WorldWideScience

Sample records for early medication change

  1. Why change habits? Early modern medical innovation between medicalisation and medical culture.

    Science.gov (United States)

    Loetz, Francisca

    2010-01-01

    Based on a discussion of the concept of medicalisation and medical culture in Anglo-American, French-, and German-speaking historiography the paper argues that medical innovation in Europe from the sixteenth to the mid-nineteenth century should be approached in a different way. Instead of asking from the perspective of a too narrow concept of medicalisation why medical innovations were rejected by the population, (medical) historians should analyse medical culture and ask why people should have changed their health and illness behaviour. This conceptual argument is deduced from four empirical examples: the introduction of smallpox vaccination, "medical police," the problem of medical professionalization, and the questions arising around the relations between the healthy/sick and their practitioners.

  2. Neurosurgery Elective for Preclinical Medical Students: Early Exposure and Changing Attitudes.

    Science.gov (United States)

    Zuckerman, Scott L; Mistry, Akshitkumar M; Hanif, Rimal; Chambless, Lola B; Neimat, Joseph S; Wellons, John C; Mocco, J; Sills, Allen K; McGirt, Matthew J; Thompson, Reid C

    2016-02-01

    Exposure to surgical subspecialties is limited during the preclinical years of medical school. To offset this limitation, the authors created a neurosurgery elective for first- and second-year medical students. The objective was to provide each student with early exposure to neurosurgery by combining clinical experience with faculty discussions about the academic and personal realities of a career in neurosurgery. From 2012 to 2013, the authors offered a neurosurgery elective course to first- and second-year medical students. Each class consisted of the following: 1) peer-reviewed article analysis; 2) student presentation; 3) faculty academic lecture; 4) faculty personal lecture with question and answer period. Thirty-five students were enrolled over a 2-year period. After completing the elective, students were more likely to: consider neurosurgery as a future career (P life to be higher (P life, and family-work balance, while not altering the students' views about the difficulty of training. Adopting a neurosurgery elective geared towards preclinical medical students can significantly change attitudes about the field of neurosurgery and has potential to increase interest in pursuing a career in neurosurgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. The Process of Change in Cognitive Therapy for Depression when Combined with Antidepressant Medication: Predictors of Early Intersession Symptom Gains

    Science.gov (United States)

    Strunk, Daniel R.; Cooper, Andrew A.; Ryan, Elizabeth T.; DeRubeis, Robert J.; Hollon, Steven D.

    2012-01-01

    Objective: Previous studies of cognitive therapy (CT) for depression have examined therapist adherence and the therapeutic alliance as predictors of subsequent symptom change. However, little is known about these CT process variables when CT is delivered in combination with antidepressant medication. Method: In a sample of 176 depressed…

  4. Predictors of medical student remediation and their underlying causes: early lessons from a curriculum change in the University of Auckland Medical Programme.

    Science.gov (United States)

    Grainger, Brian; Yielder, Jill; Reid, Papaarangi; Bagg, Warwick

    2017-08-11

    The purpose of this study was to identify predictors of remediation in a medical programme and assess the underlying causes and the quality of remediation provided within the context of a recent curriculum change. A mixed methods study incorporating a retrospective cohort analysis of demographic predictors of remediation during 2013 and 2014, combined with thematic qualitative analysis of educator perspectives derived by interview on factors underlying remediation and the quality of that currently provided by the faculty. 17.7% of all students required some form of remedial assistance and 93% of all students offered remediation passed their year of study. Multivariate analysis showed international students (OR 4.59 95% CI 2.62-7.98) and students admitted via the Māori and Pacific Admission Scheme (OR 3.43 2.29-5.15) were significantly more likely to require remediation. Male students were also slightly more likely than their female classmates to require assistance. No effect was observed for rural origin students, completion of a prior degree or completion of clinical placement in a peripheral hospital. Knowledge application and information synthesis were the most frequently identified underlying problems. Most faculty believed remediation was successful, however, flexibility in the programme structure, improved diagnostics and improved access to dedicated teaching staff were cited as areas for improvement. Remediation is required by nearly a fifth of University of Auckland medical students, with MAPAS and international students being particularly vulnerable groups. Remediation is largely successful, however, interventions addressing reasoning and knowledge application may improve its effectiveness.

  5. The Impact of Health Changes on Labor Supply: Evidence from Merged Data on Individual Objective Medical Diagnosis Codes and Early Retirement Behavior

    DEFF Research Database (Denmark)

    Christensen, Bent Jesper; Kallestrup-Lamb, Malene

    2012-01-01

    The justification bias in the estimated impact of health shocks on retirement is mitigated by using objective health measures from a large, register-based longitudinal data set including medical diagnosis codes, along with labor market status, financial, and socio-economic variables. The duration...... until retirement is modeled using single and competing risk specifications, observed and unobserved heterogeneity, and flexible baseline hazards. Wealth is used as a proxy for elapsed duration to mitigate the potential selection bias stemming from conditioning on initial participation. The competing...... risk specification distinguishes complete multi-period routes to retirement, such as unemployment followed by early retirement. A result on comparison of coefficients across all states is offered. The empirical results indicate a strong impact of health changes on retirement, and hence a large...

  6. Medical education: Changes and perspectives

    Science.gov (United States)

    Zhang, Qin; Lee, Liming; Gruppen, Larry D.; Ba, Denian

    2013-01-01

    As medical education undergoes significant internationalization, it is important for the medical education community to understand how different countries structure and provide medical education. This article highlights the current landscape of medical education in China, particularly the changes that have taken place in recent years. It also examines policies and offers suggestions about future strategies for medical education in China. Although many of these changes reflect international trends, Chinese medical education has seen unique transformations that reflect its particular culture and history. PMID:23631405

  7. Medical specialty preferences in early medical school training in Canada.

    Science.gov (United States)

    Vo, Anthony; McLean, Laurie; McInnes, Matthew D F

    2017-11-14

    To understand what medical students consider when choosing their specialty, prior to significant clinical exposure to develop strategies to provide adequate career counseling. A cross-sectional study was performed by distributing optional questionnaires to 165 first-year medical students at the University of Ottawa in their first month of training with a sample yield of 54.5% (n=90).  Descriptive statistics, analysis of variance, Spearman's rank correlation, Cronbach's alpha coefficient, Kaiser-Meyer-Olkin Measure, and exploratory factor analyses were used to analyze the anonymized results. "Job satisfaction", "lifestyle following training" and, "impact on the patient" were the three highest rated considerations when choosing a specialty.  Fifty-two and seventeen percent (n=24) and 57.89% (n=22) of males and females ranked non-surgical specialties as their top choice. Student confidence in their specialty preferences was moderate, meaning their preference could likely change (mean=2.40/5.00, SD=1.23). ANOVA showed no significant differences between confidence and population size (F(2,86)=0.290, p=0.75) or marital status (F(2,85)=0.354, p=0.70) in both genders combined. Five underlying factors that explained 44.32% of the total variance were identified. Five themes were identified to enhance career counseling. Medical students in their first month of training have already considered their specialty preferences, despite limited exposure. However, students are not fixed in their specialty preference. Our findings further support previous results but expand what students consider when choosing their specialty early in their training. Medical educators and administrators who recognize and understand the importance of these considerations may further enhance career counseling and medical education curricula.

  8. Early medical abortion with methotrexate and misoprostol.

    Science.gov (United States)

    Borgatta, L; Burnhill, M S; Tyson, J; Leonhardt, K K; Hausknecht, R U; Haskell, S

    2001-01-01

    To evaluate the introduction of an early medical abortion program with methotrexate and misoprostol, using a standardized protocol. A total of 1973 women at 34 Planned Parenthood sites participated in a case series of early medical abortion. Ultrasound was used to confirm gestational age of less than 49 days from the first day of the last menstrual period. Women were given intramuscular methotrexate 50 mg/m(2) of body surface area on day 1, and then they inserted misoprostol 800 microg vaginally at home on day 5, 6, or 7. Women were advised to have a suction curettage if the pregnancy appeared viable 2 weeks after methotrexate or if any gestational sac persisted 4 weeks after methotrexate. Outcomes were complete medical abortion and suction curettage. Sixteen hundred fifty-nine women (84.1%) had a complete medical abortion, and 257 (13.0%) had suction curettage. The most common reason for curettage was patient option (8.9%). At 2 weeks after methotrexate use, 1.4% of women had curettage because of a viable pregnancy; at 4 weeks, 1.6% of women had curettage because of a persistent but nonviable pregnancy. One percent of women had curettage because of physician recommendation, most commonly for bleeding. Suction curettage rates decreased with site experience (P <.006) and were lower at early gestational ages (P <.004) and in nulliparous women (P <.004). Medical abortion with methotrexate and misoprostol is safe and effective and can be offered in a community setting.

  9. Antipsychotic medication for early episode schizophrenia

    Science.gov (United States)

    Bola, John; Kao, Dennis; Soydan, Haluk; Adams, Clive E

    2014-01-01

    Background Long-term treatment with antipsychotic medications in early episode schizophrenia spectrum disorders is common, but both short and long-term effects on the illness are unclear. There have been numerous suggestions that people with early episodes of schizophrenia appear to respond differently than those with multiple prior episodes. The number of episodes may moderate response to drug treatment. Objectives To assess the effects of antipsychotic medication treatment on people with early episode schizophrenia spectrum disorders. Search methods We searched the Cochrane Schizophrenia Group register (July 2007) as well as references of included studies. We contacted authors of studies for further data. Selection criteria Studies with a majority of first and second episode schizophrenia spectrum disorders comparing initial antipsychotic medication treatment with placebo, milieu, or psychosocial treatment. Data collection and analysis Working independently, we critically appraised records from 681 studies, of which five studies met inclusion criteria. We calculated risk ratios (RR) and their 95% confidence intervals (CI) where possible. For continuous data, we calculated mean difference (MD). We calculated numbers needed to treat/harm (NNT/NNH) where appropriate. Main results Five studies (combined total n=998) met inclusion criteria. Four studies (n=724) provided leaving the study early data and results suggested that individuals treated with a typical antipsychotic medication are less likely to leave the study early than those treated with placebo (Chlorpromazine: 3 RCTs n=353, RR 0.4 CI 0.3 to 0.5, NNT 3.2, Fluphenaxine: 1 RCT n=240, RR 0.5 CI 0.3 to 0.8, NNT 5; Thioridazine: 1 RCT n=236, RR 0.44 CI 0.3 to 0.7, NNT 4.3, Trifulperazine: 1 RCT n=94, RR 0.96 CI 0.3 to 3.6). Two studies contributed data to assessment of adverse effects and present a general pattern of more frequent side effects among individuals treated with typical antipsychotic medications

  10. Early experiences with big data at an academic medical center.

    Science.gov (United States)

    Halamka, John D

    2014-07-01

    Beth Israel Deaconess Medical Center (BIDMC), an academic health care institution affiliated with Harvard University, has been an early adopter of electronic applications since the 1970s. Various departments of the medical center and the physician practice groups affiliated with it have implemented electronic health records, filmless imaging, and networked medical devices to such an extent that data storage at BIDMC now amounts to three petabytes and continues to grow at a rate of 25 percent a year. Initially, the greatest technical challenge was the cost and complexity of data storage. However, today the major focus is on transforming raw data into information, knowledge, and wisdom. This article discusses the data growth, increasing importance of analytics, and changing user requirements that have shaped the management of big data at BIDMC. Project HOPE—The People-to-People Health Foundation, Inc.

  11. Medical students' professional identity development in an early nursing attachment

    NARCIS (Netherlands)

    Helmich, Esther; Derksen, Els; Prevoo, Mathieu; Laan, Roland; Bolhuis, Sanneke; Koopmans, Raymond

    Objectives The importance of early clinical experience for medical training is well documented. However, to our knowledge there are no studies that assess the influence of very early nursing attachments on the professional development and identity construction of medical students. Working as an

  12. Medical students' professional identity development in an early nursing attachment.

    NARCIS (Netherlands)

    Helmich, E.; Derksen, E.; Prevoo, M.; Laan, R.F.J.M.; Bolhuis, S.; Koopmans, R.T.C.M.

    2010-01-01

    OBJECTIVES: The importance of early clinical experience for medical training is well documented. However, to our knowledge there are no studies that assess the influence of very early nursing attachments on the professional development and identity construction of medical students. Working as an

  13. The Impact of Health Changes on Labor Supply: Evidence from Merged Data on Individual Objective Medical Diagnosis Codes and Early Retirement Behavior

    DEFF Research Database (Denmark)

    Christensen, Bent Jesper; Kallestrup-Lamb, Malene

    2012-01-01

    The justification bias in the estimated impact of health shocks on retirement is mitigated by using objective health measures from a large, register-based longitudinal data set including medical diagnosis codes, along with labor market status, financial, and socio-economic variables. The duration...... until retirement is modeled using single and competing risk specifications, observed and unobserved heterogeneity, and flexible baseline hazards. Wealth is used as a proxy for elapsed duration to mitigate the potential selection bias stemming from conditioning on initial participation. The competing...

  14. The Impact of Health Changes on Labor Supply: Evidence from Merged Data on Individual Objective Medical Diagnosis Codes and Early Retirement Behavior

    DEFF Research Database (Denmark)

    Christensen, Bent Jesper; Kallestrup-Lamb, Malene

    with a host of demographic, labor market and financial regressors. The panel structure of the data allows following individuals year by year from the age of 50 and precisely measure changes in objectively measured health and other regressors, as well as labor market status. We consider 12 broad, mutually...

  15. Understanding Early Educators' Readiness to Change

    Science.gov (United States)

    Peterson, Shira M.

    2012-01-01

    Researchers in the fields of humanistic psychology, counseling, organizational change, and implementation science have been asking a question that is at the heart of today's early care and education quality improvement efforts: When it comes to changing one's behavior, what makes a person ready to change? Although the concept of readiness to…

  16. Medical Students' Attitudinal Changes towards Cadaver Dissection ...

    African Journals Online (AJOL)

    Background: Recently, not only the medical school curriculum but also medical students' attitude towards cadaver-based learning of anatomy has changed. This investigation is therefore designed to analyse students' attitudes towards human cadaveric dissection before and after exposure to dissection. Methods: A ...

  17. A chapter of early medical africana | Norwich | South African Medical ...

    African Journals Online (AJOL)

    Reference is also made to an interestino original medical volume to which Ten Rhyne contributed the use of acupuncture and scarification for the treatment of podagra (gout). A description of the physical methods used by the Hottentots of that period is illustrated from original engravings contained in the famous Kolbe ...

  18. The relation between antihistamine medication during early ...

    African Journals Online (AJOL)

    Rabah M. Shawky

    2015-05-11

    May 11, 2015 ... during early pregnancy & birth defects. Rabah M. Shawky a,. *, Neveen S. .... eration antihistamines targeting histamine – type 1 (H1) receptors. 2.1. ... can help in the treatment of inflammation in allergic airway disease [27]. ... mediated end points in animals that are given up to 120 times the human dose.

  19. Review of early assessment models of innovative medical technologies

    DEFF Research Database (Denmark)

    Fasterholdt, Iben; Krahn, Murray D; Kidholm, Kristian

    2017-01-01

    INTRODUCTION: Hospitals increasingly make decisions regarding the early development of and investment in technologies, but a formal evaluation model for assisting hospitals early on in assessing the potential of innovative medical technologies is lacking. This article provides an overview of models...

  20. Radiodiagnosis of early radiation intestinal changes

    International Nuclear Information System (INIS)

    Volodina, G.I.; Abdulkhakova, D.A.

    1987-01-01

    X-ray examination of the colon in 102 patients and of the small intestine in 62 was performed during combined radiation therapy of cervical cancer and at different time after its discontinuation. Early radiation functional and morphological changes in the ileum and colon were detected. Radiation changes in the ileac mucosa were noted in 52% of the patients, changes of various degree in the rectal, sigmoid and cecal mucosa were noted in 41.2%. Moderate radiation changes in the ascending, descending and horizontal parts of the colon were noted in 10.7%. Early radiation intestinal injuries in the form of erosions and ulcers were revealed in 5.8% of the patients. In most of the patients radiation intestinal changes were without noticeable clinical manifestations. All these patients could be defined as a group at risk of developing late radiation changes

  1. Early-life medical care and human capital accumulation

    DEFF Research Database (Denmark)

    Daysal, N. Meltem

    2015-01-01

    that both types of interventions may benefit not only child health but also long-term educational outcomes. In addition, early-life medical interventions may improve the educational outcomes of siblings. These findings can be used to design policies that improve long-term outcomes and reduce economic......Ample empirical evidence links adverse conditions during early childhood (the period from conception to age five) to worse health outcomes and lower academic achievement in adulthood. Can early-life medical care and public health interventions ameliorate these effects? Recent research suggests...

  2. Early characteristic radiographic changes in mucolipidosis II

    Energy Technology Data Exchange (ETDEWEB)

    Lai, Lillian M. [Lucile Packard Children' s Hospital and Stanford University, Pediatric Radiology, Palo Alto, CA (United States); Lachman, Ralph S. [Lucile Packard Children' s Hospital and Stanford University, Pediatric Radiology, Palo Alto, CA (United States); University of California, International Skeletal Dysplasia Registry, Los Angeles, CA (United States)

    2016-11-15

    Although mucolipidosis type II has similar metabolic abnormalities to those found in all the mucopolysaccharidoses and mucolipidoses, there are distinctive diagnostic radiographic changes of mucolipidosis II in the perinatal/newborn/infant period. To describe the early characteristic radiographic changes of mucolipidosis II and to document when these changes manifest and resolve. We retrospectively reviewed radiographs and clinical records of 19 cases of mucolipidosis II from the International Skeletal Dysplasia Registry (1971-present; fetal age to 21/2 years). A radiologist with special expertise in skeletal dysplasias evaluated the radiographs. The most common abnormalities were increased vertebral body height (80%, nonspecific), talocalcaneal stippling (86%), periosteal cloaking (74%) and vertebral body rounding (50%). Unreported findings included sacrococcygeal sclerosis (54%) and vertebral body sclerosis (13%). Rickets and hyperparathyroidism-like (pseudohyperparathyroidism) changes (rarely reported) were found in 33% of cases. These changes invariably started in the newborn period and resolved by 1 year of age. The conversion from these early infantile radiographic features to dysostosis multiplex changes occurred in 41% of cases, and within the first year after birth. Several findings strongly suggest the diagnosis of mucolipidosis II, including cloaking in combination with one or more of the following radiographic criteria: talocalcaneal stippling, sacrococcygeal or generalized vertebral body sclerosis, vertebral body rounding, or rickets/hyperparathyroidism-like changes in the perinatal/newborn/infancy period. These findings are not found in the other two forms of mucolipidosis nor in any of the mucopolysaccharidoses. (orig.)

  3. Early characteristic radiographic changes in mucolipidosis II

    International Nuclear Information System (INIS)

    Lai, Lillian M.; Lachman, Ralph S.

    2016-01-01

    Although mucolipidosis type II has similar metabolic abnormalities to those found in all the mucopolysaccharidoses and mucolipidoses, there are distinctive diagnostic radiographic changes of mucolipidosis II in the perinatal/newborn/infant period. To describe the early characteristic radiographic changes of mucolipidosis II and to document when these changes manifest and resolve. We retrospectively reviewed radiographs and clinical records of 19 cases of mucolipidosis II from the International Skeletal Dysplasia Registry (1971-present; fetal age to 21/2 years). A radiologist with special expertise in skeletal dysplasias evaluated the radiographs. The most common abnormalities were increased vertebral body height (80%, nonspecific), talocalcaneal stippling (86%), periosteal cloaking (74%) and vertebral body rounding (50%). Unreported findings included sacrococcygeal sclerosis (54%) and vertebral body sclerosis (13%). Rickets and hyperparathyroidism-like (pseudohyperparathyroidism) changes (rarely reported) were found in 33% of cases. These changes invariably started in the newborn period and resolved by 1 year of age. The conversion from these early infantile radiographic features to dysostosis multiplex changes occurred in 41% of cases, and within the first year after birth. Several findings strongly suggest the diagnosis of mucolipidosis II, including cloaking in combination with one or more of the following radiographic criteria: talocalcaneal stippling, sacrococcygeal or generalized vertebral body sclerosis, vertebral body rounding, or rickets/hyperparathyroidism-like changes in the perinatal/newborn/infancy period. These findings are not found in the other two forms of mucolipidosis nor in any of the mucopolysaccharidoses. (orig.)

  4. The early medical response to the Goiania accident

    International Nuclear Information System (INIS)

    Valverde, N.J.; Oliveira, A.R.

    2000-01-01

    The Goiania accident was the most severe radiological one that ever happened in the western hemisphere. The response to its human, social, environmental, economical and psychological burdens represented a huge challenge. Thanks to a multi-institutional intervention the consequences of the accident were greatly minimised. The medical response followed the same pattern and was based on a three-level system of progressive assistance. The early medical response encompassed medical and 'radiological' triage, admission to a specially prepared ward of a local hospital and treatment at a reference center in Rio de Janeiro. (author)

  5. Modeling determinants of medication attitudes and poor adherence in early nonaffective psychosis

    DEFF Research Database (Denmark)

    Drake, Richard J; Nordentoft, Merete; Haddock, Gillian

    2015-01-01

    the hypothesis that medication attitudes, while meaningfully different from "insight," correlated with insight and self-esteem, and change in each influenced the others. Rosenberg Self-Esteem Scale, Birchwood Insight Scale, and Positive and Negative Syndrome Scale insight were assessed at presentation, after 6...... medication attitudes, self-esteem, and insight in an early psychosis cohort better to understand their relationships. Existing longitudinal data from 309 patients with early Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, nonaffective psychosis (83% first episode) were analyzed to test...... five latent constructs best fitted the data: medication attitudes, self-esteem, accepting need for treatment, self-rated insight, and objective insight. All were related and each affected the others as it changed, except self-esteem and medication attitudes. Low self-reported insight at presentation...

  6. Changing Medical School IT to Support Medical Education Transformation.

    Science.gov (United States)

    Spickard, Anderson; Ahmed, Toufeeq; Lomis, Kimberly; Johnson, Kevin; Miller, Bonnie

    2016-01-01

    Many medical schools are modifying curricula to reflect the rapidly evolving health care environment, but schools struggle to provide the educational informatics technology (IT) support to make the necessary changes. Often a medical school's IT support for the education mission derives from isolated work units employing separate technologies that are not interoperable. We launched a redesigned, tightly integrated, and novel IT infrastructure to support a completely revamped curriculum at the Vanderbilt School of Medicine. This system uses coordinated and interoperable technologies to support new instructional methods, capture students' effort, and manage feedback, allowing the monitoring of students' progress toward specific competency goals across settings and programs. The new undergraduate medical education program at Vanderbilt, entitled Curriculum 2.0, is a competency-based curriculum in which the ultimate goal is medical student advancement based on performance outcomes and personal goals rather than a time-based sequence of courses. IT support was essential in the creation of Curriculum 2.0. In addition to typical learning and curriculum management functions, IT was needed to capture data in the learning workflow for analysis, as well as for informing individual and programmatic success. We aligned people, processes, and technology to provide the IT infrastructure for the organizational transformation. Educational IT personnel were successfully realigned to create the new IT system. The IT infrastructure enabled monitoring of student performance within each competency domain across settings and time via personal student electronic portfolios. Students use aggregated performance data, derived in real time from the portfolio, for mentor-guided performance assessment, and for creation of individual learning goals and plans. Poorly performing students were identified earlier through online communication systems that alert the appropriate instructor or coach of

  7. Perceived Behavioral Changes in Early Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Fabiana Souza Lima

    2007-01-01

    Full Text Available Acquired behavioral changes have essentially been described in advanced multiple sclerosis (MS. The present study was designed to determine whether behavioral modifications specifically related to the MS pathological process could be identified in the initial phase of the disease, as compared to control patients with chronic, relapsing and progressive inflammatory disorders not involving the central nervous system (CNS. Eighty-eight early MS patients (Expanded Disability Status Scale score ≤ 2.5 and 48 controls were tested. Perceived changes by informants in behavioral control, goal-directed behavior, decision making, emotional expression, insight and interpersonal relationships were assessed using the Iowa Scale of Personality Change (ISPC. Executive behavioral disturbances were screened using the Dysexecutive Questionnaire (DEX. The mean change between the premorbid and postmorbid ISPC ratings was similar in the MS [12.2 (SD 15.6] and in the control [11.5 (SD 15.1] group. The perceived behavioral changes (PBCs most frequently reported in both groups were lack of stamina, lability/moodiness, anxiety, vulnerability to stress and irritability. Pathological scores in the DEX were also similar in both groups. Correlations between PBCs and DEX scores were different in MS and control groups. MS patients with cognitive impairment had a marginally higher number of PBCs than control patients (p = 0.056 and a significantly higher DEXp score (p = 0.04. These results suggest that (1 PBCs occurring in early MS patients were not different from those induced by comparable chronic non-CNS disorders, (2 qualitative differences in the relationship between behavioral symptoms and executive-behavioral changes may exist between MS and control groups, and (3 behavioral symptoms seem associated with cognitive deficits in MS. We further plan to assess these observations longitudinally.

  8. Medical students, early general practice placements and positive supervisor experiences.

    Science.gov (United States)

    Henderson, Margaret; Upham, Susan; King, David; Dick, Marie-Louise; van Driel, Mieke

    2018-03-01

    Introduction Community-based longitudinal clinical placements for medical students are becoming more common globally. The perspective of supervising clinicians about their experiences and processes involved in maximising these training experiences has received less attention than that of students. Aims This paper explores the general practitioner (GP) supervisor perspective of positive training experiences with medical students undertaking urban community-based, longitudinal clinical placements in the early years of medical training. Methods Year 2 medical students spent a half-day per week in general practice for either 13 or 26 weeks. Transcribed semi-structured interviews from a convenience sample of participating GPs were thematically analysed by two researchers, using a general inductive approach. Results Identified themes related to the attributes of participating persons and organisations: GPs, students, patients, practices and their supporting institution; GPs' perceptions of student development; and triggers enhancing the experience. A model was developed to reflect these themes. Conclusions Training experiences were enhanced for GPs supervising medical students in early longitudinal clinical placements by the synergy of motivated students and keen teachers with support from patients, practice staff and academic institutions. We developed an explanatory model to better understand the mechanism of positive experiences. Understanding the interaction of factors enhancing teaching satisfaction is important for clinical disciplines wishing to maintain sustainable, high quality teaching.

  9. Review of early assessment models of innovative medical technologies.

    Science.gov (United States)

    Fasterholdt, Iben; Krahn, Murray; Kidholm, Kristian; Yderstræde, Knud Bonnet; Pedersen, Kjeld Møller

    2017-08-01

    Hospitals increasingly make decisions regarding the early development of and investment in technologies, but a formal evaluation model for assisting hospitals early on in assessing the potential of innovative medical technologies is lacking. This article provides an overview of models for early assessment in different health organisations and discusses which models hold most promise for hospital decision makers. A scoping review of published studies between 1996 and 2015 was performed using nine databases. The following information was collected: decision context, decision problem, and a description of the early assessment model. 2362 articles were identified and 12 studies fulfilled the inclusion criteria. An additional 12 studies were identified and included in the review by searching reference lists. The majority of the 24 early assessment studies were variants of traditional cost-effectiveness analysis. Around one fourth of the studies presented an evaluation model with a broader focus than cost-effectiveness. Uncertainty was mostly handled by simple sensitivity or scenario analysis. This review shows that evaluation models using known methods assessing cost-effectiveness are most prevalent in early assessment, but seems ill-suited for early assessment in hospitals. Four models provided some usable elements for the development of a hospital-based model. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

  10. Hospitalist and Internal Medicine Leaders' Perspectives of Early Discharge Challenges at Academic Medical Centers.

    Science.gov (United States)

    Patel, Hemali; Fang, Margaret C; Mourad, Michelle; Green, Adrienne; Wachter, Robert M; Murphy, Ryan D; Harrison, James D

    2018-06-01

    Improving early discharges may improve patient flow and increase hospital capacity. We conducted a national survey of academic medical centers addressing the prevalence, importance, and effectiveness of early-discharge initiatives. We assembled a list of hospitalist and general internal medicine leaders at 115 US-based academic medical centers. We emailed each institutional representative a 30-item online survey regarding early-discharge initiatives. The survey included questions on discharge prioritization, the prevalence and effectiveness of early-discharge initiatives, and barriers to implementation. We received 61 responses from 115 institutions (53% response rate). Forty-seven (77%) "strongly agreed" or "agreed" that early discharge was a priority. "Discharge by noon" was the most cited goal (n = 23; 38%) followed by "no set time but overall goal for improvement" (n = 13; 21%). The majority of respondents reported early discharge as more important than obtaining translators for non-English-speaking patients and equally important as reducing 30-day readmissions and improving patient satisfaction. The most commonly reported factors delaying discharge were availability of postacute care beds (n = 48; 79%) and patient-related transport complications (n = 44; 72%). The most effective early discharge initiatives reported involved changes to the rounding process, such as preemptive identification and early preparation of discharge paperwork (n = 34; 56%) and communication with patients about anticipated discharge (n = 29; 48%). There is a strong interest in increasing early discharges in an effort to improve hospital throughput and patient flow. © 2017 Society of Hospital Medicine.

  11. Medical Connections and Exchanges in the Early Modern World

    Directory of Open Access Journals (Sweden)

    Michael Naylor Pearson

    2011-12-01

    Full Text Available For most of human history there have been extensive exchanges of medical information all over Eurasia. Some diseases were considered to be geographically determined, and hence had to be cured using local knowledge. Other ailments were found in many places, but cures could differ according to location. Most healers, whether book based or experiential, took a non-judgemental approach to different healing methods, as seen especially in India in the early colonial period.

  12. Medical students' preparedness for professional activities in early clerkships.

    Science.gov (United States)

    Bosch, Josefin; Maaz, Asja; Hitzblech, Tanja; Holzhausen, Ylva; Peters, Harm

    2017-08-22

    Sufficient preparedness is important for transitions to workplace participation and learning in clinical settings. This study aims to analyse medical students' preparedness for early clerkships using a three-dimensional, socio-cognitive, theory-based model of preparedness anchored in specific professional activities and their supervision level. Medical students from a competency-based undergraduate curriculum were surveyed about preparedness for 21 professional activities and level of perceived supervision during their early clerkships via an online questionnaire. Preparedness was operationalized by the three dimensions of confidence to carry out clerkship activities, being prepared through university teaching and coping with failure by seeking support. Factors influencing preparedness and perceived stress as outcomes were analysed through step-wise regression. Professional activities carried out by the students (n = 147; 19.0%) and their supervision levels varied. While most students reported high confidence to perform the tasks, the activity-specific analysis revealed important gaps in preparation through university teaching. Students regularly searched for support in case of difficulty. One quarter of the variance of each preparedness dimension was explained by self-efficacy, supervision quality, amount of prior clerkship experience and nature of professional activities. Preparedness contributed to predicting perceived stress. The applied three-dimensional concept of preparedness and the task-specific approach provided a detailed and meaningful view on medical students' workplace participation and experiences in early clerkships.

  13. A mixed methods analysis of experiences and expectations among early-career medical oncologists in Australia.

    Science.gov (United States)

    Wong, W K Tim; Kirby, Emma; Broom, Alex; Sibbritt, David; Francis, Kay; Karapetis, Christos S; Karikios, Deme; Harrup, Rosemary; Lwin, Zarnie

    2018-01-26

    A viable and sustainable medical oncology profession is integral for meeting the increasing demand for quality cancer care. The aim of this study was to explore the workforce-related experiences, perceptions and career expectations of early-career medical oncologists in Australia. A mixed-methods design, including a survey (n  =  170) and nested qualitative semistructured interviews (n  =  14) with early-career medical oncologists. Recruitment was through the Medical Oncology Group of Australia. Qualitative data were thematically analyzed and for the survey results, logistic regression modeling was conducted. Early-career medical oncologists experienced uncertainty regarding their future employment opportunities. The competitive job market has made them cautious about securing a preferred job leading to a perceived need to improve their qualifications through higher degree training and research activities. The following themes and trends were identified from the qualitative and quantitative analyses: age, career stage and associated early-career uncertainty; locale, professional competition and training preferences; participation in research and evolving professional expectations; and workload and career development opportunities as linked to career uncertainty. Perceived diminished employment opportunities in the medical oncology profession, and shifting expectations to be "more qualified," have increased uncertainty among junior medical oncologists in terms of their future career prospects. Structural factors relating to adequate funding of medical oncology positions may facilitate or inhibit progressive change in the workforce and its sustainability. Workforce planning and strategies informed by findings from this study will be necessary in ensuring that both the needs of cancer patients and of medical oncologists are met. © 2018 John Wiley & Sons Australia, Ltd.

  14. Predictive patterns of early medication adherence in renal transplantation.

    Science.gov (United States)

    Nevins, Thomas E; Robiner, William N; Thomas, William

    2014-10-27

    Patients' adherence with posttransplant immunosuppression is known to affect renal transplant outcomes. Prospectively, individual medication adherence patterns in 195 kidney transplant recipients were quantified with electronic medication monitors. Monitored drugs were mycophenolate mofetil, sirolimus, or azathioprine. Monitoring began at hospital discharge and continued an average of 15±8 months. Patient follow-up for clinical outcomes averaged 8±3 years. Each month's adherence percentage was calculated as the sum of daily adherence percents, divided by the number of evaluable days. During the first 3 months after transplantation, patients (n=44) with declining medication adherence, defined as dropping by 7% or higher (equal to missing 2 days) between months 1 and 2, later experienced lower mean medication adherence for months 6 to 12, 73% versus 92% respectively (Padherence, they also had more frequent (P=0.034) and earlier (P=0.065) acute rejection episodes. This was additionally associated with more frequent (P=0.017) and earlier (P=0.046) death-censored graft loss.In addition, daily medication adherence, expressed as the percentage of doses taken, decreased as the number of prescribed daily doses increased. During the first 3 months after transplantation, adherence with four doses per day averaged 84%, compared to 91% for patients on twice-daily dosing (P=0.024) and 93.5% for patients on once-daily dosing (P=0.008). Early declining medication nonadherence is associated with adverse clinical outcomes. This pattern is detectable during the first 2 months after transplantation. Early detection of nonadherence provides opportunities to target interventions toward patients at the highest risk for adverse behaviors and events.

  15. Why support a women's medical college? Philadelphia's early male medical pro-feminists.

    Science.gov (United States)

    Peitzman, Steven J

    2003-01-01

    The male founders and early faculty of Philadelphia's Woman's Medical College were mostly abolitionist physicians, zealous moralists for whom medical feminism formed only one of the cherished causes they could "manfully" and righteously defend. Male faculty of the late nineteenth century comprised "self-made" men, mostly new specialists, for whom strict sexism probably seemed inconsistent with progressive medicine. For some of these physicians-obviously a small minority-defending medical women and breaking the barriers of fraternity could be consistent with "manly" responsibility. The outcome of the collaboration of women and the dissident men physicians in nineteenth-century Philadelphia amounted to another seeming paradox: the majority of the male medical profession, both locally and nationally, tyrannically hindered women's entry into the profession, yet medicine opened its doors in advance of law and the clergy; and where this first occurred, such as in the community centered on Woman's Medical College, a novel gender rearrangement arose based on collaboration and friendship.

  16. Medical students' professional identity development in an early nursing attachment.

    Science.gov (United States)

    Helmich, Esther; Derksen, Els; Prevoo, Mathieu; Laan, Roland; Bolhuis, Sanneke; Koopmans, Raymond

    2010-07-01

    The importance of early clinical experience for medical training is well documented. However, to our knowledge there are no studies that assess the influence of very early nursing attachments on the professional development and identity construction of medical students. Working as an assistant nurse while training to be a doctor may offer valuable learning experiences, but may also present the student with difficulties with respect to identity and identification issues. The aim of the present study was to describe first-year medical students' perceptions of nurses, doctors and their own future roles as doctors before and after a nursing attachment. A questionnaire containing open questions concerning students' perceptions of nurses, doctors and their own future roles as doctors was administered to all Year 1 medical students (n=347) before and directly after a 4-week nursing attachment in hospitals and nursing homes. We carried out two confirmatory focus group interviews. We analysed the data using qualitative and quantitative content analyses. The questionnaire was completed by 316 students (response rate 91%). Before starting the attachment students regarded nurses as empathic, communicative and responsible. After the attachment students reported nurses had more competencies and responsibilities than they had expected. Students' views of doctors were ambivalent. Before and after the attachment, doctors were seen as interested and reliable, but also as arrogant, detached and insensible. However, students maintained positive views of their own future roles as doctors. Students' perceptions were influenced by age, gender and place of attachment. An early nursing attachment engenders more respect for the nursing profession. The ambivalent view of doctors needs to be explored further in relation to students' professional development. It would seem relevant to attune supervision to the age and gender differences revealed in this study.

  17. Cranial thickness changes in early childhood

    Science.gov (United States)

    Gajawelli, Niharika; Deoni, Sean; Shi, Jie; Dirks, Holly; Linguraru, Marius George; Nelson, Marvin D.; Wang, Yalin; Lepore, Natasha

    2017-11-01

    The neurocranium changes rapidly in early childhood to accommodate the developing brain. However, developmental disorders may cause abnormal growth of the neurocranium, the most common one being craniosynostosis, affecting about 1 in 2000 children. It is important to understand how the brain and neurocranium develop together to understand the role of the neurocranium in neurodevelopmental outcomes. However, the neurocranium is not as well studied as the human brain in early childhood, due to a lack of imaging data. CT is typically employed to investigate the cranium, but, due to ionizing radiation, may only be used for clinical cases. However, the neurocranium is also visible on magnetic resonance imaging (MRI). Here, we used a large dataset of MRI images from healthy children in the age range of 1 to 2 years old and extracted the neurocranium. A conformal geometry based analysis pipeline is implemented to determine a set of statistical atlases of the neurocranium. A growth model of the neurocranium will help us understand cranial bone and suture development with respect to the brain, which will in turn inform better treatment strategies for neurocranial disorders.

  18. Predictors of early faculty attrition at one Academic Medical Center.

    Science.gov (United States)

    Bucklin, Brenda A; Valley, Morgan; Welch, Cheryl; Tran, Zung Vu; Lowenstein, Steven R

    2014-02-10

    Faculty turnover threatens the research, teaching and clinical missions of medical schools. We measured early attrition among newly-hired medical school faculty and identified personal and institutional factors associated with early attrition. This retrospective cohort study identified faculty hired during the 2005-2006 academic year at one school. Three-year attrition rates were measured. A 40-question electronic survey measured demographics, career satisfaction, faculty responsibilities, institutional/departmental support, and reasons for resignation. Odds ratios (ORs) and 95 percent confidence intervals (95% CI) identified variables associated with early attrition. Of 139 faculty, 34% (95% CI = 26-42%) resigned within three years of hire. Attrition was associated with: perceived failure of the Department Chair to foster a climate of teaching, research, and service (OR = 6.03; 95% CI: 1.84, 19.69), inclusiveness, respect, and open communication (OR = 3.21; 95% CI: 1.04, 9.98). Lack of professional development of the faculty member (OR = 3.84; 95% CI: 1.25, 11.81); institutional recognition and support for excellence in teaching (OR = 2.96; 95% CI: 0.78, 11.19) and clinical care (OR = 3.87; 95% CI: 1.04, 14.41); and >50% of professional time devoted to patient care (OR = 3.93; 95% CI: 1.29, 11.93) predicted attrition. Gender, race, ethnicity, academic degree, department type and tenure status did not predict early attrition. Of still-active faculty, an additional 27 (48.2%, 95% CI: 35.8, 61.0) reported considering resignation within the 5 years. In this pilot study, one-third of new faculty resigned within 3 years of hire. Greater awareness of predictors of early attrition may help schools identify threats to faculty career satisfaction and retention.

  19. Alcohol consumption in early adolescence and medical care.

    Science.gov (United States)

    Borrás Santiesteban, Tania

    2016-10-01

    Alcohol consumptionin adolescents is a risky behavior that can be prevented. Objective. To determine health care and alcohol consumption pattern in early adolescence and its relation to determinants of health (biological, environmental, social and health system factors). A qualitative-quantitative, crosssectional study was carried out in the four schools belonging to Popular Council 8 of Mario Gutiérrez Ardaya health sector in May, 2013. The study universe was made up of adolescents aged 10-14. The sample was determined through a simple randomized sampling. Surveys were administered to adolescents, parents, educators and senior health staff members to determine alcohol consumption, medical care quality and level of knowledge on the problem. A nominal group with health professionals was created. Two hundred and eighty eight adolescents were included. 54.5% were alcohol users, of which 30.2% were 10-11 years old. Those classified as low risk were prevailing (55.6%). 100% of the senior health staff expressed the need for a methodology of care. 90.4% of education staff considered adolescence as a vulnerable stage. Relatives reported that there should be adolescent-specific medical appointments (61.8%). The nominal group's most important opinions were based on the main features that a consultation for adolescents should have and on the problems hindering proper care. Alcohol consumption was considered high and early start prevailed. Insufficient care to early adolescents who use alcohol was made evident. Sociedad Argentina de Pediatría.

  20. Transfusion-associated circulatory overload in adult, medical emergency patients with perspectives on early warning practice

    DEFF Research Database (Denmark)

    Gosmann, Fanny; Nørgaard, Astrid; Rasmussen, Maj-Britt

    2018-01-01

    of transfusion-associated dyspnoea. Vital signs and changes in dyspnoea and blood pressure were registered within the frame of the Early Warning Score, and one case was documented as being transfusion-related in the medical record. No cases were reported to the haemovigilance system. DISCUSSION: The incidence...... to the haemovigilance system. The clinical implications are discussed within the frame of the Early Warning Score. METHODS: We conducted a retrospective audit of electronic hospital medical records of patients receiving blood transfusion in a single medical emergency unit. Patients were admitted during a 6-month period...... and data on symptoms and vital signs were extracted from the records. RESULTS: Of 4,353 consecutively admitted patients, 156 patients were transfused with a total of 411 blood components. The audit identified five cases of transfusion-associated circulatory overload (incidence 3.2%) and four cases...

  1. EARLY MEDICAL REHABILITATION OF THE PATIENTS WITH SPINAL CORD INJURY

    Directory of Open Access Journals (Sweden)

    Aleš Demšar

    2003-12-01

    Full Text Available Background. Early medical rehabilitation (EMR of the patients with spinal cord injury is discussed in this article.For successful rehabilitation adequate surgical treatment, which enables early verticalisation, is compulsory.Predictable respiratory, vascular, intestinal and urologic complications, contractures and bed sores are described and algorhytms of EMR in the period of spinal shock and after, until transferring the patient to the IRSR, are presented.Respiratory therapy, thromboprophylaxis, kinesiotherapy and functional electrical stimulation as well as the methods of early bladder and bowel control, contractures and bed sores prevention, as procedures of EMR are fully presented.With special importance early verticalisation from the 5th post operative day with help of the tilt table is presented as the key point of EMR.Conclusions. With aggressive EMR the paraplegic patient is able to gain erect posture from the 5th post operative day, sits in a wheel chair from 10th to 14th day and stands in the paralel bar from 15th day on.

  2. Advancing medical-surgical nursing practice: improving management of the changing patient condition.

    Science.gov (United States)

    Monroe, Heidi; Plylar, Peggy; Krugman, Mary

    2014-01-01

    Higher patient acuities and more novice nurses on medical-surgical units have Educators focused on achieving positive outcomes with changes in patient condition. An educational program was developed to enhance nurses' knowledge, skill, and confidence in assessing hemodynamics, recognizing early signs of instability, and administering vasoactive medications. The program was successful with significant knowledge improvement as well as an increased use of the Medical Emergency Team while maintaining a low number of code calls.

  3. [The early medical textbooks in Korea: medical textbooks published at Je Joong Won-Severance Hospital Medical School].

    Science.gov (United States)

    Park, H W

    1998-01-01

    Kwang Hye Won(Je Joong Won), the first western hospital in Korea, was founded in 1885. The first western Medical School in Korea was open in 1886 under the hospital management. Dr. O. R. Avison, who came to Korea in 1893, resumed the medical education there, which was interrupted for some time before his arrival in Korea. He inaugurated translating and publishing medical textbooks with the help of Kim Pil Soon who later became one of the first seven graduates in Severance Hospital Medical School. The first western medical textbook translated into Korean was Henry Gray's Anatomy. However, these twice-translated manuscripts were never to be published on account of being lost and burnt down. The existing early anatomy textbooks, the editions of 1906 and 1909, are not the translation of Gray's Anatomy, but that of Japanese anatomy textbook of Gonda. The remaining oldest medical textbook in Korean is Inorganic Materia Medica published in 1905. This book is unique among its kind that O. R. Avison is the only translator of the book and it contains the prefaces of O. R. Avison and Kim Pil Soon. The publication of medical textbook was animated by the participation of other medical students, such as Hong Suk Hoo and Hong Jong Eun. The list of medical textbooks published includes almost all the field of medicine. The medical textbooks in actual existence are as follows: Inorganic Materia Medica (1905), Inorganic Chemistry (1906), Anatomy I (1906), Physiology (1906), Diagnostics I (1906), Diagnostics II (1907), Obstetrics (1908), Organic Chemistry (1909), Anatomy (1909), and Surgery (1910).

  4. ORIGINAL ARTICLES Changing gender profile of medical schools ...

    African Journals Online (AJOL)

    2008-06-23

    Jun 23, 2008 ... Changing gender profile of medical schools in South Africa. Mignonne ... The Higher Education Management Information System. (HEMIS) ..... specialty and gender: A study of teachers at a Swedish medical school. BMC Med ...

  5. Modeling determinants of medication attitudes and poor adherence in early nonaffective psychosis: implications for intervention.

    Science.gov (United States)

    Drake, Richard J; Nordentoft, Merete; Haddock, Gillian; Arango, Celso; Fleischhacker, W Wolfgang; Glenthøj, Birte; Leboyer, Marion; Leucht, Stefan; Leweke, Markus; McGuire, Phillip; Meyer-Lindenberg, Andreas; Rujescu, Dan; Sommer, Iris E; Kahn, René S; Lewis, Shon W

    2015-05-01

    We aimed to design a multimodal intervention to improve adherence following first episode psychosis, consistent with current evidence. Existing literature identified medication attitudes, insight, and characteristics of support as important determinants of adherence to medication: we examined medication attitudes, self-esteem, and insight in an early psychosis cohort better to understand their relationships. Existing longitudinal data from 309 patients with early Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, nonaffective psychosis (83% first episode) were analyzed to test the hypothesis that medication attitudes, while meaningfully different from "insight," correlated with insight and self-esteem, and change in each influenced the others. Rosenberg Self-Esteem Scale, Birchwood Insight Scale, and Positive and Negative Syndrome Scale insight were assessed at presentation, after 6 weeks and 3 and 18 months. Drug Attitudes Inventory (DAI) and treatment satisfaction were rated from 6 weeks onward. Structural equation models of their relationships were compared. Insight measures' and DAI's predictive validity were compared against relapse, readmission, and remission. Analysis found five latent constructs best fitted the data: medication attitudes, self-esteem, accepting need for treatment, self-rated insight, and objective insight. All were related and each affected the others as it changed, except self-esteem and medication attitudes. Low self-reported insight at presentation predicted readmission. Good 6-week insight (unlike drug attitudes) predicted remission. Literature review and data modeling indicated that a multimodal intervention using motivational interviewing, online psychoeducation, and SMS text medication reminders to enhance adherence without damaging self-concept was feasible and appropriate. © The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For

  6. Early Lessons on Bundled Payment at an Academic Medical Center.

    Science.gov (United States)

    Jubelt, Lindsay E; Goldfeld, Keith S; Blecker, Saul B; Chung, Wei-Yi; Bendo, John A; Bosco, Joseph A; Errico, Thomas J; Frempong-Boadu, Anthony K; Iorio, Richard; Slover, James D; Horwitz, Leora I

    2017-09-01

    Orthopaedic care is shifting to alternative payment models. We examined whether New York University Langone Medical Center achieved savings under the Centers for Medicare and Medicaid Services Bundled Payments for Care Improvement initiative. This study was a difference-in-differences study of Medicare fee-for-service patients hospitalized from April 2011 to June 2012 and October 2013 to December 2014 for lower extremity joint arthroplasty, cardiac valve procedures, or spine surgery (intervention groups), or for congestive heart failure, major bowel procedures, medical peripheral vascular disorders, medical noninfectious orthopaedic care, or stroke (control group). We examined total episode costs and costs by service category. We included 2,940 intervention episodes and 1,474 control episodes. Relative to the trend in the control group, lower extremity joint arthroplasty episodes achieved the greatest savings: adjusted average episode cost during the intervention period decreased by $3,017 (95% confidence interval [CI], -$6,066 to $31). For cardiac procedures, the adjusted average episode cost decreased by $2,999 (95% CI, -$8,103 to $2,105), and for spinal fusion, it increased by $8,291 (95% CI, $2,879 to $13,703). Savings were driven predominantly by shifting postdischarge care from inpatient rehabilitation facilities to home. Spinal fusion index admission costs increased because of changes in surgical technique. Under bundled payment, New York University Langone Medical Center decreased total episode costs in patients undergoing lower extremity joint arthroplasty. For patients undergoing cardiac valve procedures, evidence of savings was not as strong, and for patients undergoing spinal fusion, total episode costs increased. For all three conditions, the proportion of patients referred to inpatient rehabilitation facilities upon discharge decreased. These changes were not associated with an increase in index hospital length of stay or readmission rate

  7. Changes in hospital competitive strategy: a new medical arms race?

    Science.gov (United States)

    Devers, Kelly J; Brewster, Linda R; Casalino, Lawrence P

    2003-02-01

    To describe changes in hospitals' competitive strategies, specifically the relative emphasis placed on strategies for competing along price and nonprice (i.e., service, amenities, perceived quality) dimensions, and the reasons for any observed shifts. This study uses data gathered through the Community Tracking Study site visits, a longitudinal study of a nationally representative sample of 12 U.S. communities. Research teams visited each of these communities every two years since 1996 and conducted between 50 to 90 semistructured interviews. Additional information on hospital competition and strategy was gathered from secondary data. We found that hospitals' strategic emphasis changed significantly between 1996-1997 and 2000-2001. In the mid-1990s, hospitals primarily competed on price through "wholesale" strategies (i.e., providing services attractive to managed care plans). By 2000-2001, nonprice competition was becoming increasingly important and hospitals were reviving "retail" strategies (i.e., providing services attractive to individual physicians and the patients they serve). Three major factors explain this shift in hospital strategy: less than anticipated selective contracting and capitated payment; the freeing up of hospital resources previously devoted to horizontal and vertical integration strategies; and, the emergence and growth of new competitors. Renewed emphasis on nonprice competition and retail strategies, and the service mimicking and one-upmanship that result, suggest that a new medical arms race is emerging. However, there are important differences between the medical arms race today and the one that occurred in the 1970s and early 1980s: the hospital market is more concentrated and price competition remains relatively important. The development of a new medical arms race has significant research and policy implications.

  8. Change and continuity in early modern cosmology

    CERN Document Server

    Bonner, Patrick

    2011-01-01

    Seen as a flash point of the Scientific Revolution, early modern astronomy witnessed an explosion of views about the function and structure of the world. This study explores these theories in a wide variety of settings, and challenges our view of modern science as the straightforward successor of Aristotelian natural philosophy.

  9. Early resistance change and stress/electromigrationmodeling in aluminium interconnects

    NARCIS (Netherlands)

    Petrescu, V.; Mouthaan, A.J.; Schoenmaker, W.

    1997-01-01

    A complete description for early resistance change and two dimensional simulation of mechanical stress evolution in confined Al interconnects, related to the electromigration, is given in this paper. The model, combines the stress/ vacancy concentration evolution with the early resistance change of

  10. Changing Medical Students' Attitudes toward Older Adults

    Science.gov (United States)

    Gonzales, Ernest; Morrow-Howell, Nancy; Gilbert, Pat

    2010-01-01

    Given the growth in the number of older adults and the ageist attitudes many in the health care profession hold, interventions aimed at improving health professionals' attitudes toward older adults are imperative. Vital Visionaries is an intergenerational art program designed to improve medical students' attitudes toward older adults. Participants…

  11. Preventability of early vs. late readmissions in an academic medical center.

    Directory of Open Access Journals (Sweden)

    Kelly L Graham

    Full Text Available It is unclear if the 30-day unplanned hospital readmission rate is a plausible accountability metric.Compare preventability of hospital readmissions, between an early period [0-7 days post-discharge] and a late period [8-30 days post-discharge]. Compare causes of readmission, and frequency of markers of clinical instability 24h prior to discharge between early and late readmissions.120 patient readmissions in an academic medical center between 1/1/2009-12/31/2010.Sum-score based on a standard algorithm that assesses preventability of each readmission based on blinded hospitalist review; average causation score for seven types of adverse events; rates of markers of clinical instability within 24h prior to discharge.Readmissions were significantly more preventable in the early compared to the late period [median preventability sum score 8.5 vs. 8.0, p = 0.03]. There were significantly more management errors as causative events for the readmission in the early compared to the late period [mean causation score [scale 1-6, 6 most causal] 2.0 vs. 1.5, p = 0.04], and these errors were significantly more preventable in the early compared to the late period [mean preventability score 1.9 vs 1.5, p = 0.03]. Patients readmitted in the early period were significantly more likely to have mental status changes documented 24h prior to hospital discharge than patients readmitted in the late period [12% vs. 0%, p = 0.01].Readmissions occurring in the early period were significantly more preventable. Early readmissions were associated with more management errors, and mental status changes 24h prior to discharge. Seven-day readmissions may be a better accountability measure.

  12. Ecological theories of systems and contextual change in medical education.

    Science.gov (United States)

    Ellaway, Rachel H; Bates, Joanna; Teunissen, Pim W

    2017-12-01

    Contemporary medical practice is subject to many kinds of change, to which both individuals and systems have to respond and adapt. Many medical education programmes have their learners rotating through different training contexts, which means that they too must learn to adapt to contextual change. Contextual change presents many challenges to medical education scholars and practitioners, not least because of a somewhat fractured and contested theoretical basis for responding to these challenges. There is a need for robust concepts to articulate and connect the various debates on contextual change in medical education. Ecological theories of systems encompass a range of concepts of how and why systems change and how and why they respond to change. The use of these concepts has the potential to help medical education scholars explore the nature of change and understand the role it plays in affording as well as limiting teaching and learning. This paper, aimed at health professional education scholars and policy makers, explores a number of key concepts from ecological theories of systems to present a comprehensive model of contextual change in medical education to inform theory and practice in all areas of medical education. The paper considers a range of concepts drawn from ecological theories of systems, including biotic and abiotic factors, panarchy, attractors and repellers, basins of attraction, homeostasis, resilience, adaptability, transformability and hysteresis. Each concept is grounded in practical examples from medical education. Ecological theories of systems consider change and response in terms of adaptive cycles functioning at different scales and speeds. This can afford opportunities for systematic consideration of responses to contextual change in medical education, which in turn can inform the design of education programmes, activities, evaluations, assessments and research that accommodates the dynamics and consequences of contextual change.

  13. Medical specialty considerations by medical students early in their clinical experience

    Directory of Open Access Journals (Sweden)

    Weissman Charles

    2012-03-01

    Full Text Available Abstract Background Specialty selection by medical students determines the future composition of the physician workforce. Selection of career specialties begins in earnest during the clinical rotations with exposure to the clinical and intellectual environments of various specialties. Career specialty selection is followed by choosing a residency program. This is the period where insight into the decision process might help healthcare leaders ascertain whether, when, and how to intervene and attempt to influence students' decisions. The criteria students consider important in selecting a specialty and a residency program during the early phases of their clinical rotations were examined. Methods Questionnaires distributed to fifth-year medical students at two Israeli medical schools. Results 229 of 275 (83% questionnaires were returned. 80% of the students had considered specialties; 62% considered one specialty, 25% two, the remainder 3-5 specialties. Students took a long-range view; 55% considered working conditions after residency more important than those during residency, another 42% considered both equally important. More than two-thirds wanted an interesting and challenging bedside specialty affording control over lifestyle and providing a reasonable relationship between salary and lifestyle. Men were more interested in well-remunerated procedure-oriented specialties that allowed for private practice. Most students rated as important selecting a challenging and interesting residency program characterized by good relationships between staff members, with positive treatment by the institution, and that provided much teaching. More women wanted short residencies with few on-calls and limited hours. More men rated as important residencies affording much responsibility for making clinical decisions and providing research opportunities. More than 50% of the students considered it important that their residency be in a leading department, and in

  14. Scaffolding conceptual change in early childhood

    Science.gov (United States)

    Fleer, Marilyn

    1990-01-01

    The general educational literature draws our attention to the limitations of Piaget’s work and presents a number of interesting ideas that science educators and researchers could consider. Of interest are Soviet psychologist Lev Vygotsky’s writings on the zone of proximal development and the more recent writings of Jerome Bruner on scaffolding. The notion of learning as a a socially constructed process in opposition to the more individualistic orientation of Piaget has challenged much of our educational practice. This paper will briefly explore the basic tenets of constructivism and contrast the theories developed from within this paradigm to the work of Vygotsky and Bruner through an analysis of classroom discourse collected from a number of early childhood classes involved in the interactive teaching approach to science. Transcripts of teacher-child discourse are presented as evidence to support the proposition that when the teacher’s role is not clearly defined, the range of teacher-child interactions will vary enormously, and the subsequent learning outcomes for children will be quite different.

  15. Motor subtype changes in early Parkinson's disease.

    Science.gov (United States)

    Eisinger, Robert S; Hess, Christopher W; Martinez-Ramirez, Daniel; Almeida, Leonardo; Foote, Kelly D; Okun, Michael S; Gunduz, Aysegul

    2017-10-01

    Distinct motor subtypes of Parkinson's disease (PD) have been described through both clinical observation and through data-driven approaches. However, the extent to which motor subtypes change during disease progression remains unknown. Our objective was to determine motor subtypes of PD using an unsupervised clustering methodology and evaluate subtype changes with disease duration. The Parkinson's Progression Markers Initiative database of 423 newly diagnosed PD patients was utilized to retrospectively identify unique motor subtypes through a data-driven, hierarchical correlational clustering approach. For each patient, we assigned a subtype to each motor assessment at each follow-up visit (time points) and by using published criteria. We examined changes in PD subtype with disease duration using both qualitative and quantitative methods. Five distinct motor subtypes were identified based on the motor assessment items and these included: Tremor Dominant (TD), Axial Dominant, Appendicular Dominant, Rigidity Dominant, and Postural and Instability Gait Disorder Dominant. About half of the patients had consistent subtypes at all time points. Most patients met criteria for TD subtype soon after diagnosis. For patients with inconsistent subtypes, there was an overall trend to shift away from a TD phenotype with disease duration, as shown by chi-squared test, p motor subtypes in PD can shift with increasing disease duration. Shifting subtypes is a factor that should be accounted for in clinical practice or in clinical trials. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. Motivation, Work Satisfaction, and Teacher Change among Early Childhood Teachers

    Science.gov (United States)

    Wagner, Brigid Daly; French, Lucia

    2010-01-01

    This study tests the explanatory power of Deci and Ryan's (1985) self-determination theory as a framework for describing how interactions between early childhood teachers and the systems within which their work is embedded influence motivation for professional growth and change in teaching practice. Fifty-four early childhood teachers and teacher…

  17. Medical audit on problem analysis and implementing changes at the ...

    African Journals Online (AJOL)

    Infection control and continuing medical education committees were formed where they did not exist. Conclusion/Recommendation: Hospital medical audit on problem analysis and implementation of changes in health units is highly effective in stimulating and empowering health care workers and hospital administrators to ...

  18. Changing gender profile of medical schools in South Africa | Breier ...

    African Journals Online (AJOL)

    ... between 1999 and 2005. Conclusions. The study provides a basic quantitative overview of the changing profile of medical enrolments and raises questions about the career choices of women after they graduate and the social factors influencing these choices. South African Medical Journal Vol. 98 (7) 2008: pp. 557-560 ...

  19. Learning Styles of Medical Students Change in Relation to Time

    Science.gov (United States)

    Gurpinar, Erol; Bati, Hilal; Tetik, Cihat

    2011-01-01

    The aim of the present study was to investigate if any changes exist in the learning styles of medical students over time and in relation to different curriculum models with these learning styles. This prospective cohort study was conducted in three different medical faculties, which implement problem-based learning (PBL), hybrid, and integrated…

  20. Acquiring skill at medical image inspection: learning localized in early visual processes

    Science.gov (United States)

    Sowden, Paul T.; Davies, Ian R. L.; Roling, Penny; Watt, Simon J.

    1997-04-01

    Acquisition of the skill of medical image inspection could be due to changes in visual search processes, 'low-level' sensory learning, and higher level 'conceptual learning.' Here, we report two studies that investigate the extent to which learning in medical image inspection involves low- level learning. Early in the visual processing pathway cells are selective for direction of luminance contrast. We exploit this in the present studies by using transfer across direction of contrast as a 'marker' to indicate the level of processing at which learning occurs. In both studies twelve observers trained for four days at detecting features in x- ray images (experiment one equals discs in the Nijmegen phantom, experiment two equals micro-calcification clusters in digitized mammograms). Half the observers examined negative luminance contrast versions of the images and the remainder examined positive contrast versions. On the fifth day, observers swapped to inspect their respective opposite contrast images. In both experiments leaning occurred across sessions. In experiment one, learning did not transfer across direction of luminance contrast, while in experiment two there was only partial transfer. These findings are consistent with the contention that some of the leaning was localized early in the visual processing pathway. The implications of these results for current medical image inspection training schedules are discussed.

  1. Teaching About Climate Change in Medical Education: An Opportunity.

    Science.gov (United States)

    Maxwell, Janie; Blashki, Grant

    2016-04-26

    Climate change threatens many of the gains in development and health over the last century. However, it could also be a catalyst for a necessary societal transformation to a sustainable and healthy future. Doctors have a crucial role in climate change mitigation and health system adaptation to prepare for emergent health threats and a carbon-constrained future. This paper argues that climate change should be integrated into medical education for three reasons: first, to prepare students for clinical practice in a climate-changing world; secondly, to promote public health and eco-health literacy; and finally, to deepen existing learning and strengthen graduate attributes. This paper builds on existing literature and the authors' experience to outline potential learning objectives, teaching methods and assessment tasks. In the wake of recent progress at the United Nations climate change conference, COP-21, it is hoped that this paper will assist universities to integrate teaching about climate change into medical education. Significance for public healthThere is a strong case for teaching about climate change in medical education. Anthropogenic climate change is accepted by scientists, governments and health authorities internationally. Given the dire implications for human health, climate change is of fundamental relevance to future doctors. Integrating climate change into medical education offers an opportunity for future doctors to develop skills and insights essential for clinical practice and a public health role in a climate-changing world. This echoes a broader call for improved public health literacy among medical graduates. This paper provides medical schools with a rationale and an outline for teaching on climate change.

  2. Changes in neurocranium thickness in early childhood

    Science.gov (United States)

    Gajawelli, Niharika; Deoni, Sean; Shi, Jie; Xu, Liang; Dirks, Holly; Dean, Douglas; O'Muircheartaigh, Jonathan; Sawardekar, Siddhant; Ezis, Andrea; Nelson, Marvin D.; Wang, Yalin; Lepore, Natasha

    2015-12-01

    Several developmental disorders involve shape abnormalities of the neurocranium, the most common one being craniosynostosis, that affects about 1 in 2000 infants. A key step in determining how these disorders affect neurodevelopment is to establish how the brain and neurocranium co-evolve in the normally developing child. However, due to the scarcity of normally developing infant and pediatric imaging data, there have been a lack of imaging studies pertaining to normal neurocranial development. Here, taking advantage of a large data bank of high quality brain MRI from healthy children ages 0-4 years old, and of a novel conformal geometry-based analysis pipeline, we have been determining a set of statistical atlases of the neurocranium, divided into age groups. In this first part of the study, we focus more specifically on a comparison of 1 and 2 year old infants. Characterizing neurocranium shape changes will enable us to understand how the cranial bones develop in relation to brain development. This in turn will allow a better determination of the effects of neurocranial disorders, which will help inform treatment strategies.

  3. How education changes clinical documentation in early pregnancy.

    Science.gov (United States)

    Ali, Fida; Higgins, Mary F

    2016-05-01

    The aim of this audit was to record medical history taking in the records of women attending with early pregnancy issues in order to assess the effect of training in this area. The medical education intervention comprised of a 30-min interactive tutorial. Retrospective chart review at three time points: pre education (July 2013, n = 45), immediately post-education (August 2013, n = 45) and longer term post-intervention (October 2013, n = 20). Pre-education, medical history was missing in 77.8% of charts compared to 13.4% immediately post-intervention and 10% long-term post-intervention (p Education in requirements for medical history taking can improve documentation.

  4. Transforming medical professionalism to fit changing health needs

    Directory of Open Access Journals (Sweden)

    Starfield Barbara

    2009-10-01

    Full Text Available Abstract Background The professional organization of medical work no longer reflects the changing health needs caused by the growing number of complex and chronically ill patients. Key stakeholders enforce coordination and remove power from the medical professions in order allow for these changes. However, it may also be necessary to initiate basic changes to way in which the medical professionals work in order to adapt to the changing health needs. Discussion Medical leaders, supported by health policy makers, can consciously activate the self-regulatory capacity of medical professionalism in order to transform the medical profession and the related professional processes of care so that it can adapt to the changing health needs. In doing so, they would open up additional routes to the improvement of the health services system and to health improvement. This involves three consecutive steps: (1 defining and categorizing the health needs of the population; (2 reorganizing the specialty domains around the needs of population groups; (3 reorganizing the specialty domains by eliminating work that could be done by less educated personnel or by the patients themselves. We suggest seven strategies that are required in order to achieve this transformation. Summary Changing medical professionalism to fit the changing health needs will not be easy. It will need strong leadership. But, if the medical world does not embark on this endeavour, good doctoring will become merely a bureaucratic and/or marketing exercise that obscures the ultimate goal of medicine which is to optimize the health of both individuals and the entire population.

  5. Concern beliefs in medications: changes over time and medication use factors related to a change in beliefs.

    Science.gov (United States)

    Shiyanbola, Olayinka O; Farris, Karen B; Chrischilles, Elizabeth

    2013-01-01

    Concern belief in medication is a construct that may characterize patients' attitude toward managing medicines, and this could change with time. Understanding the factors that would impact a change in concern beliefs would be helpful in interventions that could reframe patients' perceptions about their medicines. To examine if patient concern beliefs in medications change over time, assess the characteristics of individuals whose beliefs change, and determine what factors might impact a change in patient beliefs. Secondary data analysis using 2 longitudinal studies. The first study was an Internet-based survey of Medicare enrollees pre-post Medicare Part D. The second study was a randomized controlled trial evaluating a medication management intervention among adults with physical limitations. Respondents were classified as those whose beliefs remained stable and those whose beliefs increased and decreased over 2 separate periods. Chi-square analysis examined significant differences across the groups. Multiple linear regressions examined factors that influence changes in patient beliefs. Among older adults, there were differences in perceived health status (χ(2)=26.05, P=.001), number of pharmacies used (χ(2)=17.41, P=.008), and number of medicines used after the start of Medicare Part D. There were no significant differences among adults with physical limitations. Among older adults, having an increased number of medicines over time and reporting a self-reported adverse effect to a physician were positively associated with an increase in concern beliefs in medication. Having an increase in adherence was associated with a decrease in concern beliefs over time. Concern beliefs in medications may contribute independent information about individuals' response to drug programs and policies. Outcomes of medication use may influence patient anxieties about medicines. The instability of patient concerns in medications that occurs with prescription drug coverage changes

  6. Change in Physical Attraction in Early Romantic Relationships

    OpenAIRE

    Victor Karandashev; Brittany Fata

    2014-01-01

    The goal of our research was to study the changes in physical attraction during the early stages of romantic relationships. The longitudinal study explored the personality characteristics of a partner and relationship events affecting physical attraction of early (within the first year) romantic relationships. Participants completed an eight-week longitudinal rating of their attraction toward their romantic partner. Factor analysis revealed behavioral, cognitive, emotional, and physiological ...

  7. Early phase telemedicine requirements elicitation in collaboration with medical practitioners

    NARCIS (Netherlands)

    Larburu Rubio, Nekane; Widya, I.A.; Bults, Richard G.A.; Hermens, Hermanus J.; Napolitano, Carlo

    2013-01-01

    Ubiquity of Information and Communication Technology enables innovative telemedicine treatment applications for disease management of ambulant patients. Development of new treatment applications must comply with medical protocols and ‘way of working’ to obtain safety and efficacy evidence before

  8. chronicles of medical history biomimetics: the early years

    African Journals Online (AJOL)

    2014-12-22

    Dec 22, 2014 ... basic sciences of physics, mathematics and chemistry ... Department of Pharmacology and Therapeutics, Faculty of Basic Medical Sciences, College of ... approach man's tool for the ultimate conquest of sickness and disease ...

