WorldWideScience

Sample records for future clinical tests

  1. Future requirements. Clinical investigations

    DEFF Research Database (Denmark)

    Qvist, V.

    2002-01-01

    Biocompatability, Cariology, Clinical trials, Dental materials, Helath services research, Human, Pedodontics......Biocompatability, Cariology, Clinical trials, Dental materials, Helath services research, Human, Pedodontics...

  2. The future of anticoagulation clinics.

    Science.gov (United States)

    Macik, B Gail

    2003-01-01

    Anticoagulation therapy is the foundation of treatment for thromboembolic disorders; and coumarin derivatives (warfarin in the United States) are the only orally administered anticoagulant medications currently available. Due to the expense and relative difficulties associated with this route of administration, parenteral drugs are not used routinely for long-term therapy, leaving warfarin as the anticoagulant of choice in the outpatient setting. The management of warfarin is problematic, however, due the nuances of its pharmacodynamic and pharmacokinetic profile and the requirement for frequent monitoring of blood levels. Although management by anticoagulation clinics is considered the gold standard for warfarin therapy, management by an anticoagulation clinic may not be the optimal option from a clinician's view and, in many cases, may not be an option at all. Anticoagulation clinics may impinge on the doctor-patient relationship. Difficulties of communication and reimbursement are not ameliorated by a specialty clinic. Innovations in warfarin management, including patient self-management and computerized dosing programs, are alternatives for improved care that are available with or without input by an anticoagulation service. New oral drugs on the horizon do not require the same intensity of monitoring and do not present the same pharmacodynamic problems associated with warfarin. Warfarin will become obsolete in the foreseeable future. If anticoagulation clinics continue, they must re-define their role as the major part of the workload, warfarin management, disappears. To adapt, clinics must strengthen and enhance their role as coordinators and educators, and less so, managers of anticoagulation therapy.

  3. The clinical situation of point-of-care testing and its future development at the emergency department in Shanghai.

    Science.gov (United States)

    Leong, Waiian; Chen, Lianxiang; Yu, Ping; Wei, Bohua; Wang, Cuicui; Ying, Yilin; Jiang, Jie; Tong, Jianjing; Zhu, Dingliang; Ye, Jing; Lu, Yiming

    2014-12-01

    We assessed the efficiency of point-of-care (POC) tests in the emergency department (ED) by comparing them with the international standard. We recorded the turnaround times (TATs) for processing laboratory biomarkers to assess laboratory efficiency from 17 EDs in national/regional hospitals. We also compared patient components between national and regional hospitals. Although the 17 enrolled hospitals expanded their EDs, they contained only five POC machines among them. The P50 (P25, P75) of the TATs for POC tests was 47 min (39, 55.5 min) for cardiac troponin T, which was much longer than the international standard (30 min). The TATs of other cardiac biomarkers were also longer than 30 min. The low efficiency of TATs for POC tests was a common feature in both regional and national hospitals (p > 0.05). Myocardial infarction was diagnosed in 61% of investigated ED patients who visited national hospitals, which is more frequently than those diagnosed at regional hospitals (46%, p administrative management of EDs. This issue should be addressed in the next version of the medical reform policy. © 2014 Society for Laboratory Automation and Screening.

  4. The future of psychiatry as clinical neuroscience.

    Science.gov (United States)

    Reynolds, Charles F; Lewis, David A; Detre, Thomas; Schatzberg, Alan F; Kupfer, David J

    2009-04-01

    Psychiatry includes the assessment, treatment, and prevention of complex brain disorders, such as depression, bipolar disorder, anxiety disorders, schizophrenia, developmental disorders (e.g., autism), and neurodegenerative disorders (e.g., Alzheimer dementia). Its core mission is to prevent and alleviate the distress and impairment caused by these disorders, which account for a substantial part of the global burden of illness-related disability. Psychiatry is grounded in clinical neuroscience. Its core mission, now and in the future, is best served within this context because advances in assessment, treatment, and prevention of brain disorders are likely to originate from studies of etiology and pathophysiology based in clinical and translational neuroscience. To ensure its broad public health relevance in the future, psychiatry must also bridge science and service, ensuring that those who need the benefits of its science are also its beneficiaries. To do so effectively, psychiatry as clinical neuroscience must strengthen its partnerships with the disciplines of public health (including epidemiology), community and behavioral health science, and health economics.The authors present a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis of psychiatry and identify strategies for strengthening its future and increasing its relevance to public health and the rest of medicine. These strategies encompass new approaches to strengthening the relationship between psychiatry and neurology, financing psychiatry's mission, emphasizing early and sustained multidisciplinary training (research and clinical), bolstering the academic infrastructure, and reorganizing and refinancing mental health services both for preventive intervention and cost-effective chronic disease management.

  5. The Future of Psychiatry as Clinical Neuroscience

    Science.gov (United States)

    Reynolds, Charles F.; Lewis, David A.; Detre, Thomas; Schatzberg, Alan F.; Kupfer, David J.

    2009-01-01

    Psychiatry includes the assessment, treatment, and prevention of complex brain disorders, such as depression, bipolar disorder, anxiety disorders, schizophrenia, developmental disorders (e.g., autism), and neurodegenerative disorders (e.g., Alzheimer dementia). Its core mission is to prevent and alleviate the distress and impairment caused by these disorders, which account for a substantial part of the global burden of illness-related disability. Psychiatry is grounded in clinical neuroscience. Its core mission, now and in the future, is best served within this context because advances in assessment, treatment, and prevention of brain disorders are likely to originate from studies of etiology and pathophysiology based in clinical and translational neuroscience. To ensure its broad public health relevance in the future, psychiatry must also bridge science and service, ensuring that those who need the benefits of its science are also its beneficiaries. To do so effectively, psychiatry as clinical neuroscience must strengthen its partnerships with the disciplines of public health (including epidemiology), community and behavioral health science, and health economics. The authors present a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis of psychiatry and identify strategies for strengthening its future and increasing its relevance to public health and the rest of medicine. These strategies encompass new approaches to strengthening the relationship between psychiatry and neurology, financing psychiatry’s mission, emphasizing early and sustained multidisciplinary training (research and clinical), bolstering the academic infrastructure, and reorganizing and refinancing mental health services both for preventive intervention and cost-effective chronic disease management. PMID:19318776

  6. Molecular profiling of cancer--the future of personalized cancer medicine: a primer on cancer biology and the tools necessary to bring molecular testing to the clinic.

    Science.gov (United States)

    Stricker, Thomas; Catenacci, Daniel V T; Seiwert, Tanguy Y

    2011-04-01

    Cancers arise as a result of an accumulation of genetic aberrations that are either acquired or inborn. Virtually every cancer has its unique set of molecular changes. Technologies have been developed to study cancers and derive molecular characteristics that increasingly have implications for clinical care. Indeed, the identification of key genetic aberrations (molecular drivers) may ultimately translate into dramatic benefit for patients through the development of highly targeted therapies. With the increasing availability of newer, more powerful, and cheaper technologies such as multiplex mutational screening, next generation sequencing, array-based approaches that can determine gene copy numbers, methylation, expression, and others, as well as more sophisticated interpretation of high-throughput molecular information using bioinformatics tools like signatures and predictive algorithms, cancers will routinely be characterized in the near future. This review examines the background information and technologies that clinicians and physician-scientists will need to interpret in order to develop better, personalized treatment strategies. Copyright © 2011 Elsevier Inc. All rights reserved.

  7. Clinical linguistics: its past, present and future.

    Science.gov (United States)

    Perkins, Michael R

    2011-11-01

    Historiography is a growing area of research within the discipline of linguistics, but so far the subfield of clinical linguistics has received virtually no systematic attention. This article attempts to rectify this by tracing the development of the discipline from its pre-scientific days up to the present time. As part of this, I include the results of a survey of articles published in Clinical Linguistics & Phonetics between 1987 and 2008 which shows, for example, a consistent primary focus on phonetics and phonology at the expense of grammar, semantics and pragmatics. I also trace the gradual broadening of the discipline from its roots in structural linguistics to its current reciprocal relationship with speech and language pathology and a range of other academic disciplines. Finally, I consider the scope of clinical linguistic research in 2011 and assess how the discipline seems likely develop in the future.

  8. Have the Software Testing a Future?

    Directory of Open Access Journals (Sweden)

    Juan A. Godoy

    2012-06-01

    Full Text Available Software testing is directed to a dark future, with greater political isolation management, less funding and poorer overall quality. The hopes of the theory of software quality and test new technologies of the 1990s have been usurped by "tastes" in the development focused on ideas such as "Agile", "Object Oriented", "Cloud” and applications “Mobile” of $ 0.99. The new languages and development methods are designed to allow developers to "throw" code faster and not to improve versions, maintenance, testing and traceability or auditing. The costs of maintenance and development will increase, the budgets for the test will fall and more projects fail. The future of the tests is shade. In this article is analyzed this situation.

  9. Clinic exam room design: present and future.

    Science.gov (United States)

    Freihoefer, Kara; Nyberg, Gary; Vickery, Christine

    2013-01-01

    This article aims to deconstruct various design qualities and strategies of clinic exam rooms, and discuss how they influence users' interaction and behavior in the space. Relevant literature supports the advantages and disadvantages of different design strategies. Annotated exam room prototypes illustrate the design qualities and strategies discussed. Advancements in technology and medicine, along with new legislative policies, are influencing the way care providers deliver care and ultimately clinic exam room designs. The patient-centered medical home model has encouraged primary care providers to make patients more active leaders of their health plan which will influence the overall functionality and configuration of clinic exam rooms. Specific design qualities discussed include overall size, location of doors and privacy curtains, positioning of exam tables, influence of technology in the consultation area, types of seating, and placement of sink and hand sanitizing dispensers. In addition, future trends of exam room prototypes are presented. There is a general lack of published evidence to support design professionals' design solutions for outpatient exam rooms. Future research should investigate such topics as the location of exam tables and privacy curtains as they relate to patient privacy; typical size and location of consultation table as it relates to patient connection and communication; and placement of sinks and sanitization dispensers as they relate to frequency and patterns of usage. Literature review, outpatient, technology, visual privacy.

  10. Safety test facilities - status, needs, future directions

    International Nuclear Information System (INIS)

    Heusener, G.; Cogne, F.

    1979-08-01

    A survey is given of the in-pile programs which are presently or in the near future being performed in the DeBeNe-area and in France. Only those in-pile programs are considered which are dealing with severe accidents that might lead to disruption of major parts of the core. By comparing the needs with the goals of the present programs points are identified which are not sufficiently well covered up till now. The future procedure is described: the existing facilities will be used to the largest possible extent. Whenever it is necessary, upgrading and improvement will be foreseen. Studies of a Test Facility allowing the transient testing of large pin bundles should be continued. The construction of such a facility in Europe in the near future however seems premature

  11. Rapid Clinical Bacteriology and Its Future Impact

    Science.gov (United States)

    Durand, Géraldine; Peyret, Michel; Chatellier, Sonia; Zambardi, Gilles; Schrenzel, Jacques; Shortridge, Dee; Engelhardt, Anette; Dunne, William Michael

    2013-01-01

    Clinical microbiology has always been a slowly evolving and conservative science. The sub-field of bacteriology has been and still is dominated for over a century by culture-based technologies. The integration of serological and molecular methodologies during the seventies and eighties of the previous century took place relatively slowly and in a cumbersome fashion. When nucleic acid amplification technologies became available in the early nineties, the predicted "revolution" was again slow but in the end a real paradigm shift did take place. Several of the culture-based technologies were successfully replaced by tests aimed at nucleic acid detection. More recently a second revolution occurred. Mass spectrometry was introduced and broadly accepted as a new diagnostic gold standard for microbial species identification. Apparently, the diagnostic landscape is changing, albeit slowly, and the combination of newly identified infectious etiologies and the availability of innovative technologies has now opened new avenues for modernizing clinical microbiology. However, the improvement of microbial antibiotic susceptibility testing is still lagging behind. In this review we aim to sketch the most recent developments in laboratory-based clinical bacteriology and to provide an overview of emerging novel diagnostic approaches. PMID:23301218

  12. Test facilities for future linear colliders

    International Nuclear Information System (INIS)

    Ruth, R.D.

    1995-12-01

    During the past several years there has been a tremendous amount of progress on Linear Collider technology world wide. This research has led to the construction of the test facilities described in this report. Some of the facilities will be complete as early as the end of 1996, while others will be finishing up around the end 1997. Even now there are extensive tests ongoing for the enabling technologies for all of the test facilities. At the same time the Linear Collider designs are quite mature now and the SLC is providing the key experience base that can only come from a working collider. All this taken together indicates that the technology and accelerator physics will be ready for a future Linear Collider project to begin in the last half of the 1990s

  13. Future Transient Testing of Advanced Fuels

    Energy Technology Data Exchange (ETDEWEB)

    Jon Carmack

    2009-09-01

    The transient in-reactor fuels testing workshop was held on May 4–5, 2009 at Idaho National Laboratory. The purpose of this meeting was to provide a forum where technical experts in transient testing of nuclear fuels could meet directly with technical instrumentation experts and nuclear fuel modeling and simulation experts to discuss needed advancements in transient testing to support a basic understanding of nuclear fuel behavior under off-normal conditions. The workshop was attended by representatives from Commissariat à l'Énergie Atomique CEA, Japanese Atomic Energy Agency (JAEA), Department of Energy (DOE), AREVA, General Electric – Global Nuclear Fuels (GE-GNF), Westinghouse, Electric Power Research Institute (EPRI), universities, and several DOE national laboratories. Transient testing of fuels and materials generates information required for advanced fuels in future nuclear power plants. Future nuclear power plants will rely heavily on advanced computer modeling and simulation that describes fuel behavior under off-normal conditions. TREAT is an ideal facility for this testing because of its flexibility, proven operation and material condition. The opportunity exists to develop advanced instrumentation and data collection that can support modeling and simulation needs much better than was possible in the past. In order to take advantage of these opportunities, test programs must be carefully designed to yield basic information to support modeling before conducting integral performance tests. An early start of TREAT and operation at low power would provide significant dividends in training, development of instrumentation, and checkout of reactor systems. Early start of TREAT (2015) is needed to support the requirements of potential users of TREAT and include the testing of full length fuel irradiated in the FFTF reactor. The capabilities provided by TREAT are needed for the development of nuclear power and the following benefits will be realized by

  14. Future Transient Testing of Advanced Fuels

    International Nuclear Information System (INIS)

    Carmack, Jon

    2009-01-01

    The transient in-reactor fuels testing workshop was held on May 4-5, 2009 at Idaho National Laboratory. The purpose of this meeting was to provide a forum where technical experts in transient testing of nuclear fuels could meet directly with technical instrumentation experts and nuclear fuel modeling and simulation experts to discuss needed advancements in transient testing to support a basic understanding of nuclear fuel behavior under off-normal conditions. The workshop was attended by representatives from Commissariat energie Atomique CEA, Japanese Atomic Energy Agency (JAEA), Department of Energy (DOE), AREVA, General Electric - Global Nuclear Fuels (GE-GNF), Westinghouse, Electric Power Research Institute (EPRI), universities, and several DOE national laboratories. Transient testing of fuels and materials generates information required for advanced fuels in future nuclear power plants. Future nuclear power plants will rely heavily on advanced computer modeling and simulation that describes fuel behavior under off-normal conditions. TREAT is an ideal facility for this testing because of its flexibility, proven operation and material condition. The opportunity exists to develop advanced instrumentation and data collection that can support modeling and simulation needs much better than was possible in the past. In order to take advantage of these opportunities, test programs must be carefully designed to yield basic information to support modeling before conducting integral performance tests. An early start of TREAT and operation at low power would provide significant dividends in training, development of instrumentation, and checkout of reactor systems. Early start of TREAT (2015) is needed to support the requirements of potential users of TREAT and include the testing of full length fuel irradiated in the FFTF reactor. The capabilities provided by TREAT are needed for the development of nuclear power and the following benefits will be realized by the

  15. Clinical Neurotoxic Disorders : Past, Present and Future

    Directory of Open Access Journals (Sweden)

    Nag Devika

    2001-01-01

    Full Text Available Neurotoxins have existed on the earth from times immemorial. Old neurotoxic disorders were due to ingestion/ exposure of heavy metals and food like lathyrus sativus over a long period of time. The 20th Century with rapid industrialsation and expanding chemical and drug industry has spawned several new, hitherto unknown disorders. Old disorders continue to exist e.g. fluorosis, arsenicosis, lathyrism, manganism and lead neuropathy, along with new diseases like Minamata disease, subacute myelo optic neuropathy (SMON, MPTP-Parkinsonian syndorme, triorthcresyl phosphate (TOCP neuroparalytic disease, pesticide induced seizures, tremor and neuropathy, solvent encephalopthy, antipileptic drug foetal syndrome and excitotoxin induced behavioural disorders. Studies on pesticides Organochlorine and organophosphates, synthetic pyrethrins, solvents, heavy metals and substances abuse in the Indian context confirm the neurotoxic nature of many synthetic substances. Future problems envisaged are of concern to clinical neurologists as many of these neurotoxic disorders mimic syndromes of well known neurological disease. The new millenium poses a challenge to the clinician as newer compounds in industry, food, drugs and chemical war agents are being developed. Molecular genetics has advanced rapidly with release of the human genome map. Animal cloning and genetically modified plant products have entered the food chain. How safe are these new inventions for the central nervous system is a big question? India cannot afford disasters like Union Carbide′s Bhopal gas leak nor be a silent spectator to manipulative biotechnology. Unless it is proven beyond all doubt to be a safe innovation, Chemicals have to be cautiously introduced in our environment. To Study, ascertain and confirm safety or neurotoxicity is an exciting challenge for the neuroscientists of the 21st century.

  16. Back to the Future for Clinical Oncology.

    Science.gov (United States)

    Chabner

    1996-01-01

    Dear Colleague: I remember, but just barely, what it was like to practice medicine in the first half of this century. My Dad was a general practitioner in a very small farming community in central Illinois, with a hospital of six beds and a trusting clientele. His patients thought he knew how to do everything: deliver babies, set broken bones and take out an appendix. He was an advocate for his patients, not for an HMO or an insurance company. He derived great satisfaction from his practice and was comfortable in this role, up to a point, but knew that he frequently needed the help of specialists from Decatur, St. Louis, and the Mayo Clinic. As his experience and practice evolved, and as medicine itself changed, referrals became a sign of good practice and not an indication of weakness or inadequacy. Some doctors in our town continued to do more than they should have and resisted the trend, and their patients, many with blind faith in their doctor, suffered for it. Clearly, there were economic as well as emotional factors that contributed to this reluctance to ask for help. Clinical oncology is facing much the same situation today. Scientific and economic forces are revolutionizing medicine, but not always in compatible directions. Practice and research have evolved to the point where old patterns of practice are no longer optimal. Few cancer patients can be managed without the input, advice, and even direct involvement of specialists from sister disciplines. Thus, multimodality management of cancer patients is now the norm rather than the exception. At the same time, strong economic forces are dictating a movement in the opposite direction, undermining the strength of traditional academic centers and limiting choices, streamlining patient evaluation, and creating "pathways" to standardize patient management. Who should be setting the course for the cancer patient? We agree that it should not be a clerk at the other end of the phone at the HMO, a computerized

  17. Advanced test reactor testing experience-past, present and future

    International Nuclear Information System (INIS)

    Marshall, Frances M.

    2006-01-01

    The Advanced Test Reactor (ATR), at the Idaho National Laboratory (INL), is one of the world's premier test reactors for providing the capability for studying the effects of intense neutron and gamma radiation on reactor materials and fuels. The physical configuration of the ATR, a 4-leaf clover shape, allows the reactor to be operated at different power levels in the corner 'lobes' to allow for different testing conditions for multiple simultaneous experiments. The combination of high flux (maximum thermal neutron fluxes of 1E15 neutrons per square centimeter per second and maximum fast [E>1.0 MeV] neutron fluxes of 5E14 neutrons per square centimeter per second) and large test volumes (up to 122 cm long and 12.7 cm diameter) provide unique testing opportunities. The current experiments in the ATR are for a variety of test sponsors - US government, foreign governments, private researchers, and commercial companies needing neutron irradiation services. There are three basic types of test configurations in the ATR. The simplest configuration is the sealed static capsule, which places the capsule in direct contact with the primary coolant. The next level of experiment complexity is an instrumented lead experiment, which allows for active control of experiment conditions during the irradiation. The most complex experiment is the pressurized water loop, in which the test sample can be subjected to the exact environment of a pressurized water reactor. For future research, some ATR modifications and enhancements are currently planned. This paper provides more details on some of the ATR capabilities, key design features, experiments, and future plans

  18. [Clinical Tests Testing New Therapies for Stargardt Disease].

    Science.gov (United States)

    Kousal, B; Ďuďáková, Ľ; Hlavatá, L; Lišková, P

    2016-02-01

    To provide information on currently ongoing clinical trials for Stargardt disease. We have searched the clinical trial register (www.clinicaltrials.gov) for the keyword "Stargardt" and list active ongoing studies. There are currently eight registered clinical trials enrolling patients with Stargardt disease; all in phase I or II aiming at four mechanisms of action: inhibition of the production of vitamin A toxic dimers, gene therapy restoring wild type transcription of the ABCA4 gene, neuroprotection preventing retinal cells from oxidative damage, and replacement of the damaged retinal pigment epithelium using stem cell therapy. The basic prerequisite for enrolment in the vast majority of clinical trials is confirmation of the clinical diagnosis by mutational analysis. The wide variety of therapies that are registered as clinical trials for Stargardt disease significantly raises the possibility that effective treatments will be available in the near future for this currently incurable condition and that molecular genetic testing should be increasingly considered. Stargardt disease, clinical trial, ABCA4, mutation.

  19. Clinical neuropsychology in Israel: history, training, practice and future challenges.

    Science.gov (United States)

    Vakil, Eli; Hoofien, Dan

    2016-11-01

    This is an invited paper for a special issue on international perspectives on training and practice in clinical neuropsychology. We provide a review of the status of clinical neuropsychology in Israel, including the history of neuropsychological, educational, and accreditation requirements to become a clinical neuropsychologist and to practice clinical neuropsychology. The information is based primarily on the personal knowledge of the authors who have been practicing clinical neuropsychology for over three decades and hold various administrative and academic positions in this field. Second, we conducted three ad hoc surveys among clinical and rehabilitation psychologists; heads of academic programs for rehabilitation and neuropsychology; and heads of accredited service providers. Third, we present a literature review of publications by clinical neuropsychologists in Israel. Most of the clinical neuropsychologists are graduates of either rehabilitation or clinical training programs. The vast majority of neuropsychologists are affiliated with rehabilitation psychology. The training programs (2-3 years of graduate school) provide solid therapeutic and diagnostic skills to the students. Seventy-five percent of the participants in this survey are employed at least part-time by public or state-funded institutions. Israeli neuropsychologists are heavily involved in case management, including vocational counseling, and rehabilitation psychotherapy. Conclusions and future goals: Although clinical neuropsychologists in Israel are well educated and valued by all health professionals, there are still several challenges that must be addressed in order to further advance the field and the profession. These included the need for Hebrew-language standardized and normalized neuropsychological tests and the application of evidence-based interventions in neuropsychological rehabilitation.

  20. The future endocrine patient. Reflections on the future of clinical endocrinology

    NARCIS (Netherlands)

    S.W.J. Lamberts (Steven); J.A. Romijn (Johannes); W.M. Wiersinga (Wilmar)

    2003-01-01

    textabstractIn recent years the future position of clinical endocrinology has been extensively discussed by Western European endocrine societies. Clinical endocrinology seems to suffer from being too intellectual, generating too little income, and lacking too few spectacular

  1. Noninvasive prenatal testing: the future is now.

    Science.gov (United States)

    Norwitz, Errol R; Levy, Brynn

    2013-01-01

    available from nucleated blood cells extracted from a similar volume of whole maternal blood. There have now been numerous reports on the use of cell-free DNA (cfDNA) for NIPT for chromosomal aneuploidies-especially trisomy (an extra copy of a chromosome) or monosomy (a missing chromosome)-and a number of commercial products are already being marketed for this indication. This article reviews the various techniques being used to analyze cell-free DNA in the maternal circulation for the prenatal detection of chromosome abnormalities and the evidence in support of each. A number of areas of ongoing controversy are addressed, including the timing of maternal blood sampling, the need for genetic counseling, and the use of confirmatory invasive testing. Future applications for this technology are also reviewed.

  2. Coronary CT: clinical indications and future directions

    International Nuclear Information System (INIS)

    Nomura, Cesar H.; Serpa, Bruna S.; Kay, Fernando U.; Szarf, Gilberto; Passos, Rodrigo B.; Neto, Roberto S.; Chate, Rodigo C.; Funar, Marcelo B.; Cury, Roberto C.

    2011-01-01

    Multidetector computed tomography (MDCT) has started its implementation in cardiology with calcium quantification of coronary plaques in the study without contrast, using the calcium score, demonstrating an important independent predictor of future cardiac events. The examination with intravenous contrast, coronary angiography, appeared later as a noninvasive method for evaluation of anatomy and obstructive coronary disease, characterizing the degree of stenosis and the presence of non calcified atherosclerotic plaques, assessing not only the lumen, but also the vessel wall. With the advent of new machines with more detectors and higher temporal resolution has been a reduction in radiation dose and the possibility of new applications. (author)

  3. Current and future perspectives in clinical management

    International Nuclear Information System (INIS)

    Willett, Christopher

    1996-01-01

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

  4. Genetics of ischemic stroke: future clinical applications.

    Science.gov (United States)

    Wang, Michael M

    2006-11-01

    Ischemic stroke has long been thought to have a genetic component that is independent of conventional vascular risk factors. It has been estimated that over one half of stroke risk is determined by inherited genes. However, until recently, strong evidence of genetic influence on ischemic stroke has been subject to criticism because the risk factors for stroke are also inherited and because previous studies suffered from limitations imposed by this highly heterogeneous neurological disorder. Recent advances in molecular genetics have led to the identification of specific genetic loci that impart susceptibility to ischemic stroke. We review the studies of these genes and discuss the future potential applications of genetic markers on the management of ischemic stroke patients.

  5. Current trends and future development in pharmacologic stress testing

    International Nuclear Information System (INIS)

    Bae, Jin Ho; Lee, Jae Tae

    2005-01-01

    Pharmacologic stress testing for myocardial perfusion imaging is a widely used noninvasive method for the evaluation of known or suspected coronary artery disease. The use of exercise for cardiac stress has been practiced for over 60 years and clinicians are familiar with its using. However, there are inevitable situations in which exercise stress is inappropriate. A large number of patients with cardiac problems are unable to exercise to their full potential due to comorbidity such as osteoarthritis, vascular disease and pulmonary disease and a standard exercise stress test for myocardial perfusion imaging is suboptimal means for assessment of coronary artery disease. This problem has led to the development of the pharmacologic stress test and to a great increase in its popularity. All of the currently used pharmacologic agents have well-documented diagnostic value. This review deals the physiological actions, clinical protocols, safety, nuclear imaging applications of currently available stress agents and future development of new vasodilating agents

  6. [Clinical nursing manpower: development and future prospects].

    Science.gov (United States)

    Lin, Chiou-Fen; Kao, Ching-Chiu

    2014-04-01

    The significant changes in nursing manpower utilization in Taiwan over the past two decades are due in large part to the implementation of the National Health Insurance program and the rising need for long-term care. The changes have impacted clinical nursing manpower utilization in two important ways. Firstly, there has been a substantial increase in overall demand for nursing manpower. In particular, the need for clinical nurses has nearly quadrupled during this time period. Secondly, the level of difficulty involved in patient care has risen dramatically, with factors including increased disease severity and increased care quality expectations, among others. These changes, coupled with demands on nursing manpower imposed from other sectors, underpin and further exacerbate the problem of nursing manpower shortages throughout the healthcare system. To raise the quality of the nursing work environment, the Ministry of Health and Welfare (MOHW) brought together Taiwan's key professional nursing organizations to promote 10 care-reform strategies, establish the nursing-aid manpower system, and create the nursing classification system as an approach to effectively attract nurses to take positions in the medical system.

  7. [Future roles of clinical laboratories and clinical laboratory technologists in university hospitals].

    Science.gov (United States)

    Yokota, Hiromitsu; Yatomi, Yutaka

    2013-08-01

    Clinical laboratories in university hospitals should be operated with a good balance of medical practice, education, research, and management. The role of a clinical laboratory is to promptly provide highly reliable laboratory data to satisfy the needs of clinicians involved in medical practice and health maintenance of patients. Improvement and maintenance of the quality of the laboratory staff and environment are essential to achieve this goal. In order to implement these requirements efficiently, an appropriate quality management system should be introduced and established, and evaluated objectively by a third party (e.g. by obtaining ISO 15189 certification). ISO 15189 is an international standard regarding the quality and competence of clinical laboratories, and specifies a review of the efficient operational system and technical requirements such as competence in implementing practical tests and calibration. This means the results of laboratory tests reported by accredited laboratories withstand any international evaluation, which is very important to assure the future importance of the existence and management of clinical laboratories as well as internationalization of medical practice. "Education" and "research" have important implications in addition to "medical practice" and "management", as the roles that clinical laboratories should play in university hospitals. University hospital laboratories should be operated by keeping these four factors in good balance. Why are "education" and "research" required in addition to "medical practice" services? If individual clinical laboratory technologists can provide an appropriate response to this question, the importance of the existence of clinical laboratories would be reinforced, without being compromised.

  8. Language Testing and Technology: Past and Future.

    Science.gov (United States)

    Chalhoub-Deville, Micheline

    2001-01-01

    Reflects on what has transpired in the second language (L2) testing field in relation to technology and situates developments within the larger language testing, general measurement, and educational contexts. (Author/VWL)

  9. Medical beam monitor—Pre-clinical evaluation and future applications

    Science.gov (United States)

    Frais-Kölbl, Helmut; Griesmayer, Erich; Schreiner, Thomas; Georg, Dietmar; Pernegger, Heinz

    2007-10-01

    Future medical ion beam applications for cancer therapy which are based on scanning technology will require advanced beam diagnostics equipment. For a precise analysis of beam parameters we want to resolve time structures in the range of microseconds to nanoseconds. A prototype of an advanced beam monitor was developed by the University of Applied Sciences Wiener Neustadt and its research subsidiary Fotec in co-operation with CERN RD42, Ohio State University and the Jožef Stefan Institute in Ljubljana. The detector is based on polycrystalline Chemical Vapor Deposition (pCVD) diamond substrates and is equipped with readout electronics up to 2 GHz analog bandwidth. In this paper we present the design of the pCVD-detector system and results of tests performed in various particle accelerator based facilities. Measurements performed in clinical high energy photon beams agreed within 1.2% with results obtained by standard ionization chambers.

  10. Medical beam monitor—Pre-clinical evaluation and future applications

    CERN Document Server

    Frais-Kölbl, H; Schreiner, T; Georg, D; Pernegger, H

    2007-01-01

    Future medical ion beam applications for cancer therapy which are based on scanning technology will require advanced beam diagnostics equipment. For a precise analysis of beam parameters we want to resolve time structures in the range of microseconds to nanoseconds. A prototype of an advanced beam monitor was developed by the University of Applied Sciences Wiener Neustadt and its research subsidiary Fotec in co-operation with CERN RD42, Ohio State University and the Jožef Stefan Institute in Ljubljana. The detector is based on polycrystalline Chemical Vapor Deposition (pCVD) diamond substrates and is equipped with readout electronics up to 2 GHz analog bandwidth. In this paper we present the design of the pCVD-detector system and results of tests performed in various particle accelerator based facilities. Measurements performed in clinical high energy photon beams agreed within 1.2% with results obtained by standard ionization chambers.

  11. Expanded newborn screening by mass spectrometry: New tests, future perspectives.

    Science.gov (United States)

    Ombrone, Daniela; Giocaliere, Elisa; Forni, Giulia; Malvagia, Sabrina; la Marca, Giancarlo

    2016-01-01

    Tandem mass spectrometry (MS/MS) has become a leading technology used in clinical chemistry and has shown to be particularly sensitive and specific when used in newborn screening (NBS) tests. The success of tandem mass spectrometry is due to important advances in hardware, software and clinical applications during the last 25 years. MS/MS permits a very rapid measurement of many metabolites in different biological specimens by using filter paper spots or directly on biological fluids. Its use in NBS give us the chance to identify possible treatable metabolic disorders even when asymptomatic and the benefits gained by this type of screening is now recognized worldwide. Today the use of MS/MS for second-tier tests and confirmatory testing is promising especially in the early detection of new disorders such as some lysosomal storage disorders, ADA and PNP SCIDs, X-adrenoleucodistrophy (X-ALD), Wilson disease, guanidinoacetate methyltransferase deficiency (GAMT), and Duchenne muscular dystrophy. The new challenge for the future will be reducing the false positive rate by using second-tier tests, avoiding false negative results by using new specific biomarkers and introducing new treatable disorders in NBS programs. © 2015 Wiley Periodicals, Inc.

  12. California's Drought - Stress test for the future

    Science.gov (United States)

    Lund, J. R.

    2014-12-01

    The current California drought is in its third dry years, with this year being the third driest years in a 106-year record. This drought occurs at a time when urban, agricultural, and environmental water demands have never been greater. This drought has revealed the importance of more quantitative evaluation and methods for water assessment and management. All areas of water and environmental management are likely to become increasingly stressed, and have essentially drought-like conditions, in the future, as California's urban, agricultural, and environmental demands continue to expand and as the climate changes. In the historical past, droughts have pre-viewed stresses developing in the future and helped focus policy-makers, the public, and stakeholders on preparing for these developing future conditions. Multi-decade water management strategies are often galvinized by drought. Irrigation was galvanized by California droughts in the 1800s, reservoir systems by the 1928-32 drought, urban water conservation by the 1976-77 drought, and water markets by the 1988-92 drought. With each drought, demands for tighter accounting, rights, and management have increased. This talk reviews the prospects and challenges for increased development and use of water data and systems analysis in the service of human and environmental water demands in California's highly decentralized water management system, and the prospects if these challenges are not more successfully addressed.

  13. Future clinical trials in DIPG: bringing epigenetics to the clinic

    Directory of Open Access Journals (Sweden)

    Andres E. Morales La Madrid

    2015-07-01

    Full Text Available In spite of major recent advances in DIPG molecular characterization, this body of knowledge has not yet translated into better treatments.To date,more than 250 clinical trials evaluating radiotherapy along with conventional cytotoxic chemotherapy as well as newer biologic agents,have failed to improve the dismal outcome when compared to palliative radiation alone.The biology of DIPG remained unknown until recently when the neurosurgical expertise along with the recognition by the scientific and clinical community of the importance of tissue sampling at diagnosis;ideally in the context of a clinical trial and by trained neurosurgical teams to maximize patient safety.These pre-treatment tumor samples,and others coming from tissue obtained post-mortem,have yielded new insights into DIPG molecular biology.We now know that DIPG comprises a heterogeneous disease with variable molecular phenotypes, different from adult high grade glioma,other non-pontine pediatric high grade gliomas and even between pontine gliomas.The discovery of histone H3.3 or H3.1 mutations has been an important step forward in understanding tumor formation,maintenance and progression.Pharmacologic reversal of DIPG histone demethylation therefore offers an important potential intervention strategy for the treatment of DIPG.To date,clinical trials of newly diagnosed or progressive DIPG with epigenetic modifiers have been unsuccessful.Whether this failure represents limited activity of the agents used,their CNS penetration,redundant pathways within the tumor,or the possibility that histone mutations are necessary only to initiate DIPGs but not maintain their growth,suggest that a great deal still needs to be elucidated in both the underlying biology of these pathways,and the drugs designed to target them.In this review, we discuss the role of both epigenetic and genetic mutations within DIPG and the development of treatment strategies directed against the unique abnormalities

  14. Superstructures: First Cold Test and Future Applications

    International Nuclear Information System (INIS)

    J. Sekutowicz; C Albrecht; V Ayvazyan; R Bandelmann; T Buttner; P Castro; S Choroba; J Eschke; B Faatz; A Gossel; K Honkavaara; B Horst; J Iverson; K Jensch; H Kaiser; R Kammering; G Kreps; D Kostin; J Lorkiewicz; R Lange; A Matheisen; W -D Moller; H -B Peters; D Proch; K Rehlich; H Schlarb; S Schrieber; D Reschke; S Simrock; W Singer; X Singer; K Twarowski; T Weichert; M Wojtkiewicz; G Wendt; K Zapfe; M Liepe; M Huening; M Ferrario; E Plawski; C Pagani; P Kneisel; G Wu; N Baboi; C Thomas; H Chen; W Huang; C Tang; S Zheng

    2003-01-01

    Superstructures, chains of superconducting multi-cell cavities (subunits) connected by e/2 long tube(s) have been proposed as an alternative layout for the TESLA main accelerator [1]. After three years of preparation, two superstructures, each made of two weakly coupled superconducting 7-cell subunits driven by a single Fundamental Power Coupler (FPC), have been installed in the Tesla Test Facility linac for beam tests. Energy stability, HOM damping, frequency and field adjustment methods were tested. The measured results confirme Superstructures, chains of superconducting multi-cell cavities (subunits) connected by e/2 long tube(s) have been proposed as an alternative layout for the TESLA main accelerator [1]. After three years of preparation, two superstructures, each made of two weakly coupled superconducting 7-cell subunits driven by a single Fundamental Power Coupler (FPC), have been installed in the Tesla Test Facility linac for beam tests. Energy stability, HOM damping, frequency and field adjustment methods were tested. The measured results confirmed expectation on the superstructure performance and proved that an alternative layout for the 800 GeV upgrade of the TESLA collider is feasible. We report on the test and give here an overview of its results. The tests confirmed very good damping of HOMs in superstructures and thus has opened a possible new application of this concept to high current energy recovery machines. We have built two 1.5 GHz copper models of two superstructures: 2x5-cells and 2x2-cells to prove further improvement of HOM damping. This contribution presents also measured results on these models. d expectations on the superstructure performance and proved that an alternative layout for the 800 GeV upgrade of the TESLA collider is feasible. We report on the test and give here an overview of its results

  15. Survey of clinical infant lung function testing practices.

    Science.gov (United States)

    Peterson-Carmichael, Stacey L; Rosenfeld, Margaret; Ascher, Simon B; Hornik, Christoph P; Arets, H G M; Davis, Stephanie D; Hall, Graham L

    2014-02-01

    Data supporting the clinical use of infant lung function (ILF) tests are limited making the interpretation of clinical ILF measures difficult. To evaluate current ILF testing practices and to survey users regarding the indications, limitations and perceived clinical benefits of ILF testing. We created a 26-item survey hosted on the European Respiratory Society (ERS) website between January and May 2010. Notifications were sent to members of the ERS, American Thoracic Society and the Asian Pacific Society of Respirology. Responses were sought from ILF laboratory directors and pediatric respirologists. The survey assessed the clinical indications, patient populations, equipment and reference data used, and perceived limitations of ILF testing. We received 148 responses with 98 respondents having ILF equipment and performing testing in a clinical capacity. Centers in North America were less likely to perform ≥50 studies/year than centers in Europe or other continents (13% vs. 41%). Most respondents used ILF data to either "start a new therapy" (78%) or "help decide about initiation of further diagnostic workup such as bronchoscopy, chest CT or serological testing" (69%). Factors reported as limiting clinical ILF testing were need for sedation, uncertainty regarding clinical impact of study results and time intensive nature of the study. Clinical practices associated with ILF testing vary significantly; centers that perform more studies are more likely to use the results for clinical purposes and decision making. The future of ILF testing is uncertain in the face of the limitations perceived by the survey respondents. © 2013 Wiley Periodicals, Inc.

  16. The future endocrine patient. Reflections on the future of clinical endocrinology

    NARCIS (Netherlands)

    Lamberts, S. W. J.; Romijn, J. A.; Wiersinga, W. M.

    2003-01-01

    In recent years the future position of clinical endocrinology has been extensively discussed by Western European endocrine societies. Clinical endocrinology seems to suffer from being too intellectual, generating too little income, and lacking too few spectacular interventions. In this manuscript we

  17. Test programmes of HTTR for future generation HTGRs

    International Nuclear Information System (INIS)

    Kunitomi, K.; Tachibana, Y.; Takeda, T.; Saikusa, A.; Shiozawa, S.

    1997-01-01

    Test programs of the High Temperature Engineering Test Reactor (HTTR) for future generation High Temperature Gas-Cooled Reactors (HTGRs) have been established considering design and development status of HTGRs in Japan and the world. Test programs are divided into six categories, thermal hydraulics, fuel, safety, high temperature components, core physics and control-instrumentations. All programs are related to the technology of future generation HTGRs and will be submitted to a new Coordinated Research Program (CRP) so that all participants from the world in test programs of the HTTR can use measured data for their future generation.HTGRs. This paper describes test programs of the HTTR for the development of future generation HTGRs after explanation of a future generation HTGR in Japan. (author)

  18. [The future of clinical laboratory database management system].

    Science.gov (United States)

    Kambe, M; Imidy, D; Matsubara, A; Sugimoto, Y

    1999-09-01

    To assess the present status of the clinical laboratory database management system, the difference between the Clinical Laboratory Information System and Clinical Laboratory System was explained in this study. Although three kinds of database management systems (DBMS) were shown including the relational model, tree model and network model, the relational model was found to be the best DBMS for the clinical laboratory database based on our experience and developments of some clinical laboratory expert systems. As a future clinical laboratory database management system, the IC card system connected to an automatic chemical analyzer was proposed for personal health data management and a microscope/video system was proposed for dynamic data management of leukocytes or bacteria.

  19. Future vision for the quality assurance of oncology clinical trials

    Directory of Open Access Journals (Sweden)

    Thomas eFitzGerald, MD

    2013-03-01

    Full Text Available The National Cancer Institute clinical cooperative groups have been instrumental over the past 50 years in developing clinical trials and evidence based process improvements for clinical oncology patient care. The cooperative groups are undergoing a transformation process as we further integrate molecular biology into personalized patient care and move to incorporate international partners in clinical trials. To support this vision, data acquisition and data management informatics tools must become both nimble and robust to support transformational research at an enterprise level. Information, including imaging, pathology, molecular biology, radiation oncology, surgery, systemic therapy and patient outcome data needs to be integrated into the clinical trial charter using adaptive clinical trial mechanisms for design of the trial. This information needs to be made available to investigators using digital processes for real time data analysis. Future clinical trials will need to be designed and completed in a timely manner facilitated by nimble informatics processes for data management. This paper discusses both past experience and future vision for clinical trials as we move to develop data management and quality assurance processes to meet the needs of the modern trial.

  20. Informed Consent: Ethical Issues and Future Challenges in Clinical Education.

    Science.gov (United States)

    Angaran, David M.

    1989-01-01

    A look at pharmaceutical care needs in the future is the basis for discussion of the educational needs of clinical pharmacists. Issues discussed include the appropriate degree (bachelor's vs. doctoral), costs of instruction, faculty/student ratios, the pharmacy practice faculty as role models, and computer-assisted instruction. (MSE)

  1. Clinical Application Of Serological Tests For Syphilis

    OpenAIRE

    Lawee, David

    1980-01-01

    This article differentiates and describes the serological tests for syphilis— antitreponemal antibody tests (TPI, FTA-ABS, TPHA), non-treponemal antigen test (VDRL)—their clinical and serological correlation, the responses to therapy and the biologically false positive syndrome.

  2. Clinical review: Current state and future perspectives in the diagnosis of diabetes insipidus: a clinical review.

    Science.gov (United States)

    Fenske, Wiebke; Allolio, Bruno

    2012-10-01

    The differential diagnosis of diabetes insipidus (DI) is often challenging but essential, because treatment may vary substantially. This article analyzes the database and performance of currently used differential diagnostic tests for DI and discusses future perspectives for diagnostic improvement. A review of electronic and print data comprising original and review articles retrieved from the PubMed or Cochrane Library database up to January 2012 was conducted. The search term "polyuria polydipsia syndrome" was cross-referenced with underlying forms of disease and associated clinical, diagnostic, and therapeutic MeSH terms. In addition, references from review articles and textbook chapters were screened for papers containing original data. Search results were narrowed to articles containing primary data with a description of criteria for the differential diagnosis of DI. Fifteen articles on differential diagnosis of DI were identified, mainly consisting of small series of patients, and mostly covering only part of the differential diagnostic spectrum of DI. Test protocols differed, and prospective validation of diagnostic criteria was consistently missing. Inconsistent data were reported on the diagnostic superiority of direct plasma arginine vasopressin determination over the indirect water deprivation test. Both test methods revealed limitations, especially in the differentiation of disorders with a milder phenotype. The available data demonstrate limitations of current biochemical tests for the differential diagnosis of DI, potentially leading to incorrect diagnosis and treatment. The newly available assay for copeptin, the C terminus of the vasopressin precursor, holds promise for a higher diagnostic specificity and simplification of the differential diagnostic protocol in DI.

  3. Evaluating Past and Future USCG Use of Ohmsett Test Facility

    Science.gov (United States)

    2016-10-01

    of Pages 22 22. Price Evaluating Past and Future USCG Use of Ohmsett Test Facility iv UNCLAS//Public | | CG-926 RDC | M. Fitzpatrick, et al...Opportunity Skimming System WEC Wave energy converter Evaluating Past and Future USCG Use of Ohmsett Test Facility x UNCLAS//Public | | CG-926 RDC | M...Date Summary of Effort OCT-NOV 1993 Vessel of Opportunity Skimming System (VOSS) (5 Weeks) APR-JUN 1996 Spilled Oil Recovery System (SORS) (8 Weeks

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

    Science.gov (United States)

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

    2017-11-01

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

  5. [Issues on business of genetic testing in near future].

    Science.gov (United States)

    Takada, Fumio

    2009-06-01

    Since 1990's, a business condition that company sells genetic testing services directly to consumers without through medical facility, so called "direct-to-consumers (DTC) genetic testing", has risen. They provide genetic testing for obesity, disease susceptibility or paternity, etc. There are serious problems in this kind of business. Most of the providers do not make sales with face-to-face selling, and do through internet instead. They do not provide genetic counseling by certified genetic counselor or clinical geneticist. Most DTC genetic testing services for disease susceptibility or predispositions including obesity, lack scientific validity, clinical validity and clinical utility. And also including paternity genetic testing, they all have risks of ethical legal and social issues (ELSI) in genetic discrimination and/or eugenics. The specific problem in Japan is that the healthcare section of the government still has not paid attention and not taken seriously the requirement to deploy safety net.

  6. Development of DCC software dynamic test facility: past and future

    International Nuclear Information System (INIS)

    McDonald, A.M.; Thai, N.D.; Buijs, W.J.

    1996-01-01

    This paper describes a test facility for future dynamic testing of DCC software used in the control computers of CANDU nuclear power stations. It is a network of three computers: the DCC emulator, the dynamic CANDU plant simulator and the testing computer. Shared network files are used for input/output data exchange between computers. The DCC emulator runs directly on the binary image of the DCC software. The dynamic CANDU plant simulator accepts control signals from the DCC emulator and returns realistic plant behaviour. The testing computer accepts test scripts written in AECL Test Language. Both dynamic test and static tests may be performed on the DCC software to verify control program outputs and dynamic responses. (author)

  7. Clinical applications of preimplantation genetic testing.

    Science.gov (United States)

    Brezina, Paul R; Kutteh, William H

    2015-02-19

    Genetic diagnostic technologies are rapidly changing the way medicine is practiced. Preimplantation genetic testing is a well established application of genetic testing within the context of in vitro fertilization cycles. It involves obtaining a cell(s) from a developing embryo in culture, which is then subjected to genetic diagnostic analysis; the resulting information is used to guide which embryos are transferred into the uterus. The potential applications and use of this technology have increased in recent years. Experts agree that preimplantation genetic diagnosis is clinically appropriate for many known genetic disorders. However, some applications of such testing, such as preimplantation genetic screening for aneuploidy, remain controversial. Clinical data suggest that preimplantation genetic screening may be useful, but further studies are needed to quantify the size of the effect and who would benefit most. © BMJ Publishing Group Ltd 2015.

  8. Power Testing in Basketball: Current Practice and Future Recommendations.

    Science.gov (United States)

    Wen, Neal; Dalbo, Vincent J; Burgos, Bill; Pyne, David B; Scanlan, Aaron T

    2018-02-01

    Numerous foundational movements performed during basketball are predicated on underlying power-related attributes, including speed, change-of-direction, and jumping. Accordingly, fitness testing batteries for basketball have incorporated an assortment of linear speed tests, change-of-direction tests, and jump tests. However, due to the wide variety of testing options it is difficult for basketball practitioners to select appropriate testing protocols for the assessment of power-related attributes. As a result, there is a need to review the relevant literature to identify game-specific, power-related attributes important in basketball and the most appropriate tests available to assess power-related attributes for basketball practitioners. Therefore, the aims of this review were to: (1) identify essential power-related attributes important in basketball; (2) discuss the suitability of common and novel power-related tests; and (3) provide recommendations for future research and best practice approaches for basketball coaching staff. In this review, we propose a series of novel tests that are more targeted and specific to basketball movements including: (1) 5-m and 10-m linear sprints, (2) Modified Agility T-Test, (3) Change-of-Direction Deficit, (4) lateral bound, (5) Sargent jump, (6) one-step jump, and (7) isometric midthigh pull test. Improved testing of power-related attributes should enable basketball practitioners to develop targeted training plans for enhancing player performance.

  9. Clinical trials in orthopaedics and the future direction of clinical investigations for femoroacetabular impingement

    DEFF Research Database (Denmark)

    Clohisy, John C; Kim, Young-Jo; Lurie, Jon

    2013-01-01

    to be further defined. To date, clinical research reports have included primarily surgical case series. Future clinical investigations are needed to establish improved clinical evidence to guide patient care. Most urgent is the need to better understand the potential role of standardized nonsurgical treatment......Femoroacetabular impingement (FAI) represents a heterogeneous group of disorders that affect a diverse patient population. The natural history of the disease, the role of nonsurgical management, the indications for surgery, optimal surgical techniques, and the predictors of treatment outcomes need...... options for FAI and to define the predictors of surgical and nonsurgical outcomes. Future randomized controlled trials and large observational cohort studies targeted at these clinical research deficiencies will strengthen the evidence and improve informed decision making regarding the management...

  10. Mercury flow tests (first report). Wall friction factor measurement tests and future tests plan

    International Nuclear Information System (INIS)

    Kaminaga, Masanori; Kinoshita, Hidetaka; Haga, Katsuhiro; Hino, Ryutaro; Sudo, Yukio

    1999-07-01

    In the neutron science project at JAERI, we plan to inject a pulsed proton beam of a maximum power of 5 MW from a high intense proton accelerator into a mercury target in order to produce high energy neutrons of a magnitude of ten times or more than existing facilities. The neutrons produced by the facility will be utilized for advanced field of science such as the life sciences etc. An urgent issue in order to accomplish this project is the establishment of mercury target technology. With this in mind, a mercury experimental loop with the capacity to circulate mercury up to 15 L/min was constructed to perform thermal hydraulic tests, component tests and erosion characteristic tests. A measurement of the wall friction factor was carried out as a first step of the mercury flow tests, while testing the characteristic of components installed in the mercury loop. This report presents an outline of the mercury loop and experimental results of the wall friction factor measurement. From the wall friction factor measurement, it was made clear that the wettability of the mercury was improved with an increase of the loop operation time and at the same time the wall friction factors were increased. The measured wall friction factors were much lower than the values calculated by the Blasius equation at the beginning of the loop operation because of wall slip caused by a non-wetted condition. They agreed well with the values calculated by the Blasius equation within a deviation of 10% when the sum of the operation time increased more than 11 hours. This report also introduces technical problems with a mercury circulation and future tests plan indispensable for the development of the mercury target. (author)

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

    Science.gov (United States)

    Kretschmer, Alexander; Tilki, Derya

    2017-12-01

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

  12. Feline genetics: clinical applications and genetic testing.

    Science.gov (United States)

    Lyons, Leslie A

    2010-11-01

    DNA testing for domestic cat diseases and appearance traits is a rapidly growing asset for veterinary medicine. Approximately 33 genes contain 50 mutations that cause feline health problems or alterations in the cat's appearance. A variety of commercial laboratories can now perform cat genetic diagnostics, allowing both the veterinary clinician and the private owner to obtain DNA test results. DNA is easily obtained from a cat via a buccal swab with a standard cotton bud or cytological brush, allowing DNA samples to be easily sent to any laboratory in the world. The DNA test results identify carriers of the traits, predict the incidence of traits from breeding programs, and influence medical prognoses and treatments. An overall goal of identifying these genetic mutations is the correction of the defect via gene therapies and designer drug therapies. Thus, genetic testing is an effective preventative medicine and a potential ultimate cure. However, genetic diagnostic tests may still be novel for many veterinary practitioners and their application in the clinical setting needs to have the same scrutiny as any other diagnostic procedure. This article will review the genetic tests for the domestic cat, potential sources of error for genetic testing, and the pros and cons of DNA results in veterinary medicine. Highlighted are genetic tests specific to the individual cat, which are a part of the cat's internal genome. Copyright © 2010 Elsevier Inc. All rights reserved.

  13. Clinical investigation of radioallergosorbent test (RAST)

    International Nuclear Information System (INIS)

    Okuda, Minoru; Usami, Atsushi

    1974-01-01

    Relationship of radioallergosorbent test (RAST), intracutaneous reaction, serum IgE determination and RMCD (Rat Mast Cell Degranulation Test) in subjects with tick allergy was compared in order to investigate clinical application for nasal allergy. 1. RAST is suitable for clinical examinations as determination of IgE. Because it is simple in technique, a technical expert can treat many subjects within a short time, and the result can be decleared within 2 days. 2. RAST was high in specificity and was consistent with clinical findings. RAST positive was thought to be allergy by the antigen, but RAST negative could not deny allergy by the antigen. 3. Correlation of some degree was found to exist between RAST and intracutaneous reaction or degree of induced reaction or threshold value of antigen intracutaneous reaction. But degree of intracutaneous reaction and induced reaction and threshold value of intracutaneous reaction could not be determined from the result of RAST. 4. Determination of IgE antibody by RAST was more useful in clinical study than that of IgE or IgE antibody by RMCD. (Oyama, S.)

  14. Recent irradiation tests for future nuclear system at HANARO

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Man Soon; Choo, Kee Nam; Yang, Seong Woo; Park, Sang Jun [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2016-05-15

    The capsule at HANARO is a device that evaluates the irradiation effects of nuclear materials and fuels, which can reproduce the environment of nuclear power plants and accelerate to reach to the end of life condition. As the integrity assessment and the extension of lifetime of nuclear power plants are recently considered as important issues in Korea, the requirements for irradiation test are gradually being increased. The capacity and capability irradiation tests at HANARO are becoming important because Korea strives to develop SFR (Sodium-cooled Fast Reactor) and VHTR (Very High Temperature Reactor) among the future nuclear system and to export the research reactors and to develop the fusion reactor technology.

  15. Decaying relevance of clinical data towards future decisions in data-driven inpatient clinical order sets.

    Science.gov (United States)

    Chen, Jonathan H; Alagappan, Muthuraman; Goldstein, Mary K; Asch, Steven M; Altman, Russ B

    2017-06-01

    Determine how varying longitudinal historical training data can impact prediction of future clinical decisions. Estimate the "decay rate" of clinical data source relevance. We trained a clinical order recommender system, analogous to Netflix or Amazon's "Customers who bought A also bought B..." product recommenders, based on a tertiary academic hospital's structured electronic health record data. We used this system to predict future (2013) admission orders based on different subsets of historical training data (2009 through 2012), relative to existing human-authored order sets. Predicting future (2013) inpatient orders is more accurate with models trained on just one month of recent (2012) data than with 12 months of older (2009) data (ROC AUC 0.91 vs. 0.88, precision 27% vs. 22%, recall 52% vs. 43%, all P<10 -10 ). Algorithmically learned models from even the older (2009) data was still more effective than existing human-authored order sets (ROC AUC 0.81, precision 16% recall 35%). Training with more longitudinal data (2009-2012) was no better than using only the most recent (2012) data, unless applying a decaying weighting scheme with a "half-life" of data relevance about 4 months. Clinical practice patterns (automatically) learned from electronic health record data can vary substantially across years. Gold standards for clinical decision support are elusive moving targets, reinforcing the need for automated methods that can adapt to evolving information. Prioritizing small amounts of recent data is more effective than using larger amounts of older data towards future clinical predictions. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  16. Leaders, leadership and future primary care clinical research

    Directory of Open Access Journals (Sweden)

    Qureshi Nadeem

    2008-09-01

    Full Text Available Abstract Background A strong and self confident primary care workforce can deliver the highest quality care and outcomes equitably and cost effectively. To meet the increasing demands being made of it, primary care needs its own thriving research culture and knowledge base. Methods Review of recent developments supporting primary care clinical research. Results Primary care research has benefited from a small group of passionate leaders and significant investment in recent decades in some countries. Emerging from this has been innovation in research design and focus, although less is known of the effect on research output. Conclusion Primary care research is now well placed to lead a broad re-vitalisation of academic medicine, answering questions of relevance to practitioners, patients, communities and Government. Key areas for future primary care research leaders to focus on include exposing undergraduates early to primary care research, integrating this early exposure with doctoral and postdoctoral research career support, further expanding cross disciplinary approaches, and developing useful measures of output for future primary care research investment.

  17. [Clinical neuropsychology in perspective: future challenges based on current developments].

    Science.gov (United States)

    Verdejo-García, Antonio; Tirapu-Ustárroz, Javier

    2012-02-01

    New lines of translational, interdisciplinary research are emerging among different fields of the neurosciences, which often point at clinical neuropsychology as the hinge discipline capable of linking the basic findings with their clinical implications and thereby endow them with some meaning for phenomenological experience. To establish the great lines of progress made in the fields of neuroscience and neuropsychology in recent years, so as to be able to foresee the strategic lines and priorities of neuroscience in the near future. To achieve this aim, the first step will be to identify the changes of paradigm that have taken place in the areas of neuroscience and psychology in the last two decades. The next step will be to propose new topics and fields of application that these changes in paradigm offer and demand from neuroscience. The false dichotomies of genes versus environment, mind versus brain, and reason versus emotion are considered, as are the new applications of neuropsychology to the understanding of psychopathological disorders, from the neurodegenerative to neurodevelopment, from 'dirty' drugs to cognitive and affective enhancers.

  18. Bridge to the future: nontraditional clinical settings, concepts and issues.

    Science.gov (United States)

    Faller, H S; Dowell, M A; Jackson, M A

    1995-11-01

    Healthcare restructuring in the wake of healthcare reform places greater emphasis on primary healthcare. Clinical education in acute care settings and existing community health agencies are not compatible with teaching basic concepts, principles and skills fundamental to nursing. Problems of clients in acute care settings are too complex and clients in the community are often too dispersed for necessary faculty support and supervision of beginning nursing students. Nontraditional learning settings offer the baccalaureate student the opportunity to practice fundamental skills of care and address professional skills of negotiation, assertiveness, organization, collaboration and leadership. An overview of faculty designed clinical learning experiences in nontraditional sites such as McDonald's restaurants, inner city churches, YWCA's, the campus community and homes are presented. The legal, ethical and academic issues associated with nontraditional learning settings are discussed in relation to individual empowerment, decision making and evaluation. Implications for the future address the role of the students and faculty as they interact with the community in which they live and practice.

  19. Validation of Clinical Testing for Warfarin Sensitivity

    Science.gov (United States)

    Langley, Michael R.; Booker, Jessica K.; Evans, James P.; McLeod, Howard L.; Weck, Karen E.

    2009-01-01

    Responses to warfarin (Coumadin) anticoagulation therapy are affected by genetic variability in both the CYP2C9 and VKORC1 genes. Validation of pharmacogenetic testing for warfarin responses includes demonstration of analytical validity of testing platforms and of the clinical validity of testing. We compared four platforms for determining the relevant single nucleotide polymorphisms (SNPs) in both CYP2C9 and VKORC1 that are associated with warfarin sensitivity (Third Wave Invader Plus, ParagonDx/Cepheid Smart Cycler, Idaho Technology LightCycler, and AutoGenomics Infiniti). Each method was examined for accuracy, cost, and turnaround time. All genotyping methods demonstrated greater than 95% accuracy for identifying the relevant SNPs (CYP2C9 *2 and *3; VKORC1 −1639 or 1173). The ParagonDx and Idaho Technology assays had the shortest turnaround and hands-on times. The Third Wave assay was readily scalable to higher test volumes but had the longest hands-on time. The AutoGenomics assay interrogated the largest number of SNPs but had the longest turnaround time. Four published warfarin-dosing algorithms (Washington University, UCSF, Louisville, and Newcastle) were compared for accuracy for predicting warfarin dose in a retrospective analysis of a local patient population on long-term, stable warfarin therapy. The predicted doses from both the Washington University and UCSF algorithms demonstrated the best correlation with actual warfarin doses. PMID:19324988

  20. Nuclear physics at PEP: First test and future plans

    International Nuclear Information System (INIS)

    Van Bibber, K.; Dietrich, F.S.; Melnikoff, S.O.

    1986-09-01

    A test run of internal target nuclear physics at the PEP storage ring is described. The Time Projection Chamber (TPC-2γ detector) was used to detect the inelastically scattered electron and complete hadronic final state in the interaction of 14.5 GeV electrons with D 2 , Ar and Xe gas targets. The data comprise mostly low-x low-Q 2 events, but some deep inelastic scattering as well. The future possibilities of a dedicated nuclear physics program at PEP are outlined. 15 refs., 25 figs

  1. Tests of gravity with future space-based experiments

    Science.gov (United States)

    Sakstein, Jeremy

    2018-03-01

    Future space-based tests of relativistic gravitation—laser ranging to Phobos, accelerometers in orbit, and optical networks surrounding Earth—will constrain the theory of gravity with unprecedented precision by testing the inverse-square law, the strong and weak equivalence principles, and the deflection and time delay of light by massive bodies. In this paper, we estimate the bounds that could be obtained on alternative gravity theories that use screening mechanisms to suppress deviations from general relativity in the Solar System: chameleon, symmetron, and Galileon models. We find that space-based tests of the parametrized post-Newtonian parameter γ will constrain chameleon and symmetron theories to new levels, and that tests of the inverse-square law using laser ranging to Phobos will provide the most stringent constraints on Galileon theories to date. We end by discussing the potential for constraining these theories using upcoming tests of the weak equivalence principle, and conclude that further theoretical modeling is required in order to fully utilize the data.

  2. Scoping Future Policy Dynamics in Raw Materials Through Scenarios Testing

    Science.gov (United States)

    Correia, Vitor; Keane, Christopher; Sturm, Flavius; Schimpf, Sven; Bodo, Balazs

    2017-04-01

    The International Raw Materials Observatory (INTRAW) project is working towards a sustainable future for the European Union in access to raw materials, from an availability, economical, and environmental framework. One of the major exercises for the INTRAW project is the evaluation of potential future scenarios for 2050 to frame economic, research, and environmental policy towards a sustainable raw materials supply. The INTRAW consortium developed three possible future scenarios that encompass defined regimes of political, economic, and technological norms. The first scenario, "Unlimited Trade," reflects a world in which free trade continues to dominate the global political and economic environment, with expectations of a growing demand for raw materials from widely distributed global growth. The "National Walls" scenario reflects a world where nationalism and economic protectionism begins to dominate, leading to stagnating economic growth and uneven dynamics in raw materials supply and demand. The final scenario, "Sustainability Alliance," examines the dynamics of a global political and economic climate that is focused on environmental and economic sustainability, leading towards increasingly towards a circular raw materials economy. These scenarios were reviewed, tested, and provided simulations of impacts with members of the Consortium and a panel of global experts on international raw materials issues which led to expected end conditions for 2050. Given the current uncertainty in global politics, these scenarios are informative to identifying likely opportunities and crises. The details of these simulations and expected responses to the research demand, technology investments, and economic components of raw materials system will be discussed.

  3. Chemical compound-based direct reprogramming for future clinical applications

    Science.gov (United States)

    Takeda, Yukimasa; Harada, Yoshinori; Yoshikawa, Toshikazu; Dai, Ping

    2018-01-01

    Recent studies have revealed that a combination of chemical compounds enables direct reprogramming from one somatic cell type into another without the use of transgenes by regulating cellular signaling pathways and epigenetic modifications. The generation of induced pluripotent stem (iPS) cells generally requires virus vector-mediated expression of multiple transcription factors, which might disrupt genomic integrity and proper cell functions. The direct reprogramming is a promising alternative to rapidly prepare different cell types by bypassing the pluripotent state. Because the strategy also depends on forced expression of exogenous lineage-specific transcription factors, the direct reprogramming in a chemical compound-based manner is an ideal approach to further reduce the risk for tumorigenesis. So far, a number of reported research efforts have revealed that combinations of chemical compounds and cell-type specific medium transdifferentiate somatic cells into desired cell types including neuronal cells, glial cells, neural stem cells, brown adipocytes, cardiomyocytes, somatic progenitor cells, and pluripotent stem cells. These desired cells rapidly converted from patient-derived autologous fibroblasts can be applied for their own transplantation therapy to avoid immune rejection. However, complete chemical compound-induced conversions remain challenging particularly in adult human-derived fibroblasts compared with mouse embryonic fibroblasts (MEFs). This review summarizes up-to-date progress in each specific cell type and discusses prospects for future clinical application toward cell transplantation therapy. PMID:29739872

  4. Experimental tests of general relativity: recent progress and future directions

    International Nuclear Information System (INIS)

    Turyshev, S G

    2009-01-01

    Einstein's general theory of relativity is the standard theory of gravity, especially where the needs of astronomy, astrophysics, cosmology, and fundamental physics are concerned. As such, this theory is used for many practical purposes involving spacecraft navigation, geodesy, and time transfer. We review the foundations of general relativity, discuss recent progress in tests of relativistic gravity, and present motivations for the new generation of high-accuracy tests of new physics beyond general relativity. Space-based experiments in fundamental physics are presently capable of uniquely addressing important questions related to the fundamental laws of nature. We discuss the advances in our understanding of fundamental physics that are anticipated in the near future and evaluate the discovery potential of a number of recently proposed space-based gravitational experiments. (reviews of topical problems)

  5. The Past, Present, and Future of Preimplantation Genetic Testing.

    Science.gov (United States)

    Imudia, Anthony N; Plosker, Shayne

    2016-06-01

    Preimplantation genetic testing (PGT) of oocytes and embryos is the earliest form of prenatal testing. PGT requires in vitro fertilization for embryo creation. In the past 25 years, the use of PGT has increased dramatically. The indications of PGT include identification of embryos harboring single-gene disorders, chromosomal structural abnormalities, chromosomal numeric abnormalities, and mitochondrial disorders; gender selection; and identifying unaffected, HLA-matched embryos to permit the creation of a savior sibling. PGT is not without risks, limitations, or ethical controversies. This review discusses the techniques and clinical applications of different forms of PGT and the debate surrounding its associated uncertainty and expanded use. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Alternatives to animal testing: current status and future perspectives.

