournier, Marion; d'Arripe-Longueville, Fabienne; Radel, Rémi

    2017-03-01

    Instrumental learning occurs through both goal-directed and habit memory systems, which are supported by anatomically distinct brain systems. Interestingly, stress may promote habits at the expense of goal-directed performance, since stress before training in an instrumental task was found to cause individuals to carry on with the learned association in spite of a devalued outcome. These findings nevertheless left pending questions, and it has been difficult to determine which system is primarily affected by stress (an improved habit system, an impaired goal-directed system, or both) and at what point the stress acts (at the moment of learning by making more resistant habits, or after devaluation by making individuals less sensitive to change in the outcome value). The present study (N=72 participants, 63 males and 9 females) aimed to answer these questions with (i) an instrumental task that dissociates the two memory systems and (ii) three conditions of psychosocial stress exposure (Trier Social Stress Test): stress induced before learning, before devaluation, and not induced for the control group. The study confirms that exposure to psychosocial stress leads to habitual performance. Moreover, it provides new insight into this effect by locating its origin as an impairment in the capacity of the goal-directed system rather than a reinforcement in habit learning. These results are discussed in light of recent neurobiological models of stress and memory. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Product behavior and appearance effects on experienced engagement during experimental and goal-directed tasks

    NARCIS (Netherlands)

    Rozendaal, M.C.; Keyson, D.V.; Ridder, de H.

    2007-01-01

    This study examines how digital products can be designed towards increased levels of experienced engagement. An experiment was conducted in which 24 participants were asked to interact with a videogame that varied in behavior and appearance aspects during experiential and goal-directed tasks.

  14. Early versus delayed initiation of antiretroviral therapy for Indian HIV-Infected individuals with tuberculosis on antituberculosis treatment

    Directory of Open Access Journals (Sweden)

    Sinha Sanjeev

    2012-07-01

    Full Text Available Abstract Background For antiretroviral therapy (ART naive human immunodeficiency virus (HIV infected adults suffering from tuberculosis (TB, there is uncertainty about the optimal time to initiate highly active antiretroviral therapy (HAART after starting antituberculosis treatment (ATT, in order to minimize mortality, HIV disease progression, and adverse events. Methods In a randomized, open label trial at All India Institute of Medical Sciences, New Delhi, India, eligible HIV positive individuals with a diagnosis of TB were randomly assigned to receive HAART after 2-4 or 8-12 weeks of starting ATT, and were followed for 12 months after HAART initiation. Participants received directly observed therapy short course (DOTS for TB, and an antiretroviral regimen comprising stavudine or zidovudine, lamivudine, and efavirenz. Primary end points were death from any cause, and progression of HIV disease marked by failure of ART. Findings A total of 150 patients with HIV and TB were initiated on HAART: 88 received it after 2-4 weeks (early ART and 62 after 8-12 weeks (delayed ART of starting ATT. There was no significant difference in mortality between the groups after the introduction of HAART. However, incidence of ART failure was 31% in delayed versus 16% in early ART arm (p = 0.045. Kaplan Meier disease progression free survival at 12 months was 79% for early versus 64% for the delayed ART arm (p = 0.05. Rates of adverse events were similar. Interpretation Early initiation of HAART for patients with HIV and TB significantly decreases incidence of HIV disease progression and has good tolerability. Trial registration CTRI/2011/12/002260

  15. A Novel Therapy for People Who Attempt Suicide and Why We Need New Models of Suicide

    Directory of Open Access Journals (Sweden)

    Konrad Michel

    2017-03-01

    Full Text Available This paper presents a model of suicidal behaviour based on suicide as a goal-directed action, and its implications. An action theoretical model has guided the authors in the development of a brief therapy for individuals who attempt suicide (ASSIP—Attempted Suicide Short Intervention Program. Key elements are an early therapeutic alliance, narrative interviewing, psychoeducation, a joint case conceptualization, safety planning, and regular letters over 24 months. In a randomized controlled trial, ASSIP was highly effective in reducing the risk of suicide reattempts. The therapeutic elements in this treatment are described and possible implications for future directions in clinical suicide prevention discussed.

  16. Functional Magnetic Resonance Imaging of Goal-Directed Reaching in Children with Autism Spectrum Disorders: A Feasibility Study

    Directory of Open Access Journals (Sweden)

    Nicole M. G. Salowitz

    2014-04-01

    Full Text Available An unanswered question concerning the neural basis of autism spectrum disorders (ASD is how sensorimotor deficits in individuals with ASD are related to abnormalities of brain function. We previously described a robotic joystick and video game system that allows us to record functional magnetic resonance images (FMRI while adult humans make goal-directed wrist motions. We anticipated several challenges in extending this approach to studying goal-directed behaviors in children with ASD and in typically developing (TYP children. In particular we were concerned that children with autism may express increased levels of anxiety as compared to typically developing children due to the loud sounds and small enclosed space of the MRI scanner. We also were concerned that both groups of children might become restless during testing, leading to an unacceptable amount of head movement. Here we performed a pilot study evaluating the extent to which autistic and typically developing children exhibit anxiety during our experimental protocol as well as their ability to comply with task instructions. Our experimental controls were successful in minimizing group differences in drop-out due to anxiety. Kinematic performance and head motion also were similar across groups. Both groups of children engaged cortical regions (frontal, parietal, temporal, occipital while making goal-directed movements. In addition, the ASD group exhibited task-related correlations in subcortical regions (cerebellum, thalamus, whereas correlations in the TYP group did not reach statistical significance in subcortical regions. Four distinct regions in frontal cortex showed a significant group difference such that TYP children exhibited positive correlations between the hemodynamic response and movement, whereas children with ASD exhibited negative correlations. These findings demonstrate feasibility of simultaneous application of robotic manipulation and functional imaging to study goal-directed

  17. Prediction of Reach Goals in Depth and Direction from the Parietal Cortex

    Directory of Open Access Journals (Sweden)

    Matteo Filippini

    2018-04-01

    Full Text Available Summary: The posterior parietal cortex is well known to mediate sensorimotor transformations during the generation of movement plans, but its ability to control prosthetic limbs in 3D environments has not yet been fully demonstrated. With this aim, we trained monkeys to perform reaches to targets located at various depths and directions and tested whether the reach goal position can be extracted from parietal signals. The reach goal location was reliably decoded with accuracy close to optimal (>90%, and this occurred also well before movement onset. These results, together with recent work showing a reliable decoding of hand grip in the same area, suggest that this is a suitable site to decode the entire prehension action, to be considered in the development of brain-computer interfaces. : Filippini et al. show that it is possible to use parietal cortex activity to predict in which direction the arm will move and how far it will reach. This opens up the possibility of neural prostheses that can accurately guide reach and grasp using signals from this part of the brain. Keywords: neuroprosthetics, offline neural decoding, reaching in depth, monkey, V6A, machine learning, visuomotor transformations, hand guidance, prehension, robotics

  18. Future directions for ICT in aphasia therapy for older adults: enhancing current practices through interdisciplinary perspectives

    OpenAIRE

    Kötteritzsch, Anna; Gerling, Kathrin

    2015-01-01

    Growing numbers of older adults requiring aphasia therapy create challenges for the health care system. Information and communication technology (ICT) has the potential to provide computer-mediated, self-administered aphasia therapy that complements conventional therapy. We explore overlaps in ICT for older adults and aphasia therapy applications with the goal of integrating innovative ICT in aphasia therapy. Based on a case study, we explain how results of different disciplines developing IC...

  19. Indirect vs Direct Voice Therapy for Children With Vocal Nodules: A Randomized Clinical Trial.

    Science.gov (United States)

    Hartnick, Christopher; Ballif, Catherine; De Guzman, Vanessa; Sataloff, Robert; Campisi, Paolo; Kerschner, Joseph; Shembel, Adrianna; Reda, Domenic; Shi, Helen; Sheryka Zacny, Elinore; Bunting, Glenn

    2018-02-01

    Benign vocal fold nodules affect 12% to 22% of the pediatric population, and 95% of otolaryngologists recommend voice therapy as treatment. However, no randomized clinical trials that we are aware of have shown its benefits. To determine the impact of voice therapy in children with vocal fold nodules according to pretherapy and posttherapy scores on the Pediatric Voice-Related Quality of Life (PVRQOL) survey; secondary objectives included changes in phonatory parameters. For this multicenter randomized clinical trial, 114 children ages 6 to 10 years with vocal fold nodules, PVRQOL scores less than 87.5, and dysphonia for longer than 12 weeks were recruited from outpatient voice and speech clinics. This age range was identified because these patients have not experienced pubertal changes of the larynx, tolerate stroboscopy, and cooperate with voice therapy. Participants were blinded to treatment arm. Participants received either indirect or direct therapy for 8 to 12 weeks. Indirect therapy focused on education and discussion of voice principles, while direct treatment used the stimulus, response, antecedent paradigm. The primary outcome measure was PVRQOL score change before and after treatment. Secondary phonatory measures were also compared. Overall, 114 children were recruited for study (mean [SD] age, 8 [1.4] years; 83 males [73%]); with 57 randomized to receive either indirect or direct therapy. Both direct and indirect therapy approaches showed significant differences in PVRQOL scores pretherapy to posttherapy. The mean increase in PVRQOL score for direct therapy was 19.2, and 14.7 for indirect therapy (difference, 4.5; 95.3% CI, -10.8 to 19.8). Of 44 participants in the direct therapy group, 27 (61%) achieved a clinically meaningful PVRQOL improvement, compared with 26 of 49 (53%) for indirect therapy (difference, 8%; 95% CI, -12 to 28). Post hoc stratification showed robust effects in the direct therapy group for older children (Cohen d = 0.50) and the

  20. Group Therapy Goals: A Comparison of Group Therapy Providers and Male Inmates

    Science.gov (United States)

    Morgan, Robert D.; Garland, J. Travis; Rozycki, Alicia T.; Reich, Darcy A.; Wilson, Scott

    2005-01-01

    This study was designed to identify important process and content goals from the perspective of inmates and compare these goals to the goals identified by group therapists in a previous study conducted by Winterowd, Morgan, and Ferrell (2001). Utilizing survey data from 156 incarcerated adult males, an initial confirmatory factor analysis…

  1. INSTALLING AN ERP SYSTEM WITH A METHODOLOGY BASED ON THE PRINCIPLES OF GOAL DIRECTED PROJECT MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Ioannis Zafeiropoulos

    2010-01-01

    Full Text Available This paper describes a generic methodology to support the process of modelling, adaptation and implementation (MAI of Enterprise Resource Planning Systems (ERPS based on the principles of goal directed project management (GDPM. The proposed methodology guides the project manager through specific stages in order to successfully complete the ERPS implementation. The development of the proper MAI methodology is deemed necessary because it will simplify the installation process of ERPS. The goal directed project management method was chosen since it provides a way of focusing all changes towards a predetermined goal. The main stages of the methodology are the promotion and preparation steps, the proposal, the contract, the implementation and the completion. The methodology was applied as a pilot application by a major ERPS development company. Important benefits were the easy and effective guidance for all installation and analysis stages, the faster installation for the ERPS and the control and cost reduction for the installation, in terms of time, manpower, technological equipment and other resources.

  2. The attribution of navigational- and goal-directed agency in dogs (Canis familiaris) and human toddlers (Homo sapiens).

    Science.gov (United States)

    Tauzin, Tibor; Csík, Andor; Lovas, Kata; Gergely, György; Topál, József

    2017-02-01

    Both human infants and nonhuman primates can recognize unfamiliar entities as instrumental agents ascribing to them goals and efficiency of goal-pursuit. This competence relies on movement cues indicating distal sensitivity to the environment and choice of efficient goal-approach. Although dogs' evolved sensitivity to social cues allow them to recognize humans as communicative agents, it remains unclear whether they have also evolved a basic concept of instrumental agency. We used a preferential object-choice procedure to test whether adult pet dogs and human toddlers can identify unfamiliar entities as agents based on different types of movement cues that specify different levels of agency. In the navigational agency condition, dogs preferentially chose an object that modified its pathway to avoid collision with obstacles over another object showing no evidence of distal sensitivity (regularly bumping into obstacles). However, in the goal-efficiency condition where neither object collided with obstacles as it navigated toward a distal target, but only 1 of them exhibited efficient goal-approach as well, toddlers, but not dogs, showed a preference toward the efficient goal-directed agent. These findings indicate that dogs possess a limited concept of environmentally sensitive navigational agency that they attribute to self-propelled entities capable of modifying their movement to avoid colliding with obstacles. Toddlers, in contrast, demonstrated clear sensitivity to cues of efficient variability of goal-approach as the basis for differentiating, attributing, and showing preference for goal-directed instrumental agency. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  3. Reliance on habits at the expense of goal-directed control following dopamine precursor depletion

    NARCIS (Netherlands)

    de Wit, S.; Standing, H.R.; DeVito, E.E.; Robinson, O.J.; Ridderinkhof, K.R.; Robbins, T.W.; Sahakian, B.J.

    2012-01-01

    Rationale Dopamine is well known to play an important role in learning and motivation. Recent animal studies have implicated dopamine in the reinforcement of stimulus-response habits, as well as in flexible, goal-directed action. However, the role of dopamine in human action control is still not

  4. Early Intervention Stem Cell-Based Therapy (EISCBT) for Corneal Burns and Trauma

    Science.gov (United States)

    2016-10-01

    described in their manuscript fully available, without restriction and from the time of publication, with only rare exceptions to address legal and... aborting the early inflammatory response. Molecular therapy : the journal of the American Society of Gene Therapy. 2012;20(11):2143-52. Epub 2012/08/30

  5. Optimizing hydroxyurea therapy for sickle cell anemia.

    Science.gov (United States)

    Ware, Russell E

    2015-01-01

    Hydroxyurea has proven efficacy in numerous clinical trials as a disease-modifying treatment for patients with sickle cell anemia (SCA) but is currently under-used in clinical practice. To improve the effectiveness of hydroxyurea therapy, efforts should be directed toward broadening the clinical treatment indications, optimizing the daily dosage, and emphasizing the benefits of early and extended treatment. Here, various issues related to hydroxyurea treatment are discussed, focusing on both published evidence and clinical experience. Specific guidance is provided regarding important but potentially unfamiliar aspects of hydroxyurea treatment for SCA, such as escalating to maximum tolerated dose, treating in the setting of cerebrovascular disease, switching from chronic transfusions to hydroxyurea, and using serial phlebotomy to alleviate iron overload. Future research directions to optimize hydroxyurea therapy are also discussed, including personalized dosing based on pharmacokinetic modeling, prediction of fetal hemoglobin responses based on pharmacogenomics, and the risks and benefits of hydroxyurea for non-SCA genotypes and during pregnancy/lactation. Another critical initiative is the introduction of hydroxyurea safely and effectively into global regions that have a high disease burden of SCA but limited resources, such as sub-Saharan Africa, the Caribbean, and India. Final considerations emphasize the long-term goal of optimizing hydroxyurea therapy, which is to help treatment become accepted as standard of care for all patients with SCA. © 2015 by The American Society of Hematology. All rights reserved.

  6. Systemic therapy for HER2-positive early-stage breast cancer.

    Science.gov (United States)

    Mathew, Aju; Romond, Edward H

    The advent of the targeted monoclonal antbody trastuzumab for treatment of human epidermal growth factor receptor 2 (HER2)-positive breast cancer marked a revolution in the understanding and management of mammary carcinoma and, in practice, separated this subtype from other kinds of primary breast malignancy. Long term follow-up from the initial large adjuvant trials continue to show remarkably positive results. Currently, at least four additional agents targeting this receptor, using different and complementary mechanisms of action compared with trastuzumab, have been incorporated into clinical trials. The small molecule tyrosine kinase inhibitors lapatinib and neratinib, in addition to the antibody pertuzumab and the antibody-drug conjugate trastuzumab-ematansine, have shown efficacy in metastatic breast cancer and are being evaluated both in neoadjuvant and adjuvant trials for early stage disease. The cytotoxic chemotherapy regimens used in combination with these agents also are evolving and different therapeutic approaches are emerging for patients depending on their relative level of risk from their cancers, thus moving clinical management toward individualized therapy. Much has been learned about managing the toxicities of treatment and pre-operative approaches have provided a means of assessing the sensitivity of individual patients' cancers to specific treatment regimens. This review traces the development of these studies and focuses on improvements in adjuvant and neoadjuvant therapy for patients with HER2-positive disease whose prognosis has changed in the last decade from dire to favorable. A path forward has been set by which the goal of cure is attainable for almost all patients faced with this aggressive form of breast cancer. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. How Does Awareness Modulate Goal-Directed and Stimulus-Driven Shifts of Attention Triggered by Value Learning?

    Directory of Open Access Journals (Sweden)

    Alexia Bourgeois

    Full Text Available In order to behave adaptively, attention can be directed in space either voluntarily (i.e., endogenously according to strategic goals, or involuntarily (i.e., exogenously through reflexive capture by salient or novel events. The emotional or motivational value of stimuli can also strongly influence attentional orienting. However, little is known about how reward-related effects compete or interact with endogenous and exogenous attention mechanisms, particularly outside of awareness. Here we developed a visual search paradigm to study subliminal value-based attentional orienting. We systematically manipulated goal-directed or stimulus-driven attentional orienting and examined whether an irrelevant, but previously rewarded stimulus could compete with both types of spatial attention during search. Critically, reward was learned without conscious awareness in a preceding phase where one among several visual symbols was consistently paired with a subliminal monetary reinforcement cue. Our results demonstrated that symbols previously associated with a monetary reward received higher attentional priority in the subsequent visual search task, even though these stimuli and reward were no longer task-relevant, and despite reward being unconsciously acquired. Thus, motivational processes operating independent of conscious awareness may provide powerful influences on mechanisms of attentional selection, which could mitigate both stimulus-driven and goal-directed shifts of attention.

  8. How Does Awareness Modulate Goal-Directed and Stimulus-Driven Shifts of Attention Triggered by Value Learning?

    Science.gov (United States)

    Bourgeois, Alexia; Neveu, Rémi; Vuilleumier, Patrik

    2016-01-01

    In order to behave adaptively, attention can be directed in space either voluntarily (i.e., endogenously) according to strategic goals, or involuntarily (i.e., exogenously) through reflexive capture by salient or novel events. The emotional or motivational value of stimuli can also strongly influence attentional orienting. However, little is known about how reward-related effects compete or interact with endogenous and exogenous attention mechanisms, particularly outside of awareness. Here we developed a visual search paradigm to study subliminal value-based attentional orienting. We systematically manipulated goal-directed or stimulus-driven attentional orienting and examined whether an irrelevant, but previously rewarded stimulus could compete with both types of spatial attention during search. Critically, reward was learned without conscious awareness in a preceding phase where one among several visual symbols was consistently paired with a subliminal monetary reinforcement cue. Our results demonstrated that symbols previously associated with a monetary reward received higher attentional priority in the subsequent visual search task, even though these stimuli and reward were no longer task-relevant, and despite reward being unconsciously acquired. Thus, motivational processes operating independent of conscious awareness may provide powerful influences on mechanisms of attentional selection, which could mitigate both stimulus-driven and goal-directed shifts of attention.

  9. Expectations and beliefs in science communication: Learning from three European gene therapy discussions of the early 1990s.

    Science.gov (United States)

    Meyer, Gitte

    2016-04-01

    There is widespread agreement that the potential of gene therapy was oversold in the early 1990s. This study, however, comparing written material from the British, Danish and German gene therapy discourses of the period finds significant differences: Over-optimism was not equally strong everywhere; gene therapy was not universally hyped. Against that background, attention is directed towards another area of variation in the material: different basic assumptions about science and scientists. Exploring such culturally rooted assumptions and beliefs and their possible significance to science communication practices, it is argued that deep beliefs may constitute drivers of hype that are particularly difficult to deal with. To participants in science communication, the discouragement of hype, viewed as a practical-ethical challenge, can be seen as a learning exercise that includes critical attention to internalised beliefs. © The Author(s) 2014.

  10. Bidirectional modulation of goal-directed actions by prefrontal cortical dopamine.

    Science.gov (United States)

    Hitchcott, Paul K; Quinn, Jennifer J; Taylor, Jane R

    2007-12-01

    Instrumental actions are a vital cognitive asset that endows an organism with sensitivity to the consequences of its behavior. Response-outcome feedback allows responding to be shaped in order to maximize beneficial, and minimize detrimental, outcomes. Lesions of the medial prefrontal cortex (mPFC) result in behavior that is insensitive to changes in outcome value in animals and compulsive behavior in several human psychopathologies. Such insensitivity to changes in outcome value is a defining characteristic of instrumental habits: responses that are controlled by antecedent stimuli rather than goal expectancy. Little is known regarding the neurochemical substrates mediating this sensitivity. The present experiments used sensitivity to posttraining outcome devaluation to index the action-habit status of instrumental responding. Infusions of dopamine into the ventral mPFC (vmPFC), but not dorsal mPFC, restored outcome sensitivity bidirectionally-decreasing responding following outcome devaluation and increasing responding when the outcome was not devalued. This bidirectionality makes the possibility that these infusions nonspecifically dysregulated vmPFC dopamine transmission unlikely. VmPFC dopamine promoted instrumental responding appropriate to outcome value. Reinforcer consumption data indicated that this was not a consequence of altered sensitivity to the reinforcer itself. We suggest that vmPFC dopamine reengages attentional processes underlying goal-directed behavior.

  11. Developing a typology of patient-generated behavioral goals for cognitive behavioral therapy for chronic pain (CBT-CP): classification and predicting outcomes.

    Science.gov (United States)

    Heapy, Alicia A; Wandner, Laura; Driscoll, Mary A; LaChappelle, Kathryn; Czlapinski, Rebecca; Fenton, Brenda T; Piette, John D; Aikens, James E; Janevic, Mary R; Kerns, Robert D

    2018-04-01

    Patient-generated treatment goals describe what patients value, yet the content of these goals, and the relationship among goal types, goal accomplishment, and treatment outcomes has received little examination. We used inductive sorting to categorize patient-generated goals made by 147 adults receiving cognitive-behavioral therapy for chronic pain. The resulting goal categories were: Physical Activity (29.0%), Functional Status (24.6%), Wellness (16.3%), Recreational Activities (11.3%), House/Yard Work (9.7%), Socializing (7.1%), and Work/School (2.0%). Next, we examined associations between number of goals by category, goal accomplishment, and clinically meaningful improvements in pain-related interference, pain intensity and depressive symptoms. Improvement in all outcome domains was related to goal accomplishment. Additionally, depressive symptoms were related to number of Physical Activity, House/Yard Work, Recreational Activities, and Wellness goals, whereas improved pain-intensity was significantly related to House/Yard Work. Classifying patient-generated goals facilitates investigation of the relationships among goal type, goal accomplishment and treatment outcomes.

  12. Current guidelines for high-density lipoprotein cholesterol in therapy and future directions

    Directory of Open Access Journals (Sweden)

    Subedi BH

    2014-04-01

    Full Text Available Bishnu H Subedi,1,2 Parag H Joshi,1 Steven R Jones,1 Seth S Martin,1 Michael J Blaha,1 Erin D Michos1 1Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, 2Greater Baltimore Medical Center, Baltimore, MD, USA Abstract: Many studies have suggested that a significant risk factor for atherosclerotic cardiovascular disease (ASCVD is low high-density lipoprotein cholesterol (HDL-C. Therefore, increasing HDL-C with therapeutic agents has been considered an attractive strategy. In the prestatin era, fibrates and niacin monotherapy, which cause modest increases in HDL-C, reduced ASCVD events. Since their introduction, statins have become the cornerstone of lipoprotein therapy, the benefits of which are primarily attributed to decrease in low-density lipoprotein cholesterol. Findings from several randomized trials involving niacin or cholesteryl ester transfer protein inhibitors have challenged the concept that a quantitative elevation of plasma HDL-C will uniformly translate into ASCVD benefits. Consequently, the HDL, or more correctly, HDL-C hypothesis has become more controversial. There are no clear guidelines thus far for targeting HDL-C or HDL due to lack of solid outcomes data for HDL specific therapies. HDL-C levels are only one marker of HDL out of its several structural or functional properties. Novel approaches are ongoing in developing and assessing agents that closely mimic the structure of natural HDL or replicate its various functions, for example, reverse cholesterol transport, vasodilation, anti-inflammation, or inhibition of platelet aggregation. Potential new approaches like HDL infusions, delipidated HDL, liver X receptor agonists, Apo A-I upregulators, Apo A mimetics, and gene therapy are in early phase trials. This review will outline current therapies and describe future directions for HDL therapeutics. Keywords: high-density lipoprotein, lipids, cholesterol, atherosclerosis, cardiovascular disease, therapy

  13. [Becoming more "goal-oriented" in therapy of dyslipidemias: results of the Hungarian MULTI GAP 2010].

    Science.gov (United States)

    Reiber, István; Paragh, György; Márk, László; Pados, Gyula

    2011-05-22

    Previous studies have found that many high-risk patients are not achieving their LDL-cholesterol goals, and many patients, despite being treated with lipid-lowering therapy, also have elevated triglycerides and/or low levels of HDL-cholesterol. Authors analyzed the treatment strategies for dyslipidemic subjects following cardiovascular events similarly to their former survey from 2008 and 2009. In the MULTI GAP (MULTI Goal Attainment Problem) 2010 trial data from standard and structured questionnaires of 2332 patients were processed. Authors analyzed the proportion of the patients reaching target levels for total cholesterol, LDL-C, HDL-C, A-C (atherogen cholesterol) and triglyceride. 15% (n = 355) of the patients did not receive any lipid lowering treatment. 44% of the patients treated by specialists reached the target LDL-C level of 2.5 mmol/l. In "high risk" group target levels for HDL-C were reached by 61% of the patients, and for triglyceride by 43% of the subjects. 43% of the patients with the best compliance (>90%) reached the target LDL-C level of 2.5 mmol/l. There is a need for more effective lipid lowering therapy with more frequent use of higher doses of statins or combinations of lipid lowering drugs.

  14. Motivation and value influences in the relative balance of goal-directed and habitual behaviours in obsessive-compulsive disorder.

    Science.gov (United States)

    Voon, V; Baek, K; Enander, J; Worbe, Y; Morris, L S; Harrison, N A; Robbins, T W; Rück, C; Daw, N

    2015-11-03

    Our decisions are based on parallel and competing systems of goal-directed and habitual learning, systems which can be impaired in pathological behaviours. Here we focus on the influence of motivation and compare reward and loss outcomes in subjects with obsessive-compulsive disorder (OCD) on model-based goal-directed and model-free habitual behaviours using the two-step task. We further investigate the relationship with acquisition learning using a one-step probabilistic learning task. Forty-eight OCD subjects and 96 healthy volunteers were tested on a reward and 30 OCD subjects and 53 healthy volunteers on the loss version of the two-step task. Thirty-six OCD subjects and 72 healthy volunteers were also tested on a one-step reversal task. OCD subjects compared with healthy volunteers were less goal oriented (model-based) and more habitual (model-free) to reward outcomes with a shift towards greater model-based and lower habitual choices to loss outcomes. OCD subjects also had enhanced acquisition learning to loss outcomes on the one-step task, which correlated with goal-directed learning in the two-step task. OCD subjects had greater stay behaviours or perseveration in the one-step task irrespective of outcome. Compulsion severity was correlated with habitual learning in the reward condition. Obsession severity was correlated with greater switching after loss outcomes. In healthy volunteers, we further show that greater reward magnitudes are associated with a shift towards greater goal-directed learning further emphasizing the role of outcome salience. Our results highlight an important influence of motivation on learning processes in OCD and suggest that distinct clinical strategies based on valence may be warranted.

  15. Protocolised Management In Sepsis (ProMISe): a multicentre randomised controlled trial of the clinical effectiveness and cost-effectiveness of early, goal-directed, protocolised resuscitation for emerging septic shock.

    Science.gov (United States)

    Mouncey, Paul R; Osborn, Tiffany M; Power, G Sarah; Harrison, David A; Sadique, M Zia; Grieve, Richard D; Jahan, Rahi; Tan, Jermaine C K; Harvey, Sheila E; Bell, Derek; Bion, Julian F; Coats, Timothy J; Singer, Mervyn; Young, J Duncan; Rowan, Kathryn M

    2015-11-01

    Early goal-directed therapy (EGDT) is recommended in international guidance for the resuscitation of patients presenting with early septic shock. However, adoption has been limited and uncertainty remains over its clinical effectiveness and cost-effectiveness. The primary objective was to estimate the effect of EGDT compared with usual resuscitation on mortality at 90 days following randomisation and on incremental cost-effectiveness at 1 year. The secondary objectives were to compare EGDT with usual resuscitation for requirement for, and duration of, critical care unit organ support; length of stay in the emergency department (ED), critical care unit and acute hospital; health-related quality of life, resource use and costs at 90 days and at 1 year; all-cause mortality at 28 days, at acute hospital discharge and at 1 year; and estimated lifetime incremental cost-effectiveness. A pragmatic, open, multicentre, parallel-group randomised controlled trial with an integrated economic evaluation. Fifty-six NHS hospitals in England. A total of 1260 patients who presented at EDs with septic shock. EGDT (n = 630) or usual resuscitation (n = 630). Patients were randomly allocated 1 : 1. All-cause mortality at 90 days after randomisation and incremental net benefit (at £20,000 per quality-adjusted life-year) at 1 year. Following withdrawals, data on 1243 (EGDT, n = 623; usual resuscitation, n = 620) patients were included in the analysis. By 90 days, 184 (29.5%) in the EGDT and 181 (29.2%) patients in the usual-resuscitation group had died [p = 0.90; absolute risk reduction -0.3%, 95% confidence interval (CI) -5.4 to 4.7; relative risk 1.01, 95% CI 0.85 to 1.20]. Treatment intensity was greater for the EGDT group, indicated by the increased use of intravenous fluids, vasoactive drugs and red blood cell transfusions. Increased treatment intensity was reflected by significantly higher Sequential Organ Failure Assessment scores and more advanced

  16. Decreasing Striatopallidal Pathway Function Enhances Motivation by Energizing the Initiation of Goal-Directed Action

    Science.gov (United States)

    Carvalho Poyraz, Fernanda; Holzner, Eva; Bailey, Matthew R.; Meszaros, Jozsef; Kenney, Lindsay; Kheirbek, Mazen A.

    2016-01-01

    Altered dopamine D2 receptor (D2R) binding in the striatum has been associated with abnormal motivation in neuropsychiatric disorders, including schizophrenia. Here, we tested whether motivational deficits observed in mice with upregulated D2Rs (D2R-OEdev mice) are reversed by decreasing function of the striatopallidal “no-go” pathway. To this end, we expressed the Gαi-coupled designer receptor hM4D in adult striatopallidal neurons and activated the receptor with clozapine-N-oxide (CNO). Using a head-mounted miniature microscope we confirmed with calcium imaging in awake mice that hM4D activation by CNO inhibits striatopallidal function measured as disinhibited downstream activity in the globus pallidus. Mice were then tested in three operant tasks that address motivated behavior, the progressive ratio task, the progressive hold-down task, and outcome devaluation. Decreasing striatopallidal function in the dorsomedial striatum or nucleus accumbens core enhanced motivation in D2R-OEdev mice and control littermates. This effect was due to increased response initiation but came at the cost of goal-directed efficiency. Moreover, response vigor and the sensitivity to changes in reward value were not altered. Chronic activation of hM4D by administering CNO for 2 weeks in drinking water did not affect motivation due to a tolerance effect. However, the acute effect of CNO on motivation was reinstated after discontinuing chronic treatment for 48 h. Used as a therapeutic approach, striatopallidal inhibition should consider the risk of impairing goal-directed efficiency and behavioral desensitization. SIGNIFICANCE STATEMENT Motivation involves a directional component that allows subjects to efficiently select the behavior that will lead to an optimal outcome and an activational component that initiates and maintains the vigor and persistence of actions. Striatal output pathways modulate motivated behavior, but it remains unknown how these pathways regulate specific

  17. Decreasing Striatopallidal Pathway Function Enhances Motivation by Energizing the Initiation of Goal-Directed Action.

    Science.gov (United States)

    Carvalho Poyraz, Fernanda; Holzner, Eva; Bailey, Matthew R; Meszaros, Jozsef; Kenney, Lindsay; Kheirbek, Mazen A; Balsam, Peter D; Kellendonk, Christoph

    2016-06-01

    Altered dopamine D2 receptor (D2R) binding in the striatum has been associated with abnormal motivation in neuropsychiatric disorders, including schizophrenia. Here, we tested whether motivational deficits observed in mice with upregulated D2Rs (D2R-OEdev mice) are reversed by decreasing function of the striatopallidal "no-go" pathway. To this end, we expressed the Gαi-coupled designer receptor hM4D in adult striatopallidal neurons and activated the receptor with clozapine-N-oxide (CNO). Using a head-mounted miniature microscope we confirmed with calcium imaging in awake mice that hM4D activation by CNO inhibits striatopallidal function measured as disinhibited downstream activity in the globus pallidus. Mice were then tested in three operant tasks that address motivated behavior, the progressive ratio task, the progressive hold-down task, and outcome devaluation. Decreasing striatopallidal function in the dorsomedial striatum or nucleus accumbens core enhanced motivation in D2R-OEdev mice and control littermates. This effect was due to increased response initiation but came at the cost of goal-directed efficiency. Moreover, response vigor and the sensitivity to changes in reward value were not altered. Chronic activation of hM4D by administering CNO for 2 weeks in drinking water did not affect motivation due to a tolerance effect. However, the acute effect of CNO on motivation was reinstated after discontinuing chronic treatment for 48 h. Used as a therapeutic approach, striatopallidal inhibition should consider the risk of impairing goal-directed efficiency and behavioral desensitization. Motivation involves a directional component that allows subjects to efficiently select the behavior that will lead to an optimal outcome and an activational component that initiates and maintains the vigor and persistence of actions. Striatal output pathways modulate motivated behavior, but it remains unknown how these pathways regulate specific components of motivation. Here

  18. Cognitive Development in Infantile-Onset Pompe Disease Under Very Early Enzyme Replacement Therapy.

    Science.gov (United States)

    Lai, Chih-Jou; Hsu, Ting-Rong; Yang, Chia-Feng; Chen, Shyi-Jou; Chuang, Ya-Chin; Niu, Dau-Ming

    2016-12-01

    Most patients with infantile-onset Pompe disease die in early infancy before beginning enzyme replacement therapy, which has made it difficult to evaluate the impact of Pompe disease on cognitive development. Patients with infantile-onset Pompe disease can survive with enzyme replacement therapy, and physicians can evaluate cognitive development in these patients. We established an effective newborn screening program with quick clinical diagnostic criteria. Cognitive and motor development were evaluated using the Bayley Scales of Infant and Toddler Development-Third Edition at 6, 12, and 24 months of age. The patients who were treated very early demonstrate normal cognitive development with no significant change in cognition during this period (P = .18 > .05). The cognitive development was positively correlated with motor development (r = 0.533, P = .011). The results indicated that very early enzyme replacement therapy could protect cognitive development in patients with infantile-onset Pompe disease up to 24 months of age. © The Author(s) 2016.

  19. Getting on the Same Page: Identifying Goals for Technology Use in Early Childhood Education. Policy Brief

    Science.gov (United States)

    Daugherty, Lindsay; Dossani, Rafiq; Johnson, Erin-Elizabeth; Wright, Cameron

    2014-01-01

    Technology use among young children is increasingly a fact of life, and establishing a clear set of goals that are broadly accepted by stakeholders is critical to planning for the successful integration of technology into early childhood education (ECE). However, debates about the role of technology in ECE settings are ongoing, with some…

  20. Corticostriatal connectivity underlies individual differences in the balance between habitual and goal-directed action control

    NARCIS (Netherlands)

    Wit, S. de; Watson, A.J.P.; Harsay, H.A.; Cohen, M.X.; Vijver, I. van de; Ridderinkhof, K.R.

    2012-01-01

    Why are some individuals more susceptible to the formation of inflexible habits than others? In the present study, we used diffusion tensor imaging to demonstrate that brain connectivity predicts individual differences in relative goal-directed and habitual behavioral control in humans.

  1. Self-directed therapy programmes for arm rehabilitation after stroke: a systematic review.

    Science.gov (United States)

    Da-Silva, Ruth H; Moore, Sarah A; Price, Christopher I

    2018-05-01

    To investigate the effectiveness of self-directed arm interventions in adult stroke survivors. A systematic review of Medline, EMBASE, CINAHL, SCOPUS and IEEE Xplore up to February 2018 was carried out. Studies of stroke arm interventions were included where more than 50% of the time spent in therapy was initiated and carried out by the participant. Quality of the evidence was assessed using the Cochrane risk of bias tool. A total of 40 studies ( n = 1172 participants) were included (19 randomized controlled trials (RCTs) and 21 before-after studies). Studies were grouped according to no technology or the main additional technology used (no technology n = 5; interactive gaming n = 6; electrical stimulation n = 11; constraint-induced movement therapy n = 6; robotic and dynamic orthotic devices n = 8; mirror therapy n = 1; telerehabilitation n = 2; wearable devices n = 1). A beneficial effect on arm function was found for self-directed interventions using constraint-induced movement therapy ( n = 105; standardized mean difference (SMD) 0.39, 95% confidence interval (CI) -0.00 to 0.78) and electrical stimulation ( n = 94; SMD 0.50, 95% CI 0.08-0.91). Constraint-induced movement therapy and therapy programmes without technology improved independence in activities of daily living. Sensitivity analysis demonstrated arm function benefit for patients >12 months poststroke ( n = 145; SMD 0.52, 95% CI 0.21-0.82) but not at 0-3, 3-6 or 6-12 months. Self-directed interventions can enhance arm recovery after stroke but the effect varies according to the approach used and timing. There were benefits identified from self-directed delivery of constraint-induced movement therapy, electrical stimulation and therapy programmes that increase practice without using additional technology.

  2. Effects of direct-to-consumer advertising of hydroxymethylglutaryl coenzyme a reductase inhibitors on attainment of LDL-C goals.

    Science.gov (United States)

    Bradford, W David; Kleit, Andrew N; Nietert, Paul J; Ornstein, Steven

    2006-12-01

    Although highly controversial, directto-consumer (DTC) television advertising for prescription drugs is an established practice in the US health care industry. While the US Food and Drug Administration is currently reexamining its regulatory stance, little evidence exists regarding the impact of DTC advertising on patient health outcomes. The objective of this research was to study the relationship between heavy television promotion of 3 major hydroxymethylglutaryl coenzyme A reductase inhibitors ("statins") and the frequency with which patients are able to attain low-density lipoprotein cholesterol (LDL-C) blood-level goals after treatment with any statin. We used logistic regression to determine achievement of LDL-C goals at 6 months after statin treatment, using electronic medical record extract data from patients from geographically dispersed primary care practices in the United States. We identified LDL-C blood levels as being at or less than goal, as defined by risk-adjusted guidelines published by the National Heart, Lung, and Blood Institute from the Adult Treatment Panel III (ATP III) data. A total of 50,741 patients, identified from 88 practices, were diagnosed with hyperlipidemia and had begun therapy with any statin medication during the 1998-2004 time period. In addition, total dollars spent each month on television advertising at the national and local levels for atorvastatin, pravastatin, and simvastatin were obtained. DTC advertising data were merged by local media market where the physician practice was located and by the month in which the patient was first prescribed a statin. The models were run for all patients who initiated therapy, and also on a subsample of patients who continued to receive prescriptions for the drugs for at least 6 months. Logistic regressions were used to predict the likelihood that each patient attained the ATP III LDL-C blood-level goals as a function of DTC advertising and other factors. High levels of national DTC

  3. Feature Interactions Enable Decoding of Sensorimotor Transformations for Goal-Directed Movement

    Science.gov (United States)

    Barany, Deborah A.; Della-Maggiore, Valeria; Viswanathan, Shivakumar; Cieslak, Matthew

    2014-01-01

    Neurophysiology and neuroimaging evidence shows that the brain represents multiple environmental and body-related features to compute transformations from sensory input to motor output. However, it is unclear how these features interact during goal-directed movement. To investigate this issue, we examined the representations of sensory and motor features of human hand movements within the left-hemisphere motor network. In a rapid event-related fMRI design, we measured cortical activity as participants performed right-handed movements at the wrist, with either of two postures and two amplitudes, to move a cursor to targets at different locations. Using a multivoxel analysis technique with rigorous generalization tests, we reliably distinguished representations of task-related features (primarily target location, movement direction, and posture) in multiple regions. In particular, we identified an interaction between target location and movement direction in the superior parietal lobule, which may underlie a transformation from the location of the target in space to a movement vector. In addition, we found an influence of posture on primary motor, premotor, and parietal regions. Together, these results reveal the complex interactions between different sensory and motor features that drive the computation of sensorimotor transformations. PMID:24828640

  4. Reducing the uncertainties in particle therapy

    Energy Technology Data Exchange (ETDEWEB)

    Oancea, C., E-mail: oancea@jinr.ru [Laboratory of Nuclear Problems, Joint Institute for Nuclear Research, 6 Joliot-Curie Street, 141980, Dubna, Moscow Region, Russia and Faculty of Physics, University of Bucharest, Atomistilor Street 405, 077125 Bucharest-Magurele, Ilfov Region (Romania); Shipulin, K. N.; Mytsin, G. V.; Luchin, Y. I. [Laboratory of Nuclear Problems, Joint Institute for Nuclear Research, 6 Joliot-Curie Street, 141980, Dubna, Moscow Region (Russian Federation)

    2015-02-24

    The use of fundamental Nuclear Physics in Nuclear Medicine has a significant impact in the fight against cancer. Hadrontherapy is an innovative cancer radiotherapy method using nuclear particles (protons, neutrons and ions) for the treatment of early and advanced tumors. The main goal of proton therapy is to deliver high radiation doses to the tumor volume with minimal damage to healthy tissues and organs. The purpose of this work was to investigate the dosimetric errors in clinical proton therapy dose calculation due to the presence of metallic implants in the treatment plan, and to determine the impact of the errors. The results indicate that the errors introduced by the treatment planning systems are higher than 10% in the prediction of the dose at isocenter when the proton beam is passing directly through a metallic titanium alloy implant. In conclusion, we recommend that pencil-beam algorithms not be used when planning treatment for patients with titanium alloy implants, and to consider implementing methods to mitigate the effects of the implants.

  5. Early Intervention for Borderline Personality Disorder: Psychodynamic Therapy in Adolescents.

    Science.gov (United States)

    Salzer, Simone; Cropp, Carola; Streeck-Fischer, Annette

    2014-01-01

    Borderline personality disorder (BPD) should be understood as a disorder of development (Streeck-Fischer 2008, 2013) that has its first manifestation in late childhood and adolescence. There are only few treatment studies of adolescents meeting the diagnostic criteria of borderline personality disorder, although early interventions for these patients are urgently needed (see Chanen & McCutcheon 2013). We examined the effectiveness of an inpatient psychodynamic therapy (PDT). Twenty-eight adolescents fulfilling the DSM-IV diagnostic criteria of borderline personality disorder were treated with psychodynamic therapy. The mean duration of treatment was 29.87 weeks (SD = 15.88). Outcomes were remission rates, GAF, GSI, SDQ, IIP and BPI scores. Assessments were made at admission and after treatment. Pre-post comparisons and comparisons with normative data were conducted. At the end of treatment 39.29% of the patients were remitted. We found significant improvements for the GAF, GSI, SDQ, IIP (all p0.001) and the BPI (p = 0.006). These clinically relevant improvements demonstrate the effectiveness of psychodynamic therapy in adolescents with borderline personality disorder and stress the usefulness of an early intervention for these patients.

  6. Clinical trial: a randomized trial of early endoscopy, Helicobacter pylori testing and empirical therapy for the management of dyspepsia in primary care.

    Science.gov (United States)

    Duggan, A E; Elliott, C A; Miller, P; Hawkey, C J; Logan, R F A

    2009-01-01

    Early endoscopy, Helicobacter pylori eradication and empirical acid suppression are commonly used dyspepsia management strategies in primary care but have not been directly compared in a single trial. To compare endoscopy, H. pylori test and refer, H. pylori test and treat and empirical acid suppression for dyspepsia in primary care. Patients presenting to their general practitioner with dyspepsia were randomized to endoscopy, H. pylori'test and treat', H. pylori test and endoscope positives, or empirical therapy with symptoms, patient satisfaction, healthcare costs and cost effectiveness at 12 months being the outcomes. At 2 months, the proportion of patients reporting no or minimal dyspeptic symptoms ranged from 74% for those having early endoscopy to 55% for those on empirical therapy (P = 0.009), but at 1 year, there was little difference among the four strategies. Early endoscopy was associated with fewer subsequent consultations for dyspepsia (P = 0.003). 'Test and treat' resulted in fewer endoscopies overall and was most cost-effective over a range of cost assumptions. Empirical therapy resulted in the lowest initial costs, but the highest rate of subsequent endoscopy. Gastro-oesophageal cancers were found in four patients randomized to the H. pylori testing strategies. While early endoscopy offered some advantages 'Test and treat' was the most cost-effective strategy. In older patients, early endoscopy may be an appropriate strategy in view of the greater risk of malignant disease. © 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd.

  7. VAC Therapy Direct to the Medullary Cavity for Chronic Tibial Osteomyelitis.

    Science.gov (United States)

    Miyamura, Satoshi; Tsuji, Shigeyoshi; Iwai, Takao; Hamada, Masayuki

    2016-06-01

    Vacuum-assisted wound closure (VAC) is useful for difficult wound beds, although sites where bleeding or infection is expected are usually regarded as problematic for this therapy. This report outlines the treatment of chronic tibial osteomyelitis (Cierny- Mader type III) due to mixed infection with Nocardia spp and Bacteroi- des fragilis by postoperative VAC therapy direct to the medullary cavity, followed by wound coverage with a gastrocnemius myocutaneous skin flap. A 64-year-old man developed chronic left tibial os- teomyelitis after a work injury. The nonviable tissues were debrided, including a sequestrum. Nocardia spp and B. fragilis were isolated from surgical bone specimens, and chronic tibial osteomyelitis due to mixed infection was diagnosed. Postoperatively, VAC therapy was performed directly to the open medullary cavity of the tibia and sub- sequently covered the residual soft tissue defect with a gastrocnemius myocutaneous flap. The authors could not find any English literature on VAC therapy direct to the medullary cavity combined with transplantation of a myocutaneous flap for osteomyelitis. Nocardia spp can cause a variety of infections, among which osteomyelitis occupies a relatively small percentage. This case raises the possibil- ity of treating chronic tibial osteomyelitis caused by mixed infection with Nocardia spp and B. fragilis by applying postoperative VAC ther- apy directly to the medullary cavity and covering the residual wound with a gastrocnemius myocutaneous flap.

  8. Geographic access to radiation therapy facilities and disparities of early-stage breast cancer treatment

    Directory of Open Access Journals (Sweden)

    Yan Lin

    2018-05-01

    Full Text Available Few studies of breast cancer treatment have focused on the Northern Plains of the United States, an area with a high mastectomy rate. This study examined the association between geographic access to radiation therapy facilities and receipt of breast cancer treatments among early-stage breast cancer patients in South Dakota. Based on 4,209 early-stage breast cancer patients diagnosed between 2001 and 2012 in South Dakota, the study measured geographic proximity to radiation therapy facilities using the shortest travel time for patients to the closest radiation therapy facility. Two-level logistic regression models were used to estimate for early stage cases i the odds of mastectomy versus breast conserving surgery (BCS; ii the odds of not receiving radiation therapy after BCS versus receiving follow-up radiation therapy. Covariates included race/ethnicity, age at diagnosis, tumour grade, tumour sequence, year of diagnosis, census tract-level poverty rate and urban/rural residence. The spatial scan statistic method was used to identify geographic areas with significantly higher likelihood of experiencing mastectomy. The study found that geographic accessibility to radiation therapy facilities was negatively associated with the likelihood of receiving mastectomy after adjustment for other covariates, but not associated with radiation therapy use among patients receiving BCS. Compared with patients travelling less than 30 minutes to a radiation therapy facility, patients travelling more than 90 minutes were about 1.5 times more likely to receive mastectomy (odds ratio, 1.51; 95% confidence interval, 1.08-2.11 and patients travelling more than 120 minutes were 1.7 times more likely to receive mastectomy (odds ratio, 1.70; 95% confidence interval, 1.19-2.42. The study also identified a statistically significant cluster of patients receiving mastectomy who were located in south-eastern South Dakota, after adjustment for other factors. Because

  9. Helping Children with Disabilities through Animal-Assisted Therapy

    Science.gov (United States)

    Watts, Katie; Everly, Janet Stout

    2009-01-01

    The Delta Society defines animal-assisted therapy as "a goal-directed intervention in which an animal is incorporated as an integral part of the clinical healthcare treatment process." Unlike other animal-assisted activities, animal-assisted therapy, or AAT, is led by a professional such as a physical therapist, occupational therapist,…

  10. Role of chemotherapy and targeted therapy in early-stage non-small cell lung cancer.

    Science.gov (United States)

    Nagasaka, Misako; Gadgeel, Shirish M

    2018-01-01

    Adjuvant platinum based chemotherapy is accepted as standard of care in stage II and III non-small cell lung cancer (NSCLC) patients and is often considered in patients with stage IB disease who have tumors ≥ 4 cm. The survival advantage is modest with approximately 5% at 5 years. Areas covered: This review article presents relevant data regarding chemotherapy use in the perioperative setting for early stage NSCLC. A literature search was performed utilizing PubMed as well as clinical trial.gov. Randomized phase III studies in this setting including adjuvant and neoadjuvant use of chemotherapy as well as ongoing trials on targeted therapy and immunotherapy are also discussed. Expert commentary: With increasing utilization of screening computed tomography scans, it is possible that the percentage of early stage NSCLC patients will increase in the coming years. Benefits of adjuvant chemotherapy in early stage NSCLC patients remain modest. There is a need to better define patients most likely to derive survival benefit from adjuvant therapy and spare patients who do not need adjuvant chemotherapy due to the toxicity of such therapy. Trials for adjuvant targeted therapy, including adjuvant EGFR-TKI trials and trials of immunotherapy drugs are ongoing and will define the role of these agents as adjuvant therapy.

  11. The Current Status and Future Directions of Heavy Charged Particle Therapy in Medicine

    Science.gov (United States)

    Levy, Richard P.; Blakely, Eleanor A.; Chu, William T.; Coutrakon, George B.; Hug, Eugen B.; Kraft, Gerhard; Tsujii, Hirohiko

    2009-03-01

    As aggressive, 3D-conformal treatment has become the clearly accepted goal of radiation oncology, heavy charged-particle treatment with protons and heavier ions has concurrently and relentlessly ascended to the forefront. Protons and helium nuclei, with relatively low linear-energy-transfer (LET) properties, have consistently been demonstrated to be beneficial for aggressive (high-dose) local treatment of many types of tumors. Protons have been applied to the majority of solid tumors, and have reached a high degree of general acceptance in radiation oncology after three decades and 55,000 patients treated. However, some 15% to 20% of tumor types have proven resistant to even the most aggressive low-LET irradiation. For these radio-resistant tumors, treatment with heavier ions (e.g., carbon) offers great potential benefit. These high-LET particles have increased relative biological effectiveness (RBE) that reaches its maximum in the Bragg peak. Irradiation with these heavier ions offers the unique combination of excellent 3D-dose distribution and increased RBE. We are presently witnessing several, important parallel developments in particle therapy. Protons will likely continue their exponential growth phase, and more compact design systems will make protons available to a larger patient population—thus becoming the "heavy charged particle of choice" for Cancer Centers with limited financial resources. In parallel, major academic efforts will further advance the field of heavier ion therapy, exploring all opportunities for particle treatment and continuing the search for the ideal particle(s) for specific tumors. The future of ion therapy will be best realized by clinical trials that have ready access to top-quality delivery of both protons and heavier ions that can be accurately shaped for treatment of a specific pathology, and which will permit direct randomized-trial comparison of the effectiveness of the various ions for different diseases. Optimal results

  12. Cognitive behavioural therapy attenuates the enhanced early facial stimuli processing in social anxiety disorders: an ERP investigation.

