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.

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.

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.

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.

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 �

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.

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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.

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

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.

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…

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

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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.)…

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.

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.

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

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...

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

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

Directory of Open Access Journals (Sweden)

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

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.

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

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.

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...

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...

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

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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

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.

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.

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.

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

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…

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.

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.

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.

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

NARCIS (Netherlands)

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

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

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...

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.

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.

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.

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.

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.

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.

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.

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...

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...

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

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.

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.

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.

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...

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.

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.

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.

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.

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.

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.

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, ...

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.

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.

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.

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.

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.

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

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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…

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.

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

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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

Transcultural adaptation of the Johns Hopkins Fall Risk Assessment Tool.

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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

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

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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.

Premorbid adjustment and neuropsychological performance in schizophrenia.

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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.

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

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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.

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.

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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.

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

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

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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)…

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

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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.

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

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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.

[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.

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

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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...

Perceived parenting and adolescents’ adjustment

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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.

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

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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.

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

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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...

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

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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

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

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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

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

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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.

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

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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)....

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

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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.

Treatment of trauma-affected refugees with venlafaxine versus sertraline combined with psychotherapy

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Sonne, Charlotte; Lohmann, Jessica Mariana Carlsson; Bech, Per

2016-01-01

Trauma Questionnaire – part IV, which was the primary outcome measure. Other outcome measures included: Hopkins Symptom Check List-25 (depression and anxiety), Social Adjustment Scale – short version (social functioning), WHO-5 Well-being Index (quality of life), Crisis Support Scale (support from social......, which is supported by other studies, a final conclusion on tolerability cannot be drawn from the current study due to lack of systematic reporting of side effects. Trial Registration: ClinicalTrials.gov NCT01569685. Registration date: 28/2/12...

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

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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.

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

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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

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

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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...

Adjustment disorder: current perspectives

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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

Operative management of Marfan syndrome: The Johns Hopkins experience.

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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.

AIDS: just the facts from specialists at Johns Hopkins.

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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.

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

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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.

Can casemix-systems be applied in Danish primary care?

DEFF Research Database (Denmark)

Halling, Anders; Kristensen, Troels

-sectional study uses individual data on gender, age and diagnoses for the year 2013 from the Danish General Practice Database (DAMD) to make ACG groupings of a sample of 700,443 citizens of Zealand in Denmark. The Johns Hopkins Adjusted Clinical Groups ACG software, Version 10 December 2011 was applied to make...... that the corresponding ACG / RUB-grouping provide useful estimates of morbidity burden (casemix) and related resource need. Before a casemix system is implemented in Denmark, however, further research should be undertaken of the applicability of the DAMD data and the corresponding ACG groupings....

Marital adjustment between mothers and fathers of patients with eating disorders

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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.

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

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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.

Stability of anterior open-bite treatment with occlusal adjustment.

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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.

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.

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

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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.

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

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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.

Age-Adjusted D-Dimer in the Prediction of Pulmonary Embolism: Does a Normal Age-Adjusted D-Dimer Rule Out PE?

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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.

The Persian Version of Fertility Adjustment Scale: Psychometric Properties

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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.

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

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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.

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

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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.

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)

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.

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.

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

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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

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...

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.

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

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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 ...

Adjustment Criterion and Algorithm in Adjustment Model with Uncertain

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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.

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.

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.

Medical device innovation and the value analysis process.

Science.gov (United States)

Krantz, Heidi; Strain, Barbara; Torzewski, Jane

2017-09-01

Heidi A. Krantz, RN, BSN is the Director of Value Analysis at Johns Hopkins Bayview Medical Center in the Johns Hopkins Health System. Barbara Strain, MA, CVAHP is the Director of Value Management at the University of Virginia Health System. Jane Torzewski RN, MAN, MBA is a Senior Category Manager for the Mayo Clinic Physician Preference Contracting team. She previously was a Senior Clinical Value Analyst on the Mayo Clinic Value Analysis team. Copyright © 2018. Published by Elsevier Inc.

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

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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.

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…

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.

[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.

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

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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.

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...

Psychopathology and psychosocial adjustment in patients with HIV-associated lipodystrophy

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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.

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.

The dyadic adjustment of female-to-male transsexuals.

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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.

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.

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.

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.

[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.

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

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.

Linking care of patients with obesity to outpatient weight control clinics following acute hospitalizations

Directory of Open Access Journals (Sweden)

Harris CM

2018-01-01

Full Text Available Ché M Harris,1 Lawrence J Cheskin,2 Trina L Gipson-Jones,3 Jennifer A Hartfield,4 Flora Kisuule1 1Division of General Internal Medicine, Johns Hopkins School of Medicine, 2Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, USA; 3School of Nursing, Hampton University, Hampton, VA, USA; 4Center for Research on Men’s Health, Vanderbilt University, Nashville, TN, USA Abstract: Despite obesity impacting over one-third of US adults, guideline recommendations have not been effectively utilized by health care providers in hospital settings. Initiation of weight loss plans for obese patients during hospitalizations followed by linkage of care to weight control centers may improve compliance with the guidelines. Provider recognition and awareness that obesity is a chronic condition that warrants inpatient counsel and management with appropriate arrangement of postdischarge follow-up care will be critical to guideline implementation. Keywords: guideline compliance, health systems, intervention, linkage 

Adjustment problems and residential care environment

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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

Facilitators and barriers to hypertension self-management in urban African Americans: perspectives of patients and family members

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Flynn SJ

2013-08-01

Full Text Available Sarah J Flynn,1,2 Jessica M Ameling,1,2 Felicia Hill-Briggs,1–3 Jennifer L Wolff,4,5 Lee R Bone,1,3 David M Levine,1,4 Debra L Roter,3 LaPricia Lewis-Boyer,1,2 Annette R Fisher,6 Leon Purnell,6 Patti L Ephraim,2,7 Jeffrey Barbers,1,2 Stephanie L Fitzpatrick,1,2 Michael C Albert,1,8 Lisa A Cooper,1,2 Peter J Fagan,9,10 Destiny Martin,1 Hema C Ramamurthi,1,2 L Ebony Boulware1,2,7 1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 2Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; 3Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 4Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 5Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 6Community and Provider Advisory Board, Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD, USA; 7Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 8Johns Hopkins Community Physicians, Johns Hopkins Medical Institutions, Baltimore, MD, USA; 9Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 10Johns Hopkins HealthCare LLC, Glen Burnie, MD, USA Introduction: We aimed to inform the design of behavioral interventions by identifying patients’ and their family members’ perceived facilitators and barriers to hypertension self-management. Materials and methods: We conducted focus groups of African American patients with hypertension and their family members to elicit their views about factors influencing patients’ hypertension self-management. We recruited African American patients with hypertension (n = 18 and their family members (n = 12 from an urban, community-based clinical

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.

Use of risk-adjusted CUSUM charts to monitor 30-day mortality in Danish hospitals

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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

EFFECTIVENESS OF CHIROPRACTIC ADJUSTMENT IN LUMBAR PAIN IN CROSSFIT PRACTITIONERS

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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.

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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.

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.

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

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.

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.

Testing for clinical inertia in medication treatment of bipolar disorder.

Science.gov (United States)

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

2016-11-15

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

Parenting stress and external stressors as predictors of maternal ratings of child adjustment.

Science.gov (United States)

Ostberg, Monica; Hagekull, Berit

2013-06-01

This study sought to disentangle the effects of different kinds of stress on maternal ratings of child externalizing and internalizing problems, social inhibition, and social competence, with a primary focus on parenting stress. The relations were explored in a sample consisting of mothers of 436 children (Mage  = 7 years) in Sweden. Half the sample had had early clinical contacts during infancy due to child regulation problems, and the rest were mothers without known such early contacts. Demographic factors, family stressors, and parenting stress were examined in stress - adjustment models. Family stressors were clinical contact during infancy, current child and parent health problems, recent negative life events, and insufficient social support. Parenting stress as a mediator of the effect of other stressors on rated child adjustment was tested as was social support as a moderator of the effect of parenting stress on adjustment. The results showed that a higher parenting stress level was associated with maternal ratings of more externalizing and internalizing behaviors, more social inhibition, and lower social competence. Other family stressors and background variables were also found to be of importance, mainly for externalizing and internalizing problems and to some extent for social competence. Social inhibition had a unique relation to parenting stress only. Parenting stress mediated effects of other stressors in twelve models, whereas social support had no moderating effect on the link between parenting stress and child adjustment. Thus, parenting stress seems to be an important overarching construct. Clinical implications are proposed. © 2013 The Authors. Scandinavian Journal of Psychology © 2013 The Scandinavian Psychological Associations.

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.

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

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...

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.

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...

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

[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.

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...

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.

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.

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...

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.

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.

Reliability of risk-adjusted outcomes for profiling hospital surgical quality.

Science.gov (United States)

Krell, Robert W; Hozain, Ahmed; Kao, Lillian S; Dimick, Justin B

2014-05-01

Quality improvement platforms commonly use risk-adjusted morbidity and mortality to profile hospital performance. However, given small hospital caseloads and low event rates for some procedures, it is unclear whether these outcomes reliably reflect hospital performance. To determine the reliability of risk-adjusted morbidity and mortality for hospital performance profiling using clinical registry data. A retrospective cohort study was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program, 2009. Participants included all patients (N = 55,466) who underwent colon resection, pancreatic resection, laparoscopic gastric bypass, ventral hernia repair, abdominal aortic aneurysm repair, and lower extremity bypass. Outcomes included risk-adjusted overall morbidity, severe morbidity, and mortality. We assessed reliability (0-1 scale: 0, completely unreliable; and 1, perfectly reliable) for all 3 outcomes. We also quantified the number of hospitals meeting minimum acceptable reliability thresholds (>0.70, good reliability; and >0.50, fair reliability) for each outcome. For overall morbidity, the most common outcome studied, the mean reliability depended on sample size (ie, how high the hospital caseload was) and the event rate (ie, how frequently the outcome occurred). For example, mean reliability for overall morbidity was low for abdominal aortic aneurysm repair (reliability, 0.29; sample size, 25 cases per year; and event rate, 18.3%). In contrast, mean reliability for overall morbidity was higher for colon resection (reliability, 0.61; sample size, 114 cases per year; and event rate, 26.8%). Colon resection (37.7% of hospitals), pancreatic resection (7.1% of hospitals), and laparoscopic gastric bypass (11.5% of hospitals) were the only procedures for which any hospitals met a reliability threshold of 0.70 for overall morbidity. Because severe morbidity and mortality are less frequent outcomes, their mean

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.

Adjusted drug treatment is superior to renal sympathetic denervation in patients with true treatment-resistant hypertension.

Science.gov (United States)

Fadl Elmula, Fadl Elmula M; Hoffmann, Pavel; Larstorp, Anne C; Fossum, Eigil; Brekke, Magne; Kjeldsen, Sverre E; Gjønnæss, Eyvind; Hjørnholm, Ulla; Kjaer, Vibeke N; Rostrup, Morten; Os, Ingrid; Stenehjem, Aud; Høieggen, Aud

2014-05-01

We aimed to investigate for the first time the blood pressure (BP)-lowering effect of renal sympathetic denervation (RDN) versus clinically adjusted drug treatment in true treatment-resistant hypertension (TRH) after excluding patients with confounding poor drug adherence. Patients with apparent TRH (n=65) were referred for RDN, and those with secondary and spurious hypertension (n=26) were excluded. TRH was defined as office systolic BP (SBP) >140 mm Hg, despite maximally tolerated doses of ≥3 antihypertensive drugs including a diuretic. In addition, ambulatory daytime SBP >135 mm Hg after witnessed intake of antihypertensive drugs was required, after which 20 patients had normalized BP and were excluded. Patients with true TRH were randomized and underwent RDN (n=9) performed with Symplicity Catheter System versus clinically adjusted drug treatment (n=10). The study was stopped early for ethical reasons because RDN had uncertain BP-lowering effect. Office SBP and diastolic BP in the drug-adjusted group changed from 160±14/88±13 mm Hg (±SD) at baseline to 132±10/77±8 mm Hg at 6 months (P<0.0005 and P=0.02, SBP and diastolic BP, respectively) and in the RDN group from 156±13/91±15 to 148±7/89±8 mm Hg (P=0.42 and P=0.48, SBP and diastolic BP, respectively). SBP and diastolic BP were significantly lower in the drug-adjusted group at 6 months (P=0.002 and P=0.004, respectively), and absolute changes in SBP were larger in the drug-adjusted group (P=0.008). Ambulatory BPs changed in parallel to office BPs. Our data suggest that adjusted drug treatment has superior BP lowering effects compared with RDN in patients with true TRH. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT01673516.

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.

The Ostomy Adjustment Scale: translation into Norwegian language with validation and reliability testing.

Science.gov (United States)

Indrebø, Kirsten Lerum; Andersen, John Roger; Natvig, Gerd Karin

2014-01-01

The purpose of this study was to adapt the Ostomy Adjustment Scale to a Norwegian version and to assess its construct validity and 2 components of its reliability (internal consistency and test-retest reliability). One hundred fifty-eight of 217 patients (73%) with a colostomy, ileostomy, or urostomy participated in the study. Slightly more than half (56%) were men. Their mean age was 64 years (range, 26-91 years). All respondents had undergone ostomy surgery at least 3 months before participation in the study. The Ostomy Adjustment Scale was translated into Norwegian according to standard procedures for forward and backward translation. The questionnaire was sent to the participants via regular post. The Cronbach alpha and test-retest were computed to assess reliability. Construct validity was evaluated via correlations between each item and score sums; correlations were used to analyze relationships between the Ostomy Adjustment Scale and the 36-item Short Form Health Survey, the Quality of Life Scale, the Hospital Anxiety & Depression Scale, and the General Self-Efficacy Scale. The Cronbach alpha was 0.93, and test-retest reliability r was 0.69. The average correlation quotient item to sum score was 0.49 (range, 0.31-0.73). Results showed moderate negative correlations between the Ostomy Adjustment Scale and the Hospital Anxiety and Depression Scale (-0.37 and -0.40), and moderate positive correlations between the Ostomy Adjustment Scale and the 36-item Short Form Health Survey, the Quality of Life Scale, and the General Self-Efficacy Scale (0.30-0.45) with the exception of the pain domain in the Short Form 36 (0.28). Regression analysis showed linear associations between the Ostomy Adjustment Scale and sociodemographic and clinical variables with the exception of education. The Norwegian language version of the Ostomy Adjustment Scale was found to possess construct validity, along with internal consistency and test-retest reliability. The instrument is

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....

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...

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)

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/

Adjusting survival time estimates to account for treatment switching in randomized controlled trials--an economic evaluation context: methods, limitations, and recommendations.

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Latimer, Nicholas R; Abrams, Keith R; Lambert, Paul C; Crowther, Michael J; Wailoo, Allan J; Morden, James P; Akehurst, Ron L; Campbell, Michael J

2014-04-01

Treatment switching commonly occurs in clinical trials of novel interventions in the advanced or metastatic cancer setting. However, methods to adjust for switching have been used inconsistently and potentially inappropriately in health technology assessments (HTAs). We present recommendations on the use of methods to adjust survival estimates in the presence of treatment switching in the context of economic evaluations. We provide background on the treatment switching issue and summarize methods used to adjust for it in HTAs. We discuss the assumptions and limitations associated with adjustment methods and draw on results of a simulation study to make recommendations on their use. We demonstrate that methods used to adjust for treatment switching have important limitations and often produce bias in realistic scenarios. We present an analysis framework that aims to increase the probability that suitable adjustment methods can be identified on a case-by-case basis. We recommend that the characteristics of clinical trials, and the treatment switching mechanism observed within them, should be considered alongside the key assumptions of the adjustment methods. Key assumptions include the "no unmeasured confounders" assumption associated with the inverse probability of censoring weights (IPCW) method and the "common treatment effect" assumption associated with the rank preserving structural failure time model (RPSFTM). The limitations associated with switching adjustment methods such as the RPSFTM and IPCW mean that they are appropriate in different scenarios. In some scenarios, both methods may be prone to bias; "2-stage" methods should be considered, and intention-to-treat analyses may sometimes produce the least bias. The data requirements of adjustment methods also have important implications for clinical trialists.

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

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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.

The impact of calcium assay change on a local adjusted calcium equation.

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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.

EVALUATION OF ADJUSTABLE SUTURE TECHNIQUE IN OUTCOME OF PTOSIS SURGERY

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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

Profiles of dyadic adjustment for advanced prostate cancer to inform couple-based intervention.

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Elliott, Kate-Ellen J; Scott, Jennifer L; Monsour, Michael; Nuwayhid, Fadi

2015-01-01

The purpose of the study is to describe from a relational perspective, partners' psychological adjustment, coping and support needs for advanced prostate cancer. A mixed methods design was adopted, employing triangulation of qualitative and quantitative data, to produce dyadic profiles of adjustment for six couples recruited from the urology clinics of local hospitals in Tasmania, Australia. Dyads completed a video-taped communication task, semi-structured interview and standardised self-report questionnaires. Themes identified were associated with the dyadic challenges of the disease experience (e.g. relationship intimacy, disease progression and carer burden). Couples with poor psychological adjustment profiles had both clinical and global locus of distress, treatment side-effects, carer burden and poor general health. Resilient couples demonstrated relationship closeness and adaptive cognitive and behavioural coping strategies. The themes informed the adaption of an effective program for couples coping with women's cancers (CanCOPE, to create a program for couples facing advanced prostate cancer (ProCOPE-Adv). Mixed method results inform the development of psychological therapy components for couples coping with advanced prostate cancer. The concomitance of co-morbid health problems may have implications for access and engagement for older adult populations in face-to-face intervention.

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

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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.

Repatriation Adjustment: Literature Review

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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.

Influence of cognition, premorbid adjustment and psychotic symptoms on psycho-social functioning in first-episode psychosis.

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Grau, Norma; Rubio-Abadal, Elena; Usall, Judith; Barajas, Ana; Butjosa, Anna; Dolz, Montserrat; Baños, Iris; Sánchez, Bernardo; Rodríguez, Maria José; Peláez, Trinidad; Sammut, Stephanie; Carlson, Janina; Huerta-Ramos, Elena; Ochoa, Susana

2016-08-30

The aim of this study is to evaluate the relationship between psycho-social functioning and symptoms, cognitive function, and premorbid adjustment, in patients with a first-episode psychosis. Clinical data were obtained from 90 patients, who were assessed with the Disability Assessment Scale (DAS-sv), the Positive and Negative Syndrome Scale (PANSS), the Premorbid Adjustment Scale (PAS-S) and with a battery of cognitive tests including Trail Making Tests A and B (TMTA- B), Continous Performance Test (CPT), some subscales of the Wechler Adult Intelligence Scale (WAIS), and the Verbal Learning Test España-Complutense (TAVEC). The results of the study suggest that psycho-social functioning in first-episode psychosis is significantly related to: positive, negative, excitative, affective and disorganized symptoms, social premorbid adjustment, cognitive flexibility, working memory, short term and long term memory. Of these, those which best explained psycho-social functioning are the positive and excitative symptoms, premorbid adjustment, flexibility and memory. These findings highlight the importance early intervention on cognitive and clinical variables to help provide a better psycho-social functioning in people with a first-episode of psychosis. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Worksite adjustments and work ability among employed cancer survivors.

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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.

Efficacy of the resilience and adjustment intervention after traumatic brain injury: a randomized controlled trial.

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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).

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

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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,…

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

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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.

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

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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.

Everyday ethics issues in the outpatient clinical practice of pediatric residents.

