WorldWideScience

Sample records for individualized treatment approach

  1. [An individual approach to the surgical treatment and medical rehabilitation of duodenal ulcer patients].

    Science.gov (United States)

    Kochetkov, A V; Barashkov, V G; Papazov, V I

    1996-01-01

    Since 1986 403 patients have been treated according to the following programme: successive preparation for surgery, the operative intervention chosen individually for each patient, the purposeful medical rehabilitation. Different types of vagotomy with draining operations were performed in 85.6% of the cases, stomach resection--in 14.4% of the patients. The mortality rate was 0%. The indications for various types of vagotomy, stomach resection and different types of draining operations were determined. Rehabilitation of 55% of the patients after the operative treatment took place at the gastroenterological department, the others--at an outpatient department. The indications for rehabilitation, its volume and time were established. The best remote results in the follow-up periods up to five years were obtained after truncal vagotomy and stomach resection. Ulcer recurrences were noted in 3.5% and 5.2% of the cases respectively. Recurrences of the disease were noted in 7.8% after combined vagotomy and in more than 20% after SPV. Nine patients out of 34 with recurrent ulcers were reoperated with good results, the others were successfully treated by conservative therapy.

  2. CAD/CAM technologies in the surgical and prosthetic treatment of the edentulous patient with biomymetic individualized approach.

    Science.gov (United States)

    Pozzi, A; Gargari, M; Barlattani, A

    2008-04-01

    The advent of modern endosseous implant design and improved surface technology has allowed the development of new restorative techniques that decrease patient's total treatment time. Utilizing the latest scanning, CAD/CAM and manufacturing technolgies we are able to manufacture individualized dental restoration with high accuracy and a perfect precision of fit. This report describes the rehabilitation of a completely edentulous patient utilizing a CT-based implant planning with computer-assisted surgical design, simultaneous CAD/CAM fabrication of a surgical template, a flapless surgical placement of the implants, and a prefabricated fixed complete denture for an immediately loaded restoration according to Nobel Biocare's Teeth-in-an-Hour™ (Nobel Biocare Goteborg, Sweden) protocol. This systematic approach to full mouth rehabilitation reduces the time necessary for an edentulous patient to go from severely atrophic alveolar support to implant retained prosthetic restoration. These aspects of minimally invasive and simplified surgery, along with reducing the treatment time and postsurgical discomfort, are beneficial to the patient, and allowing for rehabilitation with the same level of success as in flap surgery. The Teeth-in-an-Hour protocol is a unique solution made possible by the Procera System. With the aid of the CT scans and a virtual planning software, a custom fabricated precision drill guide and a pre-manufactured prosthesis can be made before surgery. The execution of implant placement is performed with a flapless procedure that results in minimal surgical intervention. This results in a short and non-traumatic surgery with a minimum of postoperative complications, allowing the patient to leave the chair with a fixed prosthesis. Utilizing the latest scanning, CAD/CAM and manufacturing technologies the dental team is able to develop individualized zirconia full arch framework with high accuracy and precision of fit.

  3. Tumor Molecular Profiling for an Individualized Approach to the Treatment of Hepatocellular Carcinoma: A Patient Case Study

    Directory of Open Access Journals (Sweden)

    Kristine Posadas

    2018-04-01

    Full Text Available Hepatocellular carcinoma (HCC is increasing in incidence, and the associated mortality rate remains among the highest. For advanced HCC, sorafenib has been shown to slightly prolong survival, and regorafenib and nivolumab, both recently approved by the United States Food and Drug Administration (FDA, may produce clinical benefits to a limited extent. Systemic chemotherapy has been shown to produce a modest response, but there is no clinically valid biomarker that can be used to predict which patients may benefit. In this case study, we present two patients with metastatic HCC, they received systemic treatment using capecitabine, oxaliplatin, and either bevacizumab or sorafenib. The tumor response to treatment was determined by the progression-free survival (PFS. Molecular profiling of the tumors showed differential expression of biochemical markers and different mutational status of the TP53 and β-catenin (CTNNB1 genes. We hypothesize that the PFS correlates with the tumor molecular profiles, which may be predictive of the therapeutic response to systemic chemotherapy. Further investigation is indicated to correlate tumor biomarkers and treatment responses, with the objective of personalizing the therapies for patients with advanced HCC.

  4. An exploration of food and the lived experience of individuals after treatment for colorectal cancer using a phenomenological approach.

    Science.gov (United States)

    Burden, S T; Stamataki, Z; Hill, J; Molasiotis, A; Todd, C

    2016-04-01

    There is a paucity of qualitative literature investigating people's experiences of food and nutrition after treatment for cancer. The present study aimed to explore people's relationships with food and nutrition throughout their colorectal cancer journey. In-depth semi-structured interviews were conducted with 25 participants who had undergone surgery for colorectal cancer. The study design was informed by principles of phenomenology. Data were collected then transcribed and analysed using an inductive coding process and a thematic analysis to allow the themes to highlight people's lived experiences. Data enabled five primary themes to be drawn including: 'appetite swings', 'emotions on a changing physicality', 'the medicalisation of food', 'taking control of symptom management' and a cross-cutting theme 'drivers and vehicles for action'. Feelings and emotions described by participants around their relationship with food and nutritional status often guided decisions on what was eaten more than objective nutritional measure or dietary advice. Participants used weight changes, appetite and food as barometers to measure their overall recovery. Food was an area over which people exhibited control of their lives and they could quantify, in measurable units, their overall well-being and rehabilitation. They did this either by using the currency of body weight in pounds or the size of portions eaten. Appetite, weight and symptoms influenced dietary intake substantially and were poignant issues affecting people's lives. The relationship people have with food determines their eating habits and an understanding of the essences and nuances of their experiences is essential to enable the delivery of patient-centred care. © 2015 The British Dietetic Association Ltd.

  5. Individual Biomarkers Using Molecular Personalized Medicine Approaches.

    Science.gov (United States)

    Zenner, Hans P

    2017-01-01

    Molecular personalized medicine tries to generate individual predictive biomarkers to assist doctors in their decision making. These are thought to improve the efficacy and lower the toxicity of a treatment. The molecular basis of the desired high-precision prediction is modern "omex" technologies providing high-throughput bioanalytical methods. These include genomics and epigenomics, transcriptomics, proteomics, metabolomics, microbiomics, imaging, and functional analyses. In most cases, producing big data also requires a complex biomathematical analysis. Using molecular personalized medicine, the conventional physician's check of biomarker results may no longer be sufficient. By contrast, the physician may need to cooperate with the biomathematician to achieve the desired prediction on the basis of the analysis of individual big data typically produced by omex technologies. Identification of individual biomarkers using molecular personalized medicine approaches is thought to allow a decision-making for the precise use of a targeted therapy, selecting the successful therapeutic tool from a panel of preexisting drugs or medical products. This should avoid the treatment of nonresponders and responders that produces intolerable unwanted effects. © 2017 S. Karger AG, Basel.

  6. Long-term GERD management: The individualized approach

    NARCIS (Netherlands)

    Tytgat, Guido

    2006-01-01

    Gastroesophageal reflux disease (GERD) is a complex condition, and both mucosal lesions and symptoms are important parameters in evaluating disease severity and the impact of treatment. An individualized approach in which treatment is tailored to each patient is the appropriate strategy. Treatment

  7. Individual approach to the treatment of obese copd patients can reduce anthropometric indicators, the level of systemic inflammation and improve the quality of life.

    Science.gov (United States)

    Savchenko, Lesia V; Kaidashev, Igor P

    2018-01-01

    Introduction: Chronic obstructive pulmonary disease (COPD) and obesity are major causes of morbidity and mortality worldwide, and according to current estimates, the global burden of these conditions will be even greater. The basis for COPD treatment is bronchodilator therapy and non-pharmacotherapy approaches, such as respiratory rehabilitation and dietary counseling. The aim of this study was to assess the impact of lifestyle modification on anthropometric indices, markers of systemic inflammation, quality of life in patients with COPD and obesity. Materials and methods: 53 patients with COPD in stable condition with BMI - 30.0-39.9 kg/m2 were included in the study. The patients were divided into 2 groups: the first group - obese COPD patients with lifestyle modification (n=26) and the second group (n=27) -without lifestyle modification. Lifestyle modification involved: nutritional correction and regular physical exercise. The duration of the study was 9 months. We evaluated body mass indices (BMI), waist circumference (WC), actual nutrition, dyspnea by the mMRC scale, quality of life (QL), 6-minute walking distance test (6MWD), spirometry, serum levels of C-reactive protein (CRP) and sputum level of interleukin-26 (IL-26). Results: After 9 months in obese COPD patients with lifestyle modification we found a decrease in body weight and BMI by 1.16 times (p systemic inflammation markers decreased - serum CRP by 2.06 times (p < 0.0001), IL-26 level in the induced sputum by 1.65 times (p <0.0001); increased the walked distance by 9.38% (p = 0.0004) and QL (p <0.0001). Conclusions: Application of individually developed therapeutic measures incorporating the nutrition correction, taking into account the indicators of the basic metabolism in patients and regular physical activity against the background of inhaled basic therapy, allows us to the reduction of WC, BMI, activity of the inflammatory process, increase tolerance to physical activity and improvement of life

  8. Genders and Individual Treatment Progress in (Non-)Binary Trans Individuals.

    Science.gov (United States)

