WorldWideScience

Sample records for general practice long-term

  1. Long-term performance of resin based fissure sealants placed in a general dental practice.

    NARCIS (Netherlands)

    Hevinga, M.; Opdam, N.J.M.; Bronkhorst, E.M.; Truin, G.J.; Huysmans, M.C.D.N.J.M.

    2010-01-01

    OBJECTIVES: The aim of the present retrospective study was to evaluate the long-term performance of resin based fissure sealants applied in a general dental practice. METHODS: Regularly attending patients visiting the practice between July 2006 until November 2007 and who had received sealants befor

  2. Long-term benzodiazepine and Z-drugs use in the UK: a survey of general practice.

    Science.gov (United States)

    Davies, James; Rae, Todd C; Montagu, Luke

    2017-07-17

    Current British National Formulary (BNF) guidelines state that benzodiazepines and zolpidem, zopiclone, and zaleplon, commonly known as Z-drugs (BZD), be prescribed for no more than 4 weeks, although anecdotal data suggest that many patients are prescribed BZDs for much longer. As there are no recent, evidence-based estimates of long-term (>12 months) BZD use in the UK, the scale of this potential problem is unknown. To produce the first reliable, evidence-based estimate of long-term BZD use in the UK. Estimates of UK long-term BZD use were projected from data obtained from a survey conducted in 2014-2015 by the Bridge Project, a prescribed-drug withdrawal support charity in the North of England (Bradford). Percentages of long-term users of BZD were derived from the survey, by sampling primary care GP surgeries with around 100 000 registered patients, and these were applied to UK-wide NHS patient numbers. The data were filtered to exclude the very young and old, and those with other health issues. The mean percentage of registered patients prescribed BZDs for more than a year in the survey sample is 0.69% (95% confidence interval [CI] = 0.54 to 0.84). Applying this value to national patient numbers yields a mean projection of 296 929 (95% CI = 232 553 to 361 305) long-term users of BZD in the UK. The data also suggest that as many as 119 165 of these patients may be willing to accept prescribed drug dependency withdrawal services. More than a quarter of a million people in the UK are likely to be taking highly dependency-forming hypnotic medication far beyond the recommended time scales. As there is evidence that long-term use of BZDs causes adverse physiological and neurological effects, and protracted withdrawal (with associated complications), this represents a serious public health problem. © British Journal of General Practice 2017.

  3. Long-term prognosis of acute back pain in patients seen in general practice

    DEFF Research Database (Denmark)

    Schiøttz-Christensen, Berit; Nielsen, Gunnar Lauge; Hansen, Vivian Kjær

    1999-01-01

    to develop chronic LBP and (iii) a history of LBP having caused previous sick leave. CONCLUSIONS: LBP in general practice has a good prognosis with regard to sick leave, but a high proportion of patients continue to complain of LBP. We were not able to identify objective measures that strongly predict...

  4. Long-term prognosis of acute low back pain in patients seen in general practice

    DEFF Research Database (Denmark)

    Schiøttz-Christensen, Berit; Nielsen, G L; Hansen, V K

    1999-01-01

    to develop chronic LBP and (iii) a history of LBP having caused previous sick leave. CONCLUSIONS: LBP in general practice has a good prognosis with regard to sick leave, but a high proportion of patients continue to complain of LBP. We were not able to identify objective measures that strongly predict...

  5. Long-term effectiveness of a quality improvement program for patients with type 2 diabetes in general practice.

    NARCIS (Netherlands)

    Renders, C.M.; Valk, G.D.; Franse, L.V.; Schellevis, F.; Eijk, J.T.M. van; Wal, G. van der

    2001-01-01

    OBJECTIVE— To assess the long-term effectiveness of a quality improvement program on care provided and patient outcomes in patients with diabetes. RESEARCH DESIGN AND METHODS— A nonrandomized trial was performed with 312 patients with type 2 diabetes in the intervention group and 77 patients with ty

  6. Antibiotic treatment of exacerbations of COPD in general practice: long-term impact on healthrelated quality of life

    Directory of Open Access Journals (Sweden)

    Marc Miravitlles

    2010-01-01

    exacerbations.Conclusions: In COPD outpatients, treatment of exacerbations with moxifloxacin had a more favorable long-term effect on quality of life than amoxicillin/clavulanate.Keywords: COPD, exacerbations, moxifloxacin, amoxicillin/clavulanate, quality of life, SGRQ

  7. Enhancing Practical Evaluation Training through Long-Term Evaluation Projects.

    Science.gov (United States)

    Trevisan, Michael S.

    2002-01-01

    Suggests an approach to providing practical evaluation training through university-supported, long-term funded evaluation projects. Such projects are managed through a university center that provides assistance to clients in student assessment and program evaluation. Discusses the benefits and challenges of these experiences for students. (SLD)

  8. General practitioners' management of the long-term sick role.

    Science.gov (United States)

    Higgins, Angela; Porter, Sam; O'Halloran, Peter

    2014-04-01

    In this paper, we use qualitative research techniques to examine the role of general practitioners in the management of the long-term sickness absence. In order to uncover the perspectives of all the main agents affected by the actions of general practitioners, a case study approach focussing on one particular employment sector, the public health service, is adopted. The role of family physicians is viewed from the perspectives of health service managers, occupational health physicians, employees/patients, and general practitioners. Our argument is theoretically framed by Talcott Parsons's model of the medical contribution to the sick role, along with subsequent conceptualisations of the social role and position of physicians. Sixty one semi-structured interviews and three focus group interviews were conducted in three Health and Social Care Trusts in Northern Ireland between 2010 and 2012. There was a consensus among respondents that general practitioners put far more weight on the preferences and needs of their patients than they did on the requirements of employing organisations. This was explained by respondents in terms of the propinquity and longevity of relationships between doctors and their patients, and by the ideology of holistic care and patient advocacy that general practitioners viewed as providing the foundations of their approach to patients. The approach of general practitioners was viewed negatively by managers and occupational health physicians, and more positively by general practitioners and patients. However, there is some evidence that general practitioners would be prepared to forfeit their role as validators of sick leave. Given the imperatives of both state and capital to reduce the financial burden of long-term sickness, this preparedness puts into doubt the continued role of general practitioners as gatekeepers to legitimate long-term sickness absence. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. Early predictors of the long-term outcome of low back pain - results of a 22-year prospective cohort study from general practice

    DEFF Research Database (Denmark)

    Lonnberg, F.; Pedersen, P.; Siersma, V.

    2010-01-01

    BACKGROUND: Poor outcome of low back pain in patients seen in general practice is related to the pain history, physical impairment and working conditions, at least in short-term follow-ups. We do not know if these findings hold, seen from the perspective of decades. OBJECTIVES: To show if patients...... consulting the GP for the first time regarding an episode of low back pain have excess poor outcome 22 years later and, if so, whether the best predictors are data based on the symptoms, clinical signs or work history. The design of the study is a 22-year follow-up of an inception cohort of 78 patients...... with low back pain. The setting of the study is a single general practice in a suburb of Copenhagen, Denmark. METHODS: Selected predictors were separated into pain characteristics, clinical signs and indicators related to the work history. Outcome measures were the 1-year period prevalence of low back pain...

  10. Long-Term Effect of Interactive Online Dietician Weight Loss Advice in General Practice (LIVA Protocol for a Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Carl J. Brandt

    2014-01-01

    Full Text Available Background. Internet-based complex interventions aiming to promote weight loss and optimize healthy behaviors have attracted much attention. However, evidence for effect is lacking. Obesity is a growing problem, resulting in an increasing demand for cost efficient weight loss programs suitable for use on a large scale, for example, as part of standard primary care. In a previous pilot project by Brandt et al. (2011 without a control group, we examined the effects of online dietician counseling and found an average weight loss of 7.0 kg (95% CI: 4.6 to 9.3 kg after 20 months. Aims and Methods. To analyze the effects of a complex intervention using trained dieticians in a general practice setting combined with internet-based interactive and personalized weight management support compared with conventional advice with a noninteractive internet support as placebo treatment in 340 overweight patients during a 2-year period. Primary endpoints are weight loss and lowering of cholesterol (LDL. We will also explore patients’ sociodemographics and use of the intervention as well as the health professionals’ views and perceptions of the intervention (their role and the advice and support that they provide. Perspective. The project will generate knowledge on the cost-effectiveness of a complex internet-based intervention in a general practice setting and on barriers and acceptability among professionals and patients.

  11. Long-Term Effect of Interactive Online Dietician Weight Loss Advice in General Practice (LIVA) Protocol for a Randomized Controlled Trial

    DEFF Research Database (Denmark)

    Brandt, Carl J; Brandt, Vibeke; Pedersen, Mathilde

    2014-01-01

    Background. Internet-based complex interventions aiming to promote weight loss and optimize healthy behaviors have attracted much attention. However, evidence for effect is lacking. Obesity is a growing problem, resulting in an increasing demand for cost efficient weight loss programs suitable...... for use on a large scale, for example, as part of standard primary care. In a previous pilot project by Brandt et al. (2011) without a control group, we examined the effects of online dietician counseling and found an average weight loss of 7.0 kg (95% CI: 4.6 to 9.3 kg) after 20 months. Aims and Methods....... To analyze the effects of a complex intervention using trained dieticians in a general practice setting combined with internet-based interactive and personalized weight management support compared with conventional advice with a noninteractive internet support as placebo treatment in 340 overweight patients...

  12. Benchmarking 2010: measuring long-term care and consultant pharmacy practice.

    Science.gov (United States)

    Martin, Caren McHenry

    2011-07-01

    The American Society of Consultant Pharmacists, with support from the pharmacy management software company QS/1, has completed its 2010 survey to determine industry standards for long-term care pharmacy operations, consultant pharmacist practice, and the use of health information technology in the long-term care setting. The report presents data collected in this annual business benchmarking survey. Examples of data include gross profit margins of long-term care/closed-door pharmacies, pharmacists' salaries, prescription payer mix, consultant pharmacist productivity and contracting, and implementation of technology solutions such as ePrescribing, electronic medication administration records, electronic medical records, and automated dispensing.

  13. The Long-Term Effects of Childhood Music Instruction on Intelligence and General Cognitive Abilities

    Science.gov (United States)

    Costa-Giomi, Eugenia

    2015-01-01

    This article reviews research on the effects of music instruction on general cognitive abilities. The review of more than 75 reports shows (1) the consistency in results pertaining to the short-term effects of music instruction on cognitive abilities and the lack of clear evidence on the long-term effects on intelligence; (2) the complex nature of…

  14. Treatment of generalized social phobia : Results at long-term follow-up

    NARCIS (Netherlands)

    Scholing, A; Emmelkamp, PMG

    1996-01-01

    This study investigated the long-term follow-up effectiveness-of (cognitive-)behavioural group and individual treatments for generalized social phobia. Patients were reassessed 18 months after they had finished one of the following treatment packages: (1) exposure in vivo; (2) cognitive therapy foll

  15. The Long-Term Effects of Childhood Music Instruction on Intelligence and General Cognitive Abilities

    Science.gov (United States)

    Costa-Giomi, Eugenia

    2015-01-01

    This article reviews research on the effects of music instruction on general cognitive abilities. The review of more than 75 reports shows (1) the consistency in results pertaining to the short-term effects of music instruction on cognitive abilities and the lack of clear evidence on the long-term effects on intelligence; (2) the complex nature of…

  16. eLearning, knowledge brokering, and nursing: strengthening collaborative practice in long-term care.

    Science.gov (United States)

    Halabisky, Brenda; Humbert, Jennie; Stodel, Emma J; MacDonald, Colla J; Chambers, Larry W; Doucette, Suzanne; Dalziel, William B; Conklin, James

    2010-01-01

    Interprofessional collaboration is vital to the delivery of quality care in long-term care settings; however, caregivers in long-term care face barriers to participating in training programs to improve collaborative practices. Consequently, eLearning can be used to create an environment that combines convenient, individual learning with collaborative experiential learning. Findings of this study revealed that learners enjoyed the flexibility of the Working Together learning resource. They acquired new knowledge and skills that they were able to use in their practice setting to achieve higher levels of collaborative practice. Nurses were identified as team leaders because of their pivotal role in the long-term care home and collaboration with all patient care providers. Nurses are ideal as knowledge brokers for the collaborative practice team. Quantitative findings showed no change in learner's attitudes regarding collaborative practice; however, interviews provided examples of positive changes experienced. Face-to-face collaboration was found to be a challenge, and changes to organizations, systems, and technology need to be made to facilitate this process. The Working Together learning resource is an important first step toward strengthening collaboration in long-term care, and the pilot implementation provides insights that further our understanding of both interprofessional collaboration and effective eLearning.

  17. Effect of Long-Term Physical Activity Practice after Cardiac Rehabilitation on Some Risk Factors

    Science.gov (United States)

    Freyssin, Celine, Jr.; Blanc, Philippe; Verkindt, Chantal; Maunier, Sebastien; Prieur, Fabrice

    2011-01-01

    The objective of this study was to evaluate the effects of long-term physical activity practice after a cardiac rehabilitation program on weight, physical capacity and arterial compliance. The Dijon Physical Activity Score was used to identify two groups: sedentary and active. Weight, distance at the 6-min walk test and the small artery elasticity…

  18. Creation and Long-term Preservation of Digital Multimedia Resources:Some Preliminary Practices

    Institute of Scientific and Technical Information of China (English)

    ZHAO BAOYING; LUO YUNCHUAN

    2008-01-01

    This paper gives a comprehensive introduction of National Cultural Information Resources Sharing Project.It discusses the best practices in creation and long-term preservation of multimedia digital resources,and recommends solutions to the key issues in resource selection,standards & specifications and copyright.

  19. Increased risk of atrial fibrillation among elderly Norwegian men with a history of long-term endurance sport practice.

    Science.gov (United States)

    Myrstad, M; Løchen, M-L; Graff-Iversen, S; Gulsvik, A K; Thelle, D S; Stigum, H; Ranhoff, A H

    2014-08-01

    Atrial fibrillation (AF) is the most common cardiac arrhythmia. The prevalence increases with increasing age. In middle-aged men, endurance sport practice is associated with increased risk of AF but there are few studies among elderly people. The aim of this study was to investigate the role of long-term endurance sport practice as a risk factor for AF in elderly men. A cross-sectional study compared 509 men aged 65-90 years who participated in a long-distance cross-country ski race with 1768 men aged 65-87 years from the general population. Long-term endurance sport practice was the main exposure. Self-reported AF and covariates were assessed by questionnaires. Risk differences (RDs) for AF were estimated by using a linear regression model. After multivariable adjustment, a history of endurance sport practice gave an added risk for AF of 6.0 percent points (pp) (95% confidence interval 0.8-11.1). Light and moderate leisure-time physical activity during the last 12 months reduced the risk with 3.7 and 4.3 pp, respectively, but the RDs were not statistically significant. This study suggests that elderly men with a history of long-term endurance sport practice have an increased risk of AF compared with elderly men in the general population.

  20. Long-term chamomile (Matricaria chamomilla L.) treatment for generalized anxiety disorder: A randomized clinical trial.

    Science.gov (United States)

    Mao, Jun J; Xie, Sharon X; Keefe, John R; Soeller, Irene; Li, Qing S; Amsterdam, Jay D

    2016-12-15

    Generalized Anxiety Disorder (GAD) is one of the most common anxiety disorders treated in primary care, yet current therapies have limited efficacy and substantial side effects. To evaluate long-term chamomile (Matricaria chamomilla L.) use for prevention of GAD symptom relapse. Outpatients from primary care practices and local communities with a primary diagnosis of moderate-to-severe GAD were enrolled for this two-phase study at a large US academic medical center. During Phase 1, eligible participants received 12 weeks of open-label therapy with chamomile pharmaceutical grade extract 1500mg (500mg capsule 3 times daily). During Phase 2, treatment responders were randomized to either 26 weeks of continuation chamomile therapy or placebo in a double-blinded, placebo-substitution design. The primary outcome was time to relapse during continuation therapy, analyzed using Cox proportional hazards. Secondary outcomes included the proportion who relapsed, treatment-emergent adverse events, and vital sign changes. This study is registered at ClinicalTrials.gov, identifier NCT01072344. Between March 1, 2010, and June 30, 2015, we enrolled 179 participants. Of those, 93 (51.9%) were responders and agreed to continue in the double-blind randomized controlled trial. A numerically greater number of placebo-switched (n=12/47; 25.5%) versus chamomile-continuation (n = 7/46; 15.2%) participants relapsed during follow-up. Mean time to relapse was 11.4 ± 8.4 weeks for chamomile and 6.3 ± 3.9 weeks for placebo. Hazard of relapse was non-significantly lower for chamomile (hazard ratio, 0.52; 95% CI, 0.20-1.33; P = 0.16). During follow-up, chamomile participants maintained significantly lower GAD symptoms than placebo (P = 0.0032), with significant reductions in body weight (P = 0.046) and mean arterial blood pressure (P = 0.0063). Both treatments had similar low adverse event rates. Long-term chamomile was safe and significantly reduced moderate

  1. Standard practice for digital detector array performance evaluation and long-term stability

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2010-01-01

    1.1 This practice describes the evaluation of DDA systems for industrial radiology. It is intended to ensure that the evaluation of image quality, as far as this is influenced by the DDA system, meets the needs of users, and their customers, and enables process control and long term stability of the DDA system. 1.2 This practice specifies the fundamental parameters of Digital Detector Array (DDA) systems to be measured to determine baseline performance, and to track the long term stability of the DDA system. 1.3 The DDA system performance tests specified in this practice shall be completed upon acceptance of the system from the manufacturer and at intervals specified in this practice to monitor long term stability of the system. The intent of these tests is to monitor the system performance for degradation and to identify when an action needs to be taken when the system degrades by a certain level. 1.4 The use of the gages provided in this standard is mandatory for each test. In the event these tests or ga...

  2. Delegation in Long-term Care: Scope of practice or job description?

    Science.gov (United States)

    Corazzini, Kirsten N; Anderson, Ruth A; Rapp, Carla Gene; Mueller, Christine; McConnell, Eleanor S; Lekan, Deborah

    2010-05-31

    This study is a qualitative, descriptive study of how registered nurses (RNs) (N=33) in leadership roles in institutionalized long-term care settings delegate care, including their strategies and processes for delegating care, and their perceptions of barriers to effective delegation and potential benefits of delegation. Findings indicate two key approaches to delegation, including the "follow the job description" approach, emphasizing adherence to facility-level roles and job descriptions, and the "consider the scope of practice" approach, emphasizing consideration of multiple aspects of scope of practice and licensure, and the context of care. While the former resulted in more clarity and certainty for the RN, the latter facilitated a focus on quality of resident care outcomes as linked to the delegation process. Barriers to effective delegation were comparable among RNs using either approach to delegation, and almost all RNs could describe benefits of delegation for long-term care.

  3. Witnessing Interparental Violence, Parenting Practices, and Children´s Long-Term Psychological Distress

    OpenAIRE

    Manuel Gámez-Guadix; Carmen Almendros

    2011-01-01

    The first objective of this study was to examine the relationship between witnessing interparental violence and children´s long-term psychological distress, and the extent to which this relation is mediated by deteriorating parenting practices (i.e., harsh discipline, affection/support, interparental and intraparental consistency). The second objective was to analyze the possible gender differences in the relationships specified. The sample comprised 680 Spanish university students (62.4% fem...

  4. Relationships among leadership practices, work environments, staff communication and outcomes in long-term care.

    Science.gov (United States)

    Tourangeau, Ann; Cranley, Lisa; Spence Laschinger, Heather K; Pachis, Jaime

    2010-11-01

    To examine the role that work relationships have on two long-term care outcomes: job satisfaction and turnover intention. It is easy to overlook the impact that human relations have in shaping work environments that are conducive to organizational effectiveness. Employee job satisfaction and retention are important organizational outcomes. Six hundred and seventy-five nursing and other staff from 26 long-term care facilities were surveyed about their work environments, work group relationships, observed leadership practices, organizational support, job satisfaction and turnover intention. Higher job satisfaction was associated with lower emotional exhaustion burnout, higher global empowerment, higher organizational support, higher psychological empowerment, stronger work group cohesion and higher personal accomplishment. Higher turnover intention was associated with lower job satisfaction, higher emotional exhaustion burnout, more outside job opportunities, weaker work group cohesion, lower personal accomplishment and higher depersonalization. No relationship was found between leadership practices and job satisfaction or turnover intention. Stronger work group relationships, stronger sense of personal accomplishment and lower emotional exhaustion have direct effects on increasing job satisfaction and lowering turnover intention. To retain long-term care staff, attention should be paid to fostering positive work group cohesion, supporting and acknowledging staff accomplishments and minimizing staff burnout. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

  5. A review of methodologies applied in Australian practice to evaluate long-term coastal adaptation options

    Directory of Open Access Journals (Sweden)

    Timothy David Ramm

    2017-01-01

    Full Text Available Rising sea levels have the potential to alter coastal flooding regimes around the world and local governments are beginning to consider how to manage uncertain coastal change. In doing so, there is increasing recognition that such change is deeply uncertain and unable to be reliably described with probabilities or a small number of scenarios. Characteristics of methodologies applied in Australian practice to evaluate long-term coastal adaptation options are reviewed and benchmarked against two state-of-the-art international methods suited for conditions of uncertainty (Robust Decision Making and Dynamic Adaptive Policy Pathways. Seven out of the ten Australian case studies assumed the uncertain parameters, such as sea level rise, could be described deterministically or stochastically when identifying risk and evaluating adaptation options across multi-decadal periods. This basis is not considered sophisticated enough for long-term decision-making, implying that Australian practice needs to increase the use of scenarios to explore a much larger uncertainty space when assessing the performance of adaptation options. Two Australian case studies mapped flexible adaptation pathways to manage uncertainty, and there remains an opportunity to incorporate quantitative methodologies to support the identification of risk thresholds. The contextual framing of risk, including the approach taken to identify risk (top-down or bottom-up and treatment of uncertain parameters, were found to be fundamental characteristics that influenced the methodology selected to evaluate adaptation options. The small sample of case studies available suggests that long-term coastal adaptation in Australian is in its infancy and there is a timely opportunity to guide local government towards robust methodologies for developing long-term coastal adaptation plans.

  6. Effect of Clickers "versus" Online Homework on Students' Long-Term Retention of General Chemistry Course Material

    Science.gov (United States)

    Gebru, Misganaw T.; Phelps, Amy J.; Wulfsberg, Gary

    2012-01-01

    This study reports the effects of student response systems (clickers) "versus" online homework on students' long-term retention of General Chemistry I course material. Long-term content retention was measured by a comprehensive yearlong American Chemical Society (ACS) GC97 exam administered seven months after students had completed the General…

  7. Effect of Clickers "versus" Online Homework on Students' Long-Term Retention of General Chemistry Course Material

    Science.gov (United States)

    Gebru, Misganaw T.; Phelps, Amy J.; Wulfsberg, Gary

    2012-01-01

    This study reports the effects of student response systems (clickers) "versus" online homework on students' long-term retention of General Chemistry I course material. Long-term content retention was measured by a comprehensive yearlong American Chemical Society (ACS) GC97 exam administered seven months after students had completed the General…

  8. Tapering Long-term Opioid Therapy in Chronic Noncancer Pain: Evidence and Recommendations for Everyday Practice.

    Science.gov (United States)

    Berna, Chantal; Kulich, Ronald J; Rathmell, James P

    2015-06-01

    Increasing concern about the risks and limited evidence supporting the therapeutic benefit of long-term opioid therapy for chronic noncancer pain are leading prescribers to consider discontinuing the use of opioids. In addition to overt addiction or diversion, the presence of adverse effects, diminishing analgesia, reduced function and quality of life, or the absence of progress toward functional goals can justify an attempt at weaning patients from long-term opioid therapy. However, discontinuing opioid therapy is often hindered by patients' psychiatric comorbidities and poor coping skills, as well as the lack of formal guidelines for the prescribers. The aim of this article is to review the existing literature and formulate recommendations for practitioners aiming to discontinue long-term opioid therapy. Specifically, this review aims to answer the following questions: What is an optimal opioid tapering regimen? How can the risks involved in a taper be managed? What are the alternatives to an opioid taper? A PubMed literature search was conducted using the keywords chronic pain combined with opioid withdrawal, taper, wean and detoxification. Six hundred ninety-five documents were identified and screened; 117 were deemed directly relevant and are included. On the base of this literature review, this article proposes evidence-based recommendations and expert-based suggestions for clinical practice. Furthermore, areas of lack of evidence are identified, providing opportunities for further research.

  9. Long-term use of fluticasone propionate/salmeterol fixed-dose combination and incidence of cataracts and glaucoma among chronic obstructive pulmonary disease patients in the UK General Practice Research Database

    Directory of Open Access Journals (Sweden)

    Miller DP

    2011-09-01

    Full Text Available David P Miller, Stephanie E Watkins, Tim Sampson, Kourtney J Davis WorldWide Epidemiology, GlaxoSmithKline, Durham, NC, USA Objectives: Some large population-based studies have reported a dose-related increased risk of cataracts and glaucoma associated with use of inhaled corticosteroids (ICS in patients with asthma or chronic obstructive pulmonary disease (COPD. We evaluated the association between use of ICS-containing products, specifically fluticasone propionate/salmeterol fixed-dose combination (FSC, and incidence of cataracts and glaucoma among patients with COPD in a large electronic medical record database in the United Kingdom. Methods: We identified a cohort of patients aged 45 years and over with COPD in the General Practice Research Database (GPRD between 2003 and 2006. Cases of incident cataracts or glaucoma were defined based on diagnosis and procedure codes and matched to controls from the risk set to estimate odds ratios (OR and 95% confidence intervals (CI. The association with FSC or ICS exposure was modeled using conditional logistic regression. Medication exposure was assessed with respect to recency, duration, and number of prescriptions prior to the index date. Average daily dose was defined as none, low (1–250 mcg, medium (251–500 mcg, high (501–1000 mcg, or very high (1001+ mcg using fluticasone propionate (FP equivalents. Results: We identified 2941 incident cataract cases and 327 incident glaucoma cases in the COPD cohort (n = 53,191. FSC or ICS prescriptions were not associated with risk of incident cataracts or glaucoma for any exposure category, after adjusting for confounders. We observed a lack of a dose response in all analyses, where low dose was the reference group. The odds of cataracts associated with FSC dose were medium OR: 1.1 (95% CI: 0.9–1.4; high OR: 1.2 (95% CI: 0.9–1.5; and very high OR: 1.2 (95% CI: 0.9–1.7. The odds of glaucoma associated with FSC dose: medium OR: 1.0 (95% CI: 0.5–2

  10. Practice Change Interventions in Long-Term Care Facilities: What Works, and Why?

    Science.gov (United States)

    Caspar, Sienna; Cooke, Heather A; Phinney, Alison; Ratner, Pamela A

    2016-09-01

    Over the past three decades, there has been a notable increase in studies of practice change interventions in long-term care (LTC) settings. This review, based on a modified realist approach, addresses the following questions: What practice change intervention characteristics work? And, in what circumstances do they work and why? A modified realist approach was applied to identify and explain the interactions among context, mechanism, and outcome. We searched electronic databases and published literature for empirical studies of practice change interventions that (a) were conducted in LTC settings, (b) involved formal care staff members, and (c) reported a formal evaluation. Ninety-four articles met the inclusion criteria. Interventions that included only predisposing factors were least likely to be effective. Interventions that included reinforcing factors were most likely to produce sustained outcomes. We concluded that interventions aimed at practice change in LTC settings should include feasible and effective enabling and reinforcing factors.

  11. Self-reported musculoskeletal pain predicts long-term increase in general health care use

    DEFF Research Database (Denmark)

    Hartvigsen, Jan; Davidsen, Michael; Søgaard, Karen

    2014-01-01

    reported during the past two weeks from the Danish National Cohort Study were merged with data from the Danish National Health Insurance Registry and the National Patient Registry containing information on consultations in the Danish primary and secondary care sector. Absolute and relative rates for all......Aims: Musculoskeletal pain and disability is a modern epidemic and a major reason for seeking health care. The aim of this study is to determine absolute and relative rates of care seeking over 20 years for adults reporting musculoskeletal complaints. Methods: Interview data on musculoskeletal pain...... to any of the outcomes. CONCLUSIONS SELF-REPORT OF MUSCULOSKELETAL PAIN REPORTED WITHIN THE PAST TWO WEEKS PREDICTS A STATISTICALLY SIGNIFICANT LONG-TERM INCREASE IN GENERAL USE OF HEALTH CARE SERVICES IN BOTH THE PRIMARY AND THE SECONDARY HEALTH CARE SECTOR:...

  12. Recommendations From the International Consortium on Professional Nursing Practice in Long-Term Care Homes.

    Science.gov (United States)

    McGilton, Katherine S; Bowers, Barbara J; Heath, Hazel; Shannon, Kay; Dellefield, Mary Ellen; Prentice, Dawn; Siegel, Elena O; Meyer, Julienne; Chu, Charlene H; Ploeg, Jenny; Boscart, Veronique M; Corazzini, Kirsten N; Anderson, Ruth A; Mueller, Christine A

    2016-02-01

    In response to the International Association of Gerontology and Geriatrics' global agenda for clinical research and quality of care in long-term care homes (LTCHs), the International Consortium on Professional Nursing Practice in Long Term Care Homes (the Consortium) was formed to develop nursing leadership capacity and address the concerns regarding the current state of professional nursing practice in LTCHs. At its invitational, 2-day inaugural meeting, the Consortium brought together international nurse experts to explore the potential of registered nurses (RNs) who work as supervisors or charge nurses within the LTCHs and the value of their contribution in nursing homes, consider what RN competencies might be needed, discuss effective educational (curriculum and practice) experiences, health care policy, and human resources planning requirements, and to identify what sustainable nurse leadership strategies and models might enhance the effectiveness of RNs in improving resident, family, and staff outcomes. The Consortium made recommendations about the following priority issues for action: (1) define the competencies of RNs required to care for older adults in LTCHs; (2) create an LTCH environment in which the RN role is differentiated from other team members and RNs can practice to their full scope; and (3) prepare RN leaders to operate effectively in person-centered care LTCH environments. In addition to clear recommendations for practice, the Consortium identified several areas in which further research is needed. The Consortium advocated for a research agenda that emphasizes an international coordination of research efforts to explore similar issues, the pursuit of examining the impact of nursing and organizational models, and the showcasing of excellence in nursing practice in care homes, so that others might learn from what works. Several studies already under way are also described.

  13. Witnessing Interparental Violence, Parenting Practices, and Children´s Long-Term Psychological Distress

    Directory of Open Access Journals (Sweden)

    Manuel Gámez-Guadix

    2011-07-01

    Full Text Available The first objective of this study was to examine the relationship between witnessing interparental violence and children´s long-term psychological distress, and the extent to which this relation is mediated by deteriorating parenting practices (i.e., harsh discipline, affection/support, interparental and intraparental consistency. The second objective was to analyze the possible gender differences in the relationships specified. The sample comprised 680 Spanish university students (62.4% females selected by random, stratified, and proportional sampling (by faculty and sex. Participants retrospectively reported the physical and psychological violence perpetrated by one of his or her parents against the other, the parenting practices when they were preadolescents, and the psychological distress during the past two weeks. Results revealed that harsh discipline and the level of affection and affection/support partially mediated the association between children´s witnessing interparental violence and their long-term psychological distress. These relationships were not significantly different as a function of participants´ sex. Lastly, we discuss the implications of these findings for the planning and development of intervention programs.

  14. Homeopathic medical practice: Long-term results of a cohort study with 3981 patients

    Directory of Open Access Journals (Sweden)

    Baur Roland

    2005-11-01

    Full Text Available Abstract Background On the range of diagnoses, course of treatment, and long-term outcome in patients who chose to receive homeopathic medical treatment very little is known. We investigated homeopathic practice in an industrialized country under everyday conditions. Methods In a prospective, multicentre cohort study with 103 primary care practices with additional specialisation in homeopathy in Germany and Switzerland, data from all patients (age >1 year consulting the physician for the first time were observed. The main outcome measures were: Patient and physician assessments (numeric rating scales from 0 to 10 and quality of life at baseline, and after 3, 12, and 24 months. Results A total of 3,981 patients were studied including 2,851 adults (29% men, mean age 42.5 ± 13.1 years; 71% women, 39.9 ± 12.4 years and 1,130 children (52% boys, 6.5 ± 3.9 years; 48% girls, 7.0 ± 4.3 years. Ninety-seven percent of all diagnoses were chronic with an average duration of 8.8 ± 8 years. The most frequent diagnoses were allergic rhinitis in men, headache in women, and atopic dermatitis in children. Disease severity decreased significantly (p Conclusion Disease severity and quality of life demonstrated marked and sustained improvements following homeopathic treatment period. Our findings indicate that homeopathic medical therapy may play a beneficial role in the long-term care of patients with chronic diseases.

  15. The effect of long term combined yoga practice on the basal metabolic rate of healthy adults

    Directory of Open Access Journals (Sweden)

    Nagendra HR

    2006-08-01

    Full Text Available Abstract Background Different procedures practiced in yoga have stimulatory or inhibitory effects on the basal metabolic rate when studied acutely. In daily life however, these procedures are usually practiced in combination. The purpose of the present study was to investigate the net change in the basal metabolic rate (BMR of individuals actively engaging in a combination of yoga practices (asana or yogic postures, meditation and pranayama or breathing exercises for a minimum period of six months, at a residential yoga education and research center at Bangalore. Methods The measured BMR of individuals practicing yoga through a combination of practices was compared with that of control subjects who did not practice yoga but led similar lifestyles. Results The BMR of the yoga practitioners was significantly lower than that of the non-yoga group, and was lower by about 13 % when adjusted for body weight (P Conclusion This study shows that there is a significantly reduced BMR, probably linked to reduced arousal, with the long term practice of yoga using a combination of stimulatory and inhibitory yogic practices.

  16. Long-term cost-effectiveness of single indirect restorations in selected dental practices.

    Science.gov (United States)

    Kelly, P G; Smales, R J

    2004-05-22

    To determine the relative cost-effectiveness of alternative methods for restoring large tooth substance loss in adults. Long-term survival estimates and discounted costs for 245 large indirect restorations were used to calculate their incremental cost-effectiveness over 15 years when compared with direct placement Class II cusp-overlay amalgams and Class IV multisurface resin composites, placed in 100 patients from three private dental practices. The direct placement restorations were more cost-effective than the indirect restorations at all time intervals over the 15-year study period. The full gold crown and the ceramometal crown were the most cost-effective indirect posterior and anterior restorations respectively. The cast gold onlay and the porcelain jacket crown were the least cost-effective indirect posterior and anterior restorations respectively. When clinically practicable, large direct placement restorations should be placed initially in preference to indirect restorations.

  17. The impact of statin therapy on long-term cardiovascular outcomes in an outpatient cardiology practice

    Science.gov (United States)

    Lai, Hoang M.; Aronow, Wilbert S.; Mercando, Anthony D.; Kalen, Phoenix; Desai, Harit V.; Gandhi, Kaushang; Sharma, Mala; Amin, Harshad; Lai, Trung M.

    2011-01-01

    Summary Background Statins reduce coronary events in patients with coronary artery disease. Material/Methods Chart reviews were performed in 305 patients (217 men and 88 women, mean age 74 years) not treated with statins during the first year of being seen in an outpatient cardiology practice but subsequently treated with statins. Based on the starting date of statins use, the long-term outcomes of myocardial infarction (MI), percutaneous coronary intervention (PCI), and coronary artery bypass graft surgery (CABGS) before and after statin use were compared. Results Mean follow-up was 65 months before statins use and 66 months after statins use. MI occurred in 31 of 305 patients (10%) before statins, and in 13 of 305 patients (4%) after statins (pcardiology practice reduces the incidence of MI, PCI, and CABGS. PMID:22129898

  18. Enabling Long-Term Earth Science Research: Changing Data Practices (Invited)

    Science.gov (United States)

    Baker, K. S.

    2013-12-01

    Data stewardship plans are shaped by our shared experiences. As a result, community engagement and collaborative activities are central to the stewardship of data. Since modes and mechanisms of engagement have changed, we benefit from asking anew: ';Who are the communities?' and ';What are the lessons learned?'. Data stewardship with its long-term care perspective, is enriched by reflection on community experience. This presentation draws on data management issues and strategies originating from within long-term research communities as well as on recent studies informed by library and information science. Ethnographic case studies that capture project activities and histories are presented as resources for comparative analysis. Agency requirements and funding opportunities are stimulating collaborative endeavors focused on data re-use and archiving. Research groups including earth scientists, information professionals, and data systems designers are recognizing the possibilities for new ways of thinking about data in the digital arena. Together, these groups are re-conceptualizing and reconfiguring for data management and data curation. A differentiation between managing data for local use and production of data for re-use remotely in locations and fields remote from the data origin is just one example of the concepts emerging to facilitate development of data management. While earth scientists as data generators have the responsibility to plan new workflows and documentation practices, data and information specialists have responsibility to promote best practices as well as to facilitate the development of community resources such as controlled vocabularies and data dictionaries. With data-centric activities and changing data practices, the potential for creating dynamic community information environments in conjunction with development of data facilities exists but remains elusive.

  19. IRRIGATION PRACTICES IN LONG-TERM SURVIVORS OF COLORECTAL CANCER (CRC) WITH COLOSTOMIES

    Science.gov (United States)

    Grant, Marcia; McMullen, Carmit K.; Altschuler, Andrea; Hornbrook, Mark C.; Herrinton, Lisa J.; Wendel, Christopher S.; Baldwin, Carol M.; Krouse, Robert S.

    2014-01-01

    Creation of a colostomy in colorectal (CRC) cancer patients results in a loss of control over bowel evacuation. The only way to re-establish some control is through irrigation, a procedure that involves instilling fluid into the bowel to allow for gas and fecal output. This article reports on irrigation practices of participants in a large, multi-site, multi-investigator study of health-related quality of life (HR-QOL) in long term CRC survivors. Questions about irrigation practices were identified in open-ended questions within a large HR-QOL survey and in focus groups of men and women with high and low HR-QOL. Descriptive data on survivors were combined with content analysis of irrigation knowledge and practices. Patient education and use of irrigation in the United States has decreased over the years, with no clear identification of why this change in practice has occurred. Those respondents who used irrigation had their surgery longer ago, and spent more time in colostomy care than those that did not irrigate. Reasons for the decrease in colostomy irrigation are unreported and present priorities for needed research. PMID:23022935

  20. Long-term enhancement of maze learning in mice via a generalized Mozart effect.

    Science.gov (United States)

    Aoun, Peter; Jones, Timothy; Shaw, Gordon L; Bodner, Mark

    2005-12-01

    An animal model of the 'generalized Mozart effect' (GME) - enhanced/normalized higher brain function in response to music exposure - has been established. We extend those results in two studies using another species (mice). Study 1: (1) maze testing after music exposure was extended to a minimum of 6 hours; (2) no exposure to music in utero. Study 2: (1) music exposure time further reduced; (2) maze testing extended to 24 hours. Study 1: two mouse groups were exposed to music continuously for 10 hours per day for 10 weeks (Group I: Mozart's Sonata K.448, Group II: Beethoven's Fur Elise). After 10 weeks, the ability to negotiate a T-maze was assessed (recording working time in maze, number of errors). Maze ability was tested 6 hours following the last music exposure. Study 2: two mouse groups were exposed periodically to music (58% silence) 10 hours per day for 10 weeks. Experiments after 10 weeks examined the groups' abilities to run the maze (recording working time/errors). Experiments were conducted 24 hours following the last music exposure. The Mozart group exhibited significant enhancements compared with the control mice in both studies, i.e. significantly lower working time (p<0.05) and committed fewer errors. Observation of GME in another species supports its generality for the mammalian cortex. The absence of a GME in fMRI studies for the control music also indicates a neurophysiological basis. With extended exposure, GME is a long-term effect, indicating potential clinical importance. It has been demonstrated that GME reduces neuropathological spiking significantly in epileptics. We discuss the relevance of this study for epilepsy treatment.

  1. [Dental care and oral hygiene practices in long-term geriatric care institutions].

    Science.gov (United States)

    Ferreira, Raquel Conceição; Schwambach, Carolina Wolff; de Magalhães, Cláudia Silami; Moreira, Allyson Nogueira

    2011-04-01

    This study evaluated the activities of dentists, dental care and oral hygiene practices in the long-term care institutions of Belo Horizonte (Minas Gerais, Brazil). A semi-structured questionnaire was handed out to the coordinators of 37 philanthropic and 30 private institutions. The data was compared by the chi-square and Fisher's Exact Tests. 81% of the questionnaires were answered. The majority of the private (74.2%) and philanthropic institutions (87%) do not have a dentist (p=0.21). The location, period of existence, type institution kind and number of residents weren't factors regarding the presence of a dentist (p>0.05). 67% of the philanthropic institutions with equipped consultation rooms had dentists, though there were none when there was no consultation room. Even without consultation rooms, 13% of the private institutions had dentists. When necessary, 69.6% of the philanthropic institutions refer the elderly to public health centers, while 58.1% of the private institutions refer them to their family dentists. A higher percentage of the private institutions adopted systematic oral hygiene procedures (p=0.01), with a considerable divergence of treatment reported. There is a need to include a dentist on the health staff in the institutions and for systematization of oral hygiene practices.

  2. Pathways for best practice diffusion: the structure of informal relationships in Canada's long-term care sector.

    Science.gov (United States)

    Dearing, James W; Beacom, Amanda M; Chamberlain, Stephanie A; Meng, Jingbo; Berta, Whitney B; Keefe, Janice M; Squires, Janet E; Doupe, Malcolm B; Taylor, Deanne; Reid, Robert Colin; Cook, Heather; Cummings, Greta G; Baumbusch, Jennifer L; Knopp-Sihota, Jennifer; Norton, Peter G; Estabrooks, Carole A

    2017-02-03

    Initiatives to accelerate the adoption and implementation of evidence-based practices benefit from an association with influential individuals and organizations. When opinion leaders advocate or adopt a best practice, others adopt too, resulting in diffusion. We sought to identify existing influence throughout Canada's long-term care sector and the extent to which informal advice-seeking relationships tie the sector together as a network. We conducted a sociometric survey of senior leaders in 958 long-term care facilities operating in 11 of Canada's 13 provinces and territories. We used an integrated knowledge translation approach to involve knowledge users in planning and administering the survey and in analyzing and interpreting the results. Responses from 482 senior leaders generated the names of 794 individuals and 587 organizations as sources of advice for improving resident care in long-term care facilities. A single advice-seeking network appears to span the nation. Proximity exhibits a strong effect on network structure, with provincial inter-organizational networks having more connections and thus a denser structure than interpersonal networks. We found credible individuals and organizations within groups (opinion leaders and opinion-leading organizations) and individuals and organizations that function as weak ties across groups (boundary spanners and bridges) for all studied provinces and territories. A good deal of influence in the Canadian long-term care sector rests with professionals such as provincial health administrators not employed in long-term care facilities. The Canadian long-term care sector is tied together through informal advice-seeking relationships that have given rise to an emergent network structure. Knowledge of this structure and engagement with its opinion leaders and boundary spanners may provide a route for stimulating the adoption and effective implementation of best practices, improving resident care and strengthening the long-term

  3. Towards a practical Johnson noise thermometer for long-term measurements in harsh environments

    Energy Technology Data Exchange (ETDEWEB)

    Greenen, Adam; Pearce, Jonathan [National Physical Laboratory, Hampton Road, Teddington, TW11 0LW, (United Kingdom); Cruickshank, David; Bramley, Paul [Metrosol Limited, Plum Park Estate, Watling Street, Paulerspury, Northamptonshire, NN12 6LQ, (United Kingdom)

    2015-07-01

    The impact of mechanical and chemical changes in conventional sensors such as thermocouples and resistance thermometers can be avoided by instead using temperature sensors based on fundamental thermometry. A prime example of this is Johnson noise thermometry, which is based on measurement of the fluctuations in the voltage of a resistor arising from thermal motion of charge carriers - i.e. the 'Johnson noise'. A Johnson noise thermometer never needs calibration and is insensitive to the condition of the sensor material. It is therefore ideally suited to long-term temperature measurements in harsh environments, such as nuclear reactor coolant circuits, in-pile measurements, nuclear waste management and storage, and severe accident monitoring. There have been a number of previous attempts to develop a Johnson noise thermometer for the nuclear industry, but none have reached commercial exploitation because of technical problems in practical implementation. The main challenge is to extract the tiny Johnson noise signal from ambient electrical noise influences, both from the internal amplification electronics, and from external electrical noise sources. Recent advances in electronics technology and digital signal processing techniques have opened up new possibilities for developing a viable, practical Johnson noise thermometer. We describe a project funded by the UK Technology Strategy Board (now Innovate UK) 'Developing the nuclear supply chain' call, currently underway, to develop a practical Johnson noise thermometer that makes use of innovative electronics for ultralow noise amplification and signal processing. The new electronics technology has the potential to help overcome the problems encountered with previous attempts at constructing a practical Johnson noise thermometer. An outline of the new developments is presented, together with an overview of the current status of the project. (authors)

  4. Idosos asilados em hospitais gerais Long-term care elderly residents in general hospitals

    Directory of Open Access Journals (Sweden)

    Milton Luiz Gorzoni

    2006-12-01

    Full Text Available Instituições de longa permanência para idosos interagem periodicamente com hospitais gerais para internações de casos agudos ou dos que necessitam de métodos diagnósticos complexos e da atenção de várias especialidades simultaneamente. A decisão de indicar hospitalização é multifatorial, sendo influenciada por circunstâncias como a gravidade do quadro clínico e a infra-estrutura das instituições de longa permanência para idosos. Internações hospitalares apresentam benefícios e riscos, como o desenvolvimento de iatrogenias, delirium e declínios funcionais, podendo resultar em piora do estado geral e da qualidade de vida do idoso asilado durante e/ou após a hospitalização. O objetivo do estudo foi abordar aspectos peculiares na avaliação, tratamento e manejo de idosos asilados em internações hospitalares, particularmente quanto a cuidados que os auxiliem efetivamente nessas circunstâncias. Discutiram-se situações freqüentes como delirium, iatrogenias, desnutrição, declínio funcional e cuidados paliativos e características próprias de residentes em instituições para idosos durante internações em hospitais gerais.Long-term care facilities for the elderly have regularly to work together with general hospitals to provide care to acutely ill residents or when they require all together more complex diagnostic procedures and multi-specialty care. The decision to hospitalize a nursing home elderly resident is multifactorial and it is based on factors such as illness severity and care facility infrastructure. Hospitalizations have benefits and risks such developing iatrogenic diseases, delirium, and functional decline, which may deteriorate patients' general condition and their quality of life during and/or after hospitalization. This study aimed at addressing specific aspects of assessment, treatment and management of nursing home elderly who require to be hospitalized, especially focusing on their effective care

  5. General health status of long-term cervical cancer survivors after radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sung Uk; Park, Ji Eun [National Cancer Center, Proton Therapy Center, Research Institute and Hospital, Goyang (Korea, Republic of); Kim, Young Ae [National Cancer Center, Cancer Policy Branch, Research Institute and Hospital, Goyang (Korea, Republic of); Yoon, Young-Ho [Seoul National University College of Medicine, Cancer Research Institute, Seoul (Korea, Republic of); Kim, Yeon-Joo [National Cancer Center, Proton Therapy Center, Research Institute and Hospital, Goyang (Korea, Republic of); National Cancer Center, Center for Uterine Cancer, Research Institute and Hospital, Goyang (Korea, Republic of); Lim, Myong Cheol [National Cancer Center, Center for Uterine Cancer, Research Institute and Hospital, Goyang (Korea, Republic of); National Cancer Center, Gynecologic Cancer Branch, Research Institute and Hospital, Goyang (Korea, Republic of); National Cancer Center, Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, Goyang (Korea, Republic of); Park, Sang-Yoon; Seo, Sang-Soo [National Cancer Center, Center for Uterine Cancer, Research Institute and Hospital, Goyang (Korea, Republic of); Kim, Joo-Young [National Cancer Center, Proton Therapy Center, Research Institute and Hospital, Goyang (Korea, Republic of); National Cancer Center, Center for Uterine Cancer, Research Institute and Hospital, Goyang (Korea, Republic of); National Cancer Center, Research Institute and Hospital, Goyang (Korea, Republic of)

    2017-07-15

    To evaluate the global health status of long-term cervical cancer survivors (LCCS) who survived for more than 4 years after curative radiation treatment (RT). Medical records of 562 women treated with RT in our institution between 2003 and 2010 were reviewed. Excluding 259 women who died of disease or were lost to follow-up, disease status and late morbidities were evaluated in 303 LCCS. Quality of life (QoL) was analyzed in 168 LCCS using a questionnaire from the European Organization for the Research and Treatment of Cancer, and the results were compared with an age-matched healthy Korean female population. Median follow-up was 6.8 years (range 4.1-12.5 years). There were 14 deaths (7 cancer specific) and 14 recurrences (5 local recurrences and 9 distant metastases). The median time to recurrence was 6.0 years (range 4.1-8.2 years). Grade ≥2 late toxicities were frequently observed in the bladder (19%) and small/large intestine (15%). Multivariate analysis revealed a higher rate of late toxicity in patients aged ≥51 years at diagnosis (small/large intestine: hazard ratio, HR, 2.5 [1.2-5.5]; bladder: HR 2.4 [1.3-4.5]; and bone: HR 4.3 [1.2-15.8]) than patients aged <51 years. Compared to the general population, LCCS exhibited a significantly higher rate of body image concerns, sexual dysfunction, lymphedema, and peripheral neuropathy. New recurrences occurred in 5% of LCCS and grade ≥2 treatment-related morbidities were present in 33%. A significant proportion of LCCS also showed decreased cervical-cancer-specific QoL. These results suggest the need for long-term surveillance and follow-up care for LCCS. (orig.) [German] Bewertung des allgemeinen Gesundheitsstatus bei Langzeitueberlebenden von Gebaermutterhalskrebs (LCCS), die nach Strahlenbehandlung (RT) mehr als 4 Jahre lebten. Ueberprueft wurden Krankenakten von 562 Frauen, die zwischen 2003 und 2010 in unserem Institut mit RT behandelt wurden. Ausgeschlossen wurden 259 Frauen, die aufgrund der Erkrankung

  6. Modelling long-term sustainability of irrigation practices in semi arid region

    Science.gov (United States)

    Guyennon, Nicolas; Romano, Emanuele; Portoghese, Ivan

    2016-04-01

    The impact of climate change on groundwater or surface water resources can be investigated through models simulating the hydrological and hydrogeological processes at the atmosphere/surface water/soil/groundwater interfaces. However, in aquifers extensively exploited for irrigation purposes, the water demand variability related to actual water availability, as well as to variation of the crops, and associated supply management options should be considered to evaluate impacts. Moreover, in the case of a multi-resources water supply system it is necessary to develop models able to simulate also the variation of the total demand distribution among each resource. We proposed a modeling scheme able to simulate an integrated multiple-resources and multiple-purposes water supply system by merging distributed crop water requirements with surface reservoir and ground water mass balance, considering resources availability and management, with emphasis on irrigation practices. The overall framework has been implemented for the case study of the Fortore water supply system, a semi-arid region in south Italy. It permits to simulate the conjunctive use of the water from the Occhito artificial reservoir (160 Mm3) and from groundwater to supply domestic, industrial and agricultural demand. The overall model successfully reproduces the Occhito dam level variability (both seasonal and inter-annual) as well as the observed groundwater depletion. The proposed model was forced by 60 years of meteorological observation to test the long-term sustainability of the current irrigation practices and has been extended to the next decades under a1b IPCC scenario using three ENSEMBLES member to test adaptation strategies.

  7. Impact of coastal management practice on long-term foredune behaviour

    Science.gov (United States)

    Wijnberg, Kathelijne M.; Bochev-van der Burgh, Lisette M.

    2010-05-01

    Coastal dunes located in densely populated areas provide various services to man, such as protection against flooding during storm surges, recreation, and nature conservation. As a result, man will interfere with the natural dynamics of coastal dunes if these negatively affect these functions. For example, local storm erosion of the foredune will reduce the safety level of dunes as flooding defence, or the resulting steep dune front can be perceived as a public safety issue (collapse). Usually, the applied management interventions aim at restoring the pre-storm situation. As such they result in an increased recovery rate from an erosional event as compared to post-storm recovery rates occurring without human intervention. The above raises the question whether the usually localized and intermittent human interventions will actually interfere with the long term evolution of the foredune area. And if so, whether these short term management interventions can turn out to be detrimental to the persistence of these functions in the long run. Especially for the flooding defence functionality this is of importance, as we can expect natural drivers of coastal behaviour, such as storm climatology and mean sea level stand, to change over the next century. To increase insight in the above issues we performed a case study on the behaviour of managed foredunes along the Holland coast (The Netherlands). Information on the morphologic behaviour was extracted by EOF-analysis from a 40 year data set (1965-2004) of annual, high-resolution elevation surveys of the subaerial part of coastal profile along about 90 km of coastline. Information on the applied dune management during this period was retrieved from documents as well as from interviews with coastal managers with long-term involvement in the actual dune maintenance practice in the studied area. It appeared that during the studied period the coastal management policy changed from being essentially reactive in nature to being pro

  8. Imaging windows for long-term intravital imaging: General overview and technical insights.

    Science.gov (United States)

    Alieva, Maria; Ritsma, Laila; Giedt, Randy J; Weissleder, Ralph; van Rheenen, Jacco

    2014-01-01

    Intravital microscopy is increasingly used to visualize and quantitate dynamic biological processes at the (sub)cellular level in live animals. By visualizing tissues through imaging windows, individual cells (e.g., cancer, host, or stem cells) can be tracked and studied over a time-span of days to months. Several imaging windows have been developed to access tissues including the brain, superficial fascia, mammary glands, liver, kidney, pancreas, and small intestine among others. Here, we review the development of imaging windows and compare the most commonly used long-term imaging windows for cancer biology: the cranial imaging window, the dorsal skin fold chamber, the mammary imaging window, and the abdominal imaging window. Moreover, we provide technical details, considerations, and trouble-shooting tips on the surgical procedures and microscopy setups for each imaging window and explain different strategies to assure imaging of the same area over multiple imaging sessions. This review aims to be a useful resource for establishing the long-term intravital imaging procedure.

  9. Searching for long-term trends in prehistoric manuring practice. δ15N analyses of charred cereal grains from the 4th to the 1st millennium BC

    DEFF Research Database (Denmark)

    Kanstrup, Marie; Holst, M.K.; Jensen, Peter Mose

    2014-01-01

    investigation of long term trends in δ15N values of charred cereal grains, which previous research have proposed as an indicator for prehistoric manuring practice. Our study suggests a long-term (3900–500 BC) decrease of manuring intensity in emmer cropping. Conversely the long-term (2300 BC – AD 1) trend...

  10. General Inattentiveness Is a Long-Term Reliable Trait Independently Predictive of Psychological Health

    DEFF Research Database (Denmark)

    Jensen, Christian Gaden; Niclasen, Janni; Vangkilde, Signe

    2016-01-01

    The Mindful Attention Awareness Scale (MAAS) measures perceived degree of inattentiveness in different contexts and is often used as a reversed indicator of mindfulness. MAAS is hypothesized to reflect a psychological trait or disposition when used outside attentional training contexts, but the l......The Mindful Attention Awareness Scale (MAAS) measures perceived degree of inattentiveness in different contexts and is often used as a reversed indicator of mindfulness. MAAS is hypothesized to reflect a psychological trait or disposition when used outside attentional training contexts......, but the long-term test-retest reliability of MAAS scores is virtually untested. It is unknown whether MAAS predicts psychological health after controlling for standardized socioeconomic status classifications. First, MAAS translated to Danish was validated psychometrically within a randomly invited healthy...... adult community sample (N = 490). Factor analysis confirmed that MAAS scores quantified a unifactorial construct of excellent composite reliability and consistent convergent validity. Structural equation modeling revealed that MAAS scores contributed independently to predicting psychological distress...

  11. Human Land-Use Practices Lead to Global Long-Term Increases in Photosynthetic Capacity

    Science.gov (United States)

    Mueller, Thomas; Tucker, Compton J.; Dressler, Gunnar; Pinzon, Jorge E.; Leimgruber, Peter; Dubayah, Ralph O.; Hurtt, George C.; Boehning-Gaese, Katrin; Fagan, William F.

    2014-01-01

    Long-term trends in photosynthetic capacity measured with the satellite-derived Normalized Difference Vegetation Index (NDVI) are usually associated with climate change. Human impacts on the global land surface are typically not accounted for. Here, we provide the first global analysis quantifying the effect of the earth's human footprint on NDVI trends. Globally, more than 20% of the variability in NDVI trends was explained by anthropogenic factors such as land use, nitrogen fertilization, and irrigation. Intensely used land classes, such as villages, showed the greatest rates of increase in NDVI, more than twice than those of forests. These findings reveal that factors beyond climate influence global long-term trends in NDVI and suggest that global climate change models and analyses of primary productivity should incorporate land use effects.

  12. Human Land-Use Practices Lead to Global Long-Term Increases in Photosynthetic Capacity

    Directory of Open Access Journals (Sweden)

    Thomas Mueller

    2014-06-01

    Full Text Available Long-term trends in photosynthetic capacity measured with the satellite-derived Normalized Difference Vegetation Index (NDVI are usually associated with climate change. Human impacts on the global land surface are typically not accounted for. Here, we provide the first global analysis quantifying the effect of the earth’s human footprint on NDVI trends. Globally, more than 20% of the variability in NDVI trends was explained by anthropogenic factors such as land use, nitrogen fertilization, and irrigation. Intensely used land classes, such as villages, showed the greatest rates of increase in NDVI, more than twice than those of forests. These findings reveal that factors beyond climate influence global long-term trends in NDVI and suggest that global climate change models and analyses of primary productivity should incorporate land use effects.

  13. Influence of long-term Sahaja Yoga meditation practice on emotional processing in the brain: An ERP study.

    Science.gov (United States)

    Reva, N V; Pavlov, S V; Loktev, K V; Korenyok, V V; Aftanas, L I

    2014-12-05

    Despite growing interest in meditation as a tool for alternative therapy of stress-related and psychosomatic diseases, brain mechanisms of beneficial influences of meditation practice on health and quality of life are still unclear. We propose that the key point is a persistent change in emotional functioning, specifically the modulation of the early appraisal of motivational significance of events. The main aim was to study the effects of long-term meditation practice on event-related brain potentials (ERPs) during affective picture viewing. ERPs were recorded in 20 long-term Sahaja Yoga meditators and 20 control subjects without prior experience in meditation. The meditators' mid-latency (140-400ms) ERPs were attenuated for both positive and negative pictures (i.e. there were no arousal-related increases in ERP positivity) and this effect was more prominent over the right hemisphere. However, we found no differences in the long latency (400-800ms) responses to emotional images, associated with meditation practice. In addition we found stronger ERP negativity in the time window 200-300ms for meditators compared to the controls, regardless of picture valence. We assume that long-term meditation practice enhances frontal top-down control over fast automatic salience detection, based on amygdala functions. Copyright © 2014 IBRO. Published by Elsevier Ltd. All rights reserved.

  14. Long-term mortality rates (>8-year) improve as compared to the general and obese population following bariatric surgery.

    Science.gov (United States)

    Telem, Dana A; Talamini, Mark; Shroyer, A Laurie; Yang, Jie; Altieri, Maria; Zhang, Qiao; Gracia, Gerald; Pryor, Aurora D

    2015-03-01

    Sparse data are available on long-term patient mortality following bariatric surgery as compared to the general population. The purpose of this study was to assess long-term mortality rates and identify risk factors for all-cause mortality following bariatric surgery. New York State (NYS) Planning and Research Cooperative System (SPARCS) longitudinal administrative data were used to identify 7,862 adult patients who underwent a primary laparoscopic bariatric surgery from 1999 to 2005. The Social Security Death Index database identified >30-day mortalities. Risk factors for mortality were screened using a univariate Cox proportional hazard (PH) model and analyzed using a multiple PH model. Based on age, gender, and race/ethnicity, actuarial projections for NYS mortality rates obtained from Centers of Disease Control were compared to the actual post-bariatric surgery mortality rates observed. The mean bariatric mortality rate was 2.5 % with 8-14 years of follow-up. Mean time to death ranged from 4 to 6 year and did not differ by operation (p = 0.073). From 1999 to 2010, the actuarial mortality rate predicted for the general NYS population was 2.1 % versus the observed 1.5 % for the bariatric surgery population (p = 0.005). Extrapolating to 2013, demonstrated the actuarial mortality predictions at 3.1 % versus the bariatric surgery patients' observed morality rate of 2.5 % (p = 0.01). Risk factors associated with an earlier time to death included: age, male gender, Medicare/Medicaid insurance, congestive heart failure, rheumatoid arthritis, pulmonary circulation disorders, and diabetes. No procedure-specific or perioperative complication impact for time-to-death was found. Long-term mortality rate of patients undergoing bariatric surgery significantly improves as compared to the general population regardless of bariatric operation performed. Additionally, perioperative complications do not increase long-term mortality risk. This study did identify specific patient

  15. Long-Term use of Modified Diets in Huntington's Disease: A Descriptive Clinical Practice Analysis on Improving Dietary Enjoyment.

    Science.gov (United States)

    Moorhouse, Bronwyn; Fisher, Caroline A

    2016-01-01

    Dysphagia is a very common occurrence in Huntington's disease (HD). As such, many people with HD require texture modified diets. This commentary discusses the implications for individuals living long-term on modified diets, including the loss of sensory stimulation and dietary enjoyment. Clinical practice analyses of two interventions aimed at promoting dietary satisfaction and involvement in food preparation for those with HD are described and parameters for future research are discussed.

  16. Long-term stability of a torque-balance variometer with photoelectric converters in observatory practice

    Science.gov (United States)

    Jankowski, J.; Marianiuk, J.; Ruta, A.; Sucksdorff, C.; Kivinen, M.

    1984-07-01

    Conventional magnetometers of the Bobrov type were equipped with photoelectric converters and feedback loops having a feedback factor of 1000. Tests made at the Belsk and Nurmijärvi Observatories demonstrated that: (a) the long-term stability of the base-line values was the same or better than that in conventional magnetometers (e.g. at Nurmijärvi), i.e. the changes were less than 0.5 nT a month; (b) the short-term stability was the same as in the conventional magnetometers: (c) the reliability of the instrument was good, the time between failures in the instruments tested being more than a year: (d) the same instruments can be used simultaneously for normal recording and for recording magnetic pulsations.

