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  1. An in-depth assessment of a diagnosis-based risk adjustment model based on national health insurance claims: the application of the Johns Hopkins Adjusted Clinical Group case-mix system in Taiwan

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    Weiner Jonathan P

    2010-01-01

    Full Text Available Abstract Background Diagnosis-based risk adjustment is becoming an important issue globally as a result of its implications for payment, high-risk predictive modelling and provider performance assessment. The Taiwanese National Health Insurance (NHI programme provides universal coverage and maintains a single national computerized claims database, which enables the application of diagnosis-based risk adjustment. However, research regarding risk adjustment is limited. This study aims to examine the performance of the Adjusted Clinical Group (ACG case-mix system using claims-based diagnosis information from the Taiwanese NHI programme. Methods A random sample of NHI enrollees was selected. Those continuously enrolled in 2002 were included for concurrent analyses (n = 173,234, while those in both 2002 and 2003 were included for prospective analyses (n = 164,562. Health status measures derived from 2002 diagnoses were used to explain the 2002 and 2003 health expenditure. A multivariate linear regression model was adopted after comparing the performance of seven different statistical models. Split-validation was performed in order to avoid overfitting. The performance measures were adjusted R2 and mean absolute prediction error of five types of expenditure at individual level, and predictive ratio of total expenditure at group level. Results The more comprehensive models performed better when used for explaining resource utilization. Adjusted R2 of total expenditure in concurrent/prospective analyses were 4.2%/4.4% in the demographic model, 15%/10% in the ACGs or ADGs (Aggregated Diagnosis Group model, and 40%/22% in the models containing EDCs (Expanded Diagnosis Cluster. When predicting expenditure for groups based on expenditure quintiles, all models underpredicted the highest expenditure group and overpredicted the four other groups. For groups based on morbidity burden, the ACGs model had the best performance overall. Conclusions Given the

  2. An in-depth assessment of a diagnosis-based risk adjustment model based on national health insurance claims: the application of the Johns Hopkins Adjusted Clinical Group case-mix system in Taiwan.

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    Chang, Hsien-Yen; Weiner, Jonathan P

    2010-01-18

    Diagnosis-based risk adjustment is becoming an important issue globally as a result of its implications for payment, high-risk predictive modelling and provider performance assessment. The Taiwanese National Health Insurance (NHI) programme provides universal coverage and maintains a single national computerized claims database, which enables the application of diagnosis-based risk adjustment. However, research regarding risk adjustment is limited. This study aims to examine the performance of the Adjusted Clinical Group (ACG) case-mix system using claims-based diagnosis information from the Taiwanese NHI programme. A random sample of NHI enrollees was selected. Those continuously enrolled in 2002 were included for concurrent analyses (n = 173,234), while those in both 2002 and 2003 were included for prospective analyses (n = 164,562). Health status measures derived from 2002 diagnoses were used to explain the 2002 and 2003 health expenditure. A multivariate linear regression model was adopted after comparing the performance of seven different statistical models. Split-validation was performed in order to avoid overfitting. The performance measures were adjusted R2 and mean absolute prediction error of five types of expenditure at individual level, and predictive ratio of total expenditure at group level. The more comprehensive models performed better when used for explaining resource utilization. Adjusted R2 of total expenditure in concurrent/prospective analyses were 4.2%/4.4% in the demographic model, 15%/10% in the ACGs or ADGs (Aggregated Diagnosis Group) model, and 40%/22% in the models containing EDCs (Expanded Diagnosis Cluster). When predicting expenditure for groups based on expenditure quintiles, all models underpredicted the highest expenditure group and overpredicted the four other groups. For groups based on morbidity burden, the ACGs model had the best performance overall. Given the widespread availability of claims data and the superior explanatory

  3. School-Based Health Clinics: An Analysis of the Johns Hopkins Study. Research Developments.

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    Demsko, Tobin W.

    School-based health clinics, adolescent pregnancy prevention programs offering comprehensive health services, represent the latest initiative to reduce the incidence of teenage pregnancy. Researchers at Johns Hopkins University designed and administered a pregnancy prevention program which offered sexuality education and family planning services…

  4. Evaluation of adjuvant chemoradiation therapy for ampullary adenocarcinoma: the Johns Hopkins Hospital - Mayo Clinic collaborative study

    International Nuclear Information System (INIS)

    Narang, Amol K; Haddock, Michael G; Donohue, John H; Schulick, Richard D; Wolfgang, Christopher L; Cameron, John L; Herman, Joseph M; Miller, Robert C; Hsu, Charles C; Bhatia, Sumita; Pawlik, Timothy M; Laheru, Dan; Hruban, Ralph H; Zhou, Jessica; Winter, Jordan M

    2011-01-01

    The role of adjuvant chemoradiation therapy for ampullary carcinoma is unknown. Previous literature suggests that certain populations with high risk factors for recurrence may benefit from adjuvant chemoradiation. We combined the experience of two institutions to better delineate which patients may benefit from adjuvant chemoradiation. Patients who underwent curative surgery for ampullary carcinoma at the Johns Hopkins Hospital (n = 290; 1992-2007) and at the Mayo Clinic (n = 130; 1977-2005) were reviewed. Patients with <60 days of follow-up, metastatic disease at surgery, or insufficient pathologic data were excluded. The final combined study consisted of 186 patients (n = 104 Johns Hopkins, n = 82 Mayo). Most patients received 5-FU based chemoradiation with conformal radiation. Cox proportional hazards models were used for survival analysis. Median overall-survival was 39.9 months with 2- and 5-year survival rates of 62.4% and 39.1%. On univariate analysis, adverse prognostic factors for overall survival included T3/T4 stage disease (RR = 1.86, p = 0.002), node positive status (RR = 3.18, p < 0.001), and poor histological grade (RR = 1.69, p = 0.011). Patients who received adjuvant chemoradiation (n = 66) vs. surgery alone (n = 120) showed a higher rate of T3/T4 stage disease (57.6% vs. 30.8%, P < 0.001), lymph node involvement (72.7% vs. 30.0%, P < 0.001), and close or positive margins (4.6% vs. 0.0%, P = 0.019). Five year survival rates among node negative and node positive patients were 58.7% and 18.4% respectively. When compared with surgery alone, use of adjuvant chemoradiation improved survival among node positive patients (mOS 32.1 vs. 15.7 mos, 5 yr OS: 27.5% vs. 5.9%; RR = 0.47, P = 0.004). After adjusting for adverse prognostic factors on multivariate analysis, patients treated with adjuvant chemoradiation demonstrated a significant survival benefit (RR = 0.40, P < 0.001). Disease relapse occurred in 37.1% of all patients, most commonly metastatic

  5. Validación retrospectiva del Johns-Hopkins ACG Case-Mix System en la población Española Validating the Adjusted Clinical Groups [ACG] Case-mix System in a Spanish population setting: a multicenter study

    Directory of Open Access Journals (Sweden)

    Antoni Sicras-Mainar

    2009-06-01

    Full Text Available Introducción: Validar la aplicación retrospectiva de los Adjusted Clinical Groups (ACG en varios centros de atención primaria y especializada en la población española. Métodos: Estudio restrospectivo-multicéntrico, realizado a partir de los registros de sujetos atendidos en 5 equipos de atención primaria (AP y dos hospitalarios, durante el año 2005. Las principales mediciones fueron dependientes (visitas, episodios, coste en AP y coste total y de casuística/morbilidad con el ACG Case-Mix-System. Cálculo del poder explicativo: cociente de determinación, pPurpose: To validate the Johns Hopkins ACG case-mix system used in various primary and specialized care centers attending a defined population in Spain. Methods: A retrospective, multicenter study was carried out by applying the ACG case-mix system to the clinical records of patients attending five primary care teams and two hospitals over a 1-year period in 2005. The main measurements were dependent variables (visits, episodes, primary care costs, and total costs, and morbidity. The determination coefficient (R²; p<0.05 was used to measure the explained variability. Results: A total of 81,873 patients were included with a mean (standard deviation number of 4.8 (3.5 episodes and 8.0 (8.1 visits/patient/year. The explained variance (R² of ACG classification was 73.1% (75.5% log transformation for episodes, 43.2% (54.0% log transformation for visits, 19.6% (54.8% log transformation for primary care costs, and 22.7% (48.3% log transformation for total costs (p<0.001. Conclusion: The ACG system classified a defined population on the basis of morbidity and individual resource consumption. Moreover, the ACG system was useful to assess the clinical (comorbidity and economical information of each center.

  6. Hepatobiliary Hands of Hopkins.

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    Pitt, Henry A

    2018-02-01

    This historical perspective documents the role that John L. Cameron played in advancing hepatobiliary research, education, and surgery at Johns Hopkins in the 1970s, 1980s, and 1990s. Dating back to William S. Halsted in the 19th century, leaders of the Department of Surgery at Johns Hopkins have been interested in hepatobiliary disease and surgery. John L. Cameron had broad hepato-pancreato-biliary (HPB) interests when he completed his surgical training. Over the next 3 decades, he focused on the pancreas. As a result, many faculty and trainee hepatobiliary careers were launched. This perspective is based on 18 years of service as a surgical resident and faculty member at Johns Hopkins. An extensive literature search on the hepatobiliary publications of Halsted, Trimble, Blalock, Longmire, Zuidema, and Cameron was undertaken for this manuscript. Numerous hepatobiliary publications from Johns Hopkins from the 1970s, 1980s, 1990s, and early 2000s were also reviewed. John L. Cameron's early biliary interests included stones, infections, malignancies, and strictures. He was innovative with respect to portal hypertension and Budd-Chiari surgery and supportive when liver transplantation emerged in the 1980s. Volume-outcome studies in the 1990s included hepatic and complex biliary surgery. He supported and encouraged studies of biliary lithotripsy, laparoscopic cholecystectomy, clinical pathways, hepatobiliary cysts, and gallstone pathogenesis. Lessons learned by many who worked with John L. Cameron included the importance of mentorship, innovation, friendship, and collaboration. He taught leadership and change management by example. He fostered a multidisciplinary approach and encouraged randomized controlled trials.

  7. [Curricular adjustments in the clinical fields].

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    Uribe Elías, Roberto

    2011-01-01

    The 2010 undergraduate medical degree curriculum at the National Autonomous University of Mexico (UNAM) faculty of medicine is based on the reality of the operating structure of the medical care units qualified for teaching. The clinical teaching/learning is based on the cooperative work of the professor and student; this means, it is based on the institutional physician responsible for medical care in a professor/assistant action together with the student being brought up. Therefore, the permanent education and training of all medical teams in the institutions offering teaching is essential. Teaching must be one distinctive characteristic of excellence for the units of the Health Ministry as it is teaching the central factor that raises the quality of medical care. The clinical evaluation must be permanent, improving the value of the daily action in front of a patient at the formative level and as a means to allow the assessment for its development, as it is the clinical aspect that is the essence of medicine.

  8. Impairment of different protein domains causes variable clinical presentation within Pitt-Hopkins syndrome and suggests intragenic molecular syndromology of TCF4.

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    Bedeschi, Maria Francesca; Marangi, Giuseppe; Calvello, Maria Rosaria; Ricciardi, Stefania; Leone, Francesca Pia Chiara; Baccarin, Marco; Guerneri, Silvana; Orteschi, Daniela; Murdolo, Marina; Lattante, Serena; Frangella, Silvia; Keena, Beth; Harr, Margaret H; Zackai, Elaine; Zollino, Marcella

    2017-11-01

    Pitt-Hopkins syndrome is a neurodevelopmental disorder characterized by severe intellectual disability and a distinctive facial gestalt. It is caused by haploinsufficiency of the TCF4 gene. The TCF4 protein has different functional domains, with the NLS (nuclear localization signal) domain coded by exons 7-8 and the bHLH (basic Helix-Loop-Helix) domain coded by exon 18. Several alternatively spliced TCF4 variants have been described, allowing for translation of variable protein isoforms. Typical PTHS patients have impairment of at least the bHLH domain. To which extent impairment of the remaining domains contributes to the final phenotype is not clear. There is recent evidence that certain loss-of-function variants disrupting TCF4 are associated with mild ID, but not with typical PTHS. We describe a frameshift-causing partial gene deletion encompassing exons 4-6 of TCF4 in an adult patient with mild ID and nonspecific facial dysmorphisms but without the typical features of PTHS, and a c.520C > T nonsense variant within exon 8 in a child presenting with a severe phenotype largely mimicking PTHS, but lacking the typical facial dysmorphism. Investigation on mRNA, along with literature review, led us to suggest a preliminary phenotypic map of loss-of-function variants affecting TCF4. An intragenic phenotypic map of loss-of-function variants in TCF4 is suggested here for the first time: variants within exons 1-4 and exons 4-6 give rise to a recurrent phenotype with mild ID not in the spectrum of Pitt-Hopkins syndrome (biallelic preservation of both the NLS and bHLH domains); variants within exons 7-8 cause a severe phenotype resembling PTHS but in absence of the typical facial dysmorphism (impairment limited to the NLS domain); variants within exons 9-19 cause typical Pitt-Hopkins syndrome (impairment of at least the bHLH domain). Understanding the TCF4 molecular syndromology can allow for proper nosology in the current era of whole genomic investigations. Copyright

  9. Johns Hopkins Particulate Matter Research Center

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    Federal Laboratory Consortium — The Johns Hopkins Particulate Matter Research Center will map health risks of PM across the US based on analyses of national databases on air pollution, mortality,...

  10. Clinical-scale investigation of stable isotopes in human blood: delta13C and delta15N from 406 patients at the Johns Hopkins Medical Institutions.

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    Kraft, Rebecca A; Jahren, A Hope; Saudek, Christopher D

    2008-11-01

    Objective chemical biomarkers are needed in clinical studies of diet-related diseases to supplement subjective self-reporting methods. We report on several critical experiments for the development of clinically legitimate dietary stable isotope biomarkers within human blood. Our examination of human blood revealed the following: (1) Within blood clot and serum from anonymous individuals (201 males, 205 females) we observed: mean serum delta13C = -19.1 +/- 0.8 per thousand (standard deviation, SD); clot, -19.3 +/- 0.8 per thousand (SD); range = -15.8 per thousand to -23.4 per thousand. Highly statistically significant differences are observed between clot and serum, males and females for both clot and serum. For 15N (n = 206), mean serum = +8.8 +/- 0.5 per thousand (SD); clot +7.4 +/- 0.4 per thousand (SD); range = +6.3 per thousand to +10.5 per thousand. Blood serum is enriched in 15N relative to blood clot by +1.4 per thousand on average, which may reflect differing protein amino acid content. Serum nitrogen is statistically significantly different for males and females, however, clot shows no statistical difference. (2) Relative to clot, capillary blood is marginally different for 13C, but not 15N. Clot 13C is not significantly different from serum; however, it is depleted in 15N by 1.5 per thousand relative to serum. (3) We assessed the effect of blood additives (sodium fluoride and polymerized acrylamide resin) and laboratory process (autoclaving, freeze drying) commonly used to preserve or prepare venous blood. On average, no alteration in delta13C or delta15N is detected compared with unadulterated blood from the same individual. (4) Storage of blood with and without the additives described above for a period of up to 115 days exhibits statistically significant differences for 13C and 15N for sodium fluoride. However, storage for unadulterated blood and blood preserved with polymerized acrylamide resin does not change the delta13C or delta15N isotopic

  11. Síndrome de Hopkins no diagnóstico diferencial das paralisias flácidas na infância: aspectos clínicos e neurofisiológicos. Relato de caso Hopkins' syndrome in the differential diagnosis of flaccid paralysis in children: clinical and neurophysiological features. Case report

    Directory of Open Access Journals (Sweden)

    Daniel B. Nora

    2003-06-01

    Full Text Available INTRODUÇÃO: A síndrome de Hopkins (SH é caracterizada por monoplegia ou diplegia, decorrente de lesão no corno anterior da medula, que se segue a um ataque agudo de asma, ocorre geralmente em crianças e sua etiologia ainda não está definida. Há 34 casos descritos no mundo, sendo este o primeiro relato na América do Sul e durante o primeiro ano de vida. CASO: Criança internada aos 4 meses de idade com quadro de sibilância e insuficiência respiratória. Cerca de 3 dias após melhora do quadro respiratório, observou-se perda de força nos membros inferiores. Teve alta hospitalar com regressão do quadro respiratório mantendo a paraparesia. Reinternada aos 9 meses de idade por novo quadro de broncoespasmo, demonstrando paralisia flácida assimétrica (E>D e atrofia nos membros inferiores. EXAME NEUROLÓGICO: força e reflexos miotáticos normais nos membros superiores, arreflexia miotática nos membros inferiores e sensibilidade preservada. Exames de líquor, ressonância magnética de coluna lombossacra e potencial evocado somatossensitivo dos membros inferiores: normais. BIÓPSIA MUSCULAR: Grupamento de fibras. A eletroneuromiografia demonstrou sinais de lesão do neurônio motor do corno anterior da medula nos metâmeros lombossacros. CONCLUSÃO: A Síndrome de Hopkins, apesar de rara, deve ser lembrada no diagnóstico diferencial de paralisias flácidas, quando houver concomitância com asma.INTRODUCTION: Hopkins syndrome is a motor neuron disease which leads to a flaccid paralysis affecting one or more limbs resembling poliomyelites. It follows an asthmatic attack and the prognosis is poor. All the 34 related cases occured after 13 months of age and there is no report in South America. Our objective is to describe a case of Hopkins Syndrome in Brazil affecting a patient younger than 1 year. CASE: Male 4 months-old infant, started presenting wheezing that turned into respiratory failure which required mecanical ventilation. Three

  12. Comparison between clinical significance of height-adjusted and weight-adjusted appendicular skeletal muscle mass.

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    Furushima, Taishi; Miyachi, Motohiko; Iemitsu, Motoyuki; Murakami, Haruka; Kawano, Hiroshi; Gando, Yuko; Kawakami, Ryoko; Sanada, Kiyoshi

    2017-02-13

    This study aimed to compare relationships between height- or weight-adjusted appendicular skeletal muscle mass (ASM/Ht 2 or ASM/Wt) and risk factors for cardiometabolic diseases or osteoporosis in Japanese men and women. Subjects were healthy Japanese men (n = 583) and women (n = 1218). The study population included a young group (310 men and 357 women; age, 18-40 years) and a middle-aged and elderly group (273 men and 861 women; age, ≥41 years). ASM was measured by dual-energy X-ray absorptiometry. The reference values for class 1 and 2 sarcopenia in each sex were defined as values one and two standard deviations below the sex-specific means of the young group, respectively. The reference values for class 1 and 2 sarcopenia defined by ASM/Ht 2 were 7.77 and 6.89 kg/m 2 in men and 6.06 and 5.31 kg/m 2 in women, respectively. The reference values for ASM/Wt were 35.0 and 32.0% in men and 29.6 and 26.4% in women, respectively. In both men and women, ASM/Wt was negatively correlated with higher triglycerides (TG) and positively correlated with serum high-density lipoprotein cholesterol (HDL-C), but these associations were not found in height-adjusted ASM. In women, TG, systolic blood pressure, and diastolic blood pressure in sarcopenia defined by ASM/Wt were significantly higher than those in normal subjects, but these associations were not found in sarcopenia defined by ASM/Ht 2 . Whole-body and regional bone mineral density in sarcopenia defined by ASM/Ht 2 were significantly lower than those in normal subjects, but these associations were not found in sarcopenia defined by ASM/Wt. Weight-adjusted definition was able to identify cardiometabolic risk factors such as TG and HDL-C while height-adjusted definition could identify factors for osteoporosis.

  13. The Johns Hopkins Hospital: A Summer Internship

    OpenAIRE

    Smith, Adam

    2016-01-01

    Adam Smith, a native of Richmond, Indiana, is an advanced pharmacy practice student in the College of Pharmacy at Purdue University. In this article, he describes how career exploration through a summer internship with The Johns Hopkins Hospital in Baltimore, Maryland solidified his desire to pursue a career in pharmacy administration.

  14. Genetics Home Reference: Pitt-Hopkins syndrome

    Science.gov (United States)

    ... 1 link) PubMed OMIM (1 link) PITT-HOPKINS SYNDROME Sources for This Page Amiel J, Rio M, de Pontual L, Redon R, Malan V, Boddaert N, Plouin P, Carter NP, Lyonnet S, Munnich A, Colleaux L. Mutations in TCF4, ... a severe epileptic encephalopathy associated with autonomic dysfunction. ...

  15. Graduate Management Project: The Capital Equipment Acquisition Process at The Johns Hopkins Hospital Evaluating Acquisition Strategies Through Financial Analysis

    National Research Council Canada - National Science Library

    McGowan, Colleen

    1999-01-01

    .... The purpose of this paper is to first develop an equipment evaluation process at The Johns Hopkins Hospital which considers both clinical and financial factors when allocating capital dollars to acquire equipment...

  16. Covariate Imbalance and Adjustment for Logistic Regression Analysis of Clinical Trial Data

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    Ciolino, Jody D.; Martin, Reneé H.; Zhao, Wenle; Jauch, Edward C.; Hill, Michael D.; Palesch, Yuko Y.

    2014-01-01

    In logistic regression analysis for binary clinical trial data, adjusted treatment effect estimates are often not equivalent to unadjusted estimates in the presence of influential covariates. This paper uses simulation to quantify the benefit of covariate adjustment in logistic regression. However, International Conference on Harmonization guidelines suggest that covariate adjustment be pre-specified. Unplanned adjusted analyses should be considered secondary. Results suggest that that if adjustment is not possible or unplanned in a logistic setting, balance in continuous covariates can alleviate some (but never all) of the shortcomings of unadjusted analyses. The case of log binomial regression is also explored. PMID:24138438

  17. Clinical antibacterial effectiveness of the self-adjusting file system.

    Science.gov (United States)

    Neves, M A S; Rôças, I N; Siqueira, J F

    2014-04-01

    To evaluate in vivo the antibacterial effectiveness of the self-adjusting file (SAF) using molecular methods. Root canals from single-rooted teeth with apical periodontitis were instrumented using the SAF system under continuous irrigation with 2.5% NaOCl. DNA extracts from samples taken before and after instrumentation were subjected to quantitative analysis of total bacteria counts and levels of streptococci by quantitative real-time polymerase chain reaction (qPCR). The reverse-capture checkerboard assay was also used to identify 28 bacterial taxa before (S1) and after (S2) SAF instrumentation. SAF was also compared with a conventional hand nickel-titanium instrumentation technique for total bacterial reduction. Data from qPCR were analysed statistically within groups using the Wilcoxon matched pairs test and between groups using the Mann-Whitney U-test and the Fisher's exact test, with significance level set at P file significantly reduced the total bacterial counts from a mean number of 1.96 × 10(7) cells to 1.34 × 10(4) cells (P system was significantly superior to the 95.1% reduction obtained by hand instrumentation (P system succeeded in significantly reducing the streptococcal levels, but four cases still harboured these bacteria in S2. Checkerboard analysis revealed that not only streptococci but also some anaerobic and even as-yet-uncultivated bacteria may resist the effects of chemomechanical procedures. The SAF instrumentation system was highly effective in reducing bacterial populations from infected root canals and performed significantly better than hand instrumentation. However, because half of the samples still had detectable bacteria after preparation with SAF, supplementary disinfection is still required to maximize bacterial elimination. © 2013 International Endodontic Journal. Published by John Wiley & Sons Ltd.

  18. Comparison of clinical probability-adjusted D-dimer and age-adjusted D-dimer interpretation to exclude venous thromboembolism.

    Science.gov (United States)

    Takach Lapner, Sarah; Julian, Jim A; Linkins, Lori-Ann; Bates, Shannon; Kearon, Clive

    2017-10-05

    Two new strategies for interpreting D-dimer results have been proposed: i) using a progressively higher D-dimer threshold with increasing age (age-adjusted strategy) and ii) using a D-dimer threshold in patients with low clinical probability that is twice the threshold used in patients with moderate clinical probability (clinical probability-adjusted strategy). Our objective was to compare the diagnostic accuracy of age-adjusted and clinical probability-adjusted D-dimer interpretation in patients with a low or moderate clinical probability of venous thromboembolism (VTE). We performed a retrospective analysis of clinical data and blood samples from two prospective studies. We compared the negative predictive value (NPV) for VTE, and the proportion of patients with a negative D-dimer result, using two D-dimer interpretation strategies: the age-adjusted strategy, which uses a progressively higher D-dimer threshold with increasing age over 50 years (age in years × 10 µg/L FEU); and the clinical probability-adjusted strategy which uses a D-dimer threshold of 1000 µg/L FEU in patients with low clinical probability and 500 µg/L FEU in patients with moderate clinical probability. A total of 1649 outpatients with low or moderate clinical probability for a first suspected deep vein thrombosis or pulmonary embolism were included. The NPV of both the clinical probability-adjusted strategy (99.7 %) and the age-adjusted strategy (99.6 %) were similar. However, the proportion of patients with a negative result was greater with the clinical probability-adjusted strategy (56.1 % vs, 50.9 %; difference 5.2 %; 95 % CI 3.5 % to 6.8 %). These findings suggest that clinical probability-adjusted D-dimer interpretation is a better way of interpreting D-dimer results compared to age-adjusted interpretation.

  19. A method to adjust radiation dose-response relationships for clinical risk factors

    DEFF Research Database (Denmark)

    Appelt, Ane Lindegaard; Vogelius, Ivan R

    2012-01-01

    Several clinical risk factors for radiation induced toxicity have been identified in the literature. Here, we present a method to quantify the effect of clinical risk factors on radiation dose-response curves and apply the method to adjust the dose-response for radiation pneumonitis for patients...

  20. The History of Heart Surgery at The Johns Hopkins Hospital.

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    Patel, Nishant D; Alejo, Diane E; Cameron, Duke E

    2015-01-01

    Johns Hopkins has made many lasting contributions to cardiac surgery, including the discovery of heparin and the Blalock-Taussig Shunt, which represents the dawn of modern cardiac surgery. Equally important, Johns Hopkins has trained some of the world's leaders in academic cardiac surgery, and is committed to training the future leaders in our specialty. Copyright © 2015. Published by Elsevier Inc.

  1. A comparison of internal versus external risk-adjustment for monitoring clinical outcomes

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    Koetsier, Antonie; de Keizer, Nicolette; Peek, Niels

    2011-01-01

    Internal and external prognostic models can be used to calculate severity of illness adjusted mortality risks. However, it is unclear what the consequences are of using an external model instead of an internal model when monitoring an institution's clinical performance. Theoretically, using an

  2. Psychosocial adjustment among patients with ostomy: a survey in stoma clinics, Nepal

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    Gautam S

    2016-08-01

    Full Text Available Sital Gautam,1 Surya Koirala,2 Anju Poudel,1 Dipak Paudel,3 1Department of Nursing, Nepal Medical College, 2Department of Nursing, Institute of Medicine, Tribhuvan University, Nursing Campus Maharajgunj, 3Department of Medicine, People’s Medical College, Kathmandu, Nepal Background: Ostomy changes the overall lifestyle of a person, and ostomates have been identified as a chronic illness population frequently experiencing adjustment problems. Purpose: The aim of this study was to determine the psychosocial adjustment and its predictors among patients with ostomy in Nepal. Patients and methods: A descriptive cross-sectional study was conducted in two stoma clinics of Nepal. Patients who had a colostomy, ileostomy, or urostomy, visited the selected stoma clinics during the data collection period, and who had ostomy for at least 6 months before data collection were included in the study. A total of 130 patients were included in this study. Data on sociodemographic and clinical variables were collected. Psychosocial adjustment score was measured using Ostomy Adjustment Inventory-23. Results: A total of 130 patients (80 males and 50 females were included in the study. The mean age of the patients was 51 years, ranging from 23 to 78 years. The study findings revealed that mean ±SD adjustment score was 41.49±13.57, indicating moderate impairment in the psychosocial adjustment among ostomates, and the mean ±SD scores of acceptance, anxious preoccupation, social engagement, and anger were 22.01±6.99, 8.75±3.89, 5.38±3.41, 5.35±1.62, respectively. Four variables contributed significantly to the final model, explaining 46.8% of variance in the psychosocial adjustment score (R2 =0.468, F(4, 125 =27.53, P<0.001. Perceived lack of family support (β=−0.367, P<0.001, total dependence on others to care for ostomy (ß=−0.357, P<0.001, and unemployment (ß=−0.144, P=0.032 significantly predicted lower psychosocial adjustment scores. However

  3. Gerard Manley Hopkins and Walter Pater : the labyrinths of transience

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    Mirko Starčević

    2016-12-01

    Full Text Available Transience forming life's very essence left an indelible mark on the creative explorations of Gerard Manley Hopkins and Walter Pater. The permanently indeterminable presence of mutability made both of them face the umbrous and unknowable aspect of death, thus revealing unto them the task of determining the role of art in life ruled by ceaseless corrosion. Pater accepts the flux of mutability as the primary particle in the revelatory act of the authentic creative experience. The power of that which is frolicsome in art augments the constitution of life's essence submerged in the unsettled condition of fate. Hopkins the priest particularly in his theoretic excursions recognizes in art itself only an approximate value to the timeless grandeur of God's ubiquity. His poetry, however, presents a dissimilar narrative. The poetic image that Hopkins forges corresponds to the mode of exposed individuality of the Romantic spirit, which Pater perceives as the harmony of strangeness and beauty. During Hopkins' student days at Oxford, Pater's relationship to the young poet was not confined to coaching only. Much of their time they spent in conversation, meditating upon the essential principles of artistic expression. Pater influenced Hopkins greatly and contributed impressively to the discipline of his poetic heart. Traces of this companionship do not find the path to Hopkins' religious ruminations; they announce their own existence, although very subtly, upon the individual levels of Hopkins' poetic yearnings.

  4. The Johns Hopkins RTR Consortium: A Collaborative Approach to Advance Translational Science and Standardize Clinical Monitoring of Restorative Transplantation - Immunomodulation and Tolerance Induction after VCA using Biologic Agent (cTLA4-Ig) and Donor Bone Marrow Cells

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    2014-10-01

    Standardize Clinical Monitoring of Restorative Transplantation – Immunomodulation and Tolerance Induction after VCA using Biologic Agent (cTLA4-Ig) and...Translational Science and Standardize Clinical Monitoring of Restorative Transplantation – Immunomodulation and Tolerance Induction after VCA using Biologic...wider application. Thus the purpose of this project is to develop novel clinically relevant regimens for immunomodulation and tolerance induction after

  5. Risk-adjusted Outcomes of Clinically Relevant Pancreatic Fistula Following Pancreatoduodenectomy: A Model for Performance Evaluation.

    Science.gov (United States)

    McMillan, Matthew T; Soi, Sameer; Asbun, Horacio J; Ball, Chad G; Bassi, Claudio; Beane, Joal D; Behrman, Stephen W; Berger, Adam C; Bloomston, Mark; Callery, Mark P; Christein, John D; Dixon, Elijah; Drebin, Jeffrey A; Castillo, Carlos Fernandez-Del; Fisher, William E; Fong, Zhi Ven; House, Michael G; Hughes, Steven J; Kent, Tara S; Kunstman, John W; Malleo, Giuseppe; Miller, Benjamin C; Salem, Ronald R; Soares, Kevin; Valero, Vicente; Wolfgang, Christopher L; Vollmer, Charles M

    2016-08-01

    To evaluate surgical performance in pancreatoduodenectomy using clinically relevant postoperative pancreatic fistula (CR-POPF) occurrence as a quality indicator. Accurate assessment of surgeon and institutional performance requires (1) standardized definitions for the outcome of interest and (2) a comprehensive risk-adjustment process to control for differences in patient risk. This multinational, retrospective study of 4301 pancreatoduodenectomies involved 55 surgeons at 15 institutions. Risk for CR-POPF was assessed using the previously validated Fistula Risk Score, and pancreatic fistulas were stratified by International Study Group criteria. CR-POPF variability was evaluated and hierarchical regression analysis assessed individual surgeon and institutional performance. There was considerable variability in both CR-POPF risk and occurrence. Factors increasing the risk for CR-POPF development included increasing Fistula Risk Score (odds ratio 1.49 per point, P ratio 3.30, P performance outliers were identified at the surgeon and institutional levels. Of the top 10 surgeons (≥15 cases) for nonrisk-adjusted performance, only 6 remained in this high-performing category following risk adjustment. This analysis of pancreatic fistulas following pancreatoduodenectomy demonstrates considerable variability in both the risk and occurrence of CR-POPF among surgeons and institutions. Disparities in patient risk between providers reinforce the need for comprehensive, risk-adjusted modeling when assessing performance based on procedure-specific complications. Furthermore, beyond inherent patient risk factors, surgical decision-making influences fistula outcomes.

  6. Summary of the 2015 International Paediatric Heart Failure Summit of Johns Hopkins All Children's Heart Institute.

    Science.gov (United States)

    Jacobs, Jeffrey P; Quintessenza, James A; Karl, Tom R; Asante-Korang, Alfred; Everett, Allen D; Collins, Susan B; Ramirez-Correa, Genaro A; Burns, Kristin M; Cohen, Mitchell; Colan, Steven D; Costello, John M; Daly, Kevin P; Franklin, Rodney C G; Fraser, Charles D; Hill, Kevin D; Huhta, James C; Kaushal, Sunjay; Law, Yuk M; Lipshultz, Steven E; Murphy, Anne M; Pasquali, Sara K; Payne, Mark R; Rossano, Joseph; Shirali, Girish; Ware, Stephanie M; Xu, Mingguo; Jacobs, Marshall L

    2015-08-01

    In the United States alone, ∼14,000 children are hospitalised annually with acute heart failure. The science and art of caring for these patients continues to evolve. The International Pediatric Heart Failure Summit of Johns Hopkins All Children's Heart Institute was held on February 4 and 5, 2015. The 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children's Heart Institute was funded through the Andrews/Daicoff Cardiovascular Program Endowment, a philanthropic collaboration between All Children's Hospital and the Morsani College of Medicine at the University of South Florida (USF). Sponsored by All Children's Hospital Andrews/Daicoff Cardiovascular Program, the International Pediatric Heart Failure Summit assembled leaders in clinical and scientific disciplines related to paediatric heart failure and created a multi-disciplinary "think-tank". The purpose of this manuscript is to summarise the lessons from the 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children's Heart Institute, to describe the "state of the art" of the treatment of paediatric cardiac failure, and to discuss future directions for research in the domain of paediatric cardiac failure.

  7. Eight months of clinical experience with the Self-Adjusting File system.

    Science.gov (United States)

    Solomonov, Michael

    2011-06-01

    The Self-Adjusting File (SAF) system (ReDent-Nova, Ra'anana, Israel) has been recently introduced for the simultaneous instrumentation and irrigation of root canals. The SAF is claimed to adapt itself three dimensionally to the root canal, including its cross-section. It is operated with a continuous flow of sodium hypochlorite that is delivered into the root canal through the hollow file and claimed to be activated by sonic agitation of the irrigant. Our aim was to present for the first time clinical cases prepared with the SAF system and to describe a clinical classification of canals, according to their difficulty, with recommendations for endodontic treatment sequences for each category. This report is based on the experience of a single endodontist, who used the system to treat more than 50 consecutive primary endodontic cases over the prior 8 months. A clinical classification was developed which enabled the operator to select a treatment protocol for easy and optimal glide path preparation to be effectively used with the SAF file in the various root canals encountered in the clinical environment. Clinical classification of canal difficulty makes root canal treatment sequences with the SAF simple and predictable. Many types of cases can be treated with the SAF system although a novice user is advised to advance slowly along the learning curve from simpler to more complicated canals. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  8. Development, cognition, and behaviour in Pitt-Hopkins

    NARCIS (Netherlands)

    Van Balkom, I.D.; Vuijk, P.J.; Franssens, M.; Hoek, H.W.; Hennekam, R.C.

    2012-01-01

    Aim The aim of the study was to collect detailed data on behavioural, adaptive, and psychological functioning in 10 individuals with Pitt-Hopkins syndrome (PTHS), with specific attention to manifestations of autism spectrum disorder (ASD). Method The participants (four females, six males), residing

  9. Results of an academic promotion and career path survey of faculty at the Johns Hopkins University School of Medicine.

    Science.gov (United States)

    Thomas, Patricia A; Diener-West, Marie; Canto, Marcia I; Martin, Don R; Post, Wendy S; Streiff, Michael B

    2004-03-01

    Clinician-educator faculty are increasing in numbers in academic medical centers, but their academic advancement is slower than that of research faculty. The authors sought to quantify the magnitude of this difference in career advancement and to explore the characteristics of faculty that might explain the difference. In 1999, a questionnaire was administered to all MD faculty at the rank of instructor and above (259) in the Department of Medicine at the Johns Hopkins University School of Medicine. A total of 180 (69%) faculty returned questionnaires. Of these, 178 identified with one of four career paths: basic researcher (46), clinical researcher (69), academic clinician (38), or teacher-clinician (25). Career path did not differ by age, gender, rank, years on faculty, hours worked per week, family responsibility, or global work satisfaction. After adjusting for age, gender, time at rank, and work satisfaction, the odds of being at a higher rank were 85% less for academic clinicians (odds ratio,.15; 95% confidence interval, 0.06-0.40) and 69% less for teacher-clinicians (odds ratio,.31; 95% confidence interval, 0.11-0.88) than for basic researchers. Clinical researchers did not differ from basic researchers in the likelihood of being at higher rank. Similarly, compared with basic research faculty, the adjusted odds of being more satisfied with progress towards academic promotion were 92% lower for academic clinicians and 87% lower for teacher-clinicians. Clinician-educator faculty were less likely to be at higher rank at this institution than were faculty in research paths. Differences in rank may be explained by lower rank at hire for faculty in these career paths, time available for scholarly activities, or other resources available to support scholarship. Retaining clinician-educators will require further exploration of barriers to promotion inherent to these career paths and methods of modifying these barriers.

  10. Public Reporting of Primary Care Clinic Quality: Accounting for Sociodemographic Factors in Risk Adjustment and Performance Comparison.

    Science.gov (United States)

    Wholey, Douglas R; Finch, Michael; Kreiger, Rob; Reeves, David

    2018-01-03

    Performance measurement and public reporting are increasingly being used to compare clinic performance. Intended consequences include quality improvement, value-based payment, and consumer choice. Unintended consequences include reducing access for riskier patients and inappropriately labeling some clinics as poor performers, resulting in tampering with stable care processes. Two analytic steps are used to maximize intended and minimize unintended consequences. First, risk adjustment is used to reduce the impact of factors outside providers' control. Second, performance categorization is used to compare clinic performance using risk-adjusted measures. This paper examines the effects of methodological choices, such as risk adjusting for sociodemographic factors in risk adjustment and accounting for patients clustering by clinics in performance categorization, on clinic performance comparison for diabetes care, vascular care, asthma, and colorectal cancer screening. The population includes all patients with commercial and public insurance served by clinics in Minnesota. Although risk adjusting for sociodemographic factors has a significant effect on quality, it does not explain much of the variation in quality. In contrast, taking into account the nesting of patients within clinics in performance categorization has a substantial effect on performance comparison.

  11. Demographic variables, clinical aspects, and medicolegal implications in a population of patients with adjustment disorder

    Directory of Open Access Journals (Sweden)

    Anastasia A

    2016-04-01

    Full Text Available Annalisa Anastasia,1 Chiara Colletti,1 Valentina Cuoco,1 Adele Quartini,1 Stefania Urso,2 Raffaella Rinaldi,2 Giuseppe Bersani1 1Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, 2Department of Anatomical, Istological, Forensic and Locomotor System Sciences, Sapienza University of Rome, Rome, Italy Introduction: Although adjustment disorder (AD is considered as residual diagnosis and receives little attention in research, it plays an important role in clinical practice and also assumes an increasingly important role in the field of legal medicine, where the majority of diagnostic frameworks (eg, mobbing often refer to AD. Our study aimed to look for specific stressor differences among demographic and clinical variables in a naturalistic setting of patients with AD.Methods: A restrospective statistical analysis of the data of patients diagnosed with AD from November 2009 to September 2012, identified via manual search from the archive of the outpatient setting at the University Unit of Psychiatry “A. Fiorini” Hospital, Terracina (Latina, Italy, was performed.Results: The sample consisted of 93 patients (46 males and 47 females, aged between 26 and 85, with medium–high educational level who were mainly employed. In most cases (54.80%, a diagnosis of AD with mixed anxiety and depressed mood was made. In all, 72% of the sample reported a negative family history for psychiatric disorders. In 22.60%, a previous history of psychopathology, especially mood disorders (76.19%, was reported. The main stressors linked to the development of AD were represented by working problems (32.30%, family problems (23.70%, and/or somatic disease (22.60% with significant differences with respect to age and sex. Half of the patients were subjected to a single first examination; 24.47% requested a copy of medical records.Conclusion: Confirming previous data from previous reports, our results

  12. Demographic variables, clinical aspects, and medicolegal implications in a population of patients with adjustment disorder.

    Science.gov (United States)

    Anastasia, Annalisa; Colletti, Chiara; Cuoco, Valentina; Quartini, Adele; Urso, Stefania; Rinaldi, Raffaella; Bersani, Giuseppe

    2016-01-01

    Although adjustment disorder (AD) is considered as residual diagnosis and receives little attention in research, it plays an important role in clinical practice and also assumes an increasingly important role in the field of legal medicine, where the majority of diagnostic frameworks (eg, mobbing) often refer to AD. Our study aimed to look for specific stressor differences among demographic and clinical variables in a naturalistic setting of patients with AD. A restrospective statistical analysis of the data of patients diagnosed with AD from November 2009 to September 2012, identified via manual search from the archive of the outpatient setting at the University Unit of Psychiatry "A. Fiorini" Hospital, Terracina (Latina, Italy), was performed. The sample consisted of 93 patients (46 males and 47 females), aged between 26 and 85, with medium-high educational level who were mainly employed. In most cases (54.80%), a diagnosis of AD with mixed anxiety and depressed mood was made. In all, 72% of the sample reported a negative family history for psychiatric disorders. In 22.60%, a previous history of psychopathology, especially mood disorders (76.19%), was reported. The main stressors linked to the development of AD were represented by working problems (32.30%), family problems (23.70%), and/or somatic disease (22.60%) with significant differences with respect to age and sex. Half of the patients were subjected to a single first examination; 24.47% requested a copy of medical records. Confirming previous data from previous reports, our results suggest that AD may have a distinct profile in demographic and clinical terms. Increased scientific attention is hoped, particularly focused on addressing a better definition of diagnostic criteria, whose correctness and accuracy are critical, especially in situations with medicolegal implications.

  13. Psychometric validation of the Chinese version of the Johns Hopkins Fall Risk Assessment Tool for older Chinese inpatients.

    Science.gov (United States)

    Zhang, Junhong; Wang, Min; Liu, Yu

    2016-10-01

    To culturally adapt and evaluate the reliability and validity of the Chinese version of the Johns Hopkins Fall Risk Assessment Tool among older inpatients in the mainland of China. Patient falls are an important safety consideration within hospitals among older inpatients. Nurses need specific risk assessment tools for older inpatients to reliably identify at-risk populations and guide interventions that highlight fixable risk factors for falls and consequent injuries. In China, a few tools have been developed to measure fall risk. However, they lack the solid psychometric development necessary to establish their validity and reliability, and they are not widely used for elderly inpatients. A cross-sectional study. A convenient sampling was used to recruit 201 older inpatients from two tertiary-level hospitals in Beijing and Xiamen, China. The Johns Hopkins Fall Risk Assessment Tool was translated using forward and backward translation procedures and was administered to these 201 older inpatients. Reliability of the tool was calculated by inter-rater reliability and Cronbach's alpha. Validity was analysed through content validity index and construct validity. The Inter-rater reliability of Chinese version of Johns Hopkins Fall Risk Assessment Tool was 97·14% agreement with Cohen's Kappa of 0·903. Cronbach's α was 0·703. Content of Validity Index was 0·833. Two factors represented intrinsic and extrinsic risk factors were explored that together explained 58·89% of the variance. This study provided evidence that Johns Hopkins Fall Risk Assessment Tool is an acceptable, valid and reliable tool to identify older inpatients at risk of falls and falls with injury. Further psychometric testing on criterion validity and evaluation of its advanced utility in geriatric clinical settings are warranted. The Chinese version of Johns Hopkins Fall Risk Assessment Tool may be useful for health care personnel to identify older Chinese inpatients at risk of falls and falls

  14. Meharry-Johns Hopkins Center for Prostate Cancer Research

    Science.gov (United States)

    2015-11-01

    formerly at the Institute for Health, Social, and Community Research (IHSCR) Center for Survey Research ( CSR ) at Shaw University in Raleigh, NC...survey will be conducted at CSR which is now located at Johns Hopkins Bloomberg School of Public Health (JHBSPH) located in Raleigh, NC. The Sons...the strategy to contact sons for whom she had no address or phone number. It was hoped that the father will notify the son to contact the study

  15. Hopkins syndrome and phantom hernia: a rare association.

    Science.gov (United States)

    Elizabeth, K E; Guruprasad, C S; Sindhu, T G

    2011-06-01

    Acute flaccid paralysis (AFP), other than paralytic poliomyelitis, are usually due to demyelination like Guillian Barre syndrome (GBS), transverse myelitis and traumatic neuritis. Poliomyelitis like illness, Hopkins syndrome or Post Asthmatic Amotrophy, associated with bronchial asthma and hyperIgEemia has been reported in literature. We present a two and a half year old child who developed AFP with phantom hernia following an episode of bronchial asthma.

  16. The clinical application and nursing experience of adjustable shunt valve in treatment for patients with normal pressure hydrocephalus

    Directory of Open Access Journals (Sweden)

    YANG Li-rong

    2012-02-01

    Full Text Available Objective To introduce the application of adjustable shunt valve in treatment for patients with normal pressure hydrocephalus. Methods Twenty-four patients with normal pressure hydrocephalus implanted adjustable shunt valve underwent ventriculo-peritoneal shunt surgery and nursing care. Results After operation, cerebrospinal pressure was regulated for 0-6 (1.88 ± 1.52 times. Clinical symptoms were improved, especially in gait disturbance. Conclusion Treatment of normal pressure hydrocephalus with adjustable shunt valve can alleviate symptoms of hydrocephalus. It is especially suitable for patients with short course and secondary normal hydrocephalus patients.

  17. Validating the Johns Hopkins ACG Case-Mix System of the elderly in Swedish primary health care

    Directory of Open Access Journals (Sweden)

    Fridh Gerd

    2006-06-01

    Full Text Available Abstract Background Individualbased measures for comorbidity are of increasing importance for planning and funding health care services. No measurement for individualbased healthcare costs exist in Sweden. The aim of this study was to validate the Johns Hopkins ACG Case-Mix System's predictive value of polypharmacy (regular use of 4 or more prescription medicines used as a proxy for health care costs in an elderly population and to study if the prediction could be improved by adding variables from a population based study i.e. level of education, functional status indicators and health perception. Methods The Johns Hopkins ACG Case-Mix System was applied to primary health care diagnoses of 1402 participants (60–96 years in a cross-sectional community based study in Karlskrona, Sweden (the Swedish National study on Ageing and Care during a period of two years before they took part in the study. The predictive value of the Johns Hopkins ACG Case-Mix System was modeled against the regular use of 4 or more prescription medicines, also using age, sex, level of education, instrumental activity of daily living- and measures of health perception as covariates. Results In an exploratory biplot analysis the Johns Hopkins ACG Case-Mix System, was shown to explain a large part of the variance for regular use of 4 or more prescription medicines. The sensitivity of the prediction was 31.9%, whereas the specificity was 88.5%, when the Johns Hopkins ACG Case-Mix System was adjusted for age. By adding covariates to the model the sensitivity was increased to 46.3%, with a specificity of 90.1%. This increased the number of correctly classified by 5.6% and the area under the curve by 11.1%. Conclusion The Johns Hopkins ACG Case-Mix System is an important factor in measuring comorbidity, however it does not reflect an individual's capability to function despite a disease burden, which has importance for prediction of comorbidity. In this study we have shown that

  18. Poverty and Children's Adjustment. Developmental Clinical Psychology and Psychiatry, Volume 41.

    Science.gov (United States)

    Luthar, Suniya S.

    The focus of this book is on the risk and protective processes that modify the effects of poverty on children's social and emotional adjustment. The attempt is to integrate findings of empirical research conducted over the past three decades on the adjustment of children facing socioeconomic deprivation. The chapters are: (1)…

  19. One Hundred Years of Psychiatry at Johns Hopkins: A Story of Meyer to McHugh.

    Science.gov (United States)

    DePaulo, J Raymond

    2017-04-01

    This article describes a history of clinical methods and constructs that guide Psychiatry at Johns Hopkins Phipps Clinic today. The contributions of Adolf Meyer and Paul McHugh are central and closely connected. Both emphasize the clinical examination as the central practice of psychiatry as a specialty within medicine. Meyer's comprehensive examination of the patient became the centerpiece of his approach and was the standard for psychiatrists in the English-speaking world. McHugh, with Phillip Slavney, developed a pluralistic and practical framework for interpreting that history and examination. Both argued against the uncritical use of the modern disease construct. McHugh argues that the disease construct, although fundamental, is but one of four useful "perspectives of psychiatry" and is, thus, an insufficient basis for psychiatric practice. The perspectives could be used as an organizing framework by all physicians who seek a practical and truly personalized approach to the care of patients.

  20. Neurally Adjusted Ventilatory Assist After Pediatric Cardiac Surgery: Clinical Experience and Impact on Ventilation Pressures.

    Science.gov (United States)

    Crulli, Benjamin; Khebir, Mariam; Toledano, Baruch; Vobecky, Suzanne; Poirier, Nancy; Emeriaud, Guillaume

    2018-02-01

    After pediatric cardiac surgery, ventilation with high airway pressures can be detrimental to right ventricular function and pulmonary blood flow. Neurally adjusted ventilatory assist (NAVA) improves patient-ventilator interactions, helping maintain spontaneous ventilation. This study reports our experience with the use of NAVA in children after a cardiac surgery. We hypothesize that using NAVA in this population is feasible and allows for lower ventilation pressures. We retrospectively studied all children ventilated with NAVA (invasively or noninvasively) after undergoing cardiac surgery between January 2013 and May 2015 in our pediatric intensive care unit. The number and duration of NAVA episodes were described. For the first period of invasive NAVA in each subject, detailed clinical and ventilator data in the 4 h before and after the start of NAVA were extracted. 33 postoperative courses were included in 28 subjects with a median age of 3 [interquartile range (IQR) 1-12] months. NAVA was used invasively in 27 courses for a total duration of 87 (IQR 15-334) h per course. Peak inspiratory pressures and mean airway pressures decreased significantly after the start of NAVA (mean differences of 5.8 cm H 2 O (95% CI 4.1-7.5) and 2.0 cm H 2 O (95% CI 1.2-2.8), respectively, P < .001 for both). There was no significant difference in vital signs or blood gas values. NAVA was used noninvasively in 14 subjects, over 79 (IQR 25-137) h. NAVA could be used in pediatric subjects after cardiac surgery. The significant decrease in airway pressures observed after transition to NAVA could have a beneficial impact in this specific population, which should be investigated in future interventional studies. Copyright © 2018 by Daedalus Enterprises.

  1. Sensitivity analysis for missing dichotomous outcome data in multi-visit randomized clinical trial with randomization-based covariance adjustment.

    Science.gov (United States)

    Li, Siying; Koch, Gary G; Preisser, John S; Lam, Diana; Sanchez-Kam, Matilde

    2017-01-01

    Dichotomous endpoints in clinical trials have only two possible outcomes, either directly or via categorization of an ordinal or continuous observation. It is common to have missing data for one or more visits during a multi-visit study. This paper presents a closed form method for sensitivity analysis of a randomized multi-visit clinical trial that possibly has missing not at random (MNAR) dichotomous data. Counts of missing data are redistributed to the favorable and unfavorable outcomes mathematically to address possibly informative missing data. Adjusted proportion estimates and their closed form covariance matrix estimates are provided. Treatment comparisons over time are addressed with Mantel-Haenszel adjustment for a stratification factor and/or randomization-based adjustment for baseline covariables. The application of such sensitivity analyses is illustrated with an example. An appendix outlines an extension of the methodology to ordinal endpoints.

  2. Pitt-Hopkins syndrome: report of a case with a TCF4 gene mutation

    Directory of Open Access Journals (Sweden)

    Orsini Alessandro

    2010-02-01

    Full Text Available Abstract Aims We will discuss the clinical and genetic diagnosis of a child with severe psychomotor delay, who at 3 years of age presented with paroxysms of hyperpnea-apnea and seizures unrelated to breathing anomalies. Methods The child underwent genetic (karyotype, FISH telomeres and neuroradiological (cranial CT and MRI tests, which proved to be normal. He came under our clinical observation at 3 years and 5 months of age. Due to severe psychomotor delay and facial dysmorphisms we completed the genetic investigations based on his clinical feature and analysis of the available literature. Results The presence of severe mental retardation associated with anomalous breathing pattern may suggest the Joubert and Rett syndrome, however these were excluded on the basis of clinical and genetic examination. Angelman syndrome, suspected for facial dysmorphisms and absent language, was also excluded because of the presence of a normal pattern of methylation at SNRPN locus. Another possible diagnosis was the Pitt-Hopkins Syndrome (PHS, characterized by severe mental retardation, breathing anomalies (paroxisms of hyperpnea-apnea, dysmorphisms and sometimes epilepsy. Haploinsufficiency of TCF4 gene located at 18q21.2 region has been recently identified as causative of this syndrome. In our patient the research of TCF4 mutation by the Institute of Human Genetics, University Hospital Erlangen (Germany, showed a de novo mutation. Conclusions The diagnosis of Pitt-Hopkins syndrome, an underdiagnosed cause of mental retardation, was based on clinical and genetic findings. Searching for TCF4 mutations is highly recommended when others overlapping syndromes was excluded. At our knowledge our patient is the first italian case of PHS diagnosed at molecular level.

  3. The past, present, and future of paediatric cardiology training at the Johns Hopkins Hospital, in the tradition of Dr Helen Taussig.

    Science.gov (United States)

    Beasley, Gary S; Murphy, Anne M; Brenner, Joel I; Ravekes, William J

    2016-12-01

    Johns Hopkins has been a leader in paediatric cardiology for over 85 years. In the 1940s, Dr Helen Taussig began training fellows in paediatric cardiology at Johns Hopkins at a time when the diagnosis and treatment of CHD were in the earliest stage. Under her leadership, the fellowship developed a strong foundation that has continued to evolve to meet the current needs of learners and educators. In the current era, the Johns Hopkins programme implements the current theories of adult education and actively engages our fellows in learning as well as teaching. The programme uses techniques such as flipped classroom, structured case-based small-group learning, observed and structured clinical examination, simulations, and innovative educational technology. These strategies combined with our faculty and rich history give our fellows a unique educational experience.

  4. An interpersonal perspective on depression: the role of marital adjustment, conflict communication, attributions, and attachment within a clinical sample.

    Science.gov (United States)

    Heene, Els; Buysse, Ann; Van Oost, Paulette

    2007-12-01

    Previous studies have focused on the difficulties in psychosocial functioning in depressed persons, underscoring the distress experienced by both spouses. We selected conflict communication, attribution, and attachment as important domains of depression in the context of marital adjustment, and we analyzed two hypotheses in one single study. First, we analyzed whether a clinical sample of couples with a depressed patient would differ significantly from a control group on these variables. Second, we explored to what degree these variables mediate/moderate the relationship between depressive symptoms and marital adjustment. The perspectives of both spouses were taken into account, as well as gender differences. In total, 69 clinical and 69 control couples were recruited, and a series of multivariate analyses of variance and regression analyses were conducted to test both hypotheses. Results indicated that both patients and their partners reported less marital adjustment associated with more negative perceptions on conflict communication, causal attributions, and insecure attachment. In addition, conflict communication and causal attributions were significant mediators of the association between depressive symptoms and marital adjustment for both depressed men and women, and causal attributions also moderated this link. Ambivalent attachment was a significant mediator only for the female identified patients. Several sex differences and clinical implications are discussed.

  5. Development of global health education at Johns Hopkins University School of Medicine: a student-driven initiative

    Directory of Open Access Journals (Sweden)

    Dane Moran

    2015-07-01

    Full Text Available Global health is increasingly present in the formal educational curricula of medical schools across North America. In 2008, students at Johns Hopkins University School of Medicine (JHUSOM perceived a lack of structured global health education in the existing curriculum and began working with the administration to enhance global health learning opportunities, particularly in resource-poor settings. Key events in the development of global health education have included the introduction of a global health intersession mandatory for all first-year students; required pre-departure ethics training for students before all international electives; and the development of a clinical global health elective (Global Health Leadership Program, GHLP. The main challenges to improving global health education for medical students have included securing funding, obtaining institutional support, and developing an interprofessional program that benefits from the resources of the Schools of Medicine, Public Health, and Nursing. Strategies used included objectively demonstrating the need for and barriers to more structured global health experiences; obtaining guidance and modifying existing resources from other institutions and relevant educational websites; and harnessing institution-specific strengths including the large Johns Hopkins global research footprint and existing interprofessional collaborations across the three schools. The Johns Hopkins experience demonstrates that with a supportive administration, students can play an important and effective role in improving global health educational opportunities. The strategies we used may be informative for other students and educators looking to implement global health programs at their own institutions.

  6. Workshop held at Johns Hopkins University, March 2013

    CERN Document Server

    2013-01-01

    Cyber-physical systems (CPS) involve deeply integrated, tightly coupled computational and physical components. These systems, spanning multiple scientific and technological domains, are highly complex and pose several fundamental challenges. They are also critically important to society’s advancement and security. The design and deployment of the adaptable, reliable CPS of tomorrow requires the development of a basic science foundation, synergistically drawing on various branches of engineering, mathematics, computer science, and domain specific knowledge.   This book brings together 19 invited papers presented at the Workshop on Control of Cyber-Physical Systems, hosted by the Department of Electrical & Computer Engineering at The Johns Hopkins University in March 2013. It highlights the central role of control theory and systems thinking in developing the theory of CPS, in addressing the challenges of cyber-trust and cyber-security, and in advancing emerging cyber-physical applications ranging from s...

