WorldWideScience

Sample records for great clinical importance

  1. Great Importance Attached to Intangible Cultural Heritage

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    @@ Intangible Cultural Heritage on Verge of Extinction? With the acceleration of globalization and modernization, dramatic changes have taken place in China's cultural ecology: intangible cultural heritage is confronted with great challenges and a lot of orally and behaviorally transmitted cultural heritage disappear one after another; a great deal of traditional craftsmanship is on the verge of extinction; a large number of precious objects and materials of historical and cultural values are destroyed,deserted or lost in foreign countries; arbitrary misuse and excessive exploitation of intangible cultural heritage occur from time to time. Therefore, the protection of intangible cultural heritage brooks no delay.

  2. Clinical importance of electromagnetic fields

    International Nuclear Information System (INIS)

    Ruppe, I.

    1993-01-01

    The clinical importance of most of the electromagnetic fields is not highly. Mostly they only have thermal effects, produced by energy-absorption. About 1 C increase of whole-body-temperature is valid for tolerable limit. For measuring is used the SAR-Value (Specific Absorption Rate) in W/kg body mass. SAR = 0,8W/kg for the whole body is valid to be safety. For the evaluation of possible other effects of electromagnetic fields the scientific knowledges are till now not sufficient to allow a final statement. That could be impacts of electromagnetic fields to conduction or switch processes in the nerves or brains, in the framwork of cellular regulations, in the genetic reactions are occurig is little, but if is necessary to find it out in scinentific investigations. (orig.) [de

  3. Pyometra in a Great Dane: A Clinical Case Report

    Directory of Open Access Journals (Sweden)

    Malik Abu Rafee

    2015-04-01

    Full Text Available A 4-year-old Great Dane was admitted with continuous sanguino-purulent vaginal discharge, distended abdomen, and cachexia. The dog was clinically diagnosed with pyometra and successfully cured by ovario-hysterectomy. This is the first case report of pyometra seen in as Great Dane in Bareilly, India.

  4. The importance of Clinical Research

    Directory of Open Access Journals (Sweden)

    Frank Lizaraso Caparó

    2016-01-01

    Full Text Available Objetives: to describe the clinical and epidemiological characteristics, evolution and to identify mortality factors associated in patients with snp.Material and methods: descriptive study of a serie of cases of the intensive care unit (icu of a general hospital. medical records of patients which received medical attention and who meet the selection criteria were reviewed. Results: forty-one clinical records were evaluated. the average age was 69 old, predominantly male (68,3%. snp was the reason of admission in 60.9% and 95.1% required mechanical ventilation. hospital stay prior to diagnosis was 10 days, 65% of patients had some risk factor for multi resistence organisms, cpis of entry was 9.3, cultures were positive in 39% of the cases and of these, 48.8% received proper antibiotic according to culture results. the days of stay in icu were 20.6 days and 20 of the 41 medical records were for death patients. the clinical and epidemiological characteristics were similar between death and alive patients. an analysis of factors that could be associated with mortality snp was made and it was found that for an age ≥ 70 years, the presence of any risk factor for multidrug resistence organism and control cpis ≥ 6 were associated with higher mortality; while acquisition of the icu was associated to lower mortality. Conclusions: the clinical, epidemiological characteristics and evolution of patients with snp in our icu were similar to those describe in the literature. three factors associated with mortality in the icu were identified.

  5. Progress in understanding the importance of coastal wetland nursery habitat to Great Lakes fisheries support

    Science.gov (United States)

    Great Lakes coastal wetlands provide important habitat for Great Lakes fishes of all life stages. A literature review of ichthyoplankton surveys conducted in Great Lakes coastal wetlands found at least 82 species reported to be captured during the larval stage. Twenty of those sp...

  6. Listeriosis in Mexico: Clinical and epidemiological importance

    Directory of Open Access Journals (Sweden)

    Gloria Castañeda-Ruelas

    2014-11-01

    Full Text Available Listeriosis is caused by Listeria monocytogenes, an important food-borne disease due to its clinical forms, high mortality rate, and the economic impact in both clinical and food production industries. In Mexico, the lack of epidemiological surveillance systems leads to the need of accurate data on the incidence of listeriosis and its association with food-borne disease. In this paper, we present data about the presence of this bacterium in food, reports related to clinical cases of listeriosis, and information of diseases in which L. monocytogenes may be involved. However, in most of these cases the etiology was not established. Given this, there´s a need to inform and warn the appropriate entities, to define strategies for the mandatory search of L. monocytogenes through the whole food production chain and clinical suspects, for the epidemiological importance and control of listeriosis in Mexico.

  7. Responsiveness and minimal clinically important change

    DEFF Research Database (Denmark)

    Christiansen, David Høyrup; Frost, Poul; Falla, Deborah

    2015-01-01

    Study Design A prospective cohort study nested in a randomized controlled trial. Objectives To determine and compare responsiveness and minimal clinically important change of the modified Constant score (CS) and the Oxford Shoulder Score (OSS). Background The OSS and the CS are commonly used...... to assess shoulder outcomes. However, few studies have evaluated the measurement properties of the OSS and CS in terms of responsiveness and minimal clinically important change. Methods The study included 126 patients who reported having difficulty returning to usual activities 8 to 12 weeks after...... were observed for the CS and the OSS. Minimal clinically important change ROC values were 6 points for the OSS and 11 points for the CS, with upper 95% cutoff limits of 12 and 22 points, respectively. Conclusion The CS and the OSS were both suitable for assessing improvement after decompression surgery....

  8. Giant U waves: an important clinical clue

    Directory of Open Access Journals (Sweden)

    Verma N

    2011-04-01

    Full Text Available Nitin Verma, Vincent M Figueredo, Allan M Greenspan, Gregg S PressmanAlbert Einstein Medical Center, Philadelphia, PA, USAAbstract: Electrocardiographic U waves are a common clinical finding, and yet are poorly understood by many physicians. They can be seen in many clinical conditions, most importantly hypokalemia and ischemic heart disease. Over the years, many theories have been put forth to explain their origin. While still not completely understood, it now appears that mechanoelectrical interactions are responsible for normal U waves. Pathologic U waves may be seen in ischemic heart disease where they sometimes point to acute ischemic events. The large U waves of hypokalemia are most likely not true U waves but rather the terminal deflection in a bifid T wave.Keywords: U waves, hypokalemia, myocardial ischemia, electrocardiogram

  9. The importance of clinical and management scripts.

    Science.gov (United States)

    Levin, Roger P

    2004-07-01

    Simply having excellent clinical skills is not enough to enable you to achieve practice goals. In the end, people will validate the quality of the practice based on the way you and your team communicate. It is amazing to realize how much impact we have on other individuals, based purely on what we say. A well-groomed dentist and staff possessing very attractive features and beautiful teeth almost invariably will work in the practice's favor. However, these traits, powerful as they may be, are incomplete without the ability to say the right thing at the right time. In the practice, the easiest way to ensure consistently excellent communication is to use clinical and management scripts. Nothing you do in your practice will equal the impact of what you say because it affects patient perceptions of quality and overall customer service experiences. Your goal is to have all routine communications in the practice turned into written scripts within 6 months.

  10. Clinical importance of caffeine dependence and abuse.

    Science.gov (United States)

    Ogawa, Naoshi; Ueki, Hirofumi

    2007-06-01

    Caffeine is the most widely consumed psychoactive substance and is a legal stimulant that is readily available to children. Caffeine has occasionally been considered a drug of abuse and the potential for dependence on caffeine has been debated. Presently, due to a paucity of clinical evidence on caffeine dependence or abuse, no such diagnosis is included in the Diagnostic and Statistical Manual of Mental Disorder-fourth edition. The authors present two cases of abuse or dependence on the caffeine contained in 'eutrophic' (energy/nutritional) beverages or caffeine preparations, followed by a review of clinical studies demonstrating evidence that some people can manifest a clinical syndrome of caffeine dependence or abuse. The cases suggest that caffeine can produce a clinical dependence syndrome similar to those produced by other psychoactive substances and has a potential for abuse. In a recent study using a structured interview and the Diagnostic and Statistical Manual of Mental Disorder-fourth edition criteria for substance dependence and abuse, a subset of the general population was found to demonstrate caffeine dependence or caffeine abuse. Therefore, the authors propose that companies or businesses manufacturing or marketing caffeine or products containing caffeine must meet the following guidelines: (i) clearly indicate the caffeine content of products containing comparatively higher quantities of caffeine; (ii) warn that such products should be avoided by infants and children wherever possible, and inform adult consumers about the precise quantity of caffeine that is considered safe for consumption; and (iii) clearly state that consuming large quantities of caffeine and the long-term use of caffeine carry health risks.

  11. [Clinical microbiology laboratory and imported parasitic diseases].

    Science.gov (United States)

    Martín-Rabadán, Pablo; Martínez-Ruiz, Rocío; Cuadros, Juan; Cañavate, Carmen

    2010-12-01

    Imported parasitosis represents an increasingly frequent diagnostic challenge for microbiology laboratories. A surge in immigration and international travel has led to a rise in the number of imported cases of parasitosis, and this trend is expected to continue in the future. The present article addresses this challenge by reviewing recommended diagnostic approaches and tests. Currently, microscopy is always recommended when analysing blood samples for parasites. If malaria is suspected, rapid antigen testing (including at least HRP2 antigen) should also be performed. The work-up for suspected leishmaniasis should include serology, culture, and in selected cases detection of antigen in urine. In suspected Chagas disease, two different serological tests should be performed. PCR for blood protozoa is highly sensitive, although it cannot be used to rule out Chagas disease, since this condition may be present without parasitemia. Accurate diagnosis of intestinal amebiasis usually requires PCR or antigen detection tests. In helminthiasis, traditional microscopy may need to be complemented with other tests, such as agar plate culture for strongyloidiasis, Og4C3 antigen detection for bancroftian filariasis, and antibody detection test for filariasis and schistosomiasis. Copyright © 2010 Elsevier España, S.L. All rights reserved.

  12. Prevalence of zoonotic important parasites in the red fox (Vulpes vulpes) in Great Britain.

    Science.gov (United States)

    Smith, G C; Gangadharan, B; Taylor, Z; Laurenson, M K; Bradshaw, H; Hide, G; Hughes, J M; Dinkel, A; Romig, T; Craig, P S

    2003-12-01

    A national necropsy survey of red foxes was carried out across Great Britain to record Echinococcus, Trichinella and Toxoplasma. The survey did not record directly, or indirectly using coproantigen/PCR tests, evidence for the presence of Echinococcus multilocularis in 588 animals, although E. granulosus was suspected in six animals. Parasitological evidence for Trichinella spp. could not be found in 587 fox muscle digests, and a specific PCR test also failed to detect Toxoplasma in a sub-set of 61 random fox tongue biopsies. The upper 95% confidence interval for the above parasites was 0.60% (E. multilocularis), 0.60% (Trichinella spp.) and 5.6% (Toxoplasma). The commonest gut parasites were the hookworm Uncinaria stenocephala (41.3%) and the ascarid Toxocara canis (61.6%). This study also reports the second occurrence of Trichuris vulpis in Great Britain.

  13. The most important parameters of life quality of the Great Patriotic War veterans

    Directory of Open Access Journals (Sweden)

    Yuanov A.A.

    2015-03-01

    Full Text Available Purpose of the study was to estimate current state of quality of life of Great Patriotic War veterans. Materials and methods. The study included 368 veterans of the Great Patriotic War according to Federal State "Concerning veterans" #5, 1995. Protocol of the study included adapted fragments of WHOQOL, WHOQOL-Old, SF-36, SIP questioners as well as visually-analog scale of self-assessment of quality of life with further going quality of life index calculations. Re-sults. In the studied sample of the Great Patriotic War (GPW veterans including long-livers comparably was detected high level of quality of life (QOL by physical criteria and independence level. It was revealed that QOL by self-service criteria in the GPW veterans was low and extremely variable by other criteria groups. Both ageing and gender influenced upon physical activity, self-service and QOL self-assessment. Women were outstanding by psychological criteria and independence with no association with age group. Conclusion. QOL indication in the GPW veterans of studied sample elucidated a satisfactory level of healthcare in the region, which allows veterans in certain way preserve both physical and psychological health, as well as grounds positive self-assessment of personal position in society and values system according to their life-goals and expectations.

  14. The importance of Northern Dobrogea in the migration of Great Cormorant (Phalacrocorax carbo

    Directory of Open Access Journals (Sweden)

    SÁNDOR D. Attila

    2009-09-01

    Full Text Available The Great Cormorants breeding and migrating through Dobrogea belong to the Phalacrocorax carbo sinensis subspecies. It is the subspecies with the most migratory populations out of the 12 subspecies ofGreat Cormorant. The species is in expansion in most regions of Europe, the P. c. sinensis subspecies’ range is expanding the most. In Romania both the number of colonies and their size have increased since 1990. The observed increase was too fast to be based only on the reproduction rate of the original local population. We suspect that a certain degree of the increase is fuelled by cormorants originating from other populations. Out of 667 cormorants ringedduring their nesting period in the Danube Delta 11 (1.64 % were recovered, while there are 15 recoveries of this speciesringed in other countries and recaptured in Dobrogea. Most of the birds ringed in the Danube Delta migrate South, being recovered in Bulgaria (in late summer or autumn and Turkey (in winter, with one out of the range record of a bird observed in the UK. The recoveries from abroad originated from either countries around the Baltic Sea (Denmark, Estonia or from Southern Ukraine and Russia. These recoveries date from autumn (mostly October and November and spring months, with one record in December and January each. As a conclusion, we state that there is a possibility that the population increase is fuelled by immigrant birds, but this assumption should be tested by a large scale capture-recapture study, based on colorringing.

  15. Great Apes

    Science.gov (United States)

    Sleeman, Jonathan M.; Cerveny, Shannon

    2014-01-01

    Anesthesia of great apes is often necessary to conduct diagnostic analysis, provide therapeutics, facilitate surgical procedures, and enable transport and translocation for conservation purposes. Due to the stress of remote delivery injection of anesthetic agents, recent studies have focused on oral delivery and/or transmucosal absorption of preanesthetic and anesthetic agents. Maintenance of the airway and provision of oxygen is an important aspect of anesthesia in great ape species. The provision of analgesia is an important aspect of the anesthesia protocol for any procedure involving painful stimuli. Opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) are often administered alone, or in combination to provide multi-modal analgesia. There is increasing conservation management of in situ great ape populations, which has resulted in the development of field anesthesia techniques for free-living great apes for the purposes of translocation, reintroduction into the wild, and clinical interventions.

  16. Clinical and diagnostic importance of proteinuria: A review | Oni ...

    African Journals Online (AJOL)

    Clinical and diagnostic importance of proteinuria: A review. ... shown that diabetis mellitus, cardiovascular disease and hypertension could provoke secondary ... Proteinuria is also significant in some non-pathological cases such as pregnancy

  17. The phytocoenoses of anthropogenically transformed areas with a great importance for Apoidea

    Directory of Open Access Journals (Sweden)

    Małgorzata Wrzesień

    2012-12-01

    Full Text Available The paper indicates the phytocenoses most rich in bee taxons and occurring in habitats located along railway lines crossing Lublin Upland. To date, in the study area 124 basic phytocoenoses have been discovered, described and classifi ed into 12 different synecological groups. Among 52 phytocoenoses, the participation of bee flora was considerable. Most voluble phytocoenoses represent ruderal and segetal associations (Artemisietea vulgaris, Stellarietea mediae classes - 87 species, meadow and pasture associations (Mollinio-Arrhenatheretea - 56 species, psammophilous and xerothermic grasslands (Festuco- Brometea, Koelerio glauce-Corynophoretea canescensis - 38 species, thermophilous forest edge communities and thickets (Trifolio-Geranietea and Rhamno-Prunetea - 33 species. Significantly fewer melliferous and polleniferous taxons were noticed in mesophilous deciduous forests or thermophilous oak forests - 29 species. Most simple in structure and species richness are associations with Rumex acetosa, Reseda lutea, Linaria vulgaris, Papaver rhoeas, Cirsium arvense, Oenothera biennis, Viola arvensis and Potentilletum anserine or Sisymbrietum altissimi. The communities form patches (15-20 m2 with 80-100% cover of the diagnostic taxon and are of low or medium stability. The most persistent and floristically stable are Tanaceto Artemisietum, Rudbeckio- Solidaginetum, Echio-Melilotetum, Sambucetum nigrae, Rubo fruticosi-Prunetum spinosae and communities with Rosa rugosa, Rubus caesius, Geranium robertianum, Pastinaca sativa, Trifolium medium or Euphorbia cyparissias. The maintenance of the mosaic of phytocoenoses in anthropogenically transformed habitats, including those along railway lines, is of decisive importance for the protection of floristic diversity and adaptation processes of Apoidea.

  18. Importance of agricultural landscapes to nesting burrowing owls in the Northern Great Plains, USA

    Science.gov (United States)

    Restani, M.; Davies, J.M.; Newton, W.E.

    2008-01-01

    Anthropogenic habitat loss and fragmentation are the principle factors causing declines of grassland birds. Declines in burrowing owl (Athene cunicularia) populations have been extensive and have been linked to habitat loss, primarily the decline of black-tailed prairie dog (Cynomys ludovicianus) colonies. Development of habitat use models is a research priority and will aid conservation of owls inhabiting human-altered landscapes. From 2001 to 2004 we located 160 burrowing owl nests on prairie dog colonies on the Little Missouri National Grassland in North Dakota. We used multiple linear regression and Akaike's Information Criterion to estimate the relationship between cover type characteristics surrounding prairie dog colonies and (1) number of owl pairs per colony and (2) reproductive success. Models were developed for two spatial scales, within 600 m and 2,000 m radii of nests for cropland, crested wheatgrass (Agropyron cristatum), grassland, and prairie dog colonies. We also included number of patches as a metric of landscape fragmentation. Annually, fewer than 30% of prairie dog colonies were occupied by owls. None of the models at the 600 m scale explained variation in number of owl pairs or reproductive success. However, models at the 2,000 m scale did explain number of owl pairs and reproductive success. Models included cropland, crested wheatgrass, and prairie dog colonies. Grasslands were not included in any of the models and had low importance values, although percentage grassland surrounding colonies was high. Management that protects prairie dog colonies bordering cropland and crested wheatgrass should be implemented to maintain nesting habitat of burrowing owls. ?? 2008 Springer Science+Business Media B.V.

  19. 3D molecular descriptors important for clinical success.

    Science.gov (United States)

    Kombo, David C; Tallapragada, Kartik; Jain, Rachit; Chewning, Joseph; Mazurov, Anatoly A; Speake, Jason D; Hauser, Terry A; Toler, Steve

    2013-02-25

    The pharmacokinetic and safety profiles of clinical drug candidates are greatly influenced by their requisite physicochemical properties. In particular, it has been shown that 2D molecular descriptors such as fraction of Sp3 carbon atoms (Fsp3) and number of stereo centers correlate with clinical success. Using the proteomic off-target hit rate of nicotinic ligands, we found that shape-based 3D descriptors such as the radius of gyration and shadow indices discriminate off-target promiscuity better than do Fsp3 and the number of stereo centers. We have deduced the relevant descriptor values required for a ligand to be nonpromiscuous. Investigating the MDL Drug Data Report (MDDR) database as compounds move from the preclinical stage toward the market, we have found that these shape-based 3D descriptors predict clinical success of compounds at preclinical and phase1 stages vs compounds withdrawn from the market better than do Fsp3 and LogD. Further, these computed 3D molecular descriptors correlate well with experimentally observed solubility, which is among well-known physicochemical properties that drive clinical success. We also found that about 84% of launched drugs satisfy either Shadow index or Fsp3 criteria, whereas withdrawn and discontinued compounds fail to meet the same criteria. Our studies suggest that spherical compounds (rather than their elongated counterparts) with a minimal number of aromatic rings may exhibit a high propensity to advance from clinical trials to market.

  20. Many faces of rationality: Implications of the great rationality debate for clinical decision-making.

    Science.gov (United States)

    Djulbegovic, Benjamin; Elqayam, Shira

    2017-10-01

    Given that more than 30% of healthcare costs are wasted on inappropriate care, suboptimal care is increasingly connected to the quality of medical decisions. It has been argued that personal decisions are the leading cause of death, and 80% of healthcare expenditures result from physicians' decisions. Therefore, improving healthcare necessitates improving medical decisions, ie, making decisions (more) rational. Drawing on writings from The Great Rationality Debate from the fields of philosophy, economics, and psychology, we identify core ingredients of rationality commonly encountered across various theoretical models. Rationality is typically classified under umbrella of normative (addressing the question how people "should" or "ought to" make their decisions) and descriptive theories of decision-making (which portray how people actually make their decisions). Normative theories of rational thought of relevance to medicine include epistemic theories that direct practice of evidence-based medicine and expected utility theory, which provides the basis for widely used clinical decision analyses. Descriptive theories of rationality of direct relevance to medical decision-making include bounded rationality, argumentative theory of reasoning, adaptive rationality, dual processing model of rationality, regret-based rationality, pragmatic/substantive rationality, and meta-rationality. For the first time, we provide a review of wide range of theories and models of rationality. We showed that what is "rational" behaviour under one rationality theory may be irrational under the other theory. We also showed that context is of paramount importance to rationality and that no one model of rationality can possibly fit all contexts. We suggest that in context-poor situations, such as policy decision-making, normative theories based on expected utility informed by best research evidence may provide the optimal approach to medical decision-making, whereas in the context

  1. Effects of competition on great and blue tit reproduction: intensity and importance in relation to habitat quality.

    Science.gov (United States)

    Dhondt, André A

    2010-01-01

    1. In studies on the effect of competition in plant communities two terms are used to describe its effects: the absolute reduction in growth of an individual as a consequence of the presence of another one is called intensity, while the relative impact of competition on an individual as a proportion of the impact of the whole environment is called importance. One school of thought is that the role of competition remains constant across productivity gradients, while the other is that it decreases with increasing severity. J.B. Grace (1991. A clarification of the debate between grime and tilman. Functional Ecology, 5, 583-587.) suggested that the apparent contradiction might be solved if we acknowledge that the two schools are discussing different aspects of competition: the intensity of competition might remain constant while its importance declines with increasing severity. 2. There are no studies that compare intensity and importance of competition in bird populations between areas that differ in quality or productivity and hence it is not possible to make predictions how intensity or importance of competition would vary between them. 3. I compared variation in intensity and importance of competition of three demographic variables between five plots that differ strongly in quality for great Parus major L. and blue tit Cyanistes caeruleus (L.). 4. Both intensity and importance of competition are larger in great than in blue tit populations meaning that the effect of competition on demographic variables is stronger in great than in blue tits and that the contribution of competition to variation in these variables is relatively higher in great than in blue tits. 5. Intensity of competition is higher in low quality than in high quality plots for both species, a result not expected from studies in plant communities. 6. Importance of competition varies strongly between plots. It is larger in oak-dominated plots than in mixed deciduous plots. 7. In birds breeding density

  2. The importance of dialogue in student nurses' clinical education.

    Science.gov (United States)

    Haugan, Grethe; Sørensen, Ann-Hallfrid; Hanssen, Ingrid

    2012-05-01

    Develop in-hospital tutorials where the hospital unit's nurse preceptor, the college teacher and student nurses discuss clinical experiences and together acquire knowledge. Literary research combined with examples from a clinical tutorial/discussion group project with B.A. student nurses, clinical nurses and college teacher. Clinical reflection groups may be an important step towards accomplishing stability in a collaborative effort between hospital and college to help students become knowledgeable, perceptive, reflecting, caring and effective nurses. The teacher's role in clinical practice is changing. The learning method described in this text, however resource-demanding, furthers close collaboration between hospital and college, and success depends on the educator's and clinician's collective competency. Our experience is that all parties concerned found that they gained a more holistic view of nurse education through participating in a forum focused on students' experiences through patient histories. Copyright © 2011 Elsevier Ltd. All rights reserved.

  3. Students' Assessment and Self-assessment of Nursing Clinical Faculty Competencies: Important Feedback in Clinical Education?

    Science.gov (United States)

    Lovrić, Robert; Prlić, Nada; Zec, Davor; Pušeljić, Silvija; Žvanut, Boštjan

    2015-01-01

    The students' assessment of clinical faculty competencies and the faculty members' self-assessment can provide important information about nursing clinical education. The aim of this study was to identify the differences between the students' assessment of the clinical faculty member's competencies and the faculty member's self-assessment. These differences can reveal interesting insights relevant for improving clinical practice.

  4. Importance of Pharmaceutical Training and Clinical Research at Medical Facilities.

    Science.gov (United States)

    Myotoku, Michiaki

    2017-01-01

    To respond to advancements in medical techniques, and to address the separation of medical and dispensary practices, clinical professors are required to educate human resource staff to become highly-skilled pharmacists. For this purpose, it is extremely important for these professors to learn about cutting-edge practical skills and knowledge, as well as to advance their expertise. In addition, they need to conduct clinical research in cooperation with relevant facilities. As our university does not have its own hospital or pharmacy, it is important to provide training for clinical professors in clinical facilities. Such training mainly involves medical teams' in-hospital rounds and participation in conferences (nutrition support team; NST), operation of the pharmacy department, and intervention targeting improvement in the department's duties. We have conducted collaborative studies, provided research instructions, implemented studies aimed at improving the department's work (pharmacists appointed on wards at all times to ensure medical safety) as well as studies regarding team medical care (nutritional evaluation during outpatient chemotherapy), and resolved issues regarding this work (drug solution mixability in a hand-held constant infusion pump, and a safe pump-filling methods). Thus, it has become possible to keep track of the current state of a pharmacists' work within team medical care, to access information about novel drugs, to view clinical and prescription-claim data, to cooperate with other professionals (e.g., doctors and nurses), to promote pharmacists' self-awareness of their roles in cooperative medical practice, and to effectively maintain the hospital's clinical settings.

  5. Public health importance of lassa fever epidemiology, clinical ...

    African Journals Online (AJOL)

    The public health importance of Lassa fever can not be over emphasized if one considers the high infectivity and mortality rates associated with the disease. This study dealt extensively on the epidemiology, clinical features and current management of Lassa fever through literature review. The aim of this study is to sensitise ...

  6. Reversible left ventricular dysfunction - important clinical problem of contemporary cardiology

    International Nuclear Information System (INIS)

    Witkowski, A.

    1994-01-01

    An important clinical issue there is determination whether left ventricular damages are reversible or not single photon emission computed tomography and positron computed tomography techniques are shown to provide valuable data in this problem. Article describes basic syndromes connected with left ventricular dysfunction, namely: hibernating myocardium, stunned myocardium and ischemic myocardium preconditioning. (author). 18 refs

  7. The importance of intuition in the occupational medicine clinical consultation.

    Science.gov (United States)

    Philipp, R; Philipp, E; Thorne, P

    1999-01-01

    Clinical consultation involves unspoken elements which flow between doctor and patient. They are vital ingredients of successful patient management but are not easily measured, objective or evidence-based. These elements include empathy and intuition for what the patient is experiencing and trying to express, or indeed suppressing. Time is needed to explore the instinctive feeling for what is important, particularly in present day society which increasingly recognizes the worth of psychosocial factors. This time should be available in the occupational health consultation. In this paper the importance of intuition and its essential value in the clinical interview are traced through history. Differences between intuition and empathy are explored and the use of intuition as a clinical tool is examined.

  8. Graduate admissions in clinical neuropsychology: the importance of undergraduate training.

    Science.gov (United States)

    Karazsia, Bryan T; Stavnezer, Amy Jo; Reeves, Jonathan W

    2013-11-01

    Discussions of and recommendations for the training of clinical neuropsychologists exist at the doctoral, internship, and post-doctoral level. With few exceptions, the literature on undergraduate preparations in clinical neuropsychology is sparse and lacks empirical evidence. In the present study, graduate-level faculty and current trainees completed surveys about graduate school preparations. Faculty expectations of minimum and ideal undergraduate training were highest for research methods, statistics, and assessment. Preferences for "goodness of fit" also emerged as important admissions factors. These results offer evidence for desirable undergraduate preparations for advanced study in clinical neuropsychology. Although undergraduate training in psychology is intentionally broad, results from this study suggest that students who desire advanced study in clinical neuropsychology need to tailor their experiences to be competitive in the application process. The findings have implications for prospective graduate students, faculty who train and mentor undergraduates, and faculty who serve on admissions committees.

  9. The importance of coastal altimetry retracking and detiding: A case study around the Great Barrier Reef, Australia

    DEFF Research Database (Denmark)

    Idris, Nurul H.; Deng, Xiaoli; Andersen, Ole Baltazar

    2014-01-01

    , fuzzy-retracked SLAs become available within 5 km of the coast; meanwhile it becomes more important to use pointwise tide modelling rather than state-of-the-art global tidal models, as the latter leave residual ocean tide signals in retracked SLAs. These improvements are demonstrated for Jason-2...... waveforms in the area of the Great Barrier Reef, Australia. Comparing the retrieved SLAs with in situ tide gauge data from Townsville and Bundaberg stations showed that the SLAs from this study generally outperform those from conventional methods, demonstrating that adequate waveform retracking and detiding...

  10. Many faces of rationality: Implications of the great rationality debate for clinical decision‐making

    Science.gov (United States)

    Elqayam, Shira

    2017-01-01

    Abstract Given that more than 30% of healthcare costs are wasted on inappropriate care, suboptimal care is increasingly connected to the quality of medical decisions. It has been argued that personal decisions are the leading cause of death, and 80% of healthcare expenditures result from physicians' decisions. Therefore, improving healthcare necessitates improving medical decisions, ie, making decisions (more) rational. Drawing on writings from The Great Rationality Debate from the fields of philosophy, economics, and psychology, we identify core ingredients of rationality commonly encountered across various theoretical models. Rationality is typically classified under umbrella of normative (addressing the question how people “should” or “ought to” make their decisions) and descriptive theories of decision‐making (which portray how people actually make their decisions). Normative theories of rational thought of relevance to medicine include epistemic theories that direct practice of evidence‐based medicine and expected utility theory, which provides the basis for widely used clinical decision analyses. Descriptive theories of rationality of direct relevance to medical decision‐making include bounded rationality, argumentative theory of reasoning, adaptive rationality, dual processing model of rationality, regret‐based rationality, pragmatic/substantive rationality, and meta‐rationality. For the first time, we provide a review of wide range of theories and models of rationality. We showed that what is “rational” behaviour under one rationality theory may be irrational under the other theory. We also showed that context is of paramount importance to rationality and that no one model of rationality can possibly fit all contexts. We suggest that in context‐poor situations, such as policy decision‐making, normative theories based on expected utility informed by best research evidence may provide the optimal approach to medical decision

  11. Minimal clinically important difference in the fibromyalgia impact questionnaire.

    Science.gov (United States)

    Bennett, Robert M; Bushmakin, Andrew G; Cappelleri, Joseph C; Zlateva, Gergana; Sadosky, Alesia B

    2009-06-01

    The Fibromyalgia Impact Questionnaire (FIQ) is a disease-specific composite instrument that measures the effect of problems experienced by patients with fibromyalgia (FM). Utilization of the FIQ in measuring changes due to interventions in FM requires derivation of a clinically meaningful change for that instrument. Analyses were conducted to estimate the minimal clinically important difference (MCID), and to propose FIQ severity categories. Data from 3 similarly designed, 3-month placebo-controlled, clinical treatment trials of pregabalin 300, 450, and 600 mg/day in patients with FM were modeled to estimate the change in the mean FIQ total and stiffness items corresponding to each category on the Patient Global Impression of Change. FIQ severity categories were modeled and determined using established pain severity cutpoints as an anchor. A total of 2228 patients, mean age 49 years, 93% women, with a mean baseline FIQ total score of 62 were treated in the 3 studies. Estimated MCID on a given measure were similar across the studies. In a pooled analysis the estimated MCID (95% confidence interval) was 14% (13; 15) and for FIQ stiffness it was 13% (12; 14). In the severity analysis a FIQ total score from 0 to or= 39 to or=59 to 100 a severe effect. The analysis indicates that a 14% change in the FIQ total score is clinically relevant, and results of these analyses should enhance the clinical utility of the FIQ in research and practice.

  12. Optimizer convergence and local minima errors and their clinical importance

    International Nuclear Information System (INIS)

    Jeraj, Robert; Wu, Chuan; Mackie, Thomas R

    2003-01-01

    Two of the errors common in the inverse treatment planning optimization have been investigated. The first error is the optimizer convergence error, which appears because of non-perfect convergence to the global or local solution, usually caused by a non-zero stopping criterion. The second error is the local minima error, which occurs when the objective function is not convex and/or the feasible solution space is not convex. The magnitude of the errors, their relative importance in comparison to other errors as well as their clinical significance in terms of tumour control probability (TCP) and normal tissue complication probability (NTCP) were investigated. Two inherently different optimizers, a stochastic simulated annealing and deterministic gradient method were compared on a clinical example. It was found that for typical optimization the optimizer convergence errors are rather small, especially compared to other convergence errors, e.g., convergence errors due to inaccuracy of the current dose calculation algorithms. This indicates that stopping criteria could often be relaxed leading into optimization speed-ups. The local minima errors were also found to be relatively small and typically in the range of the dose calculation convergence errors. Even for the cases where significantly higher objective function scores were obtained the local minima errors were not significantly higher. Clinical evaluation of the optimizer convergence error showed good correlation between the convergence of the clinical TCP or NTCP measures and convergence of the physical dose distribution. On the other hand, the local minima errors resulted in significantly different TCP or NTCP values (up to a factor of 2) indicating clinical importance of the local minima produced by physical optimization

  13. Clinically Significant Behavior Problems among Young Children 2 Years after the Great East Japan Earthquake

    Science.gov (United States)

    Fujiwara, Takeo; Yagi, Junko; Homma, Hiroaki; Mashiko, Hirobumi; Nagao, Keizo; Okuyama, Makiko

    2014-01-01

    Background On March 11, 2011, a massive undersea earthquake and tsunami struck East Japan. Few studies have investigated the impact of exposure to a natural disaster on preschool children. We investigated the association of trauma experiences during the Great East Japan Earthquake on clinically significant behavior problems among preschool children 2 years after the earthquake. Method Participants were children who were exposed to the 2011 disaster at preschool age (affected area, n = 178; unaffected area, n = 82). Data were collected from September 2012 to June 2013 (around 2 years after the earthquake), thus participants were aged 5 to 8 years when assessed. Severe trauma exposures related to the earthquake (e.g., loss of family members) were assessed by interview, and trauma events in the physical environment related to the earthquake (e.g. housing damage), and other trauma exposure before the earthquake, were assessed by questionnaire. Behavior problems were assessed by caregivers using the Child Behavior Checklist (CBCL), which encompasses internalizing, externalizing, and total problems. Children who exceeded clinical cut-off of the CBCL were defined as having clinically significant behavior problems. Results Rates of internalizing, externalizing, and total problems in the affected area were 27.7%, 21.2%, and 25.9%, respectively. The rate ratio suggests that children who lost distant relatives or friends were 2.36 times more likely to have internalizing behavior problems (47.6% vs. 20.2%, 95% CI: 1.10–5.07). Other trauma experiences before the earthquake also showed significant positive association with internalizing, externalizing, and total behavior problems, which were not observed in the unaffected area. Conclusions One in four children still had behavior problems even 2 years after the Great East Japan Earthquake. Children who had other trauma experiences before the earthquake were more likely to have behavior problems. These data will be

  14. Vitamin D binding protein: a multifunctional protein of clinical importance.

    Science.gov (United States)

    Speeckaert, Marijn M; Speeckaert, Reinhart; van Geel, Nanja; Delanghe, Joris R

    2014-01-01

    Since the discovery of group-specific component and its polymorphism by Hirschfeld in 1959, research has put spotlight on this multifunctional transport protein (vitamin D binding protein, DBP). Besides the transport of vitamin D metabolites, DBP is a plasma glycoprotein with many important functions, including sequestration of actin, modulation of immune and inflammatory responses, binding of fatty acids, and control of bone development. A considerable DBP polymorphism has been described with a specific allele distribution in different geographic area. Multiple studies have shed light on the interesting relationship between polymorphisms of the DBP gene and the susceptibility to diseases. In this review, we give an overview of the multifunctional character of DBP and describe the clinical importance of DBP and its polymorphisms. Finally, we discuss the possibilities to use DBP as a novel therapeutic agent.

  15. Revision and Implementation of "Clinical Guideline for Tuberculosis and HIV in Prisons", Great Tehran Prison, Iran.

    Science.gov (United States)

    Farhoudi, Behnam; SeyedAlinaghi, SeyedAhmad; Tabarsi, Payam; Mohraz, Minoo; Golrokhy, Raheleh; Farnia, Marzieh; Shahbazi, Mohammad; Alasvand, Ramin; Ebrahimi, Bahman; Esfehani, Jafar; Tashakoriyan, Mehrzad

    2018-01-01

    To evaluate the feasibility of the revised "Clinical Guideline for HIV and TB" in the Great Tehran Prison during October 2013 to June 2014. The guideline includes all aspects of HIV/TB diagnosis based on active case finding (ACF), treatment and care services. Before the implementation, a focus group discussion was conducted, and attended by experts on prison health. The objective was to identify defects and limitations of the guideline. After the discussion, the guideline was revised. The Great Tehran Prison contains three separate units; all prisoners are taken first to "reception and identification unit (quarantine)" and then send to two housing units according to their legal status. An HIV ACF strategy was employed in the quarantine, and two units through a voluntary provider-initiated HIV testing. Three staff of the triangular clinic trained the prisoners about common routes of HIV transmission and the symptoms of TB in the units. In the quarantine, all prisoners were examined for all HIV-risk factors, HIV testing and symptoms of TB. In unit one, healthcare staff continued the ACF process, while in unit two, the peers of prisoners were assigned as the healthcare communicators to proceed with the strategy. At this caring process, when the test result was positive, then the process of care, treatment and follow ups was initiated. Moreover, the use of directly observed therapy (DOT) for antiretroviral therapy (ART) and TB was applied to the sick prisoners. There was also a follow-up caring for released prisoner to refer them to care and treatment services outside the prison. The guideline was implemented in the prison successfully. Regarding feasibility of the guideline, the investigators of this study suggest that the guideline should be implemented in other prisons across the country. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  16. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations

    DEFF Research Database (Denmark)

    Dworkin, R.H.; Turk, D.C.; Wyrwich, K.W.

    2008-01-01

    of 40 participants from universities, governmental agencies, a patient self-help organization, and the pharmaceutical industry considered methodologic issues and research results relevant to determining the clinical importance of changes in the specific outcome measures previously recommended by IMMPACT...

  17. MARTIN–GRUBER ANASTOMOSIS AND ITS CLINICAL IMPORTANCE

    Directory of Open Access Journals (Sweden)

    I. G. Mikhaylyuk

    2015-01-01

    Full Text Available The communication between the median and ulnar nerves on the forearm, known as the Martin–Gruber anastomosis, is widespread in the general population. Despite the fact that this connection is described by anatomists in XVIII century, its importance has only recently been appreciated because of the widespread of the electrophysiological techniques in clinical practies. However, in the Russian literature aspects of its practical value described so far is not enough. This article deals with the prevalence of the anastomosis, its anatomical and electrophysiological classification, options innervation of muscles of the hand, is carried out through him, described electrophysiological methods and criteria for its diagnosis, including the collision technique, in healthy subjects and patients with lesions of the median and ulnar nerves, given its practical value. Such a course of nerve fibers through this anastomosis can have a significant impact on the clinical manifestations in patients with lesions of the median and ulnar nerves, as well as the results of an electrophysiological study. Martin–Gruber anastomosis provides variability innervation muscles of the hand, which can make it difficult topic diagnostic damage to the median and ulnar nerves, in addition, because of the connection between the nerves of the clinical presentation may not reflect the extent of their defeat: the hand muscles function can be preserved with full nerve damage or, conversely, significantly disrupted with minimal nerve lesions. Moreover, different electrophysiological findings on patients with pathology of the median or ulnar nerves in the conditions of functioning anastomosis may also complicate the interpretation of the clinical data. Thus, knowledge of the anatomy and physiology of the Martin–Gruber communication as necessary for the electrophysiologist for correct interpretation of the finding and the clinician to accurately diagnose the pathology of the median

  18. Health status measurement in COPD : the minimal clinically important difference of the clinical COPD questionnaire

    NARCIS (Netherlands)

    Kocks, J. W. H.; Tuinenga, M. G.; Uil, S. M.; van den Berg, J. W. K.; Stahl, E.; van der Molen, T.

    2006-01-01

    Background: Patient-reported outcomes ( PRO) questionnaires are being increasingly used in COPD clinical studies. The challenge facing investigators is to determine what change is significant, ie what is the minimal clinically important difference (MCID). This study aimed to identify the MCID for

  19. Clinically important drug interactions with zopiclone, zolpidem and zaleplon.

    Science.gov (United States)

    Hesse, Leah M; von Moltke, Lisa L; Greenblatt, David J

    2003-01-01

    Insomnia, an inability to initiate or maintain sleep, affects approximately one-third of the American population. Conventional benzodiazepines, such as triazolam and midazolam, were the treatment of choice for short-term insomnia for many years but are associated with adverse effects such as rebound insomnia, withdrawal and dependency. The newer hypnosedatives include zolpidem, zaleplon and zopiclone. These agents may be preferred over conventional benzodiazepines to treat short-term insomnia because they may be less likely to cause significant rebound insomnia or tolerance and are as efficacious as the conventional benzodiazepines. This review aims to summarise the published clinical drug interaction studies involving zolpidem, zaleplon and zopiclone. The pharmacokinetic and pharmacodynamic interactions that may be clinically important are highlighted. Clinical trials have studied potential interactions of zaleplon, zolpidem and zopiclone with the following types of drugs: cytochrome P450 (CYP) inducers (rifampicin), CYP inhibitors (azoles, ritonavir and erythromycin), histamine H(2) receptor antagonists (cimetidine and ranitidine), antidepressants, antipsychotics, antagonists of benzodiazepines and drugs causing sedation. Rifampicin significantly induced the metabolism of the newer hypnosedatives and decreased their sedative effects, indicating that a dose increase of these agents may be necessary when they are administered with rifampicin. Ketoconazole, erythromycin and cimetidine inhibited the metabolism of the newer hypnosedatives and enhanced their sedative effects, suggesting that a dose reduction may be required. Addition of ethanol to treatment with the newer hypnosedatives resulted in additive sedative effects without altering the pharmacokinetic parameters of the drugs. Compared with some of the conventional benzodiazepines, fewer clinically important interactions appear to have been reported in the literature with zaleplon, zolpidem and zopiclone. The

  20. Clinical importance of voluntary and induced Bennett movement.

    Science.gov (United States)

    Tupac, R G

    1978-07-01

    A total of 136 dentulous patients were divided into three groups for purposes of quantitative pantographic comparison of voluntary and induced Bennett movement. The effects of patient age and operator experience on recording the Bennett movement were also studied. The results indicates that for patients studied with Bennett movement iduced in the manner described: 1. Experienced operators can obtain more induced Bennett movement that inexperienced operators. 2. Inducing Bennett movement has a greater effect on the immediate side shift component than it has on the progressive side shift component. 3. For older individuals the amount and direction of induced immediate side shift is greater than for younger patients, statistically highly significant, and therefore clinically important. In conclusion, if the objective of a pantographic survey is to record the complete capacity of the joint to move, *lateral jaw movements must be induced.

  1. The importance of clinical case reports in research

    Directory of Open Access Journals (Sweden)

    Ricardo Pineda-Leguízamo

    2018-04-01

    Full Text Available Clinical case reports correspond to articles that have the lowest level of evidence within different research trials. However, not only are they common and significant in the medical field, but they have often been the basis the generation of research. The purpose of their publication can be scientific or educational. In general terms, the discovery of new diseases, the presentation of rare diseases, unusual forms of common diseases, the complications of a common treatment, or the effect (beneficial or adverse of a treatment, among other things, are narrated in these documents. Clinical case reports continue to be one of the most important sources of knowledge. The advent of a standardized guideline for the creation of this type of reports allows homogenizing the form and content of the cases intended to be described in the near future and, furthermore, will enable authors to have a reference when preparing this type of publications. Case reports are valuable resources of new and unusual information that can encourage and serve to conduct future research studies with a higher level of evidence.

  2. Bactericidal effects of bioactive glasses on clinically important aerobic bacteria.

    Science.gov (United States)

    Munukka, Eveliina; Leppäranta, Outi; Korkeamäki, Mika; Vaahtio, Minna; Peltola, Timo; Zhang, Di; Hupa, Leena; Ylänen, Heimo; Salonen, Jukka I; Viljanen, Matti K; Eerola, Erkki

    2008-01-01

    Bioactive glasses (BAGs) have been studied for decades for clinical use, and they have found many dental and orthopedic applications. BAGs have also been shown to have an antibacterial effect e.g., on some oral microorganisms. In this extensive work we show that six powdered BAGs and two sol-gel derived materials have a clear antibacterial effect on 29 clinically important bacterial species. We also incorporated a rapid and accurate flow cytometric (FCM) method to calculate and standardize the numbers of viable bacteria inoculated in the suspensions used in the tests for antibacterial activity. In all materials tested growth inhibition could be demonstrated, although the concentration and time needed for the effect varied depending on the BAG. The most effective glass was S53P4, which had a clear growth-inhibitory effect on all pathogens tested. The sol-gel derived materials CaPSiO and CaPSiO II also showed a strong antibacterial effect. In summary, BAGs were found to clearly inhibit the growth of a wide selection of bacterial species causing e.g., infections on the surfaces of prostheses in the body after implantation.

  3. Variations in Transverse Foramina of Cervical Vertebrae: Morphology & Clinical Importance

    Directory of Open Access Journals (Sweden)

    Vaishakhi Gonsai

    2015-12-01

    Full Text Available Background: The purpose of this study is to investigate variations in transverse foramina in the cervical vertebrae and its morphological and clinical importance. Materials and Method : The variations in the number and size of transverse foramina was studied in total 200 human dried cervical vertebrae, which were taken from the Department of Anatomy, B.J.Medical College, Ahmedabad. All the vertebrae were observed for variation in number and size of transverse foramina. Results: Out of 200 cervical vertebrae, complete double transverse foramina were observed in 40 vertebrae (20%, among them unilateral double foramina were found in 31 vertebrae (15.5% and the bilateral double foramina were found in 9 vertebrae (4.5%. Incomplete double transverse foramina were observed in 22 vertebrae (11%, among them unilateral double foramina were found in 16 vertebrae (8% and bilateral double foramina were observed in 6 vertebrae (3%. Conclusion: Complete unilateral double transverse foramina of cervical vertebrae were more common than bilateral. Also unilateral small size transverse foramina of cervical vertebrae were also common. This variation is important for the neurosurgeon during cervical surgery. Under such condition the course of the vertebral artery may be distorted. It is also useful for Radiologist during CT and MRI scan.

  4. [Antibacterial and antifungal activity of Salvia apiana against clinically important microorganisms].

    Science.gov (United States)

    Córdova-Guerrero, Iván; Aragon-Martinez, Othoniel H; Díaz-Rubio, Laura; Franco-Cabrera, Santiago; Serafín-Higuera, Nicolas A; Pozos-Guillén, Amaury; Soto-Castro, Tely A; Martinez-Morales, Flavio; Isiordia-Espinoza, Mario

    Due to the great global concern regarding bacterial resistance to antibiotics, an ongoing search for new molecules having antibacterial activity is necessary. This study evaluated the antibacterial and anticandidal effects of a hexane extract from the root of Salvia apiana. Salvia extracts at concentrations of 27, 13.5, 6.8 and 3.4mg/ml caused growth inhibition of Staphylococcus aureus, Streptococcus pyogenes, Enterococcus faecalis and Candida albicans. However, no significant effect was observed on Escherichia coli and Candida tropicalis in comparison to vehicle. It was here demonstrated for the first time that Salvia apiana has an important antimicrobial effect on human pathogens of great clinical value, thus opening the field to continue the evaluation of this lamiaceous plant for its future use as a therapeutic agent. Copyright © 2016 Asociación Argentina de Microbiología. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Reasoning, evidence, and clinical decision-making: The great debate moves forward.

    Science.gov (United States)

    Loughlin, Michael; Bluhm, Robyn; Buetow, Stephen; Borgerson, Kirstin; Fuller, Jonathan

    2017-10-01

    When the editorial to the first philosophy thematic edition of this journal was published in 2010, critical questioning of underlying assumptions, regarding such crucial issues as clinical decision making, practical reasoning, and the nature of evidence in health care, was still derided by some prominent contributors to the literature on medical practice. Things have changed dramatically. Far from being derided or dismissed as a distraction from practical concerns, the discussion of such fundamental questions, and their implications for matters of practical import, is currently the preoccupation of some of the most influential and insightful contributors to the on-going evidence-based medicine debate. Discussions focus on practical wisdom, evidence, and value and the relationship between rationality and context. In the debate about clinical practice, we are going to have to be more explicit and rigorous in future in developing and defending our views about what is valuable in human life. © 2017 John Wiley & Sons, Ltd.

  6. Importance of training on clinical thinking and clinical competence to interventional radiologists

    International Nuclear Information System (INIS)

    Xu Ke; Zhong Hongshan

    2010-01-01

    Although the history of Interventional Radiology is no longer than 50 years, interventional techniques have been dramatically developed. Interventional radiologists have been responsible for much of the medical innovations and development of the minimally invasive procedures that are commonplace today to treat many complicated diseases as physicians. But the education backgrounds of interventional radiologist in China are different. Therefore, we should be aware that the job of an interventional radiologist is totally different from that of a diagnostic radiologist. It is very important to train interventional radiologists for improving their clinical thinking and clinical competence. Herein, we propose our suggestions on how to improve the clinical thinking and clinical competence of interventional radiologists. In this paper we also systemically introduce the accurate and proper treatment procedures which should be strictly followed in clinical work and,meanwhile, the perioperative patients care is emphasized. (authors)

  7. PET: the importance of physicists for the clinical arena

    CERN Multimedia

    2005-01-01

    David Townsend giving a seminar at CERN on 9 February. The past few years have seen significant advances in the development of instrumentation for Positron Emission Tomography (PET). The recent appearance of combined PET and Computed Tomography (CT) scanners that can simultaneously image both anatomy and function is of particular importance. This was the main subject of "Advances in PET imaging: from physics to physician", a seminar presented at CERN by David Townsend on Wednesday 9 February  and organized by the TT and PH groups. David Townsend, who started his career at CERN in the 1970s, is now Professor at the Department of Medicine, University of Tennessee Medical Center (Knoxville, TN). Recipient of the 2004 Clinical Scientist of the Year Award, he is an internationally renowned researcher and PET physicist, with over 25 years of experience in the field. His 1999 image of the year, an award from the Society of Nuclear Medicine in the US, was produced using a combined state-of-the art PET and a true d...

  8. Is statistical significance clinically important?--A guide to judge the clinical relevance of study findings

    NARCIS (Netherlands)

    Sierevelt, Inger N.; van Oldenrijk, Jakob; Poolman, Rudolf W.

    2007-01-01

    In this paper we describe several issues that influence the reporting of statistical significance in relation to clinical importance, since misinterpretation of p values is a common issue in orthopaedic literature. Orthopaedic research is tormented by the risks of false-positive (type I error) and

  9. Copy number variation plays an important role in clinical epilepsy

    Science.gov (United States)

    Olson, Heather; Shen, Yiping; Avallone, Jennifer; Sheidley, Beth R.; Pinsky, Rebecca; Bergin, Ann M.; Berry, Gerard T.; Duffy, Frank H.; Eksioglu, Yaman; Harris, David J.; Hisama, Fuki M.; Ho, Eugenia; Irons, Mira; Jacobsen, Christina M.; James, Philip; Kothare, Sanjeev; Khwaja, Omar; Lipton, Jonathan; Loddenkemper, Tobias; Markowitz, Jennifer; Maski, Kiran; Megerian, J. Thomas; Neilan, Edward; Raffalli, Peter C.; Robbins, Michael; Roberts, Amy; Roe, Eugene; Rollins, Caitlin; Sahin, Mustafa; Sarco, Dean; Schonwald, Alison; Smith, Sharon E.; Soul, Janet; Stoler, Joan M.; Takeoka, Masanori; Tan, Wen-Han; Torres, Alcy R.; Tsai, Peter; Urion, David K.; Weissman, Laura; Wolff, Robert; Wu, Bai-Lin; Miller, David T.; Poduri, Annapurna

    2015-01-01

    Objective To evaluate the role of copy number abnormalities detectable by chromosomal microarray (CMA) testing in patients with epilepsy at a tertiary care center. Methods We identified patients with ICD-9 codes for epilepsy or seizures and clinical CMA testing performed between October 2006 and February 2011 at Boston Children’s Hospital. We reviewed medical records and included patients meeting criteria for epilepsy. We phenotypically characterized patients with epilepsy-associated abnormalities on CMA. Results Of 973 patients who had CMA and ICD-9 codes for epilepsy or seizures, 805 patients satisfied criteria for epilepsy. We observed 437 copy number variants (CNVs) in 323 patients (1–4 per patient), including 185 (42%) deletions and 252 (58%) duplications. Forty (9%) were confirmed de novo, 186 (43%) were inherited, and parental data were unavailable for 211 (48%). Excluding full chromosome trisomies, CNV size ranged from 18 kb to 142 Mb, and 34% were over 500 kb. In at least 40 cases (5%), the epilepsy phenotype was explained by a CNV, including 29 patients with epilepsy-associated syndromes and 11 with likely disease-associated CNVs involving epilepsy genes or “hotspots.” We observed numerous recurrent CNVs including 10 involving loss or gain of Xp22.31, a region described in patients with and without epilepsy. Interpretation Copy number abnormalities play an important role in patients with epilepsy. Given that the diagnostic yield of CMA for epilepsy patients is similar to the yield in autism spectrum disorders and in prenatal diagnosis, for which published guidelines recommend testing with CMA, we recommend the implementation of CMA in the evaluation of unexplained epilepsy. PMID:24811917

  10. Clinical features and surgical outcomes of complete transposition of the great arteries

    Directory of Open Access Journals (Sweden)

    Suk Jin Hong

    2012-10-01

    Full Text Available <B>Purpose:</B> This single-center study aimed to assess the clinical features and surgical approaches and outcomes of complete transposition of the great arteries (TGA. <B>Methods:</B> TGA patients who had undergone surgical correction at the Kyungpook National University Hospital from January 2000 to December 2010, were retrospectively evaluated for patient characteristics, clinical manifestation, preoperative management, intraoperative findings, postoperative progress, and follow-up status. <B>Results:</B> Twenty-eight patients (17 boys and 11 girls, mean age= 10.6±21.5 days were included and were categorized as follows: group I, TGA with intact ventricular septum (n=13; group II, TGA with ventricular septal defect (VSD, n=12; and group III, TGA/VSD with pulmonary stenosis (n=3. Group I underwent the most intensive preoperative management (balloon atrial septostomy and prostaglandin E1 medication. Group II showed the highest incidence of heart failure (P<0.05. Usual and unusual coronary anatomy patterns were observed in 20 (71% and 8 patients, respectively. Arterial and half-turned truncal switch operations were performed in 25 and 3 patients (Group III, respectively. Postoperative complications included cardiac arrhythmias (8 patients, central nervous system complications (3 patients, acute renal failure (1 patient, infections (3 patients, and cardiac tamponade (1 patient, and no statistically significant difference was observed between the groups. Group II showed the mildest aortic regurgitation on follow-up echocardiograms (P<0.05. One patient underwent reoperation, and 1 died. The overall mortality rate was 4%. <B>Conclusion:</B> Our study showed favorable results in all the groups and no significant difference in postoperative complication, reoperation, and mortality among the groups. However, our results were

  11. Role of the Vision Van, a mobile ophthalmic outpatient clinic, in the Great East Japan Earthquake

    Directory of Open Access Journals (Sweden)

    Yuki K

    2014-04-01

    Full Text Available Kenya Yuki,1 Toru Nakazawa,2 Daijiro Kurosaka,3 Tsunehiko Yoshida,4–6 Eduardo C Alfonso,7 Richard K Lee,7 Shigeru Takano,8 Kazuo Tsubota1 1Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; 2Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan; 3Department of Ophthalmology, Iwate Medical University, Iwate, Japan; 4The House of Representatives of Japan, Tokyo, Japan; 5Nagoya University Hospital, Aichi, Japan; 6Aichi Medical University Hospital, Aichi, Japan; 7Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA; 8Japan Ophthalmological Association, Tokyo, Japan Purpose: The Great East Japan Earthquake of March 11, 2011 triggered powerful tsunami waves off the northeastern Pacific coast of Japan that destroyed almost all of the built-up areas along the coast. The study reported here examined the role played by the Vision Van, a mobile outpatient ophthalmological clinic, in providing eye care to disaster evacuees. Methods: This was a retrospective case-series study of 2,070 victims (male: 732, female: 1,338 who visited the Vision Van. The subjects' medical records were examined retrospectively and analyzed in terms of age, sex, and date of visit to the Vision Van. Information regarding each patient's chief complaint, diagnosis, medication(s prescribed, and eyeglasses and contact lenses provided, was also examined. Results: The Vision Van was used to conduct medical examinations on 39 days between April 23 and June 29, 2011. The average number of subjects visiting the Vision Van each day was 53±31 (range: 7–135, with examinations carried out in Miyagi Prefecture and Iwate Prefecture. The most frequent complaint was a need for eye drops (871/2,070 [42.1%]. The second and third most frequent complaints, respectively, were the need for contact lenses (294/2,070 [14.2%] and eyeglasses (280/2,070 [13.5%]. The most frequent ocular disease diagnosis

  12. Clinical importance of cross-reactivity in food allergy

    NARCIS (Netherlands)

    van Ree, Ronald

    2004-01-01

    PURPOSE OF REVIEW: Review of recent developments in the field of cross-reactivity in food allergy and the clinical relevance of these developments. RECENT FINDINGS: New foods have been added to the list of Bet v 1 and profilin-related food allergies. Clinical relevance of cross-reactions based on

  13. Clinical and Business Intelligence: Why It's Important to Your Pharmacy.

    Science.gov (United States)

    Pinto, Brian; Fox, Brent I

    2016-07-01

    According to the Healthcare Information Management and Systems Society, "Clinical & Business Intelligence (C&BI) is the use and analysis of data captured in the healthcare setting to directly inform decision-making" (http://www.himss.org/library/clinical-business-intelligence). Some say that it is the right information given to the right person at the right time in the right way. No matter how you define it, the fact remains that timely access, synthesis, and visualization of clinical data have become key to how health professionals make patient care decisions and improve care delivery.

  14. Importance of clinical microbiologists for U.S. healthcare infrastructure.

    Science.gov (United States)

    Carvalho, John

    2011-01-01

    Clinical microbiologists are highly skilled scientists within national hospitals and reference laboratories who diagnose patients with infections by emerging pathogens. Most advanced training for clinical microbiologists occurs at universities, where an individual can receive certification as a "Medical Laboratory Scientist" (MLS). Unfortunately, many MLS programs have closed in the United States and this has caused a shortage of clinical microbiologists at U.S. hospitals and reference laboratories. This paper explores the present crisis in MLS training and its ramifications for the emergence of antibiotic-resistant bacteria, the economics of hospitals, and the overall health of the nation, and provides resolutions for better public health policy with respect to MLS education.

  15. Clinical results of a new strategy (modified CHIVA) for surgical treatment of anterior accessory great saphenous varicose veins.

    Science.gov (United States)

    Maldonado-Fernández, Nicolás; Linares-Palomino, Jose Patricio; López-Espada, Cristina; Martínez-Gámez, Francisco Javier; Ros-Díe, Eduardo

    2016-03-01

    Traditionally, anterior accessory great saphenous vein insufficiency was managed by crossectomy and resection of varicose veins. The aim of this paper is to show the safety and efficacy of a new therapeutic strategy for anterior accessory great saphenous varicose veins. This non-randomised prospective study included 65 patients with varicose veins from the anterior accessory great saphenous vein. The novelty of the technique is to avoid the great saphenous vein crossectomy and perform just flebectomy of the visible veins. Venous duplex studies were performed preoperatively, a month and a year postoperatively. The clinical assessment was done by the Fligelstone scale. The baseline CEAP clinical classification was: 58% C2, 26% C3 and 15% C4-6. The new strategy was applied to all cases. 3 haematomas, 7 cases of asymptomatic partial anterior saphenous thrombosis. Reduction of the initial average diameter was from 6.4 mm anterior saphenous to 3.4 mm by one year (p <0.001). At twelve months a forward flow is maintained in 82% of cases. Recurrence of varicose veins was 8%. All patients improved their clinical status based on the Fligelstone scale. Cases with saphenous diameter bigger than 7.5 mm and obesity were identified as predictors of worse clinical and hemodynamic outcome. This modified surgical strategy for anterior saphenous varicose veins results in better clinical outcomes at one year postoperatively. Copyright © 2015 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Great gray owls (Strix nebulosa) in Yosemite National Park: on the importance of food, forest structure, and human disturbance

    Science.gov (United States)

    van Riper, Charles; Fontaine, Joseph J.; van Wagtendonk, Jan W.

    2013-01-01

    We studied great gray owls (Strix nebulosa Forster) in Yosemite National Park, California, measuring variables that could potentially influence patterns of occurrence and conservation of this stateendangered species. We found that owl presence was closely tied to habitat (red fir (Abies magnified A. Murray) and the abundance of meadows), prey, and snags across the landscape. We also found that indicators of human recreational activities negatively influenced owl distribution and habitat use. Great gray owls appear to prefer mid-elevation red fir forest with meadows that are drier and more productive in terms of small mammal populations. That these areas also have the highest human activity presents a paradox, both for individual owls and for the future conservation and management of this California endangered species. The extent to which human recreation in natural areas affects animal behavior, species distribution, and productivity is a growing issue in natural area management. We present information that will allow land managers to better understand how existing natural resources, coupled with human recreation, influence the distribution and habitat use of the great gray owl.

  17. Participation in HIV research: the importance of clinic contact factors.

    Science.gov (United States)

    Worthington, Catherine A; Gill, M John

    2008-08-01

    Recruiting minority populations living with HIV to many types of clinic-based HIV research is a concern. This study examined an expanded range of predictors of HIV research participation (clinic contact, clinical, and personal characteristics) to investigate observed ethnocultural differences in HIV research participation. Research participation was defined as participation in any of diagnostic, pathogenesis, drug trial or survey research. Logistic regression modeling was used to predict research participation of 657 eligible patients (93% of the patient population) who began care between January 1997 and the end of September 2003 at a regional outpatient HIV care program in Calgary, Canada. Approximately one third (32%) were non-white, including 18% Aboriginal, 9% black, 4% Asian, and 1% Hispanic individuals. Twenty-nine percent (187/657) of the patients participated in at least one study of any kind. Multivariate analysis indicated that the strongest predictors of any research participation (including diagnostic, pathogenesis, drug trial, or survey studies) are clinical (including nadir CD4 count [odds ratio {OR} = 0.132, p percentage of appointments kept [OR = 1.022, p service use shown by these groups that may influence research participation. To attract under researched populations, attention should shift from the "who" of research participation to the "how" of clinical interactions.

  18. Secondary Hemophagocytic Syndrome: The Importance of Clinical Suspicion

    Directory of Open Access Journals (Sweden)

    Cristina Oliveira

    2014-01-01

    Full Text Available Hemophagocytic syndrome is a rare and potentially fatal disorder characterized by pathological immune activation associated with a primary familial disorder, genetic mutations, or occurring as a sporadic condition. The latter can be secondary to infections, malignancies, or autoimmune diseases. Clinically, patients present signs of severe inflammation, with unremitting fever, cytopenias, spleen enlargement, phagocytosis of bone marrow elements, hypertriglyceridemia, and hypofibrinogenemia. Increased suspicion is determinant to timely initiate treatment in an attempt to alter the natural history. The authors present three clinical cases of this syndrome, with a brief review of the diagnostic criteria and treatment.

  19. Sleep syncope: Important clinical associations with phobia and vagotonia

    NARCIS (Netherlands)

    Busweiler, L.; Jardine, D. L.; Frampton, C. M.; Wieling, W.

    2010-01-01

    Objectives: To compare demographic and clinical data from patients with sleep syncope to those of patients with "classical" vasovagal syncope [VVS] collected over the last 8 years. Design: Retrospective case-controlled study. Setting: Syncope unit. Patients and methods: Fifty-four patients with a

  20. Importance of placebo effect in cough clinical trials.

    Science.gov (United States)

    Eccles, Ron

    2010-01-01

    Cough is a unique symptom because, unlike sneeze and other symptoms, it can be under voluntary control and this complicates clinical trials on cough medicines. All over-the-counter cough medicines (OTC) are very effective treatments because of their placebo effect. The placebo effect is enhanced by expectancy related to advertising, brand, packaging, and formulation. This placebo effect creates a problem for the conduct of clinical trials on OTC cough medicines that attempt to demonstrate the efficacy of a pharmacological agent above that of any placebo effect. Up to 85% of the efficacy of some cough medicines can be attributed to a placebo effect. The placebo effect apparent in clinical trials consists of several components: natural recovery, regression of cough response toward mean, demulcent effect, effect of sweetness, voluntary control, and effects related to expectancy and meaning of the treatment. The placebo effect has been studied most in the pain model, and placebo analgesia is reported to depend on the activation of endogenous opioid systems in the brain; this model may be applicable to cough. A balanced placebo design may help to control for the placebo effect, but this trial design may not be acceptable due to deception of patients. The placebo effect in clinical trials may be controlled by use of a crossover design, where feasible, and the changes in the magnitude of the placebo effect in this study design are discussed.

  1. [Recurrent clinical mastitis in dairy cattle - importance and causes].

    Science.gov (United States)

    Grieger, A-S; Zoche-Golob, V; Paduch, J-H; Hoedemaker, M; Krömker, V

    2014-01-01

    Clinical mastitis as a frequently recurrent event can cause substantive economic loss on dairy farms. The reason for recurrent mastitis can be either a persistent infection of the bovine mammary gland by a mastitis pathogen or a reinfection of a quarter or udder after bacteriological cure. The virulence properties of a mastitis pathogen and the cure odds of an individual cow determine the development of persistent infections. Clinical episodes may alternate with periods without symptoms in the course of persistent infections. Strategies to reduce cases of recurrent mastitis have to include improved treatment concepts and measures to decrease new infection rates. The present literature review summarises the knowledge of definitions, frequencies, causes and effects of recurrent mastitis.

  2. Financial disclosure and clinical research: what is important to participants?

    Science.gov (United States)

    Hutchinson, Anastasia; Rubinfeld, Abe R

    2008-08-18

    To assess what participants in company-sponsored clinical trials wish to know about financial aspects of the study. Cross-sectional questionnaire administered to 324 participants in six clinical trials conducted at the Royal Melbourne Hospital in 1999-2000 and 2006 for non-acute conditions (asthma, chronic obstructive pulmonary disease, osteoporosis, rheumatoid arthritis, diabetes and influenza vaccine efficacy). Participants' desire for information on study funding, investigators' conflicts of interest, and use of accrued funds. 259 participants (80%) completed the survey. Participants wanted to be informed about the identity of the project sponsor (148 participants; 57%), whether the investigators owned shares in the company (105; 41%) or received travel grants (83; 32%), how much funding was accrued at study completion (88; 34%), how accrued funds were used (98; 38%), and who approved their use (91; 35%). After adjusting for year of survey and level of education, younger subjects (aged informed more often than older participants of who sponsored the project (odds ratio [OR], 2.35 [95% CI, 1.21-4.55]; P=0.012), whether the investigators owned shares in the company (OR, 2.41 [95% CI, 1.27-4.60]; P=0.007) and how much funding was available for other uses (OR, 1.79 [95% CI, 0.94-3.41]; P=0.078). While most participants indicated that they would take part in clinical research again regardless of whether they received financial information, providing information on the sponsor, the investigators' financial interest in the company, whether accrual of funds is expected, and how these funds will be spent should satisfy the interests of participants in company-sponsored clinical trials.

  3. Composition of physiologically important fatty acids in great tits differs between urban and rural populations on a seasonal basis

    Directory of Open Access Journals (Sweden)

    Martin N Andersson

    2015-08-01

    Full Text Available Fatty acids (FA have crucial functions in animals, affecting e.g. inflammatory responses, thermoregulation, and cell membrane fluidity. Diet and ambient temperature affect animals’ FA composition, which, in turn, may influence these physiological processes. Great tits (Parus major −common in both urban and rural habitats− are mainly granivorous during winter and insectivorous during summer. These diets show pronounced differences in FA composition. Such variation has context-dependent effects on physiology, because the thermal environment, food availability, and levels of pro-inflammatory environmental stressors differ between urban and rural areas. Thus, we investigated how great tit plasma FA composition varied between urban and rural habitats and across seasons. Eight FAs differed between urban and rural birds. Among these, arachidonic acid (omega (ω-6 polyunsaturated FA with thermoregulatory and pro-inflammatory properties was more abundant in urban than rural birds in winter, whereas ω-3 FAs with anti-inflammatory properties were more abundant in rural birds. The difference in pro- and anti-inflammatory FAs suggest that the negative health effects that urban birds suffer from being exposed to higher levels of pollutants might be enhanced by an elevated inflammatory response. Eight FAs differed between winter and summer birds. This variation reflected the diet change: FAs common in seeds, e.g. oleic- and linoleic acid, were present in higher amounts in winter birds, whereas ω-3 polyunsaturated FAs that are common in caterpillars were more abundant in summer birds. Overall, a larger seasonal variation was seen among the urban birds. This study is the first to reveal a difference in FA composition between urban and rural populations for all animals studied to date. Future experiments should unravel the physiological implications of this variation, and ultimately, link its effects to fitness of animals with different physiological and

  4. Health status measurement in COPD: the minimal clinically important difference of the clinical COPD questionnaire

    Directory of Open Access Journals (Sweden)

    van den Berg JWK

    2006-04-01

    Full Text Available Abstract Background Patient-reported outcomes (PRO questionnaires are being increasingly used in COPD clinical studies. The challenge facing investigators is to determine what change is significant, ie what is the minimal clinically important difference (MCID. This study aimed to identify the MCID for the clinical COPD questionnaire (CCQ in terms of patient referencing, criterion referencing, and by the standard error of measurement (SEM. Methods Patients were ≥40 years of age, diagnosed with COPD, had a smoking history of >10 pack-years, and were participating in a randomized, controlled clinical trial comparing intravenous and oral prednisolone in patients admitted with an acute exacerbation of COPD. The CCQ was completed on Days 1–7 and 42. A Global Rating of Change (GRC assessment was taken to establish the MCID by patient referencing. For criterion referencing, health events during a period of 1 year after Day 42 were included in this analysis. Results 210 patients were recruited, 168 completed the CCQ questionnaire on Day42. The MCID of the CCQ total score, as indicated by patient referencing in terms of the GRC, was 0.44. The MCID of the CCQ in terms of criterion referencing for the major outcomes was 0.39, and calculation of the SEM resulted in a value of 0.21. Conclusion This investigation, which is the first to determine the MCID of a PRO questionnaire via more than one approach, indicates that the MCID of the CCQ total score is 0.4.

  5. Taxonomy and antifungal susceptibility of clinically important Rasamsonia species

    DEFF Research Database (Denmark)

    Houbraken, J.; Giraud, S.; Meijer, M.

    2013-01-01

    In recent years, Geosmithia argillacea has been increasingly reported in humans and animals and can be considered an emerging pathogen. The taxonomy of Geosmithia was recently studied, and Geosmithia argillacea and related species were transferred to the new genus Rasamsonia. The diversity among...... reported clinical isolates from animal or human patients. Susceptibility tests showed that the antifungal susceptibility profiles of the four members of the R. argillacea complex are similar, and caspofungin showed significant activity in vitro, followed by amphotericin B and posaconazole. Voriconazole...

  6. Study of electrical power facilities and measures for planned outages in Japanese hemodialysis clinics after the Great East Japan Earthquake.

    Science.gov (United States)

    Ishida, Kai; Sawa, Manami; Fujiwara, Kousaku; Hirose, Minoru; Tsuruta, Harukazu; Takeuchi, Akihiro; Ikeda, Noriaki

    2013-02-01

    The Great East Japan Earthquake on 11 March 2011 caused major damage in northeastern Japan. The Kanto region experienced a massive electrical power shortage in the summer of 2011. A questionnaire was submitted to 354 hemodialysis clinics in Kanagawa prefecture and the Tokyo metropolitan area, excluding isolated islands, and 176 responses were analyzed (49.7%). The questions included evaluation of the availability of a private electricity generator, countermeasures in case of a planned outage, awareness of saving electricity, and improvement of safety of medical devices or electrical facilities after the earthquake. Only 12% of the clinics had private electricity generators and many clinics had no plans to introduce this facility. However, 96% of the clinics had established countermeasures to deal with a planned outage. Many clinics planned to provide dialysis on a different day or at a different time. All clinics had tried hard to establish procedures to save electricity in the summer of 2011, and 84% of the clinics had reconsidered and improved the safety of medical devices or electricity facilities after the earthquake. These results show that the awareness of crisis management was greatly improved in the wake of the earthquake. © 2012 The Authors. Therapeutic Apheresis and Dialysis © 2012 International Society for Apheresis.

  7. CLINICAL IMPORTANCE OF INTERLEUKIN-4 IN SYSTEMIC SCLERODERMA

    Directory of Open Access Journals (Sweden)

    T A Nevskaya

    2002-01-01

    Full Text Available The aim of the study was to investigate whether serum levels of interleukin-4 ( IL-4 reflects the clinical disease status and laboratory features of systemic sclerosis (SSc. IL-4 was measured by ELISA in forty patients wilh SSc. We revealed IL-4 (Ю-lOOOpg/ml in sera from 12 of 40 pts (30%. These pts had significantly less duration of disease, the progression of skin and visceral involvement by the time of investigation and a trend lo the greater frequency of lung fibrosis. There was no correlation of IL-4 level with type of SSc. The pts with increased scrum levels of IL-4 had higher levels of circulated immune complexes, y-globulins, but the levels of acute phase reactants (CRP, fibrinogen were lower compared with the of others. We suggest that serum IL-4 may serve a biologic marker for the progression of skin and lung fibrosis, but the results require confirmation in longitudinal study.