  9. Changes in themes over time from medical student journaling.

    Science.gov (United States)

    Cayley, William; Schilling, Rae; Suechting, Ralph

    2007-12-01

    There has been little exploration of journaling in medical student education. To document the themes on which medical students reflect during training. We evaluated journals kept by primary care medical students to identify prominent themes and determine change or constancy in themes over time. We looked at third-year medical students participating in a required primary care clerkship in a university-affiliated, community-based family medicine residency program with a rural catchment area. During 1994-1996 and 2001-2003, students were asked to keep weekly journals reflecting on their thoughts and feelings regarding "topical content, course processes and methods, and personal reflections on becoming a doctor." Faculty evaluated journals to identify change or constancy in themes over time. Prominent themes included gender issues, professional identity emergence, career choice, and rural practice, the experience of learning, the experience of relating to patients, and the nature of medical practice. We found both constancy and change in student journal themes over time. Changes in journal themes appeared to correlate with outside events and educational trends, including increased attention to reflective practice, changing demographics in medicine and the increasing acceptance of female physicians, and personal life events.

  10. Resilience in Change: Positive Perspectives on the Dynamics of Change in Early Childhood Systems

    Science.gov (United States)

    Douglass, Anne

    2016-01-01

    Change is a central feature of the early care and education landscape today. Much of the research on educational change focuses on the negative or challenging aspects of change. This study employed a critical theory framework from the organizational sciences field, positive organizational scholarship, to offer a new way of thinking about change in…

  11. Protecting health from climate change: Preparedness of medical interns

    Directory of Open Access Journals (Sweden)

    Majra Jai

    2009-01-01

    Full Text Available Context : Climate change is a significant and emerging threat to public health and to meet the challenge, health systems require qualified staff. Aims : To study the preparedness of medical interns to meet the challenge of protecting health from climate change. Settings and Design: Medical colleges in a coastal town. Cross-sectional study. Materials and Methods: A proportionate number of medical interns from five medical colleges were included in the study. Level of awareness was used as a criterion to judge the preparedness. A self-administered, pretested, open-ended questionnaire was used. Responses were evaluated and graded. Statistical Analysis Used: Proportions, percentage, Chi-test. Results : About 90% of the medical interns were aware of the climate change and human activities that were playing a major role. Ninety-four percent were aware of the direct health impacts due to higher temperature and depletion in ozone concentration, and about 78% of the respondents were aware about the change in frequency / distribution of vector-borne diseases, water borne / related diseases, malnutrition, and health impact of population displacement. Knowledge regarding health protection was limited to mitigation of climate change and training / education. Options like adaptation, establishing / strengthening climate and disease surveillance systems, and health action in emergency were known to only nine (7%, eight (6%, and 17 (13%, respectively. Collegewise difference was statistically insignificant. Extra / co-curricular activities were the major source of knowledge. Conclusions : Majority of medical interns were aware of the causes and health impacts of climate change, but their knowledge regarding health protection measures was limited.

  12. 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

  13. Medical students' emotional development in early clinical experience : a model

    NARCIS (Netherlands)

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

    Dealing with emotions is a critical feature of professional behaviour. There are no comprehensive theoretical models, however, explaining how medical students learn about emotions. We aimed to explore factors affecting their emotions and how they learn to deal with emotions in themselves and others.

  14. The Early Years of the University of the Witwatersrand Medical ...

    African Journals Online (AJOL)

    1973-01-20

    Jan 20, 1973 ... Witwatersrand Medical School and its Students*. G. R. BEATON, M.B. B.CH. UNIV. .... sion to South African universities, and to travel to. Europe became the .... provement of the residence food at the Queen Victoria. Hospital.

  15. Network contact changes in early and later postseparation years

    NARCIS (Netherlands)

    Terhell, E.L.; Broese Van Groenou, M.I.; van Tilburg, T.G.

    2007-01-01

    This study explains changes in contact frequency in relationships of the preseparation personal network in the early and later years after partners separate. The explanation includes general and separation-related characteristics of the network relationship and the individual. Personal interviews

  16. Evaluation of early changes of cartilage biomarkers following ...

    African Journals Online (AJOL)

    Evaluation of early changes of cartilage biomarkers following arthroscopic meniscectomy in young Egyptian adults. ... Asked Questions about PDFs. Alternatively, you can download the PDF file directly to your computer, from where it can be opened using a PDF reader. To download the PDF, click the Download link above.

  17. Early assessment of medical devices in development for company decision making : An exploration of best practices

    NARCIS (Netherlands)

    Markiewicz, Katarzyna; Van Til, Janine; IJzerman, Maarten

    2017-01-01

    To improve successful development and clinical use of medical technologies, it is suggested that manufacturers should start collecting evidence on devices effectiveness and eficiency early in their development. The aim of this study was to explore whether and how Dutch manufacturers perform an early

  18. Changing concepts of neuroanatomy teaching in medical education.

    Science.gov (United States)

    Hazelton, Lara

    2011-10-01

    Anatomy teaching is often described as foundational in the education of physicians, but in recent years there has been increasing pressure on teachers of neuroanatomy to justify its place in the curriculum. This article examines theoretical assumptions that have traditionally influenced the neuroanatomy curriculum and explains how evolution of thought in the field of medical education has led to a shift in how the pedagogy of neuroanatomy is conceptualized. The widespread adoption of competency-based education, the emphasis on outcome-based objectives, patient- and learner-centered approaches, and a renewed interest in humanistic aspects of medical education have all contributed to a changing educational milieu. These changes have led to a number of curricular innovations. However, questions remain as to what should be taught to medical learners, and how best to teach it.

  19. Intrasubject registration for change analysis in medical imaging

    NARCIS (Netherlands)

    Staring, M.

    2008-01-01

    Image matching is important for the comparison of medical images. Comparison is of clinical relevance for the analysis of differences due to changes in the health of a patient. For example, when a disease is imaged at two time points, then one wants to know if it is stable, has regressed, or

  20. How lead consultants approach educational change in postgraduate medical education.

    Science.gov (United States)

    Fokkema, Joanne P I; Westerman, Michiel; Teunissen, Pim W; van der Lee, Nadine; Scherpbier, Albert J J A; van der Vleuten, Cees P M; Dörr, P Joep; Scheele, Fedde

    2012-04-01

      Consultants in charge of postgraduate medical education (PGME) in hospital departments ('lead consultants') are responsible for the implementation of educational change. Although difficulties in innovating in medical education are described in the literature, little is known about how lead consultants approach educational change.   This study was conducted to explore lead consultants' approaches to educational change in specialty training and factors influencing these approaches.   From an interpretative constructivist perspective, we conducted a qualitative exploratory study using semi-structured interviews with a purposive sample of 16 lead consultants in the Netherlands between August 2010 and February 2011. The study design was based on the research questions and notions from corporate business and social psychology about the roles of change managers. Interview transcripts were analysed thematically using template analysis.   The lead consultants described change processes with different stages, including cause, development of content, and the execution and evaluation of change, and used individual change strategies consisting of elements such as ideas, intentions and behaviour. Communication is necessary to the forming of a strategy and the implementation of change, but the nature of communication is influenced by the strategy in use. Lead consultants differed in their degree of awareness of the strategies they used. Factors influencing approaches to change were: knowledge, ideas and beliefs about change; level of reflection; task interpretation; personal style, and department culture.   Most lead consultants showed limited awareness of their own approaches to change. This can lead them to adopt a rigid approach, whereas the ability to adapt strategies to circumstances is considered important to effective change management. Interventions and research should be aimed at enhancing the awareness of lead consultants of approaches to change in PGME.

  1. Early hemodynamic assessment and treatment of elderly patients in the medical ICU.

    Science.gov (United States)

    Voga, Gorazd; Gabršček-Parežnik, Lucija

    2016-12-01

    The aim of this retrospective study was to analyze differences in the initial hemodynamic assessment and its impact on the treatment in patients aged 80 years or older compared to younger patients during the first 6 h after admission to the medical intensive care unit (ICU). We analyzed 615 consecutive patients admitted to the medical ICU of which 124 (20%) were aged 80 years or more. The older group had a significantly higher acute physiology and chronic health evaluation (APACHE II) score, an overall mortality in the ICU and a presence of pre-existing cardiac disease. Both groups did not differ in the presence of shock and shock types on admission. In 57% of older and in 56% of younger patients, transthoracic echocardiography was performed with a higher therapeutic impact in the older patients. Transesophageal echocardiography was performed in 3% of the patients in both groups for specific diagnostic problems. Early reassessment with transthoracic echocardiography was necessary in 5% of the older and in 6% of the younger patients and resulted in a change of the treatment in one third of the patients. Continuous invasive hemodynamic monitoring was used in 11% of the older and in 10% of the younger patients and resulted in a therapeutic change in 71% of the older and in 64% of the younger patients. Patients aged 80 years or older represent 20% of all admissions to the medical ICU. Once admitted the older patients were similarly hemodynamically assessed as the younger ones with a similar impact on the treatment.

  2. The origins of scientific cinematography and early medical applications.

    Science.gov (United States)

    Barboi, Alexandru C; Goetz, Christopher G; Musetoiu, Radu

    2004-06-08

    To examine the neurologic cinematographic contributions of Gheorghe Marinescu. Near the end of the 19th century, cinematography developed and was immediately recognized as a new technique applicable to medical documentation. After studying with several prominent European neurologists and deeply influenced by Jean-Martin Charcot, Marinescu returned to Bucharest in 1897 and applied moving picture techniques to the study of neurologic patients. The Romanian State Archives were researched for original Marinescu films, and related publications were translated from Romanian and French. Between 1899 and 1902, Marinescu perfected the use of cinematography as a research method in neurosciences and published five articles based on cinematographic documents. He focused his studies particularly on organic gait disorders, locomotor ataxia, and hysteria. He adapted Charcot's method of lining up several patients with the same disorder and showing them together to permit appreciation of archetypes and formes frustes. He decomposed the moving pictures into sequential tracings for publication. He documented treatment results with cases filmed before and after therapy. Processed and digitized excerpts of these films accompany this manuscript. Marinescu's cinematographic studies led to several original contributions in clinical neurology. Remaining film archives include examples of many neurologic diseases, his examination techniques, and the working medical environment of the young founder of the Romanian school of neurology.

  3. Change in settings for early-season influenza vaccination among US adults, 2012 to 2013

    Directory of Open Access Journals (Sweden)

    Sarah J. Clark, MPH

    2016-12-01

    Full Text Available Vaccination in non-medical settings is recommended as a strategy to increase access to seasonal influenza vaccine. To evaluate change in early-season influenza vaccination setting, we analyzed data from the National Internet Flu Survey. Bivariate comparison of respondent characteristics by location of vaccination was assessed using chi-square tests. Multinomial logistic regression was performed to compare the predicted probability of being vaccinated in medical, retail, and mobile settings in 2012 vs 2013. In both 2012 and 2013, vaccination in medical settings was more likely among elderly adults, those with chronic conditions, and adults with a high school education or less. Adults 18–64 without a chronic condition had a lower probability of vaccination in the medical setting, and higher probability of vaccination in a retail or mobile setting, in 2013 compared to 2012. Adults 18–64 with a chronic condition had no change in their location of flu vaccination. Elderly adults had a lower probability of vaccination in the medical setting, and higher probability of vaccination in a retail setting, in 2013 compared to 2012. Non-medical settings continue to play an increasing role in influenza vaccination of adults, particularly for adults without a chronic condition and elderly adults. Retail and mobile settings should continue to be viewed as important mechanisms to ensure broad access to influenza vaccination.

  4. Measuring Changes in the Economics of Medical Practice.

    Science.gov (United States)

    Fleming, Christopher; Rich, Eugene; DesRoches, Catherine; Reschovsky, James; Kogan, Rachel

    2015-08-01

    For the latter third of the twentieth century, researchers have estimated production and cost functions for physician practices. Today, those attempting to measure the inputs and outputs of physician practice must account for many recent changes in models of care delivery. In this paper, we review practice inputs and outputs as typically described in research on the economics of medical practice, and consider the implications of the changing organization of medical practice and nature of physician work. This evolving environment has created conceptual challenges in what are the appropriate measures of output from physician work, as well as what inputs should be measured. Likewise, the increasing complexity of physician practice organizations has introduced challenges to finding the appropriate data sources for measuring these constructs. Both these conceptual and data challenges pose measurement issues that must be overcome to study the economics of modern medical practice. Despite these challenges, there are several promising initiatives involving data sharing at the organizational level that could provide a starting point for developing the needed new data sources and metrics for physician inputs and outputs. However, additional efforts will be required to establish data collection approaches and measurements applicable to smaller and single specialty practices. Overcoming these measurement and data challenges will be key to supporting policy-relevant research on the changing economics of medical practice.

  5. Neural changes underlying early stages of L2 vocabulary acquisition.

    Science.gov (United States)

    Pu, He; Holcomb, Phillip J; Midgley, Katherine J

    2016-11-01

    Research has shown neural changes following second language (L2) acquisition after weeks or months of instruction. But are such changes detectable even earlier than previously shown? The present study examines the electrophysiological changes underlying the earliest stages of second language vocabulary acquisition by recording event-related potentials (ERPs) within the first week of learning. Adult native English speakers with no previous Spanish experience completed less than four hours of Spanish vocabulary training, with pre- and post-training ERPs recorded to a backward translation task. Results indicate that beginning L2 learners show rapid neural changes following learning, manifested in changes to the N400 - an ERP component sensitive to lexicosemantic processing and degree of L2 proficiency. Specifically, learners in early stages of L2 acquisition show growth in N400 amplitude to L2 words following learning as well as a backward translation N400 priming effect that was absent pre-training. These results were shown within days of minimal L2 training, suggesting that the neural changes captured during adult second language acquisition are more rapid than previously shown. Such findings are consistent with models of early stages of bilingualism in adult learners of L2 ( e.g. Kroll and Stewart's RHM) and reinforce the use of ERP measures to assess L2 learning.

  6. A History of Medicine and the Establishment of Medical Institutions in Middlesex County, New Jersey that Transformed Doctor and Patient Relationships during the Early Twentieth Century

    Science.gov (United States)

    Whitfield-Spinner, Linda

    2011-01-01

    The early twentieth century was a period of tremendous advancements in medicine and technology and as a result experienced a revolutionary change in the delivery of healthcare in America. Modern medicine which encompassed specialized knowledge, technical procedures, and rules of behavior, changed the way medical care was provided in the United…

  7. Limbic grey matter changes in early Parkinson's disease.

    Science.gov (United States)

    Li, Xingfeng; Xing, Yue; Schwarz, Stefan T; Auer, Dorothee P

    2017-05-02

    The purpose of this study was to investigate local and network-related changes of limbic grey matter in early Parkinson's disease (PD) and their inter-relation with non-motor symptom severity. We applied voxel-based morphometric methods in 538 T1 MRI images retrieved from the Parkinson's Progression Markers Initiative website. Grey matter densities and cross-sectional estimates of age-related grey matter change were compared between subjects with early PD (n = 366) and age-matched healthy controls (n = 172) within a regression model, and associations of grey matter density with symptoms were investigated. Structural brain networks were obtained using covariance analysis seeded in regions showing grey matter abnormalities in PD subject group. Patients displayed focally reduced grey matter density in the right amygdala, which was present from the earliest stages of the disease without further advance in mild-moderate disease stages. Right amygdala grey matter density showed negative correlation with autonomic dysfunction and positive with cognitive performance in patients, but no significant interrelations were found with anxiety scores. Patients with PD also demonstrated right amygdala structural disconnection with less structural connectivity of the right amygdala with the cerebellum and thalamus but increased covariance with bilateral temporal cortices compared with controls. Age-related grey matter change was also increased in PD preferentially in the limbic system. In conclusion, detailed brain morphometry in a large group of early PD highlights predominant limbic grey matter deficits with stronger age associations compared with controls and associated altered structural connectivity pattern. This provides in vivo evidence for early limbic grey matter pathology and structural network changes that may reflect extranigral disease spread in PD. Hum Brain Mapp, 2017. © 2017 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc. © 2017 The

  8. Limited scleroderma and early detection of visceral changes

    International Nuclear Information System (INIS)

    Kalyuzhnaya, L.D.; Potsibina, V.V.; Stychinskaya, L.P.; Turik, N.V.

    1989-01-01

    The state of liver, kidneys, osteoarticular apparatus at the early stages of development of limited scleroderma and with the exclusion of visceral changes on the basis of clinical-laboratory studies is investigated. 11 patients with scleroderma in the age of 7-18 years were examined. Osteoscintigraphy with 99m TC-phosphone and dynamic scintigraphy of kidneys without additional introduction of RF, and hepatocholecyctoscintigraphy with 99m tc-HIPA of the patients were realized. The conclusion is made that radionuclide investigation methods permit to reveal various visceral changes, which are not recognizable by clinical methods

  9. Early and phasic cortical metabolic changes in vestibular neuritis onset.

    Directory of Open Access Journals (Sweden)

    Marco Alessandrini

    Full Text Available Functional brain activation studies described the presence of separate cortical areas responsible for central processing of peripheral vestibular information and reported their activation and interactions with other sensory modalities and the changes of this network associated to strategic peripheral or central vestibular lesions. It is already known that cortical changes induced by acute unilateral vestibular failure (UVF are various and undergo variations over time, revealing different cortical involved areas at the onset and recovery from symptoms. The present study aimed at reporting the earliest change in cortical metabolic activity during a paradigmatic form of UVF such as vestibular neuritis (VN, that is, a purely peripheral lesion of the vestibular system, that offers the opportunity to study the cortical response to altered vestibular processing. This research reports [(18F]fluorodeoxyglucose positron emission tomography brain scan data concerning the early cortical metabolic activity associated to symptoms onset in a group of eight patients suffering from VN. VN patients' cortical metabolic activity during the first two days from symptoms onset was compared to that recorded one month later and to a control healthy group. Beside the known cortical response in the sensorimotor network associated to vestibular deafferentation, we show for the first time the involvement of Entorhinal (BAs 28, 34 and Temporal (BA 38 cortices in early phases of symptomatology onset. We interpret these findings as the cortical counterparts of the attempt to reorient oneself in space counteracting the vertigo symptom (Bas 28, 34 and of the emotional response to the new pathologic condition (BA 38 respectively. These interpretations were further supported by changes in patients' subjective ratings in balance, anxiety, and depersonalization/derealization scores when tested at illness onset and one month later. The present findings contribute in expanding

  10. Changing opinions about research by Saudi medical students

    Directory of Open Access Journals (Sweden)

    Abulaban A

    2017-08-01

    Full Text Available Ahmad Abulaban, Abdulrahman Alharbi, Osama BinDajam, Mohammed Al Jarbou, Hatem Alharbi, Faiz Alanazi, Khalid Aldamiri, Ahmed Althobaiti, Abdulla Al Sayyari Department of Medicine, Division of Neurology, King Saud bin-Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia Objective: The objective of this study was to investigate and compare the opinions and attitudes of medical students toward medical research in five Saudi universities and examine the changes observed in these opinions and attitudes in one of these universities over a period of time.Methods: This is a cross-sectional study conducted among medical students in five Saudi universities. This study was based on a survey undertaken in 2015. The survey consisted of five questions inquiring about the opinions and attitudes of medical students toward medical research. The same survey was carried out 8 years earlier in one of these universities (King Abdulaziz University [KAU], and the results obtained during the two periods (2007 and 2015 were compared.Results: A convenient sample of 924 students was selected from five Saudi universities. Ninety-five (10.3% of the medical students were not aware of the usefulness and importance scientific research will have on their future careers. A total of 409 (44.3% stated that they had no knowledge on how to conduct scientific research. On the other hand, a vast majority of medical students (98.1% expressed a willingness and interest to participate in scientific research if provided with an opportunity. The percentage of students from KAU strongly agreeing to participate in research rose from 33.1% in 2007 to 81.5% in 2015 (P=0.001. Of all the students surveyed, 431 (46.6% had participated in scientific research as undergraduates.Conclusion: Most students in five Saudi universities expressed enthusiasm for participating in a research project, but only a few of them had

  11. Developmental Changes in Sleep Oscillations during Early Childhood

    Directory of Open Access Journals (Sweden)

    Eckehard Olbrich

    2017-01-01

    Full Text Available Although quantitative analysis of the sleep electroencephalogram (EEG has uncovered important aspects of brain activity during sleep in adolescents and adults, similar findings from preschool-age children remain scarce. This study utilized our time-frequency method to examine sleep oscillations as characteristic features of human sleep EEG. Data were collected from a longitudinal sample of young children (n=8; 3 males at ages 2, 3, and 5 years. Following sleep stage scoring, we detected and characterized oscillatory events across age and examined how their features corresponded to spectral changes in the sleep EEG. Results indicated a developmental decrease in the incidence of delta and theta oscillations. Spindle oscillations, however, were almost absent at 2 years but pronounced at 5 years. All oscillatory event changes were stronger during light sleep than slow-wave sleep. Large interindividual differences in sleep oscillations and their characteristics (e.g., “ultrafast” spindle-like oscillations, theta oscillation incidence/frequency also existed. Changes in delta and spindle oscillations across early childhood may indicate early maturation of the thalamocortical system. Our analytic approach holds promise for revealing novel types of sleep oscillatory events that are specific to periods of rapid normal development across the lifespan and during other times of aberrant changes in neurobehavioral function.

  12. Mountains as early warning indicators of climate change

    Science.gov (United States)

    Williams, M. W.

    2015-12-01

    The panoramic splendor and complexity of mountain environments have inspired and challenged humans for centuries. These areas have been variously perceived as physical structures to be conquered, as sites of spiritual inspiration, and as some of the last untamed natural places on Earth. In our time, the perception that "mountains are forever" may provide solace to those seeking stability in a rapidly changing world. However, changes in the hydrology and in the abundance and species composition of the native flora and fauna of mountain ecosystems are potential bellwethers of global change, because these systems have a propensity to amplify environmental changes within specific portions of this landscape. Mountain areas are thus sentinels of climate change. We are seeing effects today in case histories I present from the Himalaya's, Andes, Alps, and Rocky Mountains. Furthermore, these ecosystem changes are occurring in mountain areas before they occur in downstream ecosystems. Thus, mountains are early warning indicators of perturbations such as climate change. The sensitivity of mountain ecosystems begs for enhanced protection and worldwide protection. Our understanding of the processes that control mountain ecosystems—climate interactions, snowmelt runoff, biotic diversity, nutrient cycling—is much less developed compared to downstream ecosystems where human habitation and development has resulted in large investments in scientific knowledge to sustain health and agriculture. To address these deficiencies, I propose the formation of an international mountain research consortium.

  13. Medical specialty selection criteria of Israeli medical students early in their clinical experience: subgroups.

    Science.gov (United States)

    Avidan, Alexander; Weissman, Charles; Elchalal, Uriel; Tandeter, Howard; Zisk-Rony, Rachel Yaffa

    2018-04-18

    Israeli medical school classes include a number of student subgroups. Therefore, interventions aimed at recruiting medical students to the various specialties should to be tailored to each subgroup. Questionnaires, distributed to 6 consecutive 5th-year classes of the Hebrew University - Hadassah School of Medicine, elicited information on criteria for choosing a career specialty, criteria for choosing a residency program and the importance of finding a specialty interesting and challenging when choosing a residency. Completed questionnaires were returned by 540 of 769 (70%) students. The decision processes for choosing a medical specialty and choosing a residency program were different. Family and colleagues had minimal influence on choosing a specialty, while family and their residential locality had much influence on choosing a residency, especially among women. Older age, marriage, and spousal influence were positively associated with choice of a specialty. Two-thirds of the students had completed military service, 20% were attending medical school prior to military service, 5% had completed national service and 9% had entered medical school without serving. Despite the pre-military subgroup being younger and having another 7 years of medical school, internship and military service before residency, they had begun thinking about which specialty to choose, just like the post-military students. When choosing a residency program, post-military women were more influenced by their families and family residential locality than their pre-military counterparts; differences ascribed to the older and often married post-military women having or wanting to begin families. This difference was reinforced by fewer post- than pre-military women willing to wait 2-3 years for a residency in the specialty that interested them most and were willing to begin residency immediately after internship in a specialty that interested them less. Medical school classes are composed of

  14. Change in Physical Attraction in Early Romantic Relationships

    Directory of Open Access Journals (Sweden)

    Victor Karandashev

    2014-12-01

    Full Text Available The goal of our research was to study the changes in physical attraction during the early stages of romantic relationships. The longitudinal study explored the personality characteristics of a partner and relationship events affecting physical attraction of early (within the first year romantic relationships. Participants completed an eight-week longitudinal rating of their attraction toward their romantic partner. Factor analysis revealed behavioral, cognitive, emotional, and physiological dimensions. The behavioral and emotional dimensions play the largest role in attraction among both genders, with cognitive dimension also affecting attraction in women. Personality characteristics of one’s partner are significant predictors of physical attraction for both men and women. However, events occurring in the relationship seem to be only reliable predictors for a women’s attraction.

  15. Early embryonic androgen exposure induces transgenerational epigenetic and metabolic changes.

    Science.gov (United States)

    Xu, Ning; Chua, Angela K; Jiang, Hong; Liu, Ning-Ai; Goodarzi, Mark O

    2014-08-01

    Androgen excess is a central feature of polycystic ovary syndrome (PCOS), which affects 6% to 10% of young women. Mammals exposed to elevated androgens in utero develop PCOS-like phenotypes in adulthood, suggesting fetal origins of PCOS. We hypothesize that excess androgen exposure during early embryonic development may disturb the epigenome and disrupt metabolism in exposed and unexposed subsequent generations. Zebrafish were used to study the underlying mechanism of fetal origins. Embryos were exposed to androgens (testosterone and dihydrotestosterone) early at 26 to 56 hours post fertilization or late at 21 to 28 days post fertilization. Exposed zebrafish (F0) were grown to adults and crossed to generate unexposed offspring (F1). For both generations, global DNA methylation levels were examined in ovaries using a luminometric methylation assay, and fasting and postprandial blood glucose levels were measured. We found that early but not late androgen exposure induced changes in global methylation and glucose homeostasis in both generations. In general, F0 adult zebrafish exhibited altered global methylation levels in the ovary; F1 zebrafish had global hypomethylation. Fasting blood glucose levels were decreased in F0 but increased in F1; postprandial glucose levels were elevated in both F0 and F1. This androgenized zebrafish study suggests that transient excess androgen exposure during early development can result in transgenerational alterations in the ovarian epigenome and glucose homeostasis. Current data cannot establish a causal relationship between epigenetic changes and altered glucose homeostasis. Whether transgenerational epigenetic alteration induced by prenatal androgen exposure plays a role in the development of PCOS in humans deserves study.

  16. Utilisation of helicopter emergency medical services in the early medical response to major incidents: a systematic literature review.

    Science.gov (United States)

    Johnsen, Anne Siri; Fattah, Sabina; Sollid, Stephen J M; Rehn, Marius

    2016-02-09

    This systematic review identifies, describes and appraises the literature describing the utilisation of helicopter emergency medical services (HEMS) in the early medical response to major incidents. Early prehospital phase of a major incident. Systematic literature review performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Web of Science, PsycINFO, Scopus, Cinahl, Bibsys Ask, Norart, Svemed and UpToDate were searched using phrases that combined HEMS and 'major incidents' to identify when and how HEMS was utilised. The identified studies were subjected to data extraction and appraisal. The database search identified 4948 articles. Based on the title and abstract, the full text of 96 articles was obtained; of these, 37 articles were included in the review, and an additional five were identified by searching the reference lists of the 37 articles. HEMS was used to transport medical and rescue personnel to the incident and to transport patients to the hospital, especially when the infrastructure was damaged. Insufficient air traffic control, weather conditions, inadequate landing sites and failing communication were described as challenging in some incidents. HEMS was used mainly for patient treatment and to transport patients, personnel and equipment in the early medical management of major incidents, but the optimal utilisation of this specialised resource remains unclear. This review identified operational areas with improvement potential. A lack of systematic indexing, heterogeneous data reporting and weak methodological design, complicated the identification and comparison of incidents, and more systematic reporting is needed. CRD42013004473. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  17. The medical profession and changing attitudes towards advertising and competition.

    Science.gov (United States)

    Bell, J D; Fay, M T

    1991-02-27

    This paper examines the attitudes of general medical practitioners towards competition and advertising and the changes that have occurred between 1985 and 1988. The data was derived from a self completion questionnaire, 1500 of which were evenly distributed among the members of five professions; doctors, dentists, lawyers, accountants and veterinarians. General practitioners are now favourably disposed towards advertising by the profession as a whole in an effort to increase awareness of medical services (70% in favour in 1988 compared to only 53% in 1985), but the perceived need for increased business efficiency has lessened (70% in 1988 compared to 78% in 1985). Collegiality continues to be the dominant ideology but this position has weakened slightly. In 1988 only 65% of general practitioners regarded other members of the profession as colleagues rather than competitors, compared to 73% in 1985.

  18. Radiation induced early onset of neuro-cognitive changes

    International Nuclear Information System (INIS)

    Kumar, Mayank; Haridas, Seenu; Gupta, Mamta; Trivedi, Richa; Khushu, Subhash; Manda, Kailash

    2012-01-01

    Exposure to ionizing radiations has been shown to cause many detrimental effects. Primarily, the effects observed are broadly classified into hematopoietic syndrome at lower doses, gastrointestinal syndrome and central nervous system dysfunctions at high doses. However, recent studies reported that even at lower doses, there is an effect seen on the nervous system which can be observed as a decline in cognitive abilities. This has been reported in patients undergoing radiotherapy. The cognitive decline, especially in young patients affects development and has been shown to persist for years after the therapy. Thus, the aim of this study was to study and consolidate the early effects of radiation exposure which result in behavioural alterations and cognitive decline. Since, radiation-induced early changes in behavioural functions are poorly understood, therefore, the present investigation aimed to conceptualize and design behavioural test batteries in order to systematically study the immediate alterations in behavioural function following irradiation with a-rays. The behavioural alterations were correlated to changes in the different area of brain like hippocampus, thalamus, hypothalamus and corpus callosum using Diffusion Tensor Imaging (DTI) studies. Present study reported profound changes in behaviour, as well as alterations in the morphology of the brain tissue as perceived by DTI, 48 hours after exposure to ionizing radiations. These changes need to be correlated and clarified further to understand the mechanisms behind the cognitive dysfunctions occurring immediately after radiation exposure as well as to find out a therapeutic window to counteract or reduce the effect of long term cognitive changes following irradiation. (author)

  19. Early detection of structual changes in random signal

    International Nuclear Information System (INIS)

    Kuroda, Yoshiteru; Yokota, Katsuhiro

    1981-01-01

    Early detection of structual changes in observed random signal is very important from the point of system diagnosis. In this paper, the following procedures are applied to this problem and the results are compared. (1) auto-regressive model to random signal to calculate the prediction error, i.e., the defference between observed and predicted values. (2) auto-regressive method to caluculate the sum of the prediction error. (3) a method is based on AIC (Akaike Information Criterion). Simulation is made of these procedures, indicating their merits and demerits as a diagostic tools. (author)

  20. Increased knowledge of thalassemia promotes early carrier status examination among medical students

    Directory of Open Access Journals (Sweden)

    Julius Broto Dewanto

    2016-04-01

    A higher thalassemia knowledge score causes medical students to be willing to undergo thalassemia carrier status examination at an earlier point in timing. A well-organized educational program focusing on thalassemia and early screening in young adults may enhance the thalassemia prevention program.

  1. Value of research and value of development in early assessments of new medical technologies

    NARCIS (Netherlands)

    Retèl, Valesca P.; Grutters, Janneke P.C.; van Harten, Wim H.; Joore, Manuela A.

    2013-01-01

    Objectives: In early stages of development of new medical technologies, there are conceptually separate but related societal decisions to be made concerning adoption, further development (i.e., technical improvement), and research (i.e., clinical trials) of new technologies. This article presents a

  2. Drought early warning and risk management in a changing environment

    Science.gov (United States)

    Pulwarty, R. S.

    2011-12-01

    Drought has long been recognized as falling into the category of incremental but long-term and cumulative environmental changes, also termed slow-onset or creeping events. These event types would include: air and water quality decline, desertification processes, deforestation and forest fragmentation, loss of biodiversity and habitats, and nitrogen overloading, among others. Climate scientists continue to struggle with recognizing the onset of drought and scientists and policy makers continue to debate the basis (i.e., criteria) for declaring an end to a drought. Risk-based management approaches to drought planning at the national and regional levels have been recommended repeatedly over the years but their prototyping, testing and operational implementation have been limited. This presentation will outline two avenues for disaster risk reduction in the context of drought (1) integrated early warning information systems, and (2) linking disaster risk reduction to climate change adaptation strategies. Adaptation involves not only using operational facilities and infrastructure to cope with the immediate problems but also leaving slack or reserve for coping with multiple stress problems that produce extreme impacts and surprise. Increasing the 'anticipatability' of an event, involves both monitoring of key indicators from appropriate baseline data, and observing early warning signs that assumptions in risk management plans are failing and critical transitions are occurring. Illustrative cases will be drawn from the IPCC Special Report on Managing the Risks of Extreme Events and Disasters (2011), the UN Global Assessment of Disaster Risk Reduction (2011) and implementation activities in which the author has been engaged. Most drought early warning systems have tended to focus on the development and use of physical system indicators and forecasts of trends and thresholds. We show that successful early warning systems that meet expectations of risk management also have

  3. Navigating the Complexities of Undergraduate Medical Curriculum Change: Change Leaders' Perspectives.

    Science.gov (United States)

    Velthuis, Floor; Varpio, Lara; Helmich, Esther; Dekker, Hanke; Jaarsma, A Debbie C

    2018-02-06

    Changing an undergraduate medical curriculum is a recurring, high-stakes undertaking at medical schools. This study aimed to explore how people leading major curriculum changes conceived of the process of enacting change and the strategies they relied on to succeed in their efforts. The first author individually interviewed nine leaders who were leading or had led the most recent undergraduate curriculum change in one of the eight medical schools in the Netherlands. Interviews were between December 2015 and April 2016, using a semi-structured interview format. Data analysis occurred concurrently with data collection, with themes being constructed inductively from the data. Leaders conceived of curriculum change as a dynamic, complex process. They described three major challenges they had to deal with while navigating this process: the large number of stakeholders championing a multitude of perspectives, dealing with resistance, and steering the change process. Additionally, strategies for addressing these challenges were described. The authors identified an underlying principle informing the work of these leaders: being and remaining aware of emerging situations, and carefully constructing strategies for ensuring the intended outcomes were reached and contributed to the progress of the change process. This empirical, descriptive study enriches the understanding of how institutional leaders navigate the complexities of major medical curriculum changes. The insights serve as a foundation for training and coaching future change leaders. To broaden the understanding of curriculum change processes, future studies could investigate the processes through alternative stakeholder perspectives.Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a "work of the United States Government" for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not

  4. Early changes in left atrial volume after acute myocardial infarction

    DEFF Research Database (Denmark)

    Bakkestrom, R.; Andersen, Mads J; Ersboll, M.

    2016-01-01

    . The objective was to assess changes in LA volume early after MI in patients with diastolic dysfunction and the relation to invasive hemodynamics and natriuretic peptides. Methods: 62 patients with left ventricle ejection fraction (LVEF) >= 45%, diastolic E/e' > 8 and LA volume index >34 ml/m(2) within 48 h......Background: Dilatation of left atrium (LA) reflects chronic LA pressure or volume overload that possesses considerable prognostic information. Little is known regarding the interaction between LA remodeling after acute myocardial infarction (MI) and left atrial pressure at rest and during exercise...... of MI were enrolled. After 1 and 4 months blood sampling, echocardiography and right heart catheterization were performed during exercise test. Results: LA remodeling was considered in patients with a change from mild (35-41 ml/m(2)), to severe (>48ml/m(2)) dilatation after 4 months (Found in 22...

  5. Early Cretaceous climate change (Hauterivian - Early Aptian): Learning from the past to prevent modern reefs decline

    Science.gov (United States)

    Godet, Alexis; Bodin, Stéphane; Adatte, Thierry; Föllmi, Karl B.

    2010-05-01

    In the last decades, the anthropogenic increase pCO2atm has been considered as one of the main contributors for the decline of modern coral reefs, and nearly 60% of these marine ecosystems are presently threatened (Bryant et al., 1998). Interactions between anthropogenic change and reef growth can, however, not be reduced to a single factor, and it is essential to look at the Earth's history to understand and counterbalance. During the Early Cretaceous, enhanced pCO2atm may have been responsible, at least in part, for the demise of the carbonate platform along the northern margin of the Tethys through climatic feedback mechanisms. From the Hauterivian to the Early Aptian, increased rainfalls are documented from the clay-mineral association, by a change from a smectite-dominated (most of the Hauterivian), to a kaolinite-dominated assemblage (latest Hauterivian up to the early Late Barremian). This switch is dated to the Pseudothurmannia ohmi ammonozone in the Vocontian Trough of southeastern France (Angles section, Godet et al., 2008). It is immediately followed in time by major nutrient input, as is illustrated by the substantial increase in phosphorus accumulation rates (PAR), not only in this section, but also in the Ultrahelvetic area of Switzerland and in the Umbria-Marche basin of Italy (Bodin et al., 2006). On the other hand, the remainder of the Hauterivian is characterized by PAR mean values characteristic of mesotrophic conditions, whereas the Late Barremian witnesses the return to oligotrophic environments (lower PAR values). Synchronously, these perturbations are mirrored on the platform by changes in the type of carbonate ecosystems. Indeed, a stronger continental runoff, and a subsequent input in the oceanic domain of nutrients (e.g., phosphorus) and clastic material modified marine palaeoenvironmental conditions and triggered changes in ecosystems. A unique archive of the Early Cretaceous carbonate platform is preserved in the Helvetic Alps, where the

  6. [Early detection of cervical cancer in Chile: time for change].

    Science.gov (United States)

    Léniz Martelli, Javiera; Van De Wyngard, Vanessa; Lagos, Marcela; Barriga, María Isabel; Puschel Illanes, Klaus; Ferreccio Readi, Catterina

    2014-08-01

    Mortality rates for cervical cancer (CC) in Chile are higher than those of developed countries and it has an unequal socioeconomic distribution. The recognition of human papilloma virus (HPV) as the causal agent of cervical cancer in the early 80's changed the prevention paradigms. Current goals are to prevent HPV infection by vaccination before the onset of sexual activity and to detect HPV infection in women older than 30 years. This article reviews CC prevention and early detection methods, discusses relevant evidence to support a change in Chile and presents an innovation proposal. A strategy of primary screening based on HPV detection followed by triage of HPV-positive women by colposcopy in primary care or by cytological or molecular reflex testing is proposed. Due to the existence in Chile of a well-organized nationwide CC prevention program, the replacement of a low-sensitivity screening test such as the Papanicolau test with a highly sensitive one such as HPV detection, could quickly improve the effectiveness of the program. The program also has a network of personnel qualified to conduct naked-eye inspections of the cervix, who could easily be trained to perform triage colposcopy. The incorporation of new prevention strategies could reduce the deaths of Chilean women and correct inequities.

  7. Changes in insomnia subtypes in early Parkinson disease.

    Science.gov (United States)

    Tholfsen, Lena K; Larsen, Jan P; Schulz, Jörn; Tysnes, Ole-Bjørn; Gjerstad, Michaela D

    2017-01-24

    To examine the development of factors associated with insomnia in a cohort of originally drug-naive patients with incident Parkinson disease (PD) during the first 5 years after diagnosis. One hundred eighty-two drug-naive patients with PD derived from a population-based incident cohort and 202 control participants were assessed for insomnia before treatment initiation and were repeatedly examined after 1, 3, and 5 years. Insomnia was diagnosed according to the Stavanger Sleepiness Questionnaire. The Parkinson's Disease Sleep Scale was used to differentiate sleep initiation problems from problems of sleep maintenance. Generalized estimating equation models were applied for statistical measures. The prevalence of insomnia in general was not higher in patients with PD compared to controls at the 5-year follow-up. There were changes in the prevalence of the different insomnia subtypes over the 5-year follow-up. The prevalence of solitary problems in sleep maintenance increased from 31% (n = 18) in the drug-naive patients at baseline to 49% (n = 29) after 1 year and were associated with the use of dopamine agonists and higher Montgomery-Åsberg Depression Rating Scale scores. The prevalence of solitary sleep initiation problems decreased continuously from 21% (n = 12) at baseline to 7.4% (n = 4) after 5 years; these were associated with less daytime sleepiness. The prevalence rates of the different insomnia subtypes changed notably in patients with early PD. The frequency of sleep maintenance problems increased, and these problems were associated with dopamine agonist use and depressive symptoms, while the total number of patients with insomnia remained stable. Our findings reflect the need for early individual assessments of insomnia subtypes and raise the possibility of intervention to reduce these symptoms in patients with early PD. © 2016 American Academy of Neurology.

  8. Early career retention of Malawian medical graduates: a retrospective cohort study.

    Science.gov (United States)

    Mandeville, Kate L; Ulaya, Godwin; Lagarde, Mylene; Gwesele, Lyson; Dzowela, Titha; Hanson, Kara; Muula, Adamson S

    2015-01-01

    There have been longstanding concerns over Malawian doctors migrating to high-income countries. Early career is a particularly vulnerable period. After significant policy changes, we examined the retention of recent medical graduates within Malawi and the public sector. We obtained data on graduates between 2006 and 2012 from the University of Malawi College of Medicine and Malawi Ministry of Health. We utilised the alumni network to triangulate official data and contacted graduates directly for missing or uncertain data. Odds ratios and chi-squared tests were employed to investigate relationships by graduation year and gender. We traced 256 graduates, with complete information for more than 90%. Nearly 80% of registered doctors were in Malawi (141/178, 79.2%), although the odds of emigration doubled with each year after graduation (odds ratio = 1.98, 95% CI = 1.54-2.56, P < 0.0001). Of the 37 graduates outside Malawi (14.5%), 23 (62.2%) were training in South Africa under a College of Medicine sandwich programme. More than 80% of graduates were working in the public sector (185/218, 82.6%), with the odds declining by 27% for each year after graduation (odds ratio = 0.73, 95% CI = 0.61-0.86, P < 0.0001). While most doctors remain in Malawi and the public sector during their early careers, the odds of leaving both increase with time. The majority of graduates outside Malawi are training in South Africa under visa restrictions, reflecting the positive impact of postgraduate training in Malawi. Concerns over attrition from the public sector are valid and require further exploratory work. © 2014 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

  9. Changes in medical errors after implementation of a handoff program.

    Science.gov (United States)

    Starmer, Amy J; Spector, Nancy D; Srivastava, Rajendu; West, Daniel C; Rosenbluth, Glenn; Allen, April D; Noble, Elizabeth L; Tse, Lisa L; Dalal, Anuj K; Keohane, Carol A; Lipsitz, Stuart R; Rothschild, Jeffrey M; Wien, Matthew F; Yoon, Catherine S; Zigmont, Katherine R; Wilson, Karen M; O'Toole, Jennifer K; Solan, Lauren G; Aylor, Megan; Bismilla, Zia; Coffey, Maitreya; Mahant, Sanjay; Blankenburg, Rebecca L; Destino, Lauren A; Everhart, Jennifer L; Patel, Shilpa J; Bale, James F; Spackman, Jaime B; Stevenson, Adam T; Calaman, Sharon; Cole, F Sessions; Balmer, Dorene F; Hepps, Jennifer H; Lopreiato, Joseph O; Yu, Clifton E; Sectish, Theodore C; Landrigan, Christopher P

    2014-11-06

    Miscommunications are a leading cause of serious medical errors. Data from multicenter studies assessing programs designed to improve handoff of information about patient care are lacking. We conducted a prospective intervention study of a resident handoff-improvement program in nine hospitals, measuring rates of medical errors, preventable adverse events, and miscommunications, as well as resident workflow. The intervention included a mnemonic to standardize oral and written handoffs, handoff and communication training, a faculty development and observation program, and a sustainability campaign. Error rates were measured through active surveillance. Handoffs were assessed by means of evaluation of printed handoff documents and audio recordings. Workflow was assessed through time-motion observations. The primary outcome had two components: medical errors and preventable adverse events. In 10,740 patient admissions, the medical-error rate decreased by 23% from the preintervention period to the postintervention period (24.5 vs. 18.8 per 100 admissions, P<0.001), and the rate of preventable adverse events decreased by 30% (4.7 vs. 3.3 events per 100 admissions, P<0.001). The rate of nonpreventable adverse events did not change significantly (3.0 and 2.8 events per 100 admissions, P=0.79). Site-level analyses showed significant error reductions at six of nine sites. Across sites, significant increases were observed in the inclusion of all prespecified key elements in written documents and oral communication during handoff (nine written and five oral elements; P<0.001 for all 14 comparisons). There were no significant changes from the preintervention period to the postintervention period in the duration of oral handoffs (2.4 and 2.5 minutes per patient, respectively; P=0.55) or in resident workflow, including patient-family contact and computer time. Implementation of the handoff program was associated with reductions in medical errors and in preventable adverse events

  10. Changing Policy, Changing Culture: Steps toward Early Learning Quality Improvement in Australia

    Science.gov (United States)

    Tayler, Collette

    2011-01-01

    Across Australia a combined government effort is underway to reform early childhood education and care (ECEC) provision. A National Law Bill passed in 2010 heralds a new legal, regulatory and accountability framework that embraces all types ECEC provision. As a result, service providers face rapid change to address a new orientation and higher…

  11. Mood and anxiety disorders as early manifestations of medical illness: a systematic review.

    Science.gov (United States)

    Cosci, Fiammetta; Fava, Giovanni A; Sonino, Nicoletta

    2015-01-01

    Affective disturbances involving alterations of mood, anxiety and irritability may be early symptoms of medical illnesses. The aim of this paper was to provide a systematic review of the literature with qualitative data synthesis. MEDLINE, PsycINFO, EMBASE, Cochrane, and ISI Web of Science were systematically searched from inception to February 2014. Search terms were 'prodrome/early symptom', combined using the Boolean 'AND' operator with 'anxiety/depression/mania/hypomania/irritability/irritable mood/hostility', combined with the Boolean 'AND' operator with 'medical illness/medical disorder'. PRISMA guidelines were followed. A total of 21 studies met the inclusion criteria and were analyzed. Depression was found to be the most common affective prodrome of medical disorders and was consistently reported in Cushing's syndrome, hypothyroidism, hyperparathyroidism, pancreatic and lung cancer, myocardial infarction, Wilson's disease, and AIDS. Mania, anxiety and irritability were less frequent. Physicians may not pursue medical workup of cases that appear to be psychiatric in nature. They should be alerted that disturbances in mood, anxiety and irritability may antedate the appearance of a medical disorder.

  12. Medical Students' Perspectives on Implementing Curriculum Change at One Institution.

    Science.gov (United States)

    Yengo-Kahn, Aaron M; Baker, Courtney E; Lomis, And Kimberly D

    2017-04-01

    Training physicians to be effective practitioners throughout their careers begins in undergraduate medical education with particular focus on self-directed inquiry, professional and interprofessional development, and competency-based assessment. A select number of medical schools are restructuring their curricula by placing the student at the center of content delivery to enhance the learning experience. While this restructuring may benefit the adult learner, administrators often make assumptions about how students will perceive and respond to such innovative and unfamiliar educational concepts. This can create a disconnect between students and their curriculum. Administrative mindfulness of student experiences is needed to ensure successful implementation of curricular change, facilitate the transition from old to new modalities, and train competent physician graduates.Vanderbilt University School of Medicine (VUSM) recently completed a curriculum update, and student representatives have been essential participants in the transition, from the earliest stages in preplanning to rapid-cycle feedback as the curriculum runs. Two of the authors are members of VUSM's Student Curriculum Committee, which facilitates gathering and relaying student feedback to the administration. Drawing from their experiences, five specific considerations to address and manage when implementing student-centered curricular change are presented: (1) Communicate the rationale, (2) acknowledge anxiety, (3) adjust extracurricular leadership roles, (4) manage "The Bulge" of learners in the clinical environment, and (5) foster ongoing collaboration of students and administrators. For each consideration, examples and proposed solutions are provided.

  13. Changes in spontaneous brain activity in early Parkinson's disease.

    Science.gov (United States)

    Yang, Hong; Zhou, Xiaohong Joe; Zhang, Min-Ming; Zheng, Xu-Ning; Zhao, Yi-Lei; Wang, Jue

    2013-08-09

    Resting state brain activity can provide valuable insights into the pathophysiology of Parkinson's disease (PD). The purpose of the present study was (a) to investigate abnormal spontaneous neuronal activity in early PD patients using resting-state functional MRI (fMRI) with a regional homogeneity (ReHo) method and (b) to demonstrate the potential of using changes in abnormal spontaneous neuronal activity for monitoring the progression of PD during its early stages. Seventeen early PD patients were assessed with the Unified Parkinson's Disease Rating Scale (UPDRS), the Hoehn and Yahr disability scale and the Mini-mental State Examination (MMSE) were compared with seventeen gender- and age-matched healthy controls. All subjects underwent MRI scans using a 1.5T General Electric Signa Excite II scanner. The MRI scan protocol included whole-brain volumetric imaging using a 3D inversion recovery prepared (IR-Prep) fast spoiled gradient-echo pulse sequence and 2D multi-slice (22 axial slices covering the whole brain) resting-state fMRI using an echo planar imaging (EPI) sequence. Images were analyzed in SPM5 together with a ReHo algorithm using the in-house software program REST. A corrected threshold of pbrain regions, including the left cerebellum, left parietal lobe, right middle temporal lobe, right sub-thalamic nucleus areas, right superior frontal gyrus, middle frontal gyrus (MFG), right inferior parietal lobe (IPL), right precuneus lobe, left MFG and left IPL. Additionally, significantly reduced ReHo was also observed in the early PD patients in the following brain regions: the left putamen, left inferior frontal gyrus, right hippocampus, right anterior cingulum, and bilateral lingual gyrus. Moreover, in PD patients, ReHo in the left putamen was negatively correlated with the UPDRS scores (r=-0.69). These results indicate that the abnormal resting state spontaneous brain activity associated with patients with early PD can be revealed by Reho analysis. Copyright

  14. [The evolutionist fallacy of early visitors. Analogies between 'primitive peoples' and prehistoric man in medical historiography].

    Science.gov (United States)

    Bruchhausen, Walter

    2006-01-01

    Accounts of 'prehistoric medicine' and 'ethnomedicine' have sometimes led to conclusions by analogy in medical historiography that are seen as highly problematic in modern cultural anthropology. However, this review of medical historical writings of the last three centuries shows that evolutionist identifications of early with foreign medicine were not a permanent trait of medical historiography. This approach flourished mainly in the climate of certain movements or periods that were characterised by fanatical belief in progress and by social utopias: the French Revolution, Darwinism and the period of industrial expansion in Germany, and National Socialism. Medical historiography shared this problematic approach with contemporary (social and cultural) anthropology, and - despite this methodological misuse - both acknowledged the legitimacy or even requirement of studying also similarities in the development of different periods and cultures.

  15. Public health policy decisions on medical innovations: what role can early economic evaluation play?

    Science.gov (United States)

    Hartz, Susanne; John, Jürgen

    2009-02-01

    Our contribution aims to explore the different ways in which early economic data can inform public health policy decisions on new medical technologies. A literature research was conducted to detect methodological contributions covering the health policy perspective. Early economic data on new technologies can support public health policy decisions in several ways. Embedded in horizon scanning and HTA activities, it adds to monitoring and assessment of innovations. It can play a role in the control of technology diffusion by informing coverage and reimbursement decisions as well as the direct public promotion of healthcare technologies, leading to increased efficiency. Major problems include the uncertainty related to economic data at early stages as well as the timing of the evaluation of an innovation. Decision-makers can benefit from the information supplied by early economic data, but the actual use in practice is difficult to determine. Further empirical evidence should be gathered, while the use could be promoted by further standardization.

  16. Using a personality inventory to identify risk of distress and burnout among early stage medical students.

    Science.gov (United States)

    Bughi, Stephanie A; Lie, Desiree A; Zia, Stephanie K; Rosenthal, Jane

    2017-01-01

    Distress and burnout are common among medical students and negatively impact students' physical, mental, and emotional health. Personality inventories such as the Myers-Briggs Type Indicator (MBTI), used in medical education, may have a role in identifying burnout risk early. The authors conducted a cross-sectional survey study among 185 1st year medical students with the MBTI, the general well-being schedule (GWB), and Maslach Burnout Inventory-Student Survey (MBI-SS). Descriptive statistics and one-way MANOVAs were used to identify the prevalence and differences in MBTI preferences and distress/burnout risk. Response rate was 185/185 (100%). Distress (GWB) was reported by 84/185 (45.4%). High scores on exhaustion were reported by 118/182 (64.8%), cynicism by 76/182 (41.8%), and decreased professional efficacy by 38/182 (20.9%) for the three dimensions of the MBI-SS. Only 21/182 (11.5%) of respondents had high scores on all three dimensions of burnout. Students with MBTI preferences for extraversion reported greater positive well-being (P burnout are prevalent early in medical training. The significant difference between extraversion and introversion in relation to distress and burnout deserves further study. Use of a personality inventory may help identify students at risk of burnout and allow appropriate early stress management.

  17. Interpersonal Development, Stability, and Change in Early Adulthood

    Science.gov (United States)

    Wright, Aidan G. C.; Pincus, Aaron L.; Lenzenweger, Mark F.

    2011-01-01

    Objective This goal of this research was to explore the development of the interpersonal system mapped by the interpersonal circumplex in early adulthood (Ages 18-22). Method This study uses the Longitudinal Study of Personality Disorders sample (N = 250; 53% Female). Participants completed the Revised Interpersonal Adjective Scales (Wiggins, Trapnell, & Phillips, 1988) in their freshman, sophomore, and senior years of college. Estimates of structural, rank-order, mean, individual, and ipsative stability were calculated for the broad interpersonal dimensions of Dominance and Affiliation, and also the lower-order octant scales. Additionally, the interpersonal profile parameters of differentiation and prototypicality were calculated at each wave and explored longitudinally, and also used as predictors of interpersonal stability. Results We found excellent structural and high rank-order and ipsative stability in the interpersonal scales over this time period. Mean increases on the Affiliation axis, but not on the Dominance axis, were found to mask differential rates of change among the octant scales, along with significant individual variation in the rates of change. Interpersonal differentiation and prototypicality were related to higher stability in overall interpersonal style. Conclusions Results point to evidence of both stability and nuanced change, illuminating some of the features of the structural variables that can be derived from interpersonal circumplex profiles. PMID:22224462

  18. Neuroscience curriculum changes and outcomes: medical university of South Carolina, 2006 to 2010.

    Science.gov (United States)

    Holden, Kenton R; Cooper, S Lewis; Wong, Jeffrey G

    2012-07-01

    To develop future neurologists and translational neuroscientists, we created a neurosciences pathway throughout our medical school curriculum that included early exposure to clinical neurosciences decision-making and added variety to the choices of later clinical neurosciences experiences. Our curricular innovation had 3 parts: (1) integrating basic neurosciences content into an explicit clinical context in a College of Medicine (COM) first year of medical school; (2) expanding pathophysiological principles related to neurosciences in COM second year of medical school; and (3) creating a variety of 3-week clinical neurosciences selectives in COM third year of medical school and 4-week electives/externships for interested learners in COM fourth year of medical school. These new changes were evaluated (1) by comparing national standardized examinations including Neurology Subject examination scores for students choosing clinical neurosciences selectives; (2) by student satisfaction Graduate Questionnaires; and (3) by the total number of our graduates matching in US neurosciences disciplines. Students taking neuroscience selectives demonstrated a nonsignificant trend toward higher Step 2 Clinical Knowledge scores. The students' Neurology Subject examination scores were comparable with those scores reported nationally for other US COM third year of medical school students on 4-week rotations. Student-reported satisfaction in clinical neurology teaching improved from 43.9% (before) to 81.8% (after). The percentage of students matching into clinical neuroscience disciplines rose from 2% (before) to 6% (after). Our neurosciences curricular innovation increased graduating student satisfaction scores, had a mild positive impact on Step 2 Clinical Knowledge scores, and increased the number of students choosing careers in the clinical neurosciences. This model may be a consideration for other medical schools who wish to integrate neurosciences teaching throughout their

  19. Changes in moral reasoning and the teaching of medical ethics

    DEFF Research Database (Denmark)

    Holm, S; Norup, M; Vegner, A

    1995-01-01

    Courses in medical ethics are becoming an integral part of many medical school curricula in Europe. At the medical school of the University of Copenhagen, a course on philosophy of medicine has been compulsory for all medical students since 1988. The effect of such courses on the ethical awareness...

  20. Early Modern “Citation Index”? Medical Authorities in Academic Treatises on Plague (1480–1725

    Directory of Open Access Journals (Sweden)

    Karel Černý

    2012-01-01

    Full Text Available The paper deals with the problem of early modern scientific citations. It attempts to establish a measure of scientific popularity in a specific area of the academic medicine in a way which resembles a modern evaluation of scientific activity (citation index. For this purpose an analysis of a series of plague treatises written between 1480 and 1725 in Europe was conducted. Citations for various historical medical authorities (Hippocrates, Galen, etc. are given in Tables which reflect a long time development of popularity. The authorities from various groups (Ancient, Medieval, Arabic, Early Modern are linked together, and “generic authorities” are explained and discussed.

  1. Undergraduate Medical Education Research in Malaysia: Time for a Change.

    Science.gov (United States)

    Salam, Abdus; Hamzah, Jemaima Che; Chin, Tan Geok; Siraj, Harlina Halizah; Idrus, Ruszymah; Mohamad, Nabishah; Raymond, Azman Ali

    2015-01-01

    Special Study Module (SSM) is a mandatory research module implemented in Universiti Kebangsaan Malaysia (UKM). The objective of this paper is to provide a brief overview on the student research activities and to find out the outcome measures in terms of publication. It was a retrospective study done on SSM research projects at UKM. The SSM research is conducted from beginning of year-4 until 1(st) seven weeks of year-5. In year-4, students are assigned to a faculty-supervisor in small groups and spend every Thursday afternoon to plan and carry the research. Whole first seven weeks of year-5, students are placed with their supervisor continuously to collect data, do analysis, write report and present in the scientific conference. Outcomes of 5-years SSM research-projects starting from 2008/2009 to 2012/2013 academic session were analyzed. Total 257 projects were completed and presented in annual scientific meetings from which 57 (22.2%) articles were published in peer reviewed journals. Mandatory undergraduate student research project brings an opportunity to develop students' capacity building from conception to final report writing and thereby narrowing the gap between education and practice. Medical schools should implement research module to bring changes in research and publication culture of undergraduate medical education.

  2. Undergraduate Medical Education Research in Malaysia: Time for a Change

    Science.gov (United States)

    Salam, Abdus; Hamzah, Jemaima Che; Chin, Tan Geok; Siraj, Harlina Halizah; Idrus, Ruszymah; Mohamad, Nabishah; Raymond, Azman Ali

    2015-01-01

    Objective: Special Study Module (SSM) is a mandatory research module implemented in Universiti Kebangsaan Malaysia (UKM). The objective of this paper is to provide a brief overview on the student research activities and to find out the outcome measures in terms of publication. Methods: It was a retrospective study done on SSM research projects at UKM. The SSM research is conducted from beginning of year-4 until 1st seven weeks of year-5. In year-4, students are assigned to a faculty-supervisor in small groups and spend every Thursday afternoon to plan and carry the research. Whole first seven weeks of year-5, students are placed with their supervisor continuously to collect data, do analysis, write report and present in the scientific conference. Outcomes of 5-years SSM research-projects starting from 2008/2009 to 2012/2013 academic session were analyzed. Results: Total 257 projects were completed and presented in annual scientific meetings from which 57 (22.2%) articles were published in peer reviewed journals. Conclusion: Mandatory undergraduate student research project brings an opportunity to develop students’ capacity building from conception to final report writing and thereby narrowing the gap between education and practice. Medical schools should implement research module to bring changes in research and publication culture of undergraduate medical education. PMID:26150832

  3. Children with medical complexity: the change in the pediatric epidemiology

    Directory of Open Access Journals (Sweden)

    Rino Agostiniani

    2014-06-01

    Full Text Available In the last years, epidemiological landscape of pediatric illness is changed; we are facing a progressive raising of the number of children affected by chronic illness (children with special health care needs [CSHCN], mainly due to the amelioration in surviving and in care. These patients have become the majority of the inpatients in some specialist hospitals, like the Meyer Children’s Hospital (Florence, Italy, in 2012. One important group of CSHCN is represented by the children who are most medically fragile and have the most intensive health care needs (children with medical complexity [CMC]. In these patients, the complexity of the pathological framework frequently results in a plenty of visits and tests, with high risk of redundant and expensive cares. They also need outside support networks such as advocacy and accommodations at school, at home, in social life. The CMC needs specific skill and new strategies that could involve pediatricians in hospital as in home care. The professional competencies are ready but a clear and shared strategy is lacking. Proceedings of the 10th International Workshop on Neonatology · Cagliari (Italy · October 22nd-25th, 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou

  4. Agents for change: nonphysician medical providers and health care quality.

    Science.gov (United States)

    Boucher, Nathan A; Mcmillen, Marvin A; Gould, James S

    2015-01-01

    Quality medical care is a clinical and public health imperative, but defining quality and achieving improved, measureable outcomes are extremely complex challenges. Adherence to best practice invariably improves outcomes. Nonphysician medical providers (NPMPs), such as physician assistants and advanced practice nurses (eg, nurse practitioners, advanced practice registered nurses, certified registered nurse anesthetists, and certified nurse midwives), may be the first caregivers to encounter the patient and can act as agents for change for an organization's quality-improvement mandate. NPMPs are well positioned to both initiate and ensure optimal adherence to best practices and care processes from the moment of initial contact because they have robust clinical training and are integral to trainee/staff education and the timely delivery of care. The health care quality aspects that the practicing NPMP can affect are objective, appreciative, and perceptive. As bedside practitioners and participants in the administrative and team process, NPMPs can fine-tune care delivery, avoiding the problem areas defined by the Institute of Medicine: misuse, overuse, and underuse of care. This commentary explores how NPMPs can affect quality by 1) supporting best practices through the promotion of guidelines and protocols, and 2) playing active, if not leadership, roles in patient engagement and organizational quality-improvement efforts.

  5. Changing the culture of medical training: An important step toward the implementation of competency-based medical education.

    Science.gov (United States)

    Ferguson, Peter C; Caverzagie, Kelly J; Nousiainen, Markku T; Snell, Linda

    2017-06-01

    The current medical education system is steeped in tradition and has been shaped by many long-held beliefs and convictions about the essential components of training. The objective of this article is to propose initiatives to overcome biases against competency-based medical education (CBME) in the culture of medical education. At a retreat of the International Competency Based Medical Education (ICBME) Collaborators group, an intensive brainstorming session was held to determine potential barriers to adoption of CBME in the culture of medical education. This was supplemented with a review of the literature on the topic. There continues to exist significant key barriers to the widespread adoption of CBME. Change in educational culture must be embraced by all components of the medical education hierarchy. Research is essential to provide convincing evidence of the benefit of CBME. The widespread adoption of CBME will require a change in the professional, institutional, and organizational culture surrounding the training of medical professionals.

  6. Early positivity signals changes in an abstract linguistic pattern.

    Directory of Open Access Journals (Sweden)

    Júlia Monte-Ordoño

    Full Text Available The extraction of abstract structures from speech (or from gestures in the case of sign languages has been claimed to be a fundamental mechanism for language acquisition. In the present study we registered the neural responses that are triggered when a violation of an abstract, token-independent rule is detected. We registered ERPs while presenting participants with trisyllabic CVCVCV nonsense words in an oddball paradigm. Standard stimuli followed an ABB rule (where A and B are different syllables. Importantly, to distinguish neural responses triggered by changes in surface information from responses triggered by changes in the underlying abstract structure, we used two types of deviant stimuli. Phoneme deviants differed from standards only in their phonemes. Rule deviants differed from standards in both their phonemes and their composing rule. We observed a significant positivity as early as 300 ms after the presentation of deviant stimuli that violated the abstract rule (Rule deviants. The amplitude of this neural response was correlated with participants' performance in a behavioral rule learning test. Differences in electrophysiological responses observed between learners and non-learners suggest that individual differences in an abstract rule learning task might be related to how listeners select relevant sources of information.

  7. Early-stage valuation of medical devices: the role of developmental uncertainty.

    Science.gov (United States)

    Girling, Alan; Young, Terry; Brown, Celia; Lilford, Richard

    2010-08-01

    At the concept stage, many uncertainties surround the commercial viability of a new medical device. These include the ultimate functionality of the device, the cost of producing it and whether, and at what price, it can be sold to a health-care provider (HCP). Simple assessments of value can be made by estimating such unknowns, but the levels of uncertainty may mean that their operational value for investment decisions is unclear. However, many decisions taken at the concept stage are reversible and will be reconsidered later before the product is brought to market. This flexibility can be exploited to enhance early-stage valuations. To develop a framework for valuing a new medical device at the concept stage that balances benefit to the HCP against commercial costs. This is done within a simplified stage-gated model of the development cycle for new products. The approach is intended to complement existing proposals for the evaluation of the commercial headroom available to new medical products. A model based on two decision gates can lead to lower bounds (underestimates) for product value that can serve to support a decision to develop the product. Quantifiable uncertainty that can be resolved before the device is brought to market will generally enhance early-stage valuations of the device, and this remains true even when some components of uncertainty cannot be fully described. Clinical trials and other evidence-gathering activities undertaken as part of the development process can contribute to early-stage estimates of value.

  8. Native language change during early stages of second language learning.

    Science.gov (United States)

    Bice, Kinsey; Kroll, Judith F

    2015-11-11

    Research on proficient bilinguals has demonstrated that both languages are always active, even when only one is required. The coactivation of the two languages creates both competition and convergence, facilitating the processing of cognate words, but slowing lexical access when there is a requirement to engage control mechanisms to select the target language. Critically, these consequences are evident in the native language (L1) as well as in the second language (L2). The present study questioned whether L1 changes can be detected at early stages of L2 learning and how they are modulated by L2 proficiency. Native English speakers learning Spanish performed an English (L1) lexical decision task that included cognates while event-related potentials were recorded. They also performed verbal fluency, working memory, and inhibitory control tasks. A group of matched monolinguals performed the same tasks in English only. The results revealed that intermediate learners demonstrate a reduced N400 for cognates compared with noncognates in English (L1), and an emerging effect is visually present in beginning learners as well; however, no behavioral cognate effect was present for either group. In addition, slower reaction times in English (L1) are related to a larger cognate N400 magnitude in English (L1) and Spanish (L2), and to better inhibitory control for learners but not for monolinguals. The results suggest that contrary to the claim that L2 affects L1 only when L2 speakers are highly proficient, L2 learning begins to impact L1 early in the development of the L2 skill.

  9. Chronological shifts and changing causes of death after radiotherapy for early-stage oral cancer.

    Science.gov (United States)

    Fujisawa, Rina; Shibuya, Hitoshi; Harata, Naoki; Yuasa-Nakagawa, Keiko; Toda, Kazuma; Hayashi, Keiji

    2014-02-01

    Following recent improvements in the curability of oral cancer, chronological shifts and changes in the causes of death after treatment have been observed. We conducted a review of the post-treatment causes of death following radiotherapy for oral cancers. The medical records of 966 patients with early-stage (stage I and II) oral cancer treated at our institute between 1980 and 2001 were reviewed, and the chronological shifts and changes in the causes of death after radiotherapy were assessed. Of the 966 patients enrolled in this study, 365 have died to date. Two hundred and eleven patients died of their primary malignancy; 193 of these deaths occurred within 5 years of treatment for the primary oral cancer. The second most frequent cause of death was second primary cancer (n = 90). Twenty-three patients with head and neck cancers and 18 patients with esophageal cancers died within 10 years of radiotherapy, and six patients with lung cancers died after more than 10 years. Within the first 5 years following treatment, the major cause of death was the primary oral cancer. After 5-10 years, a second primary cancer, such as head and neck cancer or esophageal cancer, became the leading cause of death. Over a 10-year period, the proportion of deaths from a second primary cancer in the lung was significant. We have demonstrated that there are chronological shifts and changes in the causes of death following treatment for early-stage oral cancer.