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Moon, Margaret; Taylor, Holly A; McDonald, Erin L; Hughes, Mark T; Carrese, Joseph A

2009-09-01

To describe the ethics issues that pediatric residents encounter during routine care in an outpatient teaching clinic. Qualitative study including in-depth interviews with pediatric residents and direct observation of interactions between preceptors and residents in a pediatric teaching clinic. The Johns Hopkins Harriet Lane Pediatric Primary Care Clinic, March 20 through April 11, 2006. A convenience sample including all pediatric faculty preceptors supervising at the clinic during the 19 half-day sessions that occurred during the observation period (N = 15) and the pediatric residents seeing patients during these clinic sessions (N = 50). Main Outcome Measure Field notes of preceptor-resident discussions about patient care were made and transcribed for qualitative analysis. Qualitative analysis of the ethics content of cases presented by residents in this pediatric teaching clinic identified 5 themes for categorizing ethics challenges: (1) promoting the child's best interests in complex and resource-poor home and social settings; (2) managing the therapeutic alliance with parents and caregivers; (3) protecting patient privacy and confidentiality; (4) balancing the dual roles of learner and health care provider; and (5) using professional authority appropriately. Qualitative analysis of the ethics content of directly observed preceptor-resident case discussions yielded a set of themes describing the ethics challenges facing pediatric residents. The themes are somewhat different from the lists of residents' ethics experiences developed using recall or survey methods and may be very different from the ideas usually included in hospital-based ethics discussions. This may have implications for improving ethics education during residency training.

Use of the mini-MAC scale in the evaluation of mental adjustment to cancer.

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Czerw, Aleksandra Izabela; Marek, Ewelina; Deptała, Andrzej

2015-01-01

The objective of the study was to evaluate mental adjustment to cancer in patients diagnosed with an oncologic disease through identification of the coping strategies they had adopted. Seventy-four patients of the Clinic of Oncology and Haematology at the Central Clinical Hospital (CSK) of the Ministry of Interior (MSW) in Warsaw were included in the study. The degree of adaptation to cancer was evaluated with the use of the mini-Mental Adjustment to Cancer (mini-MAC) scale. The individual subscales, i.e. fighting spirit, positive redefinition, helplessness-hopelessness, and anxious preoccupation, were collated with socio-demographic characteristics. Study findings indicate that: 1) tumour patients typically manifest behaviour that allows one to identify their adjustment to cancer; 2) in malignant tumour patients constructive behaviour prevails over destructive behaviour; 3) the helplessness-hopelessness response is more pronounced in men than women; 4) metastatic patients manifest stronger helplessness-hopelessness response than patients with locally limited tumours; 5) pensioners more often than people of working age adopt the helplessness-hopelessness strategy; and 6) patients with the shortest disease period manifest the strongest fighting spirit. Cancer patients employ various strategies of coping with disease depending on socio-demographic factors.

Case mix adjusted variation in cesarean section rate in Sweden.

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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.

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

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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.

[Family characteristics, organic risk factors, psychopathological picture and premorbid adjustment of hospitalized adolescent patients].

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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.

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.

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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.

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

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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.

Adjustable Pitot Probe

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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.

Student use and perceptions of mobile technology in clinical clerkships - Guidance for curriculum design.

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Law, Joanna K; Thome, Parker A; Lindeman, Brenessa; Jackson, Daren C; Lidor, Anne O

2018-01-01

We examined the types of technology used by medical students in clinical clerkships, and the perception of technology implementation into the curriculum. An online survey about technology use was completed prior to general surgery clinical clerkship. Types of devices and frequency/comfort of use were recorded. Perceptions of the benefits and barriers to technology use in clerkship learning were elicited. 125/131 (95.4%) students responded. Most students owned a smart phone (95.2%), tablet (52.8%), or both (50%); 61.6% spent > 11 h/week learning on a device at the Johns Hopkins School of Medicine for educational purposes. Technology use was seen as beneficial by 97.6% of students. Classes that used technology extensively were preferred by 54% of students, although 47.2% perceived decreased faculty/classmate interaction. Students use mobile technology to improve how they learn new material, and prefer taking classes that incorporate information technology. However, in-person/blended curricula are preferable to completely online courses. Copyright © 2017 Elsevier Inc. All rights reserved.

Adjusting kinematics and kinetics in a feedback-controlled toe walking model

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Olenšek Andrej

2012-08-01

Full Text Available Abstract Background In clinical gait assessment, the correct interpretation of gait kinematics and kinetics has a decisive impact on the success of the therapeutic programme. Due to the vast amount of information from which primary anomalies should be identified and separated from secondary compensatory changes, as well as the biomechanical complexity and redundancy of the human locomotion system, this task is considerably challenging and requires the attention of an experienced interdisciplinary team of experts. The ongoing research in the field of biomechanics suggests that mathematical modeling may facilitate this task. This paper explores the possibility of generating a family of toe walking gait patterns by systematically changing selected parameters of a feedback-controlled model. Methods From the selected clinical case of toe walking we identified typical toe walking characteristics and encoded them as a set of gait-oriented control objectives to be achieved in a feedback-controlled walking model. They were defined as fourth order polynomials and imposed via feedback control at the within-step control level. At the between-step control level, stance leg lengthening velocity at the end of the single support phase was adaptively adjusted after each step so as to facilitate gait velocity control. Each time the gait velocity settled at the desired value, selected intra-step gait characteristics were modified by adjusting the polynomials so as to mimic the effect of a typical therapeutical intervention - inhibitory casting. Results By systematically adjusting the set of control parameters we were able to generate a family of gait kinematic and kinetic patterns that exhibit similar principal toe walking characteristics, as they were recorded by means of an instrumented gait analysis system in the selected clinical case of toe walking. We further acknowledge that they to some extent follow similar improvement tendencies as those which one can

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

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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.

Children's adjustment in conflicted marriage and divorce: a decade review of research.

Science.gov (United States)

Kelly, J B

2000-08-01

To review important research of the past decade in divorce, marital conflict, and children's adjustment and to describe newer divorce interventions. Key empirical studies from 1990 to 1999 were surveyed regarding the impact of marital conflict, parental violence, and divorce on the psychological adjustment of children, adolescents, and young adults. Recent studies investigating the impact of divorce on children have found that many of the psychological symptoms seen in children of divorce can be accounted for in the years before divorce. The past decade also has seen a large increase in studies assessing complex variables within the marriage which profoundly affect child and adolescent adjustment, including marital conflict and violence and related parenting behaviors. This newer literature provides provocative and helpful information for forensic and clinical psychiatrists in their work with both married and divorcing families. While children of divorced parents, as a group, have more adjustment problems than do children of never-divorced parents, the view that divorce per se is the major cause of these symptoms must be reconsidered in light of newer research documenting the negative effects of troubled marriages on children.

Predictors of Marital Adjustment: Are There Any Differences Between Women and Men?

Directory of Open Access Journals (Sweden)

Antoaneta Andreea Muraru

2013-08-01

Full Text Available The purpose of this study was to explore if there are differences between women and men in relationships among family-of-origin, romantic attachment, and marital adjustment. Two hundred and forty-nine participants filled out four self-reported measures: The Differentiation in the Family System Scale, Family Adaptability and Cohesion Evaluation Scale, Experiences in Close Relationship Scale, and Revised Dyadic Adjustment Scale. In order to analyze the data, multiple-group analysis with AMOS 16.0 was used. There was no difference between women and men in all observed variables. Regardless of gender, only the romantic attachment was a significant predictor of marital adjustment. Only in women, family-of-origin significantly predicted their romantic attachment. Across gender groups, the configural model fitted satisfactorily the observed data. When measurement and structural weights, as well as residuals were constrained to be equal across gender groups, the invariance of the model was also supported. The results suggest women and men could be similar when it comes to the relationships among constructions they both have regarding family-of-origin experiences, romantic attachment patterns, and marital adjustment. Some implications for research and clinical practice with marital couples are briefly discussed.

Exposure to violence and psychosocial adjustment among urban school-aged children.

Science.gov (United States)

Purugganan, Oscar H; Stein, Ruth E K; Silver, Ellen Johnson; Benenson, Blanch S

2003-12-01

This study determines the relationship between psychosocial adjustment in school-aged children and one aspect of exposure to violence, the proximity of exposure, in terms of (1) "physical" proximity and (2) "emotional" proximity to the victims of violence. A convenience sample of 175 children aged 9 to 12 years from a primary care clinic of a large urban hospital were interviewed about their exposure to violence using the Children's Report of Exposure to Violence. Psychosocial adjustment was measured through maternal reports using the Child Behavior Checklist (CBCL) and the Personal Adjustment and Role Skills Scale (PARS III). Children were categorized into three groups according to their closest proximity to exposure to violence ("victim" > "witness" > exposure through other people's "report") and two groups according to emotional proximity (victim was a "familiar person" or "stranger"). All children (23/175) who scored above the CBCL clinical cutoff (T score > 63) were witnesses or victims of violence. The CBCL total T scores (higher score = more maladjustment) showed that the "victims" group (mean 52.4) scored significantly higher than the "witness" group (mean 50.0) and "report" group (mean 47.4). The PARS III total scores (lower scores = more maladjustment) showed that the "victims" group (mean 87.5) scored significantly lower than the "witness" group (mean 93.1) and "report" group (mean 98.2). The relationship of the child to the victim was not associated with significantly different CBCL and PARS III scores. Children exposed to more proximal forms of violence as victims or witnesses exhibited more psychosocial maladjustment.

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…

The mediating role of spirituality (meaning, peace, faith) between psychological distress and mental adjustment in cancer patients.

Science.gov (United States)

Jimenez-Fonseca, Paula; Lorenzo-Seva, Urbano; Ferrando, Pere Joan; Carmona-Bayonas, Alberto; Beato, Carmen; García, Teresa; Muñoz, María Del Mar; Ramchandani, Avinash; Ghanem, Ismael; Rodríguez-Capote, Alejandra; Jara, Carlos; Calderon, Caterina

2018-05-01

The objectives of this study were (a) to determine the psychometric properties of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp) scale and (b) to provide that FACIT scores behave one-dimensional to establish the mediating role of spiritual well-being in psychological distress and mental adjustment in a sample of patients with non-metastatic, resected cancer. A total of 504 consecutive patients completed the FACIT-Sp, Brief Symptom Inventory, and Mini-Mental Adjustment to Cancer scales. The dimensionality and structure of the scale were assessed by semi-confirmatory factor analysis; the reliability of the derived scale scores was evaluated using the omega coefficient, and regression analysis appraised the FACIT-Sp's mediating role between psychological distress and mental adjustment. A clear and theoretically interpretable solution in two factors that agreed generally with solutions reported in other languages was obtained for the FACIT item scores and omega reliabilities of the derived Meaning/Peace (0.85) and Faith (0.86) scales were acceptable. The oblique solution in two factors was compatible with an essentially unidimensional solution of general well-being and associated strongly with psychological distress and mental adjustment. Spiritual well-being acted as a partial mediator between psychological distress and mental adjustment strategies, such as fighting spirit, hope, and cognitive avoidance. The Spanish version of the FACIT-Sp scale is a reliable and valid clinical evaluation tool, and further highlights the potential clinical implications of spirituality for improving quality of life and adjustment to cancer.

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.

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.

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...

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

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.

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.

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.

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...

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.

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.

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

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.

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.

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

Emotion knowledge, emotion regulation, and psychosocial adjustment in children with nonverbal learning disabilities.

Science.gov (United States)

Metsala, Jamie L; Galway, Tanya M; Ishaik, Galit; Barton, Veronica E

2017-07-01

Nonverbal learning disability is a childhood disorder with basic neuropsychological deficits in visuospatial processing and psychomotor coordination, and secondary impairments in academic and social-emotional functioning. This study examines emotion recognition, understanding, and regulation in a clinic-referred group of young children with nonverbal learning disabilities (NLD). These processes have been shown to be related to social competence and psychological adjustment in typically developing (TD) children. Psychosocial adjustment and social skills are also examined for this young group, and for a clinic-referred group of older children with NLD. The young children with NLD scored lower than the TD comparison group on tasks assessing recognition of happy and sad facial expressions and tasks assessing understanding of how emotions work. Children with NLD were also rated as having less adaptive regulation of their emotions. For both young and older children with NLD, internalizing and externalizing problem scales were rated higher than for the TD comparison groups, and the means of the internalizing, attention, and social problem scales were found to fall within clinically concerning ranges. Measures of attention and nonverbal intelligence did not account for the relationship between NLD and Social Problems. Social skills and NLD membership share mostly overlapping variance in accounting for internalizing problems across the sample. The results are discussed within a framework wherein social cognitive deficits, including emotion processes, have a negative impact on social competence, leading to clinically concerning levels of depression and withdrawal in this population.

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)

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

Horizontal integration of OMIM across the medical school preclinical curriculum for early reinforcement of clinical genetics principles.

Science.gov (United States)

Diehl, Adam C; Reader, Lauren; Hamosh, Ada; Bodurtha, Joann N

2015-02-01

With the relentless expansion of genetics into every field of medicine, stronger preclinical and clinical medical student education in genetics is needed. The explosion of genetic information cannot be addressed by simply adding content hours. We proposed that students be provided a tool to access accurate clinical information on genetic conditions and, through this tool, build life-long learning habits to carry them through their medical careers. Surveys conducted at the Johns Hopkins University School of Medicine revealed that medical students in all years lacked confidence when approaching genetic conditions and lacked a reliable resource for accurate genetic information. In response, the school created a horizontal thread that stretches across the first-year curriculum and is devoted to teaching students how to use Online Mendelian Inheritance in Man (OMIM) (http://omim.org) and the databases to which it links as a starting point for approaching genetic conditions. The thread improved the first-year students' confidence in clinical genetics concepts and encouraged use of OMIM as a primary source for genetic information. Most students showed confidence in OMIM as a learning tool and wanted to see the thread repeated in subsequent years. Incorporating OMIM into the preclinical curriculum improved students' confidence in clinical genetics concepts.

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

External quality assurance performance of clinical research laboratories in sub-saharan Africa.

Science.gov (United States)

Amukele, Timothy K; Michael, Kurt; Hanes, Mary; Miller, Robert E; Jackson, J Brooks

2012-11-01

Patient Safety Monitoring in International Laboratories (JHU-SMILE) is a resource at Johns Hopkins University that supports and monitors laboratories in National Institutes of Health-funded international clinical trials. To determine the impact of the JHU-SMILE quality assurance scheme in sub-Saharan African laboratories, we reviewed 40 to 60 months of external quality assurance (EQA) results of the College of American Pathologists (CAP) in these laboratories. We reviewed the performance of 8 analytes: albumin, alanine aminotransferase, creatinine, sodium, WBC, hemoglobin, hematocrit, and the human immunodeficiency virus antibody rapid test. Over the 40- to 60-month observation period, the sub-Saharan laboratories had a 1.63% failure rate, which was 40% lower than the 2011 CAP-wide rate of 2.8%. Seventy-six percent of the observed EQA failures occurred in 4 of the 21 laboratories. These results demonstrate that a system of remote monitoring, feedback, and audits can support quality in low-resource settings, even in places without strong regulatory support for laboratory quality.

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...

"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

Social problem-solving and social adjustment in paediatric traumatic brain injury.

Science.gov (United States)

Moran, Lisa M; Bigler, Erin; Dennis, Maureen; Gerhardt, Cynthia A; Rubin, Kenneth H; Stancin, Terry; Taylor, H Gerry; Vannatta, Kathryn A; Yeates, Keith Owen

2015-01-01

Little is known regarding the predictors of social deficits that occur following childhood traumatic brain injury (TBI). The current study sought to investigate social problem solving (SPS) and its relationship to social adjustment after TBI. Participants included 8-13 year old children, 25 with severe TBI, 57 with complicated mild-to-moderate TBI and 61 with orthopaedic injuries (OI). Children responded to scenarios involving negative social situations by selecting from a fixed set of choices their causal attribution for the event, their emotional reaction to the event and how they would behave in response. Parent ratings of social behaviours and classmate friendship nominations and sociometric ratings were obtained for a sub-set of all participants. Children with severe TBI were less likely than children with OI to indicate they would attribute external blame or respond by avoiding the antagonist; they were more likely to indicate they would feel sad and request adult intervention. Although several SPS variables had indirect effects on the relationship between TBI and social adjustment, clinical significance was limited. The findings suggest that, while children with TBI display atypical SPS skills, SPS cannot be used in isolation to accurately predict social adjustment.

Applying JIT principles to resident education to reduce patient delays: a pilot study in an academic medical center pain clinic.

Science.gov (United States)

Williams, Kayode A; Chambers, Chester G; Dada, Maqbool; Christo, Paul J; Hough, Douglas; Aron, Ravi; Ulatowski, John A

2015-02-01

This study investigated the effect on patient waiting times, patient/doctor contact times, flow times, and session completion times of having medical trainees and attending physicians review cases before the clinic session. The major hypothesis was that review of cases prior to clinic hours would reduce waiting times, flow times, and use of overtime, without reducing patient/doctor contact time. Prospective quality improvement. Specialty pain clinic within Johns Hopkins Outpatient Center, Baltimore, MD, United States. Two attending physicians participated in the intervention. Processing times for 504 patient visits are involved over a total of 4 months. Trainees were assigned to cases the day before the patient visit. Trainees reviewed each case and discussed it with attending physicians before each clinic session. Primary measures were activity times before and after the intervention. These were compared and also used as inputs to a discrete event simulation to eliminate differences in the arrival process as a confounding factor. The average time that attending physicians spent teaching trainees while the patient waited was reduced, but patient/doctor contact time was not significantly affected. These changes reduced patient waiting times, flow times, and clinic session times. Moving some educational activities ahead of clinic time improves patient flows through the clinic and decreases congestion without reducing the times that trainees or patients interact with physicians. Wiley Periodicals, Inc.

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 ...

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.

Measurement of fractionated plasma metanephrines for exclusion of pheochromocytoma: Can specificity be improved by adjustment for age?

Directory of Open Access Journals (Sweden)

Gafni Amiram

2005-02-01

Full Text Available Abstract Background Biochemical testing for pheochromocytoma by measurement of fractionated plasma metanephrines is limited by false positive rates of up to 18% in people without known genetic predisposition to the disease. The plasma normetanephrine fraction is responsible for most false positives and plasma normetanephrine increases with age. The objective of this study was to determine if we could improve the specificity of fractionated plasma measurements, by statistically adjusting for age. Methods An age-adjusted metanephrine score was derived using logistic regression from 343 subjects (including 33 people with pheochromocytoma who underwent fractionated plasma metanephrine measurements as part of investigations for suspected pheochromocytoma at Mayo Clinic Rochester (derivation set. The performance of the age-adjusted score was validated in a dataset of 158 subjects (including patients 23 with pheochromocytoma that underwent measurements of fractionated plasma metanephrines at Mayo Clinic the following year (validation dataset. None of the participants in the validation dataset had known genetic predisposition to pheochromocytoma. Results The sensitivity of the age-adjusted metanephrine score was the same as that of traditional interpretation of fractionated plasma metanephrine measurements, yielding a sensitivity of 100% (23/23, 95% confidence interval [CI] 85.7%, 100%. However, the false positive rate with traditional interpretation of fractionated plasma metanephrine measurements was 16.3% (22/135, 95% CI, 11.0%, 23.4% and that of the age-adjusted score was significantly lower at 3.0% (4/135, 95% CI, 1.2%, 7.4% (p Conclusion An adjustment for age in the interpretation of results of fractionated plasma metanephrines may significantly decrease false positives when using this test to exclude sporadic pheochromocytoma. Such improvements in false positive rate may result in savings of expenditures related to confirmatory imaging.

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...

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...

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.

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...

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 ...

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

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.

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

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.

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...

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

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

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...

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

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

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)

Ibrutinib versus previous standard of care: an adjusted comparison in patients with relapsed/refractory chronic lymphocytic leukaemia.

Science.gov (United States)

Hansson, Lotta; Asklid, Anna; Diels, Joris; Eketorp-Sylvan, Sandra; Repits, Johanna; Søltoft, Frans; Jäger, Ulrich; Österborg, Anders

2017-10-01

This study explored the relative efficacy of ibrutinib versus previous standard-of-care treatments in relapsed/refractory patients with chronic lymphocytic leukaemia (CLL), using multivariate regression modelling to adjust for baseline prognostic factors. Individual patient data were collected from an observational Stockholm cohort of consecutive patients (n = 144) diagnosed with CLL between 2002 and 2013 who had received at least second-line treatment. Data were compared with results of the RESONATE clinical trial. A multivariate Cox proportional hazards regression model was used which estimated the hazard ratio (HR) of ibrutinib versus previous standard of care. The adjusted HR of ibrutinib versus the previous standard-of-care cohort was 0.15 (p ibrutinib in the RESONATE study were significantly longer than with previous standard-of-care regimens used in second or later lines in routine healthcare. The approach used, which must be interpreted with caution, compares patient-level data from a clinical trial with outcomes observed in a daily clinical practice and may complement results from randomised trials or provide preliminary wider comparative information until phase 3 data exist.