  17. Long-Term Clinical Practice Experience with Cinacalcet for Treatment of Hypercalcemic Hyperparathyroidism after Kidney Transplantation

    Directory of Open Access Journals (Sweden)

    Ursula Thiem

    2015-01-01

    Full Text Available Within this prospective, open-label, self-controlled study, we evaluated the long-term effects of the calcimimetic cinacalcet on calcium and phosphate homeostasis in 44 kidney transplant recipients (KTRs with hypercalcemic hyperparathyroidism by comparing biochemical parameters of mineral metabolism between pre- and posttreatment periods. Results are described as mean differences (95% CIs between pre- and posttreatment medians that summarize all repeated measurements of a parameter of interest between the date of initial hypercalcemia and cinacalcet initiation (median of 1.6 (IQR: 0.6–3.8 years and up to four years after treatment start, respectively. Cinacalcet was initiated after 1.8 (0.8–4.7 years posttransplant and maintained for 6.2 (3.9–7.6 years. It significantly decreased total serum calcium (−0.30 (−0.34 to −0.26 mmol/L, P<0.001 and parathyroid hormone levels (−79 (−103 to −55 pg/mL, P<0.001. Serum levels of inorganic phosphate (Pi and renal tubular reabsorption of phosphate to glomerular filtration rate (TmP/GFR increased simultaneously (Pi: 0.19 (0.15–0.23 mmol/L, P<0.001, TmP/GFR: 0.20 (0.16–0.23 mmol/L, P<0.001. In summary, cinacalcet effectively controlled hypercalcemic hyperparathyroidism in KTRs in the long-term and increased low Pi levels without causing hyperphosphatemia, pointing towards a novel indication for the use of cinacalcet in KTRs.

  18. Long-term clinical practice experience with cinacalcet for treatment of hypercalcemic hyperparathyroidism after kidney transplantation.

    Science.gov (United States)

    Thiem, Ursula; Gessl, Alois; Borchhardt, Kyra

    2015-01-01

    Within this prospective, open-label, self-controlled study, we evaluated the long-term effects of the calcimimetic cinacalcet on calcium and phosphate homeostasis in 44 kidney transplant recipients (KTRs) with hypercalcemic hyperparathyroidism by comparing biochemical parameters of mineral metabolism between pre- and posttreatment periods. Results are described as mean differences (95% CIs) between pre- and posttreatment medians that summarize all repeated measurements of a parameter of interest between the date of initial hypercalcemia and cinacalcet initiation (median of 1.6 (IQR: 0.6-3.8) years) and up to four years after treatment start, respectively. Cinacalcet was initiated after 1.8 (0.8-4.7) years posttransplant and maintained for 6.2 (3.9-7.6) years. It significantly decreased total serum calcium (-0.30 (-0.34 to -0.26) mmol/L, P < 0.001) and parathyroid hormone levels (-79 (-103 to -55) pg/mL, P < 0.001). Serum levels of inorganic phosphate (Pi) and renal tubular reabsorption of phosphate to glomerular filtration rate (TmP/GFR) increased simultaneously (Pi: 0.19 (0.15-0.23) mmol/L, P < 0.001, TmP/GFR: 0.20 (0.16-0.23) mmol/L, P < 0.001). In summary, cinacalcet effectively controlled hypercalcemic hyperparathyroidism in KTRs in the long-term and increased low Pi levels without causing hyperphosphatemia, pointing towards a novel indication for the use of cinacalcet in KTRs.

  19. Long-term forecasts of road traffic fatalities in the European Union : general methods and results.

    NARCIS (Netherlands)

    Stipdonk, H. & Wesemann, P.

    2007-01-01

    This report describes methods to forecast road crash fatalities. The methods were used in two European Union studies, Impact Assessment and ASSESS. These studies were both carried out in 2005. This report describes the general method, compares the applications in the two studies and presents the res

  20. Practical management of NSCLC patients with long-term bevacizumab treatment: a report of four cases

    Directory of Open Access Journals (Sweden)

    Herder GJM

    2013-10-01

    Full Text Available GJM Herder,1 H Codrington,2 CD Colder,3 JG Aerts4,51St Antonius Hospital, Nieuwegein, The Netherlands; 2Haga Hospital, The Hague, The Netherlands; 3St Jansdal Hospital, Harderwijk, The Netherlands; 4Amphia Hospital, Breda; 5Erasmus MC Rotterdam, The NetherlandsIntroduction: Previous research showed that the addition of bevacizumab (a monoclonal antibody against vascular endothelial growth factor [VEGF] to chemotherapy resulted in a significant efficacy benefit in the treatment of selected patients with advanced nonsquamous non–small cell lung cancer (NSCLC. However, the occurrence and management of adverse events (AEs during long-term maintenance treatment with bevacizumab is not well known.Methods: This report presents a descriptive analysis, including the management of AEs, of four patients with advanced NSCLC, who received a relatively long period of bevacizumab maintenance treatment.Results: In patient 1, a 72-year-old retired man with stage cT2N2M1b NSCLC, the only AE related to bevacizumab was a grade 1 rhinorrhea. Treatment resulted in a stable disease, with duration of response of 38 months. Patient 2 had NSCLC stage cT4N3M1b and developed a cavitation and infection after the first cycle of chemotherapy and bevacizumab, which caused a temporary decrease of her quality of life. Bevacizumab therapy resulted in a partial response, with duration of response of 15 months. A 52-year-old female (patient 3 with stage T2bN2M1a NSCLC is currently under treatment and has so far received 42 cycles of maintenance bevacizumab, with stabilized response (duration of response of 29 months and no noteworthy AEs. The last patient is a 74-year-old male farmer with NSCLC T1N0M1, whose response has lasted for more than 3 years, with until now, no AEs.Conclusion: Our retrospective findings of these four patients show the long-term efficacy and safety of bevacizumab treatment in a real-life setting.Keywords: lung cancer, non–small cell lung cancer

  1. Impact of long term Yoga practice on sleep quality and quality of life in the elderly

    Directory of Open Access Journals (Sweden)

    Mangesh A Bankar

    2013-01-01

    Full Text Available Background: Sleep disturbances and decline in the physical functionality are common conditions associated with aging. Pharmacological treatment of sleep disturbances can be associated with various adverse effects. Short term trials of Yoga on sleep have shown beneficial effects. Objectives: To evaluate the effect of long-term Yoga exercises on sleep quality and quality of life (QOL in the elderly. Materials and Methods: This was a cross-sectional study in which data were collected from elderly people aged 60 years or more living in Nagpur city. We employed two types of survey questionnaires: Pittsburgh sleep quality index (PSQI and QOL Leiden-Padua (LEIPAD Questionnaire. A total of 65 elderly men and women who signed an informed consent and completed questionnaires were included in the study. Sleep quality score PSQI and QOL (LEIPAD Questionnaire score of the study group were evaluated and compared with the control group using Mann-Whitney U test. Results: Total PSQI score in Yoga group was lower than that of the control group. Also various QOL scores of the Yoga groups were higher than the control group. Conclusion: Addition of regular Yoga exercises in the daily routine of elderly people can help to achieve good sleep quality as well as improve the QOL.

  2. Effect of general anesthesia in infancy on long-term recognition memory in humans and rats.

    Science.gov (United States)

    Stratmann, Greg; Lee, Joshua; Sall, Jeffrey W; Lee, Bradley H; Alvi, Rehan S; Shih, Jennifer; Rowe, Allison M; Ramage, Tatiana M; Chang, Flora L; Alexander, Terri G; Lempert, David K; Lin, Nan; Siu, Kasey H; Elphick, Sophie A; Wong, Alice; Schnair, Caitlin I; Vu, Alexander F; Chan, John T; Zai, Huizhen; Wong, Michelle K; Anthony, Amanda M; Barbour, Kyle C; Ben-Tzur, Dana; Kazarian, Natalie E; Lee, Joyce Y Y; Shen, Jay R; Liu, Eric; Behniwal, Gurbir S; Lammers, Cathy R; Quinones, Zoel; Aggarwal, Anuj; Cedars, Elizabeth; Yonelinas, Andrew P; Ghetti, Simona

    2014-09-01

    Anesthesia in infancy impairs performance in recognition memory tasks in mammalian animals, but it is unknown if this occurs in humans. Successful recognition can be based on stimulus familiarity or recollection of event details. Several brain structures involved in recollection are affected by anesthesia-induced neurodegeneration in animals. Therefore, we hypothesized that anesthesia in infancy impairs recollection later in life in humans and rats. Twenty eight children ages 6-11 who had undergone a procedure requiring general anesthesia before age 1 were compared with 28 age- and gender-matched children who had not undergone anesthesia. Recollection and familiarity were assessed in an object recognition memory test using receiver operator characteristic analysis. In addition, IQ and Child Behavior Checklist scores were assessed. In parallel, thirty three 7-day-old rats were randomized to receive anesthesia or sham anesthesia. Over 10 months, recollection and familiarity were assessed using an odor recognition test. We found that anesthetized children had significantly lower recollection scores and were impaired at recollecting associative information compared with controls. Familiarity, IQ, and Child Behavior Checklist scores were not different between groups. In rats, anesthetized subjects had significantly lower recollection scores than controls while familiarity was unaffected. Rats that had undergone tissue injury during anesthesia had similar recollection indices as rats that had been anesthetized without tissue injury. These findings suggest that general anesthesia in infancy impairs recollection later in life in humans and rats. In rats, this effect is independent of underlying disease or tissue injury.

  3. [Long-term dental interventions in mentally retarded children under general anesthesia with sevoflurane].

    Science.gov (United States)

    Sitkin, S I; Gasparian, A L; Ivanova, T Iu; Nesterova, E Iu; Drozdova, N I

    2015-01-01

    Dental procedures in mentally retarded children is challenging for both dentist and for anesthesiologist. The aim of the study was to evaluate the efficacy and safety of dental care procedures under general anesthesia with sevoflurane by means of laryngeal mask in mentally retarded children. The randomized controlled study included 65 mentally retarded children with ASA 2-3 who underwent dental treatment. All patients had multiple caries. The children were divided into two groups. The first group included 35 children with normal body weigh while the second one - 30 obese children. All patients received a rapid induction with sevoflurane with the subsequent installation of the laryngeal mask. In the second group the signs of hypoventilation recorded an average of 10 ± 4 minutes after induction of anesthesia, which was manifested in increasing Pсо₂greater than 50 mm Hg. In the first group, the signs of hypoventilation marked an average of 18 ± 3.5 minutes from the start of induction of anesthesia. All patients were transferred to the artificial lung ventilation through the LMA. By dental treatment under general anesthesia with sevoflurane and laryngeal mask all mentally retarded children had respiratory depression with increased levels of carbon dioxide greater than 50 mmHg, but obese children developed these signs of hypoventilation twice as fast. Conducting long dental treatment in mentally retarded children require artificial lung ventilation.

  4. [Comparison of long-term dental treatment effects of children treated under general anesthesia and passive restraint].

    Science.gov (United States)

    Zhou, F; Xia, B; Zhang, S; Ma, W L; Xiao, Y M; Ge, L H

    2017-02-09

    Objective: To compare the long-term dental treatment effects, oral health habits and oral-health-related qualities of life of children treated under general anesthesia (GA) and passive restraint (PR), respectively. Methods: Twenty seven 2 to 4-year-old children treated under GA and thirty four children treated under PR were recruited in the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology. Up to 2 years after the treatment, a follow up assessment was conducted. The data of general information, dental plaque level and the unplanned treatments were recorded and analyzed. The questionnaire of oral health habits and early childhood oral health impact scale (ECOHIS) for each child was also completed and analyzed. The survival rate and median survival time of the deciduous teeth were calculated. Multivariate analysis was performed by using Cox proportional hazard model. Results: Twenty-five children under GA and 32 under PR were finally included, with a total of 1 098 deciduous teeth. The postoperative dental plaque indicesin both GA and PR groups had significantly improved than that of before the treatments (P=0.019, P<0.001). The oral health habits had also improved, and the improvement in PR group was more obvious than that in GA group. Totally 128 teeth (27.0%) appeared unplanned treatments in GA group and 232 teeth (37.2%) in PR group during the follow-ups. The new caries and recurrent caries in PR group were significantly more than that in GA group (P<0.001, P=0.012). No significant differences were found between the two groups in restoration failure, secondary caries and endodontic diseases (P=0.129, P=0.822, P=0.642). However, the time of occurrence of endodontic disease and secondary caries in GA group were significantly longer than that in PR group (P<0.01, P<0.001). The median survival time of teeth in GA group was 1 018 days comparing to 944 days in PR group. The difference was statistically significant (P<0.05). The

  5. Brain morphometry shows effects of long-term musical practice in middle-aged keyboard players

    Directory of Open Access Journals (Sweden)

    Hanna eGärtner

    2013-09-01

    Full Text Available To what extent does musical practice change the structure of the brain? In order to understand how long-lasting musical training changes brain structure, 20 male right-handed, middle-aged professional musicians and 19 matched controls were investigated. Among the musicians, 13 were pianists or organists with intensive practice regimes. The others were either music teachers at schools or string instrumentalists, who had studied the piano at least as a subsidiary subject, and practiced less intensively. The study was based on T1-weighted MR images, which were analyzed using Deformation Field Morphometry. Cytoarchitectonic probabilistic maps of cortical areas and subcortical nuclei as well as myeloarchitectonic maps of fiber tracts were used as regions of interest to compare volume differences in the brains of musicians and controls. In addition, maps of voxel-wise volume differences were computed and analyzed.Musicians showed a significantly better symmetric motor performance as well as a greater capability of controlling hand independence than controls. Structural MRI-data revealed significant volumetric differences between the brains of keyboard players, who practiced intensively and controls in right sensorimotor areas and the corticospinal tract as well as in the entorhinal cortex and the left superior parietal lobule. Moreover, they showed also larger volumes in a comparable set of regions than the less intensively practicing musicians. The structural changes in the sensory and motor systems correspond well to the behavioral results, and can be interpreted in terms of plasticity as a result of intensive motor training. Areas of the superior parietal lobule and the entorhinal cortex might be enlarged in musicians due to their special skills in sight-playing and memorizing of scores. In conclusion, intensive and specific musical training seems to have an impact on brain structure, not only during the sensitive period of childhood but throughout

  6. Brain morphometry shows effects of long-term musical practice in middle-aged keyboard players.

    Science.gov (United States)

    Gärtner, H; Minnerop, M; Pieperhoff, P; Schleicher, A; Zilles, K; Altenmüller, E; Amunts, K

    2013-01-01

    To what extent does musical practice change the structure of the brain? In order to understand how long-lasting musical training changes brain structure, 20 male right-handed, middle-aged professional musicians and 19 matched controls were investigated. Among the musicians, 13 were pianists or organists with intensive practice regimes. The others were either music teachers at schools or string instrumentalists, who had studied the piano at least as a subsidiary subject, and practiced less intensively. The study was based on T1-weighted MR images, which were analyzed using deformation-based morphometry. Cytoarchitectonic probabilistic maps of cortical areas and subcortical nuclei as well as myeloarchitectonic maps of fiber tracts were used as regions of interest to compare volume differences in the brains of musicians and controls. In addition, maps of voxel-wise volume differences were computed and analyzed. Musicians showed a significantly better symmetric motor performance as well as a greater capability of controlling hand independence than controls. Structural MRI-data revealed significant volumetric differences between the brains of keyboard players, who practiced intensively and controls in right sensorimotor areas and the corticospinal tract as well as in the entorhinal cortex and the left superior parietal lobule. Moreover, they showed also larger volumes in a comparable set of regions than the less intensively practicing musicians. The structural changes in the sensory and motor systems correspond well to the behavioral results, and can be interpreted in terms of plasticity as a result of intensive motor training. Areas of the superior parietal lobule and the entorhinal cortex might be enlarged in musicians due to their special skills in sight-playing and memorizing of scores. In conclusion, intensive and specific musical training seems to have an impact on brain structure, not only during the sensitive period of childhood but throughout life.

  7. A framework and a measurement instrument for sustainability of work practices in long-term care.

    Science.gov (United States)

    Slaghuis, Sarah S; Strating, Mathilde M H; Bal, Roland A; Nieboer, Anna P

    2011-11-16

    In health care, many organizations are working on quality improvement and/or innovation of their care practices. Although the effectiveness of improvement processes has been studied extensively, little attention has been given to sustainability of the changed work practices after implementation. The objective of this study is to develop a theoretical framework and measurement instrument for sustainability. To this end sustainability is conceptualized with two dimensions: routinization and institutionalization. The exploratory methodological design consisted of three phases: a) framework development; b) instrument development; and c) field testing in former improvement teams in a quality improvement program for health care (N teams = 63, N individual = 112). Data were collected not until at least one year had passed after implementation.Underlying constructs and their interrelations were explored using Structural Equation Modeling and Principal Component Analyses. Internal consistency was computed with Cronbach's alpha coefficient. A long and a short version of the instrument are proposed. The χ2- difference test of the -2 Log Likelihood estimates demonstrated that the hierarchical two factor model with routinization and institutionalization as separate constructs showed a better fit than the one factor model (p work practices. Even though the two dimensions routinization and institutionalization are related, they are clearly distinguishable and each has distinct value in the discussion of sustainability. Finally, the subscales conformed to psychometric properties defined in literature. The instrument can be used in the evaluation of improvement projects.

  8. A framework and a measurement instrument for sustainability of work practices in long-term care

    Directory of Open Access Journals (Sweden)

    Slaghuis Sarah S

    2011-11-01

    Full Text Available Abstract Background In health care, many organizations are working on quality improvement and/or innovation of their care practices. Although the effectiveness of improvement processes has been studied extensively, little attention has been given to sustainability of the changed work practices after implementation. The objective of this study is to develop a theoretical framework and measurement instrument for sustainability. To this end sustainability is conceptualized with two dimensions: routinization and institutionalization. Methods The exploratory methodological design consisted of three phases: a framework development; b instrument development; and c field testing in former improvement teams in a quality improvement program for health care (N teams = 63, N individual = 112. Data were collected not until at least one year had passed after implementation. Underlying constructs and their interrelations were explored using Structural Equation Modeling and Principal Component Analyses. Internal consistency was computed with Cronbach's alpha coefficient. A long and a short version of the instrument are proposed. Results The χ2- difference test of the -2 Log Likelihood estimates demonstrated that the hierarchical two factor model with routinization and institutionalization as separate constructs showed a better fit than the one factor model (p Conclusions The theoretical framework offers a valuable starting point for the analysis of sustainability on the level of actual changed work practices. Even though the two dimensions routinization and institutionalization are related, they are clearly distinguishable and each has distinct value in the discussion of sustainability. Finally, the subscales conformed to psychometric properties defined in literature. The instrument can be used in the evaluation of improvement projects.

  9. [Usefulness of group work as a teaching strategy for long-term practical training in the 6-year pharmaceutical education].

    Science.gov (United States)

    Kubo, Kazuko; Okazaki, Hiromi; Ichikawa, Hiroki; Nishihara, Shigeki; Nawa, Hideki; Okazaki, Masatoshi; Kawasaki, Yoichi; Nakura, Hironori; Matsunaga, Hisashi; Sendo, Toshiaki

    2012-01-01

    At the initiation of long-term practical training in the 6-year pharmaceutical education, there are many issues to be solved. For example, it is necessary for teaching pharmacists, who are in charge of both staffing and teaching pharmacy students, to manage their workload with other staff pharmacists. To overcome this situation and to improve the motivation of teaching pharmacists towards student practical training, we twice held group work (GW) sessions for teaching pharmacists, and then evaluated whether such training was effective for their understanding of the Model Core Curriculum for Practical Training and for promoting a higher level of motivation. During the two-day GW discussions, teaching pharmacists, who work daily in the dispensing area, were separated into two groups to discuss teaching skills. A questionnaire survey was completed by participants before and after each GW session. According to the survey, more than 90% of the pharmacists had a higher motivation level for practical training after the sessions. Particularly in the second GW training, the response rate of "being actively involved" improved from 40% to 70%. Furthermore, "The Educational Evaluation Testing" was conducted, which confirmed the increased participant comprehension. The median scores of the comprehensive exams significantly (pteaching pharmacists involved in the practical training of students. We hope that this exercise will lead to higher student motivation and satisfaction during their practical training.

  10. Dynamics of volume of competition practice and facilities of training of jumpers in length and triple in the process of long-term preparation

    Directory of Open Access Journals (Sweden)

    Sovenko S.P.

    2012-12-01

    Full Text Available Analysed and systematized information in relation to the volume of competition practice and facilities of different primary orientation of jumpers in length and triple in the process of long-term preparation. The expert questioning is conducted 16 trainers. The documents of planning of training process are analysed, the analysis of diaries of sportsmen is carried out (n=22. The volume of competition practice of sportsmen and facilities of training of different primary orientation is certain. The results of analysis in relation to the construction of training process are reflected by the leading trainers of Ukraine on track-and-field. An approach classification of facilities of training taking into account the specific of training process of sportsmen is presented. It is set that the volume of facilities of general preparation is most on the initial stages of long-term perfection, then stabilized on the stages specialized base and preparations to higher achievements and a few diminishes on maximal implementation of individual possibilities and maintainance of higher sporting trade phases. It is related to diminishing of duration of the general preparatory stages of annual preparation.

  11. Academic-practice partnerships to promote evidence-based practice in long-term care: oral hygiene care practices as an exemplar.

    Science.gov (United States)

    McConnell, Eleanor Schildwachter; Lekan, Deborah; Hebert, Catherine; Leatherwood, Lisa

    2007-01-01

    Learning in practice disciplines suffers when gaps exist between classroom instruction and students' observations of routine clinical practices.(1) Academic institutions, therefore, have a strong interest in fostering the rapid and effective translation of evidence-based care techniques into routine practice. Long-term care (LTC) practice sites are particularly vulnerable to gaps between classroom teaching and how daily care is implemented, owing to the recent rapid advances in the scientific bases of care for frail older adults, the relative isolation of most LTC sites from academic settings,(2) and the relatively small number of registered nurses (RNs) available in LTC settings who can facilitate translation of research-based practices into care.(3) The aim of this project was to demonstrate the feasibility and value of an academic practice partnership to implement evidence-based approaches to solving resident care problems in LTC, as many scientifically proven practices hold promise for improving resident outcomes yet adoption is often slow.(4) We developed and implemented a clinical practice improvement process, based on diffusion of innovations theory and research,(5-8) to serve as a new model of academic-practice collaboration between a university school of nursing, LTC facility management and direct-care staff, as a means of developing high quality clinical sites for student rotations. The goal was to implement a sustainable evidence-based oral care program as an exemplar of how scientific evidence can be translated into LTC practice. This project focused on oral hygiene because the staff was dissatisfied with their existing resident oral care program, and an evidence-base for oral care in LTC existed that had not yet been incorporated into care routines. This article describes a systematic, replicable process for linking advanced practice registered nurse expertise with staff insights about care systems to reduce the gap between teaching and practice in

  12. Testing the generalized complementary relationship of evaporation with continental-scale long-term water-balance data

    Science.gov (United States)

    Szilagyi, Jozsef; Crago, Richard; Qualls, Russell J.

    2016-09-01

    The original and revised versions of the generalized complementary relationship (GCR) of evaporation (ET) were tested with six-digit Hydrologic Unit Code (HUC6) level long-term (1981-2010) water-balance data (sample size of 334). The two versions of the GCR were calibrated with Parameter-Elevation Regressions on Independent Slopes Model (PRISM) mean annual precipitation (P) data and validated against water-balance ET (ETwb) as the difference of mean annual HUC6-averaged P and United States Geological Survey HUC6 runoff (Q) rates. The original GCR overestimates P in about 18% of the PRISM grid points covering the contiguous United States in contrast with 12% of the revised version. With HUC6-averaged data the original version has a bias of -25 mm yr-1 vs the revised version's -17 mm yr-1, and it tends to more significantly underestimate ETwb at high values than the revised one (slope of the best fit line is 0.78 vs 0.91). At the same time it slightly outperforms the revised version in terms of the linear correlation coefficient (0.94 vs 0.93) and the root-mean-square error (90 vs 92 mm yr-1).

  13. Long-term care facilities in Utah: a description of human and information technology resources applied to infection control practice.

    Science.gov (United States)

    Jones, Makoto; Samore, Matthew H; Carter, Marjorie; Rubin, Michael A

    2012-06-01

    Little is known about the implementation of infection control (IC) programs and information technology (IT) infrastructure in long-term care facilities (LTCFs). We assessed the IC human resources, IT infrastructure, and IC scope of practice at LTCFs in Utah. All LTCFs throughout Utah (n = 80) were invited to complete a written survey in 2005 regarding IC staffing, policies and practices, and IT infrastructure and capacity. Responses were received from 62 facilities (77.5%). Most infection preventionists (IPs) were registered nurses (71%) with on-the-job training (81.7%). Most had other duties besides their IC work (93.5%), which took up the majority of their time. Most facilities provided desktop computers (96.8%) and all provided Internet access, but some of the infrastructure was not current. A minority (14.5%) used sophisticated software packages to support their IC activities. Less than 20% of the facilities had integrated radiology, diagnostic laboratory, or microbiology data with their facility computer system. The Internet was used primarily as a reference tool (77.4%). Most IPs reported taking responsibility for routine surveillance and monitoring tasks, but a substantial number did not perform all queried tasks. They may have difficulty with feedback of specific unit and physician infection rates (43.2% and 67.7%, respectively). Our findings underscore what has previously been reported about LTCFs' IC human resources and IP scope of practice. We also found that some IT infrastructure was outdated, and that existing resources were underutilized for IC purposes. Published by Mosby, Inc.

  14. PDF-ECG in clinical practice: A model for long-term preservation of digital 12-lead ECG data.

    Science.gov (United States)

    Sassi, Roberto; Bond, Raymond R; Cairns, Andrew; Finlay, Dewar D; Guldenring, Daniel; Libretti, Guido; Isola, Lamberto; Vaglio, Martino; Poeta, Roberto; Campana, Marco; Cuccia, Claudio; Badilini, Fabio

    2017-08-12

    In clinical practice, data archiving of resting 12-lead electrocardiograms (ECGs) is mainly achieved by storing a PDF report in the hospital electronic health record (EHR). When available, digital ECG source data (raw samples) are only retained within the ECG management system. The widespread availability of the ECG source data would undoubtedly permit successive analysis and facilitate longitudinal studies, with both scientific and diagnostic benefits. PDF-ECG is a hybrid archival format which allows to store in the same file both the standard graphical report of an ECG together with its source ECG data (waveforms). Using PDF-ECG as a model to address the challenge of ECG data portability, long-term archiving and documentation, a real-world proof-of-concept test was conducted in a northern Italy hospital. A set of volunteers undertook a basic ECG using routine hospital equipment and the source data captured. Using dedicated web services, PDF-ECG documents were then generated and seamlessly uploaded in the hospital EHR, replacing the standard PDF reports automatically generated at the time of acquisition. Finally, the PDF-ECG files could be successfully retrieved and re-analyzed. Adding PDF-ECG to an existing EHR had a minimal impact on the hospital's workflow, while preserving the ECG digital data. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Long-term prognosis of breast cancer: An analysis of 462 patients in a general hospital in south east Netherlands

    NARCIS (Netherlands)

    H.W. Nab (Henk); N. Kluck (Nadine); E.J.T. Rutgers (Emiel); J.W.W. Coebergh (Jan Willem); W.C.J. Hop (Wim)

    1995-01-01

    textabstractIn this study the long-term prognosis was analysed of all 462 consecutive female breast cancer patients who were diagnosed and carefully staged between 1970 and 1980 in a 600-bed community hospital in Eindhoven, south east Netherlands. Follow-up of recurrence and causes of death was obta

  16. Long-term drug survival and clinical effectiveness of etanercept treatment in patients with ankylosing spondylitis in daily clinical practice.

    Science.gov (United States)

    Arends, Suzanne; Brouwer, Elisabeth; Efde, Monique; van der Veer, Eveline; Bootsma, Hendrika; Wink, Freke; Spoorenberg, Anneke

    2017-01-01

    Randomised controlled trials and open-label extension studies have demonstrated the clinical efficacy and safety of tumour necrosis factor-alpha (TNF-α) blocking therapy in pre-selected study patients with ankylosing spondylitis (AS). Our aim was to investigate the 7-year drug survival and clinical effectiveness of etanercept treatment in AS patients in daily clinical practice. Consecutive AS patients from the prospective observational GLAS cohort who started etanercept because of active disease were included and evaluated over 7 years according to a fixed protocol. Continuation of treatment was based on BASDAI improvement and/or expert opinion. Of the 89 included AS patients, 45 (51%) were still using etanercept at 7 years of follow-up. Reasons for treatment discontinuation were adverse events (n=22), inefficacy (n=13), or other reasons although good clinical response (n=9). Etanercept treatment resulted in a rapid (after 6 weeks) and sustained improvement in disease activity (BASDAI, ASDAS, CRP, physician GDA), spinal mobility, physical function (BASFI), quality of life (ASQoL), and extra-spinal manifestations (swollen joints, tender joints and tender entheses). Furthermore, concomitant NSAID or DMARD use decreased significantly during follow-up. At 7 years, low disease activity and remission were present in 67-73% and 29-30% of the 45 patients, respectively. Of the patients who discontinued etanercept, 18 switched successfully to a second or third TNF-α blocker during follow-up. In a large cohort of AS patients treated with etanercept, approximately 50% continued this treatment for 7 years. Our broad evaluation of clinical endpoints proves the long-term effectiveness of etanercept treatment in daily clinical practice.

  17. Hand-hygiene practices and observed barriers in pediatric long-term care facilities in the New York metropolitan area.

    Science.gov (United States)

    Løyland, Borghild; Wilmont, Sibyl; Cohen, Bevin; Larson, Elaine

    2016-02-01

    To describe hand-hygiene practices in pediatric long-term care (pLTC) facilities and to identify observed barriers to, and potential solutions for, improved infection prevention. Observational study using (i) the World Health Organization's '5 Moments for Hand Hygiene' validated observation tool to record indications for hand hygiene and adherence; and (ii) individual logs of subjective impressions of behavioral and/or systemic barriers witnessed during direct observation. Staff in three pLTC facilities (284 beds total) were observed by two trained nurses 1 day a week for 3 weeks in February and March 2015. Direct providers of health, therapeutic and rehabilitative care, and other staff responsible for social and academic activities for children with complex, chronic medical conditions. Hand-hygiene indications, adherence and barriers. Hand hygiene was performed for 40% of the 847 indications observed and recorded. Adherence increased at one site and decreased in the other two sites during the study period. Adherence appeared to be influenced by individuals' knowledge, attitudes, beliefs and work setting. Poor hand-hygiene adherence was observed overall. Specific barriers were identified, which suggest a contextual approach to the interpretation of results indicated in this uniquely challenging setting. We offer some practical suggestions for overcoming those barriers or mitigating their effect. Ultimately, an adaptation of the '5 Moments for Hand Hygiene' may be necessary to improve infection prevention in pLTC. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  18. 10 CFR 40.28 - General license for custody and long-term care of uranium or thorium byproduct materials disposal...

    Science.gov (United States)

    2010-01-01

    ... or thorium byproduct materials disposal sites. 40.28 Section 40.28 Energy NUCLEAR REGULATORY... long-term care of uranium or thorium byproduct materials disposal sites. (a) A general license is... in this part for uranium or thorium mill tailings sites closed under title II of the Uranium...

  19. Prognostic factors for neckpain in general practice.

    NARCIS (Netherlands)

    Hoving, J.L.; Vet, H.C.W. de; Twisk, J.W.R.; Devillé, W.L.J.M.; Windt, D. van der; Koes, B.W.; Bouter, L.M.

    2004-01-01

    Prognostic studies on neck pain are scarce and are typically restricted to short-term follow-up only. In this prospective cohort study, indicators of short- and long-term outcomes of neck pain were identified that can easily be measured in general practice. Patients between 18 and 70 years of age, s

  20. Examining the Long-Term Impact of Collaborative Action Research on Teacher Identity and Practice: The Perceptions of K-12 Teachers

    Science.gov (United States)

    Goodnough, Karen

    2011-01-01

    This study focused on teacher perceptions of the long-term impacts of engaging in collaborative action research on professional identity and practice. This qualitative, phenomenological study focused on understanding the lived experiences of 10 teachers before, during, and after engaging in action research. Each teacher was interviewed before…

  1. Pre-hospital thrombolytic therapy with either alteplase or streptokinase. : Practical applications, complications and long-term results in 529 patients.

    NARCIS (Netherlands)

    E.W.M. Grijseels (Els); M.J.M. Bouten; J.W. Deckers (Jaap); A.W. Hoes (Arno); J.A.M. Hartman; E. van der Does (Emiel); M.L. Simoons (Maarten); T. Lenderink (Timo)

    1995-01-01

    markdownabstractOBJECTIVE: To assess the practical application, safety and long-term outcome of pre-hospital thrombolytic intervention with either alteplase or streptokinase in patients with extensive myocardial infarction. DESIGN: Prospective study. SUBJECTS: Patients with chest pain of more

  2. Long-term N fertilization and conservation tillage practices conserve surface but not profile SOC stocks under semi-arid irrigated corn

    Science.gov (United States)

    No tillage (NT) and N fertilization can increase surface soil organic C (SOC) stocks, but the effects deeper in the soil profile are uncertain. Subsequent tillage could counter SOC stabilized through NT practices by disrupting soil aggregation and promoting decomposition. We followed a long-term ti...

  3. A comparison of the long-term durability of nevirapine, efavirenz and lopinavir in routine clinical practice in Europe

    DEFF Research Database (Denmark)

    Reekie, J; Reiss, P; Ledergerber, B;

    2011-01-01

    The durability of combination antiretroviral therapy (cART) regimens can be measured as time to discontinuation because of toxicity or treatment failure, development of clinical disease or serious long-term adverse events. The aim of this analysis was to compare the durability of nevirapine...

  4. Long-term effects of emissions to the sea from the offshore sector. General note; Langtidsvirkninger fra utslipp til sjoe fra offshoresektoren

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-06-01

    This general note reviews the general understanding of the long-term effects of emission to the sea from the offshore sector and the need for competence and research. During the last 20 years, considerable efforts have been made in environmental research and monitoring in the oil sector. Nevertheless, evidently more research is needed in several fields. Priority has been given to the research needed according to (1) the amount of money needed for increased knowledge about the long-term effects of emissions to the sea from the oil sector, (2) the extent of missing knowledge, (3) to what extent new knowledge would be expected to contribute to improved decisions about environmental measures, (4) the extent of potential impacts on the ecosystems in Norwegian seas and the geographical extent of a possible effect. The identified research areas are, according to priority, (1) effects in the water column of produced water, (2) sudden emissions and drilling fluid, (3) joint research and monitoring, (4) special research programmes in arctic regions, (5) emissions in progress from cuttings and long-term effects of sudden emissions in coastal zones and beach zones. Research currently in progress should be co-ordinated through a special research programme, for which there is a clear need. The funds for such a programme should come from both the industry and the authorities.

  5. Model complexity and choice of model approaches for practical simulations of CO2 injection, migration, leakage and long-term fate

    Energy Technology Data Exchange (ETDEWEB)

    Celia, Michael A. [Princeton Univ., NJ (United States)

    2016-12-30

    This report documents the accomplishments achieved during the project titled “Model complexity and choice of model approaches for practical simulations of CO2 injection,migration, leakage and long-term fate” funded by the US Department of Energy, Office of Fossil Energy. The objective of the project was to investigate modeling approaches of various levels of complexity relevant to geologic carbon storage (GCS) modeling with the goal to establish guidelines on choice of modeling approach.

  6. An audit of the outcome of long-term biliary stenting in the treatment of common bile duct stones in a general hospital.

    Science.gov (United States)

    Ang, Tiing Leong; Fock, Kwong Ming; Teo, Eng Kiong; Chua, Tju Siang; Tan, Jessica

    2006-08-01

    This study audited the clinical outcome of a cohort of patients with choledocholithiasis treated with long-term biliary stenting in order to determine the feasibility of this practice. Over 2 years, 83 patients with symptomatic choledocholithiasis were treated with long-term stenting because they either refused further treatments or were medically unfit for further procedures after the initial endoscopic retrograde cholangiopancreatography (ERCP). Recurrence of clinical events, need for stent change, morbidity, and mortality were analyzed. As a secondary analysis, published data on long-term biliary stenting were reviewed. ERCP and biliary stenting were successful in all cases with no complications. The mean follow-up was 19 months (1-103 months). The median number of ERCPs performed was 1 (1-4). The mean duration of stent patency was 12.4 months (1-54.8 months). A total of 28 clinical events (cholangitis, 71%) occurred in 24 patients during follow-up, for a late complication rate of 33.7%. ERCP was repeated and the stents changed on 15 occasions in 11 asymptomatic patients with abnormal liver function tests detected on routine follow-up. No biliary-related mortality occurred. Review of published data revealed a mean late complication rate of 22.4% (0%-64%), a biliary-related mortality rate of 3.5% (0%-21.1%), and a nonbiliary-related mortality rate of 20.8% (0%-60.3%). Long-term biliary stenting is a feasible option for patients who decline or are medically unfit for further elective endoscopic or surgical procedures. Close follow-up is mandatory to detect and treat late complications.

  7. Change in healthcare utilization and costs following initiation of benzodiazepine therapy for long-term treatment of generalized anxiety disorder: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Berger Ariel

    2012-10-01

    Full Text Available Abstract Background Selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and benzodiazepine anxiolytics are used in the US to treat generalized anxiety disorder (GAD. While benzodiazepines typically provide rapid symptomatic relief, long-term use is not recommended due to risks of dependency, sedation, falls, and accidents. Methods Using a US health insurance database, we identified all persons with GAD (ICD-9-CM diagnosis code 300.02 who began a long-term course of treatment (≥90 days with a benzodiazepine anxiolytic between 1/1/2003 and 12/31/2007, We compared healthcare utilization and costs over the six-month periods preceding and following the date of treatment initiation (“pretreatment” and “post-treatment”, respectively, and focused attention on accident-related encounters (e.g., for treatment of fractures and care received for other reasons possibly related benzodiazepine use (e.g., sedation, dizziness. Results A total of 866 patients met all study entry criteria; 25% of patients began treatment on an add-on basis (i.e., adjunctive to escitalopram, paroxetine, sertraline, or venlafaxine, while 75% of patients did not receive concomitant therapy. Mean total healthcare costs increased by $2334 between the pretreatment and post-treatment periods (from $4637 [SD=$9840] to $6971 [$17,002]; p Conclusions Healthcare costs increase in patients with GAD beginning long-term (≥90 days treatment with a benzodiazepine anxiolytic; a substantial proportion of this increase is attributable to care associated with accidents and other known sequelae of long-term benzodiazepine use.

  8. Changing Practice Patterns and Long-term Outcomes of Endothelial Versus Penetrating Keratoplasty: A Prospective Dutch Registry Study.

    Science.gov (United States)

    Dickman, Mor M; Peeters, Jean Marie P W U; van den Biggelaar, Frank J H M; Ambergen, Ton A W; van Dongen, Martin C J M; Kruit, Pieter Jan; Nuijts, Rudy M M A

    2016-10-01

    To compare graft survival, best-corrected visual acuity (BCVA), endothelial cell density (ECD), and refraction following penetrating keratoplasty (PK) vs endothelial keratoplasty (EK) for Fuchs endothelial dystrophy (FED) and pseudophakic bullous keratopathy (PBK). Nonrandomized treatment comparison with national registry data. All consecutive patients undergoing first keratoplasty for FED and PBK between 1998 and 2014 were analyzed, with a maximum follow-up of 5 years (mean ± SD follow-up 39 ± 20 months, range 0-60 months). Graft survival was analyzed using Kaplan-Meier survival curves and Cox regression analysis. BCVA, ECD, and refractive error were compared using linear mixed models. Main outcome measures were graft survival, BCVA, refraction, and ECD. A total of 5115 keratoplasties (PK = 2390; EK = 2725) were identified. Two-year graft survival following EK was lower compared with PK (94.5% vs 96.3%, HR = 1.56, P = .001). Five-year survival was comparable for EK and PK (93.4% vs 89.7%, HR = 0.89, P = .261). EK graft survival improved significantly over time while remaining stable for PK. One-year BCVA was better following EK vs PK (0.34 vs 0.47 logMAR, P < .001). Astigmatism was lower 1 year after EK vs PK (-1.69 vs -3.52 D, P < .001). One-year ECD was lower after EK vs PK (1472 vs 1859 cells/mm(2), P < .001). At 3 years, ECD did not differ between EK and PK. Long-term graft survival after EK and PK is high and comparable despite lower short-term survival for EK. EK graft survival improved over time, suggesting a learning curve. EK results in better BCVA, lower astigmatism, and similar long-term ECD compared with PK for FED and PBK. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Carnitine deficiency with hyperbilirubinemia, generalized skeletal muscle weakness and reactive hypoglycemia in a patient on long-term total parenteral nutrition: treatment with intravenous L-carnitine.

    Science.gov (United States)

    Worthley, L I; Fishlock, R C; Snoswell, A M

    1983-01-01

    Low levels of plasma carnitine and reduced urinary carnitine excretion with persistently elevated plasma bilirubin levels, reactive hypoglycemia and generalized skeletal muscle weakness are described in a patient requiring long-term total parenteral nutrition (TPN). Intravenous administration of L-carnitine at 400 mg/day for 7 days and subsequently a maintenance dose of 60 mg/day corrected the plasma carnitine deficiency and reactive hypoglycemia and was associated with a return to normal plasma bilirubin levels and a restoration of skeletal muscle strength.

  10. Long-term and widespread changes in agricultural practices influence ring-necked pheasant abundance in California

    Science.gov (United States)

    Coates, Peter S.; Brussee, Brianne E.; Howe, Kristy B.; Fleskes, Joseph P.; Dwight, Ian; Connelly, Daniel P.; Meshriy, Matt G.; Gardner, Scott C.

    2017-01-01

    Declines in bird populations in agricultural regions of North America and Europe have been attributed to agricultural industrialization, increases in use of agrochemical application, and increased predation related to habitat modification. Based on count data compiled from Breeding Bird Survey (BBS) from 1974 to 2012, Christmas Bird Count (CBC) collected from 1914 to 2013, and hunter data from Annual Game Take Survey (AGTS) for years 1948–2010, ring-necked pheasants (Phasianus colchicus) in California have experienced substantial declines in agricultural environments. Using a modeling approach that integrates all three forms of survey data into a joint response abundance index, we found pheasant abundance was related to the amount of harvested and unharvested crop land, types of crops produced, amount of total pesticide applied, minimum temperature, precipitation, and numbers of avian competitors and predators. Specifically, major changes in agricultural practices over the last three decades were associated with declines in pheasant numbers and likely reflected widespread loss of habitat. For example, increases in cropland were associated with increased pheasant abundance during early years of study but this effect decreased through time, such that no association in recent years was evidenced. A post hoc analysis revealed that crops beneficial to pheasant abundance (e.g., barley) have declined substantially in recent decades and were replaced by less advantageous crops (e.g., nut trees). An additional analysis using a restricted data set (1990–2013) indicated recent negative impacts on pheasant numbers associated with land use practices were also associated with relatively high levels of pesticide application. Our results may provide valuable information for management policies aimed at reducing widespread declines in pheasant populations in California and may be applicable to other avian species within agricultural settings. Furthermore, this general

  11. Effects of Boreal Well Site Reclamation Practices on Long-Term Planted Spruce and Deciduous Tree Regeneration

    Directory of Open Access Journals (Sweden)

    Laurie A. Frerichs

    2017-06-01

    Full Text Available Well site development associated with oil sands exploration is common in boreal mixedwood forests of northern Alberta, Canada, and necessitates reforestation to accommodate other land uses. Little is known about the impact of soil and debris handling strategies during well site construction on long-term forest regeneration. This study addresses the impact of soil disturbance intensity, debris treatment, soil storage, and planting on the reforestation of 33 well sites reclaimed prior to 2006. Data on the survival and growth of planted white spruce (Picea glauca (Moench Voss and the regeneration density of deciduous trees, including trembling aspen (Populus tremuloides Michx, are presented from 2014 to 2015. The survival of planted spruce increased from 81% to 88% at well sites with a high relative to low soil disturbance. The total tree densities were lower in most treatments (≤2.69 stems m−2 than those in clear cuts (5.17 stems m−2, with the exception of root salvage areas where clear cuts had greater balsam poplar (Populus balsamifera L. densities (2.05 stems m−2 vs. <0.71 stems m−2 on all other treatments. Aspen densities were up to five times greater at well sites with low disturbance when compared to those with high disturbance, and this was further aided by shallow mulch at low disturbance sites. Spruce growth did not respond to well site treatments. Aspen growth (diameter and height remained similar between well site disturbance regimes; aspen exposed to high disturbance underperformed relative to low disturbance well sites and clear cut controls. With high disturbance, progressive soil piling led to increases in the density of aspen and birch (Betula papyrifera Marshall. Few long-term changes in soil were found due to well site development, with a greater soil pH in high disturbance sites compared to low disturbance sites. Overall, these results indicate that the nature of well site construction, including the extent of soil

  12. Long-term collections

    CERN Multimedia

    Collectes à long terme

    2007-01-01

    The Committee of the Long Term Collections (CLT) asks for your attention for the following message from a young Peruvian scientist, following the earthquake which devastated part of her country a month ago.

  13. Alcohol Habits in Patients with Long-Term Musculoskeletal Pain: Comparison with a Matched Control Group from the General Population

    Science.gov (United States)

    Thelin Bronner, Kerstin Birgitta; Wennberg, Peter; Kallmen, Hakan; Schult, Marie-Louise Birgitta

    2012-01-01

    This prospective study aimed to describe alcohol habits in patients with chronic pain compared with those in a matched control group from the general Swedish population. In total, 100 consecutive patients enrolled were matched against 100 individuals in a control group on the basis of age and sex. Alcohol habits were measured using the Alcohol Use…

  14. 10 CFR 40.27 - General license for custody and long-term care of residual radioactive material disposal sites.

    Science.gov (United States)

    2010-01-01

    ... this general license is to ensure that uranium mill tailings disposal sites will be cared for in such a.... (d) As specified in the Uranium Mill Tailings Radiation Control Act of 1978, as amended, the...) of the Atomic Energy Act of 1954, as amended, for disposal sites under title I of the Uranium...

  15. Long-term memory and response generalization in mushroom body extrinsic neurons in the honeybee Apis mellifera.

    Science.gov (United States)

    Haehnel, Melanie; Menzel, Randolf

    2012-02-01

    Honeybees learn to associate an odor with sucrose reward under conditions that allow the monitoring of neural activity by imaging Ca(2+) transients in morphologically identified neurons. Here we report such recordings from mushroom body extrinsic neurons - which belong to a recurrent tract connecting the output of the mushroom body with its input, potentially providing inhibitory feedback - and other extrinsic neurons. The neurons' responses to the learned odor and two novel control odors were measured 24 h after learning. We found that calcium responses to the learned odor and an odor that was strongly generalized with it were enhanced compared with responses to a weakly generalized control. Thus, the physiological responses measured in these extrinsic neurons accurately reflect what is observed in behavior. We conclude that the recorded recurrent neurons feed information back to the mushroom body about the features of learned odor stimuli. Other extrinsic neurons may signal information about learned odors to different brain regions.

  16. Incorporating patient preferences in the management of multiple long-term conditions: is this a role for clinical practice guidelines?

    Directory of Open Access Journals (Sweden)

    Charlotte E. Young

    2015-11-01

    Full Text Available Background: Clinical practice guidelines provide an evidence-based approach to managing single chronic conditions, but their applicability to multiple conditions has been actively debated. Incorporating patient-preference recommendations and involving consumers in guideline development may enhance their applicability, but further understanding is needed. Objectives: To assess guidelines that include recommendations for comorbid conditions to determine the extent to which they incorporate patient-preference recommendations; use consumer-engagement processes during development, and, if so, whether these processes produce more patient-preference recommendations; and meet standard quality criteria, particularly in relation to stakeholder involvement. Design: A review of Australian guidelines published from 2006 to 2014 that incorporated recommendations for managing comorbid conditions in primary care. Document analysis of guidelines examined the presence of patient-preference recommendations and the consumer-engagement processes used. The Appraisal of Guidelines for Research and Evaluation instrument was used to assess guideline quality. Results: Thirteen guidelines were reviewed. Twelve included at least one core patient-preference recommendation. Ten used consumer-engagement processes, including participation in development groups (seven guidelines and reviewing drafts (ten guidelines. More extensive consumer engagement was generally linked to greater incorporation of patient-preference recommendations. Overall quality of guidelines was mixed, particularly in relation to stakeholder involvement. Conclusions: Guidelines do incorporate some patient-preference recommendations, but more explicit acknowledgement is required. Consumer-engagement processes used during guideline development have the potential to assist in identifying patient preferences, but further research is needed. Clarification of the consumer role and investment in consumer training

  17. Ca. Nitrososphaera and Bradyrhizobium are inversely correlated and related to agricultural practices in long-term field experiments

    Directory of Open Access Journals (Sweden)

    Kateryna eZhalnina

    2013-05-01

    Full Text Available Agricultural land management, such as fertilization, liming, and tillage affects soil properties, including pH, organic matter content, nitrification rates, and the microbial community. Three different study sites were used to identify microorganisms that correlate with agricultural land use and to determine which factors regulate the relative abundance of the microbial signatures of the agricultural land-use. The three sites included in this study are the Broadbalk Experiment at Rothamsted Research, UK, the Everglades Agricultural Area, Florida, USA and the Kellogg Biological Station, Michigan, USA. The effects of agricultural management on the abundance and diversity of bacteria and archaea were determined using high throughput, barcoded 16S rRNA sequencing. In addition, the relative abundance of these organisms was correlated with soil features. Two groups of microorganisms involved in nitrogen cycle were highly correlated with land use at all three sites. The ammonia oxidizing-archaea, dominated by Ca. Nitrososphaera, were positively correlated with agriculture while a ubiquitous group of soil bacteria closely related to the diazotrophic symbiont, Bradyrhizobium, was negatively correlated with agricultural management. Analysis of successional plots showed that the abundance of ammonia oxidizing-archaea declined and the abundance of bradyrhizobia increased with time away from agriculture. This observation suggests that the effect of agriculture on the relative abundance of these genera is reversible. Soil pH and NH3 concentrations were positively correlated with archaeal abundance but negatively correlated with the abundance of Bradyrhizobium. The high correlations of Ca. Nitrososphaera and Bradyrhizobium abundances with agricultural management at three long-term experiments with different edaphoclimatic conditions allowed us to suggest these two genera as signature microorganisms for agricultural land use.

  18. Global Longitudinal Strain by Echocardiography Predicts Long-Term Risk of Cardiovascular Morbidity and Mortality in a Low-Risk General Population

    DEFF Research Database (Denmark)

    Biering-Sørensen, Tor; Biering-Sørensen, Sofie Reumert; Olsen, Flemming Javier

    2017-01-01

    BACKGROUND: Global longitudinal strain (GLS) is prognostic of adverse cardiovascular outcomes in various patient populations, but the prognostic utility of GLS for long-term cardiovascular morbidity and mortality in the general population is unknown. METHODS AND RESULTS: A total of 1296...... participants in a general population study underwent a health examination, including echocardiography measurement of GLS. The primary end point was the composite of incident heart failure, acute myocardial infarction, or cardiovascular death. During a median follow-up of 11 years, 149 (12%) participants were...... diagnosed with heart failure, acute myocardial infarction, or cardiovascular death. Lower GLS was associated with a higher risk of the composite end point (hazard ratio, 1.12; 95% confidence interval, 1.08-1.17; Page...

  19. Q&A for physician practices: how to build long-term success with effective strategic planning sessions.

    Science.gov (United States)

    Anderson, Chip

    2011-01-01

    As physician practices face stealthy marketplace competition, decreasing reimbursements, and increasing costs, it is crucial that they take a proactive approach toward strategic planning for their business. Merely accepting today's rocky business environment as the status quo and allowing it to dictate the direction of the practice can be a formula for failure. In fact, practices can and should rely on their colleagues and industry data for assistance and direction. As the saying goes, "There are no foolish questions." This article will address a few questions about strategic planning and how groups can implement an action plan to ensure success.

  20. Mid- and long-term effects of family constellation seminars in a general population sample: 8- and 12-month follow-up.

    Science.gov (United States)

    Hunger, Christina; Weinhold, Jan; Bornhäuser, Annette; Link, Leoni; Schweitzer, Jochen

    2015-06-01

    In a previous randomized controlled trial (RCT), short-term efficacy of family constellation seminars (FCSs) in a general population sample was demonstrated. In this article, we examined mid- and long-term stability of these effects. Participants were 104 adults (M = 47 years; SD = 9; 84% female) who were part of the intervention group in the original RCT (3-day FCS; 64 active participants and 40 observing participants). FCSs were carried out according to manuals. It was predicted that FCSs would improve psychological functioning (Outcome Questionnaire OQ-45.2) at 8- and 12-month follow-up. Additionally, we assessed the effects of FCSs on psychological distress, motivational incongruence, individuals' experience in their personal social systems, and overall goal attainment. Participants yielded significant improvement in psychological functioning (d = 0.41 at 8-month follow-up, p = .000; d = 0.40 at 12-month follow-up, p = .000). Results were confirmed for psychological distress, motivational incongruence, the participants' experience in their personal social systems, and overall goal attainment. No adverse events were reported. This study provides first evidence for the mid- and long-term efficacy of FCSs in a nonclinical population. The implications of the findings are discussed. © 2014 Family Process Institute.

  1. Long-term Outcomes of the FRESH START Trial: Exploring the Role of Self-efficacy in Cancer Survivors’ Maintenance of Dietary Practices and Physical Activity

    Science.gov (United States)

    Mosher, Catherine E.; Lipkus, Isaac; Sloane, Richard; Snyder, Denise C.; Lobach, David F.; Demark-Wahnefried, Wendy

    2012-01-01

    Objective This study examined whether changes in self-efficacy explain the effects of a mailed print intervention on long-term dietary practices of breast and prostate cancer survivors. The relationship between change in self-efficacy and long-term physical activity (PA) also was examined. Methods Breast and prostate cancer survivors (N=543) from 39 U.S. states and two Canadian provinces participated in the FRESH START intervention trial. Participants were randomly assigned to receive a 10-month program of mailed print materials on diet and PA available in the public domain or a 10-month program of tailored materials designed to increase fruit and vegetable (F&V) intake, decrease fat intake, and/or increase PA. Changes in self-efficacy for F&V intake and fat restriction were analyzed as potential mediators of the intervention’s effects on diet at 2-year follow-up. Because we previously found that change in self-efficacy for PA did not vary by group assignment, the relationship between change in self-efficacy and PA at 2-year follow-up was examined across study conditions. Results Results suggest that change in self-efficacy for fat restriction partially explained the intervention’s effect on fat intake (mean indirect effect=-.28), and change in self-efficacy for F&V consumption partially explained the intervention’s effect on daily F&V intake (mean indirect effect=.11). Change in self-efficacy for fat restriction partially accounted for the intervention’s impact on overall diet quality among men only (mean indirect effect=.60). Finally, change in self-efficacy for PA predicted PA at 2-year follow-up. Conclusions Findings suggest that self-efficacy may influence long-term maintenance of healthy lifestyle practices among cancer survivors. PMID:22544562

  2. The main physical properties of planosol in maize (Zea mays L.) cultivation under different long-term reduced tillage practices in the Baltic region

    Institute of Scientific and Technical Information of China (English)

    Kstutis Romaneckas; Egidijusarauskis; DovilAviienyt; Sidona Buragien; David Arney

    2015-01-01

    The impact of sustainable reduced til age (RT) on the physical properties of soil is wel documented worldwide;however, there is no precise information about the inlfuence of long-term RT or no-til (NT) on the soils at the boundary for grain maize-growing in the semi-humid subarctic climate conditions of the Baltic states, especial y on the formation of a hard-ened upper soil layer (10–15 cm in depth)-“loosening hardpan”. This study was carried out at the Research Station of Aleksandras Stulginskis University, Lithuania from 2009–2012. The investigations were based on a long-term (since 1988) ifeld experiment. The aim of the investigation was to ascertain the inlfuence of reduced primary til age on the main soil’s physical properties. This study examined soils that were deep ploughing (DP), shal ow ploughing (SP), deep cultivation (DC), shal ow cultivation (SC), and no-til (NT). Reducing the til age intensity to NT had no signiifcant effect on the structural soil’s composition;however, the stability of the structure of the>1 and>0.25 mm-size fractions was signiifcantly higher in the non-reversibly til ed (DC, SC) and NT plots. The penetration resistance of the DP soils was less after primary til age and wintering, and became similar to the NT plots at the end of the maize growth season. After primary til age and wintering, the soil moisture content in the upper soil layer (0–5 cm depth) of the NT plots was 17–49 and 16–18%higher than that in the DP. Long-term reduction of primary til age up to NT general y had no signiifcant effect on the moisture content and soil bulk density of the 0–10 and 10–20 cm layers. The results showed that long-term RT stabilized the physical quality of soil. Less soil penetration resistance was established in the DP plots compared to both RT and NT, however, indicators of the formation of a uniform“loosening hardpan”layer were not found. It is summarized that long-term RT or NT systems stabilize, or may increase

  3. Adjunctive levetiracetam in children, adolescents, and adults with primary generalized seizures: Open-label, noncomparative, multicenter, long-term follow-up study.

    LENUS (Irish Health Repository)

    Delanty, Norman

    2012-02-01

    Purpose: To evaluate the long-term efficacy and tolerability of adjunctive levetiracetam (LEV) in patients with uncontrolled idiopathic generalized epilepsy (IGE). Methods: This phase III, open-label, long-term, follow-up study (N167; NCT00150748) enrolled patients (4 to <65 years) with primary generalized seizures (tonic-clonic, myoclonic, absence). Patients received adjunctive LEV at individualized doses (1,000-4,000 mg\\/day; 20-80 mg\\/kg\\/day for children\\/adolescents weighing <50 kg). Efficacy results are reported for all seizure types [intention-to-treat (ITT) population, N = 217] and subpopulations with tonic-clonic (n = 152), myoclonic (n = 121), and\\/or absence (n = 70) seizures at baseline. Key Findings: One hundred twenty-five (57.6%) of 217 patients were still receiving treatment at the end of the study. Mean (standard deviation, SD) LEV dose was 2,917.5 (562.9) mg\\/day. Median (Q1-Q3) exposure to LEV was 2.1 (1.5-2.8) years, and the maximum duration was 4.6 years. Most patients were taking one (124\\/217, 57.1%) or >\\/=2 (92\\/217, 42.4%) concomitant antiepileptic drugs (AEDs). Seizure freedom of >\\/=6 months (all seizure types; primary efficacy end point) was achieved by 122 (56.2%) of 217 patients, and 49 (22.6%) of 217 patients had complete seizure freedom. Seizure freedom of >\\/=6 months from tonic-clonic, myoclonic, and absence seizures was achieved by 95 (62.5%) of 152, 75 (62.0%) of 121, and 44 (62.9%) of 70 patients, respectively. Mean (SD) maximum seizure freedom duration was 371.7 (352.4) days. At least one treatment-emergent adverse event (TEAE) was reported by 165 (76%) of 217 patients; most TEAEs were mild\\/moderate in severity, with no indication of an increased incidence over time. Seventeen (7.8%) of 217 patients discontinued medication because of TEAEs. The most common psychiatric TEAEs were depression (16\\/217, 7.4%), insomnia (9\\/217, 4.1%), nervousness (8\\/217, 3.7%), and anxiety (7\\/217, 3.2%). Significance: Adjunctive

  4. Long term survival of HER2-positive early breast cancer treated with trastuzumab-based adjuvant regimen: a large cohort study from clinical practice.

    Science.gov (United States)

    Bonifazi, Martina; Franchi, Matteo; Rossi, Marta; Zambelli, Alberto; Moja, Lorenzo; Zambon, Antonella; Corrao, Giovanni; La Vecchia, Carlo; Zocchetti, Carlo; Negri, Eva

    2014-10-01

    Trastuzumab-based regimens for the adjuvant treatment of HER2-positive early breast cancer significantly prolonged overall survival (OS) and disease free survival (DFS) in large randomized trials, with sustained benefits at four-year follow-up. We assessed long-term survival estimates and predictors in a large cohort of Italian women with early breast cancer treated with trastuzumab in clinical practice. Through a record linkage between five regional healthcare databases, we identified women treated with trastuzumab for early breast cancer in Lombardy (2006-2009). DFS and OS were estimated using the Kaplan-Meier method, and independent predictors were assessed using proportional hazard models. 2046 women received trastuzumab in early breast cancer adjuvant setting. Overall, the proportion of patients surviving free of disease was 93.9% at one year, 85.8% at 2 years, 79.4% at 3 years, and 75.0% at 4 years. OS estimates were 98.7%, 95.4%, 91.5% and 89.4% at 1, 2, 3 and 4 years, respectively. Significant independent predictors of worse survival outcomes were age breast surgery, combination therapy with paclitaxel, having at least one comorbidity (i.e. diabetes, cardiovascular disease), and a trastuzumab-based regimen lasting less than six months. Long term survival rates of women treated with trastuzumab for early breast cancer in clinical practice were consistent with estimates from clinical trials testing the drug in the adjuvant setting.

  5. Implementing Montessori Methods for Dementia™ in Ontario long-term care homes: Recreation staff and multidisciplinary consultants' perceptions of policy and practice issues.

    Science.gov (United States)

    Ducak, Kate; Denton, Margaret; Elliot, Gail

    2016-01-08

    Montessori-based activities use a person-centred approach to benefit persons living with dementia by increasing their participation in, and enjoyment of, daily life. This study investigated recreation staff and multidisciplinary consultants' perceptions of factors that affected implementing Montessori Methods for Dementia™ in long-term care homes in Ontario, Canada. Qualitative data were obtained during semi-structured telephone interviews with 17 participants who worked in these homes. A political economy of aging perspective guided thematic data analysis. Barriers such as insufficient funding and negative attitudes towards activities reinforced a task-oriented biomedical model of care. Various forms of support and understanding helped put Montessori Methods for Dementia™ into practice as a person-centred care program, thus reportedly improving the quality of life of residents living with dementia, staff and family members. These results demonstrate that when Montessori Methods for Dementia™ approaches are learned and understood by staff they can be used as practical interventions for long-term care residents living with dementia. © The Author(s) 2016.

  6. Carbon Dioxide Emissions as Affected by Alternative Long-Term Irrigation and Tillage Management Practices in the Lower Mississippi River Valley

    Directory of Open Access Journals (Sweden)

    S. F. Smith

    2014-01-01

    Full Text Available Ensuring the sustainability of cultivated soils is an ever-increasing priority for producers in the Lower Mississippi River Valley (LMRV. As groundwater sources become depleted and environmental regulations become more strict, producers will look to alternative management practices that will ensure the sustainability and cost-effectiveness of their production systems. This study was conducted to assess the long-term (>7 years effects of irrigation (i.e., irrigated and dryland production and tillage (conventional and no-tillage on estimated carbon dioxide (CO2 emissions from soil respiration during two soybean (Glycine max L. growing seasons from a wheat- (Triticum aestivum L.- soybean, double-cropped production system in the LMRV region of eastern Arkansas. Soil surface CO2 fluxes were measured approximately every two weeks during two soybean growing seasons. Estimated season-long CO2 emissions were unaffected by irrigation in 2011 (P>0.05; however, during the unusually dry 2012 growing season, season-long CO2 emissions were 87.6% greater (P=0.044 under irrigated (21.9 Mg CO2 ha−1 than under dryland management (11.7 Mg CO2 ha−1. Contrary to what was expected, there was no interactive effect of irrigation and tillage on estimated season-long CO2 emissions. Understanding how long-term agricultural management practices affect soil respiration can help improve policies for soil and environmental sustainability.

  7. Long-Term Collections

    CERN Multimedia

    Comité des collectes à long terme

    2011-01-01

    It is the time of the year when our fireman colleagues go around the laboratory for their traditional calendars sale. A part of the money of the sales will be donated in favour of the long-term collections. We hope that you will welcome them warmly.