  10. Impact of early in-hospital medication review by clinical pharmacists on health services utilization.

    Directory of Open Access Journals (Sweden)

    Corinne M Hohl

    Full Text Available Adverse drug events are a leading cause of emergency department visits and unplanned admissions, and prolong hospital stays. Medication review interventions aim to identify adverse drug events and optimize medication use. Previous evaluations of in-hospital medication reviews have focused on interventions at discharge, with an unclear effect on health outcomes. We assessed the effect of early in-hospital pharmacist-led medication review on the health outcomes of high-risk patients.We used a quasi-randomized design to evaluate a quality improvement project in three hospitals in British Columbia, Canada. We incorporated a clinical decision rule into emergency department triage pathways, allowing nurses to identify patients at high-risk for adverse drug events. After randomly selecting the first eligible patient for participation, clinical pharmacists systematically allocated subsequent high-risk patients to medication review or usual care. Medication review included obtaining a best possible medication history and reviewing the patient's medications for appropriateness and adverse drug events. The primary outcome was the number of days spent in-hospital over 30 days, and was ascertained using administrative data. We used median and inverse propensity score weighted logistic regression modeling to determine the effect of pharmacist-led medication review on downstream health services use.Of 10,807 high-risk patients, 6,416 received early pharmacist-led medication review and 4,391 usual care. Their baseline characteristics were balanced. The median number of hospital days was reduced by 0.48 days (95% confidence intervals [CI] = 0.00 to 0.96; p = 0.058 in the medication review group compared to usual care, representing an 8% reduction in the median length of stay. Among patients under 80 years of age, the median number of hospital days was reduced by 0.60 days (95% CI = 0.06 to 1.17; p = 0.03, representing 11% reduction in the median length of stay

  11. Early auditory change detection implicitly facilitated by ignored concurrent visual change during a Braille reading task.

    Science.gov (United States)

    Aoyama, Atsushi; Haruyama, Tomohiro; Kuriki, Shinya

    2013-09-01

    Unconscious monitoring of multimodal stimulus changes enables humans to effectively sense the external environment. Such automatic change detection is thought to be reflected in auditory and visual mismatch negativity (MMN) and mismatch negativity fields (MMFs). These are event-related potentials and magnetic fields, respectively, evoked by deviant stimuli within a sequence of standard stimuli, and both are typically studied during irrelevant visual tasks that cause the stimuli to be ignored. Due to the sensitivity of MMN/MMF to potential effects of explicit attention to vision, however, it is unclear whether multisensory co-occurring changes can purely facilitate early sensory change detection reciprocally across modalities. We adopted a tactile task involving the reading of Braille patterns as a neutral ignore condition, while measuring magnetoencephalographic responses to concurrent audiovisual stimuli that were infrequently deviated either in auditory, visual, or audiovisual dimensions; 1000-Hz standard tones were switched to 1050-Hz deviant tones and/or two-by-two standard check patterns displayed on both sides of visual fields were switched to deviant reversed patterns. The check patterns were set to be faint enough so that the reversals could be easily ignored even during Braille reading. While visual MMFs were virtually undetectable even for visual and audiovisual deviants, significant auditory MMFs were observed for auditory and audiovisual deviants, originating from bilateral supratemporal auditory areas. Notably, auditory MMFs were significantly enhanced for audiovisual deviants from about 100 ms post-stimulus, as compared with the summation responses for auditory and visual deviants or for each of the unisensory deviants recorded in separate sessions. Evidenced by high tactile task performance with unawareness of visual changes, we conclude that Braille reading can successfully suppress explicit attention and that simultaneous multisensory changes can

  12. Usher syndrome type 1: early detection of electroretinographic changes.

    Science.gov (United States)

    Flores-Guevara, Roberto; Renault, Francis; Loundon, Natalie; Marlin, Sandrine; Pelosse, Béatrice; Momtchilova, Martha; Auzoux-Chevé, Monique; Vermersch, Anne Isabelle; Richard, Pascal

    2009-11-01

    Usher syndrome type 1 needs to be diagnosed at early age in order to timely manage speech therapy, cochlear implantation, and genetic counseling. Few data are available regarding electroretinographic testing before the age of six years. To describe electroretinographic changes in young children with Usher syndrome type 1. Retrospective study of fourteen patients. Age at first neurophysiologic testing was between 17 months and 5 years 4 months. Electroretinogram was performed using flash stimulation in mesopic conditions in the conscious child. Analysis was focused on the amplitudes and latencies of a- and b-waves. Whatever the age, an abnormal fundus was always confirmed with an absent electroretinogram. The youngest patient with absent electroretinogram was 17 month-old. When recorded on and after the 29th month of age, electroretinogram was absent in all cases, including 6 patients with normal fundus. In three patients a low-amplitude electroretinogram was present at first recording within the 26th and 27th months. Electroretinogram showed retinopathy in young children with Usher syndrome type 1, even in the absence of fundoscopic signs of retinal degeneration.

  13. Early structural changes in sheep lung following thoracic irradiation

    International Nuclear Information System (INIS)

    Guerry-Force, M.L.; Perkett, E.A.; Brigham, K.L.; Meyrick, B.

    1988-01-01

    Using a large animal model of radiation lung injury--the sheep exposed to bilateral thoracic irradiation--we have recently shown the development of sustained pulmonary hypertension during the first 4 weeks following radiation. This is the period prior to the onset of pneumonitis and pulmonary fibrosis. In the present study, we have examined biopsy and autopsy lung tissue from these same sheep and assessed the sequential changes in lung morphology. Six unanesthetized sheep received bilateral thoracic irradiation (a total of 15 Gy); control sheep were sham irradiated. Lung biopsy tissue was taken prior to and at weekly or biweekly intervals during the 4 weeks immediately following radiation. The lungs were also removed at autopsy for light and electron microscopic examination. Our results show early (Week 1) interstitial and progressive intraalveolar edema accompanied by endothelial and epithelial injury. A gradual increase in number of interstitial mononuclear cells was evident from Week 1, both in the lung tissue and in perivascular cuffs. The number of peripheral lung interstitial mononuclear cells was twice baseline from Week 3 and included accumulation of lymphocytes, fibroblasts, and intravascular macrophages. The increased numbers of mononuclear cells paralleled the development of chronic pulmonary hypertension, perhaps suggesting their involvement in the pathogenesis of this disease. Alternatively, it may be that increased mononuclear cell number represents a stage of lung repair

  14. Emerging Use of Early Health Technology Assessment in Medical Product Development: A Scoping Review of the Literature.

    Science.gov (United States)

    IJzerman, Maarten J; Koffijberg, Hendrik; Fenwick, Elisabeth; Krahn, Murray

    2017-07-01

    Early health technology assessment is increasingly being used to support health economic evidence development during early stages of clinical research. Such early models can be used to inform research and development about the design and management of new medical technologies to mitigate the risks, perceived by industry and the public sector, associated with market access and reimbursement. Over the past 25 years it has been suggested that health economic evaluation in the early stages may benefit the development and diffusion of medical products. Early health technology assessment has been suggested in the context of iterative economic evaluation alongside phase I and II clinical research to inform clinical trial design, market access, and pricing. In addition, performing early health technology assessment was also proposed at an even earlier stage for managing technology portfolios. This scoping review suggests a generally accepted definition of early health technology assessment to be "all methods used to inform industry and other stakeholders about the potential value of new medical products in development, including methods to quantify and manage uncertainty". The present review also aimed to identify recent published empirical studies employing an early-stage assessment of a medical product. With most included studies carried out to support a market launch, the dominant methodology was early health economic modeling. Further methodological development is required, in particular, by combining systems engineering and health economics to manage uncertainty in medical product portfolios.

  15. Faculty Development for Fostering Clinical Reasoning Skills in Early Medical Students Using a Modified Bayesian Approach.

    Science.gov (United States)

    Addy, Tracie Marcella; Hafler, Janet; Galerneau, France

    2016-01-01

    Clinical reasoning is a necessary skill for medical students to acquire in the course of their education, and there is evidence that they can start this process at the undergraduate level. However, physician educators who are experts in their given fields may have difficulty conveying their complex thought processes to students. Providing faculty development that equips educators with tools to teach clinical reasoning may support skill development in early medical students. We provided faculty development on a modified Bayesian method of teaching clinical reasoning to clinician educators who facilitated small-group, case-based workshops with 2nd-year medical students. We interviewed them before and after the module regarding their perceptions on teaching clinical reasoning. We solicited feedback from the students about the effectiveness of the method in developing their clinical reasoning skills. We carried out this project during an institutional curriculum rebuild where clinical reasoning was a defined goal. At the time of the intervention, there was also increased involvement of the Teaching and Learning Center in elevating the status of teaching and learning. There was high overall satisfaction with the faculty development program. Both the faculty and the students described the modified Bayesian approach as effective in fostering the development of clinical reasoning skills. Through this work, we learned how to form a beneficial partnership between a clinician educator and Teaching and Learning Center to promote faculty development on a clinical reasoning teaching method for early medical students. We uncovered challenges faced by both faculty and early learners in this study. We observed that our faculty chose to utilize the method of teaching clinical reasoning in a variety of manners in the classroom. Despite obstacles and differing approaches utilized, we believe that this model can be emulated at other institutions to foster the development of clinical

  16. The validity of student tutors’ judgments in early detection of struggling in medical school. A prospective cohort study

    DEFF Research Database (Denmark)

    O'Neill, Lotte; Mørcke, Anne Mette; Eika, Berit

    2016-01-01

    Early identification and support of strugglers in medical education is generally recommended in the research literature, though very little evidence of the diagnostic qualities of early teacher judgments in medical education currently exists. The aim of this study was to examine the validity...... of early diagnosis of struggling in medical school based on informal teacher judgements of in-class behavior. The study design was a prospective cohort study and the outcomes/truth criteria were anatomy failure and medical school drop out. Six weeks into an anatomy course, student tutors attempted...... to identify medical students, who they reckoned would fail the anatomy course or drop out, based on their everyday experiences with students in a large group educational setting. In addition, they were asked to describe the indicators of struggling they observed. Sixteen student tutors evaluated 429 medical...

  17. A prospective cohort study among new Chinese coal miners: the early pattern of lung function change

    Energy Technology Data Exchange (ETDEWEB)

    Wang, M.L.; Wu, Z.E.; Du, Q.G.; Petsonk, E.L.; Peng, K.L.; Li, Y.D.; Li, S.K.; Han, G.H.; Atffield, M.D. [NIOSH, Morgantown, WV (United States)

    2005-11-01

    The early pattern of lung function changes in 317 newly hired Chinese underground coal miners was compared to 132 referents. This three year prospective cohort study involved a pre-employment and 15 follow up health surveys, including a questionnaire and spirometry tests. Twice a month, total and respirable dust area sampling was done. The authors used a two stage analysis and a linear mixed effects model approach to analyse the longitudinal spirometry data, and to investigate the changes in forced expiratory volume in 1 second (FEV1) over time, controlling for age, height, pack years of smoking, mean respirable dust concentration, the room temperature during testing, and the group x time interaction terms. Results: FEV1 change over time in new miners is non-linear. New miners experience initial rapid FEV1 declines, primarily during the first year of mining, little change during the second year, and partial recovery during the third year. Both linear and quadratic time trends in FEV1 change are highly significant. Smoking miners lost more FEV1 than non-smokers. Referents, all age less than 20 years, showed continued lung growth, whereas the miners who were under age 20 exhibited a decline in FEV1. Conclusion: Dust and smoking affect lung function in young, newly hired Chinese coal miners. FEV1 change over the first three years of employment is non-linear. The findings have implications for both methods and interpretation of medical screening in coal mining and other dusty work: during the first several years of employment more frequent testing may be desirable, and caution is required in interpreting early FEV1 declines.

  18. Improvement of early detection of breast cancer through collaborative multi-country efforts: Medical physics component.

    Science.gov (United States)

    Mora, Patricia; Faulkner, Keith; Mahmoud, Ahmed M; Gershan, Vesna; Kausik, Aruna; Zdesar, Urban; Brandan, María-Ester; Kurt, Serap; Davidović, Jasna; Salama, Dina H; Aribal, Erkin; Odio, Clara; Chaturvedi, Arvind K; Sabih, Zahida; Vujnović, Saša; Paez, Diana; Delis, Harry

    2018-04-01

    The International Atomic Energy Agency (IAEA) through a Coordinated Research Project on "Enhancing Capacity for Early Detection and Diagnosis of Breast Cancer through Imaging", brought together a group of mammography radiologists, medical physicists and radiographers; to investigate current practices and improve procedures for the early detection of breast cancer by strengthening both the clinical and medical physics components. This paper addresses the medical physics component. The countries that participated in the CRP were Bosnia and Herzegovina, Costa Rica, Egypt, India, Kenya, the Frmr. Yug. Rep. of Macedonia, Mexico, Nigeria, Pakistan, Philippines, Slovenia, Turkey, Uganda, United Kingdom and Zambia. Ten institutions participated using IAEA quality control protocols in 9 digital and 3 analogue mammography equipment. A spreadsheet for data collection was generated and distributed. Evaluation of image quality was done using TOR MAX and DMAM2 Gold phantoms. QC results for analogue equipment showed satisfactory results. QC tests performed on digital systems showed that improvements needed to be implemented, especially in thickness accuracy, signal difference to noise ratio (SDNR) values for achievable levels, uniformity and modulation transfer function (MTF). Mean glandular dose (MGD) was below international recommended levels for patient radiation protection. Evaluation of image quality by phantoms also indicated the need for improvement. Common activities facilitated improvement in mammography practice, including training of medical physicists in QC programs and infrastructure was improved and strengthened; networking among medical physicists and radiologists took place and was maintained over time. IAEA QC protocols provided a uniformed approach to QC measurements. Copyright © 2018 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  19. Occupational, social and medical characteristics of early prenatal leave in France.

    Science.gov (United States)

    Vigoureux, Solène; Blondel, Béatrice; Ringa, Virginie; Saurel-Cubizolles, Marie-Josèphe

    2016-12-01

    In France, most women of childbearing age work. The prenatal leave law in France protects women during pregnancy and their employment. We aimed to describe how long before delivery women stopped working and analyse the association between occupational, social and medical factors and early prenatal leave (before 24 weeks' gestation). The sample was extracted from the 2010 French National Perinatal Survey. Women were interviewed in French maternity units during a 1-week period. We focused on all women with a singleton live birth who were working during pregnancy (n = 10 149). Women were interviewed between delivery and discharge to collect information on employment, date of leave, sociodemographic and medical characteristics. Among women who worked during pregnancy, 27.5% reported early occupational leave (before 24 weeks' gestation). Early occupational leave was more frequent among women with unstable jobs (fixed-term vs. non-fixed-term contract: adjusted odds ratio aOR = 1.60 [95% confidence interval 1.40-1.84]) and with less-qualified occupational categories (manual workers vs. managers and upper-intellectual positions: aOR = 2.96 [2.30-3.82]), even after adjusting for sociodemographic and other employment characteristics. Women with a pathological or at risk pregnancy left work earlier than other women. After stratification on type of pregnancy there was still a higher rate of early leave for women with less qualified occupational group. In France, social vulnerability of pregnant women, linked to low sociodemographic situation or low occupational categories, is associated with early leave during pregnancy, even after stratification on type of pregnancy. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  20. “When That Wounds Are Evil Healed”: Revisiting Pleonastic That in Early English Medical Writing

    Directory of Open Access Journals (Sweden)

    Martín Javier Calle

    2017-03-01

    Full Text Available The origin of pleonastic that can be traced back to Old English, where it could appear in syntactic constructions consisting of a preposition + a demonstrative pronoun (i.e., for py pat, for pæm pe or a subordinator (i.e., op pat. The diffusion of this pleonastic form is an Early Middle English development as a result of the standardization of that as the general subordinator in the period, which motivated its use as a pleonastic word in combination with many kinds of conjunctions (i.e., now that, if that, when that, etc. and prepositions (i.e., before that, save that, in that (Fischer 1992: 295. The phenomenon increased considerably in Late Middle English, declining rapidly in the 17th century to such an extent that it became virtually obliterated towards the end of that same century (Rissanen 1999: 303-304. The list of subordinating elements includes relativizers (i.e., this that, adverbial relatives (i.e., there that, and a number of subordinators (i.e., after, as, because, before, beside, for, if, since, sith, though, until, when, while, etc.. The present paper examines the status of pleonastic that in the history of English pursuing the following objectives: (a to analyse its use and distribution in a corpus of early English medical writing (in the period 1375-1700; (b to classify the construction in terms of genre, i.e., treatises and recipes; and (c to assess its decline with the different conjunctive words. The data used as source of evidence come from The Corpus of Early English Medical Writing, i.e., Middle English Medical Texts (MEMT for the period 1375-1500 and Early Modern English Medical Texts (EMEMT for the period 1500-1700. The use of pleonastic that in medical writing allows us to reconsider the history of the construction in English, becoming in itself a Late Middle English phenomenon with its progressive decline throughout the 16th and 17th centuries.

  1. A Medical School's Organizational Readiness for Curriculum Change (MORC): Development and Validation of a Questionnaire

    NARCIS (Netherlands)

    Jippes, M.; Driessen, E.W.; Broers, N.J.; Majoor, G.D.; Gijselaers, W.H.; Vleuten, C.P.M. van der

    2013-01-01

    PURPOSE: Because successful change implementation depends on organizational readiness for change, the authors developed and assessed the validity of a questionnaire, based on a theoretical model of organizational readiness for change, designed to measure, specifically, a medical school's

  2. Medical tourism: game-changing innovation or passing fad?

    Science.gov (United States)

    Underwood, Howard R; Makadon, Harvey J

    2010-09-01

    Outbound medical tourism presents several concerns for U.S. providers: Potential lost revenue could reach almost $600 billion by 2017. Continuity of care can become an issue if complete medical records are not available to the patient's home physician and communications are not maintained between the domestic physician and the physician who rendered medical care abroad. Potential malpractice liability could place the U.S.-based provider at risk.

  3. DOES BONE MINERAL DENSITY CHANGE IN EARLY AXIAL SPONDYLOARTHRITIS?

    Directory of Open Access Journals (Sweden)

    E. E. Gubar

    2016-01-01

    Full Text Available The rate of osteoporosis (OP and the mechanism  of its development in patients with ankylosing spondylitis (AS and other spondyloarthrititides (SpA have not been sufficiently investigated. Steady-state  inflammatory disease activity is anticipated  to be the leading factor of OP in AS.Objective: to investigate lumbar spine (LS and femoral neck (FN  bone mineral density (BMD  in patients with early axial SpA (axSpA and to reveal its association with inflammatory disease activity.Subjects and methods. A total of 150 patients (59 men and 91 women aged 18 to 45 years with inflammatory back pain for ≥3 months and ≤5 years were examined. The diagnosis of axSpA was established in accordance  with the 2009 ASAS criteria. BASDAI and ASDAS-CRP were used to assess activity and functional status was evaluated with BASFI. The examination  included determination of HLA-B27, X-ray of the pelvis and LS, magnetic resonance imaging (MRI  of the sacroiliac joints, LS, and hip joints (in the presence of clinical signs of their involvement,  and densitometry of LS (LI–IV  and FN. By taking into account the patients’ young age, the Z score was used to estimate BMD. The Z-score -2 SD or lower in at the least one of the regions examined is considered to be diminished BMD. Results and discussion. The median Z-score was -0.7 [-1.3; -0.2] SD for FN and -0.9 [-1.6; -0.6] SD for LS. Reduced BMD in at the least one of the regions examined was diagnosed in 27 (18.0% patients. There was lower BMD in LS in 21 (14.0% patients and in FN in 8 (5.3%. Two (1.3% patients were diagnosed as having osteopenia in the two examined regions. There was no association between diminished BMD and age, gender, disease activity assessed with BASDAI, ASDAS-СRP, erythrocyte sedimentation rate (ESR and C-reactive protein (CRP. An association was found between inflammatory LS changes, as evidenced by MRI (MRI spondylitis, and reduced BMD in at least one of the examined regions. MRI

  4. [Studies on the development of the medical occupational image in Egypt's early times].

    Science.gov (United States)

    Engelmann, Heinz; Hallof, Jochen

    2004-01-01

    Shamanism in pre-dynastic Egypt, practise by Sem-priests, combines social, psycho-hygienic and para-medical elements of both Near-Eastern and African provenance. These activities, which included health care and medical prophylaxes, were organised by highly qualified advisors of the Pharaoh with the establishment of Egyptian state religion. Their aim was to protect the rulers against his "enemies". These enemies included illnesses of all kinds, as well as injuries to health caused by impure food. The importance of this task is emphasised by the fact that it was usually the eldest son of the Pharoah who was responsible for the correct performance of the royal rituals, which included these medical aspects. Changes in religious concepts made these special advisors and priests superfluous. They took over other tasks in the funeral service of the Pharaoh or were included in the professional group of physicians, known from the time of the pyramids as "Sahkmet-priests", i.e. medical specialists. They were particularly responsible for precautionary measures against epidemics and for curing snake and scorpion bites. They created the first medical papyri and established the legal foundation for the medical care of the inhabitants of Egypt by royal order.

  5. Power and Resistance: Leading Change in Medical Education

    Science.gov (United States)

    Sundberg, Kristina; Josephson, Anna; Reeves, Scott; Nordquist, Jonas

    2017-01-01

    A key role for educational leaders within undergraduate medical education is to continually improve the quality of education; global quality health care is the goal. This paper reports the findings from a study employing a power model to highlight how educational leaders influence the development of undergraduate medical curricula and the…

  6. How learning analytics can early predict under-achieving students in a blended medical education course.

    Science.gov (United States)

    Saqr, Mohammed; Fors, Uno; Tedre, Matti

    2017-07-01

    Learning analytics (LA) is an emerging discipline that aims at analyzing students' online data in order to improve the learning process and optimize learning environments. It has yet un-explored potential in the field of medical education, which can be particularly helpful in the early prediction and identification of under-achieving students. The aim of this study was to identify quantitative markers collected from students' online activities that may correlate with students' final performance and to investigate the possibility of predicting the potential risk of a student failing or dropping out of a course. This study included 133 students enrolled in a blended medical course where they were free to use the learning management system at their will. We extracted their online activity data using database queries and Moodle plugins. Data included logins, views, forums, time, formative assessment, and communications at different points of time. Five engagement indicators were also calculated which would reflect self-regulation and engagement. Students who scored below 5% over the passing mark were considered to be potentially at risk of under-achieving. At the end of the course, we were able to predict the final grade with 63.5% accuracy, and identify 53.9% of at-risk students. Using a binary logistic model improved prediction to 80.8%. Using data recorded until the mid-course, prediction accuracy was 42.3%. The most important predictors were factors reflecting engagement of the students and the consistency of using the online resources. The analysis of students' online activities in a blended medical education course by means of LA techniques can help early predict underachieving students, and can be used as an early warning sign for timely intervention.

  7. Scent and synaesthesia: The medical use of spice bags in early China.

    Science.gov (United States)

    Lu, Di; Lo, Vivienne

    2015-06-05

    The history of Chinese spices has received increasing attention in recent years, but little research been carried out on where they fit on the food-medicine continuum for early China, during the formation of the classical medical system. This paper describes how the synaesthetic qualities of spices attracted a particular analysis in that emerging system which serves to mark them as different to other medical materials and foodstuffs. We aim to clarify the special role created for spices to accommodate their boundary-crossing synaesthetic action on the body. This paper analyses the contents of several spice bags excavated in 1972 from a tomb that was closed in the second century BCE. It uses archaeological reports of material culture together with the early Chinese textual record, extant in both manuscripts and received texts, to bring out the role of spices in ritual, food and medicine. Noting that the flavours and aromas of early China were assigned physiological potency in the first centuries BCE, we argue that by medieval times the unique synaesthetic role that spices played in mediating the senses was systematically medicalised. While being deployed for the purpose of curing disease in medicine, they also remained within the realm of everyday healthcare, and religious practice, deployed both as aromatics to perfume the environment, attracting benign spirits, but also to ward off the agents of disease, as well as for enhancing health through their use in cookery. While foodstuffs entered the digestive system spices were all considered 'pungent' in the emerging clasical medical system. They acted on the body through the nose and lungs, making them neither food nor drug. This implicit categorisation medicalised spices which, like music, could affect the passions and lighten the spirit, codifying observations about the impact on the body of the ritual environment. Copyright © 2015. Published by Elsevier Ireland Ltd.

  8. Trusting early learners with critical professional activities through emergency medical technician certification.

    Science.gov (United States)

    Brenner, Judith; Bird, Jeffrey; Ginzburg, Samara B; Kwiatkowski, Thomas; Papasodero, Vincent; Rennie, William; Schlegel, Elisabeth; Ten Cate, Olle; Willey, Joanne M

    2018-03-08

    Two dominant themes face medical education: developing integrated curricula and improving the undergraduate medical education (UME) to graduate medical education (GME) transition. An innovative solution to both of these challenges at the Zucker School of Medicine has been the application of the cognitive apprenticeship framework in requiring emergency medical technician (EMT) certification during the first course in medical school as the core on which to build an integrated curriculum and provide entrustable clinical skills. Beginning with the Class of 2011, student feedback about the short-term impact of the experience was collected annually. In addition, perceptions of near graduates and alumni were surveyed in 2017 to explore the long-term impact of the experience. Theme analysis was conducted via inductive coding. Both first-year and more experienced learners report the value of the EMT curriculum as an integrated component of the first course of medical school. Reported positive long-term impacts included the first-hand observation of social determinants of health and interprofessionalism. Negative comments by early learners focused on course logistics, whereas older learners recalled the variability of clinical experiences during ambulance runs. The integration of the EMT curriculum as a core component of the first course serves multiple purposes: 1) it provides the foundation of a spiral learning approach; 2) it contextualizes the basic sciences within clinical practice; 3) it provides opportunities for students to engage in authentic clinical activities under the guidance of mentors; 4) it introduces students to the interdisciplinary nature of medicine; and 5) it serves as the first entrustable professional activity (EPA) for our students.

  9. Early or Late Surgical Ligation of Medical Refractory Patent Ductus Arteriosus in Premature Infants

    Directory of Open Access Journals (Sweden)

    Chien-Chou Hsiao

    2009-01-01

    Full Text Available Optimal time to surgical ligation of patent ductus arteriosus (PDA in very-low-birth-weight ( 14 days groups. Basic clinical features, major morbidity of prematurity and mortality were compared. Clinical features and major outcomes were similar. The early ligation group had earlier onset of symptomatic PDA (5.7 ± 1.6 days vs. 8.1 ± 3.6 days, p = 0.024, and fewer days of total parenteral nutrition (TPN (39.6 ± 13.9 days vs. 60.4 ± 31.4 days, p = 0.025 and ventilator use (11.1 ± 6.7 days vs. 18.6 ± 10.5 days, p = 0.019. Early ligation of medical refractory PDA in very-low-birth-weight premature infants improves enteral feeding tolerance and reduces TPN and ventilator use, but long-term benefits need further investigation.

  10. The strategic impact of a changing curriculum and learning environment on medical students' academic performance.

    Science.gov (United States)

    Williams, Pamela C; Epps, Anna Cherrie; McCammon, Sametria

    2011-01-01

    In recent years, the administration of Meharry Medical College, School of Medicine (SOM), Nashville, Tennessee, recognized the need to modify the curriculum to help improve student academic performance especially on the National Board of Medical Examiners (NBME) US Medical Licensing Examination (USMLE) steps 1 and 2. Thus, a number of changes occurred with respect to the traditional curriculum in the SOM, resulting in an integrated organ system-based curriculum design. The change in the learning environment was studied to determine the impact on performance after the introduction of the integrated organ system-based curriculum as compared to that of the traditional curriculum. With the utilization of a cadre of variables, it was believed that the strategic impact anticipated would provide a predictive validity profile to assist in the identification of students "at risk" of failure so that proactive intervention methodology could be made available to facilitate the students' successful progression during matriculation in the SOM. The purpose of this study was to analyze whether students trained with the integrated organ systems curriculum perform better than students trained with the traditional medical school curriculum on the medical education preclinical subject board examinations, and the NBME USMLE steps 1 and 2 examinations. From the 584 students studied in the control group (graduation classes for years 2005, 2006, and 2007) and the intervention group (graduation classes for years 2008, 2009, and 2010), significant improvement in performance on the NBME USMLE steps 1 and 2 examinations was noted following the introduction of the integrated organ system-based curriculum particularly among "at-risk" students. Data access availability from the School of Medicine of Meharry Medical College automatically gave reason for a preferential comparative relationship and study of the resulting strategic impact on cohorts graduating in years 2005-2010. Thus, this

  11. Medical migration and Africa: an unwanted legacy of educational change.

    Science.gov (United States)

    Bundred, Peter; Gibbs, Trevor

    2007-11-01

    The opportunities given for medical staff to travel, work and remain in countries other than that of their domicile or graduation have led to the phenomenon of medical migration. This has been supported by ease of travel, improved technology and a drive to share good examples of medical education through improved communication. Whilst these opportunities create positive advantages to the individuals and countries involved, through the transfer of knowledge and medical management, the situation does not always lead to long term benefits, and clear disadvantages begin to emerge. The gulf between the developed and developing countries becomes pronounced, leading to a general drift of resources away from the areas where they are most needed and subsequent profound effects upon the indigenous population. This paper suggests that it is a responsibility of medical educators throughout the world to recognize this effect and create opportunities whereby the specialty of medical education positively effects medical migration to the benefit of the less fortunate areas of the world.

  12. THINGS THAT CAN BE CHANGED IN EARLY INTERVENTION IN CHILDHOOD.

    Science.gov (United States)

    Golubović, Špela; Marković, Jasminka; Perović, Lidija

    2015-01-01

    Early intervention implies a model of support focused on a child, family and a broader community from early childhood. The aim of this study was to analyze the elements of the successful early intervention in childhood, as well as to assess the role of a special educator and rehabilitator and level of their involvement in implementing the program on the territory of Novi Sad. The study sample included 100 parents of children with disabilities (aged 3-7), who completed the questionnaire designed for the purposes of this research, based on a similar questionnaire design. Speech delay is one of the most common reasons (over 50%) why parents seek professional help. By the end of the first year of life of their child, 43% of parents responded that they had noticed the first problems, that is, a problem was identified in 25% of children of this age group, and the same number was included in the treatment. About 55% of children were involved in organized treatment from 3 years of age onwards. Special educators and rehabilitators are usually involved in treatment when the team consists of three or more professionals. It is necessary to improve early intervention services, to educate staff, and provide conditions which would make it possible to overcome the existing disadvantages in treating children from an early age. In addition, the involvement of special education and rehabilitation professionals in treatment teams since children's early age is vital.

  13. Probability elicitation to inform early health economic evaluations of new medical technologies: a case study in heart failure disease management.

    Science.gov (United States)

    Cao, Qi; Postmus, Douwe; Hillege, Hans L; Buskens, Erik

    2013-06-01

    Early estimates of the commercial headroom available to a new medical device can assist producers of health technology in making appropriate product investment decisions. The purpose of this study was to illustrate how this quantity can be captured probabilistically by combining probability elicitation with early health economic modeling. The technology considered was a novel point-of-care testing device in heart failure disease management. First, we developed a continuous-time Markov model to represent the patients' disease progression under the current care setting. Next, we identified the model parameters that are likely to change after the introduction of the new device and interviewed three cardiologists to capture the probability distributions of these parameters. Finally, we obtained the probability distribution of the commercial headroom available per measurement by propagating the uncertainty in the model inputs to uncertainty in modeled outcomes. For a willingness-to-pay value of €10,000 per life-year, the median headroom available per measurement was €1.64 (interquartile range €0.05-€3.16) when the measurement frequency was assumed to be daily. In the subsequently conducted sensitivity analysis, this median value increased to a maximum of €57.70 for different combinations of the willingness-to-pay threshold and the measurement frequency. Probability elicitation can successfully be combined with early health economic modeling to obtain the probability distribution of the headroom available to a new medical technology. Subsequently feeding this distribution into a product investment evaluation method enables stakeholders to make more informed decisions regarding to which markets a currently available product prototype should be targeted. Copyright © 2013. Published by Elsevier Inc.

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

    Science.gov (United States)

    Thompson, David E.

    2018-01-01

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

  15. Behavioural outcomes of subthalamic stimulation and medical therapy versus medical therapy alone for Parkinson's disease with early motor complications (EARLYSTIM trial): secondary analysis of an open-label randomised trial.

    Science.gov (United States)

    Lhommée, Eugénie; Wojtecki, Lars; Czernecki, Virginie; Witt, Karsten; Maier, Franziska; Tonder, Lisa; Timmermann, Lars; Hälbig, Thomas D; Pineau, Fanny; Durif, Franck; Witjas, Tatiana; Pinsker, Marcus; Mehdorn, Maximilian; Sixel-Döring, Friederike; Kupsch, Andreas; Krüger, Rejko; Elben, Saskia; Chabardès, Stephan; Thobois, Stéphane; Brefel-Courbon, Christine; Ory-Magne, Fabienne; Regis, Jean-Marie; Maltête, David; Sauvaget, Anne; Rau, Jörn; Schnitzler, Alfons; Schüpbach, Michael; Schade-Brittinger, Carmen; Deuschl, Gunther; Houeto, Jean-Luc; Krack, Paul

    2018-03-01

    Although subthalamic stimulation is a recognised treatment for motor complications in Parkinson's disease, reports on behavioural outcomes are controversial, which represents a major challenge when counselling candidates for subthalamic stimulation. We aimed to assess changes in behaviour in patients with Parkinson's disease receiving combined treatment with subthalamic stimulation and medical therapy over a 2-year follow-up period as compared with the behavioural evolution under medical therapy alone. We did a parallel, open-label study (EARLYSTIM) at 17 surgical centres in France (n=8) and Germany (n=9). We recruited patients with Parkinson's disease who were disabled by early motor complications. Participants were randomly allocated (1:1) to either medical therapy alone or bilateral subthalamic stimulation plus medical therapy. The primary outcome was mean change in quality of life from baseline to 2 years. A secondary analysis was also done to assess behavioural outcomes. We used the Ardouin Scale of Behavior in Parkinson's Disease to assess changes in behaviour between baseline and 2-year follow-up. Apathy was also measured using the Starkstein Apathy Scale, and depression was assessed with the Beck Depression Inventory. The secondary analysis was done in all patients recruited. We used a generalised estimating equations (GEE) regression model for individual items and mixed model regression for subscores of the Ardouin scale and the apathy and depression scales. This trial is registered with ClinicalTrials.gov, number NCT00354133. The primary analysis has been reported elsewhere; this report presents the secondary analysis only. Between July, 2006, and November, 2009, 251 participants were recruited, of whom 127 were allocated medical therapy alone and 124 were assigned bilateral subthalamic stimulation plus medical therapy. At 2-year follow-up, the levodopa-equivalent dose was reduced by 39% (-363·3 mg/day [SE 41·8]) in individuals allocated bilateral

  16. Medical education in India: time to make some changes.

    Science.gov (United States)

    Jayakrishnan, T; Honhar, M; Jolly, G P; Abraham, J; T, Jayakrishnan

    2012-01-01

    India is in need of well-trained doctors. We highlight and analyse some of the problems affecting medical education in India and their possible solutions. The medical education system can be reviewed under four heads: selection of students, medical training, evaluation, and the development and accreditation of faculty. In India, students enter medical colleges without receiving sufficient orientation about the profession. If students were given some exposure to various professions in the final years of school, it would help address this issue. Medical students are selected on the basis of pre-medical tests consisting of multiple-choice questions, the validity of which is being questioned increasingly. There is no coordination between the scheduling of lectures on various diseases and their management and the clinical exposure of the students. Active involvement in treatment is limited to the final year, called internship, which is hampered by preparation for postgraduate entrance examinations. Efforts should be made to provide hands-on experience at an earlier time in the course. A systematic and reliable programme for evaluation is a must. There is a need for a shift in the focus of evaluation, which should assess the application of knowledge rather than the ability to recall facts. The replacement of the traditional long-/short-case examinations with more valid and reliable instruments for the assessment of clinical skills should be considered. 'Vision 2015', a document developed by the Medical Council of India, contains many notable recommendations for the improvement of the current system. If these are implemented effectively, the impact of improvement in Indian medical education will be felt globally. Copyright 2012, NMJI.

  17. Medical Malpractice Phenomena: Signals for Changing Medical and Health Care Values

    DEFF Research Database (Denmark)

    Brødsgaard, I.; Moore, R.

    1990-01-01

    Excellent discussion of the economic factors such as medical malpractice and corporate medicine that have begun to interfere with the doctor-patient relationship and why this relationship is so essential in order to prevent medical malpractice. Issues of quality assurance are relevant to the doctor-patient...... relationship and the quality of health care....

  18. Early Mentoring of Medical Students and Junior Doctors on a Path to Academic Cardiothoracic Surgery.

    Science.gov (United States)

    Fricke, Tyson A; Lee, Melissa G Y; Brink, Johann; d'Udekem, Yves; Brizard, Christian P; Konstantinov, Igor E

    2018-01-01

    In 2005 the Department of Cardiothoracic Surgery at The Royal Children's Hospital started an early academic mentoring program for medical students and junior doctors with the aim of fostering an interest in academic surgery. Between 2005 and 2015, 37 medical students and junior doctors participated in research in the Department of Cardiothoracic Surgery at The Royal Children's Hospital. Each was given an initial project on which to obtain ethics approval, perform a literature review, data collection, statistical analysis, and prepare a manuscript for publication. A search of the names of these former students and doctors was conducted on PubMed to identify publications. A total of 113 journal articles were published in peer-reviewed journals with an average impact factor of 4.1 (range, 1.1 to 19.9). Thirty (30 of 37, 81%) published at least one article. A mean of 4.3 journal articles was published per student or junior doctor (range, 0 to 29). Eleven (11 of 37, 30%) received scholarships for their research. Nine (9 of 37, 24%) have completed or are enrolled in higher research degrees with a cardiothoracic surgery focus. Of these 9, 2 have completed doctoral degrees while in cardiothoracic surgery training. Five will complete their cardiothoracic surgery training with a doctoral degree and the other 2 are pursuing training in cardiology. A successful early academic mentoring program in a busy cardiothoracic surgery unit is feasible. Mentoring of motivated individuals in academic surgery benefits not only their medical career, but also helps maintain high academic output of the unit. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  19. Medicated early weaning to obtain pigs free from pathogens endemic in the herd of origin.

    Science.gov (United States)

    Alexander, T J; Thornton, K; Boon, G; Lysons, R J; Gush, A F

    1980-02-09

    A field trial was conducted to assess the value of medicated early weaning for obtaining pigs free from some of the pathogens endemic in their herd of origin. The trial comprised 51 sows from a closed herd, which were farrowed in an isolated farrowing house in seven separate groups. The sows in each group were bred at the same time and induced to farrow on the same day. Their thriftiest piglets were weaned at five days of age and moved to an isolated early-weaning unit. At about six weeks of age they were moved to one of three isolated grow-out units where they were held to slaughter weight. Sows in five of the groups were dosed with high levels of tiamulin and trimethoprim-sulphonamide preparations from their entry into the farrowing house until their biggest piglets were weaned. Their piglets were dosed with similar drugs from birth until 10 days of age. The first and seventh groups of sows and their litters were not medicated. Tests were carried out on pigs aged five to 11 weeks, on slaughter pigs, and on pigs which died or were killed at different ages, for Mycoplasma hyopneumoniae, Bordetella bronchiseptica and colonic treponemes, which were readily detectable in the herd of origin. No evidence could be found of mycoplasma or bordetella. Colonic treponemes were recovered from some of the pigs at slaughter, but not from younger pigs. Thirty-seven boars and gilts from the medicated groups were introduced into 11 herds thought to be free of enzootic pneumonia and 13 were introduced into three herds which had enzootic pneumonia. No subsequent signs of enzootic pneumonia were noted in 10 of the enzootic pneumonia-free herds.

  20. Hypofractionated three-dimensional conformal radiotherapy for medically inoperable early stage

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Joo Ho; Wu, Hong Gyun; KIm, Hak Jae; Park, Charn Il; Lee, Se Hoon; Kim, Dong Wan; Heo, Dae Seong [Seoul National University College of Medicine, Seou (Korea, Republic of)

    2013-01-15

    The purpose of this study was to assess the clinical outcomes of hypofractionated radiotherapy (HFRT) with three-dimensional conformal technique for medically inoperable patients with early stage non-small-cell lung cancer (NSCLC) and to evaluate prognostic factors. We performed a retrospective review of 26 patients who underwent HFRT for early stage NSCLC between September 2005 and August 2011. Only clinical stage T1-3N0 was included. The median RT dose was 70 Gy (range, 60 to 72 Gy) and the median biologically equivalent dose (BED) was 94.5 Gy (range, 78.0 to 100.8 Gy). In 84.6% of patients, 4 Gy per fraction was used. Neoadjuvant chemotherapy with paclitaxel and cisplatin was given to 2 of 26 patients. The median follow-up time for surviving patients was 21 months (range, 13 to 49 months). The overall response rate was 53.9%, and the initial local control rate was 100%. The median survival duration was 27.8 months. Rates of 2-year overall survival, progression-free survival (PFS), local control (LC), and locoregional-free survival (LRFS) were 54.3%, 61.1%, 74.6%, and 61.9%, respectively. Multivariate analysis showed that BED (>90 vs. {<=}90 Gy) was an independent prognostic factor influencing PFS, LC, and LRFS. Severe toxicities over grade 3 were not observed. Radical HFRT can yield satisfactory disease control with acceptable rates of toxicities in medically inoperable patients with early stage NSCLC. HFRT is a viable alternative for clinics and patients ineligible for stereotactic ablative radiotherapy. BED over 90 Gy and 4 Gy per fraction might be appropriate for HFRT.

  1. Evaluation of early changes of cartilage biomarkers following arthroscopic meniscectomy in young Egyptian adults

    Directory of Open Access Journals (Sweden)

    Hamdy Khamis Koryem

    2015-09-01

    Conclusion: Cartilage volume loss by MRI combined with changes in cartilage matrix turnover detected by molecular biomarkers may reflect the initial changes associated with cartilage degeneration that account for early OA.

  2. The birth of the subspecialty of medical oncology and examples of its early scientific foundations.

    Science.gov (United States)

    Band, Pierre R

    2010-08-01

    "Passion is not accepting defeat."--Emil Frei III. In the early 1950s, an experimental and clinical program characterized by unique cross-fertilization was developed. The clinical importance of experimental animal models in drug screening and in establishing key chemotherapy concepts and the role of the pioneers of medical oncology in the design of the various phases of drug trials, using childhood acute leukemia and breast cancer as models, are discussed. Over a short time and with only a few drugs, principles of chemotherapy were laid out, which led to cures in such diseases as childhood acute leukemia and Hodgkin's disease and to improved disease-free survival in breast cancer. It is these and other achievements that paved the way to medical oncology. At the instigation of the American Society of Clinical Oncology (ASCO), the American Board of Internal Medicine made inquiries about a subspecialty in oncology. ASCO and B. J. Kennedy, MD, played key roles in the events leading to the official recognition of medical oncology as a new subspecialty of internal medicine in 1972.

  3. Chronic Disease Management Strategies of Early Childhood Caries: Support from the Medical and Dental Literature.

    Science.gov (United States)

    Edelstein, Burton L; Ng, Man Wai

    2015-01-01

    An Institute of Medicine report places chronic disease management (CDM) as an intervention on a treatment spectrum between prevention and acute care. CDM commonly focuses on conditions in which patient self-care efforts are significant. Framing early childhood caries (ECC) as such a chronic condition invites dentistry to reconsider its approach to caries management and shift gears from a strictly surgical approach to one that also incorporates a medical approach. This paper's purpose was to explore the definition of and concepts inherent in CDM. An explanatory model is introduced to describe the multiple factors that influence ECC-CDM strategies. Reviewed literature suggests that early evidence from ECC-CDM interventions, along with results of pediatric asthma and diabetes CDM, supports CDM of ECC as a valid approach that is independent of both prevention and repair. Early results of ECC-CDM endeavors have demonstrated a reduction in rates of new cavitation, dental pain, and referral to the operating room compared to baseline rates. ECC-CDM strategies hold strong promise to curtail caries activity while complementing dental repair when needed, thereby reducing disease progression and cavity recurrence. Institutionalizing ECC-CDM will both require and benefit from evolving health care delivery and financing systems that reward positive health outcomes.

  4. Environmental Change & Fragile States Early Warning and Intervention

    Science.gov (United States)

    2011-05-12

    Natural Resources and Ecosystem Services] Sources: Adapted from Maslow , 1943; Butts as reported by Damonte, 2006 8  Research...how positions of competing interests will evolve. Synthesizes political science, microeconomics, game theory , decision theory , and spatial...explanation of why outcomes occur (actor motivations ) Senturion Software 19 Integrated Crisis Early Warning System (ICEWS)  Developed By DARPA

  5. Managing Risks? Early Warning Systems for Climate Change

    Science.gov (United States)

    Sitati, A. M.; Zommers, Z. A.; Habilov, M.

    2014-12-01

    Early warning systems are a tool with which to minimize risks posed by climate related hazards. Although great strides have been made in developing early warning systems most deal with one hazard, only provide short-term warnings and do not reach the most vulnerable. This presentation will review research results of the United Nations Environment Programme's CLIM-WARN project. The project seeks to identify how governments can better communicate risks by designing multi-hazard early warning systems that deliver actionable warnings across timescales. Household surveys and focus group discussions were conducted in 36 communities in Kenya, Ghana and Burkina Faso in order to identify relevant climate related hazards, current response strategies and early warning needs. Preliminary results show significant variability in both risks and needs within and between countries. For instance, floods are more frequent in rural western parts of Kenya. Droughts are frequent in the north while populations in urban areas face a range of hazards - floods, droughts, disease outbreaks - that sometimes occur simultaneously. The majority of the rural population, especially women, the disabled and the elderly, do not have access to modern media such as radio, television, or internet. While 55% of rural populace never watches television, 64% of urban respondents watch television on a daily basis. Communities have different concepts of how to design warning systems. It will be a challenge for national governments to create systems that accommodate such diversity yet provide standard quality of service to all. There is a need for flexible and forward-looking early warning systems that deliver broader information about risks. Information disseminated through the system could not only include details of hazards, but also long-term adaptation options, general education, and health information, thus increasingly both capabilities and response options.

  6. The validity of student tutors' judgments in early detection of struggling in medical school. A prospective cohort study.

    Science.gov (United States)

    O'Neill, Lotte Dyhrberg; Morcke, Anne Mette; Eika, Berit

    2016-12-01

    Early identification and support of strugglers in medical education is generally recommended in the research literature, though very little evidence of the diagnostic qualities of early teacher judgments in medical education currently exists. The aim of this study was to examine the validity of early diagnosis of struggling in medical school based on informal teacher judgements of in-class behavior. The study design was a prospective cohort study and the outcomes/truth criteria were anatomy failure and medical school drop out. Six weeks into an anatomy course, student tutors attempted to identify medical students, who they reckoned would fail the anatomy course or drop out, based on their everyday experiences with students in a large group educational setting. In addition, they were asked to describe the indicators of struggling they observed. Sixteen student tutors evaluated 429 medical students for signs of struggling. By week six, the student tutors were able to detect approximately 1/4-1/3 of the students who eventually failed or dropped out, and for ¾ of the strugglers they identified, they were correct in their judgments. Informal student tutor's judgements showed incremental validity for both outcomes when controlling for grades obtained in preceeding exams. Lack of participation, lack of commitment, poor academic performance, poor social interactions and general signs of distress were the main indicators of struggling identified. Teachers' informal judgements of in-class behavior may be an untapped source of information in the early identification of struggling medical students with added value above and beyond formal testing.

  7. Changes in early-successional hardwood forest area in four bird conservation regions across four decades

    Science.gov (United States)

    Sonja N. Oswalt; Kathleen E. Franzreb; David A. Buehler

    2012-01-01

    Early successional hardwood forests constitute important breeding habitat for many migratory songbirds. Declines in populations of these species suggest changes in habitat availability either on the species’ wintering grounds or on their early successional breeding grounds. We used Forest Inventory and Analysis data from 11 states across four decades to examine changes...

  8. Early resistance change and stress/electromigration evolution in near bamboo interconnects

    NARCIS (Netherlands)

    Petrescu, V.; Mouthaan, A.J.; Dima, G.; Govoreanu, B.; Mitrea, O.; Profirescu, M.

    1997-01-01

    A complete description for early resistance change and mechanical stress evolution in near-bamboo interconnects, related to the electromigration, is given in this paper. The proposed model, for the first time, combines the stress/vacancy concentration evolution with the early resistance change of

  9. Does the Brief Observation of Social Communication Change Help Moving Forward in Measuring Change in Early Autism Intervention Studies?

    Science.gov (United States)

    Pijl, Mirjam K. J.; Rommelse, Nanda N. J.; Hendriks, Monica; De Korte, Manon W. P.; Buitelaar, Jan K.; Oosterling, Iris J.

    2018-01-01

    The field of early autism research is in dire need of outcome measures that adequately reflect subtle changes in core autistic behaviors. This article compares the ability of a newly developed measure, the Brief Observation of Social Communication Change (BOSCC), and the Autism Diagnostic Observation Schedule (ADOS) to detect changes in core…

  10. Medical imaging: Material change for X-ray detectors

    Science.gov (United States)

    Rowlands, John A.

    2017-10-01

    The X-ray sensitivity of radiology instruments is limited by the materials used in their detectors. A material from the perovskite family of semiconductors could allow lower doses of X-rays to be used for medical imaging. See Letter p.87

  11. The German medical dissertation--time to change?

    Science.gov (United States)

    Diez, C; Arkenau, C; Meyer-Wentrup, F

    2000-08-01

    German medical students must conduct a research project and write a dissertation in order to receive the title "Doctor." However, the dissertation is not required to graduate, enter a residency, or practice medicine. About 90% of practicing physicians hold the title "Doctor"; a career in academic medicine almost always requires it. Although no convincing evidence supports the usefulness of the dissertation, many regard its completion as important to maintaining a high level of scientific competence and patient care. In recent years, the number of successfully completed dissertations has declined. Lack of time during medical school, the perceived irrelevance of the dissertation to medical practice, and the poor design of many projects may be at least part of the problem. There is also increasing evidence that conducting research frequently delays graduation and may affect clinical skills because students working on projects attend fewer classes, ward rounds, and clinical tutorials and do not spent sufficient time preparing for examinations. The scientific value of students' research has also been criticized; critics point out that students do not have enough time or experience to critically analyze methods and data, and they often are not properly supervised. European unification will probably lead to standardized requirements for medical education and research. The authors hope this will eliminate the dissertation requirement in Germany.

  12. How 3D immersive visualization is changing medical diagnostics

    Science.gov (United States)

    Koning, Anton H. J.

    2011-03-01

    Originally the only way to look inside the human body without opening it up was by means of two dimensional (2D) images obtained using X-ray equipment. The fact that human anatomy is inherently three dimensional leads to ambiguities in interpretation and problems of occlusion. Three dimensional (3D) imaging modalities such as CT, MRI and 3D ultrasound remove these drawbacks and are now part of routine medical care. While most hospitals 'have gone digital', meaning that the images are no longer printed on film, they are still being viewed on 2D screens. However, this way valuable depth information is lost, and some interactions become unnecessarily complex or even unfeasible. Using a virtual reality (VR) system to present volumetric data means that depth information is presented to the viewer and 3D interaction is made possible. At the Erasmus MC we have developed V-Scope, an immersive volume visualization system for visualizing a variety of (bio-)medical volumetric datasets, ranging from 3D ultrasound, via CT and MRI, to confocal microscopy, OPT and 3D electron-microscopy data. In this talk we will address the advantages of such a system for both medical diagnostics as well as for (bio)medical research.

  13. Medication use in early pregnancy-prevalence and determinants of use in a prospective cohort of women.

    LENUS (Irish Health Repository)

    Cleary, Brian J

    2012-02-01

    PURPOSE: To examine the extent, nature and determinants of medication use in early pregnancy. METHODS: We reviewed early pregnancy medication use, as reported to a midwife at the booking interview, in women delivering between 2000 and 2007 in a large maternity hospital in Dublin, Ireland (n = 61 252). RESULTS: Excluding folic acid, at least one medication was reported in 23 989 (39.2%) pregnancies. Over the counter (OTC) medications were reported in 11 970 (19.5%) pregnancies, illicit drugs or methadone in 545 (0.9%) and herbal medicines\\/supplements in 352 (0.58%). FDA category D and X medications were reported by 1532 (2.5%) and 1987 (3.2%) women. Asthma, depression and hypertension were among the most commonly reported chronic medical disorders. Medications with potential for foetal harm were reported by 86 (15.7%) women treated for depression and 68 (20%) women treated for hypertension. Factors associated with reporting the use of medications with potential for foetal harm included unplanned pregnancy (adjusted odds ratio [aOR] 1.31, 95% confidence interval [CI] 1.12-1.52), booking at less than 12 weeks gestation (aOR 1.83, 95%CI 1.58-2.13), being above 25 years of age, unemployed (aOR 2.58, 95%CI 2.03-3.29), nulliparous (aOR 1.41; 95%CI 1.22-1.63), single (aOR 1.28; 95%CI 1.06-1.54) or smoking during pregnancy (aOR 1.96, 95%CI 1.67-2.28). CONCLUSIONS: Women frequently report medication use in early pregnancy. Women and prescribers need to be aware of the lack of pregnancy safety data for many medications, and the need for pre-pregnancy planning. Prescribers should ensure that optimal medications are used when treating women of childbearing potential with chronic medical disorders.

  14. Global inter-annual gravity changes from GRACE: Early results

    DEFF Research Database (Denmark)

    Andersen, Ole Baltazar; Hinderer, J.

    2005-01-01

    with an accuracy of 0.4 muGal corresponding to 9 mm water thickness on spatial scales longer than 1300 km. Four of the most widely used global hydrological models have been investigated for their spatial comparison with GRACE observations of inter-annual gravity field variations due to changes in continental water...... storage. The Global Land Data Assimilation System model has a spatial correlation coefficient with GRACE observations of 0.65 over the northern hemisphere. This demonstrates that the observed gravity field changes on these scales are largely related to changes in continental water storage.......Fifteen monthly gravity field solutions from the GRACE twin satellites launched more than two years ago have been studied to estimate gravity field changes between 2002 and 2003. The results demonstrate that GRACE is capable of capturing the changes in ground water on inter-annual scales...

  15. Measures for assessing practice change in medical practitioners.

    Science.gov (United States)

    Hakkennes, Sharon; Green, Sally

    2006-12-06

    There are increasing numbers of randomised trials and systematic reviews examining the efficacy of interventions designed to bring about a change in clinical practice. The findings of this research are being used to guide strategies to increase the uptake of evidence into clinical practice. Knowledge of the outcomes measured by these trials is vital not only for the interpretation and application of the work done to date, but also to inform future research in this expanding area of endeavour and to assist in collation of results in systematic reviews and meta-analyses. The objective of this review was to identify methods used to measure change in the clinical practices of health professionals following an intervention aimed at increasing the uptake of evidence into practice. All published trials included in a recent, comprehensive Health Technology Assessment of interventions to implement clinical practice guidelines and change clinical practice (n = 228) formed the sample for this study. Using a standardised data extraction form, one reviewer (SH), extracted the relevant information from the methods and/or results sections of the trials. Measures of a change of health practitioner behaviour were the most common, with 88.8% of trials using these as outcome measures. Measures that assessed change at a patient level, either actual measures of change or surrogate measures of change, were used in 28.8% and 36.7% of studies (respectively). Health practitioners' knowledge and attitudes were assessed in 22.8% of the studies and changes at an organisational level were assessed in 17.6%. Most trials of interventions aimed at changing clinical practice measured the effect of the intervention at the level of the practitioner, i.e. did the practitioner change what they do, or has their knowledge of and/or attitude toward that practice changed? Less than one-third of the trials measured, whether or not any change in practice, resulted in a change in the ultimate end-point of

  16. How philosophy of medicine has changed medical ethics.

    Science.gov (United States)

    Veatch, Robert M

    2006-12-01

    The celebration of thirty years of publication of The Journal of Medicine and Philosophy provides an opportunity to reflect on how medical ethics has evolved over that period. The reshaping of the field has occurred in no small part because of the impact of branches of philosophy other than ethics. These have included influences from Kantian theory of respect for persons, personal identity theory, philosophy of biology, linguistic analysis of the concepts of health and disease, personhood theory, epistemology, and political philosophy. More critically, medicine itself has begun to be reshaped. The most fundamental restructuring of medicine is currently occurring--stemming, in part, from the application of contemporary philosophy of science to the medical field. There is no journal more central to these critical events of the past three decades than The Journal of Medicine and Philosophy.

  17. Decreasing Irradiated Rat Lung Volume Changes Dose-Limiting Toxicity From Early to Late Effects

    Energy Technology Data Exchange (ETDEWEB)

    Veen, Sonja J. van der; Faber, Hette; Ghobadi, Ghazaleh [Department of Cell Biology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Brandenburg, Sytze [KVI Center for Advanced Radiation Research, University of Groningen, Groningen (Netherlands); Langendijk, Johannes A. [Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Coppes, Robert P. [Department of Cell Biology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Luijk, Peter van, E-mail: p.van.luijk@umcg.nl [Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands)

    2016-01-01

    Purpose: Technological developments in radiation therapy result in smaller irradiated volumes of normal tissue. Because the risk of radiation therapy-induced toxicity generally depends on irradiated volume, changing volume could change the dose-limiting toxicity of a treatment. Recently, in our rat model, we found that early radiation-induced lung dysfunction (RILD) was closely related to irradiated volume dependent vascular remodeling besides inflammation. The exact relationship between early and late RILD is still unknown. Therefore, in this preclinical study we investigated the dose-volume relationship of late RILD, assessed its dependence on early and late pathologies and studied if decreasing irradiated volume changed the dose-limiting toxicity. Methods and Materials: A volume of 25%, 32%, 50%, 63%, 88%, or 100% of the rat lung was irradiated using protons. Until 26 weeks after irradiation, respiratory rates were measured. Macrovascular remodeling, pulmonary inflammation, and fibrosis were assessed at 26 weeks after irradiation. For all endpoints dose-volume response curves were made. These results were compared to our previously published early lung effects. Results: Early vascular remodeling and inflammation correlated significantly with early RILD. Late RILD correlated with inflammation and fibrosis, but not with vascular remodeling. In contrast to the early effects, late vascular remodeling, inflammation and fibrosis showed a primarily dose but not volume dependence. Comparison of respiratory rate increases early and late after irradiation for the different dose-distributions indicated that with decreasing irradiated volumes, the dose-limiting toxicity changed from early to late RILD. Conclusions: In our rat model, different pathologies underlie early and late RILD with different dose-volume dependencies. Consequently, the dose-limiting toxicity changed from early to late dysfunction when the irradiated volume was reduced. In patients, early and late

  18. Impact of a Comprehensive Early Clinical Exposure Program for Preclinical Year Medical Students

    Directory of Open Access Journals (Sweden)

    Sumitra Govindarajan

    2018-06-01

    Full Text Available Purpose: To study the impact of an early clinical exposure program designed to provide a wide variety (cognitive, affective and psychomotor of learning experiences for the preclinical year students. Method: One hundred and fifty preclinical students were posted in small groups to selected departments – Transfusion medicine, Catheterization lab, Simulation lab, Radiology, Neurology, Nephrology, Respiratory medicine and General surgery. Each student had atleast ten hours  of clinical exposure under this program. The program was evaluated through a series of pre and post-test questionnaires, which were designed based on the learning objectives of each session. Students who wished to participate in the program evaluation gave informed consent, took up the pre / post test and were also asked to give their written open comments about the program. Results: There was a significant increase in the post-test scores (ranging from 9.14±2.67 to 36.65±6.62 when compared to the pre-test scores (ranging from 7.94±2.31 to 28.69±6.11 for all the sessions (p value <0.001, n=144. Analysis of the open feedback showed that the program had significant impact on the cognitive, psychomotor and affective domains. “Application of basic sciences in clinical practice”, “motivation to learn”, “got familiar with various specialties”, “insight about what the patient undergoes” were the themes identified from the open comments. Conclusion: The innovative use of early clinical exposure program to teach/learn clinical skills like phlebotomy and Basic Life Support had been well appreciated by the students. The present design involving a variety of learning experiences has been successful in introducing the various dimensions of medical profession like scientific, ethical, interpersonal, professional and social to the new entrants in addition to enhancing their motivation to learn. Keywords: Attitude, Learning, Simulation lab, Medical education, Curriculum

  19. Microstructural Changes of the Human Brain from Early to Mid-Adulthood

    OpenAIRE

    Tian, Lixia; Ma, Lin

    2017-01-01

    Despite numerous studies on the microstructural changes of the human brain throughout life, we have indeed little direct knowledge about the changes from early to mid-adulthood. The aim of this study was to investigate the microstructural changes of the human brain from early to mid-adulthood. We performed two sets of analyses based on the diffusion tensor imaging (DTI) data of 111 adults aged 18–55 years. Specifically, we first correlated age with skeletonized fractional anisotropy (FA), mea...

  20. 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.

  1. Can Early Rehabilitation after Total Hip Arthroplasty Reduce Its Major Complications and Medical Expenses? Report from a Nationally Representative Cohort

    Directory of Open Access Journals (Sweden)

    Daniel Chiung-Jui Su

    2015-01-01

    Full Text Available Objective. To investigate whether early rehabilitation reduces the occurrence of posttotal hip arthroplasty (THA complications, adverse events, and medical expenses within one postoperative year. Method. We retrospectively retrieve data from Taiwan’s National Health Insurance Research Database. Patients who had undergone THA during the period from 1998 to 2010 were recruited, matched for propensity scores, and divided into 2 groups: early rehabilitation (Early Rehab and delayed rehabilitation (Delayed Rehab. Results. Eight hundred twenty of 999 THA patients given early rehabilitation treatments were matched to 205 of 233 THA patients given delayed rehabilitation treatments. The Delayed Rehab group had significantly (all p<0.001 higher medical and rehabilitation expenses and more outpatient department (OPD visits than the Early Rehab group. In addition, the Delayed Rehab group was associated with more prosthetic infection (odds ratio (OR: 3.152; 95% confidence interval (CI: 1.211–8.203; p<0.05 than the Early Rehab group. Conclusions. Early rehabilitation can significantly reduce the incidence of prosthetic infection, total rehabilitation expense, total medical expenses, and number of OPD visits within the first year after THA.

  2. Measures for assessing practice change in medical practitioners

    Directory of Open Access Journals (Sweden)

    Green Sally

    2006-12-01

    Full Text Available Abstract Background There are increasing numbers of randomised trials and systematic reviews examining the efficacy of interventions designed to bring about a change in clinical practice. The findings of this research are being used to guide strategies to increase the uptake of evidence into clinical practice. Knowledge of the outcomes measured by these trials is vital not only for the interpretation and application of the work done to date, but also to inform future research in this expanding area of endeavour and to assist in collation of results in systematic reviews and meta-analyses. Methods The objective of this review was to identify methods used to measure change in the clinical practices of health professionals following an intervention aimed at increasing the uptake of evidence into practice. All published trials included in a recent, comprehensive Health Technology Assessment of interventions to implement clinical practice guidelines and change clinical practice (n = 228 formed the sample for this study. Using a standardised data extraction form, one reviewer (SH, extracted the relevant information from the methods and/or results sections of the trials. Results Measures of a change of health practitioner behaviour were the most common, with 88.8% of trials using these as outcome measures. Measures that assessed change at a patient level, either actual measures of change or surrogate measures of change, were used in 28.8% and 36.7% of studies (respectively. Health practitioners' knowledge and attitudes were assessed in 22.8% of the studies and changes at an organisational level were assessed in 17.6%. Conclusion Most trials of interventions aimed at changing clinical practice measured the effect of the intervention at the level of the practitioner, i.e. did the practitioner change what they do, or has their knowledge of and/or attitude toward that practice changed? Less than one-third of the trials measured, whether or not any change

  3. Consultant medical trainers, modernising medical careers (MMC and the European time directive (EWTD: tensions and challenges in a changing medical education context

    Directory of Open Access Journals (Sweden)

    Payne Heather

    2008-05-01

    Full Text Available Abstract Background We analysed the learning and professional development narratives of Hospital Consultants training junior staff ('Consultant Trainers' in order to identify impediments to successful postgraduate medical training in the UK, in the context of Modernising Medical Careers (MMC and the European Working Time Directive (EWTD. Methods Qualitative study. Learning and continuing professional development (CPD, were discussed in the context of Consultant Trainers' personal biographies, organisational culture and medical education practices. We conducted life story interviews with 20 Hospital Consultants in six NHS Trusts in Wales in 2005. Results Consultant Trainers felt that new working patterns resulting from the EWTD and MMC have changed the nature of medical education. Loss of continuity of care, reduced clinical exposure of medical trainees and loss of the popular apprenticeship model were seen as detrimental for the quality of medical training and patient care. Consultant Trainers' perceptions of medical education were embedded in a traditional medical education culture, which expected long hours' availability, personal sacrifices and learning without formal educational support and supervision. Over-reliance on apprenticeship in combination with lack of organisational support for Consultant Trainers' new responsibilities, resulting from the introduction of MMC, and lack of interest in pursuing training in teaching, supervision and assessment represent potentially significant barriers to progress. Conclusion This study identifies issues with significant implications for the implementation of MMC within the context of EWTD. Postgraduate Deaneries, NHS Trusts and the new body; NHS: Medical Education England should deal with the deficiencies of MMC and challenges of ETWD and aspire to excellence. Further research is needed to investigate the views and educational practices of Consultant Medical Trainers and medical trainees.

  4. Accounting for psychotropic medication changes in prisons: patient and doctor perspectives.

    Science.gov (United States)

    Hassan, Lamiece; Edge, Dawn; Senior, Jane; Shaw, Jenny

    2015-07-01

    Psychotropic medicines are widely used to treat mental illness; however, people entering prison commonly report that prescribed psychotropic medicines are changed or withdrawn, adding to their distress in difficult times. Drawing on three extracts from a larger qualitative dataset in which patients and doctors were interviewed about psychotropic medication use in English prisons, we combined discursive psychological and Foucauldian discourse analysis techniques to examine how individuals accounted for medication changes. Patients used four discursive strategies to organize descriptions of medication changes: they established entitlement to psychotropic medication, questioned the clinical judgment of prison doctors; highlighted communication problems; and attributed negative health outcomes to medication regime changes. In contrast, we examined an effective defense by a general practitioner, which showed how clinical needs were prioritized over previously held prescriptions when making prescribing decisions. Wider implications for continuity and equivalence of care between prisons and the wider community are discussed. © The Author(s) 2014.

  5. Radiotherapy-induced Early ECG Changes and Their Comparison with Echocardiography in Patients with Early-stage Breast Cancer.

    Science.gov (United States)

    Tuohinen, Suvi Sirkku; Keski-Pukkila, Konsta; Skyttä, Tanja; Huhtala, Heini; Virtanen, Vesa; Kellokumpu-Lehtinen, Pirkko-Liisa; Raatikainen, Pekka; Nikus, Kjell

    2018-04-01

    Early electrocardiogram (ECG) changes after breast cancer radiotherapy (RT) have been reported, but their characteristics and associated factors are largely unknown. This study aimed to explore early RT-induced ECG changes and to compare them with echocardiography changes. Sixty eligible patients with chemotherapy-naïve left-sided and 20 with right-sided breast cancer were evaluated with echocardiography, blood samples and ECG before and after RT. RT-induced ECG changes in the anterior leads. T-Wave changes were most frequent. T-Wave decline was associated independently with patient age (β=-0.245, p=0.005), mean heart radiation dose (β=1.252, p=0.001) and global systolic strain rate change (β=7.943, p=0.002). T-Wave inversion was associated independently with mean heart radiation dose (β=0.143, pECG changes were prevalent and associated with functional and structural changes in echocardiography. ECG could be used for post-RT cardiac screening. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  6. Early rehospitalizations of frail elderly patients – the role of medications: a clinical, prospective, observational trial

    Directory of Open Access Journals (Sweden)

    Ekerstad N

    2017-08-01

    Full Text Available Niklas Ekerstad,1,2 Kristoffer Bylin,3 Björn W Karlson3,4 1Department of Cardiology, NU (NÄL-Uddevalla Hospital Group, Trollhättan, 2Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, 3Department of Acute and Internal Medicine, NU (NÄL-Uddevalla Hospital Group, Trollhättan, 4Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Background and objective: Early readmissions of frail elderly patients after an episode of hospital care are common and constitute a crucial patient safety outcome. Our purpose was to study the impact of medications on such early rehospitalizations. Patients and methods: This is a clinical, prospective, observational study on rehospitalizations within 30 days after an acute hospital episode for frail patients over the age of 75 years. To identify adverse drug reactions (ADRs, underuse of evidence-based treatment and avoidability of rehospitalizations, the Naranjo score, the Hallas criteria and clinical judgment were used. Results: Of 390 evaluable patients, 96 (24.6% were rehospitalized. The most frequent symptoms and conditions were dyspnea (n = 25 and worsened general condition (n = 18. The most frequent diagnoses were heart failure (n = 17 and pneumonia/acute bronchitis (n = 13. By logistic regression analysis, independent risk predictors for rehospitalization were heart failure (odds ratio [OR] = 1.8; 95% CI = 1.1–3.1 and anemia (OR = 2.3; 95% CI = 1.3–4.0. The number of rehospitalizations due to probable ADRs was 13, of which two were assessed as avoidable. The number of rehospitalizations probably due to underuse of evidence-based drug treatment was 19, all of which were assessed as avoidable. The number of rehospitalizations not due to ADRs or underuse of evidence-based drug treatment was 64, of which none was assessed as avoidable. Conclusion: One out of four

  7. Attachment change processes in the early years of marriage.

    Science.gov (United States)

    Davila, J; Karney, B R; Bradbury, T N

    1999-05-01

    The authors examined 4 models of attachment change: a contextual model, a social-cognitive model, an individual-difference model, and a diathesis-stress model. Models were examined in a sample of newlyweds over the first 2 years of marriage, using growth curve analyses. Reciprocal processes, whereby attachment representations and interpersonal life circumstances affect one another over time, also were studied. On average, newlyweds became more secure over time. However, there was significant within-subject variability on attachment change that was predicted by intra- and interpersonal factors. Attachment representations changed in response to contextual, social-cognitive, and individual-difference factors. Reciprocal processes between attachment representations and marital variables emerged, suggesting that these factors influence one another in an ongoing way.