    Science.gov (United States)

    Cao, Jianqin; Liu, Quanying; Li, Yang; Yang, Jun; Gu, Ruolei; Liang, Jin; Qi, Yanyan; Wu, Haiyan; Liu, Xun

    2017-07-28

    Previous studies of patients with social anxiety have demonstrated abnormal early processing of facial stimuli in social contexts. In other words, patients with social anxiety disorder (SAD) tend to exhibit enhanced early facial processing when compared to healthy controls. Few studies have examined the temporal electrophysiological event-related potential (ERP)-indexed profiles when an individual with SAD compares faces to objects in SAD. Systematic comparisons of ERPs to facial/object stimuli before and after therapy are also lacking. We used a passive visual detection paradigm with upright and inverted faces/objects, which are known to elicit early P1 and N170 components, to study abnormal early face processing and subsequent improvements in this measure in patients with SAD. Seventeen patients with SAD and 17 matched control participants performed a passive visual detection paradigm task while undergoing EEG. The healthy controls were compared to patients with SAD pre-therapy to test the hypothesis that patients with SAD have early hypervigilance to facial cues. We compared patients with SAD before and after therapy to test the hypothesis that the early hypervigilance to facial cues in patients with SAD can be alleviated. Compared to healthy control (HC) participants, patients with SAD had more robust P1-N170 slope but no amplitude effects in response to both upright and inverted faces and objects. Interestingly, we found that patients with SAD had reduced P1 responses to all objects and faces after therapy, but had selectively reduced N170 responses to faces, and especially inverted faces. Interestingly, the slope from P1 to N170 in patients with SAD was flatter post-therapy than pre-therapy. Furthermore, the amplitude of N170 evoked by the facial stimuli was correlated with scores on the interaction anxiousness scale (IAS) after therapy. Our results did not provide electrophysiological support for the early hypervigilance hypothesis in SAD to faces, but

  13. Occupational Therapy Contributions in Early Intervention: Implications for Personnel Preparation and Interprofessional Practice

    Science.gov (United States)

    Muhlenhaupt, Mary; Pizur-Barnekow, Kris; Schefkind, Sandra; Chandler, Barbara; Harvison, Neil

    2015-01-01

    Occupational therapy provides a unique contribution in early intervention programs for families and their children from birth to 3 years old who are at risk for, or who have, identified disabilities. This article describes occupational therapy's distinct value and presents the profession's perspective on services to enhance families' caregiving…

  14. Are Audiologists Directly Referring Children with Hearing Loss to Early Intervention?

    OpenAIRE

    Loyola, Natalie; Shanahan, Bridget; Shanahan, Cailin; Kawai, Kosuke; Stiles, Derek J

    2017-01-01

    This article describes the ways that pediatric audiologists are directing infants into Early Intervention, and the related barriers and facilitators. Over one hundred pediatric audiologists responded to an online survey including questions on how audiologists provide direct and indirect referrals to Early Intervention for those infants that are diagnosed with hearing loss. Most respondents agreed that audiologists are the best person to provide this referral, but many audiologists did not mak...

  15. Early diagnosis and empiric therapy for cirrhosis associated with infection

    Directory of Open Access Journals (Sweden)

    NAN Yuemin

    2015-03-01

    Full Text Available Infection is a frequent complication of cirrhosis, which often occurs in the lungs, chest, abdomen, biliary tract, urinary tract, soft tissue, and skin, and occasionally causes spontaneous bacteremia in patients. This paper reviews the risk factors and common types of infection in cirrhosis associated with infection, and the early diagnosis and symptomatic treatment of different types of infection. Moreover, this paper points out that cirrhosis associated with infection is a key factor for disease progression and the early diagnosis and treatment are essential for successful treatment. The third-generation cephalosporins are the first-line antibiotic agents. Drug-resistant bacteria should be treated with antibiotic compound containing β-lactamase inhibitors or carbapenems. Methicillin-resistant Staphylococcus aureus should be treated with glycopeptide antibiotics or combination therapies. Pulmonary mycoses are mainly treated with caspofungin or voriconazole. Antibiotics combined with supportive therapies including the administration of albumin can improve the treatment outcome and prognosis.

  16. Alcohol-paired contextual cues produce an immediate and selective loss of goal-directed action in rats

    Directory of Open Access Journals (Sweden)

    Sean B Ostlund

    2010-07-01

    Full Text Available We assessed whether the presence of contextual cues paired with alcohol would disrupt rats’ capacity to express appropriate goal-directed action control. Rats were first given differential context conditioning such that one set of contextual cues was paired with the injection of ethanol and a second, distinctive set of cues was paired with the injection of saline. All rats were then trained in a third, neutral context to press one lever for grain pellets and another lever for sucrose pellets. They were then given two extinction tests to evaluate their ability to choose between the two actions in response to the devaluation of one of the two food outcomes with one test conducted in the alcohol-paired context and the other conducted in the control (saline-paired context. In the control context, rats exhibited goal-directed action control; i.e., they were able selectively to withhold the action that previously earned the now devalued outcome. However, these same rats were impaired when tested in the alcohol-paired context, performing both actions at the same rate regardless of the current value of their respective outcomes. Subsequent testing revealed that the rats were capable of overcoming this impairment if they were giving response-contingent feedback about the current value of the food outcomes. These results provide a clear demonstration of the disruptive influence that alcohol-paired cues can exert on decision-making in general and goal-directed action selection and choice in particular.

  17. Achievement Goal Orientations and Adolescents' Subjective Well-Being in School: The Mediating Roles of Academic Social Comparison Directions.

    Science.gov (United States)

    Tian, Lili; Yu, Tingting; Huebner, E Scott

    2017-01-01

    The purpose of this study was to examine the multiple mediational roles of academic social comparison directions (upward academic social comparison and downward academic social comparison) on the relationships between achievement goal orientations (i.e., mastery goals, performance-approach goals, and performance-avoidance goals) and subjective well-being (SWB) in school (school satisfaction, school affect) in adolescent students in China. A total of 883 Chinese adolescent students (430 males; Mean age = 12.99) completed a multi-measure questionnaire. Structural equation modeling was used to examine the hypotheses. Results indicated that (1) mastery goal orientations and performance-approach goal orientations both showed a statistically significant, positive correlation with SWB in school whereas performance-avoidance goal orientations showed a statistically significant, negative correlation with SWB in school among adolescents; (2) upward academic social comparisons mediated the relation between the three types of achievement goal orientations (i.e., mastery goals, performance-approach goals, and performance-avoidance goals) and SWB in school; (3) downward academic social comparisons mediated the relation between mastery goal orientations and SWB in school as well as the relation between performance-avoidance goal orientations and SWB in school. The findings suggest possible important cultural differences in the antecedents of SWB in school in adolescent students in China compared to adolescent students in Western nations.

  18. Shaping magnetic fields to direct therapy to ears and eyes.

    Science.gov (United States)

    Shapiro, B; Kulkarni, S; Nacev, A; Sarwar, A; Preciado, D; Depireux, D A

    2014-07-11

    Magnetic fields have the potential to noninvasively direct and focus therapy to disease targets. External magnets can apply forces on drug-coated magnetic nanoparticles, or on living cells that contain particles, and can be used to manipulate them in vivo. Significant progress has been made in developing and testing safe and therapeutic magnetic constructs that can be manipulated by magnetic fields. However, we do not yet have the magnet systems that can then direct those constructs to the right places, in vivo, over human patient distances. We do not yet know where to put the external magnets, how to shape them, or when to turn them on and off to direct particles or magnetized cells-in blood, through tissue, and across barriers-to disease locations. In this article, we consider ear and eye disease targets. Ear and eye targets are too deep and complex to be targeted by a single external magnet, but they are shallow enough that a combination of magnets may be able to direct therapy to them. We focus on how magnetic fields should be shaped (in space and time) to direct magnetic constructs to ear and eye targets.

  19. Inter-individual differences in decision-making, flexible and goal-directed behaviors: novel insights within the prefronto-striatal networks.

    Science.gov (United States)

    Fitoussi, Aurélie; Renault, Prisca; Le Moine, Catherine; Coutureau, Etienne; Cador, Martine; Dellu-Hagedorn, Françoise

    2018-03-01

    Inflexible behavior is a hallmark of several decision-making-related disorders such as ADHD and addiction. As in humans, a subset of healthy rats makes poor decisions and prefers immediate larger rewards despite suffering large losses in a rat gambling task (RGT). They also display a combination of traits reminiscent of addiction, notably inflexible behavior and perseverative responses. The goal of the present work was twofold: (1) to elucidate if behavioral inflexibility of poor decision-makers could be related to a lower quality of goal-directed behavior (action-outcome associations); (2) to uncover the neural basis of inter-individual differences in goal-directed behavior. We specifically assessed inter-individual differences in decision-making in the RGT, flexibility in the RGT-reversed version and goal-directed behavior in a contingency degradation test, i.e., response adaptation when dissociating reward delivery from the animal's action. The contributions of the medial prefrontal cortex and the dorsal striatum to action-outcome associations were assessed using Zif268 immunodetection. Inflexible behavior was related to a lower sensitivity to contingency degradation in all poor decision-makers and only in a few good decision-makers. This poorer sensitivity was associated with a lower immunoreactivity in prelimbic and infralimbic cortices and a higher one in the dorsomedial and dorsolateral striatum. These findings suggest that an imbalanced prefronto-striatal activity could underlie inaccurate goal representation in changing environments and may promote maladaptive habit formation among poor decision-makers. These data strengthen our previous work identifying biomarkers of vulnerability to develop psychiatric disorders and demonstrate the relevance of inter-individual differences to model maladaptive behaviors.

  20. Mapping the timecourse of goal-directed attention to location and colour in human vision.

    Science.gov (United States)

    Adams, Rachel C; Chambers, Christopher D

    2012-03-01

    Goal-directed attention prioritises perception of task-relevant stimuli according to location, features, or onset time. In this study we compared the behavioural timecourse of goal-directed selection to locations and colours by varying the stimulus-onset asynchrony (SOA) between cue and target in a strategic cueing paradigm. Participants reported the presence or absence of a target following prior information regarding its location or colour. Results revealed that preparatory selection by colour is more effective at enhancing perceptual sensitivity than selection by location, even though both types of cue provided equivalent overall information. More detailed analysis revealed that this advantage arose due a limitation of spatial attention in maintaining a sufficiently broad focus (>2°) for target detection across multiple stimuli. In contrast, when target stimuli fell within 2° of the spatial attention spotlight, the strategic advantages and speed of spatial and colour attention were equated. Our findings are consistent with the conclusion that, under spatially optimal conditions, prior spatial and colour information are equally proficient at guiding top-down selection. When spatial locations are ambiguous, however, colour-based selection is the more efficient mechanism. Copyright © 2012 Elsevier B.V. All rights reserved.

  1. Pharmacological Blockade of Adenosine A2A but Not A1 Receptors Enhances Goal-Directed Valuation in Satiety-Based Instrumental Behavior

    Directory of Open Access Journals (Sweden)

    Yan Li

    2018-04-01

    Full Text Available The balance and smooth shift between flexible, goal-directed behaviors and repetitive, habitual actions are critical to optimal performance of behavioral tasks. The striatum plays an essential role in control of goal-directed versus habitual behaviors through a rich interplay of the numerous neurotransmitters and neuromodulators to modify the input, processing and output functions of the striatum. The adenosine receptors (namely A2AR and A1R, with their high expression pattern in the striatum and abilities to interact and integrate dopamine, glutamate and cannabinoid signals in the striatum, may represent novel therapeutic targets for modulating instrumental behavior. In this study, we examined the effects of pharmacological blockade of the A2ARs and A1Rs on goal-directed versus habitual behaviors in different information processing phases of instrumental learning using a satiety-based instrumental behavior procedure. We found that A2AR antagonist acts at the coding, consolidation and expression phases of instrumental learning to modulate animals’ sensitivity to goal-directed valuation without modifying action-outcome contingency. However, pharmacological blockade and genetic knockout of A1Rs did not affect acquisition or sensitivity to goal-valuation of instrumental behavior. These findings provide pharmacological evidence for a potential therapeutic strategy to control abnormal instrumental behaviors associated with drug addiction and obsessive-compulsive disorder by targeting the A2AR.

  2. Does early change predict long-term (6 months) improvements in subjects who receive manual therapy for low back pain?

    Science.gov (United States)

    Cook, Chad; Petersen, Shannon; Donaldson, Megan; Wilhelm, Mark; Learman, Ken

    2017-09-01

    Early change is commonly assessed for manual therapy interventions and has been used to determine treatment appropriateness. However, current studies have only explored the relationship of between or within-session changes and short-/medium-term outcomes. The goal of this study was to determine whether pain changes after two weeks of pragmatic manual therapy could predict those participants with chronic low back pain who demonstrate continued improvements at 6-month follow-up. This study was a retrospective observational design. Univariate logistic regression analyses were performed using a 33% and a 50% pain change to predict improvement. Those who experienced a ≥33% pain reduction by 2 weeks had 6.98 (95% CI = 1.29, 37.53) times higher odds of 50% improvement on the GRoC and 4.74 (95% CI = 1.31, 17.17) times higher odds of 50% improvement on the ODI (at 6 months). Subjects who reported a ≥50% pain reduction at 2 weeks had 5.98 (95% CI = 1.56, 22.88) times higher odds of a 50% improvement in the GRoC and 3.99 (95% CI = 1.23, 12.88) times higher odds of a 50% improvement in the ODI (at 6 months). Future studies may investigate whether a change in plan of care is beneficial for patients who are not showing early improvement predictive of a good long-term outcome.

  3. Pro-Social Goals in Achievement Situations: Amity Goal Orientation Enhances the Positive Effects of Mastery Goal Orientation.

    Science.gov (United States)

    Levontin, Liat; Bardi, Anat

    2018-04-01

    Research has neglected the utility of pro-social goals within achievement situations. In this article, four studies demonstrate that amity goal orientation, promoting mutual success of oneself together with others, enhances the utility of mastery goal orientation. We demonstrate this in longitudinally predicting performance (Studies 1 and 2) and in maintaining motivation after a disappointing performance (Studies 3 and 4). The studies demonstrate the same interaction effect in academic and in work achievement contexts. Specifically, whereas amity goal orientation did not predict achievement on its own, it enhanced the positive effect of mastery goal orientation. Together, these studies establish the importance of amity goal orientation while also advancing our understanding of the effects of other achievement goal orientations. We suggest future directions in examining the utility of amity goals in other contexts.

  4. Couple Therapy with Veterans: Early Improvements and Predictors of Early Dropout.

    Science.gov (United States)

    Fischer, Melanie S; Bhatia, Vickie; Baddeley, Jenna L; Al-Jabari, Rawya; Libet, Julian

    2017-07-28

    Family services within Veterans Affairs Medical Centers fulfill an important role in addressing relationship distress among Veterans, which is highly prevalent and comorbid with psychopathology. However, even for evidence-based couple therapies, effectiveness is weaker compared to controlled studies, maybe because many Veteran couples drop out early and do not reach the "active" treatment stage after the 3-4 session assessment. In order to improve outcomes, it is critical to identify couples at high risk for early dropout, and understand whether couples may benefit from the assessment as an intervention. The current study examined (a) demographics, treatment delivery mode, relationship satisfaction, and psychological symptoms as predictors of dropout during and immediately following the assessment phase, and (b) changes in relationship satisfaction during assessment. 174 couples completed questionnaires during routine intake procedures. The main analyses focused on 140 male Veterans and their female civilian partners; 36.43% dropped out during the assessment phase and 24.74% of the remaining couples immediately following the first treatment session. More severe depressive symptoms in non-Veteran partners were associated with dropout during assessment. Relationship satisfaction improved significantly during the assessment phase for couples who did not drop out, with larger gains for non-Veteran partners. No demographics or treatment delivery mode were associated with dropout. Although more research is needed on engaging couples at risk for early dropout and maximizing early benefits, the findings suggest that clinicians should attend to the civilian partner's and Veteran's depressive symptoms at intake and consider the assessment part of active treatment. © 2017 Family Process Institute.

  5. Real-time decreased sensitivity to an audio-visual illusion during goal-directed reaching.

    Directory of Open Access Journals (Sweden)

    Luc Tremblay

    Full Text Available In humans, sensory afferences are combined and integrated by the central nervous system (Ernst MO, Bülthoff HH (2004 Trends Cogn. Sci. 8: 162-169 and appear to provide a holistic representation of the environment. Empirical studies have repeatedly shown that vision dominates the other senses, especially for tasks with spatial demands. In contrast, it has also been observed that sound can strongly alter the perception of visual events. For example, when presented with 2 flashes and 1 beep in a very brief period of time, humans often report seeing 1 flash (i.e. fusion illusion, Andersen TS, Tiippana K, Sams M (2004 Brain Res. Cogn. Brain Res. 21: 301-308. However, it is not known how an unfolding movement modulates the contribution of vision to perception. Here, we used the audio-visual illusion to demonstrate that goal-directed movements can alter visual information processing in real-time. Specifically, the fusion illusion was linearly reduced as a function of limb velocity. These results suggest that cue combination and integration can be modulated in real-time by goal-directed behaviors; perhaps through sensory gating (Chapman CE, Beauchamp E (2006 J. Neurophysiol. 96: 1664-1675 and/or altered sensory noise (Ernst MO, Bülthoff HH (2004 Trends Cogn. Sci. 8: 162-169 during limb movements.

  6. Goal-directed behaviour and instrumental devaluation: a neural system-level computational model

    Directory of Open Access Journals (Sweden)

    Francesco Mannella

    2016-10-01

    Full Text Available Devaluation is the key experimental paradigm used to demonstrate the presence of instrumental behaviours guided by goals in mammals. We propose a neural system-level computational model to address the question of which brain mechanisms allow the current value of rewards to control instrumental actions. The model pivots on and shows the computational soundness of the hypothesis for which the internal representation of instrumental manipulanda (e.g., levers activate the representation of rewards (or `action-outcomes', e.g. foods while attributing to them a value which depends on the current internal state of the animal (e.g., satiation for some but not all foods. The model also proposes an initial hypothesis of the integrated system of key brain components supporting this process and allowing the recalled outcomes to bias action selection: (a the sub-system formed by the basolateral amygdala and insular cortex acquiring the manipulanda-outcomes associations and attributing the current value to the outcomes; (b the three basal ganglia-cortical loops selecting respectively goals, associative sensory representations, and actions; (c the cortico-cortical and striato-nigro-striatal neural pathways supporting the selection, and selection learning, of actions based on habits and goals. The model reproduces and integrates the results of different devaluation experiments carried out with control rats and rats with pre- and post-training lesions of the basolateral amygdala, the nucleus accumbens core, the prelimbic cortex, and the dorso-medial striatum. The results support the soundness of the hypotheses of the model and show its capacity to integrate, at the system-level, the operations of the key brain structures underlying devaluation. Based on its hypotheses and predictions, the model also represents an operational framework to support the design and analysis of new experiments on the motivational aspects of goal-directed behaviour.

  7. Early Therapeutic Alliance and Treatment Outcome in Individual and Family Therapy for Adolescent Behavior Problems

    Science.gov (United States)

    Hogue, Aaron; Dauber, Sarah; Stambaugh, Leyla Faw; Cecero, John J.; Liddle, Howard A.

    2006-01-01

    The impact of early therapeutic alliance was examined in 100 clients receiving either individual cognitive-behavioral therapy (CBT) or family therapy for adolescent substance abuse. Observational ratings of adolescent alliance in CBT and adolescent and parent alliance in family therapy were used to predict treatment retention (in CBT only) and…

  8. Early Left Parietal Activity Elicited by Direct Gaze: A High-Density EEG Study

    Science.gov (United States)

    Burra, Nicolas; Kerzel, Dirk; George, Nathalie

    2016-01-01

    Gaze is one of the most important cues for human communication and social interaction. In particular, gaze contact is the most primary form of social contact and it is thought to capture attention. A very early-differentiated brain response to direct versus averted gaze has been hypothesized. Here, we used high-density electroencephalography to test this hypothesis. Topographical analysis allowed us to uncover a very early topographic modulation (40–80 ms) of event-related responses to faces with direct as compared to averted gaze. This modulation was obtained only in the condition where intact broadband faces–as opposed to high-pass or low-pas filtered faces–were presented. Source estimation indicated that this early modulation involved the posterior parietal region, encompassing the left precuneus and inferior parietal lobule. This supports the idea that it reflected an early orienting response to direct versus averted gaze. Accordingly, in a follow-up behavioural experiment, we found faster response times to the direct gaze than to the averted gaze broadband faces. In addition, classical evoked potential analysis showed that the N170 peak amplitude was larger for averted gaze than for direct gaze. Taken together, these results suggest that direct gaze may be detected at a very early processing stage, involving a parallel route to the ventral occipito-temporal route of face perceptual analysis. PMID:27880776

  9. New directions for feminist therapy based on social constructionism.

    Science.gov (United States)

    Finfgeld, D L

    2001-06-01

    Feminist therapy has made significant contributions in the area of women's mental health care. Of late, however, critics have argued that feminist therapists are neglecting the needs of many women. The unique perspectives of women of color, lower and upper class women, lesbians, and other persons have been ignored. As such, it is proposed that social constructionism offers a metaframework for reinterpreting feminist therapy tenets to better address the needs of a broad range of individuals. Clinical implications are offered along with future directions for research and education. Copyright 2001 by W.B. Saunders Company

  10. Stem cell clinics online: the direct-to-consumer portrayal of stem cell medicine.

    Science.gov (United States)

    Lau, Darren; Ogbogu, Ubaka; Taylor, Benjamin; Stafinski, Tania; Menon, Devidas; Caulfield, Timothy

    2008-12-04

    Despite the immature state of stem cell medicine, patients are seeking and accessing putative stem cell therapies in an "early market" in which direct-to-consumer advertising via the internet likely plays an important role. We analyzed stem cell clinic websites and appraised the relevant published clinical evidence of stem cell therapies to address three questions about the direct-to-consumer portrayal of stem cell medicine in this early market: What sorts of therapies are being offered? How are they portrayed? Is there clinical evidence to support the use of these therapies? We found that the portrayal of stem cell medicine on provider websites is optimistic and unsubstantiated by peer-reviewed literature.

  11. Achievement Goal Orientations and Adolescents’ Subjective Well-Being in School: The Mediating Roles of Academic Social Comparison Directions

    Science.gov (United States)

    Tian, Lili; Yu, Tingting; Huebner, E. Scott

    2017-01-01

    The purpose of this study was to examine the multiple mediational roles of academic social comparison directions (upward academic social comparison and downward academic social comparison) on the relationships between achievement goal orientations (i.e., mastery goals, performance-approach goals, and performance-avoidance goals) and subjective well-being (SWB) in school (school satisfaction, school affect) in adolescent students in China. A total of 883 Chinese adolescent students (430 males; Mean age = 12.99) completed a multi-measure questionnaire. Structural equation modeling was used to examine the hypotheses. Results indicated that (1) mastery goal orientations and performance-approach goal orientations both showed a statistically significant, positive correlation with SWB in school whereas performance-avoidance goal orientations showed a statistically significant, negative correlation with SWB in school among adolescents; (2) upward academic social comparisons mediated the relation between the three types of achievement goal orientations (i.e., mastery goals, performance-approach goals, and performance-avoidance goals) and SWB in school; (3) downward academic social comparisons mediated the relation between mastery goal orientations and SWB in school as well as the relation between performance-avoidance goal orientations and SWB in school. The findings suggest possible important cultural differences in the antecedents of SWB in school in adolescent students in China compared to adolescent students in Western nations. PMID:28197109

  12. Functional integration processes underlying the instruction-based learning of novel goal-directed behaviors.

    Science.gov (United States)

    Ruge, Hannes; Wolfensteller, Uta

    2013-03-01

    How does the human brain translate symbolic instructions into overt behavior? Previous studies suggested that this process relies on a rapid control transition from the lateral prefrontal cortex (LPFC) to the anterior striatum (aSTR) and premotor cortex (PMC). The present fMRI study investigated whether the transfer from symbolic to pragmatic stimulus-response (S-R) rules relies on changes in the functional coupling among these and other areas and to which extent action goal representations might get integrated within this symbolic-pragmatic transfer. Goal integration processes were examined by manipulating the contingency between actions and differential outcomes (i.e. action goals). We observed a rapid strengthening of the functional coupling between the LPFC and the basal ganglia (aSTR and putamen) and orbitofrontal cortex (OFC) as well as between the LPFC and the anterior dorsal PMC (pre-PMd), the anterior inferior parietal lobule (aIPL), and the posterior superior parietal lobule (pSPL). Importantly, only some of these functional integration processes were sensitive to the outcome contingency manipulation, including LPFC couplings with aSTR, OFC, aIPL, and pre-PMd. This suggests that the symbolic-pragmatic rule transfer is governed by principles of both, instrumental learning (increasingly tighter coupling between LPFC and aSTR/OFC) and ideomotor learning (increasingly tighter coupling between LPFC and aIPL/pre-PMd). By contrast, increased functional coupling between LPFC and putamen was insensitive to outcome contingency possibly indicating an early stage of habit formation under instructed learning conditions. Copyright © 2012 Elsevier Inc. All rights reserved.

  13. How does reward compete with goal-directed and stimulus-driven shifts of attention?

    Science.gov (United States)

    Bourgeois, Alexia; Neveu, Rémi; Bayle, Dimitri J; Vuilleumier, Patrik

    2017-01-01

    In order to behave adaptively, attention can be directed in space either voluntarily (i.e. endogenously) according to strategic goals, or involuntarily (i.e. exogenously) through reflexive capture by salient or novel events. The emotional or motivational values of stimuli can also influence attentional orienting. However, little is known about how reward-related effects compete or interact with endogenous and exogenous attention mechanisms. Here we designed a visual search paradigm in which goal-driven and stimulus-driven shifts of attention were manipulated by classic spatial cueing procedures, while an irrelevant, but previously rewarded stimulus also appeared as a distractor and hence competed with both types of spatial attention during search. Our results demonstrated that stimuli previously associated with a high monetary reward received higher attentional priority in the subsequent visual search task, even though these stimuli and reward were no longer task-relevant, mitigating the attentional orienting induced by both endogenous and exogenous cues.

  14. Post-treatment HIV-1 controllers with a long-term virological remission after the interruption of early initiated antiretroviral therapy ANRS VISCONTI Study.

    Directory of Open Access Journals (Sweden)

    Asier Sáez-Cirión

    2013-03-01

    Full Text Available Combination antiretroviral therapy (cART reduces HIV-associated morbidities and mortalities but cannot cure the infection. Given the difficulty of eradicating HIV-1, a functional cure for HIV-infected patients appears to be a more reachable short-term goal. We identified 14 HIV patients (post-treatment controllers [PTCs] whose viremia remained controlled for several years after the interruption of prolonged cART initiated during the primary infection. Most PTCs lacked the protective HLA B alleles that are overrepresented in spontaneous HIV controllers (HICs; instead, they carried risk-associated HLA alleles that were largely absent among the HICs. Accordingly, the PTCs had poorer CD8+ T cell responses and more severe primary infections than the HICs did. Moreover, the incidence of viral control after the interruption of early antiretroviral therapy was higher among the PTCs than has been reported for spontaneous control. Off therapy, the PTCs were able to maintain and, in some cases, further reduce an extremely low viral reservoir. We found that long-lived HIV-infected CD4+ T cells contributed poorly to the total resting HIV reservoir in the PTCs because of a low rate of infection of naïve T cells and a skewed distribution of resting memory CD4+ T cell subsets. Our results show that early and prolonged cART may allow some individuals with a rather unfavorable background to achieve long-term infection control and may have important implications in the search for a functional HIV cure.

  15. Future Directions in the Study of Early-Life Stress and Physical and Emotional Health: Implications of the Neuroimmune Network Hypothesis.

    Science.gov (United States)

    Hostinar, Camelia E; Nusslock, Robin; Miller, Gregory E

    2018-01-01

    Early-life stress is associated with increased vulnerability to physical and emotional health problems across the lifespan. The recently developed neuroimmune network hypothesis proposes that one of the underlying mechanisms for these associations is that early-life stress amplifies bidirectional crosstalk between the brain and the immune system, contributing to several mental and physical health conditions that have inflammatory underpinnings, such as depression and coronary heart disease. Neuroimmune crosstalk is thought to perpetuate inflammation and neural alterations linked to early-life stress exposure, and also foster behaviors that can further compromise health, such as smoking, drug abuse and consumption of high-fat diets. The goal of the present review is to briefly summarize the neuroimmune network hypothesis and use it as a starting point for generating new questions about the role of early-life stress in establishing a dysregulated relationship between neural and immune signaling, with consequences for lifespan physical and emotional health. Specifically, we aim to discuss implications and future directions for theory and empirical research on early-life stress, as well as for interventions that may improve the health and well-being of children and adolescents living in adverse conditions.

  16. Selection of Optimal Adjuvant Chemotherapy and Targeted Therapy for Early Breast Cancer: ASCO Clinical Practice Guideline Focused Update.

    Science.gov (United States)

    Denduluri, Neelima; Chavez-MacGregor, Mariana; Telli, Melinda L; Eisen, Andrea; Graff, Stephanie L; Hassett, Michael J; Holloway, Jamie N; Hurria, Arti; King, Tari A; Lyman, Gary H; Partridge, Ann H; Somerfield, Mark R; Trudeau, Maureen E; Wolff, Antonio C; Giordano, Sharon H

    2018-05-22

    Purpose To update key recommendations of the ASCO guideline adaptation of the Cancer Care Ontario guideline on the selection of optimal adjuvant chemotherapy regimens for early breast cancer and adjuvant targeted therapy for breast cancer. Methods An Expert Panel conducted targeted systematic literature reviews guided by a signals approach to identify new, potentially practice-changing data that might translate to revised practice recommendations. Results The Expert Panel reviewed phase III trials that evaluated adjuvant capecitabine after completion of standard preoperative anthracycline- and taxane-based combination chemotherapy by patients with early-stage breast cancer HER2-negative breast cancer with residual invasive disease at surgery; the addition of 1 year of adjuvant pertuzumab to combination chemotherapy and trastuzumab for patients with early-stage, HER2-positive breast cancer; and the use of neratinib as extended adjuvant therapy for patients after combination chemotherapy and trastuzumab-based adjuvant therapy with early-stage, HER2-positive breast cancer. Recommendations Patients with early-stage HER2-negative breast cancer with pathologic, invasive residual disease at surgery following standard anthracycline- and taxane-based preoperative therapy may be offered up to six to eight cycles of adjuvant capecitabine. Clinicians may add 1 year of adjuvant pertuzumab to trastuzumab-based combination chemotherapy in patients with high-risk, early-stage, HER2-positive breast cancer. Clinicians may use extended adjuvant therapy with neratinib to follow trastuzumab in patients with early-stage, HER2-positive breast cancer. Neratinib causes substantial diarrhea, and diarrhea prophylaxis must be used. Additional information can be found at www.asco.org/breast-cancer-guidelines .

  17. Stereotactic body radiation therapy versus conventional radiation therapy in patients with early stage non-small cell lung cancer

    DEFF Research Database (Denmark)

    Jeppesen, Stefan Starup; Schytte, Tine; Jensen, Henrik R

    2013-01-01

    Abstract Introduction. Stereotactic body radiation therapy (SBRT) for early stage non-small cell lung cancer (NSCLC) is now an accepted and patient friendly treatment, but still controversy exists about its comparability to conventional radiation therapy (RT). The purpose of this single...... and SBRT predicted improved prognosis. However, staging procedure, confirmation procedure of recurrence and technical improvements of radiation treatment is likely to influence outcomes. However, SBRT seems to be as efficient as conventional RT and is a more convenient treatment for the patients....

  18. Goal setting in psychotherapy: the relevance of approach and avoidance goals for treatment outcome.

    Science.gov (United States)

    Wollburg, Eileen; Braukhaus, Christoph

    2010-07-01

    The present study is the first aimed at investigating the influence of goal definition on treatment outcome in a sample of depressed patients. Data from 657 inpatients admitted to a psychosomatic clinic in Germany being treated in a cognitive-behavioral therapy program were analyzed. Treatment goals were identified as either approach or avoidance, and the sample was classified accordingly. Patients who identified approach goals only were placed in the approach group, and those who identified at least one avoidance goal were placed in the avoidance group. Results showed that framing goals using avoidance terms was associated with less symptomatic improvement but did not affect goal attainment. Findings from this research should be utilized in practice not only for process management such as individual treatment planning but also to control outcome quality. Furthermore, goal definition should be considered as a control variable in research on depression.

  19. Dynamic muscle O2 saturation response is impaired during major non-cardiac surgery despite goal-directed haemodynamic therapy.

    Science.gov (United States)

    Feldheiser, A; Hunsicker, O; Kaufner, L; Köhler, J; Sieglitz, H; Casans Francés, R; Wernecke, K-D; Sehouli, J; Spies, C

    2016-03-01

    Near-infrared spectroscopy combined with a vascular occlusion test (VOT) could indicate an impairment of microvascular reactivity (MVR) in septic patients by detecting changes in dynamic variables of muscle O2 saturation (StO2). However, in the perioperative context the consequences of surgical trauma on dynamic variables of muscle StO2 as indicators of MVR are still unknown. This study is a sub-analysis of a randomised controlled trial in patients with metastatic primary ovarian cancer undergoing debulking surgery, during which a goal-directed haemodynamic algorithm was applied using oesophageal Doppler. During a 3 min VOT, near-infrared spectroscopy was used to assess dynamic variables arising from changes in muscle StO2. At the beginning of surgery, values of desaturation and recovery slope were comparable to values obtained in healthy volunteers. During the course of surgery, both desaturation and recovery slope showed a gradual decrease. Concomitantly, the study population underwent a transition to a surgically induced systemic inflammatory response state shown by a gradual increase in norepinephrine administration, heart rate, and Interleukin-6, with a peak immediately after the end of surgery. Higher rates of norepinephrine and a higher heart rate were related to a faster decline in StO2 during vascular occlusion. Using near-infrared spectroscopy combined with a VOT during surgery showed a gradual deterioration of MVR in patients treated with optimal haemodynamic care. The deterioration of MVR was accompanied by the transition to a surgically induced systemic inflammatory response state. Copyright © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. A gene expression profile indicative of early stage HER2 targeted therapy response.

    Science.gov (United States)

    O'Neill, Fiona; Madden, Stephen F; Clynes, Martin; Crown, John; Doolan, Padraig; Aherne, Sinéad T; O'Connor, Robert

    2013-07-01

    Efficacious application of HER2-targetting agents requires the identification of novel predictive biomarkers. Lapatinib, afatinib and neratinib are tyrosine kinase inhibitors (TKIs) of HER2 and EGFR growth factor receptors. A panel of breast cancer cell lines was treated with these agents, trastuzumab, gefitinib and cytotoxic therapies and the expression pattern of a specific panel of genes using RT-PCR was investigated as a potential marker of early drug response to HER2-targeting therapies. Treatment of HER2 TKI-sensitive SKBR3 and BT474 cell lines with lapatinib, afatinib and neratinib induced an increase in the expression of RB1CC1, ERBB3, FOXO3a and NR3C1. The response directly correlated with the degree of sensitivity. This expression pattern switched from up-regulated to down-regulated in the HER2 expressing, HER2-TKI insensitive cell line MDAMB453. Expression of the CCND1 gene demonstrated an inversely proportional response to drug exposure. A similar expression pattern was observed following the treatment with both neratinib and afatinib. These patterns were retained following exposure to traztuzumab and lapatinib plus capecitabine. In contrast, gefitinib, dasatinib and epirubicin treatment resulted in a completely different expression pattern change. In these HER2-expressing cell line models, lapatinib, neratinib, afatinib and trastuzumab treatment generated a characteristic and specific gene expression response, proportionate to the sensitivity of the cell lines to the HER2 inhibitor.Characterisation of the induced changes in expression levels of these genes may therefore give a valuable, very early predictor of the likely extent and specificity of tumour HER2 inhibitor response in patients, potentially guiding more specific use of these agents.

  1. Examining the Motivational Impact of Intrinsic Versus Extrinsic Goal Framing and Autonomy-Supportive Versus Internally Controlling Communication Style on Early Adolescents' Academic Achievement

    Science.gov (United States)

    Vansteenkiste, Maarten; Simons, Joke; Lens, Willy; Soenens, Bart; Matos, Lennia

    2005-01-01

    The present experimental research examined whether framing early adolescents' (11- to 12-year-olds) learning activity in terms of the attainment of an extrinsic (i.e., physical attractiveness) versus intrinsic (i.e., health) goal and communicating these different goal contents in an internally controlling versus autonomy-supportive way affect…

  2. Radiation therapy and patient age in the survival from early-stage breast cancer

    International Nuclear Information System (INIS)

    Joslyn, Sue A.

    1999-01-01

    Purpose: To analyze the use of radiation therapy following local excision of invasive localized breast cancer and subsequent survival by 5-year age category. Methods: Data for 27,399 women diagnosed with localized stage of breast cancer and treated with local excision surgery from 1983 through 1992 were collected and provided by the national Surveillance, Epidemiology, and End Results (SEER) program. Use of radiation therapy was analyzed by race, ethnic background, geographic location, and age at diagnosis. Survival for women treated with local excision plus radiation therapy was compared to that of women treated with local excision alone for each 5-year age category. Results: Subjects in older age groups were significantly less likely (p < 0.001) to receive radiation following local excision compared to younger age groups. Statistically significant survival advantages were conferred on women receiving radiation therapy in each 5-year age category from age 35 to 84 years (ranging from p = 0.02 to p < 0.0001). Conclusion: While the use of radiation therapy following local excision of early-stage breast tumors drops significantly in older age groups, women aged 35-84 years receiving radiation therapy had significant reductions in mortality. These results did not appear to be influenced by the presence of mortal comorbid conditions. These results strongly suggest the need to consider carefully patient characteristics other than age in deciding the course of treatment for early-stage breast cancer

  3. Therapy of Sjögren's syndrome. New aspects and future directions.

    Science.gov (United States)

    Vlachoyiannopoulos, P G

    1998-02-01

    Therapy of Sjögren's syndrome remains empirical and symptomatic. The main goals are to treat the disease related features, especially sicca manifestations, since the immunosuppressive therapy has not given promising results. For the treatment of keratoconjunctivitis sicca: local stimulators of tear secretion, protective bicarbonate buffered solutions, replacement therapy or supportive operative procedures should be tried. For oral manifestations: stimulators of salivary secretion such as pilocarpine, or agents changing the consistency of saliva such as bromhexine orally should be tried. Saliva substitutes have a transient effect. Frequent ingestion of sugar free liquids may help. Oral hygiene is important to avoid oral candidiasis and dental caries. Treatment of parotid gland swelling is not necessary. Pulmonary manifestations include pulmonary infiltrates in perialveolar areas, nodular or cavitary lesions which may represent lymphoma. Hilar adenopathy, solid or cavitary lesions should be biopsied. In case of vasculitis prednisolone 1 mg/kg/day with progressive tapering should be tried. Renal involvement is manifested mainly as interstitial disease. Administration of NaHCO3 or sodium citrate is important to prevent acidosis and nephrocalcinosis. Vasculitis, when it is of the leukoclasic form, does not need therapy; when it is manifested with severe major organ involvement corticosteroids and/or cytotoxic therapy should be tried. Lymphoma is treated as in the patients without Sjögren's in close collaboration with the oncology department.

  4. The early career researcher's toolkit:translating tissue engineering, regenerative medicine and cell therapy products

    OpenAIRE

    Rafiq, Qasim A.; Ortega, Ilida; Jenkins, Stuart I.; Wilson, Samantha L.; Patel, Asha K.; Barnes, Amanda L.; Adams, Christopher F.; Delcassian, Derfogail; Smith, David

    2015-01-01

    Although the importance of translation for the development of tissue engineering, regenerative medicine and cell-based therapies is widely recognized, the process of translation is less well understood. This is particularly the case among some early career researchers who may not appreciate the intricacies of translational research or make decisions early in development which later hinders effective translation. Based on our own research and experiences as early career researchers involved in...

  5. Early medical rehabilitation after neurosurgical treatment of malignant brain tumours in Slovenia.

    Science.gov (United States)

    Kos, Natasa; Kos, Boris; Benedicic, Mitja

    2016-06-01

    The number of patients with malignant brain tumours is on the rise, but due to the novel treatment methods the survival rates are higher. Despite increased survival the consequences of tumour properties and treatment can have a significant negative effect on the patients' quality of life. Providing timely and appropriate rehabilitation interventions is an important aspect of patient treatment and should be started immediately after surgery. The most important goal of rehabilitation is to prevent complications that could have a negative effect on the patients' ability to function. By using individually tailored early rehabilitation it is often possible to achieve the patients' independence in mobility as well as in performing daily tasks before leaving the hospital. A more precise evaluation of the patients' functional state after completing additional oncologic therapy should be performed to stratify the patients who should be directed to complex rehabilitation treatment. The chances of a good functional outcome in patients with malignant brain tumours could be increased with good early medical rehabilitation treatment.

  6. Music therapy for early cognitive rehabilitation post-childhood TBI: an intrinsic mixed methods case study.

    Science.gov (United States)

    Bower, Janeen; Catroppa, Cathy; Grocke, Denise; Shoemark, Helen

    2014-10-01

    The primary aim of this case study was to explore the behavioural changes of a paediatric patient in post-traumatic amnesia (PTA) during a music therapy session. A secondary objective was to measure the effect of the music therapy intervention on agitation. Video data from pre, during and post-music therapy sessions were collected and analysed using video micro-analysis and the Agitated Behaviour Scale. The participant displayed four discrete categories of behaviours: Neutral, Acceptance, Recruitment and Rejection. Further analysis revealed brief but consistent and repeated periods of awareness and responsiveness to the live singing of familiar songs, which were classified as Islands of Awareness. Song offered an Environment of Potential to maximise these periods of emerging consciousness. The quantitative data analysis yielded inconclusive results in determining if music therapy was effective in reducing agitation during and immediately post the music therapy sessions. The process of micro-analysis illuminated four discrete participant behaviours not apparent in the immediate clinical setting. The results of this case suggest that the use of familiar song as a music therapy intervention may harness early patient responsiveness to foster cognitive rehabilitation in the early acute phase post-TBI.

  7. Patient-relevant treatment goals in psoriasis.

    Science.gov (United States)

    Blome, Christine; Gosau, Ramona; Radtke, Marc A; Reich, Kristian; Rustenbach, Stephan J; Spehr, Christina; Thaçi, Diamant; Augustin, Matthias

    2016-03-01

    Patient-oriented care requires therapeutic decisions to agree with the patients' treatment needs and goals. This study addressed the following questions: What is important to psoriasis patients starting systemic treatment? How stable are these preferences within the first year of treatment? Are treatment goals associated with age, gender, or treatment success? The importance of treatment goals was assessed for patients with moderate-to-severe psoriasis in the German Psoriasis Registry (PsoBest) at baseline (onset of a systemic treatment; n = 3066) and at a 1-year follow-up (n = 1444) using the Patient Benefit Index (PBI). Treatment success was measured with PBI global score and Psoriasis Area Severity Index (PASI). Patients with moderate-to-severe psoriasis pursued a wide range of different goals. The most general treatment goals were rated most relevant, including skin healing and quick skin improvement (94.8/94.5 % "quite" or "very" important), confidence in the therapy (93.0 %), control over the disease (92.3 %), and a clear diagnosis and therapy (89.6 %). Further important goals related to not being in fear of the disease getting worse (84.8 %), reduction in itching (83.9 %), burning (70.6 %), and pain (60.6 %) as well as attaining a normal everyday life (78.4 %) and low treatment burden (64.2-77.9 %). Goals were mostly not associated with sex and gender. Goal importance slightly increased with treatment success. In a substantial proportion of patients (30.3-54.7 %) goal importance changed within 1 year after onset of systemic treatment. We conclude that treatment goal importance should be assessed in clinical practice on a regular basis.

  8. The role of metastasis-directed therapy and local therapy of the primary tumor in the management of oligometastatic prostate cancer.

    Science.gov (United States)

    Kim, Jongchan; Park, Jee Soo; Ham, Won Sik

    2017-09-01

    Oligometastasis has been proposed as an intermediate stage of cancer spread between localized disease and widespread metastasis. Oligometastatic malignancy is now being diagnosed more frequently as the result of improvements in diagnostic modalities such as functional imaging. The importance of oligometastasis in managing metastatic prostate cancer is that it is possible to treat with a curative aim by metastasis-directed or local therapy in selected patients. Many studies have shown that these aggressive treatments lead to improved survival in other oligometastatic malignancies. However, few studies have shown definitive benefits of metastasis-directed or local therapy in oligometastatic prostate cancer. Review of the available studies suggests that stereotactic radiotherapy (RT) of metastatic lesions in oligorecurrent disease is a feasible and safe modality for managing oligometastatic prostate cancer. Also, stereotactic RT can delay the start of androgen deprivation therapy. Many retrospective studies of metastatic prostate cancer have shown that patients undergoing local therapy seem to have superior overall and cancer-specific survival compared with patients not receiving local therapy. Ongoing prospective randomized trials would be helpful to evaluate the role of local therapy in oligometastatic prostate cancer.

  9. The role of metastasis-directed therapy and local therapy of the primary tumor in the management of oligometastatic prostate cancer

    Directory of Open Access Journals (Sweden)

    Jongchan Kim

    2017-09-01

    Full Text Available Oligometastasis has been proposed as an intermediate stage of cancer spread between localized disease and widespread metas-tasis. Oligometastatic malignancy is now being diagnosed more frequently as the result of improvements in diagnostic modalities such as functional imaging. The importance of oligometastasis in managing metastatic prostate cancer is that it is possible to treat with a curative aim by metastasis-directed or local therapy in selected patients. Many studies have shown that these aggressive treatments lead to improved survival in other oligometastatic malignancies. However, few studies have shown definitive benefits of metastasis-directed or local therapy in oligometastatic prostate cancer. Review of the available studies suggests that stereotac-tic radiotherapy (RT of metastatic lesions in oligorecurrent disease is a feasible and safe modality for managing oligometastatic prostate cancer. Also, stereotactic RT can delay the start of androgen deprivation therapy. Many retrospective studies of metastatic prostate cancer have shown that patients undergoing local therapy seem to have superior overall and cancer-specific survival compared with patients not receiving local therapy. Ongoing prospective randomized trials would be helpful to evaluate the role of local therapy in oligometastatic prostate cancer.

  10. Evaluation of therapy response in breast and ovarian cancer patients by positron emission tomography (PET)

    Energy Technology Data Exchange (ETDEWEB)

    Baum, R. P.; Przetak, C. [Zentralklinik Bad Berka, Clinic of Nuclear Medicine, Center for PET, Bad Berka (Germany)

    2001-09-01

    Positron emission tomography (PET) has the potential to contribute significantly to treatment planning and to the evaluation of response to therapy in patients with cancer. For disease recurrence PET imaging provides information non-invasively. The final goal is to biologically characterize an individual patients' tumor and to predict the response to treatment at the earliest possible time. Quantitative and/or semi-quantitative PET studies yield valuable information in breast cancer regarding prognosis and response to chemohormontherapy in a timely fashion. In ovarian cancer, up to now only few studies have been performed applying PET techniques for the evaluation of treatment response. These preliminary studies indicate that serial assessment of tumor metabolism by FDG-PET early during effective chemotherapy may predict subsequent response to such therapy. PET studies can be repeated without any side-effects and with low radiation exposure and results can be directly correlated with clinical laboratory data and histology. Therapy monitoring by PET could help to optimize neoadjuvant therapy protocols and to avoid ineffective preoperative therapy in non-responders, but this has to be proven in a larger number of patients and in different neoadjuvant settings such as chemotherapy, radiation therapy, hormone therapy or a combination of these.

  11. Evaluation of therapy response in breast and ovarian cancer patients by positron emission tomography (PET)

    International Nuclear Information System (INIS)

    Baum, R. P.; Przetak, C.

    2001-01-01

    Positron emission tomography (PET) has the potential to contribute significantly to treatment planning and to the evaluation of response to therapy in patients with cancer. For disease recurrence PET imaging provides information non-invasively. The final goal is to biologically characterize an individual patients' tumor and to predict the response to treatment at the earliest possible time. Quantitative and/or semi-quantitative PET studies yield valuable information in breast cancer regarding prognosis and response to chemohormontherapy in a timely fashion. In ovarian cancer, up to now only few studies have been performed applying PET techniques for the evaluation of treatment response. These preliminary studies indicate that serial assessment of tumor metabolism by FDG-PET early during effective chemotherapy may predict subsequent response to such therapy. PET studies can be repeated without any side-effects and with low radiation exposure and results can be directly correlated with clinical laboratory data and histology. Therapy monitoring by PET could help to optimize neoadjuvant therapy protocols and to avoid ineffective preoperative therapy in non-responders, but this has to be proven in a larger number of patients and in different neoadjuvant settings such as chemotherapy, radiation therapy, hormone therapy or a combination of these

  12. Intact goal-directed control in treatment-seeking drug users indexed by outcome-devaluation and Pavlovian to instrumental transfer: Critique of habit theory.

    Science.gov (United States)

    Hogarth, Lee; Lam-Cassettari, Christa; Pacitti, Helena; Currah, Tara; Mahlberg, Justin; Hartley, Lucie; Moustafa, Ahmed

    2018-05-22

    Animal studies have demonstrated that chronic exposure to drugs of abuse impairs goal-directed control over action selection indexed by the outcome-devaluation and specific Pavlovian to instrumental transfer procedures, suggesting this impairment might underpin addiction. However, there is currently only weak evidence for impaired goal-directed control in human drug users. Two experiments were undertaken in which treatment-seeking drug users and non-matched normative reference samples (controls) completed outcome-devaluation and specific Pavlovian to instrumental transfer procedures notionally translatable to animal procedures (Experiment 2 used a more challenging biconditional schedule). The two experiments found significant outcome-devaluation and specific Pavlovian to instrumental transfer effects overall and there was no significant difference between groups in the magnitude of these effects. Moreover, Bayes factor supported the null hypothesis for these group comparisons. Although limited by non-matched group comparisons and small sample sizes, the two studies suggest that treatment-seeking drug users have intact goal-directed control over action selection, adding uncertainty to already mixed evidence concerning the role of habit learning in human drug dependence. Neuro-interventions might seek to tackle goal-directed drug-seeking rather than habit formation in drug users. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  13. Habit strength is predicted by activity dynamics in goal-directed brain systems during training.

    Science.gov (United States)

    Zwosta, Katharina; Ruge, Hannes; Goschke, Thomas; Wolfensteller, Uta

    2018-01-15

    Previous neuroscientific research revealed insights into the brain networks supporting goal-directed and habitual behavior, respectively. However, it remains unclear how these contribute to inter-individual differences in habit strength which is relevant for understanding not only normal behavior but also more severe dysregulations between these types of action control, such as in addiction. In the present fMRI study, we trained subjects on approach and avoidance behavior for an extended period of time before testing the habit strength of the acquired stimulus-response associations. We found that stronger habits were associated with a stronger decrease in inferior parietal lobule activity for approach and avoidance behavior and weaker vmPFC activity at the end of training for avoidance behavior, areas associated with the anticipation of outcome identity and value. VmPFC in particular showed markedly different activity dynamics during the training of approach and avoidance behavior. Furthermore, while ongoing training was accompanied by increasing functional connectivity between posterior putamen and premotor cortex, consistent with previous assumptions about the neural basis of increasing habitualization, this was not predictive of later habit strength. Together, our findings suggest that inter-individual differences in habitual behavior are driven by differences in the persistent involvement of brain areas supporting goal-directed behavior during training. Copyright © 2017. Published by Elsevier Inc.

  14. Music Therapy in Europe

    DEFF Research Database (Denmark)

    2015-01-01

    Professional development and recognition is an 'old' issue in music therapy but still a relevant, complex and crucial one. Burning questions regarding professionalisation are at the forefront of most music therapy associations’ agendas across Europe and beyond, and feed back directly to the work...... of the EMTC. Considering the wider political, socio-economic, cultural and disciplinary aspects of professionalisation, different development pathways impact directly on music therapy practice, training, ethics, professional collaboration and employment conditions. Although a number of endeavours have been...... implemented regarding music therapy’s professional development and recognition in different countries, documentation and sharing of such endeavours on international level has been limited and scattered. Drawing from the EMTC’s work since the early ‘90s, as well as from colleagues’ experiences (and struggles...

  15. [Synergistic effect of cell kinetics-directed chemo-endocrine therapy on experimental mammary tumors].

    Science.gov (United States)

    Ueki, H

    1987-11-01

    We tried to demonstrate that the cell kinetics-directed chemoendocrine therapy is more effective on hormone dependent breast cancer than empirical combination of the endocrine therapy and chemotherapy. Cell kinetics of each tumor was measured by flow cytometric analysis. Estrogen dependent human breast cancer cell line MCF-7 was used in vitro. In vivo, androgen dependent SC-115 carcinoma was transplanted to DDS mice. In vitro, tamoxifen was administered as the endocrine therapy. In vivo, we carried out testectomy on DDS mice. Effect of the endocrine therapy on the cell kinetics of the tumor was thought to be G1-S depression. High density 5FU was administered as the chemotherapeutic agents, whose content was 1 microgram/ml in vitro and 40 mg/kg in vivo. 5FU brought temporary decrease of cells in S phase. Only anteceding 5FU administration had synergistic effect in combination of 5FU and the endocrine therapy. 5FU was convinced to act more effectively on cells in S phase, so it was shown that cell kinetics-directed schedule was superior to the empirical treatment schedule in chemoendocrine therapy.

  16. Movement Structure in Young and Elderly Adults during Goal-Directed Movements of the Left and Right Arm

    Science.gov (United States)

    Poston, Brach; Van Gemmert, Arend W. A.; Barduson, Beth; Stelmach, George E.