  7. The metaphysical club at the Johns Hopkins University (1879-1885).

    Science.gov (United States)

    Behrens, Peter J

    2005-11-01

    Of the earliest American universities, The Johns Hopkins in Baltimore holds a unique position for psychology. At Hopkins, many of America's first psychologists received their graduate training. Of special interest is the Hopkins Metaphysical Club, organized in 1879 by Charles Sanders Peirce. It provided a forum for research and scholarship by faculty and students. Papers related to topics of the "new" psychology began to appear in 1883, about the time G. Stanley Hall was given a 3-year appointment at Hopkins. When Peirce departed Hopkins in 1885, Hall was free to develop psychology in his image and disbanded the club. Nevertheless, the Metaphysical Club played an important role in the emergence of American scientific psychology.

  8. Validity and reliability of The Johns Hopkins Adapted Cognitive Exam for critically ill patients.

    Science.gov (United States)

    Lewin, John J; LeDroux, Shannon N; Shermock, Kenneth M; Thompson, Carol B; Goodwin, Haley E; Mirski, Erin A; Gill, Randeep S; Mirski, Marek A

    2012-01-01

    To validate The Johns Hopkins Adapted Cognitive Exam designed to assess and quantify cognition in critically ill patients. Prospective cohort study. Neurosciences, surgical, and medical intensive care units at The Johns Hopkins Hospital. One hundred six adult critically ill patients. One expert neurologic assessment and four measurements of the Adapted Cognitive Exam (all patients). Four measurements of the Folstein Mini-Mental State Examination in nonintubated patients only. Adapted Cognitive Exam and Mini-Mental State Examination were performed by 76 different raters. One hundred six patients were assessed, 46 intubated and 60 nonintubated, resulting in 424 Adapted Cognitive Exam and 240 Mini-Mental State Examination measurements. Criterion validity was assessed by comparing Adapted Cognitive Exam with a neurointensivist's assessment of cognitive status (ρ = 0.83, p validity was assessed by comparing Adapted Cognitive Exam with Mini-Mental State Examination in nonintubated patients (ρ = 0.81, p validity was assessed by surveying raters who used both the Adapted Cognitive Exam and Mini-Mental State Examination and indicated the Adapted Cognitive Exam was an accurate reflection of the patient's cognitive status, more sensitive a marker of cognition than the Mini-Mental State Examination, and easy to use. The Adapted Cognitive Exam demonstrated excellent interrater reliability (intraclass correlation coefficient = 0.997; 95% confidence interval 0.997-0.998) and interitem reliability of each of the five subscales of the Adapted Cognitive Exam and Mini-Mental State Examination (Cronbach's α: range for Adapted Cognitive Exam = 0.83-0.88; range for Mini-Mental State Examination = 0.72-0.81). The Adapted Cognitive Exam is the first valid and reliable examination for the assessment and quantification of cognition in critically ill patients. It provides a useful, objective tool that can be used by any member of the interdisciplinary critical care team to support

  9. Introduction to the 2015 Supplement to Cardiology in the Young: Proceedings of the 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children's Heart Institute.

    Science.gov (United States)

    Jacobs, Jeffrey P

    2015-08-01

    In the United States of America alone, ~14,000 children are hospitalised annually with acute heart failure. The science and art of caring for these patients continues to evolve. The International Pediatric Heart Failure Summit of Johns Hopkins All Children's Heart Institute was held on 4 and 5 February, 2015. The 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children's Heart Institute was funded through the Andrews/Daicoff Cardiovascular Program Endowment, a philanthropic collaboration between All Children's Hospital and the Morsani College of Medicine at the University of South Florida (USF). Sponsored by All Children's Hospital Andrews/Daicoff Cardiovascular Program, the Johns Hopkins All Children's Heart Institute International Pediatric Heart Failure Summit assembled leaders in clinical and scientific disciplines related to paediatric heart failure and created a multi-disciplinary "think-tank". Information about George R. Daicoff, MD, and Ed and Sarainne Andrews is provided in this introductory manuscript to the 2015 Supplement to Cardiology in the Young entitled: "Proceedings of the 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children's Heart Institute". Dr Daicoff founded the All Children's Hospital Pediatric Heart Surgery programme and directed this programme for over two decades. Sarainne Andrews made her generous bequest to All Children's Hospital in honour of her husband Ed and his friendship with Dr Daicoff in order to support cardiovascular surgery research efforts.

  10. Validity and Reliability of Persian Version of Johns Hopkins Fall Risk Assessment Tool among Aged People

    Directory of Open Access Journals (Sweden)

    hadi hojati

    2018-04-01

    Full Text Available Background & Aim: It is crucial to identify aged patients in risk of falls in clinical settings. Johns Hopkins Fall Risk Assessment Tool (JHFRAT is one of most applied international instrument to assess elderly patients for the risk of falls. The aim of this study was to evaluate reliability and internal consistency of the JHFRAT. Methods & Materials: In this cross-sectional study for validity assessment of the tool, WHO’s standard protocol was applied for translation-back translation of the tool. Face and content validity of the tool was confirmed by ten person of expert faculty members for its applicability in clinical setting. In this pilot study, the inclusion criteria were being 60 or more years old, hospitalized in the last 8 hours prior to assessment and in proper cognitive condition assessed by MMSE. Subjects of the study were (n=70 elderly patients who were newly hospitalized in Shahroud Emam Hossein Hospital. Data were analyzed using SPSS software- version 16. Internal consistency of the tool was calculated by Cronbach’s alpha. Results: According to the results of the study Persian version of JHFRAT was a valid tool for application on clinical setting. The Persian version of the tool had Cronbach’s alpha equal to 0/733. Conclusion: Based on the findings of the current study, it can be concluded that Persian version of the JHFRAT is a valid and reliable tool to be applied for assessment of elderly senior citizens on admission in any clinical settings.

  11. Clinical effects of pre-adjusted edgewise orthodontic brackets: a systematic review and meta-analysis.

    Science.gov (United States)

    Papageorgiou, Spyridon N; Konstantinidis, Ioannis; Papadopoulou, Konstantina; Jäger, Andreas; Bourauel, Christoph

    2014-06-01

    Fixed-appliance treatment is a major part of orthodontic treatment, but clinical evidence remains scarce. Objective of this systematic review was to investigate how the therapeutic effects and side-effects of brackets used during the fixed-appliance orthodontic treatment are affected by their characteristics. SEARCH METHODS AND SELECTION CRITERIA: We searched MEDLINE and 18 other databases through April 2012 without restrictions for randomized controlled trials and quasi-randomized controlled trials investigating any bracket characteristic. After duplicate selection and extraction procedures, risk of bias was assessed also in duplicate according to Cochrane guidelines and quality of evidence according to the Grades of Recommendation. Assessment, Development and Evaluation approach. Random-effects meta-analyses, subgroup analyses, and sensitivity analyses were performed with the corresponding 95 per cent confidence intervals (CI) and 95 per cent prediction intervals (PI). We included 25 trials on 1321 patients, with most comparing self-ligated (SL) and conventional brackets. Based on the meta-analyses, the duration of orthodontic treatment was on average 2.01 months longer among patients with SL brackets (95 per cent CI: 0.45 to 3.57). The 95 per cent PIs for a future trial indicated that the difference could be considerable (-1.46 to 5.47 months). Treatment characteristics, outcomes, and side-effects were clinically similar between SL and conventional brackets. For most bracket characteristics, evidence is insufficient. Some meta-analyses included trials with high risk of bias, but sensitivity analyses indicated robustness. Based on existing evidence, no clinical recommendation can be made regarding the bracket material or different ligation modules. For SL brackets, no conclusive benefits could be proven, while their use was associated with longer treatment durations.

  12. Diabetes guidelines may delay timely adjustments during treatment and might contribute to clinical inertia.

    Science.gov (United States)

    Pimazoni-Netto, Augusto; Zanella, Maria Teresa

    2014-11-01

    Clinical inertia and poor knowledge by many physicians play an important role in delaying diabetes control. Among other guidelines, the Position Statement of the American Diabetes Association/European Association for the Study of Diabetes on Management of Hyperglycemia in Type 2 Diabetes is a respected guideline with high impact on this subject in terms of influencing physicians in the definition of strategic approach to overcome poor glycemic control. But, on the other hand, it carries a recommendation that might contribute to clinical inertia because it can delay the needed implementation of more vigorous, intensive, and effective strategies to overcome poor glycemic control within a reasonable time frame during the evolution of the disease. The same is true with other respected algorithms from different diabetes associations. Together with pharmacological interventions, diabetes education and more intensive blood glucose monitoring in the initial phases after the diagnosis are key strategies for the effective control of diabetes. The main reason why a faster glycemic control should be implemented in an effective and safe way is to boost the confidence and the compliance of the patient to the recommendations of the diabetes care team. Better and faster results in glycemic control can only be safely achieved with educational strategies, structured self-monitoring of blood glucose, and adequate pharmacological therapy in the majority of cases.

  13. The Johns Hopkins model of psychological first aid (RAPID-PFA): curriculum development and content validation.

    Science.gov (United States)

    Everly, George S; Barnett, Daniel J; Links, Jonathan M

    2012-01-01

    There appears to be virtual universal endorsement of the need for and value of acute "psychological first aid" (PFA) in the wake of trauma and disasters. In this paper, we describe the development of the curriculum for The Johns Hopkins RAPID-PFA model of psychological first aid. We employed an adaptation of the basic framework for the development of a clinical science as recommended by Millon which entailed: historical review, theoretical development, and content validation. The process of content validation of the RAPID-PFA curriculum entailed the assessment of attitudes (confidence in the application of PFA interventions, preparedness in the application of PFA); knowledge related to the application of immediate mental health interventions; and behavior (the ability to recognize clinical markers in the field as assessed via a videotape recognition exercise). Results of the content validation phase suggest the six-hour RAPID-PFA curriculum, initially based upon structural modeling analysis, can improve confidence in the application of PFA interventions, preparedness in the application of PFA, knowledge related to the application of immediate mental health interventions, and the ability to recognize clinical markers in the field as assessed via a videotape recognition exercise.

  14. AIDS: just the facts from specialists at Johns Hopkins.

    Science.gov (United States)

    Finkbeiner, A

    1985-12-01

    This article, based on information from specialists at Johns Hopkins, poses and then answers 3 broad questions about the acquired immunodeficiency syndrome (AIDS). 1st, it is asked, "What is AIDS and how serious is it?" It is noted that AIDS is only 1 of several forms taken by infection with the human T-lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV). The earliest form of infection is believed to occur within a few weeks of exposure to the virus, and some patients develop an acute syndrome that resembles infectious mononucleosis. These symptoms disappear after 4-6 weeks, by which time the patient has developed antibodies to the virus. About 2-4%/year of asymptomatic carriers go on to develop AIDS-related complex (ARC), and 15-30% of ARC patients develop AIDS within 5 years. The 2nd question posed is, "How do you catch AIDS?" To cause infection, the virus must go directly into the blood, although the virus alone may not be enough to cause sickness. Previous viral infections such as hepatitis B, herpes, cytomegalovirus, and intestinal parasites have been suggested as co-factors of AIDS. Promiscuity increases the chances of contracting AIDS. Observations of the families of AIDS patients and health care personnel who work with AIDS patients suggest that AIDS cannot be caught by casual contact. Finally, it is asked, "What is being done about AIDS?" 4 strategies are outlined: 1) as a result of donor screening for antibodies to HTLV-III/LAV, AIDS has been completely removed from the blood banks; 2) virologists are attempting to understand the virus so that it can be attacked, and understanding has been advanced by the theory that HTLV-III might be what is called a "slow virus;" 3) education about AIDS is changing the sexual practices that transmit AIDS; and 4) epidemiologists are carefully following those who are at risk, have been exposed, or are already sick.

  15. Graduate Management Project: An Evaluation of the Johns Hopkins Outpatient Surgery Center Patient Satisfaction Survey

    National Research Council Canada - National Science Library

    Evan, Barry

    1999-01-01

    .... Customer or patient satisfaction is a widely accepted measure of quality. Numerous organizations use satisfaction surveys as the foundation for organizational improvement and the Johns Hopkins Health System is no different...

  16. Transcultural adaptation of the Johns Hopkins Fall Risk Assessment Tool.

    Science.gov (United States)

    Martinez, Maria Carmen; Iwamoto, Viviane Ernesto; Latorre, Maria do Rosário Dias de Oliveira; Noronha, Adriana Moreira; Oliveira, Ana Paula de Sousa; Cardoso, Carlos Eduardo Alves; Marques, Ifigenia Augusta Braga; Vendramim, Patrícia; Lopes, Paula Cristina; Sant'Ana, Thais Helena Saes de

    2016-08-29

    to perform the transcultural adaptation and content validity analysis of the Johns Hopkins Fall Risk Assessment Tool to assess both fall risk and fall-related injury risk for hospitalized elderly in Brazil. the transcultural adaptation consisted of translating the scale to Portuguese (Brazil), back-translating it into its language of origin, establishing a consensus version, and having an expert committee verify its transcultural equivalence. Content assessment was conducted by a committee of judges, ending with the calculation of the items and scales' content validity index. Nurses tested the tool. the scale's translated version went through two evaluation rounds by the judges, based on which, the items with unsatisfactory performance were changed. The content validity index for the items was ≥80.0% and the global index 97.1%. The experimental application showed the scale is user-friendly. the scale presents valid content for the assessment of fall risk and risk of fall-related injuries and is easy to use, with the potential to contribute to the proper identification of risks and the establishment of care actions. realizar a adaptação transcultural para uso no Brasil e a avaliação da validade de conteúdo da Johns Hopkins Fall Risk Assessment Tool para avaliação de risco de quedas e de danos por quedas em pacientes adultos hospitalizados. adaptação transcultural consistiu na tradução da escala para a língua portuguesa (Brasil), retrotradução para a língua de origem, versão de consenso e análise da equivalência transcultural por um comitê de especialistas. A avaliação do conteúdo foi realizada por meio de um comitê de juízes, finalizando com o cálculo do índice de validade de conteúdo dos itens e da escala. Foi realizada a aplicação experimental do instrumento por enfermeiros. a versão traduzida da escala passou por duas rodadas de avaliação pelos juízes, a partir das quais os itens com desempenho insatisfatório foram modificados

  17. The Johns Hopkins Hunterian Laboratory Philosophy: Mentoring Students in a Scientific Neurosurgical Research Laboratory.

    Science.gov (United States)

    Tyler, Betty M; Liu, Ann; Sankey, Eric W; Mangraviti, Antonella; Barone, Michael A; Brem, Henry

    2016-06-01

    After over 50 years of scientific contribution under the leadership of Harvey Cushing and later Walter Dandy, the Johns Hopkins Hunterian Laboratory entered a period of dormancy between the 1960s and early 1980s. In 1984, Henry Brem reinstituted the Hunterian Neurosurgical Laboratory, with a new focus on localized delivery of therapies for brain tumors, leading to several discoveries such as new antiangiogenic agents and Gliadel chemotherapy wafers for the treatment of malignant gliomas. Since that time, it has been the training ground for 310 trainees who have dedicated their time to scientific exploration in the lab, resulting in numerous discoveries in the area of neurosurgical research. The Hunterian Neurosurgical Laboratory has been a unique example of successful mentoring in a translational research environment. The laboratory's philosophy emphasizes mentorship, independence, self-directed learning, creativity, and people-centered collaboration, while maintaining productivity with a focus on improving clinical outcomes. This focus has been served by the diverse backgrounds of its trainees, both in regard to educational status as well as culturally. Through this philosophy and strong legacy of scientific contribution, the Hunterian Laboratory has maintained a positive and productive research environment that supports highly motivated students and trainees. In this article, the authors discuss the laboratory's training philosophy, linked to the principles of adult learning (andragogy), as well as the successes and the limitations of including a wide educational range of students in a neurosurgical translational laboratory and the phenomenon of combining clinical expertise with rigorous scientific training.

  18. Technical Performance and Clinical Effectiveness of Drop Type With Adjustable Concentrator-Cell Free and Concentrated Ascites Reinfusion Therapy.

    Science.gov (United States)

    Yamada, Yosuke; Harada, Makoto; Yamaguchi, Akinori; Kobayashi, Yasuko; Chino, Takashi; Minowa, Takashi; Kosuge, Takashi; Tsukada, Wataru; Hashimoto, Koji; Kamijo, Yuji

    2017-12-01

    Cell-free and concentrated ascites reinfusion therapy (CART) is a very useful treatment method for refractory ascites but is difficult for many hospitals to employ due to its need for specialized equipment. We have therefore developed drop-type with adjustable concentrator CART (DC-CART) that uses a drop-type filtration mechanism and requires only a simple pump and pressure monitor for its concentration process. Easy adjustment of ascites concentration is possible through a recirculation loop, and filter membrane washing is aided by DC-CART's external pressure-type filtration to enable the processing of any quality or quantity of ascites. Moreover, the absence of a roller pump before filtration avoids inflammatory substance release from compressed cells. A total of 268 sessions of DC-CART using ascites from 98 patients were performed with good clinical results at our hospitals between January 2012 and June 2016. This report presents the detailed methods of DC-CART and summarizes its clinical effectiveness using patient ascites and blood data obtained from 59 sessions between March 2015 and February 2016. This novel technique successfully processed refractory ascites in numerous diseases with no serious adverse events. DC-CART could concentrate large amounts of ascites (from median weight: 4900 g [max: 20 200 g] to median weight: 695 g; median concentration ratio: 7.4), and a high amount of protein (median weight: 73 g [max: 294 g]) could be reinfused. Serum albumin levels were significantly increased (P = 0.010) and kidney function and systemic hemodynamics were well maintained in treated subjects. Additional concentration of ascites and adjustment of ascites volume were easily performed by recirculation (from median weight: 615 g to median weight: 360 g; median concentration ratio: 1.5). Time was needed during DC-CART for filter membrane cleaning, especially for viscous ascites. Overall, DC-CART represents a safe and useful treatment method for various forms

  19. Operative management of Marfan syndrome: The Johns Hopkins experience.

    Science.gov (United States)

    Baumgartner, W A; Cameron, D E; Redmond, J M; Greene, P S; Gott, V L

    1999-06-01

    Doctor Antoine Marfan described the first case of Marfan syndrome in 1896. It was over 50 years later that the development of aortic aneurysms and subsequent rupture was appreciated as the most life-threatening component of the syndrome. Doctor Vincent Gott, at our institution, performed the first Bentall procedure for an aneurysm of the ascending aorta in 1976. Since that time, the aortic root has been replaced in 231 Marfan patients. Of this group, 218 patients had a composite graft repair, 11 had an aortic root replacement with a homograft, and 2 patients had valve sparing procedures. There were 168 males and 63 females. Of the total 231 patients, 150 were operated on by Dr Gott. The remaining 81 patients were operated on by 10 other Hopkins surgeons. The average diameter of the ascending aorta was 6.8 cm, with a range from 4.5 to 10. The average aortic diameter of 43 patients who had an ascending aortic dissection was 7.3 cm. Fourteen of these patients had dissection with an aortic diameter of 6.5 cm or less. Among the 198 patients who underwent elective repair, there was no 30-day mortality. Thirty-three patients underwent urgent repair with 2 deaths, yielding a 30-day mortality of 6.1%. The mortality for the entire group of patients was 0.9%. Complications associated with this series of patients included 8 with endocarditis, 7 with thromboembolism, and 4 late coronary dehiscences. Actuarial survival was 88% at 5 years, 81% at 10 years, and 75% at 20 years. Multivariate analysis revealed New York Heart Association classification, male gender and urgent surgery as independent risk factors for mortality. Marfan patients with aortic aneurysms can undergo elective surgery with a low operative risk and excellent long-term survival with low morbidity. We feel that elective resection of an aneurysm in a Marfan patient should occur when it approaches a diameter of 5.5 cm. It is essential that a timely diagnosis be made in this group of young patients.

  20. Interdisciplinary medical, nursing, and administrator education in practice: the Johns Hopkins experience.

    Science.gov (United States)

    Walrath, Jo M; Muganlinskaya, Nailya; Shepherd, Megan; Awad, Michael; Reuland, Charles; Makary, Martin A; Kravet, Steven

    2006-08-01

    Reforming graduate medical, nursing and health administrators' education to include the core competencies of interdisciplinary teamwork and quality improvement (QI) techniques is a key strategy to improve quality in hospital settings. Practicing clinicians are best positioned in these settings to understand systems issues and craft potential solutions. The authors describe how, in ten months during 2004 and 2005 the school of medicine, the school of nursing, and an administrative residency program, all at Johns Hopkins University, implemented and evaluated the Achieving Competency Today II Program (ACT II), a structured and interdisciplinary approach to learning QI that was piloted at various sites around the United States. Six teams of learners participated, each consisting of a medical, nursing, and administrative resident. The importance of interdisciplinary participation in planning QI projects, the value of the patient's perspective on systems issues, and the value of a system's perspective in crafting solutions to issues all proved to be valuable lessons. Challenges were encountered throughout the program, such as (1) participants' difficulties in balancing competing academic, personal and clinical responsibilities, (2) difficulties in achieving the intended goals of a broad curriculum, (3) barriers to openly discussing interdisciplinary team process and dynamics, and (4) the need to develop faculty expertise in systems thinking and QI. In spite of these challenges steps have been identified to further enhance and develop interdisciplinary education within this academic setting.

  1. Parents who hit and scream: interactive effects of verbal and severe physical aggression on clinic-referred adolescents' adjustment.

    Science.gov (United States)

    LeRoy, Michelle; Mahoney, Annette; Boxer, Paul; Gullan, Rebecca Lakin; Fang, Qijuan

    2014-05-01

    The goals of this study were first, to delineate the co-occurrence of parental severe physical aggression and verbal aggression toward clinic-referred adolescents, and second, to examine the interactive effects of parental severe physical aggression and verbal aggression on adolescent externalizing and internalizing behavior problems. This research involved 239 referrals of 11- to 18-year-old youth and their dual-parent families to a non-profit, private community mental health center in a semi-rural Midwest community. Multiple informants (i.e., adolescents and mothers) were used to assess parental aggression and adolescent behavior problems. More than half of clinic-referred adolescents (51%) experienced severe physical aggression and/or high verbal aggression from one or both parents. A pattern of interactive effects of mother-to-adolescent severe physical aggression and verbal aggression on adolescent behavior problems emerged, indicating that when severe physical aggression was present, mother-to-adolescent verbal aggression was positively associated with greater adolescent behavior problems whereas when severe physical aggression was not present, the links between verbal aggression and behavior problems was no longer significant. No interactive effects were found for father-to-adolescent severe physical aggression and verbal aggression on adolescent adjustment; however, higher father-to-adolescent verbal aggression was consistently linked to behavior problems above and beyond the influence of severe physical aggression. The results of this study should promote the practice of routinely assessing clinic-referred adolescents and their parents about their experiences of verbal aggression in addition to severe physical aggression and other forms of abuse. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. The relationships between father involvement and parental acceptance on the psychological adjustment of children and adolescents: The moderating effects of clinical status.

    Science.gov (United States)

    Rodríguez Ruiz, Mercedes; Holgado-Tello, Francisco Pablo; Carrasco, Miguel Ángel

    2017-10-01

    This study analyzes how a child's clinical condition modifies the relationship of father involvement, parental (fathers and mothers) acceptance and the child´s psychological adjustment, including the internalizing and externalizing problems. The cohort studied was composed of 226 subjects (61.94% males) with a mean age of 14.08 years, of which 113 children were from an incidental clinical sample and 113 from the general population. Both groups were matched by sex, age and family status, and the data show that the same structure of parent-child relationships that predict the child´s psychological adjustment can be accepted for both the clinical and non-clinical groups of children. However, the intensity of the relationships between the variables father involvement, parental acceptance and the child´s outcomes differed in function of the child's clinical status. Specifically, in the clinically-referred sample compared to non-clinical sample father involvement had a stronger effect on the children´s internalizing (but not the externalizing) problems and on their global psychological adjustment via their perceived maternal acceptance. The role of father involvement in the family relationships of clinical children is discussed. This study provides important evidence to support the need for enhanced paternal participation in the intervention programs for families. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Hindi translation and validation of Cambridge-Hopkins Diagnostic Questionnaire for RLS (CHRLSq).

    Science.gov (United States)

    Gupta, Ravi; Allan, Richard P; Pundeer, Ashwini; Das, Sourav; Dhyani, Mohan; Goel, Deepak

    2015-01-01

    Restless legs syndrome also known as Willis-Ekbom's Disease (RLS/WED) is a common illness. Cambridge-Hopkins diagnostic questionnaire for RLS (CHRLSq) is a good diagnostic tool and can be used in the epidemiological studies. However, its Hindi version is not available. Thus, this study was conducted to translate and validate it in the Hindi speaking population. After obtaining the permission from the author of the CHRLSq, it was translated into Hindi language by two independent translators. After a series of forward and back translations, the finalized Hindi version was administered to two groups by one of the authors, who were blinded to the clinical diagnosis. First group consisted of RLS/WED patients, where diagnosis was made upon face to face interview and the other group - the control group included subjects with somatic symptoms disorders or exertional myalgia or chronic insomnia. Each group had 30 subjects. Diagnosis made on CHRLSq was compared with the clinical diagnosis. Analysis was done using Statistical Package for Social Sciences (SPSS) v 21.0. Descriptive statistics was calculated. Proportions were compared using chi-square test; whereas, categorical variables were compared using independent sample t-test. Sensitivity, specificity, and positive predictive value of the translated version of questionnaire were calculated. Average age was comparable between the cases and control group (RLS/WED = 39.1 ± 10.1 years vs 36.2 ± 11.4 years in controls; P = 0.29). Women outnumbered men in the RLS/WED group (87% in RLS/WED group vs 57% among controls; χ(2) = 6.64; P = 0.01). Both the sensitivity and specificity of the translated version was 83.3%. It had the positive predictive value of 86.6%. Hindi version of CHRLSq has positive predictive value of 87% and it can be used to diagnose RLS in Hindi speaking population.

  4. Hindi translation and validation of Cambridge-Hopkins Diagnostic Questionnaire for RLS (CHRLSq

    Directory of Open Access Journals (Sweden)

    Ravi Gupta

    2015-01-01

    Full Text Available Background: Restless legs syndrome also known as Willis-Ekbom′s Disease (RLS/WED is a common illness. Cambridge-Hopkins diagnostic questionnaire for RLS (CHRLSq is a good diagnostic tool and can be used in the epidemiological studies. However, its Hindi version is not available. Thus, this study was conducted to translate and validate it in the Hindi speaking population. Materials and Methods: After obtaining the permission from the author of the CHRLSq, it was translated into Hindi language by two independent translators. After a series of forward and back translations, the finalized Hindi version was administered to two groups by one of the authors, who were blinded to the clinical diagnosis. First group consisted of RLS/WED patients, where diagnosis was made upon face to face interview and the other group - the control group included subjects with somatic symptoms disorders or exertional myalgia or chronic insomnia. Each group had 30 subjects. Diagnosis made on CHRLSq was compared with the clinical diagnosis. Statistical Analysis: Analysis was done using Statistical Package for Social Sciences (SPSS v 21.0. Descriptive statistics was calculated. Proportions were compared using chi-square test; whereas, categorical variables were compared using independent sample t-test. Sensitivity, specificity, and positive predictive value of the translated version of questionnaire were calculated. Results: Average age was comparable between the cases and control group (RLS/WED = 39.1 ± 10.1 years vs 36.2 ± 11.4 years in controls; P = 0.29. Women outnumbered men in the RLS/WED group (87% in RLS/WED group vs 57% among controls; χ2 = 6.64; P = 0.01. Both the sensitivity and specificity of the translated version was 83.3%. It had the positive predictive value of 86.6%. Conclusion: Hindi version of CHRLSq has positive predictive value of 87% and it can be used to diagnose RLS in Hindi speaking population.

  5. Cultivating Hygiene as a Science: The Welch-Rose Report's Influence at Johns Hopkins and Beyond.

    Science.gov (United States)

    Thomas, Karen Kruse

    2016-03-01

    In 1915, William Henry Welch and Wickliffe Rose submitted a report to the Rockefeller Foundation that became the template for public health professional education in the United States and abroad. Based on the Welch-Rose Report's recommendations, the Foundation awarded a grant to Johns Hopkins University in 1916 to establish the first independent graduate school of public health, with Welch serving as the founding dean. The Welch-Rose Report and, by extension, the Johns Hopkins School of Hygiene and Public Health established and transmitted a new model of scientific training that wove the laboratory mindset together with the methods of public health administration and epidemiologic fieldwork. During the School's first quarter-century, faculty and alumni were remarkably active in frontline public health problem-solving, as well as launching public health agencies and schools of all types and sizes. The most lasting contribution of the Welch-Rose Report and the Johns Hopkins School of Hygiene and Public Health, now the Johns Hopkins Bloomberg School of Public Health, has been to "cultivate the science of hygiene" to bring about exponential growth in the evidence base for public health. The schools that have adopted the Johns Hopkins model of public health education worldwide have produced professionals who have worked to achieve wide-ranging reforms dedicated to preserving life, protecting health, and preventing injury across populations and continents. © The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  6. The life, times, and health care of Harry L Hopkins: Presidential advisor and perpetual patient.

    Science.gov (United States)

    Pappas, Theodore N; Swanson, Sven

    2018-02-01

    Harry Hopkins was the most important nontitled allied leader in World War II. He was the advisor to President Roosevelt who managed the diplomacy between Roosevelt, Churchill, and Stalin from 1941 to 1946. Throughout these times, Hopkins was ill and required transfusions, admissions to the hospital, and nutritional supplementation to keep him well enough to travel the world and manage the allied war diplomacy. There has been no unifying theory to account for all his symptoms and his reported pathologic and autopsy findings. In this paper, we will review his political and medical history and a differential diagnosis of his illness.

  7. Risk adjustment models for interhospital comparison of CS rates using Robson's ten group classification system and other socio-demographic and clinical variables.

    Science.gov (United States)

    Colais, Paola; Fantini, Maria P; Fusco, Danilo; Carretta, Elisa; Stivanello, Elisa; Lenzi, Jacopo; Pieri, Giulia; Perucci, Carlo A

    2012-06-21

    Caesarean section (CS) rate is a quality of health care indicator frequently used at national and international level. The aim of this study was to assess whether adjustment for Robson's Ten Group Classification System (TGCS), and clinical and socio-demographic variables of the mother and the fetus is necessary for inter-hospital comparisons of CS rates. The study population includes 64,423 deliveries in Emilia-Romagna between January 1, 2003 and December 31, 2004, classified according to theTGCS. Poisson regression was used to estimate crude and adjusted hospital relative risks of CS compared to a reference category. Analyses were carried out in the overall population and separately according to the Robson groups (groups I, II, III, IV and V-X combined). Adjusted relative risks (RR) of CS were estimated using two risk-adjustment models; the first (M1) including the TGCS group as the only adjustment factor; the second (M2) including in addition demographic and clinical confounders identified using a stepwise selection procedure. Percentage variations between crude and adjusted RRs by hospital were calculated to evaluate the confounding effect of covariates. The percentage variations from crude to adjusted RR proved to be similar in M1 and M2 model. However, stratified analyses by Robson's classification groups showed that residual confounding for clinical and demographic variables was present in groups I (nulliparous, single, cephalic, ≥37 weeks, spontaneous labour) and III (multiparous, excluding previous CS, single, cephalic, ≥37 weeks, spontaneous labour) and IV (multiparous, excluding previous CS, single, cephalic, ≥37 weeks, induced or CS before labour) and to a minor extent in groups II (nulliparous, single, cephalic, ≥37 weeks, induced or CS before labour) and IV (multiparous, excluding previous CS, single, cephalic, ≥37 weeks, induced or CS before labour). The TGCS classification is useful for inter-hospital comparison of CS section rates, but

  8. Topography-modified refraction: adjustment of treated cylinder amount and axis to the topography versus standard clinical refraction in myopic topography-guided LASIK

    OpenAIRE

    Alpins, Noel

    2017-01-01

    Noel Alpins1,2 1NewVision Clinics, Melbourne, VIC, Australia; 2Department Ophthalmology, Melbourne University, Melbourne, VIC, Australia It is encouraging to see the results in the article by Kanellopoulos “Topography-modified refraction (TMR): adjustment of treated cylinder amount and axis to the topography versus standard clinical refraction in myopic topography-guided LASIK”,1 where the combination of refractive and corneal data in the treatment parameters pro...

  9. Hippocampal dose volume histogram predicts Hopkins Verbal Learning Test scores after brain irradiation

    Directory of Open Access Journals (Sweden)

    Catherine Okoukoni, PhD

    2017-10-01

    Full Text Available Purpose: Radiation-induced cognitive decline is relatively common after treatment for primary and metastatic brain tumors; however, identifying dosimetric parameters that are predictive of radiation-induced cognitive decline is difficult due to the heterogeneity of patient characteristics. The memory function is especially susceptible to radiation effects after treatment. The objective of this study is to correlate volumetric radiation doses received by critical neuroanatomic structures to post–radiation therapy (RT memory impairment. Methods and materials: Between 2008 and 2011, 53 patients with primary brain malignancies were treated with conventionally fractionated RT in prospectively accrued clinical trials performed at our institution. Dose-volume histogram analysis was performed for the hippocampus, parahippocampus, amygdala, and fusiform gyrus. Hopkins Verbal Learning Test-Revised scores were obtained at least 6 months after RT. Impairment was defined as an immediate recall score ≤15. For each anatomic region, serial regression was performed to correlate volume receiving a given dose (VD(Gy with memory impairment. Results: Hippocampal V53.4Gy to V60.9Gy significantly predicted post-RT memory impairment (P < .05. Within this range, the hippocampal V55Gy was the most significant predictor (P = .004. Hippocampal V55Gy of 0%, 25%, and 50% was associated with tumor-induced impairment rates of 14.9% (95% confidence interval [CI], 7.2%-28.7%, 45.9% (95% CI, 24.7%-68.6%, and 80.6% (95% CI, 39.2%-96.4%, respectively. Conclusions: The hippocampal V55Gy is a significant predictor for impairment, and a limiting dose below 55 Gy may minimize radiation-induced cognitive impairment.

  10. Johns Hopkins Bloomberg School of Public Health OpenCourseWare

    Science.gov (United States)

    Kanchanaraksa, Sukon; Gooding, Ira; Klaas, Brian; Yager, James D.

    2009-01-01

    The need for public health knowledge is ever increasing, but the educational options have been limited to coursework delivered by academics to individuals who can afford the cost of tuition at public health institutions. To overcome this disparity, Johns Hopkins Bloomberg School of Public Health (JHSPH) has joined the Massachusetts Institute of…

  11. Response of Dendroctonus mexicanus (Hopkins) to two optical isomers of verbenone

    Science.gov (United States)

    Vicente Diaz-Nunez; Guillermo Sanchez-Martinez; Nancy E. Gillette

    2006-01-01

    Given the need for diminishing the use of pesticides in natural environments, in this research we investigated the efficacy of two optical isomers of verbenone (4, 6, 6-trimethylbicyclo[3.1.1] hepto-3-en-e-1) as controls of the attack of Dendroctonus mexicanus (Hopkins) (Coleoptera: Curculionidae: Scolytinae).Two experiments were established in the...

  12. Paradigm Lost: Public Administration at Johns Hopkins University, 1884-96.

    Science.gov (United States)

    Hoffman, M. Curtis

    2002-01-01

    Discusses the history of public administration at Johns Hopkins University from the late 1800s when a curriculum was developed to educate public servants. Suggests that the program made notable contributions to progressivism but was eclipsed by scientific management; however, it has new relevance in the current climate. (Contains 46 references.)…

  13. Adjustable Gastric Band Surgery or Medical Management in Patients With Type 2 Diabetes: A Randomized Clinical Trial.

    Science.gov (United States)

    Ding, Su-Ann; Simonson, Donald C; Wewalka, Marlene; Halperin, Florencia; Foster, Kathleen; Goebel-Fabbri, Ann; Hamdy, Osama; Clancy, Kerri; Lautz, David; Vernon, Ashley; Goldfine, Allison B

    2015-07-01

    Recommendations for surgical, compared with lifestyle and pharmacologically based, approaches for type 2 diabetes (T2D) management remain controversial. The objective was to compare laparoscopic adjustable gastric band (LAGB) to an intensive medical diabetes and weight management (IMWM) program for T2D. This was designed as a prospective, randomized clinical trial. The setting was two Harvard Medical School-affiliated academic institutions. INTERVENTIONS AND PARTICIPANTS: A 12-month randomized trial comparing LAGB (n = 23) vs IMWM (n = 22) in persons aged 21-65 years with body mass index of 30-45 kg/m(2), T2D diagnosed more than 1 year earlier, and glycated hemoglobin (HbA(1c)) ≥ 6.5% on antihyperglycemic medication(s). The proportion meeting the prespecified primary glycemic endpoint, defined as HbA(1c) medication. After randomization, five participants did not undergo the surgical intervention. Of the 40 initiating intervention (22 males/18 females; age, 51 ± 10 y; body mass index, 36.5 ± 3.7 kg/m(2); diabetes duration, 9 ± 5 y; HbA(1c), 8.2 ± 1.2%; 40% on insulin), the proportion meeting the primary glycemic endpoint was achieved in 33% of the LAGB patients and 23% of the IMWM patients (P = .457). HbA(1c) reduction was similar between groups at both 3 and 12 months (-1.2 ± 0.3 vs -1.0 ± 0.3%; P = .496). Weight loss was similar at 3 months but greater 12 months after LAGB (-13.5 ± 1.7 vs -8.5 ± 1.6 kg; P = .027). Systolic blood pressure reduction was greater after IMWM than LAGB, whereas changes in diastolic blood pressure, lipids, fitness, and cardiovascular risk scores were similar between groups. Patient-reported health status, assessed using the Short Form-36, Impact of Weight on Quality of Life, and Problem Areas in Diabetes, all improved similarly between groups. LAGB and a multidisciplinary IMWM program have similar 1-year benefits on diabetes control, cardiometabolic risk, and patient satisfaction, which should be considered in the context of

  14. Convexity Adjustments

    DEFF Research Database (Denmark)

    M. Gaspar, Raquel; Murgoci, Agatha

    2010-01-01

    A convexity adjustment (or convexity correction) in fixed income markets arises when one uses prices of standard (plain vanilla) products plus an adjustment to price nonstandard products. We explain the basic and appealing idea behind the use of convexity adjustments and focus on the situations...

  15. Risk-adjustment models for heart failure patients' 30-day mortality and readmission rates: the incremental value of clinical data abstracted from medical charts beyond hospital discharge record.

    Science.gov (United States)

    Lenzi, Jacopo; Avaldi, Vera Maria; Hernandez-Boussard, Tina; Descovich, Carlo; Castaldini, Ilaria; Urbinati, Stefano; Di Pasquale, Giuseppe; Rucci, Paola; Fantini, Maria Pia

    2016-09-06

    Hospital discharge records (HDRs) are routinely used to assess outcomes of care and to compare hospital performance for heart failure. The advantages of using clinical data from medical charts to improve risk-adjustment models remain controversial. The aim of the present study was to evaluate the additional contribution of clinical variables to HDR-based 30-day mortality and readmission models in patients with heart failure. This retrospective observational study included all patients residing in the Local Healthcare Authority of Bologna (about 1 million inhabitants) who were discharged in 2012 from one of three hospitals in the area with a diagnosis of heart failure. For each study outcome, we compared the discrimination of the two risk-adjustment models (i.e., HDR-only model and HDR-clinical model) through the area under the ROC curve (AUC). A total of 1145 and 1025 patients were included in the mortality and readmission analyses, respectively. Adding clinical data significantly improved the discrimination of the mortality model (AUC = 0.84 vs. 0.73, p < 0.001), but not the discrimination of the readmission model (AUC = 0.65 vs. 0.63, p = 0.08). We identified clinical variables that significantly improved the discrimination of the HDR-only model for 30-day mortality following heart failure. By contrast, clinical variables made little contribution to the discrimination of the HDR-only model for 30-day readmission.

  16. A novel method to adjust efficacy estimates for uptake of other active treatments in long-term clinical trials.

    Directory of Open Access Journals (Sweden)

    John Simes

    2010-01-01

    Full Text Available When rates of uptake of other drugs differ between treatment arms in long-term trials, the true benefit or harm of the treatment may be underestimated. Methods to allow for such contamination have often been limited by failing to preserve the randomization comparisons. In the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD study, patients were randomized to fenofibrate or placebo, but during the trial many started additional drugs, particularly statins, more so in the placebo group. The effects of fenofibrate estimated by intention-to-treat were likely to have been attenuated. We aimed to quantify this effect and to develop a method for use in other long-term trials.We applied efficacies of statins and other cardiovascular drugs from meta-analyses of randomized trials to adjust the effect of fenofibrate in a penalized Cox model. We assumed that future cardiovascular disease events were reduced by an average of 24% by statins, and 20% by a first other major cardiovascular drug. We applied these estimates to each patient who took these drugs for the period they were on them. We also adjusted the analysis by the rate of discontinuing fenofibrate. Among 4,900 placebo patients, average statin use was 16% over five years. Among 4,895 assigned fenofibrate, statin use was 8% and nonuse of fenofibrate was 10%. In placebo patients, use of cardiovascular drugs was 1% to 3% higher. Before adjustment, fenofibrate was associated with an 11% reduction in coronary events (coronary heart disease death or myocardial infarction (P = 0.16 and an 11% reduction in cardiovascular disease events (P = 0.04. After adjustment, the effects of fenofibrate on coronary events and cardiovascular disease events were 16% (P = 0.06 and 15% (P = 0.008, respectively.This novel application of a penalized Cox model for adjustment of a trial estimate of treatment efficacy incorporates evidence-based estimates for other therapies, preserves comparisons between the

  17. Mind the Gap: Gaps in Antidepressant Treatment, Treatment Adjustments, and Outcomes among Patients in Routine HIV Care in a Multisite U.S. Clinical Cohort.

    Directory of Open Access Journals (Sweden)

    Rushina Cholera

    Full Text Available Depression affects 20-30% of HIV-infected patients and is associated with worse HIV outcomes. Although effective depression treatment is available, depression is largely untreated or undertreated in this population.We quantified gaps in antidepressant treatment, treatment adjustments, and outcomes among US patients in routine HIV care in the nationally distributed CNICS observational clinical cohort. This cohort combines detailed clinical data with regular, self-reported depressive severity assessments (Patient Health Questionnaire-9, PHQ-9. We considered whether participants with likely depression received antidepressants, whether participants on antidepressants with persistently high depressive symptoms received timely dose adjustments, and whether participants achieved depression remission. We considered a cross-sectional analysis (6,219 participants in care in 2011-2012 and a prospective analysis (2,936 participants newly initiating CNICS care when PHQ-9 screening was active.The cross-sectional sample was 87% male, 53% Caucasian, 25% African American, and 18% Hispanic; the prospective sample was similar. In both samples, 39-44% had likely depression, with 44-60% of those receiving antidepressants. Of participants receiving antidepressants, 20-26% experienced persistently high depressive symptoms; only a small minority of those received antidepressant dose adjustments. Overall, 35-40% of participants on antidepressants achieved full depression remission. Remission among participants with persistently high depressive symptoms was rare regardless of dose adjustments.In this large, diverse cohort of US patients engaged in routine HIV care, we observed large gaps in antidepressant treatment, timely dose adjustment to address persistently high depressive symptoms, and antidepressant treatment outcomes. These results highlight the importance of more effective pharmacologic depression treatment models for HIV-infected patients.

  18. Longitudinal Evaluation of Johns Hopkins Fall Risk Assessment Tool and Nurses' Experience.

    Science.gov (United States)

    Hur, Eun Young; Jin, Yinji; Jin, Taixian; Lee, Sun-Mi

    The Johns Hopkins Fall Risk Assessment Tool (JHFRAT) is relatively new in Korea, and it has not been fully evaluated. This study revealed that the JHFRAT had good predictive validity throughout the hospitalization period. However, 2 items (fall history and elimination patterns) on the tool were not determinants of falls in this population. Interestingly, the nurses indicated those 2 items were the most difficult items to assess and needed further training to develop the assessment skills.

  19. Academic Medical Centers Forming Accountable Care Organizations and Partnering With Community Providers: The Experience of the Johns Hopkins Medicine Alliance for Patients.

    Science.gov (United States)

    Berkowitz, Scott A; Ishii, Lisa; Schulz, John; Poffenroth, Matt

    2016-03-01

    Academic medical centers (AMCs)--which include teaching hospital(s) and additional care delivery entities--that form accountable care organizations (ACOs) must decide whether to partner with other provider entities, such as community practices. Indeed, 67% (33/49) of AMC ACOs through the Medicare Shared Savings Program through 2014 are believed to include an outside community practice. There are opportunities for both the AMC and the community partners in pursuing such relationships, including possible alignment around shared goals and adding ACO beneficiaries. To create the Johns Hopkins Medicine Alliance for Patients (JMAP), in January 2014, Johns Hopkins Medicine chose to partner with two community primary care groups and one cardiology practice to support clinical integration while adding approximately 60 providers and 5,000 Medicare beneficiaries. The principal initial interventions within JMAP included care coordination for high-risk beneficiaries and later, in 2014, generating dashboards of ACO quality measures to facilitate quality improvement and early efforts at incorporating clinical pathways and Choosing Wisely recommendations. Additional interventions began in 2015.The principal initial challenges JMAP faced were data integration, generation of quality measure reports among disparate electronic medical records, receiving and then analyzing claims data, and seeking to achieve provider engagement; all these affected timely deployment of the early interventions. JMAP also created three regional advisory councils as a forum promoting engagement of local leadership. Network strategies among AMCs, including adding community practices in a nonemployment model, will continue to require thoughtful strategic planning and a keen understanding of local context.

  20. Adjustment disorder with anxiety in old age: comparing prevalence and clinical management in primary care and mental health care.

    Science.gov (United States)

    Arbus, C; Hergueta, T; Duburcq, A; Saleh, A; Le Guern, M-E; Robert, P; Camus, V

    2014-05-01

    Adjustment disorder with anxiety (AjD-A) is a common cause of severe anxiety symptoms, but little is known about its prevalence in old age. This cross-sectional study examined the prevalence of AjD-A in outpatients over the age of 60 who consecutively consulted 34 general practitioners and 22 psychiatrists during a 2-week period. The diagnosis of AjD-A was obtained using the optional module for diagnostic of adjustment disorder of the Mini International Neuropsychiatric Interview (MINI). The study procedure also explored comorbid psychiatric conditions and documented recent past stressful life events, as well as social disability and current pharmacological and non-pharmacological management. Overall, 3651 consecutive subjects were screened (2937 in primary care and 714 in mental health care). The prevalence rate of AjD-A was 3.7% (n=136). Up to 39% (n=53) of AjD-A subjects had a comorbid psychiatric condition, mostly of the anxious type. The most frequently stressful life event reported to be associated with the onset of AjD-A was personal illness or health problem (29%). More than 50% of the AjD-A patients were markedly to extremely disabled by their symptoms. Compared to patients who consulted psychiatrists, patients who were seen by primary care physicians were older, had obtained lower scores at the Hamilton Anxiety Rating Scale, benefited less frequently from non-pharmacological management and received benzodiazepines more frequently. AjD-A appears to be a significantly disabling cause of anxiety symptoms in community dwelling elderly persons, in particular those presenting personal health related problems. Improvement of early diagnosis and non-pharmacological management of AjD-A would contribute to limit risks of benzodiazepine overuse, particularly in primary care settings. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  1. 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.

  2. [Effects in the adherence treatment and psychological adjustment after the disclosure of HIV/AIDS diagnosis with the "DIRE" clinical model in Colombian children under 17].

    Science.gov (United States)

    Trejos, Ana María; Reyes, Lizeth; Bahamon, Marly Johana; Alarcón, Yolima; Gaviria, Gladys

    2015-08-01

    A study in five Colombian cities in 2006, confirms the findings of other international studies: the majority of HIV-positive children not know their diagnosis, caregivers are reluctant to give this information because they believe that the news will cause emotional distress to the child becoming primary purpose of this study to validate a model of revelation. We implemented a clinical model, referred to as: "DIRE" that hypothetically had normalizing effects on psychological adjustment and adherence to antiretroviral treatment of HIV seropositive children, using a quasi-experimental design. Test were administered (questionnaire to assess patterns of disclosure and non-disclosure of the diagnosis of VIH/SIDA on children in health professionals and participants caregivers, Family Apgar, EuroQol EQ- 5D, MOS Social Support Survey Questionnaire Information treatment for VIH/SIDA and child Symptom Checklist CBCL/6-18 adapted to Latinos) before and after implementation of the model to 31 children (n: 31), 30 caregivers (n: 30) and 41 health professionals. Data processing was performed using the Statistical Package for the Social Science version 21 by applying parametric tests (Friedman) and nonparametric (t Student). No significant differences in adherence to treatment (p=0.392), in the psychological adjustment were found positive significant differences at follow-ups compared to baseline 2 weeks (p: 0.001), 3 months (p: 0.000) and 6 months (p: 0.000). The clinical model demonstrated effectiveness in normalizing of psychological adjustment and maintaining treatment compliance. The process also generated confidence in caregivers and health professionals in this difficult task.

  3. Osteopathic Manipulative Treatment Limits Chronic Constipation in a Child with Pitt-Hopkins Syndrome

    Directory of Open Access Journals (Sweden)

    Alessandro Aquino

    2017-01-01

    Full Text Available Pitt-Hopkins Syndrome (PTHS is a rare genetic disorder caused by insufficient expression of the TCF4 gene. Children with PTHS typically present with gastrointestinal disorders and early severe chronic constipation is frequently found (75%. Here we describe the case of a PTHS male 10-year-old patient with chronic constipation in whom Osteopathic Manipulative Treatment (OMT resulted in improved bowel functions, as assessed by the diary, the QPGS-Form A Section C questionnaire, and the Paediatric Bristol Stool Form Scale. The authors suggested that OMT may be a valid tool to improve the defecation frequency and reduce enema administration in PTHS patients.

  4. Johns Hopkins's first professorship in philosophy: a critical pivot point in the history of American psychology.

    Science.gov (United States)

    Green, Christopher D

    2007-01-01

    The first professorship in philosophy at Johns Hopkins University was contested in the early 1880s by two of the most prominent and influential scholars in America: Charles Sanders Peirce and George Sylvester Morris. A third figure also vied for the position, although he was much less well known at the time: Granville Stanley Hall. Through a series of unexpected circumstances, Hall ultimately won the professorship and then used it to leverage an extraordinary career that included his opening the first American research laboratory in psychology, establishing the American Journal of Psychology, becoming president of Clark University, founding the American Psychological Association, and profoundly affecting the character of developmental psychology in America.

  5. The UCD/FLWO extensive air shower array at Mt. Hopkins Arizona

    Science.gov (United States)

    Gillanders, G. H.; Fegan, D. J.; McKeown, P. K.; Weekes, T. C.

    The design and operation of an extensive air shower (EAS) array being installed around the 10-m optical Cerenkov reflector at F.L. Whipple Observatory on Mt. Hopkins for high-energy gamma-ray astronomy are described. The advantages of an EAS array colocated with a Cerenkov facility at a mountain location are reviewed; the arrangement of the 13 1-sq m scintillation detectors in the array is indicated; the signal-processing and data-acquisition procedures are explained; and preliminary calibration data indicating an effective energy threshold of 60 TeV are presented.

  6. Profiling medical school learning environments in Malaysia: a validation study of the Johns Hopkins Learning Environment Scale

    Directory of Open Access Journals (Sweden)

    Sean Tackett

    2015-07-01

    Full Text Available Purpose: While a strong learning environment is critical to medical student education, the assessment of medical school learning environments has confounded researchers. Our goal was to assess the validity and utility of the Johns Hopkins Learning Environment Scale (JHLES for preclinical students at three Malaysian medical schools with distinct educational and institutional models. Two schools were new international partnerships, and the third was school leaver program established without international partnership. Methods: First- and second-year students responded anonymously to surveys at the end of the academic year. The surveys included the JHLES, a 28-item survey using five-point Likert scale response options, the Dundee Ready Educational Environment Measure (DREEM, the most widely used method to assess learning environments internationally, a personal growth scale, and single-item global learning environment assessment variables. Results: The overall response rate was 369/429 (86%. After adjusting for the medical school year, gender, and ethnicity of the respondents, the JHLES detected differences across institutions in four out of seven domains (57%, with each school having a unique domain profile. The DREEM detected differences in one out of five categories (20%. The JHLES was more strongly correlated than the DREEM to two thirds of the single-item variables and the personal growth scale. The JHLES showed high internal reliability for the total score (α=0.92 and the seven domains (α, 0.56-0.85. Conclusion: The JHLES detected variation between learning environment domains across three educational settings, thereby creating unique learning environment profiles. Interpretation of these profiles may allow schools to understand how they are currently supporting trainees and identify areas needing attention.

  7. Asymmetric adjustment

    NARCIS (Netherlands)

    2010-01-01

    A method of adjusting a signal processing parameter for a first hearing aid and a second hearing aid forming parts of a binaural hearing aid system to be worn by a user is provided. The binaural hearing aid system comprises a user specific model representing a desired asymmetry between a first ear

  8. End-of-treatment and serial PET imaging in primary mediastinal B-cell lymphoma following dose-adjusted-EPOCH-R: A paradigm shift in clinical decision making.

    Science.gov (United States)

    Melani, Christopher; Advani, Ranjana; Roschewski, Mark; Walters, Kelsey M; Chen, Clara C; Baratto, Lucia; Ahlman, Mark A; Miljkovic, Milos D; Steinberg, Seth M; Lam, Jessica; Shovlin, Margaret; Dunleavy, Kieron; Pittaluga, Stefania; Jaffe, Elaine S; Wilson, Wyndham H

    2018-05-10

    Dose-adjusted-EPOCH-R obviates the need for radiotherapy in most patients with primary mediastinal B-cell lymphoma. End-of-treatment PET, however, does not accurately identify patients at risk of treatment failure, thereby confounding clinical decision making. To define the role of PET in primary mediastinal B-cell lymphoma following dose-adjusted-EPOCH-R, we extended enrollment and follow-up on our published phase II trial and independent series. Ninety-three patients received dose-adjusted-EPOCH-R without radiotherapy. End-of-treatment PET was performed in 80 patients, of whom 57 received 144 serial scans. One nuclear medicine physician from each institution blindly reviewed all scans from their respective institution. End-of-treatment PET was negative (Deauville 1-3) in 55 (69%) patients with one treatment failure (8-year event-free and overall survival of 96.0% and 97.7%). Among 25 (31%) patients with a positive (Deauville 4-5) end-of-treatment PET, there were 5 (20%) treatment failures (8-year event-free and overall survival of 71.1% and 84.3%). Linear regression analysis of serial scans showed a significant decrease in SUVmax in positive end-of-treatment PET non-progressors compared to an increase in treatment failures. Among 6 treatment failures, the median end-of-treatment SUVmax was 15.4 (range, 1.9-21.3) and 4 achieved long-term remission with salvage therapy. Virtually all patients with a negative end-of-treatment PET following dose-adjusted-EPOCH-R achieved durable remissions and should not receive radiotherapy. Among patients with a positive end-of-treatment PET, only 5/25 (20%) had treatment-failure. Serial PET imaging distinguished end-of-treatment PET positive patients without treatment failure, thereby reducing unnecessary radiotherapy by 80%, and should be considered in all patients with an initial positive PET following dose-adjusted-EPOCH-R (NCT00001337). Copyright © 2018, Ferrata Storti Foundation.

  9. Relief from Back Pain Through Postural Adjustment: a Controlled Clinical Trial of the Immediate Effects of Muscular Chains Therapy (MCT).

    Science.gov (United States)

    Rosario, Jose L

    2014-09-01

    Back pain can be one of the most common health problems, causing suffering, disabilities, and financial losses. Postural models for pain treatment state that poor posture alters the joint position and causes pain, such as back pain. Muscular Chain Therapy (MCT) is a technique that is used to treat posture pathologies, among others. The aim of the present study was to assess the efficiency of a single session of Muscular Chain Therapy (MCT) on complaints of undiagnosed musculoskeletal spinal pain. Physical therapy clinic of the University of Center-West (Guarapuava, Brazil). 100 subjects, aged between 20 and 39 years, with complaints of spinal musculoskeletal pain. Randomized controlled trial. The participants were randomly assigned by a non-care provider into two groups: The MCT Group that received Muscular Chain Treatment and the Control Group that received a placebo treatment of 15 minutes turned off ultrasound therapy. All volunteers were assessed before and after treatment using an analog pain scale. A score of 0 indicated no pain and 10 was the maximum degree of pain on the scale. Degree of pain measured by analog scale. The chi-square goodness of fit test was used to compare gender distribution among groups displayed a p value = .25. Subject age had differences analyzed using the unpaired t test (p = .44). Pain assessment for treatment and placebo control groups was analyzed using a paired t test and unpaired t test. The paired t test was used for intragroup before/after treatment comparison (MCT p = .00001; Control Group p = .0001). The unpaired t test was used for comparing the difference of the pain level before and after treatment between groups (p = .0001). A priori statistical significance was set a p = .05. It is possible to conclude that one MCT session is an effective treatment of undiagnosed spinal musculoskeletal pain.

  10. Implementation and evaluation of the Johns Hopkins University School of Medicine leadership program for women faculty.