    Science.gov (United States)

    Liebsch, Manfred; Grune, Barbara; Seiler, Andrea; Butzke, Daniel; Oelgeschläger, Michael; Pirow, Ralph; Adler, Sarah; Riebeling, Christian; Luch, Andreas

    2011-08-01

    On the occasion of the 20th anniversary of the Center for Alternative Methods to Animal Experiments (ZEBET), an international symposium was held at the German Federal Institute for Risk Assessment (BfR) in Berlin. At the same time, this symposium was meant to celebrate the 50th anniversary of the publication of the book "The Principles of Humane Experimental Technique" by Russell and Burch in 1959 in which the 3Rs principle (that is, Replacement, Reduction, and Refinement) has been coined and introduced to foster the development of alternative methods to animal testing. Another topic addressed by the symposium was the new vision on "Toxicology in the twenty-first Century", as proposed by the US-National Research Council, which aims at using human cells and tissues for toxicity testing in vitro rather than live animals. An overview of the achievements and current tasks, as well as a vision of the future to be addressed by ZEBET@BfR in the years to come is outlined in the present paper.

  7. Excimer PRK testing in the clinic

    Science.gov (United States)

    Forrest, Gary T.

    1994-06-01

    Testing of the excimer lasers used in PRK requires special considerations in terms of ease of use, day-to-day reliability, and high resolution to see details of beam interference effects. SensorPhysics employs a patented photochromic material on a polyester substrate to record permanent, instant records of the laser and laser system output. Since each SensorCard is used only once concerns about detection device deterioration are not an issue. The SensorCards have a demonstrated resolving power on the order of 0.1 micrometers . A small, portable reading device is used to convert the SensorCard optical density to a mJ/cm2 value. Special software also measures beam uniformity to +/- 1% to provide both qualitative and quantitative analysis. Results of use in clinic environments will be presented. In particular detection of exposure `islands' will be demonstrated. The techniques employed are similar to those we developed for UV laser micromachining and lithography four years ago.

  8. TESTING CPT SYMMETRY WITH CURRENT AND FUTURE CMB MEASUREMENTS

    Energy Technology Data Exchange (ETDEWEB)

    Li, Si-Yu; Zhang, Xinmin [Theory Division, Institute of High Energy Physics, Chinese Academy of Science, P.O. Box 918-4, Beijing 100049 (China); Xia, Jun-Qing; Li, Hong [Key Laboratory of Particle Astrophysics, Institute of High Energy Physics, Chinese Academy of Science, P.O. Box 918-3, Beijing 100049 (China); Li, Mingzhe, E-mail: xiajq@ihep.ac.cn [Interdisciplinary Center for Theoretical Study, University of Science and Technology of China, Hefei, Anhui 230026 (China)

    2015-02-01

    In this paper, we use the current and future cosmic microwave background (CMB) experiments to test the Charge-Parity-Time Reversal (CPT) symmetry. We consider a CPT-violating interaction in the photon sector L{sub cs}∼p{sub μ}A{sub ν} F-tilde {sup μν}, which gives rise to a rotation of the polarization vectors of the propagating CMB photons. By combining the 9 yr WMAP, BOOMERanG 2003, and BICEP1 observations, we obtain the current constraint on the isotropic rotation angle α-bar =−2.12±1.14 (1σ), indicating that the significance of the CPT violation is about 2σ. Here, we particularly take the systematic errors of CMB measurements into account. Then, we study the effects of the anisotropies of the rotation angle [Δα( n-hat )] on the CMB polarization power spectra in detail. Due to the small effects, the current CMB polarization data cannot constrain the related parameters very well. We obtain the 95% C.L. upper limit of the variance of the anisotropies of the rotation angle C {sup α}(0) < 0.035 from all of the CMB data sets. More interestingly, including the anisotropies of rotation angle could lower the best-fit value of r and relax the tension on the constraints of r between BICEP2 and Planck. Finally, we investigate the capabilities of future Planck polarization measurements on α-bar and Δα( n-hat ). Benefited from the high precision of Planck data, the constraints of the rotation angle can be significantly improved.

  9. Positron Computed Tomography: Current State, Clinical Results and Future Trends

    Science.gov (United States)

    Schelbert, H. R.; Phelps, M. E.; Kuhl, D. E.

    1980-09-01

    An overview is presented of positron computed tomography: its advantages over single photon emission tomography, its use in metabolic studies of the heart and chemical investigation of the brain, and future trends. (ACR)

  10. Positron computed tomography: current state, clinical results and future trends

    Energy Technology Data Exchange (ETDEWEB)

    Schelbert, H.R.; Phelps, M.E.; Kuhl, D.E.

    1980-09-01

    An overview is presented of positron computed tomography: its advantages over single photon emission tomography, its use in metabolic studies of the heart and chemical investigation of the brain, and future trends. (ACR)

  11. Positron computed tomography: current state, clinical results and future trends

    International Nuclear Information System (INIS)

    Schelbert, H.R.; Phelps, M.E.; Kuhl, D.E.

    1980-01-01

    An overview is presented of positron computed tomography: its advantages over single photon emission tomography, its use in metabolic studies of the heart and chemical investigation of the brain, and future trends

  12. Clinical trials in nuclear medicine: Present and future

    International Nuclear Information System (INIS)

    Chaumet-Riffaud, P.; Cachin, F.; Couturier, O.; Desruet, M.D.; Kraeber-Bodere, F.; Talbot, J.N.; Vuillez, J.P.

    2009-01-01

    The particular status of radiopharmaceuticals, together with the positioning of nuclear medicine in multidisciplinary approach of oncology, lead to real difficulties for conception, validation and granting of clinical trials which are necessary for demonstrating clinical interest of new compounds, for diagnosis as well as for therapeutic use. This article is a presentation of some recent clinical trials conducted in nuclear medicine in France, showing its dynamism but also pointing out some encountered difficulties. These experiences could lead to reflexion in order to improve the clinical research performances, taking into account a scientific and regulatory context more and more constraining. (authors)

  13. Social inequality and HIV-testing: Comparing home- and clinic-based testing in rural Malawi

    Directory of Open Access Journals (Sweden)

    Alexander A. Weinreb

    2009-10-01

    Full Text Available The plan to increase HIV testing is a cornerstone of the international health strategy against the HIV/AIDS epidemic, particularly in sub-Saharan Africa. This paper highlights a problematic aspect of that plan: the reliance on clinic- rather than home-based testing. First, drawing on DHS data from across Africa, we demonstrate the substantial differences in socio-demographic and economic profiles between those who report having ever had an HIV test, and those who report never having had one. Then, using data from a random household survey in rural Malawi, we show that substituting home-based for clinic-based testing may eliminate this source of inequality between those tested and those not tested. This result, which is stable across modeling frameworks, has important implications for accurately and equitably addressing the counseling and treatment programs that comprise the international health strategy against AIDS, and that promise to shape the future trajectory of the epidemic in Africa and beyond.

  14. ESCRIME: testing bench for advanced operator workstations in future plants

    International Nuclear Information System (INIS)

    Poujol, A.; Papin, B.

    1994-01-01

    The problem of optimal task allocation between man and computer for the operation of nuclear power plants is of major concern for the design of future plants. As the increased level of automation induces the modification of the tasks actually devoted to the operator in the control room, it is very important to anticipate these consequences at the plant design stage. The improvement of man machine cooperation is expected to play a major role in minimizing the impact of human errors on plant safety. The CEA has launched a research program concerning the evolution of the plant operation in order to optimize the efficiency of the human/computer systems for a better safety. The objective of this program is to evaluate different modalities of man-machine share of tasks, in a representative context. It relies strongly upon the development of a specific testing facility, the ESCRIME work bench, which is presented in this paper. It consists of an EDF 1300MWe PWR plant simulator connected to an operator workstation. The plant simulator model presents at a significant level of details the instrumentation and control of the plant and the main connected circuits. The operator interface is based on the generalization of the use of interactive graphic displays, and is intended to be consistent to the tasks to be performed by the operator. The functional architecture of the workstation is modular, so that different cooperation mechanisms can be implemented within the same framework. It is based on a thorough analysis and structuration of plant control tasks, in normal as well as in accident situations. The software architecture design follows the distributed artificial intelligence approach. Cognitive agents cooperate in order to operate the process. The paper presents the basic principles and the functional architecture of the test bed and describes the steps and the present status of the program. (author)

  15. A critical evaluation of the validity of episodic future thinking: A clinical neuropsychology perspective.

    Science.gov (United States)

    Ward, Amanda M

    2016-11-01

    Episodic future thinking is defined as the ability to mentally simulate a future event. Although episodic future thinking has been studied extensively in neuroscience, this construct has not been explored in depth from the perspective of clinical neuropsychology. The aim of this critical narrative review is to assess the validity and clinical implications of episodic future thinking. A systematic review of episodic future thinking literature was conducted. PubMed and PsycInfo were searched through July 2015 for review and empirical articles with the following search terms: "episodic future thinking," "future mental simulation," "imagining the future," "imagining new experiences," "future mental time travel," "future autobiographical experience," and "prospection." The review discusses evidence that episodic future thinking is important for adaptive functioning, which has implications for neurological populations. To determine the validity of episodic future thinking, the construct is evaluated with respect to related constructs, such as imagination, episodic memory, autobiographical memory, prospective memory, narrative construction, and working memory. Although it has been minimally investigated, there is evidence of convergent and discriminant validity for episodic future thinking. Research has not addressed the incremental validity of episodic future thinking. Practical considerations of episodic future thinking tasks and related constructs in a clinical neuropsychological setting are considered. The utility of episodic future thinking is currently unknown due to the lack of research investigating the validity of episodic future thinking. Future work is discussed, which could determine whether episodic future thinking is an important missing piece in standard clinical neuropsychological assessment. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  16. Clinical test for Attention Enhancement System.

    Science.gov (United States)

    Cho, Baek-Hwan; Ku, Jeonghun; Jang, Dongpyo; Lee, Jaemin; Oh, Myungjin; Kim, Hun; Lee, Janghan; Kim, Jaeseok; Kim, Inyoung; Kim, Sunill

    2002-01-01

    Attention Deficit Hyperactivity Disorder (ADHD) is a childhood syndrome characterized by short attention span, impulsiveness, and hyperactivity, which often leads to learning disabilities and various behavioral problems. The prevalence rates for ADHD varied from a low of 2.0% to a high of 6.3% in 1992 statistics, and it may be higher now. Using Virtual Environments and Neurofeedback, we have developed an Attention Enhancement System for treating ADHD. And we made a clinical test. Classroom-based virtual environments are constructed for intimacy and intensive attention enhancement. In this basic virtual environment, subjects performed some training sessions. There are two kinds of training sessions. One is Virtual Reality Cognitive Training (VRCT) and the other is Virtual Reality Neurofeedback Training (VRNT). In VRNT, we made a change in the virtual environment by Neurofeedback. Namely, if the Beta ratio is greater than the specified threshold level, the change as positive reinforce is created in the virtual environment. 50 subjects, aged 14 to 18, who had committed crimes and had been isolated in a reformatory took part in this study. They were randomly assigned to one of five 10-subject groups: a control Group, two placebo groups, and two experimental groups. The experimental groups and the placebo groups underwent 10 sessions over two weeks. The control group underwent no training session during the same period of time. While the experimental groups used HMD and Head Tracker in each session, the placebo groups used only a computer monitor. Consequently, only the experimental Groups could look around the virtual classroom. Besides that, Placebo Group 1 and Experimental Group 1 performed the same task(Neurofeedback Training), and Placebo Group 2 and Experimental Group 2 also performed the same task(Cognitive Training). All subjects Continuous Performance Task(CPT) before and after all training sessions. In the number of correct answers, omission errors and signal

  17. The passive hamstring stretch test: clinical evaluation.

    Science.gov (United States)

    Fisk, J W

    1979-03-28

    The passive hamstring stretch test is described. Using a modified goniometer it is shown that independent measurements taken by trained examiners approximate very closely to each other. This establishes the test as a valid objective measurement. The possible value of this test as a research tool in low back pain problems is discussed.

  18. Opinions about the future of Clinical Trials in Turkey

    Directory of Open Access Journals (Sweden)

    Nüket Büken

    2016-09-01

    Full Text Available Even though all the rights and obligations of all parties of clinical trial – the researching physician, the volunteering patient, the industry, research institutions- have been assured with ethico-legal regulations, there still exist many problems in the world of clinical research, and suggestions of solutions to the said problems. As a medical ethicist who has been a permanent member of the Hacettepe University Ethical Committee since 2000, I have decided to write a short report that is a general look at the world of clinical research in Turkey. I wanted this report to be one that talks about some of the issues I believe are important about this subject, which include expectations and predictions on it. All of the headlines in this report are without doubt, issues that can be researched and written about widely and with much more details. Especially the process of adjustment to the new regulation of the EU (No 536/2014 of The European Parliament, the condition of non-medicational/non interventional clinical research, transparency in clinical research and budget issues are to me controversial subjects that should be especially and primarily discussed.

  19. A Two-Week Psychosocial Intervention Reduces Future Aggression and Incarceration in Clinically Aggressive Juvenile Offenders.

    Science.gov (United States)

    Kendall, Ashley D; Emerson, Erin M; Hartmann, William E; Zinbarg, Richard E; Donenberg, Geri R

    2017-12-01

    There is a largely unmet need for evidence-based interventions that reduce future aggression and incarceration in clinically aggressive juvenile offenders serving probation. We addressed this gap using a group randomized controlled trial. Offenders both with and without clinical aggression were included, enabling comparison of intervention effects. Juveniles 13 to 17 years old (N = 310, mean = 16 years, 90% African-American, 66% male) on probation were assigned to a 2-week intervention targeting psychosocial factors implicated in risky behavior (e.g., learning strategies to manage "hot" emotions that prompt risk taking) or to an equally intensive health promotion control. Participants completed aggression measures at baseline, 6-, and 12-month follow-up and reported on incarceration at 12 months. Spline regression tested symptom change. Among clinically aggressive offenders (n = 71), the intervention arm showed significantly greater reductions in aggression over the first 6 months compared with controls. Juveniles from the intervention no longer met clinical criteria, on average, but clinically significant symptoms persisted in the control group. By 12 months, participants from the intervention appeared to maintain treatment gains, but their symptom levels no longer differed significantly from those in the control. However, the intervention group was nearly 4 times less likely than controls to report incarceration. Intervention effects were significantly stronger for offenders with clinical than with nonclinical (n = 239) baseline aggression. A 2-week intervention expedited improvements in aggression and reduced incarceration in clinically aggressive juvenile offenders. The findings underscore the importance of directing intervention resources to the most aggressive youth. Clinical trial registration information-PHAT Life: Preventing HIV/AIDS Among Teens in Juvenile Justice (PHAT Life); http://clinicaltrials.gov/; NCT02647710. Copyright © 2017 American

  20. Future prospects of therapeutic clinical trials in acute myeloid leukemia

    Science.gov (United States)

    Khan, Maliha; Mansoor, Armaghan-e-Rehman; Kadia, Tapan M

    2017-01-01

    Acute myeloid leukemia (AML) is a markedly heterogeneous hematological malignancy that is most commonly seen in elderly adults. The response to current therapies to AML is quite variable, and very few new drugs have been recently approved for use in AML. This review aims to discuss the issues with current trial design for AML therapies, including trial end points, patient enrollment, cost of drug discovery and patient heterogeneity. We also discuss the future directions in AML therapeutics, including intensification of conventional therapy and new drug delivery mechanisms; targeted agents, including epigenetic therapies, cell cycle regulators, hypomethylating agents and chimeric antigen receptor T-cell therapy; and detail of the possible agents that may be incorporated into the treatment of AML in the future. PMID:27771959

  1. Minor emergency clinic: key to the future of successful hospitals.

    Science.gov (United States)

    Chawla, S; Kathawala, Y; Elmuti, D

    1992-01-01

    This project set out to determine whether there is a relationship between the minor emergency facility an individual uses and their choice of a hospital for in-patient care. In studying this relationship, the factors that are important to persons choosing a clinic or hospital facility, as well as the influence of a physician, were also identified. A structured, undisguised telephone survey was used for interviewing a randomly selected sample population of 189 San Angelo residents. Analysis of the survey data indicated that dependency does exist between minor emergency clinic use and the hospital chosen for in-patient care. The results of this study also suggested that hospitals' marketing strategy should shift the emphasis of their advertising from the hospital itself to their physician association and clinics. In addition, a number of other interesting observations concerning the relative importance of various medical factors to the participants was also explored.

  2. Comprehensive embryo testing. Experts' opinions regarding future directions: an expert panel study on comprehensive embryo testing.

    Science.gov (United States)

    Hens, Kristien; Dondorp, Wybo J; Geraedts, Joep P M; de Wert, Guido M

    2013-05-01

    What do scientists in the field of preimplantation genetic diagnosis (PGD) and preimplantation genetic screening (PGS) consider to be the future direction of comprehensive embryo testing? Although there are many biological and technical limitations, as well as uncertainties regarding the meaning of genetic variation, comprehensive embryo testing will impact the IVF/PGD practice and a timely ethical reflection is needed. Comprehensive testing using microarrays is currently being introduced in the context of PGD and PGS, and it is to be expected that whole-genome sequencing will also follow. Current ethical and empirical sociological research on embryo testing focuses on PGD as it is practiced now. However, empirical research and systematic reflection regarding the impact of comprehensive techniques for embryo testing is missing. In order to understand the potential of this technology and to be able to adequately foresee its implications, we held an expert panel with seven pioneers in PGD. We conducted an expert panel in October 2011 with seven PGD pioneers from Belgium, The Netherlands, Germany and the UK. Participants expected the use of comprehensive techniques in the context of PGD. However, the introduction of these techniques in embryo testing requires timely ethical reflection as it involves a shift from choosing an embryo without a particular genetic disease (i.e. PGD) or most likely to result in a successful pregnancy (i.e. PGS) to choosing the best embryo based on a much wider set of criteria. Such ethical reflection should take account of current technical and biological limitations and also of current uncertainties with regard to the meaning of genetic variance. However, ethicists should also not be afraid to look into the future. There was a general agreement that embryo testing will be increasingly preceded by comprehensive preconception screening, thus enabling smart combinations of genetic testing. The group was composed of seven participants from

  3. Responsiveness of clinical tests for people with neck pain

    DEFF Research Database (Denmark)

    Jørgensen, René; Ris, Inge; Juhl, Carsten

    2017-01-01

    of four clinical tests which are low cost and easy to perform in a clinical setting, including the craniocervical flexion test, cervical active range of movement, test for the cervical extensors and pressure pain threshold testing. METHODS: This study is a secondary analysis of data collected......BACKGROUND: Responsiveness of a clinical test is highly relevant in order to evaluate the effect of a given intervention. However, the responsiveness of clinical tests for people with neck pain has not been adequately evaluated. The objective of the present study was to examine the responsiveness...... in a previously published randomised controlled trial. Participants were randomized to either physical training, exercises and pain education combined or pain education only. Participants were tested on the clinical tests at baseline and at 4-month follow-up. An anchor-based approach using Receiver Operator...

  4. Early diagnosis of Alzheimer's disease. Clinical significance and future perspectives

    International Nuclear Information System (INIS)

    Buerger, K.; Teipel, S.J.; Hampel, H.

    2000-01-01

    Early diagnosis of Alzheimer's disease describes the recognition and diagnosis in patients with very mild dementia. Internationally accepted diagnostic criteria support the diagnosis based on clinical evaluation. Recent advances in structural and functional neuroimaging as well as studies on specific proteins in the cerebro-spinal fluid that are related to distinct pathophysiological disease processes are most promising approaches to defining biological markers of Alzheimer's disease. (orig.) [de

  5. 'Muscle-sparing' statins: preclinical profiles and future clinical use.

    Science.gov (United States)

    Pfefferkorn, Jeffrey A

    2009-03-01

    Coronary heart disease (CHD) is a leading cause of death in the US, and hypercholesterolemia is a key risk factor for this disease. The current standard of care for treating hypercholesterolemia is the use of HMG-CoA reductase inhibitors, also known as statins, which block the rate-limiting step of cholesterol biosynthesis. In widespread clinical use, statins have proven safe and effective for both primary prevention of CHD and secondary prevention of coronary events. Results from several recent clinical trials have demonstrated that increasingly aggressive cholesterol-lowering therapy might offer additional protection against CHD compared with less aggressive treatment standards. While higher doses of current statin therapies are capable of achieving these more aggressive treatment goals, in certain cases statin-induced myalgia, the muscle pain or weakness that sometimes accompanies high-dose statin therapy, limits patient compliance with a treatment regimen. To address this limitation, efforts have been undertaken to develop highly hepatoselective statins that are capable of delivering best-in-class efficacy with minimized risk of dose-limiting myalgia. In this review, the preclinical and early clinical data for these next generation statins are discussed.

  6. Computers in Language Testing: Present Research and Some Future Directions.

    Science.gov (United States)

    Brown, James Dean

    1997-01-01

    Explores recent developments in the use of computers in language testing in four areas: (1) item banking; (2) computer-assisted language testing; (3) computerized-adaptive language testing; and (4) research on the effectiveness of computers in language testing. Examines educational measurement literature in an attempt to forecast the directions…

  7. E3 Testing of Directed Energy Systems: A Challenging Future

    National Research Council Canada - National Science Library

    Brown, Lyndell R

    2009-01-01

    .... Compatibility testing and susceptibility to electromagnetic radiation is required. Standards, such as MIL-STD-464 and MIL-STD-237D, are being revised to include HPM levels and frequencies for E3 tests...

  8. [View of a Laboratory Physician on the Present and Future of Clinical Laboratories].

    Science.gov (United States)

    Matsuo, Shuji

    2014-10-01

    It is meaningful to discuss the "present and future of laboratories" for the development of laboratories and education of medical technologists. Laboratory staff must be able to perform urgent high-quality tests and take part in so-called team-based medicine and should be proud of devising systems that efficiently provide laboratory data for all medical staff. On the other hand, there may be staff with a poor sense of professionalism who work no more than is expected and too readily ask firms and commercial laboratories to solve problems. Overwork caused by providing team-based medicine and a decrease in numbers of clinical chemists are concerns. The following are hoped for in the future. Firstly, laboratory staff will become conscious of their own high-level abilities and expand their areas of work, for example, bioscience, proteomics, and reproductive medicine. Secondly, a consultation system for medical staff and patients will be established. Thirdly, clinical research will be advanced, such as investigating unknown pathophysiologies using laboratory data and samples, and developing new methods of measurement. Lastly, it is of overriding importance that staff of laboratory and educational facilities will cooperate with each other to train the next generation. In conclusion, each laboratory should be appreciated, attractive, positive regarding its contribution to society, and show individuality.

  9. Defibrotide: a review on clinical use and future development.

    Science.gov (United States)

    Larocca, A; Cavallo, F; Magarotto, V; Rossi, D; Patriarca, F; Boccadoro, M; Palumbo, A

    2008-08-01

    Defibrotide is a deoxyribonucleic acid derivative that has been developed for the treatment of different vascular disorders. The authors reviewed the literature to give due representation to the spectrum of pharmacological properties and clinical application of this drug, evaluating consolidate and innovative application. The authors used PubMed from November 1982 to December 2007 and meeting abstracts (form American Society of Hematology Annual Meeting) with updated data as the sources for this review and selecting the most relevant papers when two or more articles covered the same point of interest. Defibrotide has been used effectively in the treatment of endothelial complications of allogeneic stem cell transplantation and recent preclinical evidences suggest an antiangiogenic effect and an anticancer activity. Further in vivo and in vitro investigations are needed.

  10. Learning clinically useful information from images: Past, present and future.

    Science.gov (United States)

    Rueckert, Daniel; Glocker, Ben; Kainz, Bernhard

    2016-10-01

    Over the last decade, research in medical imaging has made significant progress in addressing challenging tasks such as image registration and image segmentation. In particular, the use of model-based approaches has been key in numerous, successful advances in methodology. The advantage of model-based approaches is that they allow the incorporation of prior knowledge acting as a regularisation that favours plausible solutions over implausible ones. More recently, medical imaging has moved away from hand-crafted, and often explicitly designed models towards data-driven, implicit models that are constructed using machine learning techniques. This has led to major improvements in all stages of the medical imaging pipeline, from acquisition and reconstruction to analysis and interpretation. As more and more imaging data is becoming available, e.g., from large population studies, this trend is likely to continue and accelerate. At the same time new developments in machine learning, e.g., deep learning, as well as significant improvements in computing power, e.g., parallelisation on graphics hardware, offer new potential for data-driven, semantic and intelligent medical imaging. This article outlines the work of the BioMedIA group in this area and highlights some of the challenges and opportunities for future work. Copyright © 2016 Elsevier B.V. All rights reserved.

  11. The Future of Clinical Pharmacy: Developing a Holistic Model

    Directory of Open Access Journals (Sweden)

    Patricia A. Shane

    2013-11-01

    Full Text Available This concept paper discusses the untapped promise of often overlooked humanistic skills to advance the practice of pharmacy. It highlights the seminal work that is, increasingly, integrated into medical and nursing education. The work of these educators and the growing empirical evidence that validates the importance of humanistic skills is raising questions for the future of pharmacy education and practice. To potentiate humanistic professional competencies, e.g., compassion, empathy, and emotional intelligence, how do we develop a more holistic model that integrates reflective and affective skills? There are many historical and current transitions in the profession and practice of pharmacy. If our education model is refocused with an emphasis on pharmacy’s therapeutic roots, the field has the opportunity to play a vital role in improving health outcomes and patient-centered care. Beyond the metrics of treatment effects, achieving greater patient-centeredness will require transformations that improve care processes and invest in patients’ experiences of the treatment and care they receive. Is layering on additional science sufficient to yield better health outcomes if we neglect the power of empathic interactions in the healing process?

  12. SPORT AND EXERCISE PHYSIOLOGY TESTING Volume one: Sport Testing Volume two: Exercise and Clinical Testing

    Directory of Open Access Journals (Sweden)

    Edward M. Winter

    2007-03-01

    Full Text Available DESCRIPTION The objective of the book is to discuss the theoretical and practical aspects of physiological testing in exercise and sports which is essential to evaluate and monitor developing exercise performance for athletes and public health, and improving quality of life for patients.A board of leading sport and exercise physiologists and scientists are gathered to discuss physiological assessments that have proven validity and reliability, both in sport and health relevant issues. Incidentally, it updates the reader about the current subjects of physiological exertion testing in both research and clinical procedures. Both volumes individually cover the increasing number of available research and review publications, and theoretical explanations are supported by practical examples. A step-by-step and/or checklist method is used in appropriate sections which make the guides more user-friendly than most. PURPOSE The first volume is designed to help readers develop an understanding of the essential concepts of sport specific testing whereas the second volume aims at making the exercise and clinical specific testing comprehensible, dealing with both technical terms and the theories underlying the importance of these tests. AUDIENCE As Guidelines books of the British Association of Sport and Exercise Sciences, it will be of interest to a wide range of students, researchers and practitioners in the sport and exercise disciplines whether they work in the laboratory or in the field. FEATURES The first volume features immediate practical requirements particularly in sport testing. It is composed of five parts with detailed sub-sections in all of them. The topics of the parts are: i general principles, ii methodological issues, iii general procedures, iv sport specific procedures, v special populations.The second volume is also presented in five parts, again with sub-sections in all of them, but considering the requirements in clinical and exercise

  13. Clinical Applications of CO2 and H2 Breath Test

    Directory of Open Access Journals (Sweden)

    ZHAO Si-qian;CHEN Bao-jun;LUO Zhi-fu

    2016-08-01

    Full Text Available Breath test is non-invasive, high sensitivity and high specificity. In this article, CO2 breath test, H2 breath test and their clinical applications were elaborated. The main applications of CO2 breath test include helicobacter pylori test, liver function detection, gastric emptying test, insulin resistance test, pancreatic exocrine secretion test, etc. H2 breath test can be applied in the diagnosis of lactose malabsorption and detecting small intestinal bacterial overgrowth. With further research, the breath test is expected to be applied in more diseases diagnosis.

  14. Sensitivity and Specificity of Clinical and Laboratory Otolith Function Tests.

    Science.gov (United States)

    Kumar, Lokesh; Thakar, Alok; Thakur, Bhaskar; Sikka, Kapil

    2017-10-01

    To evaluate clinic based and laboratory tests of otolith function for their sensitivity and specificity in demarcating unilateral compensated complete vestibular deficit from normal. Prospective cross-sectional study. Tertiary care hospital vestibular physiology laboratory. Control group-30 healthy adults, 20-45 years age; Case group-15 subjects post vestibular shwannoma excision or post-labyrinthectomy with compensated unilateral complete audio-vestibular loss. Otolith function evaluation by precise clinical testing (head tilt test-HTT; subjective visual vertical-SVV) and laboratory testing (headroll-eye counterroll-HR-ECR; vesibular evoked myogenic potentials-cVEMP). Sensitivity and specificity of clinical and laboratory tests in differentiating case and control subjects. Measurable test results were universally obtained with clinical otolith tests (SVV; HTT) but not with laboratory tests. The HR-ECR test did not indicate any definitive wave forms in 10% controls and 26% cases. cVEMP responses were absent in 10% controls.HTT test with normative cutoff at 2 degrees deviations from vertical noted as 93.33% sensitive and 100% specific. SVV test with normative cutoff at 1.3 degrees noted as 100% sensitive and 100% specific. Laboratory tests demonstrated poorer specificities owing primarily to significant unresponsiveness in normal controls. Clinical otolith function tests, if conducted with precision, demonstrate greater ability than laboratory testing in discriminating normal controls from cases with unilateral complete compensated vestibular dysfunction.

  15. Clinical proteomics: Current status, challenges, and future perspectives

    Directory of Open Access Journals (Sweden)

    Shyh-Horng Chiou

    2011-01-01

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

  16. Nonlinearity and intraday efficiency tests on energy futures markets

    International Nuclear Information System (INIS)

    Wang, Tao; Yang, Jian

    2010-01-01

    Using high frequency data, this paper first time comprehensively examines the intraday efficiency of four major energy (crude oil, heating oil, gasoline, natural gas) futures markets. In contrast to earlier studies which focus on in-sample evidence and assume linearity, the paper employs various nonlinear models and several model evaluation criteria to examine market efficiency in an out-of-sample forecasting context. Overall, there is evidence for intraday market inefficiency of two of the four energy future markets (heating oil and natural gas), which exists particularly during the bull market condition but not during the bear market condition. The evidence is also robust against the data-snooping bias and the model overfitting problem, and its economic significance can be very substantial. (author)

  17. Nonlinearity and intraday efficiency tests on energy futures markets

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Tao [Department of Economics, Queens College and the Graduate Center, The City University of New York, Flushing, NY 11367 (United States); Yang, Jian [The Business School, PO Box 173364, University of Colorado Denver, Denver, CO 80217-3364 (United States)

    2010-03-15

    Using high frequency data, this paper first time comprehensively examines the intraday efficiency of four major energy (crude oil, heating oil, gasoline, natural gas) futures markets. In contrast to earlier studies which focus on in-sample evidence and assume linearity, the paper employs various nonlinear models and several model evaluation criteria to examine market efficiency in an out-of-sample forecasting context. Overall, there is evidence for intraday market inefficiency of two of the four energy future markets (heating oil and natural gas), which exists particularly during the bull market condition but not during the bear market condition. The evidence is also robust against the data-snooping bias and the model overfitting problem, and its economic significance can be very substantial. (author)

  18. Broad support for regulating the clinical implementation of future reproductive techniques.

    Science.gov (United States)

    Hendriks, S; Vliegenthart, R; Repping, S; Dancet, E A F

    2018-01-01

    Do gynaecologists, infertile patients and the general public, consider that regulation of the clinical implementation of stem cell-based fertility treatments is required? There is broad support from gynaecologists, patients and the general public for regulating the clinical implementation of future stem cell-based fertility treatments. There is debate on the need to regulate the clinical implementation of novel techniques. Regulation may hinder their swift adoption and delay benefits for patients, but may prevent the implementation of ineffective or harmful techniques. Stem cell-based fertility treatments, which involve creating oocytes or spermatozoa by manipulating stem cells, are likely to be implemented in clinical practice in the near future and will probably impact future generations as well as the current one. A cross-sectional survey was conducted among gynaecologists working in fertility clinics (n = 179), patients with severe infertility (n = 348) and a representative sample of the general public (n = 1250). The questionnaire was disseminated in the Netherlands in the winter of 2015-2016. The newly developed questionnaire was reviewed by experts and tested among the general public. The questionnaire assessed whether participants wanted each of nine potential negative consequences of the clinical implementation of stem cell-based fertility treatments to be regulated. In addition, the importance of all negative and positive potential consequences, the appropriate regulatory body and its need to consult with advisors from various backgrounds was questioned. In total, 958 respondents completed the questionnaire (response rate: 54%). A large majority of each participant group (>85%) wanted regulation, for at least one potential negative consequence of the clinical implementation of stem cell-based fertility treatments. The majority of all participant groups wanted regulation for serious health risks for intended parents, serious health risks for children and

  19. The Future of World Englishes in Language Testing

    Science.gov (United States)

    Brown, James Dean

    2014-01-01

    This article begins by defining "world Englishes" (WEs) and the related paradigm of inner-, outer-, and expanding-circle English(es). The discussion then turns to the central concerns of the WEs and language testing (LT) communities with regard to how English tests can best be constructed to include various WEs by discussing (a) what…

  20. Nuclear medicine imaging in clinical practice: Current applications and future trends

    International Nuclear Information System (INIS)

    Galli, G.; Maini, C.L.

    1985-01-01

    The following conclusions can be drawn: 1) Even though developments in data digitalization enable also other imaging techniques to extract functional information, it is likely that nuclear medicine will keep and possibly increase its key role for functional studies requiring quantitative data analyses. This statement is true at present and it will probably remain true for a long time to come. 2) Nuclear medicine is and will remain an important clinical tool also for morphological or morphodynamic studies in selected situations. Of course the integration of nuclear medicine studies with other diagnostic procedures is highly desirable. The highest clinical yield of multi-test diagnostic protocols will be anyway obtained by the wisest physician as sophysticated technology is no substitution for intelligent clinical judgment. 3) The development of new radiopharmaceuticals with well characterized biokinetic features allowing precise tissue characterization opens new frontiers to be exploited by nuclear medicine centers equipped with conventional technology (digital gammacameras, SPECT). 4) Positron emission tomography is the most important new development of nuclear medicine imaging. Not only PET has already shown its enormous possibilities for physiological and pathophysiological studies, but the clinical relevance of selected applications has been proved. More experience is however needed to assess systematically the whole impact of PET studies in clinical practice and to perform dependable cost/benefit studies. 5) Among all other imaging techniques NMR is the closest to nuclear medicine because of a strict ''compatibility of aptitudes, training and methodology'' (4). Accordingly future improvements of both methods will be better achieved if they could be integrated and the results compared with the same institutions

  1. Vehicle Armor Structure and Testing for Future Combat System

    Science.gov (United States)

    2013-06-03

    D6641 measures the in-plane compressive strength, compressive modulus and in-plane Poisson ratio of fiber reinforced polymer matrix composite...compressive strength, compressive modulus, and in-plane Poisson ratio of fiber reinforced polymer matrix composite materials. In this test, one...compressive modulus and in-plane Poisson ratio of fiber reinforced polymer matrix composite materials. In this test, one fiber orientation is vertical

  2. Testing the Copernican principle with future radio-astronomy observations

    OpenAIRE

    Bester, Hertzog L.; Larena, Julien; Bishop, Nigel T.

    2017-01-01

    We use a direct observational approach to investigate the possibility of testing the Copernican principle with data from upcoming radio surveys. In particular we illustrate the importance of measuring derivatives transverse to the past light-cone when prior knowledge of the value of the cosmological constant is not available.

  3. The future of hospital laboratories. Position statement from the Royal Belgian Society of Clinical Chemistry (RBSCC).

    Science.gov (United States)

    Langlois, Michel R; Wallemacq, Pierre

    2009-01-01

    To face the economic pressures arising from the current socio-economic conjuncture, hospital laboratories are endangered by an increasing trend towards the outsourcing of clinical laboratory tests to external (mega-) laboratories. This should allow hospitals to meet their economic requirements, but with an increased risk of loss of medical quality and, mid- to long-term, loss of cost effectiveness of healthcare at the national level. To anticipate current developments (economical and technological) that inevitably will affect the future of laboratory medicine, hospital laboratories should be proactive and enhance efficiency, reduce costs by consolidation, integrate into regional networks, and form alliances or partnerships. To create additional value, the core competency of laboratory professionals must be refocused to provide medical knowledge services (consultative support to clinicians) related to in vitro diagnostic testing. To integrate cost-efficiency with medical quality, implementation of a matricial organization - operational vs. biomedical level - could be an interesting approach. This integrated structure should create total quality of laboratory testing, managing the entire medical diagnostic cycle from the pre-preanalytical to post-postanalytical phase.

  4. Achievements and Future Plans of CLIC Test Facilities

    CERN Document Server

    Braun, Hans Heinrich

    2001-01-01

    CTF2 was originally designed to demonstrate the feasibility of two-beam acceleration with high current drive beams and a string of 30 GHz CLIC accelerating structure prototypes (CAS). This goal was achieved in 1999 and the facility has since been modified to focus on high gradient testing of CAS's and 30 GHz single cell cavities (SCC). With these modifications, it is now possible to provide 30 GHz RF pulses of more than 150 MW and an adjustable pulselength from 3 to 15 ns. While the SCC results are promising, the testing of CAS's revealed problems of RF breakdown and related surface damage. As a consequence, a new R&D program has been launched to advance the understanding of RF breakdown processes, to improve surface properties, investigate new materials and to optimise the structure geometries of the CAS's. In parallel the construction of a new facility named CTF3 has started. CTF3 will mainly serve two purposes. The first is the demonstration of the CLIC drive beam generation scheme. CTF3 will acceler-a...

  5. 15N liver function tests - concept, validity, clinical use

    International Nuclear Information System (INIS)

    Faust, H.; Jung, K.; Krumbiegel, P.; Hirschberg, K.; Reinhardt, R.; Junghans, P.

    1987-01-01

    Several liver function tests using the oral application of a nitrogen compound labelled with 15 N and the subsequent determination of 15 N in a certain fraction of urine by emission spectrometry are described. Because of the key position of the liver in the metabolism of nitrogen compounds the results of these tests allow conclusions concerning disturbances of special liver functions. Instructions for the clinical use of the '[ 15 N]Ammonium Test', '[ 15 N]Hippurate Test' the '[ 15 N]Methacetin Test', and the '[ 15 N]Glycine Test' are given. (author)

  6. Functional toxicology: tools to advance the future of toxicity testing

    Science.gov (United States)

    Gaytán, Brandon D.; Vulpe, Chris D.

    2014-01-01

    The increased presence of chemical contaminants in the environment is an undeniable concern to human health and ecosystems. Historically, by relying heavily upon costly and laborious animal-based toxicity assays, the field of toxicology has often neglected examinations of the cellular and molecular mechanisms of toxicity for the majority of compounds—information that, if available, would strengthen risk assessment analyses. Functional toxicology, where cells or organisms with gene deletions or depleted proteins are used to assess genetic requirements for chemical tolerance, can advance the field of toxicity testing by contributing data regarding chemical mechanisms of toxicity. Functional toxicology can be accomplished using available genetic tools in yeasts, other fungi and bacteria, and eukaryotes of increased complexity, including zebrafish, fruit flies, rodents, and human cell lines. Underscored is the value of using less complex systems such as yeasts to direct further studies in more complex systems such as human cell lines. Functional techniques can yield (1) novel insights into chemical toxicity; (2) pathways and mechanisms deserving of further study; and (3) candidate human toxicant susceptibility or resistance genes. PMID:24847352

  7. Ethical and social implications of microdosing clinical trial (2). The draft guidance and the future tasks

    International Nuclear Information System (INIS)

    Kurihara, Chieko

    2008-01-01

    Draft of the guidance (GD) for conducting the trial in the title (MCT) was officially announced by Ministry of Health, Labour and Welfare (MHLW) in Dec., 2007, but where the trial part alone was described without the research purposes involved in the starting idea of MCT. The authority invited opinions on the draft until Feb., 2008. This paper describes the detailed content of GD draft and discusses problems in future. GD draft contains: basic concept, range of non-clinical studies necessary for beginning MCT, methods to decide the maximal dose, concept for internal exposure of volunteers when radio-labeled compound is to be administered (for methods by accelerator mass spectrometry (AMS) and positron emission tomography (PET)), quality assurance of the test compound, other notices, and references. The last item contains outlines of concerned laws and regulations (e.g., The Law Concerning Prevention from Radiation Hazards due to Radioisotopes, Etc. and Medical Law); nuclides for AMS (mainly, 14 C) (manufacturing and transporting the test compound containing 14 C, its distribution from MCT client to hospitals, handling in the hospital, and transporting of samples from hospital to AMS facility); and nuclides for PET. Public opinions collected by MHLW will decide the directions hereafter of GD, i.e. the omitted research purposes are additionally incorporated in the present GD draft or are independently described in another newer GD. (R.T.)

  8. Investigators' viewpoint of clinical trials in India: Past, present and future

    Directory of Open Access Journals (Sweden)

    Mohandas K Mallath

    2017-01-01

    Full Text Available India's success in producing food and milk for its population (Green Revolution and White Revolution happened because of scientific research and field trials. Likewise improving the health of Indians needs clinical research and clinical trials. A Large proportion of the sick Indians are poor, illiterate with no access to good health care. They are highly vulnerable to inducement and exploitation in clinical trials. The past two decades saw the rise and fall of clinical trials in India. The rise happened when our regulators created a favorable environment, and Indian investigators were invited to participate in global clinical trials. The gap between the demand and supply resulted in inadequate protection of the trial participants. Reports of abuses of the vulnerable trial participants followed by public interest litigations led to strengthening of regulations by the regulators. The stringent new regulations made the conduct of clinical trials more laborious and increased the cost of clinical trials in India. There was a loss of interest in sponsored clinical trials resulting in the fall in global clinical trials in India. Following repeated appeals by the investigators, the Indian regulators have recently relaxed some of the stringent regulations, while continuing to ensure the adequate patient protection. Clinical trials that are relevant to our population and conducted by well-trained investigators and monitored by trained and registered Ethics Committees will increase in the future. We must remain vigilant, avoid previous mistakes, and strive hard to protect the trial participants in the future trials.

  9. Immunoliposomes in clinical oncology: State of the art and future perspectives.

    Science.gov (United States)

    Merino, María; Zalba, Sara; Garrido, María J

    2018-04-10

    Liposomal formulations entrapping a vast number of molecules have improved cancer therapies overcoming certain pharmacokinetic (PK) and pharmacodynamic limitations, many of which are associated with tumor characteristics. In this context, immunoliposomes represent a new strategy that has been widely investigated in preclinical cancer models with promising results, although few have reached the stage of clinical trials. This contrasts with the emerging clinical application of monoclonal antibodies (mAbs). This formulation allows the conjugation of different mAbs or antibody derivatives, such as monovalent variable fragments Fab', to the polymers covering the surface of liposomes. The combination of this targeting strategy together with drug encapsulation in a single formulation may contribute to enhance the efficacy of these associated agents, reducing their toxicities. In this paper we will consider how factors such as particle size, lipid composition and charge, lipid-polymer conjugation, method of production and type of ligand for liposome coupling influence the efficacy of these formulations. Furthermore, the high inter-individual variability in the tumor microenvironment, as well as the poor experimental designs for the PK characterization of liposomes, make the establishment of the relationship between plasma or tumor concentrations and efficacy difficult. Thus, adequate dosing regimens and patient stratification regarding the target expression may contribute to enhance the possibility of incorporating these immunoliposomes into the therapeutic arsenal for cancer treatments. All these issues will be briefly dealt with here, together with a section showing the state of the art of those targeted liposomes that are coming up for testing in clinical trials. Finally, some insights into future developments such as the combination of specificity and controlled release, based on the application of different stimuli, for the manipulation of stability and cargo release

  10. Interference by pralidoxime (PAM) salts in clinical laboratory tests.

    Science.gov (United States)

    Nagase, Sumika; Kohguchi, Katsunori; Tohyama, Kaoru; Watanabe, Mikio; Iwatani, Yoshinori

    2013-02-01

    Drugs sometimes alter the results of clinical laboratory tests. We examined the effects of pralidoxime (PAM) salts, a medicine used to treat organophosphorus poisoning, on clinical laboratory test results for the first time. The effects of PAM salts on glucose (GLU) measurements were examined using a point-of-care testing (POCT) meter, four self-monitoring of blood glucose (SMBG) meters, and two biochemical autoanalyzers. The effects of PAM salts on other clinical tests were also evaluated. The addition of PAM iodide or potassium iodide, but not of PAM chloride or potassium chloride, to blood samples increased the GLU values measured by one POCT meter and 4 SMBG meters using the enzyme electrode (hydrogen peroxidase or oxygen electrode) method. On the other hand, PAM iodide or PAM chloride, but not KI or KCl, affected the values measured at 340 nm by an autoanalyzer using absorption spectrophotometry in 8 of 14 clinical laboratory tests. The absorption spectrum of PAM changed from 294 to 338 nm due to the reaction between PAM and the alkaline buffer, a component of the measuring reagents. PAM iodide increases the GLU values measured by the enzyme electrode method, and PAM salts affected the values measured at 340 nm by absorption spectrophotometry in many other clinical test items. Copyright © 2012 Elsevier B.V. All rights reserved.

  11. THE CAUSALITY TEST BETWEEN THE VARIANCES OF SPOT AND FUTURE MARKET PRICES

    Directory of Open Access Journals (Sweden)

    EMRAH İSMAİL ÇEVİK

    2013-06-01

    Full Text Available Volatility in financial markets urges importance of risk management with respect to investors and especially firms. Information and interaction between spot and futures markets plays an important role on formation of market prices. In this study, causality and information flows are examined on spot and futures prices of ISE 100 Index, US Dollar, and Euro which are traded at Turkish Derivatives Exchange (VOB. Dynamic causality test that is originally created by Cheung and Ng (1996 is applied. Dynamic causality test results show that in the ISE 100 Index model spot prices affect futures prices and in the exchange model futures prices affect spot prices.

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

    Directory of Open Access Journals (Sweden)

    Shi Chen, MD

    2016-12-01

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

  13. Validation of a clinical critical thinking skills test in nursing

    OpenAIRE

    Shin, Sujin; Jung, Dukyoo; Kim, Sungeun

    2015-01-01

    Purpose: The purpose of this study was to develop a revised version of the clinical critical thinking skills test (CCTS) and to subsequently validate its performance. Methods: This study is a secondary analysis of the CCTS. Data were obtained from a convenience sample of 284 college students in June 2011. Thirty items were analyzed using item response theory and test reliability was assessed. Test-retest reliability was measured using the results of 20 nursing college and graduate school stud...

  14. Design necessities for future teleradiology systems. Conclusions from the Medicus-2 field test

    International Nuclear Information System (INIS)

    Bahner, M.L.; Engelmann, U.; Meinzer, H.P.; Kaick, G. van

    1997-01-01

    During the Medicus field test we gained experience using the teleradiology system for almost daily teleconferences between a radiology department and clinics for internal medicine, urology, and gynecology. The existing system has a high degree of functionality. The full 12-bit data format is available using the DICOM protocol. A data security concept is implemented, ensuring data integrity, privacy and authentication of communication partners. This concept covers the areas of organization, technique, user training, and software implementation. A future system should be a general purpose radiology workstation covering viewing functionality, image manipulation, and digital archive access. Dedicated teleradiology features have to be a part. Specialized evaluation software, e.g. for dynamic MRI, should be integratable in a modular way. For data exchange with other systems and for the synchronization of teleconference sessions, the protocols should be independent of the network standard used (ISDN, Ethernet, ATM) and based on the DICOM protocol. Extensions of the existing standard are therefore necessary. Besides future technical developments, reimbursement for teleradiology must be accomplished. (orig.) [de

  15. Clinical Laboratory Tests in Some Acute Exogenous Poisonings.

    Science.gov (United States)

    Tufkova, Stoilka G; Yankov, Ivan V; Paskaleva, Diana A

    2017-09-01

    There is no specific toxicological screening of clinical laboratory parameters in clinical toxicology when it comes to acute exogenous poisoning. To determine routine clinical laboratory parameters and indicators for assessment of vital functions in patients with acute intoxications. One hundred and fifty-three patients were included in the present study. They were hospitalized in the Department of Clinical Toxicology at St. George University Hospital, Plovdiv for cerebral toxicity inducing medication (n = 45), alcohol (n = 40), heroin abuse (n = 33). The controls were 35. The laboratory tests were conducted in compliance with the standards of the clinical laboratory. We used the following statistical analyses: analysis of variance (the ucriterion of normal distribution, the Student's t-test, dispersion analysis based on ANOVA) and non-parametric analysis. Based on the routine hematological parameters with statistically significant changes in three groups of poisoning are: red blood cells, hematocrit, hemoglobin (except alcohol intoxication) and leukocytes. We found statistically significant changes in serum total protein, sodium and bilirubin. The highest statistical significance is the increased activity of AST and ALT. We present a model for selection of clinical laboratory tests for severe acute poisoning with modern equipment under standardized conditions. The results of the study suggest that the clinical laboratory constellation we used can be used as a mandatory element in the diagnosis of moderate and severe intoxication with the mentioned toxic substances.

  16. The value of a registry negative urine pregnancy test for the prediction of a future unintended pregnancy among young women.

    Science.gov (United States)

    Rottenstreich, Misgav; Grisaru-Granovsky, Sorina; Rottenstreich, Amihai

    2018-05-15

    Performance of urine pregnancy test in general adolescents' clinic reflects caregiver or woman's concern that there might be a pregnancy. We aimed to assess whether young-unmarried women in whom a negative urine pregnancy test was registered would be at increased risk of a future unintended pregnancy. The study cohort included consecutive women drafted by the Israeli military between 2013 and 2015. The risk of unintended pregnancy was compared between women with a negative urine pregnancy test (n = 2774), the study group, and those in whom urine pregnancy test was not carried out (n = 126,659), the control group. During the study period, 2147 (1.7%) women experienced an unintended pregnancy. The risk of unintended pregnancy was significantly higher in patients in whom a past pregnancy test was negative 4.3% (n = 118), as compared with the control group 1.6% (n = 2028) (odds ratio [OR], 2.7; 95% confidence interval [CI], 2.23-3.26). In multivariate analysis history of a negative pregnancy test results was an independent predictor for a future unintended pregnancy (adjusted OR, 2.0; 95% CI, 1.63-2.52). A history of a negative pregnancy test among young conscripted women is a significant risk indicator for a future unintended pregnancy. Directed efforts should be made in this particular vulnerable group of patients.

  17. Erythema-index of clinical patch test reactions

    DEFF Research Database (Denmark)

    Jemec, G B; Johansen, J D

    1995-01-01

    that the method could be used for the grading of eczematous reactions in a clinical setting as well. OBJECTIVE: To assess the usefulness of the erythema index for the quantification of eczematous reactions using the Derma-Spectrometer (Cortex technology, Hadsund, Denmark) in a clinical setting. METHOD......: The erythema index of 56 patch test reactions ranging from +? to +++, was compared to regional controls and negative patch tests (189). The effects of intrumental application pressure was studied in 5 volunteers. Statistical analysis was carried out using Mann-Whitney and Jonckheere-Terpstra tests. RESULTS......: The erythema-index was significantly higher in all degrees of patch test reactions than in uninvolved regional skin or negative patch tests. It also showed a significant positive trend for higher values in +, ++ and +++ reactions (P

  18. Clinical Leaders for the Future: Evaluation of the Early Clinical Careers Fellowship Pilot Programme

    OpenAIRE

    Pearson, Pauline; Machin, Alison; Rae, Anne

    2010-01-01

    The aim of this study was to systematically evaluate key features (contexts), activities (mechanisms) and outcomes of the Early Clinical Career Fellowships Pilot. In Scotland and across the United Kingdom (UK) the number of nurses likely to retire is set to double between 2005 and 2015 - equivalent to a quarter of all nurses. There is a need to build leadership capacity within the existing workforce in order to maintain the quality of service provision.

  19. An oracle: antituberculosis pharmacokinetics-pharmacodynamics, clinical correlation, and clinical trial simulations to predict the future.

    Science.gov (United States)

    Pasipanodya, Jotam; Gumbo, Tawanda

    2011-01-01

    Antimicrobial pharmacokinetic-pharmacodynamic (PK/PD) science and clinical trial simulations have not been adequately applied to the design of doses and dose schedules of antituberculosis regimens because many researchers are skeptical about their clinical applicability. We compared findings of preclinical PK/PD studies of current first-line antituberculosis drugs to findings from several clinical publications that included microbiologic outcome and pharmacokinetic data or had a dose-scheduling design. Without exception, the antimicrobial PK/PD parameters linked to optimal effect were similar in preclinical models and in tuberculosis patients. Thus, exposure-effect relationships derived in the preclinical models can be used in the design of optimal antituberculosis doses, by incorporating population pharmacokinetics of the drugs and MIC distributions in Monte Carlo simulations. When this has been performed, doses and dose schedules of rifampin, isoniazid, pyrazinamide, and moxifloxacin with the potential to shorten antituberculosis therapy have been identified. In addition, different susceptibility breakpoints than those in current use have been identified. These steps outline a more rational approach than that of current methods for designing regimens and predicting outcome so that both new and older antituberculosis agents can shorten therapy duration.

  20. The clinical testing of male gonad shields. Technical report

    International Nuclear Information System (INIS)

    Church, W.W.; Burnett, B.M.

    1975-11-01

    Two types of male gonad shields, designed for use with support garments, were tested in a number of hospitals and clinics throughout the United States. The clinical evaluation consisted of: (1) measuring dose reduction with thermoluminescent dosimeters; and (2) determining acceptability of the shields for routine use in x-ray facilities, through the use of survey forms completed by patients, technologists, and facilities. The shields proved to provide a basis for a very satisfactory male gonad shield program

  1. The clinical testing of male gonad shields. Technical report

    Energy Technology Data Exchange (ETDEWEB)

    Church, W.W.; Burnett, B.M.

    1975-11-01

    Two types of male gonad shields, designed for use with support garments, were tested in a number of hospitals and clinics throughout the United States. The clinical evaluation consisted of: (1) measuring dose reduction with thermoluminescent dosimeters; and (2) determining acceptability of the shields for routine use in x-ray facilities, through the use of survey forms completed by patients, technologists, and facilities. The shields proved to provide a basis for a very satisfactory male gonad shield program. (GRA)

  2. Platelet function testing: methods of assessment and clinical utility.

    LENUS (Irish Health Repository)

    Mylotte, Darren

    2012-02-01

    Platelets play a central role in the regulation of both thrombosis and haemostasis yet tests of platelet function have, until recently, been exclusively used in the diagnosis and management of bleeding disorders. Recent advances have demonstrated the clinical utility of platelet function testing in patients with cardiovascular disease. The ex vivo measurement of response to antiplatelet therapies (aspirin and clopidogrel), by an ever-increasing array of platelet function tests, is with some assays, predictive of adverse clinical events and thus, represents an emerging area of interest for both the clinician and basic scientist. This review article will describe the advantages and disadvantages of the currently available methods of measuring platelet function and discuss both the limitations and emerging data supporting the role of platelet function studies in clinical practice.

  3. Platelet function testing: methods of assessment and clinical utility.

    LENUS (Irish Health Repository)

    Mylotte, Darren

    2011-01-01

    Platelets play a central role in the regulation of both thrombosis and haemostasis yet tests of platelet function have, until recently, been exclusively used in the diagnosis and management of bleeding disorders. Recent advances have demonstrated the clinical utility of platelet function testing in patients with cardiovascular disease. The ex vivo measurement of response to antiplatelet therapies (aspirin and clopidogrel), by an ever-increasing array of platelet function tests, is with some assays, predictive of adverse clinical events and thus, represents an emerging area of interest for both the clinician and basic scientist. This review article will describe the advantages and disadvantages of the currently available methods of measuring platelet function and discuss both the limitations and emerging data supporting the role of platelet function studies in clinical practice.

  4. SMART drug delivery systems: Back to the future vs. clinical reality

    NARCIS (Netherlands)

    Lammers, Twan Gerardus Gertudis Maria

    2013-01-01

    Recent advances in nanotechnology and material science have re-ignited interest in drug delivery research. Arguably, however, hardly any of the systems developed and strategies proposed are really relevant for shaping the future (clinical) face of the nanomedicine field. Consequently, as outlined in

  5. Evaluating the Navy’s Enlisted Accessions Testing Program Based on Future Talent Needs

    Science.gov (United States)

    2017-03-01

    NAVY’S ENLISTED ACCESSIONS TESTING PROGRAM BASED ON FUTURE TALENT NEEDS by Shereka F. Riley March 2017 Thesis Advisor: Joseph Sullivan Co...REPORT TYPE AND DATES COVERED Master’s thesis 4. TITLE AND SUBTITLE EVALUATING THE NAVY’S ENLISTED ACCESSIONS TESTING PROGRAM BASED ON FUTURE TALENT ...public release. Distribution is unlimited. 12b. DISTRIBUTION CODE 13. ABSTRACT (maximum 200 words) In recent years, non-defense related industries

  6. Clinical Functional Capacity Testing in Patients With Facioscapulohumeral Muscular Dystrophy: Construct Validity and Interrater Reliability of Antigravity Tests.

    Science.gov (United States)

    Rijken, Noortje H; van Engelen, Baziel G; Weerdesteyn, Vivian; Geurts, Alexander C

    2015-12-01

    To evaluate the construct validity and interrater reliability of 4 simple antigravity tests in a small group of patients with facioscapulohumeral muscular dystrophy (FSHD). Case-control study. University medical center. Patients with various severity levels of FSHD (n=9) and healthy control subjects (n=10) were included (N=19). Not applicable. A 4-point ordinal scale was designed to grade performance on the following 4 antigravity tests: sit to stance, stance to sit, step up, and step down. In addition, the 6-minute walk test, 10-m walking test, Berg Balance Scale, and timed Up and Go test were administered as conventional tests. Construct validity was determined by linear regression analysis using the Clinical Severity Score (CSS) as the dependent variable. Interrater agreement was tested using a κ analysis. Patients with FSHD performed worse on all 4 antigravity tests compared with the controls. Stronger correlations were found within than between test categories (antigravity vs conventional). The antigravity tests revealed the highest explained variance with regard to the CSS (R(2)=.86, P=.014). Interrater agreement was generally good. The results of this exploratory study support the construct validity and interrater reliability of the proposed antigravity tests for the assessment of functional capacity in patients with FSHD taking into account the use of compensatory strategies. Future research should further validate these results in a larger sample of patients with FSHD. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2016-05-01

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

  9. Errors in the Total Testing Process in the Clinical Chemistry ...

    African Journals Online (AJOL)

    2018-03-01

    Mar 1, 2018 ... testing processes impair the clinical decision-making process. Such errors are ... and external quality control exceeding the target range, (14.4%) and (51.4%) .... version 3.5.3 and transferred to Statistical. Package for the ...

  10. ANTIFUNGAL SUSCEPTIBILITY TESTING: CURRENT ROLE FROM THE CLINICAL LABORATORY PERSPECTIVE

    Directory of Open Access Journals (Sweden)

    Brunella Posteraro

    2014-04-01

    Full Text Available Despite availability of many antifungal agents, antifungal clinical resistance occurs, perhaps as a result of an infecting organism found to be resistant in vitro to one or more antifungals tested. Thus, antifungal susceptibility testing (AFST results, if timely generated by the clinical microbiology and communicated to clinicians, can aid them in the therapeutic decision making, especially for difficult-to-treat invasive candidiasis and aspergillosis. Although recently refined AFST methods are commercially available to allow a close antifungal resistance surveillance in many clinical setting, novel assays, relying on short-time antifungal drug exposure of fungal isolates, are upcoming tools for AFST. Based on emerging technologies such as flow cytometry, MALDI-TOF mass spectrometry, and isothermal microcalorimetry, these assays could provide a reliable means for quicker and sensitive assessment of AFST.

  11. The Stice model of overeating: Tests in clinical and non-clinical samples

    NARCIS (Netherlands)

    Strien, T. van; Engels, R.C.M.E.; Leeuwe, J.F.J. van; Snoek, H.M.

    2005-01-01

    The present study tested the dual pathway model of Stice [Stice, E (1994). A review of the evidence for a sociocultural model of bulimia nervosa and an exploration of the mechanisms of action. Clinical Psychology Review, 14, 633-661 and Stice, E. (2001). A prospective test of the dual-pathway model

  12. Platelet Function Tests: Preanalytical Variables, Clinical Utility, Advantages, and Disadvantages.

    Science.gov (United States)

    Hvas, Anne-Mette; Grove, Erik Lerkevang

    2017-01-01

    Platelet function tests are mainly used in the diagnostic work-up of platelet disorders. During the last decade, the additional use of platelet function tests to evaluate the effect of antiplatelet therapy has also emerged in an attempt to identify patients with an increased risk of arterial thrombosis. Furthermore, platelet function tests are increasingly used to measure residual effect of antiplatelet therapy prior to surgery with the aim of reducing the risk of bleeding. To a limited extend, platelet function tests are also used to evaluate hyperaggregability as a potential marker of a prothrombotic state outside the setting of antiplatelet therapy. This multifaceted use of platelet function tests and the development of simpler point-of-care tests with narrower application have increased the use of platelet function testing and also facilitated the use of platelet function tests outside the highly specialized laboratories. The present chapter describes the preanalytical variables, which should be taken into account when planning platelet function testing. Also, the most widely used platelet function tests are introduced, and their clinical utility and their relative advantages and disadvantages are discussed.

  13. TH-AB-206-02: Nuclear Medicine Theronostics: Wave of the Future; Pre-Clinical and Clinical Opportunities

    International Nuclear Information System (INIS)

    Delpassand, E.

    2016-01-01

    In the past few decades, the field of nuclear medicine has made long strides with the continued advancement of related sciences and engineering and the availability of diagnostic and therapeutic radionuclides. Leveraging these advancements while combining the advantages of therapeutic and diagnostic radionuclides into one radiopharmaceutical has also created a new subfield “theranostics” in nuclear medicine that has the potential to further propel the field into the future. This session is composed of two talks; one focused on the physics principles of theranostics from properties of beta and alpha emitting radionuclides to dosimetric models and quantification; while the second describes preclinical and clinical applications of theranostics and discusses the challenges and opportunities of bringing them to the clinic. At the end of the session the listener should be able to identify: The different properties of beta and alpha emitting radionuclides Which radionuclides are selected for which nuclear medicine therapies and why How PET can be used to accurately quantify the uptake of tumor targeting molecules How individualized dosimetry can be performed from the management of thyroid cancer to novel radiolabeled antibody therapies Promising pre-clinical radiopharmaceutical pairs in prostate cancer and melanoma. Promising clinical Theranostics in neuroendocrine cancers. Challenges of bringing Theranostics to the clinic. E. Delpassand, RITA Foundation -Houston; SBIR Grant; CEO and share holder of RadioMedix.

  14. TH-AB-206-02: Nuclear Medicine Theronostics: Wave of the Future; Pre-Clinical and Clinical Opportunities

    Energy Technology Data Exchange (ETDEWEB)

    Delpassand, E. [Excel Diagnostic & Nuclear Oncology Center, Houston, TX (United States)

    2016-06-15

    In the past few decades, the field of nuclear medicine has made long strides with the continued advancement of related sciences and engineering and the availability of diagnostic and therapeutic radionuclides. Leveraging these advancements while combining the advantages of therapeutic and diagnostic radionuclides into one radiopharmaceutical has also created a new subfield “theranostics” in nuclear medicine that has the potential to further propel the field into the future. This session is composed of two talks; one focused on the physics principles of theranostics from properties of beta and alpha emitting radionuclides to dosimetric models and quantification; while the second describes preclinical and clinical applications of theranostics and discusses the challenges and opportunities of bringing them to the clinic. At the end of the session the listener should be able to identify: The different properties of beta and alpha emitting radionuclides Which radionuclides are selected for which nuclear medicine therapies and why How PET can be used to accurately quantify the uptake of tumor targeting molecules How individualized dosimetry can be performed from the management of thyroid cancer to novel radiolabeled antibody therapies Promising pre-clinical radiopharmaceutical pairs in prostate cancer and melanoma. Promising clinical Theranostics in neuroendocrine cancers. Challenges of bringing Theranostics to the clinic. E. Delpassand, RITA Foundation -Houston; SBIR Grant; CEO and share holder of RadioMedix.