    2009-01-01

    Elderly adults often exhibit performance deficits during goal-directed movements of the dominant arm compared with young adults. Recent studies involving hemispheric lateralization have provided evidence that the dominant and non-dominant hemisphere-arm systems are specialized for controlling different movement parameters and that hemispheric…

  17. Endoscopic therapy in early adenocarcinomas (Barrett's cancer) of the esophagus.

    Science.gov (United States)

    Knabe, Mate; May, Andrea; Ell, Christian

    2015-07-01

    The incidence of early esophageal adenocarcinoma has been increasing significantly in recent decades. Prognosis depends greatly on the choice of treatment. Early cancers can be treated by endoscopic resection, whereas advanced carcinomas have to be sent for surgery. Esophageal resection is associated with high perioperative mortality (1-5%) even in specialized centers. Early diagnosis enables curative endoscopic treatment option. Patients with gastrointestinal symptoms and a familial risk for esophageal cancer should undergo upper gastrointestinal endoscopy. High-definition endoscopes have been developed with technical add-on that helps endoscopists to find fine irregularities in the esophageal mucosa, but interpreting the findings remains challenging. In this review we discussed novel and old diagnostic procedures and their values, as well as our own recommendations and those of the authors discussed for the diagnosis and treatment of early Barrett's carcinoma. Endoscopic resection is the therapy of choice in early esophageal adenocarcinoma. It is mandatory to perform a subsequent ablation of all residual Barrett's mucosa to avoid metachronous lesions. © 2015 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

  18. Some effects of radiation therapy during early childhood on facial growth and tooth development

    International Nuclear Information System (INIS)

    Harris, A.M.P.; Nortje, C.J.; Lucchesi, M.V.

    1986-01-01

    Case histories of the dental examinations of 2 children who were treated by radiation therapy for retinoblastomas in early childhood are discussed. The evidence presented here seems to indicate that in both patients early irradiation of the orbits and, as a result thereof, the jaws, could be partly responsible for the underdevelopment of this region

  19. Towards a three-dimensional framework of centrally regulated and goal-directed exercise behaviour: a narrative review.

    Science.gov (United States)

    Venhorst, Andreas; Micklewright, Dominic; Noakes, Timothy D

    2017-08-23

    The Central Governor Model (CGM) ignited a paradigm shift from concepts of catastrophic failure towards central regulation of exercise performance. However, the CGM has focused on the central integration of afferent feedback in homeostatic control. Accordingly, it neglected the important role of volitional self-regulatory control and the integration of affective components inherently attached to all physiological cues. Another limitation is the large reliance on the Gestalt phenomenon of perceived exertion. Thus, progress towards a comprehensive multidimensional model of perceived fatigability and exercise regulation is needed. Drawing on Gate Control Theory of pain, we propose a three-dimensional framework of centrally regulated and goal-directed exercise behaviour, which differentiates between sensory, affective and cognitive processes shaping the perceptual milieu during exercise. We propose that: (A) perceived mental strain and perceived physical strain are primary determinants of pacing behaviour reflecting sensory-discriminatory processes necessary to align planned behaviour with current physiological state, (B) core affect plays a primary and mediatory role in exercise and performance regulation, and its underlying two dimensions hedonicity and arousal reflect affective-motivational processes triggering approach and avoidance behaviour, and (C) the mindset-shift associated with an action crisis plays a primary role in volitional self-regulatory control reflecting cognitive-evaluative processes between further goal-pursuit and goal-disengagement. The proposed framework has the potential to enrich theory development in centrally regulated and goal-directed exercise behaviour by emphasising the multidimensional dynamic processes underpinning perceived fatigability and provides a practical outline for investigating the complex interplay between the psychophysiological determinants of pacing and performance during prolonged endurance exercise. © Article author

  20. Contributions to clinical Occupational Therapy in the area of early intervention in interdisciplinary team

    Directory of Open Access Journals (Sweden)

    Dani Laura Peruzzolo

    2015-07-01

    Full Text Available Introduction: Specialized care for infants considers that the sooner the intervention in risk and symptoms occurs, the greater the possibility of obtaining better results. Aims: To describe the process of early intervention provided by an extension program of graduate studies in Occupational Therapy and Hearing, Speech and Languages Science courses and also discuss the theoretical and practical paths in the care for infants and in the Occupational Therapy area. Method: Case report with convenience sample. The study was carried out through an assessment interpreted in light of psychomotor, occupational therapeutic, and speech, hearing and language contributions. The intervention was under the responsibility of an occupational therapist supported by an interdisciplinary team. It occurred once a week from August 2011 to January 2012 and from March 2012 to July 2012. Data analysis was carried out by comparing the entry assessment test and the final assessment test. Results: The boy had not developed concepts of body schema and body image that could sustain his relationship with objects, space and other persons. He presented little linguistic evolution. Considering the contributions of occupational therapy in psychomotor clinic, the boy reconstructed his family place in early intervention. The possibility of language functioning connected to the boy’s demands allowed access to symbolism. Conclusion: The proposal of early occupational therapy intervention with a single therapist supported by an interdisciplinary team was able to overcome the structural and instrumental obstacles to the boy’s development.

  1. Computed tomography assessment of early response to neoadjuvant therapy in colon cancer

    DEFF Research Database (Denmark)

    Dam, Claus; Lund-Rasmussen, Vera; Pløen, John

    2015-01-01

    INTRODUCTION: Using multidetector computed tomography, we aimed to assess the early response of neoadjuvant drug therapy for locally advanced colon cancer. METHODS: Computed tomography with IV contrast was acquired from 67 patients before and after up to three cycles of preoperative treatment. All...

  2. Computational Properties of the Hippocampus Increase the Efficiency of Goal-Directed Foraging through Hierarchical Reinforcement Learning

    Directory of Open Access Journals (Sweden)

    Eric Chalmers

    2016-12-01

    Full Text Available The mammalian brain is thought to use a version of Model-based Reinforcement Learning (MBRL to guide goal-directed behavior, wherein animals consider goals and make plans to acquire desired outcomes. However, conventional MBRL algorithms do not fully explain animals’ ability to rapidly adapt to environmental changes, or learn multiple complex tasks. They also require extensive computation, suggesting that goal-directed behavior is cognitively expensive. We propose here that key features of processing in the hippocampus support a flexible MBRL mechanism for spatial navigation that is computationally efficient and can adapt quickly to change. We investigate this idea by implementing a computational MBRL framework that incorporates features inspired by computational properties of the hippocampus: a hierarchical representation of space, forward sweeps through future spatial trajectories, and context-driven remapping of place cells. We find that a hierarchical abstraction of space greatly reduces the computational load (mental effort required for adaptation to changing environmental conditions, and allows efficient scaling to large problems. It also allows abstract knowledge gained at high levels to guide adaptation to new obstacles. Moreover, a context-driven remapping mechanism allows learning and memory of multiple tasks. Simulating dorsal or ventral hippocampal lesions in our computational framework qualitatively reproduces behavioral deficits observed in rodents with analogous lesions. The framework may thus embody key features of how the brain organizes model-based RL to efficiently solve navigation and other difficult tasks.

  3. Goal setting with mothers in child development services.

    Science.gov (United States)

    Forsingdal, S; St John, W; Miller, V; Harvey, A; Wearne, P

    2014-07-01

    The aim of this grounded theory study was to explore mothers' perspectives of the processes of collaborative goal setting in multidisciplinary child development services involving follow-up home therapy. Semi-structured interviews were conducted in South East Queensland, Australia with 14 mothers of children aged 3-6 years who were accessing multidisciplinary child development services. Interviews were focussed around the process of goal setting. A grounded theory of Maternal Roles in Goal Setting (The M-RIGS Model) was developed from analysis of data. Mothers assumed Dependent, Active Participator and Collaborator roles when engaging with the therapist in goal-setting processes. These roles were characterized by the mother's level of dependence on the therapist and insight into their child's needs and therapy processes. Goal Factors, Parent Factors and Therapist Factors influenced and added complexity to the goal-setting process. The M-RIGS Model highlights that mothers take on a range of roles in the goal-setting process. Although family-centred practice encourages negotiation and collaborative goal setting, parents may not always be ready to take on highly collaborative roles. Better understanding of parent roles, goal-setting processes and influencing factors will inform better engagement with families accessing multidisciplinary child development services. © 2013 John Wiley & Sons Ltd.

  4. From Creatures of Habit to Goal-Directed Learners: Tracking the Developmental Emergence of Model-Based Reinforcement Learning.

    Science.gov (United States)

    Decker, Johannes H; Otto, A Ross; Daw, Nathaniel D; Hartley, Catherine A

    2016-06-01

    Theoretical models distinguish two decision-making strategies that have been formalized in reinforcement-learning theory. A model-based strategy leverages a cognitive model of potential actions and their consequences to make goal-directed choices, whereas a model-free strategy evaluates actions based solely on their reward history. Research in adults has begun to elucidate the psychological mechanisms and neural substrates underlying these learning processes and factors that influence their relative recruitment. However, the developmental trajectory of these evaluative strategies has not been well characterized. In this study, children, adolescents, and adults performed a sequential reinforcement-learning task that enabled estimation of model-based and model-free contributions to choice. Whereas a model-free strategy was apparent in choice behavior across all age groups, a model-based strategy was absent in children, became evident in adolescents, and strengthened in adults. These results suggest that recruitment of model-based valuation systems represents a critical cognitive component underlying the gradual maturation of goal-directed behavior. © The Author(s) 2016.

  5. Radiation therapy of early glottic cancer

    International Nuclear Information System (INIS)

    Neri, S.

    1987-01-01

    The control of early glottic cancer is equally satisfactory with either surgical resection or radiation therapy; this last method gives the patient good functional results. During the period from 1/1978 to 12/1985, 73 patients with early glottic carcinoma (T1 N0 M0) were treated in the Institute of Radiotherapy L. Galvani, University of Bologna; 45 were stage T1a (tumor limited to one vocal cord) and 28 were stage T1b (tumor of both vocal cords or involving anterior commissure); radiation treatment utilized a 60 Co machine and 5x5 cm fields; the median dose was 67.2 Gy (range 50-76) with conventional fractionation. Ten patients had local recurrence; the median time of recurrence was 13.4 months; 9/10 were treated by surgery and 2/10 died, so the overall control by radiotherapy with surgery in reserve was 100% in T1a tumers and 90.6% in T1b ones. The 5-years disease free survival rate was 93.1% in T1a tumors and 69% in T1b; lesions involving anterior commissure had the worst prognosis, independent of the dose and time-dose factor (3/10 recurrences in the group treated with TDF less than 110 and 4/18 recurrences in the group with TDF more than 110)

  6. A Good Foundation for Number Learning for Five-Year-Olds? An Evaluation of the English Early Learning "Numbers" Goal in the Light of Research

    Science.gov (United States)

    Gifford, Sue

    2014-01-01

    This article sets out to evaluate the English Early Years Foundation Stage Goal for Numbers, in relation to research evidence. The Goal, which sets out to provide "a good foundation in mathematics", has greater breadth of content and higher levels of difficulty than previous versions. Research suggests that the additional expectations…

  7. Musical Play as Therapy in an Early Intervention Programme

    Directory of Open Access Journals (Sweden)

    Julie Wylie

    2013-07-01

    Full Text Available Effective therapeutic use of music for very young children with multi-system developmental disabilities involves engaging them and their parents/caregivers in musical play activities that can regulate the children’s (and parents’ physiological systems, strengthen parent-child relationships, and open children’s minds to physical, social emotional and intellectual learning and development; both in the context of music therapy and in response to goals set by a multi-disciplinary team. This article, based on a presentation given at the ISME conference in Greece in 2012, describes the therapy programmes at the Champion Centre in Christchurch, New Zealand and presents four case studies designed to illustrate the type and range of activities that have been shown to be effective over twenty years of experience. They show how when music practitioners follow the child’s lead, and draw the parents into the interaction as full partners, the well-being of children is enhanced and their parents are encouraged to engage in similar activities at home, thereby extending music’s therapeutic reach and effectiveness.

  8. Effects of Transcranial Direct Current Stimulation on Expression of Immediate Early Genes (IEG’s)

    Science.gov (United States)

    2015-12-01

    TRANSCRANIAL DIRECT CURRENT STIMULATION OF EXPRESSION OF IMMEDIATE EARLY GENES (IEG’S) Jessica...AND SUBTITLE Effects of Transcranial Direct Current Stimulation on Expression of Immediate Early Genes (IEG’s) 5a. CONTRACT NUMBER In-House 5b...community in better understanding what is occurring biologically during tDCS. 15. SUBJECT TERMS Transcranial direct current stimulation

  9. Reinforcement Learning Approach to Generate Goal-directed Locomotion of a Snake-Like Robot with Screw-Drive Units

    DEFF Research Database (Denmark)

    Chatterjee, Sromona; Nachstedt, Timo; Tamosiunaite, Minija

    2014-01-01

    Abstract—In this paper we apply a policy improvement algorithm called Policy Improvement using Path Integrals (PI2) to generate goal-directed locomotion of a complex snake-like robot with screw-drive units. PI2 is numerically simple and has an ability to deal with high dimensional systems. Here...

  10. Therapy of anorexia and Young’s early maladaptive schemas. Longitudinal study

    Directory of Open Access Journals (Sweden)

    Dorota Mącik

    2015-10-01

    Full Text Available Background Young’s early maladaptive schemas are defined as convictions about oneself acquired in childhood, formed by a child in response to deprivation of his or her basic needs, especially in the area of relationships. In the case of anorexia, the role of the family and relations is emphasized as crucial for the genesis of this disorder. The aim of the research was to investigate whether Young’s early maladaptive schemas change during the therapy, which would prognosticate higher treatment efficiency. Participants and procedure The study group included 30 women suffering from anorexia, starting their 6-week therapeutic program. The procedure included double measurement: during the administration and discharge. The respondents filled in the Young Schema Questionnaire in its short form (YSQ-S3 (twice, the Acceptance of Illness Scale (AIS adapted by Juczyński (twice, and a demographic chart (once. Results The intensity of all schemas decreased after completion of the therapeutic program; the differences were mostly statistically significant. The composition of the most intense schemas did not change significantly: unrelenting standards and abandonment were the highest during both measurements. What changed were the interrelations between the schemas. They are also connected with the acceptance of the illness (the weaker they are, the greater the acceptance, and the stronger the relations and with psychological well-being, especially during the post-therapy measurement. Conclusions The schemas seem to be significant from the perspective of understanding anorexia. They are susceptible to be changed by integrative therapies. Nevertheless, it seems that in order to achieve a durable change, schema therapy should be applied.

  11. Psychological Therapies for Auditory Hallucinations (Voices): Current Status and Key Directions for Future Research

    NARCIS (Netherlands)

    Thomas, N.; Hayward, M.; Peters, E; van der Gaag, M.; Bentall, R.P.; Jenner, J.; Strauss, C.; Sommer, I.E.; Johns, L.C.; Varese, F.; Gracia-Montes, J.M.; Waters, F.; Dodgson, G.; McCarthy-Jones, S.

    2014-01-01

    This report from the International Consortium on Hallucinations Research considers the current status and future directions in research on psychological therapies targeting auditory hallucinations (hearing voices). Therapy approaches have evolved from behavioral and coping-focused interventions,

  12. Animal-assisted therapy for clients with dementia.

    Science.gov (United States)

    Buettner, Linda L; Fitzsimmons, Suzanne; Barba, Beth

    2011-05-01

    The purpose of this article is to increase nurses' awareness of animal-assisted therapy as a treatment option for older adults with dementia. We describe the differences between animal visitation programs and goal-directed therapy. We also address credentials of human-animal teams and provide an overview of possible therapeutic outcomes for older adults with dementia. Step-by-step methods are outlined for nurses to advocate for clients with dementia to receive these services. Copyright 2011, SLACK Incorporated.

  13. Blood culture gram stain, acridine orange stain and direct sensitivity-based antimicrobial therapy of bloodstream infection in patients with trauma.

    Science.gov (United States)

    Behera, B; Mathur, P; Gupta, B

    2010-01-01

    The purpose of this study was to ascertain if the simple practice of Gram stain, acridine orange stain and direct sensitivity determination of positive blood culture bottles could be used to guide early and appropriate treatment in trauma patients with clinical suspicion of sepsis. The study also aimed to evaluate the error in interpreting antimicrobial sensitivity by direct method when compared to standard method and find out if specific antibiotic-organism combination had more discrepancies. Findings from consecutive episodes of blood stream infection at an Apex Trauma centre over a 12-month period are summarized. A total of 509 consecutive positive blood cultures were subjected to Gram staining. AO staining was done in BacT/ALERT-positive Gram-stain negative blood cultures. Direct sensitivity was performed from 369 blood culture broths, showing single type of growth in Gram and acridine orange staining. Results of direct sensitivity were compared to conventional sensitivity for errors. No 'very major' discrepancy was found in this study. About 5.2 and 1.8% minor error rates were noted in gram-positive and gram-negative bacteria, respectively, while comparing the two methods. Most of the discrepancies in gram-negative bacteria were noted in beta lactam - beta lactamase inhibitor combinations. Direct sensitivity testing was not reliable for reporting of methicillin and vancomycin resistance in Staphylococci. Gram stain result together with direct sensitivity testing is required for optimizing initial antimicrobial therapy in trauma patients with clinical suspicion of sepsis. Gram staining and AO staining proved particularly helpful in the early detection of candidaemia.

  14. Mediodorsal thalamus hypofunction impairs flexible goal-directed behavior.

    Science.gov (United States)

    Parnaudeau, Sébastien; Taylor, Kathleen; Bolkan, Scott S; Ward, Ryan D; Balsam, Peter D; Kellendonk, Christoph

    2015-03-01

    Cognitive inflexibility is a core symptom of several mental disorders including schizophrenia. Brain imaging studies in schizophrenia patients performing cognitive tasks have reported decreased activation of the mediodorsal thalamus (MD). Using a pharmacogenetic approach to model MD hypofunction, we recently showed that decreasing MD activity impairs reversal learning in mice. While this demonstrates causality between MD hypofunction and cognitive inflexibility, questions remain about the elementary cognitive processes that account for the deficit. Using the Designer Receptors Exclusively Activated by Designer Drugs system, we reversibly decreased MD activity during behavioral tasks assessing elementary cognitive processes inherent to flexible goal-directed behaviors, including extinction, contingency degradation, outcome devaluation, and Pavlovian-to-instrumental transfer (n = 134 mice). While MD hypofunction impaired reversal learning, it did not affect the ability to learn about nonrewarded cues or the ability to modulate action selection based on the outcome value. In contrast, decreasing MD activity delayed the ability to adapt to changes in the contingency between actions and their outcomes. In addition, while Pavlovian learning was not affected by MD hypofunction, decreasing MD activity during Pavlovian learning impaired the ability of conditioned stimuli to modulate instrumental behavior. Mediodorsal thalamus hypofunction causes cognitive inflexibility reflected by an impaired ability to adapt actions when their consequences change. Furthermore, it alters the encoding of environmental stimuli so that they cannot be properly utilized to guide behavior. Modulating MD activity could be a potential therapeutic strategy for promoting adaptive behavior in human subjects with cognitive inflexibility. Copyright © 2015 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

  15. Monetary reward magnitude effects on behavior and brain function during goal-directed behavior.

    Science.gov (United States)

    Rosell-Negre, P; Bustamante, J C; Fuentes-Claramonte, P; Costumero, V; Benabarre, S; Barrós-Loscertales, A

    2017-08-01

    Reward may modulate the cognitive processes required for goal achievement, while individual differences in personality may affect reward modulation. Our aim was to test how different monetary reward magnitudes modulate brain activation and performance during goal-directed behavior, and whether individual differences in reward sensitivity affect this modulation. For this purpose, we scanned 37 subjects with a parametric design in which we varied the magnitude of monetary rewards (€0, €0.01, €0.5, €1 or €1.5) in a blocked fashion while participants performed an interference counting-Stroop condition. The results showed that the brain activity of left dorsolateral prefrontal cortex (DLPFC) and the striatum were modulated by increasing and decreasing reward magnitudes, respectively. Behavioral performance improved as the magnitude of monetary reward increased while comparing the non reward (€0) condition to any other reward condition, or the lower €0.01 to any other reward condition, and this improvement was related with individual differences in reward sensitivity. In conclusion, the locus of influence of monetary incentives overlaps the activity of the regions commonly involved in cognitive control.

  16. Non-Steroidal Anti-inflammatory Drugs As Host-Directed Therapy for Tuberculosis : A Systematic Review

    NARCIS (Netherlands)

    Kroesen, Vera M.; Gröschel, Matthias I.; Martinson, Neil; Zumla, Alimuddin; Maeurer, Markus; van der Werf, Tjip S.; Vilaplana, Cristina

    2017-01-01

    Lengthy, antimicrobial therapy targeting the pathogen is the mainstay of conventional tuberculosis treatment, complicated by emerging drug resistances. Host-directed therapies, including non-steroidal anti-inflammatory drugs (NSAIDs), in contrast, target host factors to mitigate disease severity. In

  17. 3-D direct current resistivity anisotropic modelling by goal-oriented adaptive finite element methods

    Science.gov (United States)

    Ren, Zhengyong; Qiu, Lewen; Tang, Jingtian; Wu, Xiaoping; Xiao, Xiao; Zhou, Zilong

    2018-01-01

    Although accurate numerical solvers for 3-D direct current (DC) isotropic resistivity models are current available even for complicated models with topography, reliable numerical solvers for the anisotropic case are still an open question. This study aims to develop a novel and optimal numerical solver for accurately calculating the DC potentials for complicated models with arbitrary anisotropic conductivity structures in the Earth. First, a secondary potential boundary value problem is derived by considering the topography and the anisotropic conductivity. Then, two a posteriori error estimators with one using the gradient-recovery technique and one measuring the discontinuity of the normal component of current density are developed for the anisotropic cases. Combing the goal-oriented and non-goal-oriented mesh refinements and these two error estimators, four different solving strategies are developed for complicated DC anisotropic forward modelling problems. A synthetic anisotropic two-layer model with analytic solutions verified the accuracy of our algorithms. A half-space model with a buried anisotropic cube and a mountain-valley model are adopted to test the convergence rates of these four solving strategies. We found that the error estimator based on the discontinuity of current density shows better performance than the gradient-recovery based a posteriori error estimator for anisotropic models with conductivity contrasts. Both error estimators working together with goal-oriented concepts can offer optimal mesh density distributions and highly accurate solutions.

  18. Distributed coordination of heterogeneous agents using a semantic overlay network and a goal-directed graphplan planner.

    Directory of Open Access Journals (Sweden)

    António Luís Lopes

    Full Text Available In this paper, we describe a distributed coordination system that allows agents to seamlessly cooperate in problem solving by partially contributing to a problem solution and delegating the subproblems for which they do not have the required skills or knowledge to appropriate agents. The coordination mechanism relies on a dynamically built semantic overlay network that allows the agents to efficiently locate, even in very large unstructured networks, the necessary skills for a specific problem. Each agent performs partial contributions to the problem solution using a new distributed goal-directed version of the Graphplan algorithm. This new goal-directed version of the original Graphplan algorithm provides an efficient solution to the problem of "distraction", which most forward-chaining algorithms suffer from. We also discuss a set of heuristics to be used in the backward-search process of the planning algorithm in order to distribute this process amongst idle agents in an attempt to find a solution in less time. The evaluation results show that our approach is effective in building a scalable and efficient agent society capable of solving complex distributable problems.

  19. Understanding the Self-Directed Online Learning Preferences, Goals, Achievements, and Challenges of MIT OpenCourseWare Subscribers

    Science.gov (United States)

    Bonk, Curtis J.; Lee, Mimi Miyoung; Kou, Xiaojing; Xu, Shuya; Sheu, Feng-Ru

    2015-01-01

    This research targeted the learning preferences, goals and motivations, achievements, challenges, and possibilities for life change of self-directed online learners who subscribed to the monthly OpenCourseWare (OCW) e-newsletter from MIT. Data collection included a 25-item survey of 1,429 newsletter subscribers; 613 of whom also completed an…

  20. Comparison of cardiac output optimization with an automated closed-loop goal-directed fluid therapy versus non standardized manual fluid administration during elective abdominal surgery: first prospective randomized controlled trial.

    Science.gov (United States)

    Lilot, Marc; Bellon, Amandine; Gueugnon, Marine; Laplace, Marie-Christine; Baffeleuf, Bruno; Hacquard, Pauline; Barthomeuf, Felicie; Parent, Camille; Tran, Thomas; Soubirou, Jean-Luc; Robinson, Philip; Bouvet, Lionel; Vassal, Olivia; Lehot, Jean-Jacques; Piriou, Vincent

    2018-01-27

    An intraoperative automated closed-loop system for goal-directed fluid therapy has been successfully tested in silico, in vivo and in a clinical case-control matching. This trial compared intraoperative cardiac output (CO) in patients managed with this closed-loop system versus usual practice in an academic medical center. The closed-loop system was connected to a CO monitoring system and delivered automated colloid fluid boluses. Moderate to high-risk abdominal surgical patients were randomized either to the closed-loop or the manual group. Intraoperative final CO was the primary endpoint. Secondary endpoints were intraoperative overall mean cardiac index (CI), increase from initial to final CI, intraoperative fluid volume and postoperative outcomes. From January 2014 to November 2015, 46 patients were randomized. There was a lower initial CI (2.06 vs. 2.51 l min -1 m -2 , p = 0.042) in the closed-loop compared to the control group. No difference in final CO and in overall mean intraoperative CI was observed between groups. A significant relative increase from initial to final CI values was observed in the closed-loop but not the control group (+ 28.6%, p = 0.006 vs. + 1.2%, p = 0.843). No difference was found for intraoperative fluid management and postoperative outcomes between groups. There was no significant impact on the primary study endpoint, but this was found in a context of unexpected lower initial CI in the closed-loop group.Trial registry number ID-RCB/EudraCT: 2013-A00770-45. ClinicalTrials.gov Identifier NCT01950845, date of registration: 17 September 2013.

  1. The contribution of goal specificity to goal achievement in collaborative goal setting for the management of asthma.

    Science.gov (United States)

    Smith, Lorraine; Alles, Chehani; Lemay, Kate; Reddel, Helen; Saini, Bandana; Bosnic-Anticevich, Sinthia; Emmerton, Lynne; Stewart, Kay; Burton, Debbie; Krass, Ines; Armour, Carol

    2013-01-01

    Goal setting was investigated as part of an implementation trial of an asthma management service (PAMS) conducted in 96 Australian community pharmacies. Patients and pharmacists identified asthma-related issues of concern to the patient and collaboratively set goals to address these. Although goal setting is commonly integrated into disease state management interventions, the nature of goals, and their contribution to goal attainment and health outcomes are not well understood. To identify and describe: 1) goals set collaboratively between adult patients with asthma and their pharmacist, 2) goal specificity and goal achievement, and 3) describe the relationships between specificity, achievement, asthma control and asthma-related quality of life. Measures of goal specificity, and goal achievement were developed and applied to patient data records. Goals set were thematically analyzed into goal domains. Proportions of goals set, goals achieved and their specificity were calculated. Correlational and regression analyses were undertaken to determine the relationships between goal specificity, goal achievement, asthma control and asthma-related quality of life. Data were drawn from 498 patient records. Findings showed that patients set a wide range and number of asthma-related goals (N = 1787) and the majority (93%) were either achieved or being working toward by the end of the study. Goal achievement was positively associated with specific and moderately specific goals, but not non-specific goals. However, on closer inspection, an inconsistent pattern of relationships emerged as a function of goal domain. Findings also showed that goal setting was associated with end-of-study asthma control but not to asthma-related quality of life. Pharmacists can help patients to set achievable and specific asthma management goals, and these have the potential to directly impact health outcomes such as asthma control. Goal specificity appears to be an important feature in the

  2. Processing and Integration of Contextual Information in Monkey Ventrolateral Prefrontal Neurons during Selection and Execution of Goal-Directed Manipulative Actions.

    Science.gov (United States)

    Bruni, Stefania; Giorgetti, Valentina; Bonini, Luca; Fogassi, Leonardo

    2015-08-26

    The prefrontal cortex (PFC) is deemed to underlie the complexity, flexibility, and goal-directedness of primates' behavior. Most neurophysiological studies performed so far investigated PFC functions with arm-reaching or oculomotor tasks, thus leaving unclear whether, and to which extent, PFC neurons also play a role in goal-directed manipulative actions, such as those commonly used by primates during most of their daily activities. Here we trained two macaques to perform or withhold grasp-to-eat and grasp-to-place actions, depending on the combination of two subsequently presented cues: an auditory go/no-go cue (high/low tone) and a visually presented target (food/object). By varying the order of presentation of the two cues, we could segment and independently evaluate the processing and integration of contextual information allowing the monkey to make a decision on whether or not to act, and what action to perform. We recorded 403 task-related neurons from the ventrolateral prefrontal cortex (VLPFC): unimodal sensory-driven (37%), motor-related (21%), unimodal sensory-and-motor (23%), and multisensory (19%) neurons. Target and go/no-go selectivity characterized most of the recorded neurons, particularly those endowed with motor-related discharge. Interestingly, multisensory neurons appeared to encode a behavioral decision independently from the sensory modality of the stimulus allowing the monkey to make it: some of them reflected the decision to act or refraining from acting (56%), whereas others (44%) encoded the decision to perform (or withhold) a specific action (e.g., grasp-to-eat). Our findings indicate that VLPFC neurons play a role in the processing of contextual information underlying motor decision during goal-directed manipulative actions. We demonstrated that macaque ventrolateral prefrontal cortex (VLPFC) neurons show remarkable selectivity for different aspects of the contextual information allowing the monkey to select and execute goal-directed

  3. Metacognitive reflective and insight therapy for people in early phase of a schizophrenia spectrum disorder.

    Science.gov (United States)

    Hillis, Jaclyn D; Leonhardt, Bethany L; Vohs, Jenifer L; Buck, Kelly D; Salvatore, Giampaolo; Popolo, Raffaele; Dimaggio, Giancarlo; Lysaker, Paul H

    2015-02-01

    Schizophrenia often involves a loss of metacognitive capacity, the ability to form complex and integrated representations of self and others. Independent of symptoms and neurocognition, deficits in synthetic metacognition are related to difficulties of engaging in goal-directed activities in social and vocational settings. Within this backdrop, we provide a case report of the effects of Metacognitive Reflective Insight Therapy (MERIT) that assisted a patient suffering from first episode schizophrenia during 2 years of individual psychotherapy. A total of 8 elements of MERIT that stimulate and promote metacognitive capacity are presented. As illustrated in this report, these procedures helped the patient move from a state in which he had virtually no complex ideas about himself or others to one in which he had developed integrated and realistic ideas about his own identity and the identity of others. He then could use these representations to understand and effectively respond to life challenges. © 2014 Wiley Periodicals, Inc.

  4. Dorsolateral Striatum Engagement Interferes with Early Discrimination Learning

    Directory of Open Access Journals (Sweden)

    Hadley C. Bergstrom

    2018-05-01

    Full Text Available Summary: In current models, learning the relationship between environmental stimuli and the outcomes of actions involves both stimulus-driven and goal-directed systems, mediated in part by the DLS and DMS, respectively. However, though these models emphasize the importance of the DLS in governing actions after extensive experience has accumulated, there is growing evidence of DLS engagement from the onset of training. Here, we used in vivo photosilencing to reveal that DLS recruitment interferes with early touchscreen discrimination learning. We also show that the direct output pathway of the DLS is preferentially recruited and causally involved in early learning and find that silencing the normal contribution of the DLS produces plasticity-related alterations in a PL-DMS circuit. These data provide further evidence suggesting that the DLS is recruited in the construction of stimulus-elicited actions that ultimately automate behavior and liberate cognitive resources for other demands, but with a cost to performance at the outset of learning. : What is the contribution of the DLS in early discrimination learning? Bergstrom et al. show using in vivo optogenetics, fluorescence in situ hybridization, and brain-wide activity mapping that silencing the DLS facilitates early discrimination learning, drives activity in a parallel PL-DMS circuit, and preferentially recruits the DLS “direct” output pathway. Keywords: striatum, reward, goal-directed, habit, optogenetics, plasticity, cognition, Arc

  5. Counterfactual Processing of Economic Action-Outcome Alternatives in Obsessive-Compulsive Disorder: Further Evidence of Impaired Goal-Directed Behavior

    Science.gov (United States)

    Gillan, Claire M.; Morein-Zamir, Sharon; Kaser, Muzaffer; Fineberg, Naomi A.; Sule, Akeem; Sahakian, Barbara J.; Cardinal, Rudolf N.; Robbins, Trevor W.

    2014-01-01

    Background Obsessive-compulsive disorder (OCD) is a disorder of automatic, uncontrollable behaviors and obsessive rumination. There is evidence that OCD patients have difficulties performing goal-directed actions, instead exhibiting repetitive stimulus-response habit behaviors. This might result from the excessive formation of stimulus-response habit associations or from an impairment in the ability to use outcome value to guide behavior. We investigated the latter by examining counterfactual decision making, which is the ability to use comparisons of prospective action-outcome scenarios to guide economic choice. Methods We tested decision making (forward counterfactual) and affective responses (backward counterfactual) in 20 OCD patients and 20 matched healthy control subjects using an economic choice paradigm that previously revealed attenuation of both the experience and avoidance of counterfactual emotion in schizophrenia patients and patients with orbitofrontal cortex lesions. Results The use of counterfactual comparison to guide decision making was diminished in OCD patients, who relied primarily on expected value. Unlike the apathetic affective responses previously shown to accompany this decision style, OCD patients reported increased emotional responsivity to the outcomes of their choices and to the counterfactual comparisons that typify regret and relief. Conclusions Obsessive-compulsive disorder patients exhibit a pattern of decision making consistent with a disruption in goal-directed forward modeling, basing decisions instead on the temporally present (and more rational) calculation of expected value. In contrast to this style of decision making, emotional responses in OCD were more extreme and reactive than control subjects. These results are in line with an account of disrupted goal-directed cognitive control in OCD. PMID:23452663

  6. Early farmers from across Europe directly descended from Neolithic Aegeans

    Science.gov (United States)

    Hofmanová, Zuzana; Kreutzer, Susanne; Hellenthal, Garrett; Sell, Christian; Diekmann, Yoan; Díez-del-Molino, David; van Dorp, Lucy; López, Saioa; Kousathanas, Athanasios; Link, Vivian; Kirsanow, Karola; Cassidy, Lara M.; Martiniano, Rui; Strobel, Melanie; Scheu, Amelie; Kotsakis, Kostas; Halstead, Paul; Triantaphyllou, Sevi; Kyparissi-Apostolika, Nina; Ziota, Christina; Adaktylou, Fotini; Gopalan, Shyamalika; Bobo, Dean M.; Winkelbach, Laura; Blöcher, Jens; Unterländer, Martina; Leuenberger, Christoph; Çilingiroğlu, Çiler; Horejs, Barbara; Gerritsen, Fokke; Shennan, Stephen J.; Bradley, Daniel G.; Currat, Mathias; Veeramah, Krishna R.; Thomas, Mark G.; Papageorgopoulou, Christina; Burger, Joachim

    2016-01-01

    Farming and sedentism first appeared in southwestern Asia during the early Holocene and later spread to neighboring regions, including Europe, along multiple dispersal routes. Conspicuous uncertainties remain about the relative roles of migration, cultural diffusion, and admixture with local foragers in the early Neolithization of Europe. Here we present paleogenomic data for five Neolithic individuals from northern Greece and northwestern Turkey spanning the time and region of the earliest spread of farming into Europe. We use a novel approach to recalibrate raw reads and call genotypes from ancient DNA and observe striking genetic similarity both among Aegean early farmers and with those from across Europe. Our study demonstrates a direct genetic link between Mediterranean and Central European early farmers and those of Greece and Anatolia, extending the European Neolithic migratory chain all the way back to southwestern Asia. PMID:27274049

  7. Cost-utility of COBRA-light versus COBRA therapy in patients with early rheumatoid arthritis: the COBRA-light trial

    NARCIS (Netherlands)

    ter Wee, Marieke M.; Coupé, Veerle M. H.; den Uyl, Debby; Blomjous, Birgit S.; Kooijmans, Esmee; Kerstens, Pit J. S. M.; Nurmohamed, Mike T.; van Schaardenburg, Dirkjan; Voskuyl, Alexandre E.; Boers, Maarten; Lems, Willem F.

    2017-01-01

    To evaluate if COmbinatie therapie Bij Reumatoïde Artritis (COBRA)-light therapy is cost-effective in treating patients with early rheumatoid arthritis (RA) compared with COBRA therapy. This economic evaluation was performed next to the open-label, randomised non-inferiority COBRA-light trial in 164

  8. Predicting Retrograde Autobiographical Memory Changes Following Electroconvulsive Therapy: Relationships between Individual, Treatment, and Early Clinical Factors.

    Science.gov (United States)

    Martin, Donel M; Gálvez, Verònica; Loo, Colleen K

    2015-06-19

    Loss of personal memories experienced prior to receiving electroconvulsive therapy is common and distressing and in some patients can persist for many months following treatment. Improved understanding of the relationships between individual patient factors, electroconvulsive therapy treatment factors, and clinical indicators measured early in the electroconvulsive therapy course may help clinicians minimize these side effects through better management of the electroconvulsive therapy treatment approach. In this study we examined the associations between the above factors for predicting retrograde autobiographical memory changes following electroconvulsive therapy. Seventy-four depressed participants with major depressive disorder were administered electroconvulsive therapy 3 times per week using either a right unilateral or bitemporal electrode placement and brief or ultrabrief pulse width. Verbal fluency and retrograde autobiographical memory (assessed using the Columbia Autobiographical Memory Interview - Short Form) were tested at baseline and after the last electroconvulsive therapy treatment. Time to reorientation was measured immediately following the third and sixth electroconvulsive therapy treatments. Results confirmed the utility of measuring time to reorientation early during the electroconvulsive therapy treatment course as a predictor of greater retrograde amnesia and the importance of assessing baseline cognitive status for identifying patients at greater risk for developing later side effects. With increased number of electroconvulsive therapy treatments, older age was associated with increased time to reorientation. Consistency of verbal fluency performance was moderately correlated with change in Columbia Autobiographical Memory Interview - Short Form scores following right unilateral electroconvulsive therapy. Electroconvulsive therapy treatment techniques associated with lesser cognitive side effects should be particularly considered for

  9. Psychological Therapies for Auditory Hallucinations (Voices): Current Status and Key Directions for Future Research

    Science.gov (United States)

    Thomas, Neil; Hayward, Mark; Peters, Emmanuelle; van der Gaag, Mark; Bentall, Richard P.; Jenner, Jack; Strauss, Clara; Sommer, Iris E.; Johns, Louise C.; Varese, Filippo; García-Montes, José Manuel; Waters, Flavie; Dodgson, Guy; McCarthy-Jones, Simon

    2014-01-01

    This report from the International Consortium on Hallucinations Research considers the current status and future directions in research on psychological therapies targeting auditory hallucinations (hearing voices). Therapy approaches have evolved from behavioral and coping-focused interventions, through formulation-driven interventions using methods from cognitive therapy, to a number of contemporary developments. Recent developments include the application of acceptance- and mindfulness-based approaches, and consolidation of methods for working with connections between voices and views of self, others, relationships and personal history. In this article, we discuss the development of therapies for voices and review the empirical findings. This review shows that psychological therapies are broadly effective for people with positive symptoms, but that more research is required to understand the specific application of therapies to voices. Six key research directions are identified: (1) moving beyond the focus on overall efficacy to understand specific therapeutic processes targeting voices, (2) better targeting psychological processes associated with voices such as trauma, cognitive mechanisms, and personal recovery, (3) more focused measurement of the intended outcomes of therapy, (4) understanding individual differences among voice hearers, (5) extending beyond a focus on voices and schizophrenia into other populations and sensory modalities, and (6) shaping interventions for service implementation. PMID:24936081

  10. The association between early menopause and risk of ischaemic heart disease: Influence of Hormone Therapy

    DEFF Research Database (Denmark)

    Løkkegaard, Ellen Christine Leth; Andersen, Zorana Jovanovic; Heitmann, Berit Lilienthal

    2006-01-01

    Randomised clinical trials find no protection against development of ischaemic heart disease by use of Hormone Therapy (HT) after the age of 50 years. Observational studies suggest that early menopause is a risk factor for ischaemic heart disease. Yet, a clinical very relevant question is whether...... HT reduces this risk associated with early menopause....

  11. Differentiating neural systems mediating the acquisition versus expression of goal-directed and habitual behavioral control

    Science.gov (United States)

    Liljeholm, Mimi; Dunne, Simon; O'Doherty, John P.

    2015-01-01

    Considerable behavioral data indicates that operant actions can become habitual, as evidenced by insensitivity to changes in the action-outcome contingency and in subjective outcome values. Notably, although several studies have investigated the neural substrates of habits, none has clearly differentiated the areas of the human brain that support habit formation from those that implement habitual control. We scanned participants with fMRI as they learned and performed an operant task in which the conditional structure of the environment encouraged either goal-directed encoding of the consequences of actions, or a habit-like mapping of actions to antecedent cues. Participants were also scanned during a subsequent assessment of insensitivity to outcome devaluation. We identified dissociable roles of the cerebellum and ventral striatum, across learning and test performance, in behavioral insensitivity to outcome devaluation. We also show that the inferior parietal lobule – an area previously implicated in several aspects of goal-directed action selection, including the attribution of intent and awareness of agency – predicts sensitivity to outcome devaluation. Finally, we reveal a potential functional homology between the human subgenual cortex and rodent infralimbic cortex in the implementation of habitual control. In summary, our findings suggest a broad systems division, at the cortical and subcortical levels, between brain areas mediating the encoding and expression of action-outcome and stimulus-response associations. PMID:25892332

  12. Parkinson's disease therapy: treatment of early and late disease

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Purpose To summarize the current strategies for the treatment of early and late Parkinson's disease (PD). Data sources The presented guidelines are based on the review of the literature as well as the author's extensive experience with the treatment of 7000 patients with PD over the past 25 years. Results An analysis of reported data as well as personal experience suggest that while young patients seem to have a slower progression of the disease, they are at a higher risk for developing levodopa induced complications, such as motor fluctuations and dyskinesias. It is, therefore, prudent practice to delay levodopa therapy, particularly in younger patients, until the PD symptoms become troublesome and interfere with social or occupational functioning. Other strategies, such as the use of deprenyl, amantadine, trihexyphenidyl and dopamine agonists, should be employed before instituting levodopa therapy. Entacopone and dopamine agonists are useful in smoothing out levodopa related motor fluctuations. Surgical interventions, such as pallidotomy and pallidal or subthalamic deep brain stimulation, are effective therapeutic strategies, but should be reserved only for patients in whom optimal medical therapy fails to provide satisfactory control of symptoms. Conclusion The medical and surgical treatment of patients with PD must be individualized and tailored to the needs of the individual patient.

  13. Early postoperative physical therapy for improving short-term gross motor outcome in infants with cyanotic and acyanotic congenital heart disease.

    Science.gov (United States)

    Haseba, Sumihito; Sakakima, Harutoshi; Nakao, Syuhei; Ohira, Misaki; Yanagi, Shigefumi; Imoto, Yutaka; Yoshida, Akira; Shimodozono, Megumi

    2018-07-01

    We analysed the gross motor recovery of infants and toddlers with cyanotic and acyanotic congenital heart disease (CHD) who received early postoperative physical therapy to see whether there was any difference in the duration to recovery. This study retrospectively evaluated the influence of early physical therapy on postoperative gross motor outcomes of patients with CHD. The gross motor ability of patients with cyanotic (n = 25, average age: 376.4 days) and acyanotic (n = 26, average age: 164.5 days) CHD was evaluated using our newly developed nine-grade mobility assessment scale. Physical therapy was started at an average of five days after surgery, during which each patient's gross motor ability was significantly decreased compared with the preoperative level. Patients (who received early postoperative physical therapy) with cyanotic (88.0%) and acyanotic CHD (96.2%) showed improved preoperative mobility grades by the time of hospital discharge. However, patients with cyanotic CHD had a significantly prolonged recovery period compared to those with acyanotic CHD (p congenital heart disease are likely at greater risk of gross motor delays and have a prolonged recovery period of gross motor ability compared to those with acyanotic congenital heart disease. Early postoperative physical therapy for patients with congenital heart disease after cardiac surgery promoted gross motor recovery. The postoperative recovery period to preoperative mobility grade was affected by pre-, intra-, and postoperative factors. Rehabilitation experts should consider the risk of gross motor delays of patients with congenital heart disease after cardiac surgery and the early postoperative physical therapy to promote their gross motor recovery.

  14. LDL-cholesterol goal attainment under persistent lipid-lowering therapy in northeast China: Subgroup analysis of the dyslipidemia international study of China (DYSIS-China).

    Science.gov (United States)

    Zheng, Wen; Zhang, Yu-Jiao; Bu, Xiang-Ting; Guo, Xin-Zhu; Hu, Da-Yi; Li, Zhan-Quan; Sun, Jian

    2017-11-01

    Lipid-lowering therapy with statins reduces the risk of cardiovascular events, but the efficacy of persistent treatment in a real-world setting may vary from regions. Routine lipid-lowering therapy in the region with a high prevalence of cardiovascular disease may lead to more failures of goal attainment. We therefore performed a study to observe different lipid-lowering strategies in northeast (NE) China with respect to low-density lipoprotein-cholesterol (LDL-C) reduction and goal attainments.A cross-sectional study (DYSIS-China) was conducted in 2012, involving 25,317 patients from 122 centers across China who were diagnosed with hyperlipidemia and treated with lipid-lowering therapy for at least 3 months. Of these patients, 4559 (18.0%) were assigned to the NE group according to their residential zones.Patients in the NE group tended to be younger, female, overweight, and had more comorbidities and higher blood lipid levels than those in the non-NE group (P 24 kg/m, drinking alcohol, smoking, and being residence in NE China as independent predictors of LDL-C attainment.Despite having received persistent lipid-lowering treatments, the current situation of dyslipidemia patients in NE China is unsatisfactory. The main treatment gap might be related to the choice of statin and effective combination therapy and the control of comorbidities and obesity, especially for high-risk patients.

  15. Molecular Diagnostics of Copper-Transporting Protein Mutations Allows Early Onset Individual Therapy of Menkes Disease.

    Science.gov (United States)

    Králík, L; Flachsová, E; Hansíková, H; Saudek, V; Zeman, J; Martásek, P

    2017-01-01

    Menkes disease is a severe X-linked recessive disorder caused by a defect in the ATP7A gene, which encodes a membrane copper-transporting ATPase. Deficient activity of the ATP7A protein results in decreased intestinal absorption of copper, low copper level in serum and defective distribution of copper in tissues. The clinical symptoms are caused by decreased activities of copper-dependent enzymes and include neurodegeneration, connective tissue disorders, arterial changes and hair abnormalities. Without therapy, the disease is fatal in early infancy. Rapid diagnosis of Menkes disease and early start of copper therapy is critical for the effectiveness of treatment. We report a molecular biology-based strategy that allows early diagnosis of copper transport defects and implementation of individual therapies before the full development of pathological symptoms. Low serum copper and decreased activity of copperdependent mitochondrial cytochrome c oxidase in isolated platelets found in three patients indicated a possibility of functional defects in copper-transporting proteins, especially in the ATPA7 protein, a copper- transporting P-type ATPase. Rapid mutational screening of the ATP7A gene using high-resolution melting analysis of DNA indicated presence of mutations in the patients. Molecular investigation for mutations in the ATP7A gene revealed three nonsense mutations: c.2170C>T (p.Gln724Ter); c.3745G>T (p.Glu1249Ter); and c.3862C>T (p.Gln1288Ter). The mutation c.3745G>T (p.Glu1249Ter) has not been identified previously. Molecular analysis of the ATOX1 gene as a possible modulating factor of Menkes disease did not reveal presence of pathogenic mutations. Molecular diagnostics allowed early onset of individual therapies, adequate genetic counselling and prenatal diagnosis in the affected families.

  16. Directly observed therapy for treating tuberculosis

    Science.gov (United States)

    Karumbi, Jamlick; Garner, Paul

    2015-01-01

    Background Tuberculosis (TB) requires at least six months of treatment. If treatment is incomplete, patients may not be cured and drug resistance may develop. Directly Observed Therapy (DOT) is a specific strategy, endorsed by the World Health Organization, to improve adherence by requiring health workers, community volunteers or family members to observe and record patients taking each dose. Objectives To evaluate DOT compared to self-administered therapy in people on treatment for active TB or on prophylaxis to prevent active disease. We also compared the effects of different forms of DOT. Search methods We searched the following databases up to 13 January 2015: the Cochrane Infectious Diseases Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library; MEDLINE; EMBASE; LILACS and mRCT. We also checked article reference lists and contacted relevant researchers and organizations. Selection criteria Randomized controlled trials (RCTs) and quasi-RCTs comparing DOT with routine self-administration of treatment or prophylaxis at home. Data collection and analysis Two review authors independently assessed risk of bias of each included trial and extracted data. We compared interventions using risk ratios (RR) with 95% confidence intervals (CI). We used a random-effects model if meta-analysis was appropriate but heterogeneity present (I2 statistic = 50%). We assessed the quality of the evidence using the GRADE approach. Main results Eleven trials including 5662 participants met the inclusion criteria. DOT was performed by a range of people (nurses, community health workers, family members or former TB patients) in a variety of settings (clinic, the patient's home or the home of a community volunteer). DOT versus self-administered Six trials from South Africa, Thailand, Taiwan, Pakistan and Australia compared DOT with self-administered therapy for treatment. Trials included DOT at home by family members

  17. Teachers' goal orientations: Effects on classroom goal structures and emotions.

    Science.gov (United States)

    Wang, Hui; Hall, Nathan C; Goetz, Thomas; Frenzel, Anne C

    2017-03-01

    Prior research has shown teachers' goal orientations to influence classroom goal structures (Retelsdorf et al., 2010, Learning and Instruction, 20, 30) and to also impact their emotions (Schutz et al., 2007, Emotion in education, Academic Press, Amsterdam, the Netherlands). However, empirical research evaluating possible causal ordering and mediation effects involving these variables in teachers is presently lacking. The present 6-month longitudinal study investigated the relations between varied motivational, behavioural, and emotional variables in practising teachers. More specifically, this study examined the reciprocal, longitudinal relations between teachers' achievement goals, classroom goal structures, and teaching-related emotions, as well as cumulative mediational models in which observed causal relations were evaluated. Participants were 495 practising teachers from Canada (86% female, M = 42 years). Teachers completed a web-based questionnaire at two time points assessing their instructional goals, perceived classroom goal structures, achievement emotions, and demographic items. Results from cross-lagged analyses and structural equation modelling showed teachers' achievement goals to predict their perceived classroom goal structures that, in turn, predicted their teaching-related emotions. The present results inform both Butler's (2012, Journal of Educational Psychology, 104, 726) theory on teachers' achievement goals and Frenzel's (2014, International handbook of emotions in education, Routledge, New York, NY) model of teachers' emotions in showing teachers' instructional goals to both directly predict their teaching-related emotions, as well as indirectly through the mediating effects of classroom goal structures. © 2016 The British Psychological Society.

  18. Survival Advantage With the Addition of Radiation Therapy to Chemotherapy in Early Stage Peripheral T-Cell Lymphoma, Not Otherwise Specified

    International Nuclear Information System (INIS)

    Zhang, Xi-Mei; Li, Ye-Xiong; Wang, Wei-Hu; Jin, Jing; Wang, Shu-Lian; Liu, Yue-Ping; Song, Yong-Wen; Fang, Hui; Ren, Hua; Zhou, Li-Qiang; Liu, Xin-Fan; Yu, Zi-Hao

    2013-01-01

    Purpose: Early stage peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) is rare. The purpose of this study was to evaluate the outcome of treatment as well as the potential role of radiation therapy in PTCL-NOS. Methods and Materials: Thirty-five patients with early stage PTCL-NOS were included. There were 13 patients with stage I disease and 22 with stage II. All patients except 1 received doxorubicin-based chemotherapy alone (n=13) or a combination of chemotherapy and radiation therapy (CMT) (n=21). Results: The 3-year overall survival (OS) and progression-free survival (PFS) rates for the entire group were 41.3% and 25.7%, respectively. The addition of radiation therapy to chemotherapy significantly improved OS and PFS in early stage PTCL-NOS. The 3-year OS and PFS rates were 49.7% and 33.3% for CMT, compared with 23.1% (P=.042) and 15.4% (P=.035) for chemotherapy alone, respectively. The prognosis for patients who achieved a complete response (CR) was significantly better than that observed in those who did not achieve a CR. Conclusions: Despite the aggressive clinical course of early stage PTCL-NOS, additional radiation therapy has a significant impact on outcome. The integration of local radiation therapy into more effective systemic therapies may further improve survival

  19. Survival Advantage With the Addition of Radiation Therapy to Chemotherapy in Early Stage Peripheral T-Cell Lymphoma, Not Otherwise Specified

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Xi-Mei [Department of Radiation Oncology, Cancer Hospital and Institution, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing (China); Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin (China); Li, Ye-Xiong, E-mail: yexiong@yahoo.com [Department of Radiation Oncology, Cancer Hospital and Institution, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing (China); Wang, Wei-Hu; Jin, Jing; Wang, Shu-Lian; Liu, Yue-Ping; Song, Yong-Wen; Fang, Hui; Ren, Hua [Department of Radiation Oncology, Cancer Hospital and Institution, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing (China); Zhou, Li-Qiang [Department of Medical Oncology, Cancer Hospital and Institution, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing (China); Liu, Xin-Fan; Yu, Zi-Hao [Department of Radiation Oncology, Cancer Hospital and Institution, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing (China)

    2013-03-15

    Purpose: Early stage peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) is rare. The purpose of this study was to evaluate the outcome of treatment as well as the potential role of radiation therapy in PTCL-NOS. Methods and Materials: Thirty-five patients with early stage PTCL-NOS were included. There were 13 patients with stage I disease and 22 with stage II. All patients except 1 received doxorubicin-based chemotherapy alone (n=13) or a combination of chemotherapy and radiation therapy (CMT) (n=21). Results: The 3-year overall survival (OS) and progression-free survival (PFS) rates for the entire group were 41.3% and 25.7%, respectively. The addition of radiation therapy to chemotherapy significantly improved OS and PFS in early stage PTCL-NOS. The 3-year OS and PFS rates were 49.7% and 33.3% for CMT, compared with 23.1% (P=.042) and 15.4% (P=.035) for chemotherapy alone, respectively. The prognosis for patients who achieved a complete response (CR) was significantly better than that observed in those who did not achieve a CR. Conclusions: Despite the aggressive clinical course of early stage PTCL-NOS, additional radiation therapy has a significant impact on outcome. The integration of local radiation therapy into more effective systemic therapies may further improve survival.