Clinical practice guidelines for translating pharmacogenomic knowledge to bedside. Focus on anticancer drugs.

Directory of Open Access Journals (Sweden)

José A G Agúndez

2014-08-01

Full Text Available The development of clinical practice recommendations or guidelines for the clinical use of pharmacogenomics data is an essential issue for improving drug therapy, particularly for drugs with high toxicity and/or narrow therapeutic index such as anticancer drugs. Although pharmacogenomic-based recommendations have been formulated for over 40 anticancer drugs, the number of clinical practice guidelines available is very low. The guidelines already published indicate that pharmacogenomic testing is useful for patient selection, but final dosing adjustment should be carried out on the basis of clinical or analytical parameters rather than on pharmacogenomic information.Patient selection may seem a modest objective, but it constitutes a crucial improvement with regard to the pre-pharmacogenomics situation and it saves patients’ lives. However we should not overstate the current power of pharmacogenomics. At present the pharmacogenomics of anticancer drugs is not sufficiently developed for dose adjustments based on pharmacogenomics only, and no current guidelines recommend such adjustments without considering clinical and/or analytical parameters.

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...

Cognitive Coping, Goal Adjustment, and Depressive and Anxiety Symptoms in People Undergoing Infertility Treatment A Prospective Study

NARCIS (Netherlands)

Kraaij, Vivian; Garnefski, Nadia; Schroevers, Maya J.; Weijmer, Janneke; Helmerhorst, Frans

The relationships between cognitive coping strategies, goal adjustment, and symptoms of depression and anxiety were studied in people with fertility problems. Both cross-sectional and prospective relationships were studied in a sample of 313 patients attending an infertility clinic. Self-report

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…

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.

Benchmarking Outpatient Rehabilitation Clinics Using Functional Status Outcomes.

Science.gov (United States)

Gozalo, Pedro L; Resnik, Linda J; Silver, Benjamin

2016-04-01

To utilize functional status (FS) outcomes to benchmark outpatient therapy clinics. Outpatient therapy data from clinics using Focus on Therapeutic Outcomes (FOTO) assessments. Retrospective analysis of 538 clinics, involving 2,040 therapists and 90,392 patients admitted July 2006-June 2008. FS at discharge was modeled using hierarchical regression methods with patients nested within therapists within clinics. Separate models were estimated for all patients, for those with lumbar, and for those with shoulder impairments. All models risk-adjusted for intake FS, age, gender, onset, surgery count, functional comorbidity index, fear-avoidance level, and payer type. Inverse probability weighting adjusted for censoring. Functional status was captured using computer adaptive testing at intake and at discharge. Clinic and therapist effects explained 11.6 percent of variation in FS. Clinics ranked in the lowest quartile had significantly different outcomes than those in the highest quartile (p < .01). Clinics ranked similarly in lumbar and shoulder impairments (correlation = 0.54), but some clinics ranked in the highest quintile for one condition and in the lowest for the other. Benchmarking models based on validated FS measures clearly separated high-quality from low-quality clinics, and they could be used to inform value-based-payment policies. © Health Research and Educational Trust.

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.

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

A cohort study on psychosocial adjustment and psychopathology in adolescents and young adults with congenital heart disease

Science.gov (United States)

Freitas, Isabela Ribeiro; Castro, Marta; Sarmento, Sofia Lourenço; Moura, Cláudia; Viana, Victor; Areias, José Carlos; Areias, Maria Emília Guimarães

2013-01-01

Objectives Our purpose was to study psychosocial adjustment and psychiatric morbidity of adolescents and young adults with congenital heart disease (CHD). Design All assessment measures were obtained on a single occasion. Clinical data was obtained through the patient's clinical records. Setting A teaching and tertiary care facility in Porto, Portugal. Participants We evaluated 110 CHD patients (62 male) aged from 12 to 26 years (mean=18.00±3.617), 58 cyanotic. All assessment measures were obtained on a single occasion in a tertiary hospital. Demographic information and clinical history were collected. Primary and secondary outcome measures Questionnaires regarded topics such as social support, family educational style, self-image and physical limitations, a standardised psychiatric interview Schedule for Affective Disorders and Schizophrenia—Lifetime version (SADS-L), and a self-report questionnaire on psychosocial adjustment, youth self-report or adult self-report. One of the relatives completed an observational version of the same questionnaire (child behaviour checklist (CBCL) or ABCL (adult behaviour checklist)). Results We found a 21.8% lifetime prevalence of psychopathology, 31.3%, in females, 14.5% in males, showing a somewhat increased proneness in CHD patients. Females also showed worse psychosocial adjustment, with more somatic complaints (u=260 000; p=0.011), anxiety/depression (u=984 000; p=0.002), aggressive behaviour (u=920 500; p=0.001), attention problems (u=1123 500; p=0.027), thought problems (u=1069 500; p=0.010), internalisation (u=869 000; p=0.0) and externalisation (u=1163 000; p=0.05). Patients with severe CHD (u=939 000; p=0.03) and surgical repair (u=719 000; p=0.037) showed worse psychosocial adjustment. Those with poor social support showed more withdrawal (u=557 500; p=0.0) and social problems (u=748 500; p=0.023), and patients with unsatisfactory school performance revealed more anxiety/depression (u=916�

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)

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.

Maintenance of Clinical Expertise and Clinical Research by the Clinical Professors at Gifu Pharmaceutical University.

Science.gov (United States)

Tachi, Tomoya; Noguchi, Yoshihiro; Teramachi, Hitomi

2017-01-01

The clinical professors at Gifu Pharmaceutical University (GPU) provide pharmaceutical services at GPU Pharmacy, Gifu University Hospital, and Gifu Municipal Hospital to keep their clinical skills up-to-date; they also perform clinical research in collaboration with many clinical institutes. The Laboratory of Clinical Pharmacy is part of the Department of Pharmacy Practice and Science, to which the clinical professors belong, and is composed of three clinical professors (a professor, an associate professor, and an assistant professor). The professor administers the GPU Pharmacy as its director, while the associate professor and assistant professor provide pharmaceutical services to patients at Gifu Municipal Hospital, and also provide practical training for students in the GPU Pharmacy. Collectively, they have performed research on such topics as medication education for students, clinical communication education, and analysis of clinical big data. They have also conducted research in collaboration with clinical institutes, hospitals, and pharmacies. Here, we introduce the collaborative research between the Laboratory of Clinical Pharmacy and Gifu Municipal Hospital. These studies include "Risk factors contributing to urinary protein expression resulting from bevacizumab combination chemotherapy", "Hyponatremia and hypokalemia as risk factors for falls", "Economic evaluation of adjustments of levofloxacin dosage by dispensing pharmacists for patients with renal dysfunction", and "Effect of patient education upon discharge for use of a medication notebook on purchasing over-the-counter drugs and health foods". In this symposium, we would like to demonstrate one model of the association and collaborative research between these clinical professors and clinical institutes.

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,

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 ...

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...

Rheumatoid Arthritis Educational Video Series

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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...

A case-mix classification system for explaining healthcare costs using administrative data in Italy.

Science.gov (United States)

Corti, Maria Chiara; Avossa, Francesco; Schievano, Elena; Gallina, Pietro; Ferroni, Eliana; Alba, Natalia; Dotto, Matilde; Basso, Cristina; Netti, Silvia Tiozzo; Fedeli, Ugo; Mantoan, Domenico

2018-03-04

The Italian National Health Service (NHS) provides universal coverage to all citizens, granting primary and hospital care with a copayment system for outpatient and drug services. Financing of Local Health Trusts (LHTs) is based on a capitation system adjusted only for age, gender and area of residence. We applied a risk-adjustment system (Johns Hopkins Adjusted Clinical Groups System, ACG® System) in order to explain health care costs using routinely collected administrative data in the Veneto Region (North-eastern Italy). All residents in the Veneto Region were included in the study. The ACG system was applied to classify the regional population based on the following information sources for the year 2015: Hospital Discharges, Emergency Room visits, Chronic disease registry for copayment exemptions, ambulatory visits, medications, the Home care database, and drug prescriptions. Simple linear regressions were used to contrast an age-gender model to models incorporating more comprehensive risk measures aimed at predicting health care costs. A simple age-gender model explained only 8% of the variance of 2015 total costs. Adding diagnoses-related variables provided a 23% increase, while pharmacy based variables provided an additional 17% increase in explained variance. The adjusted R-squared of the comprehensive model was 6 times that of the simple age-gender model. ACG System provides substantial improvement in predicting health care costs when compared to simple age-gender adjustments. Aging itself is not the main determinant of the increase of health care costs, which is better explained by the accumulation of chronic conditions and the resulting multimorbidity. Copyright © 2018. Published by Elsevier B.V.

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

Self-Esteem, Coping Efforts and Marital Adjustment

Directory of Open Access Journals (Sweden)

Claude Bélanger

2014-11-01

Full Text Available The main objective of this study is to investigate the relationship between self-esteem, specific coping strategies and marital adjustment. The sample consists of 216 subjects from 108 couples who completed the Dyadic Adjustment Scale, the Rosenberg Self-Esteem Scale and the Ways of Coping Checklist. The results confirm the presence of a relationship between self-esteem, specific coping strategies and marital adjustment in men and women. High self-esteem and marital adjustment are associated with the use of problem solving strategies and less avoidance as a way of coping. Moreover, cross analyses reveal that one’s feelings of self-worth are associated with his/her spouse's marital adjustment. The theoretical implications of these results are discussed.

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...

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)

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)

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...

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...

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...

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...

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

Evaluation of trauma care using TRISS method: the role of adjusted misclassification rate and adjusted w-statistic.

Science.gov (United States)

Llullaku, Sadik S; Hyseni, Nexhmi Sh; Bytyçi, Cen I; Rexhepi, Sylejman K

2009-01-15

Major trauma is a leading cause of death worldwide. Evaluation of trauma care using Trauma Injury and Injury Severity Score (TRISS) method is focused in trauma outcome (deaths and survivors). For testing TRISS method TRISS misclassification rate is used. Calculating w-statistic, as a difference between observed and TRISS expected survivors, we compare our trauma care results with the TRISS standard. The aim of this study is to analyze interaction between misclassification rate and w-statistic and to adjust these parameters to be closer to the truth. Analysis of components of TRISS misclassification rate and w-statistic and actual trauma outcome. The component of false negative (FN) (by TRISS method unexpected deaths) has two parts: preventable (Pd) and non-preventable (nonPd) trauma deaths. Pd represents inappropriate trauma care of an institution; otherwise nonpreventable trauma deaths represents errors in TRISS method. Removing patients with preventable trauma deaths we get an Adjusted misclassification rate: (FP + FN - Pd)/N or (b+c-Pd)/N. Substracting nonPd from FN value in w-statistic formula we get an Adjusted w-statistic: [FP-(FN - nonPd)]/N, respectively (FP-Pd)/N, or (b-Pd)/N). Because adjusted formulas clean method from inappropriate trauma care, and clean trauma care from the methods error, TRISS adjusted misclassification rate and adjusted w-statistic gives more realistic results and may be used in researches of trauma outcome.

Rheumatoid Arthritis Educational Video Series

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Full Text Available ... Arthritis Managing Chronic Pain and Depression in Arthritis Nutrition & Rheumatoid Arthritis Arthritis and Health-related Quality of ... Hopkins Rheumatology Arthritis Center Lupus Center Lyme Disease Clinical Research Center Myositis Center Scleroderma Center Sjogren’s Syndrome ...

Suicidal tendency in a sample of adolescent outpatients with adjustment disorder: gender differences.

Science.gov (United States)

Ferrer, Laia; Kirchner, Teresa

2014-08-01

Although Adjustment Disorder (AD) is a prevalent diagnosis in adolescent mental health services and linked to suicidal tendency in adolescence, little research exists examining prevalence and gender differences of suicidal symptoms among AD patients using standardized instruments. The present study aims to assess the presence of suicidal tendency in a clinical sample of Spanish adolescents with AD analyzing gender differences. Ninety-seven adolescents with AD were recruited at a public mental health center and included in the AD sample; they were administered the Inventario de Riesgo Suicida para Adolescentes (Suicide Risk Inventory for Adolescents-IRIS) and the Millon Adolescent Clinical Inventory (MACI). Ninety-nine community adolescents were recruited and administered the IRIS inventory. The community sample works as a contrast group. Girls with AD show higher levels of suicidal symptoms than boys on both the IRIS Suicidal Ideation and Intention scale (t=8.15, p<.001) and the MACI Suicidal Tendency scale (t=6.6, p<.001). Girls with AD scored significantly higher than girls from the community contrast group sample in the IRIS Suicidal Ideation and Intention scale, but boys with AD presented no differences with regard to boys form the community contrast group sample. Compared with normative clinical samples of the MACI, no differences in the Suicidal Tendency scale scores were found between AD and normative girls, but AD boys showed significantly lower mean scores than normative boys. Suicidal symptoms were presented by 27% of girls and 18% of boys, although only 6% of the girls and none of the boys presented clear suicidal tendencies. Considering suicidal tendencies in adolescents with Adjustment Disorder is important-especially in girls, who present high suicidal tendencies in relation both to boys and to community peers and the normative clinical population. Copyright © 2014 Elsevier Inc. All rights reserved.

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...

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...

The choice: Lewellys F. Barker and the full-time plan.

Science.gov (United States)

Bryan, Charles S; Stinson, M Shawn

2002-09-17

In 1914, Lewellys F. Barker, William Osler's successor as Professor of Medicine and physician-in-chief at Johns Hopkins University School of Medicine, resigned to enter private practice rather than accept the terms of a full-time plan, whereby professors in clinical departments would be salaried like other professors in the university. Barker had been an early proponent of the full-time plan. His decision reflected not only a personal desire for a larger income but also contradictions inherent in the Flexnerian ideal of clinical medicine as a research-oriented university discipline devoid of financial incentives to see patients. In private practice, Barker maintained a high profile as a teacher, writer, supporter of the Johns Hopkins medical institutions, and public figure. The issues raised by his difficult decision remain relevant and have not been satisfactorily resolved.

Psychosocial Adjustment over a Two-Year Period in Children Referred for Learning Problems: Risk, Resilience, and Adaptation.

Science.gov (United States)

Sorensen, Lisa G.; Forbes, Peter W.; Bernstein, Jane H.; Weiler, Michael D.; Mitchell, William M.; Waber, Deborah P.

2003-01-01

A 2-year study evaluated the relationship among psychosocial adjustment, changes in academic skills, and contextual factors in 100 children (ages 7-11) with learning problems. Contextual variables were significantly associated with psychosocial adaptation, including the effectiveness of the clinical assessment, extent of academic support, and the…

Usefulness of administrative databases for risk adjustment of adverse events in surgical patients.

Science.gov (United States)

Rodrigo-Rincón, Isabel; Martin-Vizcaíno, Marta P; Tirapu-León, Belén; Zabalza-López, Pedro; Abad-Vicente, Francisco J; Merino-Peralta, Asunción; Oteiza-Martínez, Fabiola

2016-03-01

The aim of this study was to assess the usefulness of clinical-administrative databases for the development of risk adjustment in the assessment of adverse events in surgical patients. The study was conducted at the Hospital of Navarra, a tertiary teaching hospital in northern Spain. We studied 1602 hospitalizations of surgical patients from 2008 to 2010. We analysed 40 comorbidity variables included in the National Surgical Quality Improvement (NSQIP) Program of the American College of Surgeons using 2 sources of information: The clinical and administrative database (CADB) and the data extracted from the complete clinical records (CR), which was considered the gold standard. Variables were catalogued according to compliance with the established criteria: sensitivity, positive predictive value and kappa coefficient >0.6. The average number of comorbidities per study participant was 1.6 using the CR and 0.95 based on CADB (p<.0001). Thirteen types of comorbidities (accounting for 8% of the comorbidities detected in the CR) were not identified when the CADB was the source of information. Five of the 27 remaining comorbidities complied with the 3 established criteria; 2 pathologies fulfilled 2 criteria, whereas 11 fulfilled 1, and 9 did not fulfil any criterion. CADB detected prevalent comorbidities such as comorbid hypertension and diabetes. However, the CABD did not provide enough information to assess the variables needed to perform the risk adjustment proposed by the NSQIP for the assessment of adverse events in surgical patients. Copyright © 2015. Publicado por Elsevier España, S.L.U.

Process monitoring in intensive care with the use of cumulative expected minus observed mortality and risk-adjusted P charts.

Science.gov (United States)

Cockings, Jerome G L; Cook, David A; Iqbal, Rehana K

2006-02-01

A health care system is a complex adaptive system. The effect of a single intervention, incorporated into a complex clinical environment, may be different from that expected. A national database such as the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme in the UK represents a centralised monitoring, surveillance and reporting system for retrospective quality and comparative audit. This can be supplemented with real-time process monitoring at a local level for continuous process improvement, allowing early detection of the impact of both unplanned and deliberately imposed changes in the clinical environment. Demographic and UK Acute Physiology and Chronic Health Evaluation II (APACHE II) data were prospectively collected on all patients admitted to a UK regional hospital between 1 January 2003 and 30 June 2004 in accordance with the ICNARC Case Mix Programme. We present a cumulative expected minus observed (E-O) plot and the risk-adjusted p chart as methods of continuous process monitoring. We describe the construction and interpretation of these charts and show how they can be used to detect planned or unplanned organisational process changes affecting mortality outcomes. Five hundred and eighty-nine adult patients were included. The overall death rate was 0.78 of predicted. Calibration showed excess survival in ranges above 30% risk of death. The E-O plot confirmed a survival above that predicted. Small transient variations were seen in the slope that could represent random effects, or real but transient changes in the quality of care. The risk-adjusted p chart showed several observations below the 2 SD control limits of the expected mortality rate. These plots provide rapid analysis of risk-adjusted performance suitable for local application and interpretation. The E-O chart provided rapid easily visible feedback of changes in risk-adjusted mortality, while the risk-adjusted p chart allowed statistical evaluation. Local analysis of

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.

The Association of Frailty With Outcomes and Resource Use After Emergency General Surgery: A Population-Based Cohort Study.

Science.gov (United States)

McIsaac, Daniel I; Moloo, Husein; Bryson, Gregory L; van Walraven, Carl

2017-05-01

Older patients undergoing emergency general surgery (EGS) experience high rates of postoperative morbidity and mortality. Studies focused primarily on elective surgery indicate that frailty is an important predictor of adverse outcomes in older surgical patients. The population-level effect of frailty on EGS is poorly described. Therefore, our objective was to measure the association of preoperative frailty with outcomes in a population of older patients undergoing EGS. We created a population-based cohort study using linked administrative data in Ontario, Canada, that included community-dwelling individuals aged >65 years having EGS. Our main exposure was preoperative frailty, as defined by the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnoses indicator. The Adjusted Clinical Groups frailty-defining diagnoses indicator is a binary variable that uses 12 clusters of frailty-defining diagnoses. Our main outcome measures were 1-year all-cause mortality (primary), intensive care unit admission, length of stay, institutional discharge, and costs of care (secondary). Of 77,184 patients, 19,779 (25.6%) were frail. Death within 1 year occurred in 6626 (33.5%) frail patients compared with 11,366 (19.8%) nonfrail patients. After adjustment for sociodemographic and surgical confounders, this resulted in a hazard ratio of 1.29 (95% confidence interval [CI] 1.25-1.33). The risk of death for frail patients varied significantly across the postoperative period and was particularly high immediately after surgery (hazard ratio on postoperative day 1 = 23.1, 95% CI 22.3-24.1). Frailty was adversely associated with all secondary outcomes, including a 5.82-fold increase in the adjusted odds of institutional discharge (95% CI 5.53-6.12). After EGS, frailty is associated with increased rates of mortality, institutional discharge, and resource use. Strategies that might improve perioperative outcomes in frail EGS patients need to be developed and tested.