    Koehler, Andreas; Eyssel, Jana; Nieder, Timo O

    2018-01-01

    Health care for transgender and transsexual (ie, trans) individuals has long been based on a binary understanding of gender (ie, feminine vs masculine). However, the existence of non-binary or genderqueer (NBGQ) genders is increasingly recognized by academic and/or health care professionals. To gain insight into the individual health care experiences and needs of binary and NBGQ individuals to improve their health care outcomes and experience. Data were collected using an online survey study on experiences with trans health care. The non-clinical sample consisted of 415 trans individuals. An individual treatment progress score was calculated to report and compare participants' individual progress toward treatment completion and consider the individual treatment needs and definitions of completed treatment (ie, amount and types of different treatments needed to complete one's medical transition). Main outcome measures were (i) general and trans-related sociodemographic data and (ii) received and planned treatments. Participants reported binary (81.7%) and different NBGQ (18.3%) genders. The 2 groups differed significantly in basic demographic data (eg, mean age; P < .05). NBGQ participants reported significantly fewer received treatments compared with binary participants. For planned treatments, binary participants reported more treatments related to primary sex characteristics only. Binary participants required more treatments for a completed treatment than NBGQ participants (6.0 vs 4.0). There were no differences with regard to individual treatment progress score. Because traditional binary-focused treatment practice could have hindered NBGQ individuals from accessing trans health care or sufficiently articulating their needs, health care professionals are encouraged to provide a holistic and individual treatment approach and acknowledge genders outside the gender binary to address their needs appropriately. Because the study was made inclusive for non

  9. The concept of individual approach in sport

    Directory of Open Access Journals (Sweden)

    Zh.L. Kozina

    2015-03-01

    Full Text Available Purpose : prove the concept of individual approach to sports training. Develop a common scheme ways individualization process of training athletes. Material: the study involved 149 athletes: 38 volleyball players and 111 players. Was carried out comprehensive testing athletes for 33 pedagogical, psycho-physiological, biochemical parameters. Also conducted an analysis of indicators of competitive activity. Results : we propose the following areas of the individualization process of preparation of athletes: 1 - systematization of mathematical indicators of preparedness and condition of the athlete in a single point in time; 2 - regression analysis of the dynamics of individual game performance athletes; 3 - the use of universal methods of individualization of various aspects of the training process. It is established that the individual characteristics of players in basketball and volleyball are connected not only with the anthropometric data, but also depend on the physiological and psychophysiological indicators. In this aspect there is provided use of cluster and factor analysis for the construction of individual training programs for players. It was found that the dynamics of the gaming performance is described by quadratic, cubic and sinusoidal functions. In the case of sinusoidal oscillation period of regression models in girls is 25-30 days, 31-38 days in boys. This allows to determine the most preferred times of increasing and reducing the efficiency of competitive. Conclusions : the concept of individual approach in sport involves the separation of a wide range of indicators leading factors in the individual structure of athletes, in the analysis and prediction of individual dynamics of competitive performance, to develop universal methods of individualization with the activation of awareness of various aspects of the training process.

  10. Autistic Learning Disabilities and Individualizing Treatment for Autistic Spectrum Disorders.

    Science.gov (United States)

    Siegel, Bryna

    1999-01-01

    This article evaluates three early intervention approaches--applied behavior analysis, TEAACH (Treatment and Education of Autistic and Related Communication Handicapped Children), a structured classroom-based program, and relationship therapy/"floor time"--to identify which aspects of each approach complement individual learning styles…

  11. Approaches to methadone treatment

    DEFF Research Database (Denmark)

    Järvinen, Margaretha

    2008-01-01

    and does not focus on the consequences of drug use alone but also on their problematic relationship to drugs (legal as well as illegal). Furthermore, the users’ attitudes towards methadone are far more ambivalent than the staff's. For the users, methadone is not just medicine; it is also a dependence...... in the model are three dimensions (1) treatment goals at the methadone centres (abstinence vs. stabilisation) (2) treatment focus (focus on addiction vs. focus on the consequences of addiction) and (3) conceptualisation of methadone (methadone as similar to or different from heroin). The paper shows......-producing and ‘dangerous’ drug....

  12. 'Image and treat': an individualized approach to urological tumors

    DEFF Research Database (Denmark)

    Bouchelouche, Kirsten; Capala, Jacek

    2010-01-01

    The current treatment options for advanced urologic cancers demonstrate limited efficacy. To obtain optimal clinical results, there is a need for new, individualized, therapeutic strategies, which have only recently been applied to these malignancies. Nuclear medicine plays an important role in e...... in establishing imaging biomarkers necessary for personalized medicine. This review focuses on the current status of the 'image and treat' approach combining molecular imaging with targeted radionuclide therapy of urological malignancies...

  13. Current evidence of anti-tumor necrosis factor α treatment efficacy in childhood chronic uveitis: a systematic review and meta-analysis approach of individual drugs.

    Science.gov (United States)

    Simonini, Gabriele; Druce, Katie; Cimaz, Rolando; Macfarlane, Gary J; Jones, Gareth T

    2014-07-01

    To summarize evidence regarding the effectiveness of anti-tumor necrosis factor α (anti-TNFα) treatments in childhood autoimmune chronic uveitis (ACU), refractory to previous disease-modifying antirheumatic drugs (DMARDs). A systematic search between January 2000 and October 2012 was conducted using EMBase, Ovid Medline, Evidence-Based Medicine (EBM) Reviews: American College of Physicians Journal Club, Cochrane libraries, and EBM Reviews. Studies investigating the efficacy of anti-TNFα therapy, in children ages ≤16 years, as the first treatment with a biologic agent for ACU, refractory to topical and/or systemic steroid therapy and at least 1 DMARD, were eligible for inclusion. The primary outcome measure was the improvement of intraocular inflammation, as defined by the Standardization of Uveitis Nomenclature Working Group criteria. We determined a combined estimate of the proportion of children responding to anti-TNFα treatment, including etanercept (ETA), infliximab (INF), or adalimumab (ADA). We initially identified 989 articles, of which 148 were potentially eligible. In total, 22 retrospective chart reviews and 1 randomized clinical trial were deemed eligible, thus including 229 children (ADA: n = 31, ETA: n = 54, and INF: n = 144). On pooled analysis of observational studies, the proportion of responding children was 87% (95% confidence interval [95% CI] 75-98%) for ADA, 72% (95% CI 64-79%) for INF, and 33% (95% CI 19-47%) for ETA. There was no difference in the proportion of responders between ADA and INF (χ(2) = 3.06, P = 0.08), although both showed superior efficacy compared with ETA (ADA versus ETA: χ(2) = 20.9, P < 0.001 and INF versus ETA: χ(2) = 20.9, P < 0.001). Although randomized controlled trials are needed, the available evidence suggests that INF and ADA provide proven similar benefits in the treatment of childhood ACU, and they are both superior to ETA. Copyright © 2014 by the American College of Rheumatology.

  14. Methodological Individualism and the Organizational Capabilities Approach

    DEFF Research Database (Denmark)

    Felin, Teppo; Foss, Nicolai Juul

    2004-01-01

    AbstractDuring the last decade, strategy scholars have increasingly converged on organizationalcapabilities as a key construct in strategy research. We explicate some of the underlying,unstated assumptions of current capabilities-based work by drawing on seminal work in thephilosophy of social...... critical individual-levelconsiderations, including individual action and heterogeneity. In this note we do not denyor reject the notion of routines or capabilities per se, but rather call for an increasedemphasis on how these collective structures originate and change as a result of individualactions...

  15. Clinical approaches to treatment of Internet addiction.

    Science.gov (United States)

    Przepiorka, Aneta Małgorzata; Blachnio, Agata; Miziak, Barbara; Czuczwar, Stanisław Jerzy

    2014-04-01

    Internet appearance was one of the main breakthroughs for the mankind in the latest decades. It revolutionized our lives in many aspects and brought about many undeniably positive changes. However, at the same time caused negative consequences. It has led to the emergence of the Internet addiction (IA). The paper is concerned with the issue of treatment of IA. The paper reviews the current findings on the approaches to IA treatment and evaluates their effectiveness. The main focus of the article concentrates on cognitive and pharmacologic treatment. The individual approach to IA treatment is advisable. Among drugs for the management of IA, antidepressants, antipsychotics, opioid receptor antagonists, glutamate receptor antagonists, and psychostimulants may be recommended. Some antiepileptics, and especially valproate, are considered as potential drugs for the treatment of IA. Effective therapy may require an individual approach and best results are expected when psychological and pharmacological treatments are combined. Copyright © 2014 Institute of Pharmacology, Polish Academy of Sciences. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  16. INDIVIDUAL BASED MODELLING APPROACH TO THERMAL ...

    Science.gov (United States)

    Diadromous fish populations in the Pacific Northwest face challenges along their migratory routes from declining habitat quality, harvest, and barriers to longitudinal connectivity. Changes in river temperature regimes are producing an additional challenge for upstream migrating adult salmon and steelhead, species that are sensitive to absolute and cumulative thermal exposure. Adult salmon populations have been shown to utilize cold water patches along migration routes when mainstem river temperatures exceed thermal optimums. We are employing an individual based model (IBM) to explore the costs and benefits of spatially-distributed cold water refugia for adult migrating salmon. Our model, developed in the HexSim platform, is built around a mechanistic behavioral decision tree that drives individual interactions with their spatially explicit simulated environment. Population-scale responses to dynamic thermal regimes, coupled with other stressors such as disease and harvest, become emergent properties of the spatial IBM. Other model outputs include arrival times, species-specific survival rates, body energetic content, and reproductive fitness levels. Here, we discuss the challenges associated with parameterizing an individual based model of salmon and steelhead in a section of the Columbia River. Many rivers and streams in the Pacific Northwest are currently listed as impaired under the Clean Water Act as a result of high summer water temperatures. Adverse effec

  17. Individual treatment selection for patients with posttraumatic stress disorder.

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    Deisenhofer, Anne-Katharina; Delgadillo, Jaime; Rubel, Julian A; Böhnke, Jan R; Zimmermann, Dirk; Schwartz, Brian; Lutz, Wolfgang

    2018-04-16

    Trauma-focused cognitive behavioral therapy (Tf-CBT) and eye movement desensitization and reprocessing (EMDR) are two highly effective treatment options for posttraumatic stress disorder (PTSD). Yet, on an individual level, PTSD patients vary substantially in treatment response. The aim of the paper is to test the application of a treatment selection method based on a personalized advantage index (PAI). The study used clinical data for patients accessing treatment for PTSD in a primary care mental health service in the north of England. PTSD patients received either EMDR (N = 75) or Tf-CBT (N = 242). The Patient Health Questionnaire (PHQ-9) was used as an outcome measure for depressive symptoms associated with PTSD. Variables predicting differential treatment response were identified using an automated variable selection approach (genetic algorithm) and afterwards included in regression models, allowing the calculation of each patient's PAI. Age, employment status, gender, and functional impairment were identified as relevant variables for Tf-CBT. For EMDR, baseline depressive symptoms as well as prescribed antidepressant medication were selected as predictor variables. Fifty-six percent of the patients (n = 125) had a PAI equal or higher than one standard deviation. From those patients, 62 (50%) did not receive their model-predicted treatment and could have benefited from a treatment assignment based on the PAI. Using a PAI-based algorithm has the potential to improve clinical decision making and to enhance individual patient outcomes, although further replication is necessary before such an approach can be implemented in prospective studies. © 2018 Wiley Periodicals, Inc.