  20. Principles of fluid management and stewardship in septic shock: it is time to consider the four D's and the four phases of fluid therapy.

    Science.gov (United States)

    Malbrain, Manu L N G; Van Regenmortel, Niels; Saugel, Bernd; De Tavernier, Brecht; Van Gaal, Pieter-Jan; Joannes-Boyau, Olivier; Teboul, Jean-Louis; Rice, Todd W; Mythen, Monty; Monnet, Xavier

    2018-05-22

    In patients with septic shock, the administration of fluids during initial hemodynamic resuscitation remains a major therapeutic challenge. We are faced with many open questions regarding the type, dose and timing of intravenous fluid administration. There are only four major indications for intravenous fluid administration: aside from resuscitation, intravenous fluids have many other uses including maintenance and replacement of total body water and electrolytes, as carriers for medications and for parenteral nutrition. In this paradigm-shifting review, we discuss different fluid management strategies including early adequate goal-directed fluid management, late conservative fluid management and late goal-directed fluid removal. In addition, we expand on the concept of the "four D's" of fluid therapy, namely drug, dosing, duration and de-escalation. During the treatment of patients with septic shock, four phases of fluid therapy should be considered in order to provide answers to four basic questions. These four phases are the resuscitation phase, the optimization phase, the stabilization phase and the evacuation phase. The four questions are "When to start intravenous fluids?", "When to stop intravenous fluids?", "When to start de-resuscitation or active fluid removal?" and finally "When to stop de-resuscitation?" In analogy to the way we handle antibiotics in critically ill patients, it is time for fluid stewardship.

  1. Development of a Combination Cell and Gene Therapy Approach for Early-Stage Breast Cancer

    National Research Council Canada - National Science Library

    Lewis, Michael T

    2005-01-01

    The unique biology of the breast presents the opportunity to these cell and gene therapy techniques in a way that circumvents many of these technical limitations for the treatment of early stage breast cancer...

  2. Goal directed worry rules are associated with distinct patterns of amygdala functional connectivity and vagal modulation during perseverative cognition

    OpenAIRE

    Meeten, Frances; Davey, Graham C L; Makovac, Elena; Watson, David R.; Garfinkel, Sarah N.; Critchley, Hugo D.; Ottaviani, Cristina

    2016-01-01

    Excessive and uncontrollable worry is a defining feature of Generalized Anxiety Disorder (GAD). An important endeavor in the treatment of pathological worry is to understand why some people are unable to stop worrying once they have started. Worry perseveration is associated with a tendency to deploy goal-directed worry rules (known as “as many as can” worry rules; AMA). These require attention to the goal of the worry task and continuation of worry until the aims of the “worry bout” are achi...

  3. Synergistic effect of combined transcranial direct current stimulation/constraint-induced movement therapy in children and young adults with hemiparesis: study protocol.

    Science.gov (United States)

    Gillick, Bernadette; Menk, Jeremiah; Mueller, Bryon; Meekins, Gregg; Krach, Linda E; Feyma, Timothy; Rudser, Kyle

    2015-11-12

    Perinatal stroke occurs in more than 1 in 2,500 live births and resultant congenital hemiparesis necessitates investigation into interventions which may improve long-term function and decreased burden of care beyond current therapies ( http://www.cdc.gov/ncbddd/cp/data.html ). Constraint-Induced Movement Therapy (CIMT) is recognized as an effective hemiparesis rehabilitation intervention. Transcranial direct current stimulation as an adjunct treatment to CIMT may potentiate neuroplastic responses and improve motor function. The methodology of a clinical trial in children designed as a placebo-controlled, serial -session, non-invasive brain stimulation trial incorporating CIMT is described here. The primary hypotheses are 1) that no serious adverse events will occur in children receiving non-invasive brain stimulation and 2) that children in the stimulation intervention group will show significant improvements in hand motor function compared to children in the placebo stimulation control group. A randomized, controlled, double-blinded clinical trial. Twenty children and/or young adults (ages 8-21) with congenital hemiparesis, will be enrolled. The intervention group will receive ten 2-hour sessions of transcranial direct current stimulation combined with constraint-induced movement therapy and the control group will receive sham stimulation with CIMT. The primary outcome measure is safety assessment of transcranial direct current stimulation by physician evaluation, vital sign monitoring and symptom reports. Additionally, hand function will be evaluated using the Assisting Hand Assessment, grip strength and assessment of goals using the Canadian Occupational Performance Measure. Neuroimaging will confirm diagnoses, corticospinal tract integrity and cortical activation. Motor cortical excitability will also be examined using transcranial magnetic stimulation techniques. Combining non-invasive brain stimulation and CIMT interventions has the potential to improve motor

  4. Early identification of risk factors for refractory secondary hyperparathyroidism in patients with long-term renal replacement therapy

    NARCIS (Netherlands)

    Jorna, Francisca Hillegonda; Tobe, TJM; Huisman, RM; de Jong, PE; Plukker, JTM; Stegeman, CA

    Background. Secondary hyperparathyroidism can complicate renal replacement therapy (RRT) in patients with end-stage renal disease. Current medical therapies often result in hypercalcaemia and fail to correct hyperparathyroidism, but might be more effective at an early stage of disease. The aim of

  5. Dynamics of multiple-goal pursuit.

    Science.gov (United States)

    Louro, Maria J; Pieters, Rik; Zeelenberg, Marcel

    2007-08-01

    The authors propose and test a model of multiple-goal pursuit that specifies how individuals allocate effort among multiple goals over time. The model predicts that whether individuals decide to step up effort, coast, abandon the current goal, or switch to pursue another goal is determined jointly by the emotions that flow from prior goal progress and the proximity to future goal attainment, and proximally determined by changes in expectancies about goal attainment. Results from a longitudinal diary study and 2 experiments show that positive and negative goal-related emotions can have diametrically opposing effects on goal-directed behavior, depending on the individual's proximity to goal attainment. The findings resolve contrasting predictions about the influence of positive and negative emotions in volitional behavior, critically amend the goal gradient hypothesis, and provide new insights into the dynamics and determinants of multiple-goal pursuit.

  6. The Effect of Inconsistency Appeals on the Influence of Direct-to-Consumer Prescription Drug Advertisements: An Application of Goal Disruption Theory.

    Science.gov (United States)

    Rosenberg, Benjamin D; Siegel, Jason T

    2016-01-01

    Scholars across multiple domains have identified the presence of inconsistency-arousing information in direct-to-consumer prescription drug advertisements and have suggested that these appeals, which highlight differences between people's actual and desired lives, may create psychological disequilibrium. However, experimental assessment of the distinct influence of inconsistency-arousing information in this domain is rare. Guided by goal disruption theory-a framework that outlines people's reactions to goal expectation violations-we created direct-to-consumer advertisements designed to make people's life inconsistencies salient. The influence of these ads on people's perceptions of, and intentions to use, prescription drugs was then assessed. Results from a structural equation modeling analysis supported the proposed model, indicating that compared to a control ad, an ad containing a goal expectation violation manipulation resulted in higher levels of psychological disequilibrium; in turn, psychological disequilibrium led to positive evaluations of the ad and the drug, positive outcome expectations of the drug, increased purposive harm endurance, and increased usage intentions. The current results suggest a psychological pathway that begins with a negative goal expectation violation and ends with increased usage intentions and a greater willingness to endure harm to make use possible.

  7. [Near-infrared spectroscopy in sepsis therapy : predictor of a low central venous oxygen saturation].

    Science.gov (United States)

    Lichtenstern, C; Koch, C; Röhrig, R; Rosengarten, B; Henrich, M; Weigand, M A

    2012-10-01

    Early goal-directed hemodynamic optimization has become a cornerstone of sepsis therapy. One major defined goal is to achieve adequate central venous oxygen saturation (SO(2)). This study aimed to investigate the correlation between central venous SO(2) and frontal cerebral near-infrared spectroscopy (NIRS) measurement in patients with severe sepsis and septic shock. The NIRS method provides non-invasive measurement of regional oxygen saturation (rSO(2)) in tissues approximately 2 cm below the optical NIRS sensors which depends on arterial, capillary and venous blood. Thus this system gives site-specific real-time data about the balance of oxygen supply and demand. This was a secondary analysis from a prospective study of surgical intensive care (ICU) patients in the early phase of severe sepsis or septic shock. Bilateral cerebral rSO(2), central venous SO(2), arterial oxygen saturation (S(a)O(2)) and other surrogate parameters of oxygen supply, such as hemoglobin, partial pressure of oxygen and oxygen content in arterial blood were recorded. A total of 16 ICU patients (4 women, median age 65.5 years) were included in the study. As sepsis focus an intra-abdominal infection was detected in 62.5 % of patients, severe pneumonia was determined in 31.3 % and skin and soft tissue infections were recognized in 12.5 %. At study inclusion 50 % of patients had septic shock, the median sequential organ failure assessment (SOFA) score was 10.2 (interquartile range 5.25-8.75) and the median acute physiology and chronic health evaluation II (APACHE II) score was 26 (range 23.25-29.75). Mortality at day 28 was 37.5 %. Minimum rSO(2) (median 58) and right-sided rSO(2) (median 58) values showed a significant correlation in the analysis of receiver operating characteristics (area under the curve 0.844, p= 0.045). A central venous SO(2)< 70 % was indicated by rSO(2)< 56.5 with sensitivity and specificity of 75 % and 100 %, respectively. Cerebral NIRS could provide a fast and easily

  8. Counterfactual processing of economic action-outcome alternatives in obsessive-compulsive disorder: further evidence of impaired goal-directed behavior.

    Science.gov (United States)

    Gillan, Claire M; Morein-Zamir, Sharon; Kaser, Muzaffer; Fineberg, Naomi A; Sule, Akeem; Sahakian, Barbara J; Cardinal, Rudolf N; Robbins, Trevor W

    2014-04-15

    Obsessive-compulsive disorder (OCD) is a disorder of automatic, uncontrollable behaviors and obsessive rumination. There is evidence that OCD patients have difficulties performing goal-directed actions, instead exhibiting repetitive stimulus-response habit behaviors. This might result from the excessive formation of stimulus-response habit associations or from an impairment in the ability to use outcome value to guide behavior. We investigated the latter by examining counterfactual decision making, which is the ability to use comparisons of prospective action-outcome scenarios to guide economic choice. We tested decision making (forward counterfactual) and affective responses (backward counterfactual) in 20 OCD patients and 20 matched healthy control subjects using an economic choice paradigm that previously revealed attenuation of both the experience and avoidance of counterfactual emotion in schizophrenia patients and patients with orbitofrontal cortex lesions. The use of counterfactual comparison to guide decision making was diminished in OCD patients, who relied primarily on expected value. Unlike the apathetic affective responses previously shown to accompany this decision style, OCD patients reported increased emotional responsivity to the outcomes of their choices and to the counterfactual comparisons that typify regret and relief. Obsessive-compulsive disorder patients exhibit a pattern of decision making consistent with a disruption in goal-directed forward modeling, basing decisions instead on the temporally present (and more rational) calculation of expected value. In contrast to this style of decision making, emotional responses in OCD were more extreme and reactive than control subjects. These results are in line with an account of disrupted goal-directed cognitive control in OCD. Copyright © 2014 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

  9. Of goals and habits: Age-related and individual differences in goal-directed decision-making

    Directory of Open Access Journals (Sweden)

    Ben eEppinger

    2013-12-01

    Full Text Available In this study we investigated age-related and individual differences in habitual (model-free and goal-directed (model-based decision-making. Specifically, we were interested in three questions. First, does age affect the balance between model-based and model-free decision mechanisms? Second, are these age-related changes due to age differences in working memory (WM capacity? Third, can model-based behavior be affected by manipulating the distinctiveness of the reward value of choice options? To answer these questions we used a two-stage Markov decision task in in combination with computational modeling to dissociate model-based and model-free decision mechanisms. To affect model-based behavior in this task we manipulated the distinctiveness of reward probabilities of choice options. The results show age-related deficits in model-based decision-making, which are particularly pronounced if unexpected reward indicates the need for a shift in decision strategy. In this situation younger adults explore the task structure, whereas older adults show perseverative behavior. Consistent with previous findings, these results indicate that older adults have deficits in the representation and updating of expected reward value. We also observed substantial individual differences in model-based behavior. In younger adults high WM capacity is associated with greater model-based behavior and this effect is further elevated when reward probabilities are more distinct. However, in older adults we found no effect of WM capacity. Moreover, age differences in model-based behavior remained statistically significant, even after controlling for WM capacity. Thus, factors other than decline in WM, such as deficits in the in the integration of expected reward value into strategic decisions may contribute to the observed impairments in model-based behavior in older adults.

  10. Neuromodulatory adaptive combination of correlation-based learning in cerebellum and reward-based learning in basal ganglia for goal-directed behavior control.

    Science.gov (United States)

    Dasgupta, Sakyasingha; Wörgötter, Florentin; Manoonpong, Poramate

    2014-01-01

    Goal-directed decision making in biological systems is broadly based on associations between conditional and unconditional stimuli. This can be further classified as classical conditioning (correlation-based learning) and operant conditioning (reward-based learning). A number of computational and experimental studies have well established the role of the basal ganglia in reward-based learning, where as the cerebellum plays an important role in developing specific conditioned responses. Although viewed as distinct learning systems, recent animal experiments point toward their complementary role in behavioral learning, and also show the existence of substantial two-way communication between these two brain structures. Based on this notion of co-operative learning, in this paper we hypothesize that the basal ganglia and cerebellar learning systems work in parallel and interact with each other. We envision that such an interaction is influenced by reward modulated heterosynaptic plasticity (RMHP) rule at the thalamus, guiding the overall goal directed behavior. Using a recurrent neural network actor-critic model of the basal ganglia and a feed-forward correlation-based learning model of the cerebellum, we demonstrate that the RMHP rule can effectively balance the outcomes of the two learning systems. This is tested using simulated environments of increasing complexity with a four-wheeled robot in a foraging task in both static and dynamic configurations. Although modeled with a simplified level of biological abstraction, we clearly demonstrate that such a RMHP induced combinatorial learning mechanism, leads to stabler and faster learning of goal-directed behaviors, in comparison to the individual systems. Thus, in this paper we provide a computational model for adaptive combination of the basal ganglia and cerebellum learning systems by way of neuromodulated plasticity for goal-directed decision making in biological and bio-mimetic organisms.

  11. Ammonia Volatilization from Urea-Application Influenced Germination and Early Seedling Growth of Dry Direct-Seeded Rice

    Directory of Open Access Journals (Sweden)

    Xiaoli Qi

    2012-01-01

    Full Text Available Poor seed germination and early seedling growth associated with urea-induced soil ammonia volatilization are major constraints in the adoption of dry direct-seeded rice. To directly examine soil ammonia volatilization and its damage to seed germination and early seedling growth of dry direct-seeded rice when urea is applied at seeding, two Petri-dish incubation experiments and a field experiment were conducted. Ammonia volatilization due to urea application significantly reduced seed germination and early seedling growth of dry direct-seedling rice. NBPT significantly reduced ammonia volatilization following urea application. The application of ammonium sulfate, instead of urea at seeding, may mitigate poor crop establishment of dry direct-seeded rice. Root growth of dry direct-seeded rice was more seriously inhibited by soil ammonia volatilization than that of shoot. Results suggest that roots are more sensitive to soil ammonia toxicity than shoots in dry direct-seeded rice system when N is applied as urea at seeding.

  12. Effects of Botulinum Toxin-A and Goal-Directed Physiotherapy in Children with Cerebral Palsy GMFCS Levels I & II.

    Science.gov (United States)

    Löwing, Kristina; Thews, Karin; Haglund-Åkerlind, Yvonne; Gutierrez-Farewik, Elena M

    2017-08-01

    To evaluate short and long-term effects of botulinum toxin-A combined with goal-directed physiotherapy in children with cerebral palsy (CP). A consecutive selection of 40 children, ages 4-12 years, diagnosed with unilateral or bilateral CP, and classified in GMFCS levels I-II. During the 24 months, 9 children received one BoNT-A injection, 10 children two injections, 11 children three injections, and 10 children received four injections. 3D gait analysis, goal-attainment scaling, and body function assessments were performed before and at 3, 12, and 24 months after initial injections. A significant but clinically small long-term improvement in gait was observed. Plantarflexor spasticity was reduced after three months and remained stable, while passive ankle dorsiflexion increased after 3 months but decreased slightly after 12 months. Goal-attainment gradually increased, reached the highest levels at 12 months, and levels were maintained at 24 months. The treatments' positive effect on spasticity reduction was identified, but did not relate to improvement in gait or goal-attainment. No long-term positive change in passive ankle dorsiflexion was observed. Goal attainment was achieved in all except four children. The clinical significance of the improved gait is unclear. Further studies are recommended to identify predictors for positive treatment outcome.

  13. A Curriculum and Software Design Scaffolding Goal Directed Teaching in Classrooms

    DEFF Research Database (Denmark)

    Misfeldt, Morten; Bundsgaard, Jeppe; Slot, Marie Falkesgaard

    , the tool itself, and selected findings from qualitative and quantitative studies in the project. 2. International trends in goal oriented and data driven teaching The Danish curriculum reform builds on recent trends in school development and curriculum research suggesting the importance of a competence...... development and curriculum research suggesting the importance of a competence framework, learning goals and aggregation of classroom data to efficient teaching (Earl & Fullan 2003). Learning goals are supposed to support the student’s pace and sense of progression, inform classroom decisions, structure...... student has knowledge of text structure”). The curriculum can be presented in a number of graphical modes, e.g. in a matrix or in a hypertext structure. The curriculum reform was implemented in order to promote a goal oriented teaching and learning practice based heavily on research around data driven...

  14. A nudge in a healthier direction: How environmental cues help restrained eaters pursue their weight-control goal.

    Science.gov (United States)

    Stämpfli, Aline E; Stöckli, Sabrina; Brunner, Thomas A

    2017-03-01

    Losing weight is a goal for many people, but it is hard to pursue. However, dieting cues in the environment hold promise for improving individuals' eating behavior. For example, exposure to thin, human-like sculptures by the artist Alberto Giacometti has been found to promote healthy snack choices at a vending machine. Whether health- or weight-related processes drive such effects has not yet been determined. However, a detailed understanding of the content-related drivers of environmental cues' effects provides the first indications regarding a cue's possible use. Therefore, two laboratory studies were conducted. They examined the Giacometti sculptures' effects on unhealthy and healthy food intake (Study 1) and on the completion of weight- and health-related fragmented words (Study 2). Study 1 indicated that the sculptures are weight-related by showing that they reduced food intake independent of food healthiness. Furthermore, the "Giacometti effect" was moderated by restrained eating. Restrained eaters, who are known for their weight-control goal, ate less after having been exposed to the thin sculptures. The results of Study 2 pointed in the same direction. Restrained eaters completed more weight-related words after being exposed to the sculptures. Overall, these studies suggest that the thin sculptures are primarily weight-related cues and particularly helpful for restrained eaters. Environmental weight-control cues such as the Giacometti sculptures could act as a counterforce to our obesogenic environment and help restrained eaters pursue their weight-control goal. In this way, they could nudge food decisions in a healthier direction. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Constraint-Induced Movement Therapy Combined with Transcranial Direct Current Stimulation over Premotor Cortex Improves Motor Function in Severe Stroke: A Pilot Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Suellen M. Andrade

    2017-01-01

    Full Text Available Objective. We compared the effects of transcranial direct current stimulation at different cortical sites (premotor and motor primary cortex combined with constraint-induced movement therapy for treatment of stroke patients. Design. Sixty patients were randomly distributed into 3 groups: Group A, anodal stimulation on premotor cortex and constraint-induced movement therapy; Group B, anodal stimulation on primary motor cortex and constraint-induced movement therapy; Group C, sham stimulation and constraint-induced movement therapy. Evaluations involved analysis of functional independence, motor recovery, spasticity, gross motor function, and muscle strength. Results. A significant improvement in primary outcome (functional independence after treatment in the premotor group followed by primary motor group and sham group was observed. The same pattern of improvement was highlighted among all secondary outcome measures regarding the superior performance of the premotor group over primary motor and sham groups. Conclusions. Premotor cortex can contribute to motor function in patients with severe functional disabilities in early stages of stroke. This study was registered in ClinicalTrials.gov database (NCT 02628561.

  16. Psychological morbidities in adolescent and young adult blood cancer patients during curative-intent therapy and early survivorship.

    Science.gov (United States)

    Muffly, Lori S; Hlubocky, Fay J; Khan, Niloufer; Wroblewski, Kristen; Breitenbach, Katherine; Gomez, Joseline; McNeer, Jennifer L; Stock, Wendy; Daugherty, Christopher K

    2016-03-15

    Adolescents and young adults (AYAs) with cancer face unique psychosocial challenges. This pilot study was aimed at describing the prevalence of psychological morbidities among AYAs with hematologic malignancies during curative-intent therapy and early survivorship and at examining provider perceptions of psychological morbidities in their AYA patients. Patients aged 15 to 39 years with acute leukemia, non-Hodgkin lymphoma, or Hodgkin lymphoma who were undergoing curative-intent therapy (on-treatment group) or were in remission within 2 years of therapy completion (early survivors) underwent a semistructured interview that incorporated measures of anxiety, depression, and posttraumatic stress (PTS). A subset of providers (n = 15) concomitantly completed a survey for each of the first 30 patients enrolled that evaluated their perception of each subject's anxiety, depression, and PTS. Sixty-one of 77 eligible AYAs participated. The median age at diagnosis was 26 years (range, 15-39 years), 64% were male, and 59% were non-Hispanic white. On-treatment demographics differed significantly from early-survivor demographics only in the median time from diagnosis to interview. Among the 61 evaluable AYAs, 23% met the criteria for anxiety, 28% met the criteria for depression, and 13% met the criteria for PTS; 46% demonstrated PTS symptomatology. Thirty-nine percent were impaired in 1 or more psychological domains. Psychological impairments were as frequent among early survivors as AYAs on treatment. Provider perceptions did not significantly correlate with patient survey results. AYAs with hematologic malignancies experience substantial psychological morbidities while they are undergoing therapy and during early survivorship, with more than one-third of the patients included in this study meeting the criteria for anxiety, depression, or traumatic stress. This psychological burden may not be accurately identified by their oncology providers. © 2016 American Cancer Society.

  17. Distinct roles of theta and alpha oscillations in the involuntary capture of goal-directed attention.

    Science.gov (United States)

    Harris, Anthony M; Dux, Paul E; Jones, Caelyn N; Mattingley, Jason B

    2017-05-15

    Mechanisms of attention assign priority to sensory inputs on the basis of current task goals. Previous studies have shown that lateralized neural oscillations within the alpha (8-14Hz) range are associated with the voluntary allocation of attention to the contralateral visual field. It is currently unknown, however, whether similar oscillatory signatures instantiate the involuntary capture of spatial attention by goal-relevant stimulus properties. Here we investigated the roles of theta (4-8Hz), alpha, and beta (14-30Hz) oscillations in human goal-directed visual attention. Across two experiments, we had participants respond to a brief target of a particular color among heterogeneously colored distractors. Prior to target onset, we cued one location with a lateralized, non-predictive cue that was either target- or non-target-colored. During the behavioral task, we recorded brain activity using electroencephalography (EEG), with the aim of analyzing cue-elicited oscillatory activity. We found that theta oscillations lateralized in response to all cues, and this lateralization was stronger if the cue matched the target color. Alpha oscillations lateralized relatively later, and only in response to target-colored cues, consistent with the capture of spatial attention. Our findings suggest that stimulus induced changes in theta and alpha amplitude reflect task-based modulation of signals by feature-based and spatial attention, respectively. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. The strategy of therapy of the axilla in early cancer. Surgery or radiotherapy

    International Nuclear Information System (INIS)

    Izuo, Masaru

    1998-01-01

    The therapy of the axillary lymph node in early breast cancer was assessed perspectively. Recently, axillary irradiation was carried out and compared with surgery. Radiotherapy was not evaluated more successful. To carry out in accordance with the present guide line, so called ''modern technique'' or ''modern dosage schedule'', radiotherapy of the axilla is effective as well as surgery. We have many agreements that the rate of incidence of complication associated with irradiation was decreased in accordance with ''modern technique''. It is reasonable to radiate additionally after the selection by the ''node sampling'' in the sense of decreasing unnecessary irradiation. But it is not sufficient in their reliability, it is hard to expect this method getting more popular than now. We cannot find any difference in the effect of the treatment itself between present dissection and radiotherapy. However we have many agreements that axillary dissection may give the information about n-stage, and the contribution to the suitable selection to the prognosis factor and adjuvant chemotherapy was not so less even in early cancer. Some early cancers (non-invasive carcinoma or micro carcinoma) will not need the axillary therapy. It is one of the options ''to combine mastectomy under local anesthesia and radiotherapy'' in close cooperation with the skilled radiologist. (K.H.) 120 refs

  19. Dissociating Goal-Directed and Stimulus-Driven Determinants in Attentional Capture

    Directory of Open Access Journals (Sweden)

    Louis K. H. Chan

    2011-05-01

    Full Text Available Although attentional capture is now a commonplace finding, the exact roles played by goal-directed and stimulus-driven determents remain elusive. An unsettled issue is on the relative contribution of attentional set and visual saliency. In the present study, we investigated this issue by mixing color and orientation search trials, so that distractors of either feature dimension fell into the current attentional set. In our test, color features were more salient. As a result, in orientation search, whereas a color distractor produced huge capture (109 ms, an orientation distractor produced moderate capture (50 ms. With color targets, distractors were not interfering. On one hand, these results reflect that relative salience of the target and the distractor is critical for producing capture; on the other hand, a huge capture size associated with a nontarget dimension feature is novel. Similar previous measurements, but without matching the attentional set, consistently report attentional capture of only 20-30 ms. This comparison shows the role played by attentional set. Taken together, we suggest that visual saliency determines search order, and sets the platform for capture. However, attentional dwell time on the distractor is determined by how much it matches the current attentional set, and in turn explains the capture size.

  20. The efficacy of self-directed modules for clinical learning: advanced competencies in entry-level physical therapy education.

    Science.gov (United States)

    Peck, Kirk; Paschal, Karen; Black, Lisa; Nelson, Kelly

    2014-01-01

    Prior to graduation, students often express an interest to advance clinical and professional skills in teaching, research, administration, and various niche practice areas. The acquisition of advanced education in selected areas of practice is believed to improve employment opportunities, accelerate career advancement including eligibility for professional certifications, and contribute to personal satisfaction in the profession. The purpose of this paper is to (1) describe an innovative model of education, the Directed Practice Experience (DPE) elective, that incorporates a student-initiated learning process designed to achieve student-identified professional goals, and (2) report the outcomes for graduates who have completed the DPE in an entry-level program in physical therapy education. Students who met select criteria were eligible to complete a DPE. Applicants designed a 4- to 6-week clinical education experience consisting of stated rationale for personal and professional growth, examples of leadership and service, and self-directed objectives that are beyond entry-level expectations as measured by the revised Physical Therapist Clinical Performance Instrument, version 2006. Twenty-six students have completed DPEs since 2005. Fifty percent resulted in new academic partnerships. At least 25% of graduates now serve as clinical instructors for the entry-level program. Those who participated in DPEs have also completed post-graduate residencies, attained ABPTS Board certifications, authored peer-reviewed publications, and taught in both PT and residency programs. The DPE model allows qualified students to acquire advanced personal skills and knowledge prior to graduation in areas of professional practice that exceed entry-level expectations. The model is applicable to all CAPTE accredited physical therapy education programs and is especially beneficial for academic programs desiring to form new community partnerships for student clinical education.

  1. Rescue localized intra-arterial thrombolysis for hyperacute MCA ischemic stroke patients after early non-responsive intravenous tissue plasminogen activator therapy

    International Nuclear Information System (INIS)

    Kim, Dong Joon; Kim, Dong Ik; Kim, Seo Hyun; Lee, Kyung Yeol; Heo, Ji Hoe; Han, Sang Won

    2005-01-01

    The outcome of patients who show no early response to intravenous (i.v.) tissue plasminogen activator (tPA) therapy is poor. The objective of this study was to evaluate the feasibility of rescue localized intra-arterial thrombolysis (LIT) therapy for acute ischemic stroke patients after an early non-responsive i.v. tPA therapy. Patients with proximal MCA occlusions who were treated by LIT (n=10) after failure of early response [no improvement or improvement of National Institute of Health Stroke Scale (NIHSS) scores of ≤3] to i.v. tPA therapy (0.9 mg/kg - 10% bolus and 90% i.v. infusion over 60 min) were selected. The recanalization rates, incidence of post-thrombolysis hemorrhage and clinical outcomes [baseline and discharge NIHSS scores, mortality, 3 months Barthel index (BI) and modified Rankin score (mRS)] were evaluated. Rescue LIT therapy was performed on ten MCA occlusion patients (male:female=3:7, mean age 71 years). The mean time between the initiation of i.v. tPA therapy and the initiation of intra-arterial urokinase (i.a. UK) was 117±25.0 min [time to i.v. tPA 137±32 min; time to digital subtraction angiography (DSA) 221±42 min; time to i.a. UK 260±46 min]. The baseline NIHSS scores showed significant improvement at discharge (median from 18 to 6). Symptomatic hemorrhage and, consequent, mortality were noted in 2/10 (20%) patients. Three months good outcome was noted in 4/10 (40%, mRS 0-2) and 3/10 (30%, BI ≥95). In conclusion, rescue LIT therapy can be considered as a treatment option for patients not showing early response to full dose i.v. tPA therapy. Larger scale studies for further validation of this protocol may be necessary. (orig.)

  2. Early and Late Onset Side Effects of Photodynamic Therapy

    Directory of Open Access Journals (Sweden)

    Francesco Borgia

    2018-01-01

    Full Text Available Photodynamic Therapy (PDT is a non-invasive treatment successfully used for neoplastic, inflammatory and infectious skin diseases. One of its strengths is represented by the high safety profile, even in elderly and/or immuno-depressed subjects. PDT, however, may induce early and late onset side effects. Erythema, pain, burns, edema, itching, desquamation, and pustular formation, often in association with each other, are frequently observed in course of exposure to the light source and in the hours/days immediately after the therapy. In particular, pain is a clinically relevant short-term complication that also reduces long-term patient satisfaction. Rare complications are urticaria, contact dermatitis at the site of application of the photosensitizer, and erosive pustular dermatosis. Debated is the relationship between PDT and carcinogenesis: the eruptive appearance of squamous cell carcinoma (SCC in previously treated areas has been correlated to a condition of local and/or systemic immunosuppression or to the selection of PDT-resistant SCC. Here we review the literature, with particular emphasis to the pathogenic hypotheses underlying these observations.

  3. Early clinical experience: do students learn what we expect?

    Science.gov (United States)

    Helmich, Esther; Bolhuis, Sanneke; Laan, Roland; Koopmans, Raymond

    2011-07-01

    Early clinical experience is thought to contribute to the professional development of medical students, but little is known about the kind of learning processes that actually take place. Learning in practice is highly informal and may be difficult to direct by predefined learning outcomes. Learning in medical practice includes a socialisation process in which some learning outcomes may be valued, but others neglected or discouraged. This study describes students' learning goals (prior to a Year 1 nursing attachment) and learning outcomes (after the attachment) in relation to institutional educational goals, and evaluates associations between learning outcomes, student characteristics and place of attachment. A questionnaire containing open-ended questions about learning goals and learning outcomes was administered to all Year 1 medical students (n = 347) before and directly after a 4-week nursing attachment in either a hospital or a nursing home. Two confirmatory focus group interviews were conducted and data were analysed using qualitative and quantitative content analyses. Students' learning goals corresponded with educational goals with a main emphasis on communication and empathy. Other learning goals included gaining insight into the organisation of health care and learning to deal with emotions. Self-reported learning outcomes were the same, but students additionally mentioned reflection on professional behaviour and their own future development. Women and younger students mentioned communication and empathy more often than men and older students. Individual learning goals, with the exception of communicating and empathising with patients, did not predict learning outcomes. Students' learning goals closely match educational goals, which are adequately met in early nursing attachments in both hospitals and nursing homes. Learning to deal with emotions was under-represented as a learning goal and learning outcome, which may indicate that emotional aspects

  4. Early antibiotic administration but not antibody therapy directed against IL-6 improves survival in septic mice predicted to die based upon high IL-6 levels

    Science.gov (United States)

    Vyas, Dinesh; Javadi, Pardis; DiPasco, Peter J; Buchman, Timothy G; Hotchkiss, Richard S; Coopersmith, Craig M

    2005-01-01

    Elevated interleukin (IL)-6 levels correlate with increased mortality following sepsis. IL-6 levels >14,000 pg/ml drawn 6 hours following cecal ligation and puncture (CLP) are associated with 100% mortality in ND4 mice, even if antibiotic therapy is initiated 12 hours after the septic insult. The first aim of this study was to see if earlier institution of antibiotic therapy could improve overall survival in septic mice and rescue the subset of animals predicted to die based upon high IL-6 levels. Mice (n=184) were subjected to CLP, had IL-6 levels drawn six hours later and then were randomized to receive imipenem, a broad spectrum antimicrobial agent, beginning six or twelve hours post-operatively. Overall one-week survival improved from 25.5% to 35.9% with earlier administration of antibiotics (p14,000 pg/ml, 25% survived if imipenem was started at 6 hours, while none survived if antibiotics were started later (p14,000 pg/ml. These results demonstrate that earlier systemic therapy can improve outcome in a subset of mice predicted to die in sepsis, but we are unable to demonstrate any benefit in similar animals using targeted therapy directed at IL-6. PMID:15947070

  5. Implementation of a Goal-Directed Mechanical Ventilation Order Set Driven by Respiratory Therapists Improves Compliance With Best Practices for Mechanical Ventilation.

    Science.gov (United States)

    Radosevich, Misty A; Wanta, Brendan T; Meyer, Todd J; Weber, Verlin W; Brown, Daniel R; Smischney, Nathan J; Diedrich, Daniel A

    2017-01-01

    Data regarding best practices for ventilator management strategies that improve outcomes in acute respiratory distress syndrome (ARDS) are readily available. However, little is known regarding processes to ensure compliance with these strategies. We developed a goal-directed mechanical ventilation order set that included physician-specified lung-protective ventilation and oxygenation goals to be implemented by respiratory therapists (RTs). We sought as a primary outcome to determine whether an RT-driven order set with predefined oxygenation and ventilation goals could be implemented and associated with improved adherence with best practice. We evaluated 1302 patients undergoing invasive mechanical ventilation (1693 separate episodes of invasive mechanical ventilation) prior to and after institution of a standardized, goal-directed mechanical ventilation order set using a controlled before-and-after study design. Patient-specific goals for oxygenation partial pressure of oxygen in arterial blood (Pao 2 ), ARDS Network [Net] positive end-expiratory pressure [PEEP]/fraction of inspired oxygen [Fio 2 ] table use) and ventilation (pH, partial pressure of carbon dioxide) were selected by prescribers and implemented by RTs. Compliance with the new mechanical ventilation order set was high: 88.2% compliance versus 3.8% before implementation of the order set ( P mechanical ventilation, intensive care unit (ICU) length of stay, and in-hospital or ICU mortality. A standardized best practice mechanical ventilation order set can be implemented by a multidisciplinary team and is associated with improved compliance to written orders and adherence to the ARDSNet PEEP/Fio 2 table.

  6. Can children identify and achieve goals for intervention? A randomized trial comparing two goal-setting approaches.

    Science.gov (United States)

    Vroland-Nordstrand, Kristina; Eliasson, Ann-Christin; Jacobsson, Helén; Johansson, Ulla; Krumlinde-Sundholm, Lena

    2016-06-01

    The efficacy of two different goal-setting approaches (children's self-identified goals and goals identified by parents) were compared on a goal-directed, task-oriented intervention. In this assessor-blinded parallel randomized trial, 34 children with disabilities (13 males, 21 females; mean age 9y, SD 1y 4mo) were randomized using concealed allocation to one of two 8-week, goal-directed, task-oriented intervention groups with different goal-setting approaches: (1) children's self-identified goals (n=18) using the Perceived Efficacy and Goal-Setting System, or (2) goals identified by parents (n=16) using the Canadian Occupational Performance Measure (COPM). Participants were recruited through eight paediatric rehabilitation centres and randomized between October 2011 and May 2013. The primary outcome measure was the Goal Attainment Scaling and the secondary measure, the COPM performance scale (COPM-P). Data were collected pre- and post-intervention and at the 5-month follow-up. There was no evidence of a difference in mean characteristics at baseline between groups. There was evidence of an increase in mean goal attainment (mean T score) in both groups after intervention (child-goal group: estimated mean difference [EMD] 27.84, 95% CI 22.93-32.76; parent-goal group: EMD 21.42, 95% CI 16.16-26.67). There was no evidence of a difference in the mean T scores post-intervention between the two groups (EMD 6.42, 95% CI -0.80 to 13.65). These results were sustained at the 5-month follow-up. Children's self-identified goals are achievable to the same extent as parent-identified goals and remain stable over time. Thus children can be trusted to identify their own goals for intervention, thereby influencing their involvement in their intervention programmes. © 2015 Mac Keith Press.

  7. Early severe morbidity and resource utilization in South African adults on antiretroviral therapy

    Directory of Open Access Journals (Sweden)

    Meintjes Graeme A

    2009-12-01

    Full Text Available Abstract Background High rates of mortality and morbidity have been described in sub-Saharan African patients within the first few months of starting highly active antiretroviral therapy (HAART. There is limited data on the causes of early morbidity on HAART and the associated resource utilization. Methods A cross-sectional study was conducted of medical admissions at a secondary-level hospital in Cape Town, South Africa. Patients on HAART were identified from a register and HIV-infected patients not on HAART were matched by gender, month of admission, and age group to correspond with the first admission of each case. Primary reasons for admission were determined by chart review. Direct health care costs were determined from the provider's perspective. Results There were 53 in the HAART group with 70 admissions and 53 in the no-HAART group with 60 admissions. The median duration of HAART was 1 month (interquartile range 1-3 months. Median baseline CD4 count in the HAART group was 57 × 106 cells/L (IQR 15-115. The primary reasons for admission in the HAART group were more likely to be due to adverse drug reactions and less likely to be due to AIDS events than the no-HAART group (34% versus 7%; p Conclusions Causes of early morbidity are different and more complex in HIV-infected patients on HAART. This results in greater resource utilization of diagnostic and therapeutic services.

  8. Perfusion MDCT enables early detection of therapeutic response to antiangiogenic therapy.

    Science.gov (United States)

    Sabir, Adeel; Schor-Bardach, Rachel; Wilcox, Carol J; Rahmanuddin, Syed; Atkins, Michael B; Kruskal, Jonathan B; Signoretti, Sabina; Raptopoulos, Vassilios D; Goldberg, S Nahum

    2008-07-01

    The objective of our study was to determine whether perfusion CT can be used to detect early changes in therapeutic response to antiangiogenic therapy in an animal tumor model. Twenty-five rats implanted with R3230 mammary adenocarcinoma (diameter, 1.2-2.0 cm) randomly received 7.5 or 30 mg/kg of an antiangiogenic agent, sorafenib, by daily gavage for 4 (n = 4), 9 (n = 9), or 14 (n = 5) days. Seven untreated animals served as a control group. Perfusion MDCT was performed at days 0, 4, 9, and 14 with 0.4 mL of ioversol (350 mg/mL) and included four 5-mm slices covering the entire tumor volume. Changes in tumor growth were determined by volumetric analysis of CT data. Serial changes in tumor volume and blood flow were assessed and correlated with pathology findings. All control tumors grew larger (from 2.0 +/- 0.7 cm(3) at day 0 to 5.9 +/- 1.0 cm(3) at day 14), whereas all treated tumors shrank (from 2.5 +/- 1.1 to 2.1 +/- 1.0 cm(3)), with a statistically significant rate of growth or shrinkage in both groups (p histopathologic viability despite the fact that these tumors were shrinking in size from day 4 onward (day 4, 2.18 +/- 0.8 cm(3); day 9, 1.98 +/- 0.8 cm(3)). Perfusion MDCT can detect focal blood flow changes even when the tumor is shrinking, possibly indicating early reversal of tumor responsiveness to antiangiogenic therapy. Given that changes in tumor volume after antiangiogenic therapy do not necessarily correlate with true treatment response, physiologic imaging of tumor perfusion may be necessary.

  9.  Effect of Thrombolytic Therapy on the Incidence of Early Left Ventricular Infarct Expansion in Acute Anterior Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Namir Ghanim Al-Tawil

    2011-11-01

    Full Text Available  Objectives: To determine the incidence of early left ventricular infarct expansion within five days after first anterior ST-segment elevation myocardial infarction and the effect of early thrombolytic therapy on the incidence of early infarct expansion compared with late thrombolytic therapy.Methods: In a prospective study of 101 patients (75males and 26 females, with the first attack of acute anterior myocardial infarction, their ages ranged from 40-80 years (mean age: 61.07±10.78 who had been admitted to the Coronary Care Unit of Hawler Teaching Hospital for the period from July 2007 through to September 2009. Those who received alteplase ≤3 hours of acute myocardial infarction were labelled as group-I (49 patients and those who received alteplase >3-12 hours were labelled as group-II (52 patients.Results: The incidence of early left ventricular infarct expansion was diagnosed by 2D-echocardiography and was found to be 17.8�20Group I patients had a lower incidence of early left ventricular infarct expansion (8.16�20compared with group-II (26.92�20 p=0.014. Patients with early left ventricular infarct expansion had a higher frequency rate of left ventricular systolic dysfunction (94.44�20compared to patients without early left ventricular infarct expansion (8.43�20p<0.001. There was a significant difference in the incidence of in-hospital mortality between the patients who developed early left ventricular infarct expansion (11.1�20compared with patients without early left ventricular infarct expansion (1.2�20p=0.025.Conclusion: Early reperfusion therapy in acute anterior myocardial infarction can decrease the incidence of early left ventricular infarct expansion, preserve left ventricular systolic function and decrease in-hospital mortality.

  10. Metacognitive Reflection and Insight Therapy for Early Psychosis: A preliminary study of a novel integrative psychotherapy.

    Science.gov (United States)

    Vohs, Jenifer L; Leonhardt, Bethany L; James, Alison V; Francis, Michael M; Breier, Alan; Mehdiyoun, Nikki; Visco, Andrew C; Lysaker, Paul H

    2018-05-01

    Poor insight impedes treatment in early phase psychosis (EPP). This manuscript outlines preliminary findings of an investigation of the novel metacognitively oriented integrative psychotherapy, Metacognitive Reflection and Insight Therapy, for individuals with early phase psychosis (MERIT-EP). Twenty adults with EPP and poor insight were randomized to either six months of MERIT-EP or treatment as usual (TAU). Therapists were trained and therapy was successfully delivered under routine, outpatient conditions. Insight, assessed before and after treatment, revealed significant improvement for the MERIT-EP, but not TAU, group. These results suggest MERIT-EP is feasible to deliver, accepted by patients, and leads to clinically significant improvements in insight. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. Photodynamic therapy in early esophageal squamous cell carcinoma

    Science.gov (United States)

    Spinelli, Pasquale; Dal Fante, Marco; Mancini, Andrea; Massetti, Renato; Meroni, Emmanuele

    1995-03-01

    From 1/1985 to 7/1993, 18 patients underwent endoscopic photodynamic therapy (PDT) for early stage esophageal squamous cell carcinoma -- as two patients had two synchronous esophageal cancers, 20 lesions were treated. Tumors were staged as Tis in 7 cases and T1 in 13. The average light energy delivered was 50 J/cm2 and 70 J/cm2 for the treatment of Tis and T1, respectively. To obtain a more uniform distribution of laser light in 12 cases the irradiation was performed through the wall of a transparent tube previously placed over the endoscope and advanced into the stomach. The overall results show a complete response in 14/20 (70%) tumors. Three patients developed a local recurrence, 6, 12, and 14 months after therapy. After a follow-up of 5 to 75 months, there was no evidence of disease in 10/18 patients (56%). The actuarial survival rate was 95%, 79%, and 26% at 1, 3, and 5 years, respectively. Complications were skin reaction in one patient and esophageal stenosis at the treatment site, that gradually responded to endoscopic bougienage, in 2 patients. Endoscopic PDT proved to be safe and effective in the treatment of superficial carcinoma of the esophagus.

  12. Early antibiotic administration but not antibody therapy directed against IL-6 improves survival in septic mice predicted to die on basis of high IL-6 levels.

    Science.gov (United States)

    Vyas, Dinesh; Javadi, Pardis; Dipasco, Peter J; Buchman, Timothy G; Hotchkiss, Richard S; Coopersmith, Craig M

    2005-10-01

    Elevated interleukin (IL)-6 levels correlate with increased mortality following sepsis. IL-6 levels >14,000 pg/ml drawn 6 h after cecal ligation and puncture (CLP) are associated with 100% mortality in ND4 mice, even if antibiotic therapy is initiated 12 h after septic insult. Our first aim was to see whether earlier institution of antibiotic therapy could improve overall survival in septic mice and rescue the subset of animals predicted to die on the basis of high IL-6 levels. Mice (n = 184) were subjected to CLP, had IL-6 levels drawn 6 h later, and then were randomized to receive imipenem, a broad spectrum antimicrobial agent, beginning 6 or 12 h postoperatively. Overall 1-wk survival improved from 25.5 to 35.9% with earlier administration of antibiotics (P 14,000 pg/ml, 25% survived if imipenem was started at 6 h, whereas none survived if antibiotics were started later (P 14,000 pg/ml. These results demonstrate that earlier systemic therapy can improve outcome in a subset of mice predicted to die in sepsis, but we are unable to demonstrate any benefit in similar animals using targeted therapy directed at IL-6.

  13. Effects of FVIII immunity on hepatocyte and hematopoietic stem cell–directed gene therapy of murine hemophilia A

    Science.gov (United States)

    Lytle, Allison M; Brown, Harrison C; Paik, Na Yoon; Knight, Kristopher A; Wright, J Fraser; Spencer, H Trent; Doering, Christopher B

    2016-01-01

    Immune responses to coagulation factors VIII (FVIII) and IX (FIX) represent primary obstacles to hemophilia treatment. Previously, we showed that hematopoietic stem cell (HSC) retroviral gene therapy induces immune nonresponsiveness to FVIII in both naive and preimmunized murine hemophilia A settings. Liver-directed adeno-associated viral (AAV)-FIX vector gene transfer achieved similar results in preclinical hemophilia B models. However, as clinical immune responses to FVIII and FIX differ, we investigated the ability of liver-directed AAV-FVIII gene therapy to affect FVIII immunity in hemophilia A mice. Both FVIII naive and preimmunized mice were administered recombinant AAV8 encoding a liver-directed bioengineered FVIII expression cassette. Naive animals receiving high or mid-doses subsequently achieved near normal FVIII activity levels. However, challenge with adjuvant-free recombinant FVIII induced loss of FVIII activity and anti-FVIII antibodies in mid-dose, but not high-dose AAV or HSC lentiviral (LV) vector gene therapy cohorts. Furthermore, unlike what was shown previously for FIX gene transfer, AAV-FVIII administration to hemophilia A inhibitor mice conferred no effect on anti-FVIII antibody or inhibitory titers. These data suggest that functional differences exist in the immune modulation achieved to FVIII or FIX in hemophilia mice by gene therapy approaches incorporating liver-directed AAV vectors or HSC-directed LV. PMID:26909355

  14. The discriminatory analysis about factors correlative with the early hypothyroidism after 131I therapy for hyperthyroidism

    International Nuclear Information System (INIS)

    Xiong Lingjing; Liang Changhua; Deng Haoyu; Li Xinhui; Hu Shuo

    2002-01-01

    Objective: To explore the factors correlative with the early hypothyroidism after 131 I therapy for Graves' hyperthyroidism so as to cure it and decrease the early hypothyroidism occurring and prevent it from becoming irreversible hypothyroidism. Methods: Logistic regression discriminatory analysis by introducing multiple factors from group data and forward stepwise selection of 11 independent variables of 240 hyperthyroidism patients from clinical data and 1 dependent variable from follow-up data after 131 I therapy was conducted. Univariate analysis of each observed factor was performed, too. Results: (1)The results of multivariate analysis showed that the age of patients, the weight of thyroid, the suffering situation, the curve of 131 I absorption rate and the giving 131 I dosage/g thyroid tissue were correlated to early hypothyroidism. The results of univariate analysis showed that the weight of thyroid, the highest absorption of 131 I, the total treatment dosage of 131 I were correlated to early hypothyroidism. (2) The logistic regression equation was statistically significant. (3) The positive and negative predicting accuracy of the early hypothyroidism occurring was 64.08 %, 78.83 %, respectively, the overall predicting accuracy was 72.50%. Conclusions: The dosage of 131 I for treatment of hyperthyroid is the key factor according to the five correlative factors which are relating to the early hypothyroidism and the discriminatory classification. Enhanced follow-up and in time supplement of thyroid hormone are important measures for preventing the early hypothyroidism from becoming irreversible hypothyroidism

  15. Pharmacogenetics of hepatitis C: transition from interferon-based therapies to direct-acting antiviral agents

    Directory of Open Access Journals (Sweden)

    Kamal SM

    2014-06-01

    Full Text Available Sanaa M Kamal1,21Department of Medicine, Division of Hepatology, Gastroenterology and Tropical Medicine, Ain Shams Faculty of Medicine, Cairo, Egypt, 2Department of Medicine, Salman Bin Abdul Aziz College of Medicine, Kingdom of Saudi ArabiaAbstract: Hepatitis C virus (HCV has emerged as a major viral pandemic over the past two decades, infecting 170 million individuals, which equates to approximately 3% of the world's population. The prevalence of HCV varies according to geographic region, being highest in developing countries such as Egypt. HCV has a high tendency to induce chronic progressive liver damage in the form of hepatic fibrosis, cirrhosis, or liver cancer. To date, there is no vaccine against HCV infection. Combination therapy comprising PEGylated interferon-alpha and ribavirin has been the standard of care for patients with chronic hepatitis C for more than a decade. However, many patients still do not respond to therapy or develop adverse events. Recently, direct antiviral agents such as protease inhibitors, polymerase inhibitors, or NS5A inhibitors have been used to augment PEGylated interferon and ribavirin, resulting in better efficacy, better tolerance, and a shorter treatment duration. However, most clinical trials have focused on assessing the efficacy and safety of direct antiviral agents in patients with genotype 1, and the response of other HCV genotypes has not been elucidated. Moreover, the prohibitive costs of such triple therapies will limit their use in patients in developing countries where most of the HCV infection exists. Understanding the host and viral factors associated with viral clearance is necessary for individualizing therapy to maximize sustained virologic response rates, prevent progression to liver disease, and increase the overall benefits of therapy with respect to its costs. Genome wide studies have shown significant associations between a set of polymorphisms in the region of the interleukin-28B (IL

  16. When memory is not enough: Electrophysiological evidence for goal-dependent use of working memory representations in guiding visual attention

    Science.gov (United States)

    Carlisle, Nancy B.; Woodman, Geoffrey F.

    2014-01-01

    Biased competition theory proposes that representations in working memory drive visual attention to select similar inputs. However, behavioral tests of this hypothesis have led to mixed results. These inconsistent findings could be due to the inability of behavioral measures to reliably detect the early, automatic effects on attentional deployment that the memory representations exert. Alternatively, executive mechanisms may govern how working memory representations influence attention based on higher-level goals. In the present study, we tested these hypotheses using the N2pc component of participants’ event-related potentials (ERPs) to directly measure the early deployments of covert attention. Participants searched for a target in an array that sometimes contained a memory-matching distractor. In Experiments 1–3, we manipulated the difficulty of the target discrimination and the proximity of distractors, but consistently observed that covert attention was deployed to the search targets and not the memory-matching distractors. In Experiment 4, we showed that when participants’ goal involved attending to memory-matching items that these items elicited a large and early N2pc. Our findings demonstrate that working memory representations alone are not sufficient to guide early deployments of visual attention to matching inputs and that goal-dependent executive control mediates the interactions between working memory representations and visual attention. PMID:21254796

  17. Advances in gene therapy and early imaging monitoring for avascular necrosis of the femoral head

    International Nuclear Information System (INIS)

    Wang Peng; Lan Xiaoli; Zhang Yongxue; Qi Hongyan

    2012-01-01

    Gene therapy is a method that transfers foreign gene to target cells, so as to correct or compensate the disease which is caused by the gene defects and abnormalities. As a new technology, gene therapy has been used in many fields, such as cancer, cardiovascular and nervous system disease, and it brings some hope for patients with difficult and complicated disease. Avascular necrosis of femoral head is a refractory and common disease in clinical, but the traditional surgery therapy and conservative treatment both have many shortcomings,and the effect is unsatisfactory. As a new technology,gene therapy showed bright future in orthopedics ischemic disease, and its potential feasibility has been confirmed by many animal experiments. This article focuses on the research progress of gene therapy and early monitoring in the avascular necrosis of the femoral head. (authors)

  18. Dissociable corticostriatal circuits underlie goal-directed vs. cue-elicited habitual food seeking after satiation : Evidence from a multimodal MRI study

    NARCIS (Netherlands)

    van Steenbergen, H.; Watson, P.; Wiers, R.W.; Hommel, B.; de Wit, S.