  8. Podocyte number and density changes during early human life.

    Science.gov (United States)

    Kikuchi, Masao; Wickman, Larysa; Rabah, Raja; Wiggins, Roger C

    2017-05-01

    Podocyte depletion, which drives progressive glomerulosclerosis in glomerular diseases, is caused by a reduction in podocyte number, size or function in the context of increasing glomerular volume. Kidneys obtained at autopsy from premature and mature infants who died in the first year of life (n = 24) were used to measure podometric parameters for comparison with previously reported data from older kidneys. Glomerular volume increased 4.6-fold from 0.13 ± 0.07 μm 3 x10 6 in the pre-capillary loop stage, through 0.35 μm 3 x10 6 at the capillary loop, to 0.60 μm 3 x10 6 at the mature glomerular stage. Podocyte number per glomerulus increased from 326 ± 154 per glomerulus at the pre-capillary loop stage to 584 ± 131 per glomerulus at the capillary loop stage of glomerular development to reach a value of 589 ± 166 per glomerulus in mature glomeruli. Thus, the major podocyte number increase occurs in the early stages of glomerular development, in contradistinction to glomerular volume increase, which continues after birth in association with body growth. As glomeruli continue to enlarge, podocyte density (number per volume) rapidly decreases, requiring a parallel rapid increase in podocyte size that allows podocyte foot processes to maintain complete coverage of the filtration surface area. Hypertrophic stresses on the glomerulus and podocyte during development and early rapid growth periods of life are therefore likely to play significant roles in determining how and when defects in podocyte structure and function due to genetic variants become clinically manifest. Therapeutic strategies aimed at minimizing mismatch between these factors may prove clinically useful.

  9. ECG Changes In Patients On Chronic Psychotropic medication

    African Journals Online (AJOL)

    2006-08-31

    Aug 31, 2006 ... The use of psychotropic drugs is associated with. ECG changes in ... impact, while the secondary tricyclic antidepressants (nortriptyline, desipramine) ... Human Research Ethics Committee approved the study. Procedures.

  10. Ultrastructural changes in goat interspecies and intraspecies reconstructed early embryos

    DEFF Research Database (Denmark)

    Tao, Yong; Gheng, Lizi; Zhang, Meiling

    2008-01-01

    and dispered gradually from the 4-cell period. The nucleolus of GC and GG embryos changed from electron dense to a fibrillo-granular meshwork at the 16-cell stage, showing that nucleus function in the reconstructed embryos was activated. The broken nuclear envelope and multiple nucleoli in one blastomere......- and intraspecies reconstructed embryos have a similar pattern of developmental change to that of in vivo-produced embryos for ZP, rough ER, Gi and nucleolus, but differ for mitochondria, LD, vesicles, nucleus and gap junction development. In particular, the interspecies cloned embryos showed more severe...

  11. Climate change: what competencies and which medical education and training approaches?

    Directory of Open Access Journals (Sweden)

    Bell Erica J

    2010-04-01

    Full Text Available Abstract Background Much research has been devoted to identifying healthcare needs in a climate-changing world. However, while there are now global and national policy statements about the importance of health workforce development for climate change, little has been published about what competencies might be demanded of practitioners in a climate-changing world. In such a context, this debate and discussion paper aims to explore the nature of key competencies and related opportunities for teaching climate change in medical education and training. Particular emphasis is made on preparation for practice in rural and remote regions likely to be greatly affected by climate change. Discussion The paper describes what kinds of competencies for climate change might be included in medical education and training. It explores which curricula, teaching, learning and assessment approaches might be involved. Rather than arguing for major changes to medical education and training, this paper explores well established precedents to offer practical suggestions for where a particular kind of literacy--eco-medical literacy--and related competencies could be naturally integrated into existing elements of medical education and training. Summary The health effects of climate change have, generally, not yet been integrated into medical education and training systems. However, the necessary competencies could be taught by building on existing models, best practice and innovative traditions in medicine. Even in crowded curricula, climate change offers an opportunity to reinforce and extend understandings of how interactions between people and place affect health.

  12. Medical Student Perceptions of the Learning Environment in Medical School Change as Students Transition to Clinical Training in Undergraduate Medical School.

    Science.gov (United States)

    Dunham, Lisette; Dekhtyar, Michael; Gruener, Gregory; CichoskiKelly, Eileen; Deitz, Jennifer; Elliott, Donna; Stuber, Margaret L; Skochelak, Susan E

    2017-01-01

    Phenomenon: The learning environment is the physical, social, and psychological context in which a student learns. A supportive learning environment contributes to student well-being and enhances student empathy, professionalism, and academic success, whereas an unsupportive learning environment may lead to burnout, exhaustion, and cynicism. Student perceptions of the medical school learning environment may change over time and be associated with students' year of training and may differ significantly depending on the student's gender or race/ethnicity. Understanding the changes in perceptions of the learning environment related to student characteristics and year of training could inform interventions that facilitate positive experiences in undergraduate medical education. The Medical School Learning Environment Survey (MSLES) was administered to 4,262 students who matriculated at one of 23 U.S. and Canadian medical schools in 2010 and 2011. Students completed the survey at the end of each year of medical school as part of a battery of surveys in the Learning Environment Study. A mixed-effects longitudinal model, t tests, Cohen's d effect size, and analysis of variance assessed the relationship between MSLES score, year of training, and demographic variables. After controlling for gender, race/ethnicity, and school, students reported worsening perceptions toward the medical school learning environment, with the worst perceptions in the 3rd year of medical school as students begin their clinical experiences, and some recovery in the 4th year after Match Day. The drop in MSLES scores associated with the transition to the clinical learning environment (-0.26 point drop in addition to yearly change, effect size = 0.52, p effect size = 0.14, p work-life balance and informal student relationships. There was some, but not complete, recovery in perceptions of the medical school learning environment in the 4th year. Insights: Perceptions of the medical school learning

  13. Medical biochemistry: Is it time to change the teaching style?

    Science.gov (United States)

    Palocaren, Jeeji; Pillai, Lekha S; Celine, T M

    2016-01-01

    The Medical Council of India (MCI) recommendations on medical education suggest a shift from didactic lectures to more interactive lectures. This study assessed the effectiveness of different pedagogical methods in biochemistry and the perceptions of students and teachers about the shift from didactic to interactive lectures. An interventional crossover study was done with the topic divided into three biochemical modules and one clinical module. The students were divided into two batches, one of which was given didactic and the other, interactive lectures. They were assessed immediately after the lecture and four months later. Anonymous feedback was obtained to gauge the students' perceptions regarding the mode of teaching. The teachers' feedback on the use of both pedagogical styles was also obtained. There was no significant difference between the performance of the two groups in either examination in three of the modules. However, there was a statistically significant difference between the two groups' performance in the module that had clinical applications, with students from the interactive lecture group performing better. All students preferred interactive classes, irrespective of the topic taught. The teachers indicated that, although at the outset the interactive lectures were difficult to manage, both in terms of content and time, these drawbacks could be overcome with time and practice. Interactive lectures are an effective teaching method in biochemistry, especially in topics involving clinical application.

  14. The Changing Drug Culture: Medical and Recreational Marijuana.

    Science.gov (United States)

    Albertson, Timothy E; Chenoweth, James A; Colby, Daniel K; Sutter, Mark E

    2016-02-01

    The major psychoactive compounds in marijuana (cannabis) are cannabinoids, the most significant of which is delta-9-tetrahydrocannabinol. There are also two synthetic pharmaceutical cannabinoids, nabilone and dronabinol, available by prescription in the United States. The use of marijuana has increased in the United States with passage of medical marijuana laws in many states and legalization of recreational marijuana use in several states. In addition, the potency of marijuana has increased in recent years. Marijuana has been used for a variety of medical purposes, including management of nausea and vomiting, appetite and immunologic stimulation in patients with HIV infection and AIDS, glaucoma, neurologic disorders, and pain relief. Studies on the benefits of marijuana as a treatment for various conditions have been inconsistent, except for those on pain management. Marijuana has adverse effects, and has been associated with driving impairment, psychosis, dependence and withdrawal syndromes, hyperemesis, acute cardiac events, some cancers, and impaired lung function. As with studies on the benefits of marijuana, studies of adverse effects have yielded inconsistent results. Except for impaired driving and the occurrence of dependence and withdrawal syndromes, the adverse effects of marijuana use have not been fully studied. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

  15. Children's Physic: Medical Perceptions and Treatment of Sick Children in Early Modern England, c. 1580-1720.

    Science.gov (United States)

    Newton, Hannah

    2010-12-01

    Historians of medicine, childhood and paediatrics have often assumed that early modern doctors neither treated children, nor adapted their medicines to suit the peculiar temperaments of the young. Through an examination of medical textbooks and doctors' casebooks, this article refutes these assumptions. It argues that medical authors and practising doctors regularly treated children, and were careful to tailor their remedies to complement the distinctive constitutions of children. Thus, this article proposes that a concept of 'children's physic' existed in early modern England. This term refers to the notion that children were physiologically distinct, requiring special medical care. Children's physic was rooted in the ancient traditions of Hippocratic and Galenic medicine: it was the child's humoral make-up that underpinned all medical ideas about children's bodies, minds, diseases and treatments. Children abounded in the humour blood, which made them humid and weak, and in need of medicines of a particularly gentle nature.

  16. Does the Brief Observation of Social Communication Change help moving forward in measuring change in early autism intervention studies?

    NARCIS (Netherlands)

    Pijl, M.K.J.; Rommelse, N.N.J.; Hendriks, M.; Korte, M.W.P. de; Buitelaar, J.K.; Oosterling, I.J.

    2018-01-01

    The field of early autism research is in dire need of outcome measures that adequately reflect subtle changes in core autistic behaviors. This article compares the ability of a newly developed measure, the Brief Observation of Social Communication Change (BOSCC), and the Autism Diagnostic

  17. Early anti-correlated BOLD signal changes of physiologic origin.

    Science.gov (United States)

    Bright, Molly G; Bianciardi, Marta; de Zwart, Jacco A; Murphy, Kevin; Duyn, Jeff H

    2014-02-15

    Negative BOLD signals that are synchronous with resting state fluctuations have been observed in large vessels in the cortical sulci and surrounding the ventricles. In this study, we investigated the origin of these negative BOLD signals by applying a Cued Deep Breathing (CDB) task to create transient hypocapnia and a resultant global fMRI signal decrease. We hypothesized that a global stimulus would amplify the effect in large vessels and that using a global negative (vasoconstrictive) stimulus would test whether these voxels exhibit either inherently negative or simply anti-correlated BOLD responses. Significantly anti-correlated, but positive, BOLD signal changes during respiratory challenges were identified in voxels primarily located near edges of brain spaces containing CSF. These positive BOLD responses occurred earlier than the negative CDB response across most of gray matter voxels. These findings confirm earlier suggestions that in some brain regions, local, fractional changes in CSF volume may overwhelm BOLD-related signal changes, leading to signal anti-correlation. We show that regions with CDB anti-correlated signals coincide with most, but not all, of the regions with negative BOLD signal changes observed during a visual and motor stimulus task. Thus, the addition of a physiological challenge to fMRI experiments can help identify which negative BOLD signals are passive physiological anti-correlations and which may have a putative neuronal origin. Published by Elsevier Inc.

  18. Evaluation of early changes of cartilage biomarkers following ...

    African Journals Online (AJOL)

    Hamdy Khamis Koryem

    2014-08-15

    Aug 15, 2014 ... resulting in structural, biochemical and mechanical changes that can progress from pre-clinical, to pre-radiographic .... blasts/chondrocytes) that produce an extracellular matrix of ... to represent an adequate index of the rate of type II collagen ... collagenous proteins (e.g. cartilage oligomeric matrix protein,.

  19. Medical education changes students' attitudes on psychiatry: survey among medical students in Croatia.

    Science.gov (United States)

    Flajsman, Ana Medic; Degmecic, Dunja; Pranjkovic, Tamara; Rogulja, Stanislav; Bošnjak, Dina; Kuzman, Martina Rojnic

    2017-12-01

    In Croatia, psychiatric disorders are the leading group of disorders by days of hospitalization and they are in second place according to the number of hospitalizations in the period of working age. Nevertheless, psychiatry in Croatia, as well as in the world, is one of the least attractive specialties for medical students. In this paper we determined the impact of compulsory education in psychiatry on the attitudes of medical students of the fourth year of the Zagreb school of medicine and Osijek school of medicine. We tested attitudes toward psychiatry, psychiatric treatment and attitudes toward seeking professional psychological help using questionnaires that were filled out twice, at the beginning of psychiatry placement and at the end of psychiatry placement. Questionnaires were completed by 239 students from the Zagreb school of medicine and Faculty of medicine Osijek (response rate 78.4%). After the placement, students had significantly more positive attitudes about psychiatry and psychiatric treatment, as well as the attitudes toward seeking professional psychological help. Attitudes towards psychiatry, seeking psychological help and attitude towards psychiatric medication and psychotherapy correlated with the evaluation of the quality of psychiatric education. Additional forms of education in psychiatry should be offered, in order to maintain and increase the impact of education on students' attitudes.

  20. Organizational Change and How It Affects Healthcare Employees: A Study on Employee Resistance to Change in Electronic Medical Record Implementation

    Science.gov (United States)

    Adeyemi, Oluwakemi A.

    2017-01-01

    The purpose of the exploratory qualitative study was to explore the strategies for reducing employee resistance to Electronic Medical Record (EMR) technology changes in a healthcare organization during implementation. The study focused on EPIC as the EMR application. Ten healthcare participants who had experienced a change to EMR were selected in…

  1. Organizational readiness for change: Preceptor perceptions regarding early immersion of student pharmacists in health-system practice.

    Science.gov (United States)

    Sanders, Kimberly A; Wolcott, Michael D; McLaughlin, Jacqueline E; D'Ostroph, Amanda; Shea, Christopher M; Pinelli, Nicole R

    To examine preceptors' perceptions regarding readiness for change pre- and post-implementation of a pilot early immersion program engaging student pharmacists in direct patient care. Student pharmacists enrolled in the second professional year of a Doctor of Pharmacy degree program completed a four-week health-system introductory pharmacy practice experience (IPPE) which was modified to include direct patient care roles in operational (drug preparation and dispensing) and clinical (comprehensive medication management) pharmacy environments. Pharmacy preceptors with direct oversight for program implementation completed a pre/post Organizational Readiness for Implementing Change (ORIC) survey and a 50-min interview or focus group post-experience. The ORIC survey evaluates two dimensions of organizational readiness for change - change commitment and change efficacy. Additional items assessed included implementation needs, support, and perceived value of the change. ORIC survey constructs were compared before and after the experience. Interviews and focus groups were audio recorded, transcribed, and evaluated by constant comparative analysis. A mixed methods approach was used to triangulate findings and develop greater understanding of the ORIC survey results. Twenty pharmacy preceptors (37 ± 8 years of age, 60% female, 65% clinical pharmacist position, 70% prior preceptor experience) participated in the study. There were no significant changes in pre/post survey constructs, except for a decline in the perception of organizational change commitment (p change (p changes for student pharmacist engagement. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Family Relationships from Adolescence to Early Adulthood: Changes in the Family System following Firstborns' Leaving Home

    Science.gov (United States)

    Whiteman, Shawn D.; McHale, Susan M.; Crouter, Ann C.

    2011-01-01

    This study charted the course of parent-child and sibling relationships from early adolescence to early adulthood and examined how these relationships changed following firstborns' departure from their parents' home for the first time. Data were drawn from a 10-year longitudinal study of family relationships. Participants included mothers,…

  3. Total and regional body-composition changes in early postmenopausal women

    DEFF Research Database (Denmark)

    Wang, Q; Hassager, C; Ravn, Pernille

    1994-01-01

    Total and regional body composition were measured in 373 early postmenopausal women aged 49-60 y by dual-energy x-ray absorptiometry to evaluate whether the changes in body composition in the early postmenopausal years are related to menopause itself or merely to age. Both fat mass and fat...

  4. Early Childhood Development Policy and Programming in India: Critical Issues and Directions for Paradigm Change

    Science.gov (United States)

    Sharma, Adarsh; Sen, Rekha Sharma; Gulati, Renu

    2008-01-01

    The critical importance of the early childhood years and the rights perspective to human development has made policy and programming for early childhood development an imperative for every nation. In India, poverty, changing economic and social structures resulting in the breakdown of traditional coping mechanisms and family care systems, and the…

  5. Linking medical faculty stress/burnout to willingness to implement medical school curriculum change: a preliminary investigation.

    Science.gov (United States)

    Arvandi, Zeinab; Emami, Amirhossein; Zarghi, Nazila; Alavinia, Seyed Mohammad; Shirazi, Mandana; Parikh, Sagar V

    2016-02-01

    Balancing administrative demands from the medical school while providing patient support and seeking academic advancement can cause personal hardship that ranges from high stress to clinically recognizable conditions such as burnout. Regarding the importance of clinical faculties' burnout and its effects on different aspects of their professional career, this study was conducted and aimed to evaluate the relationship between willingness to change teaching approaches as characterized by a modified stage-of-change model and measures of stress and burnout. This descriptive analytic study was conducted on 143 clinical faculty members of Tehran University of Medical Sciences in Iran. Participants were asked to complete three questionnaires: a modified stages of change questionnaire the Maslach Burnout Inventory and the General Health Questionnaire. Data were analysed by SPSS: 16 using non-parametric statistical tests such as multiple regression and ICC (intra-class coefficient) and Spearman correlation coefficient test. A significant relationship was found between faculty members' readiness to change teaching approaches and the subscales of occupational burnout. Specifically, participants with low occupational burnout were more likely to be in the action stage, while those with high burnout were in the attitude or intention stage, which could be understood as not being ready to implement change. There was no significant correlation between general health scores and stage of change. We found it feasible to measure stages of change as well as stress/burnout in academic doctors. Occupational burnout directly reduces the readiness to change. To have successful academic reform in medical schools, it therefore would be beneficial to assess and manage occupational burnout among clinical faculty members. © 2015 John Wiley & Sons, Ltd.

  6. Speech disorders in Parkinson's disease: early diagnostics and effects of medication and brain stimulation.

    Science.gov (United States)

    Brabenec, L; Mekyska, J; Galaz, Z; Rektorova, Irena

    2017-03-01

    Hypokinetic dysarthria (HD) occurs in 90% of Parkinson's disease (PD) patients. It manifests specifically in the areas of articulation, phonation, prosody, speech fluency, and faciokinesis. We aimed to systematically review papers on HD in PD with a special focus on (1) early PD diagnosis and monitoring of the disease progression using acoustic voice and speech analysis, and (2) functional imaging studies exploring neural correlates of HD in PD, and (3) clinical studies using acoustic analysis to evaluate effects of dopaminergic medication and brain stimulation. A systematic literature search of articles written in English before March 2016 was conducted in the Web of Science, PubMed, SpringerLink, and IEEE Xplore databases using and combining specific relevant keywords. Articles were categorized into three groups: (1) articles focused on neural correlates of HD in PD using functional imaging (n = 13); (2) articles dealing with the acoustic analysis of HD in PD (n = 52); and (3) articles concerning specifically dopaminergic and brain stimulation-related effects as assessed by acoustic analysis (n = 31); the groups were then reviewed. We identified 14 combinations of speech tasks and acoustic features that can be recommended for use in describing the main features of HD in PD. While only a few acoustic parameters correlate with limb motor symptoms and can be partially relieved by dopaminergic medication, HD in PD seems to be mainly related to non-dopaminergic deficits and associated particularly with non-motor symptoms. Future studies should combine non-invasive brain stimulation with voice behavior approaches to achieve the best treatment effects by enhancing auditory-motor integration.

  7. Changing the Medical Malpractice Dispute Process: What Have We Learned from California's MICRA?

    National Research Council Canada - National Science Library

    2004-01-01

    In 1975, amid growing concern over the price and availability of medical malpractice insurance, California changed the laws that govern how personal injury claims arising from health care treatment...

  8. Longitudinal Changes in Total Brain Volume in Schizophrenia: Relation to Symptom Severity, Cognition and Antipsychotic Medication

    NARCIS (Netherlands)

    Veijola, J.; Guo, J.Y.; Moilanen, J.S.; Jaaskelainen, E.; Miettunen, J.; Kyllonen, M.; Haapea, M.; Huhtaniska, S.; Alaraisanen, A.; Maki, P.; Kiviniemi, V.; Nikkinen, J.; Starck, T.; Remes, J.J.; Tanskanen, P.; Tervonen, O.; Wink, A.M.; Kehagia, A.; Suckling, J.; Kobayashi, H.; Barnett, J.H.; Barnes, A.; Koponen, H.J.; Jones, P.B.; Isohanni, M.; Murray, G.K.

    2014-01-01

    Studies show evidence of longitudinal brain volume decreases in schizophrenia. We studied brain volume changes and their relation to symptom severity, level of function, cognition, and antipsychotic medication in participants with schizophrenia and control participants from a general population

  9. An optimal painless treatment for early hemorrhoids; our experience in Government Medical College and Hospital

    Science.gov (United States)

    Singal, R; Gupta, S; Dalal, AK; Dalal, U; Attri, AK

    2013-01-01

    Objective - To evaluate the efficacy of Infrared Coagulation Therapy (IRC) for hemorrhoids. IRC is a painless, safe and successful procedure. Place and duration of study - Department of Surgery, Government Medical College and Hospital, Sector-32, Chandigarh, India, from August 2006 to October 2008. The choice of procedure depends on the patient's symptoms, the extent of the hemorrhoidal disease, and the experience of the surgeon along with the availability of the techniques/instruments. Materials and methods - This is a prospective study done from August 2006 to October 2008. Total number of 155 patients was included in the study. Infrared Coagulation Therapy (IRC) was performed through a special designed proctoscope. Patients excluded were with coagulopathy disorders, fissure in ano, and anal ulcers. Results - It is an outpatient Department (OPD), non-surgical, ambulatory, painless and bloodless procedure, without any hospital stay. Early recovery and minimal recurrence of hemorrhoids were noted without any morbidity or mortality. We have studied 155 patients, treated with IRC on OPD basis. Surgery was required in few patients in whom IRC failed or was contraindicated. Out of the total 155 patients, 127 came for follow up. After the 1st sitting of IRC therapy: out of 127; 43 patients got a total relief, mass shrinkage was of > 75% in 57 cases and 75% relief in 15 cases and >50 % relief in 11 patients. In the 3rd sitting out of 26/84 cases: 13 cases got a total relief and 13 cases refused to take the third sitting; however, in 7 cases the hemorrhoidal mass shrank up to 50% after the two sittings. These 14 were operated as there was no relief from bleeding after giving two sittings of IRC. Our opinion is that, in the above 14 cases, the patient might have not followed the instructions properly for dietary habits. Conclusion - IRC is a safe, simple and effective procedure for early hemorrhoids without any complications. IRC is nowadays the world’s leading office

  10. Probability Elicitation to Inform Early Health Economic Evaluations of New Medical Technologies : A Case Study in Heart Failure Disease Management

    NARCIS (Netherlands)

    Cao, Qi; Postmus, Douwe; Hillege, Hans L.; Buskens, Erik

    Objectives: Early estimates of the commercial headroom available to a new medical device can assist producers of health technology in making appropriate product investment decisions. The purpose of this study was to illustrate how this quantity can be captured probabilistically by combining

  11. A medical school's organizational readiness for curriculum change (MORC): development and validation of a questionnaire.

    Science.gov (United States)

    Jippes, Mariëlle; Driessen, Erik W; Broers, Nick J; Majoor, Gerard D; Gijselaers, Wim H; van der Vleuten, Cees P M

    2013-09-01

    Because successful change implementation depends on organizational readiness for change, the authors developed and assessed the validity of a questionnaire, based on a theoretical model of organizational readiness for change, designed to measure, specifically, a medical school's organizational readiness for curriculum change (MORC). In 2012, a panel of medical education experts judged and adapted a preliminary MORC questionnaire through a modified Delphi procedure. The authors administered the resulting questionnaire to medical school faculty involved in curriculum change and tested the psychometric properties using exploratory and confirmatory factor analysis, and generalizability analysis. The mean relevance score of the Delphi panel (n = 19) reached 4.2 on a five-point Likert-type scale (1 = not relevant and 5 = highly relevant) in the second round, meeting predefined criteria for completing the Delphi procedure. Faculty (n = 991) from 131 medical schools in 56 countries completed MORC. Exploratory factor analysis yielded three underlying factors-motivation, capability, and external pressure-in 12 subscales with 53 items. The scale structure suggested by exploratory factor analysis was confirmed by confirmatory factor analysis. Cronbach alpha ranged from 0.67 to 0.92 for the subscales. Generalizability analysis showed that the MORC results of 5 to 16 faculty members can reliably evaluate a school's organizational readiness for change. MORC is a valid, reliable questionnaire for measuring organizational readiness for curriculum change in medical schools. It can identify which elements in a change process require special attention so as to increase the chance of successful implementation.

  12. Medical school accreditation in Australia: Issues involved in assessing major changes and new programs

    Directory of Open Access Journals (Sweden)

    Michael J. Field

    2011-06-01

    Full Text Available The Australian Medical Council (AMC is an independent company for quality assurance and quality improvement in medical education in Australia and New Zealand. Accreditation procedures for the 20 medical schools in these two countries are somewhat different for three different circumstances or stages of school development: existing medical schools, established courses undergoing major changes, and new schools. This paper will outline some issues involved in major changes to existing courses, and new medical school programs. Major changes have included change from a 6 year undergraduate course to a 5 year undergraduate course or 4 year graduate-entry course, introduction of a lateral graduate-entry stream, new domestic site of course delivery, offshore course delivery, joint program between two universities, and major change to curriculum. In the case of a major change assessment, accreditation of the new or revised course may be granted for a period up to two years after the full course has been implemented. In the assessment of proposals for introduction of new medical courses, six issues needing careful consideration have arisen: forward planning, academic staffing, adequate clinical experience, acceptable research program, adequacy of resources, postgraduate training program and employment.

  13. Evolution and acceptability of medical applications of RFID implants among early users of technology.

    Science.gov (United States)

    Smith, Alan D

    2007-01-01

    RFID as a wireless identification technology that may be combined with microchip implants have tremendous potential in today's market. Although these implants have their advantages and disadvantages, recent improvements how allowed for implants designed for humans. Focus was given to the use of RFID tags and its effects on technology and CRM through a case study on VeriChip, the only corporation to hold the rights and the patent to the implantable chip for humans, and an empirically based study on working professionals to measure perceptions by early adopters of such technology. Through hypotheses-testing procedures, it was found that although some resistance to accept microchip implants was found in several applications, especially among gender, it was totally expected that healthcare and medical record keeping activities would be universally treated in a positive light and the use of authorities (namely governmental agencies) would be equally treated in a negative light by both sexes. Future trends and recommendations are presented along with statistical results collected through personal interviews.

  14. Team functioning as a predictor of patient outcomes in early medical home implementation.

    Science.gov (United States)

    Wu, Frances M; Rubenstein, Lisa V; Yoon, Jean

    2018-03-12

    New models of patient-centered primary care such as the patient-centered medical home (PCMH) depend on high levels of interdisciplinary primary care team functioning to achieve improved outcomes. A few studies have qualitatively assessed barriers and facilitators to optimal team functioning; however, we know of no prior study that assesses PCMH team functioning in relationship to patient health outcomes. The aim of the study was to assess the relationships between primary care team functioning, patients' use of acute care, and mortality. Retrospective longitudinal cohort analysis of patient outcomes measured at two time points (2012 and 2013) after PCMH implementation began in Veterans Health Administration practices. Multilevel models examined practice-level measures of team functioning in relationship to patient outcomes (all-cause and ambulatory care-sensitive condition-related hospitalizations, emergency department visits, and mortality). We controlled for practice-level factors likely to affect team functioning, including leadership support, provider and staff burnout, and staffing sufficiency, as well as for individual patient characteristics. We also tested the model among a subgroup of vulnerable patients (homeless, mentally ill, or with dementia). In adjusted analyses, higher team functioning was associated with lower mortality (OR = 0.92, p = .04) among all patients and with fewer all-cause admissions (incidence rate ratio [IRR] = 0.90, p team functioning within PCMH models for achieving improved patient outcomes. A focus on team functioning is important especially in the early implementation of team-based primary care models.

  15. Management of Pediatric Perforated Appendicitis: Comparing Outcomes Using Early Appendectomy Versus Solely Medical Management.

    Science.gov (United States)

    Bonadio, William; Rebillot, Katie; Ukwuoma, Onyinyechi; Saracino, Christine; Iskhakov, Arthur

    2017-10-01

    There is controversy regarding whether children with perforated appendicitis should receive early appendectomy (EA) versus medical management (MM) with antibiotics and delayed interval appendectomy. The objective of this study was to compare outcomes of children with perforated appendicitis who receive EA versus MM. Case review of consecutive children appendicitis who received either EA or MM during an 8-year period. Criteria for hospital discharge included patient being afebrile for at least 24 hours, pain-free and able to tolerate oral intake. Of 203 patients diagnosed with perforated appendicitis, 122 received EA and 81 received MM. All received parenteral antibiotic therapy initiated in the emergency department and continued during hospitalization. There were no significant differences between groups in mean patient age, mean complete blood count total white blood cells count, gender distribution, rates of emergency department fever or rates of intra-abdominal infection (abscess or phlegmon) identified on admission. Compared with patients receiving MM, those receiving EA experienced significantly fewer (1) days of hospitalization, parenteral antibiotic therapy and in-hospital fever; (2) radiographic studies, percutaneous drainage procedures and placement of central venous catheters performed; (3) post admission intra-abdominal complications and (4) unscheduled repeat hospitalizations after hospital discharge. Only 1 EA-managed patient developed a postoperative wound infection. Children with perforated appendicitis who receive EA experience significantly less morbidity and complications versus those receiving MM. The theoretical concern for enhanced morbidity associated with EA management of perforated appendicitis is not supported by our analysis.

  16. An Analysis of the Changes in Communication Techniques in the Italian Codes of Medical Deontology.

    Science.gov (United States)

    Conti, Andrea Alberto

    2017-04-28

    The code of deontology of the Italian National Federation of the Colleges of Physicians, Surgeons and Dentists (FNOMCeO) contains the principles and rules to which the professional medical practitioner must adhere. This work identifies and analyzes the medical-linguistic choices and the expressive techniques present in the different editions of the code, and evaluates their purpose and function, focusing on the first appearance and the subsequent frequency of key terms. Various aspects of the formal and expressive revisions of the eight editions of the Codes of Medical Deontology published after the Second World War (from 1947/48 to 2014) are here presented, starting from a brief comparison with the first edition of 1903. Formal characteristics, choices of medical terminology and the introduction of new concepts and communicative attitudes are here identified and evaluated. This paper, in presenting a quantitative and epistemological analysis of variations, modifications and confirmations in the different editions of the Italian code of medical deontology over the last century, enucleates and demonstrates the dynamic paradigm of changing attitudes in the medical profession. This analysis shows the evolution in medical-scientific communication as embodied in the Italian code of medical deontology. This code, in its adoption, changes and adaptations, as evidenced in its successive editions, bears witness to the expressions and attitudes pertinent to and characteristic of the deontological stance of the medical profession during the twentieth century.

  17. [Becoming medical doctors in colonial Korea: focusing on the faculty of medical colleges in early north Korea].

    Science.gov (United States)

    Kim, Geun Bae

    2014-12-01

    This paper traces how Koreans of north area became medical doctors in colonial Korea. Most of the past research have focused only on the well-known medical doctors, or even when they discussed a great number of doctors, many research tended to only pay attention to the explicit final results of those doctors. This research, on the other hand, includes ordinary medical doctors as well as the renowed ones, and adjusts the focus to the lifetime period of their growth and activities. As a result, the misunderstanding and obscurity about the Korean medical doctors of north area during this period have been cleared. The new characteristics of the Korean medical doctors of this period have been found, along with their embodiment of historical significance. At the time, Koreans had to get through a number of qualifications in order to become doctors. First is the unique background of origin in which the family held interest in the modern education and was capable of supporting it financially. Second is the long-term status of education that the education from elementary to high school was completed without interruption. Third is the academic qualification that among various institutions of higher education, medical science was chosen as a major. Fourth is the condition of career in which as the career as a doctor had consistently continued. Thus, in oder to become a modern medical doctor, Koreans had to properly complete these multiple steps of process. The group of Korean medical doctors in north area, which was formed after getting through these series of process, possessed a number of characteristics. Firstly, as the upper-middle classes constituted the majority of medical doctors in Korea, the societal status of doctors rose and the foundation for the career as a doctor to be persisted as the family occupation settled. Secondly, the research career and academic degree became the principal method to escape from the discrimination and hierarchy existed between doctors. A

  18. Environmental change during the Late Berriasian - Early Valanginian: a prelude to the late Early Valanginian carbon-isotope event?

    Science.gov (United States)

    Morales, Chloé; Schnyder, Johann; Spangenberg, Jorge; Adatte, Thierry; Westermann, Stephane; Föllmi, Karl

    2010-05-01

    The Valanginian period is well known for a positive excursion in marine and terrestrial δ13C records, which has been interpreted as the consequence of a major perturbation in the global carbon cycle (Lini et al., 1992; Erba et al., 2004). In contrast to the positive δ13C excursions of the Early Aptian and latest Cenomanian, marine organic-rich sediments have only been recognized from a few localities (van de Schootbrugge et al., 2003; Reboulet et al., 2003; Gröcke et al., 2005; Westermann et al., in press). The δ13C excursion began in the late Early Valanginian (campylotoxus ammonite zone) and gradually ended during the Late Valanginian. It is associated with a phase of widespread carbonate-platform drowning on the shelf (Föllmi et al., 1994) and a decline in calcareous nannofossils in the pelagic realm (Erba et al., 2004). As a triggering mechanism, numerous authors invoke the formation of the Parañà-Etendeka flood basalt. The correlation of this episode with the Valanginian δ13C event depends, however, on the absolute ages attributed to the Valanginian stage. The recent geological timescale by Ogg et al. (2008) shows that the major eruptional phase occurred during the Late Valanginian. This may imply that the late Early Valanginian δ13C event resulted from a combination of different factors. Important paleoenvironmental change occurred already in the latest Berriasian and earliest Valanginian, prior to the positive δ13C excursion. An increase in nutrient input near the onset of the δ13C excursion (campylotoxus ammonite zone), which may be considered as a trigger of the carbon cycle perturbation, has been identified in different studies, (Hennig, 2003; Duchamp-Alphonse et al., 2007; Bornemann & Mutterlose, 2008). Heterozoan faunal associations became dominant since the Early Valanginian on the northern Tethyan Helvetic platform and may indicate the beginning of sea-water eutrophication (Föllmi et al., 2007). Clay assemblages in the Tethys and Western

  19. The role of medical language in changing public perceptions of illness.

    Directory of Open Access Journals (Sweden)

    Meredith E Young

    Full Text Available This study was designed to investigate the impact of medical terminology on perceptions of disease. Specifically, we look at the changing public perceptions of newly medicalized disorders with accompanying newly medicalized terms (e.g. impotence has become erectile dysfunction disorder. Does using "medicalese" to label a recently medicalized disorder lead to a change in the perception of that condition? Undergraduate students (n = 52 rated either the medical or lay label for recently medicalized disorders (such as erectile dysfunction disorder vs. impotence and established medical conditions (such as a myocardial infarction vs. heart attack for their perceived seriousness, disease representativeness and prevalence. Students considered the medical label of the recently medicalized disease to be more serious (mean = 4.95 (SE = .27 vs. mean = 3.77 (SE = .24 on a ten point scale, more representative of a disease (mean = 2.47 (SE = .09 vs. mean = 1.83 (SE = .09 on a four point scale, and have lower prevalence (mean = 68 (SE = 12.6 vs. mean = 122 (SE = 18.1 out of 1,000 than the same disease described using common language. A similar pattern was not seen in the established medical conditions, even when controlled for severity. This study demonstrates that the use of medical language in communication can induce bias in perception; a simple switch in terminology results in a disease being perceived as more serious, more likely to be a disease, and more likely to be a rare condition. These findings regarding the conceptualization of disease have implications for many areas, including medical communication with the public, advertising, and public policy.

  20. Physiologic changes associated with violence and abuse exposure: an examination of related medical conditions.

    Science.gov (United States)

    Keeshin, Brooks R; Cronholm, Peter F; Strawn, Jeffrey R

    2012-01-01

    Although the extant evidence is replete with data supporting linkages between exposure to violence or abuse and the subsequent development of medical illnesses, the underlying mechanisms of these relationships are poorly defined and understood. Physiologic changes occurring in violence- or abuse-exposed individuals point to potentially common biological pathways connecting traumatic exposures with medical outcomes. Herein, the evidence describing the long-term physiologic changes in abuse- and violence-exposed populations and associated medical illnesses are reviewed. Current data support that (a) specific neurobiochemical changes are associated with exposure to violence and abuse; (b) several biological pathways have the potential to lead to the development of future illness; and (c) common physiologic mechanisms may moderate the severity, phenomenology, or clinical course of medical illnesses in individuals with histories of exposure to violence or abuse. Importantly, additional work is needed to advance our emerging understanding of the biological mechanisms connecting exposure to violence and abuse and negative health outcomes.

  1. Computer simulation in conjunction with medical thermography as an adjunct tool for early detection of breast cancer

    Directory of Open Access Journals (Sweden)

    Sudharsan NM

    2004-04-01

    Full Text Available Abstract Background Mathematical modelling and analysis is now accepted in the engineering design on par with experimental approaches. Computer simulations enable one to perform several 'what-if' analyses cost effectively. High speed computers and low cost of memory has helped in simulating large-scale models in a relatively shorter time frame. The possibility of extending numerical modelling in the area of breast cancer detection in conjunction with medical thermography is considered in this work. Methods Thermography enables one to see the temperature pattern and look for abnormality. In a thermogram there is no radiation risk as it only captures the infrared radiation from the skin and is totally painless. But, a thermogram is only a test of physiology, whereas a mammogram is a test of anatomy. It is hoped that a thermogram along with numerical modelling will serve as an adjunct tool. Presently mammogram is the 'gold-standard' in breast cancer detection. But the interpretation of a mammogram is largely dependent on the radiologist. Therefore, a thermogram that looks into the physiological changes in combination with numerical simulation performing 'what-if' analysis could act as an adjunct tool to mammography. Results The proposed framework suggested that it could reduce the occurrence of false-negative/positive cases. Conclusion A numerical bioheat model of a female breast is developed and simulated. The results are compared with experimental results. The possibility of this method as an early detection tool is discussed.

  2. Computer simulation in conjunction with medical thermography as an adjunct tool for early detection of breast cancer

    International Nuclear Information System (INIS)

    Ng, Eddie Y-K; Sudharsan, NM

    2004-01-01

    Mathematical modelling and analysis is now accepted in the engineering design on par with experimental approaches. Computer simulations enable one to perform several 'what-if' analyses cost effectively. High speed computers and low cost of memory has helped in simulating large-scale models in a relatively shorter time frame. The possibility of extending numerical modelling in the area of breast cancer detection in conjunction with medical thermography is considered in this work. Thermography enables one to see the temperature pattern and look for abnormality. In a thermogram there is no radiation risk as it only captures the infrared radiation from the skin and is totally painless. But, a thermogram is only a test of physiology, whereas a mammogram is a test of anatomy. It is hoped that a thermogram along with numerical modelling will serve as an adjunct tool. Presently mammogram is the 'gold-standard' in breast cancer detection. But the interpretation of a mammogram is largely dependent on the radiologist. Therefore, a thermogram that looks into the physiological changes in combination with numerical simulation performing 'what-if' analysis could act as an adjunct tool to mammography. The proposed framework suggested that it could reduce the occurrence of false-negative/positive cases. A numerical bioheat model of a female breast is developed and simulated. The results are compared with experimental results. The possibility of this method as an early detection tool is discussed

  3. Client preferences and acceptability for medical abortion and MVA as early pregnancy termination method in Northwest Ethiopia

    Directory of Open Access Journals (Sweden)

    White Mary T

    2011-06-01

    Full Text Available Abstract Background Increasing access to safe abortion services is the most effective way of preventing the burden of unsafe abortion, which is achieved by increasing safe choices for pregnancy termination. Medical abortion for termination of early abortion is said to safe, effective, and acceptable to women in several countries. In Ethiopia, however, medical methods have, until recently, never been used. For this reason it is important to assess women's preferences and the acceptability of medical abortion and manual vacuum aspiration (MVA in the early first trimester pregnancy termination and factors affecting acceptability of medical and MVA abortion services. Methods A prospective study was conducted in two hospitals and two clinics from March 2009 to November 2009. The study population consisted of 414 subjects over the age of 18 with intrauterine pregnancies of up to 63 days' estimated gestation. Of these 251 subjects received mifepristone and misoprostol and 159 subjects received MVA. Questionnaires regarding expectations and experiences were administered before the abortion and at the 2-week follow-up visit. Results The study groups were similar with respect to age, marital status, educational status, religion and ethnicity. Their mean age was about 23, majority in both group completed secondary education and about half were married. Place of residence and duration of pregnancy were associated with method choice. Subjects undergoing medical abortions reported significantly greater satisfaction than those undergoing surgical abortions (91.2% vs 82.4%; P Conclusions Women receiving medical abortion were more satisfied with their method and more likely to choose the same method again than were subjects undergoing surgical abortion. We conclude that medical abortion can be used widely as an alternative method for early pregnancy termination.

  4. Early 21st century spatially detailed elevation changes of Jammu and Kashmir glaciers (Karakoram–Himalaya)

    DEFF Research Database (Denmark)

    Vijay, Saurabh; Braun, Matthias

    2018-01-01

    Although a number of studies indicate the regional heterogeneity of the glacier elevation and mass changes in high-mountain Asia in the early 21st century, little is known about these changes with high spatial detail for some of the regions. In this study we present respective glacier elevation a...

  5. California forests show early indications of both range shifts and local persistence under climate change

    Science.gov (United States)

    Josep M. Serra-Diaz; Janet Franklin; Whalen W. Dillon; Alexandra D. Syphard; Frank W. Davis; Ross K. Meentemeyer

    2015-01-01

    Aim Forest regeneration data provide an early signal of the persistence and migration of tree species, so we investigated whether species shifts due to climate change exhibit a common signal of response or whether changes vary by species. Location California Floristic Province, United...

  6. Frameworks for Change: Four Recurrent Themes for Quality in Early Childhood Curriculum Initiatives

    Science.gov (United States)

    Burgess, Jennifer; Fleet, Alma

    2009-01-01

    This paper reports on the first phase of a case study that investigated how early childhood teachers experience organisational change. As one of three levels of quality improvement, State government-funded curriculum initiatives were developed with an aim to promote change. Three curriculum documents, one each focusing on literacy, pedagogy and…

  7. Topical Collection: Climate-change research by early-career hydrogeologists

    Science.gov (United States)

    Re, Viviana; Maldaner, Carlos H.; Gurdak, Jason J.; Leblanc, Marc; Resende, Tales Carvalho; Stigter, Tibor Y.

    2018-05-01

    Scientific outreach, international networking, collaboration and adequate courses are needed in both developed and developing countries to enable early-career hydrogeologists to promote long-term multidisciplinary approaches to cope with climate-change issues and emphasize the importance of groundwater in a global strategy for adaptation. One such collaboration has involved the Early Career Hydrogeologists' Network of the International Association of Hydrogeologists (ECHN-IAH) and the UNESCO International Hydrological Programme's (IHP) Groundwater Resources Assessment under the Pressures of Humanity and Climate Changes (GRAPHIC) project. This collaboration seeks to foster the education and involvement of the future generation of water leaders in the debate over groundwater and climate change.

  8. Organizational change, psychosocial work environment, and non-disability early retirement

    DEFF Research Database (Denmark)

    Breinegaard, Nina; Jensen, Johan Høy; Bonde, Jens Peter

    2017-01-01

    Objective: This study examines the impact of organizational change and psychosocial work environment on non-disability early retirement among senior public service employees. Methods: In January and February 2011, Danish senior public service employees aged 58–64 years (N=3254) from the Capital...... psychosocial work environment contribute to non-disability early retirement among senior public service employees, measured at work-unit level....... Region of Denmark responded to a survey assessing psychosocial work environment (ie, social capital, organizational justice, and quality of management). Work-unit organizational changes (ie, change of management, merging, demerging, and relocation) were recorded from January 2009 to March 2011. Weekly...

  9. The Changing Health Care Landscape and Implications of Organizational Ethics on Modern Medical Practice

    NARCIS (Netherlands)

    Castlen, Joseph P; Cote, David J; Moojen, Wouter A.; Robe, Pierre A.; Balak, Naci; Brennum, Jannick; Ammirati, Mario; Mathiesen, Tiit; Broekman, Marike L.D.

    2017-01-01

    Introduction Medicine is rapidly changing, both in the level of collective medical knowledge and in how it is being delivered. The increased presence of administrators in hospitals helps to facilitate these changes and ease administrative workloads on physicians; however, tensions sometimes form

  10. Name Changes in Medically Important Fungi and Their Implications for Clinical Practice

    DEFF Research Database (Denmark)

    de Hoog, G. Sybren; Chaturvedi, Vishnu; Denning, David W.

    2015-01-01

    Recent changes in the Fungal Code of Nomenclature and developments in molecular phylogeny are about to lead to dramatic changes in the naming of medically important molds and yeasts. In this article, we present a widely supported and simple proposal to prevent unnecessary nomenclatural instability....

  11. Name changes in medically important fungi and their implications for clinical practice

    NARCIS (Netherlands)

    de Hoog, G Sybren; Chaturvedi, Vishnu; Denning, David W; Dyer, Paul S; Frisvad, Jens Christian; Geiser, David; Gräser, Yvonne; Guarro, Josep; Haase, Gerhard; Kwon-Chung, Kyung-Joo; Meis, Jacques F; Meyer, Wieland; Pitt, John I; Samson, Robert A; Taylor, John W; Tintelnot, Kathrin; Vitale, Roxana G; Walsh, Thomas J; Lackner, Michaela

    2014-01-01

    Recent changes in the Fungal Code of Nomenclature and developments in molecular phylogeny are about to lead to dramatic changes in the naming of medically important moulds and yeasts. In this article, we present a widely supported and simple proposal to prevent unnecessary nomenclatural instability.

  12. 78 FR 69694 - Changing Regulatory and Reimbursement Paradigms for Medical Devices in the Treatment of Obesity...

    Science.gov (United States)

    2013-11-20

    ...] Changing Regulatory and Reimbursement Paradigms for Medical Devices in the Treatment of Obesity and... Administration (FDA) is announcing a public workshop entitled ``Changing Regulatory and Reimbursement Paradigms... information on the AGA Web site. If you need special accommodations due to a disability, please contact...

  13. 3D quantitative analysis of early decomposition changes of the human face.

    Science.gov (United States)

    Caplova, Zuzana; Gibelli, Daniele Maria; Poppa, Pasquale; Cummaudo, Marco; Obertova, Zuzana; Sforza, Chiarella; Cattaneo, Cristina

    2018-03-01

    Decomposition of the human body and human face is influenced, among other things, by environmental conditions. The early decomposition changes that modify the appearance of the face may hamper the recognition and identification of the deceased. Quantitative assessment of those changes may provide important information for forensic identification. This report presents a pilot 3D quantitative approach of tracking early decomposition changes of a single cadaver in controlled environmental conditions by summarizing the change with weekly morphological descriptions. The root mean square (RMS) value was used to evaluate the changes of the face after death. The results showed a high correlation (r = 0.863) between the measured RMS and the time since death. RMS values of each scan are presented, as well as the average weekly RMS values. The quantification of decomposition changes could improve the accuracy of antemortem facial approximation and potentially could allow the direct comparisons of antemortem and postmortem 3D scans.

  14. Early diagnosis of myocardial infarction using absolute and relative changes in cardiac troponin concentrations

    OpenAIRE

    Irfan Affan Bin; Reichlin Tobias R.; Twerenbold Raphael; Meister Marc; Moehring Berit; Wildi Karin; Bassetti Stefano; Zellweger Christa; Gimenez Maria Rubini; Hoeller Rebeca; Murray Karsten; Sou SeoungMann; Mueller Mira; Mosimann Tamina; Reiter Miriam

    2013-01-01

    Background: Absolute changes in high sensitivity cardiac troponin T (hs cTnT) seem to have higher diagnostic accuracy in the early diagnosis of acute myocardial infarction compared with relative changes. It is unknown whether the same applies to high sensitivity cardiac troponin I (hs cTnI) assays and whether the combination of absolute and relative change might further increase accuracy. Methods: In a prospective international multicenter study high sensitivity cardiac troponin (hs cTn) was ...

  15. Adapt or withdraw? Evidence on technological changes and early retirement using matched worker-firm data

    OpenAIRE

    Torbjørn Hægeland; Dag Rønningen; Kjell G. Salvanes

    2007-01-01

    Abstract: Older workers typically possess older vintages of skills than younger workers, and they may suffer more from technological change. Experienced workers may nevertheless have accumulated human capital making them suitable for adopting new technologies. On the other hand, to adjust to new technologies, workers must invest in training. This may not be worthwhile for the oldest workers, and technological change may thus induce early retirement. If technological change occu...

  16. Early perception of medication benefit predicts subsequent antipsychotic response in schizophrenia: "the consumer has a point" revisited.

    Science.gov (United States)

    Ascher-Svanum, Haya; Weiden, Peter; Nyhuis, Allen W; Faries, Douglas E; Stauffer, Virginia; Kollack-Walker, Sara; Kinon, Bruce J

    2014-07-01

    An easy-to-administer tool for predicting response to antipsychotic treatment could improve the acute management of patients with schizophrenia. We assessed whether a patient's perception of medication benefit early in treatment could predict subsequent response or nonresponse to continued use of the same treatment. This post hoc analysis used data from a randomized, open-label trial of antipsychotics for treatment of schizophrenia in which attitudes about medication adherence were assessed after two weeks of antipsychotic treatment using the Rating of Medication Influences (ROMI) scale. The analysis included 439 patients who had Positive and Negative Syndrome Scale (PANSS) and ROMI scale data at Weeks 2 and 8. Scores on the ROMI subscale Perceived Medication Benefit factor were used to predict subsequent antipsychotic response at Week 8, defined as a .20% reduction from baseline on the PANSS. Logistic regression was used to identify a cut-off score for the Perceived Medication Benefit factor that could accurately identify antipsychotic responders vs. nonresponders at Week 8. A score of .2.75 (equal to a mean subscale score of .11.00) on the ROMI scale Perceived Medication Benefit factor at Week 2 predicted response at Week 8 with high specificity (72%) and negative predictive value (70%), moderate sensitivity (44%) and positive predictive value (47%), and with a 38% misclassification rate. A brief assessment of the patient's perception of medication benefit at two weeks into treatment appears to be a good predictor of subsequent response and nonresponse after eight weeks of treatment with the same antipsychotic.

  17. 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

  18. Changes in medical students' motivation and self-regulated learning: a preliminary study.

    Science.gov (United States)

    Kim, Kyong-Jee; Jang, Hye W

    2015-12-28

    To investigate whether medical students' motivation and Self-Regulated Learning (SRL) change over time to enhance our understanding of these constructs as dependent variables in medical education. A cohort of first-year students (n=43) at a medical school in South Korea completed a self-report questionnaire on motivation and SRL--the Motivated Strategies for Learning Questionnaire (MSLQ). The same questionnaire was administered to the same cohort in the beginning of Year 2. A Wilcoxon signed-rank test was conducted to determine if changes in participants' MSLQ scores occurred between in Years 1 and 2. Forty-one students completed the questionnaires in both years (95% response rate). Participants' motivation scores significantly increased, whereas their SRL scores decreased significantly after they went through Year 1. The most notable change in participants' MLSQ scores was in the increase in their test anxiety. There was a positive association between the participants' test anxiety and their cognitive strategies use in Year 1, which changed to a negative one in Year 2. Meanwhile, participants' test anxiety scores and their self-regulation scores became more negatively associated over time. Our study shows that even as medical students become more motivated, they actually use fewer self-regulated strategies over time. Our findings highlight the need for change in the medical school's learning environment to lessen students' test anxiety to facilitate their use of cognitive and meta-cognitive strategies.

  19. Development of a behaviour change communication tool for medical students: the 'Tent Pegs' booklet.

    Science.gov (United States)

    Chisholm, Anna; Hart, Jo; Mann, Karen; Peters, Sarah

    2014-01-01

    To describe the development and validation of a behaviour change communication tool for medical students. Behaviour change techniques (BCTs) were identified within the literature and used to inform a communication tool to support medical students in discussing health-related behaviour change with patients. BCTs were organized into an accessible format for medical students (the 'Tent Pegs' booklet) and validated using discriminant content validity methods with 11 expert judges. One-sample t-tests showed that judges reliably mapped BCTs onto six of the seven Tent Pegs domains (confidence rating means ranged from 4.0 to 5.1 out of 10, all p≤0.002). Only BCTs within the 'empowering people to change' domain were not significantly different from the value zero (mean confidence rating=1.2, p>0.05); these BCTs were most frequently allocated to the 'addressing thoughts and emotions' domain instead. BCTs within the Tent Pegs booklet are reliably allocated to corresponding behaviour change domains with the exception of those within the 'empowering people to change' domain. The existing evidence-base on BCTs can be used to directly inform development of a communication tool to support medical students facilitate health behaviour change with patients. Crown Copyright © 2013. Published by Elsevier Ireland Ltd. All rights reserved.

  20. Teaching medical ethics to meet the realities of a changing health care system.

    Science.gov (United States)

    Millstone, Michael

    2014-06-01

    The changing context of medical practice--bureaucratic, political, or economic--demands that doctors have the knowledge and skills to face these new realities. Such changes impose obstacles on doctors delivering ethical care to vulnerable patient populations. Modern medical ethics education requires a focus upon the knowledge and skills necessary to close the gap between the theory and practice of ethical care. Physicians and doctors-in-training must learn to be morally sensitive to ethical dilemmas on the wards, learn how to make professionally grounded decisions with their patients and other medical providers, and develop the leadership, dedication, and courage to fulfill ethical values in the face of disincentives and bureaucratic challenges. A new core focus of medical ethics education must turn to learning how to put ethics into practice by teaching physicians to realistically negotiate the new institutional maze of 21st-century medicine.

  1. Dynamic changes in the interchromosomal interaction of early histone gene loci during development of sea urchin.

    Science.gov (United States)

    Matsushita, Masaya; Ochiai, Hiroshi; Suzuki, Ken-Ichi T; Hayashi, Sayaka; Yamamoto, Takashi; Awazu, Akinori; Sakamoto, Naoaki

    2017-12-15

    The nuclear positioning and chromatin dynamics of eukaryotic genes are closely related to the regulation of gene expression, but they have not been well examined during early development, which is accompanied by rapid cell cycle progression and dynamic changes in nuclear organization, such as nuclear size and chromatin constitution. In this study, we focused on the early development of the sea urchin Hemicentrotus pulcherrimus and performed three-dimensional fluorescence in situ hybridization of gene loci encoding early histones (one of the types of histone in sea urchin). There are two non-allelic early histone gene loci per sea urchin genome. We found that during the morula stage, when the early histone gene expression levels are at their maximum, interchromosomal interactions were often formed between the early histone gene loci on separate chromosomes and that the gene loci were directed to locate to more interior positions. Furthermore, these interactions were associated with the active transcription of the early histone genes. Thus, such dynamic interchromosomal interactions may contribute to the efficient synthesis of early histone mRNA during the morula stage of sea urchin development. © 2017. Published by The Company of Biologists Ltd.

  2. Preparing for the changing role of instructional technologies in medical education.

    Science.gov (United States)

    Robin, Bernard R; McNeil, Sara G; Cook, David A; Agarwal, Kathryn L; Singhal, Geeta R

    2011-04-01

    As part of an international faculty development conference in February 2010, a working group of medical educators and physicians discussed the changing role of instructional technologies and made recommendations for supporting faculty in using these technologies in medical education. The resulting discussion highlighted ways technology is transforming the entire process of medical education and identified several converging trends that have implications for how medical educators might prepare for the next decade. These trends include the explosion of new information; all information, including both health knowledge and medical records, becoming digital; a new generation of learners; the emergence of new instructional technologies; and the accelerating rate of change, especially related to technology. The working group developed five recommendations that academic health leaders and policy makers may use as a starting point for dealing with the instructional technology challenges facing medical education over the next decade. These recommendations are (1) using technology to provide/support experiences for learners that are not otherwise possible-not as a replacement for, but as a supplement to, face-to-face experiences, (2) focusing on fundamental principles of teaching and learning rather than learning specific technologies in isolation, (3) allocating a variety of resources to support the appropriate use of instructional technologies, (4) supporting faculty members as they adopt new technologies, and (5) providing funding and leadership to enhance electronic infrastructure to facilitate sharing of resources and instructional ideas. © by the Association of American Medical Colleges.

  3. The role of advocacy in occasioning community and organizational change in a medical-legal partnership.

    Science.gov (United States)

    Anderson-Carpenter, Kaston D; Collie-Akers, Vicki; Colvin, Jeffrey D; Cronin, Katie

    2013-01-01

    Health disparities among low-income individuals remain a significant problem. A number of social determinants are associated with adverse health outcomes. Medical-legal partnerships address legal concerns of low-income individuals to improve health and wellness in adults and children. The Medical-Legal Partnership at Legal Aid of Western Missouri provides free direct legal services for patients with legal concerns affecting health. There is limited evidence regarding the association between advocacy-related efforts and changes within both the medical-legal partnership structure and in health-care facilities. Three health-care organizations in Kansas City, MO participated in implementing the medical-legal partnership model between 2007 and 2010. Advocacy efforts conducted by key medical-legal partnership personnel were strongly associated with changes in health-care organizations and within the medical-legal partnership structure. This study extends the current evidence base by examining the types of advocacy efforts required to bring about community and organizational changes.

  4. Early Childhood Obesity Risk Factors: Socioeconomic Adversity, Family Dysfunction, Offspring Distress, and Junk Food Self-Medication.

    Science.gov (United States)

    Hemmingsson, Erik

    2018-06-01

    To explore the sequence and interaction of infancy and early childhood risk factors, particularly relating to disturbances in the social environment, and how the consequences of such exposures can promote weight gain and obesity. This review will argue that socioeconomic adversity is a key upstream catalyst that sets the stage for critical midstream risk factors such as family strain and dysfunction, offspring insecurity, stress, emotional turmoil, low self-esteem, and poor mental health. These midstream risk factors, particularly stress and emotional turmoil, create a more or less perfect foil for calorie-dense junk food self-medication and subtle addiction, to alleviate uncomfortable psychological and emotional states. Disturbances in the social environment during infancy and early childhood appear to play a critical role in weight gain and obesity, through such mechanisms as insecurity, stress, and emotional turmoil, eventually leading to junk food self-medication and subtle addiction.

  5. Preconception and early pregnancy maternal haemodynamic changes in healthy women in relation to pregnancy viability.

    Science.gov (United States)

    Foo, F L; Collins, A; McEniery, C M; Bennett, P R; Wilkinson, I B; Lees, C C

    2017-05-01

    . Similarly, between the groups, there were no differences in pregnancy adaptation with similar trends in cardiovascular function changes from pre-pregnancy to 6 weeks gestation. Whilst this is the first study to investigate preconception and early pregnancy haemodynamic and arterial function in relation to viability, the relatively modest number of miscarriages may not be sufficient to show subtle differences in haemodynamic changes if these were present. This study suggests that pre-pregnancy haemodynamic and arterial function is unlikely to be the causal link between miscarriages and future cardiovascular disease. Our findings suggests that factors other than the presence of a viable embryo drive cardiovascular changes in early pregnancy. This study raises new questions about miscarriages as an independent risk event which predisposes women to increased cardiovascular risk later in life. The investigators are funded by NIHR Imperial BRC, NIHR Cambridge BRC, Action Medical Research, Imperial College Healthcare Charity and Tommy's Charity. We acknowledge the loan of ultrasound equipment from Samsung Medison (South Korea)/MIS Ltd and provision of fertility monitors from SPD Development Company Ltd (Bedford, UK). There are no competing interests. C.C.L. is supported by the UK National Institute for Health Research Biomedical Research Centre based at Imperial College Healthcare National Health Service Trust and Imperial College London. N/A. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  6. Medical student mental health 3.0: improving student wellness through curricular changes.

    Science.gov (United States)

    Slavin, Stuart J; Schindler, Debra L; Chibnall, John T

    2014-04-01

    Medical education can have significant negative effects on the well-being of medical students. To date, efforts to improve student mental health have focused largely on improving access to mental health providers, reducing the stigma and other barriers to mental health treatment, and implementing ancillary wellness programs. Still, new and innovative models that build on these efforts by directly addressing the root causes of stress that lie within the curriculum itself are needed to properly promote student wellness. In this article, the authors present a new paradigm for improving medical student mental health, by describing an integrated, multifaceted, preclinical curricular change program implemented through the Office of Curricular Affairs at the Saint Louis University School of Medicine starting in the 2009-2010 academic year. The authors found that significant but efficient changes to course content, contact hours, scheduling, grading, electives, learning communities, and required resilience/mindfulness experiences were associated with significantly lower levels of depression symptoms, anxiety symptoms, and stress, and significantly higher levels of community cohesion, in medical students who participated in the expanded wellness program compared with those who preceded its implementation. The authors discuss the utility and relevance of such curricular changes as an overlooked component of change models for improving medical student mental health.

  7. New medical schools in the United States: forces of change past and present.

    Science.gov (United States)

    Smith, Lawrence

    2009-01-01

    The new millennium has ushered in a growth phase in the number of American medical schools. Historically the United States has built schools during bursts of activity with relative quiescence in between these periods. We had a twenty-two year period with no growth in medical school size or number. During that time there were significant changes in patient characteristics, student culture, financial reimbursement, quality, and manpower needs that have put stress on medical schools, hospitals, clinical practice and healthcare systems. In addition, there have been remarkable new opportunities in the way we teach, including changes in teaching methodology, educational technology, and a better understanding of how students actually learn. All of these advances have taken place during a period of enormous pressure to change residency programs, reorganize medical and clinical science, and question the very need for traditional departmental structures. It is likely that the new medical schools will emerge looking different from the older schools and they are likely to catalyze a period of curricular change.

  8. Early changes in socioeconomic status do not predict changes in body mass in the first decade of life.

    Science.gov (United States)

    Starkey, Leighann; Revenson, Tracey A

    2015-04-01

    Many studies link childhood socioeconomic status (SES) to body mass index (BMI), but few account for the impact of socioeconomic mobility throughout the lifespan. This study aims to investigate the impact of socioeconomic mobility on changes in BMI in childhood. Analyses tested whether [1] socioeconomic status influences BMI, [2] changes in socioeconomic status impact changes in BMI, and [3] timing of socioeconomic status mobility impacts BMI. Secondary data spanning birth to age 9 were analyzed. SES and BMI were investigated with gender, birth weight, maternal race/ethnicity, and maternal nativity as covariates. Autoregressive structural equation modeling and latent growth modeling were used. Socioeconomic status in the first year of life predicted body mass index. Child covariates were consistently associated with body mass index. Rate of change in socioeconomic status did not predict change in body mass index. The findings suggest that early socioeconomic status may most influence body mass in later childhood.

  9. Subcortical grey matter changes in untreated, early stage Parkinson's disease without dementia.

    Science.gov (United States)

    Lee, Hye Mi; Kwon, Kyum-Yil; Kim, Min-Jik; Jang, Ji-Wan; Suh, Sang-Il; Koh, Seong-Beom; Kim, Ji Hyun

    2014-06-01

    Previous MRI studies have investigated cortical or subcortical grey matter changes in patients with Parkinson's disease (PD), yielding inconsistent findings between the studies. We therefore sought to determine whether focal cortical or subcortical grey matter changes may be present from the early disease stage. We recruited 49 untreated, early stage PD patients without dementia and 53 control subjects. Voxel-based morphometry was used to evaluate cortical grey matter changes, and automated volumetry and shape analysis were used to assess volume changes and shape deformation of the subcortical grey matter structures, respectively. Voxel-based morphometry showed neither reductions nor increases in grey matter volume in patients compared to controls. Compared to controls, PD patients had significant reductions in adjusted volumes of putamen, nucleus accumbens, and hippocampus (corrected p grey matter and clinical variables representing disease duration and severity. Our results suggest that untreated, early stage PD without dementia is associated with volume reduction and shape deformation of subcortical grey matter, but not with cortical grey matter reduction. Our findings of structural changes in the posterolateral putamen and ventromedial putamen/nucleus accumbens could provide neuroanatomical basis for the involvement of motor and limbic striatum, further implicating motor and non-motor symptoms in PD, respectively. Early hippocampal involvement might be related to the risk for developing dementia in PD patients. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. Achievement goal structures and self-regulated learning: relationships and changes in medical school.

    Science.gov (United States)

    Artino, Anthony R; Dong, Ting; DeZee, Kent J; Gilliland, William R; Waechter, Donna M; Cruess, David; Durning, Steven J

    2012-10-01

    Practicing physicians have a societal obligation to maintain their competence. Unfortunately, the self-regulated learning skills likely required for lifelong learning are not explicitly addressed in most medical schools. The authors examined how medical students' perceptions of the learning environment relate to their self-regulated learning behaviors. They also explored how students' perceptions and behaviors correlate with performance and change across medical school. The authors collected survey data from 304 students at different phases of medical school training. The survey items assessed students' perceptions of the learning environment, as well as their metacognition, procrastination, and avoidance-of-help-seeking behaviors. The authors operationalized achievement as cumulative medical school grade point average (GPA) and, for third- and fourth-year students, collected clerkship outcomes. Students' perceptions of the learning environment were associated with their metacognition, procrastination, and help-avoidance behaviors. These behaviors were also related to academic outcomes. Specifically, avoidance of help seeking was negatively correlated with cumulative medical school GPA (r=-0.23, P<.01) as well as exam (r=-0.22, P<.05) and clinical performance (r=-0.34, P<.01) in the internal medical clerkship; these help-avoidance behaviors were also positively correlated with students' presentation at a grade adjudication committee (r=0.20, P<.05). Additionally, students' perceptions of the learning environment varied as a function of their phase of training. Medical students' perceptions of the learning environment are related, in predictable ways, to their use of self-regulated learning behaviors; these perceptions seem to change across medical school.

  11. A model for training medical student innovators: the Harvard Medical School Center for Primary Care Abundance Agents of Change program.

    Science.gov (United States)

    Duong, David B; Sullivan, Erin E; Minter-Jordan, Myechia; Giesen, Lindsay; Ellner, Andrew L

    2016-01-01

    In 2013, the Harvard Medical School Center for Primary Care established the Abundance Agents of Change (AoC) program to promote interprofessional learning and innovation, increase partnership between 15 academic and community health centers (CHCs) in Boston's most under-served communities, and increase medical student interest in primary care careers. The AoC is modeled in the form of a 'grants challenge', offering $20,000 to interprofessional student teams to develop an innovative solution that addresses a healthcare delivery need identified by CHCs. The program's initial two years were characterized by a four-stage process which included working with CHCs and crafting a request for proposals, forming interprofessional 20 student teams comprising students from across and outside of Harvard University, training students using a systems-based innovation curriculum, and performing program evaluation. Our evaluation data from cohorts 1 and 2 of the AoC program demonstrate that we succeeded in training students as innovators and members of interprofessional teams. We also learned valuable lessons regarding creating better alignment with CHC priorities, extending the program cycle from 12 to 18 months, and changing the way funding is disbursed to 25 students, which will be incorporated in later versions of the program. Based on our experience and evaluation data, we believe that this program is a replicable way to train students as innovators and members of interprofessional teams to address the current complex healthcare environment.