  18. [Modern treatment approaches to gambling].

    Science.gov (United States)

    Egorov, A Iu

    2014-01-01

    Compulsive gambling has received widespread attention in the last decade. Gambling has become the first non-chemical addiction, which went down to the section "Addiction and related disorders" of the modern DSM-V. The review considers non-pharmacological and pharmacological approaches to the treatment of gambling. Among non-drug approaches, cognitive-behavioral therapy and 12-step programs have gained the most popularity in the "Gamblers Anonymous" community. Among pharmacological approaches, three classes of drugs: antidepressants (mainly SSRIs), opiate antagonists (naltrexone and nalmefene) and mood stabilizers (valproate, lithium, topiramate) proved to be effective in treatment of gambling. No differences in the efficacy of the three classes of psychotropic drugs have been identified. Preliminary results for N-acetylcysteine and memantine cause optimism in terms of perspective.

  19. [Individual, community, regulatory, and systemic approaches to tobacco control interventions].

    Science.gov (United States)

    Gorini, Giuseppe

    2011-01-01

    During the 60s and the 70s strategies for decreasing initiation or quitting have been developed, in order to find those with high success rates. Unfortunately, interventions with an individual approach involved few smokers, so their impact in decreasing smoking prevalence was limited. The socio-ecological model offers a theoretical framework to community interventions for smoking cessation developed during the 80s, in which smoking was considered not only an individual, but also a social problem. In the 80s and the 90s smoking cessation community trials were developed, such as the Community Intervention Trial for Smoking Cessation (COMMIT). Afterwards, policy interventions (price policy; smoking bans in public places; advertising bans; bans of sales to minors) were developed, such as the American Stop Smoking Intervention Study for Cancer Prevention (ASSIST). California has been the first State all over the world to develop a comprehensive Tobacco Control Program in 1988, becoming the place for an ever-conducted natural experiment. All policy interventions in tobacco control have been finally grouped together in the World Health Organization - Framework Convention on Tobacco Control (WHO-FCTC), the first Public Health Treaty. Study designs have changed, according to the individual, community, or regulatory approaches: the classical randomized controlled trials (RCTs), in which the sampling unit is the individual, have been carried out for the evaluation of smoking cessation treatments, whereas cluster RCTs, in which the sampling unit is the community, have been conducted for evaluating community interventions, such as COMMIT. Finally, quasi-experimental studies (before/after study; prospective cohorts, both with a control group), in which the observational unit is a State, have been used for evaluating tobacco control policies, such as ASSIST and the International Tobacco Control Policy Evaluation Project. Although the successes of the last 20 years, tobacco

  20. Novel approaches to epilepsy treatment

    DEFF Research Database (Denmark)

    Sørensen, Andreas T; Kokaia, Merab

    2013-01-01

    The aim of epilepsy treatment is to achieve complete seizure freedom. Nonetheless, numerous side effects and seizure resistance to antiepileptic drugs (AEDs) affecting about 30-40% of all patients are main unmet needs in today's epileptology. For this reason, novel approaches to treat epilepsy......, and inhibitory neurotransmitters. We also address new molecular-genetic approaches utilizing optogenetic technology. The therapeutic strategies presented herein are predominately aimed toward treatment of partial/focal epilepsies, but could also be envisaged for targeting key seizure propagation areas...... are highly needed. Herein, we highlight recent progress in stem-cell-based and gene transfer-based therapies in epilepsy according to findings in animal models and address their potential clinical application. Multiple therapeutic targets are described, including neuropeptides, neurotrophic factors...

  1. AN INDIVIDUALIZED APPROACH TO THE EVALUATION OF CUSHING SYNDROME.

    Science.gov (United States)

    Sharma, Susmeeta T

    2017-06-01

    Cushing syndrome (CS) is caused by chronic exposure to excess glucocorticoids. Early recognition and treatment of hypercortisolemia can lead to decreased morbidity and mortality. The diagnosis of CS and thereafter, establishing the cause can often be difficult, especially in patients with mild and cyclic hypercortisolism. Surgical excision of the cause of excess glucocorticoids is the optimal treatment for CS. Medical therapy (steroidogenesis inhibitors, medications that decrease adrenocorticotropic hormone [ACTH] levels or glucocorticoid antagonists) and pituitary radiotherapy may be needed as adjunctive treatment modalities in patients with residual, recurrent or metastatic disease, in preparation for surgery, or when surgery is contraindicated. A multidisciplinary team approach, individualized treatment plan and long-term follow-up are important for optimal management of hypercortisolemia and the comorbidities associated with CS. ACTH = adrenocorticotropic hormone; BIPSS = bilateral inferior petrosal sinus sampling; CBG = corticosteroid-binding globulin; CD = Cushing disease; CRH = corticotropin-releasing hormone; CS = Cushing syndrome; Dex = dexamethasone; DST = dexamethasone suppression test; EAS = ectopic ACTH syndrome; FDA = U.S. Food & Drug Administration; HDDST = high-dose DST; IPS/P = inferior petrosal sinus to peripheral; MRI = magnetic resonance imaging; NET = neuroendocrine tumor; PET = positron emission tomography; UFC = urinary free cortisol.

  2. Treatment Heterogeneity and Individual Qualitative Interaction

    Science.gov (United States)

    2011-08-01

    dark- coloured individuals escape.” ~ Charles Darwin “What is food to one to some becomes Fierce poison” ~ Lucretius The quotations above...the evaluation of the plausibility and frequency of such IQIs. The ideas may also be useful in evaluating advertising claims. Consider the context

  3. Arrest—Individual Treatment with Cord Blood

    Directory of Open Access Journals (Sweden)

    A. Jensen

    2013-01-01

    Full Text Available Each year, thousands of children incur brain damage that results in lifelong sequelae. Therefore, based on experimental evidence, we explored the therapeutic potential of human cord blood, known to contain stem cells, to examine the functional neuroregeneration in a child with cerebral palsy after cardiac arrest. The boy, whose cord blood was stored at birth, was 2.5 years old and normally developed when global ischemic brain damage occurred resulting in a persistent vegetative state. Nine weeks later, he received autologous cord blood (91.7 mL, cryopreserved, 5.75×10e8 mononuclear cells intravenously. Active rehabilitation (physio- and ergotherapy was provided daily, follow-up at 2, 5, 12, 24, 30, and 40 months. At 2-months follow-up the boy’s motor control improved, spastic paresis was largely reduced, and eyesight was recovered, as did the electroencephalogram. He smiled when played with, was able to sit and to speak simple words. At 40 months, independent eating, walking in gait trainer, crawling, and moving from prone position to free sitting were possible, and there was significantly improved receptive and expressive speech competence (four-word sentences, 200 words. This remarkable functional neuroregeneration is difficult to explain by intense active rehabilitation alone and suggests that autologous cord blood transplantation may be an additional and causative treatment of pediatric cerebral palsy after brain damage.

  4. Identity and individual economic agents: a narrative approach

    NARCIS (Netherlands)

    Davis, J.B.; White, M.D.; van Staveren, I.

    2010-01-01

    This paper offers an account of how individuals act as agents when we employ a narrative approach to explaining their personal identities. It applies Korsgaard's idea of a "reflective structure of consciousness" to provide foundations for a richer account of the individual economic agent, and uses

  5. Identity and individual economic agents: a narrative approach

    NARCIS (Netherlands)

    Davis, J.B.

    2009-01-01

    This paper offers an account of how individuals act as agents when we employ a narrative approach to explaining their personal identities. It applies Korsgaard's idea of a "reflective structure of consciousness" to provide foundations for a richer account of the individual economic agent, and uses

  6. Characterization of Individuals Seeking Treatment for Caffeine Dependence

    OpenAIRE

    Juliano, Laura M.; Evatt, Daniel P.; Richards, Brian D.; Griffiths, Roland R.

    2012-01-01

    Previous investigations have identified individuals who meet criteria for DSM-IV-TR substance dependence as applied to caffeine, but there is little research on treatments for caffeine dependence. This study aimed to thoroughly characterize individuals who are seeking treatment for problematic caffeine use. Ninety-four individuals who identified as being psychologically or physically dependent on caffeine, or who had tried unsuccessfully to modify caffeine consumption participated in a face-t...

  7. A Review of Educational Approaches for Individuals with Autism.

    Science.gov (United States)

    Dempsey, Ian; Foreman, Phil

    2001-01-01

    This article reviews research on educational approaches to the management of autism. Approaches include sensory-motor therapies (sensory integration training, auditory integration therapy, music therapy), applied behavior analysis, communication therapies, multi-treatment programs, and play and group therapy. Recommendations are made about the…

  8. Assessing Instructional Modalities: Individualized Treatment Effects for Personalized Learning

    Science.gov (United States)

    Beemer, Joshua; Spoon, Kelly; Fan, Juanjuan; Stronach, Jeanne; Frazee, James P.; Bohonak, Andrew J.; Levine, Richard A.