  8. Long-term cost–effectiveness of Oncotype DX® versus current clinical practice from a Dutch cost perspective

    NARCIS (Netherlands)

    Kip, Michelle Maria Aleida; Monteban, Helma; Steuten, Lotte Maria Gertruda

    2015-01-01

    This study analyzes the incremental cost–effectiveness of Oncotype DX® testing to support adjuvant chemotherapy recommendations, versus current clinical practice, for patients with estrogen receptor-positive (ER+), node-negative or micrometastatic (pN1mic) early-stage breast cancer in The

  9. A Systematic Review of Mindfulness Intervention for Individuals with Developmental Disabilities: Long-Term Practice and Long Lasting Effects

    Science.gov (United States)

    Hwang, Yoon-Suk; Kearney, Patrick

    2013-01-01

    Can individuals with developmental disabilities learn mindfulness? If so, with what result? A systematic literature review identified 12 studies that taught mindfulness practice to individuals with mild to severe developmental disabilities, demonstrating that mindfulness intervention could significantly reduce the behavioural and/or psychological…

  10. A Systematic Review of Mindfulness Intervention for Individuals with Developmental Disabilities: Long-Term Practice and Long Lasting Effects

    Science.gov (United States)

    Hwang, Yoon-Suk; Kearney, Patrick

    2013-01-01

    Can individuals with developmental disabilities learn mindfulness? If so, with what result? A systematic literature review identified 12 studies that taught mindfulness practice to individuals with mild to severe developmental disabilities, demonstrating that mindfulness intervention could significantly reduce the behavioural and/or psychological…

  11. Long-term cost–effectiveness of Oncotype DX® versus current clinical practice from a Dutch cost perspective

    NARCIS (Netherlands)

    Kip, Michelle; Monteban, Helma; Steuten, Lotte

    2015-01-01

    This study analyzes the incremental cost–effectiveness of Oncotype DX® testing to support adjuvant chemotherapy recommendations, versus current clinical practice, for patients with estrogen receptor-positive (ER+), node-negative or micrometastatic (pN1mic) early-stage breast cancer in The Netherland

  12. Exploring How to Walk the Talk: Examining the Practical Application of Models of Science Communication in Long-Term Ecological Research Sites

    Science.gov (United States)

    Bartock, L.; Rickard, L. N.

    2014-12-01

    This research investigates the relationship between science communication at a theoretical level and the practice of science communication in long-term ecological research sites (LTERs). In particular, we examine if and how the work of LTER science communication practitioners, individuals with the responsibility to communicate, report, or interpret the findings of his/her LTER with any other group, excluding through K-12 educational programs, aligns with theoretically established models of science communication. Broadly speaking, as over two decades of research in science communication attests, these models tend to emphasize the deficit approach, dialogue with and between audiences, and/or audience participation. Does the practitioners' work fall neatly into these three "ideal type" categories, or do their practices blur the boundaries of established models? Do practitioners appeal to more than one type of model in the course of their work? Is there evidence of hybrid approaches, or other, new models that have not yet been identified in the literature? Participating organizations will be selected from the Long Term Ecological Research Network, an organization of LTERs funded by the National Science Foundation. The LTER network is actively involved in science communication, as shown by the most recent LTER Strategic Communication Plan. Science communicators may be involved in variety of practices, such as creating translational materials for policymakers to better understand the findings of LTERs, developing training courses for conservation professionals, or organizing site tours for journalists or funders. Practitioners will participate in semi-structured interviews covering how their practices relate to established models of science communication, how they view their roles and responsibilities, and how they view their audience(s). This presentation will cover emerging results from ongoing analysis of interviews conducted with a purposive sample of these

  13. Interparental violence and children’s long-term psychosocial adjustment: the mediating role of parenting practices

    OpenAIRE

    Gámez Guadix, Manuel; Almendros, Carmen; Carrobles Isabel, José Antonio; Muñoz Rivas, Marina

    2013-01-01

    Subject to file availability and provided the posting includes a prominent statement of the full bibliographical details, a copyright notice in the name of the copyright holder (Cambridge University Press or the sponsoring Society, as appropriate), and a link to the online edition of the journal at Cambridge Journals Online. The objectives of this study were: (a) to examine the direct and indirect relationships among witnessing interparental violence, parenting practices, and children’s lo...

  14. Long-term safety of icatibant treatment of patients with angioedema in real-world clinical practice

    DEFF Research Database (Denmark)

    Zanichelli, A; Maurer, M; Aberer, W

    2017-01-01

    The Icatibant Outcome Survey (IOS) is an observational study monitoring safety and effectiveness of icatibant in the real-world setting. We analyzed safety data from 3025 icatibant-treated attacks in 557 patients (enrolled between July 2009 and February 2015). Icatibant was generally well tolerat...

  15. Long-term outcome of FFR-guided PCI for stable coronary artery disease in daily clinical practice

    DEFF Research Database (Denmark)

    De Backer, Ole; Biasco, Luigi; Lønborg, Jacob

    2016-01-01

    AIMS: Our aim was to investigate the strength of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) in daily practice. METHODS AND RESULTS: For this study, 3,512 patients with stable CAD and at least one 50-89% coronary stenosis...... were identified; those patients thought to require PCI (n=1,716) were selected. Of these, 962 (56%) were treated based on angiography (XA) alone, whereas 754 patients (44%) had an FFR-guided treatment. In the latter group, 321 patients (43%) were reallocated to another treatment, predominantly medical...

  16. Practices and barriers in long-term living kidney donor follow-up: a survey of U.S. transplant centers.

    Science.gov (United States)

    Mandelbrot, Didier A; Pavlakis, Martha; Karp, Seth J; Johnson, Scott R; Hanto, Douglass W; Rodrigue, James R

    2009-10-15

    Many have called for more comprehensive follow-up of living kidney donors, both for the donor's benefit and to establish a high-quality database of donor outcomes. United Network for Organ Sharing currently requires transplant centers to report donor follow-up information at several time points after donation, but little is known about how frequently this information is obtained, or which barriers exist to compliance with United Network for Organ Sharing requirements. To assess practices and barriers in providing follow-up care to living donors, we sent a questionnaire to all program directors at U.S. transplant centers. Few transplant centers are currently seeing donors for long-term follow-up. Many centers recommend that donor follow-up care be provided by primary care physicians, but follow-up information is rarely received from primary care physicians. The main barriers to collecting more complete information are donor inconvenience, costs, and lack of reimbursement to the transplant center for providing follow-up care. Significant changes are required to improve long-term donor follow-up by U.S. transplant centers.

  17. Long-term dynamics simulation: Modeling requirements

    Energy Technology Data Exchange (ETDEWEB)

    Morched, A.S.; Kar, P.K.; Rogers, G.J.; Morison, G.K. (Ontario Hydro, Toronto, ON (Canada))

    1989-12-01

    This report details the required performance and modelling capabilities of a computer program intended for the study of the long term dynamics of power systems. Following a general introduction which outlines the need for long term dynamic studies, the modelling requirements for the conduct of such studies is discussed in detail. Particular emphasis is placed on models for system elements not normally modelled in power system stability programs, which will have a significant impact in the long term time frame of minutes to hours following the initiating disturbance. The report concludes with a discussion of the special computational and programming requirements for a long term stability program. 43 refs., 36 figs.

  18. Long Term Effect on Professionals' Knowledge, Practice and Attitudes towards User Involvement Four Years after Implementing an Organisational Development Plan: A Controlled Study.

    Directory of Open Access Journals (Sweden)

    Marit By Rise

    Full Text Available Health service organisations are increasingly implementing user involvement initiatives according to requirements from governments, such as user representation in administrational boards, better information to users, and more involvement of the users during treatment. Professionals are vital in all initiatives to enhance user involvement, and initiatives to increase involvement should influence the professionals' practice and attitudes. The implementation of a development plan intending to enhance user involvement in a mental health hospital in Central Norway had no effect on the professionals after 16 months. The objective was therefore to investigate the long term effect on the professionals' knowledge, practice and attitudes towards user involvement after four years.This was a non-randomized controlled study including professionals from three mental health hospitals in Central Norway. A development plan intended to enhance user participation was implemented in one of the hospitals, including establishing a patient education centre and a user office, purchasing of user expertise, appointing contact professionals for next of kin, and improving of the centre's information and the professional culture. The professionals at two other hospitals constituted the control group. All professionals were invited to answer the Consumer Participation Questionnaire (CPQ and additional questions, at a four year interval.A total of 399 professionals participated (43% response rate. Comparing the changes in the intervention group with the changes in the control group, the results showed that the plan had improved some aspects of the professionals' knowledge about the user involvement taking place in the hospital. In addition, some parts of the professionals' practice of providing information to the service users was improved, and the development plan might have raised their awareness about insufficient involvement of next of kin.This is the first controlled

  19. The Long-Term Financial and Clinical Impact of an Electronic Health Record on an Academic Ophthalmology Practice

    Directory of Open Access Journals (Sweden)

    Michele C. Lim

    2015-01-01

    Full Text Available Purpose. To examine financial and clinical work productivity outcomes associated with the use of the electronic health record (EHR. Methods. 191,360 billable clinical encounters were analyzed for 12 clinical providers over a 9-year study period during which an EHR was implemented. Main outcome measures were clinical revenues collected per provider and secondary outcomes were charge capture, patient visit coding levels, transcription costs, patient visit volume per provider, digital drawing, and digital imaging volume. Results. The difference in inflation adjusted net clinical revenue per provider per year did not change significantly in the period after EHR implementation (mean = $404,198; SD = $17,912 than before (mean = $411,420; SD = $39,366 (P=0.746. Charge capture, the proportion of higher- and lower-level visit codes for new and established patients, and patient visits per provider remained stable. A total savings of $188,951 in transcription costs occurred over a 4-year time period post-EHR implementation. The rate of drawing the ophthalmic exam in the EHR was low (mean = 2.28%; SD = 0.05% for all providers. Conclusions. This study did not show a clear financial gain after EHR implementation in an academic ophthalmology practice. Ophthalmologists do not rely on drawings to document the ophthalmic exam; instead, the ophthalmic exam becomes text-driven in a paperless world.

  20. Analysing long term discursive processes

    DEFF Research Database (Denmark)

    Horsbøl, Anders

    What do timescales - the notion that processes take place or can be viewed within a shorter or longer temporal range (Lemke 2005) - mean for the analysis of discourse? What are the methodological consequences of analyzing discourse at different timescales? It may be argued that discourse analysis...... in general has favored either the analysis of short term processes such as interviews, discussions, and lessons, or the analysis of non-processual entities such as (multimodal) texts, arguments, discursive repertoires, and discourses (in a Foucaultian sense). In contrast, analysis of long term processes...... which extend beyond the single interaction, for instance negotiations or planning processes, seems to have played a less important role, with studies such as Iedema 2001 and Wodak 2000 as exceptions. These long term processes, however, are central to the constitution and workings of organizations...

  1. Temporal variability of CO2 and N2O emissions in an agricultural long-term field trial regarding effects of different management practices and extreme weather effects

    Science.gov (United States)

    Koal, Philipp; Schilling, Rolf; Gerl, Georg; Pritsch, Karin; Munch, Jean Charles

    2016-04-01

    In order to achieve a reduction of greenhouse gas emissions, modern agronomic management practices need to be established. Therefore, to assess the effect of different farming practices on greenhouse gas emissions, reliable data are required. The experiment covers and compares main aspects of agricultural management for a better implementation of sustainable land use. The focus lies on the determination and interpretation of greenhouse gas emissions, where the effects of diverse tillage systems and fertilisation practices of an integrated farming system as well as the impacts of extreme weather conditions are observed. In addition, with analysis of the alterable biological, physical and chemical soil properties a link between the impact of different management systems on greenhouse gas emissions and the observed cycle of matter in the soil, especially the nitrogen and carbon cycle, is enabled. Measurements have been carried out on long-term field trials at the Research Farm Scheyern located in a Tertiary hilly landscape approximately 40 km north of Munich (South Germany). The long-term integrated farming system trial was started in 1992. Since then parcels of land (each around 0.2-0.4 ha) with a particular interior plot set-up have been conducted with the same crop rotation, tillage and fertilisation practice referring to integrated farming management. Thus, the management impacts on the soil of more than 20 years have been examined. Fluxes of CH4, N2O and CO2 have been monitored since 2007 for the integrated farming system trial using an automated system which consists of chambers (0.4 m2 area) with a motor-driven lid, an automated gas sampling unit, an on-line gas chromatographic analysis system, and a control and data logging unit. Precipitation and temperature data have been observed for the experimental field to include weather effects. The main outcomes are the analysis of temporal and spatial dynamics of greenhouse gas emissions influenced by management

  2. Conveying practical clinical skills with the help of teaching associates-a randomised trial with focus on the long term learning retention.

    Science.gov (United States)

    Hoefer, Sebastian H; Sterz, Jasmina; Bender, Bernd; Stefanescu, Maria-Christina; Theis, Marius; Walcher, Felix; Sader, Robert; Ruesseler, Miriam

    2017-03-28

    Ensuring that all medical students achieve adequate clinical skills remains a challenge, yet the correct performance of clinical skills is critical for all fields of medicine. This study analyzes the influence of receiving feedback by teaching associates in the context of achieving and maintaining a level of expertise in complex head and skull examination. All third year students at a German university who completed the obligatory surgical skills lab training and surgical clerkship participated in this study. The students were randomized into two groups. lessons by an instructor and peer-based practical skills training. Intervention group: training by teaching associates who are examined as simulation patients and provided direct feedback on student performance. Their competency in short- and long-term competence (directly after intervention and at 4 months after the training) of head and skull examination was measured. Statistical analyses were performed using SPSS Statistics version 19 (IBM, Armonk, USA). Parametric and non-parametric test methods were applied. As a measurement of correlation, Pearson correlations and correlations via Kendall's-Tau-b were calculated and Cohen's d effect size was calculated. A total of 181 students were included (90 intervention, 91 control). Out of those 181 students 81 agreed to be videotaped (32 in the control group and 49 in the TA group) and examined at time point 1. At both time points, the intervention group performed the examination significantly better (time point 1, p = teaching associates for teaching complex practical skills is effective for short- and long-term retention. We anticipate the method could be easily translated to nearly every patient-based clinical skill, particularly with regards to a competence-based education of future doctors.

  3. Emerging communities of child-healthcare practice in the management of long-term conditions such as chronic kidney disease: qualitative study of parents’ accounts

    Science.gov (United States)

    2014-01-01

    Background Parents of children and young people with long-term conditions who need to deliver clinical care to their child at home with remote support from hospital-based professionals, often search the internet for care-giving information. However, there is little evidence that the information available online was developed and evaluated with parents or that it acknowledges the communities of practice that exist as parents and healthcare professionals share responsibility for condition management. Methods The data reported here are part of a wider study that developed and tested a condition-specific, online parent information and support application with children and young people with chronic-kidney disease, parents and professionals. Semi-structured interviews were conducted with 19 fathers and 24 mothers who had recently tested the novel application. Data were analysed using Framework Analysis and the Communities of Practice concept. Results Evolving communities of child-healthcare practice were identified comprising three components and several sub components: (1) Experiencing (parents making sense of clinical tasks) through Normalising care, Normalising illness, Acceptance & action, Gaining strength from the affected child and Building relationships to formalise a routine; (2) Doing (Parents executing tasks according to their individual skills) illustrated by Developing coping strategies, Importance of parents’ efficacy of care and Fear of the child’s health failing; and (3) Belonging/Becoming (Parents defining task and group members’ worth and creating a personal identity within the community) consisting of Information sharing, Negotiation with health professionals and Achieving expertise in care. Parents also recalled factors affecting the development of their respective communities of healthcare practice; these included Service transition, Poor parent social life, Psycho-social affects, Family chronic illness, Difficulty in learning new procedures

  4. Emerging communities of child-healthcare practice in the management of long-term conditions such as chronic kidney disease: qualitative study of parents' accounts.

    Science.gov (United States)

    Carolan, Ian; Smith, Trish; Hall, Andy; Swallow, Veronica M

    2014-07-07

    Parents of children and young people with long-term conditions who need to deliver clinical care to their child at home with remote support from hospital-based professionals, often search the internet for care-giving information. However, there is little evidence that the information available online was developed and evaluated with parents or that it acknowledges the communities of practice that exist as parents and healthcare professionals share responsibility for condition management. The data reported here are part of a wider study that developed and tested a condition-specific, online parent information and support application with children and young people with chronic-kidney disease, parents and professionals. Semi-structured interviews were conducted with 19 fathers and 24 mothers who had recently tested the novel application. Data were analysed using Framework Analysis and the Communities of Practice concept. Evolving communities of child-healthcare practice were identified comprising three components and several sub components: (1) Experiencing (parents making sense of clinical tasks) through Normalising care, Normalising illness, Acceptance & action, Gaining strength from the affected child and Building relationships to formalise a routine; (2) Doing (Parents executing tasks according to their individual skills) illustrated by Developing coping strategies, Importance of parents' efficacy of care and Fear of the child's health failing; and (3) Belonging/Becoming (Parents defining task and group members' worth and creating a personal identity within the community) consisting of Information sharing, Negotiation with health professionals and Achieving expertise in care. Parents also recalled factors affecting the development of their respective communities of healthcare practice; these included Service transition, Poor parent social life, Psycho-social affects, Family chronic illness, Difficulty in learning new procedures, Shielding and avoidance, and

  5. Long-Term Collections

    CERN Multimedia

    Staff Association

    2016-01-01

    45 years helping in developing countries! CERN personnel have been helping the least fortunate people on the planet since 1971. How? With the Long-Term Collections! Dear Colleagues, The Staff Association’s Long-Term Collections (LTC) Committee is delighted to share this important milestone in the life of our Laboratory with you. Indeed, whilst the name of CERN is known worldwide for scientific discoveries, it also shines in the many humanitarian projects which have been supported by the LTC since 1971. Several schools and clinics, far and wide, carry its logo... Over the past 45 years, 74 projects have been supported (9 of which are still ongoing). This all came from a group of colleagues who wanted to share a little of what life offered them here at CERN, in this haven of mutual understanding, peace and security, with those who were less fortunate elsewhere. Thus, the LTC were born... Since then, we have worked as a team to maintain the dream of these visionaries, with the help of regular donat...

  6. Long-Term Collection

    CERN Document Server

    Staff Association

    2016-01-01

    Dear Colleagues, As previously announced in Echo (No. 254), your delegates took action to draw attention to the projects of the Long-Term Collections (LTC), the humanitarian body of the CERN Staff Association. On Tuesday, 11 October, at noon, small Z-Cards were widely distributed at the entrances of CERN restaurants and we thank you all for your interest. We hope to have achieved an important part of our goal, which was to inform you, convince you and find new supporters among you. We will find out in the next few days! An exhibition of the LTC was also set up in the Main Building for the entire week. The Staff Association wants to celebrate the occasion of the Long-Term Collection’s 45th anniversary at CERN because, ever since 1971, CERN personnel have showed great support in helping the least fortunate people on the planet in a variety of ways according to their needs. On a regular basis, joint fundraising appeals are made with the Directorate to help the victims of natural disasters around th...

  7. Collectes à long terme

    CERN Document Server

    Collectes à long terme

    2014-01-01

    En cette fin d’année 2014 qui approche à grands pas, le Comité des Collectes à Long Terme remercie chaleureusement ses fidèles donatrices et donateurs réguliers pour leurs contributions à nos actions en faveur des plus démunis de notre planète. C’est très important, pour notre Comité, de pouvoir compter sur l’appui assidu que vous nous apportez. Depuis plus de 40 ans maintenant, le modèle des CLT est basé principalement sur des actions à long terme (soit une aide pendant 4-5 ans par projet, mais plus parfois selon les circonstances), et sa planification demande une grande régularité de ses soutiens financiers. Grand MERCI à vous ! D’autres dons nous parviennent au cours de l’année, et ils sont aussi les bienvenus. En particulier, nous tenons à remercier...

  8. [Psychotropic drugs in general practice].

    Science.gov (United States)

    Zimmer, Alexander

    2014-06-18

    The article presents a user-friendly overview of psychotropic drugs which are helpful for the prescription in a primary care practice. The author recommends to get familiar with just a small selection of drugs first and second line. This means to know well about their effectiveness, short-and long-term side effects, interactions with other drugs and the necessary monitoring that should be done.

  9. Long-term fat redistribution in ARV-naïve HIV+ patients initiating a non-thymidine containing regimen in clinical practice

    Directory of Open Access Journals (Sweden)

    Elena Ferrer

    2014-11-01

    Full Text Available Introduction: Lipodystrophy is still a matter of concern in HIV+ patients receiving ART. However, long-term fat change in patients taking non-thymidine regimens is not well known. Materials and Methods: A prospective ongoing fat change assessment including clinical evaluation and dexa scans (Hologic QDR 4500 is being conducted in all consecutive patients initiating ART from January 2008. Arm, leg, trunk and total fat as well as fat mass ratio (FMR=% trunk fat/% leg fat were determined. Patients with data at baseline (BL, 12 and 36 m are included in this analysis. ITT and OT were performed. Multivariate general linear models were used to assess changes in fat measures. Results: One hundred patients were included. 81% men, 42.9 years, 18% AIDS, CD4 218.5 (6-756, viral load 5 log (2.9-6.8, leg fat 4644g, trunk fat 6693g, FMR 0.94. Around 40 patients (40% initiated a PIr (17 LPVr, 11 ATVr, 9 DRVr, 3 FPVr, 34 (34% NVP and 21 (21% EFV. About 83% received TDF/FTC and 10% ABC/3TC. Groups were comparable at BL except for a lower viral load in NVP patients (p=0.047 and lower c-LDL in PI patients (p=0.043. After 36 m, no patient presented a clinically evident lipodystrophy. At 12 m, an overall significant increase was found from baseline in trunk, leg and FMR (median 759 g, 479.4 g and 0.03, respectively, p<0.05 and at 36 m in trunk and leg fat (median 989.9 g, 566 g, respectively, p<0.05. According to ART, at 12 m a significant increase in trunk and leg fat was observed in EFV and PIr. At 36 m, in NVP patients trunk and leg fat as well as FMR increased, whereas in PIr patients only leg fat increased (see figure. In ITT analysis, adjusted by age, sex, risk practice and BL CD4, EFV was associated with a greater increase in FMR (p=0.036 at 36 m vs PIr. In OT analysis, at 12 m, NVP was associated with a smaller percentage increase in trunk fat (vs PIr and EFV, p=0.006 and in leg fat (vs PIr, p=0.046. These differences did not persist at 36 m. Conclusions: In

  10. Long-Term Engagement in Authentic Research with NASA (LEARN): Innovative Practices Suggested By a New Model for Teacher Research Experiences

    Science.gov (United States)

    Pippin, M. R.; Joseph, J. D.; Yang, M. M.; Omar, A. H.; Crecelius, S.; Harte, T.; Lewis, P. M., Jr.; Taylor, J.; Bujosa, R.; Moulton, C.; Haggard, C. S.; Hyater-Adams, S.; Kollmeyer, R.; Weisman, A.

    2014-12-01

    NASA's LEARN Project is an innovative program that provides long-term immersion in the practice of atmospheric science for middle and high school in-service teachers. Working alongside NASA scientists and using authentic NASA Science Mission Directorate research data, teachers develop individual research topics of interest during two weeks in the summer while on-site at NASA Langley. With continued, intensive mentoring by NASA scientists, the teachers further develop their research throughout the academic year through virtual group meetings and data team meetings mirroring scientific collaborations. At the end of the first year, LEARN teachers present scientific posters. The LEARN experience has had such an impact that multiple teachers from the first two cohorts have elected to continue their research. The LEARN project evaluation has provided insights into particularly effective elements of this new approach. Findings indicate that teachers' perceptions of the scientific enterprise have changed, and that LEARN provided substantial resources to help them take real-world research to their students. This presentation will focus on key factors from LEARN's implementation that inform best practices for the incorporation of authentic scientific research into teacher professional development experiences. We suggest that these factors should be considered in the development of other such experiences, including: (1) The involvement of a single scientist as both the project leader/manager and the project scientist, to ensure that the project can meet teachers' needs. (2) An emphasis on framing and approaching scientific research questions, so that teachers can learn to evaluate the feasibility of studies based on scope, scale, and availability of data. (3) Long term, ongoing relationships where teachers and scientists work as collaborators, beyond the workshop "mold." (4) A focus on meeting the needs of individual teachers, whether their needs relate to elements of

  11. [Long-term outcome of patients discharged with fever of unknown origin in the Department of General Internal Medicine of Peking Union Medical College Hospital].

    Science.gov (United States)

    Li, Yuanjie; Zhu, Weiguo; Wang, Yu; Sha, Yue; Huang, Xiaoming; Huang, Chengjin; Jiao, Yang; Chen, Jialin; Fang, Weigang; Zeng, Xuejun

    2015-10-01

    To investigate the clinical characteristics and outcome of patients with undiagnosed fever of unknown origin (FUO). To retrospectively review the clinic data of patients discharged with FUO from the Department of General Internal Medicine, Peking Union Medical College Hospital during 2004 to 2008. Medical records and phone call follow-up data were collected until 2014. Among 758 in-patients diagnosed with FUO, 70 patients still discharged with FUO were enrolled in this study, including 23 males and 47 females. There were 14 missing patients. Finally, definite diagnoses were made in 20 patients by clinical reassessments, empirical therapy or repeated biopsies, in whom 3 patients dying from underlying diseases. A total of 36 patients did not get final diagnoses, while fever was relieved in 23 patients, including 10 treated with corticosteroids or non-steroid anti-inflammatory drugs (NSAIDs) from 1 month to 12 months due to suspected connective tissue diseases. Another 3 patients still had episodic fever. Seven patients died shortly after discharge. There were 3 dying in the long-term follow-up. The overall FUO-related mortality was 18.6%. Mortality was correlated with the number of dysfunctional organs, especially cytopenia, coagulation dysfunction, bleeding events, respiratory damage and acute renal failure with OR 2.1, 9.9, 3.3 and 6.6 (P < 0.05) respectively. Close follow-up, intermittent clinical reassessments, repeated biopsies will contribute to the diagnosis of patients discharged with FUO. Empirical therapy with corticosteroids, NSAIDs or anti-tubercular drugs in selected patients may be safe and effective. Mortality rates increased with impaired organs, especially the hematological, respiratory and renal systems.

  12. LONG TERM COLLECTIONS

    CERN Multimedia

    STAFF ASSOCIATION

    2010-01-01

    ACKNOWLEDGMENTS The Long-Term Collections (CLT) committee would like to warmly thank its faithful donors who, year after year, support our actions all over the world. Without you, all this would not be possible. We would like to thank, in particular, the CERN Firemen’s Association who donated 5000 CHF in the spring thanks to the sale of their traditional calendar, and the generosity of the CERN community. A huge thank you to the firemen for their devotion to our cause. And thank you to all those who have opened their door, their heart, and their purses! Similarly, we warmly thank the CERN Yoga Club once again for its wonderful donation of 2000 CHF we recently received. We would also like to tell you that all our projects are running well. Just to remind you, we are currently supporting the activities of the «Réflexe-Partage» Association in Mali; the training centre of «Education et Développement» in Abomey, Benin; and the orphanage and ...

  13. A qualitative investigation of the long-term effects of a staff development project on two middle school science teachers' literacy practices

    Science.gov (United States)

    Stevens, Lisa Patel

    The focus of this study was to explore the changes in literacy practice that occurred after two middle school science teachers completed their participation in a long-term staff development project on content area literacy. There were two participants in this study, were a sixth-grade life science teacher in her 22nd year of teaching, and an eighth grade physical science teacher in her 4th year of teaching. Multiple data sources were collected, including field notes from the staff development meetings, interviews of participants and other school personnel, classroom observations, descriptive surveys, lesson plans, exit slips and evaluation forms. Qualitative methodologies were used to guide analysis, classification and interpretation of the data collected. The data were read and reread to construct domains and themes (Spradley, 1980) found in each teacher's literacy practices and beliefs. Additionally, the methods of critical discourse analysis were used to analyze the data for issues pertaining to the influential social and political structures of secondary schools (Fairclough, 1989). This second type of analysis afforded opportunities to regard the teachers' literacy practices as social in nature and assumes asymmetrical power distributions within and among three different social contexts---an immediate local context (e.g., the science classroom), a wider institutional context (e.g., teaching, middle school), and the larger social contexts (e.g., Discourses of literacy, adolescents, and schooling). The results showed that the teachers' epistemological stances toward teaching and learning had profound impacts on the strategies they continued to use after the staff development. Findings also indicated that the larger societal Discourses about adolescents, high stakes assessment, and teachers as individuals were reflected in the teachers' decisions to use particular instructional approaches.

  14. Field Performance Test of an Air-Cleaner with Photocatalysis-Plasma Synergistic Reactors for Practical and Long-Term Use

    Directory of Open Access Journals (Sweden)

    Tsuyoshi Ochiai

    2014-10-01

    Full Text Available A practical and long-term usable air-cleaner based on the synergy of photocatalysis and plasma treatments has been developed. A field test of the air-cleaner was carried out in an office smoking room. The results were compared to previously reported laboratory test results. Even after a treatment of 12,000 cigarettes-worth of tobacco smoke, the air-cleaner maintained high-level air-purification activity (98.9% ± 0.1% and 88% ± 1% removal of the total suspended particulate (TSP and total volatile organic compound (TVOC concentrations, respectively at single-pass conditions. Although the removal ratio of TSP concentrations was 98.6% ± 0.2%, the ratio of TVOC concentrations was 43.8% after a treatment of 21,900 cigarettes-worth of tobacco smoke in the field test. These results indicate the importance of suitable maintenance of the reactors in the air-cleaner during field use.

  15. [Manual therapy in general practice].

    Science.gov (United States)

    Березуцкий, Владимир И

    2016-01-01

    The article is devoted to manual therapy practice for diagnostics and treatment of vertebrogenic pain syndrome in general practice. Analytical roundup of sources proves medical advantage of implementation of manual therapy basic methods by general practice specialists.

  16. The role of the curriculum and other factors in determining the medium- to long-term attitude of the practicing dentist towards life-long learning.

    LENUS (Irish Health Repository)

    Polyzois, I

    2010-05-01

    To investigate the significance of the undergraduate dental curriculum on the medium- to long-term attitudes of the clinician to life-long learning, and to identify demographical and professional characteristics which may influence this attitude.

  17. Long-term energy contracts and cartel law. Overview of the case practice of the cartel authorities and courts on long-term gas, electricity, and district heating supply contracts and corresponding energy transport and gas storage contracts; Langfristige Energievertraege und Kartellrecht. Uebersicht ueber die Entscheidungspraxis der Kartellbehoerden und Gerichte zu langfristigen Gas-, Strom- und Fernwaermeliefervertraegen sowie entsprechenden Energietransport- und Gasspeichervertraegen

    Energy Technology Data Exchange (ETDEWEB)

    Fischer, Florian

    2011-07-01

    Energy contracts should be drawn up with due consideration not only to the stipulations of civil law but also to aspects of cartel law. In recent times the cartel authorities and legislature have again sharpened their focus on long-term energy contracts. The present study gives an overview of the decisions of the European Commission and the German Federal Cartel Office concerning long-term energy contracts. It offers energy supply companies reference points for an assessment of their own contract practice. It also takes account of the new regulations of the amended Gas Network Access Ordinance as well as the changes soon to come with the EU's Third Single Energy Market Package. For the sake of clarity the study presents the case practice of the cartel authorities separately by energy carrier, making further distinctions by economic level and contractual relationships. It deals not only with natural gas and electricity but also district heating, an energy carrier which is increasingly moving into the focus of the German cartel authorities. The study also discusses the compatibility of long-term energy contracts with European state aid legislation.

  18. Long-Term Blood Pressure Variability, New-Onset Diabetes Mellitus, and New-Onset Chronic Kidney Disease in the Japanese General Population.

    Science.gov (United States)

    Yano, Yuichiro; Fujimoto, Shouichi; Kramer, Holly; Sato, Yuji; Konta, Tsuneo; Iseki, Kunitoshi; Iseki, Chiho; Moriyama, Toshiki; Yamagata, Kunihiro; Tsuruya, Kazuhiko; Narita, Ichiei; Kondo, Masahide; Kimura, Kenjiro; Asahi, Koichi; Kurahashi, Issei; Ohashi, Yasuo; Watanabe, Tsuyoshi

    2015-07-01

    Whether long-term blood pressure (BP) variability among individuals without diabetes mellitus is associated with new-onset chronic kidney disease (CKD) risk, independently of other BP parameters (eg, mean BP, cumulative exposure to BP) and metabolic profile changes during follow-up, remains uncertain. We used data from a nationwide study of 48 587 Japanese adults aged 40 to 74 years (mean age, 61.7 years; 39% men) without diabetes mellitus or CKD (estimated glomerular filtration rate diabetes mellitus, long-term BP variability during 3 years was associated with new-onset CKD risk, independently of mean or cumulative exposure to BP and metabolic profile changes during follow-up.

  19. Discontinuation of long-term benzodiazepine use by sending a letter to users in family practice: a prospective controlled intervention study

    NARCIS (Netherlands)

    Gorgels, W.J.M.J.; Voshaar, R.C. Oude; Mol, A.J.J.; Lisdonk, van de E.H.; Balkom, van A.J.L.M.; Hoogen, van den H.J.M.; Mulder, J.; Breteler, M.H.M.; Zitman, F.G.

    2005-01-01

    Minimal intervention strategies to decrease long-term benzodiazepine use have not yet been evaluated in large primary care based studies with a blinded control condition and a long follow-up period. The purpose of this study was to assess the effects of a letter with a discontinuation advice sent to

  20. Discontinuation of long-term benzodiazepine use by sending a letter to users in family practice: a prospective controlled intervention study.

    NARCIS (Netherlands)

    Gorgels, W.J.M.J.; Oude Voshaar, R.C.; Mol, A.J.J.; Lisdonk, E.H. van de; Balkom, A.J.L.M. van; Hoogen, H.J.M. van den; Mulder, J.; Breteler, M.H.M.; Zitman, F.G.

    2005-01-01

    Minimal intervention strategies to decrease long-term benzodiazepine use have not yet been evaluated in large primary care based studies with a blinded control condition and a long follow-up period. The purpose of this study was to assess the effects of a letter with a discontinuation advice sent to

  1. Preventive Intervention for Preschoolers at High Risk for Antisocial Behavior: Long-Term Effects on Child Physical Aggression and Parenting Practices

    Science.gov (United States)

    Brotman, Laurie Miller; Gouley, Kathleen Kiely; Huang, Keng-Yen; Rosenfelt, Amanda; O'Neal, Colleen; Klein, Rachel G.; Shrout, Patrick

    2008-01-01

    This article presents long-term effects of a preventive intervention for young children at high risk for antisocial behavior. Ninety-two children (M age = 4 years) were randomly assigned to an 8-month family intervention or no-intervention control condition and assessed 4 times over a 24-month period. Intent-to-treat analyses revealed significant…

  2. Long-term outcomes after severe shock.

    Science.gov (United States)

    Pratt, Cristina M; Hirshberg, Eliotte L; Jones, Jason P; Kuttler, Kathryn G; Lanspa, Michael J; Wilson, Emily L; Hopkins, Ramona O; Brown, Samuel M

    2015-02-01

    Severe shock is a life-threatening condition with very high short-term mortality. Whether the long-term outcomes among survivors of severe shock are similar to long-term outcomes of other critical illness survivors is unknown. We therefore sought to assess long-term survival and functional outcomes among 90-day survivors of severe shock and determine whether clinical predictors were associated with outcomes. Seventy-six patients who were alive 90 days after severe shock (received ≥1 μg/kg per minute of norepinephrine equivalent) were eligible for the study. We measured 3-year survival and long-term functional outcomes using the Medical Outcomes Study 36-Item Short-Form Health Survey, the EuroQOL 5-D-3L, the Hospital Anxiety and Depression Scale, the Impact of Event Scale-Revised, and an employment instrument. We also assessed the relationship between in-hospital predictors and long-term outcomes. The mean long-term survival was 5.1 years; 82% (62 of 76) of patients survived, of whom 49 were eligible for follow-up. Patients who died were older than patients who survived. Thirty-six patients completed a telephone interview a mean of 5 years after hospital admission. The patients' Physical Functioning scores were below U.S. population norms (P shock had a high 3-year survival rate. Patients' long-term physical and psychological outcomes were similar to those reported for cohorts of less severely ill intensive care unit survivors. Anxiety and depression were relatively common, but only a few patients had symptoms of posttraumatic stress disorder. This study supports the observation that acute illness severity does not determine long-term outcomes. Even extremely critically ill patients have similar outcomes to general intensive care unit survivor populations.

  3. Long-term urethral catheterisation.

    Science.gov (United States)

    Turner, Bruce; Dickens, Nicola

    This article discusses long-term urethral catheterisation, focusing on the relevant anatomy and physiology, indications for the procedure, catheter selection and catheter care. It is important that nurses have a good working knowledge of long-term catheterisation as the need for this intervention will increase with the rise in chronic health conditions and the ageing population.

  4. Menopause as a long-term risk to health: implications of general practitioner accounts of prevention for women's choice and decision-making.

    Science.gov (United States)

    Murtagh, Madeleine J; Hepworth, Julie

    2003-03-01

    Over the past two decades medical researchers and modernist feminist researchers have contested the meaning of menopause. In this article we examine various meanings of menopause in major medical and feminist literature and the construction of menopause in a semi-structured interview study of general practitioners in rural South Australia. Three discursive themes are identified in these interviews; (i) .the hormonal menopause - symptoms, risk, prevention; (ii). the informed menopausal woman; and (iii). decision-making and hormone replacement therapy. By using the discourse of prevention, general practitioners construct menopause in relation to women's health care choices, empowerment and autonomy. We argue that the ways in which these concepts are deployed by general practitioners in this study produces and constrains the options available to women. The implications of these general practitioner accounts are discussed in relation to the proposition that medical and feminist descriptions of menopause posit alternative but equally-fixed truths about menopause and their relationship with the range of responses available to women at menopause. Social and cultural explanations of disease causality (c.f. Germov 1998, Hardey 1998) are absent from the new menopause despite their being an integral part of the framework of the women's health movement and health promotion drawn on by these general practitioners. Further, the shift of responsibility for health to the individual woman reinforces practice claims to empower women, but oversimplifies power relations and constructs menopause as a site of self-surveillance. The use of concepts from the women's health movement and health promotion have nevertheless created change in both the positioning of women as having 'choices' and the positioning of some general practitioners in terms of greater information provision to women and an attention to the woman's autonomy. In conclusion, we propose that a new menopause has evolved

  5. Biomonitoring short- and long-term exposure to the herbicide terbuthylazine in agriculture workers and in the general population using urine and hair specimens.

    Science.gov (United States)

    Mercadante, Rosa; Polledri, Elisa; Bertazzi, Pier Alberto; Fustinoni, Silvia

    2013-10-01

    The aim of this work was to evaluate short-term and long-term exposure to terbuthylazine (TBA) in agriculture workers (AW), rural residents (RR), and urban residents (UR) using urine and hair specimens. Twelve AW, 13 RR, and 17 UR were included in the study. Urine spot samples were collected with two different protocols. AW urine samples were collected before the application season (February, U0), at bedtime on the day of TBA application (March-May, U1), and prior to the next shift on the day after TBA application (U2). RR and UR urine samples were collected on any day during the application season (Ue). Hair samples were collected for all subjects before the application season (February, H0) and at the end of the season (June, H1). TBA and its metabolite desethylterbuthylazine (DET) were measured by liquid chromatography coupled with triple quadrupole mass spectrometry detection. DET was exclusively found in urine, while TBA was mostly found in the hair. In the AW, the urinary levels of DET were not detected in the U0 samples, and they increased to median levels of 1.81 and 2.94μg/L in the U1 and U2 samples, respectively (p<0.001). In the RR and UR, DET was not detected in the Ue samples. In the UR, TBA was not detected in the H0 samples, and the median levels of TBA were 0.01ng/mg hair in both the AW and RR. In the H1 samples, the median TBA levels were not detected, 0.01, and 0.08ng/mg hair in the UR, RR, and AW, respectively (p<0.001). Urinary DET and hair TBA are promising candidates for biomonitoring short- and long-term exposure to TBA. The use of this herbicide in agriculture leads to exposure in rural residents.

  6. Long-term use of non-steroidal anti-inflammatory drugs and the risk of myocardial infarction in the general population

    Directory of Open Access Journals (Sweden)

    González-Pérez Antonio

    2005-11-01

    Full Text Available Abstract Background Recent data indicate that chronic use of coxibs leads to an increased occurrence of thrombotic cardiovascular events. This raises the question as to whether traditional non-steroidal anti-inflammatory drugs (tNSAIDs might also produce similar hazards. Our aim has been to evaluate the association between the chronic use of tNSAIDs and the risk of myocardial infarction (MI in patients. Methods We performed a nested case-control analysis with 4,975 cases of acute MI and 20,000 controls, frequency matched to cases by age, sex, and calendar year. Results Overall, current use of tNSAID was not associated with an increased risk of MI (RR:1.07;95%CI: 0.95–1.21. However, we found that the relative risk (RR of MI for durations of tNSAID treatment of >1 year was 1.21 (95% CI, 1.00–1.48. The corresponding RR was 1.34 (95% CI, 1.06–1.70 for non-fatal MI. The effect was independent from dose. The small risk associated with long-term use of tNSAIDs was observed among patients not taking low-dose aspirin (RR: 1.29; 95% CI, 1.01–1.65. The effect of long-term use for individual tNSAIDs ranged from a RR of 0.87 (95% CI, 0.47–1.62 with naproxen to 1.38 (95% CI, 1.00–1.90 with diclofenac. Conclusion This study adds support to the hypothesis that chronic treatment with some tNSAIDs is associated with a small increased risk of non-fatal MI. Our data are consistent with a substantial variability in cardiovascular risks between individual tNSAIDs.

  7. Gratitude in Long Term Care

    Directory of Open Access Journals (Sweden)

    Brooke Abrams Sunding

    2015-04-01

    Full Text Available An exploratory study was conducted to examine the effectiveness of a group gratitude intervention with 29 permanent residents at a long term care/skilled nursing facility in improving elder mood, behavior and well- being over a 3 week time period. The sample included individuals diagnosed with dementia, other cognitive impairment, major depressive disorder, insomnia and generalized anxiety disorder. The gratitude intervention consisted of asking elders to share what they are thankful for at the dinner table each day. Measures included the Elder Well Being Scale and The Dinner Rating Scale. On both measures, higher scores indicated better functioning. To test the hypothesis that post treatment elder well-being will be significantly higher than pretreatment elder well-being ratings, a one-way ANOVA was conducted. Post-hoc tests revealed a statistically significant increase in Elder Well Being Scale scores. An ANOVA of comparing Dinner Ratings demonstrated a nonsignificant increase over the 3 week experiment. Implications are discussed.

  8. Identification of nitrate long term trends in Loire-Brittany river district (France) in connection with hydrogeological contexts, agricultural practices and water table level variations

    Science.gov (United States)

    Lopez, B.; Baran, N.; Bourgine, B.; Ratheau, D.

    2009-04-01

    follow a significant downward trend period (Orléans). In the nineties, a transition period may have occurred with a higher proportion of upward than downward trends (82 % against 7 % respectively) for the 1980-1990 period and a lower proportion of upward than downward trends for the 2000-2007 period (37 % against 51 % respectively). Combined with the analyse of the current groundwater nitrate concentrations, the KR test reveals zones where trends in nitrate concentrations have been significantly raising with high nitrate current mean values (> 50 mg NO3 L-1). On the other hand, some zones show a significant regional downward trend since 1995 and low current nitrate concentrations (series gives a hint of a positive correlation between these two variables. Evolution of nitrate concentrations in superficial aquifers may thus depend on a combined effect of changes in both agricultural practices and evolution of water table levels linked with climatic context. References Aguilar J.B., Orban P., Dassargues A., Brouyère S., (2007) - Identification of groundwater quality trends in a chalk aquifer threatened by intensive agriculture in Belgium. Hydrogeology journal 15: 1615-1627. Broers H.P., van der Grift B., (2004) - Regional monitoring of temporal changes in groundwater quality. Journal of hydrology 296: 192-220. Frans L.M., Helsel D.R. (2005) - Evaluating regional trends in ground water nitrate concentrations of the Columbia Basin Ground Water management Area, Washington. U.S. Geological Survey Scientific Investigations Report 2005-5078, 7p. Stuart M.E., Chilton P.J., Kiniiburgh D.G., Cooper D.M., (2007) - Screening for long-term trends in groundwater nitrate monitoring data. Quaterly Journal of Engineering Geology and Hydrogeology, 40: 361-376. Funding The study was funded by the Loire-Brittany River Basin Agency and from proper BRGM funds.

  9. Practical application of cure mixture model for long-term censored survivor data from a withdrawal clinical trial of patients with major depressive disorder

    Directory of Open Access Journals (Sweden)

    Hamasaki Toshimitsu

    2010-04-01

    Full Text Available Abstract Background Survival analysis methods such as the Kaplan-Meier method, log-rank test, and Cox proportional hazards regression (Cox regression are commonly used to analyze data from randomized withdrawal studies in patients with major depressive disorder. However, unfortunately, such common methods may be inappropriate when a long-term censored relapse-free time appears in data as the methods assume that if complete follow-up were possible for all individuals, each would eventually experience the event of interest. Methods In this paper, to analyse data including such a long-term censored relapse-free time, we discuss a semi-parametric cure regression (Cox cure regression, which combines a logistic formulation for the probability of occurrence of an event with a Cox proportional hazards specification for the time of occurrence of the event. In specifying the treatment's effect on disease-free survival, we consider the fraction of long-term survivors and the risks associated with a relapse of the disease. In addition, we develop a tree-based method for the time to event data to identify groups of patients with differing prognoses (cure survival CART. Although analysis methods typically adapt the log-rank statistic for recursive partitioning procedures, the method applied here used a likelihood ratio (LR test statistic from a fitting of cure survival regression assuming exponential and Weibull distributions for the latency time of relapse. Results The method is illustrated using data from a sertraline randomized withdrawal study in patients with major depressive disorder. Conclusions We concluded that Cox cure regression reveals facts on who may be cured, and how the treatment and other factors effect on the cured incidence and on the relapse time of uncured patients, and that cure survival CART output provides easily understandable and interpretable information, useful both in identifying groups of patients with differing prognoses and in

  10. Standards for Psychological Services in Long-Term Care Facilities.

    Science.gov (United States)

    Morrow-Howell, Nancy; Lichtenberg, Peter A.; Smith, Michael; Frazer, Deborah; Molinari, Victor; Rosowsky, Erlene; Crose, Royda; Stillwell, Nick; Kramer, Nanette; Hartman-Stein, Paula; Qualls, Sara; Salamon, Michael; Duffy, Michael; Parr, Joyce; Gallagher-Thompson, Dolores

    1998-01-01

    Describes the development of standards for psychological practice in long-term care facilities. The standards, which were developed by Psychologists in Long-Term Care, address provider characteristics, methods of referral, assessment practices, treatment, and ethical issues. Offers suggestions for use of the standards. (MKA)

  11. Impetigo in General Practice

    NARCIS (Netherlands)

    S. Koning (Sander)

    2005-01-01

    textabstractImpetigo is a common skin infection, usually caused by Staphylococcus aureus that mainly occurs in children. Patients with impetigo usually consult their general practitioner, who also treats the vast majority of cases. Impetigo is considered highly infectious, and consequently childr

  12. Behavioural science in general practice.

    Science.gov (United States)

    Wood, D R

    1979-10-01

    Dr Peter Sowerby has written an important criticism of Michael Balint's work based on his understanding of Karl Popper's writings. I dispute Sowerby's interpretation of Popper and disagree with his conclusions, which I suggest would lead general practice into a retreat. I believe Balint made a major contribution to general practice and has helped us towards practising whole-person medicine.

  13. Recruitment of general practices

    DEFF Research Database (Denmark)

    Riis, Allan; Jensen, Cathrine Elgaard; Maindal, Helle Terkildsen;

    2016-01-01

    Introduction: Health service research often involves the active participation of healthcare professionals. However, their ability and commitment to research varies. This can cause recruitment difficulties and thereby prolong the study period and inflate budgets. Solberg has identified seven R......, which was fewer than planned (100 practices). In this evaluation, five of Solberg’s seven R-factors were successfully addressed and two factors were not. The need to involve (reciprocity) end users in the development of new software and the amount of time needed to conduct recruitment (resolution) were...

  14. Patient self-management of oral anticoagulation with vitamin K antagonists in everyday practice: efficacy and safety in a nationwide long-term prospective cohort study.

    Directory of Open Access Journals (Sweden)

    Michael Nagler

    Full Text Available Patient self-management (PSM of oral anticoagulation is under discussion, because evidence from real-life settings is missing. Using data from a nationwide, prospective cohort study in Switzerland, we assessed overall long-term efficacy and safety of PSM and examined subgroups. Data of 1140 patients (5818.9 patient-years were analysed and no patient were lost to follow-up. Median follow-up was 4.3 years (range 0.2-12.8 years. Median age at the time of training was 54.2 years (range 18.2-85.2 and 34.6% were women. All-cause mortality was 1.4 per 100 patient-years (95% CI 1.1-1.7 with a higher rate in patients with atrial fibrillation (2.5; 1.6-3.7; p50 years of age (2.0; 1.6-2.6; p<0.001, and men (1.6; 1.2-2.1; p = 0.036. The rate of thromboembolic events was 0.4 (0.2-0.6 and independent from indications, sex and age. Major bleeding were observed in 1.1 (0.9-1.5 per 100 patient-years. Efficacy was comparable to standard care and new oral anticoagulants in a network meta-analysis. PSM of properly trained patients is effective and safe in a long-term real-life setting and robust across clinical subgroups. Adoption in various clinical settings, including those with limited access to medical care or rural areas is warranted.

  15. The Advantage of Cyclosporine A and Methotrexate Rotational Therapy in Long-Term Systemic Treatment for Chronic Plaque Psoriasis in a Real World Practice

    Science.gov (United States)

    Choi, Chong Won; Kim, Bo Ri; Ohn, Jungyoon

    2017-01-01

    Background Psoriasis is a chronic inflammatory disease. In the treatment of psoriasis, cyclosporine is commonly prescribed systemic agents. However, long-term use of cyclosporine is not recommended because of side effects such as nephrotoxicity or hypertension. Objective To ascertain the improved safety of rotational therapy using cyclosporine and methotrexate, we investigated the frequency of abnormal results in laboratory test after long term rotational therapy using cyclosporine and methotrexate. Methods From January 2009 to June 2014, patients who were treated with cyclosporine or methotrexate were enrolled. The clinical data and usage of medications were reviewed. Laboratory tests were conducted before starting the treatment and regularly follow-up. The occurrences of any laboratory abnormalities during the treatments were investigated. Results A total of 21 psoriatic patients were enrolled. The mean of medication period and cumulative dose of cyclosporine and methotrexate were 497.81±512.06 days and 115.68±184.34 g in cyclosporine and 264.19±264.71 days and 448.71±448.63 mg in methotrexate. Laboratory abnormalities were found in total two patients after rotational therapy: two patients (9.5%) in aspartate aminotransferase/alanine aminotransferase and one patient (4.8%) in uric acid. No laboratory abnormalities were found in renal function test. Conclusion We found that the rotational approaches using cyclosporine and methotrexate reduced the possibility of the development of nephrotoxicity. In addition to other advantage such as quick switching from one agent to another, the rotational therapy using cyclosporine and methotrexate can minimize the adverse events during the systemic treatment of chronic plaque psoriasis. PMID:28223747

  16. Methodological practicalities in analytical generalization

    DEFF Research Database (Denmark)

    Halkier, Bente

    2011-01-01

    In this article, I argue that the existing literature on qualitative methodologies tend to discuss analytical generalization at a relatively abstract and general theoretical level. It is, however, not particularly straightforward to “translate” such abstract epistemological principles into more...... operative methodological strategies for producing analytical generalizations in research practices. Thus, the aim of the article is to contribute to the discussions among qualitatively working researchers about generalizing by way of exemplifying some of the methodological practicalities in analytical...... and processes in producing the three different ways of generalizing: ideal typologizing, category zooming, and positioning....

  17. The long term characteristics of greenschist

    Science.gov (United States)

    Jang, Bo-An

    2016-04-01

    The greenschist in the Jinping II Hydropower Station in southwest China exhibits continuous creep behaviour because of the geological conditions in the region. This phenomenon illustrates the time-dependent deformation and progressive damage that occurs after excavation. In this study, the responses of greenschist to stress over time were determined in a series of laboratory tests on samples collected from the access tunnel walls at the construction site. The results showed that the greenschist presented time-dependent behaviour under long-term loading. The samples generally experienced two stages: transient creep and steady creep, but no accelerating creep. The periods of transient creep and steady creep increased with increasing stress levels. The long-term strength of the greenschist was identified based on the variation of creep strain and creep rate. The ratio of long-term strength to conventional strength was around 80% and did not vary much with confining pressures. A quantitative method for predicting the failure period of greenschist, based on analysis of the stress-strain curve, is presented and implemented. At a confining pressure of 40 MPa, greenschist was predicted to fail in 5000 days under a stress of 290 MPa and to fail in 85 days under the stress of 320 MPa, indicating that the long-term strength identified by the creep rate and creep strain is a reliable estimate.

  18. Increased healthcare utilization costs following initiation of insulin treatment in type 2 diabetes: A long-term follow-up in clinical practice.

    Science.gov (United States)

    Kalkan, Almina; Bodegard, Johan; Sundström, Johan; Svennblad, Bodil; Östgren, Carl Johan; Nilsson, Peter Nilsson; Johansson, Gunnar; Ekman, Mattias

    2017-04-01

    To compare long-term changes in healthcare utilization and costs for type 2 diabetes patients before and after insulin initiation, as well as healthcare costs after insulin versus non-insulin anti-diabetic (NIAD) initiation. Patients newly initiated on insulin (n=2823) were identified in primary health care records from 84 Swedish primary care centers, between 1999 to 2009. First, healthcare costs per patient were evaluated for primary care, hospitalizations and secondary outpatient care, before and up to seven years after insulin initiation. Second, patients prescribed insulin in second line were matched to patients prescribed NIAD in second line, and the healthcare costs of the matched groups were compared. The total mean annual healthcare cost increased from €1656 per patient 2 years before insulin initiation to €3814 seven years after insulin initiation. The total cumulative mean healthcare cost per patient at year 5 after second-line treatment was €13,823 in the insulin group compared to €9989 in the NIAD group. Initiation of insulin in type 2 diabetes patients was followed by increased healthcare costs. The increases in costs were larger than those seen in a matched patient population initiated on NIAD treatment in second-line. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  19. What makes a sustainability tool valuable, practical and useful in real-world healthcare practice? A mixed-methods study on the development of the Long Term Success Tool in Northwest London.

    Science.gov (United States)

    Lennox, Laura; Doyle, Cathal; Reed, Julie E; Bell, Derek

    2017-09-24

    Although improvement initiatives show benefits to patient care, they often fail to sustain. Models and frameworks exist to address this challenge, but issues with design, clarity and usability have been barriers to use in healthcare settings. This work aimed to collaborate with stakeholders to develop a sustainability tool relevant to people in healthcare settings and practical for use in improvement initiatives. Tool development was conducted in six stages. A scoping literature review, group discussions and a stakeholder engagement event explored literature findings and their resonance with stakeholders in healthcare settings. Interviews, small-scale trialling and piloting explored the design and tested the practicality of the tool in improvement initiatives. National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Northwest London (CLAHRC NWL). CLAHRC NWL improvement initiative teams and staff. The iterative design process and engagement of stakeholders informed the articulation of the sustainability factors identified from the literature and guided tool design for practical application. Key iterations of factors and tool design are discussed. From the development process, the Long Term Success Tool (LTST) has been designed. The Tool supports those implementing improvements to reflect on 12 sustainability factors to identify risks to increase chances of achieving sustainability over time. The Tool is designed to provide a platform for improvement teams to share their own views on sustainability as well as learn about the different views held within their team to prompt discussion and actions. The development of the LTST has reinforced the importance of working with stakeholders to design strategies which respond to their needs and preferences and can practically be implemented in real-world settings. Further research is required to study the use and effectiveness of the tool in practice and assess engagement with

  20. Prescription in Dutch general practice.

    NARCIS (Netherlands)

    Dijk, L. van

    2006-01-01

    The second Dutch National Survey of General Practice (DNSGP-2) has combined registration data on morbidity and prescription, making it possible to unravel diagnosis-specific prescription behaviour of general practitioners(GPs). Prescription rates for different disorders vary considerably, especially

  1. Manual therapy, physical therapy, or continued care by the general practitioner for patients with neck pain: long-term results from a pragmatic randomized clinical trial.

    NARCIS (Netherlands)

    Hoving, J.L.; Vet, H.C.W. de; Koes, B.W.; Mameren, H. van; Devillé, W.L.J.M.; Windt, D.A.W.M. van der; Assendelft, W.J.J.; Pool, J.J.M.; Scholten, R.J.P.M.; Korthals-de Bos, I.B.C.; Bouter, L.M.

    2006-01-01

    OBJECTIVES: The authors' goals were to compare the effectiveness of manual therapy (MT; mainly spinal mobilization), physical therapy (PT; mainly exercise therapy), and continued care by the general practitioner (GP; analgesics, counseling and education) over a period of 1 year. METHODS: One hundred

  2. Long-term psychosocial behavioral outcomes in children following anesthesia: A comparison of the effects of general versus regional anesthesia on term infants delivered by elective cesarean section

    Directory of Open Access Journals (Sweden)

    Aouni Alameddine

    2013-01-01

    Full Text Available Background: Data on the effects of general anesthesia on the fetal and neonatal brain are limited. Animal studies demonstrated that anesthetic agents leave their consequences in the form of learning and memory deficits. The effects of propofol on the fetal neurodevelopment are not clear yet. Materials and Methods: This is a telephone-based questionnaire survey that addressed the effect of general anesthesia by propofol during cesarean section at term with no perinatal complications on the psychosocial behavior of children at 8-10 years of age compared with children having same characteristics except for delivery under neuraxial anesthesia using the Pediatric Symptom Checklist as a score. Results: A total of 187 children were born at term between January 1, 2002 and December 31, 2004 with no perinatal distress under induction of general anesthesia by propofol. 66 children (35.3% were lost to follow-up and parents of two children (1.1% refused to participate. A total of 189 children were included in the study: 119 were born by cesarean section under general anesthesia and 70 were born by cesarean section under neuraxial block. The incidence of psychosocial behavior impairment at 8-10 years of age was not found to be affected by the mode of anesthesia during delivery by cesarean section nor by neonatal nor parental characteristics. Conclusion: Exposure to propofol as an induction agent for general anesthesia or cesarean section does not seem to increase the psychosocial behavior disorder development risk at 8-10 years of age.

  3. Using MIQUEST in General Practice

    Directory of Open Access Journals (Sweden)

    Victoria Hammersley

    1998-11-01

    Full Text Available This paper describes ten months' experience with MIQUEST software used for the collection of data from computerised databases in General Practice. We report on the following: the MIQUEST software in use, the time costs to the practice, the completeness of confidentiality barriers and the accuracy of data collected using MIQUEST compared with similar data collected by the practice system (EMIS. There were no problems encountered with installation of MIQUEST-related software. With experience, MIQUEST was equal to the practice system for speed and ease of use. The confidentiality safeguards were found to be in accordance with the GMSC/RCGP Guidelines - patients could not be directly, or indirectly, identified from the data extracted by external searches. Inaccuracies in the data collected using MIQUEST were identified, but these were largely attributable to problems with the EMIS-written interpreter available on the practice system at the time, or with the coding schemes used by the practice. In an individual practice, MIQUEST represents an alternative data collection method to the practice-based software. For data collection from multiple general practices it should prove an invaluable tool for Health Authorities and research organisations.

  4. What are the beliefs, attitudes and practices of front-line staff in long-term care (LTC facilities related to osteoporosis awareness, management and fracture prevention?

    Directory of Open Access Journals (Sweden)

    Adachi Jonathan D

    2010-10-01

    Full Text Available Abstract Background Compared to the general elderly population, those institutionalized in LTC facilities have the highest prevalence of osteoporosis and subsequently have higher incidences of vertebral and hip fractures. The goal of this study is to determine how well nurses at LTC facilities are educated to properly administer bisphosphonates. A secondary question assessed was the nurse's and PSW's attitudes and beliefs regarding the role and benefits of vitamin D for LTC patients. Methods Eight LTC facilities in Hamilton were surveyed, and all nurses were offered a survey. A total 57 registered nurses were surveyed. A 21 item questionnaire was developed to assess existing management practices and specific osteoporosis knowledge areas. Results The questionnaire assessed the nurse's and personal support worker's (PSWs education on how to properly administer bisphosphonates by having them select all applicable responses from a list of options. These options included administering the drug before, after or with meals, given with or separate from other medications, given with juice, given with or without water, given with the patient sitting up, or finally given with the patient supine. Only 52% of the nurses and 8.7% of PSWs administered the drug properly, where they selected the options: (given before meals, given with water, given separate from all other medications, and given in a sitting up position. If at least one incorrect option was selected, then it was scored as an inappropriate administration. Bisphosphonates were given before meals by 85% of nurses, given with water by 90%, given separately from other medication by 71%, and was administered in an upright position by 79%. Only 52% of the nurses and 8.7% of PSWs surveyed were administering the drug properly. Regarding the secondary question, of the 57 nurses surveyed, 68% strongly felt their patients should be prescribed vitamin D supplements. Of the 124 PSWs who completed the survey

  5. Developmental Dyslexia and Explicit Long-Term Memory

    Science.gov (United States)

    Menghini, Deny; Carlesimo, Giovanni Augusto; Marotta, Luigi; Finzi, Alessandra; Vicari, Stefano

    2010-01-01

    The reduced verbal long-term memory capacities often reported in dyslexics are generally interpreted as a consequence of their deficit in phonological coding. The present study was aimed at evaluating whether the learning deficit exhibited by dyslexics was restricted only to the verbal component of the long-term memory abilities or also involved…

  6. Long-Term Hearing Results After Ossiculoplasty.

    Science.gov (United States)

    Cox, Matthew D; Trinidade, Aaron; Russell, James Shep; Dornhoffer, John L

    2017-04-01

    To determine if the OOPS index is predictive of long-term hearing results after ossiculoplasty. Case series with retrospective chart review. Tertiary care otology practice. Adult and pediatric patients (3-88 years of age). Ossiculoplasty with cartilage tympanoplasty, with or without mastoidectomy. Primary outcome measures included short-term hearing results (pure-tone average air-bone gap [PTA-ABG] measured between 60 days and 1 year after surgery), long-term hearing results (PTA-ABG measured ≥5 years after surgery), and the rate of successful ABG closure to ≤20 dB. Secondary measures included the need for revision surgery, delayed tympanic membrane graft failure, worsening conductive hearing loss (after an initially satisfactory hearing result), and recurrence of cholesteatoma. There was no significant difference between adults and children for short-term hearing results (average post-op PTA-ABG was 18.9 dB vs. 19.8 dB, respectively; p = 0.544), long-term hearing results (average final PTA-ABG was 19.3 dB vs. 19.4 dB, respectively; p = 0.922), or rate of ABG closure to less than 20 dB (63.1% vs. 58.0%, p = 0.282). Spearman's rank-order correlation (ρ) identified a strong positive correlation between OOPS index score and average post-operative PTA-ABG (ρ = 0.983; p hearing outcomes in adult and pediatric patients undergoing ossiculoplasty in both the short term and the long term.