  8. What is clinical leadership…and why is it important?

    Science.gov (United States)

    Swanwick, Tim; McKimm, Judy

    2011-03-01

    The 'invitation' for clinicians to participate in leadership practices, previously considered the province of the professional health service manager, is driven by a number of international policy and professional agendas. This article, the first in a short series, considers definitions and theories of clinical leadership and management, and explores leadership roles and responsibilities of the clinician in terms of levels of engagement. Recent developments in the UK's National Health Service (NHS), the largest health care organisation in the world, are used as illustrations of how theory has informed clinical leadership development. Narrative review and discussion. The tensions arising from the situation of health care professionals within managed health care are described. Leadership is defined alongside its relationship to management. Key theories of leadership are considered and applications of theory to practice explored. The role and usefulness of the 'competency framework' in leadership development is debated. Health care is delivered by complex systems often involving large numbers of individuals and organisations. The effective clinician needs to understand these pathways and systems of care if they are to be able to function effectively, and must be comfortable working both within, and with, these systems for the benefit of their patients. Engaging in leading and managing systems of health care, on whatever scale - team, department, unit, hospital or health authority - is therefore a professional obligation of all clinicians. Just as leadership is argued to be necessary 'at all levels', so 'leadership development', assessment and feedback must be provided throughout the education and training of health professionals. © Blackwell Publishing Ltd 2011.

  9. Many faces of rationality: Implications of the great rationality debate for clinical decision-making

    OpenAIRE

    Djulbegovic, B.; Elqayam, Shira

    2017-01-01

    open access article Given that more than 30% of healthcare costs are wasted on inappropriate care, suboptimal care is increasingly connected to the quality of medical decisions. It has been argued that personal decisions are the leading cause of death, and 80% of healthcare expenditures result from physicians' decisions. Therefore, improving healthcare necessitates improving medical decisions, ie, making decisions (more) rational. Drawing on writings fromThe Great Rationality Debate from t...

  10. Biometrics of Pyramidalis Muscle and its Clinical Importance.

    Science.gov (United States)

    Das, Sushant Swaroop; Saluja, Sandeep; Vasudeva, Neelam

    2017-02-01

    Pyramidalis is classified as a vestigial muscle which is frequently present. It is muscle of the anterior abdominal wall. It is thought to tense the linea alba. It has been used as a surgical landmark, source of muscle stem cells and in various surgical procedures. The aim of this study was to describe the morphometry and morphology of pyramidalis muscle in an adult Indian population and its correlation with the clinical significance. A cadaveric study on 25 formalin fixed cadavers (males-17, females-8) was conducted in context with prevalence, morphology and morphometry of pyramidalis muscle. Statistical analysis was done using the Chi-Square test and student's t-test using SPSS version 23. The pyramidalis muscle was present in 92% cases, usually bilaterally (72%) than unilaterally (20%) and more frequently in males (94.11%) than in females (87.5%). This study was conducted in Department of Anatomy, Maulana Azad Medical College, New Delhi, India from August 2014 to August 2016. Bilateral asymmetry was reported. The mean length of the muscle in males and females was 52.21±14.32 and 50.13±13.62mm on the right and 53.97±15.11 and 51.22±13.78mm on the left side. No significant gender predominance existed on the right and left-sided pyramidalis lengths. The mean width of the right-sided pyramidalis in males and females was 18.35±5.15 and 17.05±4.99mm and the left-sided was 17.8±4.80 and 16.21±4.23mm without gender dimorphism. The mean thickness of the right-sided pyramidalis in males and females was 4.91±1.33 and 4.53±1.29mm and the left-sided 4.33±1.28 and 4.38±1.27mm without gender differences. The mean pyramidalis-puboumbilical index was 35.15±4.38%, 36.01±4.97% in males and females respectively. No anatomical variations with regard to origin and insertion were seen. This study provides valuable information on pyramidalis muscle which may help in appropriate understanding of anatomy, functions and clinical significance of the muscle.

  11. Bone biology in the elderly: clinical importance for fracture treatment

    Directory of Open Access Journals (Sweden)

    Rolvien Tim

    2016-12-01

    Full Text Available Age-related bone impairment often leads to fragility fractures in the elderly. Although excellent surgical care is widely provided, diagnosis and treatment of the underlying bone disorder are often not kept in mind. The interplay of the three major bone cells – osteoblasts, osteoclasts, and osteocytes – is normally well regulated via the secretion of messengers to control bone remodeling. Possible imbalances that might occur in the elderly are partly due to age, genetic risk factors, and adverse lifestyle factors but importantly also due to imbalances in calcium homeostasis (mostly due to vitamin D deficiency or hypochlorhydria, which have to be eliminated. Therefore, the cooperation between the trauma surgeon and the osteologist is of major importance to diagnose and treat the respective patients at risk. We propose that any patient suffering from fragility fractures is rigorously screened for osteoporosis and metabolic bone diseases. This includes bone density measurement by dual-energy X-ray absorptiometry, laboratory tests for calcium, phosphate, vitamin D, and bone turnover markers, as well as additional diagnostic modalities if needed. Thereby, most risk factors, including vitamin D deficiency, can be identified and treated while patients who meet the criteria for a specific therapy (i.e. antiresorptive and osteoanabolic receive such. If local health systems succeed to manage this process of secondary fracture prevention, morbidity and mortality of fragility fractures will decline to a minimum level.

  12. Polymorphism of human haptoglobin and its clinical importance

    Directory of Open Access Journals (Sweden)

    Vânia Peretti de Albuquerque Wobeto

    2008-01-01

    Full Text Available Haptoglobin (Hp is a plasma glycoprotein, the main biological function of which is to bind free hemoglobin (Hb and prevent the loss of iron and subsequent kidney damage following intravascular hemolysis. Haptoglobin is also a positive acute-phase protein with immunomodulatory properties. In humans, the HP locus is polymorphic, with two codominant alleles (HP1 and HP2 that yield three distinct genotypes/phenotypes (Hp1-1, Hp2-1 and Hp2-2. The corresponding proteins have structural and functional differences that may influence the susceptibility and/or outcome in several diseases. This article summarizes the available data on the structure and functions of Hp and the possible effects of Hp polymorphism in a number of important human disorders.

  13. The clinical importance of radiological determination of the heart volume

    International Nuclear Information System (INIS)

    Jaedicke, W.; Ong, T.S.; Barmeyer, J.

    1982-01-01

    The size of the heart is an autonomous, important parameter of its functional state, i.e. in the radiologic heart diagnostics, the measurement of the heart volume is of equal value as the shape analysis. A size determination which must be exact enough for course controls and differentiation from the normal picture makes sense only if the measurement is carriet out in 3 dimensions and not in only one as is done when determining the heart-lung-quotient. The heart volume measurement carried out in lying or sitting position is considerably more reliable than in standing position as too many extracardiac factors influence the heart volume when the patient is standing. The echo cardiogram is a nearly ideal supplement but no competitor of radiological heart volume measurement and can be of the same value as or superior to heart volume measurement for functional diagnostics only in diseases limited to nearly exclusively to the left ventricle as in coronary diseases. (orig.) [de

  14. Endovenous laser ablation of the great saphenous vein using a bare fibre versus a tulip fibre: a randomised clinical trial.

    Science.gov (United States)

    Vuylsteke, M E; Thomis, S; Mahieu, P; Mordon, S; Fourneau, I

    2012-12-01

    This clinical trial aimed to evaluate the clinical results of the use of a tulip fibre versus the use of a bare fibre for endovenous laser ablation. In a multicentre prospective randomised trial 174 patients were randomised for the treatment of great saphenous vein reflux. A duplex scan was scheduled 1 month, 6 months and 1 year postoperatively. Ecchymosis was measured on the 5th postoperative day. In addition, pain, analgesics requirement, postoperative quality of life (CIVIQ 2) and patient satisfaction rate were noted. Patients treated with a tulip fibre had significantly less postoperative ecchymosis (0.04 vs. 0.21; p tulip fibre for EVLA of the great saphenous vein results, when compared with the use of a bare fibre, in equal occlusion rates at 1 year but causes less postoperative ecchymosis and pain and in a better postoperative quality of life. Copyright © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  15. Antibiotic resistance plasmids of Staphylococcus aureus and their clinical importance

    International Nuclear Information System (INIS)

    Lacey, R.W.

    1975-01-01

    A variety of plasmids were isolated physically, and most antibiotic resistance is thought to be plasmid mediated. A number of characters (e.g., resistance to erythromycin or methicillin, and production of pigment) are determined by genes that do not give clear indications of either plasmid or chromosomal location. Although the formation of a particular plasmid is probably, even in bacterial terms, a very rare event, once formed such an element can spread rapidly among the bacterial population. The spectacular increase in the incidence of penicillinase-producing hospital strains in the late 1940's could have been due in part to this process. Evidence is stronger, however, for the intercell transfer of recently isolated plasmids coding for resistance to fusidic acid (and penicillinase production), or for neomycin, or for tetracycline resistance. Study of bacterial plasmids can resolve fundamental biochemical problems, and give some insight into the life of the cell at the molecular level. But the immediate application of the study of staphylococcal plasmids may be directed towards improving the effectiveness of antibiotic therapy. The most important aspect of future anti-staphylococcal chemotherapy should thus be the limitation of the use of antibiotics, particularly for application to the skin and nose. (U.S.)

  16. The human coronary collateral circulation: development and clinical importance.

    Science.gov (United States)

    Seiler, Christian; Stoller, Michael; Pitt, Bertram; Meier, Pascal

    2013-09-01

    Coronary collaterals are an alternative source of blood supply to myocardium jeopardized by ischaemia. In comparison with other species, the human coronary collateral circulation is very well developed. Among individuals without coronary artery disease (CAD), there are preformed collateral arteries preventing myocardial ischaemia during a brief vascular occlusion in 20-25%. Determinants of such anastomoses are low heart rate and the absence of systemic arterial hypertension. In patients with CAD, collateral arteries preventing myocardial ischaemia during a brief occlusion are present in every third individual. Collateral flow sufficient to prevent myocardial ischaemia during coronary occlusion amounts to one-fifth to one-fourth the normal flow through the open vessel. Myocardial infarct size, the most important prognostic determinant after such an event, is the product of coronary artery occlusion time, area at risk for infarction, and the inverse of collateral supply. Well-developed coronary collateral arteries in patients with CAD mitigate myocardial infarcts and improve survival. Approximately one-fifth of patients with CAD cannot be revascularized by percutaneous coronary intervention or coronary artery bypass grafting. Therapeutic promotion of collateral growth is a valuable treatment strategy in those patients. It should aim at growth of large conductive collateral arteries (arteriogenesis). Potential arteriogenic approaches include the treatment with granulocyte colony-stimulating factor, physical exercise training, and external counterpulsation.

  17. [Applied anatomy study and clinical application of great saphenous veno-saphenous neurocutaneous vascular flap].

    Science.gov (United States)

    Li, Zelong; Ding, Zihai; Wang, Peixin; Xie, Yibo; Zeng, Bo

    2006-03-01

    To provide the anatomic basis for defect repair of the knee, leg, foot and ankle with great saphenous veno-saphenous neurocutaneous vascular island flaps. The origin, diameter, branches, distribution and anastomoses of the saphenous artery and saphenous neurocutaneous vascular were observed on 20 sides of adult leg specimens and 4 fresh cadaver voluntary legs. Another 4 fresh cadaver voluntary legs were radiographed with a soft X-ray system after the intravenous injection of Vermilion and cross-sections under profound fascial, other hand, micro-anatomic examination was also performed in these 4 fresh cadaver legs. The soft tissue defects in lower extremity, upper extremity, heel or Hucou in hand were repaired with the proximal or distal pedicle flaps or free flaps in 18 patients (12 males and 6 females,aging from 7 to 53 years). The defect was caused by trauma, tumour, ulcer and scar. The locations were Hucou (1 case), upper leg (3 cases), lower extremity and heal (14 cases). Of then, 7 cases were complicated by bone exposure, 3 cases by tendon exposure and 1 case by steel espouse, the defect size were 4 cm x 4 cm to 7 cm x 13 cm. The flap sizes were 4 cm x 6 cm to 8 cm x 15 cm, which pedicle length was 8-11 cm with 2.5-4.0 cm fascia and 1-2 cm skin at width. Genus descending genicular artery began from 9.33 +/- 0.81 cm away from upper the condyles medialis, it branched saphenous artery accompanying saphenous nerve descendent. And saphenous artery reached the surface of the skin 7.21 +/- 0.82 cm away from lower the condyles medialis, and anastomosed with the branches of tibialis posterior artery, like "Y" or "T" pattern. The chain linking system of arteries were found accompanying along the great saphenous vein as saphenous nerve, and then a axis blood vessel was formed. The small artery of only 0.05-0.10 mm in diameter, distributed around the great saphenous vein within 5-8 mm and arranged parallelly along the vein like water wave in soft X-ray film. All proximal

  18. DEVELOPMENT OF NANOTECHNOLOGIES IN CONSTRUCTION – A TASK WHICH IS OF GREAT IMPORTANCE FOR SCIENTISTS AND ENGINEERS. Part 6

    Directory of Open Access Journals (Sweden)

    KARPOV Alexey Ivanovich

    2013-12-01

    Full Text Available To popularize scientific achievements in construction the main results of Russian and foreign scientists’ research are published in the form of abstract. Within the investigation «Physical and chemical study of nanocomposite materials produced in a template way with the controlled sol-gel synthesis method» new approaches to functionalization of silica matrix with the immobilization of cyclodextrin complexes and APG micelles with solubilizated water insoluble substances which is performed under favourable conditions in aqueous solutions without organic dissolvents were developed. These approaches can be used to produce selective sorbents and luminescence materials. The proposed method of crystall titanium dioxide nanoparticles synthesis which is carried out under room temperature, can be regarded as an alternative for its high-temperature production for photocatalysts, sensors and solar batteries. Within the investigation «Controlled self-organization of azaporphyrins in 2D and 3D nanostructure in Langmuire layers and Langmuir-Blodgett films» it was shown that along with the model design and development of method which determines nanostructured Langmuire layer structure Langmuir-Blodgett (LB technology which allows obtaining nanosized films becomes the tool to study and form 2D and iD-nanostructures in floating layers and LB films as well as to produce thin-film nanomaterials based on organic compounds with developed p-system and possessing specified structure and properties. The designed model also allows solving one of the most important problems in nanotechnology and science on nanomaterials for the low dimension systems – the problem concerning determination of dependency between the size of formed particles and the conditions needed for their formation.

  19. Advanced clinical practice for radiographers in Great Britain: professional roles, accountability and the educational provision

    International Nuclear Information System (INIS)

    Hogg, P.

    2004-01-01

    A change in British health care has resulted in a broadening of roles and responsibilities beyond 'traditional boundaries' for a range of health care professionals. This has occurred because of staff shortages (particularly within the medical profession) and the recognition that many 'non-doctor' health care staff can make safe, competent and effective contributions outside their 'normal' sphere of responsibilities. In the context of advanced clinical practice, this paper will explain the current arrangements for radiographers' roles and responsibilities, their accountability and the educational provision that underpins the development of competencies at these higher clinical levels. Some advanced roles that British radiographers perform, within their current normal responsibilities, will be identified and some British legislation and professional body guidance that make role advancement possible will be outlined. The article will conclude with an indication of the educational level at which the advanced competencies are learned and assessed. (author)

  20. Great Lakes Science Center

    Data.gov (United States)

    Federal Laboratory Consortium — Since 1927, Great Lakes Science Center (GLSC) research has provided critical information for the sound management of Great Lakes fish populations and other important...

  1. 77 FR 75670 - Importer of Controlled Substances; Notice of Registration; Fisher Clinical Services,Inc.

    Science.gov (United States)

    2012-12-21

    ... Registration; Fisher Clinical Services,Inc. By Notice dated September 20, 2012, and published in the Federal Register on October 2, 2012, 77 FR 60143, Fisher Clinical Services, Inc., 7554 Schantz Road, Allentown... that the registration of Fisher Clinical Services, Inc., to import the basic class of controlled...

  2. 78 FR 23958 - Importer of Controlled Substances: Notice of Registration; Fisher Clinical Services, Inc.

    Science.gov (United States)

    2013-04-23

    ... Registration; Fisher Clinical Services, Inc. By Notice dated November 27, 2012, and published in the Federal Register on December 5, 2012, 77 FR 72409, Fisher Clinical Services, Inc., 7554 Schantz Road, Allentown... the registration of Fisher Clinical Services, Inc., to import the basic class of controlled substance...

  3. 78 FR 5497 - Importer of Controlled Substances; Notice of Registration; Fisher Clinical Services, Inc.

    Science.gov (United States)

    2013-01-25

    ... Registration; Fisher Clinical Services, Inc. By Notice dated November 1, 2012, and published in the Federal Register on November 9, 2012, 77 FR 67396, Fisher Clinical Services, Inc., 7554 Schantz Road, Allentown... the registration of Fisher Clinical Services, Inc., to import the basic class of controlled substance...

  4. 78 FR 46371 - Importer of Controlled Substances; Notice of Registration; Almac Clinical Services, Inc.

    Science.gov (United States)

    2013-07-31

    ... Register on April 19, 2013, 78 FR 23594, Almac Clinical Services, Inc., (ACSI), 25 Fretz Road, Souderton... registration of Almac Clinical Services, Inc., (ACSI) to import the basic classes of controlled substances is..., conventions, or protocols in effect on May 1, 1971. DEA has investigated Almac Clinical Services, Inc., (ACSI...

  5. What constitutes a clinically important pain reduction in patients after third molar surgery?

    NARCIS (Netherlands)

    Martin, W.J.J.M.; Ashton-James, C.E.; Skorpil, N.E.; Heymans, M.W.; Forouzanfar, T.

    2013-01-01

    BACKGROUND: For patients with surgical third molar removal, it is unknown what constitutes a clinically important change in patients’ visual analogue scale (VAS) reports of pain intensity. OBJECTIVES: To determine what constitutes a clinically important change in pain intensity on a VAS following

  6. 77 FR 66848 - Minimum Clinically Important Difference: An Outcome Metric in Orthopaedic Device Science and...

    Science.gov (United States)

    2012-11-07

    ...] Minimum Clinically Important Difference: An Outcome Metric in Orthopaedic Device Science and Regulation... Clinically Important Difference: An Outcome Metric in Orthopaedic Device Science and Regulation.'' FDA is co... (MCID) for patient-reported outcome (PRO) instruments used in orthopaedic extremity device-related...

  7. The Importance of Conditional Probability in Diagnostic Reasoning and Clinical Decision Making: A Primer for the Eye Care Practitioner.

    Science.gov (United States)

    Sanfilippo, Paul G; Hewitt, Alex W; Mackey, David A

    2017-04-01

    To outline and detail the importance of conditional probability in clinical decision making and discuss the various diagnostic measures eye care practitioners should be aware of in order to improve the scope of their clinical practice. We conducted a review of the importance of conditional probability in diagnostic testing for the eye care practitioner. Eye care practitioners use diagnostic tests on a daily basis to assist in clinical decision making and optimizing patient care and management. These tests provide probabilistic information that can enable the clinician to increase (or decrease) their level of certainty about the presence of a particular condition. While an understanding of the characteristics of diagnostic tests are essential to facilitate proper interpretation of test results and disease risk, many practitioners either confuse or misinterpret these measures. In the interests of their patients, practitioners should be aware of the basic concepts associated with diagnostic testing and the simple mathematical rule that underpins them. Importantly, the practitioner needs to recognize that the prevalence of a disease in the population greatly determines the clinical value of a diagnostic test.

  8. The study of Forest Hara Biosphere Reserve in coast of Persian Gulf and the importance of heavy metal accumulation; Case study: feathers of great cormorant

    Directory of Open Access Journals (Sweden)

    MIR MEHRDAD MIRSANJARI

    2014-11-01

    Full Text Available Mirsanjari MM, Sheybanifar F, Arjmand F. 2014. The study of forest Hara Biosphere Reserve in coast of Persian Gulf and the importance of heavy metal accumulation; Case study: feathers of great cormorant. Nusantara Bioscience 6: 159-164. In recent years, concerns about the long term effects of heavy metals as environmental polluters have arisen, since considerable quantities of heavy metals have been released into the environment as a result of extensive human activities. Heavy metal has been determined as a serious threat to the stability of ecosystems. In this study, we examined the levels of zinc‚ copper‚ lead, and cadmium in the feathers of twenty great cormorants (Phalacrocorax carbo, collected from Hara Biosphere Reserve during November and December in 2012. The results revealed that the mean concentration of heavy metals in the feathers of males is significantly higher than females (P < 0.05. In addition‚ no significant difference was observed in heavy metal concentration between juvenile and adult birds. Moreover, according to the results, the high concentration of heavy metals in some samples indicated this fact that birds are potentially exposed to the risk of heavy metals in their habitat.

  9. What Constitutes a Clinically Important Pain Reduction in Patients after Third Molar Surgery?

    Directory of Open Access Journals (Sweden)

    Wilhelmus JJM Martin

    2013-01-01

    Full Text Available BACKGROUND: For patients with surgical third molar removal, it is unknown what constitutes a clinically important change in patients’ visual analogue scale (VAS reports of pain intensity.

  10. 77 FR 67396 - Importer of Controlled Substances; Notice of Application, Fisher Clinical Services, Inc.

    Science.gov (United States)

    2012-11-09

    ... DEPARTMENT OF JUSTICE Drug Enforcement Administration Importer of Controlled Substances; Notice of Application, Fisher Clinical Services, Inc. Pursuant to Title 21 Code of Federal Regulations 1301.34(a), this is notice that on August 20, 2012, Fisher Clinical Services, Inc., 7554 Schantz Road, [[Page 67397...

  11. 77 FR 60143 - Importer of Controlled Substances; Notice of Application; Fisher Clinical Services, Inc.

    Science.gov (United States)

    2012-10-02

    ... DEPARTMENT OF JUSTICE Drug Enforcement Administration Importer of Controlled Substances; Notice of Application; Fisher Clinical Services, Inc. Pursuant to Title 21 Code of Federal Regulations 1301.34(a), this is notice that on July 18, 2012, Fisher Clinical Services, Inc., 7554 Schantz Road, Allentown...

  12. 77 FR 72409 - Importer of Controlled Substances; Notice of Application; Fisher Clinical Services, Inc.

    Science.gov (United States)

    2012-12-05

    ... DEPARTMENT OF JUSTICE Drug Enforcement Administration Importer of Controlled Substances; Notice of Application; Fisher Clinical Services, Inc. Pursuant to Title 21 Code of Federal Regulations 1301.34 (a), this is notice that on October 16, 2012, Fisher Clinical Services, Inc., 7554 Schantz Road, Allentown...

  13. 78 FR 59064 - Importer of Controlled Substances; Notice of Application; Fisher Clinical Services, Inc.

    Science.gov (United States)

    2013-09-25

    ... DEPARTMENT OF JUSTICE Drug Enforcement Administration Importer of Controlled Substances; Notice of Application; Fisher Clinical Services, Inc. Pursuant to Title 21 Code of Federal Regulations (CFR) 1301.34 (a), this is notice that on June 21, 2013, Fisher Clinical Services, Inc., 7554 Schantz Road, Allentown...

  14. 77 FR 24985 - Importer of Controlled Substances; Notice of Application; Almac Clinical Services, Inc., (ACSI)

    Science.gov (United States)

    2012-04-26

    ... DEPARTMENT OF JUSTICE Drug Enforcement Administration Importer of Controlled Substances; Notice of Application; Almac Clinical Services, Inc., (ACSI) Pursuant to 21 U.S.C. 958(i), the Attorney General shall... on March 5, 2012, Almac Clinical Services, Inc., (ACSI), 25 Fretz Road, Souderton, Pennsylvania 18964...

  15. 77 FR 50162 - Importer of Controlled Substances; Notice of Registration; Almac Clinical Services, Inc.

    Science.gov (United States)

    2012-08-20

    ... Register on April 26, 2012, 77 FR 24985, Almac Clinical Services, Inc., (ACSI), 25 Fretz Road, Souderton... that the registration of Almac Clinical Services, Inc. (ACSI) to import the basic classes of controlled..., Inc. (ACSI) to ensure that the company's registration is consistent with the public interest. The...

  16. 78 FR 23594 - Importer of Controlled Substances, Notice of Application, Almac Clinical Services, Inc., (ACSI)

    Science.gov (United States)

    2013-04-19

    ... DEPARTMENT OF JUSTICE Drug Enforcement Administration Importer of Controlled Substances, Notice of Application, Almac Clinical Services, Inc., (ACSI) Pursuant to Title 21 Code of Federal Regulations 1301.34(a), this is notice that on March 5, 2013, Almac Clinical Services, Inc., (ACSI), 25 Fretz Road, Souderton...

  17. Coronary artery anomalies and clinically important anatomy in patients with congenital heart disease: multislice CT findings

    International Nuclear Information System (INIS)

    Goo, Hyun Woo; Seo, Dong-Man; Yun, Tae-Jin; Park, Jeong-Jun; Park, In-Sook; Ko, Jae Kon; Kim, Young Hwee

    2009-01-01

    In patients with congenital heart disease, coronary artery anomalies are common and have different clinical importance from individuals with structurally normal hearts. Visibility of the coronary arteries by CT has markedly improved due to high temporal resolution and ECG-synchronized data acquisition. In this article we describe current multislice CT techniques for coronary artery imaging and illustrate coronary artery anomalies and clinically important coronary artery anatomy from the point of view of congenital heart disease. (orig.)

  18. Coronary artery anomalies and clinically important anatomy in patients with congenital heart disease: multislice CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Goo, Hyun Woo [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul (Korea); Seo, Dong-Man; Yun, Tae-Jin; Park, Jeong-Jun [University of Ulsan College of Medicine, Department of Pediatric Cardiac Surgery, Asan Medical Center, Seoul (Korea); Park, In-Sook; Ko, Jae Kon; Kim, Young Hwee [University of Ulsan College of Medicine, Department of Pediatric Cardiology, Asan Medical Center, Seoul (Korea)

    2009-03-15

    In patients with congenital heart disease, coronary artery anomalies are common and have different clinical importance from individuals with structurally normal hearts. Visibility of the coronary arteries by CT has markedly improved due to high temporal resolution and ECG-synchronized data acquisition. In this article we describe current multislice CT techniques for coronary artery imaging and illustrate coronary artery anomalies and clinically important coronary artery anatomy from the point of view of congenital heart disease. (orig.)

  19. Pattern of Clinical Medication Seeking for Import Malaria by Migrant Workers

    Directory of Open Access Journals (Sweden)

    Muhammad Mahmudi

    2015-05-01

    Full Text Available Number of malaria cases in Kabupaten Trenggalek in 2014 is 89 cases, and 83 cases are import malaria from migrant workers. Import malaria is transmitted across two areas and affects the clinical medication seeking. This research wants to describe the pattern of clinical medication seeking for import malaria by migrant workers in Puskesmas Pandean working area. This was cross sectional study with descriptive quantitative approach. Research’s sample is 26 import malaria sufferers in 2013–2015 who has chosen purposively with inclusion criteria. Interview had used to get information about characteristics, place felt the symptom, first clinical medication seeking (place and time, clinical diagnosis, medication follow up, and recovery status. The result of the research shows 100% respondent is man and the age about 20-30 years old (53,8 who is working as agricultural laborers outside Java. Mostly of respondent feel the malaria symptoms in their working place (53,8%. The day seeks clinical medication at day three after symptom (34, 6%. Respondents that feel the symptom in Puskesmas Pandean working area chose Puskesmas as clinical medication place (42,3%, and hospital (19,2% for them whose experience the malaria symptom in their working area. Puskesmas is chosen as clinical diagnosis place (69% and only 11,5% respondent got medication follow up. Puskesmas is chosen as intermediate clinical medication place (60% for 19,2% respondent that is not recovered well, although 20% go to Dukun. All of respondent chose the clinical medication as their prime medication. Need to make medication follow up visitation well complete. Keyword: pattern, clinical medication, import malaria, migrant worker

  20. Important considerations for designing and reporting epidemiologic and clinical studies in dental traumatology.

    Science.gov (United States)

    Andersson, Lars; Andreasen, Jens O

    2011-08-01

    The purpose of this article is to suggest important considerations for epidemiologic and clinical studies in the field of dental traumatology. The article is based on the authors' experiences from research in this field and editorial board work for the scientific journal Dental Traumatology. Examples are given of issues where development is important. The importance of planning ahead of the study and consulting with experts in other fields is emphasized. © 2011 John Wiley & Sons A/S.

  1. Important considerations for designing and reporting epidemiologic and clinical studies in dental traumatology

    DEFF Research Database (Denmark)

    Andersson, Lars; Andreasen, Jens O

    2011-01-01

    The purpose of this article is to suggest important considerations for epidemiologic and clinical studies in the field of dental traumatology. The article is based on the authors' experiences from research in this field and editorial board work for the scientific journal Dental Traumatology....... Examples are given of issues where development is important. The importance of planning ahead of the study and consulting with experts in other fields is emphasized....

  2. Minimal Clinically Important Differences for American Orthopaedic Foot & Ankle Society Score in Hallux Valgus Surgery.

    Science.gov (United States)

    Chan, Hiok Yang; Chen, Jerry Yongqiang; Zainul-Abidin, Suraya; Ying, Hao; Koo, Kevin; Rikhraj, Inderjeet Singh

    2017-05-01

    The American Orthopaedic Foot & Ankle Society (AOFAS) score is one of the most common and adapted outcome scales in hallux valgus surgery. However, AOFAS is predominantly physician based and not patient based. Although it may be straightforward to derive statistical significance, it may not equate to the true subjective benefit of the patient's experience. There is a paucity of literature defining MCID for AOFAS in hallux valgus surgery although it could have a great impact on the accuracy of analyzing surgical outcomes. Hence, the primary aim of this study was to define the Minimal Clinically Important Difference (MCID) for the AOFAS score in these patients, and the secondary aim was to correlate patients' demographics to the MCID. We conducted a retrospective cross-sectional study. A total of 446 patients were reviewed preoperatively and followed up for 2 years. An anchor question was asked 2 years postoperation: "How would you rate the overall results of your treatment for your foot and ankle condition?" (excellent, very good, good, fair, poor, terrible). The MCID was derived using 4 methods, 3 from an anchor-based approach and 1 from a distribution-based approach. Anchor-based approaches were (1) mean difference in 2-year AOFAS scores of patients who answered "good" versus "fair" based on the anchor question; (2) mean change of AOFAS score preoperatively and at 2-year follow-up in patients who answered good; (3) receiver operating characteristic (ROC) curves method, where the area under the curve (AUC) represented the likelihood that the scoring system would accurately discriminate these 2 groups of patients. The distribution-based approach used to calculate MCID was the effect size method. There were 405 (90.8%) females and 41 (9.2%) males. Mean age was 51.2 (standard deviation [SD] = 13) years, mean preoperative BMI was 24.2 (SD = 4.1). Mean preoperative AOFAS score was 55.6 (SD = 16.8), with significant improvement to 85.7 (SD = 14.4) in 2 years ( P value

  3. Aloantígenos de granulocitos: Importancia clínica The granulocyte alloantigens. Clinical importance

    Directory of Open Access Journals (Sweden)

    María del Rosario López De Roux

    2003-12-01

    Full Text Available Los aloantígenos de granulocitos se agrupan en 2 grandes categorías: antígenos específicos de granulocitos y antígenos cuya distribución es más amplia y comprende otras líneas celulares. En 1998 se acordó establecer una nueva nomenclatura de los aloantígenos de granulocitos, basada en la localización glucoproteica de estos antígenos. La molécula FcgRIIIb es un miembro de la superfamilia de inmunoglobulinas (CD 16 en la cual se asientan varios de los aloantígenos específicos de granulocitos. Existen otros aloantígenos cuya función y localización se desconocen. Estas moléculas son de gran importancia clínica, pues se ven envueltas en una serie de enfermedades como la neutropenia neonatal aloinmune, cuyo carácter clínico moderado hace que pase inadvertida, la reacción febril no hemolítica, el daño pulmonar agudo relacionado con la transfusión, la neutropenia inmune asociada con el trasplante de médula ósea y la neutropenia autoinmune. Aunque se han producido avances en la caracterización de los aloantígenos de granulocitos, muchos puntos quedan sin aclarar, entre ellos, la significación clínica de muchos antígenos. El desarrollo creciente de técnicas moleculares, bioquímicas y serológicas para el estudio de los antígenos de células sanguíneas, nos permitirá aclarar los puntos que aún permanecen oscuros en este campo de la investigaciónThe granulocyte alloantigens are grouped into 2 big categories: specific granulocyte antigens and antigens, whose distribution is wider and comprises other cellular lines. In 1998, it was agreed to establish a new nomenclature of granulocyte alloantigens based on the glycoprotein localization of these antigens. The FcgRIIIb molecule is a member of the superfamily of immunoglobulins (CD 16, in which many of the specific granulocyte alloantigens are found. There are other alloantigens with an unknown function and localization. These molecules have a great clinical importance

  4. Clinical skill center: a review of present situation and importance in medical education curriculum

    Directory of Open Access Journals (Sweden)

    Haleh Talaei

    2002-07-01

    Full Text Available Clinical skill centers were designed in 1960, offers innovative, more effective clinical health care and treatment curriculum. Clinical skill center (CSC can provide a special facility for clinical and communication skills practice in a setting outside hospital wards in order to train students with enough confidence of confronting real patients. Learning clinical skills in these centers are not patient-dependent and by practicing on manikins and simulated models errors in real patients can be prevented. Moreover, possible feedback of this method can be used for evaluation and can improve quality and quantity of the education. This review intends to determine the purpose, undertaking, and structure of CSC. The study emphasizes the importance of integrating the clinical skill centers into the teaching curriculum of medical universities. Apparently, organizing clinical skill centers can play an important role for improving the quality and quantity of the educational system and consequently post-graduate performance. The authors recommend this program can be a solution for having both the knowledge and skill of diagnosis and treatment seasonal and rare diseases. Key words clinical skill center, medical education, curriculum

  5. Determining Minimal Clinically Important Differences in Japanese Cedar/Cypress Pollinosis Patients

    OpenAIRE

    Takaya Higaki; Mitsuhiro Okano; Shin Kariya; Tazuko Fujiwara; Takenori Haruna; Haruka Hirai; Aya Murai; Minoru Gotoh; Kimihiro Okubo; Shuji Yonekura; Yoshitaka Okamoto; Kazunori Nishizaki

    2013-01-01

    Background: Statistically significant results of medical intervention trials are not always clinically meaningful. We sought to estimate the minimal clinically important difference (MCID) (the smallest change in a given endpoint that is meaningful to a patient) during seasonal alteration of Japanese cedar/cypress pollinosis (JCCP). Methods: Results of a double-blinded, placebo-controlled trial of JCCP patients conducted between 2008 and 2010 were analyzed using an anchor-based method in wh...

  6. Organohalogen contaminants and Blood plasma clinical-chemical parameters in three colonies of North Atlantic Great skua (Stercorarius skua)

    DEFF Research Database (Denmark)

    Sonne, Christian; Rigét, Frank F; Leat, Eliza H K

    2013-01-01

    to compare Great skua BCCPs in different exposure scenarios. Persistent organic pollutants (organochlorines: PCB, DDT, chlordanes, HCB, HCH, mirex and brominated flame retardants: PBDEs) and nineteen BCCPs were analysed in 114 adult Great skuas sampled during summer 2009 in North Atlantic colonies...

  7. The Importance of Clinical Phenotype in Understanding and Preventing Spontaneous Preterm Birth.

    Science.gov (United States)

    Esplin, M Sean

    2016-02-01

    Spontaneous preterm birth (SPTB) is a well-known cause of maternal and neonatal morbidity. The search for the underlying pathways, documentation of the genetic causes, and identification of markers of spontaneous PTB have been marginally successful due to the fact that it is highly complex, with numerous processes that lead to a final common pathway. There is a great need for a comprehensive, consistent, and uniform classification system, which will be useful in identifying mechanisms, assigning prognosis, aiding in clinical management, and can identify areas of interest for intervention and future study. Effective classification systems must overcome obstacles including the lack of widely accepted definitions and uncertainty about inclusion of classifying features (e.g., presentation at delivery and multiple gestations) and levels of detail of these features. The optimal classification system should be based on the clinical phenotype, including characteristics of the mother, fetus, placenta, and the presentation for delivery. We present a proposed phenotyping system for spontaneous PTB. Future classification systems must establish a universally accepted set of definitions and a standardized clinical workup for all PTBs including the minimum clinical data to be collected and the laboratory and pathologic evaluation that should be completed. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  8. Avoiding misdiagnosis of imported malaria: screening of emergency department samples with thrombocytopenia detects clinically unsuspected cases

    NARCIS (Netherlands)

    Hänscheid, Thomas; Melo-Cristino, José; Grobusch, Martin P.; Pinto, Bernardino G.

    2003-01-01

    BACKGROUND: Misdiagnosis of imported malaria is not uncommon and even abnormal routine laboratory tests may not trigger malaria smears. However, blind screening of all thrombocytopenic samples might be a possible way to detect clinically unsuspected malaria cases in the accident and emergency

  9. Statistical significance versus clinical importance: trials on exercise therapy for chronic low back pain as example.

    NARCIS (Netherlands)

    van Tulder, M.W.; Malmivaara, A.; Hayden, J.; Koes, B.

    2007-01-01

    STUDY DESIGN. Critical appraisal of the literature. OBJECIVES. The objective of this study was to assess if results of back pain trials are statistically significant and clinically important. SUMMARY OF BACKGROUND DATA. There seems to be a discrepancy between conclusions reported by authors and

  10. An Update on the Epidemiology of Schizophrenia with a Special Reference to Clinically Important Risk Factors

    Science.gov (United States)

    El-Missiry, Ahmed; Aboraya, Ahmed Sayed; Manseur, Hader; Manchester, Johnna; France, Cheryl; Border, Katherine

    2011-01-01

    Schizophrenia is a chronic mental illness which poses a tremendous burden on the families, caregivers and the society. The purpose of this paper is to provide an updated review of the epidemiology of schizophrenia with a special attention to the clinically important risk factors such as drug abuse, hormonal factors and the new advances in genetic…

  11. Approaches for estimating minimal clinically important differences in systemic lupus erythematosus.

    Science.gov (United States)

    Rai, Sharan K; Yazdany, Jinoos; Fortin, Paul R; Aviña-Zubieta, J Antonio

    2015-06-03

    A minimal clinically important difference (MCID) is an important concept used to determine whether a medical intervention improves perceived outcomes in patients. Prior to the introduction of the concept in 1989, studies focused primarily on statistical significance. As most recent clinical trials in systemic lupus erythematosus (SLE) have failed to show significant effects, determining a clinically relevant threshold for outcome scores (that is, the MCID) of existing instruments may be critical for conducting and interpreting meaningful clinical trials as well as for facilitating the establishment of treatment recommendations for patients. To that effect, methods to determine the MCID can be divided into two well-defined categories: distribution-based and anchor-based approaches. Distribution-based approaches are based on statistical characteristics of the obtained samples. There are various methods within the distribution-based approach, including the standard error of measurement, the standard deviation, the effect size, the minimal detectable change, the reliable change index, and the standardized response mean. Anchor-based approaches compare the change in a patient-reported outcome to a second, external measure of change (that is, one that is more clearly understood, such as a global assessment), which serves as the anchor. Finally, the Delphi technique can be applied as an adjunct to defining a clinically important difference. Despite an abundance of methods reported in the literature, little work in MCID estimation has been done in the context of SLE. As the MCID can help determine the effect of a given therapy on a patient and add meaning to statistical inferences made in clinical research, we believe there ought to be renewed focus on this area. Here, we provide an update on the use of MCIDs in clinical research, review some of the work done in this area in SLE, and propose an agenda for future research.

  12. Incidental extracerebral findings on brain nonenhanced magnetic resonance imaging: frequency, nondetection rate, and clinical importance

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Ming-Liang; Wei, Xiao-Er [School of Medicine, Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People' s Hospital, Shanghai (China); Lu, Li-Yan [Nanjing Medical University, Department of Radiology, Nanjing First Hospital, Nanjing (China); Li, Wen-Bin [School of Medicine, Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People' s Hospital, Shanghai (China); Kashgar Prefecture Second People' s Hospital, Imaging Center, Kashgar (China)

    2017-03-15

    This study aims to elucidate the frequency, nondetection rate, and clinical importance of incidental extracerebral findings (IECFs) on brain nonenhanced magnetic resonance imaging (MRI). A total of 8284 brain MRIs performed between January 1, 2015 and December 31, 2015 were evaluated for the presence of IECFs and the distribution of IECFs was analyzed. IECFs were categorized as E1 (clinically unimportant, e.g., sinus mucosal thickening); E2 (likely unimportant, e.g., pharyngeal mucosal symmetrical thickening); and E3 (potentially important, e.g., pharyngeal mucosal asymmetrical thickening). The nondetection rate was determined by comparing the results of the structured approach with the initial MRI reports. The medical records were examined for patients with E3 IECFs to assess clinical importance and outcome of these lesions. A total of 5992 IECFs were found in 4469 of the 8284 patients (54.0%). E1 findings constituted 82.2% (4924/5992) of all IECFs; E2 constituted 16.6% (995/5992) and E3 constituted 1.2% (73/5992). Overall IECFs and E1 findings were significantly more common in male patients (P < 0.05). Statistically significant difference was also seen between the different age groups (P < 0.001). The nondetection rate was 56.9% (3409/5992) for overall IECFs and 32.9% (24/73) for E3 IECFs. Of the 73 patients with E3 IECFs, 34 (46.6%) received final diagnosis and appropriate treatment during the study period. IECFs are prevalent in clinical patients on brain MR images with a nondetection rate of 32.9% for potentially important (E3) findings. The reporting of IECFs according to clinical importance is helpful for patients' management. (orig.)

  13. The Minimal Clinically Important Difference for the Mayo-Portland Adaptability Inventory.

    Science.gov (United States)

    Malec, James F; Kean, Jacob; Monahan, Patrick O

    To determine the Minimal Clinically Important Difference (MCID) and Robust Clinically Important Difference (RCID) of the Mayo-Portland Adaptability Inventory-4 (MPAI-4) as measures of response to intervention. Retrospective analysis of existing data. Both distribution- and anchor-based methods were used to triangulate on the MCID and to identify a moderate, that is, more robust, level of change (RCID) for the MPAI-4. These were further evaluated with respect to clinical provider ratings. Data for individuals with acquired brain injury in rehabilitation programs throughout the United States in the OutcomeInfo Database (n = 3087) with 2 MPAI-4 ratings. MPAI-4, Supervision Rating Scale, Clinician Rating of Global Clinical Improvement. Initial analyses suggested 5 T-score points (5T) as the MCID and 9T as the RCID. Eighty-one percent to 87% of clinical raters considered a 5T change and 99% considered a 9T change to indicate meaningful improvement. 5T represents the MCID for the MPAI-4 and 9T, the RCID. Both values are notably less than the Reliable Change Index (RCI). While the RCI indicates change with a high level of statistical confidence, it may be insensitive to change that is considered meaningful by providers and participants as indicated by the MCID.

  14. Minimal clinically important difference on the Motor Examination part of MDS-UPDRS.

    Science.gov (United States)

    Horváth, Krisztina; Aschermann, Zsuzsanna; Ács, Péter; Deli, Gabriella; Janszky, József; Komoly, Sámuel; Balázs, Éva; Takács, Katalin; Karádi, Kázmér; Kovács, Norbert

    2015-12-01

    Recent studies increasingly utilize the Movement Disorders Society Sponsored Unified Parkinson's Disease Rating Scale (MDS-UPDRS). However, the minimal clinically important difference (MCID) has not been fully established for MDS-UPDRS yet. To assess the MCID thresholds for MDS-UPDRS Motor Examination (Part III). 728 paired investigations of 260 patients were included. At each visit both MDS-UPDRS and Clinician-reported Global Impression-Improvement (CGI-I) scales were assessed. MDS-UPDRS Motor Examination (ME) score changes associated with CGI-I score 4 (no change) were compared with MDS-UPDRS ME score changes associated with CGI-I score 3 (minimal improvement) and CGI-I score 5 (minimal worsening). Both anchor- and distribution-based techniques were utilized to determine the magnitude of MCID. The MCID estimates for MDS-UPDRS ME were asymmetric: -3.25 points for detecting minimal, but clinically pertinent, improvement and 4.63 points for observing minimal, but clinically pertinent, worsening. MCID is the smallest change of scores that are clinically meaningful to patients. These MCID estimates may allow the judgement of a numeric change in MDS-UPDRS ME on its clinical importance. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. The attitudes of medical students in Europe toward the clinical importance of histology.

    Science.gov (United States)

    Moxham, Bernard John; Emmanouil-Nikoloussi, Elpida; Brenner, Erich; Plaisant, Odile; Brichova, Hana; Kucera, Tomas; Pais, Diogo; Stabile, Isobel; Borg, Jordy; Scholz, Michael; Paulsen, Friedrich; Luis Bueno-López, José; Alfonso Arraez Aybar, Luis; De Caro, Raffaele; Arsic, Stojanka; Lignier, Baptiste; Chirculescu, Andy

    2017-07-01

    Many studies have been undertaken to assess the attitudes of medical students to the clinical importance of gross anatomy. However, much less is known about their attitudes toward the clinical importance of histology. Using Thurstone and Chave methods to assess attitudes, over 2,000 early stage medical students across Europe provided responses to a survey that tested the hypothesis that the students have a high regard for histology's clinical relevance. Regardless of the university and country surveyed, and of the teaching methods employed for histology, our findings were not consistent with our hypotheses, students providing a more moderate assessment of histology's importance compared to gross anatomy but more positive than their attitudes toward embryology. Histology should play a significant role in medical education in terms of appreciating not just normal structure and function but also pathology. We conclude that teachers of histology should pay special attention to informing newly-recruited medical students of the significant role played by histology in attaining clinical competence and in underpinning their status as being learned members of a healthcare profession. This work was conducted under the auspices of the Trans-European Pedagogic Research Group (TEPARG). Clin. Anat. 30:635-643, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  16. Emerging souvenirs-clinical presentation of the returning traveller with imported arbovirus infections in Europe.

    Science.gov (United States)

    Eckerle, I; Briciu, V T; Ergönül, Ö; Lupşe, M; Papa, A; Radulescu, A; Tsiodras, S; Tsitou, C; Drosten, C; Nussenblatt, V R; Reusken, C B; Sigfrid, L A; Beeching, N J

    2018-03-01

    Arboviruses are an emerging group of viruses that are causing increasing health concerns globally, including in Europe. Clinical presentation usually consists of a nonspecific febrile illness that may be accompanied by rash, arthralgia and arthritis, with or without neurological or haemorrhagic syndromes. The range of differential diagnoses of other infectious and noninfectious aetiologies is broad, presenting a challenge for physicians. While knowledge of the geographical distribution of pathogens and the current epidemiological situation, incubation periods, exposure risk factors and vaccination history can help guide the diagnostic approach, the nonspecific and variable clinical presentation can delay final diagnosis. This narrative review aims to summarize the main clinical and laboratory-based findings of the three most common imported arboviruses in Europe. Evidence is extracted from published literature and clinical expertise of European arbovirus experts. We present three cases that highlight similarities and differences between some of the most common travel-related arboviruses imported to Europe. These include a patient with chikungunya virus infection presenting in Greece, a case of dengue fever in Turkey and a travel-related case of Zika virus infection in Romania. Early diagnosis of travel-imported cases is important to reduce the risk of localized outbreaks of tropical arboviruses such as dengue and chikungunya and the risk of local transmission from body fluids or vertical transmission. Given the global relevance of arboviruses and the continuous risk of (re)emerging arbovirus events, clinicians should be aware of the clinical syndromes of arbovirus fevers and the potential pitfalls in diagnosis. Copyright © 2018. Published by Elsevier Ltd.

  17. "As I deeply understand the importance and greatly admire the poetry of experiment..." (on the eve of P N Lebedev's anniversary)

    Science.gov (United States)

    Shcherbakov, R. N.

    2016-02-01

    Whatever we think of the eminent Russian physicist P N Lebedev, whatever our understanding of how his work was affected by circumstances in and outside of Russia, whatever value is placed on the basic elements of his twenty-year career and personal life and of his great successes and, happily, not so great failures, and whatever the stories of his happy times and his countless misfortunes, one thing remains clear — P N Lebedev's skill and talent served well to foster the development of global science and to improve the reputation of Russia as a scientific nation.

  18. [Clinical analysis of two cases of imported children Zika virus infection in China].

    Science.gov (United States)

    Zheng, C G; Xu, Y; Jiang, H Q; Yin, Y X; Zhang, J H; Zhu, W J; Liang, X J; Chen, M X; Ye, J W; Tan, L M; Luo, D; Gong, S T

    2016-05-01

    To analyze the clinical characteristics, outcome and diagnosis of two cases of imported children Zika virus infection in China. A retrospective analysis was performed on clinical characteristics, treatment and outcome of two cases of imported children with Zika virus infection in February 2016 in Enping People's Hospital of Guangdong. Two cases of children with imported Zika virus infection resided in an affected area of Venezuela, 8-year-old girl and her 6 year-old brother. The main findings on physical examination included the following manifestations: fever, rash, and conjunctivitis. The rash was first limited to the abdomen, but extended to the torso, neck and face, and faded after 3-4 d. The total number of white blood cells was not high and liver function was normal. The diagnosis of two cases of Zika virus infection was confirmed by the expert group of Guangdong Provincial Center for Disease Control and Prevention, according to the epidemiological history, clinical manifestations and Zika virus nucleic acid detection results.Treatment of Zika virus infection involves supportive care. Two Zika virus infection children had a relatively benign outcome. At present, Zika virus infection in children is an imported disease in China. No specific therapy is available for this disease. Information on long-term outcomes among infants and children with Zika virus disease is limited, routine pediatric care is advised for these infants and children.

  19. CT and MR imaging of the liver. Clinical importance of nutritional status

    International Nuclear Information System (INIS)

    Leander, P.; Sjoeberg, S.; Hoeglund, P.

    2000-01-01

    Purpose: In an experimental study in rats a correlation between nutritional status and hepatic attenuation in CT and signal intensities in MR imaging was shown. Is physiological nutritional status of importance in clinical CT and MR imaging? Material and methods: In a cross-over study including 12 healthy volunteers (6 women and 6 men, mean age 34 years), CT and MR imaging of the liver were performed with nutritional status at three different levels, i.e., normal, fasting and after glycogen-rich meals. CT and MR were performed on clinical imaging systems and hepatic attenuation and signal intensity, respectively, were assessed. In MR, T1-weighted, proton density-weighted and T2-weighted pulse-sequences were used. Results: In CT there were significantly (p<0.01) higher liver attenuations in normal nutritional status and after glycogen rich-meals compared to the fasting condition. The difference between fasting and glycogen-rich meals were 10.5 HU for men, 7.4 for women and mean 8.8 HU for all 12 volunteers. In MR imaging the differences were small and non-significant. The results of this study are in accordance with an earlier experimental study in rats. Conclusion: In CT it may be of importance not to have patients in a fasting condition as it lowers the attenuation in normal liver tissue. The findings are important for planning of clinical studies where hepatic attenuation will be assessed and may be of some importance in clinical CT. In MR imaging the results indicate that the nutritional status is of less importance

  20. Association between clinically important depressive symptoms and academic achivement among students in Cartagena, Colombia

    Directory of Open Access Journals (Sweden)

    Zuleima Cogollo

    2007-06-01

    Full Text Available Background: Some studies show a strongassociation between depressive symptoms andacademic achievement in the adolescent population.However, there are few Colombian publicationsabout this topic.Objective: To establish the association betweenclinically important depressive symptoms and academic achievement among low socioeconomicstatus adolescent students.Method: A group of 13 to 17 year-aged adolescentswas studied. Meaningful clinically depressivesymptoms were measured with Zung’self-rating depression scale (40/80. Academicachievement was evaluated according to Colombianqualitative model.Results: A total of 43.5% of students reportedclinically important depressive symptoms and30.7% accomplished a poor academic achievement,according to teacher report. The academicachievement was independent of meaningfulclinically depressive symptoms, after controllingother variables.Conclusion: Meaningful clinically depressivesymptoms are frequent in low socioeconomic statusadolescent students. But, meaningful clinicallydepressive symptoms are not associatedwith academic performance. Further investigationsare needed.

  1. Specific determination of clinical and toxicological important substances in biological samples by LC-MS

    International Nuclear Information System (INIS)

    Mitulovic, G.

    2001-02-01

    This thesis of this dissertation is the specific determination of clinical and toxicological important substances in biological samples by LC-MS. Nicotine was determined in serum after application of nicotine plaster and nicotine nasal spray with HPLC-ESI-MS. Cotinine was determined direct in urine with HPLC-ESI-MS. Short time anesthetics were determined in blood and cytostatics were determined in liquor with HPLC-ESI-MS. (botek)

  2. The comparative importance of books: clinical psychology in the health sciences library.

    Science.gov (United States)

    Wehmeyer, J M; Wehmeyer, S

    1999-01-01

    Clinical psychology has received little attention as a subject in health sciences library collections. This study seeks to demonstrate the relative importance of the monographic literature to clinical psychology through the examination of citations in graduate student theses and dissertations at the Fordham Health Sciences Library, Wright State University. Dissertations and theses were sampled randomly; citations were classified by format, counted, and subjected to statistical analysis. Books and book chapters together account for 35% of the citations in clinical psychology dissertations, 25% in nursing theses, and 8% in biomedical sciences theses and dissertations. Analysis of variance indicates that the citations in dissertations and theses in the three areas differ significantly (F = 162.2 with 2 and 253 degrees of freedom, P = 0.0001). Dissertations and theses in biomedical sciences and nursing theses both cite significantly more journals per book than the dissertations in clinical psychology. These results support the hypothesis that users of clinical psychology literature rely more heavily on books than many other users of a health sciences library. Problems with using citation analyses in a single subject to determine a serials to monographs ratio for a health sciences library are pointed out. PMID:10219478

  3. Which factors are important for the successful development and implementation of clinical pathways? A qualitative study.

    Science.gov (United States)

    De Allegri, Manuela; Schwarzbach, Matthias; Loerbroks, Adrian; Ronellenfitsch, Ulrich

    2011-03-01

    Clinical pathways (CPs) are detailed longitudinal care plans delineating measures to be conducted during a patient's treatment. Although positive effects on resource consumption and quality of care have been shown, CPs are still underutilised in many clinical settings because their development and implementation are difficult. Evidence underpinning successful development and implementation is sparse. The authors conducted semistructured face-to-face interviews with key staff members involved in the design and implementation of CPs in a large surgery department. Interviewees were asked to provide opinions on various issues, which were previously identified as potentially important in CP development and implementation. The transcribed text was read and coded independently by two researchers. Respondents highlighted the importance of a multidisciplinary participatory approach for CP design and implementation. There was a strong initial fear of losing individual freedom of treatment, which subsided after people worked with CPs in clinical everyday life. It was appreciated that the project originated from people at different levels of the department's hierarchy. Likewise, it was felt that CP implementation granted more autonomy to lower-level staff. The structured qualitative approach of this study provides information on what issues are considered important by staff members for CP design and implementation. Whereas some concepts such as the importance of a multidisciplinary approach or continuous feedback of results are known from theories, others such as strengthening the authority especially of lower-level health professionals through CPs have not been described so far. Many of the findings point towards strong interactions between factors important for CP implementation and a department's organisational structure.

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

    Science.gov (United States)

    Hauser, Robert A; Auinger, Peggy

    2011-04-01

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

  5. MEDIASTINAL SHIFT: A SIGN OF SIGNIFICANT CLINICAL AND RADIOLOGICAL IMPORTANCE IN DIAGNOSIS OF MALIGNANT PLEURAL EFFUSION

    Directory of Open Access Journals (Sweden)

    R Khajotia

    2012-08-01

    Full Text Available Mediastinal shift (upper and lower is a clinical and radiologicalmarker of significant importance, which at times helps todetermine the aetiological cause of the underlying pathology.Tracheal shift is an indicator of upper mediastinal shift, whilea shift in the position of the heart indicates a lower mediastinalshift. Since the pleural cavity is confined by the rib cage, incase of a moderately large pleural effusion, the structures inthe thoracic cavity normally get ‘pushed’ to the opposite sideresulting in a shift of the upper and lower mediastinum. Thisis clinically and radiologically detected by a shift in the tracheaand heart to the side opposite to the pleural effusion. This iscommonly seen in pleural effusions resulting from tuberculosisor other infections. However, in some cases even a largepleural effusion fails to shift the mediastinum to the oppositeside. In fact, in some cases, the trachea and heart areobserved to be central or even shifted to the same side asthe effusion. This finding is of immense importance as it is aclinical indicator of a more serious condition which needsprompt diagnosis and urgent management. We report here,one such case of a middle-aged man who presented to theemergency department with complaints of increasingbreathlessness and whose clinical and radiological examinationrevealed a moderately large right-sided pleural effusion withthe trachea and heart also shifted to the right side.

  6. Pragmatic characteristics of patient-reported outcome measures are important for use in clinical practice.

    Science.gov (United States)

    Kroenke, Kurt; Monahan, Patrick O; Kean, Jacob

    2015-09-01

    Measures for assessing patient-reported outcomes (PROs) that may have initially been developed for research are increasingly being recommended for use in clinical practice as well. Although psychometric rigor is essential, this article focuses on pragmatic characteristics of PROs that may enhance uptake into clinical practice. Three sources were drawn on in identifying pragmatic criteria for PROs: (1) selected literature review including recommendations by other expert groups; (2) key features of several model public domain PROs; and (3) the authors' experience in developing practical PROs. Eight characteristics of a practical PRO include: (1) actionability (i.e., scores guide diagnostic or therapeutic actions/decision making); (2) appropriateness for the relevant clinical setting; (3) universality (i.e., for screening, severity assessment, and monitoring across multiple conditions); (4) self-administration; (5) item features (number of items and bundling issues); (6) response options (option number and dimensions, uniform vs. varying options, time frame, intervals between options); (7) scoring (simplicity and interpretability); and (8) accessibility (nonproprietary, downloadable, available in different languages and for vulnerable groups, and incorporated into electronic health records). Balancing psychometric and pragmatic factors in the development of PROs is important for accelerating the incorporation of PROs into clinical practice. Published by Elsevier Inc.

  7. Determining the Minimal Clinically Important Difference for Six-Minute Walk Distance in Fibromyalgia

    Science.gov (United States)

    Kaleth, Anthony S.; Slaven, James E.; Ang, Dennis C.

    2016-01-01

    Objective To estimate the minimal clinically important difference (MCID) for 6-minute walk distance (6MWD) in patients with fibromyalgia (FM). Design Data from a recently completed trial that included 187 patients who completed the 6-minute walk test, Fibromyalgia Impact Questionnaire (FIQ), and Short-Form 36 (SF36) at 12 and 36 weeks were used to examine longitudinal changes in 6MWD. An anchor-based approach that used linear regression analyses was used to determine the MCID for 6MWD, using the total FIQ score (FIQ-Total) and SF36-physical function domain (SF36-PF) as clinical anchors. Results The mean (SD) change in 6MWD from baseline to week 36 was 34.4 (65.2) m (pFIQ and SF36-PF, respectively. These MCID’s correspond with clinically meaningful improvements in FIQ (14% reduction) and SF36-PF (10 point increase). Conclusion The MCID for 6MWD in patients with FM was 156 to 167 m. These findings provide the first evidence of the change in 6MWD that is perceived by patients to be clinically meaningful. Further research using other MCID calculation methods is needed to refine estimates of the MCID for 6MWD in patients with FM. PMID:27003201

  8. Determining the Minimal Clinically Important Difference for 6-Minute Walk Distance in Fibromyalgia.

    Science.gov (United States)

    Kaleth, Anthony S; Slaven, James E; Ang, Dennis C

    2016-10-01

    The aim of this study was to estimate the minimal clinically important difference (MCID) for 6-min walk distance (6MWD) in patients with fibromyalgia. Data from a recently completed trial that included 187 patients who completed the 6-min walk test, Fibromyalgia Impact Questionnaire (FIQ), and Short-Form 36 (SF36) at 12 and 36 wks were used to examine longitudinal changes in 6MWD. An anchor-based approach that used linear regression analyses was used to determine the MCID for 6MWD, using the total FIQ score (FIQ-Total) and SF36-physical function domain as clinical anchors. The mean (SD) change in 6MWD from baseline to week 36 was 34.4 (65.2) m (P FIQ and SF36-physical function domain, respectively. These MCIDs correspond with clinically meaningful improvements in FIQ (14% reduction) and SF36-physical function domain (10-point increase). The MCID for 6MWD in patients with fibromyalgia was 156 to 167 m. These findings provide the first evidence of the change in 6MWD that is perceived by patients to be clinically meaningful. Further research using other MCID calculation methods is needed to refine estimates of the MCID for 6MWD in patients with fibromyalgia.

  9. The mollusks in zootherapy: traditional medicine and clinical-pharmacological importance

    Directory of Open Access Journals (Sweden)

    Eraldo Medeiros Costa Neto

    2006-09-01

    Full Text Available The use of animals as sources of medicines is a cross-cultural phenomenon that is historically ancient and geographically widespread. This article reviews the use of mollusks in traditional medicine and discusses the clinical and pharmacological importance of these invertebrates. The roles that mollusks play in folk practices related to the healing and/or prevention of illnesses have been recorded in different social-cultural contexts worldwide. The clinical and therapeutic use of compounds coming from different species of mollusks is recorded in the literature. The chemistry of natural products provided by oysters, mussels, clams, sluggards, and snails has been substantially investigated, but the majority of these studies have focused on the subclasses Opistobranchia and Prosobranchia. Research into the knowledge and practices of folk medicine makes possible a better understanding of the interaction between human beings and the environment, in addition to allowing the elaboration of suitable strategies for the conservation of natural resources.

  10. Antibacterial effect of bioactive glasses on clinically important anaerobic bacteria in vitro.

    Science.gov (United States)

    Leppäranta, Outi; Vaahtio, Minna; Peltola, Timo; Zhang, Di; Hupa, Leena; Hupa, Mikko; Ylänen, Heimo; Salonen, Jukka I; Viljanen, Matti K; Eerola, Erkki

    2008-02-01

    Bioactive glasses (BAGs) of different compositions have been studied for decades for clinical use and they have found many dental and orthopaedic applications. Particulate BAGs have also been shown to have antibacterial properties. This large-scale study shows that two bioactive glass powders (S53P4 and 13-93) and a sol-gel derived material (CaPSiO II) have an antibacterial effect on 17 clinically important anaerobic bacterial species. All the materials tested demonstrated growth inhibition, although the concentration and time needed for the effect varied depending on the BAG. Glass S53P4 had a strong growth-inhibitory effect on all pathogens tested. Glass 13-93 and sol-gel derived material CaPSiO II showed moderate antibacterial properties.

  11. Analyses of infrequent (quasi-decadal) large groundwater recharge events in the northern Great Basin: Their importance for groundwater availability, use, and management

    Science.gov (United States)

    Masbruch, Melissa D.; Rumsey, Christine; Gangopadhyay, Subhrendu; Susong, David D.; Pruitt, Tom

    2016-01-01

    There has been a considerable amount of research linking climatic variability to hydrologic responses in the western United States. Although much effort has been spent to assess and predict changes in surface water resources, little has been done to understand how climatic events and changes affect groundwater resources. This study focuses on characterizing and quantifying the effects of large, multiyear, quasi-decadal groundwater recharge events in the northern Utah portion of the Great Basin for the period 1960–2013. Annual groundwater level data were analyzed with climatic data to characterize climatic conditions and frequency of these large recharge events. Using observed water-level changes and multivariate analysis, five large groundwater recharge events were identified with a frequency of about 11–13 years. These events were generally characterized as having above-average annual precipitation and snow water equivalent and below-average seasonal temperatures, especially during the spring (April through June). Existing groundwater flow models for several basins within the study area were used to quantify changes in groundwater storage from these events. Simulated groundwater storage increases per basin from a single recharge event ranged from about 115 to 205 Mm3. Extrapolating these amounts over the entire northern Great Basin indicates that a single large quasi-decadal recharge event could result in billions of cubic meters of groundwater storage. Understanding the role of these large quasi-decadal recharge events in replenishing aquifers and sustaining water supplies is crucial for long-term groundwater management.

  12. Do clinical diagnoses correlate with pathological diagnoses in cardiac transplant patients? The importance of endomyocardial biopsy

    DEFF Research Database (Denmark)

    Luk, Adriana; Metawee, Mohammed; Ahn, Eric

    2009-01-01

    . Patient records were reviewed for preoperative clinical diagnoses and other relevant data, including pretransplant endomyocardial biopsy (EMB) results, information regarding left ventricular assist devices and, finally, evidence of disease recurrence in the grafted heart. RESULTS: A shift...... diagnose patients with diseases such as sarcoidosis, amyloidosis and particular types of myocarditis because these can readily recur in the grafted heart. The risk for recurrence must be known to practitioners and, most importantly, to the patient. We strongly recommend the use of EMB if a nonischemic...

  13. The importance of genotype-phenotype correlation in the clinical management of Marfan syndrome.

    Science.gov (United States)

    Becerra-Muñoz, Víctor Manuel; Gómez-Doblas, Juan José; Porras-Martín, Carlos; Such-Martínez, Miguel; Crespo-Leiro, María Generosa; Barriales-Villa, Roberto; de Teresa-Galván, Eduardo; Jiménez-Navarro, Manuel; Cabrera-Bueno, Fernando

    2018-01-22

    Marfan syndrome (MFS) is a disorder of autosomal dominant inheritance, in which aortic root dilation is the main cause of morbidity and mortality. Fibrillin-1 (FBN-1) gene mutations are found in more than 90% of MFS cases. The aim of our study was to summarise variants in FBN-1 and establish the genotype-phenotype correlation, with particular interest in the onset of aortic events, in a broad population of patients with an initial clinical suspicion of MFS. This single centre prospective cohort study included all patients presenting variants in the FBN-1 gene who visited a Hereditary Aortopathy clinic between September 2010 and October 2016. The study included 90 patients with FBN-1 variants corresponding to 58 non-interrelated families. Of the 57 FBN-1 variants found, 25 (43.9%) had previously been described, 23 of which had been identified as associated with MFS, while the the remainder are described for the first time. For 84 patients (93.3%), it was possible to give a definite diagnosis of Marfan syndrome in accordance with Ghent criteria. 44 of them had missense mutations, 6 of whom had suffered an aortic event (with either prophylactic surgery for aneurysm or dissection), whereas 20 of the 35 patients with truncating mutations had suffered an event (13.6% vs. 57.1%, p importance not only in the diagnosis, but also in risk stratification and clinical management of patients with suspected MFS.

  14. Late radiation-induced heart disease after radiotherapy. Clinical importance, radiobiological mechanisms and strategies of prevention

    International Nuclear Information System (INIS)

    Andratschke, Nicolaus; Maurer, Jean; Molls, Michael; Trott, Klaus-Ruediger

    2011-01-01

    The clinical importance of radiation-induced heart disease, in particular in post-operative radiotherapy of breast cancer patients, has been recognised only recently. There is general agreement, that a co-ordinated research effort would be needed to explore all the potential strategies of how to reduce the late risk of radiation-induced heart disease in radiotherapy. This approach would be based, on one hand, on a comprehensive understanding of the radiobiological mechanisms of radiation-induced heart disease after radiotherapy which would require large-scale long-term animal experiments with high precision local heart irradiation. On the other hand - in close co-operation with mechanistic in vivo research studies - clinical studies in patients need to determine the influence of dose distribution in the heart on the risk of radiation-induced heart disease. The aim of these clinical studies would be to identify the critical structures within the organ which need to be spared and their radiation sensitivity as well as a potential volume and dose effect. The results of the mechanistic studies might also provide concepts of how to modify the gradual progression of radiation damage in the heart by drugs or biological molecules. The results of the studies in patients would need to also incorporate detailed dosimetric and imaging studies in order to develop early indicators of impending radiation-induced heart disease which would be a pre-condition to develop sound criteria for treatment plan optimisation.

  15. Quality of Life After Cardiac Surgery Based on the Minimal Clinically Important Difference Concept.

    Science.gov (United States)

    Grand, Nathalie; Bouchet, Jean Baptiste; Zufferey, Paul; Beraud, Anne Marie; Awad, Sahar; Sandri, Fabricio; Campisi, Salvator; Fuzellier, Jean François; Molliex, Serge; Vola, Marco; Morel, Jerome

    2018-03-23

    Health-related quality of life (HRQOL) is an increasingly important issue in assessing the consequences of any surgical or medical intervention. Our study aimed to evaluate change in HRQOL 6 months after elective cardiac surgery and to identify specific predictors of poor HRQOL. In this prospective, single-center study, HRQOL was evaluated before and 6 months after surgery using the SF-36 questionnaire and its two components: the physical component summary (PCS) and the mental component summary (MCS). We distinguished patients with worsening of HRQOL according to the minimal clinically important difference. All consecutive adult patients undergoing cardiac surgery were included. 326 patients completed the preoperative and postoperative SF-36 questionnaires and 24 patients died before completing follow-up questionnaires. Based on the definition used, clinically significant deterioration of HRQOL was observed in 93 patients (26.6%) for PCS and 99 patients (28.2%) for MCS. Renal replacement for acute renal failure and mechanical ventilation for longer than 48 hours were independent risk factors for PCS and MCS worsening or death. Although our study showed overall improvement of QOL after cardiac surgery, over a quarter of the patients manifested deterioration of HRQOL at 6 months post-surgery. The findings from this study should help clinicians to inform patients about their likely postoperative functional status and quality of life. Copyright © 2018. Published by Elsevier Inc.

  16. What is clinical leadership and why might it be important in dentistry?

    Science.gov (United States)

    Brocklehurst, P; Ferguson, J; Taylor, N; Tickle, M

    2013-03-01

    The concept of leadership means different things to different people. At present there is no single definition of leadership nor an established theoretical approach. Despite this, leadership in the clinical environment is becoming increasingly cited as an important component in the transition of the National Health Service (NHS) and in the development of clinician led services. In medicine, clinical commissioning groups (CCGs) will soon be operational and the Department of Health (DH) seeks to establish a similar approach in dentistry, where local clinicians drive forward a quality agenda with a focus on patient outcomes. To facilitate this, the NHS Commissioning Board (NHSCB) are in the process of developing Local Professional Networks (LPNs) for dentistry. Given this shift towards localism and clinician led services it would appear that leadership will have a significant role in both medicine and dentistry. This paper explores what leadership is, before determining why it might be important in providing a clinician-led, patient-based and outcomes-focused service.

  17. A great pioneer of clinical science remembered: introduction to the special issue in honor of Paul E. Meehl.

    Science.gov (United States)

    Lilienfeld, Scott O; Waller, Niels G

    2005-10-01

    In this special issue, the seminal contributions to clinical psychology of Paul E. Meehl, who passed away in 2003, are commemorated. The nine articles comprising this special issue chronicle Meehl's remarkable intellectual biography and examine his influence on diverse domains of psychology, including the clinical versus actuarial prediction debate, the cognitive activity of the clinician, personality assessment and trait theory, the etiology of schizophrenia, the shortcomings of statistical significance testing, and the use of metascientific methods to evaluate competing models of human nature. These articles illustrate not only Meehl's legendary brilliance but also his pivotal role in forcing clinical psychologists to think more clearly and incisively about their subject matter. 2005 Wiley Periodicals, Inc.

  18. Recruitment of childhood leukaemia patients to clinical trials in Great Britain during 1980-2007: variation by birth weight, congenital malformation, socioeconomic status and ethnicity.

    Science.gov (United States)

    Shah, Anjali; Diggens, Nicole; Stiller, Charles; Richards, Sue; Stevens, Michael C G; Murphy, Michael F G

    2014-05-01

    To assess recruitment of children to national clinical trials for acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML) in Great Britain during 1980-2007 and describe variation by some factors that might influence trial entry. Records of leukaemia patients aged 0-14 years at diagnosis were identified in the National Registry of Childhood Tumours and linked to birth registrations, Children's Cancer and Leukaemia Group records, Hospital Episode Statistics and Medical Research Council clinical trial registers. Trial entry rates were compared between categories of birth weight, congenital malformation, socioeconomic status and ethnicity. 9147 ALL and 1466 AML patients were eligible for national clinical trials during 1980-2007. Overall recruitment rates were 81% and 60% respectively. For ALL, rates varied significantly with congenital malformation (Down syndrome 61%, other malformations 80%, none 82%; p4000 g 67%; p=0.001) and congenital malformation (Down syndrome 28%, other malformations 56%, none 63%; pcongenital malformations.

  19. Antimicrobial activity of extracts from macroalgae Ulva lactuca against clinically important Staphylococci is impacted by lunar phase of macroalgae harvest.

    Science.gov (United States)

    Deveau, A M; Miller-Hope, Z; Lloyd, E; Williams, B S; Bolduc, C; Meader, J M; Weiss, F; Burkholder, K M

    2016-05-01

    Staphylococcus aureus is a common human bacterial pathogen that causes skin and soft tissue infections. Methicillin-resistant Staph. aureus (MRSA) are increasingly drug-resistant, and thus there is great need for new therapeutics to treat Staph. aureus infections. Attention has focused on potential utility of natural products, such as extracts of marine macroalgae, as a source of novel antimicrobial compounds. The green macroalgae Ulva lactuca produces compounds inhibitory to human pathogens, although the effectiveness of U. lactuca extracts against clinically relevant strains of Staph. aureus is poorly understood. In addition, macroalgae produce secondary metabolites that may be influenced by exogenous factors including lunar phase, but whether lunar phase affects U. lactuca antimicrobial capacity is unknown. We sought to evaluate the antibacterial properties of U. lactuca extracts against medically important Staphylococci, and to determine the effect of lunar phase on antimicrobial activity. We report that U. lactuca methanolic extracts inhibit a range of Staphylococci, and that lunar phase of macrolagae harvest significantly impacts antimicrobial activity, suggesting that antimicrobial properties can be maximized by manipulating time of algal harvest. These findings provide useful parameters for future studies aimed at isolating and characterizing U. lactuca anti-Staphylococcal agents. The growing prevalence of antibiotic-resistant human pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) has intensified efforts towards discovery and development of novel therapeutics. Marine macroalgae like Ulva lactuca are increasingly recognized as potential sources of antimicrobials, but the efficacy of U. lactuca extracts against common, virulent strains of Staph. aureus is poorly understood. We demonstrate that U. lactuca methanolic extracts inhibit a variety of clinically relevant Staphylococcus strains, and that the antimicrobial activity can

  20. Is daily routine important for sleep? An investigation of social rhythms in a clinical insomnia population.

    Science.gov (United States)

    Moss, Taryn G; Carney, Colleen E; Haynes, Patricia; Harris, Andrea L

    2015-02-01

    Social rhythms, also known as daily routines (e.g. exercise, of school or work, recreation, social activities), have been identified as potential time cues to help to regulate the biological clock. Past research has shown links between regularity and healthy sleep. This study examined the regularity and frequency of daytime activities in a clinical insomnia population and a good sleeper comparison group. Participants (N = 69) prospectively monitored their sleep and daily activities for a 2-week period. Although participants with insomnia and good sleepers had similar levels of activity, relative to good sleepers, those with insomnia were less regular in their activities. Findings from this study add to the growing number of studies that highlight the relative importance of the regularity of daytime activities on sleep. Accordingly, future research should test treatment components that focus on regulating daytime activities, which would likely improve treatment outcomes.