    2018-01-01

    Estimating the efficacy of different instructional modalities, techniques, and interventions is challenging because teaching style covaries with instructor, and the typical student only takes a course once. We introduce the individualized treatment effect (ITE) from analyses of personalized medicine as a means to quantify individual student…

  9. [Individuals and changes in health organizations: a psychosociological approach].

    Science.gov (United States)

    Azevedo, Creuza da Silva; Braga Neto, Francisco Campos; Sá, Marilene de Castilho

    2002-01-01

    The Brazilian health sector has undergone a severe crisis, affecting the case-resolving capacity, efficiency and governability of the health system as a whole and health organizations in particular. Although innovative management systems and tools have been encouraged, such innovations are limited in their ability to spawn organizational change, especially with regard to the challenge of enabling individual adherence to institutional projects and relations involving individuals and organizations. This paper focuses on the French psychosociological approach for analyzing and intervening in organizations, one of whose main thinkers is Eugène Enriquez. In its view of contemporary organizations, this approach focuses on the conflict between reproduction and creation as the main problem to be solved by management processes. While an organization is essentially seen as a place of order and repetition, organizational change implies the challenge of bringing creative individuals into the organization's project, avoiding the trap of controlling their minds and behavior.

  10. Approach bias for food cues in obese individuals.

    Science.gov (United States)

    Kemps, Eva; Tiggemann, Marika

    2015-01-01

    This study aimed to investigate the existence of an approach bias for food cues in obese individuals. A community sample of 56 obese women and 56 normal weight controls completed an approach-avoidance variant of the implicit association task. The obese participants were faster to respond to trials that paired food words with approach words, and trials that paired non-food words with avoid words, than the converse pairings, thus, demonstrating an approach bias for food. This bias was evident for both high caloric and low caloric food words, and was not attributable to a state of deprivation or feelings of hunger. By contrast, the normal weight controls did not show any such bias. The results are consistent with recent neurocognitive perspectives of obesity. At a practical level, approach biases for food may present a potential target for modifying (excessive) food intake.

  11. Homeless Individuals Approaching the End of Life: Symptoms and Attitudes.

    Science.gov (United States)

    Tobey, Matthew; Manasson, Julia; Decarlo, Kristen; Ciraldo-Maryniuk, Katrina; Gaeta, Jessie M; Wilson, Erica

    2017-04-01

    Over a million individuals in the United States experience homelessness annually and homeless individuals die at a higher rate than domiciled peers. Homeless individuals often have unique experiences at the end of life (EOL). This study examined the symptoms experienced by homeless individuals nearing the EOL and explored social background, attitudes, and experiences. Investigators conducted surveys of homeless individuals approaching the EOL at a medical respite home. Eligibility required a serious medical condition and for the patient's medical provider to answer "no" to the question "Would you be surprised if this patient were not alive in one year?" Interviews explored symptoms using the Memorial Symptom Assessment Survey. Symptoms were compared with those of relevant comparator groups in other studies. Participants (n = 20) were young to face the EOL (median age = 58) and suffered high rates of substance use disorders (n = 18; 90%) and psychiatric diagnoses (n = 16; 80%). Symptom frequency was high, especially as regarded pain and psychological symptoms. Previous experience with death among family and peers was universal (n = 20; 100%). Mistrust of others' decisions about the EOL was common, as was concern about receiving too little (n = 11; 55%) or too much (n = 8; 40%) care at the EOL. The frequency of symptoms was higher than in three comparator studies and those studies' subgroups (P Homeless individuals may experience a high frequency of pain and other symptoms as they approach the EOL. Care for such individuals may require a tailored approach. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  12. Implementation of the individual placement and support approach

    DEFF Research Database (Denmark)

    Bonfils, Inge Storgaard; Hansen, Henrik; Stentoft Dalum, Helle

    2017-01-01

    The individual placement and support approach (IPS) has become a widely recognized evidence-based practice to provide work for more people with severe mental illness. The aim of this literature review was to identify and evaluate research on implementation of IPS, focusing on facilitators...... and barriers. Contextual, local organizational, cooperation/team and individual factors influence the implementation process. Key facilitators are the use of a fidelity scale to measure and develop quality and the employment of skilled local leaders and IPS specialists. Barriers are located at the contextual...

  13. Treatment Approaches in Down's Syndrome: A Review.

    Science.gov (United States)

    Foreman, Philip J.; Ward, James

    1986-01-01

    The paper reviews research into treatment approaches in Down's Syndrome. Pharmacological treatments reviewed include thyroid therapy, 5-hydroxytryptophan, vitamin therapy, and cell therapy. Other treatments considered are movement patterning, early intervention, and facial surgery. Early educational intervention is seen as the most effective…

  14. Characteristics of Transgender Individuals Entering Substance Abuse Treatment

    Science.gov (United States)

    Heck, Nicholas C.; Sorensen, James L.

    2014-01-01

    Little is known about the needs or characteristics of transgender individuals in substance abuse treatment settings. Transgender (n=199) and non-transgender (cisgender, n=13440) individuals were compared on psychosocial factors related to treatment, health risk behaviors, medical and mental health status and utilization, and substance use behaviors within a database that documented individuals entering substance abuse treatment in San Francisco, CA from 2007–2009 using logistic and linear regression analyses (run separately by identified gender). Transgender men (assigned birth sex of female) differed from cisgender men across many psychosocial factors, including having more recent employment, less legal system involvement, greater incidence of living with a substance abuser, and greater family conflict, while transgender women (assigned birth sex of male) were less likely to have minor children than cisgender women. Transgender women reported greater needle use and HIV testing rates were greater among transgender women. Transgender men and women reported higher rates of physical health problems, mental health diagnoses, and psychiatric medications but there were no differences in service utilization. There were no differences in substance use behaviors except that transgender women were more likely to endorse primary methamphetamine use. Transgender individuals evidence unique strengths and challenges that could inform targeted services in substance abuse treatment. PMID:24561017

  15. Advances in multidisciplinary individualized treatment of refractory hepatic alveolar echinococcosis

    Directory of Open Access Journals (Sweden)

    ABUDUAINI Abulizi

    2015-04-01

    Full Text Available Hepatic alveolar echinococcosis (HAE is a zoonotic parasitic disease that seriously threatens the population in western China and compromises patients′ quality of life. With the continuous improvement in radical resection rate in recent years, late-stage HAE patients that were incurable in the past now have the opportunity for radical resection. However, patients who are not suitable candidates for radical resection still suffer from various complications and poor quality of life. Therefore, HAE is still considered a refractory and complex disease. The simple empirical treatment model provided by traditional professional discussion is unable to satisfy the treatment of advanced refractory HAE as it is unable to integrate specialized, standardized clinical skills for diagnosis and treatment. Multidisciplinary individualized treatment (MDT organically integrates the advantages of the available treatment into a reasonable individualized comprehensive treatment regimen. This review summarizes the advances in MDT for HAE as the best option to increase long-term survival, and suggests MDT as the first-line treatment for late-stage refractory hepatic alveolar echinococcosis.

  16. Characterization of individuals seeking treatment for caffeine dependence.

    Science.gov (United States)

    Juliano, Laura M; Evatt, Daniel P; Richards, Brian D; Griffiths, Roland R

    2012-12-01

    Previous investigations have identified individuals who meet criteria for Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000) substance dependence as applied to caffeine, but there is little research on treatments for caffeine dependence. This study aimed to thoroughly characterize individuals who are seeking treatment for problematic caffeine use. Ninety-four individuals who identified as being psychologically or physically dependent on caffeine, or who had tried unsuccessfully to modify caffeine consumption participated in a face-to-face diagnostic clinical interview. They also completed measures concerning caffeine use and quitting history, reasons for seeking treatment, and standardized self-report measures of psychological functioning. Caffeine treatment seekers (mean age 41 years, 55% women) consumed an average of 548 mg caffeine per day. The primary source of caffeine was coffee for 50% of the sample and soft drinks for 37%. Eighty-eight percent reported prior serious attempts to modify caffeine use (mean 2.7 prior attempts), and 43% reported being advised by a medical professional to reduce or eliminate caffeine. Ninety-three percent met criteria for caffeine dependence when generic DSM-IV-TR substance dependence criteria were applied to caffeine use. The most commonly endorsed criteria were withdrawal (96%), persistent desire or unsuccessful efforts to control use (89%), and use despite knowledge of physical or psychological problems caused by caffeine (87%). The most common reasons for wanting to modify caffeine use were health-related (59%) and not wanting to be dependent on caffeine (35%). This investigation reveals that there are individuals with problematic caffeine use who are seeking treatment and suggests that there is a need for effective caffeine dependence treatments. 2013 APA, all rights reserved

  17. Writing Treatment for Aphasia: A Texting Approach

    Science.gov (United States)

    Beeson, Pelagie M.; Higginson, Kristina; Rising, Kindle

    2013-01-01

    Purpose: Treatment studies have documented the therapeutic and functional value of lexical writing treatment for individuals with severe aphasia. The purpose of this study was to determine whether such retraining could be accomplished using the typing feature of a cellular telephone, with the ultimate goal of using text messaging for…

  18. Machine Learning for Treatment Assignment: Improving Individualized Risk Attribution.

    Science.gov (United States)

    Weiss, Jeremy; Kuusisto, Finn; Boyd, Kendrick; Liu, Jie; Page, David

    2015-01-01

    Clinical studies model the average treatment effect (ATE), but apply this population-level effect to future individuals. Due to recent developments of machine learning algorithms with useful statistical guarantees, we argue instead for modeling the individualized treatment effect (ITE), which has better applicability to new patients. We compare ATE-estimation using randomized and observational analysis methods against ITE-estimation using machine learning, and describe how the ITE theoretically generalizes to new population distributions, whereas the ATE may not. On a synthetic data set of statin use and myocardial infarction (MI), we show that a learned ITE model improves true ITE estimation and outperforms the ATE. We additionally argue that ITE models should be learned with a consistent, nonparametric algorithm from unweighted examples and show experiments in favor of our argument using our synthetic data model and a real data set of D-penicillamine use for primary biliary cirrhosis.