  12. Defining the minimal detectable change in scores on the eight-item Morisky Medication Adherence Scale.

    Science.gov (United States)

    Muntner, Paul; Joyce, Cara; Holt, Elizabeth; He, Jiang; Morisky, Donald; Webber, Larry S; Krousel-Wood, Marie

    2011-05-01

    Self-report scales are used to assess medication adherence. Data on how to discriminate change in self-reported adherence over time from random variability are limited. To determine the minimal detectable change for scores on the 8-item Morisky Medication Adherence Scale (MMAS-8). The MMAS-8 was administered twice, using a standard telephone script, with administration separated by 14-22 days, to 210 participants taking antihypertensive medication in the CoSMO (Cohort Study of Medication Adherence among Older Adults). MMAS-8 scores were calculated and participants were grouped into previously defined categories (<6, 6 to <8, and 8 for low, medium, and high adherence). The mean (SD) age of participants was 78.1 (5.8) years, 43.8% were black, and 68.1% were women. Overall, 8.1% (17/210), 16.2% (34/210), and 51.0% (107/210) of participants had low, medium, and high MMAS-8 scores, respectively, at both survey administrations (overall agreement 75.2%; 158/210). The weighted κ statistic was 0.63 (95% CI 0.53 to 0.72). The intraclass correlation coefficient was 0.78. The within-person standard error of the mean for change in MMAS-8 scores was 0.81, which equated to a minimal detectable change of 1.98 points. Only 4.3% (9/210) of the participants had a change in MMAS-8 of 2 or more points between survey administrations. Within-person changes in MMAS-8 scores of 2 or more points over time may represent a real change in antihypertensive medication adherence.

  13. Incorporation of web-based applications and online resources in undergraduate medical education in the Irish Republic. Can new changes be incorporated in the current medical curriculum?

    Science.gov (United States)

    Dhatt, Karanvir Singh; Kaliaperumal, Chandrasekaran

    2014-07-01

    Significant change has been happening in the introduction of technology in medical teaching all over the world. We aim to determine if the undergraduate medical students and teachers are open to incorporating changes in the current medical curriculum or if there is a need for the same in the Republic of Ireland. A cross-sectional study involving 202 participants of whom 152 were medical students and 50 medical professionals (teachers and hospital doctors) were carried out involving three different medical universities namely; University College Cork (UCC), University College Dublin (UCD), and National University of Ireland in Galway (NUIG). Participants were requested to answer a series of 15 questions designed incorporating various fields of technology necessary for the study. The data was collected and analyzed using Statistical Package for Social Sciences (SPSS) software to determine statistical significance. The participants overall had a positive attitude toward the utility of modern technology and web-based applications in current medical curriculum. Ninety-one percent of the participants preferred the introduction of modern technology into medical education and 7% were against the idea and a further 2% of them remained undecided. There seems to be a "technology gap" in the current undergraduate medical curriculum in Ireland. A large-scale study involving more participants from all the medical schools in Ireland is recommended. We believe, changes can be brought into the current medical teaching and learning to make the process more fruitful and successful.

  14. EARLY POSTOPERATIVE HOMEOSTATIC CHANGES AFTER TRANSURETHRAL RESECTION OF THE PROSTATE AND WAYS OF PREVENTING ITS COMPLICATIONS

    Directory of Open Access Journals (Sweden)

    D. Yu. Volkov

    2011-01-01

    Full Text Available During the study, the authors assessed changes in the blood coagulation system and made a spectral analysis of serum and prostate tissue. They revealed immunological changes suggesting occult disseminated intravascular coagulation, an evolving systemic inflammatory response and the latter caused by endothelial damage, microcirculatory disorders, lipid peroxidation, and release of inflammatory factors. The findings permit a tactic for medical prevention of complications to be elaborated.

  15. Climate change implications and use of early warning systems for global dust storms

    Science.gov (United States)

    Harriman, Lindsey M.

    2014-01-01

    With increased changes in land cover and global climate, early detection and warning of dust storms in conjunction with effective and widespread information broadcasts will be essential to the prevention and mitigation of future risks and impacts. Human activities, seasonal variations and long-term climatic patterns influence dust storms. More research is needed to analyse these factors of dust mobilisation to create more certainty for the fate of vulnerable populations and ecosystems in the future. Early warning and communication systems, when in place and effectively implemented, can offer some relief to these vulnerable areas. As an issue that affects many regions of the world, there is a profound need to understand the potential changes and ultimately create better early warning systems for dust storms.

  16. Social change in ‘Phoenicia’ in the late Bronze/early Iron Age transition

    OpenAIRE

    Boyes, Philip

    2013-01-01

    This dissertation explores social, cultural and political changes in the region later known as ‘Phoenicia’ during the period of approximately 1300-900 BC. By applying modern approaches to theoretical questions such as the nature of social change, identity, migration and how such phenomena are represented in the archaeological record, this dissertation aims to provide a discussion of Late Bronze/Early Iron Age Phoenicia based on a more solid methodological foundation than has of...

  17. Stage 3 recommendations - the early recognition of breast cancer in Germany. Abridged version forr medical practioners

    International Nuclear Information System (INIS)

    Schulz, K.D.; Albert, U.S.; Kreienberg, R.; Fischer, R.

    2003-01-01

    The Aim of this level 3 good clinical practice guideline is to help physicians, women and patients in decision making about the appropriate health care for early detection of breast cancer. The principle of early detection of breast cancer comprise the detection and diagnosis of premalignant breast tumors (stage 0, Carcinoma in situ), risk reduction of cancer development as well as the detection and diagnosis of breast cancer at an early stage (stage I), with a 90% chance of cure as shown by a large number of clinical trials. To establish a nation wide, comprehensive quality assuring program for the early detection of breast cancer the guideline summarized in the following paper offers the basis for a timely mortality reduction of breast cancer. The cure of early stage disease will be additionally possible by less invasive treatment allowing patients to maintain quality of life. The guideline leads to a major improvement of women's health care. (orig.) [de

  18. Is change in health behavior of Dutch medical students related to change in their ideas on how a physician's lifestyle influences their patient's lifestyle?

    NARCIS (Netherlands)

    Ketelaar, Sarah M.; Frings-Dresen, Monique H. W.; Sluiter, Judith K.

    2014-01-01

    A change of medical students' health behavior over time may be related to a change in their opinion regarding the relationship between physicians' own health behavior and effective healthy lifestyle counseling in patients. To investigate Dutch medical students' (1) change of health behavior over

  19. Motivation of university and non-university stakeholders to change medical education in Vietnam

    Directory of Open Access Journals (Sweden)

    Ruitenberg EJ

    2009-07-01

    Full Text Available Abstract Background Both university and non-university stakeholders should be involved in the process of curriculum development in medical schools, because all are concerned with the competencies of the graduates. That may be difficult unless appropriate strategies are used to motivate each stakeholder. From 1999 to 2006, eight medical schools in Vietnam worked together to change the curriculum and teaching for general medical students to make it more community oriented. This paper describes the factors that motivated the different stakeholders to participate in curriculum change and teaching in Vietnamese medical schools and the activities to address those factors and have sustainable contributions from all relevant stakeholders. Methods Case study analysis of contributions to the change process, using reports, interviews, focus group discussions and surveys and based on Herzberg's Motivation Theory to analyze involvement of different stakeholders. Results Different stakeholders were motivated by selected activities, such as providing opportunities for non-university stakeholders to share their opinions, organizing interactions among university stakeholders, stimulating both bottom-up and top-down inputs, focusing on learning from each other, and emphasizing self-motivation factors. Conclusion The Herzberg Motivation theory helped to identify suitable approaches to ensure that teaching topics, materials and assessment methods more closely reflected the health care needs of the community. Other medical schools undertaking a reform process may learn from this experience.

  20. Motivation of university and non-university stakeholders to change medical education in Vietnam.

    Science.gov (United States)

    Luu, Ngoc Hoat; Nguyen, Lan Viet; van der Wilt, G J; Broerse, J; Ruitenberg, E J; Wright, E P

    2009-07-24

    Both university and non-university stakeholders should be involved in the process of curriculum development in medical schools, because all are concerned with the competencies of the graduates. That may be difficult unless appropriate strategies are used to motivate each stakeholder. From 1999 to 2006, eight medical schools in Vietnam worked together to change the curriculum and teaching for general medical students to make it more community oriented. This paper describes the factors that motivated the different stakeholders to participate in curriculum change and teaching in Vietnamese medical schools and the activities to address those factors and have sustainable contributions from all relevant stakeholders. Case study analysis of contributions to the change process, using reports, interviews, focus group discussions and surveys and based on Herzberg's Motivation Theory to analyze involvement of different stakeholders. Different stakeholders were motivated by selected activities, such as providing opportunities for non-university stakeholders to share their opinions, organizing interactions among university stakeholders, stimulating both bottom-up and top-down inputs, focusing on learning from each other, and emphasizing self-motivation factors. The Herzberg Motivation theory helped to identify suitable approaches to ensure that teaching topics, materials and assessment methods more closely reflected the health care needs of the community. Other medical schools undertaking a reform process may learn from this experience.

  1. Of paradox and plausibility: the dynamic of change in medical law.

    Science.gov (United States)

    Harrington, John

    2014-01-01

    This article develops a model of change in medical law. Drawing on systems theory, it argues that medical law participates in a dynamic of 'deparadoxification' and 'reparadoxification' whereby the underlying contingency of the law is variously concealed through plausible argumentation, or revealed by critical challenge. Medical law is, thus, thoroughly rhetorical. An examination of the development of the law on abortion and on the sterilization of incompetent adults shows that plausibility is achieved through the deployment of substantive common sense and formal stylistic devices. It is undermined where these elements are shown to be arbitrary and constructed. In conclusion, it is argued that the politics of medical law are constituted by this antagonistic process of establishing and challenging provisionally stable normative regimes. © The Author [2014]. Published by Oxford University Press; all rights reserved. For Permissions, please email: journals.permissions@oup.com.

  2. Early onset of cannabis use: Does personality modify the relation with changes in perceived parental involvement?

    NARCIS (Netherlands)

    Creemers, H.E.; Buil, J.M.; Van Lier, P.A.C.; Keijsers, L.; Meeus, W.; Koot, H.M.; Huizink, A.C.

    2015-01-01

    Background: The present study examined (1) the association between changes in perceived parental control and support from age 13 to 15 and early onset of cannabis use (before age 16), and (2) whether personality modifies the association between a decline in perceived parental control and support and

  3. Early development of Calanus hyperboreus nauplii: Response to a changing ocean

    DEFF Research Database (Denmark)

    Jung-Madsen, Signe; Nielsen, Torkel Gissel; Grønkjær, Peter

    2013-01-01

    To forecast effects of temperature changes on recruitment and population dynamics of the Arctic copepod Calanus hyperboreus, laboratory experiments investigating temperature and food effects on early development were performed in Disko Bay, western Greenland, in 2009, and ascent rates of C. hyper...

  4. Early onset of cannabis use: Does personality modify the relation with changes in perceived parental involvement?

    NARCIS (Netherlands)

    Creemers, Hanneke E.; Buil, J. Marieke; van Lier, Pot A. C.; Keijsers, Loes; Meeus, W.H.J.; Koot, Hans M.; Huizink, Anja C.

    2015-01-01

    Background The present study examined (1) the association between changes in perceived parental control and support from age 13 to 15 and early onset of cannabis use (before age 16), and (2) whether personality modifies the association between a decline in perceived parental control and support and

  5. Changes in the welfare state and the ethics of early childhood educators

    DEFF Research Database (Denmark)

    Hjort, Katrin

    2016-01-01

    Ethical reflection is more relevant than ever before. As a reaction to both the trend of utilitarianism in early childhood education and the changes in the organisation of welfare sevices in the Nordic countries a professional ethics of virtue must be revitalized. However, it is not an easy path...

  6. Early Diagnosis of Autism Spectrum Disorder: Stability and Change in Clinical Diagnosis and Symptom Presentation

    Science.gov (United States)

    Guthrie, Whitney; Swineford, Lauren B.; Nottke, Charly; Wetherby, Amy M.

    2013-01-01

    Background: Although a diagnosis of autism spectrum disorder (ASD) appears to be stable in children as young as age three, few studies have explored stability of a diagnosis in younger children. Predictive value of diagnostic tools for toddlers and patterns of symptom change are important considerations for clinicians making early diagnoses. Most…

  7. The Early Childhood Care and Education Workforce from 1990 through 2010: Changing Dynamics and Persistent Concerns

    Science.gov (United States)

    Bassok, Daphna; Fitzpatrick, Maria; Loeb, Susanna; Paglayan, Agustina S.

    2013-01-01

    Historically, the early childhood care and education (ECCE) workforce has been characterized as a low-education, low-compensation, low-stability workforce. In recent years, considerable investments have been made to correct this, but we lack evidence about the extent to which these investments were accompanied by changes in the characteristics of…

  8. Network based early warning indicators of vegetation changes in a land–atmosphere model

    NARCIS (Netherlands)

    Yin, Z.; Dekker, S.C.; Rietkerk, M.; Hurk, B.J.J.M. van den; Dijkstra, H.A.

    2016-01-01

    Abstract Numerous model studies demonstrate that ecosystems might not shift smoothly with a gradual change in resource concentration. At specific points, vegetation can suddenly shift from one stable state to another. To predict such undesirable shifts, statistical indicators are proposed for early

  9. Early segmental changes in ischemic acute tubular necrosis of the rat kidney

    DEFF Research Database (Denmark)

    Faarup, Poul; Nørgaard, Tove; Hegedüs, Viktor

    2004-01-01

    The background and mechanisms of ischemic acute tubular necrosis are still essentially unclarified. Therefore a quantitative morphological technique was applied for evaluation of the early structural changes in different fractions of the proximal convoluted tubule in the rat renal cortex. In male...

  10. How Does Early Feedback in an Online Programming Course Change Problem Solving?

    Science.gov (United States)

    Ebrahimi, Alireza

    2012-01-01

    How does early feedback change the programming problem solving in an online environment and help students choose correct approaches? This study was conducted in a sample of students learning programming in an online course entitled Introduction to C++ and OOP (Object Oriented Programming) using the ANGEL learning management system platform. My…

  11. Changes in Parent-Child Relationship Quality across Early Adolescence: Implications for Engagement in Sexual Behavior

    Science.gov (United States)

    McElwain, Alyssa D.; Bub, Kristen L.

    2018-01-01

    The present study investigated how changes in specific dimensions of the parent-adolescent relationship predict adolescent engagement in sexual intercourse and oral sex. Longitudinal data from 1,364 participants in the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development were gathered at…

  12. Professional Development of Preschool Teachers and Changing the Culture of the Institution of Early Education

    Science.gov (United States)

    Vujicic, Lidija; Camber Tambolaš, Akvilina

    2017-01-01

    The culture of institutions of early education is a strong network of customs, rules, norms and behaviours that affect the daily life and work of all its individuals. Consequently, the professional development of preschool teachers is not only an individual process of professional advancement, but also a process that changes the culture of the…

  13. 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.

  14. Clarifying changes in student empathy throughout medical school: a scoping review.

    Science.gov (United States)

    Ferreira-Valente, Alexandra; Monteiro, Joana S; Barbosa, Rita M; Salgueira, Ana; Costa, Patrício; Costa, Manuel J

    2017-12-01

    Despite the increasing awareness of the relevance of empathy in patient care, some findings suggest that medical schools may be contributing to the deterioration of students' empathy. Therefore, it is important to clarify the magnitude and direction of changes in empathy during medical school. We employed a scoping review to elucidate trends in students' empathy changes/differences throughout medical school and examine potential bias associated with research design. The literature published in English, Spanish, Portuguese and French from 2009 to 2016 was searched. Two-hundred and nine potentially relevant citations were identified. Twenty articles met the inclusion criteria. Effect sizes of empathy scores variations were calculated to assess the practical significance of results. Our results demonstrate that scoped studies differed considerably in their design, measures used, sample sizes and results. Most studies (12 out of 20 studies) reported either positive or non-statistically significant changes/differences in empathy regardless of the measure used. The predominant trend in cross-sectional studies (ten out of 13 studies) was of significantly higher empathy scores in later years or of similar empathy scores across years, while most longitudinal studies presented either mixed-results or empathy declines. There was not a generalized international trend in changes in students' empathy throughout medical school. Although statistically significant changes/differences were detected in 13 out of 20 studies, the calculated effect sizes were small in all but two studies, suggesting little practical significance. At the present moment, the literature does not offer clear conclusions relative to changes in student empathy throughout medical school.

  15. Student pharmacist experiences as inpatient psychiatry medication education group leaders during an early immersion program.

    Science.gov (United States)

    McLaughlin, Jacqueline E; Kennedy, Lindsey; Garris, Shauna; Harris, Suzanne C; Hillman, Ashley; Pinelli, Nicole R; Rhoney, Denise H

    2017-09-01

    While research suggests that pharmacists generally hold positive attitudes toward consumers of psychiatric medications, they often feel less comfortable talking about these medications and providing services for patients with mental illness. The purpose of this program was to train second and third year student pharmacists as psychiatry medication education groups leaders and to examine resulting student self-efficacy and mental health stigma. In partnership with the University of North Carolina (UNC) Eshelman School of Pharmacy, the inpatient psychiatry service at UNC Medical Center expanded weekly medication education groups with the help of trained student pharmacists. All second- and third-year student pharmacists were invited to participate. Pre/post surveys and reflection statements were collected from 13 students that received training, provided informed consent, and participated in one or more medication education groups. Data were analyzed with a mixed methods approach. Student responses revealed an increase in student self-efficacy (p appreciation for pharmacists and the workplace while developing self-efficacy and strategies for engaging with patients with mental illness as a part of medication education groups. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Pilot Point-of-Care Ultrasound Curriculum at Harvard Medical School: Early Experience

    Science.gov (United States)

    Rempell, Joshua S.; Saldana, Fidencio; DiSalvo, Donald; Kumar, Navin; Stone, Michael B.; Chan, Wilma; Luz, Jennifer; Noble, Vicki E.; Liteplo, Andrew; Kimberly, Heidi; Kohler, Minna J.

    2016-01-01

    Introduction Point-of-care ultrasound (POCUS) is expanding across all medical specialties. As the benefits of US technology are becoming apparent, efforts to integrate US into pre-clinical medical education are growing. Our objective was to describe our process of integrating POCUS as an educational tool into the medical school curriculum and how such efforts are perceived by students. Methods This was a pilot study to introduce ultrasonography into the Harvard Medical School curriculum to first- and second-year medical students. Didactic and hands-on sessions were introduced to first-year students during gross anatomy and to second-year students in the physical exam course. Student-perceived attitudes, understanding, and knowledge of US, and its applications to learning the physical exam, were measured by a post-assessment survey. Results All first-year anatomy students (n=176) participated in small group hands-on US sessions. In the second-year physical diagnosis course, 38 students participated in four sessions. All students (91%) agreed or strongly agreed that additional US teaching should be incorporated throughout the four-year medical school curriculum. Conclusion POCUS can effectively be integrated into the existing medical school curriculum by using didactic and small group hands-on sessions. Medical students perceived US training as valuable in understanding human anatomy and in learning physical exam skills. This innovative program demonstrates US as an additional learning modality. Future goals include expanding on this work to incorporate US education into all four years of medical school. PMID:27833681

  17. Has growth mixture modeling improved our understanding of how early change predicts psychotherapy outcome?

    Science.gov (United States)

    Koffmann, Andrew

    2017-03-02

    Early change in psychotherapy predicts outcome. Seven studies have used growth mixture modeling [GMM; Muthén, B. (2001). Second-generation structural equation modeling with a combination of categorical and continuous latent variables: New opportunities for latent class-latent growth modeling. In L. M. Collins & A. G. Sawyers (Eds.), New methods for the analysis of change (pp. 291-322). Washington, DC: American Psychological Association] to identify patient classes based on early change but have yielded conflicting results. Here, we review the earlier studies and apply GMM to a new data set. In a university-based training clinic, 251 patients were administered the Outcome Questionnaire-45 [Lambert, M. J., Hansen, N. B., Umphress, V., Lunnen, K., Okiishi, J., Burlingame, G., … Reisinger, C. W. (1996). Administration and scoring manual for the Outcome Questionnaire (OQ 45.2). Wilmington, DE: American Professional Credentialing Services] at each psychotherapy session. We used GMM to identify class structure based on change in the first six sessions and examined trajectories as predictors of outcome. The sample was best described as a single class. There was no evidence of autoregressive trends in the data. We achieved better fit to the data by permitting latent variables some degree of kurtosis, rather than to assume multivariate normality. Treatment outcome was predicted by the amount of early improvement, regardless of initial level of distress. The presence of sudden early gains or losses did not further improve outcome prediction. Early improvement is an easily computed, powerful predictor of psychotherapy outcome. The use of GMM to investigate the relationship between change and outcome is technically complex and computationally intensive. To date, it has not been particularly informative.

  18. Weight change associated with the use of migraine-preventive medications.

    Science.gov (United States)

    Taylor, Frederick R

    2008-06-01

    Medications administered long term, such as those used for migraine prophylaxis, are often associated with weight change as a side effect. Such effects may compromise general health status, exacerbate coexisting medical conditions, and affect medication adherence. Weight gain should be of particular concern in patients with migraine, as there is evidence that overweight and obese patients with migraine are at risk for an increased frequency and severity of migraine attacks. This article reviews weight-change data from recent clinical studies of migraine-preventive medications in children, adolescents, and adults with migraine. A PubMed search was conducted for English-language articles published between January 1970 and November 2007. Among the search terms were migraine prevention, migraine prophylaxis, migraine treatment, antidepressant drug, beta-adrenergic-receptor blockers, antiepileptic drug, anticonvulsant drug, weight gain, and weight loss. Studies that reported weight-change data (gain, loss, or neutral) were included. When available, double-blind, placebo-controlled studies were selected for review. Open-label, retrospective or prospective trials may also have been included. Most of the migraine-preventive medications classified by the United States Headache Consortium as group 1 based on the high level of evidence for their efficacy--for instance, amitriptyline, propranolol, and divalproex sodium-have been associated with varying degrees of weight gain. The exceptions are timolol, which is weight neutral, and topiramate, which is associated with weight loss. Among the drugs that have been associated with weight gain, a higher incidence of weight gain was observed with amitriptyline and divalproex sodium than with propranolol. Weight-change effects require careful consideration when selecting migraine-preventive medications, and weight should be monitored carefully over the course of any migraine treatment plan.

  19. The Impact of Perceived Adverse Effects on Medication Changes in Heart Failure Patients

    NARCIS (Netherlands)

    De Smedt, Ruth H. E.; Jaarsma, Tiny; Haaijer-Ruskamp, Flora M.; Denig, Petra

    Background: Given the importance of patient safety and well-being, we quantified the likelihood and type of medication changes observed after 5 possible adverse effects (AE) perceived by heart failure (HF) patients. Methods and Results: We conducted a retrospective cohort study using 18 months

  20. 78 FR 32991 - Medicaid Program; Increased Federal Medical Assistance Percentage Changes Under the Affordable...

    Science.gov (United States)

    2013-06-03

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Part 433 [CMS-2327-CN] RIN 0938-AR38 Medicaid Program; Increased Federal Medical Assistance Percentage Changes Under the Affordable Care Act of 2010; Correction AGENCY: Centers for Medicare & Medicaid Services (CMS...

  1. The contrasting effects of short-term climate change on the early recruitment of tree species.

    Science.gov (United States)

    Ibáñez, Inés; Katz, Daniel S W; Lee, Benjamin R

    2017-07-01

    Predictions of plant responses to climate change are frequently based on organisms' presence in warmer locations, which are then assumed to reflect future performance in cooler areas. However, as plant life stages may be affected differently by environmental changes, there is little empirical evidence that this approach provides reliable estimates of short-term responses to global warming. Under this premise, we analyzed 8 years of early recruitment data, seed production and seedling establishment and survival, collected for two tree species at two latitudes. We quantified recruitment to a wide range of environmental conditions, temperature, soil moisture and light, and simulated recruitment under two forecasted climatic scenarios. Annual demographic transitions were affected by the particular conditions taking place during their onset, but the effects of similar environmental shifts differed among the recruitment stages; seed production was higher in warmer years, while seedling establishment and survival peaked during cold years. Within a species, these effects also varied between latitudes; increasing temperatures at the southern location will have stronger detrimental effects on recruitment than similar changes at the northern locations. Our simulations illustrate that warmer temperatures may increase seed production, but they will have a negative effect on establishment and survival. When the three early recruitment processes were simultaneously considered, simulations showed little change in recruitment dynamics at the northern site and a slight decrease at the southern site. It is only when we considered these three stages that we were able to assess likely changes in early recruitment under the predicted conditions.

  2. Radiation induced early delayed changes in mice brain: a 1h MRS and behavioral evaluation study

    International Nuclear Information System (INIS)

    Gupta, Mamta; Rana, Poonam; Haridas, Seenu; Manda, Kailash; Hemanth Kumar, B.S.; Khushu, Subash

    2014-01-01

    Radiation induced CNS injury can be classified as acute, early delayed and late delayed. Most of the studies suggest that acute injury is reversible whereas early delayed and late delayed injury is irreversible leading to metabolic and cognitive impairment. Extensive research has been carried out on cranial radiation induced early and late delayed changes, there are no reports on whole body radiation induced early and delayed changes. The present study was designed to observe early delayed effects of radiation during whole body radiation exposure. A total of 20 C57 male mice were divided in two groups of 10 animals each. One group was exposed to a dose of 5 Gy whole body radiation through Tele 60 Co irradiation facility with source operating at 2.496 Gy/min, while other group served as sham irradiated control. Behavioral and MR spectroscopy was carried out 3 months post irradiation. Behavioral parameters such as locomotor activity and working memory were evaluated first then followed by MR spectroscopy at 7T animal MRI system. For MRS, voxel was localised in the cortex-hippocampus region of mouse brain. MR spectra were acquired using PRESS sequence, FID was processed using LC model for quantitation. The data showed impaired cognitive functions and altered metabolite levels during early delayed phase of whole body radiation induced injury. In behavioural experiments, there was a significant impairment in the cognitive as well as exploratory functions at 3 months post irradiation in irradiated group as compared to controls. MRS results explained changes in mI, glutamine and glx levels in irradiated animals compared to controls. Altered mI level has been found to be associated with reduced cognitive abilities in many brain disorders including MCI and Alzheimer's disease. The findings of this study suggest that whole body radiation exposure may have long lasting effect on the cognitive performance. (author)

  3. Is the global rise of asthma an early impact of anthropogenic climate change?

    Directory of Open Access Journals (Sweden)

    Paul John Beggs

    Full Text Available The increase in asthma incidence, prevalence, and morbidity over recent decades presents a significant challenge to public health. Pollen is an important trigger of some types of asthma, and both pollen quantity and season depend on climatic and meteorological variables. Over the same period as the global rise in asthma, there have been considerable increases in atmospheric carbon dioxide concentration and global average surface temperature. We hypothesize anthropogenic climate change as a plausible contributor to the rise in asthma. Greater concentrations of carbon dioxide and higher temperatures may increase pollen quantity and induce longer pollen seasons. Pollen allergenicity can also increase as a result of these changes in climate. Exposure in early life to a more allergenic environment may also provoke the development of other atopic conditions, such as eczema and allergic rhinitis. Although the etiology of asthma is complex, the recent global rise in asthma could be an early health effect of anthropogenic climate change.

  4. Early extracellular matrix changes are associated with later development of bronchiolitis obliterans syndrome after lung transplantation

    DEFF Research Database (Denmark)

    Müller, Catharina; Andersson-Sjöland, Annika; Schultz, Hans Henrik

    2017-01-01

    are largely unknown. The aim of this study was to identify potential early changes in the extracellular matrix (ECM) in different compartments of the transplanted lung prior to the development of BOS. Methods: Transbronchial biopsies from a cohort of 58 lung transplantation patients at the Copenhagen...... and immunohistochemistry. Results: A time-specific and compartment-specific pattern of ECM changes was detected. Alveolar total collagen (p=0.0190) and small airway biglycan (p=0.0199) increased between 3 and 12 months after transplantation in patients developing BOS, while collagen type IV (p=0.0124) increased...... in patients without BOS. Patients with early-onset BOS mirrored this increase. Patients developing grade 3 BOS showed distinct ECM changes already at 3 months. Patients with BOS with treated acute rejections displayed reduced alveolar total collagen (p=0.0501) and small airway biglycan (p=0.0485) at 3 months...

  5. Early Integration of Palliative Care in Oncology Practice: Results of the Italian Association of Medical Oncology (AIOM) Survey.

    Science.gov (United States)

    Zagonel, Vittorina; Torta, Riccardo; Franciosi, Vittorio; Brunello, Antonella; Biasco, Guido; Cattaneo, Daniela; Cavanna, Luigi; Corsi, Domenico; Farina, Gabriella; Fioretto, Luisa; Gamucci, Teresa; Lanzetta, Gaetano; Magarotto, Roberto; Maltoni, Marco; Mastromauro, Cataldo; Melotti, Barbara; Meriggi, Fausto; Pavese, Ida; Piva, Erico; Sacco, Cosimo; Tonini, Giuseppe; Trentin, Leonardo; Ermacora, Paola; Varetto, Antonella; Merlin, Federica; Gori, Stefania; Cascinu, Stefano; Pinto, Carmine

    2016-01-01

    Early integration of palliative care in oncology practice ("simultaneous care", SC) has been shown to provide better care resulting in improved quality-of-life and also survival. We evaluated the opinions of Italian Association of Medical Oncology (AIOM) members. A 37-item questionnaire was delivered to 1119 AIOM members. Main areas covered were: social, ethical, relational aspects of disease and communication, training, research, organizational and management models in SC. Three open questions explored the definition of Quality of Life, Medical Oncologist and Palliative Care. Four hundred and forty-nine (40.1%) medical oncologists returned the questionnaires. Forty-nine percent stated they address non-curability when giving a diagnosis of metastatic tumor, and 43% give the information only to patients who clearly ask for it. Fifty-five percent say the main formative activity in palliative medicine came from attending meetings and 90% agree that specific palliative care training should be part of the core curriculum in oncology. Twenty-two percent stated they consulted guidelines for symptom management, 45% relied upon personal experience and 26% make a referral to a palliative care specialist. Seventy-four percent were in favor of more research in palliative medicine. An integration between Units of Oncology and Palliative Care Services early in the course of advanced disease was advocated by 86%. Diverse and multifaceted definitions were given for the concepts of Quality of Life, Palliative Care and Medical Oncologist. SC is felt as an important task, as well as training of medical oncologists in symptom management and research in this field.

  6. Developmental Changes in Sleep Spindle Characteristics and Sigma Power across Early Childhood

    Directory of Open Access Journals (Sweden)

    Ian J. McClain

    2016-01-01

    Full Text Available Sleep spindles, a prominent feature of the non-rapid eye movement (NREM sleep electroencephalogram (EEG, are linked to cognitive abilities. Early childhood is a time of rapid cognitive and neurophysiological maturation; however, little is known about developmental changes in sleep spindles. In this study, we longitudinally examined trajectories of multiple sleep spindle characteristics (i.e., spindle duration, frequency, integrated spindle amplitude, and density and power in the sigma frequency range (10–16 Hz across ages 2, 3, and 5 years (n=8; 3 males. At each time point, nocturnal sleep EEG was recorded in-home after 13-h of prior wakefulness. Spindle duration, integrated spindle amplitude, and sigma power increased with age across all EEG derivations (C3A2, C4A1, O2A1, and O1A2; all ps < 0.05. We also found a developmental decrease in mean spindle frequency (p<0.05 but no change in spindle density with increasing age. Thus, sleep spindles increased in duration and amplitude but decreased in frequency across early childhood. Our data characterize early developmental changes in sleep spindles, which may advance understanding of thalamocortical brain connectivity and associated lifelong disease processes. These findings also provide unique insights into spindle ontogenesis in early childhood and may help identify electrophysiological features related to healthy and aberrant brain maturation.

  7. International outsourcing of medical research by high-income countries: changes from 1995 to 2005.

    Science.gov (United States)

    Belforti, Raquel K; Wall, Michal Sarah; Lindenauer, Peter K; Pekow, Penelope S; Rothberg, Michael B

    2010-02-01

    Medical research outsourcing provides a financial benefit to those conducting research and financial incentives to the developing countries hosting the research. Little is known about how frequently outsourcing occurs or the type of research that is outsourced. To document changes in medical research outsourcing over a 10-year period, we conducted a cross-sectional comparison of 3 medical journals: Lancet, The New England Journal of Medicine, and JAMA: The Journal of the American Medical Association in the last 6 months of 1995 and 2005. The main outcome measure was the 10-year change in proportion of studies including patients from low-income countries. We reviewed 598 articles. During the 10-year period, the proportion of first authors from low-income countries increased from 3% to 6% (P = 0.21), whereas studies with participants from low-income countries increased from 8% to 22% (P = Outsourcing of medical research seems to be increasing. Additional studies are required to know if subjects from low-income countries are being adequately protected.

  8. Driving change in rural workforce planning: the medical schools outcomes database.

    Science.gov (United States)

    Gerber, Jonathan P; Landau, Louis I

    2010-01-01

    The Medical Schools Outcomes Database (MSOD) is an ongoing longitudinal tracking project ofmedical students from all medical schools in Australia and New Zealand. It was established in 2005 to track the career trajectories of medical students and will directly help develop models of workforce flow, particularly with respect to rural and remote shortages. This paper briefly outlines the MSOD project and reports on key methodological factors in tracking medical students. Finally, the potential impact of the MSOD on understanding changes in rural practice intentions is illustrated using data from the 2005 pilot cohort (n = 112). Rural placements were associated with a shift towards rural practice intentions, while those who intended to practice rurally at both the start and end of medical school tended to be older and interested in a generalist career. Continuing work will track these and future students as they progress through the workforce, as well as exploring issues such as the career trajectories of international fee-paying students, workforce succession planning, and the evaluation of medical education initiatives.

  9. Identifying configurations of behavior change techniques in effective medication adherence interventions: a qualitative comparative analysis.

    Science.gov (United States)

    Kahwati, Leila; Viswanathan, Meera; Golin, Carol E; Kane, Heather; Lewis, Megan; Jacobs, Sara

    2016-05-04

    Interventions to improve medication adherence are diverse and complex. Consequently, synthesizing this evidence is challenging. We aimed to extend the results from an existing systematic review of interventions to improve medication adherence by using qualitative comparative analysis (QCA) to identify necessary or sufficient configurations of behavior change techniques among effective interventions. We used data from 60 studies in a completed systematic review to examine the combinations of nine behavior change techniques (increasing knowledge, increasing awareness, changing attitude, increasing self-efficacy, increasing intention formation, increasing action control, facilitation, increasing maintenance support, and motivational interviewing) among studies demonstrating improvements in adherence. Among the 60 studies, 34 demonstrated improved medication adherence. Among effective studies, increasing patient knowledge was a necessary but not sufficient technique. We identified seven configurations of behavior change techniques sufficient for improving adherence, which together accounted for 26 (76 %) of the effective studies. The intervention configuration that included increasing knowledge and self-efficacy was the most empirically relevant, accounting for 17 studies (50 %) and uniquely accounting for 15 (44 %). This analysis extends the completed review findings by identifying multiple combinations of behavior change techniques that improve adherence. Our findings offer direction for policy makers, practitioners, and future comparative effectiveness research on improving adherence.

  10. [Social media and medical apps: how they can change health communication, education and care].

    Science.gov (United States)

    Santoro, Eugenio

    2013-05-01

    Social media and medical apps for smartphones and tablets are changing health communication, education and care. This change involves physicians and other health care professionals which for their education, training and updating have started to follow public pages and profiles opened by medical journals and professional societies on the online social networking sites (such as Facebook, Twitter and Google+), to access scientific content (videos, images, slides) available on user-generated contents sites (such as SlideShare, Pinterest and YouTube) or on health professional online communities such as Sermo, and to use medical and health apps on their smartphones and tablets. As shown by a number of experiences conducted in US by health institutions such as the Centers for Disease Control and Prevention of Atlanta and hospitals such a the Mayo Clinic, these tools are also transforming the way to make health promotion activities and communication, promote healthy habits and lifestyles, and prevent chronic diseases. Finally this change involves patients which are starting to use medical and health apps on their smartphones and tablets to monitor their diseases, and tools such as Patients Like Me (an online patients' community), Facebook and Twitter to share with others the same disease experience, to learn about the disease and treatments, and to find opinions on physicians, hospitals and medical centers. These new communication tools allow users to move to a kind of collaborative education and updating where news and contents (such as public health recommendations, results of the most recent clinical researches or medical guidelines) may be shared and discussed.

  11. Riboflavin intake and 5-year blood pressure change in Chinese adults: interaction with hypertensive medication.

    Science.gov (United States)

    Shi, Zumin; Yuan, Baojun; Taylor, Anne W; Zhen, Shiqi; Zuo, Hui; Dai, Yue; Wittert, Gary A

    2014-03-01

    One previous large cross-sectional study across four countries suggests that riboflavin intake may be inversely associated with blood pressure. The aim of this analysis was to investigate a possible association between riboflavin intake and change in blood pressure over 5 years. The study population comprised Chinese men and women who participated in the Jiangsu Nutrition Study. Quantitative data relating to riboflavin intake at baseline in 2002 and measurements of blood pressure at baseline and follow-up in 2007 were available for 1,227 individuals. Overall, 97.2% of the participants had inadequate riboflavin intake (below the Estimated Average Requirement). In multivariable analysis adjusted for sociodemographic and lifestyle factors and dietary patterns, a higher riboflavin intake was inversely associated with change in systolic blood pressure (p = .036). In participants taking antihypertensive medication at baseline, the relationship between riboflavin intake and systolic blood pressure persisted; whereas, in those not taking antihypertensive medication, the diastolic blood pressure was less likely to increase with the increasing intake of riboflavin (p = .031). There was a three-way interaction between antihypertensive medications, body mass index, and riboflavin intake. Among those who were obese and taking antihypertensive medication, a higher riboflavin intake was associated with a smaller increment in systolic blood pressure and pulse pressure. There are complex interactions between riboflavin intake and blood pressure change that depend on prior antihypertensive use and the presence or absence of obesity.

  12. Medical library downsizing administrative, professional, and personal strategies for coping with change

    CERN Document Server

    Schott, Michael

    2005-01-01

    Learn how to stay ahead of the game when budgets and staff are cut Medical Library Downsizing: Administrative, Professional, and Personal Strategies for Coping with Change explores corporate downsizing and other company-wide events as they relate to medical librarians in their organization. This training manual is designed to help librarians prepare for a new era where shrinking budgets, inflated journal costs, and the increasing demand for new and expensive services now put salaries and jobs at risk. While focused on health care issues, this book will appeal to a general library audience and

  13. Challenges Faced by International Medical Students Due to Changes in Canadian Entrance Exam Policy

    Directory of Open Access Journals (Sweden)

    Pishoy Gouda

    2015-03-01

    Full Text Available The Medical Council of Canada has set new eligibility criteria for examinations that are required in order to apply to postgraduate training. This is to facilitate the establishment of the National Assessment Collaboration Objective Structured Clinical Examination. These changes result in increased hardships on Canadians studying abroad who are wishing to apply for postgraduate training in Canada. While these exams are crucial to protect medical standards and the quality of healthcare in Canada, slight modifications of the examination timelines may alleviate some of the burdens caused by these exams.

  14. CHANGING TRENDS IN LIFESTYLE BEHAVIOUR AND PHYSICAL ACTIVITY ON BODY MASS INDEX AMONG MEDICAL STUDENTS

    Directory of Open Access Journals (Sweden)

    Viji

    2016-03-01

    Full Text Available BACKGROUND Early sleep, early waking up, regular breakfast and light-to-moderate exercise all constitute healthy habits. Balanced diet, regular sleep and adequate physical activity are major factors in the promotion and maintenance of good health in human life. Regrettably these habits are not very frequent among medical students, because of exceptionally tiring schedule, protracted studies and burden of performing well in medical colleges. The study aims to correlate the trends in breakfast habits, mid-day snacking, sleeping habits and physical activity in relation to body mass index among medical students. METHOD This was a single centre cross-sectional questionnaire based study conducted at Jubilee Mission Medical College & Research Institute, Thrissur, Kerala. The target population was 1 st year MBBS students. We collected data from 234 students. The study duration was from August 2014 till September 2015. Convenient sampling was implied for the collection of data. RESULTS Mean age of participants was 20.85 ± 0.9 years, while mean BMI of participants was 24.7 ± 6.31 kg/m2. Average sleep duration was 7.1 hours ± 3.9 hours while average physical activity was 208 min/week ± 92 min/week. We observed that females (63.4% tend to skip breakfast twice more than males (27.9%. Students who had regular breakfast were found to have a lower BMI than those who did not. Moreover, those who took breakfast were found to be more physically active than those who skipped breakfast. CONCLUSION Since it was found that a regular consumption of breakfast, adequate sleep and exercise not only lowers BMI but also makes a person more physically fit. Therefore, it is recommended to start the day with a healthy breakfast having all the essential nutrients.

  15. Feeding variations and shape changes of a temperate reef clingfish during its early ontogeny

    Directory of Open Access Journals (Sweden)

    Valentina Bernal-Durán

    2017-06-01

    Full Text Available The majority of rocky reef fishes have complex life cycles, involving transition from a pelagic to a benthic environment. This means that as they grow, their morphology, behaviour and feeding habits must change. Therefore, shape changes occurring during early development of these fishes will be related to diet changes. The clingfish Sicyases sanguineus was selected for this study, because it displays a noticeable variation in shape from pelagic larvae to juvenile stage, and it is expected that diet composition will change as well. The pattern of shape changes was studied using geometric morphometrics. A set of 9 landmarks were digitized in 159 larval and juvenile fish and the same specimens were used for gut content analysis. Allometric growth was most prominent early in the ontogeny, from 4 to 12 mm. Morphology changed from a thin and hydrodynamic shape to a more robust and deeper body prior to settlement. The diet of the clingfish during larval stages showed preferences for a variety of copepod stages. As individual grows the ingested prey volume increases, but not the number and width of prey. A partial least square analysis showed low covariance between shape changes and diet composition changes in prey number and volume, suggesting that the two processes were temporally decoupled. The biggest shape changes, a lengthening of the visceral cavity and a flattening of the head, occurred up to 12 mm standard length, while the largest feeding differentiation, shifting from copepods to microalgae, occurred after 16 mm. Results suggest that shape changes precede trophic changes in this clingfish species during the transition from a pelagic to a benthic habitat.

  16. Preparing medical students to facilitate lifestyle changes with obese patients: a systematic review of the literature.

    Science.gov (United States)

    Chisholm, Anna; Hart, Jo; Mann, Karen V; Harkness, Elaine; Peters, Sarah

    2012-07-01

    Doctors will increasingly encounter opportunities to support obese patients in lifestyle change efforts, but the extent to which medical schools prepare their students for this challenge is unknown. Further, despite evidence indicating theory-based techniques are effective in facilitating patients' behavioral changes, the methods taught to medical students and the means of content delivery are unclear. The authors reviewed the literature to investigate how effective educational interventions are in preparing medical students to facilitate lifestyle changes with obese patients. The authors systematically searched Excerpta Medica (EMBASE), PsycINFO, MEDLINE, and Scopus for educational interventions on obesity management for medical students published in English between January 1990 and November 2010 and matching PICOS (Population, Interventions, Comparators, Outcomes, Study design) inclusion criteria. Results of a narrative synthesis are presented. Of 1,680 studies initially identified, 36 (2%) full-text articles were reviewed, and 12 (1%) were included in the final dataset. Eleven (92%) of these studies had quantitative designs; of these, 7 (64%) did not include control groups. Nine (75%) of the 12 studies were atheoretical, and 4 (33%) described behavior management strategies. Despite positive reported outcomes regarding intervention evaluations, procedures to control for bias were infrequently reported, and conclusions were often unsupported by evidence. Evidence from this systematic review revealed data highly susceptible to bias; thus, intervention efficacy could not be determined. Additionally, evidence-based strategies to support patients' obesity-related behavior changes were not applied to these studies, and thus it remains unknown how best to equip medical students for this task.

  17. Climate Change Decouples Drought from Early Wine Grape Harvests in France

    Science.gov (United States)

    Cook, Benjamin I.; Wolkovich, Elizabeth M.

    2016-01-01

    Across the world, wine grape phenology has advanced in recent decades, in step with climate-change-induced trends in temperature - the main driver of fruit maturation - and drought. Fully understanding how climate change contributes to changes in harvest dates, however, requires analysing wine grape phenology and its relationship to climate over a longer-term context, including data predating anthropogenic interference in the climate system. Here, we investigate the climatic controls of wine grape harvest dates from 1600-2007 in France and Switzerland using historical harvest and climate data. Early harvests occur with warmer temperatures (minus 6 days per degree Centigrade) and are delayed by wet conditions (plus 0.07 days per millimeter; plus 1.68 days per PDSI (Palmer drought severity index)) during spring and summer. In recent decades (1981-2007), however, the relationship between harvest timing and drought has broken down. Historically, high summer temperatures in Western Europe, which would hasten fruit maturation, required drought conditions to generate extreme heat. The relationship between drought and temperature in this region, however, has weakened in recent decades and enhanced warming from anthropogenic greenhouse gases can generate the high temperatures needed for early harvests without drought. Our results suggest that climate change has fundamentally altered the climatic drivers of early wine grape harvests in France, with possible ramifications for viticulture management and wine quality.

  18. Management of encopresis in early adolescence in a medical-psychiatric unit.

    Science.gov (United States)

    Fennig, S; Fennig, S

    1999-01-01

    The aim of this work is to present the role of a medical-psychiatric unit in the treatment of chronic resistant encopresis in adolescence as an effective alternative to the standard approach. Four case reports are presented. The integrative program is based on full patient cooperation and involves separating the patient from the family environment and the use of medical intervention combined with modified behavioral therapy and parental education and guidance. The patient is given full responsibility for the cure. The median full hospital stay for our patients was 2 weeks, and outcome in all cases was complete remission. This experience suggests that chronic resistant encopresis in adolescents requires a different approach from the standard because of the patient's developmental stage and the often hostile family dynamics. A medical-psychiatric setting provides an excellent management milieu and can lead to a dramatic improvement in this chronic disabling condition.

  19. Between professional autonomy and economic orientation - The medical profession in a changing health care system.

    Science.gov (United States)

    Kälble, Karl

    2005-02-17

    The current discussions surrounding the German health care system are being determined and defined by the concepts of "profitability", "efficiency" and "saving". These concepts also determine the demands made on this system and have had an effect on the medical profession. The economy's growing influence on physicians' decision-making and the increasing necessity to look at and regulate services under economic aspects arising from the need to save costs are seen by the medical profession as a threat to its autonomous conduct and freedom to make decisions, in other words it sees it as a danger to its medical orientation. Conflicts between medical autonomy and economic orientation in physicians' conduct are therefore already foreseeable, as are conflicts between medicine and economy in regards to who has the power to define the terms of the public health system. This article will outline the area of conflict based on the available literature. It will discuss how the political and economic regulatory attempts affect the medical profession's autonomous conduct. It will also discuss which conflicts of conduct emerge for physicians, what types of solutions the medical profession tends to develop as a reaction, and whether or not this tension between medical and economic orientation can be resolved in an acceptable way. This article should first outline the changed economic and political basic conditions and the attempts to reform the German health care system, using this as a starting point. Following this, it will explore the significance professional autonomy acquires within the concept of profession from the point of view of the sociology of professions. With this in mind, the third part of this article will describe and analyze the effects of advanced economization on the medical profession's autonomous conduct, which has long been regarded as uncontested. This part of the article will also describe and analyze the medical profession's strategies it uses to defend

  20. Between professional autonomy and economic orientation — The medical profession in a changing health care system

    Science.gov (United States)

    Kälble, Karl

    2005-01-01

    The current discussions surrounding the German health care system are being determined and defined by the concepts of "profitability", "efficiency" and "saving". These concepts also determine the demands made on this system and have had an effect on the medical profession. The economy's growing influence on physicians' decision-making and the increasing necessity to look at and regulate services under economic aspects arising from the need to save costs are seen by the medical profession as a threat to its autonomous conduct and freedom to make decisions, in other words it sees it as a danger to its medical orientation. Conflicts between medical autonomy and economic orientation in physicians' conduct are therefore already foreseeable, as are conflicts between medicine and economy in regards to who has the power to define the terms of the public health system. Objective: This article will outline the area of conflict based on the available literature. It will discuss how the political and economic regulatory attempts affect the medical profession's autonomous conduct. It will also discuss which conflicts of conduct emerge for physicians, what types of solutions the medical profession tends to develop as a reaction, and whether or not this tension between medical and economic orientation can be resolved in an acceptable way. Methodology: This article should first outline the changed economic and political basic conditions and the attempts to reform the German health care system, using this as a starting point. Following this, it will explore the significance professional autonomy acquires within the concept of profession from the point of view of the sociology of professions. With this in mind, the third part of this article will describe and analyze the effects of advanced economization on the medical profession's autonomous conduct, which has long been regarded as uncontested. This part of the article will also describe and analyze the medical profession

  1. Socialization, Indifference, and Convenience: Exploring the Uptake of Influenza Vaccine Among Medical Students and Early Career Doctors.

    Science.gov (United States)

    Edge, Rhiannon; Goodwin, Dawn; Isba, Rachel; Keegan, Thomas

    2017-11-01

    The Chief Medical Officer recommends that all health care workers receive an influenza vaccination annually. High vaccination coverage is believed to be the best protection against the spread of influenza within a hospital, although uptake by health care workers remains low. We conducted semistructured interviews with seven medical students and nine early career doctors, to explore the factors informing their influenza vaccination decision making. Data collection and analysis took place iteratively, until theoretical saturation was achieved, and a thematic analysis was performed. Socialization was important although its effects were attenuated by participants' previous experiences and a lack of clarity around the risks and benefits of vaccination. Many participants did not have strong intentions regarding vaccination. There was considerable disparity between an individual's opinion of the vaccine, their intentions, and their vaccination status. The indifference demonstrated here suggests few are strongly opposed to the vaccination-there is potential to increase vaccination coverage.

  2. Early transcriptional changes in cardiac mitochondria during chronic doxorubicin exposure and mitigation by dexrazoxane in mice

    Energy Technology Data Exchange (ETDEWEB)

    Vijay, Vikrant; Moland, Carrie L.; Han, Tao; Fuscoe, James C. [Personalized Medicine Branch, Division of Systems Biology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079 (United States); Lee, Taewon [Department of Mathematics, Korea University, Sejong (Korea, Republic of); Herman, Eugene H. [Toxicology and Pharmacology Branch, Developmental Therapeutics Program, Division of Cancer Treatment and Diagnosis, The National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850-9734 (United States); Jenkins, G. Ronald [Personalized Medicine Branch, Division of Systems Biology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079 (United States); Lewis, Sherry M. [Office of Scientific Coordination, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079 (United States); Cummings, Connie A. [UltraPath Imaging, 2228 Page Road, Durham, NC 27703 (United States); Gao, Yuan; Cao, Zhijun; Yu, Li-Rong [Biomarkers and Alternative Models Branch, Division of Systems Biology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079 (United States); Desai, Varsha G., E-mail: varsha.desai@fda.hhs.gov [Personalized Medicine Branch, Division of Systems Biology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079 (United States)

    2016-03-15

    Identification of early biomarkers of cardiotoxicity could help initiate means to ameliorate the cardiotoxic actions of clinically useful drugs such as doxorubicin (DOX). Since DOX has been shown to target mitochondria, transcriptional levels of mitochondria-related genes were evaluated to identify early candidate biomarkers in hearts of male B6C3F{sub 1} mice given a weekly intravenous dose of 3 mg/kg DOX or saline (SAL) for 2, 3, 4, 6, or 8 weeks (6, 9, 12, 18, or 24 mg/kg cumulative DOX doses, respectively). Also, a group of mice was pretreated (intraperitoneally) with the cardio-protectant, dexrazoxane (DXZ; 60 mg/kg) 30 min before each weekly dose of DOX or SAL. At necropsy a week after the last dose, increased plasma concentrations of cardiac troponin T (cTnT) were detected at 18 and 24 mg/kg cumulative DOX doses, whereas myocardial alterations were observed only at the 24 mg/kg dose. Of 1019 genes interrogated, 185, 109, 140, 184, and 451 genes were differentially expressed at 6, 9, 12, 18, and 24 mg/kg cumulative DOX doses, respectively, compared to concurrent SAL-treated controls. Of these, expression of 61 genes associated with energy metabolism and apoptosis was significantly altered before and after occurrence of myocardial injury, suggesting these as early genomics markers of cardiotoxicity. Much of these DOX-induced transcriptional changes were attenuated by pretreatment of mice with DXZ. Also, DXZ treatment significantly reduced plasma cTnT concentration and completely ameliorated cardiac alterations induced by 24 mg/kg cumulative DOX. This information on early transcriptional changes during DOX treatment may be useful in designing cardioprotective strategies targeting mitochondria. - Highlights: • Altered mitochondria-related gene expression before heart injury by doxorubicin • Dexrazoxane mitigated doxorubicin-induced early expression changes in mitochondria. • Dexrazoxane completely ameliorated doxorubicin-induced pathology in mouse heart.

  3. Big Five personality stability, change, and codevelopment across adolescence and early adulthood.

    Science.gov (United States)

    Borghuis, Jeroen; Denissen, Jaap J A; Oberski, Daniel; Sijtsma, Klaas; Meeus, Wim H J; Branje, Susan; Koot, Hans M; Bleidorn, Wiebke

    2017-10-01

    Using data from 2 large and overlapping cohorts of Dutch adolescents, containing up to 7 waves of longitudinal data each (N = 2,230), the present study examined Big Five personality trait stability, change, and codevelopment in friendship and sibling dyads from age 12 to 22. Four findings stand out. First, the 1-year rank-order stability of personality traits was already substantial at age 12, increased strongly from early through middle adolescence, and remained rather stable during late adolescence and early adulthood. Second, we found linear mean-level increases in girls' conscientiousness, in both genders' agreeableness, and in boys' openness. We also found temporal dips (i.e., U-shaped mean-level change) in boys' conscientiousness and in girls' emotional stability and extraversion. We did not find a mean-level change in boys' emotional stability and extraversion, and we found an increase followed by a decrease in girls' openness. Third, adolescents showed substantial individual differences in the degree and direction of personality trait changes, especially with respect to conscientiousness, extraversion, and emotional stability. Fourth, we found no evidence for personality trait convergence, for correlated change, or for time-lagged partner effects in dyadic friendship and sibling relationships. This lack of evidence for dyadic codevelopment suggests that adolescent friends and siblings tend to change independently from each other and that their shared experiences do not have uniform influences on their personality traits. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  4. Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population.

    Science.gov (United States)

    Dyrbye, Liselotte N; West, Colin P; Satele, Daniel; Boone, Sonja; Tan, Litjen; Sloan, Jeff; Shanafelt, Tait D

    2014-03-01

    To compare the prevalence of burnout and other forms of distress across career stages and the experiences of trainees and early career (EC) physicians versus those of similarly aged college graduates pursuing other careers. In 2011 and 2012, the authors conducted a national survey of medical students, residents/fellows, and EC physicians (≤ 5 years in practice) and of a probability-based sample of the general U.S. population. All surveys assessed burnout, symptoms of depression and suicidal ideation, quality of life, and fatigue. Response rates were 35.2% (4,402/12,500) for medical students, 22.5% (1,701/7,560) for residents/fellows, and 26.7% (7,288/27,276) for EC physicians. In multivariate models that controlled for relationship status, sex, age, and career stage, being a resident/fellow was associated with increased odds of burnout and being a medical student with increased odds of depressive symptoms, whereas EC physicians had the lowest odds of high fatigue. Compared with the population control samples, medical students, residents/fellows, and EC physicians were more likely to be burned out (all P prevalence of burnout, depressive symptoms, and recent suicidal ideation are relatively small. At each stage, burnout is more prevalent among physicians than among their peers in the U.S. population.

  5. The influence of labor market changes on first-time medical school applicant pools.

    Science.gov (United States)

    Cort, David A; Morrison, Emory

    2014-12-01

    To explore whether the number and composition of first-time applicants to U.S. MD-granting medical schools, which have fluctuated over the past 30 years, are related to changes in labor market strength, specifically the unemployment rate and wages. The authors merged time series data from 1980 through 2010 (inclusive) from five sources and used multivariate time series models to determine whether changes in labor market strength (and several other macro-level factors) were related to the number of the medical school applicants as reported by the American Medical College Application Service. Analyses were replicated across specific sex and race/ethnicity applicant pools. Two results surfaced in the analyses. First, the strength of the labor market was not influential in explaining changes in applicant pool sizes for all applicants, but was strongly influential in explaining changes for black and Hispanic males. Increases of $1,000 in prevailing median wages produced a 1.6% decrease in the white male applicant pool, while 1% increases in the unemployment rate were associated with 4.5% and 3.1% increases in, respectively, the black and Hispanic male applicant pools. Second, labor market strength was a more important determinant in applications from males than in applications from females. Although stakeholders cannot directly influence the overall economic market, they can plan and prepare for fewer applications from males, especially those who are black and Hispanic, when the labor market is strong.

  6. Implementing competency-based medical education: What changes in curricular structure and processes are needed?

    Science.gov (United States)

    Nousiainen, Markku T; Caverzagie, Kelly J; Ferguson, Peter C; Frank, Jason R

    2017-06-01

    Medical educators must prepare for a number of challenges when they decide to implement a competency-based curriculum. Many of these challenges will pertain to three key aspects of implementation: organizing the structural changes that will be necessary to deliver new curricula and methods of assessment; modifying the processes of teaching and evaluation; and helping to change the culture of education so that the CBME paradigm gains acceptance. This paper focuses on nine key considerations that will support positive change in first two of these areas. Key considerations include: ensuring that educational continuity exists amongst all levels of medical education, altering how time is used in medical education, involving CBME in human health resources planning, ensuring that competent doctors work in competent health care systems, ensuring that information technology supports CBME, ensuring that faculty development is supported, ensuring that the rights and responsibilities of the learner are appropriately balanced in the workplace, preparing for the costs of change, and having appropriate leadership in order to achieve success in implementation.

  7. Integrating nutrition education into the cardiovascular curriculum changes eating habits of second-year medical students.

    Science.gov (United States)

    Vargas, Eric J; Zelis, Robert

    2014-01-01

    Survey of medical curricula continues to show that nutrition education is not universally adequate. One measure of nutritional educational competence is a positive change in student eating habits. The objective of this study was to evaluate whether integrating nutrition education within the second-year cardiovascular course for medical students, using the "Rate Your Plate" (RYP) questionnaire, coupled with knowledge of student personal 30-year risk of a cardiovascular event was useful in changing students' eating behaviors. Thirty-two students completed an unpublished 24-item questionnaire (modified-RYP) about their eating habits in the spring of their first year. The same students then completed the questionnaire in the spring of their second year. Paired t test was used to analyze the difference in RYP scores. Pearson correlation coefficients were calculated for the Framingham 30-year cardiovascular event risk and change in RYP score to examine whether risk knowledge may have changed eating habits. Mean scores at baseline and 1 year later were 57.19 and 58.97, respectively (paired t test, P eating healthy at baseline, integration of nutrition education within the second-year cardiovascular medical curriculum was associated with improved heart healthy eating habits. Because student attitudes about prevention counseling are influenced by personal eating habits, this suggests that students with a more healthy diet will be more likely to recommend the same for their patients. Copyright © 2014 National Lipid Association. Published by Elsevier Inc. All rights reserved.

  8. Accuracy of Assessment of Eligibility for Early Medical Abortion by Community Health Workers in Ethiopia, India and South Africa.

    Science.gov (United States)

    Johnston, Heidi Bart; Ganatra, Bela; Nguyen, My Huong; Habib, Ndema; Afework, Mesganaw Fantahun; Harries, Jane; Iyengar, Kirti; Moodley, Jennifer; Lema, Hailu Yeneneh; Constant, Deborah; Sen, Swapnaleen

    2016-01-01

    To assess the accuracy of assessment of eligibility for early medical abortion by community health workers using a simple checklist toolkit. Diagnostic accuracy study. Ethiopia, India and South Africa. Two hundred seventeen women in Ethiopia, 258 in India and 236 in South Africa were enrolled into the study. A checklist toolkit to determine eligibility for early medical abortion was validated by comparing results of clinician and community health worker assessment of eligibility using the checklist toolkit with the reference standard exam. Accuracy was over 90% and the negative likelihood ratio India and 6.3 in South Africa. When used by community health workers the overall accuracy of the toolkit was 92% in Ethiopia, 80% in India and 77% in South Africa negative likelihood ratios were 0.08 in Ethiopia, 0.25 in India and 0.22 in South Africa and positive likelihood ratios were 5.9 in Ethiopia and 2.0 in India and South Africa. The checklist toolkit, as used by clinicians, was excellent at ruling out participants who were not eligible, and moderately effective at ruling in participants who were eligible for medical abortion. Results were promising when used by community health workers particularly in Ethiopia where they had more prior experience with use of diagnostic aids and longer professional training. The checklist toolkit assessments resulted in some participants being wrongly assessed as eligible for medical abortion which is an area of concern. Further research is needed to streamline the components of the tool, explore optimal duration and content of training for community health workers, and test feasibility and acceptability.

  9. Value of multi-criteria decision analysis in early assessment of medical diagnostic devices

    NARCIS (Netherlands)

    IJzerman, Maarten Joost; Hummel, J. Marjan

    2010-01-01

    OBJECTIVES: Multicriteria decision analytic (MCDA) techniques are a powerful tool in evaluating health care interventions where multiple, often competing, factors need to be considered. The analytic hierarchy process (AHP) is one such technique. We have applied AHP to evaluate medical diagnostic

  10. Early fault detection using design models for collision prevention in medical equipment

    NARCIS (Netherlands)

    Mooij, A.J.; Hooman, J.; Albers, R.

    2013-01-01

    In the medical domain there is a tension between the requested speed of innovation and the time needed to deliver a certifiable system. To ensure the required safety, usually a long test and integration phase is needed. To shorten this phase and to avoid late bug fixing, the aim is to detect faults

  11. Early Seizure Frequency and Aetiology Predict Long-Term Medical Outcome in Childhood-Onset Epilepsy

    Science.gov (United States)

    Sillanpaa, Matti; Schmidt, Dieter

    2009-01-01

    In clinical practice, it is important to predict as soon as possible after diagnosis and starting treatment, which children are destined to develop medically intractable seizures and be at risk of increased mortality. In this study, we determined factors predictive of long-term seizure and mortality outcome in a population-based cohort of 102…

  12. Forests and Phenology: Designing the Early Warning System to Understand Forest Change

    Science.gov (United States)

    Pierce, T.; Phillips, M. B.; Hargrove, W. W.; Dobson, G.; Hicks, J.; Hutchins, M.; Lichtenstein, K.

    2010-12-01

    Vegetative phenology is the study of plant development and changes with the seasons, such as the greening-up and browning-down of forests, and how these events are influenced by variations in climate. A National Phenology Data Set, based on Moderate Resolution Imaging Spectroradiometer satellite images covering 2002 through 2009, is now available from work by NASA, the US Forest Service, and Oak Ridge National Laboratory. This new data set provides an easily interpretable product useful for detecting changes to the landscape due to long-term factors such as climate change, as well as finding areas affected by short-term forest threats such as insects or disease. The Early Warning System (EWS) is a toolset being developed by the US Forest Service and the University of North Carolina-Asheville to support distribution and use of the National Phenology Data Set. The Early Warning System will help research scientists, US Forest Service personnel, forest and natural resources managers, decision makers, and the public in the use of phenology data to better understand unexpected change within our nation’s forests. These changes could have multiple natural sources such as insects, disease, or storm damage, or may be due to human-induced events, like thinning, harvest, forest conversion to agriculture, or residential and commercial use. The primary goal of the Early Warning System is to provide a seamless integration between monitoring, detection, early warning and prediction of these forest disturbances as observed through phenological data. The system consists of PC and web-based components that are structured to support four user stages of increasing knowledge and data sophistication. Building Literacy: This stage of the Early Warning System educates potential users about the system, why the system should be used, and the fundamentals about the data the system uses. The channels for this education include a website, interactive tutorials, pamphlets, and other technology

  13. Implicit and Explicit Weight Bias in a National Sample of 4732 Medical Students: The Medical Student CHANGES Study

    OpenAIRE

    Phelan, Sean M.; Dovidio, John F.; Puhl, Rebecca M.; Burgess, Diana J.; Nelson, David B.; Yeazel, Mark W.; Hardeman, Rachel; Perry, Sylvia; van Ryn, Michelle

    2014-01-01

    Objective To examine the magnitude of explicit and implicit weight biases compared to biases against other groups; and identify student factors predicting bias in a large national sample of medical students. Design and Methods A web-based survey was completed by 4732 1st year medical students from 49 medical schools as part of a longitudinal study of medical education. The survey included a validated measure of implicit weight bias, the implicit association test, and 2 measures of explicit bi...

  14. Defining smallness for gestational age in the early years of the Danish Medical Birth Registry

    DEFF Research Database (Denmark)

    á Rogvi, Rasmus; Mathiasen, Rene; Greisen, Gorm

    2011-01-01

    , but due to variable data quality, data is most often used only from 1981 onwards, and birth registers in other countries may have similar problems for the early years. We wanted to examine whether the data can be used for identification of children born SGA and used in future research....

  15. Medical Complications of the Critically Ill Newborn: A Review for Early Intervention Professionals.

    Science.gov (United States)

    McNab, Theresa C.; Blackman, James A.

    1998-01-01

    Provides early-intervention professionals with a basic familiarity and understanding of some of the newest technologies employed in the neonatal intensive care units for neonates with respiratory distress syndrome, persistent fetal circulation, retinopathy of prematurity, intraventricular hemorrhage, and periventricular leukomalacia. Early…

  16. Contacto precoz con la realidad asistencial: una experiencia piloto en medicina Early contact with medical practice: a pilot experience in medical students

    Directory of Open Access Journals (Sweden)

    J.E. Baños

    2011-03-01

    Full Text Available Introducción: Varios estudios han sugerido que el contacto precoz del estudiante de medicina con la realidad asistencial puede tener unos efectos beneficiosos sobre su motivación, el conocimiento de la relación médico-paciente y la aceptación de la importancia de las materias médicas básicas. En el nuevo grado conjunto de Medicina de la Universitat Autònoma de Barcelona y la Universitat Pompeu Fabra se ha incorporado una asignatura denominada 'Prácticas de Grado' que se imparte durante los tres primeros años, destinada a permitir el contacto de los estudiantes con la asistencia primaria, los equipos de enfermería y los centros sociosanitarios. El presente artículo describe la experiencia y la opinión de los estudiantes que la cursaron durante el primer año. Materiales y métodos: El artículo describe las características académicas de la asignatura. Se realizó una encuesta a los estudiantes al finalizar la asignatura para evaluar su grado de satisfacción y su percepción sobre el cumplimiento de los objetivos y las competencias que debían alcanzarse. Resultados: Existió una elevada satisfacción con la nueva actividad y una percepción entre los estudiantes de que las competencias preestablecidas se habían alcanzado en su mayor parte. Conclusión: El contacto precoz con la realidad asistencial es un elemento esencial para la comprensión de la actividad médica por los estudiantes de medicina de primer año.Introduction: Several studies have suggested that early contact of medical students with medical care may have beneficial effects on their motivation, knowledge of doctor-patient relationship and acceptance of the interest of biomedical sciences. In the new joint degree of Medicine of Autonomous University of Barcelona and Pompeu Fabra University we have incorporated the subject 'Prácticas de Grado' during the first three years. It is devoted to permit the early contact of medical students with primary care, nursing

  17. Examining changes in certification/licensure requirements and the international medical graduate examinee pool.

    Science.gov (United States)

    McKinley, Danette W; Hess, Brian J; Boulet, John R; Lipner, Rebecca S

    2014-03-01

    Changes in certification requirements and examinee characteristics are likely to influence the validity of the evidence associated with interpretations made based on test data. We examined whether changes in Educational Commission for Foreign Medical Graduates (ECFMG) certification requirements over time were associated with changes in internal medicine (IM) residency program director ratings and certification examination scores. Comparisons were made between physicians who were ECFMG-certified before and after the Clinical Skills Assessment (CSA) requirement. A multivariate analysis of covariance was conducted to examine the differences in program director ratings based on CSA cohort and whether the examinees emigrated for undergraduate medical education (national vs. international students). A univariate analysis of covariance was conducted to examine differences in scores from the American Board of Internal Medicine (ABIM) Internal Medicine Certification Examination. For both analyses, United States Medical Licensing Examination (USMLE) Step 1 and Step 2 scores were used as covariates. Results indicate that, of those certified by ECFMG between 1993 and 1997, 17 % (n = 1,775) left their country of citizenship for undergraduate medical education. In contrast, 38 % (n = 1,874) of those certified between 1999 and 2003 were international students. After adjustment by covariates, the main effect of cohort membership on the program director ratings was statistically significant (Wilks' λ = 0.99, F 5, 15391 = 19.9, P migration status was statistically significant and weak (Wilks' λ = 0.98, F 5,15391 = 45.3, P Internal Medicine Certification Examination scores based on whether or not CSA were required was statistically significant, although the magnitude of the association between these variables was very small. The findings suggest that the implementation of an additional evaluation of skills (e.g., history-taking, physical examination) as a

  18. Big Five personality stability, change, and co-development across adolescence and early adulthood

    OpenAIRE

    Borghuis, J.; Denissen, J.J.A.; Oberski, D.L.; Sijtsma, K.; Meeus, W.H.J.; Branje, S; Koot, H.M.; Bleidorn, Wiebke

    2017-01-01

    Using data from 2 large and overlapping cohorts of Dutch adolescents, containing up to 7 waves of longitudinal data each (N = 2,230), the present study examined Big Five personality trait stability, change, and codevelopment in friendship and sibling dyads from age 12 to 22. Four findings stand out. First, the 1-year rank-order stability of personality traits was already substantial at age 12, increased strongly from early through middle adolescence, and remained rather stable during late ado...