Effect of Race and Marital Status on Mothers’ Observed Parenting and Adolescent Adjustment in Youth With Type 1 Diabetes

Science.gov (United States)

Young, Mackenzie T.; Gruhn, Meredith A.; Grey, Margaret; Delamater, Alan M.; Jaser, Sarah S.

2015-01-01

Objective To examine demographic differences in parenting behaviors and adjustment in youth with type 1 diabetes. Methods Adolescents’ psychosocial adjustment was assessed via self-reports and parent reports, and clinical data were obtained from adolescents’ medical records. Mother–adolescent dyads (N = 93) engaged in a videotaped discussion task, which was coded for observed parenting behaviors. Results Single and non-White mothers exhibited significantly more overinvolved and less collaborative parenting behaviors. Higher levels of overinvolved parenting and lower levels of collaborative parenting were associated with poorer adolescent adjustment (i.e., higher levels of externalizing problems). Observed parenting was not significantly associated with glycemic control. There was an indirect effect of marital status and race/ethnicity on externalizing behaviors through parenting. Conclusions The current study highlights parenting as a potential target for interventions, especially in single and minority mothers, to improve adjustment in this population. PMID:25248850

Evaluation of trauma care using TRISS method: the role of adjusted misclassification rate and adjusted w-statistic

Directory of Open Access Journals (Sweden)

Bytyçi Cen I

2009-01-01

Full Text Available Abstract Background Major trauma is a leading cause of death worldwide. Evaluation of trauma care using Trauma Injury and Injury Severity Score (TRISS method is focused in trauma outcome (deaths and survivors. For testing TRISS method TRISS misclassification rate is used. Calculating w-statistic, as a difference between observed and TRISS expected survivors, we compare our trauma care results with the TRISS standard. Aim The aim of this study is to analyze interaction between misclassification rate and w-statistic and to adjust these parameters to be closer to the truth. Materials and methods Analysis of components of TRISS misclassification rate and w-statistic and actual trauma outcome. Results The component of false negative (FN (by TRISS method unexpected deaths has two parts: preventable (Pd and non-preventable (nonPd trauma deaths. Pd represents inappropriate trauma care of an institution; otherwise nonpreventable trauma deaths represents errors in TRISS method. Removing patients with preventable trauma deaths we get an Adjusted misclassification rate: (FP + FN - Pd/N or (b+c-Pd/N. Substracting nonPd from FN value in w-statistic formula we get an Adjusted w-statistic: [FP-(FN - nonPd]/N, respectively (FP-Pd/N, or (b-Pd/N. Conclusion Because adjusted formulas clean method from inappropriate trauma care, and clean trauma care from the methods error, TRISS adjusted misclassification rate and adjusted w-statistic gives more realistic results and may be used in researches of trauma outcome.

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.

Non-invasive ventilation with neurally adjusted ventilatory assist in newborns.

Science.gov (United States)

Stein, Howard; Beck, Jennifer; Dunn, Michael

2016-06-01

Neurally adjusted ventilatory assist (NAVA) is a mode of ventilation in which both the timing and degree of ventilatory assist are controlled by the patient. Since NAVA uses the diaphragm electrical activity (Edi) as the controller signal, it is possible to deliver synchronized non-invasive NAVA (NIV-NAVA) regardless of leaks and to monitor continuously patient respiratory pattern and drive. Advantages of NIV-NAVA over conventional modes include improved patient-ventilator interaction, reliable respiratory monitoring and self-regulation of respiratory support. In theory, these characteristics make NIV-NAVA an ideal mode to provide effective, appropriate non-invasive support to newborns with respiratory insufficiency. NIV-NAVA has been successfully used clinically in neonates as a mode of ventilation to prevent intubation, to allow early extubation, and as a novel way to deliver nasal continuous positive airway pressure. The use of NAVA in neonates is described with an emphasis on studies and clinical experience with NIV-NAVA. Copyright © 2016 Elsevier Ltd. All rights reserved.

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)

Occlusal adjustment using the bite plate-induced occlusal position as a reference position for temporomandibular disorders: a pilot study

Directory of Open Access Journals (Sweden)

Chiwata Ichiro

2010-03-01

Full Text Available Abstract Background Many researchers have not accepted the use of occlusal treatments for temporomandibular disorders (TMDs. However, a recent report described a discrepancy between the habitual occlusal position (HOP and the bite plate-induced occlusal position (BPOP and discussed the relation of this discrepancy to TMD. Therefore, the treatment outcome of evidence-based occlusal adjustments using the bite plate-induced occlusal position (BPOP as a muscular reference position should be evaluated in patients with TMD. Methods The BPOP was defined as the position at which a patient voluntarily closed his or her mouth while sitting in an upright posture after wearing an anterior flat bite plate for 5 minutes and then removing the plate. Twenty-one patients with TMDs underwent occlusal adjustment using the BPOP. The occlusal adjustments were continued until bilateral occlusal contacts were obtained in the BPOP. The treatment outcomes were evaluated using the subjective dysfunction index (SDI and the Helkimo Clinical Dysfunction Index (CDI before and after the occlusal adjustments; the changes in these two indices between the first examination and a one-year follow-up examination were then analyzed. In addition, the difference between the HOP and the BPOP was three-dimensionally measured before and after the treatment. Results The percentage of symptom-free patients after treatment was 86% according to the SDI and 76% according to the CDI. The changes in the two indices after treatment were significant (p 0.1. Conclusion Although the results of the present study should be confirmed in other studies, a randomized clinical trial examining occlusal adjustments using the BPOP as a reference position appears to be warranted.

Assessment of children's emotional adjustment: construction and validation of a new instrument.

Science.gov (United States)

Thorlacius, Ö; Gudmundsson, E

2015-09-01

The present study describes the Children's Emotional Adjustment Scale (CEAS), a 47-item parent-reported scale designed to capture children's emotional functioning on four continuous dimensions. A large community sample of mothers of children (n = 606) aged 6-13 years was used to examine the psychometric properties of the CEAS. Exploratory and confirmatory factor analysis supported the hypothesized four-factor structure of the instrument: (1) temper control; (2) anxiety control; (3) mood repair; and (4) social assertiveness. Cronbach's alphas for the factors were consistently above 0.90, and convergent validity of the factors was satisfactory with maternal ratings of child psychopathology. Children rated by their mothers as having emotional problems in the clinical range on the Strengths and Difficulties Questionnaire had significantly lower scores on the CEAS scales. The CEAS is a psychometrically sound instrument, covering healthy emotional adjustment as well as maladjustment. The scale might prove to be valuable in the assessment and screening of behaviours underlying child psychopathology. © 2014 John Wiley & Sons Ltd.

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...

75 FR 4578 - Notice of Adjustment of Statewide Per Capita Threshold for Recommending a Cost Share Adjustment

Science.gov (United States)

2010-01-28

... Robert T. Stafford Disaster Relief and Emergency Assistance Act is adjusted annually. The adjustment to... Management Assistance Grant; 97.048, Disaster Housing Assistance to Individuals and Households In Presidentially Declared Disaster Areas; 97.049, Presidentially Declared Disaster Assistance--Disaster Housing...

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...

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.

Goal adjustment, physical and sedentary activity, and well-being and health among breast cancer survivors.

Science.gov (United States)

Wrosch, Carsten; Sabiston, Catherine M

2013-03-01

This longitudinal study examined whether goal adjustment capacities (i.e., goal disengagement and goal reengagement) would predict breast cancer survivors' emotional well-being and physical health by facilitating high levels of physical activity and low levels of sedentary activity. Self-reports of goal adjustment capacities were measured among 176 female breast cancer survivors at baseline. Self-reports of physical activity, sedentary activity, daily affect, and daily physical health symptoms (e.g., nausea or pain) were measured at baseline and 3-month follow-up. Goal reengagement predicted high levels of positive affect and low levels of physical symptoms at baseline and increases in positive affect over 3 months. The combination of high goal disengagement and high goal reengagement was associated with particularly large 3-month increases in positive affect. The effects of goal reengagement on baseline affect and physical health were mediated by high baseline levels of physical activity, and the interaction effect on 3-month changes in positive affect was mediated by low baseline levels of sedentary activity. Goal adjustment capacities can exert beneficial effects on breast cancer survivors' well-being and physical health by facilitating adaptive levels of physical and sedentary activity. Integrating goal adjustment processes into clinical practice may be warranted. Copyright © 2012 John Wiley & Sons, Ltd.

Influence of occlusal loading on peri-implant clinical parameters. A pilot study.

Science.gov (United States)

Pellicer-Chover, Hilario; Viña-Almunia, José; Romero-Millán, Javier; Peñarrocha-Oltra, David; García-Mira, Berta; Peñarrocha-Diago, María

2014-05-01

To investigate the relation between occlusal loading and peri-implant clinical parameters (probing depth, bleeding on probing, gingival retraction, width of keratinized mucosa, and crevicular fluid volume) in patients with implant-supported complete fixed prostheses in both arches. This clinical study took place at the University of Valencia (Spain) dental clinic. It included patients attending the clinic for regular check-ups during at least 12 months after rehabilitation of both arches with implant-supported complete fixed ceramo-metallic prostheses. One study implant and one control implant were established for each patient using the T-Scan®III computerized system (Tesco, South Boston, USA). The maxillary implant closest to the point of maximum occlusal loading was taken as the study implant and the farthest (with least loading) as the control. Occlusal forces were registered with the T-Scan® III and then occlusal adjustment was performed to distribute occlusal forces correctly. Peri-implant clinical parameters were analyzed in both implants before and two and twelve months after occlusal adjustment. Before occlusal adjustment, study group implants presented a higher mean volume of crevicular fluid (51.3 ± 7.4 UP) than the control group (25.8 ± 5.5 UP), with statistically significant difference. Two months after occlusal adjustment, there were no significant differences between groups (24.6 ± 3.8 UP and 26 ± 4.5 UP respectively) (p=0.977). After twelve months, no significant differences were found between groups (24.4 ± 11.1 UP and 22.5 ± 8.9 UP respectively) (p=0.323). For the other clinical parameters, no significant differences were identified between study and control implants at any of the study times (p>0.05). Study group implants receiving higher occlusal loading presented significantly higher volumes of crevicular fluid than control implants. Crevicular fluid volumes were similar in both groups two and twelve months after occlusal adjustment.

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....

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

Proposal for a national inventory adjustment for trade in the presence of border carbon adjustment: Assessing carbon tax policy in Japan

International Nuclear Information System (INIS)

Zhou, Xin; Yano, Takashi; Kojima, Satoshi

2013-01-01

In this paper we pointed out a hidden inequality in accounting for trade-related emissions in the presence of border carbon adjustment. Under a domestic carbon pricing policy, producers pay for the carbon costs in exchange for the right to emit. Under border carbon adjustment, however, the exporting country pays for the carbon costs of their exports to the importing country but not be given any emission credits. As a result, export-related emissions will be remained in the national inventory of the exporting country based on the UNFCCC inventory approach. This hidden inequality is important to climate policy but has not yet been pointed out. To address this issue we propose a method of National Inventory Adjustment for Trade, by which export-related emissions will be deducted from the national inventory of the exporting country and added to the national inventory of the importing country which implements border carbon adjustment. To assess the policy impacts, we simulated a carbon tax policy with border tax adjustment for Japan using a multi-region computable general equilibrium model. The results indicate that with the National Inventory Adjustment for Trade, both Japan′s national inventory and the carbon leakage effects of Japan′s climate policy will be greatly different. - Highlights: • The inequality in GHG accounting caused by border carbon adjustment presented. • National inventory adjustment for trade under border carbon adjustment proposed. • Policy impacts on international competitiveness and carbon leakage assessed. • Practical issues related to the national inventory adjustment for trade discussed

Goal pursuit, goal adjustment, and affective well-being following lower limb amputation.

Science.gov (United States)

Coffey, Laura; Gallagher, Pamela; Desmond, Deirdre; Ryall, Nicola

2014-05-01

This study examined the relationships between tenacious goal pursuit (TGP), flexible goal adjustment (FGA), and affective well-being in a sample of individuals with lower limb amputations. Cross-sectional, quantitative. Ninety-eight patients recently admitted to a primary prosthetic rehabilitation programme completed measures of TGP, FGA, positive affect, and negative affect. Hierarchical regression analyses revealed that TGP and FGA accounted for a significant proportion of the variance in both positive and negative affect, controlling for sociodemographic and clinical characteristics. TGP was significantly positively associated with positive affect, while FGA was significantly negatively associated with negative affect. Moderated regression analyses indicated that the beneficial effect of FGA on negative affect was strongest at high levels of amputation-related pain intensity and low levels of TGP. TGP and FGA appear to influence subjective well-being in different ways, with TGP promoting the experience of positive affect and FGA buffering against negative affect. TGP and FGA may prove useful in identifying individuals at risk of poor affective outcomes following lower limb amputation and represent important targets for intervention in this patient group. What is already known on this subject? The loss of a limb has a significant impact on several important life domains. Although some individuals experience emotional distress following amputation, the majority adjust well to their limb loss, with some achieving positive change or growth as a result of their experiences. Theories of self-regulation propose that disruptions in goal attainment have negative affective consequences. The physical, social, and psychological upheaval caused by limb loss is likely to threaten the attainment of valued goals, which may leave individuals vulnerable to negative psychosocial outcomes if they do not regulate their goals in response to these challenges. According to the dual

Considerations for automated machine learning in clinical metabolic profiling: Altered homocysteine plasma concentration associated with metformin exposure.

Science.gov (United States)

Orlenko, Alena; Moore, Jason H; Orzechowski, Patryk; Olson, Randal S; Cairns, Junmei; Caraballo, Pedro J; Weinshilboum, Richard M; Wang, Liewei; Breitenstein, Matthew K

2018-01-01

With the maturation of metabolomics science and proliferation of biobanks, clinical metabolic profiling is an increasingly opportunistic frontier for advancing translational clinical research. Automated Machine Learning (AutoML) approaches provide exciting opportunity to guide feature selection in agnostic metabolic profiling endeavors, where potentially thousands of independent data points must be evaluated. In previous research, AutoML using high-dimensional data of varying types has been demonstrably robust, outperforming traditional approaches. However, considerations for application in clinical metabolic profiling remain to be evaluated. Particularly, regarding the robustness of AutoML to identify and adjust for common clinical confounders. In this study, we present a focused case study regarding AutoML considerations for using the Tree-Based Optimization Tool (TPOT) in metabolic profiling of exposure to metformin in a biobank cohort. First, we propose a tandem rank-accuracy measure to guide agnostic feature selection and corresponding threshold determination in clinical metabolic profiling endeavors. Second, while AutoML, using default parameters, demonstrated potential to lack sensitivity to low-effect confounding clinical covariates, we demonstrated residual training and adjustment of metabolite features as an easily applicable approach to ensure AutoML adjustment for potential confounding characteristics. Finally, we present increased homocysteine with long-term exposure to metformin as a potentially novel, non-replicated metabolite association suggested by TPOT; an association not identified in parallel clinical metabolic profiling endeavors. While warranting independent replication, our tandem rank-accuracy measure suggests homocysteine to be the metabolite feature with largest effect, and corresponding priority for further translational clinical research. Residual training and adjustment for a potential confounding effect by BMI only slightly modified

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.

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.

Enhanced clinical pharmacy service targeting tools: risk-predictive algorithms.

Science.gov (United States)

El Hajji, Feras W D; Scullin, Claire; Scott, Michael G; McElnay, James C

2015-04-01

This study aimed to determine the value of using a mix of clinical pharmacy data and routine hospital admission spell data in the development of predictive algorithms. Exploration of risk factors in hospitalized patients, together with the targeting strategies devised, will enable the prioritization of clinical pharmacy services to optimize patient outcomes. Predictive algorithms were developed using a number of detailed steps using a 75% sample of integrated medicines management (IMM) patients, and validated using the remaining 25%. IMM patients receive targeted clinical pharmacy input throughout their hospital stay. The algorithms were applied to the validation sample, and predicted risk probability was generated for each patient from the coefficients. Risk threshold for the algorithms were determined by identifying the cut-off points of risk scores at which the algorithm would have the highest discriminative performance. Clinical pharmacy staffing levels were obtained from the pharmacy department staffing database. Numbers of previous emergency admissions and admission medicines together with age-adjusted co-morbidity and diuretic receipt formed a 12-month post-discharge and/or readmission risk algorithm. Age-adjusted co-morbidity proved to be the best index to predict mortality. Increased numbers of clinical pharmacy staff at ward level was correlated with a reduction in risk-adjusted mortality index (RAMI). Algorithms created were valid in predicting risk of in-hospital and post-discharge mortality and risk of hospital readmission 3, 6 and 12 months post-discharge. The provision of ward-based clinical pharmacy services is a key component to reducing RAMI and enabling the full benefits of pharmacy input to patient care to be realized. © 2014 John Wiley & Sons, Ltd.

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

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...

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…

Intra-operative adjustment of standard planes in C-arm CT image data.

Science.gov (United States)

Brehler, Michael; Görres, Joseph; Franke, Jochen; Barth, Karl; Vetter, Sven Y; Grützner, Paul A; Meinzer, Hans-Peter; Wolf, Ivo; Nabers, Diana

2016-03-01

With the help of an intra-operative mobile C-arm CT, medical interventions can be verified and corrected, avoiding the need for a post-operative CT and a second intervention. An exact adjustment of standard plane positions is necessary for the best possible assessment of the anatomical regions of interest but the mobility of the C-arm causes the need for a time-consuming manual adjustment. In this article, we present an automatic plane adjustment at the example of calcaneal fractures. We developed two feature detection methods (2D and pseudo-3D) based on SURF key points and also transferred the SURF approach to 3D. Combined with an atlas-based registration, our algorithm adjusts the standard planes of the calcaneal C-arm images automatically. The robustness of the algorithms is evaluated using a clinical data set. Additionally, we tested the algorithm's performance for two registration approaches, two resolutions of C-arm images and two methods for metal artifact reduction. For the feature extraction, the novel 3D-SURF approach performs best. As expected, a higher resolution ([Formula: see text] voxel) leads also to more robust feature points and is therefore slightly better than the [Formula: see text] voxel images (standard setting of device). Our comparison of two different artifact reduction methods and the complete removal of metal in the images shows that our approach is highly robust against artifacts and the number and position of metal implants. By introducing our fast algorithmic processing pipeline, we developed the first steps for a fully automatic assistance system for the assessment of C-arm CT images.

The relationship of parental overprotection, perceived vulnerability, and parenting stress to behavioral, emotional, and social adjustment in children with cancer.

Science.gov (United States)

Colletti, Christina J M; Wolfe-Christensen, Cortney; Carpentier, Melissa Y; Page, Melanie C; McNall-Knapp, René Y; Meyer, William H; Chaney, John M; Mullins, Larry L

2008-08-01

To examine the relationship of self-reported parental overprotection, perceived child vulnerability, and parenting stress to parent-reported behavioral, emotional, and social adjustment of children currently on treatment for cancer. Parents of 62 children (34 boys, 28 girls) currently on treatment for cancer were recruited from an outpatient pediatric cancer clinic. Children ranged in age from 2 to 12 years; age at diagnosis ranged from 1.33 to 11.83 years. Higher levels of parenting stress, but not parental overprotection or perceived child vulnerability, were associated with poorer behavioral and social adjustment. Higher levels of perceived child vulnerability and parenting stress, but not parental overprotection, were independently associated with poorer emotional adjustment. Specific parenting variables appear to be related to specific adjustment outcomes in children with cancer. Longitudinal follow-up of these children is necessary to determine the developmental trajectory of parent variables and long-term child outcomes.

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...

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.