  1. Shared decision making in mental health: the importance for current clinical practice.

    Science.gov (United States)

    Alguera-Lara, Victoria; Dowsey, Michelle M; Ride, Jemimah; Kinder, Skye; Castle, David

    2017-12-01

    We reviewed the literature on shared decision making (regarding treatments in psychiatry), with a view to informing our understanding of the decision making process and the barriers that exist in clinical practice. Narrative review of published English-language articles. After culling, 18 relevant articles were included. Themes identified included models of psychiatric care, benefits for patients, and barriers. There is a paucity of published studies specifically related to antipsychotic medications. Shared decision making is a central part of the recovery paradigm and is of increasing importance in mental health service delivery. The field needs to better understand the basis on which decisions are reached regarding psychiatric treatments. Discrete choice experiments might be useful to inform the development of tools to assist shared decision making in psychiatry.

  2. Importance/performance analysis: a tool for service quality control by clinical laboratories.

    Science.gov (United States)

    Scammon, D L; Weiss, R

    1991-01-01

    A study of customer satisfaction with clinical laboratory service is used as the basis for identifying potential improvements in service and more effectively targeting marketing activities to enhance customer satisfaction. Data on customer satisfaction are used to determine the aspects of service most critical to customers, how well the organization is doing in delivery of service, and how consistent service delivery is. Importance-performance analysis is used to highlight areas for future resource reallocation and strategic emphasis. Suggestions include the establishment of performance guidelines for customer contact personnel, the enhancement of timely delivery of reports via electronic transmission (computer and fax), and the development of standardized graphics for request and report forms to facilitate identification of appropriate request forms and guide clients to key items of information on reports.

  3. Differential Diagnoses of Overgrowth Syndromes: The Most Important Clinical and Radiological Disease Manifestations

    International Nuclear Information System (INIS)

    Lacerda, L.S.; Alves, U.D.; Zanier, J.F.C.; Machado, D.C.; Camilo, G.B.; Machado, D.C.; Camilo, G.B.; Lopes, A.J.

    2014-01-01

    Overgrowth syndromes comprise a heterogeneous group of diseases that are characterized by excessive tissue development. Some of these syndromes may be associated with dysfunction in the receptor tyrosine kinase (RTK)/PI3K/AKT pathway, which results in an increased expression of the insulin receptor. In the current review, four overgrowth syndromes were characterized (Proteus syndrome, Klippel-Trenaunay-Weber syndrome, Made lung’s disease, and neurofibromatosis type I) and illustrated using cases from our institution. Because these syndromes have overlapping clinical manifestations and have no established genetic tests for their diagnosis, radiological methods are important contributors to the diagnosis of many of these syndromes. The correlation of genetic discoveries and molecular pathways that may contribute to the phenotypic expression is also of interest, as this may lead to potential therapeutic interventions

  4. ABC gene expression profiles have clinical importance and possibly form a new hallmark of cancer.

    Science.gov (United States)

    Dvorak, Pavel; Pesta, Martin; Soucek, Pavel

    2017-05-01

    Adenosine triphosphate-binding cassette proteins constitute a large family of active transporters through extracellular and intracellular membranes. Increased drug efflux based on adenosine triphosphate-binding cassette protein activity is related to the development of cancer cell chemoresistance. Several articles have focused on adenosine triphosphate-binding cassette gene expression profiles (signatures), based on the expression of all 49 human adenosine triphosphate-binding cassette genes, in individual tumor types and reported connections to established clinicopathological features. The aim of this study was to test our theory about the existence of adenosine triphosphate-binding cassette gene expression profiles common to multiple types of tumors, which may modify tumor progression and provide clinically relevant information. Such general adenosine triphosphate-binding cassette profiles could constitute a new attribute of carcinogenesis. Our combined cohort consisted of tissues from 151 cancer patients-breast, colorectal, and pancreatic carcinomas. Standard protocols for RNA isolation and quantitative real-time polymerase chain reaction were followed. Gene expression data from individual tumor types as well as a merged tumor dataset were analyzed by bioinformatics tools. Several general adenosine triphosphate-binding cassette profiles, with differences in gene functions, were established and shown to have significant relations to clinicopathological features such as tumor size, histological grade, or clinical stage. Genes ABCC7, A3, A8, A12, and C8 prevailed among the most upregulated or downregulated ones. In conclusion, the results supported our theory about general adenosine triphosphate-binding cassette gene expression profiles and their importance for cancer on clinical as well as research levels. The presence of ABCC7 (official symbol CFTR) among the genes with key roles in the profiles supports the emerging evidence about its crucial role in various

  5. How Do Psychiatrists Apply the Minimum Clinically Important Difference to Assess Patient Responses to Treatment?

    Directory of Open Access Journals (Sweden)

    Alan J. McMichael BSc

    2016-11-01

    Full Text Available Symptom report scales are used in clinical practice to monitor patient outcomes. Using them permits the definition of a minimum clinically important difference (MCID beyond which a patient may be judged as having responded to treatment. Despite recommendations that clinicians routinely use MCIDs in clinical practice, statisticians disagree about how MCIDs should be used to evaluate individual patient outcomes and responses to treatment. To address this issue, we asked how clinicians actually use MCIDs to evaluate patient outcomes in response to treatment. Sixty-eight psychiatrists made judgments about whether hypothetical patients had responded to treatment based on their pre- and posttreatment change scores on the widely used Positive and Negative Syndrome Scale. Psychiatrists were provided with the scale’s MCID on which to base their judgments. Our secondary objective was to assess whether knowledge of the patient’s genotype influenced psychiatrists’ responder judgments. Thus, psychiatrists were also informed of whether patients possessed a genotype indicating hyperresponsiveness to treatment. While many psychiatrists appropriately used the MCID, others accepted a far lower posttreatment change as indicative of a response to treatment. When psychiatrists accepted a lower posttreatment change than the MCID, they were less confident in such judgments compared to when a patient’s posttreatment change exceeded the scale’s MCID. Psychiatrists were also less likely to identify patients as responders to treatment if they possessed a hyperresponsiveness genotype. Clinicians should recognize that when judging patient responses to treatment, they often tolerate lower response thresholds than warranted. At least some conflate their judgments with information, such as the patient’s genotype, that is irrelevant to a post hoc response-to-treatment assessment. Consequently, clinicians may be at risk of persisting with treatments that have failed

  6. [Imported malaria and HIV infection in Madrid. Clinical and epidemiological features].

    Science.gov (United States)

    Ramírez-Olivencia, G; Herrero, M D; Subirats, M; de Juanes, J R; Peña, J M; Puente, S

    2012-01-01

    Few data are available in Spain data on human immunodeficiency virus (HIV) patients coinfected with malaria. This study has aimed to determine the epidemiological and clinical characteristics of imported malaria in patients coinfected with HIV. A case-series retrospective study was performed using the patient's medical records. The study population consisted on patients diagnosed with malaria attended in our center from january 1, 2002 to december 31, 2007. A total of 484 episodes of malaria, 398 of which were included in this study, were identified. Co-infection with HIV was described in 32 cases. All of them occurred in individuals presumably with some degree of semi-immunity. In the coinfected group, there were 13 cases (40.6%) asymptomatic, whereas this event occurred in 99 cases of patients not coinfected (37.2%) (P=0.707). The greater presence of anemia in co-infected patients (62.5% vs 32.3% in non-coinfected [P=0.001]) stands out. In present study, the clinical presentation forms were similar, regardless of the presence or absence of HIV infection. Although the study population does not reflect all possible scenarios of malaria and HIV coinfection, our results indicate the reality of patients attended in the Autonomous Community of Madrid. Copyright © 2011 Elsevier España, S.L. All rights reserved.

  7. Clinical importance of pharmacogenetics in the treatment of hepatitis C virus infection.

    Science.gov (United States)

    Kamal, Adina Maria; MitruŢ, Paul; Kamal, Kamal Constantin; Tica, Oana Sorina; Niculescu, Mihaela; Alexandru, Dragoş Ovidiu; Tica, Andrei Adrian

    2016-01-01

    Globally, over 4% of the world population is affected by hepatitis C virus (HCV) infection. The current standard of care for hepatitis C infection is combination therapy with pegylated interferon and ribavirin for 48 weeks, which yield a sustained virological response in only a little over half of the patients with genotype 1 HCV. We investigated the clinical importance of pharmacogenetics in treatment efficacy and prediction of hematotoxicity. A total of 148 patients infected with HCV were enrolled. All patients were treated for a period of 48 weeks or less with pegylated interferon and ribavirin. Four genotypes were investigated: inosine triphosphatase (ITPA) rs1127354, C20orf194 rs6051702, interferon lambda (IFNL)3 rs8099917, IFNL3÷4 rs12979860 in the population from southwestern Romania. Genetic variants for rs129798660 and rs6051702 proved once more to represent an indisputable clinical tool for predicting sustained virological response (SVR) (69.23%, chi-square p=0.007846, ppharmacogenetics should play a constant role in treatment decisions for patients infected with hepatitis C virus.

  8. The importance, impact and influence of group clinical supervision for graduate entry nursing students.

    Science.gov (United States)

    Sheppard, Fiona; Stacey, Gemma; Aubeeluck, Aimee

    2018-01-01

    This paper will report on an evaluation of group clinical supervision (CS) facilitated for graduate entry nursing (GEN) students whilst on clinical placement. The literature suggests educational forums which enable GEN students to engage in critical dialogue, promote reflective practice and ongoing support are an essential element of GEN curricula. The model of supervision employed was informed by Proctor's three function interactive CS model and Inskipp and Proctor's Supervision Alliance. Both emphasise the normative, formative and restorative functions of CS as task areas within an overarching humanistic supervisory approach. The three-function model informed the design of a questionnaire which intended to measure their importance, impact and influence through both structured and open-ended questions. Findings suggest the restorative function of supervision is most valued and is facilitated in an environment where humanistic principles of non-judgement, empathy and trust are clearly present. Also the opportunity to learn from others, consider alternative perspectives and question personal assumptions regarding capability and confidence are a priority for this student group. It is suggested that the restorative function of CS should be prioritised within future developments and models which view this function as a key purpose of CS should be explored. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Importance of patient-centred signage and navigation guide in an orthopaedic and plastics clinic.

    Science.gov (United States)

    Maqbool, Talha; Raju, Sneha; In, Eunji

    2016-01-01

    Gulshan & Nanji Orthopaedic and Plastics Center at the North York General Hospital is the second busiest site after the emergency department serving more than 26,000 patients annually. Increase in patient flow, overworked staff, and recent renovations to the hospital have resulted in patients experiencing long wait times, and thusly patient dissatisfaction and stress. Several factors contribute to patient dissatisfaction and stress: i) poor and unfriendly signage; ii) inconsistent utilization of the numbering system; and iii) difficulty navigating to and from the imaging center. A multidisciplinary QI team was assembled to improve the patient experience. We developed a questionnaire to assess patient stress levels at the baseline. Overall, more than half of the patients (54.8%) strongly agreed or agreed to having a stressful waiting experience. Subsequently, based on patient feedback and staff perspectives, we implemented two PDSA cycles. For PDSA 1, we placed a floor graphic (i.e. black tape) to assist patients in navigating from the clinic to the imaging centre and back. For PDSA 2, we involved creating a single 21"×32" patient-friendly sign at the entrance to welcome patients, with clear instructions outlining registration procedures. Surveys were re-administered to assess patient stress levels. A combination of both interventions caused a statistically significant reduction in patient stress levels based on the Kruskal-Wallis and Mann-Whitney U Tests. The present project highlighted the importance of involving stakeholders as well as frontline staff when undertaking quality improvement projects as a way to identify bottlenecks as well as establish sustainable solutions. Additionally, the team recognized the importance of incorporating empirical based solutions and involving experts in the field to optimize results. The present project successfully implemented strategies to improve patient satisfaction and reduce stress in a high flow community clinic. These

  10. The importance of histopathological and clinical variables in predicting the evolution of colon cancer.

    Science.gov (United States)

    Diculescu, Mircea; Iacob, Răzvan; Iacob, Speranţa; Croitoru, Adina; Becheanu, Gabriel; Popeneciu, Valentin

    2002-09-01

    It has been a consensus that prognostic factors should always be taken into account before planning treatment in colorectal cancer. A 5 year prospective study was conducted, in order to assess the importance of several histopathological and clinical prognostic variables in the prediction of evolution in colon cancer. Some of the factors included in the analysis are still subject to dispute by different authors. 46 of 53 screened patients qualified to enter the study and underwent a potentially curative resection of the tumor, followed, when necessary, by adjuvant chemotherapy. Univariate and multivariate analyses were carried out in order to identify independent prognostic indicators. The endpoint of the study was considered the recurrence of the tumor or the detection of metastases. 65.2% of the patients had a good evolution during the follow up period. Multivariate survival analysis performed by Cox proportional hazard model identified 3 independent prognostic factors: Dukes stage (p = 0.00002), the grade of differentiation (p = 0.0009) and the weight loss index, representing the weight loss of the patient divided by the number of months when it was actually lost (p = 0.02). Age under 40 years, sex, microscopic aspect of the tumor, tumor location, anemia degree were not identified by our analysis as having prognostic importance. Histopathological factors continue to be the most valuable source of information regarding the possible evolution of patients with colorectal cancer. Individual clinical symptoms or biological parameters such as erytrocyte sedimentation rate or hemoglobin level are of little or no prognostic value. More research is required relating to the impact of a performance status index (which could include also weight loss index) as another reliable prognostic variable.

  11. The importance of clinical monitoring for compliance with Continuous Positive Airway Pressure.

    Science.gov (United States)

    Pelosi, Lucas B; Silveira, Mariana L C; Eckeli, Alan L; Chayamiti, Emilia M P C; Almeida, Leila A; Sander, Heidi H; Küpper, Daniel S; Valera, Fabiana C P

    Obstructive sleep apnea syndrome is currently a public health problem of great importance. When misdiagnosed or improperly treated, it can lead to serious consequences on patients' quality of life. The gold standard treatment for cases of obstructive sleep apnea syndrome, especially in mild to severe and symptomatic cases, is continuous positive airway pressure therapy. Compliance with continuous positive airway pressure therapy is directly dependent on the active participation of the patient, which can be influenced by several factors. The objective of this study is to describe the factors related to compliance with continuous positive airway pressure therapy, and to analyze which associated factors directly influence the efficiency of the treatment. Patients who received continuous positive airway pressure therapy through the Municipal Health Department of the city of Ribeirão Preto were recruited. A structured questionnaire was administered to the patients. Compliance with continuous positive airway pressure therapy was assessed by average hours of continuous positive airway pressure therapy usage per night. Patients with good compliance (patients using continuous positive airway pressure therapy ≥4h/night) were compared to those with poor compliance (patients using <4h/night). 138 patients were analyzed: 77 (55.8%) were considered compliant while 61 (44.2%) were non-compliant. The comparison between the two groups showed that regular monitoring by a specialist considerably improved compliance with continuous positive airway pressure therapy (odds ratio, OR=2.62). Compliance with continuous positive airway pressure therapy is related to educational components, which can be enhanced with continuous and individualized care to patients with obstructive sleep apnea syndrome. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  12. Great Expectations

    NARCIS (Netherlands)

    Dickens, Charles

    2005-01-01

    One of Dickens's most renowned and enjoyable novels, Great Expectations tells the story of Pip, an orphan boy who wishes to transcend his humble origins and finds himself unexpectedly given the opportunity to live a life of wealth and respectability. Over the course of the tale, in which Pip

  13. The importance of coral larval recruitment for the recovery of reefs impacted by cyclone Yasi in the central Great Barrier Reef.

    Directory of Open Access Journals (Sweden)

    Vimoksalehi Lukoschek

    Full Text Available Cyclone Yasi, one of the most severe tropical storms on record, crossed the central Great Barrier Reef (GBR in February 2011, bringing wind speeds of up to 285 km hr⁻¹ and wave heights of at least 10 m, and causing massive destruction to exposed reefs in the Palm Island Group. Following the cyclone, mean (± S.E. hard coral cover ranged from just 2.1 (0.2 % to 5.3 (0.4 % on exposed reefs and no reproductively mature colonies of any species of Acropora remained. Although no fragments of Acropora were found at impacted exposed sites following the cyclone, small juvenile colonies of Acropora (<10 cm diameter were present, suggesting that their small size and compact morphologies enabled them to survive the cyclone. By contrast, sheltered reefs appeared to be unaffected by the cyclone. Mean (± S.E. hard coral cover ranged from 18.2 (2.4 % to 30.0 (1.0 % and a large proportion of colonies of Acropora were reproductively mature. Macroalgae accounted for 8 to 16% of benthic cover at exposed sites impacted by cyclone Yasi but were absent at sheltered sites. Mean (± S.E. recruitment of acroporids to settlement tiles declined from 25.3 (4.8 recruits tile⁻¹ in the pre-cyclone spawning event (2010 to 15.4 (2.2 recruits tile⁻¹ in the first post-cyclone spawning event (2011. Yet, post-cyclone recruitment did not differ between exposed (15.2±2.1 S.E. and sheltered sites (15.6±2.2 S.E., despite the loss of reproductive colonies at the exposed sites, indicating larval input from external sources. Spatial variation in impacts, the survival of small colonies, and larval replenishment to impacted reefs suggest that populations of Acropora have the potential to recover from this severe disturbance, provided that the Palm Islands are not impacted by acute disturbances or suffer additional chronic stressors in the near future.

  14. Clinical importance of the anterior choroidal artery: a review of the literature.

    Science.gov (United States)

    Yu, Jing; Xu, Ning; Zhao, Ying; Yu, Jinlu

    2018-01-01

    The anterior choroidal artery (AChA) is a critical artery in brain physiology and function. The AChA is involved in many diseases, including aneurysm, brain infarct, Moyamoya disease (MMD), brain tumor, arteriovenous malformation (AVM), etc. The AChA is vulnerable to damage during the treatment of these diseases and is thus a very important vessel. However, a comprehensive systematic review of the importance of the AChA is currently lacking. In this study, we used the PUBMED database to perform a literature review of the AChA to increase our understanding of its role in neurophysiology. Although the AChA is a small thin artery, it supplies an extremely important region of the brain. The AChA consists of cisternal and plexal segments, and the point of entry into the choroidal plexus is known as the plexal point. During treatment for aneurysms, tumors, AVM or AVF, the AChA cisternal segments should be preserved as a pathway to prevent the infarction of the AChA target region in the brain. In MMD, a dilated AChA provides collateral flow for posterior circulation. In brain infarcts, rapid treatment is necessary to prevent brain damage. In Parkinson disease (PD), the role of the AChA is unclear. In trauma, the AChA can tear and result in intracranial hematoma. In addition, both chronic and non-chronic branch vessel occlusions in the AChA are clinically silent and should not deter aneurysm treatment with flow diversion. Based on the data available, the AChA is a highly essential vessel.

  15. The importance of exercise self-efficacy for clinical outcomes in pulmonary rehabilitation.

    Science.gov (United States)

    Selzler, Anne-Marie; Rodgers, Wendy M; Berry, Tanya R; Stickland, Michael K

    2016-11-01

    Pulmonary rehabilitation (PR) improves functional exercise capacity and health status in people with chronic obstructive pulmonary disease (COPD), although these outcomes are often not maintained following PR. Self-efficacy is a precursor to outcomes achievement, yet few studies have examined the importance of self-efficacy to outcome improvement during PR, or how it develops over time. Further, the contribution of exercise-specific self-efficacy to outcomes in PR is unknown. The aims of this study were to determine (a) whether baseline exercise self-efficacy predicts PR attendance and change in functional exercise capacity and health status over PR, and (b) if exercise self-efficacy changes with PR. Fifty-eight out of 64 patients with COPD completed PR and assessments of exercise self-efficacy (task, coping, scheduling), the 6-minute walk test (6MWT), and St. George's Respiratory Questionnaire (SGRQ) at the beginning and end of PR. Analyses were conducted to predict attendance, and change in 6MWT and SGRQ, while controlling for baseline demographic and clinical indicators. Change in 6MWT, SGRQ, and self-efficacy with PR was also examined. Clinically significant increases in the 6MWT and SGRQ were achieved with PR. Stronger task self-efficacy predicted better attendance, while stronger coping self-efficacy predicted greater 6MWT improvement. No variables predicted SGRQ change. Scheduling self-efficacy significantly improved with PR, whereas task and coping self-efficacy did not. Baseline exercise self-efficacy appears to be a determinant of rehabilitation attendance and functional exercise improvement with PR. Clinicians should evaluate and target exercise self-efficacy to maximize adherence and health outcome improvement with PR. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  16. Hip Arthroscopy Outcomes With Respect to Patient Acceptable Symptomatic State and Minimal Clinically Important Difference.

    Science.gov (United States)

    Levy, David M; Kuhns, Benjamin D; Chahal, Jaskarndip; Philippon, Marc J; Kelly, Bryan T; Nho, Shane J

    2016-09-01

    To determine whether the hip arthroscopy literature to date has shown outcomes consistent with published patient acceptable symptomatic state (PASS) and minimal clinically important difference (MCID) estimates. All clinical investigations of hip arthroscopy using modified Harris Hip Score (mHHS) and/or Hip Outcome Score (HOS) outcomes with at least 1 year of follow-up were reviewed. Ninety-one studies (9,746 hips) were included for review. Eighty-one studies (9,317 hips) contained only primary hip arthroscopies and were the primary focus of this review. The remaining studies (429 hips) did not exclude patients with prior surgical history and were thus considered separately. Mean mHHS, HOS-ADL (Activities of Daily Living) and HOS-SS (Sports-Specific) scores were compared with previously published PASS and MCID values. After 31 ± 20 months, 5.8% of study populations required revision arthroscopy and 5.5% total hip arthroplasty. A total of 88%, 25%, and 30% of study populations met PASS for mHHS, HOS-ADL, and HOS-SS, respectively, and 97%, 90%, and 93% met MCID. On bivariate analysis, increasing age was associated with significantly worse postoperative mHHS (P arthroscopy, we have found that more than 90% of study populations meet MCID standards for the most commonly used patient-reported outcomes measures in hip arthroscopy literature, mHHS and HOS. Eighty-eight percent meet PASS standards for the mHHS, but PASS standards are far more difficult to achieve for HOS-ADL (25%) and HOS-SS (30%) subscales. Differences in psychometric properties of the mHHS and HOS likely account for the discrepancies in PASS. Level IV, systematic review of Level I to IV studies. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  17. Evaluating clinically meaningful change on the ITP-PAQ: preliminary estimates of minimal important differences.

    Science.gov (United States)

    Mathias, Susan D; Gao, Sue K; Rutstein, Mark; Snyder, Claire F; Wu, Albert W; Cella, David

    2009-02-01

    Interpretation of data from health-related quality of life (HRQoL) questionnaires can be enhanced with the availability of minimally important difference (MID) estimates. This information will aid clinicians in interpreting HRQoL differences within patients over time and between treatment groups. The Immune Thrombocytopenic Purpura (ITP)-Patient Assessment Questionnaire (PAQ) is the only comprehensive HRQoL questionnaire available for adults with ITP. Forty centers from within the US and Europe enrolled ITP patients into one of two multicenter, randomized, placebo-controlled, double-blind, 6-month, phase III clinical trials of romiplostim. Patients enrolled in these studies self-administered the ITP-PAQ and two items assessing global change (anchors) at baseline and weeks 4, 12, and 24. Using data from the ITP-PAQ and these two anchors, an anchor-based estimate was computed and combined with the standard error of measurement and standard deviation to compute a distribution-based estimate in order to provide an MID range for each of the 11 scales of the ITP-PAQ. A total of 125 patients participated in these clinical trials and provided data for use in these analyses. Combining results from anchor- and distribution-based approaches, MID values were computed for 9 of the 11 scales. MIDs ranged from 8 to 12 points for Symptoms, Bother, Psychological, Overall QOL, Social Activity, Menstrual Symptoms, and Fertility, while the range was 10 to 15 points for the Fatigue and Activity scales of the ITP-PAQ. These estimates, while slightly higher than other published MID estimates, were consistent with moderate effect sizes. These MID estimates will serve as a useful tool to researchers and clinicians using the ITP-PAQ, providing guidance for interpretation of baseline scores as well as changes in ITP-PAQ scores over time. Additional work should be done to finalize these initial estimates using more appropriate anchors that correlate more highly with the ITP-PAQ scales.

  18. Clinical Trials With Large Numbers of Variables: Important Advantages of Canonical Analysis.

    Science.gov (United States)

    Cleophas, Ton J

    2016-01-01

    Canonical analysis assesses the combined effects of a set of predictor variables on a set of outcome variables, but it is little used in clinical trials despite the omnipresence of multiple variables. The aim of this study was to assess the performance of canonical analysis as compared with traditional multivariate methods using multivariate analysis of covariance (MANCOVA). As an example, a simulated data file with 12 gene expression levels and 4 drug efficacy scores was used. The correlation coefficient between the 12 predictor and 4 outcome variables was 0.87 (P = 0.0001) meaning that 76% of the variability in the outcome variables was explained by the 12 covariates. Repeated testing after the removal of 5 unimportant predictor and 1 outcome variable produced virtually the same overall result. The MANCOVA identified identical unimportant variables, but it was unable to provide overall statistics. (1) Canonical analysis is remarkable, because it can handle many more variables than traditional multivariate methods such as MANCOVA can. (2) At the same time, it accounts for the relative importance of the separate variables, their interactions and differences in units. (3) Canonical analysis provides overall statistics of the effects of sets of variables, whereas traditional multivariate methods only provide the statistics of the separate variables. (4) Unlike other methods for combining the effects of multiple variables such as factor analysis/partial least squares, canonical analysis is scientifically entirely rigorous. (5) Limitations include that it is less flexible than factor analysis/partial least squares, because only 2 sets of variables are used and because multiple solutions instead of one is offered. We do hope that this article will stimulate clinical investigators to start using this remarkable method.

  19. Establishing the minimal clinically important difference for the Questionnaire of Olfactory Disorders.

    Science.gov (United States)

    Mattos, Jose L; Schlosser, Rodney J; Mace, Jess C; Smith, Timothy L; Soler, Zachary M

    2018-05-02

    Olfactory-specific quality of life (QOL) can be measured using the Questionnaire of Olfactory Disorders Negative Statements (QOD-NS). Changes in the QOD-NS after treatment can be difficult to interpret since there is no standardized definition of clinically meaningful improvement. Patients with chronic rhinosinusitis (CRS) completed the QOD-NS. Four distribution-based methods were used to calculate the minimal clinically important difference (MCID): (1) one-half standard deviation (SD); (2) standard error of the mean (SEM); (3) Cohen's effect size (d) of the smallest unit of change; and (4) minimal detectable change (MDC). We also averaged all 4 of the scores together. Finally, the likelihood of achieving a MCID after sinus surgery using these methods, as well as average QOD-NS scores, was stratified by normal vs abnormal baseline QOD-NS scores. Outcomes were examined on 128 patients. The mean ± SD improvement in QOD-NS score after surgery was 4.3 ± 11.0 for the entire cohort and 9.6 ± 12.9 for those with abnormal baseline scores (p < 0.001). The MCID values using the different techniques were: (1) SD = 6.5; (2) SEM = 3.1; (3) d = 2.6; and (4) MDC = 8.6. The MCID score was 5.2 on average. For the total cohort analysis, the likelihood of reporting a MCID ranged from 26% to 51%, and 49% to 70% for patients reporting preoperative abnormal olfaction. Distribution-based MCID values of the QOD-NS range between 2.6 and 8.6 points, with an average of 5.2. When stratified by preoperative QOD-NS scores the majority of patients reporting abnormal preoperative QOD-NS scores achieved a MCID. © 2018 ARS-AAOA, LLC.

  20. The Importance of Prolonged Provocation in Drug Allergy - Results From a Danish Allergy Clinic.

    Science.gov (United States)

    Fransson, Sara; Mosbech, Holger; Kappel, Mogens; Hjortlund, Janni; Poulsen, Lars K; Kvisselgaard, Ask D; Garvey, Lene H

    Drug provocation is the "Gold Standard" in drug allergy investigation. Recent studies suggest that a negative drug provocation on first dose should be followed by a prolonged provocation over several days. To evaluate drug allergy investigations on the basis of drug provocation, including prolonged provocation. Data from adult patients investigated for drug allergy in a Danish Allergy Clinic during the period 2010 to 2014 were entered into a database. Data included clinical details and results of provocations with suspected culprit drug (for penicillins performed only in specific IgE-negative patients). If provocation was negative on first dose, treatment was continued for 3 to 10 days. A total of 1,913 provocations were done in 1,659 patients, median age 46 years, of whom 1,237 (74.6%) were females. Drugs investigated were antibiotics, 1,776 (92.8%), of which 1,590 (89.5%) were penicillins; analgesics, 59 (3.1%); local anesthetics, 33 (1.7%); and other drugs, 45 (2.4%). In total, 211 of 1,913 (11.0%) provocations were positive. Causes were antibiotics, 198 (93.8%), of which 167 (84.3%) were penicillins; analgesics, 7 (3.3%); local anesthetics, 0; and other drugs, 6 (2.8%). Only 43 (20.4%) provocations were positive on first dose, whereas 95 (45.0%) turned positive more than 3 days later. Only 11.0% of the provocations were positive. Importantly, only 1 of 5 patients tested positive on the first dose, indicating that prolonged exposure should always be considered when drug provocation is included in allergy investigations. Most provocations were with penicillins, reflecting the pattern of antibiotic use in Denmark, which differs from that in other countries, especially outside Northern Europe. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  1. Positive clinical interventions : Why are they important and how do they work?

    NARCIS (Netherlands)

    Bohlmeijer, E. T.; Bolier, L.; Lamers, S. M.A.; Westerhof, G. J.

    2017-01-01

    In this paper we discuss positive clinical psychology as an emerging field within clinical psychology. Positive clinical psychology is based on research demonstrating that mental health is more than the absence of mental illness, on research showing that well-being has buffering effects on the

  2. Inhibitory effect of Allium sativum and Zingiber officinale extracts on clinically important drug resistant pathogenic bacteria

    Directory of Open Access Journals (Sweden)

    Gull Iram

    2012-04-01

    Full Text Available Abstract Background Herbs and spices are very important and useful as therapeutic agent against many pathological infections. Increasing multidrug resistance of pathogens forces to find alternative compounds for treatment of infectious diseases. Methods In the present study the antimicrobial potency of garlic and ginger has been investigated against eight local clinical bacterial isolates. Three types of extracts of each garlic and ginger including aqueous extract, methanol extract and ethanol extract had been assayed separately against drug resistant Escherichia coli, Pseudomonas aeruginosa, Bacillus subtilis, Staphylococcus aureus, Klebsiella pneumoniae, Shigella sonnei, Staphylococcusepidermidis and Salmonella typhi. The antibacterial activity was determined by disc diffusion method. Results All tested bacterial strains were most susceptible to the garlic aqueous extract and showed poor susceptibility to the ginger aqueous extract. The (minimum inhibitory concentration MIC of different bacterial species varied from 0.05 mg/ml to 1.0 mg/ml. Conclusion In the light of several socioeconomic factors of Pakistan mainly poverty and poor hygienic condition, present study encourages the use of spices as alternative or supplementary medicine to reduce the burden of high cost, side effects and progressively increasing drug resistance of pathogens.

  3. Cardiac Alpha1-Adrenergic Receptors: Novel Aspects of Expression, Signaling Mechanisms, Physiologic Function, and Clinical Importance

    Science.gov (United States)

    O’Connell, Timothy D.; Jensen, Brian C.; Baker, Anthony J.

    2014-01-01

    Adrenergic receptors (AR) are G-protein-coupled receptors (GPCRs) that have a crucial role in cardiac physiology in health and disease. Alpha1-ARs signal through Gαq, and signaling through Gq, for example, by endothelin and angiotensin receptors, is thought to be detrimental to the heart. In contrast, cardiac alpha1-ARs mediate important protective and adaptive functions in the heart, although alpha1-ARs are only a minor fraction of total cardiac ARs. Cardiac alpha1-ARs activate pleiotropic downstream signaling to prevent pathologic remodeling in heart failure. Mechanisms defined in animal and cell models include activation of adaptive hypertrophy, prevention of cardiac myocyte death, augmentation of contractility, and induction of ischemic preconditioning. Surprisingly, at the molecular level, alpha1-ARs localize to and signal at the nucleus in cardiac myocytes, and, unlike most GPCRs, activate “inside-out” signaling to cause cardioprotection. Contrary to past opinion, human cardiac alpha1-AR expression is similar to that in the mouse, where alpha1-AR effects are seen most convincingly in knockout models. Human clinical studies show that alpha1-blockade worsens heart failure in hypertension and does not improve outcomes in heart failure, implying a cardioprotective role for human alpha1-ARs. In summary, these findings identify novel functional and mechanistic aspects of cardiac alpha1-AR function and suggest that activation of cardiac alpha1-AR might be a viable therapeutic strategy in heart failure. PMID:24368739

  4. Importance of public health nurses precepting students in clinical practice: a qualitative study.

    Science.gov (United States)

    Hjälmhult, Esther; Haaland, Gerd Unstad; Litland, Astrid Synnøve

    2013-04-01

    Preceptors' working environment, support and competence affect how they perform the preceptor role, are therefore important for developing students and can influence students' roles as students and future professionals. Previous research has focused on precepting student nurses and not so much on public health nurses or other postgraduate students. Knowledge in this field is therefore lacking. The article aims to present a grounded theory of the role of public health nurses as student preceptors in Norway. We conducted 20 interviews with public health nurses in addition to a focus group with four participants. We used classical grounded theory method to gather and analyze data. The preceptors were strongly concerned about invisibility and lack of recognition of the preceptor role. This main concern was resolved by the strategy of being obligated and included three patterns: optimistic, ambivalent and reluctant performance, all with differing motivation for being obligated. All stakeholders involved in clinical practice seem to contribute to making the preceptors' role invisible and thereby contribute to the lack of recognition, support and reward, which again seem to self-reinforce invisibility. The study highlights the obligation of public health nurses in precepting students and increases the understanding of the challenges of this role. Ensuring education of a high academic standard requires paying more attention to developing effective support for the people involved. Copyright © 2012 Elsevier Ltd. All rights reserved.

  5. Adhesive systems: important aspects related to their composition and clinical use

    Directory of Open Access Journals (Sweden)

    Mario Honorato Silva e Souza Junior

    2010-06-01

    Full Text Available This literature review article addresses the types and the main components of different etch-and-rinse and self-etch adhesive systems available in the market, and relates them to their function, possible chemical interactions and infuence of handling characteristics. Scanning electron microscopy (SEM images are presented to characterize the interface between adhesives and dentin. Adhesive systems have been recently classifed according to their adhesion approaches in etch-and-rinse, self-etch and glass ionomer. The etch-and-rinse systems require a specifc acid-etch procedure and may be performed in two or three steps. Self-etch systems employ acidic monomers that demineralize and impregnate dental substrates almost at the same time. These systems are separated in one or two steps. Some advantages and defciencies were noted for etch-and-rinse and self-etch approaches, mainly for the simplifed ones due to some chemical associations and interactions. The SEM micrographs illustrate different relationships between adhesive systems and dental structures, particularly dentin. The knowledge of composition, characteristics and mechanisms of adhesion of each adhesive system is of fundamental importance to permit the adoption of ideal bonding strategies under clinical conditions.

  6. Clinical importance of median mandibular flexure in oral rehabilitation: a review.

    Science.gov (United States)

    Sivaraman, K; Chopra, A; Venkatesh, S B

    2016-03-01

    The mandible has a property to flex inwards around the mandibular symphysis with change in shape and decrease in mandibular arch width during opening and protrusion of the mandible. The mandibular deformation may range from a few micrometres to more than 1 mm. The movement occurs because of the contraction of lateral pterygoid muscles that pulls mandibular condyles medially and causes a sagittal movement of the posterior segments. This movement of mandible can have a profound influence on prognosis and treatment outcome for various restorative, endodontics, fixed, removable and implant-related prosthesis. The review unfolds the causes, importance and clinical implications of median mandibular flexure in oral rehabilitation. This review also highlights the appropriate preventive measures and techniques that should be adopted by clinicians to minimise the effect of flexural movement of the jaw during oral rehabilitation. This would not only help clinicians to achieve a good prosthesis with accurate fit and longevity but also maintain the health of the surrounding periodontal or periimplant gingival tissues and bone. © 2015 John Wiley & Sons Ltd.

  7. Great Lakes

    Science.gov (United States)

    Edsall, Thomas A.; Mac, Michael J.; Opler, Paul A.; Puckett Haecker, Catherine E.; Doran, Peter D.

    1998-01-01

    The Great Lakes region, as defined here, includes the Great Lakes and their drainage basins in Minnesota, Wisconsin, Illinois, Indiana, Ohio, Pennsylvania, and New York. The region also includes the portions of Minnesota, Wisconsin, and the 21 northernmost counties of Illinois that lie in the Mississippi River drainage basin, outside the floodplain of the river. The region spans about 9º of latitude and 20º of longitude and lies roughly halfway between the equator and the North Pole in a lowland corridor that extends from the Gulf of Mexico to the Arctic Ocean.The Great Lakes are the most prominent natural feature of the region (Fig. 1). They have a combined surface area of about 245,000 square kilometers and are among the largest, deepest lakes in the world. They are the largest single aggregation of fresh water on the planet (excluding the polar ice caps) and are the only glacial feature on Earth visible from the surface of the moon (The Nature Conservancy 1994a).The Great Lakes moderate the region’s climate, which presently ranges from subarctic in the north to humid continental warm in the south (Fig. 2), reflecting the movement of major weather masses from the north and south (U.S. Department of the Interior 1970; Eichenlaub 1979). The lakes act as heat sinks in summer and heat sources in winter and are major reservoirs that help humidify much of the region. They also create local precipitation belts in areas where air masses are pushed across the lakes by prevailing winds, pick up moisture from the lake surface, and then drop that moisture over land on the other side of the lake. The mean annual frost-free period—a general measure of the growing-season length for plants and some cold-blooded animals—varies from 60 days at higher elevations in the north to 160 days in lakeshore areas in the south. The climate influences the general distribution of wild plants and animals in the region and also influences the activities and distribution of the human

  8. Clinical leadership in mental health nursing: the importance of a calm and confident approach.

    Science.gov (United States)

    Ennis, Gary; Happell, Brenda; Reid-Searl, Kerry

    2015-01-01

    Explore the perceptions of nurses working in mental health of effective clinical leadership. In-depth interviews were conducted with registered nurses employed in a mental health setting. Qualitative research using grounded theory. Remaining calm and confident in times of crisis and uncertainty was identified as one attribute of clinical leadership. Participants noted clinical leaders' demeanor during stressful or crisis situations, and their ability to manage unpredictable or unexpected clinical situations as contributing positively to clinical practice. Understanding these characteristics and how they can influence positive outcomes for clients is crucial in addressing the recruitment and retention challenges for the nursing workforce. © 2014 Wiley Periodicals, Inc.

  9. [Radiation-induced bystander effect: the important part of ionizing radiation response. Potential clinical implications].

    Science.gov (United States)

    Wideł, Maria; Przybyszewski, Waldemar; Rzeszowska-Wolny, Joanna

    2009-08-18

    It has long been a central radiobiological dogma that the damaging effects of ionizing radiation, such as cell death, cytogenetic changes, apoptosis, mutagenesis, and carcinogenesis, are the results of the direct ionization of cell structures, particularly DNA, or indirect damage via water radiolysis products. However, several years ago attention turned to a third mechanism of radiation, termed the "bystander effect" or "radiation-induced bystander effect" (RIBE). This is induced by agents and signals emitted by directly irradiated cells and manifests as a lowering of survival, cytogenetic damage, apoptosis enhancement, and biochemical changes in neighboring non-irradiated cells. The bystander effect is mainly observed in in vitro experiments using very low doses of alpha particles (range; mGy, cGy), but also after conventional irradiation (X-rays, gamma rays) at low as well as conventional doses. The mechanisms responsible for the bystander effect are complex and still poorly understood. It is believed that molecular signals released from irradiated cells induce different signaling ways in non-irradiated neighboring cells, leading to the observed events. The molecular signals may be transmitted through gap junction intercellular communication and through a medium transfer mechanism. The nature of these transmitted factors are diverse, and still not definitely established. It seems that RIBE may have important clinical implications for health risk associated with radiation exposure. Potentially, this effect may have important implications in the creation of whole-body or localized side effects in tissues beyond the irradiation field and also in low-dose radiological and radioisotope diagnostics. Factors emitted by irradiated cells may result in the risk of genetic instability, mutations, and second primary cancer induction. They might also have their own part in inducing and extending post-radiation side effects in normal tissue. The bystander effect may be a

  10. Radiation-induced bystander effect: The important part of ionizing radiation response. Potential clinical implications

    Directory of Open Access Journals (Sweden)

    Maria Wideł

    2009-08-01

    Full Text Available It has long been a central radiobiological dogma that the damaging effects of ionizing radiation, such as cell death, cytogenetic changes, apoptosis, mutagenesis, and carcinogenesis, are the results of the direct ionization of cell structures, particularly DNA, or indirect damage via water radiolysis products. However, several years ago attention turned to a third mechanism of radiation, termed the “bystander effect” or “radiation-induced bystander effect” (RIBE. This is induced by agents and signals emitted by directly irradiated cells and manifests as a lowering of survival, cytogenetic damage, apoptosis enhancement, and biochemical changes in neighboring non-irradiated cells. The bystander effect is mainly observed in in vitro experiments using very low doses of alpha particles (range; mGy, cGy, but also after conventional irradiation (X-rays, gamma rays at low as well as conventional doses. The mechanisms responsible for the bystander effect are complex and still poorly understood. It is believed that molecular signals released from irradiated cells induce different signaling ways in non-irradiated neighboring cells, leading to the observed events. The molecular signals may be transmitted through gap junction intercellular communication and through a medium transfer mechanism. The nature of these transmitted factors are diverse, and still not defi nitely established. It seems that RIBE may have important clinical implications for health risk associated with radiation exposure. Potentially, this effectmay have important implications in the creation of whole-body or localized side effects in tissues beyond the irradiation fi eld and also in low-dose radiological and radioisotope diagnostics. Factors emitted by irradiated cells may result in the risk of genetic instability, mutations, and second primary cancer induction. They might also have their own part in inducing and extending post-radiation side effects in normal tissue. The

  11. Prevention of clinically important deteriorations in COPD with umeclidinium/vilanterol

    Directory of Open Access Journals (Sweden)

    Singh D

    2016-06-01

    Full Text Available Dave Singh,1 M Reza Maleki-Yazdi,2 Lee Tombs,3 Ahmar Iqbal,4 William A Fahy,5 Ian Naya5 1Medicines Evaluation Unit, University of Manchester, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK; 2Division of Respiratory Medicine, Women’s College Hospital, University of Toronto, ON, Canada; 3Precise Approach LTD, London UK; 4Respiratory Medical Franchise, GSK, Research Triangle Park, NC, USA; 5Respiratory Medicines Development Centre, GSK, Stockley Park, Middlesex, UK Background: Minimizing the risk of disease progression and exacerbations is the key goal of COPD management, as these are well-established indicators of poor COPD prognosis. We developed a novel composite end point assessing three important aspects (lung function, health status, and exacerbations of worsening in COPD. The objective was to determine whether dual bronchodilation with umeclidinium/vilanterol (UMEC/VI reduces clinically important deteriorations (CIDs in COPD versus placebo or bronchodilator monotherapy.  Methods: This study is a post hoc analysis of two 24-week trials comparing UMEC/VI 62.5/25 µg with UMEC 62.5 µg, VI 25 µg, or placebo (Study A; NCT01313650, or UMEC/VI 62.5/25 µg with tiotropium (TIO 18 µg (Study B; NCT01777334 in patients with symptomatic COPD, without a history of frequent exacerbations. Deterioration was assessed as the time to a first CID, a composite measure defined as a decrease of ≥100 mL in trough forced expiratory volume in 1 second or ≥4-unit increase in St George’s Respiratory Questionnaire total score or an on-treatment moderate-to-severe COPD exacerbation.  Results: In Study A, fewer patients experienced a first CID with UMEC/VI (44% versus UMEC (50%, VI (56%, and placebo (75%. The risk of a first CID was reduced with UMEC/VI (hazard ratio [HR]: 0.37 [95% confidence interval, CI: 0.30, 0.45], UMEC (HR: 0.46 [95% CI: 0.38, 0.56], and VI (HR: 0.55 [95% CI: 0.45, 0.66]; all P<0.001 versus placebo

  12. Fix my child: The importance of including siblings in clinical assessments.

    Science.gov (United States)

    Farnfield, Steve

    2017-07-01

    This study examined concordance in the attachment strategies of school-aged siblings with reference to environmental risk in terms of poverty and maltreatment. It also investigated the effect of child maltreatment and maternal mental illness on children's psychosocial functioning in terms of the Dynamic-Maturational Model of Attachment and Adaptation (DMM) including unresolved trauma and the DMM Depressed modifier. The attachment strategies of 30 sibling pairs, aged 5-14 years, were assessed using the School-age Assessment of Attachment (SAA). Unlike most previous studies, this study included siblings from large families of two to six children. The main finding was that as environmental risk increases, the diversity of sibling attachment strategies decreases with greater recourse to the DMM Type A3-6 and A/C strategies. Unlike previous studies, the highest level of concordance was found in sibling pairs with the opposite gender. Boys whose mothers had a history of mental illness were significantly more likely than girls to be assessed with the DMM-depression modifier. As danger increases, children in the same family experience more of the same childhood. Further research should focus on single case, intra-familial studies to build a systemic model of the shared environment. Research should also evaluate the effects of environmental risk compared with size of the sibling group on children's attachment strategies. The clinical implications point to the importance of assessing all children in the family using a model built around functional formulation rather than diagnosing the symptoms of a particular child.

  13. Clinical Importance of Angiogenic Cytokines, Fibrinolytic Activity and Effusion Size in Parapneumonic Effusions

    Science.gov (United States)

    Chung, Chi-Li; Hsiao, Shih-Hsin; Hsiao, George; Sheu, Joen-Rong; Chen, Wei-Lin; Chang, Shi-Chuan

    2013-01-01

    Objective To investigate the relationship among angiogenic cytokines, fibrinolytic activity and effusion size in parapneumonic effusion (PPE) and their clinical importance. Methods From January 2008 through December 2010, 26 uncomplicated (UPPE) and 38 complicated (CPPE) PPE were studied. Based on chest ultrasonography, there were non-loculated in 30, uni-loculated in 12, and multi-loculated effusions in 22 patients. The effusion size radiological scores, and effusion vascular endothelial growth factor (VEGF), interleukin (IL)-8, plasminogen activator inhibitor type-1 (PAI-1) and tissue type plasminogen activator (tPA) were measured on admission. Treatment outcome and pleural fibrosis, defined as radiological residual pleural thickening (RPT), were assessed at 6-month follow-up. Results The effusion size and effusion VEGF, IL-8 and PAI-1/tPA ratio were significantly higher in CPPE than in UPPE, and significantly higher in multi-loculated PPE than in non-locualted and uni-loculated PPE, respectively. VEGF (cutoff value 1975 pg/ml) and IL-8 (cutoff value 1937 pg/ml) seemed best to discriminate between UPPE and CPPE. VEGF, IL-8 and effusion size correlated positively with PAI-1/tPA ratio in both UPPE and CPPE. Moreover, the level of VEGF, but not IL-8, correlated positively with effusion size in all patients (r = 0.79, peffusion were prone to have medical treatment failure (n = 10; VEGF, odds ratio 1.01, p = 0.02; effusion size, odds ratio 1.26, p = 0.01). Additionally, ten patients with RPT had larger effusion size and higher levels of VEGF and PAI-1/tPA ratio than did those without. Conclusions In PPE, VEGF and IL-8 levels are valuable to identify CPPE, and higher VEGF level or larger effusion is associated with decreased fibrinolytic activity, development of pleural loculation and fibrosis, and higher risk of medical treatment failure. PMID:23308155

  14. The Importance of Medicinal Chemistry Knowledge in the Clinical Pharmacist's Education.

    Science.gov (United States)

    Fernandes, João Paulo S

    2018-03-01

    Objective. To show why medicinal chemistry must be a key component of the education of pharmacy students, as well as in the pharmacist's practice. Findings. Five case reports were selected by their clinically relevant elements of medicinal chemistry and were explained using structure-activity relationship data of the drugs involved in the case easily obtained from primary literature and in medicinal chemistry textbooks. Summary. This paper demonstrates how critical clinical decisions can be addressed using medicinal chemistry knowledge. While such knowledge may not explain all clinical decisions, medicinal chemistry concepts are essential for the education of pharmacy students to explain drug action in general and clinical decisions.

  15. Combining clinical practice and academic work in nursing: a qualitative study about perceived importance, facilitators and barriers regarding clinical academic careers for nurses in university hospitals.

    NARCIS (Netherlands)

    Oostveen, C.J. van; Goedhart, N.S.; Francke, A.L.; Vermeulen, H.

    2017-01-01

    Aims and objectives: To obtain in-depth insight into the perceptions of nurse aca- demics and other stakeholders regarding the importance, facilitators and barriers for nurses combining clinical and academic work in university hospitals. Background: Combining clinical practice and academic work

  16. The Clinical Importance of Assessing Tumor Hypoxia: Relationship of Tumor Hypoxia to Prognosis and Therapeutic Opportunities

    Science.gov (United States)

    Walsh, Joseph C.; Lebedev, Artem; Aten, Edward; Madsen, Kathleen; Marciano, Liane

    2014-01-01

    I. Introduction II. The Clinical Importance of Tumor Hypoxia A. Pathophysiology of hypoxia B. Hypoxia's negative impact on the effectiveness of curative treatment 1. Hypoxic tumors accumulate and propagate cancer stem cells 2. Hypoxia reduces the effectiveness of radiotherapy 3. Hypoxia increases metastasis risk and reduces the effectiveness of surgery 4. Hypoxic tumors are resistant to the effects of chemotherapy and chemoradiation C. Hypoxia is prognostic for poor patient outcomes III. Diagnosis of Tumor Hypoxia A. Direct methods 1. Oxygen electrode—direct pO2 measurement most used in cancer research 2. Phosphorescence quenching—alternative direct pO2 measurement 3. Electron paramagnetic resonance 4. 19F-magnetic resonance spectroscopy 5. Overhauser-enhanced MRI B. Endogenous markers of hypoxia 1. Hypoxia-inducible factor-1α 2. Carbonic anhydrase IX 3. Glucose transporter 1 4. Osteopontin 5. A combined IHC panel of protein markers for hypoxia 6. Comet assay C. Physiologic methods 1. Near-infrared spectroscopy/tomography—widely used for pulse oximetry 2. Photoacoustic tomography 3. Contrast-enhanced color duplex sonography 4. MRI-based measurements 5. Blood oxygen level-dependent MRI 6. Pimonidazole 7. EF5 (pentafluorinated etanidazole) 8. Hypoxia PET imaging—physiologic hypoxia measurement providing tomographic information a. 18F-fluoromisonidazole b. 18F-fluoroazomycinarabinofuranoside c. 18F-EF5 (pentafluorinated etanidazole) d. 18F-flortanidazole e. Copper (II) (diacetyl-bis (N4-methylthiosemicarbazone)) f. 18F-FDG imaging of hypoxia IV. Modifying Hypoxia to Improve Therapeutic Outcomes A. Use of hypoxia information in radiation therapy planning B. Use of hypoxia assessment for selection of patients responsive to nimorazole C. Use of hypoxia assessment for selection of patients responsive to tirapazamine D. Use of hypoxia assessment for selection of patients

  17. Clinical importance of angiogenic cytokines, fibrinolytic activity and effusion size in parapneumonic effusions.

    Directory of Open Access Journals (Sweden)

    Chi-Li Chung

    Full Text Available OBJECTIVE: To investigate the relationship among angiogenic cytokines, fibrinolytic activity and effusion size in parapneumonic effusion (PPE and their clinical importance. METHODS: From January 2008 through December 2010, 26 uncomplicated (UPPE and 38 complicated (CPPE PPE were studied. Based on chest ultrasonography, there were non-loculated in 30, uni-loculated in 12, and multi-loculated effusions in 22 patients. The effusion size radiological scores, and effusion vascular endothelial growth factor (VEGF, interleukin (IL-8, plasminogen activator inhibitor type-1 (PAI-1 and tissue type plasminogen activator (tPA were measured on admission. Treatment outcome and pleural fibrosis, defined as radiological residual pleural thickening (RPT, were assessed at 6-month follow-up. RESULTS: The effusion size and effusion VEGF, IL-8 and PAI-1/tPA ratio were significantly higher in CPPE than in UPPE, and significantly higher in multi-loculated PPE than in non-locualted and uni-loculated PPE, respectively. VEGF (cutoff value 1975 pg/ml and IL-8 (cutoff value 1937 pg/ml seemed best to discriminate between UPPE and CPPE. VEGF, IL-8 and effusion size correlated positively with PAI-1/tPA ratio in both UPPE and CPPE. Moreover, the level of VEGF, but not IL-8, correlated positively with effusion size in all patients (r = 0.79, p<0.001 and in UPPE (r = 0.64, p<0.001 and CPPE (r = 0.71, p<0.001 groups. The patients with higher VEGF or greater effusion were prone to have medical treatment failure (n = 10; VEGF, odds ratio 1.01, p = 0.02; effusion size, odds ratio 1.26, p = 0.01. Additionally, ten patients with RPT had larger effusion size and higher levels of VEGF and PAI-1/tPA ratio than did those without. CONCLUSIONS: In PPE, VEGF and IL-8 levels are valuable to identify CPPE, and higher VEGF level or larger effusion is associated with decreased fibrinolytic activity, development of pleural loculation and fibrosis, and higher risk of medical treatment failure.

  18. Automated realtime data import for the i2b2 clinical data warehouse: introducing the HL7 ETL cell.

    Science.gov (United States)

    Majeed, Raphael W; Röhrig, Rainer

    2012-01-01

    Clinical data warehouses are used to consolidate all available clinical data from one or multiple organizations. They represent an important source for clinical research, quality management and controlling. Since its introduction, the data warehouse i2b2 gathered a large user base in the research community. Yet, little work has been done on the process of importing clinical data into data warehouses using existing standards. In this article, we present a novel approach of utilizing the clinical integration server as data source, commonly available in most hospitals. As information is transmitted through the integration server, the standardized HL7 message is immediately parsed and inserted into the data warehouse. Evaluation of import speeds suggest feasibility of the provided solution for real-time processing of HL7 messages. By using the presented approach of standardized data import, i2b2 can be used as a plug and play data warehouse, without the hurdle of customized import for every clinical information system or electronic medical record. The provided solution is available for download at http://sourceforge.net/projects/histream/.

  19. Great Lakes Literacy Principles

    Science.gov (United States)

    Fortner, Rosanne W.; Manzo, Lyndsey

    2011-03-01

    Lakes Superior, Huron, Michigan, Ontario, and Erie together form North America's Great Lakes, a region that contains 20% of the world's fresh surface water and is home to roughly one quarter of the U.S. population (Figure 1). Supporting a $4 billion sport fishing industry, plus $16 billion annually in boating, 1.5 million U.S. jobs, and $62 billion in annual wages directly, the Great Lakes form the backbone of a regional economy that is vital to the United States as a whole (see http://www.miseagrant.umich.edu/downloads/economy/11-708-Great-Lakes-Jobs.pdf). Yet the grandeur and importance of this freshwater resource are little understood, not only by people in the rest of the country but also by many in the region itself. To help address this lack of knowledge, the Centers for Ocean Sciences Education Excellence (COSEE) Great Lakes, supported by the U.S. National Science Foundation and the National Oceanic and Atmospheric Administration, developed literacy principles for the Great Lakes to serve as a guide for education of students and the public. These “Great Lakes Literacy Principles” represent an understanding of the Great Lakes' influences on society and society's influences on the Great Lakes.

  20. Clinical importance of neutralising antibodies against interferon beta in patients with relapsing-remitting multiple sclerosis

    DEFF Research Database (Denmark)

    Sorensen, Per Soelberg; Ross, Christian; Clemmesen, Katja Maria

    2003-01-01

    Interferon beta is the first-line treatment for relapsing-remitting multiple sclerosis, but the drug can induce neutralising antibodies against itself, which might reduce effectiveness. We aimed to assess the clinical effect of neutralising antibodies....

  1. POSITIVE CLINICAL INTERVENTIONS: WHY ARE THEY IMPORTANT AND HOW DO THEY WORK?

    Directory of Open Access Journals (Sweden)

    E.T. Bohlmeijer

    2017-01-01

    Full Text Available In this paper we discuss positive clinical psychology as an emerging field within clinical psychology. Positive clinical psychology is based on research demonstrating that mental health is more than the absence of mental illness, on research showing that wellbeing has buffering effects on the incidence of psychopathology and mental illnesses and on studies demonstrating that positive characteristics, such as positive emotions and gratitude, can predict pathology beyond the predictive power of negative characteristics. In this paper we present three distinct forms of well-being: emotional, psychological and social. In addition we review three types of positive clinical interventions: well-being therapy, positive psychotherapy and acceptance and commitment therapy. The paper ends with a call for a transformation of mental health care in which illness oriented treatments are complemented with well-being oriented treatments.

  2. In vitro susceptibility patterns of clinically important Trichophyton and Epidermophyton species against nine antifungal drugs

    NARCIS (Netherlands)

    Badali, Hamid; Mohammadi, Rasoul; Mashedi, Olga; de Hoog, G Sybren; Meis, Jacques F

    Despite the common, worldwide, occurrence of dermatophytes, little information is available regarding susceptibility profiles against currently available and novel antifungal agents. A collection of sixty-eight clinical Trichophyton species and Epidermophyton floccosum were previously identified and

  3. Important clinical descriptors to include in the examination and assessment of patients with femoroacetabular impingement syndrome

    DEFF Research Database (Denmark)

    Reiman, M P; Thorborg, K; Covington, K

    2017-01-01

    PURPOSE: Determine which examination findings are key clinical descriptors of femoroacetabular impingement syndrome (FAIS) through use of an international, multi-disciplinary expert panel. METHODS: A three-round Delphi survey utilizing an international, multi-disciplinary expert panel operationally...

  4. The clinical importance of expanded subarachnoid spaces detected by CT in early infancy

    International Nuclear Information System (INIS)

    Krusche, S.

    1982-01-01

    It depends on the clinical course and on follow-jup CT findings whether expansions of the subarachnoid space should be considered as pathological changes or as normal. There is no direct correlation between the degree of severity of the clinical symptoms on the one hand and the CT changes on the other. The clinical course and the follow-up CT images are found to be uncorrelated, too. CT findings alone are insufficient in predicting children's development. Especially in the case of unspecific changes, e.g. slight expansions of the subarachnoid space, cranial CT can only provide further proof of a suspected clinical diagnosis. The ventricular indices frequently used for CT interpretation can rarely be used as decision aids or as factors providing new information. (orig./MG) [de

  5. Catheter-directed thrombolysis for acute iliofemoral deep vein thrombosis via the ipsilateral great saphenous vein approach: a comparative clinical study

    International Nuclear Information System (INIS)

    Su Haobo; Gu Jianping; Lou Wensheng; He Xu; Chen Liang; Chen Guoping; Song Jinhua; Wang Tao

    2011-01-01

    Objective: To investigate prospectively the feasibility and clinical value of catheterization via the ipsilateral great saphenous vein in catheter-directed thrombolysis (CDT) for acute iliofemoral deep vein thrombosis (IFVT) by a comparative study. Methods: The prospective study included 93 cases of IFVT proved by venography. All patients were divided into three groups randomly. In group A, 31 patients received CDT via the ipsilateral great saphenous vein. In group B, 27 patients received CDT via the ipsilateral popliteal vein. In group C, 35 patients received anterograde thrombolysis via an ipsilateral dorsalis pedis vein. Urokinase was adopted as the thrombolytic agent in all cases. The assessment of the curative effect include therapeutic effective rate, rate of edema reduction and venous patency which were observed according to the clinical symptoms and the follow-up venograms obtained 5 days after thrombolysis. The time and comfort scores of procedures was recorded and compared between group A and B using two independent samples t test. The rate of edema reduction and venous patency were assessed using analysis of variance (LSD method). Therapeutic effective rate and complication rate were assessed using Chi-square test. Results: The total effective rate of the three groups were 90.3% (28/31), 92.6% (25/27) and 68.6% (24/35) respectively. The limbs edema reduction rate were (83.5±21.1)%, (82.4±20.1)%, and (67.0±23.3)% respectively (F= 6.059, P=0.003). The venous patency rate after thrombolysis were (61.2±20.2)%, (55.7±20.5)%, and (44.2±23.6)% respectively. There was no significant difference between group A and B in therapeutic effective rate (χ 2 =0.09, P=0.759), rate of edema reduction (P=0.822) and venous patency (P=0.343) . There was a significant difference statistically in therapeutic effective rate (χ 2 =4.65, P=0.031), rate of edema reduction (P=0.002) and venous patency (P=0.002) between group A and C. Compared with group A and B, the

  6. Rational use of intensity-modulated radiation therapy: the importance of clinical outcome.

    Science.gov (United States)

    De Neve, Wilfried; De Gersem, Werner; Madani, Indira

    2012-01-01

    During the last 2 decades, intensity-modulated radiation therapy (IMRT) became a standard technique despite its drawbacks of volume delineation, planning, robustness of delivery, challenging quality assurance, and cost as compared with non-IMRT. The theoretic advantages of IMRT dose distributions are generally accepted, but the clinical advantages remain debatable because of the lack of clinical assessment of the effort that is required to overshadow the disadvantages. Rational IMRT use requires a positive advantage/drawback balance. Only 5 randomized clinical trials (RCTs), 3 in the breast and 2 in the head and neck, which compare IMRT with non-IMRT (2-dimensional technique in four fifths of the trials), have been published (as of March 2011), and all had toxicity as the primary endpoint. More than 50 clinical trials compared results of IMRT-treated patients with a non-IMRT group, mostly historical controls. RCTs systematically showed a lower toxicity in IMRT-treated patients, and the non-RCTs confirmed these findings. Toxicity reduction, counterbalancing the drawbacks of IMRT, was convincing for breast and head and neck IMRT. For other tumor sites, the arguments favoring IMRT are weaker because of the inability to control bias outside the randomized setting. For anticancer efficacy endpoints, like survival, disease-specific survival, or locoregional control, the balance between advantages and drawbacks is fraught with uncertainties because of the absence of robust clinical data. Copyright © 2012 Elsevier Inc. All rights reserved.

  7. Clinical Outcome of Degenerative Mitral Regurgitation: Critical Importance of Echocardiographic Quantitative Assessment in Routine Practice.

    Science.gov (United States)

    Antoine, Clemence; Benfari, Giovanni; Michelena, Hector I; Malouf, Joseph F; Nkomo, Vuyisile T; Thapa, Prabin; Enriquez-Sarano, Maurice

    2018-05-31

    Background -Echocardiographic quantitation of degenerative mitral regurgitation (DMR) is recommended whenever possible in clinical guidelines but is criticized and its scalability to routine clinical practice doubted. We hypothesized that echocardiographic DMR quantitation, performed in routine clinical practice by multiple practitioners predicts independently long-term survival, and thus is essential to DMR management. Methods -We included patients diagnosed with isolated mitral-valve-prolapse 2003-2011 and any degree of MR quantified by any physician/sonographer in routine clinical practice. Clinical/echocardiographic data acquired at diagnosis were retrieved electronically. Endpoint was mortality under medical treatment analyzed by Kaplan-Meir method and Proportional-Hazard models. Results -The cohort included 3914 patients (55% male) aged 62±17 years, with left ventricular ejection fraction (LVEF) 63±8% and routinely measured effective regurgitant orifice area (EROA) 19[0-40] mm 2 During follow-up (6.7±3.1 years) 696 patients died under medical management and 1263 underwent mitral surgery. In multivariate analysis, routinely measured EROA was associated with mortality (adjusted-hazard-ratio 1.19[1.13-1.24] p 40 mm 2 threshold. Conclusions -Echocardiographic DMR quantitation is scalable to routine practice and is independently associated with clinical outcome. Routinely measured EROA is strongly associated with long-term survival under medical treatment. Excess mortality vs. the general population appears in the "moderate" DMR range and steadily increases with higher EROA. Hence, individual EROA values should be integrated into therapeutic considerations, additionally to categorical DMR grading.

  8. Immunosuppression by hypoxic cell radiosensitizers: a phenomenon of potential clinical importance

    International Nuclear Information System (INIS)

    Rockwell, S.; Kapp, D.S.

    1982-01-01

    The nitroimidazoles metronidazole, misonidazol, and desmethyl misonidazole are currently undergoing clinical trials as possible adjuncts to radiotherapy. Ongoing clinical trials are evaluating the effectiveness of these agents and also documenting the pharmacokinetics and toxicities of radiosensitizing doses of these drugs in man. A variety of toxic effects have been noted in man, including anorexia, nausea and vomiting, peripheral neuropathy, central nervous system symptoms, ototoxicity, allergy, and fear. Laboratory studies have also suggested that these agents have potential to be mutagenic, carcinogenic, and teratogenic. In the editorial presented, the author attempts to draw attention to an additional toxic effect of nitroimidazoles - the inhibition of cell-mediated immune responses

  9. The Diagnostic importance of clinical and radiologic features of the Multiple Cemento-osseous dysplasia

    International Nuclear Information System (INIS)

    Han, M. R.; Kim, Y. H.; Kang, B. C.

    1998-01-01

    This case was diagnosed as multiple cementoosseous dysplasia on the basis of clinical and radiological features but was diagnosed as ossifying fibroma on the basis of histopathological feature. The histopathologic features of the multiple cementoosseous dysplasia and cementoossifying fibroma have common features of cementum, fibrous network and bone. Multiple cementoosseous dysplasia is reactive lesion and shows restricted lesion size, occurred on anterior and posterior tooth of the mandible and needs no treatment except periodic follow up. But Cementoossifying fibroma is the true neoplasm and grows continuously and needs surgical removal. The final diagnosis of the multiple cementoosseous dysplasia requires good correlation of the clinical histopathological, and radiological features.

  10. Is non‐steroidal anti‐inflammaory drug (NSAID) enteropathy clinically more important than NSAID gastropathy?

    Science.gov (United States)

    Adebayo, D; Bjarnason, I

    2006-01-01

    The side effects of conventional non‐steroidal anti‐inflammatory drugs (NSAIDs) on the stomach is undoubtedly a serious public health problem contributing significantly to the morbidity and mortality of patients receiving these drugs. However, the damage of NSAIDs is not confined to the stomach. Indeed the short term and long term damage of NSAIDs on the small bowel (NSAID enteropathy) is more frequent than NSAID gastropathy. Furthermore, NSAID enteropathy is associated with complications (bleeding and protein loss). While many of these are mild, the serious events (significant bleeding, perforation, obstruction, and sudden death) are frequent as that reported for NSAID gastropathy. The diagnosis of NSAID enteropathy has been greatly aided by the introduction of wireless capsule enteroscopy. PMID:16517800

  11. Is non-steroidal anti-inflammaory drug (NSAID) enteropathy clinically more important than NSAID gastropathy?

    Science.gov (United States)

    Adebayo, D; Bjarnason, I

    2006-03-01

    The side effects of conventional non-steroidal anti-inflammatory drugs (NSAIDs) on the stomach is undoubtedly a serious public health problem contributing significantly to the morbidity and mortality of patients receiving these drugs. However, the damage of NSAIDs is not confined to the stomach. Indeed the short term and long term damage of NSAIDs on the small bowel (NSAID enteropathy) is more frequent than NSAID gastropathy. Furthermore, NSAID enteropathy is associated with complications (bleeding and protein loss). While many of these are mild, the serious events (significant bleeding, perforation, obstruction, and sudden death) are frequent as that reported for NSAID gastropathy. The diagnosis of NSAID enteropathy has been greatly aided by the introduction of wireless capsule enteroscopy.

  12. Why quality of life measurement is important in dermatology clinical practice

    DEFF Research Database (Denmark)

    Finlay, A Y; Salek, M S; Abeni, D

    2017-01-01

    The aim of this study was to describe the many ways in which quality of life (QoL) measurement may potentially be advantageous in routine clinical dermatology practice. Thirteen members of the EADV Task Force on Quality of Life, eight dermatologists, three health psychologists, one epidemiologist...

  13. Are estimates of meaningful decline in mobility performance consistent among clinically important subgroups? (Health ABC Study).

    NARCIS (Netherlands)

    Perera, S.; Studenski, S.; Newman, A.; Simonsick, E.; Harris, T.; Schwartz, A.; Visser, M.

    2014-01-01

    Background: Meaningful change criteria help determine if function has improved or declined, but their magnitudes may vary across clinically relevant subgroups. We estimate meaningful decline in four common measures of physical performance in subgroups of older adults based on initial performance,

  14. Determining Minimal Clinically Important Differences in Japanese Cedar/Cypress Pollinosis Patients

    Directory of Open Access Journals (Sweden)

    Takaya Higaki

    2013-01-01

    Conclusions: For T5SS in the diary, T6SS and QOL in JRQLQ, unit differences of 1.5 (0.3 per item, 3.6 (0.6 and 8.2 (0.5, respectively, were considered clinically meaningful by JCCP patients. The MCID for symptoms recorded in the diary was stable irrespective of the dispersed pollen level.

  15. Importance of clinical toxicology teaching and its impact in improving knowledge: sharing experience from a workshop

    International Nuclear Information System (INIS)

    Khan, N.U.; Fayyaz, J.; Khan, U.R.; Feroze, A.

    2013-01-01

    Objective: To assess the impact of a one-day clinical toxicology workshop in improving knowledge. Methods: A one-day clinical toxicology workshop was conducted as a pre-conference workshop of the Annual Emergency Medicine Conference at the Aga Khan University Hospital, Karachi, in April 2012. The course was composed of poisoning-related common clinical scenarios. The pre-test and post-test understanding was used to assess the impact of the course in improving knowledge. The participants also evaluated the workshop as a whole thorough written evaluation forms. SPSS 19 was used for statistical analysis of the data. Result: There were 22 participants in the course. The pre-test mean score was 31.6+-15.1% (95% CI; 24-40; n=19) compared to the post-test the mean score of 56.0+-10.8% (95% CI; 47- 61; n=17). The positive difference was also statistically significant (p<0.001). The overall workshop was evaluated as excellent by 08 (47.46%) and very good by 10 (52.63%) participants. Conclusion: Short training in clinical toxicology improved knowledge of the participants. (author)

  16. Clinical and diagnostic importance of changes of colon at chronic prostatitis

    Directory of Open Access Journals (Sweden)

    V.M. Popkov

    2010-06-01

    Full Text Available The aim of researches was studying clinical, microbiological and morphological characteristic of colon at patients at chronic prostatitis, definition of method of pathogenetic therapy on the basis of the received results. Material and methods of investigation. 50 patients at chronic bacterial prostatitis, 50 patients at asymptomatic inflammatory prostatitis and 30 practically healthy males were inspected. Microflora of prostata's secret and colon, morphology and structure of components of diffuse neuroendocrine system of colon were studied. Clinical, microbiological, иммуногистохимические methods and morphometrical analysis were applied. Results. It is defined, that at 74% patients with asymptomatic inflammatory prostatitis irritable bowel syndrome and at 26% - chronic nonulcerative colitis were diagnosed. At all patients at chronic bacterial prostatitis chronic nonulcerative colitis were detected. These variants were correlleted with different types of intestinal dysbiosis and degree of microbe producing of prostate. Use probiotic Bactistatin® at patients with a chronic prostatitis raises clinical efficiency of antibacterial therapy, promotes reduction of inflammatory changes, restoration of its microbic landscape and neuroendocrine homeostasis of colon. inclusion. At chronic prostatitis structural and functional pathology of colon are often registered, they are connected with clinical variant of prostatitis and can mask of prostata's pathology. Using Bactistatin® at patients with a chronic prostatitis is proved and effective

  17. Important options available - from start to finish -for translating proteomics results to clinical chemistry

    DEFF Research Database (Denmark)

    Heegaard, Niels H H; Ostergaard, Ole; Bahl, Justyna M C

    2015-01-01

    assay development downstream. Putative new assay candidates generated by proteomics discovery projects compete with well-established assays with known indications, well-described performance, and of known value in specific clinical settings. Careful attention to the many options available in the design...

  18. PCR diagnosis and characterization of Leishmania in local and imported clinical samples

    NARCIS (Netherlands)

    Schönian, Gabriele; Nasereddin, Abedelmajeed; Dinse, Nicole; Schweynoch, Carola; Schallig, Henk D. F. H.; Presber, Wolfgang; Jaffe, Charles L.

    2003-01-01

    Leishmaniasis diagnosis in regions where multiple species exist should identify each species directly in the clinical sample without parasite culturing. The sensitivity of two PCR approaches which amplify part of the ssu rRNA gene and the ribosomal internal transcribed spacer (ITS), respectively,

  19. Importance of comprehensive molecular profiling for clinical outcome in children with recurrent cancer

    DEFF Research Database (Denmark)

    Østrup, Olga; Nysom, Karsten; Scheie, David

    2018-01-01

    treatment. Results: Of the 48 patients, 33 had actionable findings. The most efficient method for the identification of actionable findings was WES (39%), followed by SNP array (37%). Of note, gene fusions were identified by RNAseq in 21% of the samples. Eleven findings led to clinical intervention, i...

  20. Predictors, Prognosis, and Management of New Clinically Important Atrial Fibrillation After Noncardiac Surgery: A Prospective Cohort Study.