  7. Long-term CO2 flux dynamics and soil C stock changes of a drained fen mire under different grassland management practices in Northeast Germany

    Science.gov (United States)

    Augustin, Juergen; Giebels, Michael; Albiac Borraz, Elisa; Hoffmann, Mathias; Sommer, Michael

    2014-05-01

    time all combinations of land use intensity and soil types acted as strong CO2 sources and showed high soil C losses (up to 1070 g C m-2 yr-1). There was a tendency of lower soil C losses in case of extensive grassland compared to intensive grassland use (820 vs. 1070 g C m-2 yr-1) and grassland at the Gleysol site compared to the Histosol site (538 vs. 946 g C m-2 yr-1). However, the cumulated C fluxes and the soil C losses are subject to a very strong interannual variability. The actual range varied from 245 to 2092 g C m-2 yr-1 in case of the soil C losses. It can be therefore concluded that only long-term measurements (> 3 years) provides reliable information about the C dynamics of drained fen mires. Due to the high interannual variability, there is a high risk to get largely biased results if only short-term measurements will be done.

  8. Long-term prospective teaching effectivity of practical skills training and a first OSCE in cranio maxillofacial surgery for dental students.

    Science.gov (United States)

    Landes, Constantin A; Hoefer, Sebastian; Schuebel, Florian; Ballon, Alexander; Teiler, Anna; Tran, Andreas; Weber, Roxane; Walcher, Felix; Sader, Robert

    2014-07-01

    Basic skills in oral/CMF surgery should be taught effectively to dental students as surgical skills training is traditionally under-represented in the dental curriculum compared to its later need in daily clinical practice. Rigid curricular time frames and prospectively condensed professional education foster new effective teaching and examination formats. Transmitting and assessing clinical competence objectively (independent of subjective bias), reliably (repeatable, inter-rater consistency) and valid (representative, structured task selection) was intended and evaluated in oral/CMF surgery skills acquisition starting in summer 2009. A small-group practical skills training (PST) day initiated a one-week practical training course, covering previously formulated learning objectives. An objective structured clinical evaluation (OSCE) was held at the end of each semester. Theoretical background knowledge and clinical skills should have to be memorized within a representative number of practical tasks (test stations). A first semester (26 students) used classical practical training alone as controls, the following semesters (171 students) had PST, considered as a study group. All 197 students were assessed with OSCE's over a 3-year period. An instructor held PST based on presentations, videos and practical training, including mannequins, with pairs of students. This included history taking, communication and interpretation of laboratory/image diagnostics, structured clinical facial examination, fracture diagnosis, venipuncture, suturing, biopsy and wire loops on pig jaws for manual and clinical skills, which were later incorporated in OSCE stations. OSCE average results increased from 63.3 ± 9.7% before and to 75.5 ± 10% after the inclusion of PST (p skills as evaluated by OSCE.

  9. Long term stability of power systems

    Energy Technology Data Exchange (ETDEWEB)

    Kundur, P.; Gao, B. [Powertech Labs. Inc., Surrey, BC (Canada)

    1994-12-31

    Power system long term stability is still a developing subject. In this paper we provide our perspectives and experiences related to long term stability. The paper begins with the description of the nature of the long term stability problem, followed by the discussion of issues related to the modeling and solution techniques of tools for long term stability analysis. Cases studies are presented to illustrate the voltage stability aspect and plant dynamics aspect of long term stability. (author) 20 refs., 11 figs.

  10. Low and then high frequency oscillations of distinct right cortical networks are progressively enhanced by medium and long term Satyananda Yoga meditation practice

    Directory of Open Access Journals (Sweden)

    John eThomas

    2014-06-01

    Full Text Available Meditation proficiency is related to trait-like (learned effects on brain function, developed over time. Previous studies show increases in EEG power in lower frequency bands (theta, alpha in experienced meditators in both meditation states and baseline conditions. Higher gamma band power has been found in advanced Buddhist meditators, yet it is not known if this occurs in Yoga meditation practices. This study used eLORETA to compare differences in cortical source activity underlying scalp EEG from intermediate (mean experience 4 years and advanced (mean experience 30 years Australian meditators from the Satyananda Yoga tradition during a body-steadiness meditation, mantra meditation and non-meditation mental calculation condition. Intermediate Yoga meditators showed greater source activity in low frequencies (particularly theta and alpha1 during mental calculation, body-steadiness and mantra meditation. A similar spatial pattern of significant differences was found in all conditions but the number of significant voxels was double during body-steadiness and mantra meditation than in the non-meditation (calculation condition. These differences were greatest in right (R superior frontal and R precentral gyri and extended back to include the R parietal and occipital lobes. Advanced Yoga meditators showed greater activity in high frequencies (beta and especially gamma in all conditions but greatly expanded during meditation practice. Across all conditions (meditation and non-meditation differences were greatest in the same regions; R insula, R inferior frontal gyrus and R anterior temporal lobe. Distinct R core networks were identified in alpha1 (8-10 Hz and gamma (25-42 Hz bands respectively. The voxels recruited to these networks greatly expanded during meditation practice to include homologous regions of the left hemisphere. Functional interpretation parallels traditionally described stages of development in Yoga proficiency.

  11. Calcipotriol/betamethasone dipropionate ointment in mild-to-moderate paediatric psoriasis: long-term daily clinical practice data in a prospective cohort.

    Science.gov (United States)

    van Geel, M J; Mul, K; Oostveen, A M; van de Kerkhof, P C M; de Jong, E M G J; Seyger, M M B

    2014-08-01

    Psoriasis in children has a significant negative impact on the quality of life (QoL) and effective treatment can improve this. The two-compound ointment calcipotriol 50 μg g(-1) and betamethasone dipropionate 0·5 mg g(-1) is an effective treatment option for moderate-to-severe psoriasis in adults. To study prospectively the effectiveness and safety of calcipotriol/betamethasone dipropionate ointment in paediatric patients with mild-to-moderate plaque psoriasis in daily clinical practice and to investigate the influence on QoL. Data were obtained from a prospective, longitudinal paediatric psoriasis registry, called Child-CAPTURE. Severity was assessed using the Psoriasis Area and Severity Index (PASI) and body surface area (BSA). The Children's Dermatology Life Quality Index (CDLQI) was used to assess QoL and visual analogue scores (VAS) for pain and itch were collected. For safety data the number of (serious) adverse events was recorded. Seventy-three patients (mean age 10·8 years, range 3-18) were treated for a median time of 35·0 weeks (range 1·0-176·0). At week 12, mean PASI decreased 15·4% (from 5·2 to 4·4), BSA barely changed, and median CDLQI decreased significantly from 5·5 to 4·0. VAS scores for pain and itch declined. At week 24, mean PASI decreased to 4·3 (17·3%). No related serious adverse events were observed. In this daily clinical practice study in paediatric psoriasis, calcipotriol/betamethasone dipropionate ointment initially improved mild-to-moderate psoriasis and then maintained its effect. In addition, it improved QoL, with few adverse events. © 2014 British Association of Dermatologists.

  12. [Autoimmune processes after long-term low-level exposure to electromagnetic fields (the results of an experiment). Part 2. General scheme and conditions of the experiment. Development of RF exposure conditions complying with experimental tasks. Animal's status during the long-term exposure].

    Science.gov (United States)

    Grigor'ev, Iu G; Grigor'ev, O A; Merkulov, A V; Shafirkin, A V; Vorob'ev, A A

    2010-01-01

    This paper describes the conditions for handling and exposure of experimental animals (Wistar rats) and methods used in the study of immunological effects of long-term low-level (500 microW/cm2) exposure to radiofrequency (2450 MHz) electromagnetic fields, performed under auspices of the World Health Organization.

  13. Long-Term Dynamics of Autonomous Fractional Differential Equations

    Science.gov (United States)

    Liu, Tao; Xu, Wei; Xu, Yong; Han, Qun

    This paper aims to investigate long-term dynamic behaviors of autonomous fractional differential equations with effective numerical method. The long-term dynamic behaviors predict where systems are heading after long-term evolution. We make some modification and transplant cell mapping methods to autonomous fractional differential equations. The mapping time duration of cell mapping is enlarged to deal with the long memory effect. Three illustrative examples, i.e. fractional Lotka-Volterra equation, fractional van der Pol oscillator and fractional Duffing equation, are studied with our revised generalized cell mapping method. We obtain long-term dynamics, such as attractors, basins of attraction, and saddles. Compared with some existing stability and numerical results, the validity of our method is verified. Furthermore, we find that the fractional order has its effect on the long-term dynamics of autonomous fractional differential equations.

  14. Environmental Management Long-Term Stewardship Transition Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Kristofferson, Keith

    2001-11-01

    Long-term stewardship consists of those actions necessary to maintain and demonstrate continued protection of human health and the environment after the completion of facility cleanup. Long-term stewardship is administered and overseen by the U.S. Department of Energy Environmental Management Office of Science and Technology. This report describes the background of long-term stewardship and gives general guidance about considerations when ownership and/or responsibility of a site should be transferred to a long-term stewardship program. This guidance document will assist the U.S. Department of Energy in: (a) ensuring that the long-term stewardship program leads transition planning with respect to facility and site areas, and (b) describing the classes and types of criteria and data required to initiate transition for areas and sites where the facility mission has ended and cleanup is complete.

  15. Laser therapy in general dental practice

    Science.gov (United States)

    Darbar, Arun A.

    2006-02-01

    This is a clinical presentation on the use of laser therapy in a private dental practice using a 810nm diode. A wide range of conditions involving pain management, treatment and as an adjunct to procedures to enhance patient comfort and experience. This will include cases treated for TMD (Temporo mandibular dysfunction), apthous ulcers, angular chelitis, cold sores, gingival retraction, periodontal treatment and management of failing dental implants. The case presentation will include the protocols used and some long term reviews. The results have been very positive and will be shared to enable this form of treatment to be used more frequently and with confidence within dental practice.

  16. Long-Term Durability of Tenofovir-Based Antiretroviral Therapy in Relation to the Co-Administration of Other Drug Classes in Routine Clinical Practice

    Science.gov (United States)

    Bonora, Stefano; Madeddu, Giordano; Maggiolo, Franco; Antinori, Andrea; Galli, Massimo; Di Perri, Giovanni; Viale, Pierluigi; d’Arminio Monforte, Antonella; Gori, Andrea

    2016-01-01

    Background In clinical trials, toxicity leading to tenofovir disoproxil fumarate (TDF) discontinuation is rare (3% by 2 years); however in clinical practice it seems to be higher, particularly when TDF is co-administered with ritonavir-boosted protease inhibitors (PI/r). Aims of this study were to assess the rate of TDF discontinuations in clinical practice and to identify factors associated with the risk of stopping TDF. Methods All antiretroviral treatment (ART)-naive patients initiating a TDF-based regimen were selected from the ICONA Foundation Study cohort. The primary outcome was TDF discontinuation regardless of the reason; secondary outcome measures were TDF discontinuation due to toxicity and selective TDF discontinuation (that is, TDF discontinuation or substitution, maintaining unchanged the remaining antiretroviral treatment). Results 3,618 ART-naïve patients were included: 54% started a PI/r-based and 46% a NNRTI-based based regimen. Two-hundred-seventy-seven patients discontinued TDF and reintroduced ART within 30 days without TDF. The probability of TDF discontinuation regardless of the reason was of 7.4% (95%CI:6.4–8.5) by 2 years and 14.1% (95%CI:12.2–16.1) by 5 years. The 5-year KM estimates in the PI/r vs. NNRTI group were 20.4% vs. 7.6%, respectively (log-rank p = 0.0001), for the outcome of stopping regardless of the reason, and 10.7% vs. 4.7% (p = 0.0001) for discontinuation due to toxicity. PI/r use and lower eGFR were associated with an increased risk of discontinuing TDF. Conclusion In our cohort, the frequency of TDF discontinuations was higher than that observed in clinical trials. Co-administration of TDF with PI/r was associated with an increased rate of TDF discontinuations. Further studies are needed to clarify the mechanisms that might have led to this outcome. PMID:27716843

  17. Effects of long-term practice and task complexity on brain activities when performing abacus-based mental calculations: a PET study

    Energy Technology Data Exchange (ETDEWEB)

    Wu, Tung-Hsin [Chung Shan Medical University, Department of Medical Imaging and Radiological Sciences, Taichung (China); National Yang-Ming University, Department of Biomedical Imaging and Radiological Sciences, Taipei (China); Chen, Chia-Lin [Chung Shan Medical University, Department of Medical Imaging and Radiological Sciences, Taichung (China); Huang, Yung-Hui [I-Shou University, Department of Medical Imaging and Radiological Sciences, Kaohsiung County (China); Liu, Ren-Shyan [National Yang-Ming University, Department of Nuclear Medicine, Faculty of Medicine, Taipei (China); Taipei Veterans General Hospital, Department of Nuclear Medicine, Taipei (China); Hsieh, Jen-Chuen [National Yang-Ming University, Brain Research Center and Institute of Brain Science, Taipei (China); Taipei Veterans General Hospital, Department of Medical Research and Education, Taipei (China); Lee, Jason J.S. [National Yang-Ming University, Department of Biomedical Imaging and Radiological Sciences, Taipei (China)

    2009-03-15

    The aim of this study was to examine the neural bases for the exceptional mental calculation ability possessed by Chinese abacus experts through PET imaging. We compared the different regional cerebral blood flow (rCBF) patterns using {sup 15}O-water PET in 10 abacus experts and 12 non-experts while they were performing each of the following three tasks: covert reading, simple addition, and complex contiguous addition. All data collected were analyzed using SPM2 and MNI templates. For non-experts during the tasks of simple addition, the observed activation of brain regions were associated with coordination of language (inferior frontal network) and visuospatial processing (left parietal/frontal network). Similar activation patterns but with a larger visuospatial processing involvement were observed during complex contiguous addition tasks, suggesting the recruitment of more visuospatial memory for solving the complex problems. For abacus experts, however, the brain activation patterns showed slight differences when they were performing simple and complex addition tasks, both of which involve visuospatial processing (bilateral parietal/frontal network). These findings supported the notion that the experts were completing all the calculation process on a virtual mental abacus and relying on this same computational strategy in both simple and complex tasks, which required almost no increasing brain workload for solving the latter. In conclusion, after intensive training and practice, the neural pathways in an abacus expert have been connected more effectively for performing the number encoding and retrieval that are required in abacus tasks, resulting in exceptional mental computational ability. (orig.)

  18. The impact of focused, long-term, and collaborative professional development in math and science participants' self-efficacy, classroom practice, and student achievement

    Science.gov (United States)

    Nottingham, Mary E.

    The purpose of this study was to investigate the impact of a 2-year professional development model in math and science on the self-efficacy of the teacher and its effects on teacher practice and student outcomes. Further, this study sought to incorporate the instructional use of Inquiry-Based Learning methods of Problem-Based Learning, Japanese Lesson Study, and Action Research. Additionally, this study examined the impacts of these interventions on teacher efficacy and student outcomes. Thirty-eight collaborating participants were purposefully selected by the Math and Science Teacher Academy (MASTA) project grant co-directors because of their content-focused classrooms of mathematics and science. This quasi-experimental study included mathematics and science in-service teachers working on their masters in education. The 2-year, bi-monthly professional development model included collaborating Inquiry-Based Learning communities with in-depth focus on Japanese Lesson Study, Problem-Based Learning instruction, and Action Research. A chi-square analysis was conducted by grade on the difference in passing rate from the Texas Assessment of Knowledge and Skills mathematics and science tests between the MASTA participants and the state passing average. In mathematics there were significant v differences only at grades 3 and 7 where the state passing average was significantly higher than the MASTA students' passing rate. Only at grade 5 was the MASTA students' passing rate higher than the state, but the difference was not significantly different. The science passing rate received from three grade 5 MASTA participants was compared to the state average and a chi-squared was conducted. Although the passing rate for the grade 5 science test was 6% higher for MASTA student that the state, the difference was not statistically significant. However, after analyzing the qualitative participant responses from data gathered during the 2-year MASTA grant the data clearly reflected that

  19. The effects of land abandonment and long-term afforestation practices on the organic carbon and lignin content of a Mediteranean soil

    Science.gov (United States)

    Stijsiger, Romy; Nadal-Romero, Estela; Campo, Julian; Cammeraat, Erik

    2016-04-01

    Afforestation is an important strategy that can decrease atmospheric carbon in sequestering it in biomass and soils (Pérez-Crusado et al., 2014). In Spain an active afforestation program was adopted in the 1950s, when after wide spread land abandonment the soils were severely eroded (FAO, 2015). In this research the organic carbon and lignin content of the soils in the Araguás catchment area in the Spanish Pyrenees were examined. This research is part of a larger research examining the effect of afforestation over time (Med Afforest Project, PIEF-GA-2013-624974). The research area was afforested with both the P. sylvestris (Scotts Pine) and the P.nigra (Black Pine). Both sites were compared to bare soil (representing severely eroded soil), natural secondary succession (re-vegetation) and meadows. The method used to assess the lignin content is Curie-point pyrolysis with tetramethylammonium hydroxide (TMAH). The results showed a reducing trend for the soil organic carbon (SOC) content with depth. The highest SOC and lignin contents in the topsoil were found under P.nigra and secondary succession. This decline in lignin content corresponds with a high degradation rate (Ad/Al) in the top soil and lower degradation rates in depths of >20 cm. Meadows showed an increased SOC content in deeper horizons, which corresponds to high lignin content as well. In which the meadows showed an increase in lignin content for the soil depths of >20 cm that was unusual and could not be explained by the S/G and P/G ratios and the degradation ratio (Ad/Al). According to the results, P. nigra was the best afforestation practice for increasing the SOC and lignin contents in the soil. The P. sylvestris was considered but proved to be less successful than natural secondary succession. Acknowledgements This research was supported by a Marie Curie Intra-European Fellowship in the project "MED-AFFOREST" (PIEF-GA-2013-624974). JC also acknowledges the VALi+d postdoctoral contract (APOSTD/2014

  20. Asthma Medicines: Long-Term Control

    Science.gov (United States)

    ... Size Email Print Share Asthma Medicines: Long-term Control Page Content Article Body Corticosteroids Synthetic versions of ... form, they are used exclusively for long-term control; they are not very effective for acute symptoms. ...

  1. Long term complications after radical cystoprostatectomy with ...

    African Journals Online (AJOL)

    Long term complications after radical cystoprostatectomy with orthotopic diversion in male ... AFRICAN JOURNALS ONLINE (AJOL) · Journals · Advanced Search · USING ... Objective: To evaluate the long-term outcomes beyond 1 year, both ...

  2. Teacher Cultural Competency and Long-Term English Language Learners

    OpenAIRE

    Wilson, Jannis

    2015-01-01

    Students that have been designated English Language Learners for five or more years are Long-Term English Learners. The literature review addresses some typical characteristics and experiences of students that are Long- Term English Language Learners, and the need for culturally responsive practices to meet their needs. Teacher attitudes, perceptions about English Language Learners, positionality, and opportunities to learn are integrated into the review. The author discusses linguistic aware...

  3. long term energy long term energy performan performan power pla ...

    African Journals Online (AJOL)

    User

    requirements- food, shelter, clothing and wo which are so .... unit is a steam thermal plant that makes use of steam to drive its ... into Scilab scientific and engineering software which was used .... low quality of fuel, inefficient operation practices,.

  4. Epilepsy care in general practice.

    LENUS (Irish Health Repository)

    Varley, J

    2009-06-01

    Epilepsy care in Ireland is shared between primary, secondary and tertiary care services with the General Practitioner (GP) managing the process. Barriers to effective epilepsy care in Irish general practice remain undocumented although sub-optimal and fragmented services are frequently anecdotally reported. This survey of Irish GPs reports on such barriers to epilepsy care and on the Information & Communication Technology (ICT) issues potentially relevant to the use of an epilepsy specific Electronic Patient Record (EPR). The response rate was 247\\/700 (35.3%). Respondents supported the concept of shared care for epilepsy 237 (96%) however they were very dissatisfied with existing neurology services, including pathways of referral 207 (84%) and access to specialist neurology advice and investigations 232 (94%). They reported that neurology services and investigations may be accessed more expeditiously by patients with private health insurance than those without 178 (72%). Consequently many patients are referred to the emergency department for assessment and treatment 180 (73%). A deficit in epilepsy care expertise among GPs was acknowledged 86 (35%). While computerisation of GP practices appears widespread 230 (93%), just over half the respondents utilise available electronic functionalities specific to chronic disease management. GP specific electronic systems infrequently link or communicate with external electronic sources 133 (54%). While the current pathways of care for epilepsy in Ireland appear fragmented and inadequate, further investigations to determine the quality and cost effectiveness of the current service are required.

  5. Epilepsy care in general practice.

    Science.gov (United States)

    Varley, J; Fitzsimons, M; Delanty, N; Collins, C; Boland, M; Normand, C

    2009-06-01

    Epilepsy care in Ireland is shared between primary, secondary and tertiary care services with the General Practitioner (GP) managing the process. Barriers to effective epilepsy care in Irish general practice remain undocumented although sub-optimal and fragmented services are frequently anecdotally reported. This survey of Irish GPs reports on such barriers to epilepsy care and on the Information & Communication Technology (ICT) issues potentially relevant to the use of an epilepsy specific Electronic Patient Record (EPR). The response rate was 247/700 (35.3%). Respondents supported the concept of shared care for epilepsy 237 (96%) however they were very dissatisfied with existing neurology services, including pathways of referral 207 (84%) and access to specialist neurology advice and investigations 232 (94%). They reported that neurology services and investigations may be accessed more expeditiously by patients with private health insurance than those without 178 (72%). Consequently many patients are referred to the emergency department for assessment and treatment 180 (73%). A deficit in epilepsy care expertise among GPs was acknowledged 86 (35%). While computerisation of GP practices appears widespread 230 (93%), just over half the respondents utilise available electronic functionalities specific to chronic disease management. GP specific electronic systems infrequently link or communicate with external electronic sources 133 (54%). While the current pathways of care for epilepsy in Ireland appear fragmented and inadequate, further investigations to determine the quality and cost effectiveness of the current service are required.

  6. Long-Term Stability of Horseshoe Orbits

    CERN Document Server

    Ćuk, Matija; Holman, Matthew J

    2012-01-01

    Unlike Trojans, horseshoe coorbitals are not generally considered to be long-term stable (Dermott and Murray, 1981; Murray and Dermott, 1999). As the lifetime of Earth's and Venus's horseshoe coorbitals is expected to be about a Gyr, we investigated the possible contribution of late-escaping inner planet coorbitals to the lunar Late Heavy Bombardment. Contrary to analytical estimates, we do not find many horseshoe objects escaping after first 100 Myr. In order to understand this behaviour, we ran a second set of simulations featuring idealized planets on circular orbits with a range of masses. We find that horseshoe coorbitals are generally long lived (and potentially stable) for systems with primary-to-secondary mass ratios larger than about 1200. This is consistent with results of Laughlin and Chambers (2002) for equal-mass pairs or coorbital planets and the instability of Jupiter's horseshoe companions (Stacey and Connors, 2008). Horseshoe orbits at smaller mass ratios are unstable because they must approa...

  7. Climate Predictability and Long Term Memory

    Science.gov (United States)

    Zhu, X.; Blender, R.; Fraedrich, K.; Liu, Z.

    2010-09-01

    The benefit of climate Long Term Memory (LTM) for long term prediction is assessed using data from a millennium control simulation with the atmosphere ocean general circulation model ECHAM5/MPIOM. The forecast skills are evaluated for surface temperature time series at individual grid points. LTM is characterised by the Hurst exponent in the power-law scaling of the fluctuation function which is determined by detrended fluctuation analysis (DFA). LTM with a Hurst exponent close to 0.9 occurs mainly in high latitude oceans, which are also characterized by high potential predictability. Climate predictability is diagnosed in terms of potentially predictable variance fractions. Explicit prediction experiments for various time steps are conducted on a grid point basis using an auto-correlation (AR1) predictor: in regions with LTM, prediction skills are beyond that expected from red noise persistence; exceptions occur in some areas in the southern oceans and over the northern hemisphere continents. Extending the predictability analysis to the fully forced simulation shows large improvement in prediction skills.

  8. Institutionalization and Organizational Long-term Success

    Directory of Open Access Journals (Sweden)

    Denise L. Fleck

    2007-05-01

    Full Text Available Institutionalization processes have an ambivalent effect on organizational long-term success. Even though they foster organizational stability and permanence, they also bring about rigidity and resistance to change. As a result, successful organizations are likely to lose their competitive advantage over time. The paper addresses this issue through the investigation of the institutionalization processes of two long-lived companies: General Electric, a firm that has been a long-term success and its rival, Westinghouse, which was broken up after eleven decades of existence. The longitudinal, multilevel analysis of firms and industry has identified two different modes of organizational institutionalization. The reactive mode gives rise to rigidity and change resistance, much like institutional theory predicts; the proactive mode, on the other hand, neutralizes those negative effects of institutionalization processes. In the reactive mode, structure predominates. In the proactive mode, agency plays a major role in organizational institutionalization, and in managing the organization’s relations with the environment, clearly contributing to environmental institutionalization.

  9. Technology for long-term care.

    Science.gov (United States)

    Tak, Sunghee H; Benefield, Lazelle E; Mahoney, Diane Feeney

    2010-01-01

    Severe staff shortages in long-term care (LTC) make it difficult to meet the demands of the growing aging population. Further, technology-savvy Baby Boomers are expected to reshape the current institutional environments toward gaining more freedom and control in their care and lives. Voices from business, academia, research, advocacy organizations, and government bodies suggest that innovative technological approaches are the linchpin that may prepare society to cope with these projected demands. In this article, we review the current state of aging-related technology, identify potential areas for efficacy testing on improving the quality of life of LTC residents in future research, and discuss barriers to implementation of LTC technology. Finally, we present a vision of future technology use that could transform current care practices.

  10. Long-term Outcomes After Bladder-preserving Tri-modality Therapy for Patients with Muscle-invasive Bladder Cancer: An Updated Analysis of the Massachusetts General Hospital Experience.

    Science.gov (United States)

    Giacalone, Nicholas J; Shipley, William U; Clayman, Rebecca H; Niemierko, Andrzej; Drumm, Michael; Heney, Niall M; Michaelson, Marc D; Lee, Richard J; Saylor, Philip J; Wszolek, Matthew F; Feldman, Adam S; Dahl, Douglas M; Zietman, Anthony L; Efstathiou, Jason A

    2017-06-01

    Tri-modality therapy (TMT) is a recognized treatment strategy for selected patients with muscle-invasive bladder cancer (MIBC). Report long-term outcomes of patients with MIBC treated by TMT. Four hundred and seventy-five patients with cT2-T4a MIBC were enrolled on protocols or treated as per protocol at the Massachusetts General Hospital between 1986 and 2013. Patients underwent transurethral resection of bladder tumor followed by concurrent radiation and chemotherapy. Patients with less than a complete response (CR) to chemoradiation or with an invasive recurrence were recommended to undergo salvage radical cystectomy. Disease-specific survival (DSS) and overall survival (OS) were calculated using the Kaplan-Meier method. Median follow-up for surviving patients was 7.21 yr. Five- and 10-yr DSS rates were 66% and 59%, respectively. Five- and 10-yr OS rates were 57% and 39%, respectively. The risk of salvage cystectomy at 5 yr was 29%. In multivariate analyses, T2 disease (OS hazard ratio [HR]: 0.57, 95% confidence interval [CI]: 0.44-0.75, DSS HR: 0.51, 95% CI: 0.36-0.73), CR to chemoradiation (OS HR: 0.61, 95% CI: 0.46-0.81, DSS HR: 0.49, 95% CI: 0.34-0.71), and presence of tumor-associated carcinoma in situ (OS HR: 1.56, 95% CI: 1.17-2.08, DSS HR: 1.50, 95% CI: 1.03-2.17) were significant predictors for OS and DSS. When evaluating our cohort over treatment eras, rates of CR improved from 66% to 88% and 5-yr DSS improved from 60% to 84% during the eras of 1986-1995 to 2005-2013, while the 5-yr risk of salvage radical cystectomy rate decreased from 42% to 16%. These data demonstrate high rates of CR and bladder preservation in patients receiving TMT, and confirm DSS rates similar to modern cystectomy series. Contemporary results are particularly encouraging, and therefore TMT should be discussed and offered as a treatment option for selected patients. Tri-modality therapy is an alternative to radical cystectomy for patients with muscle-invasive bladder cancer, and

  11. Prescribing antibiotics in general practice:

    DEFF Research Database (Denmark)

    Sydenham, Rikke Vognbjerg; Pedersen, Line Bjørnskov; Plejdrup Hansen, Malene

    Objectives The majority of antibiotics are prescribed from general practice. The use of broad-spectrum antibiotics increases the risk of development of bacteria resistant to antibiotic treatment. In spite of guidelines aiming to minimize the use of broad-spectrum antibiotics we see an increase...... in the use of these agents. The overall aim of the project is to explore factors influencing the decision process and the prescribing behaviour of the GPs when prescribing antibiotics. We will study the impact of microbiological testing on the choice of antibiotic. Furthermore the project will explore how...... the GPs’ prescribing behaviour is influenced by selected factors. Method The study consists of a register-based study and a questionnaire study. The register-based study is based on data from the Register of Medicinal Product Statistics (prescribed antibiotics), Statistics Denmark (socio-demographic data...

  12. Practical Recommendations for Long-term Management of Modifiable Risks in Kidney and Liver Transplant Recipients: A Guidance Report and Clinical Checklist by the Consensus on Managing Modifiable Risk in Transplantation (COMMIT) Group.

    Science.gov (United States)

    Neuberger, James M; Bechstein, Wolf O; Kuypers, Dirk R J; Burra, Patrizia; Citterio, Franco; De Geest, Sabina; Duvoux, Christophe; Jardine, Alan G; Kamar, Nassim; Krämer, Bernhard K; Metselaar, Herold J; Nevens, Frederik; Pirenne, Jacques; Rodríguez-Perálvarez, Manuel L; Samuel, Didier; Schneeberger, Stefan; Serón, Daniel; Trunečka, Pavel; Tisone, Giuseppe; van Gelder, Teun

    2017-04-01

    Short-term patient and graft outcomes continue to improve after kidney and liver transplantation, with 1-year survival rates over 80%; however, improving longer-term outcomes remains a challenge. Improving the function of grafts and health of recipients would not only enhance quality and length of life, but would also reduce the need for retransplantation, and thus increase the number of organs available for transplant. The clinical transplant community needs to identify and manage those patient modifiable factors, to decrease the risk of graft failure, and improve longer-term outcomes.COMMIT was formed in 2015 and is composed of 20 leading kidney and liver transplant specialists from 9 countries across Europe. The group's remit is to provide expert guidance for the long-term management of kidney and liver transplant patients, with the aim of improving outcomes by minimizing modifiable risks associated with poor graft and patient survival posttransplant.The objective of this supplement is to provide specific, practical recommendations, through the discussion of current evidence and best practice, for the management of modifiable risks in those kidney and liver transplant patients who have survived the first postoperative year. In addition, the provision of a checklist increases the clinical utility and accessibility of these recommendations, by offering a systematic and efficient way to implement screening and monitoring of modifiable risks in the clinical setting.

  13. The barriers to empowering niche-innovations in long-term care

    NARCIS (Netherlands)

    Cramer, Hendrik Johannes

    2014-01-01

    This thesis deals with innovative long-term care projects that aimed at changing long-term care delivery practices. Around the world, long-term care systems are pressured by an aging population, increasing costs and the scarcity of care professionals. Therefore, the concept of niches becomes ever mo

  14. The barriers to empowering niche-innovations in long-term care

    NARCIS (Netherlands)

    Cramer, Hendrik

    2014-01-01

    This thesis deals with innovative long-term care projects that aimed at changing long-term care delivery practices. Around the world, long-term care systems are pressured by an aging population, increasing costs and the scarcity of care professionals. Therefore, the concept of niches becomes ever

  15. [Enteral nutrition through long-term jejunostomy].

    Science.gov (United States)

    Fernández, T; Neira, P; Enríquez, C

    2008-01-01

    We present the case of a female patient suffering a peritonitis episode after subtotal gastrectomy due to gastric neoplasm in relation to lesser curvature necrosis extending to the anterior esophageal wall. This an uncommon andsevere complication that made mandatory further aggressive surgery: transection of the abdominal esophagus, transection of the gastric stump, and cervical esophagostomy with creation of a jejunostomy with a needle catheter for feeding. This digestive tube access technique is generally used during major abdominal post-surgery until oral intake is reestablished. Our patient has been 187 days with this therapy since reconstruction of the GI tract was ruled out due to tumoral infiltration of the colon and tumor recurrence at the gastrohepatic omentum. To date, there has been no complication from permanence and/or long-term use of this technique.

  16. Patient empowerment in long-term conditions: development and preliminary testing of a new measure.

    Science.gov (United States)

    Small, Nicola; Bower, Peter; Chew-Graham, Carolyn A; Whalley, Diane; Protheroe, Joanne

    2013-07-08

    Patient empowerment is viewed by policy makers and health care practitioners as a mechanism to help patients with long-term conditions better manage their health and achieve better outcomes. However, assessing the role of empowerment is dependent on effective measures of empowerment. Although many measures of empowerment exist, no measure has been developed specifically for patients with long-term conditions in the primary care setting. This study presents preliminary data on the development and validation of such a measure. We conducted two empirical studies. Study one was an interview study to understand empowerment from the perspective of patients living with long-term conditions. Qualitative analysis identified dimensions of empowerment, and the qualitative data were used to generate items relating to these dimensions. Study two was a cross-sectional postal study involving patients with different types of long-term conditions recruited from general practices. The survey was conducted to test and validate our new measure of empowerment. Factor analysis and regression were performed to test scale structure, internal consistency and construct validity. Sixteen predominately elderly patients with different types of long-term conditions described empowerment in terms of 5 dimensions (identity, knowledge and understanding, personal control, personal decision-making, and enabling other patients). One hundred and ninety seven survey responses were received from mainly older white females, with relatively low levels of formal education, with the majority retired from paid work. Almost half of the sample reported cardiovascular, joint or diabetes long-term conditions. Factor analysis identified a three factor solution (positive attitude and sense of control, knowledge and confidence in decision making and enabling others), although the structure lacked clarity. A total empowerment score across all items showed acceptable levels of internal consistency and relationships

  17. Scientific Understanding from Long Term Observations: Insights from the Long Term Ecological Research (LTER) Program

    Science.gov (United States)

    Gosz, J.

    2001-12-01

    The network dedicated to Long Term Ecological Research (LTER) in the United States has grown to 24 sites since it was formed in 1980. Long-term research and monitoring are performed on parameters thatare basic to all ecosystems and are required to understand patterns, processes, and relationship to change. Collectively, the sites in the LTER Network provide opportunities to contrast marine, coastal, and continental regions, the full range of climatic gradients existing in North America, and aquatic and terrestrial habitats in a range of ecosystem types. The combination of common core areas and long-term research and monitoring in many habitats have allowed unprecedented abilities to understand and compare complex temporal and spatial dynamics associated with issues like climate change, effects of pollution, biodiversity and landuse. For example, McMurdo Dry Valley in the Antarctic has demonstrated an increase in glacier mass since 1993 which coincides with a period of cooler than normal summers and more than average snowfall. In contrast, the Bonanza Creek and Toolik Lake sites in Alaska have recorded a warming period unprecedented in the past 200 years. Nitrogen deposition effects have been identified through long-term watershed studies on biogeochemical cycles, especially at Coweeta Hydrological Lab, Harvard Forest, and the Hubbard Brook Experimental Forest. In aquatic systems, such as the Northern Temperate Lakes site, long-term data revealed time lags in effects of invaders and disturbance on lake communities. Biological recovery from an effect such as lake acidification was shown to lag behind chemical recovery. The long-term changes documented over 2 decades have been instrumental in influencing management practices in many of the LTER areas. In Puerto Rico, the Luquillo LTER demonstrated that dams obstruct migrations of fish and freshwater shrimp and water abstraction at low flows can completely obliterate downstream migration of juveniles and damage

  18. 高校构建践行群众路线长效机制途径分析%Analysis on the Ways of Constructing the Long Term Mechanism of Practicing Mass Line in Colleges and Universities

    Institute of Scientific and Technical Information of China (English)

    侯东喜; 乔长水

    2016-01-01

    高校通过构建践行群众路线长效机制,可以促进高校管理干部的工作作风的转变,完成人才培养的历史使命,促进学校内涵式发展。高校师生维护权益权利意识增强,群众利益诉求多样化,网络传播过程中可能产生的对信息的扭曲和放大,高校党组织建设水平和党员干部队伍素养,都对构建践行群众路线长效机制产生不利影响。通过健全师生员工参与重大事项决策和监督机制,规范各级干部的决策过程等,使群众路线在高校得到长期坚持。%The university through the construction of long-term mechanism to practice the mass line, can promote the trans-formation of university management cadre's work style, to complete the training mission, to promote the connotative develop-ment of schools. University teachers and students to maintain the rights and interests of rights awareness, the interests of the masses demand diversity, may occur in the process of network communication of information distorted and exaggerated, ac-complishment of party organizations and party members and cadres in colleges and universities, to build a long-term mechan-ism for the practice of the mass line produced adverse effects. Through perfecting the teachers and students staff participate in making important decisions and supervision mechanism, specifications cadres at all levels of decision-making process, etc., makes the mass line in colleges and universities insist for a long time.

  19. HOME LONG-TERM CARE IN POLAND

    Directory of Open Access Journals (Sweden)

    Ewa Kułagowska

    2011-06-01

    Full Text Available The considerable proportion of the elderly, the chronically ill and the disabled in community is an economic and organizational challenge for the state social policy. It requires a large, steadily increasing financing from the public funds and creating an optional care model to fulfill the needs of citizens and guarantee high quality services. Development of the long-term care is one of the problems to be solved. This paper presents: – a long-term care forms, organization and tasks; – a role of long-term care but particularly home longterm care to protect health in Poland; – problems related with home long-term care functioning.

  20. Commentary: The Broader Context of Long-Term Care Ethics.

    Science.gov (United States)

    Lesandrini, Jason; O'Connell, Carol

    2016-07-01

    Ethical issues in long-term care settings, although having received attention in the literature, have not in our opinion received the appropriate level they require. Thus, we applaud the Cambridge Quarterly for publishing this case. We can attest to the significance of ethical issues arising in long-term care facilities, as Mr. Hope's case is all too familiar to those practicing in these settings. What is unique about this case is that an actual ethics consult was made in a long-term care setting. We have seen very little in the published literature on the use of ethics structures in long-term care populations. Our experience is that these healthcare settings are ripe for ethical concerns and that providers, patients, families, and staff need/desire ethics resources to actively and preventively address ethical concerns. The popular press has begun to recognize the ethical issues involved in long-term care settings and the need for ethics structures. Recently, in California a nurse refused to initiate CPR for an elderly patient in a senior residence. In that case, the nurse was quoted as saying that the facility had a policy that nurses were not to start CPR for elderly patients. 1 Although this case is not exactly the same as that of Mr. Hope, it highlights the need for developing robust ethics program infrastructures in long-term care settings that work toward addressing ethical issues through policy, education, and active consultation.

  1. "Best practice" skills lab training vs. a "see one, do one" approach in undergraduate medical education: an RCT on students' long-term ability to perform procedural clinical skills.

    Directory of Open Access Journals (Sweden)

    Anne Herrmann-Werner

    Full Text Available BACKGROUND: Benefits of skills lab training are widely accepted, but there is sparse research on its long-term effectiveness. We therefore conducted a prospective, randomised controlled-trial to investigate whether in a simulated setting students trained according to a "best practice" model (BPSL perform two skills of different complexity (nasogastral tube insertion, NGT; intravenous cannulation, IVC better than students trained with a traditional "see one, do one" teaching approach (TRAD, at follow-up of 3 or 6 months. METHODOLOGY AND PRINCIPAL FINDINGS: 94 first-year medical students were randomly assigned to one of four groups: BPSL training or TRAD teaching with follow-up at 3 (3M or 6 (6M months. BPSL included structured feedback, practice on manikins, and Peyton's "Four-Step-Approach", while TRAD was only based on the "see one - do one" principle. At follow-up, manikins were used to assess students' performance by two independent blinded video-assessors using binary checklists and a single-item global assessment scale. BPSL students scored significantly higher immediately after training (NGT: BPSL3M 94.8%±0.2 and BPSL6M 95.4%±0.3 percentage of maximal score ± SEM; TRAD3M 86.1%±0.5 and TRAD6M 84.7%±0.4. IVC: BPSL3M 86.4%±0.5 and BPSL6M 88.0%±0.5; TRAD3M 73.2%±0.7 and TRAD6M 72.5%±0.7 and lost significantly less of their performance ability at each follow-up (NGT: BPSL3M 86.3%±0.3 and TRAD3M 70.3%±0.6; BPSL6M 89.0%±0.3 and TRAD6M 65.4%±0.6; IVC: BPSL3M 79.5%±0.5 and TRAD3M 56.5%±0.5; BPSL6M 73.2%±0.4 and TRAD6M 51.5%±0.8. In addition, BPSL students were more often rated clinically competent at all assessment times. The superiority at assessment after training was higher for the more complex skill (IVC, whereas NGT with its lower complexity profited more with regard to long-term retention. CONCLUSIONS: This study shows that within a simulated setting BPSL is significantly more effective than TRAD for skills of different

  2. Introduction: Long term economic development

    DEFF Research Database (Denmark)

    Pyka, Andreas; Andersen, Esben Sloth

    2012-01-01

    The general theme of the 13th International Joseph A. Schumpeter Society Conference, held during June 21st–24th, 2010 at Aalborg University in Denmark, was the exploration of the interrelated phenomena of innovation, organization, sustainability and crises. By addressing these phenomena an attempt...

  3. Intimate partner violence - identification and response in general practice.

    Science.gov (United States)

    Hegarty, Kelsey; O'Doherty, Lorna

    2011-11-01

    Intimate partner violence is a common problem among women attending general practice, with around one in 10 women currently experiencing physical, sexual or emotional abuse by a partner. Abused women frequently present with physical and psychosocial issues. Yet intimate partner violence often remains concealed and addressing it poses challenges for the clinician and patient alike. Although some of the general recommendations in this review may also apply to same-sex relationships and to women who abuse men, this article discusses identifying intimate partner violence in women who present to general practice. Identifying intimate partner violence is important in clinical practice as it underlies many common physical and mental health presentations. Facilitating disclosure and responding effectively requires good communication skills. Safety assessment of women and their families, pinpointing level of readiness to contemplate action, and providing appropriate referral options and ongoing nonjudgmental support are elements of an effective response. General practitioners have the potential to identify women and support them safely on a pathway to recovery, thereby avoiding the long term impacts of intimate partner violence.

  4. Differences in health status between long-term and short-term benzodiazepine users.

    NARCIS (Netherlands)

    Zandstra, S.M.; Furer, J.W.; Lisdonk, E.H. van de; Bor, J.H.J.; Zitman, F.G.; Weel, C. van

    2002-01-01

    BACKGROUND: Despite generally accepted advice to keep treatment short, benzodiazepines are often prescibed for more than six months. Prevention of long-term benzodiazepine use could be facilitated by the utilisation of risk indicators for long-term use. However, the characteristics of long-term benz

  5. Standard practice for prediction of the long-term behavior of materials, including waste forms, used in engineered barrier systems (EBS) for geological disposal of high-level radioactive waste

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2007-01-01

    1.1 This practice describes test methods and data analyses used to develop models for the prediction of the long-term behavior of materials, such as engineered barrier system (EBS) materials and waste forms, used in the geologic disposal of spent nuclear fuel (SNF) and other high-level nuclear waste in a geologic repository. The alteration behavior of waste form and EBS materials is important because it affects the retention of radionuclides by the disposal system. The waste form and EBS materials provide a barrier to release either directly (as in the case of waste forms in which the radionuclides are initially immobilized), or indirectly (as in the case of containment materials that restrict the ingress of groundwater or the egress of radionuclides that are released as the waste forms and EBS materials degrade). 1.1.1 Steps involved in making such predictions include problem definition, testing, modeling, and model confirmation. 1.1.2 The predictions are based on models derived from theoretical considerat...

  6. Differences in health status between long-term and short-term benzodiazepine users.

    OpenAIRE

    2002-01-01

    BACKGROUND: Despite generally accepted advice to keep treatment short, benzodiazepines are often prescibed for more than six months. Prevention of long-term benzodiazepine use could be facilitated by the utilisation of risk indicators for long-term use. However, the characteristics of long-term benzodiazepine users described in the literature are based on studies in which long-term users were compared with non-users. Thus these characteristics may be imprecise. AIM: To study the characteristi...

  7. The Association Between Self-Assessed Future Work Ability and Long-Term Sickness Absence, Disability Pension and Unemployment in a General Working Population: A 7-Year Follow-Up Study.

    Science.gov (United States)

    Lundin, A; Kjellberg, K; Leijon, O; Punnett, L; Hemmingsson, T

    2016-06-01

    Purpose Work ability is commonly measured with self-assessments, in the form of indices or single items. The validity of these assessments lies in their predictive ability. Prospective studies have reported associations between work ability and sickness absence and disability pension, but few examined why these associations exist. Several correlates of work ability have been reported, but their mechanistic role is largely unknown. This study aims to investigate to what extent individual's own prognosis of work ability predicts labor market participation and whether this was due to individual characteristics and/or working conditions. Methods Self-assessed prognosis of work ability, 2 years from "now," in the Stockholm Public Health Questionnaire (2002-2003) was linked to national registers on sickness absence, disability pension and unemployment up to year 2010. Effects were studied with Cox regression models. Results Of a total of 12,064 individuals 1466 reported poor work ability. There were 299 cases of disability pension, 1466 long-term sickness absence cases and 765 long-term unemployed during follow-up. Poor work ability increased the risk of long-term sickness absence (HR 2.25, CI 95 % 1.97-2.56), disability pension (HR 5.19, CI 95 % 4.07-6.62), and long-term unemployment (HR 2.18, CI 95 % 1.83-2.60). These associations were partially explained by baseline health conditions, physical and (less strongly) psychosocial aspects of working conditions. Conclusions Self-assessed poor ability predicted future long-term sickness absence, disability pension and long-term unemployment. Self-assessed poor work ability seems to be an indicator of future labor market exclusion of different kinds, and can be used in public health monitoring.

  8. Long-term survival after perforated diverticulitis

    NARCIS (Netherlands)

    J. Vermeulen (Jan); M.P. Gosselink (Martijn Pieter); W.C.J. Hop (Wim); E. van der Harst (Erwin); B.E. Hansen (Bettina); G.H.H. Mannaerts (Guido); P-P. Coene (Peter Paul); W.F. Weidema (Wibo); J.F. Lange (Johan)

    2011-01-01

    textabstractAim: Short-term survival after emergency surgery for perforated diverticulitis is poor. Less is known about long-term survival. The aims of this study were to evaluate long-term survival after discharge from hospital and to identify factors associated with prognosis. Method: All patients

  9. Virtual Models of Long-Term Care

    Science.gov (United States)

    Phenice, Lillian A.; Griffore, Robert J.

    2012-01-01

    Nursing homes, assisted living facilities and home-care organizations, use web sites to describe their services to potential consumers. This virtual ethnographic study developed models representing how potential consumers may understand this information using data from web sites of 69 long-term-care providers. The content of long-term-care web…

  10. Intercultural communication in general practice.

    Science.gov (United States)

    van Wieringen, Joke C M; Harmsen, Johannes A M; Bruijnzeels, Marc A

    2002-03-01

    Little is known about the causes of problems in communication between health care professionals and ethnic-minority patients. Not only language difficulties, but also cultural differences may result in these problems. This study explores the influence of communication and patient beliefs about health (care) and disease on understanding and compliance of native-born and ethnic-minority patients. In this descriptive study seven general practices located in a multi-ethnic neighbourhood in Rotterdam participated. Eighty-seven parents who visited their GP with a child for a new health problem took part: more than 50% of them belonged to ethnic-minorities. The consultation between GP and patient was recorded on video and a few days after the consultation patients were interviewed at home. GPs filled out a short questionnaire immediately after the consultation. Patient beliefs and previous experiences with health care were measured by different questionnaires in the home interview. Communication was analysed using the Roter Interaction Analysis System based on the videos. Mutual understanding between GP and patient and therapy compliance was assessed by comparing GP's questionnaires with the home interview with the parents. In 33% of the consultations with ethnic-minority patients (versus 13% with native-born patients) mutual understanding was poor. Different aspects of communication had no influence on mutual understanding. Problems in the relationship with the GP, as experienced by patients, showed a significant relation with mutual understanding. Consultations without mutual understanding more often ended in non-compliance with the prescribed therapy. Ethnic-minority parents more often report problems in their relationship with the GP and they have different beliefs about health and health care from native-born parents. Good relationships between GP and patients are necessary for mutual understanding. Mutual understanding has a strong correlation with compliance

  11. Medical Underwriting In Long-Term Care Insurance: Market Conditions Limit Options For Higher-Risk Consumers.

    Science.gov (United States)

    Cornell, Portia Y; Grabowski, David C; Cohen, Marc; Shi, Xiaomei; Stevenson, David G

    2016-08-01

    A key feature of private long-term care insurance is that medical underwriters screen out would-be buyers who have health conditions that portend near-term physical or cognitive disability. We applied common underwriting criteria based on data from two long-term care insurers to a nationally representative sample of individuals in the target age range (50-71 years) for long-term care insurance. The screening criteria put upper bounds on the current proportion of Americans who could gain coverage in the individual market without changes to medical underwriting practice. Specifically, our simulations show that in the target age range, approximately 30 percent of those whose wealth meets minimum industry standards for suitability for long-term care insurance would have their application for such insurance rejected at the underwriting stage. Among the general population-without considering financial suitability-we estimated that 40 percent would have their applications rejected. The predicted rejection rates are substantially higher than the rejection rates of about 20-25 percent of applicants in the actual market. In evaluating reforms for long-term care financing and their potential to increase private insurance rates, as well as to reduce financial pressure on public safety-net programs, policy makers need to consider the role of underwriting in the market for long-term care insurance.

  12. Minimally Invasive Long-Term Management of Direct Restorations: the '5 Rs'.

    Science.gov (United States)

    Green, David; Mackenzie, Louis; Banerjee, Avijit

    2015-06-01

    The assessment and operative long-term management of direct restorations is a complex and controversial subject in conservative dentistry. Employing a minimally invasive (MI) approach helps preserve natural tooth structure and maintain endodontic health for as long as possible during the restorative cycle. This paper discusses how minimally invasive techniques may be applied practically to reviewing, resealing, refurbishing, repairing or replacing deteriorating/failed direct coronal restorations (the'5 Rs') and provides an update of contemporary MI clinical procedures. CPD/CLINICAL RELEVANCE: The assessment and long-term clinical management of deteriorating/failing direct restorations is a major component of the general dental practice workload and NHS UK budget expenditure for operative dentistry.

  13. Long-term human-robot interaction with young users

    NARCIS (Netherlands)

    Baxter, P.; Belpaeme, T.; Canamero, L.; Cosi, P.; Demiris, Y.; Enescu, V.; Et al.

    2011-01-01

    Artificial companion agents have the potential to combine novel means for effective health communication with young patients support and entertainment. However, the theory and practice of long-term child-robot interaction is currently an underdeveloped area of research. This paper introduces an appr

  14. Long-term human-robot interaction with young users

    NARCIS (Netherlands)

    Baxter, P.; Belpaeme, T.; Canamero, L.; Cosi, P.; Demiris, Y.; Enescu, V.; Et al.

    2011-01-01

    Artificial companion agents have the potential to combine novel means for effective health communication with young patients support and entertainment. However, the theory and practice of long-term child-robot interaction is currently an underdeveloped area of research. This paper introduces an appr

  15. Prediction of Long Term Degradation of Insulating Materials

    Science.gov (United States)

    2015-05-01

    fiberglass, foam, or cellulose insulation in areas where thermal bridges may be formed or used in places where it is not practical to install thicker...ER D C/ CE RL T R- 15 -8 Prediction of Long Term Degradation of Insulating Materials Co ns tr uc tio n En gi ne er in g R es ea rc h...acwc.sdp.sirsi.net/client/default. ERDC/CERL TR-15-8 May 2015 Prediction of Long Term Degradation of Insulating Materials L. D. Stephenson, Andrew

  16. Comparison of long-term clinical outcome after successful implantation of FIREBIRD and CYPHER sirolimus-eluting stents in daily clinical practice:analysis of a large single-center registry

    Institute of Scientific and Technical Information of China (English)

    XU Bo; LIU Hai-bo; WU Yong-jian; CHEN Jue; YUAN Jin-qing; YOU Shi-jie; LI Wei; GAO Run-lin; DOU Ke-fei; YANG Yue-jin; CHEN Ji-lin; QIAO Shu-bin; WANG Yang; LI Jian-jun; QIN Xue-wen; YAO Min

    2011-01-01

    Background Recent data have shown that sirolimus-eluting stents (SES) reduced not only the incidences of restenosis but also of target vessel revascularization (TVR). CYPHER and FIREBIRD stents are both widely used SES in China.However,comparative data concerning differences in long-term safety and efficacy regarding CYPHER and FIREBIRD stents in the Chinese population are still not available.Methods From April 2004 to October 2006,3979 consecutive patients who underwent successful SES (FIREBIRD 2274;CYPHER 1705) implantation were prospectively enrolled into this study. All enrolled patients were divided into two groups based on stent type. Follow-up data,including death,myocardial infarction (MI),thrombosis,target lesion revascularization (TLR),TVR,and major adverse cardiac events (MACE,the composite of death,MI,and TVR) were obtained at 24 months. Cox's proportional-hazards models were used to assess relative risks of all the outcomemeasures between the two groups before and after propensity match.Results Unadjusted clinical outcomes demonstrated higher TVR (hazard ratio (HR) 1.78,95%Cl 1.26-2.50) and MACE (HR 1.40,95%C/1.08-1.82) for patients treated with FIREBIRD SES. After propensity match,the results showed a non-significant trend towards superiority of the CYPHER stent in all the analyzed parameters,however,no significant differences were found for all events at 24 months between FIREBIRD and CYPHER groups,and all thrombosis rates by Academic Research Consortium (ARC) definition were comparable between the two groups.Conclusions In this large,real-world population,the use of domestic FIREBIRD SES in China was associated with nearly the same safety and efficacy versus the imported CYPHER SES. FIREBIRD SES can be taken as an alternative for CYPHER SES in daily practice.

  17. Child maltreatment: pathway to chronic and long-term conditions?

    Science.gov (United States)

    Taylor, Julie; Bradbury-Jones, Caroline; Lazenbatt, Anne; Soliman, Francesca

    2016-09-01

    The manifesto Start Well, Live Better by the UK Faculty of Public Health (Start Well, Live Better-A Manifesto for the Public's Health. London: UK Faculty of Public Health, 2014) sets out 12 compelling priorities for the protection of people's health. The focus of this document is preventative, calling for a comprehensive strategy to target a wide-ranging set of challenges to public health; however, it fails to mention child maltreatment and its negative impact on long-term health outcomes. In this article, we explore the long-term negative consequences of child maltreatment and how these can be conceptually aligned with four different characteristics of long-term health conditions. We suggest that situating child maltreatment within a long-term conditions framework could have significant advantages and implications for practice, policy and research, by strengthening a commitment across disciplines to apply evidence-based principles linked with policy and evaluation and recognizing the chronic effects of maltreatment to concentrate public, professional and government awareness of the extent and impact of the issue. We argue that a public health approach is the most effective way of focusing preventative efforts on the long-term sequelae of child maltreatment and to foster cooperation in promoting children's rights to grow and develop in a safe and caring environment free from violence and abuse. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  18. Sexuality and Physical Intimacy in Long Term Care

    Science.gov (United States)

    Lichtenberg, Peter A.

    2015-01-01

    Sexuality and sexual needs in older adults remains a neglected area of clinical intervention, particularly so in long term care settings. Because older adults in medical rehabilitation and long term care beds present with significant frailties, and often significant neurocognitive disorders it makes it difficult for occupational therapists and other staff to evaluate the capacity of an older adult resident to participate in sexual relationships. The current paper reviews the current literature on sexuality and aging, examines some of the clinical practices and guidelines regarding sexual expression in long term care and presents two case examples. A semi-structured interview and decision tree is presented to assist therapists in making careful and informed decisions and thereby balancing needs for protection with needs for autonomy. PMID:24354331

  19. Winning market positioning strategies for long term care facilities.

    Science.gov (United States)

    Higgins, L F; Weinstein, K; Arndt, K

    1997-01-01

    The decision to develop an aggressive marketing strategy for its long term care facility has become a priority for the management of a one-hundred bed facility in the Rocky Mountain West. Financial success and lasting competitiveness require that the facility in question (Deer Haven) establish itself as the preferred provider of long term care for its target market. By performing a marketing communications audit, Deer Haven evaluated its present market position and created a strategy for solidifying and dramatizing this position. After an overview of present conditions in the industry, we offer a seven step process that provides practical guidance for positioning a long term care facility. We conclude by providing an example application.

  20. Long-Term Ownership by Industrial Foundations

    DEFF Research Database (Denmark)

    Børsting, Christa Winther; Kuhn, Johan Moritz; Poulsen, Thomas

    2016-01-01

    Short-termism has become a serious concern for businesses and policy makers and this has inspired a search for governance arrangement to promote long term decision making. In this paper we study a particularly long-term ownership structure, which is fairly common in Northern Europe, particularly...... in Denmark. Industrial foundations are independent legal entities without owners or members typically with the dual objective of preserving the company and using excess profits for charity. We use a unique Danish data set to examine the governance of foundation-owned companies. We show that they are long-term...... in several respects. Foundations hold on to their shares for longer. Foundation-owned companies replace managers less frequently. They have more conservative capital structures with less leverage. Their companies survive longer. Their business decisions appear to be more long term. This paper supports...

  1. Long Term Care Minimum Data Set (MDS)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Long-Term Care Minimum Data Set (MDS) is a standardized, primary screening and assessment tool of health status that forms the foundation of the comprehensive...

  2. Long Term Care Minimum Data Set (MDS)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Long-Term Care Minimum Data Set (MDS) is a standardized, primary screening and assessment tool of health status that forms the foundation of the comprehensive...

  3. Long-Term Care Ombudsman Program

    Science.gov (United States)

    ... Strategic Plan Federal Initiatives Career Opportunities Contact Us Administration on Aging (AoA) Long-Term Care Ombudsman Program ( ... Prevention HIV/AIDS Nutrition Services Oral Health Elder Justice & Adult Protective Services Elder Justice Coordinating Council Prevention ...

  4. Pituitary diseases : long-term clinical consequences

    NARCIS (Netherlands)

    Klaauw, Agatha Apolonia van der

    2008-01-01

    This thesis describes various studies during the long-term follow-up of patients after treatment for pituitary diseases. The focus of this thesis is acromegaly, growth hormone deficiency, sleep and quality of life. Various aspects are described.

  5. Long-term outcome of meniscectomy

    DEFF Research Database (Denmark)

    Roos, Ewa M.; Ostenberg, A; Roos, H;

    2001-01-01

    To describe the long-term influence of meniscectomy on pain, functional limitations, and muscular performance. To assess the effects of radiographic osteoarthritis (OA), gender and age on these outcomes in patients with meniscectomy....

  6. Pituitary diseases : long-term clinical consequences

    NARCIS (Netherlands)

    Klaauw, Agatha Apolonia van der

    2008-01-01

    This thesis describes various studies during the long-term follow-up of patients after treatment for pituitary diseases. The focus of this thesis is acromegaly, growth hormone deficiency, sleep and quality of life. Various aspects are described.

  7. Anticipating Long-Term Stock Market Volatility

    OpenAIRE

    Conrad, Christian; Loch, Karin

    2012-01-01

    We investigate the relationship between long-term U.S. stock market risks and the macroeconomic environment using a two component GARCH-MIDAS model. Our results provide strong evidence in favor of counter-cyclical behavior of long-term stock market volatility. Among the various macro variables in our dataset the term spread, housing starts, corporate profits and the unemployment rate have the highest predictive ability for stock market volatility . While the term spread and housing starts are...

  8. [Psychotic disorders: special aspects in general practice].

    Science.gov (United States)

    Kurmann, Julius

    2015-09-30

    In emergency situations the general practitioner is often the first professional contact psychotic patients have. The following article conveys basic knowledge about psychotic disorders and their clinical features typically seen in general practice.

  9. Mesozoic long-term eustatic cycles and their uncertain hierarchy

    Institute of Scientific and Technical Information of China (English)

    Dmitry A.Ruban

    2015-01-01

    Global sea-level has changed in a cyclic manner through geologic history, but the regularities of these changes are yet to be fully understood. Despite certain (and sometimes significant) differences, the available Mesozoic eustatic curves permit the outlining of long-term eustatic cycles, which are provi-sionally defined as cycles recognizable at the stage level and higher. Interpretation of the Triassic eustatic curves indicates two orders of long-term cycles and a 1st-order sea-level rise throughout the entire period. The Jurassic eustatic curves imply cyclicity of one or two orders, and a 1st-order eustatic rise during the entire period is also evident. Most challenges are interpretations for the Cretaceous; two to four orders of long-term eustatic cycles can be established for this period. Generally, the hierarchy of the long-term eustatic cycles might have changed through the Mesozoic. If so, and if one considers differ-ences of cycles of the same order between the periods of this era, it is difficult to apply “standard”hi-erarchical classifications to the documented cycles. The hypothetical uncertainty of the hierarchy of the Mesozoic long-term eustatic cycles is an important challenge for modern researchers.

  10. Long-term impact of sales promotion on brand image

    Directory of Open Access Journals (Sweden)

    Danijela Mandić

    2009-12-01

    Full Text Available Sales promotion (SP is an inevitable tool in the marketing communications mix, especially in the FMCG markets, due to pressures such as retailers’ growing demands and increasing competition. This has proven to be an issue for many companies, especially those with a premium brand positioning and those concerned about the impact that SP might have on the long-term image of the company. Despite the fact that literature is replete with research on SP, it seems to be vastly generalized and mostly focused on price reductions. Thus, this paper aims to analyze and discuss the issue of the long-term impact that SP has on companies, especially on premium brands in the FMCG markets. It concludes that, when used properly and strategically, SP may have a positive long-term impact on brands.

  11. Using long-term transit timing to detect terrestrial planets

    CERN Document Server

    Heyl, J S; Heyl, Jeremy S.; Gladman, Brett J.

    2006-01-01

    We propose that the presence of additional planets in extrasolar planetary systems can be detected by long-term transit timing studies. If a transiting planet is on an eccentric orbit then the presence of another planet causes a secular advance of the transiting planet's pericenter over and above the effect of general relativity. Although this secular effect is impractical to detect over a small number of orbits, it causes long-term differences in when future transits occur, much like the long-term decay observed in pulsars. Measuring this transit-timing delay would thus allow the detection of either one or more additional planets in the system or the first measurements of non-zero oblateness ($J_2$) of the central stars.