  19. Seeking psychological help: a comparison of individual and group treatment.

    Science.gov (United States)

    Shechtman, Zipora; Vogel, David; Maman, Neta

    2010-01-01

    The study examined public and self-stigma and their association with attitudes and intentions to seek psychological help in regard to both individual and group treatment as well as to various subgroups, including gender, ethnicity, educational orientation, level of religion, and age. Undergraduate students (N=307) in three universities in Israel participated in the study. Results partly confirmed the model for both individual and group therapy: Self-stigma was related to attitudes and intentions to seek help. However, public stigma was not related to self-stigma. Importantly, some differences were also found among the various subgroups, and the model, which takes into account the different subgroups, looks somewhat different for individual and group therapy.

  20. Individually dosed omalizumab: an effective treatment for severe peanut allergy.

    Science.gov (United States)

    Brandström, J; Vetander, M; Lilja, G; Johansson, S G O; Sundqvist, A-C; Kalm, F; Nilsson, C; Nopp, A

    2017-04-01

    Treatment with omalizumab has shown a positive effect on food allergies, but no dosages are established. Basophil allergen threshold sensitivity (CD-sens) can be used to objectively measure omalizumab treatment efficacy and correlates with the outcome of double-blind placebo-controlled food challenge to peanut. To evaluate whether individualized omalizumab treatment monitored by CD-sens could be an effective intervention for suppression of allergic reactions to peanut. Severely peanut allergic adolescents (n = 23) were treated with omalizumab for 8 weeks, and CD-sens was analysed before and after. Based on whether CD-sens was suppressed after 8 weeks, the patients either were subject to a peanut challenge or received eight more weeks with increased dose of omalizumab, followed by peanut challenge or another 8-week cycle of omalizumab. IgE and IgE-antibodies to peanut and its components were analysed before treatment. After individualized omalizumab treatment (8-24 weeks), all patients continued with an open peanut challenge with no (n = 18) or mild (n = 5) objective allergic symptoms. Patients (n = 15) needing an elevated omalizumab dose (ED) to suppress CD-sens had significantly higher CD-sens values at baseline 1.49 (0.44-20.5) compared to those (n = 8) who managed with normal dose (ND) 0.32 (0.24-5.5) (P omalizumab, monitored by CD-sens, is an effective and safe treatment for severe peanut allergy. The ratio of IgE-ab to storage protein Ara h 2/IgE as well as CD-sens to peanut may predict the need of a higher omalizumab dose. Clinical trials numbers: EudraCT; 2012-005625-78, ClinicalTrials.gov; NCT02402231. © 2016 John Wiley & Sons Ltd.

  1. Functional Recovery in Major Depressive Disorder: Providing Early Optimal Treatment for the Individual Patient

    Science.gov (United States)

    Katzman, Martin A; Habert, Jeffrey; McIntosh, Diane; MacQueen, Glenda M; Milev, Roumen V; McIntyre, Roger S; Blier, Pierre

    2018-01-01

    Abstract Major depressive disorder is an often chronic and recurring illness. Left untreated, major depressive disorder may result in progressive alterations in brain morphometry and circuit function. Recent findings, however, suggest that pharmacotherapy may halt and possibly reverse those effects. These findings, together with evidence that a delay in treatment is associated with poorer clinical outcomes, underscore the urgency of rapidly treating depression to full recovery. Early optimized treatment, using measurement-based care and customizing treatment to the individual patient, may afford the best possible outcomes for each patient. The aim of this article is to present recommendations for using a patient-centered approach to rapidly provide optimal pharmacological treatment to patients with major depressive disorder. Offering major depressive disorder treatment determined by individual patient characteristics (e.g., predominant symptoms, medical history, comorbidities), patient preferences and expectations, and, critically, their own definition of wellness provides the best opportunity for full functional recovery. PMID:29024974

  2. Individual, social, and cultural approaches to knowledge sharing

    Directory of Open Access Journals (Sweden)

    Widen, Gunilla

    2017-09-01

    Full Text Available Workplace knowledge sharing is a complex process and there are a large number of studies in the area. In this article three theoretical approaches in library and information science are used to discuss knowledge sharing in the workplace. The approaches are information behavior, social capital, and information culture, and they bring important insights that need to be considered from a holistic management point of view when it comes to knowledge sharing. The individual's relation to different levels of context is important, meaning both in relation to work roles, work tasks, situations, organizational structures, and culture. The frameworks also shed light on where and how knowledge sharing activities are present in the organization. From a knowledge management point of view, it is important to acknowledge that when knowledge is valued, there is also an awareness of the knowledge sharing activities. Also, in addition to more traditional views of context, the frameworks bring forward different views on context, such as time and space as contextual factors.

  3. Treatment Needs and Adverse Events Related to Dental Treatment under General Anesthesia for Individuals with Autism

    Science.gov (United States)

    Rada, Robert E.

    2013-01-01

    Individuals with autism can be quite challenging to treat in a routine dental-office setting, especially when extensive dental treatment and disruptive behavioral issues exist. Individuals with autism may also be at higher risk for oral disease. Frequently, general anesthesia is the only method to facilitate completion of the needed dental…

  4. Complex Regional Pain Syndrome and Treatment Approaches

    Directory of Open Access Journals (Sweden)

    Neslihan Gokcen

    2013-08-01

    Full Text Available Complex Regional Pain Syndrome is a symptom complex including severe pain which is disproportioned by the initiating event. Formerly, it was known as reflex sympathetic dystropy, Sudeck’s atrophy and algoneurodystrophy. There are two types of complex regional pain syndrome (CPRS. CRPS type 1 (Reflex sympathetic dystropy occurs after a minor trauma of the extremities, CRPS type 2 (Causalgia occurs following peripheral nevre injury. Diagnosis is made according to the history, symptoms and physical findings of the patients. Patient education, physical therapy and medical treatment are the most common treatment approaches of complex regional pain syndrome. The aim of this review is to revise the treatment options ofcomplex regional pain syndrome, as well as to overview the new treatment approaches and options for the refractory complex regional pain syndrome cases. [Archives Medical Review Journal 2013; 22(4.000: 514-531

  5. A Systems Medicine Approach: Translating Emerging Science into Individualized Wellness

    Directory of Open Access Journals (Sweden)

    J. S. Bland

    2017-01-01

    Full Text Available In today’s aging society, more people are living with lifestyle-related noncommunicable diseases (NCDs such as cardiovascular disease, type 2 diabetes, obesity, and cancer. Numerous opinion-leader organizations recommend lifestyle medicine as the first-line approach in NCD prevention and treatment. However, there is a strong need for a personalized approach as “one-size-fits-all” public health recommendations have been insufficient in addressing the interindividual differences in the diverse populations. Advancement in systems biology and the “omics” technologies has allowed comprehensive analysis of how complex biological systems are impacted upon external perturbations (e.g., nutrition and exercise, and therefore is gradually pushing personalized lifestyle medicine toward reality. Clinicians and healthcare practitioners have a unique opportunity in advocating lifestyle medicine because patients see them as a reliable source of advice. However, there are still numerous technical and logistic challenges to overcome before personal “big data” can be translated into actionable and clinically relevant solutions. Clinicians are also facing various issues prior to bringing personalized lifestyle medicine to their practice. Nevertheless, emerging ground-breaking research projects have given us a glimpse of how systems thinking and computational methods may lead to personalized health advice. It is important that all stakeholders work together to create the needed paradigm shift in healthcare before the rising epidemic of NCDs overwhelm the society, the economy, and the dated health system.

  6. Approaches to genotyping individual miracidia of Schistosoma japonicum.

    Science.gov (United States)

    Xiao, Ning; Remais, Justin V; Brindley, Paul J; Qiu, Dong-Chuan; Carlton, Elizabeth J; Li, Rong-Zhi; Lei, Yang; Blair, David

    2013-12-01

    Molecular genetic tools are needed to address questions as to the source and dynamics of transmission of the human blood fluke Schistosoma japonicum in regions where human infections have reemerged, and to characterize infrapopulations in individual hosts. The life stage that interests us as a target for collecting genotypic data is the miracidium, a very small larval stage that consequently yields very little DNA for analysis. Here, we report the successful development of a multiplex format permitting genotyping of 17 microsatellite loci in four sequential multiplex reactions using a single miracidium held on a Whatman Classic FTA indicating card. This approach was successful after short storage periods, but after long storage (>4 years), considerable difficulty was encountered in multiplex genotyping, necessitating the use of whole genome amplification (WGA) methods. WGA applied to cards stored for long periods of time resulted in sufficient DNA for accurate and repeatable genotyping. Trials and tests of these methods, as well as application to some field-collected samples, are reported, along with the discussion of the potential insights to be gained from such techniques. These include recognition of sibships among miracidia from a single host, and inference of the minimum number of worm pairs that might be present in a host.

  7. Treatment and Counseling Approaches for Eating Disorders.

    Science.gov (United States)

    Hamilton, Kristin L.