    Science.gov (United States)

    Alonso-Coello, Pablo; Cook, Deborah; Xu, Shou Chun; Sigamani, Alben; Berwanger, Otavio; Sivakumaran, Soori; Yang, Homer; Xavier, Denis; Martinez, Luz Ximena; Ibarra, Pedro; Rao-Melacini, Purnima; Pogue, Janice; Zarnke, Kelly; Paniagua, Pilar; Ostrander, Jack; Yusuf, Salim; Devereaux, P J

    2017-07-01

    Despite the frequency of new clinically important atrial fibrillation (AF) after noncardiac surgery and its increased association with the risk of stroke at 30 days, there are limited data informing their prediction, association with outcomes, and management. We used the data from the PeriOperative ISchemic Evaluation trial to determine, in patients undergoing noncardiac surgery, the association of new clinically important AF with 30-day outcomes, and to assess management of these patients. We also aimed to derive a clinical prediction rule for new clinically important AF in this population. We defined new clinically important AF as new AF that resulted in symptoms or required treatment. We recorded an electrocardiogram 6 to 12 hours postoperatively and on the 1st, 2nd, and 30th days after surgery. A total of 211 (2.5% [8351 patients]; 95% confidence interval, 2.2%-2.9%) patients developed new clinically important AF within 30 days of randomization (8140 did not develop new AF). AF was independently associated with an increased length of hospital stay by 6.0 days (95% confidence interval, 3.5-8.5 days) and vascular complications (eg, stroke or congestive heart failure). The usage of an oral anticoagulant at the time of hospital discharge among patients with new AF and a CHADS2 score of 0, 1, 2, 3, and ≥4 was 6.9%, 10.2%, 23.0%, 9.4%, and 33.3%, respectively. Two independent predictors of patients developing new clinically important AF were identified (ie, age and surgery). The prediction rule included the following factors and assigned weights: age ≥85 years (4 points), age 75 to 84 years (3 points), age 65 to 74 years (2 points), intrathoracic surgery (3 points), major vascular surgery (2 points), and intra-abdominal surgery (1 point). The incidence of new AF based on scores of 0 to 1, 2, 3 to 4, and 5 to 6 was 0.5%, 1.0%, 3.1%, and 5.3%, respectively. Age and surgery are independent predictors of new clinically important AF in the perioperative setting. A

  1. Evolving Identification of Blood Cells Associated with Clinically Isolated Syndrome: Importance of Time since Clinical Presentation and Diagnostic MRI.

    Science.gov (United States)

    Trend, Stephanie; Jones, Anderson P; Geldenhuys, Sian; Byrne, Scott N; Fabis-Pedrini, Marzena J; Nolan, David; Booth, David R; Carroll, William M; Lucas, Robyn M; Kermode, Allan G; Hart, Prue H

    2017-06-15

    It is not clear how the profile of immune cells in peripheral blood differs between patients with clinically isolated syndrome (CIS) and healthy controls (HC). This study aimed to identify a CIS peripheral blood signature that may provide clues for potential immunomodulatory approaches early in disease. Peripheral blood mononuclear cells (PBMCs) were collected from 18 people with CIS, 19 HC and 13 individuals with other demyelinating conditions (ODC) including multiple sclerosis (MS). Individuals with CIS separated into two groups, namely those with early (≤14 days post-diagnostic magnetic resonance imaging (MRI); n = 6) and late (≥27 days; n = 12) blood sampling. Transitional B cells were increased in the blood of CIS patients independently of when blood was taken. However, there were two time-dependent effects found in the late CIS group relative to HC, including decreased CD56bright NK cells, which correlated significantly with time since MRI, and increased CD141+ myeloid dendritic cell (mDC2) frequencies. Higher CD1c+ B cells and lower non-classical monocyte frequencies were characteristic of more recent demyelinating disease activity (ODC and early CIS). Analysing cell populations by time since symptoms (subjective) and diagnostic MRI (objective) may contribute to understanding CIS.

  2. Dopamine transporter imaging in clinically unclear cases of parkinsonism and the importance of Scans Without Evidence of Dopaminergic Deficit (SWEDDs

    Directory of Open Access Journals (Sweden)

    Marco A. T. Utiumi

    2012-09-01

    Full Text Available The clinical diagnosis of Parkinson's disease (PD is susceptible to misdiagnosis, especially in the earlier stages of the disease. Recently, in vivo imaging techniques assessing the presynaptic dopamine transporter (DAT have emerged as a useful tool in PD diagnosis, improving its accuracy. OBJECTIVE: It was to illustrate the clinical usefulness of a brain single-photon emission computed tomography (SPECT DAT ligand, and highlight relevant aspects of scans without evidence of dopaminergic deficit (SWEDDs in this context. CASES: We described four representative patients with clinically unclear parkinsonian syndromes who underwent [99mTc]-TRODAT-1 SPECT and reviewed the clinical implications. CONCLUSION: DAT-SPECT is an important, cost-effective, technique for the differential diagnosis of parkinsonian syndromes. Additionally, SWEDD cases present clinical and paraclinical peculiarities that may retrospectively identify them as essential/dystonic tremor. The lack of histopathological data limits further conclusions.

  3. Combining clinical practice and academic work in nursing: A qualitative study about perceived importance, facilitators and barriers regarding clinical academic careers for nurses in university hospitals.

    Science.gov (United States)

    van Oostveen, Catharina J; Goedhart, Nicole S; Francke, Anneke L; Vermeulen, Hester

    2017-12-01

    To obtain in-depth insight into the perceptions of nurse academics and other stakeholders regarding the importance, facilitators and barriers for nurses combining clinical and academic work in university hospitals. Combining clinical practice and academic work facilitates the use of research findings for high-quality patient care. However, nurse academics move away from the bedside because clinical academic careers for nurses have not yet been established in the Netherlands. This qualitative study was conducted in two Dutch university hospitals and their affiliated medical faculties and universities of applied sciences. Data were collected between May 2015 and August 2016. We used purposive sampling for 24 interviews. We asked 14 participants in two focus groups for their perceptions of importance, facilitators and barriers in nurses' combined clinical and academic work in education and research. We audiotaped, transcribed and thematically analysed the interviews and focus groups. Three themes related to perceived importance, facilitators and barriers: culture, leadership and infrastructure. These themes represent deficiencies in facilitating clinical academic careers for nurses. The current nursing culture emphasises direct patient care, which is perceived as an academic misfit. Leadership is lacking at all levels, resulting in the underuse of nurse academics and the absence of supporting structures for nurses who combine clinical and academic work. The present nursing culture appears to be the root cause of the dearth of academic positions and established clinical academic posts. A culture change would require a show of leadership that would promote and enable combined research, teaching and clinical practice and that would introduce clinical academic career pathways for nurses. Meanwhile, nurse academics should collaborate with established medical academics for whom combined roles are mainstream, and they should take advantage of their established infrastructure

  4. Nontuberculous mycobacteria in Denmark, incidence and clinical importance during the last quarter-century

    DEFF Research Database (Denmark)

    Hermansen, Thomas S; Ravn, Pernille; Svensson, Erik

    2017-01-01

    and trends in annual incidence rates. 524,119 clinical specimens were cultured for mycobacteria from 1991 through 2015 at the International Reference Laboratory of Mycobacteriology in Denmark. Among these, 8,227 NTM strains were identified from 3,462 patients and distributed according to microbiological...... disease criteria. We observed no increase in NTM disease incidence or proportion of patients with positive NTM cultures during the study period (Quasi-Poisson regression, p = 0.275 and 0.352 respectively). Annual incidence rates were 1.20/105 for definite NTM disease, 0.49/105 for possible NTM disease...... and 0.88/105 for NTM colonization. The incidence rate of NTM disease was highest in children aged 0-4 years (5.36/105/year), predominantly with cervical Mycobacterium avium complex (MAC) adenitis. Surprisingly, based on more than half a million clinical specimens cultured for mycobacteria in Denmark...

  5. Nontuberculous mycobacteria in Denmark, incidence and clinical importance during the last quarter-century

    DEFF Research Database (Denmark)

    Hermansen, Thomas S; Ravn, Pernille; Svensson, Erik

    2017-01-01

    and trends in annual incidence rates. 524,119 clinical specimens were cultured for mycobacteria from 1991 through 2015 at the International Reference Laboratory of Mycobacteriology in Denmark. Among these, 8,227 NTM strains were identified from 3,462 patients and distributed according to microbiological...... disease criteria. We observed no increase in NTM disease incidence or proportion of patients with positive NTM cultures during the study period (Quasi-Poisson regression, p = 0.275 and 0.352 respectively). Annual incidence rates were 1.20/10(5) for definite NTM disease, 0.49/10(5) for possible NTM disease...... and 0.88/10(5) for NTM colonization. The incidence rate of NTM disease was highest in children aged 0-4 years (5.36/10(5)/year), predominantly with cervical Mycobacterium avium complex (MAC) adenitis. Surprisingly, based on more than half a million clinical specimens cultured for mycobacteria in Denmark...

  6. [The Classification of Headache: Important Aspects of Patient's History and Clinical Diagnostic].

    Science.gov (United States)

    Kamm, Katharina; Ruscheweyh, Ruth; Eren, Ozan; Straube, Andreas

    2017-03-01

    Headache disorders are the most occuring symptoms in human population. Basis for a successful therapy of headaches is a definite diagnosis, which needs in turn valid criteria for the graduation of headaches. Corresponding to the classification of the International Headache Society (IHS) especially relevant questions about patient's history and clinical examination lead to a diagnosis. © Georg Thieme Verlag KG Stuttgart · New York.

  7. Characterization and susceptibility patterns of clinically important Enterococcus species in eastern Nepal.

    Science.gov (United States)

    Acharya, A; Khanal, A; Kanungo, R; Mohapatra, T

    2007-12-01

    Life threatening infections caused by enterococcus species with multidrug resistance has emerged as a threat to medical care in the present era. This study was conducted to characterize enterococcus species isolated from different clinical samples and to detect the pattern of susceptibility to some of the commonly used antibiotics in B.P Koirala Institute of Health Sciences (BPKIHS), a tertiary care hospital in eastern Nepal. Clinical samples submitted to the microbiology unit of Central Laboratory Service (CLS) for culture and sensitivity during March 2002 - February 2003 was analyzed. Enterococcus species were identified by colony characteristics, gram staining and relevant biochemical tests. Antibiotic susceptibility test was done by the Kirby Bauer disc diffusion technique. Of 50 Enterococcus species isolated, E. faecalis was the predominant isolate (48.0%) followed by E. faecium (32.0%) and E. avium (20.0%). Eighty-eight percent of E. faecalis showed sensitivity to cephotaxime and 87.0% to vancomycin. Multiple drug resistance was observed most commonly in E. faecium. Seventeen percent of E. faecium were resistant to vancomycin and 63.0% to ciprofloxacin and 44.0% to ampicillin. On the contrary E. avium rarely showed resistance to the antimicrobials tested including vancomycin. Enterococcal infections are common nowadays specially in hospitalized patients. Inappropriate use of antibiotics in clinical practice and poultry should be discouraged to prevent the emergence of multidrug resistant species.

  8. Clinical Findings in Patients with Splenic Injuries: Are Injuries to the Left Lower Chest Important?

    Directory of Open Access Journals (Sweden)

    Schneir, Aaron

    2001-07-01

    Full Text Available The purpose of this study was to describe the clinical findings in patients with splenic injury and to determine if isolated left lower chest injury may be the single clinical indicator of splenic injury. The medical records of all adult blunt trauma patients with splenic injury over a 14 month period were reviewed. Significant left lower chest injury was considered present if the patient had left sided pleuritic chest pain with tenderness to ribs 7-12 or if these ribs were visualized as fractured on any imaging study. Patients were considered to have clinical findings suggestive of splenic injury if they had pre-hospital or emergency department hypotension, abdominal pain or tenderness, a Glasgow coma scale < 15, or gross hematuria. Ninety patients had splenic injury. Thirty-nine (43%. 95% CI 33, 54% patients had significant left lower chest injury. In five (6%. 95% CI 2, 12% patients, injury to this portion of the chest was the single indicator of splenic injury. Nearly half the patients with splenic injury will have significant injury to the left lower chest and this finding may be the only indicator of splenic injury.

  9. Clinical importance of achieving biochemical control with medical therapy in adult patients with acromegaly

    Science.gov (United States)

    Christofides, Elena A

    2016-01-01

    In acromegaly, achieving biochemical control (growth hormone [GH] level acromegaly is challenging because it is rooted in observing subtle clinical manifestations, and it is typical for acromegaly to evolve for up to 10 years before it is recognized. This results in chronic exposure to elevated levels of GH and IGF-1 and delay in patients receiving appropriate treatment, which consequently increases mortality risk. In this review, the clinical impact of elevated GH and IGF-1 levels, the effectiveness of current therapies, and the potential role of novel treatments for acromegaly will be discussed. Clinical burden of acromegaly and benefits associated with management of GH and IGF-1 levels will be reviewed. Major treatment paradigms in acromegaly include surgery, medical therapy, and radiotherapy. With medical therapies, such as somatostatin analogs, dopamine agonists, and GH receptor antagonists, a substantial proportion of patients achieve reduced GH and normalized IGF-1 levels. In addition, signs and symptoms, quality of life, and comorbidities have also been reported to improve to varying degrees in patients who achieve biochemical control. Currently, there are several innovative therapies in development to improve patient outcomes, patient use, and access. Timely biochemical control of acromegaly ensures that the patient can ultimately improve morbidity and mortality from this disease and its extensive consequences. PMID:27471378

  10. Authorship issues in multi-centre clinical trials: the importance of making an authorship contract.

    Science.gov (United States)

    Rosenberg, Jacob; Burcharth, Jakob; Pommergaard, Hans-Christian; Vinther, Siri

    2015-02-01

    Discussions about authorship often arise in multi-centre clinical trials. Such trials may involve up to hundreds of contributors of whom some will eventually co-author the final publication. It is, however, often impossible to involve all contributors in the manuscript process sufficiently for them to qualify for authorship as defined by the International Committee of Medical Journal Editors. Therefore, rules for authorship in multi-centre trials are strongly recommended. We propose two contracts to prevent conflicts regarding authorship; both are freely available for use without pay but with reference to the original source.

  11. Zika virus and the risk of imported infection in returned travelers: Implications for clinical care

    NARCIS (Netherlands)

    Goorhuis, Abraham; Von Eije, Karin J.; Douma, Renée A.; Rijnberg, Noor; van Vugt, Michele; Stijnis, Cornelis; Grobusch, Martin P.

    2016-01-01

    Since late 2015, an unprecedented outbreak of Zika virus is spreading quickly across Southern America. The large size of the current outbreak in The Americas will also result in an increase in Zika virus infections among travelers returning from endemic areas. We report five cases of imported Zika

  12. Clinical importance of the middle meningeal artery: A review of the literature

    Science.gov (United States)

    Yu, Jinlu; Guo, Yunbao; Xu, Baofeng; Xu, Kan

    2016-01-01

    The middle meningeal artery (MMA) is a very important artery in neurosurgery. Many diseases, including dural arteriovenous fistula (DAVF), pseudoaneurysm, true aneurysm, traumatic arteriovenous fistula (AVF), moyamoya disease (MMD), recurrent chronic subdural hematoma (CSDH), migraine and meningioma, can involve the MMA. In these diseases, the lesions occur in either the MMA itself and treatment is necessary, or the MMA is used as the pathway to treat the lesions; therefore, the MMA is very important to the development and treatment of a variety of neurosurgical diseases. However, no systematic review describing the importance of MMA has been published. In this study, we used the PUBMED database to perform a review of the literature on the MMA to increase our understanding of its role in neurosurgery. After performing this review, we found that the MMA was commonly used to access DAVFs and meningiomas. Pseudoaneurysms and true aneurysms in the MMA can be effectively treated via endovascular or surgical removal. In MMD, the MMA plays a very important role in the development of collateral circulation and indirect revascularization. For recurrent CDSHs, after burr hole irrigation and drainage have failed, MMA embolization may be attempted. The MMA can also contribute to the occurrence and treatment of migraines. Because the ophthalmic artery can ectopically originate from the MMA, caution must be taken to avoid causing damage to the MMA during operations. PMID:27766029

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

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  14. Clinical importance of the middle meningeal artery: A review of the literature.

    Science.gov (United States)

    Yu, Jinlu; Guo, Yunbao; Xu, Baofeng; Xu, Kan

    2016-01-01

    The middle meningeal artery (MMA) is a very important artery in neurosurgery. Many diseases, including dural arteriovenous fistula (DAVF), pseudoaneurysm, true aneurysm, traumatic arteriovenous fistula (AVF), moyamoya disease (MMD), recurrent chronic subdural hematoma (CSDH), migraine and meningioma, can involve the MMA. In these diseases, the lesions occur in either the MMA itself and treatment is necessary, or the MMA is used as the pathway to treat the lesions; therefore, the MMA is very important to the development and treatment of a variety of neurosurgical diseases. However, no systematic review describing the importance of MMA has been published. In this study, we used the PUBMED database to perform a review of the literature on the MMA to increase our understanding of its role in neurosurgery. After performing this review, we found that the MMA was commonly used to access DAVFs and meningiomas. Pseudoaneurysms and true aneurysms in the MMA can be effectively treated via endovascular or surgical removal. In MMD, the MMA plays a very important role in the development of collateral circulation and indirect revascularization. For recurrent CDSHs, after burr hole irrigation and drainage have failed, MMA embolization may be attempted. The MMA can also contribute to the occurrence and treatment of migraines. Because the ophthalmic artery can ectopically originate from the MMA, caution must be taken to avoid causing damage to the MMA during operations.

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

    NARCIS (Netherlands)

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

    2014-01-01

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

  16. The importance of hydration in wound healing: reinvigorating the clinical perspective.

    Science.gov (United States)

    Ousey, K; Cutting, K F; Rogers, A A; Rippon, M G

    2016-03-01

    Balancing skin hydration levels is important as any disruption in skin integrity will result in disturbance of the dermal water balance. The discovery that a moist environment actively supports the healing response when compared with a dry environment highlights the importance of water and good hydration levels for optimal healing. The benefits of 'wet' or 'hyper-hydrated' wound healing appear similar to those offered by moist over a dry environment. This suggests that the presence of free water may not be detrimental to healing, but any adverse effects of wound fluid on tissues is more likely related to the biological components contained within chronic wound exudate, for example elevated protease levels. Appropriate dressings applied to wounds must not only be able to absorb the exudate, but also retain this excess fluid together with its protease solutes, while concurrently preventing desiccation. This is particularly important in the case of chronic wounds where peri-wound skin barrier properties are compromised and there is increased permeation across the injured skin. This review discusses the importance of appropriate levels of hydration in skin, with a particular focus on the need for optimal hydration levels for effective healing. Declaration of interest: This paper was supported by Paul Hartmann Ltd. The authors have provided consultative services to Paul Hartmann Ltd.

  17. Epidermotropic presentation by splenic B-cell lymphoma: The importance of clinical-pathologic correlation.

    Science.gov (United States)

    Hedayat, Amin A; Carter, Joi B; Lansigan, Frederick; LeBlanc, Robert E

    2018-04-01

    There are exceedingly rare reports of patients with epidermotropic B-cell lymphomas. A subset presented with intermittent, variably pruritic papular eruptions and involvement of their spleens, peripheral blood and bone marrow at the time of diagnosis. Furthermore, some experienced an indolent course despite dissemination of their lymphomas. We report a 66-year-old woman with a 12-year history of intermittent eruptions of non-pruritic, salmon-colored papules on her torso and proximal extremities that occurred in winter and resolved with outdoor activity in spring. Skin biopsy revealed an epidermotropic B-cell lymphoma with a non-specific B-cell phenotype and heavy chain class switching with IgG expression. On workup, our patient exhibited mild splenomegaly and low-level involvement of her peripheral blood and bone marrow by a kappa-restricted B-cell population. A splenic B-cell lymphoma was diagnosed. Considering her longstanding history and absences of cytopenias, our patient has been followed without splenectomy or systemic therapy. Furthermore, the papules have responded dramatically to narrowband UVB. Our case and a review of similar rare reports aim to raise awareness among dermatopathologists and dermatologists of a clinically distinct and indolent subset of epidermotropic splenic lymphomas with characteristic clinical and histologic findings. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. The importance of clinical information in patients with gastroenteropancreatic neuroendocrine tumor.

    Science.gov (United States)

    Kudo, Atsushi; Akashi, Takumi; Kumagai, Jiro; Ban, Daisuke; Inokuchi, Mikito; Kojima, Kazuyuki; Kawano, Tatsuyuki; Tanaka, Shinji; Arii, Shigeki

    2012-01-01

    The WHO 2010 grading system for gastroenteropancreatic neuroendocrine tumors(GEP-NETs) is used to evaluate the malignant potential without clinicopathological information. This study was conducted to examine whether the new index is superior to the previous WHO 2004 classification, e.g.for well-differentiated endocrine carcinoma (WEC),involving clinical information. Between 2000 and 2011, 77 patients with sporadic GEP-NETs were treated at our institution and statistically estimated risk factors for overall survival (OS) were evaluated. Cox proportional hazards regression analyses were performed to estimate risk factors for OS. Overall 1-, 3- and 5-year survival rates were 92.8%, 78.4% and 76.0%, respectively. Median OS was 551 days in WEC-patients (odds ratio (OR)for OS=13.1, 95% confidence interval (CI)=2.90-59.5;p=0.001). The median OS was 813 days in G3-patients as compared with 1885 days in G1/G2-patients(OR for OS= 2.64, p=0.002). Multivariate analyses according to baseline characteristics revealed WEC as independent risk factor (OR=9.06, p=0.01). WEC was the only predictor of prognosis with an area under the receiver operating characteristic curves of 0.78(p=0.001). Clinical information was the best predictor for the prognosis of NETs.

  19. QUALITY OF LIFE IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: importance of clinical, demographic and psychosocial factors

    Directory of Open Access Journals (Sweden)

    Joana MAGALHÃES

    2014-09-01

    Full Text Available Context Inflammatory bowel disease causes physical and psychosocial consequences that can affect the health related quality of life. Objectives To analyze the relationship between clinical and sociodemographic factors and quality of life in inflammatory bowel disease patients. Methods Ninety two patients with Crohn’s disease and 58 with ulcerative colitis, filled in the inflammatory bowel disease questionnaire (IBDQ-32 and a questionnaire to collect sociodemographic and clinical data. The association between categorical variables and IBDQ-32 scores was determined using Student t test. Factors statistically significant in the univariate analysis were included in a multivariate regression model. Results IBDQ-32 scores were significantly lower in female patients (P<0.001, patients with an individual perception of a lower co-workers support (P<0.001 and career fulfillment (P<0.001, patients requiring psychological support (P = 0.010 and pharmacological treatment for anxiety or depression (P = 0.002. A multivariate regression analysis identified as predictors of impaired HRQOL the female gender (P<0.001 and the perception of a lower co-workers support (P = 0.025 and career fulfillment (P = 0.001. Conclusions The decrease in HRQQL was significantly related with female gender and personal perception of disease impact in success and social relations. These factors deserve a special attention, so timely measures can be implemented to improve the quality of life of patients.

  20. A rare variant of the ulnar artery with important clinical implications: a case report

    Directory of Open Access Journals (Sweden)

    Casal Diogo

    2012-11-01

    Full Text Available Abstract Background Variations in the major arteries of the upper limb are estimated to be present in up to one fifth of people, and may have significant clinical implications. Case presentation During routine cadaveric dissection of a 69-year-old fresh female cadaver, a superficial brachioulnar artery with an aberrant path was found bilaterally. The superficial brachioulnar artery originated at midarm level from the brachial artery, pierced the brachial fascia immediately proximal to the elbow, crossed superficial to the muscles that originated from the medial epicondyle, and ran over the pronator teres muscle in a doubling of the antebrachial fascia. It then dipped into the forearm fascia, in the gap between the flexor carpi radialis and the palmaris longus. Subsequently, it ran deep to the palmaris longus muscle belly, and superficially to the flexor digitorum superficialis muscle, reaching the gap between the latter and the flexor carpi ulnaris muscle, where it assumed is usual position lateral to the ulnar nerve. Conclusion As far as the authors could determine, this variant of the superficial brachioulnar artery has only been described twice before in the literature. The existence of such a variant is of particular clinical significance, as these arteries are more susceptible to trauma, and can be easily confused with superficial veins during medical and surgical procedures, potentially leading to iatrogenic distal limb ischemia.

  1. The importance of communication for clinical leaders in mental health nursing: the perspective of nurses working in mental health.

    Science.gov (United States)

    Ennis, Gary; Happell, Brenda; Broadbent, Marc; Reid-Searl, Kerry

    2013-11-01

    Communication has been identified as an important attribute of clinical leadership in nursing. However, there is a paucity of research on its relevance in mental health nursing. This article presents the findings of a grounded theory informed study exploring the attributes and characteristics required for effective clinical leadership in mental health nursing, specifically the views of nurses working in mental health about the importance of effective communication in day to day clinical leadership. In-depth interviews were conducted to gain insight into the participants' experiences and views on clinical leadership in mental health nursing. The data that emerged from these interviews were constantly compared and reviewed, ensuring that any themes that emerged were based on the participants' own experiences and views. Participants recognized that effective communication was one of the attributes of effective clinical leadership and they considered communication as essential for successful working relationships and improved learning experiences for junior staff and students in mental health nursing. Four main themes emerged: choice of language; relationships; nonverbal communication, and listening and relevance. Participants identified that clinical leadership in mental health nursing requires effective communication skills, which enables the development of effective working relationships with others that allows them to contribute to the retention of staff, improved outcomes for clients, and the development of the profession.

  2. Child-rearing practices toward children with hemophilia: The relative importance of clinical characteristics and parental emotional reactions

    NARCIS (Netherlands)

    Banis, Hendrika; Suurmeijer, Th.P.B.M.; van Peer, D.R.

    This study addresses the relative importance of clinical characteristics of the child and parental emotional reactions, to child-rearing practices towards children who suffer from hemophilia. The variables were assessed in a Dutch sample of 108 zero-to-twelve-year-old boys with hemophilia and their

  3. The clinical importance of the anatomic variations in the paranasal sinuses

    International Nuclear Information System (INIS)

    Teixeira Junior, Francisco Ribeiro; Bretas, Elisa Almeida Sathler; Madeira, Ivana Andrade; Diniz, Renata Furletti; Ribeiro, Marcelo Almeida; Motta, Emilia Guerra Pinto Coelho; Moreira, Wanderval

    2008-01-01

    The anatomic variations of the paranasal sinuses are common findings. The importance of such variations predisposing disease through the obstruction of the drainage pathway has been discussed by several authors, although it is not yet a matter of agreement. The literature was reviewed and a iconographic assay was prepared aiming the discussion of the importance of the main anatomic variations of the paranasal sinuses. The prevalence of anatomic variations of the paranasal sinuses varies largely amongst studies and its role in sinus disease is controversial. In this article, it is described the different variations associated to paranasal disease and how they relate to pathologic conditions. Most studies confirm the concept that anatomic variations of the paranasal sinuses are related to disease when they obstruct the drainage pathways. The knowledge of such alterations and its relations to pathologic conditions is expected from the general radiologist. (author)

  4. Importance of carbon dioxide in the critical patient: Implications at the cellular and clinical levels.

    Science.gov (United States)

    Morales Quinteros, Luis; Bringué Roque, Josep; Kaufman, David; Artigas Raventós, Antonio

    2018-02-24

    Important recent insights have emerged regarding the cellular and molecular role of carbon dioxide (CO 2 ) and the effects of hypercapnia. The latter may have beneficial effects in patients with acute lung injury, affording reductions in pulmonary inflammation, lessened oxidative alveolar damage, and the regulation of innate immunity and host defenses by inhibiting the expression of inflammatory cytokines. However, other studies suggest that CO 2 can have deleterious effects upon the lung, reducing alveolar wound repair in lung injury, decreasing the rate of reabsorption of alveolar fluid, and inhibiting alveolar cell proliferation. Clearly, hypercapnia has both beneficial and harmful consequences, and it is important to determine the net effect under specific conditions. The purpose of this review is to describe the immunological and physiological effects of carbon dioxide, considering their potential consequences in patients with acute respiratory failure. Copyright © 2018 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  5. State-of-the-art measurements in human body composition: A moving frontier of clinical importance

    Science.gov (United States)

    Gallagher, D.; Shaheen, I.; Zafar, K.

    2010-01-01

    The measurement of human body composition allows for the estimation of body tissues, organs, and their distributions in living persons without inflicting harm. From a nutritional perspective, the interest in body composition has increased multi-fold with the global increase in the prevalence of obesity and its complications. The latter has driven in part the need for improved measurement methods with greater sensitivity and precision. There is no single gold standard for body-composition measurements in-vivo. All methods incorporate assumptions that do not apply in all individuals and the more accurate models are derived by using a combination of measurements, thereby reducing the importance of each assumption. This review will discuss why the measurement of body composition or human phenotyping is important; discuss new areas where the measurement of body composition (human phenotyping) is recognized as having important application; and will summarize recent advances made in new methodology. Reference will also be made to areas we cannot yet measure due to the lack of appropriate measurement methodologies, most especially measurements methods that provide information on kinetic states (not just static state) and metabolic function. PMID:21234275

  6. Comparison of medication reconciliation and medication review: errors and clinical importance

    DEFF Research Database (Denmark)

    Bjeldbak-Olesen, Mette; Danielsen, Anja Gadsbølle; Tomsen, Dorthe Vilstrup

    2013-01-01

    in the patient record and the EMS. 15% of the discrepancies were potentially serious or fatal, 62% were potentially significant and 23% were potentially non-significant. A total of 129 DRPs were identified by medication review, 1.7 per patient. The most frequent DRPs were sub therapeutic dosage, inappropriate......Introduction: The objective of this study was to compare medication reconciliation and medication review based on number, type and severity of discrepancies and drug-re­lated problems (DRPs), denoted errors. Material and methods: This was a retrospective study conducted at the Department...... of Cardiology, Hillerød Hos­pital. Medication reconciliation compared the prescriptions in patient records, an electronic medication system (EMS) and in discharge summaries (DS). The medication review was based on the EMS. The two methods were performed on the same data material. To assess the clinical...

  7. The symmetrical calcification of the basal cerebral ganglia (SCBG): its clinical importance

    International Nuclear Information System (INIS)

    Stellamor, V.; Summer, K.; Stellamor, K.

    1984-01-01

    Since CT is has been possible to detect subtle SCBG. Usually they are without any symptoms. Massive calcification is visible in conventional radiogram; it can form the patho-anatomical substrate for neuro-psychiatric defects. Fahr's triad consists of SCBG, typical neuro-psychiatric symptoms, and decreased activity of the parathyroid symptoms, and decreased activity of the parathyroid glands leading to a pathologic calcium-metabolism. In our opinion SCBG is of clinical relevance in each stage. Calcium-metabolism, intoxications and sclerosis of cerebral vessels have to be looked for. The combination of hypoparathyroidism and sclerosis of the cerebral vessels turned out to be fatal with one of our patients. In a case of SCBG the neuro-psychiatric symptoms were progressive. Interventions in the calcium-metabolism e.g. in strumectomy should depend on the status of the cerebral vessels. (Author)

  8. Follicular neoplasms of the thyroid: importance of clinical and cytological correlation.

    Science.gov (United States)

    Granados-García, Martín; Cortés-Flores, Ana Olivia; del Carmen González-Ramírez, Imelda; Cano-Valdez, Ana María; Flores-Hernández, Lorena; Aguilar-Ponce, José Luis

    2010-01-01

    Thyroid cancer presents as nodules. Thyroid nodules are frequent, but only 5-30% are malignant. Fine needle aspiration biopsy (FNAB) is useful for initial evaluation; nevertheless, malignancy is uncertain when follicular neoplasm is reported. Some factors can be associated with malignancy. Therefore, we analyzed our follicular neoplasms in order to identify those factors associated with a higher risk of malignancy. We analyzed the clinical files of consecutive patients with cytological diagnoses of follicular neoplasm. From 1,005 cases of thyroid nodules, 121 were follicular neoplasms according to cytology. Of these, 75 were surgically treated. Definitive report showed 45 benign (60%) and 30 malignant (40%) cases. Benign cases included 29 goiters, 11 follicular adenomas, and 5 cases of thyroiditis. Malignant cases were comprised of 12 papillary carcinomas, 4 follicular carcinomas, 3 papillary carcinomas-follicular variant, 1 lymphoma, 1 teratoma, 5 medullary carcinomas, 2 insular carcinomas, 1 anaplastic carcinoma and 1 metastatic breast carcinoma. Tumor size of benign lesions was 3.43 ± 2.04 cm, and 4.67 ± 2.78 (p = 0.049) for malignant lesions. Age was 46.95 ± 15.39 years for benign lesions and 48.67 ± 17.28 for malignant lesions (p = 0.66). Fifty percent of males showed malignancy vs. 37.7% of females (p < 0.005). Our results suggest that size and gender, but not age, are associated with cytological pattern. Ultrasonographic characteristics may be useful discriminating patients with a higher risk of malignancy. FNAB is a useful tool for initial evaluation of thyroid nodules, but clinical evaluation can enhance predictive value.

  9. Importância da avaliação genético-clínica na hidrocefalia Importance of the clinical genetics evaluation on hydrocephalus

    Directory of Open Access Journals (Sweden)

    Marta Wey-Vieira

    2004-06-01

    Full Text Available Os objetivos deste estudo foram caracterizar a presença de possíveis quadros de etiologia genética entre portadores de hidrocefalia congênita de etiologia não anteriormente esclarecida e confirmar aqueles com etiologia identificada previamente. A casuística compôs-se de 16 pacientes portadores de hidrocefalia congênita. O protocolo de investigação incluiu anamnese, investigação de história familial, exame clínico-dismorfológico, tomografia computadorizada ou ressonância magnética de sistema nervoso central, radiografia vertebral simples, cariótipo e estudo dismorfológico. Para análise dos resultados, a casuística foi dividida em dois grupos. O Grupo I (3M:6F caracterizado por indivíduos com hidrocefalia e sinais clínicos inespecíficos; o Grupo II (7M, em que os indivíduos apresentavam hidrocefalia congênita e sinais sugestivos do espectro da doença L1. Orientação genética específica foi possível em 11 casos. Os resultados demonstram a heterogeneidade etiológica envolvida na hidrocefalia, evidenciando a necessidade de avaliação clínico-dismorfológica como instrumento complementar na investigação dessa condição clínica.The aim of this study was to characterize the possibility of genetic etiology in a group of individuals with congenital hydrocephalus in which the etiology was indeterminate and to confirm that earlier diagnosed. The casuistry was composed by 16 individuals with congenital hydrocephalus. Investigation protocol included anamnesis, familial investigation, physical examination, computerized tomography or magnetic resonance image of head, vertebral column X-ray, karyotype and dysmorphological study. Results were analyzed in two groups. In Group I (3M:9F was composed by hydrocephalus associated with unspecific signs. Group II (7 males had findings of epectrum of L1 disease. Genetic counseling could be offered in 11 cases. These results demonstrate the great etiological heterogeneity of congenital

  10. Abnormal muscle and hematopoietic gene expression may be important for clinical morbidity in primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Reppe, Sjur; Stilgren, Lis; Abrahamsen, Bo

    2007-01-01

    out in biopsies obtained before and 1 yr after parathyroidectomy in seven patients discovered by routine blood [Ca(2+)] screening. The tissue distribution of PTH receptor (PTHR1 and PTHR2) mRNAs were quantitated using real-time RT-PCR in unrelated persons to define PTH target tissues. Of about 10......, muscle, and hematopoietic cells have to be considered as one independent, important cause of molecular disease in PHPT leading to profound alterations in gene expression that may help explain symptoms like muscle fatigue, cardiovascular pathology, and precipitation of psychiatric illness....

  11. Importance of repeated CT scan in Fournier gangrene treatment: clinical case

    International Nuclear Information System (INIS)

    Ignatenco, Sergiu

    2011-01-01

    A patient of 53 years presented fever, swelling and erythema in the perineal region. After computed tomography (CT) was diagnosed Fournier gangrene. After aggressive surgical debridement postoperative evolution was unfavorable. Repeated CT scan trace spread of infection to new areas that led to new surgical debridement on time. Use of CT scan in the postoperative period allows assessment of the effectiveness of surgical debridement and spread of infection. This article presents CT scan images and the most important periods of intraoperative surgical intervention. (authors)

  12. Difficulty in the Clinical Diagnosis of Tularemia: Highlighting the Importance of a Physical Exam

    Directory of Open Access Journals (Sweden)

    Rupin Kumar

    2018-01-01

    Full Text Available We report an 18-month-old male who presented with fever and nonspecific symptoms. He was evaluated for multiple differential diagnoses including Kawasaki disease and JIA and received treatment for them. After he was readmitted, tularemia was considered based on the physical exam finding of an ulcer on the scalp and enlarged lymph nodes. Tularemia titers were positive, and the patient was given the appropriate antibiotic and was discharged home. Follow-up of the patient showed complete resolution of symptoms. This is a case that demonstrates the importance of physical exam in identifying rare diseases presenting with common signs and symptoms.

  13. Hypersensitivity pneumonitis associated with mushroom worker's lung: an update on the clinical significance of the importation of exotic mushroom varieties.

    Science.gov (United States)

    Moore, John E; Convery, Rory P; Millar, B Cherie; Rao, Juluri R; Elborn, J Stuart

    2005-01-01

    Hypersensitivity pneumonitis remains an important industrial disease in mushroom workers. It has a significant morbidity, and early diagnosis and removal from exposure to the antigen are critically important in its management. Recently, several new allergens have been described, particularly those from mushroom species originating in the Far East, which are of clinical significance to workers occupationally exposed to such allergens in cultivation, picking, and packing of commercial mushroom crops. Importing of exotic mushrooms including Shiitake is common in EU countries, and some of the exotic species of mushrooms are cultivated for local markets. This practice may contribute to an increase in clinical cases of mushroom hypersensitivity pneumonitis. This update reviews the recent literature and examines changing trends of mushroom worker's lung, with increased movement of commercial product and labour markets worldwide.

  14. Lutetium-177 - Broad Production Capabilities are Expected to Stimulate Clinical Applications of this Important Therapeutic Radioisotope

    International Nuclear Information System (INIS)

    Knapp, F.F. Jr.

    2009-01-01

    though the effort and expense increase exponentially as higher levels of nca Lu-177 are required, with more experience, these methods would be expected to be optimized and automated. Effective clinical results of targeted therapy exemplified with Lu-177-DOTAT-TOC and other peptides have been widely reported for neuroendocrine tumors. For this application, SA of probably > 10 Ci/mg is required. For arthritis therapy with Lu-177-EDTMP, much lower SA is sufficient (∼ 0.5 Ci Lu-177/mg). Although not yet realized, the unique opportunity to produce high activity levels/high SA Lu-177 essentially anywhere in the world would be expected to catalyze broader clinical use of Lu-177. In fact, this is a unique situation where production capabilities for both HSA and LSA Lu-177 far exceed current demand. The goals of this presentation are to discuss the issues associated with the routine production and processing of high activity levels of lutetium-177 and current and expected clinical applications. Research at the Oak Ridge National Laboratory (ORNL) is supported by the U.S. Department of Energy (DOE) under contract DE-AC05-00OR22725 with UT-Battelle, LLC. 'The submitted manuscript has been authored by a contractor of the U.S. Government under contract DE-AC05-00OR22725. Accordingly, the U.S. Government retains a nonexclusive, royalty-free license to publish or reproduce the published form of this contribution, or allow others to do so, for U.S. Government purposes.' (author)

  15. THE IMPORTANCE OF ELECTROENCEPHALOGRAPHIC ACTIVATING METHODS IN CLINICAL PRACTICE OF NEUROLOGIST

    Directory of Open Access Journals (Sweden)

    L. Yu. Glukhova

    2013-01-01

    Full Text Available The electroencephalographic activating methods are widely used during the EEG investigation to detect the reactivity of normal electric activity of the brain and for provocation of pathological (especially epileptiform activity. The most common activating procedures are intermittent photic stimulation, hyperventilation, the probe "opening – closing" of the eyes, sleep deprivation and sleep. The more different activation methods are used during EEG investigation the more information EEG-method can propose in diagnostics of various pathological conditions , especially epilepsy, since epileptiform activity typically occur under certain conditions. In practice it is desirable to apply the activating procedures that are easily achievable with the available equipment and without possible adverse effects for the patients. The use of activating methods during EEG helps to establish correct diagnosis and to improve the efficacy of the treatment. The authors proposed a detailed review, devoted to the clinical aspects of these activating methods, combined with their own illustrations of EEG- responses to a variety of activating procedures.

  16. Anatomical variations within the deep posterior compartment of the leg and important clinical consequences.

    Science.gov (United States)

    Hislop, M; Tierney, P

    2004-09-01

    The management of musculoskeletal conditions makes up a large part of a sports medicine practitioner's practice. A thorough knowledge of anatomy is an essential component of the armament necessary to decipher the large number of potential conditions that may confront these practitioners. To cloud the issue further, anatomical variations may be present, such as supernumerary muscles, thickened fascial bands or variant courses of nerves and blood vessels, which can themselves manifest as acute or chronic conditions that lead to significant morbidity or limitation of activity. There are a number of contentious areas within the literature surrounding the anatomy of the leg, particularly involving the deep posterior compartment. Conditions such as chronic exertional compartment syndrome, tibial periostitis (shin splints), peripheral nerve entrapment and tarsal tunnel syndrome may all be affected by subtle anatomical variations. This paper primarily focuses on the deep posterior compartment of the leg and uses the gross dissection of cadaveric specimens to describe definitively the anatomy of the deep posterior compartment. Variant fascial attachments of flexor digitorum longus are documented and potential clinical sequelae such as chronic exertional compartment syndrome and tarsal tunnel syndrome are discussed.

  17. Clinical importance of appearance of cesarean hysterotomy scar at transvaginal ultrasonography in nonpregnant women.

    Science.gov (United States)

    Vikhareva Osser, Olga; Valentin, Lil

    2011-03-01

    To estimate the association between the appearance of cesarean hysterotomy scars at transvaginal ultrasound examination of nonpregnant women and the outcome of subsequent pregnancies and deliveries. A total of 162 women who had ever given birth by cesarean underwent transvaginal ultrasound examination of the hysterotomy scar 6 to 9 months after the latest cesarean delivery. Published ultrasound definitions of large scar defects were used. The appearance of the hysterotomy scar at ultrasound examination was compared with the outcome of subsequent pregnancies and deliveries. Clinical information on subsequent pregnancies was obtained from medical records. Six women were lost to follow-up, leaving 156 for analysis. Of these 156 women, 69 became pregnant after the ultrasound examination (99 pregnancies, 65 deliveries). There were no placental complications or scar pregnancies. At the first repeat cesarean delivery after the ultrasound examination, 5.3% (1/19) of the women with an intact scar or a small scar defect had uterine dehiscence or rupture compared with 42.9% (3/7) of those with a large defect (P=.047), odds ratio 11.8 (95% confidence interval 0.7-746). Our results point toward a likely association between large defects in the hysterotomy scar after cesarean delivery detected by transvaginal ultrasonography in nonpregnant women and uterine rupture or dehiscence in subsequent pregnancy.

  18. Clinically Important Features of Porphyrin and Heme Metabolism and the Porphyrias

    Directory of Open Access Journals (Sweden)

    Siddesh Besur

    2014-11-01

    Full Text Available Heme, like chlorophyll, is a primordial molecule and is one of the fundamental pigments of life. Disorders of normal heme synthesis may cause human diseases, including certain anemias (X-linked sideroblastic anemias and porphyrias. Porphyrias are classified as hepatic and erythropoietic porphyrias based on the organ system in which heme precursors (5-aminolevulinic acid (ALA, porphobilinogen and porphyrins are chiefly overproduced. The hepatic porphyrias are further subdivided into acute porphyrias and chronic hepatic porphyrias. The acute porphyrias include acute intermittent, hereditary copro-, variegate and ALA dehydratase deficiency porphyria. Chronic hepatic porphyrias include porphyria cutanea tarda and hepatoerythropoietic porphyria. The erythropoietic porphyrias include congenital erythropoietic porphyria (Gűnther’s disease and erythropoietic protoporphyria. In this review, we summarize the key features of normal heme synthesis and its differing regulation in liver versus bone marrow. In both organs, principal regulation is exerted at the level of the first and rate-controlling enzyme, but by different molecules (heme in the liver and iron in the bone marrow. We also describe salient clinical, laboratory and genetic features of the eight types of porphyria.

  19. Clinical Importance of Morphological Appearance of Seminiferous Tubules During MicroTESE in NOA Cases

    Directory of Open Access Journals (Sweden)

    A. H. Haliloglu

    2005-12-01

    Full Text Available Design: Clinical study. Setting: Research Center on Infertility, Ankara University; and Urology Department. Patients: 65 men with nonobstructive azoospermia (NOA.\tInterventions: Microscopical appearance of seminiferous tubules was recorded during TESE surgery. Differing from others, the largest opaque-white in color tubules were cut and removed. When all the tubules have no discriminating appearance, randomized biopsies were obtained. Removed tissue pieces were subjected to mechanical mincing under the stereomicroscope and then enzymatic digestion processes. Using inversion microscope (x32 magnification spermatozoa were searched. Main Outcome Measures: Morphological appearance of seminiferous tubules under optical magnification, spermatozoa recovery rates and histopathological findings were compared.\tRESULTS: In cases of Sertoli cell-only syndrome (SCOS, maturation arrest, hypospermatogenesis and focal spermatogenesis TESE yielded at least one spermatozoon in 37%, 52%, 100% and 63% of the cases, respectively. When all the seminiferous tubules were homogenously swollen, histopathological diagnosis was hypospermatogenesis in 100% of the cases. Homogenously thin and transparent tubules corresponded to SCOS or maturation arrest in 90% and 10% of the cases, respectively. Mature spermatozoa recovery rates were 100% and zero in homogenously-swollen observed and homogenously-thin observed tubules, respectively. CONCLUSIONS: Present data indicate that in cases of all tubules are homogenous in appearance and none of them can be discriminated from others, using microscope has no advantage in selection of the tubuli to be removed, but randomizely selection would also be sufficient. MicroTESE significantly increases the success in NOA cases with seminiferous tubules dispersed heterogeneously.

  20. In Vitro Activity of E1210, a Novel Antifungal, against Clinically Important Yeasts and Molds▿

    Science.gov (United States)

    Miyazaki, Mamiko; Horii, Takaaki; Hata, Katsura; Watanabe, Nao-aki; Nakamoto, Kazutaka; Tanaka, Keigo; Shirotori, Syuji; Murai, Norio; Inoue, Satoshi; Matsukura, Masayuki; Abe, Shinya; Yoshimatsu, Kentaro; Asada, Makoto

    2011-01-01

    E1210 is a new antifungal compound with a novel mechanism of action and broad spectrum of antifungal activity. We investigated the in vitro antifungal activities of E1210 compared to those of fluconazole, itraconazole, voriconazole, amphotericin B, and micafungin against clinical fungal isolates. E1210 showed potent activities against most Candida spp. (MIC90 of ≤0.008 to 0.06 μg/ml), except for Candida krusei (MICs of 2 to >32 μg/ml). E1210 showed equally potent activities against fluconazole-resistant and fluconazole-susceptible Candida strains. E1210 also had potent activities against various filamentous fungi, including Aspergillus fumigatus (MIC90 of 0.13 μg/ml). E1210 was also active against Fusarium solani and some black molds. Of note, E1210 showed the greatest activities against Pseudallescheria boydii (MICs of 0.03 to 0.13 μg/ml), Scedosporium prolificans (MIC of 0.03 μg/ml), and Paecilomyces lilacinus (MICs of 0.06 μg/ml) among the compounds tested. The antifungal action of E1210 was fungistatic, but E1210 showed no trailing growth of Candida albicans, which has often been observed with fluconazole. In a cytotoxicity assay using human HK-2 cells, E1210 showed toxicity as low as that of fluconazole. Based on these results, E1210 is likely to be a promising antifungal agent for the treatment of invasive fungal infections. PMID:21825291

  1. PCR-RFLP on β-tubulin gene for rapid identification of the most clinically important species of Aspergillus.

    Science.gov (United States)

    Nasri, Tuba; Hedayati, Mohammad Taghi; Abastabar, Mahdi; Pasqualotto, Alessandro C; Armaki, Mojtaba Taghizadeh; Hoseinnejad, Akbar; Nabili, Mojtaba

    2015-10-01

    Aspergillus species are important agents of life-threatening infections in immunosuppressed patients. Proper speciation in the Aspergilli has been justified based on varied fungal virulence, clinical presentations, and antifungal resistance. Accurate identification of Aspergillus species usually relies on fungal DNA sequencing but this requires expensive equipment that is not available in most clinical laboratories. We developed and validated a discriminative low-cost PCR-based test to discriminate Aspergillus isolates at the species level. The Beta tubulin gene of various reference strains of Aspergillus species was amplified using the universal fungal primers Bt2a and Bt2b. The PCR products were subjected to digestion with a single restriction enzyme AlwI. All Aspergillus isolates were subjected to DNA sequencing for final species characterization. The PCR-RFLP test generated unique patterns for six clinically important Aspergillus species, including Aspergillus flavus, Aspergillus fumigatus, Aspergillus nidulans, Aspergillus terreus, Aspergillus clavatus and Aspergillus nidulans. The one-enzyme PCR-RFLP on Beta tubulin gene designed in this study is a low-cost tool for the reliable and rapid differentiation of the clinically important Aspergillus species. Copyright © 2015 Elsevier B.V. All rights reserved.

  2. Clinical characteristics of importance to outcome in patients with axial spondyloarthritis

    DEFF Research Database (Denmark)

    Andreasen, Rikke Asmussen; Kristensen, Lars Erik; Ellingsen, Torkell

    2017-01-01

    the PDQ and other phenotypical patient characteristics are prognostically important for response to biological therapy according to established response criteria like 50% improvement in the Bath Ankylosing Spondylitis Disease Activity Index (50%) and Ankylosing Spondylitis Disease Activity Score. ETHICS......-radiographic axSpA (nr-axSpA). Tumour necrosis factor-α inhibitors have revolutionised the treatment of patients with axSpA who failed to respond to non-steroidal anti-inflammatory drugs and physical therapy. Chronic pain is common in patients with SpA and may still persist despite the lack of signs...... of the PDQ regarding treatment response in patients with axSpA 3 months after initiating a biological agent. Secondary aim is to evaluate the impact of extra-articular manifestations, comorbidities and patient-reported outcomes and elucidate if these factors influence treatment response. METHOD AND ANALYSIS...

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

    Science.gov (United States)

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

    1990-08-27

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

  4. Importance of dosimetry of irradiators for pre-clinical radiobiological experiments

    International Nuclear Information System (INIS)

    Vikram, Bhadrasain

    2014-01-01

    Importance of radiation dose in radiation biology has been increasingly recognized due to translational use of beyond 2Gy dose is in current practice. Hence, accurate dosimetry of biological irradiators is warranted. To address these problems and propose recommendations, the National Cancer Institute (NCI) along with the National Institute of Allergy and Infectious Diseases (NIAID) as well as the National Institute of Standards and Technology (NIST) highlighted a number of recommendations that will be presented in this talk that includes creating dosimetry standard operating procedures (SOPs) for both in-vitro as well as in-vivo experiments. Other recommendations include for journals (as well as to funding agencies) mandating the reporting of dosimetry of biological irradiators. (author)

  5. Public health and clinical importance of amoebiasis in Malaysia: a review.

    Science.gov (United States)

    Tengku, S A; Norhayati, M

    2011-08-01

    Entamoeba histolytica, the causative agent of human amoebiasis remains a significant cause of morbidity and mortality in developing countries and is responsible for up to 100,000 deaths worldwide each year. Entamoeba dispar, morphologically indistinguishable from E. histolytica is more common in humans in many parts of the world. Similarly Entamoeba moshkovskii, which was long considered to be a free-living amoeba is also morphologically identical to E. histolytica and E. dispar, and is highly prevalent in some E. histolytica endemic countries. Humans are the host of infection and there would not appear to be other meaningful animal reservoirs of E. histolytica. Entamoeba. histolytica can be present in sewage and contaminated water. The infection is mainly transmitted via ingestion of water or food contaminated by faeces containing E. histolytica cysts. Clinical features of amoebiasis range from asymptomatic colonization to amoebic dysentery and invasive extraintestinal amoebiasis, which is manifested most commonly in the form of abscesses in liver and lungs. The epidemiology of amoebiasis has dramatically changed since the separation of E. histolytica and E. dispar species and the worldwide prevalence of these species has not been estimated until recently. Morever, E. moshkovskii, another morphologically indistinguishable human parasitic Entamoeba was not mentioned or considered as a contributor to the prevalence figures in endemic areas. Amoebiasis is still a major health problem especially in aboriginal settlements and amongst people living in remote area in Malaysia. However, until now there is only one data currently available to indicate the true prevalence and incidence of E. histolytica and E. dispar. Further studies are needed to determine the burden of E. histolytica, E. dispar and E. moshkovskii infections in Malaysia. In the present review, we briefly summarize all methods use in diagnosing Entamoeba species, ranging from microscopic identification to

  6. The clinical importance of axillary lymphadenopathy detected on screening mammography: revisited

    International Nuclear Information System (INIS)

    Patel, T.; Given-Wilson, R.M.; Thomas, V.

    2005-01-01

    AIM: The aim of this study was to re-evaluate our protocol for the management of isolated axillary lymphadenopathy (ALP) on mammographic screening. METHODS: In a retrospective review of 200,716 women screened at the South West London Breast Screening Service (SWLBSS) over 7 years, 72 women with ALP with an otherwise normal mammogram were identified. Thirteen patients were not recalled, nine of who had a known underlying diagnosis and the remainder had longstanding unchanged mammograms. Fifty-nine patients were recalled for further clinical assessment and investigations, including ultrasound, further mammographic views, fine-needle aspiration cytology (FNAC), blood tests and a chest radiograph. Those with a definite diagnosis were referred for appropriate management and those with benign reactive cytology on FNAC reviewed at 6 weeks with subsequent referral for excision of persisting abnormal nodes. RESULTS: The ultimate diagnosis was benign in 45 cases: 26 benign reactive changes, 11 arthritides, five with dermatological and viral conditions and three with tuberculosis. Malignancy was diagnosed in 13 cases: four with metastatic breast carcinoma and nine with lymphoma/leukaemia. The total number of newly diagnosed malignancies was 20% of women recalled. Another 5% of patients had active tuberculosis. Of the 22 patients with benign reactive cytology, one had significant pathology on excision biopsy: tuberculosis. Over 95% of the results from excision biopsy in these patients did not alter management. CONCLUSION: In the majority of patients, the FNAC results were representative of the final excision pathology. The present study suggests that excision biopsy could be omitted for those patients whose FNAC and culture are negative

  7. Clinical importance of serum HE4 and MMP2 levels in endometrial cancer patients

    Directory of Open Access Journals (Sweden)

    Cymbaluk-Ploska A

    2017-06-01

    Full Text Available Aneta Cymbaluk-Płoska,1 Anita Chudecka-Głaz,1 Ewa Pius-Sadowska,2 Agnieszka Sompolska-Rzechuła,3 Bogusław Machaliński,2 Anna Surowiec,1 Janusz Menkiszak1 1Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, 2Department of General Pathology, Pomeranian Medical University, 3Department of Statistics, West Pomeranian University of Technology, Szczecin, Poland Introduction: Endometrial cancer is the one of the most common cancers of the genital organ. HE4 and MMP2 are both proteins whose serum levels increase in endometrial cancer.Aim: To explore the diagnostic potential of the serum levels of HE4 and MMP2 in patients with endometrial cancer and benign endometrial diseases. To assess the relationship between the serum levels of HE4 and MMP2 and the typical prognostic factors in patients with endometrial cancer.Materials and methods: Included in the study was a group of 112 patients presenting with bleeding abnormalities at the Pomeranian Medical University in years 2012–2016. Serum HE4 concentrations were measured using the Elecsys Electrochemiluminescence Immunoassay (ECLIA. MMP2 concentrations were quantified in the serum using multiplex immunoassays.Results: We observed statistically significant differences in mean serum levels of HE4 and MMP2 between the group of endometrial cancer patients and the group of patients with no changes in the endometrium (P=0.002/0.003. The diagnostic potential of HE4 and MMP2 in differentiation of high (International Federation of Gynecology and Obstetrics [FIGO] III and IV vs low (FIGO I and II clinical stage of tumor and prediction of cellular differentiation grade (G1 vs G3 on the basis of the analysis of the area under the curve is, respectively, 0.86 and 0.82 for HE4 and 0.82 and 0.74 for MMP2. The HE4 marker was significantly more specific than MMP2 in every study group and amounted to 93% vs 86% in all patients included in the analysis, 94% vs 84% in pre

  8. Import and visualization of clinical medical imagery into multiuser VR environments

    Science.gov (United States)

    Mehrle, Andreas H.; Freysinger, Wolfgang; Kikinis, Ron; Gunkel, Andreas; Kral, Florian

    2005-03-01

    The graphical representation of three-dimensional data obtained from tomographic imaging has been the central problem since this technology is available. Neither the representation as a set of two-dimensional slices nor the 2D projection of three-dimensional models yields satisfactory results. In this paper a way is outlined which permits the investigation of volumetric clinical data obtained from standard CT, MR, PET, SPECT or experimental very high resolution CT-scanners in a three dimensional environment within a few worksteps. Volumetric datasets are converted into surface data (segmentation process) using the 3D-Slicer software tool and saved as .vtk files and exported as a collection of primitives in any common file format (.iv, .pfb). Subsequently this files can be displayed and manipulated in the CAVE virtual reality center. The CAVE is a multiuser walkable virtual room consisting of several walls on which stereoscopic images are projected by rear panel beamers. Adequate tracking of the head position and separate image calculation for each eye yields a vivid impression for one or several users. With the use of a seperately tracked 6D joystick manipulations such as rotation, translation, zooming, decomposition or highlighting can be done intuitively. The usage of the CAVE technology opens new possibilities especially in surgical training ("hands-on-effect") and as an educational tool (availability of pathological data). Unlike concurring technologies the CAVE permits a walk-through into the virtual scene but preserves enough physical perception to allow interaction between multiple users, e.g. gestures and movements. By training in a virtual environment on one hand the learning process of students in complex anatomic findings may be improved considerably and on the other hand unaccustomed views such as the one through a microscope or endoscope can be trained in advance. The availability of low-cost PC based CAVE-like systems and the rapidly decreasing price

  9. [Calcium and vitamin D in bone metabolism: Clinical importance for fracture treatment].

    Science.gov (United States)

    Amling, M

    2015-12-01

    A balanced calcium homeostasis is of critical importance not only for bone remodeling, the physiological process of bone resorption and bone formation that constantly renews bone throughout life but also for normal fracture healing. Given that disturbances of calcium homeostasis are present in 50 % of the German population and that this might result in delayed fracture healing after correct surgical treatment, this paper focusses on calcium and vitamin D in the daily practice in orthopedics and trauma surgery. To ensure the required enteral calcium uptake the following three conditions are required: (1) sufficient calcium intake via the nutrition, (2) a 25-hydroxyvitamin D serum level > 30 µg/l and (3) the presence of sufficient gastric acidification. Given the endemic vitamin D deficiency in Germany as well as the constantly increasing number of people using proton pump inhibitors on a regular basis, it is necessary to closely connect trauma orthopedic surgery and osteological treatment. The first issue to be dealt with is to control and if needed normalize calcium homeostasis in order to allow a normal undisturbed fracture healing process after both conservative as well as operative treatment of fractures.

  10. The use of Fluorescence Resonance Energy Transfer (FRET peptidesfor measurement of clinically important proteolytic enzymes

    Directory of Open Access Journals (Sweden)

    Adriana K. Carmona

    2009-09-01

    Full Text Available Proteolytic enzymes have a fundamental role in many biological processes and are associated with multiple pathological conditions. Therefore, targeting these enzymes may be important for a better understanding of their function and development of therapeutic inhibitors. Fluorescence Resonance Energy Transfer (FRET peptides are convenient tools for the study of peptidases specificity as they allow monitoring of the reaction on a continuous basis, providing a rapid method for the determination of enzymatic activity. Hydrolysis of a peptide bond between the donor/acceptor pair generates fluorescence that permits the measurement of the activity of nanomolar concentrations of the enzyme. The assays can be performed directly in a cuvette of the fluorimeter or adapted for determinations in a 96-well fluorescence plate reader. The synthesis of FRET peptides containing ortho-aminobenzoic acid (Abz as fluorescent group and 2, 4-dinitrophenyl (Dnp or N-(2, 4-dinitrophenylethylenediamine (EDDnp as quencher was optimized by our group and became an important line of research at the Department of Biophysics of the Federal University of São Paulo. Recently, Abz/Dnp FRET peptide libraries were developed allowing high-throughput screening of peptidases substrate specificity. This review presents the consolidation of our research activities undertaken between 1993 and 2008 on the synthesis of peptides and study of peptidases specificities.As enzimas proteolíticas têm um papel fundamental em muitos processos biológicos e estão associadas a vários estados patológicos. Por isso, o estudo da especificidade das peptidases pode ser importante para uma melhor compreensão da função destas enzimas e para o desenvolvimento de inibidores. Os substratos com supressão intramolecular de fluorescência constituem uma excelente ferramenta, pois permitem o monitoramento da reação de forma contínua, proporcionando um método prático e rápido para a determinação da

  11. [Anaesthetists learn--do institutions also learn? Importance of institutional learning and corporate culture in clinics].

    Science.gov (United States)

    Schüpfer, G; Gfrörer, R; Schleppers, A

    2007-10-01

    In only a few contexts is the need for substantial learning more pronounced than in health care. For a health care provider, the ability to learn is essential in a changing environment. Although individual humans are programmed to learn naturally, organisations are not. Learning that is limited to individual professions and traditional approaches to continuing medical education is not sufficient to bring about substantial changes in the learning capacity of an institution. Also, organisational learning is an important issue for anaesthesia departments. Future success of an organisation often depends on new capabilities and competencies. Organisational learning is the capacity or processes within an organisation to maintain or improve performance based on experience. Learning is seen as a system-level phenomenon as it stays in the organisation regardless of the players involved. Experience from other industries shows that learning strategies tend to focus on single loop learning, with relatively little double loop learning and virtually no meta-learning or non-learning. The emphasis on team delivery of health care reinforces the need for team learning. Learning organisations make learning an intrinsic part of their organisations and are a place where people continually learn how to learn together. Organisational learning practice can help to improve existing skills and competencies and to change outdated assumptions, procedures and structures. So far, learning theory has been ignored in medicine, due to a wide variety of complex political, economic, social, organisational culture and medical factors that prevent innovation and resist change. The organisational culture is central to every stage of the learning process. Learning organisations move beyond simple employee training into organisational problem solving, innovation and learning. Therefore, teamwork and leadership are necessary. Successful organisations change the competencies of individuals, the systems

  12. Seizure semiology: an important clinical clue to the diagnosis of autoimmune epilepsy.

    Science.gov (United States)

    Lv, Rui-Juan; Ren, Hai-Tao; Guan, Hong-Zhi; Cui, Tao; Shao, Xiao-Qiu

    2018-02-01

    The purpose of this study is to analyze the seizure semiologic characteristics of patients with autoimmune epilepsy (AE) and describe the investigation characteristics of AE using a larger sample size. This observational retrospective case series study was conducted from a tertiary epilepsy center between May 2014 and March 2017. Cases of new-onset seizures were selected based on laboratory evidence of autoimmunity. At the same time, typical mesial temporal lobe epilepsy (MTLE) patients with hippocampal sclerosis (HS) were recruited as the control group from the subjects who underwent presurgical evaluation during the same period. A total of 61 patients with AE were identified. Specific autoimmune antibodies were detected in 39 patients (63.93%), including anti-VGKC in 23 patients (37.70%), anti-NMDA-R in 9 patients (14.75%), anti-GABA B -R in 6 patients (9.84%), and anti-amphiphysin in 1 patient (1.64%). Regarding the seizure semiology, no significant differences were noted between AE patients with autoantibody and patients with suspected AE without antibody. Compared to typical MTLE patients with HS, both AE patients with autoantibody and patients with suspected AE without antibody had the same seizure semiologic characteristics, including more frequent SPS or CPS, shorter seizure duration, rare postictal confusion, and common sleeping SGTC seizures. This study highlights important seizure semiologic characteristics of AE. Patients with autoimmune epilepsy had special seizure semiologic characteristics. For patients with autoimmune epilepsy presenting with new-onset seizures in isolation or with a seizure-predominant neurological disorder, the special seizure semiologic characteristics may remind us to test neuronal nuclear/cytoplasmic antibodies early and initiate immunomodulatory therapies as soon as possible. Furthermore, the absence of neural-specific autoantibodies does not rule out AE.

  13. Morphometry of A1 segment of the anterior cerebral artery and its clinical importance.

    Science.gov (United States)

    Krishnamurthy, A; Nayak, S R; Bagoji, I B; D'Costa, S; Pai, M M; Jiji, P J; Kumar, C G; Rai, R

    2010-01-01

    Anterior cerebral artery, one of the terminal branches of the internal carotid artery is an important vessel taking part in the formation of circle of Willis. It supplies a large part of the medial surface of the cerebral hemisphere containing the areas of motor and somatosensory cortices of the lower limb. Aim of this study was the morphometry of A1 segment of the anterior cerebral artery. 93 formalin fixed brain specimen of either sex and of Indian origin were studied. The mean length, mean external diameter and the anomalies present in A1 segment of the vessel were studied in detail and photographed. The mean length of A1 segment of the vessel was 14.49+/-0.28 mm and 14.22+/-0.22 mm on right and left side respectively. The mean external diameter of the vessel on right and left side was 2.12+/-0.07 mm and 2.32+/-0.06 mm respectively. Narrowing, aneurysm formation, buttonhole formation and median anterior cerebral artery were the anomalies seen with an occurrence of 15.05%, 5.37%, 3.22% and 12.9%, respectively. The above anomalies did not have any sex or side predilection. Knowledge of morphometry of the vessel will be of use to neurosurgeons while performing the shunt operation, in assessing the feasibility of such operations and in the choice of patients. From this study we infer that the morphometry of anterior cerebral artery varies in different population and that the neurosurgeons operating should have a thorough knowledge of the possible variations.

  14. A Study of the Incidence of the Minor Psychoses-their Clinical and Industrial Importance.

    Science.gov (United States)

    Culpin, M

    1928-01-01

    percentage of high assessments as clerical workers, but illness rates are low. Satisfaction of the workers with their work seems an important factor in illness.Since the incidence of the minor psychoses varies little from group to group, and does not seem to be statistically related to the incidence of psychoneurotic illness, other factors must be at work and should be investigated.

  15. Investigating the mobilome in clinically important lineages of Enterococcus faecium and Enterococcus faecalis.

    Science.gov (United States)

    Mikalsen, Theresa; Pedersen, Torunn; Willems, Rob; Coque, Teresa M; Werner, Guido; Sadowy, Ewa; van Schaik, Willem; Jensen, Lars Bogø; Sundsfjord, Arnfinn; Hegstad, Kristin

    2015-04-10

    possible functional CRISPR-Cas systems, and still resistance and prophage sequences were generally well represented. The targeted MGEs were highly prevalent among the selected STs, underlining their potential importance in the evolution of hospital-adapted lineages of enterococci. Although the propensity of inter-species horizontal gene transfer (HGT) must be emphasized, the considerable species-specificity of these MGEs indicates a separate vertical evolution of MGEs within each species, and for E. faecalis within each ST.

  16. A Customizable Importer for the Clinical Data Warehouses PaDaWaN and I2B2.

    Science.gov (United States)

    Fette, Georg; Kaspar, Mathias; Dietrich, Georg; Ertl, Maximilian; Krebs, Jonathan; Stoerk, Stefan; Puppe, Frank

    2017-01-01

    In recent years, clinical data warehouses (CDW) storing routine patient data have become more and more popular to support scientific work in the medical domain. Although CDW systems provide interfaces to import new data, these interfaces have to be used by processing tools that are often not included in the systems themselves. In order to establish an extraction-transformation-load (ETL) workflow, already existing components have to be taken or new components have to be developed to perform the load part of the ETL. We present a customizable importer for the two CDW systems PaDaWaN and I2B2, which is able to import the most common import formats (plain text, CSV and XML files). In order to be run, the importer only needs a configuration file with the user credentials for the target CDW and a list of XML import configuration files, which determine how already exported data is indented to be imported. The importer is provided as a Java program, which has no further software requirements.

  17. Multicenter Evaluation of the Bruker MALDI Biotyper CA System for the Identification of Clinically Important Bacteria and Yeasts.

    Science.gov (United States)

    Wilson, Deborah A; Young, Stephen; Timm, Karen; Novak-Weekley, Susan; Marlowe, Elizabeth M; Madisen, Neil; Lillie, Jennifer L; Ledeboer, Nathan A; Smith, Rebecca; Hyke, Josh; Griego-Fullbright, Christen; Jim, Patricia; Granato, Paul A; Faron, Matthew L; Cumpio, Joven; Buchan, Blake W; Procop, Gary W

    2017-06-01

    A report on the multicenter evaluation of the Bruker MALDI Biotyper CA System (MBT-CA; Bruker Daltonics, Billerica, MA) for the identification of clinically important bacteria and yeasts. In total, 4,399 isolates of medically important bacteria and yeasts were assessed in the MBT-CA. These included 2,262 aerobic gram-positive (AGP) bacteria, 792 aerobic gram-negative (AGN) bacteria 530 anaerobic (AnA) bacteria, and 815 yeasts (YSTs). Three processing methods were assesed. Overall, 98.4% (4,329/4,399) of all bacterial and yeast isolates were correctly identified to the genus and species/species complex level, and 95.7% of isolates were identified with a high degree of confidence. The percentage correctly identified and the percentage identified correctly with a high level of confidence, respectively, were as follows: AGP bacteria (98.6%/96.5%), AGN bacteria (98.5%/96.8%), AnA bacteria (98.5%/97.4%), and YSTs (97.8%/87.6%). The extended direct transfer method was only minimally superior to the direct transfer method for bacteria (89.9% vs 86.8%, respectively) but significantly superior for yeast isolates (74.0% vs 48.9%, respectively). The Bruker MALDI Biotyper CA System accurately identifies most clinically important bacteria and yeasts and has optional processing methods to improve isolate characterization. © American Society for Clinical Pathology, 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  18. [THE CONDITION AND TENDENCIES OF DEVELOPMENT OF CLINICAL AND SANITARY MICROBIOLOGY IN THE RUSSIAN FEDERATION AND PROBLEM OF IMPORT SUBSTITUTION].

    Science.gov (United States)

    Dyatlov, I A; Mironov, A Yu; Shepelin, A P; Aleshkin, V A

    2015-08-01

    The import substitution becomes one of the strategic tasks of national economy as a result of prolongation of economic sanctions concerning the Russian Federation of part of the USA, EU countries, Japan and number of other countries. It is not proper to be limited in import substitution only by goods because in conditions ofsanctions when access toforeign technologies is complicated Russia is needed to substitute foreign technologies by national designs in faster manner One of directions of effective import substitution is localization of production of laboratory equipment and consumables for clinical and sanitary microbiology on the territory ofthe Russian Federation and countries of Customs union. In Russia, in the field ofdiagnostic of dangerous and socially significant infections, all components for import substitution to implement gene diagnostic, immune diagnostic. bio-sensory and biochip approaches, isolation and storage of live microbial cultures, implementation of high-tech methods of diagnostic are available. At the same time, national diagnostic instrument-making industry for microbiology is factually absent. The few devices of national production more than on 50% consist of import components. The microbiological laboratories are to be equipped only with import devices of open type for applying national components. The most perspective national designs to be implemented are multiplex polimerase chain reaction test-systems and biochips on the basis of national plotters and readers. The modern development of diagnostic equipment and diagnostic instruments requires supplement of national collections of bacterial and viral pathogens and working-through of organizational schemes of supplying collections with strains. The presented data concerning justification of nomenclature of laboratory equipment and consumables permits to satisfy in fill scope the needs of clinical and sanitary microbiology in devices, growth mediums, consumables of national production

  19. Deep brain stimulation may reduce the relative risk of clinically important worsening in early stage Parkinson's disease.

    Science.gov (United States)

    Hacker, Mallory L; Tonascia, James; Turchan, Maxim; Currie, Amanda; Heusinkveld, Lauren; Konrad, Peter E; Davis, Thomas L; Neimat, Joseph S; Phibbs, Fenna T; Hedera, Peter; Wang, Lily; Shi, Yaping; Shade, David M; Sternberg, Alice L; Drye, Lea T; Charles, David

    2015-10-01

    The Vanderbilt pilot trial of deep brain stimulation (DBS) in early Parkinson's disease (PD) enrolled patients on medications six months to four years without motor fluctuations or dyskinesias. We conducted a patient-centered analysis based on clinically important worsening of motor symptoms and complications of medical therapy for all subjects and a subset of subjects with a more focused medication duration. Continuous outcomes were also analyzed for this focused cohort. A post hoc analysis was conducted on all subjects from the pilot and a subset of subjects taking PD medications 1-4 years at enrollment. Clinically important worsening is defined as both a ≥ 3 point increase in UPDRS Part III and a ≥ 1 point increase in Part IV. DBS plus optimal drug therapy (DBS + ODT) subjects experienced a 50-80% reduction in the relative risk of worsening after two years. The DBS + ODT group was improved compared to optimal drug therapy (ODT) at each time point on Total UPDRS and Part III (p = 0.04, p = 0.02, respectively, at 24 months). Total UPDRS, Part IV, and PDQ-39 scores significantly worsened in the ODT group after two years (p < 0.003), with no significant change in the DBS + ODT group. DBS + ODT in early PD may reduce the risk of clinically important worsening. These findings further confirm the need to determine if DBS + ODT is superior to medical therapy for managing symptoms, reducing the complications of medications, and improving quality of life. The FDA has approved the conduct of a large-scale, pivotal clinical trial of DBS in early stage PD. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. Making Psychotherapy Great Again?

    Science.gov (United States)

    Plakun, Eric M

    2017-05-01

    Psychotherapy never stopped being as "great" as other treatments. This column explores the evidence base for both psychotherapy and medications, using depression as a specific example. The limitations are comparable for psychotherapy and medication, with much of the evidence based on small degrees of "statistically significant" rather than "clinically meaningful" change. Our field's biomedical emphasis leads to a false assumption that most patients present with single disorders, when comorbidity is the rule rather than the exception. This false assumption contributes to limitations in the evidence base and in our ability to treat patients optimally.

  1. The Great Recession was not so Great

    NARCIS (Netherlands)

    van Ours, J.C.

    2015-01-01

    The Great Recession is characterized by a GDP-decline that was unprecedented in the past decades. This paper discusses the implications of the Great Recession analyzing labor market data from 20 OECD countries. Comparing the Great Recession with the 1980s recession it is concluded that there is a

  2. Gorlin syndrome: Importance of clinical signs and danger of delayed diagnosis - A case report with eight years follow-up

    Directory of Open Access Journals (Sweden)

    Erica Dorigatti de-Avila

    2015-02-01

    Full Text Available Nevoid basal cell carcinoma (NBCCS or Gorlin-Goltz syndrome (GS is a multidisciplinary problem, the early diagnosis of which allows secondary prophylaxis that follows an appropriate regimen to delay progression of the syndrome. The aim of this study was to present a case of delayed diagnosis of GS in a young patient who received multidisciplinary treatment 5 years after onset. The patient presented for evaluation with painless swelling of the left maxilla. Histological examination confirmed the diagnosis of a keratocyst odontogenic tumor (KOT that was enucleated. On presentation, the patient's symptoms and clinical signs were not related to complications of GS, and the possibility of GS was initially rejected, as he did not have a family history of the syndrome. Four years after the first surgery to remove the lesion, the patient came to our clinic with a brown, pigmented lesion. Computed tomography revealed ectopic lamellar calcification of the falx cerebri, which was the conclusive factor for the diagnosis of GS. It is important that clinicians recognize the clinical signs of GS, which mainly manifests itself as multiple basal cell carcinomas in the skin. [Arch Clin Exp Surg 2015; 4(1.000: 49-53

  3. Cognitive performance is of clinical importance, but is unrelated to pain severity in women with chronic fatigue syndrome.