Waist Circumference Adjusted for Body Mass Index and Intra-Abdominal Fat Mass

Science.gov (United States)

Berentzen, Tina Landsvig; Ängquist, Lars; Kotronen, Anna; Borra, Ronald; Yki-Järvinen, Hannele; Iozzo, Patricia; Parkkola, Riitta; Nuutila, Pirjo; Ross, Robert; Allison, David B.; Heymsfield, Steven B.; Overvad, Kim; Sørensen, Thorkild I. A.; Jakobsen, Marianne Uhre

2012-01-01

Background The association between waist circumference (WC) and mortality is particularly strong and direct when adjusted for body mass index (BMI). One conceivable explanation for this association is that WC adjusted for BMI is a better predictor of the presumably most harmful intra-abdominal fat mass (IAFM) than WC alone. We studied the prediction of abdominal subcutaneous fat mass (ASFM) and IAFM by WC alone and by addition of BMI as an explanatory factor. Methodology/Principal Findings WC, BMI and magnetic resonance imaging data from 742 men and women who participated in clinical studies in Canada and Finland were pooled. Total adjusted squared multiple correlation coefficients (R2) of ASFM and IAFM were calculated from multiple linear regression models with WC and BMI as explanatory variables. Mean BMI and WC of the participants in the pooled sample were 30 kg/m2 and 102 cm, respectively. WC explained 29% of the variance in ASFM and 51% of the variance in IAFM. Addition of BMI to WC added 28% to the variance explained in ASFM, but only 1% to the variance explained in IAFM. Results in subgroups stratified by study center, sex, age, obesity level and type 2 diabetes status were not systematically different. Conclusion/Significance The prediction of IAFM by WC is not improved by addition of BMI. PMID:22384179

Psychological adjustment of men with prostate cancer: a review of the literature

Directory of Open Access Journals (Sweden)

Couper Jeremy

2007-01-01

Full Text Available Abstract Objective Prostate cancer (PCA is the most common malignancy and a major cause of death in men but, importantly, a substantial proportion will live for several years following diagnosis. However, they face the prospect of experiencing symptoms, side-effects of treatment and diminished quality of life. The patient's psychological adjustment is particularly complex, given the potential trajectory of the disease, from the point of diagnosis, with its immediate impact, to the phase of palliative care, with its attendant issue of facing mortality. Since a comprehensive review of the literature on psychological adjustment of men with PCA has not yet been done, we have documented relevant research, integrated findings and drawn conclusions, where possible, in order to map out clinical and research implications. Method We searched 5 databases for the period 1994 – July 2006, during which most of the work in the field has been done. Results We found few studies of substance among the 60 we examined to draw conclusions about psychological adjustment to prostate cancer and its treatment. This is in marked contrast to the picture in breast cancer. While some patterns have emerged, many gaps remain to be filled. Discussion Aspects of methodology need attention, particularly longitudinal, prospective designs, incorporation of control groups and the use of valid and reliable measures. There is scope for qualitative studies as a complement to quantitative research.

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...

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...

Genomic and clinical predictors for improving estimator precision in randomized trials of breast cancer treatments

Directory of Open Access Journals (Sweden)

Prasad Patil

2016-08-01

Conclusions: Adjusting only for clinical variables led to substantial precision gains (at least 5% in three of the four data sets, with a 1% precision loss in the remaining data set. These gains were unchanged or increased when sample sizes were doubled in our simulations. The precision gains due to incorporating genomic information, beyond the gains from adjusting for clinical variables, were not substantial.

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...

Nurses' clinical reasoning practices that support safe medication administration: An integrative review of the literature.

Science.gov (United States)

Rohde, Emily; Domm, Elizabeth

2018-02-01

To review the current literature about nurses' clinical reasoning practices that support safe medication administration. The literature about medication administration frequently focuses on avoiding medication errors. Nurses' clinical reasoning used during medication administration to maintain medication safety receives less attention in the literature. As healthcare professionals, nurses work closely with patients, assessing and intervening to promote mediation safety prior to, during and after medication administration. They also provide discharge teaching about using medication safely. Nurses' clinical reasoning and practices that support medication safety are often invisible when the focus is medication errors avoidance. An integrative literature review was guided by Whittemore and Knafl's (Journal of Advanced Nursing, 5, 2005 and 546) five-stage review of the 11 articles that met review criteria. This review is modelled after Gaffney et al.'s (Journal of Clinical Nursing, 25, 2016 and 906) integrative review on medical error recovery. Health databases were accessed and systematically searched for research reporting nurses' clinical reasoning practices that supported safe medication administration. The level and quality of evidence of the included research articles were assessed using The Johns Hopkins Nursing Evidence-Based Practice Rating Scale©. Nurses have a central role in safe medication administration, including but not limited to risk awareness about the potential for medication errors. Nurses assess patients and their medication and use knowledge and clinical reasoning to administer medication safely. Results indicated nurses' use of clinical reasoning to maintain safe medication administration was inadequately articulated in 10 of 11 studies reviewed. Nurses are primarily responsible for safe medication administration. Nurses draw from their foundational knowledge of patient conditions and organisational processes and use clinical reasoning that

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

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.

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.

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...

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...

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...

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...

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...

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...

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...

Peak Serum AST Is a Better Predictor of Acute Liver Graft Injury after Liver Transplantation When Adjusted for Donor/Recipient BSA Size Mismatch (ASTi

Directory of Open Access Journals (Sweden)

Kyota Fukazawa

2014-01-01

Full Text Available Background. Despite the marked advances in the perioperative management of the liver transplant recipient, an assessment of clinically significant graft injury following preservation and reperfusion remains difficult. In this study, we hypothesized that size-adjusted AST could better approximate real AST values and consequently provide a better reflection of the extent of graft damage, with better sensitivity and specificity than current criteria. Methods. We reviewed data on 930 orthotopic liver transplant recipients. Size-adjusted AST (ASTi was calculated by dividing peak AST by our previously reported index for donor-recipient size mismatch, the BSAi. The predictive value of ASTi of primary nonfunction (PNF and graft survival was assessed by receiver operating characteristic curve, logistic regression, Kaplan-Meier survival, and Cox proportional hazard model. Results. Size-adjusted peak AST (ASTi was significantly associated with subsequent occurrence of PNF and graft failure. In our study cohort, the prediction of PNF by the combination of ASTi and PT-INR had a higher sensitivity and specificity compared to current UNOS criteria. Conclusions. We conclude that size-adjusted AST (ASTi is a simple, reproducible, and sensitive marker of clinically significant graft damage.

Understanding heart rate alarm adjustment in the intensive care units through an analytical approach.

Directory of Open Access Journals (Sweden)

Richard L Fidler

Full Text Available Heart rate (HR alarms are prevalent in ICU, and these parameters are configurable. Not much is known about nursing behavior associated with tailoring HR alarm parameters to individual patients to reduce clinical alarm fatigue.To understand the relationship between heart rate (HR alarms and adjustments to reduce unnecessary heart rate alarms.Retrospective, quantitative analysis of an adjudicated database using analytical approaches to understand behaviors surrounding parameter HR alarm adjustments. Patients were sampled from five adult ICUs (77 beds over one month at a quaternary care university medical center. A total of 337 of 461 ICU patients had HR alarms with 53.7% male, mean age 60.3 years, and 39% non-Caucasian. Default HR alarm parameters were 50 and 130 beats per minute (bpm. The occurrence of each alarm, vital signs, and physiologic waveforms was stored in a relational database (SQL server.There were 23,624 HR alarms for analysis, with 65.4% exceeding the upper heart rate limit. Only 51% of patients with HR alarms had parameters adjusted, with a median upper limit change of +5 bpm and -1 bpm lower limit. The median time to first HR parameter adjustment was 17.9 hours, without reduction in alarms occurrence (p = 0.57.HR alarms are prevalent in ICU, and half of HR alarm settings remain at default. There is a long delay between HR alarms and parameters changes, with insufficient changes to decrease HR alarms. Increasing frequency of HR alarms shortens the time to first adjustment. Best practice guidelines for HR alarm limits are needed to reduce alarm fatigue and improve monitoring precision.

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)

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...

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...

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

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…

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.

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.

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)

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...

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...

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...

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...

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...

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 ...

A controlled trial of automated classification of negation from clinical notes

Directory of Open Access Journals (Sweden)

Carruth William

2005-05-01

Full Text Available Abstract Background Identification of negation in electronic health records is essential if we are to understand the computable meaning of the records: Our objective is to compare the accuracy of an automated mechanism for assignment of Negation to clinical concepts within a compositional expression with Human Assigned Negation. Also to perform a failure analysis to identify the causes of poorly identified negation (i.e. Missed Conceptual Representation, Inaccurate Conceptual Representation, Missed Negation, Inaccurate identification of Negation. Methods 41 Clinical Documents (Medical Evaluations; sometimes outside of Mayo these are referred to as History and Physical Examinations were parsed using the Mayo Vocabulary Server Parsing Engine. SNOMED-CT™ was used to provide concept coverage for the clinical concepts in the record. These records resulted in identification of Concepts and textual clues to Negation. These records were reviewed by an independent medical terminologist, and the results were tallied in a spreadsheet. Where questions on the review arose Internal Medicine Faculty were employed to make a final determination. Results SNOMED-CT was used to provide concept coverage of the 14,792 Concepts in 41 Health Records from John's Hopkins University. Of these, 1,823 Concepts were identified as negative by Human review. The sensitivity (Recall of the assignment of negation was 97.2% (p Conclusion Automated assignment of negation to concepts identified in health records based on review of the text is feasible and practical. Lexical assignment of negation is a good test of true Negativity as judged by the high sensitivity, specificity and positive likelihood ratio of the test. SNOMED-CT had overall coverage of 88.7% of the concepts being negated.

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)

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...

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...

Self-adjustable glasses in the developing world

Directory of Open Access Journals (Sweden)

Murthy Gudlavalleti VS

2014-02-01

Full Text Available Venkata S Murthy Gudlavalleti,1 Komal Preet Allagh,1 Aashrai SV Gudlavalleti2 1Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, 2Centre for Chronic Disease Control, Public Health Foundation of India, New Delhi, India Abstract: Uncorrected refractive errors are the single largest cause of visual impairment globally. Refractive errors are an avoidable cause of visual impairment that are easily correctable. Provision of spectacles is a cost-effective measure. Unfortunately, this simple solution becomes a public health challenge in low- and middle-income countries because of the paucity of human resources for refraction and optical services, lack of access to refraction services in rural areas, and the cost of spectacles. Low-cost approaches to provide affordable glasses in developing countries are critical. A number of approaches has been tried to surmount the challenge, including ready-made spectacles, the use of focometers and self-adjustable glasses, among other modalities. Recently, self-adjustable spectacles have been validated in studies in both children and adults in developed and developing countries. A high degree of agreement between self-adjustable spectacles and cycloplegic subjective refraction has been reported. Self-refraction has also been found to be less prone to accommodative inaccuracy compared with non-cycloplegic autorefraction. The benefits of self-adjusted spectacles include: the potential for correction of both distance and near vision, applicability for all ages, the empowerment of lay workers, the increased participation of clients, augmented awareness of the mechanism of refraction, reduced costs of optical and refraction units in low-resource settings, and a relative reduction in costs for refraction services. Concerns requiring attention include a need for the improved cosmetic appearance of the currently available self-adjustable spectacles, an increased range of correction (currently

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

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.

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...

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.

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

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.

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....

40 CFR 91.112 - Requirement of certification-adjustable parameters.

Science.gov (United States)

2010-07-01

... adjustment in the physically available range. (b) An operating parameter is not considered adjustable if it... adjustable range during certification, production line testing, selective enforcement auditing or any in-use...

A simple mechanism for measuring and adjusting distraction forces during maxillary advancement.

Science.gov (United States)

Suzuki, Eduardo Yugo; Suzuki, Boonsiva

2009-10-01

Direct measurement of distraction forces on the craniofacial skeleton has never been reported. The present report describes the development of a method of assessing and adjusting traction forces applied through maxillary distraction osteogenesis. A simple mechanism to measure and adjust tension force during maxillary distraction osteogenesis was developed and connected bilaterally to the traction screws of a rigid external distraction device. Measurements were carried out before and after activation using a Shimpo (Nidec-Shimpo America Corporation, Itasca, IL) force gauge in 4 patients (2 with unilateral cleft lip and/or palate, 1 with bilateral cleft lip and palate, and 1 with noncleft) during the distraction process. Activation was performed twice a day at a rate of 1 mm/day. The average maximum force applied throughout the distraction period was 42.5 N (range 16.4 to 65.3 N), with increments, after activation, averaging 10.5 N (range 7.9 to 15.7 N). In patients with unilateral cleft lip and/or palate, distraction forces on the larger segment were 65.1% higher than on the lesser segment. A differential pattern of forces was also observed in the patients with asymmetric noncleft. However, the differential forces between lateral segments were not observed in the patient with bilateral cleft lip and palate. During the activation period, distraction forces progressively increased, whereas the amount of maxillary movement decreased. Pain and discomfort were reported with high forces. Through this mechanism, direct measurement and adjustment of distraction forces during maxillary advancement was possible. The unbalanced pattern of forces observed in patients with cleft suggests the necessity of individual adjustments for controlling pain and clinical symptoms. Accordingly, assessment of distraction forces during maxillary distraction osteogenesis is extremely helpful in understanding the biomechanics of the distraction process.

Covariate-adjusted measures of discrimination for survival data

DEFF Research Database (Denmark)

White, Ian R; Rapsomaniki, Eleni; Frikke-Schmidt, Ruth

2015-01-01

by the study design (e.g. age and sex) influence discrimination and can make it difficult to compare model discrimination between studies. Although covariate adjustment is a standard procedure for quantifying disease-risk factor associations, there are no covariate adjustment methods for discrimination...... statistics in censored survival data. OBJECTIVE: To develop extensions of the C-index and D-index that describe the prognostic ability of a model adjusted for one or more covariate(s). METHOD: We define a covariate-adjusted C-index and D-index for censored survival data, propose several estimators......, and investigate their performance in simulation studies and in data from a large individual participant data meta-analysis, the Emerging Risk Factors Collaboration. RESULTS: The proposed methods perform well in simulations. In the Emerging Risk Factors Collaboration data, the age-adjusted C-index and D-index were...

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.

[Neurally adjusted ventilatory assist (NAVA). A new mode of assisted mechanical ventilation].

Science.gov (United States)

Moerer, O; Barwing, J; Quintel, M

2008-10-01

The aim of mechanical ventilation is to assure gas exchange while efficiently unloading the respiratory muscles and mechanical ventilation is an integral part of the care of patients with acute respiratory failure. Modern lung protective strategies of mechanical ventilation include low-tidal-volume ventilation and the continuation of spontaneous breathing which has been shown to be beneficial in reducing atelectasis and improving oxygenation. Poor patient-ventilator interaction is a major issue during conventional assisted ventilation. Neurally adjusted ventilator assist (NAVA) is a new mode of mechanical ventilation that uses the electrical activity of the diaphragm (EAdi) to control the ventilator. First experimental studies showed an improved patient-ventilator synchrony and an efficient unloading of the respiratory muscles. Future clinical studies will have to show that NAVA is of clinical advantage when compared to conventional modes of assisted mechanical ventilation. This review characterizes NAVA according to current publications on this topic.

Twins conceived using IVF: a follow-up of the family environment and psychosocial adjustment in adolescence.

Science.gov (United States)

Anderson, K N; Connor, J J; Koerner, A F; Rueter, M A

2016-12-01

Compared to families with IVF singletons, what are parental depressive, parent-adolescent interaction and adolescent adjustment outcomes in families with 11-17-year-old IVF twins? No differences were detected for any measured outcome between families with 11-17-year-old IVF twins and those with IVF singletons, despite high statistical power. When IVF twins are younger than 5-years-old, parents tend to have more mental health difficulties and poorer parent-child interactions relative to IVF singletons. By middle childhood, these differences may no longer exist and available studies with middle childhood-aged IVF twins challenge the expected long-term implications of the early concerns. IVF twins may even have more optimum adjustment than IVF singletons in middle childhood. Study of 280, 11-17-year-old IVF children (n = 122 twins and n = 158 singletons) from 195 families at a US reproductive endocrinology clinic. At Wave 1, clinic patients with an IVF child born between 1998 and 2004 were invited to participate in an online survey. In this follow-up study, mothers and fathers provided information on each of their 11-17-year-old IVF adolescents. There were no differences between 11- and 17-year-old IVF twins and IVF singletons in parent depressive symptoms, parent-adolescent interactions or adolescent adjustment outcomes. Although the family demographics are representative of IVF patients, participants were drawn from one US clinic. Study results provide reassurance that by adolescence IVF twins and their families function as well as IVF singletons and their families. University of Minnesota (UMN) Agriculture Experiment Station (MN-52-107), UMN Grant-in-Aid of Research, Artistry and Scholarship, UMN College of Education and Human Development Research Development Investment Grant, UMN Women's Philosophic Leadership Circle Award, UMN Eva Miller Endowed Fellowship. The authors have no conflicts of interest to declare. © The Author 2016. Published by Oxford

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...

Validation of the Parenting and Family Adjustment Scales to Measure Parenting Skills and Family Adjustment in Chinese Parents

Science.gov (United States)

Guo, Mingchun; Morawska, Alina; Filus, Ania

2017-01-01

This study validated a parent-report measure of the Parenting and Family Adjustment Scales in a Chinese cultural context through investigating 650 Chinese parents. The results provided evidence for satisfactory reliability and validity of Parenting and Family Adjustment Scales in a Chinese context, which is thus promising to be used for Chinese…

Machinability of lithium disilicate glass ceramic in in vitro dental diamond bur adjusting process.

Science.gov (United States)

Song, Xiao-Fei; Ren, Hai-Tao; Yin, Ling

2016-01-01

Esthetic high-strength lithium disilicate glass ceramics (LDGC) are used for monolithic crowns and bridges produced in dental CAD/CAM and oral adjusting processes, which machinability affects the restorative quality. A machinability study has been made in the simulated oral clinical machining of LDGC with a dental handpiece and diamond burs, regarding the diamond tool wear and chip control, machining forces and energy, surface finish and integrity. Machining forces, speeds and energy in in vitro dental adjusting of LDGC were measured by a high-speed data acquisition and force sensor system. Machined LDGC surfaces were assessed using three-dimensional non-contact chromatic confocal optical profilometry and scanning electron microscopy (SEM). Diamond bur morphology and LDGC chip shapes were also examined using SEM. Minimum tool wear but significant LDGC chip accumulations were found. Machining forces and energy significantly depended on machining conditions (pceramics (pceramics (pceramics. Surface roughness for machined LDGC was comparable for other glass ceramics. The removal mechanisms of LDGC were dominated by penetration-induced brittle fracture and shear-induced plastic deformation. Unlike most other glass ceramics, distinct intergranular and transgranular fractures of lithium disilicate crystals were found in LDGC. This research provides the fundamental data for dental clinicians on the machinability of LDGC in intraoral adjustments. Copyright © 2015 Elsevier Ltd. All rights reserved.

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...

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...

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

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

Case-Mix Adjustment of the Bereaved Family Survey.

Science.gov (United States)

Kutney-Lee, Ann; Carpenter, Joan; Smith, Dawn; Thorpe, Joshua; Tudose, Alina; Ersek, Mary

2018-01-01

Surveys of bereaved family members are increasingly being used to evaluate end-of-life (EOL) care and to measure organizational performance in EOL care quality. The Bereaved Family Survey (BFS) is used to monitor EOL care quality and benchmark performance in the Veterans Affairs (VA) health-care system. The objective of this study was to develop a case-mix adjustment model for the BFS and to examine changes in facility-level scores following adjustment, in order to provide fair comparisons across facilities. We conducted a cross-sectional secondary analysis of medical record and survey data from veterans and their family members across 146 VA medical centers. Following adjustment using model-based propensity weighting, the mean change in the BFS-Performance Measure score across facilities was -0.6 with a range of -2.6 to 0.6. Fifty-five (38%) facilities changed within ±0.5 percentage points of their unadjusted score. On average, facilities that benefited most from adjustment cared for patients with greater comorbidity burden and were located in urban areas in the Northwest and Midwestern regions of the country. Case-mix adjustment results in minor changes to facility-level BFS scores but allows for fairer comparisons of EOL care quality. Case-mix adjustment of the BFS positions this National Quality Forum-endorsed measure for use in public reporting and internal quality dashboards for VA leadership and may inform the development and refinement of case-mix adjustment models for other surveys of bereaved family members.

Case mix adjustment of health outcomes, resource use and process indicators in childbirth care: a register-based study.