    Maladaptive eating behaviors are a growing phenomenon which has captured the interest of not only health and psychology professionals, but also the general public. This paper examines the various types of treatment and counseling approaches for treating anorexia nervosa and bulimia nervosa. Definitions for both disorders are provided, followed by…

  8. Different approaches to acute organophosphorus poison treatment.

    Science.gov (United States)

    Nurulain, Syed Muhammad

    2012-07-01

    Organophosphorus compounds (OPCs) have a wide variety of applications and are a serious threat for self-poisoning, unintentional misuse, terrorist attack, occupational hazard and warfare attack. The present standard treatment has been reported to be unsatisfactory. Many novel approaches are being used and tested for acute organophosphorus (OP) poison treatment. The bioscavenger concept captured high attention among the scientific community during the last few decades. Other approaches like alkalinisation of blood plasma/serum and use of weak inhibitors against strong inhibitors, though it showed promising results, did not get such wide attention. The introduction of a novel broad-spectrum oxime has also been in focus. In this mini-review, an update of the overview of four different approaches has been discussed. The standard therapy that is atropine+oxime+benzodiazepine along with supportive measures will continue to be the best option with only the replacement of a single oxime to improve its broad-spectrum efficacy.

  9. [Etiological analysis and individualized treatment of pharyngeal paraesthesia].

    Science.gov (United States)

    Lou, Zhengcai; Gong, Xuhong; Lou, Fangyi; He, Lanjuan; Zhu, Qiaoying

    2009-07-01

    To analyze the nosazontology of pharyngeal paraesthesia and investigate the treatment. Two hundred and twelve misdiagnosed pharyngeal paraesthesia patients were investigated by history inquiry, routine examination, 24-hour esophageal pH monitoring, barium X-ray of the oesophagus, anxieties-athymic private measuring scale, coefficient of variation of the R-R (CVR-R), bioavailable testosterone detection (Bio-T), erection experiment and questionnaire about man climacteric syndrome. The concomitant symptoms and positions of pharyngeal paresthesia were also studied. We adopted individuallized sequential multi-therapy for every patient according to the cause of disease. The cause of disease within 212 cases of pharyngeal paraesthesia included 62 psychic trauma, 32 endocrine system disease, 106 upper gastrointestinal disease, circulatory disease, 9 circulatory disease, 3 idiopathic. With individualized treatment, 110 cases had fully recovered, 63 cases excellence and 31 cases utility, and the efficiency rate was 96.23%. Pharyngeal paraesthesia can be caused by several factors. Thorough examination and comprehensive analysis should be applied to those incurable patient who has been treated for a long time. Short course of treatment and irrational drug use are the main causes of short-term recurrence and unsatisfactory curative effect.

  10. Multidisciplinary treatment approach in Treacher Collins syndrome.

    Science.gov (United States)

    Hylton, Joseph B; Leon-Salazar, Vladimir; Anderson, Gary C; De Felippe, Nanci L O

    2012-01-01

    Treacher Collins syndrome (TCS) is a common genetic disorder with high penetrance and phenotypic variability. First and second branchial arches are affected in TCS, resulting in craniofacial and intraoral anomalies such as: severe convex facial profile; mid-face hypoplasia; microtia; eyelid colobomas; mandibular retrognathism; cleft palate; dental hypoplasia; heterotopic teeth; maxillary transverse hypoplasia; anterior open bite; and Angle Class II molar relationship. A high incidence of caries is also a typical finding in TCS patients. Nonetheless, even simple dental restorative procedures can be challenging in this patient population due to other associated medical conditions, such as: congenital heart defects; decreased oropharyngeal airways; hearing loss; and anxiety toward treatment. These patients often require a multidisciplinary treatment approach, including: audiology; speech and language pathology; otorhinolaryngology; general dentistry; orthodontics; oral and maxillofacial surgery; and plastic and reconstructive surgeries to improve facial appearance. This paper's purpose was to present a current understanding of Treacher Collins syndrome etiology, phenotype, and current treatment approaches.

  11. Determinants of Individual Investor Behaviour: An Orthogonal Linear Transformation Approach

    OpenAIRE

    Chandra, Abhijeet; Kumar, Ravinder

    2011-01-01

    Expected utility theory views the individual investment decision as a tradeoff between immediate consumption and deferred consumption. But individuals do not always prefer according to the classical theory of economics. Recent studies on individual investor behavior have shown that they do not act in a rational manner, rather several factors influences their investment decisions in stock market. The present study considers this theory of irrationality of individual investors and investigates ...

  12. Predicting Change in Postpartum Depression: An Individual Growth Curve Approach.

    Science.gov (United States)

    Buchanan, Trey

    Recently, methodologists interested in examining problems associated with measuring change have suggested that developmental researchers should focus upon assessing change at both intra-individual and inter-individual levels. This study used an application of individual growth curve analysis to the problem of maternal postpartum depression.…

  13. [Approaches in the treatment of pathologic gambling].

    Science.gov (United States)

    Nespor, K

    1994-06-01

    In the treatment of pathological gambling the diagnosis, treatment of the accessory psychopathology and the somatic condition are important. Motivation training, behavioural and reality-oriented therapy, modification of the lifestyle relaxation techniques and yoga proved useful. There is also experience with dynamically oriented treatment techniques self-esteem reinforcement, training of social skills, strategies which promote impulse control, artetherapy, group therapy, provision of relevant information etc. Family therapy is important both for a pathological gambler and his/her relatives. Very important is contact with the family of the pathological gambler for his own treatment and with regard to the needs of his/her relatives. A therapeutic approach common abroad is participation in a self-help group, Gamblers Anonymous.

  14. Adult orthodontics: multi- or interdisciplinary treatment approach

    DEFF Research Database (Denmark)

    Melsen, Birte

    2007-01-01

    An increasing number of adult patients seen in the orthodontic offices are presenting with an ongoing degeneration caused either by loss of one or more teeth and/or progressing periodontal disease. The treatment of these patients can rarely stand alone and both diagnosis and treatment planning...... experiments carried out on monkeys and dogs have repeatedly demonstrated that it is possible to regain lost attachment even in the case of horizontal bone loss through a carefully conducted combined periodontal- and orthodontic treatment and long-term follow-up have confirmed that the results can...... of the conservative approach practiced in many places within periodontology, it should be appreciated that any orthodontic tooth movement involving intrusive components should not be performed in the presence of pathological pockets. New regenerative periodontal treatment procedures have improved the prognosis...

  15. Unemployment risk among individuals undergoing medical treatment for chronic diseases.

    Science.gov (United States)

    Nakaya, N; Nakamura, T; Tsuchiya, N; Tsuji, I; Hozawa, A; Tomita, H

    2016-03-01

    Chronic diseases increase the risk of unemployment even in non-disaster settings; therefore, in post-disaster settings, special attention needs to be paid to the employment status of those suffering from chronic diseases. To examine the association between chronic disease and the risk of unemployment in a disaster area. This cross-sectional study was conducted in Shichigahama Town, Miyagi, north-eastern Japan, where had been severely inundated by the 2011 tsunami. Logistic regression analyses were used to evaluate the association between undergoing medical treatment for a combination of chronic diseases (stroke, cancer, myocardial infarction and angina) and unemployment risk. Confounders such as psychological distress and levels of daily life activity were considered. Among the 2588 individuals studied, there was a statistically significant association between undergoing medical treatment for chronic disease and the risk of unemployment [odds ratio (OR) = 1.7, 95% confidence interval (CI) 1.02-2.7, P unemployment risk was observed only in participants with a higher degree of psychological distress and/or poorer levels of daily life activity. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  16. The Key to Individualized Addiction Treatment is Comprehensive Assessment and Monitoring of Symptoms and Behavioral Change

    Directory of Open Access Journals (Sweden)

    Thomas F. Hilton

    2015-10-01

    Full Text Available Modern health services now strive for individualized treatment. This approach has been enabled by the increase in knowledge derived from neuroscience and genomics. Substance use disorders are no exception to individualized treatment even though there are no gene-specific medications yet available. What is available is the ability to quickly and precisely assess and monitor biopsychosocial variables known to vary during addiction recovery and which place addicts at increased risk of relapse. Monitoring a broad spectrum of biopsychosocial health enables providers to address diverse genome-specific changes that might trigger withdrawal from treatment or recovery relapse in time to prevent that from occurring. This paper describes modern measurement tools contained in the NIH Patient-Reported Outcomes Measurement Information System (PROMIS and the NIH Toolbox and suggests how they might be applied to support recovery from alcohol and other substance use disorders in both pharmacological and abstinence-oriented modalities of care.

  17. Using Functional Analysis as a Framework to Guide Individualized Treatment for Negative Symptoms

    Directory of Open Access Journals (Sweden)

    Tania M. Lincoln

    2017-12-01

    Full Text Available Although numerous interventions are available for negative symptoms, outcomes have been unsatisfactory with pharmacological and psychological interventions producing changes of only limited clinical significance. Here, we argue that because negative symptoms occur as a complex syndrome caused and maintained by numerous factors that vary between individuals they are unlikely to be treated effectively by the present “one size fits all” approaches. Instead, a well-founded selection of those interventions relevant to each individual is needed to optimize both the efficiency and the efficacy of existing approaches. The concept of functional analysis (FA can be used to structure existing knowledge so that it can guide individualized treatment planning. FA is based on stimulus—response learning mechanisms taking into account the characteristics of the organism that contribute to the responses, their consequences and the contingency with which consequences are tied to the response. FA can thus be flexibly applied to the level of individual patients to understand the factors causing and maintaining negative symptoms and derive suitable interventions. In this article we will briefly introduce the concept of FA and demonstrate—exemplarily—how known psychological and biological correlates of negative symptoms can be incorporated into its framework. We then outline the framework's implications for individual assessment and treatment. Following the logic of FA, we argue that a detailed assessment is needed to identify the key factors causing or maintaining negative symptoms for each individual patient. Interventions can then be selected according to their likelihood of changing these key factors and need to take interactions between different factors into account. Supplementary case vignettes exemplify the usefulness of functional analysis for individual treatment planning. Finally, we discuss and point to avenues for future research guided by this

  18. A RELATIONAL FAIRNESS PERSPECTIVE ON INDIVIDUALITY AND INDIVIDUALIZATION IN CONTEMPORARY APPROACHES TO COMPENSATION IN ORGANIZATIONS

    DEFF Research Database (Denmark)

    Petersen, Martin Lund

    The primary concern of this thesis is to explore the relations between contemporary compensation systems based on individualization and individuality, the constitution of the fair claim, the causality of blame and the causality of rewarding, and the need to belong and it relation with human...... motivation. More specifically, the primary research question on which this thesis is based is: How is the fair claim constituted in, respec-tively, a compensation system based on individualization and individuality, a social relational perspective; and in which ways might potential differences influence...