    The present multimodal MRI study advances our understanding of the corticostriatal circuits underlying goal-directed vs. cue-driven, habitual food seeking. To this end, we employed a computerized Pavlovian-instrumental transfer paradigm. During the test phase, participants were free to perform

  19. The optimal management of anti-thrombotic therapy after valve replacement: certainties and uncertainties.

    Science.gov (United States)

    Iung, Bernard; Rodés-Cabau, Josep

    2014-11-07

    Anti-thrombotic therapy after valve replacement encompasses a number of different situations. Long-term anticoagulation of mechanical prostheses uses vitamin K antagonists with a target international normalized ratio adapted to the characteristics of the prosthesis and the patient. The association of low-dose aspirin is systematic in the American guidelines and more restrictive in the European guidelines. Early heparin therapy is frequently used early after mechanical valve replacement, although there are no precise recommendations regarding timing, type, and dose of drug. Direct oral anticoagulants are presently contraindicated in patients with mechanical prosthesis. The main advantage of bioprostheses is the absence of long-term anticoagulant therapy. Early anticoagulation is indicated after valve replacement for mitral bioprostheses, whereas aspirin is now favoured early after bioprosthetic valve replacement in the aortic position. Early dual antiplatelet therapy is indicated after transcatheter aortic valve implantation, followed by single antiplatelet therapy. However, this relies on low levels of evidence and optimization of anti-thrombotic therapy is warranted in these high-risk patients. Although guidelines are consistent in most instances, discrepancies and the low-level of evidence of certain recommendations highlight the need for further controlled trials, in particular with regard to the combination of antiplatelet therapy with oral anticoagulant and the early post-operative anti-thrombotic therapy following the procedure. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

  20. Prolonged Exposure Therapy for a Vietnam Veteran with PTSD and Early-Stage Dementia

    Science.gov (United States)

    Duax, Jeanne M.; Waldron-Perrine, Brigid; Rauch, Sheila A. M.; Adams, Kenneth M.

    2013-01-01

    Although prolonged exposure therapy (PE) is considered an evidence-based treatment for PTSD, there has been little published about the use of this treatment for older adults with comorbid early-stage dementia. As the number of older adults in the United States continues to grow, so will their unique mental health needs. The present article…

  1. Direct diabetes-related costs in young patients with early-onset, long-lasting type 1 diabetes.

    Directory of Open Access Journals (Sweden)

    Christina Bächle

    Full Text Available OBJECTIVE: To estimate diabetes-related direct health care costs in pediatric patients with early-onset type 1 diabetes of long duration in Germany. RESEARCH DESIGN AND METHODS: Data of a population-based cohort of 1,473 subjects with type 1 diabetes onset at 0-4 years of age within the years 1993-1999 were included (mean age 13.9 (SD 2.2 years, mean diabetes duration 10.9 (SD 1.9 years, as of 31.12.2007. Diabetes-related health care services utilized in 2007 were derived from a nationwide prospective documentation system (DPV. Health care utilization was valued in monetary terms based on inpatient and outpatient medical fees and retail prices (perspective of statutory health insurance. Multiple regression models were applied to assess associations between direct diabetes-related health care costs per patient-year and demographic and clinical predictors. RESULTS: Mean direct diabetes-related health care costs per patient-year were €3,745 (inter-quartile range: 1,943-4,881. Costs for glucose self-monitoring were the main cost category (28.5%, followed by costs for continuous subcutaneous insulin infusion (25.0%, diabetes-related hospitalizations (22.1% and insulin (18.4%. Female gender, pubertal age and poor glycemic control were associated with higher and migration background with lower total costs. CONCLUSIONS: Main cost categories in patients with on average 11 years of diabetes duration were costs for glucose self-monitoring, insulin pump therapy, hospitalization and insulin. Optimization of glycemic control in particular in pubertal age through intensified care with improved diabetes education and tailored insulin regimen, can contribute to the reduction of direct diabetes-related costs in this patient group.

  2. Patient-directed music therapy reduces anxiety and sedation exposure in mechanically-ventilated patients: a research critique.

    Science.gov (United States)

    Gullick, Janice G; Kwan, Xiu Xian

    2015-05-01

    This research appraisal, guided by the CASP Randomised Controlled Trial Checklist, critiques a randomised, controlled trial of patient-directed music therapy compared to either noise-cancelling headphones or usual care. This study recruited 373 alert, mechanically-ventilated patients across five intensive care units in the United States. The Music Assessment Tool, administered by a music therapist, facilitated music selection by participants in the intervention group. Anxiety was measured using the VAS-A scale. Sedation exposure was measured by both sedation frequency and by sedation intensity using a daily sedation intensity score. Context for the data was supported by an environmental scan form recording unit activity and by written comments from nurses about the patient's responses to the protocol. Patient-directed music therapy allowed a significant reduction in sedation frequency compared to noise-cancelling headphones and usual care participants. Patient-directed music therapy led to significantly lower anxiety and sedation intensity compared to usual care, but not compared to noise-cancelling headphones. This is a robust study with clear aims and a detailed description of research methods and follow-up. While no participants were lost to follow-up, not all were included in the analysis: 37% did not have the minimum of two anxiety assessments for comparison and 23% were not included in sedation analysis. While some participants utilised the intervention or active control for many hours-per-day, half the music therapy participants listened for 12min or less per day and half of the noise-cancelling headphone participants did not appear to use them. While the results suggest that patient-directed music therapy and noise-cancelling headphones may be useful and cost-effective interventions that lead to an overall improvement in anxiety and sedation exposure, these may appeal to a subset of ICU patients. The self-directed use of music therapy and noise

  3. Stem Cell Gene Therapy for Fanconi Anemia: Report from the 1st International Fanconi Anemia Gene Therapy Working Group Meeting

    Science.gov (United States)

    Tolar, Jakub; Adair, Jennifer E; Antoniou, Michael; Bartholomae, Cynthia C; Becker, Pamela S; Blazar, Bruce R; Bueren, Juan; Carroll, Thomas; Cavazzana-Calvo, Marina; Clapp, D Wade; Dalgleish, Robert; Galy, Anne; Gaspar, H Bobby; Hanenberg, Helmut; Von Kalle, Christof; Kiem, Hans-Peter; Lindeman, Dirk; Naldini, Luigi; Navarro, Susana; Renella, Raffaele; Rio, Paula; Sevilla, Julián; Schmidt, Manfred; Verhoeyen, Els; Wagner, John E; Williams, David A; Thrasher, Adrian J

    2011-01-01

    Survival rates after allogeneic hematopoietic cell transplantation (HCT) for Fanconi anemia (FA) have increased dramatically since 2000. However, the use of autologous stem cell gene therapy, whereby the patient's own blood stem cells are modified to express the wild-type gene product, could potentially avoid the early and late complications of allogeneic HCT. Over the last decades, gene therapy has experienced a high degree of optimism interrupted by periods of diminished expectation. Optimism stems from recent examples of successful gene correction in several congenital immunodeficiencies, whereas diminished expectations come from the realization that gene therapy will not be free of side effects. The goal of the 1st International Fanconi Anemia Gene Therapy Working Group Meeting was to determine the optimal strategy for moving stem cell gene therapy into clinical trials for individuals with FA. To this end, key investigators examined vector design, transduction method, criteria for large-scale clinical-grade vector manufacture, hematopoietic cell preparation, and eligibility criteria for FA patients most likely to benefit. The report summarizes the roadmap for the development of gene therapy for FA. PMID:21540837

  4. Indirect versus direct feedback in computer-based Prism Adaptation Therapy

    DEFF Research Database (Denmark)

    Wilms, Inge Linda; Rytter, Hana Malá

    2010-01-01

    Prism Adaptation Therapy (PAT) is an intervention method in the treatment of the attention disorder neglect (Frassinetti, Angeli, Meneghello, Avanzi, & Ladavas, 2002; Rossetti, et al., 1998). The aim of this study was to investigate whether one session of PAT using a computer-attached touchscreen...... in the aftereffect. The findings have direct implications for future implementations of computer-based methods of treatment of visuospatial disorders and computer-assisted rehabilitation in general....

  5. Emotion recognition in early Parkinson's disease patients undergoing deep brain stimulation or dopaminergic therapy: a comparison to healthy participants

    Directory of Open Access Journals (Sweden)

    Lindsey G. McIntosh

    2015-01-01

    Full Text Available Parkinson’s disease (PD is traditionally regarded as a neurodegenerative movement disorder, however, nigrostriatal dopaminergic degeneration is also thought to disrupt non-motor loops connecting basal ganglia to areas in frontal cortex involved in cognition and emotion processing. PD patients are impaired on tests of emotion recognition, but it is difficult to disentangle this deficit from the more general cognitive dysfunction that frequently accompanies disease progression. Testing for emotion recognition deficits early in the disease course, prior to cognitive decline, better assesses the sensitivity of these non-motor corticobasal ganglia-thalamocortical loops involved in emotion processing to early degenerative change in basal ganglia circuits. In addition, contrasting this with a group of healthy aging individuals demonstrates changes in emotion processing specific to the degeneration of basal ganglia circuitry in PD. Early PD patients (EPD were recruited from a randomized clinical trial testing the safety and tolerability of deep brain stimulation of the subthalamic nucleus (STN-DBS in early-staged PD. EPD patients were previously randomized to receive optimal drug therapy only (ODT, or drug therapy plus STN-DBS (ODT+DBS. Matched healthy elderly controls (HEC and young controls (HYC also participated in this study. Participants completed two control tasks and three emotion recognition tests that varied in stimulus domain. EPD patients were impaired on all emotion recognition tasks compared to HEC. Neither therapy type (ODT or ODT+DBS nor therapy state (ON/OFF altered emotion recognition performance in this study. Finally, HEC were impaired on vocal emotion recognition relative to HYC, suggesting a decline related to healthy aging. This study supports the existence of impaired emotion recognition early in the PD course, implicating an early disruption of fronto-striatal loops mediating emotional function.

  6. Are family-centred principles, functional goal setting and transition planning evident in therapy services for children with cerebral palsy?

    Science.gov (United States)

    Darrah, J; Wiart, L; Magill-Evans, J; Ray, L; Andersen, J

    2012-01-01

    Family-centred service, functional goal setting and co-ordination of a child's move between programmes are important concepts of rehabilitation services for children with cerebral palsy identified in the literature. We examined whether these three concepts could be objectively identified in programmes providing services to children with cerebral palsy in Alberta, Canada. Programme managers (n= 37) and occupational and physical therapists (n= 54) representing 59 programmes participated in individual 1-h semi-structured interviews. Thirty-nine parents participated in eleven focus groups or two individual interviews. Evidence of family-centred values in mission statements and advisory boards was evaluated. Therapists were asked to identify three concepts of family-centred service and to complete the Measures of Process of Care for Service Providers. Therapists also identified therapy goals for children based on clinical case scenarios. The goals were coded using the components of the International Classification of Functioning Disability and Health. Programme managers and therapists discussed the processes in their programmes for goal setting and for preparing children and their families for their transition to other programmes. Parents reflected on their experiences with their child's rehabilitation related to family-centredness, goal setting and co-ordination between programmes. All respondents expressed commitment to the three concepts, but objective indicators of family-centred processes were lacking in many programmes. In most programmes, the processes to implement the three concepts were informal rather than standardized. Both families and therapists reported limited access to general information regarding community supports. Lack of formal processes for delivery of family-centred service, goal-setting and co-ordination between children's programmes may result in inequitable opportunities for families to participate in their children's rehabilitation despite

  7. Mild cognitive impairment in Parkinson's disease is improved by transcranial direct current stimulation combined with physical therapy.

    Science.gov (United States)

    Manenti, Rosa; Brambilla, Michela; Benussi, Alberto; Rosini, Sandra; Cobelli, Chiara; Ferrari, Clarissa; Petesi, Michela; Orizio, Italo; Padovani, Alessandro; Borroni, Barbara; Cotelli, Maria

    2016-05-01

    Parkinson's disease (PD) is characterized by both motor and cognitive deficits. In PD, physical exercise has been found to improve physical functioning. Recent studies demonstrated that repeated sessions of transcranial direct current stimulation led to an increased performance in cognitive and motor tasks in patients with PD. The present study investigated the effects of anodal transcranial direct current stimulation applied over the dorsolateral prefrontal cortex and combined with physical therapy in PD patients. A total of 20 patients with PD were assigned to 1 of 2 study groups: group 1, anodal transcranial direct current stimulation plus physical therapy (n = 10) or group 2, placebo transcranial direct current stimulation plus physical therapy (n = 10). The 2 weeks of treatment consisted of daily direct current stimulation application for 25 minutes during physical therapy. Long-term effects of treatment were evaluated on clinical, neuropsychological, and motor task performance at 3-month follow-up. An improvement in motor abilities and a reduction of depressive symptoms were observed in both groups after the end of treatment and at 3-month follow-up. The Parkinson's Disease Cognitive Rating Scale and verbal fluency test performances increased only in the anodal direct current stimulation group with a stable effect at follow-up. The application of anodal transcranial direct current stimulation may be a relevant tool to improve cognitive abilities in PD and might be a novel therapeutic strategy for PD patients with mild cognitive impairment. © 2016 International Parkinson and Movement Disorder Society. © 2016 International Parkinson and Movement Disorder Society.

  8. [The importance of early exercise therapy in the treatment of Colles' fracture. A clinically controlled study].

    Science.gov (United States)

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

    1990-08-27

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

  9. [Significance of emotion-focused concepts to cognitive-behavioral therapy].

    Science.gov (United States)

    Lammers, C-H

    2006-09-01

    Emotions are the central process of motivation and play a key role in adaptive behavior in humans. Although cognitive-behavioral therapy stresses the importance of changing both cognition and behavior, there is growing emphasis on direct therapeutic work on emotions and emotional processing, as problematic emotional processes are at the core of nearly all psychic disorders. This type of work is the goal of emotion-focused psychotherapy, which centers on direct change of problematic emotions, especially those which are usually suppressed resp. overregulated by the patient. This paper examines the basic phobic/emotional conflict, the problematic emotional processes arising from this conflict, and the importance to cognitive-behavioral therapy of their potentially integrative role.

  10. Psychodynamic psychotherapy for social phobia: a treatment manual based on supportive-expressive therapy.

    Science.gov (United States)

    Leichsenring, Falk; Beutel, Manfred; Leibing, Eric

    2007-01-01

    Social phobia is a very frequent mental disorder characterized by an early onset, a chronic unremitting course, severe psychosocial impairments and high socioeconomic costs. To date, no manual for the psychodynamic treatment of social phobia exists. After a brief description of the disorder, a manual for a short-term psychodynamic treatment of social phobia is presented. The treatment is based on Luborsky s supportive-expressive (SE) therapy, which is complemented by treatment elements specific to social phobia. The treatment includes the characteristic elements of SE therapy, that is, setting goals, focus on the Core Conflictual Relationship Theme (CCRT) associated with the patient s symptoms, interpretive interventions to enhance insight into the CCRT, and supportive interventions, in particular fostering a helping alliance. In order to tailor the treatment more specifically to social phobia, treatment elements have been added, for example informing the patient about the disorder and the treatment, a specific focus on shame and on unrealistic demands, and encouraging the patient to confront anxiety-producing situations. More directive interventions are included as well, such as specific prescriptions to stop persisting self-devaluations. The treatment manual is presently being used in a large-scale randomized controlled multicenter study comparing short-term psychodynamic psychotherapy and cognitive-behavioral therapy in the treatment of social phobia.

  11. The role of selective attention in short-term memory and goal-directed behavior

    OpenAIRE

    Vissers, M.E.

    2018-01-01

    Selective attention enables the prioritization of goal-relevant aspects of our sensory environment in order to guide our actions, or to store goal-relevant information in short-term memory. Yet, it remains largely unclear how attention prioritizes goal-relevant information. For example, selective attention may enhance processing of goal-relevant information, suppress processing of distracting information, or both. The research presented in this dissertation examined the neurophysiological mec...

  12. Effects of FVIII immunity on hepatocyte and hematopoietic stem cell–directed gene therapy of murine hemophilia A

    Directory of Open Access Journals (Sweden)

    Allison M Lytle

    2016-01-01

    Full Text Available Immune responses to coagulation factors VIII (FVIII and IX (FIX represent primary obstacles to hemophilia treatment. Previously, we showed that hematopoietic stem cell (HSC retroviral gene therapy induces immune nonresponsiveness to FVIII in both naive and preimmunized murine hemophilia A settings. Liver-directed adeno-associated viral (AAV-FIX vector gene transfer achieved similar results in preclinical hemophilia B models. However, as clinical immune responses to FVIII and FIX differ, we investigated the ability of liver-directed AAV-FVIII gene therapy to affect FVIII immunity in hemophilia A mice. Both FVIII naive and preimmunized mice were administered recombinant AAV8 encoding a liver-directed bioengineered FVIII expression cassette. Naive animals receiving high or mid-doses subsequently achieved near normal FVIII activity levels. However, challenge with adjuvant-free recombinant FVIII induced loss of FVIII activity and anti-FVIII antibodies in mid-dose, but not high-dose AAV or HSC lentiviral (LV vector gene therapy cohorts. Furthermore, unlike what was shown previously for FIX gene transfer, AAV-FVIII administration to hemophilia A inhibitor mice conferred no effect on anti-FVIII antibody or inhibitory titers. These data suggest that functional differences exist in the immune modulation achieved to FVIII or FIX in hemophilia mice by gene therapy approaches incorporating liver-directed AAV vectors or HSC-directed LV.

  13. Using tablet-based technology in patient education about systemic therapy options for early-stage breast cancer: a pilot study.

    Science.gov (United States)

    Morgan, E R; Laing, K; McCarthy, J; McCrate, F; Seal, M D

    2015-10-01

    Patient education in early-stage breast cancer has been shown to improve patient well-being and quality of life, but it poses a challenge given the increasingly complex regimens and time constraints in clinical practice. Technology-aided teaching in the clinic could help to improve the understanding of adjuvant systemic therapy for patients. In this prospective pilot study, we used a clinician-administered, tablet-based teaching aid to teach patients with early-stage breast cancer about adjuvant systemic therapy. Participation was offered to newly diagnosed patients with early-stage breast cancer presenting for their first medical oncology visit at a provincial cancer centre. Participants were shown a tablet-based presentation describing procedures, rationales, risks, and benefits of adjuvant systemic therapy as an adjunct to a discussion with the medical oncologist. After the clinic visit, participants completed a questionnaire measuring satisfaction with the visit and knowledge of the treatment plan discussed. The 25 patients recruited for the study had a mean age of 57 years. An offer of upfront chemotherapy alone was made to 12 participants (48%), chemotherapy with trastuzumab to 4 (16%), and hormonal therapy to 9 (36%). Correct answers to all questions related to treatment knowledge were given by 22 patients (88%). Satisfaction with the clinic visit was high (mean satisfaction score: 4.53 ± 0.1 of a possible 5). We found that a tablet-based presentation about adjuvant systemic therapy was satisfactory to patients with early-stage breast cancer and that knowledge retention after the clinic visit was high. Tablet-based teaching could be a feasible and effective way of educating patients in the breast oncology clinic and warrants further investigation in randomized studies.

  14. Phospholipid micelle-based magneto-plasmonic nanoformulation for magnetic field-directed, imaging-guided photo-induced cancer therapy.

    Science.gov (United States)

    Ohulchanskyy, Tymish Y; Kopwitthaya, Atcha; Jeon, Mansik; Guo, Moran; Law, Wing-Cheung; Furlani, Edward P; Kim, Chulhong; Prasad, Paras N

    2013-11-01

    We present a magnetoplasmonic nanoplatform combining gold nanorods (GNR) and iron-oxide nanoparticles within phospholipid-based polymeric nanomicelles (PGRFe). The gold nanorods exhibit plasmon resonance absorbance at near infrared wavelengths to enable photoacoustic imaging and photothermal therapy, while the Fe3O4 nanoparticles enable magnetophoretic control of the nanoformulation. The fabricated nanoformulation can be directed and concentrated by an external magnetic field, which provides enhancement of a photoacoustic signal. Application of an external field also leads to enhanced uptake of the magnetoplasmonic formulation by cancer cells in vitro. Under laser irradiation at the wavelength of the GNR absorption peak, the PGRFe formulation efficiently generates plasmonic nanobubbles within cancer cells, as visualized by confocal microscopy, causing cell destruction. The combined magnetic and plasmonic functionalities of the nanoplatform enable magnetic field-directed, imaging-guided, enhanced photo-induced cancer therapy. In this study, a nano-formulation of gold nanorods and iron oxide nanoparticles is presented using a phospholipid micelle-based delivery system for magnetic field-directed and imaging-guided photo-induced cancer therapy. The gold nanorods enable photoacoustic imaging and photothermal therapy, while the Fe3O4 nanoparticles enable magnetophoretic control of the formulation. This and similar systems could enable more precise and efficient cancer therapy, hopefully in the near future, after additional testing. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Low-Dose Consolidation Radiation Therapy for Early Stage Unfavorable Hodgkin Lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Torok, Jordan A., E-mail: jordan.torok@dm.duke.edu [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Wu, Yuan [Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina (United States); Prosnitz, Leonard R.; Kim, Grace J. [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Beaven, Anne W.; Diehl, Louis F. [Division of Hematologic Malignancy and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina (United States); Kelsey, Chris R. [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States)

    2015-05-01

    Purpose: The German Hodgkin Study Group (GHSG) trial HD11 established 4 cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) and 30 Gy of radiation therapy (RT) as a standard for early stage (I, II), unfavorable Hodgkin lymphoma (HL). Additional cycles of ABVD may allow for a reduction in RT dose and improved toxicity profile. Methods and Materials: Patients treated with combined modality therapy at the Duke Cancer Institute for early stage, unfavorable HL by GHSG criteria from 1994 to 2012 were included. Patients who did not undergo post-chemotherapy functional imaging (positron emission tomography or gallium imaging) or who failed to achieve a complete response were excluded. Clinical outcomes were estimated using the Kaplan-Meier method. Late effects were also evaluated. Results: A total of 90 patients met inclusion criteria for analysis. Median follow-up was 5 years. Chemotherapy consisted primarily of ABVD (88%) with a median number of 6 cycles. The median dose of consolidation RT was 23.4 Gy. Four patients had relapses, 2 of which were in-field. Ten-year progression-free survival (PFS) and overall survival (OS) were 93% (95% confidence interval [CI]: 0.82-0.97) and 98% (95% CI: 0.92-0.99), respectively. For the subset of patients (n=46) who received 5 to 6 cycles of chemotherapy and ≤24 Gy, the 10-year PFS and OS values were 88% (95% CI: 70%-96%) and 98% (95% CI: 85% - 99%), respectively. The most common late effect was hypothyroidism (20%) with no cardiac complications. Seven secondary malignancies were diagnosed, with only 1 arising within the RT field. Conclusions: Lower doses of RT may be sufficient when combined with more than 4 cycles of ABVD for early stage, unfavorable HL and may result in a more favorable toxicity profile than 4 cycles of ABVD and 30 Gy of RT.

  16. Implementing communication and decision-making interventions directed at goals of care: a theory-led scoping review.

    Science.gov (United States)

    Cummings, Amanda; Lund, Susi; Campling, Natasha; May, Carl R; Richardson, Alison; Myall, Michelle

    2017-10-06

    To identify the factors that promote and inhibit the implementation of interventions that improve communication and decision-making directed at goals of care in the event of acute clinical deterioration. A scoping review was undertaken based on the methodological framework of Arksey and O'Malley for conducting this type of review. Searches were carried out in Medline and Cumulative Index to Nursing and Allied Health Literature (CINAHL) to identify peer-reviewed papers and in Google to identify grey literature. Searches were limited to those published in the English language from 2000 onwards. Inclusion and exclusion criteria were applied, and only papers that had a specific focus on implementation in practice were selected. Data extracted were treated as qualitative and subjected to directed content analysis. A theory-informed coding framework using Normalisation Process Theory (NPT) was applied to characterise and explain implementation processes. Searches identified 2619 citations, 43 of which met the inclusion criteria. Analysis generated six themes fundamental to successful implementation of goals of care interventions: (1) input into development; (2) key clinical proponents; (3) training and education; (4) intervention workability and functionality; (5) setting and context; and (6) perceived value and appraisal. A broad and diverse literature focusing on implementation of goals of care interventions was identified. Our review recognised these interventions as both complex and contentious in nature, making their incorporation into routine clinical practice dependent on a number of factors. Implementing such interventions presents challenges at individual, organisational and systems levels, which make them difficult to introduce and embed. We have identified a series of factors that influence successful implementation and our analysis has distilled key learning points, conceptualised as a set of propositions, we consider relevant to implementing other complex

  17. Contexts Paired with Junk Food Impair Goal-Directed Behavior in Rats: Implications for Decision Making in Obesogenic Environments.

    Science.gov (United States)

    Kendig, Michael D; Cheung, Ambrose M K; Raymond, Joel S; Corbit, Laura H

    2016-01-01

    The high prevalence of obesity and related metabolic diseases calls for greater understanding of the factors that drive excess energy intake. Calorie-dense palatable foods are readily available and often are paired with highly salient environmental cues. These cues can trigger food-seeking and consumption in the absence of hunger. Here we examined the effects of palatable food-paired environmental cues on control of instrumental food-seeking behavior. In Experiment 1, adult male rats received exposures to one context containing three "junk" foods (JFs context) and another containing chow (Chow context). Next, rats were food-deprived and trained to perform instrumental responses (lever-press) for two novel food rewards in a third, distinct context. Contextual influences on flexible control of food-seeking behavior were then assessed by outcome devaluation tests held in the JF, chow and training contexts. Devaluation was achieved using specific satiety and test order was counterbalanced. Rats exhibited goal-directed control over behavior when tested in the training and chow-paired contexts. Notably, performance was habitual (insensitive to devaluation) when tested in the JF context. In Experiment 2 we tested whether the impairment found in the JF context could be ameliorated by the presentation of a discrete auditory cue paired with the chow context, relative to a second cue paired with the JF context. Consistent with the results of Experiment 1, the devaluation effect was not significant when rats were tested in the JF context with the JF cue. However, presenting the chow cue increased the impact of the devaluation treatment leading to a robust devaluation effect. Further tests confirmed that performance in the chow context was goal-directed and that sensory-specific satiety in the JF context was intact. These results show that environments paired with palatable foods can impair goal-directed control over food-seeking behavior, but that this deficit was improved by

  18. Contexts paired with junk food impair goal-directed behaviour in rats: implications for decision making in obesogenic environments

    Directory of Open Access Journals (Sweden)

    Michael D. Kendig

    2016-11-01

    Full Text Available The high prevalence of obesity and related metabolic diseases calls for greater understanding of the factors that drive excess energy intake. Calorie-dense palatable foods are readily available and often are paired with highly salient environmental cues. These cues can trigger food-seeking and consumption in the absence of hunger. Here we examined the effects of palatable food-paired environmental cues on control of instrumental food-seeking behaviour. In Experiment 1, adult male rats received exposures to one context containing three ‘junk’ foods (JF context and another containing chow (Chow context. Next, rats were food-deprived and trained to perform instrumental responses (lever-press for two novel food rewards in a third, distinct context. Contextual influences on flexible control of food-seeking behaviour were then assessed by outcome devaluation tests held in the JF, chow, and training contexts. Devaluation was achieved using specific satiety and test order was counterbalanced. Rats exhibited goal-directed control over behaviour when tested in the training and chow-paired contexts. Notably, performance was habitual (insensitive to devaluation when tested in the JF context. In Experiment 2 we tested whether the impairment found in the JF context could be ameliorated by the presentation of a discrete auditory cue paired with the chow context, relative to a second cue paired with the JF context. Consistent with the results of Experiment 1, the devaluation effect was not significant when rats were tested in the JF context with the JF cue. However, presenting the chow cue increased the impact of the devaluation treatment leading to a robust devaluation effect. Further tests confirmed that performance in the chow context was goal-directed and that sensory-specific satiety in the JF context was intact. These results show that environments paired with palatable foods can impair goal-directed control over food-seeking behaviour, but that this

  19. The role of selective attention in short-term memory and goal-directed behavior

    NARCIS (Netherlands)

    Vissers, M.E.

    2018-01-01

    Selective attention enables the prioritization of goal-relevant aspects of our sensory environment in order to guide our actions, or to store goal-relevant information in short-term memory. Yet, it remains largely unclear how attention prioritizes goal-relevant information. For example, selective

  20. Verification of extended model of goal directed behavior applied on aggression

    Directory of Open Access Journals (Sweden)

    Katarína Vasková

    2016-01-01

    Full Text Available The study was aimed to verify Model of Goal Directed Behavior (EMGB by Perugini and Bagozzi (2001 applied on aggression by Richetin, Richardson and Boykin (2011. Two different studies were performed. Firstly original form of model was verified. In the second study, modification of EMGB through new conceptualization of scale of perceived behavioral control was executed. The research sample consisted together from 385 students of University of P.J. Šafárik and High school in Košice (182 respondents (78 men, 104 women with average age 20,84 years and standard deviation 1,94, who were involved in first study and 203 students (49 men and 154 women, with average age 19,71 and standard deviation 1,99 participated in second study who were administrated questionnaire by Richetin et al. (2011 and Richardson Conflict Response Questionnaire (Richardson & Green, 2006. Expectancy of comparable relationships between particular factors of EMGB in comparison to its published original version was verified. Data were analyzed by structural equation modeling. In first study was shown insufficient fit of EMGB model. There were hypothesized two main sources of problems. At first, weak relationship between attitudes and behavioral desire was shown. Following statistical procedures confirmed its direct impact on intention, what is in correspondence with another studies (see Leone, Perugini & Ercolani, 2004, Perugini & Bagozzi, 2001, Richetin et al., 2011. Second source of problems was identified in factor named perceived behavioral control. Difficulties from our point of view lied in conceptualization of the term and its subsequent measurement. In the second study was involved new conceptualization of control. It corresponded with Baumeister´s understanding of selfcontrol as asserting control over one´s emotions, thoughts and behavior. After this modification sufficient fit of EMGB was shown. Besides this, factor of self-control was the strongest predictor of

  1. Goal Setting for Cognitive Rehabilitation in Mild to Moderate Parkinson's Disease Dementia and Dementia with Lewy Bodies.

    Science.gov (United States)

    Watermeyer, Tamlyn J; Hindle, John V; Roberts, Julie; Lawrence, Catherine L; Martyr, Anthony; Lloyd-Williams, Huw; Brand, Andrew; Gutting, Petra; Hoare, Zoe; Edwards, Rhiannon Tudor; Clare, Linda

    2016-01-01

    Alongside the physical symptoms associated with Parkinson's disease dementia and dementia with Lewy bodies, health services must also address the cognitive impairments that accompany these conditions. There is growing interest in the use of nonpharmacological approaches to managing the consequences of cognitive disorder. Cognitive rehabilitation is a goal-orientated behavioural intervention which aims to enhance functional independence through the use of strategies specific to the individual's needs and abilities. Fundamental to this therapy is a person's capacity to set goals for rehabilitation. To date, no studies have assessed goal setting in early-stage Parkinson's disease dementia or dementia with Lewy bodies. Semistructured interviews were carried out with 29 participants from an ongoing trial of cognitive rehabilitation for people with these conditions. Here, we examined the goal statements provided by these participants using qualitative content analysis, exploring the types and nature of the goals set. Participants' goals reflected their motivations to learn new skills or improve performance in areas such as technology-use, self-management and orientation, medication management, and social and leisure activities. These results suggest that goal setting is achievable for these participants, provide insight into the everyday cognitive difficulties that they experience, and highlight possible domains as targets for intervention. The trial is registered with ISRCTN16584442 (DOI 10.1186/ISRCTN16584442 13/04/2015).

  2. Abnormal-induced theta activity supports early directed-attention network deficits in progressive MCI.

    Science.gov (United States)

    Deiber, Marie-Pierre; Ibañez, Vicente; Missonnier, Pascal; Herrmann, François; Fazio-Costa, Lara; Gold, Gabriel; Giannakopoulos, Panteleimon

    2009-09-01

    The electroencephalography (EEG) theta frequency band reacts to memory and selective attention paradigms. Global theta oscillatory activity includes a posterior phase-locked component related to stimulus processing and a frontal-induced component modulated by directed attention. To investigate the presence of early deficits in the directed attention-related network in elderly individuals with mild cognitive impairment (MCI), time-frequency analysis at baseline was used to assess global and induced theta oscillatory activity (4-6Hz) during n-back working memory tasks in 29 individuals with MCI and 24 elderly controls (EC). At 1-year follow-up, 13 MCI patients were still stable and 16 had progressed. Baseline task performance was similar in stable and progressive MCI cases. Induced theta activity at baseline was significantly reduced in progressive MCI as compared to EC and stable MCI in all n-back tasks, which were similar in terms of directed attention requirements. While performance is maintained, the decrease of induced theta activity suggests early deficits in the directed-attention network in progressive MCI, whereas this network is functionally preserved in stable MCI.

  3. Information Needs of Older Women With Early-Stage Breast Cancer When Making Radiation Therapy Decisions.

    Science.gov (United States)

    Wang, Shi-Yi; Kelly, Gabrielle; Gross, Cary; Killelea, Brigid K; Mougalian, Sarah; Presley, Carolyn; Fraenkel, Liana; Evans, Suzanne B

    2017-07-15

    To identify the information older women with early-stage breast cancer need when making radiation therapy decisions, and who patients identify as the main decision maker. We surveyed (through face-to-face interview, telephone, or mail) women aged ≥65 years who received lumpectomy and were considering or receiving adjuvant radiation therapy for early-stage breast cancer. The survey instrument was constructed with input from patient and professional advisory committees, including breast cancer survivors, advocates of breast cancer care and aging, clinicians, and researchers. Participants rated the importance (on a 4-point scale) of 24 statements describing the benefits, side effects, impact on daily life, and other issues of radiation therapy in relation to radiation therapy decision making. Participants also designated who was considered the key decision maker. The response rate was 56.4% (93 of 165). Mean age was 72.5 years, ranging from 65 to 93 years. More than 96% of participants indicated they were the main decision maker on receiving radiation therapy. There was wide variation in information needs regarding radiation therapy decision making. Participants rated a mean of 18 (range, 3-24) items as "essential." Participants rated items related to benefits highest, followed by side effects. Participants who were older than 75 years rated 13.9 questions as essential, whereas participants aged ≤74 years rated 18.7 as essential (P=.018). Older women desire information and have more agency and input in the decision-making process than prior literature would suggest. The variation in information needs indicates that future decision support tools should provide options to select what information would be of interest to the participants. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Characterizing the protocol for early modified constraint-induced movement therapy in the EXPLICIT-stroke trial

    NARCIS (Netherlands)

    Nijland, R van; Wegen, E. van; Krogt, H. van der; Bakker, C.D.; Buma, F.; Klomp, A.; Kordelaar, J. van; Kwakkel, G.; Geurts, A.C.; Kuijk, A.A. van; Lindeman, E.; Visser-Meily, J.M.A.; Arendzen, H.J.; Meskers, C.G.; Helm, F.C.T. van der; Vlugt, E. de

    2013-01-01

    Constraint-induced movement therapy (CIMT) is a commonly used rehabilitation intervention to improve upper limb function after stroke. CIMT was originally developed for patients with a chronic upper limb paresis. Although there are indications that exercise interventions should start as early as

  5. Non-Steroidal Anti-inflammatory Drugs As Host-Directed Therapy for Tuberculosis: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Vera M. Kroesen

    2017-06-01

    Full Text Available Lengthy, antimicrobial therapy targeting the pathogen is the mainstay of conventional tuberculosis treatment, complicated by emerging drug resistances. Host-directed therapies, including non-steroidal anti-inflammatory drugs (NSAIDs, in contrast, target host factors to mitigate disease severity. In the present Systematic Review, we investigate whether NSAIDs display any effects as therapy of TB and discuss possible mechanisms of action of NSAIDs as adjunctive therapy of TB. Ten studies, seven preclinical studies in mice and three clinical trials, were included and systematically reviewed. Our results point toward a beneficial effect of NSAIDs as adjunct to current TB therapy regimens, mediated by decreased lung pathology balancing host-immune reaction. The determination of the best timing for their administration in order to obtain the potential beneficial effects needs further investigation. Even if the preclinical evidence requires clinical evaluation, NSAIDs might represent a potential safe, simple, and cheap improvement in therapy of TB.

  6. Animal-assisted therapy in early childhood schools in São Paulo, Brazil

    Directory of Open Access Journals (Sweden)

    Amanda O. Ferreira

    Full Text Available Abstract: Since ancient times, humans and animals have interacted for different purposes. Animal Assisted Therapy (AAT is used for the assistance and treatment in humans and educational projects where animals are used as co-therapists or co-educators. The use of animals facilitates the process of teaching and learning, and stimulates physical and therapeutic activities. So that knowledge on AAT could be expanded, current study analyzes the opinion of people directly involved in education on AAT implementation as an educational model in early childhood schools in São Paulo, Brazil. Questionnaires were handed out to 10 pedagogical coordinators, 32 teachers, 23 parents and 26 children aged 3-6 years. Results revealed that AAT is not well-known for most interviewees, including pedagogical coordinators, teachers and parents. However, interviewees believe in the benefits of child-pet interactions and are favorable to the implementation of AATs in schools. Projects should be interdisciplinary and must involve professionals from other areas, such as psychologists and veterinarians. Regarding the educational model, interviewees believe in the innovation capacity of AAT and in the possibilities of interdisciplinarity among teachers in the use of animals. Research also demonstrated that children like and support the use of animals in the school.

  7. Rational Emotive Behvioural Therapy (REBT) untuk Meningkatkan Kemampuan Regulasi Emosi Remaja Korban Kekerasan Seksual.

    OpenAIRE

    Anggreiny, Nila

    2014-01-01

    This study ia a pre-experimental research that aimed to examine the effect of therapy Rational Emotive Behavior Therapy (REBT) in improving emotion regulation in young victims of sexual abuse. Emotion regulation ability differences seen using Difficulties in Emotion Regulation Scale (ders) that reveals Difficulties engaging in goal direct behaviour, impulse control difficulties, nonaccept of emotional responses, lack of awareness, limited access to emotion regulation strateg...

  8. Bone metastases of differentiated thyroid cancer: the importance of early diagnosis and 131I therapy on prognosis

    International Nuclear Information System (INIS)

    Zanotti-Fregonara, P.; Rubello, D.; Hindie, E.

    2008-01-01

    Complete text of publication follows: Distant metastases are found at diagnosis or during follow-up in 10%-15% of patients with differentiated thyroid cancer. Bone is the second most commonly involved site. Patients with bone metastases, whether isolated or associated with lung metastases, have a markedly poor prognosis. Ten-year survival rates range from 13% to 21%. Given such poor prognosis, the use of 131 I therapy has been questioned. However, it might well be that poor prognosis of bone metastases can be overcome if 131 I therapy is delivered at an early stage, when tumor burden is small, as previously demonstrated for pulmonary metastases. A review of a large series of patients showed that only rarely were bone metastases diagnosed at an early stage. Among 109 patients with bone metastases reported by Bernier et al., only 4 had both radioiodine uptake and a negative standard radiography examination. Similarly, Durante et al. reported that only 8 of 115 patients had negative radiography findings at presentation. Prognosis may improve if bone metastases are detected earlier. In a recent study, bone metastases were first detected by 131 I scanning in 8 of 16 patients, when complementary radiologic studies were negative. Six of these patients showed an excellent response to 131 I therapy. Today, the nuclear medicine community is well armed for this challenge toward earlier diagnosis. Postsurgery thyroid remnant ablation is more widely used. The 131 I whole body scan associated with thyroid remnant ablation after thyroidectomy has a major role in early diagnosis of functioning distant metastases at a time when complementary imaging techniques (CT, MRI, bone scanning) are often still showing negative findings. Early diagnosis of specific 131 I-avid bone foci will be improved with the advent and generalization of SPECT/CT. When early diagnosis is achieved, repeated 131 I therapy can be effective by targeting not only visible metastases but also those still too small

  9. Early Angiographic Resolution of Cerebral Vasospasm with High Dose Intravenous Milrinone Therapy

    Directory of Open Access Journals (Sweden)

    F. A. Zeiler

    2015-01-01

    Full Text Available Background. Treatment of symptomatic delayed cerebral ischemia (DCI after subarachnoid hemorrhage (SAH is difficult. Recent studies suggest intravenous (IV high dose milrinone as a potential therapy. The timing to angiographic response with this is unclear. Methods. We reviewed the chart of one patient admitted for SAH who developed symptomatic DCI and was treated with high dose IV milrinone. Results. A 66-year-old female was admitted with a Hunt and Hess clinical grade 4, World Federation of Neurological Surgeons (WFNS clinical grade 4, and SAH secondary to a left anterior choroidal artery aneurysm which was clipped. After bleed day 6, the patient developed symptomatic DCI. We planned for angioplasty of the proximal segments. We administered high dose IV milrinone bolus followed by continuous infusion which led to clinical improvement prior to angiography. The angiogram performed 1.5 hours after milrinone administration displayed resolution of the CT angiogram and MRI based cerebral vasospasm such that further intra-arterial therapy was aborted. She completed 6 days of continuous IV milrinone therapy, was transferred to the ward, and subsequently rehabilitated. Conclusions. High dose IV milrinone therapy for symptomatic DCI after SAH can lead to rapid neurological improvement with dramatic early angiographic improvement of cerebral vasospasm.

  10. The early career researcher's toolkit: translating tissue engineering, regenerative medicine and cell therapy products.

    Science.gov (United States)

    Rafiq, Qasim A; Ortega, Ilida; Jenkins, Stuart I; Wilson, Samantha L; Patel, Asha K; Barnes, Amanda L; Adams, Christopher F; Delcassian, Derfogail; Smith, David

    2015-11-01

    Although the importance of translation for the development of tissue engineering, regenerative medicine and cell-based therapies is widely recognized, the process of translation is less well understood. This is particularly the case among some early career researchers who may not appreciate the intricacies of translational research or make decisions early in development which later hinders effective translation. Based on our own research and experiences as early career researchers involved in tissue engineering and regenerative medicine translation, we discuss common pitfalls associated with translational research, providing practical solutions and important considerations which will aid process and product development. Suggestions range from effective project management, consideration of key manufacturing, clinical and regulatory matters and means of exploiting research for successful commercialization.

  11. Examining Motivational Orientation and Learning Strategies in Computer-Supported Self-Directed Learning (CS-SDL) for Mathematics: The Perspective of Intrinsic and Extrinsic Goals

    Science.gov (United States)

    Lao, Andrew Chan-Chio; Cheng, Hercy N. H.; Huang, Mark C. L.; Ku, Oskar; Chan, Tak-Wai

    2017-01-01

    One-to-one technology, which allows every student to receive equal access to learning tasks through a personal computing device, has shown increasing potential for self-directed learning in elementary schools. With computer-supported self-directed learning (CS-SDL), students may set their own learning goals through the suggestions of the system…

  12. Safety and immunogenicity of therapeutic DNA vaccination in individuals treated with antiretroviral therapy during acute/early HIV-1 infection.

    Directory of Open Access Journals (Sweden)

    Eric S Rosenberg

    2010-05-01

    Full Text Available An effective therapeutic vaccine that could augment immune control of HIV-1 replication may abrogate or delay the need for antiretroviral therapy. AIDS Clinical Trials Group (ACTG A5187 was a phase I/II, randomized, placebo-controlled, double-blinded trial to evaluate the safety and immunogenicity of an HIV-1 DNA vaccine (VRC-HVDNA 009-00-VP in subjects treated with antiretroviral therapy during acute/early HIV-1 infection. (clinicaltrials.gov NCT00125099Twenty healthy HIV-1 infected subjects who were treated with antiretroviral therapy during acute/early HIV-1 infection and had HIV-1 RNA<50 copies/mL were randomized to receive either vaccine or placebo. The objectives of this study were to evaluate the safety and immunogenicity of the vaccine. Following vaccination, subjects interrupted antiretroviral treatment, and set-point HIV-1 viral loads and CD4 T cell counts were determined 17-23 weeks after treatment discontinuation.Twenty subjects received all scheduled vaccinations and discontinued antiretroviral therapy at week 30. No subject met a primary safety endpoint. No evidence of differences in immunogenicity were detected in subjects receiving vaccine versus placebo. There were also no significant differences in set-point HIV-1 viral loads or CD4 T cell counts following treatment discontinuation. Median set-point HIV-1 viral loads after treatment discontinuation in vaccine and placebo recipients were 3.5 and 3.7 log(10 HIV-1 RNA copies/mL, respectively.The HIV-1 DNA vaccine (VRC-HIVDNA 009-00-VP was safe but poorly immunogenic in subjects treated with antiretroviral therapy during acute/early HIV-1 infection. Viral set-points were similar between vaccine and placebo recipients following treatment interruption. However, median viral load set-points in both groups were lower than in historical controls, suggesting a possible role for antiretroviral therapy in persons with acute or early HIV-1 infection and supporting the safety of

  13. Neonatal lesions of orbital frontal areas 11/13 in monkeys alter goal-directed behavior but spare fear conditioning and safety signal learning.

    Directory of Open Access Journals (Sweden)

    Andy M Kazama

    2014-03-01

    Full Text Available Recent studies in monkeys have demonstrated that damage to the lateral subfields of orbital frontal cortex (OFC areas 11/13 yields profound changes in flexible modulation of goal-directed behaviors and a lack in fear regulation. Yet, little consideration has been placed on its role in emotional and social development throughout life. The current study investigated the effects of neonatal lesions of the OFC on the flexible modulation of goal-directed behaviors and fear responses in monkeys. Infant monkeys received neonatal lesions of OFC areas 11/13 or sham-lesions during the first post-natal week. Modulation of goal-directed behaviors was measured with a devaluation task at 3-4 years and 6-7 years. Modulation of fear reactivity by safety signals was assessed with the AX+/BX- potentiated-startle paradigm at 6-7 years. Similar to adult-onset OFC lesions, selective neonatal lesions of OFC areas 11/13 yielded a failure to modulate behavioral responses guided by changes in reward value, but spared the ability to modulate fear responses in the presence of safety signals. These results suggest that these areas play a critical role in the development of behavioral adaptation during goal-directed behaviors, but not, or less so, in the development of the ability to process emotionally salient stimuli and to modulate emotional reactivity using environmental contexts, which could be supported by other OFC subfields, such as the most ventromedial subfields (i.e. areas 14/25. Given similar impaired decision-making abilities and spared modulation of fear followed both neonatal lesions of either OFC areas 11 and 13 or amygdala (Kazama et al., 2012; Kazama & Bachevalier, 2013, the present results suggest that interactions between these two neural structures play a critical role in the development of behavioral adaptation; an ability essential for the self-regulation of emotion and behavior that assures the maintenance of successful social relationships.

  14. A Longitudinal Assessment of Early Childhood Education with Integrated Speech Therapy for Children with Significant Language Impairment in Germany

    Science.gov (United States)

    Ullrich, Dieter; Ullrich, Katja; Marten, Magret

    2014-01-01

    Background: In Lower Saxony, Germany, pre-school children with language- and speech-deficits have the opportunity to access kindergartens with integrated language-/speech therapy prior to attending primary school, both regular or with integrated speech therapy. It is unknown whether these early childhood education treatments are helpful and…

  15.   Indirect versus direct feedback in computer-based Prism Adaptation Therapy

    DEFF Research Database (Denmark)

    Wilms, Inge Linda; Rytter, Hana Malá

    2010-01-01

      Prism Adaptation Therapy (PAT) is an intervention method in the treatment of the attention disorder neglect (Frassinetti, Angeli, Meneghello, Avanzi, & Ladavas, 2002; Rossetti, et al., 1998). The aim of this study was to investigate whether one session of PAT using a computer-attached touchscreen...... have direct implications for future implementations of computer-based methods of treatment of visuospatial disorders and computer-assisted rehabilitation in general....

  16. Strategies to Optimize Adult Stem Cell Therapy for Tissue Regeneration

    Directory of Open Access Journals (Sweden)

    Shan Liu

    2016-06-01

    Full Text Available Stem cell therapy aims to replace damaged or aged cells with healthy functioning cells in congenital defects, tissue injuries, autoimmune disorders, and neurogenic degenerative diseases. Among various types of stem cells, adult stem cells (i.e., tissue-specific stem cells commit to becoming the functional cells from their tissue of origin. These cells are the most commonly used in cell-based therapy since they do not confer risk of teratomas, do not require fetal stem cell maneuvers and thus are free of ethical concerns, and they confer low immunogenicity (even if allogenous. The goal of this review is to summarize the current state of the art and advances in using stem cell therapy for tissue repair in solid organs. Here we address key factors in cell preparation, such as the source of adult stem cells, optimal cell types for implantation (universal mesenchymal stem cells vs. tissue-specific stem cells, or induced vs. non-induced stem cells, early or late passages of stem cells, stem cells with endogenous or exogenous growth factors, preconditioning of stem cells (hypoxia, growth factors, or conditioned medium, using various controlled release systems to deliver growth factors with hydrogels or microspheres to provide apposite interactions of stem cells and their niche. We also review several approaches of cell delivery that affect the outcomes of cell therapy, including the appropriate routes of cell administration (systemic, intravenous, or intraperitoneal vs. local administration, timing for cell therapy (immediate vs. a few days after injury, single injection of a large number of cells vs. multiple smaller injections, a single site for injection vs. multiple sites and use of rodents vs. larger animal models. Future directions of stem cell-based therapies are also discussed to guide potential clinical applications.

  17. From goal motivation to goal progress: the mediating role of coping in the Self-Concordance Model.

    Science.gov (United States)

    Gaudreau, Patrick; Carraro, Natasha; Miranda, Dave

    2012-01-01

    The present studies examined the mediating role of self-regulatory mechanisms in the relationship between goal motivation and goal progress in the Self-Concordance Model. First, a systematic review, using meta-analytical path analysis, supported the mediating role of effort and action planning in the positive association between autonomous goal motivation and goal progress. Second, results from two additional empirical studies, using structural equation modeling, lent credence to the mediating role of coping in the relationship between goal motivation and goal progress of university students. Autonomous goal motivation was positively associated with task-oriented coping, which predicted greater goal progress during midterm exams (Study 1, N=702) and at the end of the semester in a different sample (Study 2, N=167). Controlled goal motivation was associated with greater disengagement-oriented coping (Study 1 and Study 2) and lesser use of task-oriented coping (Study 2), which reduced goal progress. These results held up after controlling for perceived stress (Study 2). Our findings highlight the importance of coping in the "inception-to-attainment" goal process because autonomous goal motivation indirectly rather than directly predicts goal progress of university students through their usage of task-oriented coping.

  18. Developing Singing Confidence in Early Childhood Teachers Using Acceptance and Commitment Therapy and Group Singing: A Randomized Trial

    Science.gov (United States)

    Swain, Nicola; Bodkin-Allen, Sally

    2017-01-01

    Early childhood teachers are often required to sing, which requires confidence. The purpose of the present study was to treat early childhood teachers who self-identified as uncertain singers using either a group singing (GS) approach, or a talking approach, based on Acceptance and Commitment Therapy (ACT). The aim of the study was to increase…

  19. Goal Setting for Cognitive Rehabilitation in Mild to Moderate Parkinson’s Disease Dementia and Dementia with Lewy Bodies

    Directory of Open Access Journals (Sweden)

    Tamlyn J. Watermeyer

    2016-01-01

    Full Text Available Alongside the physical symptoms associated with Parkinson’s disease dementia and dementia with Lewy bodies, health services must also address the cognitive impairments that accompany these conditions. There is growing interest in the use of nonpharmacological approaches to managing the consequences of cognitive disorder. Cognitive rehabilitation is a goal-orientated behavioural intervention which aims to enhance functional independence through the use of strategies specific to the individual’s needs and abilities. Fundamental to this therapy is a person’s capacity to set goals for rehabilitation. To date, no studies have assessed goal setting in early-stage Parkinson’s disease dementia or dementia with Lewy bodies. Semistructured interviews were carried out with 29 participants from an ongoing trial of cognitive rehabilitation for people with these conditions. Here, we examined the goal statements provided by these participants using qualitative content analysis, exploring the types and nature of the goals set. Participants’ goals reflected their motivations to learn new skills or improve performance in areas such as technology-use, self-management and orientation, medication management, and social and leisure activities. These results suggest that goal setting is achievable for these participants, provide insight into the everyday cognitive difficulties that they experience, and highlight possible domains as targets for intervention. The trial is registered with ISRCTN16584442 (DOI 10.1186/ISRCTN16584442 13/04/2015.