    Science.gov (United States)

    Levine, Rachel B; González-Fernández, Marlís; Bodurtha, Joann; Skarupski, Kimberly A; Fivush, Barbara

    2015-05-01

    Women continue to be underrepresented in top leadership roles in academic medicine. Leadership training programs for women are designed to enhance women's leadership skills and confidence and increase overall leadership diversity. The authors present a description and evaluation of a longitudinal, cohort-based, experiential leadership program for women faculty at the Johns Hopkins University School of Medicine. We compared pre- and post-program self-assessed ratings of 11 leadership skills and specific negotiation behaviors from 3 cohorts of leadership program participants (n=134) from 2010 to 2013. Women reported significant improvements in skills across 11 domains with the exceptions of 2 domains, Public Speaking and Working in Teams, both of which received high scores in the pre-program assessment. The greatest improvement in rankings occurred within the domain of negotiation skills. Although women reported an increase in their negotiation skills, we were not able to demonstrate an increase in the number of times that women negotiated for salary, space, or promotion following participation in the program. The Johns Hopkins School of Medicine Leadership Program for Women Faculty has demonstrable value for the professional development of participants and addresses institutional strategies to enhance leadership diversity and the advancement of women.

  11. Salary adjustments

    CERN Multimedia

    HR Department

    2008-01-01

    In accordance with decisions taken by the Finance Committee and Council in December 2007, salaries are adjusted with effect from 1 January 2008. Scale of basic salaries and scale of stipends paid to fellows (Annex R A 5 and R A 6 respectively): increased by 0.71% with effect from 1 January 2008. As a result of the stability of the Geneva consumer price index, following elements do not increase: a) Family Allowance, Child Allowance and Infant Allowance (Annex R A 3). b) Reimbursement of education fees: maximum amounts of reimbursement (Annex R A 4.01) for the academic year 2007/2008. Related adjustments will be implemented, wherever applicable, to Paid Associates and Students. As in the past, the actual percentage increase of each salary position may vary, due to the application of a constant step value and the rounding effects. Human Resources Department Tel. 73566

  12. Salary adjustments

    CERN Multimedia

    HR Department

    2008-01-01

    In accordance with decisions taken by the Finance Committee and Council in December 2007, salaries are adjusted with effect from 1 January 2008. Scale of basic salaries and scale of stipends paid to fellows (Annex R A 5 and R A 6 respectively): increased by 0.71% with effect from 1 January 2008. As a result of the stability of the Geneva consumer price index, the following elements do not increase: a)\tFamily Allowance, Child Allowance and Infant Allowance (Annex R A 3); b)\tReimbursement of education fees: maximum amounts of reimbursement (Annex R A 4.01) for the academic year 2007/2008. Related adjustments will be applied, wherever applicable, to Paid Associates and Students. As in the past, the actual percentage increase of each salary position may vary, due to the application of a constant step value and rounding effects. Human Resources Department Tel. 73566

  13. Shaft adjuster

    Science.gov (United States)

    Harry, Herbert H.

    1989-01-01

    Apparatus and method for the adjustment and alignment of shafts in high power devices. A plurality of adjacent rotatable angled cylinders are positioned between a base and the shaft to be aligned which when rotated introduce an axial offset. The apparatus is electrically conductive and constructed of a structurally rigid material. The angled cylinders allow the shaft such as the center conductor in a pulse line machine to be offset in any desired alignment position within the range of the apparatus.

  14. Adjustable collimator

    International Nuclear Information System (INIS)

    Carlson, R.W.; Covic, J.; Leininger, G.

    1981-01-01

    In a rotating fan beam tomographic scanner there is included an adjustable collimator and shutter assembly. The assembly includes a fan angle collimation cylinder having a plurality of different length slots through which the beam may pass for adjusting the fan angle of the beam. It also includes a beam thickness cylinder having a plurality of slots of different widths for adjusting the thickness of the beam. Further, some of the slots have filter materials mounted therein so that the operator may select from a plurality of filters. Also disclosed is a servo motor system which allows the operator to select the desired fan angle, beam thickness and filter from a remote location. An additional feature is a failsafe shutter assembly which includes a spring biased shutter cylinder mounted in the collimation cylinders. The servo motor control circuit checks several system conditions before the shutter is rendered openable. Further, the circuit cuts off the radiation if the shutter fails to open or close properly. A still further feature is a reference radiation intensity monitor which includes a tuning-fork shaped light conducting element having a scintillation crystal mounted on each tine. The monitor is placed adjacent the collimator between it and the source with the pair of crystals to either side of the fan beam

  15. Meant to make a difference, the clinical experience of minimally invasive endodontics with the self-adjusting file system in India.

    Science.gov (United States)

    Pawar, Ajinkya M; Pawar, Mansing G; Kokate, Sharad R

    2014-01-01

    The vital steps in any endodontic treatment are thorough mechanical shaping and chemical cleaning followed by obtaining a fluid tight impervious seal by an inert obturating material. For the past two decades, introduction and use of rotary nickel-titanium (Ni-Ti) files have changed our concepts of endodontic treatment from conventional to contemporary. They have reported good success rates, but still have many drawbacks. The Self-Adjusting File (SAF) introduces a new era in endodontics by performing the vital steps of shaping and cleaning simultaneously. The SAF is a hollow file in design that adapts itself three-dimensionally to the root canal and is a single file system, made up of Ni-Ti lattice. The case series presented in the paper report the clinical experience, while treating primary endodontic cases with the SAF system in India.

  16. Meant to make a difference, the clinical experience of minimally invasive endodontics with the self-adjusting file system in India

    Directory of Open Access Journals (Sweden)

    Ajinkya M Pawar

    2014-01-01

    Full Text Available The vital steps in any endodontic treatment are thorough mechanical shaping and chemical cleaning followed by obtaining a fluid tight impervious seal by an inert obturating material. For the past two decades, introduction and use of rotary nickel-titanium (Ni-Ti files have changed our concepts of endodontic treatment from conventional to contemporary. They have reported good success rates, but still have many drawbacks. The Self-Adjusting File (SAF introduces a new era in endodontics by performing the vital steps of shaping and cleaning simultaneously. The SAF is a hollow file in design that adapts itself three-dimensionally to the root canal and is a single file system, made up of Ni-Ti lattice. The case series presented in the paper report the clinical experience, while treating primary endodontic cases with the SAF system in India.

  17. Establishment of age- and sex-adjusted reference data for hand bone mass and investigation of hand bone loss in patients with rheumatoid arthritis treated in clinical practice

    DEFF Research Database (Denmark)

    Ørnbjerg, Lykke Midtbøll; Østergaard, Mikkel; Jensen, Trine

    2016-01-01

    remission (0.0032 vs. 0.0058 g/cm(2)/year; p clinical practice, and only......BACKGROUND: Rheumatoid arthritis is characterised by progressive joint destruction and loss of periarticular bone mass. Hand bone loss (HBL) has therefore been proposed as an outcome measure for treatment efficacy. A definition of increased HBL adjusted for age- and sex-related bone loss is lacking....... In this study, we aimed to: 1) establish reference values for normal hand bone mass (bone mineral density measured by digital x-ray radiogrammetry (DXR-BMD)); and 2) examine whether HBL is normalised in rheumatoid arthritis patients during treatment with tumour necrosis factor alpha inhibitors (TNFI). METHODS...

  18. The Johns Hopkins Bloomberg School of Public Health: A Brief History of a Century of Epidemiologic Discovery.

    Science.gov (United States)

    Sommer, Alfred

    2016-03-01

    During its first century, the Johns Hopkins University Bloomberg School of Public Health has been home to several faculty members who have played leading roles in defining and expanding the field and science of epidemiology. They have done so by training leaders in the field, creating new methods and applications, and making relevant discoveries in the worlds of infectious and chronic diseases. These methodologic innovations and discoveries underlie many of today's major health policies and practices. © The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  19. Topography-modified refraction (TMR): adjustment of treated cylinder amount and axis to the topography versus standard clinical refraction in myopic topography-guided LASIK.

    Science.gov (United States)

    Kanellopoulos, Anastasios John

    2016-01-01

    To evaluate the safety, efficacy, and contralateral eye comparison of topography-guided myopic LASIK with two different refraction treatment strategies. Private clinical ophthalmology practice. A total of 100 eyes (50 patients) in consecutive cases of myopic topography-guided LASIK procedures with the same refractive platform (FS200 femtosecond and EX500 excimer lasers) were randomized for treatment as follows: one eye with the standard clinical refraction (group A) and the contralateral eye with the topographic astigmatic power and axis (topography-modified treatment refraction; group B). All cases were evaluated pre- and post-operatively for the following parameters: refractive error, best corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), topography (Placido-disk based) and tomography (Scheimpflug-image based), wavefront analysis, pupillometry, and contrast sensitivity. Follow-up visits were conducted for at least 12 months. Mean refractive error was -5.5 D of myopia and -1.75 D of astigmatism. In group A versus group B, respectively, the average UDVA improved from 20/200 to 20/20 versus 20/16; post-operative CDVA was 20/20 and 20/13.5; 1 line of vision gained was 27.8% and 55.6%; and 2 lines of vision gained was 5.6% and 11.1%. In group A, 27.8% of eyes had over -0.50 diopters of residual refractive astigmatism, in comparison to 11.7% in group B ( P Topography-modified refraction (TMR): topographic adjustment of the amount and axis of astigmatism treated, when different from the clinical refraction, may offer superior outcomes in topography-guided myopic LASIK. These findings may change the current clinical paradigm of the optimal subjective refraction utilized in laser vision correction.

  20. Obtaining the mean relative weights of the cost of care in Catalonia (Spain): retrospective application of the adjusted clinical groups case-mix system in primary health care.

    Science.gov (United States)

    Sicras-Mainar, Antoni; Velasco-Velasco, Soledad; Navarro-Artieda, Ruth; Aguado Jodar, Alba; Plana-Ripoll, Oleguer; Hermosilla-Pérez, Eduardo; Bolibar-Ribas, Bonaventura; Prados-Torres, Alejandra; Violan-Fors, Concepción

    2013-04-01

    The study aims to obtain the mean relative weights (MRWs) of the cost of care through the retrospective application of the adjusted clinical groups (ACGs) in several primary health care (PHC) centres in Catalonia (Spain) in routine clinical practice. This is a retrospective study based on computerized medical records. All patients attended by 13 PHC teams in 2008 were included. The principle measurements were: demographic variables (age and sex), dependent variables (number of diagnoses and total costs), and case-mix or co-morbidity variables (International Classification of Primary Care). The costs model for each patient was established by differentiating the fix costs from the variable costs. In the bivariate analysis, the Student's t, analysis of variance, chi-squared, Pearson's linear correlation and Mann-Whitney-Wilcoxon tests were used. In order to compare the MRW of the present study with those of the United States (US), the concordance [intraclass correlation coefficient (ICC) and concordance correlation coefficient (CCC)] and the correlation (coefficient of determination: R²) were measured. The total number of patients studied was 227,235, and the frequentation was 5.9 visits/habitant/year) and with a mean diagnoses number of 4.5 (3.2). The distribution of costs was €148.7 million, of which 29.1% were fixed costs. The mean total cost per patient/year was €654.2 (851.7), which was considered to be the reference MRW. Relationship between study-MRW and US-MRW: ICC was 0.40 [confidential interval (CI) 95%: 0.21-0.60] and the CCC was 0.42 (CI 95%: 0.35-0.49). The correlation between the US MRW and the MRW of the present study can be seen; the adjusted R² value is 0.691. The explanatory power of the ACG classification was 36.9% for the total costs. The R² of the total cost without considering outliers was 56.9%. The methodology has been shown appropriate for promoting the calculation of the MRW for each category of the classification. The results provide

  1. Psychometric validation of the Hopkins Symptom Checklist (SCL-90) subscales for depression, anxiety, and interpersonal sensitivity

    DEFF Research Database (Denmark)

    Bech, P; Bille, J; Møller, S B

    2014-01-01

    BACKGROUND: The psychometric validity of many subscales of the 90-item Hopkins Symptom Checklist (SCL-90) remains largely unknown. Therefore, the aim of the present study was to evaluate the psychometric properties of the "Hamilton-subscales" for depression (SCL-D16), anxiety (SCL-A14), their 6......-item core-measures (SCL-D6 and SCL-A6), the anxiety symptom scale (SCL-ASS8) and the interpersonal sensitivity scale (IPS5). METHODS: The psychometric properties of the SCL-D16, SCL-A14, SCL-D6, SCL-A6, SCL-ASS8, and the IPS5 were evaluated based on SCL-90 ratings from 850 day patients from a Danish...... SCL-90 subscales were identified. Using these scales it is possible to perform a psychometrically valid evaluation of psychiatric patients regarding the severity of depression (HAM-D6), specific anxiety (SCL-ASS8) and interpersonal sensitivity (IPS5)....

  2. Test of the decaying dark matter hypothesis using the Hopkins Ultraviolet Telescope

    Science.gov (United States)

    Davidsen, A. F.; Kriss, G. A.; Ferguson, H. C.; Blair, W. P.; Bowers, C. W.; Kimble, R. A.

    1991-01-01

    Sciama's hypothesis that the dark matter associated with galaxies, galaxy clusters, and the intergalactic medium consists of tau neutrinos of rest mass 28-30 eV whose decay generates ultraviolet photons of energy roughly 14-15 eV, has been tested using the Hopkins Ultraviolet Telescope flows aboard the Space Shuttle Columbia. A straightforward application of Sciama's model predicts that a spectral line from neutrino decay photons should be observed from the rich galaxy cluster Abell 665 with an SNR of about 30. No such emission was detected. For neutrinos in the mass range 27.2-32.1 eV, the observations set a lower lifetime limit significantly greater than Sciama's model requires.

  3. Energy Programs at the Johns Hopkins University Applied Physics Laboratory, Quarterly Report, October-December 1980

    Energy Technology Data Exchange (ETDEWEB)

    None

    1980-12-01

    The Johns Hopkins University Applied Physics Laboratory is engaged in developing energy resources, utilization concepts, and monitoring and storage methods. This Quarterly Report summarizes the work on the various tasks as of 31 December 1980. The Energy Quarterly Report is divided into five sections. The first, Geothermal Energy Development Planning and Technical Assistance, supported by the Department of Energy/Division of Geothermal Energy (DOE/DGE), contains reports on the progress of geothermal-related tasks on which effort was concentrated during the quarter. The second section, Operational Research, Hydroelectric Power Development, supported by the Department of Energy/Resource Applications (DOE/RA), contains a report on institutional problems for small-scale hydroelectric power development in the southeastern states and a list of documents published by APL in the hydroelectric program and in the geothermal program, above. The third section, Seismotectonic Investigations, contains an article on work on the geologic structure of the Danbury Quadrangle that is supported by the Reactor Safety Research Division of the Nuclear Regulatory Commission (NRC) and an in-house supported study on a new method for assessing earthquakes in intraplate regions. The fourth section, Energy Conversion and Storage Techniques, contains four articles. The first is an evaluation of the Einstein refrigerator, supported by independent IR and D funds. The second concerns fly-wheel technology development at APL supported by the Department of Energy, Division of Energy Storage (DOE/STOR). The third is a report on APL energy conservation efforts at its own buildings, and the fourth is an article on liquefied natural gas (LNG) safety evaluation, supported by the National Academy of Sciences. The fifth section explores the value of establishing an Energy Research Institute at The Johns Hopkins University.

  4. Explaining prescription drug use and expenditures using the adjusted clinical groups case-mix system in the population of British Columbia, Canada.

    Science.gov (United States)

    Hanley, Gillian E; Morgan, Steve; Reid, Robert J

    2010-05-01

    Given that prescription drugs have become a major financial component of health care, there is an increased need to explain variations in the use of and expenditure on medicines. Case-mix systems built from existing administrative datasets may prove very useful for such prediction. We estimated the concurrent and prospective predictive validity of the adjusted clinical groups (ACG) system in pharmaceutical research and compared the ACG system with the Charlson index of comorbidity. We ran a generalized linear models to examine the predictive validity of the ACG system and the Charlson index and report the correlation between the predicted and observed expenditures. We reported mean predictive ratios across medical condition and cost-defined groups. When predicting use of medicines, we used C-statistics to summarize the area under the receiver operating characteristic curve. The 3,908,533 British Columbia residents who were registered for the universal health care plan for 275+ days in the calendar years 2004 and 2005. Outcomes were total pharmaceutical expenditures, use of any medicines, and use of medicines from 4+ different therapeutic categories. The ACG case mix system predicted drug expenditures better than the Charlson index. The mean predictive ratios for the ACG system models were all within 4% of the actual costs when examining medical condition group and the C-stats for the 2 dichotomous outcomes were between 0.82 and 0.89. ACG case-mix adjusters are a valuable predictor of pharmaceutical use and expenditures with much higher predictive power than age, sex, and the Charlson index of comorbidity.

  5. Premorbid functioning of patients with first-episode nonaffective psychosis: a comparison of deterioration in academic and social performance, and clinical correlates of Premorbid Adjustment Scale scores.

    Science.gov (United States)

    Monte, Ralph C; Goulding, Sandra M; Compton, Michael T

    2008-09-01

    Motivated by a previous study among male veterans [Allen, D.N., Frantom, L.V., Strauss, G.P., van Kammen, D.P., 2005. Differential patterns of premorbid academic and social deterioration in patients with schizophrenia. Schizophr. Res. 75, 389-397], the present analysis examined: (1) patterns of premorbid academic and social functioning during childhood, early adolescence, and late adolescence, and (2) associations between these premorbid functioning dimensions and a number of clinical variables. Data on premorbid functioning were collected using the Premorbid Adjustment Scale (PAS) in 95 hospitalized first-episode patients. Analyses were similar to those conducted by Allen and colleagues (2005). Deterioration was evident in both academic and social functioning from childhood to early adolescence, along with a pronounced/accelerated deterioration in academic functioning from early adolescence to late adolescence, occurring in both male and female patients. Age at onset of prodromal symptoms was predicted by childhood/early adolescent/late adolescent academic functioning scores, and age at onset of psychotic symptoms was significantly associated only with childhood academic functioning. Severity of negative symptoms was predicted by childhood and late adolescent social functioning scores, and severity of general psychopathology symptoms was predicted by late adolescent academic functioning, as well as childhood and late adolescent social functioning scores. Consistent with prior findings, deterioration in premorbid functioning appears to be more pronounced in the academic than social dimension of the PAS. Some PAS scores are predictive of ages at onset of prodrome/psychosis and severity of psychotic symptoms. Ongoing research on premorbid adjustment in schizophrenia may have implications for future prevention goals.

  6. Fixed-pressure CPAP versus auto-adjusting CPAP: comparison of efficacy on blood pressure in obstructive sleep apnoea, a randomised clinical trial.

    Science.gov (United States)

    Pépin, J L; Tamisier, R; Baguet, J P; Lepaulle, B; Arbib, F; Arnol, N; Timsit, J F; Lévy, P

    2016-08-01

    Millions of individuals with obstructive sleep apnoea (OSA) are treated by CPAP aimed at reducing blood pressure (BP) and thus cardiovascular risk. However, evidence is scarce concerning the impact of different CPAP modalities on BP evolution. This double-blind, randomised clinical trial of parallel groups of patients with OSA indicated for CPAP treatment compared the efficacy of fixed-pressure CPAP (FP-CPAP) with auto-adjusting CPAP (AutoCPAP) in reducing BP. The primary endpoint was the change in office systolic BP after 4 months. Secondary endpoints included 24 h BP measurements. Patients (322) were randomised to FP-CPAP (n=161) or AutoCPAP (n=161). The mean apnoea+hypopnoea index (AHI) was 43/h (SD, 21); mean age was 57 (SD, 11), with 70% of males; mean body mass index was 31.3 kg/m(2) (SD, 6.6) and median device use was 5.1 h/night. In the intention-to-treat analysis, office systolic blood pressure decreased by 2.2 mm Hg (95% CI -5.8 to 1.4) and 0.4 mm Hg (-4.3 to 3.4) in the FP-CPAP and AutoCPAP group, respectively (group difference: -1.3 mm Hg (95% CI -4.1 to 1.5); p=0.37, adjusted for baseline BP values). 24 h diastolic BP (DBP) decreased by 1.7 mm Hg (95% CI -3.9 to 0.5) and 0.5 mm Hg (95% CI -2.3 to 1.3) in the FP-CPAP and AutoCPAP group, respectively (group difference: -1.4 mm Hg (95% CI -2.7 to -0.01); p=0.048, adjusted for baseline BP values). The result was negative regarding the primary outcome of office BP, while FP-CPAP was more effective in reducing 24 h DBP (a secondary outcome). NCT01090297. 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/

  7. Protecting Health and Saving Lives: The Part-Time/Internet-Based Master of Public Health Program at the Johns Hopkins Bloomberg School of Public Health

    Science.gov (United States)

    Bruce, Linda; Gresh, Kathy; Vanchiswaran, Rohini; Werapitiya, Deepthi

    2007-01-01

    This article discusses the part-time/Internet-based Master of Public Health (MPH) program at the Johns Hopkins Bloomberg School of Public Health (JHSPH). The Johns Hopkins Bloomberg School of Public Health was the first school of public health in the United States to offer a Master of Public Health program via the Internet. The JHSPH MPH Program…

  8. Isolation and characterization of 16 microsatellite loci in the mountain pine beetle, Dendroctonus ponderosae Hopkins (Coleoptera: Curculionidae: Scolytinae)

    Science.gov (United States)

    C. S. Davis; K. E. Mock; B. J. Bentz; S. M. Bromilow; N. V. Bartell; B. W. Murray; A. D. Roe; J. E. K. Cooke

    2009-01-01

    We isolated 16 polymorphic microsatellite loci in the mountain pine beetle (Dendroctonus ponderosae Hopkins) and developed conditions for amplifying these markers in four multiplex reactions. Three to 14 alleles were detected per locus across two sampled populations. Observed and expected heterozygosities ranged from 0.000 to 0.902 and from 0.100 to 0.830, respectively...

  9. Flight periodicity of the Douglas-fir beetle, Dendroctonus pseudotsugae Hopkins (Coleoptera: Curculionidae: Scolytinae) in Colorado, U.S.A

    Science.gov (United States)

    Jose F. Negron; Willis C. Schaupp; Lee Pederson

    2011-01-01

    There are about 500 species of bark beetles (Coleoptera: Curculionidae: Scolytinae) in the United States (Wood 1982). A number of them are important disturbance agents in forested ecosystems, occasionally creating large tracts of dead trees. One eruptive species is the Douglas-fir beetle, Dendroctonus pseudotsugae Hopkins, which utilizes Douglas-fir, Pseudotsuga...

  10. Phenotype and natural history in 101 individuals with Pitt-Hopkins syndrome through an internet questionnaire system

    NARCIS (Netherlands)

    de Winter, Channa F.; Baas, Melanie; Bijlsma, Emilia K.; van Heukelingen, John; Routledge, Sue; Hennekam, Raoul C. M.

    2016-01-01

    Pitt-Hopkins syndrome (PTHS; MIM# 610954) is a genetically determined entity mainly caused by mutations in TransCription Factor 4 (TCF4). We have developed a new way to collect information on (ultra-)rare disorders through a web-based database which we call 'waihonapedia' (waihona [meaning treasure

  11. Sellar door: Harvey Cushing's entry into the pituitary gland, the unabridged Johns Hopkins experience 1896-1912.

    Science.gov (United States)

    Pendleton, Courtney; Adams, Hadie; Mathioudakis, Nestoras; Quiñones-Hinojosa, Alfredo

    2013-02-01

    To review the original surgical records from the Johns Hopkins Hospital, and analyze the records of patients Cushing treated for pituitary disorders from 1896 to 1912. Following IRB approval, and through the courtesy of the Alan Mason Chesney Archives, we reviewed the original surgical files from the Johns Hopkins Hospital. Patients presenting with pituitary-related symptoms, who underwent surgical treatment directed at the pituitary gland, were selected for further review. Thirty-seven patients who underwent surgical intervention for pituitary disorders were found. Of these patients, 12 were mentioned only briefly in Cushing's 1912 monograph, whereas 6 were not described at all. The remaining 19 were documented by Cushing in his 1912 monograph. Cushing used three main surgical approaches to the pituitary: transsphenoidal, transcranial, and the subfrontal "omega incision." There were 6 inpatient deaths. The mean time to last follow-up was 41.0 months. At follow-up, headache was the most common unresolved symptom. This review highlights Cushing's accomplishments in the surgical treatment of suspected pituitary pathology during his early career as a young attending at Johns Hopkins Hospital. It reveals new information about patients whom Cushing did not include in his publications detailing his surgical experience at the Johns Hopkins Hospital. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. On the shoulders of giants: Harvey Cushing's experience with acromegaly and gigantism at the Johns Hopkins Hospital, 1896-1912.

    NARCIS (Netherlands)

    Pendleton, C.; Adams, H.; Salvatori, R.; Wand, G.; Quinones-Hinojosa, A.

    2011-01-01

    A review of Dr. Cushing's surgical cases at Johns Hopkins Hospital revealed new information about his early operative experience with acromegaly. Although in 1912 Cushing published selective case studies regarding this work, a review of all his operations for acromegaly during his early years has

  13. Fellowship training at John Hopkins: programs leading to careers in librarianship and informatics as informaticians or informationists.

    Science.gov (United States)

    Campbell, Jayne M; Roderer, Nancy K

    2005-01-01

    Preparing librarians to meet the information challenges faced in the current and future health care environments is critical. At Johns Hopkins University, three NLM-funded fellowship programs provide opportunities for librarians to utilize the rich environments of the Welch Medical Library and the Division of Health Sciences Informatics in support of life-long learning.

  14. Adaptive capacity of the Adjusted Clinical Groups Case-Mix System to the cost of primary healthcare in Catalonia (Spain): a observational study.

    Science.gov (United States)

    Sicras-Mainar, Antoni; Velasco-Velasco, Soledad; Navarro-Artieda, Ruth; Prados-Torres, Alexandra; Bolibar-Ribas, Buenaventura; Violan-Fors, Concepción

    2012-01-01

    To describe the adaptive capacity of the Adjusted Clinical Groups (ACG) system to the cost of care in primary healthcare centres in Catalonia (Spain). Retrospective study (multicentres) conducted using computerised medical records. 13 primary care teams in 2008 were included. All patients registered in the study centres who required care between 1 January and 31 December 2008 were finally studied. Patients not registered in the study centres during the study period were excluded. Demographic (age and sex), dependent (cost of care) and case-mix variables were studied. The cost model for each patient was established by differentiating the fixed and variable costs. To evaluate the adaptive capacity of the ACG system, Pearson's coefficient of variation and the percentage of outliers were calculated. To evaluate the explanatory power of the ACG system, the authors used the coefficient of determination (R(2)). The number of patients studied was 227 235 (frequency: 5.9 visits per person per year), with a mean of 4.5 (3.2) episodes and 8.1 (8.2) visits per patient per year. The mean total cost was €654.2. The explanatory power of the ACG system was 36.9% for costs (56.5% without outliers). 10 ACG categories accounted for 60.1% of all cases and 19 for 80.9%. 5 categories represented 71% of poor performance (N=78 887, 34.7%), particularly category 0300-Acute Minor, Age 6+ (N=26 909, 11.8%), which had a coefficient of variation =139% and 6.6% of outliers. The ACG system is an appropriate manner of classifying patients in routine clinical practice in primary healthcare centres in Catalonia, although improvements to the adaptive capacity through disaggregation of some categories according to age groups and, especially, the number of acute episodes in paediatric patients would be necessary to reduce intra-group variation.

  15. A cluster-analytic profiling of heroin-dependent patients based on level, clinical adequacy, and patient-desired adjustment of buprenorphine dosage during buprenorphine-naloxone maintenance treatment in sixteen Spanish centers.

    Science.gov (United States)

    Alcaraz, Saul; González-Saiz, Francisco; Trujols, Joan; Vergara-Moragues, Esperanza; Siñol, Núria; Pérez de Los Cobos, José

    2018-06-01

    Buprenorphine dosage is a crucial factor influencing outcomes of buprenorphine treatment for heroin use disorders. Therefore, the aim of the present study is to identify naturally occurring profiles of heroin-dependent patients regarding individualized management of buprenorphine dosage in clinical practice of buprenorphine-naloxone maintenance treatment. 316 patients receiving buprenorphine-naloxone maintenance treatment were surveyed at 16 Spanish centers during the stabilization phase of this treatment. Patients were grouped using cluster analysis based on three key indicators of buprenorphine dosage management: dose, adequacy according to physician, and adjustment according to patient. The clusters obtained were compared regarding different facets of patient clinical condition. Four clusters were identified and labeled as follows (buprenorphine average dose and percentage of participants in each cluster are given in brackets): "Clinically Adequate and Adjusted to Patient Desired Low Dosage" (2.60 mg/d, 37.05%); "Clinically Adequate and Adjusted to Patient Desired High Dosage" (10.71 mg/d, 29.18%); "Clinically Adequate and Patient Desired Reduction of Low Dosage" (3.38 mg/d, 20.0%); and "Clinically Inadequate and Adjusted to Patient Desired Moderate Dosage" (7.55 mg/d, 13.77%). Compared to patients from the other three clusters, participants in the latter cluster reported more frequent use of heroin and cocaine during last week, lower satisfaction with buprenorphine-naloxone as a medication, higher prevalence of buprenorphine-naloxone adverse effects and poorer psychological adjustment. Our results show notable differences between clusters of heroin-dependent patients regarding buprenorphine dosage management. We also identified a group of patients receiving clinically inadequate buprenorphine dosage, which was related to poorer clinical condition. Copyright © 2018 Elsevier B.V. All rights reserved.

  16. Clinical assessment of auto-positive end-expiratory pressure by diaphragmatic electrical activity during pressure support and neurally adjusted ventilatory assist.

    Science.gov (United States)

    Bellani, Giacomo; Coppadoro, Andrea; Patroniti, Nicolò; Turella, Marta; Arrigoni Marocco, Stefano; Grasselli, Giacomo; Mauri, Tommaso; Pesenti, Antonio

    2014-09-01

    Auto-positive end-expiratory pressure (auto-PEEP) may substantially increase the inspiratory effort during assisted mechanical ventilation. Purpose of this study was to assess whether the electrical activity of the diaphragm (EAdi) signal can be reliably used to estimate auto-PEEP in patients undergoing pressure support ventilation and neurally adjusted ventilatory assist (NAVA) and whether NAVA was beneficial in comparison with pressure support ventilation in patients affected by auto-PEEP. In 10 patients with a clinical suspicion of auto-PEEP, the authors simultaneously recorded EAdi, airway, esophageal pressure, and flow during pressure support and NAVA, whereas external PEEP was increased from 2 to 14 cm H2O. Tracings were analyzed to measure apparent "dynamic" auto-PEEP (decrease in esophageal pressure to generate inspiratory flow), auto-EAdi (EAdi value at the onset of inspiratory flow), and IDEAdi (inspiratory delay between the onset of EAdi and the inspiratory flow). The pressure necessary to overcome auto-PEEP, auto-EAdi, and IDEAdi was significantly lower in NAVA as compared with pressure support ventilation, decreased with increase in external PEEP, although the effect of external PEEP was less pronounced in NAVA. Both auto-EAdi and IDEAdi were tightly correlated with auto-PEEP (r = 0.94 and r = 0.75, respectively). In the presence of auto-PEEP at lower external PEEP levels, NAVA was characterized by a characteristic shape of the airway pressure. In patients with auto-PEEP, NAVA, compared with pressure support ventilation, led to a decrease in the pressure necessary to overcome auto-PEEP, which could be reliably monitored by the electrical activity of the diaphragm before inspiratory flow onset (auto-EAdi).

  17. The starlight night the sky in the writings of Shakespeare, Tennyson, and Hopkins

    CERN Document Server

    Levy, David H

    2016-01-01

    In this updated second edition renowned amateur comet-searcher David H. Levy expands on his work about the intricate relationship between the night sky and the works of English Literature. This revised and expanded text includes new sections on Alfred Lord Tennyson and Gerald Manley Hopkins (both amateur astronomers), extending the time period analyzed in the first edition from early modern literature to encompass the Victorian age. Although the sky enters into much of literature through the ages, British authors offer an especially fertile connection to the heavens, and Levy links the works of seminal authors from Shakespeare on to specific celestial events and scientific advances.  From the impact of comets and supernovae to eclipses, Levy’s ultimate goal in this book is to inspire his readers to do the same thing as their ancestors did so long ago—look up and appreciate the stars. His insights in this revised book spread farther and wider than ever before in this learned and enchanting tour of the ski...

  18. Enhanced Tobacco Control Initiative at Johns Hopkins Health System: Employee Fairness Perception.

    Science.gov (United States)

    Durrani, Shabnum; Lucik, Meg; Safeer, Richard

    2018-02-01

    Organizations often fail to establish a clear awareness of what employees consider fair when implementing changes to employee benefits in the workplace. In 2016, the Johns Hopkins Health System (JHHS) enhanced their tobacco control efforts. In addition to enhanced smoking cessation benefits, employees were offered an increased reduction in their insurance premiums if they were nonsmokers. To qualify for the reduction, employees participated in testing rather than relying on self-reporting as had been done in the past. The shift to testing prompted a concern by some senior management at JHHS who did not want employees to feel they were not trusted. As the program unfolded at JHHS, the four-component model of procedural justice was applied to provide a framework for reviewing the implementation of the new voluntary tobacco testing at JHHS from a fairness lens. The purpose of this article is to illustrate the application of the four-component procedural model of justice to the tobacco testing process at JHHS. As approximately 75% of employees participated in the program, the experience at JHHS can be instructive to other employers who are looking to implement changes in their workplaces and how to minimize unintended consequences with their employees.

  19. Energy Programs at the Johns Hopkins University Applied Physics Laboratory, Quarterly Report, July-September 1980

    Energy Technology Data Exchange (ETDEWEB)

    None

    1980-09-01

    The Johns Hopkins University Applied Physics Laboratory, under contracts with several agencies of the federal government, is engaged in developing energy resources, utilization concepts, and monitoring and storage methods. This Quarterly Report summarizes the work on the various tasks as of 31 September 1980. The Energy Quarterly Report is divided into four sections. The first, Geothermal Energy Development Planning and Technical Assistance, supported by the Department of Energy/Division of Geothermal Energy (DOE/DGE), contains reports on the progress of geothermal-related tasks on which effort was concentrated during the quarter. The second section, Operational Research, Hydroelectric Power Development, supported by the Department of Energy/Resource Applications (DOE/RA), contains reports on small-scale hydroelectric investigations in the southeastern states. The third section, Seismotectonic Investigations, supported by the Reactor Safety Research Division of the Nuclear Regulatory Commission (NRC), reports on neotectonic investigations of the Manhattan Prong. The fourth section, Energy Conversion and Storage Techniques, contains three articles. The first is an evaluation of the Einstein refrigerator, supported by independent IR&D funds. The second concerns OTEC pilot plant performance calculations, supported by the Department of Energy/Division of Central Solar Technology (DOE/CST). The third, describing a study of landfill methane recovery, is supported by the National Park Service.

  20. Hashimoto's Thyroiditis: Celebrating the Centennial Through the Lens of the Johns Hopkins Hospital Surgical Pathology Records

    Science.gov (United States)

    De Remigis, Alessandra; Chuang, Kelly; Dembele, Marieme; Iwama, Akiko; Iwama, Shintaro

    2013-01-01

    Hashimoto's thyroiditis is now considered the most prevalent autoimmune disease, as well as the most common endocrine disorder. It was initially described in 1912, but only rarely reported until the early 1950s. To celebrate this centennial, we reviewed the surgical pathology archives of the Johns Hopkins hospital for cases of Hashimoto's thyroiditis, spanning the period from May 1889 to October 2012. Approximately 15,000 thyroidectomies were performed at this hospital over 124 years. The first surgical case was reported in 1942, 30 years after the original description. Then, 867 cases of Hashimoto's thyroiditis were seen from 1942 to 2012, representing 6% of all thyroidectomies. Hashimoto's thyroiditis was the sole pathological finding in 462 cases; it accompanied other thyroid pathologies in the remaining 405 cases. The most commonly associated pathology was papillary thyroid cancer, an association that increased significantly during the last two decades. The most common indication for thyroidectomy was a thyroid nodule that was cytologically suspicious for malignancy. Hashimoto's thyroiditis remains a widespread, intriguing, and multifaceted disease of unknown etiology one century after its description. Advances in the understanding of its pathogenesis and preoperative diagnosis will improve recognition and treatment of this disorder, and may one day lead to its prevention. PMID:23151083

  1. Energy Programs at the Johns Hopkins University Applied Physics Laboratory, Quarterly Report, January-March 1980

    Energy Technology Data Exchange (ETDEWEB)

    Entingh, Daniel J.

    1980-03-01

    The Johns Hopkins University Applied Physics Laboratory, under contracts with several agencies of the federal government and an agency of the State of Maryland, is engaged in developing energy resources, utilization concepts, and monitoring and storage methods. This Quarterly Report summarizes the work on the various tasks as of 31 March 1980. The Energy Quarterly Report is divided into four sections. The first, Geothermal Energy Development Planning and Technical Assistance, supported by the Department of Energy/Division of Geothermal Energy (DOE/DGE), contains reports on the progress of geothermal-related tasks on which effort was concentrated during the quarter. The second section, Operational Research, Hydroelectric Power Development, supported by the Department of Energy/Resource Applications (DOE/DGE), contains reports on small-scale hydroelectric investigations in the southeastern states. The third section, Seismotectonic Investigation, supported by the Reactor Safety Research Division of the Nuclear Regulatory Commission, reports on a neotectonic investigation in Connecticut. The fourth section, Energy Conversion and Storage Techniques, contains two articles, the first on OTEC core unit testing supported by the Department of Energy/Division of Central Solar Technology (DOE/CST), and the second on an analysis of the Community Annual Storage Energy System at the U.S. Naval Air Station, Norfolk, Va. This work is supported by the Department of Energy and the Department of Defense, Naval Facilities Engineering Command/Atlantic Division.

  2. Energy Programs at the Johns Hopkins University Applied Physics Laboratory, Quarterly Report, April-June 1980

    Energy Technology Data Exchange (ETDEWEB)

    None

    1980-06-01

    The Johns Hopkins University Applied Physics Laboratory, under contracts with several agencies of the federal government and an agency of the State of Maryland, is engaged in developing energy resources, utilization concepts, and monitoring and storage methods. This Quarterly Report summarizes the work on the various tasks as of 30 June 1980. The Energy Quarterly Report is divided into three sections. The first, Geothermal Energy Development Planning and Technical Assistance, supported by the Department of Energy/Division of Geothermal Energy (DOE/DGE), contains reports on the progress of geothermal-related tasks on which effort was concentrated during the quarter. The second section, Operational Research, Hydroelectric Power Development, supported by the Department of Energy/Resource Applications (DOE/RA), contains reports on small-scale hydroelectric investigations in the southeastern states. The third section, Energy Conversion and Storage Techniques, contains three articles. The first is on data analysis of OTEC core unit condenser tests, and is supported by the Department of Energy/Division of Central Solar Technology (DOE/CST). The second is on the current status of the Community Annual Storage Energy System at the U.S. Naval Air Station, Norfolk, Va., and is supported by the Department of Energy and the Department of Defense, Naval Facilities Engineering Command/Atlantic Division. The third is on utilization of landfill methane and is supported by Argonne National Laboratory.

  3. Tsinghua-Johns Hopkins Joint Center for Biomedical Engineering Research: scientific and cultural exchange in undergraduate engineering.

    Science.gov (United States)

    Wisneski, Andrew D; Huang, Lixia; Hong, Bo; Wang, Xiaoqin

    2011-01-01

    A model for an international undergraduate biomedical engineering research exchange program is outlined. In 2008, the Johns Hopkins University in collaboration with Tsinghua University in Beijing, China established the Tsinghua-Johns Hopkins Joint Center for Biomedical Engineering Research. Undergraduate biomedical engineering students from both universities are offered the opportunity to participate in research at the overseas institution. Programs such as these will not only provide research experiences for undergraduates but valuable cultural exchange and enrichment as well. Currently, strict course scheduling and rigorous curricula in most biomedical engineering programs may present obstacles for students to partake in study abroad opportunities. Universities are encouraged to harbor abroad opportunities for undergraduate engineering students, for which this particular program can serve as a model.

  4. Stand Characteristics and Downed Woody Debris Accumulations Associated with a Mountain Pine Beetle (Dendroctonus ponderosae Hopkins) Outbreak in Colorado

    OpenAIRE

    Klutsch, Jennifer G; Negron, Jose F; Costello, Sheryl L; Rhoades, Charles C; West, Daniel R; Popp, John; Caissie, Rick

    2009-01-01

    Lodgepole pine (Pinus contorta Dougl. ex Loud.)-dominated ecosystems in north-central Colorado are undergoing rapid and drastic changes associated with overstory tree mortality from a current mountain pine beetle (Dendroctonus ponderosae Hopkins) outbreak. To characterize stand characteristics and downed woody debris loads during the first 7 years of the outbreak, 221 plots (0.02 ha) were randomly established in infested and uninfested stands distributed across the Arapaho National Forest, ...

  5. Leadership of the Department of Epidemiology of the Johns Hopkins Bloomberg School of Public Health in Its First Century.

    Science.gov (United States)

    Celentano, David D

    2016-03-01

    This commentary reviews the contributions of each of the 7 Chairs of the Department of Epidemiology from the Department's inception in 1919 to the advent of the Centennial Celebration of the Johns Hopkins Bloomberg School of Public Health in 2016. The founding Chair, Wade Hampton Frost (1919-1938), was among the handful of foundational thinkers in the discipline of epidemiology. Kenneth Maxcy (1938-1954) and Philip Sartwell (1954-1970) oversaw the Department through the epidemiologic transition from a preponderance of morbidity and mortality due to infectious diseases to a preponderance of noncommunicable diseases. Abraham Lilienfeld (1970-1975) and Leon Gordis (1975-1993) were perhaps best known for their mastery of teaching, influencing generations of both medical and public health students. Jonathan Samet (1994-2008) oversaw a major curriculum revision and expanded the Department significantly, and David Celentano (2008-) is working to rebalance the practice of epidemiology with the etiological foundations of epidemiology. All Chairs were a product of their times, and their research focus and portfolios influenced the direction of the Department. Future generations of Johns Hopkins students will be influenced directly or indirectly by the heritage of these Chairs' actions and those of their faculty. © The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  6. Introducing Pitt-Hopkins syndrome-associated mutations of TCF4 to Drosophila daughterless

    Directory of Open Access Journals (Sweden)

    Laura Tamberg

    2015-12-01

    Full Text Available Pitt-Hopkins syndrome (PTHS is caused by haploinsufficiency of Transcription factor 4 (TCF4, one of the three human class I basic helix-loop-helix transcription factors called E-proteins. Drosophila has a single E-protein, Daughterless (Da, homologous to all three mammalian counterparts. Here we show that human TCF4 can rescue Da deficiency during fruit fly nervous system development. Overexpression of Da or TCF4 specifically in adult flies significantly decreases their survival rates, indicating that these factors are crucial even after development has been completed. We generated da transgenic fruit fly strains with corresponding missense mutations R578H, R580W, R582P and A614V found in TCF4 of PTHS patients and studied the impact of these mutations in vivo. Overexpression of wild type Da as well as human TCF4 in progenitor tissues induced ectopic sensory bristles and the rough eye phenotype. By contrast, overexpression of DaR580W and DaR582P that disrupt DNA binding reduced the number of bristles and induced the rough eye phenotype with partial lack of pigmentation, indicating that these act dominant negatively. Compared to the wild type, DaR578H and DaA614V were less potent in induction of ectopic bristles and the rough eye phenotype, respectively, suggesting that these are hypomorphic. All studied PTHS-associated mutations that we introduced into Da led to similar effects in vivo as the same mutations in TCF4 in vitro. Consequently, our Drosophila models of PTHS are applicable for further studies aiming to unravel the molecular mechanisms of this disorder.

  7. Adjustment disorder: current perspectives

    Directory of Open Access Journals (Sweden)

    Zelviene P

    2018-01-01

    Full Text Available Paulina Zelviene, Evaldas Kazlauskas Department of Clinical and Organizational Psychology, Vilnius University, Vilnius, Lithuania Abstract: Adjustment disorder (AjD is among the most often diagnosed mental disorders in clinical practice. This paper reviews current status of AjD research and discusses scientific and clinical issues associated with AjD. AjD has been included in diagnostic classifications for over 50 years. Still, the diagnostic criteria for AjD remain vague and cause difficulties to mental health professionals. Controversies in definition resulted in the lack of reliable and valid measures of AjD. Epidemiological data on prevalence of AjD is scarce and not reliable because prevalence data are biased by the diagnostic algorithm, which is usually developed for each study, as no established diagnostic standards for AjD are available. Considerable changes in the field of AjD could follow after the release of the 11th edition of International Classification of Diseases (ICD-11. A new AjD symptom profile was introduced in ICD-11 with 2 main symptoms as follows: 1 preoccupation and 2 failure to adapt. However, differences between the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and ICD-11 AjD diagnostic criteria could result in diverse research findings in the future. The best treatment approach for AjD remains unclear, and further treatment studies are needed to provide AjD treatment guidelines to clinicians. Keywords: adjustment disorder, review, diagnosis, prevalence, treatment, DSM, ICD

  8. Estimated disability-adjusted life years averted by long-term provision of long acting contraceptive methods in a Brazilian clinic.

    Science.gov (United States)

    Bahamondes, Luis; Bottura, Bruna F; Bahamondes, M Valeria; Gonçalves, Mayara P; Correia, Vinicius M; Espejo-Arce, Ximena; Sousa, Maria H; Monteiro, Ilza; Fernandes, Arlete

    2014-10-10

    What is the contribution of the provision, at no cost for users, of long acting reversible contraceptive methods (LARC; copper intrauterine device [IUD], the levonorgestrel-releasing intrauterine system [LNG-IUS], contraceptive implants and depot-medroxyprogesterone [DMPA] injection) towards the disability-adjusted life years (DALY) averted through a Brazilian university-based clinic established over 30 years ago. Over the last 10 years of evaluation, provision of LARC methods and DMPA by the clinic are estimated to have contributed to DALY averted by between 37 and 60 maternal deaths, 315-424 child mortalities, 634-853 combined maternal morbidity and mortality and child mortality, and 1056-1412 unsafe abortions averted. LARC methods are associated with a high contraceptive effectiveness when compared with contraceptive methods which need frequent attention; perhaps because LARC methods are independent of individual or couple compliance. However, in general previous studies have evaluated contraceptive methods during clinical studies over a short period of time, or not more than 10 years. Furthermore, information regarding the estimation of the DALY averted is scarce. We reviewed 50 004 medical charts from women who consulted for the first time looking for a contraceptive method over the period from 2 January 1980 through 31 December 2012. Women who consulted at the Department of Obstetrics and Gynaecology, University of Campinas, Brazil were new users and users switching contraceptive, including the copper IUD (n = 13 826), the LNG-IUS (n = 1525), implants (n = 277) and DMPA (n = 9387). Estimation of the DALY averted included maternal morbidity and mortality, child mortality and unsafe abortions averted. We obtained 29 416 contraceptive segments of use including 25 009 contraceptive segments of use from 20 821 new users or switchers to any LARC method or DMPA with at least 1 year of follow-up. The mean (± SD) age of the women at first consultation ranged from 25

  9. Growth and clinical variables in nitrogen-restricted piglets fed an adjusted essential amino acid mix: Effects using partially intact protein-based diets

    Science.gov (United States)

    Current recommendations for protein levels in infant formula ensure that growth matches or exceeds growth of breast-fed infants, but may provide a surplus of amino acids (AA). Recent studies in infants using AA-based formulas support specific adjustment of the essential AA (EAA) composition allowing...

  10. The relationship between effectiveness and costs measured by a risk-adjusted case-mix system: multicentre study of Catalonian population data bases

    Directory of Open Access Journals (Sweden)

    Flor-Serra Ferran

    2009-06-01

    Full Text Available Abstract Background The main objective of this study is to measure the relationship between morbidity, direct health care costs and the degree of clinical effectiveness (resolution of health centres and health professionals by the retrospective application of Adjusted Clinical Groups in a Spanish population setting. The secondary objectives are to determine the factors determining inadequate correlations and the opinion of health professionals on these instruments. Methods/Design We will carry out a multi-centre, retrospective study using patient records from 15 primary health care centres and population data bases. The main measurements will be: general variables (age and sex, centre, service [family medicine, paediatrics], and medical unit, dependent variables (mean number of visits, episodes and direct costs, co-morbidity (Johns Hopkins University Adjusted Clinical Groups Case-Mix System and effectiveness. The totality of centres/patients will be considered as the standard for comparison. The efficiency index for visits, tests (laboratory, radiology, others, referrals, pharmaceutical prescriptions and total will be calculated as the ratio: observed variables/variables expected by indirect standardization. The model of cost/patient/year will differentiate fixed/semi-fixed (visits costs of the variables for each patient attended/year (N = 350,000 inhabitants. The mean relative weights of the cost of care will be obtained. The effectiveness will be measured using a set of 50 indicators of process, efficiency and/or health results, and an adjusted synthetic index will be constructed (method: percentile 50. The correlation between the efficiency (relative-weights and synthetic (by centre and physician indices will be established using the coefficient of determination. The opinion/degree of acceptance of physicians (N = 1,000 will be measured using a structured questionnaire including various dimensions. Statistical analysis: multiple regression

  11. High-dose chemotherapy for patients with high-risk breast cancer: a clinical and economic assessment using a quality-adjusted survival analysis.

    Science.gov (United States)

    Marino, Patricia; Roché, Henri; Moatti, Jean-Paul

    2008-04-01

    The benefit of high-dose chemotherapy (HDC) has not been clearly demonstrated. It may offer disease-free survival improvement at the expense of major toxicity and increasing cost. We evaluated the trade-offs between toxicity, relapse, and costs using a quality-adjusted time without symptoms or toxicity (Q-TWiST) analysis. The analysis was conducted in the context of a randomized trial (PEGASE 01) evaluating the benefit of HDC for 314 patients with high-risk breast cancer. A Q-TWiST analysis was first performed to compare HDC with standard chemotherapy. We then used the results of this Q-TWiST analysis to inform a cost per quality-adjusted life-year (QALY) comparison between treatments. Q-TWiST durations were in favor of HDC, whatever the weighting coefficients used for the analysis. This benefit was significant when the weighting coefficient related to the time spent after relapse was low (0.78), HDC offered no benefit. For intermediate values, the results depended on the weighting coefficient attributed to the toxicity period. The incremental cost per QALY ranged from 12,691euro/QALY to 26,439euro/QALY, according to the coefficients used to weight toxicity and relapse. The benefits of HDC outweigh the burdens of treatment for a wide range of utility coefficients. Economic impact is not a barrier to HDC diffusion in this situation. Nevertheless, no significant benefit was demonstrated for a certain range of utility values.

  12. Medida de los pesos relativos del coste de la asistencia como efecto de la aplicación retrospectiva de los adjusted clinical groups en atención primaria Measurement of relative cost weights as an effect of the retrospective application of adjusted clinical groups in primary care

    Directory of Open Access Journals (Sweden)

    Antoni Sicras-Mainar

    2006-03-01

    Full Text Available Objetivo: El objeto del estudio es obtener los pesos relativos medios de los costes de la asistencia con la aplicación retrospectiva de los adjusted clinical groups (ACG en población atendida por equipos de atención primaria en situación de práctica clínica habitual. Métodos: Estudio descriptivo de carácter retrospectivo. Fueron incluidos en el estudio todos los pacientes atendidos por 4 equipos de atención primaria durante el año 2003. Las principales mediciones fueron: variables universales (edad y sexo, dependientes (visitas y costes y de casuística o comorbilidad. El modelo de costes para cada paciente se estableció diferenciando los costes fijos y los variables. Se efectuó un análisis de regresión lineal múltiple para la predicción de los modelos. El coste relativo de cada ACG se obtuvo dividiendo el coste medio de cada categoría entre el coste medio de toda la población de referencia. Resultados: El número total de pacientes estudiados fue de 62.311 (intensidad de uso del 76,7%, con una media de 4,8 ± 3,2 episodios y 7,8 ± 7,5 visitas/paciente/año. La distribución de los costes fue de 24.135.236,41 €, el 28,9% fijos. El coste unitario total por visita/año fue de 49,62 ± 24,71 € y el promedio paciente/año de 387,34 ± 145,87 € (pesos relativos de referencia. El poder explicativo de la clasificación ACG fue del 50,1% en las visitas y del 54,9% para los costes totales. Conclusiones: Los ACG se muestran como un aceptable sistema de clasificación de pacientes en situación de práctica clínica habitual. De confirmarse los resultados posibilitarían una mejora en la aplicación práctica de los ACG como una posible herramienta para la gestión clínica en los centros de atención primaria.Objective: The objective of the study is to obtain the cost's relative average weights of the assistance with the retrospective application of the Adjusted Clinical Groups (ACG's in four teams of Primary Care with an attended

  13. Variability in prescription drug expenditures explained by adjusted clinical groups (ACG case-mix: A cross-sectional study of patient electronic records in primary care

    Directory of Open Access Journals (Sweden)

    Serrat Josep

    2008-03-01

    Full Text Available Abstract Background In view of rapidly increasing prescription costs, case-mix adjustment should be considered for effective control of costs. We have estimated the variability in pharmacy costs explained by ACG in centers using patient electronic records, profiled centers and physicians and analyzed the correlation between cost and quality of prescription. Methods We analyzed 65,630 patient records attending five primary care centers in Spain during 2005. Variables explored were age, gender, registered diagnosed episodes of care during 2005, total cost of prescriptions, physician and center. One ACG was assigned to each patient with ACG case-mix software version 7.1. In a two-part model, logistic regression was used to explain the incurrence of drug expenditure at the first stage and a linear mixed model that considered the multilevel structure of data modeled the cost, conditional upon incurring any expense. Risk and efficiency indexes in pharmacy cost adjusted for ACG were obtained for centers and physicians. Spearman rank correlation between physician expenditure, adjusted for ACG, and a prescription quality index was also obtained. Pediatric and adult data were analyzed separately. Results No prescription was recorded for 13% of adults and 39.6% of children. The proportion of variance of the incurrence of expenditure explained by ACGs was 0.29 in adults and 0.21 in children. For adults with prescriptions, the variance of cost explained by ACGs was 35.4%, by physician-center was 1.8% and age 10.5% (residual 52.3%. For children, ACGs explained 22.4% of cost and physician-center 10.9% (residual 66.7%. Center efficiency index for adults ranged 0.58 to 1.22 and for children 0.32 to 2.36. Spearman correlation between expenditure and prescription quality index was -0.36 in family physicians (p = 0.019, N = 41 and -0.52 in pediatricians (p = 0.08, N = 12. Conclusion In our setting, ACG is the variable studied that explains more variability in

  14. The Johns Hopkins RTR Consortium: A Collaborative Approach to Advance Translational Science and Standardize Clinical Monitoring of Restorative Transplantation

    Science.gov (United States)

    2016-10-01

    showed indirect signs of higher ATP production in the MP group when compared to the CSP. The adenine family has a variety of roles in cellular...which leads into oxidative damage and disintegration of cellular membranes when prolonged hypothermia, anoxia, and limited glucose supply is imposed

  15. The Johns Hopkins RTR Consortium: A Collaborative Approach to Advance Translational Science and Standardize Clinical Monitoring of Restorative Transplantation

    Science.gov (United States)

    2016-10-01

    immunosuppression sparing regimens allowing for immunomodulation and tolerance induction after VCA using a translational large animal model. A total of...group I animals died prematurely due to infectious complications related to high dose tacrolimus treatment. 2/3 animals that received sub...Immunomodulation, Chimerism, Costimulatory blockade, Belatacept, CTLA4-Ig, Large animal model 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF

  16. An information and communication technology-based centralized clinical trial to determine the efficacy and safety of insulin dose adjustment education based on a smartphone personal health record application: a randomized controlled trial.

    Science.gov (United States)

    Kim, Gyuri; Bae, Ji Cheol; Yi, Byoung Kee; Hur, Kyu Yeon; Chang, Dong Kyung; Lee, Moon-Kyu; Kim, Jae Hyeon; Jin, Sang-Man

    2017-07-18

    A Personal Health Record (PHR) is an online application that allows patients to access, manage, and share their health data. PHRs not only enhance shared decision making with healthcare providers, but also enable remote monitoring and at-home-collection of detailed data. The benefits of PHRs can be maximized in insulin dose adjustment for patients starting or intensifying insulin regimens, as frequent self-monitoring of glucose, self-adjustment of insulin dose, and precise at-home data collection during the visit-to-visit period are important for glycemic control. The aim of this study is to examine the efficacy and safety of insulin dose adjustment based on a smartphone PHR application in patients with diabetes mellitus (DM) and to confirm the validity and stability of an information and communication technology (ICT)-based centralized clinical trial monitoring system. This is a 24-week, open-label, randomized, multi-center trial. There are three follow-up measures: baseline, post-intervention at week 12, and at week 24. Subjects diagnosed with type 1 DM, type 2 DM, and/or post-transplant DM who initiate basal insulin or intensify their insulin regimen to a basal-bolus regimen are included. After education on insulin dose titration and prevention for hypoglycemia and a 1-week acclimation period, subjects are randomized in a 1:1 ratio to either an ICT-based intervention group or a conventional intervention group. Subjects in the conventional intervention group will save and send their health information to the server via a PHR application, whereas those in ICT-based intervention group will receive additional algorithm-based feedback messages. The health information includes level of blood glucose, insulin dose, details on hypoglycemia, food diary, and step count. The primary outcome will be the proportion of patients who reach an optimal insulin dose within 12 weeks of study enrollment, without severe hypoglycemia or unscheduled clinic visits. This clinical trial

  17. Annual Adjustment Factors

    Data.gov (United States)

    Department of Housing and Urban Development — The Department of Housing and Urban Development establishes the rent adjustment factors - called Annual Adjustment Factors (AAFs) - on the basis of Consumer Price...

  18. Dietary and medication adjustments to improve seizure control in patients treated with the ketogenic diet

    Science.gov (United States)

    Selter, Jessica H.; Turner, Zahava; Doerrer, Sarah C.; Kossoff, Eric H.