    Science.gov (United States)

    Ickmans, Kelly; Meeus, Mira; Kos, Daphne; Clarys, Peter; Meersdom, Geert; Lambrecht, Luc; Pattyn, Nathalie; Nijs, Jo

    2013-10-01

    In various chronic pain populations, decreased cognitive performance is known to be related to pain severity. Yet, this relationship has not been investigated in patients with chronic fatigue syndrome (CFS). This study investigated the relationship between cognitive performance and (1) pain severity, (2) level of fatigue, and (3) self-reported symptoms and health status in women with CFS. Examining the latter relationships is important for clinical practice, since people with CFS are often suspected to exaggerate their symptoms. A sample of 29 female CFS patients and 17 healthy controls aged 18 to 45 years filled out three questionnaires (Medical Outcomes Study 36-Item Short-Form Health Survey, Checklist Individual Strength (CIS), and CFS Symptom List) and performed three performance-based cognitive tests (psychomotor vigilance task, Stroop task, and operation span task), respectively. In both groups, pain severity was not associated with cognitive performance. In CFS patients, the level of fatigue measured with the CFS Symptom List, but not with the CIS, was significantly correlated with sustained attention. Self-reported mental health was negatively correlated with all investigated cognitive domains in the CFS group. These results provide evidence for the clinical importance of objectively measured cognitive problems in female CFS patients. Furthermore, a state-like measure (CFS Symptom List) appears to be superior over a trait-like measure (CIS) in representing cognitive fatigue in people with CFS. Finally, the lack of a significant relationship between cognitive performance and self-reported pain severity suggests that pain in CFS might be unique.

  4. The importance of academic literacy for undergraduate nursing students and its relationship to future professional clinical practice: A systematic review.

    Science.gov (United States)

    Jefferies, Diana; McNally, Stephen; Roberts, Katriona; Wallace, Anna; Stunden, Annette; D'Souza, Suzanne; Glew, Paul

    2018-01-01

    This systematic review was designed to assess the importance of academic literacy for undergraduate nursing students and its relationship to future professional clinical practice. It aimed to explore the link between academic literacy and writing in an undergraduate nursing degree and the development of critical thinking skills for their future professional clinical practice. A systematic review of qualitative studies and expert opinion publications. A systematic literature search was undertaken of the following databases: ERIC, PubMed, CINAHL, MEDLINE and Scopus. All papers reviewed were from 2000 to 2016 and were written in English. We identified 981 studies and expert opinion papers from the selected databases. After reviewing key words and abstracts for the inclusion and exclusion criteria, 48 papers were selected for review. These were read and reread, with 22 papers, including one thesis, selected for quality appraisal. One paper was discarded due to the exclusion criteria. Three major themes were evident from this study. First, students need assistance to develop tertiary level academic literacy skills when they commence their undergraduate nursing degree. Second, that teaching practices need to be consistent in both designing assessments and in giving feedback to students, in order to assist improvement of academic literacy skills. And finally, academic literacy can facilitate critical thinking when students are assessed using discipline specific genres that relate to their future professional nursing practice. This review highlights the importance of critical thinking in clinical nursing practice and its strong relationship with academic writing skills. It has shown critical thinking is discipline specific and nursing students need to be taught discipline specific literacy genres in undergraduate nursing degrees. Nursing has a diverse educational and cultural mix of students, and educators should not assume academic literacy skills upon commencement of an

  5. Importance of clinical examination in diagnostics of Osgood-Schlatter Disease in boys playing soccer or basketball

    Directory of Open Access Journals (Sweden)

    Amela Halilbasic

    2012-04-01

    Full Text Available Introduction: Osgood–Schlatter disease is an irritation of the patellar tendon at the tibial tubercle. Sports with jumps, running, and repeated contractions of knee extension apparatus are considered to be importantexternal risk-factors which could cause Osgood–Schlatter disease.Objectives of the study are to draw attention to the importance of clinical examination in diagnostics of Osgood–Schlatter disease in boys playing soccer or basketball.Methods: The research included data obtained from 120 boys, average age of 14 years. Examinees were split into two groups, one with young athletes which regularly have soccer or basketball trainings and thesecond one with boys who do not participating in sports. We performed anthropological measurements and clinical examinations of both knees and hips for both groups. For the statistical analysis we used pointbiserialcorrelation coefficient.Results: Based on clinical examination, Osgood–Schlatter disease was diagnosed in 51 examinees (42.5%. In “athletic group” Osgood–Schlatter disease had 31 boys or 52%, comparing with “non-athletic group” wherewe found 20 adolescents with disease (33%. Number of boys with Osgood–Schlatter disease was higher for 19% in “athletic group” comparing with “non-athletic group”. Comparing incidence rate for boys in both groups with diagnosed II and III level of Osgood–Schlatter disease we found that rate is higher in “athletic group” 2.25 times comparing with “non-athletic group”.Conclusions: Clinical examination is critical method in the process of diagnosing Osgood–Schlatter disease especially for identifying II and III level of this disease.

  6. Molecular characterization of NRXN1 deletions from 19,263 clinical microarray cases identifies exons important for neurodevelopmental disease expression

    Science.gov (United States)

    Lowther, Chelsea; Speevak, Marsha; Armour, Christine M.; Goh, Elaine S.; Graham, Gail E.; Li, Chumei; Zeesman, Susan; Nowaczyk, Malgorzata J.M.; Schultz, Lee-Anne; Morra, Antonella; Nicolson, Rob; Bikangaga, Peter; Samdup, Dawa; Zaazou, Mostafa; Boyd, Kerry; Jung, Jack H.; Siu, Victoria; Rajguru, Manjulata; Goobie, Sharan; Tarnopolsky, Mark A.; Prasad, Chitra; Dick, Paul T.; Hussain, Asmaa S.; Walinga, Margreet; Reijenga, Renske G.; Gazzellone, Matthew; Lionel, Anath C.; Marshall, Christian R.; Scherer, Stephen W.; Stavropoulos, Dimitri J.; McCready, Elizabeth; Bassett, Anne S.

    2016-01-01

    Purpose The purpose of the current study was to assess the penetrance of NRXN1 deletions. Methods We compared the prevalence and genomic extent of NRXN1 deletions identified among 19,263 clinically referred cases to that of 15,264 controls. The burden of additional clinically relevant CNVs was used as a proxy to estimate the relative penetrance of NRXN1 deletions. Results We identified 41 (0.21%) previously unreported exonic NRXN1 deletions ascertained for developmental delay/intellectual disability, significantly greater than in controls [OR=8.14 (95% CI 2.91–22.72), p< 0.0001)]. Ten (22.7%) of these had a second clinically relevant CNV. Subjects with a deletion near the 3′ end of NRXN1 were significantly more likely to have a second rare CNV than subjects with a 5′ NRXN1 deletion [OR=7.47 (95% CI 2.36–23.61), p=0.0006]. The prevalence of intronic NRXN1 deletions was not statistically different between cases and controls (p=0.618). The majority (63.2%) of intronic NRXN1 deletion cases had a second rare CNV, a two-fold greater prevalence than for exonic NRXN1 deletion cases (p=0.0035). Conclusions The results support the importance of exons near the 5′ end of NRXN1 in the expression of neurodevelopmental disorders. Intronic NRXN1 deletions do not appear to substantially increase the risk for clinical phenotypes. PMID:27195815

  7. Initial non-weight-bearing therapy is important for preventing vertebral body collapse in elderly patients with clinical vertebral fractures

    Directory of Open Access Journals (Sweden)

    Kishikawa Y

    2012-04-01

    group.Conclusion: These results suggest that initial non-weight-bearing therapy is important for preventing vertebral body collapse and for relieving pain among elderly patients with clinical vertebral fractures.Keywords: clinical vertebral fracture, non-weight-bearing, brace, osteoporosis

  8. Different minimally important clinical difference (MCID) scores lead to different clinical prediction rules for the Oswestry disability index for the same sample of patients.

    Science.gov (United States)

    Schwind, Julie; Learman, Kenneth; O'Halloran, Bryan; Showalter, Christopher; Cook, Chad

    2013-05-01

    Minimal clinically important difference (MCID) scores for outcome measures are frequently used evidence-based guides to gage meaningful changes. There are numerous outcome instruments used for analyzing pain, disability, and dysfunction of the low back; perhaps the most common of these is the Oswestry disability index (ODI). A single agreed-upon MCID score for the ODI has yet to be established. What is also unknown is whether selected baseline variables will be universal predictors regardless of the MCID used for a particular outcome measure. To explore the relationship between predictive models and the MCID cutpoint on the ODI. Data were collected from 16 outpatient physical therapy clinics in 10 states. Secondary database analysis using backward stepwise deletion logistic regression of data from a randomized controlled trial (RCT) to create prognostic clinical prediction rules (CPR). One hundred and forty-nine patients with low back pain (LBP) were enrolled in the RCT. All were treated with manual therapy, with a majority also receiving spine-strengthening exercises. The resultant predictive models were dependent upon the MCID used and baseline sample characteristics. All CPR were statistically significant (P < 001). All six MCID cutpoints used resulted in completely different significant predictor variables with no predictor significant across all models. The primary limitations include sub-optimal sample size and study design. There is extreme variability among predictive models created using different MCIDs on the ODI within the same patient population. Our findings highlight the instability of predictive modeling, as these models are significantly affected by population baseline characteristics along with the MCID used. Clinicians must be aware of the fragility of CPR prior to applying each in clinical practice.

  9. Florid cemento-osseous dysplasia: review of an uncommon fibro-osseous lesion of the jaw with important clinical implications.

    Science.gov (United States)

    Fenerty, Sarah; Shaw, Wei; Verma, Rahul; Syed, Ali B; Kuklani, Riya; Yang, Jie; Ali, Sayed

    2017-05-01

    Florid cemento-osseous dysplasia (FCOD) is a rare, benign, multifocal fibro-osseous dysplastic process affecting tooth-bearing areas of the jaw, characterized by replacement of normal trabecular bone with osseous tissue and dense acellular cementum in a fibrous stroma. It is one clinicopathologic variant in a spectrum of related non-neoplastic fibro-osseous lesions known as cemento-osseous dysplasias (CODs), thought to arise from elements of the periodontal ligament. Diagnosis primarily relies upon radiographic and clinical findings; unnecessary biopsy should be avoided, as inoculation with oral pathogens may precipitate chronic infection in these hypovascular lesions. Appropriate management of uncomplicated FCOD consists of periodic radiographic follow-up. Accordingly, it is important that both radiologists and clinicians performing endodontic interventions possess familiarity with this entity in order to prevent misdiagnosis and inappropriate intervention, which may result in a protracted clinical course. Lesions are usually asymptomatic in the absence of infection, typically discovered on routine dental radiographs or imaging performed for unrelated indications. Radiographically, the condition typically manifests as widespread non-expansile intraosseous masses of varying internal lucency and sclerosis that surround the root apices of vital teeth or edentulous areas in the posterior jaw. While all CODs share similar microscopic features, FCOD is distinguished by its multifocal distribution, involving two or more quadrants of the maxilla and mandible, often in a bilateral symmetric fashion. The vast majority of cases are sporadic, though few exhibit an autosomal dominant familial inheritance pattern. In this pictorial review, we discuss the radiologic characteristics of this entity, pertinent clinical and histologic features, differential diagnoses, and management options.

  10. Comparisons between the attitudes of medical and dental students toward the clinical importance of gross anatomy and physiology.

    Science.gov (United States)

    Olowo-Ofayoku, Anthony; Moxham, Bernard John

    2014-10-01

    Marked changes are occurring within both the medical and dental curricula and new ways of teaching the basic sciences have been devised and traditional methods (e.g., dissection for gross anatomy and of bench-based animal preparations for physiology) are increasingly no longer the norm. Although there is much anecdotal evidence that students are not in favor of such changes, there is little evidence for this based on quantitative analyses of students' attitudes. Using Thurstone and Chave attitude analyses, we assessed the attitudes of first year medical and dental students at Cardiff University toward gross anatomy and physiology in terms of their perceived clinical importance. In addition, we investigated the appropriateness ("fitness for purpose") of teaching methodologies used for anatomy and physiology. The hypotheses tested recognized the possibility that medical and dental students differed in their opinions, but that they had a preference to being taught gross anatomy through the use of dissection and had no preference for physiology teaching. It was found that both medical and dental students displayed positive attitudes toward the clinical relevance of gross anatomy and that they preferred to be taught by means of dissection. Although both medical and dental students displayed positives attitudes toward the clinical relevance of physiology, this was greater for the medical students. Both medical and dental students showed a preference for being taught physiology through didactic teaching in small groups but the medical students also appreciated being taught by means of practicals. Overall, this study highlights the expectations that students have for the basic science foundation teaching within their professional training and signals a preference for being taught experientially/practically. Differences were discerned between medical and dental students that might reflect the direct association between systems physiology and pathophysiology and the

  11. [Serum uric acid is associated with disease severity and an important predictor for clinical outcome in patients with pulmonary hypertension].

    Science.gov (United States)

    Luo, D L; Zhang, C J; Huang, Y G; Huang, T; Li, H Z

    2017-06-24

    Objective: The growing body of literature showed a link between uric acid and pulmonary hypertension (PH), but the impact of hyperuremia on outcome of patients with PH has not been well defined. Therefore, the present study was performed to analyze the impact of uric acid on outcome of PH patients. Methods: One hundred seventy-three PH patients (112 females, mean age 38 years old), who were hospitalized in our department between January 2010 and December 2015, were included in our study, the PH diagnosis was made based on right heart catheterization examination result (mean pulmonary artery pressure≥25 mmHg(1 mmHg=0.133 kPa)). PH patients were divided into mild to moderate PH group (Rp/Rs≤0.6, n =97) and severe PH group (Rp/Rs>0.6, n =76). Fifty-one patients (33 females, mean age 45 years old) without PH based on right heart catheterization were included as control subjects. All participants were followed up for a median of 24 months(6-71 months). Clinical endpoints were defined as cardiogenic death or heart-and-lung transplantation. Results: Uric acid was positively correlated with pulmonary vascular resistance( r =0.398, P uric acid level was significantly higher in patients with severe PH than in patients with mild-to-moderate PH and the control subjects (both P uric acid level to predict the outcome of PH patients (sensitivity 50%, specificity 72%). During follow-up, patients with higher level of uric acid (>425.5 μmol/L) were linked with poorer clinical outcome compared to patients with uric acid uric acid is associated with the severity of PH and higher uric acid level serves as an important predictor for poor clinical outcome of PH patients.

  12. Assessment of first-year veterinary students' communication skills using an objective structured clinical examination: the importance of context.

    Science.gov (United States)

    Hecker, Kent G; Adams, Cindy L; Coe, Jason B

    2012-01-01

    Communication skills are considered to be a core clinical skill in veterinary medicine and essential for practice success, including outcomes of care for patients and clients. While veterinary schools include communication skills training in their programs, there is minimal knowledge on how best to assess communication competence throughout the undergraduate program. The purpose of this study was to further our understanding of the reliability, utility, and suitability of a communication skills Objective Structured Clinical Examination (OSCE). Specifically we wanted to (1) identify the greatest source of variability (student, rater, station, and track) within a first-year, four station OSCE using exam scores and scores from videotape review by two trained raters, and (2) determine the effect of different stations on students' communication skills performance. Reliability of the scores from both the exam data and the two expert raters was 0.50 and 0.46 respectively, with the greatest amount of variance attributable to student by station. The percentage of variance due to raters in the exam data was 16.35%, whereas the percentage of variance for the two expert raters was 0%. These results have three important implications. First, the results reinforce the need for communication educators to emphasize that use of communication skills is moderated by the context of the clinical interaction. Second, by increasing rater training the amount of error in the scores due to raters can be reduced and inter-rater reliability increases. Third, the communication assessment method (in this case the OSCE checklist) should be built purposefully, taking into consideration the context of the case.

  13. Elimination of importance factors for clinically accurate selection of beam orientations, beam weights and wedge angles in conformal radiation therapy

    International Nuclear Information System (INIS)

    Bedford, James L.; Webb, Steve

    2003-01-01

    A method of simultaneously optimizing beam orientations, beam weights, and wedge angles for conformal radiotherapy is presented. This method removes the need for importance factors by optimizing one objective only, subject to a set of rigid constraints. This facilitates the production of inverse solutions which, without trial-and-error modification of importance factors, precisely satisfy the specified constraints. The algorithm minimizes an objective function which is based upon the single objective to be optimized, but which is forced to an artificially high value when the constraints are not met, so that only satisfactory solutions are allowed. Due to the complex nature of the objective function space, including multiple local minima separated by large regions of plateau, a random search technique equivalent to fast simulated annealing is used for producing inverse plans. To illustrate the novel features of the new algorithm, a simulation is first presented, for the case of a cylindrical phantom. The morphology of the objective function space is shown to be significantly different for the new algorithm, compared to that for a conventional quadratic objective function. Clinical cases for prostate and craniopharyngioma are then presented. For the prostate case, the objective is to reduce irradiated rectal volume. Three-field, four-field, and six-field optimizations, with or without orientation optimization, are shown to provide solutions which are consistent with previously reported plans and class solutions. For the craniopharyngioma case, which involves the use of a high-precision stereotactic conformal technique, the objective is to reduce the irradiated volume of normal brain. Practically feasible beam angles are produced which, compared to a standard plan, provide a small but worthwhile sparing of normal brain. The algorithm is thereby shown to be robust and suitable for clinical application

  14. Minimal Clinically Important Difference in Parkinson’s Disease as Assessed in Pivotal Trials of Pramipexole Extended Release

    Directory of Open Access Journals (Sweden)

    Robert A. Hauser

    2014-01-01

    Full Text Available Background. The minimal clinically important difference (MCID is the smallest change in an outcome measure that is meaningful for patients. Objectives. To calculate the MCID for Unified Parkinson’s Disease Rating Scale (UPDRS scores in early Parkinson’s disease (EPD and for UPDRS scores and “OFF” time in advanced Parkinson’s disease (APD. Methods. We analyzed data from two pivotal, double-blind, parallel-group trials of pramipexole ER that included pramipexole immediate release (IR as an active comparator. We calculated MCID as the mean change in subjects who received active treatment and rated themselves “a little better” on patient global impression of improvement (PGI-I minus the mean change in subjects who received placebo and rated themselves unchanged. Results. MCIDs in EPD (pramipexole ER, pramipexole IR for UPDRS II were −1.8 and −2.0, for UPDRS III −6.2 and −6.1, and for UPDRS II + III −8.0 and −8.1. MCIDs in APD for UPDRS II were −1.8 and −2.3, for UPDRS III −5.2 and −6.5, and for UPDRS II + III −7.1 and −8.8. MCID for “OFF” time (pramipexole ER, pramipexole IR was −1.0 and −1.3 hours. Conclusions. A range of MCIDs is emerging in the PD literature that provides the basis for power calculations and interpretation of clinical trials.

  15. Distinguishing papillary endothelial hyperplasia and angiosarcoma on core needle biopsy of the breast: The importance of clinical and radiologic correlation.

    Science.gov (United States)

    Guilbert, Marie-Christine; Frost, Elisabeth P; Brock, Jane E; Lester, Susan C

    2018-02-24

    Papillary endothelial hyperplasia (PEH) is a rare non-neoplastic exuberant organizing hematoma that can closely mimic angiosarcoma due to a resemblance to malignant anastomosing blood vessels. It could be particularly difficult to distinguish PEH from angiosarcoma in breast core needle biopsies. We identified all cases of these lesions diagnosed on core needle biopsy in order to identify clinical, radiologic, and pathologic features that could prove helpful to arrive at the correct diagnosis. Four cases of PEH and 4 cases of angiosarcoma were identified. The mean age at diagnosis was 62 for PEH and 33 for primary angiosarcoma. All cases of PEH formed small masses with circumscribed or lobulated margins by imaging (mean size 0.9 cm). In 3 cases, the masses were difficult or impossible to identify after the biopsy. Angiosarcomas presented as larger masses with ill-defined margins (mean size 2.8 cm) that were unchanged in size after biopsy. PEH was surrounded by adipose tissue, whereas angiosarcoma invaded into fibrous stroma and involved lobules. The pseudopapillary structures of PEH were composed mainly of collagen, and thus, additional histologic stains for fibrin were not helpful for diagnosis. The 4 patients with PEH received no further treatment and are alive and disease-free at 2-11 years of follow-up. In contrast, the patients with angiosarcoma underwent mastectomy and chemotherapy or radiation therapy. Two of the patients with angiosarcoma died 3 years after diagnosis and the other 2 patients are alive without disease at 5 and 6 years. Therefore, distinguishing PEH and angiosarcoma is essential for appropriate management. This is the first series to compare these lesions on core needle biopsy and the first to note important clinical, imaging, and histologic differences that aid in making a diagnosis of PEH with confidence on breast core needle biopsy. © 2018 Wiley Periodicals, Inc.

  16. Prognostic importance of HPV and p16 in patients with oropharyngeal carcinoma in ENT clinic in Nove Zamky

    International Nuclear Information System (INIS)

    Kurinec, F.

    2017-01-01

    Purpose: The incidence of oropharyngeal squamous cell carcinoma (OPSCC) is rising in contrast to the decreasing incidence of carcinomas in other subsides of the head and neck, in spite of the reduced prevalence of smoking in developed countries. Human papilloma virus (HPV) infection, is now recognized as a significant marker in the onset of HPV positive OPSCC, with different epidemiological, clinical, anatomical, radiological, behavioural, biological and prognostic characteristics from HPV negative OPSCC. Aim: The aim of our work was to measure the impact of HPV infection and anti-oncogene p16 on survival and analyze lifestyles in our sample of patients. Material and methods: 61 patients with newly diagnosed oropharyngeal cancer in ENT clinic in Nove Zamky included in our study from March 2011 till February 2014. They were divided into two categories- HPV positive and HPV negative patients (n-39 versus 22). Results: HPV infection was analysed by DNA detection viral DNA with PCR (Cobas 4800 HPV Test) and expression E6/E7 oncogenes by mRNA. In addition, we detected p16 overexpression immunohistochemistry as a surrogate marker for high risk HPV(HR HPV). We analysed clinicopatological characteristic, smoking and alcohol abuse history, sexual behaviours and compared treatment and overall survival between HPV positive and HPV negative patients. The 2- year rates of overall survival were 86% versus 41% in HPV + and HPV – patients and 88% versus 25% in p16+ and p16- tumors, respectively. Conclusion: These observations lead to questions regarding management choices for patients based on tumour HPV and p16status with important consequences on treatment and on the role of targeted therapy and vaccines and over the upcoming years. (author)

  17. Minimal clinically important difference and the effect of clinical variables on the ankle osteoarthritis scale in surgically treated end-stage ankle arthritis.

    Science.gov (United States)

    Coe, Marcus P; Sutherland, Jason M; Penner, Murray J; Younger, Alastair; Wing, Kevin J

    2015-05-20

    There is much debate regarding the best outcome tool for use in foot and ankle surgery, specifically in patients with ankle arthritis. The Ankle Osteoarthritis Scale (AOS) is a validated, disease-specific score. The goals of this study were to investigate the clinical performance of the AOS and to determine a minimal clinically important difference (MCID) for it, using a large cohort of 238 patients undergoing surgery for end-stage ankle arthritis. Patients treated with total ankle arthroplasty or ankle arthrodesis were prospectively followed for a minimum of two years at a single site. Data on demographics, comorbidities, AOS score, Short Form-36 results, and the relationship between expectations and satisfaction were collected at baseline (preoperatively), at six and twelve months, and then yearly thereafter. A linear regression analysis examined the variables affecting the change in AOS scores between baseline and the two-year follow-up. An MCID in the AOS change score was then determined by employing an anchor question, which asked patients to rate their relief from symptoms after surgery. Surgical treatment of end-stage ankle arthritis resulted in a mean improvement (and standard deviation) of 31.2 ± 22.7 points in the AOS score two years after surgery. The MCID of the AOS change score was a mean of 28.0 ± 17.9 points. The change in AOS score was significantly affected by the preoperative AOS score, smoking, back pain, and age. Patients undergoing arthroplasty or arthrodesis for end-stage ankle arthritis experienced a mean improvement in AOS score that was greater than the estimated MCID (31.2 versus 28.0 points). Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

  18. Determining the minimal clinically important difference and responsiveness of the Dermatology Life Quality Index (DLQI): further data.

    Science.gov (United States)

    Basra, M K A; Salek, M S; Camilleri, L; Sturkey, R; Finlay, A Y

    2015-01-01

    To determine the minimal clinically important difference (MCID) of the Dermatology Life Quality Index (DLQI) and its responsiveness to change in inflammatory skin diseases. A longitudinal study: at stage 1, patients completed the DLQI and a disease severity global question; at stage 2, a global rating of change in quality of life (QoL; Global Rating of Change Questionnaire, GRCQ) was added and used as an anchor to measure the MCID of the DLQI. 192 patients completed stage 1 and 107 completed stage 2. The mean DLQI score at stage 1 was 9.8 and 7.4 at stage 2 with a mean change of 2.4 (p < 0.0001). 31 patients experienced a 'small change' in their QoL (±3 and ±2) on the GRCQ. The mean corresponding change in DLQI scores was 3.3, which is regarded as the approximate MCID. Previous estimates of the MCID of the DLQI have varied from 3 to 5. Although this study demonstrated a MCID of 3.3, we recommend that the MCID in inflammatory skin diseases should be 4. © 2015 S. Karger AG, Basel.

  19. Performance of Rapid Diagnostic Tests for Imported Malaria in Clinical Practice: Results of a National Multicenter Study

    Science.gov (United States)

    Houzé, Sandrine; Boutron, Isabelle; Marmorat, Anne; Dalichampt, Marie; Choquet, Christophe; Poilane, Isabelle; Godineau, Nadine; Le Guern, Anne-Sophie; Thellier, Marc; Broutier, Hélène; Fenneteau, Odile; Millet, Pascal; Dulucq, Stéphanie; Hubert, Véronique; Houzé, Pascal; Tubach, Florence; Le Bras, Jacques; Matheron, Sophie

    2013-01-01

    We compared the performance of four rapid diagnostic tests (RDTs) for imported malaria, and particularly Plasmodium falciparum infection, using thick and thin blood smears as the gold standard. All the tests are designed to detect at least one protein specific to P. falciparum ( Plasmodium histidine-rich protein 2 (PfHRP2) or Plasmodium LDH (PfLDH)) and one pan-Plasmodium protein (aldolase or Plasmodium LDH (pLDH)). 1,311 consecutive patients presenting to 9 French hospitals with suspected malaria were included in this prospective study between April 2006 and September 2008. Blood smears revealed malaria parasites in 374 cases (29%). For the diagnosis of P. falciparum infection, the three tests detecting PfHRP2 showed high and similar sensitivity (96%), positive predictive value (PPV) (90%) and negative predictive value (NPV) (98%). The PfLDH test showed lower sensitivity (83%) and NPV (80%), despite good PPV (98%). For the diagnosis of non-falciparum species, the PPV and NPV of tests targeting pLDH or aldolase were 94–99% and 52–64%, respectively. PfHRP2-based RDTs are thus an acceptable alternative to routine microscopy for diagnosing P. falciparum malaria. However, as malaria may be misdiagnosed with RDTs, all negative results must be confirmed by the reference diagnostic method when clinical, biological or other factors are highly suggestive of malaria. PMID:24098699

  20. The importance of least restrictive care: the clinical implications of a recent High Court decision on negligence.

    Science.gov (United States)

    Ryan, Christopher James; Callaghan, Sascha; Large, Matthew

    2015-08-01

    This paper aims to explain the meaning and implications for practice of the High Court of Australia's finding in the negligence case, Hunter and New England Local Health District v McKenna [2014] HCA 44. The facts of the case and the law of negligence are reviewed before reporting the Court's decision. The High Court found that the obligation upon doctors to provide the least restrictive option for care that was imposed by the, then applicable, Mental Health Act 1990 (NSW) was inconsistent with an obligation that might otherwise be imposed by a common law duty to have regard to the interests of those with whom a psychiatric patient may come into contact if not detained. The Court's finding underlines the importance of clinicians documenting their clinical reasoning around why their negotiated management plan was the option least restrictive of the patient's freedom and most protective of his or her human rights. © The Royal Australian and New Zealand College of Psychiatrists 2015.

  1. Defining the minimum clinically important difference for grade I degenerative lumbar spondylolisthesis: insights from the Quality Outcomes Database.

    Science.gov (United States)

    Asher, Anthony L; Kerezoudis, Panagiotis; Mummaneni, Praveen V; Bisson, Erica F; Glassman, Steven D; Foley, Kevin T; Slotkin, Jonathan; Potts, Eric A; Shaffrey, Mark E; Shaffrey, Christopher I; Coric, Domagoj; Knightly, John J; Park, Paul; Fu, Kai-Ming; Devin, Clinton J; Archer, Kristin R; Chotai, Silky; Chan, Andrew K; Virk, Michael S; Bydon, Mohamad

    2018-01-01

    OBJECTIVE Patient-reported outcomes (PROs) play a pivotal role in defining the value of surgical interventions for spinal disease. The concept of minimum clinically important difference (MCID) is considered the new standard for determining the effectiveness of a given treatment and describing patient satisfaction in response to that treatment. The purpose of this study was to determine the MCID associated with surgical treatment for degenerative lumbar spondylolisthesis. METHODS The authors queried the Quality Outcomes Database registry from July 2014 through December 2015 for patients who underwent posterior lumbar surgery for grade I degenerative spondylolisthesis. Recorded PROs included scores on the Oswestry Disability Index (ODI), EQ-5D, and numeric rating scale (NRS) for leg pain (NRS-LP) and back pain (NRS-BP). Anchor-based (using the North American Spine Society satisfaction scale) and distribution-based (half a standard deviation, small Cohen's effect size, standard error of measurement, and minimum detectable change [MDC]) methods were used to calculate the MCID for each PRO. RESULTS A total of 441 patients (80 who underwent laminectomies alone and 361 who underwent fusion procedures) from 11 participating sites were included in the analysis. The changes in functional outcome scores between baseline and the 1-year postoperative evaluation were as follows: 23.5 ± 17.4 points for ODI, 0.24 ± 0.23 for EQ-5D, 4.1 ± 3.5 for NRS-LP, and 3.7 ± 3.2 for NRS-BP. The different calculation methods generated a range of MCID values for each PRO: 3.3-26.5 points for ODI, 0.04-0.3 points for EQ-5D, 0.6-4.5 points for NRS-LP, and 0.5-4.2 points for NRS-BP. The MDC approach appeared to be the most appropriate for calculating MCID because it provided a threshold greater than the measurement error and was closest to the average change difference between the satisfied and not-satisfied patients. On subgroup analysis, the MCID thresholds for laminectomy-alone patients were

  2. Indirect immunofluorescence assay for the simultaneous detection of antibodies against clinically important old and new world hantaviruses.

    Directory of Open Access Journals (Sweden)

    Sabine Lederer

    Full Text Available In order to detect serum antibodies against clinically important Old and New World hantaviruses simultaneously, multiparametric indirect immunofluorescence assays (IFAs based on biochip mosaics were developed. Each of the mosaic substrates consisted of cells infected with one of the virus types Hantaan (HTNV, Puumala (PUUV, Seoul (SEOV, Saaremaa (SAAV, Dobrava (DOBV, Sin Nombre (SNV or Andes (ANDV. For assay evaluation, serum IgG and IgM antibodies were analyzed using 184 laboratory-confirmed hantavirus-positive sera collected at six diagnostic centers from patients actively or previously infected with the following hantavirus serotypes: PUUV (Finland, n=97; SEOV (China, n=5; DOBV (Romania, n=7; SNV (Canada, n=23; ANDV (Argentina and Chile, n=52. The control panel comprised 89 sera from healthy blood donors. According to the reference tests, all 184 patient samples were seropositive for hantavirus-specific IgG (n=177; 96% and/or IgM (n=131; 72%, while all control samples were tested negative. In the multiparametric IFA applied in this study, 183 (99% of the patient sera were IgG and 131 (71% IgM positive (accordance with the reference tests: IgG, 96%; IgM, 93%. Overall IFA sensitivity for combined IgG and IgM analysis amounted to 100% for all serotypes, except for SNV (96%. Of the 89 control sera, 2 (2% showed IgG reactivity against the HTNV substrate, but not against any other hantavirus. Due to the high cross-reactivity of hantaviral nucleocapsid proteins, endpoint titrations were conducted, allowing serotype determination in >90% of PUUV- and ANDV-infected patients. Thus, multiparametric IFA enables highly sensitive and specific serological diagnosis of hantavirus infections and can be used to differentiate PUUV and ANDV infection from infections with Murinae-borne hantaviruses (e.g. DOBV and SEOV.

  3. Validity, responsiveness, and minimal clinically important difference of EQ-5D-5L in stroke patients undergoing rehabilitation.

    Science.gov (United States)

    Chen, Poyu; Lin, Keh-Chung; Liing, Rong-Jiuan; Wu, Ching-Yi; Chen, Chia-Ling; Chang, Ku-Chou

    2016-06-01

    To examine the criterion validity, responsiveness, and minimal clinically important difference (MCID) of the EuroQoL 5-Dimensions Questionnaire (EQ-5D-5L) and visual analog scale (EQ-VAS) in people receiving rehabilitation after stroke. The EQ-5D-5L, along with four criterion measures-the Medical Research Council scales for muscle strength, the Fugl-Meyer assessment, the functional independence measure, and the Stroke Impact Scale-was administered to 65 patients with stroke before and after 3- to 4-week therapy. Criterion validity was estimated using the Spearman correlation coefficient. Responsiveness was analyzed by the effect size, standardized response mean (SRM), and criterion responsiveness. The MCID was determined by anchor-based and distribution-based approaches. The percentage of patients exceeding the MCID was also reported. Concurrent validity of the EQ-Index was better compared with the EQ-VAS. The EQ-Index has better power for predicting the rehabilitation outcome in the activities of daily living than other motor-related outcome measures. The EQ-Index was moderately responsive to change (SRM = 0.63), whereas the EQ-VAS was only mildly responsive to change. The MCID estimation of the EQ-Index (the percentage of patients exceeding the MCID) was 0.10 (33.8 %) and 0.10 (33.8 %) based on the anchor-based and distribution-based approaches, respectively, and the estimation of EQ-VAS was 8.61 (41.5 %) and 10.82 (32.3 %). The EQ-Index has shown reasonable concurrent validity, limited predictive validity, and acceptable responsiveness for detecting the health-related quality of life in stroke patients undergoing rehabilitation, but not for EQ-VAS. Future research considering different recovery stages after stroke is warranted to validate these estimations.

  4. Evaluation of great saphenous vein occlusion rate and clinical outcome in patients undergoing laser thermal ablation with a 1470-nm bare fiber laser with low linear endovenous energy density

    Directory of Open Access Journals (Sweden)

    Walter Junior Boim Araujo

    2015-12-01

    Full Text Available Abstract Background Water-specific 1470-nm lasers enable vein ablation at lower energy densities and with fewer side effects because they target interstitial water in the vessel wall. Objectives To determine great saphenous vein (GSV occlusion rate after thermal ablation with 1470-nm laser using 7W power and to evaluate clinical outcomes and complications. Method Nineteen patients (31 GSVs underwent thermal ablation. Follow-up duplex scanning, clinical evaluation using the Venous Clinical Severity Score (VCSS, and evaluation of procedure-related complications were performed at 3-5 days after the procedure and at 30 and 180 days. Results Mean patient age was 46 years and 17 of the patients were female (89.47%. Of 31 limbs treated, 2 limbs were clinical class C2, 19 were C3, 9 were C4, and 1 limb was C5 according to the Clinical-Etiology-Anatomy-Pathophysiology (CEAP classification. Mean linear endovenous energy density was 33.53 J/cm. The GSV occlusion rate was 93.5% immediately after treatment, 100% at 3-5 days and 100% at 30 days after treatment and 87.1% 180 days after treatment. There was a significant reduction in VCSS at all time points. Conclusions The data from this study support the possibility that the incidence of complications can be reduced without significantly affecting the clinical outcomes, by using lower energy density. However, this appears to be at the cost of reduced efficacy in terms of GSV occlusion rates.

  5. Trust, moral responsibility, the self, and well-ordered societies: the importance of basic philosophical concepts for clinical ethics.

    Science.gov (United States)

    Mccullough, Laurence B

    2002-02-01

    Although the work of clinical ethics is intensely practical, it employs and presumes philosophical concepts from the central branches of philosophy, including metaphysics, epistemology, ethics, and political philosophy. This essay introduces this issue in the Journal on clinical ethics by considering how the papers and book reviews included in it illuminate four such concepts: trust, moral responsibility, the self and well-ordered societies.

  6. Prevalence and Clinical Import of Thoracic Injury Identified by Chest Computed Tomography but Not Chest Radiography in Blunt Trauma: Multicenter Prospective Cohort Study.

    Science.gov (United States)

    Langdorf, Mark I; Medak, Anthony J; Hendey, Gregory W; Nishijima, Daniel K; Mower, William R; Raja, Ali S; Baumann, Brigitte M; Anglin, Deirdre R; Anderson, Craig L; Lotfipour, Shahram; Reed, Karin E; Zuabi, Nadia; Khan, Nooreen A; Bithell, Chelsey A; Rowther, Armaan A; Villar, Julian; Rodriguez, Robert M

    2015-12-01

    Chest computed tomography (CT) diagnoses more injuries than chest radiography, so-called occult injuries. Wide availability of chest CT has driven substantial increase in emergency department use, although the incidence and clinical significance of chest CT findings have not been fully described. We determine the frequency, severity, and clinical import of occult injury, as determined by changes in management. These data will better inform clinical decisions, need for chest CT, and odds of intervention. Our sample included prospective data (2009 to 2013) on 5,912 patients at 10 Level I trauma center EDs with both chest radiography and chest CT at physician discretion. These patients were 40.6% of 14,553 enrolled in the parent study who had either chest radiography or chest CT. Occult injuries were pneumothorax, hemothorax, sternal or greater than 2 rib fractures, pulmonary contusion, thoracic spine or scapula fracture, and diaphragm or great vessel injury found on chest CT but not on preceding chest radiography. A priori, we categorized thoracic injuries as major (having invasive procedures), minor (observation or inpatient pain control >24 hours), or of no clinical significance. Primary outcome was prevalence and proportion of occult injury with major interventions of chest tube, mechanical ventilation, or surgery. Secondary outcome was minor interventions of admission rate or observation hours because of occult injury. Two thousand forty-eight patients (34.6%) had chest injury on chest radiography or chest CT, whereas 1,454 of these patients (71.0%, 24.6% of all patients) had occult injury. Of these, in 954 patients (46.6% of injured, 16.1% of total), chest CT found injuries not observed on immediately preceding chest radiography. In 500 more patients (24.4% of injured patients, 8.5% of all patients), chest radiography found some injury, but chest CT found occult injury. Chest radiography found all injuries in only 29.0% of injured patients. Two hundred and two

  7. A randomized prospective long-term (>1 year) clinical trial comparing the efficacy and safety of radiofrequency ablation to 980 nm laser ablation of the great saphenous vein.

    Science.gov (United States)

    Sydnor, Malcolm; Mavropoulos, John; Slobodnik, Natalia; Wolfe, Luke; Strife, Brian; Komorowski, Daniel

    2017-07-01

    Purpose To compare the short- and long-term (>1 year) efficacy and safety of radiofrequency ablation (ClosureFAST™) versus endovenous laser ablation (980 nm diode laser) for the treatment of superficial venous insufficiency of the great saphenous vein. Materials and methods Two hundred patients with superficial venous insufficiency of the great saphenous vein were randomized to receive either radiofrequency ablation or endovenous laser ablation (and simultaneous adjunctive therapies for surface varicosities when appropriate). Post-treatment sonographic and clinical assessment was conducted at one week, six weeks, and six months for closure, complications, and patient satisfaction. Clinical assessment of each patient was conducted at one year and then at yearly intervals for patient satisfaction. Results Post-procedure pain ( p radiofrequency ablation group. Improvements in venous clinical severity score were noted through six months in both groups (endovenous laser ablation 6.6 to 1; radiofrequency ablation 6.2 to 1) with no significant difference in venous clinical severity score ( p = 0.4066) or measured adverse effects; 89 endovenous laser ablation and 87 radiofrequency patients were interviewed at least 12 months out with a mean long-term follow-up of 44 and 42 months ( p = 0.1096), respectively. There were four treatment failures in each group, and every case was correctable with further treatment. Overall, there were no significant differences with regard to patient satisfaction between radiofrequency ablation and endovenous laser ablation ( p = 0.3009). There were no cases of deep venous thrombosis in either group at any time during this study. Conclusions Radiofrequency ablation and endovenous laser ablation are highly effective and safe from both anatomic and clinical standpoints over a multi-year period and neither modality achieved superiority over the other.

  8. Sex-Divergent Clinical Outcomes and Precision Medicine: An Important New Role for Institutional Review Boards and Research Ethics Committees

    Directory of Open Access Journals (Sweden)

    Ignacio Segarra

    2017-07-01

    Full Text Available The efforts toward individualized medicine have constantly increased in an attempt to improve treatment options. These efforts have led to the development of small molecules which target specific molecular pathways involved in cancer progression. We have reviewed preclinical studies of sunitinib that incorporate sex as a covariate to explore possible sex-based differences in pharmacokinetics and drug–drug interactions (DDI to attempt a relationship with published clinical outputs. We observed that covariate sex is lacking in most clinical outcome reports and suggest a series of ethic-based proposals to improve research activities and identify relevant different sex outcomes. We propose a deeper integration of preclinical, clinical, and translational research addressing statistical and clinical significance jointly; to embed specific sex-divergent endpoints to evaluate possible gender differences objectively during all stages of research; to pay greater attention to sex-divergent outcomes in polypharmacy scenarios, DDI and bioequivalence studies; the clear reporting of preclinical and clinical findings regarding sex-divergent outcomes; as well as to encourage the active role of scientists and the pharmaceutical industry to foster a new scientific culture through their research programs, practice, and participation in editorial boards and Institutional Ethics Review Boards (IRBs and Research Ethics Committees (RECs. We establish the IRB/REC as the centerpiece for the implementation of these proposals. We suggest the expansion of its competence to follow up clinical trials to ensure that sex differences are addressed and recognized; to engage in data monitoring committees to improve clinical research cooperation and ethically address those potential clinical outcome differences between male and female patients to analyze their social and clinical implications in research and healthcare policies.

  9. Quantifying the importance of disease burden on perceived general health and depressive symptoms in patients within the Mayo Clinic Biobank.

    Science.gov (United States)

    Ryu, Euijung; Takahashi, Paul Y; Olson, Janet E; Hathcock, Matthew A; Novotny, Paul J; Pathak, Jyotishman; Bielinski, Suzette J; Cerhan, James R; Sloan, Jeff A

    2015-07-03

    Deficits in health-related quality of life (HRQOL) may be associated with worse patient experiences, outcomes and even survival. While there exists evidence to identify risk factors associated with deficits in HRQOL among patients with individual medical conditions such as cancer, it is less well established in more general populations without attention to specific illnesses. This study used patients with a wide range of medical conditions to identify contributors with the greatest influence on HRQOL deficits. Self-perceived general health and depressive symptoms were assessed using data from 21,736 Mayo Clinic Biobank (MCB) participants. Each domain was dichotomized into categories related to poor health: deficit (poor/fair for general health and ≥3 for PHQ-2 depressive symptoms) or non-deficit. Logistic regression models were used to test the association of commonly collected demographic characteristics and disease burden with each HRQOL domain, adjusting for age and gender. Gradient boosting machine (GBM) models were applied to quantify the relative influence of contributors on each HRQOL domain. The prevalence of participants with a deficit was 9.5 % for perception of general health and 4.6 % for depressive symptoms. For both groups, disease burden had the strongest influence for deficit in HRQOL (63 % for general health and 42 % for depressive symptoms). For depressive symptoms, age was equally influential. The prevalence of a deficit in general health increased slightly with age for males, but remained stable across age for females. Deficit in depressive symptoms was inversely associated with age. For both HRQOL domains, risk of a deficit was associated with higher disease burden, lower levels of education, no alcohol consumption, smoking, and obesity. Subjects with deficits were less likely to report that they were currently working for pay than those without a deficit; this association was stronger among males than females. Comorbid health burden has the

  10. Epidemiological Characteristics and Clinical Treatment Outcome of Typhoid Fever in Ningbo, China, 2005-2014: Pulsed-Field Gel Electorophoresis Results Revealing Great Proportion of Common Transmission Sources.

    Science.gov (United States)

    Song, Qifa; Yang, Yuanbin; Lin, Wenping; Yi, Bo; Xu, Guozhang

    2017-09-25

    We aimed to describe the molecular epidemiological characteristics and clinical treatment outcome of typhoid fever in Ningbo, China during 2005-2014. Eighty-eight Salmonella Typhi isolates were obtained from 307 hospitalized patients. Three prevalent pulsed-field gel electrophoresis (PFGE) patterns of 54 isolates from 3 outbreaks were identified. Overall, there were 64 (72.7%) isolates from clustered cases and 24 (27.3%) isolates from sporadic cases. Resistance to nalidixic acid (NAL) (n = 47; 53.4%) and ampicillin (AMP) (n = 40; 45.4%) and rare resistance to tetracycline (TET) (n = 2; 2.3%) and gentamicin (GEN) (n = 2; 2.3%) were observed. No isolates resistant to cefotaxime (CTX), chloramphenicol (CL), ciprofloxacin (CIP), and trimethoprim-sulfamethoxazole (SXT) were found. The occurrence of reduced sensitivity to CIP was 52.3% (n = 46). The medians of fever clearance time in cases with and without complications were 7 (interquartile range (IQR): 4-10) and 5 (IQR: 3-7) days (P = 0.001), respectively, when patients were treated with CIP or levofloxacin (LEV) and/or third-generation cephalosporins (CEP). Rates of serious complications were at low levels: peritonitis (2.3%), intestinal hemorrhage (6.8%), and intestinal perforation (1.1%). The present study revealed a long-term clustering trend with respect to PFGE patterns, occasional outbreaks, and the rapid spread of AMP resistance and decreased CIP susceptibility among S. Typhi isolates in recent years.

  11. A cross-cultural convergent parallel mixed methods study of what makes a cancer-related symptom or functional health problem clinically important.

    Science.gov (United States)

    Giesinger, Johannes M; Aaronson, Neil K; Arraras, Juan I; Efficace, Fabio; Groenvold, Mogens; Kieffer, Jacobien M; Loth, Fanny L; Petersen, Morten Aa; Ramage, John; Tomaszewski, Krzysztof A; Young, Teresa; Holzner, Bernhard

    2018-02-01

    In this study, we investigated what makes a symptom or functional impairment clinically important, that is, relevant for a patient to discuss with a health care professional (HCP). This is the first part of a European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group project focusing on the development of thresholds for clinical importance for the EORTC QLQ-C30 questionnaire and its corresponding computer-adaptive version. We conducted interviews with cancer patients and HCPs in 6 European countries. Participants were asked to name aspects of a symptom or problem that make it clinically important and to provide importance ratings for a predefined set of aspects (eg, need for help and limitations of daily functioning). We conducted interviews with 83 cancer patients (mean age, 60.3 y; 50.6% men) and 67 HCPs. Participants related clinical importance to limitations of everyday life (patients, 65.1%; HCPs, 77.6%), the emotional impact of a symptom/problem (patients, 53.0%; HCPs, 64.2%), and duration/frequency (patients, 51.8%; HCPs, 49.3%). In the patient sample, importance ratings were highest for worries by partner or family, limitations in everyday life, and need for help from the medical staff. Health care professionals rated limitations in everyday life and need for help from the medical staff to be most important. Limitations in everyday life, need for (medical) help, and emotional impact on the patient or family/partner were found to be relevant aspects of clinical importance. Based on these findings, we will define anchor items for the development of thresholds for clinical importance for the EORTC measures in a Europe-wide field study. Copyright © 2017 John Wiley & Sons, Ltd.

  12. Making a Great First Impression

    Science.gov (United States)

    Evenson, Renee

    2007-01-01

    Managers and business owners often base hiring decisions on first impressions. That is why it is so important to teach students to make a great first impression--before they go on that first job interview. Managers do not have unrealistic expectations, they just want to hire people who they believe can develop into valuable employees. A nice…

  13. Provider Initiated Testing and Counseling (PITC for HIV in resource-limited clinical settings: important questions unanswered

    Directory of Open Access Journals (Sweden)

    Peter Twyman

    2009-09-01

    Full Text Available Testing is the gateway to HIV care and support services, and efforts to broaden treatment must include a proactive and inclusive approach to testing. Provider Initiated Testing and Counseling (PITC for HIV utilizes the opportunity afforded by the clinical encounter for the care provider to make a clinical recommendation that the patient have a voluntary HIV test. It is hoped that by broadening testing by such strategies as PITC more patients may be identified and linked to treatment and support. However, there exist multiple challenges and questions regarding the provision of routine HIV testing and counseling in clinical facilities. In order to support further PITC efforts and scale up of current testing programs, a research agenda that addresses the ethical, social and operational components of PITC programming in health facilities, is critically needed to further guide its expansion.

  14. Predicting failing performance on a standardized patient clinical performance examination: the importance of communication and professionalism skills deficits.

    Science.gov (United States)

    Chang, Anna; Boscardin, Christy; Chou, Calvin L; Loeser, Helen; Hauer, Karen E

    2009-10-01

    The purpose is to determine which assessment measures identify medical students at risk of failing a clinical performance examination (CPX). Retrospective case-control, multiyear design, contingency table analysis, n = 149. We identified two predictors of CPX failure in patient-physician interaction skills: low clerkship ratings (odds ratio 1.79, P = .008) and student progress review for communication or professionalism concerns (odds ratio 2.64, P = .002). No assessments predicted CPX failure in clinical skills. Performance concerns in communication and professionalism identify students at risk of failing the patient-physician interaction portion of a CPX. This correlation suggests that both faculty and standardized patients can detect noncognitive traits predictive of failing performance. Early identification of these students may allow for development of a structured supplemental curriculum with increased opportunities for practice and feedback. The lack of predictors in the clinical skills portion suggests limited faculty observation or feedback.

  15. Rudimentary horn pregnancy in the first trimester; importance of ultrasound and clinical suspicion in early diagnosis: A case report

    Directory of Open Access Journals (Sweden)

    Hasan Terzi

    2014-09-01

    Full Text Available We aimed to present 7-8 weeks rudimentary horn pregnancy detected preoperatively. A 37-year-old woman, gravida 3, para 2, at 7-8 weeks’ gestation referred to our clinic with a complaint of abdominal pain. The patient was primarily infertile, and she had unicornuate uterus detected during infertility investigation. Due to abnormal ultrasonographic image, rudimentary horn pregnancy was considered. Accurate diagnosis was made by laparoscopy, and rudimentary horn excision was performed. Prerupture diagnosis is very difficult in rudimentary horn pregnancies. The key role in preoperative diagnosis is suspicion. Ultrasonographic examination and clinical suspicion are sufficient in most cases.

  16. Equol, a Clinically Important Metabolite, Inhibits the Development and Pathogenicity of Magnaporthe oryzae, the Causal Agent of Rice Blast Disease

    Directory of Open Access Journals (Sweden)

    Jiaoyu Wang

    2017-10-01

    Full Text Available Equol, a metabolite of soybean isoflavone daidzein, has been proven to have various bioactivities related to human health, but little is known on its antifungal activity to plant fungal pathogens. Magnaporthe oryzae is a phytopathogenic fungus that causes rice blast, a devastating disease on rice. Here, we demonstrated that equol influences the development and pathogenicity of M. oryzae. Equol showed a significant inhibition to the mycelial growth, conidial generation and germination, and appressorial formation of M. oryzae. As a result, equol greatly reduced the virulence of M. oryzae on rice and barley leaves. The antifungal activity of equol was also found in several other plant fungal pathogens. These findings expand our knowledge on the bioactivities of equol.

  17. Importance of Clinical and Laboratory Findings in the Diagnosis and Surgical Prognosis of Patients with Constrictive Pericarditis

    Directory of Open Access Journals (Sweden)

    Fábio Fernandes

    2017-10-01

    Full Text Available Abstract Background: International studies have reported the value of the clinical profile and laboratory findings in the diagnosis of constrictive pericarditis. However, Brazilian population data are scarce. Objective: To assess the clinical characteristics, sensitivity of imaging tests and factors related to the death of patients with constrictive pericarditis undergoing pericardiectomy. Methods: Patients with constrictive pericarditis surgically confirmed were retrospectively assessed regarding their clinical and laboratory variables. Two methods were used: transthoracic echocardiography and cardiac magnetic resonance imaging. Mortality predictors were determined by use of univariate analysis with Cox proportional hazards model and hazard ratio. All tests were two-tailed, and an alpha error ≤ 5% was considered statically significant. Results: We studied 84 patients (mean age, 44 ± 17.9 years; 67% male. Signs and symptoms of predominantly right heart failure were present with jugular venous distention, edema and ascites in 89%, 89% and 62% of the cases, respectively. Idiopathic etiology was present in 69.1%, followed by tuberculosis (21%. Despite the advanced heart failure degree, low BNP levels (median, 157 pg/mL were found. The diagnostic sensitivities for constriction of echocardiography and magnetic resonance imaging were 53.6% and 95.9%, respectively. There were 9 deaths (10.7%, and the risk factors were: anemia, BNP and C reactive protein levels, pulmonary hypertension >55 mm Hg, and atrial fibrillation. Conclusions: Magnetic resonance imaging had better diagnostic sensitivity. Clinical, laboratory and imaging markers were associated with death.

  18. Bottom–up protein identifications from microliter quantities of individual human tear samples. Important steps towards clinical relevance.

    Directory of Open Access Journals (Sweden)

    Peter Raus

    2015-12-01

    With 375 confidently identified proteins in the healthy adult tear, the obtained results are comprehensive and in large agreement with previously published observations on pooled samples of multiple patients. We conclude that, to a limited extent, bottom–up tear protein identifications from individual patients may have clinical relevance.

  19. The Next Great Generation?

    Science.gov (United States)

    Brownstein, Andrew

    2000-01-01

    Discusses ideas from a new book, "Millennials Rising: The Next Great Generation," (by Neil Howe and William Strauss) suggesting that youth culture is on the cusp of a radical shift with the generation beginning with this year's college freshmen who are typically team oriented, optimistic, and poised for greatness on a global scale. Includes a…

  20. Growth hormone receptor exon 3 isoforms may have no importance in the clinical setting of multiethnic Brazilian acromegaly patients.

    Science.gov (United States)

    de Oliveira Machado, Evelyn; Lima, Carlos Henrique Azeredo; Ogino, Liana Lumi; Kasuki, Leandro; Gadelha, Mônica R

    2016-08-01

    Acromegaly is associated with significant morbidity and increased mortality, but has a variable severity phenotype. The presence of the exon 3-deleted isoform of the growth hormone receptor (d3-GHR) may influence the disease phenotype and treatment outcomes, including the frequency of biochemical discordance after medical treatment. The objective of this study was to analyze the influence of the d3-GHR isoform on clinical and biochemical characteristics and in the treatment outcomes of Brazilian multiethnic acromegaly patients. We retrospectively analyzed our acromegaly outpatient clinic databank and collected demographic, clinical, biochemical and treatment outcome data from those patients who agreed to participate in the study. A blood sample was collected from all patients, the DNA was extracted and the GHR isoforms were evaluated by PCR, with the full length (fl)-GHR represented by a 935-bp fragment and the d3-GHR represented by a 532-bp fragment. A total of 121 patients were included. Fifty-six patients (46.3 %) were full-length homozygous (fl/fl), 48 (39.7 %) were heterozygous (fl/d3) and 17 (14.0 %) were d3-GHR homozygous (d3/d3). There was no difference between patients homozygous for the fl isoform and those harboring at least one d3-GHR allele in the demographic, clinical and biochemical data or in the treatment outcomes, including somatostatin receptor ligands (SRL) monotherapy, combination therapy with SRL and cabergoline and pegvisomant treatment. There was also no difference between the groups for the frequency of GH and IGF-I discordance after medical treatment. GHR exon 3 genotyping appears to have no clinical significance, at least in Brazilian acromegaly patients.

  1. Incidental abdominopelvic findings on expanded field-of-view lumbar spinal MRI: frequency, clinical importance, and concordance in interpretation by neuroimaging and body imaging radiologists

    International Nuclear Information System (INIS)

    Maxwell, A.W.P.; Keating, D.P.; Nickerson, J.P.

    2015-01-01

    Aim: To characterize the frequency of identification, clinical importance, and concordance in interpretation of incidental abdominopelvic findings identified on routine lumbar spinal MRI using supplemental expanded field-of-view (FOV) coronal imaging. Materials and methods: All lumbar spinal MRI reports over a 12-month period were retrospectively reviewed for the presence of incidental abdominopelvic findings identified using expanded FOV coronal imaging. Medical records were used to identify those findings that received follow-up, which were then categorized according to final diagnosis and classified as “indeterminate,” “likely clinically unimportant,” and “likely clinically important”. All cases that received follow-up were blindly and independently re-reviewed by a neuroimaging radiologist and body-imaging radiologist, and reviewer performances were compared to assess for agreement with regard to lesion significance, need for follow-up, and other parameters. Results: In total, 2067 reports were reviewed: 687 (33.2%) featured one or more incidental abdominopelvic findings, and 102 (4.9%) findings received further evaluation. Of these, 11 (10.9%) were classified as “indeterminate,” 50 (49%) as “likely clinically unimportant,” and 41 (40.1%) were classified as “likely clinically important.” Excellent agreement was observed between the reviewing radiologists for all evaluated parameters. Conclusion: The addition of an expanded FOV coronal sequence to the standard lumbar spinal MRI protocol was associated with the identification of a large number of incidental abdominopelvic findings, the minority of which represent likely clinically important findings. Most incidental findings were confidently dismissed by a neuroimaging radiologist as likely clinically unimportant without utilization of additional clinical or radiographic resources. - Highlights: • Expanded field-of-view (FOV) MRI improves detection of important incidental findings.

  2. Systemic right ventricular fibrosis detected by cardiovascular magnetic resonance is associated with clinical outcome, mainly new-onset atrial arrhythmia, in patients after atrial redirection surgery for transposition of the great arteries.

    Science.gov (United States)

    Rydman, Riikka; Gatzoulis, Michael A; Ho, Siew Yen; Ernst, Sabine; Swan, Lorna; Li, Wei; Wong, Tom; Sheppard, Mary; McCarthy, Karen P; Roughton, Michael; Kilner, Philip J; Pennell, Dudley J; Babu-Narayan, Sonya V

    2015-05-01

    We hypothesized that fibrosis detected by late gadolinium enhancement (LGE) cardiovascular magnetic resonance predicts outcomes in patients with transposition of the great arteries post atrial redirection surgery. These patients have a systemic right ventricle (RV) and are at risk of arrhythmia, premature RV failure, and sudden death. Fifty-five patients (aged 27±7 years) underwent LGE cardiovascular magnetic resonance and were followed for a median 7.8 (interquartile range, 3.8-9.6) years in a prospective single-center cohort study. RV LGE was present in 31 (56%) patients. The prespecified composite clinical end point comprised new-onset sustained tachyarrhythmia (atrial/ventricular) or decompensated heart failure admission/transplantation/death. Univariate predictors of the composite end point (n=22 patients; 19 atrial/2 ventricular tachyarrhythmia, 1 death) included RV LGE presence and extent, RV volumes/mass/ejection fraction, right atrial area, peak Vo(2), and age at repair. In bivariate analysis, RV LGE presence was independently associated with the composite end point (hazard ratio, 4.95 [95% confidence interval, 1.60-15.28]; P=0.005), and only percent predicted peak Vo(2) remained significantly associated with cardiac events after controlling for RV LGE (hazard ratio, 0.80 [95% confidence interval, 0.68-0.95]; P=0.009/5%). In 8 of 9 patients with >1 event, atrial tachyarrhythmia, itself a known risk factor for mortality, occurred first. There was agreement between location and extent of RV LGE at in vivo cardiovascular magnetic resonance and histologically documented focal RV fibrosis in an explanted heart. There was RV LGE progression in a different case restudied for clinical indications. Systemic RV LGE is strongly associated with adverse clinical outcome especially arrhythmia in transposition of the great arteries, thus LGE cardiovascular magnetic resonance should be incorporated in risk stratification of these patients. © 2015 American Heart

  3. The importance of clinical pharmacokinetic–pharmacodynamic studies in unraveling the determinants of early and late tuberculosis outcomes

    OpenAIRE

    McCallum, Andrew; Sloan, Derek

    2017-01-01

    Tuberculosis remains a major infectious cause of morbidity and mortality worldwide. Current antibiotic regimens, constructed prior to the development of modern pharmacokinetic-pharmacodynamic (PK–PD) tools, are based on incomplete understanding of exposure–response relationships in drug susceptible and multidrug resistant tuberculosis. Preclinical and population PK data suggest that clinical PK–PD studies may enable therapeutic drug monitoring for some agents and revised dosingf or others. Fu...

  4. The importance of acoustic radiation force impulse (ARFI) elastography in the diagnosis and clinical course of acute pancreatitis.

    Science.gov (United States)

    Kaya, Muhsin; Değirmenci, Serdar; Göya, Cemil; Tuncel, Elif Tuba; Uçmak, Feyzullah; Kaplan, Mehmet Ali

    2018-05-01

    Acute pancreatitis (AP) is characterized by acute inflammation of the pancreas and it has a highly variable clinical course. The aim of our study was to evaluate the value of acoustic radiation force impulse (ARFI) elastography in the diagnosis and clinical course of AP. Consecutive patients with a diagnosis of AP (patients group) and healthy subject (control group) were prospectively enrolled to the study. Demographic features and clinical, laboratory, and radiological data were recorded. Virtual Touch Tissue Quantification (VTQ) was used to implement ARFI elastography. The tissue elasticity is proportional to the square of the wave velocity (SWV). A total of 108 patients (age, 57±1.8 y) and 79 healthy subjects (age, 53.6±1.81 y) were included in the study. There were 100 (92.5%) edematous and 8 (7.4%) necrotizing AP. The mean SWV was significantly higher in the patient group than in the control group (2.43±0.08 vs. 1.27±0.025 m/s, p < 0.001). There was not significant difference between patient and control group regarding age and gender. SWV cutoff value of 1.63 m/s was associated with 100% sensitivity and 98% specificity for the diagnosis of AP. There was not significant difference between patients with and without complications and patients with edematous and necrotizing AP regarding mean SWV value. There was also not significant correlation between mean SWV value and age, mean length of hospital stay, and mean amylase level. ARFI elastography may be a feasible method for the diagnosis of AP, but it has no value for the prediction of clinical course of AP.

  5. Diagnostic yield of preoperative computed tomography imaging and the importance of a clinical decision for lung cancer surgery

    International Nuclear Information System (INIS)

    Sato, Shuichi; Koike, Teruaki; Yamato, Yasushi

    2010-01-01

    This study aimed to evaluate the diagnostic yield of preoperative computed tomography (CT) imaging and the validity of surgical intervention based on the clinical decision to perform surgery for lung cancer or suspected lung cancer. We retrospectively evaluated 1755 patients who had undergone pulmonary resection for lung cancer or suspected lung cancer. CT scans were performed on all patients. Surgical intervention to diagnose and treat was based on a medical staff conference evaluation for the suspected lung cancer patients who were pathologically undiagnosed. We evaluated the relation between resected specimens and preoperative CT imaging in detail. A total of 1289 patients were diagnosed with lung cancer by preoperative pathology examination; another 466 were not pathologically diagnosed preoperatively. Among the 1289 patients preoperatively diagnosed with lung cancer, the diagnoses were confirmed postoperatively in 1282. Among the 466 patients preoperatively undiagnosed, 435 were definitively diagnosed with lung cancer, and there were 383 p-stage I disease patients. There were 38 noncancerous patients who underwent surgery with a diagnosis of confirmed or suspected lung cancer. Among the 1755 patients who underwent surgery, 1717 were pathologically confirmed with lung cancer, and the diagnostic yield of preoperative CT imaging was 97.8%. Among the 466 patients who were preoperatively undiagnosed, 435 were compatible with the predicted findings of lung cancer. Diagnostic yields of preoperative CT imaging based on clinical evaluation are sufficiently reliable. Diagnostic surgical intervention was acceptable when the clinical probability of malignancy was high and the malignancy was pathologically undiagnosed. (author)

  6. The importance of bony impingement in restricting flexion after total knee arthroplasty: computer simulation model with clinical correlation.

    Science.gov (United States)

    Mizu-Uchi, Hideki; Colwell, Clifford W; Fukagawa, Shingo; Matsuda, Shuichi; Iwamoto, Yukihide; D'Lima, Darryl D

    2012-10-01

    We constructed patient-specific models from computed tomography data after total knee arthroplasty to predict knee flexion based on implant-bone impingement. The maximum flexion before impingement between the femur and the tibial insert was computed using a musculoskeletal modeling program (KneeSIM; LifeModeler, Inc, San Clemente, California) during a weight-bearing deep knee bend. Postoperative flexion was measured in a clinical cohort of 21 knees (low-flex group: 6 knees with 125° of flexion at 2 years). Average predicted flexion angles were within 2° of clinical measurements for the high-flex group. In the low-flex group, 4 cases had impingement involving the bone cut at the posterior condyle, and the average predicted knee flexion was 102° compared with 93° measured clinically. These results indicate that the level of the distal femoral resection should be carefully planned and that exposed bone proximal to the tips of the posterior condyles of the femoral component should be removed if there is risk of impingement. Copyright © 2012 Elsevier Inc. All rights reserved.

  7. A case of Balint syndrome: the importance of a specific neuropsychological appraisal in the clinical diagnosis of visuospatial disorders

    Directory of Open Access Journals (Sweden)

    Giuseppe Caravaglios

    2015-11-01

    Full Text Available Balint syndrome is characterized by a severe disturbance of visual spatial analysis including impaired oculomotor behaviour, optic ataxia, and simultanagnosia. The complete syndrome is relatively rare, and partial syndromes have been reported more frequently. The present study aims to describe a case of Balint syndrome who displayed all the three main neuropsychological features as a consequence of infarction in the watershed between the anterior and posterior cerebral artery territories. In this case report three days post stroke the clinical assessment showed a severe impairment in several visual spatial tasks (e.g. reading, writing, description of a visual scene, voluntary gaze-shift. Twelve weeks post-stroke the clinical assessment showed a significant improvement in reading, writing, as well as in verbal delayed recall processes, but only a mild improvement in visual spatial tasks like the description of a complex visual scene was registered. Balint’s syndrome is rare and is not easy to assess with standard clinical tools. The classical neurological examination evaluates in detail the senses, motility, balance, and to some extent language, but, sometimes, it is much less concerned with cognitive functions. The case discussed here is a good example of the need to emphasize that an acutely ill patient should also be accurately evaluated for the presence of cognitive and behavioural disturbances.

  8. [Serological and clinical proof of freedom from Equine Infectious Anemia (EIA) in imported and domestic horses in Switzerland].

    Science.gov (United States)

    Kaiser, A; Meier, H P; Doherr, M G; Perler, L; Zanoni, R; Gerber, V

    2009-04-01

    Since 1991, no cases of Equine Infectious Anemia (EIA) have been reported in Switzerland. Risk factors for introduction of the virus into Switzerland are still present or have even increased as frequent inapparent infections, large numbers of imported horses, (since 2003) absence of compulsory testing prior to importation, EIA cases in surrounding Europe, possible illegal importation of horses, frequent short-term stays, poor knowledge of the disease among horse owners and even veterinarians. The aim of this study was to provide evidence of freedom from EIA in imported and domestic horses in Switzerland. The serum samples from 434 horses imported since 2003 as well as from 232 domestic horses fifteen years of age or older (since older horses have naturally had a longer time of being exposed to the risk of infection) were analysed using a commercially available ELISA test. All samples were seronegative, indicating that the maximum possible prevalence that could have been missed with this sample was 0.5% (95% confidence).

  9. The clinical and virological features of the first imported case causing MERS-CoV outbreak in South Korea, 2015.

    Science.gov (United States)

    Lee, Ji Yeon; Kim, You-Jin; Chung, Eun Hee; Kim, Dae-Won; Jeong, Ina; Kim, Yeonjae; Yun, Mi-Ran; Kim, Sung Soon; Kim, Gayeon; Joh, Joon-Sung

    2017-07-14

    In 2015, the largest outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infection outside the Middle East occurred in South Korea. We summarized the epidemiological, clinical, and laboratory findings of the first Korean case of MERS-CoV and analyzed whole-genome sequences of MERS-CoV derived from the patient. A 68-year-old man developed fever and myalgia 7 days after returning to Korea, following a 10-day trip to the Middle East. Before diagnosis, he visited 4 hospitals, potentially resulting in secondary transmission to 28 patients. On admission to the National Medical Center (day 9, post-onset of clinical illness), he presented with drowsiness, hypoxia, and multiple patchy infiltrations on the chest radiograph. He was intubated (day 12) because of progressive acute respiratory distress syndrome (ARDS) and INF-α2a and ribavirin treatment was commenced. The treatment course was prolonged by superimposed ventilator associated pneumonia. MERS-CoV PCR results converted to negative from day 47 and the patient was discharged (day 137), following rehabilitation therapy. The complete genome sequence obtained from a sputum sample (taken on day 11) showed the highest sequence similarity (99.59%) with the virus from an outbreak in Riyadh, Saudi Arabia, in February 2015. The first case of MERS-CoV infection had high transmissibility and was associated with a severe clinical course. The patient made a successful recovery after early treatment with antiviral agents and adequate supportive care. This first case in South Korea became a super-spreader because of improper infection control measures, rather than variations of the virus.

  10. A Pilot Study Exploring the Plasma Potassium Variation in Dogs Undergoing Steroid Therapy and Its Clinical Importance.

    Science.gov (United States)

    Baltar, Marina; Costa, Alexandra; Carreira, L Miguel

    2016-06-01

    In most situations in veterinary medicine, glucocorticoids are the drugs of choice used, that is, to reduce the inflammatory response or limit an inappropriate immune response. Their use in long-term therapy may cause side effects that may weaken the patient. The aim of the study was to evaluate possible variations in the plasma potassium concentrations and their clinical relevance in dogs undergoing steroid therapy with methylprednisolone in anti-inflammatory doses. The study used a sample of 21 dogs (n = 21) presented for consultation, with a clinical condition requiring a corticosteroid therapeutic protocol with an anti-inflammatory dose of methylprednisolone. All the individuals were submitted to a corticosteroid therapeutic protocol administered orally during 18 days. During this period, 3 time points were considered: T0 (the day the prescription was first given), T1 (3 days later), and T2 (8 days later). Blood samples were collected from a peripheral vein to measure plasma potassium concentrations in T0, T1, and T2. Corticosteroid therapy on an outpatient basis statistically significantly decreased plasma potassium levels, especially between T1 and T2 (P = .03). The plasma potassium levels decreased in 12.5% of the males, compared with a decrease of 23.1% in the females. No statistically significant relationships were observe between the decreased plasma potassium levels and age, clinical condition, and patient׳s body weight. However, we found a statistically significant association between decreased plasma potassium levels and sex. The study results may justify the need for the systematic prescription of potassium supplements in patients undergoing steroid therapy, similar to what already occurs in human medicine. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Technical Note: Display window setting: An important factor for detecting subtle but clinically relevant artifacts in daily CT quality control.

    Science.gov (United States)

    Long, Zaiyang; Bruesewitz, Michael R; Sheedy, Emily N; Powell, Michele A; Kramer, Jacqualynn C; Supalla, Randall R; Colvin, Chance M; Bechel, Jessica R; Favazza, Christopher P; Kofler, James M; Leng, Shuai; McCollough, Cynthia H; Yu, Lifeng

    2016-12-01

    This study aimed to investigate the influence of display window setting on technologist performance detecting subtle but clinically relevant artifacts in daily computed tomography (CT) quality control (dQC) images. Fifty three sets of dQC images were retrospectively selected, including 30 sets without artifacts, and 23 with subtle but clinically relevant artifacts. They were randomized and shown to six CT technologists (two new and four experienced). Each technologist reviewed all images in each of two sessions, one with a display window width (WW) of 100 HU, which is currently recommended by the American College of Radiology, and the other with a narrow WW of 40 HU, both at a window level of 0 HU. For each case, technologists rated the presence of image artifacts based on a five point scale. The area under the receiver operating characteristic curve (AUC) was used to evaluate the artifact detection performance. At a WW of 100 HU, the AUC (95% confidence interval) was 0.658 (0.576, 0.740), 0.532 (0.429, 0.635), and 0.616 (0.543, 0.619) for the experienced, new, and all technologists, respectively. At a WW of 40 HU, the AUC was 0.768 (0.687, 0.850), 0.546 (0.433, 0.658), and 0.694 (0.619, 0.769), respectively. The performance significantly improved at WW of 40 HU for experienced technologists (p = 0.009) and for all technologists (p = 0.040). Use of a narrow display WW significantly improved technologists' performance in dQC for detecting subtle but clinically relevant artifacts as compared to that using a 100 HU display WW.

  12. Great Indoors Awards 2007

    Index Scriptorium Estoniae

    2007-01-01

    Hollandis Maastrichtis jagati 17. XI esimest korda rahvusvahelist auhinda The Great Indoors Award. Aasta sisekujundusfirmaks valiti Masamichi Katayama asutatud Wonderwall. Auhinna said veel Zaha Hadid, Heatherwick Studio, Ryui Nakamura Architects ja Item Idem

  13. Great Lakes Bathymetry

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Bathymetry of Lakes Michigan, Erie, Saint Clair, Ontario and Huron has been compiled as a component of a NOAA project to rescue Great Lakes lake floor geological and...