  19. Recent considerations in regenerative endodontic treatment approaches

    Directory of Open Access Journals (Sweden)

    Hacer Aksel

    2014-09-01

    Conclusion: Although the regenerative treatment approaches have good clinical outcomes in the majority of case reports, the outcomes are unpredictable. Since the current clinical protocols for regenerative endodontics do not fully fulfill the triad of tissue engineering ((growth factors, scaffold and stem cells, further translational studies are required to achieve more pulp- and dentin-like tissue in the root canal system to achieve pulp regeneration.

  20. Approach to Dynamic Assembling of Individualized Learning Paths

    Science.gov (United States)

    Lubchak, Vladimir; Kupenko, Olena; Kuzikov, Borys

    2012-01-01

    E-learning students are generally heterogeneous and have different capabilities knowledge base and needs. The aim of the Sumy State University (SSU) e-learning system project is to cater to these individual needs by assembling individual learning path. This paper shows current situation with e-learning in Ukraine, state-of-art of development of…

  1. Evolution of transoral approaches, endoscopic endonasal approaches, and reduction strategies for treatment of craniovertebral junction pathology: a treatment algorithm update.

    Science.gov (United States)

    Dlouhy, Brian J; Dahdaleh, Nader S; Menezes, Arnold H

    2015-04-01

    The craniovertebral junction (CVJ), or the craniocervical junction (CCJ) as it is otherwise known, houses the crossroads of the CNS and is composed of the occipital bone that surrounds the foramen magnum, the atlas vertebrae, the axis vertebrae, and their associated ligaments and musculature. The musculoskeletal organization of the CVJ is unique and complex, resulting in a wide range of congenital, developmental, and acquired pathology. The refinements of the transoral approach to the CVJ by the senior author (A.H.M.) in the late 1970s revolutionized the treatment of CVJ pathology. At the same time, a physiological approach to CVJ management was adopted at the University of Iowa Hospitals and Clinics in 1977 based on the stability and motion dynamics of the CVJ and the site of encroachment, incorporating the transoral approach for irreducible ventral CVJ pathology. Since then, approaches and techniques to treat ventral CVJ lesions have evolved. In the last 40 years at University of Iowa Hospitals and Clinics, multiple approaches to the CVJ have evolved and a better understanding of CVJ pathology has been established. In addition, new reduction strategies that have diminished the need to perform ventral decompressive approaches have been developed and implemented. In this era of surgical subspecialization, to properly treat complex CVJ pathology, the CVJ specialist must be trained in skull base transoral and endoscopic endonasal approaches, pediatric and adult CVJ spine surgery, and must understand and be able to treat the complex CSF dynamics present in CVJ pathology to provide the appropriate, optimal, and tailored treatment strategy for each individual patient, both child and adult. This is a comprehensive review of the history and evolution of the transoral approaches, extended transoral approaches, endoscopie assisted transoral approaches, endoscopie endonasal approaches, and CVJ reduction strategies. Incorporating these advancements, the authors update the

  2. Pathways to treatment retention for individuals legally coerced to substance use treatment: the interaction of hope and treatment motivation.

    Science.gov (United States)

    Hampton, Ashley S; Conner, Bradley T; Albert, Dustin; Anglin, M Douglas; Urada, Darren; Longshore, Douglas

    2011-11-01

    Although several states have adopted policies diverting individuals convicted of non-violent drug offenses to substance use treatment, in lieu of incarceration or as a condition of probation, previous research has produced inconsistent findings on the effectiveness of such programs when comparing outcomes for legally coerced individuals to more voluntary entrants. Less studied in these populations is within group variation in treatment expectations and motivation influences, which have been shown to affect retention as well. As motivation has traditionally been viewed as contributing to treatment retention and higher levels of hope (the perception that goals can be met) are viewed as an asset in treatment, the role of these factors in predicting better retention between legally coerced and more voluntary clients were examined in a sample of 289 treatment admissions in California. Results found that motivation mediates the relationship between hope and retention for participants in general. Although the differences in mediation between the legally coerced and the non-legally coerced were not significant, when examining the groups separately, there was a significant mediation of the relationship between hope and retention by motivation only for those individuals who were not legally coerced into treatment (plead to different pathways to treatment retention, for individuals who were not legally coerced, higher levels of hope may play an important role in determining treatment retention. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  3. Optimal chemotherapy for leukemia: a model-based strategy for individualized treatment.

    Directory of Open Access Journals (Sweden)

    Devaraj Jayachandran

    Full Text Available Acute Lymphoblastic Leukemia, commonly known as ALL, is a predominant form of cancer during childhood. With the advent of modern healthcare support, the 5-year survival rate has been impressive in the recent past. However, long-term ALL survivors embattle several treatment-related medical and socio-economic complications due to excessive and inordinate chemotherapy doses received during treatment. In this work, we present a model-based approach to personalize 6-Mercaptopurine (6-MP treatment for childhood ALL with a provision for incorporating the pharmacogenomic variations among patients. Semi-mechanistic mathematical models were developed and validated for i 6-MP metabolism, ii red blood cell mean corpuscular volume (MCV dynamics, a surrogate marker for treatment efficacy, and iii leukopenia, a major side-effect. With the constraint of getting limited data from clinics, a global sensitivity analysis based model reduction technique was employed to reduce the parameter space arising from semi-mechanistic models. The reduced, sensitive parameters were used to individualize the average patient model to a specific patient so as to minimize the model uncertainty. Models fit the data well and mimic diverse behavior observed among patients with minimum parameters. The model was validated with real patient data obtained from literature and Riley Hospital for Children in Indianapolis. Patient models were used to optimize the dose for an individual patient through nonlinear model predictive control. The implementation of our approach in clinical practice is realizable with routinely measured complete blood counts (CBC and a few additional metabolite measurements. The proposed approach promises to achieve model-based individualized treatment to a specific patient, as opposed to a standard-dose-for-all, and to prescribe an optimal dose for a desired outcome with minimum side-effects.

  4. Narcolepsy: current treatment options and future approaches

    Science.gov (United States)

    Billiard, Michel

    2008-01-01

    The management of narcolepsy is presently at a turning point. Three main avenues are considered in this review: 1) Two tendencies characterize the conventional treatment of narcolepsy. Modafinil has replaced methylphenidate and amphetamine as the first-line treatment of excessive daytime sleepiness (EDS) and sleep attacks, based on randomized, double blind, placebo-controlled clinical trials of modafinil, but on no direct comparison of modafinil versus traditional stimulants. For cataplexy, sleep paralysis, and hypnagogic hallucinations, new antidepressants tend to replace tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) in spite of a lack of randomized, double blind, placebo-controlled clinical trials of these compounds; 2) The conventional treatment of narcolepsy is now challenged by sodium oxybate, the sodium salt of gammahydroxybutyrate, based on a series of randomized, double-blind, placebo-controlled clinical trials and a long-term open label study. This treatment has a fairly good efficacy and is active on all symptoms of narcolepsy. Careful titration up to an adequate level is essential both to obtain positive results and avoid adverse effects; 3) A series of new treatments are currently being tested, either in animal models or in humans, They include novel stimulant and anticataplectic drugs, endocrine therapy, and, more attractively, totally new approaches based on the present state of knowledge of the pathophysiology of narcolepsy with cataplexy, hypocretine-based therapies, and immunotherapy. PMID:18830438

  5. Narcolepsy: current treatment options and future approaches

    Directory of Open Access Journals (Sweden)

    Michel Billiard

    2008-06-01

    Full Text Available Michel BilliardDepartment of Neurology, Gui de Chauliac Hospital, Montpellier, FranceAbstract: The management of narcolepsy is presently at a turning point. Three main avenues are considered in this review: 1 Two tendencies characterize the conventional treatment of narcolepsy. Modafinil has replaced methylphenidate and amphetamine as the first-line treatment of excessive daytime sleepiness (EDS and sleep attacks, based on randomized, double blind, placebo-controlled clinical trials of modafinil, but on no direct comparison of modafinil versus traditional stimulants. For cataplexy, sleep paralysis, and hypnagogic hallucinations, new antidepressants tend to replace tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs in spite of a lack of randomized, double blind, placebo-controlled clinical trials of these compounds; 2 The conventional treatment of narcolepsy is now challenged by sodium oxybate, the sodium salt of gammahydroxybutyrate, based on a series of randomized, double-blind, placebo-controlled clinical trials and a long-term open label study. This treatment has a fairly good efficacy and is active on all symptoms of narcolepsy. Careful titration up to an adequate level is essential both to obtain positive results and avoid adverse effects; 3 A series of new treatments are currently being tested, either in animal models or in humans, They include novel stimulant and anticataplectic drugs, endocrine therapy, and, more attractively, totally new approaches based on the present state of knowledge of the pathophysiology of narcolepsy with cataplexy, hypocretine-based therapies, and immunotherapy.Keywords: narcolepsy, treatment, conventional drugs, modafinil, sodium oxybate, future treatments

  6. Classification System for Individualized Treatment of Adult Buried Penis Syndrome.

    Science.gov (United States)

    Tausch, Timothy J; Tachibana, Isamu; Siegel, Jordan A; Hoxworth, Ronald; Scott, Jeremy M; Morey, Allen F

    2016-09-01

    The authors present their experience with reconstructive strategies for men with various manifestations of adult buried penis syndrome, and propose a comprehensive anatomical classification system and treatment algorithm based on pathologic changes in the penile skin and involvement of neighboring abdominal and/or scrotal components. The authors reviewed all patients who underwent reconstruction of adult buried penis syndrome at their referral center between 2007 and 2015. Patients were stratified by location and severity of involved anatomical components. Procedures performed, demographics, comorbidities, and clinical outcomes were reviewed. Fifty-six patients underwent reconstruction of buried penis at the authors' center from 2007 to 2015. All procedures began with a ventral penile release. If the uncovered penile skin was determined to be viable, a phalloplasty was performed by anchoring penoscrotal skin to the proximal shaft, and the ventral shaft skin defect was closed with scrotal flaps. In more complex patients with circumferential nonviable penile skin, the penile skin was completely excised and replaced with a split-thickness skin graft. Complex patients with severe abdominal lipodystrophy required adjacent tissue transfer. For cases of genital lymphedema, the procedure involved complete excision of the lymphedematous tissue, and primary closure with or without a split-thickness skin graft, also often involving the scrotum. The authors' overall success rate was 88 percent (49 of 56), defined as resolution of symptoms without the need for additional procedures. Successful correction of adult buried penis often necessitates an interdisciplinary, multimodal approach. Therapeutic, IV.