  12. Long-term drought severity variations in Morocco

    Science.gov (United States)

    Esper, Jan; Frank, David; Büntgen, Ulf; Verstege, Anne; Luterbacher, Jürg; Xoplaki, Elena

    2007-09-01

    Cedrus atlantica ring width data are used to reconstruct long-term changes in the Palmer Drought Severity Index (PDSI) over the past 953 years in Morocco, NW Africa. The reconstruction captures the dry conditions since the 1980s well and places this extreme period within a millennium-long context. PDSI values were above average for most of the 1450-1980 period, which let recent drought appear exceptional. However, our results also indicate that this pluvial episode of the past millennium was preceded by generally drier conditions back to 1049. Comparison of PDSI estimates with large-scale pressure field reconstructions revealed steady synoptic patterns for drought conditions over the past 350 years. The long-term changes from initially dry to pluvial to recent dry conditions are similar to PDSI trends reported from N America, and we suggest that they are related to long-term temperature changes, potentially teleconnected with ENSO variability and forced by solar irradiance changes.

  13. The efficiency of dyslipidemia control in real clinical practice and the possibilities of its correction in patients with coronary heart disease and diabetes mellitus in the long -term use of simvastatin

    Directory of Open Access Journals (Sweden)

    F. Yu. Valikulova

    2014-07-01

    Full Text Available Objective: To show the efficiency of dyslipidemia control in patients with coronary heart disease (CHD and diabetes mellitus (DM in real outpatient clinical practice and the possibilities of its correction in the long-term use of simvastatin (simvastatin forte 40 mg in one of theNizhny Novgorod polyclinics.Subjects and methods. The efficiency of lipid profile control was analyzed in a sample from the entire dispensary group of patients with DM (n = 713. Patients at highest cardiovascular risk were selected from the dispensary group and included into a group of CHD and DM. There were a total of 461 (64.7 % such patients. Forty-three patients were identified in this group, who were matched for baseline systolic and diastolic blood pressures, age, gender, and DM duration and were found to have significant hypercholesterolemia. Simvastatin forte 40 mg wasprescribed to these patients at their outpatient visit. During a year, the patient made 6 visits to his/her physician (5 visits at 6-werk intervals and the sixth visit by the end of the follow-up year. The dose of simvastatin was unchanged throughout the study.Results.In the entire dispensary group, 64.7 % of the patients had a concurrence of CHD and DM. This group of patients was at high risk for dyslipidemia. In this group, 2.8 % had a total cholesterol (TC level of ≤ 3.5 mmol/l; 4.7 % had a low-density lipoprotein cholesterol (LDL-C level of < 1.8 mmol/l. The total lipid profile was analyzed in only 6.3% of the patients from the entire dispensary group. 28.6 % of the patients with type 1 DM and 21.3% of those with CHD and type 2 DM took statins. Fifty-two week therapy with simvastatin forte 40 mg showed its high efficiency in real practice in decreasing the levels of atherogenic lipids and lipoproteins: TC by 27.6 % (p < 0.001, LDL-C by 36.9 % (p < 0.001, and triglycerides by 34.3 % (p < 0.001 with antiatherogenic high-density lipoprotein cholesterol elevation by 15.2 % (p < 0

  14. [Tetanus prophylaxis in general practice

    NARCIS (Netherlands)

    Boukes, F.S.; Wiersma, T.J.; Beaujean, D.; Burgmeijer, R.J.; Timen, A.

    2004-01-01

    In response to the report 'Immunisation against tetanus following injuries' from the Dutch Health Council, the Dutch College of General Practitioners, the National Coordinating Body for the Control of Infectious Diseases and The Netherlands Vaccine Institute have drawn up guidelines for tetanus

  15. [Tetanus prophylaxis in general practice

    NARCIS (Netherlands)

    Boukes, F.S.; Wiersma, T.J.; Beaujean, D.; Burgmeijer, R.J.; Timen, A.

    2004-01-01

    In response to the report 'Immunisation against tetanus following injuries' from the Dutch Health Council, the Dutch College of General Practitioners, the National Coordinating Body for the Control of Infectious Diseases and The Netherlands Vaccine Institute have drawn up guidelines for tetanus prop

  16. Multiple sclerosis: management in Dutch general practice.

    NARCIS (Netherlands)

    Donker, G.A.; Foets, M.; Spreeuwenberg, P.

    1996-01-01

    BACKGROUND AND OBJECTIVES: A descriptive study on 118 MS patients in general practice, to describe the family physician's role in diagnosis, treatment and follow-up of patients. METHOD: Random sample of 103 general practices (161 family physicians) throughout The Netherlands with a total list of 335

  17. 河南省“医养结合型”长期照护模式实践及伦理问题探讨%Practice and Ethical Issues of Long Term Care Mode that Combined Medicine with Pension in Henan Province

    Institute of Scientific and Technical Information of China (English)

    马宁; 孙荣青; 段峰; 倪居; 李洪玲; 曾西

    2016-01-01

    通过对“医养结合型”养老模式之长期照护发展概况及存在的伦理问题的概述,指出未来“医养结合型”长期照护模式应加强公立医院参与的积极性,减少政府部门多重管理,建立完善的法律法规及医保制度,提高从业人员及社会大众的责任意识,同时积极践行伦理学的人道与尊重、公平与效率、诚实与守信等原则,为该模式的发展提供新思路及新方向。%Through an overview of the development of long-term care mode that combined medicine and pen-sion and the existing ethical issues, this paper pointed out that the future long-term care mode should strengthen the enthusiasm of public hospitals to participate in, reduce multiple management by government departments, es-tablish perfect laws and regulations and medical insurance system, enhance the responsibility of the practitioners and the general public, meanwhile, actively practice the principle of humanity and respect, fairness and efficiency, honesty and reliability in ethics, to provide new ideas and directions for the development of this model.

  18. Long term cultivation of larger benthic Foraminifera

    Science.gov (United States)

    Wöger, Julia; Eder, Wolfgang; Kinoshita, Shunichi; Antonino, Briguglio; Carles, Ferrandes-Cañadell; Hohenegger, Johann

    2015-04-01

    Benthic Foraminifera are used in a variety of applications employing numerous different methods, i.e. ecological monitoring, studying the effects of ocean acidification, reconstructing palaeo-bathymetry or investigating palaeo-salinity and palaeo-temperature to name only a few. To refine our understanding of ecological influences on larger benthic foraminiferal biology and to review inferences from field observations, culture experiments have become an indispensable tool. While culture experiments on smaller benthic foraminifera have become increasingly frequent in the past century, reports of the cultivation of symbiont bearing larger Foraminifera are rare. Generally, cultivation experiments can be divided into two groups: Culturing of populations and cultivation of single specimens allowing individual investigation. The latter differ form the former by several restrictions resulting from the need to limit individual motility without abridging microenvironmental conditions in the Foraminiferans artificial habitat, necessary to enable the individual to development as unfettered as possible. In this study we present first experiences and preliminary results of the long-term cultivation of larger benthic Foraminifera conducted at the 'Tropical Biosphere Research Station Sesoko Island, University of the Ryukyus', Japan, trying to reproduce natural conditions as closely as possible. Individuals of three species of larger benthic Foraminifera (Heterostegina depressa, Palaeonummulites venosus and Operculina complanata) have been cultured since April 2014. At the time of the general assembly the cultivation experiments will have been going on for more than one year, with the aim to investigate growth rates, longevities and reproduction strategies for comparison with results statistically inferred from application of the of the 'natural laboratory' method. The most important factor influencing foraminiferal health and development was found to be light intensity and light

  19. Long-term follow-up study and long-term care of childhood cancer survivors

    Directory of Open Access Journals (Sweden)

    Hyeon Jin Park

    2010-04-01

    Full Text Available The number of long-term survivors is increasing in the western countries due to remarkable improvements in the treatment of childhood cancer. The long-term complications of childhood cancer survivors in these countries were brought to light by the childhood cancer survivor studies. In Korea, the 5-year survival rate of childhood cancer patients is approaching 70%; therefore, it is extremely important to undertake similar long-term follow-up studies and comprehensive long-term care for our population. On the basis of the experiences of childhood cancer survivorship care of the western countries and the current Korean status of childhood cancer survivors, long-term follow-up study and long-term care systems need to be established in Korea in the near future. This system might contribute to the improvement of the quality of life of childhood cancer survivors through effective intervention strategies.

  20. Development Of The Technique Of Assessment Of Banking Risks Of Long-Term Crediting Of Investments (On The Example Of Banks Of Sevastopol

    Directory of Open Access Journals (Sweden)

    Ulyana Viktorovna Dremova

    2015-03-01

    Full Text Available The external destabilizing factor — financial crisis — has significantly influenced on the level increase of riskiness of the banking credit operations. Taking into account that the increased level of risk follows long-term credits, these operations has been influenced the most, that can be as one of the constraining conditions for the provision of bank long-term credit resources. It, in turn, causes the need to develop the risk assessment technique of long-term credits in regulation of banks’ long-term credit operations. As the risk assessment of credit operations in banking practice is generally limited to the calculation of credit risk, it is efficient to consider the scientifically reasonable approach to a risks assessment of long-term crediting including influence of private risks for the purpose of carrying out the generalized assessment of riskiness both separate types of long-term credits, and a long-term credit portfolio in general. The offered method is based on the calculation of aggregate risk coefficient of the long-term credits, calculated by means of mathematical method of principal component. In the work, it is offered to perform an assessment of private risks by means of statistics: the expectation value, mean square deviation, and the coefficient of a variation. The use of the principal components’ method at the risk assessment of longterm crediting meets such requirements as a lack of value judgment, accounting of specific features of private risks of long-term credits, mathematical validity. It gives the chance to apply the offered risk assessment method of long-term credits in banking. The conclusion is made that the application of an aggregative risk indicator of a long-term crediting will allow banks to trace more accurately the level of riskiness of a long-term credit portfolio and separate types of long-term credits that will strengthen the bank information and analytical base on risk regulation in the field and

  1. Long-term Multiwavelength Observations of Polars

    Science.gov (United States)

    Santana, Joshua; Mason, Paul A.

    2016-06-01

    Polars are cataclysmic variables with the highest magnetic field strengths (10-250 MG). Matter is accreted after being funneled by the strong magnetic field of the white dwarf. We perform a meta-study of multi-wavelength data of polars. Many polars have been observed in surveys, such as SDSS, 2MASS, ROSAT, just to name a few. Some polars have now been detected by the JVLA, part of an expanding class of radio CVs. A large subset of polars have long-term optical light curves from CRTS and AAVSO. We suggest that the long term light curves of polars display a variety of signature behaviors and may be grouped accordingly. Additional characteristics such a binary period, magnetic field strengths, X-ray properties, and distance estimates are examined in context with long-term observations.

  2. Gastroenteritis in sentinel general practices, the Netherlands.

    NARCIS (Netherlands)

    Wit, M.A.S. de; Koopmans, M.P.G.; Kortbeek, L.M.; Leeuwen, N.J. van; Bartelds, A.I.M.; Duynhoven, Y.T.H.P. van

    2001-01-01

    From 1996 to 1999, the incidence of gastroenteritis in general practices and the role of a broad range of pathogens in the Netherlands were studied. All patients with gastroenteritis who had visited a general practitioner were reported. All patients who had visited a general practitioner for gastroe

  3. Generalizing and Skepticism: Bringing Research to Practice

    Science.gov (United States)

    Yopp, David A.; Ellsworth, Jacob L.

    2016-01-01

    Empirical arguments rely on examples without necessarily addressing all cases. Students should be skeptical of empirical evidence and should seek more secure arguments for generalizations, such as those that explain why a generalization is true for all cases. Generalizing on the basis of patterns in data is an important mathematical practice;…

  4. Gastroenteritis in sentinel general practices, the Netherlands.

    NARCIS (Netherlands)

    Wit, M.A.S. de; Koopmans, M.P.G.; Kortbeek, L.M.; Leeuwen, N.J. van; Bartelds, A.I.M.; Duynhoven, Y.T.H.P. van

    2001-01-01

    From 1996 to 1999, the incidence of gastroenteritis in general practices and the role of a broad range of pathogens in the Netherlands were studied. All patients with gastroenteritis who had visited a general practitioner were reported. All patients who had visited a general practitioner for

  5. Long-term home care scheduling

    DEFF Research Database (Denmark)

    Gamst, Mette; Jensen, Thomas Sejr

    In several countries, home care is provided for certain citizens living at home. The long-term home care scheduling problem is to generate work plans spanning several days such that a high quality of service is maintained and the overall cost is kept as low as possible. A solution to the problem...... provides detailed information on visits and visit times for each employee on each of the covered days. We propose a branch-and-price algorithm for the long-term home care scheduling problem. The pricing problem generates one-day plans for an employee, and the master problem merges the plans with respect...

  6. [Fetal pain: immediate and long term consequences].

    Science.gov (United States)

    Houfflin Debarge, Véronique; Dutriez, Isabelle; Pusniak, Benoit; Delarue, Eléonore; Storme, Laurent

    2010-06-01

    Several situations are potentially painful for fetuses, such as malformations and invasive procedures. Nociceptive pathways are known to be functional at 26 weeks. Even if it is not possible to evaluate the fetal experience of pain, it is essential to examine its immediate and long-term consequences. As early as the beginning of the second trimester, hemodynamic and hormonal responses are observed following fetal nociceptive stimulation, In experimental studies, long-term changes have been noted in the corticotrop axis, subsequent responses to pain, and behavior after perinatal nociceptive stimulation.

  7. Keratoprosthesis: a long-term review.

    Science.gov (United States)

    Barnham, J J; Roper-Hall, M J

    1983-07-01

    A keratoprosthesis (KP), is an artificial cornea which is inserted into an opacified cornea in an attempt to restore useful vision or, less commonly, to make the eye comfortable in painful keratopathy. Results o a retrospective study of 35 patients, with 55 KP insertions, are reviewed with regard to visual acuity, length of time vision is maintained, retention time, and complication. Overall there were a number of long-term real successes, eith retention of the KP and maintenance of improved vision in eyes not amenable to conventional treatment. Careful long-term follow-up was needed, with further surgical procedures often being necessary.

  8. Long-term duration of function of ovarian tissue transplants

    DEFF Research Database (Denmark)

    Andersen, Claus Yding; Silber, Sherman J; Berghold, Stinne Holm

    2012-01-01

    These three case reports describe the long-term duration of function of ovarian cortical tissue grafts among patients in a university fertility preservation programme in Europe and in a private practice programme in the USA. One woman underwent sterilizing cancer treatment and had frozen ovarian...... or to alleviate its symptoms. These three case reports describe the long-term duration of function of ovarian cortical tissue grafts among patients in a university fertility preservation programme in Europe and in a private practice programme in the USA. One woman underwent sterilizing cancer treatment and had...... tissue transplanted, and two women underwent fresh ovarian tissue transplants. The function of ovarian cortical strips has continued for more than 7years in these three women, with the birth of eight healthy babies following a single graft per patient. In addition to these three cases, transplantation...

  9. Accreditation in general practice in Denmark

    DEFF Research Database (Denmark)

    Andersen, Merethe K; Pedersen, Line B; Siersma, Volkert

    2017-01-01

    practice and mortality. All outcomes relate to quality indicators included in the Danish Healthcare Quality Program, which is based on general principles for accreditation. Discussion: The consequences of accreditation and standard-setting processes are generally under-researched, particularly in general......Background: Accreditation is used increasingly in health systems worldwide. However, there is a lack of evidence on the effects of accreditation, particularly in general practice. In 2016 a mandatory accreditation scheme was initiated in Denmark, and during a 3-year period all practices, as default......, should undergo accreditation according to the Danish Healthcare Quality Program. The aim of this study is primarily to evaluate the effects of a mandatory accreditation scheme. Methods/design: The study is conducted as a cluster-randomized controlled trial among 1252 practices (clusters) with 2211...

  10. Organization and change in general practice

    DEFF Research Database (Denmark)

    Andersen, John Sahl

    Organization and change in general practice Abstract for a symposium at Nordic Congress for General Practice Thursday 14 May at 15.30-17.00 General practice is under increasing pressure to assume new tasks, adopt new technologies and engage in new organizational structures. However, in a field...... of multiple actors and concerns such visions are rarely straightforward to realize. This symposium explores the significance of various organizational, cultural and regulative features of general practice in relation to proposals for change in the sector. Presentations: Thorkil Thorsen, Marius Kousgaard......, Ann Dorrit Guassora. Providing coherent care: Case-managers and other modes of coordination. A case-manager is often understood as a person coordinating health care services. It has been suggested that GPs should carry out this function for several types of diseases. The question addressed is whether...

  11. Consequences of long-term hyperparathyroidism

    NARCIS (Netherlands)

    Graal, M B; Wolffenbuttel, B H

    1998-01-01

    We describe a young woman with long-term untreated hyperparathyroidism with a superimposed vitamin D deficiency and an extremely decreased bone mineral density that was complicated by a vertebral fracture. Despite pretreatment with intravenous pamidronate and short-term vitamin D supplementation, se

  12. Long-term prevention of diabetic nephropathy

    DEFF Research Database (Denmark)

    Schjoedt, K J; Hansen, H P; Tarnow, L

    2008-01-01

    AIMS/HYPOTHESIS: In type 1 diabetic patients with microalbuminuria not receiving antihypertensive treatment, an increase in urinary AER (UAER) of 6-14%/year and a risk of developing diabetic nephropathy (DN) of 3-30%/year have been reported. We audited the long-term effect of blocking the renin-a...

  13. Long Term Transfer Effect of Metaphoric Allusion.

    Science.gov (United States)

    Hayes, David A.; Mateja, John A.

    A study was conducted to investigate the long term transfer effect of metaphoric allusion used to clarify unfamiliar subject matter. Forty-nine high school students were given unfamiliar prose materials variously augmented by metaphoric allusion. The subjects' immediate performance on a transfer task was compared to their performance on an…

  14. Long-Term Memory and Learning

    Science.gov (United States)

    Crossland, John

    2011-01-01

    The English National Curriculum Programmes of Study emphasise the importance of knowledge, understanding and skills, and teachers are well versed in structuring learning in those terms. Research outcomes into how long-term memory is stored and retrieved provide support for structuring learning in this way. Four further messages are added to the…

  15. Long-Term Stability of Social Participation

    Science.gov (United States)

    Hyyppa, Markku T.; Maki, Juhani; Alanen, Erkki; Impivaara, Olli; Aromaa, Arpo

    2008-01-01

    The long-term stability of social participation was investigated in a representative urban population of 415 men and 579 women who had taken part in the nationwide Mini-Finland Health Survey in the years 1978-1980 and were re-examined 20 years later. Stability was assessed by means of the following tracking coefficients: kappa, proportion of…

  16. Pituitary diseases : long-term psychological consequences

    NARCIS (Netherlands)

    Tiemensma, Jitske

    2012-01-01

    Nowadays, pituitary adenomas can be appropriately treated, but patients continue to report impaired quality of life (QoL) despite long-term remission or cure. In patients with Cushing’s disease, Cushing’s syndrome or acromegaly, doctors should be aware of subtle cognitive impairments and the

  17. 26 CFR 1.460-2 - Long-term manufacturing contracts.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 6 2010-04-01 2010-04-01 false Long-term manufacturing contracts. 1.460-2... manufacturing contracts. (a) In general. Section 460 generally requires a taxpayer to determine the income from a long-term manufacturing contract using the percentage-of-completion method described in §...

  18. Apgar Scores: Examining the Long-term Significance

    OpenAIRE

    Montgomery, Kristen S.

    2000-01-01

    The Apgar scoring system was intended as an evaluative measure of a newborn's condition at birth and of the need for immediate attention. In the most recent past, individuals have unsuccessfully attempted to link Apgar scores with long-term developmental outcomes. This practice is not appropriate, as the Apgar score is currently defined. Expectant parents need to be aware of the limitations of the Apgar score and its appropriate uses.

  19. The long-term stock market valuation of customer satisfaction

    OpenAIRE

    Aksoy, Lerzan

    2008-01-01

    Firm valuation has been an important domain of interest for finance. However, most financial models do not include customer-related metrics in this process. Studies in marketing have found that one particular customer metric, customer satisfaction, improves the ability to predict future cash flows, long-term financial measures, stock performance, and shareholder value. However, most of these studies predominantly employ models that are not directly used in finance practice. This article exten...

  20. Improving evidence-based general practice

    NARCIS (Netherlands)

    Kortekaas, MF

    2016-01-01

    This thesis provides knowledge on how to improve the practice of evidence-based medicine (EBM) by general practitioners (GPs) and GP trainees. EBM is defined as the integration of clinical expertise, patient values and the best available clinical evidence in daily clinical practice. We describe the

  1. [The practice guideline 'Smoking cessation' from the Dutch College of General Practitioners; a response from the perspective of pulmonary medicine].

    Science.gov (United States)

    van Spiegel, P I

    2008-06-28

    The practice guideline 'Smoking cessation' from the Dutch College of General Practitioners has been published. If general practitioners are going to use the standard, this can have a great impact on smoking in the Dutch population. A decrease in smokers among the population will also have an impact on several smoking-related chronic diseases from a preventive point of view. The guideline emphasizes that smoking cessation is not a one-stop shop but that it requires a long-term effort.

  2. Small business, cash budgets and general practice.

    Science.gov (United States)

    Jackson, A R

    1991-01-01

    In practice management, general practice falls into the category of small business with all its attendant generic problems. Disciplined planning and good financial management are not often seen in small business. These are required if general practitioners are to continue (or return to) the provision of high quality medical services. An effective budget process, especially cash-flow budgeting, is the key to successful planning and financial management. Budgeting will bring Control, Co-ordination, and Credibility to your practice. It will enable you to set goals and to achieve them.

  3. Undertreatment of urinary incontinence in general practice.

    NARCIS (Netherlands)

    Penning-van Beest, F.J.A.; Sturkenboom, M.C.; Bemelmans, B.L.H.; Herings, R.M.C.

    2005-01-01

    BACKGROUND: In the urinary incontinence guidelines that are issued by the Dutch College of General Practitioners, treatment guidelines are related to the type of incontinence. It is unknown whether treatment of urinary incontinence in general practice complies with these guidelines. OBJECTIVE: To de

  4. Toward A Practical General Systems Methodological Theory

    OpenAIRE

    Nagib Callaos; Belkis Sánchez de Callaos

    2003-01-01

    Our main purpose in this paper is to describe the way in which we have been relating General System Theory (GST) to practice and to the design of a General Systems Methodology (GSM). Our first step was to apply GST to design a methodology for software development. Then, in a second step, by means of the experience/knowledge learned from applying the methodology to developing specific information systems, a continuous designing and re-designing process started, which simultaneously generalized...

  5. Disrupted caring attachments: implications for long-term care.

    Science.gov (United States)

    Flannery, Raymond B

    2002-01-01

    Caring attachments or social supports are the positive psychological and physical contacts and relationships between people. These attachments have been associated with improved health, well-being, and longevity. It is also true that disrupted caring attachments are associated with impaired health and well-being. This paper reviews the general medical and elder medical findings of disrupted caring attachments and negative health outcomes. The implications of these findings for dementia sufferers, caregivers, and long-term care staff are examined.

  6. Long-term socioeconomic consequences and health care costs of childhood and adolescent-onset epilepsy

    DEFF Research Database (Denmark)

    Jennum, Poul; Christensen, Jakob; Ibsen, Rikke

    2016-01-01

    the epilepsy, those with epilepsy tended to have a lower level of education, to be less likely to be married, to be more likely to live alone, and to have higher divorce and unemployment rates, lower employment rates, and people with epilepsy were more likely to receive disability pension and social security...... persons with epilepsy onset at 0-5 and 6-20 years, including costs for outpatient and inpatient services (hospital services), emergency room use, primary health care sector (general practice), and use of medication. SIGNIFICANCE: The long-term negative effects on all aspects of health care and social...

  7. A technique for long term continent gastrostomy.

    Science.gov (United States)

    Locker, D L; Foster, J E; Craun, M L; Torma, M J

    1985-01-01

    The use of the continent gastrostomy described herein offers several advantages: 1, the elimination of an indwelling catheter; 2, prevention of soiling at skin level; 3, long term access to the normal gastrointestinal track for alimentation without fear of tube erosion; 4, little compromise to gastric volume, and 5, ease of stoma care. We recommend this operation in instances when long term tube feedings are indicated either because of damage to the central nervous system or as a palliative treatment for patients with higher obstructing gastrointestinal malignant disease. The procedure may also be useful for patients in whom esophagogastric continuity has been interrupted (surgically or traumatically) and in whom reconstruction of the gastrointestinal tract would not seem feasible within a three to six month interval.

  8. Long-term opioid therapy in Denmark

    DEFF Research Database (Denmark)

    Birke, H; Ekholm, O; Sjøgren, P

    2017-01-01

    BACKGROUND: Longitudinal population-based studies of long-term opioid therapy (L-TOT) in chronic non-cancer pain (CNCP) patients are sparse. Our study investigated incidence and predictors for initiating L-TOT and changes in self-rated health, pain interference and physical activities in long......-term opioid users. METHODS: Data were obtained from the national representative Danish Health and Morbidity Surveys and The Danish National Prescription Registry. Respondents with no dispensed opioids the year before the survey were followed from 2000 and from 2005 until the end of 2012 (n = 12...... defined as those who were dispensed at least one opioid prescription in six separate months within a year. RESULTS: The incidence of L-TOT was substantially higher in CNCP patients at baseline than in others (9/1000 vs. 2/1000 person-years). Smoking behaviour and dispensed benzodiazepines were...

  9. Case presentation: long-term treatment.

    Science.gov (United States)

    Glucksman, Myron L

    2013-01-01

    The long-term (14 years) psychodynamic psychotherapy and pharmacotherapy of a depressed, suicidal, self-mutilating female patient is described. Her diagnoses included Chronic Posttraumatic Stress Disorder, Borderline Personality Disorder, and Recurrent Major Depression. Treatment was punctuated with repeated hospitalizations for self-mutilation (cutting) and suicidal ideation. A major determinant for her psychopathology was sexual abuse by her father from ages 6 to 14. This resulted in feelings of guilt and rage that she repressed and acted out through self-mutilating and suicidal behavior. A prolonged negative transference gradually became ambivalent, then positive. This was associated with her internalization of the healing qualities of the therapeutic relationship. She also gained insight into the reasons for her need to punish herself. Her initial self-representation as unworthy and bad was transformed into perceiving herself as a worthwhile, loving person. This case illustrates the role of long-term treatment for a complex, life-threatening, psychiatric disorder.

  10. SOIL AGROCHEMICAL PROPERTIES IMPROVEMENT IN LONG TERM FIELD EXPERIMENT WITH FERTILIZERS

    Directory of Open Access Journals (Sweden)

    Mihaela Lungu

    2005-10-01

    Full Text Available Soil fertility is studied in long-term field experiments. Researches are carried out in several agricultural research stations, out of which the following have been chosen for the present paper: Albic Luvisol* at Albota; Haplic Phaeozem at Fundulea; Chromic Luvisol at Şimnic; Calcic Chernozem at Secuieni; and Haplic Chernozem at Podu Iloaiei. Long term fertilization with nitrogen and phosphorus generally improved the soil agrochemical properties. The evolution of organic matter, nitrogen, mobile phosphorus and potassium, and mobile microelements contents were studied, using the standardized method used in the ICPA laboratories. The organic matter and total nitrogen contents didn’t change significantly under the nitrogen and phosphorus long-term fertilization influence. The mobile phosphorus contents have the tendency to grow very significantly with the growth of phosphorus fertilizers. At the same time, slight depletions of these contents are registered as the high nitrogen doses from fertilizers stimulate plant growth and, obviously, nutritive elements absorption. Mobile potassium contents changes very little, with insignificant differences. Significant depletions are registered only with high fertilizers doses, due to the stimulation of the nutritive elements absorption in plants. Microelements contents don’t change almost at all. They are within the normal content limits and no excess or deficiency was registered, in any of the studied stations. For the agricultural practice, economical studies are recommended, about how high fertilizing expenses are covered by the yield growth. Not the least, production quality study in different variants of mineral fertilization could prove interesting.

  11. Timber joints under long-term loading

    DEFF Research Database (Denmark)

    Feldborg, T.; Johansen, M.

    This report describes tests and results from stiffness and strength testing of splice joints under long-term loading. During two years of loading the spicimens were exposed to cyclically changing relative humidity. After the loading period the specimens were short-term tested. The connectors were...... integral nail-plates and nailed steel and plywood gussets. The report is intended for designers and researchers in timber engineering....

  12. Cutaneous oxalosis after long-term hemodialysis.

    Science.gov (United States)

    Abuelo, J G; Schwartz, S T; Reginato, A J

    1992-07-01

    A 27-year-old woman undergoing long-term hemodialysis developed cutaneous calcifications on her fingers. A skin biopsy specimen showed that the deposits were calcium oxalate. To our knowledge, only one previous article has reported pathologic and crystallographic studies on calcifications of the skin resulting from dialysis oxalosis. We speculate that vitamin C supplements, liberal tea consumption, an increased serum ionized calcium concentration, and the long duration of hemodialysis contributed to the production of these deposits.

  13. Long term evolution 4G and beyond

    CERN Document Server

    Yacoub, Michel; Figueiredo, Fabrício; Tronco, Tania

    2016-01-01

    This book focus on Long Term Evolution (LTE) and beyond. The chapters describe different aspects of research and development in LTE, LTE-Advanced (4G systems) and LTE-450 MHz such as telecommunications regulatory framework, voice over LTE, link adaptation, power control, interference mitigation mechanisms, performance evaluation for different types of antennas, cognitive mesh network, integration of LTE network and satellite, test environment, power amplifiers and so on. It is useful for researchers in the field of mobile communications.

  14. Consequences of long-term hyperparathyroidism.

    Science.gov (United States)

    Graal, M B; Wolffenbuttel, B H

    1998-07-01

    We describe a young woman with long-term untreated hyperparathyroidism with a superimposed vitamin D deficiency and an extremely decreased bone mineral density that was complicated by a vertebral fracture. Despite pretreatment with intravenous pamidronate and short-term vitamin D supplementation, severe and long-standing hypocalcaemia ('hungry bone syndrome') developed after parathyroidectomy. We discuss the consequences of hyperparathyroidism, especially the effects on bone, the complications of parathyroidectomy and the possibilities of preoperative treatment with bisphosphonates.

  15. Long-term behaviour of GRP pipes

    OpenAIRE

    Faria, H; A Vieira; Reis, J; Marques, A. T.; Guedes, R.M.; Ferreira, A. J. M.

    2005-01-01

    The main objective of the research programme /1/ described is the study of creep and relaxation behaviour of glass-rein forced thermosetting (GRP) pipes, in order to find alternative methods to predict the long-term properties, rendering a considerable reduction of the time needed for testing and assuring, as far as possible, equivalent reliability when compared to the existing methods. Experimental procedures were performed and are presented here, together with discussion of results, as well...

  16. Early Life Environments and Long Term Outcomes

    OpenAIRE

    Bolbocean, Corneliu

    2015-01-01

    A large literature has linked “in utero” environment to health and socio-economic outcomes in adulthood. We consider the effect of early life environments on health and skill formation outcomes. We first evaluate the impact of perinatal-neonatal level of technology at birth, which varies across delivery institutions, on the long-term neurodevelopmental outcomes of children with Cerebral Palsy. The level of technology at delivery determines the type of therapy newborns receive immediately afte...

  17. Long term economic relationships from cointegration maps

    Science.gov (United States)

    Vicente, Renato; Pereira, Carlos de B.; Leite, Vitor B. P.; Caticha, Nestor

    2007-07-01

    We employ the Bayesian framework to define a cointegration measure aimed to represent long term relationships between time series. For visualization of these relationships we introduce a dissimilarity matrix and a map based on the sorting points into neighborhoods (SPIN) technique, which has been previously used to analyze large data sets from DNA arrays. We exemplify the technique in three data sets: US interest rates (USIR), monthly inflation rates and gross domestic product (GDP) growth rates.

  18. Practice and Experience of the Establishment of Long Term Mechanism of Continuous Quality Improvement%建立医疗质量持续改进长效机制的实践与体会

    Institute of Scientific and Technical Information of China (English)

    谭天林; 欧兵玺; 廖世川; 罗力; 李雪

    2011-01-01

    探讨建立医疗质量持续改进长效机制,确保患者医疗安全,提高患者满意度.坚持将健全组织、完善制度、优化流程、全员培训、全面监控、加强沟通、整改到位等措施,贯穿于基础质量控制、环节质量控制和终末质量控3个环节,是建立医疗质量持续改进长效机制的有效方法.%The establishment of long-term mechanism for continuous improvement of health care quality is explored to ensure the safety of patients, and to improve patient satisfaction. Adhering to a sound organization, improving the system, streamlining business process, training all staff, and enhancing comprehensive monitoring and communication are needed in place corrective measures, such as quality control throughout the base, part of quality control and quality control of the three terminal links, and are effective ways of continuous quality improvement of establishing long-term mechanism.

  19. Adherence to asthma guidelines in general practices.

    Science.gov (United States)

    Roghmann, M C; Sexton, M

    1999-06-01

    Adherence to asthma practice guidelines is low. Improved compliance could potentially improve care of patients with asthma. The purpose of this study was to determine if patients managed in a general practice with an associated asthma clinic are more likely to use asthma medications according to clinical practice guidelines than patients managed in the general surgery of the practice. A cross-sectional study of adult asthmatics, aged 18-55 years, was conducted in six British general practices. Prescription data on all asthma medication was collected for a 6-month period. Information on asthma clinic attendance, age, sex, employment status, other medical illness, and how patients used their inhaled beta2-agonist was collected through questionnaire. The prescription data for asthma medication and patient use of inhaled beta2-agonist were compared to the British Thoracic Society's (BTS) Guidelines for Management of Asthma in Adults to determine if the patient's asthma medication regimen was appropriate. There was no significant association found between appropriate asthma medication and asthma clinic attendance or other patient characteristics. Adherence to the BTS guidelines was low. Fifty-eight percent of the asthma patients used asthma medication regimens that were not consistent with the BTS guidelines published 1 year earlier. Adherence to the BTS guidelines was low regardless of patient characteristics, including asthma clinic attendance, age, sex, employment status, other medical illness, or individual practice. These findings underscore the need to document the utility of clinical practice guidelines which may improve physician compliance.

  20. A survey assessing the impact of a hospital-based general practice residency program on dentists and dental practice.

    Science.gov (United States)

    Tejani, Asif; Epstein, Joel B; Gibson, Gary; Le, Nhu

    2002-01-01

    The purpose of this survey was to evaluate the outcome of completing a general practice hospital-based dental residency program. A survey was mailed to all individuals who had completed a general practice residency program (resident) between 1980 and 1996 and to dentists who had not completed a hospital program (undergraduate). The responses were evaluated by Fisher's exact test. Seventy-four percent of the resident group and 68% from the undergraduate sample group returned the questionnaire. Approximately half the residents were in general dental practice. Twenty-six percent were involved in specialty dentistry, 7% in hospital dentistry, and 20% in teaching at a dental school. Of the undergraduate dentists, more than three-quarters were in general practice, 5% were entered into specialty programs, 1% were involved in hospital dentistry, and 15% taught at a dental school. Half of the residents held staff privileges in a hospital or ambulatory setting, compared with 16% of undergraduates. Forty-three percent of the residents provided consultation in a hospital or long-term-care facility, compared with 21% of the undergraduates. Practice characteristics suggested enhanced clinical skills in oral surgery, periodontics, emergency dental care, and oral medicine/pathology in those completing the hospital program. The findings of this study confirm that the outcome of completing a hospital program is a change in practice profile, site of practice, services for complex patients, and continuing involvement in teaching.

  1. [Participation as Target of Social Medicine and Nursing Care: - Legal Definition of Long-Term Care Dependency - Strategies to Prevent Long-Term Care Dependency].

    Science.gov (United States)

    Nüchtern, Elisabeth; Gansweid, Barbara; Gerber, Hans; von Mittelstaedt, Gert

    2017-01-01

    Objective: By the "Second Bill to Strengthen Long-Term Care", a new concept of long-term care dependency will be introduced, valid from 2017. Long-term care dependency according to Social Code XI will be defined covering more aspects than today. Therefore, the working group "Nursing Care" of the division "Social Medicine in Practice and Rehabilitation" in the German Society for Social Medicine and Prevention presents their results after working on the social medicine perspective of the definition and prevention of long-term care dependency. Methods: Both the definition and strategies to prevent long-term care dependency are systematically taken into consideration from the point of view of social medicine on the basis of the International Classification of Functioning, Disability and Health (ICF), as long-term care dependency means a defined condition of disability. Results: Both the current and the new concept of long-term care dependency focus activity limitations. The perspective of social medicine considers the interactions of health condition, its effects on daily activities and personal as well as environmental factors. From this point of view approaches for social benefits concerning prevention and rehabilitation can be identified systematically so as to work against the development and progression of long-term care dependency. The reference to the ICF can facilitate the communication between different professions. The new "graduation" of long-term care dependency would allow an international "translation" referring to the ICF. Conclusion: Experts from the field of social medicine as well as those of nursing care, care-givers and nursing researchers have in common the objective that persons in need of nursing care can participate in as many aspects of life of importance to them in an autonomous and self-determined way. The point of view of social medicine on long-term care dependency is fundamental for all occupational groups that are involved and for their

  2. Long-term RNA persistence in postmortem contexts

    DEFF Research Database (Denmark)

    Fordyce, Sarah Louise; Kampmann, Marie-Louise; van Doorn, Nienke L

    2013-01-01

    Ribonucleic acids (RNA) are generally considered fragile molecules that are readily degraded. However, there is growing documentation of long-term (from days to centuries) RNA persistence in a variety of contexts and tissue types, and as such a number of academic disciplines are beginning...... to exploit degraded RNA. While the reasons for its survival are not fully understood, there are several plausible mechanisms that would safeguard this molecule against degradation. However, after examining the literature available on the postmortem instability and decay mechanisms of RNA, it has become clear...... that limited experimental studies and no reviews offer an overview of these mechanisms. Hence in this review we outline molecular reasons for RNA surviving long-term postmortem, and provide specific examples of RNA survival in forensic, archival and archaeological contexts. A better understanding...

  3. The long-term treatment of restless legs syndrome/Willis-Ekbom disease: evidence-based guidelines and clinical consensus best practice guidance: a report from the International Restless Legs Syndrome Study Group.

    Science.gov (United States)

    Garcia-Borreguero, Diego; Kohnen, Ralf; Silber, Michael H; Winkelman, John W; Earley, Christopher J; Högl, Birgit; Manconi, Mauro; Montplaisir, Jacques; Inoue, Yuichi; Allen, Richard P

    2013-07-01

    A Task Force was established by the International Restless Legs Syndrome Study Group (IRLSSG) to develop evidence-based and consensus-based recommendations for the long-term pharmacologic treatment of restless legs syndrome/Willis-Ekbom disease (RLS/WED). The Task Force reviewed the results of all studies of RLS/WED treatments with durations of 6 months or longer presented at meetings over the past 2 years, posted on Web sites of pharmaceutical companies, or published in peer-reviewed journals, asking the questions, "What is the efficacy of this treatment in patients with RLS/WED?" and "What is the safety of this treatment in patients with RLS/WED?" The Task Force developed guidelines based on their review of 61 papers meeting inclusion criteria, and using a modified evidence-grading scheme. Pregabalin has been established as effective for up to 1 year in treating RLS/WED (Level A evidence). Pramipexole, ropinirole, and rotigotine have been established as effective for up to 6 months in treating RLS/WED (Level A). The following drugs have been established as probably effective (Level B) in treating RLS/WED for durations ranging from 1 to 5 years: gabapentin enacarbil, pramipexole, and ropinirole (1 year); levodopa (2 years); and rotigotine (5 years). Because of associated safety concerns, pergolide and cabergoline should not be used in the treatment of RLS/WED unless the benefits clearly outweigh the risks. Other pharmacologic therapies have insufficient evidence to support their long-term use in treating RLS/WED. The IRLSSG Task Force also developed consensus-based strategies for the prevention and treatment of complications (such as augmentation, loss of efficacy, excessive daytime sleepiness, and impulse control disorders) that may develop with the long-term pharmacologic treatment of RLS/WED. The use of either a dopamine-receptor agonist or α2δ calcium-channel ligand is recommended as the first-line treatment of RLS/WED for most patients, with the choice of

  4. Long Term Debt and the Political Support for a Monetary Union

    NARCIS (Netherlands)

    Uhlig, H.F.H.V.S.

    1997-01-01

    This paper examines the role of long term debt for the political support of a monetary union or, more generally, an inflation-reduction policy. The central idea is that the decision about membership in the union leads to a redistribution between debtors and creditors, if they are holding long term d

  5. Notes and Talk: An Examination of a Long-Term English Learner Reading-to-Learn in a High School Biology Classroom

    Science.gov (United States)

    Brooks, Maneka Deanna

    2016-01-01

    Long-term English learners (LTELs) are frequently characterized as struggling with academic reading in English. This paper moves beyond broad generalizations about this population's English-reading practices to a situated analysis of one "LTEL"--Lizbeth Sanchez's--making meaning in her sophomore biology classroom. This analysis of…

  6. Elderly and long-term care trends and policy in Taiwan: Challenges and opportunities for health care professionals

    Directory of Open Access Journals (Sweden)

    Hsiu-Hung Wang

    2012-09-01

    Full Text Available The purpose of this article is to address the trends and policy of elderly and long-term care in Taiwan. In response to the increasing demand of an aging society, healthcare professionals play crucial roles in elderly and long-term care and quality assurance of services. This article focuses on the current situation of elderly health care, demands of long-term care, long-term care policy in Taiwan, draft of the Long-term Care Services Act, and draft of the Long-term Care Insurance Act. After the 10-year long-term care project was proposed by the Taiwan government, the supply of health care services and demand for long-term care have created many challenges and opportunities for innovative health professional development. Challenges consist of low old dependency ratio caused by low birth rate, lack of elderly and long-term care related manpower, services and education reform related to long-term care for the future society, and interprofessional collaboration and team work of long-term care. Opportunities include expanding the roles and the career pathways of healthcare professionals, promoting the concepts of active aging and good quality of life, and developing industrial cooperation related to long-term care services. Under these circumstances, healthcare professonals are actively involved in practice, education and research of long-term care services that ensure elderly and disabled people can live a healthier and better life.

  7. Characteristics of crop yield and nutrient balance under different long-term fertilization practices in black soil%长期不同施肥措施下黑土作物产量与养分平衡特征

    Institute of Scientific and Technical Information of China (English)

    郝小雨; 周宝库; 马星竹; 高中超

    2015-01-01

    With a cropping area of 7.0 million hm2, the black soil (Typic hapludoll) region of Northeast China plays a crucial role in food security to the regional and whole country. In fact, the application of chemical fertilizer is an effective and fast way to increase crop production in a relatively short time. Recently, organic manure application has almost disappeared because its application in cropping system is both labor-demanding and uneconomical. However, there is limited information on crop yields under long-term fertilization of organic and inorganic fertilizers in this rotation system. Nutrient input/output and balance in farmland is critical for nutrient management, scientific distribution and application of fertilizer resources, and improving nutrient use efficiency, etc. The study was conducted to reveal the difference of grain yield and nutrient balance based on the average crop yields, the variation trends of crop yields and apparent balance of soil nutrients under different long-term fertilization conditions in black soil, and to provide scientific references for establishing effective long-term fertilization mode and promoting the sustainable development of crop production. A long-term experiment with various fertilizations was carried out during 1979-2014 in a rotation system with wheat (Triticum Aestivium L.)-soybean (Glycine max Merr.)-maize (Zea mays L.) in black soil area of Northeast China. The experiment consisted of 5 treatments:non-fertilization (CK), conventional chemical fertilizer (wheat:N 150kg/hm2, P2O5 75 kg/hm2, soybean:N 75kg/hm2, P2O5 150 kg/hm2, corn:N 150kg/hm2, P2O5 75 kg/hm2, K2O 75kg/hm2, NPK), conventional horse manure (18 600 kg/hm2 , M), conventional horse manure plus chemical fertilizer(the amount of chemical fertilizer was same as NPK, and the amount of horse manure was same as M), and 200% of the MNP (horse manure and chemical fertilizer, the amount was 2 times that of MNP, M2N2P2,). The results showed that: 1) Compared with

  8. IS THE PRICE RIGHT? PRICING FOR LONG TERM PROFITABILITY

    Directory of Open Access Journals (Sweden)

    Andrea Erika NYÁRÁDI

    2007-01-01

    Full Text Available The way how we choose our pricing strategy has a significant impact on company’s success. Nowadays companies more and more adopt a new way of thinking in pricing, namely pricing for a long term period in order to bring higher profitability, to build an efficient pricing strategy. Marketers have only recently begun to focus seriously on effective pricing. These companies are the so called progressive companies. They have begun doing more than just worrying about pricing. To increase profitability many are abandoning traditional reactive pricing procedures in favor of proactive pricing, making explicit corporate decisions to change their focus to growth in top-line sales to growth in profitability. The long-term implications of price strategies are still under-researched, and managers should be aware of shifts in customer reactions that may result from frequent adoption of certain strategies. The company pricing strategy should be seen in relation to developments in the company variables, internal ones (capital strength, competencies, organizational conditions, efficiency of the work force etc. as well as external ones (customers, competitors, the technological development etc., adopting strategic pricing. In this paper I will present the most effective pricing strategies leading to long term profitability, and also suggest practical conditions for pricing strategies to maximize profit in the long run.

  9. Development and validation of a prediction model for long-term sickness absence based on occupational health survey variables.

    Science.gov (United States)

    Roelen, Corné; Thorsen, Sannie; Heymans, Martijn; Twisk, Jos; Bültmann, Ute; Bjørner, Jakob

    2016-11-10

    The purpose of this study is to develop and validate a prediction model for identifying employees at increased risk of long-term sickness absence (LTSA), by using variables commonly measured in occupational health surveys. Based on the literature, 15 predictor variables were retrieved from the DAnish National working Environment Survey (DANES) and included in a model predicting incident LTSA (≥4 consecutive weeks) during 1-year follow-up in a sample of 4000 DANES participants. The 15-predictor model was reduced by backward stepwise statistical techniques and then validated in a sample of 2524 DANES participants, not included in the development sample. Identification of employees at increased LTSA risk was investigated by receiver operating characteristic (ROC) analysis; the area-under-the-ROC-curve (AUC) reflected discrimination between employees with and without LTSA during follow-up. The 15-predictor model was reduced to a 9-predictor model including age, gender, education, self-rated health, mental health, prior LTSA, work ability, emotional job demands, and recognition by the management. Discrimination by the 9-predictor model was significant (AUC = 0.68; 95% CI 0.61-0.76), but not practically useful. A prediction model based on occupational health survey variables identified employees with an increased LTSA risk, but should be further developed into a practically useful tool to predict the risk of LTSA in the general working population. Implications for rehabilitation Long-term sickness absence risk predictions would enable healthcare providers to refer high-risk employees to rehabilitation programs aimed at preventing or reducing work disability. A prediction model based on health survey variables discriminates between employees at high and low risk of long-term sickness absence, but discrimination was not practically useful. Health survey variables provide insufficient information to determine long-term sickness absence risk profiles. There is a need for

  10. Long-Term Recency in Anterograde Amnesia.

    Directory of Open Access Journals (Sweden)

    Deborah Talmi

    Full Text Available Amnesia is usually described as an impairment of a long-term memory (LTM despite an intact short-term memory (STM. The intact recency effect in amnesia had supported this view. Although dual-store models of memory have been challenged by single-store models based on interference theory, this had relatively little influence on our understanding and treatment of amnesia, perhaps because the debate has centred on experiments in the neurologically intact population. Here we tested a key prediction of single-store models for free recall in amnesia: that people with amnesia will exhibit a memory advantage for the most recent items even when all items are stored in and retrieved from LTM, an effect called long-term recency. People with amnesia and matched controls studied, and then free-recalled, word lists with a distractor task following each word, including the last (continual distractor task, CDFR. This condition was compared to an Immediate Free Recall (IFR, no distractors and a Delayed Free Recall (DFR, end-of-list distractor only condition. People with amnesia demonstrated the full long-term recency pattern: the recency effect was attenuated in DFR and returned in CDFR. The advantage of recency over midlist items in CDFR was comparable to that of controls, confirming a key prediction of single-store models. Memory deficits appeared only after the first word recalled in each list, suggesting the impairment in amnesia may emerge only as the participant's recall sequence develops, perhaps due to increased susceptibility to output interference. Our findings suggest that interference mechanisms are preserved in amnesia despite the overall impairment to LTM, and challenge strict dual-store models of memory and their dominance in explaining amnesia. We discuss the implication of our findings for rehabilitation.

  11. Long-Term Recency in Anterograde Amnesia.

    Science.gov (United States)

    Talmi, Deborah; Caplan, Jeremy B; Richards, Brian; Moscovitch, Morris

    2015-01-01

    Amnesia is usually described as an impairment of a long-term memory (LTM) despite an intact short-term memory (STM). The intact recency effect in amnesia had supported this view. Although dual-store models of memory have been challenged by single-store models based on interference theory, this had relatively little influence on our understanding and treatment of amnesia, perhaps because the debate has centred on experiments in the neurologically intact population. Here we tested a key prediction of single-store models for free recall in amnesia: that people with amnesia will exhibit a memory advantage for the most recent items even when all items are stored in and retrieved from LTM, an effect called long-term recency. People with amnesia and matched controls studied, and then free-recalled, word lists with a distractor task following each word, including the last (continual distractor task, CDFR). This condition was compared to an Immediate Free Recall (IFR, no distractors) and a Delayed Free Recall (DFR, end-of-list distractor only) condition. People with amnesia demonstrated the full long-term recency pattern: the recency effect was attenuated in DFR and returned in CDFR. The advantage of recency over midlist items in CDFR was comparable to that of controls, confirming a key prediction of single-store models. Memory deficits appeared only after the first word recalled in each list, suggesting the impairment in amnesia may emerge only as the participant's recall sequence develops, perhaps due to increased susceptibility to output interference. Our findings suggest that interference mechanisms are preserved in amnesia despite the overall impairment to LTM, and challenge strict dual-store models of memory and their dominance in explaining amnesia. We discuss the implication of our findings for rehabilitation.

  12. Comorbidity of chronic diseases in general practice.

    NARCIS (Netherlands)

    Schellevis, F.G.; Velden, J. van der; Lisdonk, E. van de; Eijk, J.T.M. van; Weel, C. van

    1993-01-01

    With the increasing number of elderly people in The Netherlands the prevalence of chronic diseases will rise in the next decades. It is recognized in general practice that many older patients suffer from more than one chronic disease (comorbidity). The aim of this study is to describe the extent of

  13. Acute Neck Pain in General Practice

    NARCIS (Netherlands)

    C.J. Vos (Kees)

    2006-01-01

    textabstractWe performed a prospective cohort study with one-year follow-up of patients with acute neck pain in general practice. Patients above 18 years of age consulting their GP for non-specific acute neck pain lasting no longer than six weeks were invited to participate. Self-administered quest

  14. Effects of electronic communication in general practice

    NARCIS (Netherlands)

    van der Kam, WJ; Moorman, PW; Koppejan-Mulder, MJ

    2000-01-01

    Objective: To obtain insight into the effects of electronic communication on GPs by studying those publications in literature describing the effects of structured electronic clinical communication in general practice. Methods: We retrieved all publications in the English language indexed in MEDLINE

  15. Guidelines for computer security in general practice

    Directory of Open Access Journals (Sweden)

    Peter Schattner

    2007-06-01

    Conclusions This paper maps out a process for developing computer security guidelines for general practice. The specific content will vary in different countries according to their levels of adoption of IT, and cultural, technical and other health service factors. Making these guidelines relevant to local contexts should help maximise their uptake.

  16. Long-term policy on gas composition

    Energy Technology Data Exchange (ETDEWEB)

    Verhagen, M.J.M.

    2012-03-13

    This letter sets out the policy of the Dutch cabinet on the long-term change to the composition of low calorific gas that is distributed via the public gas grid. The title of a separate attachment to this letter is 'The composition of low calorific gas in the more distant future and the requirements for gas appliances covered by the Gas Appliances Directive'. The attachment sets out the composition of low calorific gas as network operators can distribute it via the public gas grid from 2021 (or from a later date). This relates to the changes in the 'exit specification' of the gas.

  17. Safety of long-term PPI therapy

    DEFF Research Database (Denmark)

    Reimer, Christina

    2013-01-01

    Proton pump inhibitors have become the mainstay of medical treatment of acid-related disorders. Long-term use is becoming increasingly common, in some cases without a proper indication. A large number of mainly observational studies on a very wide range of possible associations have been published...... is based on a relevant indication. The concern for complications should primarily be directed at elderly, malnourished with significant co-morbidity. In this population an increased risk for enteric infections, fractures and nutritional deficiencies might have clinical consequences and should lead...

  18. Long-term space flights - personal impressions

    Science.gov (United States)

    Polyakov, V. V.

    During a final 4-month stage of a 1-year space flight of cosmonauts Titov and Manarov, a physician, Valery Polyakov was included on a crew for the purpose of evaluating their health, correcting physical status to prepare for the spacecraft reentry and landing operations. The complex program of scientific investigations and experiments performed by the physician included an evaluation of adaptation reactions of the human body at different stages of space mission using clinicophysiological and biochemical methods; testing of alternative regimes of exercise and new countermeasures to prevent an unfavourable effect of long-term weightlessness.

  19. The long term stability of lidar calibrations

    DEFF Research Database (Denmark)

    Courtney, Michael; Gayle Nygaard, Nicolai

    Wind lidars are now used extensively for wind resource measurements. One of the requirements for the data to be accepted in support of project financing (so-called ‘banka-bility’) is to demonstrate the long-term stability of lidar cali-brations. Calibration results for six Leosphere WindCube li-dars......-ters pertaining in the different calibration periods. This is supported by sliding-window analyses of one lidar at one location where the same order of variation is observed as between pre-service and post-service calibrations....

  20. Long-term effects of sibling incest.

    Science.gov (United States)

    Daie, N; Witztum, E; Eleff, M

    1989-11-01

    Although sexual abuse of children is recognized as a serious problem, sibling incest has received relatively little attention. A distinction has been made between power-oriented sibling incest and nurturance-oriented incest. The authors review the relevant literature and present four clinical examples. The cases illustrate the broad range of sibling incest and demonstrate its effects, including the long-term consequences for the perpetrator. Lasting difficulties in establishing and maintaining close relationships, especially sexual ones, are prominent features of each case. Without denying the occurrences of benign sex-play between siblings, the authors emphasize exploitation and abuse as pathogenic aspects of sibling incest.

  1. Long Term Analysis for the BAM device

    Science.gov (United States)

    Bonino, D.; Gardiol, D.

    2011-02-01

    Algorithms aimed at the evaluation of critical quantities are based on models with many parameters, which values are estimated from data. The knowledge, with high accuracy, of these values and the control of their temporal evolution are important features. In this work, we focus on the latter subject, and we show a proposed pipeline for the BAM (Basic Angle Monitoring) Long Term Analysis, aimed at the study of the calibration parameters of the BAM device and of the Basic Angle variation, searching for unwanted trends, cyclic features, or other potential unexpected behaviours.

  2. Long-Term Wind Power Variability

    Energy Technology Data Exchange (ETDEWEB)

    Wan, Y. H.

    2012-01-01

    The National Renewable Energy Laboratory started collecting wind power data from large commercial wind power plants (WPPs) in southwest Minnesota with dedicated dataloggers and communication links in the spring of 2000. Over the years, additional WPPs in other areas were added to and removed from the data collection effort. The longest data stream of actual wind plant output is more than 10 years. The resulting data have been used to analyze wind power fluctuations, frequency distribution of changes, the effects of spatial diversity, and wind power ancillary services. This report uses the multi-year wind power data to examine long-term wind power variability.

  3. Terminating a long-term clinical trial.

    Science.gov (United States)

    Klimt, C R

    1981-05-01

    Long-term clinical trials often include more than one active treatment group. These may be discontinued independently if found to be ineffective or possibly harmful. Certain subgroups of patients may be discovered, in the course of a clinical trial, who do not respond satisfactorily and are, therefore, excluded during the course of a trial. Yet another kind of termination comes when we have a therapeutic breakthrough or when hope has to be abandoned for demonstrating beneficial effects for one, several, or all treatments included in a trial. Examples from the authors' experience are presented, as are successful and unsuccessful techniques in managing terminations of various types.

  4. Long-term academic stress enhances early processing of facial expressions.

    Science.gov (United States)

    Zhang, Liang; Qin, Shaozheng; Yao, Zhuxi; Zhang, Kan; Wu, Jianhui

    2016-11-01

    Exposure to long-term stress can lead to a variety of emotional and behavioral problems. Although widely investigated, the neural basis of how long-term stress impacts emotional processing in humans remains largely elusive. Using event-related brain potentials (ERPs), we investigated the effects of long-term stress on the neural dynamics of emotionally facial expression processing. Thirty-nine male college students undergoing preparation for a major examination and twenty-one matched controls performed a gender discrimination task for faces displaying angry, happy, and neutral expressions. The results of the Perceived Stress Scale showed that participants in the stress group perceived higher levels of long-term stress relative to the control group. ERP analyses revealed differential effects of long-term stress on two early stages of facial expression processing: 1) long-term stress generally augmented posterior P1 amplitudes to facial stimuli irrespective of expression valence, suggesting that stress can increase sensitization to visual inputs in general, and 2) long-term stress selectively augmented fronto-central P2 amplitudes for angry but not for neutral or positive facial expressions, suggesting that stress may lead to increased attentional prioritization to processing negative emotional stimuli. Together, our findings suggest that long-term stress has profound impacts on the early stages of facial expression processing, with an increase at the very early stage of general information inputs and a subsequent attentional bias toward processing emotionally negative stimuli.

  5. [Local registries in general/family practice].

    Science.gov (United States)

    Cindrić, Jasna

    2007-02-01

    Entering medical records into registries of all sorts has always been a part of everyday work of a general/family physician. There is a distinction between public/population registries on the one hand, and internal, local registries on the other hand. Local registries refer to the catchment population of a particular general/family practice. While keeping population-registries has become a routine with a high level of uniformity in collecting, delivering, recording, analyzing and controlling information, there are no recommendations or standards for keeping local registries, although their importance as well as indisputable necessity have been recognized. They are invaluable for providing an insight into the condition and history of a particular disease in a particular area, planning and taking preventive measures and activities, supervising therapy and medical treatment, as well as for statistical analyses and scientific studies. The most important registry in the field of general practice is the one called "List of health care under the supervision of chosen general/family physicians", which can serve as an index for any other individual record or record of diseases by name kept at a particular general/family practice. Although local registries have "evolved" from notebooks into modern informatic databases, the problem of up-to-dateness cannot be solved until the whole health care system has been connected for competent and authorized persons to be able to record changes of data where and when they take place.

  6. Turnover of regulated nurses in long-term care facilities.

    Science.gov (United States)

    Chu, Charlene H; Wodchis, Walter P; McGilton, Katherine S

    2014-07-01

    To describe the relationship between nursing staff turnover in long-term care (LTC) homes and organisational factors consisting of leadership practices and behaviours, supervisory support, burnout, job satisfaction and work environment satisfaction. The turnover of regulated nursing staff [Registered Nurses (RNs) and Registered Practical Nurses (RPNs)] in LTC facilities is a pervasive problem, but there is a scarcity of research examining this issue in Canada. The study was conceptualized using a Stress Process model. Distinct surveys were distributed to administrators to measure organisational factors and to regulated nurses to measure personal and job-related sources of stress and workplace support. In total, 324 surveys were used in the linear regression analysis to examine factors associated with high turnover rates. Higher leadership practice scores were associated with lower nursing turnover; a one score increase in leadership correlated with a 49% decrease in nursing turnover. A significant inverse relationship between leadership turnover and nurse turnover was found: the higher the administrator turnover the lower the nurse turnover rate. Leadership practices and administrator turnover are significant in influencing regulated nurse turnover in LTC. Long-term care facilities may want to focus on building good leadership and communication as an upstream method to minimize nurse turnover. © 2013 John Wiley & Sons Ltd.

  7. Management of upper dyspepsia in general practice

    DEFF Research Database (Denmark)

    Kjeldsen, Hans Christian; Kier, Svend; Husum, Gitte

    of dyspepsia, dyspeptic episodes, main symptom, previous contact to general practice, previous gastroscopia, use of antacids or NSAID's, Helicobacter Pylori status and mental/physical well being (SF-36 measurement scale) (Table 1). After two weeks the GPs assessed 46 % of the patients to be free of symptoms...... Aim: To compare the effect of two strategies for management of dyspepsia. Evaluation based on GP's assessment after two weeks and patients assessment after three months.   Design: Prospective randomised controlled trial in general practice   Methods: 357 patients with dyspepsia where the general...... after 3 months.   Results: Response rate GPs after two weeks were 92% (330/357). Response rate patients after three months were 71% (252/357). There were no significant difference between the groups randomised to strategy 1(PPI group) and strategy 2 (endoscopy group) concerning, age, gender, duration...

  8. Accreditation in general practice in Denmark

    DEFF Research Database (Denmark)

    Andersen, Merethe K; Pedersen, Line B; Siersma, Volkert;

    2017-01-01

    , should undergo accreditation according to the Danish Healthcare Quality Program. The aim of this study is primarily to evaluate the effects of a mandatory accreditation scheme. METHODS/DESIGN: The study is conducted as a cluster-randomized controlled trial among 1252 practices (clusters) with 2211...... practice and mortality. All outcomes relate to quality indicators included in the Danish Healthcare Quality Program, which is based on general principles for accreditation. DISCUSSION: The consequences of accreditation and standard-setting processes are generally under-researched, particularly in general...... to assess changes due to accreditation; (3) availability of data from registers with no self-reporting data. The primary outcome is the number of prescribed drugs in patients older than 65 years. Secondary outcomes are changes in outcomes related to other perspectives of safe medication, good clinical...

  9. Advancing nursing leadership in long-term care.

    Science.gov (United States)

    O'Brien, Jennifer; Ringland, Margaret; Wilson, Susan

    2010-05-01

    Nurses working in the long-term care (LTC) sector face unique workplace stresses, demands and circumstances. Designing approaches to leadership training and other supportive human-resource strategies that reflect the demands of the LTC setting fosters a positive work life for nurses by providing them with the skills and knowledge necessary to lead the care team and to address resident and family issues. Through the St. Joseph's Health Centre Guelph demonstration site project, funded by the Nursing Secretariat of Ontario's Ministry of Health and Long-Term Care, the Excelling as a Nurse Leader in Long Term Care training program and the Mentor Team program were developed to address these needs. Evaluation results show that not only have individual nurses benefitted from taking part in these programs, but also that the positive effects were felt in other parts of the LTC home (as reported by Directors of Care). By creating a generally healthier work environment, it is anticipated that these programs will also have a positive effect on recruitment and retention.

  10. Evidence-based medicine (EBM): what long-term care providers need to know.

    Science.gov (United States)

    Cheng, Huai Y

    2011-05-01

    Evidence-based medicine (EBM) has been widely used in medicine for 2 decades. Recently, EBM has become a central part of reforming nursing homes and quality improvement. It is very important for long-term care providers to practice EBM. This article briefly introduces the concept of EBM; addresses some potential benefits, harms, and challenges of practicing EBM in long-term care settings; and promotes EBM and its appropriate use among long-term care providers. Copyright © 2011 Elsevier Inc. All rights reserved.