Science.gov (United States)

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

2016-05-31

Unwarranted variation in care practice and outcomes has gained attention and inter-hospital comparisons are increasingly being used to highlight and understand differences between hospitals. Adjustment for case mix is a prerequisite for meaningful comparisons between hospitals with different patient populations. The objective of this study was to identify and quantify maternal characteristics that impact a set of important indicators of health outcomes, resource use and care process and which could be used for case mix adjustment of comparisons between hospitals. In this register-based study, 139 756 deliveries in 2011 and 2012 were identified in regional administrative systems from seven Swedish regions, which together cover 67 % of all deliveries in Sweden. Data were linked to the Medical birth register and Statistics Sweden's population data. A number of important indicators in childbirth care were studied: Caesarean section (CS), induction of labour, length of stay, perineal tears, haemorrhage > 1000 ml and post-partum infections. Sociodemographic and clinical characteristics deemed relevant for case mix adjustment of outcomes and resource use were identified based on previous literature and based on clinical expertise. Adjustment using logistic and ordinary least squares regression analysis was performed to quantify the impact of these characteristics on the studied indicators. Almost all case mix factors analysed had an impact on CS rate, induction rate and length of stay and the effect was highly statistically significant for most factors. Maternal age, parity, fetal presentation and multiple birth were strong predictors of all these indicators but a number of additional factors such as born outside the EU, body mass index (BMI) and several complications during pregnancy were also important risk factors. A number of maternal characteristics had a noticeable impact on risk of perineal tears, while the impact of case mix factors was less pronounced for

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.

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 ...

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 ...

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.

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...

Development and Validation of Perioperative Risk-Adjustment Models for Hip Fracture Repair, Total Hip Arthroplasty, and Total Knee Arthroplasty.

Science.gov (United States)

Schilling, Peter L; Bozic, Kevin J

2016-01-06

Comparing outcomes across providers requires risk-adjustment models that account for differences in case mix. The burden of data collection from the clinical record can make risk-adjusted outcomes difficult to measure. The purpose of this study was to develop risk-adjustment models for hip fracture repair (HFR), total hip arthroplasty (THA), and total knee arthroplasty (TKA) that weigh adequacy of risk adjustment against data-collection burden. We used data from the American College of Surgeons National Surgical Quality Improvement Program to create derivation cohorts for HFR (n = 7000), THA (n = 17,336), and TKA (n = 28,661). We developed logistic regression models for each procedure using age, sex, American Society of Anesthesiologists (ASA) physical status classification, comorbidities, laboratory values, and vital signs-based comorbidities as covariates, and validated the models with use of data from 2012. The derivation models' C-statistics for mortality were 80%, 81%, 75%, and 92% and for adverse events were 68%, 68%, 60%, and 70% for HFR, THA, TKA, and combined procedure cohorts. Age, sex, and ASA classification accounted for a large share of the explained variation in mortality (50%, 58%, 70%, and 67%) and adverse events (43%, 45%, 46%, and 68%). For THA and TKA, these three variables were nearly as predictive as models utilizing all covariates. HFR model discrimination improved with the addition of comorbidities and laboratory values; among the important covariates were functional status, low albumin, high creatinine, disseminated cancer, dyspnea, and body mass index. Model performance was similar in validation cohorts. Risk-adjustment models using data from health records demonstrated good discrimination and calibration for HFR, THA, and TKA. It is possible to provide adequate risk adjustment using only the most predictive variables commonly available within the clinical record. This finding helps to inform the trade-off between model performance and data

7 CFR 4287.112 - Interest rate adjustments.

Science.gov (United States)

2010-01-01

... 7 Agriculture 15 2010-01-01 2010-01-01 false Interest rate adjustments. 4287.112 Section 4287.112... Loans § 4287.112 Interest rate adjustments. (a) Reductions. The borrower, lender, and holder (if any) may collectively initiate a permanent or temporary reduction in the interest rate of the guaranteed...

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…

5 CFR 831.702 - Adjustment of annuities.

Science.gov (United States)

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Adjustment of annuities. 831.702 Section... (CONTINUED) RETIREMENT Computation of Annuities § 831.702 Adjustment of annuities. (a)(1) An annuity which... benefit shall require a corresponding deduction in the civil service annuity. (3) Any cost-of-living...

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...

Metabolic profile of clinically severe obese patients.

Science.gov (United States)

Faria, Silvia Leite; Faria, Orlando Pereira; Menezes, Caroline Soares; de Gouvêa, Heloisa Rodrigues; de Almeida Cardeal, Mariane

2012-08-01

Since low basal metabolic rate (BMR) is a risk factor for weight regain, it is important to measure BMR before bariatric surgery. We aimed to evaluate the BMR among clinically severe obese patients preoperatively. We compared it with that of the control group, with predictive formulas and correlated it with body composition. We used indirect calorimetry (IC) to collect BMR data and multifrequency bioelectrical impedance to collect body composition data. Our sample population consisted of 193 patients of whom 130 were clinically severe obese and 63 were normal/overweight individuals. BMR results were compared with the following predictive formulas: Harris-Benedict (HBE), Bobbioni-Harsch (BH), Cunningham (CUN), Mifflin-St. Jeor (MSJE), and Horie-Waitzberg & Gonzalez (HW & G). This study was approved by the Ethics Committee for Research of the University of Brasilia. Statistical analysis was used to compare and correlate variables. Clinically severe obese patients had higher absolute BMR values and lower adjusted BMR values (p BMR were found in both groups. Among the clinically severe obese patients, the formulas of HW & G and HBE overestimated BMR values (p = 0.0002 and p = 0.0193, respectively), while the BH and CUN underestimated this value; only the MSJE formulas showed similar results to those of IC. The clinically severe obese patients showed low BMR levels when adjusted per kilogram per body weight. Body composition may influence BMR. The use of the MSJE formula may be helpful in those cases where it is impossible to use IC.

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...

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...

17 CFR 143.8 - Inflation-adjusted civil monetary penalties.

Science.gov (United States)

2010-04-01

... 17 Commodity and Securities Exchanges 1 2010-04-01 2010-04-01 false Inflation-adjusted civil... JURISDICTION General Provisions § 143.8 Inflation-adjusted civil monetary penalties. (a) Unless otherwise amended by an act of Congress, the inflation-adjusted maximum civil monetary penalty for each violation of...

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.

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)

25 CFR 39.145 - Can a school receive both a small school adjustment and a small high school adjustment?

Science.gov (United States)

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Can a school receive both a small school adjustment and a small high school adjustment? 39.145 Section 39.145 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR EDUCATION THE INDIAN SCHOOL EQUALIZATION PROGRAM Indian School Equalization Formula Small School...

Chief medical clinic manager of a university OB/GYN clinic--an innovative job description as management response for increase of profitability, quality of care, and physicians' freedom of action.

Science.gov (United States)

Jacobs, Volker R; Mallmann, Peter

2010-01-01

Leadership structures in German clinics are adjusting parallel to DRG (diagnose-related groups)-induced economic reorientation of the health care system. A Chief Medical Clinic Manager (CMCM) is a new job description and an innovative approach to combine medical competence and business economics at the operational level of care. The ideal qualification is a medical specialist in the clinical field with practical experience in patient care and leadership as well as in hospital economics and quality control. A CMCM is placed at a superior level in the clinic, with authorizing competence for the entire physician team. Main tasks are cost transparency within the clinic, organizational development by structured processes, and financial and strategic controlling of all business aspects. A CMCM induces change management and financial adjustment of care to reimbursement with maintaining the standard of care. In cooperation with the director of the clinic, a CMCM develops a vision for clinic development, an investment strategy, and a business plan. The success parameters are positive operative results of the clinic, cost-covering care, increased investment rate, employee satisfaction, and implementation of innovations in research and therapy. A CMCM thereby increases financial and organizational freedom of action at the clinic level in a non-profit public health care system.

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...

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

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...

The Unified Levelling Network of Sarawak and its Adjustment

Science.gov (United States)

Som, Z. A. M.; Yazid, A. M.; Ming, T. K.; Yazid, N. M.

2016-09-01

The height reference network of Sarawak has seen major improvement in over the past two decades. The most significant improvement was the establishment of extended precise leveling network of which is now able to connect all three major datum points at Pulau Lakei, Original and Bintulu. Datum by following the major accessible routes across Sarawak. This means the leveling network in Sarawak has now been inter-connected and unified. By having such a unified network leads to the possibility of having a common single least squares adjustment been performed for the first time. The least squares adjustment of this unified levelling network was attempted in order to compute the height of all Bench Marks established in the entire levelling network. The adjustment was done by using MoreFix levelling adjustment package developed at FGHT UTM. The computational procedure adopted is linear parametric adjustment by minimum constraint. Since Sarawak has three separate datums therefore three separate adjustments were implemented by utilizing datum at Pulau Lakei, Original Miri and Bintulu Datum respectively. Results of the MoreFix unified adjustment agreed very well with adjustment repeated using Starnet. Further the results were compared with solution given by Jupem and they are in good agreement as well. The difference in height analysed were within 10mm for the case of minimum constraint at Pulau Lakei datum and with much better agreement in the case of Original Miri Datum.

THE UNIFIED LEVELLING NETWORK OF SARAWAK AND ITS ADJUSTMENT

Directory of Open Access Journals (Sweden)

Z. A. M. Som

2016-09-01

Full Text Available The height reference network of Sarawak has seen major improvement in over the past two decades. The most significant improvement was the establishment of extended precise leveling network of which is now able to connect all three major datum points at Pulau Lakei, Original and Bintulu. Datum by following the major accessible routes across Sarawak. This means the leveling network in Sarawak has now been inter-connected and unified. By having such a unified network leads to the possibility of having a common single least squares adjustment been performed for the first time. The least squares adjustment of this unified levelling network was attempted in order to compute the height of all Bench Marks established in the entire levelling network. The adjustment was done by using MoreFix levelling adjustment package developed at FGHT UTM. The computational procedure adopted is linear parametric adjustment by minimum constraint. Since Sarawak has three separate datums therefore three separate adjustments were implemented by utilizing datum at Pulau Lakei, Original Miri and Bintulu Datum respectively. Results of the MoreFix unified adjustment agreed very well with adjustment repeated using Starnet. Further the results were compared with solution given by Jupem and they are in good agreement as well. The difference in height analysed were within 10mm for the case of minimum constraint at Pulau Lakei datum and with much better agreement in the case of Original Miri Datum.

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

[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.

"Symptom-based insulin adjustment for glucose normalization" (SIGN) algorithm: a pilot study.

Science.gov (United States)

Lee, Joyce Yu-Chia; Tsou, Keith; Lim, Jiahui; Koh, Feaizen; Ong, Sooim; Wong, Sabrina

2012-12-01

Lack of self-monitoring of blood glucose (SMBG) records in actual practice settings continues to create therapeutic challenges for clinicians, especially in adjusting insulin therapy. In order to overcome this clinical obstacle, a "Symptom-based Insulin adjustment for Glucose Normalization" (SIGN) algorithm was developed to guide clinicians in caring for patients with uncontrolled type 2 diabetes who have few to no SMBG records. This study examined the clinical outcome and safety of the SIGN algorithm. Glycated hemoglobin (HbA1c), insulin usage, and insulin-related adverse effects of a total of 114 patients with uncontrolled type 2 diabetes who refused to use SMBG or performed SMBG once a day for less than three times per week were studied 3 months prior to the implementation of the algorithm and prospectively at every 3-month interval for a total of 6 months after the algorithm implementation. Patients with type 1 diabetes, nonadherence to diabetes medications, or who were not on insulin therapy at any time during the study period were excluded from this study. Mean HbA1c improved by 0.29% at 3 months (P = 0.015) and 0.41% at 6 months (P = 0.006) after algorithm implementation. A slight increase in HbA1c was observed when the algorithm was not implemented. There were no major hypoglycemic episodes. The number of minor hypoglycemic episodes was minimal with the majority of the cases due to irregular meal habits. The SIGN algorithm appeared to offer a viable and safe approach when managing uncontrolled patients with type 2 diabetes who have few to no SMBG records.

LSL: a logarithmic least-squares adjustment method

International Nuclear Information System (INIS)

Stallmann, F.W.

1982-01-01

To meet regulatory requirements, spectral unfolding codes must not only provide reliable estimates for spectral parameters, but must also be able to determine the uncertainties associated with these parameters. The newer codes, which are more appropriately called adjustment codes, use the least squares principle to determine estimates and uncertainties. The principle is simple and straightforward, but there are several different mathematical models to describe the unfolding problem. In addition to a sound mathematical model, ease of use and range of options are important considerations in the construction of adjustment codes. Based on these considerations, a least squares adjustment code for neutron spectrum unfolding has been constructed some time ago and tentatively named LSL

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...

Anatomically constrained dipole adjustment (ANACONDA) for accurate MEG/EEG focal source localizations

Science.gov (United States)

Im, Chang-Hwan; Jung, Hyun-Kyo; Fujimaki, Norio

2005-10-01

This paper proposes an alternative approach to enhance localization accuracy of MEG and EEG focal sources. The proposed approach assumes anatomically constrained spatio-temporal dipoles, initial positions of which are estimated from local peak positions of distributed sources obtained from a pre-execution of distributed source reconstruction. The positions of the dipoles are then adjusted on the cortical surface using a novel updating scheme named cortical surface scanning. The proposed approach has many advantages over the conventional ones: (1) as the cortical surface scanning algorithm uses spatio-temporal dipoles, it is robust with respect to noise; (2) it requires no a priori information on the numbers and initial locations of the activations; (3) as the locations of dipoles are restricted only on a tessellated cortical surface, it is physiologically more plausible than the conventional ECD model. To verify the proposed approach, it was applied to several realistic MEG/EEG simulations and practical experiments. From the several case studies, it is concluded that the anatomically constrained dipole adjustment (ANACONDA) approach will be a very promising technique to enhance accuracy of focal source localization which is essential in many clinical and neurological applications of MEG and EEG.

Anatomically constrained dipole adjustment (ANACONDA) for accurate MEG/EEG focal source localizations

International Nuclear Information System (INIS)

Im, Chang-Hwan; Jung, Hyun-Kyo; Fujimaki, Norio

2005-01-01

This paper proposes an alternative approach to enhance localization accuracy of MEG and EEG focal sources. The proposed approach assumes anatomically constrained spatio-temporal dipoles, initial positions of which are estimated from local peak positions of distributed sources obtained from a pre-execution of distributed source reconstruction. The positions of the dipoles are then adjusted on the cortical surface using a novel updating scheme named cortical surface scanning. The proposed approach has many advantages over the conventional ones: (1) as the cortical surface scanning algorithm uses spatio-temporal dipoles, it is robust with respect to noise; (2) it requires no a priori information on the numbers and initial locations of the activations; (3) as the locations of dipoles are restricted only on a tessellated cortical surface, it is physiologically more plausible than the conventional ECD model. To verify the proposed approach, it was applied to several realistic MEG/EEG simulations and practical experiments. From the several case studies, it is concluded that the anatomically constrained dipole adjustment (ANACONDA) approach will be a very promising technique to enhance accuracy of focal source localization which is essential in many clinical and neurological applications of MEG and EEG

Can the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) be used to accurately report clinic total reproductive potential (TRP)?

Science.gov (United States)

Stern, Judy E; Hickman, Timothy N; Kinzer, Donna; Penzias, Alan S; Ball, G David; Gibbons, William E

2012-04-01

To assess whether total reproductive potential (TRP), the chance of a live birth from each fresh cycle (fresh cycle plus frozen transfers), could be calculated from the national Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) database and whether information not available in SART CORS resulted in significant changes to the TRP calculation. Retrospective study using SART CORS and clinic data. Three assisted reproductive technology clinics. Women undergoing ART. None. Two- and three-year TRPs for 2005 and 2006 were calculated according to patient age at cycle start by linking fresh to frozen cycles up to first live birth. Clinic records were used to adjust for (remove) frozen cycles that used more than one fresh cycle as a source of embryos and for any embryos donated to other patients or research or shipped to another facility before a live birth. TRP was higher than fresh per-cycle rates for most ages at all clinics, although accuracy was compromised when there were fewer than 20 cycles per category. Two- and 3-year TRPs differed in only 2 of 24 calculations. Adjusted TRPs differed less than three percentage points from unadjusted TRPs when volume was sufficient. Clinic TRP can be calculated from SART CORS. Data suggest that calculations of clinic TRP from the national dataset would be meaningful. Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

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…

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)

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

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).

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

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...

AUTOTRANSPLANTATION OF THE LUNG: EXPERIMENTAL ...

African Journals Online (AJOL)

Johns Hopkins Hospital, Baltimore, Maryland, USA; AND M. G. LOTTER, M.Sc., Medical Physics Division,. Karl Bremer Hospital and the ... clinically in the treatment of severe bronchial asthma in man,"'lS with some improvement ..... regeneration occurs, but it may be responsible for the gradual improvement in perfusion of ...

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.

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

Risk adjustment for case mix and the effect of surgeon volume on morbidity.

Science.gov (United States)

Maas, Matthew B; Jaff, Michael R; Rordorf, Guy A

2013-06-01

complications. Variables selected for risk adjustment in studies using administrative databases appear to be inadequate to control for case mix bias between low-volume and high-volume surgeons. Risk adjustment should empirically analyze for case mix imbalances between surgeons to identify meaningful risk modifiers in clinical practice such as the American Society of Anesthesiologists Physical Status classification. A true relationship between surgeon volume and outcomes remains uncertain, and caution is advised in developing policies based on these findings.

Job adjustment as a means to reduce sickness absence during pregnancy.

Science.gov (United States)

Strand, K; Wergeland, E; Bjerkedal, T

1997-10-01

This study examined the effect of job adjustment on sickness absence during pregnancy and also determined the conditions under which such adjustments are obtained. Data were derived from a nationally representative survey on work conditions during pregnancy in Norway in 1989. For employees (N = 2713) remaining in the same job throughout pregnancy, the percentage of women on sick leave immediately before delivery was determined according to the need for job adjustment and the obtainment of job adjustment. Those obtaining job adjustment were grouped according to workplace size, labor-market sector, co-worker gender, educational level, work schedules, weekly workhours, children under 16 years of age in the household, and age. All told, 1691 women (62.3%) needed job adjustment, among whom 936 (55.4%) obtained such adjustment. The proportions of those on sick leave before delivery were 45.2% for "no need", 67.9% for "need - adjustment obtained", and 79.2% for "need - adjustment not obtained". In the last category, the difference (versus "adjustment obtained") constituted 44.5% of the weeks lost because of sickness absence in the last half of pregnancy. The odds ratio (OR) for obtaining job adjustment was larger for workplaces with more than 50 employees (OR 1.4) and smaller for jobs with work schedules other than daytime or shift work (OR 0.5) and also for women living with children under 16 years of age (OR 0.8). Job adjustment is associated with reduced sickness absence during pregnancy. Further studies should explore workplace characteristics that make it difficult to obtain such adjustments, as required by law.

Mexican-origin parents' work conditions and adolescents' adjustment.

Science.gov (United States)

Wheeler, Lorey A; Updegraff, Kimberly A; Crouter, Ann

2015-06-01

Mexican-origin parents' work experiences are a distal extrafamilial context for adolescents' adjustment. This 2-wave multiinformant study examined the prospective mechanisms linking parents' work conditions (i.e., self-direction, work pressure, workplace discrimination) to adolescents' adjustment (i.e., educational expectations, depressive symptoms, risky behavior) across the transition to high school drawing on work socialization and spillover models. We examined the indirect effects of parental work conditions on adolescent adjustment through parents' psychological functioning (i.e., depressive symptoms, role overload) and aspects of the parent-adolescent relationship (i.e., parental solicitation, parent-adolescent conflict), as well as moderation by adolescent gender. Participants were 246 predominantly immigrant, Mexican-origin, 2-parent families who participated in home interviews when adolescents were approximately 13 and 15 years of age. Results supported the positive impact of fathers' occupational self-direction on all 3 aspects of adolescents' adjustment through decreased father-adolescent conflict, after controlling for family socioeconomic status and earner status, and underemployment. Parental work pressure and discrimination were indirectly linked to adolescents' adjustment, with different mechanisms emerging for mothers and fathers. Adolescents' gender moderated the associations between fathers' self-direction and girls' depressive symptoms, and fathers' experiences of discrimination and boys' risk behavior. Results suggest that Mexican-origin mothers' and fathers' perceptions of work conditions have important implications for multiple domains of adolescents' adjustment across the transition to high school. (c) 2015 APA, all rights reserved).