  19. Progressive changes in arch width from primary to early mixed dentition period: A longitudinal study

    OpenAIRE

    S Sangwan; H S Chawla; A Goyal; K Gauba; U Mohanty

    2011-01-01

    Objective: The present study was conducted to evaluate, on a longitudinal basis, the changes in intercanine and intermolar widths form the primary to the early mixed dentition periods. Materials and Methods: A total of 38 children aged 4-5 years, with normal occlusion without any proximal caries or any dental anomalies, were selected. The impressions were recorded and casts were prepared. Intercanine and intermolar widths were measured on these dental casts with the help of a digital vernier ...

  20. Early Changes of Articular Cartilage and Subchondral Bone in The DMM Mouse Model of Osteoarthritis

    OpenAIRE

    Fang, Hang; Huang, Lisi; Welch, Ian; Norley, Chris; Holdsworth, David W.; Beier, Frank; Cai, Daozhang

    2018-01-01

    To examine the early changes of articular cartilage and subchondral bone in the DMM mouse model of osteoarthritis, mice were subjected to DMM or SHAM surgery and sacrificed at 2-, 5- and 10-week post-surgery. Catwalk gait analyses, Micro-Computed Tomography, Toluidine Blue, Picrosirius Red and Tartrate-Resistant Acid Phosphatase (TRAP) staining were used to investigate gait patterns, joint morphology, subchondral bone, cartilage, collagen organization and osteoclasts activity, respectively. R...

  1. Perianal disease, small bowel disease, smoking, prior steroid or early azathioprine/biological therapy are predictors of disease behavior change in patients with Crohn’s disease

    Science.gov (United States)

    Lakatos, Peter Laszlo; Czegledi, Zsofia; Szamosi, Tamas; Banai, Janos; David, Gyula; Zsigmond, Ferenc; Pandur, Tunde; Erdelyi, Zsuzsanna; Gemela, Orsolya; Papp, Janos; Lakatos, Laszlo

    2009-01-01

    AIM: To assess the combined effect of disease phenotype, smoking and medical therapy [steroid, azathioprine (AZA), AZA/biological therapy] on the probability of disease behavior change in a Caucasian cohort of patients with Crohn’s disease (CD). METHODS: Three hundred and forty well-characterized, unrelated, consecutive CD patients were analyzed (M/F: 155/185, duration: 9.4 ± 7.5 years) with a complete clinical follow-up. Medical records including disease phenotype according to the Montreal classification, extraintestinal manifestations, use of medications and surgical events were analyzed retrospectively. Patients were interviewed on their smoking habits at the time of diagnosis and during the regular follow-up visits. RESULTS: A change in disease behavior was observed in 30.8% of patients with an initially non-stricturing, non-penetrating disease behavior after a mean disease duration of 9.0 ± 7.2 years. In a logistic regression analysis corrected for disease duration, perianal disease, smoking, steroid use, early AZA or AZA/biological therapy use were independent predictors of disease behavior change. In a subsequent Kaplan-Meier survival analysis and a proportional Cox regression analysis, disease location (P = 0.001), presence of perianal disease (P < 0.001), prior steroid use (P = 0.006), early AZA (P = 0.005) or AZA/biological therapy (P = 0.002), or smoking (P = 0.032) were independent predictors of disease behavior change. CONCLUSION: Our data suggest that perianal disease, small bowel disease, smoking, prior steroid use, early AZA or AZA/biological therapy are all predictors of disease behavior change in CD patients. PMID:19630105

  2. Perianal disease, small bowel disease, smoking, prior steroid or early azathioprine/biological therapy are predictors of disease behavior change in patients with Crohn's disease.

    Science.gov (United States)

    Lakatos, Peter Laszlo; Czegledi, Zsofia; Szamosi, Tamas; Banai, Janos; David, Gyula; Zsigmond, Ferenc; Pandur, Tunde; Erdelyi, Zsuzsanna; Gemela, Orsolya; Papp, Janos; Lakatos, Laszlo

    2009-07-28

    To assess the combined effect of disease phenotype, smoking and medical therapy [steroid, azathioprine (AZA), AZA/biological therapy] on the probability of disease behavior change in a Caucasian cohort of patients with Crohn's disease (CD). Three hundred and forty well-characterized, unrelated, consecutive CD patients were analyzed (M/F: 155/185, duration: 9.4 +/- 7.5 years) with a complete clinical follow-up. Medical records including disease phenotype according to the Montreal classification, extraintestinal manifestations, use of medications and surgical events were analyzed retrospectively. Patients were interviewed on their smoking habits at the time of diagnosis and during the regular follow-up visits. A change in disease behavior was observed in 30.8% of patients with an initially non-stricturing, non-penetrating disease behavior after a mean disease duration of 9.0 +/- 7.2 years. In a logistic regression analysis corrected for disease duration, perianal disease, smoking, steroid use, early AZA or AZA/biological therapy use were independent predictors of disease behavior change. In a subsequent Kaplan-Meier survival analysis and a proportional Cox regression analysis, disease location (P = 0.001), presence of perianal disease (P < 0.001), prior steroid use (P = 0.006), early AZA (P = 0.005) or AZA/biological therapy (P = 0.002), or smoking (P = 0.032) were independent predictors of disease behavior change. Our data suggest that perianal disease, small bowel disease, smoking, prior steroid use, early AZA or AZA/biological therapy are all predictors of disease behavior change in CD patients.

  3. Determination of minimal clinically important change in early and advanced Parkinson's disease.

    Science.gov (United States)

    Hauser, Robert A; Auinger, Peggy

    2011-04-01

    Two common primary efficacy outcome measures in Parkinson's disease (PD) are change in Unified Parkinson's Disease Rating Scale (UPDRS) scores in early PD and change in "off" time in patients with motor fluctuations. Defining the minimal clinically important change (MCIC) in these outcome measures is important to interpret the clinical relevance of changes observed in clinical trials and other situations. We analyzed data from 2 multicenter, placebo-controlled, randomized clinical trials of rasagiline; TEMPO studied 404 early PD subjects, and PRESTO studied 472 levodopa-treated subjects with motor fluctuations. An anchor-based approach using clinical global impression of improvement (CGI-I) was used to determine MCIC for UPDRS scores and daily "off" time. MCIC was defined as mean change in actively treated subjects rated minimally improved on CGI-I. Receiver operating characteristic (ROC) curves defined optimal cutoffs discriminating between changed and unchanged subjects. MCIC for improvement in total UPDRS score (parts I-III) in early PD was determined to be -3.5 points based on mean scores and -3.0 points based on ROC curves. In addition, we found an MCIC for reduction in "off" time of 1.0 hours as defined by mean reduction in "off" time in active treated subjects self-rated as minimally improved on CGI-I minus mean reduction in "off" time in placebo-treated subjects self-rated as unchanged (1.9-0.9 hours). We hypothesize that many methodological factors can influence determination of the MCIC, and a range of values is likely to emerge from multiple studies. Copyright © 2011 Movement Disorder Society.

  4. Early behavioral changes and quantitative analysis of neuropathological features in murine prion disease

    Science.gov (United States)

    Borner, Roseane; Bento-Torres, João; Souza, Diego RV; Sadala, Danyelle B; Trevia, Nonata; Farias, José Augusto; Lins, Nara; Passos, Aline; Quintairos, Amanda; Diniz, José Antônio; Perry, Victor Hugh; Vasconcelos, Pedro Fernando; Cunningham, Colm

    2011-01-01

    Behavioral and neuropathological changes have been widely investigated in murine prion disease but stereological based unbiased estimates of key neuropathological features have not been carried out. After injections of ME7 infected (ME7) or normal brain homogenates (NBH) into dorsal CA1 of albino Swiss mice and C57BL6, we assessed behavioral changes on hippocampal-dependent tasks. We also estimated by optical fractionator at 15 and 18 weeks post-injections (w.p.i.) the total number of neurons, reactive astrocytes, activated microglia and perineuronal nets (PN) in the polymorphic layer of dentate gyrus (PolDG), CA1 and septum in albino Swiss mice. On average, early behavioral changes in albino Swiss mice start four weeks later than in C57BL6. Cluster and discriminant analysis of behavioral data in albino Swiss mice revealed that four of nine subjects start to change their behavior at 12 w.p.i. and reach terminal stage at 22 w.p.i and the remaining subjects start at 22 w.p.i. and reach terminal stage at 26 w.p.i. Biotinylated dextran-amine BDA-tracer experiments in mossy fiber pathway confirmed axonal degeneration and stereological data showed that early astrocytosis, microgliosis and reduction in the perineuronal nets are independent of a change in the number of neuronal cell bodies. Statistical analysis revealed that the septal region had greater levels of neuroinflammation and extracellular matrix damage than CA1. This stereological and multivariate analysis at early stages of disease in an outbred model of prion disease provided new insights connecting behavioral changes and neuroinflammation and seems to be important to understand the mechanisms of prion disease progression. PMID:21862877

  5. Early diagnosis of myocardial infarction using absolute and relative changes in cardiac troponin concentrations.

    Science.gov (United States)

    Irfan, Affan; Reichlin, Tobias; Twerenbold, Raphael; Meister, Marc; Moehring, Berit; Wildi, Karin; Bassetti, Stefano; Zellweger, Christa; Gimenez, Maria Rubini; Hoeller, Rebeca; Murray, Karsten; Sou, Seoung Mann; Mueller, Mira; Mosimann, Tamina; Reiter, Miriam; Haaf, Philip; Ziller, Ronny; Freidank, Heike; Osswald, Stefan; Mueller, Christian

    2013-09-01

    Absolute changes in high-sensitivity cardiac troponin T (hs-cTnT) seem to have higher diagnostic accuracy in the early diagnosis of acute myocardial infarction compared with relative changes. It is unknown whether the same applies to high-sensitivity cardiac troponin I (hs-cTnI) assays and whether the combination of absolute and relative change might further increase accuracy. In a prospective, international multicenter study, high-sensitivity cardiac troponin (hs-cTn) was measured with 3 novel assays (hs-cTnT, Roche Diagnostics Corp, Indianapolis, Ind; hs-cTnI, Beckman Coulter Inc, Brea, Calif; hs-cTnI, Siemens, Munich, Germany) in a blinded fashion at presentation and after 1 and 2 hours in a blinded fashion in 830 unselected patients with suspected acute myocardial infarction. The final diagnosis was adjudicated by 2 independent cardiologists. The area under the receiver operating characteristic curve for diagnosing acute myocardial infarction was significantly higher for 1- and 2-hour absolute versus relative hs-cTn changes for all 3 assays (P Siemens, 0.96 [95% CI, 0.93-0.99]) were high and provided some benefit compared with the use of absolute change alone for hs-cTnT, but not for the hs-cTnI assays. Reclassification analysis confirmed the superiority of absolute changes versus relative changes. Absolute changes seem to be the preferred metrics for both hs-cTnT and hs-cTnI in the early diagnosis of acute myocardial infarction. The combination of absolute and relative changes provides a small added value for hs-cTnT, but not for hs-cTnI. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. Socrates was not a pimp: changing the paradigm of questioning in medical education.

    Science.gov (United States)

    Kost, Amanda; Chen, Frederick M

    2015-01-01

    The slang term "pimping" is widely recognized by learners and educators in the clinical learning environment as the act of more senior members of the medical team publicly asking questions of more junior members. Although questioning as a pedagogical practice has many benefits, pimping, as described in the literature, evokes negative emotions in learners and leads to an environment that is not conducive to adult learning. Medical educators may employ pimping as a pedagogic technique because of beliefs that it is a Socratic teaching method. Although problems with pimping have previously been identified, no alternative techniques for questioning in the clinical environment were suggested. The authors posit that using the term "pimping" to describe questioning in medical education is harmful and unprofessional, and they propose clearly defining pimping as "questioning with the intent to shame or humiliate the learner to maintain the power hierarchy in medical education." Explicitly separating pimping from the larger practice of questioning allows the authors to make three recommendations for improving questioning practices. First, educators should examine the purpose of each question they pose to learners. Second, they should apply historic and modern interpretations of Socratic teaching methods that promote critical thinking skills. Finally, they should consider adult learning theories to make concrete changes to their questioning practices. These changes can result in questioning that is more learner centered, aids in the acquisition of knowledge and skills, performs helpful formative and summative assessments of the learner, and improves community in the clinical learning environment.

  7. Lessons learned from a pharmacy practice model change at an academic medical center.

    Science.gov (United States)

    Knoer, Scott J; Pastor, John D; Phelps, Pamela K

    2010-11-01

    The development and implementation of a new pharmacy practice model at an academic medical center are described. Before the model change, decentralized pharmacists responsible for order entry and verification and clinical specialists were both present on the care units. Staff pharmacists were responsible for medication distribution and sterile product preparation. The decentralized pharmacists handling orders were not able to use their clinical training, the practice model was inefficient, and few clinical services were available during evenings and weekends. A task force representing all pharmacy department roles developed a process and guiding principles for the model change, collected data, and decided on a model. Teams consisting of decentralized pharmacists, decentralized pharmacy technicians, and team leaders now work together to meet patients' pharmacy needs and further departmental safety, quality, and cost-saving goals. Decentralized service hours have been expanded through operational efficiencies, including use of automation (e.g., computerized provider order entry, wireless computers on wheels used during rounds with physician teams). Nine clinical specialist positions were replaced by five team leader positions and four pharmacists functioning in decentralized roles. Additional staff pharmacist positions were shifted into decentralized roles, and the hospital was divided into areas served by teams including five to eight pharmacists. Technicians are directly responsible for medication distribution. No individual's job was eliminated. The new practice model allowed better alignment of staff with departmental goals, expanded pharmacy hours and services, more efficient medication distribution, improved employee engagement, and a staff succession plan.

  8. The diagnostic value of sacroiliac CT for detecting early changes of ankylosing spondylitis

    Energy Technology Data Exchange (ETDEWEB)

    Park, Ju Hyun; Park, Ji Seon; Ryu, Kyung Nam [Kyunghee University Medical Center, Seoul (Korea, Republic of); Jin, Wook [East-West Neo Medical Center, Seoul (Korea, Republic of)

    2007-02-15

    We wanted to evaluate the diagnostic value of the various findings on sacroiliac CT for detecting the early changes of ankylosing spondylitis (AS). Between April 2005 and March 2006, 51 sacroiliac CT images with the clinical suspicion of AS, but no definite evidence of AS on the plain radiograph only, were retrospectively reviewed. Finally, 36 patients (mean age: 28.6 years; 34 males and 2 females), who were clinically diagnosed as AS (AS group, n = 26) or they had no evidence of AS (non-AS group, n = 10), were evaluated. Two musculoskeletal radiologists analyzed the presence of marginal irregularity, bony erosion and subchondral sclerosis. A statistical analysis was performed to evaluate the incidence, sensitivity and specificity of each finding. Marginal irregularity was seen in 21 of 26 AS subjects, and in 8 of 10 non-AS subjects. Bony erosion was only seen in 13 of 26 AS subjects. Subchondral sclerosis was observed in 19 of 26 AS subjects and in 8 of 10 non-AS subjects. The sensitivity/specificity for each findings were 72.4%/28.6%, 100%/43.5% and 70.4%/22.2%, respectively. Except for bony erosions, these results showed no statistical significance ({rho} = .006). Bony erosion on CT is a very sensitive finding for the early changes of AS, whereas marginal irregularity or subchondral sclerosis is not so helpful in differentiating AS from non-AS. Attention to these results may further enhance the accurate diagnosis of the early changes in AS.

  9. Impacts of Early Summer Eurasian Snow Cover Change on Atmospheric Circulation in Northern Mid-Latitudes

    Science.gov (United States)

    Nozawa, T.

    2016-12-01

    Recently, Japan Aerospace Exploration Agency (JAXA) has developed a new long-term snow cover extent (SCE) product using Advanced Very High Resolution Radiometer (AVHRR) and Moderate Resolution Imaging Spectroradiometer (MODIS) data spanning from 1980's to date. This new product (JAXA/SCE) has higher spatial resolution and smaller commission error compared with traditional SCE dataset of National Oceanic and Atmospheric Administration (NOAA/SCE). Continuity of the algorithm is another strong point in JAXA/SCE. According to the new JAXA/SCE dataset, the Eurasian SCE has been significantly retreating since 1980's, especially in late spring and early summer. Here, we investigate impacts of early summer Eurasian snow cover change on atmospheric circulation in Northern mid-latitudes, especially over the East Asia, using the new JAXA/SCE dataset and a few reanalysis data. We will present analyzed results on relationships between early summer SCE anomaly over the Eurasia and changes in atmospheric circulations such as upper level zonal jets (changes in strength, positions, etc.) over the East Asia.

  10. Early changes of lymphocyte RNA and serum immunoglobulins following chronic exposure to benzene

    Energy Technology Data Exchange (ETDEWEB)

    Chircu, V.; Ionescu, M.; Zgoan

    Hematologic and immunochemical investigations carried out in 270 workers with chronic exposure to benzene demonstrated changes of the nucleologram and of the area of lymphocyte nucleoli as well as disorders of the humoral immune response revealed by radial immunodiffusion. The numerical rise of bi- and polynucleolated cells, of cells with irregular macronucleoli as well as an enlargement of the nucleolar area are assumed to reflect an increase of the endolymphocytic amounts of RNA. An increased capacity of immunoglobulin formation, particularly of IgM, was also observed. All these changes are considered as early signs of an enhanced immune reactivity following chronic exposure to benzene.

  11. Changes in oscillatory dynamics in the cell cycle of early Xenopus laevis embryos.

    Directory of Open Access Journals (Sweden)

    Tony Y-C Tsai

    2014-02-01

    Full Text Available During the early development of Xenopus laevis embryos, the first mitotic cell cycle is long (∼85 min and the subsequent 11 cycles are short (∼30 min and clock-like. Here we address the question of how the Cdk1 cell cycle oscillator changes between these two modes of operation. We found that the change can be attributed to an alteration in the balance between Wee1/Myt1 and Cdc25. The change in balance converts a circuit that acts like a positive-plus-negative feedback oscillator, with spikes of Cdk1 activation, to one that acts like a negative-feedback-only oscillator, with a shorter period and smoothly varying Cdk1 activity. Shortening the first cycle, by treating embryos with the Wee1A/Myt1 inhibitor PD0166285, resulted in a dramatic reduction in embryo viability, and restoring the length of the first cycle in inhibitor-treated embryos with low doses of cycloheximide partially rescued viability. Computations with an experimentally parameterized mathematical model show that modest changes in the Wee1/Cdc25 ratio can account for the observed qualitative changes in the cell cycle. The high ratio in the first cycle allows the period to be long and tunable, and decreasing the ratio in the subsequent cycles allows the oscillator to run at a maximal speed. Thus, the embryo rewires its feedback regulation to meet two different developmental requirements during early development.

  12. Longitudinal changes in total brain volume in schizophrenia: relation to symptom severity, cognition and antipsychotic medication.

    Directory of Open Access Journals (Sweden)

    Juha Veijola

    Full Text Available Studies show evidence of longitudinal brain volume decreases in schizophrenia. We studied brain volume changes and their relation to symptom severity, level of function, cognition, and antipsychotic medication in participants with schizophrenia and control participants from a general population based birth cohort sample in a relatively long follow-up period of almost a decade. All members of the Northern Finland Birth Cohort 1966 with any psychotic disorder and a random sample not having psychosis were invited for a MRI brain scan, and clinical and cognitive assessment during 1999-2001 at the age of 33-35 years. A follow-up was conducted 9 years later during 2008-2010. Brain scans at both time points were obtained from 33 participants with schizophrenia and 71 control participants. Regression models were used to examine whether brain volume changes predicted clinical and cognitive changes over time, and whether antipsychotic medication predicted brain volume changes. The mean annual whole brain volume reduction was 0.69% in schizophrenia, and 0.49% in controls (p = 0.003, adjusted for gender, educational level, alcohol use and weight gain. The brain volume reduction in schizophrenia patients was found especially in the temporal lobe and periventricular area. Symptom severity, functioning level, and decline in cognition were not associated with brain volume reduction in schizophrenia. The amount of antipsychotic medication (dose years of equivalent to 100 mg daily chlorpromazine over the follow-up period predicted brain volume loss (p = 0.003 adjusted for symptom level, alcohol use and weight gain. In this population based sample, brain volume reduction continues in schizophrenia patients after the onset of illness, and antipsychotic medications may contribute to these reductions.

  13. Incorporation of medical informatics and information technology as core components of undergraduate medical education - time for change!

    Science.gov (United States)

    Otto, Anthony; Kushniruk, Andre

    2009-01-01

    It is generally accepted that Information Technology (IT) is a highly desirable and a very necessary ingredient of modern health care. Review of available literature reveals a paucity of medical informatics and information technology courses in undergraduate medical curricula and a lack of research to assess the effectiveness of medical informatics in undergraduate medical education. The need for such initiatives is discussed and a pilot project is described that evaluated the effectiveness of education in the use of Electronic Medical Record (EMR) applications. Educational activities, for example, could be medical students conducting virtual medical encounters or interacting with EMR applications. An EMR application, which was used in several related projects, has been adapted to the educational environment: standardized patient records can be created and cloned so that individual students can interact with a "standard" patient and alter the patient's data.

  14. Change detection of medical images using dictionary learning techniques and PCA

    Science.gov (United States)

    Nika, Varvara; Babyn, Paul; Zhu, Hongmei

    2014-03-01

    Automatic change detection methods for identifying the changes of serial MR images taken at different times are of great interest to radiologists. The majority of existing change detection methods in medical imaging, and those of brain images in particular, include many preprocessing steps and rely mostly on statistical analysis of MRI scans. Although most methods utilize registration software, tissue classification remains a difficult and overwhelming task. Recently, dictionary learning techniques are used in many areas of image processing, such as image surveillance, face recognition, remote sensing, and medical imaging. In this paper we present the Eigen-Block Change Detection algorithm (EigenBlockCD). It performs local registration and identifies the changes between consecutive MR images of the brain. Blocks of pixels from baseline scan are used to train local dictionaries that are then used to detect changes in the follow-up scan. We use PCA to reduce the dimensionality of the local dictionaries and the redundancy of data. Choosing the appropriate distance measure significantly affects the performance of our algorithm. We examine the differences between L1 and L2 norms as two possible similarity measures in the EigenBlockCD. We show the advantages of L2 norm over L1 norm theoretically and numerically. We also demonstrate the performance of the EigenBlockCD algorithm for detecting changes of MR images and compare our results with those provided in recent literature. Experimental results with both simulated and real MRI scans show that the EigenBlockCD outperforms the previous methods. It detects clinical changes while ignoring the changes due to patient's position and other acquisition artifacts.

  15. Early-career researchers in medical applications @ CERN | 6 June | Main Auditorium

    CERN Multimedia

    2016-01-01

      Discover how technological advances for high-energy physics have become essential tools for modern medicine. CERN seeks to answer fundamental questions about the Universe, and this mission naturally contributes to advancing the frontiers of technology. State-of-the-art techniques developed for particle accelerators, detectors, and physics computing have applications beyond the high-energy physics community in the medical field. These applications now have an essential role in clinical practices and medical research centres: from imaging devices, accelerator-technology dedicated to cancer therapy, to simulations and data science tools. This knowledge transfer from the high energy physics community to innovation in other fields is an inherent component of CERN’s mission and culture. It fuels scientific collaboration and technological advances, and drives innovation. In addition, it motivates future generations of scientists, and contributes to the public awareness of the impact of fu...

  16. In Vivo Changes in Lamina Cribrosa Microarchitecture and Optic Nerve Head Structure in Early Experimental Glaucoma.

    Directory of Open Access Journals (Sweden)

    Kevin M Ivers

    Full Text Available The lamina cribrosa likely plays an important role in retinal ganglion cell axon injury in glaucoma. We sought to (1 better understand optic nerve head (ONH structure and anterior lamina cribrosa surface (ALCS microarchitecture between fellow eyes of living, normal non-human primates and (2 characterize the time-course of in vivo structural changes in the ONH, ALCS microarchitecture, and retinal nerve fiber layer thickness (RNFLT in non-human primate eyes with early experimental glaucoma (EG. Spectral domain optical coherence tomography (SDOCT images of the ONH were acquired cross-sectionally in six bilaterally normal rhesus monkeys, and before and approximately every two weeks after inducing unilateral EG in seven rhesus monkeys. ONH parameters and RNFLT were quantified from segmented SDOCT images. Mean ALCS pore area, elongation and nearest neighbor distance (NND were quantified globally, in sectors and regionally from adaptive optics scanning laser ophthalmoscope images. In bilaterally normal monkeys, ONH parameters were similar between fellow eyes with few inter-eye differences in ALCS pore parameters. In EG monkeys, an increase in mean ALCS Depth (ALCSD was the first structural change measured in 6 of 7 EG eyes. A decrease in mean minimum rim width (MRW simultaneously accompanied this early change in 4 of 6 EG eyes and was the first structural change in the 7th EG eye. Mean ALCS pore parameters were among the first or second changes measured in 4 EG eyes. Mean ALCS pore area and NND increased in superotemporal and temporal sectors and in central and peripheral regions at the first time-point of change in ALCS pore geometry. RNFLT and/or mean ALCS radius of curvature were typically the last parameters to initially change. Survival analyses found mean ALCSD was the only parameter to significantly show an initial change prior to the first measured loss in RNFLT across EG eyes.

  17. Changes in Prescribing Symptomatic and Preventive Medications in the Last Year of Life in Older Nursing Home Residents

    NARCIS (Netherlands)

    van der Meer, Helene G.; Taxis, Katja; Pont, Lisa G.

    2018-01-01

    Background At the end of life goals of care change from disease prevention to symptomatic control, however little is known about the patterns of medication prescribing at this stage. Objectives To explore changes in prescribing of symptomatic and preventive medication in the last year of life in

  18. Innovative Approaches To Educating Medical Students for Practice in a Changing Health Care Environment: The National UME-21 Project.

    Science.gov (United States)

    Rabinowitz, Howard K.; Babbott, David; Bastacky, Stanford; Pascoe, John M.; Patel, Kavita K.; Pye, Karen L.; Rodak, John, Jr.; Veit, Kenneth J.; Wood, Douglas L.

    2001-01-01

    Describes the major curriculum changes that have been implemented through Undergraduate Medical Education for the 21st Century (UME-21), a 3-year national demonstration project to encourage innovation in medical education. Discusses challenges that occurred in carrying out those changes, and outlines the strategies for evaluating the project. (EV)

  19. Endoscopic Submucosal Dissection for Early Colorectal Neoplasms: Clinical Experience in a Tertiary Medical Center in Taiwan

    Directory of Open Access Journals (Sweden)

    Mei-Yu Tseng

    2013-01-01

    Full Text Available Objectives. Endoscopic submucosal dissection (ESD is a promising technique to treat early colorectal neoplasms by facilitating en bloc resection without size limitations. Although ESD for early gastrointestinal epithelial neoplasms has been popular in Japan, clinical experience with colorectal ESD has been rarely reported in Taiwan. Methods. From March 2006 to December 2011, 92 consecutive patients with early colorectal neoplasms resected by ESD at Tri-Service General Hospital were included. ESD was performed for colorectal epithelial neoplasms with a noninvasive pit pattern which had the following criteria: (1 lesions difficult to remove en bloc with a snare, such as laterally spreading tumors-nongranular type (LST-NG ≧20 mm and laterally spreading tumors-granular type (LST-G ≧30 mm; (2 lesions with fibrosis or which had recurred after endoscopic mucosal resection with a nonlifting sign. Results. The mean age of the patients was 66.3±12.9 years, and the male-female ratio was 1.8 : 1. The mean tumor size was 37.2±17.9 mm. The en bloc resection rate was 90.2% and the R0 resection rate was 89.1%. Perforations during ESD occurred in 11 patients (12.0% and all of them were effectively treated by endoscopic closure with hemoclips. No delayed perforation or postoperative bleeding was recorded. There were no procedure-related morbidities or mortalities. Conclusion. ESD is an effective method for en bloc resection of large early colorectal neoplasms and those with a nonlifting sign. An endoscopic technique to close perforations is essential for colorectal ESD.

  20. Rabi Rashidi (Rashidi Quarters): a late thirteen to early fourteenth century Middle Eastern Medical School.

    Science.gov (United States)

    Abbasnejad, Feridoon; Shoja, Mohammadali M; Agutter, Paul S; Alakbarli, Farid; Loukas, Marios; Shokouhi, Ghaffar; Khalili, Majid; Tubbs, R Shane

    2012-11-01

    Following the Mongolian invasion of the Middle East in the thirteenth century, a regional power called the Ilkhanid emerged and was ruled by the heirs of Temujin from Mongolia. Embracing present-day Iran, Iraq, Afghanistan, Azerbaijan, areas of Russia, Turkey, and Pakistan, and nearby Middle Eastern territories, the Ilkhanid state patronized medicine and various other professions. Centered in Tabriz (Tauris), a city in the northwest of present-day Iran, was a non-profit-making educational and medical complex founded by Grand Minister Rashid al-Din Fazlollah Hamadani. This paper reviews the literature regarding the rise and fall of the thirteenth century university and the Rabi Rashidi, emphasizing the structure of its medical school. The background training of Rashid al-Din and his keen interest in science turned this complex, Rabi Rashidi (literally meaning the Rashidi Quarters), into a cosmopolitan university that freely trained medical scholars nationally and internationally. The possibility that Rashid al-Din was inspired by university developments in Europe is discussed.

  1. The Changing Health Care Landscape and Implications of Organizational Ethics on Modern Medical Practice.

    Science.gov (United States)

    Castlen, Joseph P; Cote, David J; Moojen, Wouter A; Robe, Pierre A; Balak, Naci; Brennum, Jannick; Ammirati, Mario; Mathiesen, Tiit; Broekman, Marike L D

    2017-06-01

    Medicine is rapidly changing, both in the level of collective medical knowledge and in how it is being delivered. The increased presence of administrators in hospitals helps to facilitate these changes and ease administrative workloads on physicians; however, tensions sometimes form between physicians and administrators. This situation is based on perceptions from both sides that physicians obstruct cost-saving measures and administrators put profits before patients. In reality, increasing patient populations and changes in health care are necessitating action by hospitals to prevent excessive spending as health care systems become larger and more difficult to manage. Recognizing the cause of changes in health care, which do not always originate with physicians and administrators, along with implementing changes in hospitals such as increased physician leadership, could help to ease tensions and promote a more collaborative atmosphere. Ethically, there is a need to preserve physician autonomy, which is a tenet of medical professionalism, and a need to rein in spending costs and ensure that patients receive the best possible care. Physicians and administrators both need to have a well-developed personal ethic to achieve these goals. Physicians need be allowed to retain relative autonomy over their practices as they support and participate in administrator-led efforts toward distributive justice. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Early Self-Regulation, Early Self-Regulatory Change, and Their Longitudinal Relations to Adolescents' Academic, Health, and Mental Well-Being Outcomes.

    Science.gov (United States)

    Howard, Steven J; Williams, Kate E

    2018-05-16

    To evaluate the extent to which early self-regulation and early changes in self-regulation are associated with adolescents' academic, health, and mental well-being outcomes. Data were collected from 1 of the cohorts in a large dual-cohort cross-sequential study of Australian children. This cohort consisted of a nationally representative data set of 4983 Australian children assessed at 4 to 5 years of age, who were followed longitudinally to 14 to 15 years of age. Using regression within a path analysis framework, we first sought to investigate associations of early self-regulation (at 4-5 years and 6-7 years of age) with a broad range of academic, health, and mental well-being outcomes in adolescence (at 14-15 years). We next investigated the extent to which an early change in self-regulation (from 4 to 7 years of age) predicted these adolescents' outcomes. Early self-regulation predicted the full range of adolescents' outcomes considered such that a 1-SD increase in self-regulation problems was associated with a 1.5- to 2.5-times greater risk of more-negative outcomes. An early positive change in self-regulation was associated with a reduced risk of these negative outcomes for 11 of the 13 outcomes considered. These results suggest the potential of early self-regulation interventions, in particular, in influencing long-term academic, health, and well-being trajectories.

  3. Physician-Directed Diabetes Education without a Medication Change and Associated Patient Outcomes

    Directory of Open Access Journals (Sweden)

    Hun-Sung Kim

    2017-05-01

    Full Text Available BackgroundWhen patients with diabetes mellitus (DM are first referred to a hospital from primary health care clinics, physicians have to decide whether to administer an oral hypoglycemic agent (OHA immediately or postpone a medication change in favor of diabetes education regarding diet or exercise. The aim of this study was to determine the effect of diabetes education alone (without alterations in diabetes medication on blood glucose levels.MethodsThe study was conducted between January 2009 and December 2013 and included patients with DM. The glycosylated hemoglobin (HbA1c levels were evaluated at the first visit and after 3 months. During the first medical examination, a designated doctor also conducted a diabetes education session that mainly covered dietary management.ResultsPatients were divided into those who received no diabetic medications (n=66 and those who received an OHA (n=124. Education resulted in a marked decrease in HbA1c levels in the OHA group among patients who had DM for 10 years showed a slightly lower HbA1c target achievement rate of <6.5% (odds ratio, 0.089; P=0.0024.ConclusionFor patients who had DM for more than 5 years, higher doses or changes in medication were more effective than intensive active education. Therefore, individualized and customized education are needed for these patients. For patients with a shorter duration of DM, it may be more effective to provide initial intensive education for diabetes before prescribing medicines, such as OHAs.

  4. Changing the culture of academic medicine: the C-Change learning action network and its impact at participating medical schools.

    Science.gov (United States)

    Krupat, Edward; Pololi, Linda; Schnell, Eugene R; Kern, David E

    2013-09-01

    The culture of academic medicine has been described as hierarchical, competitive, and not highly supportive of female or minority faculty. In response to this, the authors designed the Learning Action Network (LAN), which was part of the National Initiative on Gender, Culture and Leadership in Medicine (C-Change). The LAN is a five-school consortium aimed at changing the organizational culture of its constituent institutions. The authors selected LAN schools to be geographically diverse and representative of U.S. medical schools. Institutional leaders and faculty representatives from constituent schools met twice yearly for four years (2006-2010), forming a cross-institutional learning community. Through their quarterly listing of institutional activities, schools reported a wide array of actions. Most common were increased faculty development and/or mentoring, new approaches to communication, and adoption of new policies and procedures. Other categories included data collection/management, engagement of key stakeholders, education regarding gender/diversity, and new/expanded leadership positions. Through exit interviews, most participants reported feeling optimistic about maintaining the momentum of change. However, some, especially in schools with leadership changes, expressed uncertainty. Participants reported that they felt that the LAN enabled, empowered, facilitated, and/or caused the reported actions.For others who might want to work toward changing the culture of academic medicine, the authors offer several lessons learned from their experiences with C-Change. Most notably, people, structures, policies, and reward systems must be put into place to support cultural values, and broad-based support should be created in order for changes to persist when inevitable transitions in leadership occur.

  5. Change detection of medical images using dictionary learning techniques and principal component analysis.

    Science.gov (United States)

    Nika, Varvara; Babyn, Paul; Zhu, Hongmei

    2014-07-01

    Automatic change detection methods for identifying the changes of serial MR images taken at different times are of great interest to radiologists. The majority of existing change detection methods in medical imaging, and those of brain images in particular, include many preprocessing steps and rely mostly on statistical analysis of magnetic resonance imaging (MRI) scans. Although most methods utilize registration software, tissue classification remains a difficult and overwhelming task. Recently, dictionary learning techniques are being used in many areas of image processing, such as image surveillance, face recognition, remote sensing, and medical imaging. We present an improved version of the EigenBlockCD algorithm, named the EigenBlockCD-2. The EigenBlockCD-2 algorithm performs an initial global registration and identifies the changes between serial MR images of the brain. Blocks of pixels from a baseline scan are used to train local dictionaries to detect changes in the follow-up scan. We use PCA to reduce the dimensionality of the local dictionaries and the redundancy of data. Choosing the appropriate distance measure significantly affects the performance of our algorithm. We examine the differences between [Formula: see text] and [Formula: see text] norms as two possible similarity measures in the improved EigenBlockCD-2 algorithm. We show the advantages of the [Formula: see text] norm over the [Formula: see text] norm both theoretically and numerically. We also demonstrate the performance of the new EigenBlockCD-2 algorithm for detecting changes of MR images and compare our results with those provided in the recent literature. Experimental results with both simulated and real MRI scans show that our improved EigenBlockCD-2 algorithm outperforms the previous methods. It detects clinical changes while ignoring the changes due to the patient's position and other acquisition artifacts.

  6. Information systems in a changing climate: Early warnings and drought risk management

    Directory of Open Access Journals (Sweden)

    Roger S. Pulwarty

    2014-06-01

    Full Text Available Drought is among the most damaging, and least understood, of all “natural” hazards. Although some droughts last a single season and affect only small areas, the instrumental and paleoclimate records show that droughts have sometimes continued for decades and have impacted millions of square kilometers in North America, West Africa, and East Asia. To cross the spectrum of potential drivers and impacts, drought information systems have multiple sub-systems which include an integrated risk assessment, communication and decision support system of which early warning is a central component and output. An early warning system is much more than a forecast – it is a linked risk information (including people׳s perception of risk and communication system that actively engages communities involved in preparedness. There are numerous drought systems warning systems being implemented at different scales of governance. We draw on the lessons of over 21 drought early warning systems around the world, in both developing and developed countries and at regional, national and community levels. The successes illustrate that effective early warning depends upon a multi-sectoral and interdisciplinary collaboration among all concerned actors at each stage in the warning process from monitoring to response and evaluation. However, the links between the community-based approach and the national and global EWSs are relatively weak. Using the rich experience of information systems across the globe, this paper identifies pathways for knowledge management and action at the relevant scales for decision-making in response to a changing climate.

  7. Financialization impedes climate change mitigation: Evidence from the early American solar industry.

    Science.gov (United States)

    Jerneck, Max

    2017-03-01

    The article investigates how financialization impedes climate change mitigation by examining its effects on the early history of one low-carbon industry, solar photovoltaics in the United States. The industry grew rapidly in the 1970s, as large financial conglomerates acquired independent firms. While providing needed financial support, conglomerates changed the focus from existing markets in consumer applications toward a future utility market that never materialized. Concentration of the industry also left it vulnerable to the corporate restructuring of the 1980s, when the conglomerates were dismantled and solar divisions were pared back or sold off to foreign firms. Both the move toward conglomeration, when corporations became managed as stock portfolios, and its subsequent reversal were the result of increased financial dominance over corporate governance. The American case is contrasted with the more successful case of Japan, where these changes to corporate governance did not occur. Insulated from shareholder pressure and financial turbulence, Japanese photovoltaics manufacturers continued to expand investment throughout the 1980s when their American rivals were cutting back. The study is informed by Joseph Schumpeter's theory of creative destruction and Hyman Minsky's theory of financialization, along with economic sociology. By highlighting the tenuous and conflicting relation between finance and production that shaped the early history of the photovoltaics industry, the article raises doubts about the prevailing approach to mitigate climate change through carbon pricing. Given the uncertainty of innovation and the ease of speculation, it will do little to spur low-carbon technology development without financial structures supporting patient capital.

  8. Global situational awareness and early warning of high-consequence climate change.

    Energy Technology Data Exchange (ETDEWEB)

    Backus, George A.; Carr, Martin J.; Boslough, Mark Bruce Elrick

    2009-08-01

    Global monitoring systems that have high spatial and temporal resolution, with long observational baselines, are needed to provide situational awareness of the Earth's climate system. Continuous monitoring is required for early warning of high-consequence climate change and to help anticipate and minimize the threat. Global climate has changed abruptly in the past and will almost certainly do so again, even in the absence of anthropogenic interference. It is possible that the Earth's climate could change dramatically and suddenly within a few years. An unexpected loss of climate stability would be equivalent to the failure of an engineered system on a grand scale, and would affect billions of people by causing agricultural, economic, and environmental collapses that would cascade throughout the world. The probability of such an abrupt change happening in the near future may be small, but it is nonzero. Because the consequences would be catastrophic, we argue that the problem should be treated with science-informed engineering conservatism, which focuses on various ways a system can fail and emphasizes inspection and early detection. Such an approach will require high-fidelity continuous global monitoring, informed by scientific modeling.

  9. Microstructural Changes of the Human Brain from Early to Mid-Adulthood

    Directory of Open Access Journals (Sweden)

    Lixia Tian

    2017-08-01

    Full Text Available Despite numerous studies on the microstructural changes of the human brain throughout life, we have indeed little direct knowledge about the changes from early to mid-adulthood. The aim of this study was to investigate the microstructural changes of the human brain from early to mid-adulthood. We performed two sets of analyses based on the diffusion tensor imaging (DTI data of 111 adults aged 18–55 years. Specifically, we first correlated age with skeletonized fractional anisotropy (FA, mean diffusivity (MD, axial diffusivity (AD and radial diffusivity (RD at global and regional level, and then estimated individuals’ ages based on each DTI metric using elastic net, a kind of multivariate pattern analysis (MVPA method that aims at selecting the model that achieves the best trade-off between goodness of fit and model complexity. We observed statistically significant negative age-vs-FA correlations and relatively less changes of MD. The negative age-vs-FA correlations were associated with negative age-vs-AD and positive age-vs-RD correlations. Regional negative age-vs-FA correlations were observed in the bilateral genu of the corpus callosum (CCg, the corticospinal tract (CST, the fornix and several other tracts, and these negative correlations may indicate the earlier changes of the fibers with aging. In brain age estimation, the chronological-vs-estimated-age correlations based on FA, MD, AD and RD were R = 0.62, 0.44, 0.63 and 0.69 (P = 0.002, 0.008, 0.002 and 0.002 based on 500 permutations, respectively, and these results indicate that even the microstructural changes from early to mid-adulthood alone are sufficiently specific to decode individuals’ ages. Overall, the current results not only demonstrated statistically significant FA decreases from early to mid-adulthood and clarified the driving factors of the FA decreases (RD increases and AD decreases, in contrast to increases of both measures in late-adulthood, but highlighted the

  10. Microstructural Changes of the Human Brain from Early to Mid-Adulthood.

    Science.gov (United States)

    Tian, Lixia; Ma, Lin

    2017-01-01

    Despite numerous studies on the microstructural changes of the human brain throughout life, we have indeed little direct knowledge about the changes from early to mid-adulthood. The aim of this study was to investigate the microstructural changes of the human brain from early to mid-adulthood. We performed two sets of analyses based on the diffusion tensor imaging (DTI) data of 111 adults aged 18-55 years. Specifically, we first correlated age with skeletonized fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) at global and regional level, and then estimated individuals' ages based on each DTI metric using elastic net, a kind of multivariate pattern analysis (MVPA) method that aims at selecting the model that achieves the best trade-off between goodness of fit and model complexity. We observed statistically significant negative age-vs-FA correlations and relatively less changes of MD. The negative age-vs-FA correlations were associated with negative age-vs-AD and positive age-vs-RD correlations. Regional negative age-vs-FA correlations were observed in the bilateral genu of the corpus callosum (CCg), the corticospinal tract (CST), the fornix and several other tracts, and these negative correlations may indicate the earlier changes of the fibers with aging. In brain age estimation, the chronological-vs-estimated-age correlations based on FA, MD, AD and RD were R = 0.62, 0.44, 0.63 and 0.69 ( P = 0.002, 0.008, 0.002 and 0.002 based on 500 permutations), respectively, and these results indicate that even the microstructural changes from early to mid-adulthood alone are sufficiently specific to decode individuals' ages. Overall, the current results not only demonstrated statistically significant FA decreases from early to mid-adulthood and clarified the driving factors of the FA decreases (RD increases and AD decreases, in contrast to increases of both measures in late-adulthood), but highlighted the necessity of

  11. Salivary changes in medically compromised patients: A clinical and biochemical study

    Directory of Open Access Journals (Sweden)

    Yehoshuva R Tummuru

    2017-01-01

    Full Text Available Introduction: Medically compromised patients require special attention when dental procedures are performed on them. These individuals may require modified or slightly altered techniques. Aims and Objectives: The present study was taken up with two main objectives. The first one being examining and recording various oral manifestations in medically compromised patients, and the second objective was to collect samples of saliva from such patients and to analyze and establish any salivary changes in such medically compromised patients. Materials and Methods: A total of 100 patients were selected for the study. These patients were divided into four groups of 25 patients each: diabetes mellitus group, chronic renal failure group, liver cirrhosis group and control group. All the selected patients were subjected to a detailed general and intra oral examinations and the relevant data was recorded on a specially designed proforma; salivary analysis was done to know the flow rate, pH, total salivary proteins, sodium, potassium, and LDH levels. Results: From the findings, it can be inferred that salivary changes namely changes in salivary pH, salivary flow rates, salivary sodium, salivary potassium, salivary total proteins, and salivary lactate dehydrogenase are significant in medically compromised patients namely uncontrolled diabetes mellitus, chronic renal failure, cirrhosis of liver compared to the control group. Conclusion: pH of saliva was elevated in chronic renal failure patients. Salivary flow rates and sodium were decreased in diabetes mellitus, chronic renal failure, and cirrhosis of liver patients. There was a significant elevation of salivary potassium in chronic renal failure patients. LDH elevation was significant in uncontrolled diabetes mellitus.

  12. Mitochondrial Epigenetic Changes Link to Increased Diabetes Risk and Early-Stage Prediabetes Indicator

    Science.gov (United States)

    Zheng, Louise D.; Linarelli, Leah E.; Brooke, Joseph; Smith, Cayleen; Wall, Sarah S.; Greenawald, Mark H.; Seidel, Richard W.; Estabrooks, Paul A.; Almeida, Fabio A.; Cheng, Zhiyong

    2016-01-01

    Type 2 diabetes (T2D) is characterized by mitochondrial derangement and oxidative stress. With no known cure for T2D, it is critical to identify mitochondrial biomarkers for early diagnosis of prediabetes and disease prevention. Here we examined 87 participants on the diagnosis power of fasting glucose (FG) and hemoglobin A1c levels and investigated their interactions with mitochondrial DNA methylation. FG and A1c led to discordant diagnostic results irrespective of increased body mass index (BMI), underscoring the need of new biomarkers for prediabetes diagnosis. Mitochondrial DNA methylation levels were not correlated with late-stage (impaired FG or A1c) but significantly with early-stage (impaired insulin sensitivity) events. Quartiles of BMI suggested that mitochondrial DNA methylation increased drastically from Q1 (20 40, morbidly obese). A significant change was also observed from Q1 to Q2 in HOMA insulin sensitivity but not in A1c or FG. Thus, mitochondrial epigenetic changes link to increased diabetes risk and the indicator of early-stage prediabetes. Further larger-scale studies to examine the potential of mitochondrial epigenetic marker in prediabetes diagnosis will be of critical importance for T2D prevention. PMID:27298712

  13. [Predictors and longitudinal changes of depression and anxiety among medical college students].

    Science.gov (United States)

    Lee, Hyun-Ji; Jang, Eun-Young; Park, Yong-Chon; Kim, Daeho

    2013-06-01

    This longitudinal study was designed to examine the change in depression and anxiety and their predictors over 1 year among premedical and medical students. We compared depression and anxiety from 2 waves and determined the predictive power of personality, narcissism, social comparison, and social reward value on them. Two hundred twenty-six students at a medical school in Seoul were divided into 4 groups according to academic year and completed a questionnaire at the end of 2010 and 2011. The questionnaire included the Zung Depression Scale; Zung Anxiety Scale; scales for social comparison, narcissism, and social reward value; and Neuroticism-Extraversion-Openness Personality Inventory. Among first- and second-year medical students, depression and anxiety increased significantly over the previous year. However, irrespective of academic year, depression increased significantly after 1 year. Also, social reward value had a moderating effect. Specifically, among students with low social reward value who entered their first year of medical school, the negative impact of the tendency toward depression and anxiety was amplified compared with older students. Because the predictors of mental health differ between groups, each group must receive specific, appropriate education. Also, because social reward value is important moderating factor of mental health, education and intervention programs that focus on social reward value are needed.

  14. An exploration of changes in cognitive and emotional empathy among medical students in the Caribbean

    Science.gov (United States)

    Youssef, Farid F.; Nunes, Paula; Sa, Bidyadhar; Williams, Stella

    2014-01-01

    Objectives: This study explored the empathy profile of students across five years of medical training. In addition the study examined whether the Jefferson Scale for Physician Empathy correlated with a measure of cognitive empathy, the Reading the Mind in the Eyes Test and a measure of affective empathy, the Toronto Empathy Questionnaire. Methods: The study was a comparative cross-sectional design at one Caribbean medical school. Students were contacted in class, participation was voluntary and empathy was assessed using all three instruments Descriptive statistics were calculated and differences between groups evaluated using non-parametric tests. Results: Overall 669 students participated (response rate, 67%). There was a significant correlation between the Jefferson Scale of Physician Empathy and the Toronto Empathy Questionnaire (P = 0.48), both scales indicating a decline in medical student empathy scores over time. There was, however, little correlation between scores from the Reading the Mind in the Eyes Test and the Jefferson Scale of Physician Empathy. Female students demonstrated significantly higher scores on all three measures. Conclusions: Medical students’ lower empathy scores during their final years of training appear to be due to a change in the affective component of empathy. These findings may reflect an adaptive neurobiological response to the stressors associated with encountering new clinical situations. Attention should be paid not only to providing empathy training for students but also to teaching strategies for improved cognitive processing capacity when they are encountering new and challenging circumstances. PMID:25341229

  15. Competing and coexisting logics in the changing field of English general medical practice.

    Science.gov (United States)

    McDonald, Ruth; Cheraghi-Sohi, Sudeh; Bayes, Sara; Morriss, Richard; Kai, Joe

    2013-09-01

    Recent reforms, which change incentive and accountability structures in the English National Health Service, can be conceptualised as trying to shift the dominant institutional logic in the field of primary medical care (general medical practice) away from medical professionalism towards a logic of "population based medicine". This paper draws on interviews with primary care doctors, conducted during 2007-2009 and 2011-2012. It contrasts the approach of active management of populations, in line with recent reforms with responses to patients with medically unexplained symptoms. Our data suggest that rather than one logic becoming dominant, different dimensions of organisational activity reflect different logics. Although some aspects of organisational life are relatively untouched by the reforms, this is not due to 'resistance' on the part of staff within these organisations to attempts to 'control' them. We suggest that a more helpful way of understanding the data is to see these different aspects of work as governed by different institutional logics. Copyright © 2012 Elsevier Ltd. All rights reserved.

  16. Relationship between academic performance and affective changes during the first year at medical school.

    Science.gov (United States)

    Del-Ben, Cristina Marta; Machado, Vanessa Foresto; Madisson, Mariani Mendes; Resende, Tamara Lovatto; Valério, Fernando Passador; Troncon, Luiz Ernesto De Almeida

    2013-05-01

    Entering medical school may be associated with changes in the students' life, which can affect academic motivation and impair academic performance. This work aimed at measuring longitudinally academic motivation, anxiety, depression and social adjustment in first-year medical students and determining the relationships between these variables and academic performance, as measured mainly by grades on regular exams. Eighty-five first-year medical students (age: 17-25 years) were included after giving informed consent. Beck's Anxiety (BAI) and Beck's Depression (BDI) Inventories, the self-reported Social Adjustment Scale (SAS-SR) and the Academic Motivation Scale (AMS) were applied two months after admission and at the end of the academic year. BAI scores increased throughout the year (7.3 ± 6.6 versus 28.8 ± 6.7; p 0.10). SAS-SR subscales scores remained stable, except for a decreasing pattern for leisure/social life (1.8 ± 0.4 versus 2.1 ± 0.4; p motivation to know (22.2 ± 4.5 versus 19.7 ± 5.5; p academic performance and the global scores for any of the scales except for the SAS-SR subscale for academic life (r = -0.48, p academic year, first-year medical students showed increased anxiety, decreased academic motivation and a maladjusted leisure/social life, which however does not seem to affect academic achievement.

  17. Cortisol Secretion and Change in Sleep Problems in Early Childhood: Moderation by Maternal Overcontrol

    Science.gov (United States)

    Kiel, Elizabeth J.; Hummel, Alexandra C.; Luebbe, Aaron M.

    2015-01-01

    Childhood sleep problems are prevalent and relate to a wide range of negative psychological outcomes. However, it remains unclear how biological processes, such as HPA activity, may predict sleep problems over time in childhood in the context of certain parenting environments. Fifty-one mothers and their 18–20 month-old toddlers participated in a short-term longitudinal study assessing how shared variance among morning levels, diurnal change, and nocturnal change in toddlers’ cortisol secretion predicted change in sleep problems in the context of maternal overprotection and critical control. A composite characterized by low variability in, and, to a lesser extent, high morning values of cortisol, predicted increasing sleep problems from age 2 to age 3 when mothers reported high critical control. Results suggest value in assessing shared variance among different indices of cortisol secretion patterns and the interaction between cortisol and the environment in predicting sleep problems in early childhood. PMID:25766262

  18. Hepcidin plasma levels are not associated with changes in haemoglobin in early rheumatoid arthritis patients

    DEFF Research Database (Denmark)

    Østgård, R D; Glerup, H; Jurik, A G

    2017-01-01

    Objective: A reduction in haemoglobin level is a frequent complication among rheumatoid arthritis (RA) patients. Hepcidin has been linked to disturbed erythropoiesis. The objective of this study was to investigate the longitudinal changes in hepcidin in patients with early RA. Method: Hepcidin...... with disease-modifying anti-rheumatic drugs (DMARDs) and with additional adalimumab (ADA, n = 42) or placebo (PLA, n = 38) during 52 weeks, using a treat-to-target strategy, aiming for a 28-joint Disease Activity Score (DAS28) levels [median (interquartile range)] were 9...... = 0.48, p levels of haemoglobin and hepcidin at baseline or during the 52 week follow-up. No change in haemoglobin levels was seen as a function of hepcidin changes. In a mixed statistical model, no single factor was connected with the regulation...

  19. Coping with a changing environment: The effects of early life stress

    DEFF Research Database (Denmark)

    Vindas, Marco A.; Madaro, Angelico; Fraser, Thomas W.K.

    2016-01-01

    to environmental changes is particularly evident at early life stages. We investigated the performance of salmon, previously subjected to an unpredictable chronic stress (UCS) treatment at an early age (10 month old parr), over several months and life stages. The UCS fish showed overall higher specific growth...... rates compared with unstressed controls after smoltification, a particularly challenging life stage, and after seawater transfer. Furthermore, subjecting fish to acute stress at the end of the experiment, we found that UCS groups had an overall lower hypothalamic catecholaminergic and brain stem...... serotonergic response to stress compared with control groups. In addition, serotonergic activity was negatively correlated with final growth rates,which implies that serotonin responsive individuals have growth disadvantages. Altogether, our results may imply that a subduedmonoaminergic response in stressful...

  20. Early medical skull surgery for treatment of post-traumatic osteomyelitis 5,000 years ago.

    Directory of Open Access Journals (Sweden)

    Pierpaolo Petrone

    Full Text Available Here we describe the findings of a unique example of the early techniques adopted in neurosurgery around 5000 years ago, consisting in a double well healed skull trephination associated with a post-cranial traumatic event occurring intra vitam to a young male from the Early Chalcolithic cemetery of Pontecagnano (South Italy, ca. 4,900 - 4,500 cal BP. Morphological, X-ray and 3D-CT scan skull-cap evaluation revealed that the main orifice was produced by scraping, obtained by clockwise rotary motion of a right-handed surgeon facing the patient, while the partial trephination was carried out by using a stone point as a drilling tool. In both cases, bone regrowth is indicative of the individual's prolonged postoperative survival and his near-complete recovery. The right femur shows a poorly healed mid-shaft fracture presumably induced by a high energy injury, and a resulting chronic osteomyelitis, affecting both femurs by hematogenous spread of the infection. Our observations on the visual and radiological features of skull and femur lesions, along with evidence on the timing of experimental bone regrowth vs. healing of lower limb fractures associated to long-term bone infections now suggest that this young man underwent a double skull trephination in order to alleviate his extremely painful condition induced by chronic osteomyelitis, which is thought to have been the cause of death.

  1. Competency-based medical education and continuing professional development: A conceptualization for change.

    Science.gov (United States)

    Lockyer, Jocelyn; Bursey, Ford; Richardson, Denyse; Frank, Jason R; Snell, Linda; Campbell, Craig

    2017-06-01

    Competency-based medical education (CBME) is as important in continuing professional development (CPD) as at any other stage of a physician's career. Principles of CBME have the potential to revolutionize CPD. Transitioning to CBME-based CPD will require a cultural change to gain commitment from physicians, their employers and institutions, CPD providers, professional organizations, and medical regulators. It will require learning to be aligned with professional and workplace standards. Practitioners will need to develop the expertise to systematically examine their own clinical performance data, identify performance improvement opportunities and possibilities, and develop a plan to address areas of concern. Health care facilities and systems will need to produce data on a regular basis and to develop and train CPD educators who can work with physician groups. Stakeholders, such as medical regulatory authorities who are responsible for licensing physicians and other standard-setting bodies that credential and develop maintenance-of-certification systems, will need to change their paradigm of competency enhancement through CPD.

  2. Early Life Factors and Adult Leisure Time Physical Inactivity Stability and Change.

    Science.gov (United States)

    Pinto Pereira, Snehal M; Li, Leah; Power, Chris

    2015-09-01

    Physical inactivity has a high prevalence and associated disease burden. A better understanding of influences on sustaining and changing inactive lifestyles is needed. We aimed to establish whether leisure time inactivity was stable in midadulthood and whether early life factors were associated with inactivity patterns. In the 1958 British birth cohort (n = 12,271), leisure time inactivity (frequency, less than once a week) assessed at 33 and 50 yr was categorized as "never inactive," "persistently inactive," "deteriorating," or "improving." Early life factors (birth to 16 yr) were categorized into three (physical, social, and behavioral) domains. Using multinomial logistic regression, we assessed associations with inactivity persistence and change of factors within each early life domain and the three domains combined with and without adjustment for adult factors. Inactivity prevalence was similar at 33 and 50 yr (approximately 31%), but 17% deteriorated and 18% improved with age. In models adjusted for all domains simultaneously, factors associated with inactivity persistence versus never inactive were prepubertal stature (8% lower risk/height SD), poor hand control/coordination (17% higher risk/increase on four-point scale), cognition (16% lower/SD in ability) (physical); parental divorce (25% higher), class at birth (7% higher/reduction on four-point scale), minimal parental education (16% higher), household amenities (2% higher/increase in 19-point score (high = poor)) (social); and inactivity (22% higher/reduction in activity on four-point scale), low sports aptitude (47% higher), smoking (30% higher) (behavioral). All except stature, parental education, sports aptitude, and smoking were associated also with inactivity deterioration. Poor hand control/coordination was the only factor associated with improved status (13% lower/increase on four-point scale) versus persistently inactive. Adult leisure time inactivity is moderately stable. Early life factors are

  3. Body temperature change and outcomes in patients undergoing long-distance air medical transport.

    Science.gov (United States)

    Nakajima, Mikio; Aso, Shotaro; Yasunaga, Hideo; Shirokawa, Masamitsu; Nakano, Tomotsugu; Miyakuni, Yasuhiko; Goto, Hideaki; Yamaguchi, Yoshihiro

    2018-04-30

    Short-distance air medical transport for adult emergency patients does not significantly affect patients' body temperature and outcomes. This study aimed to examine the influence of long-distance air medical transport on patients' body temperatures and the relationship between body temperature change and mortality. We retrospectively enrolled consecutive patients transferred via helicopter or plane from isolated islands to an emergency medical center in Tokyo, Japan between April 2010 and December 2016. Patients' average body temperature was compared before and after air transport using a paired t-test, and corrections between body temperature change and flight duration were calculated using Pearson's correlation coefficient. Multivariable logistic regression models were then used to examine the association between body temperature change and in-hospital mortality. Of 1253 patients, the median age was 72 years (interquartile range, 60-82 years) and median flight duration was 71 min (interquartile range, 54-93 min). In-hospital mortality was 8.5%, and average body temperature was significantly different before and after air transport (36.7 °C versus 36.3 °C; difference: -0.36 °C; 95% confidence interval, -0.30 to -0.42; p 38.0 °C) or normothermia (36.0-37.9 °C) before air transport and hypothermia after air transport (odds ratio, 2.08; 95% confidence interval, 1.20-3.63; p = 0.009), and (ii) winter season (odds ratio, 2.15; 95% confidence interval, 1.08-4.27; p = 0.030). Physicians should consider body temperature change during long-distance air transport in patients with not only hypothermia but also normothermia or hyperthermia before air transport, especially in winter. Copyright © 2018 Elsevier Inc. All rights reserved.

  4. Best practices in early phase medical device development: Engineering, prototyping, and the beginnings of a quality management system.

    Science.gov (United States)

    Fearis, Kristy; Petrie, Aidan

    2017-03-01

    Kristy Fearis is the founder and president of KPConsulting. She has held various positions in the medical device and research industry. She has led programs for medical industry leaders Medtronic, Edward Lifesciences, and Kimberly-Clark Healthcare to develop and commercialize Class II and III devices. Although a true quality management systems specialist at heart, Kristy has a passion for effectively and efficiently applying quality systems principles to early stage development to maximize benefit while minimizing impact on resources and time to market. Kristy works with both precommercial and commercial companies to build and implement quality systems that are "right sized" and support both an effective business model and high product quality. Aidan Petrie is the cofounder and chief innovation officer of Ximedica. Aidan drives innovation in Ximedica's core markets of medical device development and consumer healthcare. With a focus on human-centered design, usability, technical innovation and industrial design, Aidan has helped bring hundreds of products to market. Ranging from simple drug compliance aids to wearable therapeutics, home monitoring products, and complex surgical systems, Aidan challenges his teams to rethink the role design plays in the success of each product. Covering topics around usability, sensor and wearable technology, and current trends in medical design and development, Aidan is a sought-after industry speaker and widely published author. In addition to his role at Ximedica, Aidan advises multiple startups in the healthcare space and has interests in a number of related companies. He sits on the Board of MassArt and teaches and lectures at the Rhode Island School of Design, Massachusetts Institute of Technology, the Harvard iLab, and others. Aidan holds an undergraduate degree from Central St Martins in product design/engineering and a Masters in industrial design from the Rhode Island School of Design. Copyright © 2016 Elsevier Inc. All

  5. Medical students' learning orientation regarding interracial interactions affects preparedness to care for minority patients: a report from Medical Student CHANGES.

    Science.gov (United States)

    Burgess, Diana J; Burke, Sara E; Cunningham, Brooke A; Dovidio, John F; Hardeman, Rachel R; Hou, Yuefeng; Nelson, David B; Perry, Sylvia P; Phelan, Sean M; Yeazel, Mark W; van Ryn, Michelle

    2016-09-29

    There is a paucity of evidence on how to train medical students to provide equitable, high quality care to racial and ethnic minority patients. We test the hypothesis that medical schools' ability to foster a learning orientation toward interracial interactions (i.e., that students can improve their ability to successfully interact with people of another race and learn from their mistakes), will contribute to white medical students' readiness to care for racial minority patients. We then test the hypothesis that white medical students who perceive their medical school environment as supporting a learning orientation will benefit more from disparities training. Prospective observational study involving web-based questionnaires administered during first (2010) and last (2014) semesters of medical school to 2394 white medical students from a stratified, random sample of 49 U.S. medical schools. Analysis used data from students' last semester to build mixed effects hierarchical models in order to assess the effects of medical school interracial learning orientation, calculated at both the school and individual (student) level, on key dependent measures. School differences in learning orientation explained part of the school difference in readiness to care for minority patients. However, individual differences in learning orientation accounted for individual differences in readiness, even after controlling for school-level learning orientation. Individual differences in learning orientation significantly moderated the effect of disparities training on white students' readiness to care for minority patients. Specifically, white medical students who perceived a high level of learning orientation in their medical schools regarding interracial interactions benefited more from training to address disparities. Coursework aimed at reducing healthcare disparities and improving the care of racial minority patients was only effective when white medical students perceived their

  6. Hunter New England Training (HNET): how to effect culture change in a psychiatry medical workforce.

    Science.gov (United States)

    Cohen, Martin; Llewellyn, Anthony; Ditton-Phare, Philippa; Sandhu, Harsimrat; Vamos, Marina

    2011-12-01

    It is now recognized that education and training are at the core of quality systems in health care. In this paper we discuss the processes and drivers that underpinned the development of high quality education and training programs and placements for all junior doctors. The early identification and development of doctors interested in psychiatry as a career, engagement and co-operation with the broader junior doctor network and the creation of teaching opportunities for trainees that was linked to their stage of development were identified as key to the success of the program. Targeted, high quality education programs and clinical placements coupled with strategic development of workforce has reduced staff turn over, led to the stabilization of the medical workforce and created a culture where learning and supervision are highly valued.

  7. A quality control method for detecting energy changes of medical accelerators

    International Nuclear Information System (INIS)

    McGinley, P.H.

    2000-01-01

    A description is presented of a simple and sensitive method for detecting a change in the energy of the electrons bombarding the target of medical accelerators. This technique is useful for x-ray beams with end point energy in the range of 15.7 to 25 MeV. The method is based on the photoactivation of 16 O and 14 N in a small sample of ammonium nitrate. It was found that the ratio of the activity induced in the oxygen divided by that produced in the nitrogen can be used as a quality control technique to detect a change in the energy of the electrons that bombard the target of the accelerator. An electron energy change of the order of 0.2 MeV can be determined using this method. (author)

  8. The changing purpose of mental health law: From medicalism to legalism to new legalism.

    Science.gov (United States)

    Brown, Jennifer

    2016-01-01

    The role of law in regulating mental health detention has come to engender great contention in the legal and sociological disciplines alike. This conflict is multifaceted but is centred upon the extent to which law should control the psychiatric power of detention. In this manner the evolution of law regulating mental health detention has been seen in terms of a pendulous movement between two extremes of medicalism and legalism. Drawing on socio-legal literature, legislation, international treaties and case law this article examines the changing purpose of mental health law from an English and Council of Europe perspective by utilizing the concepts of medicalism, legalism and new legalism as descriptive devices before arguing that the UN Convention on the Rights of Persons with Disabilities goes further than all of these concepts and has the potential to influence mental health laws internationally. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Heterogeneity in global vegetation and terrestrial climate change during the late Eocene to early Oligocene transition.

    Science.gov (United States)

    Pound, Matthew J; Salzmann, Ulrich

    2017-02-24

    Rapid global cooling at the Eocene - Oligocene Transition (EOT), ~33.9-33.5 Ma, is widely considered to mark the onset of the modern icehouse world. A large and rapid drop in atmospheric pCO 2 has been proposed as the driving force behind extinctions in the marine realm and glaciation on Antarctica. However, the global terrestrial response to this cooling is uncertain. Here we present the first global vegetation and terrestrial temperature reconstructions for the EOT. Using an extensive palynological dataset, that has been statistically grouped into palaeo-biomes, we show a more transitional nature of terrestrial climate change by indicating a spatial and temporal heterogeneity of vegetation change at the EOT in both hemispheres. The reconstructed terrestrial temperatures show for many regions a cooling that started well before the EOT and continued into the Early Oligocene. We conclude that the heterogeneous pattern of global vegetation change has been controlled by a combination of multiple forcings, such as tectonics, sea-level fall and long-term decline in greenhouse gas concentrations during the late Eocene to early Oligocene, and does not represent a single response to a rapid decline in atmospheric pCO 2 at the EOT.

  10. Changes in nucleosome repeat lengths precede replication in the early replicating metallothionein II gene region of cells synchronized in early S phase

    International Nuclear Information System (INIS)

    D'Anna, J.A.; Tobey, R.A.