  11. Long term effects of Escherichia coli mastitis.

    Science.gov (United States)

    Blum, Shlomo E; Heller, Elimelech D; Leitner, Gabriel

    2014-07-01

    Escherichia coli is one of the most frequently diagnosed causes of bovine mastitis, and is typically associated with acute, clinical mastitis. The objective of the present study was to evaluate the long term effects of intramammary infections by E. coli on milk yield and quality, especially milk coagulation. Twenty-four Israeli Holstein cows diagnosed with clinical mastitis due to intramammary infection by E. coli were used in this study. Mean lactation number, days in milk (DIM) and daily milk yield (DMY) at the time of infection was 3.3 ± 1.3, 131.7 days ± 78.6 and 45.7 L ± 8.4, respectively. DMY, milk constituents, somatic cells count (SCC), differential leukocytes count and coagulation parameters were subsequently assessed. Two patterns of inflammation were identified: 'short inflammation', characterized by 15% decrease in DMY and >30 days to reach a new maximum DMY (n = 19). The estimated mean loss of marketable milk during the study was 200 L/cow for 'short inflammation' cases, and 1,500 L/cow for 'long inflammation' ones. Significant differences between 'short' and 'long inflammation' effects were found in almost all parameters studied. Long-term detrimental effects on milk quality were found regardless of clinical or bacteriological cure of affected glands.

  12. Long term perfusion system supporting adipogenesis.

    Science.gov (United States)

    Abbott, Rosalyn D; Raja, Waseem K; Wang, Rebecca Y; Stinson, Jordan A; Glettig, Dean L; Burke, Kelly A; Kaplan, David L

    2015-08-01

    Adipose tissue engineered models are needed to enhance our understanding of disease mechanisms and for soft tissue regenerative strategies. Perfusion systems generate more physiologically relevant and sustainable adipose tissue models, however adipocytes have unique properties that make culturing them in a perfusion environment challenging. In this paper we describe the methods involved in the development of two perfusion culture systems (2D and 3D) to test their applicability for long term in vitro adipogenic cultures. It was hypothesized that a silk protein biomaterial scaffold would provide a 3D framework, in combination with perfusion flow, to generate a more physiologically relevant sustainable adipose tissue engineered model than 2D cell culture. Consistent with other studies evaluating 2D and 3D culture systems for adipogenesis we found that both systems successfully model adipogenesis, however 3D culture systems were more robust, providing the mechanical structure required to contain the large, fragile adipocytes that were lost in 2D perfused culture systems. 3D perfusion also stimulated greater lipogenesis and lipolysis and resulted in decreased secretion of LDH compared to 2D perfusion. Regardless of culture configuration (2D or 3D) greater glycerol was secreted with the increased nutritional supply provided by perfusion of fresh media. These results are promising for adipose tissue engineering applications including long term cultures for studying disease mechanisms and regenerative approaches, where both acute (days to weeks) and chronic (weeks to months) cultivation are critical for useful insight.

  13. Long-term environmental behaviour of radionuclides

    Energy Technology Data Exchange (ETDEWEB)

    Brechignac, F.; Moberg, L.; Suomela, M

    2000-04-01

    The radioactive pollution of the environment results from the atmospheric nuclear weapons testing (during the mid-years of twentieth century), from the development of the civilian nuclear industry and from accidents such as Chernobyl. Assessing the resulting radiation that humans might receive requires a good understanding of the long-term behaviour of radionuclides in the environment. This document reports on a joint European effort to advance this understanding, 3 multinational projects have been coordinated: PEACE, EPORA and LANDSCAPE. This report proposes an overview of the results obtained and they are presented in 6 different themes: (i) redistribution in the soil-plant system, (ii) modelling, (iii) countermeasures, (iv) runoff (v) spatial variations, and (vi) dose assessment. The long term behaviour of the radionuclides {sup 137}Cs, {sup 90}Sr and {sup 239-240}Pu is studied through various approaches, these approaches range from in-situ experiments designed to exploit past contamination events to laboratory simulations. A broad scope of different ecosystems ranging from arctic and boreal regions down to mediterranean ones has been considered. (A.C.)

  14. Long term testing of PSI-membranes

    Energy Technology Data Exchange (ETDEWEB)

    Huslage, J.; Brack, H.P.; Geiger, F.; Buechi, F.N.; Tsukada, A.; Scherer, G.G. [Paul Scherrer Inst. (PSI), Villigen (Switzerland)

    1999-08-01

    Long term tests of PSI membranes based on radiation-grafted FEP and ETFE films were carried out and FEP-based membranes were evaluated by monitoring the in-situ membrane area resistance measured by a current pulse method. By modifying our irradiation procedure and using the double crosslinking concept we obtain reproducible membrane cell lifetimes (in term of in-situ membrane resistance) of greater than 5000 hours at 60-65{sup o}C. Preliminary tests at 80-85{sup o}C with lifetimes of greater than 2500 demonstrate the potential long term stability of PSI proton exchange membranes based on FEP over the whole operating temperature range of low-temperature polymer electrolyte fuel cells. Radiation grafted PSI membranes based on ETFE have better mechanical properties than those of the FEP membranes. Mechanical properties are particularly important in large area cells and fuel cell stacks. ETFE membranes have been tested successfully for approximately 1000 h in a 2-cell stack (100 cm{sup 2} active area each cell). (author) 4 figs., 4 refs.

  15. Long Term Changes in the Polar Vortices

    Science.gov (United States)

    Braathen, Geir O.

    2016-04-01

    As the amount of halogens in the stratosphere is slowly declining and the ozone layer slowly recovers it is of interest to see how the meteorological conditions in the vortex develop over the long term since such changes might alter the foreseen ozone recovery. In conjunction with the publication of the WMO Antarctic and Arctic Ozone Bulletins, WMO has acquired the ERA Interim global reanalysis data set for several meteorological parameters. This data set goes from 1979 - present. These long time series of data can be used for several useful studies of the long term development of the polar vortices. Several "environmental indicators" for vortex change have been calculated, and a climatology, as well as trends, for these parameters will be presented. These indicators can act as yardsticks and will be useful for understanding past and future changes in the polar vortices and how these changes affect polar ozone depletion. Examples of indicators are: vortex mean temperature, vortex minimum temperature, vortex mean PV, vortex "importance" (PV*area), vortex break-up time, mean and maximum wind speed. Data for both the north and south polar vortices have been analysed at several isentropic levels from 350 to 850 K. A possible link between changes in PV and sudden stratospheric warmings will be investigated, and the results presented. The unusual meteorological conditions of the 2015 south polar vortex and the 2010/11 and 2015/16 north polar vortices will be compared to other recent years.

  16. Long-term Caspian Sea level change

    Science.gov (United States)

    Chen, J. L.; Pekker, T.; Wilson, C. R.; Tapley, B. D.; Kostianoy, A. G.; Cretaux, J.-F.; Safarov, E. S.

    2017-07-01

    Caspian Sea level (CSL) has undergone substantial fluctuations during the past several hundred years. The causes over the entire historical period are uncertain, but we investigate here large changes seen in the past several decades. We use climate model-predicted precipitation (P), evaporation (E), and observed river runoff (R) to reconstruct long-term CSL changes for 1979-2015 and show that PER (P-E + R) flux predictions agree very well with observed CSL changes. The observed rapid CSL increase (about 12.74 cm/yr) and significant drop ( -6.72 cm/yr) during the periods 1979-1995 and 1996-2015 are well accounted for by integrated PER flux predictions of +12.38 and -6.79 cm/yr, respectively. We show that increased evaporation rates over the Caspian Sea play a dominant role in reversing the increasing trend in CSL during the past 37 years. The current long-term decline in CSL is expected to continue into the foreseeable future, under global warming scenarios.

  17. Pediatric HIV Long-Term Nonprogressors

    Directory of Open Access Journals (Sweden)

    B. H. Rimawi

    2014-01-01

    Full Text Available Patients infected with HIV are best categorized along a continuum from rapid progressors to HIV long-term nonprogressors. Long-term nonprogressors (LTNPs are those in which AIDS develop many years after being infected with HIV, often beyond the 10-year mark, and represent 15–20% of the HIV infected patients. Many of these patients are able to control their infection and maintain undetectable viral loads for long periods of time without antiretroviral therapy. After a comprehensive literature search, we found extensive data related to HIV LTNPs in the adult population; however, very limited data was available related to LTNPs within the pediatric population. We present a case of pediatric HIV LTNPs, perinatally infected patient with undetectable viral loads, despite never receiving ART. Although there are not many instances of LTNPs among children, this child may be one, though she had intermittent viremia. She has continued to manifest serologic evidence of infection, with yearly ELISA and western blot positive tests. Based on the viral fitness studies that were performed, this case exemplifies an adolescent LTNP.

  18. Sleep facilitates long-term face adaptation.

    Science.gov (United States)

    Ditye, Thomas; Javadi, Amir Homayoun; Carbon, Claus-Christian; Walsh, Vincent

    2013-10-22

    Adaptation is an automatic neural mechanism supporting the optimization of visual processing on the basis of previous experiences. While the short-term effects of adaptation on behaviour and physiology have been studied extensively, perceptual long-term changes associated with adaptation are still poorly understood. Here, we show that the integration of adaptation-dependent long-term shifts in neural function is facilitated by sleep. Perceptual shifts induced by adaptation to a distorted image of a famous person were larger in a group of participants who had slept (experiment 1) or merely napped for 90 min (experiment 2) during the interval between adaptation and test compared with controls who stayed awake. Participants' individual rapid eye movement sleep duration predicted the size of post-sleep behavioural adaptation effects. Our data suggest that sleep prevented decay of adaptation in a way that is qualitatively different from the effects of reduced visual interference known as 'storage'. In the light of the well-established link between sleep and memory consolidation, our findings link the perceptual mechanisms of sensory adaptation--which are usually not considered to play a relevant role in mnemonic processes--with learning and memory, and at the same time reveal a new function of sleep in cognition.

  19. Quantitative analyses of the abundance and composition of ammonia-oxidizing bacteria and ammonia-oxidizing archaea of a Chinese upland red soil under long-term fertilization practices.

    Science.gov (United States)

    He, Ji-Zheng; Shen, Ju-Pei; Zhang, Li-Mei; Zhu, Yong-Guan; Zheng, Yuan-Ming; Xu, Ming-Gang; Di, Hongjie

    2007-09-01

    The abundance and composition of soil ammonia-oxidizing bacteria (AOB) and ammonia-oxidizing archaea (AOA) were investigated by using quantitative real-time polymerase chain reaction, cloning and sequencing approaches based on amoA genes. The soil, classified as agri-udic ferrosols with pH (H(2)O) ranging from 3.7 to 6.0, was sampled in summer and winter from long-term field experimental plots which had received 16 years continuous fertilization treatments, including fallow (CK0), control without fertilizers (CK) and those with combinations of fertilizer nitrogen (N), phosphorus (P) and potassium (K): N, NP, NK, PK, NPK and NPK plus organic manure (OM). Population sizes of AOB and AOA changed greatly in response to the different fertilization treatments. The NPK + OM treatment had the highest copy numbers of AOB and AOA amoA genes among the treatments that received mineral fertilizers, whereas the lowest copy numbers were recorded in the N treatment. Ammonia-oxidizing archaea were more abundant than AOB in all the corresponding treatments, with AOA to AOB ratios ranging from 1.02 to 12.36. Significant positive correlations were observed among the population sizes of AOB and AOA, soil pH and potential nitrification rates, indicating that both AOB and AOA played an important role in ammonia oxidation in the soil. Phylogenetic analyses of the amoA gene fragments showed that all AOB sequences from different treatments were affiliated with Nitrosospira or Nitrosospira-like species and grouped into cluster 3, and little difference in AOB community composition was recorded among different treatments. All AOA sequences fell within cluster S (soil origin) and cluster M (marine and sediment origin). Cluster M dominated exclusively in the N, NP, NK and PK treatments, indicating a pronounced difference in the community composition of AOA in response to the long-term fertilization treatments. These findings could be fundamental to improve our understanding of the importance of

  20. The new Australian after-hours general practice incentive payment mechanism: equity for rural general practice?

    Science.gov (United States)

    Neil, Amanda L; Nelson, Mark; Palmer, Andrew J

    2016-07-01

    In July 2015, a national scheme for after-hours incentive funding for general practices was re-introduced in Australia, 2-years after funding was transferred to regional primary health care organisations (Medicare Locals). The re-introduction was recommended in a 2014 review of after-hours primary care reflecting the "overwhelming desire" among general practice. Given the centrality of after-hours care provision in rural and remote practices identified in the review, we compare and contrast the current and historical after-hours incentive funding mechanisms focussing on fairness towards rural general practices. While there are similarities between the current and historical mechanisms, significant differences exist. The comparison is not straightforward. The major consistency is utilisation of practice standardised whole patient equivalents (SWPE) as the basis of funding, inherently favouring large urban general practices. This bias is expected to increase given a shift in focus from practices with no option but to provide 24/7 care to any practice providing 24/7 care; and an associated increased funding per SWPE. Differences primarily pertain to classification processes, in which the realities of rural service provision and recognition of regional support mechanisms are given minimal consideration. Rapid introduction of the new general practice after-hours incentive funding mechanism has led to inconsistencies and has exacerbated inherent biases, particularly inequity towards rural providers. Impact on morale and service provision in non-urban areas should be monitored.

  1. Relational Coordination in Danish General Practice

    DEFF Research Database (Denmark)

    Lundstrøm, Sanne Lykke

    and relationship networks through which work is coordinated across functional and organisational boundaries. Previous studies have shown that relational coordination is positively associated with delivery of care for patients with chronic illness. Organisational social capital is used when analysing...... the psychosocial work environment in organisations, and is seen as a powerful resources for improving organisational performance. Relational coordination and organisational social capital may oer new insight and opportunities for general practice to learn. General practice provides cost-efficient, first....... The dissertation present the research study and a collection of three research papers prepared during the period from May 2010 to June 2014. Relational coordination and organisational social capital are measures of novel aspects of an organisation's performance. Relational coordination analyse the communication...

  2. E-dietician in general practice

    DEFF Research Database (Denmark)

    Brandt, Carl J.; Arendal, Cecilia; Glintborg, Dorte

    2010-01-01

    of 46 obese patients in general practice were offered participation in a cohort study during May 15th to December 1st 2008. Patients from three different health centers were included. 32 patients gave informed consent to participate and were given access to weekly e-mail consultations with a dietician...... and the amount of consultations (p=0.3). The individual expense to prevention- and e-mail consultations was 1,165DKK. In comparison the expense of 3 months of conventional treatment with 6-8 visits would be 1,300-1,700DKK. We conclude that weight loss as a result of econsultations is comparable with conventional...... weight loss treatments in general practice. The utilization of e-mail consultations can furthermore result in a saving in expenses and premises if the e-mail correspondences are held outside of the health centre....

  3. Antibiotic Prescription in Danish General Practice

    DEFF Research Database (Denmark)

    Sydenham, Rikke Vognbjerg; Plejdrup Hansen, Malene; Pedersen, Line Bjørnskov

    2016-01-01

    will explore how the GPs prescription behaviour is influenced by selected factors. Antibiotics are essential when treating potentially lethal infections. An increasing development of resistant bacteria is considered one of the primary threats to public health. The majority of antibiotics (90%) are prescribed...... from general practice. The prescription of broad-spectrum antibiotics can cause unnecessary side effects for the individual and increases the risk of development of bacteria resistant to antibiotic treatment. Both the prescription of broad-spectrum antibiotics and the level of resistant bacteria......1. Background & Aim The overall aim of the project is to describe antibiotic consumption in Danish general practice with emphasis on specific types of antibiotics. The project will shed light on the impact of microbiological diagnostic methods (MDM) on the choice of antibiotic and the project...

  4. Adherence to COPD guidelines in general practice

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli; Sørensen, Tina Brandt; Højmark, Torben Brunse

    2013-01-01

    BACKGROUND: The general practitioner (GP) is often the first healthcare contact for patients with chronic obstructive pulmonary disease (COPD). AIMS: To determine whether participating in a standardised educational programme delivered in the GP's own practice is associated with adherence to COPD...... guidelines. METHODS: A nationwide register-based observational before and after study was undertaken with a control group of propensity-matched practices (follow-up period 6 months). COPD was defined as age 40+ years and at least two prescriptions for inhaled medication. The educational programme consisted...... were used to compare the rate of spirometry testing, preventive consultations, and influenza vaccinations provided to COPD patients and the rate of spirometry testing in non-COPD individuals, assumed to reflect diagnostic activity. RESULTS: Data for 102 participating GP practices were analysed...

  5. Management of psychosis in Australian general practice.

    Science.gov (United States)

    Charles, Janice; Miller, Graeme; Ng, Anthea

    2006-03-01

    The BEACH program, a continuous national study of general practice activity in Australia, gives us an overview of consultations involving the management of psychoses. In this analysis we have included schizophrenia, affective disorders/bipolar, organic psychoses, and senile psychoses, with undefined psychosis and chronic brain syndrome grouped as 'other'. This synopsis provides a backdrop against which the theme articles in this issue of Australian Family Physician can be further considered.

  6. [Femoral angioplasty. Long-term results].

    Science.gov (United States)

    Foucart, H; Carlier, C; Baudrillard, J C; Joffre, F; Cécile, J P

    1990-01-01

    A study on the long-term efficacy of femoral-popliteal angioplasty was carried out on 185 angioplasty cases over a 5 year follow-up period. A classification of data according to the type of lesion treated, revealed that results were favorable in case of stenosis (87%), short obstruction (70%) and long obstruction (35%). A special study of the outcome of treatments for stage IV arteritis was carried out. After comparing results with those obtained by other teams, the authors list the complications encountered, hematomas, and thromboses, and show their current tendency for regression. Lastly, the authors stress the advantages of angioscopy, which permits to identify the nature of the treated lesions and to predict possible complications, which are usually underrated by angiography.

  7. Emotional behavior in long-term marriage.

    Science.gov (United States)

    Carstensen, L L; Gottman, J M; Levenson, R W

    1995-03-01

    In exploring the emotional climate of long-term marriages, this study used an observational coding system to identify specific emotional behaviors expressed by middle-aged and older spouses during discussions of a marital problem. One hundred and fifty-six couples differing in age and marital satisfaction were studied. Emotional behaviors expressed by couples differed as a function of age, gender, and marital satisfaction. In older couples, the resolution of conflict was less emotionally negative and more affectionate than in middle-aged marriages. Differences between husbands and wives and between happy and unhappy marriages were also found. Wives were more affectively negative than husbands, whereas husbands were more defensive than wives, and unhappy marriages involved greater exchange of negative affect than happy marriages.

  8. Long-term variations of solar activity

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Using the Lomb-Scargle periodogram we analyzed two sunspot series: the one over the past 11000 years at the 10-year interval based upon the survey data of 14C concentration in tree-rings, reconstructed by Solanki et al.; and the sunspot number over the past 7000 years, derived from geomagnetic variations by Usoskin et al. We found the periods and quasi-periods in solar activity, such as about 225, 352, 441, 522 and 561 a, and near 1000 and 2000 a. An approach of wavelet transform was applied to check the two sunspot time series, with emphasis on investigating time-varying characteristics in the long-term fluctuations of solar activity. The results show that the lengths and amplitudes of the periods have changed with time, and large variations have taken place during some periods.

  9. Autobiographical reasoning in long-term fandom

    Directory of Open Access Journals (Sweden)

    C. Lee Harrington

    2010-09-01

    Full Text Available We explore the social psychological processes through which fan-based experiences become situated in fans' larger life narratives. Drawing on original survey data with long-term U.S. soap opera fans, we examine how the psychological mechanism of autobiographical reasoning functions in fans' construction of self-narratives over time. The case study presented here is a subset of a larger investigation into the age-related structure of fans' activities, identities, and interpretive capacities. Situated at the intersections of gerontological (life span/life course theory and contemporary fan studies, our project mines relatively uninvestigated theoretical terrain. We conclude with a brief discussion of implications for future fan studies.

  10. Brodie's abscess. A long-term review.

    Science.gov (United States)

    Stephens, M M; MacAuley, P

    1988-09-01

    In 20 patients with 21 Brodie's abscesses, a long-term review revealed that 13 occurred in the second decade of life. All had local symptoms for six weeks or more. The tibia was involved in 11 cases and seven of these were in the proximal metaphysis. The erythrocyte sedimentation rate (ESR) was elevated in only six cases. When the ESR was more than 40 mm per hour, recurrence was more likely. Staphylococcus aureus was cultured from 11 abscesses. Curettage and antibiotics for six weeks were adequate for treatment in most cases. However, lesions larger than 3 cm in diameter should be grafted, and patients with an elevated ESR require more aggressive decompression and prolonged antibiotic therapy. Lesions within the neck of the femur pose particular anatomic problems and should not be approached laterally. All cases were followed to full bone maturity. No significant leg length inequality was clinically or roentgenologically apparent. If an abscess was juxtaphyseal, deformity of the epiphysis could develop.

  11. Long-term dynamics of Typha populations

    Science.gov (United States)

    Grace, J.B.; Wetzel, R.G.

    1998-01-01

    The zonation of Typha populations in an experimental pond in Michigan was re-examined 15 years after the original sampling to gain insight into the long-term dynamics. Current distributions of Typha populations were also examined in additional experimental ponds at the site that have been maintained for 23 years. The zonation between T. latifolia and T. angustifolia in the previously studied pond 15 years after the initial sampling revealed that the density and distribution of shoots had not changed significantly. Thus, it appears that previously reported results (based on 7- year old populations) have remained consistent over time. Additional insight into the interaction between these two taxa was sought by comparing mixed and monoculture stands in five experimental ponds that have remained undisturbed for their 23-year history. The maximum depth of T. latifolia, the shallow- water species, was not significantly reduced when growing in the presence of the more flood tolerant T. angustifolia. In contrast, the minimum depth of T. angustifolia was reduced from 0 to 37 cm when in the presence of T. latifolia. When total populations were compared between monoculture and mixed stands, the average density of T. angustifolia shoots was 59.4 percent lower in mixed stands while the density of T. latifolia was 32 percent lower, with T. angustifolia most affected at shallow depths (reduced by 92 percent) and T. latifolia most affected at the deepest depths (reduced by 60 percent). These long-term observations indicate that competitive displacement between Typha taxa has remained stable over time.

  12. Long-term reductions in tinnitus severity

    Directory of Open Access Journals (Sweden)

    Folmer Robert L

    2002-09-01

    Full Text Available Abstract Background This study was undertaken to assess long-term changes in tinnitus severity exhibited by patients who completed a comprehensive tinnitus management program; to identify factors that contributed to changes in tinnitus severity within this population; to contribute to the development and refinement of effective assessment and management procedures for tinnitus. Methods Detailed questionnaires were mailed to 300 consecutive patients prior to their initial appointment at the Oregon Health & Science University Tinnitus Clinic. All patients were then evaluated and treated within a comprehensive tinnitus management program. Follow-up questionnaires were mailed to the same 300 patients 6 to 36 months after their initial tinnitus clinic appointment. Results One hundred ninety patients (133 males, 57 females; mean age 57 years returned follow-up questionnaires 6 to 36 months (mean = 22 months after their initial tinnitus clinic appointment. This group of patients exhibited significant long-term reductions in self-rated tinnitus loudness, Tinnitus Severity Index scores, tinnitus-related anxiety and prevalence of current depression. Patients who improved their sleep patterns or Beck Depression Inventory scores exhibited greater reductions of tinnitus severity scores than patients who continued to experience insomnia and depression at follow-up. Conclusions Individualized tinnitus management programs that were designed for each patient contributed to overall reductions in tinnitus severity exhibited on follow-up questionnaires. Identification and treatment of patients experiencing anxiety, insomnia or depression are vital components of an effective tinnitus management program. Utilization of acoustic therapy also contributed to improvements exhibited by these patients.

  13. Long term results of pneumatic retinopexy

    Directory of Open Access Journals (Sweden)

    Ellakwa AF

    2012-01-01

    Full Text Available Amin F EllakwaMenoufiya University, Shibin el Kom, Al-Menoufiya, EgyptBackground: Rhegmatogenous retinal detachment is a commonly encountered retinal problem where rapid treatment can prevent irreversible vision loss. Pneumatic retinopexy (PR is a simple, minimally invasive procedure for retinal reattachment.Purpose: This study aimed to assess the long-term anatomical and functional outcome of pneumatic retinopexy in primary rhegmatogenous retinal detachment.Patients and methods: A prospective interventional study was performed. Subjects with rhegmatogenous retinal detachment who underwent pneumatic retinopexy from May 2006 to May 2007 at Menoufiya University Hospital were included in this study with at least 3 years follow-up.Results: A total of 40 cases were included in the study. The mean age of patients was 44.25 ± 10.85 years. Reattachment of the retina was achieved in 100% of cases. In 75% of cases, the primary intervention was successful. However, the retina redetached in 20% of these during the first 6 months, requiring reinjection or another procedure. Three years after the first intervention, follow-up measurement of the mean visual acuity of the eyes without reoperation was 0.40 ± 0.21 while the mean visual acuity of the eyes which needed additional operations was 0.22 ± 0.13.Conclusion: Sixty percent of the cases obtained long-term retinal reattachment with a single operation success (SOS, with good visual recovery and less morbidity than other more invasive procedures like scleral buckling or pars plana vitrectomy, translating to higher productivity for the patient. This procedure, being quicker than the alternatives, also saves the surgeon's time, making PR a good choice for managing primary rhegmatogenous retinal detachment in developing countries.Keywords: pneumatic, retinopexy, rhegmatogenous, retinal detachment

  14. Uncertainty Assessment in Long Term Urban Drainage Modelling

    DEFF Research Database (Denmark)

    Thorndahl, Søren

    the probability of system failures (defined as either flooding or surcharge of manholes or combined sewer overflow); (2) an application of the Generalized Likelihood Uncertainty Estimation methodology in which an event based stochastic calibration is performed; and (3) long term Monte Carlo simulations...... with the purpose of estimating the uncertainties on the extreme event statistics of maximum water levels and combined sewer overflow volumes in drainage systems. The thesis concludes that the uncertainties on both maximum water levels and combined sewer overflow volumes are considerable, especially on the large...

  15. Preeclampsia: Short-term and Long-term Implications.

    Science.gov (United States)

    Pauli, Jaimey M; Repke, John T

    2015-06-01

    Preeclampsia is a hypertensive disorder that affects 4% of pregnancies and has a high risk of maternal, fetal, and neonatal morbidity and mortality, as well as long-term cardiovascular risk. Recent updates in the definition, diagnosis, and management guidelines for preeclampsia warrant review by general obstetrician-gynecologists. Screening and prevention algorithms for preeclampsia are available, but ultimately the cure remains delivery of the fetus and placenta. Close monitoring for the development and worsening of preeclampsia during pregnancy is essential to optimize both maternal and fetal/neonatal outcomes.

  16. RIPED and IFP Built a Long-term Cooperative Partnership

    Institute of Scientific and Technical Information of China (English)

    Wang Mingyi

    2005-01-01

    @@ On March 15, the general geologist of PetroChina and the dean of Research Institute Petroleum Exploration and Development,CNPC (RIPED), Mr. Jia Chengzao, and the scientific and development principals in the aspects of exploration and development, refining & marketing, natural gas & pipelines and from RIPED met 8 specialists leading by Mr.Olivier Appert, the dean of Institut Francais du Pétrole (IFP). The two sides exchanged ideas broadly on the research topics that both parties were interested in commonly and signed a memorandum of understanding for building a long-term cooperative partnership between RIPED and IFP.

  17. The influence of organizational characteristics on employee solidarity in the long-term care sector

    NARCIS (Netherlands)

    J.M. Cramm (Jane); M.M.H. Strating (Mathilde); A.P. Nieboer (Anna)

    2013-01-01

    textabstractAim. This article is a report of a study that identifies organizational characteristics explaining employee solidarity in the long-term care sector. Background. Employee solidarity reportedly improves organizations' effectiveness and efficiency. Although general research on solidarity in

  18. The influence of organizational characteristics on employee solidarity in the long-term care sector

    NARCIS (Netherlands)

    J.M. Cramm (Jane); M.M.H. Strating (Mathilde); A.P. Nieboer (Anna)

    2013-01-01

    textabstractAim. This article is a report of a study that identifies organizational characteristics explaining employee solidarity in the long-term care sector. Background. Employee solidarity reportedly improves organizations' effectiveness and efficiency. Although general research on solidarity in

  19. Pre-emptive analgesia using intravenous fentanyl plus low-dose ketamine for radical prostatectomy under general anesthesia does not produce short-term or long-term reductions in pain or analgesic use.

    NARCIS (Netherlands)

    Katz, J.; Schmid, R.L.; Snijdelaar, D.G.; Coderre, T.J.; McCartney, C.J.; Wowk, A.

    2004-01-01

    The aim of the study was to evaluate post-operative pain and analgesic use after pre-operative or post-incisional i.v. fentanyl plus low dose i.v. ketamine vs. a standard treatment receiving i.v. fentanyl but not ketamine. Men undergoing radical prostatectomy under general anesthesia were randomly a

  20. Long-term potentiation and long-term depression: a clinical perspective

    Directory of Open Access Journals (Sweden)

    Timothy V.P. Bliss

    2011-01-01

    Full Text Available Long-term potentiation and long-term depression are enduring changes in synaptic strength, induced by specific patterns of synaptic activity, that have received much attention as cellular models of information storage in the central nervous system. Work in a number of brain regions, from the spinal cord to the cerebral cortex, and in many animal species, ranging from invertebrates to humans, has demonstrated a reliable capacity for chemical synapses to undergo lasting changes in efficacy in response to a variety of induction protocols. In addition to their physiological relevance, long-term potentiation and depression may have important clinical applications. A growing insight into the molecular mechanisms underlying these processes, and technological advances in non-invasive manipulation of brain activity, now puts us at the threshold of harnessing long-term potentiation and depression and other forms of synaptic, cellular and circuit plasticity to manipulate synaptic strength in the human nervous system. Drugs may be used to erase or treat pathological synaptic states and non-invasive stimulation devices may be used to artificially induce synaptic plasticity to ameliorate conditions arising from disrupted synaptic drive. These approaches hold promise for the treatment of a variety of neurological conditions, including neuropathic pain, epilepsy, depression, amblyopia, tinnitus and stroke.

  1. Real-life effectiveness of smoking-cessation treatments in general practice clinics in Denmark. The Escape Smoke project

    DEFF Research Database (Denmark)

    Poulsen, Peter Bo; Spillemose, Heidi; Nielsen, Gerda

    2015-01-01

    BACKGROUND: The smoking prevalence has not decreased in the last years in Denmark. General practice (GP) offers smoking cessation (SC) treatment. Studies of real-life effectiveness of daily practice SC-activities from the GP-setting opposed to efficacy results from randomized clinical trials......-clinics recruited 515 (273 females, 20% COPD) daily smokers being moderately nicotine dependent and heavy smoking (19 cigarettes/day). Receiving intensive advice, 74% did use SC-medicine paid out-of-pocket (1/3 NRT and 2/3 prescription-based). After 6 months, 187 participants had remained abstinent (36%). Adjusted......-medicine were independent significant predictors for long-term abstinence. CONCLUSIONS: Smoking cessation in Danish GP-clinics with some prior SC-activity can result in rather high long-term quit rates, especially when combining counseling and prescription-based SC-medicine. The effectiveness of prescription...

  2. Problems of long-term preservation of web pages

    Directory of Open Access Journals (Sweden)

    Mitja Dečman

    2011-01-01

    Full Text Available The World Wide Web is a distributed collection of web sites available on the Internet anywhere in the world. Its content is constantly changing: old data are being replaced which causes constant loss of a huge amount of information and consequently the loss of scientific, cultural and other heritage. Often, unnoticeably even legal certainty is questioned. In what way the data on the web can be stored and how to preserve them for the long term is a great challenge. Even though some good practices have been developed, the question of final solution on the national level still remains. The paper presents the problems of long-term preservation of web pages from technical and organizational point of view. It includes phases such as capturing and preserving web pages, focusing on good solutions, world practices and strategies to find solutions in this area developed by different countries. The paper suggests some conceptual steps that have to be defined in Slovenia which would serve as a framework for all document creators in the web environment and therefore contributes to the consciousness in this field, mitigating problems of all dealing with these issues today and in the future.

  3. The long-term health of vegetarians and vegans.

    Science.gov (United States)

    Appleby, Paul N; Key, Timothy J

    2016-08-01

    Vegetarians, who do not eat any meat, poultry or fish, constitute a significant minority of the world's population. Lacto-ovo-vegetarians consume dairy products and/or eggs, whereas vegans do not eat any foods derived wholly or partly from animals. Concerns over the health, environmental and economic consequences of a diet rich in meat and other animal products have focussed attention on those who exclude some or all of these foods from their diet. There has been extensive research into the nutritional adequacy of vegetarian diets, but less is known about the long-term health of vegetarians and vegans. We summarise the main findings from large cross-sectional and prospective cohort studies in western countries with a high proportion of vegetarian participants. Vegetarians have a lower prevalence of overweight and obesity and a lower risk of IHD compared with non-vegetarians from a similar background, whereas the data are equivocal for stroke. For cancer, there is some evidence that the risk for all cancer sites combined is slightly lower in vegetarians than in non-vegetarians, but findings for individual cancer sites are inconclusive. Vegetarians have also been found to have lower risks for diabetes, diverticular disease and eye cataract. Overall mortality is similar for vegetarians and comparable non-vegetarians, but vegetarian groups compare favourably with the general population. The long-term health of vegetarians appears to be generally good, and for some diseases and medical conditions it may be better than that of comparable omnivores. Much more research is needed, particularly on the long-term health of vegans.

  4. Elevated rheumatoid factor and long term risk of rheumatoid arthritis

    DEFF Research Database (Denmark)

    Nielsen, Sune F; Bojesen, Stig E; Schnohr, Peter;

    2012-01-01

    To test whether elevated concentration of rheumatoid factor is associated with long term development of rheumatoid arthritis.......To test whether elevated concentration of rheumatoid factor is associated with long term development of rheumatoid arthritis....

  5. Long term hypolipidaemic and anti-atherogenic effects of Carica ...

    African Journals Online (AJOL)

    Long term hypolipidaemic and anti-atherogenic effects of Carica papaya Linn. ... AFRICAN JOURNALS ONLINE (AJOL) · Journals · Advanced Search · USING ... This study was designed to assess the long term (24 weeks) effects of daily oral ...

  6. Seasonal And Long Term Rainfall Trends In Calabar, Nigeria ...

    African Journals Online (AJOL)

    Seasonal And Long Term Rainfall Trends In Calabar, Nigeria. ... AFRICAN JOURNALS ONLINE (AJOL) · Journals · Advanced Search ... Both seasonal and long term trends of rain fall in Calabar between 1985 and 2003 have been examined.

  7. Memory Vocabulary Learning Strategies and Long-Term Retention ...

    African Journals Online (AJOL)

    Memory Vocabulary Learning Strategies and Long-Term Retention. ... AFRICAN JOURNALS ONLINE (AJOL) · Journals · Advanced Search · USING ... The results were reflected in the students' short-term and long-term memory retention.

  8. IPO-related organizational change and long-term performance

    NARCIS (Netherlands)

    Eije, J.H. von; Witte, M.C. de; Zwaan, A.H. van der

    2000-01-01

    Mainstream literature on long-term performance of initial public offerings focuses on long-term underperformance. Because underperformance is an anomalous phenomenon, many authors search for explanations based on financial market imperfections. More recently, however, the attention shifts from

  9. LONG-TERM MONITORING SENSOR NETWORK

    Energy Technology Data Exchange (ETDEWEB)

    Stephen P. Farrington; John W. Haas; Neal Van Wyck

    2003-10-16

    Long-term monitoring (LTM) associated with subsurface contamination sites is a key element of Long Term Stewardship and Legacy Management across the Department of Energy (DOE) complex. However, both within the DOE and elsewhere, LTM is an expensive endeavor, often exceeding the costs of the remediation phase of a clean-up project. The primary contributors to LTM costs are associated with labor. Sample collection, storage, preparation, analysis, and reporting can add a significant financial burden to project expense when extended over many years. Development of unattended, in situ monitoring networks capable of providing quantitative data satisfactory to regulatory concerns has the potential to significantly reduce LTM costs. But survival and dependable operation in a difficult environment is a common obstacle to widespread use across the DOE complex or elsewhere. Deploying almost any sensor in the subsurface for extended periods of time will expose it to chemical and microbial degradation. Over the time-scales required for in situ LTM, even the most advanced sensor systems may be rendered useless. Frequent replacement or servicing (cleaning) of sensors is expensive and labor intensive, offsetting most, if not all, of the cost savings realized with unattended, in situ sensors. To enable facile, remote monitoring of contaminants and other subsurface parameters over prolonged periods, Applied Research Associates, Inc has been working to develop an advanced LTM sensor network consisting of three key elements: (1) an anti-fouling sensor chamber that can accommodate a variety of chemical and physical measurement devices based on electrochemical, optical and other techniques; (2) two rapid, cost effective, and gentle means of emplacing sensor packages either at precise locations directly in the subsurface or in pre-existing monitoring wells; and (3) a web browser-based data acquisition and control system (WebDACS) utilizing field-networked microprocessor-controlled smart

  10. Dienogest in long-term treatment of endometriosis

    Directory of Open Access Journals (Sweden)

    Schindler AE

    2011-07-01

    Full Text Available Adolf E SchindlerInstitute for Medical Research and Education, Essen, GermanyAbstract: Endometriosis is a chronic disease primarily affecting women of childbearing age, in which endometriotic lesions form outside the uterus, typically leading to painful symptoms, fatigue, and infertility. The symptoms of endometriosis may cause significant impairment in quality of life and represent a substantial economic burden to patients, families, and society. There is no cure for endometriosis; management consists of alleviating pain and other symptoms, reducing endometriotic lesions, and improving quality of life. Recurrence after surgical intervention is common, while the clinical evidence to support the efficacy and safety of many medications currently used in endometriosis is limited. Dienogest is an oral progestin that has been investigated extensively in the treatment of endometriosis in two clinical programs performed in Europe and Japan, including dose-ranging, placebo-controlled, active comparator-controlled, and long-term (up to 65 weeks studies. These studies demonstrated that dienogest 2 mg daily effectively alleviates the painful symptoms of endometriosis, reduces endometriotic lesions, and improves indices of quality of life. Dienogest showed a favorable safety and tolerability profile in these studies, with predictable adverse effects, high rates of patient compliance, and low withdrawal rates. This review article describes the clinical trial evidence that characterizes the efficacy and safety of dienogest in endometriosis, including two studies characterizing dienogest in long-term use. The relevance of these findings to the management of endometriosis in clinical practice is discussed.Keywords: dienogest, endometriosis, progestins, long-term treatment, quality of life, symptoms, pain

  11. Termite and earthworm abundance and taxonomic richness under long-term conservation soil management in Saria, Burkina Faso, West Africa

    NARCIS (Netherlands)

    Zida, Z.; Ouedraogo, E.; Mando, A.; Stroosnijder, L.

    2011-01-01

    Unsustainable crop and soil management practices are major causes of soil degradation and declining soil biodiversity in West Africa. Identifying soil management practices that favor macrofauna abundance is highly desirable for long-term soil health. This study investigates the effects of long-term

  12. Long-term benzodiazepine treatment in patients with psychotic disorders attending a mental health service in rural Greece

    Directory of Open Access Journals (Sweden)

    Vaios Peritogiannis

    2016-01-01

    Full Text Available Introduction: Long-term benzodiazepine (BZD treatment in patients with mental disorders is widespread in clinical practice, and this is also the case of patients with schizophrenia, although the evidence is weak and BZD prescription is discouraged by guidelines and medical authorities. Data on BZD prescription are usually derived from national or regional databases whereas information on the use of BZD by patients with schizophrenia and related psychoses in general population-based samples is limited. Materials and Methods: Information for 77 patients with psychotic disorders who were regularly attending follow-up appointments with the multidisciplinary Mobile Mental Health Unit of the prefectures of Ioannina and Thesprotia, Northwest Greece, during 1-year period (2015 was obtained from our database. Results: From the total of 77 engaged patients, 30 (39% were regularly prescribed BZDs in the long term, as part of their treatment regimen. Prescribed BZDs were mostly diazepam and lorazepam, in 43.3% of cases each. The mean daily dose of these compounds was 13 mg and 3.77 mg, respectively. Statistical analysis showed a correlation of long-term BZD use with the history of alcohol/substance abuse. Most patients were receiving BZD continuously for several years, and the mean dose was steady within this interval. Conclusions: A large proportion of patients with psychotic disorders were regularly prescribed BZD in long term. It appears that when BZDs are prescribed for some period in the course of a psychotic disorder, their use commonly exceeds the recommended interval and then becomes a regular part of the chronic treatment regimen. Future research should address the factors that may be related to the long-term BZD use by patients with psychotic disorders. Interventions for the reduction of regular BZD prescription should target the primary care setting and all those who treat first episode patients.

  13. Long-term psychosocial outcomes after intraoperative awareness with recall.

    Science.gov (United States)

    Laukkala, Tanja; Ranta, Seppo; Wennervirta, Johanna; Henriksson, Markus; Suominen, Kirsi; Hynynen, Markku

    2014-07-01

    Posttraumatic stress disorder, a common psychiatric disorder in the general population, may follow a traumatic experience of awareness with recall during general anesthesia. We conducted a matched cohort design with 9 subjects after intraoperative awareness with recall during general anesthesia. A psychiatric diagnostic interview and questionnaire were performed on 9 matched controls and 9 subjects, a median of 17.2 years from their documented awareness episode. The subjects and the matched controls completed a battery of questionnaires related to psychosocial well-being, after which they participated in a diagnostic Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders. Patients with awareness did not seem to differ from their matched controls in subsequent psychosocial outcome, psychiatric morbidity, or quality of life. We found no indication that intraoperative awareness with recall had any deleterious long-term effects on patients' psychosocial outcome.

  14. Improving students' long-term knowledge retention through personalized review.

    Science.gov (United States)

    Lindsey, Robert V; Shroyer, Jeffery D; Pashler, Harold; Mozer, Michael C

    2014-03-01

    Human memory is imperfect; thus, periodic review is required for the long-term preservation of knowledge and skills. However, students at every educational level are challenged by an ever-growing amount of material to review and an ongoing imperative to master new material. We developed a method for efficient, systematic, personalized review that combines statistical techniques for inferring individual differences with a psychological theory of memory. The method was integrated into a semester-long middle-school foreign-language course via retrieval-practice software. Using a cumulative exam administered after the semester's end, we compared time-matched review strategies and found that personalized review yielded a 16.5% boost in course retention over current educational practice (massed study) and a 10.0% improvement over a one-size-fits-all strategy for spaced study.

  15. Acute Neck Pain in General Practice

    OpenAIRE

    2006-01-01

    textabstractWe performed a prospective cohort study with one-year follow-up of patients with acute neck pain in general practice. Patients above 18 years of age consulting their GP for non-specific acute neck pain lasting no longer than six weeks were invited to participate. Self-administered questionnaires were collected from patients at baseline and after 6, 12, 26 and 52 weeks. 187 patients were included and we have follow-up data of 138 patients (74%). After one-year 47% still reported ne...

  16. Long-term outcome of neuroparacoccidioidomycosis treatment

    Directory of Open Access Journals (Sweden)

    Fabio Francesconi

    2011-02-01

    Full Text Available INTRODUCTION: Neuroparacoccidioidomycosis (NPCM is a term used to describe the invasion of the central nervous system by the pathogenic fungus Paracoccidioides brasiliensis. NPCM has been described sporadically in some case reports and small case series, with little or no focus on treatment outcome and long-term follow-up. METHODS: All patients with NPCM from January 1991 to December 2006 were analyzed and were followed until December 2009. RESULTS: Fourteen (3.8% cases of NPCM were identified out of 367 patients with paracoccidioidomycosis (PCM. A combination of oral fluconazole and sulfamethoxazole/trimethoprim (SMZ/TMP was the regimen of choice, with no documented death due to Paracoccidioides brasiliensis infection. Residual neurological deficits were observed in 8 patients. Residual calcification was a common finding in neuroimaging follow-up. CONCLUSIONS: All the patients in this study responded positively to the association of oral fluconazole and sulfamethoxazole/trimethoprim, a regimen that should be considered a treatment option in cases of NPCM. Neurological sequela was a relatively common finding. For proper management of these patients, anticonvulsant treatment and physical therapy support were also needed.

  17. Long-Term Soft Denture Lining Materials

    Science.gov (United States)

    Chladek, Grzegorz; Żmudzki, Jarosław; Kasperski, Jacek

    2014-01-01

    Long-term soft denture lining (LTSDL) materials are used to alleviate the trauma associated with wearing complete dentures. Despite their established clinical efficacy, the use of LTSDLs has been limited due to the unfavorable effects of the oral environment on some of their mechanical and performance characteristics. The unresolved issue of LTSDL colonization by Candida albicans is particularly problematic. Silicone-based LTSDL (SLTSDL) materials, which are characterized by more stable hardness, sorption and solubility than acrylic-based LTSDLs (ALTSDLs), are currently the most commonly used LTSDLs. However, SLTSDLs are more prone to debonding from the denture base. Moreover, due to their limitations, the available methods for determining bond strength do not fully reflect the actual stability of these materials under clinical conditions. SLTSDL materials exhibit favorable viscoelastic properties compared with ALTSDLs. Furthermore, all of the lining materials exhibit an aging solution-specific tendency toward discoloration, and the available cleansers are not fully effective and can alter the mechanical properties of LTSDLs. Future studies are needed to improve the microbiological resistance of LTSDLs, as well as some of their performance characteristics. PMID:28788163

  18. Long-term predictions using natural analogues

    Energy Technology Data Exchange (ETDEWEB)

    Ewing, R.C. [Univ. of New Mexico, Albuquerque, NM (United States)

    1995-09-01

    One of the unique and scientifically most challenging aspects of nuclear waste isolation is the extrapolation of short-term laboratory data (hours to years) to the long time periods (10{sup 3}-10{sup 5} years) required by regulatory agencies for performance assessment. The direct validation of these extrapolations is not possible, but methods must be developed to demonstrate compliance with government regulations and to satisfy the lay public that there is a demonstrable and reasonable basis for accepting the long-term extrapolations. Natural systems (e.g., {open_quotes}natural analogues{close_quotes}) provide perhaps the only means of partial {open_quotes}validation,{close_quotes} as well as data that may be used directly in the models that are used in the extrapolation. Natural systems provide data on very large spatial (nm to km) and temporal (10{sup 3}-10{sup 8} years) scales and in highly complex terranes in which unknown synergisms may affect radionuclide migration. This paper reviews the application (and most importantly, the limitations) of data from natural analogue systems to the {open_quotes}validation{close_quotes} of performance assessments.

  19. Long-term corrosion testing pan.

    Energy Technology Data Exchange (ETDEWEB)

    Wall, Frederick Douglas; Brown, Neil R. (Los Alamos National Laboratory, Los Alamos, NM)

    2008-08-01

    This document describes the testing and facility requirements to support the Yucca Mountain Project long-term corrosion testing needs. The purpose of this document is to describe a corrosion testing program that will (a) reduce model uncertainty and variability, (b) reduce the reliance upon overly conservative assumptions, and (c) improve model defensibility. Test matrices were developed for 17 topical areas (tasks): each matrix corresponds to a specific test activity that is a subset of the total work performed in a task. A future document will identify which of these activities are considered to be performance confirmation activities. Detailed matrices are provided for FY08, FY09 and FY10 and rough order estimates are provided for FY11-17. Criteria for the selection of appropriate test facilities were developed through a meeting of Lead Lab and DOE personnel on October 16-17, 2007. These criteria were applied to the testing activities and recommendations were made for the facility types appropriate to carry out each activity. The facility requirements for each activity were assessed and activities were identified that can not be performed with currently available facilities. Based on this assessment, a total of approximately 10,000 square feet of facility space is recommended to meet all future testing needs, given that all testing is consolidated to a single location. This report is a revision to SAND2007-7027 to address DOE comments and add a series of tests to address NWTRB recommendations.

  20. Long-term corrosion testing plan.

    Energy Technology Data Exchange (ETDEWEB)

    Wall, Frederick Douglas; Brown, Neil R. (Los Alamos National Laboratory, Los Alamos, NM)

    2009-02-01

    This document describes the testing and facility requirements to support the Yucca Mountain Project long-term corrosion testing program. The purpose of this document is to describe a corrosion testing program that will (a) reduce model uncertainty and variability, (b) reduce the reliance upon overly conservative assumptions, and (c) improve model defensibility. Test matrices were developed for 17 topical areas (tasks): each matrix corresponds to a specific test activity that is a subset of the total work performed in a task. A future document will identify which of these activities are considered to be performance confirmation activities. Detailed matrices are provided for FY08, FY09 and FY10 and rough order estimates are provided for FY11-17. Criteria for the selection of appropriate test facilities were developed through a meeting of Lead Lab and DOE personnel on October 16-17, 2007. These criteria were applied to the testing activities and recommendations were made for the facility types appropriate to carry out each activity. The facility requirements for each activity were assessed and activities were identified that can not be performed with currently available facilities. Based on this assessment, a total of approximately 10,000 square feet of facility space is recommended to accommodate all future testing, given that all testing is consolidated to a single location. This report is a revision to SAND2008-4922 to address DOE comments.

  1. Downlink Scheduling in Long Term Evolution

    Directory of Open Access Journals (Sweden)

    Anwar Hossain

    2015-06-01

    Full Text Available This is an investigated research article on resource block scheduling of Long Term Evolution (LTE. LTE is one of the evolutions of the Universal Mobile Telecommunication System (UMTS. It provides internet access to mobile users through smart phone, laptop and other android devices. LTE offers a high speed data and multimedia services. It supports data rates up to 100 Mbps in the downlink and 50 Mbps in the uplink transmission. Our research investigation was aim to the downlink scheduling. We have considered The Best CQI scheduling algorithm and the Round Robin scheduling algorithm. The implementation, analysis and comparison of these scheduling algorithms have been performed through MATLAB simulator. We have analyzed the impact of the scheduling schemes on the throughput and the fairness of both scheduling schemes. Here we have proposed a new scheduling algorithm that achieves a compromise between the throughput and the fairness. Orthogonal Frequency Division Multiplexing (OFDM has been adopted as the downlink transmission scheme. We have considered the impact of the channel delay on the throughput. In addition, MIMO transceiver systems have been implemented to increase the throughput

  2. Long Term Evolution of Plasma Wakefields

    CERN Document Server

    Sahai, Aakash A; Tsung, F S; Mori, W B

    2014-01-01

    We study the long-term evolution (LTE) of plasma wakefields over multiple plasma-electron periods and few plasma-ion periods, much less than a recombination time. The evolution and relaxation of such a wakefield-perturbed plasma over these timescales has important implications for the upper limits of repetition-rates in plasma colliders. Intense fields in relativistic lasers (or intense beams) create plasma wakefields (modes around {\\omega}pe) by transferring energy to the plasma electrons. Charged-particle beams in the right phase may be accelerated with acceleration/focusing gradients of tens of GeV/m. However, wakefields leave behind a plasma not in equilibrium, with a relaxation time of multiple plasma-electron periods. Ion motion over ion timescales, caused by energy transfer from the driven plasma-electrons to the plasma-ions can create interesting plasma states. Eventually during LTE, the dynamics of plasma de-coheres (multiple modes through instability driven mixing), thermalizing into random motion (...

  3. Long term results of mandibular distraction

    Directory of Open Access Journals (Sweden)

    Batra Puneet

    2006-03-01

    Full Text Available Mandibular distraction osteogenesis has become a popular surgical modality due to its many advantages over conventional orthognathic surgical procedures. However, in spite of the technique having been used for over 15 years, no concrete long term results are available regarding the stability of results. We discuss the various studies which have reported either in favour or against the stablility of results after distraction. We report a series of 6 cases (3 unilateral and 3 bilateral distraction where distraction was carried out before puberty and followed them up to seven years after removal of distractors. This case series shows that results achieved by distraction osteogenesis are unstable or best unpredictable with respect to producing a permanent size increase in the mandible. The role of the distraction osteogenesis in overcoming the pterygomassetric sling is questionable. We suggest a multicenter study with adequate patient numbers treated with a similar protocol and documented after growth cessation to have meaningful conclusions on the debate of distraction osteogenesis versus orthognathic surgery.

  4. Long-term data storage in diamond

    Science.gov (United States)

    Dhomkar, Siddharth; Henshaw, Jacob; Jayakumar, Harishankar; Meriles, Carlos A.

    2016-01-01

    The negatively charged nitrogen vacancy (NV−) center in diamond is the focus of widespread attention for applications ranging from quantum information processing to nanoscale metrology. Although most work so far has focused on the NV− optical and spin properties, control of the charge state promises complementary opportunities. One intriguing possibility is the long-term storage of information, a notion we hereby introduce using NV-rich, type 1b diamond. As a proof of principle, we use multicolor optical microscopy to read, write, and reset arbitrary data sets with two-dimensional (2D) binary bit density comparable to present digital-video-disk (DVD) technology. Leveraging on the singular dynamics of NV− ionization, we encode information on different planes of the diamond crystal with no cross-talk, hence extending the storage capacity to three dimensions. Furthermore, we correlate the center’s charge state and the nuclear spin polarization of the nitrogen host and show that the latter is robust to a cycle of NV− ionization and recharge. In combination with super-resolution microscopy techniques, these observations provide a route toward subdiffraction NV charge control, a regime where the storage capacity could exceed present technologies.

  5. DIFFERENTIAL DIAGNOSIS OF LONG TERM TONGUE ULCERS

    Directory of Open Access Journals (Sweden)

    Hegde Nidarsh D.

    2012-08-01

    Full Text Available Oral ulcers is a very common disorder of the oral mucosa. Patients with signs or symptoms of oral ulcers are sometimes referred to gastroenterology clinics, however, in most instances the ulcers does not reflect gastrointestinal disease, some with a chronic non- healing ulcer are advised biopsy. Indeed, a spectrum of disorders can give rise to oral mucosal ulcers ranging from minor local trauma to significant local disease such as malignancy or systemic illness. Lesions of the tongue have a broad differential diagnosis ranging from benign idiopathic processes to infections, cancers, and infiltrative disorders. This article will focus on common ulcerative disorders of the tongue in aspects of their clinical features and differential diagnosis, two case reports with the diagnosis and conservative management for long-term chronic ulcers. The two cases which are reported in this article had a differential diagnosis of Squamous cell carcinoma of the tongue. The clinical picture was craterlike lesion, having a velvety-red base and a rolled, indurated border and most important painless in both cases. Removal of the irritant which was the tooth, rehabilitation of the oral mucosa by lubrication with Cocus Nucifera resulted in the healing of the ulcers. Functional components of Cocus Nucifera are Squaline, tocopherol, phytosterols and other sterols which are all plant steroids.

  6. Long-Term Soft Denture Lining Materials

    Directory of Open Access Journals (Sweden)

    Grzegorz Chladek

    2014-08-01

    Full Text Available Long-term soft denture lining (LTSDL materials are used to alleviate the trauma associated with wearing complete dentures. Despite their established clinical efficacy, the use of LTSDLs has been limited due to the unfavorable effects of the oral environment on some of their mechanical and performance characteristics. The unresolved issue of LTSDL colonization by Candida albicans is particularly problematic. Silicone-based LTSDL (SLTSDL materials, which are characterized by more stable hardness, sorption and solubility than acrylic-based LTSDLs (ALTSDLs, are currently the most commonly used LTSDLs. However, SLTSDLs are more prone to debonding from the denture base. Moreover, due to their limitations, the available methods for determining bond strength do not fully reflect the actual stability of these materials under clinical conditions. SLTSDL materials exhibit favorable viscoelastic properties compared with ALTSDLs. Furthermore, all of the lining materials exhibit an aging solution-specific tendency toward discoloration, and the available cleansers are not fully effective and can alter the mechanical properties of LTSDLs. Future studies are needed to improve the microbiological resistance of LTSDLs, as well as some of their performance characteristics.

  7. CERN Services for Long Term Data Preservation

    CERN Document Server

    Shiers, Jamie; Blomer, Jakob; Ganis, Gerardo; Dallmeier-Tiessen, Sunje; Simko, Tibor; Cancio Melia, German; CERN. Geneva. IT Department

    2016-01-01

    In this paper we describe the services that are offered by CERN for Long Term preservation of High Energy Physics (HEP) data, with the Large Hadron Collider (LHC) as a key use case. Data preservation is a strategic goal for European High Energy Physics (HEP), as well as for the HEP community worldwide and we position our work in this global content. Specifically, we target the preservation of the scientific data, together with the software, documentation and computing environment needed to process, (re-)analyse or otherwise (re-)use the data. The target data volumes range from hundreds of petabytes (PB – 10^15 bytes) to hundreds of exabytes (EB – 10^18 bytes) for a target duration of several decades. The Use Cases driving data preservation are presented together with metrics that allow us to measure how close we are to meeting our goals, including the possibility for formal certification for at least part of this work. Almost all of the services that we describe are fully generic – the exception being A...

  8. 40 CFR 52.29 - Visibility long-term strategies.

    Science.gov (United States)

    2010-07-01

    ...-term strategy. (1) A long-term strategy is a 10- to 15-year plan for making reasonable progress toward... every 3 years from November 24, 1987. (3) During the long-term strategy review process, the... 40 Protection of Environment 3 2010-07-01 2010-07-01 false Visibility long-term strategies. 52.29...

  9. TIA and Stroke: the long-term perspective

    NARCIS (Netherlands)

    Wijk, I. van

    2006-01-01

    Background Survival after stroke has improved, but little is known about the long-term risk of new vascular events and the functioning of long-term survivors. The main objective of this thesis was to evaluate the long-term perspective of these patients. Methods Two longitudinal studies were carried

  10. CHARACTERISTICS OF LONG-TERM UNEMPLOYMENT SPELLS IN ROMANIA

    OpenAIRE

    Daniela-Emanuela Danacica; Raluca Mazilescu

    2012-01-01

    The aim of this paper is to analyze characteristics of long-term unemployment spells in Romania and to estimate the effect of factors influencing long-term unemployment spells. The study period is in between January 1st 2008 and December 31st 2010. 468159 long-term spells registered in the specified period at the National Agency of Employment are analyzed.

  11. Management of upper dyspepsia in general practice

    DEFF Research Database (Denmark)

    Kjeldsen, Hans Christian; Kier, Svend; Husum, Gitte

     Aim: To compare the effect of two strategies for management of dyspepsia. Evaluation based on GP's assessment after two weeks and patients assessment after three months.   Design: Prospective randomised controlled trial in general practice   Methods: 357 patients with dyspepsia where the general......) for two weeks. If symptoms were unchanged after to weeks => referral to endoscopy. Later recurrence of symptoms => endoscopy (> 45 year) or management strategy according to helicobacter pylori status and/or clinical reflux (measures......)   Conclusion In management of dyspepsia therapy does have a better short term effect than endoscopy concerning symptom relief, but after 3 months the endoscopy strategy had a better effect than PPI concerning symptom relief  ...

  12. Clinical Activity in General Practice and Cancer

    DEFF Research Database (Denmark)

    Hjertholm, Peter

    2015-01-01

    BACKGROUND AND AIMS Cancer is a common, serious disease and early diagnosis is a cornerstone in the effort to improve the outcome from cancer disease. The general practitioner (GP) plays a crucial role in achieving this goal. Little is known about GPs’ suspicion of cancer and the activities the GPs...... institute in relation to such suspicion. Knowledge is also sparse on any effects of different diagnostic activities in general practice. The overall aims of this thesis were therefore: -to describe how often Danish GPs suspected cancer or other serious diseases and how they acted on the suspicion......, and to analyse how a suspicion influenced the demand for health care services and predicted a future diagnosis of serious disease - to investigate whether variation in GPs’ diagnostic activity influences cancer patients’ prognosis in relation to prostate-specific antigen (PSA) testing and prostate cancer...

  13. The Effects of ACMI Flight Crew’s Long Term Outstation Hotel Stay on Accumulated Fatigue

    Directory of Open Access Journals (Sweden)

    Gislason Sigurdur Hrafn

    2015-11-01

    Full Text Available ACMI flight crews spend considerable time away from home on outstations. This manuscript suggests that long term stay carries its own considerations in regards to rest recovery with practical implications for Fatigue Risk Management. Four recovery factors are identified and are to be correlated with 28 crew behaviors. The end result might indicate improvement considerations for airline management organizing a long term contract with ACMI crews.

  14. Outcomes of endodontic therapy in general practice

    Science.gov (United States)

    Bernstein, Susan D.; Horowitz, Allan J.; Man, Martin; Wu, Hongyu; Foran, Denise; Vena, Donald A.; Collie, Damon; Matthews, Abigail G.; Curro, Frederick A.; Thompson, Van P.; Craig, Ronald G.