    2014-01-01

    Unlike anticonvulsant drugs and vagus nerve stimulation, there are no guidelines regarding adjustments to ketogenic diet regimens to improve seizure efficacy once the diet has been started. A retrospective chart review was performed of 200 consecutive patients treated with the ketogenic diet at Johns Hopkins Hospital from 2007-2013. Ten dietary and supplement changes were identified, along with anticonvulsant adjustments. A total of 391 distinct interventions occurred, of which 265 were made specifically to improve seizure control. Adjustments lead to >50% further seizure reduction in-18%, but only 3% became seizure-free. The benefits of interventions did not decrease over time. There was a trend towards medication adjustments being more successful than dietary modifications (24% vs. 15%, p = 0.08). No single dietary change stood out as the most effective, but calorie changes were largely unhelpful (10% with additional benefit). PMID:24859788

  19. Dietary and medication adjustments to improve seizure control in patients treated with the ketogenic diet.

    Science.gov (United States)

    Selter, Jessica H; Turner, Zahava; Doerrer, Sarah C; Kossoff, Eric H

    2015-01-01

    Unlike anticonvulsant drugs and vagus nerve stimulation, there are no guidelines regarding adjustments to ketogenic diet regimens to improve seizure efficacy once the diet has been started. A retrospective chart review was performed of 200 consecutive patients treated with the ketogenic diet at Johns Hopkins Hospital from 2007 to 2013. Ten dietary and supplement changes were identified, along with anticonvulsant adjustments. A total of 391 distinct interventions occurred, of which 265 were made specifically to improve seizure control. Adjustments led to >50% further seizure reduction in 18%, but only 3% became seizure-free. The benefits of interventions did not decrease over time. There was a trend towards medication adjustments being more successful than dietary modifications (24% vs 15%, P = .08). No single dietary change stood out as the most effective, but calorie changes were largely unhelpful (10% with additional benefit). © The Author(s) 2014.

  20. Singing Thy Sweet Radiance Encircling the Gem like World: A Comparative Study between Gerard Manley Hopkins and Rabindranath Tagore

    Directory of Open Access Journals (Sweden)

    Mohammad Kaosar Ahmed

    2013-05-01

    Full Text Available Rabindranath Tagore, the first Nobel- Laureate in the Indian sub-continent journeyed all spheres of the domain of Bangla Literature in 19th century. His works are viewed in the West as spiritual and mercurial. On the other hand, Born in Victorian England and being influenced by the Oxford Movement, Hopkins decided to convert into restricted form of Catholicism, Jesuit life that made him culturally isolated. Despite having different religious and socio-cultural background their central philosophical concern is in most cases similar. Shading   light on their views about nature, devotion to God, spiritual agony, this article goes deep into their values and beliefs and makes an analogy between them.

  1. Seasonal shifts in accumulation of glycerol biosynthetic gene transcripts in mountain pine beetle, Dendroctonus ponderosae Hopkins (Coleoptera: Curculionidae, larvae

    Directory of Open Access Journals (Sweden)

    Jordie D. Fraser

    2017-06-01

    Full Text Available Winter mortality is a major factor regulating population size of the mountain pine beetle, Dendroctonus ponderosae Hopkins (Coleoptera: Curculionidae. Glycerol is the major cryoprotectant in this freeze intolerant insect. We report findings from a gene expression study on an overwintering mountain pine beetle population over the course of 35 weeks. mRNA transcript levels suggest glycerol production in the mountain pine beetle occurs through glycogenolytic, gluconeogenic and potentially glyceroneogenic pathways, but not from metabolism of lipids. A two-week lag period between fall glycogen phosphorylase transcript and phosphoenolpyruvate carboxykinase transcript up-regulation suggests that gluconeogenesis serves as a secondary glycerol-production process, subsequent to exhaustion of the primary glycogenolytic source. These results provide a first look at the details of seasonal gene expression related to the production of glycerol in the mountain pine beetle.

  2. Howard Atwood Kelly (1858-1943): founding Professor of Gynecology at Johns Hopkins Hospital and pioneer American radium therapist

    International Nuclear Information System (INIS)

    Robison, R. F.

    2010-01-01

    To date no objective scientific medical biography has been published on Howard Atwood Kelly, one of America's foremost radium pioneers. He had become internationally known since 1889 as the founding Chief of the Gynecology Service at Johns Hopkins, well before the discovery of radium. He was also later to maintain his own hospital in Baltimore. He was a multifaceted man and his biography provides some fascinating reading about the treatment of gynaecological cancer in the USA at the end of the 19 th century and well into the 20 th century. An Appendix is included which contains extracts from Curtis Bumam's 1936 Janeway Memorial Lecture on 'Early Experiences with Radium' which was published (without quoting any references) in the American Journal of Roentgenology (AJR). Bumam was probably the most important of Kelly's collaborators and he provides unique personal and scientific insights on Kelly and the trials (and) tribulations of obtaining and using radium in 1911. (author)

  3. Risk Factors for Possible Dementia Using the Hopkins Verbal Learning Test and the Mini-Mental State Examination in Shanghai

    Directory of Open Access Journals (Sweden)

    Xin Xu

    2015-11-01

    Full Text Available Using a combination of the Hopkins Verbal Learning Test (HVLT and the Mini-Mental State Examination (MMSE, we investigated the prevalence of possible dementia (DEM in community-dwelling elderly in Shanghai. Subsequently, we investigated significant risk factors for DEM and generated a DEM self-checklist for early DEM detection and case management. We found that among a total of 521 participants using a HVLT cut-off score of <19 and a MMSE cut-off score of <24, a total of 69 DEM cases were identified. Risk factors, such as advanced age (≥68 years, low education (no or primary level, self-reported history of hypertension, and self-reported subjective memory complaints (SMC were significantly predictive of DEM. The presence of ≥3 out of four of the above mentioned risk factors can effectively discriminate DEM cases from non-DEM subjects.

  4. NET SALARY ADJUSTMENT

    CERN Multimedia

    Finance Division

    2001-01-01

    On 15 June 2001 the Council approved the correction of the discrepancy identified in the net salary adjustment implemented on 1st January 2001 by retroactively increasing the scale of basic salaries to achieve the 2.8% average net salary adjustment approved in December 2000. We should like to inform you that the corresponding adjustment will be made to your July salary. Full details of the retroactive adjustments will consequently be shown on your pay slip.

  5. On the shoulders of giants: Harvey Cushing's experience with acromegaly and gigantism at the Johns Hopkins Hospital, 1896-1912.

    Science.gov (United States)

    Pendleton, Courtney; Adams, Hadie; Salvatori, Roberto; Wand, Gary; Quiñones-Hinojosa, Alfredo

    2011-03-01

    A review of Dr. Cushing's surgical cases at Johns Hopkins Hospital revealed new information about his early operative experience with acromegaly. Although in 1912 Cushing published selective case studies regarding this work, a review of all his operations for acromegaly during his early years has never been reported. We uncovered 37 patients who Cushing treated with surgical intervention directed at the pituitary gland. Of these, nine patients who presented with symptoms of acromegaly, and one with symptoms of gigantism were selected for further review. Two patients underwent transfrontal 'omega incision' approaches, and the remaining eight underwent transsphenoidal approaches. Of the 10 patients, 6 were male. The mean age was 38.0 years. The mean hospital stay was 39.4 days. There was one inpatient death during primary interventions (10%) and three patients were deceased at the time of last follow-up (33%). The mean time to death, calculated from the date of the primary surgical intervention, and including inpatient and outpatient deaths, was 11.3 months. The mean time to last follow-up, calculated from the day of discharge, was 59.3 months. At the time of last follow-up, two patients reported resolution of headache; four patients reported continued visual deficits, and two patients reported ongoing changes in mental status. This review analyzes the outcomes for 10 patients who underwent surgical intervention for acromegaly or gigantism, and offers an explanation for Cushing's transition from the transfrontal "omega incision" to the transsphenoidal approach while practicing at the Johns Hopkins Hospital.

  6. [Changes in clinical standards and the need for adjusting legal standards of care from the point of view of civil law].

    Science.gov (United States)

    Rosenberger, Rainer

    2007-01-01

    The legal standard of medical care is laid down in Sect. 276 of the German Civil Code (principle of due diligence). It applies to both contractual and tortious liability and likewise to the treatment of patients insured under the statutory health insurance scheme and self-payers. The legal standard of care conforms to the clinical standards because medical liability means medical professional liability. Liability law does not distinguish between different standards of care in the treatment of patients insured under the statutory health insurance scheme on the one hand and privately insured patients on the other. Changes in clinical standards immediately affect liability law without the need for formal adaptation of the legal standard of care. Liability law cannot claim more diligence than that owed from a medical point of view. Legislative changes that result in a lowering of medical standards (reduction in the quality of treatment) will have to be accepted by liability law, even if these are regulations pertaining to Social Law (SGB V, Book 5 of the German Social Code). In this respect, the principle of legal unity applies. In consideration of this kind of changes the due diligence requirements for the treatment of patients insured under the statutory health insurance scheme and privately insured patients remain basically equal. If these changes lead to an increase of risk for the patient, the resulting liabilities are not to be attributed to the therapist. What remains to be seen is whether there will be an increased attempt to minimise risk by "additionally purchasing health care services".

  7. Johns Hopkins Perceptual Test; Technical Report 9. Disadvantaged Children and Their First School Experiences. ETS-Head Start Longitudinal Study. Technical Report Series.

    Science.gov (United States)

    Gilbert, Lynn E.; Shipman, Virginia C.

    The Johns Hopkins Perceptual Test, a brief measure of intelligence in children, requires the child to choose a form identical to a standard. It consists of 3 practice and 30 test items, all involving black geometric figures printed on white cards. There is one booklet for stimulus cards and one for response cards. The child is presented with a…

  8. Adjustment in the clinical practice of treat-to-target guidelines for rheumatoid arthritis: Results of the ToARCan study.

    Science.gov (United States)

    Naranjo, Antonio; Cáceres, Laura; Hernández-Beriaín, José Ángel; Francisco, Félix; Ojeda, Soledad; Talaverano, Sigrid; Nóvoa-Medina, Javier; Martín, José Adán; Delgado, Esmeralda; Trujillo, Elisa; Álvarez, Fátima; Magdalena, Laura; Rodríguez-Lozano, Carlos

    2016-01-01

    To analyze compliance with t2t clinical practice guidelines. Cross-sectional observational study in consecutive patients with rheumatoid arthritis (RA) in 5 hospitals in the Canary Islands. Patients filled out activity scales, HAQ and answered the question of whether the doctor had explained the treatment target. The rheumatologist also collected: visits in the past year, use of activity indices and HAQ, DAS28 of current visit and date of the next visit. The percentage of compliance to indicators based on the t2t recommendations (R) 1, 3, 5-7 and 10 was analyzed. A total of 343 patients were recruited, 77% female, mean age 57, RA duration of 10 years. Median visits in the last year were 3 and mean time between last and current visit was 5.6 months. A total of 93% of the patients were treated with DMARDs and 44% were in remission by DAS (R1). In the previous visit, documented joint count was present in 85%, a HAQ in 19%, patient VAS in 41%, and a DAS28 in 35% of the patients (R6). The next visit was scheduled at an average of 4.3 months (R5). In 64% of patients with DAS28> 3.2 a visit between one and 3 months was scheduled (R5). A total of 96% of patients said they had been informed of the treatment target (R10). Variability between centers existed but was moderate. The only factor determining the performance of a DAS28 in the last visit was the patient's center of origin. The Canary Island centers studied achieved high levels of remission and low activity in their patients. The performance of composite indices and follow-up frequency recommended by the t2t are met, although there is room for improvement. Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  9. Repatriation Adjustment: Literature Review

    Directory of Open Access Journals (Sweden)

    Gamze Arman

    2009-12-01

    Full Text Available Expatriation is a widely studied area of research in work and organizational psychology. After expatriates accomplish their missions in host countries, they return to their countries and this process is called repatriation. Adjustment constitutes a crucial part in repatriation research. In the present literature review, research about repatriation adjustment was reviewed with the aim of defining the whole picture in this phenomenon. Present research was classified on the basis of a theoretical model of repatriation adjustment. Basic frame consisted of antecedents, adjustment, outcomes as main variables and personal characteristics/coping strategies and organizational strategies as moderating variables.

  10. ADJUSTABLE CHIP HOLDER

    DEFF Research Database (Denmark)

    2009-01-01

    An adjustable microchip holder for holding a microchip is provided having a plurality of displaceable interconnection pads for connecting the connection holes of a microchip with one or more external devices or equipment. The adjustable microchip holder can fit different sizes of microchips...

  11. Premorbid adjustment and neuropsychological performance in schizophrenia.

    Science.gov (United States)

    Silverstein, Marshall L; Mavrolefteros, George; Close, David

    2002-01-01

    To examine the relationship between premorbid adjustment and neuropsychological deficit in schizophrenia, this report examined retrospective ratings of social and school adjustment during three age epochs (childhood, early adolescence, and late adolescence) as predictors of neurocognitive performance in 61 clinically and pharmacologically stabilized schizophrenia outpatients. Results indicated greater cognitive deficits when premorbid adjustment was unfavorable, particularly for measures of attention and executive functions. Premorbid number and quality of peer relationships and psychosocial adaptation to the school environment were more closely related to neuropsychological performance during adulthood than were premorbid withdrawal and premorbid academic performance. Early onset of poor premorbid adjustment rather than deterioration from childhood to adolescence was associated with greater neuropsychological disturbance in adulthood. It is suggested that childhood onset of premorbid deficits in selective areas of social and academic adjustment appears to influence the cognitive performance seen in adult schizophrenia. This study is consistent with findings from other related reports; it extends these findings to a larger and clinically stabilized sample.

  12. Extreme ultraviolet observations of G191-B2B and the local interstellar medium with the Hopkins Ultraviolet Telescope

    Science.gov (United States)

    Kimble, Randy A.; Davidsen, Arthur F.; Blair, William P.; Bowers, Charles W.; Van Dyke Dixon, W.; Durrance, Samuel T.; Feldman, Paul D.; Ferguson, Henry C.; Henry, Richard C.; Kriss, Gerard A.

    1993-01-01

    During the Astro-l mission in 1990 December, the Hopkins Ultraviolet Telescope (HUT) was used to observe the extreme ultraviolet spectrum (415-912 A) of the hot DA white dwarf GI91-B2B. Absorption by neutral helium shortward of the 504 A He I absorption edge is clearly detected in the raw spectrum. Model fits to the observed spectrum require interstellar neutral helium and neutral hydrogen column densities of 1.45 +/- 0.065 x 10 exp 17/sq cm and 1.69 +/- 0.12 x 10 exp 18/sq cm, respectively. Comparison of the neutral columns yields a direct assessment of the ionization state of the local interstellar cloud surrounding the Sun. The neutral hydrogen to helium ratio of 11.6 +/- 1.0 observed by HUT strongly contradicts the widespread view that hydrogen is much more ionized than helium in the local interstellar medium, a view which has motivated some exotic theoretical explanations for the supposed high ionization.

  13. Perceived parenting and adolescents’ adjustment

    Directory of Open Access Journals (Sweden)

    Joana Jaureguizar

    2018-05-01

    Full Text Available Abstract Adolescence is an important developmental period that is characterised by heightened problems of adjustment. The aim of this study is to analyse adolescents’ adjustment, and to explore the typologies and dimensions of parenting, and thus to determine the relationships between these factors. The sample comprised 1285 adolescent students aged 12 to 16 from the Basque Country (Spain. The students filled out the self-report of the Behavior Assessment System for Children (BASC and the Parental Acceptance-Rejection/Control Questionnaire, (PARQ/Control. Differences by age were found in the adolescents’ school maladjustment and parenting style perception. Moreover, perceptions of little parental warmth were related to higher levels of clinical and school maladjustment, and the lower the parental control, the greater the clinical maladjustment. Finally, the results obtained revealed that the interaction between the mothers’ and fathers’ parenting styles was significant only for clinical maladjustment; those students with neglectful mothers and authoritative fathers presented the highest level of clinical maladjustment, followed by other combinations of neglectful mothers. Furthermore, the students from neglectful and authoritarian families presented the highest levels of school maladjustment, without differences between neglectful and authoritarian or between indulgent and authoritative families.

  14. The relationship between prostate volume and prostate-specific antigen variability: data from the Baltimore Longitudinal Study of Aging and the Johns Hopkins Active Surveillance Program.

    Science.gov (United States)

    Nichols, John H; Loeb, Stacy; Metter, E Jeffrey; Ferrucci, Luigi; Carter, H Ballentine

    2012-05-01

    Study Type--Prognostic (cohort). Level of Evidence 2b. What's known on the subject? And what does the study add? Previous studies have attempted to characterize the normal biological variability in PSA among men without prostate cancer. These reports suggest that PSA variability is unrelated to age, but there are conflicting data on its association with the baseline PSA level. There are limited published data regarding the effects of prostate volume on PSA variability. A prior study assessing whether prostate volume changes would confound the use of PSA velocity in clinical practice reported that prostate volume changes were not significantly related to PSA changes. This study did not directly address the effect of baseline prostate volume on serial PSA variability. The objective of the current study was to further examine the relationship between prostate volume and PSA variability. Our hypothesis was that larger baseline prostate volume would be associated with increased PSA variability in men without known prostate cancer and in those with suspected small-volume disease. The results of the study suggest that baseline PSA, not prostate volume, is the primary driver of PSA variability in these populations. • To clarify the relationship between serial prostate-specific antigen (PSA) variability and prostate volume in both cancer-free participants from the Baltimore Longitudinal Study of Aging (BLSA) and patients with low-risk prostate cancer from the Johns Hopkins Active Surveillance Program (AS). • In all, 287 men from the BLSA and 131 patients from the AS were included in the analysis, all with at least two PSA measurements and concurrent prostate volume measurements. • PSA variability was calculated in ng/mL per year, and a linear mixed-effects model was used to determine the relative effects of prostate volume, baseline PSA and age on PSA change over time. • In a model with prostate volume, age and baseline PSA, there was no significant relationship

  15. Adjusting estimative prediction limits

    OpenAIRE

    Masao Ueki; Kaoru Fueda

    2007-01-01

    This note presents a direct adjustment of the estimative prediction limit to reduce the coverage error from a target value to third-order accuracy. The adjustment is asymptotically equivalent to those of Barndorff-Nielsen & Cox (1994, 1996) and Vidoni (1998). It has a simpler form with a plug-in estimator of the coverage probability of the estimative limit at the target value. Copyright 2007, Oxford University Press.

  16. Adjustable Pitot Probe

    Science.gov (United States)

    Ashby, George C., Jr.; Robbins, W. Eugene; Horsley, Lewis A.

    1991-01-01

    Probe readily positionable in core of uniform flow in hypersonic wind tunnel. Formed of pair of mating cylindrical housings: transducer housing and pitot-tube housing. Pitot tube supported by adjustable wedge fairing attached to top of pitot-tube housing with semicircular foot. Probe adjusted both radially and circumferentially. In addition, pressure-sensing transducer cooled internally by water or other cooling fluid passing through annulus of cooling system.

  17. Demographically corrected norms for African Americans and Caucasians on the Hopkins Verbal Learning Test-Revised, Brief Visuospatial Memory Test-Revised, Stroop Color and Word Test, and Wisconsin Card Sorting Test 64-Card Version.

    Science.gov (United States)

    Norman, Marc A; Moore, David J; Taylor, Michael; Franklin, Donald; Cysique, Lucette; Ake, Chris; Lazarretto, Deborah; Vaida, Florin; Heaton, Robert K

    2011-08-01

    Memory and executive functioning are two important components of clinical neuropsychological (NP) practice and research. Multiple demographic factors are known to affect performance differentially on most NP tests, but adequate normative corrections, inclusive of race/ethnicity, are not available for many widely used instruments. This study compared demographic contributions for widely used tests of verbal and visual learning and memory (Brief Visual Memory Test-Revised, Hopkins Verbal Memory Test-Revised) and executive functioning (Stroop Color and Word Test, Wisconsin Card Sorting Test-64) in groups of healthy Caucasians (n = 143) and African Americans (n = 103). Demographic factors of age, education, gender, and race/ethnicity were found to be significant factors on some indices of all four tests. The magnitude of demographic contributions (especially age) was greater for African Americans than for Caucasians on most measures. New, demographically corrected T-score formulas were calculated for each race/ethnicity. The rates of NP impairment using previously published normative standards significantly overestimated NP impairment in African Americans. Utilizing the new demographic corrections developed and presented herein, NP impairment rates were comparable between the two race/ethnicities and were unrelated to the other demographic characteristics (age, education, gender) in either race/ethnicity group. Findings support the need to consider extended demographic contributions to neuropsychological test performance in clinical and research settings.

  18. Combined Use of the Rationalization of Home Medication by an Adjusted STOPP in Older Patients (RASP) List and a Pharmacist-Led Medication Review in Very Old Inpatients: Impact on Quality of Prescribing and Clinical Outcome.

    Science.gov (United States)

    Van der Linden, Lorenz; Decoutere, Liesbeth; Walgraeve, Karolien; Milisen, Koen; Flamaing, Johan; Spriet, Isabel; Tournoy, Jos

    2017-02-01

    Polypharmacy and potentially inappropriate drugs have been associated with negative outcomes in older adults which might be reduced by pharmacist interventions. Our objective was to evaluate the effect of a pharmacist intervention, consisting of the application of the Rationalization of home medication by an Adjusted STOPP in older Patients (RASP) list and a pharmacist-led medication review on polypharmacy, the quality of prescribing, and clinical outcome in geriatric inpatients. A monocentric, prospective controlled trial was undertaken at the geriatric wards of a large university hospital. Pharmacists applied the RASP list to the drugs reconciled on admission and additionally performed an expert-based medication review, upon which recommendations were provided to the treating physicians. The primary outcome was the composite endpoint of drug discontinuation and dose reduction of drugs taken on admission. Secondary outcomes included RASP-identified potentially inappropriate medications (PIMs), the number of Emergency Department (ED) visits and quality of life (QOL) registered up to 3 months after discharge. On average, patients (n = 172) took 10 drugs on admission and were 84.5 years (standard deviation 4.8) of age. More drugs were discontinued or reduced in dose in the intervention group {control vs.intervention:median (interquartile range [IQR]) 3 (2-5) vs. 5 (3-7); p < 0.001}. More PIMs were discontinued in the intervention group, leading to less PIM at discharge [control vs.intervention:median (IQR) 2 (1-3) vs. 0.5 (0-1); p < 0.001]. No signal of harm was seen, and a significant improvement of QOL and less ED visits without hospitalization were observed. The combined intervention safely reduced drug use in very old inpatients and outperformed usual geriatric care. An increased QOL was seen, as well as a trend towards less ED visits. ClinicalTrials.gov Identifier: NCT01513265.

  19. Convexity Adjustments for ATS Models

    DEFF Research Database (Denmark)

    Murgoci, Agatha; Gaspar, Raquel M.

    . As a result we classify convexity adjustments into forward adjustments and swaps adjustments. We, then, focus on affine term structure (ATS) models and, in this context, conjecture convexity adjustments should be related of affine functionals. In the case of forward adjustments, we show how to obtain exact...

  20. Sustainable urban regime adjustments

    DEFF Research Database (Denmark)

    Quitzau, Maj-Britt; Jensen, Jens Stissing; Elle, Morten

    2013-01-01

    The endogenous agency that urban governments increasingly portray by making conscious and planned efforts to adjust the regimes they operate within is currently not well captured in transition studies. There is a need to acknowledge the ambiguity of regime enactment at the urban scale. This direc...

  1. CNTNAP2 and NRXN1 are mutated in autosomal-recessive Pitt-Hopkins-like mental retardation and determine the level of a common synaptic protein in Drosophila

    DEFF Research Database (Denmark)

    Zweier, Christiane; de Jong, Eiko K; Zweier, Markus

    2009-01-01

    , phenotypically overlapping with Pitt-Hopkins syndrome. With a frequency of at least 1% in our cohort of 179 patients, recessive defects in CNTNAP2 appear to significantly contribute to severe MR. Whereas the established synaptic role of NRXN1 suggests that synaptic defects contribute to the associated...... protein can reorganize synaptic morphology and induce increased density of active zones, the synaptic domains of neurotransmitter release. Moreover, both Nrx-I and Nrx-IV determine the level of the presynaptic active-zone protein bruchpilot, indicating a possible common molecular mechanism in Nrx...

  2. Downhole adjustable bent assemblies

    International Nuclear Information System (INIS)

    Askew, W.E.

    1992-01-01

    This patent describes downhole adjustable apparatus for creating a bend angle in order to affect the inclination of a drilled borehole. It comprises an upper tubular member having an upper portion and a lower portion; lower tubular member having an upper portion and a lower portion; one of the portions being received within the other for relative rotational movement about an axis that is inclined with respect to the the longitudinal axes of the members, whereby in a first rotational position the longitudinal axes have one geometrical relationship, and in a second rotational position the longitudinal axes have a second, different geometrical relationship

  3. Continuously adjustable Pulfrich spectacles

    Science.gov (United States)

    Jacobs, Ken; Karpf, Ron

    2011-03-01

    A number of Pulfrich 3-D movies and TV shows have been produced, but the standard implementation has inherent drawbacks. The movie and TV industries have correctly concluded that the standard Pulfrich 3-D implementation is not a useful 3-D technique. Continuously Adjustable Pulfrich Spectacles (CAPS) is a new implementation of the Pulfrich effect that allows any scene containing movement in a standard 2-D movie, which are most scenes, to be optionally viewed in 3-D using inexpensive viewing specs. Recent scientific results in the fields of human perception, optoelectronics, video compression and video format conversion are translated into a new implementation of Pulfrich 3- D. CAPS uses these results to continuously adjust to the movie so that the viewing spectacles always conform to the optical density that optimizes the Pulfrich stereoscopic illusion. CAPS instantly provides 3-D immersion to any moving scene in any 2-D movie. Without the glasses, the movie will appear as a normal 2-D image. CAPS work on any viewing device, and with any distribution medium. CAPS is appropriate for viewing Internet streamed movies in 3-D.

  4. Adjustment Criterion and Algorithm in Adjustment Model with Uncertain

    Directory of Open Access Journals (Sweden)

    SONG Yingchun

    2015-02-01

    Full Text Available Uncertainty often exists in the process of obtaining measurement data, which affects the reliability of parameter estimation. This paper establishes a new adjustment model in which uncertainty is incorporated into the function model as a parameter. A new adjustment criterion and its iterative algorithm are given based on uncertainty propagation law in the residual error, in which the maximum possible uncertainty is minimized. This paper also analyzes, with examples, the different adjustment criteria and features of optimal solutions about the least-squares adjustment, the uncertainty adjustment and total least-squares adjustment. Existing error theory is extended with new observational data processing method about uncertainty.

  5. Statistical Reasoning and Methods in Epidemiology to Promote Individualized Health: In Celebration of the 100th Anniversary of the Johns Hopkins Bloomberg School of Public Health.

    Science.gov (United States)

    Ogburn, Elizabeth L; Zeger, Scott L

    2016-03-01

    Epidemiology is concerned with determining the distribution and causes of disease. Throughout its history, epidemiology has drawn upon statistical ideas and methods to achieve its aims. Because of the exponential growth in our capacity to measure and analyze data on the underlying processes that define each person's state of health, there is an emerging opportunity for population-based epidemiologic studies to influence health decisions made by individuals in ways that take into account the individuals' characteristics, circumstances, and preferences. We refer to this endeavor as "individualized health." The present article comprises 2 sections. In the first, we describe how graphical, longitudinal, and hierarchical models can inform the project of individualized health. We propose a simple graphical model for informing individual health decisions using population-based data. In the second, we review selected topics in causal inference that we believe to be particularly useful for individualized health. Epidemiology and biostatistics were 2 of the 4 founding departments in the world's first graduate school of public health at Johns Hopkins University, the centennial of which we honor. This survey of a small part of the literature is intended to demonstrate that the 2 fields remain just as inextricably linked today as they were 100 years ago. © The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  6. A life domains perspective on acculturation and psychological adjustment: a study of refugees from the former Soviet Union.

    Science.gov (United States)

    Birman, Dina; Simon, Corrina D; Chan, Wing Yi; Tran, Nellie

    2014-03-01

    The study articulates a contextual approach to research on acculturation of immigrants, suggesting that the relationship between acculturation and adjustment is dependent on the cultural demands of the life domains considered. Specifically, the study investigated the mediating effects of adjustment in occupational and social life domains on the relationship between acculturation and psychological adjustment for 391 refugees from the former Soviet Union. The study used bilinear measures of acculturation to the host (American) and heritage (Russian) cultures. Using Structural Equation Modeling, the study confirmed the hypothesized relationships, such that the positive effects of American acculturation on psychological adjustment were mediated by occupational adjustment, and the effects of Russian acculturation on psychological adjustment were mediated by satisfaction with co-ethnic social support. Psychological adjustment was measured in two ways, as psychological well-being, using a measure of life satisfaction, and as symptoms of depression and anxiety, using the Hopkins symptom checklist (HSCL). Life satisfaction served as a mediator between adjustment in occupational and social domains and HSCL, suggesting that it may be an intervening variable through which environmental stress associated with immigration contributes to the development of symptoms of mental disorder.

  7. Adjustable continence balloons

    DEFF Research Database (Denmark)

    Kjær, Line; Fode, Mikkel; Nørgaard, Nis

    2012-01-01

    Abstract Objective. This study aimed to evaluate the results of the Danish experience with the ProACT urinary continence device inserted in men with stress urinary incontinence. Material and methods. The ProACT was inserted in 114 patients. Data were registered prospectively. The main endpoints...... in urinary leakage > 50% was seen in 72 patients (80%). Complications were seen in 23 patients. All of these were treated successfully by removal of the device in the outpatient setting followed by replacement of the device. Another eight patients had a third balloon inserted to improve continence further....... Fourteen patients (12%) ended up with an artificial sphincter or a urethral sling. Sixty patients (63%) experienced no discomfort and 58 (61%) reported being dry or markedly improved. Overall, 50 patients (53%) reported being very or predominantly satisfied. Conclusions. Adjustable continence balloons seem...

  8. Metric adjusted skew information

    DEFF Research Database (Denmark)

    Hansen, Frank

    2008-01-01

    ) that vanishes for observables commuting with the state. We show that the skew information is a convex function on the manifold of states. It also satisfies other requirements, proposed by Wigner and Yanase, for an effective measure-of-information content of a state relative to a conserved observable. We...... establish a connection between the geometrical formulation of quantum statistics as proposed by Chentsov and Morozova and measures of quantum information as introduced by Wigner and Yanase and extended in this article. We show that the set of normalized Morozova-Chentsov functions describing the possible......We extend the concept of Wigner-Yanase-Dyson skew information to something we call "metric adjusted skew information" (of a state with respect to a conserved observable). This "skew information" is intended to be a non-negative quantity bounded by the variance (of an observable in a state...

  9. Adolescent Mothers' Adjustment to Parenting.

    Science.gov (United States)

    Samuels, Valerie Jarvis; And Others

    1994-01-01

    Examined adolescent mothers' adjustment to parenting, self-esteem, social support, and perceptions of baby. Subjects (n=52) responded to questionnaires at two time periods approximately six months apart. Mothers with higher self-esteem at Time 1 had better adjustment at Time 2. Adjustment was predicted by Time 2 variables; contact with baby's…

  10. HPGe detector shielding adjustment

    International Nuclear Information System (INIS)

    Trnkova, L.; Rulik, P.

    2008-01-01

    Low-level background shielding of HPGe detectors is used mainly for environmental samples with very low content of radionuclides. National Radiation Protection Institute (SURO) in Prague is equipped with 14 HPGe detectors with relative efficiency up to 150%. The detectors are placed in a room built from materials with low content of natural radionuclides and equipped with a double isolation of the floor against radon. Detectors themselves are placed in lead or steel shielding. Steel shielding with one of these detectors with relative efficiency of 100% was chosen to be rebuilt to achieve lower minimum detectable activity (MDA). Additional lead and copper shielding was built up inside the original steel shielding to reduce the volume of the inner space and filled with nitrogen by means of evaporating liquid nitrogen. The additional lead and copper shielding, consequent reduction of the inner volume and supply of evaporated nitrogen, caused a decrease of the background count and accordingly MDA values as well. The effect of nitrogen evaporation on the net areas of peaks belonging to radon daughters is significant. The enhanced shielding adjustment has the biggest influence in low energy range, what can be seen in collected data. MDA values in energy range from 30 keV to 400 keV decreased to 0.65-0.85 of original value, in energy range from 400 keV to 2 MeV they fell to 0.70-0.97 of original value. (authors)

  11. Drugs prescribed by general practitioners according to age, gender and socioeconomic status after adjustment for multimorbidity level

    DEFF Research Database (Denmark)

    Skoog, Jessica; Midlöv, Patrik; Beckman, Anders

    2014-01-01

    of prescription drugs among patients, issued in primary health care, according to age, gender and socioeconomic status after adjustment for multimorbidity level.MethodData were collected on all individuals above 20 years of age in Östergötland county with about 400 000 inhabitants in year 2006. The John Hopkins...... ACG Case-mix was used as a proxy for multimorbidity level. Odds ratio (OR) of having prescription drugs issued in primary health care in the population and rates of prescription drug use among patients in primary health care, stated as incidence rate ratio (IRR), according to age, gender......BackgroundAge, gender and socioeconomic status have been shown to be associated with the use of prescription drugs, even after adjustment for multimorbidity. General practitioners have a holistic and patient-centred perspective and our hypothesis is that this may reflect on the prescription...

  12. Highlights of the 34th Annual Ralph E. Hopkins at Jackson Hole Seminars (JHS) on February 7-12, 2014, Jackson Hole, WY, USA.

    Science.gov (United States)

    da Silva, Rodrigo Donalisio; Schulte, Mary Beth; Miano, Roberto; Gustafson, Diedra; Nogueira, Leticia; Kim, Fernando J

    2014-04-01

    The prestigious Jackson Hole Seminars (JHS) successfully gathered several world leaders in academic urology and urologists in private practice for a unique scientific experience in Wyoming, USA. Unfortunately, this year Dr. Ralph Hopkins' seat was empty but his spirit continue to be the driving force for the meeting's excellence and friendship. The JHS has pioneered the concept of a Critique Panel comprised of previous speakers that would discuss in depth the presentations of the faculty chosen by the scientific board of the JHS. The 2014 JHS featured Dr. Fernando J. Kim, the President of JHS, Dr. Robert Flanigan, the Program Chair, and the Critique Panel that included: Drs. Peter Albertsen, Arthur Burnett, Michael Coburn, Ann Gormley, and Marshal Stoller. The invited speakers were: Drs. Leonard Gomella (1st prize), Olivier Traxer (2nd prize), Jennifer Anger, Anthony Bella, Jim Hu, and Allen Morey. Some of the in depth discussions and topics are highlighted.

  13. Ebenezer Hopkins Frost (1824-1866): William T.G. Morton's first identified patient and why he was invited to the Ether demonstration of October 16, 1846.

    Science.gov (United States)

    LeVasseur, Ryan; Desai, Sukumar P

    2012-08-01

    Although he was not the first to use ether as an anesthetic, it was not until William Thomas Green Morton's demonstration of the efficacy of ether anesthesia that its use spread rapidly throughout the world. Full identities of the first anesthetized patients of William Edward Clarke and Horace Wells are not known, but we are quite certain that Crawford Williamson Long correctly identified James Venable as his first patient to receive anesthesia. Using municipal records, historical accounts, and recent analyses of Morton's unsavory side, we undertook this study to explore three questions. First, we examine how Morton refined the technique of administering anesthesia based on Wells' failed attempt. Second, we describe the circumstances under which Morton encountered his first patient to receive anesthesia. Third, we offer an explanation as to why Morton insisted on bringing along this patient to attend the grand event we celebrate as Ether Day. This is an essay about William Thomas Green Morton and Ebenezer Hopkins Frost.

  14. Developing an academia-based public health observatory: the new global public health observatory with emphasis on urban health at Johns Hopkins Bloomberg School of Public Health.

    Science.gov (United States)

    Castillo-Salgado, Carlos

    2015-11-01

    Health observatories may differ according to their mission, institutional setting, topical emphasis or geographic coverage. This paper discusses the development of a new urban-focused health observatory, and its operational research and training infrastructure under the academic umbrella of the Department of Epidemiology and the Institute of Urban Health at the Johns Hopkins Bloomberg School of Public Health (BSPH) in Baltimore, USA. Recognizing the higher education mission of the BSPH, the development of a new professional training in public health was an important first step for the development of this observatory. This new academia-based observatory is an innovative public health research and training platform offering faculty, investigators, professional epidemiology students and research partners a physical and methodological infrastructure for their operational research and training activities with both a local urban focus and a global reach. The concept of a public health observatory and its role in addressing social health inequalities in local urban settings is discussed.

  15. Developing an academia-based public health observatory: the new global public health observatory with emphasis on urban health at Johns Hopkins Bloomberg School of Public Health

    Directory of Open Access Journals (Sweden)

    Carlos Castillo-Salgado

    2015-11-01

    Full Text Available Abstract Health observatories may differ according to their mission, institutional setting, topical emphasis or geographic coverage. This paper discusses the development of a new urban-focused health observatory, and its operational research and training infrastructure under the academic umbrella of the Department of Epidemiology and the Institute of Urban Health at the Johns Hopkins Bloomberg School of Public Health (BSPH in Baltimore, USA. Recognizing the higher education mission of the BSPH, the development of a new professional training in public health was an important first step for the development of this observatory. This new academia-based observatory is an innovative public health research and training platform offering faculty, investigators, professional epidemiology students and research partners a physical and methodological infrastructure for their operational research and training activities with both a local urban focus and a global reach. The concept of a public health observatory and its role in addressing social health inequalities in local urban settings is discussed.

  16. Using the CDC Worksite Health ScoreCard to Assess Employer Health Promotion Efforts: A Case Study at Johns Hopkins Medicine.

    Science.gov (United States)

    Safeer, Richard; Bowen, Wendy; Maung, Zaw; Lucik, Meg

    2018-02-01

    The aim of this study was to determine whether the Centers for Disease Control and Prevention Worksite Health ScoreCard (ScoreCard) is an effective vehicle for measuring workplace health promotion programs and causing change in a large employer with multiple entities defined by different physical environments and types of workers. Johns Hopkins Medicine (JHM) representatives completed a baseline ScoreCard for each of their entities. In the subsequent year, improvement of the ScoreCard was tied to leadership performance evaluation. JHM year over year scores were analyzed, along with comparisons to national benchmarks. Eleven of the 12 JHM entities improved their overall score from year one to year two and the JHM enterprise surpassed national benchmarks in year two. Organizations can use the ScoreCard as an effective measurement tool and as a method to improve the number of evidenced-based health promotion strategies provided to their employees.

  17. Susceptibility of ponderosa pine, Pinus ponderosa (Dougl. Ex Laws.), to mountain pine beetle, Dendroctonus ponderosae Hopkins, attack in uneven-aged stands in the Black Hills of South Dakota and Wyoming USA

    Science.gov (United States)

    Jose F. Negron; Kurt Allen; Blaine Cook; John R. Withrow

    2008-01-01

    Mountain pine beetle, Dendroctonus ponderosae Hopkins can cause extensive tree mortality in ponderosa pine, Pinus ponderosa Dougl. ex Laws., forests in the Black Hills of South Dakota and Wyoming. Most studies that have examined stand susceptibility to mountain pine beetle have been conducted in even-aged stands. Land managers...

  18. A Holistic Approach to Healthy School Meals: "How Hopkins High School Looked Beyond its Cafeteria when it Changed Meal Service from Fast Food to Nutritional Food. IssueTrak": A CEFPI Brief on Educational Facility Issues

    Science.gov (United States)

    Dufault, Timothy; Parsons, Meg

    2006-01-01

    The new cafeteria at Hopkins High School in Minnetonka, Minnesota is part restaurant, part study hall, part lounge area and part health-food store. From the beginning, the superintendent and food service leaders planned the facility to ensure that balanced diets with quickly prepared, but healthy, foods are offered to students to help them…

  19. Metric-adjusted skew information

    DEFF Research Database (Denmark)

    Liang, Cai; Hansen, Frank

    2010-01-01

    on a bipartite system and proved superadditivity of the Wigner-Yanase-Dyson skew informations for such states. We extend this result to the general metric-adjusted skew information. We finally show that a recently introduced extension to parameter values 1 ...We give a truly elementary proof of the convexity of metric-adjusted skew information following an idea of Effros. We extend earlier results of weak forms of superadditivity to general metric-adjusted skew information. Recently, Luo and Zhang introduced the notion of semi-quantum states...... of (unbounded) metric-adjusted skew information....

  20. [Adjustment disorder and DSM-5: A review].

    Science.gov (United States)

    Appart, A; Lange, A-K; Sievert, I; Bihain, F; Tordeurs, D

    2017-02-01

    This paper exposes the complexity and discrete characteristic of the adjustment disorder with reference to its clinical and scientific diagnosis. Even though the disorder occurs in frequent clinical circumstances after important life events, such as mobbing, burn-out, unemployment, divorce or separation, pregnancy denial, surgical operation or cancer, the adjustment disorder is often not considered in the diagnosis since better known disorders with similar symptoms prevail, such as major depression and anxiety disorder. Ten years ago, Bottéro had already noticed that the adjustment disorder diagnosis remained rather uncommon with reference to patients he was working with while Langlois assimilated this disorder with an invisible diagnosis. In order to maximize the data collection, we used the article review below and challenged their surveys and results: National Center for Biotechnology Information (NBCI - Pubmed) for international articles and Cairn.info for French literature. Moreover, we targeted the following keywords on the search engine and used articles, which had been published from 1 February 1975 to 31 January 2015: "adjustment", "adjustment disorder" and the French translation "trouble de l'adaptation". One hundred and ninety-one articles matched our search criteria. However, after a closer analysis, solely 105 articles were selected as being of interest. Many articles were excluded since they were related to non-psychiatric fields induced by the term "adaptation". Indeed, the number of corresponding articles found for the adjustment disorder literally pointed-out the lack of existing literature on that topic in comparison to more known disorders such as anxiety disorder (2661 articles) or major depression (5481 articles). This represents up to 50 times more articles in comparison to the number of articles we found on adjustment disorder and up to 20 times more articles for the eating disorder (1994), although the prevalence is not significantly

  1. A complete generalized adjustment criterion

    NARCIS (Netherlands)

    Perković, Emilija; Textor, Johannes; Kalisch, Markus; Maathuis, Marloes H.

    2015-01-01

    Covariate adjustment is a widely used approach to estimate total causal effects from observational data. Several graphical criteria have been developed in recent years to identify valid covariates for adjustment from graphical causal models. These criteria can handle multiple causes, latent

  2. Parental Divorce and Children's Adjustment.

    Science.gov (United States)

    Lansford, Jennifer E

    2009-03-01

    This article reviews the research literature on links between parental divorce and children's short-term and long-term adjustment. First, I consider evidence regarding how divorce relates to children's externalizing behaviors, internalizing problems, academic achievement, and social relationships. Second, I examine timing of the divorce, demographic characteristics, children's adjustment prior to the divorce, and stigmatization as moderators of the links between divorce and children's adjustment. Third, I examine income, interparental conflict, parenting, and parents well-being as mediators of relations between divorce and children's adjustment. Fourth, I note the caveats and limitations of the research literature. Finally, I consider notable policies related to grounds for divorce, child support, and child custody in light of how they might affect children s adjustment to their parents divorce. © 2009 Association for Psychological Science.

  3. Evaluating psychiatric symptoms in Parkinson's Disease by a clinimetric analysis of the Hopkins Symptom Checklist (SCL-90-R)

    DEFF Research Database (Denmark)

    Carrozzino, Danilo; Morberg, Bo Mohr; Siri, Chiara

    2018-01-01

    , psychoticism, and neurasthenia (apathy), as well as the SCL-90-R GSI, were the most impaired psychiatric syndromes reaching a clinically significant effect size above 0.80, whereas the total SCL-28 GSI obtained an effect size of just 0.80. Our clinimetric analysis has shown that patients with PD not only...... patients with a control group from a general population study. Scalability was tested by the non-parametric item response theory model by use of a Mokken analysis. Among the various SCL-90-R or SCL-28 subscales we identified from the clinimetric analysis that the somatization, anxiety, phobic anxiety...

  4. A clinimetric analysis of the Hopkins Symptom Checklist (SCL-90-R) in general population studies (Denmark, Norway, and Italy)

    DEFF Research Database (Denmark)

    Carrozzino, Danilo; Vassend, Olav; Bjørndal, Flemming

    2016-01-01

    the factor structure. The scalability of the traditional SCL-90-R subscales (somatization, hostility, and interpersonal sensitivity) as well as the affective subscales (depression and anxiety and ADHD) were tested by Mokken’s item response theory model. Results: Across the three general population studies...... the traditional scaled SCL-90-R factor including 83 items was identified by PCA. The Mokken analysis accepted the scalability of both the general factor and the clinical SCL-90-R subscales under examination. Conclusion: The traditional, scaled, general 83 item SCL-90-R scale is a valid measure of general...

  5. Feasibility and acceptability of the DSM-5 Field Trial procedures in the Johns Hopkins Community Psychiatry Programs.

    Science.gov (United States)

    Clarke, Diana E; Wilcox, Holly C; Miller, Leslie; Cullen, Bernadette; Gerring, Joan; Greiner, Lisa H; Newcomer, Alison; McKitty, Mellisha V; Regier, Darrel A; Narrow, William E

    2014-06-01

    The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) contains criteria for psychiatric diagnoses that reflect advances in the science and conceptualization of mental disorders and address the needs of clinicians. DSM-5 also recommends research on dimensional measures of cross-cutting symptoms and diagnostic severity, which are expected to better capture patients' experiences with mental disorders. Prior to its May 2013 release, the American Psychiatric Association (APA) conducted field trials to examine the feasibility, clinical utility, reliability, and where possible, the validity of proposed DSM-5 diagnostic criteria and dimensional measures. The methods and measures proposed for the DSM-5 field trials were pilot tested in adult and child/adolescent clinical samples, with the goal to identify and correct design and procedural problems with the proposed methods before resources were expended for the larger DSM-5 Field Trials. Results allowed for the refinement of the protocols, procedures, and measures, which facilitated recruitment, implementation, and completion of the DSM-5 Field Trials. These results highlight the benefits of pilot studies in planning large multisite studies. Copyright © 2013, American Psychiatric Association. All rights reserved.

  6. Feasibility and acceptability of the DSM-5 Field Trial procedures in the Johns Hopkins Community Psychiatry Programs†

    Science.gov (United States)

    Clarke, Diana E.; Wilcox, Holly C.; Miller, Leslie; Cullen, Bernadette; Gerring, Joan; Greiner, Lisa H.; Newcomer, Alison; Mckitty, Mellisha V.; Regier, Darrel A.; Narrow, William E.

    2014-01-01

    The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) contains criteria for psychiatric diagnoses that reflect advances in the science and conceptualization of mental disorders and address the needs of clinicians. DSM-5 also recommends research on dimensional measures of cross-cutting symptoms and diagnostic severity, which are expected to better capture patients’ experiences with mental disorders. Prior to its May 2013 release, the American Psychiatric Association (APA) conducted field trials to examine the feasibility, clinical utility, reliability, and where possible, the validity of proposed DSM-5 diagnostic criteria and dimensional measures. The methods and measures proposed for the DSM-5 field trials were pilot tested in adult and child/adolescent clinical samples, with the goal to identify and correct design and procedural problems with the proposed methods before resources were expended for the larger DSM-5 Field Trials. Results allowed for the refinement of the protocols, procedures, and measures, which facilitated recruitment, implementation, and completion of the DSM-5 Field Trials. These results highlight the benefits of pilot studies in planning large multisite studies. PMID:24615761

  7. How Do I Deal with Depression and Adjustment to My Spinal Cord Injury?

    Medline Plus

    Full Text Available ... adjustment and depression Adjustment to paralysis is a process of changing one's thoughts and feelings and is ... stem cell research? What is the clinical trials process? Get support Ask us anything Get a peer ...

  8. Medications for Sleep Schedule Adjustments in Athletes.

    Science.gov (United States)

    Baird, Matthew B; Asif, Irfan M

    Sleep schedule adjustments are common requirements of modern-day athletes. Many nonpharmacologic and pharmacologic strategies exist to facilitate circadian rhythm shifts to maximize alertness and performance during competition. This review summarizes the evidence for commonly used pharmacologic agents and presents recommendations for the sports medicine provider. MEDLINE searches were performed using the following keywords: sleep aids, circadian rhythm adjustment, athletes and sleep, caffeine and sports, melatonin and athletes, and sleep aids and sports. Pertinent articles were extracted and discussed. Clinical review. Level 2. There are very few available studies investigating pharmacologic sleep aids in athletes. Data from studies involving shift workers and airline personnel are more abundant and were used to formulate recommendations and conclusions. Melatonin, caffeine, and nonbenzodiazepine sleep aids have a role in facilitating sleep schedule changes in athletes and maximizing sports performance through sleep enhancement.

  9. Normal Stress or Adjustment Disorder?

    Science.gov (United States)

    ... disorder is a type of stress-related mental illness that can affect your feelings, thoughts and behaviors. Signs and symptoms of an adjustment disorder can include: Anxiety Poor school or work performance Relationship problems Sadness ...

  10. Time-adjusted variable resistor

    Science.gov (United States)

    Heyser, R. C.

    1972-01-01

    Timing mechanism was developed effecting extremely precisioned highly resistant fixed resistor. Switches shunt all or portion of resistor; effective resistance is varied over time interval by adjusting switch closure rate.

  11. Adjustable chain trees for proteins

    DEFF Research Database (Denmark)

    Winter, Pawel; Fonseca, Rasmus

    2012-01-01

    A chain tree is a data structure for changing protein conformations. It enables very fast detection of clashes and free energy potential calculations. A modified version of chain trees that adjust themselves to the changing conformations of folding proteins is introduced. This results in much...... tighter bounding volume hierarchies and therefore fewer intersection checks. Computational results indicate that the efficiency of the adjustable chain trees is significantly improved compared to the traditional chain trees....

  12. Electronic gaming and psychosocial adjustment.

    Science.gov (United States)

    Przybylski, Andrew K

    2014-09-01

    The rise of electronic games has driven both concerns and hopes regarding their potential to influence young people. Existing research identifies a series of isolated positive and negative effects, yet no research to date has examined the balance of these potential effects in a representative sample of children and adolescents. The objective of this study was to explore how time spent playing electronic games accounts for significant variation in positive and negative psychosocial adjustment using a representative cohort of children aged 10 to 15 years. A large sample of children and adolescents aged 10 to 15 years completed assessments of psychosocial adjustment and reported typical daily hours spent playing electronic games. Relations between different levels of engagement and indicators of positive and negative psychosocial adjustment were examined, controlling for participant age and gender and weighted for population representativeness. Low levels (3 hours daily) of game engagement was linked to key indicators of psychosocial adjustment. Low engagement was associated with higher life satisfaction and prosocial behavior and lower externalizing and internalizing problems, whereas the opposite was found for high levels of play. No effects were observed for moderate play levels when compared with non-players. The links between different levels of electronic game engagement and psychosocial adjustment were small (Games consistently but not robustly associated with children's adjustment in both positive and negative ways, findings that inform policy-making as well as future avenues for research in the area. Copyright © 2014 by the American Academy of Pediatrics.

  13. Accounting for disagreements on average cone loss rates in retinitis pigmentosa with a new kinetic model: Its relevance for clinical trials.

    Science.gov (United States)

    Baumgartner, W A; Baumgartner, A M

    2016-04-01

    contrast to this, we show that cone loss occurs in patients with increasing -k values during RP progression. And as the Hopkins' protocol selects more advanced RP cases than Harvard's to assure avoidance of ceiling effects (Harvard does this by kinetic monitoring), we show increasing -k kinetics to be the reason Harvard obtains more +k and small -k values. Thus the combined effects of (i) and (ii) produce Harvard's smaller average -k value. The relevance of the increasing biochemical stress model for optimizing clinical trials is discussed. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. The legacy of attack: implications of high phloem resin monoterpene levels in lodgepole pines following mass attack by mountain pine beetle, Dendroctonus ponderosae Hopkins.

    Science.gov (United States)

    Clark, E L; Huber, D P W; Carroll, A L

    2012-04-01

    The mountain pine beetle (Dendroctonus ponderosae Hopkins) is the most serious pest of pines (Pinus) in western North America. Host pines protect themselves from attack by producing a complex mixture of terpenes in their resin. We sampled lodgepole pine (Pinus contorta variety latifolia) phloem resin at four widely separated locations in the interior of British Columbia, Canada, both just before (beginning of July) and substantially after (end of August) the mountain pine beetle dispersal period. The sampled trees then were observed the next spring for evidence of survival, and the levels of seven resin monoterpenes were compared between July and August samples. Trees that did not survive consistently had significantly higher phloem resin monoterpene levels at the end of August compared with levels in July. Trees that did survive mainly did not exhibit a significant difference between the two sample dates. The accumulation of copious defense-related secondary metabolites in the resin of mountain pine beetle-killed lodgepole pine has important implications for describing the environmental niche that the beetle offspring survive in as well as that of parasitoids, predators, and other associates.

  15. Fiscal Adjustment in IMF-Supported Adjustment Programmes: The ...

    African Journals Online (AJOL)

    Fiscal adjustment is an essential element of macro-economic stability and economic growth. Given that economic growth is the most powerful weapon in the fight for higher living standards, poor growth performance in African countries, has been a challenge to economists, policy makers and international development ...

  16. Acculturation, personality, and psychological adjustment.

    Science.gov (United States)

    Ahadi, Stephan A; Puente-Díaz, Rogelio

    2011-12-01

    Two studies investigated relationships between traditional indicators of acculturation, cultural distance, acculturation strategies, and basic dimensions of personality as they pertain to psychological adjustment among Hispanic students. Although personality characteristics have been shown to be important determinants of psychological well-being, acculturation research has put less emphasis on the role of personality in the well-being of immigrants. Hierarchical regression analysis showed that basic dimensions of personality such as extraversion and neuroticism were strongly related to psychological adjustment. Acculturation strategies did not mediate the effect of personality variables, but cultural resistance made a small, independent contribution to the explanation of some aspects of negative psychological adjustment. The implications of the results were discussed.

  17. GPU Parallel Bundle Block Adjustment

    Directory of Open Access Journals (Sweden)

    ZHENG Maoteng

    2017-09-01

    Full Text Available To deal with massive data in photogrammetry, we introduce the GPU parallel computing technology. The preconditioned conjugate gradient and inexact Newton method are also applied to decrease the iteration times while solving the normal equation. A brand new workflow of bundle adjustment is developed to utilize GPU parallel computing technology. Our method can avoid the storage and inversion of the big normal matrix, and compute the normal matrix in real time. The proposed method can not only largely decrease the memory requirement of normal matrix, but also largely improve the efficiency of bundle adjustment. It also achieves the same accuracy as the conventional method. Preliminary experiment results show that the bundle adjustment of a dataset with about 4500 images and 9 million image points can be done in only 1.5 minutes while achieving sub-pixel accuracy.

  18. Initial Clinical Experience With the Strut-Adjusted Volume Implant (SAVI) Breast Brachytherapy Device for Accelerated Partial-Breast Irradiation (APBI): First 100 Patients With More Than 1 Year of Follow-Up

    International Nuclear Information System (INIS)

    Yashar, Catheryn M.; Scanderbeg, Daniel; Kuske, Robert; Wallace, Anne; Zannis, Victor; Blair, Sarah; Grade, Emily; Swenson, Virginia H.; Quiet, Coral

    2011-01-01

    Purpose: The Strut-Adjusted Volume Implant (SAVI; Cianna Medical, Aliso Viejo, CA) is a multichannel single-entry brachytherapy device designed to allow dose modulation to minimize normal tissue dose while simultaneously maximizing target coverage. This is the first report on the initial 102 patients with nearly 2 years of median follow-up. Methods and Materials: One hundred two patients were treated at two institutions. Data were collected on eligibility and dosimetry and followed for toxicity and recurrence. Results: The median follow-up is 21 months. Overall dosimetry is outstanding (median percent of target volume receiving 90% of the prescription dose was 95.9%, volume of target receiving 150% of the prescription dose was 27.8 mL, and volume of target receiving 200% of the prescription dose was 14.0 cm 3 ). No devices were pulled prior to treatment completion. For patients with a skin bridge of less than 7 mm, the maximum median skin dose was 280 cGy (median percent of target volume receiving 90% of the prescription dose was 95.2%, volume of target receiving 150% of the prescription dose was 25.8 cm 3 and volume of target receiving 200% of the prescription dose was 12.7 mL). For patients with both chest wall and skin of less than 7 mm, the maximum median lung dose was 205 cGy with simultaneous skin dose of 272 cGy. The rate of telangiectasia was 1.9%. Grade 1 hyperpigmentation developed in 10 patients (9.8%) and Grade 2 fibrosis in 2 patients (1.9%). There were 2 symptomatic seromas and 2 cases of asymptomatic fat necrosis (1.9%). Of the patients, 27% were not eligible for MammoSite balloon brachytherapy (Hologic, Inc., Marlborough, MA) and 5% were not eligible for any balloon brachytherapy. The recurrence rate was 1%. Conclusions: The SAVI appears to safely allow an increase in eligibility for APBI over balloon brachytherapy or three-dimensional conformal radiation, highlighting the outstanding device flexibility to maximize the target dose and minimize the

  19. Risk and Protective Factors at Age 16: Psychological Adjustment in Children With a Cleft Lip and/or Palate.

    Science.gov (United States)

    Feragen, Kristin Billaud; Stock, Nicola Marie; Kvalem, Ingela Lundin

    2015-09-01

    Explore psychological functioning in adolescents with a cleft at age 16 from a broad perspective, including cognitive, emotional, behavioral, appearance-related, and psychosocial adjustment. High-risk groups were identified within each area of adjustment to investigate whether vulnerable adolescents were found across domains or whether risk was limited to specific areas of adjustment. Cross-sectional data based on psychological assessments at age 16 (N = 857). The effect of gender, cleft visibility, and the presence of an additional condition were investigated on all outcome variables. Results were compared with large national samples. Hopkins Symptom Checklist, Harter Self-Perception Scale for Adolescents, Child Experience Questionnaire, and Satisfaction With Appearance scale. The main factor influencing psychological adjustment across domains was gender, with girls in general reporting more psychological problems, as seen in reference groups. The presence of an additional condition also negatively affected some of the measures. No support was found for cleft visibility as a risk factor except for dissatisfaction with appearance. Correlation analyses of risk groups seem to point to an association between social and emotional risk and between social risk and dissatisfaction with appearance. Associations between other domains were found to be weak. The results point to areas of both risk and strength in adolescents born with a cleft lip and/or palate. Future research should investigate how protective factors could counteract potential risk in adolescents with a cleft.