  20. Extending Parent–Child Interaction Therapy for Early Childhood Internalizing Problems: New Advances for an Overlooked Population

    Science.gov (United States)

    Puliafico, Anthony C.; Kurtz, Steven M. S.; Pincus, Donna B.; Comer, Jonathan S.

    2014-01-01

    Although efficacious psychological treatments for internalizing disorders are now well established for school-aged children, until recently there have regrettably been limited empirical efforts to clarify indicated psychological intervention methods for the treatment of mood and anxiety disorders presenting in early childhood. Young children lack many of the developmental capacities required to effectively participate in established treatments for mood and anxiety problems presenting in older children, making simple downward extensions of these treatments for the management of preschool internalizing problems misguided. In recent years, a number of research groups have successfully adapted and modified parent–child interaction therapy (PCIT), originally developed to treat externalizing problems in young children, to treat various early internalizing problems with a set of neighboring protocols. As in traditional PCIT, these extensions target child symptoms by directly reshaping parent–child interaction patterns associated with the maintenance of symptoms. The present review outlines this emerging set of novel PCIT adaptations and modifications for mood and anxiety problems in young children and reviews preliminary evidence supporting their use. Specifically, we cover (a) PCIT for early separation anxiety disorder; (b) the PCIT-CALM (Coaching Approach behavior and Leading by Modeling) Program for the full range of early anxiety disorders; (c) the group Turtle Program for behavioral inhibition; and (d) the PCIT-ED (Emotional Development) Program for preschool depression. In addition, emerging PCIT-related protocols in need of empirical attention—such as the PCIT-SM (selective mutism) Program for young children with SM—are also considered. Implications of these protocols are discussed with regard to their unique potential to address the clinical needs of young children with internalizing problems. Obstacles to broad dissemination are addressed, and we consider

  1. Extending parent-child interaction therapy for early childhood internalizing problems: new advances for an overlooked population.

    Science.gov (United States)

    Carpenter, Aubrey L; Puliafico, Anthony C; Kurtz, Steven M S; Pincus, Donna B; Comer, Jonathan S

    2014-12-01

    Although efficacious psychological treatments for internalizing disorders are now well established for school-aged children, until recently there have regrettably been limited empirical efforts to clarify indicated psychological intervention methods for the treatment of mood and anxiety disorders presenting in early childhood. Young children lack many of the developmental capacities required to effectively participate in established treatments for mood and anxiety problems presenting in older children, making simple downward extensions of these treatments for the management of preschool internalizing problems misguided. In recent years, a number of research groups have successfully adapted and modified parent-child interaction therapy (PCIT), originally developed to treat externalizing problems in young children, to treat various early internalizing problems with a set of neighboring protocols. As in traditional PCIT, these extensions target child symptoms by directly reshaping parent-child interaction patterns associated with the maintenance of symptoms. The present review outlines this emerging set of novel PCIT adaptations and modifications for mood and anxiety problems in young children and reviews preliminary evidence supporting their use. Specifically, we cover (a) PCIT for early separation anxiety disorder; (b) the PCIT-CALM (Coaching Approach behavior and Leading by Modeling) Program for the full range of early anxiety disorders; (c) the group Turtle Program for behavioral inhibition; and (d) the PCIT-ED (Emotional Development) Program for preschool depression. In addition, emerging PCIT-related protocols in need of empirical attention--such as the PCIT-SM (selective mutism) Program for young children with SM--are also considered. Implications of these protocols are discussed with regard to their unique potential to address the clinical needs of young children with internalizing problems. Obstacles to broad dissemination are addressed, and we consider

  2. The Extraordinary Progress in Very Early Cancer Diagnosis and Personalized Therapy: The Role of Onco markers and Nano technology

    International Nuclear Information System (INIS)

    Fruscella, M.; Crema, A.; Carloni, G.; Fruscella, M.; Ponzetto, A.

    2016-01-01

    The impact of nano technology on oncology is revolutionizing cancer diagnosis and therapy and largely improving prognosis. This is mainly due to clinical translation of the most recent findings in cancer research, that is, the application of bio- and nano technologies. Cancer genomics and early diagnostics are increasingly playing a key role in developing more precise targeted therapies for most human tumors. In the last decade, accumulation of basic knowledge has resulted in a tremendous breakthrough in this field. Nano oncology, through the discovery of new genetic and epigenetic biomarkers, has facilitated the development of more sensitive biosensors for early cancer detection and cutting-edge multi functionalized nanoparticles for tumor imaging and targeting. In the near future, nano oncology is expected to enable a very early tumor diagnosis, combined with personalized therapeutic approaches.

  3. Effectiveness of early adalimumab therapy in psoriatic arthritis patients from Reuma.pt - EARLY PsA.

    Science.gov (United States)

    Santos, Helena; Eusébio, Mónica; Borges, Joana; Gonçalves, Diana; Ávila-Ribeiro, Pedro; Faria, Daniela Santos; Lopes, Carina; Rovisco, João; Águeda, Ana; Nero, Patrícia; Valente, Paula; Cravo, Ana Rita; Santos, Maria José

    2017-01-01

    Objective To compare outcomes in psoriatic arthritis (PsA) patients initiating adalimumab (ADA), with short- and long-term disease duration and to evaluate the potential effect of concomitant conventional synthetic disease-modifying antirheumatic drugs (csDMARD) or glucocorticoids. Methods Analyses included adult PsA patients registered in the Rheumatic Diseases Portuguese Register (Reuma.pt) between June 2008-June 2016 who received ADA for ≥3 months. Psoriatic Arthritis Response Criteria (PsARC) response, tender and swollen joint count, inflammatory parameters, patient (PtGA) and physician global assessment (PhGA), Disease Activity Score-28 joints (DAS28), and Health Assessment Questionnaire Disability Index (HAQ-DI) were compared between patients with PsA) and those with ≥5 years of disease duration (late PsA). Time to achieving PsARC response was estimated using the Kaplan-Meier method. Results Of 135 PsA patients treated with ADA, 126 had information on disease duration (earlyPsA, n=41). PsARC response was achieved by 72.9% of the patients (88.0% early PsA vs 62.2% late PsA; P=0.022) after 3 months and by 85.4% after 24 months (100% early PsA vs 75.9% late PsA; P=0.044). Early PsA patients achieved significantly less painful joints (2.7 vs 6.7, p=0.006), lower mean C-reactive protein (0.5 mg/dL vs 1.3 mg/dL; P=0.011), and PhGA (18.3 vs 28.1; P=0.020) at 3 months. In the long term, early PsA patients also had fewer swollen joints (0.3 vs 1.7; P=0.030) and lower PhGA (6.3 vs 21.9; PPsA, respectively. Early PsA patients obtained PsARC response more rapidly than late PsA (3.8 and 7.4 months, respectively; P=0.008). Concomitant csDMARDs showed clinical benefit (2-year PsARC response, 88.3% vs 60.0%; P=0.044). Concomitant glucocorticoids had no effect on PsARC response over 2 years of follow-up. Persistence on ADA was similar in both groups. Conclusion Early PsA patients had a greater chance of improvement after ADA therapy and better functional outcome, and

  4. Some evidence for the usefulness of an optimal foraging theory perspective on goal conflict and goal facilitation.

    Science.gov (United States)

    Tomasik, Martin J; Knecht, Michaela; Freund, Alexandra M

    2017-12-01

    Based on optimal foraging theory, we propose a metric that allows evaluating the goodness of goal systems, that is, systems comprising multiple goals with facilitative and conflicting interrelations. This optimal foraging theory takes into account expectancy and value, as well as opportunity costs, of foraging. Applying this approach to goal systems provides a single index of goodness of a goal system for goal striving. Three quasi-experimental studies (N = 277, N = 145, and N = 210) provide evidence for the usefulness of this approach for goal systems comprising between 3 to 10 goals. Results indicate that persons with a more optimized goal-system are more conscientious and open to new experience, are more likely to represent their goals in terms of means (i.e., adopt a process focus), and are more satisfied and engaged with their goals. Persons with a suboptimal goal system tend to switch their goals more often and thereby optimize their goal system. We discuss limitations as well as possible future directions of this approach. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  5. Prognostic factors for patients with early-stage uterine serous carcinoma without adjuvant therapy.

    Science.gov (United States)

    Tate, Keisei; Yoshida, Hiroshi; Ishikawa, Mitsuya; Uehara, Takashi; Ikeda, Shun Ichi; Hiraoka, Nobuyoshi; Kato, Tomoyasu

    2018-05-01

    Uterine serous carcinoma (USC) is an aggressive type 2 endometrial cancer. Data on prognostic factors for patients with early-stage USC without adjuvant therapy are limited. This study aims to assess the baseline recurrence risk of early-stage USC patients without adjuvant treatment and to identify prognostic factors and patients who need adjuvant therapy. Sixty-eight patients with International Federation of Gynecology and Obstetrics (FIGO) stage I-II USC between 1997 and 2016 were included. All the cases did not undergo adjuvant treatment as institutional practice. Clinicopathological features, recurrence patterns, and survival outcomes were analyzed to determine prognostic factors. FIGO stages IA, IB, and II were observed in 42, 7, and 19 cases, respectively. Median follow-up time was 60 months. Five-year disease-free survival (DFS) and overall survival (OS) rates for all cases were 73.9% and 78.0%, respectively. On multivariate analysis, cervical stromal involvement and positive pelvic cytology were significant predictors of DFS and OS, and ≥1/2 myometrial invasion was also a significant predictor of OS. Of 68 patients, 38 patients had no cervical stromal invasion or positive pelvic cytology and showed 88.8% 5-year DFS and 93.6% 5-year OS. Cervical stromal invasion and positive pelvic cytology are prognostic factors for stage I-II USC. Patients with stage IA or IB USC showing negative pelvic cytology may have an extremely favorable prognosis and need not receive any adjuvant therapies. Copyright © 2018. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology.

  6. Thin-plate spline analysis of treatment effects of rapid maxillary expansion and face mask therapy in early Class III malocclusions.

    Science.gov (United States)

    Baccetti, T; Franchi, L; McNamara, J A

    1999-06-01

    An effective morphometric method (thin-plate spline analysis) was applied to evaluate shape changes in the craniofacial configuration of a sample of 23 children with Class III malocclusions in the early mixed dentition treated with rapid maxillary expansion and face mask therapy, and compared with a sample of 17 children with untreated Class III malocclusions. Significant treatment-induced changes involved both the maxilla and the mandible. Major deformations consisted of forward displacement of the maxillary complex from the pterygoid region and of anterior morphogenetic rotation of the mandible, due to a significant upward and forward direction of growth of the mandibular condyle. Significant differences in size changes due to reduced increments in mandibular dimensions were associated with significant shape changes in the treated group.

  7. Elucidating a Goal-Setting Continuum in Brain Injury Rehabilitation.

    Science.gov (United States)

    Hunt, Anne W; Le Dorze, Guylaine; Trentham, Barry; Polatajko, Helene J; Dawson, Deirdre R

    2015-08-01

    For individuals with brain injury, active participation in goal setting is associated with better rehabilitation outcomes. However, clinicians report difficulty engaging these clients in goal setting due to perceived or real deficits (e.g., lack of awareness). We conducted a study using grounded theory methods to understand how clinicians from occupational therapy facilitate client engagement and manage challenges inherent in goal setting with this population. Through constant comparative analysis, a goal-setting continuum emerged. At one end of the continuum, therapists embrace client-determined goals and enable clients to decide their own goals. At the other, therapists accept preset organization-determined goals (e.g., "the goal is discharge") and pay little attention to client input. Although all participants aspired to embrace client-determined goal setting, most felt powerless to do so within perceived organizational constraints. Views of advocacy and empowerment help to explain our findings and inform more inclusive practice. © The Author(s) 2015.

  8. Low hemorrhage-related mortality in trauma patients in a Level I trauma center employing transfusion packages and early thromboelastography-directed hemostatic resuscitation with plasma and platelets

    DEFF Research Database (Denmark)

    Johansson, Pär I; Sørensen, Anne Marie Møller; Larsen, Claus F

    2013-01-01

    (ISS), transfusion therapy, and mortality were registered. Hemostatic resuscitation was based on a massive transfusion protocol encompassing transfusion packages and thromboelastography (TEG)-guided therapy. RESULTS: A total of 182 patients were included (75% males, median age 43 years, ISS of 17, 92....... Nonsurvivors had lower clot strength by kaolin-activated TEG and TEG functional fibrinogen and lower kaolin-tissue factor-activated TEG α-angle and lysis after 30 minutes compared to survivors. None of the TEG variables were independent predictors of massive transfusion or mortality. CONCLUSION: Three......-fourths of the patients transfused with plasma or PLTs within 24 hours received these in the first 2 hours. Hemorrhage caused 14% of the deaths. We introduced transfusion packages and early TEG-directed hemostatic resuscitation at our hospital 10 years ago and this may have contributed to reducing hemorrhagic trauma...

  9. Gender and the millenium development goals

    CSIR Research Space (South Africa)

    Njiro, E

    2006-03-01

    Full Text Available It has taken nearly half a century for the goals of poverty reduction and gender equality to achieve this prominence in mainstream policy concerns. In the process, the understanding of poverty has been transformed from the early equation with income...

  10. Goal-orientated cognitive rehabilitation for dementias associated with Parkinson's disease-A pilot randomised controlled trial.

    Science.gov (United States)

    Hindle, John V; Watermeyer, Tamlyn J; Roberts, Julie; Brand, Andrew; Hoare, Zoe; Martyr, Anthony; Clare, Linda

    2018-05-01

    To examine the appropriateness and feasibility of cognitive rehabilitation for people with dementias associated with Parkinson's in a pilot randomised controlled study. This was a single-blind pilot randomised controlled trial of goal-oriented cognitive rehabilitation for dementias associated with Parkinson's. After goal setting, participants were randomised to cognitive rehabilitation (n = 10), relaxation therapy (n = 10), or treatment-as-usual (n = 9). Primary outcomes were ratings of goal attainment and satisfaction with goal attainment. Secondary outcomes included quality of life, mood, cognition, health status, everyday functioning, and carers' ratings of goal attainment and their own quality of life and stress levels. Assessments were at 2 and 6 months following randomisation. At 2 months, cognitive rehabilitation was superior to treatment-as-usual and relaxation therapy for the primary outcomes of self-rated goal attainment (d = 1.63 and d = 1.82, respectively) and self-rated satisfaction with goal attainment (d = 2.04 and d = 1.84). At 6 months, cognitive rehabilitation remained superior to treatment-as-usual (d = 1.36) and relaxation therapy (d = 1.77) for self-rated goal attainment. Cognitive rehabilitation was superior to treatment as usual and/or relaxation therapy in a number of secondary outcomes at 2 months (mood, self-efficacy, social domain of quality of life, carers' ratings of participants' goal attainment) and at 6 months (delayed recall, health status, quality of life, carer ratings of participants' goal attainment). Carers receiving cognitive rehabilitation reported better quality of life, health status, and lower stress than those allocated to treatment-as-usual. Cognitive rehabilitation is feasible and potentially effective for dementias associated with Parkinson's disease. Copyright © 2018 John Wiley & Sons, Ltd.

  11. Developing Mobile Clinical Decision Support for Nursing Home Staff Assessment of Urinary Tract Infection using Goal-Directed Design.

    Science.gov (United States)

    Jones, Wallace; Drake, Cynthia; Mack, David; Reeder, Blaine; Trautner, Barbara; Wald, Heidi

    2017-06-20

    Unique characteristics of nursing homes (NHs) contribute to high rates of inappropriate antibiotic use for asymptomatic bacteriuria (ASB), a benign condition. A mobile clinical decision support system (CDSS) may support NH staff in differentiating urinary tract infections (UTI) from ASB and reducing antibiotic days. We used Goal-Directed Design to: 1) Characterize information needs for UTI identification and management in NHs; 2) Develop UTI Decide, a mobile CDSS prototype informed by personas and scenarios of use constructed from Aim 1 findings; 3) Evaluate the UTI Decide prototype with NH staff. Focus groups were conducted with providers and nurses in NHs in Denver, Colorado (n= 24). Qualitative descriptive analysis was applied to focus group transcripts to identify information needs and themes related to mobile clinical decision support for UTI identification and management. Personas representing typical end users were developed; typical clinical context scenarios were constructed using information needs as goals. Usability testing was performed using cognitive walk-throughs and a think-aloud protocol. Four information needs were identified including guidance regarding resident assessment; communication with providers; care planning; and urine culture interpretation. Design of a web-based application incorporating a published decision support algorithm for evidence-based UTI diagnoses proceeded with a focus on nursing information needs during resident assessment and communication with providers. Certified nursing assistant (CNA) and registered nurse (RN) personas were constructed in 4 context scenarios with associated key path scenarios. After field testing, a high fidelity prototype of UTI Decide was completed and evaluated by potential end users. Design recommendations and content recommendations were elicited. Goal-Directed Design informed the development of a mobile CDSS supporting participant-identified information needs for UTI assessment and communication

  12. Profiling persistent tubercule bacilli from patient sputa during therapy predicts early drug efficacy.

    Science.gov (United States)

    Honeyborne, Isobella; McHugh, Timothy D; Kuittinen, Iitu; Cichonska, Anna; Evangelopoulos, Dimitrios; Ronacher, Katharina; van Helden, Paul D; Gillespie, Stephen H; Fernandez-Reyes, Delmiro; Walzl, Gerhard; Rousu, Juho; Butcher, Philip D; Waddell, Simon J

    2016-04-07

    New treatment options are needed to maintain and improve therapy for tuberculosis, which caused the death of 1.5 million people in 2013 despite potential for an 86 % treatment success rate. A greater understanding of Mycobacterium tuberculosis (M.tb) bacilli that persist through drug therapy will aid drug development programs. Predictive biomarkers for treatment efficacy are also a research priority. Genome-wide transcriptional profiling was used to map the mRNA signatures of M.tb from the sputa of 15 patients before and 3, 7 and 14 days after the start of standard regimen drug treatment. The mRNA profiles of bacilli through the first 2 weeks of therapy reflected drug activity at 3 days with transcriptional signatures at days 7 and 14 consistent with reduced M.tb metabolic activity similar to the profile of pre-chemotherapy bacilli. These results suggest that a pre-existing drug-tolerant M.tb population dominates sputum before and after early drug treatment, and that the mRNA signature at day 3 marks the killing of a drug-sensitive sub-population of bacilli. Modelling patient indices of disease severity with bacterial gene expression patterns demonstrated that both microbiological and clinical parameters were reflected in the divergent M.tb responses and provided evidence that factors such as bacterial load and disease pathology influence the host-pathogen interplay and the phenotypic state of bacilli. Transcriptional signatures were also defined that predicted measures of early treatment success (rate of decline in bacterial load over 3 days, TB test positivity at 2 months, and bacterial load at 2 months). This study defines the transcriptional signature of M.tb bacilli that have been expectorated in sputum after two weeks of drug therapy, characterizing the phenotypic state of bacilli that persist through treatment. We demonstrate that variability in clinical manifestations of disease are detectable in bacterial sputa signatures, and that the changing M.tb m

  13. A Neurocomputational Model of Goal-Directed Navigation in Insect-Inspired Artificial Agents.

    Science.gov (United States)

    Goldschmidt, Dennis; Manoonpong, Poramate; Dasgupta, Sakyasingha

    2017-01-01

    Despite their small size, insect brains are able to produce robust and efficient navigation in complex environments. Specifically in social insects, such as ants and bees, these navigational capabilities are guided by orientation directing vectors generated by a process called path integration. During this process, they integrate compass and odometric cues to estimate their current location as a vector, called the home vector for guiding them back home on a straight path. They further acquire and retrieve path integration-based vector memories globally to the nest or based on visual landmarks. Although existing computational models reproduced similar behaviors, a neurocomputational model of vector navigation including the acquisition of vector representations has not been described before. Here we present a model of neural mechanisms in a modular closed-loop control-enabling vector navigation in artificial agents. The model consists of a path integration mechanism, reward-modulated global learning, random search, and action selection. The path integration mechanism integrates compass and odometric cues to compute a vectorial representation of the agent's current location as neural activity patterns in circular arrays. A reward-modulated learning rule enables the acquisition of vector memories by associating the local food reward with the path integration state. A motor output is computed based on the combination of vector memories and random exploration. In simulation, we show that the neural mechanisms enable robust homing and localization, even in the presence of external sensory noise. The proposed learning rules lead to goal-directed navigation and route formation performed under realistic conditions. Consequently, we provide a novel approach for vector learning and navigation in a simulated, situated agent linking behavioral observations to their possible underlying neural substrates.

  14. Cross-Lagged Relationships between Career Aspirations and Goal Orientation in Early Adolescents

    Science.gov (United States)

    Creed, Peter; Tilbury, Clare; Buys, Nick; Crawford, Meegan

    2011-01-01

    We surveyed 217 students (145 girls; average age = 14.6 years) on two occasions, twelve months apart, on measures of career aspirations (job aspirations, job expectations, educational aspirations) and goal orientation (learning, performance-prove, performance-avoid), and tested the causal relationship between goal orientation and aspirations. We…

  15. Host-directed therapy of tuberculosis: what is in it for microRNA?

    Science.gov (United States)

    Iannaccone, Marco; Dorhoi, Anca; Kaufmann, Stefan H E

    2014-05-01

    Tuberculosis (TB) is a major health threat and current intervention measures are far from satisfactory. MicroRNAs (miRs) have become major targets of investigations for different diseases due to their propensity to regulate gene expression in various biological processes. More recently, miRs have been found to play key roles in the control of infectious diseases. Consequently, the potential of miRs for diagnosis and therapy of TB is being considered. In this editorial, we discuss most recent lines of evidence for regulation of the immune response in TB by miRs that could form the basis for diagnosis and host-directed therapy in adjunct to canonical intervention measures in TB.

  16. Bone metastases of differentiated thyroid cancer: the importance of early diagnosis and {sup 131}I therapy on prognosis

    Energy Technology Data Exchange (ETDEWEB)

    Zanotti-Fregonara, P. [CEA, DSV, I2BM, SHFJ, UMNRC, Orsay (France); Rubello, D. [Santa Maria Misericordia Hosp, Rovigo (Italy); Hindie, E. [Hop StLouis, Paris (France)

    2008-07-01

    Complete text of publication follows: Distant metastases are found at diagnosis or during follow-up in 10%-15% of patients with differentiated thyroid cancer. Bone is the second most commonly involved site. Patients with bone metastases, whether isolated or associated with lung metastases, have a markedly poor prognosis. Ten-year survival rates range from 13% to 21%. Given such poor prognosis, the use of {sup 131}I therapy has been questioned. However, it might well be that poor prognosis of bone metastases can be overcome if {sup 131}I therapy is delivered at an early stage, when tumor burden is small, as previously demonstrated for pulmonary metastases. A review of a large series of patients showed that only rarely were bone metastases diagnosed at an early stage. Among 109 patients with bone metastases reported by Bernier et al., only 4 had both radioiodine uptake and a negative standard radiography examination. Similarly, Durante et al. reported that only 8 of 115 patients had negative radiography findings at presentation. Prognosis may improve if bone metastases are detected earlier. In a recent study, bone metastases were first detected by {sup 131}I scanning in 8 of 16 patients, when complementary radiologic studies were negative. Six of these patients showed an excellent response to {sup 131}I therapy. Today, the nuclear medicine community is well armed for this challenge toward earlier diagnosis. Postsurgery thyroid remnant ablation is more widely used. The {sup 131}I whole body scan associated with thyroid remnant ablation after thyroidectomy has a major role in early diagnosis of functioning distant metastases at a time when complementary imaging techniques (CT, MRI, bone scanning) are often still showing negative findings. Early diagnosis of specific {sup 131}I-avid bone foci will be improved with the advent and generalization of SPECT/CT. When early diagnosis is achieved, repeated {sup 131}I therapy can be effective by targeting not only visible

  17. The effects of treatment adherence and treatment-specific therapeutic competencies on outcome and goal attainment in telephone-based therapy with caregivers of people with dementia.

    Science.gov (United States)

    Schinköthe, Denise; Altmann, Uwe; Wilz, Gabriele

    2015-01-01

    Contradictory results have been found for the impact of therapist's adherence and competence on intervention outcomes. Most studies focus on generic aspects of competence and adherence, rather than taking into account treatment-specific aspects or specific challenges of the clientele. Appropriate analyses are lacking for cognitive behavioral therapy (CBT) with caregivers of people with dementia. In a sample of 43 caregivers, we examined adherence and different competence ratings of 80 complete sessions, as predictors of symptom change and goal attainment. Therapist's competence was evaluated by four raters, using an adapted version of the cognitive therapy scale (CTS) on three subscales of competence: General therapeutic (GT), session-structuring (SS), and treatment-specific CBT technique (CT). Therapist's adherence to the manual was also assessed. The results show that GT competencies were associated with lower post-test depression scores and that CT competencies predicted a decrease in caregiver burden and higher goal attainment, while SS competencies predicted higher post-test burden. Therapist's adherence had no relationship to outcome, but the higher application of modifying dysfunctional thoughts was associated with higher goal attainment. The results suggest the importance of treatment-specific competencies for outcome. Future research should identify empirically what kind of therapeutic behavior is appropriate to the challenges of a specific clientele such as caregivers of people with dementia.

  18. Comparing Three Models of Achievement Goals: Goal Orientations, Goal Standards, and Goal Complexes

    Science.gov (United States)

    Senko, Corwin; Tropiano, Katie L.

    2016-01-01

    Achievement goal theory (Dweck, 1986) initially characterized mastery goals and performance goals as opposites in a good-bad dualism of student motivation. A later revision (Harackiewicz, Barron, & Elliot, 1998) contended that both goals can provide benefits and be pursued together. Perhaps both frameworks are correct: Their contrasting views…

  19. Purposeful Goal-Directed Movements Give Rise to Higher Tactile Discrimination Performance

    Directory of Open Access Journals (Sweden)

    Georgiana Juravle

    2011-10-01

    Full Text Available Tactile perception is inhibited during goal-directed reaching movements (sensory suppression. Here, participants performed simple reaching or exploratory movements (where contact with the table surface was maintained. We measured tactile discrimination thresholds for vibratory stimuli delivered to participants' wrists while executing the movement, and while at rest. Moreover, we measured discrimination performance (in a same vs. different task for the materials covering the table surface, during the execution of the different movements. The threshold and discrimination tasks could be performed either singly or together, both under active movement and passive conditions (ie, no movement required, but with tactile stimulation. Thresholds measured at rest were significantly lower than thresholds measured during both active movements and passive touches. This provides a clear indication of sensory suppression during movement execution. Moreover, the discrimination data revealed main effects of task (single vs. dual, movement execution type (passive vs. active, and movement type (reach vs. exploration: Discrimination performance was significantly higher under conditions of single-tasking, active movements, as well as exploratory movements. Therefore, active movement of the hand with the purpose of gaining tactual information about the surface of the table gives rise to enhanced performance, thus suggesting that we feel more when we need to; It would appear that tactual information is prioritized when relevant for the movement being executed.

  20. Early effects of boron neutron capture therapy on rat glioma models

    International Nuclear Information System (INIS)

    Nakagawa, N.; Akai, F.; Fukawa, N.; Taneda, M.; Ono, K.; Suzuki, M.

    2006-01-01

    Early effects of boron neutron capture therapy on malignant gliomas are characterized by reduction of the enhanced area regression of the peritumoral edema radiologically. The aim of this study is to investigate the early histological changes of tumors and inflammatory cells after BNCT in the rat brain. The rats were treated with BNCT using boronophenyialanine (BPA) 7 days after implantation of C6 glioma cells. The tumors were assessed their sizes and configurations with magnetic resonance imaging, then killed 4 days after BNCT. The mean tumor volumes were 39mm 3 in BNCT-treated group, and 138 mm 3 in the control group. In the histological examination, tumors of the BNCT group showed less pleomorphic appearance with atypical nuclei and mitotic figures, compared with the control group. Necrosis and edematous changes in the neuropile were negligible. There existed remnant tumors adjacent to the lateral ventricle. The reactions of the inflammatory cells were examined with ED-1 of macrophage marker. ED-1 positive cells and their processes were reduced in the marginal area of tumor in the BNCT group. BNCT reduce the tumor progression by suppression of the proliferation. Inhibition of the activated macrophages may reduce peritumoral edema in early phase. (author)

  1. Abnormal early cleavage events predict early embryo demise: sperm oxidative stress and early abnormal cleavage.

    Science.gov (United States)

    Burruel, Victoria; Klooster, Katie; Barker, Christopher M; Pera, Renee Reijo; Meyers, Stuart

    2014-10-13

    Human embryos resulting from abnormal early cleavage can result in aneuploidy and failure to develop normally to the blastocyst stage. The nature of paternal influence on early embryo development has not been directly demonstrated although many studies have suggested effects from spermatozoal chromatin packaging, DNA damage, centriolar and mitotic spindle integrity, and plasma membrane integrity. The goal of this study was to determine whether early developmental events were affected by oxidative damage to the fertilizing sperm. Survival analysis was used to compare patterns of blastocyst formation based on P2 duration. Kaplan-Meier survival curves demonstrate that relatively few embryos with short (P2 times reached blastocysts, and the two curves diverged beginning on day 4, with nearly all of the embryos with longer P2 times reaching blastocysts by day 6 (p < .01). We determined that duration of the 2nd to 3rd mitoses were sensitive periods in the presence of spermatozoal oxidative stress. Embryos that displayed either too long or too short cytokineses demonstrated an increased failure to reach blastocyst stage and therefore survive for further development. Although paternal-derived gene expression occurs later in development, this study suggests a specific role in early mitosis that is highly influenced by paternal factors.

  2. Teenage hyperthyroidism and radioiodine therapy

    International Nuclear Information System (INIS)

    Hussain, F.A.; Nisa, L.; Hoque, M.; Jehan, A.H.

    2007-01-01

    Full text: Objective: To assess the efficacy of radioiodine therapy in teenage patients with hyperthyroidism. Method: The medical records of 28 patients (age range 16 -18 years) were purposely selected from a pool of 3637 hyperthyroid patients treated with radioiodine during the period January 1982 to December 2006. Data for analysis included the age, sex, clinical symptoms, type of hyperthyroidism, antithyroid medications received, doses of radioiodine therapy given and the outcome of the therapy after one and five years. Results: The mean age of the patients treated for hyperthyroidism was 17.60 ± 0.73 years and 82 % were females. The most common type of hyperthyroidism was Graves' disease (75%). All patients were pre-treated with antithyroid drugs for variable duration periods (6 months to 2 years). The mean administered dose of radioiodine was 10.69 ± 2.77 mCi. The dose of I-131 was calculated on the basis of gland size and morphology (assessment by palpation and scintigraphy) and percentage of radioactive iodine uptake. Effective control of hyperthyroidism after radioiodine treatment occurred in 60.72% patients with a single dose, 35.71% required a second dose and 3.57% required more than two doses. Frequency of early hypothyroidism within one year was 38.09 % in Graves' disease and 33.33% in toxic multinodular goiter. Most patients (66.66%) in the toxic nodule group remained euthyroid up to one year after I-131 therapy. Overall incidence rates of hypothyroidism after 1 year and 5 years of radioiodine therapy were 32.14% and 75%, respectively. Conclusion: Hyperthyroidism in the teen group of patients was effectively controlled with radioiodine. There were no early side effects. The only long-term effect was hypothyroidism. Appearance of early/late hypothyroidism showed a direct relationship with the type of hyperthyroidism and the dose of radioiodine administered. In general, patients with Graves' disease showed a greater tendency in the evolution of early

  3. Goals and Strategies for the Human Lunar Reference Architecture

    Science.gov (United States)

    Seaman, Calvin H.

    2010-01-01

    The presentation examines common goals for human lunar exploration and strategic guidance. Three major sections include illustrative example goals, introduction to the GPoD campaign, and GPoD overview. The first section includes slides about strategic view of partnerships, the moon as a stepping stone and a uniquely preserved record, human-robotic partnership, innovative engagement, strategic considerations, and evaluation of campaigns against common goals. The second section examines campaigns considered, the philosophy of GPoD, GPoD campaign phase definitions, and GPoD design decision points. The third section examines lunar exploration capabilities, extended stay-relocation exploration mode, notional campaign destinations for GPoD, early robotics phase, development of the GPoD early robotics phase, polar exploration/system validation phase, polar relocatability phase, non-polar relocatability phase, long duration phase, and return to evaluation of campaigns.

  4. Early response to therapy and survival in multiple myeloma.

    Science.gov (United States)

    Schaar, C G; Kluin-Nelemans, J C; le Cessie, S; Franck, P F H; te Marvelde, M C; Wijermans, P W

    2004-04-01

    Whether the response to chemotherapy is a prognosticator in multiple myeloma (MM) is still not known. Therefore, the relationship between survival and the rate of monoclonal protein (M-protein) decrement during the first cycles of therapy was prospectively assessed in 262 patients with newly diagnosed MM that were included in a phase III trial (HOVON-16). M-proteins were collected monthly during melphalan-prednisone therapy (MP: melphalan 0.25 mg/kg, prednisone 1.0 mg/kg orally for 5 d every 4 weeks). Patients with light chain disease (n = 18), immunoglobulin M (IgM)-MM (n = 1) and no immunotyping (n = 1) were excluded. Of the 242 patients studied, 75% had IgG M-protein and 25% IgA; MM stages: I: 1%, II: 35% and III: 64%. The median M-protein decrease after the first cycle of MP was 21% for IgG and 27% for IgA, and declined to < 5% after four cycles. An obvious survival advantage was seen for patients who had an M-protein decrease of at least 30% after the first MP cycle, which became significant when an M-protein decrease of 40% or more was reached. As established prognostic parameters (Salmon & Durie stage, serum creatinine, and haemoglobin) also remained prognostically significant, we concluded that early response to MP predicts for survival in MM.

  5. Comparing the achievement goal orientation of mathematics ...

    African Journals Online (AJOL)

    Comparing the achievement goal orientation of mathematics learners with and without attention-deficit hyperactivity disorder. ... in recognising methods to direct learners' goals for better engagement with and improved results in mathematics, which could support learners to develop to their full potential in the subject.

  6. [Therapeutic goals and indications: psychotherapy patient's self-reports during diagnostic assessment].

    Science.gov (United States)

    Faller, H

    2000-07-01

    Although individual therapeutic goals are considered to be important factors motivating patients to engage in therapeutic work, they have gained little attention in empirical research. In the present study, patients were given a questionnaire containing 24 therapeutic goals which could be rated according to their subjective relevance on a 5-point scale. N = 152 patients (mean age 34.5 years, 59.2% female) who presented at a university psychotherapy outpatient department to attend a diagnostic interview participated in the study. "To solve my problems" and "to get relief from my complaints" were the goals that were rated as most important. Goals pertaining to mental health such as more contentness and calmness, self-assertion and insight scored high, too. Three rational scales were constructed: 1. insight, 2. sociability, and 3. self-assertion. These scales were correlated with both patients' causal attributions and therapy expectations in plausible ways. However, the general strength of intercorrelations point of the conception patients goals were not very succinct at the time of the intake interview. Indication groups regarding specific therapeutic measures did not differ with respect to therapy goals. Only the general decision whether to recommend a psychotherapeutic intervention or not seemed to be influenced by patients' therapeutic aims.

  7. Goal conflict, goal facilitation, and health professionals' provision of physical activity advice in primary care: an exploratory prospective study.

    Science.gov (United States)

    Presseau, Justin; Francis, Jill J; Campbell, Neil C; Sniehotta, Falko F

    2011-07-15

    The theory of planned behaviour has well-evidenced utility in predicting health professional behaviour, but focuses on a single behaviour isolated from the numerous potentially conflicting and facilitating goal-directed behaviours performed alongside. Goal conflict and goal facilitation may influence whether health professionals engage in guideline-recommended behaviours, and may supplement the predictive power of the theory of planned behaviour. We hypothesised that goal facilitation and goal conflict contribute to predicting primary care health professionals' provision of physical activity advice to patients with hypertension, over and above predictors of behaviour from the theory of planned behaviour. Using a prospective predictive design, at baseline we invited a random sample of 606 primary care health professionals from all primary care practices in NHS Grampian and NHS Tayside (Scotland) to complete postal questionnaires. Goal facilitation and goal conflict were measured alongside theory of planned behaviour constructs at baseline. At follow-up six months later, participants self-reported the number of patients, out of those seen in the preceding two weeks, to whom they provided physical activity advice. Forty-four primary care physicians and nurses completed measures at both time points (7.3% response rate). Goal facilitation and goal conflict improved the prediction of behaviour, accounting for substantial additional variance (5.8% and 8.4%, respectively) in behaviour over and above intention and perceived behavioural control. Health professionals' provision of physical activity advice in primary care can be predicted by perceptions about how their conflicting and facilitating goal-directed behaviours help and hinder giving advice, over and above theory of planned behaviour constructs. Incorporating features of multiple goal pursuit into the theory of planned behaviour may help to better understand health professional behaviour.

  8. Physical and relational aggression in early adolescence: associations with narcissism, temperament, and social goals.

    Science.gov (United States)

    Ojanen, Tiina; Findley, Danielle; Fuller, Sarah

    2012-01-01

    This study examined adolescent narcissism, temperament (frustration and affiliation), and social goals in association with peer-reported physical and relational aggression (N = 384; 12-14 years). Narcissism was positively associated with dominance goals and negatively with closeness goals for peer interaction. Moreover, narcissism was positively associated with physical aggression via dominance goals for boys, and with relational aggression via dominance goals for both genders. Temperamental frustration and affiliation were both positively associated with relational aggression, but also interacted in their associations with this variable; affiliation was positively associated with relational aggression only at high levels of frustration. Supporting and extending existing research, the present findings suggest that adolescent personality and social goals are meaningfully associated with physical and relational aggression in the peer context. © 2012 Wiley Periodicals, Inc.

  9. The Relationship between Media Multitasking and Executive Function in Early Adolescents

    Science.gov (United States)

    Baumgartner, Susanne E.; Weeda, Wouter D.; van der Heijden, Lisa L.; Huizinga, Mariëtte

    2014-01-01

    The increasing prevalence of media multitasking among adolescents is concerning because it may be negatively related to goal-directed behavior. This study investigated the relationship between media multitasking and executive function in 523 early adolescents (aged 11-15; 48% girls). The three central components of executive functions (i.e.,…

  10. Considering baseline factors and early response rates to optimize therapy for chronic myeloid leukemia in chronic phase.

    Science.gov (United States)

    Akard, Luke P; Bixby, Dale

    2016-05-01

    Multiple BCR-ABL tyrosine kinase inhibitors (TKIs) are available for the treatment of chronic myeloid leukemia in chronic phase (CML-CP), and several baseline and on-treatment predictive factors have been identified that can be used to help guide TKI selection for individual patients. In particular, early molecular response (EMR; BCR-ABL ≤10% on the International Scale at 3 months) has become an accepted benchmark for evaluating whether patients with CML-CP are responding optimally to frontline TKI therapy. Failure to achieve EMR is considered an inadequate initial response according to the National Comprehensive Cancer Network guidelines and a warning response according to the European LeukemiaNet recommendations. Here we review data supporting the importance of achieving EMR for improving patients' long-term outcomes and discuss key considerations for selecting a frontline TKI in light of these data. Because a higher proportion of patients achieve EMR with second-generation TKIs such as nilotinib and dasatinib than with imatinib, these TKIs may be preferable for many patients, particularly those with known negative prognostic factors at baseline. We also discuss other considerations for frontline TKI choice, including toxicities, cost-effectiveness, and the emerging goals of deep molecular response and treatment-free remission.

  11. Factors predlisposing to developing early hypothyroidism after 131I therapy in patients with Graves' disease

    International Nuclear Information System (INIS)

    Zhu Mingfeng; Wen Chijun; Qian Hong

    2006-01-01

    Objective: To explore the clinical meanings of changes of serum TRAb, TGA, TMA contents during treatment of Graves' disease with 131 I, especially in those patients developing early hypothyroidism. Methods: Serum levels of TRAb, TGA, TMA, TSH, T 3 , T 4 were measured in 167 patients with Graves' disease both before and six months after mi therapy. Results: Six months after 131 I treatment, the original 167 patients could be divided into three groups based apon their thyroid ruction statas: Group A, improved but remained hyperthyroid, n=91, Group B, enthyroid, n=48, Group C, developing early hypothyroidism, n=28. Average age in Group C (hypothyroid) was significantly lower than that in Group A (hyperthyroid) (P 131 I treatment in younger patients. (2) Patients with high TRAb levels before 131 I therapy were less likely to be rendered enthyroid after a single course of treatment while those with low TRAb levels were easily rendered hypothyroid. (3) Development of hypothyroidism after 131 I treatment was closely related to the increase of TGA, TMA levels. (authors)

  12. Photodynamic therapy of early stage oral cavity and oropharynx neoplasms: an outcome analysis of 170 patients

    NARCIS (Netherlands)

    Karakullukcu, Baris; van Oudenaarde, Kim; Copper, Marcel P.; Klop, W. M. C.; van Veen, Robert; Wildeman, Maarten; Bing Tan, I.

    2011-01-01

    The indications of photodynamic therapy (PDT) of oral cavity and oropharynx neoplasms are not well defined. The main reason is that the success rates are not well established. The current paper analyzes our institutional experience of early stage oral cavity and oropharynx neoplasms (Tis-T2) to

  13. MOTIVATION: Goals and Goal Setting

    Science.gov (United States)

    Stratton, Richard K.

    2005-01-01

    Goal setting has great impact on a team's performance. Goals enable a team to synchronize their efforts to achieve success. In this article, the author talks about goals and goal setting. This articles complements Domain 5--Teaching and Communication (p.14) and discusses one of the benchmarks listed therein: "Teach the goal setting process and…

  14. Efficacy and safety of olmesartan/amlodipine/hydrochlorothiazide in patients with hypertension not at goal with mono, dual or triple drug therapy: results of the CHAMPiOn study.

    Science.gov (United States)

    Punzi, Henry A

    2014-02-01

    To assess the efficacy and safety of once daily olmesartan medoxomil (OM)/amlodipine besylate (AM)/hydrochlorothiazide (HCTZ) 40/10/25 mg in patients with hypertension not at goal with mono, dual or triple drug therapy. This was a single-center, prospective, open-label, blinded-endpoint study. After a 1-week screening visit, 40 patients were enrolled into the study and given once daily treatment with OM/AM/HCTZ after the patients underwent baseline ambulatory blood pressure monitoring (ABPM) on their original therapy. The primary endpoint was changes from baseline in mean 24 h ABPM [systolic blood pressure (SBP)] after the first day of therapy with OM/AM/HCTZ 40/10/25 mg. Secondary endpoints were changes from baseline in mean 24 h ABPM [diastolic blood pressure (DBP)] after the first day of therapy with OM/AM/HCTZ 40/10/25 mg; mean changes from baseline in trough seated SBP (SeSBP) at day 1 and SeSBP at weeks 1, 2, 3 and 4; mean changes from baseline in trough seated DBP (SeDBP) at day 1 and SeDBP at weeks 1, 2, 3 and 4; and the percentage of subjects achieving mean 24 h, daytime and night-time ABPM BP goals. The baseline paired t-test systolic ABPM was 134.0 ± 2.77 mmHg and day 1 was 128.6 ± 2.47 mmHg with a treatment difference of -5.55 ± 1.3 mmHg (pABPM SBP reduction was 117.7 ± 2.0 mmHg with a treatment difference of -16.5 ± 1.8 mmHg (p ABPM SBP reduction was 115.8 ± 1.8 mmHg with a treatment difference of -18.4 ± 2.0 mmHg (p ABPM SBP reduction was 115.5 ± 1.9 mmHg with a treatment difference of -18.6 ± 2.0 mmHg (p ABPM SBP reduction was 115.5 ± 1.8 mmHg with a treatment difference of -18.6 ± 2.2 mmHg (p ABPM reductions compared with mono, dual or triple drug therapy, resulting in all patients achieving systolic ABPM goal without ABPM documented hypotension.

  15. Goal-directed diuresis: A case - control study of continuous furosemide infusion in critically ill trauma patients

    Directory of Open Access Journals (Sweden)

    Daniel Dante Yeh

    2015-01-01

    Full Text Available Background: Excessive crystalloid administration is common and associated with negative outcomes in critically ill trauma patients. Continuous furosemide infusion (CFI to remove excessive fluid has not been previously described in this population. We hypothesized that a goal-directed CFI is more effective for fluid removal than intermittent bolus injection (IBI diuresis without excess incidence of hypokalemia or renal failure. Materials and Methods: CFI cases were prospectively enrolled between November 2011 and August 2012, and matched to historic IBI controls by age, gender, Injury Severity Score (ISS, and net fluid balance (NFB at diuresis initiation. Paired and unpaired analyses were performed to compare groups. The primary endpoints were net fluid balance, potassium and creatinine levels. Secondary endpoints included intensive care unit (ICU and hospital length of stay (LOS, ventilator-free days (VFD, and mortality. Results: 55 patients were included, with 19 cases and 36 matched controls. Mean age was 54 years, mean ISS was 32.7, and mean initial NFB was +7.7 L. After one day of diuresis with CFI vs. IBI, net 24 h fluid balance was negative (−0.55 L vs. +0.43 L, P = 0.026 only for the CFI group, and there was no difference in potassium and creatinine levels. Cumulative furosemide dose (59.4mg vs. 25.4mg, P < 0.001 and urine output (4.2 L vs. 2.8 L, P < 0.001 were also significantly increased with CFI vs. IBI. There were no statistically significant differences in ICU LOS, hospital LOS, VFD, or mortality. Conclusions: Compared to IBI, goal-directed diuresis by CFI is more successful in achieving net negative fluid balance in patients with fluid overload with no detrimental side effects on renal function or patient outcome.

  16. Hormone therapy and radiotherapy for early prostate cancer: A utility-adjusted number needed to treat (NNT) analysis

    International Nuclear Information System (INIS)

    Jani, Ashesh B.; Kao, Johnny; Heimann, Ruth; Hellman, Samuel

    2005-01-01

    Purpose: To quantify, using the number needed to treat (NNT) methodology, the benefit of short-term (≤6 months) hormone therapy adjuvant to radiotherapy in the group of patients with early (clinical stage T1-T2c) prostate cancer. Methods and materials: The absolute biochemical control benefit for the use of hormones adjuvant to radiotherapy in early-stage disease was determined by literature review. A model was developed to estimate the utility-adjusted survival detriment due to the side effects of hormone therapy. The NNTs before and after the incorporation of hormone sequelae were computed; the sign and magnitude of the NNTs were used to gauge the effect of the hormones. Results: The absolute NNT analysis, based on summarizing the results of 8 reports including a total of 3652 patients, demonstrated an advantage to the addition of hormones for the general early-stage prostate cancer population as well as for all prognostic groups. After adjustment for hormone-induced functional loss, the advantage of hormones remained considerable in the high- and intermediate-risk groups, with the utility-adjusted NNT becoming weakened in the low-risk group when the utility compromise from complications of hormones was assumed to be considerable. Conclusions: Short-term hormone therapy seems to be beneficial for selected early-stage prostate cancer patients. The advantage seems to be greatest in the intermediate- and high-risk groups; with current follow-up, the side effects of hormones may outweigh their benefit in certain clinical situations in the favorable group. The present investigation demonstrates the significant role of the NNT technique for oncologic and radiotherapeutic management decisions when treatment complications need to be considered and balanced with the beneficial effects of the treatment

  17. Patient-Centered Goal Setting in a Hospital-Based Outpatient Stroke Rehabilitation Center.

    Science.gov (United States)

    Rice, Danielle B; McIntyre, Amanda; Mirkowski, Magdalena; Janzen, Shannon; Viana, Ricardo; Britt, Eileen; Teasell, Robert

    2017-09-01

    Goal-setting can have a positive impact on stroke recovery during rehabilitation. Patient participation in goal formulation can ensure that personally relevant goals are set, and can result in greater satisfaction with the rehabilitation experience, along with improved recovery of stroke deficits. This, however, not yet been studied in a stroke outpatient rehabilitation setting. To assess patient satisfaction of meeting self-selected goals during outpatient rehabilitation following a stroke. Retrospective chart review. Stroke patients enrolled in a multidisciplinary outpatient rehabilitation program, who set at least 1 goal during rehabilitation. Patients recovering from a stroke received therapy through the outpatient rehabilitation program between January 2010 and December 2013. Upon admission and discharge from rehabilitation, patients rated their satisfaction with their ability to perform goals that they wanted to achieve. Researchers independently sorted and labeled recurrent themes of goals. Goals were further sorted into International Classification of Functioning, Disability and Health (ICF) categories. To compare the perception of patients' goal satisfaction, repeated-measures analysis of variance was conducted across the 3 ICF goal categorizations. Goal satisfaction scores. A total of 286 patients were included in the analysis. Patient goals concentrated on themes of improving hand function, mobility, and cognition. Goals were also sorted into ICF categories in which impairment-based and activity limitation-based goals were predominant. Compared to activity-based and participation-based goals, patients with impairment-based goals perceived greater satisfaction with meeting their goals at admission and discharge (P rehabilitation program (P stroke rehabilitation setting, patients set heterogeneous goals that were predominantly impairment based. Satisfaction in achieving goals significantly improved after receiving therapy. The type of goals that patients

  18. Photodynamic therapy of early stage cancer of lung, esophagus, and stomach with two different photosensitizers

    Science.gov (United States)

    Chissov, Valery I.; Sokolov, Victor V.; Trakhtenberg, A. K.; Mamontov, A. S.; Vaschakmadze, L. A.; Frank, George A.; Filonenko, E. V.; Telegina, L. V.; Belous, T. A.; Gladunov, V. K.; Aristarkhova, E. I.; Zharkova, Natalia N.; Menenkov, V. D.

    1996-01-01

    The paper presents the results of photodynamic therapy (PDT) of early-stage cancer of lung (17 patients), esophagus (8 patients) and stomach (10 patients). Fifteen patients had second primary tumors. New drugs photoheme and photosens were used as photosensitizers. Complete remission was obtained in 87%. The patients are followed up without relapses to 2.5 years.

  19. Early Outcomes From Three Prospective Trials of Image-Guided Proton Therapy for Prostate Cancer

    International Nuclear Information System (INIS)

    Mendenhall, Nancy P.; Li Zuofeng; Hoppe, Bradford S.; Marcus, Robert B.; Mendenhall, William M.; Nichols, R. Charles; Morris, Christopher G.; Williams, Christopher R.; Costa, Joseph; Henderson, Randal

    2012-01-01

    Purpose: To report early outcomes with image-guided proton therapy for prostate cancer. Methods and Materials: We accrued 211 prostate cancer patients on prospective Institutional Review Board-approved trials of 78 cobalt gray equivalent (CGE) in 39 fractions for low–risk disease, dose escalation from 78 to 82 CGE for intermediate-risk disease, and 78 CGE with concomitant docetaxel followed by androgen deprivation for high-risk disease. Minimum follow-up was 2 years. Results: One intermediate-risk patient and 2 high-risk patients had disease progression. Pretreatment genitourinary (GU) symptom management was required in 38% of patients. A cumulative 88 (42%) patients required posttreatment GU symptom management. Four transient Grade 3 GU toxicities occurred, all among patients requiring pretreatment GU symptom management. Multivariate analysis showed correlation between posttreatment GU 2+ symptoms and pretreatment GU symptom management (p < 0.0001) and age (p = 0.0048). Only 1 Grade 3+ gastrointestinal (GI) symptom occurred. The prevalence of Grade 2+ GI symptoms was 0 (0%), 10 (5%), 12 (6%), and 8 (4%) at 6, 12, 18, and 24 months, with a cumulative incidence of 20 (10%) patients at 2 years after proton therapy. Univariate and multivariate analyses showed significant correlation between Grade 2+ rectal bleeding and proctitis and the percentage of rectal wall (rectum) receiving doses ranging from 40 CGE (10 CGE) to 80 CGE. Conclusions: Early outcomes with image-guided proton therapy suggest high efficacy and minimal toxicity with only 1.9% Grade 3 GU symptoms and <0.5% Grade 3 GI toxicities.

  20. Early Outcomes From Three Prospective Trials of Image-Guided Proton Therapy for Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Mendenhall, Nancy P., E-mail: menden@shands.ufl.edu [University of Florida Proton Therapy Institute, Jacksonville, FL (United States); Li Zuofeng; Hoppe, Bradford S.; Marcus, Robert B.; Mendenhall, William M.; Nichols, R. Charles; Morris, Christopher G. [University of Florida Proton Therapy Institute, Jacksonville, FL (United States); Williams, Christopher R.; Costa, Joseph [Division of Urology, College of Medicine, University of Florida, Jacksonville, FL (United States); Henderson, Randal [University of Florida Proton Therapy Institute, Jacksonville, FL (United States)

    2012-01-01

    Purpose: To report early outcomes with image-guided proton therapy for prostate cancer. Methods and Materials: We accrued 211 prostate cancer patients on prospective Institutional Review Board-approved trials of 78 cobalt gray equivalent (CGE) in 39 fractions for low-risk disease, dose escalation from 78 to 82 CGE for intermediate-risk disease, and 78 CGE with concomitant docetaxel followed by androgen deprivation for high-risk disease. Minimum follow-up was 2 years. Results: One intermediate-risk patient and 2 high-risk patients had disease progression. Pretreatment genitourinary (GU) symptom management was required in 38% of patients. A cumulative 88 (42%) patients required posttreatment GU symptom management. Four transient Grade 3 GU toxicities occurred, all among patients requiring pretreatment GU symptom management. Multivariate analysis showed correlation between posttreatment GU 2+ symptoms and pretreatment GU symptom management (p < 0.0001) and age (p = 0.0048). Only 1 Grade 3+ gastrointestinal (GI) symptom occurred. The prevalence of Grade 2+ GI symptoms was 0 (0%), 10 (5%), 12 (6%), and 8 (4%) at 6, 12, 18, and 24 months, with a cumulative incidence of 20 (10%) patients at 2 years after proton therapy. Univariate and multivariate analyses showed significant correlation between Grade 2+ rectal bleeding and proctitis and the percentage of rectal wall (rectum) receiving doses ranging from 40 CGE (10 CGE) to 80 CGE. Conclusions: Early outcomes with image-guided proton therapy suggest high efficacy and minimal toxicity with only 1.9% Grade 3 GU symptoms and <0.5% Grade 3 GI toxicities.