  15. UNMASKING MASKED HYPERTENSION: PREVALENCE, CLINICAL IMPLICATIONS, DIAGNOSIS, CORRELATES, AND FUTURE DIRECTIONS

    Science.gov (United States)

    Peacock, James; Diaz, Keith M.; Viera, Anthony J.; Schwartz, Joseph E.; Shimbo, Daichi

    2014-01-01

    ‘Masked hypertension’ is defined as having non-elevated clinic blood pressure (BP) with elevated out-of-clinic average BP, typically determined by ambulatory BP monitoring. Approximately 15–30% of adults with non-elevated clinic BP have masked hypertension. Masked hypertension is associated with increased risks of cardiovascular morbidity and mortality compared to sustained normotension (non-elevated clinic and ambulatory BP), which is similar to or approaching the risk associated with sustained hypertension (elevated clinic and ambulatory BP). The confluence of increased cardiovascular risk and a failure to be diagnosed by the conventional approach of clinic BP measurement makes masked hypertension a significant public health concern. However, many important questions remain. First, the definition of masked hypertension varies across studies. Further, the best approach in the clinical setting to exclude masked hypertension also remains unknown. It is unclear whether home BP monitoring is an adequate substitute for ambulatory BP monitoring in identifying masked hypertension. Few studies have examined the mechanistic pathways that may explain masked hypertension. Finally, scarce data are available on the best approach to treating individuals with masked hypertension. Herein, we review the current literature on masked hypertension including definition, prevalence, clinical implications, special patient populations, correlates, issues related to diagnosis, treatment, and areas for future research. PMID:24573133

  16. Current clinical trials testing combinations of immunotherapy and radiation.

    Science.gov (United States)

    Crittenden, Marka; Kohrt, Holbrook; Levy, Ronald; Jones, Jennifer; Camphausen, Kevin; Dicker, Adam; Demaria, Sandra; Formenti, Silvia

    2015-01-01

    Preclinical evidence of successful combinations of ionizing radiation with immunotherapy has inspired testing the translation of these results to the clinic. Interestingly, the preclinical work has consistently predicted the responses encountered in clinical trials. The first example came from a proof-of-principle trial started in 2001 that tested the concept that growth factors acting on antigen-presenting cells improve presentation of tumor antigens released by radiation and induce an abscopal effect. Granulocyte-macrophage colony-stimulating factor was administered during radiotherapy to a metastatic site in patients with metastatic solid tumors to translate evidence obtained in a murine model of syngeneic mammary carcinoma treated with cytokine FLT-3L and radiation. Subsequent clinical availability of vaccines and immune checkpoint inhibitors has triggered a wave of enthusiasm for testing them in combination with radiotherapy. Examples of ongoing clinical trials are described in this report. Importantly, most of these trials include careful immune monitoring of the patients enrolled and will generate important data about the proimmunogenic effects of radiation in combination with a variety of immune modulators, in different disease settings. Results of these studies are building a platform of evidence for radiotherapy as an adjuvant to immunotherapy and encourage the growth of this novel field of radiation oncology. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Evaluation of clinical methods for peroneal muscle testing.

    Science.gov (United States)

    Sarig-Bahat, Hilla; Krasovsky, Andrei; Sprecher, Elliot

    2013-03-01

    Manual muscle testing of the peroneal muscles is well accepted as a testing method in musculoskeletal physiotherapy for the assessment of the foot and ankle. The peroneus longus and brevis are primary evertors and secondary plantar flexors of the ankle joint. However, some international textbooks describe them as dorsi flexors, when instructing peroneal muscle testing. The identified variability raised a question whether these educational texts are reflected in the clinical field. The purposes of this study were to investigate what are the methods commonly used in the clinical field for peroneal muscle testing and to evaluate their compatibility with functional anatomy. A cross-sectional study was conducted, using an electronic questionnaire sent to 143 Israeli physiotherapists in the musculoskeletal field. The survey questioned on the anatomical location of manual resistance and the combination of motions resisted. Ninety-seven responses were received. The majority (69%) of respondents related correctly to the peronei as evertors, but asserted that resistance should be located over the dorsal aspect of the fifth metatarsus, thereby disregarding the peroneus longus. Moreover, 38% of the respondents described the peronei as dorsi flexors, rather than plantar flexors. Only 2% selected the correct method of resisting plantarflexion and eversion at the base of the first metatarsus. We consider this technique to be the most compatible with the anatomy of the peroneus longus and brevis. The Fisher-Freeman-Halton test indicated that there was a significant relationship between responses on the questions (P = 0.0253, 95% CI 0.0249-0.0257), thus justifying further correspondence analysis. The correspondence analysis found no clustering of the answers that were compatible with anatomical evidence and were applied in the correct technique, but did demonstrate a common error, resisting dorsiflexion rather than plantarflexion, which was in agreement with the described

  18. Evolutions in clinical reasoning assessment: The Evolving Script Concordance Test.

    Science.gov (United States)

    Cooke, Suzette; Lemay, Jean-François; Beran, Tanya

    2017-08-01

    Script concordance testing (SCT) is a method of assessment of clinical reasoning. We developed a new type of SCT case design, the evolving SCT (E-SCT), whereby the patient's clinical story is "evolving" and with thoughtful integration of new information at each stage, decisions related to clinical decision-making become increasingly clear. We aimed to: (1) determine whether an E-SCT could differentiate clinical reasoning ability among junior residents (JR), senior residents (SR), and pediatricians, (2) evaluate the reliability of an E-SCT, and (3) obtain qualitative feedback from participants to help inform the potential acceptability of the E-SCT. A 12-case E-SCT, embedded within a 24-case pediatric SCT (PaedSCT), was administered to 91 pediatric residents (JR: n = 50; SR: n = 41). A total of 21 pediatricians served on the panel of experts (POE). A one-way analysis of variance (ANOVA) was conducted across the levels of experience. Participants' feedback on the E-SCT was obtained with a post-test survey and analyzed using two methods: percentage preference and thematic analysis. Statistical differences existed across levels of training: F = 19.31 (df = 2); p decision-making process. The E-SCT demonstrated very good reliability and was effective in distinguishing clinical reasoning ability across three levels of experience. Participants found the E-SCT engaging and representative of real-life clinical reasoning and decision-making processes. We suggest that further refinement and utilization of the evolving style case will enhance SCT as a robust, engaging, and relevant method for the assessment of clinical reasoning.

  19. Clinical trials transparency and the Trial and Experimental Studies Transparency (TEST) act.

    Science.gov (United States)

    Logvinov, Ilana

    2014-03-01

    Clinical trial research is the cornerstone for successful advancement of medicine that provides hope for millions of people in the future. Full transparency in clinical trials may allow independent investigators to evaluate study designs, perform additional analysis of data, and potentially eliminate duplicate studies. Current regulatory system and publishers rely on investigators and pharmaceutical industries for complete and accurate reporting of results from completed clinical trials. Legislation seems to be the only way to enforce mandatory disclosure of results. The Trial and Experimental Studies Transparency (TEST) Act of 2012 was introduced to the legislators in the United States to promote greater transparency in research industry. Public safety and advancement of science are the driving forces for the proposed policy change. The TEST Act may benefit the society and researchers; however, there are major concerns with participants' privacy and intellectual property protection. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Are traditional cognitive tests useful in predicting clinical success?

    Science.gov (United States)

    Gray, Sarah A; Deem, Lisa P; Straja, Sorin R

    2002-11-01

    The purpose of this research was to determine the predictive value of the Dental Admission Test (DAT) for clinical success using Ackerman's theory of ability determinants of skilled performance. The Ackerman theory is a valid, reliable schema in the applied psychology literature used to predict complex skill acquisition. Inconsistent stimulus-response skill acquisition depends primarily on determinants of cognitive ability. Consistent information-processing tasks have been described as "automatic," in which stimuli and responses are mapped in a manner that allows for complete certainty once the relationships have been learned. It is theorized that the skills necessary for success in the clinical component of dental schools involve a significant amount of automatic processing demands and, as such, student performance in the clinics should begin to converge as task practice is realized and tasks become more consistent. Subtest scores of the DAT of four classes were correlated with final grades in nine clinical courses. Results showed that the DAT subtest scores played virtually no role with regard to the final clinical grades. Based on this information, the DAT scores were determined to be of no predictive value in clinical achievement.

  1. Futures

    DEFF Research Database (Denmark)

    Pedersen, Michael Haldrup

    2017-01-01

    Currently both design thinking and critical social science experience an increased interest in speculating in alternative future scenarios. This interest is not least related to the challenges issues of global sustainability present for politics, ethics and design. This paper explores the potenti......Currently both design thinking and critical social science experience an increased interest in speculating in alternative future scenarios. This interest is not least related to the challenges issues of global sustainability present for politics, ethics and design. This paper explores...... the potentials of speculative thinking in relation to design and social and cultural studies, arguing that both offer valuable insights for creating a speculative space for new emergent criticalities challenging current assumptions of the relations between power and design. It does so by tracing out discussions...... of ‘futurity’ and ‘futuring’ in design as well as social and cultural studies. Firstly, by discussing futurist and speculative approaches in design thinking; secondly by engaging with ideas of scenario thinking and utopianism in current social and cultural studies; and thirdly by showing how the articulation...

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

    Directory of Open Access Journals (Sweden)

    Tharwat El Zahran

    2018-01-01

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

  3. Clinical implementation of KRAS testing in metastatic colorectal carcinoma: the pathologist's perspective.

    Science.gov (United States)

    Ross, Jeffrey S

    2012-10-01

    Mutation status of the KRAS gene identifies a distinct disease subtype of metastatic colorectal carcinoma that does not respond to antibody therapeutics targeting the epidermal growth factor receptor. This is currently the only validated marker in metastatic colorectal carcinoma with a clear implication in treatment selection. KRAS testing is widely accepted in clinical practice to guide metastatic colorectal carcinoma therapeutic decisions, and there are many commercially available platforms to perform the test. To evaluate the critical role of pathologists in the full implementation of KRAS testing by optimizing tumor tissue collection and fixation procedures and by choosing testing technologies and reliable Clinical Laboratory Improvement Amendments of 1988-certified laboratories to perform the tests. Prospective clinical trials, retrospective studies, and quality assessment and survey reports were identified in the following databases: PubMed, American Society of Clinical Oncology Proceedings (American Society of Clinical Oncology Annual Meeting and Gastrointestinal Cancer Symposium) and European Society for Medical Oncology Proceedings (Annals of Oncology European Society for Medical Oncology Congress and Annals of Oncology World Congress on Gastrointestinal Cancers). More bona fide standards are needed to address the variety of available test methods, which have different performance characteristics including speed, sensitivity to detect rare mutations, and technical requirements. Refined standards addressing timing of KRAS testing, laboratory performance and accuracy, quality assurance and control, proper tissue collection, and appropriate result reporting would also be greatly beneficial. Pathologists should be aware that the amount of information they need to manage will increase, because future trends and technological advances will enhance the predictive power of diagnostic tests or the scope of the biomarker panels tested routinely across tumor types.

  4. Galectin-3: The Impact on the Clinical Management of Patients with Thyroid Nodules and Future Perspectives

    Directory of Open Access Journals (Sweden)

    Armando Bartolazzi

    2018-02-01

    Full Text Available Galectins (S-type lectins are an evolutionarily-conserved family of lectin molecules, which can be expressed intracellularly and in the extracellular matrix, as well. Galectins bind β-galactose-containing glycoconjugates and are functionally active in converting glycan-related information into cell biological programs. Altered glycosylation notably occurring in cancer cells and expression of specific galectins provide, indeed, a fashionable mechanism of molecular interactions able to regulate several tumor relevant functions, among which are cell adhesion and migration, cell differentiation, gene transcription and RNA splicing, cell cycle and apoptosis. Furthermore, several galectin molecules also play a role in regulating the immune response. These functions are strongly dependent on the cell context, in which specific galectins and related glyco-ligands are expressed. Thyroid cancer likely represents the paradigmatic tumor model in which experimental studies on galectins’ glycobiology, in particular on galectin-3 expression and function, contributed greatly to the improvement of cancer diagnosis. The discovery of a restricted expression of galectin-3 in well-differentiated thyroid carcinomas (WDTC, compared to normal and benign thyroid conditions, contributed also to promoting preclinical studies aimed at exploring new strategies for imaging thyroid cancer in vivo based on galectin-3 immuno-targeting. Results derived from these recent experimental studies promise a further improvement of both thyroid cancer diagnosis and therapy in the near future. In this review, the biological role of galectin-3 expression in thyroid cancer, the validation and translation to a clinical setting of a galectin-3 test method for the preoperative characterization of thyroid nodules and a galectin-3-based immuno-positron emission tomography (immuno-PET imaging of thyroid cancer in vivo are presented and discussed.

  5. Oligonucleotide-based pharmaceuticals: Non-clinical and clinical safety signals and non-clinical testing strategies.

    Science.gov (United States)

    Mustonen, Enni-Kaisa; Palomäki, Tiina; Pasanen, Markku

    2017-11-01

    Antisense oligonucleotides, short interfering RNAs (siRNAs) and aptamers are oligonucleotide-based pharmaceuticals with a promising role in targeted therapies. Currently, five oligonucleotide-based pharmaceuticals have achieved marketing authorization in Europe or USA and many more are undergoing clinical testing. However, several safety concerns have been raised in non-clinical and clinical studies. Oligonucleotides share properties with both chemical and biological pharmaceuticals and therefore they pose challenges also from the regulatory point of view. We have analyzed the safety data of oligonucleotides and evaluated the applicability of current non-clinical toxicological guidelines for assessing the safety of oligonucleotide-based pharmaceuticals. Oligonucleotide-based pharmaceuticals display a similar toxicological profile, exerting adverse effects on liver and kidney, evoking hematological alterations, as well as causing immunostimulation and prolonging the coagulation time. It is possible to extrapolate some of these effects from non-clinical studies to humans. However, evaluation strategies for genotoxicity testing of "non-natural" oligonucleotides should be revised. Additionally, the selective use of surrogates and prediction of clinical endpoints for non-clinically observed immunostimulation is complicated by its multiple potential manifestations, demanding improvements in the testing strategies. Utilizing more relevant and mechanistic-based approaches and taking better account of species differences, could possibly improve the prediction of relevant immunological/proinflammatory effects in humans. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. The future of viral hepatitis testing: innovations in testing technologies and approaches.

    Science.gov (United States)

    Peeling, Rosanna W; Boeras, Debrah I; Marinucci, Francesco; Easterbrook, Philippa

    2017-11-01

    A large burden of undiagnosed hepatitis virus cases remains globally. Despite the 257 million people living with chronic hepatitis B virus infection, and 71 million with chronic viraemic HCV infection, most people with hepatitis remain unaware of their infection. Advances in rapid detection technology have created new opportunities for enhancing access to testing and care, as well as monitoring of treatment. This article examines a range of other technological innovations that can be leveraged to provide more affordable and simplified approaches to testing for HBV and HCV infection and monitoring of treatment response. These include improved access to testing through alternative sampling methods (use of dried blood spots, oral fluids, self-testing) and combination rapid diagnostic tests for detection of HIV, HBV and HCV infection; more affordable options for confirmation of virological infection (HBV DNA and HCV RNA) such as point-of-care molecular assays, HCV core antigen and multi-disease polyvalent molecular platforms that make use of existing centralised laboratory based or decentralised TB and HIV instrumentation for viral hepatitis testing; and finally health system improvements such as integration of laboratory services for procurement and sample transportation and enhanced data connectivity to support quality assurance and supply chain management.

  7. Fast Flux Test Facility: first three years of operation and future mission

    International Nuclear Information System (INIS)

    Peckinpaugh, C.L.; Newland, D.J.; Evans, E.A.

    1985-03-01

    In summary, the FFTF has proven to be a high performance, versatile test reactor. Results obtained during its first three years of operation - and those to be obtained in the coming years - are building a technology and experience base that is invaluable to future LMRs. The FFTF demonstrates proven LMR technology with a focus for the future and provides the US with international LMR technology leadership

  8. Syndromic Panel-Based Testing in Clinical Microbiology.

    Science.gov (United States)

    Ramanan, Poornima; Bryson, Alexandra L; Binnicker, Matthew J; Pritt, Bobbi S; Patel, Robin

    2018-01-01

    The recent development of commercial panel-based molecular diagnostics for the rapid detection of pathogens in positive blood culture bottles, respiratory specimens, stool, and cerebrospinal fluid has resulted in a paradigm shift in clinical microbiology and clinical practice. This review focuses on U.S. Food and Drug Administration (FDA)-approved/cleared multiplex molecular panels with more than five targets designed to assist in the diagnosis of bloodstream, respiratory tract, gastrointestinal, or central nervous system infections. While these panel-based assays have the clear advantages of a rapid turnaround time and the detection of a large number of microorganisms and promise to improve health care, they present certain challenges, including cost and the definition of ideal test utilization strategies (i.e., optimal ordering) and test interpretation. Copyright © 2017 American Society for Microbiology.

  9. Clinical investigation of 14C-urea breath test

    International Nuclear Information System (INIS)

    Yu Yongli; Zhu Ruisen; Ji Hong; Luo Quanyong

    2000-01-01

    To investigate clinical value of 14 C-urea breath test ( 14 C-UBT) for the diagnosis of Helicobacter pylori(Hp), 70 patients were both performed gastroscopy (taking gastric mucosae biopsy for rapid urease test and histology) and 14 C-UBT (some patients by Hp-IgG or DNAHp test also) within two days. The positive cases of both rapid urease test and histology was defined as 'gold standard' of Hp-positive, whereas the negative cases of both rapid urease test and histology as 'gold standard' of Hp-negative. The sensitivity of 14 C-UBT was 93.2%, the specificity 73.1%, and the diagnostic accuracy 85.7%. The difference (comparing with 'gold standard') was not marked (x 2 = 0.9 0.05(1) 2 = 3.84, P>0.05). But the diagnostic accuracy of 14 C-UBT (85.7%) and Hp-IgG (50%) had a marked difference (x 2 13.80>x 0.01(1) 2 = 6.64, P 14 C-UBT was easy to operate, reliable and suitable for clinical application

  10. Clinical balance tests, proprioceptive system and adolescent idiopathic scoliosis.

    Science.gov (United States)

    Le Berre, Morgane; Guyot, Marc-Alexandre; Agnani, Olivier; Bourdeauducq, Isabelle; Versyp, Marie-Christine; Donze, Cécile; Thévenon, André; Catanzariti, Jean-Francois

    2017-06-01

    Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spinal column of unknown etiology. Multiple factors could be involved, including neurosensory pathways and, potentially, an elective disorder of dynamic proprioception. The purpose of this study was to determine whether routine balance tests could be used to demonstrate an elective alteration of dynamic proprioception in AIS. This was a multicentre case-control study based on prospectively collected clinical data, in three hospitals pediatric, with spine consultation, from January 2013 through April 2015. From an original population of 547 adolescents, inclusion and non-inclusion criteria indentified 114 adolescents with right thoracic AIS (mean age 14.5 ± 1.9 years, Cobb angle 35.7 ± 15.3°) and 81 matched adolescents without scoliosis (mean age 14.1 ± 1.9 years). Participants performed three routine clinical balance tests to assess the static and dynamic proprioception: the Fukuda-Utenberger stepping test (angle of rotation in degrees and distance of displacement in cm) to assess dynamic balance; the sharpened Romberg test and the unipedal stance test (eyes closed) to assess static balance. There was no significant difference between AIS subjects and controls for the static tests, but there was a significant difference for the dynamic test for both measures: distance of displacement (p tests can be performed in routine practice. Their validity as a biomarker for screening and monitoring purposes should be assessed.

  11. A core competency-based objective structured clinical examination (OSCE) can predict future resident performance.

    Science.gov (United States)

    Wallenstein, Joshua; Heron, Sheryl; Santen, Sally; Shayne, Philip; Ander, Douglas

    2010-10-01

    This study evaluated the ability of an objective structured clinical examination (OSCE) administered in the first month of residency to predict future resident performance in the Accreditation Council for Graduate Medical Education (ACGME) core competencies. Eighteen Postgraduate Year 1 (PGY-1) residents completed a five-station OSCE in the first month of postgraduate training. Performance was graded in each of the ACGME core competencies. At the end of 18 months of training, faculty evaluations of resident performance in the emergency department (ED) were used to calculate a cumulative clinical evaluation score for each core competency. The correlations between OSCE scores and clinical evaluation scores at 18 months were assessed on an overall level and in each core competency. There was a statistically significant correlation between overall OSCE scores and overall clinical evaluation scores (R = 0.48, p competencies of patient care (R = 0.49, p competencies. An early-residency OSCE has the ability to predict future postgraduate performance on a global level and in specific core competencies. Used appropriately, such information can be a valuable tool for program directors in monitoring residents' progress and providing more tailored guidance. © 2010 by the Society for Academic Emergency Medicine.

  12. Clinical Validation of a Test for the Diagnosis of Vaginitis.

    Science.gov (United States)

    Gaydos, Charlotte A; Beqaj, Sajo; Schwebke, Jane R; Lebed, Joel; Smith, Bonnie; Davis, Thomas E; Fife, Kenneth H; Nyirjesy, Paul; Spurrell, Timothy; Furgerson, Dorothy; Coleman, Jenell; Paradis, Sonia; Cooper, Charles K

    2017-07-01

    Vaginitis may be diagnosed as bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis, or coinfection. A new molecular test assays the vaginal microbiome and organisms that cause three common infections. The objective of the trial was to evaluate the clinical accuracy of the investigational test for vaginal swabs collected by patients (self) or clinicians. The primary and secondary outcomes were to compare the investigational test with reference methods for the three most common causes of vaginitis and compare clinician-collected with self-collected swabs. We conducted a cross-sectional study in which women with symptoms of vaginitis were recruited at ten clinical centers and consented to the investigation between May and September 2015. The woman collected a vaginal swab, sheathed, and then handed it to the clinician. These swabs were to evaluate how self-collected swabs compared with clinician-collected swabs. The clinician collected an investigational test swab and reference test swabs. From 1,740 symptomatic patients, clinician-collected and self-collected vaginal swabs were evaluated by the molecular test and six tests. The reference methods for bacterial vaginosis were Nugent's score and Amsel's criteria for intermediate Nugent results. The reference methods for Candida infection were isolation of any potential Candida microorganisms from inoculation of two culture media: chromogenic and Sabouraud agar and sequencing. The reference methods for trichomoniasis were wet mount and culture. For clinician-collected swabs, by reference methods, bacterial vaginosis was diagnosed in 56.5%, vaginal candidiasis in 32.8%, trichomoniasis in 8%, and none of the three infections in 24% with a coinfection rate of 20%. The investigational test sensitivity was 90.5% (95% confidence interval [CI] 88.3-92.2%) and specificity was 85.8% (95% CI 83.0-88.3%) for bacterial vaginosis. The investigational test sensitivity was 90.9% (95% CI 88.1-93.1%) and specificity was 94

  13. A critique of statistical hypothesis testing in clinical research

    Directory of Open Access Journals (Sweden)

    Somik Raha

    2011-01-01

    Full Text Available Many have documented the difficulty of using the current paradigm of Randomized Controlled Trials (RCTs to test and validate the effectiveness of alternative medical systems such as Ayurveda. This paper critiques the applicability of RCTs for all clinical knowledge-seeking endeavors, of which Ayurveda research is a part. This is done by examining statistical hypothesis testing, the underlying foundation of RCTs, from a practical and philosophical perspective. In the philosophical critique, the two main worldviews of probability are that of the Bayesian and the frequentist. The frequentist worldview is a special case of the Bayesian worldview requiring the unrealistic assumptions of knowing nothing about the universe and believing that all observations are unrelated to each other. Many have claimed that the first belief is necessary for science, and this claim is debunked by comparing variations in learning with different prior beliefs. Moving beyond the Bayesian and frequentist worldviews, the notion of hypothesis testing itself is challenged on the grounds that a hypothesis is an unclear distinction, and assigning a probability on an unclear distinction is an exercise that does not lead to clarity of action. This critique is of the theory itself and not any particular application of statistical hypothesis testing. A decision-making frame is proposed as a way of both addressing this critique and transcending ideological debates on probability. An example of a Bayesian decision-making approach is shown as an alternative to statistical hypothesis testing, utilizing data from a past clinical trial that studied the effect of Aspirin on heart attacks in a sample population of doctors. As a big reason for the prevalence of RCTs in academia is legislation requiring it, the ethics of legislating the use of statistical methods for clinical research is also examined.

  14. Spent fuel metal storage cask performance testing and future spent fuel concrete module performance testing

    International Nuclear Information System (INIS)

    McKinnon, M.A.; Creer, J.M.

    1988-10-01

    REA-2023 Gesellshaft fur Nuklear Service (GNS) CASTOR-V/21, Transnuclear TN-24P, and Westinghouse MC-10 metal storage casks, have been performance tested under the guidance of the Pacific Northwest Laboratory to determine their thermal and shielding performance. The REA-2023 cask was tested under Department of Energy (DOE) sponsorship at General Electric's facilities in Morris, Illinois, using BWR spent fuel from the Cooper Reactor. The other three casks were tested under a cooperative agreement between Virginia Power Company and DOE at the Idaho National Engineering Laboratory (INEL) by EGandG Idaho, Inc., using intact spent PWR fuel from the Surry reactors. The Electric Power Research Institute (EPRI) made contributions to both programs. A summary of the various cask designs and the results of the performance tests is presented. The cask designs include: solid and liquid neutron shields; lead, steel, and nodular cast iron gamma shields; stainless steel, aluminum, and copper baskets; and borated materials for criticality control. 4 refs., 8 figs., 6 tabs

  15. Informatics in clinical research in oncology: current state, challenges, and a future perspective.

    Science.gov (United States)

    Chahal, Amar P S

    2011-01-01

    The informatics landscape of clinical trials in oncology has changed significantly in the last 10 years. The current state of the infrastructure for clinical trial management, execution, and data management is reviewed. The systems, their functionality, the users, and the standards available to researchers are discussed from the perspective of the oncologist-researcher. Challenges in complexity and in the processing of information are outlined. These challenges include the lack of communication and information-interchange between systems, the lack of simplified standards, and the lack of implementation and adherence to the standards that are available. The clinical toxicology criteria from the National Cancer Institute (CTCAE) are cited as a successful standard in oncology, and HTTP on the Internet is referenced for its simplicity. Differences in the management of information standards between industries are discussed. Possible future advances in oncology clinical research informatics are addressed. These advances include strategic policy review of standards and the implementation of actions to make standards free, ubiquitous, simple, and easily interpretable; the need to change from a local data-capture- or transaction-driven model to a large-scale data-interpretation model that provides higher value to the oncologist and the patient; and the need for information technology investment in a readily available digital educational model for clinical research in oncology that is customizable for individual studies. These new approaches, with changes in information delivery to mobile platforms, will set the stage for the next decade in clinical research informatics.

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

    Science.gov (United States)

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

    2011-01-01

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

  17. Duplicate laboratory test reduction using a clinical decision support tool.

    Science.gov (United States)

    Procop, Gary W; Yerian, Lisa M; Wyllie, Robert; Harrison, A Marc; Kottke-Marchant, Kandice

    2014-05-01

    Duplicate laboratory tests that are unwarranted increase unnecessary phlebotomy, which contributes to iatrogenic anemia, decreased patient satisfaction, and increased health care costs. We employed a clinical decision support tool (CDST) to block unnecessary duplicate test orders during the computerized physician order entry (CPOE) process. We assessed laboratory cost savings after 2 years and searched for untoward patient events associated with this intervention. This CDST blocked 11,790 unnecessary duplicate test orders in these 2 years, which resulted in a cost savings of $183,586. There were no untoward effects reported associated with this intervention. The movement to CPOE affords real-time interaction between the laboratory and the physician through CDSTs that signal duplicate orders. These interactions save health care dollars and should also increase patient satisfaction and well-being.

  18. Advances in prenatal screening for Down syndrome: II first trimester testing, integrated testing, and future directions.

    Science.gov (United States)

    Benn, Peter A

    2002-10-01

    The acceptability of prenatal screening and diagnosis of Down syndrome is dependent, in part, on the gestational age at which the testing is offered. First trimester screening could be advantageous if it has sufficient efficacy and can be effectively delivered. Two first trimester maternal serum screening markers, pregnancy-associated plasma protein-A (PAPP-A) and free beta-human chorionic gonadotropin (beta-hCG), are useful for identifying women at increased risk for fetal Down syndrome. In addition, measurement of an enlarged thickness of the subcutaneous fluid-filled space at the back of the neck of the developing fetus (referred to as nuchal translucency or NT) has been demonstrated to be an indicator for these high-risk pregnancies. When these three parameters are combined, estimates for Down syndrome efficacy exceed those currently attainable in the second trimester. Women who are screen-positive in the first trimester can elect to receive cytogenetic testing of a chorionic villus biopsy. The first trimester tests could also, theoretically, be combined with the second trimester maternal serum screening tests (integrated screening) to obtain even higher levels of efficacy. There are, however, several practical limitations to first trimester and integrated screening. These include scheduling of testing within relatively narrow gestational age intervals, availability of appropriately trained ultrasonographers for NT measurement, risks associated with chorionic villus biopsy, and costs. There is also increasing evidence that an enlarged NT measurement is indicative of a high risk for spontaneous abortion and for fetal abnormalities that are not detectable by cytogenetic analysis. Women whose fetuses show enlarged NT, therefore, need first trimester counseling regarding their Down syndrome risks and the possibility of other adverse pregnancy outcomes. Follow-up ultrasound and fetal echocardiography in the second trimester are also indicated. First trimester

  19. Present status and future perspective of research and test reactors in JAERI

    International Nuclear Information System (INIS)

    Baba, Osamu; Kaieda, Keisuke

    1999-01-01

    Since 1957, Japan Atomic Energy Research Institute (JAERI) has constructed several research and test reactors to fulfil a major role in the study of nuclear energy and fundamental research. At present, four reactors, the Japan Research Reactor No. 3 and No. 4 (JRR-3M and JRR-4 respectively), the Japan Materials Testing Reactor (JMTR) and the Nuclear Safety Research Reactor (NSRR), are in operation, and a new High Temperature Engineering Test Reactor (HTTR) has reached first criticality and is waiting for the power-up test. This paper introduce these reactors and describe their present operational status. The recent tendency of utilization and future perspectives are also reported. (author)

  20. Present status and future perspective of research and test reactors in JAERI

    Energy Technology Data Exchange (ETDEWEB)

    Baba, Osamu [Japan Atomic Energy Research Inst., Oarai, Ibaraki (Japan). Oarai Research Establishment; Kaieda, Keisuke

    1999-08-01

    Since 1957, Japan Atomic Energy Research Institute (JAERI) has constructed several research and test reactors to fulfil a major role in the study of nuclear energy and fundamental research. At present, four reactors, the Japan Research Reactor No. 3 and No. 4 (JRR-3M and JRR-4 respectively), the Japan Materials Testing Reactor (JMTR) and the Nuclear Safety Research Reactor (NSRR), are in operation, and a new High Temperature Engineering Test Reactor (HTTR) has reached first criticality and is waiting for the power-up test. This paper introduce these reactors and describe their present operational status. The recent tendency of utilization and future perspectives are also reported. (author)

  1. Clinical Trial Results Summary for Laypersons: A User Testing Study.

    Science.gov (United States)

    Raynor, D K; Myers, L; Blackwell, K; Kress, B; Dubost, A; Joos, A

    2018-01-01

    To apply "user testing" to maximize readability and acceptability of a Clinical Trial Results Laypersons Summary-a new European requirement. "User testing" (using questionnaire and semistructured interview) assessed whether people could find and understand key points. Findings were used to improve content and design, prior to retesting. Participants had a range of levels of health literacy and there was a higher education group. Participants accessed the summary on screen. In round 1 we tested 12 points of information. In round 2 a revised summary addressing round 1 findings was tested, leading to a third final version. In round 1, 2 of 12 points of information did not reach the target and interviews raised further format and content issues (some distracting technical explanations and inability to find or understand the 2 main study purposes). These findings informed revisions for the version tested in round 2, with 2 different points not reaching the target (inclusion criteria relating to duration of seasonal allergies and how researchers found out about participants' symptoms). Identified problems in both rounds were addressed and reflected in the final version. Despite improvements, participants did not consistently understand that summaries were intended for the public, or to only interpret results of single trials in the context of additional trials. All readers, including those with higher education, found the clear and straightforward language acceptable. Applying "user testing" resulted in a largely health-literate summary suitable for people across a range of backgrounds.

  2. [Clinical investigation of basophil activation test as a complementary test for house dust mite allergen].

    Science.gov (United States)

    Ren, H L; Li, J D; Miao, Y H; Xu, T

    2018-03-01

    Objective: To investigate the clinical application of glass micro fiber basophil activation test (BAT) used as a complementary test for house dust mite allergen. Method: Forty patients with clinical diagnosed allergic rhinitis was test by three methods for house dust mite allergen, skin prick test(SPT),Immuno CAP sIgE, and BAT in vitro. The sensitivity and specificity of glass micro fiber were accessed, and the consistency between BAT, SPT, and Immuno sIgE was analyzed. As in vivo provocation was not performed, gold standard is regarded as the combination of medical history and positive reports of SPT and/or ImmunoCAP sIgE test. Result: Twentythree patients are diagnosed as house dust mite allergic rhinitis by gold standard. The sensitivity and specificity of glass micro fiber BAT were 60.9% and 88.2%, the sensitivity of SPT and sIgE was 87.0% and sIgE 73.9%. The correlation rates between BAT with SPT is 0.67( P house dust mite allergic rhinitis, BAT have a good consistency with SPT and sIgE, while as it has only moderate consistency with "gold standard", further studies are needed to prove its clinical significance. Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.

  3. Building blocks for future detectors: Silicon test masses and 1550 nm laser light

    International Nuclear Information System (INIS)

    Schnabel, R; Britzger, M; Burmeister, O; Danzmann, K; Duck, J; Eberle, T; Friedrich, D; Luck, H; Mehmet, M; Steinlechner, S; Willke, B; Brueckner, F; Nawrodt, R

    2010-01-01

    Current interferometric gravitational wave detectors use the combination of quasi-monochromatic, continuous-wave laser light at 1064 nm and fused silica test masses at room temperature. Detectors of the third generation, such as the Einstein-Telescope, will involve a considerable sensitivity increase. The combination of 1550 nm laser radiation and crystalline silicon test masses at low temperatures might be important ingredients in order to achieve the sensitivity goal. Here we compare some properties of the fused silica and silicon test mass materials relevant for decreasing the thermal noise in future detectors as well as the recent technology achievements in the preparation of laser radiation at 1064 nm and 1550 nm relevant for decreasing the quantum noise. We conclude that silicon test masses and 1550 nm laser light have the potential to form the future building blocks of gravitational wave detection.

  4. Genetic testing in congenital heart disease:A clinical approach

    Institute of Scientific and Technical Information of China (English)

    Marie A Chaix; Gregor Andelfinger; Paul Khairy

    2016-01-01

    Congenital heart disease(CHD) is the most common type of birth defect. Traditionally, a polygenic model defined by the interaction of multiple genes and environmental factors was hypothesized to account for different forms of CHD. It is now understood that the contribution of genetics to CHD extends beyond a single unified paradigm. For example, monogenic models and chromosomal abnormalities have been associated with various syndromic and non-syndromic forms of CHD. In such instances, genetic investigation and testing may potentially play an important role in clinical care. A family tree with a detailed phenotypic description serves as the initial screening tool to identify potentially inherited defects and to guide further genetic investigation. The selection of a genetic test is contingent upon the particular diagnostic hypothesis generated by clinical examination. Genetic investigation in CHD may carry the potential to improve prognosis by yielding valuable information with regards to personalized medical care, confidence in the clinical diagnosis, and/or targeted patient followup. Moreover, genetic assessment may serve as a tool to predict recurrence risk, define the pattern of inheritance within a family, and evaluate the need for further family screening. In some circumstances, prenatal or preimplantation genetic screening could identify fetuses or embryos at high risk for CHD. Although genetics may appear to constitute a highly specialized sector of cardiology, basic knowledge regarding inheritance patterns, recurrence risks, and available screening and diagnostic tools, including their strengths and limitations, could assist the treating physician in providing sound counsel.

  5. [Innovative Prenatal Testing: Clinical Applications and Ethical Considerations].

    Science.gov (United States)

    Huang, Mei-Chih; Lin, Shio-Jean; Chen, Chih-Ling; Huang, Tzu-Jung

    2017-10-01

    The biomedical technology related to prenatal screen/diagnosis has developed rapidly in recent decades. Many prenatal genetic examinations are now available to assist pregnant women to better understand the status and development of their fetus. Moreover, many commercial advertisements for innovative prenatal examinations are now shown in the media. Cell-free DNA Screening (cfDNA screening), a non-invasive prenatal testing (NIPT) procedure, is a safe and high accuracy test that may be done at an earlier gestational age to screen for fetal aneuploidy. The following questions should be considered when applying cfDNA screening in clinical practice: 1. what is cfDNA screening, 2. who are its potential users, and 3. what ethical and policy considerations are associated with this examination? This article provides relevant information, clinical practice guidelines, and ethical / policy considerations related to cfDNA screening. Discussing cases involving different clinical situations helps promote understanding of cfDNA screening and maternal-care quality.

  6. Genetic testing in congenital heart disease: A clinical approach

    Science.gov (United States)

    Chaix, Marie A; Andelfinger, Gregor; Khairy, Paul

    2016-01-01

    Congenital heart disease (CHD) is the most common type of birth defect. Traditionally, a polygenic model defined by the interaction of multiple genes and environmental factors was hypothesized to account for different forms of CHD. It is now understood that the contribution of genetics to CHD extends beyond a single unified paradigm. For example, monogenic models and chromosomal abnormalities have been associated with various syndromic and non-syndromic forms of CHD. In such instances, genetic investigation and testing may potentially play an important role in clinical care. A family tree with a detailed phenotypic description serves as the initial screening tool to identify potentially inherited defects and to guide further genetic investigation. The selection of a genetic test is contingent upon the particular diagnostic hypothesis generated by clinical examination. Genetic investigation in CHD may carry the potential to improve prognosis by yielding valuable information with regards to personalized medical care, confidence in the clinical diagnosis, and/or targeted patient follow-up. Moreover, genetic assessment may serve as a tool to predict recurrence risk, define the pattern of inheritance within a family, and evaluate the need for further family screening. In some circumstances, prenatal or preimplantation genetic screening could identify fetuses or embryos at high risk for CHD. Although genetics may appear to constitute a highly specialized sector of cardiology, basic knowledge regarding inheritance patterns, recurrence risks, and available screening and diagnostic tools, including their strengths and limitations, could assist the treating physician in providing sound counsel. PMID:26981213

  7. 412th Test Engineering Group Vision for Future Knowledge Management (KM)

    Science.gov (United States)

    2018-05-17

    Presentation 3. DATES COVERED (From - To) 17 May 2018 4. TITLE AND SUBTITLE 412th Test Engineering Group Vision for Future Knowledge Management (KM... Engineering Group 307 E. Popson Ave Edwards AFB, CA 93523 8. PERFORMING ORGANIZATION REPORT NUMBER 412TW-PA...centers for the TENG test customers to allow the data to be readily available within minutes of a flight, for the data to be organized so that the engineer

  8. Graduate Education for the Future: New Models and Methods for the Clinical and Translational Workforce

    Science.gov (United States)

    Bennett, L. Michelle; Cicutto, Lisa; Gadlin, Howard; Moss, Marc; Tentler, John; Schoenbaum, Ellie

    2015-01-01

    Abstract This paper is the third in a five‐part series on the clinical and translational science educational pipeline, and it focuses on strategies for enhancing graduate research education to improve skills for interdisciplinary team science. Although some of the most cutting edge science takes place at the borders between disciplines, it is widely perceived that advancements in clinical and translational science are hindered by the “siloed” efforts of researchers who are comfortable working in their separate domains, and reluctant to stray from their own discipline when conducting research. Without appropriate preparation for career success as members and leaders of interdisciplinary teams, talented scientists may choose to remain siloed or to leave careers in clinical and translational science all together, weakening the pipeline and depleting the future biomedical research workforce. To address this threat, it is critical to begin at what is perhaps the most formative moment for academics: graduate training. This paper focuses on designs for graduate education, and contrasts the methods and outcomes from traditional educational approaches with those skills perceived as essential for the workforce of the future, including the capacity for research collaboration that crosses disciplinary boundaries. PMID:26643714

  9. Update of the International Consensus on Palliative Radiotherapy Endpoints for Future Clinical Trials in Bone Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Chow, Edward, E-mail: Edward.Chow@sunnybrook.ca [Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada); Hoskin, Peter [Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, Middlesex (United Kingdom); Mitera, Gunita; Zeng Liang [Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada); Lutz, Stephen [Department of Radiation Oncology, Blanchard Valley Regional Cancer Center, Findlay, OH (United States); Roos, Daniel [Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia (Australia); Hahn, Carol [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States); Linden, Yvette van der [Radiotherapeutic Institute Friesland, Leeuwarden (Netherlands); Hartsell, William [Department of Radiation Oncology, Advocate Good Samaritan Cancer Center, Downers Grove, IL (United States); Kumar, Eshwar [Department of Oncology, Atlantic Health Sciences Cancer Centre, Saint John Regional Hospital, Saint John, NB (Canada)

    2012-04-01

    Purpose: To update the international consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases by surveying international experts regarding previous uncertainties within the 2002 consensus, changes that may be necessary based on practice pattern changes and research findings since that time. Methods and Materials: A two-phase survey was used to determine revisions and new additions to the 2002 consensus. A total of 49 experts from the American Society for Radiation Oncology, the European Society for Therapeutic Radiology and Oncology, the Faculty of Radiation Oncology of the Royal Australian and New Zealand College of Radiologists, and the Canadian Association of Radiation Oncology who are directly involved in the care of patients with bone metastases participated in this survey. Results: Consensus was established in areas involving response definitions, eligibility criteria for future trials, reirradiation, changes in systemic therapy, radiation techniques, parameters at follow-up, and timing of assessments. Conclusion: An outline for trials in bone metastases was updated based on survey and consensus. Investigators leading trials in bone metastases are encouraged to adopt the revised guideline to promote consistent reporting. Areas for future research were identified. It is intended for the consensus to be re-examined in the future on a regular basis.

  10. Update of the International Consensus on Palliative Radiotherapy Endpoints for Future Clinical Trials in Bone Metastases

    International Nuclear Information System (INIS)

    Chow, Edward; Hoskin, Peter; Mitera, Gunita; Zeng Liang; Lutz, Stephen; Roos, Daniel; Hahn, Carol; Linden, Yvette van der; Hartsell, William; Kumar, Eshwar

    2012-01-01

    Purpose: To update the international consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases by surveying international experts regarding previous uncertainties within the 2002 consensus, changes that may be necessary based on practice pattern changes and research findings since that time. Methods and Materials: A two-phase survey was used to determine revisions and new additions to the 2002 consensus. A total of 49 experts from the American Society for Radiation Oncology, the European Society for Therapeutic Radiology and Oncology, the Faculty of Radiation Oncology of the Royal Australian and New Zealand College of Radiologists, and the Canadian Association of Radiation Oncology who are directly involved in the care of patients with bone metastases participated in this survey. Results: Consensus was established in areas involving response definitions, eligibility criteria for future trials, reirradiation, changes in systemic therapy, radiation techniques, parameters at follow-up, and timing of assessments. Conclusion: An outline for trials in bone metastases was updated based on survey and consensus. Investigators leading trials in bone metastases are encouraged to adopt the revised guideline to promote consistent reporting. Areas for future research were identified. It is intended for the consensus to be re-examined in the future on a regular basis.

  11. Tests of Scintillator+WLS Strips for Muon System at Future Colliders

    Energy Technology Data Exchange (ETDEWEB)

    Denisov, Dmitri [Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States); Evdokimov, Valery [Inst. for High Energy Physics (IHEP), Protvino (Russian Federation); Lukić, Strahinja [Univ. of Belgrade (Serbia)

    2015-10-11

    Prototype scintilator+WLS strips with SiPM readout for muon system at future colliders were tested for light yield, time resolution and position resolution. Depending on the configuration, light yield of up to 36 photoelectrons per muon per SiPM has been achieved, as well as time resolution of 0.5 ns and position resolution of ~ 7 cm.

  12. What should we want to know about our future? A Kantian view on predictive genetic testing.

    Science.gov (United States)

    Heinrichs, Bert

    2005-01-01

    Recent advances in genomic research have led to the development of new diagnostic tools, including tests which make it possible to predict the future occurrence of monogenetic diseases (e.g. Chorea Huntington) or to determine increased susceptibilities to the future development of more complex diseases (e.g. breast cancer). The use of such tests raises a number of ethical, legal and social issues which are usually discussed in terms of rights. However, in the context of predictive genetic tests a key question arises which lies beyond the concept of rights, namely, What should we want to know about our future? In the following I shall discuss this question against the background of Kant's Doctrine of Virtue. It will be demonstrated that the system of duties of virtue that Kant elaborates in the second part of his Metaphysics of Morals offers a theoretical framework for addressing the question of a proper scope of future knowledge as provided by genetic tests. This approach can serve as a source of moral guidance complementary to a justice perspective. It does, however, not rest on the-rather problematic--claim to be able to define what the "good life" is.

  13. Future time perspective, regulatory focus, and selection, optimization, and compensation: Testing a longitudinal model

    NARCIS (Netherlands)

    Baltes, B.B.; Wynne, K.; Sirabian, M.; Krenn, D.; Lange, A.H. de

    2014-01-01

    This study examines the behavioral processes through which future time perspective (FTP) and regulatory focus may influence coping behaviors in older workers. A three-wave longitudinal study was conducted to test a novel model, positing that FTP affects regulatory focus, which then influences the

  14. The quality of veterinary in-clinic and reference laboratory biochemical testing.

    Science.gov (United States)

    Rishniw, Mark; Pion, Paul D; Maher, Tammy

    2012-03-01

    Although evaluation of biochemical analytes in blood is common in veterinary practice, studies assessing the global quality of veterinary in-clinic and reference laboratory testing have not been reported. The aim of this study was to assess the quality of biochemical testing in veterinary laboratories using results obtained from analyses of 3 levels of assayed quality control materials over 5 days. Quality was assessed by comparison of calculated total error with quality requirements, determination of sigma metrics, use of a quality goal index to determine factors contributing to poor performance, and agreement between in-clinic and reference laboratory mean results. The suitability of in-clinic and reference laboratory instruments for statistical quality control was determined using adaptations from the computerized program, EZRules3. Reference laboratories were able to achieve desirable quality requirements more frequently than in-clinic laboratories. Across all 3 materials, > 50% of in-clinic analyzers achieved a sigma metric ≥ 6.0 for measurement of 2 analytes, whereas > 50% of reference laboratory analyzers achieved a sigma metric ≥ 6.0 for measurement of 6 analytes. Expanded uncertainty of measurement and ± total allowable error resulted in the highest mean percentages of analytes demonstrating agreement between in-clinic and reference laboratories. Owing to marked variation in bias and coefficient of variation between analyzers of the same and different types, the percentages of analytes suitable for statistical quality control varied widely. These findings reflect the current state-of-the-art with regard to in-clinic and reference laboratory analyzer performance and provide a baseline for future evaluations of the quality of veterinary laboratory testing. © 2012 American Society for Veterinary Clinical Pathology.

  15. Routine pharmacogenetic testing in clinical practice: dream or reality?

    Science.gov (United States)

    Grossman, Iris

    2007-10-01

    Pharmacogenetics (PGx) has become progressively popular in recent years, thanks to growing anticipation among scientists, healthcare providers and the general public for the incorporation of genetic tests into the diagnostic arsenal at the physician's disposal. Indeed, much research has been dedicated to elucidation of genetic determinants underlying interindividual variability in pharmacokinetic parameters, as well as drug safety and efficacy. However, few PGx applications have thus far been realized in healthcare management. This review uses examples from PGx research of psychiatric drugs to illustrate why the current published findings are inadequate and insufficient for utilization as routine clinical predictors of treatment safety, efficacy or dosing. I therefore suggest the necessary steps to demonstrate the validity, utility and cost-effectiveness of PGx. These recommendations include a whole range of aspects, starting from standardization of criteria and assessment of the technical quality of genotyping assays, up to design of prospective PGx studies, providing the basis for reimbursement programs to be recognized in routine clinical practice.

  16. Genomic Testing and Therapies for Breast Cancer in Clinical Practice

    Science.gov (United States)

    Haas, Jennifer S.; Phillips, Kathryn A.; Liang, Su-Ying; Hassett, Michael J.; Keohane, Carol; Elkin, Elena B.; Armstrong, Joanne; Toscano, Michele

    2011-01-01

    Purpose: Given the likely proliferation of targeted testing and treatment strategies for cancer, a better understanding of the utilization patterns of human epidermal growth factor receptor 2 (HER2) testing and trastuzumab and newer gene expression profiling (GEP) for risk stratification and chemotherapy decision making are important. Study Design: Cross-sectional. Methods: We performed a medical record review of women age 35 to 65 years diagnosed between 2006 and 2007 with invasive localized breast cancer, identified using claims from a large national health plan (N = 775). Results: Almost all women received HER2 testing (96.9%), and 24.9% of women with an accepted indication received GEP. Unexplained socioeconomic differences in GEP use were apparent after adjusting for age and clinical characteristics; specifically, GEP use increased with income. For example, those in the lowest income category (< $40,000) were less likely than those with an income of $125,000 or more to receive GEP (odds ratio, 0.34; 95% CI, 0.16 to 0.73). A majority of women (57.7%) with HER2-positive disease received trastuzumab; among these women, differences in age and clinical characteristics were not apparent, although surprisingly, those in the lowest income category were more likely than those in the high-income category to receive trastuzumab (P = .02). Among women who did not have a positive HER2 test, 3.9% still received trastuzumab. Receipt of adjuvant chemotherapy increased as GEP score indicated greater risk of recurrence. Conclusion: Identifying and eliminating unnecessary variation in the use of these expensive tests and treatments should be part of quality improvement and efficiency programs. PMID:21886507

  17. Integrated Testing Strategy (ITS) - Opportunities to better use existing data and guide future testing in toxicology.

    Science.gov (United States)

    Jaworska, Joanna; Hoffmann, Sebastian

    2010-01-01

    The topic of Integrated Testing Strategies (ITS) has attracted considerable attention, and not only because it is supposed to be a central element of REACH, the ambitious European chemical regulation effort. Although what ITSs are supposed to do seems unambiguous, i.e. speeding up hazard and risk assessment while reducing testing costs, not much has been said, except basic conceptual proposals, about the methodologies that would allow execution of these concepts. Although a pressing concern, the topic of ITS has drawn mostly general reviews, broad concepts, and the expression of a clear need for more research on ITS. Published research in the field remains scarce. Solutions for ITS design emerge slowly, most likely due to the methodological challenges of the task, and perhaps also to it its complexity and the need for multidisciplinary collaboration. Along with the challenge, ITS offer a unique opportunity to contribute to the Toxicology of the 21st century by providing frameworks and tools to actually implement 21st century toxicology data in the chemical management and decision making processes. Further, ITS have the potential to significantly contribute to a modernization of the science of risk assessment. Therefore, to advance ITS research we propose a methodical approach to their design and will discuss currently available approaches as well as challenges to overcome. To this end, we define a framework for ITS that will inform toxicological decisions in a systematic, transparent, and consistent way. We review conceptual requirements for ITS developed earlier and present a roadmap to an operational framework that should be probabilistic, hypothesis-driven, and adaptive. Furthermore, we define properties an ITS should have in order to meet the identified requirements and differentiate them from evidence synthesis. Making use of an ITS for skin sensitization, we demonstrate how the proposed ITS concepts can be implemented.

  18. Clinical pharmacogenomics testing in the era of next generation sequencing: challenges and opportunities for precision medicine.

    Science.gov (United States)

    Ji, Yuan; Si, Yue; McMillin, Gwendolyn A; Lyon, Elaine

    2018-04-23

    The rapid development and dramatic decrease in cost of sequencing techniques have ushered the implementation of genomic testing in patient care. Next generation DNA sequencing (NGS) techniques have been used increasingly in clinical laboratories to scan the whole or part of the human genome in order to facilitate diagnosis and/or prognostics of genetic disease. Despite many hurdles and debates, pharmacogenomics (PGx) is believed to be an area of genomic medicine where precision medicine could have immediate impact in the near future. Areas covered: This review focuses on lessons learned through early attempts of clinically implementing PGx testing; the challenges and opportunities that PGx testing brings to precision medicine in the era of NGS. Expert commentary: Replacing targeted analysis approach with NGS for PGx testing is neither technically feasible nor necessary currently due to several technical limitations and uncertainty involved in interpreting variants of uncertain significance for PGx variants. However, reporting PGx variants out of clinical whole exome or whole genome sequencing (WES/WGS) might represent additional benefits for patients who are tested by WES/WGS.

  19. MRD Testing in Multiple Myeloma: From a Surrogate Marker of Clinical Outcomes to an Every-Day Clinical Tool.

    Science.gov (United States)

    Landgren, Ola

    2018-01-01

    Minimal residual disease (MRD) testing in multiple myeloma is here to stay. Studies show that MRD negativity is consistently associated with longer progression-free survival (PFS). It is just a matter of time until MRD negativity will become a regulatory endpoint for drug approval. Until that can happen, more analysis will be required to define the exact details of MRD in the regulatory setting. For example, for randomized studies there is need to define the amount of improvement in MRD negativity between the experimental arm and the control arm at a given time-point for a drug to obtain regulatory accelerated approval. Such efforts are underway. For the multiple myeloma field as a whole, important tasks for the (near) coming future are as follows: (1) to conduct or finalize the expanded analysis to define the exact details of MRD in the regulatory setting, (2) to develop new and better MRD assays-both more sensitive MRD assays for bone marrow aspirates and nonbone marrow aspirate-based assays (eg, blood-based and imaging-based MRD assays), and (3) to design novel clinical studies to formally assess the effect of MRD negativity in clinical decision making. The aim with this issue of the Journal is to provide a deep and comprehensive summary of the latest MRD knowledge in the field, and to outline future directions. Copyright © 2018 Elsevier Inc. All rights reserved.

  20. A Bright Future for Precision Medicine: Advances in Fluorescent Chemical Probe Design and Their Clinical Application.

    Science.gov (United States)

    Garland, Megan; Yim, Joshua J; Bogyo, Matthew

    2016-01-21

    The Precision Medicine Initiative aims to use advances in basic and clinical research to develop therapeutics that selectively target and kill cancer cells. Under the same doctrine of precision medicine, there is an equally important need to visualize these diseased cells to enable diagnosis, facilitate surgical resection, and monitor therapeutic response. Therefore, there is a great opportunity for chemists to develop chemically tractable probes that can image cancer in vivo. This review focuses on recent advances in the development of optical probes, as well as their current and future applications in the clinical management of cancer. The progress in probe development described here suggests that optical imaging is an important and rapidly developing field of study that encourages continued collaboration among chemists, biologists, and clinicians to further refine these tools for interventional surgical imaging, as well as for diagnostic and therapeutic applications. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Back to the future: the history and development of the clinical linear accelerator

    International Nuclear Information System (INIS)

    Thwaites, David I; Tuohy, John B

    2006-01-01

    The linear accelerator (linac) is the accepted workhorse in radiotherapy in 2006. The first medical linac treated its first patient, in London, in 1953, so the use of these machines in clinical practice has been almost co-existent with the lifetime of Physics in Medicine and Biology. This review is a personal selection of things the authors feel are interesting in the history, particularly the early history, and development of clinical linacs. A brief look into the future is also given. One significant theme throughout is the continuity of ideas, building on previous experience. We hope the review might re-connect younger radiotherapy physicists in particular with some of the history and emphasize the continual need, in any human activity, to remain aware of the past, in order to make best use of past experience when taking decisions in the present. (review)

  2. Determinants of contraceptive use and future contraceptive intentions of women attending child welfare clinics in urban Ghana.

    Science.gov (United States)

    Wuni, Caroline; Turpin, Cornelius A; Dassah, Edward T

    2017-08-01

    Family planning is an integral component of maternal and child health services in Ghana. Although knowledge on contraception is universal and most women attend maternal and child health services, contraceptive use remains low among women after delivery. This study aimed to determine factors influencing current use and future contraceptive intentions of women who were attending child welfare clinics within 2 years of delivery in Sunyani Municipality, Ghana. We conducted an analytical cross-sectional study among mothers in six selected health care facilities. Data was collected on their socio-demographic characteristics, reproductive and contraceptive experiences and future contraceptive intentions. Categorical variables were compared using the chi-squared (χ 2 ) test. Factors associated with current use and future contraceptive intentions were determined using Poisson regression with a robust error variance to estimate crude and adjusted relative risks (RRs) with 95% confidence intervals (CIs). P contraception, 30.7% modern and 19.5% traditional methods. Compared to previous use, more women were using and would prefer the more effective contraceptive methods in future. Significant factors associated with current contraceptive use were, level of education (p = 0.02), discussing family planning during antenatal care (adjusted RR, 1.28; 95% CI, 1.07-1.53), or with one's partner (adjusted RR, 1.22; 95% CI, 1.01-1.47) and previous contraceptive use (adjusted RR, 1.91; 95% CI, 1.56-2.33). Family planning discussions during child welfare clinic (adjusted RR, 1.12; 95% CI, 0.99-1.26) or with one's spouse (adjusted RR, 1.20; 95% CI, 1.08-1.34), desire to space children (adjusted RR, 1.35; 95% CI, 1.17-1.55), previous (adjusted RR, 1.15; 95% CI, 1.05-1.27) and current (adjusted RR, 1.11; 95% CI, 1.01-1.22) contraceptive use were predictive of clients' intention to adopt family planning in the future. Effective counselling on family planning during antenatal and child

  3. Determinants of contraceptive use and future contraceptive intentions of women attending child welfare clinics in urban Ghana

    Directory of Open Access Journals (Sweden)

    Caroline Wuni

    2017-08-01

    Full Text Available Abstract Background Family planning is an integral component of maternal and child health services in Ghana. Although knowledge on contraception is universal and most women attend maternal and child health services, contraceptive use remains low among women after delivery. This study aimed to determine factors influencing current use and future contraceptive intentions of women who were attending child welfare clinics within 2 years of delivery in Sunyani Municipality, Ghana. Methods We conducted an analytical cross-sectional study among mothers in six selected health care facilities. Data was collected on their socio-demographic characteristics, reproductive and contraceptive experiences and future contraceptive intentions. Categorical variables were compared using the chi-squared (χ2 test. Factors associated with current use and future contraceptive intentions were determined using Poisson regression with a robust error variance to estimate crude and adjusted relative risks (RRs with 95% confidence intervals (CIs. P < 0.1 was considered statistically significant. Results A total of 590 women were recruited into the study. Overall, 50.2% of the women were using contraception, 30.7% modern and 19.5% traditional methods. Compared to previous use, more women were using and would prefer the more effective contraceptive methods in future. Significant factors associated with current contraceptive use were, level of education (p = 0.02, discussing family planning during antenatal care (adjusted RR, 1.28; 95% CI, 1.07-1.53, or with one’s partner (adjusted RR, 1.22; 95% CI, 1.01-1.47 and previous contraceptive use (adjusted RR, 1.91; 95% CI, 1.56-2.33. Family planning discussions during child welfare clinic (adjusted RR, 1.12; 95% CI, 0.99-1.26 or with one’s spouse (adjusted RR, 1.20; 95% CI, 1.08-1.34, desire to space children (adjusted RR, 1.35; 95% CI, 1.17-1.55, previous (adjusted RR, 1.15; 95% CI, 1.05-1.27 and current (adjusted RR, 1

  4. Paediatric case mix in a rural clinical school is relevant to future practice.

    Science.gov (United States)

    Wright, Helen M; Maley, Moira A L; Playford, Denese E; Nicol, Pam; Evans, Sharon F

    2017-11-29

    Exposure to a representative case mix is essential for clinical learning, with logbooks established as a way of demonstrating patient contacts. Few studies have reported the paediatric case mix available to geographically distributed students within the same medical school. Given international interest in expanding medical teaching locations to rural contexts, equitable case exposure in rural relative to urban settings is topical. The Rural Clinical School of Western Australia locates students up to 3500 km from the urban university for an academic year. There is particular need to examine paediatric case mix as a study reported Australian graduates felt unprepared for paediatric rotations. We asked: Does a rural clinical school provide a paediatric case mix relevant to future practice? How does the paediatric case mix as logged by rural students compare with that by urban students? The 3745 logs of 76 urban and 76 rural consenting medical students were categorised by presenting symptoms and compared to the Australian Institute of Health and Welfare (AIHW) database Major Diagnostic Categories (MDCs). Rural and urban students logged core paediatric cases, in similar order, despite the striking difference in geographic locations. The pattern of overall presenting problems closely corresponded to Australian paediatric hospital admissions. Rural students logged 91% of cases in secondary healthcare settings; urban students logged 90% of cases in tertiary settings. The top four presenting problems were ENT/respiratory, gastrointestinal/urogenital, neurodevelopmental and musculoskeletal; these made up 60% of all cases. Rural and urban students logged similar proportions of infants, children and adolescents, with a variety of case morbidity. Rural clinical school students logged a mix of core paediatric cases relevant to illnesses of Australian children admitted to public hospitals, with similar order and pattern by age group to urban students, despite major differences

  5. Clinical audit in the final year of undergraduate medical education: towards better care of future generations.

    Science.gov (United States)

    Mak, Donna B; Miflin, Barbara

    2012-01-01

    In Australia, in an environment undergoing rapidly changing requirements for health services, there is an urgent need for future practitioners to be knowledgeable, skilful and self-motivated in ensuring the quality and safety of their practice. Postgraduate medical education and vocational programs have responded by incorporating training in quality improvement into continuing professional development requirements, but undergraduate medical education has been slower to respond. This article describes the clinical audit programme undertaken by all students in the final year of the medical course at the University of Notre Dame, Fremantle, Australia, and examines the educational worth of this approach. Data were obtained from curricular documents, including the clinical audit handbook, and from evaluation questionnaires administered to students and supervisors. The clinical audit programme is based on sound educational principles, including situated and participatory learning and reflective practice. It has demonstrated multi-dimensional benefits for students in terms of learning the complexities of conducting an effective audit in professional practice, and for health services in terms of facilitating quality improvement. Although this programme was developed in a medical course, the concept is readily transferable to a variety of other health professional curricula in which students undertake clinical placements.

  6. 50 years of pediatric immunology: progress and future, a clinical perspective.

    Science.gov (United States)

    Singh, Surjit; Gupta, Anju; Rawat, Amit

    2013-01-08

    Rapidly evolving advances in the field of immunology over the last few decades have impacted the practice of clinical medicine in many ways. In fact, understanding the immunological basis of disease has been pivotal in deciphering the pathogenesis of several disease processes, infective or otherwise. As of today, there is hardly any specialty of medicine which is not influenced by immunology. Pediatric rheumatological disorders, vasculitides, Human Immunodeficiency Virus (HIV) infection, Primary Immunodeficiency Diseases (PIDs) and autoimmune disorders fall under the domain of clinical immunology. This specialty is poised to emerge as a major clinical specialty in our country. The gulf between bench and bedside is narrowing down as our understanding of the complex immunological mechanisms gets better. However, a lot still needs to be done in this field as the morbidity and mortality of some of these conditions is unacceptably high in the Indian setup. A number of medical schools and institutes in the country now have the resources and the wherewithal to develop into specialized centres of clinical immunology. We need to concentrate on training more physicians and pediatricians in this field. The future is bright and the prospects exciting.

  7. [The future of clinical research: why do we need an ecological approach?].

    Science.gov (United States)

    Liberati, Alessandro; Moja, Lorenzo P; Moschetti, Ivan

    2006-11-01

    In this paper we try to define the future goals of the clinical research, with particular reference to methodological and policy issues. There is an increasing tension between the real drivers of clinical research and its scientific and ethical aims. To consumers the goal is to strengthen the relevance and usefulness of clinical research. This is possible only if consumers are empowered and actively involved. For the health care systems it is mandatory to re-engineer the process, enforcing national and international legislation. This should help to fill the research-clinical practice gap and to balance the research agenda, better reflecting health priorities. Finally the scientific community should reflect on its own conflicts of interests and analyse the causes of the ethical divide between the needs and the market. Scientists too often seem to loose sight of the original cumulative nature of research and of the idea of research as a collective good. More non-commercial research is needed, integrated with the health care systems, to support a transparent, more realistic and valid information useful for patient care, scientific information.

  8. Validation of a clinical critical thinking skills test in nursing

    Directory of Open Access Journals (Sweden)

    Sujin Shin

    2015-01-01

    Full Text Available Purpose: The purpose of this study was to develop a revised version of the clinical critical thinking skills test (CCTS and to subsequently validate its performance. Methods: This study is a secondary analysis of the CCTS. Data were obtained from a convenience sample of 284 college students in June 2011. Thirty items were analyzed using item response theory and test reliability was assessed. Test-retest reliability was measured using the results of 20 nursing college and graduate school students in July 2013. The content validity of the revised items was analyzed by calculating the degree of agreement between instrument developer intention in item development and the judgments of six experts. To analyze response process validity, qualitative data related to the response processes of nine nursing college students obtained through cognitive interviews were analyzed. Results: Out of initial 30 items, 11 items were excluded after the analysis of difficulty and discrimination parameter. When the 19 items of the revised version of the CCTS were analyzed, levels of item difficulty were found to be relatively low and levels of discrimination were found to be appropriate or high. The degree of agreement between item developer intention and expert judgments equaled or exceeded 50%. Conclusion: From above results, evidence of the response process validity was demonstrated, indicating that subjects respondeds as intended by the test developer. The revised 19-item CCTS was found to have sufficient reliability and validity and will therefore represents a more convenient measurement of critical thinking ability.

  9. Validation of a clinical critical thinking skills test in nursing.

    Science.gov (United States)

    Shin, Sujin; Jung, Dukyoo; Kim, Sungeun

    2015-01-27

    The purpose of this study was to develop a revised version of the clinical critical thinking skills test (CCTS) and to subsequently validate its performance. This study is a secondary analysis of the CCTS. Data were obtained from a convenience sample of 284 college students in June 2011. Thirty items were analyzed using item response theory and test reliability was assessed. Test-retest reliability was measured using the results of 20 nursing college and graduate school students in July 2013. The content validity of the revised items was analyzed by calculating the degree of agreement between instrument developer intention in item development and the judgments of six experts. To analyze response process validity, qualitative data related to the response processes of nine nursing college students obtained through cognitive interviews were analyzed. Out of initial 30 items, 11 items were excluded after the analysis of difficulty and discrimination parameter. When the 19 items of the revised version of the CCTS were analyzed, levels of item difficulty were found to be relatively low and levels of discrimination were found to be appropriate or high. The degree of agreement between item developer intention and expert judgments equaled or exceeded 50%. From above results, evidence of the response process validity was demonstrated, indicating that subjects respondeds as intended by the test developer. The revised 19-item CCTS was found to have sufficient reliability and validity and will therefore represents a more convenient measurement of critical thinking ability.