Patient mental adjustment to selected types of cancer.

Science.gov (United States)

Religioni, Urszula; Czerw, Aleksandra; Deptała, Andrzej

2018-02-28

Physical symptoms related to cancer are associated with various mental conditions. An adopted attitude towards pain and disease affects the quality of life of patients and may even decide about the final outcome of therapy. The objective of the study was to assess the degree of mental adjustment of patients diagnosed with breast, lung, colorectal and prostate cancer. The analysis also covered the effect of socioeconomic factors on mental adjustment in patients in the above groups. The study included 902 patients treated on an outpatient basis at the Center of Oncology, the Maria Skłodowska-Curie Institute in Warsaw, in the year 2013. The study participants were patients diagnosed with breast, lung, colorectal and prostate carcinoma. The Paper and Pencil Interview (PAPI) technique was applied. The questionnaire interview included demographic-type questions (socioeconomic variables) and the Mini-Mental Adjustment to Cancer (mini-MAC) scale, which measures the degree of mental adjustment to disease. The highest scores in the anxious preoccupation and helplessness-hopelessness subclasses were those of the lung, colorectal, breast and prostate cancer patients. In breast and lung cancer study participants, differences between individual categories distinguished due to socioeconomic features proved statistically insignificant. However, significant dependencies were observed between mental adjustment to disease and chemotherapy in the past year; though, the results differ with respect to the primary site. The primary site affects patient adjustment to disease. Socioeconomic factors in the area of mental adaptation differentiate colorectal carcinoma patients.

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.

College Adjustment of First Year Students: The Role of Social Anxiety

Directory of Open Access Journals (Sweden)

Ruseno Arjanggi

2016-05-01

Full Text Available This research aims to analyze the correlation between social anxiety and college adjustment. 436 undergraduate psychology students of five universities in Central Java were involved in this study. All respondents completed a questionnaire about student adjustment to college, and social anxiety scale. Canonical correlation was conducted to analyze the data. The result showed that fear of negative evaluation correlates with academic and personal-emotional adjustment, but not with social adjustment and institutional adjustment, while social avoidance and distress correlate with all of the dependent variables. This study suggests about the role of social anxiety to college adjustment. These findings investigate further discussion about appropriate intervention to address adjustment problems among college students.

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

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

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...

75 FR 63437 - Trade Adjustment Assistance for Farmers

Science.gov (United States)

2010-10-15

... DEPARTMENT OF AGRICULTURE Foreign Agricultural Service Trade Adjustment Assistance for Farmers... Service and reviewed by the TAA for Farmers Program Review Committee, comprised of representatives from... assistance in FY 2011. FOR FURTHER INFORMATION CONTACT: Trade Adjustment Assistance for Farmers Program Staff...

75 FR 23226 - 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... Web site for the Trade Adjustment Assistance for Farmers program. The URL is http://www.fas.usda.gov...

Real-time adjustment of ventricular restraint therapy in heart failure.

Science.gov (United States)

Ghanta, Ravi K; Lee, Lawrence S; Umakanthan, Ramanan; Laurence, Rita G; Fox, John A; Bolman, Ralph Morton; Cohn, Lawrence H; Chen, Frederick Y

2008-12-01

Current ventricular restraint devices do not allow for either the measurement or adjustment of ventricular restraint level. Periodic adjustment of restraint level post-device implantation may improve therapeutic efficacy. We evaluated the feasibility of an adjustable quantitative ventricular restraint (QVR) technique utilizing a fluid-filled polyurethane epicardial balloon to measure and adjust restraint level post-implantation guided by physiologic parameters. QVR balloons were implanted in nine ovine with post-infarction dilated heart failure. Restraint level was defined by the maximum restraint pressure applied by the balloon to the epicardium at end-diastole. An access line connected the balloon lumen to a subcutaneous portacath to allow percutaneous access. Restraint level was adjusted while left ventricular (LV) end-diastolic volume (EDV) and cardiac output was assessed with simultaneous transthoracic echocardiography. All nine ovine successfully underwent QVR balloon implantation. Post-implantation, restraint level could be measured percutaneously in real-time and dynamically adjusted by instillation and withdrawal of fluid from the balloon lumen. Using simultaneous echocardiography, restraint level could be adjusted based on LV EDV and cardiac output. After QVR therapy for 21 days, LV EDV decreased from 133+/-15 ml to 113+/-17 ml (p<0.05). QVR permits real-time measurement and physiologic adjustment of ventricular restraint therapy after device implantation.

The empty wagons adjustment algorithm of Chinese heavy-haul railway

International Nuclear Information System (INIS)

Zhang, Jinchuan; Yang, Hao; Wei, Yuguang; Shang, Pan

2016-01-01

The paper studied the problem of empty wagons adjustment of Chinese heavy-haul railway. Firstly, based on the existing study of the empty wagons adjustment of heavy-haul railway in the world, Chinese heavy-haul railway was analyzed, especially the mode of transportation organization and characteristics of empty wagons adjustment. Secondly, the optimization model was set up to solve the empty wagons adjustment of heavy-haul railway and the model took the minimum idling period as the function goal. Finally, through application and solution of one case, validity and practicability of model and algorithm had been proved. So, the model could offer decision support to transport enterprises on adjusting empty wagons.

75 FR 59683 - Trade Adjustment Assistance for Farmers

Science.gov (United States)

2010-09-28

... DEPARTMENT OF AGRICULTURE Foreign Agricultural Service Trade Adjustment Assistance for Farmers... Adjustment Assistance for Farmers Program Review Committee, comprised of representatives from USDA's Office... for Farmers Program Staff, Office of Trade Programs, FAS, USDA; or by phone at (202) 720-0638, or (202...

The Impact of Macro-adjustment Programmes on Housing ...

African Journals Online (AJOL)

The Impact of Macro-adjustment Programmes on Housing Investment in Kampala City, Uganda: Shelter Implications for the Urban Poor. ... Eastern Africa Social Science Research Review ... The adjustment methodology has side-lined and gravely undermined the housing sector thereby aggravating the shelter problem.

75 FR 17462 - Quarterly Rail Cost Adjustment Factor

Science.gov (United States)

2010-04-06

... decision may be purchased by contacting the office of Public Assistance, Governmental Affairs, and...-2)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board has approved the second quarter 2010 Rail Cost...

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

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

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.

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...

75 FR 48931 - Trade Adjustment Assistance for Farmers

Science.gov (United States)

2010-08-12

... DEPARTMENT OF AGRICULTURE Foreign Agricultural Service Trade Adjustment Assistance for Farmers... assistance and cash benefits. FOR FURTHER INFORMATION CONTACT: Trade Adjustment Assistance for Farmers....usda.gov ; or visit the TAA for Farmers' Web site: www.fas.usda.gov/itp/taa . Dated: July 30, 2010...

75 FR 48642 - Trade Adjustment Assistance for Farmers

Science.gov (United States)

2010-08-11

... DEPARTMENT OF AGRICULTURE Foreign Agricultural Service Trade Adjustment Assistance for Farmers... benefits. FOR FURTHER INFORMATION CONTACT: Trade Adjustment Assistance for Farmers Program Staff, FAS, USDA... the TAA for Farmers' Web site: http://www.fas.usda.gov/itp/taa . Dated: July 30, 2010. John D. Brewer...

75 FR 49458 - Trade Adjustment Assistance for Farmers

Science.gov (United States)

2010-08-13

... DEPARTMENT OF AGRICULTURE Foreign Agricultural Service Trade Adjustment Assistance for Farmers... and cash benefits. FOR FURTHER INFORMATION CONTACT: Trade Adjustment Assistance for Farmers Program....gov ; or visit the TAA for Farmers' Web site: http://www.fas.usda.gov/itp/taa . Dated: August 3, 2010...

75 FR 11513 - Trade Adjustment Assistance for Farmers

Science.gov (United States)

2010-03-11

... DEPARTMENT OF AGRICULTURE Foreign Agricultural Service Trade Adjustment Assistance for Farmers... Service (FAS), will begin accepting Trade Adjustment Assistance (TAA) for Farmers petitions for fiscal... received by the TAA for Farmers Staff by close of business April 14, 2010. The petition must be sent in...

75 FR 49886 - Trade Adjustment Assistance for Farmers

Science.gov (United States)

2010-08-16

... DEPARTMENT OF AGRICULTURE Foreign Agricultural Service Trade Adjustment Assistance for Farmers... INFORMATION CONTACT: Trade Adjustment Assistance for Farmers Program Staff, FAS, USDA by phone: (202) 720-0638... for Farmers' Web site: http://www.fas.usda.gov/itp/taa . Dated: August 3, 2010. Suzanne Hale, Acting...

75 FR 42375 - Trade Adjustment Assistance for Farmers

Science.gov (United States)

2010-07-21

... DEPARTMENT OF AGRICULTURE Foreign Agricultural Service Trade Adjustment Assistance for Farmers... INFORMATION CONTACT: Trade Adjustment Assistance for Farmers Staff, FAS, USDA, by phone: (202) 720-0638, or (202) 690-0633; or by e-mail: [email protected] ; or visit the TAA for Farmers' Web site...

Relationship between Parenting Styles and Marital Adjustment of ...

African Journals Online (AJOL)

The data obtained from these instruments were subjected to multiple regression analysis using SPSS and the results showed that there was a low, positive and significant relationship between authoritative parenting style and marital adjustment. The relationship between authoritarian parenting style and marital adjustment ...

77 FR 76169 - Quarterly Rail Cost Adjustment Factor

Science.gov (United States)

2012-12-26

....stb.dot.gov . Copies of the decision may be purchased by contacting the Office of Public Assistance...)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board, DOT. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board has approved the AAR's proposed rebasing calculations and...

Development and Evaluation of an Automated Machine Learning Algorithm for In-Hospital Mortality Risk Adjustment Among Critical Care Patients.

Science.gov (United States)

Delahanty, Ryan J; Kaufman, David; Jones, Spencer S

2018-06-01

Risk adjustment algorithms for ICU mortality are necessary for measuring and improving ICU performance. Existing risk adjustment algorithms are not widely adopted. Key barriers to adoption include licensing and implementation costs as well as labor costs associated with human-intensive data collection. Widespread adoption of electronic health records makes automated risk adjustment feasible. Using modern machine learning methods and open source tools, we developed and evaluated a retrospective risk adjustment algorithm for in-hospital mortality among ICU patients. The Risk of Inpatient Death score can be fully automated and is reliant upon data elements that are generated in the course of usual hospital processes. One hundred thirty-one ICUs in 53 hospitals operated by Tenet Healthcare. A cohort of 237,173 ICU patients discharged between January 2014 and December 2016. The data were randomly split into training (36 hospitals), and validation (17 hospitals) data sets. Feature selection and model training were carried out using the training set while the discrimination, calibration, and accuracy of the model were assessed in the validation data set. Model discrimination was evaluated based on the area under receiver operating characteristic curve; accuracy and calibration were assessed via adjusted Brier scores and visual analysis of calibration curves. Seventeen features, including a mix of clinical and administrative data elements, were retained in the final model. The Risk of Inpatient Death score demonstrated excellent discrimination (area under receiver operating characteristic curve = 0.94) and calibration (adjusted Brier score = 52.8%) in the validation dataset; these results compare favorably to the published performance statistics for the most commonly used mortality risk adjustment algorithms. Low adoption of ICU mortality risk adjustment algorithms impedes progress toward increasing the value of the healthcare delivered in ICUs. The Risk of Inpatient Death

Risk-adjusted capitation: recent experiences in The Netherlands.

Science.gov (United States)

van de Ven, W P; van Vliet, R C; van Barneveld, E M; Lamers, L M

1994-01-01

The market-oriented health care reforms taking place in the Netherlands show a clear resemblance to the proposals for managed competition in U.S. health care. In both countries good risk adjustment mechanisms that prevent cream skimming--that is, that prevent plans from selecting the best health risks--are critical to the success of the reforms. In this paper we present an overview of the Dutch reforms and of our research concerning risk-adjusted capitation payments. Although we are optimistic about the technical possibilities for solving the problem of cream skimming, the implementation of good risk-adjusted capitation is a long-term challenge.

First test results for an adjustable phase undulator

International Nuclear Information System (INIS)

Carr, R.; Nuhn, H.D.; Corbett, J.

1992-01-01

An Adjustable Phase Undulator (APU) was installed and tested on the beamline 5 of the SPEAR storage ring. The APU has the same magnetic structure as a conventional adjustable gap undulator (AGU), but its magnetic field is varied by changing the longitudinal position between the rows of magnets, while keeping the gap between them fixed. The tests described here show that this undulator performs according to theoretical predictions and numerical models. The main reason to consider a phase adjustable design is the substantial reduction in size, complexity, and cost over comparable conventional designs. (author) 4 refs.; 3 figs

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...

Gauge-adjusted rainfall estimates from commercial microwave links

Directory of Open Access Journals (Sweden)

M. Fencl

2017-01-01

experimental layouts of ground truth from rain gauges (RGs with different spatial and temporal resolutions. The results suggest that CMLs adjusted by RGs with a temporal aggregation of up to 1 h (i provide precise high-resolution QPEs (relative error  < 7 %, Nash–Sutcliffe efficiency coefficient  >  0.75 and (ii that the combination of both sensor types clearly outperforms each individual monitoring system. Unfortunately, adjusting CML observations to RGs with longer aggregation intervals of up to 24 h has drawbacks. Although it substantially reduces bias, it unfavourably smoothes out rainfall peaks of high intensities, which is undesirable for stormwater management. A similar, but less severe, effect occurs due to spatial averaging when CMLs are adjusted to remote RGs. Nevertheless, even here, adjusted CMLs perform better than RGs alone. Furthermore, we provide first evidence that the joint use of multiple CMLs together with RGs also reduces bias in their QPEs. In summary, we believe that our adjustment method has great potential to improve the space–time resolution of current urban rainfall monitoring networks. Nevertheless, future work should aim to better understand the reason for the observed systematic error in QPEs from CMLs.

The connection between dysfunctional relationship beliefs and dyadic adjustment

Directory of Open Access Journals (Sweden)

Filipović Severina

2014-01-01

Full Text Available The purpose of this study was to determine the connection between dyadic adjustment and dysfunctional relationship beliefsthat are discussed in the contemporary cognitive-behavioural perspective. Given the nature of personal relationships, the study included intrapersonal and interpersonal approach. The intrapersonal approach suggests that one's perception of dyadic adjustment is determined by one's own personality characteristics, while the interpersonal approach suggests that one's partner's characteristics have influence, too. Accordingly, it was assumed that people perceive their marriages as less adjusted if they themselves and their partner have more pronounced dysfunctional beliefs. The sample consisted of 100 married couples from Serbia aged 20-64 years (M=41.8. The participants completed the Relationship Beliefs Questionnaire and the Dyadic Adjustment Scale. Significant intrapersonal effects of relationship beliefs on theperceived dyadic adjustment were found for both genders. Expected intrapersonal effects were found only in the female sample. Additionally, unexpected positive effects of certain groups of relationship beliefs(e.g. romantic idealism were found.

Transgressive first clinical experiences

DEFF Research Database (Denmark)

Jensen, Carsten Juul; Jeppesen, Lise Kofoed; Drachmann, Merete

2014-01-01

. The nursing students’ learning seems to be oriented towards socialization in the clinic as a workplace. This means that the nursing students seek to deal with overwhelming experiences concerning the naked bodies of patients and death, useful application of theoretical knowledge, the path from novice...... to advanced beginner, and adjusting to the workplace community. The conclusion is that the learning of nursing students during their first clinical in-service placement appears informal and not founded on evident best practice....... graduation as a Nurse. The Study has a qualitative methodology, inspired by Michael Eraut’s thoughts on learning in the workplace. When the workplace perspective is applied, learning seems to be concentrated on actual situations which the Learner is in, in contrast to employing constructed concepts...

5 CFR 837.505 - Cost-of-living adjustments on Member annuities.

Science.gov (United States)

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Cost-of-living adjustments on Member... Cost-of-living adjustments on Member annuities. (a) Applying cost-of-living adjustments to recomputed... appointive position subject to CSRS, will include the cost-of-living adjustments under section 8340 of title...

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.

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...

75 FR 43485 - Trade Adjustment Assistance for Farmers

Science.gov (United States)

2010-07-26

... Service Trade Adjustment Assistance for Farmers AGENCY: Foreign Agricultural Service, USDA. ACTION: Notice... cash benefits. FOR FURTHER INFORMATION CONTACT: Trade Adjustment Assistance for Farmers Staff, FAS... visit the TAA for Farmers' Web site: http://www.fas.usda.gov/itp/taa . Dated: July 14, 2010. John D...

75 FR 51978 - Trade Adjustment Assistance for Farmers

Science.gov (United States)

2010-08-24

... DEPARTMENT OF AGRICULTURE Foreign Agricultural Service Trade Adjustment Assistance for Farmers... CONTACT: Trade Adjustment Assistance for Farmers Program Staff, FAS, USDA by phone: (202) 720-0638 or (202) 690- 0633: or by e-mail at: [email protected] ; or visit the TAA for Farmers' Web site...

75 FR 28780 - Trade Adjustment Assistance for Farmers

Science.gov (United States)

2010-05-24

... DEPARTMENT OF AGRICULTURE Foreign Agricultural Service Trade Adjustment Assistance for Farmers... Service (FAS) will begin accepting Trade Adjustment Assistance (TAA) for Farmers petitions for Fiscal Year... TAA for Farmers Program as established by Subtitle C of Title I of the Trade Act of 2002 (Pub. L. 107...

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…

75 FR 35877 - Quarterly Rail Cost Adjustment Factor

Science.gov (United States)

2010-06-23

... available on our Web site, http://www.stb.dot.gov . Copies of the decision may be purchased by contacting...-3)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board has approved the third quarter 2010 rail cost...

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.

Modified adjustable suture hang-back recession: Description of technique and comparison with conventional adjustable hang-back recession

Directory of Open Access Journals (Sweden)

Siddharth Agrawal

2017-01-01

Full Text Available Purpose: This study aims to describe and compare modified hang-back recession with the conventional hang-back recession in large angle comitant exotropia (XT. Methods: A prospective, interventional, double-blinded, randomized study on adult patients (>18 years undergoing single eye recession-resection for large angle (>30 prism diopters constant comitant XT was conducted between January 2011 and December 2015. Patients in Group A underwent modified hang-back lateral rectus recession with adjustable knot while in Group B underwent conventional hang-back recession with an adjustable knot. Outcome parameters studied were readjustment rate, change in deviation at 6 weeks, complications and need for resurgery at 6 months. Results: The groups were comparable in terms of age and preoperative deviation. The patients with the modified hang back (Group A fared significantly better (P < 0.05 than those with conventional hang back (Group B in terms of lesser need for adjustment, greater correction in deviation at 6 weeks and lesser need for resurgery at 6 months. Conclusion: This modification offers several advantages, significantly reduces resurgery requirement and has no added complications.

Relation between premorbid adjustment, duration of untreated psychosis and close interpersonal trauma in first-episode psychosis

DEFF Research Database (Denmark)

Haahr, Ulrik Helt; Larsen, Tor Ketil; Simonsen, Erik

2018-01-01

Trauma Survey at their 5 years follow-up interview. RESULTS: Half of the patients reported that they had experienced interpersonal trauma and one-third reported having experienced close interpersonal trauma before the age of 18. Women reported more sexual abuse, physical attacks and emotional...... different types of trauma, in particular close interpersonal traumas experienced before the age of 18, premorbid factors and baseline clinical characteristics in a sample of first-episode psychosis patients. METHODS: A total of 191 patients from the 'TIPS' cohort completed assessment with the Brief Betrayal...... and physical maltreatment than men. There were significant associations between early interpersonal trauma and premorbid adjustment and duration of untreated psychosis, but no significant associations with length of education, comorbid substance use or baseline clinical symptomatology. CONCLUSIONS: Close...

Estimating the subjective value of future rewards: comparison of adjusting-amount and adjusting-delay procedures.