  14. A quantum-like model of homeopathy clinical trials: importance of in situ randomization and unblinding.

    Science.gov (United States)

    Beauvais, Francis

    2013-04-01

    The randomized controlled trial (RCT) is the 'gold standard' of modern clinical pharmacology. However, for many practitioners of homeopathy, blind RCTs are an inadequate research tool for testing complex therapies such as homeopathy. Classical probabilities used in biological sciences and in medicine are only a special case of the generalized theory of probability used in quantum physics. I describe homeopathy trials using a quantum-like statistical model, a model inspired by quantum physics and taking into consideration superposition of states, non-commuting observables, probability interferences, contextuality, etc. The negative effect of blinding on success of homeopathy trials and the 'smearing effect' ('specific' effects of homeopathy medicine occurring in the placebo group) are described by quantum-like probabilities without supplementary ad hoc hypotheses. The difference of positive outcome rates between placebo and homeopathy groups frequently vanish in centralized blind trials. The model proposed here suggests a way to circumvent such problems in masked homeopathy trials by incorporating in situ randomization/unblinding. In this quantum-like model of homeopathy clinical trials, success in open-label setting and failure with centralized blind RCTs emerge logically from the formalism. This model suggests that significant differences between placebo and homeopathy in blind RCTs would be found more frequently if in situ randomization/unblinding was used. Copyright © 2013. Published by Elsevier Ltd.

  15. Distribution-based estimates of minimum clinically important difference in cognition, arm function and lower body function after slow release-fampridine treatment of patients with multiple sclerosis

    DEFF Research Database (Denmark)

    Jensen, H B; Mamoei, Sepehr; Ravnborg, M.

    2016-01-01

    OBJECTIVE: To provide distribution-based estimates of the minimal clinical important difference (MCID) after slow release fampridine treatment on cognition and functional capacity in people with MS (PwMS). METHOD: MCID values were determined after SR-Fampridine treatment in 105 PwMS. Testing...

  16. A cross-cultural convergent parallel mixed methods study of what makes a cancer-related symptom or functional health problem clinically important

    NARCIS (Netherlands)

    Giesinger, J.M.; Aaronson, N.K.; Arraras, J.I.; Efficace, F.; Groenvold, M.; Kieffer, J.M.; Loth, F.L.; Petersen, M.A.; Ramage, J.; Tomaszewski, K.A.; Young, T.; Holzner, B.

    2018-01-01

    Objective: In this study, we investigated what makes a symptom or functional impairment clinically important, that is, relevant for a patient to discuss with a health care professional (HCP). This is the first part of a European Organisation for Research and Treatment of Cancer (EORTC) Quality of

  17. The importance of clinical mistletoe cancer therapy and korean mistletoe pharmacopuncture preparation development and application possibility for oriental medicine

    Directory of Open Access Journals (Sweden)

    Ok-Byung Choi

    2009-03-01

    Full Text Available Objectives : Mistletoe extracts have been in use for around 85 years, predominantly in the area of cancer therapy. Today mistletoe preparations are among the most prescribed drugs in cancer medicine, thus constituting a standard biological therapy in the area of oncology. The purpose of this study is to analyze the practical implications of mistletoe cancer therapy, their clinical status, their preparation techniques and companies. Contents : Mistletoe therapy for cancer has been developed within the context of anthroposophical medicine. One major effect of mistletoe extract is that it stimulates the immune system and cancer defences. In Germany, a total of eight different mistletoe preparations are available, five developed by Anthroposophic Medicine and three evolved from research in phytotherapy. Therapy always consists of an introductory phase in order to test the patient′s tolerance, find the right dosage and choose the most suitable preparation. This paper covers the background of mistletoe medical plant materials, mistletoe therapy for cancer, the anthroposophical medicine and clinical research, the practical regulation of treatment, preparation of mistletoe drugs. Result & suggestion : Mistletoe extracts are a complementary teratment of cancer, widely used in intergrative cancer care. The study of the integration of korean mistletoe extracts to oriental cancer medicine, its development and feasibility in Korea are urgently needed. The products, substances, compositions of european mistletoe drugs are very similar to those of oriental medicine theory. Applying the mistletoe cancer therapy and its preparation techniques to oriental medicine, the herbal acupuncture preparation should be modernized and korean mistletoe products are to be developed. To this end, government and herbal acupuncture society need to interact each other for the development of oriental mistletoe cancer medicine.

  18. How common is clinically inactive disease in a prospective cohort of patients with juvenile idiopathic arthritis? The importance of definition.

    Science.gov (United States)

    Shoop-Worrall, Stephanie J W; Verstappen, Suzanne M M; Baildam, Eileen; Chieng, Alice; Davidson, Joyce; Foster, Helen; Ioannou, Yiannis; McErlane, Flora; Wedderburn, Lucy R; Thomson, Wendy; Hyrich, Kimme L

    2017-08-01

    Many criteria for clinically inactive disease (CID) and minimal disease activity (MDA) have been proposed for juvenile idiopathic arthritis (JIA). It is not known to what degree each of these criteria overlap within a single patient cohort. This study aimed to compare the frequency of MDA and CID across different criteria in a cohort of children with JIA at 1 year following presentation. The Childhood Arthritis Prospective Study recruits children at initial presentation to paediatric or adolescent rheumatology in seven UK centres. Children recruited between October 2001 and December 2013 were included. The proportions of children with CID and MDA at 1 year were calculated using four investigator-defined and eight published composite criteria. Missing data were accounted for using multiple imputation under different assumptions. In a cohort of 1415 children and adolescents, 67% patients had no active joints at 1 year. Between 48% and 61% achieved MDA and between 25% and 38% achieved CID using published criteria. Overlap between criteria varied. Of 922 patients in MDA by either the original composite criteria, Juvenile Arthritis Disease Activity Score (JADAS) or clinical JADAS cut-offs, 68% were classified as in MDA by all 3 criteria. Similarly, 44% of 633 children with CID defined by either Wallace's preliminary criteria or the JADAS cut-off were in CID according to both criteria. In a large JIA prospective inception cohort, a majority of patients have evidence of persistent disease activity after 1 year. Published criteria to capture MDA and CID do not always identify the same groups of patients. This has significant implications when defining and applying treat-to-target strategies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  19. Flomoxef showed excellent in vitro activity against clinically important gram-positive and gram-negative pathogens causing community- and hospital-associated infections.

    Science.gov (United States)

    Yang, Qiwen; Zhang, Hui; Cheng, Jingwei; Xu, Zhipeng; Hou, Xin; Xu, Yingchun

    2015-04-01

    The objective of this study was to better understand the in vitro activity of flomoxef against clinical pathogens. A total of 545 clinical isolates, including Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, methicillin-susceptible Staphylococcus aureus (MSSA), methicillin-resistant S. aureus, Streptococcus pneumoniae, and Streptococcus pyogenes, were isolated consecutively from clinical specimens from Peking Union Medical College Hospital in 2013. MICs were determined using broth microdilution method. esbl and ampC genes were detected by polymerase chain reaction and sequencing. Flomoxef showed excellent activity against E. coli, K. pneumoniae, and P. mirabilis isolates, with susceptibility rate of 88.8%, 88.3%, and 97.7%, separately. Moreover, flomoxef exhibited great activity against extended-spectrum beta-lactamase (ESBL) producers, with MIC50/MIC90 of 0.125/(0.5-1) μg/mL. Flomoxef showed MIC50/MIC90 of 0.5/0.5 μg/mL against MSSA, 0.125/0.25 μg/mL against S. pyogenes, and 2/16 μg/mL against S. pneumoniae. In conclusion, flomoxef is one of the cephamycins showing excellent activity against ESBL-producing or ESBL-nonproducing E. coli, K. pneumoniae, and P. mirabilis and was also potent against MSSA, S. pyogenes, and S. pneumoniae. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. The Clinical Importance of Perforator Preservation in Intracranial Aneurysm Surgery: An Overview with a Review of the Literature.

    Science.gov (United States)

    Joo, Sung-Pil; Kim, Tae-Sun

    2017-01-01

    Clipping for intracranial aneurysms is done to achieve complete occlusion of the aneurysm without a remnant sac. Despite modern advancements of neurosurgical techniques, morbidity related to the clipping of intracranial aneurysms still exists. Clip occlusion of a parent artery or small hidden perforators commonly leads to permanent neurological deficits, and is a serious and unwanted complication. Thus, preserving blood flow in the branches and perforators of a parent artery is very important for successful surgery without postoperative morbidity and mortality. The aim of this review article is to discuss the consequences of perforator injury and how to avoid this phenomenon in aneurysm surgeries using intraoperative monitoring devices.

  1. Southern Great Plains Safety Orientation

    Energy Technology Data Exchange (ETDEWEB)

    Schatz, John

    2014-05-01

    Welcome to the Atmospheric Radiation Measurement (ARM) Climate Research Facility (ARM) Southern Great Plains (SGP) site. This U.S. Department of Energy (DOE) site is managed by Argonne National Laboratory (ANL). It is very important that all visitors comply with all DOE and ANL safety requirements, as well as those of the Occupational Safety and Health Administration (OSHA), the National Fire Protection Association, and the U.S. Environmental Protection Agency, and with other requirements as applicable.

  2. The information sources and journals consulted or read by UK paediatricians to inform their clinical practice and those which they consider important: a questionnaire survey.

    Science.gov (United States)

    Jones, Teresa H; Hanney, Steve; Buxton, Martin J

    2007-01-15

    Implementation of health research findings is important for medicine to be evidence-based. Previous studies have found variation in the information sources thought to be of greatest importance to clinicians but publication in peer-reviewed journals is the traditional route for dissemination of research findings. There is debate about whether the impact made on clinicians should be considered as part of the evaluation of research outputs. We aimed to determine first which information sources are generally most consulted by paediatricians to inform their clinical practice, and which sources they considered most important, and second, how many and which peer-reviewed journals they read. We inquired, by questionnaire survey, about the information sources and academic journals that UK medical paediatric specialists generally consulted, attended or read and considered important to their clinical practice. The same three information sources--professional meetings & conferences, peer-reviewed journals and medical colleagues--were, overall, the most consulted or attended and ranked the most important. No one information source was found to be of greatest importance to all groups of paediatricians. Journals were widely read by all groups, but the proportion ranking them first in importance as an information source ranged from 10% to 46%. The number of journals read varied between the groups, but Archives of Disease in Childhood and BMJ were the most read journals in all groups. Six out of the seven journals previously identified as containing best paediatric evidence are the most widely read overall by UK paediatricians, however, only the two most prominent are widely read by those based in the community. No one information source is dominant, therefore a variety of approaches to Continuing Professional Development and the dissemination of research findings to paediatricians should be used. Journals are an important information source. A small number of key ones can be

  3. Diffuse sclerosing variant of papillary carcinoma of the thyroid. Clinical importance, surgical treatment, and follow-up study

    Energy Technology Data Exchange (ETDEWEB)

    Fujimoto, Y.; Obara, T.; Ito, Y.; Kodama, T.; Aiba, M.; Yamaguchi, K. (Tokyo Women' s Medical College (Japan))

    1990-12-01

    A diffuse sclerosing variant is not very rare among papillary carcinomas of the thyroid when the patients are female and younger than 30 years of age. The variant is characterized by diffuse involvement of one or both thyroid lobes, with dense sclerosis, patchy lymphocytic infiltration, and abundant psammoma bodies. Controversy still exists concerning its prognosis. We reviewed our experience with 14 patients treated between 1958 and 1988. All patients were young females, their age being from 10 to 28 years with a mean of 19.6. Hashimoto's thyroiditis had been suspected in nine patients before they came to our clinic. Nowadays the diagnosis of this cancer is possible when we have this entity in mind and detect abundant psammoma bodies either by ultrasonography or by soft-tissue roentgenography of the neck. Total thyroidectomy with modified neck dissection was carried out in eight patients, subtotal thyroidectomy with neck dissection in five, and lobectomy with neck dissection in one. All of them are alive and well without distant metastasis at a mean follow-up of 16 years. Because most of the patients with this variant of papillary carcinoma are young women and the prognosis is favorable, a complete resection without causing later recurrence, but also cosmetic and complication-free surgery, should be considered.

  4. Improving the accuracy of self-assessment of practical clinical skills using video feedback--the importance of including benchmarks.

    Science.gov (United States)

    Hawkins, S C; Osborne, A; Schofield, S J; Pournaras, D J; Chester, J F

    2012-01-01

    Isolated video recording has not been demonstrated to improve self-assessment accuracy. This study examines if the inclusion of a defined standard benchmark performance in association with video feedback of a student's own performance improves the accuracy of student self-assessment of clinical skills. Final year medical students were video recorded performing a standardised suturing task in a simulated environment. After the exercise, the students self-assessed their performance using global rating scales (GRSs). An identical self-assessment process was repeated following video review of their performance. Students were then shown a video-recorded 'benchmark performance', which was specifically developed for the study. This demonstrated the competency levels required to score full marks (30 points). A further self-assessment task was then completed. Students' scores were correlated against expert assessor scores. A total of 31 final year medical students participated. Student self-assessment scores before video feedback demonstrated moderate positive correlation with expert assessor scores (r = 0.48, p benchmark performance demonstration, self-assessment scores demonstrated a very strong positive correlation with expert scores (r = 0.83, p benchmark performance in combination with video feedback may significantly improve the accuracy of students' self-assessments.

  5. Fibrodysplasia ossificans progressiva (FOP): watch the great toes!

    Science.gov (United States)

    Kartal-Kaess, Mutlu; Shore, Eileen M; Xu, Meiqi; Schwering, Ludwig; Uhl, Markus; Korinthenberg, Rudolf; Niemeyer, Charlotte; Kaplan, Frederick S; Lauten, Melchior

    2010-11-01

    Fibrodysplasia ossificans progressiva (FOP) is a rare genetic disorder and the most disabling condition of heterotopic (extraskeletal) ossification in humans. Extraskeletal bone formation associated with inflammation preceding the osseous conversion usually begins in the first decade, predominantly in the head, neck, and shoulders. All patients have malformed great toes. Most patients have a spontaneous mutation of the ACVR1 gene. We report a 17-year-old girl with malformed great toes who had her first episode of heterotopic ossification and impaired mobility of the left hip at the age of 13 years. No inflammatory fibroproliferative masses preceded the onset of heterotopic ossification. Radiographic studies demonstrated myositis ossificans, but failure to associate the great toe malformation with heterotopic ossification led to a failure to diagnose FOP. She underwent repeated and unnecessary operative procedures to remove a recurrent lesion. FOP was finally suspected when the great toe malformation was correlated with the trauma-induced heterotopic ossification. Genetic analysis confirmed the presence of the classic FOP mutation (ACVR1 c.617G>A; R206H). This case highlights the importance of examining the great toes in anyone with heterotopic ossification. The association of malformations of the great toe with heterotopic ossification in all cases of classic FOP will lead to prompt clinical diagnosis and the prevention of iatrogenic harm.

  6. Medical physics in radiotherapy: The importance of preserving clinical responsibilities and expanding the profession's role in research, education, and quality control.

    Science.gov (United States)

    Malicki, Julian

    2015-01-01

    Medical physicists have long had an integral role in radiotherapy. In recent decades, medical physicists have slowly but surely stepped back from direct clinical responsibilities in planning radiotherapy treatments while medical dosimetrists have assumed more responsibility. In this article, I argue against this gradual withdrawal from routine therapy planning. It is essential that physicists be involved, at least to some extent, in treatment planning and clinical dosimetry for each and every patient; otherwise, physicists can no longer be considered clinical specialists. More importantly, this withdrawal could negatively impact treatment quality and patient safety. Medical physicists must have a sound understanding of human anatomy and physiology in order to be competent partners to radiation oncologists. In addition, they must possess a thorough knowledge of the physics of radiation as it interacts with body tissues, and also understand the limitations of the algorithms used in radiotherapy. Medical physicists should also take the lead in evaluating emerging challenges in quality and safety of radiotherapy. In this sense, the input of physicists in clinical audits and risk assessment is crucial. The way forward is to proactively take the necessary steps to maintain and advance our important role in clinical medicine.

  7. Medical physics in radiotherapy: The importance of preserving clinical responsibilities and expanding the profession's role in research, education, and quality control

    Science.gov (United States)

    Malicki, Julian

    2015-01-01

    Medical physicists have long had an integral role in radiotherapy. In recent decades, medical physicists have slowly but surely stepped back from direct clinical responsibilities in planning radiotherapy treatments while medical dosimetrists have assumed more responsibility. In this article, I argue against this gradual withdrawal from routine therapy planning. It is essential that physicists be involved, at least to some extent, in treatment planning and clinical dosimetry for each and every patient; otherwise, physicists can no longer be considered clinical specialists. More importantly, this withdrawal could negatively impact treatment quality and patient safety. Medical physicists must have a sound understanding of human anatomy and physiology in order to be competent partners to radiation oncologists. In addition, they must possess a thorough knowledge of the physics of radiation as it interacts with body tissues, and also understand the limitations of the algorithms used in radiotherapy. Medical physicists should also take the lead in evaluating emerging challenges in quality and safety of radiotherapy. In this sense, the input of physicists in clinical audits and risk assessment is crucial. The way forward is to proactively take the necessary steps to maintain and advance our important role in clinical medicine. PMID:25949219

  8. Atypical Clinical Presentation of Xeroderma Pigmentosum in a Patient Harboring a Novel Missense Mutation in the XPC Gene: The Importance of Clinical Suspicion.

    Science.gov (United States)

    Meneses, Marina; Chavez-Bourgeois, Marion; Badenas, Celia; Villablanca, Salvador; Aguilera, Paula; Bennàssar, Antoni; Alos, Llucia; Puig, Susana; Malvehy, Josep; Carrera, Cristina

    2015-01-01

    Xeroderma pigmentosum (XP) is a genodermatosis caused by abnormal DNA repair. XP complementation group C (XPC) is the most frequent type in Mediterranean countries. We describe a case with a novel mutation in the XPC gene. A healthy Caucasian male patient was diagnosed with multiple primary melanomas. Digital follow-up and molecular studies were carried out. During digital follow-up 8 more additional melanomas were diagnosed. Molecular studies did not identify mutations in CDKN2A, CDK4 or MITF genes. Two heterozygous mutations in the XPC gene were detected: c.2287delC (p.Leu763Cysfs*4) frameshift and c.2212A>G (p.Thr738Ala) missense mutations. The p.Thr738Ala missense mutation has not been previously described. Missense mutations in the XPC gene may allow partial functionality that could explain this unusual late onset XP. Atypical clinical presentation of XPC could be misdiagnosed when genetic aberrations allow partial DNA repair capacity. © 2015 S. Karger AG, Basel.

  9. The GREAT3 challenge

    International Nuclear Information System (INIS)

    Miyatake, H; Mandelbaum, R; Rowe, B

    2014-01-01

    The GRavitational lEnsing Accuracy Testing 3 (GREAT3) challenge is an image analysis competition that aims to test algorithms to measure weak gravitational lensing from astronomical images. The challenge started in October 2013 and ends 30 April 2014. The challenge focuses on testing the impact on weak lensing measurements of realistically complex galaxy morphologies, realistic point spread function, and combination of multiple different exposures. It includes simulated ground- and space-based data. The details of the challenge are described in [1], and the challenge website and its leader board can be found at http://great3challenge.info and http://great3.projects.phys.ucl.ac.uk/leaderboard/, respectively

  10. The importance of the concepts of disaster, catastrophe, violence, trauma and barbarism in defining posttraumatic stress disorder in clinical practice

    Directory of Open Access Journals (Sweden)

    Mello Marcelo F

    2008-08-01

    Full Text Available Abstract Background Several terms in the scientific literature about posttraumatic stress disorder are used with different meanings in studies conducted by different authors. Words such as trauma, violence, catastrophe, disaster and barbarism are often used vaguely or confusingly, and their meanings change in different articles. The lack of conceptual references for these expressions complicates the organization of literature. Furthermore, the absence of clear concepts may be an obstacle to clinical treatment because the use of these words by the patients does not necessarily point to a diagnosis of posttraumatic stress disorder. Discussion A critical review of scientific literature showed that stress can be divided in stages to facilitate specific terminological adjustments to the event itself, to the subject-event interaction and to psychological responses. Moreover, it demonstrated that the varying concept of trauma expands into fundamental psychotherapeutic definitions and that the meanings of violence associated with barbarism are an obstacle to resilience. Therefore, this study updates the etymological origins and applications of these words, connects them to the expansions of meanings that can be operated in the clinical care of patients with posttraumatic stress disorder, and analyzes them critically according to the criterion A of DSM-IV and ICD-10. Summary The terminology in the literature about posttraumatic stress disorder includes a plethora of terms whose meanings are not fully understood, and that, therefore, limit this terminology. The analysis of these terms suggested that the transformation of the concept of trauma led to a broader understanding of this phenomenon in its psychic dimensions, that a barbarian type of violence constitutes an obstacle to resilience, and that the criterion A of the DSM-IV and ICD-10 shows imprecision and conceptual fragilities. Methods To develop this debate article, a current specialized literature

  11. The importance of the concepts of disaster, catastrophe, violence, trauma and barbarism in defining posttraumatic stress disorder in clinical practice.

    Science.gov (United States)

    Braga, Luciana L; Fiks, Jose P; Mari, Jair J; Mello, Marcelo F

    2008-08-12

    Several terms in the scientific literature about posttraumatic stress disorder are used with different meanings in studies conducted by different authors. Words such as trauma, violence, catastrophe, disaster and barbarism are often used vaguely or confusingly, and their meanings change in different articles. The lack of conceptual references for these expressions complicates the organization of literature. Furthermore, the absence of clear concepts may be an obstacle to clinical treatment because the use of these words by the patients does not necessarily point to a diagnosis of posttraumatic stress disorder. A critical review of scientific literature showed that stress can be divided in stages to facilitate specific terminological adjustments to the event itself, to the subject-event interaction and to psychological responses. Moreover, it demonstrated that the varying concept of trauma expands into fundamental psychotherapeutic definitions and that the meanings of violence associated with barbarism are an obstacle to resilience. Therefore, this study updates the etymological origins and applications of these words, connects them to the expansions of meanings that can be operated in the clinical care of patients with posttraumatic stress disorder, and analyzes them critically according to the criterion A of DSM-IV and ICD-10. The terminology in the literature about posttraumatic stress disorder includes a plethora of terms whose meanings are not fully understood, and that, therefore, limit this terminology. The analysis of these terms suggested that the transformation of the concept of trauma led to a broader understanding of this phenomenon in its psychic dimensions, that a barbarian type of violence constitutes an obstacle to resilience, and that the criterion A of the DSM-IV and ICD-10 shows imprecision and conceptual fragilities. To develop this debate article, a current specialized literature review was achieved by searching and retrieving the key terms from

  12. Long term outcomes following achievement of clinically inactive disease in juvenile idiopathic arthritis: the importance of definition.

    Science.gov (United States)

    Shoop-Worrall, Stephanie Jw; Verstappen, Suzanne Mm; McDonagh, Janet E; Baildam, Eileen; Chieng, Alice; Davidson, Joyce; Foster, Helen; Ioannou, Yiannis; McErlane, Flora; Wedderburn, Lucy R; Thomson, W; Hyrich, Kimme L

    2018-04-12

    Potential targets for treat-to-target strategies in JIA are minimal disease activity (MDA) and clinically inactive disease (CID). Short and long-term outcomes following achievement of MDA and CID on the cJADAS10 and CID on Wallace's preliminary criteria were compared. Children recruited to the Childhood Arthritis Prospective Study, a UK multicentre inception cohort, were selected if recruited prior to January 2011 and diagnosed with oligoarthritis or rheumatoid factor negative or positive polyarthritis. At one year following diagnosis, children were assessed for MDA on the cJADAS10 and CID on both Wallace's preliminary criteria and the cJADAS10. Associations were tested between these disease states and i) functional ability, ii) absence of limited joints, iii) psychosocial health and v) pain at one year and annually to five years. Of 832 children, 70% were female and the majority had oligoarthritis (68%). At one year, 21% had achieved CID according to both definitions, 7% on Wallace's preliminary criteria only, 16% on cJADAS10 only and 56% on neither. Only 10% of children in the entire cohort achieved MDA without also having CID. Achieving either early CID state was associated with greater absence of limited joints. However, only CID on cJADAS10 was associated with improved functional ability and psychosocial health. Achieving CID was superior to MDA in terms of short and long-term pain and the absence of limited joints. CID on the cJADAS10 may be a preferable treatment target to CID on Wallace's preliminary criteria in terms of both feasibility of application and long-term outcomes. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  13. Nothing Great Is Easy

    OpenAIRE

    Stansbie, Lisa

    2014-01-01

    A solo exhibition of 13 pieces of art work.\\ud \\ud Nothing Great is Easy is an exhibition of sculpture, film, drawing and photography that proposes reconstructed narratives using the sport of swimming and in particular the collective interaction and identity of the channel swimmer. The work utilises the processes, rituals/rules, language and the apparatus of sport.\\ud \\ud “Nothing great is easy” are the words on the memorial to Captain Matthew Webb who was the first man to swim the English ch...

  14. [Biological markers for the status of vitamins B12 and D: the importance of some analytical aspects in relation to clinical interpretation of results].

    Science.gov (United States)

    Boulat, O; Rey, F; Mooser, V

    2012-10-31

    Biological markers for the status of vitamins B12 and D: the importance of some analytical aspects in relation to clinical interpretation of results When vitamin B12 deficiency is expressed clinically, the diagnostic performance of total cobalamin is identical to that of holotranscobalamin II. In subclinical B12 deficiency, the two aforementioned markers perform less well. Additional analysis of a second, functional marker (methylmalonate or homocysteine) is recommended. Different analytical approaches for 25-hydroxyvitamin D quantification, the marker of vitamin D deficiency, are not yet standardized. Measurement biases of up to +/- 20% compared with the original method used to establish threshold values are still observed.

  15. [Importance of Post-Marketing Studies in Gathering of Clinical Evidences for Proper Usage of Anti-Cancer Drugs, and the StudyRequirements for Their Credibility].

    Science.gov (United States)

    Inagaki, Osamu

    2016-04-01

    Pharmaceutical companies recognize the importance of post-marketing studies because they are crucial in the generation of clinical evidences for the usage of new medicines. To generate clinical evidences, quality of post-marketing studies should be well controlled from view point of "ethical conduction" and "reliability of results". In addition, control of conflict of interest (COI) between researchers and industries is also indispensable and is requested for the transparency of the studies. Japan Pharmaceutical Manufacturers Association(JPMA)stresses its commitment to the progressof transparency in post-marketing studies.

  16. Credit spread variability in U.S. business cycles: the Great Moderation versus the Great Recession

    OpenAIRE

    Hylton Hollander; Guangling Liu

    2014-01-01

    This paper establishes the prevailing financial factors that influence credit spread variability, and its impact on the U.S. business cycle over the Great Moderation and Great Recession periods. To do so, we develop a dynamic general equilibrium framework with a central role of financial intermediation and equity assets. Over the Great Moderation and Great Recession periods, we find an important role for bank market power (sticky rate adjustments and loan rate markups) on credit spread variab...

  17. Credit spread variability in U.S. business cycles: The Great Moderation versus the Great Recession

    OpenAIRE

    Hylton Hollander and Guangling Liu

    2014-01-01

    This paper establishes the prevailing financial factors that influence credit spread variability, and its impact on the U.S. business cycle over the Great Moderation and Great Recession periods. To do so, we develop a dynamic general equilibrium framework with a central role of financial intermediation and equity assets. Over the Great Moderation and Great Recession periods, we find an important role for bank market power (sticky rate adjustments and loan rate markups) on credit spread variab...

  18. Importance of Metastatic Lymph Node Ratio in Non-Metastatic, Lymph Node-Invaded Colon Cancer: A Clinical Trial

    Science.gov (United States)

    Isik, Arda; Peker, Kemal; Firat, Deniz; Yilmaz, Bahri; Sayar, Ilyas; Idiz, Oguz; Cakir, Coskun; Demiryilmaz, Ismail; Yilmaz, Ismayil

    2014-01-01

    Background The aim of this study was to evaluate the prognostic importance of the metastatic lymph node ratio for stage III colon cancer patients and to find a cut-off value at which the overall survival and disease-free survival change. Material/Methods Patients with pathological stage III colon cancer were retrospectively evaluated for: age; preoperative values of Crp, Cea, Ca 19-9, and Afp; pathologic situation of vascular, perineural, lymphatic, and serosal involvement; and metastatic lymph node ratio values were calculated. Results The study included 58 stage III colon cancer patients: 20 (34.5%) females and 38 (65.5%) males were involved in the study. Multivariate analysis was applied to the following variables to evaluate significance for overall survival and disease-free survival: age, Crp, Cea, perineural invasion, and metastatic lymph node ratio. The metastatic lymph node ratio (<0.25 or ≥0.25) is the only independent variable significant for overall and disease-free survival. Conclusions Metastatic lymph node ratio is an ideal prognostic marker for stage III colon cancer patients, and 0.25 is the cut-off value for prognosis. PMID:25087904

  19. Effect of Erica sp. Honey against Microorganisms of Clinical Importance: Study of the Factors Underlying this Biological Activity

    Directory of Open Access Journals (Sweden)

    Leticia M. Estevinho

    2013-04-01

    Full Text Available This study aimed to determine the factors (phenolic compounds, flavonoids, sugars or H2O2 that contribute the most to the antimicrobial activity of heather honey samples against four yeasts and four bacteria with medical importance. To discard the effect of H2O2 in the antimicrobial activity, catalase was added. To evaluate the osmotic pressure’s effect, artificial honey was also used. Phenolic compounds and flavonoids were determined and Pearson’s correlation analysis was performed to assess whether these correlated with antimicrobial activity. The amount of phenolic compounds ranged from 630.89 ± 5.21 GAE kg−1 to 718.92 ± 4.41 GAE kg−1, while the flavonoids varied between 450.72 ± 5.67 CAE kg−1 and 673.98 ± 4.33 CAE kg−1. For the bacteria, the minimum inhibitory concentration (MIC of the honey without catalase ranged from 1.01 ± 0.50% to 10.00 ± 4.72% and was between 2.00 ± 0.94% and 13.27 ± 5.23% for honey with catalase. Concerning the yeasts, the MICs was between 13.16 ± 4.08% and 20.00 ± 5.09% for honey without catalase and between 14.95 ± 4.16% and 25.67 ± 5.50% for honey with catalase. The elucidation of the antimicrobial factors and action mechanisms is essential for the correct use of honey in therapeutic applications.

  20. The Great Mathematician Project

    Science.gov (United States)

    Goldberg, Sabrina R.

    2013-01-01

    The Great Mathematician Project (GMP) introduces both mathematically sophisticated and struggling students to the history of mathematics. The rationale for the GMP is twofold: first, mathematics is a uniquely people-centered discipline that is used to make sense of the world; and second, students often express curiosity about the history of…

  1. What great managers do.

    Science.gov (United States)

    Buckingham, Marcus

    2005-03-01

    Much has been written about the qualities that make a great manager, but most of the literature overlooks a fundamental question: What does a great manager actually do? While there are countless management styles, one thing underpins the behavior of all great managers. Above all, an exceptional manager comes to know and value the particular quirks and abilities of her employees. She figures out how to capitalize on her staffers' strengths and tweaks her environment to meet her larger goals. Such a specialized approach may seem like a lot of work. But in fact, capitalizing on each person's uniqueness can save time. Rather than encourage employees to conform to strict job descriptions that may include tasks they don't enjoy and aren't good at, a manager who develops positions for his staff members based on their unique abilities will be rewarded with behaviors that are far more efficient and effective than they would be otherwise. This focus on individuals also makes employees more accountable. Because staffers are evaluated on their particular strengths and weaknesses, they are challenged to take responsibility for their abilities and to hone them. Capitalizing on a person's uniqueness also builds a stronger sense of team. By taking the time to understand what makes each employee tick, a great manager shows that he sees his people for who they are. This personal investment not only motivates individuals but also galvanizes the entire team. Finally, this approach shakes up existing hierarchies, which leads to more creative thinking. To take great managing from theory to practice, the author says, you must know three things about a person: her strengths, the triggers that activate those strengths, and how she learns. By asking the right questions, squeezing the right triggers, and becoming aware of your employees' learning styles, you will discover what motivates each person to excel.

  2. Minimal clinically important improvement (MCII) and patient-acceptable symptom state (PASS) in total hip arthroplasty (THA) patients 1 year postoperatively

    DEFF Research Database (Denmark)

    Paulsen, Aksel; Roos, Ewa M.; Pedersen, Alma Becic

    2014-01-01

    -55% improvement from mean baseline PRO score and PASSs corresponded to absolute follow-up scores of 57-91% of the maximum score in THA patients 1 year after surgery. Interpretation - This study improves the interpretability of PRO scores. The different estimation approaches presented may serve as a guide......Background and purpose - The increased use of patient-reported outcomes (PROs) in orthopedics requires data on estimated minimal clinically important improvements (MCIIs) and patient-acceptable symptom states (PASSs). We wanted to find cut-points corresponding to minimal clinically important PRO...... change score and the acceptable postoperative PRO score, by estimating MCII and PASS 1 year after total hip arthroplasty (THA) for the Hip Dysfunction and Osteoarthritis Outcome Score (HOOS) and the EQ-5D. Patients and methods - THA patients from 16 different departments received 2 PROs and additional...

  3. The Importance of Integrating Clinical Relevance and Statistical Significance in the Assessment of Quality of Care--Illustrated Using the Swedish Stroke Register.

    Directory of Open Access Journals (Sweden)

    Anita Lindmark

    Full Text Available When profiling hospital performance, quality inicators are commonly evaluated through hospital-specific adjusted means with confidence intervals. When identifying deviations from a norm, large hospitals can have statistically significant results even for clinically irrelevant deviations while important deviations in small hospitals can remain undiscovered. We have used data from the Swedish Stroke Register (Riksstroke to illustrate the properties of a benchmarking method that integrates considerations of both clinical relevance and level of statistical significance.The performance measure used was case-mix adjusted risk of death or dependency in activities of daily living within 3 months after stroke. A hospital was labeled as having outlying performance if its case-mix adjusted risk exceeded a benchmark value with a specified statistical confidence level. The benchmark was expressed relative to the population risk and should reflect the clinically relevant deviation that is to be detected. A simulation study based on Riksstroke patient data from 2008-2009 was performed to investigate the effect of the choice of the statistical confidence level and benchmark value on the diagnostic properties of the method.Simulations were based on 18,309 patients in 76 hospitals. The widely used setting, comparing 95% confidence intervals to the national average, resulted in low sensitivity (0.252 and high specificity (0.991. There were large variations in sensitivity and specificity for different requirements of statistical confidence. Lowering statistical confidence improved sensitivity with a relatively smaller loss of specificity. Variations due to different benchmark values were smaller, especially for sensitivity. This allows the choice of a clinically relevant benchmark to be driven by clinical factors without major concerns about sufficiently reliable evidence.The study emphasizes the importance of combining clinical relevance and level of statistical

  4. The Importance of Integrating Clinical Relevance and Statistical Significance in the Assessment of Quality of Care--Illustrated Using the Swedish Stroke Register.

    Science.gov (United States)

    Lindmark, Anita; van Rompaye, Bart; Goetghebeur, Els; Glader, Eva-Lotta; Eriksson, Marie

    2016-01-01

    When profiling hospital performance, quality inicators are commonly evaluated through hospital-specific adjusted means with confidence intervals. When identifying deviations from a norm, large hospitals can have statistically significant results even for clinically irrelevant deviations while important deviations in small hospitals can remain undiscovered. We have used data from the Swedish Stroke Register (Riksstroke) to illustrate the properties of a benchmarking method that integrates considerations of both clinical relevance and level of statistical significance. The performance measure used was case-mix adjusted risk of death or dependency in activities of daily living within 3 months after stroke. A hospital was labeled as having outlying performance if its case-mix adjusted risk exceeded a benchmark value with a specified statistical confidence level. The benchmark was expressed relative to the population risk and should reflect the clinically relevant deviation that is to be detected. A simulation study based on Riksstroke patient data from 2008-2009 was performed to investigate the effect of the choice of the statistical confidence level and benchmark value on the diagnostic properties of the method. Simulations were based on 18,309 patients in 76 hospitals. The widely used setting, comparing 95% confidence intervals to the national average, resulted in low sensitivity (0.252) and high specificity (0.991). There were large variations in sensitivity and specificity for different requirements of statistical confidence. Lowering statistical confidence improved sensitivity with a relatively smaller loss of specificity. Variations due to different benchmark values were smaller, especially for sensitivity. This allows the choice of a clinically relevant benchmark to be driven by clinical factors without major concerns about sufficiently reliable evidence. The study emphasizes the importance of combining clinical relevance and level of statistical confidence when

  5. Social capital among healthcare professionals: A prospective study of its importance for job satisfaction, work engagement and engagement in clinical improvements.

    Science.gov (United States)

    Strömgren, Marcus; Eriksson, Andrea; Bergman, David; Dellve, Lotta

    2016-01-01

    Social capital can be an important resource to facilitate the needed improvements in quality of care and efficiency in hospitals. To assess the importance of social capital (recognition, vertical trust, horizontal trust and reciprocity) for job satisfaction, work engagement and engagement in clinical improvements. A prospective cohort design was used. Intensive care units and emergency, surgical and medical units at five Swedish hospitals with ongoing development of their processes of care. Healthcare professionals (physicians, registered nurses, assistant nurses) at five Swedish midsize hospitals. The participants answered a questionnaire at two occasions, NN=1602 at baseline and NN=1548 at one-year follow-up. Mean hospital response rate was 53% at baseline and 59% at follow-up. Univariate, multivariate and logistic regression analyses were performed, and the prospective analysis was based on 477 respondents. Social capital was associated with healthcare professionals' general work engagement and job satisfaction. Analysis showed positive associations between all measured aspects of social capital and engagement in clinical improvements of patient safety and quality of care. The prospective analysis showed that increased social capital predicted increased job satisfaction, work engagement and engagement in clinical improvements of patient safety. Social capital is strongly related to job satisfaction and active engagement with clinical improvements. The findings contribute to a deeper knowledge of social capital as a predictive factor that influences patient safety and health among healthcare staff. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Defining patient-based minimal clinically important effect sizes: a study in palliative radiotherapy for painful unresectable pelvic recurrences from rectal cancer

    International Nuclear Information System (INIS)

    Wong, Rebecca K.S.; Gafni, Amiram; Whelan, Tim; Franssen, Edmee; Fung, Karen

    2002-01-01

    Purpose: To measure patient-based minimal clinically important effect sizes (minimal incremental benefit that an individual would require to accept one treatment option over another) for pain relief between two contrasting palliative radiotherapy regimens for painful pelvic recurrences from rectal cancer. Methods and Materials: Forty-three patients with a history of cancer pain without prior pelvic radiotherapy participated in decision aid-facilitated trade-off exercises. The clinical scenario and treatment options of a 5-day vs. a 20-day course of radiotherapy were described. The duration of pain relief for the 20-day regimen was increased until the respondents' preferences switched to the 20-day regimen. The exercises were repeated for different probabilities of benefit and pain intensity at the time of decision making. Results: When the probability of pain relief was unchanged, the median switch point for the duration of pain relief was 6.7 and 7.2 months for severe and mild pain, respectively. The cumulative percentage frequency curve for the switch points approximated a sigmoid distribution. Conclusion: Determining the minimal clinically important effect sizes for symptom relief for palliative therapies is feasible. This type of information can be used to incorporate patient values into clinical trial designs. Modification of this method can be used to improve our understanding of shared (physician and patient) decision making

  7. A importância da qualidade da água reagente no laboratório clínico The importance of water quality in clinical laboratory reagent

    Directory of Open Access Journals (Sweden)

    Maria Elizabete Mendes

    2011-06-01

    Full Text Available A água é um reagente utilizado na maioria dos testes laboratoriais e por isso deve seguir um padrão de controle de qualidade rigoroso. O fornecimento urbano de água apresenta moléculas orgânicas, íons inorgânicos, partículas, coloides, gases, bactérias e seus produtos, que podem alterar os resultados dos exames laboratoriais e causar eventuais erros e falhas mecânicas em equipamentos analíticos. Para remover essas impurezas, é necessário recorrer a uma combinação de tecnologias de purificação. Há várias organizações que especificam normas sobre a água reagente, a fim de minimizar sua interferência nos ensaios laboratoriais. A maioria dos laboratórios utiliza as normas estabelecidas pelo Clinical and Laboratory Standards Institute (CLSI que classifica a água em: clinical laboratory reagent water (CLRW, special reagent water (SRW e instrumental feed water (IFW. O monitoramento da qualidade é realizado pela determinação de resistividade, condutividade, carbono orgânico total (TOC, controle microbiológico e endotoxinas. Os parâmetros são avaliados de acordo com a periodicidade estabelecida pela norma utilizada. Neste artigo, discutem-se a importância da água utilizada nos procedimentos laboratoriais, o controle da qualidade e as interferências nos ensaios laboratoriais.Water is a reagent used in most laboratory tests and, therefore, must follow stringent quality control standards. The urban water supply has organic molecules, inorganic ions, particles, colloids, gases, bacteria and their products, which may alter laboratory test results and cause occasional errors and mechanical failures in diagnostic equipment. To remove these impurities, it is necessary to use a combination of purification technologies. There are several organizations that specify reagent water standards to minimize its interference in laboratory assays. Most laboratories set standards established by the Clinical and Laboratory Standards

  8. Temporo-mandibular disorders are an important comorbidity of migraine and may be clinically difficult to distinguish them from tension-type headache

    Directory of Open Access Journals (Sweden)

    Ariovaldo Alberto da Silva Júnior

    2014-02-01

    Full Text Available Clinical differentiation between the primary headaches and temporomandibular disorders (TMD can be challenging. Objectives : To investigate the relationship between TMD and primary headaches by conducting face to face assessments in patients from an orofacial pain clinic and a headache tertiary center. Method : Sample consists of 289 individuals consecutively identified at a headache center and 78 individuals seen in an orofacial pain clinic because of symptoms suggestive of TMD. Results : Migraine was diagnosed in 79.8% of headache sufferers, in headache tertiary center, and 25.6% of those in orofacial pain clinic (p<0.001. Tension-type headache was present in 20.4% and 46.1%, while the TMD painful occurred in 48.1% and 70.5% respectively (p<0.001. Conclusion : TMD is an important comorbidity of migraine and difficult to distinguish clinically from tension-type headache, and this headache was more frequent in the dental center than at the medical center.

  9. Great magnetic storms

    International Nuclear Information System (INIS)

    Tsurutani, B.T.; Yen Te Lee; Tang, F.; Gonzalez, W.D.

    1992-01-01

    The five largest magnetic storms that occurred between 1971 and 1986 are studied to determine their solar and interplanetary causes. All of the events are found to be associated with high speed solar wind streams led by collisionless shocks. The high speed streams are clearly related to identifiable solar flares. It is found that (1) it is the extreme values of the southward interplanetary magnetic fields rather than solar wind speeds that are the primary causes of great magnetic storms, (2) shocked and draped sheath fields preceding the driver gas (magnetic cloud) are at least as effective in causing the onset of great magnetic storms (3 of 5 events ) as the strong fields within the driver gas itself, and (3) precursor southward fields ahead of the high speed streams allow the shock compression mechanism (item 2) to be particularly geoeffective

  10. The great intimidators.

    Science.gov (United States)

    Kramer, Roderick M

    2006-02-01

    After Disney's Michael Eisner, Miramax's Harvey Weinstein, and Hewlett-Packard's Carly Fiorina fell from their heights of power, the business media quickly proclaimed thatthe reign of abrasive, intimidating leaders was over. However, it's premature to proclaim their extinction. Many great intimidators have done fine for a long time and continue to thrive. Their modus operandi runs counter to a lot of preconceptions about what it takes to be a good leader. They're rough, loud, and in your face. Their tactics include invading others' personal space, staging tantrums, keeping people guessing, and possessing an indisputable command of facts. But make no mistake--great intimidators are not your typical bullies. They're driven by vision, not by sheer ego or malice. Beneath their tough exteriors and sharp edges are some genuine, deep insights into human motivation and organizational behavior. Indeed, these leaders possess political intelligence, which can make the difference between paralysis and successful--if sometimes wrenching--organizational change. Like socially intelligent leaders, politically intelligent leaders are adept at sizing up others, but they notice different things. Those with social intelligence assess people's strengths and figure out how to leverage them; those with political intelligence exploit people's weaknesses and insecurities. Despite all the obvious drawbacks of working under them, great intimidators often attract the best and brightest. And their appeal goes beyond their ability to inspire high performance. Many accomplished professionals who gravitate toward these leaders want to cultivate a little "inner intimidator" of their own. In the author's research, quite a few individuals reported having positive relationships with intimidating leaders. In fact, some described these relationships as profoundly educational and even transformational. So before we throw out all the great intimidators, the author argues, we should stop to consider what

  11. Great Lakes Energy Institute

    Energy Technology Data Exchange (ETDEWEB)

    Alexander, J. Iwan [Case Western Reserve Univ., Cleveland, OH (United States)

    2012-11-18

    The vision of the Great Lakes Energy Institute is to enable the transition to advanced, sustainable energy generation, storage, distribution and utilization through coordinated research, development, and education. The Institute will place emphasis on translating leading edge research into next generation energy technology. The Institute’s research thrusts focus on coordinated research in decentralized power generation devices (e.g. fuel cells, wind turbines, solar photovoltaic devices), management of electrical power transmission and distribution, energy storage, and energy efficiency.

  12. Identification of cultured isolates of clinically important yeast species using fluorescent fragment length analysis of the amplified internally transcribed rRNA spacer 2 region

    Directory of Open Access Journals (Sweden)

    Muylaert An

    2002-07-01

    Full Text Available Abstract Background The number of patients with yeast infection has increased during the last years. Also the variety of species of clinical importance has increased. Correct species identification is often important for efficient therapy, but is currently mostly based on phenotypic features and is sometimes time-consuming and depends largely on the expertise of technicians. Therefore, we evaluated the feasibility of PCR-based amplification of the internally transcribed spacer region 2 (ITS2, followed by fragment size analysis on the ABI Prism 310 for the identification of clinically important yeasts. Results A rapid DNA-extraction method, based on simple boiling-freezing was introduced. Of the 26 species tested, 22 could be identified unambiguously by scoring the length of the ITS2-region. No distinction could be made between the species Trichosporon asteroides and T. inkin or between T. mucoides and T. ovoides. The two varieties of Cryptococcus neoformans (var. neoformans and var. gattii could be differentiated from each other due to a one bp length difference of the ITS2 fragment. The three Cryptococcus laurentii isolates were split into two groups according to their ITS2-fragment lengths, in correspondence with the phylogenetic groups described previously. Since the obtained fragment lengths compare well to those described previously and could be exchanged between two laboratories, an internationally usable library of ITS2 fragment lengths can be constructed. Conclusions The existing ITS2 size based library enables identification of most of the clinically important yeast species within 6 hours starting from a single colony and can be easily updated when new species are described. Data can be exchanged between laboratories.

  13. Integration of DPC and clinical microbiological data in Japan reveals importance of confirming a negative follow-up blood culture in patients with MRSA bacteremia.

    Science.gov (United States)

    Miyamoto, Naoki; Yahara, Koji; Horita, Rie; Yano, Tomomi; Tashiro, Naotaka; Morii, Daiichi; Tsutsui, Atsuko; Yaita, Kenichiro; Shibayama, Keigo; Watanabe, Hiroshi

    2017-10-01

    Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is one of the commonest and most life-threatening of all infectious diseases. The morbidity and mortality rates associated with MRSA bacteremia are higher than those associated with bacteremia caused by other pathogens. A common guideline in MRSA bacteremia treatment is to confirm bacteremia clearance through additional blood cultures 2-4 days after initial positive cultures and as needed thereafter. However, no study has presented statistical evidence of how and to what extent confirming a negative follow-up blood culture impacts clinical outcome. We present this evidence for the first time, by combining clinical microbiological data of blood cultures and the DPC administrative claims database; both had been systematically accumulated through routine medical care in hospitals. We used electronic medical records to investigate the clinical background and infection source in detail. By analyzing data from a university hospital, we revealed how survival curves change when a negative follow-up blood culture is confirmed. We also demonstrated confirmation of a negative culture is significantly associated with clinical outcomes: there was a more than three-fold increase in mortality risk (after adjusting for clinical background) if a negative blood culture was not confirmed within 14 days of the initial positive blood culture. Although we used data from only one university hospital, our novel approach and results will be a basis for future studies in several hospitals in Japan to provide statistical evidence of the clinical importance of confirming a negative follow-up blood culture in bacteremia patients, including those with MRSA infections. Copyright © 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  14. An Assessment in SpondyloArthritis International Society (ASAS)-endorsed definition of clinically important worsening in axial spondyloarthritis based on ASDAS.

    Science.gov (United States)

    Molto, Anna; Gossec, Laure; Meghnathi, Bhowmik; Landewé, Robert B M; van der Heijde, Désirée; Atagunduz, Pamir; Elzorkany, Bassel Kamal; Akkoc, Nurullah; Kiltz, Uta; Gu, Jieruo; Wei, James Cheng Chung; Dougados, Maxime

    2018-01-01

    In a previous phase, 12 draft definitions for clinically important worsening in axial spondyloarthritis (axSpA) were selected, of which 3 were based on absolute changes in Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP (ASDAS). The objective here was to select the best cut-off for ASDAS for clinically important worsening in axSpA for use in clinical trials and observational studies. An international longitudinal prospective study evaluating stable patients with axSpA was conducted. Data necessary to calculate ASDAS were collected at two consecutive visits (spaced 7 days to 6 months). Sensitivity and specificity of the three cut-offs for change in ASDAS were tested against the patient's subjective assessment of worsening as the external standard (ie, the patient reporting that he had worsened and felt a need for treatment intensification). Final selection was made by a consensus and voting procedure among Assessment of SpondyloArthritis International Society (ASAS) members. In total, 1169 patients with axSpA were analysed: 64.8% were male and had a mean age of 41.7 (SD 12.4) years. At the second visit, 127 (10.9%) patients judged their situation as worsened.Sensitivity and specificity for an increase of at least 0.6, 0.9 and 1.1 ASDAS points to detect patient-reported worsening were 0.55 (Se) and 0.91 (Sp), 0.38 (Se) and 0.96 (Sp), and 0.33 (Se) and 0.98 (Sp), respectively. The ASAS consensus was to define clinically important worsening as an increase in ASDAS of at least 0.9 points. This data-driven ASAS consensus process resulted in an ASDAS-based cut-off value defining clinically important worsening in axSpA for use in trials. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  15. Measuring mental health in the clinical setting: what is important to service users? The Mini-Service user Recovery Evaluation scale (Mini-SeRvE).

    Science.gov (United States)

    Barber, Joanna M; Parsons, Helen; Wilson, Carol A; Cook, Christopher C H

    2017-12-01

    Since 2001, a policy of positive mental health recovery has been promoted in the UK, with service user involvement. This has not been easy to implement in the clinical setting. To develop and validate a brief self-report, service user-designed, outcome measure (Mini-SeRvE), for clinical use, including spiritual and religious issues. From the previously developed Service user Recovery Evaluation scale (SeRvE), 15 questions were selected for Mini-SeRvE which was self-completed by 207 people; 100 service users and, for comparison, 107 staff. Results were analysed using SPSS software (SPSS Inc., Chicago, IL). Mini-SeRvE is reliable, Cronbach's alpha 0.852. Correlation with another recovery scale, Mental Health Recovery Measure, was high, r = 0.819. Three reliable subscales emerged; existential well-being (EWB), mental ill-being (MIB) and religious well-being (RWB). Scores of the EWB and MIB subscales were higher for staff, consistent with higher mental well-being. Religious well-being scores were higher in service users, who also rated religion as more important to them. Mini-SeRvE is a valid measure of service user recovery. The importance of religion/spiritual belief for our users is highlighted, this being reflected in the subject matter of Mini-SeRvE. Mini-SeRvE assessments could show individual priorities, evaluate therapy and aid clinical decision-making.

  16. Student travel health and the role of universities and health clinics in New Zealand to prevent imported infections: a cross-sectional study.

    Science.gov (United States)

    Neave, Penny E; Nair, Balakrishnan; Heywood, Anita E

    2017-05-01

    Tertiary students are at risk of acquiring infectious diseases during overseas travel as they visit low-income countries, have low perceptions of risk and are unlikely to access travel health advice. Some will visit friends and relatives abroad, a group identified as disproportionately affected by imported infections. There is no national student travel health policy in NZ. This study aimed to explore travel health training of university-based health providers; academics' practices and perceptions of travel health; reasons for travel and countries visited by NZ university students, their travel health uptake and factors affecting decision making about this. A cross-sectional study consisting of surveys sent in 2014 to university clinics, senior academics and students. Surveys were completed by 251 respondents. Three of nine clinicians had only undertaken a short course in travel health. Competing resources and time constraints in health clinics were amongst the barriers to providing optimal services. Of the senior academics, only 14% were able to confirm their university collaborated with health clinics. Sixty seven percent of students were unaware that clinics provided travel health services and 19% had or intended to seek professional travel health advice. A national policy is warranted involving all stakeholders, utilizing innovative technologies to increase uptake of student travel health services. © International Society of Travel Medicine, 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

  17. Importance of diagnostic laboratory methods of beta hemolytic streptococcus group A in comparison with clinical findings in the diagnosis of streptococcal sore throat and unnecessary antibacterial therapy

    Directory of Open Access Journals (Sweden)

    Peiman Eini

    2012-04-01

    Full Text Available Background: Streptococcus Pyogenes (group A streptococcus, GAS is the most important cause of bacterial pharyngitis in children and adolescents. Acute pharyngitis is one of the most common conditions in all ages but it is most common in children. Over diagnosis of acute pharyngitis represents one of the major causes of antibiotic abuse. The goal of this study is to make an estimate of the frequency of group A streptococcus in sore throat patients in Farshchian hospital emergency department and clinic in Hamadan. Methods: For estimation of the clinical features role in diagnosis of streptococcal sore throat, we took samples of 100 patients with average age of 32.96±29.86 years with sore throat. We took samples from pharynx and used standard methods of bacteriology in order to detect streptococcus. Results: Group A Streptococcus (GAS accounts for 3 percent of all cases of pharyngitis. Clinically, all of the patients had sore throat. The percent breakdowns are as follows: 30% had exudate, 78% had fever, 8% had lymphadenopathy and 7.7 percent of exudative pharyngitis was streptococcal. The cost for unnecessary antibiotic therapy for every single patient who had negative pharynx culture was approximately 32160 Rails. Conclusion: The low frequency of streptococcus pharyngitis in treated patients reveal that diagnosis based on clinical features is not reliable. We recommend use of other diagnostic methods such as Rapid Antigen Detection Tests (RATs. Only reliable and scientific protocols for antibiotic to therapy.

  18. Idiopathic great saphenous phlebosclerosis.

    Directory of Open Access Journals (Sweden)

    Ahmadreza Jodati

    2013-06-01

    Full Text Available Arterial sclerosis has been extensively described but reports on venous sclerosis are very sparse. Phlebosclerosis refers to the thickening and hardening of the venous wall. Despite its morphological similarities with arteriosclerosis and potential morbid consequences, phlebosclerosis has gained only little attention. We report a 72 year old male with paralysis and atrophy of the right leg due to childhood poliomyelitis who was referred for coronary artery bypass surgery. The great saphenous vein, harvested from the left leg, showed a hardened cord-like obliterated vein. Surprisingly, harvested veins from the atrophic limb were normal and successfully used for grafting.

  19. Great software debates

    CERN Document Server

    Davis, A

    2004-01-01

    The industry’s most outspoken and insightful critic explains how the software industry REALLY works. In Great Software Debates, Al Davis, shares what he has learned about the difference between the theory and the realities of business and encourages you to question and think about software engineering in ways that will help you succeed where others fail. In short, provocative essays, Davis fearlessly reveals the truth about process improvement, productivity, software quality, metrics, agile development, requirements documentation, modeling, software marketing and sales, empiricism, start-up financing, software research, requirements triage, software estimation, and entrepreneurship.

  20. Matrix-assisted laser desorption/ionization-time of flight mass spectrometry: protocol standardization and database expansion for rapid identification of clinically important molds.

    Science.gov (United States)

    Paul, Saikat; Singh, Pankaj; Rudramurthy, Shivaprakash M; Chakrabarti, Arunaloke; Ghosh, Anup K

    2017-12-01

    To standardize the matrix-assisted laser desorption ionization-time of flight mass spectrometry protocols and expansion of existing Bruker Biotyper database for mold identification. Four different sample preparation methods (protocol A, B, C and D) were evaluated. On analyzing each protein extraction method, reliable identification and best log scores were achieved through protocol D. The same protocol was used to identify 153 clinical isolates. Of these 153, 123 (80.3%) were accurately identified by using existing database and remaining 30 (19.7%) were not identified due to unavailability in database. On inclusion of missing main spectrum profile in existing database, all 153 isolates were identified. Matrix-assisted laser desorption ionization-time of flight mass spectrometry can be used for routine identification of clinically important molds.

  1. PFGE: importance in food quality.

    Science.gov (United States)

    Vernile, Anna; Giammanco, Giovanni; Massa, Salvatore

    2009-11-01

    In late 19 century, great interest has arisen for food quality. This is referred as absence of pathogens in food (safety for consumers) and as nutritional quality of food (organoleptic characteristics). Pulsed-field gel electrophoresis (PFGE) is, among the molecular techniques developed in the last years, one of the most reliable, discriminative and reproducible technique. It can be used in clinical field for the identification of pathogens and the origin of outbreaks, and in food microbiology for the identification of pathogens (food borne disease surveillance) or of microorganisms responsible for the organoleptic characteristics of food. The present article shows some useful patents related to PFGE and importance in food quality.

  2. Clinical importance of cine-MRI assessment of small bowel motility in patients with chronic intestinal pseudo-obstruction: a retrospective study of 33 patients.

    Science.gov (United States)

    Fuyuki, Akiko; Ohkubo, Hidenori; Higurashi, Takuma; Iida, Hiroshi; Inoh, Yumi; Inamori, Masahiko; Nakajima, Atsushi

    2017-05-01

    Although chronic intestinal pseudo-obstruction (CIPO) is a rare and extremely severe functional digestive disorder, its clinical course and severity show various patterns. We assessed small bowel peristalsis in CIPO patients using cine-MRI (video-motion MRI) and their clinical characteristics to evaluate the clinical importance of performing cine-MRI in patients with this intractable disease. The medical records of 131 patients referred to our institution with a suspected diagnosis of CIPO between 2010 and 2015 were retrospectively evaluated. Thirty-three patients (22 female/11 male; age range 16-79 years) who met the criteria for CIPO and underwent cine-MRI were enrolled. Mean luminal diameter (MLD), contraction ratio (CR), and contraction cycle (CC) were determined and compared with these parameters in healthy volunteers. Clinical outcomes in patients with CIPO were also evaluated. The median follow-up time was 25.2 months (range, 1-65 months). Of the 33 patients with CIPO, 23 (70 %) showed apparently disturbed small intestinal peristalsis, whereas 10 (30 %) did not. The percentage of patients requiring intravenous alimentation was significantly higher (p = 0.03), and the mean serum albumin level was significantly lower (p = 0.04), in patients with than without impaired small intestinal peristalsis. Although both cine-MRI and CT findings in the latter ten cases were within the normal range, MLD and CR differed significantly from healthy volunteers. Cine-MRI is useful in predicting severe clinical features in patients with CIPO, and in detecting slightly impaired small contractility that cannot be detected on CT.

  3. Estimation of minimal clinically important change of the Japanese version of EQ-5D in patients with chronic noncancer pain: a retrospective research using real-world data

    OpenAIRE

    Yoshizawa, Kazutake; Kobayashi, Hisanori; Fujie, Motoko; Ogawa, Yoshimasa; Yajima, Tsutomu; Kawai, Koji

    2016-01-01

    Background Quality of life (QoL) is routinely assessed and evaluated in medical research. However, in Japan, there is a lack of solid cutoff criteria for evaluating QoL improvement in chronic noncancer pain management. The present study was conducted to identify the minimal clinically important change (MCIC) of the Japanese version of EuroQol-5D 3L(EQ-5D) utility score and numeric rating scale (NRS) with an emphasis on chronic noncancer pain. Methods The data source for this post hoc research...

  4. Great apes prefer cooked food.

    Science.gov (United States)

    Wobber, Victoria; Hare, Brian; Wrangham, Richard

    2008-08-01

    The cooking hypothesis proposes that a diet of cooked food was responsible for diverse morphological and behavioral changes in human evolution. However, it does not predict whether a preference for cooked food evolved before or after the control of fire. This question is important because the greater the preference shown by a raw-food-eating hominid for the properties present in cooked food, the more easily cooking should have been adopted following the control of fire. Here we use great apes to model food preferences by Paleolithic hominids. We conducted preference tests with various plant and animal foods to determine whether great apes prefer food items raw or cooked. We found that several populations of captive apes tended to prefer their food cooked, though with important exceptions. These results suggest that Paleolithic hominids would likewise have spontaneously preferred cooked food to raw, exapting a pre-existing preference for high-quality, easily chewed foods onto these cooked items. The results, therefore, challenge the hypothesis that the control of fire preceded cooking by a significant period.

  5. Importância clínica e laboratorial do volume plaquetário médio The clinical and laboratory importance of mean platelet volume

    Directory of Open Access Journals (Sweden)

    Mariela Granero Farias

    2010-08-01

    Full Text Available Os índices plaquetários fornecidos pelos analisadores hematológicos são provavelmente os parâmetros mais ignorados pela maioria dos laboratórios clínicos, em virtude da dificuldade de sua padronização. Desses índices, o volume plaquetário médio (VPM vem merecendo destaque por sua grande utilidade, não só em casos de trombose e hemostasia, mas também em uma série de patologias, como diabetes, doenças da tireoide, doenças vasculares, entre outras. O VPM é um parâmetro plaquetário fornecido no hemograma que não gera custos adicionais para o laboratório. Junto com a contagem de plaquetas, ele é um sensível indicador de desordens plaquetárias in vivo, mas pode ser tecnicamente difícil de analisá-lo in vitro por causa dos interferentes pré-analíticos, como tempo de armazenamento da amostra e artefatos gerados pelos anticoagulantes. Neste artigo descrevemos as principais metodologias e seus interferentes na determinação da contagem plaquetária e do VPM, destacando a importância do laboratório de análises clínicas em validar esse parâmetro, proporcionando sua utilização no diagnóstico de desordens hematológicas e de outras patologias.The platelet indices provided by the hematological analyzers are probably the parameters mostly ignored by most clinical laboratories due to standardization difficulties. Among those indices, the mean platelet volume (MPV has stood out due to its usefulness not only in cases of thrombosis and hemostasy, but also in a series of pathologies, such as diabetes, thyroid and vascular diseases, among others. MPV is a platelet parameter provided by the hemogram, which does not represent additional costs to the laboratory. Along with platelet count, it is a sensitive indicator of platelet disorders in vivo. However, it may be technically difficult to analyze it in vitro owing to preanalytical interferences, such as sample storage time and anticoagulant artifacts. In this article we described

  6. Clinical and molecular investigation of a canine distemper outbreak and vector-borne infections in a group of rescue dogs imported from Hungary to Switzerland.

    Science.gov (United States)

    Willi, Barbara; Spiri, Andrea M; Meli, Marina L; Grimm, Felix; Beatrice, Laura; Riond, Barbara; Bley, Tim; Jordi, Rolf; Dennler, Matthias; Hofmann-Lehmann, Regina

    2015-07-16

    Canine distemper virus (CDV) is a major pathogen of dogs and wild carnivores worldwide. In Switzerland, distemper in domestic dogs is rarely reported. In recent years, the import of dogs from Eastern Europe to Switzerland has steadily increased. In the present study, we describe a distemper outbreak in 15 rescue dogs that were imported from Hungary to Switzerland by an animal welfare organisation. The data on vaccination and medical history were recorded (14 dogs), and the samples were collected to investigate CDV and vector-borne infections (13 dogs) and canine parvovirus infection (12 dogs). The dogs were monitored for six months. One dog was euthanised directly after import. Thirteen dogs showed clinical signs after arrival, i.e., diarrhoea (57 %), coughing (43 %) and nasal and/or ocular discharge (21 %); radiographic findings that were compatible with bronchopneumonia were present in four dogs. CDV infection was diagnosed in 11 dogs (85 %); 10 dogs (91 %) tested PCR-positive in conjunctival swabs. Vector-borne infections (Babesia spp., Leishmania infantum, Dirofilaria immitis) were found in 4 dogs (31 %). Three dogs were hospitalized, and six dogs received ambulatory therapy for up to two months until recovery. None of the dogs developed neurological disease. CDV shedding was detected for a period of up to four months. Because dogs were put under strict quarantine until CDV shedding ceased, CDV did not spread to any other dogs. The CDV isolates showed 99 % sequence identity in the HA gene among each other and belonged to the Arctic-like lineage of CDV. The present study highlights the imminent risks of spreading contagious viral and vector-borne infections through the non-selective import of sick dogs and dogs with incomplete vaccination from Eastern Europe. CDV shedding was detected for several months after the cessation of clinical signs, which emphasised the roles of asymptomatic carriers in CDV epidemiology. A long-term follow-up using sensitive PCR and

  7. Great Britain at CERN

    CERN Multimedia

    2006-01-01

    From 14 to 16 November 2006 Administration Building, Bldg. 60/61 - ground and 1st floor 09.30 - 17.30 Fifteen companies will present their latest technologies at the 'Great Britain at CERN' exhibition. British industry will exhibit products and technologies related to the field of particle physics. The main fields represented will be computing technologies, electrical engineering, electronics, mechanical engineering, vacuum & low temperature technologies and particle detectors. The exhibition is organised by BEAMA Exhibitions (the British Electrotechnical and Allied Manufacturers Association). Below you will find: a list of the exhibitors. A detailed programme will be available in due course: from your Departmental secretariat, from the Reception information desk, Building 33, at the exhibition itself. A detailed list of the companies is available at the following FI link: http://fi-dep.web.cern.ch/fi-dep/structure/memberstates/exhibitions_visits.htm LIST OF EXHIBITORS 3D Metrics Almat...

  8. Great Britain at CERN

    CERN Multimedia

    2006-01-01

    From 14 to 16 November 2006 Administration Building, Bldg. 60/61 - ground and 1st floor 09.30 - 17.30 Fifteen companies will present their latest technologies at the 'Great Britain at CERN' exhibition. British industry will exhibit products and technologies related to the field of particle physics. The main fields represented will be computing technologies, electrical engineering, electronics, mechanical engineering, vacuum & low temperature technologies and particle detectors. The exhibition is organised by BEAMA Exhibitions (the British Electrotechnical and Allied Manufacturers Association). Below you will find: a list of the exhibitors. A detailed programme will be available in due course: from your Departmental secretariat, from the Reception information desk, Building 33, at the exhibition itself. A detailed list of the companies is available at the following FI link: http://fi-dep.web.cern.ch/fi-dep/structure/memberstates/exhibitions_visits.htm LIST OF EXHIBITORS 3D Metrics Alma...

  9. Defining a minimal clinically important difference for endometriosis-associated pelvic pain measured on a visual analog scale: analyses of two placebo-controlled, randomized trials

    Directory of Open Access Journals (Sweden)

    Schmitz Heinz

    2010-11-01

    Full Text Available Abstract Background When comparing active treatments, a non-inferiority (or one-sided equivalence study design is often used. This design requires the definition of a non-inferiority margin, the threshold value of clinical relevance. In recent studies, a non-inferiority margin of 15 mm has been used for the change in endometriosis-associated pelvic pain (EAPP on a visual analog scale (VAS. However, this value was derived from other chronic painful conditions and its validation in EAPP was lacking. Methods Data were analyzed from two placebo-controlled studies of active treatments in endometriosis, including 281 patients with laparoscopically-confirmed endometriosis and moderate-to-severe EAPP. Patients recorded EAPP on a VAS at baseline and the end of treatment. Patients also assessed their satisfaction with treatment on a modified Clinical Global Impression scale. Changes in VAS score were compared with patients' self-assessments to derive an empirically validated non-inferiority margin. This anchor-based value was compared to a non-inferiority margin derived using the conventional half standard deviation rule for minimal clinically important difference (MCID in patient-reported outcomes. Results Anchor-based and distribution-based MCIDs were-7.8 mm and-8.6 mm, respectively. Conclusions An empirically validated non-inferiority margin of 10 mm for EAPP measured on a VAS is appropriate to compare treatments in endometriosis.

  10. Defining clinically important perioperative blood loss and transfusion for the Standardised Endpoints for Perioperative Medicine (StEP) collaborative: a protocol for a scoping review.

    Science.gov (United States)

    Bartoszko, Justyna; Vorobeichik, Leon; Jayarajah, Mohandas; Karkouti, Keyvan; Klein, Andrew A; Lamy, Andre; Mazer, C David; Murphy, Mike; Richards, Toby; Englesakis, Marina; Myles, Paul S; Wijeysundera, Duminda N

    2017-06-30

    'Standardised Endpoints for Perioperative Medicine' (StEP) is an international collaboration undertaking development of consensus-based consistent definitions for endpoints in perioperative clinical trials. Inconsistency in endpoint definitions can make interpretation of trial results more difficult, especially if conflicting evidence is present. Furthermore, this inconsistency impedes evidence synthesis and meta-analyses. The goals of StEP are to harmonise definitions for clinically meaningful endpoints and specify standards for endpoint reporting in clinical trials. To help inform this endeavour, we aim to conduct a scoping review to systematically characterise the definitions of clinically important endpoints in the existing published literature on perioperative blood loss and transfusion. The scoping review will be conducted using the widely adopted framework developed by Arksey and O'Malley, with modifications from Levac. We refined our methods with guidance from research librarians as well as researchers and clinicians with content expertise. The electronic literature search will involve several databases including Medline, PubMed-not-Medline and Embase. Our review has three objectives, namely to (1) identify definitions of significant blood loss and transfusion used in previously published large perioperative randomised trials; (2) identify previously developed consensus-based definitions for significant blood loss and transfusion in perioperative medicine and related fields; and (3) describe the association between different magnitudes of blood loss and transfusion with postoperative outcomes. The multistage review process for each question will involve two reviewers screening abstracts, reading full-text articles and performing data extraction. The abstracted data will be organised and subsequently analysed in an iterative process. This scoping review of the previously published literature does not require research ethics approval. The results will be used

  11. Monitoring somatic symptoms in patients with mental disorders: Sensitivity to change and minimal clinically important difference of the Somatic Symptom Scale - 8 (SSS-8).

    Science.gov (United States)

    Gierk, Benjamin; Kohlmann, Sebastian; Hagemann-Goebel, Marion; Löwe, Bernd; Nestoriuc, Yvonne

    2017-09-01

    The SSS-8 is a brief questionnaire for the assessment of somatic symptom burden. This study examines its sensitivity to change and the minimal clinically important difference (MCID) in patients with mental disorders. 55 outpatients with mental disorders completed the SSS-8 and measures of anxiety, depression, and disability before and after receiving treatment. Effect sizes and correlations between the change scores were calculated. The MCID was estimated using a one standard error of measurement threshold and the change in disability as an external criterion. There was a medium decline in somatic symptom burden for the complete sample (n=55, d z =0.53) and a large decline in a subgroup with very high somatic symptom burden at baseline (n=11, d z =0.94). Decreases in somatic symptom burden were associated with decreases in anxiety (r=0.68, pSSS-8 is sensitive to change. A 3-point decrease reflects a clinically important improvement. Due to its brevity and sound psychometric properties, the SSS-8 is useful for monitoring somatic symptom burden. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Importância da avaliação da hemoglobina fetal na clínica da anemia falciforme The importance of the evaluation of fetal hemoglobin in the clinical assessment of sickle cell disease

    Directory of Open Access Journals (Sweden)

    Rita de Cassia Mousinho-Ribeiro

    2008-04-01

    Full Text Available A anemia falciforme está entre as doenças genéticas mais comuns e mais estudadas em todo o mundo. Ela é causada por mutação no gene β, produzindo alteração estrutural na molécula da hemoglobina. As moléculas de HbS, decorrentes da mutação, sofrem processo de polimerização fisiologicamente provocado pela baixa tensão de oxigênio, acidose e desidratação. Com isso, os eritrócitos passam a apresentar a forma de foice, causando vaso-oclusão e outras conseqüências. O objetivo desse estudo foi revisar a importância da hemoglobina fetal na clínica de pacientes portadores de anemia falciforme. O significado clínico da associação da elevação da hemoglobina fetal na anemia falciforme mostra-se favorável em termos hematológicos, pois, nessa interação, as células-F têm baixas concentrações de HbS e, com isso, inibem a polimerização da HbS e a alteração da morfologia dos eritrócitos. O tratamento com hidroxiuréia, em função do aumento na expressão da hemoglobina fetal que este fármaco proporciona, traz aos pacientes falcêmicos uma melhora significativa em sua clínica. Portanto, a hemoglobina fetal consiste no maior inibidor da polimerização da desoxi-HbS e, com isso, evita a falcização do eritrócito, a anemia hemolítica crônica, as crises dolorosas vaso-oclusivas, o infarto e a necrose em diversos órgãos, melhorando a clínica e a expectativa de vida dos pacientes.Sickle cell disease is one of the commonest and most studied genetic diseases in the world. Caused by a mutation of the β gene, it changes the molecular structure of hemoglobin. Abnormal Hb S molecules suffer polymerization physiologically provoked by a low oxygen tension, acidosis and dehydration. As a result, red blood cells take on a sickle cell form, which causes microvascular occlusion with varying consequences. The objective of this study was to review the importance of fetal hemoglobin in the clinical assessment of sickle cell

  13. The Minimally Important Difference for the Fatigue Visual Analog Scale in Patients with Rheumatoid Arthritis followed in an Academic Clinical Practice

    Science.gov (United States)

    Khanna, Dinesh; Pope, Janet; Khanna, Puja P.; Maloney, Michelle; Samedi, Nooshin; Norrie, Debbie; Ouimet, Gillian; Hays, Ron D

    2011-01-01

    Introduction Fatigue is a common symptom in RA and used as an outcome measure in RA clinical trials. We studied a large academic clinical practice to estimate the minimally important difference (MID) for a fatigue visual analog scale using patient-reported anchors (fatigue, pain and overall health). Methods RA patients (N=307) had clinic visits at 2 time points at a median of 5.9 months apart. They completed fatigue visual analog scale (VAS; 0–10) and retrospective anchor items, “How would you describe your overall fatigue/pain/overall health since the last visit?” Much worsened, Somewhat worsened, Same, Somewhat better, or Much better. The fatigue anchor was used for primary analysis and the pain/ overall health anchors for sensitivity analyses. The minimally changed group was defined by those reporting they were somewhat better or somewhat worsened. Results The mean (SD) age was 59.4 (13.2) years, disease duration was 14.1 (11.5) years, and 83% of patients were women. The baseline mean (SD) HAQ-DI score was 0.84 (0.75). The baseline fatigue VAS score was 4.2 (2.9) and at follow up was 4.3 (2.8) (mean change of −0.07 [2.5], p=NS). The fatigue change score (0–10 scale) for somewhat better and somewhat worsened for fatigue anchor averaged −1.12 and 1.26, respectively. Using pain anchor, the fatigue changed score for somewhat better and somewhat worsened averaged −0.87 and 1.13 and using global anchor, the fatigue changed score for somewhat better and somewhat worsened averaged −0.82 and 1.17, respectively. Effect size (ES) estimates using 3 anchors were small for somewhat better (range: 0.27 to 0.39) and somewhat worsened (range: 0.40 to 0.44) groups but larger than the no-change group (range: 0.03 to 0.08). Conclusions The MID for fatigue VAS is between −0.82 to −1.12 for improvement and 1.13 to 1.26 for worsening on 0–10 scale in a large RA clinical practice and similar to that seen in RA clinical trials. This information can aid in

  14. Patients receiving anti-TNF therapies experience clinically important improvements in RA-related fatigue: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis.