  10. Clinic and Emergency Room Evaluation and Testing of Headache.

    Science.gov (United States)

    Nye, Barbara L; Ward, Thomas N

    2015-10-01

    Evaluation of the headache patient in the outpatient clinic and emergency department (ED) has different focuses and goals. The focus of this paper is to review the evaluation of patients in both settings with mention of evaluation in the pediatric and pregnant patient population.  The patient's history should drive the practitioner's decision and evaluation choices. We review recommendations made by the American Board of Internal Medicine and American Headache Society through the Choosing Wisely Campaign, which has an emphasis on choosing the right imaging modality for the clinical situation and elimination/prevention of medication overuse headache, as well as the US Headache Consortium guidelines for migraine headache. We will also review focusing on ED evaluation of the pediatric patient and pregnant patient presenting with headache. At the end of the review we hope to have provided you with a framework to think about the headache patient and what is the appropriate test in the given clinical setting in order to ensure that the patient gets the right diagnosis and is set on a path to the appropriate management plan. © 2015 American Headache Society.

  11. Initial clinical test of a breast-PET scanner

    International Nuclear Information System (INIS)

    Raylman, Raymond R.; Koren, Courtney; Schreiman, Judith S.; Majewski, Stan; Marano, Gary D.; Abraham, Jame; Kurian, Sobha; Hazard, Hannah; Filburn, Shannon

    2011-01-01

    The goal of this initial clinical study was to test a new positron emission/tomography imager and biopsy system (PEM/PET) in a small group of selected subjects to assess its clinical imaging capabilities. Specifically, the main task of this study is to determine whether the new system can successfully be used to produce images of known breast cancer and compare them to those acquired by standard techniques. The PEM/PET system consists of two pairs of rotating radiation detectors located beneath a patient table. The scanner has a spatial resolution of ∼2 mm in all three dimensions. The subjects consisted of five patients diagnosed with locally advanced breast cancer ranging in age from 40 to 55 years old scheduled for pre-treatment, conventional whole body PET imaging with F-18 Fluorodeoxyglucose (FDG). The primary lesions were at least 2 cm in diameter. The images from the PEM/PET system demonstrated that this system is capable of identifying some lesions not visible in standard mammograms. Furthermore, while the relatively large lesions imaged in this study where all visualised by a standard whole body PET/CT scanner, some of the morphology of the tumours (ductal infiltration, for example) was better defined with the PEM/PET system. Significantly, these images were obtained immediately following a standard whole body PET scan. The initial testing of the new PEM/PET system demonstrated that the new system is capable of producing good quality breast-PET images compared standard methods.

  12. Nurse prescribing as an aspect of future role expansion: the views of Irish clinical nurse specialists.

    LENUS (Irish Health Repository)

    Lockwood, Emily B

    2008-10-01

    AIM: Nurses and midwives are expanding the scope of their professional practice, assuming additional responsibilities including the management and prescribing of medications. The aim of the study was to discover the attitudes of clinical nurse specialists (CNSs) in Ireland to nurse prescribing and to examine perceived barriers to engaging in this aspect of future role expansion. BACKGROUND: The expansion of the nursing role in relation to nurse prescribing is an ongoing process and is subject to incremental iterations of legislation and professional policy. Nurse prescribing as an expanded role function has become a reality in many countries. Ireland has addressed the matter in a formal and systematic way through legislation. METHOD: A questionnaire was administered to a sample of 283 CNSs practising in a variety of care settings in Ireland. Attitudes were measured using Likert-type attitudinal scales, designed specifically for the study. RESULTS AND CONCLUSIONS: Findings indicate that the majority of clinical nurse specialists were positively disposed toward nurse prescribing as a future role expansion. The fear of litigation was identified as the most significant barrier to nurse prescribing. The majority of respondents equated nurse prescribing with increased autonomy and holistic care. The findings indicate that there is a need for further examination of the educational requirements of the CNS in relation to nurse prescribing. The legislative implications for nurse prescribing and fear of legal consequences need to be considered prior to any implementation of nurse prescribing. IMPLICATIONS FOR NURSING MANAGEMENT: While senior clinicians are willing to embrace future role expansion in the area of nurse prescribing, their Nurse Managers should recognize that facilitation of nurse prescribing needs to address the legal and educational requirements for such activity. Failure to address these requirements can represent a barrier to role expansion. This paper offers

  13. Nurse prescribing as an aspect of future role expansion: the views of Irish clinical nurse specialists.

    Science.gov (United States)

    Lockwood, Emily B; Fealy, Gerard M

    2008-10-01

    Nurses and midwives are expanding the scope of their professional practice, assuming additional responsibilities including the management and prescribing of medications. The aim of the study was to discover the attitudes of clinical nurse specialists (CNSs) in Ireland to nurse prescribing and to examine perceived barriers to engaging in this aspect of future role expansion. The expansion of the nursing role in relation to nurse prescribing is an ongoing process and is subject to incremental iterations of legislation and professional policy. Nurse prescribing as an expanded role function has become a reality in many countries. Ireland has addressed the matter in a formal and systematic way through legislation. A questionnaire was administered to a sample of 283 CNSs practising in a variety of care settings in Ireland. Attitudes were measured using Likert-type attitudinal scales, designed specifically for the study. Findings indicate that the majority of clinical nurse specialists were positively disposed toward nurse prescribing as a future role expansion. The fear of litigation was identified as the most significant barrier to nurse prescribing. The majority of respondents equated nurse prescribing with increased autonomy and holistic care. The findings indicate that there is a need for further examination of the educational requirements of the CNS in relation to nurse prescribing. The legislative implications for nurse prescribing and fear of legal consequences need to be considered prior to any implementation of nurse prescribing. While senior clinicians are willing to embrace future role expansion in the area of nurse prescribing, their Nurse Managers should recognize that facilitation of nurse prescribing needs to address the legal and educational requirements for such activity. Failure to address these requirements can represent a barrier to role expansion. This paper offers new understandings on the views of senior clinicians concerning nurse prescribing at a

  14. Psychiatric genetic testing: Attitudes and intentions among future users and providers

    DEFF Research Database (Denmark)

    Laegsgaard, Mett Marri; Mors, Ole

    2008-01-01

    as a guide in this field, but the optimal utilization of genetic testing has also been recognized to depend on knowledge of the potential consumers' attitudes. To provide knowledge to inform the public debate on mental illness and genetics, and the future conducting of psychiatric genetic testing....... Psychiatric and somatic genetic testing attracted the same amounts of accept. General attitudes toward access to psychiatric genetic testing and information revealed substantial support for bioethical principles of autonomy and privacy. However, questions describing more specific situations revealed......Psychiatric genetic research may eventually render possible psychiatric genetic testing. Whereas all genetic knowledge has certain characteristics raising ethical, legal, and social issues, psychiatric genetic knowledge adds more controversial issues. Ethical principles have been proposed...

  15. Clinical history and biologic age predicted falls better than objective functional tests.

    Science.gov (United States)

    Gerdhem, Paul; Ringsberg, Karin A M; Akesson, Kristina; Obrant, Karl J

    2005-03-01

    Fall risk assessment is important because the consequences, such as a fracture, may be devastating. The objective of this study was to find the test or tests that best predicted falls in a population-based sample of elderly women. The fall-predictive ability of a questionnaire, a subjective estimate of biologic age and objective functional tests (gait, balance [Romberg and sway test], thigh muscle strength, and visual acuity) were compared in 984 randomly selected women, all 75 years of age. A recalled fall was the most important predictor for future falls. Only recalled falls and intake of psycho-active drugs independently predicted future falls. Women with at least five of the most important fall predictors (previous falls, conditions affecting the balance, tendency to fall, intake of psychoactive medication, inability to stand on one leg, high biologic age) had an odds ratio of 11.27 (95% confidence interval 4.61-27.60) for a fall (sensitivity 70%, specificity 79%). The more time-consuming objective functional tests were of limited importance for fall prediction. A simple clinical history, the inability to stand on one leg, and a subjective estimate of biologic age were more important as part of the fall risk assessment.

  16. Does immunoscintigraphy serve clinical needs effectively? Is there a future for radioimmunotherapy?

    International Nuclear Information System (INIS)

    Chata, J.F.; Peltier, P.; Bardies, M.; Chetanneau, A.; Thedrez, P.; Faivre-Chauvet, A.; Gestin, J.F.

    1992-01-01

    Since 1980, immunoscintigraphy has been performed in thousands of patients, and its clinical value has been demonstrated for selective indications in malignant (early detection of recurrences of colorectal and ovarian carcinomas) and non-malignant (cardiovascular and inflammatory) pathology. However, many clinicians are not yet very convinced of its efficiency. Opinions range between favourable interest and marked scepticism. The causes of this inconclusive verdict include an often moderate target-to-background ratio in images, the immunogenicity of injected murine antibodies and the fact that a true benefit for the patient has not yet been clearly demonstrated in large series of patients. Future prospects could significantly improve this and involve the reduction of non-specific activity in normal tissues (to improve disease target contrast and thus make image interpretation easier) and the decreased immunogenicity of injected immunoconjugates (to permit repetition of examinations). Radioimmunotherapy, an innovative and promising approach, is still limited by numerous problems. The results of clinical studies are still inconclusive, being encouraging only for specific indications. In the future, pre-targetting techniques should allow the rapid elimination of radioactivity from normal tissues, resulting in a significant increase in tumour-to-normal tissue ratios. Progress is also required in the choice of radionuclides and labelling techniques and in methods for dosimetric estimations. The clinical indications of radioimmunotherapy after systemic injection will concern mainly radiosensitive tumours such as lymphomas, small-cell lung cancers and neuroblastomas. After endocavitary injection, radioimmunotherapy could prove efficient in the treatment of micrometastases of ovarian carcinomas. For all indications, this new approach should be combined with other therapeutic modalities. (orig.)

  17. In Vitro Susceptibility Test of Different Clinical Isolates against Ceftriaxone

    Directory of Open Access Journals (Sweden)

    Syed Hakim Masood

    2010-06-01

    Full Text Available Objectives: Because of the prevailing penicillin resistance in microorganisms, broad spectrum cephalosporins are used empirically specially in developing countries. The aim of this study is to determine the susceptibility pattern of different gram positive and gram negative pathogens against third generation cephalosporin-ceftriaxone to explore the existing effectiveness of this antibiotic.Methods: 180 clinical isolates of different gram positive and gram negative pathogens including P.mirabilis, S. typhi P.aeruginosa, E. coli, S. aureus and Klebsiella were collected from blood and urine samples of in-patients. 30 isolates of all species were tested against each of six brands of ceftriaxone using in vitro sensitivity tests by disc diffusion method (NCCLS criteria. The susceptibility limit was ≥21 mm zone of inhibition, while moderately susceptible was considered at 20-14 mm, and those isolates which showed >13 mm or no zone of inhibition were resistant to this antibacterial drug.Results: Ceftriaxone was found most effective against S. aureus. While 96.1% of the isolates showed susceptibility towards ceftriaxone, followed by E. coli (95%, P. aeruginosa (92.7%, K. pneumonia (89.4% and S. typhi (87.2%. P. mirabilis showed lowest susceptibility amongst all the test organisms (83.8%.Conclusion: Ceftriaxone can be used as a drug of choice in infections caused by S. aureus, E. coli, P. aurigenosa, K. pneumonia and S. typhi. However, it should be used with other antimicrobial agents in order to increase its effectiveness against P. mirabilis.

  18. Epicardial fat and atrial fibrillation: current evidence, potential mechanisms, clinical implications, and future directions.

    Science.gov (United States)

    Wong, Christopher X; Ganesan, Anand N; Selvanayagam, Joseph B

    2017-05-01

    Obesity is increasingly recognized as a major modifiable determinant of atrial fibrillation (AF). Although body mass index and other clinical measures are useful indications of general adiposity, much recent interest has focused on epicardial fat, a distinct adipose tissue depot that can be readily assessed using non-invasive imaging techniques. A growing body of data from epidemiological and clinical studies has demonstrated that epicardial fat is consistently associated with the presence, severity, and recurrence of AF across a range of clinical settings. Evidence from basic science and translational studies has also suggested that arrhythmogenic mechanisms may involve adipocyte infiltration, pro-fibrotic, and pro-inflammatory paracrine effects, oxidative stress, and other pathways. Despite these advances, however, significant uncertainty exists and many questions remain unanswered. In this article, we review our present understanding of epicardial fat, including its classification and quantification, existing evidence implicating its role in AF, potential mechanisms, implications for clinicians, and future directions for research. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

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

    Directory of Open Access Journals (Sweden)

    Maximilian J. Waldner

    2017-10-01

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

  20. Current status and future prospects of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) clinical trials in ovarian cancer.

    Science.gov (United States)

    Cowan, Renee A; O'Cearbhaill, Roisin E; Zivanovic, Oliver; Chi, Dennis S

    2017-08-01

    The natural history of advanced-stage epithelial ovarian cancer is one of clinical remission after surgery and platinum/taxane-based intravenous (IV) and/or intraperitoneal (IP) chemotherapy followed by early or late recurrence in the majority of patients. Prevention of progression and recurrence remains a major hurdle in the management of ovarian cancer. Recently, many investigators have evaluated the use of normothermic and hyperthermic intraoperative IP drug delivery as a management strategy. This is a narrative review of the current status of clinical trials of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) in ovarian cancer and the future directions for this treatment strategy. The existing studies on HIPEC in patients with epithelial ovarian cancer are mostly retrospective in nature, are heterogeneous with regards to combined inclusion of primary and recurrent disease and lack unbiased data. Until data are available from evidence-based trials, it is reasonable to conclude that surgical cytoreduction and HIPEC is a rational and interesting, though still investigative, approach in the management of epithelial ovarian cancer, whose use should be employed within prospective clinical trials.

  1. Clinical Trials in Cardiac Arrest and Subarachnoid Hemorrhage: Lessons from the Past and Ideas for the Future

    Directory of Open Access Journals (Sweden)

    Jennifer A. Frontera

    2013-01-01

    Full Text Available Introduction. Elevated intracranial pressure that occurs at the time of cerebral aneurysm rupture can lead to inadequate cerebral blood flow, which may mimic the brain injury cascade that occurs after cardiac arrest. Insights from clinical trials in cardiac arrest may provide direction for future early brain injury research after subarachnoid hemorrhage (SAH. Methods. A search of PubMed from 1980 to 2012 and clinicaltrials.gov was conducted to identify published and ongoing randomized clinical trials in aneurysmal SAH and cardiac arrest patients. Only English, adult, human studies with primary or secondary mortality or neurological outcomes were included. Results. A total of 142 trials (82 SAH, 60 cardiac arrest met the review criteria (103 published, 39 ongoing. The majority of both published and ongoing SAH trials focus on delayed secondary insults after SAH (70%, while 100% of cardiac arrest trials tested interventions within the first few hours of ictus. No SAH trials addressing treatment of early brain injury were identified. Twenty-nine percent of SAH and 13% of cardiac arrest trials showed outcome benefit, though there is no overlap mechanistically. Conclusions. Clinical trials in SAH assessing acute brain injury are warranted and successful interventions identified by the cardiac arrest literature may be reasonable targets of the study.

  2. Points to consider for prioritizing clinical genetic testing services

    DEFF Research Database (Denmark)

    Severin, Franziska; Borry, Pascal; Cornel, Martina C

    2015-01-01

    Given the cost constraints of the European health-care systems, criteria are needed to decide which genetic services to fund from the public budgets, if not all can be covered. To ensure that high-priority services are available equitably within and across the European countries, a shared set...... testing services available in the next decade. Ethically and economically reflected prioritization criteria are needed. Prioritization should be based on considerations of medical benefit, health need and costs. Medical benefit includes evidence of benefit in terms of clinical benefit, benefit......, following the principles of accountability for reasonableness. We provide points to consider to stimulate this debate across the EU and to serve as a reference for improving patient management.European Journal of Human Genetics advance online publication, 24 September 2014; doi:10.1038/ejhg.2014.190....

  3. PERSONALITY AND CLINICAL TESTS IN SPANISH FOR ASSESSING JUVENILE OFFENDERS

    Directory of Open Access Journals (Sweden)

    Lorena Wenger

    2016-05-01

    Full Text Available The psychological assessment of offenders throughout the different stages in the juvenile justice system is essential. It ensures the adequacy of the legal and educational measures to be applied in the process. This paper reviews the main tests of psychological assessment available in Spanish, suitable for use by psychology professionals who work with young offenders in the juvenile justice services in Spanish-speaking countries. We classify these tools into three groups: a personological, i.e. generic tools, suitable for any professional context in psychology, b clinical, i.e. tools whose initial use has been limited to working with adolescents with mental health needs, and c forensic, tools that have been specially developed for use in the juvenile justice population. This last group is described in the second part of this article (which appears in this same issue. The most important instruments of proven utility are presented and reviewed for each group.

  4. Abnormalities of laboratory coagulation tests versus clinically evident coagulopathic bleeding

    DEFF Research Database (Denmark)

    Chang, Ronald; Fox, Erin E; Greene, Thomas J

    2018-01-01

    BACKGROUND: Laboratory-based evidence of coagulopathy (LC) is observed in 25-35% of trauma patients, but clinically-evident coagulopathy (CC) is not well described. METHODS: Prospective observational study of adult trauma patients transported by helicopter from the scene to nine Level 1 trauma...... centers in 2015. Patients meeting predefined highest-risk criteria were divided into CC+ (predefined as surgeon-confirmed bleeding from uninjured sites or injured sites not controllable by sutures) or CC-. We used a mixed-effects, Poisson regression with robust error variance to test the hypothesis...... that abnormalities on rapid thrombelastography (r-TEG) and international normalized ratio (INR) were independently associated with CC+. RESULTS: Of 1,019 highest-risk patients, CC+ (n=41, 4%) were more severely injured (median ISS 32 vs 17), had evidence of LC on r-TEG and INR, received more transfused blood...

  5. Present status and future perspectives of research and test reactor in Japan

    International Nuclear Information System (INIS)

    Kaneko, Yoshihiko; Kaieda, Keisuke

    2000-01-01

    Since 1957, Japan Atomic Energy Research Institute (JAERI) has constructed several research and test reactors to fulfill a major role in the study of nuclear energy and fundamental research. At present four reactors, the Japan Research Reactor No. 3 and No. 4 (JRR-3M and JRR-4 respectively), the Japan Materials Testing Reactor (JMTR) and the Nuclear Safety Research Reactor (NSRR) are in operation, and a new High Temperature Engineering Test Reactor (HTTR) has recently reached first criticality and now in the power up test. In 1966, the Kyoto University built the Kyoto University Reactor (KUR) and started its operation for joint use program of the Japanese universities. This paper introduces these reactors and describes their present operational status and also efforts for aging management. The recent tendency of utilization and future perspectives is also reported. (author)

  6. Present status and future perspectives of research and test reactor in Japan

    Energy Technology Data Exchange (ETDEWEB)

    Kaneko, Yoshihiko [Atomic Energy Research Laboratory, Musashi Institute of Technology, Kawasaki, Kanagawa (Japan); Kaieda, Keisuke [Department of Research Reactor, Japan Atomic Energy Research Inst., Tokai, Ibaraki (Japan)

    2000-10-01

    Since 1957, Japan Atomic Energy Research Institute (JAERI) has constructed several research and test reactors to fulfill a major role in the study of nuclear energy and fundamental research. At present four reactors, the Japan Research Reactor No. 3 and No. 4 (JRR-3M and JRR-4 respectively), the Japan Materials Testing Reactor (JMTR) and the Nuclear Safety Research Reactor (NSRR) are in operation, and a new High Temperature Engineering Test Reactor (HTTR) has recently reached first criticality and now in the power up test. In 1966, the Kyoto University built the Kyoto University Reactor (KUR) and started its operation for joint use program of the Japanese universities. This paper introduces these reactors and describes their present operational status and also efforts for aging management. The recent tendency of utilization and future perspectives is also reported. (author)

  7. Climate Science for a Sustainable Energy Future Test Bed and Data Infrastructure Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Williams, Dean N. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Foster, I. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Van Dam, Kerstin Kleese [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Shipman, G. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

    2014-05-04

    The collaborative Climate Science for a Sustainable Energy Future (CSSEF) project started in July 2011 with the goal of accelerating the development of climate model components (i.e., atmosphere, ocean and sea ice, and land surface) and enhancing their predictive capabilities while incorporating uncertainty quantification (UQ). This effort required accessing and converting observational data sets into specialized model testing and verification data sets and building a model development test bed, where model components and sub-models can be rapidly evaluated. CSSEF’s prototype test bed demonstrated, how an integrated testbed could eliminate tedious activities associated with model development and evaluation, by providing the capability to constantly compare model output—where scientists store, acquire, reformat, regrid, and analyze data sets one-by-one—to observational measurements in a controlled test bed.

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

    Science.gov (United States)

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

    2011-01-01

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

  9. Validity of Forced Eyelid Closure Test: A Novel Clinical Screening Test for Ocular Myasthenia Gravis.

    Science.gov (United States)

    Apinyawasisuk, Supanut; Zhou, Xinkai; Tian, Jack J; Garcia, Giancarlo A; Karanjia, Rustum; Sadun, Alfredo A

    2017-09-01

    Forced eyelid closure test (FECT) is a clinical screening test developed from the original Cogan lid twitch (CLT) sign to assist in the diagnosis of ocular myasthenia gravis (OMG), We evaluated the sensitivity and specificity of FECT compared with CLT and benchmarked to standard diagnostic tests. This study was a retrospective chart review of 48 patients using electronic medical records of those that presented with ptosis and/or diplopia at Doheny Eye Institute, University of California, Los Angeles between February 2015 and April 2016. Patients without FECT testing were excluded. FECT and CLT results, and final diagnosis were recorded. To perform FECT, the patient was asked to squeeze his or her eyelids shut for 5-10 seconds then open quickly and fixate in primary position. The excessive upward overshoot of eyelids movement indicated a positive FECT. The test was performed by a neuro-ophthalmologist before establishing the diagnosis. Patients who had equivocal test results and/or inconclusive final diagnosis were excluded. Of the 48 patients studied, 18 patients (37.5%) had positive FECT; 15 of whom had a final diagnosis of OMG (83.3%). Of the 30 patients with negative FECT, 1 had OMG (3.3%). Of the 48 patients, 35 patients also had a documented CLT result (72.9%). CLT was positive in 11 of these 35 patients (31.4%), and 9 of these 11 had OMG (81.8%). Of the 24 patients with negative CLT, 2 of them had OMG (8.3%). Sensitivity and specificity of FECT were 94% and 91% (joint 95% confidence region: sensitivity × specificity = [0.70, 1] × [0.75, 1]). The relative true-positive fraction (rTPF) between FECT and CLT was 1.15; the relative false-positive fraction was 1.31. FECT is a simple clinical screening test with good sensitivity and specificity for OMG.

  10. A NEW CLINICAL MUSCLE FUNCTION TEST FOR ASSESSMENT OF HIP EXTERNAL ROTATION STRENGTH: AUGUSTSSON STRENGTH TEST.

    Science.gov (United States)

    Augustsson, Jesper

    2016-08-01

    Dynamic clinical tests of hip strength applicable on patients, non-athletes and athletes alike, are lacking. The aim of this study was therefore to develop and evaluate the reliability of a dynamic muscle function test of hip external rotation strength, using a novel device. A second aim was to determine if gender differences exist in absolute and relative hip strength using the new test. Fifty-three healthy sport science students (34 women and 19 men) were tested for hip external rotation strength using a device that consisted of a strap connected in series with an elastic resistance band loop, and a measuring tape connected in parallel with the elastic resistance band. The test was carried out with the subject side lying, positioned in 45 ° of hip flexion and the knees flexed to 90 ° with the device firmly fastened proximally across the knees. The subject then exerted maximal concentric hip external rotation force against the device thereby extending the elastic resistance band. The displacement achieved by the subject was documented by the tape measure and the corresponding force production was calculated. Both right and left hip strength was measured. Fifteen of the subjects were tested on repeated occasions to evaluate test-retest reliability. No significant test-retest differences were observed. Intra-class correlation coefficients ranged 0.93-0.94 and coefficients of variation 2.76-4.60%. In absolute values, men were significantly stronger in hip external rotation than women (right side 13.2 vs 11.0 kg, p = 0.001, left side 13.2 vs 11.5 kg, p = 0.002). There were no significant differences in hip external rotation strength normalized for body weight (BW) between men and women (right side 0.17 kg/BW vs 0.17 kg/BW, p = 0.675, left side 0.17 kg/BW vs 0.18 kg/BW, p = 0.156). The new muscle function test showed high reliability and thus could be useful for measuring dynamic hip external rotation strength in patients, non-athletes and athletes

  11. 'False-positive' and 'false-negative' test results in clinical urine drug testing.

    Science.gov (United States)

    Reisfield, Gary M; Goldberger, Bruce A; Bertholf, Roger L

    2009-08-01

    The terms 'false-positive' and 'false-negative' are widely used in discussions of urine drug test (UDT) results. These terms are inadequate because they are used in different ways by physicians and laboratory professionals and they are too narrow to encompass the larger universe of potentially misleading, inappropriate and unexpected drug test results. This larger universe, while not solely comprised of technically 'true' or 'false' positive or negative test results, presents comparable interpretive challenges with corresponding clinical implications. In this review, we propose the terms 'potentially inappropriate' positive or negative test results in reference to UDT results that are ambiguous or unexpected and subject to misinterpretation. Causes of potentially inappropriate positive UDT results include in vivo metabolic conversions of a drug, exposure to nonillicit sources of a drug and laboratory error. Causes of potentially inappropriate negative UDT results include limited assay specificity, absence of drug in the urine, presence of drug in the urine, but below established assay cutoff, specimen manipulation and laboratory error. Clinical UDT interpretation is a complicated task requiring knowledge of recent prescription, over-the-counter and herbal drug administration, drug metabolism and analytical sensitivities and specificities.

  12. Testing a theoretical model of clinical nurses' intent to stay.

    Science.gov (United States)

    Cowden, Tracy L; Cummings, Greta G

    2015-01-01

    Published theoretical models of nurses' intent to stay (ITS) report inconsistent outcomes, and not all hypothesized models have been adequately tested. Research has focused on cognitive rather than emotional determinants of nurses' ITS. The aim of this study was to empirically verify a complex theoretical model of nurses' ITS that includes both affective and cognitive determinants and to explore the influence of relational leadership on staff nurses' ITS. The study was a correlational, mixed-method, nonexperimental design. A subsample of the Quality Work Environment Study survey data 2009 (n = 415 nurses) was used to test our theoretical model of clinical nurses' ITS as a structural equation model. The model explained 63% of variance in ITS. Organizational commitment, empowerment, and desire to stay were the model concepts with the strongest effects on nurses' ITS. Leadership practices indirectly influenced ITS. How nurses evaluate and respond to their work environment is both an emotional and rational process. Health care organizations need to be cognizant of the influence that nurses' feelings and views of their work setting have on their intention decisions and integrate that knowledge into the development of retention strategies. Leadership practices play an important role in staff nurses' perceptions of the workplace. Identifying the mechanisms by which leadership influences staff nurses' intentions to stay presents additional focus areas for developing retention strategies.

  13. Nuclear separations for radiopharmacy : the need for improved separations to meet future research and clinical demands

    International Nuclear Information System (INIS)

    Bond, A.H.; Rogers, R.D.; Dietz, M.L.

    2000-01-01

    Several recent national and international reports have predicted that the demand for radionuclides used in medicine will increase significantly over the next 20 years. Separation science is an integral part of the production and development of new radionuclides for diagnostic and therapeutic applications and will play a major role in process improvements to existing radiopharmaceuticals to meet increasing demands. The role of separation science in the production of radionuclides for medical applications is briefly discussed, followed by an overview of the manuscripts from the American Chemical Society symposium 'Nuclear Separations for Radiopharmacy'. A listing of the most widely used radionuclides in clinical application and medical research serves as a foundation for the discussion of future research opportunities in separation science

  14. Soft tissue sarcomas in the precision medicine era: new advances in clinical practice and future perspectives.

    Science.gov (United States)

    Badalamenti, Giuseppe; Messina, Carlo; De Luca, Ida; Musso, Emmanuela; Casarin, Alessandra; Incorvaia, Lorena

    2018-04-04

    Soft tissue sarcomas (STSs) represent a rare and heterogeneous group of solid tumours derived from mesenchymal progenitors and account for 1% of all adult malignancies. Although in the last decade anthracycline-based chemotherapy single agent or in combinations has been able to improve clinical benefits, prognosis is still poor and STSs represent an important unmet medical need. Continuous advances in cancer genetics and genomics have contributed to change management paradigms of STSs as it occurred for other solid tumours. Several treatments have been recently developed with the specific aim of targeting different cell pathways and immune-checkpoints that have been recognized to drive tumour progression. The following attempts to provide a review of literature focusing on the available data concerning novel treatments and future prospective for the management of metastatic STSs.

  15. Indocyanine green enhanced surgery; principle, clinical applications and future research directions

    Directory of Open Access Journals (Sweden)

    Catalin Alius

    2018-05-01

    Full Text Available Over the past decade a new emergent technology has become very popular in all fields of surgery using Indocyanine green and near infrared fluorescent optical systems. This revolutionary approach overlaps conventional and near infrared images to produce highly informative intraoperative images on the anatomy and physiology of various tissues. Near infrared fluorescence is employed for perioperative angiography in vascular mapping, assessment of anastomoses, location of sentinel lymph nodes and delineation of biliary tree anatomy, highlighting tumours and metastatic deposits, improving surgical techniques and for many other uses. A lot of researchers have reported better surgical outcomes and technique innovations facilitated by this novel technology which although in its early stages, it lights up great interest worldwide. This article reviews the principle of the method, the properties of the fluorescent dye, the main clinical applications and discusses future research directions.

  16. Distinguishing between unipolar depression and bipolar depression: current and future clinical and neuroimaging perspectives.

    Science.gov (United States)

    Cardoso de Almeida, Jorge Renner; Phillips, Mary Louise

    2013-01-15

    Differentiating bipolar disorder (BD) from recurrent unipolar depression (UD) is a major clinical challenge. Main reasons for this include the higher prevalence of depressive relative to hypo/manic symptoms during the course of BD illness and the high prevalence of subthreshold manic symptoms in both BD and UD depression. Identifying objective markers of BD might help improve accuracy in differentiating between BD and UD depression, to ultimately optimize clinical and functional outcome for all depressed individuals. Yet, only eight neuroimaging studies to date have directly compared UD and BD depressed individuals. Findings from these studies suggest more widespread abnormalities in white matter connectivity and white matter hyperintensities in BD than UD depression, habenula volume reductions in BD but not UD depression, and differential patterns of functional abnormalities in emotion regulation and attentional control neural circuitry in the two depression types. These findings suggest different pathophysiologic processes, especially in emotion regulation, reward, and attentional control neural circuitry in BD versus UD depression. This review thereby serves as a call to action to highlight the pressing need for more neuroimaging studies, using larger samples sizes, comparing BD and UD depressed individuals. These future studies should also include dimensional approaches, studies of at-risk individuals, and more novel neuroimaging approaches, such as connectivity analysis and machine learning. Ultimately, these approaches might provide biomarkers to identify individuals at future risk for BD versus UD and biological targets for more personalized treatment and new treatment developments for BD and UD depression. Copyright © 2013 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

  17. Quality and future of clinical laboratories: the Vico's whole cyclical theory of the recurring cycles.

    Science.gov (United States)

    Plebani, Mario

    2018-05-24

    In the last few decades, laboratory medicine has undergone monumental changes, and laboratory technology, which has made enormous advances, now has new clinical applications thanks to the identification of a growing number of biomarkers and risk factors conducive to the promotion of predictive and preventive interventions that have enhanced the role of laboratory medicine in health care delivering. However, the paradigm shift in the past 50 years has led to a gap between laboratory and clinic, with an increased risk of inappropriateness in test request and interpretation, as well as the consolidation of analytical work in focused factories and megastructurers oriented only toward achieving greater volumes, decreasing cost per test and generating a vision of laboratory services as simple commodities. A careful historical revision of the changing models for delivering laboratory services in the United States leads to the prediction that there are several reasons for counteracting the vision of clinical laboratory as a commodity, and restoring the true nature of laboratory services as an integral part of the diagnosis and therapy process. The present study, which reports on internal and external drivers for change, proposes an integrated vision of quality in laboratory medicine.

  18. Clinical leadership for high-quality care: developing future ward leaders.

    Science.gov (United States)

    Enterkin, Judith; Robb, Elizabeth; McLaren, Susan

    2013-03-01

    This paper reports upon the development, delivery and evaluation of a leadership programme for aspiring Ward Leaders in one National Health Service Trust in England. The ward sister role is fundamental to quality patient care and clinical leadership, however the role is increasingly difficult to recruit to. A lack of formal preparation and skills development for the role has been widely acknowledged. An evaluation of a programme of education for leadership. Three cohorts (n = 60) completed the programme. Semi-structured questionnaires were completed by participants (n = 36: 60%) at the conclusion of the programme. Qualitative data from questionnaires was analysed using a thematic approach. Participants reported increased political, organizational and self-awareness, increased confidence, feelings of empowerment and the ability to empower others. Opportunities for networking with peers were valued within the action learning approach. For some participants, career intentions were clarified through reflection. The majority of participants had benefited from the leadership programme and valued this development as an empowering preparation for future careers. Investment in leadership preparation for future ward sister roles is strongly recommended as part of a strategy designed to enhance quality improvement, career path development, workforce empowerment and retention. © 2012 Blackwell Publishing Ltd.

  19. Future Food Production System Development Pulling From Space Biology Crop Growth Testing in Veggie

    Science.gov (United States)

    Massa, Gioia; Romeyn, Matt; Fritsche, Ralph

    2017-01-01

    Preliminary crop testing using Veggie indicates the environmental conditions provided by the ISS are generally suitable for food crop production. When plant samples were returned to Earth for analysis, their levels of nutrients were comparable to Earth-grown ground controls. Veggie-grown produce food safety microbiology analysis indicated that space-grown crops are safe to consume. Produce sanitizing wipes were used on-orbit to further reduce risk of foodborne illness. Validation growth tests indicated abiotic challenges of insufficient or excess fluid delivery, potentially reduced air flow leading to excess water, elevated CO2 leading to physiological responses, and microorganisms that became opportunistic pathogens. As NASA works to develop future space food production, several areas of research to define these systems pull from the Veggie technology validation tests. Research into effective, reusable water delivery and water recovery methods for future food production systems arises from abiotic challenges observed. Additionally, impacts of elevated CO2 and refinement of fertilizer and light recipes for crops needs to be assessed. Biotic pulls include methods or technologies to effectively sanitize produce with few consumables and low inputs; work to understand the phytomicrobiome and potentially use it to protect crops or enhance growth; selection of crops with high harvest index and desirable flavors for supplemental nutrition; crops that provide psychosocial benefits, and custom space crop development. Planning for future food production in a deep space gateway or a deep space transit vehicle requires methods of handling and storing seeds, and ensuring space seeds are free of contaminants and long-lived. Space food production systems may require mechanization and autonomous operation, with preliminary testing initiated to identify operations and capabilities that are candidates for automation. Food production design is also pulling from Veggie logistics

  20. Present and future of clinical cardiovascular PET imaging in Europe - a position statement by the European Council of Nuclear Cardiology (ECNC)

    International Nuclear Information System (INIS)

    Le Guludec, D.; Lautamaeki, R.; Bengel, F.M.; Knuuti, J.; Bax, J.J.

    2008-01-01

    This position statement was prepared by the European Council of Nuclear Cardiology and summarises the current and future potential of PET as a clinical cardiovascular diagnostic imaging tool. The first section describes how methodological developments have positively influenced the transition of PET from a research tool towards a clinical diagnostic test. In the second section, evidence in support of its superior diagnostic accuracy, its value to guide decision making and to predict outcome and its cost effectiveness is summarised. The third section finally outlines new PET-based approaches and concepts, which will likely influence clinical cardiovascular medicine in the future. The notion that integration of cardiac PET into healthcare systems and disease management algorithms will advance quality of care is increasingly supported by the literature highlighted in this statement. (orig.)

  1. Point-of-care testing in the diagnosis of gastrointestinal cancers: current technology and future directions.

    Science.gov (United States)

    Huddy, Jeremy R; Ni, Melody Z; Markar, Sheraz R; Hanna, George B

    2015-04-14

    Point-of-care (POC) tests enable rapid results and are well established in medical practice. Recent advances in analytical techniques have led to a new generation of POC devices that will alter gastrointestinal diagnostic pathways. This review aims to identify current and new technologies for the POC diagnosis of gastrointestinal cancer. A structured search of the Embase and Medline databases was performed. Papers reporting diagnostic tests for gastrointestinal cancer available as a POC device or containing a description of feasibility for POC application were included. Studies recovered were heterogeneous and therefore results are presented as a narrative review. Six diagnostic methods were identified (fecal occult blood, fecal proteins, volatile organic compounds, pyruvate kinase isoenzyme type M2, tumour markers and DNA analysis). Fecal occult blood testing has a reported sensitivity of 66%-85% and specificity greater than 95%. The others are at a range of development and clinical application. POC devices have a proven role in the diagnosis of gastrointestinal cancer. Barriers to their implementation exist and the transition from experimental to clinical medicine is currently slow. New technologies demonstrate potential to provide accurate POC tests and an ability to diagnose gastrointestinal cancer at an early stage with improved clinical outcome and survival.

  2. Acceleration of cardiovascular MRI using parallel imaging: basic principles, practical considerations, clinical applications and future directions

    International Nuclear Information System (INIS)

    Niendorf, T.; Sodickson, D.

    2006-01-01

    Cardiovascular Magnetic Resonance (CVMR) imaging has proven to be of clinical value for non-invasive diagnostic imaging of cardiovascular diseases. CVMR requires rapid imaging; however, the speed of conventional MRI is fundamentally limited due to its sequential approach to image acquisition, in which data points are collected one after the other in the presence of sequentially-applied magnetic field gradients and radiofrequency coils to acquire multiple data points simultaneously, and thereby to increase imaging speed and efficiency beyond the limits of purely gradient-based approaches. The resulting improvements in imaging speed can be used in various ways, including shortening long examinations, improving spatial resolution and anatomic coverage, improving temporal resolution, enhancing image quality, overcoming physiological constraints, detecting and correcting for physiologic motion, and streamlining work flow. Examples of these strategies will be provided in this review, after some of the fundamentals of parallel imaging methods now in use for cardiovascular MRI are outlined. The emphasis will rest upon basic principles and clinical state-of-the art cardiovascular MRI applications. In addition, practical aspects such as signal-to-noise ratio considerations, tailored parallel imaging protocols and potential artifacts will be discussed, and current trends and future directions will be explored. (orig.)

  3. Nuclear magnetic resonance based metabolomics and liver diseases: Recent advances and future clinical applications.

    Science.gov (United States)

    Amathieu, Roland; Triba, Mohamed Nawfal; Goossens, Corentine; Bouchemal, Nadia; Nahon, Pierre; Savarin, Philippe; Le Moyec, Laurence

    2016-01-07

    Metabolomics is defined as the quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modification. It is an "omics" technique that is situated downstream of genomics, transcriptomics and proteomics. Metabolomics is recognized as a promising technique in the field of systems biology for the evaluation of global metabolic changes. During the last decade, metabolomics approaches have become widely used in the study of liver diseases for the detection of early biomarkers and altered metabolic pathways. It is a powerful technique to improve our pathophysiological knowledge of various liver diseases. It can be a useful tool to help clinicians in the diagnostic process especially to distinguish malignant and non-malignant liver disease as well as to determine the etiology or severity of the liver disease. It can also assess therapeutic response or predict drug induced liver injury. Nevertheless, the usefulness of metabolomics is often not understood by clinicians, especially the concept of metabolomics profiling or fingerprinting. In the present work, after a concise description of the different techniques and processes used in metabolomics, we will review the main research on this subject by focusing specifically on in vitro proton nuclear magnetic resonance spectroscopy based metabolomics approaches in human studies. We will first consider the clinical point of view enlighten physicians on this new approach and emphasis its future use in clinical "routine".

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

    Science.gov (United States)

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

    2016-03-02

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

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

    Science.gov (United States)

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

    2016-01-01

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

  6. Resistance to EGFR inhibitors in non-small cell lung cancer: Clinical management and future perspectives.

    Science.gov (United States)

    Tomasello, Chiara; Baldessari, Cinzia; Napolitano, Martina; Orsi, Giulia; Grizzi, Giulia; Bertolini, Federica; Barbieri, Fausto; Cascinu, Stefano

    2018-03-01

    In the last few years, the development of targeted therapies for non-small cell lung cancer (NSCLC) expressing oncogenic driver mutations (e.g. EGFR) has changed the clinical management and the survival outcomes of this specific minority of patients. Several phase III trials demonstrated the superiority of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs) over chemotherapy in EGFR-mutant NSCLC patients. However, in the vast majority of cases EGFR TKIs lose their clinical activity within 8-12 months. Many genetic aberrations have been described as possible mechanisms of EGFR TKIs acquired resistance and can be clustered in four main sub-groups: 1. Development of secondary EGFR mutations; 2. Activation of parallel signaling pathways; 3. Histological transformation; 4. Activation of downstream signaling pathways. In this review we will describe the molecular alterations underlying each of these EGFR TKIs resistance mechanisms, focusing on the currently available and future therapeutic strategies to overcome these phenomena. Copyright © 2018 Elsevier B.V. All rights reserved.

  7. Testing Quality and Metrics for the LHC Magnet Powering System throughout Past and Future Commissioning

    CERN Document Server

    Anderson, D; Charifoulline, Z; Dragu, M; Fuchsberger, K; Garnier, JC; Gorzawski, AA; Koza, M; Krol, K; Rowan, S; Stamos, K; Zerlauth, M

    2014-01-01

    The LHC magnet powering system is composed of thousands of individual components to assure a safe operation when operating with stored energies as high as 10GJ in the superconducting LHC magnets. Each of these components has to be thoroughly commissioned following interventions and machine shutdown periods to assure their protection function in case of powering failures. As well as having dependable tracking of test executions it is vital that the executed commissioning steps and applied analysis criteria adequately represent the operational state of each component. The Accelerator Testing (AccTesting) framework in combination with a domain specific analysis language provides the means to quantify and improve the quality of analysis for future campaigns. Dedicated tools were developed to analyse in detail the reasons for failures and success of commissioning steps in past campaigns and to compare the results with newly developed quality metrics. Observed shortcomings and discrepancies are used to propose addi...

  8. Future aerospace ground test facility requirements for the Arnold Engineering Development Center

    Science.gov (United States)

    Kirchner, Mark E.; Baron, Judson R.; Bogdonoff, Seymour M.; Carter, Donald I.; Couch, Lana M.; Fanning, Arthur E.; Heiser, William H.; Koff, Bernard L.; Melnik, Robert E.; Mercer, Stephen C.

    1992-01-01

    Arnold Engineering Development Center (AEDC) was conceived at the close of World War II, when major new developments in flight technology were presaged by new aerodynamic and propulsion concepts. During the past 40 years, AEDC has played a significant part in the development of many aerospace systems. The original plans were extended through the years by some additional facilities, particularly in the area of propulsion testing. AEDC now has undertaken development of a master plan in an attempt to project requirements and to plan for ground test and computational facilities over the coming 20 to 30 years. This report was prepared in response to an AEDC request that the National Research Council (NRC) assemble a committee to prepare guidance for planning and modernizing AEDC facilities for the development and testing of future classes of aerospace systems as envisaged by the U.S. Air Force.

  9. Stirling Convertor Performance Mapping Test Results for Future Radioisotope Power Systems

    Science.gov (United States)

    Qiu, Songgang; Peterson, Allen A.; Faultersack, Franklyn D.; Redinger, Darin L.; Augenblick, John E.

    2004-02-01

    Long-life radioisotope-fueled generators based on free-piston Stirling convertors are an energy-conversion solution for future space applications. The high efficiency of Stirling machines makes them more attractive than the thermoelectric generators currently used in space. Stirling Technology Company (STC) has been performance-testing its Stirling generators to provide data for potential system integration contractors. This paper describes the most recent test results from the STC RemoteGen™ 55 W-class Stirling generators (RG-55). Comparisons are made between the new data and previous Stirling thermodynamic simulation models. Performance-mapping tests are presented including variations in: internal charge pressure, cold end temperature, hot end temperature, alternator temperature, input power, and variation of control voltage.

  10. Instrumented static and dynamic balance assessment after stroke using Wii Balance Boards: reliability and association with clinical tests.

    Science.gov (United States)

    Bower, Kelly J; McGinley, Jennifer L; Miller, Kimberly J; Clark, Ross A

    2014-01-01

    The Wii Balance Board (WBB) is a globally accessible device that shows promise as a clinically useful balance assessment tool. Although the WBB has been found to be comparable to a laboratory-grade force platform for obtaining centre of pressure data, it has not been comprehensively studied in clinical populations. The aim of this study was to investigate the measurement properties of tests utilising the WBB in people after stroke. Thirty individuals who were more than three months post-stroke and able to stand unsupported were recruited from a single outpatient rehabilitation facility. Participants performed standardised assessments incorporating the WBB and customised software (static stance with eyes open and closed, static weight-bearing asymmetry, dynamic mediolateral weight shifting and dynamic sit-to-stand) in addition to commonly employed clinical tests (10 Metre Walk Test, Timed Up and Go, Step Test and Functional Reach) on two testing occasions one week apart. Test-retest reliability and construct validity of the WBB tests were investigated. All WBB-based outcomes were found to be highly reliable between testing occasions (ICC  = 0.82 to 0.98). Correlations were poor to moderate between WBB variables and clinical tests, with the strongest associations observed between task-related activities, such as WBB mediolateral weight shifting and the Step Test. The WBB, used with customised software, is a reliable and potentially useful tool for the assessment of balance and weight-bearing asymmetry following stroke. Future research is recommended to further investigate validity and responsiveness.

  11. Consensus report on the future of animal-free systemic toxicity testing.

    Science.gov (United States)

    Leist, Marcel; Hasiwa, Nina; Rovida, Costanza; Daneshian, Mardas; Basketter, David; Kimber, Ian; Clewell, Harvey; Gocht, Tilman; Goldberg, Alan; Busquet, Francois; Rossi, Anna-Maria; Schwarz, Michael; Stephens, Martin; Taalman, Rob; Knudsen, Thomas B; McKim, James; Harris, Georgina; Pamies, David; Hartung, Thomas

    2014-01-01

    Since March 2013, animal use for cosmetics testing for the European market has been banned. This requires a renewed view on risk assessment in this field. However, in other fields as well, traditional animal experimentation does not always satisfy requirements in safety testing, as the need for human-relevant information is ever increasing. A general strategy for animal-free test approaches was outlined by the US National Research Council`s vision document for Toxicity Testing in the 21st Century in 2007. It is now possible to provide a more defined roadmap on how to implement this vision for the four principal areas of systemic toxicity evaluation: repeat dose organ toxicity, carcinogenicity, reproductive toxicity and allergy induction (skin sensitization), as well as for the evaluation of toxicant metabolism (toxicokinetics) (Fig. 1). CAAT-Europe assembled experts from Europe, America and Asia to design a scientific roadmap for future risk assessment approaches and the outcome was then further discussed and refined in two consensus meetings with over 200 stakeholders. The key recommendations include: focusing on improving existing methods rather than favoring de novo design; combining hazard testing with toxicokinetics predictions; developing integrated test strategies; incorporating new high content endpoints to classical assays; evolving test validation procedures; promoting collaboration and data-sharing of different industrial sectors; integrating new disciplines, such as systems biology and high throughput screening; and involving regulators early on in the test development process. A focus on data quality, combined with increased attention to the scientific background of a test method, will be important drivers. Information from each test system should be mapped along adverse outcome pathways. Finally, quantitative information on all factors and key events will be fed into systems biology models that allow a probabilistic risk assessment with flexible

  12. Testing nonlinear-QED at the future linear collider with an intense laser

    International Nuclear Information System (INIS)

    Hartin, Anthony; Porto, Stefano; Moortgat-Pick, Gudrid; Hamburg Univ.

    2014-04-01

    The future linear collider will collide dense e + e - bunches at high energies up to 1 TeV, generating very intense electromagnetic fields at the interaction point (IP). These fields are strong enough to lead to nonlinear effects which affect all IP processes and which are described by strong field physics theory. In order to test this theory, we propose an experiment that will focus an intense laser on the LC electron beam post-IP. Similar experiments at SLAC E144 have investigated nonlinear Compton scattering, Breit-Wheeler pair production using an electron beam of 46.6 GeV. The higher beam energies available at the future LC would allow more precise studies of these phenomena. Mass-shift and spin-dependent effects could also be investigated.

  13. Vaccine development: From concept to early clinical testing.

    Science.gov (United States)

    Cunningham, Anthony L; Garçon, Nathalie; Leo, Oberdan; Friedland, Leonard R; Strugnell, Richard; Laupèze, Béatrice; Doherty, Mark; Stern, Peter

    2016-12-20

    & clinical testing. The candidate vaccine must be tested for immunogenicity, safety and efficacy in preclinical and appropriately designed clinical trials. This review considers these processes using examples of differing pathogenic challenges, including human papillomavirus, malaria, and ebola. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  14. Clinical studies for improving radiotherapy with 2-deoxy-D-glucose: Present status and future prospects

    Directory of Open Access Journals (Sweden)

    Dwarakanath B

    2009-09-01

    Full Text Available Higher rates of glucose usage generally correlate with poor prognosis in several types of malignant tumours. Experimental studies (both in vitro and in vivo have shown that 2-deoxy-D-glucose (2-DG, a glucose analog and glycolytic inhibitor, enhances radiation-induced damage selectively in tumor cells while protecting normal cells, thereby suggesting that 2-DG can be used as a differential radiomodifier to improve the efficacy of radiotherapy. Clinical trials undertaken to study the feasibility, safety, and validity of this suggested approach will be described. Based on 2-DG-induced radiosensitization observed in primary organ cultures of cerebral glioma tissues, clinical trials were designed taking into consideration the radiobiology of gliomas and pharmacokinetics of 2-DG. Phase I/II clinical trials have unequivocally demonstrated that a combination of 2-DG (200-300 mg 2-DG per kg body weight orally administered after overnight fasting, 20min before irradiation with large weekly fractions (5 Gy/fraction of low-LET radiotherapy is well tolerated without any acute toxicity or late radiation damage to the normal brain tissue. Nonserious transient side effects similar to hypoglycemia induced disturbances like restlessness, nausea, and vomiting were observed at the 2-DG doses used. Data from these trials involving more than 100 patients have clearly indicated a moderate increase in the survival, with a significant improvement in the quality of life with clinicopathological evidence of protection of normal brain tissue. A phase III multicentric trial to evaluate the efficacy of the combined treatment is in progress. Directions for future studies are discussed.

  15. Validity of a new assessment rubric for a short-answer test of clinical reasoning.

    Science.gov (United States)

    Yeung, Euson; Kulasagarem, Kulamakan; Woods, Nicole; Dubrowski, Adam; Hodges, Brian; Carnahan, Heather

    2016-07-26

    The validity of high-stakes decisions derived from assessment results is of primary concern to candidates and certifying institutions in the health professions. In the field of orthopaedic manual physical therapy (OMPT), there is a dearth of documented validity evidence to support the certification process particularly for short-answer tests. To address this need, we examined the internal structure of the Case History Assessment Tool (CHAT); this is a new assessment rubric developed to appraise written responses to a short-answer test of clinical reasoning in post-graduate OMPT certification in Canada. Fourteen physical therapy students (novices) and 16 physical therapists (PT) with minimal and substantial OMPT training respectively completed a mock examination. Four pairs of examiners (n = 8) participated in appraising written responses using the CHAT. We conducted separate generalizability studies (G studies) for all participants and also by level of OMPT training. Internal consistency was calculated for test questions with more than 2 assessment items. Decision studies were also conducted to determine optimal application of the CHAT for OMPT certification. The overall reliability of CHAT scores was found to be moderate; however, reliability estimates for the novice group suggest that the scale was incapable of accommodating for scores of novices. Internal consistency estimates indicate item redundancies for several test questions which will require further investigation. Future validity studies should consider discriminating the clinical reasoning competence of OMPT trainees strictly at the post-graduate level. Although rater variance was low, the large variance attributed to error sources not incorporated in our G studies warrant further investigations into other threats to validity. Future examination of examiner stringency is also warranted.

  16. Clinical Trials for Disease-Modifying Therapies in Alzheimer's Disease: A Primer, Lessons Learned, and a Blueprint for the Future.

    Science.gov (United States)

    Cummings, Jeffrey; Ritter, Aaron; Zhong, Kate

    2018-03-16

    Alzheimer's disease (AD) has no currently approved disease-modifying therapies (DMTs), and treatments to prevent, delay the onset, or slow the progression are urgently needed. A delay of 5 years if available by 2025 would decrease the total number of patients with AD by 50% in 2050. To meet the definition of DMT, an agent must produce an enduring change in the course of AD; clinical trials of DMTs have the goal of demonstrating this effect. AD drug discovery entails target identification followed by high throughput screening and lead optimization of drug-like compounds. Once an optimized agent is available and has been assessed for efficacy and toxicity in animals, it progresses through Phase I testing with healthy volunteers, Phase II learning trials to establish proof-of-mechanism and dose, and Phase III confirmatory trials to demonstrate efficacy and safety in larger populations. Phase III is followed by Food and Drug Administration review and, if appropriate, market access. Trial populations include cognitively normal at-risk participants in prevention trials, mildly impaired participants with biomarker evidence of AD in prodromal AD trials, and subjects with cognitive and functional impairment in AD dementia trials. Biomarkers are critical in trials of DMTs, assisting in participant characterization and diagnosis, target engagement and proof-of-pharmacology, demonstration of disease-modification, and monitoring side effects. Clinical trial designs include randomized, parallel group; delayed start; staggered withdrawal; and adaptive. Lessons learned from completed trials inform future trials and increase the likelihood of success.

  17. The nuclear heating calculation scheme for material testing in the future Jules Horowitz Reactor

    International Nuclear Information System (INIS)

    Huot, N.; Aggery, A.; Blanchet, D.; Courcelle, A.; Czernecki, S.; Di-Salvo, J.; Doederlein, C.; Serviere, H.; Willermoz, G.

    2004-01-01

    An innovative nuclear heating calculation scheme for materials testing carried out in in the future Jules Horowitz reactor (JHR) is described. A heterogeneous gamma source calculation is first performed at assembly level using the deterministic code APOLLO2. This is followed by a Monte Carlo gamma transport calculation in the whole core using the TRIPOLI4 code. The calculated gamma sources at the assembly level are applied in the whole core simulation using a weighting based on power distribution obtained from the neutronic core calculation. (authors)

  18. The development and psychometric testing of a theory-based instrument to evaluate nurses' perception of clinical reasoning competence.

    Science.gov (United States)

    Liou, Shwu-Ru; Liu, Hsiu-Chen; Tsai, Hsiu-Min; Tsai, Ying-Huang; Lin, Yu-Ching; Chang, Chia-Hao; Cheng, Ching-Yu

    2016-03-01

    The purpose of the study was to develop and psychometrically test the Nurses Clinical Reasoning Scale. Clinical reasoning is an essential skill for providing safe and quality patient care. Identifying pre-graduates' and nurses' needs and designing training courses to improve their clinical reasoning competence becomes a critical task. However, there is no instrument focusing on clinical reasoning in the nursing profession. Cross-sectional design was used. This study included the development of the scale, a pilot study that preliminary tested the readability and reliability of the developed scale and a main study that implemented and tested the psychometric properties of the developed scale. The Nurses Clinical Reasoning Scale was developed based on the Clinical Reasoning Model. The scale includes 15 items using a Likert five-point scale. Data were collected from 2013-2014. Two hundred and fifty-one participants comprising clinical nurses and nursing pre-graduates completed and returned the questionnaires in the main study. The instrument was tested for internal consistency and test-retest reliability. Its validity was tested with content, construct and known-groups validity. One factor emerged from the factor analysis. The known-groups validity was confirmed. The Cronbach's alpha for the entire instrument was 0·9. The reliability and validity of the Nurses Clinical Reasoning Scale were supported. The scale is a useful tool and can be easily administered for the self-assessment of clinical reasoning competence of clinical nurses and future baccalaureate nursing graduates. Study limitations and further recommendations are discussed. © 2015 John Wiley & Sons Ltd.

  19. Economic impact of rapid diagnostic methods in Clinical Microbiology: Price of the test or overall clinical impact.

    Science.gov (United States)

    Cantón, Rafael; Gómez G de la Pedrosa, Elia

    2017-12-01

    The need to reduce the time it takes to establish a microbiological diagnosis and the emergence of new molecular microbiology and proteomic technologies has fuelled the development of rapid and point-of-care techniques, as well as the so-called point-of-care laboratories. These laboratories are responsible for conducting both techniques partially to response to the outsourcing of the conventional hospital laboratories. Their introduction has not always been accompanied with economic studies that address their cost-effectiveness, cost-benefit and cost-utility, but rather tend to be limited to the unit price of the test. The latter, influenced by the purchase procedure, does not usually have a regulated reference value in the same way that medicines do. The cost-effectiveness studies that have recently been conducted on mass spectrometry in the diagnosis of bacteraemia and the use of antimicrobials have had the greatest clinical impact and may act as a model for future economic studies on rapid and point-of-care tests. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  20. Clinical decision making in cancer care: a review of current and future roles of patient age.

    Science.gov (United States)

    Tranvåg, Eirik Joakim; Norheim, Ole Frithjof; Ottersen, Trygve

    2018-05-09

    Patient age is among the most controversial patient characteristics in clinical decision making. In personalized cancer medicine it is important to understand how individual characteristics do affect practice and how to appropriately incorporate such factors into decision making. Some argue that using age in decision making is unethical, and how patient age should guide cancer care is unsettled. This article provides an overview of the use of age in clinical decision making and discusses how age can be relevant in the context of personalized medicine. We conducted a scoping review, searching Pubmed for English references published between 1985 and May 2017. References concerning cancer, with patients above the age of 18 and that discussed age in relation to diagnostic or treatment decisions were included. References that were non-medical or concerning patients below the age of 18, and references that were case reports, ongoing studies or opinion pieces were excluded. Additional references were collected through snowballing and from selected reports, guidelines and articles. Three hundred and forty-seven relevant references were identified. Patient age can have many and diverse roles in clinical decision making: Contextual roles linked to access (age influences how fast patients are referred to specialized care) and incidence (association between increasing age and increasing incidence rates for cancer); patient-relevant roles linked to physiology (age-related changes in drug metabolism) and comorbidity (association between increasing age and increasing number of comorbidities); and roles related to interventions, such as treatment (older patients receive substandard care) and outcome (survival varies by age). Patient age is integrated into cancer care decision making in a range of ways that makes it difficult to claim age-neutrality. Acknowledging this and being more transparent about the use of age in decision making are likely to promote better clinical decisions

  1. Laboratory tests for diagnosis of food allergy: advantages, disadvantages and future perspectives.

    Science.gov (United States)

    Moneret-Vautrin, D A; Kanny, G; Frémont, S

    2003-04-01

    Numerous biological tests point to the diagnosis of food sensitization: detection of specific IgEs by Rast techniques, multi-detection assays, immunoblotting, screening of basophil activation (BAT or FAST), assays for leukotriene LTC4 release (CAST), measurement of plasma histamine, serum tryptase, serum ECP, urinary EDN, completed by mannitol-lactulose test evaluating intestinal permeability, assay of fecal IgEs, Rast for specific IgG4. Primary screening for anti-food IgEs by multi-detection assays seeks justification from insufficient clinical data and false positive tests are common in patients sensitized to pollens or latex, on account of in vitro cross reactivities (CR). Multiple CR explain positive Rast to vegetal food allergens in such patients. Biological tests should not be performed as the first line of diagnosis. In vivo sensitisation is assessed by positive prick-tests, demonstrating the bivalence of allergens, as well as the affinity of specific IgEs, two conditions necessary to bridge membrane bound specific IgEs, leading to the release of mediators. Prick-tests are closer to clinical symptoms than biological tests. However, the diagnosis of food allergy is based on standardised oral challenges. Exceptions are high levels of specific IgEs to egg (> 6 kUl/l), peanut (> 15 kUl/l), fish (> 20 kUl/l) and milk (> 32 kUl/l), reaching a 95% predictive positive value. Rast inhibition tests are useful to identify masked allergens in foods. Research developments will have impact on the development of new diagnostic tools: allergen mixes reinforcing a food extract by associated recombinant major allergens, multiple combination of recombinant allergens (chips) or tests with synthetic epitopes aimed a the prediction of recovery. Laboratory tests take place in the decision free for the diagnosis for the food allergy and the follow-up of the levels specific IgEs is a tool to assess outcome and contributes to predict recovery or persistent allergy. Up to now the

  2. Testing the weak-form efficiency of the WTI crude oil futures market

    Science.gov (United States)

    Jiang, Zhi-Qiang; Xie, Wen-Jie; Zhou, Wei-Xing

    2014-07-01

    The weak-form efficiency of energy futures markets has long been studied and empirical evidence suggests controversial conclusions. In this work, nonparametric methods are adopted to estimate the Hurst indexes of the WTI crude oil futures prices (1983-2012) and a strict statistical test in the spirit of bootstrapping is put forward to verify the weak-form market efficiency hypothesis. The results show that the crude oil futures market is efficient when the whole period is considered. When the whole series is divided into three sub-series separated by the outbreaks of the Gulf War and the Iraq War, it is found that the Gulf War reduced the efficiency of the market. If the sample is split into two sub-series based on the signing date of the North American Free Trade Agreement, the market is found to be inefficient in the sub-periods during which the Gulf War broke out. The same analysis on short-time series in moving windows shows that the market is inefficient only when some turbulent events occur, such as the oil price crash in 1985, the Gulf war, and the oil price crash in 2008.

  3. Grappling with the Future Use of Big Data for Translational Medicine and Clinical Care.

    Science.gov (United States)

    Murphy, S; Castro, V; Mandl, K

    2017-08-01

    Objectives: Although patients may have a wealth of imaging, genomic, monitoring, and personal device data, it has yet to be fully integrated into clinical care. Methods: We identify three reasons for the lack of integration. The first is that "Big Data" is poorly managed by most Electronic Medical Record Systems (EMRS). The data is mostly available on "cloud-native" platforms that are outside the scope of most EMRs, and even checking if such data is available on a patient often must be done outside the EMRS. The second reason is that extracting features from the Big Data that are relevant to healthcare often requires complex machine learning algorithms, such as determining if a genomic variant is protein-altering. The third reason is that applications that present Big Data need to be modified constantly to reflect the current state of knowledge, such as instructing when to order a new set of genomic tests. In some cases, applications need to be updated nightly. Results: A new architecture for EMRS is evolving which could unite Big Data, machine learning, and clinical care through a microservice-based architecture which can host applications focused on quite specific aspects of clinical care, such as managing cancer immunotherapy. Conclusion: Informatics innovation, medical research, and clinical care go hand in hand as we look to infuse science-based practice into healthcare. Innovative methods will lead to a new ecosystem of applications (Apps) interacting with healthcare providers to fulfill a promise that is still to be determined. Georg Thieme Verlag KG Stuttgart.

  4. Beyond Diagnostic Accuracy: The Clinical Utility of Diagnostic Tests

    NARCIS (Netherlands)

    Bossuyt, Patrick M. M.; Reitsma, Johannes B.; Linnet, Kristian; Moons, Karel G. M.

    2012-01-01

    Like any other medical technology or intervention, diagnostic tests should be thoroughly evaluated before their introduction into daily practice. Increasingly, decision makers, physicians, and other users of diagnostic tests request more than simple measures of a test's analytical or technical

  5. Fast Flux Test Facility interim examination and maintenance cell: Past, present, and future

    International Nuclear Information System (INIS)

    Vincent, J.R.

    1990-09-01

    The Fast Flux Test Facility Interim Examination and Maintenance Cell was designed to perform interim examination and/or disassembly of experimental core components for final analysis elsewhere, as well as maintenance of sodium-wetted or neutron-activated internal reactor parts and plant support hardware. The Interim Examination and Maintenance Cell equipment developed and used for the first ten years of operation has been primarily devoted to the disassembly and examination of core component test assemblies. While no major reactor equipment has required remote repair or maintenance, the Interim Examina Examination and Maintenance Cell has served as the remote repair facility for its own in-cell equipment, and several innovative remote repairs have been accomplished. The Interim Examination and Maintenance Cell's demonstrated versatility has shown its capability to support a challenging future. 12 refs., 9 figs

  6. Assessment of scapular positioning and function as future effect measure of shoulder interventions – an inter-examiner reliability study of the clinical assessment methods

    DEFF Research Database (Denmark)

    Larsen, Camilla Marie; Eshøj, Henrik; Ingwersen, Kim Gordon

    2015-01-01

    Assessment of scapular positioning and function as future effect measure of shoulder interventions – an inter-examiner reliability study of the clinical assessment methods Eshøj H1, Ingwersen KG1, Larsen CM1, 2, Søgaard K1, Juul-Kristensen B1, 3 1 University of Southern Denmark, Institute of Sports...... only been tested for intra-examiner reliability. The objective was to investigate the inter-examiner reliability of an extended battery of clinical tests for assessing scapular positioning and function. Methods A standardized three-phase protocol for clinical reliability studies was conducted...... coefficients (ICC) and kappa values were interpreted as: 0.0-0.40 (poor); 0.40-0.75 (fair to good); and 0.75-1.00 (good to excellent). Results A total of 41 subjects (23 males, yrs 25±9), were recruited among adult overhead athletes from the municipality of Odense, DK. Prevalence of the index condition was 54...

  7. Personalized translational epilepsy research - Novel approaches and future perspectives: Part I: Clinical and network analysis approaches.