  20. The development of a model of psychological first aid for non-mental health trained public health personnel: the Johns Hopkins RAPID-PFA.

    Science.gov (United States)

    Everly, George S; Lee McCabe, O; Semon, Natalie L; Thompson, Carol B; Links, Jonathan M

    2014-01-01

    The Johns Hopkins Center for Public Health Preparedness, which houses the Centers for Disease Control and Prevention-funded Preparedness and Emergency Response Learning Center, has been addressing the challenge of disaster-caused behavioral health surge by conducting training programs in psychological first aid (PFA) for public health professionals. This report describes our approach, named RAPID-PFA, and summarizes training evaluation data to determine if relevant knowledge, skills, and attitudes are imparted to trainees to support effective PFA delivery. In the wake of disasters, there is an increase in psychological distress and dysfunction among survivors and first responders. To meet the challenges posed by this surge, a professional workforce trained in PFA is imperative. More than 1500 participants received a 1-day RAPID-PFA training. Pre-/postassessments were conducted to measure (a) required knowledge to apply PFA; (b) perceived self-efficacy, that is, belief in one's own ability, to apply PFA techniques; and (c) confidence in one's own resilience in a crisis context. Statistical techniques were used to validate the extent to which the survey successfully measured individual PFA constructs, that is, unidimensionality, and to quantify the reliability of the assessment tool. Statistically significant pre-/postimprovements were observed in (a) knowledge items supportive of PFA delivery, (b) perceived self-efficacy to apply PFA interventions, and (c) confidence about being a resilient PFA provider. Cronbach alpha coefficients ranging from 0.87 to 0.90 suggested that the self-reported measures possessed sufficient internal consistency. Findings were consistent with our pilot work, and with our complementary research initiatives validating a variant of RAPID-PFA with faith communities. The RAPID-PFA model promises to be a broadly applicable approach to extending community behavioral health surge capacity. Relevant next steps include evaluating the effectiveness

  1. Impact of a New Palliative Care Program on Health System Finances: An Analysis of the Palliative Care Program Inpatient Unit and Consultations at Johns Hopkins Medical Institutions.

    Science.gov (United States)

    Isenberg, Sarina R; Lu, Chunhua; McQuade, John; Chan, Kelvin K W; Gill, Natasha; Cardamone, Michael; Torto, Deirdre; Langbaum, Terry; Razzak, Rab; Smith, Thomas J

    2017-05-01

    Palliative care inpatient units (PCUs) can improve symptoms, family perception of care, and lower per-diem costs compared with usual care. In March 2013, Johns Hopkins Medical Institutions (JHMI) added a PCU to the palliative care (PC) program. We studied the financial impact of the PC program on JHMI from March 2013 to March 2014. This study considered three components of the PC program: PCU, PC consultations, and professional fees. Using 13 months of admissions data, the team calculated the per-day variable cost pre-PCU (ie, in another hospital unit) and after transfer to the PCU. These fees were multiplied by the number of patients transferred to the PCU and by the average length of stay in the PCU. Consultation savings were estimated using established methods. Professional fees assumed a collection rate of 50%. The total positive financial impact of the PC program was $3,488,863.17. There were 153 transfers to the PCU, 60% with cancer, and an average length of stay of 5.11 days. The daily loss pretransfer to the PCU of $1,797.67 was reduced to $1,345.34 in the PCU (-25%). The PCU saved JHMI $353,645.17 in variable costs, or $452.33 per transfer. Cost savings for PC consultations in the hospital, 60% with cancer, were estimated at $2,765,218. $370,000 was collected in professional fees savings. The PCU and PC program had a favorable impact on JHMI while providing expert patient-centered care. As JHMI moves to an accountable care organization model, value-based patient-centered care and increased intensive care unit availability are desirable.

  2. Kinematic adjustments to seismic recordings

    Energy Technology Data Exchange (ETDEWEB)

    Telegin, A.N.; Levii, N.V.; Volovik, U.M.

    1981-01-01

    The introduction of kinematic adjustments by adding the displaced blocks is studied theoretically and in test seismograms. The advantage to this method resulting from the weight variation in the trace is demonstrated together with its kinematic drawback. A variation on the displaced block addition method that does not involve realignment of the travel time curves and that has improved amplitude characteristics is proposed.

  3. Birth-Order Complementarity and Marital Adjustment.

    Science.gov (United States)

    Vos, Cornelia J. Vanderkooy; Hayden, Delbert J.

    1985-01-01

    Tested the influence of birth-order complementarity on marital adjustment among 327 married women using the Spanier Dyadic Adjustment Scale (1976). Birth-order complementarity was found to be unassociated with marital adjustment. (Author/BL)

  4. A randomized clinical trial evaluating gingivitis and plaque reduction of an oscillating-rotating power brush with a new brush head with angled bristles versus a marketed sonic brush with self-adjusting technology.

    Science.gov (United States)

    Klukowska, Malgorzata; Grender, Julie M; Conde, Erinn; Ccahuana-Vasquez, Renzo Alberto; Ram Goyal, C

    2014-08-01

    To compare the efficacy of an oscillating-rotating power toothbrush with a novel brush head incorporating angled CrissCross bristles (Oral-B Pro 7000 SmartSeries and Oral-B CrossAction brush head) versus a marketed sonic toothbrush (Colgate ProClinical A1500 with the Triple Clean brush head) in the reduction of gingivitis and plaque over a 6-week period. This was a single center, randomized, open label, examiner-blind, 2-treatment, parallel group study. Study participants who met the entrance criteria were enrolled in the study and randomly assigned to one of the two toothbrush groups. Study participants brushed with their assigned toothbrush and a marketed fluoride dentifrice for 2 minutes twice daily at home for 6 weeks. Gingivitis and plaque were evaluated at baseline and Week 6. Gingivitis was assessed using the Modified Gingival Index (MGI) and Gingival Bleeding Index (GBI) and plaque was assessed using the Rustogi Modified Navy Plaque Index (RMNPI). Data was analyzed using the ANCOVA with baseline as the covariate. In total, 130 study participants were randomized to treatment resulting in 64 study participants per group completing the study. Both brushes produced statistically significant (P gingivitis and plaque measures relative to baseline. The oscillating-rotating,brush with the novel brush head demonstrated statistically significantly (P gingivitis measures, as well as whole mouth and interproximal plaque measures, compared to the sonic toothbrush. The benefit for the oscillating- rotating brush over the sonic brush was 21.3% for gingivitis, 35.7% for gingival bleeding, 34.7% for number of bleeding sites, 17.4% for whole mouth plaque, and 21.2% for interproximal plaque. There were no adverse events reported or observed for either brush.

  5. Hopkins Syndrome with Mycoplasma Infection

    OpenAIRE

    J Gordon Millichap

    1997-01-01

    A 3-year-old boy with acute flaccid paralysis of the right lower limb developing one week after treatment and recovery from an acute asthma attack is reported from the Department of Child Health, Milton Keynes General Hospital, UK.

  6. Parenting Perfectionism and Parental Adjustment

    OpenAIRE

    Lee, Meghan A.; Schoppe-Sullivan, Sarah J.; Kamp Dush, Claire M.

    2012-01-01

    The parental role is expected to be one of the most gratifying and rewarding roles in life. As expectations of parenting become ever higher, the implications of parenting perfectionism for parental adjustment warrant investigation. Using longitudinal data from 182 couples, this study examined the associations between societal- and self-oriented parenting perfectionism and new mothers’ and fathers’ parenting self-efficacy, stress, and satisfaction. For mothers, societal-oriented parenting perf...

  7. Adjustment problems and residential care environment

    Directory of Open Access Journals (Sweden)

    Jan Sebastian Novotný

    2015-01-01

    Full Text Available Problem: Residential care environment represents a specific social space that is associated with a number of negative consequences, covering most aspects of children and youth functioning. The paper analyzes of the presence of adjustment problems among adolescents from institutional care environment and compares this results with a population of adolescents who grew up in a family. Methods: The sample consisted of two groups of adolescents. The first group included 285 adolescents currently growing up in an residential care environment, aged 13 to 21 (M = 16.23, SD = 1.643. The second group consisted of 214 adolescents growing up in a family, aged 15 to 20 (M = 17.07, SD = 1.070. We used a questionnaire Youth Self Report. Data were analyzed using descriptive statistics and MANOVA. Results: Results showed that adolescents in residential care exhibit higher average values in all adjustment problems. Also, in the context of diagnostic categories are the residential care adolescents more frequently in non-normal range (borderline and clinical, primarily in the border range. The greatest differences were reflected in the Thought problems and Rule-breaking behavior. MANOVA showed a significant multivariate effect between groups of adolescents, Hotelling's T = .803, F(8, 490 = 49.202, p <.001, d = .445 (large effect. Univariate analysis further showed a significant effect for Withdrawn/depressed (p = .044, d = .089, small effect, Somatic complaints (p = .002, d = .139, medium effect, Social problems (p = 004, d = .127, a small effect, Thought problems (p <.001, d = .633, strong effect, Attention problems (p <.001, d = .320,strong effect, Rule-breaking behavior (p <.001 , d = .383, strong effect, and Aggressive behavior (p = 015, d = .110, small effect. Results for the dimension of Anxious/depressed were not significant (p = .159. Discussion: The results didn’t confirmed the assumption that more than 30% of residential care adolescents have adjustment

  8. 12 CFR 19.240 - Inflation adjustments.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Inflation adjustments. 19.240 Section 19.240... PROCEDURE Civil Money Penalty Inflation Adjustments § 19.240 Inflation adjustments. (a) The maximum amount... Civil Penalties Inflation Adjustment Act of 1990 (28 U.S.C. 2461 note) as follows: ER10NO08.001 (b) The...

  9. Direct comparison of risk-adjusted and non-risk-adjusted CUSUM analyses of coronary artery bypass surgery outcomes.

    Science.gov (United States)

    Novick, Richard J; Fox, Stephanie A; Stitt, Larry W; Forbes, Thomas L; Steiner, Stefan

    2006-08-01

    We previously applied non-risk-adjusted cumulative sum methods to analyze coronary bypass outcomes. The objective of this study was to assess the incremental advantage of risk-adjusted cumulative sum methods in this setting. Prospective data were collected in 793 consecutive patients who underwent coronary bypass grafting performed by a single surgeon during a period of 5 years. The composite occurrence of an "adverse outcome" included mortality or any of 10 major complications. An institutional logistic regression model for adverse outcome was developed by using 2608 contemporaneous patients undergoing coronary bypass. The predicted risk of adverse outcome in each of the surgeon's 793 patients was then calculated. A risk-adjusted cumulative sum curve was then generated after specifying control limits and odds ratio. This risk-adjusted curve was compared with the non-risk-adjusted cumulative sum curve, and the clinical significance of this difference was assessed. The surgeon's adverse outcome rate was 96 of 793 (12.1%) versus 270 of 1815 (14.9%) for all the other institution's surgeons combined (P = .06). The non-risk-adjusted curve reached below the lower control limit, signifying excellent outcomes between cases 164 and 313, 323 and 407, and 667 and 793, but transgressed the upper limit between cases 461 and 478. The risk-adjusted cumulative sum curve never transgressed the upper control limit, signifying that cases preceding and including 461 to 478 were at an increased predicted risk. Furthermore, if the risk-adjusted cumulative sum curve was reset to zero whenever a control limit was reached, it still signaled a decrease in adverse outcome at 166, 653, and 782 cases. Risk-adjusted cumulative sum techniques provide incremental advantages over non-risk-adjusted methods by not signaling a decrement in performance when preoperative patient risk is high.

  10. Is the distinction between adjustment disorder with depressed mood and adjustment disorder with mixed anxious and depressed mood valid?

    Science.gov (United States)

    Zimmerman, Mark; Martinez, Jennifer H; Dalrymple, Kristy; Martinez, Jennifer H; Chelminski, Iwona; Young, Diane

    2013-11-01

    In the DSM-IV, adjustment disorder is subtyped according to the predominant presenting feature. The different diagnostic code numbers assigned to each subtype suggest their significance in DSM-IV. However, little research has examined the validity of these subtypes. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compared the demographic and clinical profiles of patients diagnosed with adjustment disorder subtypes to determine whether there was enough empirical evidence supporting the retention of multiple adjustment disorder subtypes in future versions of the DSM. A total of 3,400 psychiatric patients presenting to the Rhode Island Hospital outpatient practice were evaluated with semistructured diagnostic interviews for DSM-IV Axis I and Axis II disorders and measures of psychosocial morbidity. Approximately 7% (224 of 3,400) of patients were diagnosed with current adjustment disorder. Adjustment disorder with depressed mood and with mixed anxious and depressed mood were the most common subtypes, accounting for 80% of the patients diagnosed with adjustment disorder. There was no significant difference between these 2 groups with regard to demographic variables, current comorbid Axis I or Axis II disorders, lifetime history of major depressive disorder or anxiety disorders, psychosocial morbidity, or family history of psychiatric disorders. The only difference between the groups was lifetime history of drug use, which was significantly higher in the patients diagnosed with adjustment disorder with depressed mood. There is no evidence supporting the retention of both of these adjustment disorder subtypes, and DSM-IV previously set a precedent for eliminating adjustment disorder subtypes in the absence of any data. Therefore, in the spirit of nosologic parsimony, consideration should be given to collapsing the 2 disorders into 1: adjustment disorder with depressed mood.

  11. Adjustable extender for instrument module

    International Nuclear Information System (INIS)

    Sevec, J.B.; Stein, A.D.

    1975-01-01

    A blank extender module used to mount an instrument module in front of its console for repair or test purposes has been equipped with a rotatable mount and means for locking the mount at various angles of rotation for easy accessibility. The rotatable mount includes a horizontal conduit supported by bearings within the blank module. The conduit is spring-biased in a retracted position within the blank module and in this position a small gear mounted on the conduit periphery is locked by a fixed pawl. The conduit and instrument mount can be pulled into an extended position with the gear clearing the pawl to permit rotation and adjustment of the instrument

  12. Adjustable Tooling for Bending Brake

    Science.gov (United States)

    Ellis, J. M.

    1986-01-01

    Deep metal boxes and other parts easily fabricated. Adjustable tooling jig for bending brake accommodates spacing blocks and either standard male press-brake die or bar die. Holds spacer blocks, press-brake die, bar window die, or combination of three. Typical bending operations include bending of cut metal sheet into box and bending of metal strip into bracket with multiple inward 90 degree bends. By increasing free space available for bending sheet-metal parts jig makes it easier to fabricate such items as deep metal boxes or brackets with right-angle bends.

  13. Personality, emotional adjustment, and cardiovascular risk: marriage as a mechanism.

    Science.gov (United States)

    Smith, Timothy W; Baron, Carolynne E; Grove, Jeremy L

    2014-12-01

    A variety of aspects of personality and emotional adjustment predict the development and course of coronary heart disease (CHD), as do indications of marital quality (e.g., satisfaction, conflict, strain, disruption). Importantly, the personality traits and aspects of emotional adjustment that predict CHD are also related to marital quality. In such instances of correlated risk factors, traditional epidemiological and clinical research typically either ignores the potentially overlapping effects or examines independent associations through statistical controls, approaches that can misrepresent the key components and mechanisms of psychosocial effects on CHD. The interpersonal perspective in personality and clinical psychology provides an alternative and integrative approach, through its structural and process models of interpersonal behavior. We present this perspective on psychosocial risk and review research on its application to the integration of personality, emotional adjustment, and marital processes as closely interrelated influences on health and disease. © 2013 Wiley Periodicals, Inc.

  14. Development and Adjustment of Adopted Adolescents : Longitudinal and Concurrent Factors

    NARCIS (Netherlands)

    Jaffari-Bimmel, Nicole

    2005-01-01

    The first study of this thesis (Chapter 2) showed that the majority of the internationally adopted children are well adjusted, although a relatively large minority of adopted children had behavior problems of clinical significance or were referred to mental health services compared with non-adopted

  15. Association of Unconscious Race and Social Class Bias With Vignette-Based Clinical Assessments by Medical Students

    Science.gov (United States)

    Haider, Adil H.; Sexton, Janel; Sriram, N.; Cooper, Lisa A.; Efron, David T.; Swoboda, Sandra; Villegas, Cassandra V.; Haut, Elliott R.; Bonds, Morgan; Pronovost, Peter J.; Lipsett, Pamela A.; Freischlag, Julie A.; Cornwell, Edward E.

    2012-01-01

    Context Studies involving physicians suggest that unconscious bias may be related to clinical decision making and may predict poor patient-physician interaction. The presence of unconscious race and social class bias and its association with clinical assessments or decision making among medical students is unknown. Objective To estimate unconscious race and social class bias among first-year medical students and investigate its relationship with assessments made during clinical vignettes. Design, Setting, and Participants A secure Web-based survey was administered to 211 medical students entering classes at Johns Hopkins School of Medicine, Baltimore, Maryland, in August 2009 and August 2010. The survey included the Implicit Association Test (IAT) to assess unconscious preferences, direct questions regarding students’ explicit race and social class preferences, and 8 clinical assessment vignettes focused on pain assessment, informed consent, patient reliability, and patient trust. Adjusting for student demographics, multiple logistic regression was used to determine whether responses to the vignettes were associated with unconscious race or social class preferences. Main Outcome Measures Association of scores on an established IAT for race and a novel IAT for social class with vignette responses. Results Among the 202 students who completed the survey, IAT responses were consistent with an implicit preference toward white persons among 140 students (69%, 95% CI, 61%–75%). Responses were consistent with a preference toward those in the upper class among 174 students (86%, 95% CI, 80%–90%). Assessments generally did not vary by patient race or occupation, and multivariable analyses for all vignettes found no significant relationship between implicit biases and clinical assessments. Regression coefficient for the association between pain assessment and race IAT scores was −0.49 (95% CI, −1.00 to 0.03) and for social class, the coefficient was −0.04 (95% CI

  16. Culture, emotion regulation, and adjustment.

    Science.gov (United States)

    Matsumoto, David; Yoo, Seung Hee; Nakagawa, Sanae

    2008-06-01

    This article reports differences across 23 countries on 2 processes of emotion regulation--reappraisal and suppression. Cultural dimensions were correlated with country means on both and the relationship between them. Cultures that emphasized the maintenance of social order--that is, those that were long-term oriented and valued embeddedness and hierarchy--tended to have higher scores on suppression, and reappraisal and suppression tended to be positively correlated. In contrast, cultures that minimized the maintenance of social order and valued individual Affective Autonomy and Egalitarianism tended to have lower scores on Suppression, and Reappraisal and Suppression tended to be negatively correlated. Moreover, country-level emotion regulation was significantly correlated with country-level indices of both positive and negative adjustment. (PsycINFO Database Record (c) 2008 APA, all rights reserved).

  17. Stability of anterior open-bite treatment with occlusal adjustment.

    Science.gov (United States)

    Janson, Guilherme; Crepaldi, Marcus Vinicius; Freitas, Karina Maria Salvatore; de Freitas, Marcos Roberto; Janson, Waldyr

    2010-07-01

    In this study, we aimed to evaluate the long-term stability of anterior open-bite treatment with occlusal adjustment and the dentinal sensitivity caused by this procedure in the long term. The sample comprised 17 open-bite patients who experienced relapse of the negative vertical overbite after orthodontic treatment and were retreated with occlusal adjustment. The cephalometric changes were evaluated on lateral cephalograms obtained before and after the occlusal adjustment and in the long term (mean, 3.4 years after occlusal adjustment). Dentinal sensitivity was also evaluated before the occlusal adjustment, and 1.35 months, 4.61 months, and 3.4 years later. The cephalometric statuses between the 3 evaluations were compared with analysis of variance (ANOVA) and Tukey tests. The percentages of clinically significant relapse were calculated. To compare dentinal sensitivity at the several stages, nonparametric Friedman and Wilcoxon tests were performed. Statistically significant relapse of anterior open bite occurred in 33.3% of the patients. Those who had the procedure before 21 years of age were most likely to experience relapse. Dentinal sensitivity remained within the normal range in the long term. Despite the statistically significant relapse of anterior open bite, clinically significant stability was found in 66.7% of the patients. Copyright (c) 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

  18. EFFECTIVENESS OF CHIROPRACTIC ADJUSTMENT IN LUMBAR PAIN IN CROSSFIT PRACTITIONERS

    Directory of Open Access Journals (Sweden)

    DESIREE MOEHLECKE

    Full Text Available ABSTRACT Objective: To evaluate the efficacy of acute chiropractic adjustment in individuals who practice CrossFit with regard to complaints of low back pain and the joint range of motion in this region. Methods: A randomized clinical trial comprised of CrossFit practitioners from a box in Novo Hamburgo-RS, of both sexes and aged 18 to 40 years who had low back pain at the time of the study. The following tools were used: Semi-structured Anamnesis Questionnaire, Visual Analog Scale, McGill Pain Questionnaire, and SF-36 Quality of Life Questionnaire. Individuals in the control group answered the questionnaires before and after CrossFit training. The chiropractic group performed the same procedure, plus pre-training chiropractic adjustment and joint range of motion (ROM before and after lumbar adjustment. Results: There was a significant increase in pain in the control group, and a significant decrease in pain in the chiropractic group, including one day after the chiropractic adjustment. In the chiropractic group, the joint ranges of motion had a significant increase in flexion and extension of the lumbar spine after chiropractic adjustment. Conclusion: The chiropractic group achieved a significant improvement in pain level and joint range of motion, suggesting that acute chiropractic adjustment was effective in reducing low back pain.

  19. The Persian Version of Fertility Adjustment Scale: Psychometric Properties

    Directory of Open Access Journals (Sweden)

    Asma Tiyuri

    2018-05-01

    Full Text Available Background Infertility is a common clinical problem. Psychological adjustment to infertility refers to changing the viewpoint and attitude of an infertile person toward infertility problems, treatments and possible outcomes. The present study aims to prepare a valid and reliable scale for assessing the psychological adjustment to infertility, by determining the cultural adaptation, validity and reliability of the Persian version of the Fertility Adjustment Scale. Materials and Methods This is a cross-sectional study performed to localize and validate the Fertility Adjustment Scale, in which 40 infertile women and 40 healthy subjects (fertile or having children were detected by a gynecolo- gist and the subjects who completed the Fertility Adjustment Scale (FAS questionnaire were recruited. This study had four steps: in the first step, the literature was reviewed, in the second step, the scale was translated, in the third step, the content and construct validity indicators were calculated, and in the fourth step, reliability of the scale was validated. Results The mean (± SE and range of fertility adjustment total scores in the infertile group and the control group were 43.2 (1.2 and 27-57 and 42.3 (1.5 and 18-57, respectively (P=0.623. The content validity was good according to Con- tent Validity Index score (0.7-0.8. A two-component structure was extracted from factor analysis which approximately justifies 52.0% of the cumulative variations. A Cronbach’s alpha value of 0.68 showed moderate reliability. Conclusion The results of this study revealed that the infertility adjustment scale is a useful tool for the analysis of psy- chological reactions towards infertility problems and evaluation of the consequences of treating this social-clinical problem.

  20. Theory of Work Adjustment Personality Constructs.

    Science.gov (United States)

    Lawson, Loralie

    1993-01-01

    To measure Theory of Work Adjustment personality and adjustment style dimensions, content-based scales were analyzed for homogeneity and successively reanalyzed for reliability improvement. Three sound scales were developed: inflexibility, activeness, and reactiveness. (SK)

  1. Refractive accuracy with light-adjustable intraocular lenses.

    Science.gov (United States)

    Villegas, Eloy A; Alcon, Encarna; Rubio, Elena; Marín, José M; Artal, Pablo

    2014-07-01

    To evaluate efficacy, predictability, and stability of refractive treatments using light-adjustable intraocular lenses (IOLs). University Hospital Virgen de la Arrixaca, Murcia, Spain. Prospective nonrandomized clinical trial. Eyes with a light-adjustable IOL (LAL) were treated with spatial intensity profiles to correct refractive errors. The effective changes in refraction in the light-adjustable IOL after every treatment were estimated by subtracting those in the whole eye and the cornea, which were measured with a Hartmann-Shack sensor and a corneal topographer, respectively. The refractive changes in the whole eye and light-adjustable IOL, manifest refraction, and visual acuity were obtained after every light treatment and at the 3-, 6-, and 12-month follow-ups. The study enrolled 53 eyes (49 patients). Each tested light spatial pattern (5 spherical; 3 astigmatic) produced a different refractive change (Plight adjustments induced a maximum change in spherical power of the light-adjustable IOL of between -1.98 diopters (D) and +2.30 D and in astigmatism of up to -2.68 D with axis errors below 9 degrees. Intersubject variability (standard deviation) ranged between 0.10 D and 0.40 D. The 2 required lock-in procedures induced a small myopic shift (range +0.01 to +0.57 D) that depended on previous adjustments. Light-adjustable IOL implantation achieved accurate refractive outcomes (around emmetropia) with good uncorrected distance visual acuity, which remained stable over time. Further refinements in nomograms and in the treatment's protocol would improve the predictability of refractive and visual outcomes with these IOLs. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  2. 12 CFR 313.55 - Salary adjustments.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Salary adjustments. 313.55 Section 313.55 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION PROCEDURE AND RULES OF PRACTICE PROCEDURES FOR CORPORATE DEBT COLLECTION Salary Offset § 313.55 Salary adjustments. Any negative adjustment to pay arising...

  3. Do fair value adjustments influence dividend policy?

    NARCIS (Netherlands)

    Goncharov, I.; van Triest, S.

    2011-01-01

    We examine the impact of positive fair value adjustments on dividend policy. If fair value adjustments are transitory in nature and managers are able to assess their implications for future earnings, fair value adjustments in net income is expected to have no distribution consequences. However,

  4. 24 CFR 5.611 - Adjusted income.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Adjusted income. 5.611 Section 5... Serving Persons with Disabilities: Family Income and Family Payment; Occupancy Requirements for Section 8 Project-Based Assistance Family Income § 5.611 Adjusted income. Adjusted income means annual income (as...

  5. 12 CFR 1780.80 - Inflation adjustments.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Inflation adjustments. 1780.80 Section 1780.80... DEVELOPMENT RULES OF PRACTICE AND PROCEDURE RULES OF PRACTICE AND PROCEDURE Civil Money Penalty Inflation Adjustments § 1780.80 Inflation adjustments. The maximum amount of each civil money penalty within OFHEO's...

  6. 7 CFR 1744.64 - Budget adjustment.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 11 2010-01-01 2010-01-01 false Budget adjustment. 1744.64 Section 1744.64... Disbursement of Funds § 1744.64 Budget adjustment. (a) If more funds are required than are available in a budget account, the borrower may request RUS's approval of a budget adjustment to use funds from another...

  7. An adjustable linear Halbach array

    Energy Technology Data Exchange (ETDEWEB)

    Hilton, J.E., E-mail: James.Hilton@csiro.au [CSIRO Mathematics, Informatics and Statistics, Clayton South, VIC 3169 (Australia); McMurry, S.M. [School of Physics, Trinity College, Dublin (Ireland)

    2012-07-15

    The linear Halbach array is a well-known planar magnetic structure capable, in the idealized case, of generating a one-sided magnetic field. We show that such a field can be created from an array of uniformly magnetized rods, and rotating these rods in an alternating fashion can smoothly transfer the resultant magnetic field through the plane of the device. We examine an idealized model composed of infinite line dipoles and carry out computational simulations on a realizable device using a magnetic boundary element method. Such an arrangement can be used for an efficient latching device, or to produce a highly tunable field in the space above the device. - Highlights: Black-Right-Pointing-Pointer We model an adjustable 'one-sided' flux sheet made up of a series of dipolar magnetic field sources. Black-Right-Pointing-Pointer We show that magnetic field can be switched from one side of sheet to other by a swap rotation of each of magnetic sources. Black-Right-Pointing-Pointer Investigations show that such an arrangement is practical and can easily be fabricated. Black-Right-Pointing-Pointer The design has a wide range of potential applications.

  8. Control of Adjustable Compliant Actuators

    Directory of Open Access Journals (Sweden)

    Berno J.E. Misgeld

    2014-05-01

    Full Text Available Adjustable compliance or variable stiffness actuators comprise an additional element to elastically decouple the actuator from the load and are increasingly applied to human-centered robotic systems. The advantages of such actuators are of paramount importance in rehabilitation robotics, where requirements demand safe interaction between the therapy system and the patient. Compliant actuator systems enable the minimization of large contact forces arising, for example, from muscular spasticity and have the ability to periodically store and release energy in cyclic movements. In order to overcome the loss of bandwidth introduced by the elastic element and to guarantee a higher range in force/torque generation, new actuator designs consider variable or nonlinear stiffness elements, respectively. These components cannot only be adapted to the walking speed or the patient condition, but also entail additional challenges for feedback control. This paper introduces a novel design method for an impedance-based controller that fulfills the control objectives and compares the performance and robustness to a classical cascaded control approach. The new procedure is developed using a non-standard positive-real Η2 controller design and is applied to a loop-shaping approach. Robust norm optimal controllers are designed with regard to the passivity of the actuator load-impedance transfer function and the servo control problem. Classical cascaded and positive-real Η2 controller designs are validated and compared in simulations and in a test bench using a passive elastic element of varying stiffness.

  9. An adjustable linear Halbach array

    International Nuclear Information System (INIS)

    Hilton, J.E.; McMurry, S.M.

    2012-01-01

    The linear Halbach array is a well-known planar magnetic structure capable, in the idealized case, of generating a one-sided magnetic field. We show that such a field can be created from an array of uniformly magnetized rods, and rotating these rods in an alternating fashion can smoothly transfer the resultant magnetic field through the plane of the device. We examine an idealized model composed of infinite line dipoles and carry out computational simulations on a realizable device using a magnetic boundary element method. Such an arrangement can be used for an efficient latching device, or to produce a highly tunable field in the space above the device. - Highlights: ► We model an adjustable ‘one-sided’ flux sheet made up of a series of dipolar magnetic field sources. ► We show that magnetic field can be switched from one side of sheet to other by a swap rotation of each of magnetic sources. ► Investigations show that such an arrangement is practical and can easily be fabricated. ► The design has a wide range of potential applications.

  10. Depletion calculations of adjuster rods in Darlington

    Energy Technology Data Exchange (ETDEWEB)

    Arsenault, B.; Tsang, K., E-mail: benoit.arsenault@amecfw.com, E-mail: kwok.tsang@amecfw.com [AMEC Foster Wheeler, Toronto, ON (Canada)

    2015-07-01

    This paper describes the simulation methodology and reactivity worth calculated for aged adjuster rods in the Darlington core. ORIGEN-S IST was applied to simulate the isotope transmutation process of the stainless steel and titanium adjusters. The compositions were used in DRAGON-IST to calculate the change in incremental properties of aged adjusters. Pre-simulations of the reactivity worth of the stainless steel and titanium adjusters in Darlington were performed using RFSP-IST and the results showed that the titanium adjuster rods exhibit faster reactivity-worth drop than that of stainless steel rods. (author)

  11. Artificial muscles with adjustable stiffness

    International Nuclear Information System (INIS)

    Mutlu, Rahim; Alici, Gursel

    2010-01-01

    This paper reports on a stiffness enhancement methodology based on using a suitably designed contact surface with which cantilevered-type conducting polymer bending actuators are in contact during operation. The contact surface constrains the bending behaviour of the actuators. Depending on the topology of the contact surface, the resistance of the polymer actuators to deformation, i.e. stiffness, is varied. As opposed to their predecessors, these polymer actuators operate in air. Finite element analysis and modelling are used to quantify the effect of the contact surface on the effective stiffness of a trilayer cantilevered beam, which represents a one-end-free, the-other-end-fixed polypyrrole (PPy) conducting polymer actuator under a uniformly distributed load. After demonstrating the feasibility of the adjustable stiffness concept, experiments were conducted to determine the stiffness of bending-type conducting polymer actuators in contact with a range (20–40 mm in radius) of circular contact surfaces. The numerical and experimental results presented demonstrate that the stiffness of the actuators can be varied using a suitably profiled contact surface. The larger the radius of the contact surface is, the higher is the stiffness of the polymer actuators. The outcomes of this study suggest that, although the stiffness of the artificial muscles considered in this study is constant for a given geometric size, and electrical and chemical operation conditions, it can be changed in a nonlinear fashion to suit the stiffness requirement of a considered application. The stiffness enhancement methodology can be extended to other ionic-type conducting polymer actuators

  12. The dyadic adjustment of female-to-male transsexuals.

    Science.gov (United States)

    Fleming, M; MacGowan, B; Costos, D

    1985-02-01

    Dyadic adjustment, sexual activities, and marital stability in the relationships of female-to-male transsexuals and their spouses were examined. Participants were 22 female-to-male transsexuals who had undergone some form of surgery to alter their anatomical sex, their spouses, and a control group of married or cohabitating nontranssexual men and women. Participants were administered the Dyadic Adjustment Scale and additional items to assess quantitatively their marital relationships. The transsexuals and their spouses were also asked open-ended interview questions concerning marital and life adjustments. Generally, the transsexuals and their spouses reported good and mutually satisfying interpersonal relationships that are in many ways comparable to those of the matched control group. These findings lend support to the previous clinical interview studies that have reported that female-to-male transsexuals form stable and enduring intimate relationships.

  13. Radiology film tracking in a distributed clinical network

    International Nuclear Information System (INIS)

    Marquette, D.D.; Arrildt, W.

    1985-01-01

    This paper describes a system for tracking radiology films designed and installed at the Johns Hopkins Hospital. The installation of database and network capabilities in a large hospital environment provide the opportunity to extend to all nursing units and clinics access to the hospital's film tracking system. Ethernet communication technology allows communication to remote libraries. The integration of film tracking with scheduling and order entry systems in radiology make it possible to attain a high level of automated database interface and film jacket label production

  14. EVALUATION OF ADJUSTABLE SUTURE TECHNIQUE IN OUTCOME OF PTOSIS SURGERY

    Directory of Open Access Journals (Sweden)

    Nagaraju

    2015-10-01

    Full Text Available AIM: To evaluate the outcome of adjustable suture technique in ptosis surgery. INTRODUCTION : Surgical management of blepharoptosis is indicated in multiple situations and the post - operative outcomes can be as variable as the indications for surgery. Adjustable suture techniques in ptosis repair have been introduced and variable efficacies have been reported. MATERIALS AND METHODS: A retrospective case review of medical records from June 2010 to May 2011 (12 months of 5 eyes of 5 consecutive patients operated by a single surgeon at a Tertiary Eye care center in South India were reviewed. The clinical profile of patients included was r ecorded and results of adjustable suture technique described by Borman and collegues for these patients was reported. RESULTS: 5 eyes of 5 patients underwent adjustable suture ptosis repair in the study duration. 4 patients with moderate and 1 with severe ptosis, all having good levator function were diagnosed to have c ongenital ptosis in 3 cases and a cquired involutional ptosis in 2 cases. All 5 cases had a satisfactory outcome at day 4 post - operative after adjustment of lid height in the out - patient clini c. 1 patient with acquired involutional ptosis, identified with levator dehiscence intra - operatively had overcorrection at 6 months warranting re - surgery while the other 4 patients had satisfactory cosmetic lid height and functional outcome at 6 months fol low up after the adjustable suture technique for ptosis repair. CONCLUSION: Use of adjustable sutures in ptosis surgery can eliminate the intraoperative lid factors that can lead to unpredictable results. The technique described is easy to adapt and perfor m and can give repeatable and well acceptable results in the properly selected cases

  15. [Psychosocial adjustment in colorectal cancer patients undergoing chemotherapy or chemoradiotherapy].

    Science.gov (United States)

    Alvarado-Aguilar, Salvador; Guerra-Cruz, Hilda Griselda; Cupil-Rodríguez, Aura Lizbet; Calderillo-Ruiz, Germán; Oñate-Ocaña, Luis Fernando

    2011-01-01

    Psychosocial adaptation is a measurement that represents the patient's adjustment to those changes involved in their illness. We undertook this study to search for individual characteristics and clinical aspects associated with successful psychosocial adjustment in patients with colorectal cancer (CRC) undergoing (CT) chemotherapy or chemoradiotherapy (CRT). Seventy-five patients with CRC treated with CT or CRT in a cancer center were included. Psychosocial Adjustment to Illness Scale Self-Reporting (PAIS-SR) questionnaire was used as a measurement of psychosocial adjustment. Psychosocial adaptation was successful in 18 patients (24%) and unsuccessful in 57 patients (76%). Young patients, married patients and males showed lower psychosocial adaptation to disease. This is associated with the decrease in sexual relations, economic resources and psychological symptoms. Patients complained that they were unsatisfied due to the lack of disease and treatment information offered by the heath care team. In the process of adaptation, clinical features such as tumor location and treatment scheme are considered basic, as well as age, education, marital status. Areas such as sexuality, interpersonal and family relationships, economic status and emotional state of patients affected by the disease and treatments provide a deep complexity in the study of the psychosocial adaptation process in patients with CRC.

  16. Suicidal Tendency Among Adolescents With Adjustment Disorder.

    Science.gov (United States)

    Ferrer, Laia; Kirchner, Teresa

    2015-01-01

    Adolescents with adjustment disorder (AD) are at risk of presenting suicidal symptoms. Certain personality traits are linked to suicidal tendencies. There is a lack of information about the link between suicide and personality patterns in adolescents with AD. To identify the personality characteristics that predispose to or prevent the development of suicidal ideation and behavior among adolescents with AD. We recruited 108 adolescents with AD at a public mental health center near Barcelona (Spain). They were administered the Inventario de Riesgo Suicida para Adolescentes (IRIS) to assess suicidal symptoms, as well as the Millon Adolescent Clinical Inventory (MACI) and the 16PF Adolescent Personality Questionnaire (16PF-APQ) to appraise personality features. Doleful personality emerged as the principal risk for suicidal symptoms. The conforming personality pattern exerted a protective effect, and emotional stability was associated with low levels of suicidal tendencies. Among the Big Five factors, anxiety had the highest explanatory power for suicidal tendencies. Certain personality characteristics are associated with heightened or reduced risk of suicidal tendencies in adolescents with AD. Their identification is important for clinicians designing treatment programs for these patients.

  17. TREE AGE AS ADJUSTMENT FACTOR TO NDVI

    OpenAIRE

    Elias Fernando Berra; Denise Cybis Fontana; Tatiana Mora Kuplich

    2018-01-01

    ABSTRACT This study aimed to increase satellite-derived Normalized Difference Vegetation Index (NDVI) sensitivity to biophysical parameters changes with aid of a forest age-based adjustment factor. This factor is defined as a ratio between stand age and age of rotation, which value multiplied by Landsat-5/TM-derived NDVI generated the so-called adjusted index NDVI_a. Soil Adjusted Vegetation Index (SAVI) was also calculated. The relationship between these vegetation indices (VI) with Eucalypt...

  18. Neutron spectrum adjustment. The role of covariances

    International Nuclear Information System (INIS)

    Remec, I.

    1992-01-01

    Neutron spectrum adjustment method is shortly reviewed. Practical example dealing with power reactor pressure vessel exposure rates determination is analysed. Adjusted exposure rates are found only slightly affected by the covariances of measured reaction rates and activation cross sections, while the multigroup spectra covariances were found important. Approximate spectra covariance matrices, as suggested in Astm E944-89, were found useful but care is advised if they are applied in adjustments of spectra at locations without dosimetry. (author) [sl

  19. A Simple Measure of Price Adjustment Coefficients.

    OpenAIRE

    Damodaran, Aswath

    1993-01-01

    One measure of market efficiency is the speed with which prices adjust to new information. The author develops a simple approach to estimating these price adjustment coefficients by using the information in return processes. This approach is used to estimate t he price adjustment coefficients for firms listed on the NYSE and the A MEX as well as for over-the-counter stocks. The author finds evidence of a lagged adjustment to new information in shorter return intervals for firms in all market ...

  20. Case mix adjusted variation in cesarean section rate in Sweden.

    Science.gov (United States)

    Mesterton, Johan; Ladfors, Lars; Ekenberg Abreu, Anna; Lindgren, Peter; Saltvedt, Sissel; Weichselbraun, Marianne; Amer-Wåhlin, Isis

    2017-05-01

    Cesarean section (CS) rate is a well-established indicator of performance in maternity care and is also related to resource use. Case mix adjustment of CS rates when performing comparisons between hospitals is important. The objective of this study was to estimate case mix adjusted variation in CS rate between hospitals in Sweden. In total, 139 756 deliveries in 2011 and 2012 were identified in administrative systems in seven regions covering 67% of all deliveries in Sweden. Data were linked to the Medical birth register and population data. Twenty-three different sociodemographic and clinical characteristics were used for adjustment. Analyses were performed for the entire study population as well as for two subgroups. Logistic regression was used to analyze differences between hospitals. The overall CS rate was 16.9% (hospital minimum-maximum 12.1-22.6%). Significant variations in CS rate between hospitals were observed after case mix adjustment: hospital odds ratios for CS varied from 0.62 (95% CI 0.53-0.73) to 1.45 (95% CI 1.37-1.52). In nulliparous, cephalic, full-term, singletons the overall CS rate was 14.3% (hospital minimum-maximum: 9.0-19.0%), whereas it was 4.7% for multiparous, cephalic, full-term, singletons with no previous CS (hospital minimum-maximum: 3.2-6.7%). In both subgroups significant variations were observed in case mix adjusted CS rates. Significant differences in CS rate between Swedish hospitals were found after adjusting for differences in case mix. This indicates a potential for fewer interventions and lower resource use in Swedish childbirth care. Best practice sharing and continuous monitoring are important tools for improving childbirth care. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  1. Correlational indicators of psychosocial adjustment among senior ...

    African Journals Online (AJOL)

    There was a significant joint contribution of the independent variables (sense of coherence, optimism and self-efficacy) to the prediction of psychosocial adjustment. This suggested that the three independent variables combined accounted for 30.4% (Adj.R2= .304) variation in the prediction of psychosocial adjustment.

  2. Parenting Styles and Adjustment in Gifted Children

    Science.gov (United States)

    Pilarinos, Vassiliki; Solomon, C. R.

    2017-01-01

    The present study examined the relationship between parenting styles and the psychosocial adjustment of 48 children aged 7 to 11 years, each of whom had been identified as gifted on the basis of a score of 130 or above on the Wechsler Intelligence Scale for Children--Fourth Edition. Parenting styles and child psychosocial adjustment were measured…

  3. 14 CFR Appendix - Example of SIFL Adjustment

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Example of SIFL Adjustment Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION (AVIATION PROCEEDINGS) POLICY STATEMENTS... taxes for rate purposes. Pt. 399, Subpt. C, Example Example of SIFL Adjustment [Methodology for...

  4. relationship between parenting styles and marital adjustment

    African Journals Online (AJOL)

    PROF. BARTH EKWEME

    positive and significant joint relationship between the parenting styles and marital adjustment of married ... correlate significantly with marital adjustment of married teachers in secondary ... In other words, it refers to the management of ... dealing with each other so as to reduce ill-feeling. ..... Behavior exchange in happy.

  5. Psychologica and social adjustment to blindness: Understanding ...

    African Journals Online (AJOL)

    Psychologica and social adjustment to blindness: Understanding from two groups of blind people in Ilorin, Nigeria. ... Background: Blindness can cause psychosocial distress leading to maladjustment if not mitigated. Maladjustment is a secondary burden that further reduces quality of life of the blind. Adjustment is often ...

  6. 28 CFR 11.7 - Salary adjustments.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Salary adjustments. 11.7 Section 11.7 Judicial Administration DEPARTMENT OF JUSTICE DEBT COLLECTION Administration of Debt Collection § 11.7 Salary adjustments. The following debts shall not be subject to the salary offset procedures of § 11.8...

  7. Sickness presence, sick leave and adjustment latitude

    Directory of Open Access Journals (Sweden)

    Joachim Gerich

    2014-10-01

    Full Text Available Objectives: Previous research on the association between adjustment latitude (defined as the opportunity to adjust work efforts in case of illness and sickness absence and sickness presence has produced inconsistent results. In particular, low adjustment latitude has been identified as both a risk factor and a deterrent of sick leave. The present study uses an alternative analytical strategy with the aim of joining these results together. Material and Methods: Using a cross-sectional design, a random sample of employees covered by the Upper Austrian Sickness Fund (N = 930 was analyzed. Logistic and ordinary least square (OLS regression models were used to examine the association between adjustment latitude and days of sickness absence, sickness presence, and an estimator for the individual sickness absence and sickness presence propensity. Results: A high level of adjustment latitude was found to be associated with a reduced number of days of sickness absence and sickness presence, but an elevated propensity for sickness absence. Conclusions: Employees with high adjustment latitude experience fewer days of health complaints associated with lower rates of sick leave and sickness presence compared to those with low adjustment latitude. In case of illness, however, high adjustment latitude is associated with a higher pro­bability of taking sick leave rather than sickness presence.

  8. 7 CFR 718.110 - Adjustments.

    Science.gov (United States)

    2010-01-01

    ... MARKETING QUOTAS, ACREAGE ALLOTMENTS, AND PRODUCTION ADJUSTMENT PROVISIONS APPLICABLE TO MULTIPLE PROGRAMS... in order to avoid a marketing quota penalty if such person: (1) Notifies the county committee of such... committee; and (2) Pays the cost of a farm inspection to determine the adjusted acreage prior to the date...

  9. Does Fall History Influence Residential Adjustments?

    Science.gov (United States)

    Leland, Natalie; Porell, Frank; Murphy, Susan L.

    2011-01-01

    Purpose of the study: To determine whether reported falls at baseline are associated with an older adult's decision to make a residential adjustment (RA) and the type of adjustment made in the subsequent 2 years. Design and Methods: Observations (n = 25,036) were from the Health and Retirement Study, a nationally representative sample of…

  10. 10 CFR 905.34 - Adjustment provisions.

    Science.gov (United States)

    2010-01-01

    ... continue to take place based on existing contract/marketing criteria principles. ... 10 Energy 4 2010-01-01 2010-01-01 false Adjustment provisions. 905.34 Section 905.34 Energy DEPARTMENT OF ENERGY ENERGY PLANNING AND MANAGEMENT PROGRAM Power Marketing Initiative § 905.34 Adjustment...

  11. relationship between parenting styles and marital adjustment

    African Journals Online (AJOL)

    PROF. BARTH EKWEME

    The relationship between permissive parenting style and marital adjustment was also very low, positive and insignificant. There was a low, positive and significant joint relationship between the parenting styles and marital adjustment of married teachers in secondary schools in Obio/Akpor Local Government Area of Rivers ...

  12. Equity Mispricing and Leverage Adjustment Costs

    NARCIS (Netherlands)

    Warr, R.S.; Elliott, W.B.; Koeter-Kant, J.; Oztekin, O.

    2012-01-01

    We find that equity mispricing impacts the speed at which firms adjust to their target leverage (TL) and does so in predictable ways depending on whether the firm is over- or underlevered. For example, firms that are above their TL and should therefore issue equity (or retire debt) adjust more

  13. Consanguineous Marriage and Marital Adjustment in Turkey.

    Science.gov (United States)

    Fisiloglu, Hurol

    2001-01-01

    Investigates the relationship between consanguineous marriage and marital adjustment in Turkey. The results of the study show that the consanguineous marriage group had significantly lower marital adjustment and had more conflict with extended family than the nonconsanguineous marriage group. The finding is discussed in the context of research and…

  14. Religiousity, Spirituality and Adolescents' Self-Adjustment

    Science.gov (United States)

    Japar, Muhammad; Purwati

    2014-01-01

    Religiuosity, spirituality, and adolescents' self-adjustment. The objective of this study is to test the correlation among religiosity, spirituality and adolescents' self-adjustment. A quantitative approach was employed in this study. Data were collected from 476 junior high schools students of 13 State Junior High Schools and one Junior High…

  15. Adjustment Following Disability: Representative Case Studies.

    Science.gov (United States)

    Heinemann, Allen W.; Shontz, Franklin C.

    1984-01-01

    Examined adjustment following physical disability using the representative case method with two persons with quadriplegia. Results highlighted the importance of previously established coping styles as well as the role of the environment in adjustment. Willingness to mourn aided in later growth. (JAC)

  16. Adjustment of the Internal Tax Scale

    CERN Multimedia

    2013-01-01

    In application of Article R V 2.03 of the Staff Regulations, the internal tax scale has been adjusted with effect on 1 January 2012. The new scale may be consulted via the CERN Admin e-guide.  The notification of internal annual tax certificate for the financial year 2012 takes into account this adjustment. HR Department (Tel. 73907)

  17. Adjustable Speed Drives - Future Challenges and Applications

    DEFF Research Database (Denmark)

    Blaabjerg, Frede; Thoegersen, Paul

    2004-01-01

    The main trends within Adjustable Drives in industrial and appliance applications for the next decade are discussed based on the newest developments seen on the market and a few historical trends. Different drive configurations are presented and the general demands to adjustable speed drives...

  18. Utilización de los grupos clínicos ajustados en un centro de atención primaria español: estudio retrospectivo de base poblacional Adjusted clinical groups use at a Spanish primary care center: a retrospective, population-based study

    Directory of Open Access Journals (Sweden)

    Antoni Sicras-Mainar

    2010-01-01

    Full Text Available OBJETIVOS: Evaluar los resultados de la aplicación del sistema de clasificación mediante grupos clínicos ajustados (GCA en un centro de atención primaria de salud (APS de una población española. MÉTODOS: Estudio transversal retrospectivo a partir de los registros médicos informatizados de los pacientes atendidos ambulatoriamente durante 2007 en el centro de salud La Roca, administrado por una empresa de gestión de servicios de salud en La Roca del Vallès, Barcelona, España. Los GCA se conformaron según la Clasificación Internacional de Enfermedades, 9.ª revisión, modificación clínica. Se calcularon los pesos relativos medios en dólares estadounidenses de cada GCA respecto al costo medio total y, a partir de ellos, se crearon las bandas de utilización de recursos. Se determinaron los índices de riesgo (IR y eficiencia (IE con respecto a 2006 y se estimó el poder explicativo de la clasificación empleada. RESULTADOS: Se estudiaron 8 294 pacientes, para una cobertura de 82,7%, con una media de 4,1 episodios por paciente, 6,9 visitas por paciente y 5,7 visitas por habitante al año. A siete GCA correspondió 51,0% de los pacientes atendidos. El IR fue de 1,015, el IE en las visitas de 0,975 y el poder explicativo de la clasificación en GCA fue de 53,4% para las visitas y de 74,8% para los episodios. CONCLUSIONES: El sistema de GCA permitió agrupar a los pacientes de una población según su estado clínico y puede ayudar, entre otros aspectos, en la asignación de recursos y la evaluación de la eficiencia de los equipos de APS.OBJECTIVES: To evaluate the results of implementing a classification system based on adjusted clinical groups (ACG at a primary health care (PHC in a Spanish population. METHODS: A retrospective, cross-sectional study based on the computerized medical records of outpatients seen in 2007 by the La Roca clinic, administered by a health services management company in La Roca del Vallès, Barcelona, Spain

  19. Cultural Distance Asymmetry in Expatriate Adjustment

    DEFF Research Database (Denmark)

    Selmer, Jan; Chiu, Randy K.; Shenkar, Oded

    2007-01-01

    of the assignment. Design/methodology/approach - Using a two-flow sample of US expatriates in Germany and German expatriates in the USA, we examine and compare the psychological and socio-cultural adjustment of each group of executives. Findings - Controlling for the length of assignment, we find that German...... expatriates in the USA were better adjusted, both socio-culturally and psychologically, than American expatriates in Germany. These results support the asymmetry hypothesis and call into question previous findings attesting to the relationship between CD and expatriate adjustment. Originality......Purpose - The current literature implicitly assumes a symmetric impact of cultural distance (CD) on expatriate adjustment. By using distance as a predictor of adjustment, the literature has rendered the direction of the flow irrelevant: a US expatriate in Germany is presumed to face the same hurdle...

  20. Factors influencing adjustment to a colostomy in Chinese patients: a cross-sectional study.

    Science.gov (United States)

    Hu, Ailing; Pan, Yunfeng; Zhang, Meifen; Zhang, June; Zheng, Meichun; Huang, Manrong; Ye, Xinmei; Wu, Xianrong

    2014-01-01

    We evaluated persons living with a colostomy in order to characterize and describe relationships among adjustment, self-care ability, and social support. One hundred twenty-nine colostomy patients from 5 hospitals in Guangzhou, capital city of the Guangdong province, were recruited by convenience sampling. Cross-sectional data were collected from a survey that included demographic and pertinent clinical data related to their ostomy. The survey also incorporated Chinese language versions of the Ostomy Adjustment Scale, Exercise of Self-Care Agency Scale, and Perceived Social Support Scale. These scales were used to measure the levels and degrees of adjustment, self-care ability, and social support of colostomy patients. Respondents completed the survey during outpatient clinics visit after creation of a colostomy. Scores from the Ostomy Adjustment Scale revealed that 96.9% of colostomy patients reported low to moderate adjustment (128.6 ± 19.38) to their stoma. Self-care ability and social support of patients were positively correlated with the adjustment level (R = 0.33, R = 0.21). Several factors, including being a housewife, paying medical expense by oneself, inability to manage the ostomy without assistance, and not participating in an ostomy support group, were associated with a lower level of adjustment (P colostomy was moderate. Self-care ability and social support associated with having a colostomy positively influenced adjustment. Adjustment was also influenced by occupation, health insurance provider, and ability to care for the stoma without requiring assistance.

  1. Coping and emotional adjustment following traumatic brain injury.

    Science.gov (United States)

    Anson, Katie; Ponsford, Jennie

    2006-01-01

    To examine the association between coping style and emotional adjustment following traumatic brain injury. Thirty three individuals who had sustained a traumatic brain injury (mean duration of posttraumatic amnesia = 32 days) between 1(1/2) months and almost 7 years previously. Coping Scale for Adults, Hospital Anxiety and Depression Scale, Rosenberg Self-Esteem Scale, State-Trait Anger Expression Inventory, and the Sickness Impact Profile. Approximately 50% of the sample reported clinically significant levels of anxiety and depression. Coping characterized by avoidance, worry, wishful thinking, self-blame, and using drugs and alcohol was associated with higher levels of anxiety, depression, and psychosocial dysfunction and lower levels of self-esteem. Coping characterized by actively working on the problem and using humor and enjoyable activities to manage stress was associated with higher self-esteem. Lower premorbid intelligence (measured via the National Adult Reading Test) and greater self-awareness (measured via the Self-Awareness of Deficits Interview) were associated with an increased rate of maladaptive coping. The strong association between the style of coping used to manage stress and emotional adjustment suggests the possibility that emotional adjustment might be improved by the facilitation of more adaptive coping styles. It is also possible that improving emotional adjustment may increase adaptive coping. The development and evaluation of interventions aimed at facilitating adaptive coping and decreasing emotional distress represent important and potentially fruitful contributions to enhancing long-term outcome following brain injury.

  2. Role of Osmotic Adjustment in Plant Productivity

    Energy Technology Data Exchange (ETDEWEB)

    Gebre, G.M.

    2001-01-11

    Successful implementation of short rotation woody crops requires that the selected species and clones be productive, drought tolerant, and pest resistant. Since water is one of the major limiting factors in poplar (Populus sp.) growth, there is little debate for the need of drought tolerant clones, except on the wettest of sites (e.g., lower Columbia River delta). Whether drought tolerance is compatible with productivity remains a debatable issue. Among the many mechanisms of drought tolerance, dehydration postponement involves the maintenance of high leaf water potential due to, for example, an adequate root system. This trait is compatible with productivity, but requires available soil moisture. When the plant leaf water potential and soil water content decline, the plant must be able to survive drought through dehydration tolerance mechanisms, such as low osmotic potential or osmotic adjustment. Osmotic adjustment and low osmotic potential are considered compatible with growth and yield because they aid in the maintenance of leaf turgor. However, it has been shown that turgor alone does not regulate cell expansion or stomatal conductance and, therefore, the role of osmotic adjustment is debated. Despite this finding, osmotic adjustment has been correlated with grain yield in agronomic crop species, and gene markers responsible for osmotic adjustment are being investigated to improve drought tolerance in productive progenies. Although osmotic adjustment and low osmotic potentials have been investigated in several forest tree species, few studies have investigated the relationship between osmotic adjustment and growth. Most of these studies have been limited to greenhouse or container-grown plants. Osmotic adjustment and rapid growth have been specifically associated in Populus and black spruce (Picea mariuna (Mill.) B.S.P.) progenies. We tested whether these relationships held under field conditions using several poplar clones. In a study of two hybrid poplar

  3. Adjustment and mental health problem in prisoners

    Directory of Open Access Journals (Sweden)

    Sudhinta Sinha

    2010-01-01

    Full Text Available Background : "Crime" is increasing day by day in our society not only in India but also all over the world. In turn, the number of prisoners is also increasing at the same rate. They remain imprisoned for a long duration or in some cases for the whole life. Living in a prison for long time becomes difficult for all inmates. So they often face adjustment and mental health problems. Recent findings suggest that mental illness rate in prison is three times higher than in the general population. Objective: The aim of the present study was to investigate the adjustment and the mental health problem and its relation in the prisoners. Materials and Methods : In the present study, 37 male prisoners of district jail of Dhanbad District of Jharkhand were selected on purposive sampling basis. Each prisoner was given specially designed Performa - Personal Data Sheet, General Health Questionnaire-12 and Bell Adjustment Inventory. Appropriate statistical tools were used to analyze the data. Results: The results obtained showed poor adjustment in social and emotional areas on the adjustment scale. The study also revealed a significant association between adjustment and mental health problem in the prisoners. Conclusion: The prisoners were found to have poor social and emotional adjustment which has strong association with their mental health.