    Science.gov (United States)

    Druce, Katie L; Jones, Gareth T; Macfarlane, Gary J; Basu, Neil

    2015-06-01

    Pro-inflammatory cytokines such as TNF-α are important in the pathogenesis of fatigue in conditions such as RA. This study aimed to determine whether fatigue improved in a cohort of RA patients with clinically relevant fatigue commencing anti-TNF-α therapy and, if so, to identify predictors of improvement. Participants recruited to a long-term observational cohort study (the British Society for Rheumatology Biologics Register for RA) provided information on fatigue using the 36-item Short Form Health Survey (SF-36) vitality subscale. The prevalence of severe baseline fatigue (SF-36 vitality ≤12.5) was calculated and improvements, considered as (i) absolute values and (ii) improvement from severe to non-severe fatigue (SF-36 vitality >12.5), were examined 6 months subsequently. A comprehensive set of putative predictors of fatigue improvement were evaluated using multivariable logistic regression. In 6835 participants the prevalence of severe baseline fatigue was 38.8%. Of those with severe fatigue, 70% reported clinically relevant improvement and 66% moved to the non-severe fatigue category (i.e. improvers). The mean change for improvers was three times the minimum clinically important difference for improvement (33.0 U). Independent baseline predictors of improvement were female sex [odds ratio (OR) 1.3 (95% CI 1.1, 1.7)], not being unemployed due to ill health [OR 1.5 (95% CI 1.2, 1.7)], low disability [OR 1.2 (95% CI 1.001, 1.5)], seropositivity [OR 1.2 (95% CI 0.98, 1.4)], not using steroids [OR 1.2 (95% CI 1.03, 1.5)], no history of hypertension [OR 1.4 (95% CI 1.1, 1.6)] or depression [OR 1.3 (95% CI 1.1, 1.5)] and good mental health [SF-36 mental health subscale >35; OR 1.4 (95% CI 1.2, 1.7)]. Fatigued RA patients reported substantial improvement in their fatigue after commencing anti-TNF-α therapy. Further, a number of clinical and psychosocial baseline factors identified those most likely to improve, supporting future stratified approaches to RA

  15. The diverse impacts of the great recession

    OpenAIRE

    Makoto Nakajima

    2013-01-01

    The Great Recession had a large negative impact on the U.S. economy. Asset prices, most notably stock and house prices, declined substantially, resulting in a loss in wealth for many American households. In this article, Makoto Nakajima documents how diverse households were affected in a variety of dimensions during the Great Recession, in particular between 2007 and 2009, using newly available data from the 2007-2009 Survey of Consumer Finances. He discusses why it is important to look at th...

  16. A putative biomarker signature for clinically effective AKT inhibition: correlation of in vitro, in vivo and clinical data identifies the importance of modulation of the mTORC1 pathway.

    Science.gov (United States)

    Cheraghchi-Bashi, Azadeh; Parker, Christine A; Curry, Ed; Salazar, Jean-Frederic; Gungor, Hatice; Saleem, Azeem; Cunnea, Paula; Rama, Nona; Salinas, Cristian; Mills, Gordon B; Morris, Shannon R; Kumar, Rakesh; Gabra, Hani; Stronach, Euan A

    2015-12-08

    Our identification of dysregulation of the AKT pathway in ovarian cancer as a platinum resistance specific event led to a comprehensive analysis of in vitro, in vivo and clinical behaviour of the AKT inhibitor GSK2141795. Proteomic biomarker signatures correlating with effects of GSK2141795 were developed using in vitro and in vivo models, well characterised for related molecular, phenotypic and imaging endpoints. Signatures were validated in temporally paired biopsies from patients treated with GSK2141795 in a clinical study. GSK2141795 caused growth-arrest as single agent in vitro, enhanced cisplatin-induced apoptosis in vitro and reduced tumour volume in combination with platinum in vivo. GSK2141795 treatment in vitro and in vivo resulted in ~50-90% decrease in phospho-PRAS40 and 20-80% decrease in fluoro-deoxyglucose (FDG) uptake. Proteomic analysis of GSK2141795 in vitro and in vivo identified a signature of pathway inhibition including changes in AKT and p38 phosphorylation and total Bim, IGF1R, AR and YB1 levels. In patient biopsies, prior to treatment with GSK2141795 in a phase 1 clinical trial, this signature was predictive of post-treatment changes in the response marker CA125. Development of this signature represents an opportunity to demonstrate the clinical importance of AKT inhibition for re-sensitisation of platinum resistant ovarian cancer to platinum.

  17. The minimally important difference for the health assessment questionnaire in rheumatoid arthritis clinical practice is smaller than in randomized controlled trials.

    Science.gov (United States)

    Pope, Janet E; Khanna, Dinesh; Norrie, Deborah; Ouimet, Janine M

    2009-02-01

    Patient-reported outcomes are used in clinical practice and trials. We studied a large clinical practice to determine the minimally important difference (MID) estimates for (1) the Health Assessment Questionnaire-Damage Index (HAQ-DI): improvement and worsening using patient global assessment anchor; and (2) pain using a patient-reported pain anchor. Patients with rheumatoid arthritis (RA; N = 225) had clinic visits at 2 timepoints within 1 year, completed the HAQ-DI and pain visual analog scale (VAS; 0-100 mm), and answered the question, "How would you describe your overall status/overall pain since the last visit?", as much worsened, somewhat worsened, the same, somewhat improved, or much improved. If rated as somewhat improved or worsened, they were defined as the minimally changed subgroups. Eighty-three percent were women, mean age 60 years, with disease duration 11.7 +/- 10.7 years. The baseline HAQ-DI was 0.97 +/- SD 0.76, and at followup 1.0 +/- 0.77 (mean change +0.03 +/- 0.40). The baseline pain VAS was 42.3 +/- 28.8, and at followup 38.5 +/- 27.9 (mean change -2.8 +/- 25.9). The mean (SD) HAQ-DI change score was -0.09 (0.42) for somewhat improved and 0.15 (0.33) for somewhat worsened. The HAQ-DI change for somewhat/much better was -0.20 +/- 0.52, and for somewhat/much worse +0.21 +/- 0.33. For pain, somewhat improved changed by -11.9 mm on the VAS, and somewhat worsened by 6.8 mm. Estimates for HAQ-DI and pain were larger than the for no-change group, 0.03 (0.32) and -3.2 (20.9). The MID for HAQ-DI in clinical practice is smaller than it is in trials. This may have implications for observational studies and clinical care.

  18. Great E-xpectations.

    Science.gov (United States)

    Klinger, Donna

    2000-01-01

    Discusses issues raised in a May 2000 forum on the growing investment by colleges and universities in various electronic businesses, including offering distance education, providing a portal to the Internet, and marketing. Discusses issues concerning the importance of business process redesign, use of E-business as a strategic tool, brand value…

  19. PCR-Based Analysis of ColE1 Plasmids in Clinical Isolates and Metagenomic Samples Reveals Their Importance as Gene Capture Platforms

    Directory of Open Access Journals (Sweden)

    Manuel Ares-Arroyo

    2018-03-01

    Full Text Available ColE1 plasmids are important vehicles for the spread of antibiotic resistance in the Enterobacteriaceae and Pasteurellaceae families of bacteria. Their monitoring is essential, as they harbor important resistant determinants in humans, animals and the environment. In this work, we have analyzed ColE1 replicons using bioinformatic and experimental approaches. First, we carried out a computational study examining the structure of different ColE1 plasmids deposited in databases. Bioinformatic analysis of these ColE1 replicons revealed a mosaic genetic structure consisting of a host-adapted conserved region responsible for the housekeeping functions of the plasmid, and a variable region encoding a wide variety of genes, including multiple antibiotic resistance determinants. From this exhaustive computational analysis we developed a new PCR-based technique, targeting a specific sequence in the conserved region, for the screening, capture and sequencing of these small plasmids, either specific for Enterobacteriaceae or specific for Pasteurellaceae. To validate this PCR-based system, we tested various collections of isolates from both bacterial families, finding that ColE1 replicons were not only highly prevalent in antibiotic-resistant isolates, but also present in susceptible bacteria. In Pasteurellaceae, ColE1 plasmids carried almost exclusively antibiotic resistance genes. In Enterobacteriaceae, these plasmids encoded a large range of traits, including not only antibiotic resistance determinants, but also a wide variety of genes, showing the huge genetic plasticity of these small replicons. Finally, we also used a metagenomic approach in order to validate this technique, performing this PCR system using total DNA extractions from fecal samples from poultry, turkeys, pigs and humans. Using Illumina sequencing of the PCR products we identified a great diversity of genes encoded by ColE1 replicons, including different antibiotic resistance

  20. Review: The Great Gatsby

    Directory of Open Access Journals (Sweden)

    Antonia de Jesus Sales

    2016-08-01

    Full Text Available A presente resenha busca discutir a tradução de The Great Gatsby para o contexto brasileiro. Diversas traduções foram feitas, em diversas épocas e com repercussão positiva no contexto brasileiro. Para o presente estudo, foi observada a tradução de Vanessa Bárbara, de 2011. Nesse sentido, o aspecto biográficos do autor e a forma como se apresentam os personagens na obra são fatores de cotejamento na obra original e na tradução brasileira. Francis Scott Key Fitzgerald (1896 – 1940 é famoso por ter em suas obras traços biográficos, algo que certamente influencia o leitor que adentra a sua obra. Quanto à recepção de O Grande Gatsby no contexto brasileiro, há que se considerar que O Grande Gatsby teve diversas traduções no Brasil. Depois dessa tradução de Vanessa Bárbara, em 2011, outras três vieram em 2013, juntamente com o filme. Há que considerar os aspectos comerciais embutidos nessas traduções e que muito corroboram para o resultado final. Prova disso são as capas, que são sempre diferenciadas em cada edição lançada. O tradutor nem sempre pode opinar sobre questões como estas. A tradução, a meu ver, é uma obra de qualidade, visto que a tradutora buscou ser fiel, sem dificultar a interpretação da obra para o leitor.

  1. Review: The Great Gatsby

    Directory of Open Access Journals (Sweden)

    Antonia de Jesus Sales

    2016-05-01

    Full Text Available A presente resenha busca discutir a tradução de The Great Gatsby para o contexto brasileiro. Diversas traduções foram feitas, em diversas épocas e com repercussão positiva no contexto brasileiro. Para o presente estudo, foi observada a tradução de Vanessa Bárbara, de 2011. Nesse sentido, o aspecto biográficos do autor e a forma como se apresentam os personagens na obra são fatores de cotejamento na obra original e na tradução brasileira. Francis Scott Key Fitzgerald (1896 – 1940 é famoso por ter em suas obras traços biográficos, algo que certamente influencia o leitor que adentra a sua obra. Quanto à recepção de O Grande Gatsby no contexto brasileiro, há que se considerar que O Grande Gatsby teve diversas traduções no Brasil. Depois dessa tradução de Vanessa Bárbara, em 2011, outras três vieram em 2013, juntamente com o filme. Há que considerar os aspectos comerciais embutidos nessas traduções e que muito corroboram para o resultado final. Prova disso são as capas, que são sempre diferenciadas em cada edição lançada. O tradutor nem sempre pode opinar sobre questões como estas. A tradução, a meu ver, é uma obra de qualidade, visto que a tradutora buscou ser fiel, sem dificultar a interpretação da obra para o leitor.

  2. Potential clinical impact of advanced imaging and computer-aided diagnosis in chest radiology: importance of radiologist's role and successful observer study.

    Science.gov (United States)

    Li, Feng

    2015-07-01

    This review paper is based on our research experience in the past 30 years. The importance of radiologists' role is discussed in the development or evaluation of new medical images and of computer-aided detection (CAD) schemes in chest radiology. The four main topics include (1) introducing what diseases can be included in a research database for different imaging techniques or CAD systems and what imaging database can be built by radiologists, (2) understanding how radiologists' subjective judgment can be combined with technical objective features to improve CAD performance, (3) sharing our experience in the design of successful observer performance studies, and (4) finally, discussing whether the new images and CAD systems can improve radiologists' diagnostic ability in chest radiology. In conclusion, advanced imaging techniques and detection/classification of CAD systems have a potential clinical impact on improvement of radiologists' diagnostic ability, for both the detection and the differential diagnosis of various lung diseases, in chest radiology.

  3. A warning to the Brazilian Speech-Language Pathology and Audiology community about the importance of scientific and clinical activities in primary progressive aphasia.

    Science.gov (United States)

    Beber, Bárbara Costa; Brandão, Lenisa; Chaves, Márcia Lorena Fagundes

    2015-01-01

    This article aims to warn the Brazilian Speech-Language Pathology and Audiology scientific community about the importance and necessity of scientific and clinical activities regarding Primary Progressive Aphasia. This warning is based on a systematic literature review of the scientific production on Primary Progressive Aphasia, from which nine Brazilian articles were selected. It was observed that there is an obvious lack of studies on the subject, as all the retrieved articles were published in medical journals and much of it consisted of small samples; only two articles described the effectiveness of speech-language therapy in patients with Primary Progressive Aphasia. A perspective for the future in the area and characteristics of Speech-Language Therapy for Primary Progressive Aphasia are discussed. As a conclusion, it is evident the need for greater action by Speech-Language Pathology and Audiology on Primary Progressive Aphasia.

  4. An embedded longitudinal multi-faceted qualitative evaluation of a complex cluster randomized controlled trial aiming to reduce clinically important errors in medicines management in general practice

    Directory of Open Access Journals (Sweden)

    Cresswell Kathrin M

    2012-06-01

    Full Text Available Abstract Background There is a need to shed light on the pathways through which complex interventions mediate their effects in order to enable critical reflection on their transferability. We sought to explore and understand key stakeholder accounts of the acceptability, likely impact and strategies for optimizing and rolling-out a successful pharmacist-led information technology-enabled (PINCER intervention, which substantially reduced the risk of clinically important errors in medicines management in primary care. Methods Data were collected at two geographical locations in central England through a combination of one-to-one longitudinal semi-structured telephone interviews (one at the beginning of the trial and another when the trial was well underway, relevant documents, and focus group discussions following delivery of the PINCER intervention. Participants included PINCER pharmacists, general practice staff, researchers involved in the running of the trial, and primary care trust staff. PINCER pharmacists were interviewed at three different time-points during the delivery of the PINCER intervention. Analysis was thematic with diffusion of innovation theory providing a theoretical framework. Results We conducted 52 semi-structured telephone interviews and six focus group discussions with 30 additional participants. In addition, documentary data were collected from six pharmacist diaries, along with notes from four meetings of the PINCER pharmacists and feedback meetings from 34 practices. Key findings that helped to explain the success of the PINCER intervention included the perceived importance of focusing on prescribing errors to all stakeholders, and the credibility and appropriateness of a pharmacist-led intervention to address these shortcomings. Central to this was the face-to-face contact and relationship building between pharmacists and a range of practice staff, and pharmacists’ explicitly designated role as a change agent

  5. RELATIONSHIP BETWEEN ISOMETRIC THIGH MUSCLE STRENGTH AND MINIMAL CLINICALLY IMPORTANT DIFFERENCES (MCIDS) IN KNEE FUNCTION IN OSTEOARTHRITIS – DATA FROM THE OSTEOARTHRITIS INITIATIVE

    Science.gov (United States)

    Ruhdorfer, Anja; Wirth, Wolfgang; Eckstein, Felix

    2014-01-01

    Objective To determine the relationship between thigh muscle strength and clinically relevant differences in self-assessed lower limb function. Methods Isometric knee extensor and flexor strength of 4553 Osteoarthritis Initiative participants (2651 women/1902 men) was related to Western Ontario McMasters Universities (WOMAC) physical function scores by linear regression. Further, groups of Male and female participant strata with minimal clinically important differences (MCIDs) in WOMAC function scores (6/68) were compared across the full range of observed values, and to participants without functional deficits (WOMAC=0). The effect of WOMAC knee pain and body mass index on the above relationships was explored using stepwise regression. Results Per regression equations, a 3.7% reduction in extensor and a 4.0% reduction in flexor strength were associated with an MCID in WOMAC function in women, and a 3.6%/4.8% reduction in men. For strength divided by body weight, reductions were 5.2%/6.7% in women and 5.8%/6.7% in men. Comparing MCID strata across the full observed range of WOMAC function confirmed the above estimates and did not suggest non-linear relationships across the spectrum of observed values. WOMAC pain correlated strongly with WOMAC function, but extensor (and flexor) muscle strength contributed significant independent information. Conclusion Reductions of approximately 4% in isometric muscle strength and of 6% in strength/weight were related to a clinically relevant difference in WOMAC functional disability. Longitudinal studies will need to confirm these relationships within persons. Muscle extensor (and flexor) strength (per body weight) provided significant independent information in addition to pain in explaining variability in lower limb function. PMID:25303012

  6. Relationship between isometric thigh muscle strength and minimum clinically important differences in knee function in osteoarthritis: data from the osteoarthritis initiative.

    Science.gov (United States)

    Ruhdorfer, Anja; Wirth, Wolfgang; Eckstein, Felix

    2015-04-01

    To determine the relationship between thigh muscle strength and clinically relevant differences in self-assessed lower leg function. Isometric knee extensor and flexor strength of 4,553 Osteoarthritis Initiative participants (2,651 women and 1,902 men) was related to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function scores by linear regression. Further, groups of male and female participant strata with minimum clinically important differences (MCIDs) in WOMAC function scores (6 of 68 units) were compared across the full range of observed values and to participants without functional deficits (WOMAC score 0). The effect of WOMAC knee pain and body mass index on the above relationships was explored using stepwise regression. Per regression equations, a 3.7% reduction in extensor strength and a 4.0% reduction in flexor strength were associated with an MCID in WOMAC function in women, and, respectively, a 3.6% and 4.8% reduction in men. For strength divided by body weight, reductions were 5.2% and 6.7%, respectively, in women and 5.8% and 6.7%, respectively, in men. Comparing MCID strata across the full observed range of WOMAC function confirmed the above estimates and did not suggest nonlinear relationships across the spectrum of observed values. WOMAC pain correlated strongly with WOMAC function, but extensor (and flexor) muscle strength contributed significant independent information. Reductions of approximately 4% in isometric muscle strength and of 6% in strength per body weight were related to a clinically relevant difference in WOMAC functional disability. Longitudinal studies will need to confirm these relationships within persons. Muscle extensor (and flexor) strength (per body weight) provided significant independent information in addition to pain in explaining variability in lower leg function. Copyright © 2015 by the American College of Rheumatology.

  7. Evaluation of the measurement model and clinically important differences for menopause-specific quality of life associated with bazedoxifene/conjugated estrogens.

    Science.gov (United States)

    Bushmakin, Andrew G; Abraham, Lucy; Pinkerton, JoAnn V; Cappelleri, Joseph C; Mirkin, Sebastian

    2014-08-01

    This study aims to confirm the factor structure of the Menopause-Specific Quality of Life (MENQOL) questionnaire by using confirmatory factor analysis (CFA) and to determine whether improvements in menopause-specific health-related quality of life (HRQOL) observed with bazedoxifene (BZA)/conjugated estrogens (CE) relative to placebo are clinically meaningful. Postmenopausal women with seven or more moderate to severe hot flushes per day (or ≥50 per wk) received BZA 20 mg/CE 0.45 mg, BZA 20 mg/CE 0.625 mg, or placebo for 12 weeks. HRQOL and treatment satisfaction were evaluated using the MENQOL questionnaire and the Menopause Symptoms Treatment Satisfaction Questionnaire, respectively. The structure of the MENQOL questionnaire was evaluated using CFA. To estimate clinically important differences (CIDs) in HRQOL, we used a repeated-measures model to estimate changes in MENQOL domain and total scores using Menopause Symptoms Treatment Satisfaction Questionnaire items as anchors. The CFA model fits the MENQOL data (Bentler's comparative fit index >0.9). CID estimates ranged from 0.5 to 1.2 for the MENQOL domains and total score. Change from baseline in MENQOL vasomotor domain score for BZA 20 mg/CE 0.45 mg and BZA 20 mg/CE 0.625 mg compared with placebo was greater than the estimated CID, as were changes in MENQOL physical domain and total scores for BZA 20 mg/CE 0.625 mg compared with placebo. CFA confirms the factor structure of the MENQOL questionnaire. Treatment with BZA/CE provides clinically meaningful improvements in HRQOL in a population of postmenopausal women with bothersome vasomotor symptoms.

  8. Comparison of the clinical and microbiological characteristics of Campylobacter and Helicobacter bacteremia: the importance of time to blood culture positivity using the BACTEC blood culture systems.

    Science.gov (United States)

    Yamamoto, Kei; Hayakawa, Kayoko; Nagashima, Maki; Shimada, Kayo; Kutsuna, Satoshi; Takeshita, Nozomi; Kato, Yasuyuki; Kanagawa, Shuzo; Yamada, Koji; Mezaki, Kazuhisa; Kirikae, Teruo; Ohmagari, Norio

    2017-11-28

    Campylobacter spp. and Helicobacter spp. are rare but important causes of bacteremia in humans. Distinguishing these bacteria is complicated because of their similar phenotypic profiles. We conducted clinical and microbiological investigations of Campylobacter spp. or Helicobacter spp. bacteremia. Patients diagnosed with bacteremia from 2008 to 2014 were included. The clinical and microbiological characteristics of Campylobacter spp. and Helicobacter spp. bacteremia were compared. The BACTEC system was used in blood cultures. A receiver operating characteristic curve was plotted based on the time to blood culture positivity. Sixteen cases of Helicobacter spp. bacteremia (patient age: 61 ± 18 years) and 14 cases of Campylobacter spp. bacteremia (patient age: 49 ± 21 years) were identified. Median time to blood culture positivity was longer for the Helicobacter spp. cases than the Campylobacter spp. cases (91.4 h vs 55.3 h, p culture positivity > 75 h predicted Helicobacter spp. bacteremia with a sensitivity of 0.88 and a specificity of 0.93 (area under the receiver operating characteristic curve of 0.90). In conclusion, a time to blood culture positivity was useful in distinguishing Helicobacter spp. bacteremia from Campylobacter spp. bacteremia.

  9. What are the effects of varenicline compared with nicotine replacement therapy on long-term smoking cessation and clinically important outcomes? Protocol for a prospective cohort study.

    Science.gov (United States)

    Davies, Neil M; Taylor, Gemma; Taylor, Amy E; Thomas, Kyla H; Windmeijer, Frank; Martin, Richard M; Munafò, Marcus R

    2015-11-05

    Smoking is a major avoidable cause of ill-health and premature death. Treatments that help patients successfully quit smoking have an important effect on health and life expectancy. Varenicline is a medication that can help smokers successfully quit smoking. However, there are concerns that it may cause adverse effects, such as increase in the occurrence of depression, self-harm and suicide and cardiovascular disease. In this study we aim to examine the effects of varenicline versus other smoking cessation pharmacotherapies on smoking cessation, health service use, all-cause and cause-specific mortality and physical and mental health conditions. In this project we will investigate the effects of varenicline compared to nicotine replacement therapies on: (1) long-term smoking cessation and whether these effects differ by area level deprivation; and (2) the following clinically-important outcomes: rate of general practice and hospital attendance; all-cause mortality and death due to diseases of the respiratory system and cardiovascular disease; and a primary care diagnosis of respiratory illness, myocardial infarction or depression and anxiety. The study is based on a cohort of patients prescribed these smoking cessation medications from the Clinical Practice Research Datalink (CPRD). We will use three methods to overcome confounding: multivariable adjusted Cox regression, propensity score matched Cox regression, and instrumental variable regression. The total expected sample size for analysis will be at least 180,000. Follow-up will end with the earliest of either an 'event' or censoring due to the end of registration or death. Ethics approval was not required for this study. This project has been approved by the CPRD's Independent Scientific Advisory Committee (ISAC). We will disseminate our findings via publications in international peer-reviewed journals and presentations at international conferences. Published by the BMJ Publishing Group Limited. For permission

  10. Responsiveness, minimal detectable change, and minimal clinically important difference of the Nottingham Extended Activities of Daily Living Scale in patients with improved performance after stroke rehabilitation.

    Science.gov (United States)

    Wu, Ching-yi; Chuang, Li-ling; Lin, Keh-chung; Lee, Shin-da; Hong, Wei-hsien

    2011-08-01

    To determine the responsiveness, minimal detectable change (MDC), and minimal clinically important differences (MCIDs) of the Nottingham Extended Activities of Daily Living (NEADL) scale and to assess percentages of patients' change scores exceeding the MDC and MCID after stroke rehabilitation. Secondary analyses of patients who received stroke rehabilitation therapy. Medical centers. Patients with stroke (N=78). Secondary analyses of patients who received 1 of 4 rehabilitation interventions. Responsiveness (standardized response mean [SRM]), 90% confidence that a change score at this threshold or higher is true and reliable rather than measurement error (MDC(90)), and MCID on the NEADL score and percentages of patients exceeding the MDC(90) and MCID. The SRM of the total NEADL scale was 1.3. The MDC(90) value for the total NEADL scale was 4.9, whereas minima and maxima of the MCID for total NEADL score were 2.4 and 6.1 points, respectively. Percentages of patients exceeding the MDC(90) and MCID of the total NEADL score were 50.0%, 73.1%, and 32.1%, respectively. The NEADL is a responsive instrument relevant for measuring change in instrumental activities of daily living after stroke rehabilitation. A patient's change score has to reach 4.9 points on the total to indicate a true change. The mean change score of a stroke group on the total NEADL scale should achieve 6.1 points to be regarded as clinically important. Our findings are based on patients with improved NEADL performance after they received specific interventions. Future research with larger sample sizes is warranted to validate these estimates. Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  11. Importance measures

    International Nuclear Information System (INIS)

    Gomez Cobo, A.

    1997-01-01

    The presentation discusses the following: general concepts of importance measures; example fault tree, used to illustrate importance measures; Birnbaum's structural importance; criticality importance; Fussel-Vesely importance; upgrading function; risk achievement worth; risk reduction worth

  12. Great Lakes Environmental Database (GLENDA)

    Data.gov (United States)

    U.S. Environmental Protection Agency — The Great Lakes Environmental Database (GLENDA) houses environmental data on a wide variety of constituents in water, biota, sediment, and air in the Great Lakes area.

  13. Assessing the stroke-specific quality of life for outcome measurement in stroke rehabilitation: minimal detectable change and clinically important difference.

    Science.gov (United States)

    Lin, Keh-chung; Fu, Tiffany; Wu, Ching-yi; Hsieh, Ching-ju

    2011-01-19

    This study was conducted to establish the minimal detectable change (MDC) and clinically important differences (CIDs) of the physical category of the Stroke-Specific Quality of Life Scale in patients with stroke. MDC and CIDs scores were calculated from the data of 74 participants enrolled in randomized controlled trials investigating the effects of two rehabilitation programs in patients with stroke. These participants received treatments for 3 weeks and underwent clinical assessment before and after treatment. To obtain test-retest reliability for calculating MDC, another 25 patients with chronic stroke were recruited. The MDC was calculated from the standard error of measurement (SEM) to indicate a real change with 95% confidence for individual patients (MDC95). Distribution-based and anchor-based methods were adopted to triangulate the ranges of minimal CIDs. The percentage of scale width was calculated by dividing the MDC and CIDs by the total score range of each physical category. The percentage of patients exceeding MDC95 and minimal CIDs was also reported. The MDC95 of the mobility, self-care, and upper extremity (UE) function subscales were 5.9, 4.0, and 5.3 respectively. The minimal CID ranges for these 3 subscales were 1.5 to 2.4, 1.2 to 1.9, and 1.2 to 1.8. The percentage of patients exceeding MDC95 and minimal CIDs of the mobility, self-care, and UE function subscales were 9.5% to 28.4%, 6.8% to 28.4%, and 12.2% to 33.8%, respectively. The change score of an individual patient has to reach 5.9, 4.0, and 5.3 on the 3 subscales to indicate a true change. The mean change scores of a group of patients with stroke on these subscales should reach the lower bound of CID ranges of 1.5 (6.3% scale width), 1.2 (6.0% scale width), and 1.2 (6.0% scale width) to be regarded as clinically important change. This information may facilitate interpretations of patient-reported outcomes after stroke rehabilitation. Future research is warranted to validate these findings.

  14. The minimally important difference for the fatigue visual analog scale in patients with rheumatoid arthritis followed in an academic clinical practice.

    Science.gov (United States)

    Khanna, Dinesh; Pope, Janet E; Khanna, Puja P; Maloney, Michelle; Samedi, Nooshin; Norrie, Debbie; Ouimet, Gillian; Hays, Ron D

    2008-12-01

    To estimate the minimally important difference (MID) for a fatigue visual analog scale (VAS) using patient-reported anchors (fatigue, pain, and overall health). Patients with rheumatoid arthritis (RA; n = 307) had 2 clinic visits at a median of 5.9 months apart. They completed a fatigue VAS (0-10 scale) and the retrospective anchor items, "How would you describe your overall fatigue/pain/overall health since the last visit?" with response options: Much worsened, Somewhat worsened, Same, Somewhat better, or Much better. The fatigue anchor was used for primary analysis and the pain/overall health anchors for sensitivity analyses. The minimally changed group was defined by those reporting they were somewhat better or somewhat worsened. The mean [standard deviation (SD)] age was 59.4 (13.2) years, disease duration was 14.1 (11.5) years, and 83% of patients were women. The baseline mean (SD) Health Assessment Questionnaire-Disability Index score was 0.84 (0.75). The baseline fatigue VAS score was 4.2 (2.9) and at followup was 4.3 (2.8) [mean change of -0.07 (2.5); p = not significant]. The fatigue change score (0-10 scale) for Somewhat better and Somewhat worsened for the fatigue anchor averaged -1.12 and 1.26, respectively. Using the pain anchor, the fatigue change score for Somewhat better and Somewhat worsened averaged -0.87 and 1.13; and using the global anchor, the fatigue change score for Somewhat better and Somewhat worsened averaged -0.82 and 1.17, respectively. Effect size estimates using 3 anchors were small for the Somewhat better (range 0.27-0.39) and Somewhat worsened (0.40-0.44) groups, but larger than for the no-change group (0.03-0.08). The MID for fatigue VAS is between -0.82 for -1.12 for improvement and is 1.13 to 1.26 for worsening on a 0-10 scale in a large RA clinical practice, and is similar to that seen in RA clinical trials. This information can aid in interpreting fatigue VAS in day-to-day care in clinical practice.

  15. Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales.

    Science.gov (United States)

    Copay, Anne G; Glassman, Steven D; Subach, Brian R; Berven, Sigurd; Schuler, Thomas C; Carreon, Leah Y

    2008-01-01

    The impact of lumbar spinal surgery is commonly evaluated with three patient-reported outcome measures: Oswestry Disability Index (ODI), the physical component summary (PCS) of the Short Form of the Medical Outcomes Study (SF-36), and pain scales. A minimum clinically important difference (MCID) is a threshold used to measure the effect of clinical treatments. Variable threshold values have been proposed as MCID for those instruments despite a lack of agreement on the optimal MCID calculation method. This study has three purposes. First, to illustrate the range of values obtained by common anchor-based and distribution-based methods to calculate MCID. Second, to determine a statistically sound and clinically meaningful MCID for ODI, PCS, back pain scale, and leg pain scale in lumbar spine surgery patients. Third, to compare the discriminative ability of two anchors: a global health assessment and a rating of satisfaction with the results of the surgery. This study is a review of prospectively collected patient-reported outcomes data. A total of 454 patients from a large database of surgeries performed by the Lumbar Spine Study Group with a 1-year follow-up on either ODI or PCS were included in the study. Preoperative and 1-year postoperative scores for ODI, PCS, back pain scale, leg pain scale, health transition item (HTI) of the SF-36, and Satisfaction with Results scales. ODI, SF-36, and pain scales were administered before and 1 year after spinal surgery. Several candidate MCID calculation methods were applied to the data and the resulting values were compared. The HTI of the SF-36 was used as the anchor and compared with a second anchor (Satisfaction with Results scale). Potential MCID calculations yielded a range of values: fivefold for ODI, PCS, and leg pain, 10-fold for back pain. Threshold values obtained with the two anchors were very similar. The minimum detectable change (MDC) appears as a statistically and clinically appropriate MCID value. MCID values

  16. FACE Analysis as a Fast and Reliable Methodology to Monitor the Sulfation and Total Amount of Chondroitin Sulfate in Biological Samples of Clinical Importance

    Directory of Open Access Journals (Sweden)

    Evgenia Karousou

    2014-06-01

    Full Text Available Glycosaminoglycans (GAGs due to their hydrophilic character and high anionic charge densities play important roles in various (pathophysiological processes. The identification and quantification of GAGs in biological samples and tissues could be useful prognostic and diagnostic tools in pathological conditions. Despite the noteworthy progress in the development of sensitive and accurate methodologies for the determination of GAGs, there is a significant lack in methodologies regarding sample preparation and reliable fast analysis methods enabling the simultaneous analysis of several biological samples. In this report, developed protocols for the isolation of GAGs in biological samples were applied to analyze various sulfated chondroitin sulfate- and hyaluronan-derived disaccharides using fluorophore-assisted carbohydrate electrophoresis (FACE. Applications to biologic samples of clinical importance include blood serum, lens capsule tissue and urine. The sample preparation protocol followed by FACE analysis allows quantification with an optimal linearity over the concentration range 1.0–220.0 µg/mL, affording a limit of quantitation of 50 ng of disaccharides. Validation of FACE results was performed by capillary electrophoresis and high performance liquid chromatography techniques.

  17. Clinically-Important Brain Injury and CT Findings in Pediatric Mild Traumatic Brain Injuries: A Prospective Study in a Chinese Reference Hospital

    Directory of Open Access Journals (Sweden)

    Huiping Zhu

    2014-03-01

    Full Text Available This study investigated injury patterns and the use of computed tomography (CT among Chinese children with mild traumatic brain injury (MTBI. We enrolled children with MTBI who were treated within 24 hours of head trauma in the emergency department of Wuhan Medical Care Center for Women and Children in Wuhan, China. Characteristics of MTBIs were analyzed by age and gender. Results of cranial CT scan and clinically-important brain injury (ciTBI for children were obtained. The definition of ciTBI was: death from TBI, intubation for more than 24 h for TBI, neurosurgery, or hospital admission of 2 nights or more. Of 455 eligible patients with MTBI, ciTBI occurred in two, and no one underwent neurosurgical intervention. CT scans were performed for 441 TBI patients (96.9%, and abnormal findings were reported for 147 patients (33.3%, 95% CI 29.0–37.8. Falls were the leading cause of MTBI (61.5%, followed by blows (18.9% and traffic collisions (14.1% for children in the 0–2 group and 10–14 group. For children aged between 3 and 9, the top three causes of TBI were falls, traffic collisions and blows. Leisure activity was the most reported activity when injuries occurred for all age groups. Sleeping/resting and walking ranked in the second and third place for children between 0 and 2 years of age, and walking and riding for the other two groups. The places where the majority injuries occurred were the home for the 0–2 and 3–9 years of age groups, and school for the 10–14 years of age group. There was no statistical difference between boys and girls with regard to the activity that caused the MTBI. This study highlights the important roles that parents and school administrators in the development of preventive measures to reduce the risk of traumatic brain injury in children. Also, identifying children who had a head trauma at very low risk of clinically important TBI for whom CT might be unnecessary is a priority area of research in China.

  18. The great climate debate

    International Nuclear Information System (INIS)

    Sudhakara Reddy, B.; Assenza, Gaudenz B.

    2009-01-01

    For over two decades, scientific and political communities have debated whether and how to act on climate change. The present paper revisits these debates and synthesizes the longstanding arguments. Firstly, it provides an overview of the development of international climate policy and discusses clashing positions, represented by sceptics and supporters of action on climate change. Secondly, it discusses the market-based measures as a means to increase the win-win opportunities and to attract profit-minded investors to invest in climate change mitigation. Finally, the paper examines whether climate protection policies can yield benefits both for the environment and the economy. A new breed of analysts are identified who are convinced of the climate change problem, while remaining sceptical of the proposed solutions. The paper suggests the integration of climate policies with those of development priorities that are vitally important for developing countries and stresses the need for using sustainable development as a framework for climate change policies.

  19. The Relative Importance of Family History, Gender, Mode of Onset, and Age at Onsetin Predicting Clinical Features of First-Episode Psychotic Disorders.

    Science.gov (United States)

    Compton, Michael T; Berez, Chantal; Walker, Elaine F

    Family history of psychosis, gender, mode of onset, and age at onset are considered prognostic factors important to clinicians evaluating first-episode psychosis; yet, clinicians have little guidance as to how these four factors differentially predict early-course substance abuse, symptomatology, and functioning. We conducted a "head-to-head comparison" of these four factors regarding their associations with key clinical features at initial hospitalization. We also assessed potential interactions between gender and family history with regard to age at onset of psychosis and symptom severity. Consecutively admitted first-episode patients (n=334) were evaluated in two studies that rigorously assessed a number of early-course variables. Associations among variables of interest were examined using Pearson correlations, χ 2 tests, Student's t-tests, and 2×2 factorial analyses of variance. Substance (nicotine, alcohol, and cannabis) abuse and positive symptom severity were predicted only by male gender. Negative symptom severity and global functioning impairments were predicted by earlier age at onset of psychosis. General psychopathology symptom severity was predicted by both mode of onset and age at onset. Interaction effects were not observed with regard to gender and family history in predicting age at onset or symptom severity. The four prognostic features have differential associations with substance abuse, domains of symptom severity, and global functioning. Gender and age at onset of psychosis appear to be more predictive of clinical features at the time of initial evaluation (and thus presumably longer term outcomes) than the presence of a family history of psychosis and a more gradual mode of onset.

  20. Estimation of minimal clinically important change of the Japanese version of EQ-5D in patients with chronic noncancer pain: a retrospective research using real-world data.

    Science.gov (United States)

    Yoshizawa, Kazutake; Kobayashi, Hisanori; Fujie, Motoko; Ogawa, Yoshimasa; Yajima, Tsutomu; Kawai, Koji

    2016-03-01

    Quality of life (QoL) is routinely assessed and evaluated in medical research. However, in Japan, there is a lack of solid cutoff criteria for evaluating QoL improvement in chronic noncancer pain management. The present study was conducted to identify the minimal clinically important change (MCIC) of the Japanese version of EuroQol-5D 3L(EQ-5D) utility score and numeric rating scale (NRS) with an emphasis on chronic noncancer pain. The data source for this post hoc research was the post-marketing surveillance (PMS) data for a tramadol/acetaminophen combination tablet, which was previously conducted in real-world settings. The parameters extracted from the PMS data were sociodemographic characteristics, NRS, EQ-5D, and dichotomous physician's global impression of treatment effectiveness (PGI). The optimal cutoff points of MCIC for EQ-5D utility and NRS scores were evaluated using receiver operating characteristics (ROC) analysis. An anchor-based approach using PGI was applied. Data of 710 patients with chronic noncancer pain were extracted from the PMS database. The NRS score decreased by 2.7 (standard deviation, 2.3) points, whereas the EQ-5D score increased by 0.16 (0.20) points at 4 weeks from baseline. The changes from baseline in NRS and EQ-5D were significantly correlated (r = 0.53, p 0.80 in both analyses. These results demonstrated novel cutoff criteria for the Japanese version of EQ-5D, focusing on patients with chronic noncancer pain. The obtained criteria were fairly consistent and can be confidently utilized as an evaluation tool in medical research on chronic noncancer pain in Japan, with additional functionality and usability for QoL assessment in pain management practice. The data source of this post hoc research was a PMS study with the identifier number UMIN000015901 at umin.ac.jp, UMIN clinical trial registry (UMIN-CTR).

  1. Pacific salmonines in the Great Lakes Basin

    Science.gov (United States)

    Claramunt, Randall M.; Madenjian, Charles P.; Clapp, David; Taylor, William W.; Lynch, Abigail J.; Léonard, Nancy J.

    2012-01-01

    Pacific salmon (genus Oncorhynchus) are a valuable resource, both within their native range in the North Pacific rim and in the Great Lakes basin. Understanding their value from a biological and economic perspective in the Great Lakes, however, requires an understanding of changes in the ecosystem and of management actions that have been taken to promote system stability, integrity, and sustainable fisheries. Pacific salmonine introductions to the Great Lakes are comprised mainly of Chinook salmon, coho salmon, and steelhead and have accounted for 421, 177, and 247 million fish, respectively, stocked during 1966-2007. Stocking of Pacific salmonines has been effective in substantially reducing exotic prey fish abundances in several of the Great Lakes (e.g., lakes Michigan, Huron, and Ontario). The goal of our evaluation was to highlight differences in management strategies and perspectives across the basin, and to evaluate policies for Pacific salmonine management in the Great Lakes. Currently, a potential conflict exists between Pacific salmonine management and native fish rehabilitation goals because of the desire to sustain recreational fisheries and to develop self-sustaining populations of stocked Pacific salmonines in the Great Lakes. We provide evidence that suggests Pacific salmonines have not only become naturalized to the food webs of the Great Lakes, but that their populations (specifically Chinook salmon) may be fluctuating in concert with specific prey (i.e., alewives) whose populations are changing relative to environmental conditions and ecosystem disturbances. Remaining questions, however, are whether or not “natural” fluctuations in predator and prey provide enough “stability” in the Great Lakes food webs, and even more importantly, would a choice by managers to attempt to reduce the severity of predator-prey oscillations be antagonistic to native fish restoration efforts. We argue that, on each of the Great Lakes, managers are pursuing

  2. Clinical Trials

    Medline Plus

    Full Text Available ... Studies Learn more about Children and Clinical Studies Importance of Children in Clinical Studies Children have often ... participants. Children and Clinical Studies Learn about the importance of children in clinical studies and get answers ...

  3. The heart and great vessels

    International Nuclear Information System (INIS)

    Condon, V.

    1985-01-01

    Heart disease is the fifth most common cause of death in infants and children (preceded by anoxic and hypoxic conditions, gross congenital malformations, accidental death, and immaturity). Of all the cardiac lesions, congenital heart disease (CHD) makes up the gross majority, accounting for approximately 90% of all cardiac deaths. Approximately two-thirds of all infants who die from CHD do so within the first year of life; of these, approximately one-third die within the first month. The most common cause of death in the first month is hypoplastic left heart syndrome and lesions associated with it, i.e., aortic atresia/critical aortic stenosis and mitral atresia/critical mitral stenosis. Severe coarctation of the aorta (coarctation syndrome) and transposition of the great arteries are the other most important causes of death in this age group. CHD occurs as a familial condition in approximately 1-4% of cases; ventricular septal defects, patent ductus arteriosus, and atrial septal defect are particularly common forms. Parental age plays an important role, with a significantly increased risk of CHD in infants of mothers over 39 years of age. Patent ductus arteriosus is more prevalent in firstborn children, particularly those born prematurely to young mothers. Environmental factors, such as exposure to teratogenic agents, have also been shown to increase the incidence of CHD. Children with various syndromes also have increased incidence of CHD. Down syndrome is a classic example, as are other trisomies

  4. The importance of the clinical observer in the development of a white-coat effect in African-American patients with hypertension.

    Science.gov (United States)

    Labinson, Paul T; Giacco, Sharon; Gift, Henry; Mansoor, George A; White, William B

    2008-06-01

    As the office-awake blood pressure (BP) difference (white-coat effect) in African-Americans has not been evaluated, we studied the ethnicity, professional status (nurse versus doctor) and sex of the observer on the white-coat effect in African-American patients with hypertension. Seated clinical BP measurements were obtained in random order by an African-American male research physician, a Caucasian male research physician, and a Caucasian female nurse who is of similar age and clinical experience. Within 1 week, ambulatory BP recordings were performed. A total of 65 African-American patients [54+/-13 years, 55% women, body mass index (BMI) 31+/-6 kg/m, 62% on drug therapy, 28% current smokers] participated in the study. Twenty-two percent had a systolic white-coat effect >20 mmHg and 49% had a diastolic white-coat effect >10 mmHg (average of all observers). Although there were no differences in the magnitude of the white-coat effect among the three study observers, the primary physician's diastolic white-coat effect was significantly greater than that of the African-American physician (14+/-12 vs. 9+/-12, P=0.05), but not the systolic white-coat effect (16+/-16 vs. 10+/-16 mmHg, P=0.09). BMI positively correlated with the systolic and diastolic white-coat effect (r=0.30, P=0.02 and r=0.41, P=0.0001), but this correlation was true only for female patients in multiple regression analyses. BMI significantly predicted the systolic (P=0.043) and diastolic (P=0.004) white-coat effects. A white-coat effect is relatively common in African-American patients with hypertension and is the largest when the observer is their usual doctor. The clinical observer's ethnicity or sex does not play an important role in generating a white-coat effect in African-American patients with hypertension.

  5. Clinically important deterioration in patients undergoing lumbar spine surgery: a choice of evaluation methods using the Oswestry Disability Index, 36-Item Short Form Health Survey, and pain scales: clinical article.

    Science.gov (United States)

    Gum, Jeffrey L; Glassman, Steven D; Carreon, Leah Y

    2013-11-01

    Health-related quality of life (HRQOL) measures have become the mainstay for outcome appraisal in spine surgery. Clinically meaningful interpretation of HRQOL improvement has centered on the minimum clinically important difference (MCID). The purpose of this study was to calculate clinically important deterioration (CIDET) thresholds and determine a CIDET value for each HRQOL measure for patients undergoing lumbar fusion. Seven hundred twenty-two patients (248 males, 127 smokers, mean age 60.8 years) were identified with complete preoperative and 1-year postoperative HRQOLs including the Oswestry Disability Index (ODI), 36-Item Short Form Health Survey (SF-36), and numeric rating scales (0-10) for back and leg pain following primary, instrumented, posterior lumbar fusion. Anchor-based and distribution-based methods were used to calculate CIDET for each HRQOL. Anchor-based methods included change score, change difference, and receiver operating characteristic curve analysis. The Health Transition Item, an independent item of the SF-36, was used as the external anchor. Patients who responded "somewhat worse" and "much worse" were combined and compared with patients responding "about the same." Distribution-based methods were minimum detectable change and effect size. Diagnoses included spondylolisthesis (n = 332), scoliosis (n = 54), instability (n = 37), disc pathology (n = 146), and stenosis (n = 153). There was a statistically significant change (p < 0.0001) for each HRQOL measure from preoperatively to 1-year postoperatively. Only 107 patients (15%) reported being "somewhat worse" (n = 81) or "much worse" (n = 26). Calculation methods yielded a range of CIDET values for ODI (0.17-9.06), SF-36 physical component summary (-0.32 to 4.43), back pain (0.02-1.50), and leg pain (0.02-1.50). A threshold for clinical deterioration was difficult to identify. This may be due to the small number of patients reporting being worse after surgery and the variability across

  6. ["Great jobs"-also in psychiatry?].

    Science.gov (United States)

    Spiessl, H; Hübner-Liebermann, B

    2003-09-01

    Against the background of a beginning shortage of psychiatrists, results from interviews with 112 employees of an automotive company with the topic "Great Job" are presented to discuss their relevance to psychiatry. The interviews were analysed by means of a qualitative content analysis. Most employees assigned importance to great pay, constructive collaboration with colleagues, and work appealing to personal interests. Further statements particularly relevant to psychiatry were: successful career, flexible working hours, manageable job, work-life balance, well-founded training, no bureaucracy within the company, and personal status in society. The well-known economic restrictions in health care and the still negative attitude towards psychiatry currently reduce the attraction of psychiatry as a profession. From the viewpoint of personnel management, the attractors of a great job revealed in this study are proposed as important clues for the recruitment of medical students for psychiatry and the development of psychiatric staff.

  7. SHBG is an important factor in stemness induction of cells by DHT in vitro and associated with poor clinical features of prostate carcinomas.

    Science.gov (United States)

    Ma, Yuanyuan; Liang, Dongming; Liu, Jian; Wen, Jian-Guo; Servoll, Einar; Waaler, Gudmund; Sæter, Thorstein; Axcrona, Karol; Vlatkovic, Ljiljana; Axcrona, Ulrika; Paus, Elisabeth; Yang, Yue; Zhang, Zhiqian; Kvalheim, Gunnar; Nesland, Jahn M; Suo, Zhenhe

    2013-01-01

    Androgen plays a vital role in prostate cancer development. However, it is not clear whether androgens influence stem-like properties of prostate cancer, a feature important for prostate cancer progression. In this study, we show that upon DHT treatment in vitro, prostate cancer cell lines LNCaP and PC-3 were revealed with higher clonogenic potential and higher expression levels of stemness related factors CD44, CD90, Oct3/4 and Nanog. Moreover, sex hormone binding globulin (SHBG) was also simultaneously upregulated in these cells. When the SHBG gene was blocked by SHBG siRNA knock-down, the induction of Oct3/4, Nanog, CD44 and CD90 by DHT was also correspondingly blocked in these cells. Immunohistochemical evaluation of clinical samples disclosed weakly positive, and areas negative for SHBG expression in the benign prostate tissues, while most of the prostate carcinomas were strongly positive for SHBG. In addition, higher levels of SHBG expression were significantly associated with higher Gleason score, more seminal vesicle invasions and lymph node metastases. Collectively, our results show a role of SHBG in upregulating stemness of prostate cancer cells upon DHT exposure in vitro, and SHBG expression in prostate cancer samples is significantly associated with poor clinicopathological features, indicating a role of SHBG in prostate cancer progression.

  8. Heterogeneous clinical spectrum of anti-SRP myositis and importance of the methods of detection of anti-SRP autoantibodies: a multicentric study.

    Science.gov (United States)

    Picard, Cécile; Vincent, Thierry; Lega, Jean-Christophe; Hue, Sophie; Fortenfant, Françoise; Lakomy, Daniela; Humbel, René-Louis; Goetz, Joelle; Molinari, Nicolas; Bardin, Nathalie; Bertin, Daniel; Johanet, Catherine; Chretien, Pascale; Dubucquoi, Sylvain; Streichenberger, Nathalie; Desplat-Jégo, Sophie; Bossuyt, Xavier; Sibilia, Jean; Abreu, Isabelle; Chevailler, Alain; Fabien, Nicole

    2016-06-01

    Anti-signal recognition particle (SRP) antibodies are important serological markers for the diagnosis and the prognosis of idiopathic inflammatory myopathy (IIM), especially to distinguish immune-mediated necrotizing myopathy (IMNM). This study was set up to investigate the phenotype associated with anti-SRP antibodies and to evaluate the methods for detecting these antibodies. Clinical and biological data were retrospectively obtained from 60 adult patients with anti-SRP antibodies detected by a dot immunoassay from 12 centers. Thirty-six (60 %) out of these 60 patients suffered from an IIM, and among them, 21 patients were diagnosed as IMNM. Among patients with a definite IIM, proximal weakness and myalgia were prominent symptoms at the time of diagnosis. Only few patients displayed severe extra-muscular symptoms such as cardiac involvement or severe myositis. Mean creatine kinase levels were high for all patients except for two of them. When testing by indirect immunofluorescence (IIF) on HEp2 cells, the fraction of patients displaying the typical anti-SRP fine speckled staining of the cytoplasm was higher in patients with IIM (30/36) (83 %) than in patients with non-IIM (3/24) (12.5 %) (p myositis, whereas only 6 (22 %) out of 27 patients with a positive immunodot but a negative cytoplasmic pattern suffered from a myositis (p myositis.

  9. SHBG is an important factor in stemness induction of cells by DHT in vitro and associated with poor clinical features of prostate carcinomas.

    Directory of Open Access Journals (Sweden)

    Yuanyuan Ma

    Full Text Available Androgen plays a vital role in prostate cancer development. However, it is not clear whether androgens influence stem-like properties of prostate cancer, a feature important for prostate cancer progression. In this study, we show that upon DHT treatment in vitro, prostate cancer cell lines LNCaP and PC-3 were revealed with higher clonogenic potential and higher expression levels of stemness related factors CD44, CD90, Oct3/4 and Nanog. Moreover, sex hormone binding globulin (SHBG was also simultaneously upregulated in these cells. When the SHBG gene was blocked by SHBG siRNA knock-down, the induction of Oct3/4, Nanog, CD44 and CD90 by DHT was also correspondingly blocked in these cells. Immunohistochemical evaluation of clinical samples disclosed weakly positive, and areas negative for SHBG expression in the benign prostate tissues, while most of the prostate carcinomas were strongly positive for SHBG. In addition, higher levels of SHBG expression were significantly associated with higher Gleason score, more seminal vesicle invasions and lymph node metastases. Collectively, our results show a role of SHBG in upregulating stemness of prostate cancer cells upon DHT exposure in vitro, and SHBG expression in prostate cancer samples is significantly associated with poor clinicopathological features, indicating a role of SHBG in prostate cancer progression.

  10. SHBG Is an Important Factor in Stemness Induction of Cells by DHT In Vitro and Associated with Poor Clinical Features of Prostate Carcinomas

    Science.gov (United States)

    Ma, Yuanyuan; Liang, Dongming; Liu, Jian; Wen, Jian-Guo; Servoll, Einar; Waaler, Gudmund; Sæter, Thorstein; Axcrona, Karol; Vlatkovic, Ljiljana; Axcrona, Ulrika; Paus, Elisabeth; Yang, Yue; Zhang, Zhiqian; Kvalheim, Gunnar; Nesland, Jahn M.; Suo, Zhenhe

    2013-01-01

    Androgen plays a vital role in prostate cancer development. However, it is not clear whether androgens influence stem-like properties of prostate cancer, a feature important for prostate cancer progression. In this study, we show that upon DHT treatment in vitro, prostate cancer cell lines LNCaP and PC-3 were revealed with higher clonogenic potential and higher expression levels of stemness related factors CD44, CD90, Oct3/4 and Nanog. Moreover, sex hormone binding globulin (SHBG) was also simultaneously upregulated in these cells. When the SHBG gene was blocked by SHBG siRNA knock-down, the induction of Oct3/4, Nanog, CD44 and CD90 by DHT was also correspondingly blocked in these cells. Immunohistochemical evaluation of clinical samples disclosed weakly positive, and areas negative for SHBG expression in the benign prostate tissues, while most of the prostate carcinomas were strongly positive for SHBG. In addition, higher levels of SHBG expression were significantly associated with higher Gleason score, more seminal vesicle invasions and lymph node metastases. Collectively, our results show a role of SHBG in upregulating stemness of prostate cancer cells upon DHT exposure in vitro, and SHBG expression in prostate cancer samples is significantly associated with poor clinicopathological features, indicating a role of SHBG in prostate cancer progression. PMID:23936228

  11. Uptake of 18F-DCFPyL in Paget's Disease of Bone, an Important Potential Pitfall in Clinical Interpretation of PSMA PET Studies.

    Science.gov (United States)

    Rowe, Steven P; Deville, Curtiland; Paller, Channing; Cho, Steve Y; Fishman, Elliot K; Pomper, Martin G; Ross, Ashley E; Gorin, Michael A

    2015-12-01

    Prostate-specific membrane antigen (PSMA)-targeted PET imaging is an emerging technique for evaluating patients with prostate cancer (PCa) in a variety of clinical contexts. As with any new imaging modality, there are interpretive pitfalls that are beginning to be recognized. In this image report, we describe the findings in a 63-year-old male with biochemically recurrent PCa after radical prostatectomy who was imaged with 18 F-DCFPyL, a small molecule inhibitor of PSMA. Diffuse radiotracer uptake was noted throughout the sacrum, corresponding to imaging findings on contrast-enhanced CT, bone scan, and pelvic MRI consistent with Paget's disease of bone. The uptake of 18 F-DCFPyL in Paget's disease is most likely due to hyperemia and increased radiotracer delivery. In light of the overlap in patients affected by PCa and Paget's, it is important for nuclear medicine physicians and radiologists interpreting PSMA PET/CT scans to be aware of the potential for this diagnostic pitfall. Correlation to findings on conventional imaging such as diagnostic CT and bone scan can help confirm the diagnosis.

  12. Clinical Trials

    Medline Plus

    Full Text Available ... Trials About Clinical Trials Clinical trials are research studies that explore whether a medical strategy, treatment, or ... and Clinical Studies Web page. Children and Clinical Studies Learn more about Children and Clinical Studies Importance ...

  13. Avaliando a comutatividade: importante requisito da qualidade para laboratórios clínicos Understanding commutability: important quality requirement for clinical laboratories

    Directory of Open Access Journals (Sweden)

    Chams Bicalho Maluf

    2011-12-01

    results, probably due to the lack of procedure expertise as well as the neglected importance of its assessment. OBJECTIVE: The aim of this study was to evaluate the commutability of hematological test results performed with three automated analyzers at the laboratory of a public university hospital in Belo Horizonte, MG, Brazil, proposing a practical, simple, and feasible procedure to be applied in clinical laboratories. MATERIAL AND METHODS: Samples were selected in order to obtain hematologic values for therapeutic decision levels. Six samples were processed in duplicate in three analyzers daily during a four-day period amounting to a total of 48 replicates in each instrument. The correlation between the results of 10 hematologic parameters obtained with test instruments and the reference instrument was assessed. Systematic and total errors were estimated and criteria for acceptable performance were based on the biological variation specifications. RESULTS: The correlation coefficient (r between test instruments and reference instrument results was > 0.975. Systematic (mean and total errors met the required quality specifications when compared with reference instruments. Discussion: Commutability is an important process of quality management in clinical laboratories and it ensures the comparability of test results carried out with different procedures. CONCLUSION: Through a practical, simple, and internationally standardized procedure, this study showed that test results from the evaluated instruments were equivalent, which allows their use in patient monitoring.

  14. The Great Work of the New Millennium

    Science.gov (United States)

    Berry, Thomas

    2013-01-01

    Thomas Berry explores the meaning of work from the standpoint of human civilization responding to the call of the universe, replacing use and exploitation of nature with the wonder, rapport, and intimacy so important to the psychic balance of the developing human and natural harmony of life on Earth. The Great Work is defined as the work of…

  15. Great plains regional climate assessment technical report

    Science.gov (United States)

    The Great Plains region (GP) plays important role in providing food and energy to the economy of the United States. Multiple climatic and non-climatic stressors put multiple sectors, livelihoods and communities at risk, including agriculture, water, ecosystems and rural and tribal communities. The G...

  16. Great Lakes rivermouths: a primer for managers

    Science.gov (United States)

    Pebbles, Victoria; Larson, James; Seelbach, Paul; Pebbles, Victoria; Larson, James; Seelbach, Paul

    2013-01-01

    by the Millennium Ecosystem Assessment (Table1). Collectively, this primer synthesizes existing information in a new way that aims to support management of rivermouths as distinct and important ecosystems. The development and management decisions made around rivermouths today will shape the future of these ecosystems, and the human communities within them, well into the future. 1 The information presented in this paper was derived from discussions and draft documents of the Great Lakes Rivermouth Collaboratory. The Great Lakes Rivermouth Collaboratory was established by the U.S. Geological Survey's Great Lakes Science Center (USGS-GLSC) in collaboration with the Great Lakes Commission to engage the Great Lakes scientific community in sharing and documenting knowledge about freshwater rivermouth ecosystems. For more information, see http://www.glc.org/habitat/Rivermouth-Collaboratory.html.

  17. What Caused the Great Depression?

    Science.gov (United States)

    Caldwell, Jean; O'Driscoll, Timothy G.

    2007-01-01

    Economists and historians have struggled for almost 80 years to account for the American Great Depression, which began in 1929 and lasted until the early years of World War II. In this article, the authors discuss three major schools of thought on the causes of the Great Depression and the long failure of the American economy to return to full…

  18. Biological activities of Allium sativum and Zingiber officinale extracts on clinically important bacterial pathogens, their phytochemical and FT-IR spectroscopic analysis.

    Science.gov (United States)

    Awan, Uzma Azeem; Ali, Shaukat; Shahnawaz, Amna Mir; Shafique, Irsa; Zafar, Atiya; Khan, Muhammad Abdul Rauf; Ghous, Tahseen; Saleem, Azhar; Andleeb, Saiqa

    2017-05-01

    The spread of bacterial infectious diseases is a major public threat. Herbs and spices have offered an excellent, important and useful source of antimicrobial agents against many pathological infections. In the current study, the antimicrobial potency of fresh, naturally and commercial dried Allium sativum and Zingiber officinale extracts had been investigated against seven local clinical bacterial isolates such as Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumonia, Staphylococcus aureus, Streptococcus pyogenes, Staphylococcus epidermidis, and Serratia marcesnces by the agar disc diffusion method. All tested pathogens except P. aeruginosa and E. coli were most susceptible to ethanolic and methanolic extracts of A. sativum. Similarly, chloroform and diethyl ether extracts of Z. officinale showed a greater zone of inhibition of tested pathogens except for P. aeruginosa and E. coli. We found that all extracts of A. sativum and Z. officinale have a strong antibacterial effect compared to recommended standard antibiotics through activity index. All results were evaluated statistically and a significant difference was recorded at Psativum and Z. officinale proposed the presence of various phytochemicals such as tannins, phenols, alkaloids, steroids and saponins. Retention factor of diverse phytochemicals provides a valuable clue regarding their polarity and the selection of solvents for separation of phytochemicals. Significant inhibition of S. aureus was also observed through TLC-Bioautography. FT-IR Spectrometry was also performed to characterize both natural and commercial extracts of A. sativum and Z. officinale to evaluate bioactive compounds. These findings provide new insights to use A. sativum and Z. officinale as potential plant sources for controlling pathogenic bacteria and potentially considered as cost-effective in the management of diseases and to the threat of drug resistance phenomenon.

  19. The Synthesis of L-Alanyl and β-Alanyl Derivatives of 2-Aminoacridone and Their Application in the Detection of Clinically-Important Microorganisms.

    Directory of Open Access Journals (Sweden)

    Marie Cellier

    Full Text Available In clinical microbiology the speed with which pathogenic microorganisms may be detected has a direct impact on patient health. One important strategy used in the laboratory is the growth of cultures in the presence of an enzymatic substrate which, once transformed by the appropriate microbial enzyme, generates a detectable colour or fluorescence output. Such substrates have previously been prepared by our group and others and are available as commercial diagnostic kits, however they all suffer from some degree of diffusion when used in a solid growth medium. This diffusion complicates the detection and differentiation of species in polymicrobial cultures and so we sought to improve on our previous work. In this work we have prepared and evaluated a series of novel fluorogenic enzyme substrates based on N-substituted-2-aminoacridones. All of the prepared substrates were found to be suitable for the detection and differentiation of certain microorganisms, however those based on the 2-amino-10-benzylacridone core in particular showed no apparent diffusion when incorporated into solid growth media. On transformation these substrates generated brightly fluorescent colonies that are clearly contrasted with the background medium due to the difference in emission wavelength (λem 445-450 nm for the substrate, λem 550 nm for the product. Here we have shown that our L-alanyl aminopeptidase substrate, 2-(N-L-alanylamino-10-benzylacridone, is particularly suited to the detection of Gram-negative bacteria, and our β-alanyl aminopeptidase substrate, 2-(N- β-alanylamino-10-benzylacridone, to the detection of Pseudomonas aeruginosa and Serratia marcescens when grown on solid media incorporating these substrates. The resulting fluorophore shows no apparent diffusion from the colonies of interest, and the enhanced sensitivity offered by fluorescent emission may allow for the detection of these organisms as microcolonies using automated fluorescence microscopy.

  20. Cervical flexor muscle training reduces pain, anxiety, and depression levels in patients with chronic neck pain by a clinically important amount: A prospective cohort study.

    Science.gov (United States)

    Nazari, Goris; Bobos, Pavlos; Billis, Evdokia; MacDermid, Joy C

    2018-03-14

    Neck pain is the fourth leading cause of disability in the United States and exerts an important socio-economic burden around the world. The aims of this study were to determine the effectiveness of deep and superficial flexor muscle training in addition to home-based exercises in reducing chronic neck pain and anxiety/depression levels. This was a prospective cohort study. Patients between 18 and 65 years old with chronic neck pain were eligible to participate if they had disability levels at least 5 out of 50 on the Neck Disability Index. Patients were divided into three groups: Group A received deep neck flexor and home-based exercises; Group B received superficial muscle and home-based exercises; and Group C received home-based exercises only. The Numeric Pain Rating Scale (NPRS), Neck Disability Index, and Hospital Anxiety and Depression Scale were administered at baseline and 7 weeks later. The highest improvements in pain intensity levels were observed in Group A with 4.75 (1.74) NPRS points, and the lowest were in Group C with 1.00 (1.10). The highest reductions in anxiety and depression levels were noted in Group A (2.80) and Group B (1.65), respectively. The highest improvements in pain intensity levels were observed among Groups A versus C with 2.80 (0.52) NPRS. The highest reductions in anxiety and depression levels were noted among Groups A versus C with 1.75 (1.10) points and Groups B versus C with 1.60 (0.90) points, respectively. Deep and superficial flexor muscle training along with home-based exercises is likely to reduce chronic neck pain and anxiety/depression levels by a clinically relevant amount. Future larger scaled randomized controlled trials are warranted to further support these findings. Copyright © 2018 John Wiley & Sons, Ltd.

  1. Which aspects of non-clinical quality of care are most important? Results from WHO's general population surveys of "health systems responsiveness" in 41 countries

    NARCIS (Netherlands)

    Valentine, Nicole; Darby, Charles; Bonsel, Gouke J.

    2008-01-01

    Quality of care research has reached some agreement on concepts like structure, process and outcome, and non-clinical versus clinical processes of care. These concepts are commonly explored through surveys measuring patient experiences, yet few surveys have focused on patient, or "user", priorities

  2. Energy and water in the Great Lakes.

    Energy Technology Data Exchange (ETDEWEB)

    Tidwell, Vincent Carroll

    2011-11-01

    The nexus between thermoelectric power production and water use is not uniform across the U.S., but rather differs according to regional physiography, demography, power plant fleet composition, and the transmission network. That is, in some regions water demand for thermoelectric production is relatively small while in other regions it represents the dominate use. The later is the case for the Great Lakes region, which has important implications for the water resources and aquatic ecology of the Great Lakes watershed. This is today, but what about the future? Projected demographic trends, shifting lifestyles, and economic growth coupled with the threat of global climate change and mounting pressure for greater U.S. energy security could have profound effects on the region's energy future. Planning for such an uncertain future is further complicated by the fact that energy and environmental planning and regulatory decisionmaking is largely bifurcated in the region, with environmental and water resource concerns generally taken into account after new energy facilities and technologies have been proposed, or practices are already in place. Based on these confounding needs, the objective of this effort is to develop Great Lakes-specific methods and tools to integrate energy and water resource planning and thereby support the dual goals of smarter energy planning and development, and protection of Great Lakes water resources. Guiding policies for this planning are the Great Lakes and St. Lawrence River Basin Water Resources Compact and the Great Lakes Water Quality Agreement. The desired outcome of integrated energy-water-aquatic resource planning is a more sustainable regional energy mix for the Great Lakes basin ecosystem.

  3. Clinical importance of the basal cavernous sinuses and cavernous carotid arteries relative to the pituitary gland and macroadenomas: quantitative analysis of the complete anatomy.

    Science.gov (United States)

    Yilmazlar, Selcuk; Kocaeli, Hasan; Eyigor, Ozhan; Hakyemez, Bahattin; Korfali, Ender

    2008-08-01

    macroadenomas, some part of the CA's diameter was located below the line passing from the basal dural layer ranging from 12.5% to 100%. Our results indicate that a working area of 15.0 +/- 2.6 x 10.3 +/- 2.1 mm is safe during TSS. The position of the CCA posterior segment was notably more caudal than the anterior segment with respect to the basal dura, which should be taken into account during extended exposure. Also, preoperative recognition of the anatomical variations is beneficial for detection of the boundaries of dissection, which is particularly important in the BCS, where variable course of CCAs may transform the anatomical configuration. Slowly growing pituitary adenomas stretch out both CCAs considerably from medial to lateral directions, and they cause widening of intercarotid distances in all segments. Processing of fixation, decalcification, and paraffin embedding for the cadaveric tissue in contrast to physiologically hydrated tissues may change the accuracy of measurements. These measurements are significantly different than those in the radiologic images when arterial blood under pressure is in the CCA as well as when venous blood fills the cavernous sinus as is the case in vivo. In clinical practice, these facts must be taken into consideration in the cadaveric measurements.

  4. A DUPLICATED GREAT SAPHENOUS VEIN AND CLINICAL SIGNIFICANCE FOR VARICOSITY. Duplicación de la vena safena magna y significado clínico de las várices

    Directory of Open Access Journals (Sweden)

    Waseem Al Talalwah

    2016-03-01

    Full Text Available En varios estudios se ha relacionado la vena safena magna doble con dilataciones varicosas. Durante una clase de disección de pre-grado de la extremidad inferior se encontró una doble vena safena magna unilateral en el miembro inferior izquierdo de un cadáver masculino. La incidencia de esta variación fue del 1,3% de todos los especímenes muestra. En este trabajo se reporta la variabilidad del drenaje venoso de las extremidades inferiores para mejorar la conciencia para los radiólogos vasculares y proporcionar además una opción adicional en la cirugía de bypass de la arteria coronaria para evitar las várices iatrogénicas. A double great saphenous vein has been associated with varicosity in a number of studies. During routine undergraduate dissection of the lower limb a unilateral double great saphenous was found in the left lower limb of a male cadaver. The incidence of this variation was 1.3% of all specimens. This paper reports the variability of lower limb venous drainage to increase the awareness for vascular radiologists and provide further an additional option in coronary artery bypass surgery to avoid iatrogenic varicosity.

  5. Integrated Clinical Decision Support Systems Promote Absolute Cardiovascular Risk Assessment: An Important Primary Prevention Measure in Aboriginal and Torres Strait Islander Primary Health Care

    Directory of Open Access Journals (Sweden)

    Veronica Matthews

    2017-09-01

    Full Text Available BackgroundAboriginal and Torres Strait Islander Australians experience a greater burden of disease compared to non-Indigenous Australians. Around one-fifth of the health disparity is caused by cardiovascular disease (CVD. Despite the importance of absolute cardiovascular risk assessment (CVRA as a screening and early intervention tool, few studies have reported its use within the Australian Indigenous primary health care (PHC sector. This study utilizes data from a large-scale quality improvement program to examine variation in documented CVRA as a primary prevention strategy for individuals without prior CVD across four Australian jurisdictions. We also examine the proportion with elevated risk and follow-up actions recorded.MethodsWe undertook cross-sectional analysis of 2,052 client records from 97 PHC centers to assess CVRA in Indigenous adults aged ≥20 years with no recorded chronic disease diagnosis (2012–2014. Multilevel regression was used to quantify the variation in CVRA attributable to health center and client level factors. The main outcome measure was the proportion of eligible adults who had CVRA recorded. Secondary outcomes were the proportion of clients with elevated risk that had follow-up actions recorded.ResultsApproximately 23% (n = 478 of eligible clients had documented CVRA. Almost all assessments (99% were conducted in the Northern Territory. Within this jurisdiction, there was wide variation between centers in the proportion of clients with documented CVRA (median 38%; range 0–86%. Regression analysis showed health center factors accounted for 48% of the variation. Centers with integrated clinical decision support systems were more likely to document CVRA (OR 21.1; 95% CI 5.4–82.4; p < 0.001. Eleven percent (n = 53 of clients were found with moderate/high CVD risk, of whom almost one-third were under 35 years (n = 16. Documentation of follow-up varied with respect to the targeted risk factor

  6. Temporo-mandibular disorders are an important comorbidity of migraine and may be clinically difficult to distinguish them from tension-type headache.

    Science.gov (United States)

    Silva, Ariovaldo Alberto da; Brandão, Karina Viana; Faleiros, Bruno Engler; Tavares, Rafael Mattos; Lara, Rodrigo Pinto; Januzzi, Eduardo; Carvalho, Anísio Bueno de; Carvalho, Eliane Maria Duarte de; Gomes, João Bosco Lima; Leite, Frederico Mota Gonçalves; Alves, Betania Mara Franco; Gómez, Rodrigo Santiago; Teixeira, Antônio Lúcio

    2014-02-01

    Clinical differentiation between the primary headaches and temporomandibular disorders (TMD) can be challenging. To investigate the relationship between TMD and primary headaches by conducting face to face assessments in patients from an orofacial pain clinic and a headache tertiary center. Sample consists of 289 individuals consecutively identified at a headache center and 78 individuals seen in an orofacial pain clinic because of symptoms suggestive of TMD. Migraine was diagnosed in 79.8% of headache sufferers, in headache tertiary center, and 25.6% of those in orofacial pain clinic (pheadache was present in 20.4% and 46.1%, while the TMD painful occurred in 48.1% and 70.5% respectively (pheadache, and this headache was more frequent in the dental center than at the medical center.

  7. Incidence and clinical importance of chronic reactive periostal new formations of bone in the cervical region in patients with varying neurological symptomatology

    Energy Technology Data Exchange (ETDEWEB)

    Trattnig, S; Fruehwald, F; Schwaighofer, B; Huebsch, P; Reisner, T; Binder, H

    1989-02-01

    81 patients classed into three groups with clinical evidence of neurological symptoms and posttraumatic pain of the cervical spine and the incidence of degenerative disorders were studied noninvasively via CT scanning. In about half of the patients with nerve-root symptomatology as well as with signs of involvement of long tracts, narrowing of the foramen intervertebrale, respectively of the spinal tract, was seen, attributable to degenerative osseous apposition with excellent clinical segmental and (according to radicular symptoms) side correlation. In contrast to these results the group of patients with posttraumatic clinical symptoms showed almost 50% less preexisting degenerative disorders of the cervical spine. Hypertrophic changes of the processus articulares with narrowing of the spinal canal occurred in 14% and were therefore of minor clinical significance. (orig./GDG).