    Science.gov (United States)

    Rosenow, Felix; van Alphen, Natascha; Becker, Albert; Chiocchetti, Andreas; Deichmann, Ralf; Deller, Thomas; Freiman, Thomas; Freitag, Christine M; Gehrig, Johannes; Hermsen, Anke M; Jedlicka, Peter; Kell, Christian; Klein, Karl Martin; Knake, Susanne; Kullmann, Dimitri M; Liebner, Stefan; Norwood, Braxton A; Omigie, Diana; Plate, Karlheinz; Reif, Andreas; Reif, Philipp S; Reiss, Yvonne; Roeper, Jochen; Ronellenfitsch, Michael W; Schorge, Stephanie; Schratt, Gerhard; Schwarzacher, Stephan W; Steinbach, Joachim P; Strzelczyk, Adam; Triesch, Jochen; Wagner, Marlies; Walker, Matthew C; von Wegner, Frederic; Bauer, Sebastian

    2017-11-01

    Despite the availability of more than 15 new "antiepileptic drugs", the proportion of patients with pharmacoresistant epilepsy has remained constant at about 20-30%. Furthermore, no disease-modifying treatments shown to prevent the development of epilepsy following an initial precipitating brain injury or to reverse established epilepsy have been identified to date. This is likely in part due to the polyetiologic nature of epilepsy, which in turn requires personalized medicine approaches. Recent advances in imaging, pathology, genetics and epigenetics have led to new pathophysiological concepts and the identification of monogenic causes of epilepsy. In the context of these advances, the First International Symposium on Personalized Translational Epilepsy Research (1st ISymPTER) was held in Frankfurt on September 8, 2016, to discuss novel approaches and future perspectives for personalized translational research. These included new developments and ideas in a range of experimental and clinical areas such as deep phenotyping, quantitative brain imaging, EEG/MEG-based analysis of network dysfunction, tissue-based translational studies, innate immunity mechanisms, microRNA as treatment targets, functional characterization of genetic variants in human cell models and rodent organotypic slice cultures, personalized treatment approaches for monogenic epilepsies, blood-brain barrier dysfunction, therapeutic focal tissue modification, computational modeling for target and biomarker identification, and cost analysis in (monogenic) disease and its treatment. This report on the meeting proceedings is aimed at stimulating much needed investments of time and resources in personalized translational epilepsy research. Part I includes the clinical phenotyping and diagnostic methods, EEG network-analysis, biomarkers, and personalized treatment approaches. In Part II, experimental and translational approaches will be discussed (Bauer et al., 2017) [1]. Copyright © 2017 Elsevier Inc

  8. The National Market for Medicare Clinical Laboratory Testing

    Data.gov (United States)

    U.S. Department of Health & Human Services — Current Medicare payment policy for outpatient laboratory services is outdated. Future reforms, such as competitive bidding, should consider the characteristics of...

  9. PAU-SA: A Synthetic Aperture Interferometric Radiometer Test Bed for Potential Improvements in Future Missions

    Directory of Open Access Journals (Sweden)

    Merce Vall-llosera

    2012-06-01

    Full Text Available The Soil Moisture and Ocean Salinity (SMOS mission is an Earth Explorer Opportunity mission from the European Space Agency (ESA. Its goal is to produce global maps of soil moisture and ocean salinity using the Microwave Imaging Radiometer by Aperture Synthesis (MIRAS. The purpose of the Passive Advanced Unit Synthetic Aperture (PAU-SA instrument is to study and test some potential improvements that could eventually be implemented in future missions using interferometric radiometers such as the Geoestacionary Atmosferic Sounder (GAS, the Precipitation and All-weather Temperature and Humidity (PATH and the Geostationary Interferometric Microwave Sounder (GIMS. Both MIRAS and PAU-SA are Y-shaped arrays with uniformly distributed antennas, but the receiver topology and the processing unit are quite different. The purpose of this work is to identify the elements in the MIRAS’s design susceptible of improvement and apply them in the PAU-SA instrument demonstrator, to test them in view of these future interferometric radiometer missions.

  10. Red Blood Cell Mechanical Fragility Test for Clinical Research Applications.

    Science.gov (United States)

    Ziegler, Luke A; Olia, Salim E; Kameneva, Marina V

    2017-07-01

    Red blood cell (RBC) susceptibility to mechanically induced hemolysis, or RBC mechanical fragility (MF), is an important parameter in the characterization of erythrocyte membrane health. The rocker bead test (RBT) and associated calculated mechanical fragility index (MFI) is a simple method for the assessment of RBC MF. Requiring a minimum of 15.5 mL of blood and necessitating adjustment of hematocrit (Ht) to a "standard" value (40%), the current RBT is not suitable for use in most studies involving human subjects. To address these limitations, we propose a 6.5 mL reduced volume RBT and corresponding modified MFI (MMFI) that does not require prior Ht adjustment. This new method was assessed for i) correlation to the existing text, ii) to quantify the effect of Ht on MFI, and iii) validation by reexamining the protective effect of plasma proteins on RBC MF. The reduced volume RBT strongly correlated (r = 0.941) with the established large volume RBT at matched Hts, and an equation was developed to calculate MMFI: a numerical estimation (R 2  = 0.923) of MFI if performed with the reduced volume RBT at "standard" (40%) Ht. An inversely proportional relationship was found between plasma protein concentration and RBC MF using the MMFI-reduced volume method, supporting previous literature findings. The new reduced volume RBT and modified MFI will allow for the measurement of RBC MF in clinical and preclinical studies involving humans or small animals. © 2017 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  11. In Situ Estuarine and Marine Toxicity Testing: A Review, Including Recommendations for Future Use in Ecological Risk Assessment

    Science.gov (United States)

    2009-09-01

    field and microcosms than they do under laboratory test conditions. In the case of tributyltin ( TBT ) exposures in San Diego Bay, he found that...TECHNICAL REPORT 1986 September 2009 In Situ Estuarine and Marine Toxicity Testing A Review, Including Recommendations for Future Use in...Pacific TECHNICAL REPORT 1986 September 2009 In Situ Estuarine and Marine Toxicity Testing A Review, Including Recommendations for Future Use in

  12. Past, present and future aspects of studies of heavy ion radiotherapy. 2. Future view of clinical studies of heavy ion radiotherapy

    International Nuclear Information System (INIS)

    Tsujii, Hirohiko; Kamata, Tadashi

    2007-01-01

    The purpose of clinical studies of heavy ion radiotherapy (HIR, using carbon beam) in National Institute of Radiological Sciences (NIRS) is, in treatment of cancers, to elucidate its potential and significance for establishing the methodology for curing the disease safely and reliably to further spread the therapy. Here is presented a future view of clinical studies of HIR based on the past results and along authorities' medical policy. NIRS has treated 3,100 or more cancer patients in about 50 clinical trials from the start of HIR in 1994. In those studies, curing the intractable malignancies has become possible in a short term of therapy, and the irradiating machine is being miniaturized (actually under construction in Gunma Univ.). At the end of 2006, about 4,000 patients have been treated with HIR globally: the impact of NIRS HIR. There are such future HIR plans as the promotion of clinical trials, development of irradiation technology, promotion and efficient practice as an advanced frontier medicare, imaging diagnosis for the aim of treatment, biological studies, and comparative studies to elucidate the usefulness. Cooperation of NIRS, manufacturers and authorities will make HIR a more useful, less burdensome mean to treat patients with more intractable cancers. (R.T.)

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

    Science.gov (United States)

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

    2015-01-01

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

  14. Borderline Personality Disorder and Oxytocin: Review of Clinical Trials and Future Directions.

    Science.gov (United States)

    Amad, Ali; Thomas, Pierre; Perez-Rodriguez, M Mercedes

    2015-01-01

    Borderline personality disorder (BPD) is a common mental disorder characterized by a pervasive pattern of emotional Borderline personality disorder (BPD) is a common mental disorder characterized by a pervasive pattern of emotional lability, impulsivity, interpersonal difficulties, identity disturbances, and disturbed cognition. Traditional pharmacotherapies are effective in treating some of these core symptoms but have only modest effects on the domain of interpersonal dysfunction of BPD. Thus there is a need to develop new, neurobiologically informed pharmacological treatments for BPD. This review focuses on the potential use of intranasal oxytocin (OXT), which has key roles in the regulation of complex social cognition and behaviors, to target symptoms of interpersonal dysfunction in BPD. Surprisingly, despite promising data on the prosocial effects of OXT, only 5 trials in BPD have been published to date. These trials show mixed results with on one hand, a decrease of emotional responses to stress and on the other hand, some "paradoxical" reactions with worsened interpersonal anxiety and decreased cooperative behavior. These mixed results are interpreted according to different theoretical models and also in light of some methodological limitations. Further studies are needed to understand the effect of OXT in patients with BPD and ongoing clinical trials will provide some answers to remaining questions on the use of OXT in BPD. Recommendations for future studies are also proposed in this review.

  15. CT coronary angiography: examination technique, clinical results, and outlook on future developments

    International Nuclear Information System (INIS)

    Dewey, M.; Hamm, B.

    2007-01-01

    Multislice computed tomography (MSCT) after intravenous contrast agent administration enables visualization of the coronary arteries with high spatial resolution (voxel sizes down to 0.5 x 0.35 x 0.35 mm3) and a short scan time. Magnetic resonance imaging (MRI) is also intensively studied with respect to the noninvasive detection of coronary artery stenosis and thus the detection of coronary artery disease (CAD) without radiation exposure but is not equal to MSCT at present. This article provides an overview of the historical development of CT coronary angiography from 4-slice CT to 16-slice CT and 64-slice CT. A crucial aspect of this development is the improvement in image quality resulting from shorter breath-hold periods and the reduced gantry rotation time. Other techniques that appear to considerably improve image quality and accuracy and make CT independent of patient heart rates are multisegment reconstruction and dual-source CT. Sublingual nitroglycerin as well as oral or intravenous betablocker administration should be considered in relation to the diagnostic question to be answered and the patient's heart rate. In the studies available CT coronary angiography with at least 12 simultaneous detector rows has a sensitivity of 96.9 % and a specificity of 75.3 % at the patient level. Especially the negative predictive value of CT (94.6 %) emphasizes the idea that this technique may reliably exclude CAD in patients with intermediate pretest likelihood. In the near future, 256-slice CT will allow examination of the entire heart during one heartbeat or even 4D CT scanning with simultaneous assessment of myocardial perfusion. Automatic or semiautomatic software tools will assume a central place in detecting and quantifying coronary artery stenoses and plaques as well as in the analysis of cardiac function in the clinical setting over the next years. Prior to its routine clinical use, the cost-effectiveness of CT coronary angiography must be determined and the

  16. The Alcock Paczy'nski test with Baryon Acoustic Oscillations: systematic effects for future surveys

    Energy Technology Data Exchange (ETDEWEB)

    Lepori, Francesca; Viel, Matteo; Baccigalupi, Carlo [SISSA—International School for Advanced Studies, Via Bonomea 265, 34136 Trieste (Italy); Dio, Enea Di [INAF—Osservatorio Astronomico di Trieste, Via G.B. Tiepolo 11, I-34143 Trieste (Italy); Durrer, Ruth, E-mail: flepori@sissa.it, E-mail: enea.didio@oats.inaf.it, E-mail: viel@oats.inaf.it, E-mail: carlo.baccigalupi@sissa.it, E-mail: Ruth.Durrer@unige.ch [Université de Genève, Département de Physique Théorique and CAP, 24 quai Ernest-Ansermet, CH-1211 Genève 4 (Switzerland)

    2017-02-01

    We investigate the Alcock Paczy'nski (AP) test applied to the Baryon Acoustic Oscillation (BAO) feature in the galaxy correlation function. By using a general formalism that includes relativistic effects, we quantify the importance of the linear redshift space distortions and gravitational lensing corrections to the galaxy number density fluctuation. We show that redshift space distortions significantly affect the shape of the correlation function, both in radial and transverse directions, causing different values of galaxy bias to induce offsets up to 1% in the AP test. On the other hand, we find that the lensing correction around the BAO scale modifies the amplitude but not the shape of the correlation function and therefore does not introduce any systematic effect. Furthermore, we investigate in details how the AP test is sensitive to redshift binning: a window function in transverse direction suppresses correlations and shifts the peak position toward smaller angular scales. We determine the correction that should be applied in order to account for this effect, when performing the test with data from three future planned galaxy redshift surveys: Euclid, the Dark Energy Spectroscopic Instrument (DESI) and the Square Kilometer Array (SKA).

  17. 3D printed drug delivery and testing systems - a passing fad or the future?

    Science.gov (United States)

    Lim, Seng Han; Kathuria, Himanshu; Tan, Justin Jia Yao; Kang, Lifeng

    2018-05-18

    The US Food and Drug Administration approval of the first 3D printed tablet in 2015 has ignited growing interest in 3D printing, or additive manufacturing (AM), for drug delivery and testing systems. Beyond just a novel method for rapid prototyping, AM provides key advantages over traditional manufacturing of drug delivery and testing systems. These includes the ability to fabricate complex geometries to achieve variable drug release kinetics; ease of personalising pharmacotherapy for patient and lowering the cost for fabricating personalised dosages. Furthermore, AM allows fabrication of complex and micron-sized tissue scaffolds and models for drug testing systems that closely resemble in vivo conditions. However, there are several limitations such as regulatory concerns that may impede the progression to market. Here, we provide an overview of the advantages of AM drug delivery and testing, as compared to traditional manufacturing techniques. Also, we discuss the key challenges and future directions for AM enabled pharmaceutical applications. Copyright © 2018 Elsevier B.V. All rights reserved.

  18. Indications, applications and future prospects of diagnostic examinations in clinical cardiology

    International Nuclear Information System (INIS)

    Sugishita, Yasuro; Koseki, Susumu; Matsuda, Mitsuo

    1982-01-01

    Nowadays there are various kinds of diagnostic examinations in the field of clinical cardiology. In this field, information concerning structure, dimension (hypertrophy and dilatation) and cardiac function is essentially imporant. For the diagnosis of valvular and congenital heart diseases and of cardiomyopathy, ultrasonic examinations are more useful; for ischemic heart disease, nuclear medicine is superior. Angiocardiography provides us much information but it is invasive. A combination of an exercise-test with the examinations mentioned above is useful for the detection of left ventricular and coronary reserves. The determinants of left ventricular reserve, being related to the prognosis of the patients, can be analyzed by exercise echocardiography. Exercise echocardiography can reveal instantaneous changes in myocardial ischemia during exercise. Regional and global left ventricular performances revealed by exercise radionuclide angiocardiography can lead us to a new interpretation of an exercise ECG. (author)

  19. In vitro clinical trials: the future of cell-based profiling

    Directory of Open Access Journals (Sweden)

    Nathan T Ross

    2014-05-01

    Full Text Available The drug discovery process classically revolves around a set of biochemical and cellular assays to drive potency optimization and structural-activity relationship (SAR models. Layered on top of these concepts is the inclusion of molecular features that affect final drug use, things like: bioavailability, toxicity, stability, solubility, formulation, route of administration, etc. Paradoxically, most drugs entering clinical trials are only tested in a handful of human genetic backgrounds before they are given to people. Here we review efforts and opine on the use of large scale in vitro cellular and in vivo models that attempt to model human disease and include diversity found in the human genetic population. Because hundreds to thousands of individual assays are needed to scratch the surface of human genetic diversity, sophisticated high throughput automation technologies or pooling & deconvolution strategies are required. Characterization of each model needs to be extensive to enable non-biased informatics based modeling. Such approaches will enable deep understanding of genetic to pharmacological response and result in new methods for patient stratification in the clinic. Oncology medicines and cancer genetics have been paving the way for these approaches and we expect to see continued expansion to other fields such as immunology and neuroscience.

  20. Bonding to oxide ceramics—laboratory testing versus clinical outcome.

    Science.gov (United States)

    Kern, Matthias

    2015-01-01

    Despite a huge number of published laboratory bonding studies on dental oxide ceramics clinical long-term studies on resin bonded oxide ceramic restorations are rare. The purpose of this review is to present the best available clinical evidence for successful bonding of dental oxide ceramic restorations. Clinical trials with resin-bonded restorations that had no or only limited mechanical retention and were made from alumina or zirconia ceramic were identified using an electronic search in PubMed database. Overall 10 publications with clinical trials could be identified. Their clinical outcome was compared with that laboratory bond strength studies. Clinical data provide strong evidence that air-abrasion at a moderate pressure in combination with using phosphate monomer containing primers and/or luting resins provide long-term durable bonding to glass-infiltrated alumina and zirconia ceramic under the humid and stressful oral conditions. As simple and clinically reliable bonding methods to oxide ceramics exist, the rationale for development of alternative bonding methods might be reconsidered especially when these methods are more time consuming or require rather complicated and/or technique sensitive procedures. Copyright © 2014 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

  1. Clinical review: Distinguishing constitutional delay of growth and puberty from isolated hypogonadotropic hypogonadism: critical appraisal of available diagnostic tests.

    Science.gov (United States)

    Harrington, Jennifer; Palmert, Mark R

    2012-09-01

    Determining the etiology of delayed puberty during initial evaluation can be challenging. Specifically, clinicians often cannot distinguish constitutional delay of growth and puberty (CDGP) from isolated hypogonadotropic hypogonadism (IHH), with definitive diagnosis of IHH awaiting lack of spontaneous puberty by age 18 yr. However, the ability to make a timely, correct diagnosis has important clinical implications. The aim was to describe and evaluate the literature regarding the ability of diagnostic tests to distinguish CDGP from IHH. A PubMed search was performed using key words "puberty, delayed" and "hypogonadotropic hypogonadism," and citations within retrieved articles were reviewed to identify studies that assessed the utility of basal and stimulation tests in the diagnosis of delayed puberty. Emphasis was given to a test's ability to distinguish prepubertal adolescents with CDGP from those with IHH. Basal gonadotropin and GnRH stimulation tests have limited diagnostic specificity, with overlap in gonadotropin levels between adolescents with CDGP and IHH. Stimulation tests using more potent GnRH agonists and/or human chorionic gonadotropin may have better discriminatory value, but small study size, lack of replication of diagnostic thresholds, and prolonged protocols limit clinical application. A single inhibin B level in two recent studies demonstrated good differentiation between groups. Distinguishing IHH from CDGP is an important clinical issue. Basal inhibin B may offer a simple, discriminatory test if results from recent studies are replicated. However, current literature does not allow for recommendation of any diagnostic test for routine clinical use, making this an important area for future investigation.

  2. FutureGen 2.0 Oxy-combustion Large Scale Test – Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Kenison, LaVesta [URS, Pittsburgh, PA (United States); Flanigan, Thomas [URS, Pittsburgh, PA (United States); Hagerty, Gregg [URS, Pittsburgh, PA (United States); Gorrie, James [Air Liquide, Kennesaw, GA (United States); Leclerc, Mathieu [Air Liquide, Kennesaw, GA (United States); Lockwood, Frederick [Air Liquide, Kennesaw, GA (United States); Falla, Lyle [Babcock & Wilcox and Burns McDonnell, Kansas City, MO (United States); Macinnis, Jim [Babcock & Wilcox and Burns McDonnell, Kansas City, MO (United States); Fedak, Mathew [Babcock & Wilcox and Burns McDonnell, Kansas City, MO (United States); Yakle, Jeff [Babcock & Wilcox and Burns McDonnell, Kansas City, MO (United States); Williford, Mark [Futuregen Industrial Alliance, Inc., Morgan County, IL (United States); Wood, Paul [Futuregen Industrial Alliance, Inc., Morgan County, IL (United States)

    2016-04-01

    The primary objectives of the FutureGen 2.0 CO2 Oxy-Combustion Large Scale Test Project were to site, permit, design, construct, and commission, an oxy-combustion boiler, gas quality control system, air separation unit, and CO2 compression and purification unit, together with the necessary supporting and interconnection utilities. The project was to demonstrate at commercial scale (168MWe gross) the capability to cleanly produce electricity through coal combustion at a retrofitted, existing coal-fired power plant; thereby, resulting in near-zeroemissions of all commonly regulated air emissions, as well as 90% CO2 capture in steady-state operations. The project was to be fully integrated in terms of project management, capacity, capabilities, technical scope, cost, and schedule with the companion FutureGen 2.0 CO2 Pipeline and Storage Project, a separate but complementary project whose objective was to safely transport, permanently store and monitor the CO2 captured by the Oxy-combustion Power Plant Project. The FutureGen 2.0 Oxy-Combustion Large Scale Test Project successfully achieved all technical objectives inclusive of front-end-engineering and design, and advanced design required to accurately estimate and contract for the construction, commissioning, and start-up of a commercial-scale "ready to build" power plant using oxy-combustion technology, including full integration with the companion CO2 Pipeline and Storage project. Ultimately the project did not proceed to construction due to insufficient time to complete necessary EPC contract negotiations and commercial financing prior to expiration of federal co-funding, which triggered a DOE decision to closeout its participation in the project. Through the work that was completed, valuable technical, commercial, and programmatic lessons were learned. This project has significantly advanced the development of near-zero emission technology and will

  3. Intelligent Testing: Integrating Psychological Theory and Clinical Practice

    Science.gov (United States)

    Kaufman, James C., Ed.

    2009-01-01

    The field of intelligence testing has been revolutionized by Alan S. Kaufman. He developed the Wechsler Intelligence Scale for Children-Revised (WISC-R) with David Wechsler, and his best-selling book, Intelligent Testing with the WISC-R, introduced the phrase "intelligent testing." Kaufman, with his wife, Nadeen, then created his own…

  4. Robotic Needle Guide for Prostate Brachytherapy: Clinical Testing of Feasibility and Performance

    Science.gov (United States)

    Song, Danny Y; Burdette, Everette C; Fiene, Jonathan; Armour, Elwood; Kronreif, Gernot; Deguet, Anton; Zhang, Zhe; Iordachita, Iulian; Fichtinger, Gabor; Kazanzides, Peter

    2010-01-01

    Purpose Optimization of prostate brachytherapy is constrained by tissue deflection of needles and fixed spacing of template holes. We developed and clinically tested a robotic guide towards the goal of allowing greater freedom of needle placement. Methods and Materials The robot consists of a small tubular needle guide attached to a robotically controlled arm. The apparatus is mounted and calibrated to operate in the same coordinate frame as a standard template. Translation in x and y directions over the perineum ±40mm are possible. Needle insertion is performed manually. Results Five patients were treated in an IRB-approved study. Confirmatory measurements of robotic movements for initial 3 patients using infrared tracking showed mean error of 0.489 mm (SD 0.328 mm). Fine adjustments in needle positioning were possible when tissue deflection was encountered; adjustments were performed in 54/179 (30.2%) needles placed, with 36/179 (20.1%) adjustments of > 2mm. Twenty-seven insertions were intentionally altered to positions between the standard template grid to improve the dosimetric plan or avoid structures such as pubic bone and blood vessels. Conclusions Robotic needle positioning provided a means of compensating for needle deflections as well as the ability to intentionally place needles into areas between the standard template holes. To our knowledge, these results represent the first clinical testing of such a system. Future work will be incorporation of direct control of the robot by the physician, adding software algorithms to help avoid robot collisions with the ultrasound, and testing the angulation capability in the clinical setting. PMID:20729152

  5. Integrated Human-in-the-Loop Ground Testing - Value, History, and the Future

    Science.gov (United States)

    Henninger, Donald L.

    2016-01-01

    Systems for very long-duration human missions to Mars will be designed to operate reliably for many years and many of these systems will never be returned to Earth. The need for high reliability is driven by the requirement for safe functioning of remote, long-duration crewed systems and also by unsympathetic abort scenarios. Abort from a Mars mission could be as long as 450 days to return to Earth. The key to developing a human-in-the-loop architecture is a development process that allows for a logical sequence of validating successful development in a stepwise manner, with assessment of key performance parameters (KPPs) at each step; especially important are KPPs for technologies evaluated in a full systems context with human crews on Earth and on space platforms such as the ISS. This presentation will explore the implications of such an approach to technology development and validation including the roles of ground and space-based testing necessary to develop a highly reliable system for long duration human exploration missions. Historical development and systems testing from Mercury to the International Space Station (ISS) to ground testing will be reviewed. Current work as well as recommendations for future work will be described.

  6. Six-minute stepper test: a valid clinical exercise tolerance test for COPD patients

    Directory of Open Access Journals (Sweden)

    Grosbois JM

    2016-03-01

    .005. Performances on the 6MST and 6MWT were significantly improved after PR (570 vs 488 steps, P=0.001 and 448 vs 406 m, respectively; P<0.0001. Improvements of the 6MST and 6MWT after PR were significantly correlated (r=0.34; P=0.03.Conclusion: The results of this study show that the 6MST is a valid test to evaluate exercise tolerance in COPD patients. The use of this test in clinical practice appears to be particularly relevant for the assessment of patients managed by home PR. Keywords: 6-minute stepper test, 6-minute walk test, exercise tolerance, pulmonary rehabilitation, cardiopulmonary exercise testing, validity

  7. Testing sterile neutrino extensions of the Standard Model at future lepton colliders

    Science.gov (United States)

    Antusch, Stefan; Fischer, Oliver

    2015-05-01

    Extending the Standard Model (SM) with sterile ("right-handed") neutrinos is one of the best motivated ways to account for the observed neutrino masses. We discuss the expected sensitivity of future lepton collider experiments for probing such extensions. An interesting testable scenario is given by "symmetry protected seesaw models", which theoretically allow for sterile neutrino masses around the electroweak scale with up to order one mixings with the light (SM) neutrinos. In addition to indirect tests, e.g. via electroweak precision observables, sterile neutrinos with masses around the electroweak scale can also be probed by direct searches, e.g. via sterile neutrino decays at the Z pole, deviations from the SM cross section for four lepton final states at and beyond the WW threshold and via Higgs boson decays. We study the present bounds on sterile neutrino properties from LEP and LHC as well as the expected sensitivities of possible future lepton colliders such as ILC, CEPC and FCC-ee (TLEP).

  8. The current and future status of the Concealed Information Test for field use

    Directory of Open Access Journals (Sweden)

    Izumi eMatsuda

    2012-11-01

    Full Text Available The Concealed Information Test (CIT is a psychophysiological technique for examining whether a person has knowledge of crime-relevant information. Many laboratory studies have shown that the CIT has good scientific validity. However, the CIT has seldom been used for actual criminal investigations. One successful exception is its use by the Japanese police. In Japan, the CIT has been widely used for criminal investigations, although its probative force in court is not strong. In this paper, we first review the current use of the field CIT in Japan. Then, we discuss two possible approaches to increase its probative force: sophisticated statistical judgment methods and combining new psychophysiological measures with classic autonomic measures. On the basis of these considerations, we propose several suggestions for future practice and research involving the field CIT.

  9. Compatibility of Clinical Manifestation with Skin Prick Test Result and Food Provocation Test in Food Cross Reaction

    OpenAIRE

    Lubis, Azwin; Barlianto, Wisnu; Endaryanto, Anang; Harsono, Ariyanto

    2017-01-01

    Background: Subjective diagnostic test of food allergy is hugely biased, resulting in irrational diet avoidance. Additional objective tools by skin prick test following food provocation test resulting more accurate cause and prevalence on population. Purpose: To evaluate the compatibility of clinical symptoms with skin prick test and provocation test for imunoglobulin E (IgE) mediated food allergy in Dr. Soetomo Hospital Surabaya. Methods: Cross sectional observational analytic study. Patient...

  10. Clinical experimentation with aerosol antibiotics: current and future methods of administration

    Directory of Open Access Journals (Sweden)

    Zarogoulidis P

    2013-10-01

    Full Text Available Paul Zarogoulidis,1,2 Ioannis Kioumis,1 Konstantinos Porpodis,1 Dionysios Spyratos,1 Kosmas Tsakiridis,3 Haidong Huang,4 Qiang Li,4 J Francis Turner,5 Robert Browning,6 Wolfgang Hohenforst-Schmidt,7 Konstantinos Zarogoulidis1 1Pulmonary Department, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; 2Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany; 3Cardiothoracic Surgery Department, Saint Luke Private Hospital of Health Excellence, Thessaloniki, Greece; 4Department of Respiratory Diseases, Shanghai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai, People’s Republic of China; 5Pulmonary Medicine, University of Nevada School of Medicine, National Supercomputing Center for Energy and the Environment University of Nevada, Las Vegas, NV, USA; 6Pulmonary and Critical Care Medicine, Interventional Pulmonology, National Naval Medical Center, Walter Reed Army Medical Center, Bethesda, MD, USA; 7II Medical Department, Regional Clinic of Coburg, University of Wuerzburg, Coburg, Germany Abstract: Currently almost all antibiotics are administered by the intravenous route. Since several systems and situations require more efficient methods of administration, investigation and experimentation in drug design has produced local treatment modalities. Administration of antibiotics in aerosol form is one of the treatment methods of increasing interest. As the field of drug nanotechnology grows, new molecules have been produced and combined with aerosol production systems. In the current review, we discuss the efficiency of aerosol antibiotic studies along with aerosol production systems. The different parts of the aerosol antibiotic methodology are presented. Additionally, information regarding the drug molecules used is presented and future applications of this method are discussed

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

    Science.gov (United States)

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

    2014-09-01

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

  12. Barefoot running: an evaluation of current hypothesis, future research and clinical applications.

    Science.gov (United States)

    Tam, Nicholas; Astephen Wilson, Janie L; Noakes, Timothy D; Tucker, Ross

    2014-03-01

    Barefoot running has become a popular research topic, driven by the increasing prescription of barefoot running as a means of reducing injury risk. Proponents of barefoot running cite evolutionary theories that long-distance running ability was crucial for human survival, and proof of the benefits of natural running. Subsequently, runners have been advised to run barefoot as a treatment mode for injuries, strength and conditioning. The body of literature examining the mechanical, structural, clinical and performance implications of barefoot running is still in its infancy. Recent research has found significant differences associated with barefoot running relative to shod running, and these differences have been associated with factors that are thought to contribute to injury and performance. Crucially, long-term prospective studies have yet to be conducted and the link between barefoot running and injury or performance remains tenuous and speculative. The injury prevention potential of barefoot running is further complicated by the complexity of injury aetiology, with no single factor having been identified as causative for the most common running injuries. The aim of the present review was to critically evaluate the theory and evidence for barefoot running, drawing on both collected evidence as well as literature that have been used to argue in favour of barefoot running. We describe the factors driving the prescription of barefoot running, examine which of these factors may have merit, what the collected evidence suggests about the suitability of barefoot running for its purported uses and describe the necessary future research to confirm or refute the barefoot running hypotheses.

  13. The Future of Animals, Cells, Models, and Systems in Research, Development, Education, and Testing: Proceedings of a Symposium.

    Science.gov (United States)

    National Academy of Sciences - National Research Council, Washington, DC. Inst. of Lab. Animal Resources.

    This volume contains the prepared papers and discussions of a National Academy of Sciences - National Research Council Symposium on the Future of Animals, Cells, Models, and Systems in Research, Development, Education, and Testing. The purpose of the symposium was to examine the past, present, and future contributions of animals to human health…

  14. Brayton Power Conversion Unit Tested: Provides a Path to Future High-Power Electric Propulsion Missions

    Science.gov (United States)

    Mason, Lee S.

    2003-01-01

    Closed-Brayton-cycle conversion technology has been identified as an excellent candidate for nuclear electric propulsion (NEP) power conversion systems. Advantages include high efficiency, long life, and high power density for power levels from about 10 kWe to 1 MWe, and beyond. An additional benefit for Brayton is the potential for the alternator to deliver very high voltage as required by the electric thrusters, minimizing the mass and power losses associated with the power management and distribution (PMAD). To accelerate Brayton technology development for NEP, the NASA Glenn Research Center is developing a low-power NEP power systems testbed that utilizes an existing 2- kWe Brayton power conversion unit (PCU) from previous solar dynamic technology efforts. The PCU includes a turboalternator, a recuperator, and a gas cooler connected by gas ducts. The rotating assembly is supported by gas foil bearings and consists of a turbine, a compressor, a thrust rotor, and an alternator on a single shaft. The alternator produces alternating-current power that is rectified to 120-V direct-current power by the PMAD unit. The NEP power systems testbed will be utilized to conduct future investigations of operational control methods, high-voltage PMAD, electric thruster interactions, and advanced heat rejection techniques. The PCU was tested in Glenn s Vacuum Facility 6. The Brayton PCU was modified from its original solar dynamic configuration by the removal of the heat receiver and retrofitting of the electrical resistance gas heater to simulate the thermal input of a steady-state nuclear source. Then, the Brayton PCU was installed in the 3-m test port of Vacuum Facility 6, as shown. A series of tests were performed between June and August of 2002 that resulted in a total PCU operational time of about 24 hr. An initial test sequence on June 17 determined that the reconfigured unit was fully operational. Ensuing tests provided the operational data needed to characterize PCU

  15. Using Digital Technologies in Clinical HIV Research: Real-World Applications and Considerations for Future Work.

    Science.gov (United States)

    Andriesen, Jessica; Bull, Sheana; Dietrich, Janan; Haberer, Jessica E; Van Der Pol, Barbara; Voronin, Yegor; Wall, Kristin M; Whalen, Christopher; Priddy, Frances

    2017-07-31

    Digital technologies, especially if used in novel ways, provide a number of potential advantages to clinical research in trials related to human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) and may greatly facilitate operations as well as data collection and analysis. These technologies may even allow answering questions that are not answerable with older technologies. However, they come with a variety of potential concerns for both the participants and the trial sponsors. The exact challenges and means for alleviation depend on the technology and on the population in which it is deployed, and the rapidly changing landscape of digital technologies presents a challenge for creating future-proof guidelines for technology application. The aim of this study was to identify and summarize some common themes that are frequently encountered by researchers in this context and highlight those that should be carefully considered before making a decision to include these technologies in their research. In April 2016, the Global HIV Vaccine Enterprise surveyed the field for research groups with recent experience in novel applications of digital technologies in HIV clinical research and convened these groups for a 1-day meeting. Real-world uses of various technologies were presented and discussed by 46 attendees, most of whom were researchers involved in the design and conduct of clinical trials of biomedical HIV prevention and treatment approaches. After the meeting, a small group of organizers reviewed the presentations and feedback obtained during the meeting and categorized various lessons-learned to identify common themes. A group of 9 experts developed a draft summary of the findings that was circulated via email to all 46 attendees for review. Taking into account the feedback received, the group finalized the considerations that are presented here. Meeting presenters and attendees discussed the many successful applications of digital

  16. Image registration in the brain: a test of clinical accuracy

    International Nuclear Information System (INIS)

    Rosenman, Julian; Miller, Elizabeth P.; Rinker, Lillian; Mukherji, Suresh; Tracton, Gregg; Cullip, Tim J.; Muller, Keith E.; DeLuca, Marla C.; Major, Stacey A.; Sailer, Scott; Varia, Mahesh

    1997-01-01

    Purpose/Objective: Accurate localization of tumor and normal structures is a critical step in the radiation treatment planning processes and has direct implications for tumor control success as well as normal tissue morbidity. We conducted a study to determine the accuracy of transferring tumor information from diagnostic images to the simulation films and planning CT with conventional methods using the best clinical judgment and compared that to tumor localization using 3D registration software. Materials and Methods: We measured the accuracy with which experienced clinicians could localize tumor volume from diagnostic images to either simulation films or a planning CT, with and without 3D registration software. To obtain absolute registration truth we used the method of identical pairs wherein a CT data set was duplicated and one copy resliced along a different plane than the original while maintaining the exact mathematical transformation between them. A tumor was then added to the resliced CT which became the surrogate diagnostic image. Because we were concerned that a CT/CT pair might be too easy to register, a simulated MR made by re-colorizing the resliced CT (to become a facsimile MR or fMR) was also used as a surrogate diagnostic image. Finally we studied the registration accuracy when a CT/(real)MR pair was used. The registration in this case could not be guaranteed to be exact, but the studies were obtained under carefully controlled conditions and were registered from bony landmarks using commercial radiosurgery software. A team of experts then placed the tumor from the resliced CT, fMR, or real MR to an AP and lateral 'isocenter simulation film' (a digitally reconstructed radiograph made from the unmarked CT) and to the 'planning CT' - also the unmarked CT. A registration of the data sets (CT/CT, CT/fMR and CT/MR) was also done using our 3D registration software. A total of thirty-six tasks on four subjects were performed. Four analyses (each with

  17. Testing for clinical inertia in medication treatment of bipolar disorder.

    Science.gov (United States)

    Hodgkin, Dominic; Merrick, Elizabeth L; O'Brien, Peggy L; McGuire, Thomas G; Lee, Sue; Deckersbach, Thilo; Nierenberg, Andrew A

    2016-11-15

    Clinical inertia has been defined as lack of change in medication treatment at visits where a medication adjustment appears to be indicated. This paper seeks to identify the extent of clinical inertia in medication treatment of bipolar disorder. A second goal is to identify patient characteristics that predict this treatment pattern. Data describe 23,406 visits made by 1815 patients treated for bipolar disorder during the STEP-BD practical clinical trial. Visits were classified in terms of whether a medication adjustment appears to be indicated, and also whether or not one occurred. Multivariable regression analyses were conducted to find which patient characteristics were predictive of whether adjustment occurred. 36% of visits showed at least 1 indication for adjustment. The most common indications were non-response to medication, side effects, and start of a new illness episode. Among visits with an indication for adjustment, no adjustment occurred 19% of the time, which may be suggestive of clinical inertia. In multivariable models, presence of any indication for medication adjustment was a predictor of receiving one (OR=1.125, 95% CI =1.015, 1.246), although not as strong as clinical status measures. The associations observed are not necessarily causal, given the study design. The data also lack information about physician-patient communication. Many patients remained on the same medication regimen despite indications of side effects or non-response to treatment. Although lack of adjustment does not necessarily reflect clinical inertia in all cases, the reasons for this treatment pattern merit further examination. Copyright © 2016 Elsevier B.V. All rights reserved.

  18. Errors in the Total Testing Process in the Clinical Chemistry ...

    African Journals Online (AJOL)

    2018-03-01

    Mar 1, 2018 ... Analytical errors related to internal and external quality control exceeding the target range, (14.4%) ... indicators to assess errors in the total testing process. The. University ... Evidence showed that the risk of .... Data management and quality control: Pre-test ..... indicators and specifications for key processes.

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

    Science.gov (United States)

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

    2014-09-01

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

  20. Genetic Testing of Maturity-Onset Diabetes of the Young Current Status and Future Perspectives

    Directory of Open Access Journals (Sweden)

    Parveena Firdous

    2018-05-01

    Full Text Available Diabetes is a global epidemic problem growing exponentially in Asian countries posing a serious threat. Among diabetes, maturity-onset diabetes of the young (MODY is a heterogeneous group of monogenic disorders that occurs due to β cell dysfunction. Genetic defects in the pancreatic β-cells result in the decrease of insulin production required for glucose utilization thereby lead to early-onset diabetes (often <25 years. It is generally considered as non-insulin dependent form of diabetes and comprises of 1–5% of total diabetes. Till date, 14 genes have been identified and mutation in them may lead to MODY. Different genetic testing methodologies like linkage analysis, restriction fragment length polymorphism, and DNA sequencing are used for the accurate and correct investigation of gene mutations associated with MODY. The next-generation sequencing has emerged as one of the most promising and effective tools to identify novel mutated genes related to MODY. Diagnosis of MODY is mainly relying on the sequential screening of the three marker genes like hepatocyte nuclear factor 1 alpha (HNF1α, hepatocyte nuclear factor 4 alpha (HNF4α, and glucokinase (GCK. Interestingly, MODY patients can be managed by diet alone for many years and may also require minimal doses of sulfonylureas. The primary objective of this article is to provide a review on current status of MODY, its prevalence, genetic testing/diagnosis, possible treatment, and future perspective.

  1. Genetic Testing of Maturity-Onset Diabetes of the Young Current Status and Future Perspectives

    Science.gov (United States)

    Firdous, Parveena; Nissar, Kamran; Ali, Sajad; Ganai, Bashir Ahmad; Shabir, Uzma; Hassan, Toyeeba; Masoodi, Shariq Rashid

    2018-01-01

    Diabetes is a global epidemic problem growing exponentially in Asian countries posing a serious threat. Among diabetes, maturity-onset diabetes of the young (MODY) is a heterogeneous group of monogenic disorders that occurs due to β cell dysfunction. Genetic defects in the pancreatic β-cells result in the decrease of insulin production required for glucose utilization thereby lead to early-onset diabetes (often diabetes and comprises of 1–5% of total diabetes. Till date, 14 genes have been identified and mutation in them may lead to MODY. Different genetic testing methodologies like linkage analysis, restriction fragment length polymorphism, and DNA sequencing are used for the accurate and correct investigation of gene mutations associated with MODY. The next-generation sequencing has emerged as one of the most promising and effective tools to identify novel mutated genes related to MODY. Diagnosis of MODY is mainly relying on the sequential screening of the three marker genes like hepatocyte nuclear factor 1 alpha (HNF1α), hepatocyte nuclear factor 4 alpha (HNF4α), and glucokinase (GCK). Interestingly, MODY patients can be managed by diet alone for many years and may also require minimal doses of sulfonylureas. The primary objective of this article is to provide a review on current status of MODY, its prevalence, genetic testing/diagnosis, possible treatment, and future perspective. PMID:29867778

  2. Puzzle test: A tool for non-analytical clinical reasoning assessment.

    Science.gov (United States)

    Monajemi, Alireza; Yaghmaei, Minoo

    2016-01-01

    Most contemporary clinical reasoning tests typically assess non-automatic thinking. Therefore, a test is needed to measure automatic reasoning or pattern recognition, which has been largely neglected in clinical reasoning tests. The Puzzle Test (PT) is dedicated to assess automatic clinical reasoning in routine situations. This test has been introduced first in 2009 by Monajemi et al in the Olympiad for Medical Sciences Students.PT is an item format that has gained acceptance in medical education, but no detailed guidelines exist for this test's format, construction and scoring. In this article, a format is described and the steps to prepare and administer valid and reliable PTs are presented. PT examines a specific clinical reasoning task: Pattern recognition. PT does not replace other clinical reasoning assessment tools. However, it complements them in strategies for assessing comprehensive clinical reasoning.

  3. UNMASKING MASKED HYPERTENSION: PREVALENCE, CLINICAL IMPLICATIONS, DIAGNOSIS, CORRELATES, AND FUTURE DIRECTIONS

    OpenAIRE

    Peacock, James; Diaz, Keith M.; Viera, Anthony J.; Schwartz, Joseph E.; Shimbo, Daichi

    2014-01-01

    ‘Masked hypertension’ is defined as having non-elevated clinic blood pressure (BP) with elevated out-of-clinic average BP, typically determined by ambulatory BP monitoring. Approximately 15–30% of adults with non-elevated clinic BP have masked hypertension. Masked hypertension is associated with increased risks of cardiovascular morbidity and mortality compared to sustained normotension (non-elevated clinic and ambulatory BP), which is similar to or approaching the risk associated with sustai...

  4. Future enhanced clinical role of pharmacists in emergency departments in England:multi-site observational evaluation

    OpenAIRE

    Hughes, Elizabeth; Terry, David; Huynh, Chi; Petridis, Konstantinos; Aiello, Matthew; Mazard, Louis; Ubhi, Hirminder; Terry, Alex; Wilson, Keith; Sinclair, Anthony

    2017-01-01

    Background There are concerns about maintaining appropriate clinical staffing levels in Emergency Departments. Pharmacists may be one possible solution. Objective To determine if Emergency Department attendees could be clinically managed by pharmacists with or without advanced clinical practice training. Setting Prospective 49 site cross-sectional observational study of patients attending Emergency Departments in England. Method Pharmacist data collectors identified patient attendance at thei...

  5. 15N-ammonium test in clinical research

    International Nuclear Information System (INIS)

    Jung, K.; Metzner, C.; Teichmann, B.; Leipzig Univ.

    1989-01-01

    By use of the 15 N-ammonium test the liver function is investigated under influence of hormonal contraceptives in women and in liver diseases in children. With the described noninvasive nonradioactive isotope test the ammonia detoxification capability and the urea synthesis capacity of the liver is determined by measuring of the 15 N excretion in ammonia and urea in urine after oral administering of 15 N-ammonium chloride. The 15 N-ammonium test shows a significant influence of the hormonal contraceptives on the liver function and gives diagnostic evidence for liver diseases in children. (author)

  6. [Current status and clinical application prospect of Akabane's test].

    Science.gov (United States)

    Wang, Wenjie; Du, Yanjun

    2016-06-12

    The Akabane's test is one of the meridian diagnostic methods. Compared with the current meridian diagnostic methods, it has the advantages of convenience and efficiency, but it also has several disadvantages such as the accuracy is difficult to control, the outcome interpretation is limited, etc. In this paper, the influence factors of Akabane's test were analyzed one by one, especially proposed personal opinion on outcome interpretation, which could ascertain the location and nature of disease, leading to disease syndrome. With accurate syndrome, the treatment plan could be established. The application prospect of Akabane's test was initially explored, and it was proposed that wearable automation equipment could be one of the development directions.

  7. [Static posturography versus clinical tests in elderly people with vestibular pathology].

    Science.gov (United States)

    Ortuño-Cortés, Miguel A; Martín-Sanz, Eduardo; Barona-de Guzmán, Rafael

    2008-01-01

    Balance can be quantified by clinical tests and through instrumental studies. The objective of this paper is to determine the correlation between static posturography and 4 clinical tests of balance in elderly people with vestibular disorders and to identify its capability to discriminate the groups studied. 60 patients with vestibular disorders and 60 healthy subjects performed 4 clinical tests (one leg standing with opened eyes, Timed Up and Go, Tinetti and Berg tests) and a static posturography analysis (NedSVE/IBV system) under 4 conditions: Romberg Test, Eyes Open (REO), Romberg Test, Eyes Closed (REC), Romberg Test on Foam with Eyes Open (RFEO), and Romberg Test on Foam with Eyes Closed (RFEC). RFEO correlated best with the clinical tests and RFEC was the worst. RFEO distinguished between healthy individuals and decompensated patients. RFEO gave the best information about postural balance in the elderly. RFEC was not useful. Static posturography can be useful to distinguish vestibular compensation status.

  8. A robust test for growth hormone doping--present status and future prospects.

    Science.gov (United States)

    Nelson, Anne E; Ho, Ken K

    2008-05-01

    Although doping with growth hormone (GH) is banned, there is anecdotal evidence that it is widely abused. GH is reportedly used often in combination with anabolic steroids at high doses for several months. Development of a robust test for GH has been challenging because recombinant human 22 kDa (22K) GH used in doping is indistinguishable analytically from endogenous GH and there are wide physiological fluctuations in circulating GH concentrations. One approach to GH testing is based on measurement of different circulating GH isoforms using immunoassays that differentiate between 22K and other GH isoforms. Administration of 22K GH results in a change in its abundance relative to other endogenous pituitary GH isoforms. The differential isoform method has been implemented; however, its utility is limited because of the short window of opportunity of detection. The second approach, which will extend the window of opportunity of detection, is based on the detection of increased levels of circulating GH-responsive proteins, such as insulin-like growth factor (IGF) axis and collagen peptides. Age and gender are the major determinants of variability for IGF-I and the collagen markers; therefore, a test based on these markers must take age into account for men and women. Extensive data is now available that validates the GH-responsive marker approach and implementation is now largely dependent on establishing an assured supply of standardized assays. Future directions will include more widespread implementation of both approaches by the World Anti-Doping Agency, possible use of other platforms for measurement and an athlete's passport to establish individual reference levels for biological parameters such as GH-responsive markers. Novel approaches include gene expression and proteomic profiling. 2008, Asian Journal of Andrology, SIMM and SJTU. All rights reserved.

  9. [Clinical research IV. Relevancy of the statistical test chosen].

    Science.gov (United States)

    Talavera, Juan O; Rivas-Ruiz, Rodolfo

    2011-01-01

    When we look at the difference between two therapies or the association of a risk factor or prognostic indicator with its outcome, we need to evaluate the accuracy of the result. This assessment is based on a judgment that uses information about the study design and statistical management of the information. This paper specifically mentions the relevance of the statistical test selected. Statistical tests are chosen mainly from two characteristics: the objective of the study and type of variables. The objective can be divided into three test groups: a) those in which you want to show differences between groups or inside a group before and after a maneuver, b) those that seek to show the relationship (correlation) between variables, and c) those that aim to predict an outcome. The types of variables are divided in two: quantitative (continuous and discontinuous) and qualitative (ordinal and dichotomous). For example, if we seek to demonstrate differences in age (quantitative variable) among patients with systemic lupus erythematosus (SLE) with and without neurological disease (two groups), the appropriate test is the "Student t test for independent samples." But if the comparison is about the frequency of females (binomial variable), then the appropriate statistical test is the χ(2).

  10. Experimental investigation of thermal limits in parallel plate configuration for the future material testing reactor (JHR)

    International Nuclear Information System (INIS)

    Brigitte Noel

    2005-01-01

    Full text of publication follows: The design of the future material testing reactor, named Jules Horowitz Reactor and dedicated to technological irradiations, will allow very high performances. The JHR will be cooled and moderated by light water. The preliminary core of JHR consists of 46 assemblies, arranged in a triangular lattice inside a rectangular aluminium matrix. It is boarded on two sides by a beryllium reflector. The other two sides are left free in order to introduce mobile irradiation devices. The JHR assembly would be composed of 3 x 6 cylindrical fuel plates maintained by 3 stiffeners. The external diameter of the assembly is close to 8 cm with a 600 mm heated length, coolant channels having a 1.8 mm gap width. The JHR core must be designed to accommodate high power densities using a high coolant mass flux and sub-cooling level at moderate pressure. The JHR core configuration with multi-channels is subject to a potential excursive instability, called flow redistribution, and is distinguished from a true critical heat flux which would occur at a fixed channel flow rate. At thermal-hydraulic conditions applicable to the JHR, the availability of experimental data for both flow redistribution and CHF is very limited. Consequently, a thermal-hydraulic test facility (SULTAN-RJH) was designed and built in CEA-Grenoble to simulate a full-length coolant sub-channel representative of the JHR core, allowing determination of both thermal limits under relevant thermal hydraulics conditions. The SULTAN-RJH test section simulates a single sub-channel in the JHR core with a cross section corresponding to a mean span (∼50 mm) that has a full reactor length (600 mm), the same flow channel gap (1.5 mm) and Inconel plates of 1 mm thickness. The tests with light water flowing vertically upward will investigate a heat flux range of 0-7 MW/m 2 , velocity range of 0.6-18 m/s, exit pressure range of 0.2-1.0 MPa and inlet temperature range of 25-180 deg. C. The test section

  11. Experience of targeted Usher exome sequencing as a clinical test

    Science.gov (United States)

    Besnard, Thomas; García-García, Gema; Baux, David; Vaché, Christel; Faugère, Valérie; Larrieu, Lise; Léonard, Susana; Millan, Jose M; Malcolm, Sue; Claustres, Mireille; Roux, Anne-Françoise

    2014-01-01

    We show that massively parallel targeted sequencing of 19 genes provides a new and reliable strategy for molecular diagnosis of Usher syndrome (USH) and nonsyndromic deafness, particularly appropriate for these disorders characterized by a high clinical and genetic heterogeneity and a complex structure of several of the genes involved. A series of 71 patients including Usher patients previously screened by Sanger sequencing plus newly referred patients was studied. Ninety-eight percent of the variants previously identified by Sanger sequencing were found by next-generation sequencing (NGS). NGS proved to be efficient as it offers analysis of all relevant genes which is laborious to reach with Sanger sequencing. Among the 13 newly referred Usher patients, both mutations in the same gene were identified in 77% of cases (10 patients) and one candidate pathogenic variant in two additional patients. This work can be considered as pilot for implementing NGS for genetically heterogeneous diseases in clinical service. PMID:24498627

  12. Prospective Clinical Testing of Regulatory Dendritic Cells in Organ Transplantation

    OpenAIRE

    Thomson, Angus W.; Zahorchak, Alan F.; Ezzelarab, Mohamed B.; Butterfield, Lisa H.; Lakkis, Fadi G.; Metes, Diana M.

    2016-01-01

    Dendritic cells (DC) are rare, professional antigen-presenting cells with ability to induce or regulate alloimmune responses. Regulatory DC (DCreg) with potential to down-modulate acute and chronic inflammatory conditions that occur in organ transplantation can be generated in vitro under a variety of conditions. Here, we provide a rationale for evaluation of DCreg therapy in clinical organ transplantation with the goal of promoting sustained, donor-specific hyporesponsiveness, while lowering...

  13. Blinded trials taken to the test: an analysis of randomized clinical trials that report tests for the success of blinding

    DEFF Research Database (Denmark)

    Hróbjartsson, A; Forfang, E; Haahr, M T

    2007-01-01

    Blinding can reduce bias in randomized clinical trials, but blinding procedures may be unsuccessful. Our aim was to assess how often randomized clinical trials test the success of blinding, the methods involved and how often blinding is reported as being successful....

  14. Instrumented static and dynamic balance assessment after stroke using Wii Balance Boards: reliability and association with clinical tests.

    Directory of Open Access Journals (Sweden)

    Kelly J Bower

    Full Text Available The Wii Balance Board (WBB is a globally accessible device that shows promise as a clinically useful balance assessment tool. Although the WBB has been found to be comparable to a laboratory-grade force platform for obtaining centre of pressure data, it has not been comprehensively studied in clinical populations. The aim of this study was to investigate the measurement properties of tests utilising the WBB in people after stroke.Thirty individuals who were more than three months post-stroke and able to stand unsupported were recruited from a single outpatient rehabilitation facility. Participants performed standardised assessments incorporating the WBB and customised software (static stance with eyes open and closed, static weight-bearing asymmetry, dynamic mediolateral weight shifting and dynamic sit-to-stand in addition to commonly employed clinical tests (10 Metre Walk Test, Timed Up and Go, Step Test and Functional Reach on two testing occasions one week apart. Test-retest reliability and construct validity of the WBB tests were investigated.All WBB-based outcomes were found to be highly reliable between testing occasions (ICC  = 0.82 to 0.98. Correlations were poor to moderate between WBB variables and clinical tests, with the strongest associations observed between task-related activities, such as WBB mediolateral weight shifting and the Step Test.The WBB, used with customised software, is a reliable and potentially useful tool for the assessment of balance and weight-bearing asymmetry following stroke. Future research is recommended to further investigate validity and responsiveness.

  15. Exaggerated Exercise Blood Pressure Response During Treadmill Testing as a Predictor of Future Hypertension in Men: A Longitudinal Study.

    Science.gov (United States)

    Jae, Sae Young; Franklin, Barry A; Choo, Jina; Choi, Yoon-Ho; Fernhall, Bo

    2015-11-01

    The purpose of this study was to evaluate receiver operating characteristic curves to identify optimal cutoff values of exercise systolic blood pressure (SBP) using both peak SBP and relative SBP (peak SBP minus resting SBP) as predictors of future hypertension (HTN). Participants were 3,742 healthy normotensive men who underwent symptom-limited treadmill testing at baseline. Incident HTN was defined as SBP/diastolic blood pressure greater than 140/90 mm Hg and/or diagnosed HTN by a physician. During an average 5-year follow-up, 364 (9.7%) new cases of HTN were observed. The most discriminatory cutoff values for peak SBP and relative SBP for predicting incident HTN were 181 mm Hg (areas under the curve (AUC) = 0.644, sensitivity = 54%, and specificity = 69%) and 52 mm Hg (AUC = 0.549, sensitivity = 64.3%, and specificity = 44.6%), respectively. Participants with peak SBP greater than 181 mm Hg and relative SBP greater than 52 mm Hg had 1.54-fold (95% CI: 1.23-1.93) and 1.44-fold (95% CI: 1.16-1.80) risks of developing HTN after adjusting for potential confounding variables. When these 2 variables were entered simultaneously into the Cox proportional hazards regression model with adjustment for potential confounding variables, only peak SBP (relative risk: 1.39, 95% CI: 1.02-1.89) was a predictor of the development of HTN. The most accurate discriminators for peak and relative SBP during treadmill exercise testing to predict incident HTN were greater than 181 and 52 mm Hg, respectively, in normotensive men. A peak SBP greater than 181 mm Hg during treadmill exercise testing may provide a useful predictor for the development of HTN in clinical practice. © American Journal of Hypertension, Ltd 2015. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  16. Clinical and para-clinical tests in the routine examination of headache patients

    DEFF Research Database (Denmark)

    Friberg, L; Sandrini, G; Jänig, W

    2000-01-01

    Para-clinical examinations in the diagnosis and treatment control of headache patients vary considerably between clinics and headache centers. Among the neurological societies in Europe there has been a consensus that some common procedures and recommendations should be created. In the Fall of 19...

  17. Parents’ Attitudes toward Clinical Genetic Testing for Autism Spectrum Disorder—Data from a Norwegian Sample

    Directory of Open Access Journals (Sweden)

    Jarle Johannessen

    2017-05-01

    Full Text Available Clinical genetic testing (CGT of children with autism spectrum disorder (ASD may have positive and negative effects. Knowledge about parents’ attitudes is needed to ensure good involvement of caregivers, which is crucial for accurate diagnosis and effective clinical management. This study aimed to assess parents’ attitudes toward CGT for ASD. Parent members of the Norwegian Autism Society were given a previously untested questionnaire and 1455 answered. Linear regression analyses were conducted to evaluate contribution of parent and child characteristics to attitude statements. Provided it could contribute to a casual explanation of their child’s ASD, 76% would undergo CGT. If it would improve the possibilities for early interventions, 74% were positive to CGT. Between 49–67% agreed that CGT could have a negative impact on health insurance, increase their concern for the child’s future and cause family conflicts. Parents against CGT (9% were less optimistic regarding positive effects, but not more concerned with negative impacts. The severity of the children’s ASD diagnosis had a weak positive association with parent’s positive attitudes to CGT (p-values range from <0.001 to 0.975. Parents prefer that CGT is offered to those having a child with ASD (65%, when the child’s development deviates from normal (48%, or before pregnancy (36%. A majority of the parents of children with ASD are positive to CGT due to possibilities for an etiological explanation.

  18. Parents' Attitudes toward Clinical Genetic Testing for Autism Spectrum Disorder-Data from a Norwegian Sample.

    Science.gov (United States)

    Johannessen, Jarle; Nærland, Terje; Hope, Sigrun; Torske, Tonje; Høyland, Anne Lise; Strohmaier, Jana; Heiberg, Arvid; Rietschel, Marcella; Djurovic, Srdjan; Andreassen, Ole A

    2017-05-18

    Clinical genetic testing (CGT) of children with autism spectrum disorder (ASD) may have positive and negative effects. Knowledge about parents' attitudes is needed to ensure good involvement of caregivers, which is crucial for accurate diagnosis and effective clinical management. This study aimed to assess parents' attitudes toward CGT for ASD. Parent members of the Norwegian Autism Society were given a previously untested questionnaire and 1455 answered. Linear regression analyses were conducted to evaluate contribution of parent and child characteristics to attitude statements. Provided it could contribute to a casual explanation of their child's ASD, 76% would undergo CGT. If it would improve the possibilities for early interventions, 74% were positive to CGT. Between 49-67% agreed that CGT could have a negative impact on health insurance, increase their concern for the child's future and cause family conflicts. Parents against CGT (9%) were less optimistic regarding positive effects, but not more concerned with negative impacts. The severity of the children's ASD diagnosis had a weak positive association with parent's positive attitudes to CGT ( p -values range from <0.001 to 0.975). Parents prefer that CGT is offered to those having a child with ASD (65%), when the child's development deviates from normal (48%), or before pregnancy (36%). A majority of the parents of children with ASD are positive to CGT due to possibilities for an etiological explanation.

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

    Science.gov (United States)

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

    2016-03-01

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

  20. The future of research in craniofacial biology and what this will mean for oral health professional education and clinical practice.

    Science.gov (United States)

    Slavkin, H C

    2014-06-01

    Today, and looking to the future, scientific discoveries from cellular, developmental and molecular biology inform our understanding of cell, tissue and organ morphogenesis as exemplified in skin, bone, cartilage, dentine, enamel, muscle, nerve and many organs such as salivary glands and teeth. Present day biomedical science yields principles for the biomimetic design and fabrication of cells, tissues and organs. Bioengineering has become a strategy that can 'mimic' biological processes, and inform clinical procedures for tissue and organ replacements. The future of regenerative craniofacial biology holds enormous promise for the diagnosis and treatment of congenital birth defects, traumatic injuries, degenerative chronic diseases as well as for Mendelian single gene and complex multigene diseases and disorders. The past 50 years have heralded the completion of the human genome and the introduction of 'personalized medicine and dentistry', the utilization of stem cell therapy for an array of diseases and disorders, the 'proof of principle' to reverse select inherited diseases such as anhidrotic ectodermal dysplasia (ED), and the fruits from interdisciplinary research drawn from the diverse biomedical sciences. Looking to the future, we can readily anticipate as major goals to emphasize the clinician's role in identifying clinical phenotypes that can lead to differential diagnosis, and rejuvenate missing or damaged tissues by establishing processes for the utilization of gene, cell and/or protein therapies. The future is replete with remarkable opportunities to enhance clinical outcomes for congenital as well as acquired craniofacial malformations. Clinicians play a pivotal role because critical thinking and sound clinical acumen substantially improve diagnostic precision and thereby clinical health outcomes. © 2014 Australian Dental Association.

  1. Frequency and determinants of consistent STI/HIV testing among men who have sex with men testing at STI outpatient clinics in the Netherlands: a longitudinal study.

    Science.gov (United States)

    Visser, Maartje; Heijne, Janneke C M; Hogewoning, Arjan A; van Aar, Fleur

    2017-09-01

    Men who have sex with men (MSM) are at highest risk for STIs and HIV infections in the Netherlands. However, official guidelines on STI testing among MSM are lacking. They are advised to test for STIs at least every six months, but their testing behaviour is not well known. This study aimed to get insight into the proportion and determinants of consistent 6-monthly STI testing among MSM testing at STI outpatient clinics in the Netherlands. This study included longitudinal surveillance data of STI consultations among MSM from all 26 STI outpatient clinics in the Netherlands between 1 June 2014 and 31 December 2015. Multinomial logistic regression analysis was used to identify determinants of consistent 6-monthly testing compared with single testing and inconsistent testing. Determinants of time between consultations among men with multiple consultations were analysed using a Cox Prentice-Williams-Peterson gap-time model. A total of 34 605 STI consultations of 18 634 MSM were included. 8966 (48.1%) men had more than one consultation, and 3516 (18.9%) men tested consistently 6-monthly. Indicators of high sexual risk behaviour, including having a history of STI, being HIV positive and having more than 10 sex partners, were positively associated with both being a consistent tester and returning to the STI clinic sooner. Men who were notified by a partner or who reported STI symptoms were also more likely to return to the STI clinic sooner, but were less likely to be consistent testers, identifying a group of event-driven testers. The proportion of consistent 6-monthly testers among MSM visiting Dutch STI outpatient clinics was low. Testing behaviour was associated with sexual risk behaviour, but exact motives to test consistently remain unclear. Evidence-based testing guidelines are needed to achieve optimal reductions in STI transmission in the future. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence

  2. Stakeholder consultation insights on the future of genomics at the clinical-public health interface.

    Science.gov (United States)

    Modell, Stephen M; Kardia, Sharon L R; Citrin, Toby

    2014-05-01

    In summer 2011, the Centers for Disease Control and Prevention Office of Public Health Genomics conducted a stakeholder consultation, administered by the University of Michigan Center for Public Health and Community Genomics, and Genetic Alliance, to recommend priorities for public health genomics from 2012 through 2017. Sixty-two responses from health professionals, administrators, and members of the public were pooled with 2 sets of key informant interviews and 3 discussion groups. NVivo 9 and manual methods were used to organize themes. This review offers an interim analysis of progress with respect to the final recommendations, which demonstrated a strong interest in moving genomic discoveries toward implementation and comparative effectiveness (T3/T4) translational research. A translational research continuum exists with familial breast and ovarian cancer at one end and prostate cancer at the other. Cascade screening for inherited arrhythmia syndromes and hypercholesterolemia lags stakeholder recommendations in the United States but not in Europe; implementation of health service-based screening for Lynch syndrome, and integration into electronic health information systems, is on pace with the recommended timeline. A number of options exist to address deficits in the funding of translational research, particularly for oncogenomic gene expression profiling. The goal of personalized risk assessment necessitates both research progress (eg, in whole genome sequencing, as well as provider education in the differentiation of low- vs high-risk status. The public health approach supports an emphasis on genetic test validation while endorsing clinical translation research inclusion of an environmental and population-based perspective. Copyright © 2014 Mosby, Inc. All rights reserved.

  3. Pros and Cons of Clinical Basophil Testing (BAT)

    NARCIS (Netherlands)

    Hoffmann, Hans Jürgen; Knol, Edward F; Ferrer, Martha; Mayorga, Lina; Sabato, Vito; Santos, Alexandra F; Eberlein, Bernadette; Nopp, Anna; MacGlashan, Donald

    PURPOSE OF REVIEW: We review basophil testing by flow cytometry with an emphasis on advantages and disadvantages. RECENT FINDINGS: There are many tools available to assess the presence and severity of allergic diseases in patients. For 50 years, peripheral blood basophils have been used as tools to

  4. A Clinical Perspective on Ethical Issues in Genetic Testing

    NARCIS (Netherlands)

    Sijmons, R. H.; Van Langen, I. M.; Sijmons, J. G.

    2011-01-01

    Genetic testing is traditionally preceded by counselling to discuss its advantages and disadvantages with individuals so they can make informed decisions. The new technique of whole genome or exome sequencing, which is currently only used in research settings, can identify many gene mutations,

  5. Open-source Software for Demand Forecasting of Clinical Laboratory Test Volumes Using Time-series Analysis.

    Science.gov (United States)

    Mohammed, Emad A; Naugler, Christopher

    2017-01-01

    Demand forecasting is the area of predictive analytics devoted to predicting future volumes of services or consumables. Fair understanding and estimation of how demand will vary facilitates the optimal utilization of resources. In a medical laboratory, accurate forecasting of future demand, that is, test volumes, can increase efficiency and facilitate long-term laboratory planning. Importantly, in an era of utilization management initiatives, accurately predicted volumes compared to the realized test volumes can form a precise way to evaluate utilization management initiatives. Laboratory test volumes are often highly amenable to forecasting by time-series models; however, the statistical software needed to do this is generally either expensive or highly technical. In this paper, we describe an open-source web-based software tool for time-series forecasting and explain how to use it as a demand forecasting tool in clinical laboratories to estimate test volumes. This tool has three different models, that is, Holt-Winters multiplicative, Holt-Winters additive, and simple linear regression. Moreover, these models are ranked and the best one is highlighted. This tool will allow anyone with historic test volume data to model future demand.