  4. 39 CFR 3010.25 - Limitation on unused rate adjustment authority rate adjustments.

    Science.gov (United States)

    2010-07-01

    ... only be applied together with inflation-based limitation rate adjustments or when inflation-based... used in lieu of an inflation-based limitation rate adjustment. ... 39 Postal Service 1 2010-07-01 2010-07-01 false Limitation on unused rate adjustment authority...

  5. Unacknowledged Rape in the Community: Rape Characteristics and Adjustment.

    Science.gov (United States)

    Littleton, Heather; Layh, Marlee; Rudolph, Kelly

    2018-02-01

    Unacknowledged rape, labeling a rape as a nonvictimizing event, remains largely unstudied among non-college women. This study therefore sought to examine differences in assault characteristics, adjustment, and disclosure by rape acknowledgment status among a sample of lower income rape victims (n = 104) recruited from a reproductive health clinic (mean age = 28.8 years). Although unacknowledged rape was infrequent (17.1% of victims), unacknowledged victims reported that the perpetrator used less force and were less likely to have assertively resisted, as compared to acknowledged victims. There were no significant differences in disclosure, depression, and somatic complaints between unacknowledged and acknowledged rape victims. Implications of the findings for understanding rape acknowledgment and postrape adjustment among community women are discussed.

  6. Robotically-adjustable microstereotactic frames for image-guided neurosurgery

    Science.gov (United States)

    Kratchman, Louis B.; Fitzpatrick, J. Michael

    2013-03-01

    Stereotactic frames are a standard tool for neurosurgical targeting, but are uncomfortable for patients and obstruct the surgical field. Microstereotactic frames are more comfortable for patients, provide better access to the surgical site, and have grown in popularity as an alternative to traditional stereotactic devices. However, clinically available microstereotactic frames require either lengthy manufacturing delays or expensive image guidance systems. We introduce a robotically-adjusted, disposable microstereotactic frame for deep brain stimulation surgery that eliminates the drawbacks of existing microstereotactic frames. Our frame can be automatically adjusted in the operating room using a preoperative plan in less than five minutes. A validation study on phantoms shows that our approach provides a target positioning error of 0.14 mm, which exceeds the required accuracy for deep brain stimulation surgery.

  7. Adjustment to Cancer: Anxiety and Distress (PDQ)

    Science.gov (United States)

    ... with adjustment disorders. Individual (one-to-one) and group counseling have been shown to help cancer patients with ... to-one) counseling. Couple and family counseling. Crisis counseling. Group therapy. Self-help groups. Other treatments used to ...

  8. Adjusting water resources management to climate change

    Energy Technology Data Exchange (ETDEWEB)

    Riebsame, W E

    1988-01-01

    The nature of climate impacts and adjustment in water supply and flood management is discussed, and a case study of water manager response to climate fluctuation in California's Sacramento Basin is presented. The case illuminates the effect on climate impact and response of traditional management approaches, the dynamic qualities of maturing water systems, socially imposed constraints, and climate extremes. A dual pattern of crisis-response and gradual adjustment emerges, and specific mechanisms for effecting adjustment of water management systems are identified. The case study, and broader trends in US water development, suggest that oversized structural capacity, the traditional adjustment to climate variability in water resources, may prove less feasible in the future as projects become smaller and new facilities are delayed by economic and environmental concerns.

  9. Theatre Practice and Social Adjustment in Nigeria

    African Journals Online (AJOL)

    Nneka Umera-Okeke

    Media Sociology Lecturer ... adjustments in favour of local processes to drive social and economic .... needs the need to meet the requirements of all motivated efficiency, a certain degree of .... Centre for Production of Tourism, Arts and Culture.

  10. Annual adjustments to 2015 financial benefits

    CERN Multimedia

    HR Department

    2015-01-01

    In accordance with recommendations made by the Finance Committee and decisions taken by Council in December 2014, no adjustments have been made to basic salaries and stipends, subsistence allowances or family benefits as at 1 January 2015.

  11. Annual adjustments to 2016 financial benefits

    CERN Multimedia

    HR Department

    2016-01-01

    In accordance with recommendations made by the Finance Committee and decisions taken by the Council in December 2015, no adjustments have been made to basic salaries and stipends, subsistence allowances or family benefits as at 1 January 2016.  

  12. Annual adjustments to 2014 financial benefits

    CERN Multimedia

    2013-01-01

    In accordance with recommendations made by the Finance Committee and decisions taken by Council in December 2013, no adjustments have been made to basic salaries and stipends, subsistence allowances or family benefits as at 1 January 2014. HR Department

  13. Marital Adjustment and Psychological Distress in Japan

    Science.gov (United States)

    Li, Angela; Robustelli, Briana L.; Whisman, Mark A.

    2016-01-01

    This study was conducted to examine the association between marital adjustment and psychological distress in a large, probability sample of married adults in Japan (N = 710) from the Midlife Development in Japan (MIDJA) study. Results indicate that positive and negative dimensions of marital adjustment were significantly associated with dimensional and categorical measures of psychological distress. Furthermore, the associations between marital adjustment and psychological distress remained significant when statistically controlling for neuroticism, quality of friend and family relationships, and demographic variables. These results demonstrate that the well-established association between marital adjustment and psychological distress found in European-American countries is also found in Japan. Findings support continued research on marital functioning and psychological distress in East Asian countries. PMID:28082761

  14. Speed of adjustment: Evidence from Borsa Istanbul

    Directory of Open Access Journals (Sweden)

    Emrah Arioglu

    2014-06-01

    Full Text Available In this study, we investigate the speed of adjustment for leverage ratios of firms listed on Borsa Istanbul, in order to investigate the prediction of the trade-off theory, regarding capital structure rebalancing. For this purpose, we estimate the speed of adjustment by using Generalized Method of Moments system estimation technique. The results of this estimation suggest the speed of adjustment as approximately 29%. This significant speed of adjustment is consistent with the prediction of trade-off theory, which suggests that firms follow target capital structures and when the firms' leverage ratios deviate from these targets; they make financial decisions with the goal of closing the gap between the previous year's leverage and target leverage of the current period.

  15. Adjustment model of thermoluminescence experimental data

    International Nuclear Information System (INIS)

    Moreno y Moreno, A.; Moreno B, A.

    2002-01-01

    This model adjusts the experimental results for thermoluminescence according to the equation: I (T) = I (a i * exp (-1/b i * (T-C i )) where: a i , b i , c i are the i-Th peak adjusted to a gaussian curve. The adjustments of the curve can be operated manual or analytically using the macro function and the solver.xla complement installed previously in the computational system. In this work it is shown: 1. The information of experimental data from a LiF curve obtained from the Physics Institute of UNAM which the data adjustment model is operated in the macro type. 2. A LiF curve of four peaks obtained from Harshaw information simulated in Microsoft Excel, discussed in previous works, as a reference not in macro. (Author)

  16. Annual adjustments to 2013 financial benefits

    CERN Multimedia

    2013-01-01

    In accordance with recommendations made by the Finance Committee and decisions taken by Council in December 2012, no adjustments have been made to basic salaries and stipends, subsistence allowances or family benefits as at 1 January 2013. HR Department

  17. Determinants of intercultural adjustment among expatriate spouses

    NARCIS (Netherlands)

    Ali, Anees; Van der Zee, K.I.; Sanders, G

    The adaptation of expatriate families to a host country seems crucial to successful fulfilment of international business assignments. The present study focused on personality, family characteristics and characteristics of expatriates' work life as determinants of the intercultural adjustment of

  18. Price Changes, Resource Adjustments and Rational Expectations

    DEFF Research Database (Denmark)

    Hoffmann, Kira

    This study investigates the relationship between the accuracy of managerial demand expectations, resource adjustment decisions and selling price changes. In line with rational expectation theory, it is argued that managers adjust resources and selling prices differently in response to expected...... that cost elasticity is higher when a demand decrease is expected among companies with similar exposure to demand uncertainty. Overall, this implies that managerial competences in predicting future demand significantly determines firms’ profitability; especially when demand uncertainty is high...

  19. Worksite adjustments and work ability among employed cancer survivors.

    Science.gov (United States)

    Torp, Steffen; Nielsen, Roy A; Gudbergsson, Sævar B; Dahl, Alv A

    2012-09-01

    This study was conducted to determine how many cancer survivors (CSs) make worksite adjustments and what kinds of adjustments they make. Changes in work ability among employed CSs were explored, and clinical, sociodemographic, and work-related factors associated with the current total work ability were studied. CSs of the ten most common invasive types of cancer for men and women in Norway completed a mailed questionnaire 15-39 months after being diagnosed with cancer. Included in the analyses were all participants who worked both at the time of diagnosis and at the time of the survey and who had not changed their labor force status since diagnosis (n = 563). The current total work ability was compared to the lifetime best (0-10 score). Twenty-six percent of the employed CSs had made adjustments at work, and the most common adjustment was changing the number of work hours per week. Despite the fact that 31% and 23% reported reduced physical and mental work abilities, respectively, more than 90% of the CSs reported that they coped well with their work demands. The mean total work ability score was high (8.6) among both men and women. Being self-employed and working part-time at the time of diagnosis showed significant negative correlations with total work ability, while a favorable psychosocial work environment showed a significant positive correlation. CSs with low work ability were more often in contact with the occupational health service and also made more worksite adjustments than others. The prospects of future work life seem optimistic for Norwegian employed CSs who return to work relatively soon after primary treatment.

  20. Clinical biochemistry

    Science.gov (United States)

    Alexander, W. C.; Leach, C. S.; Fischer, C. L.

    1975-01-01

    The objectives of the biochemical studies conducted for the Apollo program were (1) to provide routine laboratory data for assessment of preflight crew physical status and for postflight comparisons; (2) to detect clinical or pathological abnormalities which might have required remedial action preflight; (3) to discover as early as possible any infectious disease process during the postflight quarantine periods following certain missions; and (4) to obtain fundamental medical knowledge relative to man's adjustment to and return from the space flight environment. The accumulated data presented suggest that these requirements were met by the program described. All changes ascribed to the space flight environment were subtle, whereas clinically significant changes were consistent with infrequent illnesses unrelated to the space flight exposure.

  1. EFFECTIVENESS OF CHIROPRACTIC ADJUSTMENT IN LUMBAR PAIN IN CROSSFIT PRACTITIONERS

    OpenAIRE

    MOEHLECKE, DESIREE; FORGIARINI JUNIOR, LUIZ ALBERTO

    2017-01-01

    ABSTRACT Objective: To evaluate the efficacy of acute chiropractic adjustment in individuals who practice CrossFit with regard to complaints of low back pain and the joint range of motion in this region. Methods: A randomized clinical trial comprised of CrossFit practitioners from a box in Novo Hamburgo-RS, of both sexes and aged 18 to 40 years who had low back pain at the time of the study. The following tools were used: Semi-structured Anamnesis Questionnaire, Visual Analog Scale, McGill ...

  2. Topics in data adjustment theory and applications

    International Nuclear Information System (INIS)

    Hwang, R.N.

    1988-01-01

    The methodologies of the uncertainty analysis and data adjustment have been well-developed and widely used abroad since the early 70's. With limited amount of covariance data on the differential cross section and the integral experiments available at the time, their accomplishments are, indeed, astounding. The fundamental adjustment equations, however, remain qualitatively unchanged. For the past few year, extensive efforts on these subjects have also begun at ANL in order to utilize the massive amount of integral experiments accumulated over years to provide the basis for improving the reactor parameters encountered in various design calculations. Pertinent covariance matrices and sensitivity matrices of the existing integral experiments have been evaluated and systematically compiled in the data files along with the cross section covariance data derived from the ENDF-B/V for the 21 group structure currently under consideration. A production code GMADJ that provides the adjusted quantities for a large number of cross section types has been developed by Poenitz for routine applications. The primary purpose of the present paper is to improve understanding of the application oriented issues important to the data adjustment theory and the subsequent usage of the adjusted quantities in the design calculations in support of these activities. 30 refs., 12 figs., 5 tabs

  3. Adjustment of the 235U Fission Spectrum

    International Nuclear Information System (INIS)

    GRIFFIN, PATRICK J.; WILLIAMS, J.G.

    1999-01-01

    The latest nuclear data are used to examine the sensitivity of the least squares adjustment of the 235 U fission spectrum to the measured reaction rates, dosimetry cross sections, and prior spectrum covariance matrix. All of these parameters were found to be very important in the spectrum adjustment. The most significant deficiency in the nuclear data is the absence of a good prior covariance matrix. Covariance matrices generated from analytic models of the fission spectra have been used in the past. This analysis reveals some unusual features in the covariance matrix produced with this approach. Specific needs are identified for improved nuclear data to better determine the 235 U spectrum. An improved 235 U covariance matrix and adjusted spectrum are recommended for use in radiation transport sensitivity analyses

  4. Adjustments to financial and social benefits

    CERN Multimedia

    HR Department

    2010-01-01

    In accordance with recommendations made by the Finance Committee in November 2009 and decisions taken by the Council in December 2009, certain financial benefits have been adjusted with effect from 1 January 2010. An increase of 1.6% has been applied to the scale of basic salaries and to stipends paid to Fellows (Annexes R A 5 and R A 6 of the Staff Rules and Regulations, respectively). The adjusted amounts are available from the HR Department intranet site or from departmental secretariats. As a result of the evolution of the Geneva consumer price index, no adjustments have been made to the subsistence allowances of Paid Associates and Students (Annex R A 7 of the Staff Rules and Regulations). The following social benefits also remain unchanged: Family, child and infant allowances (Annex R A 3 of the Staff Rules and Regulations). Payment ceilings of education fees (Annex R A 4 of the Staff Rules and Regulations). Tel. 70674 (Classification and Remuneration Service)

  5. Attachment style and adjustment to divorce.

    Science.gov (United States)

    Yárnoz-Yaben, Sagrario

    2010-05-01

    Divorce is becoming increasingly widespread in Europe. In this study, I present an analysis of the role played by attachment style (secure, dismissing, preoccupied and fearful, plus the dimensions of anxiety and avoidance) in the adaptation to divorce. Participants comprised divorced parents (N = 40) from a medium-sized city in the Basque Country. The results reveal a lower proportion of people with secure attachment in the sample group of divorcees. Attachment style and dependence (emotional and instrumental) are closely related. I have also found associations between measures that showed a poor adjustment to divorce and the preoccupied and fearful attachment styles. Adjustment is related to a dismissing attachment style and to the avoidance dimension. Multiple regression analysis confirmed that secure attachment and the avoidance dimension predict adjustment to divorce and positive affectivity while preoccupied attachment and the anxiety dimension predicted negative affectivity. Implications for research and interventions with divorcees are discussed.

  6. Speed of adjustment and market structure

    International Nuclear Information System (INIS)

    Lanza, A.

    1991-01-01

    This paper studies the relationship between changes in costs and prices in the gasoline market in the Federal Republic of Germany for the period 1980-90. We shall use an econometric model, and distinguish two stages in the transmission of cost changes to prices. The first is the adjustment of gasoline prices ex-refinery to changes in the price of crude oil, and the second is the adjustment of gasoline price (net of taxes) at the pump to ex-refinery prices. The study of price adjustments to cost changes involves the analysis of two inter-related but different phenomena. The first is the speed of adjustment, defined here as the mean of the length of the time periods required for the transmission of the full effect of an exogenous shock from the independent to the dependent variable of the econometric model used in the analysis. The second relates to possible asymmetries in the response of prices to increases and decreases in costs. Both phenomena are closely related to the structure of the market. The common assumption is that the first is negatively correlated to the degree of competition, and that the second is an indication of the prevailing market structure. The main findings of this paper are as follows: (a) at the refinery level there is only weak evidence of asymmetrical reaction; the average lag in case of crude price increases or decreases is about three months; (b) at the consumers' level, the speed of adjustment was lower when the ex-refinery price was declining than when it was rising; the adjustment lag was about 6.07 months when ex-refinery prices were declining and 5.37 months when they were rising. (author)

  7. Kinematic synthesis of adjustable robotic mechanisms

    Science.gov (United States)

    Chuenchom, Thatchai

    1993-01-01

    Conventional hard automation, such as a linkage-based or a cam-driven system, provides high speed capability and repeatability but not the flexibility required in many industrial applications. The conventional mechanisms, that are typically single-degree-of-freedom systems, are being increasingly replaced by multi-degree-of-freedom multi-actuators driven by logic controllers. Although this new trend in sophistication provides greatly enhanced flexibility, there are many instances where the flexibility needs are exaggerated and the associated complexity is unnecessary. Traditional mechanism-based hard automation, on the other hand, neither can fulfill multi-task requirements nor are cost-effective mainly due to lack of methods and tools to design-in flexibility. This dissertation attempts to bridge this technological gap by developing Adjustable Robotic Mechanisms (ARM's) or 'programmable mechanisms' as a middle ground between high speed hard automation and expensive serial jointed-arm robots. This research introduces the concept of adjustable robotic mechanisms towards cost-effective manufacturing automation. A generalized analytical synthesis technique has been developed to support the computational design of ARM's that lays the theoretical foundation for synthesis of adjustable mechanisms. The synthesis method developed in this dissertation, called generalized adjustable dyad and triad synthesis, advances the well-known Burmester theory in kinematics to a new level. While this method provides planar solutions, a novel patented scheme is utilized for converting prescribed three-dimensional motion specifications into sets of planar projections. This provides an analytical and a computational tool for designing adjustable mechanisms that satisfy multiple sets of three-dimensional motion specifications. Several design issues were addressed, including adjustable parameter identification, branching defect, and mechanical errors. An efficient mathematical scheme for

  8. Mitral valve repair with adjustable ring annuloplasty.

    Science.gov (United States)

    Andreas, Martin; Haberl, Thomas; Paul Werner, Paul Werner; Guri, Jani; Kocher, Alfred; Hamza, Ouafa; Podesser, Bruno; Laufer, Guenther

    2018-02-28

    We demonstrate the technical aspects of a novel adjustable mitral ring. This new ring was implanted in a female landrace pig, for training and educational purposes. It can be adjusted independently in the P1, P2 and P3 segments, if required, to treat  recurrent mitral regurgitation, and this is a key difference to comparable devices. The first-in-man implantation is anticipated in the near future. © The Author 2016. Published by MMCTS on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  9. Simultaneous neutron and gamma spectrum adjustment

    International Nuclear Information System (INIS)

    Remec, I.

    1996-01-01

    The spectrum adjustment procedure was extended to simultaneous neutron and gamma spectrum adjustment, and the feasibility of this technique is demonstrated in the analysis of HFIR dosimetry experiments. Conditions in which gamma rays may contribute considerably to radiation damage in steels are discussed. Beryllium helium accumulation fluence monitors (HAFMs) were found to be good monitors in gamma fields of intensities high enough to contribute to steel embrittlement. Use of 237 Np, 238 U, and 9 Be HAFM as gamma dosimeters is proposed for high-dose irradiations in high-energy, high-intensity gamma fields

  10. Cultural similarity and adjustment of expatriate academics

    DEFF Research Database (Denmark)

    Selmer, Jan; Lauring, Jakob

    2009-01-01

    The findings of a number of recent empirical studies of business expatriates, using different samples and methodologies, seem to support the counter-intuitive proposition that cultural similarity may be as difficult to adjust to as cultural dissimilarity. However, it is not obvious...... and non-EU countries. Results showed that although the perceived cultural similarity between host and home country for the two groups of investigated respondents was different, there was neither any difference in their adjustment nor in the time it took for them to become proficient. Implications...

  11. Development of Cognitive Bias Modification (CBM) Tools to Promote Adjustment during Reintegration following Deployment

    Science.gov (United States)

    2017-06-01

    a meta-analysis. Child development 73 (3), 916-934. Owen, J.M., 2011. Transdiagnostic cognitive processes in high trait anger. Clinical Psychology ...Award Number: W81XWH-13-2-0001 TITLE: : Development of Cognitive Bias Modification (CBM) Tools to Promote Adjustment during Reintegration...DATES COVERED 15-OCT-2012 TO 14-OCT-2016 4. TITLE AND SUBTITLE Development of Cognitive Bias Modification (CBM) Tools to Promote Adjustment during

  12. Heterogeneity in the Speed of Adjustment toward Target Leverage

    DEFF Research Database (Denmark)

    Elsas, Ralf; Florysiak, David

    2011-01-01

    Estimating the speed of adjustment toward target leverage using the standard partial adjustment model assumes that all firms within the sample adjust at the same (average) pace. Dynamic capital structure theory predicts heterogeneity in adjustment speed due to firm-specific adjustment costs. Appl...

  13. Do Daily Retail Gasoline Prices adjust Asymmetrically?

    NARCIS (Netherlands)

    L.J.H. Bettendorf (Leon); S.A. van der Geest (Stéphanie); G. Kuper

    2005-01-01

    textabstractThis paper analyzes adjustments in the Dutch retail gasoline prices. We estimate an error correction model on changes in the daily retail price for gasoline (taxes excluded) for the period 1996-2004 taking care of volatility clustering by estimating an EGARCH model. It turns out the

  14. Do daily retail gasoline prices adjust asymmetrically?

    NARCIS (Netherlands)

    Bettendorf, L.; van der Geest, S. A.; Kuper, G. H.

    2009-01-01

    This paper analyses adjustments in the Dutch retail gasoline prices. We estimate an error correction model on changes in the daily retail price for gasoline (taxes excluded) for the period 1996-2004, taking care of volatility clustering by estimating an EGARCH model. It turns out that the volatility

  15. [Relationship between family variables and conjugal adjustment].

    Science.gov (United States)

    Jiménez-Picón, Nerea; Lima-Rodríguez, Joaquín-Salvador; Lima-Serrano, Marta

    2018-04-01

    To determine whether family variables, such as type of relationship, years of marriage, existence of offspring, number of members of family, stage of family life cycle, transition between stages, perceived social support, and/or stressful life events are related to conjugal adjustment. A cross-sectional and correlational study using questionnaires. Primary care and hospital units of selected centres in the province of Seville, Spain. Consecutive stratified sampling by quotas of 369 heterosexual couples over 18years of age, who maintained a relationship, with or without children, living in Seville. A self-report questionnaire for the sociodemographic variables, and the abbreviated version of the Dyadic Adjustment Scale, Questionnaire MOS Perceived Social Support, and Social Readjustment Rating Scale, were used. Descriptive and inferential statistics were performed with correlation analysis and multivariate regression. Statistically significant associations were found between conjugal adjustment and marriage years (r=-10: Pfamily life cycle (F=2.65; Pfamily life cycle stage (mature-aged stage) on conjugal adjustment (R2=.21; F=9.9; df=356; Prelationship. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  16. Stress and adjustment in diabetes mellitus.

    Science.gov (United States)

    Parveen, S; Singh, S B

    1999-01-01

    Stress and adjustment in diabetics is studied in order to know the influence of maladjustment and stress in the causation of the disease. The sample of study consists of 100 diabetics patients, 100 nonpsychosomatic and 100 normal person. Results obtained are discussed in detail. It is concluded that maladjustment and stress are important contributing factors in' diabetes mellitus.

  17. Stochastic Strategy Adjustment in Coordination Games

    NARCIS (Netherlands)

    Kosfeld, M.

    1999-01-01

    We explore a model of equilibrium selection in coordination games, where agents stochastically adjust their strategies to changes in their local environment. Instead of playing perturbed best-response, we assume that agents follow a rule of "switching to better strategies more likely". We relate

  18. Associations between faith, distress and mental adjustment

    DEFF Research Database (Denmark)

    Johannessen-Henry, Christine Tind

    2013-01-01

    = −0.79, CI −0.92; −0.66) and increased adjustment to cancer (fighting spirit, anxious preoccupation, helplessness-hopelessness). Specific aspects of faith were associated with high confusion-bewilderment and tension-anxiety, but also lower score on vigor-activity, and with higher anxious...

  19. Macroeconomic shocks and firms' labor adjustment

    DEFF Research Database (Denmark)

    Eriksson, Tor

    2013-01-01

    This article discusses some recent research which aims at producing evidence on how firms adjust their employment in response to output shocks using micro-level data and with a particular focus on the relationship between worker and job flows. The evidence presented is mainly based on Danish data...

  20. Social Adjustment and Personality Development in Children.

    Science.gov (United States)

    Roff, Merrill; And Others

    This book describes a series of studies included in a 5-year program of research on the social adjustment of school children in the third through sixth grades. The sample consists of a total of 40,000 children from Texas and Minnesota, including a small subsample of 5,000 used in a 4-year longitudinal study. Peer acceptance-rejection scores…

  1. Work Adjustment of Vocational Education Teachers.

    Science.gov (United States)

    Muncrief, Martha Crawford

    To investigate work adjustment of vocational education teachers, a nation-wide study was conducted focusing on vocational needs, job satisfaction, and job success. The study involved 180 secondary teachers from three vocational areas, business, home economics, and industrial education. A multistage sampling process was utilized to select…

  2. Extendable linearised adjustment model for deformation analysis

    NARCIS (Netherlands)

    Hiddo Velsink

    2015-01-01

    Author supplied: "This paper gives a linearised adjustment model for the affine, similarity and congruence transformations in 3D that is easily extendable with other parameters to describe deformations. The model considers all coordinates stochastic. Full positive semi-definite covariance matrices

  3. Extendable linearised adjustment model for deformation analysis

    NARCIS (Netherlands)

    Velsink, H.

    2015-01-01

    This paper gives a linearised adjustment model for the affine, similarity and congruence transformations in 3D that is easily extendable with other parameters to describe deformations. The model considers all coordinates stochastic. Full positive semi-definite covariance matrices and correlation

  4. An Adjustment Restriction on Fish Quota

    NARCIS (Netherlands)

    Dijk, van Diana; Hendrix, E.M.T.; Haijema, Rene; Groeneveld, R.A.; Ierland, van E.C.

    2017-01-01

    Management objectives of the European Union for North Sea fish stocks are shifting towards considering both biological sustainability and economic benefits. As part of multiannual management plans, an adjustment restriction on fish quota has been introduced. Its objective is to obtain an

  5. Output filters for AC adjustable speed drives

    DEFF Research Database (Denmark)

    Blaabjerg, Frede; Hanigovszki, Norbert; Landkildehus, Jorn, Jorn

    2007-01-01

    The standard industrial solution for adjustable speed drives (ASD) is the use of induction motors (IM) fed by voltage-source inverters (VSI). The inverter generates a pulsewidth modulated (PWM) voltage, with dv/dt values of about 6 kV/¿s or even more. In three-leg inverters for three-phase appli...

  6. Frequency adjustable MEMS vibration energy harvester

    Science.gov (United States)

    Podder, P.; Constantinou, P.; Amann, A.; Roy, S.

    2016-10-01

    Ambient mechanical vibrations offer an attractive solution for powering the wireless sensor nodes of the emerging “Internet-of-Things”. However, the wide-ranging variability of the ambient vibration frequencies pose a significant challenge to the efficient transduction of vibration into usable electrical energy. This work reports the development of a MEMS electromagnetic vibration energy harvester where the resonance frequency of the oscillator can be adjusted or tuned to adapt to the ambient vibrational frequency. Micro-fabricated silicon spring and double layer planar micro-coils along with sintered NdFeB micro-magnets are used to construct the electromagnetic transduction mechanism. Furthermore, another NdFeB magnet is adjustably assembled to induce variable magnetic interaction with the transducing magnet, leading to significant change in the spring stiffness and resonance frequency. Finite element analysis and numerical simulations exhibit substantial frequency tuning range (25% of natural resonance frequency) by appropriate adjustment of the repulsive magnetic interaction between the tuning and transducing magnet pair. This demonstrated method of frequency adjustment or tuning have potential applications in other MEMS vibration energy harvesters and micromechanical oscillators.

  7. 49 CFR 1135.1 - Quarterly adjustment.

    Science.gov (United States)

    2010-10-01

    ... subsequent amendments thereto. In addition, the AAR shall calculate the productivity-adjusted RCAF as..., the Association of American Railroads (AAR) shall calculate and file with the Board by the fifth day... all-inclusive index of railroad costs and calculate and file the RCAF unadjusted for changes in...

  8. Gender Differences in International Students' Adjustment

    Science.gov (United States)

    Lee, Seungcheol Austin; Park, Hee Sun; Kim, Wonsun

    2009-01-01

    As gender roles in the society are being rapidly redefined, female students today are showing outstanding academic prowess and pursuing higher education. The current study recruited Korean international students (n = 76) enrolled in universities in the US and examined gender differences in academic adjustment. The findings of the current study…

  9. 22 CFR 142.44 - Academic adjustments.

    Science.gov (United States)

    2010-04-01

    ... services and actions. Recipients need not provide attendants, individually prescribed devices, readers for... adjustments. (a) Academic requirements. A recipient to which this subpart applies shall make such... applicant or student. Academic requirements that the recipient can demonstrate are essential to the...

  10. 45 CFR 605.44 - Academic adjustments.

    Science.gov (United States)

    2010-10-01

    ... impairments, and other similar services and actions. Recipients need not provide attendents, individually... Postsecondary Education § 605.44 Academic adjustments. (a) Academic requirements. A recipient to which this..., against a qualified handicapped applicant or student. Academic requirements that the recipient can...

  11. 15 CFR 8b.22 - Academic adjustments.

    Science.gov (United States)

    2010-01-01

    ... actions. Recipients need not provide attendants, individually prescribed devices, readers for personal use... Secondary Education § 8b.22 Academic adjustments. (a) Academic requirements. A recipient to which this..., against a qualified handicapped applicant or student. Academic requirements that the recipient can...

  12. 24 CFR 882.410 - Rent adjustments.

    Science.gov (United States)

    2010-04-01

    ... PROGRAM) SECTION 8 MODERATE REHABILITATION PROGRAMS Special Procedures for Moderate Rehabilitation-Basic... Annual Adjustment Factor by the base rents. However, if the amounts borrowed to finance the rehabilitation costs or to finance purchase of the property are subject to a variable rate or are otherwise...

  13. 19 CFR 201.205 - Salary adjustments.

    Science.gov (United States)

    2010-04-01

    ... 19 Customs Duties 3 2010-04-01 2010-04-01 false Salary adjustments. 201.205 Section 201.205 Customs Duties UNITED STATES INTERNATIONAL TRADE COMMISSION GENERAL RULES OF GENERAL APPLICATION Debt... of coverage, or a change in coverage, under a Federal benefits program requiring periodic deductions...

  14. Predictors of College Adjustment among Hispanic Students

    Science.gov (United States)

    Yazedjian, Ani; Toews, Michelle L.

    2006-01-01

    The purpose of this study is to assess personal and interpersonal predictors of college adjustment among a sample of 190 first-year Hispanic students. Specifically, we examined the extent to which personal factors such as self-esteem, acculturation, and ethnic identity and interpersonal factors such as parental education and parental attachment…

  15. Psychosocial Adjustment Needs of Menopausal Women | Dimkpa ...

    African Journals Online (AJOL)

    The purpose of this study was to examine the psychosocial adjustment needs of menopausal women. The population of the study consisted of 623 menopausal women who were out-patients in Federal Medical Centre and a private hospital in Yenagoa Local Government Area, Bayelsa State of. Nigeria. The sample ...

  16. Host country language ability and expatriate adjustment

    DEFF Research Database (Denmark)

    Selmer, Jan; Lauring, Jakob

    2015-01-01

    countries, one with an easy, relatively simple language and the other with a difficult, highly complex language. Consistent with Goal-Setting Theory, results indicated a relative advantage of expatriates’ language ability in terms of their adjustment in the host country with the difficult language...

  17. Vietnamese Graduate International Student Repatriates: Reverse Adjustment

    Science.gov (United States)

    Le, Anh T.; LaCost, Barbara Y.

    2017-01-01

    The purpose of this study is to explore the experiences of Vietnamese international students who have returned to Vietnam after graduation from a U.S. higher education institution. The findings suggest that participants found it harder to readjust to Vietnam than to adjust to the U.S. even though they had lived most of their lives in Vietnam. Time…

  18. Stabilization and structural adjustment in Mozambique

    DEFF Research Database (Denmark)

    Tarp, Finn; Arndt, Channing; Jensen, Henning Tarp

    2000-01-01

    This paper outlines the complex historical legacy and structural adjustment efforts in Mozambique in addition to reviewing recent economic developments. An in-depth analysis of new and more reliable national accounts data show that macroeconomic stabilization has occurred through recovery from...

  19. Frequency adjustable MEMS vibration energy harvester

    International Nuclear Information System (INIS)

    Podder, P; Constantinou, P; Roy, S; Amann, A

    2016-01-01

    Ambient mechanical vibrations offer an attractive solution for powering the wireless sensor nodes of the emerging “Internet-of-Things”. However, the wide-ranging variability of the ambient vibration frequencies pose a significant challenge to the efficient transduction of vibration into usable electrical energy. This work reports the development of a MEMS electromagnetic vibration energy harvester where the resonance frequency of the oscillator can be adjusted or tuned to adapt to the ambient vibrational frequency. Micro-fabricated silicon spring and double layer planar micro-coils along with sintered NdFeB micro-magnets are used to construct the electromagnetic transduction mechanism. Furthermore, another NdFeB magnet is adjustably assembled to induce variable magnetic interaction with the transducing magnet, leading to significant change in the spring stiffness and resonance frequency. Finite element analysis and numerical simulations exhibit substantial frequency tuning range (25% of natural resonance frequency) by appropriate adjustment of the repulsive magnetic interaction between the tuning and transducing magnet pair. This demonstrated method of frequency adjustment or tuning have potential applications in other MEMS vibration energy harvesters and micromechanical oscillators. (paper)

  20. Occupational adjustment of immigrants in the Netherlands

    NARCIS (Netherlands)

    Zorlu, A.

    2013-01-01

    This article examines the speed of the occupational adjustment of immigrants using Labour Force Surveys 2004 and 2005 from Statistics Netherlands. The analysis provides new evidence that immigrants start with jobs at the lower levels of skill distribution. Their occupational achievement improves

  1. Premium adjustment: actuarial analysis on epidemiological models ...

    African Journals Online (AJOL)

    In this paper, we analyse insurance premium adjustment in the context of an epidemiological model where the insurer's future financial liability is greater than the premium from patients. In this situation, it becomes extremely difficult for the insurer since a negative reserve would severely increase its risk of insolvency, ...

  2. Inflation - Adjusted Accounting and Corporate Value Redefinition ...

    African Journals Online (AJOL)

    This paper, therefore, addresses the twisty advocacy and seeming intricacy of Inflation-Adjusted Accounting Systems (IAAS), with a view to illuminating the translational hurdles. The results abundantly necessitate the expeditious consolidation of a more robust framework to fix impending inhibitors such as lack of awareness, ...

  3. The academic adjustment scale : Measuring the adjustment of permanent resident or sojourner students

    NARCIS (Netherlands)

    Anderson, Joel R.; Guan, Yao; Koc, Yasin

    In this paper we developed and validated the Academic Adjustment Scale (AAS) - a new scale for measuring academic adjustment, which was developed with a focus on student sojourners who temporarily relocate to a new culture for the purpose of tertiary education, but also is validated for use with

  4. [An adjustable distractor for transverse maxillary distraction osteogenesis].

    Science.gov (United States)

    Leyder, P; Wycisk, G; Quilichini, J

    2013-06-01

    The posterior skeletal widening in conventional distractions (Surgical Assisted Rapid Maxillary Expansion) is often modest, in contrast with a predominant anterior expansion. Until recently, it was not possible to consider transverse palatal distraction osteogenesis and Le Fort I impaction or advancement in the same procedure, as the osteosynthesis plates impeded maxillary anterior opening. We developed new sliding osteosynthesis plates allowing to perform an advancement or impaction Le Fort I osteotomy associated with a low-resistance bipartite palatal distraction osteogenesis. We had for aim to describe the device and to determine its clinical applications. This new palatal distractor is made up of two independent stainless steel jacks allowing for an adjustable distraction in the anterior or posterior area as needed. Bone-borne and tooth-borne versions are available. This new distractor can be adjusted sagittally. The distraction can be angular or parallel, and the distraction mode can be modified during post-operative distraction. This device should be adapted to all clinical presentations. It can be used in combination with sliding osteosynthesis to perform a Le Fort 1 osteotomy and at the same time a complete correction of vertical, horizontal, and sagittal deficiencies. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  5. Self-esteem, social adjustment and suicidality in affective disorders.

    Science.gov (United States)

    Daskalopoulou, E G; Dikeos, D G; Papadimitriou, G N; Souery, D; Blairy, S; Massat, I; Mendlewicz, J; Stefanis, C N

    2002-09-01

    Self-esteem (SE) and social adjustment (SA) are often impaired during the course of affective disorders; this impairment is associated with suicidal behaviour. The aim of the present study was to investigate SE and SA in unipolar or bipolar patients in relation to demographic and clinical characteristics, especially the presence of suicidality (ideation and/or attempt). Forty-four patients, 28 bipolar and 16 unipolar, in remission for at least 3 months, and 50 healthy individuals were examined through a structured clinical interview. SE and SA were assessed by the Rosenberg self-esteem scale and the social adjustment scale, respectively. The results have shown that bipolar patients did not differ from controls in terms of SE, while unipolar patients had lower SE than bipolars and controls. No significant differences in the mean SA scores were found between the three groups. Suicidality during depression was associated only in bipolar patients with lower SE at remission; similar but not as pronounced was the association of suicidality with SA. It is concluded that low SE lasting into remission seems to be related to the expression of suicidality during depressive episodes of bipolar patients, while no similar pattern is evident in unipolar patients.

  6. Odds per adjusted standard deviation: comparing strengths of associations for risk factors measured on different scales and across diseases and populations.

    Science.gov (United States)

    Hopper, John L

    2015-11-15

    How can the "strengths" of risk factors, in the sense of how well they discriminate cases from controls, be compared when they are measured on different scales such as continuous, binary, and integer? Given that risk estimates take into account other fitted and design-related factors-and that is how risk gradients are interpreted-so should the presentation of risk gradients. Therefore, for each risk factor X0, I propose using appropriate regression techniques to derive from appropriate population data the best fitting relationship between the mean of X0 and all the other covariates fitted in the model or adjusted for by design (X1, X2, … , Xn). The odds per adjusted standard deviation (OPERA) presents the risk association for X0 in terms of the change in risk per s = standard deviation of X0 adjusted for X1, X2, … , Xn, rather than the unadjusted standard deviation of X0 itself. If the increased risk is relative risk (RR)-fold over A adjusted standard deviations, then OPERA = exp[ln(RR)/A] = RR(s). This unifying approach is illustrated by considering breast cancer and published risk estimates. OPERA estimates are by definition independent and can be used to compare the predictive strengths of risk factors across diseases and populations. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. Marital adjustment between mothers and fathers of patients with eating disorders

    Directory of Open Access Journals (Sweden)

    Ignacio Jáuregui-Lobera

    2016-10-01

    Full Text Available Objective: The association between marital adjustment and psychological disorders has been well described. The aim of this work was to analyse that adjustment between mothers and fathers of patients with Eating Disorders (ED and its relationship with some eatingand aesthetic body shape model-related variables. Method: A total of 104 mothers and fathers of ED patients were included in the study. They fulfilled some marital adjustment-, irrational food beliefs- and aesthetic body shape model (CIMEC-related questionnaires. Results: With respect to marital adjustment and areas of CIMEC, no significant correlations between mothers and fathers were found. A significant and positive correlation was found in the case of the irrational food beliefs subscale. Mothers showed higher scores on this subscale than fathers did. In addition, mothers scored higher on concerns of being thin, influence of friends, interpersonal influences, body anxiety, influence of advertisements and global CIMEC. The degree of marital adjustment was in the range obtained in clinical populations. Conclusions: The marital adjustment among parents of ED patients is moderate, similar to the described in clinical populations, worse than the found in non-clinical populations and no specific. The more presence of irrational food beliefs in the case of mothers along with a greater influence of the current aesthetic body shape model and the distress caused by the marital maladjustment could be a negative factor to bear in mind during the therapeutic process in ED, especially when working with parents as co-therapists.

  8. Quality-adjusted life-years. Ethical implications for physicians and policymakers.

    Science.gov (United States)

    La Puma, J; Lawlor, E F

    1990-06-06

    Quality-adjusted life-years have been used in economic analyses as a measure of health outcomes, one that reflects both lives saved and patients' valuations of quality of life in alternative health states. The concept of "cost per quality-adjusted life year" as a guideline for resource allocation is founded on six ethical assumptions: quality of life can be accurately measured and used, utilitarianism is acceptable, equity and efficiency are compatible, projections of community preferences can substitute for individual preferences, the old have less "capacity to benefit" than the young, and physicians will not use quality-adjusted life-years as clinical maxims. Quality-adjusted life-years signal two shifts in the locus of control and the nature of the clinical encounter: first, formal expressions of community preferences and societal usefulness would counterbalance patient autonomy, and second, formal tools of resource allocation and applied decision analysis would counterbalance the use of clinical judgment. These shifts reflect and reinforce a new financial ethos in medical decision making. Presently using quality-adjusted life-years for health policy decisions is problematic and speculative; using quality-adjusted life-years at the bedside is dangerous.

  9. Should adjustment disorder be conceptualized as transitional disorder? In pursuit of adjustment disorders definition.

    Science.gov (United States)

    Israelashvili, Moshe

    2012-12-01

    The DSM classification of an adjustment disorder is frequently criticized for not being well differentiated from other disorders. A possible reason for this is the vague definition of the term adjustment in social science literature. Hence, the current paper discusses the definition of adjustment and its implications for understanding maladjustment. Differential definitions of the terms adjustment, adaptation, socialization and coping are outlined, leading to the proposition that each one of them represents a different type of demand that is imposed on an individual who encounters a transitional event. Moreover, the four types of demands might be the possible sources of maladjustment. Helping people in transition requires an identification of the source, or combination of sources, that have led to the adjustment problem first, followed by the implementation of an adequate helping approach.

  10. Cultural Novelty and Adjustment: Western Business Expatriates in China

    DEFF Research Database (Denmark)

    Selmer, Jan

    2006-01-01

    Western business expatriates in China. Three sociocultural adjustment variables were examined; general, interaction and work adjustment. Although a negative relationship was hypothesized between cultural novelty and the three adjustment variables, results of the hierarchical multiple regression analysis...

  11. The association between pre-morbid adjustment, duration of untreated psychosis and outcome in first-episode psychosis

    DEFF Research Database (Denmark)

    Jeppesen, P; Petersen, L; Thorup, A

    2008-01-01

    The association between the duration of untreated psychosis (DUP) and outcome of schizophrenia may be confounded by other factors such as poor pre-morbid adjustment. The aim of the present study was to examine the independent contributions of DUP and of pre-morbid adjustment to the clinical...

  12. Effect of gender on psychosocial adjustment of colorectal cancer survivors with ostomy.

    Science.gov (United States)

    Gautam, Sital; Poudel, Anju

    2016-12-01

    Stoma can pose extensive challenges for colorectal cancer survivors. Identifying the psychological and social adjustment among them and how it differs by gender will aid in identifying those particularly at risk of having poor adjustment and in planning programs to improve their adjustment. The purpose of this study was to determine the effect of gender on psychosocial adjustment of colorectal cancer survivors with ostomy. A descriptive cross sectional study was carried out in the stoma clinic of B.P. Koirala Memorial Cancer Hospital, Bharatpur, Nepal. A purposive sample of 122 patients with ostomy was taken from the above mentioned setting. Selection criteria included colorectal cancer survivors having ostomy for at least 6 months. Data on socio-demographic and clinical variables were collected. Psychosocial adjustment was measured using Ostomy Adjustment Inventory-23 (OAI-23). A total of 122 patients were included in the study. Mean time since ostomy surgery was 2.53 and 1.98 years for men and women respectively. Both men and women had significant impairment in the psychosocial adjustment, however, men had significantly lower psychosocial adjustment score (37.68±12.96 vs . 43.45±12.81, t=-2.47, P=0.015) at 95% CI as compared to women and they reported more negative emotions. Furthermore, men significantly predicted low acceptance {β=-3.078, P=0.023, ΔR 2 =0.036, F [4,117] =7.90, Postomy should be monitored for psychosocial concerns in regular basis and health care providers should tailor care based on their need. Approaches of survivorship care and psychosocial interventions in colorectal cancer survivors with ostomy should take into account gender specific concerns and requirements to aid adjustment.

  13. Nuclear Data Parameter Adjustment BNL-INL

    International Nuclear Information System (INIS)

    Palmiotti, G.; Hoblit, S.; Herman, M.; Nobre, G.P.A.; Palumbo, A.; Hiruta, H.; Salvatores, M.

    2013-01-01

    This presentation reports on the consistent adjustment of nuclear data parameters performed within a BNL-INL collaboration. The main advantage compared to the classical adjustment of multigroup constants is to provide final nuclear data constrained by the nuclear reaction theory and consistent with both differential and integral measurements. The feasibility of a single-isotope assimilation was tested on a few priority materials ( 23 Na, 56 Fe, 105 Pd, 235,238 U, 239 Pu) using a selection of clean integral experiments. The multi-isotope assimilation is under study for the Big-3 ( 235,238 U, 239 Pu). This work shows that a consistent assimilation is feasible, but there are pitfalls to avoid (e.g. non-linearity, cross section fluctuations) and prerequisites (e.g. realistic covariances, good prior, realistic weighting of differential and integral experiments). Finally, only all experimental information combined with the state of the art modelling may provide a 'right' answer

  14. Article mounting and position adjustment stage

    Science.gov (United States)

    Cutburth, Ronald W.; Silva, Leonard L.

    1988-01-01

    An improved adjustment and mounting stage of the type used for the detection of laser beams is disclosed. A ring sensor holder has locating pins on a first side thereof which are positioned within a linear keyway in a surrounding housing for permitting reciprocal movement of the ring along the keyway. A rotatable ring gear is positioned within the housing on the other side of the ring from the linear keyway and includes an oval keyway which drives the ring along the linear keyway upon rotation of the gear. Motor-driven single-stage and dual (x, y) stage adjustment systems are disclosed which are of compact construction and include a large laser transmission hole.

  15. Adjusted Money's Worth Ratios in Life Annuities

    OpenAIRE

    Jaime Casassus; Eduardo Walker

    2013-01-01

    The Money's Worth Ratio (MWR) measures an annuity's actuarial fairness. It is calculated as the discounted present value of expected future payments divided by its cost. We argue that from the perspective of annuitants, this measure may overestimate the value-for-money obtained, since it does not adjust for liquidity or risk factors. Measuring these factors is challenging, requiring detailed knowledge of assets, liabilities, and of the stochastic processes followed by them. Using a multi-fact...

  16. Underwriters' view of risk - An adjuster's perspective

    International Nuclear Information System (INIS)

    Smith, M.

    1992-01-01

    This paper reviews how a risk assessment is performed by an insurance adjuster to determine rates and insurability of a client. It provides a historical perspective on insurance and how information systems are used to monitor past claims to determine future risk. Although this paper does not specifically address the oil and gas industry, it is informative in identifying how insurance rates are determined and risk assessments for various oil and gas operations are performed

  17. Markup cyclicality, employment adjustment, and financial constraints

    OpenAIRE

    Askildsen, Jan Erik; Nilsen, Øivind Anti

    2001-01-01

    We investigate the existence of markups and their cyclical behaviour. Markup is not directly observed. Instead, it is given as a price-cost relation that is estimated from a dynamic model of the firm. The model incorporates potential costly employment adjustments and takes into consideration that firms may be financially constrained. When considering size of the future labour stock, financially constrained firms may behave as if they have a higher discount factor, which may affect the realise...

  18. Adjustment problems and residential care environment

    OpenAIRE

    Jan Sebastian Novotný

    2015-01-01

    Problem: Residential care environment represents a specific social space that is associated with a number of negative consequences, covering most aspects of children and youth functioning. The paper analyzes of the presence of adjustment problems among adolescents from institutional care environment and compares this results with a population of adolescents who grew up in a family. Methods: The sample consisted of two groups of adolescents. The first group included 285 adolescents currently g...

  19. Learning-parameter adjustment in neural networks

    Science.gov (United States)

    Heskes, Tom M.; Kappen, Bert

    1992-06-01

    We present a learning-parameter adjustment algorithm, valid for a large class of learning rules in neural-network literature. The algorithm follows directly from a consideration of the statistics of the weights in the network. The characteristic behavior of the algorithm is calculated, both in a fixed and a changing environment. A simple example, Widrow-Hoff learning for statistical classification, serves as an illustration.

  20. Mechanism of laser micro-adjustment

    International Nuclear Information System (INIS)

    Shen Hong

    2008-01-01

    Miniaturization is a requirement in engineering to produce competitive products in the field of optical and electronic industries. Laser micro-adjustment is a new and promising technology for sheet metal actuator systems. Efforts have been made to understand the mechanisms of metal plate forming using a laser heating source. Three mechanisms have been proposed for describing the laser forming processes in different scenarios, namely the temperature gradient mechanism (TGM), buckling mechanism and upsetting mechanism (UM). However, none of these mechanisms can fully describe the deformation mechanisms involved in laser micro-adjustment. Based on the thermal and elastoplastic analyses, a coupled TGM and UM are presented in this paper to illustrate the thermal mechanical behaviours of two-bridge actuators when applying a laser forming process. To validate the proposed coupling mechanism, numerical simulations are carried out and the corresponding results demonstrate the mechanism proposed. The mechanism of the micro-laser adjustment could be taken as a supplement to the laser forming process.

  1. Adjustment of nursing home quality indicators

    Directory of Open Access Journals (Sweden)

    Hirdes John P

    2010-04-01

    Full Text Available Abstract Background This manuscript describes a method for adjustment of nursing home quality indicators (QIs defined using the Center for Medicaid & Medicare Services (CMS nursing home resident assessment system, the Minimum Data Set (MDS. QIs are intended to characterize quality of care delivered in a facility. Threats to the validity of the measurement of presumed quality of care include baseline resident health and functional status, pattern of comorbidities, and facility case mix. The goal of obtaining a valid facility-level estimate of true quality of care should include adjustment for resident- and facility-level sources of variability. Methods We present a practical and efficient method to achieve risk adjustment using restriction and indirect and direct standardization. We present information on validity by comparing QIs estimated with the new algorithm to one currently used by CMS. Results More than half of the new QIs achieved a "Moderate" validation level. Conclusions Given the comprehensive approach and the positive findings to date, research using the new quality indicators is warranted to provide further evidence of their validity and utility and to encourage their use in quality improvement activities.

  2. Player Modeling for Intelligent Difficulty Adjustment

    Science.gov (United States)

    Missura, Olana; Gärtner, Thomas

    In this paper we aim at automatically adjusting the difficulty of computer games by clustering players into different types and supervised prediction of the type from short traces of gameplay. An important ingredient of video games is to challenge players by providing them with tasks of appropriate and increasing difficulty. How this difficulty should be chosen and increase over time strongly depends on the ability, experience, perception and learning curve of each individual player. It is a subjective parameter that is very difficult to set. Wrong choices can easily lead to players stopping to play the game as they get bored (if underburdened) or frustrated (if overburdened). An ideal game should be able to adjust its difficulty dynamically governed by the player’s performance. Modern video games utilise a game-testing process to investigate among other factors the perceived difficulty for a multitude of players. In this paper, we investigate how machine learning techniques can be used for automatic difficulty adjustment. Our experiments confirm the potential of machine learning in this application.

  3. Adjustments to financial and social benefits

    CERN Document Server

    HR Department

    2009-01-01

    In accordance with decisions taken by the Finance Committee and Council in December 2008, certain financial and social benefits will be adjusted with effect from 1st January 2009. An increase of 2.7% will be applied to the scale of basic salaries and the scale of stipends paid to Fellows (Annexes R A 5 and R A 6 of the Staff Rules and Regulations, respectively). As a result of the evolution of the Geneva consumer price index, the following financial elements will increase by 3.2%: a) Family Allowance, Child Allowance and Infant Allowance (Annex R A 3 of the Staff Rules and Regulations) b) Payment of education fees: payment ceilings (Annex R A 4 of the Staff Rules and Regulations) for the academic year 2008/2009. As a result of the evolution of the Geneva consumer price index, adjustments will be applied to the subsistence allowances of Paid Associates and Students. The adjusted amounts are available in Departmental Secretariats. Human Resources Department Tel. 70674

  4. Intracranial Pressure-Guided Shunt Valve Adjustments with the Miethke Sensor Reservoir.

    Science.gov (United States)

    Antes, Sebastian; Stadie, Axel; Müller, Simon; Linsler, Stefan; Breuskin, David; Oertel, Joachim

    2018-01-01

    Telemetric intracranial pressure (ICP) monitoring seems to be a promising therapy-supporting option in shunt-treated patients. Benefits become obvious when headaches are unspecific and clinical symptoms cannot be related to possible overdrainage or underdrainage. In this study, we evaluated a new telemetric device to individually adjust shunt valves according to ICP measurements. Between December 2015 and November 2016, 25 patients with suspected suboptimal shunt valve settings underwent insertion of a telemetric ICP sensor (Sensor Reservoir; Christoph Miethke, Potsdam, Germany). Over a 1-year period, a total of 183 telemetric ICP measurements and 85 shunt valve adjustments were carried out. Retrospective statistic analyses focused on valve adjustments, ICP values, and clinical outcomes. ICP-guided valve adjustments positively changed the clinical state in 18 out of 25 patients. Clinical improvement over time was associated with significant changes of the valve settings and ICP values. Interestingly, a therapeutically normalized ICP profile was not automatically associated with clinical improvement. The Sensor Reservoir is an important and valuable tool for shunt-treated patients suffering from drainage-related problems. The possibility to simultaneously recognize and solve shunt problems represents the decisive advantage. Nevertheless, measurements with the Sensor Reservoir did not allow for the determination of default valve settings or universal target ICP values. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. The Student's Adjustment Inventory Manual | Tanyi | IFE PsychologIA

    African Journals Online (AJOL)

    The term school adjustment according to this study relates directly to personality formation of a child at school. Personality also here refers to stable behaviors in the process of adjustment. Stable forms of adjustment or adaptations can be regarded as traits of personality. School adjustment therefore, is a behavioural pattern ...

  6. 13 CFR 315.6 - Firm eligibility for Adjustment Assistance.

    Science.gov (United States)

    2010-01-01

    ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Firm eligibility for Adjustment..., DEPARTMENT OF COMMERCE TRADE ADJUSTMENT ASSISTANCE FOR FIRMS General Provisions § 315.6 Firm eligibility for Adjustment Assistance. (a) Firms participate in the Trade Adjustment Assistance for Firms program in...

  7. 26 CFR 1.1368-2 - Accumulated adjustments account (AAA).

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 11 2010-04-01 2010-04-01 true Accumulated adjustments account (AAA). 1.1368-2... adjustments account (AAA). (a) Accumulated adjustments account—(1) In general. The accumulated adjustments account is an account of the S corporation and is not apportioned among shareholders. The AAA is relevant...

  8. 78 FR 5722 - Civil Monetary Penalty Inflation Adjustment

    Science.gov (United States)

    2013-01-28

    ... Civil Monetary Penalty Inflation Adjustment AGENCY: U.S. Army Corps of Engineers, DoD. ACTION: Direct... for inflation. The adjustment of civil penalties to account for inflation is required by the Federal Civil Penalties Inflation Adjustment Act of 1990, as amended. Since we have not made any adjustments to...

  9. 12 CFR 263.65 - Civil penalty inflation adjustments.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Civil penalty inflation adjustments. 263.65... Money Penalties § 263.65 Civil penalty inflation adjustments. (a) Inflation adjustments. In accordance with the Federal Civil Penalties Inflation Adjustment Act of 1990 (28 U.S.C. 2461 note), the Board has...

  10. 76 FR 74625 - Civil Monetary Penalties Inflation Adjustment

    Science.gov (United States)

    2011-12-01

    ...-2011] RIN 1125-AA69 Civil Monetary Penalties Inflation Adjustment AGENCIES: U.S. Customs and Border... adjust for inflation certain civil monetary penalties assessed under the Immigration and Nationality Act... assessed under the INA. The Federal Civil Penalties Inflation Adjustment Act of 1990 (Adjustment Act...

  11. FLOODPLAIN MAPPING FOR HOPKINS COUNTY TX

    Data.gov (United States)

    Federal Emergency Management Agency, Department of Homeland Security — The Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

  12. The Relationship Between Psychosocial Adjustment and Coping Strategies Among Patients With Multiple Sclerosis in Turkey.

    Science.gov (United States)

    Okanli, Ayse; Tanriverdi, Derya; Ipek Coban, Gülay; Asi Karakaş, Sibel

    Multiple sclerosis (MS) is a disease with significant psychosocial adjustment challenges. The objective of the study was to assess the psychosocial adjustment and coping strategies in patients with MS and to put forth the relationships between them. The sample group comprised 85 outpatients with MS who were admitted to the Neurology Clinic of a university hospital for treatment between October 2007 and July 2008. Data were acquired via an information form and the Psychosocial Adjustment to Illness Scale and Coping Strategy Indicator. It was determined that 55% of the patients had poor psychosocial adjustment levels. Statistically significant relationship was found between Psychosocial Adjustment to Illness Scale-Self-Report and problem solving as well as seeking social support coping strategies ( p Psychosocial adjustment got worse with decreasing problem-solving and seeking-social support coping strategies of patients. The psychosocial adjustment to MS of patients is closely related with effective coping strategies. The results have emphasized the significant role of mental health and social services and coping strategies regarding the comprehensive care needs of these patients.