    1989-01-01

    Previous investigations showed that inhibition of DNA synthesis by hydroxyurea, aphidicolin, or 5-fluorodeoxyuridine produced large changes in the composition and nucleosome repeat lengths of bulk chromatin. There the authors report results of investigations to determine whether the changes in nucleosome repeat lengths might be localized in the initiated replicons, as postulated. In most experiments, Chinese hamster (line CHO) cells were synchronized in G1, or they were synchronized in early S phase by allowing G1 cells to enter S phase in medium containing 1 mM hydroxyurea or 5 μg mL -1 aphidicolin, a procedure believed to produce an accumulation of initiated replicons that arise from normally early replicating DNA. Measurements of nucleosome repeat lengths of bulk chromatin, the early replicating unexpressed metallothionein II (MTII) gene region, and a later replicating repeated sequence indicate that the changes in repeat lengths occur preferentially in the early replicating MTII gene region as G1 cells enter and become synchronized in early S phase. During that time, the MTII gene region is not replicated nor is there any evidence for induction of MTII messenger RNA. Thus, the results are consistent with the hypothesis that changes in chromatin structure occur preferentially in the early replicating (presumably initiated) replicons at initiation or that changes in chromatin structure can precede replication during inhibition of DNA synthesis. The shortened repeat lengths that precede MTII replication are, potentially, reversible, because they become elongated when the synchronized early S-phase cells are released to resume cell cycle progression

  11. Theoretical analysis about early detection of hepatocellular carcinoma by medical imaging procedure

    Energy Technology Data Exchange (ETDEWEB)

    Odano, Ikuo; Hinata, Hiroshi; Hara, Keiji; Sakai, Kunio [Niigata Univ. (Japan). School of Medicine

    1983-04-01

    It is well-known that patients with chronic hepatitis and liver cirrhosis are frequently accompanied by hepatocellular carcinoma (hepatoma). They are called high risk group for hepatoma. In order to detect a small hepatoma, it is reasonable for us to perform screening examinations on these high risk group patients. Optimal screening interval, however, has not been established. In this report, a theoretical analysis was made to estimate optimal screening interval by imaging procedure such as ultrasonography, x-ray computed tomography and scintigraphy. By the analysis of eight cases, mean doubling time of hepatoma was estimated about four months (73 - 143 days). If we want to detect a hepatoma not greater than 3.0cm in diameter, medical screening procedure combining ultrasonography and scintigraphy should be performed once per about nine months.

  12. Using Technology to Enhance Teaching of Patient-Centered Interviewing for Early Medical Students.

    Science.gov (United States)

    Kaltman, Stacey; Talisman, Nicholas; Pennestri, Susan; Syverson, Eleri; Arthur, Paige; Vovides, Yianna

    2018-06-01

    Effective strategies for teaching communication skills to health professions students are needed. This article describes the design and evaluation of immersive and interactive video simulations for medical students to practice basic communication skills. Three simulations were developed, focusing on patient-centered interviewing techniques such as using open-ended questions, reflections, and empathic responses while assessing a patient's history of present illness. First-year medical students were randomized to simulation or education-as-usual arms. Students in the simulation arm were given access to three interactive video simulations developed using Articulate Storyline, an e-learning authoring tool, to practice and receive feedback on patient-centered interviewing techniques to prepare for their Observed Structured Clinical Examination (OSCE). Trained raters evaluated videos of two OSCE cases for each participant to assess specific communication skills used during the history of present illness component of the interview. Eighty-seven percent of the students in the simulation arm interacted with at least one simulation during the history of present illness. For both OSCE cases, students in the simulation arm asked significantly more open-ended questions. Students in the simulation arm asked significantly fewer closed-ended questions and offered significantly more empathic responses in one OSCE case. No differences were found for reflections. Students reported that the simulations helped improve their communication skills. The use of interactive video simulations was found to be feasible to incorporate into the curriculum and was appealing to students. In addition, students in the simulation arm displayed more behaviors consistent with the patient-centered interviewing model practiced in the simulations. Continued development and research are warranted.

  13. Text mining approach to predict hospital admissions using early medical records from the emergency department.

    Science.gov (United States)

    Lucini, Filipe R; S Fogliatto, Flavio; C da Silveira, Giovani J; L Neyeloff, Jeruza; Anzanello, Michel J; de S Kuchenbecker, Ricardo; D Schaan, Beatriz

    2017-04-01

    Emergency department (ED) overcrowding is a serious issue for hospitals. Early information on short-term inward bed demand from patients receiving care at the ED may reduce the overcrowding problem, and optimize the use of hospital resources. In this study, we use text mining methods to process data from early ED patient records using the SOAP framework, and predict future hospitalizations and discharges. We try different approaches for pre-processing of text records and to predict hospitalization. Sets-of-words are obtained via binary representation, term frequency, and term frequency-inverse document frequency. Unigrams, bigrams and trigrams are tested for feature formation. Feature selection is based on χ 2 and F-score metrics. In the prediction module, eight text mining methods are tested: Decision Tree, Random Forest, Extremely Randomized Tree, AdaBoost, Logistic Regression, Multinomial Naïve Bayes, Support Vector Machine (Kernel linear) and Nu-Support Vector Machine (Kernel linear). Prediction performance is evaluated by F1-scores. Precision and Recall values are also informed for all text mining methods tested. Nu-Support Vector Machine was the text mining method with the best overall performance. Its average F1-score in predicting hospitalization was 77.70%, with a standard deviation (SD) of 0.66%. The method could be used to manage daily routines in EDs such as capacity planning and resource allocation. Text mining could provide valuable information and facilitate decision-making by inward bed management teams. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  14. In vitro early changes in intercellular junctions by treatment with a chemical carcinogen.

    Science.gov (United States)

    Tachikawa, T; Kohno, Y; Matsui, Y; Yoshiki, S

    1986-06-01

    To examine early intercellular junction changes caused by treatment with 9,10-dimethyl-1,2-benzanthracene (DMBA), rat lingual epithelium was cultivated in isolation and observed by electrophysiological, freeze-fracture and whole-mount electron microscopy. Electrophysiological measurements showed a transient decrease in membrane potential of -10.2 mV 6 h after the treatment. It returned to almost the same level as that of the control group 1 day later. Six hours after treatment, input resistance decreased rapidly to 5.3 M omega but increased to 18.0 M omega 12 h after treatment. Transient reduction of input resistance and membrane potential occurred prior to the decrease in the coupling ratio 6 h after treatment with DMBA. In freeze-fracture replicas, the number of gap junctions decreased by approximately 45% of the control value 6 h after treatment with DMBA. At 12 h and thereafter, the number and area of gap junctions subsequently decreased by 60-80% of the control value. Alterations in the number and area of desmosomes were similar to those of the gap junctions. The formation of epithelial cytoskeletons, partially devoid of the 2-4 and 5-8 nm filaments was also observed. A decrease in the density of filament networks beneath the plasma membranes was especially apparent. Treatment with a carcinogen brought about morphological cellular changes as early as 6 h after treatment, and such early changes might trigger metabolic cellular abnormalities. Affected cells appear to move away from normal cells in a process of repeated destruction and revision of intercellular junctions, and cytoskeletons.

  15. Diffusion tensor imaging of early changes in corpus callosum after acute cerebral hemisphere lesions in newborns

    International Nuclear Information System (INIS)

    Righini, Andrea; Doneda, Chiara; Parazzini, Cecilia; Arrigoni, Filippo; Triulzi, Fabio; Matta, Ursula

    2010-01-01

    The main purpose was to investigate any early diffusion tensor imaging (DTI) changes in corpus callosum (CC) associated with acute cerebral hemisphere lesions in term newborns. We retrospectively analysed 19 cases of term newborns acutely affected by focal or multi-focal lesions: hypoxic-ischemic encephalopathy, hypoglycaemic encephalopathy, focal ischemic stroke and deep medullary vein associated lesions. DTI was acquired at 1.5 Tesla with dedicated neonatal coil. DTI metrics (apparent diffusion coefficient (ADC), fractional anisotropy (FA), axial λ parallel and radial λ diffusivity) were measured in the hemisphere lesions and in the CC. The control group included seven normal newborns. The following significant differences were found between patients and normal controls in the CC: mean ADC was lower in patients (0.88 SD 0.23 versus 1.18 SD 0.07 μm 2 /s) and so was mean FA (0.50 SD 0.1 versus 0.67 SD 0.05) and mean λ parallel value (1.61 SD 0.52 versus 2.36 SD 0.14 μm 2 /s). In CC the percentage of ADC always diminished independently of lesion age (with one exception), whereas in hemisphere lesions, it was negative in earlier lesions, but exceeded normal values in the older lesions. CC may undergo early DTI changes in newborns with acute focal or multi-focal hemisphere lesions of different aetiology. Although a direct insult to CC cannot be totally ruled out, DTI changes in CC (in particular λ parallel ) may also be compatible with very early Wallerian degeneration or pre-Wallerian degeneration. (orig.)

  16. Diffusion tensor imaging of early changes in corpus callosum after acute cerebral hemisphere lesions in newborns

    Energy Technology Data Exchange (ETDEWEB)

    Righini, Andrea; Doneda, Chiara; Parazzini, Cecilia; Arrigoni, Filippo; Triulzi, Fabio [Children' s Hospital V. Buzzi, ICP, Radiology and Neuroradiology Department, Milan (Italy); Matta, Ursula [University of Milan, Radiology Institute, Milan (Italy)

    2010-11-15

    The main purpose was to investigate any early diffusion tensor imaging (DTI) changes in corpus callosum (CC) associated with acute cerebral hemisphere lesions in term newborns. We retrospectively analysed 19 cases of term newborns acutely affected by focal or multi-focal lesions: hypoxic-ischemic encephalopathy, hypoglycaemic encephalopathy, focal ischemic stroke and deep medullary vein associated lesions. DTI was acquired at 1.5 Tesla with dedicated neonatal coil. DTI metrics (apparent diffusion coefficient (ADC), fractional anisotropy (FA), axial {lambda} {sub parallel} and radial {lambda} diffusivity) were measured in the hemisphere lesions and in the CC. The control group included seven normal newborns. The following significant differences were found between patients and normal controls in the CC: mean ADC was lower in patients (0.88 SD 0.23 versus 1.18 SD 0.07 {mu}m{sup 2}/s) and so was mean FA (0.50 SD 0.1 versus 0.67 SD 0.05) and mean {lambda} {sub parallel} value (1.61 SD 0.52 versus 2.36 SD 0.14 {mu}m{sup 2}/s). In CC the percentage of ADC always diminished independently of lesion age (with one exception), whereas in hemisphere lesions, it was negative in earlier lesions, but exceeded normal values in the older lesions. CC may undergo early DTI changes in newborns with acute focal or multi-focal hemisphere lesions of different aetiology. Although a direct insult to CC cannot be totally ruled out, DTI changes in CC (in particular {lambda} {sub parallel}) may also be compatible with very early Wallerian degeneration or pre-Wallerian degeneration. (orig.)

  17. Early diagnosis of autism spectrum disorder: stability and change in clinical diagnosis and symptom presentation.

    Science.gov (United States)

    Guthrie, Whitney; Swineford, Lauren B; Nottke, Charly; Wetherby, Amy M

    2013-05-01

    Although a diagnosis of autism spectrum disorder (ASD) appears to be stable in children as young as age three, few studies have explored stability of a diagnosis in younger children. Predictive value of diagnostic tools for toddlers and patterns of symptom change are important considerations for clinicians making early diagnoses. Most findings come from high-risk samples, but reports on children screened in community settings are also needed. Stability of diagnosis and Autism Diagnostic Observation Schedule – Toddler Module (ADOS-T) classifications and scores was examined across two time points in a sample of 82 children identified through the FIRST WORDS Project.Children received two comprehensive diagnostic evaluations at average ages of 19.39 (SD = 2.12) and 36.89 (SD = 3.85) months. Stability was 100% when confirming and ruling out a diagnosis of ASD based on a comprehensive diagnostic evaluation that included clinic and home observations,although diagnosis was initially deferred for 17% of the sample. Receiver Operating Characteristic curves revealed excellent sensitivity and acceptable specificity for the ADOS-T compared to concurrent diagnosis. Logistic regressions indicated good predictive value of initial ADOS-T scores for follow-up diagnosis. Finally, both ASD and Non-ASD children demonstrated a decrease in Social Affect scores (i.e.,improvement), whereas children with ASD demonstrated an increase in Restricted and Repetitive Behavior scores (i.e., worsening), changes that were accounted for by nonverbal developmental level in mixed model analyses. Short-term stability was documented for children diagnosed at 19 months on average, although a minority of children initially showed unclear diagnostic presentations.Findings highlight utility of the ADOS-T in making early diagnoses and predicting follow-up diagnoses. Children with ASD demonstrated improvement in social communication behaviors and unfolding of repetitive behaviors, suggesting that certain

  18. The Impact of Everyday Discrimination and Racial Identity Centrality on African American Medical Student Well-Being: a Report from the Medical Student CHANGE Study.

    Science.gov (United States)

    Perry, Sylvia P; Hardeman, Rachel; Burke, Sara E; Cunningham, Brooke; Burgess, Diana J; van Ryn, Michelle

    2016-09-01

    Positive psychological well-being is an important predictor of and contributor to medical student success. Previous work showed that first-year African American medical students whose self-concept was highly linked to their race (high racial identity centrality) were at greater risk for poor well-being. The current study extends this work by examining (a) whether the psychological impact of racial discrimination on well-being depends on African American medical students' racial identity centrality and (b) whether this process is explained by how accepted students feel in medical school. This study used baseline data from the Medical Student Cognitive Habits and Growth Evaluation (CHANGE) Study, a large national longitudinal cohort study of 4732 medical students at 49 medical schools in the USA (n = 243). Regression analyses were conducted to test whether medical student acceptance mediated an interactive effect of discrimination and racial identity centrality on self-esteem and well-being. Both racial identity centrality and everyday discrimination were associated with negative outcomes for first-year African American medical students. Among participants who experienced higher, but not lower, levels of everyday discrimination, racial identity centrality was associated with negative outcomes. When everyday discrimination was high, but not low, racial identity was negatively related to perceived acceptance in medical school, and this in turn was related to increased negative outcomes. Our results suggest that discrimination may be particularly harmful for African American students who perceive their race to be central to their personal identity. Additionally, our findings speak to the need for institutional change that includes commitment and action towards inclusivity and the elimination of structural racism.

  19. CBT for eating disorders: The impact of early changes in eating pathology on later changes in personality pathology, anxiety and depression.

    Science.gov (United States)

    Turner, Hannah; Marshall, Emily; Wood, Francesca; Stopa, Lusia; Waller, Glenn

    2016-02-01

    Whilst studies have consistently identified early symptom reduction as an important predictor of treatment outcome, the impact of early change on common comorbid features has not been investigated. This study of CBT for eating disorders explored patterns of early change in eating pathology and longer-term change in personality pathology, anxiety and depression. It also explored the impact of early change in eating pathology on overall change in personality pathology, anxiety and depression. Participants were 179 adults diagnosed with eating disorders who were offered 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 and following the 6th session. They also completed measures of personality disorder cognitions, anxiety and depression at the start and end of treatment. There were significant changes in eating pathology over the first six sessions of treatment. Significant improvements were also seen in personality disorder pathology, anxiety and depression by the end of therapy. Effect sizes were medium to large for both completer and intention to treat analyses. Early changes in eating pathology were associated with later changes in common comorbid features, with early reduction in restraint being a key predictor. These findings demonstrate that early symptom change can be achieved in CBT for eating disorders when delivered in routine clinical practice. Such change has long-term benefits that go beyond the domain of eating pathology, enhancing change in personality pathology, anxiety and depression. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. Implementing change in primary care practices using electronic medical records: a conceptual framework.

    Science.gov (United States)

    Nemeth, Lynne S; Feifer, Chris; Stuart, Gail W; Ornstein, Steven M

    2008-01-16

    Implementing change in primary care is difficult, and little practical guidance is available to assist small primary care practices. Methods to structure care and develop new roles are often needed to implement an evidence-based practice that improves care. This study explored the process of change used to implement clinical guidelines for primary and secondary prevention of cardiovascular disease in primary care practices that used a common electronic medical record (EMR). Multiple conceptual frameworks informed the design of this study designed to explain the complex phenomena of implementing change in primary care practice. Qualitative methods were used to examine the processes of change that practice members used to implement the guidelines. Purposive sampling in eight primary care practices within the Practice Partner Research Network-Translating Researching into Practice (PPRNet-TRIP II) clinical trial yielded 28 staff members and clinicians who were interviewed regarding how change in practice occurred while implementing clinical guidelines for primary and secondary prevention of cardiovascular disease and strokes. A conceptual framework for implementing clinical guidelines into primary care practice was developed through this research. Seven concepts and their relationships were modelled within this framework: leaders setting a vision with clear goals for staff to embrace; involving the team to enable the goals and vision for the practice to be achieved; enhancing communication systems to reinforce goals for patient care; developing the team to enable the staff to contribute toward practice improvement; taking small steps, encouraging practices' tests of small changes in practice; assimilating the electronic medical record to maximize clinical effectiveness, enhancing practices' use of the electronic tool they have invested in for patient care improvement; and providing feedback within a culture of improvement, leading to an iterative cycle of goal setting

  1. Predictors of early change in bulimia nervosa after a brief psychoeducational therapy.

    Science.gov (United States)

    Fernàndez-Aranda, Fernando; Álvarez-Moya, Eva M; Martínez-Viana, Cristina; Sànchez, Isabel; Granero, Roser; Penelo, Eva; Forcano, Laura; Peñas-Lledó, Eva

    2009-06-01

    We aimed to examine baseline predictors of treatment response in bulimic patients. 241 seeking-treatment females with bulimia nervosa completed an exhaustive assessment and were referred to a six-session psychoeducational group. Regression analyses of treatment response were performed. Childhood obesity, lower frequency of eating symptomatology, lower body mass index, older age, and lower family's and patient's concern about the disorder were predictors of poor abstinence. Suicidal ideation, alcohol abuse, higher maximum BMI, higher novelty seeking and lower baseline purging frequency predicted dropouts. Predictors of early symptom changes and dropouts were similar to those identified in longer CBT interventions.

  2. EVALUATION OF EARLY ISCHEMIC CHANGES IN STROKE PATIENTS TREATED WITH THROMBOLYTIC THERAPY

    OpenAIRE

    Kolevski Goran; Korneti-Pekevska Kostandina

    2016-01-01

    Introduction:The aim of this study is to evaluate early brain ischemic changes on CT scan in stroke patients in correlation with the clinical outcome, as well as to evaluate if there is prognostic and predictive features that can be used. Patients and methods: We examined 20 patients with acute ischemic stroke, from which 12 were male and 8 were female, at the age from 47 to 76 years. Results: The hyperdense medial artery (HMA) sign was present in 10 (50%) patients. Concerning the ASPECTS s...

  3. Early change in coping strategies in responsive treatments for borderline personality disorder: A mediation analysis.

    Science.gov (United States)

    Kramer, Ueli; Keller, Sabine; Caspar, Franz; de Roten, Yves; Despland, Jean-Nicolas; Kolly, Stéphane

    2017-05-01

    Difficulty in emotion regulation is a hallmark feature of patients with borderline personality disorder (BPD). Therefore, change in the frequency of certain patients' coping strategies-aiming at emotion regulation-are among the most promising mechanisms of change in treatments for BPD. In parallel, it was highlighted that therapist responsiveness significantly contributed to outcome across treatment approaches (Stiles, 2009). Based on a randomized controlled trial (Kramer et al., 2014), the present process-outcome mediation analysis aims at examining the patient's early change in frequency of coping strategies-in particular the decrease in behavioral forms of coping-as potential mechanism of change in responsive treatments for BPD. A total of 57 patients with BPD were included in the present analysis, out of whom 27 were randomly assigned to a 10-session psychiatric treatment and 30 to a 10-session psychiatric treatment augmented with the responsive intervention of the motive-oriented therapeutic relationship (Caspar, 2007). The 1st, 5th, and 9th session of each therapy were transcribed and analyzed using the Coping Action Pattern Rating Scale (Perry et al., 2005; 171 sessions analyzed in total), a validated observer-rated method for assessing coping strategies in the therapy process. Psychological distress was assessed using the OQ-45 at intake, after Session 5, and after Session 10. The results confirmed a responsiveness effect associated with the motive-oriented therapeutic relationship and showed a significant decrease in frequency of behavioral forms of coping, F(1, 54) = 3.09, p = .05, d = .56, which was not different between the 2 conditions. In addition, we demonstrated that the early decrease in behavioral forms of coping between Sessions 1 and 5 partially mediated the link between the group assignment and the change in psychological distress between Sessions 5 and 10. These results shed light on the centrality of therapist responsiveness in treatments for

  4. Determinants of preferences for lifestyle changes versus medication and beliefs in ability to maintain lifestyle changes. A population-based survey

    Directory of Open Access Journals (Sweden)

    Dorte Ejg Jarbøl

    2017-06-01

    For conclusion we found a pervasive preference for lifestyle changes over medical treatment when individuals were promised the same benefits. Lifestyle risk factors and socioeconomic characteristics were associated with preference for lifestyle changes as well as belief in ability to maintain lifestyle changes. For health professionals risk communication should not only focus on patient preferences but also on patients' beliefs in their own ability to initiate lifestyle changes and possible barriers against maintaining changes.

  5. Naturally-occurring changes in social-cognitive factors modify change in physical activity during early adolescence.

    Directory of Open Access Journals (Sweden)

    Rod K Dishman

    Full Text Available To determine whether naturally-occurring changes in children's motives and beliefs are associated with the steep decline in physical activity observed from childhood to early adolescence.Latent growth modeling was applied in longitudinal tests of social-cognitive influences, and their interactions, on physical activity in a large cohort of boys and girls evaluated annually between 5th and 7th grades.Measurement equivalence of motives and beliefs was confirmed between boys and girls. After adjustment for gender and maturity differences, physical activity declined less in children who reported the least decreases in self-efficacy for overcoming barriers to activity and perceived parental support. Physical activity also declined less in students who persistently felt they had more parental and friend support for activity compared to those who reported the largest decrease in support from friends. After further adjustment for race, the decline in physical activity was less in those who had the largest decrease in perceived barriers and maintained a favorable perception of their neighborhood environment. Changes in enjoyment and social motives were unrelated to change in physical activity.Using an objective measure of physical activity, we confirm that naturally-occurring changes in children's beliefs about barriers to physical activity and their ability to overcome them, as well as perceptions of their neighborhood environment and social support, are concurrent with age-related declines in children's physical activity. The longitudinal findings confirm these putative social-cognitive mediators as plausible, interacting targets of interventions designed to mitigate the marked decline in physical activity that occurs during the transition between elementary and middle schools.

  6. Pediatric surgeons and anesthesiologists expand the dialogue on the neurotoxicity question, rationale for early and delayed surgeries, and practice changes while awaiting definitive evidence.

    Science.gov (United States)

    Byrne, Mary W; Casale, Pasquale; Garzon, Maria; Hyman, Joshua E; Lin, Albert Y; Lynch, Lisa R; Schleien, Charles L; Stylianos, Steven

    2014-10-01

    The Pediatric Anesthesia NeuroDevelopment Assessment team at Columbia University Medical Center Department of Anesthesiology convened its fourth biennial Symposium to address unresolved issues concerning potential neurotoxic effects of anesthetic agents and sedatives on young children and to assess study findings to date. Dialogue initiated at the third Symposium was continued between anesthesiologists, researchers, and a panel of expert pediatric surgeons representing general surgery and dermatology, orthopedic, and urology specialties. The panel explored the need to balance benefits of early surgery using improved technologies against potential anesthetic risks, practice changes while awaiting definitive answers, and importance of continued interprofessional dialogue.

  7. Rapid Temperature Changes and the Early Activity on Comet 67P/Churyumov-Gerasimenko

    Science.gov (United States)

    Alí-Lagoa, V.; Delbo', M.; Libourel, G.

    2015-09-01

    The so-called “early activity” of comet 67P/Churyumov-Gerasimenko has been observed to originate mostly in parts of the concave region or “neck” between its two lobes. Since activity is driven by the sublimation of volatiles, this is a puzzling result because this area is less exposed to the Sun and is therefore expected to be cooler on average. We used a thermophysical model that takes into account thermal inertia, global self-heating, and shadowing, to compute surface temperatures of the comet. We found that, for every rotation in the 2014 August-December period, some parts of the neck region undergo the fastest temperature variations of the comet’s surface precisely because they are shadowed by their surrounding terrains. Our work suggests that these fast temperature changes are correlated to the early activity of the comet, and we put forward the hypothesis that erosion related to thermal cracking is operating at a high rate on the neck region due to these rapid temperature variations. This may explain why the neck contains some ice—as opposed to most other parts of the surface—and why it is the main source of the comet’s early activity. In a broader context, these results indicate that thermal cracking can operate faster on atmosphereless bodies with significant concavities than implied by currently available estimates.

  8. Early and Middle Jurassic climate changes: implications for palaeoceanography and tectonics

    DEFF Research Database (Denmark)

    Korte, Christoph; Hesselbo, Stephen; Ullmann, Clemens Vinzenz

    2014-01-01

    The occurrence of ‘ice ages’ within the overall warm Jurassic Period has been the subject of much discussion and not a little controversy. Recently it has been suggested on the basis of occurrence of glendonites in circum-Arctic basins that cold episodes took place in the Jurassic (Price, 1999; R...... by substantial changes in oceanic current patterns which were initiated by a major tectonic uplift that prevented the transport of heat to Polar Regions....... three pronounced oxygen isotope ‘Ice Age’ cycles, and the subsequent well known Toarcian Oceanic Anoxic ‘supergreenhouse’ Event is followed by very warm seawater temperatures in the late Toarcian. Moreover, a very pronounced and effective cooling occurred during the latest Toarcian and early Aalenian...... (Early-Middle Jurassic Boundary Event) resulted in substantial expansion of Arctic climates to palaeolatitudes as low as 45° and in distinctly cooler seawater temperatures in lower latitude European seas. At least the extensive cooling at the Early-Middle Jurassic Boundary Event was most likely driven...

  9. Maternal-child adrenocortical attunement in early childhood: continuity and change.

    Science.gov (United States)

    Hibel, Leah C; Granger, Douglas A; Blair, Clancy; Finegood, Eric D

    2015-01-01

    This study evaluated continuity and change in maternal-child hypothalamic-pituitary-adrenal axis attunement in early childhood. Participants were drawn from a prospective study of 1,292 mother-child dyads, which were racially diverse, predominantly low-income, and non-urban. Child focused stress tasks designed to elicit anger, fear, and frustration were administered during early infancy, later infancy, and toddlerhood. Mothers' and children's saliva samples (later assayed for cortisol) were collected before and after the tasks. The strength of mother-child adrenocortical attunement was conserved across infancy and toddlerhood. The magnitude of maternal-child adrenocortical attunement decreased in response to the child-focused stress tasks. Maternal sensitivity and the child's task-related emotional reactivity moderated adrenocortical attunement across the task, with greater maternal sensitivity during a free-play, and lower levels of child emotional reactivity during the stress tasks, stabilizing attunement from pre- to post-task levels. The findings advance our understanding of individual differences in the social regulation of adrenocortical activity in early childhood. © 2014 Wiley Periodicals, Inc.

  10. New phenomenon in early development of sporelings in Gracilaria asiatica Chang et Xia (Gracilariaceae, Rhodophyta)

    Science.gov (United States)

    Zhao, Fengjuan; Wang, Aihua; Liu, Jidong; Duan, Delin

    2006-12-01

    Study on the early development of sporelings from carpospores of Gracilaria asiatica Chang et Xia was conducted indoors under controlled culture conditions. Besides normal development of sporelings, a new developmental phenomenon of filamentous frond was observed. It was composed of one or two rows of cells, and took place from the outmost brim of the basal disc. During the early disc stage of germinated carpospores, one or two filamentous fronds formed on about 10% basal discs. Simultaneously, young fronds began to arch slightly from the centers of single and coalescent discs; lately more filamentous fronds up to 80% appeared on the brims of basal discs. Meanwhile one or more upright fronds protuberated on the basal discs. Generally, filamentous fronds exhibited in self-existence or co-existence forms with normal young sporelings on the same basal disc, and single cell detached from filamentous fronds developed into a new filamentous frond. This new phenomenon exhibited a unique differentiation pathway during the early development of G. asiatica, which would be potential for the application in artificial sporelings nursery.

  11. Mid-term evaluation of the Climate Change Action Fund: Technology Early Action Measures (TEAM) block

    International Nuclear Information System (INIS)

    2001-11-01

    To assist Canada in meeting its commitments under the Kyoto Protocol for the reduction of greenhouse gas emissions, the Government of Canada established the Climate Change Action Fund (CCAF) in 1998. Under the CCAF umbrella, the Technology Early Action Measures (TEAM) Block was initially allocated 60 million dollars over a three-year period for the provision of cost-shared support to speed up the development and deployment of cost-effective near market-ready greenhouse gases emission reducing technologies. The main avenues adopted by TEAM in its mandate were: supporting technology development and deployment, overcoming obstacles to technology development and deployment, and piloting technology transfer to developing countries and countries in transition. A mid-term evaluation of its performance to date was conducted. It proved to be too early for an adequate assessment of the extent to which the projects sponsored by TEAM demonstrated technical success in reducing greenhouse gases emissions, considering the time-consuming tasks required for the development and negotiation of technology projects. Most projects to date have not moved beyond the early stages benchmark. It was determined that the expected outcomes will be achieved. The innovative approach selected by TEAM, building on existing programs, appeared to be very effective. Findings and recommendations were discussed in this report

  12. Early changes in plasma glucagon and growth hormone response to oral glucose in experimental hyperthyroidism.

    Science.gov (United States)

    Tosi, F; Moghetti, P; Castello, R; Negri, C; Bonora, E; Muggeo, M

    1996-08-01

    The mechanisms underlying deterioration of glucose tolerance associated with hyperthyroidism are not completely understood. Increases in glucagon and growth hormone (GH) secretion have been previously found in hyperthyroid subjects, and could play a crucial role in this phenomenon. However, studies have not yet established the time sequence of changes in plasma glucose on the one hand and glucagon and GH on the other. To assess the early effects of thyroid hormone excess on glucose tolerance and plasma concentrations of the main glucoregulatory hormones, 12 nondiabetic euthyroid subjects underwent an oral glucose tolerance test (OGTT) before and after triiodothyronine ([T3] 120 micrograms/d) was administered for 10 days. Plasma levels of glucose, insulin, glucagon, and GH were determined at fasting and after the glucose load. T3 administration caused a marked increase in serum T3 (8.8 +/- 0.6 v 2.0 +/- 0.1 nmol/L), with clinical and biochemical signs of thyrotoxicosis. During the treatment, plasma glucose significantly increased both at fasting and after the glucose load (basal, 5.3 +/- 0.1 v 4.9 +/- 0.2 mmol/L, P hormone excess rapidly impairs glucose tolerance. Altered secretion of GH is an early event in thyrotoxicosis accompanying the onset of hyperglycemia, whereas plasma glucagon is appropriately suppressed by the increased plasma glucose levels. Thus, GH but not glucagon may contribute to the early hyperglycemic effect of thyrotoxicosis.

  13. Effectiveness of a group-based intervention to change medication beliefs and improve medication adherence in patients with rheumatoid arthritis: a randomized controlled trial.

    Science.gov (United States)

    Zwikker, Hanneke E; van den Ende, Cornelia H; van Lankveld, Wim G; den Broeder, Alfons A; van den Hoogen, Frank H; van de Mosselaar, Birgit; van Dulmen, Sandra; van den Bemt, Bart J

    2014-03-01

    To assess the effect of a group-based intervention on the balance between necessity beliefs and concern beliefs about medication and on medication non-adherence in patients with rheumatoid arthritis (RA). Non-adherent RA patients using disease-modifying anti-rheumatic drugs (DMARDs) were randomized to an intervention or control arm. The intervention consisted, amongst others, of two motivational interviewing-guided group sessions led by the same pharmacist. Control patients received brochures about their DMARDs. Questionnaires were completed up to 12 months follow-up. 123 patients (mean age: 60 years, female: 69%) were randomized. No differences in necessity beliefs and concern beliefs about medication and in medication non-adherence were detected between the intervention and control arm, except at 12 months' follow-up: participants in the intervention arm had less strong necessity beliefs about medication than participants in the control arm (b: -1.0 (95% CI: -2.0, -0.1)). This trial did not demonstrate superiority of our intervention over the control arm in changing beliefs about medication or in improving medication adherence over time. Absent intervention effects might have been due to, amongst others, selection bias and a suboptimal treatment integrity level. Hence, targeting beliefs about medication in clinical practice should not yet be ruled out. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  14. Do we need to change the medical curriculum: regarding the pain of others

    Directory of Open Access Journals (Sweden)

    Sundeep Mishra

    2015-05-01

    Full Text Available The current curriculum is behind its time and urgently requires to be reformed. The changes required are not only in the amount and type of desired information but also in the way this knowledge is acquired. Further, literature, art and philosophy require to be integrated in the curriculum so that a medical student can find his/her bearings in the society. Finally, but most importantly focus must be on developing empathy so that a prospective physician can correlate with the pain of patients and act towards relieving it rather than intellectualizing it.

  15. Early radiation changes of normal dog brain following internal and external brain irradiation: A preliminary report

    International Nuclear Information System (INIS)

    Chin, H.; Maruyama, Y.; Markesbery, W.; Goldstein, S.; Wang, P.; Tibbs, P.; Young, B.; Feola, J.; Beach, L.

    1984-01-01

    To examine radiation-induced changes in the normal brain, internal or external radiation was given to normal dog brain. Seven medium-sized dogs were used in this study. Two dogs were controls and an ice-pick (plastic implant applicator) was placed in the right frontal lobe for about 5 hours but no irradiation. Two dogs underwent Cs-137 brain implantation for 4 and 5 hours, respectively using an ice-pick technique. Two dogs were given internal neutron irradiation using the same technique of intracerebral ice-pick brachytherapy. One dog received an external photon irradiation using 6-Mev Linear Accelerator. Postmortem microscopic examination was made to study the early cerebral changes to irradiation in three dogs: one control with no irradiation; one received intracerebral Cesium implantation; and one external photon irradiation. Vascular change was the most prominent microscopic finding. There were hemorrhage, endothelial proliferation and fibrinoid changes of small vessel wall. Most of the changes were localized in the white matter and the cortex remained intact. Details (CT, NMR and histological studies) are discussed

  16. A study on early microstructural changes in the rabbit gallbladder induced by shock waves

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Eun Oak [Hong-Sung Koryo Hospital, Hongsung (Korea, Republic of); Shim, Hyung Jin; Kim, Kun Sang; Ryo, Dae Sik; Choi, Yun Sun; Song, In Sup; Kim, Young Koo [College of Medicine, Chung Ang University, Seoul (Korea, Republic of)

    1994-05-15

    In order to evaluate microstructural changes after shock wave exposure, gross, light microscopic and transmission electron microscopic findings were analyzed with rabbit gallbladders. A preliminary study(2 rabbits) was performed to determine the dosage intensity of shock waves needed to inflict damage, using a EDAP LT 01 piezoelectric extracorporeal shock wave lothotriptor. The Gallbladders of three different groups of rabbits were given shock waves of various intensity. A storage value of 100, 50, 25 at rate of 20/sec under 80% power were given to group I (4 rabbits), group II (4 rabbits), and group III (3 rabbits), respectively. The rabbits were sacrificed 6-12 hours later. The observed pathologic changes in the transmission electron microscopy were vaculization of cytoplasm and swelling of epithelial cells with dilatation and structural alteration of intracellular organelles, especially endoplasmic reticulum. Cell membrane rupture and necrosis were observed at the markedly affected area. The structural changes of intracellular organelles were minimally found at a storage value of 25. However, above pathologic changes with dilatation and structural alterations of endoplasmic reticulums were more profound at value of 100. Early histologic changes induced by shocked waves are dose dependent and findings of cellular damage caused by ESWL might be explained as above.

  17. Early grey matter changes in structural covariance networks in Huntington's disease.

    Science.gov (United States)

    Coppen, Emma M; van der Grond, Jeroen; Hafkemeijer, Anne; Rombouts, Serge A R B; Roos, Raymund A C

    2016-01-01

    Progressive subcortical changes are known to occur in Huntington's disease (HD), a hereditary neurodegenerative disorder. Less is known about the occurrence and cohesion of whole brain grey matter changes in HD. We aimed to detect network integrity changes in grey matter structural covariance networks and examined relationships with clinical assessments. Structural magnetic resonance imaging data of premanifest HD ( n  = 30), HD patients (n = 30) and controls (n = 30) was used to identify ten structural covariance networks based on a novel technique using the co-variation of grey matter with independent component analysis in FSL. Group differences were studied controlling for age and gender. To explore whether our approach is effective in examining grey matter changes, regional voxel-based analysis was additionally performed. Premanifest HD and HD patients showed decreased network integrity in two networks compared to controls. One network included the caudate nucleus, precuneous and anterior cingulate cortex (in HD p  covariance might be a sensitive approach to reveal early grey matter changes, especially for premanifest HD.

  18. Cognitive Changes After Adjuvant Treatment in Older Adults with Early-Stage Breast Cancer.

    Science.gov (United States)

    Lange, Marie; Heutte, Natacha; Noal, Sabine; Rigal, Olivier; Kurtz, Jean-Emmanuel; Lévy, Christelle; Allouache, Djelila; Rieux, Chantal; Lefel, Johan; Clarisse, Bénédicte; Leconte, Alexandra; Veyret, Corinne; Barthélémy, Philippe; Longato, Nadine; Tron, Laure; Castel, Hélène; Eustache, Francis; Giffard, Bénédicte; Joly, Florence

    2018-06-22

    Group-based trajectory modeling is particularly important to identify subgroups of patients with pathological cognitive changes after cancer treatment. To date, only one study has explored cognitive trajectories in older patients with cancer. The present article describes objective cognitive changes before to after adjuvant treatment in older adults with early-stage breast cancer (EBC) after adjuvant treatment compared with healthy controls. Participants were patients ≥65 years of age with newly diagnosed EBC and healthy controls (age-, sex-, and education-matched). The pretreatment assessment was conducted before adjuvant therapy, and the post-treatment assessment after the end of the first adjuvant treatment. Objective cognitive changes before to after treatment were evaluated based on the Reliable Change Index for cognitive decline accounting for cognitive impairment status. The sample consisted of women newly diagnosed with EBC ( n  = 118) and healthy controls ( n  = 62). Five patterns of changes before to after treatment were identified based on the presence of cognitive decline and cognitive impairment. The distribution of these five change patterns was statistically significant ( p  = .0001). Thirty-six percent of patients had phase shift changes, 31% without initial objective cognitive impairment developed impairment, 15% had a normal aging, 12% had a nonpathological decline, and 6% experienced accelerated cognitive decline. This study described for the first time objective cognitive changes before to after treatment of older adults with EBC immediately after the end of adjuvant treatment. A longer-term remote follow-up of adjuvant treatment is needed to better understand the cognitive trajectories of older patients with EBC. The Oncologist IMPLICATIONS FOR PRACTICE: After the end of adjuvant treatment, 31% of older adults with early-stage breast cancer without initial objective cognitive impairment developed impairment, and 6% experienced

  19. Is community-based electrocardiography education feasible in the early phase of an undergraduate medical curriculum?

    Directory of Open Access Journals (Sweden)

    Carol O. Larson

    2017-10-01

    Full Text Available Accreditation authorities expect medical schools to increase their teaching standards and civic engagement, despite limited resources. The aim of this study was to investigate the feasibility of community-based (CB electrocardiography (ECG instruction in semesters 4and/or 5 of the undergraduate MBChB programme at the University of the Free State in Bloemfontein, South Africa. A literature review and 34 structured interviews were employed, using a mixed-methods QUAN (þqual research design. Regarding the preclinical phase, 18 interviewees strongly supported community-based learning (CBL and 21strongly supported task-based (TB CBL. Responses were more conservative regarding the practicability of TB CBL. Twenty-two interviewees supported preclinical phase ECG-specific CBL. There was more support for implementing CB ECG in the clinical phase than in the preclinical phase. Challenges identified included finances, transport, personnel availability, clinic space, curriculum time constraints, student and driver absenteeism, and ethical aspects. Solutions for the preclinical phase included combining electrocardiography with other CBL tasks. Many interviewees supported preclinical phase TB CBL, although several factors determine its feasibility. Availability of human and other resources and curriculum time significantly impact CB ECG learning. Solutions necessitate additional location-specific research.

  20. Early changes in shoot transcriptome of rice in response to Rhodotorula mucilaginosa JGTA-S1

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    Chinmay Saha

    2015-12-01

    Full Text Available Yeasts of Rhodotorula genus have been reported to show endophytic colonization in different plants. Some of the Rhodotorula species are found to exhibit plant growth promoting activities and also have been reported to protect plants against invading pathogens. A yeast strain closely related to Rhodotorula mucilaginosa was isolated from the endosphere of Typha angustifolia collected from a Uranium mine. A microarray analysis was performed to investigate the early changes in rice shoot transcripts in response to this yeast (R. mucilaginosa JGTA-S1. Transcriptional changes were monitored in 6 h and 24 h treated rice plant shoots as compared to 0 h control. The microarray data has been submitted to the NCBI GEO repository under the accession number of GSE64321.

  1. Testing causes for long-term changes in carbon cycling and climate during the early Paleogene

    Science.gov (United States)

    Komar, N.; Zeebe, R. E.; Dickens, G. R.

    2013-12-01

    The late Paleocene to the early Eocene (˜58-52 Ma) was marked by significant changes in global climate and carbon cycling. Among the evidence for these changes, stable isotope records reveal a prominent decrease of δ13C and δ18O (in both surface and deep ocean), indicating a reorganization in the long-term global carbon cycle and a long-term warming trend (˜4°C), respectively. Concurrently, deep-sea carbonate records at several sites indicate a deepening of the calcite compensation depth (CCD). Here, we investigate possible causes (e.g., increased volcanic degassing, decreased net organic burial, and accelerated dissociation of gas hydrate) for these observations, but from a new perspective. The basic model employed is a modified version of GEOCARB III. However, we have coupled this well-known geochemical model to LOSCAR, a model that enables simulation of seawater carbonate chemistry, the CCD, and ocean δ13C. We have also added a gas hydrate capacitor that can account for the storage and release of methane from the seafloor over millions of years. We further consider accurate input data (e.g., δ13C of carbonate) on a currently accepted time scale that spans an interval much longer than the perturbation. Several different scenarios are investigated with the goal of consistency amongst inferred changes in temperature, the CCD, and surface ocean and deep ocean δ13C. The results strongly suggest that a decrease in net organic carbon burial drove carbon cycle changes during the late Paleocene and early Eocene, although an increase in volcanic activity might have contributed. Importantly, a drop in net organic carbon burial may represent increased oxidation of previously deposited organic carbon, such as stored in peat or gas hydrates. The model successfully recreates trends in Earth surface warming, as inferred from δ18O records, the CCD, and δ13C. At the moment, however, our coupled modeling effort cannot reproduce the magnitude of change in all these

  2. Changes in food processing and occlusal dental wear during the early agricultural period in northwest Mexico.

    Science.gov (United States)

    Watson, James T

    2008-01-01

    Crown dimensions and occlusal surface wear rate and wear plane were evaluated using paired first and second mandibular molars from a sample of 84 Early Agricultural period (1600 B.C.-A.D. 200) skeletons from northwest Mexico. Although this period represents a major shift in subsistence strategies in the Sonoran Desert, from food-foraging to agriculture, archaeological and dental pathology studies have identified this period as one of relative dietary stability. It was therefore predicted that very little variation in occlusal wear would have occurred between the early phase (San Pedro: 1600-800 B.C.) and late phase (Cienega: 800 B.C.-A.D. 200). Comparison of crown diameters identified some phenotypic differences between sexes but not between archaeological phases. Molar occlusal surfaces were then divided into four quadrants, and wear scores recorded for each quadrant. Principle axis analysis was performed between total wear scores of paired, adjacent first and second mandibular molars to assess rate and occlusal wear plane over time. The analysis demonstrated that both wear rate and wear plane increased from the early to the late phase of the Early Agricultural period. These results indicate that although diet may have indeed remained stable during this period in the Sonoran Desert increases in the rate of wear and wear plane may reflect changes in food-processing techniques. It is suggested that more intensive processing of agricultural products during the Cienega phase simultaneously softened the diet to create more tooth-contact wear and introduced more grit to cause faster and more angled wear on the molar occlusal surfaces. (c) 2007 Wiley-Liss, Inc.

  3. Financialization impedes climate change mitigation: Evidence from the early American solar industry

    Science.gov (United States)

    Jerneck, Max

    2017-01-01

    The article investigates how financialization impedes climate change mitigation by examining its effects on the early history of one low-carbon industry, solar photovoltaics in the United States. The industry grew rapidly in the 1970s, as large financial conglomerates acquired independent firms. While providing needed financial support, conglomerates changed the focus from existing markets in consumer applications toward a future utility market that never materialized. Concentration of the industry also left it vulnerable to the corporate restructuring of the 1980s, when the conglomerates were dismantled and solar divisions were pared back or sold off to foreign firms. Both the move toward conglomeration, when corporations became managed as stock portfolios, and its subsequent reversal were the result of increased financial dominance over corporate governance. The American case is contrasted with the more successful case of Japan, where these changes to corporate governance did not occur. Insulated from shareholder pressure and financial turbulence, Japanese photovoltaics manufacturers continued to expand investment throughout the 1980s when their American rivals were cutting back. The study is informed by Joseph Schumpeter’s theory of creative destruction and Hyman Minsky’s theory of financialization, along with economic sociology. By highlighting the tenuous and conflicting relation between finance and production that shaped the early history of the photovoltaics industry, the article raises doubts about the prevailing approach to mitigate climate change through carbon pricing. Given the uncertainty of innovation and the ease of speculation, it will do little to spur low-carbon technology development without financial structures supporting patient capital. PMID:28435862

  4. Phenological behaviour of early spring flowering trees in Spain in response to recent climate changes

    Science.gov (United States)

    Hidalgo-Galvez, M. D.; García-Mozo, H.; Oteros, J.; Mestre, A.; Botey, R.; Galán, C.

    2018-04-01

    This research reports the phenological trends of four early spring and late winter flowering trees in Spain (south Europe) from a recent period (1986-2012). The studied species were deciduous trees growing in different climatic areas: hazel ( Corylus avellana L.), willow ( Salix alba L.), ash ( Fraxinus angustifolia Vahl.) and white mulberry ( Morus alba L.). We analysed the response to climate and the trends of the following phenophases observed at the field: budburst, leaf unfolding, flowering, fruit ripening, fruit harvesting, leaf colour change and leaf-fall. The study was carried out in 17 sampling sites in the country with the aim of detecting the recent phenological response to the climate of these species, and the possible effect of climate change. We have observed differences in the phenological response to climate depending on each species. Sixty-one percent of studied sites suffered an advance of early spring phenophases, especially budburst on average by -0.67 days and flowering on average by -0.15 days during the studied period, and also in the subsequent fruit ripening and harvesting phases on average by -1.06 days. By contrast, it has been detected that 63% of sampling sites showed a delay in autumn vegetative phases, especially leaf-fall events on average by +1.15 days. The statistic correlation analysis shows in the 55% of the studied localities that phenological advances are the consequence of the increasing trend detected for temperature—being minimum temperature the most influential factor—and in the 52% of them, phenological advances occurred by rainfall variations. In general, leaf unfolding and flowering from these species showed negative correlations in relation to temperature and rainfall, whereas that leaf colour change and leaf-fall presented positive correlations. The results obtained have a great relevance due to the fact that they can be considered as reliable bio-indicators of the impact of the recent climate changes in southern

  5. Early-seral stand age and forest structural changes in public and private forestlands in Western Oregon and Washington

    Science.gov (United States)

    Robert L Deal; Sharon Stanton; Matthew Betts; Zhiqiang. Yang

    2015-01-01

    Federal forests in the Pacific Northwest region have undergone exceptional changes in management over the past 20 years, and these changes have led to a reduction in regional timber production and significant changes in the management and current age structure of forests. Public lands include large areas of older forests with relatively little younger early-seral...

  6. Methodological issues in assessing changes in costs pre- and post-medication switch: a schizophrenia study example

    Directory of Open Access Journals (Sweden)

    Nyhuis Allen W

    2009-05-01

    Full Text Available Abstract Background Schizophrenia is a severe, chronic, and costly illness that adversely impacts patients' lives and health care payer budgets. Cost comparisons of treatment regimens are, therefore, important to health care payers and researchers. Pre-Post analyses ("mirror-image", where outcomes prior to a medication switch are compared to outcomes post-switch, are commonly used in such research. However, medication changes often occur during a costly crisis event. Patients may relapse, be hospitalized, have a medication change, and then spend a period of time with intense use of costly resources (post-medication switch. While many advantages and disadvantages of Pre-Post methodology have been discussed, issues regarding the attributability of costs incurred around the time of medication switching have not been fully investigated. Methods Medical resource use data, including medications and acute-care services (hospitalizations, partial hospitalizations, emergency department were collected for patients with schizophrenia who switched antipsychotics (n = 105 during a 1-year randomized, naturalistic, antipsychotic cost-effectiveness schizophrenia trial. Within-patient changes in total costs per day were computed during the pre- and post-medication change periods. In addition to the standard Pre-Post analysis comparing costs pre- and post-medication change, we investigated the sensitivity of results to varying assumptions regarding the attributability of acute care service costs occurring just after a medication switch that were likely due to initial medication failure. Results Fifty-six percent of all costs incurred during the first week on the newly initiated antipsychotic were likely due to treatment failure with the previous antipsychotic. Standard analyses suggested an average increase in cost-per-day for each patient of $2.40 after switching medications. However, sensitivity analyses removing costs incurred post-switch that were potentially

  7. African Americans’ Perceptions of Adherence to Medications and Lifestyle Changes Prescribed to Treat Hypertension

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    Christina M. Pettey

    2016-01-01

    Full Text Available More than 80 million Americans have hypertension (HTN, and African Americans (AAs are disproportionately affected. AAs also have lower rates of adherence to HTN treatment. It is important to understand AAs’ perceptions of adherence to develop effective interventions. The aim of this study is to examine AAs’ perceptions of adherence to medications and lifestyle changes prescribed to treat HTN. In this qualitative study, we used purposive sampling to recruit Southern AAs with HTN aged 21 and older from a free, faith-based clinic. We recorded individual, in-person interviews about perceptions related to adherence to treatment of HTN and analyzed verbatim transcripts using content analysis and constant comparison. We also conducted medical record audits. Twenty-nine AAs participated (52% female, 38% were <50 years of age, 52% had taken anti-HTN medications for ≥5 years. Audits indicated that 65% had uncontrolled HTN during the previous year. Two main themes included causes of HTN and ways to improve blood pressure. Perceived causes of HTN included diet, stress, unhealthy actions, genes, and obesity. Ways to improve HTN included using cultural treatments “passed down,” increasing exercise, reducing stress, and losing weight. Many reported using home remedies to control HTN, including drinking pickle juice. More than half of this sample had uncontrolled HTN. They identified influences of culture on perceptions of adherence including causes and treatment of HTN, and possibly detrimental home remedies. It is imperative that clinicians identify culturally appropriate interventions for this high-risk group.

  8. Effecting change through dialogue: Habermas' theory of communicative action as a tool in medical lifestyle interventions.

    Science.gov (United States)

    Walseth, Liv Tveit; Schei, Edvin

    2011-02-01

    Adjustments of everyday life in order to prevent disease or treat illness afflict partly unconscious preferences and cultural expectations that are often difficult to change. How should one, in medical contexts, talk with patients about everyday life in ways that might penetrate this blurred complexity, and help people find goals and make decisions that are both compatible with a good life and possible to accomplish? In this article we pursue the question by discussing how Habermas' theory of communicative action can be implemented in decision-making processes in general practice. The theory of deliberative decision-making offers practical guidelines for what to talk about and how to do it. For a decision to be rooted in patients' everyday life it has to take into consideration the patient's practical circumstances, emotions and preferences, and what he or she perceives as ethically right behaviour towards other people. The aim is a balanced conversation, demonstrating respect, consistency and sincerity, as well as offering information and clarifying reasons. Verbalising reasons for one's preferences may increase awareness of values and norms, which can then be reflected upon, producing decisions rooted in what the patient perceives as good and right behaviour. The asymmetry of medical encounters is both a resource and a challenge, demanding patient-centred medical leadership, characterised by empathy and ability to take the patient's perspective. The implementation and adjustments of Habermas' theory in general practice is illustrated by a case story. Finally, applications of the theory are discussed.

  9. Leading change: introducing an electronic medical record system to a paramedic service.

    Science.gov (United States)

    Baird, Shawn; Boak, George

    2016-05-03

    Purpose Leaders in health-care organizations introducing electronic medical records (EMRs) face implementation challenges. The adoption of EMR by the emergency medical and ambulance setting is expected to provide wide-ranging benefits, but there is little research into the processes of adoption in this sector. The purpose of this study is to examine the introduction of EMR in a small emergency care organization and identify factors that aided adoption. Design/methodology/approach Semi-structured interviews with selected paramedics were followed up with a survey issued to all paramedics in the company. Findings The user interfaces with the EMR, and perceived ease of use, were important factors affecting adoption. Individual paramedics were found to have strong and varied preferences about how and when they integrated the EMR into their practice. As company leadership introduced flexibility of use, this enhanced both individual and collective ability to make sense of the change and removed barriers to acceptance. Research limitations/implications This is a case study of one small organization. However, there may be useful lessons for other emergency care organizations adopting EMR. Practical implications Leaders introducing EMR in similar situations may benefit from considering a sense-making perspective and responding promptly to feedback. Originality/value The study contributes to a wider understanding of issues faced by leaders who seek to implement EMRs in emergency medical services, a sector in which there has been to date very little research on this issue.

  10. Improving medication management in multimorbidity: development of the MultimorbiditY COllaborative Medication Review And DEcision Making (MY COMRADE) intervention using the Behaviour Change Wheel.

    Science.gov (United States)

    Sinnott, Carol; Mercer, Stewart W; Payne, Rupert A; Duerden, Martin; Bradley, Colin P; Byrne, Molly

    2015-09-24

    Multimorbidity, the presence of two or more chronic conditions, affects over 60 % of patients in primary care. Due to its association with polypharmacy, the development of interventions to optimise medication management in patients with multimorbidity is a priority. The Behaviour Change Wheel is a new approach for applying behavioural theory to intervention development. Here, we describe how we have used results from a review of previous research, original research of our own and the Behaviour Change Wheel to develop an intervention to improve medication management in multimorbidity by general practitioners (GPs), within the overarching UK Medical Research Council guidance on complex interventions. Following the steps of the Behaviour Change Wheel, we sought behaviours associated with medication management in multimorbidity by conducting a systematic review and qualitative study with GPs. From the modifiable GP behaviours identified, we selected one and conducted a focused behavioural analysis to explain why GPs were or were not engaging in this behaviour. We used the behavioural analysis to determine the intervention functions, behavioural change techniques and implementation plan most likely to effect behavioural change. We identified numerous modifiable GP behaviours in the systematic review and qualitative study, from which active medication review (rather than passive maintaining the status quo) was chosen as the target behaviour. Behavioural analysis revealed GPs' capabilities, opportunities and motivations relating to active medication review. We combined the three intervention functions deemed most likely to effect behavioural change (enablement, environmental restructuring and incentivisation) to form the MultimorbiditY COllaborative Medication Review And DEcision Making (MY COMRADE) intervention. MY COMRADE primarily involves the technique of social support: two GPs review the medications prescribed to a complex multimorbid patient together. Four other

  11. Progressive changes in arch width from primary to early mixed dentition period: a longitudinal study.

    Science.gov (United States)

    Sangwan, S; Chawla, H S; Goyal, A; Gauba, K; Mohanty, U

    2011-01-01

    The present study was conducted to evaluate, on a longitudinal basis, the changes in intercanine and intermolar widths form the primary to the early mixed dentition periods. A total of 38 children aged 4-5 years, with normal occlusion without any proximal caries or any dental anomalies, were selected. The impressions were recorded and casts were prepared. Intercanine and intermolar widths were measured on these dental casts with the help of a digital vernier calliper. After 3 years follow-up, the impressions were recorded again and dental casts were prepared. Intercanine and intermolar widths were measured again at this stage and were compared with the baseline data using the paired t-test and the chi square test. There is a significant increase in the intercanine (3.93 + 1.70 mm) and intermolar width (1.49 + 1.77 mm) during the transition period from primary to early mixed dentition in both the arches and both the sexes. The gender-wise comparison showed a greater increase in males than in females, but this was not statistically significant. A thorough knowledge of growth changes during various stages of the mixed dentition period are important for a pediatric dentist to make an accurate diagnosis and treatment planning during preventive and interceptive orthodontics.

  12. Bone changes occurring spontaneously and caused by estrogen in early postmenopausal women: a local generalized phenomenon?

    International Nuclear Information System (INIS)

    Christiansen, C.; Gotfredsen, A.; Riis, B.J.; Hassager, C.

    1986-01-01

    Regional values of bone mineral content and bone mineral density were calculated from total body dual photon absorptiometry scans of 52 early postmenopausal women treated with estrogen for one year and of 52 similar women treated with placebo. The six regions were head, arms, chest, spine, pelvis, and legs. In addition, bone mineral density of the spine was calculated by dual photon absorptiometry and bone mineral content of the forearm by single photon absorptiometry, using separate special purpose scanners. All regions were unchanged after one year of treatment with estrogen, excluding the lumbar spine, for which values rose. Values for all regions except the lumbar spine fell significantly in the placebo group. The rates of loss ranged from 2 to 8%, with no significant differences between the regions. It is concluded that loss of bone in the early menopause is a generalized phenomenon, affecting all parts of the skeleton. Furthermore, estrogen prophylaxis for loss of bone is effective in all parts of the skeleton. Finally, it is suggested that the measurement of bone mineral content in the forearm be used for clinical follow up of bone changes, as this method is superior to others in the ratio of change to precision

  13. Repaired supraspinatus tendons in clinically improving patients: Early postoperative findings and interval changes on MRI

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jung Eun; Park, Ji Seon; Ryu, Kyung Nam; Rhee, Yong Girl [Kyung Hee University Hospital, Seoul (Korea, Republic of); Yoon, So Hee; Park, So Young; Jin Wook [Dept. of Radiology, Kyung Hee University Hospital at Gangdong, Seoul (Korea, Republic of)

    2015-04-15

    To demonstrate and further determine the incidences of repaired supraspinatus tendons on early postoperative magnetic resonance imaging (MRI) findings in clinically improving patients and to evaluate interval changes on follow-up MRIs. Fifty patients, who showed symptomatic and functional improvements after supraspinatus tendon repair surgery and who underwent postoperative MRI twice with a time interval, were included. The first and the second postoperative MRIs were obtained a mean of 4.4 and 11.5 months after surgery, respectively. The signal intensity (SI) patterns of the repaired tendon on T2-weighted images from the first MRI were classified into three types of heterogeneous high SI with fluid-like bright high foci (type I), heterogeneous high SI without fluid-like bright high foci (type II), and heterogeneous or homogeneous low SI (type III). Interval changes in the SI pattern, tendon thickness, and rotator cuff interval thickness between the two postoperative MRIs were evaluated. The SI patterns on the first MRI were type I or II in 45 tendons (90%) and type III in five (10%). SI decreased significantly on the second MRI (p < 0.050). The mean thickness of repaired tendons and rotator cuff intervals also decreased significantly (p < 0.050). Repaired supraspinatus tendons exhibited high SI in 90% of clinically improving patients on MRI performed during the early postsurgical period. The increased SI and thickness of the repaired tendon decreased on the later MRI, suggesting a gradual healing process rather than a retear.

  14. Repaired supraspinatus tendons in clinically improving patients: Early postoperative findings and interval changes on MRI

    International Nuclear Information System (INIS)

    Lee, Jung Eun; Park, Ji Seon; Ryu, Kyung Nam; Rhee, Yong Girl; Yoon, So Hee; Park, So Young; Jin Wook

    2015-01-01

    To demonstrate and further determine the incidences of repaired supraspinatus tendons on early postoperative magnetic resonance imaging (MRI) findings in clinically improving patients and to evaluate interval changes on follow-up MRIs. Fifty patients, who showed symptomatic and functional improvements after supraspinatus tendon repair surgery and who underwent postoperative MRI twice with a time interval, were included. The first and the second postoperative MRIs were obtained a mean of 4.4 and 11.5 months after surgery, respectively. The signal intensity (SI) patterns of the repaired tendon on T2-weighted images from the first MRI were classified into three types of heterogeneous high SI with fluid-like bright high foci (type I), heterogeneous high SI without fluid-like bright high foci (type II), and heterogeneous or homogeneous low SI (type III). Interval changes in the SI pattern, tendon thickness, and rotator cuff interval thickness between the two postoperative MRIs were evaluated. The SI patterns on the first MRI were type I or II in 45 tendons (90%) and type III in five (10%). SI decreased significantly on the second MRI (p < 0.050). The mean thickness of repaired tendons and rotator cuff intervals also decreased significantly (p < 0.050). Repaired supraspinatus tendons exhibited high SI in 90% of clinically improving patients on MRI performed during the early postsurgical period. The increased SI and thickness of the repaired tendon decreased on the later MRI, suggesting a gradual healing process rather than a retear.

  15. Progressive changes in arch width from primary to early mixed dentition period: A longitudinal study

    Directory of Open Access Journals (Sweden)

    S Sangwan

    2011-01-01

    Full Text Available Objective: The present study was conducted to evaluate, on a longitudinal basis, the changes in intercanine and intermolar widths form the primary to the early mixed dentition periods. Materials and Methods: A total of 38 children aged 4-5 years, with normal occlusion without any proximal caries or any dental anomalies, were selected. The impressions were recorded and casts were prepared. Intercanine and intermolar widths were measured on these dental casts with the help of a digital vernier calliper. After 3 years follow-up, the impressions were recorded again and dental casts were prepared. Intercanine and intermolar widths were measured again at this stage and were compared with the baseline data using the paired t-test and the chi square test. Results: There is a significant increase in the intercanine (3.93 + 1.70 mm and intermolar width (1.49 + 1.77 mm during the transition period from primary to early mixed dentition in both the arches and both the sexes. The gender-wise comparison showed a greater increase in males than in females, but this was not statistically significant. Conclusion: A thorough knowledge of growth changes during various stages of the mixed dentition period are important for a pediatric dentist to make an accurate diagnosis and treatment planning during preventive and interceptive orthodontics.

  16. Change in depression across adolescence: The role of early anger socialization and child anger.

    Science.gov (United States)

    O'Neal, Colleen R; Weston, Lynsey C; He, Xin; Huang, Keng-Yen; Pine, Daniel S; Kamboukos, Dimitra; Brotman, Laurie Miller

    2017-08-01

    The purpose of this longitudinal study was to examine the relations of early socialization of anger with change in adolescent depression, and moderation by child anger. Using a sample of low-income, ethnic minority children at familial risk for psychopathology in the United States (n = 92; ages 3-5; 53% female; 65% African American; 27% Latina/o), early anger socialization (i.e., parent response to child anger) was tested as a predictor of change in depression from preadolescence to adolescence [i.e., age 8 (n = 63), 11 (n = 58), and 13 (n = 44)]. A videotaped parent-child interaction was coded for parental socialization of preschooler anger, and psychiatric interviews of depression were conducted three times across preadolescence and adolescence. Major depression diagnoses increased from preadolescence to adolescence. Latent growth modeling indicated parent discouragement of child anger was a significant predictor of an increase in the child's later depression from preadolescence to adolescence, and child anger intensity was a significant moderator. Copyright © 2017 The Foundation for Professionals in Services for Adolescents. All rights reserved.

  17. Early weight changes after birth and serum high-molecular-weight adiponectin level in preterm infants.

    Science.gov (United States)

    Yoshida, Tomohide; Nagasaki, Hiraku; Asato, Yoshihide; Ohta, Takao

    2011-12-01

    Extra-uterine growth retardation (EUGR) is associated with an increased risk for cardiometabolic diseases later in life. The aim of the present study was to examine the relationship between early weight change after birth in preterm infants and adiponectin (adn) multimeric complexes. Subjects included 28 preterm infants born between weeks 24 and 33 of gestation. Serum adn multimeric complexes and the anthropometric parameters were measured in preterm infants at birth and at corrected term. Bodyweight (BW) decreased during the first week of life, with birthweight restored at approximately 19 days after birth. Nineteen of the subjects had EUGR at corrected term. Total (T)-adn, high-molecular-weight (H)-adn, and the ratio of H-adn to T-adn (H/T-adn) were significantly elevated at corrected term than at birth. Postmenstrual age, birthweight, birth length and lowest BW after birth were positively correlated with H-adn and H/T-adn. Weight reduction after birth was negatively correlated with H-adn. Age to restore birthweight was negatively correlated with T-adn, H-adn and H/T-adn. Stepwise multiple regression analysis indicated age to restore birthweight as the major predictor of T-adn and H-adn. Early weight changes after birth may alter serum adn level in preterm infants at corrected term. The appropriate nutritional support in the early postnatal period could reduce the prevalence of EUGR and the future risk for cardiometabolic diseases. © 2011 The Authors. Pediatrics International © 2011 Japan Pediatric Society.

  18. Early anisotropy changes in the corpus callosum of patients with optic neuritis

    International Nuclear Information System (INIS)

    Bester, M.; Ding, X.Q.; Holst, B.; Fiehler, J.; Heesen, C.; Schippling, S.; Martin, R.

    2008-01-01

    Optic neuritis (ON) and any other early manifestation of multiple sclerosis (MS) are referred to as clinically isolated syndrome (CIS) as long as MS is suspected. In this prospective study we aimed to determine whether diffusion tensor imaging (DTI) could quantify structural changes in patients with early MS. A total of 24 patients and 15 control subjects were prospectively followed by clinical examinations and MRI. the main inclusion criterion was presentation with ON. Patients underwent serial MRI scans: MRI1 (baseline, n=24), MRI2 (mean 6.6 months, n=24), MRI3 (mean 13.0 months, n=14), MRI4 (mean 39.4 months, n=5). Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) maps were derived from DTI. Four regions of interest (ROIs) were defined in normal-appearing white matter (NAWM). In the temporal course FA decreased in the genu of the callosal body (GCC) from MRI1 to MRI4 (P=0.005) and in the splenium of the callosal body (SCC) (P=0.006). Patients already had lower FA values in the SCC (P<0.01) on MRI1 compared with the controls. Patients had lower FA values in the GCC (P<0.01) starting from MRI2. Patients with definite MS on follow-up (n=9) showed a correlation between FA in the SCC and time (r=-0.40, P=0.004), whereas patients without progression did not. Our findings suggest that the corpus callosum is an early site for development of anisotropy changes in MS patients with ON. There seems to be a primary FA decrease in all patients with ON that only deteriorates in the group developing definite MS. (orig.)

  19. Role, limitations and place of medical imaging in the prevention, screening and early detection of breast cancer

    International Nuclear Information System (INIS)

    Lamarque, J.L.; Pujol, J.; Rodiere, M.J.; Laurent, J.C.; Prat, X.; Martin, J.M.; Khodr, A.

    1986-01-01

    For prevention and screening of breast cancer the triad of CLINICAL SIGNS - RADIOLOGY - CYTOLOGY constitutes the most efficient and least costly method. If properly done, clinical examinations can predict the benignity or malignancy of a lesion with an accuracy rate of 80%. While self-examinations are of interest, they cannot replace a proper medical examination. Self-palpation may cause anxiety and cancerophobia both of which may have an as yet poorly understood effect on benign mastopathis. Mammography is currently the most reliable and specific imaging technique. While it can identify stage 0 lesions, it reaches its technical limits in patients with dense breast tissue. It is reserved for high-risk patients. Aspiration cytology is an excellent technique for evaluating areas with a diameter of 1 cm and more. While it cannot diagnose breast cancers in a very early stage, it helps avoid delays in the diagnosis by providing supportive evidence for radiological and clinical findings. Recent pathologic studies showed cancers to develop most often in the presence of proliferative epithelial lesions. This would seem to suggest the need for cytohistologic typing, which can be expected to pick out high-risk patients effectively, to ensure a truly early detection and diagnosis of cancer and to provide for a meaningful prevention. (Author)

  20. Early Resumption of Sex following Voluntary Medical Male Circumcision amongst School-Going Males.

    Directory of Open Access Journals (Sweden)

    Gavin George

    Full Text Available Voluntary medical male circumcision is an integral part of the South African government's response to the HIV and AIDS epidemic. Following circumcision, it is recommended that patients abstain from sexual activity for six weeks, as sex may increase the risk of female-to-male HIV transmission and prolong the healing period. This paper investigates the resumption of sexual activity during the healing period among a cohort of school-going males in the KwaZulu-Natal province of South Africa. The analysis for this paper compares two groups of sexually active school-going males: the first group reported having sex during the healing period (n = 40 and the second group (n = 98 reported no sex during the healing period (mean age: 17.7, SD: 1.7.The results show that 29% (n = 40 of young males (mean age: 17.9, SD: 1.8 who were previously sexually active, resumed sexual activity during the healing period, had on average two partners and used condoms inconsistently. In addition, those males that engage in sexual activity during the healing period were less inclined to practice safe sex in the future (AOR = 0.055, p = 0.002 than the group of males who reported no sex during the healing period. These findings suggest that a significant proportion of young males may currently and in the future, subject themselves to high levels of risk for contracting HIV post circumcision. Education, as part of a VMMC campaign, must emphasize the high risk of HIV transmission for both the males their partners during the healing period.