  6. Open-source software for demand forecasting of clinical laboratory test volumes using time-series analysis

    Directory of Open Access Journals (Sweden)

    Emad A Mohammed

    2017-01-01

    Full Text Available Background: Demand forecasting is the area of predictive analytics devoted to predicting future volumes of services or consumables. Fair understanding and estimation of how demand will vary facilitates the optimal utilization of resources. In a medical laboratory, accurate forecasting of future demand, that is, test volumes, can increase efficiency and facilitate long-term laboratory planning. Importantly, in an era of utilization management initiatives, accurately predicted volumes compared to the realized test volumes can form a precise way to evaluate utilization management initiatives. Laboratory test volumes are often highly amenable to forecasting by time-series models; however, the statistical software needed to do this is generally either expensive or highly technical. Method: In this paper, we describe an open-source web-based software tool for time-series forecasting and explain how to use it as a demand forecasting tool in clinical laboratories to estimate test volumes. Results: This tool has three different models, that is, Holt-Winters multiplicative, Holt-Winters additive, and simple linear regression. Moreover, these models are ranked and the best one is highlighted. Conclusion: This tool will allow anyone with historic test volume data to model future demand.

  7. Crash tests with Smartcrash barriers, a technology with a future; Zukunftssichere Crashtests mit Smartcrash-Barrieren

    Energy Technology Data Exchange (ETDEWEB)

    Barz, D.; Evers, W. [Kistler Instrumente AG (Switzerland). Geschaeftsbereich Fahrzeugmesstechnik

    2005-02-01

    The Smartcrash barrier by Kistler is a completely new technology. State-of-the-art data processing with Microdau modules is combined with a singular mechanical modularity which meets all requirements of present and future crash standards. Together with a piezo measuring system perfectly tuned to the highly dynamic processes during crash tests, this provides a basis for making crash laboratories economically efficient, with safe and accurate data, and compatible with other measuring systems. The system is a 'must' for every modern crash laboratory. (orig.) [German] Die Smartcrash-Barriere von Kistler setzt in jeder Hinsicht Massstaebe. Neueste Technologie der Datenverarbeitung beim Crash mit Microdau-Modulen, wie sie auch in Dummys eingesetzt werden, wird mit einer einzigartigen mechanischen Modularitaet kombiniert, die alle erforderlichen Voraussetzungen fuer bestehende und zukuenftige Crash-Standards bietet. In Verbindung mit der fuer die Messung von hochdynamischen Kraftverlaeufen beim Crash praedestinierte Piezo-Messtechnik ist hiermit die Basis geschaffen, Crash-Laboratorien wirtschaftlich und hinsichtlich des Datenakquisition sicher und kompatibel mit anderen Messgroessen im Labor auszuruesten. Ein 'Muss' fuer jedes moderne Crash-Labor. (orig.)

  8. Qualification test of a MPPC-based PET module for future MRI-PET scanners

    Science.gov (United States)

    Kurei, Y.; Kataoka, J.; Kato, T.; Fujita, T.; Funamoto, H.; Tsujikawa, T.; Yamamoto, S.

    2014-11-01

    We have developed a high-resolution, compact Positron Emission Tomography (PET) module for future use in MRI-PET scanners. The module consists of large-area, 4×4 ch MPPC arrays (Hamamatsu S11827-3344MG) optically coupled with Ce:LYSO scintillators fabricated into 12×12 matrices of 1×1 mm2 pixels. At this stage, a pair of module and coincidence circuits was assembled into an experimental prototype gantry arranged in a ring of 90 mm in diameter to form the MPPC-based PET system. The PET detector ring was then positioned around the RF coil of the 4.7 T MRI system. We took an image of a point 22Na source under fast spin echo (FSE) and gradient echo (GE), in order to measure interference between the MPPC-based PET and the MRI. We only found a slight degradation in the spatial resolution of the PET image from 1.63 to 1.70 mm (FWHM; x-direction), or 1.48-1.55 mm (FWHM; y-direction) when operating with the MRI, while the signal-to-noise ratio (SNR) of the MRI image was only degraded by 5%. These results encouraged us to develop a more advanced version of the MRI-PET gantry with eight MPPC-based PET modules, whose detailed design and first qualification test are also presented in this paper.

  9. Prospective Clinical Testing of Regulatory Dendritic Cells in Organ Transplantation.

    Science.gov (United States)

    Thomson, Angus W; Zahorchak, Alan F; Ezzelarab, Mohamed B; Butterfield, Lisa H; Lakkis, Fadi G; Metes, Diana M

    2016-01-01

    Dendritic cells (DC) are rare, professional antigen-presenting cells with ability to induce or regulate alloimmune responses. Regulatory DC (DCreg) with potential to down-modulate acute and chronic inflammatory conditions that occur in organ transplantation can be generated in vitro under a variety of conditions. Here, we provide a rationale for evaluation of DCreg therapy in clinical organ transplantation with the goal of promoting sustained, donor-specific hyporesponsiveness, while lowering the incidence and severity of rejection and reducing patients' dependence on anti-rejection drugs. Generation of donor- or recipient-derived DCreg that suppress T cell responses and prolong transplant survival in rodents or non-human primates has been well-described. Recently, good manufacturing practice (GMP)-grade DCreg have been produced at our Institution for prospective use in human organ transplantation. We briefly review experience of regulatory immune therapy in organ transplantation and describe our experience generating and characterizing human monocyte-derived DCreg. We propose a phase I/II safety study in which the influence of donor-derived DCreg combined with conventional immunosuppression on subclinical and clinical rejection and host alloimmune responses will be examined in detail.

  10. Women’s involvement in clinical trials: historical perspective and future implications

    Directory of Open Access Journals (Sweden)

    Liu KA

    2016-03-01

    Full Text Available The importance of considering the differences between the male and female sex in clinical decision-making is crucial. However, it has been acknowledged in recent decades that clinical trials have not always adequately enrolled women or analyzed sex-specific differences in the data. As these deficiencies have hindered the progress of understanding women’s response to medications, agencies in the United States have worked towards the inclusion of women in clinical trials and appropriate analysis of sex-specific data from clinical trials. This review outlines the history and progress of women’s inclusion in clinical trials for prescription drugs and presents considerations for researchers, clinicians, and academicians on this issue.

  11. Clinical approach to obscure GI bleeding - Diagnostic testing and management

    Directory of Open Access Journals (Sweden)

    Prashanth Prabakaran

    2013-01-01

    Full Text Available Obscure gastrointestinal bleeding (OGIB can present as a diagnostic dilemma and management can be challenging. The search for causes of OGIB is usually centered on visualizing the small bowel, and in the past decade, the technology to visualize the entire small bowel has significantly advanced. Moreover, small bowel endoscopic imaging has replaced, in many instances, prior radiographic evaluation for obscure GI bleeding. These new modalities, such as small bowel capsule endoscopy (CE, balloon-assisted deep enteroscopy [double balloon enteroscopy (DBE and single balloon enteroscopy (SBE], and overtube-assisted deep enteroscopy (spiral enteroscopy, are paving the way toward more accurately identifying and treating patients with OGIB. We will review the diagnostic modalities available in evaluating a patient with OGIB and also propose the management based on clinical and endoscopic findings.

  12. Addressing demoralization in clinical staff: a true test of leadership.

    Science.gov (United States)

    Gabel, Stewart

    2011-11-01

    Demoralization is a state that occurs when an individual's personal or professional goals, principles, or values are threatened. Psychiatrists working in mental healthcare organizations may experience demoralization for numerous reasons, including diminished funding for valued programs, personnel reductions, and administrative burdens hindering patient care. Demoralization places psychiatrists and other mental health professionals at increased risk for burnout, and its associated problems related to physical and mental difficulties, poor patient care, and staff losses and turnover. Demoralization, therefore, presents an important challenge to medical and clinical leaders who must address this issue to maintain the organizational commitment to optimal patient-centered care. This can be done using sound and accepted leadership principles coupled with a values orientation. The paper provides an illustration.

  13. CAG repeat testing of androgen receptor polymorphism: is this necessary for the best clinical management of hypogonadism?

    Science.gov (United States)

    Francomano, Davide; Greco, Emanuela A; Lenzi, Andrea; Aversa, Antonio

    2013-10-01

    It is controversial whether or not testing the length of the androgen receptor polymorphism in clinical practice is useful for correct diagnosis and treatment of hypogonadism. To describe the molecular and clinical implications of testing the length of the androgen receptor polymorphism for treatment of hypogonadism in both male and female subjects. A systematic Medline search was conducted using several terms related to and including the terms "androgen receptor," "CAG-repeat polymorphism," "male hypogonadism," "female hypogonadism," and "neurodegenerative disease." Clinical evidence that demonstrates the importance of CAG repeat number investigation in male and female hypogonadism. A thorough review of the clinical utility of CAG repeat polymorphism investigation in men and women with hypogonadism is presented. The role of AR CAG repeat number investigation in hypogonadism (male and female) is not yet established in the clinical practice. In both sexes, a role during clinical management of hormonal replacement therapies may be hypothesized, but the CAG repeat number's relationship with the presence or absence of hypogonadal symptoms remains unclear. Pharmacogenomic investigations of the AR polymorphism may be a future option to tailor testosterone titration individually and to better identify subjects as potentially more or less responsive to treatments; also, investigation may be important to individually predict beneficial and side effects in special subpopulations, specifically, obese men and postmenopausal women. © 2013 International Society for Sexual Medicine.

  14. Motivation and future temporal orientation: a test of the self-handicapping hypothesis.

    Science.gov (United States)

    Lennings, C J

    1999-06-01

    Self-handicapping motivation refers to the likelihood a person will project personal ambition into the future, make a pessimistic judgement, and then mobilise effort in the present to avoid an anticipated negative outcome. It should, therefore, be a correlate of future time perspective. This study showed for a sample of 120 first-year students that, whilst future time perspective did strongly predict scores on a measure of self-handicapping motivation, neither variable was a useful predictor of outcome.

  15. Reliability, construct and discriminative validity of clinical testing in subjects with and without chronic neck pain

    DEFF Research Database (Denmark)

    Jørgensen, René; Ris Hansen, Inge; Falla, Deborah

    2014-01-01

    -retest reliability in people with and without chronic neck pain. Moreover, construct and between-group discriminative validity of the tests were examined. METHODS: Twenty-one participants with chronic neck pain and 21 asymptomatic participants were included. Intra- and inter-reliability were evaluated for the Cranio-Cervical...... Flexion Test (CCFT), Range of Movement (ROM), Joint Position Error (JPE), Gaze Stability (GS), Smooth Pursuit Neck Torsion Test (SPNTT), and neuromuscular control of the Deep Cervical Extensors (DCE). Test-retest reliability was assessed for Postural Control (SWAY) and Pressure Pain Threshold (PPT) over......BACKGROUND: The reliability of clinical tests for the cervical spine has not been adequately evaluated. Six cervical clinical tests, which are low cost and easy to perform in clinical settings, were tested for intra- and inter-examiner reliability, and two performance tests were assessed for test...

  16. 42 CFR 493.1453 - Condition: Laboratories performing high complexity testing; clinical consultant.

    Science.gov (United States)

    2010-10-01

    ... Condition: Laboratories performing high complexity testing; clinical consultant. The laboratory must have a... 42 Public Health 5 2010-10-01 2010-10-01 false Condition: Laboratories performing high complexity testing; clinical consultant. 493.1453 Section 493.1453 Public Health CENTERS FOR MEDICARE & MEDICAID...

  17. Diagnostic value of patient characteristics, history, and six clinical tests for traumatic anterior shoulder instability

    NARCIS (Netherlands)

    van Kampen, D.A.; van den Berg, T.; van der Woude, H.J.; Castelein, R.M.; Terwee, C.B.; Willems, W.J.

    2013-01-01

    Background: It is unknown which combination of patient information and clinical tests might beoptimal for the diagnosis of traumatic anterior shoulder instability. This study aimed to determinethe diagnostic value of individual clinical tests and to develop a prediction model that combined patient

  18. Accuracy of clinical tests in the diagnosis of anterior cruciate ligament injury: A systematic review

    NARCIS (Netherlands)

    M.S. Swain (Michael S.); N. Henschke (Nicholas); S.J. Kamper (Steven); A.S. Downie (Aron S.); B.W. Koes (Bart); C. Maher (Chris)

    2014-01-01

    textabstractBackground: Numerous clinical tests are used in the diagnosis of anterior cruciate ligament (ACL) injury but their accuracy is unclear. The purpose of this study is to evaluate the diagnostic accuracy of clinical tests for the diagnosis of ACL injury.Methods: Study Design: Systematic

  19. Single and Combined Diagnostic Value of Clinical Features and Laboratory Tests in Acute Appendicitis

    NARCIS (Netherlands)

    Laméris, Wytze; van Randen, Adrienne; Go, Peter M. N. Y. H.; Bouma, Wim H.; Donkervoort, Sandra C.; Bossuyt, Patrick M. M.; Stoker, Jaap; Boermeester, Marja A.

    2009-01-01

    Objectives: The objective was to evaluate the diagnostic accuracy of clinical features and laboratory test results in detecting acute appendicitis. Methods: Clinical features and laboratory test results were prospectively recorded in a consecutive series of 1,101 patients presenting with abdominal

  20. Cardiac autonomic testing and treating heart disease. 'A clinical perspective'

    Directory of Open Access Journals (Sweden)

    Nicholas L. DePace

    2014-12-01

    Full Text Available Background Coronary heart disease (CHD is a major health concern, affecting nearly half the middle-age population and responsible for nearly one-third of all deaths. Clinicians have several major responsibilities beyond diagnosing CHD, such as risk stratification of patients for major adverse cardiac events (MACE and treating risks, as well as the patient. This second of a two-part review series discusses treating risk factors, including autonomic dysfunction, and expected outcomes. Methods Therapies for treating cardiac mortality risks including cardiovascular autonomic neuropathy (CAN, are discussed. Results While risk factors effectively target high-risk patients, a large number of individuals who will develop complications from heart disease are not identified by current scoring systems. Many patients with heart conditions, who appear to be well-managed by traditional therapies, experience MACE. Parasympathetic and Sympathetic (P&S function testing provides more information and has the potential to further aid doctors in individualizing and titrating therapy to minimize risk. Advanced autonomic dysfunction (AAD and its more severe form cardiovascular autonomic neuropathy have been strongly associated with an elevated risk of cardiac mortality and are diagnosable through autonomic testing. This additional information includes patient-specific physiologic measures, such as sympathovagal balance (SB. Studies have shown that establishing and maintaining proper SB minimizes morbidity and mortality risk. Conclusions P&S testing promotes primary prevention, treating subclinical disease states, as well as secondary prevention, thereby improving patient outcomes through (1 maintaining wellness, (2 preventing symptoms and disorder and (3 treating subclinical manifestations (autonomic dysfunction, as well as (4 disease and symptoms (autonomic neuropathy.

  1. Clinical implications of using the arm motor ability test in stroke rehabilitation.

    Science.gov (United States)

    O'Dell, Michael W; Kim, Grace; Finnen, Lisa Rivera; Polistena, Caitlin

    2011-05-01

    To identify all published studies using the Arm Motor Ability Test (AMAT), a standardized, laboratory-based measure for selected upper extremity activities of daily living (ADLs); and to summarize its current uses and provide recommendations for its future use. An Ovid online search was performed using the terms "Arm Motor Ability Test" and "AMAT." The reference lists of all articles obtained were reviewed for additional studies not appearing in the literature search. In addition, the original manual for the use and administration of the AMAT was reviewed. All studies examining the psychometric properties of the AMAT or using the AMAT as an outcome measure were identified. Articles simply mentioning the AMAT without providing data and case reports or abstracts (other than those addressing a specific aspect of the scale of interest) were excluded. Studies were reviewed by the primary author. No formal system of quality review was used. The AMAT has been used as an outcome measure in stroke rehabilitation research examining upper extremity robotics, functional electrical stimulation, and cortical stimulation. The most recent version contains 10 ADL tasks, each of which is composed of 1 to 3 subtasks. Of the 3 domains originally proposed, only the "functional ability" domain is routinely assessed. Psychometric studies have demonstrated good reliability and at least reasonable construct validity. The instrument's sensitivity to change over time is less well established, and no recommendation can be made regarding a minimal clinically important difference. We recommend that the 10-item version of the AMAT and assessment of only the functional ability domain be adopted as standard going forward. Further research should include examination of sensitivity over time, minimal clinically important change, reliability and validity in the mid and lower range of scores, and in neurologic diagnoses other than stroke. Copyright © 2011 American Congress of Rehabilitation Medicine

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

    Directory of Open Access Journals (Sweden)

    Zhengwu Lu

    2010-06-01

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

  3. Potential clinical impact of normal-tissue intrinsic radiosensitivity testing

    International Nuclear Information System (INIS)

    Bentzen, Soeren M.

    1997-01-01

    A critical appraisal is given of the possible benefit from a reliable pre-treatment knowledge of individual normal-tissue sensitivity to radiotherapy. The considerations are in part, but not exclusively, based on the recent experience with in vitro colony-forming assays of the surviving fraction at 2 Gy, the SF 2 . Three strategies are reviewed: (1) to screen for rare cases with extreme radiosensitivity, so-called over-reactors, and treat these with reduced total dose, (2) to identify the sensitive tail of the distribution of 'normal' radiosensitivities, refer these patients to other treatment, and to escalate the dose to the remaining patients, or (3) to individualize dose prescriptions based on individual radiosensitivity, i.e. treating to isoeffect rather than to a specific dose-fractionation schedule. It is shown that these strategies will have a small, if any, impact on routine radiotherapy. Screening for over-reactors is hampered by the low prevalence of these among otherwise un-selected patients that leads to a low positive predictive value of in vitro radiosensitivity assays. It is argued, that this problem may persist even if the noise on current assays could be reduced to (the unrealistic value of) zero, simply because of the large biological variation in SF 2 . Removing the sensitive tail of the patient population, will only have a minor effect on the dose that could be delivered to the remaining patients, because of the sigmoid shape of empirical dose-response relationships. Finally, individualizing dose prescriptions based exclusively on information from a normal-tissue radiosensitivity assay, leads to a nearly symmetrical distribution of dose-changes that would produce a very small gain, or even a loss, of tumor control probability if implemented in the clinic. From a theoretical point of view, other strategies could be devised and some of these are considered in this review. Right now the most promising clinical use of in vitro radiosensitivity

  4. Repeat Chlamydia trachomatis testing among heterosexual STI outpatient clinic visitors in the Netherlands: a longitudinal study.

    Science.gov (United States)

    Visser, Maartje; van Aar, Fleur; Koedijk, Femke D H; Kampman, Carolina J G; Heijne, Janneke C M

    2017-12-20

    Chlamydia infections are common in both men and women, are often asymptomatic and can cause serious complications. Repeat testing in high-risk groups is therefore indicated. In the Netherlands, guidelines on repeat chlamydia testing differ between testing facilities, and knowledge on repeat testing behaviour is limited. Here, we analyse the current repeat testing behaviour of heterosexual STI clinic visitors, and aim to identify groups for which repeat testing advice could be advantageous. Longitudinal surveillance data from all Dutch STI outpatient clinics were used, which included all STI clinic consultations carried out among heterosexual men and women between June 2014 and December 2015. Repeat testing was defined as returning to the same STI clinic between 35 days and 12 months after initial consultation. We calculated chlamydia positivity at repeat test stratified by initial test result and time between consultations. Logistic regression analyses were used to identify predictors of repeat testing, and predictors of having a chlamydia positive repeat test. In total, 140,486 consultations in 75,487 women and 46,286 men were available for analyses. Overall, 15.4% of women and 11.1% of men returned to the STI clinic within the study period. Highest chlamydia positivity at repeat test was seen 3-5 months after initial positive test. Among both women and men, repeat testing was associated with non-Western ethnicity, having had more than two sex partners in the past 6 months, reporting STI symptoms, having a history of STI, and having a chlamydia positive initial test. Among repeat testers, chlamydia positive repeat test was most strongly associated with younger age, followed by a chlamydia positive initial test. Repeat testing most often resulted in a positive test result among young heterosexuals (<25) and heterosexuals of any age with a chlamydia infection at the initial consultation. Further efforts are needed to determine optimal repeat testing strategies.

  5. Cost analysis of a novel HIV testing strategy in community pharmacies and retail clinics.

    Science.gov (United States)

    Lecher, Shirley Lee; Shrestha, Ram K; Botts, Linda W; Alvarez, Jorge; Moore, James H; Thomas, Vasavi; Weidle, Paul J

    2015-01-01

    To document the cost of implementing point-of-care (POC) human immunodeficiency virus (HIV) rapid testing in busy community pharmacies and retail clinics. Providing HIV testing services in community pharmacies and retail clinics is an innovative way to expand HIV testing. The cost of implementing POC HIV rapid testing in a busy retail environment needs to be documented to provide program and policy leaders with adequate information for planning and budgeting. Cost analysis from a pilot project that provided confidential POC HIV rapid testing services in community pharmacies and retail clinics. The pharmacy sites were operated under several different ownership structures (for-profit, nonprofit, sole proprietorship, corporation, public, and private) in urban and rural areas. We included data from the initial six sites that participated in the project. We collected the time spent by pharmacy and retail clinic staff for pretest and posttest counseling in an activity log for time-in-motion for each interaction. Pharmacists and retail clinic staff. HIV rapid testing. The total cost was calculated to include costs of test kits, control kits, shipping, test supplies, training, reporting, program administration, and advertising. The six sites trained 22 staff to implement HIV testing. A total of 939 HIV rapid tests were conducted over a median time of 12 months, of which 17 were reactive. Median pretest counseling time was 2 minutes. Median posttest counseling time was 2 minutes for clients with a nonreactive test and 10 minutes for clients with a reactive test. The average cost per person tested was an estimated $47.21. When we considered only recurrent costs, the average cost per person tested was $32.17. Providing POC HIV rapid testing services required a modest amount of staff time and costs that are comparable to other services offered in these settings. HIV testing in pharmacies and retail clinics can provide an additional alternative venue for increasing the

  6. A Review of Barriers to Minorities' Participation in Cancer Clinical Trials: Implications for Future Cancer Research.

    Science.gov (United States)

    Salman, Ali; Nguyen, Claire; Lee, Yi-Hui; Cooksey-James, Tawna

    2016-04-01

    To enhance nurses' awareness and competencies in practice and research by reporting the common barriers to participation of minorities in cancer clinical trials and discussing facilitators and useful strategies for recruitment. Several databases were searched for articles published in peer reviewed journals. Some of the barriers to minorities' participation in clinical trials were identified within the cultural social-context of cancer patients. The involvement of community networking was suggested as the most effective strategy for the recruitment of minorities in cancer clinical trials. Using culturally sensitive approaches to enhance ethnic minorities' participation is important for advancing cancer care and eliminating health disparities. Awareness of barriers and potential facilitators to the enrollment of ethnic minority cancer patients may contribute to enhancing nurses' competencies of recruiting ethnic minorities in nursing research, playing efficient roles in cancer clinical trials team, and providing culturally competent quality care.

  7. Future challenges for clinical care of an ageing population infected with HIV: a modelling study

    NARCIS (Netherlands)

    Smit, Mikaela; Brinkman, Kees; Geerlings, Suzanne; Smit, Colette; Thyagarajan, Kalyani; Sighem, Ard van; de Wolf, Frank; Hallett, Timothy B.

    2015-01-01

    The population infected with HIV is getting older and these people will increasingly develop age-related non-communicable diseases (NCDs). We aimed to quantify the scale of the change and the implications for HIV care in the Netherlands in the future. We constructed an individual-based model of the

  8. Visualizing the Future: Technology Competency Development in Clinical Medicine, and Implications for Medical Education

    Science.gov (United States)

    Srinivasan, Malathi; Keenan, Craig R.; Yager, Joel

    2006-01-01

    Objective: In this article, the authors ask three questions. First, what will physicians need to know in order to be effective in the future? Second, what role will technology play in achieving that high level of effectiveness? Third, what specific skill sets will physicians need to master in order to become effective? Method: Through three case…

  9. Two patients walk into a clinic...a genomics perspective on the future of schizophrenia

    LENUS (Irish Health Repository)

    Corvin, Aiden P

    2011-11-11

    Abstract Progress is being made in schizophrenia genomics, suggesting that this complex brain disorder involves rare, moderate to high-risk mutations and the cumulative impact of small genetic effects, coupled with environmental factors. The genetic heterogeneity underlying schizophrenia and the overlap with other neurodevelopmental disorders suggest that it will not continue to be viewed as a single disease. This has radical implications for clinical practice, as diagnosis and treatment will be guided by molecular etiology rather than clinical diagnostic criteria.

  10. The Role of the Clinical Laboratory in the Future of Health Care: Lean Microbiology

    Science.gov (United States)

    Samuel, Linoj

    2014-01-01

    This commentary will introduce lean concepts into the clinical microbiology laboratory. The practice of lean in the clinical microbiology laboratory can remove waste, increase efficiency, and reduce costs. Lean, Six Sigma, and other such management initiatives are useful tools and can provide dividends but must be accompanied by organizational leadership commitment to sustaining the lean culture in the laboratory setting and providing resources and time to work through the process. PMID:24574289

  11. Future enhanced clinical role of pharmacists in Emergency Departments in England: multi-site observational evaluation.

    Science.gov (United States)

    Hughes, Elizabeth; Terry, David; Huynh, Chi; Petridis, Konstantinos; Aiello, Matthew; Mazard, Louis; Ubhi, Hirminder; Terry, Alex; Wilson, Keith; Sinclair, Anthony

    2017-08-01

    Background There are concerns about maintaining appropriate clinical staffing levels in Emergency Departments. Pharmacists may be one possible solution. Objective To determine if Emergency Department attendees could be clinically managed by pharmacists with or without advanced clinical practice training. Setting Prospective 49 site cross-sectional observational study of patients attending Emergency Departments in England. Method Pharmacist data collectors identified patient attendance at their Emergency Department, recorded anonymized details of 400 cases and categorized each into one of four possible options: cases which could be managed by a community pharmacist; could be managed by a hospital pharmacist independent prescriber; could be managed by a hospital pharmacist independent prescriber with additional clinical training; or medical team only (unsuitable for pharmacists to manage). Impact indices sensitive to both workload and proportion of pharmacist manageable cases were calculated for each clinical group. Main outcome measure Proportion of cases which could be managed by a pharmacist. Results 18,613 cases were observed from 49 sites. 726 (3.9%) of cases were judged suitable for clinical management by community pharmacists, 719 (3.9%) by pharmacist prescribers, 5202 (27.9%) by pharmacist prescribers with further training, and 11,966 (64.3%) for medical team only. Impact Indices of the most frequent clinical groupings were general medicine (13.18) and orthopaedics (9.69). Conclusion The proportion of Emergency Department cases that could potentially be managed by a pharmacist was 36%. Greatest potential for pharmacist management was in general medicine and orthopaedics (usually minor trauma). Findings support the case for extending the clinical role of pharmacists.

  12. Distinguishing between Unipolar Depression and Bipolar Depression: Current and Future Clinical and Neuroimaging Perspectives

    OpenAIRE

    de Almeida, Jorge Renner Cardoso; Phillips, Mary Louise

    2012-01-01

    Differentiating bipolar disorder (BD) from recurrent unipolar depression (UD) is a major clinical challenge. Main reasons for this include the higher prevalence of depressive relative to hypo/manic symptoms during the course of BD illness and the high prevalence of subthreshold manic symptoms in both BD and UD depression. Identifying objective markers of BD might help improve accuracy in differentiating between BD and UD depression, to ultimately optimize clinical and functional outcome for a...

  13. The era of 3Rs implementation in developmental and reproductive toxicity (DART) testing: Current overview and future perspectives.

    Science.gov (United States)

    Beekhuijzen, Manon

    2017-09-01

    Since adoption of the first globally implemented guidelines for developmental and reproductive toxicity (DART) testing for pharmaceuticals, industrial chemicals and agrochemicals, many years passed without major updates. However in recent years, significant changes in these guidelines have been made or are being implemented. These changes have been guided by the ethical drive to reduce, refine and replace (3R) animal testing, as well as the addition of endocrine disruptor relevant endpoints. Recent applied improvements have focused on reduction and refinement. Ongoing scientific and technical innovations will provide the means for replacement of animal testing in the future and will improve predictivity in humans. The aim of this review is to provide an overview of ongoing global DART endeavors in respect to the 3Rs, with an outlook towards future advances in DART testing aspiring to reduce animal testing to a minimum and the supreme ambition towards animal-free hazard and risk assessment. Copyright © 2017 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2016-07-01

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

  15. Genetic counselors’ (GC) knowledge, awareness, and understanding of clinical next-generation sequencing (NGS) genomic testing

    Science.gov (United States)

    Boland, PM; Ruth, K; Matro, JM; Rainey, KL; Fang, CY; Wong, YN; Daly, MB; Hall, MJ

    2014-01-01

    Genomic tests are increasingly complex, less expensive, and more widely available with the advent of next-generation sequencing (NGS). We assessed knowledge and perceptions among genetic counselors pertaining to NGS genomic testing via an online survey. Associations between selected characteristics and perceptions were examined. Recent education on NGS testing was common, but practical experience limited. Perceived understanding of clinical NGS was modest, specifically concerning tumor testing. Greater perceived understanding of clinical NGS testing correlated with more time spent in cancer-related counseling, exposure to NGS testing, and NGS-focused education. Substantial disagreement about the role of counseling for tumor-based testing was seen. Finally, a majority of counselors agreed with the need for more education about clinical NGS testing, supporting this approach to optimizing implementation. PMID:25523111

  16. Genetic counselors' (GC) knowledge, awareness, understanding of clinical next-generation sequencing (NGS) genomic testing.

    Science.gov (United States)

    Boland, P M; Ruth, K; Matro, J M; Rainey, K L; Fang, C Y; Wong, Y N; Daly, M B; Hall, M J

    2015-12-01

    Genomic tests are increasingly complex, less expensive, and more widely available with the advent of next-generation sequencing (NGS). We assessed knowledge and perceptions among genetic counselors pertaining to NGS genomic testing via an online survey. Associations between selected characteristics and perceptions were examined. Recent education on NGS testing was common, but practical experience limited. Perceived understanding of clinical NGS was modest, specifically concerning tumor testing. Greater perceived understanding of clinical NGS testing correlated with more time spent in cancer-related counseling, exposure to NGS testing, and NGS-focused education. Substantial disagreement about the role of counseling for tumor-based testing was seen. Finally, a majority of counselors agreed with the need for more education about clinical NGS testing, supporting this approach to optimizing implementation. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  17. HIV-1 tropism testing and clinical management of CCR5 antagonists: Quebec review and recommendations.

    Science.gov (United States)

    Tremblay, Cécile; Hardy, Isabelle; Lalonde, Richard; Trottier, Benoit; Tsarevsky, Irina; Vézina, Louis-Philippe; Roger, Michel; Wainberg, Mark; Baril, Jean-Guy

    2013-01-01

    HIV-1 tropism assays play a crucial role in determining the response to CCR5 receptor antagonists. Initially, phenotypic tests were used, but limited access to these tests prompted the development of alternative strategies. Recently, genotyping tropism has been validated using a Canadian technology in clinical trials investigating the use of maraviroc in both experienced and treatment-naive patients. The present guidelines review the evidence supporting the use of genotypic assays and provide recommendations regarding tropism testing in daily clinical management.

  18. Test Cost and Test Accuracy in Clinical Laboratories in Kampala, Uganda.

    Science.gov (United States)

    Amukele, Timothy K; Jones, Robert; Elbireer, Ali

    2018-04-25

    To assess the accuracy and costs of laboratory tests in Kampala, Uganda. A random selection of 78 laboratories tested external quality assurance samples at market rates. There were 40 moderate- to high-complexity and 38 low-complexity laboratories. Four percent (3/78) of these laboratories were accredited and 94% (73/78) were private. The 40 moderate- to high-complexity laboratories performed malaria blood smear, urine human chorionic gonadotropin (hCG), human immunodeficiency virus (HIV), syphilis, glucose, and three-panel tests: CBC, liver function tests, and kidney function tests. The 38 low-complexity laboratories performed malaria blood smear, urine hCG, and syphilis testing only. Hematology, HIV, syphilis, and malarial proficiency testing samples were prepared by accredited laboratories in Kampala. All other samples were provided by the Royal College of Pathologists of Australia. 77.1% of all results were accurate (met target values). It varied widely by laboratory (50%-100%), test identity (malaria blood smear, 96%; serum urea nitrogen, 38%), and test type (quantitative: 66% [31%-89%], qualitative: 91% [68%-97%]). Test prices varied by up to 3,600%, and there was no correlation between test cost and accuracy (r2 = 0.02). There were large differences in accuracy and price across laboratories in Kampala. Price was not associated with quality.

  19. Medical Physics: Forming and testing solutions to clinical problems.

    Science.gov (United States)

    Tsapaki, Virginia; Bayford, Richard

    2015-11-01

    According to the European Federation of Organizations for Medical Physics (EFOMP) policy statement No. 13, "The rapid advance in the use of highly sophisticated equipment and procedures in the medical field increasingly depends on information and communication technology. In spite of the fact that the safety and quality of such technology is vigorously tested before it is placed on the market, it often turns out that the safety and quality is not sufficient when used under hospital working conditions. To improve safety and quality for patient and users, additional safeguards and related monitoring, as well as measures to enhance quality, are required. Furthermore a large number of accidents and incidents happen every year in hospitals and as a consequence a number of patients die or are injured. Medical Physicists are well positioned to contribute towards preventing these kinds of events". The newest developments related to this increasingly important medical speciality were presented during the 8th European Conference of Medical Physics 2014 which was held in Athens, 11-13 September 2014 and hosted by the Hellenic Association of Medical Physicists (HAMP) in collaboration with the EFOMP and are summarized in this issue. Copyright © 2015 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  20. Transplantation of Bioprinted Tissues and Organs: Technical and Clinical Challenges and Future Perspectives.

    Science.gov (United States)

    Ravnic, Dino J; Leberfinger, Ashley N; Koduru, Srinivas V; Hospodiuk, Monika; Moncal, Kazim K; Datta, Pallab; Dey, Madhuri; Rizk, Elias; Ozbolat, Ibrahim T

    2017-07-01

    : Three-dimensional (3D) bioprinting is a revolutionary technology in building living tissues and organs with precise anatomic control and cellular composition. Despite the great progress in bioprinting research, there has yet to be any clinical translation due to current limitations in building human-scale constructs, which are vascularized and readily implantable. In this article, we review the current limitations and challenges in 3D bioprinting, including in situ techniques, which are one of several clinical translational models to facilitate the application of this technology from bench to bedside. A detailed discussion is made on the technical barriers in the fabrication of scalable constructs that are vascularized, autologous, functional, implantable, cost-effective, and ethically feasible. Clinical considerations for implantable bioprinted tissues are further expounded toward the correction of end-stage organ dysfunction and composite tissue deficits.

  1. Setting up of a cerebral visual impairment clinic for children: Challenges and future developments.

    Science.gov (United States)

    Philip, Swetha Sara

    2017-01-01

    The aim of this study is to describe the setting up of a cerebral visual impairment (CVI) clinic in a tertiary care hospital in South India and to describe the spectrum of cases seen. The CVI clinic, set up in February 2011, receives interdisciplinary input from a core team involving a pediatrician, neurologist, psychiatrist, occupational therapist, pediatric ophthalmologist, and an optometrist. All children, children (45%) had moderate CP. Forty percent of CVI was due to birth asphyxia, but about 20% did not have any known cause for CVI. Seventy percent of patients, who came back for follow-up, were carrying out the habilitation strategies suggested. Average attendance of over 300 new patients a year suggests a definite need for CVI clinics in the country. These children need specialized care to handle their complex needs. Although difficult to coordinate, an interdisciplinary team including the support groups and voluntary organizations is needed to facilitate the successful implementation of such specialized service.

  2. Two patients walk into a clinic...a genomics perspective on the future of schizophrenia

    Directory of Open Access Journals (Sweden)

    Corvin Aiden P

    2011-11-01

    Full Text Available Abstract Progress is being made in schizophrenia genomics, suggesting that this complex brain disorder involves rare, moderate to high-risk mutations and the cumulative impact of small genetic effects, coupled with environmental factors. The genetic heterogeneity underlying schizophrenia and the overlap with other neurodevelopmental disorders suggest that it will not continue to be viewed as a single disease. This has radical implications for clinical practice, as diagnosis and treatment will be guided by molecular etiology rather than clinical diagnostic criteria.

  3. Army Invests in Testing Facilities to Support Current and Future Technologies

    National Research Council Canada - National Science Library

    Bochenek, Grace M; Hitchcock, Jennifer

    2007-01-01

    The U.S. Army Tank Automotive Research, Development and Engineering Center (TARDEC) has played a critical role in developing a hybrid electric powerpack designed to meet all anticipated Future Combat Systems...

  4. The JPL optical communications telescope laboratory (OCTL) test bed for the future optical Deep Space Network

    Science.gov (United States)

    Wilson, K. E.; Page, N.; Wu, J.; Srinivasan, M.

    2003-01-01

    Relative to RF, the lower power-consumption and lower mass of high bandwidth optical telecommunications make this technology extremely attractive for returning data from future NASA/JPL deep space probes.

  5. Clinical relevance of syncope and presyncope induced by tilt testing.

    Science.gov (United States)

    Zyśko, Dorota; Gajek, Jacek; Koźluk, Edward; Agrawal, Anil Kumar; Smereka, Jacek; Checiński, Igor

    2009-08-01

    The authors investigated the relation between presyncope and syncope induced by tilt testing (HUTT) and demographics, medical history and HUTT data.The demographics, syncopal burden, data regarding the spontaneous syncope and reproduction of symptoms during HUTT were compared among patients with induced syncope and presyncope. The study group consisted of 574 patients (371 women, 203 men), aged 43.7 +/- 18.5 years. Patients with syncope induced by HUTT (418 patients, 63.9% women) had a higher number of syncopal episodes in their medical history. Stepwise logistic regression revealed that syncope provocation was independently related to the cardiodepressive type of neurocardiogenic reaction (OR 7.8, CI 4.2-14.4, P < 0.001), NTG use (OR 1.7, CI: 1.0-2.7, P < 0.05), the reproduction of the symptoms during HUTT (OR 2.0, CI: 1.3-3.1, P < 0.01) and the higher number of syncopal episodes (OR 2.0, CI: 1.3-3.0, P < 0.01). In patients with positive HUTT during a passive phase it was related to the cardiodepressive type of reaction (OR 26.5, CI: 5.9-118.5, P < 0.001). In the group with positive HUTT after NTG syncope was related to the cardiodepressive type (OR 5.7, CI: 2.9-11.2, P < 0.001), vasovagal history (OR 2.0, CI: 1.2-3.3, P < 0.01), reproduction of the spontaneous symptoms (OR 1.9, CI: 1.1-3.1, P < 0.05) and higher number of syncopal episodes (OR 2.1, CI: 1.3-3.3, P < 0.01). Syncope is more frequently a HUTT outcome than presyncope. The provocation of syncope in the passive phase of HUTT depends only on the cardiodepressive type of neurocardiogenic reaction. The induction of presyncope after nitroglycerin provocation is related to the possibility of a false positive reaction.

  6. Advances in the use of inhalation provocation tests in clinical evaluation

    NARCIS (Netherlands)

    Hargreave, F. E.; Ramsdale, E. H.; Sterk, P. J.; Juniper, E. F.

    1985-01-01

    Recent advances in the use of inhalation provocation tests in the clinical evaluation of asthma have been made with methacholine and histamine tests. The tests can be better standardized and the results more accurately interpreted. The ease of stimulation of bronchoconstriction by methacholine and

  7. A clinical audit of provider-initiated HIV counselling and testing in a ...

    African Journals Online (AJOL)

    Background. Early initiation of antiretroviral therapy reduces transmission of HIV and prolongs life. Expansion of HIV testing is therefore pivotal in overcoming the HIV pandemic. Provider-initiated counselling and testing (PICT) at first clinical contact is one way of increasing the number of individuals tested. Our impression is ...

  8. An Idea for the Future of Dental Research: A Cloud-Based Clinical Network and Database

    Science.gov (United States)

    Owtad, Payam; Taichman, Russell; Park, Jae Hyun; Yaibuathes, Sorn; Knapp, John

    2013-01-01

    Evidence-based dentistry (EBD) is an approach to oral healthcare requiring systematic assessment of relevant scientific evidence to clinical practice and patients' needs. EBD attempts to globally establish personalized dental care based upon the most recent and highest order scientific evidence. However, some times the EBD does not consider local…

  9. Robot-Mediated Upper Limb Physiotherapy: Review and Recommendations for Future Clinical Trials

    Science.gov (United States)

    Peter, Orsolya; Fazekas, Gabor; Zsiga, Katalin; Denes, Zoltan

    2011-01-01

    Robot-mediated physiotherapy provides a new possibility for improving the outcome of rehabilitation of patients who are recovering from stroke. This study is a review of robot-supported upper limb physiotherapy focusing on the shoulder, elbow, and wrist. A literature search was carried out in PubMed, OVID, and EBSCO for clinical trials with robots…

  10. VEGF in nuclear medicine : Clinical application in cancer and future perspectives (Review)

    NARCIS (Netherlands)

    Taurone, Samanta; Galli, Filippo; Signore, Alberto; Agostinelli, Enzo; Dierckx, Rudi A. J. O.; Minni, Antonio; Pucci, Marcella; Artico, Marco

    Clinical trials using antiangiogenic drugs revealed their potential against cancer. Unfortunately, a large percentage of patients does not yet benefit from this therapeutic approach highlighting the need of diagnostic tools to non-invasively evaluate and monitor response to therapy. It would also

  11. Current Concepts and Future Perspectives on Intraoperative Fluorescence Imaging in Cancer : Clinical Need

    NARCIS (Netherlands)

    van Dam, Gooitzen M.; Ntziachristos, Vasilis

    Progress with technology and regulatory approvals has recently allowed the successful clinical translation of fluorescence molecular imaging to intra-operative applications. Initial studies have demonstrated a promising outlook for imaging cancer micro-foci, margins and lymph-nodes. However, not all

  12. Taxonomy for Education and Training in Clinical Neuropsychology: past, present, and future.

    Science.gov (United States)

    Sperling, Scott A; Cimino, Cynthia R; Stricker, Nikki H; Heffelfinger, Amy K; Gess, Jennifer L; Osborn, Katie E; Roper, Brad L

    2017-07-01

    Historically, the clinical neuropsychology training community has not clearly or consistently defined education or training opportunities. The lack of consistency has limited students' and trainees' ability to accurately assess and compare the intensity of neuropsychology-specific training provided by programs. To address these issues and produce greater 'truth in advertising' across programs, CNS, with SCN's Education Advisory Committee (EAC), ADECN, AITCN, and APPCN constructed a specialty-specific taxonomy, namely, the Taxonomy for Education and Training in Clinical Neuropsychology. The taxonomy provides consensus in the description of training offered by doctoral, internship, and postdoctoral programs, as well as at the post-licensure stage. Although the CNS approved the taxonomy in February 2015, many programs have not adopted its language. Increased awareness of the taxonomy and the reasons behind its development and structure, as well as its potential benefits, are warranted. In 2016, a working group of clinical neuropsychologists from the EAC and APPCN, all authors of this manuscript, was created and tasked with disseminating information about the taxonomy. Group members held regular conference calls, leading to the generation of this manuscript. This manuscript is the primary byproduct of the working group. Its purpose is to (1) outline the history behind the development of the taxonomy, (2) detail its structure and utility, (3) address the expected impact of its adoption, and (4) call for its adoption across training programs. This manuscript outlines the development and structure of the clinical neuropsychology taxonomy and addresses the need for its adoption across training programs.

  13. Coronary CT: clinical indications and future directions; Tomografia de coronarias: indicacoes clinicas e perspectivas futuras

    Energy Technology Data Exchange (ETDEWEB)

    Nomura, Cesar H.; Serpa, Bruna S.; Kay, Fernando U.; Szarf, Gilberto; Passos, Rodrigo B.; Neto, Roberto S.; Chate, Rodigo C.; Funar, Marcelo B., E-mail: cesarnomura@gmail.com [Hospital Israelita Albert Einstein, Sao Paulo, SP (Brazil); Cury, Roberto C. [Hospital Samaritano, Sao Paulo, SP (Brazil)

    2011-01-15

    Multidetector computed tomography (MDCT) has started its implementation in cardiology with calcium quantification of coronary plaques in the study without contrast, using the calcium score, demonstrating an important independent predictor of future cardiac events. The examination with intravenous contrast, coronary angiography, appeared later as a noninvasive method for evaluation of anatomy and obstructive coronary disease, characterizing the degree of stenosis and the presence of non calcified atherosclerotic plaques, assessing not only the lumen, but also the vessel wall. With the advent of new machines with more detectors and higher temporal resolution has been a reduction in radiation dose and the possibility of new applications. (author)

  14. Variation in the Use of Vestibular Diagnostic Testing for Patients Presenting to Otolaryngology Clinics with Dizziness

    Science.gov (United States)

    Piker, Erin G.; Schulz, Kris; Parham, Kourosh; Vambutas, Andrea; Witsell, David; Tucci, Debara; Shin, Jennifer J.; Pynnonen, Melissa A.; Nguyen-Huynh, Anh; Crowson, Matthew; Ryan, Sheila E.; Langman, Alan; Roberts, Rhonda; Wolfley, Anne; Lee, Walter T.

    2016-01-01

    Objective We used a national otolaryngology practice–based research network database to characterize the utilization of vestibular function testing in patients diagnosed with dizziness and/or a vestibular disorder. Study Design Database review. Setting The Creating Healthcare Excellence through Education and Research (CHEER) practice-based research network of academic and community providers Subjects and Methods Dizzy patients in the CHEER retrospective database were identified through ICD-9 codes; vestibular testing procedures were identified with CPT codes. Demographics and procedures per patient were tabulated. Analysis included number and type of vestibular tests ordered, stratified by individual clinic and by practice type (community vs academic). Chi-square tests were performed to assess if the percentage of patients receiving testing was statistically significant across clinics. A logistic regression model was used to examine the association between receipt of testing and being tested on initial visit. Results A total of 12,468 patients diagnosed with dizziness and/or a vestibular disorder were identified from 7 community and 5 academic CHEER network clinics across the country. One-fifth of these patients had at least 1 vestibular function test. The percentage of patients tested varied widely by site, from 3% to 72%; academic clinics were twice as likely to test. Initial visit vestibular testing also varied, from 0% to 96% of dizzy patients, and was 15 times more likely in academic clinics. Conclusion There is significant variation in use and timing of vestibular diagnostic testing across otolaryngology clinics. The CHEER network research database does not contain outcome data. These results illustrate the critical need for research that examines outcomes as related to vestibular testing. PMID:27371625

  15. Medical Devices; Clinical Chemistry and Clinical Toxicology Devices; Classification of the Organophosphate Test System. Final order.

    Science.gov (United States)

    2017-10-18

    The Food and Drug Administration (FDA or we) is classifying the organophosphate test system into class II (special controls). The special controls that apply to the device type are identified in this order and will be part of the codified language for the organophosphate test system's classification. We are taking this action because we have determined that classifying the device into class II (special controls) will provide a reasonable assurance of safety and effectiveness of the device. We believe this action will also enhance patients' access to beneficial innovative devices, in part by reducing regulatory burdens.

  16. Japanese Society of Medical Oncology Clinical Guidelines: Molecular Testing for Colorectal Cancer Treatment, Third Edition.

    Science.gov (United States)

    Yamazaki, Kentaro; Taniguchi, Hiroya; Yoshino, Takayuki; Akagi, Kiwamu; Ishida, Hideyuki; Ebi, Hiromichi; Nakatani, Kaname; Muro, Kei; Yatabe, Yasushi; Yamaguchi, Kensei; Tsuchihara, Katsuya

    2018-06-01

    The Japanese Society of Medical Oncology (JSMO) previously published 2 editions of the clinical guidelines: "Japanese guidelines for testing of KRAS gene mutation in colorectal cancer" in 2008 and "Japanese Society of Medical Oncology Clinical Guidelines: RAS (KRAS/NRAS) mutation testing in colorectal cancer patients" in 2014. These guidelines have contributed to the proper use of KRAS and RAS mutation testing, respectively. Recently, clinical utility, particularly for colorectal cancer (CRC) patients with BRAF V600E mutation or DNA mismatch-repair (MMR) deficiency, has been established. Therefore, the guideline members decided these genetic alterations should also be involved. The aim of this revision is to properly carry out testing for BRAF V600E mutation and MMR deficiency in addition to RAS mutation. The revised guidelines include the basic requirements for testing for these genetic alterations based on recent scientific evidence. Furthermore, because clinical utility of comprehensive genetic testing using next-generation sequencing and somatic gene testing of analyzing circulating tumor DNA has increasingly evolved with recent advancements in testing technology, we noted the current situation and prospects for these testing technologies and their clinical implementation in the revised guidelines. © 2018 The Authors. Cancer Science published by John Wiley & Sons Australia, Ltd on behalf of Japanese Cancer Association.

  17. The future of monitoring in clinical research - a holistic approach: linking risk-based monitoring with quality management principles.

    Science.gov (United States)

    Ansmann, Eva B; Hecht, Arthur; Henn, Doris K; Leptien, Sabine; Stelzer, Hans Günther

    2013-01-01

    Since several years risk-based monitoring is the new "magic bullet" for improvement in clinical research. Lots of authors in clinical research ranging from industry and academia to authorities are keen on demonstrating better monitoring-efficiency by reducing monitoring visits, monitoring time on site, monitoring costs and so on, always arguing with the use of risk-based monitoring principles. Mostly forgotten is the fact, that the use of risk-based monitoring is only adequate if all mandatory prerequisites at site and for the monitor and the sponsor are fulfilled.Based on the relevant chapter in ICH GCP (International Conference on Harmonisation of technical requirements for registration of pharmaceuticals for human use - Good Clinical Practice) this publication takes a holistic approach by identifying and describing the requirements for future monitoring and the use of risk-based monitoring. As the authors are operational managers as well as QA (Quality Assurance) experts, both aspects are represented to come up with efficient and qualitative ways of future monitoring according to ICH GCP.

  18. The Clinical and Economic Benefits of Co-Testing Versus Primary HPV Testing for Cervical Cancer Screening: A Modeling Analysis.

    Science.gov (United States)

    Felix, Juan C; Lacey, Michael J; Miller, Jeffrey D; Lenhart, Gregory M; Spitzer, Mark; Kulkarni, Rucha

    2016-06-01

    Consensus United States cervical cancer screening guidelines recommend use of combination Pap plus human papillomavirus (HPV) testing for women aged 30 to 65 years. An HPV test was approved by the Food and Drug Administration in 2014 for primary cervical cancer screening in women age 25 years and older. Here, we present the results of clinical-economic comparisons of Pap plus HPV mRNA testing including genotyping for HPV 16/18 (co-testing) versus DNA-based primary HPV testing with HPV 16/18 genotyping and reflex cytology (HPV primary) for cervical cancer screening. A health state transition (Markov) model with 1-year cycling was developed using epidemiologic, clinical, and economic data from healthcare databases and published literature. A hypothetical cohort of one million women receiving triennial cervical cancer screening was simulated from ages 30 to 70 years. Screening strategies compared HPV primary to co-testing. Outcomes included total and incremental differences in costs, invasive cervical cancer (ICC) cases, ICC deaths, number of colposcopies, and quality-adjusted life years for cost-effectiveness calculations. Comprehensive sensitivity analyses were performed. In a simulation cohort of one million 30-year-old women modeled up to age 70 years, the model predicted that screening with HPV primary testing instead of co-testing could lead to as many as 2,141 more ICC cases and 2,041 more ICC deaths. In the simulation, co-testing demonstrated a greater number of lifetime quality-adjusted life years (22,334) and yielded $39.0 million in savings compared with HPV primary, thereby conferring greater effectiveness at lower cost. Model results demonstrate that co-testing has the potential to provide improved clinical and economic outcomes when compared with HPV primary. While actual cost and outcome data are evaluated, these findings are relevant to U.S. healthcare payers and women's health policy advocates seeking cost-effective cervical cancer screening

  19. Testing devices or experimental systems? Cancer clinical trials take the genomic turn.

    Science.gov (United States)

    Nelson, Nicole C; Keating, Peter; Cambrosio, Alberto; Aguilar-Mahecha, Adriana; Basik, Mark

    2014-06-01

    Clinical trials are often described as machine-like systems for generating specific information concerning drug safety and efficacy, and are understood as a component of the industrial drug development processes. This paper argues that contemporary clinical trials in oncology are not reducible to mere drug testing. Drawing on ethnographic fieldwork and interviews with researchers in the field of oncology from 2010 to 2013, we introduce a conceptual contrast between trials as testing machines and trials as clinical experimental systems to draw attention to the ways trials are increasingly being used to ask open-ended scientific questions. When viewed as testing machines, clinical trials are seen as a means to produce answers to straightforward questions and deviations from the protocol are seen as bugs in the system; but practitioners can also treat trials as clinical experimental systems to investigate as yet undefined problems and where heterogeneity becomes a means to produce novel biological or clinical insights. The rise of "biomarker-driven" clinical trials in oncology, which link measurable biological characteristics such as genetic mutations to clinical features such as a patient's response to a particular drug, exemplifies a trend towards more experimental styles of clinical work. These transformations are congruent with changes in the institutional structure of clinical research in oncology, including a movement towards more flexible, networked research arrangements, and towards using individual patients as model systems for asking biological questions. Copyright © 2014 Elsevier Ltd. All rights reserved.

  20. CAR T Cell Therapy for Glioblastoma: Recent Clinical Advances and Future Challenges.

    Science.gov (United States)

    Bagley, Stephen J; Desai, Arati S; Linette, Gerald P; June, Carl H; O'Rourke, Donald M

    2018-03-02

    In patients with certain hematologic malignancies, the use of autologous T cells genetically modified to express chimeric antigen receptors (CARs) has led to unprecedented clinical responses. Although progress in solid tumors has been elusive, recent clinical studies have demonstrated the feasibility and safety of CAR T cell therapy for glioblastoma. In addition, despite formidable barriers to T cell localization and effector function in glioblastoma, signs of efficacy have been observed in select patients. In this review, we begin with a discussion of established obstacles to systemic therapy in glioblastoma and how these may be overcome by CAR T cells. We continue with a summary of previously published CAR T cell trials in GBM, and end by outlining the key therapeutic challenges associated with the use of CAR T cells in this disease.

  1. Visualizing the future: technology competency development in clinical medicine, and implications for medical education.

    Science.gov (United States)

    Srinivasan, Malathi; Keenan, Craig R; Yager, Joel

    2006-01-01

    In this article, the authors ask three questions. First, what will physicians need to know in order to be effective in the future? Second, what role will technology play in achieving that high level of effectiveness? Third, what specific skill sets will physicians need to master in order to become effective? Through three case vignettes describing past, present, and potential future medical practices, the authors identify trends in major medical, technological and cultural shifts that will shape medical education and practice. From these cases, the authors generate a series of technology-related competencies and skill sets that physicians will need to remain leaders in the delivery of medical care. Physicians will choose how they will be end-users of technology, technology developers, and/or the interface between users and developers. These choices will guide the types of skills each physician will need to acquire. Finally, the authors explore the implications of these trends for medical educators, including the competencies that will be required of educators as they develop the medical curriculum. Examining historical and social trends, including how users adopt current and emerging technologies, allows us to anticipate changes in the practice of medicine. By considering market pressures, global trends and emerging technologies, medical educators and practicing physicians may prepare themselves for the changes likely to occur in the medical curriculum and in the marketplace.

  2. Spine radiosurgery for the local treatment of spine metastases: Intensity-modulated radiotherapy, image guidance, clinical aspects and future directions

    International Nuclear Information System (INIS)

    Moraes, Fabio Ynoe de; Neves-Junior, Wellington Furtado Pimenta; Hanna, Samir Abdallah; Carvalho, Heloisa de Andrade; Laufer, Ilya

    2016-01-01

    Many cancer patients will develop spinal metastases. Local control is important for preventing neurologic compromise and to relieve pain. Stereotactic body radiotherapy or spinal radiosurgery is a new radiation therapy technique for spinal metastasis that can deliver a high dose of radiation to a tumor while minimizing the radiation delivered to healthy, neighboring tissues. This treatment is based on intensity-modulated radiotherapy, image guidance and rigid immobilization. Spinal radiosurgery is an increasingly utilized treatment method that improves local control and pain relief after delivering ablative doses of radiation. Here, we present a review highlighting the use of spinal radiosurgery for the treatment of metastatic tumors of the spine. The data used in the review were collected from both published studies and ongoing trials. We found that spinal radiosurgery is safe and provides excellent tumor control (up to 94% local control) and pain relief (up to 96%), independent of histology. Extensive data regarding clinical outcomes are available; however, this information has primarily been generated from retrospective and non randomized prospective series. Currently, two randomized trials are enrolling patients to study clinical applications of fractionation schedules spinal Radiosurgery. Additionally, a phase I clinical trial is being conducted to assess the safety of concurrent stereotactic body radiotherapy and ipilimumab for spinal metastases. Clinical trials to refine clinical indications and dose fractionation are ongoing. The concomitant use of targeted agents may produce better outcomes in the future. (author)

  3. Spine radiosurgery for the local treatment of spine metastases: Intensity-modulated radiotherapy, image guidance, clinical aspects and future directions

    Energy Technology Data Exchange (ETDEWEB)

    Moraes, Fabio Ynoe de; Neves-Junior, Wellington Furtado Pimenta; Hanna, Samir Abdallah; Carvalho, Heloisa de Andrade [Hospital Sirio-Libanes, Sao Paulo, SP (Brazil). Departamento de Radioterapia; Taunk, Neil Kanth; Yamada, Yoshiya [Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York, NY (United States); Laufer, Ilya, E-mail: fymoraes@gmail.com [Memorial Sloan Kettering Cancer Center, Department of Neurosurgery, New York, NY (United States)

    2016-02-15

    Many cancer patients will develop spinal metastases. Local control is important for preventing neurologic compromise and to relieve pain. Stereotactic body radiotherapy or spinal radiosurgery is a new radiation therapy technique for spinal metastasis that can deliver a high dose of radiation to a tumor while minimizing the radiation delivered to healthy, neighboring tissues. This treatment is based on intensity-modulated radiotherapy, image guidance and rigid immobilization. Spinal radiosurgery is an increasingly utilized treatment method that improves local control and pain relief after delivering ablative doses of radiation. Here, we present a review highlighting the use of spinal radiosurgery for the treatment of metastatic tumors of the spine. The data used in the review were collected from both published studies and ongoing trials. We found that spinal radiosurgery is safe and provides excellent tumor control (up to 94% local control) and pain relief (up to 96%), independent of histology. Extensive data regarding clinical outcomes are available; however, this information has primarily been generated from retrospective and non randomized prospective series. Currently, two randomized trials are enrolling patients to study clinical applications of fractionation schedules spinal Radiosurgery. Additionally, a phase I clinical trial is being conducted to assess the safety of concurrent stereotactic body radiotherapy and ipilimumab for spinal metastases. Clinical trials to refine clinical indications and dose fractionation are ongoing. The concomitant use of targeted agents may produce better outcomes in the future. (author)

  4. Clinical implications of aging with HIV infection: perspectives and the future medical care agenda.

    Science.gov (United States)

    Guaraldi, Giovanni; Palella, Frank J

    2017-06-01

    : The increasing number of aging HIV-infected (HIV+) persons comprises a unique population at risk for illnesses and syndromes traditionally associated with the elderly. As a result, similar to the current need for primary care providers to manage chronic noninfectious comorbidities among aging persons with well controlled HIV infection, HIV clinical care will need to routinely involve geriatric medicine in a new HIV-geriatric discipline. The objective of this article is to provide a conceptual framework in which HIV and geriatric management considerations for healthcare professionals caring for HIV+ persons are integrated. The provision of contemporary HIV clinical care extends well beyond the achievement of HIV virologic suppression and antiretroviral therapy management and includes a need for careful characterization of geriatric syndromes based upon functional capacity and extent of disability. Screening for geriatric syndromes is both a multidisciplinary and multidimensional process, designed to evaluate an older person's functional ability, physical health, cognition, overall mental health, and socio-environmental circumstances. Although routine incorporation of geriatric assessment into clinical trials involving HIV+ persons is feasible, a current challenge is the availability of a consensus clinical definition of frailty or vulnerability. To maximize the efficiency, value, and convenience of outpatient care visits for older HIV+ persons, these visits should include encounters with multiple providers, including primary care clinicians, social workers, and geriatricians. Challenges may exist in the routine provision of these assessments to older HIV+ persons, but clearly such cross-disciplinary collaboration will not only markedly enhance the care of aging HIV+ persons but may also constitute a model of successful healthcare management that can be applied to all aging persons with changing healthcare needs.

  5. What is the role of clinical tests and ultrasound in acetabular labral tear diagnostics?

    DEFF Research Database (Denmark)

    Troelsen, Anders; Mechlenburg, Inger; Gelineck, John

    2009-01-01

    BACKGROUND AND PURPOSE: An acetabular labral tear is a diagnostic challenge. Various clinical tests have been described, but little is known about their diagnostic sensitivity and specificity. We investigated the diagnostic validity of clinical tests and ultrasound as compared with MR arthrography...... no or only slight signs of osteoarthritis (Tönnis grade 0-1). RESULTS: MR arthrography identified labral tears in 17 of the 18 hips. Ultrasound had a sensitivity of 94%, a positive predictive value of 94%, and was false negative in only 1 case compared to MR arthrography. The impingement test had the best...... diagnostic ability of the clinical tests, with a sensitivity of 59% and a specificity of 100%. The positive predictive value was 100% while the negative predictive value was 13%. INTERPRETATION: The impingement test is helpful in identifying acetabular labral tears. If this test is negative and if a labral...

  6. Skin signs in Ehlers-Danlos syndrome: clinical tests and para-clinical methods

    DEFF Research Database (Denmark)

    Remvig, Lars; Duhn, Ph; Ullman, S

    2010-01-01

    Objective: The criteria for Ehlers-Danlos syndrome (EDS) and the hypermobility syndrome (HMS) should be reliable. Examination for general joint hypermobility has high reliability but there is only sparse information on the reliability of skin tests, and no information on the level of normal skin...

  7. Skin signs in Ehlers-Danlos syndrome: clinical tests and para-clinical methods

    DEFF Research Database (Denmark)

    Remvig, L; Duhn, Ph; Ullman, S

    2010-01-01

    The criteria for Ehlers-Danlos syndrome (EDS) and the hypermobility syndrome (HMS) should be reliable. Examination for general joint hypermobility has high reliability but there is only sparse information on the reliability of skin tests, and no information on the level of normal skin extensibility...

  8. Ethical implications for clinical practice and future research in "at risk" individuals.

    Science.gov (United States)

    Singh, Fiza; Mirzakhanian, Heline; Fusar-Poli, Paolo; de la Fuente-Sandoval, Camilo; Cadenhead, Kristin S

    2012-01-01

    The last 15 years have witnessed a shift in schizophrenia research with increasing interest in earlier stages of illness with the hope of early intervention and ultimately prevention of psychotic illness. Large-scale longitudinal studies have identified clinical and biological risk factors associated with increased risk of psychotic conversion, which together with symptomatic and demographic risk factors may improve the power of prediction algorithms for psychotic transition. Despite these advances, 45-70% of at risk subjects in most samples do not convert to frank psychosis, but continue to function well below their age matched counterparts. The issue is of utmost importance in light of the upcoming DSM-V and the possible inclusion of the attenuated psychotic symptoms syndrome (APSS) diagnosis, with clinical and ethical implications. Clinical considerations include feasibility of reliably diagnosing the at risk state in non-academic medical centers, variable psychotic conversion rates, a non-uniform definition of conversion and extensive debate about treatment for individuals with an ill-defined outcome. On the ethical side, diagnosing APSS could lead to unnecessary prescribing of antipsychotics with long-term deleterious consequences, slow research by providing a false sense of comfort in the diagnosis, and have psychosocial implications for those who receive a diagnosis. Thus it may be prudent to engage at risk populations early and to use broad-spectrum treatments with low risk benefit ratios to relieve functional impairments, while simultaneously studying all subsets of the at risk population.

  9. [Restoring vision in blind patients following photoreceptor degeneration: clinical results and future challenges].

    Science.gov (United States)

    Bendali, Amel; Lorach, Henri; Djilas, Milan; Marre, Olivier; Bensoman, Ryad; Rousseau, Lionel; Lissorgues, Gaëlle; Scorsone, Emmanuel; Bergonzo, Philippe; Garrido, Jose A; Sahel, José Alain; Picaud, Serge

    2013-01-01

    Retinal prostheses aim at restoring vision in patients blind from photoreceptor degeneration by electrically stimulating the residual retinal tissue. Currently, the most efficient implants are either inserted in the subretinal space or on the vitreal side of the retina (epi-retinal). Although the residual tissue can partly degenerate, it was shown that acute stimulation of residual neurones can induce visual percepts. Recently, a clinical trial with the epiretinal Argus2 device (60 electrodes) from the company 2nd Sight enabled most patients to orient and find light targets, some even reading words. This device has received a CE mark. Surprisingly, when the subretinal implant from the company Retina Implant AG displaying many more electrodes (1500 electrodes) was evaluated in clinical trials, the patient visual performances were fairly similar. The restored visual performances of the patients demonstrate that blind patients can recover some visual function when their residual retina is properly stimulated. However, the resolution is not yet sufficient to perform complex tasks such as autonomous locomotion, face identification or text reading. Several challenges remain to generate an increase in pixel density corresponding to the increase in electrode number and density. These challenges include the stimulation modality, the tissue/implant interface design, the electrode materials, and the visual information encoder. This review will discuss these great challenges after introducing the major clinical results. © Société de Biologie, 2013.

  10. Keynote address: the scientific basis of the present and future practice of clinical radiotherapy

    International Nuclear Information System (INIS)

    Fletcher, G.H.