  13. Exploring the Relationship Between Resilience and Ostomy Adjustment in Adults With a Permanent Ostomy.

    Science.gov (United States)

    Scardillo, Jody; Dunn, Karen S; Piscotty, Ronald

    2016-01-01

    The aims of this study were to describe the relationship between resilience and ostomy adjustment in adults with permanent stomas and to determine if participants who report higher levels of resilience also report higher levels of adjustment to a permanent ostomy. Descriptive, correlational research design utilizing the Roy Adaptation Model as the theoretical framework was used. Persons with permanent stomas were recruited from ostomy support groups on the East Coast of the United States. The study sample included 48 respondents. Their mean age was 66 ± 12.7 years (mean ± SD); the majority (60.4%) were women, had an ileostomy (62.5%), and had a history of inflammatory bowel disease (62.5%). Respondents completed a questionnaire that queried demographic and pertinent clinical data, along with 2 previously validated instruments, the Resilience Scale and Ostomy Adjustment Inventory-23. The relationships between levels of resilience, levels of adjustment to an ostomy, and demographic characteristics were examined. Participants with higher levels of ostomy adjustment had higher levels of resilience than respondents who reported lower levels of ostomy adjustment (r = 0.65, P ≤ .01). Findings from this study suggest that higher levels of resilience facilitate adjustment to a permanent ostomy.

  14. Implication of Mauk Nursing Rehabilitation Model on Adjustment of Stroke Patients

    Directory of Open Access Journals (Sweden)

    Zeinab Ebrahimpour mouziraji

    2014-12-01

    Full Text Available Objectives: Stroke is a neurological syndrome with sudden onset or gradual destruction of brain vessels, which may take 24 hours or more. Complications of stroke effect in the variation aspects of the individual. According to De Spulveda and Chang’s Studies, disability reduced the effective adjustment. This study aimed to overview the adjustment of stroke patients based on the main concepts of rehabilitation nursing Mauk model. Methods: In a quasi-experimental one group pre-posttest design study, data was collected in the neurology clinic of Imam Khomeini hospital and stroke patient rehabilitation centers in Tehran (Tabassom. Data collection included demographic and adjustment questionnaires of stroke patients. The intervention included seven sessions as Mauk model, each session with one hour training, for seven patients. Data analysis performed with SPSS software with paired t-test and was compared with previous results. Results: There were significant differences between the mean scores of patients with stroke adjustment questionnaire in the pre-test-post-test. But in the adjustment sub-scales, except for relationship with wife and Personal adjustment, in other areas, there is no statistically significant difference between the pre and posttest. Discussion: The results indicated that training has been affected on some aspects of adjustment of stroke patients in order to, as improving functions, complications and its limitations. Nurses can help then with implementing of plans such as patients education in this regard.

  15. Inverse probability weighting for covariate adjustment in randomized studies.

    Science.gov (United States)

    Shen, Changyu; Li, Xiaochun; Li, Lingling

    2014-02-20

    Covariate adjustment in randomized clinical trials has the potential benefit of precision gain. It also has the potential pitfall of reduced objectivity as it opens the possibility of selecting a 'favorable' model that yields strong treatment benefit estimate. Although there is a large volume of statistical literature targeting on the first aspect, realistic solutions to enforce objective inference and improve precision are rare. As a typical randomized trial needs to accommodate many implementation issues beyond statistical considerations, maintaining the objectivity is at least as important as precision gain if not more, particularly from the perspective of the regulatory agencies. In this article, we propose a two-stage estimation procedure based on inverse probability weighting to achieve better precision without compromising objectivity. The procedure is designed in a way such that the covariate adjustment is performed before seeing the outcome, effectively reducing the possibility of selecting a 'favorable' model that yields a strong intervention effect. Both theoretical and numerical properties of the estimation procedure are presented. Application of the proposed method to a real data example is presented. Copyright © 2013 John Wiley & Sons, Ltd.

  16. MODULAR BUNDLE ADJUSTMENT FOR PHOTOGRAMMETRIC COMPUTATIONS

    Directory of Open Access Journals (Sweden)

    N. Börlin

    2018-05-01

    Full Text Available In this paper we investigate how the residuals in bundle adjustment can be split into a composition of simple functions. According to the chain rule, the Jacobian (linearisation of the residual can be formed as a product of the Jacobians of the individual steps. When implemented, this enables a modularisation of the computation of the bundle adjustment residuals and Jacobians where each component has limited responsibility. This enables simple replacement of components to e.g. implement different projection or rotation models by exchanging a module. The technique has previously been used to implement bundle adjustment in the open-source package DBAT (Börlin and Grussenmeyer, 2013 based on the Photogrammetric and Computer Vision interpretations of Brown (1971 lens distortion model. In this paper, we applied the technique to investigate how affine distortions can be used to model the projection of a tilt-shift lens. Two extended distortion models were implemented to test the hypothesis that the ordering of the affine and lens distortion steps can be changed to reduce the size of the residuals of a tilt-shift lens calibration. Results on synthetic data confirm that the ordering of the affine and lens distortion steps matter and is detectable by DBAT. However, when applied to a real camera calibration data set of a tilt-shift lens, no difference between the extended models was seen. This suggests that the tested hypothesis is false and that other effects need to be modelled to better explain the projection. The relatively low implementation effort that was needed to generate the models suggest that the technique can be used to investigate other novel projection models in photogrammetry, including modelling changes in the 3D geometry to better understand the tilt-shift lens.

  17. Modular Bundle Adjustment for Photogrammetric Computations

    Science.gov (United States)

    Börlin, N.; Murtiyoso, A.; Grussenmeyer, P.; Menna, F.; Nocerino, E.

    2018-05-01

    In this paper we investigate how the residuals in bundle adjustment can be split into a composition of simple functions. According to the chain rule, the Jacobian (linearisation) of the residual can be formed as a product of the Jacobians of the individual steps. When implemented, this enables a modularisation of the computation of the bundle adjustment residuals and Jacobians where each component has limited responsibility. This enables simple replacement of components to e.g. implement different projection or rotation models by exchanging a module. The technique has previously been used to implement bundle adjustment in the open-source package DBAT (Börlin and Grussenmeyer, 2013) based on the Photogrammetric and Computer Vision interpretations of Brown (1971) lens distortion model. In this paper, we applied the technique to investigate how affine distortions can be used to model the projection of a tilt-shift lens. Two extended distortion models were implemented to test the hypothesis that the ordering of the affine and lens distortion steps can be changed to reduce the size of the residuals of a tilt-shift lens calibration. Results on synthetic data confirm that the ordering of the affine and lens distortion steps matter and is detectable by DBAT. However, when applied to a real camera calibration data set of a tilt-shift lens, no difference between the extended models was seen. This suggests that the tested hypothesis is false and that other effects need to be modelled to better explain the projection. The relatively low implementation effort that was needed to generate the models suggest that the technique can be used to investigate other novel projection models in photogrammetry, including modelling changes in the 3D geometry to better understand the tilt-shift lens.

  18. BASACF, Integral Neutron Spectra Adjustment and Dosimetry

    International Nuclear Information System (INIS)

    Tichy, Milos

    1996-01-01

    1 - Description of program or function: Adjustment of a neutron spectrum based on integral detector measurements and calculation of an integral dosimetric quantity (integral flux, d.p.a., dose equivalent) and its variance. The program requires measured data (activities and their covariance matrix) and a priori information (spectrum, dosimetry cross sections, integral quantity conversion factor and their covariance matrices). All a priori covariance matrices can be read in from a file prepared by some other code or can be generated by means of three different methods (by subroutines included in the program). A subroutine which can normalize the a priori flux to measured data is also included. The program provides also adjusted dosimetry cross sections (with covariance matrix) so that it can be used for an adjustment of cross sections (or response functions of e.g. Bonner balls) by measurements in well-known neutron spectra. 2 - Method of solution: Bayesian theorem on conditional probability applied to linearized relation between activities, dosimetry cross sections and flux. All probability distributions are supposed to be normal and this supposition leads to minimizing of the same functional as least squares method (STAY'SL). This task is solved by a covariance filter method which avoids any matrix inversion and is numerically robust and stable. 3 - Restrictions on the complexity of the problem: This version can use 45 energy groups and 5 detectors and occupies 310 kB of main memory. This restriction can be modified according to available memory. The covariance matrix of activities is supposed diagonal. A solution is produced for any set of input data but in the case of non-consistent data, when measured activities do not match the a priori flux, the solution is not very meaningful

  19. Adjusting case mix payment amounts for inaccurately reported comorbidity data.

    Science.gov (United States)

    Sutherland, Jason M; Hamm, Jeremy; Hatcher, Jeff

    2010-03-01

    Case mix methods such as diagnosis related groups have become a basis of payment for inpatient hospitalizations in many countries. Specifying cost weight values for case mix system payment has important consequences; recent evidence suggests case mix cost weight inaccuracies influence the supply of some hospital-based services. To begin to address the question of case mix cost weight accuracy, this paper is motivated by the objective of improving the accuracy of cost weight values due to inaccurate or incomplete comorbidity data. The methods are suitable to case mix methods that incorporate disease severity or comorbidity adjustments. The methods are based on the availability of detailed clinical and cost information linked at the patient level and leverage recent results from clinical data audits. A Bayesian framework is used to synthesize clinical data audit information regarding misclassification probabilities into cost weight value calculations. The models are implemented through Markov chain Monte Carlo methods. An example used to demonstrate the methods finds that inaccurate comorbidity data affects cost weight values by biasing cost weight values (and payments) downward. The implications for hospital payments are discussed and the generalizability of the approach is explored.

  20. Permanent multipole magnets with adjustable strength

    International Nuclear Information System (INIS)

    Halbach, K.

    1983-01-01

    Preceded by a short discussion of the motives for using permanent magnets in accelerators, a new type of permanent magnet for use in accelerators is presented. The basic design and most important properties of a quadrople will be described that uses both steel and permanent magnet material. The field gradient produced by this magnet can be adjusted without changing any other aspect of the field produced by this quadrupole. The generalization of this concept to produce other multipole fields, or combination of multipole fields, will also be presented

  1. An Integrative Psychotherapy of Postpartum Adjustment

    Directory of Open Access Journals (Sweden)

    Carol Merle-Fishman

    2010-12-01

    Full Text Available Becoming a mother is a time of transition, transformation and sometimes trauma. The immediacy of meeting the needs of an infant, combined with the immediacy of becoming a mother, often collide to produce depression, anxiety and stress. Shame, confusion, isolation and cultural expectations often prevent women from seeking the postpartum support they need, which may result in long lasting depression, anxiety and unresolved trauma. Integrative Psychotherapy, Transactional Analysis and Attachment Theory offer ways to understand postpartum adjustment as well as methodologies for addressing this unique developmental event in the life of women.

  2. Tuning permanent magnets with adjustable field clamps

    International Nuclear Information System (INIS)

    Schermer, R.I.

    1987-01-01

    The effective length of a permanent-magnet assembly can be varied by adjusting the geometrical parameters of a field clamp. This paper presents measurements on a representative dipole and quadrupole as the field clamp is withdrawn axially or radially. The detailed behavior depends upon the magnet multipolarity and geometry. As a rule-of-thumb, a 3-mm-thick iron plate placed at one end plane of the magnet will shorten the length by one-third of the magnet bore radius

  3. Problems of state adjustment the telecommunications industry

    Directory of Open Access Journals (Sweden)

    Tregub Ilona Vladimirovna

    2015-08-01

    Full Text Available The paper presents the mechanism of state adjustment of the telecommunications industry companies, providing the additional mobile services (VAS-services, by determining the optimal rates of tax and non-tax payments to the budget. Method is based on the approach of A. Laffer, who showed the possibility of existence an optimal tax rate, which provides, on the one hand, the maximum flow of funds in the budget, on the other hand, preserves the incentives of entrepreneurship. In the present paper, we study the dependence of revenues to the Reserve Fund on the size of the contribution rate and the coefficient of profitability of enterprises providing VAS-services.

  4. Permanent multipole magnets with adjustable strength

    International Nuclear Information System (INIS)

    Halbach, K.

    1983-03-01

    Preceded by a short discussion of the motives for using permanent magnets in accelerators, a new type of permanent magnet for use in accelerators is presented. The basic design and most important properties of a quadrupole will be described that uses both steel and permanent magnet material. The field gradient produced by this magnet can be adjusted without changing any other aspect of the field produced by this quadrupole. The generalization of this concept to produce other multipole fields, or combination of multipole fields, will also be presented

  5. Adjustable Speed Drives and Power Quality

    DEFF Research Database (Denmark)

    Davari, Pooya; Yang, Yongheng; Zare, Firuz

    2016-01-01

    This paper provides an overview and proposes cost-effective and efficient opportunities in improving power quality in Adjustable Speed Drive (ASD) systems. In particular, an Electronic Inductor (EI) technique has been used in single drives to overcome the existing challenges in conventional...... frontend rectifiers even at partial loading conditions. Moreover, the effectiveness of the EI technique along with a phase-shifted current control in terms of improved grid current quality in multi-drive configurations is addressed. Furthermore, a novel DC-link current modulation scheme for multi...

  6. The Mediating Role of Psychological Adjustment between Peer Victimization and Social Adjustment in Adolescence.

    Science.gov (United States)

    Romera, Eva M; Gómez-Ortiz, Olga; Ortega-Ruiz, Rosario

    2016-01-01

    There is extensive scientific evidence of the serious psychological and social effects that peer victimization may have on students, among them internalizing problems such as anxiety or negative self-esteem, difficulties related to low self-efficacy and lower levels of social adjustment. Although a direct relationship has been observed between victimization and these effects, it has not yet been analyzed whether there is a relationship of interdependence between all these measures of psychosocial adjustment. The aim of this study was to examine the relationship between victimization and difficulties related to social adjustment among high school students. To do so, various explanatory models were tested to determine whether psychological adjustment (negative self-esteem, social anxiety and social self-efficacy) could play a mediating role in this relationship, as suggested by other studies on academic adjustment. The sample comprised 2060 Spanish high school students (47.9% girls; mean age = 14.34). The instruments used were the scale of victimization from European Bullying Intervention Project Questionnaire , the negative scale from Rosenberg Self-Esteem Scale, Social Anxiety Scale for Adolescents and a general item about social self-efficacy, all of them self-reports. Structural equation modeling was used to analyze the data. The results confirmed the partial mediating role of negative self-esteem, social anxiety and social self-efficacy between peer victimization and social adjustment and highlight the importance of empowering victimized students to improve their self-esteem and self-efficacy and prevent social anxiety. Such problems lead to the avoidance of social interactions and social reinforcement, thus making it difficult for these students to achieve adequate social adjustment.

  7. The Mediating Role of Psychological Adjustment between Peer Victimization and Social Adjustment in Adolescence

    Directory of Open Access Journals (Sweden)

    Eva M. Romera

    2016-11-01

    Full Text Available There is extensive scientific evidence of the serious psychological and social effects that peer victimization may have on students, among them internalizing problems such as anxiety or negative self-esteem, difficulties related to low self-efficacy and lower levels of social adjustment. Although a direct relationship has been observed between victimization and these effects, it has not yet been analyzed whether there is a relationship of interdependence between all these measures of psychosocial adjustment. The aim of this study was to examine the relationship between victimization and difficulties related to social adjustment among high school students. To do so, various explanatory models were tested to determine whether psychological adjustment (negative self-esteem, social anxiety and social self-efficacy could play a mediating role in this relationship, as suggested by other studies on academic adjustment. The sample comprised 2060 Spanish high school students (47.9% girls; mean age = 14.34. The instruments used were the scale of victimization from European Bullying Intervention Project Questionnaire, the negative scale from Rosenberg Self-Esteem Scale, Social Anxiety Scale for Adolescents and a general item about social self-efficacy, all of them self-reports. Structural equation modeling was used to analyze the data. The results confirmed the partial mediating role of negative self-esteem, social anxiety and social self-efficacy between peer victimization and social adjustment and highlight the importance of empowering victimized students to improve their self-esteem and self-efficacy and prevent social anxiety. Such problems lead to the avoidance of social interactions and social reinforcement, thus making it difficult for these students to achieve adequate social adjustment.

  8. Adjustment of legally binding local plans

    DEFF Research Database (Denmark)

    Hvingel, Line Træholt; Aunsborg, Christian; Christensen, Finn Kjær

    2012-01-01

    Traditionally, and by law, new urban areas in Denmark are regulated and planned through legally binding local plans. Recently a tendency has occurred: The municipalities make the legally binding local plans quite open for future adjustment, and they are using a substantial amount of ‘empowerment ...... the considerations of legal rights, the extend of the legal use of empowerment provisions and the combination of the use of legal binding local plans and other legal instruments such as easements and sales agreements.......Traditionally, and by law, new urban areas in Denmark are regulated and planned through legally binding local plans. Recently a tendency has occurred: The municipalities make the legally binding local plans quite open for future adjustment, and they are using a substantial amount of ‘empowerment...... provisions’ which empower the municipalities to later ruling. This way of making plans postpones the actual regulation of an area (i.e. the planning permission) making it an individual ruling for instance at the application of building permits. Case studies show examples of this way of regulating an area...

  9. Adjustable electronic load-alarm relay

    International Nuclear Information System (INIS)

    Mason, C.H.; Sitton, R.S.

    1976-01-01

    An improved electronic alarm relay for monitoring the current drawn by an ac motor or other electrical load is described. The circuit is designed to measure the load with high accuracy and to have excellent alarm repeatability. Chattering and arcing of the relay contacts are minimal. The operator can adjust the set point easily and can re-set both the high and the low alarm points by means of one simple adjustment. The relay includes means for generating a signal voltage proportional to the motor current. In a preferred form of the invention a first operational amplifier is provided to generate a first constant reference voltage which is higher than a preselected value of the signal voltage. A second operational amplifier is provided to generate a second constant reference voltage which is lower than the aforementioned preselected value of the signal voltage. A circuit comprising a first resistor serially connected to a second resistor is connected across the outputs of the first and second amplifiers, and the junction of the two resistors is connected to the inverting terminal of the second amplifier. Means are provided to compare the aforementioned signal voltage with both the first and second reference voltages and to actuate an alarm if the signal voltage is higher than the first reference voltage or lower than the second reference voltage

  10. Novel fluorescence adjustable photonic crystal materials

    Science.gov (United States)

    Zhu, Cheng; Liu, Xiaoxia; Ni, Yaru; Fang, Jiaojiao; Fang, Liang; Lu, Chunhua; Xu, Zhongzi

    2017-11-01

    Novel photonic crystal materials (PCMs) with adjustable fluorescence were fabricated by distributing organic fluorescent powders of Yb0.2Er0.4Tm0.4(TTA)3Phen into the opal structures of self-assembled silica photonic crystals (PCs). Via removing the silica solution in a constant speed, PCs with controllable thicknesses and different periodic sizes were obtained on glass slides. Yb0.2Er0.4Tm0.4(TTA)3Phen powders were subsequently distributed into the opal structures. The structures and optical properties of the prepared PCMs were investigated. Finite-difference-time-domain (FDTD) calculation was used to further analyze the electric field distributions in PCs with different periodic sizes while the relation between periodic sizes and fluorescent spectra of PCMs was discussed. The results showed that the emission color of the PCMs under irradiation of 980 nm laser can be easily adjusted from green to blue by increasing the periodic size from 250 to 450 nm.

  11. Initial experience with the Codman Certas adjustable valve in the management of patients with hydrocephalus

    DEFF Research Database (Denmark)

    Watt, Sara; Agerlin, Niels; Romner, Bertil

    2012-01-01

    A new adjustable valve, the Codman CertasTM valve for treatment of hydrocephalus was introduced into clinical practice in January 2011. It has 8 different settings with an opening pressure varying from 36 to over 400 mm H2O at a flow rate of 20 mL/h. The 8th setting is designed to provide...

  12. Prior use of durable medical equipment as a risk adjuster for health-based capitation

    NARCIS (Netherlands)

    R.C. van Kleef (Richard); R.C.J.A. van Vliet (René)

    2010-01-01

    textabstractThis paper examines a new risk adjuster for capitation payments to Dutch health plans, based on the prior use of durable medical equipment (DME). The essence is to classify users of DME in a previous year into clinically homogeneous classes and to apply the resulting classification as a

  13. Psychosocial Adjustment and Life Satisfaction until 5 Years after Severe Brain Damage

    Science.gov (United States)

    Sorbo, Ann K.; Blomqvist, Maritha; Emanuelsson, Ingrid M.; Rydenhag, Bertil

    2009-01-01

    The objectives of this study were to describe psychosocial adjustment and outcome over time for severely brain-injured patients and to find suitable outcome measures for clinical practice during the rehabilitation process and for individual rehabilitation planning after discharge from hospital. The methods include a descriptive, prospective,…

  14. HIV quality report cards: impact of case-mix adjustment and statistical methods.

    Science.gov (United States)

    Ohl, Michael E; Richardson, Kelly K; Goto, Michihiko; Vaughan-Sarrazin, Mary; Schweizer, Marin L; Perencevich, Eli N

    2014-10-15

    There will be increasing pressure to publicly report and rank the performance of healthcare systems on human immunodeficiency virus (HIV) quality measures. To inform discussion of public reporting, we evaluated the influence of case-mix adjustment when ranking individual care systems on the viral control quality measure. We used data from the Veterans Health Administration (VHA) HIV Clinical Case Registry and administrative databases to estimate case-mix adjusted viral control for 91 local systems caring for 12 368 patients. We compared results using 2 adjustment methods, the observed-to-expected estimator and the risk-standardized ratio. Overall, 10 913 patients (88.2%) achieved viral control (viral load ≤400 copies/mL). Prior to case-mix adjustment, system-level viral control ranged from 51% to 100%. Seventeen (19%) systems were labeled as low outliers (performance significantly below the overall mean) and 11 (12%) as high outliers. Adjustment for case mix (patient demographics, comorbidity, CD4 nadir, time on therapy, and income from VHA administrative databases) reduced the number of low outliers by approximately one-third, but results differed by method. The adjustment model had moderate discrimination (c statistic = 0.66), suggesting potential for unadjusted risk when using administrative data to measure case mix. Case-mix adjustment affects rankings of care systems on the viral control quality measure. Given the sensitivity of rankings to selection of case-mix adjustment methods-and potential for unadjusted risk when using variables limited to current administrative databases-the HIV care community should explore optimal methods for case-mix adjustment before moving forward with public reporting. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  15. Structural adjustment and drought in Zambia.

    Science.gov (United States)

    Mulwanda, M

    1995-06-01

    While drought is not uncommon in Zambia, the country is now facing the worst drought in history. The monetary and social costs will be enormous. Although it is too early to measure the economic and social costs of the drought on Zambia, it is obvious that the impact is catastrophic on a country whose economy is under pressure. The drought will affect the structural adjustment programme (SAP) unveiled by the new government which has embraced the market economy. The country has imported, and will continue to import, large quantities of maize and other foodstuffs, a situation likely to strain the balance of payments. Earlier targets with regard to export earnings, reductions in the budget deficit, and GDP growth as contained in the Policy Framework Paper (PFP) are no longer attainable due to the effects of the drought.

  16. Do Daily Retail Gasoline Prices adjust Asymmetrically?

    Energy Technology Data Exchange (ETDEWEB)

    Bettendorf, L. [Tinbergen Instituut, Amsterdam/Rotterdam (Netherlands); Van der Geest, S. [Erasmus Universiteit, Rotterdam (Netherlands); Kuper, G. [University of Groningen, Groningen (Netherlands)

    2005-04-15

    This paper analyzes adjustments in the Dutch retail gasoline prices. We estimate an error correction model on changes in the daily retail price for gasoline (taxes excluded) for the period 1996-2004 taking care of volatility clustering by estimating an EGARCH model. It turns out the volatility process is asymmetrical: an unexpected increase in the producer price has a larger effect on the variance of the producer price than an unexpected decrease. We do not find strong evidence for amount asymmetry. However, there is a faster reaction to upward changes in spot prices than to downward changes in spot prices. This implies timing or pattern asymmetry. This asymmetry starts three days after the change in the spot price and lasts for four days.

  17. Adjusting the IP $\\beta$ Functions in RHIC

    CERN Document Server

    Wittmer, W; Pilat, F; Ptitsyn, V; Van Zeijts, J

    2004-01-01

    The beta functions at the IP can be adjusted without perturbation of other optics functions via several approaches. In this paper we describe a scheme based on a vector knob, which assigns fixed values to the different tuning quadrupoles and scales them by a common multiplier. The values for the knob vector were calculated for a lattice without any errors using MADX. Previous studies for the LHC [1] have shown that this approach can meet the design goals. A specific feature of the RHIC lattice is the nested power supply system. To cope with the resulting problems a detailed response matrix analysis has been carried out and different sets of knobs were calculated and compared. The knobs were tested at RHIC during the 2004 run and preliminary results are discussed. Simultaneously a new approach to measure the beam sizes of both colliding beams at the IP, based on the tunability provided by the knobs, was developed and tested.

  18. Laparoscopic Adjustable Gastric Banding and Hypoglycemia

    Directory of Open Access Journals (Sweden)

    Sigrid Bairdain

    2013-01-01

    Full Text Available Obesity is commonplace, and surgical treatment usually includes Roux-en-Y gastric bypasses (RYGBs. RYGBs have the most documented side effects including vitamin deficiencies, rebound weight gain, and symptomatic hypoglycemia; fewer series exist describing hypoglycemia following other bariatric operations. We reviewed all patients undergoing laparoscopic adjustable gastric banding (LAGB at our institution between 2008 and 2012. Three patients were identified to have symptomatic hypoglycemia following LAGB. Mean time from surgery was 33 months (range 14–45 months, and mean weight loss was 32.7 kg (range 15.9–43.1 kg. None of the patients had preexisting diabetes. Therefore, symptomatic hypoglycemia should be investigated irrespective of bariatric operation.

  19. Signalling chains with probe and adjust learning

    Science.gov (United States)

    Gosti, Giorgio

    2018-04-01

    Many models explain the evolution of signalling in repeated stage games on social networks, differently in this study each signalling game evolves a communication strategy to transmit information across the network. Specifically, I formalise signalling chain games as a generalisation of Lewis' signalling games, where a number of players are placed on a chain network and play a signalling game in which they have to propagate information across the network. I show that probe and adjust learning allows the system to develop communication conventions, but it may temporarily perturb the system out of conventions. Through simulations, I evaluate how long the system takes to evolve a signalling convention and the amount of time it stays in it. This discussion presents a mechanism in which simple players can evolve signalling across a social network without necessarily understanding the entire system.

  20. Adjustable speed drive study, part 1

    Science.gov (United States)

    Wallace, A.

    1989-08-01

    Advances in speed control for motors in recent years, notably those in power electronics, have widened the range of application for several adjustable speed drive (ASD) types to include the smaller horsepower sizes. The dc motor drive, formerly in almost universal use for speed control, is being challenged by the high efficiency induction motor/pulse width modulation (PWM) drive; and for special small horsepower size applications, by the permanent magnet motor/PWM inverter drive or by the switched reluctance motor drive. The main characteristics of the several ASD types suitable for small horsepower size applications are discussed, as well as their unwanted side effects: poor power factor, harmonic distortion of the supply, acoustic noise, and electromagnetic interference. A procedure is recommended for determining which, if any, ASD to use.

  1. First adjustments in the solar industry

    International Nuclear Information System (INIS)

    Deye, M.

    2009-01-01

    The European environmental policy goal is to generate 23% of the end-use power consumption from renewable energy sources by 2020. The solar photovoltaic market has shown an exponential growth since 1998 with a record rise of installed capacities in 2008 (+61%). In 2009, the growth should reach 30% only. The solar industry has to face the conjugated effects of the demand decay and of the credit crisis which has led to over-capacities and prices drop. The crisis has hit the solar cell manufacturers but for some of them, it is an opportunity to make some strategic adjustments and to develop products with a higher added value. The market and the demand are still there but the clients encounter more difficulties to obtain the credits for their projects. (J.S.)

  2. Adjustment of gripping force by optical systems

    Science.gov (United States)

    Jalba, C. K.; Barz, C.

    2018-01-01

    With increasing automation, robotics also requires ever more intelligent solutions in the handling of various tasks. In this context, many grippers must also be re-designed. For this, they must always be adapted for different requirements. The equipment of the gripper systems with sensors should help to make the gripping process more intelligent. In order to achieve such objectives, optical systems can also be used. This work analyzes how the gripping force can be adjusted by means of an optical recognition. The result of this work is the creation of a connection between optical recognition, tolerances, gripping force and real-time control. In this way, algorithms can be created, with the aid of which robot grippers as well as other gripping systems become more intelligent.

  3. Adjustable speed drives improve circulating water system

    International Nuclear Information System (INIS)

    Dent, R.A.; Dicic, Z.

    1994-01-01

    This paper illustrates the integration of electrical and mechanical engineering requirements to produce a solution to past problems and future operating demands. The application of adjustable speed drives in the modifications of the circulating water system at Indian Point No. 3 Nuclear Power Plant provided increased operating flexibility, efficiency and avoided otherwise costly renovations to the plant electrical systems. Rectification of the original inadequate design of the circulating water system, in addition to maximizing plant efficiency consistent with environmental considerations, formed the basis for this modification. This entailed replacement of all six circulating water pumps and motors and physical modifications to the intake system. This paper details the methodology used in this engineering task. The new system was installed successfully and has been operating reliably and economically for the past eight years

  4. Can structural adjustment work for women farmers.

    Science.gov (United States)

    Mehra, R

    1991-12-01

    This article discusses the impact of structural adjustment programs (SAPs) on women farmers in developing countries. SAPs aim to improve economic efficiency and promote more rapid economic growth. SAPs are introduced in two phases. The first phase involves short-term loans with the condition that the country adopt monetary restraints and currency devaluation measures. In the second phase, long-term loans are given with the provision that the country deregulate their economy and open up markets. The agricultural sector is affected by SAPs because of their importance in employment, income generation, and export earnings. SAPs result in lower farm commodity prices due to currency devaluations and in removal of subsidies, which results in market-sensitive pricing or higher food prices. The impact of SAPs on agriculture vary between countries. In Morocco and Algeria, agriculture expanded under SAPs. In Indonesia, Bolivia, Costa Rica, and Mexico, the agriculture stagnated or declined. Agricultural growth was slowest in Africa. SAPs were somewhat successful in increasing agricultural exports. Food production grew slowly in many adjusting countries. Blame for failures of SAPs has been placed on government failure to implement reforms properly and overly optimistic assumptions about the timing of productive gains. Little attention has focused on the constraints facing women farmers, who are a large proportion of farmers, particularly in sub-Saharan Africa. This article focuses on the issues of limited access to resources, credit, agricultural extension and information, land ownership, education, and time as constraints to women farmers. Women also must ensure household food security. For SAPs to work effectively, complementary policies must be implemented that reallocate available productive resources and new technologies to women and that deal with women's constraints.

  5. Struggles over patriarchal structural adjustment in Tanzania.

    Science.gov (United States)

    Mbilinyi, M

    1993-10-01

    Within the space of 7 years (1986-93), structural adjustment policies have contributed to a reversal of the gains in economic development achieved in Tanzania in the 1960s and 1970s. Structural adjustment policies have helped large-scale producers and ordinary citizens but have led to a decline in social services which is reflected in drops in primary school enrollment and increases in medical costs. Government revenues are absorbed by foreign debt servicing. The reduction of support for social services has increased women's work; bolstered gender division of labor; and reduced women's access to education, formal employment, and health services. On the other hand, increased participation in market-oriented activities has increased women's mobility and exposure to modern ideas. This has led to changing gender relations which on the positive side can lead to shared decision-making but on the negative side may cause men to abdicate their familial responsibilities. Women suffer, however, from a lack of investment in ways to lighten their household responsibilities and have lost their ability to control food production because of the shift to cash crop production for export. The combination of hard work, low income, and stress has taken a toll on women's health, and both the maternal mortality rate and incidence of HIV infections among teenage girls has increased. In response to this situation, Tanzanian women have formed the Tanzania Gender Networking Programme (TGNP) which seeks to empower women and transform society through such activities as education and training, research, and lobbying and networking. Workshops sponsored by the TGNP have resulted in recommendations for adoption of a people-centered development strategy.

  6. Adjustment to Life with Lung Cancer.

    Science.gov (United States)

    Czerw, Aleksandra I; Religioni, Urszula; Deptała, Andrzej

    2016-01-01

    In Poland, lung cancer is the most common type of cancer in males (20% of all cases) and third most common type of cancer in females (9% of all cases), right behind breast and colorectal cancers. Recently, 28,000 new cases of lung cancer per year were reported in both genders. The objective of the study was to asses coping strategies, pain management, acceptance of illness and adjustment to cancer in patients diagnosed with pulmonary carcinoma and the effect of socioeconomic variables on the abovementioned issues. The study included 243 patients diagnosed with lung cancer during outpatient chemotherapy (classical chemotherapy and molecularly targeted therapies) at the Center of Oncology, Maria Skłodowska-Curie Institute in Warszawa. We applied the Paper and Pencil Interview (PAPI) technique. The questionnaire interview was composed of demographic questions and the following four psychometric tests: BPCQ measuring the influence of factors affecting pain management in patients, CSQ designed to evaluate pain coping strategies, AIS questionnaire, measuring disease acceptance, and the mini-Mac scale, assessing psychological adjustment to disease. The highest mean score recorded in the BPCQ was recorded in the powerful doctors subscale (16.79) and the lowest in the internal factors section (15.64). Education, professional status and income were the variables which differentiated the scores. We recorded the top average score in CSQ in the coping self statements subscale (mean = 19.64), and the lowest score in the reinterpreting pain sensations subscale (mean score = 10.32). The results of the test were differentiated by education and income. Patients had the highest Mini-MAC scale scores in the fighting spirit section (21.91). In the case of patients affected with lung cancer, education and professional status affect the way patients treat doctors in the disease process. These variables are also critical in patients' approach to disease and methods of coping with it.

  7. 75 FR 33379 - Railroad Cost Recovery Procedures-Productivity Adjustment; Quarterly Rail Cost Adjustment Factor

    Science.gov (United States)

    2010-06-11

    ... information is contained in the Board's June 14, 2010 decision, which is available on our website at http://www.stb.dot.gov . Copies of the decision may be purchased by contacting the office of Public... Cost Adjustment Factor AGENCY: Surface Transportation Board. [[Page 33380

  8. Interconnection: A qualitative analysis of adjusting to living with renal cell carcinoma.

    Science.gov (United States)

    Leal, Isabel; Milbury, Kathrin; Engebretson, Joan; Matin, Surena; Jonasch, Eric; Tannir, Nizar; Wood, Christopher G; Cohen, Lorenzo

    2018-04-01

    ABSTRACTObjective:Adjusting to cancer is an ongoing process, yet few studies explore this adjustment from a qualitative perspective. The aim of our qualitative study was to understand how patients construct their experience of adjusting to living with cancer. Qualitative analysis was conducted of written narratives collected from four separate writing sessions as part of a larger expressive writing clinical trial with renal cell carcinoma patients. Thematic analysis and constant comparison were employed to code the primary patterns in the data into themes until thematic saturation was reached at 37 participants. A social constructivist perspective informed data interpretation. Interconnection described the overarching theme underlying the process of adjusting to cancer and involved four interrelated themes: (1) discontinuity-feelings of disconnection and loss following diagnosis; (2) reorientation-to the reality of cancer psychologically and physically; (3) rebuilding-struggling through existential distress to reconnect; and (4) expansion-finding meaning in interconnections with others. Participants related a dialectical movement in which disruption and loss catalyzed an ongoing process of finding meaning. Our findings suggest that adjusting to living with cancer is an ongoing, iterative, nonlinear process. The dynamic interactions between the different themes in this process describe the transformation of meaning as participants move through and revisit prior themes in response to fluctuating symptoms and medical news. It is important that clinicians recognize the dynamic and ongoing process of adjusting to cancer to support patients in addressing their unmet psychosocial needs throughout the changing illness trajectory.

  9. 19 CFR 351.413 - Disregarding insignificant adjustments.

    Science.gov (United States)

    2010-04-01

    ... COUNTERVAILING DUTIES Calculation of Export Price, Constructed Export Price, Fair Value, and Normal Value § 351..., constructed export price, or normal value, as the case may be. Groups of adjustments are adjustments for...

  10. Primal and dual approaches to adjustable robust optimization

    NARCIS (Netherlands)

    de Ruiter, Frans

    2018-01-01

    Robust optimization has become an important paradigm to deal with optimization under uncertainty. Adjustable robust optimization is an extension that deals with multistage problems. This thesis starts with a short but comprehensive introduction to adjustable robust optimization. Then the two

  11. Growth Control by Ethylene: Adjusting Phenotypes to the Environment

    NARCIS (Netherlands)

    Pierik, R.; Sasidharan, R.; Voesenek, L.A.C.J.

    2007-01-01

    Plants phenotypically adjust to environmental challenges, and the gaseous plant hormone ethylene modulates many of these growth adjustments. Ethylene can be involved in environmentally induced growth inhibition as well as growth stimulation. Still, ethylene has long been considered a growth

  12. 75 FR 23227 - Trade Adjustment Assistance for Farmers

    Science.gov (United States)

    2010-05-03

    ... DEPARTMENT OF AGRICULTURE Foreign Agricultural Service Trade Adjustment Assistance for Farmers AGENCY: Foreign Agricultural Service, USDA. ACTION: Notice. The Administrator, Foreign Agricultural... be obtained at the Web site for the Trade Adjustment Assistance for Farmers program. The URL is http...

  13. 77 FR 17121 - Quarterly Rail Cost Adjustment Factor

    Science.gov (United States)

    2012-03-23

    ... decision may be purchased by contacting the Office of Public Assistance, Governmental Affairs, and...)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board, Department of Transportation. ACTION: Approval of rail cost adjustment factor. [[Page 17122

  14. Parental Divorce during Adolescence and Adjustment in Early Adulthood.

    Science.gov (United States)

    Richardson, Stacey; McCabe, Marita P.

    2001-01-01

    Examined the impact of parental divorce during adolescence, interparental conflict, and intimacy with parents on young adult adjustment. High levels of interparental conflict were found to be negatively associated with adjustment and current intimacy of parents. (Author)

  15. A properly adjusted forage harvester can save time and money

    Science.gov (United States)

    A properly adjusted forage harvester can save fuel and increase the realizable milk per ton of your silage. This article details the adjustments necessary to minimize energy while maximizing productivity and forage quality....

  16. Clinical Trials

    Medline Plus

    Full Text Available ... questions and clinical trials. Optimizing our Clinical Trials Enterprise NHLBI has a strong tradition of supporting clinical ... multi-pronged approach to Optimize our Clinical Trials Enterprise that will make our clinical trials enterprise even ...

  17. 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 ...

  18. Clinical Trials

    Medline Plus

    Full Text Available ... Clinical Trials About Clinical Trials Clinical trials are research studies that explore whether a medical strategy, treatment, or ... humans. What Are Clinical Trials? Clinical trials are research studies that explore whether a medical strategy, treatment, or ...

  19. 42 CFR 413.231 - Adjustment for wages.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Adjustment for wages. 413.231 Section 413.231... Disease (ESRD) Services and Organ Procurement Costs § 413.231 Adjustment for wages. (a) CMS adjusts the labor-related portion of the base rate to account for geographic differences in the area wage levels...

  20. 8 CFR 1209.1 - Adjustment of status of refugees.

    Science.gov (United States)

    2010-01-01

    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Adjustment of status of refugees. 1209.1... IMMIGRATION REGULATIONS ADJUSTMENT OF STATUS OF REFUGEES AND ALIENS GRANTED ASYLUM § 1209.1 Adjustment of status of refugees. The provisions of this section shall provide the sole and exclusive procedure for...

  1. 8 CFR 209.1 - Adjustment of status of refugees.

    Science.gov (United States)

    2010-01-01

    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Adjustment of status of refugees. 209.1... STATUS OF REFUGEES AND ALIENS GRANTED ASYLUM § 209.1 Adjustment of status of refugees. The provisions of this section shall provide the sole and exclusive procedure for adjustment of status by a refugee...

  2. Language Ability and Adjustment: Western Expatriates in China

    DEFF Research Database (Denmark)

    Selmer, Jan

    2006-01-01

    was directed to Western business expatriates assigned to China. Controlling for the time expatriates had spent in China, results showed that their language ability had a positive association with their sociocultural adjustment. Not surprisingly, this positive relationship was strongest for interaction...... adjustment and weakest for work adjustment. The straightforward implications of these clear findings are discussed in detail....

  3. 77 FR 58910 - Quarterly Rail Cost Adjustment Factor

    Science.gov (United States)

    2012-09-24

    ..., http://www.stb.dot.gov . Copies of the decision may be purchased by contacting the Office of Public...)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board has approved the fourth quarter 2012 rail cost adjustment factor (RCAF...

  4. 76 FR 37191 - Quarterly Rail Cost Adjustment Factor

    Science.gov (United States)

    2011-06-24

    ... our Web site, http://www.stb.dot.gov . Copies of the decision may be purchased by contacting the...)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board, DOT. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board has approved the third quarter 2011 Rail Cost Adjustment...

  5. 75 FR 80895 - Quarterly Rail Cost Adjustment Factor

    Science.gov (United States)

    2010-12-23

    ..., http://www.stb.dot.gov . Copies of the decision may be purchased by contacting the Office of Public...)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board, DOT. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board has approved the first quarter 2011 Rail Cost Adjustment...

  6. 77 FR 37958 - Quarterly Rail Cost Adjustment Factor

    Science.gov (United States)

    2012-06-25

    ..., http://www.stb.dot.gov . Copies of the decision may be purchased by contacting the Office of Public...)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board, DOT. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board has approved the third quarter 2012 rail cost adjustment...

  7. 78 FR 37660 - Quarterly Rail Cost Adjustment Factor

    Science.gov (United States)

    2013-06-21

    ..., http://www.stb.dot.gov . Copies of the decision may be purchased by contacting the Office of Public...)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board, DOT. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board approves the third quarter 2013 Rail Cost Adjustment Factor...

  8. 78 FR 17764 - Quarterly Rail Cost Adjustment Factor

    Science.gov (United States)

    2013-03-22

    ..., http://www.stb.dot.gov . Copies of the decision may be purchased by contacting the Office of Public...)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board, DOT. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board has approved the second quarter 2013 Rail Cost Adjustment...

  9. 76 FR 59483 - Quarterly Rail Cost Adjustment Factor

    Science.gov (United States)

    2011-09-26

    ... the decision may be purchased by contacting the Office of Public Assistance, Governmental Affairs, and...)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board, DOT. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board has approved the fourth quarter 2011 Rail Cost Adjustment...

  10. 76 FR 16037 - Quarterly Rail Cost Adjustment Factor

    Science.gov (United States)

    2011-03-22

    ..., http://www.stb.dot.gov . Copies of the decision may be purchased by contacting the Office of Public...)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board, DOT. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board has approved the second quarter 2011 Rail Cost Adjustment...

  11. 75 FR 58019 - Quarterly Rail Cost Adjustment Factor

    Science.gov (United States)

    2010-09-23

    ..., http://www.stb.dot.gov . Copies of the decision may be purchased by contacting the office of Public...)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board, DOT. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board has approved the fourth quarter 2010 Rail Cost Adjustment...

  12. 75 FR 16575 - Railroad Cost Recovery Procedures-Productivity Adjustment

    Science.gov (United States)

    2010-04-01

    ...)] Railroad Cost Recovery Procedures--Productivity Adjustment AGENCY: Surface Transportation Board. ACTION: Adoption of a railroad cost recovery procedures productivity adjustment. SUMMARY: By decision served on February 1, 2010, the Board proposed to adopt 1.010 (1.0% per year) as the 2008 productivity adjustment, as...

  13. 42 CFR 422.310 - Risk adjustment data.

    Science.gov (United States)

    2010-10-01

    ... that are used in the development and application of a risk adjustment payment model. (b) Data... (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Payments to Medicare Advantage Organizations § 422... risk adjustment factors used to adjust payments, as required under §§ 422.304(a) and (c). CMS also may...

  14. 77 FR 65100 - Adjustment of Civil Monetary Penalties for Inflation

    Science.gov (United States)

    2012-10-25

    ... Penalties for Inflation AGENCY: Commodity Futures Trading Commission ACTION: Final rule. SUMMARY: The... civil monetary penalties, to adjust for inflation. This rule sets forth the maximum, inflation-adjusted... Federal Civil Penalties Inflation Adjustment Act of 1990, as amended by the Debt Collection Improvement...

  15. 46 CFR 506.3 - Civil monetary penalty inflation adjustment.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 9 2010-10-01 2010-10-01 false Civil monetary penalty inflation adjustment. 506.3... PENALTY INFLATION ADJUSTMENT § 506.3 Civil monetary penalty inflation adjustment. The Commission shall... each civil monetary penalty provided by law within the jurisdiction of the Commission by the inflation...

  16. 76 FR 74720 - Inflation Adjustment of Civil Monetary Penalties; Correction

    Science.gov (United States)

    2011-12-01

    ... FEDERAL MARITIME COMMISSION 46 CFR Part 506 [Docket No. 09-04] RIN 3072-AC36 Inflation Adjustment... published in the Federal Register of Friday, July 31, 2009 (74 FR 38114). The rule adjusts for inflation the... accordance with the requirements of the Federal Civil Penalties Inflation Adjustment Act of 1990, as amended...

  17. 78 FR 5760 - Civil Monetary Penalty Inflation Adjustment

    Science.gov (United States)

    2013-01-28

    ... Civil Monetary Penalty Inflation Adjustment AGENCY: U.S. Army Corps of Engineers, DoD. ACTION: Proposed... account for inflation. The adjustment of civil penalties to account for inflation is required by the Federal Civil Penalties Inflation Adjustment Act of 1990, as amended. Since we have not made any...

  18. 32 CFR 269.3 - Civil monetary penalty inflation adjustment.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 2 2010-07-01 2010-07-01 false Civil monetary penalty inflation adjustment. 269... DEFENSE (CONTINUED) MISCELLANEOUS CIVIL MONETARY PENALTY INFLATION ADJUSTMENT § 269.3 Civil monetary penalty inflation adjustment. The Department shall, not later than 180 days after the enactment of the...

  19. 10 CFR 765.12 - Inflation index adjustment procedures.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Inflation index adjustment procedures. 765.12 Section 765... THORIUM PROCESSING SITES Reimbursement Criteria § 765.12 Inflation index adjustment procedures. (a) The... § 765.2(i) of this rule) shall be adjusted for inflation as provided by this section. (b) To make...

  20. 78 FR 56868 - Adjustment of Indemnification for Inflation

    Science.gov (United States)

    2013-09-16

    ... DEPARTMENT OF ENERGY Adjustment of Indemnification for Inflation AGENCY: Office of General Counsel...-Anderson Act. Subsection 170t. of the AEA requires an inflation adjustment of the indemnification amount at... inflation-adjusted amount based on the aggregate percentage change in the CPI during the 5-year period from...

  1. 5 CFR 847.705 - Cost-of-living adjustments.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Cost-of-living adjustments. 847.705... FUND INSTRUMENTALITIES Computation of Benefits Under the Retroactive Provisions § 847.705 Cost-of-living adjustments. Cost-of-living adjustments are applied to the rate payable to the retiree or survivor...

  2. 5 CFR 838.735 - Cost-of-living adjustments.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Cost-of-living adjustments. 838.735... Awarding Former Spouse Survivor Annuities Payment Procedures § 838.735 Cost-of-living adjustments. (a) OPM applies cost-of-living adjustments to all former spouse survivor annuities in pay status at the time of...

  3. 42 CFR 412.320 - Disproportionate share adjustment factor.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Disproportionate share adjustment factor. 412.320... Capital-Related Costs § 412.320 Disproportionate share adjustment factor. (a) Criteria for classification... adjustment factor. (1) If a hospital meets the criteria in paragraph (a)(1) of this section for a...

  4. 76 FR 80448 - Quarterly Rail Cost Adjustment Factor

    Science.gov (United States)

    2011-12-23

    ... DEPARTMENT OF TRANSPORTATION Surface Transportation Board [Docket No. EP 290 (Sub-No. 5) (2012-1)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board has approved the first quarter 2012 rail cost adjustment factor (RCAF...

  5. 42 CFR 412.352 - Budget neutrality adjustment.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Budget neutrality adjustment. 412.352 Section 412.352 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... § 412.352 Budget neutrality adjustment. For FY 1992 through FY 1995, CMS will determine an adjustment to...

  6. 7 CFR 981.401 - Adjusted kernel weight.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 8 2010-01-01 2010-01-01 false Adjusted kernel weight. 981.401 Section 981.401... Administrative Rules and Regulations § 981.401 Adjusted kernel weight. (a) Definition. Adjusted kernel weight... kernels in excess of five percent; less shells, if applicable; less processing loss of one percent for...

  7. Office chairs are often not adjusted by end-users

    NARCIS (Netherlands)

    Vink, P.; Porcar-Seder, R.; Pozo, Á.P. de; Krause, F.

    2007-01-01

    To find out how many office workers adjust their chairs, 350 office workers in Spain and the Netherlands are observed and questioned on whether they adjust their chairs. It appears that 24% of 236 Spanish office workers and 61% of 100 Dutch subjects never adjust their chair. If the chair is

  8. 29 CFR 1202.12 - National Air Transport Adjustment Board.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 4 2010-07-01 2010-07-01 false National Air Transport Adjustment Board. 1202.12 Section... § 1202.12 National Air Transport Adjustment Board. Under section 205, title II, of the Railway Labor Act... four representatives to constitute a Board known as the National Air Transport Adjustment Board. Two...

  9. Accelerated adjustment in the German hardcoal industry

    International Nuclear Information System (INIS)

    Semrau, G.

    1994-01-01

    The worsening overall economic situation and the steel crisis necessitate an accelerated adjustment of the production capacity and the output. In 1993 hardcoal production was reduced by almost 8 Mtce or 12% to some 59 Mtce. The coke production of the colliery-owned coke oven plants was even reduced by 27%. Following the strong decline of deliveries in 1992 (-6 Mt), the sale of hardcoal and coke fell by another 4 Mt to about 60 Mtce in 1993. The high sales losses resulted in a further increase in stock. At the end of 1993 23 Mt coal had been stockpiled and burdened the results and liquidity of the hardcoal mining companies. The loss of jobs is aggravating. At the end of 1993 the hardcoal industry employed a workforce of 113500, of those 106300 own employees and 7300 workers form contractors. In the course of the year 10600 jobs were lost totaling up to about 55000 since the 1987 coal round. With an underground OMS of 5267 kg the hardcoal industry has reached the highest productivity level so far. In 1994 the hardcoal industry will continue to contract. The hardcoal output is to be reduced to less than 53 Mtce to achieve a reduction of stock in the mining companies. (orig.)

  10. Design of precision position adjustable scoop

    International Nuclear Information System (INIS)

    Li Zhili; Zhang Kai; Dong Jinping

    2014-01-01

    In isotopes separation technologies, the centrifuge method has been the most popular technology now. Separation performance of centrifugal machines is greatly influenced by the flow field in the centrifugal machines. And the position of scoops in the centrifuges has a significant influence on the flow field. To obtain a better flow field characteristic and find the best position of scoops in the centrifuges, a position adjustable scoop system was studied. A micro stage and a linear encoder were used in the system to improve the position accuracy of the scoop. Eddy current sensors had been used in a position calibration measurement. The measurement result showed the sensitivity and stability of the position system could meet the performance expectation. But as the driving mean, the steel wire and pulley limit the control precision. On the basis of this scheme, an ultrasonic motor was used as driving mean. Experimental results showed the control accuracy was improved. This scheme laid a foundation to obtain internal flow field parameters of centrifuge and get the optimal feeding tube position. (authors)

  11. Severe neurological complication following adjustable gastric banding.

    Science.gov (United States)

    Martines, G; Musa, N; Aquilino, F; Capuano, P

    2018-01-01

    In the last years with the increase of bariatric surgery, first of all as a result of new indications, a rise in the incidence of nutrient-related complications has been observed. Currently little is known about the impact of post-bariatric malnutrition and neurological complications. Wernicke's encephalopathy is a severe neurological syndrome which occurs as a result of thiamine deficiency. Wernicke-Korsakoff syndrome must be considered a serious neurological complication of bariatric surgery with significant morbidity and mortality, with rapidly progressing neurological symptoms, and must be treated immediately. We report the case of a 35 years-old male patient, affected by morbid obesity, anxious-depressive syndrome and alcohol use disorder, who after adjustable gastric banding implanted in another hospital developed a severe malnutrition and neurological syndrome. The patient showed poor adherence to the follow-up and to the dietary indications and after all, we needed to place a PEG for enteral nutrition in order to resolve the malnutrition condition and the neurological syndrome. Our experience emphasizes that preoperative selection and assessment of a patient's nutritional status according to guidelines, is required to identify potential problems, and that bariatric surgeons or physicians caring for patient who have undergone bariatric surgery should be familiar with the constellation of nutritional and neurological disorder that may occur after surgery. We want to remark the importance of preoperative selection of the patients, the follow-up and the cooperation between patient and physician in order to obtain the best result and avoid severe complications.

  12. Industry adjusts 1992 E and P budgets

    International Nuclear Information System (INIS)

    Anon.

    1992-01-01

    This paper reports that a midyear update of Salomon Bros. survey of the petroleum industry's 1992 exploration and production budgets pinpoints the ways operators are adjusting outlays to match the times. The New York financial firm's latest tally shows: Operators have made deep cuts in their 1992 US and Canadian E and P budgets since yearend 1991. Moderate increases budgeted earlier for E and P outside North America are intact. Many companies substantially underspent their budgets in first half 1992. In Salomon Bros. Largest survey---247 companies responded---operators the they were budgeting a 3.2% year to year decline in their 1992 worldwide E and P spending, compared with a 1.3% increase planned for 1992 in December 1991. The decline in spending falls entirely in North America. Preliminary indications suggest that 1993 E and P spending will be relatively flat in the US and flat to moderately increased in Canada. Elsewhere, spending should continue to rise steadily in 1993, Salomon Bros. The. Budgets exclude producing property purchases and merger or acquisition of other companies when possible

  13. Adjusting Beliefs via Transformed Fuzzy Priors

    Science.gov (United States)

    Rattanadamrongaksorn, T.; Sirikanchanarak, D.; Sirisrisakulchai, J.; Sriboonchitta, S.

    2018-02-01

    Instead of leaving a decision to a pure data-driven system, intervention and collaboration by human would be preferred to fill the gap that machine cannot perform well. In financial applications, for instance, the inference and prediction during structural changes by critical factors; such as market conditions, administrative styles, political policies, etc.; have significant influences to investment strategies. With the conditions differing from the past, we believe that the decision should not be made by only the historical data but also with human estimation. In this study, the updating process by data fusion between expert opinions and statistical observations is thus proposed. The expert’s linguistic terms can be translated into mathematical expressions by the predefined fuzzy numbers and utilized as the initial knowledge for Bayesian statistical framework via the possibility-to-probability transformation. The artificial samples on five scenarios were tested in the univariate problem to demonstrate the methodology. The results showed the shifts and variations appeared on the parameters of the distributions and, as a consequence, adjust the degrees of belief accordingly.

  14. Bidirectional associations between emotions and school adjustment.

    Science.gov (United States)

    Hernández, Maciel M; Eisenberg, Nancy; Valiente, Carlos; Spinrad, Tracy L; Berger, Rebecca H; VanSchyndel, Sarah K; Silva, Kassondra M; Diaz, Anjolii; Thompson, Marilyn S; Gal, Diana E; Southworth, Jody

    2017-11-24

    We examined the relations of children's (N = 301) observed expression of negative and positive emotion in classes or nonclassroom school contexts (i.e., lunch and recess) to school adjustment from kindergarten to first grade. Naturalistic observations of children's emotional expressivity were collected, as were teachers' reports of children's school engagement and relationship quality with teachers and peers. In longitudinal panel models, greater teacher-student conflict and lower student engagement in kindergarten predicted greater negative expressivity in both school contexts. School engagement and peer acceptance in kindergarten positively predicted first grade positive emotion in the classroom. Suggestive of possible bidirectional relations, there was also small unique prediction (near significant) from negative expressivity at lunch and recess to higher teacher-student conflict, from negative expressivity in the classroom to low peer acceptance, and from positive expressivity in the classroom to higher peer acceptance. The pattern of findings suggests that the quality of experience at school uniquely predicts children's emotional expressivity at school more consistently than vice versa-a finding that highlights the important role of school context in young children's emotionality at school. © 2017 Wiley Periodicals, Inc.

  15. PERCEIVED SOCIAL SUPPORT AND PARENTS ADJUSTMENT

    Directory of Open Access Journals (Sweden)

    Patrizia VELOTTI

    2008-12-01

    Full Text Available Social networks often provide an important source of support for new parents. General, parent support programs sustain social-emotional development of children. Different aspects could impact both the quantity and quality of the sources of social support and the perception that parents would had. This study examines the role of social support in the couples of new-parents and assesses the influence of attachment models on it. The Adult Attachment Interview (AAI and the Multidimensional Scale of Perceived Social Support (MSPSS were administered to a sample of 100 participants. Results indicated a perception of social support more pronounced in women, mainly on the dimension of social support derived from the partner. Furthermore, for women and not for men, an association between attachment models to the AAI and the different perceptions of social support was revealed. Data seems support the opportunity to assess parents during early rehabilitation interventions. Support groups could be used with insecure parents and has positive effects in reducing stress and promoting adjustment to the disability for children and their families.

  16. Adjusting ability and sensibility for an accident

    International Nuclear Information System (INIS)

    Rozental, J.J.