Science.gov (United States)

Holt, Daniel D; Green, Leonard; Myerson, Joel

2012-07-01

The present study examined whether equivalent discounting of delayed rewards is observed with different experimental procedures. If the underlying decision-making process is the same, then similar patterns of results should be observed regardless of procedure, and similar estimates of the subjective value of future rewards (i.e., indifference points) should be obtained. Two experiments compared discounting on three types of procedure: adjusting-delay (AD), adjusting-immediate-amount (AIA), and adjusting-delayed-amount (ADA). For the two procedures for which discounting functions can be established (i.e., AD and AIA), a hyperboloid provided good fits to the data at both the group and individual levels, and individuals' discounting on one procedure tended to be correlated with their discounting on the other. Notably, the AIA procedure produced the more consistent estimates of the degree of discounting, and in particular, discounting on the AIA procedure was unaffected by the order in which choices were presented. Regardless of which of the three procedures was used, however, similar patterns of results were obtained: Participants systematically discounted the value of delayed rewards, and robust magnitude effects were observed. Although each procedure may have its own advantages and disadvantages, use of all three types of procedure in the present study provided converging evidence for common decision-making processes underlying the discounting of delayed rewards. Copyright © 2012 Elsevier B.V. All rights reserved.

Genetic value of herd life adjusted for milk production.

Science.gov (United States)

Allaire, F R; Gibson, J P

1992-05-01

Cow herd life adjusted for lactational milk production was investigated as a genetic trait in the breeding objective. Under a simple model, the relative economic weight of milk to adjusted herd life on a per genetic standard deviation basis was equal to CVY/dCVL where CVY and CVL are the genetic coefficients of variation of milk production and adjusted herd life, respectively, and d is the depreciation per year per cow divided by the total fixed costs per year per cow. The relative economic value of milk to adjusted herd life at the prices and parameters for North America was about 3.2. An increase of 100-kg milk was equivalent to 2.2 mo of adjusted herd life. Three to 7% lower economic gain is expected when only improved milk production is sought compared with a breeding objective that included both production and adjusted herd life for relative value changed +/- 20%. A favorable economic gain to cost ratio probably exists for herd life used as a genetic trait to supplement milk in the breeding objective. Cow survival records are inexpensive, and herd life evaluations from such records may not extend the generation interval when such an evaluation is used in bull sire selection.

Effects of parent drug use and personality on toddler adjustment.

Science.gov (United States)

Brook, J S; Whiteman, M; Shapiro, J; Cohen, P

1996-03-01

The interrelation between parental drug use and parental personality and the effects on 18-month-old children's adjustment were examined. Data on the parents were available at four points in time: Time 1 at mean age 6.1 years, Time 2 at mean age 13.7 years, Time 3 at mean age 16.4 years, and at Time 4 at mean age 22.2 years. Data on their toddlers at 18 months of age were also available. Structured interviews were used to assess personality and drug use and the toddlers' adjustment. Time 3 parental personality traits were related to Time 4 personality traits, which in turn were related to toddler adjustment. The influence of parental alcohol involvement (Time 3) on toddler adjustment was mediated by parental personality (Times 3 and 4) and parental alcohol problems (Time 4). Interactive effects demonstrated that protective parental personality traits (nondrug conducive) enhanced the effects of low parental drug use, resulting in the highest amounts of toddler adjustment. There are significant pathways between parental personality and drug use and toddler adjustment. Parental protective factors enhance the effect of parental low drug use on toddler adjustment.

Initial validation of the Mini-Mental Adjustment to Cancer (Mini-MAC) scale: study of Portuguese end-of-life cancer patients.

Science.gov (United States)

Pereira, Filomena Moreira Pinto; Santos, Célia Samarina Vilaça de Brito

2014-10-01

The Mini-Mental Adjustment to Cancer Scale (Mini-MAC) is a 29-item instrument designed to evaluate the responses developed by cancer patients during their mental adjustment to diagnosis and treatment. This study aims to validate the Mini-Mental Adjustment to Cancer Scale (Mini-MAC) translated and adapted to the Portuguese language and culture, in end-of-life cancer patients receiving palliative care. The instrument was administered to 346 Portuguese end-of-life cancer patients, receiving care through outpatient visits or admitted into palliative care units, without cognitive symptoms and with symptoms under control. A cross-sectional validation study using orthogonal rotation through the varimax method followed by convergent and discriminant validity. The analysis of the main components confirms the existence of five factors, demonstrating the validity of the construct, with good internal consistency in the subscales and Cronbach's alpha values between 0.78 and 0.93. Good test-retest reliability was also found, and r values for subscales ranged from 0.62 to 0.99. The instrument proved to be a reliable, valid and sensitive measure in the study of mental adjustment of Portuguese end-of-life patients with cancer receiving palliative care. Nurses can use the Mini-MAC Scale in research and clinical practice in order to evaluate the mental adjustment of Portuguese end-of-life cancer patients receiving palliative care. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

Physical injury assessment of male versus female chiropractic students when learning and performing various adjustive techniques: a preliminary investigative study

Directory of Open Access Journals (Sweden)

Huber Laura L

2006-08-01

Full Text Available Abstract Background Reports of musculoskeletal injuries that some chiropractic students experienced while in the role of adjustor became increasingly evident and developed into the basis of this study. The main objective of this study was to survey a select student population and identify, by gender, the specific types of musculoskeletal injuries they experienced when learning adjustive techniques in the classroom, and performing them in the clinical setting. Methods A survey was developed to record musculoskeletal injuries that students reported to have sustained while practicing chiropractic adjustment set-ups and while delivering adjustments. The survey was modeled from similar instruments used in the university's clinic as well as those used in professional practice. Stratified sampling was used to obtain participants for the study. Data reported the anatomical areas of injury, adjustive technique utilized, the type of injury received, and the recovery time from sustained injuries. The survey also inquired as to the type and area of any past physical injuries as well as the mechanism(s of injury. Results Data obtained from the study identified injuries of the shoulder, wrist, elbow, neck, low back, and mid-back. The low back was the most common injury site reported by females, and the neck was the most common site reported by males. The reported wrist injuries in both genders were 1% male complaints and 17% female complaints. A total of 13% of female respondents reported shoulder injuries, whereas less than 1% of male respondents indicated similar complaints. Conclusion The data collected from the project indicated that obtaining further information on the subject would be worthwhile, and could provide an integral step toward developing methods of behavior modification in an attempt to reduce and/or prevent the incidence of musculoskeletal injuries.

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 ...

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

Science.gov (United States)

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

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

Science.gov (United States)

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

2017-08-01

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

48 CFR 52.215-15 - Pension adjustments and asset reversions.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Pension adjustments and... Clauses 52.215-15 Pension adjustments and asset reversions. As prescribed in 15.408(g), insert the following clause: Pension Adjustments and Asset Reversions (OCT 2010) (a) The Contractor shall promptly...

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

Premorbid adjustment in individuals at ultra-high risk for developing psychosis

DEFF Research Database (Denmark)

Dannevang, Anders; Randers, Lasse; Gondan, Matthias

2017-01-01

between childhood and early adolescence. The UHR individuals had more premorbid adjustment difficulties on both the social and academic scale, and on the individual PAS scales. Conclusion: From childhood UHR individuals have lower levels of social and academic premorbid adjustment compared to healthy...... and academic scales were computed. Results: Compared to the healthy controls the UHR individuals’ social and academic premorbid adjustment declined across age periods. Social premorbid adjustment declined particularly between late adolescence and adulthood. Academic premorbid adjustment declined particularly...

5 CFR 838.241 - 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. 838.241... Affecting Employee Annuities Procedures for Computing the Amount Payable § 838.241 Cost-of-living... provide for cost-of-living adjustments on the former spouse's payment from employee annuity, the cost-of...

37 CFR 1.705 - Patent term adjustment determination.

Science.gov (United States)

2010-07-01

... 37 Patents, Trademarks, and Copyrights 1 2010-07-01 2010-07-01 false Patent term adjustment determination. 1.705 Section 1.705 Patents, Trademarks, and Copyrights UNITED STATES PATENT AND TRADEMARK OFFICE, DEPARTMENT OF COMMERCE GENERAL RULES OF PRACTICE IN PATENT CASES Adjustment and Extension of Patent Term...

Accurate tool height control by bearing gap adjustment

NARCIS (Netherlands)

Wielen, van der A.M.; Schellekens, P.H.J.; Jaartsveld, F.T.M.

2002-01-01

Face turning of optical surfaces on precision lathes needs high precision tool height adjustment, which may be a difficult and time-consuming task. In this paper we present a new tool adjustment mechanism based on varying the bearing gap height of the hydrostatic bearings present in precision lathe

Long-term health-related quality of life and psychological adjustment in children after haemolytic-uraemic syndrome.

Science.gov (United States)

Werner, Helene; Buder, Kathrin; Landolt, Markus A; Neuhaus, Thomas J; Laube, Guido F; Spartà, Giuseppina

2017-05-01

In children after haemolytic-uraemic syndrome (HUS), little is known about long-term health-related quality of life (HRQoL) and psychological adjustment as defined by behavioural problems, depressive symptoms and post-traumatic stress symptoms. Sixty-two paediatric patients with a history of HUS were included in this study. Medical data of the acute HUS episode were retrieved retrospectively from hospital records. Data on the clinical course at study investigation were assessed by clinical examination and laboratory evaluation. HRQoL and psychological adjustment data were measured by standardised, parent- and self-reported questionnaires. Haemolytic-uraemic syndrome was diagnosed at a mean of 6.5 years before the initiation of the study (standard deviation 2.9, range 0.1-15.7) years. Among the preschool children, parents reported that their child was less lively and energetic (HRQoL emotional dimension), while no increased behavioural problems were reported. In the school-age children, self- and proxy-reported HRQoL was well within or even above the norms, while increased total behavioural problems were found. The school-age children reported no increased depression scores. Also none of the children met the criteria for full or partial HUS-associated posttraumatic stress disorder. Healthcare providers should be particularly alert to behavioural problems in school-age children with a history of HUS and to lower HRQoL in preschool children.

Meaning making and psychological adjustment following cancer: the mediating roles of growth, life meaning, and restored just-world beliefs.

Science.gov (United States)

Park, Crystal L; Edmondson, Donald; Fenster, Juliane R; Blank, Thomas O

2008-10-01

Cancer survivors' efforts at meaning making may influence the extent to which they successfully make meaning from their experience (i.e., experience posttraumatic growth, find life meaningful, and restore beliefs in a just world), which may, in turn, influence their psychological adjustment. Previous research regarding both meaning making processes and meanings made as determinants of adjustment has shown inconsistent effects, partly because of the lack of clearly articulated theoretical frameworks and problematic research strategies. In a 1-year longitudinal study, the authors distinguished the meaning making process from the outcomes of that process (meanings made), employing specific measures of both. The authors tested pathways through which meaning making efforts led to 3 different meanings made (growth, life meaning, and restored just-world belief) in a sample of 172 young to middle-age adult cancer survivors, and they explored whether those meanings made mediated the effect of meaning making efforts on psychological adjustment. Cross-sectional and longitudinal path models of the meaning making process indicate that meaning making efforts are related to better adjustment through the successful creation of adaptive meanings made from the cancer experience. The authors conclude with clinical implications and suggestions for future research. (c) 2008 APA, all rights reserved.

Longitudinal Psychosocial Adjustment of Women to Human Papillomavirus Infection.

Science.gov (United States)

Hsu, Yu-Yun; Wang, Wei-Ming; Fetzer, Susan Jane; Cheng, Ya-Min; Hsu, Keng-Fu

2018-05-29

The aim of this study was to examine the psychosocial adjustment trajectory, focusing on psychological distress, sexual relationships and health care information, as well as factors which have an impact on adjustment on receiving a positive diagnosis of human papillomavirus infection. Human papillomavirus is a common sexually transmitted infection in females. To date, knowledge of the longitudinal psychosocial response to the diagnosis of human papillomavirus is limited. A prospective longitudinal design was conducted with a convenience sample. Women aged 20-65 years old were followed at one, 6 and 12 months after a diagnosis of HPV. Participants completed measures of initial emotional distress and followed-up psychosocial adjustment. A mixed-effects model was applied to analyze the longitudinal changes in psychosocial adjustment. Seventy human papillomavirus positive women participated in the study with nearly 20% of the women reporting emotional distress during their first visit. Mixed-effects model analyses showed that a trajectory of psychosocial adjustment in health care orientation, sexual relationship and psychosocial distress occur from one to 6 months after HPV diagnosis. However, a declining trend from 6-12 months was significant in health care orientation. Initial emotional distress was associated with changes in psychological adjustment. Psychosocial adjustment to human papillomavirus was worse at one month compared with 6 and 12 months after diagnosis. Healthcare providers should offer health information and psychosocial support to women according to their disease progression. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Impact of a Pharmacist-Managed Heart Failure Postdischarge (Bridge) Clinic for Veterans.

Science.gov (United States)

Hale, Genevieve M; Hassan, Sonia L; Hummel, Scott L; Lewis, Carrie; Ratz, David; Brenner, Michael

2017-07-01

Hospitals that provide early postdischarge follow-up after heart failure (HF) hospitalization tend to have lower rates of readmission. However, HF postdischarge (bridge) clinics have not been extensively evaluated. To assess the impact of a pharmacist-managed HF bridge clinic in a veteran population. HF patients hospitalized from November 2010 to August 2013 were identified. Retrospective chart review was conducted of 122 HF patients seen at bridge clinic compared with 122 randomly selected HF patients not seen at this clinic (usual care). Primary end point was 90-day all-cause readmission and death. Secondary outcomes were 30-day all-cause readmission and death, time to first postdischarge follow-up, first all-cause readmission. Bridge clinic patients were at higher baseline risk of readmission and death; other characteristics were similar. 90-day death and all-cause readmission trended lower in bridge clinic patients (adjusted hazard ratio [HR] = 0.64; 95% CI = 0.40-1.02; P = 0.06). Time to first follow-up was shorter in bridge clinic patients (11 ± 6 vs 20 ± 23 days; P bridge clinic patients (adjusted HR = 0.44; 95% CI = 0.22-0.88; P = 0.02). In veteran patients hospitalized for HF, pharmacist-managed HF bridge clinic significantly reduced the time to initial follow-up compared with usual care. Improved short-term outcomes and trend toward improvement of longer-term outcomes in bridge clinic patients was shown.

Differentiation of Self and Dyadic Adjustment in Couple Relationships: A Dyadic Analysis Using the Actor-Partner Interdependence Model.

Science.gov (United States)

Lampis, Jessica; Cataudella, Stefania; Agus, Mirian; Busonera, Alessandra; Skowron, Elizabeth A

2018-06-10

Bowen's multigenerational theory provides an account of how the internalization of experiences within the family of origin promotes development of the ability to maintain a distinct self whilst also making intimate connections with others. Differentiated people can maintain their I-position in intimate relationships. They can remain calm in conflictual relationships, resolve relational problems effectively, and reach compromises. Fusion with others, emotional cut-off, and emotional reactivity instead are common reactions to relational stress in undifferentiated people. Emotional reactivity is the tendency to react to stressors with irrational and intense emotional arousal. Fusion with others is an excessive emotional involvement in significant relationships, whilst emotional cut-off is the tendency to manage relationship anxiety through physical and emotional distance. This study is based on Bowen's theory, starting from the assumption that dyadic adjustment can be affected both by a member's differentiation of self (actor effect) and by his or her partner's differentiation of self (partner effect). We used the Actor-Partner Interdependence Model to study the relationship between differentiation of self and dyadic adjustment in a convenience sample of 137 heterosexual Italian couples (nonindependent, dyadic data). The couples completed the Differentiation of Self Inventory and the Dyadic Adjustment Scale. Men's dyadic adjustment depended only on their personal I-position, whereas women's dyadic adjustment was affected by their personal I-position and emotional cut-off as well as by their partner's I-position and emotional cut-off. The empirical and clinical implications of the results are discussed. © 2018 Family Process Institute.

Inequality-adjusted gender wage differentials in Germany

OpenAIRE

Selezneva, Ekaterina; Van Kerm, Philippe

2013-01-01

This paper exploits data from the German Socio-Economic Panel (SOEP) to re-examine the gender wage gap in Germany on the basis of inequality-adjusted measures of wage differentials which fully account for gender differences in pay distributions. The inequality-adjusted gender pay gap measures are significantly larger than suggested by standard indicators, especially in East Germany. Women appear penalized twice, with both lower mean wages and greater wage inequality. A hypothetical risky inve...

Desirability of Outcome Ranking (DOOR) and Response Adjusted for Duration of Antibiotic Risk (RADAR).

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Evans, Scott R; Rubin, Daniel; Follmann, Dean; Pennello, Gene; Huskins, W Charles; Powers, John H; Schoenfeld, David; Chuang-Stein, Christy; Cosgrove, Sara E; Fowler, Vance G; Lautenbach, Ebbing; Chambers, Henry F

2015-09-01

Clinical trials that compare strategies to optimize antibiotic use are of critical importance but are limited by competing risks that distort outcome interpretation, complexities of noninferiority trials, large sample sizes, and inadequate evaluation of benefits and harms at the patient level. The Antibacterial Resistance Leadership Group strives to overcome these challenges through innovative trial design. Response adjusted for duration of antibiotic risk (RADAR) is a novel methodology utilizing a superiority design and a 2-step process: (1) categorizing patients into an overall clinical outcome (based on benefits and harms), and (2) ranking patients with respect to a desirability of outcome ranking (DOOR). DOORs are constructed by assigning higher ranks to patients with (1) better overall clinical outcomes and (2) shorter durations of antibiotic use for similar overall clinical outcomes. DOOR distributions are compared between antibiotic use strategies. The probability that a randomly selected patient will have a better DOOR if assigned to the new strategy is estimated. DOOR/RADAR represents a new paradigm in assessing the risks and benefits of new strategies to optimize antibiotic use. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Cost per quality-adjusted life year and disability-adjusted life years: the need for a new paradigm.

Science.gov (United States)

Bevan, Gwyn; Hollinghurst, Sandra

2003-08-01

Two different paradigms have been proposed for setting priorities for access to healthcare: cost per quality-adjusted life year based on interventions, and disability-adjusted life years based on the burden of disease in a population. These formal paradigms make explicit the assumptions made implicitly every day in delivering and hence rationing access to healthcare. This paper outlines each paradigm's methodological problems and argues that each paradigm is incomplete in terms of providing the information necessary for making budgetary decisions on healthcare. It argues that a scientific revolution is required to create a new paradigm by combining the strengths of each.

Well sibling psychological adjustment to chronic physical disorder in a sibling: how important is maternal awareness of their illness attitudes and perceptions?

Science.gov (United States)

Taylor; Fuggle, P; Charman, T

2001-10-01

The psychological adjustment of healthy siblings was investigated in relation to their attitudes and perceptions about their brother's or sister's chronic physical disorder, to their mothers' awareness of these attitudes and perceptions, and to three other maternal factors (maternal distress, maternal social support, and amount of care demanded by the physical disorder). Sixty-two well siblings and mothers of children with a range of chronic physical disorders completed standardised questionnaires. The majority of siblings did not appear to have adjustment problems, although the sample had slightly increased rates of emotional symptoms compared to the general population. Mothers rated well siblings as having more negative attitudes and perceptions about the physical disorder than reported by siblings themselves. A multiple regression analysis indicated that better sibling adjustment was associated with higher maternal awareness of their attitudes and perceptions. These findings support Varni and Wallander's (1998) model that emphasises the role of relationship and attitude variables in child adjustment to chronic physical disorder. The implications of these findings for clinical practice are discussed.

Identification and adjustment of experimental occlusal interference using functional magnetic resonance imaging.

Science.gov (United States)

Oda, Masafumi; Yoshino, Kenichi; Tanaka, Tatsurou; Shiiba, Shunji; Makihara, Eri; Miyamoto, Ikuya; Nogami, Shinnosuke; Kito, Shinji; Wakasugi-Sato, Nao; Matsumoto-Takeda, Shinobu; Nishimura, Shun; Murakami, Keita; Koga, Masahiro; Kawagishi, Shigenori; Yoshioka, Izumi; Masumi, Shin-Ichi; Kimura, Mitsutaka; Morimoto, Yasuhiro