  8. Great Lakes Environmental Research Laboratory

    Data.gov (United States)

    Federal Laboratory Consortium — NOAA-GLERL and its partners conduct innovative research on the dynamic environments and ecosystems of the Great Lakes and coastal regions to provide information for...

  9. What Caused the Great Recession?

    OpenAIRE

    Homburg, Stefan

    2014-01-01

    This paper examines five possible explanations for the Great Recession of 2008 and 2009, using data for the United States and the eurozone. Of these five hypotheses, four are not supported by the data, while the fifth appears reasonable.

  10. Arthroscopy of the great toe

    NARCIS (Netherlands)

    Frey, C.; van Dijk, C. N.

    1999-01-01

    The few available reports of arthroscopic treatment of the first MTP joint in the literature indicate favorable outcome. However, arthroscopy of the great toe is an advanced technique and should only be undertaken by experienced surgeons

  11. The Sixth Great Mass Extinction

    Science.gov (United States)

    Wagler, Ron

    2012-01-01

    Five past great mass extinctions have occurred during Earth's history. Humanity is currently in the midst of a sixth, human-induced great mass extinction of plant and animal life (e.g., Alroy 2008; Jackson 2008; Lewis 2006; McDaniel and Borton 2002; Rockstrom et al. 2009; Rohr et al. 2008; Steffen, Crutzen, and McNeill 2007; Thomas et al. 2004;…

  12. A orientação profissional como rito preliminar de passagem: sua importância clínica Vocational guidance as a preliminary rite of passage: its clinical importance

    Directory of Open Access Journals (Sweden)

    André Luiz Picolli da Silva

    2001-12-01

    Full Text Available Este estudo se propõe a analisar a orientação profissional como uma perspectiva de trabalho mais ampla. Os autores demonstram que a orientação profissional pode, dentro de uma abordagem clínica, ser entendida como uma representação moderna dos antigos rituais de passagem, servindo como elemento auxiliador no amadurecimento do indivíduo, que parte do "mundo infantil", visando à entrada no "mundo adulto". A orientação profissional pode ter a função de atuar como um ritual moderno, objetivando a promoção da saúde, e permitindo ao jovem vivenciar experiências primordiais que gradativamente foram sendo postas de lado pela civilização.This paper intends to analyze the practice of vocational guidance in a larger work perspective. The authors show how vocational guidance can, in a clinical approach, be understood as a modern representation of old rites of passage, and it also helps the maturation of the individual, who aims to leave the "world of childhood" for the "adult world". Vocational guidance can function as a modern rite promoting health and allowing the teenager to have experiences that have been discarded by Western civilization.

  13. Clinical Trials

    Medline Plus

    Full Text Available ... these results are important because they advance medical knowledge and help improve patient care. Sponsorship and Funding ... All types of clinical trials contribute to medical knowledge and practice. Why Clinical Trials Are Important Clinical ...

  14. Transposition of the great arteries

    Directory of Open Access Journals (Sweden)

    Castela Eduardo

    2008-10-01

    Full Text Available Abstract Transposition of the great arteries (TGA, also referred to as complete transposition, is a congenital cardiac malformation characterised by atrioventricular concordance and ventriculoarterial (VA discordance. The incidence is estimated at 1 in 3,500–5,000 live births, with a male-to-female ratio 1.5 to 3.2:1. In 50% of cases, the VA discordance is an isolated finding. In 10% of cases, TGA is associated with noncardiac malformations. The association with other cardiac malformations such as ventricular septal defect (VSD and left ventricular outflow tract obstruction is frequent and dictates timing and clinical presentation, which consists of cyanosis with or without congestive heart failure. The onset and severity depend on anatomical and functional variants that influence the degree of mixing between the two circulations. If no obstructive lesions are present and there is a large VSD, cyanosis may go undetected and only be perceived during episodes of crying or agitation. In these cases, signs of congestive heart failure prevail. The exact aetiology remains unknown. Some associated risk factors (gestational diabetes mellitus, maternal exposure to rodenticides and herbicides, maternal use of antiepileptic drugs have been postulated. Mutations in growth differentiation factor-1 gene, the thyroid hormone receptor-associated protein-2 gene and the gene encoding the cryptic protein have been shown implicated in discordant VA connections, but they explain only a small minority of TGA cases. The diagnosis is confirmed by echocardiography, which also provides the morphological details required for future surgical management. Prenatal diagnosis by foetal echocardiography is possible and desirable, as it may improve the early neonatal management and reduce morbidity and mortality. Differential diagnosis includes other causes of central neonatal cyanosis. Palliative treatment with prostaglandin E1 and balloon atrial septostomy are usually

  15. Clinical Trials

    Medline Plus

    Full Text Available ... the NHLBI's Children and Clinical Studies Web page. Children and Clinical Studies Learn more about Children and Clinical Studies Importance of Children in Clinical Studies Children have often had to ...

  16. Clinical Trials

    Medline Plus

    Full Text Available ... clinical trials contribute to medical knowledge and practice. Why Clinical Trials Are Important Clinical trials are a ... will be done during the clinical trial and why. Each medical center that does the study uses ...

  17. MORPHOMETRIC STUDY OF THE NUTRIENT FORAMINA OF UNKNOWN RADIUS AND ULNA AND THEIR CLINICAL IMPORTANCE IN THE REGION OF KADAPA [RAYALASEEMA], ANDHRA PRADESH

    Directory of Open Access Journals (Sweden)

    Guthi Reddy Manoj Kumar

    2016-03-01

    foramen from proximal end of bone was 8.2 cm. Among 28 ulnae studied on the left side, single NF was present in all 28 bones. NF was present on the anterior surface in 26 bones, (Figure No. 5, on the interosseous border in one bone (Specimen No. 15, (Figure No. 6 and on the anterior border in one bone (Specimen No. 27, (Figure No. 7. Among 22 ulnae studied on the right side, single NF was present in all 22 bones. NF was present on the anterior surface in 21 bones, on the interosseous border in 1 bone (Specimen No. 19. CONCLUSION This study on nutrient foramen has profound clinical surgical importance, hence studied and reported.

  18. IMPORTANT NOTIFICATION

    CERN Multimedia

    HR Department

    2009-01-01

    Green plates, removals and importation of personal effects Please note that, as from 1 April 2009, formalities relating to K and CD special series French vehicle plates (green plates), removals and importation of personal effects into France and Switzerland will be dealt with by GS Department (Building 73/3-014, tel. 73683/74407). Importation and purchase of tax-free vehicles in Switzerland, as well as diplomatic privileges, will continue to be dealt with by the Installation Service of HR Department (Building 33/1-011, tel. 73962). HR and GS Departments

  19. Assessment of Mobility in Older People Hospitalized for Medical Illness Using de Morton Mobility Index and Cumulated Ambulation Score-Validity and Minimal Clinical Important Difference

    DEFF Research Database (Denmark)

    Trøstrup, Jeanette; Andersen, Helle; Kam, Charlotte Agger Meiner

    2017-01-01

    BACKGROUND AND PURPOSE: Older adults acutely hospitalized for medical illness typically have comorbidity and disability, and inhospital physical inactivity greatly increases the likelihood of developing new disability. Thus, assessment of the patients' mobility status is crucial for planning....... Assessments of mobility using the DEMMI (score range 0-100), the CAS (score range 0-6), and the Barthel Index (BI, score range 0-100) were performed by physical or occupational therapists at hospital admission and discharge. In addition, at discharge patients and therapists were independently asked to assess...... and geriatric wards. In contrast, the CAS appears to be appropriate to identify whether a patient is independently mobile or needs assistance, while the measure is less suitable for measuring improvements in mobility.This is an open-access article distributed under the terms of the Creative Commons Attribution...

  20. Diagnóstico citológico de Ascus: sua importância na conduta clínica Cytological diagnosis of Ascus: its importance in clinical conduct

    Directory of Open Access Journals (Sweden)

    Daisy N.O. Lima

    2002-01-01

    Full Text Available O termo "atipia de células escamosas de significado indeterminado" (Ascus foi introduzido, em 1988, pelo Sistema Bethesda. A conduta clínica nesses casos é controversa. Outra dificuldade é a falta de uniformização de critérios citológicos dessa anormalidade, resultando em taxas de ocorrência discrepantes. Neste trabalho, estudamos 111 casos, incluídos nesta categoria citológica, concorrendo para uma taxa de 2,4% detectada num universo de 4.634 exames citológicos no período de um ano. Todas as pacientes foram avaliadas colposcopicamente, concomitantemente à colheita do material citológico cervicovaginal. Destas, 80 (72% apresentavam anormalidades ao exame colposcópico, sendo realizadas 38 biópsias dirigidas (34%. A histopatologia mostrou cervicite crônica e/ou hiperplasia simples do epitélio malpighiano em 39% dos exames, com os 61% restantes apresentando lesões intra-epiteliais escamosas, variando de baixo grau em 20 casos (52% a alto grau em três (9%. Predominaram os casos de infecção pelo HPV (39%. Estas taxas comprovam a estreita relação de Ascus com lesões pré-neoplásicas, inclusive aquelas de alto grau. Diante do significado clínico de Ascus estabelecido neste estudo, consideramos ser indicada biópsia dirigida em todos os casos de anormalidade colposcópica concomitante, sendo a histopatologia o meio mais fidedigno na avaliação destes casos.The category atypical squamous cells of undetermined significance (Ascus, it was introduced in 1988 by the Bethesda System. The clinical conduct in such cases is controversial. Another difficulty is the lack of uniformity as to cytological criteria of this abnormality and as a result we have different rates of the ocurrence. The total number of Ascus in the present series was of 2.4% in respect to 111 cases, detected in an universe of 4,634 cytologic exams in the period of one year. All patients have been submitted to a colposcopic evaluation at the same time as the

  1. Students' Perception of Important Teaching Behaviors in Classroom and Clinical Environments of a Community College Nursing and Dental Hygiene Education Program

    Science.gov (United States)

    Kimbrough-Walls, Vickie J.

    2012-01-01

    Student success is dependent on effective instruction. Yet, effective teaching is difficult to define and described differently by students, faculty, and administrators. Nursing and dental hygiene education programs require faculty to teach in both classroom and clinical environments. However, accreditation agencies for these programs mandate…

  2. Model-based clinical dose optimization for phenobarbital in neonates: An illustration of the importance of data sharing and external validation

    NARCIS (Netherlands)

    Völler, S. (Swantje); R. Flint (Robert); L. Stolk (Lisette); Degraeuwe, P.L.J. (Pieter L.J.); S.H. Simons (Sinno); P. Pokorna (Pavla); D.M. Burger (David); de Groot, R. (Ronald); D. Tibboel (Dick); C.A.J. Knibbe (Catherijne)

    2017-01-01

    textabstractBackground: Particularly in the pediatric clinical pharmacology field, data-sharing offers the possibility of making the most of all available data. In this study, we utilize previously collected therapeutic drug monitoring (TDM) data of term and preterm newborns to develop a population

  3. Retrospective identification of a previously undetected clinical case of OXA-48-producing K-pneumoniae and E-coli : the importance of adequate detection guidelines

    NARCIS (Netherlands)

    Willemsen, Ina; van Esser, Joost; Kluytmans-van den Bergh, Marjolein; Zhou, Kai; Rossen, John W.; Verhulst, Carlo; Verduin, Kees; Kluytmans, Jan

    The laboratory detection of OXA-48-carbapenemase-producing Enterobacteriaceae is difficult, as minimum inhibition concentrations for carbapenems are often below the clinical breakpoint. In 2011, the Dutch national guideline for the detection of highly resistant micro-organisms was issued, which

  4. Famous puzzles of great mathematicians

    CERN Document Server

    Petković, Miodrag S

    2009-01-01

    This entertaining book presents a collection of 180 famous mathematical puzzles and intriguing elementary problems that great mathematicians have posed, discussed, and/or solved. The selected problems do not require advanced mathematics, making this book accessible to a variety of readers. Mathematical recreations offer a rich playground for both amateur and professional mathematicians. Believing that creative stimuli and aesthetic considerations are closely related, great mathematicians from ancient times to the present have always taken an interest in puzzles and diversions. The goal of this

  5. PCR-Based Analysis of ColE1 Plasmids in Clinical Isolates and Metagenomic Samples Reveals Their Importance as Gene Capture Platforms

    OpenAIRE

    Manuel Ares-Arroyo; Cristina Bernabe-Balas; Alfonso Santos-Lopez; Maria R. Baquero; Kashi N. Prasad; Dolores Cid; Carmen Martin-Espada; Alvaro San Millan; Bruno Gonzalez-Zorn

    2018-01-01

    ColE1 plasmids are important vehicles for the spread of antibiotic resistance in the Enterobacteriaceae and Pasteurellaceae families of bacteria. Their monitoring is essential, as they harbor important resistant determinants in humans, animals and the environment. In this work, we have analyzed ColE1 replicons using bioinformatic and experimental approaches. First, we carried out a computational study examining the structure of different ColE1 plasmids deposited in databases. Bioinformatic an...

  6. Evaluation of matrix-assisted laser desorption ionization-time of flight mass spectrometry for identification of clinically important yeast species.

    Science.gov (United States)

    Stevenson, Lindsay G; Drake, Steven K; Shea, Yvonne R; Zelazny, Adrian M; Murray, Patrick R

    2010-10-01

    We evaluated the use of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for the rapid identification of yeast species. Using Bruker Daltonics MALDI BioTyper software, we created a spectral database library with m/z ratios of 2,000 to 20,000 Da for 109 type and reference strains of yeast (44 species in 8 genera). The database was tested for accuracy by use of 194 clinical isolates (23 species in 6 genera). A total of 192 (99.0%) of the clinical isolates were identified accurately by MALDI-TOF MS. The MALDI-TOF MS-based method was found to be reproducible and accurate, with low consumable costs and minimal preparation time.

  7. Bipolar disorder: The importance of clinical assessment in identifying prognostic factors - An Audit. Part 1: An analysis of potential prognostic factors.

    Science.gov (United States)

    Verdolini, Norma; Dean, Jonathon; Elisei, Sandro; Quartesan, Roberto; Zaman, Rashid; Agius, Mark

    2014-11-01

    Prognostic factors of bipolar disorder must be identified to assist in staging and treatment, and this may be done primarily during the initial psychiatric assessment. In fact, most of the prognostic factors, which determine disease outcome, could be detected from simple but often-unrecorded questions asked during the psychiatric clinic visit. We collected data from the clinical notes of 70 bipolar outpatients seen at the initial psychiatric assessment clinic about socio-demographic and clinical factors to determine whether various factors had relevance to prevalence, prognosis, or outcome. The sample comprised 16 bipolar I (22.9%) and 54 bipolar II (77.1%) outpatients; a psychiatric comorbidity was noted in 26 patients (37.1%). 60.9% (42 patients) reported anxiety features and 12 patients (17.6%) were noted to have obsessive-compulsive characteristics. Percentages reported in our results are of the sample for which the data was available. Anhedonia is a depressive feature that was present in most of the population where this data was available (92.2%, 59 patients) and 81.8% (54 patients) reported suicidal thoughts during a depressive episode. 74.6% (47 patients) had a family history of bipolar disorder, depression, suicide or psychosis. 27 patients (39.7%) reported current alcohol use and 14 patients (22.6%) current illicit drug use. A comparison between 10 prognostic factors found that only the correlations between current illicit drug use/previous illicit drug use (χ(2)=11.471, Palcohol use/previous alcohol use (χ(2)=31.510, Palcohol use (χ(2)=5.071, P=0.023) and previous alcohol use/family history (χ(2)=4.309, P=0.037) were almost statistically significant. 17 patients (24.3%) of the 70 bipolar patients were assigned to a care coordinator; we have evaluated the possible differences between the patients with or without a care coordinator on the basis of the presence of 10 possible prognostic factors and found no statistically significant differences between

  8. Great Basin paleoenvironmental studies project

    International Nuclear Information System (INIS)

    1993-01-01

    Project goals, project tasks, progress on tasks, and problems encountered are described and discussed for each of the studies that make up the Great Basin Paleoenvironmental Studies Project for Yucca Mountain. These studies are: Paleobotany, Paleofauna, Geomorphology, and Transportation. Budget summaries are also given for each of the studies and for the overall project

  9. The Great Books and Economics.

    Science.gov (United States)

    Hartley, James E.

    2001-01-01

    Describes an introductory economics course in which all of the reading material is drawn from the Great Books of Western Civilization. Explains the rationale and mechanics of the course. Includes an annotated course syllabus that details how the reading material relates to the lecture material. (RLH)

  10. Great tit hatchling sex ratios

    NARCIS (Netherlands)

    Lessells, C.M.; Mateman, A.C.; Visser, J.

    1996-01-01

    The sex of Great Tit Parus major nestlings was determined using PCR RAPDs. Because this technique requires minute amounts of DNA, chicks could be sampled soon (0-2d) after hatching, before any nestling mortality occurred. The proportion of males among 752 chicks hatching in 102 broods (98.9% of

  11. The Great Gatsby. [Lesson Plan].

    Science.gov (United States)

    Zelasko, Ken

    Based on F. Scott Fitzgerald's novel "The Great Gatsby," this lesson plan presents activities designed to help students understand that adapting part of a novel into a dramatic reading makes students more intimate with the author's intentions and craft; and that a part of a novel may lend itself to various oral interpretations. The main activity…

  12. Great Basin wildlife disease concerns

    Science.gov (United States)

    Russ Mason

    2008-01-01

    In the Great Basin, wildlife diseases have always represented a significant challenge to wildlife managers, agricultural production, and human health and safety. One of the first priorities of the U.S. Department of Agriculture, Division of Fish and Wildlife Services was Congressionally directed action to eradicate vectors for zoonotic disease, particularly rabies, in...

  13. Importance of a Patient Dosimetry and Clinical Follow-up Program in the Detection of Radiodermatitis After Long Percutaneous Coronary Interventions

    Energy Technology Data Exchange (ETDEWEB)

    Vano, Eliseo, E-mail: eliseov@med.ucm.es [Instituto de Investigacion Sanitaria Hospital Clinico San Carlos and Complutense University, Medical Physics Service and Radiology Department (Spain); Escaned, Javier [Hospital Clinico San Carlos, Cardiovascular Institute (Spain); Vano-Galvan, Sergio [Hospital Ramon y Cajal, Dermatology Service (Spain); Fernandez, Jose M. [Instituto de Investigacion Sanitaria Hospital Clinico San Carlos and Complutense University, Medical Physics Service and Radiology Department (Spain); Galvan, Carmen, E-mail: cgalvan@med.ucm.es [Instituto de Investigacion Sanitaria Hospital Clinico San Carlos and Complutense University, Radiotherapy Service and Radiology Department (Spain)

    2013-04-15

    Complex percutaneous interventions often require high radiation doses likely to produce skin radiation injuries. We assessed the methodology used to select patients with potential skin injuries in cardiac procedures and in need of clinical follow-up. We evaluated peak skin dose and clinical follow-up in a case of radiodermatitis produced during a total occlusion recanalization. This prospective study followed CIRSE and ACC/AHA/SCAI recommendations for patient radiation dose management in interventional procedures carried out in a university hospital with a workload of 4200 interventional cardiac procedures per year. Patient dose reports were automatically transferred to a central database. Patients exceeding trigger levels for air kerma area product (500 Gy cm{sup 2}) and cumulative skin dose (5 Gy) were counseled and underwent follow-up for early detection of skin injuries, with dermatologic support. The Ethical Committee and the Quality Assurance and Radiation Safety Committee approved the program. During 2010, a total of 13 patients (3.0/1,000 that year) received dose values exceeding trigger levels in the cardiovascular institute. Only one patient, who had undergone two consecutive procedures resulting in 970 Gy cm{sup 2} and 13.0 Gy as cumulative skin dose, showed signs of serious radiodermatitis that resolved in 3.7 months. The remaining patients did not manifest skin lesions during follow-up, and whenever patient examination was not feasible as part of the follow-up, neither patients nor families reported any skin injuries. Peak skin dose calculation and close clinical follow-up were feasible and appropriate, with a moderate additional workload for the staff and satisfaction for the patient.

  14. Importance of a Patient Dosimetry and Clinical Follow-up Program in the Detection of Radiodermatitis After Long Percutaneous Coronary Interventions

    International Nuclear Information System (INIS)

    Vano, Eliseo; Escaned, Javier; Vano-Galvan, Sergio; Fernandez, Jose M.; Galvan, Carmen

    2013-01-01

    Complex percutaneous interventions often require high radiation doses likely to produce skin radiation injuries. We assessed the methodology used to select patients with potential skin injuries in cardiac procedures and in need of clinical follow-up. We evaluated peak skin dose and clinical follow-up in a case of radiodermatitis produced during a total occlusion recanalization. This prospective study followed CIRSE and ACC/AHA/SCAI recommendations for patient radiation dose management in interventional procedures carried out in a university hospital with a workload of 4200 interventional cardiac procedures per year. Patient dose reports were automatically transferred to a central database. Patients exceeding trigger levels for air kerma area product (500 Gy cm 2 ) and cumulative skin dose (5 Gy) were counseled and underwent follow-up for early detection of skin injuries, with dermatologic support. The Ethical Committee and the Quality Assurance and Radiation Safety Committee approved the program. During 2010, a total of 13 patients (3.0/1,000 that year) received dose values exceeding trigger levels in the cardiovascular institute. Only one patient, who had undergone two consecutive procedures resulting in 970 Gy cm 2 and 13.0 Gy as cumulative skin dose, showed signs of serious radiodermatitis that resolved in 3.7 months. The remaining patients did not manifest skin lesions during follow-up, and whenever patient examination was not feasible as part of the follow-up, neither patients nor families reported any skin injuries. Peak skin dose calculation and close clinical follow-up were feasible and appropriate, with a moderate additional workload for the staff and satisfaction for the patient.

  15. Treatment and Prognosis of Isolated Local Relapse after Stereotactic Body Radiotherapy for Clinical Stage I Non-Small-Cell Lung Cancer: Importance of Salvage Surgery.

    Science.gov (United States)

    Hamaji, Masatsugu; Chen, Fengshi; Matsuo, Yukinori; Ueki, Nami; Hiraoka, Masahiro; Date, Hiroshi

    2015-11-01

    Many efforts have been made to detect local relapse (LR) in the follow-up after stereotactic body radiotherapy (SBRT) for non-small-cell lung cancer (NSCLC) although limited data are available on its treatment and prognosis. We aimed to characterize treatment options and clarify long-term outcomes of isolated LR after SBRT for patients with clinical stage I NSCLC. We reviewed our institutional database in search of patients with isolated LR after SBRT for clinical stage I NSCLC at our institution between 1999 and 2013. Patient characteristics were compared with Mann-Whitney U test, χ2 test, or Fisher's exact test as appropriate. Survival outcomes were estimated with Kaplan-Meier method. Potential prognostic factors were investigated using Cox proportional hazard model. Of 308 patients undergoing SBRT for clinical stage I NSCLC, 49 patients were identified to have isolated LR. Twelve patients underwent salvage surgery, none underwent radiotherapy, and eight patients received chemotherapy, whereas 29 patients received best supportive care. No patient characteristic except operability was significantly related with patient selection for LR treatments. Five-year overall survival (OS) rate of the whole cohort was 47.9% from SBRT and 25.7% from LR. Salvage surgery was associated with improved OS after LR (p = 0.014), and 5-year OS for patients undergoing salvage surgery was 79.5% from LR. It was confirmed that our patient selection for salvage surgery for isolated LR was associated with favorable survival outcomes. Operability based on multidisciplinary conferences, rather than measurable patient characteristics, is essential for appropriate patient selection for salvage surgery.

  16. Corrected transposition of the great arteries

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Young Hi; Park, Jae Hyung; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1981-12-15

    The corrected transposition of the great arteries is an usual congenital cardiac malformation, which consists of transposition of great arteries and ventricular inversion, and which is caused by abnormal development of conotruncus and ventricular looping. High frequency of associated cardiac malformations makes it difficult to get accurate morphologic diagnosis. A total of 18 cases of corrected transposition of the great arteries is presented, in which cardiac catheterization and angiocardiography were done at the Department of Radiology, Seoul National University Hospital between September 1976 and June 1981. The clinical, radiographic, and operative findings with the emphasis on the angiocardiographic findings were analyzed. The results are as follows: 1. Among 18 cases, 13 cases have normal cardiac position, 2 cases have dextrocardia with situs solitus, 2 cases have dextrocardia with situs inversus and 1 case has levocardia with situs inversus. 2. Segmental sets are (S, L, L) in 15 cases, and (I, D,D) in 3 cases and there is no exception to loop rule. 3. Side by side interrelationships of both ventricles and both semilunar valves are noticed in 10 and 12 cases respectively. 4. Subaortic type conus is noted in all 18 cases. 5. Associated cardic malformations are VSD in 14 cases, PS in 11, PDA in 3, PFO in 3, ASD in 2, right aortic arch in 2, tricuspid insufficiency, mitral prolapse, persistent left SVC and persistent right SVC in 1 case respectively. 6. For accurate diagnosis of corrected TGA, selective biventriculography using biplane cineradiography is an essential procedure.

  17. Corrected transposition of the great arteries

    International Nuclear Information System (INIS)

    Choi, Young Hi; Park, Jae Hyung; Han, Man Chung

    1981-01-01

    The corrected transposition of the great arteries is an usual congenital cardiac malformation, which consists of transposition of great arteries and ventricular inversion, and which is caused by abnormal development of conotruncus and ventricular looping. High frequency of associated cardiac malformations makes it difficult to get accurate morphologic diagnosis. A total of 18 cases of corrected transposition of the great arteries is presented, in which cardiac catheterization and angiocardiography were done at the Department of Radiology, Seoul National University Hospital between September 1976 and June 1981. The clinical, radiographic, and operative findings with the emphasis on the angiocardiographic findings were analyzed. The results are as follows: 1. Among 18 cases, 13 cases have normal cardiac position, 2 cases have dextrocardia with situs solitus, 2 cases have dextrocardia with situs inversus and 1 case has levocardia with situs inversus. 2. Segmental sets are (S, L, L) in 15 cases, and (I, D,D) in 3 cases and there is no exception to loop rule. 3. Side by side interrelationships of both ventricles and both semilunar valves are noticed in 10 and 12 cases respectively. 4. Subaortic type conus is noted in all 18 cases. 5. Associated cardic malformations are VSD in 14 cases, PS in 11, PDA in 3, PFO in 3, ASD in 2, right aortic arch in 2, tricuspid insufficiency, mitral prolapse, persistent left SVC and persistent right SVC in 1 case respectively. 6. For accurate diagnosis of corrected TGA, selective biventriculography using biplane cineradiography is an essential procedure

  18. Importance classification

    International Nuclear Information System (INIS)

    Mizumachi, Wataru; Kobayashi, Masahide

    2008-01-01

    Conventionally, the design of a nuclear reactor has been performed from a viewpoint of a safety function and the importance on earthquake-proof on the basis of not giving off the mainly included radioactivity outside. In this Niigataken-Chuetsuoki earthquake, there is almost no damage to the system, components and structure on safe also in the earthquake beyond assumption, and the validity of the design was checked. But, the situation peculiar to a big earthquake was also generated. The emergency plan room which should serve as a connection center with the exterior was not able to open a door and use at the beginning. Fire-extinguishing system piping fractured and self-defense fire fighting was not made. And so on. Discussion from the following three viewpoints was performed. 1st: The importance from a viewpoint which should maintain a function also with the disaster in case of an earthquake like an emergency plan room etc. 2nd: In the earthquake, since the safe system and un-safe system was influenced, the importance from a viewpoint which may have influence safely inquired when the un-safe system broke down. 3rd: Although it was not directly related safely, discussion from a viewpoint which influences fear of insecurity, such as taking out smoke, for example, was performed (author)

  19. Hospital Capital Investment During the Great Recession.

    Science.gov (United States)

    Choi, Sung

    2017-01-01

    Hospital capital investment is important for acquiring and maintaining technology and equipment needed to provide health care. Reduction in capital investment by a hospital has negative implications for patient outcomes. Most hospitals rely on debt and internal cash flow to fund capital investment. The great recession may have made it difficult for hospitals to borrow, thus reducing their capital investment. I investigated the impact of the great recession on capital investment made by California hospitals. Modeling how hospital capital investment may have been liquidity constrained during the recession is a novel contribution to the literature. I estimated the model with California Office of Statewide Health Planning and Development data and system generalized method of moments. Findings suggest that not-for-profit and public hospitals were liquidity constrained during the recession. Comparing the changes in hospital capital investment between 2006 and 2009 showed that hospitals used cash flow to increase capital investment by $2.45 million, other things equal.

  20. Ultrasound assessment of great saphenous vein insufficiency

    Directory of Open Access Journals (Sweden)

    Chander RK

    2015-06-01

    Full Text Available Rajiv K Chander,1 Thomas S Monahan1,2 1Section of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, 2Department of Surgery, Baltimore Veterans Affairs Medical Center, Baltimore, MD, USA Abstract: Duplex ultrasonography is the ideal modality to assess great saphenous vein insufficiency. Duplex ultrasonography incorporates both gray scale images to delineate anatomy and color-Doppler imaging that visualizes the flow of blood in a structure. Assessment of great saphenous vein requires definition of the anatomy, augmentation of flow, evaluation for both superficial and deep vein thrombosis, and determining the presence of reflux. Currently, evolution in the treatment of reflux also relies on ultrasound for the treatment of the disease. Understanding the utilization of the ultrasound for the diagnosis and treatment of greater saphenous vein reflux is important for practitioners treating reflux disease. Keywords: duplex ultrasonography, small saphenous vein 

  1. Hospital Capital Investment During the Great Recession

    Science.gov (United States)

    Choi, Sung

    2017-01-01

    Hospital capital investment is important for acquiring and maintaining technology and equipment needed to provide health care. Reduction in capital investment by a hospital has negative implications for patient outcomes. Most hospitals rely on debt and internal cash flow to fund capital investment. The great recession may have made it difficult for hospitals to borrow, thus reducing their capital investment. I investigated the impact of the great recession on capital investment made by California hospitals. Modeling how hospital capital investment may have been liquidity constrained during the recession is a novel contribution to the literature. I estimated the model with California Office of Statewide Health Planning and Development data and system generalized method of moments. Findings suggest that not-for-profit and public hospitals were liquidity constrained during the recession. Comparing the changes in hospital capital investment between 2006 and 2009 showed that hospitals used cash flow to increase capital investment by $2.45 million, other things equal. PMID:28617202

  2. The importance of staphylococci and threshold value of somatic cell count for diagnosis of sub-clinical mastitis in Pirlak sheep at mid-lactation.

    Science.gov (United States)

    Ozenc, E; Seker, E; Baki Acar, D; Birdane, M K; Darbaz, I; Dogan, N

    2011-12-01

    This study investigated the bacterial agents causing sub-clinical mastitis and the mean somatic cell counts (SCC) of milk in Pirlak sheep at mid-lactation. The percentage of infected udder halves was 11.4% (53/464). The most frequently isolated species were coagulase-negative staphylococci (CNS) (64.2%), followed by Staphylococcus aureus (24.5%) and Escherichia coli (11.3%). Among the CNS, the most common species was Staphylococcus epidermidis (38.2%). The other species isolated from milk samples were Staphylococcus xylosus (17.7%), Staphylococcus chromogenes (14.7%), Staphylococcus simulans (8.8%) and Staphylococcus hyicus (8.8%). The mean SCC for culture positive and negative samples was 1742×10(3) and 161×10(3) cells/ml, respectively. A significant difference (pmastitis in Pirlak sheep. This is the first study to describe the bacterial agents causing sub-clinical mastitis and threshold limit for SCC in Pirlak sheep in Turkey. © 2011 Blackwell Verlag GmbH.

  3. Importance of magnesium depletion with hypofunction of the biological clock in the pathophysiology of headhaches with photophobia, sudden infant death and some clinical forms of multiple sclerosis.

    Science.gov (United States)

    Durlach, J; Pagès, N; Bac, P; Bara, M; Guiet-Bara, A

    2004-12-01

    Mg depletion is a type of Mg deficit due to a dysregulation of the Mg status. It cannot be corrected through nutritional supplementation only, but requires the most specific correction of the dysregulating mechanism. Among those, Biological Clock (BC) dysrhythmias are to be considered. The aim of this study is to analyze the clinical forms of Mg depletion with hypofunction of the Biological Clock (hBC). hBC may be due to either Primary disorders of BC [Suprachiasmatic Nuclei (SCN) and pineal gland (PG)] or Secondary with homeostatic response [reactive Photophobia (Pphi] to light neurostimulating effects [Nervous Hyper Excitability (NHE)]. The symptomatology is mainly diurnal and observed during fair weather (Spring,Summer). The elective marker of hBC is represented by a decrease in melatonin and in its metabolites in various fluids. The clinical forms of NHE due to Mg depletion with hBC are central and peripheral. The central forms associate anxiety, headaches and dyssomnia. The peripheral manifestations are neuromuscular: photosensitive epilepsia mainly. Three chronopathological forms of Mg depletion with hBC have been highlighted: 1. Headaches with Pphi: mainly migraine; 2. Sudden Infant Death Syndrome (SIDS); 3. Multiple Sclerosis (MS).- Headaches with Pphi, migraine particularly. These cephalalgias are diurnal with Pphi and are aggravated during the fair seasons (particularly during midnight sun-summer). Migraine is their typical form with its dishabituation to visual stimuli and its occipital cortex hyperexcitability. Comorbidity with anxiety is frequent. In 2/3 of the cases, it appears first.- SIDS might be linked to an impaired maturation of both photoendocrine system and brown adipose tissue. MS may be associated with primary disorders of BC Clinical forms of Mg depletion with hBC in MS present diurnal exacerbations and relapses during fair seasons. They have been underestimated because they disagree with the dogma of the , presently questioned

  4. Clinical and haemodynamic evaluation of chronic thromboembolic pulmonary hypertension patients scheduled for pulmonary thromboendarterectomy: Is schistosomiasis hypertension an important confounding factor?

    Directory of Open Access Journals (Sweden)

    Mario Terra-Filho

    2010-01-01

    Full Text Available INTRODUCTION: Chronic thromboembolic pulmonary hypertension is a disease affecting approximately 4,000 people per year in the United States. The incidence rate in Brazil, however, is unknown. The estimated survival for patients with chronic thromboembolic pulmonary hypertension without treatment is approximately three years. Pulmonary thromboendarterectomy for select patients is a potentially curative procedure when correctly applied. In Brazil, the clinical and hemodynamic profiles of chronic thromboembolic pulmonary hypertension patients have yet to be described. OBJECTIVES: To evaluate the clinical and hemodynamic characteristics of chronic thromboembolic pulmonary hypertension patients scheduled for pulmonary thromboendarterectomy in a referral center for chronic thromboembolic pulmonary hypertension treatment in Brazil. METHODS: From December 2006 to November 2009, patients were evaluated and scheduled for pulmonary thromboendarterectomy. The subjects were classified according to gender, age and functional class and were tested for thrombofilia and brain natriuretic peptide levels. RESULTS: Thirty-five consecutive chronic thromboembolic pulmonary hypertension patients were evaluated. Two patients tested positive for schistosomiasis, and 31 were enrolled in the study (19 female, 12 male. The majority of patients were categorized in functional classes III and IV. Hemodynamic data showed a mean pulmonary vascular resistance (PVR of 970.8 ± 494.36 dynas·s·cm-5 and a low cardiac output of 3.378 ± 1.13 L/min. Linear regression revealed a direct relation between cardiac output and pulmonary vascular resistance. Paradoxical septal movement was strongly correlated with pulmonary vascular resistance and cardiac output (p=0.001. Brain natriuretic peptide serum levels were elevated in 19 of 27 patients. CONCLUSIONS: In a referral center for pulmonary hypertension in Brazil, chronic thromboembolic pulmonary hypertension patients evaluated for

  5. Interrelación entre hormonas tiroideas y crecimiento: importancia clínica Interrelation between thyroid hormones and growth: clinical importance

    Directory of Open Access Journals (Sweden)

    Daysi A. Navarro Despaigne

    2005-12-01

    Full Text Available En la práctica clínica correspondiente a la endocrinología pediátrica, los trastornos del crecimiento son motivo frecuente de consulta y es la hipofunción tiroidea su causa más común. Por esta razón nos propusimos revisar aspectos teóricos relacionados con la función tiroidea, que pudieran explicar el mecanismo mediante el cual las hormonas tiroideas intervienen en el desarrollo del cartílago de crecimiento y del sistema nervioso central. Se revisa brevemente el mecanismo de regulación de las hormonas tiroideas y del efecto de los factores de crecimiento, tanto en la vida intrauterina como en la etapa posnatal. Se expone una hipótesis para explicar cómo ocurre la interrelación entre hormonas tiroideas (factores de crecimiento. Al final se hace referencia al impacto clínico del déficit de hormonas tiroideas durante la infancia.In the clinical practice of pediatric endocrinology, growth disorders is the most frequent reason to go to the doctor´s , being thyroid hypofunction the most common cause of this problem. For this reason, we intended to review theoretical aspects of thyroid function that could explain the mechanism by which thyroid hormones intervene in the development of growth cartilage and of the central nervous system. The regulating thyroid hormone mechanism along with the effect of growth factors on both intrauterine and postnatal life stages was briefly examined. A hypothesis of how the interrelation between thyroid hormones (growth factors occurs was presented. Finally, reference was made on the clinical impact of thyroid hormone deficit in childhood.

  6. Importance of cerebrospinal fluid analysis in the era of McDonald 2010 criteria: a German-Austrian retrospective multicenter study in patients with a clinically isolated syndrome.

    Science.gov (United States)

    Huss, André M; Halbgebauer, Steffen; Öckl, Patrick; Trebst, Corinna; Spreer, Annette; Borisow, Nadja; Harrer, Andrea; Brecht, Isabel; Balint, Bettina; Stich, Oliver; Schlegel, Sabine; Retzlaff, Nele; Winkelmann, Alexander; Roesler, Romy; Lauda, Florian; Yildiz, Özlem; Voß, Elke; Muche, Rainer; Rauer, Sebastian; Bergh, Florian Then; Otto, Markus; Paul, Friedemann; Wildemann, Brigitte; Kraus, Jörg; Ruprecht, Klemens; Stangel, Martin; Buttmann, Mathias; Zettl, Uwe K; Tumani, Hayrettin

    2016-12-01

    The majority of patients presenting with a first clinical symptom suggestive of multiple sclerosis (MS) do not fulfill the MRI criteria for dissemination in space and time according to the 2010 revision of the McDonald diagnostic criteria for MS and are thus classified as clinically isolated syndrome (CIS). To re-evaluate the utility of cerebrospinal fluid (CSF) analysis in the context of the revised McDonald criteria from 2010, we conducted a retrospective multicenter study aimed at determining the prevalence and predictive value of oligoclonal IgG bands (OCBs) in patients with CIS. Patients were recruited from ten specialized MS centers in Germany and Austria. We collected data from 406 patients; at disease onset, 44/406 (11 %) fulfilled the McDonald 2010 criteria for MS. Intrathecal IgG OCBs were detected in 310/362 (86 %) of CIS patients. Those patients were twice as likely to convert to MS according to McDonald 2010 criteria as OCB-negative individuals (hazard ratio = 2.1, p = 0.0014) and in a shorter time period of 25 months (95 % CI 21-34) compared to 47 months in OCB-negative individuals (95 % CI 36-85). In patients without brain lesions at first attack and presence of intrathecal OCBs (30/44), conversion rate to MS was 60 % (18/30), whereas it was only 21 % (3/14) in those without OCBs. Our data confirm that in patients with CIS the risk of conversion to MS substantially increases if OCBs are present at onset. CSF analysis definitely helps to evaluate the prognosis in patients who do not have MS according to the revised McDonald criteria.

  7. Unconventional imports

    International Nuclear Information System (INIS)

    Yamaguchi, N.D.

    2001-01-01

    This article focuses on bitumens and bitumen products from Canadian oil sands and explores how they will affect the Canadian oil industry and the US refining industry. The falling production of crude, the growing demand for it, and the stagnating refining capacity in the US are reported, and Canadian and Mexican exports to the US, the definition of bitumens and bitumen quality, and the position of Canada as world leader in bitumen resources are considered. Bitumen production techniques, sales of bitumens and synthetic crude, the production outlook, and the quality and refining of bitumen and synthetic crude are examined. Plots illustrating North American crude refining capacity, production and demand for 1980-2000; US crude imports from Canada and Mexico (1981-2000), world proven oil reserves (2001), world bitumen resources, and Canadian oil production (1998-2000) are provided. Details of the composition of crudes and bitumens, and recent synthetic crude production are tabulated

  8. Bloqueio do nervo supraescapular: procedimento importante na prática clínica. Parte II Suprascapular nerve block: important procedure in clinical practice. Part II

    Directory of Open Access Journals (Sweden)

    Marcos Rassi Fernandes

    2012-08-01

    Full Text Available O bloqueio do nervo supraescapular é um método de tratamento reprodutível, confiável e extremamente efetivo no controle da dor no ombro. Esse método tem sido amplamente utilizado por profissionais na prática clínica, como reumatologistas, ortopedistas, neurologistas e especialistas em dor, na terapêutica de enfermidades crônicas, como lesão irreparável do manguito rotador, artrite reumatoide, sequelas de AVC e capsulite adesiva, o que justifica a presente revisão (Parte II. O objetivo deste estudo foi descrever as técnicas do procedimento e suas complicações descritas na literatura, já que a primeira parte reportou as indicações clínicas, drogas e volumes utilizados em aplicação única ou múltipla. Apresentamse, detalhadamente, os acessos para a realização do procedimento tanto direto como indireto, anterior e posterior, lateral e medial, e superior e inferior. Diversas são as opções para se realizar o bloqueio do nervo supraescapular. Apesar de raras, as complicações podem ocorrer. Quando bem indicado, este método deve ser considerado.The suprascapular nerve block is a reproducible, reliable, and extremely effective treatment method in shoulder pain control. This method has been widely used by professionals in clinical practice such as rheumatologists, orthopedists, neurologists, and pain specialists in the treatment of chronic diseases such as irreparable rotator cuff injury, rheumatoid arthritis, stroke sequelae, and adhesive capsulitis, which justifies the present review (Part II. The objective of this study was to describe the techniques and complications of the procedure described in the literature, as the first part reported the clinical indications, drugs, and volumes used in single or multiple procedures. We present in details the accesses used in the procedure: direct and indirect, anterior and posterior, lateral and medial, upper and lower. There are several options to perform suprascapular nerve block

  9. Situaciones clínicas importantes en niños infectados por el Virus de la Inmunodeficiencia Humana (VIH Important clinical situations in pediatric hiv infection

    Directory of Open Access Journals (Sweden)

    Carlos Aguirre Muñoz

    2006-01-01

    Full Text Available La infección por el virus de la inmunodeficiencia humana (VIH en los niños se comporta en forma diferente a la infección en adultos, no sólo por sus manifestaciones clínicas sino por la forma de hacer el diagnóstico y el tratamiento. Los niños tienen un sistema inmune en desarrollo y no poseen inmunidad previa para la mayoría de los agentes infecciosos, a diferencia de los pacientes adultos, cuyo sistema inmune ya es competente. Por lo tanto, las infecciones oportunistas de los adultos generalmente corresponden a reactivaciones, mientras que las de los niños usualmente son el resultado de infecciones primarias. El examen físico del neonato infectado por el VIH-1 puede ser normal pero, a medida que avanza la infección, van apareciendo manifestaciones clínicas que sugieren un compromiso inmunológico. Los hallazgos más frecuentes en los niños, a diferencia de los adultos, son: infecciones bacterianas recurrentes, edema parotídeo crónico, neumonía intersticial linfoide y deterioro neurológico prematuro. Ciertos sistemas, como el respiratorio y el nervioso central, son atacados con frecuencia y gravedad y enfermedades como la tuberculosis revisten características especiales en los niños infectados por el VIH-1. Presentation of HIV infection in children differs from than in adults: there are different clinical manifestations and, therefore, diagnosis and treatment have their own particularities. Unlike adults, children have a developing immune system without previous immunity for many infectious agents; consequently, opportunistic infections in children correspond to primary infections while those in adults usually result from reactivations. Physical examination in HIV-infected newborns is usually normal, but as the infection progresses clinical manifestations of immunological incompetence appear. In contrast to adults, the most frequent findings in children are recurrent bacterial infections, parotid chronic edema, lymphoid

  10. The time since last menstrual period is important as a clinical predictor for non-steroidal aromatase inhibitor-related arthralgia.

    Science.gov (United States)

    Kanematsu, Miyuki; Morimoto, Masami; Honda, Junko; Nagao, Taeko; Nakagawa, Misako; Takahashi, Masako; Tangoku, Akira; Sasa, Mitsunori

    2011-10-10

    The clinical predictors of aromatase inhibitor-related arthralgia (AIA), a drug-related adverse reaction of aromatase inhibitors (AIs), remain unclear. AIA was prospectively surveyed every 4 months in 328 postmenopausal breast cancer patients administered a non-steroidal AI (anastrozole). Various clinicopathological parameters were recorded and analyzed (chi-square test, Fisher's exact test and logistic regression analysis). The mean observation period was 39.9 months. AIA manifested in 114 patients (34.8%), with peaks of onset at 4 (33.7%) and 8 months (11.4%) after starting AI administration. Some cases manifested even after 13 months. AIA tended to occur in younger patients (incidences of 46.3%, 37.4% and 28.0% for ages of 65 years, respectively (p = 0.063)) and decreased significantly with the age at menarche (53.3%, 35.3% and 15.4% for 15 years, respectively (p = 0.036)). The incidences were 45.1%, 46.3 and 25.1% for the time since the last menstrual period (LMP) 10 years, being significantly lower at > 10 years (p time since LMP > 10-year group versus the time since LMP became shorter ( 10 years since LMP. When the time since LMP was short, the onset of AIA was significantly earlier after starting AI administration.

  11. Potentially important periods of change in the development of social and role functioning in youth at clinical high risk for psychosis.

    Science.gov (United States)

    Velthorst, Eva; Zinberg, Jamie; Addington, Jean; Cadenhead, Kristin S; Cannon, Tyrone D; Carrión, Ricardo E; Auther, Andrea; Cornblatt, Barbara A; McGlashan, Thomas H; Mathalon, Daniel H; Perkins, Diana O; Seidman, Larry J; Tsuang, Ming T; Walker, Elaine F; Woods, Scott W; Reichenberg, Abraham; Bearden, Carrie E

    2018-02-01

    The developmental course of daily functioning prior to first psychosis-onset remains poorly understood. This study explored age-related periods of change in social and role functioning. The longitudinal study included youth (aged 12-23, mean follow-up years = 1.19) at clinical high risk (CHR) for psychosis (converters [CHR-C], n = 83; nonconverters [CHR-NC], n = 275) and a healthy control group (n = 164). Mixed-model analyses were performed to determine age-related differences in social and role functioning. We limited our analyses to functioning before psychosis conversion; thus, data of CHR-C participants gathered after psychosis onset were excluded. In controls, social and role functioning improved over time. From at least age 12, functioning in CHR was poorer than in controls, and this lag persisted over time. Between ages 15 and 18, social functioning in CHR-C stagnated and diverged from that of CHR-NC, who continued to improve (p = .001). Subsequently, CHR-C lagged behind in improvement between ages 21 and 23, further distinguishing them from CHR-NC (p role functioning, but to a lesser extent (p = .007). The results remained consistent when we accounted for the time to conversion. Our findings suggest that CHR-C start lagging behind CHR-NC in social and role functioning in adolescence, followed by a period of further stagnation in adulthood.

  12. Importance of customer adjustment regions in the non-clinical property of thought: A home examination in low and high-income areas of Mashhad.

    Science.gov (United States)

    Fazaeli, S; Yousefi, M; Banikazemi, S H; Ghazizadeh Hashemi, Sah; Khorsand, A; Badiee, Sh

    2015-01-01

    Responsiveness was proposed via WHO as a fundamental sign to evaluate the enforcement of wellness practices and evaluates with a standard organization of fields that are classified to 2 principal classes "Respect as characters" and "customer adjustment". The current research included the value of customer adjustment areas in low and high-income communities of Mashhad. In the current descriptive research, an example of 923 families was chosen stochastically of 2 low and high pay areas of Mashhad. WHO survey employed for information gathering. Regular rate reviews and Ordinal Logistic Regression (OLR) applied for information investigation. In overall, respondents chose basic amenities quality as the primary area, and the path to social care networks recognized as the wicked primary area. Families in high-income states obtained higher areas of immediate notations and selection associated with low-income. There is a meaningful correlation among parameters of ages, having a part whom required care and self-imposed health via the ranking of customer adjustment areas. The investigation of the homes' viewpoint concerning the classification of non-clinical perspectives of care quality, particularly while confronted by restricted sources, can assist in managing enterprises towards topics that are more relevant and results in the development of the wellness policy achievement and fecundity.

  13. The importance of bilateral monitoring of cerebral oxygenation (NIRS): Clinical case of asymmetry during cardiopulmonary bypass secondary to previous cerebral infarction.

    Science.gov (United States)

    Matcan, S; Sanabria Carretero, P; Gómez Rojo, M; Castro Parga, L; Reinoso-Barbero, F

    2018-03-01

    Cerebral oximetry based on near infrared spectroscopy (NIRS) technology is used to determine cerebral tissue oxygenation. We hereby present the clinical case of a 12-month old child with right hemiparesis secondary to prior left middle cerebral artery stroke 8 months ago. The child underwent surgical enlargement of the right ventricular outflow tract (RVOT) with cardiopulmonary bypass. During cardiopulmonary bypass, asymmetric NIRS results were detected between both hemispheres. The utilization of multimodal neuromonitoring (NIRS-BIS) allowed acting on both perfusion pressure and anesthetic depth to balance out the supply and demand of cerebral oxygen consumption. No new neurological sequelae were observed postoperatively. We consider bilateral NIRS monitoring necessary in order to detect asymmetries between cerebral hemispheres. Although asymmetries were not present at baseline, they can arise intraoperatively and its monitoring thus allows the detection and treatment of cerebral ischemia-hypoxia in the healthy hemisphere, which if undetected and untreated would lead to additional neurological damage. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Clinical Effectiveness and Cost of a Hospital-Based Fall Prevention Intervention: The Importance of Time Nurses Spend on the Front Line of Implementation.

    Science.gov (United States)

    Nuckols, Teryl K; Needleman, Jack; Grogan, Tristan R; Liang, Li-Jung; Worobel-Luk, Pamela; Anderson, Laura; Czypinski, Linda; Coles, Courtney; Walsh, Catherine M

    2017-11-01

    The aim of this study is to evaluate the clinical effectiveness and incremental net cost of a fall prevention intervention that involved hourly rounding by RNs at 2 hospitals. Minimizing in-hospital falls is a priority, but little is known about the value of fall prevention interventions. We used an uncontrolled before-after design to evaluate changes in fall rates and time use by RNs. Using decision-analytical models, we estimated incremental net costs per hospital per year. Falls declined at 1 hospital (incidence rate ratio [IRR], 0.47; 95% confidence interval [CI], 0.26-0.87; P = .016), but not the other (IRR, 0.83; 95% CI, 0.59-1.17; P = .28). Cost analyses projected a 67.9% to 72.2% probability of net savings at both hospitals due to unexpected declines in the time that RNs spent in fall-related activities. Incorporating fall prevention into hourly rounds might improve value. Time that RNs invest in implementing quality improvement interventions can equate to sizable opportunity costs or savings.

  15. Transrectal real-time tissue elastography targeted biopsy coupled with peak strain index improves the detection of clinically important prostate cancer.

    Science.gov (United States)

    Ma, Qi; Yang, Dong-Rong; Xue, Bo-Xin; Wang, Cheng; Chen, Han-Bin; Dong, Yun; Wang, Cai-Shan; Shan, Yu-Xi

    2017-07-01

    The focus of the present study was to evaluate transrectal real-time tissue elastography (RTE)-targeted two-core biopsy coupled with peak strain index for the detection of prostate cancer (PCa) and to compare this method with 10-core systematic biopsy. A total of 141 patients were enrolled for evaluation. The diagnostic value of peak strain index was assessed using a receiver operating characteristic curve. The cancer detection rates of the two approaches and corresponding positive cores and Gleason score were compared. The cancer detection rate per core in the RTE-targeted biopsy (44%) was higher compared with that in systematic biopsy (30%). The peak strain index value of PCa was higher compared with that of the benign lesion. PCa was detected with the highest sensitivity (87.5%) and specificity (85.5%) using the threshold value of a peak strain index of ≥5.97 with an area under the curve value of 0.95. When the Gleason score was ≥7, RTE-targeted biopsy coupled with peak strain index detected 95.6% of PCa cases, but 84.4% were detected using systematic biopsy. Peak strain index as a quantitative parameter may improve the differentiation of PCa from benign lesions in the prostate peripheral zone. Transrectal RTE-targeted biopsy coupled with peak strain index may enhance the detection of clinically significant PCa, particularly when combined with systematic biopsy.

  16. Recent declines in cancer incidence: related to the Great Recession?

    Science.gov (United States)

    Gomez, Scarlett Lin; Canchola, Alison J; Nelson, David O; Keegan, Theresa H M; Clarke, Christina A; Cheng, Iona; Shariff-Marco, Salma; DeRouen, Mindy; Catalano, Ralph; Satariano, William A; Davidson-Allen, Kathleen; Glaser, Sally L

    2017-02-01

    In recent years, cancer case counts in the U.S. underwent a large, rapid decline-an unexpected change given population growth for older persons at highest cancer risk. As these declines coincided with the Great Recession, we examined whether they were related to economic conditions. Using California Cancer Registry data from California's 30 most populous counties, we analyzed trends in cancer incidence during pre-recession (1996-2007) and recession/recovery (2008-2012) periods for all cancers combined and the ten most common sites. We evaluated the recession's association with rates using a multifactorial index that measured recession impact, and modeled associations between case counts and county-level unemployment rates using Poisson regression. Yearly cancer incidence rate declines were greater during the recession/recovery (3.3% among males, 1.4% among females) than before (0.7 and 0.5%, respectively), particularly for prostate, lung, and colorectal cancers. Lower case counts, especially for prostate and liver cancer among males and breast cancer, melanoma, and ovarian cancer among females, were associated with higher unemployment rates, irrespective of time period, but independent of secular effects. The associations for melanoma translated up to a 3.6% decrease in cases with each 1% increase in unemployment. Incidence declines were not greater in counties with higher recession impact index. Although recent declines in incidence of certain cancers are not differentially impacted by economic conditions related to the Great Recession relative to pre-recession conditions, the large recent absolute declines in the case counts of some cancer may be attributable to the large declines in unemployment in the recessionary period. This may occur through decreased engagement in preventive health behaviors, particularly for clinically less urgent cancers. Continued monitoring of trends is important to detect any rises in incidence rates as deferred diagnoses come to

  17. Executive summary of imported infectious diseases after returning from foreign travel: Consensus document of the Spanish Society for Infectious Diseases and Clinical Microbiology (SEIMC).

    Science.gov (United States)

    Pérez-Arellano, José Luis; Górgolas-Hernández-Mora, Miguel; Salvador, Fernando; Carranza-Rodríguez, Cristina; Ramírez-Olivencia, Germán; Martín-Echeverría, Esteban; Rodríguez-Guardado, Azucena; Norman, Francesca; Velasco-Tirado, Virginia; Zubero-Sulibarría, Zuriñe; Rojo-Marcos, Gerardo; Muñoz-Gutierrez, José; Ramos-Rincón, José Manuel; Sánchez-Seco-Fariñas, M Paz; Velasco-Arribas, María; Belhassen-García, Moncef; Lago-Nuñez, Mar; Cañas García-Otero, Elías; López-Vélez, Rogelio

    2018-03-01

    In a global world, knowledge of imported infectious diseases is essential in daily practice, both for the microbiologist-parasitologist and the clinician who diagnoses and treats infectious diseases in returned travelers. Tropical and subtropical countries where there is a greater risk of contracting an infectious disease are among the most frequently visited tourist destinations. The SEIMC considers it appropriate to produce a consensus document that will be useful to primary care physicians as well as specialists in internal medicine, infectious diseases and tropical medicine who help treat travelers returning from tropical and sub-tropical areas with infections. Preventive aspects of infectious diseases and infections imported by immigrants are explicitly excluded here, since they have been dealt with in other SEIMC documents. Various types of professionals (clinicians, microbiologists, and parasitologists) have helped produce this consensus document by evaluating the available evidence-based data in order to propose a series of key facts about individual aspects of the topic. The first section of the document is a summary of some of the general aspects concerning the general assessment of travelers who return home with potential infections. The main second section contains the key facts (causative agents, diagnostic procedures and therapeutic measures) associated with the major infectious syndromes affecting returned travelers [gastrointestinal syndrome (acute or persistent diarrhea); febrile syndrome with no obvious source of infection; localized cutaneous lesions; and respiratory infections]. Finally, the characteristics of special traveler subtypes, such as pregnant women and immunocompromised travelers, are described. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  18. Clinical Trials

    Medline Plus

    Full Text Available ... of clinical trials contribute to medical knowledge and practice. Why Clinical Trials Are Important Clinical trials are ... earlier than they would be in general medical practice. This is because late-phase trials have large ...

  19. The time since last menstrual period is important as a clinical predictor for non-steroidal aromatase inhibitor-related arthralgia

    International Nuclear Information System (INIS)

    Kanematsu, Miyuki; Morimoto, Masami; Honda, Junko; Nagao, Taeko; Nakagawa, Misako; Takahashi, Masako; Tangoku, Akira; Sasa, Mitsunori

    2011-01-01

    The clinical predictors of aromatase inhibitor-related arthralgia (AIA), a drug-related adverse reaction of aromatase inhibitors (AIs), remain unclear. AIA was prospectively surveyed every 4 months in 328 postmenopausal breast cancer patients administered a non-steroidal AI (anastrozole). Various clinicopathological parameters were recorded and analyzed (chi-square test, Fisher's exact test and logistic regression analysis). The mean observation period was 39.9 months. AIA manifested in 114 patients (34.8%), with peaks of onset at 4 (33.7%) and 8 months (11.4%) after starting AI administration. Some cases manifested even after 13 months. AIA tended to occur in younger patients (incidences of 46.3%, 37.4% and 28.0% for ages of < 55, 55-65 and > 65 years, respectively (p = 0.063)) and decreased significantly with the age at menarche (53.3%, 35.3% and 15.4% for < 12, 12-15 and > 15 years, respectively (p = 0.036)). The incidences were 45.1%, 46.3 and 25.1% for the time since the last menstrual period (LMP) < 5 years, 5-10 years and > 10 years, being significantly lower at > 10 years (p < 0.001). In logistic regression analysis, the AIA incidence was significantly lower in the time since LMP > 10-year group versus the < 5-year group (odds ratio 0.44, p = 0.002), but the age at menarche showed no association. AIA manifested significantly earlier (≤ 6 months) as the time since LMP became shorter (< 5 years). AIA tends to manifest early after starting AI, but some cases show delayed onset. The incidence was significantly lower in patients with a duration of > 10 years since LMP. When the time since LMP was short, the onset of AIA was significantly earlier after starting AI administration

  20. A systematic review of methodology applied during preclinical anesthetic neurotoxicity studies: important issues and lessons relevant to the design of future clinical research.

    Science.gov (United States)

    Disma, Nicola; Mondardini, Maria C; Terrando, Niccolò; Absalom, Anthony R; Bilotta, Federico

    2016-01-01

    Preclinical evidence suggests that anesthetic agents harm the developing brain thereby causing long-term neurocognitive impairments. It is not clear if these findings apply to humans, and retrospective epidemiological studies thus far have failed to show definitive evidence that anesthetic agents are harmful to the developing human brain. The aim of this systematic review was to summarize the preclinical studies published over the past decade, with a focus on methodological issues, to facilitate the comparison between different preclinical studies and inform better design of future trials. The literature search identified 941 articles related to the topic of neurotoxicity. As the primary aim of this systematic review was to compare methodologies applied in animal studies to inform future trials, we excluded a priori all articles focused on putative mechanism of neurotoxicity and the neuroprotective agents. Forty-seven preclinical studies were finally included in this review. Methods used in these studies were highly heterogeneous-animals were exposed to anesthetic agents at different developmental stages, in various doses and in various combinations with other drugs, and overall showed diverse toxicity profiles. Physiological monitoring and maintenance of physiological homeostasis was variable and the use of cognitive tests was generally limited to assessment of specific brain areas, with restricted translational relevance to humans. Comparison between studies is thus complicated by this heterogeneous methodology and the relevance of the combined body of literature to humans remains uncertain. Future preclinical studies should use better standardized methodologies to facilitate transferability of findings from preclinical into clinical science. © 2015 John Wiley & Sons Ltd.

  1. Comparative evaluation of paired blood culture (aerobic/aerobic) and single blood culture, along with clinical importance in catheter versus peripheral line at a tertiary care hospital.

    Science.gov (United States)

    Tarai, B; Das, P; Kumar, D; Budhiraja, S

    2012-01-01

    Paired blood culture (PBC) is uncommon practice in hospitals in India, leading to delayed and inadequate diagnosis. Also contamination remains a critical determinant in hampering the definitive diagnosis. To establish the need of PBC over single blood culture (SBC) along with the degree of contamination, this comparative retrospective study was initiated. We processed 2553 PBC and 4350 SBC in BacT/ALERT 3D (bioMerieux) between October 2010 and June 2011. The positive cultures were identified in VITEK 2 Compact (bioMerieux). True positivity and contaminants were also analyzed in 486 samples received from catheter and peripheral line. Out of 2553 PBC samples, positivity was seen in 350 (13.70%). In 4350 SBC samples, positivity was seen in 200 samples (4.59%). In PBC true pathogens were 267 (10.45%) and contaminants were 83 (3.25%), whereas in SBC 153 (3.51%) were true positives and contaminants were 47 (1.08%). Most of the blood cultures (99.27 %) grew within 72 h and 95.8% were isolated within 48 h. In 486 PBCs received from catheter/periphery (one each), catheter positivity was found in 85 (true positives were 48, false positives 37). In peripheral samples true positives were 50 and false positives were 8. Significantly higher positive rates were seen in PBCs compared with SBCs. Automated blood culture and identification methods significantly reduced the time required for processing of samples and also facilitated yield of diverse/rare organisms. Blood culture from catheter line had higher false positives than peripheral blood culture. Thus every positive result from a catheter must be correlated with clinical findings and requires further confirmation.

  2. Network Interactions in the Great Altai Region

    Directory of Open Access Journals (Sweden)

    Lev Aleksandrovich Korshunov

    2017-12-01

    Full Text Available To improve the efficiency and competitiveness of the regional economy, an effective interaction between educational institutions in the Great Altai region is needed. The innovation growth can enhancing this interaction. The article explores the state of network structures in the economy and higher education in the border territories of the countries of Great Altai. The authors propose an updated approach to the three-level classification of network interaction. We analyze growing influence of the countries with emerging economies. We define the factors that impede the more stable and multifaceted regional development of these countries. Further, the authors determine indicators of the higher education systems and cooperation systems at the university level between the Shanghai Cooperation Organization countries (SCO and BRICS countries, showing the international rankings of the universities in these countries. The teaching language is important to overcome the obstacles in the interregional cooperation. The authors specify the problems of the development of the universities of the SCO and BRICS countries as global educational networks. The research applies basic scientific logical methods of analysis and synthesis, induction and deduction, as well as the SWOT analysis method. We have indentified and analyzed the existing economic and educational relations. To promote the economic innovation development of the border territories of the Great Altai, we propose a model of regional network university. Modern universities function in a new economic environment. Thus, in a great extent, they form the technological and social aspects of this environment. Innovative network structures contribute to the formation of a new network institutional environment of the regional economy, which impacts the macro- and microeconomic performance of the region as a whole. The results of the research can help to optimize the regional economies of the border

  3. Estimating Spring Condensation on the Great Lakes

    Science.gov (United States)

    Meyer, A.; Welp, L.

    2017-12-01

    The Laurentian Great Lakes region provides opportunities for shipping, recreation, and consumptive water use to a large part of the United States and Canada. Water levels in the lakes fluctuate yearly, but attempts to model the system are inadequate because the water and energy budgets are still not fully understood. For example, water levels in the Great Lakes experienced a 15-year low period ending in 2013, the recovery of which has been attributed partially to decreased evaporation and increased precipitation and runoff. Unlike precipitation, the exchange of water vapor between the lake and the atmosphere through evaporation or condensation is difficult to measure directly. However, estimates have been constructed using off-shore eddy covariance direct measurements of latent heat fluxes, remote sensing observations, and a small network of monitoring buoys. When the lake surface temperature is colder than air temperature as it is in spring, condensation is larger than evaporation. This is a relatively small component of the net annual water budget of the lakes, but the total amount of condensation may be important for seasonal energy fluxes and atmospheric deposition of pollutants and nutrients to the lakes. Seasonal energy fluxes determine, and are influenced by, ice cover, water and air temperatures, and evaporation in the Great Lakes. We aim to quantify the amount of spring condensation on the Great Lakes using the National Center for Atmospheric Prediction North American Regional Reanalysis (NCEP NARR) Data for Winter 2013 to Spring 2017 and compare the condensation values of spring seasons following high volume, high duration and low volume, low duration ice cover.

  4. Learning and the Great Moderation

    OpenAIRE

    Bullard, James B.; Singh, Aarti

    2009-01-01

    We study a stylized theory of the volatility reduction in the U.S. after 1984 - the Great Moderation - which attributes part of the stabilization to less volatile shocks and another part to more difficult inference on the part of Bayesian households attempting to learn the latent state of the economy. We use a standard equilibrium business cycle model with technology following an unobserved regime-switching process. After 1984, according to Kim and Nelson (1999a), the variance of U.S. macroec...

  5. Pricing regulations in Great Britain

    International Nuclear Information System (INIS)

    Cicoletti, G.

    1993-01-01

    This paper briefly describes the structure and functions of Great Britain's essential electric power regulatory authority institutionalized by the 1989 British Electricity Act, i.e., the Office of Electricity Regulation, OFFER, and the responsibilities and tasks of the head of OFFER -the Director General of Electricity Supply (DGES). In particular, with regard to the latter, the paper describes how the DGES works together with regional electricity commissions to ensure the respect, by the various utilities, of consumer price caps and compliance with overall quality of service standards, as well as, to oversee 'pooling' activities by producers and distributors

  6. Pricing regulations in Great Britain

    International Nuclear Information System (INIS)

    Cicoletti, G.

    1993-01-01

    This paper briefly describes the structure and functions of Great Britain's essential electric power regulatory authority institutionalized by the 1989 British Electricity Act, i.e., the Office of Electricity Regulation, OFFER, and the responsibilities and tasks of the head of OFFER - the Director General of Electricity Supply (DGES). In particular, with regard to the latter, the paper describes how the DGES works together with regional electricity commissions to ensure the respect, by the various utilities, of consumer price caps and compliance with overall quality of service standards, as well as, to oversee 'pooling' activities by producers and distributors

  7. What killed Alexander the Great?

    Science.gov (United States)

    Battersby, Cameron

    2007-01-01

    The cause of the death of the Macedonian King, Alexander the Great, at Babylon in 323 BC has excited interest and conjecture throughout the ages. The information available in the surviving ancient sources, none of which is contemporaneous, has been reviewed and compared with modern knowledge as set out in several well-known recent surgical texts. The ancient sources record epic drinking by the Macedonian nobility since at least the time of Phillip II, Alexander's father. Alexander's sudden illness and death is likely to have resulted from a surgical complication of acute alcoholic excess.

  8. Commanders of the Great Victory

    Directory of Open Access Journals (Sweden)

    Anatoly Dmitriyevich Borshchov

    2015-01-01

    Full Text Available The honorary title of «commander» as well as the «admiral» is granted to a military or naval figure on the basis of public recognition of his personal contribution to the success of actions. Generals are usually individuals with creative thinking, the ability to foresee the development of military events. Generals usually have such personality traits as a strong will and determination, rich combat experience, credibility and high organizational skills. In an article dedicated to the 70th anniversary of the Soviet victory in the Great War examines the experience of formation and practice of the most talent-ed Soviet military leaders.

  9. Clinical Trials

    Medline Plus

    Full Text Available ... medical knowledge and practice. Why Clinical Trials Are Important Clinical trials are a key research tool for ... other for moderate persistent asthma. The results provided important treatment information for doctors and patients. The results ...

  10. ECOPHARMACOVIGILANCE: ITS IMPORTANCE AND CHALLENGES

    OpenAIRE

    Dr. Bhavana Srivastava

    2014-01-01

    Active pharmaceutical ingredients represent a group of emerging environmental contamination. Even in trace amounts, they are of great concern due to then continuous introduction into the environment, their impact an ecosystem and human and vetenery health is of great importance. This has given birth to the science of Ecopharmacovigilance (EPV). It aims to ensure that significant environmental issues associated with pharmaceuticals in the environment are identified and managed appropriately. ...

  11. Model-based clinical dose optimization for phenobarbital in neonates: An illustration of the importance of data sharing and external validation.

    Science.gov (United States)

    Völler, Swantje; Flint, Robert B; Stolk, Leo M; Degraeuwe, Pieter L J; Simons, Sinno H P; Pokorna, Paula; Burger, David M; de Groot, Ronald; Tibboel, Dick; Knibbe, Catherijne A J

    2017-11-15

    Particularly in the pediatric clinical pharmacology field, data-sharing offers the possibility of making the most of all available data. In this study, we utilize previously collected therapeutic drug monitoring (TDM) data of term and preterm newborns to develop a population pharmacokinetic model for phenobarbital. We externally validate the model using prospective phenobarbital data from an ongoing pharmacokinetic study in preterm neonates. TDM data from 53 neonates (gestational age (GA): 37 (24-42) weeks, bodyweight: 2.7 (0.45-4.5) kg; postnatal age (PNA): 4.5 (0-22) days) contained information on dosage histories, concentration and covariate data (including birth weight, actual weight, post-natal age (PNA), postmenstrual age, GA, sex, liver and kidney function, APGAR-score). Model development was carried out using NONMEM ® 7.3. After assessment of model fit, the model was validated using data of 17 neonates included in the DINO (Drug dosage Improvement in NeOnates)-study. Modelling of 229 plasma concentrations, ranging from 3.2 to 75.2mg/L, resulted in a one compartment model for phenobarbital. Clearance (CL) and volume (V d ) for a child with a birthweight of 2.6kg at PNA day 4.5 was 0.0091L/h (9%) and 2.38L (5%), respectively. Birthweight and PNA were the best predictors for CL maturation, increasing CL by 36.7% per kg birthweight and 5.3% per postnatal day of living, respectively. The best predictor for the increase in V d was actual bodyweight (0.31L/kg). External validation showed that the model can adequately predict the pharmacokinetics in a prospective study. Data-sharing can help to successfully develop and validate population pharmacokinetic models in neonates. From the results it seems that both PNA and bodyweight are required to guide dosing of phenobarbital in term and preterm neonates. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  12. Comparison of the accuracy of Hybrid Capture II and polymerase chain reaction in detecting clinically important cervical dysplasia: a systematic review and meta-analysis

    International Nuclear Information System (INIS)

    Luu, Hung N; Dahlstrom, Kristina R; Mullen, Patricia Dolan; VonVille, Helena M; Scheurer, Michael E

    2013-01-01

    The effectiveness of screening programs for cervical cancer has benefited from the inclusion of Human papillomavirus (HPV) DNA assays; which assay to choose, however, is not clear based on previous reviews. Our review addressed test accuracy of Hybrid Capture II (HCII) and polymerase chain reaction (PCR) assays based on studies with stronger designs and with more clinically relevant outcomes. We searched OvidMedline, PubMed, and the Cochrane Library for English language studies comparing both tests, published 1985–2012, with cervical dysplasia defined by the Bethesda classification. Meta-analysis provided pooled sensitivity, specificity, and 95% confidence intervals (CIs); meta-regression identified sources of heterogeneity. From 29 reports, we found that the pooled sensitivity and specificity to detect high-grade squamous intraepithelial lesion (HSIL) was higher for HCII than PCR (0.89 [CI: 0.89–0.90] and 0.85 [CI: 0.84–0.86] vs. 0.73 [CI: 0.73–0.74] and 0.62 [CI: 0.62–0.64]). Both assays had higher accuracy to detect cervical dysplasia in Europe than in Asia-Pacific or North America (diagnostic odd ratio – dOR = 4.08 [CI: 1.39–11.91] and 4.56 [CI: 1.86–11.17] for HCII vs. 2.66 [CI: 1.16–6.53] and 3.78 [CI: 1.50–9.51] for PCR) and accuracy to detect HSIL than atypical squamous cells of undetermined significance (ASCUS)/ low-grade squamous intraepithelial lesion (LSIL) (HCII-dOR = 9.04 [CI: 4.12–19.86] and PCR-dOR = 5.60 [CI: 2.87–10.94]). For HCII, using histology as a gold standard results in higher accuracy than using cytology (dOR = 2.87 [CI: 1.31–6.29]). Based on higher test accuracy, our results support the use of HCII in cervical cancer screening programs. The role of HPV type distribution should be explored to determine the worldwide comparability of HPV test accuracy

  13. Is it possible to estimate the minimal clinically important treatment effect needed to change practice in preterm birth prevention? Results of an obstetrician survey used to support the design of a trial

    Directory of Open Access Journals (Sweden)

    Ross Sue

    2012-03-01

    Full Text Available Abstract Background Sample sizes for obstetrical trials are often based on the opinion of investigators about clinically important effect size. We surveyed Canadian obstetricians to investigate clinically important effect sizes required before introducing new treatments into practice to prevent preterm birth. Methods Questionnaires were mailed to practicing obstetricians, asking the magnitude of pregnancy prolongation required to introduce treatments into practice. The three prophylactic treatments were of increasing invasiveness: vaginal progesterone, intramuscular progesterone, and cervical cerclage. We also asked about the perceived most relevant outcome measures for obstetrical trials and current obstetrical practice in preterm birth prevention. Results 544/1293(42.1% completed questionnaires were received. The majority of respondents required one or two weeks' increase in length of gestation before introducing vaginal (372,77.1%, and intramuscular progesterone(354,67.9%. At least three weeks increase was required before introducing prophylactic cervical cerclage(326,62.8%. Clinicians who already used a treatment required a smaller difference before introducing it into practice. Decreasing neonatal morbidity was cited as the most important outcome for obstetrical trials (349,72.2%. Conclusion Obstetricians would require a larger increase in treatment effect before introducing more invasive treatments into practice. Although infant morbidity was perceived as a more important outcome, clinicians appeared willing to change practice on the basis of prolongation of pregnancy, a surrogate outcome. We found that there is not a single minimum clinically important treatment effect that will influence all practising clinicians: rather the effect size that will influence physicians is affected by the nature of the treatment, the reported outcome measure and the clinician's own current clinical practice.