    1983-01-01

    At mid-century radiotherapy was more an art than a science, but is presently based on radiobiological parameters and cell kinetics. This close interaction between basic scientific principles and clinical practice has been made possible because one can correlate quantitatively doses of irradiation with observed responses. First, a short historical review will be made because it gives a perspective for the understanding both of progress made and prevailing misconceptions. The important radiobiological parameters and cell kinetics will then be discussed in some detail to demonstrate that they should be thoroughly understood in their relationship to radiotherapy. The overall treatment planning must be based on the clinical applications of the main radiobiological parameters. The combined treatment with surgery, either pre- or postoperatively, and multiple daily fractionations will be used as examples. The teaching of radiobiology should be considerably expanded, not only for its own scientific merit but also to show how it applies to clinical situations. This should be reflected in the expansion of the board examination

  11. A clinically useful diabetes electronic medical record: lessons from the past; pointers toward the future.

    Science.gov (United States)

    Gorman, C; Looker, J; Fisk, T; Oelke, W; Erickson, D; Smith, S; Zimmerman, B

    1996-01-01

    We have analysed the deficiencies of paper medical records in facilitating the care of patients with diabetes and have developed an electronic medical record that corrects some of them. The diabetes electronic medical record (DEMR) is designed to facilitate the work of a busy diabetes clinic. Design principles include heavy reliance on graphic displays of laboratory and clinical data, consistent color coding and aggregation of data needed to facilitate the different types of clinical encounter (initial consultation, continuing care visit, insulin adjustment visit, dietitian encounter, nurse educator encounter, obstetric patient, transplant patient, visits for problems unrelated to diabetes). Data input is by autoflow from the institutional laboratories, by desk attendants or on-line by all users. Careful attention has been paid to making data entry a point and click process wherever possible. Opportunity for free text comment is provided on every screen. On completion of the encounter a narrative text summary of the visit is generated by the computer and is annotated by the care giver. Currently there are about 7800 patients in the system. Remaining challenges include the adaptation of the system to accommodate the occasional user, development of portable laptop derivatives that remain compatible with the parent system and improvements in the screen structure and graphic display formats.

  12. WE-G-BRB-04: Leveraging Innovation to Design Future Clinical Trials

    International Nuclear Information System (INIS)

    Michalski, J.

    2015-01-01

    Over the past 20 years the NIH has funded individual grants, program projects grants, and clinical trials which have been instrumental in advancing patient care. The ways that each grant mechanism lends itself to the different phases of translating research into clinical practice will be described. Major technological innovations, such as IMRT and proton therapy, have been advanced with R01-type and P01-type funding and will be discussed. Similarly, the role of program project grants in identifying and addressing key hypotheses on the potential of 3D conformal therapy, normal tissue-guided dose escalation and motion management will be described. An overview will be provided regarding how these technological innovations have been applied to multi-institutional NIH-sponsored trials. Finally, the panel will discuss regarding which research questions should be funded by the NIH to inspire the next advances in radiation therapy. Learning Objectives: Understand the different funding mechanisms of the NIH Learn about research advances that have led to innovation in delivery Review achievements due to NIH-funded program project grants in radiotherapy over the past 20 years Understand example advances achieved with multi-institutional clinical trials NIH

  13. The pattern and technique in the clinical evaluation of the adult hip: the common physical examination tests of hip specialists.

    Science.gov (United States)

    Martin, Hal D; Kelly, Bryan T; Leunig, Michael; Philippon, Marc J; Clohisy, John C; Martin, RobRoy L; Sekiya, Jon K; Pietrobon, Ricardo; Mohtadi, Nicholas G; Sampson, Thomas G; Safran, Marc R

    2010-02-01

    The purpose of this study was to systematically evaluate the technique and tests used in the physical examination of the adult hip performed by multiple clinicians who regularly treat patients with hip problems and identify common physical examination patterns. The subjects included 5 men and 6 women with a mean age (+/-SD) of 29.8 +/- 9.4 years. They underwent physical examination of the hip by 6 hip specialists with a strong interest in hip-related problems. All examiners were blind to patient radiographs and diagnoses. Patient examinations were video recorded and reviewed. It was determined that 18 tests were most frequently performed (>or=40%) by the examiners, 3 standing, 11 supine, 3 lateral, and 1 prone. Of the most frequently performed tests, 10 were performed more than 50% of the time. The tests performed in the supine position were as follows: flexion range of motion (ROM) (percentage of use, 98%), flexion internal rotation ROM (98%), flexion external rotation ROM (86%), passive supine rotation test (76%), flexion/adduction/internal rotation test (70%), straight leg raise against resistance test (61%), and flexion/abduction/external rotation test (52%). The tests performed in the standing position were the gait test (86%) and the single-leg stance phase test (77%). The 1 test in the prone position was the femoral anteversion test (58%). There are variations in the testing that hip specialists perform to examine and evaluate their patients, but there is enough commonality to form the basis to recommend a battery of physical examination maneuvers that should be considered for use in evaluating the hip. Patients presenting with groin, abdominal, back, and/or hip pain need to have a basic examination to ensure that the hip is not overlooked. A comprehensive physical examination of the hip will benefit the patient and the physician and serve as the foundation for future multicenter clinical studies. (c) 2010 Arthroscopy Association of North America. Published

  14. [How do hospital clinical laboratories and laboratory testing companies cooperate and build reciprocal relations?].

    Science.gov (United States)

    Kawano, Seiji

    2014-12-01

    As the 2nd Joint Symposium of the Japanese Society of Laboratory Medicine and the Japanese Association of Laboratory Pathologists, the symposium on clinical test out-sourcing and branch laboratories was held at the 60th General Meeting of the Japanese Society of Laboratory Medicine on November 2nd, 2013 in Kobe. For the symposium, we conducted a questionnaire survey on the usage of clinical test out-sourcing and the introduction of branch laboratories to clinical laboratories of Japanese university hospitals, both private and public, between July 25th and August 20th, 2013. Seventy-two hospitals responded to the questionnaire survey, consisting of 41 public medical school hospitals and 31 private ones. According to the survey, the selection of each clinical test for out-sourcing was mainly determined by the capacities of hospital clinical laboratories and their equipment, as well as the profitability of each test. The main concerns of clinical laboratory members of university hospitals involved the continuity of measurement principles, traceability, and standardization of reference values for each test. They strongly requested the interchangeability and computerization of test data between laboratory testing companies. A branch laboratory was introduced to six hospitals, all of which were private medical college hospitals, out of 72 university hospitals, and eight of the other hospitals were open to its introduction. The merits and demerits of introducing a branch laboratory were also discussed. (Review).

  15. Improving clinical cognitive testing: report of the AAN Behavioral Neurology Section Workgroup.

    Science.gov (United States)

    Daffner, Kirk R; Gale, Seth A; Barrett, A M; Boeve, Bradley F; Chatterjee, Anjan; Coslett, H Branch; D'Esposito, Mark; Finney, Glen R; Gitelman, Darren R; Hart, John J; Lerner, Alan J; Meador, Kimford J; Pietras, Alison C; Voeller, Kytja S; Kaufer, Daniel I

    2015-09-08

    To evaluate the evidence basis of single-domain cognitive tests frequently used by behavioral neurologists in an effort to improve the quality of clinical cognitive assessment. Behavioral Neurology Section members of the American Academy of Neurology were surveyed about how they conduct clinical cognitive testing, with a particular focus on the Neurobehavioral Status Exam (NBSE). In contrast to general screening cognitive tests, an NBSE consists of tests of individual cognitive domains (e.g., memory or language) that provide a more comprehensive diagnostic assessment. Workgroups for each of 5 cognitive domains (attention, executive function, memory, language, and spatial cognition) conducted evidence-based reviews of frequently used tests. Reviews focused on suitability for office-based clinical practice, including test administration time, accessibility of normative data, disease populations studied, and availability in the public domain. Demographic and clinical practice data were obtained from 200 respondents who reported using a wide range of cognitive tests. Based on survey data and ancillary information, between 5 and 15 tests in each cognitive domain were reviewed. Within each domain, several tests are highlighted as being well-suited for an NBSE. We identified frequently used single-domain cognitive tests that are suitable for an NBSE to help make informed choices about clinical cognitive assessment. Some frequently used tests have limited normative data or have not been well-studied in common neurologic disorders. Utilizing standardized cognitive tests, particularly those with normative data based on the individual's age and educational level, can enhance the rigor and utility of clinical cognitive assessment. © 2015 American Academy of Neurology.

  16. Correlation Between Screening Mammography Interpretive Performance on a Test Set and Performance in Clinical Practice.

    Science.gov (United States)

    Miglioretti, Diana L; Ichikawa, Laura; Smith, Robert A; Buist, Diana S M; Carney, Patricia A; Geller, Berta; Monsees, Barbara; Onega, Tracy; Rosenberg, Robert; Sickles, Edward A; Yankaskas, Bonnie C; Kerlikowske, Karla

    2017-10-01

    Evidence is inconsistent about whether radiologists' interpretive performance on a screening mammography test set reflects their performance in clinical practice. This study aimed to estimate the correlation between test set and clinical performance and determine if the correlation is influenced by cancer prevalence or lesion difficulty in the test set. This institutional review board-approved study randomized 83 radiologists from six Breast Cancer Surveillance Consortium registries to assess one of four test sets of 109 screening mammograms each; 48 radiologists completed a fifth test set of 110 mammograms 2 years later. Test sets differed in number of cancer cases and difficulty of lesion detection. Test set sensitivity and specificity were estimated using woman-level and breast-level recall with cancer status and expert opinion as gold standards. Clinical performance was estimated using women-level recall with cancer status as the gold standard. Spearman rank correlations between test set and clinical performance with 95% confidence intervals (CI) were estimated. For test sets with fewer cancers (N = 15) that were more difficult to detect, correlations were weak to moderate for sensitivity (woman level = 0.46, 95% CI = 0.16, 0.69; breast level = 0.35, 95% CI = 0.03, 0.61) and weak for specificity (0.24, 95% CI = 0.01, 0.45) relative to expert recall. Correlations for test sets with more cancers (N = 30) were close to 0 and not statistically significant. Correlations between screening performance on a test set and performance in clinical practice are not strong. Test set performance more accurately reflects performance in clinical practice if cancer prevalence is low and lesions are challenging to detect. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2015-02-01

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

  18. The importance of academic literacy for undergraduate nursing students and its relationship to future professional clinical practice: A systematic review.

    Science.gov (United States)

    Jefferies, Diana; McNally, Stephen; Roberts, Katriona; Wallace, Anna; Stunden, Annette; D'Souza, Suzanne; Glew, Paul

    2018-01-01

    This systematic review was designed to assess the importance of academic literacy for undergraduate nursing students and its relationship to future professional clinical practice. It aimed to explore the link between academic literacy and writing in an undergraduate nursing degree and the development of critical thinking skills for their future professional clinical practice. A systematic review of qualitative studies and expert opinion publications. A systematic literature search was undertaken of the following databases: ERIC, PubMed, CINAHL, MEDLINE and Scopus. All papers reviewed were from 2000 to 2016 and were written in English. We identified 981 studies and expert opinion papers from the selected databases. After reviewing key words and abstracts for the inclusion and exclusion criteria, 48 papers were selected for review. These were read and reread, with 22 papers, including one thesis, selected for quality appraisal. One paper was discarded due to the exclusion criteria. Three major themes were evident from this study. First, students need assistance to develop tertiary level academic literacy skills when they commence their undergraduate nursing degree. Second, that teaching practices need to be consistent in both designing assessments and in giving feedback to students, in order to assist improvement of academic literacy skills. And finally, academic literacy can facilitate critical thinking when students are assessed using discipline specific genres that relate to their future professional nursing practice. This review highlights the importance of critical thinking in clinical nursing practice and its strong relationship with academic writing skills. It has shown critical thinking is discipline specific and nursing students need to be taught discipline specific literacy genres in undergraduate nursing degrees. Nursing has a diverse educational and cultural mix of students, and educators should not assume academic literacy skills upon commencement of an

  19. Consensus report on the future of animal-free systemic toxicity testing

    OpenAIRE

    Leist, Marcel; Hasiwa, Nina; Rovida, Costanza; Daneshian, Mardas; Basketter, David; Kimber, Ian; Clewell, Harvey; Gocht, Tilman; Goldberg, Alan; Busquet, Francois; Rossi, Anna-Maria; Schwarz, Michael; Stephens, Martin; Taalman, Rob; Knudsen, Thomas B

    2014-01-01

    Since March 2013, animal use for cosmetics testing for the European market has been banned. This requires a renewed view on risk assessment in this field. However, in other fields as well, traditional animal experimentation does not always satisfy requirements in safety testing, as the need for human-relevant information is ever increasing. A general strategy for animal-free test approaches was outlined by the US National Research Council`s vision document for Toxicity Testing in the 21st Cen...

  20. Clinical utility and validity of minoxidil response testing in androgenetic alopecia.

    Science.gov (United States)

    Goren, Andy; Shapiro, Jerry; Roberts, Janet; McCoy, John; Desai, Nisha; Zarrab, Zoulikha; Pietrzak, Aldona; Lotti, Torello

    2015-01-01

    Clinical response to 5% topical minoxidil for the treatment of androgenetic alopecia (AGA) is typically observed after 3-6 months. Approximately 40% of patients will regrow hair. Given the prolonged treatment time required to elicit a response, a diagnostic test for ruling out nonresponders would have significant clinical utility. Two studies have previously reported that sulfotransferase enzyme activity in plucked hair follicles predicts a patient's response to topical minoxidil therapy. The aim of this study was to assess the clinical utility and validity of minoxidil response testing. In this communication, the present authors conducted an analysis of completed and ongoing studies of minoxidil response testing. The analysis confirmed the clinical utility of a sulfotransferase enzyme test in successfully ruling out 95.9% of nonresponders to topical minoxidil for the treatment of AGA. © 2014 Wiley Periodicals, Inc.

  1. Cognitive bias in back pain patients attending osteopathy: testing the enmeshment model in reference to future thinking.

    Science.gov (United States)

    Read, Jessica; Pincus, Tamar

    2004-12-01

    Depressive symptoms are common in chronic pain. Previous research has found differences in information-processing biases in depressed pain patients and depressed people without pain. The schema enmeshment model of pain (SEMP) has been proposed to explain chronic pain patients' information-processing biases. Negative future thinking is common in depression but has not been explored in relation to chronic pain and information-processing models. The study aimed to test the SEMP with reference to future thinking. An information-processing paradigm compared endorsement and recall bias between depressed and non-depressed chronic low back pain patients and control participants. Twenty-five depressed and 35 non-depressed chronic low back pain patients and 25 control participants (student osteopaths) were recruited from an osteopathy practice. Participants were asked to endorse positive and negative ill-health, depression-related, and neutral (control) adjectives, encoded in reference to either current or future time-frame. Incidental recall of the adjectives was then tested. While the expected hypothesis of a recall bias by depressed pain patients towards ill-health stimuli in the current condition was confirmed, the recall bias was not present in the future condition. Additionally, patterns of endorsement and recall bias differed. Results extend understanding of future thinking in chronic pain within the context of the SEMP.

  2. Agile Acceptance Test-Driven Development of Clinical Decision Support Advisories: Feasibility of Using Open Source Software.

    Science.gov (United States)

    Basit, Mujeeb A; Baldwin, Krystal L; Kannan, Vaishnavi; Flahaven, Emily L; Parks, Cassandra J; Ott, Jason M; Willett, Duwayne L

    2018-04-13

    Moving to electronic health records (EHRs) confers substantial benefits but risks unintended consequences. Modern EHRs consist of complex software code with extensive local configurability options, which can introduce defects. Defects in clinical decision support (CDS) tools are surprisingly common. Feasible approaches to prevent and detect defects in EHR configuration, including CDS tools, are needed. In complex software systems, use of test-driven development and automated regression testing promotes reliability. Test-driven development encourages modular, testable design and expanding regression test coverage. Automated regression test suites improve software quality, providing a "safety net" for future software modifications. Each automated acceptance test serves multiple purposes, as requirements (prior to build), acceptance testing (on completion of build), regression testing (once live), and "living" design documentation. Rapid-cycle development or "agile" methods are being successfully applied to CDS development. The agile practice of automated test-driven development is not widely adopted, perhaps because most EHR software code is vendor-developed. However, key CDS advisory configuration design decisions and rules stored in the EHR may prove amenable to automated testing as "executable requirements." We aimed to establish feasibility of acceptance test-driven development of clinical decision support advisories in a commonly used EHR, using an open source automated acceptance testing framework (FitNesse). Acceptance tests were initially constructed as spreadsheet tables to facilitate clinical review. Each table specified one aspect of the CDS advisory's expected behavior. Table contents were then imported into a test suite in FitNesse, which queried the EHR database to automate testing. Tests and corresponding CDS configuration were migrated together from the development environment to production, with tests becoming part of the production regression test

  3. Testing painted wood : past practices at the Forest Products Laboratory and recommendations for future research

    Science.gov (United States)

    R. Sam Williams

    2009-01-01

    A brief history of paint research at the Forest Products Laboratory (FPL) in Madison, Wisconsin, sets the stage for a discussion of testing paint on wood and wood products. Tests include laboratory and outdoor tests, and I discuss them in terms of several degradation mechanisms (loss of gloss and fading, mildew growth, extractives bleed, and cracking, flaking, and...

  4. Computer-Based English Language Testing in China: Present and Future

    Science.gov (United States)

    Yu, Guoxing; Zhang, Jing

    2017-01-01

    In this special issue on high-stakes English language testing in China, the two articles on computer-based testing (Jin & Yan; He & Min) highlight a number of consistent, ongoing challenges and concerns in the development and implementation of the nationwide IB-CET (Internet Based College English Test) and institutional computer-adaptive…

  5. Genetic Tests for Ability?: Talent Identification and the Value of an Open Future

    Science.gov (United States)

    Miah, Andy; Rich, Emma

    2006-01-01

    This paper explores the prospect of genetic tests for performance in physical activity and sports practices. It investigates the terminology associated with genetics, testing, selection and ability as a means towards a socio-ethical analysis of its value within sport, education and society. Our argument suggests that genetic tests need not even be…

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

    International Nuclear Information System (INIS)

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

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Abigail T. Berman

    2015-07-01

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

  8. Colorectal Liver Metastases: Does the Future of Precision Medicine Lie in Genetic Testing?

    Science.gov (United States)

    Barbon, Carlotta; Margonis, Georgios Antonios; Andreatos, Nikolaos; Rezaee, Neda; Sasaki, Kazunari; Buettner, Stefan; Damaskos, Christos; Pawlik, Timothy M; He, Jin; Wolfgang, Christopher L; Weiss, Matthew J

    2018-04-11

    Colorectal liver metastases (CRLM) present an important clinical challenge in both surgical and medical oncology. Despite improvements in management, survival among patients undergoing resection of CRLM is still very variable and there is a paucity of clinical trial data and reliable biomarkers that could guide prognostic forecasts, treatment selection, and follow-up. Fortunately, recent advances in molecular biology and tumor sequencing have identified a number of critical genetic loci and proliferation markers that may hold the key to understanding the biologic behavior of CRLM; specifically, mutations of KRAS, BRAF, TP53, PIK3CA, APC, expression of Ki-67, and the presence of microsatellite instability appear to have a decisive impact on prognosis and response to treatment in patients with CRLM. While the applicability of genetic biomarkers in everyday clinical practice remains conditional on the development of inexpensive bedside sequencing, targeted therapies, and the conduct of appropriate clinical trials, the promise of personalized treatment may be closer to realization than ever before.

  9. THE PRESENT AND FUTURE OF CLINICAL AND HEALTH PSYCHOLOGY IN SPAIN: AN ALTERNATIVE VIEW

    Directory of Open Access Journals (Sweden)

    José Antonio Carrobles

    2015-01-01

    Full Text Available In our country, there are currently two types of psychologist qualified to practise psychology in the health field: the Specialist Psychologist in Clinical Psychology (PEPC and the General Health Psychologist (PGS. These qualifications are legally regulated and their accreditation is obtained through two different programs of postgraduate training: the Residential Internship Program (PIR in the case of the PEPC; and the Master of General Health Psychology (MPGS in the case of the PGS. These programs are of different lengths (4 years for the PIR and 2 years for the MPGS and they are accessed after completion of the corresponding degree in Psychology. However, the objectives and the skills to be attained, as well as the content of the training programs, are actually very similar, in spite of the different linguistic denominations used to describe them. On the basis of the existing differences in the terminology and the duration of the programs, some Spanish associations (ANPIR, COP, AEPCP and AEN defend the position that there should be established between the two qualifications, in addition to a hierarchical structure, a clear boundary with respect to the functions that the two types of psychologist can perform (clinical and specialised versus health and general functions and of the sectors or contexts in which they can practise (public versus private. In our article, we refute these positions and the reasons on which they are based and we argue extensively in favour of an alternative proposal more in tune with the reality of the facts and with the European context professional accreditation in clinical psychology, in the sense of accepting the existence of the two independent qualifications of clinical psychologists (the PEPC and the PGS, with direct access to both from the degree in Psychology, and with equivalent competencies and professional functions, although with some limitations in the case of the PGS, mainly with respect to the

  10. Interprofessional collaboration in research, education, and clinical practice: working together for a better future.

    Science.gov (United States)

    Green, Bart N; Johnson, Claire D

    2015-03-01

    Interprofessional collaboration occurs when 2 or more professions work together to achieve common goals and is often used as a means for solving a variety of problems and complex issues. The benefits of collaboration allow participants to achieve together more than they can individually, serve larger groups of people, and grow on individual and organizational levels. This editorial provides an overview of interprofessional collaboration in the areas of clinical practice, education, and research; discusses barriers to collaboration; and suggests potential means to overcome them.

  11. 42 CFR 493.1415 - Condition: Laboratories performing moderate complexity testing; clinical consultant.

    Science.gov (United States)

    2010-10-01

    ... § 493.1415 Condition: Laboratories performing moderate complexity testing; clinical consultant. The laboratory must have a clinical consultant who meets the qualification requirements of § 493.1417 of this... 42 Public Health 5 2010-10-01 2010-10-01 false Condition: Laboratories performing moderate...

  12. Design, testing and modifications of the Pelletron accelerator and future uses

    International Nuclear Information System (INIS)

    Lopez V, H.; Valdovinos A, M.; Hernandez M, V.; Alba P, U.; Garcia R, R.; Rodriguez, R.; Alba P, R.; Ruiz M, J.

    1989-01-01

    Solutions to various problems in the design of high voltage generator and acceleration units of the Pelletron electron accelerator designed and constructed at ININ are presented. Information on the design of the control system of the electron beams, activities proposed for utilization of sulfur hexafluoride as an accelerator isolating gas as well as some future uses of the Pelletron. (Author). 7 refs, 3 figs

  13. Future capabilities of CME polarimetric 3D reconstructions with the METIS instrument: A numerical test

    Science.gov (United States)

    Pagano, P.; Bemporad, A.; Mackay, D. H.

    2015-10-01

    fundamental importance for future space weather forecasting. In addition, we find that the column density derived from white-light images is accurate and we propose an improved technique where the combined use of the polarization ratio technique and white-light images minimizes the error in the estimation of column densities. Moreover, by applying the comparison to a set of snapshots of the simulation we can also assess the errors related to the trajectory and the expansion of the CME. Conclusions: Our method allows us to thoroughly test the performance of the polarization ratio technique and allows a determination of the errors associated with it, which means that it can be used to quantify the results from the analysis of the forthcoming METIS observations in white light (total and polarized brightness). Finally, we describe a satellite observing configuration relative to the Earth that can allow the technique to be efficiently used for space weather predictions. A movie attached to Fig. 15 is available in electronic form at http://www.aanda.org

  14. A comprehensive test of clinical reasoning for medical students: An olympiad experience in Iran.

    Science.gov (United States)

    Monajemi, Alireza; Arabshahi, Kamran Soltani; Soltani, Akbar; Arbabi, Farshid; Akbari, Roghieh; Custers, Eugene; Hadadgar, Arash; Hadizadeh, Fatemeh; Changiz, Tahereh; Adibi, Peyman

    2012-01-01

    Although some tests for clinical reasoning assessment are now available, the theories of medical expertise have not played a major role in this filed. In this paper, illness script theory was chose as a theoretical framework and contemporary clinical reasoning tests were put together based on this theoretical model. This paper is a qualitative study performed with an action research approach. This style of research is performed in a context where authorities focus on promoting their organizations' performance and is carried out in the form of teamwork called participatory research. Results are presented in four parts as basic concepts, clinical reasoning assessment, test framework, and scoring. we concluded that no single test could thoroughly assess clinical reasoning competency, and therefore a battery of clinical reasoning tests is needed. This battery should cover all three parts of clinical reasoning process: script activation, selection and verification. In addition, not only both analytical and non-analytical reasoning, but also both diagnostic and management reasoning should evenly take into consideration in this battery. This paper explains the process of designing and implementing the battery of clinical reasoning in the Olympiad for medical sciences students through an action research.

  15. The clinical utility of lipid profile and positive troponin in predicting future cardiac events

    Directory of Open Access Journals (Sweden)

    Arun Kumar

    2012-02-01

    Full Text Available Objective: To study the usefulness of traditional lipid profile levels in screening subjects who had developed chest pain due to cardiac event as indicated by a positive troponin I (TnI test. Methods: In this retrospective study data of the 740 patients presented to the emergency department with symptoms of cardiac ischemia that underwent both troponin and lipid profiles tests were compared with the lipid profiles of 411 normal healthy subjects (controls. The troponin was detected qualitatively when a specimen contains TnI above the 99th percentile (TnI >0.5 ng/ mL. The total cholesterol (TC, high density lipoproteins (HDL, very low density lipoproteins (VLDL, and triacyl glycerol (TG levels were also analyzed and low density lipoprotein level (LDL was calculated using Friedewald ’s formula. Results: Patients with chest pain and positive troponin test (with confirmed cardiac event were found to have significantly elevated levels of TC, TG, LDL and significantly reduced HDL levels when compared to the patients who experienced only chest pain (negative troponin and healthy controls. Conclusions: Traditional lipid profile levels still can be used in screening populations to identify the subjects with high risk of developing cardiac event which is identified by highly sensitive and specific positive troponin test.

  16. Predicting Future Antisocial Personality Disorder in Males from a Clinical Assessment in Childhood

    Science.gov (United States)

    Lahey, Benjamin B.; Loeber, Rolf; Burke, Jeffrey D.; Applegate, Brooks

    2005-01-01

    It is essential to identify childhood predictors of adult antisocial personality disorder (APD) to target early prevention. It has variously been hypothesized that APD is predicted by childhood conduct disorder (CD), attention-deficit/hyperactivity disorder (ADHD), or both disorders. To test these competing hypotheses, the authors used data from a…

  17. Radioselenium pancreozymin-secretin test as a clinical test for pancreatic exocrine function

    International Nuclear Information System (INIS)

    Shichiri, M.; Etani, N.; Yoshida, M.; Harano, Y.; Hoshi, M.; Shigeta, Y.; Abe, H.

    1975-01-01

    The appearance of radioselenium in the protein fraction of duodenal aspirates has been studied after an intravenous injection of 75 Se-selenomethionine. The continuous flow of pancreatic juice was stimulated by pancreozymin at 120 minutes and by secretin at 140 minutes. A good distinction between normal subjects and patients with pancreatic disease was obtained by measuring 75 Se-radioactivity in the protein fraction of duodenal aspirates; either cumulative radioactivity during the combined 80-minute post-pancreozymin-secretin period, or maximum 75 Se-specific activity during the postsecretin period was used as an index. The test presented here might be a useful and sufficiently reliable method for detecting abnormal pancreatic exocrine function. This test can be performed along with the conventional pancreozymin-secretin test, serum enzyme response to pancreozymin and secretin, and pancreatic scintiscanning

  18. Proprioception: where are we now? A commentary on clinical assessment, changes across the life course, functional implications and future interventions.

    Science.gov (United States)

    Suetterlin, Karen Joan; Sayer, Avan Aihie

    2014-05-01

    Proprioception, the sense of where one is in space, is essential for effective interaction with the environment. A lack of or reduction in proprioceptive acuity has been directly correlated with falls and with reduced functional independence in older people. Proprioceptive losses have also been shown to negatively correlate with functional recovery post stroke and play a significant role in other conditions such as Parkinson's disease. However, despite its central importance to many geriatric syndromes, the clinical assessment of proprioception has remained remarkably static. We look at approaches to the clinical assessment of proprioception, changes in proprioception across the life course, functional implications of proprioception in health and disease and the potential for targeted interventions in the future such as joint taping, and proprioception-specific rehabilitation and footwear.

  19. The clinical utility of naturalistic action test in differentiating mild cognitive impairment from early dementia in memory clinic.

    Science.gov (United States)

    Bruce, Irene; Ntlholang, Ontefetse; Crosby, Lisa; Cunningham, Conal; Lawlor, Brian

    2016-03-01

    This study aimed to examine the validity of the Naturalistic Action Test in differentiating Mild Cognitive Impairment from early dementia compared to clinical diagnosis and ascertain Naturalistic Action Test cut-off points. This was a cross-sectional study of 70 consecutive patients diagnosed with Mild Cognitive Impairment attending the memory clinic in St James's Hospital, Dublin, Ireland. Patients with a diagnosis of Mild Cognitive Impairment who attended for routine annual assessment were asked to participate in the study. The Naturalistic Action Test was carried out after the patient had completed their routine assessment in the clinic. The Area under the Curve, AUC ± SE was 0.808 ± 0.058, p Cognitive Impairment in our study (PPV 50%, NPV 91%, sensitivity 78%, specificity 73% and accuracy of 74%). There was discrepancy in 18 patients using the new cut-off point (≥11 for Mild Cognitive Impairment vs ≤10 for dementia). The Naturalistic Action Test is a useful tool that can increase diagnostic accuracy in differentiating Mild Cognitive Impairment from early dementia. Copyright © 2015 John Wiley & Sons, Ltd.

  20. [Variation in the pathology attended in out-patient Neurology Clinics: a demented future].

    Science.gov (United States)

    Morera-Guitart, J; Pedro Cano, M J

    2003-10-01

    We analyze the changes observed between 1996 and 2001 in the distribution of the pathology attended and the follow up model used by the out-patient Neurology Clinic in the Marina Alta area, in order to confirm possible variations that may have repercussions for Human Resource needs in the provision of adequate neurological care. We prospectively registered the attendance records for visits made to the Out-patient Neurology Clinic of Marina Alta in 1996. The variation coefficients between both series were calculated and compared. The average age of patients increased in 5 years. The number of patients attended increased 42.3%, new patients 40%, visits 13%, the "Review visit/First Visit" ratio reduced 29%. The attendance of patients with Cognitive Impairment (Cog. Imp.) doubled. There were no changes in the origins of the patients. Requests due to Cog. Imp. and parkinsonism increased significantly from Primary Care and Emergency Department. The delay to be attended increased 23%. Discharges increased 43.9%, highlighting an increase of 144% observed in the Cog. Imp. group. Changes have been observed in: the age of the population studied; the follow up of patients; the delay in attending them; and the pathology attended, with a significant increase in demand due to neurodegenerative pathology (especially Cog. Imp.). All this requires an increase in care needs that the Health Service has not been able to assume, creating an incongruous care model: we suggest a direct follow up model and offer a consultancy model.

  1. Albumin-bound paclitaxel in solid tumors: clinical development and future directions.

    Science.gov (United States)

    Kundranda, Madappa N; Niu, Jiaxin

    2015-01-01

    Albumin-bound paclitaxel (nab-paclitaxel) is a solvent-free formulation of paclitaxel that was initially developed more than a decade ago to overcome toxicities associated with the solvents used in the formulation of standard paclitaxel and to potentially improve efficacy. Nab-paclitaxel has demonstrated an advantage over solvent-based paclitaxel by being able to deliver a higher dose of paclitaxel to tumors and decrease the incidence of serious toxicities, including severe allergic reactions. To date, nab-paclitaxel has been indicated for the treatment of three solid tumors in the USA. It was first approved for the treatment of metastatic breast cancer in 2005, followed by locally advanced or metastatic non-small-cell lung cancer in 2012, and most recently for metastatic pancreatic cancer in 2013. Nab-paclitaxel is also under investigation for the treatment of a number of other solid tumors. This review highlights key clinical efficacy and safety outcomes of nab-paclitaxel in the solid tumors for which it is currently indicated, discusses ongoing trials that may provide new data for the expansion of nab-paclitaxel's indications into other solid tumors, and provides a clinical perspective on the use of nab-paclitaxel in practice.

  2. Prediction of clinical response to drugs in ovarian cancer using the chemotherapy resistance test (CTR-test).

    Science.gov (United States)

    Kischkel, Frank Christian; Meyer, Carina; Eich, Julia; Nassir, Mani; Mentze, Monika; Braicu, Ioana; Kopp-Schneider, Annette; Sehouli, Jalid

    2017-10-27

    In order to validate if the test result of the Chemotherapy Resistance Test (CTR-Test) is able to predict the resistances or sensitivities of tumors in ovarian cancer patients to drugs, the CTR-Test result and the corresponding clinical response of individual patients were correlated retrospectively. Results were compared to previous recorded correlations. The CTR-Test was performed on tumor samples from 52 ovarian cancer patients for specific chemotherapeutic drugs. Patients were treated with monotherapies or drug combinations. Resistances were classified as extreme (ER), medium (MR) or slight (SR) resistance in the CTR-Test. Combination treatment resistances were transformed by a scoring system into these classifications. Accurate sensitivity prediction was accomplished in 79% of the cases and accurate prediction of resistance in 100% of the cases in the total data set. The data set of single agent treatment and drug combination treatment were analyzed individually. Single agent treatment lead to an accurate sensitivity in 44% of the cases and the drug combination to 95% accuracy. The detection of resistances was in both cases to 100% correct. ROC curve analysis indicates that the CTR-Test result correlates with the clinical response, at least for the combination chemotherapy. Those values are similar or better than the values from a publication from 1990. Chemotherapy resistance testing in vitro via the CTR-Test is able to accurately detect resistances in ovarian cancer patients. These numbers confirm and even exceed results published in 1990. Better sensitivity detection might be caused by a higher percentage of drug combinations tested in 2012 compared to 1990. Our study confirms the functionality of the CTR-Test to plan an efficient chemotherapeutic treatment for ovarian cancer patients.

  3. Inter-tester reliability of selected clinical tests for long-lasting temporomandibular disorders.

    Science.gov (United States)

    Julsvoll, Elisabeth Heggem; Vøllestad, Nina Køpke; Opseth, Gro; Robinson, Hilde Stendal

    2017-09-01

    Clinical tests used to examine patients with temporomandibular disorders vary in methodological quality, and some are not tested for reliability. The purpose of this cross-sectional study was to evaluate inter-tester reliability of clinical tests and a cluster of tests used to examine patients with long-lasting temporomandibular disorders. Forty patients with pain in the temporomandibular area treated by health-professionals were included. They were between 18-70 years, had 65 symptomatic (33 right/32 left) and 15 asymptomatic joints. Two manual therapists examined all participants with selected tests. Percentage agreement and the kappa coefficient ( k ) with 95% confidence interval (CI) were used to evaluate the tests with categorical outcomes. For tests with continuous outcomes, the relative inter-tester reliability was assessed by the intraclass-correlation-coefficient (ICC 3,1 , 95% CI) and the absolute reliability was calculated by the smallest detectable change (SDC). The best reliability among single tests was found for the dental stick test, the joint-sound test ( k  = 0.80-1.0) and range of mouth-opening (ICC 3,1 (95% CI) = 0.97 (0.95-0.98) and SDC = 4 mm). The reliability of cluster of tests was excellent with both four and five positive tests out of seven. The reliability was good to excellent for the clinical tests and the cluster of tests when performed by experienced therapists. The tests are feasible for use in the clinical setting. They require no advanced equipment and are easy to perform.

  4. Integrating usability testing and think-aloud protocol analysis with "near-live" clinical simulations in evaluating clinical decision support.

    Science.gov (United States)

    Li, Alice C; Kannry, Joseph L; Kushniruk, Andre; Chrimes, Dillon; McGinn, Thomas G; Edonyabo, Daniel; Mann, Devin M

    2012-11-01

    Usability evaluations can improve the usability and workflow integration of clinical decision support (CDS). Traditional usability testing using scripted scenarios with think-aloud protocol analysis provide a useful but incomplete assessment of how new CDS tools interact with users and clinical workflow. "Near-live" clinical simulations are a newer usability evaluation tool that more closely mimics clinical workflow and that allows for a complementary evaluation of CDS usability as well as impact on workflow. This study employed two phases of testing a new CDS tool that embedded clinical prediction rules (an evidence-based medicine tool) into primary care workflow within a commercial electronic health record. Phase I applied usability testing involving "think-aloud" protocol analysis of 8 primary care providers encountering several scripted clinical scenarios. Phase II used "near-live" clinical simulations of 8 providers interacting with video clips of standardized trained patient actors enacting the clinical scenario. In both phases, all sessions were audiotaped and had screen-capture software activated for onscreen recordings. Transcripts were coded using qualitative analysis methods. In Phase I, the impact of the CDS on navigation and workflow were associated with the largest volume of negative comments (accounting for over 90% of user raised issues) while the overall usability and the content of the CDS were associated with the most positive comments. However, usability had a positive-to-negative comment ratio of only 0.93 reflecting mixed perceptions about the usability of the CDS. In Phase II, the duration of encounters with simulated patients was approximately 12 min with 71% of the clinical prediction rules being activated after half of the visit had already elapsed. Upon activation, providers accepted the CDS tool pathway 82% of times offered and completed all of its elements in 53% of all simulation cases. Only 12.2% of encounter time was spent using the

  5. Lack of Correlation between Severity of Clinical Symptoms, Skin Test Reactivity, and Radioallergosorbent Test Results in Venom-Allergic Patients

    Directory of Open Access Journals (Sweden)

    Warrington RJ

    2006-06-01

    Full Text Available Abstract Purpose To retrospectively examine the relation between skin test reactivity, venom-specific immunoglobulin E (IgE antibody levels, and severity of clinical reaction in patients with insect venom allergy. Method Thirty-six patients (including 15 females who presented with a history of allergic reactions to insect stings were assessed. The mean age at the time of the reactions was 33.4 ± 15.1 years (range, 4-76 years, and patients were evaluated 43.6 ± 90 months (range, 1-300 months after the reactions. Clinical reactions were scored according to severity, from 1 (cutaneous manifestations only to 3 (anaphylaxis with shock. These scores were compared to scores for skin test reactivity (0 to 5, indicating the log increase in sensitivity from 1 μg/mL to 0.0001 μg/mL and radioallergosorbent test (RAST levels (0 to 4, indicating venom-specific IgE levels, from undetectable to >17.5 kilounits of antigen per litre [kUA/L]. Results No correlation was found between skin test reactivity (Spearman's coefficient = 0.15, p = .377 or RAST level (Spearman's coefficient = 0.32, p = .061 and the severity of reaction. Skin test and RAST scores both differed significantly from clinical severity (p p = .042. There was no correlation between skin test reactivity and time since reaction (Spearman's coefficient = 0.18, p = .294 nor between RAST and time since reaction (r = 0.1353, p = .438. Elimination of patients tested more than 12 months after their reaction still produced no correlation between skin test reactivity (p = .681 or RAST score (p = .183 and the severity of the clinical reaction. Conclusion In venom-allergic patients (in contrast to reported findings in cases of inhalant IgE-mediated allergy, there appears to be no significant correlation between the degree of skin test reactivity or levels of venom-specific IgE (determined by RAST and the severity of the clinical reaction.

  6. Clinical Practice: Direct-to-consumer genetic testing: To test or not to ...

    African Journals Online (AJOL)

    In direct-to-consumer (DTC) genetic testing, laboratory-based genetic services are offered directly to the public without an independent healthcare professional being involved. The committee of the Southern African Society for Human Genetics (SASHG) appeals to the public and clinicians to be cautious when considering ...

  7. Service oriented architecture for clinical decision support: a systematic review and future directions.

    Science.gov (United States)

    Loya, Salvador Rodriguez; Kawamoto, Kensaku; Chatwin, Chris; Huser, Vojtech

    2014-12-01

    The use of a service-oriented architecture (SOA) has been identified as a promising approach for improving health care by facilitating reliable clinical decision support (CDS). A review of the literature through October 2013 identified 44 articles on this topic. The review suggests that SOA related technologies such as Business Process Model and Notation (BPMN) and Service Component Architecture (SCA) have not been generally adopted to impact health IT systems' performance for better care solutions. Additionally, technologies such as Enterprise Service Bus (ESB) and architectural approaches like Service Choreography have not been generally exploited among researchers and developers. Based on the experience of other industries and our observation of the evolution of SOA, we found that the greater use of these approaches have the potential to significantly impact SOA implementations for CDS.

  8. Future-proofing pathology: the case for clinical adoption of digital pathology.

    Science.gov (United States)

    Williams, Bethany Jill; Bottoms, David; Treanor, Darren

    2017-12-01

    This document clarifies the strategic context of digital pathology adoption, defines the different use cases a healthcare provider may wish to consider as part of a digital adoption and summarises existing reasons for digital adoption and its potential benefits. The reader is provided with references to the relevant literature, and illustrative case studies. The authors hope this report will be of interest to healthcare providers, pathology managers, departmental heads, pathologists and biomedical scientists that are considering digital pathology, deployments or preparing business cases for digital pathology adoption in clinical settings. The information contained in this document can be shared and used in any documentation the reader wishes to present for their own institutional case for adoption report or business case. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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

    Science.gov (United States)

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

    2012-01-01

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

  10. Methods of albumin estimation in clinical biochemistry: Past, present, and future.

    Science.gov (United States)

    Kumar, Deepak; Banerjee, Dibyajyoti

    2017-06-01

    Estimation of serum and urinary albumin is routinely performed in clinical biochemistry laboratories. In the past, precipitation-based methods were popular for estimation of human serum albumin (HSA). Currently, dye-binding or immunochemical methods are widely practiced. Each of these methods has its limitations. Research endeavors to overcome such limitations are on-going. The current trends in methodological aspects of albumin estimation guiding the field have not been reviewed. Therefore, it is the need of the hour to review several aspects of albumin estimation. The present review focuses on the modern trends of research from a conceptual point of view and gives an overview of recent developments to offer the readers a comprehensive understanding of the subject. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. Addressing the future of clinical information systems--Web-based multilayer visualization.

    Science.gov (United States)

    Poh, Chueh-Loo; Kitney, Richard I; Shrestha, Rasu B K

    2007-03-01

    This paper addresses some key issues relating to the development of new technology for clinical information systems (CIS) in relation to imaging and visualizing data. With the increasing importance of molecular and cellular biology, a new type of medicine, molecular based medicine, is now developing. This will significantly alter the way in which medicine is practiced. The view is presented that CIS will need to operate seamlessly across the Biological Continuum, i.e., the hierarchy of the human organism comprising systems, viscera, tissue, cells, proteins, and genes. We propose a multilayered visualization interface, which operates across the Biological Continuum, based on Web-based technology. A visualization interface package for two-dimensional and three-dimensional image data at the visceral and cellular levels is described. Two application examples are presented: 1) MR knee images, at the visceral level and 2) endothelial nuclei images, acquired from confocal laser microscopy, at the cellular level.

  12. Working memory and hearing aid processing: Literature findings, future directions, and clinical applications

    Directory of Open Access Journals (Sweden)

    Pamela eSouza

    2015-12-01

    Full Text Available Working memory—the ability to process and store information—has been identified as an important aspect of speech perception in difficult listening environments. Working memory can be envisioned as a limited-capacity system which is engaged when an input signal cannot be readily matched to a stored representation or template. This mismatch is expected to occur more frequently when the signal is degraded. Because working memory capacity varies among individuals, those with smaller capacity are expected to demonstrate poorer speech understanding when speech is degraded, such as in background noise. However, it is less clear whether (and how working memory should influence practical decisions, such as hearing treatment. Here, we consider the relationship between working memory capacity and response to specific hearing aid processing strategies. Three types of signal processing are considered, each of which will alter the acoustic signal: fast-acting wide-dynamic range compression, which smooths the amplitude envelope of the input signal; digital noise reduction, which may inadvertently remove speech signal components as it suppresses noise; and frequency compression, which alters the relationship between spectral peaks. For fast-acting wide-dynamic range compression, a growing body of data suggests that individuals with smaller working memory capacity may be more susceptible to such signal alterations, and may receive greater amplification benefit with low alteration processing. While the evidence for a relationship between wide-dynamic range compression and working memory appears robust, the effects of working memory on perceptual response to other forms of hearing aid signal processing are less clear cut. We conclude our review with a discussion of the opportunities (and challenges in translating information on individual working memory into clinical treatment, including clinically-feasible measures of working memory.

  13. Working Memory and Hearing Aid Processing: Literature Findings, Future Directions, and Clinical Applications.

    Science.gov (United States)

    Souza, Pamela; Arehart, Kathryn; Neher, Tobias

    2015-01-01

    Working memory-the ability to process and store information-has been identified as an important aspect of speech perception in difficult listening environments. Working memory can be envisioned as a limited-capacity system which is engaged when an input signal cannot be readily matched to a stored representation or template. This "mismatch" is expected to occur more frequently when the signal is degraded. Because working memory capacity varies among individuals, those with smaller capacity are expected to demonstrate poorer speech understanding when speech is degraded, such as in background noise. However, it is less clear whether (and how) working memory should influence practical decisions, such as hearing treatment. Here, we consider the relationship between working memory capacity and response to specific hearing aid processing strategies. Three types of signal processing are considered, each of which will alter the acoustic signal: fast-acting wide-dynamic range compression, which smooths the amplitude envelope of the input signal; digital noise reduction, which may inadvertently remove speech signal components as it suppresses noise; and frequency compression, which alters the relationship between spectral peaks. For fast-acting wide-dynamic range compression, a growing body of data suggests that individuals with smaller working memory capacity may be more susceptible to such signal alterations, and may receive greater amplification benefit with "low alteration" processing. While the evidence for a relationship between wide-dynamic range compression and working memory appears robust, the effects of working memory on perceptual response to other forms of hearing aid signal processing are less clear cut. We conclude our review with a discussion of the opportunities (and challenges) in translating information on individual working memory into clinical treatment, including clinically feasible measures of working memory.

  14. A new condition for assessing the clinical efficiency of a diagnostic test.

    Science.gov (United States)

    Bokhari, Ehsan; Hubert, Lawrence

    2015-09-01

    When prediction using a diagnostic test outperforms simple prediction using base rates, the test is said to be "clinically efficient," a term first introduced into the literature by Meehl and Rosen (1955) in Psychological Bulletin. This article provides three equivalent conditions for determining the clinical efficiency of a diagnostic test: (a) Meehl-Rosen (Meehl & Rosen, 1955); (b) Dawes (Dawes, 1962); and (c) the Bokhari-Hubert condition, introduced here for the first time. Clinical efficiency is then generalized to situations where misclassification costs are considered unequal (for example, false negatives are more costly than false positives). As an illustration, the clinical efficiency of an actuarial device for predicting violent and dangerous behavior is examined that was developed as part of the MacArthur Violence Risk Assessment Study. (c) 2015 APA, all rights reserved.

  15. Concerns about Genetic Testing for Schizophrenia among Young Adults at Clinical High Risk for Psychosis.

    Science.gov (United States)

    Lawrence, Ryan E; Friesen, Phoebe; Brucato, Gary; Girgis, Ragy R; Dixon, Lisa

    Genetic tests for schizophrenia may introduce risks and benefits. Among young adults at clinical high-risk for psychosis, little is known about their concerns and how they assess potential risks. We conducted semi-structured interviews with 15 young adults at clinical high-risk for psychosis to ask about their concerns. Participants expressed concerns about test reliability, data interpretation, stigma, psychological harm, family planning, and privacy. Participants' responses showed some departure from the ethics literature insofar as participants were primarily interested in reporting their results to people to whom they felt emotionally close, and expressed little consideration of biological closeness. Additionally, if tests showed an increased genetic risk for schizophrenia, four clinical high-risk persons felt obligated to tell an employer and another three would "maybe" tell an employer, even in the absence of clinical symptoms. These findings suggest opportunities for clinicians and genetic counselors to intervene with education and support.

  16. Ecotoxicity of engineered nanoparticles to aquatic invertebrates: a brief review and recommendations for future toxicity testing

    DEFF Research Database (Denmark)

    Baun, Anders; Hartmann, Nanna Isabella Bloch; Grieger, Khara Deanne

    2008-01-01

    Based on a literature review and an overview of toxic effects of engineered nanoparticles in aquatic invertebrates, this paper proposes a number of recommendations for the developing field of nanoecotoxicology by highlighting the importance of invertebrates as sensitive and relevant test organisms...... through standardized short-term (lethality) tests with invertebrates as a basis for investigating behaviour and bioavailability of engineered nanoparticles in the aquatic environment. Based on this literature review, we further recommend that research is directed towards invertebrate tests employing long....... Results show that there is a pronounced lack of data in this field (less than 20 peer-reviewed papers are published so far), and the most frequently tested engineered nanoparticles in invertebrate tests are C-60, carbon nanotubes, and titanium dioxide. In addition, the majority of the studies have used...

  17. HIV Rapid Testing in Substance Abuse Treatment: Implementation Following a Clinical Trial

    Science.gov (United States)

    Haynes, L. F.; Korte, J. E.; Holmes, B. E.; Gooden, L.; Matheson, T.; Feaster, D. J.; Leff, J. A.; Wilson, L.; Metsch, L. R.; Schackman, B. R.

    2011-01-01

    The Substance Abuse Mental Health Services Administration has promoted HIV testing and counseling as an evidence-based practice. Nevertheless, adoption of HIV testing in substance abuse treatment programs has been slow. This article describes the experience of a substance abuse treatment agency where, following participation in a clinical trial,…

  18. Routine use of point-of-care tests: usefulness and application in clinical microbiology.

    Science.gov (United States)

    Clerc, O; Greub, G

    2010-08-01

    Point-of-care (POC) tests offer potentially substantial benefits for the management of infectious diseases, mainly by shortening the time to result and by making the test available at the bedside or at remote care centres. Commercial POC tests are already widely available for the diagnosis of bacterial and viral infections and for parasitic diseases, including malaria. Infectious diseases specialists and clinical microbiologists should be aware of the indications and limitations of each rapid test, so that they can use them appropriately and correctly interpret their results. The clinical applications and performance of the most relevant and commonly used POC tests are reviewed. Some of these tests exhibit insufficient sensitivity, and should therefore be coupled to confirmatory tests when the results are negative (e.g. Streptococcus pyogenes rapid antigen detection test), whereas the results of others need to be confirmed when positive (e.g. malaria). New molecular-based tests exhibit better sensitivity and specificity than former immunochromatographic assays (e.g. Streptococcus agalactiae detection). In the coming years, further evolution of POC tests may lead to new diagnostic approaches, such as panel testing, targeting not just a single pathogen, but all possible agents suspected in a specific clinical setting. To reach this goal, the development of serology-based and/or molecular-based microarrays/multiplexed tests will be needed. The availability of modern technology and new microfluidic devices will provide clinical microbiologists with the opportunity to be back at the bedside, proposing a large variety of POC tests that will allow quicker diagnosis and improved patient care.

  19. CLINICAL TESTS FOR THE ASSESSMENT OF THE PELVIC GIRDLE PAIN IN PREGNANCY AND POSTPARTUM

    Directory of Open Access Journals (Sweden)

    Darija Šćepanović

    2018-02-01

    Full Text Available Background: Pregnancy-related pelvic girdle pain (PGP refers to the pain in the lumbosacral region, the sacroiliac joints and the symphysis pubis joint. The results of the high methodological quality studies indicate that the point prevalence of pregnant women suffering from PGP is about 20 %. Pregnancy-related PGP requires a comprehensive physiotherapy assessment in order to make or confirm a diagnosis, plan the treatment and evaluate the patient’s condi- tion. Physiotherapy assessment includes clinical diagnostic tests which should satisfy the criteria of safety, feasibility, reliability, sensitivity, specificity and validity. The aim of the present paper was to systematically review the literature on clinical diagnostic tests of PGP in order to determine which clinical tests meet the necessary criteria and are appropriate for clinical examination of PGP in pregnancy and postpartum. Methods: PubMed, Cinahl, Embase, Index Medicus databases and the Cochrane controlled trials reg- ister from 1980 to 2008 were searched using the key words, pregnancy/pelvic girdle pain, pregnancy/clinical tests/sacroiliac joint/symphysis pubis. Only the articles/texts in English and Slovene were reviewed unless translated abstract was available. Additional manual searches of the reference lists in books and review articles were undertaken. Along with the randomized clinical studies the literature search encompassed also the basic studies. Results: Nine studies evaluating the tests for clinical examination of the pregnancy-related PGP met the criteria for inclusion in this review. The studies evaluated and analysed six provocation tests for the sacroiliac joint, namely, the Posterior pelvic pain provocation test (P4, Patrick’s Faber test, palpation of the long dorsal ligament, compression test, separation test, Menell’s test as well as two provocation tests for the symphysis pubis joint (pain palpation and a modified Trendelenburg test and one functional

  20. Testing for boosting at the Paralympic games: policies, results and future directions.

    Science.gov (United States)

    Blauwet, Cheri A; Benjamin-Laing, Harry; Stomphorst, Jaap; Van de Vliet, Peter; Pit-Grosheide, Pia; Willick, Stuart E

    2013-09-01

    'Boosting' is defined as the intentional induction of autonomic dysreflexia (AD) by athletes with a spinal cord injury (SCI) at or above the level of T6 for the purpose of improving sports performance. Boosting has been shown to confer up to a 9.7% improvement in race time. Additionally, to compete in a hazardous dysreflexic state, whether intentional or unintentional, would present an extreme health risk to the athlete. For these reasons, the International Paralympic Committee strictly bans the practice of boosting, and has developed a protocol to test for its presence. Testing was performed at three major international Paralympic events. Education regarding the dangers of AD was provided to athletes and team staff. Testing was conducted on athletes from the relevant sport classes: Athletics (wheelchair racing classes T51/T52/T53) and Handcycling (H1). Key parameters included the athlete's demographics (gender, country of origin), classification and blood pressure measurements. An extremely elevated blood pressure was considered to be a proxy maker for AD, and a systolic blood pressure of ≥180 mm Hg was considered a positive test. A total of 78 tests for the presence of AD were performed during the three games combined. No athlete tested positive. The number of athletes tested, by classification, was: 6 in Athletics T51, 47 in Athletics T52, 9 in Athletics T53 and 16 in Handcycling H1. Of those tested, the average systolic and diastolic blood pressures were 135 mm Hg (range 98-178) and 82 mm Hg (range 44-112), respectively. All athletes were compliant with testing. No athletes were withdrawn from competition due to the presence of AD. Testing for the presence of AD in paralympic athletes with SCI prior to competition has been carried out for the first time at three major international paralympic competitions. There have been no positive tests thus far. Knowledge gained during these early testing experiences will be used to guide ongoing refinement of the testing

  1. Reversal Strategies for NOACs: State of Development, Possible Clinical Applications and Future Perspectives.

    Science.gov (United States)

    Husted, Steen; Verheugt, Freek W A; Comuth, Willemijn J

    2016-01-01

    The non-vitamin K antagonist oral anticoagulants (NOACs) are used for thromboembolic prophylaxis of patients with atrial fibrillation and in the treatment as well as secondary prophylaxis of patients with venous thromboembolism. Even though NOACs have a better safety profile than vitamin K antagonists (VKAs), there will still be bleeding complications on NOAC treatment. In some cases, stopping the NOAC and non-drug-related management such as manual compression and interventional endoscopy will be sufficient to stop the bleeding. In more serious bleeding events and before acute surgery, coagulation factor concentrates or NOAC-specific antidotes could be used. Coagulation factor concentrates can be used in patients with haemophilia and to reverse the effect of VKAs but, in NOAC-treated patients, results are inconsistent and these agents could potentially have pro-thrombotic effects. Specific antidotes for NOACs are expected to be on the market soon. Phase III clinical trials with a humanized antibody fragment directed against dabigatran (idarucizumab) and recombinant, modified factor Xa (andexanet alfa) are ongoing. A molecule (aripazine) with broad activity against various anticoagulants including NOACs is currently undergoing phase II trials. For use of these specific antidotes, it is desirable that measurements for coagulation activity with a short response delay are widely available for the different NOACs and further research in this field is needed. Furthermore, guidelines for antidote use, including general measures for the treatment of NOAC-related bleeding, should be available.

  2. VEGF in nuclear medicine: Clinical application in cancer and future perspectives (Review).

    Science.gov (United States)

    Taurone, Samanta; Galli, Filippo; Signore, Alberto; Agostinelli, Enzo; Dierckx, Rudi A J O; Minni, Antonio; Pucci, Marcella; Artico, Marco

    2016-08-01

    Clinical trials using antiangiogenic drugs revealed their potential against cancer. Unfortunately, a large percentage of patients does not yet benefit from this therapeutic approach highlighting the need of diagnostic tools to non-invasively evaluate and monitor response to therapy. It would also allow to predict which kind of patient will likely benefit of antiangiogenic therapy. Reasons for treatment failure might be due to a low expression of the drug targets or prevalence of other pathways. Molecular imaging has been therefore explored as a diagnostic technique of choice. Since the vascular endothelial growth factor (VEGF/VEGFR) pathway is the main responsible of tumor angiogenesis, several new drugs targeting either the soluble ligand or its receptor to inhibit signaling leading to tumor regression could be involved. Up today, it is difficult to determine VEGF or VEGFR local levels and their non-invasive measurement in tumors might give insight into the available target for VEGF/VEGFR-dependent antiangiogenic therapies, allowing therapy decision making and monitoring of response.

  3. Pioneering a new role: the beginning, current practice and future of the Clinical Nurse Leader.

    Science.gov (United States)

    Poulin-Tabor, Danielle; Quirk, Rebecca L; Wilson, Lauri; Orff, Sonja; Gallant, Paulette; Swan, Nina; Manchester, Nicole

    2008-07-01

    To discuss the development of a new nursing role in response to the health care crisis in the United States. The nursing shortage and fragmentation of care has contributed to the need for nurses who are prepared to laterally integrate care, bring evidence-based practice to the bedside and provide continuity of care to patients and families. The CNLs review the literature, share their experiences, and discuss outcomes related to improved quality of care. Having clinical nurses with a global perspective acting as facilitators and integrators of care is essential to maintaining a high standard of care. Organizational and management support is critical. The more CNLs that can be embedded in an institution, the more successful the role can be. The varied utilization of the CNLs in this practice setting has proven its value in a short period of time and facilitated better communication and collaboration among patients and their health care team. The flexibility and broad scope of this role allows for its use in any practice setting to realize gains in quality outcomes, cost savings, improved patient flow, increased safety, nurse satisfaction and increasing organizational capacity.

  4. Recovery and serious mental illness: a review of current clinical and research paradigms and future directions.

    Science.gov (United States)

    Leonhardt, Bethany L; Huling, Kelsey; Hamm, Jay A; Roe, David; Hasson-Ohayon, Ilanit; McLeod, Hamish J; Lysaker, Paul H

    2017-11-01

    Recovery from serious mental illness has historically not been considered a likely or even possible outcome. However, a range of evidence suggests the courses of SMI are heterogeneous with recovery being the most likely outcome. One barrier to studying recovery in SMI is that recovery has been operationalized in divergent and seemingly incompatible ways: as an objective outcome versus a subjective process. Areas covered: This paper offers a review of recovery as a subjective process and recovery as an objective outcome; contrasts methodologies utilized by each approach to assess recovery; reports rates and correlates of recovery; and explores the relationship between objective and subjective forms of recovery. Expert commentary: There are two commonalities of approaching recovery as a subjective process and an objective outcome: (i) the need to make meaning out of one's experiences to engage in either type of recovery and (ii) there exist many threats to engaging in meaning making that may impact the likelihood of moving toward recovery. We offer four clinical implications that stem from these two commonalities within a divided approach to the concept of recovery from SMI.

  5. The Legal Past, Present and Future of Prenatal Genetic Testing: Professional Liability and Other Legal Challenges Affecting Patient Access to Services

    Directory of Open Access Journals (Sweden)

    Deborah Pergament

    2014-12-01

    Full Text Available This chapter is an overview of the current status of the law in the United States regarding prenatal genetic testing with an emphasis on issues related to professional liability and other challenges affecting patient access to prenatal genetic testing. The chapter discusses the roles that federal regulations, promulgated by the Centers for Medicare and Medicaid Services (CMS, the Food and Drug Administration (FDA and the Federal Trade Commission (FTC, play in the regulation of prenatal genetic tests. The chapter discusses tort litigation based on allegations of malpractice in the provision of prenatal genetic testing and how courts have analyzed issues related to causation, damages and mitigation of damages. The chapter provides reference information regarding how individual states address causes of action under the tort theories of wrongful birth and wrongful life. The chapter concludes with a discussion of future legal issues that may affect clinical prenatal genetic testing services arising from the continued expansion of prenatal genetic testing, legal restrictions on access to abortion and the potential development of embryonic treatments.

  6. Limits of clinical tests to screen autonomic function in diabetes type 1.

    Science.gov (United States)

    Ducher, M; Bertram, D; Sagnol, I; Cerutti, C; Thivolet, C; Fauvel, J P

    2001-11-01

    A precocious detection of cardiac autonomic dysfunction is of major clinical interest that could lead to a more intensive supervision of diabetic patients. However, classical clinical exploration of cardiac autonomic function is not easy to undertake in a reproducible way. Thus, respective interests of autonomic nervous parameters provided by both clinical tests and computerized analysis of resting blood pressure were checked in type 1 diabetic patients without orthostatic hypotension and microalbuminuria. Thirteen diabetic subjects matched for age and gender to thirteen healthy subjects volunteered to participate to the study. From clinical tests (standing up, deep breathing, Valsalva maneuver, handgrip test), autonomic function was scored according to Ewing's methodology. Analysis of resting beat to beat blood pressure provided autonomic indices of the cardiac function (spectral analysis or Z analysis). 5 of the 13 diabetic patients exhibited a pathological score (more than one pathological response) suggesting the presence of cardiovascular autonomic dysfunction. The most discriminative test was the deep breathing test. However, spectral indices of BP recordings and baro-reflex sensitivity (BRS) of these 5 subjects were similar to those of healthy subjects and of remaining diabetic subjects. Alteration in Ewing's score given by clinical tests may not reflect an alteration of cardiac autonomic function in asymptomatic type 1 diabetic patients, because spectral indices of sympathetic and parasympathetic (including BRS) function were within normal range. Our results strongly suggest to confront results provided by both methodologies before concluding to an autonomic cardiac impairment in asymptomatic diabetic patients.

  7. HIV-1 Tropism Testing and Clinical Management of CCR5 Antagonists: Quebec Review and Recommendations

    Directory of Open Access Journals (Sweden)

    Cécile Tremblay

    2013-01-01

    Full Text Available HIV-1 tropism assays play a crucial role in determining the response to CCR5 receptor antagonists. Initially, phenotypic tests were used, but limited access to these tests prompted the development of alternative strategies. Recently, genotyping tropism has been validated using a Canadian technology in clinical trials investigating the use of maraviroc in both experienced and treatment-naive patients. The present guidelines review the evidence supporting the use of genotypic assays and provide recommendations regarding tropism testing in daily clinical management.

  8. The future (r)evolution of preimplantation genetic diagnosis/human leukocyte antigen testing: ethical reflections.

    Science.gov (United States)

    de Wert, Guido; Liebaers, Inge; Van de Velde, Hilde

    2007-09-01

    There has been increasing support for combining preimplantation genetic diagnosis (PGD) for specific diseases with a test for human leukocyte antigens (HLA) because the generation of HLA-matched umbilical cord blood cells may save the life of a diseased sibling. To date, this procedure has taken place in the context of conceiving another child--PGD/HLA testing type 1. However, it may well become possible to perform PGD/HLA testing outside this context, that is, to select matched embryos from which embryonic stem cells could be derived and used in cell therapy--PGD/HLA testing type 2. A proactive ethical analysis is needed and is presented in this article. Although PGD/HLA testing type 1 can be morally justified, the risks, pitfalls, and practical limitations of this procedure make it necessary to develop alternative strategies. PGD/HLA testing type 2 may provide an alternative strategy. From an ethical point of view, the controversial issue is that this procedure creates embryos purely for instrumental use. However, given the dominant view that the preimplantation embryo has only limited moral value, this alternative may be as morally justified as PGD/HLA testing type 1.

  9. Reassurance against future risk of precancer and cancer conferred by a negative human papillomavirus test.

    Science.gov (United States)

    Gage, Julia C; Schiffman, Mark; Katki, Hormuzd A; Castle, Philip E; Fetterman, Barbara; Wentzensen, Nicolas; Poitras, Nancy E; Lorey, Thomas; Cheung, Li C; Kinney, Walter K

    2014-08-01

    Primary human papillomavirus (HPV) testing (without concurrent Pap tests) every 3 years is under consideration in the United States as an alternative to the two recommended cervical cancer screening strategies: primary Pap testing every 3 years, or concurrent Pap and HPV testing ("cotesting") every 5 years. Using logistic regression and Weibull survival models, we estimated and compared risks of cancer and cervical intraepithelial neoplasia grade 3 or worse (CIN3+) for the three strategies among 1011092 women aged 30 to 64 years testing HPV-negative and/or Pap-negative in routine screening at Kaiser Permanente Northern California since 2003. All statistical tests were two sided. Three-year risks following an HPV-negative result were lower than 3-year risks following a Pap-negative result (CIN3+ = 0.069% vs 0.19%, P < .0001; Cancer = 0.011% vs 0.020%, P < .0001) and 5-year risks following an HPV-negative/Pap-negative cotest (CIN3+ = 0.069% vs 0.11%, P < .0001; Cancer = 0.011% vs 0.014%, P = .21). These findings suggest that primary HPV testing merits consideration as another alternative for cervical screening. © Published by Oxford University Press 2014.

  10. Sensor-based supporting mobile system Parkinson disease clinical tests utilising biomedical and RFID technologies

    Directory of Open Access Journals (Sweden)

    Chmielewski Mariusz

    2017-01-01

    Full Text Available This paper discusses method and tool for assisting clinical tests of pharmaceutical drugs utilising sensors and mobile technologies. Emerging sensor and mobile technologies deliver new opportunities to gather and process medical data. Presented analytical approach implements such observations and delivers new, convenient means for remote patient monitoring. Clinical tests are highly specialised process requiring methodology and tools to support such research. Currently available methods rely mostly on analogue approach (booklets, requiring the clinical test participant to fill in health state daily. Such approach often can be biased by unpunctual, not precise reporting. The mobile device can support this process by automatic scheduling and recording an actual time of reports and most of all it can record the inertial and biometric sensor data during the survey process. Presented analytical method (tremors recognition and mobile tool offers consistent approach to clinical test assistance transforming and Android smartphone into remote reporting and notification tool. The tool offers additionally features for sensor based diagnostics support for PD tremor recognition as well as specific clonic and tonic symptoms (dedicated for further system extensions towards epilepsy. Capabilities of the system delivers also RFID mechanisms for efficient on-site clinical test authorisation and configuration. This feature simplifies application installation and automatic set-up considering the participant, clinical test configuration, schedule, smartphone and sensor data. Such a composition delivers convenient and reliable tool which can assist patients and medical staff during the process objectifying the clinical tests results and helping to ensure good quality of the data, quickly available and easily accessible.