    2014-01-01

    Background The authors undertook a study involving members of a dental practice-based research network to determine the outcome and factors associated with success and failure of endodontic therapy. Methods Members in participating practices (practitioner-investigators [P-Is]) invited the enrollment of all patients seeking treatment in the practice who had undergone primary endodontic therapy and restoration in a permanent tooth three to five years previously. If a patient had more than one tooth so treated, the P-I selected as the index tooth the tooth treated earliest during the three- to five-year period. The authors excluded from the study any teeth that served as abutments for removable partial dentures or overdentures, third molars and teeth undergoing active orthodontic endodontic therapy. The primary outcome was retention of the index tooth. Secondary outcomes, in addition to extraction, that defined failure included clinical or radiographic evidence (or both) of periapical pathosis, endodontic retreatment or pain on percussion. Results P-Is in 64 network practices enrolled 1,312 patients with a mean (standard deviation) time to follow-up of 3.9 (0.6) years. During that period, 3.3 percent of the index teeth were extracted, 2.2 percent underwent retreatment, 3.6 percent had pain on percussion and 10.6 percent had periapical radiolucencies for a combined failure rate of 19.1 percent. The presence of preoperative periapical radiolucency with a diagnosis of either irreversible pulpitis or necrotic pulp was associated with failure after multivariate analysis, as were multiple canals, male sex and Hispanic/Latino ethnicity. Conclusions These results suggest that failure rates for endodontic therapy are higher than previously reported in general practices, according to results of studies based on dental insurance claims data. Clinical Implications The results of this study can help guide the practitioner in deciding the most appropriate course of therapy for

  15. Long-term funding and faithfulness to the original goal

    Energy Technology Data Exchange (ETDEWEB)

    Sjoegren, G

    1999-02-01

    The study describes long-term funding in terms of faithfulness to the original goals of the foundations. After having examined 20 different Swedish foundations three main categories of problems have appeared. The main threats to the original goals of the foundations are juridical problems, economic problems and a changing society. Fraud and embezzlement are covered by the Act (1994:1220) Concerning Foundations, but the law does not prevent unfaithfulness to the original goal of the foundation in terms of permutation. If the foundation is a private-established foundation the board has to apply for a change of the original goal to the Swedish Judicial Board for Public Lands and Funds. If the State, a municipality or a community establishes the foundation the Government can change the goal without permission of any other authority. Economic problems often strike smaller funds established by private persons, but State-established funds can also be hit by economical problems. The economic problems presented in the text are high tax levels, bad investments and problems getting donations. Both small private and large State-established foundations sometimes have to change their original goals as a result of a changing society. The goal of the foundation can be out-of-date, be against the ideology of the government party or the demography might have changed. Examples from each category are given in the text. The study is made to facilitate a description in general terms of the prospects for the Swedish nuclear funds if a final decision can not be made in the time span of 100 or 200 years. Looking back on the changes in the judicial, economical and political arenas during the last 200 years, one realizes the impossibility to foresee the changes that will occur within the next 200 years. The author`s conclusion, after examined 20 foundation, is that it is impossible to establish a perfect long-term fund as we can not foresee the long-term future

  16. Long term stability of nanowire nanoelectronics in physiological environments.

    Science.gov (United States)

    Zhou, Wei; Dai, Xiaochuan; Fu, Tian-Ming; Xie, Chong; Liu, Jia; Lieber, Charles M

    2014-03-12

    Nanowire nanoelectronic devices have been exploited as highly sensitive subcellular resolution detectors for recording extracellular and intracellular signals from cells, as well as from natural and engineered/cyborg tissues, and in this capacity open many opportunities for fundamental biological research and biomedical applications. Here we demonstrate the capability to take full advantage of the attractive capabilities of nanowire nanoelectronic devices for long term physiological studies by passivating the nanowire elements with ultrathin metal oxide shells. Studies of Si and Si/aluminum oxide (Al2O3) core/shell nanowires in physiological solutions at 37 °C demonstrate long-term stability extending for at least 100 days in samples coated with 10 nm thick Al2O3 shells. In addition, investigations of nanowires configured as field-effect transistors (FETs) demonstrate that the Si/Al2O3 core/shell nanowire FETs exhibit good device performance for at least 4 months in physiological model solutions at 37 °C. The generality of this approach was also tested with in studies of Ge/Si and InAs nanowires, where Ge/Si/Al2O3 and InAs/Al2O3 core/shell materials exhibited stability for at least 100 days in physiological model solutions at 37 °C. In addition, investigations of hafnium oxide-Al2O3 nanolaminated shells indicate the potential to extend nanowire stability well beyond 1 year time scale in vivo. These studies demonstrate that straightforward core/shell nanowire nanoelectronic devices can exhibit the long term stability needed for a range of chronic in vivo studies in animals as well as powerful biomedical implants that could improve monitoring and treatment of disease.

  17. Long term effects of smoking cessation in hospitalized schizophrenia patients.

    Science.gov (United States)

    Miyauchi, Masatoshi; Kishida, Ikuko; Suda, Akira; Shiraishi, Yohko; Fujibayashi, Mami; Taguri, Masataka; Ishii, Chie; Ishii, Norio; Moritani, Toshio; Hirayasu, Yoshio

    2017-03-07

    The prevalence of smoking in patients with schizophrenia is higher than that in the general population and is an important medical issue. Short-term smoking cessation tends to worsen psychiatric symptoms in patients with schizophrenia but decreases sympathetic nervous system activity and improves plasma cholesterol levels in healthy people. Few studies have assessed the long-term effects of smoking cessation in patients with schizophrenia. Subjects were 70 Japanese patients with schizophrenia (38 smokers, 32 non-smokers). We compared the following clinical parameters between the two groups at baseline (before smoking cessation) and in each group separately between baseline and at three years after smoking cessation: autonomic nervous system activity, plasma cholesterol levels, body weight, drug therapy, and Global Assessment of Functioning scores. We also compared the mean changes in clinical parameters throughout this study between the groups at both time points. Autonomic nervous system activity was assessed by power spectral analysis of heart rate variability. Parasympathetic nervous system activity and the doses of antiparkinsonian drugs in smokers were significantly higher than those in non-smokers at baseline. Smoking cessation was associated with significantly decreased sympathetic nervous system activity and decreased doses of antipsychotics and antiparkinsonian drugs at three years after smoking cessation. However, there was no significant difference in the mean change in clinical factors scores, except for Global Assessment of Functioning scores, between smokers and non-smokers at three years after smoking cessation. Our results suggest that smoking reduces both autonomic nervous system activity and the effectiveness of drug therapy with antipsychotics and antiparkinsonian drugs in patients with schizophrenia, but that both factors could be ameliorated over the long term by smoking cessation. Taken together with the findings of previous studies, smoking

  18. Long-term variability of the spring taryn-aufeises

    Directory of Open Access Journals (Sweden)

    V. R. Alekseev

    2016-01-01

    Full Text Available Long-term variability of large taryn-aufeises was studied for several decades in different regions of the USA (Alaska and Russia (Chukotka, Kolyma, Southern Yakutia, Transbaikalia, and Eastern Sayan. Differences between volumes of individual ice massifs and the recorded maximal values change from 2–3 to 95–100%, and they do not depend on sizes of ice fields and their geographical locations. No statistically significant dependence of the aufeis volumes on the atmospheric precipitation amount and the air temperature was revealed in the most of the above areas. However, a general tendency for decreasing of the annual maxima of the ice reserves due to the climate warming was noticed. The long-term variations of the aufeises show existence of cycles of increase and decrease in their maximum sizes with their durations of 3, 7 and 11 years with the 25–30% amplitude of variations relative to the mean long-term values. In the Arctic areas, some of the giant aufeises do not melt completely during the summer and remain for a next winter. The volume of pereletoks (shortterm permafrost varies within the range of 5–25%, averaging 16% of the spring ice reserves. In the southern geocryological zone, a clearly pronounced dependence of activity of the aufeis processes on the snow thickness was found: when the snow depth increased from 70 to 100 cm, volumes of aufeises decreased by a factor of three, and the aufeises disappeared completely under the thickness larger 120 cm. It should be noted that the processes producing the aufeis-forming sources of subsurface water, and the factors of their layered-ice accumulation remain almost unexplored.

  19. Long-term surveillance plan for the Ambrosia Lake, New Mexico disposal site

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-07-01

    This long-term surveillance plan (LTSP) for the Uranium Mill Tailings Remedial Action (UMTRA) Project Ambrosia Lake disposal site in McKinley County, New Mexico, describes the U.S. Department of Energy`s (DOE) long-term care program for the disposal site. The DOE will carry out this program to ensure that the disposal cell continues to function as designed. This LTSP was prepared as a requirement for acceptance under the U.S. Nuclear Regulatory Commission (NRC) general license for custody and long-term care of residual radioactive materials.

  20. Long-term surveillance plan for the Ambrosia Lake, New Mexico disposal site

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-11-01

    This long-term surveillance plan (LTSP) for the Uranium Mill Tailings Remedial Action (UMTRA) Project Ambrosia Lake disposal site in McKinley County, New Mexico, describes the US Department of Energy`s (DOE) long-term care program for the disposal site. The DOE will carry out this program to ensure that the disposal cell continues to function as designed. This LTSP was prepared as a requirement for acceptance under the US Nuclear Regulatory Commission (NRC) general license for custody and long-term care of residual radioactive materials.

  1. Long term health consequences of Female Genital Mutilation (FGM).

    Science.gov (United States)

    Reisel, Dan; Creighton, Sarah M

    2015-01-01

    Female Genital Mutilation (FGM) comprises various procedures which remove or damage the external female genital organs for no medical reason. FGM has no health benefits and is recognised to cause severe short and long term damage to both physical and psychological health. Although FGM is primarily performed in Africa, Asia and the Middle East, migration of FGM practising communities means that the health complications of FGM will have a global impact. It is important that health professionals world wide are aware of the damage FGM causes to long term health. In some cases it may be possible to offer interventions that will alleviate or improve symptoms. However whilst there is some high quality research on FGM and pregnancy outcomes, little is known about the effects on gynaecological, psychological and sexual function. Research is hampered by the problems of data collection on such a sensitive topic as well as the practical difficulties of analysis of studies based mainly on retrospect recall. Well planned hospital based studies of the impact of FGM on physical and psychological health are urgently need but are currently absent from the medical literature. Such studies could generate robust evidence to allow clinicians to benchmark clinical effectiveness and high quality medical care for survivors of FGM.

  2. A qualitative study of collaboration in general practice: understanding the general practice nurse's role.

    Science.gov (United States)

    McInnes, Susan; Peters, Kath; Bonney, Andrew; Halcomb, Elizabeth

    2017-07-01

    To explore the nature of collaboration between registered nurses and general practitioners in Australian general practice. There is international recognition that collaboration between health professionals can improve care coordination, enhance health outcomes, optimise the work environment and reduce healthcare costs. However, effective collaboration requires a clear understanding of each team member's role. A qualitative approach guided by Naturalistic Inquiry was used to elicit and interpret participant narratives. Eight general practitioners and fourteen registered nurses working in general practice were purposefully recruited. Data were collected via individual, semi-structured face-to-face interviews during February to May 2015. Interviews were audio recorded and transcribed verbatim. Data were analysed using thematic analysis. Data revealed three overarching themes. This study presents the data for the overarching theme 'Understanding the general practice registered nurse's role'. Many general practitioner participants lacked clarity around the role and scope of practice of the registered nurse. At the same time, nursing participants often articulated their role as an assistant rather than as an independent health professional. This limited collaboration and the nurses' role within the team. Collaboration was enhanced when general practitioners actively sought an understanding of the registered nurses scope of practice. Clarifying the nurses' role promotes collaboration and supports nurses to work to the full extent of their practice. This is important in terms of optimising the nurses' role within the team and reinforcing their professional identity. Identification of key issues around understanding the nurses' role may help inform strategies that improve collaboration and workplace relations. © 2016 John Wiley & Sons Ltd.

  3. Western Ethnic Area Cultivation and Construction of the Long-term Mechanism of Practicing Socialist Core Values%西部民族地区培育和践行社会主义核心价值观长效机制的构建

    Institute of Scientific and Technical Information of China (English)

    何林

    2015-01-01

    Ethnic minority areas construction and the cultivation and practice of socialist core values are the long-term mechanism to promote economic and social development in ethnic minority areas, to maintain social stability and national unity, and to enhance the soft power of national culture. Facing the opportunity and the challenge, building long-term mechanism should adhere to the construction of both material civilization and spiritual civilization construction, the coexistence of a leadership and multi-dimensional, and the principle of combining cultivation and practice, national identity and state identity.%西部民族地区构建培育和践行社会主义核心价值观长效机制是促进民族地区经济社会发展,维护社会稳定和国家统一,增强中华民族文化软实力的需要。面对机遇和挑战,构建长效机制要坚持物质文明建设与精神文明建设;一元主导与多元并存;培育与践行;民族认同与国家认同相结合的原则。

  4. Modeling Maintenance of Long-Term Potentiation in Clustered Synapses: Long-Term Memory without Bistability

    Directory of Open Access Journals (Sweden)

    Paul Smolen

    2015-01-01

    Full Text Available Memories are stored, at least partly, as patterns of strong synapses. Given molecular turnover, how can synapses maintain strong for the years that memories can persist? Some models postulate that biochemical bistability maintains strong synapses. However, bistability should give a bimodal distribution of synaptic strength or weight, whereas current data show unimodal distributions for weights and for a correlated variable, dendritic spine volume. Thus it is important for models to simulate both unimodal distributions and long-term memory persistence. Here a model is developed that connects ongoing, competing processes of synaptic growth and weakening to stochastic processes of receptor insertion and removal in dendritic spines. The model simulates long-term (>1 yr persistence of groups of strong synapses. A unimodal weight distribution results. For stability of this distribution it proved essential to incorporate resource competition between synapses organized into small clusters. With competition, these clusters are stable for years. These simulations concur with recent data to support the “clustered plasticity hypothesis” which suggests clusters, rather than single synaptic contacts, may be a fundamental unit for storage of long-term memory. The model makes empirical predictions and may provide a framework to investigate mechanisms maintaining the balance between synaptic plasticity and stability of memory.

  5. Nutritional deficit and Long Term Potentiation alterations

    Directory of Open Access Journals (Sweden)

    M. Petrosino

    2009-01-01

    Full Text Available In the present work we examined the ability of prenatally malnourished offspring to produce and maintain long-term potentiation (LTP of the perforant path/dentate granule cell synapse in freely moving rats at 15,30, and 90 days of age. Population spike amplitude (PSA was calculated from dentate field potential recordings prior to and at 15, 30, 60 min. and 3, 5, 18 and 24 h following tetanization of the perforant pathway. All animals of both malnourished and well-nourished diet groups at 15 days of age showed potentiation of PSA measures but the measures obtained from 15-day-old prenatally malnourished animals were significantly less than that of age-matched, well-nourished controls. At 30 days of age, remarkable effect of tetanization was likely observed from PSA measures for this age group followed much the same pattern. At 90 days of age, PSA measures obtained from malnourished animals decreased from pretetanization levels immediately following tetanization. At this age, however, at three hours time recordings, this measure growing up to a level which did not differ significantly from that of the control group. These results indicate that the width of tetanization induced enhancement of dentate granule cell response in preweanling rats (15-day-old animals is signifacantly affected fromgestational protein malnutrition and this trend is kept in animals tested at 30 and 90 days of age. The fact, however, that considerable limitation in LTP generation was gained from prenatally malnourished animals at 90 days of age, implying that dietary rehabilitation starting at birth is an intervention strategy not capable to imbrove the effects of the gestational stress.

  6. A new long-term care manifesto.

    Science.gov (United States)

    Kane, Robert L

    2015-04-01

    This article argues for a fresh look at how we provide long-term care (LTC) for older persons. Essentially, LTC offers a compensatory service that responds to frailty. Policy debate around LTC centers on costs, but we are paying for something we really don't want. Building societal enthusiasm (or even support) for LTC will require re-inventing and re-branding. LTC has three basic components: personal care, housing, and health care (primarily chronic disease management). They can be delivered in a variety of settings. It is rare to find all three done well simultaneously. Personal care (PC) needs to be both competent and compassionate. Housing must provide at least minimal amenities and foster autonomy; when travel time for PC raises costs dramatically, some form of clustered housing may be needed. Health care must be proactive, aimed at preventing exacerbations of chronic disease and resultant hospitalizations. Enhancing preferences means allowing taking informed risks. Payment incentives should reward both quality of care and quality of life, but positive outcomes must be defined as slowing decline. Paying for services but not for housing under Medicaid would automatically level the playing field between nursing homes (NH) and community-based services. Regulations should achieve greater parity between NH and community care and include both positive and negative feedback. Providing post-acute care should be separate from LTC. Using the tripartite LTC framework, we can create innovative flexible approaches to providing needed services for frail older persons in formats that are both desirable and affordable. Such care will be more socially desirable and hence worth paying for.

  7. Hormonal changes during long-term isolation.

    Science.gov (United States)

    Custaud, M A; Belin de Chantemele, E; Larina, I M; Nichiporuk, I A; Grigoriev, A; Duvareille, M; Gharib, C; Gauquelin-Koch, G

    2004-05-01

    Confinement and inactivity induce considerable psychological and physiological modifications through social and sensory deprivation. The aim of the SFINCSS-99 experiment was to determine the cardiovascular and hormonal pattern of blood volume regulation during long-term isolation and confinement. Simulation experiments were performed in pressurized chambers similar in size to the volumes of modern space vehicles. Group I consisted of four Russian male volunteers, who spent 240 days in a 100-m(3 )chamber. Group II included four males (one German and three Russians) who spent 110 days in isolation (200-m(3) module). The blood samples, taken before, during and after the isolation period, were used to determine haematocrit (Ht), growth hormone (GH), active renin, aldosterone, and osmolality levels. From the urine samples, electrolytes, osmolality, nitrites, nitrates, cortisol, antidiuretic hormone (ADH), aldosterone, normetanephrine and metanephrine levels were determined. The increase in plasma volume (PV) that is associated with a tendency for a decrease in plasma active renin is likely to be due to decreased sympathetic activity, and concords with the changes in urinary catecholamine levels during confinement. Urinary catecholamine levels were significantly higher during the recovery period than during confinement. This suggests that the sympathoadrenal system was activated, and concords with the increase in heart rate. Vascular resistance is determined by not only the vasoconstrictor but also vasodilator systems. The ratio of nitrite/nitrate in urine, as an indicator of nitric oxide release, did not reveal any significant changes. Analysis of data suggests that the duration of the isolation was a main factor involved in the regulation of hormones.

  8. Perinatal respiratory infections and long term consequences

    Directory of Open Access Journals (Sweden)

    Luciana Indinnimeo

    2015-10-01

    Full Text Available Respiratory syncytial virus (RSV is the most important pathogen in the etiology of respiratory infections in early life. 50% of children are affected by RSV within the first year of age, and almost all children become infected within two years. Numerous retrospective and prospective studies linking RSV and chronic respiratory morbidity show that RSV bronchiolitis in infancy is followed by recurrent wheezing after the acute episod. According to some authors a greater risk of wheezing in children with a history of RSV bronchiolitis would be limited to childhood, while according to others this risk would be extended into adolescence and adulthood. To explain the relationship between RSV infection and the development of bronchial asthma or the clinical pathogenetic patterns related to a state of bronchial hyperreactivity, it has been suggested that RSV may cause alterations in the response of the immune system (immunogenic hypothesis, activating directly mast cells and basophils and changing the pattern of differentiation of immune cells present in the bronchial tree as receptors and inflammatory cytokines. It was also suggested that RSV infection can cause bronchial hyperreactivity altering nervous airway modulation, acting on nerve fibers present in the airways (neurogenic hypothesis.The benefits of passive immunoprophylaxis with palivizumab, which seems to represent an effective approach in reducing the sequelae of RSV infection in the short- and long-term period, strengthen the implementation of prevention programs with this drug, as recommended by the national guidelines of the Italian Society of Neonatology. Proceedings of the 11th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy · October 26th-31st, 2015 · From the womb to the adultGuest Editors: Vassilios Fanos (Cagliari, Italy, Michele Mussap (Genoa, Italy, Antonio Del Vecchio (Bari, Italy, Bo Sun (Shanghai, China, Dorret I. Boomsma (Amsterdam, the

  9. Current practices in long-term video-EEG monitoring services : A survey among partners of the E-PILEPSY pilot network of reference for refractory epilepsy and epilepsy surgery

    NARCIS (Netherlands)

    Kobulashvili, Teia; Höfler, Julia; Dobesberger, Judith; Ernst, Florian; Ryvlin, Philippe; Cross, J. Helen; Braun, Kees; Dimova, Petia; Francione, Stefano; Hecimovic, Hrvoje; Helmstaedter, Christoph; Kimiskidis, Vasilios K.; Lossius, Morten Ingvar; Malmgren, Kristina; Marusic, Petr; Steinhoff, Bernhard J.; Boon, Paul; Craiu, Dana; Delanty, Norman; Fabo, Daniel; Gil-Nagel, Antonio; Guekht, Alla; Hirsch, Edouard; Kalviainen, Reetta; Mameniskiené, Ruta; Özkara, Çiǧdem; Seeck, Margitta; Rubboli, Guido; Krsek, Pavel; Rheims, Sylvain; Trinka, Eugen

    2016-01-01

    Purpose The European Union-funded E-PILEPSY network aims to improve awareness of, and accessibility to, epilepsy surgery across Europe. In this study we assessed current clinical practices in epilepsy monitoring units (EMUs) in the participating centers. Method A 60-item web-based survey was distrib

  10. Catalytic heat exchangers - a long-term evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Silversand, Fredrik A. [CATATOR AB, Lund (Sweden)

    2003-10-01

    A long-term evaluation concerning catalytic heat exchangers (CHEs) has been performed. The idea concerning CHEs was originally described in a number of reports issued by Catator almost a decade ago. The general idea with CHEs is to combust a fuel with a catalyst inside a heat exchanger to enable an effective heat transfer. The first design approaches demonstrated the function and the possibilities with CHEs but were defective concerning the heat exchanger design. Consequently, a heat exchanger company (SWEP International AB), which was specialised on brazed plate-type heat exchangers, joined the continued development project. Indeed, the new design approach containing Catator's wire-mesh catalysts and SWEP's plate-type heat exchangers enabled us to improve the concept considerably. The new design complied with a number of relevant technical demands, e.g.: Simplicity; Compactness and integration (few parts); High thermal efficiency; Low pressure drop; Excellent emissions; High turn-down ratio; Reasonable production cost. Spurred by the technical progresses, the importance of a long-term test under realistic conditions was clear. A long-term evaluation was initialised at Sydkraft Gas premises in Aastorp. The CHE was installed on a specially designed rig to enable accelerated testing with respect to the number of transients. The rig was operated continuously for 5000 hours and emission mapping was carried out at certain time intervals. Following some problems during the initial phase of the long-term evaluation, which unfortunately also delayed the project, the results indicated very stable conditions of operation. The emissions have been rather constant during the course of the test and we cannot see any tendencies to decreased performances. Indeed, the test verifies the function, operability and reliability of the CHE-concept. Apart from domestic boilers we foresee a number of interesting and relevant applications in heating and process technology. Since

  11. General practice in the Nordic countries

    Directory of Open Access Journals (Sweden)

    Kim Rose Olsen

    2016-04-01

    Full Text Available Background: General practice systems in the Nordic countries share certain common features. The sector is based on the Nordic model of a tax-financed supply of services with a political objective of equal access for all. The countries also share the challenges of increased political expectations to deliver primary prevention and increased workload as patients from hospital care are discharged earlier. However, within this common framework, primary care is organized differently. This is particularly in relation to the private-public mix, remuneration systems and the use of financial and non-financial incentives. Objective: The objective of this paper is to compare the differences and similarities in primary care among the Nordic countries, to create a mapping of the future plans and reforms linked to remuneration and incentives schemes, and to discuss the pros and cons for these plans with reference to the literature. An additional objective is to identify gaps in the literature and future research opportunities. Results/Conclusions: Despite the many similarities within the Nordic health care systems, the primary care sectors function under highly different arrangements. Most important are the differences in the gate-keeping function, private versus salaried practices, possibilities for corporate ownership, skill-mix and the organisational structure. Current reforms and political agendas appear to focus on the side effects of the individual countries’ specific systems. For example, countries with salaried systems with geographical responsibility are introducing incentives for private practice and more choices for patients. Countries with systems largely based on private practice are introducing more monitoring and public regulation to control budgets. We also see that new governments tends to bring different views on the future organisation of primary care, which provide considerable political tension but few actual changes. Interestingly

  12. Paediatric vaccination practice in a division of general practice.

    Science.gov (United States)

    Cook, I F; Murtagh, J

    2001-12-01

    Currently the National Health and Medical Research Council (NH&MRC) recommend the use of a 23 gauge, 25 mm long needle inserted 45-60 degrees into the anterolateral thigh for paediatric vaccination. To assess the compliance of general practitioners (GPs) in a rural practice division with vaccination practice (site and needle size and gauge) prescribed for infants and toddlers by the NH&MRC. In 1999, a questionnaire survey was sent by the divisional office to all 150 GPs in the Hunter Rural Division of General Practice. The questionnaire collected demographic data (age, gender, university of graduation, number of paediatric vaccines administered per week) and elicited responses about the site of vaccination and the size and gauge of needle to be used for children 2-18 months and 18 months and older. Completed questionnaires were available from 112 GPs (74.6% completion rate). There was a high level of compliance with the NH&MRC proscription of buttock vaccination with only 4.3% and 4.1% of responses to the question of vaccination site at 2-18 months and 18 months and older respectively nominating this site. The anterolateral thigh was the favoured site for vaccination in children 2-18 months old (77.5% of responses) with the deltoid being the favoured site in children 18 months and older (59.2% of responses). There was a very low level of compliance with the NH&MRC recommended standard needle (23 gauge, 25 mm long, blue hub needle) (3.5% of responses). The orange hub needle (25 gauge, 16 mm long needle) was most favoured (48.7% of responses) with additional strong support for the 25 gauge, 25 mm long needle (40.2% of responses). In the Hunter Rural Division of General Practice there was good compliance with the NH&MRC's recommendations for site of vaccination, but not needle size and gauge to be used in infants and small children. Imprecise wording of these recommendations has created apparent uncertainty about the site of vaccination of children at 18 months of age.

  13. [Midazolam sedation in the general dental practice].

    Science.gov (United States)

    Bertens, J; Abraham-Inpijn, L; Meuwissen, P J

    1994-03-01

    The general dental practitioner is occasionally confronted with patients who, on the basis of psychological--and often somatic--criteria, are difficult to treat. Medicinal sedation in combination with anxiety reduction may be deemed appropriate for such patients. In the Netherlands inhalation sedation by means of a combination of oxygen and nitrous oxide is generally used. The limitations and disadvantages of this method have directed attention towards sedation by means of midazolam, a quick-acting benzodiazepine. In view of the complications which may accompany the administration of midazolam, the general practitioner working alone or in a group practice is advised against using midazolam sedation. Such use should be reserved for a dentist working in a hospital setting, who is able to consult with a physician regarding the advisability of administering midazolam. Even then, the safety of the patient requires that the practitioners have a proper insight into the physical state of the patient, work according to a protocol and in accordance with clearly defined responsibilities, and provide adequate accommodation during and after treatment.

  14. Possibility of "superfast" consolidation of long-term memory.

    Science.gov (United States)

    Podolski IYa

    1998-01-01

    Two new behavioural tests in rats are described which demonstrate the fast consolidation of the long-term memory (LTM) in a dangerous natural situation (water escape). It is shown that after one-trial learning of the motor skill (jumping out of the water), long-term memory traces are retained without forgetting and are resistant to the blockade of M-cholinoreceptors by scopolamine (2 mg/kg) and of D1/D2 dopamine receptors by haloperidol (10 mg/kg) as well as electroconvulsive shock applied tank wall, learning of necessary motor skills, automatization and minimization of the skilled movements in 1.5-3.0 min, after 5 to 7 trials at two-second intervals (superfast learning) is demonstrated. It is suggested that the superfast consolidation of LTM (several minutes) is possible in life-threatening situations, the necessary time being 1-2 orders of magnitude less than it is generally accepted in the modern theories of memory. The proposed behavioural models may be helpful in investigation of some fundamental physiological and molecular mechanisms of stable neuronal interactions, as a basis for LTM consolidation.

  15. Selective criteria for successful long-term prosthetic use.

    Science.gov (United States)

    Mueller, M J; Delitto, A

    1985-07-01

    The purpose of this study was to identify criteria contributing to successful long-term prosthetic use in patients with an amputation secondary to vascular disease. All elderly patients with a unilateral below-knee amputation or an above-knee amputation, secondary to vascular disease, seen in our clinic between 1977 and 1982 were included in this telephone survey. Of those contacted, 37 of 38 below-knee amputees (BKAs) and 7 of 18 above-knee amputees (AKAs) still wore their prostheses at least part of every day (success). We used a two-tailed chi-square to compare the success of the BKAs with the success of the AKAs. The BKAs were successful more often (X2 = 24.81, df = 1, p less than .001). All AKAs also were characterized according to age, time from prescription, obesity, ambulatory status, strength, range of motion, sex, general compliance, and medical problems after prosthetic prescription. Of these criteria, only compliance and medical problems after prescription showed a significant difference between successful and nonsuccessful long-term AKA prosthetic users (X2 = 5.76, df = 1, p less than .05 for each criterion). As the demands of quality assurance and diagnostic related groupings increase, these results can assist the physical therapy clinician in setting realistic goals for the geriatric amputee and help predict if the patient will be a successful prosthetic user.

  16. [Long term results of congenital middle ear cholesteatoma in children].

    Science.gov (United States)

    Benhammou, A; Nguyen, D-Q; El Makhloufi, K; Charachon, R; Reyt, E; Schmerber, S

    2005-06-01

    To report the long term results of congenital cholesteatoma of the middle ear in children. Retrospective study of thirty two children with 33 congenital cholesteatoma (1 bilateral cholesteatoma) operated on by the same surgeon. The mean age was 6 years. The most common clinical presentation was unilateral hearing loss. A trans-canal approach was performed in 4 cases and an intact canal wall technique in 29 cases. A two staged surgery was necessary in 28 patients, whom a residual cholesteatoma was observed in 7 patients. A third stage was performed in 11 patients because of a residual cholesteatoma in 2 two cases and a functional failure in 9 cases. At five years postoperative audiometry (air bone gap inferior or equal to 20 dB HL), a functional success was obtained in 50% of cases. The diagnosis of congenital cholesteatoma must be evoked in every atypical otitis media with effusion or unilateral transmission hypoacusis. The intact canal wall technique in two stages is the most appropriate treatment, since congenital cholesteatoma in children appears aggressive in a well pneumatized mastoid. The choice for an intact canal wall technique is also justified by the ambition of a conservative surgery in the young child. The functional results are generally satisfactory in early diagnosed cases. Thus, ENT and pediatric physicians have a unique role in detecting congenital cholesteatoma in the early period of life, and in ensuring a long term follow-up.

  17. Coaches’ Adoption and Implementation of Sport Canada’s Long-Term Athlete Development Model

    Directory of Open Access Journals (Sweden)

    Charlotte Beaudoin

    2015-07-01

    Full Text Available This work explores the adoption and implementation of Sport Canada’s long-term athlete development (LTAD model by coaches and tries to understand the barriers to and enablers of these processes. LTAD adoption was studied in 14 coaches (5 female, 9 male in seven sports while implementation was assessed among 10 different coaches (2 female, 8 male from nine sports. Semistructured interviews ascertained coaches’ perceptions of and experiences with the LTAD model in their coaching practice. Coaches adhered to the global vision and general principles of LTAD. However, several barriers to LTAD adoption and implementation were identified. A mismatch between the model’s long-term and the short-term visions of results in sport was perceived as deterrent to LTAD adoption and implementation. Coaches involved in early development sports mentioned a lack of compatibility of LTAD with the demands of their sport. Coaches also perceived complexity in LTAD athlete’s developmental stage determination and the identification of “windows of opportunity” or critical periods. These barriers should be addressed to complete diffusion of LTAD among Canadian coaches.

  18. Evaluation of the long-term sound reduction performance of resilient materials in floating floor systems

    Science.gov (United States)

    Lee, Jung-Yoon; Kim, Jong-Mun; Kim, Jinyoung; Kim, Jeongho

    2016-03-01

    Building multi-dwelling units is one of the practical engineering solutions to housing shortage in urban areas with high population density. However, noise from upstairs is a major issue. The use of resilient materials in floating floor structures is recognized as an effective method to reduce such noise. In general, soft materials are considered as better resilient materials due to their superior performance in impact sound reduction. However, it is often overlooked that the sound reduction performance of soft resilient materials is susceptible to being degraded over time when subjected to a long-term load. In this study, the long-term performance of eight resilient materials is evaluated by monitoring their dynamic stiffness for 270 days under the two sustained load conditions: 250 N and 500 N. According to the experimental study, the dynamic stiffness increases consistently with loading time for all resilient materials. This leads to a decrease in the sound reduction performance. More rapid reduction in the dynamic stiffness and hence in the sound reduction performance is observed when a larger sustained load is applied. A greater decrease in the sound reduction performance is found in soft resilient materials.

  19. Novel dry polymer foam electrodes for long-term EEG measurement.

    Science.gov (United States)

    Lin, Chin-Teng; Liao, Lun-De; Liu, Yu-Hang; Wang, I-Jan; Lin, Bor-Shyh; Chang, Jyh-Yeong

    2011-05-01

    A novel dry foam-based electrode for long-term EEG measurement was proposed in this study. In general, the conventional wet electrodes are most frequently used for EEG measurement. However, they require skin preparation and conduction gels to reduce the skin-electrode contact impedance. The aforementioned procedures when wet electrodes were used usually make trouble to users easily. In order to overcome the aforesaid issues, a novel dry foam electrode, fabricated by electrically conductive polymer foam covered by a conductive fabric, was proposed. By using conductive fabric, which provides partly polarizable electric characteristic, our dry foam electrode exhibits both polarization and conductivity, and can be used to measure biopotentials without skin preparation and conduction gel. In addition, the foam substrate of our dry electrode allows a high geometric conformity between the electrode and irregular scalp surface to maintain low skin-electrode interface impedance, even under motion. The experimental results presented that the dry foam electrode performs better for long-term EEG measurement, and is practicable for daily life applications.

  20. Improving infection control in general practice.

    Science.gov (United States)

    Farrow, S C; Zeuner, D; Hall, C

    1999-03-01

    Infection control measures in the health care setting should protect patients and staff from cross-infection. The prevention of harm is an essential part of good medical practice and failure might result in professional misconduct proceedings by the General Medical Council (GMC) and prosecution under the Health and Safety at Work legislation, as well as civil liability. For a health authority, overall responsibility for public health includes arrangements for the control of communicable diseases and infection in hospital and the community (NHS Management Executive, 1993), a function usually led by the Consultant in Communicable Disease Control (CCDC). This paper describes one district's collaborative approach between public health and GPs to assess and improve local infection control standards.

  1. Discontinuation of Preventive Drugs in General Practice

    DEFF Research Database (Denmark)

    Andersen, John Sahl; Lindberg, Laura Maria Glahder; Nixon, Michael Simon

    the most preventive drugs are prescribed in general practice. Special considerations exist in relation to medication of elderly patients. The prevalence of polypharmacy and the subsequent increased risk of side effects and drug interactions is high. Drug-related problems represent the fifth leading cause...... of death in the United States. The public expenses to drug treatment are constantly increasing. The possibility to withdraw the medication must be taken into account but the decision to discontinue drugs is complex and poorly understood. Planned studies: 1. Patients’ views upon discontinuation...... of preventive drugs. Qualitative interviews with patients experiencing discontinuation of preventive drugs addressing: Which attitudes do the patients have towards preventive drugs? Which thoughts do the patients have in relation to discontinuation of the drugs? How do they understand their own and the GP...

  2. An approach to vertigo in general practice.

    Science.gov (United States)

    Dommaraju, Sindhu; Perera, Eshini

    2016-04-01

    Dizziness is a common and very distressing presentation in general practice. In more than half of these cases, the dizziness is due to vertigo, which is the illusion of movement of the body or its surroundings. It can have central or peripheral causes, and determining the cause can be difficult. The aim of this article is to provide a clear framework for approaching patients who present with vertigo. A suggested approach to the assessment of vertigo is outlined. The causes of vertigo may be central (involving the brainstem or cerebellum) or peripheral (involving the inner ear). A careful history and physical examination can distinguish between these causes. The most common causes of vertigo seen in primary care are benign paroxysmal positional vertigo (BPPV), vestibular neuronitis (VN) and Ménière's disease. These peripheral causes of vertigo are benign, and treatment involves reassurance and management of symptoms.

  3. Rating scales in general practice depression

    DEFF Research Database (Denmark)

    Bech, Per; Paykel, Eugene; Sireling, Lester

    2015-01-01

    within major depressive disorder. The CID was compared to the Hamilton Depression Rating Scale (HAM-D17). METHODS: 146 patients from a previous study in general practice with the CID were investigated. The item response theory model established by Rasch was used to investigate the scalability (a scale......׳s psychometric adequacy) of the subscales, and principal component analysis was used to identify subsyndromes with the symptoms of major depression according to DSM-5 or ICD-10. RESULTS: Whereas the HAM-D17 was found not to have an acceptable scalability, the three brief CID subscales for depression (six items......), anxiety (five items), and apathy (five items) all had an acceptable scalability. Within the major depressive symptoms, principal component analysis identified the CID items of hypersomnia, increased appetite or weight gain as defining the subsyndrome of atypical depression. In total 29 patients...

  4. LOP- LONG-TERM ORBIT PREDICTOR

    Science.gov (United States)

    Kwok, J. H.

    1994-01-01

    The Long-Term Orbit Predictor (LOP) trajectory propagation program is a useful tool in lifetime analysis of orbiting spacecraft. LOP is suitable for studying planetary orbit missions with reconnaissance (flyby) and exploratory (mapping) trajectories. Sample data is included for a geosynchronous station drift cycle study, a Venus radar mapping strategy, a frozen orbit about Mars, and a repeat ground trace orbit. LOP uses the variation-of-parameters method in formulating the equations of motion. Terms involving the mean anomaly are removed from numerical integrations so that large step sizes, on the order of days, are possible. Consequently, LOP executes much faster than programs based on Cowell's method, such as the companion program ASAP (the Artificial Satellite Analysis Program, NPO-17522, also available through COSMIC). The program uses a force model with a gravity field of up to 21 by 21, lunisolar perturbation, drag, and solar radiation pressure. The input includes classical orbital elements (either mean or oscillating), orbital elements of the sun relative to the planet, reference time and dates, drag coefficients, gravitational constants, planet radius, rotation rate. The printed output contains the classical elements for each time step or event step, and additional orbital data such as true anomaly, eccentric anomaly, latitude, longitude, periapsis altitude, and the rate of change per day of certain elements. Selected output is additionally written to a plot file for postprocessing by the user. LOP is written in FORTRAN 77 for batch execution on IBM PC compatibles running MS-DOS with a minimum of 256K RAM. Recompiling the source requires the Lahey F77 v2.2 compiler. The LOP package includes examples that use LOTUS 1-2-3 for graphical displays, but any graphics software package should be able to handle the ASCII plot file. The program is available on two 5.25 inch 360K MS-DOS format diskettes. The program was written in 1986 and last updated in 1989. LOP is

  5. Northern European long term climate archives

    Energy Technology Data Exchange (ETDEWEB)

    Hohl, Veronica [Stockholm Univ. (Sweden)

    2005-01-01

    The Swedish Nuclear Fuel and Waste Management Company is responsible for the management and disposal of Sweden's radioactive waste. It is intended to deposit the spent nuclear fuel in a deep geological repository. This repository shall keep the radiotoxic material separated from humans and the environment for extended periods, from decades to millennia and possibly to geological timescales. During this time perspective climate induced changes such as shore-level displacement and evolution of permafrost and ice sheets are expected to occur which may affect the repository. The possible occurrence, extent and duration of these long-term changes, are therefore of interest when considering the assessment of repository performance and safety. The main climate parameters determining both surface and subsurface conditions are temperature and precipitation. As a result of the last advance of the Weichselian ice sheet only few geological archives exist, which contain information on past climatic conditions in Sweden before c 16,000 years BP. The purpose of this literature review is to compile and evaluate available information from Scandinavian, Northern and Central European geological archives, which record climatic conditions during the Weichselian time period. The compilation provides paleotemperature data sets, which may be used to explore the possible evolution of periglacial permafrost in Sweden. This report is a synopsis of 22 publications detailing climatic and environmental changes during the Weichselian time period in Northwestern Europe based on quantified paleotemperature records. Some of the data is presented as temperature curves which were digitised specifically for this report. The time range covered by the different publications varies considerably. Only few authors dealt with the whole Weichselian period and the majority cover only a few thousand years. This however is not considered to influence the reliability of the archives. The reason for the

  6. Oncology nurses′ recognition of long-term cancer survivorship care in Japan

    Directory of Open Access Journals (Sweden)

    Asako Miura

    2015-01-01

    Full Text Available Objective: This study aims to assess the knowledge of definition of cancer survivors among Japanese oncology nurses and their roles in long-term cancer survivorship care. Methods: A structured self-administered and self-report questionnaire created by the study investigators was given to members of the Japanese Society of Cancer Nursing. The subjects were 81 female oncology nurses. Results: Forty-nine nurses had 11 or more years of nursing experience, while 27 nurses had cancer-related nursing certifications such as, certification in oncology nursing specialist. This study population had rather rich experience in oncology nursing. Sixty-two nurses defined a cancer survivor from the time of diagnosis, while the nurses′ recognition of long-term survivorship care was poor, compared with nursing care at the time of diagnosis, during treatment, and end of life. Conclusions: The nurses were aware of the needs to recognize and address issues faced by long-term cancer survivors and for nursing study, but very few put the effective patient education and interventions into practice. It is because oncology nurses have few chances to see cancer survivors who go out of the hands of healthcare professionals. In increasing the number of long-term survivors, long-term survivorship care is needed in addition to incorporating such education into undergraduate and graduate programs. Further study on the knowledge of long-term cancer survivorship care and nursing practices are required.

  7. Long-term meditation is associated with increased gray matter density in the brain stem

    DEFF Research Database (Denmark)

    Vestergaard-Poulsen, Peter; Beek, Martijn van; Skewes, Joshua

    2009-01-01

    Extensive practice involving sustained attention can lead to changes in brain structure. Here, we report evidence of structural differences in the lower brainstem of participants engaged in the long-term practice of meditation. Using magnetic resonance imaging, we observed higher gray matter...... density in lower brain stem regions of experienced meditators compared with age-matched nonmeditators. Our findings show that long-term practitioners of meditation have structural differences in brainstem regions concerned with cardiorespiratory control. This could account for some...... of the cardiorespiratory parasympathetic effects and traits, as well as the cognitive, emotional, and immunoreactive impact reported in several studies of different meditation practices....

  8. Long-term induced agricultural intensification in China

    DEFF Research Database (Denmark)

    Teng, Shuqing; Svenning, Jens-Christian

    2016-01-01

    a prediction that matches long-term dynamics of agricultural intensification in history? Using historical land-use data spanning two thousand years, this study estimated the dynamic trajectories of four cultivation practices with different intensive levels in a part of China and assessed the three theories......Understanding the dynamics of agricultural intensification has great implications for biodiversity conservation faced with increasing human population and food demand. How agricultural intensification evolves with human population growth is differently described by three theories, namely......, the Boserupian, Malthusian and induced intensification theories. The Malthusian theory suggests quick adoption of available techniques that increase human population, while the other two share one viewpoint that increased intensive level of agriculture is passively induced by population growth. Which theory has...

  9. Long-term experiences with pluvial flood risk management

    Directory of Open Access Journals (Sweden)

    Fritsch Kathrina

    2016-01-01

    Full Text Available The awareness of pluvial (rain-related flood risk has grown significantly in the past few years but pluvial flooding is not handled with the same intensity throughout Europe. A variety of methods and modelling technologies are used to assess pluvial flood hazard and risk and to develop suggestions for flood mitigation measures. A brief overview of current model approaches is followed by the description of a modelling methodology that has been developed throughout the last 15 years with the focus on processing large scale areas. Experiences from several projects show that only high quality models of whole catchment areas yield results with enough accuracy to gain credibility among stakeholders, planners and the public. As a best practice example shows, the model approach also helps to plan effective decentral flood protection measures. To ensure successful flood risk management, a long-term preservation of flood risk awareness among local authorities and the public is necessary.

  10. Minimal intervention dentistry II: part 2. Management of caries and periodontal risks in general dental practice.

    Science.gov (United States)

    Lallam, C; Decup, F

    2014-02-01

    The long-term clinical management of caries and periodontal diseases requires a double approach, one that is concerned with both treatment and prevention. Dentists should recognise the risk factors and their likely triggers to be able to implement the right strategy as early as the diagnostic phase. This comprehensive assessment can easily be done in general practice. All it takes is to combine the patient's general information with the systemic and behavioural factors, and the clinical observations with the local factors. The resulting patient profile can thus effectively support treatment by providing the necessary explanations, advice or prescriptions in relation with the clinical procedures. The modifiable risk factors need to be monitored and the behaviours changed to stabilise or limit disease progression. The practitioner's active approach is meant to meet the patient's demand for preventive counselling.

  11. [Long-term morbidity of living donor kidney harvesting].

    Science.gov (United States)

    Gres, Pascal; Avances, Christophe; Iborra, François; Mourad, Georges; Guiter, Jacques

    2007-04-01

    To evaluate the morbidity of living donor kidney harvesting and the long-term medical consequences and impact on quality of life (QoL). Retrospective analysis of medical and surgical data for 114 living kidney donors in a single teaching hospital between 1977 and 2005. Complications were evaluated in relation to the surgical approach and body mass index (BMI) using a Chi-square test or Fisher's exact test. Changes in renal function (serum creatinine, creatinine clearance), proteinuria and blood pressure (BP) were studied by Student's t test or a Mann-Whitney U or Wilcoxon nonparametric test. Long-term QoL was evaluated by the MOS SF-36 questionnaire and a local questionnaire and was then compared to that of the French general population. The median follow-up was 63 months. The morbidity of kidney harvesting was significantly correlated with the surgical approach (p = 0.018) and a BMI > or = 25 kg/m2 (p = 0.014). No mortality was observed in this series. A moderate elevation of serum creatinine was observed during follow-up (mean serum creatinine increased from 82.2 micromol/l [+/- 16.3] to 104.5 micromol/l [+/- 19.9]), and mean creatinine clearance decreased from 113.4 ml/min [+/- 27.6] to 76 ml/min [+/- 29.9]. Little impact was observed on proteinuria and BP and QoL was not altered by kidney harvesting. The perioperative complication rate is correlated with BMI and a flank incision. Kidney harvesting lowers glomerular filtration, but clearance remained stable during follow-up. Macroalbuminuria or hypertension may be observed, but their frequency is not higher than in the general population. The QoL of living donors is not altered. Clear information for the general public would allow promotion of living donor transplantation.

  12. [Long-term results of percutaneous transluminal angioplasty of the iliac arteries].

    Science.gov (United States)

    Carlier, C; Foucart, H; Baudrillard, J C; Joffre, F; Cécile, J P

    1990-01-01

    A well-mastered technique will cause percutaneous transluminal angioplasty of iliac arteries to achieve long-term results comparable to those obtained surgically. In isolated iliac stenosis, a 95% good result rate is attained (81% cured, 14% improved). More complex cases of iliac stenosis yield 90% good results (72% cure), with a mean Doppler ankle/arm pressure index gain of 0.5 point in a series including 673 patients at 5 years follow-up. Only the presence of combined distal femoral lesions may cause the good result score to drop to 85%, including merely 35% cure. General complications are practically lacking and local complications are minimal, which incites one to propose this technique as a first-line treatment of iliac stenosis whenever distal blood circulation is maintained.

  13. Long-term experience with (laterally) extended endopelvic resection (LEER) in relapsed pelvic malignancies.

    Science.gov (United States)

    Höckel, Michael

    2015-03-01

    Gynecologic cancers recurring in the pelvis are generally advanced in malignant progression limiting curative treatment approaches. The cancer field theory links cancer progression to reversed morphogenesis and allows the exact anatomical delineation of the cancer field, i.e., the tissue compartment of potential tumor infiltration related to the tumor's ontogenetic stage. Cancer surgery is redefined with the resection of ontogenetic stage-related cancer fields instead of the mere removal of the malignant tumor with an uninvolved tissue margin. Most gynecologic pelvic malignancies recurring in the pelvis represent ontogenetic stages 3 and 4. (Laterally) extended endopelvic resection ((L)EER) has been designed to resect the cancer fields of gynecologic tumors in these advanced ontogenetic stages. This paper reports long-term experience with (L)EER for relapsed pelvic malignancies strongly supporting the cancer field theory and the principle and practice of cancer field resection.

  14. Residential long-term care capacity planning: the shortcomings of ratio-based forecasts.

    Science.gov (United States)

    Zhang, Yue; Puterman, Martin L; Atkins, Derek

    2012-05-01

    This paper uses observations from two British Columbia studies to illustrate the shortcomings of widely used ratio-based approaches for residential long-term care capacity planning. It shows that capacity plans based on a fixed ratio of beds per population over age 75 may result in either excess capacity or long wait times for admission. It then investigates the use of linear regression models to obtain a "best" ratio by relating optimal plans derived by rigorous analytical methods to population characteristics and shows that no single ratio applies broadly. While the use of regression is promising, finding these "best" ratios is too analytically complex for general practice. The paper concludes by providing and evaluating an easy-to-use planning method, which we call the average flow model (AFM). The AFM combines demand forecasts with length-of-stay estimates to produce enhanced capacity plans. The AFM is transparent, easily implemented in a spreadsheet and well suited for "what if?" analyses.

  15. The psychophysics of transition to long term care.

    Science.gov (United States)

    Miles, Richard W

    2013-02-01

    More than a decade after the publication of To Err Is Human, cognitive error remains a mystery to physicians. Competent and conscientious physicians rarely recall making a single cognitive error, yet this must be central to the explanation for inappropriate physician nonadherence to evidence-based guidelines. Published information regarding cognitive error in the medical literature is scarce and widely scattered. We do know that cognitive error is induced by complexity, duress, and uncertainty, conditions that regularly confront long term care physicians when they assume care of a new patient at the skilled nursing facility. Negative attitudes and low expectations of care are common among new patients and families. This is compounded when care is assumed by an unfamiliar physician. The initial disquiet and negative misconceptions of patients and families regularly make the transition one of the most error-prone events in medical practice. On the brighter side, the transition provides an excellent opportunity to study cognitive error. Cognitive errors at transition typically begin with a decision to avoid mention of necessary changes to flawed treatment plans already in effect. This is done as a temporary measure to avoid further stressing the patient and family. But what appears to be an ideal compromise is a risky option and should be avoided. Evading the issue introduces long-term risk to the patient. In addition, although it is seldom acknowledged, evading change often has a negative impact on local standards of care. Five cognitive principles are presented as root causes of cognitive error. Six contextual factors are identified that are endemic to nursing home practice, making the physician even more error prone. Because mistrust is central to dysfunctional decision making at the transition, strategies are presented to expedite gaining trust. This article makes the case for adding training in the cognitive psychology of medical decision making to core

  16. Backcasting long-term climate data: evaluation of hypothesis

    Science.gov (United States)

    Saghafian, Bahram; Aghbalaghi, Sara Ghasemi; Nasseri, Mohsen

    2017-04-01

    Most often than not, incomplete datasets or short-term recorded data in vast regions impedes reliable climate and water studies. Various methods, such as simple correlation with stations having long-term time series, are practiced to infill or extend the period of observation at stations with missing or short-term data. In the current paper and for the first time, the hypothesis on the feasibility of extending the downscaling concept to backcast local observation records using large-scale atmospheric predictors is examined. Backcasting is coined here to contrast forecasting/projection; the former is implied to reconstruct in the past, while the latter represents projection in the future. To assess our hypotheses, daily and monthly statistical downscaling models were employed to reconstruct past precipitation data and lengthen the data period. Urmia and Tabriz synoptic stations, located in northwestern Iran, constituted two case study stations. SDSM and data-mining downscaling model (DMDM) daily as well as the group method of data handling (GMDH) and model tree (Mp5) monthly downscaling models were trained with National Center for Environmental Prediction (NCEP) data. After training, reconstructed precipitation data of the past was validated against observed data. Then, the data was fully extended to the 1948 to 2009 period corresponding to available NCEP data period. The results showed that DMDM performed superior in generation of monthly average precipitation compared with the SDSM, Mp5, and GMDH models, although none of the models could preserve the monthly variance. This overall confirms practical value of the proposed approach in extension of the past historic data, particularly for long-term climatological and water budget studies.

  17. Long-term runoff forecasting by combining hydrological models and meteorological records

    Science.gov (United States)

    Yang, Tao-Chang; Yu, Pao-Shan; Chen, Chiang-Chi

    2005-06-01

    Reservoir operation is generally based on the inflows of the upstream catchment of the reservoir. If the arriving inflows can be forecasted, that can benefit reservoir operation and management. This study attempts to construct a long-term inflow-forecasting model by combining a continuous rainfall-runoff model with the long-term weather outlook from the Central Weather Bureau of Taiwan. The analytical results demonstrate that the continuous rainfall-runoff model has good inflow simulation performance by using 10-day meteorological and inflow records over a 33-year period for model calibration and verification. The long-term inflow forecasting during the dry season was further conducted by combining the continuous rainfall-runoff model and the long-term weather outlook, which was found to have good performance.

  18. Integrated Clinical Geriatric Pharmacy Clerkship in Long Term, Acute and Ambulatory Care.

    Science.gov (United States)

    Polo, Isabel; And Others

    1994-01-01

    A clinical geriatric pharmacy clerkship containing three separate practice areas (long-term, acute, and ambulatory care) is described. The program follows the medical education clerkship protocol, with a clinical pharmacy specialist, pharmacy practice resident, and student. Participation in medical rounds, interdisciplinary conferences, and…

  19. Factors influencing long-term survival after aortic valve replacement.

    Directory of Open Access Journals (Sweden)

    Shigenobu,Masaharu

    1980-06-01

    Full Text Available In the aortic stenosis group, the left ventricular (LV muscle mass index was a good parameter for predicting the prognosis. Associated mitral valve disease had no influence on long term survival after aortic valve replacement. In the aortic insufficiency group, associated mitral valve disease had a marked influence on the results of aortic valve replacement. In general, the aortic insufficiency group had less clinical improvement postoperatively than the aortic stenosis group. In the annuloaortic ectasia group, left ventricular enddiastolic pressure (LVEDP might be the predictor to the prognosis. This group had the worst prognosis, of the three groups. Early operation should be considered for patients who have no, or only mild symptoms of, aortic valve disease.

  20. A portable chemotaxis platform for short and long term analysis.

    Directory of Open Access Journals (Sweden)

    Chenjie Xu

    Full Text Available Flow-based microfluidic systems have been widely utilized for cell migration studies given their ability to generate versatile and precisely defined chemical gradients and to permit direct visualization of migrating cells. Nonetheless, the general need for bulky peripherals such as mechanical pumps and tubing and the complicated setup procedures significantly limit the widespread use of these microfluidic systems for cell migration studies. Here we present a simple method to power microfluidic devices for chemotaxis assays using the commercially available ALZET® osmotic pumps. Specifically, we developed a standalone chemotaxis platform that has the same footprint as a multiwell plate and can generate well-defined, stable chemical gradients continuously for up to 7 days. Using this platform, we validated the short-term (24 hours and long-term (72 hours concentration dependent PDGF-BB chemotaxis response of human bone marrow derived mesenchymal stem cells.

  1. Long term context for recent drought in northwestern Africa

    Science.gov (United States)

    Touchan, Ramzi; Anchukaitis, Kevin J.; Meko, David M.; Attalah, Said; Baisan, Christopher; Aloui, Ali

    2008-07-01

    Anthropogenic climate change is projected to exacerbate midlatitude aridity. Here, we analyze newly developed multi-century tree-ring records for a long-term perspective on drought in Tunisia and Algeria. We use a new set of 13 Cedrus atlantica and Pinus halepensis chronologies with a strong signal for warm-season drought (May-August) to generate a robust, well-validated reconstruction of the Palmer Drought Severity Index (PDSI) for the period AD 1456-2002. Key features of the reconstruction reveal the magnitude of pre-instrumental droughts from the historic record. Remarkably, the most recent drought (1999-2002) appears to be the worst since at least the middle of the 15th century. This drought is consistent with the early signature of a transition to more arid midlatitude conditions, as projected by general circulation models.

  2. Sex differences among recipients of benzodiazepines in Dutch general practice.

    NARCIS (Netherlands)

    Waals, F.W. van der; Mohrs, J.; Foets, M.

    1993-01-01

    Objective: To analyse sex differences among recipients of benzodiazepines in Dutch general practice. Design-Study of consultations and associated interventions as recorded in the Dutch national survey of general practice. Setting: Practices of 45 general practitioners monitored during 1 April to 30

  3. Evaluation of long-term patient satisfaction and experience with the Baha(®) bone conduction implant

    DEFF Research Database (Denmark)

    Olsen, Steen Østergaard; Nielsen, Lars Holme; Rasmussen, Jacob

    2012-01-01

    Objective: Evaluate long-term patient satisfaction with bone-anchored hearing aids (the Baha(R), now referred to by Cochlear as a 'bone conduction implant') in our hospital clinic spanning the eighteen-year period from the inception of our Baha program. The researchers further wished to analyse...... the various factors leading to patient satisfaction/dissatisfaction with their Baha. We developed a new questionnaire to obtain a comprehensive impression of individual patient practices, general satisfaction, and experiences with their Baha in respect to time spent using Baha, sound quality, annoyance from...

  4. Long term behaviour of singularly perturbed parabolic degenerated equation

    Directory of Open Access Journals (Sweden)

    Ibrahima Faye

    2016-12-01

    Full Text Available In this paper we consider models built in [4] for short-term, mean-term and long-term morphodynamics of dunes and megariples. We give an existence and uniqueness result for long term dynamics of dunes. This result is based on a periodic-in-time-and-space solution existence result for degenerated parabolic equation that we set out. Finally the mean-term and long-term models are homogenized.

  5. CHARACTERISTICS OF LONG-TERM UNEMPLOYMENT SPELLS IN ROMANIA

    Directory of Open Access Journals (Sweden)

    Daniela-Emanuela Dănăcică

    2012-12-01

    Full Text Available The aim of this paper is to analyze characteristics of long-term unemployment spells in Romania and to estimate the effect of factors influencing long-term unemployment spells. The study period is in between January 1st 2008 and December 31st 2010. 468159 long-term spells registered in the specified period at the National Agency of Employment are analyzed.

  6. Quantification of long term emission potential from landfills

    OpenAIRE

    Heimovaara, T.J.

    2011-01-01

    Novel approaches for the after-care of Municipal Solid Waste (MSW) landfills are based on technological measures to reduce the long term emission potential in a short time period. Biological degradation in landfills is a means to significantly reduce the long term emission potential. Leachate emission to the groundwater is considered to be one of the largest long-term impacts related to landfilling. Currently we are starting up a research program, partly subsidized by the Dutch Technology fou...

  7. A cost of long-term memory in Drosophila

    OpenAIRE

    Mery, Frederic; Kawecki, Tadeusz J.

    2005-01-01

    Two distinct forms of consolidated associative memory are known in Drosophila: long-term memory and so-called anesthesia-resistant memory. Long-term memory is more stable, but unlike anesthesia-resistant memory, its formation requires protein synthesis. We show that flies induced to form long-term memory become more susceptible to extreme stress (such as desiccation). In contrast, induction of anesthesia-resistant memory had no detectable effect on desiccation resistance. This finding may hel...

  8. Long term behaviour of singularly perturbed parabolic degenerated equation

    CERN Document Server

    Faye, Ibrahima; Seck, Diaraf

    2011-01-01

    In this paper we consider models for short-term, mean-term and long-term morphodynamics of dunes and megariples. We give an existence and uniqueness result for long term dynamics of dunes. This result is based on a time-space periodic solution existence result for degenerated parabolic equation that we set out. Finally the mean-term and long-term models are homogenized.

  9. Short-term cognitive-behavioral therapy for binge eating disorder: long-term efficacy and predictors of long-term treatment success.

    Science.gov (United States)

    Fischer, Sophia; Meyer, Andrea H; Dremmel, Daniela; Schlup, Barbara; Munsch, Simone

    2014-07-01

    The present study evaluates the long-term efficacy (four years after treatment) of a short-term Cognitive-Behavioral Treatment (CBT) of Binge Eating Disorder (BED). We examined patient characteristics, mostly measured at the end of treatment, for their predictive value of long-term success. Forty-one BED-patients between 18 and 70 years took part in a randomized controlled trial (RCT) for a short-term treatment and were evaluated until 4 years after treatment. Assessments comprised structured interviews on comorbid mental disorder/eating disorder pathology and questionnaires on eating disorder pathology/general psychopathology. BED core symptoms and associated psychopathology improved substantially during treatment phase and further improved or at least remained stable during the follow-up period. End of treatment predictors for long term success were elevated weight and eating concern and higher frequency of objective binges. Tailoring additional interventions to patients' individual needs could further improve treatment efficacy.

  10. Patients' adherence to hard acrylic interocclusal appliance treatment in general dental practice in Sweden.

    Science.gov (United States)

    Lindfors, Erik; Helkimo, Martti; Magnusson, Tomas

    2011-01-01

    The aims of the present study were to investigate patient adherence to treatment with hard acrylic interocclusal appliance in general dentistry in Sweden and to see if some general factors could predict patient adherence or non-adherence. During the period January - May 2009 a postal questionnaire was sent to all adult patients (> or = 20 years of age) that had received a hard acrylic interocclusal appliance from the public dental health service in the County of Uppsala during 2007 (n=388). The same questionnaire was also sent to all adult patients that had received a hard acrylic interocclusal appliance at a specialist clinic during the same year (n=69). The response rate in general dental practice was 71% and at the specialist clinic the response rate was 91%. In general dental practice, 97% of the hard acrylic interocclusal appliances were stabilisation appliances. At the specialist clinic other types of interocclusal appliances was used to a greater extent. A vast majority of patients in both general dental practice and at the specialist clinic experienced that the interocclusal appliance had a positive treatment effect. In general dental practice, 73% of the patients still used their interocclusal appliances 1 1/2-2 years after they had received them. The corresponding figure at the specialist clinic was 54%. The main reasons for not using the interocclusal appliance, besides disappearance/reduction of TMD symptoms, were different kinds of comfort problems. From the results of this study it is concluded that the patient adherence to hard acrylic stabilisation appliances made in general dental practice in Sweden is good. It can also be concluded that a perceived good treatment effect, as well as treatment of more long-term conditions, predicted a better patient adherence to hard acrylic stabilisation appliances. More studies concerning factors affecting patient adherence in TMD therapy are warranted.

  11. Consider long-term care as service alternative.

    Science.gov (United States)

    Loria, L S

    1987-04-01

    The increasing demand for elderly care services, pressures on inpatient average length of stay and payment levels, and potential financial rewards from providing additional services, makes long-term care look attractive to hospitals. Long-term care, however, is not for every hospital. Before deciding to establish long-term care services, management should examine how the service fits within the hospital's strategic plan. The action plan below provides guidance in evaluating a decision to use hospital facilities for long-term care. Examine how long-term care services fit within the hospital's strategic plan. Study area demographics and competitors to assess the need and supply of long-term care services. Survey the medical staff, consumers and payers to determine attitudes, perceptions and interests regarding long-term care services. Develop a facility plan that identifies areas of excess capacity that can be most easily converted into long-term care with minimal effects on hospital operations. Prepare a financial feasibility analysis of the contribution margin and return on investment attributable to long-term care services. Include an impact analysis on hospital operations. Establish a management task force to develop a detailed implementation plan including assigned individual responsibilities and related timetable. Develop an effective marketing plan designed to generate increased patient market share.

  12. Hydrodilatation (distension arthrography): a long-term clinical outcome series

    National Research Council Canada - National Science Library

    Watson, Lyn; Bialocerkowski, Andrea; Dalziel, Rodney; Balster, Simon; Burke, Frank; Finch, Caroline

    2007-01-01

    To describe and compare the medium to long-term effectiveness of hydrodilatation and post-hydrodilatation physiotherapy in patients with primary and secondary glenohumeral joint contracture associated...