  1. Between practice, policy and politics: Music therapy and the Dementia Strategy, 2009.

    Science.gov (United States)

    Spiro, Neta; Farrant, Camilla L; Pavlicevic, Mercédès

    2017-04-01

    Does current music therapy practice address the goals encapsulated in the UK Department of Health document, Living well with dementia: a national dementia strategy (the Dementia Strategy) published in 2009? A survey elicited the views of clients, family members, music therapists, care home staff and care home managers, about this question by focusing on the relationship between music therapy and the 17 objectives outlined in the Dementia Strategy. The results showed that the objectives that are related to direct activity of the music therapists (such as care and understanding of the condition) were seen as most fulfilled by music therapy, while those regarding practicalities (such as living within the community) were seen as least fulfilled. Although the responses from the four groups of participants were similar, differences for some questions suggest that people's direct experience of music therapy influences their views. This study suggests that many aspects of the Dementia Strategy are already seen as being achieved. The findings suggest that developments of both music therapy practices and government strategies on dementia care may benefit from being mutually informed.

  2. Physiotherapy and Occupational Therapy vs No Therapy in Mild to Moderate Parkinson Disease: A Randomized Clinical Trial.

    Science.gov (United States)

    Clarke, Carl E; Patel, Smitaa; Ives, Natalie; Rick, Caroline E; Dowling, Francis; Woolley, Rebecca; Wheatley, Keith; Walker, Marion F; Sackley, Catherine M

    2016-03-01

    adverse events. Physiotherapy and occupational therapy were not associated with immediate or medium-term clinically meaningful improvements in ADL or quality of life in mild to moderate PD. This evidence does not support the use of low-dose, patient-centered, goal-directed physiotherapy and occupational therapy in patients in the early stages of PD. Future research should explore the development and testing of more structured and intensive physical and occupational therapy programs in patients with all stages of PD. isrctn.org Identifier: ISRCTN17452402.

  3. Social recovery therapy in combination with early intervention services for enhancement of social recovery in patients with first-episode psychosis (SUPEREDEN3): a single-blind, randomised controlled trial.

    Science.gov (United States)

    Fowler, David; Hodgekins, Jo; French, Paul; Marshall, Max; Freemantle, Nick; McCrone, Paul; Everard, Linda; Lavis, Anna; Jones, Peter B; Amos, Tim; Singh, Swaran; Sharma, Vimal; Birchwood, Max

    2018-01-01

    Provision of early intervention services has increased the rate of social recovery in patients with first-episode psychosis; however, many individuals have continuing severe and persistent problems with social functioning. We aimed to assess the efficacy of early intervention services augmented with social recovery therapy in patients with first-episode psychosis. The primary hypothesis was that social recovery therapy plus early intervention services would lead to improvements in social recovery. We did this single-blind, phase 2, randomised controlled trial (SUPEREDEN3) at four specialist early intervention services in the UK. We included participants who were aged 16-35 years, had non-affective psychosis, had been clients of early intervention services for 12-30 months, and had persistent and severe social disability, defined as engagement in less than 30 h per week of structured activity. Participants were randomly assigned (1:1), via computer-generated randomisation with permuted blocks (sizes of four to six), to receive social recovery therapy plus early intervention services or early intervention services alone. Randomisation was stratified by sex and recruitment centre (Norfolk, Birmingham, Lancashire, and Sussex). By necessity, participants were not masked to group allocation, but allocation was concealed from outcome assessors. The primary outcome was time spent in structured activity at 9 months, as measured by the Time Use Survey. Analysis was by intention to treat. This trial is registered with ISRCTN, number ISRCTN61621571. Between Oct 1, 2012, and June 20, 2014, we randomly assigned 155 participants to receive social recovery therapy plus early intervention services (n=76) or early intervention services alone (n=79); the intention-to-treat population comprised 154 patients. At 9 months, 143 (93%) participants had data for the primary outcome. Social recovery therapy plus early intervention services was associated with an increase in structured

  4. Reactive Goal Decomposition Hierarchies for On-Board Autonomy

    Science.gov (United States)

    Hartmann, L.

    2002-01-01

    As our experience grows, space missions and systems are expected to address ever more complex and demanding requirements with fewer resources (e.g., mass, power, budget). One approach to accommodating these higher expectations is to increase the level of autonomy to improve the capabilities and robustness of on- board systems and to simplify operations. The goal decomposition hierarchies described here provide a simple but powerful form of goal-directed behavior that is relatively easy to implement for space systems. A goal corresponds to a state or condition that an operator of the space system would like to bring about. In the system described here goals are decomposed into simpler subgoals until the subgoals are simple enough to execute directly. For each goal there is an activation condition and a set of decompositions. The decompositions correspond to different ways of achieving the higher level goal. Each decomposition contains a gating condition and a set of subgoals to be "executed" sequentially or in parallel. The gating conditions are evaluated in order and for the first one that is true, the corresponding decomposition is executed in order to achieve the higher level goal. The activation condition specifies global conditions (i.e., for all decompositions of the goal) that need to hold in order for the goal to be achieved. In real-time, parameters and state information are passed between goals and subgoals in the decomposition; a termination indication (success, failure, degree) is passed up when a decomposition finishes executing. The lowest level decompositions include servo control loops and finite state machines for generating control signals and sequencing i/o. Semaphores and shared memory are used to synchronize and coordinate decompositions that execute in parallel. The goal decomposition hierarchy is reactive in that the generated behavior is sensitive to the real-time state of the system and the environment. That is, the system is able to react

  5. The Role of Popularity Goal in Early Adolescents' Behaviors and Popularity Status

    Science.gov (United States)

    Dawes, Molly; Xie, Hongling

    2014-01-01

    The effect of popularity goal on the use of 3 popularity-related behaviors and later popularity status was examined in a diverse sample of 314 6th-grade students (176 girls and 138 boys) in both fall (Time 1) and spring (Time 2) semesters. Popularity goal and the use of popularity-driven behaviors (e.g., "I change the way I dress in order to…

  6. Emotion and goal-directed behavior: ERP evidence on cognitive and emotional conflict

    Science.gov (United States)

    Kanske, Philipp; Obermeier, Christian; Schröger, Erich; Kotz, Sonja A.

    2015-01-01

    Cognitive control supports goal-directed behavior by resolving conflict among opposing action tendencies. Emotion can trigger cognitive control processes, thus speeding up conflict processing when the target dimension of stimuli is emotional. However, it is unclear what role emotionality of the target dimension plays in the processing of emotional conflict (e.g. in irony). In two EEG experiments, we compared the influence of emotional valence of the target (emotional, neutral) in cognitive and emotional conflict processing. To maximally approximate real-life communication, we used audiovisual stimuli. Participants either categorized spoken vowels (cognitive conflict) or their emotional valence (emotional conflict), while visual information was congruent or incongruent. Emotional target dimension facilitated both cognitive and emotional conflict processing, as shown in a reduced reaction time conflict effect. In contrast, the N100 in the event-related potentials showed a conflict-specific reversal: the conflict effect was larger for emotional compared with neutral trials in cognitive conflict and smaller in emotional conflict. Additionally, domain-general conflict effects were observed in the P200 and N200 responses. The current findings confirm that emotions have a strong influence on cognitive and emotional conflict processing. They also highlight the complexity and heterogeneity of the interaction of emotion with different types of conflict. PMID:25925271

  7. Goal conflict, goal facilitation, and health professionals' provision of physical activity advice in primary care: An exploratory prospective study

    Directory of Open Access Journals (Sweden)

    Campbell Neil C

    2011-07-01

    Full Text Available Abstract Background The theory of planned behaviour has well-evidenced utility in predicting health professional behaviour, but focuses on a single behaviour isolated from the numerous potentially conflicting and facilitating goal-directed behaviours performed alongside. Goal conflict and goal facilitation may influence whether health professionals engage in guideline-recommended behaviours, and may supplement the predictive power of the theory of planned behaviour. We hypothesised that goal facilitation and goal conflict contribute to predicting primary care health professionals' provision of physical activity advice to patients with hypertension, over and above predictors of behaviour from the theory of planned behaviour. Methods Using a prospective predictive design, at baseline we invited a random sample of 606 primary care health professionals from all primary care practices in NHS Grampian and NHS Tayside (Scotland to complete postal questionnaires. Goal facilitation and goal conflict were measured alongside theory of planned behaviour constructs at baseline. At follow-up six months later, participants self-reported the number of patients, out of those seen in the preceding two weeks, to whom they provided physical activity advice. Results Forty-four primary care physicians and nurses completed measures at both time points (7.3% response rate. Goal facilitation and goal conflict improved the prediction of behaviour, accounting for substantial additional variance (5.8% and 8.4%, respectively in behaviour over and above intention and perceived behavioural control. Conclusions Health professionals' provision of physical activity advice in primary care can be predicted by perceptions about how their conflicting and facilitating goal-directed behaviours help and hinder giving advice, over and above theory of planned behaviour constructs. Incorporating features of multiple goal pursuit into the theory of planned behaviour may help to better

  8. Response of the Pre-oriented Goal-directed Attention to Usual and Unusual Distractors: A Preliminary Study

    Directory of Open Access Journals (Sweden)

    Golnaz Baghdadi

    2017-03-01

    Full Text Available Introduction: In this study, we investigated the distraction power of the unusual and usual images on the attention of 20 healthy primary school children. Methods: Our study was different from previous ones in that the participants were asked to fix the initial position of their attention on a pre-defined location after being presented with unusual images as distractors. The goals were presented in locations, which were far from the attraction basin of distractors. Our expectation was that the pre-orienting of the attention to the position of targets can reduce the attractive effect of unusual images compared to the usual ones. The percentage of correct responses and the reaction time have been measured as behavioral indicators of attention performance. Results: Results showed that using the goal-directed attention, subjects ignored both kinds of distractors nearly the same way. Conclusion: With regard to previous reports about the more attraction towards the unusual images, it is suggested that the dynamics of the visual attention system be sensitive to the initial condition. That is, changing the initial position of the attention can lead to the decrement of the unusual images’ effects. However, several other possibilities such as a probable delay in processing unusual features could explain this observation, too. 

  9. Mastitis therapy: Direct and indirect costs

    OpenAIRE

    Boboš, S.; Radinović, M.; Vidić, B.; Pajić, M.; Vidić, V.; Galfi, A.

    2013-01-01

    One of the most important problems in milk production, causing great economic loses is certainly mastitis. In order to minimize economic losses from mastitis dairy farms introduce different mastitis management programs. These programs include mastitis therapy and prevention. In mastitis control prevention is most important and when mastitis occurs cost of therapy and milk discharge is very important. In our study we examined cost of mastitis treatment and m...

  10. A computational neural model of goal-directed utterance selection.

    Science.gov (United States)

    Klein, Michael; Kamp, Hans; Palm, Guenther; Doya, Kenji

    2010-06-01

    It is generally agreed that much of human communication is motivated by extra-linguistic goals: we often make utterances in order to get others to do something, or to make them support our cause, or adopt our point of view, etc. However, thus far a computational foundation for this view on language use has been lacking. In this paper we propose such a foundation using Markov Decision Processes. We borrow computational components from the field of action selection and motor control, where a neurobiological basis of these components has been established. In particular, we make use of internal models (i.e., next-state transition functions defined on current state action pairs). The internal model is coupled with reinforcement learning of a value function that is used to assess the desirability of any state that utterances (as well as certain non-verbal actions) can bring about. This cognitive architecture is tested in a number of multi-agent game simulations. In these computational experiments an agent learns to predict the context-dependent effects of utterances by interacting with other agents that are already competent speakers. We show that the cognitive architecture can account for acquiring the capability of deciding when to speak in order to achieve a certain goal (instead of performing a non-verbal action or simply doing nothing), whom to address and what to say. Copyright 2010 Elsevier Ltd. All rights reserved.

  11. Citizen Goals Online

    Directory of Open Access Journals (Sweden)

    Catalin Vrabie

    2013-01-01

    Full Text Available The purpose of this paper is to give to public institution Web designers a better understanding of the citizens’ objectives when accessing a Web page. Understanding citizen online goals is critical because it gets to the heart of what the public institution website should or could “do.” Approach: The challenge for e-marketers is that for most agencies/institutions, there are likely to be multiple goals that represent the “reason why” citizens could come to the website. For example, a national theatre website might be very effective for people who have already been there, they know effectively what place is the best, who are the actors, etc. Research limitations: The nature of a public institution activity almost dictates the different types of goals that consumers have when visiting the site. It is clear that a citizen has a different goal when accessing a theatre Web page or when he’s accessing a municipality Web page. This is the biggest impediment for drawing a good conceptual model for a public institution Web page. Practical implications: there are likely to be many other goals that could lead people to visit the site, like receiving customer service or leaving a remark. Value: Since citizen online goals represent the starting point for Web design efforts (for public institutions, this article has attempted to highlight the nature and types of goals that e-marketers might consider when planning what their website should do in order to create. Findings: The goal a site visitor has when arriving at a website tends to be very action oriented. If the visitor has never visited the site before, the goal may simply be to evaluate the website and figure out what the site is and if it will help him. On the other hand, if the visitor has reached the site as the result of a directed search or is a repeat visitor, the user goal is likely to be specific and functional. If important citizen goals are not supported by the website, the public

  12. Citizen Goals Online

    Directory of Open Access Journals (Sweden)

    Catalin Vrabie

    2012-07-01

    Full Text Available The purpose of this paper is to give to public institution Web designers a better understanding of the citizens’ objectives when accessing a Web page. Understanding citizen online goals is critical because it gets to the heart of what the public institution website should or could “do.”Approach: The challenge for e-marketers is that for most agencies/institutions, there are likely to be multiple goals that represent the “reason why” citizens could come to the website. For example, a national theatre website might be very effective for people who have already been there, they know effectively what place is the best, who are the actors, etc.Research limitations: The nature of a public institution activity almost dictates the different types of goals that consumers have when visiting the site. It is clear that a citizen has a different goal when accessing a theatre Web page or when he’s accessing a municipality Web page. This is the biggest impediment for drawing a good conceptual model for a public institution Web page.Practical implications: there are likely to be many other goals that could lead people to visit the site, like receiving customer service or leaving a remark.Value: Since citizen online goals represent the starting point for Web design efforts (for public institutions, this article has attempted to highlight the nature and types of goals that e-marketers might consider when planning what their website should do in order to create.Findings: The goal a site visitor has when arriving at a website tends to be very action oriented. If the visitor has never visited the site before, the goal may simply be to evaluate the website and figure out what the site is and if it will help him. On the other hand, if the visitor has reached the site as the result of a directed search or is a repeat visitor, the user goal is likely to be specific and functional. If important citizen goals are not supported by the website, the public

  13. Dependence of Achievable Plan Quality on Treatment Technique and Planning Goal Refinement: A Head-and-Neck Intensity Modulated Radiation Therapy Application

    International Nuclear Information System (INIS)

    Qi, X. Sharon; Ruan, Dan; Lee, Steve P.; Pham, Andrew; Kupelian, Patrick; Low, Daniel A.; Steinberg, Michael; Demarco, John

    2015-01-01

    Purpose: To develop a practical workflow for retrospectively analyzing target and normal tissue dose–volume endpoints for various intensity modulated radiation therapy (IMRT) delivery techniques; to develop technique-specific planning goals to improve plan consistency and quality when feasible. Methods and Materials: A total of 165 consecutive head-and-neck patients from our patient registry were selected and retrospectively analyzed. All IMRT plans were generated using the same dose–volume guidelines for TomoTherapy (Tomo, Accuray), TrueBeam (TB, Varian) using fixed-field IMRT (TB-IMRT) or RAPIDARC (TB-RAPIDARC), or Siemens Oncor (Siemens-IMRT, Siemens). A MATLAB-based dose–volume extraction and analysis tool was developed to export dosimetric endpoints for each patient. With a fair stratification of patient cohort, the variation of achieved dosimetric endpoints was analyzed among different treatment techniques. Upon identification of statistically significant variations, technique-specific planning goals were derived from dynamically accumulated institutional data. Results: Retrospective analysis showed that although all techniques yielded comparable target coverage, the doses to the critical structures differed. The maximum cord doses were 34.1 ± 2.6, 42.7 ± 2.1, 43.3 ± 2.0, and 45.1 ± 1.6 Gy for Tomo, TB-IMRT, TB-RAPIDARC, and Siemens-IMRT plans, respectively. Analyses of variance showed significant differences for the maximum cord doses but no significant differences for other selected structures among the investigated IMRT delivery techniques. Subsequently, a refined technique-specific dose–volume guideline for maximum cord dose was derived at a confidence level of 95%. The dosimetric plans that failed the refined technique-specific planning goals were reoptimized according to the refined constraints. We observed better cord sparing with minimal variations for the target coverage and other organ at risk sparing for the Tomo cases, and higher

  14. [The new concept of osteoporosis. Early diagnosis, prevention and therapy are possible today].

    Science.gov (United States)

    Hesch, R D; Harms, H; Rittinghaus, E F; Brabant, G

    1990-04-15

    A paradigma of osteoporosis pathology is discussed, at the center of which is the hormone-related disturbance of the osteoblast/osteoclast functional unit. A liberal replacement of estrogen-gestagen in post-menopausal women is advocated. Early diagnosis with the aid of quantitative computed tomography makes it possible to establish the indication for timely hormonal treatment in the future, which can result in a measureable increase in bone mass. Late therapy, that is, treatment initiated after the occurrence of fractures, has proven largely ineffective.

  15. Identity Processes and Intrinsic and Extrinsic Goal Pursuits: Directionality of Effects in College Students.

    Science.gov (United States)

    Luyckx, Koen; Duriez, Bart; Green, Lindsey M; Negru-Subtirica, Oana

    2017-08-01

    Identity research has mainly focused on the degree to which adolescents and emerging adults engage in exploration and commitment to identity goals and strivings. Somewhat lacking from this research tradition is an explicit focus on the content of the identity goals that individuals deem important and pursue. The present manuscript describes two longitudinal studies sampling college students in which we examine how exploration and commitment processes relate to intrinsic and extrinsic goal pursuits as defined in Self-Determination Theory. Study 1 was a two-wave longitudinal study spanning 6 months (N = 370; 77.4% women; mean age 18.24 years); Study 2 was a three-wave longitudinal study spanning 6 months (N = 458 students; 84.9% women; mean age 18.25 years). Using cross-lagged path analyses, hypotheses were supported to various degrees of convergence between studies, pointing to the extent of which results were replicated across our two independent longitudinal samples. Whereas an intrinsic goal orientation positively predicted commitment making (Study 1) and identification with commitment over time (Studies 1 and 2), an extrinsic goal orientation positively predicted ruminative exploration over time, which led to decreases in intrinsic orientation over time (Study 2). Further, an intrinsic goal orientation negatively predicted ruminative exploration over time (Study 1). The findings in for pro-active exploration processes were inconsistent across both studies, being prospectively related to both intrinsic (Study 2) and extrinsic goal orientations (Study 1). Implications and suggestions for future research are discussed.

  16. A Randomized Controlled Trial on Very Early Speech and Language Therapy in Acute Stroke Patients with Aphasia

    Directory of Open Access Journals (Sweden)

    A.C. Laska

    2011-07-01

    Full Text Available Background: Aphasia affects one third of acute stroke patients. There is a considerable spontaneous recovery in aphasia, but impaired communication ability remains a great problem. Communication difficulties are an impediment to rehabilitation. Early treatment of the language deficits leading to increased communication ability would improve rehabilitation. The aim of this study is to elucidate the efficacy of very early speech and language therapy (SLT in acute stroke patients with aphasia. Methods: A prospective, open, randomized, controlled trial was carried out with blinded endpoint evaluation of SLT, starting within 2 days of stroke onset and lasting for 21 days. 123 consecutive patients with acute, first-ever ischemic stroke and aphasia were randomized. The SLT treatment was Language Enrichment Therapy, and the aphasia tests used were the Norsk grunntest for afasi (NGA and the Amsterdam-Nijmegen everyday language test (ANELT, both performed by speech pathologists, blinded for randomization. Results: The primary outcome, as measured by ANELT at day 21, was 1.3 in the actively treated patient group and 1.2 among controls. NGA led to similar results in both groups. Patients with a higher level of education (>12 years improved more on ANELT by day 21 than those with Conclusions: Very early intensive SLT with the Language Enrichment Therapy program over 21 days had no effect on the degree of aphasia in unselected acute aphasic stroke patients. In aphasic patients with more fluency, SLT resulted in a significant improvement as compared to controls. A higher educational level of >12 years was beneficial.

  17. SU-G-TeP4-06: An Integrated Application for Radiation Therapy Treatment Plan Directives, Management, and Reporting

    Energy Technology Data Exchange (ETDEWEB)

    Matuszak, M; Anderson, C; Lee, C; Vineberg, K; Green, M; Younge, K; Moran, J; Mayo, C [University of Michigan, Ann Arbor, MI (United States)

    2016-06-15

    Purpose: With electronic medical records, patient information for the treatment planning process has become disseminated across multiple applications with limited quality control and many associated failure modes. We present the development of a single application with a centralized database to manage the planning process. Methods: The system was designed to replace current functionalities of (i) static directives representing the physician intent for the prescription and planning goals, localization information for delivery, and other information, (ii) planning objective reports, (iii) localization and image guidance documents and (iv) the official radiation therapy prescription in the medical record. Using the Eclipse Scripting Application Programming Interface, a plug-in script with an associated domain-specific SQL Server database was created to manage the information in (i)–(iv). The system’s user interface and database were designed by a team of physicians, clinical physicists, database experts, and software engineers to ensure usability and robustness for clinical use. Results: The resulting system has been fully integrated within the TPS via a custom script and database. Planning scenario templates, version control, approvals, and logic-based quality control allow this system to fully track and document the planning process as well as physician approval of tradeoffs while improving the consistency of the data. Multiple plans and prescriptions are supported along with non-traditional dose objectives and evaluation such as biologically corrected models, composite dose limits, and management of localization goals. User-specific custom views were developed for the attending physician review, physicist plan checks, treating therapists, and peer review in chart rounds. Conclusion: A method was developed to maintain cohesive information throughout the planning process within one integrated system by using a custom treatment planning management application that

  18. Integrated learning through student goal development.

    Science.gov (United States)

    Price, Deborah; Tschannen, Dana; Caylor, Shandra

    2013-09-01

    New strategies are emerging to promote structure and increase learning in the clinical setting. Nursing faculty designed a mechanism by which integrative learning and situated coaching could occur more readily in the clinical setting. The Clinical Goals Initiative was implemented for sophomore-, junior-, and senior-level students in their clinical practicums. Students developed weekly goals reflecting three domains of professional nursing practice. Goals were shared with faculty and staff nurse mentors at the beginning of the clinical day to help guide students and mentors with planning for learning experiences. After 6 weeks, faculty and students were surveyed to evaluate project effectiveness. Faculty indicated that goal development facilitated clinical learning by providing more student engagement, direction, and focus. Students reported that goal development allowed them to optimize clinical learning opportunities and track their growth and progress. Faculty and students indicated the goals promoted student self-learning, autonomy, and student communication with nurse mentors and faculty. Copyright 2013, SLACK Incorporated.

  19. Adlerian Marriage Therapy.

    Science.gov (United States)

    Carlson, Jon; Dinkmeyer, Don, Sr.

    1987-01-01

    Describes the assumptions, processes, and techniques used in Alderian marriage therapy. Describes purpose of therapy as assessing current beliefs and behaviors while educating the couple in new procedures that can help the couple establish new goals. (Author/ABL)

  20. Achievement of Optimal Medical Therapy Goals for US Adults with Coronary Artery Disease: Results from the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

    Science.gov (United States)

    Brown, Todd M.; Voeks, Jenifer H.; Bittner, Vera; Brenner, David A.; Cushman, Mary; Goff, David C.; Glasser, Stephen; Muntner, Paul; Tabereaux, Paul B.; Safford, Monika M.

    2014-01-01

    Objective In a non-clinical trial setting, to determine the proportion of individuals with coronary artery disease (CAD) with optimal risk factor levels based on the Clinical Outcomes Utilizing Revascularization and Aggressive DruG Evaluation (COURAGE) trial. Background In COURAGE, the addition of percutaneous coronary intervention (PCI) to optimal medical therapy did not reduce the risk of death or myocardial infarction in stable CAD patients but resulted in more revascularization procedures. Methods REGARDS is a national prospective cohort study of 30,239 African American and White community-dwelling individuals aged >45 years enrolled in 2003-7. We calculated the proportion of 3,167 participants with self-reported CAD meeting 7 risk factor goals based on COURAGE: 1) aspirin use, 2) systolic blood pressure 40 mg/dL, and triglycerides goals met was 4. Less than a quarter met ≥5 of the 7 goals, and 16% met all 3 goals for aspirin, blood pressure, and LDL-C. Older age, white race, higher income, more education, and higher physical functioning were independently associated with meeting more goals. Conclusions There is substantial room for improvement in risk factor reduction among US individuals with CAD. PMID:24534599

  1. The perceptual control of goal-directed locomotion: a common control architecture for interception and navigation?

    Science.gov (United States)

    Chardenon, A; Montagne, G; Laurent, M; Bootsma, R J

    2004-09-01

    Intercepting a moving object while locomoting is a highly complex and demanding ability. Notwithstanding the identification of several informational candidates, the role of perceptual variables in the control process underlying such skills remains an open question. In this study we used a virtual reality set-up for studying locomotor interception of a moving ball. The subject had to walk along a straight path and could freely modify forward velocity, if necessary, in order to intercept-with the head-a ball moving along a straight path that led it to cross the agent's displacement axis. In a series of experiments we manipulated a local (ball size) and a global (focus of expansion) component of the visual flow but also the egocentric orientation of the ball. The experimental observations are well captured by a dynamic model linking the locomotor acceleration to properties of both global flow and egocentric direction. More precisely the changes in locomotor velocity depend on a linear combination of the change in bearing angle and the change in egocentric orientation, allowing the emergence of adaptive behavior under a variety of circumstances. We conclude that the mechanisms underlying the control of different goal-directed locomotion tasks (i.e. steering and interceptive tasks) could share a common architecture.

  2. Catheter directed thrombolysis for deep vein thrombosis during the first trimester of pregnancy: two case report

    International Nuclear Information System (INIS)

    Kim, Kum Rae; Park, Won Kyu; Kim, Jae Woon; Kwun, Woo Hyung; Suh, Bo Yang; Park, Kyeong Seok

    2008-01-01

    Anticoagulation with heparin has been the standard management therapy of deep vein thrombosis during pregnancy. Pregnancy is generally considered as a contraindication for thrombolysis. However, anticoagulation therapy alone does not protect the limbs from post-thrombotic syndrome and venous valve insufficiency. Catheter-directed thrombolysis, combined with angioplasty and stenting, can remove the thrombus and restore patency of the veins, resulting in prevention of post-thrombotic syndrome and valve insufficiency. We report successful catheter-directed thrombolysis and stenting in two early gestation patients with a deep vein thrombosis of the left lower extremity

  3. Catheter directed thrombolysis for deep vein thrombosis during the first trimester of pregnancy: two case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kum Rae; Park, Won Kyu; Kim, Jae Woon; Kwun, Woo Hyung; Suh, Bo Yang [College of Medicine, Yeungnam University, Daegu (Korea, Republic of); Park, Kyeong Seok [Yeungnam University, Medical Center, Daegu (Korea, Republic of)

    2008-02-15

    Anticoagulation with heparin has been the standard management therapy of deep vein thrombosis during pregnancy. Pregnancy is generally considered as a contraindication for thrombolysis. However, anticoagulation therapy alone does not protect the limbs from post-thrombotic syndrome and venous valve insufficiency. Catheter-directed thrombolysis, combined with angioplasty and stenting, can remove the thrombus and restore patency of the veins, resulting in prevention of post-thrombotic syndrome and valve insufficiency. We report successful catheter-directed thrombolysis and stenting in two early gestation patients with a deep vein thrombosis of the left lower extremity.

  4. Cholesterol treatment with statins: Who is left out and who makes it to goal?

    Directory of Open Access Journals (Sweden)

    Winters Paul

    2010-03-01

    Full Text Available Abstract Background Whether patient socio-demographic characteristics (age, sex, race/ethnicity, income, and education are independently associated with failure to receive indicated statin therapy and/or to achieve low density lipoprotein cholesterol (LDL-C therapy goals are not known. We examined socio-demographic factors associated with a eligibility for statin therapy among those not on statins, and b achievement of statin therapy goals. Methods Adults (21-79 years participating in the United States (US National Health and Nutrition Examination Surveys, 1999-2006 were studied. Statin eligibility and achievement of target LDL-C was assessed using the US Third Adult Treatment Panel (ATP III on Treatment of High Cholesterol guidelines. Results Among 6,043 participants not taking statins, 10.4% were eligible. Adjusted predictors of statin eligibility among statin non-users were being older, male, poorer, and less educated. Hispanics were less likely to be eligible but not using statins, an effect that became non-significant with adjustment for language usually spoken at home. Among 537 persons taking statins, 81% were at LDL-C goal. Adjusted predictors of goal failure among statin users were being male and poorer. These risks were not attenuated by adjustment for healthcare access or utilization. Conclusion Among person's not taking statins, the socio-economically disadvantaged are more likely to be eligible and among those on statins, the socio-economically disadvantaged are less likely to achieve statin treatment goals. Further study is needed to identify specific amenable patient and/or physician factors that contribute to these disparities.

  5. Hæmostatisk resuscitation til blødende traumepatienter

    DEFF Research Database (Denmark)

    Stensballe, Jakob; Johansson, Pär I; Steinmetz, Jacob

    2016-01-01

    of plasma and one pool of platelets (equal to ratio 1:1:1 in USA). Haemostatic resuscitation also includes a restricted use of crystalloids, early tranexamic acid, and a goal-directed transfusion therapy by using viscoelastic haemostatic assays to detect coagulopathy and the need for additional transfusions...

  6. Early intranasal insulin therapy halts progression of neurodegeneration: progress in Alzheimer’s disease therapeutics

    OpenAIRE

    de la Monte, Suzanne M.

    2012-01-01

    Evaluation of Craft S, Baker LD, Montine TJ, Minoshima S, Watson GS, Claxton A, et al. Intranasal Insulin Therapy for Alzheimer Disease and Amnestic Mild Cognitive Impairment: A Pilot Clinical Trial. Arch Neurol. 2011 Sep 12. Alzheimer’s disease is associated with brain insulin deficiency and insulin resistance, similar to the problems in diabetes. If insulin could be supplied to the brain in the early stages of Alzheimer’s, subsequent neurodegeneration might be prevented. ...

  7. Lung Cancer Workshop XI: Tobacco-Induced Disease: Advances in Policy, Early Detection and Management.

    Science.gov (United States)

    Mulshine, James L; Avila, Rick; Yankelevitz, David; Baer, Thomas M; Estépar, Raul San Jose; Ambrose, Laurie Fenton; Aldigé, Carolyn R

    2015-05-01

    The Prevent Cancer Foundation Lung Cancer Workshop XI: Tobacco-Induced Disease: Advances in Policy, Early Detection and Management was held in New York, NY on May 16 and 17, 2014. The two goals of the Workshop were to define strategies to drive innovation in precompetitive quantitative research on the use of imaging to assess new therapies for management of early lung cancer and to discuss a process to implement a national program to provide high quality computed tomography imaging for lung cancer and other tobacco-induced disease. With the central importance of computed tomography imaging for both early detection and volumetric lung cancer assessment, strategic issues around the development of imaging and ensuring its quality are critical to ensure continued progress against this most lethal cancer.

  8. Monitoring early tumor response to drug therapy with diffuse optical tomography

    Science.gov (United States)

    Flexman, Molly L.; Vlachos, Fotios; Kim, Hyun Keol; Sirsi, Shashank R.; Huang, Jianzhong; Hernandez, Sonia L.; Johung, Tessa B.; Gander, Jeffrey W.; Reichstein, Ari R.; Lampl, Brooke S.; Wang, Antai; Borden, Mark A.; Yamashiro, Darrell J.; Kandel, Jessica J.; Hielscher, Andreas H.

    2012-01-01

    Although anti-angiogenic agents have shown promise as cancer therapeutics, their efficacy varies between tumor types and individual patients. Providing patient-specific metrics through rapid noninvasive imaging can help tailor drug treatment by optimizing dosages, timing of drug cycles, and duration of therapy--thereby reducing toxicity and cost and improving patient outcome. Diffuse optical tomography (DOT) is a noninvasive three-dimensional imaging modality that has been shown to capture physiologic changes in tumors through visualization of oxygenated, deoxygenated, and total hemoglobin concentrations, using non-ionizing radiation with near-infrared light. We employed a small animal model to ascertain if tumor response to bevacizumab (BV), an anti-angiogenic agent that targets vascular endothelial growth factor (VEGF), could be detected at early time points using DOT. We detected a significant decrease in total hemoglobin levels as soon as one day after BV treatment in responder xenograft tumors (SK-NEP-1), but not in SK-NEP-1 control tumors or in non-responder control or BV-treated NGP tumors. These results are confirmed by magnetic resonance imaging T2 relaxometry and lectin perfusion studies. Noninvasive DOT imaging may allow for earlier and more effective control of anti-angiogenic therapy.

  9. Comparison of Bladder Directed and Pelvic Floor Therapy in Women With Interstitial Cystitis/Bladder Pain Syndrome

    Science.gov (United States)

    2017-09-01

    PROJECT NUMBER Kenneth M. Peters 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION REPORT...AWARD NUMBER: W81XWH-16-1-0307 TITLE: Comparison of Bladder-Directed and Pelvic Floor Therapy in Women With Interstitial Cystitis/Bladder Pain...Pelvic Floor Therapy in Women With Interstitial Cystitis/Bladder Pain Syndrome 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d

  10. Compliance with guideline-directed therapy in diabetic patients admitted with acute coronary syndrome: Findings from the American Heart Association's Get With The Guidelines-Coronary Artery Disease (GWTG-CAD) program.

    Science.gov (United States)

    Deedwania, Prakash; Acharya, Tushar; Kotak, Kamal; Fonarow, Gregg C; Cannon, Christopher P; Laskey, Warren K; Peacock, W Frank; Pan, Wenqin; Bhatt, Deepak L

    2017-05-01

    To evaluate and compare baseline characteristics, outcomes and compliance with guideline based therapy at discharge among diabetic and non-diabetic patients admitted with acute coronary syndromes (ACS). Study population consisted of 151,270 patients admitted with ACS from 2002 through 2008 at 411 sites participating in the American Heart Association's Get with the Guidelines (GWTG) program. Demographic variables, physical exam findings, laboratory data, left ventricular ejection fraction, length of stay, in-hospital mortality and discharge medications were compared between diabetic and non-diabetic patients. Temporal trends in compliance with guidelines directed therapy were evaluated. Of 151,270 patients, 48,938 (32%) had diabetes. Overall, diabetic patients were significantly older and more likely non-white. They had significantly more hypertension, atherosclerotic disease, CKD, and LV dysfunction and were more likely to present as NSTEMI. They had longer hospital stay and higher hospital mortality than non-diabetic patients. Diabetic patients were less likely to get LDL checks (65% vs 70%) and less frequently prescribed statins (85% vs 89%), RAAS blockers for LV dysfunction (80% vs 84%) and dual-antiplatelet therapy (69% vs 74%). Diabetic patients were less likely to achieve BP goals before discharge (75% vs 82%). Fewer diabetic patients met first medical contact to PCI time for STEMI (44% vs 52%). Temporal trends, however, showed continued progressive improvement in most performance measures from 2002 to 2008 (all P<.001). These data from a large cohort of ACS patients demonstrate gaps in compliance with guidelines directed therapy in diabetic patients but also indicate significant and continued improvement in most performance measures over time. Concerted efforts are needed to continue this positive trend. Copyright © 2017. Published by Elsevier Inc.

  11. Early sensory re-education of the hand after peripheral nerve repair based on mirror therapy: a randomized controlled trial

    Science.gov (United States)

    Paula, Mayara H.; Barbosa, Rafael I.; Marcolino, Alexandre M.; Elui, Valéria M. C.; Rosén, Birgitta; Fonseca, Marisa C. R.

    2016-01-01

    BACKGROUND: Mirror therapy has been used as an alternative stimulus to feed the somatosensory cortex in an attempt to preserve hand cortical representation with better functional results. OBJECTIVE: To analyze the short-term functional outcome of an early re-education program using mirror therapy compared to a late classic sensory program for hand nerve repair. METHOD: This is a randomized controlled trial. We assessed 20 patients with median and ulnar nerve and flexor tendon repair using the Rosen Score combined with the DASH questionnaire. The early phase group using mirror therapy began on the first postoperative week and lasted 5 months. The control group received classic sensory re-education when the protective sensation threshold was restored. All participants received a patient education booklet and were submitted to the modified Duran protocol for flexor tendon repair. The assessments were performed by the same investigator blinded to the allocated treatment. Mann-Whitney Test and Effect Size using Cohen's d score were used for inter-group comparisons at 3 and 6 months after intervention. RESULTS: The primary outcome (Rosen score) values for the Mirror Therapy group and classic therapy control group after 3 and 6 months were 1.68 (SD=0.5); 1.96 (SD=0.56) and 1.65 (SD=0.52); 1.51 (SD=0.62), respectively. No between-group differences were observed. CONCLUSION: Although some clinical improvement was observed, mirror therapy was not shown to be more effective than late sensory re-education in an intermediate phase of nerve repair in the hand. Replication is needed to confirm these findings. PMID:26786080

  12. Early sensory re-education of the hand after peripheral nerve repair based on mirror therapy: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Mayara H. Paula

    2016-02-01

    Full Text Available BACKGROUND: Mirror therapy has been used as an alternative stimulus to feed the somatosensory cortex in an attempt to preserve hand cortical representation with better functional results. OBJECTIVE: To analyze the short-term functional outcome of an early re-education program using mirror therapy compared to a late classic sensory program for hand nerve repair. METHOD: This is a randomized controlled trial. We assessed 20 patients with median and ulnar nerve and flexor tendon repair using the Rosen Score combined with the DASH questionnaire. The early phase group using mirror therapy began on the first postoperative week and lasted 5 months. The control group received classic sensory re-education when the protective sensation threshold was restored. All participants received a patient education booklet and were submitted to the modified Duran protocol for flexor tendon repair. The assessments were performed by the same investigator blinded to the allocated treatment. Mann-Whitney Test and Effect Size using Cohen's d score were used for inter-group comparisons at 3 and 6 months after intervention. RESULTS: The primary outcome (Rosen score values for the Mirror Therapy group and classic therapy control group after 3 and 6 months were 1.68 (SD=0.5; 1.96 (SD=0.56 and 1.65 (SD=0.52; 1.51 (SD=0.62, respectively. No between-group differences were observed. CONCLUSION: Although some clinical improvement was observed, mirror therapy was not shown to be more effective than late sensory re-education in an intermediate phase of nerve repair in the hand. Replication is needed to confirm these findings.

  13. A possible utilization of the mice forced swim test for modeling manic-like increase in vigor and goal-directed behavior.

    Science.gov (United States)

    Flaisher-Grinberg, Shlomit; Einat, Haim

    2009-01-01

    The lack of appropriate animal models for bipolar disorder (BPD) is a major factor hindering the research of its pathophysiology and the development of new drug treatments. In line with the notion that BPD might represent a heterogeneous group of disorders, it was suggested that models for specific domains of BPD should be developed. The present study tested the possible utilization of the forced swim test (FST) as a model for the heightened vigor and goal-directed behavior domain of mania, using mice with low baseline immobility. Black Swiss mice were previously identified to have low immobility in the FST but similar spontaneous activity levels compared with several other mice strains. Thus, spontaneous activity and behavior in the FST were evaluated following treatment with the mood stabilizer valproate and the antidepressant imipramine. The results indicated that valproate increased immobility in the FST without affecting spontaneous activity whereas imipramine had no effect in the FST but increased spontaneous activity. These findings suggest that in mice with low baseline immobility scores, the FST might be a useful model for the elevated vigor and goal-directed behavior domain of mania. As such, this test might be well integrated into a battery of models for different domains of BPD.

  14. Auger radiation targeted into DNA: a therapy perspective

    Energy Technology Data Exchange (ETDEWEB)

    Buchegger, Franz [University Hospital of Lausanne CHUV, Service of Nuclear Medicine, Lausanne (Switzerland); University Hospital of Lausanne, Service of Nuclear Medicine, Lausanne (Switzerland); Perillo-Adamer, Florence; Bischof Delaloye, Angelika [University Hospital of Lausanne CHUV, Service of Nuclear Medicine, Lausanne (Switzerland); Dupertuis, Yves M. [University Hospital of Geneva, Service of Nutrition, Geneva (Switzerland)

    2006-11-15

    Auger electron emitters that can be targeted into DNA of tumour cells represent an attractive systemic radiation therapy goal. In the situation of DNA-associated decay, the high linear energy transfer (LET) of Auger electrons gives a high relative biological efficacy similar to that of {alpha} particles. In contrast to {alpha} radiation, however, Auger radiation is of low toxicity when decaying outside the cell nucleus, as in cytoplasm or outside cells during blood transport. The challenge for such therapies is the requirement to target a high percentage of all cancer cells. An overview of Auger radiation therapy approaches of the past decade shows several research directions and various targeting vehicles. The latter include hormones, peptides, halogenated nucleotides, oligonucleotides and internalising antibodies. Here, we will discuss the basic principles of Auger electron therapy as compared with vector-guided {alpha} and {beta} radiation. We also review some radioprotection issues and briefly present the main advantages and disadvantages of the different targeting modalities that are under investigation. (orig.)

  15. Auger radiation targeted into DNA: a therapy perspective

    International Nuclear Information System (INIS)

    Buchegger, Franz; Perillo-Adamer, Florence; Bischof Delaloye, Angelika; Dupertuis, Yves M.

    2006-01-01

    Auger electron emitters that can be targeted into DNA of tumour cells represent an attractive systemic radiation therapy goal. In the situation of DNA-associated decay, the high linear energy transfer (LET) of Auger electrons gives a high relative biological efficacy similar to that of α particles. In contrast to α radiation, however, Auger radiation is of low toxicity when decaying outside the cell nucleus, as in cytoplasm or outside cells during blood transport. The challenge for such therapies is the requirement to target a high percentage of all cancer cells. An overview of Auger radiation therapy approaches of the past decade shows several research directions and various targeting vehicles. The latter include hormones, peptides, halogenated nucleotides, oligonucleotides and internalising antibodies. Here, we will discuss the basic principles of Auger electron therapy as compared with vector-guided α and β radiation. We also review some radioprotection issues and briefly present the main advantages and disadvantages of the different targeting modalities that are under investigation. (orig.)

  16. The Inhaled Steroid Treatment As Regular Therapy in Early Asthma (START) study 5-year follow-up: effectiveness of early intervention with budesonide in mild persistent asthma

    DEFF Research Database (Denmark)

    Busse, William W; Pedersen, Søren; Pauwels, Romain A

    2008-01-01

    BACKGROUND: The Inhaled Steroid Treatment as Regular Therapy in Early Asthma (START) study enrolled 7241 patients aged 5 to 66 years with recent-onset, mild persistent asthma to assess early intervention with the inhaled corticosteroid budesonide on long-term asthma control. OBJECTIVE: The open......-label phase of the START study was included to determine the effect on lung function and asthma control of adding budesonide to the reference group patients who had not initially received inhaled corticosteroids. METHODS: Patients were randomized to double-blind treatment with budesonide, 200 mug (those aged...

  17. Proton Therapy for Craniopharyngioma - An Early Report from a Single European Centre.

    Science.gov (United States)

    Ajithkumar, T; Mazhari, A-L; Stickan-Verfürth, M; Kramer, P-H; Fuentes, C-S; Lambert, J; Thomas, H; Müller, H; Fleischhack, G; Timmermann, B

    2018-05-01

    Proton beam therapy (PBT) is being increasingly used for craniopharyngioma. We describe our early outcome of patients treated with PBT. Between August 2013 and July 2016, 18 patients with craniopharyngiomas were treated with 54 Cobalt Gray Equivalent (CGE) in 30 fractions over 6 weeks at our centre. The early outcome of 16 patients included in a registry study was analysed. Radiological response was assessed by RECIST criteria and the disease- and treatment-related toxicities were scored according to the CTCAE 4.0. All patients are alive at a median follow-up of 32.6 months (range 9.2-70.6 months) from initial diagnosis. The median age at PBT was 10.2 years (range 5.4-46.9 years). One patient progressed 8.7 months after PBT and subsequently had complete resection of the tumour. At a median follow-up of 18.4 months after PBT, five patients remained in complete remission, four in partial remission and seven with stable disease. The most common adverse effects during PBT were grade 1 (cutaneous in seven patients and fatigue in six patients). There were no treatment-related grade 3 toxicities. Our early results are encouraging and comparable with the limited literature on PBT for craniopharyngioma. Copyright © 2018. Published by Elsevier Ltd.

  18. The detection, diagnosis and therapy of human lung cancer

    International Nuclear Information System (INIS)

    1978-01-01

    The Cancergram covers clinical aspects of cancers of the lung and tracheo-bronchial tree, i.e., the lower respiratory tract. This includes primary lung cancer in both early and advanced disease status. The topic includes clinically relevant aspects of the prevention, detection, diagnosis, evaluation, and therapy of lung cancer. Certain aspects of metastatic lung disease treatment or therapy which involve aspects of interest to primary lung cancer are included. With certain exceptions, general pre-clinical or animal studies not directly related to the primary human disease are excluded

  19. Predictors of receiving therapy among very low birth weight 2-year olds eligible for Part C early intervention in Wisconsin.

    Science.gov (United States)

    McManus, Beth Marie; Robert, Stephanie; Albanese, Aggie; Sadek-Badawi, Mona; Palta, Mari

    2013-07-11

    The Individuals with Disabilities Education Act (Part C) authorizes states to establish systems to provide early intervention services (e.g., therapy) for children at risk, with the incentive of federal financial support. This study examines family and neighborhood characteristics associated with currently utilizing physical, occupational, or speech therapy among very low birthweight (VLBW) 2-year-old children who meet Wisconsin eligibility requirements for early intervention services (EI) due to developmental delay. This cross-sectional analysis used data from the Newborn Lung Project, a regional cohort study of VLBW infants hospitalized in Wisconsin's newborn intensive care units during 2003-2004. We included the 176 children who were age two at follow-up, and met Wisconsin state eligibility requirements for EI based on developmental delay. Exact logistic regression was used to describe child and neighborhood socio-demographic correlates of parent-reported receipt of therapy. Among VLBW children with developmental delay, currently utilizing therapy was higher among children with Medicaid (aOR = 5.3, 95% CI: 1.3, 28.3) and concomitant developmental disability (aOR = 5.2, 95% CI: 2.1, 13.3) and lower for those living in a socially more disadvantaged neighborhood (aOR=0.48, 95% CI: 0.21, 0.98, per tertile). Among a sample of VLBW 2-year olds with developmental delays who are EI-eligible in WI, 4 out of 5 were currently receiving therapy, per parent report. Participation in Medicaid positively influences therapy utilization. Children with developmental difficulties who live in socially disadvantaged neighborhoods are at highest risk for not receiving therapy.

  20. Children's Developing Commitments to Joint Goals

    Science.gov (United States)

    Hamann, Katharina; Warneken, Felix; Tomasello, Michael

    2012-01-01

    This study investigated young children's commitment to a joint goal by assessing whether peers in collaborative activities continue to collaborate until all received their rewards. Forty-eight 2.5- and 3.5-year-old children worked on an apparatus dyadically. One child got access to her reward early. For the partner to benefit as well, this child…

  1. Early CT signs in patients with acute middle cerebral artery occlusion: incidence of contrast staining and haemorrhagic transformations after intra-arterial reperfusion therapy

    International Nuclear Information System (INIS)

    Nakano, S.; Iseda, T.; Yoneyama, T.; Wakisaka, S.

    2006-01-01

    AIM: To investigate how often early computed tomography (CT) signs are associated with blood-brain barrier (BBB) disruption and result in haemorrhagic transformations. MATERIALS AND METHODS: Serial CT findings were prospectively evaluated in 61 patients with acute middle cerebral artery (MCA) occlusion who underwent initial CT examination within 3 h of stroke onset and who were treated with intra-arterial reperfusion therapy within 6 h of stroke onset. Obscuration of the margin of the lentiform nucleus and loss of the insular ribbon were evaluated as early CT signs in the deep MCA territories. Cortical effacement was also evaluated. BBB disruption was defined as contrast medium staining in post-therapeutic CT just after reperfusion therapy. The relationship between pre-therapeutic early CT signs and post-therapeutic contrast staining or haemorrhagic transformations was investigated. RESULTS: The frequency of early CT signs in the deep MCA territories was significantly higher than that of cortical effacement (68.9 versus 27.9%). There were significant correlations between pre-therapeutic early CT signs and post-therapeutic contrast staining in both the deep and superficial MCA territories. Compared with early CT signs in the deep MCA territories, cortical effacement had a significantly higher incidence of post-therapeutic contrast staining (54.8 versus 82.4%). Although not statistically significant, cortical effacement tended to develop into haemorrhagic transformations. There was no correlation between early CT signs in the deep MCA territories and haemorrhagic transformations. CONCLUSION: Cortical effacement may be an advanced CT sign with BBB disruption and potential risk for haemorrhagic transformations. The presence of early CT signs in the deep MCA territories may not be a contraindication of reperfusion therapy

  2. The Influence of Money on Goal Pursuit and Decision-Making: Understanding Money's Unique Impact on Goal Pursuit

    Science.gov (United States)

    Moran, Nora

    Previous research suggests that activating concepts of money and wealth can increase motivation to achieve personal goals. In this dissertation, I investigate how money affects pursuit of important personal goals, and how this motivation may be affected by goal attainability. In eight studies, I show that priming concepts of money and wealth leads individuals to pursue important personal goals to a greater degree than control groups, but only when a goal is more attainable. In contrast, when a goal is less attainable, those primed with money will be less likely to work towards goals relative to control groups. Furthermore, I examine why money may have a detrimental effect on motivation when individuals are faced with less attainable but important goals, and argue those primed with money become more concerned with maintaining a sense of efficacy, and thus disengage from pursuit when success is less certain. Thus, this research identifies the needs made salient by activating money--validating one's abilities. Finally, I show the relevance of these findings for consumer behavior, and discuss the additional implications of this work, as well as future research directions.

  3. Early effects of modern electroconvulsive therapy on subjective memory in patients with mania or depression

    OpenAIRE

    Bag, Sevda; Canbek, Ozge; Atagun, Ilhan Murat; Kutlar, Tarik Mehmet

    2016-01-01

    Context: Although electroconvulsive therapy (ECT) is considered a very effective tool for the treatment of psychiatric diseases, memory disturbances are among the most important adverse effects. Aims: This study aimed to assess prospectively early subjective memory complaints in depressive and manic patients due to bilateral, brief-pulse ECT, at different stages of the treatment, compare the associations between psychiatric diagnosis, sociodemographic characteristics, and ECT characteristics....

  4. Induction immunosuppressive therapies in renal transplantation.

    Science.gov (United States)

    Gabardi, Steven; Martin, Spencer T; Roberts, Keri L; Grafals, Monica

    2011-02-01

    Induction immunosuppressive therapies for patients undergoing renal transplantation are reviewed. The goal of induction therapy is to prevent acute rejection during the early posttransplantation period by providing a high degree of immunosuppression at the time of transplantation. Induction therapy is often considered essential to optimize outcomes, particularly in patients at high risk for poor short-term outcomes. All of the induction immunosuppressive agents currently used are biological agents and are either monoclonal (muromonab-CD3, daclizumab, basiliximab, alemtuzumab) or polyclonal (antithymocyte globulin [equine] or antithymocyte globulin [rabbit]) antibodies. Although antithymocyte globulin (rabbit) is not labeled for induction therapy, it is used for this purpose more than any other agent. Basiliximab is not considered as potent an immunosuppressive agent but has a much more favorable adverse-effect profile compared with antithymocyte globulin (rabbit) and is most commonly used in patients at low risk for acute rejection. Rituximab is being studied for use as induction therapy but to date has not demonstrated any significant benefits over placebo. While head-to-head data are available comparing most induction agents, the final decision on the most appropriate induction therapy for a transplant recipient is highly dependent on preexisting medical conditions, donor characteristics, and the maintenance immunosuppressive regimen to be used. No standard induction immunosuppressive regimen exists for patients undergoing renal transplantation. Antithymocyte globulin (rabbit) is the most commonly used agent, whereas basiliximab appears safer. The choice of regimen depends on the preferences of clinicians and institutions.