  11. EMG of the hip adductor muscles in six clinical examination tests.

    Science.gov (United States)

    Lovell, Gregory A; Blanch, Peter D; Barnes, Christopher J

    2012-08-01

    To assess activation of muscles of hip adduction using EMG and force analysis during standard clinical tests, and compare athletes with and without a prior history of groin pain. Controlled laboratory study. 21 male athletes from an elite junior soccer program. Bilateral surface EMG recordings of the adductor magnus, adductor longus, gracilis and pectineus as well as a unilateral fine-wire EMG of the pectineus were made during isometric holds in six clinical examination tests. A load cell was used to measure force data. Test type was a significant factor in the EMG output for all four muscles (all muscles p stronger than Hips 45, Hips 90 and Side lay. BMI (body mass index) was a significant factor (p Muscle EMG varied significantly with clinical test position. Athletes with previous groin injury had a significant fall in some EMG outputs. Copyright © 2011 Elsevier Ltd. All rights reserved.

  12. The past, present, and future of test and research reactor physics

    International Nuclear Information System (INIS)

    Ryskamp, J.M.

    1992-01-01

    Reactor physics calculations have been performed on research reactors since the first one was built 50 yr ago under the University of Chicago stadium. Since then, reactor physics calculations have evolved from Fermi-age theory calculations performed with slide rules to three-dimensional, continuous-energy, coupled neutron-photon Monte Carlo computations performed with supercomputers and workstations. Such enormous progress in reactor physics leads us to believe that the next 50 year will be just as exciting. This paper reviews this transition from the past to the future

  13. Testing market efficiency of crude palm oil futures to European participants

    OpenAIRE

    Liu, Xing

    2009-01-01

    Palm oil is the most consumed and traded vegetable oils in the EU and the world. Increasing non-food uses for vegetable oils in especially feedstock of biofuels in recent years have caused the price volatility to rise in both EU and global market. The most efficient pricing of crude palm oil (CPO) is to found on Bursa Malaysia (BMD), and it provides by far the world’s most liquid palm oil contract. The goal of this study is to investigate CPO futures market efficiency of BMD for the European ...

  14. PIV Measurements in the 14 x 22 Low Speed Tunnel: Recommendations for Future Testing

    Science.gov (United States)

    Watson, Ralph D.; Jenkins, Luther N.; Yao, Chung-Sheng; McGinley, Catherine B.; Paschal, Keith B.; Neuhart, Dan H.

    2003-01-01

    During the period from February 4 to March 21, 2003 stereo digital particle imaging velocimetry measurements were made on a generic high lift model, the Trap Wing, as part of the High Lift Flow Physics Experiment. These measurements were the first PIV measurements made in the NASA, Langley Research Center 14 x 22 Foot Low Speed Tunnel, and several problems were encountered and solved in the acquisition of the data. It is the purpose of this paper to document the solutions to these problems and to make recommendations for further improvements to the tunnel/setup in order to facilitate future measurements of this type.

  15. Effect of home testing of international normalized ratio on clinical events.

    Science.gov (United States)

    Matchar, David B; Jacobson, Alan; Dolor, Rowena; Edson, Robert; Uyeda, Lauren; Phibbs, Ciaran S; Vertrees, Julia E; Shih, Mei-Chiung; Holodniy, Mark; Lavori, Philip

    2010-10-21

    Warfarin anticoagulation reduces thromboembolic complications in patients with atrial fibrillation or mechanical heart valves, but effective management is complex, and the international normalized ratio (INR) is often outside the target range. As compared with venous plasma testing, point-of-care INR measuring devices allow greater testing frequency and patient involvement and may improve clinical outcomes. We randomly assigned 2922 patients who were taking warfarin because of mechanical heart valves or atrial fibrillation and who were competent in the use of point-of-care INR devices to either weekly self-testing at home or monthly high-quality testing in a clinic. The primary end point was the time to a first major event (stroke, major bleeding episode, or death). The patients were followed for 2.0 to 4.75 years, for a total of 8730 patient-years of follow-up. The time to the first primary event was not significantly longer in the self-testing group than in the clinic-testing group (hazard ratio, 0.88; 95% confidence interval, 0.75 to 1.04; P=0.14). The two groups had similar rates of clinical outcomes except that the self-testing group reported more minor bleeding episodes. Over the entire follow-up period, the self-testing group had a small but significant improvement in the percentage of time during which the INR was within the target range (absolute difference between groups, 3.8 percentage points; P<0.001). At 2 years of follow-up, the self-testing group also had a small but significant improvement in patient satisfaction with anticoagulation therapy (P=0.002) and quality of life (P<0.001). As compared with monthly high-quality clinic testing, weekly self-testing did not delay the time to a first stroke, major bleeding episode, or death to the extent suggested by prior studies. These results do not support the superiority of self-testing over clinic testing in reducing the risk of stroke, major bleeding episode, and death among patients taking warfarin

  16. Impact of changed legislation on skin tests: the present and future

    NARCIS (Netherlands)

    Klimek, Ludger; Hoffmann, Hans Jürgen; Kugler, Alexa; Muraro, Antonella; Hellings, Peter W.

    2016-01-01

    To discuss the impact of current European Union regulations on the availability of commercially available skin test allergens in European member states. European Union legislations now define diagnostic allergens to be medicine requiring market authorization of every individual diagnostic allergen

  17. Validity of Commonly Used Clinical Tests to Diagnose and Screen for Spinal Pain in Adolescents

    DEFF Research Database (Denmark)

    Aartun, Ellen; Hartvigsen, Jan; Hestbaek, Lise

    2016-01-01

    , the area under the receiver operating characteristic curve ranged from 0.60 to 0.65. None of the selected tests could predict incidence cases of neck pain, mid back pain, or low back pain. CONCLUSION: Clinical tests commonly used in spinal screening in adolescents could not detect present spinal pain...... under the receiver operating characteristic curve was calculated for evaluation of all tests combined. RESULTS: The sensitivity was low, and specificity was high for all tests at both baseline (age, 11-13 years) and follow-up (age, 13-15 years). When all tests were evaluated collectively in 1 model...

  18. Attitudes about Future Genetic Testing for Posttraumatic Stress Disorder and Addiction among Community-Based Veterans

    Directory of Open Access Journals (Sweden)

    Michelle R. Lent

    2017-05-01

    Full Text Available This study explored attitudes toward hypothetical genetic testing for posttraumatic stress disorder (PTSD and addiction among veterans. We surveyed a random sample of community-based veterans (n = 700 by telephone. One year later, we asked the veterans to provide a DNA sample for analysis and 41.9% of them returned the DNA samples. Overall, most veterans were not interested in genetic testing neither for PTSD (61.7% nor for addiction (68.7%. However, bivariate analyses suggested there was an association between having the condition of interest and the likelihood of genetic testing on a 5-point scale (p < 0.001 for PTSD; p = 0.001 for alcohol dependence. While ordinal regressions confirmed these associations, the models with the best statistical fit were bivariate models of whether the veteran would likely test or not. Using logistic regressions, significant predictors for PTSD testing were receiving recent mental health treatment, history of a concussion, younger age, having PTSD, having alcohol dependence, currently taking opioids for pain, and returning the DNA sample during the follow-up. For addiction testing, significant predictors were history of concussion, younger age, psychotropic medication use, having alcohol dependence, and currently taking opioids for pain. Altogether, 25.9% of veterans reported that they would have liked to have known their genetic results before deployment, 15.6% reported after deployment, and 58.6% reported they did not want to know neither before nor after deployment. As advancements in genetic testing continue to evolve, our study suggests that consumer attitudes toward genetic testing for mental disorders are complex and better understanding of these attitudes and beliefs will be crucial to successfully promote utilization.

  19. Policy issues facing the Comprehensive Test Ban Treaty and prospects for the future

    International Nuclear Information System (INIS)

    Sweeney, J.

    1999-01-01

    This report is divided into the following 5 sections: (1) Background; (2) Major Issues Facing Ratification of CTBT; (3) Current Status on CTBT Ratification; (4) Status of CTBT Signatories and Ratifiers; and (5) CTBT Activities Not Prohibited. The major issues facing ratification of CTBT discussed here are: impact on CTBT of START II and ABM ratification; impact of India and Pakistan nuclear tests; CTBT entry into force; and establishment of the Comprehensive Nuclear Test-Ban Treaty Organization

  20. Testing for genetically modified organisms (GMOs): Past, present and future perspectives.

    Science.gov (United States)

    Holst-Jensen, Arne

    2009-01-01

    This paper presents an overview of GMO testing methodologies and how these have evolved and may evolve in the next decade. Challenges and limitations for the application of the test methods as well as to the interpretation of results produced with the methods are highlighted and discussed, bearing in mind the various interests and competences of the involved stakeholders. To better understand the suitability and limitations of detection methodologies the evolution of transformation processes for creation of GMOs is briefly reviewed.

  1. Policy issues facing the Comprehensive Test Ban Treaty and prospects for the future

    Energy Technology Data Exchange (ETDEWEB)

    Sweeney, J.

    1999-04-01

    This report is divided into the following 5 sections: (1) Background; (2) Major Issues Facing Ratification of CTBT; (3) Current Status on CTBT Ratification; (4) Status of CTBT Signatories and Ratifiers; and (5) CTBT Activities Not Prohibited. The major issues facing ratification of CTBT discussed here are: impact on CTBT of START II and ABM ratification; impact of India and Pakistan nuclear tests; CTBT entry into force; and establishment of the Comprehensive Nuclear Test-Ban Treaty Organization.

  2. Evaluation of a clinic-based cholinesterase test kit for the Washington State Cholinesterase Monitoring Program.

    Science.gov (United States)

    Hofmann, Jonathan N; Carden, Angela; Fenske, Richard A; Ruark, Harold E; Keifer, Matthew C

    2008-07-01

    The Washington State Cholinesterase Monitoring Program for pesticide handlers requires blood draws at local clinics, with samples tested at a central laboratory. At present, workers with inhibited cholinesterase activity may be re-exposed before they can be removed from work. In this study we explored the option of on-site testing at local clinics using the EQM Test-mate Kittrade mark, a portable cholinesterase test kit. Test kit cholinesterase activity measurements were performed on 50 blood samples by our research staff, and compared to measurements on the same samples by the Washington State Public Health Laboratory. Another set of samples was also analyzed with the test kit by medical staff at an eastern Washington clinic. Triplicate measurements with the test kit had a 3.3% average coefficient of variation (CV) for plasma cholinesterase (PChE), and a 3.5% average CV for erythrocyte cholinesterase (AChE) measurements. The kit's PChE measurements were similar to PHL measurements (average ratio of 0.98) when performed in the laboratory, but had a tendency to underestimate activity when used in the clinic setting (average ratio of 0.87). The kit systematically overestimated AChE activity by 42-48% relative to the PHL measurements, regardless of where the samples were analyzed. This easy-to-use test kit appeared to be a viable method for clinic-based PChE measurements, but was less consistent for AChE measurements performed in the clinic. Absolute measurements with the kit need to be evaluated carefully relative to standardized methods. (c) 2008 Wiley-Liss, Inc.

  3. Burnout during nursing education predicts lower occupational preparedness and future clinical performance: a longitudinal study.

    Science.gov (United States)

    Rudman, Ann; Gustavsson, J Petter

    2012-08-01

    Early-career burnout among nurses can influence health and professional development, as well as quality of care. However, the prospective occupational consequences of study burnout have not previously been investigated in a national sample using a longitudinal design. To prospectively monitor study burnout for a national sample of nursing students during their years in higher education and at follow-up 1 year post graduation. Further, to relate the possible development of study burnout to prospective health and life outcomes, as well as student and occupational outcomes. A longitudinal cohort of Swedish nursing students (within the population-based LANE (Longitudinal Analysis of Nursing Education/Entry) study) from all sites of education in Sweden was surveyed annually. Data were collected at four points in time over 4 years: three times during higher education and 1 year post graduation. : A longitudinal sample of 1702 respondents was prospectively followed from late autumn 2002 to spring 2006. Mean level changes of study burnout (as measured by the Oldenburg Burnout Inventory, i.e. the Exhaustion and Disengagement subscales) across time, as well as prospective effects of baseline study burnout and changes in study burnout levels, were estimated using Latent Growth Curve Modeling. An increase in study burnout (from 30% to 41%) across 3 years in higher education was found, and levels of both Exhaustion and Disengagement increased significantly across the years in education (pdevelopment of study burnout, predicted lower levels of in-class learner engagement and occupational preparedness in the final year. At follow-up 1 year post graduation, earlier development of study burnout was related to lower mastery of occupational tasks, less research utilization in everyday clinical practice and higher turnover intentions. The results suggest that study burnout may have interfered with learning and psychological well-being. Aspects related to work skills and intention to

  4. GA(2)LEN skin test study II: clinical relevance of inhalant allergen sensitizations in Europe

    DEFF Research Database (Denmark)

    Burbach, G J; Heinzerling, L M; Edenharter, G

    2009-01-01

    BACKGROUND: Skin prick testing is the standard for diagnosing IgE-mediated allergies. A positive skin prick reaction, however, does not always correlate with clinical symptoms. A large database from a Global Asthma and Allergy European Network (GA(2)LEN) study with data on clinical relevance was ...... the clinical relevance of positive skin prick tests and calls for further studies, which may, ultimately, help increase the positive predictive value of allergy testing.......BACKGROUND: Skin prick testing is the standard for diagnosing IgE-mediated allergies. A positive skin prick reaction, however, does not always correlate with clinical symptoms. A large database from a Global Asthma and Allergy European Network (GA(2)LEN) study with data on clinical relevance...... was used to determine the clinical relevance of sensitizations against the 18 most frequent inhalant allergens in Europe. The study population consisted of patients referred to one of the 17 allergy centres in 14 European countries (n = 3034, median age = 33 years). The aim of the study was to assess...

  5. Clinical evaluation of a 51Cr-labeled red blood cell survival test for in vivo blood compatibility testing

    International Nuclear Information System (INIS)

    Pineda, A.A.; Dharkar, D.D.; Wahner, H.W.

    1984-01-01

    Modified red blood cell survival studies with use of 51Cr were performed in three groups of subjects. Group 1 consisted of normal subjects who were given labeled autologous blood, group 2 were subjects in need of blood transfusions and given labeled ABO and Rh crossmatch-compatible blood, and group 3 were patients in need of blood transfusion but in whom problems arose in finding compatible blood. The results of the studies suggest that for patients with blood compatibility problems, normal red blood cell survival values at 1 hour do not exclude the possibility of severe hemolysis 24 hours later. Thus, if a 1-hour test result is normal, the procedure should be extended routinely to 24 hours. Moreover, the test can be used to evaluate the clinical importance of antibodies. We showed that anti-Yka and anti-Lan were clinically significant, but high-titer, low-avidity antibodies, anti-Kna, anti-I, and anti-HI were clinically insignificant in the cases studied. This finding emphasizes the importance of an in vivo test for the final compatibility evaluation in complicated blood replacement problems

  6. Clinical diagnosis of Graves’ or non-Graves’ hyperthyroidism compared to TSH receptor antibody test

    Directory of Open Access Journals (Sweden)

    Lauren Bell

    2018-04-01

    Full Text Available Background: TSH receptor antibody (TRAb is considered the gold standard diagnostic test for the autoimmunity of Graves’ disease (GD, which is commonly diagnosed clinically. Aim: To evaluate the true positive (sensitivity and true negative (specificity rates of clinical diagnosis of GD or non-GD hyperthyroidism compared to the TRAb test. Setting: University teaching hospital in North West England. Participants: Patients in the Endocrinology service who had a TRAb measurement between December 2009 and October 2015. Methods: Electronic patient records were studied retrospectively for a pre-TRAb clinical diagnosis of GD or non-GD hyperthyroidism. We examined descriptive statistics and binary classification tests; Fisher exact test was used to analyse contingency tables. Results: We identified 316 patients with a mean age of 45 (range, 17–89 years; 247 (78% were women. Compared to the TRAb result, clinical diagnosis had a sensitivity of 88%, specificity 66%, positive predictive value 72%, negative predictive value 84%, false negative rate 12%, false positive rate 34%, positive likelihood ratio 2.6 and negative likelihood ratio 0.2 (P < 0.0001. Conclusions: Clinicians were liable to both over- and under-diagnose GD. The TRAb test can help reduce the number of incorrect or unknown diagnoses in the initial clinical assessment of patients presenting with hyperthyroidism.

  7. American Society of Clinical Oncology Obesity Initiative: Rationale, Progress, and Future Directions.

    Science.gov (United States)

    Ligibel, Jennifer A; Wollins, Dana

    2016-12-10

    Obesity is increasingly being linked to the risk of developing and dying from cancer. In recognition of the growing contribution of obesity to cancer risk and outcomes, ASCO made obesity and cancer one of its core initiatives in 2014. The goals of this initiative included raising awareness of the relationship between obesity and cancer, providing tools and resources to oncology providers and patients to help encourage conversations regarding weight management in cancer survivors, fostering a robust research agenda, and advocating for access to evidence-based weight management programs for cancer survivors. Efforts to date have included developing patient and provider toolkits focused on weight management and physical activity, publishing a policy statement outlining ASCO's initiatives in this area, and hosting a summit focused on obesity research in cancer populations. As ASCO has defined its priorities in the area of obesity and cancer, it has become increasingly clear that obesity is a problem that extends far beyond its impact on cancer risk and outcomes. Many groups, including those focused on heart disease, diabetes, and endocrinology, have been developing, testing, and implementing obesity prevention and treatment strategies for years. As ASCO moves forward with its obesity initiative, the next steps will focus on forging collaboration with groups working on obesity-related initiatives both within and outside of the field of cancer to learn from their efforts and to partner with them on efforts to increase the education of medical professionals; raising awareness in lay populations regarding the negative health consequences of obesity and effective strategies to foster weight loss; developing collaborative research initiatives; and working together to advocate for the societal changes that will be needed to combat the obesity epidemic in the United States and beyond.

  8. 26 CFR 1.28-1 - Credit for clinical testing expenses for certain drugs for rare diseases or conditions.

    Science.gov (United States)

    2010-04-01

    ...) Definition of “carried out under” section 505(i). Human clinical testing is not carried out under section 505... disregarded. (B) In-house research expenses. If one member of a group conducts clinical testing on behalf of... expense. For purposes of determining whether the in-house research for that work is clinical testing, the...

  9. Subscale Flight Testing for Aircraft Loss of Control: Accomplishments and Future Directions

    Science.gov (United States)

    Cox, David E.; Cunningham, Kevin; Jordan, Thomas L.

    2012-01-01

    Subscale flight-testing provides a means to validate both dynamic models and mitigation technologies in the high-risk flight conditions associated with aircraft loss of control. The Airborne Subscale Transport Aircraft Research (AirSTAR) facility was designed to be a flexible and efficient research facility to address this type of flight-testing. Over the last several years (2009-2011) it has been used to perform 58 research flights with an unmanned, remotely-piloted, dynamically-scaled airplane. This paper will present an overview of the facility and its architecture and summarize the experimental data collected. All flights to date have been conducted within visual range of a safety observer. Current plans for the facility include expanding the test volume to altitudes and distances well beyond visual range. The architecture and instrumentation changes associated with this upgrade will also be presented.

  10. Safeguards Licensing Aspects of a Future Gen IV Test Facility - a Case Study

    International Nuclear Information System (INIS)

    Lindell, M. Aberg; Grape, S.; Hakansson, A.; Svaerd, S. Jacobsson

    2010-01-01

    The scope of this study covers safeguards licensing aspects of a possible future Gen IV demonstration facility. As a basis for the investigation, the facility was assumed to be located in Sweden, comprising a lead-cooled fast reactor and a reprocessing plant with fuel fabrication. The aim has been to identify safeguards requirements that may be set by the IAEA and the Swedish Radiation Safety Authority, and also to suggest how the safeguards system could be implemented in practice. The changed usage and handling of nuclear fuel, as compared to that of today, has been examined in order to determine how today's safeguards measures can be modified and extended to meet the needs of the demonstration facility. This work is part of GENIUS, the Swedish Gen IV research and development programme, which emphasizes lead-cooled fast reactors. (author)

  11. Predictive value of 14CO2 breath tests for clinical use of 13CO2 breath tests

    International Nuclear Information System (INIS)

    Glaubitt, D.M.H.

    1975-01-01

    The knowledge of the efficiency of 14 CO 2 breath tests makes possible the comparison of the efficiency of analogous tests using the stable isotope 13 C. 14 CO 2 exhalation studies render overall information. After parenteral administration of a 14 C labeled substrate, 14 CO 2 breath tests permit insight into the metabolism of the 14 C substrate and the associated intermediary metabolism. If the 14 C substrate is given orally or by intraduodenal instillation, 14 CO 2 breath tests supply information not only about gastrointenstinal absorption and digestion but also about the intermediary metabolism yielding 14 CO 2 , after the administered substrate or its degradation products have been absorbed in the gastrointestinal tract. The fraction of 14 CO 2 arising from absorption, digestion and intermediary metabolism can be estimated only by additional methods. 14 CO 2 breath tests are unable to delineate single metabolic reactions involved in the formation of carbon dioxide. Under these considerations the clinical application of 14 CO 2 breath tests may provide diagnostically useful results, especially in internal medicine and surgery. The tests are suitable for intraindividual assessment of the course of a disease and of therapeutic effects. They may be important in the research of the metabolism of 14 C labeled substrates

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

    Science.gov (United States)

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

    2017-05-01

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

  13. Clinical tests to diagnose lumbar spondylolysis and spondylolisthesis: A systematic review.

    Science.gov (United States)

    Alqarni, Abdullah M; Schneiders, Anthony G; Cook, Chad E; Hendrick, Paul A

    2015-08-01

    The aim of this paper was to systematically review the diagnostic ability of clinical tests to detect lumbar spondylolysis and spondylolisthesis. A systematic literature search of six databases, with no language restrictions, from 1950 to 2014 was concluded on February 1, 2014. Clinical tests were required to be compared against imaging reference standards and report, or allow computation, of common diagnostic values. The systematic search yielded a total of 5164 articles with 57 retained for full-text examination, from which 4 met the full inclusion criteria for the review. Study heterogeneity precluded a meta-analysis of included studies. Fifteen different clinical tests were evaluated for their ability to diagnose lumbar spondylolisthesis and one test for its ability to diagnose lumbar spondylolysis. The one-legged hyperextension test demonstrated low to moderate sensitivity (50%-73%) and low specificity (17%-32%) to diagnose lumbar spondylolysis, while the lumbar spinous process palpation test was the optimal diagnostic test for lumbar spondylolisthesis; returning high specificity (87%-100%) and moderate to high sensitivity (60-88) values. Lumbar spondylolysis and spondylolisthesis are identifiable causes of LBP in athletes. There appears to be utility to lumbar spinous process palpation for the diagnosis of lumbar spondylolisthesis, however the one-legged hyperextension test has virtually no value in diagnosing patients with spondylolysis. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. [Clinical research XVII. χ(2) test, from the expected to the observed].

    Science.gov (United States)

    Rivas-Ruiz, Rodolfo; Castelán-Martínez, Osvaldo D; Pérez, Marcela; Talavera, Juan O

    2013-01-01

    When you want to show if there is a statistical association or differences between categorical variables, it is recommended to use the χ(2) test. This nonparametric test is one of the most used in clinical research; it contrasts nominal or ordinal qualitative variables that are observed in clinical practice. This test calculates the p value that determines whether differences between groups are real or due to chance. The χ(2) test is the basis of other tests to analyze qualitative ordinal variables as χ(2) for linear trend, which compares three groups with two outcomes or McNemar test, which contrasts two related samples (a before and afterward comparison) or Mantel-Haenszel χ(2), which controls for potential confounding variables. When using small samples, where the expected results are less than 5, Fisher's exact test should be used. These tests are the most widely used in the medical literature; however, they do not give us the magnitude or the direction of the event and a proper interpretation that requires clinical judgment is needed.

  15. HIV-1 Immunogen: an overview of almost 30 years of clinical testing of a candidate therapeutic vaccine.

    Science.gov (United States)

    Graziani, Gina M; Angel, Jonathan B

    2016-07-01

    Although current antiretroviral therapy (ART) has transformed HIV infection into a chronic, manageable disease, ART does not cure HIV infection. Furthermore, the majority of the world's infected individuals live in resource-limited countries in which access to ART is limited. Thus, the development of an effective therapeutic HIV vaccine would be an invaluable treatment alternative. Developed by the late Dr. Jonas Salk, HIV-1 Immunogen (Remune®) is a candidate therapeutic vaccine that has been studied in thousands of HIV-infected individuals in more than a dozen clinical trials during almost three decades. This Drug Evaluation, which summarizes the results of these trials that have shown the vaccine to be safe and immunogenic, also discusses the contradictory and controversial conclusions drawn from the phases 2, 2/3 and 3 trials that assessed the clinical efficacy of this vaccine. Given the lack of unequivocal clinical benefits of HIV-1 Immunogen despite almost 30 years of extensive testing, it does not appear, in our view, that this vaccine is a clinically effective immunotherapy. However, inclusion of this vaccine in the newly proposed 'Kick/Shock and Kill' strategy for HIV eradication, or use as a prophylactic vaccine, could be considered for future trials.

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

    Science.gov (United States)

    Witry, Matthew J; Doucette, William R

    2009-01-01

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

  17. Fast Flux Test Facility interim examination and maintenance cell - past, present, and future

    International Nuclear Information System (INIS)

    Vincent, J.R.

    1990-01-01

    The Fast Flux Test Facility (FFTF) interim examination and maintenance (IEM) cell was designed to perform interim examination and/or disassembly of experimental core components for final analysis elsewhere, as well as maintenance of sodium-wetted or neutron-activated internal reactor parts and plant support hardware. The first 10 yr of operation were mainly devoted to the disassembly and examination of core component test assemblies. While some maintenance was performed on reactor support equipment, such as the closed-loop ex-vessel machine (CLEM) sodium-wetted grapple, 90% of IEM cell availability has been devoted to core component tests. Some test assemblies originally considered for processing in the IEM cell have not been irradiated; others, not originally planned, have been designed, irradiated, and processed. While no major reactor equipment has required remote repair or maintenance, the IEM cell has served as the remote repair facility for its own in-cell equipment, and several innovative remote repairs have been accomplished and are described

  18. Integrated Electrical and Thermal Grid Facility - Testing of Future Microgrid Technologies

    Directory of Open Access Journals (Sweden)

    Sundar Raj Thangavelu

    2015-09-01

    Full Text Available This paper describes the Experimental Power Grid Centre (EPGC microgrid test facility, which was developed to enable research, development and testing for a wide range of distributed generation and microgrid technologies. The EPGC microgrid facility comprises a integrated electrical and thermal grid with a flexible and configurable architecture, and includes various distributed energy resources and emulators, such as generators, renewable, energy storage technologies and programmable load banks. The integrated thermal grid provides an opportunity to harness waste heat produced by the generators for combined heat, power and cooling applications, and support research in optimization of combined electrical-thermal systems. Several case studies are presented to demonstrate the testing of different control and operation strategies for storage systems in grid-connected and islanded microgrids. One of the case studies also demonstrates an integrated thermal grid to convert waste heat to useful energy, which thus far resulted in a higher combined energy efficiency. Experiment results confirm that the facility enables testing and evaluation of grid technologies and practical problems that may not be apparent in a computer simulated environment.

  19. Alternative (non-animal) methods for cosmetics testing: current status and future prospects-2010

    DEFF Research Database (Denmark)

    Adler, Sarah; Basketter, David; Creton, Stuart

    2011-01-01

    The 7th amendment to the EU Cosmetics Directive prohibits to put animal-tested cosmetics on the market in Europe after 2013. In that context, the European Commission invited stakeholder bodies (industry, non-governmental organisations, EU Member States, and the Commission's Scientific Committee...

  20. A New Clinical Pain Knowledge Test for Nurses: Development and Psychometric Evaluation.

    Science.gov (United States)

    Bernhofer, Esther I; St Marie, Barbara; Bena, James F

    2017-08-01

    All nurses care for patients with pain, and pain management knowledge and attitude surveys for nurses have been around since 1987. However, no validated knowledge test exists to measure postlicensure clinicians' knowledge of the core competencies of pain management in current complex patient populations. To develop and test the psychometric properties of an instrument designed to measure pain management knowledge of postlicensure nurses. Psychometric instrument validation. Four large Midwestern U.S. hospitals. Registered nurses employed full time and part time August 2015 to April 2016, aged M = 43.25 years; time as RN, M = 16.13 years. Prospective survey design using e-mail to invite nurses to take an electronic multiple choice pain knowledge test. Content validity of initial 36-item test "very good" (95.1% agreement). Completed tests that met analysis criteria, N = 747. Mean initial test score, 69.4% correct (range 27.8-97.2). After revision/removal of 13 unacceptable questions, mean test score was 50.4% correct (range 8.7-82.6). Initial test item percent difficulty range was 15.2%-98.1%; discrimination values range, 0.03-0.50; final test item percent difficulty range, 17.6%-91.1%, discrimination values range, -0.04 to 1.04. Split-half reliability final test was 0.66. A high decision consistency reliability was identified, with test cut-score of 75%. The final 23-item Clinical Pain Knowledge Test has acceptable discrimination, difficulty, decision consistency, reliability, and validity in the general clinical inpatient nurse population. This instrument will be useful in assessing pain management knowledge of clinical nurses to determine gaps in education, evaluate knowledge after pain management education, and measure research outcomes. Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  1. Testing a model of research intention among U.K. clinical psychologists: a logistic regression analysis.

    Science.gov (United States)

    Eke, Gemma; Holttum, Sue; Hayward, Mark

    2012-03-01

    Previous research highlights barriers to clinical psychologists conducting research, but has rarely examined U.K. clinical psychologists. The study investigated U.K. clinical psychologists' self-reported research output and tested part of a theoretical model of factors influencing their intention to conduct research. Questionnaires were mailed to 1,300 U.K. clinical psychologists. Three hundred and seventy-four questionnaires were returned (29% response-rate). This study replicated in a U.K. sample the finding that the modal number of publications was zero, highlighted in a number of U.K. and U.S. studies. Research intention was bimodally distributed, and logistic regression classified 78% of cases successfully. Outcome expectations, perceived behavioral control and normative beliefs mediated between research training environment and intention. Further research should explore how research is negotiated in clinical roles, and this issue should be incorporated into prequalification training. © 2012 Wiley Periodicals, Inc.

  2. Large-scale academic achievement testing of deaf and hard-of-hearing students: past, present, and future.

    Science.gov (United States)

    Qi, Sen; Mitchell, Ross E

    2012-01-01

    The first large-scale, nationwide academic achievement testing program using Stanford Achievement Test (Stanford) for deaf and hard-of-hearing children in the United States started in 1969. Over the past three decades, the Stanford has served as a benchmark in the field of deaf education for assessing student academic achievement. However, the validity and reliability of using the Stanford for this special student population still require extensive scrutiny. Recent shifts in educational policy environment, which require that schools enable all children to achieve proficiency through accountability testing, warrants a close examination of the adequacy and relevance of the current large-scale testing of deaf and hard-of-hearing students. This study has three objectives: (a) it will summarize the historical data over the last three decades to indicate trends in academic achievement for this special population, (b) it will analyze the current federal laws and regulations related to educational testing and special education, thereby identifying gaps between policy and practice in the field, especially identifying the limitations of current testing programs in assessing what deaf and hard-of-hearing students know, and (c) it will offer some insights and suggestions for future testing programs for deaf and hard-of-hearing students.

  3. The State of Cell Blocks and Ancillary Testing: Past, Present, and Future.

    Science.gov (United States)

    Saqi, Anjali

    2016-12-01

    Cell blocks are an integral part of cytology, but their utility is recognized probably more now than ever before, largely owing to the significant role they play in ancillary testing, particularly molecular diagnostics. Modifications to improve the cell block method initially introduced more than a century ago have been made over the years. Though their value is acknowledged and they are widely used across laboratories, cell block preparations are not standardized and results of ancillary testing performed on them are inconsistent. This article reviews the state of cell blocks-summarizes the more common, currently available and used methods and their corresponding advantages and shortcomings, outlines the role of alternative techniques (eg, smears), and proposes methods to optimize results.

  4. How to diagnose neuropathic pain? The contribution from clinical examination, pain questionnaires and diagnostic tests.

    Science.gov (United States)

    La Cesa, S; Tamburin, S; Tugnoli, V; Sandrini, G; Paolucci, S; Lacerenza, M; Marchettini, P; Cruccu, G; Truini, A

    2015-12-01

    Patients with peripheral and central nervous system diseases may suffer from different types of pain, namely nociceptive, neuropathic and mixed pain. Although in some cases, the distinction between these types of pain is clinically evident, yet in some patients an accurate differential diagnosis requires dedicated clinical examination, screening questionnaires and diagnostic techniques some of which are available only in specialized pain centres. This review briefly addresses the currently agreed definitions of the different types of pain and shows how clinical examination, pain questionnaires and diagnostic tests can help the clinicians in identifying neuropathic pain.

  5. Testing Quality and Metrics for the LHC Magnet Powering System throughout Past and Future Commissioning

    OpenAIRE

    Anderson, D; Audrain, M; Charifoulline, Z; Dragu, M; Fuchsberger, K; Garnier, JC; Gorzawski, AA; Koza, M; Krol, K; Rowan, S; Stamos, K; Zerlauth, M

    2014-01-01

    The LHC magnet powering system is composed of thousands of individual components to assure a safe operation when operating with stored energies as high as 10GJ in the superconducting LHC magnets. Each of these components has to be thoroughly commissioned following interventions and machine shutdown periods to assure their protection function in case of powering failures. As well as having dependable tracking of test executions it is vital that the executed commissioning steps and applied anal...

  6. Radiation tests on service electronics for future multi TeV detectors

    International Nuclear Information System (INIS)

    Larsen, H.; Schoenbacher, H.; Massam, T.; Wulf, F.

    1993-01-01

    Irradiation tests of a number of essential components for use in the service electronics of the Leading Proton Spectrometer (LPS) have been undertaken. The components are simple medium-scale integrated circuits such as Transistor Transistor Logic (TTL) buffers from the Advanced Low-power Schottky (ALS), Low-power Schottky (LS), and Fast (F) families, optocouplers, and balanced line drivers and receivers. More complex circuits, such as a Fuse Programmable Array Logic chip, programmed as a 6-bit counter, and a complete switched-mode power supply unit were also tested. Further, monolithic voltage regulators with an output potential of 5 V, and 10 MHz quartz oscillator hybrids were tested. The different radiation fields were X-rays (80 keV), 60 Co gamma rays, electrons (2.5 MeV), and a high-energy proton accelerator environment. Depending on the device degradation, the maximum dose was up to 0.8 MGy. It is shown that the simple choice of circuit family can achieve a hardness level of nearly 1 MGy(Si), provided that one is prepared to make some sacrifices in power consumption, and in speed. It has been found that this radiation hardness can be reached with LS technology. The maximum level of about 1 MGy(Si) was obtained with 2.5 MeV electrons, which is equivalent to a 1 MeV neutron fluence of the order of 6x10 13 n/cm 2 . (orig.)

  7. Genetic testing to predict sudden cardiac death: current perspectives and future goals

    Directory of Open Access Journals (Sweden)

    Silvia G. Priori

    2014-01-01

    Full Text Available It is known that monogenic traits may predispose young and otherwise healthy individuals to die suddenly. Diseases such as Long QT Syndrome, Brugada Syndrome and Arrhythmogenic Right Ventricular Cardiomyopathy are well known causes of arrhythmic death in young individuals. For several years the concept of “genetic predisposition” to sudden cardiac death has been limited to these uncommon diseases. In the last few years clinical data have supported the view that risk of dying suddenly may cluster in families, supporting the hypothesis of a genetic component for sudden cardiac death. In this review I will try to provide an overview of current knowledge about genetics of sudden death. I will approach this topic by discussing first where we stand in the use of genetics for risk stratification and therapy selection in monogenic diseases and I will then move to discuss the contribution of genetics to patient profiling in acquired cardiovascular diseases.

  8. Radiation Tests of Real-Sized Prototype RPCs for the Future CMS RPC Upscope

    CERN Document Server

    Lee, K.S.; Choi, S.Y.; Hong, B.; Go, Y.; Kang, M.H.; Lim, J.H.; Park, S.K.; Cimmino, A.; Crucy, S.; Fagot, A.; Gul, M.; Rios, A.A.O.; Tytgat, M.; Zaganidis, N.; Aly, S.; Assran, Y.; Radi, A.; Sayed, A.; Singh, G.; Abbrescia, M.; Iaselli, G.; Maggi, M.; Pugliese, G.; Verwilligen, P.; Doninck, W.van; Colafranceschi, S.; Sharma, A.; Benussi, L.; Bianco, S.; Piccolo, D.; Primavera, F.; Bhatnagar, V.; Kumarl, R.; Metha, A.; Singh, J.; Ahmad, A.; Ahmad, M.; Ahmed, W.; Asghar, M.I.; Awan, I.M.; Hassan, Q.; Hoorani, H.; Khan, W.A.; Khurshid, T.; Muhammad, S.; Shah, M.A.; Shahzad, H.; Kim, M.S.; Goutzvitz, M.; Grenier, G.; Lagarde, F.; Laktineh, I.B.; Carpinteyro Bernardino, S.; Uribe Estrada, C.; Pedraza, I.; Severiano, C.B.; Carrillo Moreno, S.; Vazquez Valencia, F.; Pant, L.M.; Buontempo, S.; Cavallo, N.; Esposito, M.; Fabozzi, F.; Lanza, G.; Lista, L.; Meola, S.; Merola, M.; Orso, I.; Paolucci, P.; Thyssen, F.; Braghieri, A.; Magnani, A.; Montagna, P.; Riccardi, C.; Salvini, P.; Vai, I.; Vitulo, P.; Ban, Y.; Qian, S.J.; Choi, M.; Choi, Y.; Goh, J.; Kim, D.; Aleksandrov, A.; Hadjiiska, R.; Iaydjiev, P.; Rodozov, M.; Stoykova, S.; Sultanov, G.; Vutova, M.; Dimitrov, A.; Litov, L.; Pavlov, B.; Petkov, P.; Lomidze, D.; Avila, C.; Cabrera, A.; Sanabria, J.C.; Crotty, I.; Vaitkus, J.

    2016-08-10

    We report on a systematic study of double-gap and four-gap phenolic resistive plate chambers (RPCs) for future high-{\\eta} RPC triggers in the CMS. In the present study, we constructed real-sized double-gap and four-gap RPCs with gap thicknesses of 1.6 and 0.8 mm, respectively, with 2-mm-thick phenolic high-pressure-laminated (HPL) plates. We examined the prototype RPCs for cosmic rays and 100 GeV muons provided by the SPS H4 beam line at CERN. We applied maximum gamma rates of 1.5 kHz cm-2 provided by 137Cs sources at Korea University and the GIF++ irradiation facility installed at the SPS H4 beam line to examine the rate capabilities of the prototype RPCs. In contrast to the case of the four-gap RPCs, we found the relatively high threshold was conducive to effectively suppressing the rapid increase of strip cluster sizes of muon hits with high voltage, especially when measuring the narrow-pitch strips. The gamma-induced currents drawn in the four-gap RPC were about one-fourth of those drawn in the double-ga...

  9. What's next? Perspectives and future needs of cervical screening in Europe in the era of molecular testing and vaccination

    DEFF Research Database (Denmark)

    Lynge, Elsebeth; Antilla, Ahti; Arbyn, Marc

    2009-01-01

    controlled trials have found HPV-testing to increase the detection rate of cervical intraepithelial neoplasia grade 2+, CIN2+, compared with cytology. Two studies found a decreased detection rate of CIN3+ in the HPV-testing arm at the subsequent screening. Randomised controlled trials found that women......AIM: To outline the perspectives for future control of cervical cancer in Europe. METHODS: Review of current status for major cervical cancer control tools. The review was based on PubMed searches for cervical cancer prevention, Human Papillomavirus, HPV-test, HPV-vaccination, and treatment...... with large loop excision of the transformation zone, LLETZ. RESULTS: Recent studies suggest that condom use offers some but not complete protection against HPV-infection. High quality cytology screening with good population coverage reduces the incidence and mortality of cervical cancer. Randomised...

  10. The predictive validity of the BioMedical Admissions Test for pre-clinical examination performance.

    Science.gov (United States)

    Emery, Joanne L; Bell, John F

    2009-06-01

    Some medical courses in the UK have many more applicants than places and almost all applicants have the highest possible previous and predicted examination grades. The BioMedical Admissions Test (BMAT) was designed to assist in the student selection process specifically for a number of 'traditional' medical courses with clear pre-clinical and clinical phases and a strong focus on science teaching in the early years. It is intended to supplement the information provided by examination results, interviews and personal statements. This paper reports on the predictive validity of the BMAT and its predecessor, the Medical and Veterinary Admissions Test. Results from the earliest 4 years of the test (2000-2003) were matched to the pre-clinical examination results of those accepted onto the medical course at the University of Cambridge. Correlation and logistic regression analyses were performed for each cohort. Section 2 of the test ('Scientific Knowledge') correlated more strongly with examination marks than did Section 1 ('Aptitude and Skills'). It also had a stronger relationship with the probability of achieving the highest examination class. The BMAT and its predecessor demonstrate predictive validity for the pre-clinical years of the medical course at the University of Cambridge. The test identifies important differences in skills and knowledge between candidates, not shown by their previous attainment, which predict their examination performance. It is thus a valid source of additional admissions information for medical courses with a strong scientific emphasis when previous attainment is very high.

  11. Interventions to improve recruitment and retention in clinical trials: a survey and workshop to assess current practice and future priorities.

    Science.gov (United States)

    Bower, Peter; Brueton, Valerie; Gamble, Carrol; Treweek, Shaun; Smith, Catrin Tudur; Young, Bridget; Williamson, Paula

    2014-10-16

    Despite significant investment in infrastructure many trials continue to face challenges in recruitment and retention. We argue that insufficient focus has been placed on the development and testing of recruitment and retention interventions. In this current paper, we summarize existing reviews about interventions to improve recruitment and retention. We report survey data from Clinical Trials Units in the United Kingdom to indicate the range of interventions used by these units to encourage recruitment and retention. We present the views of participants in a recent workshop and a priority list of recruitment interventions for evaluation (determined by voting among workshop participants). We also discuss wider issues concerning the testing of recruitment interventions. Methods used to encourage recruitment and retention were categorized as: patient contact, patient convenience, support for recruiters, monitoring and systems, incentives, design, resources, and human factors. Interventions felt to merit investigation by respondents fell into three categories: training site staff, communication with patients, and incentives. Significant resources continue to be invested into clinical trials and other high quality studies, but recruitment remains a significant challenge. Adoption of innovative methods to develop, test, and implement recruitment interventions are required.

  12. Linkages among commodity futures prices in the recent financial crisis: An application of cointegration tests with a structural break

    Directory of Open Access Journals (Sweden)

    Yoichi Tsuchiya

    2015-12-01

    Full Text Available In this study, we investigate the existence of long-term co-movements among the prices of commodity futures contracts. We use a cointegration test, which accounts for the presence of a structural break. We show that while there is a long-term relationship among agricultural and among non-agricultural commodity futures prices when a structural break is taken into account, there is no such relationship without allowing for a structural break. We also show that these break points, in fact, occur a few months before the recent global financial crisis. Although the previous literature broadly casts doubt on such price co-movements, our results confirm that market performance improved during the sample period.

  13. Spontaneous C P -violation in the simplest little Higgs model and its future collider tests: The scalar sector

    Science.gov (United States)

    Mao, Ying-nan

    2018-04-01

    We propose spontaneous C P violation in the simplest little Higgs model. In this model, the pseudoscalar field can acquire a nonzero vacuum expectation value. This leads to a mixing between the two scalars with different C P charge, which means that spontaneous C P violation occurs. It is also a connection between the composite Higgs mechanism and C P violation. Facing the experimental constraints, the model is still viable for both scenarios in which the extra scalar appears below or around the electroweak scale. We also discuss the future collider tests of C P violation in the scalar sector through measuring h2Z Z and h1h2Z' vertices (see the definitions of the particles in the text), which provide new motivations for future e+e- and p p colliders. This also shows the importance of the vector-vector-scalar- and vector-scalar-scalar-type vertices in discovering C P -violation effects in the scalar sector.

  14. Point-of-care testing for chlamydia and gonorrhoea: implications for clinical practice.

    Directory of Open Access Journals (Sweden)

    Lisa Natoli

    Full Text Available Point-of-care (POC testing for chlamydia (CT and gonorrhoea (NG offers a new approach to the diagnosis and management of these sexually transmitted infections (STIs in remote Australian communities and other similar settings. Diagnosis of STIs in remote communities is typically symptom driven, and for those who are asymptomatic, treatment is generally delayed until specimens can be transported to the reference laboratory, results returned and the patient recalled. The objective of this study was to explore the clinical implications of using CT/NG POC tests in routine clinical care in remote settings.In-depth qualitative interviews were conducted with a purposively selected group of 18 key informants with a range of sexual health and laboratory expertise.Participants highlighted the potential impact POC testing would have on different stages of the current STI management pathway in remote Aboriginal communities and how the pathway would change. They identified implications for offering a POC test, specimen collection, conducting the POC test, syndromic management of STIs, pelvic inflammatory disease diagnosis and management, interpretation and delivery of POC results, provision of treatment, contact tracing, management of client flow and wait time, and re-testing at 3 months after infection.The introduction of POC testing to improve STI service delivery requires careful consideration of both its advantages and limitations. The findings of this study will inform protocols for the implementation of CT/NG POC testing, and also STI testing and management guidelines.

  15. Point-of-Care Testing for Chlamydia and Gonorrhoea: Implications for Clinical Practice

    Science.gov (United States)

    Natoli, Lisa; Maher, Lisa; Shephard, Mark; Hengel, Belinda; Tangey, Annie; Badman, Steven G.; Ward, James; Guy, Rebecca J.

    2014-01-01

    Objectives Point-of-care (POC) testing for chlamydia (CT) and gonorrhoea (NG) offers a new approach to the diagnosis and management of these sexually transmitted infections (STIs) in remote Australian communities and other similar settings. Diagnosis of STIs in remote communities is typically symptom driven, and for those who are asymptomatic, treatment is generally delayed until specimens can be transported to the reference laboratory, results returned and the patient recalled. The objective of this study was to explore the clinical implications of using CT/NG POC tests in routine clinical care in remote settings. Methods In-depth qualitative interviews were conducted with a purposively selected group of 18 key informants with a range of sexual health and laboratory expertise. Results Participants highlighted the potential impact POC testing would have on different stages of the current STI management pathway in remote Aboriginal communities and how the pathway would change. They identified implications for offering a POC test, specimen collection, conducting the POC test, syndromic management of STIs, pelvic inflammatory disease diagnosis and management, interpretation and delivery of POC results, provision of treatment, contact tracing, management of client flow and wait time, and re-testing at 3 months after infection. Conclusions The introduction of POC testing to improve STI service delivery requires careful consideration of both its advantages and limitations. The findings of this study will inform protocols for the implementation of CT/NG POC testing, and also STI testing and management guidelines. PMID:24956111

  16. Performance Validity Testing in Neuropsychology: Scientific Basis and Clinical Application-A Brief Review.

    Science.gov (United States)

    Greher, Michael R; Wodushek, Thomas R

    2017-03-01

    Performance validity testing refers to neuropsychologists' methodology for determining whether neuropsychological test performances completed in the course of an evaluation are valid (ie, the results of true neurocognitive function) or invalid (ie, overly impacted by the patient's effort/engagement in testing). This determination relies upon the use of either standalone tests designed for this sole purpose, or specific scores/indicators embedded within traditional neuropsychological measures that have demonstrated this utility. In response to a greater appreciation for the critical role that performance validity issues play in neuropsychological testing and the need to measure this variable to the best of our ability, the scientific base for performance validity testing has expanded greatly over the last 20 to 30 years. As such, the majority of current day neuropsychologists in the United States use a variety of measures for the purpose of performance validity testing as part of everyday forensic and clinical practice and address this issue directly in their evaluations. The following is the first article of a 2-part series that will address the evolution of performance validity testing in the field of neuropsychology, both in terms of the science as well as the clinical application of this measurement technique. The second article of this series will review performance validity tests in terms of methods for development of these measures, and maximizing of diagnostic accuracy.

  17. A Window Into Clinical Next-Generation Sequencing-Based Oncology Testing Practices.

    Science.gov (United States)

    Nagarajan, Rakesh; Bartley, Angela N; Bridge, Julia A; Jennings, Lawrence J; Kamel-Reid, Suzanne; Kim, Annette; Lazar, Alexander J; Lindeman, Neal I; Moncur, Joel; Rai, Alex J; Routbort, Mark J; Vasalos, Patricia; Merker, Jason D

    2017-12-01

    - Detection of acquired variants in cancer is a paradigm of precision medicine, yet little has been reported about clinical laboratory practices across a broad range of laboratories. - To use College of American Pathologists proficiency testing survey results to report on the results from surveys on next-generation sequencing-based oncology testing practices. - College of American Pathologists proficiency testing survey results from more than 250 laboratories currently performing molecular oncology testing were used to determine laboratory trends in next-generation sequencing-based oncology testing. - These presented data provide key information about the number of laboratories that currently offer or are planning to offer next-generation sequencing-based oncology testing. Furthermore, we present data from 60 laboratories performing next-generation sequencing-based oncology testing regarding specimen requirements and assay characteristics. The findings indicate that most laboratories are performing tumor-only targeted sequencing to detect single-nucleotide variants and small insertions and deletions, using desktop sequencers and predesigned commercial kits. Despite these trends, a diversity of approaches to testing exists. - This information should be useful to further inform a variety of topics, including national discussions involving clinical laboratory quality systems, regulation and oversight of next-generation sequencing-based oncology testing, and precision oncology efforts in a data-driven manner.

  18. Alternative (non-animal) methods for cosmetics testing: current status and future prospects-2010.

    Science.gov (United States)

    Adler, Sarah; Basketter, David; Creton, Stuart; Pelkonen, Olavi; van Benthem, Jan; Zuang, Valérie; Andersen, Klaus Ejner; Angers-Loustau, Alexandre; Aptula, Aynur; Bal-Price, Anna; Benfenati, Emilio; Bernauer, Ulrike; Bessems, Jos; Bois, Frederic Y; Boobis, Alan; Brandon, Esther; Bremer, Susanne; Broschard, Thomas; Casati, Silvia; Coecke, Sandra; Corvi, Raffaella; Cronin, Mark; Daston, George; Dekant, Wolfgang; Felter, Susan; Grignard, Elise; Gundert-Remy, Ursula; Heinonen, Tuula; Kimber, Ian; Kleinjans, Jos; Komulainen, Hannu; Kreiling, Reinhard; Kreysa, Joachim; Leite, Sofia Batista; Loizou, George; Maxwell, Gavin; Mazzatorta, Paolo; Munn, Sharon; Pfuhler, Stefan; Phrakonkham, Pascal; Piersma, Aldert; Poth, Albrecht; Prieto, Pilar; Repetto, Guillermo; Rogiers, Vera; Schoeters, Greet; Schwarz, Michael; Serafimova, Rositsa; Tähti, Hanna; Testai, Emanuela; van Delft, Joost; van Loveren, Henk; Vinken, Mathieu; Worth, Andrew; Zaldivar, José-Manuel

    2011-05-01

    The 7th amendment to the EU Cosmetics Directive prohibits to put animal-tested cosmetics on the market in Europe after 2013. In that context, the European Commission invited stakeholder bodies (industry, non-governmental organisations, EU Member States, and the Commission's Scientific Committee on Consumer Safety) to identify scientific experts in five toxicological areas, i.e. toxicokinetics, repeated dose toxicity, carcinogenicity, skin sensitisation, and reproductive toxicity for which the Directive foresees that the 2013 deadline could be further extended in case alternative and validated methods would not be available in time. The selected experts were asked to analyse the status and prospects of alternative methods and to provide a scientifically sound estimate of the time necessary to achieve full replacement of animal testing. In summary, the experts confirmed that it will take at least another 7-9 years for the replacement of the current in vivo animal tests used for the safety assessment of cosmetic ingredients for skin sensitisation. However, the experts were also of the opinion that alternative methods may be able to give hazard information, i.e. to differentiate between sensitisers and non-sensitisers, ahead of 2017. This would, however, not provide the complete picture of what is a safe exposure because the relative potency of a sensitiser would not be known. For toxicokinetics, the timeframe was 5-7 years to develop the models still lacking to predict lung absorption and renal/biliary excretion, and even longer to integrate the methods to fully replace the animal toxicokinetic models. For the systemic toxicological endpoints of repeated dose toxicity, carcinogenicity and reproductive toxicity, the time horizon for full replacement could not be estimated.

  19. Clinical identification of compensatory structures on projective tests: a self psychological approach.

    Science.gov (United States)

    Silverstein, M L

    2001-06-01

    In this article I discuss compensatory structure, a concept from Kohut's (1971, 1977) psychology of the self that is not as familiar as Kohut's other views about the self. Compensatory structures are attempts to repair selfobject failure, usually by strengthening idealization or twinship in the face of mirroring deficits. Compensatory structures, particularly their early indications, can be detected on projective tests for identifying adaptive resources and treatment potential. The clinical identification of compensatory structures on test findings is described using Rorschach and Thematic Apperception Test (Murray, 1943) content. Particular attention is devoted to the 2-part process of demonstrating first, an injury to the self, and second, how attempts to recover from such injuries can be detected on projective tests. Clinical examples are provided, and the differentiation between compensatory structures and defenses and sublimation is discussed.

  20. Clinical application and observation of curative effect in the near future of iodine-131 therapy in juvenile patients with hyperthyroidism

    International Nuclear Information System (INIS)

    Chen Huilin; Liang Jun; Liang Fengyun

    2004-01-01

    Objective: To assess clinical application of 131 I therapy and observation of curative effect in the near future after treatment in juvenile patients with hyperthyroidism Methods: 44 juvenile patients with hyperthyroidism were divided two subgroups of that children and early youths .The dosage of 131 I were respectively 135.1±34.0(3.65±0.92), 200.2±64.0 MBq(5.41±1.73 mCi). The curative effect belonged in four kinds being to fully recovered, quite a lot, fail to respond to medical and hypothyroidism at six month slater or from then. Results: 46 times treatment were gave and therapy effect was same in every subgroups. The effective rate of total was 89.1% and rater on clinical hypothyroidism was 4.3%. Conclusions: It had an obvious effect that 131 I therapy for juvenile patients with hyperthyroidism. 131 I therapy was also a firmly good select because a well ratio effect/cost. (authors)

  1. The present and future of cardiac CT in research and clinical practice. Moderated discussion and scientific debate with representatives from the four main vendors

    International Nuclear Information System (INIS)

    Dewey, M.; Vries, H. de; Vries, L. de; Haas, D.; Leidecker, C.

    2010-01-01

    Noninvasive imaging of the heart using computed tomography (CT) is an increasingly important diagnostic approach for patients with known or suspected coronary artery disease. Coronary CT angiography has recently received great attention because it provides imaging of the coronary arteries and quantification of the coronary plaque burden with a spatial and temporal resolution not available with any other noninvasive imaging test. In this moderated scientific debate we discuss the advantages and disadvantages of different technical solutions to CT imaging of the fast moving heart including its small and tortuous coronary arteries. Our discussion goes into the details of developments regarding larger Z-axis coverage (320-row volume CT, high pitch spiral acquisition), improved temporal resolution (dual-source CT, adaptive multi-segment reconstruction, and shorter gantry rotation times with air-bearing gantries), improved spatial resolution (high-definition detectors), and improved reconstruction algorithms (iterative reconstruction, cone beam reconstruction). The discussion also touches on the future technological developments that will be necessary to further improve the acceptance and widespread clinical use of cardiac CT, focusing on radiation exposure reduction and independence from heart rate. Finally, the representatives of the four main vendors explain the most important research projects regarding cardiac CT that they plan to pursue in the near future.

  2. The present and future of cardiac CT in research and clinical practice. Moderated discussion and scientific debate with representatives from the four main vendors

    Energy Technology Data Exchange (ETDEWEB)

    Dewey, M. [Charite Berlin (Germany). Radiology; Vries, H. de [Toshiba Medical Systems Europe, Zoetermeer (Netherlands). CT; Vries, L. de [Philips Medical Systems Europe (Netherlands). CT; Haas, D. [GE Healthcare (Germany). CT; Leidecker, C. [Siemens Medical Solutions (Germany). CT

    2010-04-15

    Noninvasive imaging of the heart using computed tomography (CT) is an increasingly important diagnostic approach for patients with known or suspected coronary artery disease. Coronary CT angiography has recently received great attention because it provides imaging of the coronary arteries and quantification of the coronary plaque burden with a spatial and temporal resolution not available with any other noninvasive imaging test. In this moderated scientific debate we discuss the advantages and disadvantages of different technical solutions to CT imaging of the fast moving heart including its small and tortuous coronary arteries. Our discussion goes into the details of developments regarding larger Z-axis coverage (320-row volume CT, high pitch spiral acquisition), improved temporal resolution (dual-source CT, adaptive multi-segment reconstruction, and shorter gantry rotation times with air-bearing gantries), improved spatial resolution (high-definition detectors), and improved reconstruction algorithms (iterative reconstruction, cone beam reconstruction). The discussion also touches on the future technological developments that will be necessary to further improve the acceptance and widespread clinical use of cardiac CT, focusing on radiation exposure reduction and independence from heart rate. Finally, the representatives of the four main vendors explain the most important research projects regarding cardiac CT that they plan to pursue in the near future.

  3. Evaluating a mobile application for improving clinical laboratory test ordering and diagnosis.

    Science.gov (United States)

    Meyer, Ashley N D; Thompson, Pamela J; Khanna, Arushi; Desai, Samir; Mathews, Benji K; Yousef, Elham; Kusnoor, Anita V; Singh, Hardeep

    2018-04-20

    Mobile applications for improving diagnostic decision making often lack clinical evaluation. We evaluated if a mobile application improves generalist physicians' appropriate laboratory test ordering and diagnosis decisions and assessed if physicians perceive it as useful for learning. In an experimental, vignette study, physicians diagnosed 8 patient vignettes with normal prothrombin times (PT) and abnormal partial thromboplastin times (PTT). Physicians made test ordering and diagnosis decisions for 4 vignettes using each resource: a mobile app, PTT Advisor, developed by the Centers for Disease Control and Prevention (CDC)'s Clinical Laboratory Integration into Healthcare Collaborative (CLIHC); and usual clinical decision support. Then, physicians answered questions regarding their perceptions of the app's usefulness for diagnostic decision making and learning using a modified Kirkpatrick Training Evaluation Framework. Data from 368 vignettes solved by 46 physicians at 7 US health care institutions show advantages for using PTT Advisor over usual clinical decision support on test ordering and diagnostic decision accuracy (82.6 vs 70.2% correct; P < .001), confidence in decisions (7.5 vs 6.3 out of 10; P < .001), and vignette completion time (3:02 vs 3:53 min.; P = .06). Physicians reported positive perceptions of the app's potential for improved clinical decision making, and recommended it be used to address broader diagnostic challenges. A mobile app, PTT Advisor, may contribute to better test ordering and diagnosis, serve as a learning tool for diagnostic evaluation of certain clinical disorders, and improve patient outcomes. Similar methods could be useful for evaluating apps aimed at improving testing and diagnosis for other conditions.

  4. Hepatitis C virus (HCV genotype 1 subtype identification in new HCV drug development and future clinical practice.

    Directory of Open Access Journals (Sweden)

    Stéphane Chevaliez

    Full Text Available BACKGROUND: With the development of new specific inhibitors of hepatitis C virus (HCV enzymes and functions that may yield different antiviral responses and resistance profiles according to the HCV subtype, correct HCV genotype 1 subtype identification is mandatory in clinical trials for stratification and interpretation purposes and will likely become necessary in future clinical practice. The goal of this study was to identify the appropriate molecular tool(s for accurate HCV genotype 1 subtype determination. METHODOLOGY/PRINCIPAL FINDINGS: A large cohort of 500 treatment-naïve patients eligible for HCV drug trials and infected with either subtype 1a or 1b was studied. Methods based on the sole analysis of the 5' non-coding region (5'NCR by sequence analysis or reverse hybridization failed to correctly identify HCV subtype 1a in 22.8%-29.5% of cases, and HCV subtype 1b in 9.5%-8.7% of cases. Natural polymorphisms at positions 107, 204 and/or 243 were responsible for mis-subtyping with these methods. A real-time PCR method using genotype- and subtype-specific primers and probes located in both the 5'NCR and the NS5B-coding region failed to correctly identify HCV genotype 1 subtype in approximately 10% of cases. The second-generation line probe assay, a reverse hybridization assay that uses probes targeting both the 5'NCR and core-coding region, correctly identified HCV subtypes 1a and 1b in more than 99% of cases. CONCLUSIONS/SIGNIFICANCE: In the context of new HCV drug development, HCV genotyping methods based on the exclusive analysis of the 5'NCR should be avoided. The second-generation line probe assay is currently the best commercial assay for determination of HCV genotype 1 subtypes 1a and 1b in clinical trials and practice.

  5. Current and future perspectives on lumbar degenerative disc disease: a UK survey exploring specialist multidisciplinary clinical opinion

    Science.gov (United States)

    McGregor, Alison H

    2016-01-01

    Objectives Despite lumbar degenerative disc disease (LDDD) being significantly associated with non-specific low back pain and effective treatment remaining elusive, specialist multidisciplinary clinical stakeholder opinion remains unexplored. The present study examines the views of such experts. Design A reliable and valid electronic survey was designed to establish trends using theoretical constructs relating to current assessment and management practices. Clinicians from the Society of Back Pain Research (SBPR) UK were invited to take part. Quantitative data were collated and coded using Bristol Online Surveys (BOS) software, and content analysis was used to systematically code and categorise qualitative data. Setting Specialist multidisciplinary spinal interest group in the UK. Participants 38/141 clinically active, multidisciplinary SBPR members with specialist spinal interest participated. Among them, 84% had >9 years postgraduate clinical experience. Interventions None. Outcome measures Frequency distributions were used to establish general trends in quantitative data. Qualitative responses were coded and categorised in relation to each theme and percentage responses were calculated. Results LDDD symptom recurrence, in the absence of psychosocial influence, was associated with physical signs of joint stiffness (26%), weakness (17%) and joint hypermobility (6%), while physical factors (21%) and the ability to adapt (11%) were postulated as reasons why some experience pain and others do not. No one management strategy was supported exclusively or with consensus. Regarding effective modalities, there was no significant difference between allied health professional and medic responses (p=0.1–0.8). The future of LDDD care was expressed in terms of improvements in patient communication (35%), patient education (38%) and treatment stratification (24%). Conclusions Results suggest that multidisciplinary expert spinal clinicians appear to follow UK

  6. A Functional Neuroimaging Analysis of the Trail Making Test-B: Implications for Clinical Application

    Directory of Open Access Journals (Sweden)

    Mark D. Allen

    2011-01-01

    Full Text Available Recent progress has been made using fMRI as a clinical assessment tool, often employing analogues of traditional “paper and pencil” tests. The Trail Making Test (TMT, popular for years as a neuropsychological exam, has been largely ignored in the realm of neuroimaging, most likely because its physical format and administration does not lend itself to straightforward adaptation as an fMRI paradigm. Likewise, there is relatively more ambiguity about the neural systems associated with this test than many other tests of comparable clinical use. In this study, we describe an fMRI version of Trail Making Test-B (TMTB that maintains the core functionality of the TMT while optimizing its use for both research and clinical settings. Subjects (N = 32 were administered the Functional Trail Making Test-B (f-TMTB. Brain region activations elicited by the f-TMTB were consistent with expectations given by prior TMT neurophysiological studies, including significant activations in the ventral and dorsal visual pathways and the medial pre-supplementary motor area. The f-TMTB was further evaluated for concurrent validity with the traditional TMTB using an additional sample of control subjects (N = 100. Together, these results support the f-TMTB as a viable neuroimaging adaptation of the TMT that is optimized to evoke maximally robust fMRI activation with minimal time and equipment requirements.

  7. Impact of providing fee data on laboratory test ordering: a controlled clinical trial.

    Science.gov (United States)

    Feldman, Leonard S; Shihab, Hasan M; Thiemann, David; Yeh, Hsin-Chieh; Ardolino, Margaret; Mandell, Steven; Brotman, Daniel J

    2013-05-27

    Inpatient care providers often order laboratory tests without any appreciation for the costs of the tests. To determine whether we could decrease the number of laboratory tests ordered by presenting providers with test fees at the time of order entry in a tertiary care hospital, without adding extra steps to the ordering process. Controlled clinical trial. Tertiary care hospital. All providers, including physicians and nonphysicians, who ordered laboratory tests through the computerized provider order entry system at The Johns Hopkins Hospital. We randomly assigned 61 diagnostic laboratory tests to an "active" arm (fee displayed) or to a control arm (fee not displayed). During a 6-month baseline period (November 10, 2008, through May 9, 2009), we did not display any fee data. During a 6-month intervention period 1 year later (November 10, 2009, through May 9, 2010), we displayed fees, based on the Medicare allowable fee, for active tests only. We examined changes in the total number of orders placed, the frequency of ordered tests (per patient-day), and total charges associated with the orders according to the time period (baseline vs intervention period) and by study group (active test vs control). For the active arm tests, rates of test ordering were reduced from 3.72 tests per patient-day in the baseline period to 3.40 tests per patient-day in the intervention period (8.59% decrease; 95% CI, -8.99% to -8.19%). For control arm tests, ordering increased from 1.15 to 1.22 tests per patient-day from the baseline period to the intervention period (5.64% increase; 95% CI, 4.90% to 6.39%) (P fee data to providers at the time of order entry resulted in a modest decrease in test ordering. Adoption of this intervention may reduce the number of inappropriately ordered diagnostic tests.

  8. A spallation-based irradiation