  1. Is the metaphor of 'barriers to change' useful in understanding implementation? Evidence from general medical practice.

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    Checkland, Kath; Harrison, Stephen; Marshall, Martin

    2007-04-01

    To investigate how general medical practices in the UK react to bureaucratic initiatives, such as National Health Service (NHS) National Service Frameworks (NSFs), and to explore the value of the metaphor of 'barriers to change' for understanding this. Interviews, non-participant observation and documentary analysis within case studies of four practices in northern England. The practices had not actively implemented NSFs. At interview, various 'barriers' that had prevented implementation were listed, including the complexity of the documents and lack of time. Observation suggested that these barriers were constructions used by the participants to make sense of the situation in which they found themselves. The metaphor of 'removing barriers to change' was of limited use in a context where non-implementation of policy was an emergent property of underlying organizational realities, likely to be modifiable only if these realities were addressed.

  2. The importance of cholesterol medication adherence: the need for behavioral change intervention programs

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    Bosworth HB

    2018-03-01

    Full Text Available Hayden B Bosworth,1–5 Barbara Ngouyombo,6 Jan Liska,7 Leah L Zullig,1,2 Caroline Atlani,8 Anne C Beal7 1Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, USA; 2Department of Population Health Sciences, Duke University, Durham, NC, USA; 3School of Nursing, Duke University, Durham, NC, USA; 4Department of Psychiatry, Duke University, Durham, NC, USA; 5Department of Behavioral Sciences, Duke University, Durham, NC, USA; 6Value & Access Team, Sanofi Pasteur, Lyon, France; 7Center of Excellence for Patient Centricity, Sanofi, Paris, France; 8Patient Strategy, Diabetes & Cardiovascular Unit, Sanofi, Paris, France Abstract: Lipid-lowering medications have been shown to be efficacious, but adherence is suboptimal. This is a narrative, perspective review of recently published literature in the field of medication adherence research for lipid-lowering medications. We provide an overview of the impact of suboptimal adherence and use a World Health Organization framework (patient, condition, therapy, socioeconomic, and health system-related systems to discuss factors that influence hyperlipidemia treatment adherence. Further, the review involves an evaluation of intervention strategies to increase hyperlipidemia treatment adherence with a special focus on mHealth interventions, patient reminders on packaging labels, nurse- and pharmacist-led interventions, and health teams. It also highlights opportunities for pharmaceutical companies to support and scale such behavioral interventions. Medication adherence remains a challenge for the long-term management of chronic conditions, especially those involving asymptomatic disease such as hyperlipidemia. To engage patients and enhance motivation over time, hyperlipidemia interventions must be targeted to individual patients’ needs, with sequencing and frequency of contact tailored to the various stages of behavioral change. Keywords: cardiovascular

  3. Assessing Changes in Medical Student Attitudes toward Non-Traditional Human Sexual Behaviors Using a Confidential Audience Response System

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    Tucker, Phebe; Candler, Chris; Hamm, Robert M.; Smith, E. Michael; Hudson, Joseph C.

    2010-01-01

    Medical students encountering patients with unfamiliar, unconventional sexual practices may have attitudes that can affect open communication during sexual history-taking. We measured changes in first-year US medical student attitudes toward 22 non-traditional sexual behaviors before and after exposure to human sexuality instruction. An…

  4. Copper induces expression and methylation changes of early development genes in Crassostrea gigas embryos.

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    Sussarellu, Rossana; Lebreton, Morgane; Rouxel, Julien; Akcha, Farida; Rivière, Guillaume

    2018-03-01

    Copper contamination is widespread along coastal areas and exerts adverse effects on marine organisms such as mollusks. In the Pacific oyster, copper induces severe developmental abnormalities during early life stages; however, the underlying molecular mechanisms are largely unknown. This study aims to better understand whether the embryotoxic effects of copper in Crassostrea gigas could be mediated by alterations in gene expression, and the putative role of DNA methylation, which is known to contribute to gene regulation in early embryo development. For that purpose, oyster embryos were exposed to 4 nominal copper concentrations (0.1, 1, 10 and 20 μg L -1 Cu 2+ ) during early development assays. Embryotoxicity was monitored through the oyster embryo-larval bioassay at the D-larva stage 24 h post fertilization (hpf) and genotoxicity at gastrulation 7 hpf. In parallel, the relative expression of 15 genes encoding putative homeotic, biomineralization and DNA methylation proteins was measured at three developmental stages (3 hpf morula stage, 7 hpf gastrula stage, 24 hpf D-larvae stage) using RT-qPCR. Global DNA content in methylcytosine and hydroxymethylcytosine were measured by HPLC and gene-specific DNA methylation levels were monitored using MeDIP-qPCR. A significant increase in larval abnormalities was observed from copper concentrations of 10 μg L -1 , while significant genotoxic effects were detected at 1 μg L -1 and above. All the selected genes presented a stage-dependent expression pattern, which was impaired for some homeobox and DNA methylation genes (Notochord, HOXA1, HOX2, Lox5, DNMT3b and CXXC-1) after copper exposure. While global DNA methylation (5-methylcytosine) at gastrula stage didn't show significant changes between experimental conditions, 5-hydroxymethylcytosine, its degradation product, decreased upon copper treatment. The DNA methylation of exons and the transcript levels were correlated in control samples for HOXA1 but such

  5. Online virtual patients - A driver for change in medical and healthcare professional education in developing countries?

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    Dewhurst, David; Borgstein, Eric; Grant, Mary E; Begg, Michael

    2009-08-01

    The development of online virtual patients has proved to be an effective vehicle for pedagogical and technological skills transfer and capacity building for medical and healthcare educators in Malawi. A project between the University of Edinburgh and the University of Malawi has delivered more than 20 collaboratively developed, virtual patients, contextualised for in-country medical and healthcare education and, more significantly, a cadre of healthcare professionals skilled in developing digital resources and integrating these into their emerging curricula. The process of engaging with new approaches to teaching and delivering personalised, context sensitive content via a game-informed, technology-supported process has contributed to the ability of healthcare educators in Malawi to drive pedagogical change, meet the substantial challenges of delivering new curricula, cope with increasing student numbers and promote teacher professional development. This initial phase of the project has laid the foundation for a broader second phase that focuses on promoting curriculum change, developing educational infrastructure and in-country capacity to create, and integrate digital resources into education and training across multi-professional groups and across educational levels.

  6. Perspectives on the changing healthcare system: teaching systems-based practice to medical residents

    Directory of Open Access Journals (Sweden)

    Johanna Martinez

    2013-09-01

    Full Text Available Purpose: The Accreditation Council for Graduate Medical Education restructured its accreditation system to be based on educational outcomes in six core competencies. Systems-based practice is one of the six core competencies. The purpose of this report is to describe Weill Cornell Medical College's Internal Medicine Residency program curriculum for systems-based practice (SBP and its evaluation process. Methods: To examine potential outcomes of the POCHS curriculum, an evaluation was conducted, examining participants': (1 knowledge gain; (2 course ratings; and (3 qualitative feedback. Results: On average, there was a 19 percentage point increase in knowledge test scores for all three cohorts. The course was rated overall highly, receiving an average of 4.6 on a 1–5 scale. Lastly, the qualitative comments supported that the material is needed and valued. Conclusion: The course, entitled Perspectives on the Changing Healthcare System (POCHS and its evaluation process support that systems-based practice is crucial to residency education. The course is designed not only to educate residents about the current health care system but also to enable them to think critically about the risk and benefits of the changes. POCHS provides a framework for teaching and assessing this competency and can serve as a template for other residency programs looking to create or restructure their SBP curriculum.

  7. Early changes of parotid density and volume predict modifications at the end of therapy and intensity of acute xerostomia

    International Nuclear Information System (INIS)

    Belli, Maria Luisa; Broggi, Sara; Scalco, Elisa; Rizzo, Giovanna; Sanguineti, Giuseppe; Fiorino, Claudio; Cattaneo, Giovanni Mauro; Dinapoli, Nicola; Valentini, Vincenzo; Ricchetti, Francesco

    2014-01-01

    To quantitatively assess the predictive power of early variations of parotid gland volume and density on final changes at the end of therapy and, possibly, on acute xerostomia during IMRT for head-neck cancer. Data of 92 parotids (46 patients) were available. Kinetics of the changes during treatment were described by the daily rate of density (rΔρ) and volume (rΔvol) variation based on weekly diagnostic kVCT images. Correlation between early and final changes was investigated as well as the correlation with prospective toxicity data (CTCAEv3.0) collected weekly during treatment for 24/46 patients. A higher rΔρ was observed during the first compared to last week of treatment (-0,50 vs -0,05HU, p-value = 0.0001). Based on early variations, a good estimation of the final changes may be obtained (Δρ: AUC = 0.82, p = 0.0001; Δvol: AUC = 0.77, p = 0.0001). Both early rΔρ and rΔvol predict a higher ''mean'' acute xerostomia score (≥ median value, 1.57; p-value = 0.01). Median early density rate changes for patients with mean xerostomia score ≥ / 3 /day for rΔρ and rΔvol respectively. Further studies are necessary to definitively assess the potential of early density/volume changes in identifying more sensitive patients at higher risk of experiencing xerostomia. (orig.) [de

  8. Deep brain stimulation effects in dystonia: time course of electrophysiological changes in early treatment.

    Science.gov (United States)

    Ruge, Diane; Tisch, Stephen; Hariz, Marwan I; Zrinzo, Ludvic; Bhatia, Kailash P; Quinn, Niall P; Jahanshahi, Marjan; Limousin, Patricia; Rothwell, John C

    2011-08-15

    Deep brain stimulation to the internal globus pallidus is an effective treatment for primary dystonia. The optimal clinical effect often occurs only weeks to months after starting stimulation. To better understand the underlying electrophysiological changes in this period, we assessed longitudinally 2 pathophysiological markers of dystonia in patients prior to and in the early treatment period (1, 3, 6 months) after deep brain stimulation surgery. Transcranial magnetic stimulation was used to track changes in short-latency intracortical inhibition, a measure of excitability of GABA(A) -ergic corticocortical connections and long-term potentiation-like synaptic plasticity (as a response to paired associative stimulation). Deep brain stimulation remained on for the duration of the study. Prior to surgery, inhibition was reduced and plasticity increased in patients compared with healthy controls. Following surgery and commencement of deep brain stimulation, short-latency intracortical inhibition increased toward normal levels over the following months with the same monotonic time course as the patients' clinical benefit. In contrast, synaptic plasticity changed rapidly, following a nonmonotonic time course: it was absent early (1 month) after surgery, and then over the following months increased toward levels observed in healthy individuals. We postulate that before surgery preexisting high levels of plasticity form strong memories of dystonic movement patterns. When deep brain stimulation is turned on, it disrupts abnormal basal ganglia signals, resulting in the absent response to paired associative stimulation at 1 month. Clinical benefit is delayed because engrams of abnormal movement persist and take time to normalize. Our observations suggest that plasticity may be a driver of long-term therapeutic effects of deep brain stimulation in dystonia. Copyright © 2011 Movement Disorder Society.

  9. Early-Holocene warming in Beringia and its mediation by sea-level and vegetation changes

    Science.gov (United States)

    Bartlein, P.J.; Edwards, M.E.; Hostetler, Steven W.; Shafer, Sarah; Anderson, P.M.; Brubaker, L. B; Lozhkin, A. V

    2015-01-01

    Arctic land-cover changes induced by recent global climate change (e.g., expansion of woody vegetation into tundra and effects of permafrost degradation) are expected to generate further feedbacks to the climate system. Past changes can be used to assess our understanding of feedback mechanisms through a combination of process modeling and paleo-observations. The subcontinental region of Beringia (northeastern Siberia, Alaska, and northwestern Canada) was largely ice-free at the peak of deglacial warming and experienced both major vegetation change and loss of permafrost when many arctic regions were still ice covered. The evolution of Beringian climate at this time was largely driven by global features, such as the amplified seasonal cycle of Northern Hemisphere insolation and changes in global ice volume and atmospheric composition, but changes in regional land-surface controls, such as the widespread development of thaw lakes, the replacement of tundra by deciduous forest or woodland, and the flooding of the Bering–Chukchi land bridge, were probably also important. We examined the sensitivity of Beringia's early Holocene climate to these regional-scale controls using a regional climate model (RegCM). Lateral and oceanic boundary conditions were provided by global climate simulations conducted using the GENESIS V2.01 atmospheric general circulation model (AGCM) with a mixed-layer ocean. We carried out two present-day simulations of regional climate – one with modern and one with 11 ka geography – plus another simulation for 6 ka. In addition, we performed five ~ 11 ka climate simulations, each driven by the same global AGCM boundary conditions: (i) 11 ka Control, which represents conditions just prior to the major transitions (exposed land bridge, no thaw lakes or wetlands, widespread tundra vegetation), (ii) sea-level rise, which employed present-day continental outlines, (iii) vegetation change, with deciduous needleleaf and deciduous broadleaf boreal

  10. Effect of injection time on postictal SPET perfusion changes in medically refractory epilepsy

    Energy Technology Data Exchange (ETDEWEB)

    Avery, R.A.; Corsi, M.; Seibyl, J.P.; Zubal, I.G. [Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT (United States); Spencer, S.S.; Spanaki, M.V. [Department of Neurology, Yale University School of Medicine, New Haven, Connecticut (United States)

    1999-08-01

    Single-photon emission tomography (SPET) brain imaging in epilepsy has become an increasingly important noninvasive tool in localizing the epileptogenic site. Ictal SPET demonstrates the highest localization sensitivity as compared with postictal and interictal SPET. While ictal SPET consistently reveals hyperperfusion at the epileptogenic site, postictal SPET reveals either hyper- or hypoperfusion depending on the timing of radiopharmaceutical injection. Much discussion in the literature exists about exactly when the transition from hyper- to hypoperfusion occurs at the epileptogenic site in postictal SPET. The systematic examination of two clinical variables - time of injection from seizure onset and offset - was useful in understanding postictal perfusion changes. Twenty-seven patients with medically refractory epilepsy receiving postictal and interictal SPET scans were studied. Quantitative SPET difference imaging was used to evaluate perfusion changes in relationship to injection time. Perfusion changes were found to reflect the time of injection in relation to seizure onset, but to be somewhat independent of seizure offset. Thus, the majority of patients (8/12, 67%) receiving postictal injections within 100 s after seizure onset demonstrated hyperperfusion, while all patients (15/15, 100%) receiving postictal injections more than 100 s after seizure onset showed hypoperfusion. The explanation of this phenomenon is unknown but the findings appear to parallel known changes in cerebral lactate levels. (orig.) With 2 figs., 2 tabs., 32 refs.

  11. [Social change in the physician's role and medical practice caused by managed care in Switzerland].

    Science.gov (United States)

    Meyer, P C; Denz, M D

    2000-03-01

    Switzerland is the first European country where health maintenance organizations (HMOs) characterised by capitation (per capita lumpsum) and gatekeeping were implemented according to the HMO staff model known in the USA. The development of managed health care in Switzerland relies on the belief that adequate economic incentives and competition result in cost reduction and high quality health care. Whether this is true or not--in any case the deregulation of legally accepted forms of health insurance and managed care result in profound changes in the Swiss health care system. Observations are made by using expert interviews and analysis of documents. The implementation of managed care induces socio-cultural changes of the medical profession which are as profound as the induced economic changes. We discuss conflicts of interests among physicians using four main dimensions of conflict: (1) control, (2) monopolization, (3) valuation, and (4) specialization. In the HMOs we observe pronounced conflicts of the physicians' role. The changes of the physicians' role in HMOs is on the one hand the result of new duties. On the other hand it expresses strategies of coping with the role conflict between the main clinical duties and the new obligation to control cost and to monitor treatment via gatekeeping. In HMOs the teamwork of doctors and the quality control of care promotes the satisfaction of physicians with their work, however, it can also have dysfunctional effects.

  12. Medical students' and facilitators' experiences of an Early Professional Contact course: active and motivated students, strained facilitators.

    Science.gov (United States)

    von Below, Bernhard; Hellquist, Gunilla; Rödjer, Stig; Gunnarsson, Ronny; Björkelund, Cecilia; Wahlqvist, Mats

    2008-12-02

    Today, medical students are introduced to patient contact, communication skills, and clinical examination in the preclinical years of the curriculum with the purpose of gaining clinical experience. These courses are often evaluated from the student perspective. Reports with an additional emphasis on the facilitator perspective are scarce. According to constructive alignment, an influential concept from research in higher education, the learning climate between students and teachers is also of great importance. In this paper, we approach the learning climate by studying both students' and facilitators' course experiences.In 2001, a new "Early Professional Contact" longitudinal strand through term 1-4, was introduced at the Sahlgrenska Academy, University of Gothenburg, Sweden. General practitioners and hospital specialists were facilitators.The aim of this study was to assess and analyse students' and clinical facilitators' experiences of the Early Professional Contact course and to illuminate facilitators' working conditions. Inspired by a Swedish adaptation of the Course Experience Questionnaire, an Early Professional Contact Questionnaire was constructed. In 2003, on the completion of the first longitudinal strand, a student and facilitator version was distributed to 86 students and 21 facilitators. In the analysis, both Chi-square and the Mann-Whitney tests were used. Sixty students (70%) and 15 facilitators (71%) completed the questionnaire. Both students and facilitators were satisfied with the course. Students reported gaining iiration for their future work as doctors along with increased confidence in meeting patients. They also reported increased motivation for biomedical studies. Differences in attitudes between facilitators and students were found. Facilitators experienced a greater workload, less reasonable demands and less support, than students. In this project, a new Early Professional Contact course was analysed from both student and facilitator

  13. Medical students' and facilitators' experiences of an Early Professional Contact course: Active and motivated students, strained facilitators

    Directory of Open Access Journals (Sweden)

    Gunnarsson Ronny

    2008-12-01

    Full Text Available Abstract Background Today, medical students are introduced to patient contact, communication skills, and clinical examination in the preclinical years of the curriculum with the purpose of gaining clinical experience. These courses are often evaluated from the student perspective. Reports with an additional emphasis on the facilitator perspective are scarce. According to constructive alignment, an influential concept from research in higher education, the learning climate between students and teachers is also of great importance. In this paper, we approach the learning climate by studying both students' and facilitators' course experiences. In 2001, a new "Early Professional Contact" longitudinal strand through term 1–4, was introduced at the Sahlgrenska Academy, University of Gothenburg, Sweden. General practitioners and hospital specialists were facilitators. The aim of this study was to assess and analyse students' and clinical facilitators' experiences of the Early Professional Contact course and to illuminate facilitators' working conditions. Methods Inspired by a Swedish adaptation of the Course Experience Questionnaire, an Early Professional Contact Questionnaire was constructed. In 2003, on the completion of the first longitudinal strand, a student and facilitator version was distributed to 86 students and 21 facilitators. In the analysis, both Chi-square and the Mann-Whitney tests were used. Results Sixty students (70% and 15 facilitators (71% completed the questionnaire. Both students and facilitators were satisfied with the course. Students reported gaining iiration for their future work as doctors along with increased confidence in meeting patients. They also reported increased motivation for biomedical studies. Differences in attitudes between facilitators and students were found. Facilitators experienced a greater workload, less reasonable demands and less support, than students. Conclusion In this project, a new Early

  14. Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV): Building Health and Early Development with the Pediatric Family-Centered Medical Home

    Science.gov (United States)

    Willis, David W.

    2013-01-01

    President Obama announced his Early Learning Agenda during his Second Inaugural Address. This announcement has galvanized a special focus on early childhood policy and practices, for the prenatal to 5-year-old period, to improve educational outcomes for America's youth. The emergent science of early childhood development places an emphasis on…

  15. Moderate beer consumption does not change early or mature atherosclerosis in mice

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    Blanco-Vaca Francisco

    2004-01-01

    Full Text Available Abstract Background Although the consumption of wine in particular has been associated with a lower risk of atherothrombotic cardiovascular disease, systematic reviews differ as to the relative protective effect of beer, wine and spirits. Two previous studies showed that red wine reduces fatty streak formation (early atherosclerosis but not mature atherosclerosis in apolipoprotein (apo E-deficient (apoE-/- mice. Aim of the study To determine whether a moderate beer intake would affect early and mature atherosclerotic lesion formation using control C57BL/6 and apoE-/- mice, respectively, as models. Methods Control C57BL/6 and apoE-/- mice were randomized to receive either water, ethanol, mild beer, dark beer or ethanol-free beer. The level of beer was designed to approximate the alcohol intake currently believed to be beneficial in reducing human vascular risk. Control C57BL/6 mice were fed a Western diet for 24 weeks, and apoE-/- mice a chow diet for 12 weeks. At the end of the trial period, mice were euthanized and atherosclerotic lesions quantified. Plasma lipid concentrations were also measured. Results The amount of atherosclerosis and average number of lesions in the proximal aortic region did not differ among groups in control C57BL/6 mice (p = 0.32 and p = 0.29, respectively and apoE-/- mice (p = 0.19 and p = 0.59, respectively. No consistent differences were observed in plasma lipid and lipoprotein concentrations among water, ethanol and beer groups. Conclusions Moderate beer consumption does not change the development of early or mature atherosclerosis in mice. Our findings do not support the hypothesis of an anti-atherogenic effect of beer. Other potential protective actions of moderate beer consumption such as plaque stabilization, a reduction in plaque intrinsic thrombogenicity, or a reduction in the systemic propensity to thrombosis, remain to be studied.

  16. Methylation changes associated with early maturation stages in the Atlantic salmon

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    Pérez-Figueroa Andrés

    2011-10-01

    Full Text Available Abstract Background Early maturation in the Atlantic salmon is an interesting subject for numerous research lines. Prior to sea migration, parr can reach sexual maturation and successfully fertilize adult female eggs during the reproductive season. These individuals are known as precocious parr, mature parr or "sneakers". Reasons for early maturation are unknown and this transitory stage is usually considered to be a threshold trait. Here, we compare methylation patterns between mature and immature salmon parr from two different rivers in order to infer if such methylation differences may be related to their maturation condition. First we analyzed genetic differences between rivers by means of AFLPs. Then, we compared the DNA methylation differences between mature and immature parrs, using a Methylation-Sensitive Amplified Polymorphism (MSAP, which is a modification of the AFLPs method by making use of the differential sensitivity of a pair of restriction enzymes isoschizomeres to cytosine methylation. The tissues essayed included brain, liver and gonads. Results AFLPs statistical analysis showed that there was no significant differentiation between rivers or a significant differentiation between maturation states in each river. MSAP statistical analysis showed that among the three tissues sampled, the gonads had the highest number of significant single-locus variation among populations with 74 loci followed by brain with 70 and finally liver with only 12. Principal components analysis (PCA of the MSAP profiles revealed different profiles among different tissues (liver, brain and testis clearly separating maturation states in the testis tissue when compared to the liver. Conclusions Our results reveal that genetically-similar mature and immature salmon parr present high levels of DNA methylation variation in two of the three analyzed tissues. We hypothesize that early maturation may be mostly mediated by epigenetic processes rather than by

  17. Early structural changes of the heart after experimental polytrauma and hemorrhagic shock

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    Halbgebauer, Rebecca; Eisele, Philipp; Messerer, David A. C.; Weckbach, Sebastian; Schultze, Anke; Braumüller, Sonja; Gebhard, Florian

    2017-01-01

    Evidence is emerging that systemic inflammation after trauma drives structural and functional impairment of cardiomyocytes and leads to cardiac dysfunction, thus worsening the outcome of polytrauma patients. This study investigates the structural and molecular changes in heart tissue 4 h after multiple injuries with additional hemorrhagic shock using a clinically relevant rodent model of polytrauma. We determined mediators of systemic inflammation (keratinocyte chemoattractant, macrophage chemotactic protein 1), activated complement component C3a and cardiac troponin I in plasma and assessed histological specimen of the mouse heart via standard histomorphology and immunohistochemistry for cellular and subcellular damage and ongoing apoptosis. Further we investigated spatial and quantitative changes of connexin 43 by immunohistochemistry and western blotting. Our results show significantly increased plasma levels of both keratinocyte chemoattractant and cardiac troponin I 4 h after polytrauma and 2 h after induction of hypovolemia. Although we could not detect any morphological changes, immunohistochemical evaluation showed increased level of tissue high-mobility group box 1, which is both a damage-associated molecule and actively released as a danger response signal. Additionally, there was marked lateralization of the cardiac gap-junction protein connexin 43 following combined polytrauma and hemorrhagic shock. These results demonstrate a molecular manifestation of remote injury of cardiac muscle cells in the early phase after polytrauma and hemorrhagic shock with marked disruption of the cardiac gap junction. This disruption of an important component of the electrical conduction system of the heart may lead to arrhythmia and consequently to cardiac dysfunction. PMID:29084268

  18. Early changes of procalcitonin may advise about prognosis and appropriateness of antimicrobial therapy in sepsis.

    Science.gov (United States)

    Georgopoulou, Antonia-Panagiota; Savva, Athina; Giamarellos-Bourboulis, Evangelos J; Georgitsi, Marianna; Raftogiannis, Maria; Antonakos, Nicolaos; Apostolidou, Efterpi; Carrer, Dionyssia-Pinelopi; Dimopoulos, George; Economou, Aggelos; Efthymiou, George; Galanakis, Nearchos; Galani, Labrini; Gargalianos, Panagiotis; Karaiskos, Ilias; Katsenos, Chrisostomos; Kavatha, Dimitra; Koratzanis, Evangelos; Labropoulos, Panagiotis; Lada, Malvina; Nakos, George; Paggalou, Evgenia; Panoutsopoulos, George; Paraschos, Michael; Pavleas, Ioannis; Pontikis, Konstantinos; Poulakou, Garyfallia; Prekates, Athanassios; Sybardi, Styliani; Theodorakopoulou, Maria; Trakatelli, Christina; Tsiaoussis, Panagiotis; Gogos, Charalambos; Giamarellou, Helen; Armaganidis, Apostolos; Meisner, Michael

    2011-06-01

    The objective of this study is to define if early changes of procalcitonin (PCT) may inform about prognosis and appropriateness of administered therapy in sepsis. A prospective multicenter observational study was conducted in 289 patients. Blood samples were drawn on day 1, that is, within less than 24 hours from advent of signs of sepsis, and on days 3, 7, and 10. Procalcitonin was estimated in serum by the ultrasensitive Kryptor assay (BRAHMS GmbH, Hennigsdorf, Germany). Patients were divided into the following 2 groups according to the type of change of PCT: group 1, where PCT on day 3 was decreased by more than 30% or was below 0.25 ng/mL, and group 2, where PCT on day 3 was either increased above 0.25 ng/mL or decreased less than 30%. Death occurred in 12.3% of patients of group 1 and in 29.9% of those of group 2 (P < .0001). Odds ratio for death of patients of group 1 was 0.328. Odds ratio for the administration of inappropriate antimicrobials of patients of group 2 was 2.519 (P = .003). Changes of serum PCT within the first 48 hours reflect the benefit or not of the administered antimicrobial therapy. Serial PCT measurements should be used in clinical practice to guide administration of appropriate antimicrobials. Copyright © 2011 Elsevier Inc. All rights reserved.

  19. Behavioral changes in early ALS correlate with voxel-based morphometry and diffusion tensor imaging.

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    Tsujimoto, Masashi; Senda, Jo; Ishihara, Tetsuro; Niimi, Yoshiki; Kawai, Yoshinari; Atsuta, Naoki; Watanabe, Hirohisa; Tanaka, Fumiaki; Naganawa, Shinji; Sobue, Gen

    2011-08-15

    Amyotrophic lateral sclerosis (ALS) is a multisystem disorder with impairment of frontotemporal functions such as cognition and behavior, but the behavioral changes associated with ALS are not well defined. Twenty-one consecutive patients with sporadic ALS and 21 control subjects participated in the study. The Frontal System Behavior Scale (FrSBe) was used to assess behavioral change. Voxel-based morphometry (VBM) and voxel-based analysis of diffusion tensor images (DTI) were performed to explore the associations of brain degeneration with behavior. All patients were evaluated before the notification of ALS. FrSBe scores of ALS patients before notification were significantly increased compared to those of control subjects. Moreover, the FrSBe Apathy score of ALS patients significantly changed from pre- to post-illness (P<0.001). The severity of apathy was significantly correlated with atrophy in the prefrontal cortex, especially in the orbitofrontal (P=0.006) and dorsolateral prefrontal (P=0.006) cortices in VBM, and in the right frontal gyrus (P<0.001) in DTI. ALS patients exhibited apathy during the early course of the illness, the severity of which was significantly associated with frontal lobe involvement. These findings support the view that a continuum exits between ALS and frontotemporal dementia. Copyright © 2011 Elsevier B.V. All rights reserved.

  20. A developmental change of the visual behavior of the face recognition in the early infancy.

    Science.gov (United States)

    Konishi, Yukihiko; Okubo, Kensuke; Kato, Ikuko; Ijichi, Sonoko; Nishida, Tomoko; Kusaka, Takashi; Isobe, Kenichi; Itoh, Susumu; Kato, Masaharu; Konishi, Yukuo

    2012-10-01

    The purpose of this study was to examine developmental changes in visuocognitive function, particularly face recognition, in early infancy. In this study, we measured eye movement in healthy infants with a preference gaze problem, particularly eye movement between two face stimulations. We used the eye tracker system (Tobii1750, Tobii Technologies, Sweden) to measure eye movement in infants. Subjects were 17 3-month-old infants and 16 4-month-old infants. The subjects looked two types of face stimulation (upright face/scrambled face) at the same time and we measured their visual behavior (preference/looking/eye movement). Our results showed that 4-month-old infants looked at an upright face longer than 3-month infants, and exploratory behavior while comparing two face stimulations significantly increased. In this study, 4-month-old infants showed a preference towards an upright face. The numbers of eye movements between two face stimuli significantly increased in 4-month-old infants. These results suggest that eye movements may be an important index in face cognitive function during early infancy. Copyright © 2012 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  1. Developmental changes in mismatch responses to mandarin consonants and lexical tones from early to middle childhood.

    Directory of Open Access Journals (Sweden)

    Huei-Mei Liu

    Full Text Available The purpose of this study was to use mismatch responses (MMRs to explore the dynamic changes of Mandarin speech perception abilities from early to middle childhood. Twenty preschoolers, 18 school-aged children, and 26 adults participated in this study. Two sets of synthesized speech stimuli varying in Mandarin consonant (alveolo-palatal affricate vs. fricative and lexical tone features (rising vs. contour tone were used to examine the developmental course of speech perception abilities. The results indicated that only the adult group demonstrated typical early mismatch negativity (MMN responses, suggesting that the ability to discriminate specific speech cues in Mandarin consonant and lexical tone is a continuing process in preschool- and school-aged children. Additionally, distinct MMR patterns provided evidence indicating diverse developmental courses to different speech characteristics. By incorporating data from the two speech conditions, we propose using MMR profiles consisting of mismatch negativity (MMN, positive mismatch response (p-MMR, and late discriminative negativity (LDN as possible brain indices to investigate speech perception development.

  2. Changes in protein synthetic activity in early Drosophila embryos mutant for the segmentation gene Krueppel

    International Nuclear Information System (INIS)

    Bedian, V.; Summers, M.C.; Kauffman, S.A.

    1988-01-01

    We have identified early embryo proteins related to the segmentation gene Krueppel by [35S]methionine pulse labelling and two-dimensional gel electrophoresis. Protein synthesis differences shared by homozygous embryos of two Krueppel alleles when compared to heterozygous and wild-type embryos are reported. The study was extended to syncytial blastoderm stages by pulse labelling and gel analysis of single embryos, using Krueppel-specific proteins from gastrula stages as molecular markers for identifying homozygous Krueppel embryos. Localized expression of interesting proteins was examined in embryo fragments. The earliest differences detected at nuclear migration stages showed unregulated synthesis in mutant embryos of two proteins that have stage specific synthesis in normal embryos. At the cellular blastoderm stage one protein was not synthesized and two proteins showed apparent shifts in isoelectric point in mutant embryos. Differences observed in older embryos included additional proteins with shifted isoelectric points and a number of qualitative and quantitative changes in protein synthesis. Five of the proteins with altered rates of synthesis in mutant embryos showed localized synthesis in normal embryos. The early effects observed are consistent with the hypothesis that the Krueppel product can be a negative or positive regulator of expression of other loci, while blastoderm and gastrula stage shifts in isoelectric point indicate that a secondary effect of Krueppel function may involve post-translational modification of proteins

  3. Changes in circulating peptide YY and ghrelin are associated with early smoking relapse.

    Science.gov (United States)

    Lemieux, Andrine M; al'Absi, Mustafa

    2018-01-01

    Ghrelin and peptide YY (PYY) during ad libitum smoking have been associated with decreased reported craving (ghrelin) and increased positive affect (PYY), and higher baseline ghrelin levels predicted subsequent increased risk of smoking relapse. The current study assessed PYY and ghrelin during ad libitum smoking and again after the initial 48h of a smoking cessation attempt. The data compared smokers who abstained for 28days (n=37), smokers who relapsed (n=54), and nonsmokers (n=37). Plasma samples and subjective measures assessing craving and mood were collected at the beginning of each session. Results showed that relapsers experienced greater levels of distress (ps <0.01). While nonsmokers and abstainers showed no change in ghrelin across the initial 48h, relapsers declined (p <0.01). With PYY, relapsers increased (p <0.05) across the early abstinent phase. PYY and ghrelin may be useful predictors of relapse, specifically in reference to early withdrawal. Copyright © 2017. Published by Elsevier B.V.

  4. Reconsidering Parenting in Chinese Culture: Subtypes, Stability, and Change of Maternal Parenting Style During Early Adolescence.

    Science.gov (United States)

    Zhang, Wenxin; Wei, Xing; Ji, Linqin; Chen, Liang; Deater-Deckard, Kirby

    2017-05-01

    Parenting in Chinese culture has been a central topic and there have been debate on whether western-derived parenting style is applicable to Chinese cultures in terms of both behavioral profiles and their relationships with child and adolescent adjustment. This study identified the subtypes of Chinese maternal parenting style and examined their stability and changes over the transition to early adolescence. In an urban Chinese sample (N = 2173, 48% girls), four waves of longitudinal data were collected when the adolescents were in the fifth (M = 11.27 years), sixth, seventh, and eighth grades. Latent profile analysis identified four subtypes of parenting style: authoritative, authoritarian, average-level undifferentiated, and strict-affectionate. Adolescents of authoritative mothers exhibited the best overall adjustment, while adolescents of authoritarian mothers showed the worst adjustment. Adolescents of strict-affectionate mothers generally adjusted as well as those of authoritative mothers, except they showed lower academic achievement. The strict-affectionate parenting represented a culture-specific subtype of parenting style in Chinese culture. Latent transition analysis revealed high stability of parenting styles during early adolescence, but transitions between subtypes were also evident. These findings highlight the importance of revisiting Chinese parenting and examining the developmental course of parenting style.

  5. Earlier Snowmelt Changes the Ratio Between Early and Late Season Forest Productivity

    Science.gov (United States)

    Knowles, J. F.; Molotch, N. P.; Trujillo, E.; Litvak, M. E.

    2017-12-01

    Future projections of declining snowpack and increasing potential evaporation associated with climate warming are predicted to advance the timing of snowmelt in mountain ecosystems globally. This scenario has direct implications for snowmelt-driven forest productivity, but the net effect of temporally shifting moisture dynamics is unknown with respect to the annual carbon balance. Accordingly, this study uses both satellite- and tower-based observations to document the forest productivity response to snowpack and potential evaporation variability between 1989 and 2012 throughout the southern Rocky Mountain ecoregion, USA. These results show that a combination of low snow accumulation and record high potential evaporation in 2012 resulted in the 34-year minimum ecosystem productivity that could be indicative of future conditions. Moreover, early and late season productivity were significantly and inversely related, suggesting that future shifts toward earlier or reduced snowmelt could increase late-season moisture stress to vegetation and thus restrict productivity despite a longer growing season. This relationship was further subject to modification by summer precipitation, and the controls on the early/late season productivity ratio are explored within the context of ecosystem carbon storage in the future. Any perturbation to the carbon cycle at this scale represents a potential feedback to climate change since snow-covered forests represent an important global carbon sink.

  6. Explaining the increase in family financial pressures from medical bills between 2003 and 2007: do affordability thresholds change over time?

    Science.gov (United States)

    Cunningham, Peter J

    2011-06-01

    This study examines whether affordability thresholds for medical care as defined by families change over time. The results from two nationally representative surveys show that while financial stress from medical bills--defined as the percent with problems paying medical bills--increased between 2003 and 2007, greater out-of-pocket spending accounted for this increase only for higher-income persons with employer-sponsored insurance coverage. Increased spending did not account for an increase in medical bill problems among lower-income persons. Moreover, the increase in medical bill problems among low-income persons occurred at relatively low levels of out-of-pocket spending rather than at higher levels. The results suggest that "affordability thresholds" for medical care as defined by individuals and families are not stable over time, especially for lower-income persons, which has implications for setting affordability standards in health reform.

  7. Change in bone mineral density during adjuvant chemotherapy for early-stage breast cancer

    DEFF Research Database (Denmark)

    Christensen, Carina Ørts; Cronin-Fenton, Deirdre; Frøslev, Trine

    2016-01-01

    PURPOSE: Adjuvant chemotherapy has been associated with loss of bone mineral density (BMD) either as a direct effect or due to glucocorticoids used as supportive care medication. A prospective cohort study was conducted to evaluate changes in BMD from baseline to right after completion of chemoth...... % CI -3.3; -0.1, p = 0.04) compared to never/former smokers. CONCLUSIONS: Adjuvant chemotherapy supplemented with prednisolone was not associated with loss of BMD. Postmenopausal women gained bone mass, whereas current smokers lost bone mass....... were excluded: seven because of initiation of bisphosphonate treatment due to osteoporosis at baseline, and one had non-interpretable DXA. The final cohort included 97 patients with a mean age of 53 years (range 34-72). Mean cumulative prednisolone dose was 1308 mg (95 % CI 1255; 1362). BMD increased 1.......36 % (95 % CI 0.7; 2.0, p smokers decreased 1.67 % (95...

  8. Emotional learning, stress, and development: An ever-changing landscape shaped by early-life experience.

    Science.gov (United States)

    Pattwell, Siobhan S; Bath, Kevin G

    2017-09-01

    The capacity to learn to associate cues with negative outcomes is a highly adaptive process that appears to be conserved across species. However, when the cue is no longer a valid predictor of danger, but the emotional response persists, this can result in maladaptive behaviors, and in humans contribute to debilitating emotional disorders. Over the past several decades, work in neuroscience, psychiatry, psychology, and biology have uncovered key processes underlying, and structures governing, emotional responding and learning, as well as identified disruptions in the structural and functional integrity of these brain regions in models of pathology. In this review, we highlight some of this elegant body of work as well as incorporate emerging findings from the field of developmental neurobiology to emphasize how development contributes to changes in the ability to learn and express emotional responses, and how early experiences, such as stress, shape the development and functioning of these circuits. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Do early premalignant changes in normal breast epithelial cells predict cancer development?

    International Nuclear Information System (INIS)

    Clarke, Robert B; Bundred, Nigel J

    2005-01-01

    A recent report suggests that, in an in vitro model of premalignant breast cells (vHMECs), silencing of INK4A gene is accompanied by over-expression of cyclo-oxygenase (COX)-2. This suggests that COX-2 over-expression may be an early event in breast cancer aetiology permitting clones within the normal epithelium to evade apoptosis, to increase their numbers and perhaps acquire further changes that promote the formation of hyperplasias, and eventually carcinomas. While COX-2 expression in normal breast epithelium in vivo has not been proven to be linked to an increased risk of breast cancer, its over-expression in the premalignant model in vitro does provide preliminary evidence that COX-2 inhibition may be a useful chemoprevention strategy

  10. Early life history and habitat ecology of estuarine fishes: responses to natural and human induced change

    Directory of Open Access Journals (Sweden)

    Kenneth Able

    2015-12-01

    Full Text Available Our understanding of the early life history of fishes and their habitats has proceeded from basic natural history to ecology, but we often need to return to natural history to address deficiencies in conceptual and quantitative models of ecosystems. This understanding is further limited by the complex life history of fishes and the lack of appreciation of shifting baselines in estuaries. These inadequacies are especially evident when we try to address the effects of human influences, e.g. fishing, urbanization, and climate change. Often our baselines are inadequate or inaccurate. Our work has detected these along the coasts of the U.S. in extensive time series of larval fish ingress into estuaries, studies of the effects of urbanization, and responses to catastrophes such as the BP oil spill. Long-term monitoring, especially, continues to provide critical insights

  11. Detection of Early Ischemic Changes in Noncontrast CT Head Improved with "Stroke Windows".

    Science.gov (United States)

    Mainali, Shraddha; Wahba, Mervat; Elijovich, Lucas

    2014-01-01

    Introduction. Noncontrast head CT (NCCT) is the standard radiologic test for patients presenting with acute stroke. Early ischemic changes (EIC) are often overlooked on initial NCCT. We determine the sensitivity and specificity of improved EIC detection by a standardized method of image evaluation (Stroke Windows). Methods. We performed a retrospective chart review to identify patients with acute ischemic stroke who had NCCT at presentation. EIC was defined by the presence of hyperdense MCA/basilar artery sign; sulcal effacement; basal ganglia/subcortical hypodensity; and loss of cortical gray-white differentiation. NCCT was reviewed with standard window settings and with specialized Stroke Windows. Results. Fifty patients (42% females, 58% males) with a mean NIHSS of 13.4 were identified. EIC was detected in 9 patients with standard windows, while EIC was detected using Stroke Windows in 35 patients (18% versus 70%; P Windows (14% and 36%; P Windows (6% and 46%; P Windows significantly improved detection of EIC.

  12. Personal Network Characteristics as Predictors of Change in Obesity Risk Behaviors in Early Adolescence.

    Science.gov (United States)

    Marks, Jennifer; de la Haye, Kayla; Barnett, Lisa M; Allender, Steven

    2018-05-17

    The potential for peers to influence obesity risk behavior increases in adolescence, yet there are knowledge gaps of how behaviors are modified in response to peers over time. This study examined how personal friendship network characteristics were associated with obesity-related behaviors from late childhood to early adolescence. Two waves of friendship, physical activity, screen time, and dietary recall data were collected from 11- to 13-year-old students (99% retention) in Australia (n = 308) over a five- to eight-month period. Regression models identified friendship network characteristics that predicted later health behaviors which varied by gender and behavior type, such as the number of friends positively associated with physical activity intensity (males) and screen time (females). The need for considering context to influence behavior change is discussed. © 2018 Society for Research on Adolescence.

  13. Mexican-Origin Youth's Cultural Orientations and Adjustment: Changes from Early to Late Adolescence

    Science.gov (United States)

    Updegraff, Kimberly A.; Umaña-Taylor, Adriana J.; McHale, Susan M.; Wheeler, Lorey A.; Perez-Brena, Norma

    2013-01-01

    Drawing from developmental and cultural adaptation perspectives and using a longitudinal design, this study examined: (a) mean-level changes in Mexican-origin adolescents’ cultural orientations and adjustment from early to late adolescence; and (b) bidirectional associations between cultural orientations and adjustment using a cross-lag panel model. Participants included 246 Mexican-origin, predominantly immigrant families that participated in home interviews and a series of nightly phone calls when target adolescents were 12 years and 18 years of age. Girls exhibited more pronounced declines in traditional gender role attitudes than did boys, and all youth declined in familism values, time spent with family, and involvement in Mexican culture. Bidirectional relations between cultural orientations and adjustment emerged, and some associations were moderated by adolescent nativity and gender. PMID:22966929

  14. Early hematologic changes during prostate cancer radiotherapy predictive for late urinary and bowel toxicity

    Energy Technology Data Exchange (ETDEWEB)

    Pinkawa, Michael; Djukic, Victoria; Klotz, Jens; Holy, Richard; Eble, Michael J. [RWTH Aachen University, Department of Radiation Oncology, Aachen (Germany); Ribbing, Carolina [RWTH Aachen University, Department of Diagnostic and Interventional Radiology, Aachen (Germany)

    2015-10-15

    The primary objective of the study was to identify early hematologic changes predictive for radiotherapy (RT)-associated genitourinary and gastrointestinal toxicity. In a group of 91 prostate cancer patients presenting for primary (n = 51) or postoperative (n = 40) curative RT, blood samples (blood count, acute phase proteins, and cytokines) were analyzed before (T1), three times during (T2-T4), and 6-8 weeks after (T5) radiotherapy. Before RT (baseline), on the last day (acute toxicity), a median of 2 months and 16 months (late toxicity) after RT, patients responded to a validated questionnaire (Expanded Prostate Cancer Index Composite). Acute score changes > 20 points and late changes > 10 points were considered clinically relevant. Radiotherapy resulted in significant changes of hematologic parameters, with the largest effect on lymphocytes (mean decrease of 31-45 %) and significant dependence on target volume. C-reactive protein (CRP) elevation > 5 mg/l and hemoglobin level decrease ≥ 5 G/1 at T2 were found to be independently predictive for acute urinary toxicity (p < 0.01, respectively). CRP elevation was predominantly detected in primary prostate RT (p = 0.02). Early lymphocyte level elevation ≥ 0.3G/l at T2 was protective against late urinary and bowel toxicity (p = 0.02, respectively). Other significant predictive factors for late bowel toxicity were decreasing hemoglobin levels (cut-off ≥ 5 G/l) at T2 (p = 0.04); changes of TNF-α (tumor necrosis factor; p = 0.03) and ferritin levels (p = 0.02) at T5. All patients with late bowel toxicity had interleukin (IL)-6 levels < 1.5 ng/l at T2 (63 % without; p = 0.01). Early hematologic changes during prostate cancer radiotherapy are predictive for late urinary and bowel toxicity. (orig.) [German] Das primaere Ziel der Studie war die Identifikation von fruehen haematologischen Veraenderungen mit praediktiver Bedeutung fuer radiotherapieassoziierte genitourinale und gastrointestinale Toxizitaet. In einer

  15. Nature–Culture Relations: Early Globalization, Climate Changes, and System Crisis

    Directory of Open Access Journals (Sweden)

    Sing C. Chew

    2016-01-01

    Full Text Available Globalization has been on everyone’s lips in light of the contemporary conditions. It has been viewed mostly as a stage reached as a result of long-term societal changes over the course of world history. For us, globalization has been an ongoing process for at least the last 5000 years. Little attention has been paid to the socioeconomic and natural processes that led to the current transformation. With the exception of historical sociologists, there is less interest in examining the long-term past as it is often assumed that the past has nothing to teach us, and it is the future that we have to turn our intellectual gaze. This paper will argue the opposite. We believe a long-term tracing of the socioeconomic and political processes of the making of the modern world will allow us to have a more incisive understanding of the current trajectory of world development and transformations. To plead our case, we outline the emergence of the first Eurasian World Economy linking seven regions (Europe, the Arabian Peninsula, East Africa, the Persian Gulf, Central Asia, South Asia, Ceylon, Southeast Asia, and China of the world, with the exception of the Americas, starting as early as 200 BC, and the sequence of structural crises and transformations (trading networks and commodities that has circumscribed the structures and trends of the current global system. Such consideration in our view is limited if we do not also include the relations between social systems and Nature, and the rhythms of the climate. For the latter, an awareness of the natural rhythms of the climate as well as human induced changes or climate forcing have triggered system-wide level collapses during certain early historical periods.

  16. 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

  17. Medical student changes in self-regulated learning during the transition to the clinical environment.

    Science.gov (United States)

    Cho, Kenneth K; Marjadi, Brahm; Langendyk, Vicki; Hu, Wendy

    2017-03-21

    Self-regulated learning (SRL), which is learners' ability to proactively select and use different strategies to reach learning goals, is associated with academic and clinical success and life-long learning. SRL does not develop automatically in the clinical environment and its development during the preclinical to clinical learning transition has not been quantitatively studied. Our study aims to fill this gap by measuring SRL in medical students during the transitional period and examining its contributing factors. Medical students were invited to complete a questionnaire at the commencement of their first clinical year (T0), and 10 weeks later (T1). The questionnaire included the Motivated Strategies for Learning Questionnaire (MSLQ) and asked about previous clinical experience. Information about the student's background, demographic characteristics and first clinical rotation were also gathered. Of 118 students invited to participate, complete paired responses were obtained from 72 medical students (response rate 61%). At T1, extrinsic goal orientation increased and was associated with gender (males were more likely to increase extrinsic goal orientation) and type of first attachment (critical care and community based attachments, compared to hospital ward based attachments). Metacognitive self-regulation decreased at T1 and was negatively associated with previous clinical experience. Measurable changes in self-regulated learning occur during the transition from preclinical learning to clinical immersion, particularly in the domains of extrinsic goal orientation and metacognitive self-regulation. Self-determination theory offers possible explanations for this finding which have practical implications and point the way to future research. In addition, interventions to promote metacognition before the clinical immersion may assist in preserving SRL during the transition and thus promote life-long learning skills in preparation for real-world practice.

  18. Abnormalities of white matter microstructure in unmedicated obsessive-compulsive disorder and changes after medication.

    Directory of Open Access Journals (Sweden)

    Qing Fan

    Full Text Available BACKGROUND: Abnormalities of myelin integrity have been reported in obsessive-compulsive disorder (OCD using multi-parameter maps of diffusion tensor imaging (DTI. However, it was still unknown to what degree these abnormalities might be affected by pharmacological treatment. OBJECTIVE: To investigate whether the abnormalities of white matter microstructure including myelin integrity exist in OCD and whether they are affected by medication. METHODOLOGY AND PRINCIPAL FINDINGS: Parameter maps of DTI, including fractional anisotropy (FA, axial diffusivity (AD, radial diffusivity (RD and mean diffusivity (MD, were acquired from 27 unmedicated OCD patients (including 13 drug-naïve individuals and 23 healthy controls. Voxel-based analysis was then performed to detect regions with significant group difference. We compared the DTI-derived parameters of 15 patients before and after 12-week Selective Serotonin Reuptake Inhibitor (SSRI therapies. Significant differences of DTI-derived parameters were observed between OCD and healthy groups in multiple structures, mainly within the fronto-striato-thalamo-cortical loop. An increased RD in combination with no change in AD among OCD patients was found in the left medial superior frontal gyrus, temporo-parietal lobe, occipital lobe, striatum, insula and right midbrain. There was no statistical difference in DTI-derived parameters between drug-naive and previously medicated OCD patients. After being medicated, OCD patients showed a reduction in RD of the left striatum and right midbrain, and in MD of the right midbrain. CONCLUSION: Our preliminary findings suggest that abnormalities of white matter microstructure, particularly in terms of myelin integrity, are primarily located within the fronto-striato-thalamo-cortical circuit of individuals with OCD. Some abnormalities may be partly reversed by SSRI treatment.

  19. Early inflammatory changes in radiation-induced oral mucositis. Effect of pentoxifylline in a mouse model

    Energy Technology Data Exchange (ETDEWEB)

    Gruber, Sylvia; Bozsaky, Eva; Roitinger, Eva; Schwarz, Karoline [Medical University/AKH Vienna, Applied and Translational Radiobiology, Dept. Radiation Oncology/CD Lab. Med. Radiation Research for Radiation Oncology, Vienna (Austria); Schmidt, Margret [Technische Universitaet Dresden, Dept. Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Dresden (Germany); Technische Universitaet Dresden, Helmholtz-Zentrum Dresden - Rossendorf, OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Dresden (Germany); Doerr, Wolfgang [Medical University/AKH Vienna, Applied and Translational Radiobiology, Dept. Radiation Oncology/CD Lab. Med. Radiation Research for Radiation Oncology, Vienna (Austria); Technische Universitaet Dresden, Dept. Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Dresden (Germany); Technische Universitaet Dresden, Helmholtz-Zentrum Dresden - Rossendorf, OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Dresden (Germany)

    2017-06-15

    Early inflammation is a major factor of mucosal reactions to radiotherapy. Pentoxifylline administration resulted in a significant amelioration of radiation-induced oral mucositis in the mouse tongue model. The underlying mechanisms may be related to the immunomodulatory properties of the drug. The present study hence focuses on the manifestation of early inflammatory changes in mouse tongue during daily fractionated irradiation and their potential modulation by pentoxifylline. Daily fractionated irradiation with 5 fractions of 3 Gy/week (days 0-4, 7-11) was given to the snouts of mice. Groups of 3 animals per day were euthanized every second day between day 0 and 14. Pentoxifylline (15 mg/kg, s. c.) was administered daily from day 5 to the day before sacrifice. The expression of the inflammatory proteins TNFα, NF-κB, and IL-1β were analysed. Fractionated irradiation increased the expression of all inflammatory markers. Pentoxifylline significantly reduced the expression of TNFα and IL-1β, but not NF-κB. Early inflammation, as indicated by the expression of the inflammatory markers TNFα, NF-κB, and IL-1β, is an essential component of early radiogenic oral mucositis. Pentoxifylline differentially modulated the expression of different inflammatory markers. The mucoprotective effect of pentoxifylline does not appear to be based on modulation of NF-κB-associated inflammation. (orig.) [German] Fruehe entzuendliche Veraenderungen sind ein bedeutender Faktor waehrend der Strahlenreaktion der Schleimhaut. Die Behandlung mit Pentoxifyllin erzielte eine signifikante Minderung strahleninduzierter oraler Mukositis im Mauszungenmodel. Die zugrundeliegenden Mechanismen sind potenziell auf die immunomodulatorischen Eigenschaften des Wirkstoffs zurueckzufuehren. Die vorliegenden Untersuchungen fokussieren daher auf die Manifestation frueher entzuendlicher Veraenderungen in der Mauszunge waehrend taeglich fraktionierter Bestrahlung und deren potenzieller Modifikation

  20. Early-age hydration and volume change of calcium sulfoaluminate cement-based binders

    Science.gov (United States)

    Chaunsali, Piyush

    Shrinkage cracking is a predominant deterioration mechanism in structures with high surface-to-volume ratio. One way to allay shrinkage-induced stresses is to use calcium sulfoaluminate (CSA) cement whose early-age expansion in restrained condition induces compressive stress that can be utilized to counter the tensile stresses due to shrinkage. In addition to enhancing the resistance against shrinkage cracking, CSA cement also has lower carbon footprint than that of Portland cement. This dissertation aims at improving the understanding of early-age volume change of CSA cement-based binders. For the first time, interaction between mineral admixtures (Class F fly ash, Class C fly ash, and silica fume) and OPC-CSA binder was studied. Various physico-chemical factors such as the hydration of ye'elimite (main component in CSA cement), amount of ettringite (the main phase responsible for expansion in CSA cement), supersaturation with respect to ettringite in cement pore solution, total pore volume, and material stiffness were monitored to examine early-age expansion characteristics. This research validated the crystallization stress theory by showing the presence of higher supersaturation level of ettringite, and therefore, higher crystallization stress in CSA cement-based binders. Supersaturation with respect to ettringite was found to increase with CSA dosage and external supply of gypsum. Mineral admixtures (MA) altered the expansion characteristics in OPC-CSA-MA binders with fixed CSA cement. This study reports that fly ash (FA) behaves differently depending on its phase composition. The Class C FA-based binder (OPC-CSA-CFA) ceased expanding beyond two days unlike other OPC-CSA-MA binders. Three factors were found to govern expansion of CSA cement-based binders: 1) volume fraction of ettringite in given pore volume, 2) saturation level of ettringite, and 3) dynamic modulus. Various models were utilized to estimate the macroscopic tensile stress in CSA cement

  1. A single-centre cohort study of National Early Warning Score (NEWS) and near patient testing in acute medical admissions.

    Science.gov (United States)

    Abbott, Tom E F; Torrance, Hew D T; Cron, Nicholas; Vaid, Nidhi; Emmanuel, Julian

    2016-11-01

    The utility of an early warning score may be improved when used with near patient testing. However, this has not yet been investigated for National Early Warning Score (NEWS). We hypothesised that the combination of NEWS and blood gas variables (lactate, glucose or base-excess) was more strongly associated with clinical outcome compared to NEWS alone. This was a prospective cohort study of adult medical admissions to a single-centre over 20days. Blood gas results and physiological observations were recorded at admission. NEWS was calculated retrospectively and combined with the biomarkers in multivariable logistic regression models. The primary outcome was a composite of mortality or critical care escalation within 2days of hospital admission. The secondary outcome was hospital length of stay. After accounting for missing data, 15 patients out of 322 (4.7%) died or were escalated to the critical care unit. The median length of stay was 4 (IQR 7) days. When combined with lactate or base excess, NEWS was associated with the primary outcome (OR 1.18, p=0.01 and OR 1.13, p=0.03). However, NEWS alone was more strongly associated with the primary outcome measure (OR 1.46, pglucose was not associated with the primary outcome. Neither NEWS nor any combination of NEWS and a biomarker were associated with hospital length of stay. Admission NEWS is more strongly associated with death or critical care unit admission within 2days of hospital admission, compared to combinations of NEWS and blood-gas derived biomarkers. Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  2. Better knowledge improves adherence to lifestyle changes and medication in patients with coronary heart disease.

    Science.gov (United States)

    Alm-Roijer, Carin; Stagmo, Martin; Udén, Giggi; Erhardt, Leif

    2004-12-01

    Many patients with coronary heart disease (CHD) are not managed adequately, and we often fail to reach treatment targets. To investigate if knowledge of risk factors for CHD, measured by a questionnaire, would show any relation to advice to compliance to lifestyle changes to attain treatment goals and adherence to drug therapy. Men and women event were screened consecutively (509) from the medical records. Responders (392) were interviewed, examined and received a questionnaire. Three hundred and forty-seven patients answered the questionnaire regarding their general knowledge of risk factors for CHD, compliance to lifestyle changes to attain treatment goals and adherence to drug therapy. There were statistically significant correlations between general knowledge about risk factors for CHD and compliance to certain lifestyle changes: weight, physical activity, stress management, diet, attainment of lipid level goals and the likelihood of taking prescribed blood pressure-lowering drugs. General knowledge of risk factors had no correlation to blood glucose or blood pressure levels nor on smoking habits or treatment patterns for prescribed lipid- and blood glucose-lowering drugs. Knowledge correlates to patient behaviour with respect to some risk factors, which should be recognised in preventive programs.

  3. Factors Affecting Physician Satisfaction and Wisconsin Medical Society Strategies to Drive Change.

    Science.gov (United States)

    Coleman, Michele; Dexter, Donn; Nankivil, Nancy

    2015-08-01

    Physicians' dissatisfaction in their work is increasing, which is affecting the stability of health care in America. The Wisconsin Medical Society (Society) surveyed 1016 Wisconsin physicians to determine the source of their dissatisfaction. The survey results indicate Wisconsin physicians are satisfied when it comes to practice environment, work-life balance, and income. In addition, they are extremely satisfied when it comes to rating their ability to provide high quality care, and they have identified some benefits related to the adoption of electronic health records. However, they are feeling burned out, very unsatisfied with the amount of time spent in direct patient care compared to indirect patient care, and that they are spending too much time on administrative and data entry tasks. In terms of future workforce, many physicians are either unsure or would not recommend the profession to a prospective medical student. Electronic health records serve as both a satisfier and dissatisfier and as a potential driver for future physician satisfaction interventions. Changes at the institutional, organizational, and individual levels potentially could address the identified dissatisfiers and build upon the satisfiers. The Society identifies 12 strategies to improve upon the physician experience.

  4. Changes in the 'medical research' licensing procedure under the German Radiation Protection Ordinance

    International Nuclear Information System (INIS)

    Habeck, M.; Minkov, V.; Griebel, J.; Brix, G.; Epsch, R.; Langer, M.

    2012-01-01

    This publication outlines the 'medical research' licensing procedure as specified in the amendment of the German Radiation Protection Ordinance of November 1, 2011. The general licensing requirements for the use of radiation have not been changed by the amendment. Three so-called use restrictions (i.e., dose limits of 10 mSv and 20 mSv, age limit of 50 years) have been modified. They will only apply to healthy volunteers in the future. In addition, there are considerable simplifications with respect to applications and licensing procedures of the Federal Office for Radiation Protection (Bundesamt fuer Strahlenschutz, BfS) regarding the use of radiation in the newly introduced 'accompanying diagnostics' ('Begleitdiagnostik') case group. The newly established, independent panel of experts at the German Radiological Society (Deutsche Roentgengesellschaft, DRG) may provide essential support to principal investigators, qualified physicians and sponsors for differentiating between 'medical research' and 'health care', the latter not being subject to licensing. An expert statement will be issued by the DRG within four weeks of an inquiry. This consulting service is subject to confidentiality, and is free of charge for inquirers and without any commitment. (orig.)

  5. Evaluation of changes in prescription medication use after a residential treatment programme for borderline personality disorder.

    Science.gov (United States)

    Broadbear, Jillian H; Nesci, Julian; Thomas, Rosemary; Thompson, Katherine; Beatson, Josephine; Rao, Sathya

    2016-12-01

    Residential patients diagnosed with borderline personality disorder were evaluated to determine whether borderline personality disorder-focused psychotherapy reduced prescribing, personality disorder and co-morbid symptom severity. Psychotropic prescriptions were measured at admission, discharge and 1 year later in 74 female participants with one or more personality disorder diagnosis and co-morbid mood disorders. Changes in pharmacotherapy were examined in the context of improvements in borderline personality disorder and/or co-morbid disorder symptom severity. Residential treatment included individual and group psychotherapy for borderline personality disorder. The Structured Clinical Interview for DSM-IV was used to confirm the borderline personality disorder diagnosis and associated co-morbid conditions. The Beck Depression Inventory was completed at each time point. A significant reduction in the incidence and severity of self-rated depression as well as clinician assessed personality disorder, including borderline personality disorder, was accompanied by a reduction in prescription of psychoactive medications. Three to six months of intensive borderline personality disorder-specific psychotherapy showed lasting benefit with regard to symptom severity of personality disorders (borderline personality disorder in particular) as well as depressive symptoms. This improvement corresponded with a reduction in prescriptions for psychoactive medications, which is consistent with current thinking regarding treatment for borderline personality disorder. © The Royal Australian and New Zealand College of Psychiatrists 2016.

  6. Academic standards and changing patterns of medical school admissions: a Malaysian study.

    Science.gov (United States)

    Tan, C M

    1990-07-01

    Changing social demands made it necessary for the Medical Faculty of the University of Malaya to accommodate students with a wider range of academic experience than before. However, teachers sought to achieve comparable academic standards to those in the West by striving to maintain a close resemblance to the Western model of medical education in other respects. As a result teachers failed to adapt their teaching methods, assessment techniques and curriculum design to meet the educational needs of the students, thus compromising academic standards. Many students lack basic academic skills and do not know how to learn effectively. In order to help students overcome their learning difficulties innovative teaching was required during the first year at university, designed to foster the joint development of knowledge and basic skills. In the case of less well-prepared students who lack self-confidence, a caring and supportive learning environment is crucial to the achievement of meaningful learning. Lecturers needed to become facilitators of learning rather than transmitters of knowledge. However, teachers' objective to retain international recognition of the degree, which presumably reflected the importance of teaching, was not operationalized in terms of its incentive structure such that teachers were constrained not to try to fill the new roles demanded of them. It was assumed that academic distinction accrued through scientific research was essential for the achievement of academic excellence. However, under the prevailing circumstances the two aims were mutually exclusive and incompatible and teaching quality deteriorated.

  7. Synaptic changes in rat maculae in space and medical imaging: the link

    Science.gov (United States)

    Ross, M. D.

    1998-01-01

    Two different space life sciences missions (SLS-1 and SLS-2) have demonstrated that the synapses of the hair cells of rat vestibular maculae increase significantly in microgravity. The results also indicate that macular synapses are sensitive to stress. These findings argue that vestibular maculae exhibit neuroplasticity to macroenvironmental and microenvironmental changes. This capability should be clinically relevant to rehabilitative training and/or pharmacological treatments for vestibular disease. The results of this ultrastructural research also demonstrated that type I and type II hair cells are integrated into the same neuronal circuitry. The findings were the basis for development of three-dimensional reconstruction software to learn details of macular wiring. This software, produced for scientific research, has now been adapted to reconstruct the face and skull directly from computerized tomography scans. In collaboration with craniofacial reconstructive surgeons at Stanford University Medical Center, an effort is under way to produce a virtual environment workbench for complex craniofacial surgery. When completed, the workbench will help surgeons train for and simulate surgery. The methods are patient specific. This research illustrates the value of basic research in leading to unanticipated medical applications.

  8. In vitro of quantitative MR imaging of early degenerative changes in human articular cartilage

    International Nuclear Information System (INIS)

    Kim, Ok Wha; Lee, Young Jun; Cha, Sung Suk; Hwa, Ryu Ji

    2004-01-01

    To assess the applicability of quantitative MR microscopy for the detection of glycosaminoglycan (GAG) depletion as an early sign of degeneration in the articular cartilage of humans treated by trypsin. Four cartilage-bone blocks were obtained from the patient who had suffered from osteoarthritis of the knee and underwent a total knee replacement arthroscopy. Each articular cartilage segment was resected as to a round disk shape (8 mm in diameter) with a remnant of subchondral bone 1 mm in thickness. Four different culture solutions were prepared, and these solutions were 0.2 mg/ml of trypsin solution (group 1), 1 mM of Gd (DTPA) 2-mixed trypsin solution (group 2), phosphate buffered saline (PBS) (group 3), and 1 mM of Gd (DTPA) 2-mixed PBS (group 4). The cartilages were cultured and then MR imagings were performed every hour for 5 hrs, and we continued the additional cultures of 24 hrs, 36 hrs and 48 hrs. Three imaging sequences were used: T1-weighted spin echo (TR/TE, 450/22), proton density turbo spin echo with fat suppression (TR/TE, 3000/25), and CPMG (Carr-Purcell-Meiboom-Gill) (TR/TE/TI, 760/21-168, 360). MR imaging data were analyzed with pixel-by-pixel comparisons in all groups. The GAG loss in the articular cartilage was increased proportionately to the culture duration. Mean changes of T1 relaxation time were 1.2% for group 1, -1.9% for group 3, -54.7% for group 2 and -64.2% for group 4 (p< 0.05). When comparing by linear profile on the T1-weighted images, SNR increased and T1 relaxation time decreased for group 2 and 4, as the culture duration increased (p< 0.05). On the correlation analysis, there is significant correlation between GAG loss and Gd (DTPA) 2-enhancement for group 2 (p=0.0431), but there was no significant difference for group 4 (p=0.0918). More enhancement with Gd (DTPA) 2-was noted for group 2 than for group 4. Group 2 showed a diffuse enhancement in all the layers of cartilage, but for group 4, prominent enhancement was noted only in

  9. Early warning signals of abrupt temperature change in different regions of China over the past 50 years

    International Nuclear Information System (INIS)

    Tong Ji-Long; Wu Hao; Hou Wei; He Wen-Ping; Zhou Jie

    2014-01-01

    In this paper, the early warning signals of abrupt temperature change in different regions of China are investigated. Seven regions are divided on the basis of different climate temperature patterns, obtained through the rotated empirical orthogonal function, and the signal-to-noise temperature ratios for each region are then calculated. Based on the concept of critical slowing down, the temperature data that contain noise in the different regions of China are preprocessed to study the early warning signals of abrupt climate change. First, the Mann–Kendall method is used to identify the instant of abrupt climate change in the temperature data. Second, autocorrelation coefficients that can identify critical slowing down are calculated. The results show that the critical slowing down phenomenon appeared in temperature data about 5–10 years before abrupt climate change occurred, which indicates that the critical slowing down phenomenon is a possible early warning signal for abrupt climate change, and that noise has less influence on the detection results of the early warning signals. Accordingly, this demonstrates that the model is reliable in identifying the early warning signals of abrupt climate change based on detecting the critical slowing down phenomenon, which provides an experimental basis for the actual application of the method. (geophysics, astronomy, and astrophysics)

  10. [Changing medical practices and nosocomial infection rates in French maternity units from 1997 to 2000].

    Science.gov (United States)

    Vincent-Boulétreau, A; Caillat-Vallet, E; Dumas, A M; Ayzac, L; Chapuis, C; Emery, M N; Girard, R; Haond, C; Lafarge-Leboucher, J; Tissot-Guerraz, F; Fabry, J

    2005-04-01

    In this study we describe the changes in medical practices and nosocomial infection rates in obstetrics observed through a surveillance network in the Sou