  5. Emotion and goal-directed behavior: ERP evidence on cognitive and emotional conflict.

    Science.gov (United States)

    Zinchenko, Artyom; Kanske, Philipp; Obermeier, Christian; Schröger, Erich; Kotz, Sonja A

    2015-11-01

    Cognitive control supports goal-directed behavior by resolving conflict among opposing action tendencies. Emotion can trigger cognitive control processes, thus speeding up conflict processing when the target dimension of stimuli is emotional. However, it is unclear what role emotionality of the target dimension plays in the processing of emotional conflict (e.g. in irony). In two EEG experiments, we compared the influence of emotional valence of the target (emotional, neutral) in cognitive and emotional conflict processing. To maximally approximate real-life communication, we used audiovisual stimuli. Participants either categorized spoken vowels (cognitive conflict) or their emotional valence (emotional conflict), while visual information was congruent or incongruent. Emotional target dimension facilitated both cognitive and emotional conflict processing, as shown in a reduced reaction time conflict effect. In contrast, the N100 in the event-related potentials showed a conflict-specific reversal: the conflict effect was larger for emotional compared with neutral trials in cognitive conflict and smaller in emotional conflict. Additionally, domain-general conflict effects were observed in the P200 and N200 responses. The current findings confirm that emotions have a strong influence on cognitive and emotional conflict processing. They also highlight the complexity and heterogeneity of the interaction of emotion with different types of conflict. © The Author (2015). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

  6. Development of Personalized Cancer Therapy for Men with Advanced Prostate Cancer

    Science.gov (United States)

    2017-10-01

    of this study is to develop a strategy to identify molecular markers of response of advanced prostate cancer to specific therapies using clinically...combination treatment strategies are urgently needed. The purpose of this study is to develop a strategy for identifying molecular markers of response of...PENDING) Level of Funding: $125,978 annual direct Project Goals: To develop a strategy for identifying molecular therapeutic response markers of

  7. Cystic Echinococcal Liver Disease: New Insights into an Old Disease and an Algorithm for Therapy Planning

    International Nuclear Information System (INIS)

    Rozanes, Izzet; Gueven, Koray; Acunas, Buelent; Emre, Ali

    2007-01-01

    Human cystic echinococcosis (CE) continues to be a major health problem in developing countries. A review of current literature discloses four alternatives for the management of active CE, consisting of surgery, percutaneous treatment (PT), chemotherapy, and follow-up without intervention, but no clear guidelines for directing patients to the different management options. Palliation of symptoms or prevention of complications is the main rationale for the treatment of CE. Surgery has long been considered as the gold standard treatment. However, a meta-analysis comparing the clinical outcomes of patients treated with PT with those of a control group treated with surgery found PT to be more effective, safer, and cheaper. Medical therapy is considered to be ineffective when the criterion of success is defined as the disappearance of the lesion. However, medical therapy seems to be effective when the goal of therapy is defined as the prevention of complications in asymptomatic patients. We propose an algorithm for therapy planning in CE where the first line of therapy for patients with active lesions is PT. Patients with lesions unsuitable for PT are directed to surgery if they are symptomatic, have complicated lesions or have lesions that are prone to rupture. Asymptomatic patients with uncomplicated lesions are directed to medical therapy. Medical therapy failures are redirected to surgery

  8. Assessing the Importance of Treatment Goals in Patients with Psoriasis: Analytic Hierarchy Process vs. Likert Scales.

    Science.gov (United States)

    Gutknecht, Mandy; Danner, Marion; Schaarschmidt, Marthe-Lisa; Gross, Christian; Augustin, Matthias

    2018-02-15

    functioning". Concerning the Patient Needs Questionnaire results, these dimensions were ranked in second and fifth position, whereas "strengthening of confidence in the therapy and in a possible healing" was ranked most important, which was least important in the analytic hierarchy process ranking. In both methods, "improvement of psychological well-being" and "reduction of impairments due to therapy" were equally ranked in positions three and four. In contrast to this, on the level of sub-criteria, predominantly a similar ranking of treatment goals could be observed between the analytic hierarchy process and the Patient Needs Questionnaire. From the patients' point of view, the Likert scales (Patient Needs Questionnaire) were easier to complete than the analytic hierarchy process pairwise comparisons. Patients with psoriasis assign different importance to health dimensions and associated treatment goals. In choosing a method to assess the importance of health dimensions and/or treatment goals, it needs to be considered that resulting importance weights may differ in dependence on the used method. However, in this study, observed discrepancies in importance weights of the health dimensions were most likely caused by the different methodological approaches focusing on treatment goals to assess the importance of health dimensions on the one hand (Patient Needs Questionnaire) or directly assessing health dimensions on the other hand (analytic hierarchy process).

  9. The use of drama and puppetry in occupational therapy during the 1920s and 1930s.

    Science.gov (United States)

    Phillips, M E

    1996-03-01

    The occupational therapy literature was reviewed to determine how drama was used as a clinical modality in the 1920s and 1930s. It appears that the emergence of the Little Theater Movement in the early 1900s, which enabled amateurs to perform publicly, provided the impetus for occupational therapists to use drama as purposeful activity. The theatrical modes most frequently used were pageantry, puppetry, and comedic plays. Additionally, the collective nature of drama facilitated group-centered treatment. Noble, a psychiatrist at Sheppard and Enoch Pratt in Maryland, used drama for insight-oriented therapy and recommended that occupational therapists use drama for treatment of persons with mental illness. Drama in occupational therapy still exists in some psychiatric settings, although a new discipline known as drama therapy, which is a division of the creative arts therapies, has arisen. Although drama therapy addresses psychodynamic goals, drama also can be used in occupational therapy to promote competence, enhance self-concept, and improve socialization.

  10. Social Learning Family Therapy and the Treatment of Conduct Disorder in Early Childhood: Premise, Procedures and Prospects.

    Science.gov (United States)

    Mpofu, Elias

    1997-01-01

    Discusses social learning family therapy hypotheses on the development and sustenance of conduct disorder in early childhood, together with treatment approaches that use parents as the primary agents of change. Reviews research showing that parent training procedures hold much promise for the treatment of conduct disorder in childhood. (JPB)

  11. Early Intervention in Children (0–6 Years with a Rare Developmental Disability: The Occupational Therapy Role

    Directory of Open Access Journals (Sweden)

    Lucy Dall'Alba

    2014-12-01

    Conclusion: Family-centred practice, play therapy, and individually tailored programmes are identified as key practice areas for this population. The important role occupational therapists play in early intervention teams is highlighted; however, further research is needed to develop the evidence base for best practice with particular rare developmental conditions.

  12. Enforcing a security pattern in stakeholder goal models

    OpenAIRE

    Yu, Yijun; Kaiya, Haruhiko; Washizaki, Hironori; Xiong, Yingfei; Hu, Zhenjiang; Yoshioka, Nobukazu

    2008-01-01

    Patterns are useful knowledge about recurring problems and solutions. Detecting a security problem using patterns in requirements models may lead to its early solution. In order to facilitate early detection and resolution of security problems, in this paper, we formally describe a role-based access control (RBAC) as a pattern that may occur in stakeholder requirements models. We also implemented in our goal-oriented modeling tool the formally described pattern using model-driven queries and ...

  13. Management goals for type 1 Gaucher disease: An expert consensus document from the European working group on Gaucher disease.

    Science.gov (United States)

    Biegstraaten, M; Cox, T M; Belmatoug, N; Berger, M G; Collin-Histed, T; Vom Dahl, S; Di Rocco, M; Fraga, C; Giona, F; Giraldo, P; Hasanhodzic, M; Hughes, D A; Iversen, P O; Kiewiet, A I; Lukina, E; Machaczka, M; Marinakis, T; Mengel, E; Pastores, G M; Plöckinger, U; Rosenbaum, H; Serratrice, C; Symeonidis, A; Szer, J; Timmerman, J; Tylki-Szymańska, A; Weisz Hubshman, M; Zafeiriou, D I; Zimran, A; Hollak, C E M

    2018-02-01

    Gaucher Disease type 1 (GD1) is a lysosomal disorder that affects many systems. Therapy improves the principal manifestations of the condition and, as a consequence, many patients show a modified phenotype which reflects manifestations of their disease that are refractory to treatment. More generally, it is increasingly recognised that information as to how a patient feels and functions [obtained by patient- reported outcome measurements (PROMs)] is critical to any comprehensive evaluation of treatment. A new set of management goals for GD1 in which both trends are reflected is needed. To this end, a modified Delphi procedure among 25 experts was performed. Based on a literature review and with input from patients, 65 potential goals were formulated as statements. Consensus was considered to be reached when ≥75% of the participants agreed to include that specific statement in the management goals. There was agreement on 42 statements. In addition to the traditional goals concerning haematological, visceral and bone manifestations, improvement in quality of life, fatigue and social participation, as well as early detection of long-term complications or associated diseases were included. When applying this set of goals in medical practice, the clinical status of the individual patient should be taken into account. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  14. Domestic dengue infection with hemophagocytic lymphohistiocytosis successfully treated by early steroid therapy.

    Science.gov (United States)

    Yoshifuji, Kota; Oshina, Takahiro; Sonokawa, Saeko; Noguchi, Yuma; Suzuki, Sayaka; Tanaka, Keisuke; Kumagai, Takashi

    2016-07-01

    A 34-year-old man, working at a park in Tokyo, Japan, was repeatedly bitten by mosquitoes while cutting grass. He was hospitalized with sudden fever, fatigue, and weakness. He was eventually diagnosed with dengue virus infection, detected using reverse transcription polymerase chain reaction for the genome and by the presence of nonstructural protein 1 in his peripheral blood. Symptomatic treatments such as acetaminophen for the fever were not effective. Moreover, peripheral blood examination showed drastically decreased white blood cells and platelets, as well as marked elevations of ferritin and soluble interleukin 2 receptor. Furthermore, bone marrow examination revealed increased macrophages with hemophagocytosis. Dengue infection with hemophagocytic lymphohistiocytosis (HLH) was ultimately diagnosed. Half-dose steroid pulse therapy for three days dramatically reduced his temperature, thereby ameliorating physical symptoms and restoring normal peripheral blood data. He was discharged 12 days after admission. Dengue infection with HLH is rare and this is the first report, to our knowledge, of domestic dengue infection with HLH in Japan. Early steroid therapy may be effective in such cases.

  15. Management of hepatitis C infection in the era of direct-acting antiviral therapy

    Science.gov (United States)

    Zain, L. H.; Sungkar, T.

    2018-03-01

    Hepatitis C viral infection globally affects millions of people and commonly results in debilitating complications and mortality. Initial mainstay therapy consisted of pegylated interferon α (pegIFNα) with additional ribavirin that showed unsatisfactory cure rate, common side effects and complicated dosing, contributing to high discontinuation rate. Over the last few years, newer antivirals have been extensively studied, that are Direct-Acting Antivirals (DAAs). Specifically targeting viral protein mainly during replication phase, DAAs showed greater cure rate (commonly measured as sustained virologic response), improved safety profile and shorter treatment duration compared to traditional interferon-ribavirin therapy. Current guidelines have also included Interferon-free, often ribavirin-free, DAAs combinations that suggest promising outcomes. The current review highlights development of rapidly growing hepatitis C treatment including DAAs recommendations.

  16. THE LONG REACH OF EDUCATION: EARLY RETIREMENT.

    Science.gov (United States)

    Venti, Steven; Wise, David A

    2015-12-01

    The goal of this paper is to draw attention to the long lasting effect of education on economic outcomes. We use the relationship between education and two routes to early retirement - the receipt of Social Security Disability Insurance (DI) and the early claiming of Social Security retirement benefits - to illustrate the long-lasting influence of education. We find that for both men and women with less than a high school degree the median DI participation rate is 6.6 times the participation rate for those with a college degree or more. Similarly, men and women with less than a high school education are over 25 percentage points more likely to claim Social Security benefits early than those with a college degree or more. We focus on four critical "pathways" through which education may indirectly influence early retirement - health, employment, earnings, and the accumulation of assets. We find that for women health is the dominant pathway through which education influences DI participation. For men, the health, earnings, and wealth pathways are of roughly equal magnitude. For both men and women the principal channel through which education influences early Social Security claiming decisions is the earnings pathway. We also consider the direct effect of education that does not operate through these pathways. The direct effect of education is much greater for early claiming of Social Security benefits than for DI participation, accounting for 72 percent of the effect of education for men and 67 percent for women. For women the direct effect of education on DI participation is not statistically significant, suggesting that the total effect may be through the four pathways.

  17. Potential application of ecological models in the European environmental risk assessment of chemicals. I. Review of protection goals in EU directives and regulations.

    Science.gov (United States)

    Hommen, Udo; Baveco, J M Hans; Galic, Nika; van den Brink, Paul J

    2010-07-01

    Several European directives and regulations address the environmental risk assessment of chemicals. We used the protection of freshwater ecosystems against plant protection products, biocidal products, human and veterinary pharmaceuticals, and other chemicals and priority substances under the Water Framework Directive as examples to explore the potential of ecological effect models for a refined risk assessment. Our analysis of the directives, regulations, and related guidance documents lead us to distinguish the following 5 areas for the application of ecological models in chemical risk assessment: 1) Extrapolation of organism-level effects to the population level: The protection goals are formulated in general terms, e.g., avoiding "unacceptable effects" or "adverse impact" on the environment or the "viability of exposed species." In contrast, most of the standard ecotoxicological tests provide data only on organism-level endpoints and are thus not directly linked to the protection goals which focus on populations and communities. 2) Extrapolation of effects between different exposure profiles: Especially for plant protection products, exposure profiles can be very variable and impossible to cover in toxicological tests. 3) Extrapolation of recovery processes: As a consequence of the often short-term exposures to plant protection products, the risk assessment is based on the community recovery principle. On the other hand, assessments under the other directives assume a more or less constant exposure and are based on the ecosystem threshold principle. 4) Analysis and prediction of indirect effects: Because effects on 1 or a few taxa might have consequences on other taxa that are not directly affected by the chemical, such indirect effects on communities have to be considered. 5) Prediction of bioaccumulation within food chains: All directives take the possibility of bioaccumulation, and thus secondary poisoning within the food chain, into account. (c) 2010 SETAC.

  18. Applying the model of Goal-Directed Behavior, including descriptive norms, to physical activity intentions: A contribution to improving the Theory of Planned Behavior

    Science.gov (United States)

    The theory of planned behavior (TPB) has received its fair share of criticism lately, including calls for it to retire. We contributed to improving the theory by testing extensions such as the model of goal-directed behavior (MGDB, which adds desire and anticipated positive and negative emotions) ap...

  19. Using a virtual reality game to assess goal-directed hand movements in children: A pilot feasibility study.

    Science.gov (United States)

    Gabyzon, M Elboim; Engel-Yeger, B; Tresser, S; Springer, S

    2016-01-01

    Virtual reality gaming environments may be used as a supplement to the motor performance assessment tool box by providing clinicians with quantitative information regarding motor performance in terms of movement accuracy and speed, as well as sensory motor integration under different levels of dual tasking. To examine the feasibility of using the virtual reality game `Timocco' as an assessment tool for evaluating goal-directed hand movements among typically developing children. In this pilot study, 47 typically-developing children were divided into two age groups, 4-6 years old and 6-8 years old. Performance was measured using two different virtual environment games (Bubble Bath and Falling Fruit), each with two levels of difficulty. Discriminative validity (age effect) was examined by comparing the performance of the two groups, and by comparing the performance between levels of the games for each group (level effect). Test-retest reliability was examined by reassessing the older children 3-7 days after the first session. The older children performed significantly better in terms of response time, action time, game duration, and efficiency in both games compared to the younger children. Both age groups demonstrated poorer performance at the higher game level in the Bubble Bath game compared to the lower level. A similar level effect was found in the Falling Fruit game for both age groups in response time and efficiency, but not in action time. The performance of the older children was not significantly different between the two sessions at both game levels. The discriminative validity and test-retest reliability indicate the feasibility of using the Timocco virtual reality game as a tool for assessing goal-directed hand movements in children. Further studies should examine its feasibility for use in children with disabilities.

  20. MicroRNAs as biomarkers for early breast cancer diagnosis, prognosis and therapy prediction.

    Science.gov (United States)

    Nassar, Farah J; Nasr, Rihab; Talhouk, Rabih

    2017-04-01

    Breast cancer is a major health problem that affects one in eight women worldwide. As such, detecting breast cancer at an early stage anticipates better disease outcome and prolonged patient survival. Extensive research has shown that microRNA (miRNA) are dysregulated at all stages of breast cancer. miRNA are a class of small noncoding RNA molecules that can modulate gene expression and are easily accessible and quantifiable. This review highlights miRNA as diagnostic, prognostic and therapy predictive biomarkers for early breast cancer with an emphasis on the latter. It also examines the challenges that lie ahead in their use as biomarkers. Noteworthy, this review addresses miRNAs reported in patients with early breast cancer prior to chemotherapy, radiotherapy, surgical procedures or distant metastasis (unless indicated otherwise). In this context, miRNA that are mentioned in this review were significantly modulated using more than one statistical test and/or validated by at least two studies. A standardized protocol for miRNA assessment is proposed starting from sample collection to data analysis that ensures comparative analysis of data and reproducibility of results. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Motivational Function of Plans and Goals

    Directory of Open Access Journals (Sweden)

    Sabina Alispahić

    2013-10-01

    Full Text Available The academic literature shows that by helping tune out distractions, goals can get individuals' to try harder, work longer, and achieve more. Goals that people set for themselves and that are devoted to attaining mastery are usually healthy. But goals imposed by others—sales targets, quarterly returns, standardized test scores—can sometimes have dangerous side effects (Pink, 2009. Because understanding action demands understanding intention, the idea of motivation is natural and readily expressed in everyday language. Cognitive mental events like goals and expectancies can function as a “spring to action”, a moving force that energizes and directs action in purposive ways (Reeve, 2005. Cognitive studies of motivation are dealing with relationship between cognition and action. Literature is indicating a few cognitive elements that can have motivational significance. The article presents the overview of theory and research about the motivational function of plans and goals, according to Goal setting theory (Locke & Latham, 1990 and Self-determination Theory (Deci & Ryan, 2000. Suggestions for additional research are also indicated.

  2. A Theoretical Framework for Goal-directed Care within the Prison System

    NARCIS (Netherlands)

    Bulten, B.H.; Vissers, A.W.T.M.; Oei, K.

    2008-01-01

    Mental health care in prisons involves many stakeholders. As a consequence, the goals involved are divergent but there is no sound theoretical framework that accounts for the complexity of care in prison. This paper considers a broad theory and its conceptual framework that differentiates between

  3. The failure of anxiolytic therapies in early clinical trials: what needs to be done.

    Science.gov (United States)

    Stewart, Adam Michael; Nguyen, Michael; Poudel, Manoj K; Warnick, Jason E; Echevarria, David J; Beaton, Elliott A; Song, Cai; Kalueff, Allan V

    2015-04-01

    Anxiety spectrum disorders (ASDs) are highly prevalent psychiatric illnesses that affect millions of people worldwide. Strongly associated with stress, common ASDs include generalized anxiety disorder, panic, social anxiety, phobias and drug-abuse-related anxiety. In addition to ASDs, several other prevalent psychiatric illnesses represent trauma/stressor-related disorders, such as post-traumatic stress disorder and acute stress disorder. Anxiolytic drugs, commonly prescribed to treat ASDs and trauma/stressor-related disorders, form a highly heterogenous group, modulating multiple neurotransmitters and physiological mechanisms. However, overt individual differences in efficacy and the potential for serious side-effects (including addiction and drug interaction) indicate a need for further drug development. Yet, over the past 50 years, there has been relatively little progress in the development of novel anxiolytic medications, especially when promising candidate drugs often fail in early clinical trials. Herein, the authors present recommendations of the Task Force on Anxiolytic Drugs of the International Stress and Behavior Society on how to improve anxiolytic drug discovery. These recommendations cover a wide spectrum of aspects, ranging from methodological improvements to conceptual insights and innovation. In order to improve the success of anxiolytic drugs in early clinical trials, the goals of preclinical trials may need to be adjusted from a clinical perspective and better synchronized with those of clinical studies. Indeed, it is important to realize that the strategic goals and approaches must be similar if we want to have a smoother transition between phases.

  4. Early orthopedic correction of skeletal Class III malocclusion using combined reverse twin block and face mask therapy

    Directory of Open Access Journals (Sweden)

    Vinay Kumar Chugh

    2015-01-01

    Full Text Available A 6-year 8-month-old girl presented with a moderate Class III malocclusion characterized by mid-face deficiency and an anterior cross bite. In the first phase, the patient was treated with combination of reverse twin block and facemask therapy. In phase two, fixed appliances were placed in the permanent dentition. The post treatment results were good and a favorable growth tendency could be observed. The correction of the Class III malocclusion occurred by a combination of skeletal and dental improvements. This report shows successful correction of skeletal Class III malocclusion in the early transitional dentition using combination therapy.

  5. Early Cutaneous Leishmaniasis Patients Infected With Leishmania braziliensis Express Increased Inflammatory Responses After Antimony Therapy.

    Science.gov (United States)

    Costa, Rúbia S; Carvalho, Lucas P; Campos, Taís M; Magalhães, Andréa S; Passos, Sara T; Schriefer, Albert; Silva, Juliana A; Lago, Ednaldo; Paixão, Camilla S; Machado, Paulo; Scott, Phillip; Carvalho, Edgar M

    2018-02-14

    Early cutaneous leishmaniasis (ECL) is characterized by a nonulcerated papular lesion and illness duration less than 30 days. Approximately 4 weeks later, the cutaneous leishmaniasis (CL) ulcers appear. We were surprised to find that failure after antimony therapy (Sb5) is higher in ECL than CL. We hypothesize that the inflammatory response in ECL patients may increase during Sb5 therapy, which leads to treatment failure. A cohort of 44 ECL patients infected by Leishmania braziliensis was established to evaluate the response to Sb5 and to compare immunologic responses in ECL patients with CL and healthy subjects. A hierarchical clustering based on cytokine levels showed a weak positive correlation between proinflammatory cytokine levels and those patients that failed Sb5 treatment. Although Sb5 therapy decreased interferon-γ and tumor necrosis factor levels in CL patients, we were surprised to find that an increase in these cytokines was observed in ECL patients. Moreover, interleukin (IL)-10 was less able to down-modulate immune responses in ECL. The enhanced production of proinflammatory cytokines, due in part to the decreased ability of IL-10 to down-modulate immune response during therapy in ECL, promotes the development and persistence of leishmania ulcer despite antimony therapy. © The Author(s) 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

  6. Radiation Therapy for Neovascular Age-related Macular Degeneration

    Energy Technology Data Exchange (ETDEWEB)

    Kishan, Amar U. [Harvard Medical School, Boston, Massachusetts (United States); Modjtahedi, Bobeck S.; Morse, Lawrence S. [Department of Ophthalmology and Vision Sciences, University of California, Davis, Sacramento, California (United States); Lee, Percy, E-mail: percylee@mednet.ucla.edu [Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, California (United States)

    2013-03-01

    In the enormity of the public health burden imposed by age-related macular degeneration (ARMD), much effort has been directed toward identifying effective and efficient treatments. Currently, anti-vascular endothelial growth factor (VEGF) injections have demonstrated considerably efficacy in treating neovascular ARMD, but patients require frequent treatment to fully benefit. Here, we review the rationale and evidence for radiation therapy of ARMD. The results of early photon external beam radiation therapy are included to provide a framework for the sequential discussion of evidence for the usage of stereotactic radiation therapy, proton therapy, and brachytherapy. The evidence suggests that these 3 modern modalities can provide a dose-dependent benefit in the treatment of ARMD. Most importantly, preliminary data suggest that all 3 can be used in conjunction with anti-VEGF therapeutics, thereby reducing the frequency of anti-VEGF injections required to maintain visual acuity.

  7. Uncooled EGR as a means of limiting wall-wetting under early direct injection conditions

    NARCIS (Netherlands)

    Boot, M.D.; Luijten, C.C.M.; Somers, L.M.T.; Eguz, U.; Erp, D.D.T.M. van; Albrecht, A.; Baert, R.S.G.

    2009-01-01

    Collision of injected fuel spray against the cylinder liner (wall-wetting) is one of the main hurdles that must be overcome in order for early direct injection Premixed Charge Compression Ignition (EDI PCCI) combustion to become a viable alternative for conventional DI diesel combustion. Preferably,

  8. Optimization of operating conditions in the early direct injection premixed charge compression ignition regime

    NARCIS (Netherlands)

    Boot, M.D.; Luijten, C.C.M.; Rijk, E.P.; Albrecht, B.A.; Baert, R.S.G.

    2009-01-01

    Early Direct Injection Premixed Charge Compression Ignition (EDI PCCI) is a widely researched combustion concept, which promises soot and CO2 emission levels of a spark-ignition (SI) and compression-ignition (CI) engine, respectively. Application of this concept to a conventional CI engine using a

  9. The Direct/Indirect Association of ADHD/ODD Symptoms with Self-esteem, Self-perception, and Depression in Early Adolescents.

    Science.gov (United States)

    Kita, Yosuke; Inoue, Yuki

    2017-01-01

    The present study aimed to reveal the influences of attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms on self-esteem and self-perception during early adolescence and to clarify the spillover effect of self-esteem on depressive symptoms. ADHD symptoms in 564 early adolescents were evaluated via teacher-rating scales. Self-esteem and depressive symptoms were assessed via self-reported scales. We analyzed the relationships among these symptoms using structural equation modeling. Severe inattentive symptoms decreased self-esteem and hyperactive-impulsive symptoms affected self-perception for non-academic domains. Although these ADHD symptoms did not directly affect depressive symptoms, low self-esteem led to severe depression. ODD symptoms had a direct impact on depression without the mediating effects of self-esteem. These results indicated that inattentive symptoms had a negative impact on self-esteem and an indirect negative effect on depressive symptoms in adolescents, even if ADHD symptoms were subthreshold. Severe ODD symptoms can be directly associated with depressive symptoms during early adolescence.

  10. Early Implementation of THAM for ICP Control: Therapeutic Hypothermia Avoidance and Reduction in Hypertonics/Hyperosmotics

    Directory of Open Access Journals (Sweden)

    F. A. Zeiler

    2014-01-01

    Full Text Available Background. Tromethamine (THAM has been demonstrated to reduce intracranial pressure (ICP. Early consideration for THAM may reduce the need for other measures for ICP control. Objective. To describe 4 cases of early THAM therapy for ICP control and highlight the potential to avoid TH and paralytics and achieve reduction in sedation and hypertonic/hyperosmotic agent requirements. Methods. We reviewed the charts of 4 patients treated with early THAM for ICP control. Results. We identified 2 patients with aneurysmal subarachnoid hemorrhage (SAH and 2 with traumatic brain injury (TBI receiving early THAM for ICP control. The mean time to initiation of THAM therapy was 1.8 days, with a mean duration of 5.3 days. In all patients, after 6 to 12 hours of THAM administration, ICP stability was achieved, with reduction in requirements for hypertonic saline and hyperosmotic agents. There was a relative reduction in mean hourly hypertonic saline requirements of 89.1%, 96.1%, 82.4%, and 97.0% for cases 1, 2, 3, and 4, respectively, comparing pre- to post-THAM administration. Mannitol, therapeutic hypothermia, and paralytics were avoided in all patients. Conclusions. Early administration of THAM for ICP control could potentially lead to the avoidance of other ICP directed therapies. Prospective studies of early THAM administration are warranted.

  11. Reduced butyrylcholinesterase activity is an early indicator of trauma-induced acute systemic inflammatory response

    Directory of Open Access Journals (Sweden)

    Zivkovic AR

    2016-11-01

    Full Text Available Aleksandar R Zivkovic, Jochen Bender, Thorsten Brenner, Stefan Hofer,* Karsten Schmidt* Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany *These authors contributed equally to this work Purpose: Early diagnosis of systemic inflammatory response syndrome is fundamentally important for an effective and a goal-directed therapy. Various inflammation biomarkers have been used in clinical and experimental practice. However, a definitive diagnostic tool for an early detection of systemic inflammation remains to be identified. Acetylcholine (Ach has been shown to play an important role in the inflammatory response. Serum cholinesterase (butyrylcholinesterase [BChE] is the major Ach hydrolyzing enzyme in blood. The role of this enzyme during inflammation has not yet been fully understood. This study tests whether a reduction in the BChE activity could indicate the onset of the systemic inflammatory response upon traumatic injury. Patients and methods: This observational study measured BChE activity in patients with traumatic injury admitted to the emergency room by using point-of-care-test system (POCT. In addition, the levels of routine inflammation biomarkers during the initial treatment period were measured. Injury Severity Score was used to assess the trauma severity. Results: Altered BChE activity was correlated with trauma severity, resulting in systemic inflammation. Reduction in the BChE activity was detected significantly earlier compared to those of routinely measured inflammatory biomarkers. Conclusion: This study suggests that the BChE activity reduction might serve as an early indicator of acute systemic inflammation. Furthermore, BChE activity, measured using a POCT system, might play an important role in the early diagnosis of the trauma-induced systemic inflammation. Keywords: trauma, injury, early diagnostics, cholinergic, pseudocholinesterase, SIRS

  12. 18F-FDG PET/CT-based early treatment response evaluation of nanoparticle-assisted photothermal cancer therapy

    DEFF Research Database (Denmark)

    Norregaard, Kamilla; Jørgensen, Jesper T.; Simón, Marina

    2017-01-01

    Within the field of nanoparticle-assisted photothermal cancer therapy, focus has mostly been on developing novel heat-generating nanoparticles with the right optical and dimensional properties. Comparison and evaluation of their performance in tumor-bearing animals are commonly assessed by changes...... in tumor volume; however, this is usually a late-occurring event. This study implements 2-deoxy-2-[F-18]fluoro-D-glucose positron emission tomography imaging to perform early evaluation of the treatment outcome of photothermal therapy. Silica-gold nanoshells (NS) are administered intravenously to nude mice...

  13. Direct anti-atherosclerotic therapy; development of natural anti-atherosclerotic drugs preventing cellular cholesterol retention.

    Science.gov (United States)

    Orekhov, Alexander N

    2013-01-01

    The results of numerous clinical trials with statins and other drugs have demonstrated the principal possibility of the prevention and regression of atherosclerosis by pharmacotherapy. This review describes the use of cultured human arterial cells for the mass screening of anti-atherosclerotic substances, the investigation of the mechanisms responsible for their atherosclerosis-related effects, and the optimization of anti-atherosclerotic and anti-atherogenic drug and dietary therapies. Natural products can be considered promising drugs for anti-atherosclerotic therapy. Our basic studies have shown that cellular lipidosis is the principal event in the genesis of atherosclerotic lesions. Using cellular models and natural products, we have developed an approach to prevent lipid accumulation in arterial cells. Based on our knowledge of atherosclerosis, we developed drugs that possess direct anti-atherosclerotic activity. Two-year treatment with allicor (garlic powder) has a direct anti-atherosclerotic effect on carotid atherosclerosis in asymptomatic men. Inflaminat (calendula, elder, and violet), which possesses anti-cytokine activity, has been shown to cause the regression of carotid atherosclerosis following the treatment of asymptomatic men for one year. The phytoestrogen-rich drug karinat (garlic powder, extract of grape seeds, green tea leaves, hop cones, β-carotene, α-tocopherol, and ascorbic acid) prevents the development of carotid atherosclerosis in postmenopausal women. Thus, our basic findings were successfully translated into clinical practice. Because of this translation, a novel approach to antiatherosclerotic therapy was developed. Our clinical trial confirmed the efficacy of both the novel approach and the novel drugs.

  14. Which cue to ‘want’? Opioid stimulation of central amygdala makes goal-trackers show stronger goal-tracking, just as sign-trackers show stronger sign-tracking

    Science.gov (United States)

    DiFeliceantonio, Alexandra G.; Berridge, Kent C.

    2012-01-01

    Pavlovian cues that have been paired with reward can gain incentive salience. Drug addicts find drug cues motivationally attractive and binge eaters are attracted by food cues. But the level of incentive salience elicited by a cue re-encounter still varies across time and brain states. In an animal model, cues become attractive and ‘wanted’ in an ‘autoshaping’ paradigm, where different targets of incentive salience emerge for different individuals. Some individuals (sign-trackers) find a predictive discrete cue attractive while others find a reward contiguous and goal cue more attractive (location where reward arrives: goal-trackers). Here we assessed whether central amygdala mu opioid receptor stimulation enhances the phasic incentive salience of the goal-cue for goal-trackers during moments of predictive cue presence (expressed in both approach and consummatory behaviors to goal cue), just as it enhances the attractiveness of the predictive cue target for sign-trackers. Using detailed video analysis we measured the approaches, nibbles, sniffs, and bites directed at their preferred target for both sign-trackers and goal-trackers. We report that DAMGO microinjections in central amygdala made goal-trackers, like sign-trackers, show phasic increases in appetitive nibbles and sniffs directed at the goal-cue expressed selectively whenever the predictive cue was present. This indicates enhancement of incentive salience attributed by both goal trackers and sign-trackers, but attributed in different directions: each to their own target cue. For both phenotypes, amygdala opioid stimulation makes the individual’s prepotent cue into a stronger motivational magnet at phasic moments triggered by a CS that predicts the reward UCS. PMID:22391118

  15. Therapeutic misconception in early phase gene transfer trials.

    Science.gov (United States)

    Henderson, Gail E; Easter, Michele M; Zimmer, Catherine; King, Nancy M P; Davis, Arlene M; Rothschild, Barbra Bluestone; Churchill, Larry R; Wilfond, Benjamin S; Nelson, Daniel K

    2006-01-01

    Many subjects in early phase clinical trials expect to benefit in some way from the research intervention. It is understandable that people hope for improvement in their condition, no matter what the evidence. Yet unreasonable expectation of medical benefit may reflect problems with informed consent: Investigators may not disclose clearly that direct medical benefit from an early phase experimental intervention is unlikely or impossible, or subjects may not appreciate the differences between treatment and research. This paper presents findings from recent interviews with researchers and subjects and analysis of consent forms in early phase gene transfer research, a cutting-edge technology often called 'gene therapy'. We use three variables to construct a composite measure of therapeutic misconception TM, tapping misconceptions about the purposes of early phase research and the potential for direct medical benefit in these trials. Our multivariate model demonstrates the importance of both subject- and study-level factors as predictors of this TM index: education, disease type, and communication by study personnel about the likelihood of benefit. We hope that this work will deepen the discussion of how to define and measure TM, and refine the specification of factors that are related to subjects' TM.

  16. An analysis of budgetary goals impacting organizational performance

    Directory of Open Access Journals (Sweden)

    Cheok MUI YEE

    2016-05-01

    Full Text Available This study proposes a conceptual review of how budgetary goals impact organizational performance. The aim of this study is to get a better understanding of the direct and indirect relationship between the organization’s decision-making process and operational performances. Setting the budget particularly influences subordinates’ budget goal levels and motivations (i.e., budget goal acceptance and budget goal commitment, which ultimately enhances the organization’s performance. To test these relationships, data were collected using the three perspectives approach: budgetary goal, budgetary participation and budgetary evaluation. The study provided evidence that perception of fairness mediates the relation between the levels of budget participation and goal commitment, whereas goal commitment mediates the relation between fairness perceptions and performance. At the end of the article, there are some implications for SMEs industries and some suggestions for future studies.

  17. Non-goal-directed recall of specific events in apes after long delays.

    Science.gov (United States)

    Lewis, Amy; Call, Josep; Berntsen, Dorthe

    2017-07-12

    We examined if apes spontaneously remember one-time, distinctive events across long delays when probed by discriminant cues. Apes witnessed an experimenter hide a cache of food, which they could then retrieve. They retrieved one of two food types; one more distinctive than the other. Two, 10 or 50 weeks later, the apes returned to the same enclosure and found a piece of the previously hidden food on the ground. An experimenter who had not hidden the food was also present. Apes immediately searched the location where the food was previously hidden (no food was here), showing recall of the event. One week later, apes returned to the same enclosure, with the same food on the ground, but now the experimenter that had hidden the food was present. Again, apes immediately searched the hiding location. Apes that had not witnessed the hiding event did not search. There was no significant effect of food type, and retention declined from exposure to the two-week delay, then levelled, consistent with the forgetting curve in humans (Ebbinghaus, H. 1964 Memory: a contribution to experimental psychology (transl. H.A. Ruger & C.E. Bussenvis). New York, NY: Dover. (Original work published 1885.)). This is the first study to show apes can recall a one-time, non-goal-directed event longer than two weeks ago and that apes' recall declines in accordance with a standard retention function. © 2017 The Author(s).

  18. External and internal radiation therapy: Past and future directions

    Directory of Open Access Journals (Sweden)

    Sadeghi Mahdi

    2010-01-01

    Full Text Available Cancer is a leading cause of morbidity and mortality in the modern world. Treatment modalities comprise radiation therapy, surgery, chemotherapy and hormonal therapy. Radiation therapy can be performed by using external or internal radiation therapy. However, each method has its unique properties which undertakes special role in cancer treatment, this question is brought up that: For cancer treatment, whether external radiation therapy is more efficient or internal radiation therapy one? To answer this question, we need to consider principles and structure of individual methods. In this review, principles and application of each method are considered and finally these two methods are compared with each other.

  19. The Trajectory of Popularity Goal during the Transition to Middle School

    Science.gov (United States)

    Dawes, Molly; Xie, Hongling

    2017-01-01

    The trajectory of early adolescents' popularity goal during the transition to middle school was examined in a diverse sample of 401 students. Popularity goal was assessed at five time points from the spring semester of fifth grade through the spring semester of seventh grade with the transition to middle school occurring between the fifth and…

  20. Assessment of Early Toxicity and Response in Patients Treated With Proton and Carbon Ion Therapy at the Heidelberg Ion Therapy Center Using the Raster Scanning Technique

    Energy Technology Data Exchange (ETDEWEB)

    Rieken, Stefan; Habermehl, Daniel; Nikoghosyan, Anna; Jensen, Alexandra [Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg (Germany); Haberer, Thomas [Heidelberg Ion Therapy Center, Heidelberg (Germany); Jaekel, Oliver [Heidelberg Ion Therapy Center, Heidelberg (Germany); Department of Medical Physics, German Cancer Research Center (DKFZ), Heidelberg (Germany); Muenter, Marc W.; Welzel, Thomas; Debus, Juergen [Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg (Germany); Combs, Stephanie E., E-mail: Stephanie.Combs@med.uni-hedielberg.de [Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg (Germany)

    2011-12-01

    Puropose: To asses early toxicity and response in 118 patients treated with scanned ion beams to validate the safety of intensity-controlled raster scanning at the Heidelberg Ion Therapy Center. Patients and Methods: Between November 2009 and June 2010, we treated 118 patients with proton and carbon ion radiotherapy (RT) using active beam delivery. The main indications included skull base chordomas and chondrosarcomas, salivary gland tumors, and gliomas. We evaluated early toxicity within 6 weeks after RT and the initial clinical and radiologic response for quality assurance in our new facility. Results: In all 118 patients, few side effects were observed, in particular, no high numbers of severe acute toxicity were found. In general, the patients treated with particle therapy alone showed only a few single side effects, mainly Radiation Therapy Oncology Group/Common Terminology Criteria grade 1. The most frequent side effects and cumulative incidence of single side effects were observed in the head-and-neck patients treated with particle therapy as a boost and photon intensity-modulated RT. The toxicities included common radiation-attributed reactions known from photon RT, including mucositis, dysphagia, and skin erythema. The most predominant imaging responses were observed in patients with high-grade gliomas and those with salivary gland tumors. For skull base tumors, imaging showed a stable tumor outline in most patients. Thirteen patients showed improvement of pre-existing clinical symptoms. Conclusions: Side effects related to particle treatment were rare, and the overall tolerability of the treatment was shown. The initial response was promising. The data have confirmed the safe delivery of carbon ions and protons at the newly opened Heidelberg facility.

  1. History of music therapy treatment interventions for children with autism.

    Science.gov (United States)

    Reschke-Hernández, Alaine E

    2011-01-01

    The purpose of this paper is to provide a systematic review of the history of music therapy research and treatment of children with autism. Understanding such history is important in order to improve clinical efficacy and inform future research. This paper includes a history of autism diagnosis, reviews strengths and limitations of music therapy practice with children with autism from 1940-2009, and suggests direction for future music therapy research and clinical practice with this population. Literature was limited to the English language and obtained with the following search terms: autism, autistic, (early) infantile autism, child, therapeutic music, musical therapy, and music therapy. Table of contents from music therapy journals were searched, and reference lists from obtained articles were perused for additional articles. This historical review focused primarily on journal articles, however, books and book chapters that appeared to hold particular historical significance were also included.

  2. Preparatory Training, States of Goal Orientation, and Mentoring Relationship Effectiveness

    Science.gov (United States)

    Scielzo, Shannon; Neeper, Michael; Smith-Jentsch, Kimberly A.

    2012-01-01

    We used an online academic-advising program to examine the effects of preparatory training designed to elicit high states of learning-goal orientation and low states of avoid goal orientation. Results indicate that training was effective in some cases for manipulating states of goal orientation. The training did not directly affect behaviors as…

  3. Treatment of Laryngeal Radionecrosis with Hyperbaric Oxygen Therapy: A Case Report

    Directory of Open Access Journals (Sweden)

    Ying-Che Hsu

    2005-02-01

    Full Text Available An 81-year-old male with early-stage laryngeal carcinoma had been treated with 60 Gy curative radiotherapy. He complained of a sore throat, foul odor in the mouth, progressive dyspnea, and fever 2 months after the completion of radiotherapy. Direct laryngoscopy revealed narrowing of the glottis with diffuse ulcerative necrotic tissue. Biopsies at multiple sites and pathology revealed intense coagulation necrosis with complete denudation of covering epithelium without any malignancy. Since laryngeal radionecrosis was suspected, the patient received hyperbaric oxygen (HBO therapy 40 times for 1 hour of 100% O2 at 2 atm absolute pressure. His clinical symptoms gradually improved and repeated endolaryngeal biopsies were undertaken near the end of HBO therapy and again 6 months later. The patient's larynx healed completely with diffuse fibrosis and no malignant cells were found on pathology. Radionecrosis must be differentiated from cancer recurrence following curative radiotherapy for early laryngeal cancer. HBO therapy could be a useful treatment adjunct for laryngeal radionecrosis.

  4. Mental Representation and Early Language Development: Directions for Exploring Relationships. Souvenir of Conversation Hour.

    Science.gov (United States)

    Nicolich, Lorraine McCune; And Others

    This collection of conference abstracts focuses on new directions for research on mental representation and early language development. One page summaries are provided on the following topics: Mental Representation and Initial Language Learning, by Lorraine M. Nicolich; Critical Issues in Language and Cognitive Development, by Roberta Corrigan;…

  5. Does extrinsic goal framing enhance extrinsic goal-oriented individuals' learning and performance? An experimental test of the match perspective versus self-determination theory

    OpenAIRE

    Vansteenkiste, Maarten; Timmermans, Tinneke; Lens, Willy; Soenens, Bart; Van den Broeck, Anja

    2008-01-01

    Previous work within self-determination theory has shown that experimentally framing a learning activity in terms of extrinsic rather than intrinsic goals results in poorer conceptual learning and performance, presumably because extrinsic goal framing detracts attention from the learning activity and is less directly satisfying of basic psychological needs. According to the match perspective, experimental extrinsic, compared to intrinsic, goal framing should enhance learning and performance f...

  6. Pediatric Music Therapy.

    Science.gov (United States)

    Lathom-Radocy, Wanda B.

    This book on music therapy includes relevant medical, psychological, and developmental information to help service providers, particularly music therapists, and parents to understand children with disabilities. The first two chapters describe the process of assessment and delineation of goals in music therapy that leads to the design of the music…

  7. Current therapy for Parkinson's disease

    Directory of Open Access Journals (Sweden)

    A. V. Obukhova

    2014-01-01

    Full Text Available The main goal of therapy for Parkinson's disease (PD is to correct dopamine deficiency in the nigrostriatal system. Levodopa preparations and dopamine receptor agonists (DRAs that are prescribed with regards to patient age and disease severity are mainly used now. Notwithstanding the fact that levodopa preparations are the gold standard of therapy, their long-term use gives rise to complications as motor fluctuations and drug-induced dyskinesias. The currently available DRAs are the drugs of choice for the therapy of early-stage PD as they are as effective as levodopa preparations. In extensive-stage PD, DRAs are used to enhance the therapy and correction of developed motor fluctuations and dyskinesias. Pramipexole is one of the most commonly used representatives of non-ergoline DRAs. The paper analyzes the efficacy of the medication used as both monotherapy and part of combined therapy, its effect on tremor and depression in PD. A novel extended-release formulation of pramipexole is considered separately. Both immediate- and extended-release pramipexole formulations contain the same active ingredient and have the same dopamine-receptor interaction profile, but differ in the tablet release rate of the active ingredient. The advantages of the novel formulation are its more steady-state plasma concentration and 24-hour action, which ensures continuous dopaminergic stimulation ofpostsynaptic receptors to prevent and treat already developed motor complications. The once-daily extended-release formulation of the drug makes its treatment regimen easier and patient compliance higher.

  8. Computer-assisted detection (CAD) methodology for early detection of response to pharmaceutical therapy in tuberculosis patients

    Science.gov (United States)

    Lieberman, Robert; Kwong, Heston; Liu, Brent; Huang, H. K.

    2009-02-01

    The chest x-ray radiological features of tuberculosis patients are well documented, and the radiological features that change in response to successful pharmaceutical therapy can be followed with longitudinal studies over time. The patients can also be classified as either responsive or resistant to pharmaceutical therapy based on clinical improvement. We have retrospectively collected time series chest x-ray images of 200 patients diagnosed with tuberculosis receiving the standard pharmaceutical treatment. Computer algorithms can be created to utilize image texture features to assess the temporal changes in the chest x-rays of the tuberculosis patients. This methodology provides a framework for a computer-assisted detection (CAD) system that may provide physicians with the ability to detect poor treatment response earlier in pharmaceutical therapy. Early detection allows physicians to respond with more timely treatment alternatives and improved outcomes. Such a system has the potential to increase treatment efficacy for millions of patients each year.

  9. Early use of negative pressure therapy in combination with silver dressings in a difficult breast abscess.

    Science.gov (United States)

    Richards, Alastair J; Hagelstein, Sue M; Patel, Girish K; Ivins, Nicola M; Sweetland, Helen M; Harding, Keith G

    2011-12-01

    Combining silver-based dressings with negative pressure therapy after radical excision of chronically infected breast disease is a novel application of two technologies. One patient with complex, chronic, infected breast disease underwent radical excision of the affected area and was treated early with a combination of silver-based dressings and topical negative pressure therapy. The wound was then assessed sequentially using clinical measurements of wound area and depth, pain severity scores and level of exudation. It is possible to combine accepted techniques with modern dressing technologies that result in a positive outcome. In this case, the combination of a silver-based dressing with negative pressure therapy following radical excision proved safe and was well tolerated by the patient. Full epithelisation of the wound was achieved and there was no recurrence of the infection for the duration of the treatment. © 2011 The Authors. © 2011 Blackwell Publishing Ltd and Medicalhelplines.com Inc.

  10. Comparison of dose-volume histograms for Tomo therapy, linear accelerator-based 3D conformal radiation therapy, and intensity-modulated radiation therapy

    International Nuclear Information System (INIS)

    Ji, Youn-Sang; Dong, Kyung-Rae; Kim, Chang-Bok; Choi, Seong-Kwan; Chung, Woon-Kwan; Lee, Jong-Woong

    2011-01-01

    Highlights: → Evaluation of DVH from 3D CRT, IMRT and Tomo therapy was conducted for tumor therapy. → The doses of GTV and CTV were compared using DVHs from 3D CRT, IMRT and Tomo therapy. → The GTV was higher when Tomo therapy was used, while the doses of critical organ were low. → They said that Tomo therapy satisfied the goal of radiation therapy more than the others. - Abstract: Evaluation of dose-volume histograms from three-dimensional conformal radiation therapy (3D CRT), intensity-modulated radiation therapy (IMRT), and Tomo therapy was conducted. These three modalities are among the diverse treatment systems available for tumor therapy. Three patients who received tumor therapy for a malignant oligodendroglioma in the cranium, nasopharyngeal carcinoma in the cervical neck, and prostate cancer in the pelvis were selected as study subjects. Therapy plans were made for the three patients before dose-volume histograms were obtained. The doses of the gross tumor volume (GTV) and the clinical target volume (CTV) were compared using the dose-volume histograms obtained from the LINAC-based 3D CRT, IMRT planning station (Varian Eclipse-Varian, version 8.1), and Tomo therapy planning station. In addition, the doses of critical organs in the cranium, cervix, and pelvis that should be protected were compared. The GTV was higher when Tomo therapy was used compared to 3D CRT and the LINAC-based IMRT, while the doses of critical organ tissues that required protection were low. These results demonstrated that Tomo therapy satisfied the ultimate goal of radiation therapy more than the other therapies.

  11. Goal-directed hemostatic resuscitation for massively bleeding patients: the Copenhagen concept

    DEFF Research Database (Denmark)

    Johansson, Pär I

    2010-01-01

    Continued hemorrhage remains a major cause of mortality in massively transfused patients, many of whom develop coagulopathy. A review of transfusion practice for these patients at our hospital revealed that a significant proportion received suboptimal transfusion therapy. Survivors had higher pla...

  12. Training of goal directed arm movements with motion interactive video games in children with cerebral palsy - a kinematic evaluation.

    Science.gov (United States)

    Sandlund, Marlene; Domellöf, Erik; Grip, Helena; Rönnqvist, Louise; Häger, Charlotte K

    2014-10-01

    The main aim of this study was to evaluate the quality of goal-directed arm movements in 15 children with cerebral palsy (CP) following four weeks of home-based training with motion interactive video games. A further aim was to investigate the applicability and characteristics of kinematic parameters in a virtual context in comparison to a physical context. Kinematics and kinetics were captured while the children performed arm movements directed towards both virtual and physical targets. The children's movement precision improved, their centre of pressure paths decreased, as did the variability in maximal shoulder angles when reaching for virtual objects. Transfer to a situation with physical targets was mainly indicated by increased movement smoothness. Training with motion interactive games seems to improve arm motor control in children with CP. The results highlight the importance of considering both the context and the task itself when investigating kinematic parameters.

  13. Unimanual versus bimanual therapy in children with unilateral cerebral palsy: Same, same, but different.

    Science.gov (United States)

    Hoare, Brian; Greaves, Susan

    2017-01-01

    There is high-level evidence supporting constraint-induced movement therapy (CIMT) and bimanual therapy for children with unilateral cerebral palsy. Evidence-based intervention includes time-limited, goal-directed, skills-based, intensive blocks of practice based on motor learning theory. Using supporting literature and clinical insight, we provide a theoretical rationale to highlight previously unreported differences between CIMT and bimanual therapy. The current emphasis on total dosage of practice for achieving positive outcomes fails to recognise the influence of other critical concepts within motor learning. Limitations exist in the application of motor learning principles using CIMT due to its unimanual nature. CIMT is effective for development of unimanual actions brought about by implicit learning, however it is difficult to target explicit learning that is required for learning how to use two hands together. Using bimanual therapy, object properties can be adapted to trigger goal-related perceptual and cognitive processes required for children to learn to recognise when two hands are required for task completion. CIMT and bimanual should be viewed as complementary. CIMT could be used to target unimanual actions. Once these actions are established, bimanual therapy could be used for children to learn how to use these actions for bimanual skill development.

  14. Music therapy research in the NICU: an updated meta-analysis.

    Science.gov (United States)

    Standley, Jayne

    2012-01-01

    To provide an overview of developmental and medical benefits of music therapy for preterm infants. Meta-analysis. Empirical music studies with preterm infants in the neonatal intensive care unit (NICU). Evidence-based NICU music therapy (NICU -MT ) was highly beneficial with an overall large significant effect size (Cohen's d = 0.82). Effects because of music were consistently in a positive direction. Results of the current analysis replicated findings of a prior meta-analysis and included extended use of music.(1) Benefits were greatest for live music therapy (MT ) and for use early in the infant's NICU stay (birth weight music listening for pacification, music reinforcement of sucking, and music pacification as the basis for multilayered, multimodal stimulation.

  15. High-flow nasal cannula therapy for adult patients

    Science.gov (United States)

    Zhang, Jian; Lin, Ling; Pan, Konghan; Zhou, Jiancang

    2016-01-01

    High-flow nasal cannula (HFNC) oxygen therapy has several physiological advantages over traditional oxygen therapy devices, including decreased nasopharyngeal resistance, washing out of the nasopharyngeal dead space, generation of positive pressure in the pharynx, increasing alveolar recruitment in the lungs, humidification of the airways, increased fraction of inspired oxygen and improved mucociliary clearance. Recently, the use of HFNC in treating adult critical illness patients has significantly increased, and it is now being used in many patients with a range of different disease conditions. However, there are no established guidelines to direct the safe and effective use of HFNC for these patients. This review article summarizes the available published literature on the positive physiological effects, mechanisms of action, and the clinical applications of HFNC, compared with t