  13. Unemployment and Long-Term Unemployment of Immigrants in Croatia

    Directory of Open Access Journals (Sweden)

    Valerija Botrić

    2016-04-01

    share of immigrants without prior working experience decreased in the crisis year, also regardless of the duration of their unemployment. Both factors indicate more active search in the crisis period and suggest demand constraints on the labour market, which has affected both the domicile and immigrant population. In order to determine significant predictors of very long-term in comparison to short-term unemployment, the same empirical strategy has been applied. The analysis for the 2007 (pre-crisis year has identified the following significant predictors of long-term unemployment status for immigrants in Croatia, listed in the decreasing marginal effects order: positive predictors: lower secondary education (in comparison to upper-secondary education, persons older than 55 and persons in the 45‒54 age cohort (in comparison to the reference 35‒44 age cohort. The analysis for the 2012 (crisis year has identified the following significant predictors of long-term unemployment status for immigrants in Croatia, listed in the decreasing marginal effects order: positive predictors: persons without prior working experience and persons older than 55 (in comparison to the reference age cohort; negative predictors: age cohorts 15‒24 and 25‒34 (in comparison to the reference age cohort, being married or cohabitating, male persons. Comparing the results for 2007 and 2012 it seems obvious that the most important difference is related to first-time job seekers. The crisis has created a population without previous working experience that has become long-term unemployed. Since the long-term unemployed are, in general, considered by employers as persons with lower employability, this is a serious issue that deserves policy actions. When considering future policy actions related to immigration, results for the most recent year are more important. The analysis in the paper has shown that certain occupations (elementary occupations, services and sales workers, crafts and related

  14. Desensitization to Oxcarbazepine: Long-Term Efficacy and Tolerability

    Science.gov (United States)

    Lee, Jiwon; Park, Eu Gene; Lee, Munhyang

    2017-01-01

    Background and Purpose Antiepileptic drug (AED)-associated cutaneous adverse drug reactions can lead to the discontinuation of medications. The aim of this study was to determine the long-term efficacy and safety of performing desensitization to oxcarbazepine. Methods This study involved 20 patients who exhibited cutaneous adverse drug reactions associated with oxcarbazepine use between July 2009 and March 2016 at Samsung Medical Center. All of the participants had to discontinue oxcarbazepine despite presenting initially positive responses. Human leukocyte antigen genotyping was performed to detect the genetic predisposition to Stevens-Johnson syndrome. The desensitization to oxcarbazepine was performed with a starting dosage of 0.1 mg/day. Efficacy was evaluated by comparing the frequency of seizures before and at 1 and 3 years after desensitization. Adverse events occurring during desensitization and the retention rate after desensitization were also investigated. Results Nineteen patients (95%) safely completed the desensitization protocol. One withdrew owing to emotional problems that appeared to be associated with oxcarbazepine. The follow-up period was 4.6±1.2 years (mean±SD), and oxcarbazepine was maintained for more than 3 years after desensitization in 15 patients (83.3%). The response rates were 84.2% and 77.8% at 1 and 3 years after desensitization, respectively. Eight patients remained seizure-free for 3 years, and two discontinued all AEDs. Transient adverse reactions such as mild rash and itching were reported by five patients during desensitization. Conclusions This study has demonstrated the long-term efficacy and safety of desensitization to oxcarbazepine in patients exhibiting cutaneous adverse drug reactions. This favorable outcome should encourage the implementation of desensitization in patients presenting with hypersensitivity to oxcarbazepine as an alternative strategy in clinical practice. PMID:27730770

  15. Long-term outcomes of treatment of hyperthyroidism in Ireland.

    LENUS (Irish Health Repository)

    Leary, A C

    2012-02-03

    We investigated the long-term outcome of treatment in 159 patients with hyperthyroidism first seen between 1979 and 1992. Median duration of follow-up was 10 1\\/2 years. We also inquired into current practice for the follow-up of hyperthyroidism by other endocrinologists in Ireland. Seven cases of unrecognised hyperthyroidism (4 per cent) and one of unrecognised hypothyroidism were identified. Among patients with Graves\\' disease, of those treated with an antithyroid drug, 28 per cent were in remission, 68 per cent had relapsed and 4 per cent had become hypothyroid. Of those treated by sub-total thyroidectomy, 31 per cent were in remission, 19 per cent had relapsed, 19 per cent were hypothyroid and 31 per cent were sub-clinically hypothyroid. Among patients treated with radioiodine, 19 per cent were euthyroid, 3 per cent were still hyperthyroid and three-quarters had become hypothyroid. In contrast, after radioiodine for toxic nodular goitre, 63 per cent were euthyroid and only 32 per cent had become hypothyroid (Chi Squared v. Graves\\' disease, P = 0.001). Of 73 patients receiving thyroxine replacement, plasma TSH was normal in only 41 per cent, although 82 per cent of patients had been seen by the family doctor within the previous 12 months. Seven of 17 other endocrinologists undertook long-term follow-up of hyperthyroid patients in their specialist clinics but none was using a computerised system to co-ordinate this. The findings confirm that careful follow-up is required for all hyperthyroid patients. The family doctor is well positioned to undertake this, but education and auditing are required.

  16. Long-term meditation is associated with increased gray matter density in the brain stem

    DEFF Research Database (Denmark)

    Vestergaard-Poulsen, Peter; Beek, Martijn van; Skewes, Joshua

    2009-01-01

    Extensive practice involving sustained attention can lead to changes in brain structure. Here, we report evidence of structural differences in the lower brainstem of participants engaged in the long-term practice of meditation. Using magnetic resonance imaging, we observed higher gray matter dens...... density in lower brain stem regions of experienced meditators compared with age-matched nonmeditators. Our findings show that long-term practitioners of meditation have structural differences in brainstem regions concerned with cardiorespiratory control. This could account for some...

  17. Long- term outcome of paediatric patients with ANCA vasculitis

    Directory of Open Access Journals (Sweden)

    Pusey Charles D

    2011-06-01

    Full Text Available Abstract Background Primary systemic vasculitis presenting in childhood is an uncommon but serious condition. As these patients transfer to adult clinics for continuing care, defining long term outcomes with emphasis on disease and treatment- related morbidity and mortality is important. The aim of this study is to describe the long- term clinical course of paediatric patients with ANCA vasculitis. Methods The adult patients in our vasculitis clinics who had presented in childhood, with a follow up time of greater than 10 years were included. We also reviewed the literature for articles describing the clinical outcome of paediatric patients with ANCA vasculitis. Results We describe the clinical course of 8 adults who presented in childhood with ANCA vasculitis. 7 patients had Wegener's granulomatosis and 1 had microscopic polyangiitis. The median age at presentation was 11.5 years, and follow up time ranged form 11 to 30 years. Induction therapy for all patients was steroids and/or cyclophosphamide. Maintenance therapy was with azathioprine or mycophenolate mofetil. Biological agents were used in 3 patients for relapsed disease in adulthood only. Seven patients achieved complete remission. All patients experienced disease relapse, with a median of 4 episodes. Kidney function was generally well preserved, with median eGFR 76 ml/min. Only one patient developed end-stage renal failure and one patient died after 25 years of disease. Treatment-related morbidity rates were high; 7 suffered from infections, 4 were infertile, 2 had skeletal complications, and 1 developed malignancy. Conclusion Close long- term follow up of paediatric patients with ANCA vasculitis is imperative, as this patient cohort is likely to live long enough to develop significant treatment and disease- related morbidities. Prospective cohort studies with novel therapies including paediatric patients are crucial to help us determine the best approach to managing this complex group

  18. Experiences of using email for general practice consultations: a qualitative study.

    Science.gov (United States)

    Atherton, Helen; Pappas, Yannis; Heneghan, Carl; Murray, Elizabeth

    2013-11-01

    Reports suggest approximately 21-23% of GPs in the UK have consulted with patients using email, but little is known about the nature of this use and what it means for clinicians and patients in general practice. To understand the use of email consultation in general practice by investigating the experiences of existing users and views of experts. A qualitative study conducted in 2010 using purposive sampling and semi-structured interviews in general practice and community settings in some London boroughs. A maximum variation sample of GPs and patients who had used email for consultation in general practice were recruited, as were policy and/or implementation experts. Interviews continued until saturation was achieved. In total 10 GPs, 14 patients, and six experts were interviewed. Consultation by email was often triggered by logistic or practical issues; motivators for ongoing use were the benefits, such as convenience, for GPs and patients. Both GPs and patients reported concerns about safety and lack of guidance about the 'rules of engagement' in email consultations, with GPs also concerned about workload. In response, both groups attempted to introduce their own rules, although this only went some way to addressing uncertainty. Long term, participants felt there was a need for regulation and guidance. Consultations by email in general practice occur in an unregulated and unstructured way. Current UK policy is to promote consultations by email, making it crucial to consider the responsibility and workload faced by clinicians, and the changes required to ensure safe use; not doing so may risk safety breaches and result in suboptimal care for patients.

  19. Long-term safety and efficacy of infliximab for the treatment of ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    Elalouf O

    2015-11-01

    Full Text Available Ofir Elalouf, Ori Elkayam Department of Rheumatology, Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv, Israel Abstract: The introduction of TNFα blockers has revolutionized the treatment of ankylosing spondylitis (AS. The objectives of this review are to summarize the most up-to-date data on long-term efficacy and safety of infliximab in AS, with special emphasis on axial and extra-articular disease, predictors of response, and radiological response. The general consensus of this literature search was that infliximab is highly efficacious in the treatment of AS. Most studies have demonstrated good clinical outcomes after 3 years of treatment, as measured by Spondyloarthritis International Society response in 75%–85% of treated AS patients. Reports on the long-term effects of infliximab as documented by radiological findings, however, are controversial. While some studies reported a similar progression rate as that of the historical OASIS cohort, others have suggested that infliximab may halt new bone formation. The long-term safety of infliximab is well known, mainly from data stored in national registries. While it has been suggested that side effects of infliximab may be fewer in AS compared to rheumatoid arthritis, data on this issue are sparse, with most of the information on long-term safety pertaining to rheumatoid arthritis. It can however be concluded that the long-term efficacy of infliximab is apparently maintained in AS and with an acceptable safety profile. Keywords: spondylitis, long-term efficacy, safety, TNFα blockers

  20. Dispositional optimism as predictor of outcome in short- and long-term psychotherapy.

    Science.gov (United States)

    Heinonen, Erkki; Heiskanen, Tiia; Lindfors, Olavi; Härkäpää, Kristiina; Knekt, Paul

    2017-09-01

    Dispositional optimism predicts various beneficial outcomes in somatic health and treatment, but has been little studied in psychotherapy. This study investigated whether an optimistic disposition differentially predicts patients' ability to benefit from short-term versus long-term psychotherapy. A total of 326 adult outpatients with mood and/or anxiety disorder were randomized into short-term (solution-focused or short-term psychodynamic) or long-term psychodynamic therapy and followed up for 3 years. Dispositional optimism was assessed by patients at baseline with the self-rated Life Orientation Test (LOT) questionnaire. Outcome was assessed at baseline and seven times during the follow-up, in terms of depressive (BDI, HDRS), anxiety (SCL-90-ANX, HARS), and general psychiatric symptoms (SCL-90-GSI), all seven follow-up points including patients' self-reports and three including interview-based measures. Lower dispositional optimism predicted faster symptom reduction in short-term than in long-term psychotherapy. Higher optimism predicted equally rapid and eventually greater benefits in long-term, as compared to short-term, psychotherapy. Weaker optimism appeared to predict sustenance of problems early in long-term therapy. Stronger optimism seems to best facilitate engaging in and benefiting from a long-term therapy process. Closer research might clarify the psychological processes responsible for these effects and help fine-tune both briefer and longer interventions to optimize treatment effectiveness for particular patients and their psychological qualities. Weaker dispositional optimism does not appear to inhibit brief therapy from effecting symptomatic recovery. Patients with weaker optimism do not seem to gain added benefits from long-term therapy, but instead may be susceptible to prolonged psychiatric symptoms in the early stages of long-term therapy. © 2016 The British Psychological Society.

  1. Safety analysis SFR 1. Long-term safety

    Energy Technology Data Exchange (ETDEWEB)

    2008-12-15

    regulatory authorities' previous review comments. Furthermore, definitions are given of terms and abbreviations used in SAR- 08, General Part 2, 'Long-term safety'. Chapter 2 Method. The chapter provides an overall description of the method used for the safety assessment and some aspects of the methodology are presented, such as time periods, safety principles, management of uncertainties, quality assurance and risk management. Chapter 3 Identification, ranking and handling of FEPs. The chapter systematically describes the factors to be taken into account in the assessment in the form of features, events and processes (FEPs). Interaction matrices are used to structure the information. Chapter 4 Initial state in the repository and its environs. The chapter describes the initial state, defined as the expected state of the repository and its environs, at closure in 2040. The description of the initial state is based on the technical design of the repository, present-day knowledge concerning conditions in the repository and its environs, and the expected evolution of the repository up until 2040. Chapter 5 Safety functions and safety performance indicators. Safety functions and safety performance indicators are identified and described in this chapter. A safety function is a role by means of which a repository component contributes to safety. Chapter 6 Reference evolution for the repository and its environs. This chapter describes the reference evolution of the repository and its environs and how the safety functions of the repository can be affected by this evolution up until 100,000 years after closure. Chapter 7 Selection of scenarios. This chapter describes how scenarios are selected based on safety performance indicators and interaction matrices. The selected scenarios illustrate the most important processes leading to the migration of radionuclides in the repository and to exposure of man and environment. The description of the processes is based on the

  2. Safety analysis SFR 1. Long-term safety

    Energy Technology Data Exchange (ETDEWEB)

    2008-12-15

    regulatory authorities' previous review comments. Furthermore, definitions are given of terms and abbreviations used in SAR- 08, General Part 2, 'Long-term safety'. Chapter 2 Method. The chapter provides an overall description of the method used for the safety assessment and some aspects of the methodology are presented, such as time periods, safety principles, management of uncertainties, quality assurance and risk management. Chapter 3 Identification, ranking and handling of FEPs. The chapter systematically describes the factors to be taken into account in the assessment in the form of features, events and processes (FEPs). Interaction matrices are used to structure the information. Chapter 4 Initial state in the repository and its environs. The chapter describes the initial state, defined as the expected state of the repository and its environs, at closure in 2040. The description of the initial state is based on the technical design of the repository, present-day knowledge concerning conditions in the repository and its environs, and the expected evolution of the repository up until 2040. Chapter 5 Safety functions and safety performance indicators. Safety functions and safety performance indicators are identified and described in this chapter. A safety function is a role by means of which a repository component contributes to safety. Chapter 6 Reference evolution for the repository and its environs. This chapter describes the reference evolution of the repository and its environs and how the safety functions of the repository can be affected by this evolution up until 100,000 years after closure. Chapter 7 Selection of scenarios. This chapter describes how scenarios are selected based on safety performance indicators and interaction matrices. The selected scenarios illustrate the most important processes leading to the migration of radionuclides in the repository and to exposure of man and environment. The description of the processes is based on the

  3. Long-term variations of noctilucent clouds at ALOMAR

    Science.gov (United States)

    Fiedler, Jens; Baumgarten, Gerd; Berger, Uwe; Lübken, Franz-Josef

    2017-09-01

    Noctilucent clouds (NLC) are measured by the Rayleigh/Mie/Raman-lidar at the ALOMAR research facility in Northern Norway (69°N, 16°E) since 1994. The data set contains about 2860 h of NLC detections and is investigated for the first time regarding trends. NLC properties depend on cloud brightness which is taken into account by the use of several cloud classes, related to brightness ranges. For NLC brighter than the long-term detection limit and strong NLC, respectively, the trend terms show increasing occurrence frequency (+9%/dec and+5%/dec) and brightness (+1.7×10-10 m-1 sr-1/dec and +1.5×-10 m-1 sr-1/dec) from 1998 to 2015. In the same period the altitude of faint and long-term limit clouds decreases (-66 m/dec and -108 m/dec). Over the entire time period of 22 years strong clouds show an increasing altitude by +76 m/dec. NLC properties are affected differently by solar and atmospheric parameters. In general, Lyman-α and stratospheric ozone impact all three NLC parameters, temperature at 83 km impacts mainly the NLC altitude. Time series of RMR lidar and SBUV satellite instruments match best for NLC occurrence frequency and brightness when restricting SBUV to the morning data at longitudes around ALOMAR (64-74°N, 8-24°E/0-9 LT). This suggests longitudinal dependent trends, which is confirmed by trend investigations of longitudinal subsets of the SBUV data set.

  4. 广泛性焦虑障碍两种方法撤减苯二氮(卓)药物的对照研究%Efficacy of Cognitive-behavioral Self-help Therapy for Generalized Anxiety Disorder (GAD) to Withdraw from Long-term Benzodiazepine (BZD) Use

    Institute of Scientific and Technical Information of China (English)

    王继辉; 吴小立; 甘照宇; 张海燕

    2013-01-01

    [目的]研究认知行为自助疗法(CBT-SH)联合递减疗法存广泛性焦虑障碍(GAD)患者中停止使用苯二氮(卓)类(BZD)药物中的作用.[方法]对象为门诊GAD患者,连续使用BZD类药物超过3个月,共60例,随机分为研究组和对照组各30例,对照组采用药物剂量递减疗法逐渐停用BZD药物,研究组联合递减疗法和CBT-SH,比较两组疗效的差异.在基线及治疗后2、4、6、10周末评定汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)、匹茨堡睡眠质量指数量表(PSQI)得分.[结果]10周末,研究组和对照组成功停用率分别为57%(17/30)和27%(8/30),差异具有统计学意义(P=0.018);研究组和对照组BZD剂量分别为1.19(S=1.69)mg·d-1和3.64(S=3.47)mg·d-1,差异具有统计学意义(P=0.004).回归分析结果显示,患者年龄小、入组前BZD使用时间短、联合使用CBT-SH是BZD成功停药的有利影响因素(P< 0.05).[结论]递减疗法联合CBT-SH更有助于GAD患者摆脱长期使用BZD药物;患者年龄越大、使用BZD药物时间越长,越不容易成功停用.%[ Objective ] To evaluate the efficacy and feasibility of tapering off long-term benzodiazepine use for generalized anxiety disorder (GAD), and to evaluate the value of additional cognitive behavioral therapy (CBT-SH). [Methods] A 10-week controlled trial was conducted in which 60 stabilized GAD patients attempting to discontinue long-term benzodiazepines (BZD) use (more than 3 months) were assigned to tapering off plus CBT-SH (intervention group, n = 30), or tapering off alone (control group, n - 30). All patients were assessed with Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD, 24-items) and Pittsburgh Sleep Quality Index(PSQI) on baseline and at the end of the 1st, 2nd, 6th, and 10th week treatment. [Results] At the end of 10th week, 17(57%) patients in the intervention group and 8 (27%) in the control group had discontinued benzodiazepine use (P = 0.018) ; the

  5. Long-term retention of basic science knowledge: a review study.

    Science.gov (United States)

    Custers, Eugène J F M

    2010-03-01

    In this paper, a review of long-term retention of basic science knowledge is presented. First, it is argued that retention of this knowledge has been a long-standing problem in medical education. Next, three types of studies are described that are employed in the literature to investigate long-term retention of knowledge in general. Subsequently, first the results of retention studies in general education are presented, followed by those of studies of basic science knowledge in medical education. The results of the review, in the general educational domain as well as in medical education, suggest that approximately two-third to three-fourth of knowledge will be retained after one year, with a further decrease to slightly below fifty percent in the next year. Finally, some recommendations are made for instructional strategies in curricula to improve long term retention of the subject matter dealt with.

  6. Psychological symptoms as long-term consequences of war experiences

    NARCIS (Netherlands)

    Priebe, S.; Jankovic Gavrilovic, J.; Bremner, S.; Ajdukovic, D.; Franciskovic, T.; Galeazzi, G.M.; Kucukalic, A.; Lecic-Tosevski, D.; Morina, N.; Popovski, M.; Schützwohl, M.; Bogic, M.

    2013-01-01

    Background/Aims: War experiences can affect mental health, but large-scale studies on the long-term impact are rare. We aimed to assess long-term mental health consequences of war in both people who stayed in the conflict area and refugees. Method: On average 8 years after the war in former

  7. Factors associated with long-term mortality in acute pancreatitis

    DEFF Research Database (Denmark)

    Nøjgaard, Camilla; Matzen, Peter; Bendtsen, Flemming

    2011-01-01

    Knowledge of the long-term prognosis of acute pancreatitis (AP) is limited. The aims were to investigate: (1) prognostic factors associated with long-term mortality in patients with AP; (2) whether or not the level of serum (S-)amylase at admission had an impact on the prognosis; (3) causes...

  8. Pediatric polytrauma : Short-term and long-term outcomes

    NARCIS (Netherlands)

    vanderSluis, CK; Kingma, J; Eisma, WH; tenDuis, HJ

    1997-01-01

    Objective: To assess the short-term and long-term outcomes of pediatric polytrauma patients and to analyze the extent to which short-term outcomes can predict long-term outcomes. Materials and Methods: Ail pediatric polytrauma patients (Injury Severity Score of greater than or equal to 16, less than

  9. Determinants and consequences of long-term benzodiazepine use

    NARCIS (Netherlands)

    Manthey, Leonie

    2012-01-01

    The main objective of this thesis is to describe the epidemiology of long term BZD use as well as its long term consequences. This thesis is structured into three sections: In section one, the correlates of BZD use, new use, chronic use, inappropriate use, and BZD dependence severity are investigate

  10. Quantification of long term emission potential from landfills

    NARCIS (Netherlands)

    Heimovaara, T.J.

    2011-01-01

    Novel approaches for the after-care of Municipal Solid Waste (MSW) landfills are based on technological measures to reduce the long term emission potential in a short time period. Biological degradation in landfills is a means to significantly reduce the long term emission potential. Leachate emissi

  11. [Developing the core competencies of long-term care professionals].

    Science.gov (United States)

    Chen, Huey-Tzy; Lee, Kuang-Ting

    2012-12-01

    Longer average life expectancies and an ageing society have made long-term care an urgent and important issue in Taiwan. Although the implementation of Long-Term Care Ten-year Project four years ago has begun showing success in terms of assessing Taiwan's needs in terms of long-term care services and resources, there has been little forward progress in terms of training, recruiting and maintaining more competent professionals in the long-term care sector. This paper explores the current state of long-term care competency in Taiwan and educational strategies in place to improve the competency of long-term care professionals. Results indicate that the term geriatric competency embraces sub-competencies in direct care, communication, assessment, teamwork, cultural sensitivities and career care competencies. The term long-term care competency embraces the sub-competencies of supervision, management, information technology, resource management, and organizational skill. As a main contributor to effective long-term care, the nursing profession must employ effective strategies to develop competency-based education. Also, the profession must have an adequate supply of competent manpower to effectively respond to Taiwan's aging society.

  12. Long Term Incentives for Residential Customers Using Dynamic Tariff

    DEFF Research Database (Denmark)

    Huang, Shaojun; Wu, Qiuwei; Nielsen, Arne Hejde

    2015-01-01

    This paper reviews several grid tariff schemes, including flat tariff, time-of-use, time-varying tariff, demand charge and dynamic tariff (DT), from the perspective of the long term incentives. The long term incentives can motivate the owners of flexible demands to change their energy consumption...

  13. IPO-related organizational change and long-term performance

    NARCIS (Netherlands)

    Eije, J.H. von; Witte, M.C. de; Zwaan, A.H. van der

    2000-01-01

    Mainstream literature on long-term performance of initial public offerings focuses on long-term underperformance. Because underperformance is an anomalous phenomenon, many authors search for explanations based on financial market imperfections. More recently, however, the attention shifts from under

  14. Psychological symptoms as long-term consequences of war experiences

    NARCIS (Netherlands)

    S. Priebe; J. Jankovic Gavrilovic; S. Bremner; D. Ajdukovic; T. Franciskovic; G.M. Galeazzi; A. Kucukalic; D. Lecic-Tosevski; N. Morina; M. Popovski; M. Schützwohl; M. Bogic

    2012-01-01

    Background/Aims: War experiences can affect mental health, but large-scale studies on the long-term impact are rare. We aimed to assess long-term mental health consequences of war in both people who stayed in the conflict area and refugees. Method: On average 8 years after the war in former Yugoslav

  15. The Effect of Modality on Long-Term Recognition Memory.

    Science.gov (United States)

    Dean, Raymond S.; And Others

    1988-01-01

    The effects of visual and auditory modes of input on long-term memory were examined in two experiments, each with 40 and 80 undergraduates, respectively. In both experiments, visual stimulus attributes were a more salient dimension than were auditory features in the long-term encoding and retrieval process. (SLD)

  16. A new image for long-term care.

    Science.gov (United States)

    Wager, Richard; Creelman, William

    2004-04-01

    To counter widely held negative images of long-term care, managers in the industry should implement quality-improvement initiatives that include six key strategies: Manage the expectations of residents and their families. Address customers' concerns early. Build long-term customer satisfaction. Allocate resources to achieve exceptional outcomes in key areas. Respond to adverse events with compassion. Reinforce the facility's credibility.

  17. Long-term effects of a preoperative smoking cessation programme

    DEFF Research Database (Denmark)

    Villebro, Nete Munk; Pedersen, Tom; Møller, Ann M;

    2008-01-01

    Preoperative smoking intervention programmes reduce post-operative complications in smokers. Little is known about the long-term effect upon smoking cessation.......Preoperative smoking intervention programmes reduce post-operative complications in smokers. Little is known about the long-term effect upon smoking cessation....

  18. Efficacy of ibandronate: a long term confirmation.

    Science.gov (United States)

    Di Munno, Ombretta; Delle Sedie, Andrea

    2010-01-01

    Data deriving from randomized clinical trials, observational studies and meta-analyses, including treatment regimens unlicensed for use in clinical practice, clearly support that 150 mg once-monthly oral and 3 mg quarterly i.v. doses of ibandronate are associated with efficacy, safety and tolerability; notably both these marketed regimens, which largely correspond to ACE ≥10.8 mg, may in addition provide a significant efficacy on non-vertebral and clinical fracture (Fx) efficacy. The MOBILE and the DIVA LTE studies confirmed a sustained efficacy of monthly oral and quarterly i.v. regimens respectively, over 5 years. Furthermore, improved adherence rates with monthly ibandronate, deriving from studies evaluating large prescription databases, promise to enhance fracture protection and decrease the social and economic burden of postmenopausal osteoporosis.

  19. Projecting long term medical spending growth.

    Science.gov (United States)

    Borger, Christine; Rutherford, Thomas F; Won, Gregory Y

    2008-01-01

    We present a dynamic general equilibrium model of the U.S. economy and the medical sector in which the adoption of new medical treatments is endogenous and the demand for medical services is conditional on the state of technology. We use this model to prepare 75-year medical spending forecasts and a projection of the Medicare actuarial balance, and we compare our results to those obtained from a method that has been used by government actuaries. Our baseline forecast predicts slower health spending growth in the long run and a lower Medicare actuarial deficit relative to the previous projection methodology.

  20. Experimental Researches on Long-Term Strength of Granite Gneiss

    Directory of Open Access Journals (Sweden)

    Lin Liu

    2015-01-01

    Full Text Available It is important to confirm the long-term strength of rock materials for the purpose of evaluating the long-term stability of rock engineering. In this study, a series of triaxial creep tests were conducted on granite gneiss under different pore pressures. Based on the test data, we proposed two new quantitative methods, tangent method and intersection method, to confirm the long-term strength of rock. Meanwhile, the isochronous stress-strain curve method was adopted to make sure of the accuracy and operability of the two new methods. It is concluded that the new methods are suitable for the study of the long-term strength of rock. The effect of pore pressure on the long-term strength of rock in triaxial creep tests is also discussed.

  1. Long-term surveillance plan for the Cheney disposal site near Grand Junction, Colorado

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-04-01

    This long-term surveillance plan (LTSP) describes the U.S. Department of Energy`s (DOE) long-term care program for the Uranium Mill Tailings Remedial Action (UMTRA) Project Cheney disposal site. The site is in Mesa County near Grand Junction, Colorado. The U.S. Nuclear Regulatory Commission (NRC) has developed regulations for the issuance of a general license for the custody and long-term care of UMTRA Project disposal sites in 10 CFR Part 40. The purpose of this general license is to ensure that the UMTRA Project disposal sites are cared for in a manner that protects public health and safety and the environment. Before each disposal site may be licensed, the NRC requires the DOE to submit a site-specific LTSP. The DOE prepared this LTSP to meet this requirement for the Cheney disposal site. The general license becomes effective when the NRC concurs with the DOE`s determination that remedial action is complete and the NRC formally accepts this plan. This document describes the long-term surveillance program the DOE will implement to ensure that the Cheney disposal site performs as designed. The program is based on site inspections to identify potential threats to disposal cell integrity. The LTSP is based on the UMTRA Project long-term surveillance program guidance and meets the requirements of 10 CFR {section}40.27(b) and 40 CFR {section}192.03.

  2. Long-term surveillance plan for the Gunnison, Colorado, disposal site

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-04-01

    This long-term surveillance plan (LTSP) describes the U.S. Department of Energy`s (DOE) long-term care program for the Uranium Mill Tailings Remedial Action (UMTRA) Project Gunnison disposal site in Gunnison County, Colorado. The U.S. Nuclear Regulatory Commission (NRC) has developed regulations for the issuance of a general license for the custody and long-term care of UMTRA Project disposal sites in 10 CFR Part 40. The purpose of this general license is to ensure that the UMTRA Project disposal sites will be cared for in a manner that protects the public health and safety and the environment. Before each disposal site is licensed, the NRC requires the DOE to submit a site-specific LTSP. The DOE prepared this LTSP to meet this requirement for the Gunnison disposal site. The general license becomes effective when the NRC concurs with the DOE`s determination of completion of remedial action for the Gunnison site and the NRC formally accepts this LTSP. This LTSP describes the long-term surveillance program the DOE will implement to ensure that the Gunnison disposal site performs as designed. The program is based on two distinct activities: (1) site inspections to identify threats to disposal cell integrity, and (2) ground water monitoring to demonstrate disposal cell performance. The LTSP is based on the UMTRA Project long-term surveillance program guidance and meets the requirements of 10 CFR {section}40.27(b) and 40 CFR {section}192.03.

  3. Long-term forecast: key to groundwater protection.

    Science.gov (United States)

    Gerth, Joachim; Förstner, Ulrich

    2004-01-01

    Groundwater resources are at risk from pollution, climate change and land-management practices. Long-term forecast is a tool to demonstrate future development and to support decisions on measures which can be implemented, controlled and eventually corrected. As the basis for preventive action, a forecast can be viewed as a key to groundwater protection. The soil zone plays a vital role in groundwater protection. Research on soil and groundwater trends, as affected by change of climate and/or land-management practices, is on the agenda. Integrated research is necessary to develop numerical soil-water system models reflecting all relevant transport processes at various scales. Even relatively simple problems like forecasting pollutant release from contaminated materials are difficult to resolve. Batch tests may be sufficient in low-risk cases. At higher risk when contaminated substrates are chosen for deposition on a large scale, a thorough characterization of the materials is necessary covering all aspects of stability and possible changes of the environment.

  4. A Relativistic Long-term Precession of the Earth

    Science.gov (United States)

    Tang, K.

    2016-05-01

    A long-term precession represents a secular motion of the ecliptic and th equator in a long time interval. With Vondrák et al. (2011), we assume that precession covers all periods longer than 100 centuries, while the shorter ones are included in the nutation. This thesis deals with the long-term precession in a relativistic framework. Compared with the P03 precession theory which is only valid for several centuries around the epoch J2000.0, the new theory better reflects the realistic long-term behavior of precession. All previous works are not fully consistent with General Relativity. They only consider the dominant relativistic corrections: the first-order post-Newtonian corrections due to the Sun and the geodetic precession. Their standard way to account for the geodetic precession is to solve the purely Newtonian equations of rotational motion and add the geodetic precession as a correction to the solution. In this thesis, we aim to determine the acceleration of the SSB from astrometric and geodetic observations obtained by Very Long Baseline Interferometry (VLBI), which is a technique using the telescopes globally distributed on the Earth to observe a radio source simultaneously, and with the capacity of angular positioning for compact radio sources at 10-milliarcsecond level. The method of the global solution, which allows the acceleration vector to be estimated as a global parameter in the data analysis, is developed. Through the formal error given by the solution, this method shows directly the VLBI observations' capability to constrain the acceleration of the SSB, and demonstrates the significance level of the result. In the next step, the impact of the acceleration on the ICRS is studied in order to obtain the correction of the celestial reference frame (CRF) orientation. Recently, Klioner, Gerlach, and Soffel (2010) have constructed a relativistic theory of Earth's rotation. According to the post-Newtonian equations of rotational motion given by Klioner

  5. Micro-citizenship, dementia and long-term care.

    Science.gov (United States)

    Baldwin, Clive; Greason, Michelle

    2016-05-01

    In recent years there has been an increasing interest in the concept of citizenship as a lens through which to understand dementia practice. This move from an individualist, personhood-based approach towards an understanding of people with dementia as a group facing social and structural discrimination parallels, in some ways, that previously seen in the realms of disability and mental health which have sought to politicize those experiences. In so doing, the debate has sought to reconfigure power relations, insisting that members of such discriminated groups are people with power entitled to the same from life as everyone else. Much of the discussion to date has, understandably, focused on the larger issues of social inclusion, rights and responsibilities - reflecting the traditional concern of citizenship of individuals' relationship to the state or the society in which they live. More recently, there has been a move to conceptualising citizenship as a practice - something that is realised through action and in relationship - rather than a status bestowed. In this paper, we seek to contribute to the discussion by introducing the concepts of midi- and micro-citizenship, taken from organisation studies, as a further means by which to link the personal and the political, and as grounds to build citizenship-alliances between people with dementia living in long-term care (LTC) facilities and front-line dementia care staff. We will then seek to illustrate the usefulness of these concepts in understanding citizenship in practice in LTC facilities through analysis of data drawn from focus groups involving LTC staff, and interviews with family carers whose relatives live in LTC facilities. In conclusion, we will explore some of the possibilities that such an approach holds for dementia care practice.

  6. Long-term impact of pesticides use on vineyard

    Science.gov (United States)

    Sabatier, Pierre; Poulenard, Jérôme; Fanget, Bernard; Reyss, Jean-Louis; Develle, Anne-Lise; Ployon, Estelle; Wilhelm, Bruno; Naffrechoux, Emmanuel; Dorioz, Jean-Marcel; Montuelle, Bernard; Arnaud, Fabien

    2014-05-01

    Worldwide increase of pesticides uses in agriculture has been growing over the past decades but their long-term fate and effects on environment and ecosystem are poorly understood. Here, we present a retro-observation approach based on lake sediment record to monitor micropollutants and to evaluate the long term impact of pesticides treatments on a vineyard catchment in Savoie (France). In this study, we combined sedimentological and geochemical analyses to reconstruct the recent history of wine practices. The sediment sequence chronology, based on short-live radionuclides (210Pb/137Cs), provides a well constrain continuous age-depth relationship covering to the last century. Over this period, we reconstruct the succession of fungicides, insecticides and herbicides in relation to the appearance of new chemical substances and the banning of old ones. The first use of fungicide began at the end of the 19th century with the Bordeaux mixture (Cu). After the World War II, we observed an intensification of fungicides treatment against mildew, powdery mildew, Botrytis fungi and black rot with specific molecules succession. Insecticides used in vineyard treatment against tetranychid and eriophyid mites were observed since 1940 with a main increase in 1970. Dicofol, Bromopropylate, Bifenthrin succeed to DDT banning in 1972, but a secondary source of DDT appeared at the early of 90's. The first herbicides use was observed between 1960 and 1970 with the presence of Triazine metabolite (pre-emergence herbicide) and high value of AMPA (Glyphosate metabolite, Roundup®), used as post-emergence herbicide, were found since 1990. Two sedimentation rate increases in 1973 and 1994 could be directly assigned to wine practices. In early 70's, heavy farm machinery associated to the first application of pre-emergence herbicide, induced a first increase of soil erosion. In early 90's, post-emergence herbicide (Roundup®) treatment had a stronger impact on soil erosion with a huge

  7. Professional autonomy - is it the future of general practice?

    Science.gov (United States)

    Fraser, John

    2006-05-01

    Internationally, rising financial costs and increasing expectations of health care delivery have increased regulation and decreased the autonomy of general practitioners and other health care professionals. This article explores professional autonomy within Australian general practice, and outlines the importance of autonomy in systems approaches to organisational change in general practice.

  8. Long-term use of stimulants in children with attention deficit hyperactivity disorder: safety, efficacy, and long-term outcome.

    Science.gov (United States)

    Hechtman, Lily; Greenfield, Brian

    2003-01-01

    The purpose of this review is to summarize existing data on the long-term safety and efficacy of stimulant treatment, and how long-term stimulant treatment of children with attention deficit hyperactivity disorder (ADHD) affects their outcome. Existing controlled studies of children with ADHD treated and untreated with stimulants, as well as long-term prospective follow-up studies, are reviewed. Children with ADHD treated with stimulants for as long as 2 years continue to benefit from the treatment, with improvements observed in ADHD symptoms, comorbid oppositional defiant disorder, and academic and social functioning, with no significant problems of tolerance or adverse effects. Long-term, prospective follow-up studies into adulthood show that stimulant treatment in childhood has slight benefits regarding social skills and self-esteem. Long-term adverse effects from stimulant treatment in childhood regarding adult height or future substance abuse have not been supported by existing studies.

  9. Estimated long-term health effects

    Energy Technology Data Exchange (ETDEWEB)

    Cardis, F. [International Agency for Research on Cancer, Lyon (France); Okeanov, A.E. [AN Belorusskoj SSR, Minsk (Belarus); Likthariev, I.; Prisyazhniuk [All-Union Scientific Centre of Radiation Medicine, Kiev (Ukraine); Anspaugh, L.R. [California Univ., Livermore, CA (United States) Lawrence Livermore Lab.; Mabuchi, K. [Radiation Effects Research Foundation, Hiroshima (Japan); Ivanov, V.K. [MRRC of RAMS, Obninsk (Russia)

    1996-04-01

    Apart from the dramatic increase in thyroid cancer in those exposed as children, there is no evidence to date of a major public health impact of the radiation exposure from the Chernobyl accident in the three most affected countries. Although some increases in the frequency of cancer in exposed populations have been reported, these results are difficult to interpret, mainly because of differences in the intensity and method of follow-up between exposed populations and the general population to which they are compared. If the experience of atomic bomb survivors and of other exposed populations is applicable, the major radiological impact of the accident will be cancer and the total lifetime numbers of excess cancers will be greatest among the liquidators and among the residents of contaminated territories, of the order of 2,000 to 2,500. These increases would be difficult to detect epidemiologically against an expected background number of 41,500 and 433,000 respectively (size of the exposed populations: 200,000 and 3,700,000, respectively). It is noted, however, that the exposures received by populations exposed as a result of Chernobyl are different (in type and pattern) from those of atomic bomb survivors. Predictions derived from these populations are therefore uncertain. Indeed, the extent of the increase in thyroid cancer incidence in persons exposed as children was not foreseen. In addition, only ten years have passed since the accident. It is essential therefore that monitoring of the health of the population be continued in order to assess the public health impact of the accident, even if, apart from leukemia among liquidators, little detectable increase of cancers due to radiation from the Chernobyl accident is expected.

  10. Quality of life and functional health status of long-term meditators.

    Science.gov (United States)

    Manocha, Ramesh; Black, Deborah; Wilson, Leigh

    2012-01-01

    Background. There is very little data describing the long-term health impacts of meditation. Aim. To compare the quality of life and functional health of long-term meditators to that of the normative population in Australia. Method. Using the SF-36 questionnaire and a Meditation Lifestyle Survey, we sampled 343 long-term Australian Sahaja Yoga meditation practitioners and compared their scores to those of the normative Australian population. Results. Six SF-36 subscales (bodily pain, general health, mental health, role limitation-emotional, social functioning, and vitality) were significantly better in meditators compared to the national norms whereas two of the subscales (role limitation-physical, physical functioning) were not significantly different. A substantial correlation between frequency of mental silence experience and the vitality, general health, and especially mental health subscales (P definition of meditation in enhancing quality of life, functional health and wellbeing is growing. Implications for primary mental health prevention are discussed.

  11. Long-term employment and health inequalities in Canadian communities.

    Science.gov (United States)

    Safaei, Jalil

    2008-01-01

    This study examines the long-term unemployment rate and various health outcomes across Canadian communities to estimate employment-related health inequalities in these communities. The study uses cross-sectional community-level health data along with data on the long-term employment rate for various communities across Canada to quantify health inequalities among these communities. The health outcomes that are considered in this study include total and disease specific mortality rates; health conditions such as high blood pressure, diabetes, injuries, and self rated health; and life expectancies at birth and at age 65. Health inequalities are estimated using the concentration index, which is used to measure health inequalities along socioeconomic dimensions. The concentration index is estimated by a regression of weighted relative health (ill health) over weighted cumulative relative rank of the populations. All the estimates are provided separately for males and females. The findings of the study support the existence of inequalities in community health outcomes as related to the long-term employment rates in those communities. Communities with lower long term employment rates (higher unemployment rates) have poorer health outcomes in terms of higher mortality rates, worse health conditions, and shorter life expectancies. Health inequalities related to long-term employment have important policy implications. They call for policies that would increase and maintain long term employment rates as part of a broader socioeconomic approach to health. Long term employment ensures income security and prevents the psychosocial experiences leading to mental and physical ill health.

  12. Collaborative Establishment of a Long-Term Archive for Stewardship of Interdisciplinary Scientific Data

    Science.gov (United States)

    Downs, R. R.; Chen, R. S.; Cartolano, R. T.; Bose, R.

    2008-12-01

    Much of the scientific data that are being collected today cannot be recreated if they are not properly preserved and documented. Establishment of reliable long-term digital archives is essential to preserving these data and associated documentation beyond the working lifetimes of current scientists. Numerous challenges, both technical and institutional, need to be addressed before these data or their documentation become lost or inaccessible. Direct collaboration between university research libraries and active scientific data centers is one approach to addressing these challenges. We report here on the collaboration between the Columbia Libraries / Information Services and the Center for International Earth Science Information Network (CIESIN) to establish an interdisciplinary long-term archive for data from the NASA Socioeconomic Data and Applications Center (SEDAC). The SEDAC long-term archive serves as a trustworthy digital repository to support preparation, submission, appraisal, ingest, discovery, integration, and interoperability of scientific data that are expected to be of long-term interest to both natural and social scientists. Significant progress has been made in establishing the necessary policies and procedures, implementing needed standards and technologies, and assessing strengths and possible weaknesses in the long-term sustainability of the archive. Benefits have included sharing approaches and best practices for information technology solutions and scientific data stewardship. A key issue is the expected future integration of this specialized archive into the long-term digital repository currently being developed by the University. Planned activities include testing the migration of selected data from the SEDAC long-term archive to the forthcoming Libraries repository and the development of interfaces between the digital object management systems being implemented by SEDAC and the Libraries, which are both based on the Flexible Extensible

  13. Long-term impact of precision agriculture on a farmer’s field

    Science.gov (United States)

    Targeting management practices and inputs with precision agriculture has high potential to meet some of the grand challenges of sustainability in the coming century. Although potential is high, few studies have documented long-term effects of precision agriculture on crop production and environmenta...

  14. Long-term impact of a precision agriculture system on grain crop production

    Science.gov (United States)

    Research is lacking on the long-term impacts of field-scale precision agriculture practices on grain production. Following more than a decade (1993-2003) of yield and soil mapping and water quality assessment, a multi-faceted, ‘precision agriculture system’ (PAS) was implemented from 2004 to 2014 on...

  15. Technical Assistance Model for Long-Term Systems Change: Three State Examples. Executive Summary

    Science.gov (United States)

    Kasprzak, Christina; Goode, Sue; Hurth, Joicey; Lucas, Anne; Marshall, Jacqueline; Terrell, Adriane; Jones, Elizabeth

    2010-01-01

    The NECTAC Technical Assistance (TA) Model for Long-Term Systems Change (LTSC) recognizes that components of a state system are highly interactive and changes at one level are not likely to be sustained without supportive changes at all related levels. Improved child and family outcomes require: intervention practices that are research-based,…

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

    Science.gov (United States)

    Sillanpaa, Matti; Schmidt, Dieter

    2009-01-01

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

  17. Thinking like a Spider: Teaching Artists in Long-Term Partnerships

    Science.gov (United States)

    Alexander, Philip A.

    2005-01-01

    As schools and cultural organizations face pressure to provide arts programs that meet academic standards, artist residency models have been evolving to become more in-depth and long-term. This trend, supported by schools and funding sources from both the public and private sectors, has affected Teaching Artists' (TAs) practice significantly.…

  18. Social science in the context of the long term ecological research program

    Science.gov (United States)

    Ted L. Gragson; Morgan Grove

    2006-01-01

    This special issue of Society and Natural Resources brings the results of long-term ecological research with an explicit social dimension to the attention of the social scientific research community. Contributions are from the Baltimore Ecosystem Study LTER, the Central Arizona-Phoenix LTER, the Coweeta LTER and the Northern Temperate Lakes LTER The range of practice...

  19. Statistical analysis for long-term stability studies with multiple storage conditions

    NARCIS (Netherlands)

    van den Heuvel, Edwin R.; Almalik, Osama; Nijhuis, Michiel B.; Warner, Edward I.

    2011-01-01

    To determine the shelf life of new medicinal products, long-term stability studies are conducted of at least three registration batches at multiple storage conditions. It is common practice to perform a statistical analysis on the resulting data separately for each storage condition. Although this i

  20. Long-term intended and unintended experiences after Advanced Life Support training

    DEFF Research Database (Denmark)

    Rasmussen, M.B.; Dieckmann, Peter; Issenberg, Berry

    2012-01-01

    Highly structured simulation-based training (SBT) on managing emergency situations can have a significant effect on immediate satisfaction and learning. However, there are some indications of problems when applying learned skills to practice. The aim of this study was to identify long-term intend...... and unintended learner reactions, experiences and reflections after attending a simulation based Advanced Life Support (ALS) course....

  1. Long-term trends from ecosystem research at the Hubbard Brook Experimental Forest

    Science.gov (United States)

    John L. Campbell; Charles T. Driscoll; Christopher Eagar; Gene E. Likens; Thomas G. Siccama; Chris E. Johnson; Timothy J. Fahey; Steven P. Hamburg; Richard T. Holmes; Amey S. Bailey; Donald C. Buso

    2007-01-01

    Summarizes 52 years of collaborative, long-term research conducted at the Hubbard Brook (NH) Experimental Forest on ecosystem response to disturbances such as air pollution, climate change, forest disturbance, and forest management practices. Also provides explanations of some of the trends and lists references from scientific literature for further reading.

  2. Long-Term Stewardship Baseline Report and Transition Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Kristofferson, Keith

    2001-11-01

    Long-term stewardship consists of those actions necessary to maintain and demonstrate continued protection of human health and the environment after facility cleanup is complete. As the Department of Energy’s (DOE) lead laboratory for environmental management programs, the Idaho National Engineering and Environmental Laboratory (INEEL) administers DOE’s long-term stewardship science and technology efforts. The INEEL provides DOE with technical, and scientific expertise needed to oversee its long-term environmental management obligations complexwide. Long-term stewardship is administered and overseen by the Environmental Management Office of Science and Technology. The INEEL Long-Term Stewardship Program is currently developing the management structures and plans to complete INEEL-specific, long-term stewardship obligations. This guidance document (1) assists in ensuring that the program leads transition planning for the INEEL with respect to facility and site areas and (2) describes the classes and types of criteria and data required to initiate transition for areas and sites where the facility mission has ended and cleanup is complete. Additionally, this document summarizes current information on INEEL facilities, structures, and release sites likely to enter long-term stewardship at the completion of DOE’s cleanup mission. This document is not intended to function as a discrete checklist or local procedure to determine readiness to transition. It is an overarching document meant as guidance in implementing specific transition procedures. Several documents formed the foundation upon which this guidance was developed. Principal among these documents was the Long-Term Stewardship Draft Technical Baseline; A Report to Congress on Long-Term Stewardship, Volumes I and II; Infrastructure Long-Range Plan; Comprehensive Facility Land Use Plan; INEEL End-State Plan; and INEEL Institutional Plan.

  3. Effectiveness of empathy in general practice: a systematic review

    OpenAIRE

    Derksen, F.; BENSING, J; Lagro-Janssen, A

    2013-01-01

    Background: Empathy as a characteristic of patient-physician communication in both general practice and clinical care is considered to be the backbone of the patient-physician relationship. Although the value of empathy is seldom debated, its effectiveness is little discussed in general practice. This literature review explores the effectiveness of empathy in general practice. Effects that are discussed are: patient satisfaction and adherence, feelings of anxiety and stress, patient enablemen...

  4. Long-term management of GERD in the elderly with pantoprazole

    Directory of Open Access Journals (Sweden)

    Carlo Calabrese

    2007-04-01

    Full Text Available Carlo Calabrese, Anna Fabbri, Giulio Di FeboDepartment of Internal Medicine and Gastroenterology, University of Bologna, ItalyAbstract: The prevalence of gastroesophageal reflux disease (GERD increases with age and elderly are more likely to develop severe disease. Older patients often complain of less severe or frequent heartburn than younger patients and they may present with atypical symptoms such as dysphagia, weight loss, or extraesophageal symptoms. Proton pump inhibitors (PPIs are central in the management of GERD and are unchallenged with regards to their efficacy. They are considered safe and more effective than histamine receptor antagonists for healing esophagitis and for preventing its recurrence using a long term maintenance treatment. PPI have minimal side effects and few slight drug interactions and are considered safe for long term treatment. Pantoprazole is significantly effective both for acute and long-term treatment with excellent control of relapse and symptoms. It is well tolerated even for long-term therapy and its tolerability is optimal. Pantoprazole shows to have minimal interactions with other drugs because of a lower affinity for cytocrome P450 than older PPIs. Although the majority of elderly has concomitant illnesses and receive other drugs, this does not adversely effect the efficacy of pantoprazole because of its pharmacokinetics, which are independent of patient age. Clinical practice suggests that a low dose maintenance of PPIs should be used in older patients with GERD.Keywords: GERD, long-term management, pantoprazole, safety, efficacy, tolerability

  5. Electrophysiological Correlates of Long-Term Soto Zen Meditation

    Directory of Open Access Journals (Sweden)

    Henrique Adam Pasquini

    2015-01-01

    Full Text Available This study aimed to verify the electrophysiological correlates of the changes in long-term regular meditators. We use modern techniques of high-resolution electroencephalography applied to slow potentials, power spectra, and potencies related to the events. To obtain encephalographic records, we use an assembly of 128 channels in 31 subjects (17 Soto Zen Buddhist meditators. The motivation of this study was to determine whether the induced beta power would present an increase in meditators as well as a decrease in induced theta/beta ratio in absolute and relative values. However, opposite to what we expected, no significant change was found in the beta frequency. In contrast, the main findings of the study were correlations between the frequency of weekly meditation practice and the increased theta induced relative power, increase of induced power ratio (ratio theta/beta, and increase of the ratio of induced relative powers (theta/beta ratio during our task that featured an “adapted meditation,” suggesting that the meditative state of “mindfulness” is much more related to the permittivity of “distractions” by the meditators, with a deliberate reduction of attention.

  6. Reconstruction of old radical cavities and long-term results.

    Science.gov (United States)

    Magliulo, Giuseppe; D'Amico, Raffaello; Fusconi, Massimo

    2004-06-01

    Various techniques and materials have been proposed to deal with the problems that concern radical cavities, such as recurrence of the inflammatory process, the need for regular medication, and social inconvenience (eg, inability to practice water sports, working in an adverse enviroment). This article provides a detailed report of the results of revalidation of old radical cavities using hydroxyapatite granules as a filling. The material was incorporated with fibrin adhesive to fill the mastoid cavity and was covered with a sheet of bone pate sealant. Twenty-eight patients with chronic discharging old radical cavities were selected for this study (mean follow-up 11.4 years; range 10-14 years). At the 6-month follow-up, grafting was successful in 25 patients, whereas the functional outcomes showed an air-bone gap below 30 dB in 18 patients. No postoperative sensorineural hearing loss was observed. The long-term follow-up demonstrated a slight worsening of the initial findings; four other patients had reperforation of the tympanic membrane, and hearing deteriorated in five patients to above 30 dB air-bone gap. These results could be a consequence of an alteration in the function of the eustachian tube and of the severity of the preoperative pathologic processes.

  7. Long term behavior of self-compacting reinforced concrete beams

    Institute of Scientific and Technical Information of China (English)

    LIU Xiao-jie; YU Zhi-wu; JIANG Li-zhong

    2008-01-01

    Tests were carded out on 8 self-compacting reinforced concrete(SCC) beams and 4 normal reinforced concrete beams. The effects of mode of consolidation, load level, reinforcing ratio and structural type on long term behavior of SCC were investigated. Under the same environmental conditions, the shrinkage-time curve of self-compacting concrete beam is very similar to that of normal concrete beam. For both self-compacting reinforced concrete beams and normal reinforced concrete beams, the rate of shrinkage at early stages is higher, the shrinkage strain at 2 months is about 60% of the maximum value at one year. The shrinkage strain of self-compacting reinforced concrete beam after one year is about 450×10-6. Creep deflection of self-compacting reinforced concrete beam decreases as the tensile reinforcing ratio increases. The deflection creep coefficient of self-compacting reinforced concrete beam after one and a half year is about 1.6, which is very close to that of normal reinforced concrete beams cast with vibration. Extra cautions considering shrinkage and creep behavior are not needed for the use of SCC in engineering practices.

  8. Long-term performance of motor-operated valves

    Energy Technology Data Exchange (ETDEWEB)

    Scarbrough, T.G.

    1996-12-01

    The U.S. Nuclear Regulatory Commission (NRC) requires that motor-operated valves (MOVs) important to safety be designed, fabricated, erected, and tested to quality standards commensurate with the importance of the safety functions to be performed. Despite these requirements, operating experience and research revealed problems with the performance of MOVs in operating nuclear power plants. In response to the concerns about MOV performance, the NRC issued Generic Letter (GL) 89-10, {open_quotes}Safety-Related Motor-Operated Valve Testing and Surveillance,{close_quotes} and its supplements. Most licensees have completed the aspects of their GL 89-10 programs associated with the review of MOV design bases, verification of MOV switch settings initially, testing of MOVs under design-basis conditions where practicable, and improvement of evaluations of MOV failures and necessary corrective action. Licensees are establishing processes to ensure that the long-term aspects of their MOV programs, such as periodic verification of MOV capability and the trending of MOV problems, are maintained. The NRC staff is developing a generic letter to address periodic verification of MOV design-basis capability.

  9. Just a minute meditation: Rapid voluntary conscious state shifts in long term meditators.

    Science.gov (United States)

    Nair, Ajay Kumar; Sasidharan, Arun; John, John P; Mehrotra, Seema; Kutty, Bindu M

    2017-08-01

    Meditation induces a modified state of consciousness that remains under voluntary control. Can meditators rapidly and reversibly bring about mental state changes on demand? To check, we carried out 128 channel EEG recordings on Brahma Kumaris Rajayoga meditators (36 long term: median 14240h meditation; 25 short term: 1095h) and controls (25) while they tried to switch every minute between rest and meditation states in different conditions (eyes open and closed; before and after an engaging task). Long term meditators robustly shifted states with enhanced theta power (4-8Hz) during meditation. Short term meditators had limited ability to shift between states and showed increased lower alpha power (8-10Hz) during eyes closed meditation only when pre and post task data were combined. Controls could not shift states. Thus trained beginners can reliably meditate but it takes long term practice to exercise more refined control over meditative states. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Quality indicators for the acute and long-term management of anaphylaxis

    DEFF Research Database (Denmark)

    Dhami, Sangeeta; Sheikh, Aadam; Muraro, Antonella

    2017-01-01

    is challenging. Quality indicators have the potential to support guideline implementation efforts. OBJECTIVE: To identify quality indicators to support the acute and long-term management of anaphylaxis. METHODS: We conducted a systematic review of the literature that involved searching Medline, EMBASE and CINAHL......) and long-term (n = 27) management of anaphylaxis. The majority of indicators were developed through expert consensus with relatively few of these having been formally piloted or tested to demonstrate that they could discriminate between variations in practice and/or that they were sensitive to change....... CONCLUSIONS: There is a need for a comprehensive set of quality indicators for anaphylaxis management. We have however identified some indicators for the acute and long-term management of anaphylaxis that could with relatively little additional work support efforts to translate guideline recommendations...

  11. Effect of whole-tree thinning on long-term forest growth

    Energy Technology Data Exchange (ETDEWEB)

    Tveite, B.; Hanssen, K.H.; Clarke, N. [Norwegian Forest and Landscape Inst., As (Norway)

    2010-07-01

    The demand for forest biomass as an energy source is increasing. However, whole-tree harvesting may cause long-term reductions in soil nutrient availability, and reduce forest growth in the remaining stand. Long-term growth studies are needed to assess the sustainability of intensive biomass harvesting. This study quantified the long-term growth response of Norway spruce and Scots pine to whole-tree harvesting at first thinning. A series of 8 field experiments were set up in 1972-1977 at sites in Norway. Thinning plots using conventional and whole-tree harvesting were established. The amount of dry matter and nutrients removed during the thinning was calculated, and tree growth was measured every 5 years. The study showed that whole-tree harvesting led to a decrease in forest growth in all sites after a 25 year period. Reductions averaged 10 per cent when compared with conventional harvesting practices. Results were more variable in pine stands.

  12. Care plans and care planning in the management of long-term conditions in the UK: a controlled prospective cohort study.

    Science.gov (United States)

    Reeves, David; Hann, Mark; Rick, Jo; Rowe, Kelly; Small, Nicola; Burt, Jenni; Roland, Martin; Protheroe, Joanne; Blakeman, Tom; Richardson, Gerry; Kennedy, Anne; Bower, Peter

    2014-09-01

    In the UK, the use of care planning and written care plans has been proposed to improve the management of long-term conditions, yet there is limited evidence concerning their uptake and benefits. To explore the implementation of care plans and care planning in the UK and associations with the process and outcome of care. A controlled prospective cohort study among two groups of patients with long-term conditions who were similar in demographic and clinical characteristics, but who were registered with general practices varying in their implementation of care plans and care planning. Implementation of care plans and care planning in general practice was assessed using the 2009-2010 GP Patient Survey, and relationships with patient outcomes (self-management and vitality) were examined using multilevel, mixed effects linear regression modelling. The study recruited 38 practices and 2439 patients. Practices in the two groups (high and low users of written documents) were similar in structural and population characteristics. Patients in the two groups of practices were similar in demographics and baseline health. Patients did demonstrate significant differences in reported experiences of care planning, although the differences were modest. Very few patients in the cohort reported a written plan that could be confirmed. Analysis of outcomes suggested that most patients show limited change over time in vitality and self-management. Variation in the use of care plans at the practice level was very limited and not related to patient outcomes over time. The use of written care plans in patients with long-term conditions is uncommon and unlikely to explain a substantive amount of variation in the process and outcome of care. More proactive efforts at implementation may be required to provide a rigorous test of the potential of care plans and care planning. © British Journal of General Practice 2014.

  13. Future Research Needs for Long-Term Monitoring Program Design

    Science.gov (United States)

    Minsker, B. S.; Dougherty, D. E.; Williams, G.; Davis, C. B.

    2002-05-01

    An ASCE Task Committee is preparing a manual of practice on long-term monitoring (LTM) program design for groundwater (including vadose) systems. The committee has identified several areas for future research and technology transfer that will improve LTM design. LTM is an on-going activity aimed at assessing remediation performance, containment integrity, and/or continued non-contamination of the subsurface and groundwater. LTM has different goals and needs than site characterization, so data collection, analysis, and modeling approaches must evolve to meet these new needs. Many new sensors and field measurement methods for LTM are under development, and research is needed to develop methods to integrate these data sources with more traditional samples drawn from wells to maximize the information extracted from the data. These new methods need to be able to provide information to assess performance of waste management activities and to understand long-term behavior by optimizing the collection and analysis of multiple data types. The effects of different sampling and measurement methods on monitoring results and their implications for the design of LTM programs also require study. Additional research needs include development of methods to assess flow control strategies, to identify monitoring redundancy in fractured media, and to better incorporate uncertainty into the LTM design process. Well-tested, documented, and open datasets are needed to validate and compare the performance of methods. Technology transfer activities must address the need for evolution of regulatory guidance to encompass the types of data analysis that are needed to assess remediation or containment performance, to identify appropriate LTM plans, and to incorporate novel data collection methods that may support better decision quality through the use of more extensive measurements with lower individual precisions than traditional measurements or may measure an indicator parameter rather than

  14. Management of rhinosinusitis in Dutch general practice

    NARCIS (Netherlands)

    Hoffmans, R.; Schermer, T.R.J.; Weel, C. van; Fokkens, W.

    2011-01-01

    AIMS: To determine whether general practitioners (GPs) distinguish between the management of acute rhinosinusitis (ARS) and chronic rhinosinusitis (CRS), especially with regard to prescription of antibiotics and nasal steroids. METHODS: A questionnaire on the management of rhinosinusitis was sent to

  15. The existential dimension in general practice

    DEFF Research Database (Denmark)

    Assing Hvidt, Elisabeth; Søndergaard, Jens; Ammentorp, Jette

    2016-01-01

    . As a way to enhance a practice culture in which GPs pay more explicit attention to the patients’ multidimensional concerns, opportunities for professional development could be offered (courses or seminars) that focus on mutual sharing of existential reflections, ideas and communication competencies. Key...

  16. General dentist orthodontic practice in foreign legal systems

    Directory of Open Access Journals (Sweden)

    Ivan Toshio Maruo

    2012-04-01

    Full Text Available OBJECTIVE: General dentist orthodontic practice is a controversial issue and this paper aims to analyze it comparing foreign laws to Brazilian Legal System. METHODS: Regulations and scientific texts concerning orthodontic practice by general dentists, in Portuguese or English language, were sought. RESULTS AND CONCLUSION: Portugal clearly forbids general dentist orthodontic practice; United States of America do not clearly forbid general dentist orthodontic practice, but do regulate and promote campaigns to encourage public to seek specialist service; in Australia and England, corrective orthodontics are offered both by orthodontists and general dentists; it was not possible to evaluate how orthodontic services are provided in Eastern Europe; and the fact that general dentists are forbidden to practice corrective orthodontics in Brazilian Legal System is compatible to other countries policy.

  17. Long-term monitoring for nanomedicine implants and drugs

    Science.gov (United States)

    Kendall, Michaela; Lynch, Iseult

    2016-03-01

    Increasing globalization means that traditional occupational epidemiological approaches may no longer apply, suggesting a need for an alternative model to assess the long-term impact of nanomaterial exposure on health.

  18. Long-term memory, sleep, and the spacing effect.

    Science.gov (United States)

    Bell, Matthew C; Kawadri, Nader; Simone, Patricia M; Wiseheart, Melody

    2014-01-01

    Many studies have shown that memory is enhanced when study sessions are spaced apart rather than massed. This spacing effect has been shown to have a lasting benefit to long-term memory when the study phase session follows the encoding session by 24 hours. Using a spacing paradigm we examined the impact of sleep and spacing gaps on long-term declarative memory for Swahili-English word pairs by including four spacing delay gaps (massed, 12 hours same-day, 12 hours overnight, and 24 hours). Results showed that a 12-hour spacing gap that includes sleep promotes long-term memory retention similar to the 24-hour gap. The findings support the importance of sleep to the long-term benefit of the spacing effect.

  19. Assisted Living Facilities - MO 2010 Long Term Care Facilities (SHP)

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — Long Term Care facilities (nursing homes) in Missouri - Data will not be made available for download via MSDIS. Interested parties should send an email inquiry to...

  20. Long-term intrathecal administration of midazolam and clonidine

    NARCIS (Netherlands)

    Borg, PAJ; Krijnen, HJ

    1996-01-01

    Objective: To determine the clinical usefulness of the long-term intrathecal administration of midazolam and clonidine in patients with refractory neurogenic and musculoskeletal pain. Setting: Pain Centre, Academic Hospital Groningen, Groningen, The Netherlands. Patients: Four patients with chronic