    1998-01-01

    Adjusting ability (technical competence) and sensibility (consciousness) are the two most important priorities any staff member of any organization should bear in mind while acting during a nuclear or radiological emergency. The discussion is aimed at the national authorities of states which do not have a major nuclear power reactor programme, and especially at the IAEA and WHO: although a decade has gone by, the lessons from the radiological accident in Goiania have not been fully learned. The events which unravelled in the fall of 1987 took the population of the city of Goiania completely by surprise: they did not comprehend what had happened and failed to grasp what measures needed to be taken, a situation which precipitated a very complex psychological reaction, coupled with discrimination. To ensure the safety of radiation sources and nuclear installations, national and international organizations should direct their efforts towards educating and training staff in developing countries who work with ionizing radiation and promoting organizational capacity. This should be done first, by improving safety qualitatively so as to better control the uses of radioactive materials in medicine, agriculture, industry and research, and secondly, by assisting countries without a major nuclear power reactor programme to develop an objective and realistic emergency response training programme. (author)

  17. Arrangement for adjusting the load of a turbine system

    International Nuclear Information System (INIS)

    Aanstadt, O.J.

    1974-01-01

    The invention relates to an adjustment arrangement for steam turbines with at least two stages. The inlet of steam into the two stages is adjusted by means of independant valves, and an adjustment circuit is provided for each of said valves for adjusting same so as to ensure a suitable distribution of power between the stages. The adjustment is carried out by measuring the power generated between the stages thus eliminating the influence of inaccuracies in the valves. This can be applied, in particular, to nuclear power stations [fr

  18. The Mediating Role of Psychological Adjustment between Peer Victimization and Social Adjustment in Adolescence

    OpenAIRE

    Eva M. Romera; Olga Gómez-Ortiz; Rosario Ortega-Ruiz; Rosario Ortega-Ruiz

    2016-01-01

    There is extensive scientific evidence of the serious psychological and social effects that peer victimization may have on students, among them internalizing problems such as anxiety or negative self-esteem, difficulties related to low self-efficacy and lower levels of social adjustment. Although a direct relationship has been observed between victimization and these effects, it has not yet been analyzed whether there is a relationship of interdependence between all these measures of psychoso...

  19. The College Adjustment Questionnaire: A Measure of Students' Educational, Relational, and Psychological Adjustment to the College Environment

    Science.gov (United States)

    O'Donnell, Maeve B.; Shirley, Lauren A.; Park, Stacey S.; Nolen, Julian P.; Gibbons, Alyssa M.; Rosén, Lee A.

    2018-01-01

    Several instruments exist to measure college adjustment: the Student Adaptation to College Questionnaire (SACQ; Baker & Siryk, 1989), the College Adjustment Rating Scale (Zitzow, 1984), and the College Adjustment Scales (Anton & Reed, 1991). Of these, the SACQ is the most widely used and takes a multifaceted approach to measuring college…

  20. Revenge and psychological adjustment after homicidal loss.

    Science.gov (United States)

    van Denderen, Mariëtte; de Keijser, Jos; Gerlsma, Coby; Huisman, Mark; Boelen, Paul A

    2014-01-01

    Feelings of revenge are a common human response to being hurt by others. Among crime victims of severe sexual or physical violence, significant correlations have been reported between revenge and Posttraumatic Stress Disorder (PTSD). Homicide is one of the most severe forms of interpersonal violence. It is therefore likely that individuals bereaved by homicide experience high levels of revenge, which may hamper efforts to cope with traumatic loss. The relationship between revenge and psychological adjustment following homicidal loss has not yet been empirically examined. In the current cross-sectional study, we used self-report data from 331 spouses, family members and friends of homicide victims to examine the relationships between dispositional revenge and situational revenge on the one hand and symptom-levels of PTSD and complicated grief, as well as indices of positive functioning, on the other hand. Furthermore, the association between revenge and socio-demographic and offense-related factors was examined. Participants were recruited from a governmental support organization, a website with information for homicidally bereaved individuals, and members of support groups. Levels of both dispositional and situational revenge were positively associated with symptoms of PTSD and complicated grief, and negatively with positive functioning. Participants reported significantly less situational revenge in cases where the perpetrator was a direct family member than cases where the perpetrator was an indirect family member, friend, or someone unknown. Homicidally bereaved individuals reported more situational revenge, but not more dispositional revenge than a sample of students who had experienced relatively mild interpersonal transgressions. © 2014 Wiley Periodicals, Inc.

  1. Fathers of children with cancer: involvement, coping, and adjustment.

    Science.gov (United States)

    Bennett Murphy, Laura M; Flowers, Stacy; McNamara, Kelly A; Young-Saleme, Tammi

    2008-01-01

    This study examined the role of fathers caring for children with cancer. Psychological adjustment, coping, and work patterns of mothers and fathers were described. Twenty fathers of children with cancer were compared with 20 mothers of children with cancer and 20 control fathers of healthy children. Questionnaire data were collected regarding coping, parental adjustment, child adjustment, and family involvement. Fathers did not differ from mothers or control fathers in terms of psychological adjustment or coping. However, fathers of children with cancer spent more hours at work and more hours caring for children than did control fathers. Paternal adjustment was significantly related to child adjustment only when the child had cancer. Coping was related to work outside the home for fathers and adjustment for mothers. Models of family adaptation may be different for fathers and mothers. Treatment teams must attend to the unique needs of fathers.

  2. Adjusting the displaced tip of peripherally inserted central catheter under DSA guidance

    International Nuclear Information System (INIS)

    Mao Yanjun; Dong Huijuan; Zhang Lingjuan; Li Hongmei; Xu Lianqin

    2009-01-01

    Objective: To explore a new method to adjust the displaced tip of peripherally inserted central catheter (PICC) under DSA guidance. Methods: Under DSA guidance, the displaced tip of PICC was repositioned to the ideal junction area of superior vena cava with right atrium with proper manipulation. Results: Under DSA guidance, the displaced tip of PICC was successfully corrected in 13 cases. The mean operative time was 15.53 minutes, which was markedly shorter than that needed by blind adjusting beside the bed. Conclusion: The displacement of PICC tip is a common occurrence, which is hard to be avoided. Under DSA guidance, the adjusting manipulation of the displaced PICC tip is safe and time-saving with high successful rate. It is worth popularizing this technique in clinical practice. (authors)

  3. Psychopathology and psychosocial adjustment in patients with HIV-associated lipodystrophy

    Directory of Open Access Journals (Sweden)

    Anna Barata

    Full Text Available OBJECTIVE: To study whether patients with HIV-1 associated lipodystrophy (LD on highly active antiretroviral treatment (HAART have more psychopathology and worse psychosocial adjustment than a similar group without this syndrome. METHODS: In a cross-sectional, observational study we compared 47 HIV-1 infected patients with LD (LD group with 39 HIV-1 infected patients without LD (non-LD group. All participants were on HAART. The Beck Depression Inventory (BDI, the State and Trait Anxiety Inventory (STAI and the Goldberg Health Questionnaire (GHQ-60 were administered. Levels of familial, work and social adjustment and adjustment to stressful events were evaluated in a semi-structured interview. Clinical information was extracted from the clinical records. RESULTS: In the univariate analysis patients with LD showed higher state anxiety scores (p = 0.009 and worse work adjustment (p = 0.019 than those without LD. A total of 45.3% of LD patients scored above the cut-off point on the trait anxiety scale, and over 33.3% scored above the cut-off point on the BDI, GHQ and state anxiety scales. However, in multivariate analyses LD was not independently associated with psychopathology or with worse adjustment in the studied areas. CONCLUSIONS: The finding that LD was not a predictor of greater psychopathology or worse psychosocial adjustment in HIV-1 infected patients, despite the high scores found, suggests that factors not taken into account in this study, such as LD severity and self-perception should have been included in the analysis. Further studies including a greater number of variables and a larger sample size will advance our understanding of this complex condition.

  4. The relationship between spiritual well-being and psychosocial adjustment in Taiwanese patients with colorectal cancer and a colostomy.

    Science.gov (United States)

    Li, Chia-Chun; Rew, Lynn; Hwang, Shiow-Li

    2012-01-01

    We examined relationships among demographic and clinical characteristics, spiritual well-being, and psychosocial adjustment in Taiwanese patients with colorectal cancer and a colostomy. A descriptive, cross-sectional, exploratory study design was used to answer research questions. Participants were recruited from the outpatient ambulatory clinic in the gastrointestinal surgical department at the medical center of National Taiwan University. Forty-five Taiwanese patients aged 42 to 83 years who were diagnosed with colorectal cancer and underwent colostomy surgery participated in the study. Participants completed a personal data questionnaire designed for this study, along with 2 validated instruments, the Spiritual Well-Being Scale and the Psychosocial Adjustment to Illness Scale-Self Report. Forty-five persons participated in the study; 69% reported a moderate level of spiritual well-being. Participants reported strong adjustment to extended family relationships, but poor adjustment in sexual relationships. Spiritual well-being was significantly associated with psychosocial adjustment (r = -0.52, P spiritual well-being) accounted for 53% of the variance in psychosocial adjustment. Spiritual well-being plays an important role for Taiwanese patients when faced with psychosocial adjustment related to life with colorectal cancer and a colostomy.

  5. Nomenclatural adjustments in African plants 1

    Directory of Open Access Journals (Sweden)

    Peter Goldblatt

    2014-12-01

    Full Text Available Background: Ongoing systematic studies of the African flora necessitate periodic nomenclatural adjustments and corrections. Objectives: To effect requisite nomenclatural changes. Method: Relevant literature was surveyed and type material located and studied. Results: Nomenclatural corrections were published in Justicia L. (Acanthaceae, Babiana KerGawl. and Geissorhiza Ker Gawl. (Iridaceae and Zaluzianskya F.W.Schmidt (Scrophulariaceae. Conclusions: Firstly, a complete enumeration of all southern African species of Justicia was provided within the infrageneric classification for the genus accepted by Graham (1988 and later modified and expanded by Ensermu (1990 and Hedrén (1990. In this circumscription, Justicia includes such well-established segregates in an African context as Adhatoda Miller, Aulojusticia Lindau, Duvernoia E.Mey. ex Nees, Monechma Hochst. and Siphonoglossa Oersted.Both southern African species of Adhatoda were transferred to Justicia, as well as all of the southern African species of Monechma, with eight new combinations or replacement names provided. All species were placed to section within Justicia. Secondly, the type of Gladiolus nervosus Lam. (1788 was considered to be conspecific with Gladiolus strictus Aiton (1789 and is therefore the earliest available name for the species currently known as Babiana stricta (Aiton Ker Gawl. The new combination Babiana nervosa (Lam. Goldblatt & J.C.Manning was provided. Thirdly, Geissorhiza ornithogaloides has been regarded as a new species described by F.W. Klatt (1866 but the name should be treated as the combination G. ornithogaloides (Lichst. ex Roem. & Schult. Klatt, based on Ixia ornithogaloides Lichst. ex Roem. & Schult.(1817a. Examination of the type showed that it is conspecific with Geissorhiza marlothii R.C.Foster (1941 and it is therefore the valid name for the taxon treated as G. ornithogaloides subsp. marlothii (R.C.Foster Goldblatt. An epitype for the taxon was designated

  6. Evaluation of an adjustable epidemiologic information system.

    Directory of Open Access Journals (Sweden)

    Jiunn-Shyan Julian Wu

    Full Text Available BACKGROUND: In order to facilitate public health response and to achieve early control of infectious disease epidemics, an adjustable epidemiologic information system (AEIS was established in the Taiwan public health network in February 2006. METHODOLOGY/PRINCIPAL FINDINGS: The performance of AEIS for the period 2006 through 2008 was evaluated based on a number of response times (RT and the public health impact. After implementation of the system, the apparent overall shortened RT was mainly due to the shortening of personnel response time (PRT and the time needed to draft a new questionnaire that incurred as personnel-system interface (PSI; PRT dropped from a fluctuating range of 9.8 ∼28.8 days in the first four months to <10 days in the following months and remained low till 2008 (0.88±1.52 days. The PSIs for newly emerged infectious diseases were 2.6 and 3.4 person-hours for H5N1 in 2007 and chikungunya in 2008, respectively, a much improvement from 1142.5 person-hours for SARS in 2003. The duration of each rubella epidemic cluster was evaluated as public health impact and showed a shortening trend (p = 0.019 that concurred with the shortening of PRT from 64.8±47.3 to 25.2±38.2 hours per cluster (p<0.0001. CONCLUSIONS/SIGNIFICANCE: The first evaluation of the novel instrument AEIS that had been used to assist Taiwan's multi-level government for infectious diseases control demonstrated that it was well integrated into the existing public health infrastructure. It provided flexible tools and computer algorithms with friendly interface for timely data collection, integration, and analysis; as a result, it shortened RTs, filled in gaps of personnel lacking sufficient experiences, created a more efficient flow of response, and identified asymptomatic/mild cases early to minimize further spreading. With further development, AEIS is anticipated to be useful in the application of other acute public health events needing immediate

  7. The 4C framework for making reasonable adjustments for people with learning disabilities.

    Science.gov (United States)

    Marsden, Daniel; Giles, Rachel

    2017-01-18

    Background People with learning disabilities experience significant inequalities in accessing healthcare. Legal frameworks, such as the Equality Act 2010, are intended to reduce such disparities in care, and require organisations to make 'reasonable adjustments' for people with disabilities, including learning disabilities. However, reasonable adjustments are often not clearly defined or adequately implemented in clinical practice. Aim To examine and synthesise the challenges in caring for people with learning disabilities to develop a framework for making reasonable adjustments for people with learning disabilities in hospital. This framework would assist ward staff in identifying and managing the challenges of delivering person-centred, safe and effective healthcare to people with learning disabilities in this setting. Method Fourth-generation evaluation, collaborative thematic analysis, reflection and a secondary analysis were used to develop a framework for making reasonable adjustments in the hospital setting. The authors attended ward manager and matron group meetings to collect their claims, concerns and issues, then conducted a collaborative thematic analysis with the group members to identify the main themes. Findings Four main themes were identified from the ward manager and matron group meetings: communication, choice-making, collaboration and coordination. These were used to develop the 4C framework for making reasonable adjustments for people with learning disabilities in hospital. Discussion The 4C framework has provided a basis for delivering person-centred care for people with learning disabilities. It has been used to inform training needs analyses, develop audit tools to review delivery of care that is adjusted appropriately to the individual patient; and to develop competencies for learning disability champions. The most significant benefit of the 4C framework has been in helping to evaluate and resolve practice-based scenarios. Conclusion Use of

  8. 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 ...

  9. 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 ...

  10. 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 ...

  11. Clinical Trials

    Medline Plus

    Full Text Available ... medical strategy, treatment, or device is safe and effective for humans. What Are Clinical Trials? Clinical trials ... and Centers sponsor clinical trials. Many other groups, companies, and organizations also sponsor clinical trials. Examples include ...

  12. Heating analysis of cobalt adjusters in reactor core

    International Nuclear Information System (INIS)

    Mei Qiliang; Li Kang; Fu Yaru

    2011-01-01

    In order to produce 60 Co source for industry and medicine applications in CANDU-6 reactor, the stainless steel adjusters were replaced with the cobalt adjusters. The cobalt rod will generate the heat when it is irradiated by neutron and γ ray. In addition, 59 Co will be activated and become 60 Co, the ray released due to 60 Co decay will be absorbed by adjusters, and then the adjusters will also generate the heat. So the heating rate of adjusters to be changed during normal operation must be studied, which will be provided as the input data for analyzing the temperature field of cobalt adjusters and the relative heat load of moderator. MCNP code was used to simulate whole core geometric configuration in detail, including reactor fuel, control rod, adjuster, coolant and moderator, and to analyze the heating rate of the stainless steel adjusters and the cobalt adjusters. The maximum heating rate of different cobalt adjuster based on above results will be provided for the steady thermal hydraulic and accident analysis, and make sure that the reactor is safe on the thermal hydraulic. (authors)

  13. The impact of calcium assay change on a local adjusted calcium equation.

    Science.gov (United States)

    Davies, Sarah L; Hill, Charlotte; Bailey, Lisa M; Davison, Andrew S; Milan, Anna M

    2016-03-01

    Deriving and validating local adjusted calcium equations is important for ensuring appropriate calcium status classification. We investigated the impact on our local adjusted calcium equation of a change in calcium method by the manufacturer from cresolphthalein complexone to NM-BAPTA. Calcium and albumin results from general practice requests were extracted from the Laboratory Information Management system for a three-month period. Results for which there was evidence of disturbance in calcium homeostasis were excluded leaving 13,482 sets of results for analysis. The adjusted calcium equation was derived following least squares regression analysis of total calcium on albumin and normalized to the mean calcium concentration of the data-set. The revised equation (NM-BAPTA calcium method) was compared with the previous equation (cresolphthalein complexone calcium method). The switch in calcium assay resulted in a small change in the adjusted calcium equation but was not considered to be clinically significant. The calcium reference interval differed from that proposed by Pathology Harmony in the UK. Local adjusted calcium equations should be re-assessed following changes in the calcium method. A locally derived reference interval may differ from the consensus harmonized reference interval. © The Author(s) 2015.

  14. BIOIMPEDANCE VECTOR ANALYSIS AS A TOOL FOR DETERMINATION AND ADJUSTMENT OF DRY WEIGHT IN HEMODIALYSIS PATIENTS

    Directory of Open Access Journals (Sweden)

    Ximena Atilano

    2012-06-01

    Full Text Available The hemodialysis (HD patient is fluid overloaded, even when there is no apparent edema. Due to this, is vital to know the dry weight. No clinical or laboratory parameters are reliable, simple and accessible for this purpose. The bioelectrical impedance has been applied to estimate body fluids and dry weight. The purpose was to use the bioelectrical vector analysis (BIVA as a tool to adjust the intensity of ultrafiltration and achievement of dry weight in HD patients. We performed monthly measurements of bioimpedance in 24 HD patients pre-and post-dialysis for four months. We plotted the patient´s vectors in the RXc graph in order to meet individually hydration status and adjust the dry weight. Nutritional status was evaluated by Bilbrey Index. Adjustment on dry weight, was made in 18 patients, 13 of whom (72% were able to reach it. The postdialysis vectors, migrated to upper quadrants, indicating adequate hydration. Postdialysis vectors at the end of the study were significantly different compared to baseline (Figure 1. Five patients didn´t reach dry weight despite the adjustments, 4 were men with overhydration and 3 of them were severely malnourished. A woman remained dehydrated. In conclusion, the impedance vector analysis is a useful tool for adjusting dry weight in hemodialysis patients.fx1

  15. Adjusting diet with sapropterin in phenylketonuria

    DEFF Research Database (Denmark)

    MacDonald, Anita; Ahring, Kirsten; Dokoupil, Katharina

    2011-01-01

    others are able to relax the diet to some extent. Care is required when altering the phenylalanine-restricted diet, as this may have unintended nutritional consequences and must be undertaken with caution. New clinical protocols are required for managing any dietary change while maintaining control......The usual treatment for phenylketonuria (PKU) is a phenylalanine-restricted diet. Following this diet is challenging, and long-term adherence (and hence metabolic control) is commonly poor. Patients with PKU (usually, but not exclusively, with a relatively mild form of the disorder) who...... and new questions in the dietary management of these patients. Initially, patients and carers must understand clearly the likely benefits (and limitations) of sapropterin therapy. A minority of patients who respond to sapropterin are able to discontinue the phenylalanine-restricted diet completely, while...

  16. Attachment insecurity and psychological resources associated with adjustment disorders.

    Science.gov (United States)

    Ponizovsky, Alexander M; Levov, Kathy; Schultz, Yakov; Radomislensky, Ira

    2011-04-01

    This study examined the adult attachment styles, interpersonal distance from potential attachment figures and strangers, coping strategies, perceived social support, and stress-related self-variables among patients diagnosed with adjustment disorders (AJD). Seventy patients at an outpatient clinic and 61 matched controls completed a battery of standardized questionnaires. Univariate and multivariate statistical analyses were used to evaluate the parameters of interest. Using attachment theory (J. Bowlby, 1988) and the dynamic stress-vulnerability model of depressive disorder (G. W. Brown & T. O. Harris, 1989) as the analytical frameworks, the authors hypothesized that participants with AJD would: (a) display more insecure attachment styles, (b) be less tolerant of close interpersonal proximity, (c) use more emotion-oriented coping strategies, (d) display lower self-efficacy and self-esteem, and (e) perceive less social support from family, friends, and significant others. We further hypothesized that these variables would be predictive of depressive symptoms. All of the hypotheses were confirmed. The results suggest that the insecure fearful-avoidant attachment style is associated with severe depressive symptoms in patients with AJD. However, other psychosocial factors, such as low self-esteem and poor social support from friends, were more predictive of AJD symptoms. The findings warrant further studies on the risk and protective effects of these factors in the development of AJD and other stress-induced disorders. © 2011 American Orthopsychiatric Association.

  17. Estimation of adjusted rate differences using additive negative binomial regression.

    Science.gov (United States)

    Donoghoe, Mark W; Marschner, Ian C

    2016-08-15

    Rate differences are an important effect measure in biostatistics and provide an alternative perspective to rate ratios. When the data are event counts observed during an exposure period, adjusted rate differences may be estimated using an identity-link Poisson generalised linear model, also known as additive Poisson regression. A problem with this approach is that the assumption of equality of mean and variance rarely holds in real data, which often show overdispersion. An additive negative binomial model is the natural alternative to account for this; however, standard model-fitting methods are often unable to cope with the constrained parameter space arising from the non-negativity restrictions of the additive model. In this paper, we propose a novel solution to this problem using a variant of the expectation-conditional maximisation-either algorithm. Our method provides a reliable way to fit an additive negative binomial regression model and also permits flexible generalisations using semi-parametric regression functions. We illustrate the method using a placebo-controlled clinical trial of fenofibrate treatment in patients with type II diabetes, where the outcome is the number of laser therapy courses administered to treat diabetic retinopathy. An R package is available that implements the proposed method. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  18. Australian diagnosis related groups: Drivers of complexity adjustment.

    Science.gov (United States)

    Jackson, Terri; Dimitropoulos, Vera; Madden, Richard; Gillett, Steve

    2015-11-01

    In undertaking a major revision to the Australian Refined Diagnosis Related Group (ARDRG) classification, we set out to contrast Australia's approach to using data on additional (not principal) diagnoses with major international approaches in splitting base or Adjacent Diagnosis Related Groups (ADRGs). Comparative policy analysis/narrative review of peer-reviewed and grey literature on international approaches to use of additional (secondary) diagnoses in the development of Australian and international DRG systems. European and US approaches to characterise complexity of inpatient care are well-documented, providing useful points of comparison with Australia's. Australia, with good data sources, has continued to refine its national DRG classification using increasingly sophisticated approaches. Hospital funders in Australia and in other systems are often under pressure from provider groups to expand classifications to reflect clinical complexity. DRG development in most healthcare systems reviewed here reflects four critical factors: these socio-political factors, the quality and depth of the coded data available to characterise the mix of cases in a healthcare system, the size of the underlying population, and the intended scope and use of the classification. Australia's relatively small national population has constrained the size of its DRG classifications, and development has been concentrated on inpatient care in public hospitals. Development of casemix classifications in health care is driven by both technical and socio-political factors. Use of additional diagnoses to adjust for patient complexity and cost needs to respond to these in each casemix application. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  19. Use of risk-adjusted CUSUM charts to monitor 30-day mortality in Danish hospitals

    Directory of Open Access Journals (Sweden)

    Rasmussen TB

    2018-04-01

    Full Text Available Thomas Bøjer Rasmussen, Sinna Pilgaard Ulrichsen, Mette Nørgaard Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark Background: Monitoring hospital outcomes and clinical processes as a measure of clinical performance is an integral part of modern health care. The risk-adjusted cumulative sum (CUSUM chart is a frequently used sequential analysis technique that can be implemented to monitor a wide range of different types of outcomes.Objective: The aim of this study was to describe how risk-adjusted CUSUM charts based on population-based nationwide medical registers were used to monitor 30-day mortality in Danish hospitals and to give an example on how alarms of increased hospital mortality from the charts can guide further in-depth analyses.Materials and methods: We used routinely collected administrative data from the Danish National Patient Registry and the Danish Civil Registration System to create risk-adjusted CUSUM charts. We monitored 30-day mortality after hospital admission with one of 77 selected diagnoses in 24 hospital units in Denmark in 2015. The charts were set to detect a 50% increase in 30-day mortality, and control limits were determined by simulations.Results: Among 1,085,576 hospital admissions, 441,352 admissions had one of the 77 selected diagnoses as their primary diagnosis and were included in the risk-adjusted CUSUM charts. The charts yielded a total of eight alarms of increased mortality. The median of the hospitals’ estimated average time to detect a 50% increase in 30-day mortality was 50 days (interquartile interval, 43;54. In the selected example of an alarm, descriptive analyses indicated performance problems with 30-day mortality following hip fracture surgery and diagnosis of chronic obstructive pulmonary disease.Conclusion: The presented implementation of risk-adjusted CUSUM charts can detect significant increases in 30-day mortality within 2 months, on average, in most

  20. Dyadic coping mediates the relationship between parents' grief and dyadic adjustment following the loss of a child.

    Science.gov (United States)

    Albuquerque, Sara; Narciso, Isabel; Pereira, Marco

    2018-01-01

    This study aimed to examine forms of dyadic coping (DC) as mediators of the association between parents' grief response and dyadic adjustment and to determine whether these indirect effects were moderated by the child's type of death, timing of death, and age. The study design was cross-sectional. The sample consisted of 197 bereaved parents. Participants completed the Prolonged Grief Disorder Scale, Revised Dyadic Adjustment Scale, and Dyadic Coping Inventory. Significant indirect effects of parents' grief response on dyadic adjustment were found through stress communication by oneself and by the partner, positive and negative DC by the partner, and joint DC. The timing of death moderated the association between grief response and dyadic adjustment and between joint DC and dyadic adjustment. Grief response was negatively associated with dyadic adjustment only when the death occurred after birth. Grief response was negatively associated with joint DC, which, in turn, was positively associated with dyadic adjustment, when the death occurred both before and after birth. However, the association was stronger in the latter. Specific forms of DC might be mechanisms through which grief response is associated with dyadic adjustment and should be promoted in clinical practice.

  1. Two aspects of feedforward postural control: anticipatory postural adjustments and anticipatory synergy adjustments.

    Science.gov (United States)

    Klous, Miriam; Mikulic, Pavle; Latash, Mark L

    2011-05-01

    We used the framework of the uncontrolled manifold hypothesis to explore the relations between anticipatory synergy adjustments (ASAs) and anticipatory postural adjustments (APAs) during feedforward control of vertical posture. ASAs represent a drop in the index of a multimuscle-mode synergy stabilizing the coordinate of the center of pressure in preparation to an action. ASAs reflect early changes of an index of covariation among variables reflecting muscle activation, whereas APAs reflect early changes in muscle activation levels averaged across trials. The assumed purpose of ASAs is to modify stability of performance variables, whereas the purpose of APAs is to change magnitudes of those variables. We hypothesized that ASAs would be seen before APAs and that this finding would be consistent with regard to the muscle-mode composition defined on the basis of different tasks and phases of action. Subjects performed a voluntary body sway task and a quick, bilateral shoulder flexion task under self-paced and reaction time conditions. Surface muscle activity of 12 leg and trunk muscles was analyzed to identify sets of 4 muscle modes for each task and for different phases within the shoulder flexion task. Variance components in the muscle-mode space and indexes of multimuscle-mode synergy stabilizing shift of the center of pressure were computed. ASAs were seen ∼ 100-150 ms prior to the task initiation, before APAs. The results were consistent with respect to different sets of muscle modes defined over the two tasks and different shoulder flexion phases. We conclude that the preparation for a self-triggered postural perturbation is associated with two types of anticipatory adjustments, ASAs and APAs. They reflect different feedforward processes within the hypothetical hierarchical control scheme, resulting in changes in patterns of covariation of elemental variables and in their patterns averaged across trials, respectively. The results show that synergies quantified

  2. [Family characteristics, organic risk factors, psychopathological picture and premorbid adjustment of hospitalized adolescent patients].

    Science.gov (United States)

    Małkiewicz-Borkowska, M; Namysłowska, I; Siewierska, A; Puzyńska, E; Sredniawa, H; Zechowski, C; Iwanek, A; Ruszkowska, E

    1996-01-01

    The relation of some family characteristics such as cohesion and adaptability with organic risk factors, developmental psychopathology, clinical picture and premorbid adjustment was assessed in the group of 100 hospitalized adolescent patients and families. We found correlation between: some of organic risk factors (pathology of neonatal period, pathology of early childhood), some of indicators of developmental psychopathology (eating disorders, conduct disorders), some of clinical signs (mannerism, grandiosity, hostility, suspciousness, disturbances of content of thinking), premorbid adjustment, and variables related to families, described before. We think that biological variables characterizing child (pathology of neonatal period, pathology of early childhood) have an influence on some family characteristics as independent variable. General system theory and circular thinking support these conclusions. In order to verify them, it is necessary to undertake further investigations, based on other methodology, using this results as preliminary findings.

  3. Territorial differentiation of incomes adjusted for inflation

    Directory of Open Access Journals (Sweden)

    Marina Valeryevna, Moroshkina

    2017-06-01

    Full Text Available Objective to analyze and evaluate the regional disparities of socioeconomic development of the Russian regions in terms of income differentiation adjusted for the level of inflation. Methods indicator by which to measure the level of regional growth heterogeneity is Gini coefficient allowing to determine the degree of the Russian regionsrsquo deviation from absolute equality. The unique feature of the authorrsquos approach is the calculation and analysis of the Gini coefficient not only in current prices but also in comparable prices of 1991. Thus the comparison of the Gini coefficient in terms of quotper capita incomequot in the period from 1991 to 2013 in comparable and current prices allows to estimate the impact of changes in the prices level on the dynamics of regional development. Results the article states that the regions differentiation by the level of economic development determines the necessity of considering this factor in economic policy areas. In these circumstances the analysis of income differentiation of the Russian regions has to take the impact of inflation into account. The article reviews the Russian and foreign research in the sphere of the income differentiation. Significant scientific interest to the problem of regional inequality is obvious over the past several decades. Approaches and methods of assessing the level of regional disparities are systematized as well as its key performance indicators. To assess the level of differentiation of Russian regions we used the Gini coefficient which was calculated not only by current but also by comparable prices. The calculation was carried out basing on the recalculation of the per capita income using the consumer price index. In the framework of the analysis the calculated Gini coefficient for per capita income by current and integrated prices allowed to observe the differential behavior of this indicator. In terms of quotper capita incomequot by current prices there is a

  4. Adjusted neutron spectra of STEK cores for reactivity calculations

    International Nuclear Information System (INIS)

    Dekker, J.W.M.; Dragt, J.B.; Janssen, A.J.; Heijboer, R.J.; Klippel, H.Th.

    1978-02-01

    Neutron flux and adjoint flux spectra form a pre-requisite in the analysis of reactivity worth data measured in the STEK facility. First, a survey of all available information about these spectra is given. Next a special application of a general adjustment method is described. This method has been used to obtain adjusted STEK group flux and adjoint flux spectra, starting from calculated spectra. These theoretical spectra were adjusted to reactivity worths of natural boron (nat. B) and 235 U as well as a number of fission reaction rates. As a by-product in this adjustment calculation adjusted fission group cross sections of 235 U were obtained. The results, viz. group fluxes and adjoint fluxes and adjusted fission cross sections of 235 U are given. They have been used for the interpretation of fission product reactivity worth measurements made in STEK

  5. PIA and REWIND: Two New Methodologies for Cross Section Adjustment

    Energy Technology Data Exchange (ETDEWEB)

    Palmiotti, G.; Salvatores, M.

    2017-02-01

    This paper presents two new cross section adjustment methodologies intended for coping with the problem of compensations. The first one PIA, Progressive Incremental Adjustment, gives priority to the utilization of experiments of elemental type (those sensitive to a specific cross section), following a definite hierarchy on which type of experiment to use. Once the adjustment is performed, both the new adjusted data and the new covariance matrix are kept. The second methodology is called REWIND (Ranking Experiments by Weighting for Improved Nuclear Data). This new proposed approach tries to establish a methodology for ranking experiments by looking at the potential gain they can produce in an adjustment. Practical applications for different adjustments illustrate the results of the two methodologies against the current one and show the potential improvement for reducing uncertainties in target reactors.

  6. BIOIMPEDANCE VECTOR ANALYSIS AS A TOOL FOR DETERMINATION AND ADJUSTMENT OF DRY WEIGHT IN HEMODIALYSIS PATIENTS

    OpenAIRE

    Ximena Atilano; José Luis.Miguel; Jorge Martínez; Rafael Sánchez; Rafael Selgas

    2012-01-01

    The hemodialysis (HD) patient is fluid overloaded, even when there is no apparent edema. Due to this, is vital to know the dry weight. No clinical or laboratory parameters are reliable, simple and accessible for this purpose. The bioelectrical impedance has been applied to estimate body fluids and dry weight. The purpose was to use the bioelectrical vector analysis (BIVA) as a tool to adjust the intensity of ultrafiltration and achievement of dry weight in HD patients. We performed monthly me...

  7. Raison d’être of insulin resistance: the adjustable threshold hypothesis

    OpenAIRE

    Wang, Guanyu

    2014-01-01

    The epidemics of obesity and diabetes demand a deeper understanding of insulin resistance, for which the adjustable threshold hypothesis is formed in this paper. To test the hypothesis, mathematical modelling was used to analyse clinical data and to simulate biological processes at both molecular and organismal levels. I found that insulin resistance roots in the thresholds of the cell's bistable response. By assuming heterogeneity of the thresholds, single cells' all-or-none response can col...

  8. Adjustment methodology for preliminary study on the distribution of bone tissue boron. Potential therapeutic applications

    International Nuclear Information System (INIS)

    Brandizzi, D; Dagrosa, A; Carpano, M.; Olivera, M. S.; Nievas, S; Cabrini, R.L.

    2013-01-01

    Boron is an element that has an affinity for bone tissue and represents a considered element in bone health . Other boron compounds are used in the Boron Neutron Capture Therapy (BNCT ) in the form of sodium borocaptate (BSH ) and borono phenylalanine (BPA). The results of clinical trials up to date are encouraging but not conclusive . At an experimental level , some groups have applied BNCT in osteosarcomas . We present preliminary methodological adjustments for the presence of boron in bone. (author)

  9. Adjustment of Romanian Immigrant Students in a New Educational Context

    OpenAIRE

    Aniella Mihaela VIERIU

    2014-01-01

    The present study focuses on the adjustment of Romanian immigrant students in emigration schools. The sample was comprised of 102 Romanian immigrant students, 40 male and 62 female, between the ages of 11 and 18, attending different schools in countries such as Spain, Italy and Belgium. Students’ adjustment was investigated by means of a questionnaire consisting of four subscales: linguistic adaptation, cultural adaptation, school adjustment and teacher-student relationship. Results indicate ...

  10. Technique for simultaneous adjustment of large nuclear data libraries

    International Nuclear Information System (INIS)

    Harris, D.R.; Wilson, W.B.

    1975-01-01

    Adjustment of the nuclear data base to agree with integral observations in design work has been limited in part by problems in the required inversion of matrices. It is shown that this inversion problem can be circumvented and arbitrarily large nuclear data libraries can be adjusted simultaneously when the basic data are uncorrelated. The technique is illustrated by adjusting nuclear data to integral observations made on fast reactor benchmark critical assemblies. 3 tables

  11. 25 CFR Appendix B to Subpart C - Population Adjustment Factor

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Population Adjustment Factor B Appendix B to Subpart C...—Population Adjustment Factor 1. The Population Adjustment Factor allows for participation in the IRR Program... Distribution factor* Number of tribes** Funding amount per tribe Less than 25 1 N1 MBA*** × 1 25-100 3.5 N2 MBA...

  12. INSTITUTIONAL OWNERSHIP LEVEL AND RISK-ADJUSTED RETURN

    OpenAIRE

    Isaiah, Chioma; Li, Meng (Emma)

    2017-01-01

    This paper examines the relationship between the level of institutional ownership andrisk-adjusted return on stocks. We find a significant positive relationship between the level ofinstitutional ownership on a stock and its risk-adjusted return. This result holds both in the longrun and in shorter time periods. Our findings suggest that all things being equal, it is possible toobtain risk-adjusted return by going short on the stocks with low institutional ownership andgoing long on those with...

  13. Rebalancing; Evidence from Current Account Adjustment in Europe

    OpenAIRE

    Ruben V Atoyan; Jonathan F Manning; Jesmin Rahman

    2013-01-01

    After the 2003-2007 economic boom, European countries with large pre-crisis current account imbalances are undergoing adjustments. Countries are adjusting at different paces and ways reflecting the source and magnitude of imbalances, availability of financing, competitiveness of the tradable sector and external environment. While emerging European countries with large pre-crisis imbalances and a fixed exchange rate regime have seen sharp current account adjustments and a rebound in growth, ad...

  14. Controlling chaos based on an adaptive adjustment mechanism

    International Nuclear Information System (INIS)

    Zheng Yongai

    2006-01-01

    In this paper, we extend the ideas and techniques developed by Huang [Huang W. Stabilizing nonlinear dynamical systems by an adaptive adjustment mechanism. Phys Rev E 2000;61:R1012-5] for controlling discrete-time chaotic system using adaptive adjustment mechanism to continuous-time chaotic system. Two control approaches, namely adaptive adjustment mechanism (AAM) and modified adaptive adjustment mechanism (MAAM), are investigated. In both case sufficient conditions for the stabilization of chaotic systems are given analytically. The simulation results on Chen chaotic system have verified the effectiveness of the proposed techniques

  15. Text Categorization Using Weight Adjusted k-Nearest Neighbor Classification

    National Research Council Canada - National Science Library

    Han, Euihong; Karypis, George; Kumar, Vipin

    1999-01-01

    .... The authors present a nearest neighbor classification scheme for text categorization in which the importance of discriminating words is learned using mutual information and weight adjustment techniques...

  16. Methodological aspects of journaling a dynamic adjusting entry model

    Directory of Open Access Journals (Sweden)

    Vlasta Kašparovská

    2011-01-01

    Full Text Available This paper expands the discussion of the importance and function of adjusting entries for loan receivables. Discussion of the cyclical development of adjusting entries, their negative impact on the business cycle and potential solutions has intensified during the financial crisis. These discussions are still ongoing and continue to be relevant to members of the professional public, banking regulators and representatives of international accounting institutions. The objective of this paper is to evaluate a method of journaling dynamic adjusting entries under current accounting law. It also expresses the authors’ opinions on the potential for consistently implementing basic accounting principles in journaling adjusting entries for loan receivables under a dynamic model.

  17. Age-Adjusted D-Dimer in the Prediction of Pulmonary Embolism: Does a Normal Age-Adjusted D-Dimer Rule Out PE?

    Directory of Open Access Journals (Sweden)

    Jacob Ortiz

    2017-01-01

    Full Text Available Risk assessment for pulmonary embolism (PE currently relies on physician judgment, clinical decision rules (CDR, and D-dimer testing. There is still controversy regarding the role of D-dimer testing in low or intermediate risk patients. The objective of the study was to define the role of clinical decision rules and D-dimer testing in patients suspected of having a PE. Records of 894 patients referred for computed tomography pulmonary angiography (CTPA at a University medical center were analyzed. The clinical decision rules overall had an ROC of approximately 0.70, while signs of DVT had the highest ROC (0.80. A low probability CDR coupled with a negative age-adjusted D-dimer largely excluded PE. The negative predictive value (NPV of an intermediate CDR was 86–89%, while the addition of a negative D-dimer resulted in NPVs of 94%. Thus, in patients suspected of having a PE, a low or intermediate CDR does not exclude PE; however, in patients with an intermediate CDR, a normal age-adjusted D-dimer increases the NPV.

  18. Empirical Evidence of Target Leverage, Adjustment Costs and Adjustment Speed of Non-Financial Firms in Selected African Countries

    OpenAIRE

    Oyebola Fatima Etudaiye-Muhtar; Oyebola Fatima Etudaiye-Muhtar; Rubi Ahmad

    2015-01-01

    The issue of target leverage for corporate firms in developing countries has received little attention in extant literature, especially countries in Africa. Given the imperfection that exists in African financial markets that may limit firms access to external capital, this study investigates dynamic adjustment towards a target debt ratio. In addition, the study used a dynamic panel data estimation technique to determine adjustment costs and speed of adjustment in non-financial firms in selec...

  19. A SURVEY OF DEATH ADJUSTMENT IN THE INDIAN SUBCONTINENT.

    Science.gov (United States)

    Hossain, Mohammad Samir; Irfan, Muhammad; Balhara, Yatan Pal Singh; Giasuddin, Noor Ahmed; Sultana, Syeda Naheed

    2015-01-01

    The Death Adjustment Hypothesis (DAH) postulates two key themes. Its first part postulates that death should not be considered the end of existence and the second part emphasizes that the belief in immortal pattern of human existence can only be adopted in a morally rich life with the attitude towards morality and materialism balanced mutually. We wanted to explore Death Adjustment in the Indian subcontinent and the differences among, Indians, Pakistanis and Bangladeshis. We also wanted to find the relationship between death adjustment (i.e., adaptation to death), materialistic thoughts and death adjustment thoughts. This was a cross-sectional study, conducted from May 2010 to June 2013. Using a purposive sampling strategy, a sample of 296 participants from the Indian subcontinent [Pakistan (n=100), Bangladesh (n=98) and India (n=98)] was selected. Multidimensional Fear of Death Scale (MFODS) was used to measure death adjustment. The rest of the variables were measured using lists of respective thoughts, described in elaborated DAH. Analyses were carried out using SPSSv13. The mean death adjustment score for Pakistani, Indian and Bangaldeshi population were 115.26 +/- 26.4, 125.87 +/- 24.3 and 114.91 +/- 21.2, respectively. Death adjustment was better with older age (r=0.20) and with lower scores on materialistic thoughts (r = -0.26). However, this was a weak relation. The three nationalities were compared with each other by using Analysis of variance. Death adjustment thoughts and death adjustment were significantly different when Indians were compared with Bangladeshis (p=0.00) and Pakistanis (p=0.006) but comparison between Bangladeshis and Pakistanis showed no significant difference. Subjects with lesser materialistic thoughts showed better death adjustment. There are differences between Muslims and non-Muslims in adjusting to death.

  20. Efficacy of the resilience and adjustment intervention after traumatic brain injury: a randomized controlled trial.

    Science.gov (United States)

    Kreutzer, Jeffrey S; Marwitz, Jennifer H; Sima, Adam P; Mills, Ana; Hsu, Nancy H; Lukow, Herman R

    2018-05-24

    Examine a psychoeducational and skill-building intervention's effectiveness for individuals after traumatic brain injury (TBI), using a two-arm, parallel, randomized, controlled trial with wait-listed control. The Resilience and Adjustment Intervention (RAI) targets adjustment challenges and emphasizes education, skill-building and psychological support. Overall, 160 outpatients were randomly assigned to a treatment or wait-list control (WLC) group. The manualized treatment was delivered in seven 1-h sessions. The Connor-Davidson Resilience Scale (CD-RISC) was the primary outcome measure. Secondary measures included the Mayo Portland Adaptability Inventory-4 (MPAI-4), Brief Symptom Inventory-18 (BSI-18) and 13-Item Stress Test. After adjusting for injury severity, education and time postinjury, the RAI group (N = 75) demonstrated a significantly greater increase in resilience (effect size = 1.03) compared to the WLC group (N = 73). Participants in the RAI group demonstrated more favourable scores on the MPAI-4 Adjustment and Ability Indices, BSI-18 and the 13-item Stress Test. However, only the CD-RISC and BSI-18 demonstrated a clinically significant difference. In addition, RAI participants demonstrated maintenance of gains from pre-treatment to 3-month follow-up; however, only the BSI-18 maintained a clinically significant difference. Investigation provided evidence that a resilience-focused intervention can improve psychological health and adjustment after TBI. Additional research is needed to ascertain the longer term benefits of intervention and the efficacy of alternative delivery methods (e.g., via telephone, Internet).

  1. "Subthreshold" depression: is the distinction between depressive disorder not otherwise specified and adjustment disorder valid?

    Science.gov (United States)

    Zimmerman, Mark; Martinez, Jennifer H; Dalrymple, Kristy; Chelminski, Iwona; Young, Diane

    2013-05-01

    Patients with clinically significant symptoms of depression who do not meet the criteria for major depressive disorder or dysthymic disorder are considered to have subthreshold depression. According to DSM-IV, such patients should be diagnosed with depressive disorder not otherwise specified (NOS) if the development of the symptoms is not attributable to a stressful event or with adjustment disorder if the symptoms follow a stressor. Research on the treatment of subthreshold depression rarely addresses the distinction between depressive disorder NOS and adjustment disorder. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examined the validity of this distinction. From December 1995 to June 2011, 3,400 psychiatric patients presenting to the Rhode Island Hospital outpatient practice were evaluated with semistructured diagnostic interviews for DSM-IV Axis I and Axis II disorders and measures of psychosocial morbidity. Slightly less than 10% (n = 300) of the 3,400 patients were diagnosed with depressive disorder NOS or adjustment disorder with depressed mood. The patients with depressive disorder NOS were significantly more often diagnosed with social phobia (P depressive disorder NOS reported more anhedonia, increased appetite, increased sleep, and indecisiveness, whereas the patients with adjustment disorder reported more weight loss, reduced appetite, and insomnia. There was no significant difference between the groups in overall level of severity of depression or impaired functioning. The patients with depressive disorder NOS had a nonsignificantly elevated morbid risk of depression in their first-degree relatives. Clinically significant subthreshold depression was common in psychiatric outpatients, and the present results support the validity of distinguishing between depressive disorder NOS and adjustment disorder with depressed mood. Future studies of the treatment of subthreshold depression

  2. Psychological Adjustment to Lung Cancer: the role of self-compassion and social support

    Directory of Open Access Journals (Sweden)

    Rute Batista

    2016-02-01

    Full Text Available // Introduction: The impact of the diagnosis of an oncologic disease is well-known in terms of psychological adjustment and quality of life. On the other hand it is known that depressive symptoms may also overlap the physical symptoms of cancer and cancer treatment, which may interfere in their detection and appropriate treatment approach.   Objectives: The aim of the current study was to explore the relationship between psychological adjustment to lung cancer, self-compassion, social support and emotional negative states in patients with lung cancer.   Method: Fifty-five patients diagnosed with lung cancer (38 men and 17 women with ages ranging from 44 to 87 years old participated in the study. A set of self-report instruments was used: the Mini Mental Adjustment to Cancer Scale (MiniMac, the Self-compassion Scale (SCS; Neff, 2003, the Social Support Satisfaction Scale (SSSS and the Depression, Anxiety and Stress Scale (DASS-21.   Results: Significant correlations were found between psychological adjustment, psychopathology, emotion regulation strategies (self-compassion, and social support. The predictive models for psychological adjustment and stress related symptomatology include self-compassion and social support as significant predictive variables. Regarding the predictive model for depressive symptomatology, mindfulness seems to be the only significant predictor.   Conclusions: Our findings suggest that these patients may benefit, in their therapeutic approach, from the development of this kind of strategies (new ways of relating themselves with their emotional experiences and quality of their social networks in order to promote a better psychological adjustment to their clinical condition.

  3. Adjusting a cancer mortality-prediction model for disease status-related eligibility criteria

    Directory of Open Access Journals (Sweden)

    Kimmel Marek

    2011-05-01

    Full Text Available Abstract Background Volunteering participants in disease studies tend to be healthier than the general population partially due to specific enrollment criteria. Using modeling to accurately predict outcomes of cohort studies enrolling volunteers requires adjusting for the bias introduced in this way. Here we propose a new method to account for the effect of a specific form of healthy volunteer bias resulting from imposing disease status-related eligibility criteria, on disease-specific mortality, by explicitly modeling the length of the time interval between the moment when the subject becomes ineligible for the study, and the outcome. Methods Using survival time data from 1190 newly diagnosed lung cancer patients at MD Anderson Cancer Center, we model the time from clinical lung cancer diagnosis to death using an exponential distribution to approximate the length of this interval for a study where lung cancer death serves as the outcome. Incorporating this interval into our previously developed lung cancer risk model, we adjust for the effect of disease status-related eligibility criteria in predicting the number of lung cancer deaths in the control arm of CARET. The effect of the adjustment using the MD Anderson-derived approximation is compared to that based on SEER data. Results Using the adjustment developed in conjunction with our existing lung cancer model, we are able to accurately predict the number of lung cancer deaths observed in the control arm of CARET. Conclusions The resulting adjustment was accurate in predicting the lower rates of disease observed in the early years while still maintaining reasonable prediction ability in the later years of the trial. This method could be used to adjust for, or predict the duration and relative effect of any possible biases related to disease-specific eligibility criteria in modeling studies of volunteer-based cohorts.

  4. Does spirituality facilitate adjustment and resilience among individuals and families after SCI?

    Science.gov (United States)

    Jones, Kate; Simpson, Grahame Kenneth; Briggs, Lynne; Dorsett, Pat

    2016-01-01

    The purpose of this scoping review was to investigate the role of spirituality in facilitating adjustment and resilience after spinal cord injury (SCI) for the individual with SCI and their family members. METHOD-DATA SOURCES: Peer reviewed journals were identified using PsychInfo, MEDLINE, CINAHL, Embase and Sociological Abstracts search engines. After duplicates were removed, 434 abstracts were screened applying inclusion and exclusion criteria. The selected 28 studies were reviewed in detail and grouped according to methodological approach. Of the 28 studies relating to spirituality and related meaning-making constructs, 26 addressed the adjustment of the individual with SCI alone. Only two included family members as participants. Quantitative studies demonstrated that spirituality was positively associated with life satisfaction, quality of life, mental health and resilience. The utilisation of meaning-making and hope as coping strategies in the process of adjustment were highlighted within the qualitative studies. Clinical implications included recommendations that spirituality and meaning-making be incorporated in assessment and interventions during rehabilitation. The use of narratives and peer support was also suggested. Spirituality is an important factor in adjustment after SCI. Further research into the relationship between spirituality, family adjustment and resilience is needed. Higher levels of spirituality were associated with improved quality of life, life satisfaction, mental health, and resilience for individuals affected by spinal cord injury. Health professionals can enhance the role that spirituality plays in spinal rehabilitation by incorporating the spiritual beliefs of individuals and their family members into assessment and intervention. By drawing upon meaning-making tools, such as narrative therapy, incorporating peer support, and assisting clients who report a decline in spirituality, health professionals can provide additional support

  5. COORDINATING HOSPITAL AND COMMUNITY WORK ADJUSTMENT SERVICES. FINAL REPORT.

    Science.gov (United States)

    GOERTZEL, VICTOR; AND OTHERS

    THE GOALS OF THIS STUDY WERE TO USE WORK TO HELP PATIENTS LEAVE THE CAMARILLO STATE HOSPITAL SOONER, BECOME A PART OF THE COMMUNITY, AND BECOME SELF-SUPPORTING. THE PROJECT SELECTED 146 SCHIZOPHRENIC MALES WHO HAD A HISTORY OF POOR WORK ADJUSTMENT. AS PART OF THE TREATMENT, THE MEN WERE PLACED IN THE HOSPITAL BAKERY. AFTER ADJUSTMENT TO THE WORK…

  6. The Perils of "Adjustment Disorder" as a Diagnostic Category

    Science.gov (United States)

    Daniels, John

    2009-01-01

    "Adjustment disorder" occupies a peculiar position in the diagnostic system of the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) straddling the boundary between normal and abnormal psychology. A more human-centered approach in counseling offers a defense of "normal" adjustment as…

  7. Social and Emotional Adjustment of Siblings of Children with Autism

    Science.gov (United States)

    Pilowsky, Tammy; Yirmiya, Nurit; Doppelt, Osnat; Gross-Tsur, Varda; Shalev, Ruth S.

    2004-01-01

    Background: Social and emotional adjustment of siblings of children with autism was examined, to explore their risk or resilience to effects of genetic liability and environmental factors involved in having a sibling with autism. Method: Social-emotional adjustment, behavior problems, socialization skills, and siblings' relationships were compared…

  8. Parenting Styles and Adjustment Outcomes among College Students

    Science.gov (United States)

    Love, Keisha M.; Thomas, Deneia M.

    2014-01-01

    Research has demonstrated that parenting styles partially explain college students' academic adjustment. However, to account for academic adjustment more fully, additional contributors should be identified and tested. We examined the fit of a hypothesized model consisting of parenting styles, indicators of well-being, and academic adjustment…

  9. Planned Hypothesis Tests Are Not Necessarily Exempt from Multiplicity Adjustment

    Science.gov (United States)

    Frane, Andrew V.

    2015-01-01

    Scientific research often involves testing more than one hypothesis at a time, which can inflate the probability that a Type I error (false discovery) will occur. To prevent this Type I error inflation, adjustments can be made to the testing procedure that compensate for the number of tests. Yet many researchers believe that such adjustments are…

  10. Psychological Adjustment in Bullies and Victims of School Violence

    Science.gov (United States)

    Estevez, Estefania; Murgui, Sergio; Musitu, Gonzalo

    2009-01-01

    The present study examined psychosocial adjustment in the following four groups of students: victims, bullies, bully/victims and a control group of adolescents not involved in bullying or victimization problems. Psychosocial adjustment was measured considering as indicators: level of self-esteem, depressive symptomatology, perceived stress,…

  11. Work Identity and Marital Adjustment in Blue-Collar Men.

    Science.gov (United States)

    Gaesser, David L.; Whitbourne, Susan Krauss

    1985-01-01

    Investigated the relationship between work-identity and satisfaction and marital adjustment in 40 married male blue-collar workers, ages 25 to 41 years. Satisfaction with extrinsic work factors related to marital adjustment, while satisfaction with intrinsic work factors negatively related to secondary role salience. Age negatively related to…

  12. Conversations with God: Prayer and Bargaining in Adjustment to Disability

    Science.gov (United States)

    Rodriguez, Valerie J.; Glover-Graf, Noreen M.; Blanco, E. Lisette

    2013-01-01

    The role of religiosity and spirituality in the process of adjustment to disability is of increasing interest to rehabilitation professionals. Beginning with the Kubler-Ross models of grief and adjustment to disability and terminal illness, a number of stage models have included spiritual and religious interactions as a part of the adjustment…

  13. Children's Family Drawings: A Study of Attachment, Personality, and Adjustment

    Science.gov (United States)

    Goldner, Limor; Scharf, Miri

    2011-01-01

    This study examined the relationship between children's attachment security, as manifested in their family drawings, and their personality and adjustment. Family drawings were collected from 222 Israeli children, as well as data regarding their personality and adjustment. Each drawing was coded and classified into 1 of 4 attachment categories…

  14. Study to use graded cobalt adjuster in 540 MWe PHWR

    International Nuclear Information System (INIS)

    Raj, Manish; Fernando, M.P.S.; Pradhan, A.S.; Kumar, A.N.

    2007-01-01

    Full text: There are 17 adjusters in 540 MWe PHWR, which are essentially provided for xenon override function. They also provide flux flattening being in the central region of the reactor core. The present design of adjusters consists of stainless steel tube. The adjuster rods are grouped into 8 banks for movement. Since adjusters are normally fully inserted during reactor operation, they are best suited for production of cobalt 60. The nickel-plated cobalt in the form of either slugs or pellet are used for the design of cobalt pencils. The number of pencils can be varied to optimize the reactivity load and cobalt 60 production requirement. The worth and activity of cobalt adjusters have been worked out considering different pin configuration for the adjuster assembly. To start with we have assumed all adjusters throughout its length are of the same configuration. The flux depression factors within the cobalt pencils have been considered in the estimations of the specific and total cobalt 60 activities. The option of using graded cobalt adjusters, where different pin configuration along the length is considered for better flux flattening

  15. Psychological Adjustment of Siblings to a Child with Diabetes.

    Science.gov (United States)

    Hollidge, Colin

    2001-01-01

    Examines the psychological adjustment of well child siblings living with siblings with diabetes. Psychological adjustment was assessed by measuring self-concept; behavioral difficulties; competence; anxiety; and depression on standardized tests. The well siblings demonstrated significant internal psychological stressors and maintained high levels…

  16. 42 CFR 412.322 - Indirect medical education adjustment factor.

    Science.gov (United States)

    2010-10-01

    ... Payment System for Inpatient Hospital Capital Costs Basic Methodology for Determining the Federal Rate for Capital-Related Costs § 412.322 Indirect medical education adjustment factor. (a) Basic data. CMS.... The indirect teaching adjustment factor equals [e (raised to the power of .2822×the ratio of residents...

  17. Ninth Grade Adjustment and Achievement as Related to Mobility.

    Science.gov (United States)

    Benson, Gerald P.; Weigel, Daniel J.

    1980-01-01

    School records of 643 ninth-grade students were examined. Classroom adjustment was measured by the Classroom Behavior Inventory. Results indicated that mobility was negatively related to math achievement and adjustment. Results are discussed in relation to the peer society and the use of these data for schools. (Author/RL)

  18. Emotion Regulation Profiles, Temperament, and Adjustment Problems in Preadolescents

    Science.gov (United States)

    Zalewski, Maureen; Lengua, Liliana J.; Wilson, Anna C.; Trancik, Anika; Bazinet, Alissa

    2011-01-01

    The longitudinal relations of emotion regulation profiles to temperament and adjustment in a community sample of preadolescents (N = 196, 8-11 years at Time 1) were investigated using person-oriented latent profile analysis (LPA). Temperament, emotion regulation, and adjustment were measured at 3 different time points, with each time point…

  19. Weather Radar Adjustment Using Runoff from Urban Surfaces

    DEFF Research Database (Denmark)

    Ahm, Malte; Rasmussen, Michael Robdrup

    2017-01-01

    Weather radar data used for urban drainage applications are traditionally adjusted to point ground references, e.g., rain gauges. However, the available rain gauge density for the adjustment is often low, which may lead to significant representativeness errors. Yet, in many urban catchments, rain...

  20. 5 CFR 534.504 - Annual adjustment in pay.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Annual adjustment in pay. 534.504 Section 534.504 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY UNDER OTHER SYSTEMS Pay for Senior-Level and Scientific and Professional Positions § 534.504 Annual adjustment...