  7. Organization of Individual Work of Students under Competence-Oriented Approach to Education in Higher School

    Science.gov (United States)

    Ualiyeva, Nazym T.; Murzalinova, Alma Z.

    2016-01-01

    The main objective of this research is to identify the essence, content and specifics of organization of individual work of higher school students under competence-oriented approach. The research methodology is related to the choice of competence-oriented approach to ensure transformation of individual work into individual activity in…

  8. Predicting the efficacy of radiotherapy in individual glioblastoma patients in vivo: a mathematical modeling approach

    International Nuclear Information System (INIS)

    Rockne, R; Alvord, E C Jr; Swanson, K R; Rockhill, J K; Kalet, I; Hendrickson, K; Mrugala, M; Spence, A M; Lai, A; Cloughesy, T

    2010-01-01

    Glioblastoma multiforme (GBM) is the most malignant form of primary brain tumors known as gliomas. They proliferate and invade extensively and yield short life expectancies despite aggressive treatment. Response to treatment is usually measured in terms of the survival of groups of patients treated similarly, but this statistical approach misses the subgroups that may have responded to or may have been injured by treatment. Such statistics offer scant reassurance to individual patients who have suffered through these treatments. Furthermore, current imaging-based treatment response metrics in individual patients ignore patient-specific differences in tumor growth kinetics, which have been shown to vary widely across patients even within the same histological diagnosis and, unfortunately, these metrics have shown only minimal success in predicting patient outcome. We consider nine newly diagnosed GBM patients receiving diagnostic biopsy followed by standard-of-care external beam radiation therapy (XRT). We present and apply a patient-specific, biologically based mathematical model for glioma growth that quantifies response to XRT in individual patients in vivo. The mathematical model uses net rates of proliferation and migration of malignant tumor cells to characterize the tumor's growth and invasion along with the linear-quadratic model for the response to radiation therapy. Using only routinely available pre-treatment MRIs to inform the patient-specific bio-mathematical model simulations, we find that radiation response in these patients, quantified by both clinical and model-generated measures, could have been predicted prior to treatment with high accuracy. Specifically, we find that the net proliferation rate is correlated with the radiation response parameter (r = 0.89, p = 0.0007), resulting in a predictive relationship that is tested with a leave-one-out cross-validation technique. This relationship predicts the tumor size post-therapy to within inter

  9. An Integrative Approach to Developing Organisational Capabilities and Individual Skills

    OpenAIRE

    Murnane, Sinéad; Thornley, Clare

    2017-01-01

    The tightly coupled relationship between organisational capability and the skills and competences of the individuals working in that organisation has long been recognised in both the academic literature and by the practitioner community. Simply improving individuals’ skills and hoping that the organisation’s capability automatically improves in tandem is not sufficient, however. This relationship is non-trivial and needs to be actively managed, meaning that people need to have shared goals ...

  10. Approaches to genotyping individual miracidia of Schistosoma japonicum

    OpenAIRE

    Xiao, Ning; Remais, Justin V.; Brindley, Paul J.; Qiu, Dong-chuan; Carlton, Elizabeth J.; Li, Rong-zhi; Lei, Yang; Blair, David

    2013-01-01

    Molecular genetic tools are needed to address questions as to the source and dynamics of transmission of the human blood fluke Schistosoma japonicum in regions where human infections have re-emerged, and to characterize infrapopulations in individual hosts. The life-stage that interests us as a target for collecting genotypic data is the miracidium, a very small larval stage that consequently yields very little DNA for analysis. Here, we report the successful development of a multiplex format...

  11. Endoscopic approaches to treatment of achalasia

    Science.gov (United States)

    Friedel, David; Modayil, Rani; Iqbal, Shahzad; Grendell, James H.

    2013-01-01

    Endoscopic therapy for achalasia is directed at disrupting or weakening the lower esophageal sphincter (LES). The two most commonly utilized endoscopic interventions are large balloon pneumatic dilation (PD) and botulinum toxin injection (BTI). These interventions have been extensively scrutinized and compared with each other as well as with surgical disruption (myotomy) of the LES. PD is generally more effective in improving dysphagia in achalasia than BTI, with the latter reserved for infirm older people, and PD may approach treatment results attained with myotomy. However, PD may need to be repeated. Small balloon dilation and endoscopic stent placement for achalasia have only been used in select centers. Per oral endoscopic myotomy is a newer endoscopic modality that will likely change the treatment paradigm for achalasia. It arose from the field of natural orifice transluminal endoscopic surgery and represents a scarless endoscopic approach to Heller myotomy. This is a technique that requires extensive training and preparation and thus there should be rigorous accreditation and monitoring of outcomes to ensure safety and efficacy. PMID:23503707

  12. The Case for Individualizing Behavior Management Approaches in Inclusive Classrooms

    Science.gov (United States)

    Grossman, Herbert

    2005-01-01

    In today's heterogeneous classrooms, one-method-fits-all-students behavior management approaches are ineffective and often harmful. To succeed with all of their students, teachers should determine whether students have emotional disorders, conduct/behavior disorders, robust male-typical behavior patterns, culturally influenced behavior, learning…

  13. A Psychoeducational Group Approach for Individuals Recovering from Anorexia Nervosa.

    Science.gov (United States)

    Kapp, Lisa

    Although in-depth, long-term group psychotherapy is a beneficial therapeutic experience for adolescent females suffering from anorexia nervosa, these clients are notoriously resistant to treatment and to long-term, open-ended group settings. This dissidence may stem from a motivational deficiency toward changing their eating patterns and…

  14. Are medical treatments for individuals and groups like single-play and multiple-play gambles?

    Directory of Open Access Journals (Sweden)

    Michael L. DeKay

    2006-11-01

    Full Text Available People are often more likely to accept risky monetary gambles with positive expected values when the gambles will be played more than once. We investigated whether this distinction between single-play and multiple-play gambles extends to medical treatments for individual patients and groups of patients. Resident physicians and medical students (extit{n} = 69 and undergraduates (extit{n} = 99 ranked 9 different flu shots and a no-flu-shot option in 1 of 4 combinations of perspective (individual patient vs. group of 1000 patients and uncertainty frame (probability vs. frequency. The rank of the no-flu-shot option (a measure of preference for treatment vs. no treatment was not significantly related to perspective or participant population. The main effect of uncertainty frame and the interaction between perspective and uncertainty frame approached significance (0.1 {extgreater} extit{p} {extgreater} 0.05, with the no-flu-shot option faring particularly poorly (treatment faring particularly well when decisions about many patients were based on frequency information. Undergraduate participants believed that the no-flu-shot option would be less attractive (treatment would be more attractive in decisions about many patients, but these intuitions were inconsistent with the actual ranks. These results and those of other studies suggest that medical treatments for individuals and groups are not analogous to single-play and multiple-play monetary gambles, perhaps because many people are unwilling to aggregate treatment outcomes over patients in the same way that they would compute net gains or losses over monetary gambles.

  15. A new approach for water treatment

    CERN Document Server

    Principe, R

    1999-01-01

    A quantity of up to 4000 m3/h of water is used at CERN for cooling purposes: experiments, magnets and radio frequency cavities are refrigerated by closed circuits filled with deionized water; other utilities, such as air-conditioning, use chilled/hot water, also in closed circuits. All these methods all employ a cold source, the primary supply of water, coming from the cooling towers. About 500 kCHF are spent every year on water treatment in order to keep the water within these networks in operational conditions. In the line of further rationalization of resources, the next generation of contracts with the water treatment industry will aim for improved performance and better monitoring of quality related parameters in this context. The author will provide a concise report based upon an examination of the state of the installations and of the philosophy followed up until now for water treatment. Furthermore, he/she will propose a new approach from both a technical and contractual point of view, in preparation ...

  16. Cancer find and treat the individual: The nuclear medicine approach

    International Nuclear Information System (INIS)

    Britton, K.E.; Granowska, M.

    2002-01-01

    Most cancer surgery and radiotherapy is based on the physical extent of the disease and not the biological extent. Most cancer chemotherapy is based on the clinical trials of the many and may or may not work in the individual. Nuclear Medicine treats the individual in whom it has provided evidence for uptake of the agent for therapy. Radiology requires a mass in tissue, displacing tissue, infiltrating tissue for contrast. Nuclear Medicine does not require a mass. It exploits the subtle differences between the cancer cell and the normal cell for identification. For cancer imaging, Nuclear Medicine has a considerable amplification factor. For the use of F-18 de-oxyglucose (FDG), the glucose transporter protein may be increased 5 - 10 times in the malignant cell and the hexokinase enzyme may be up-regulated 2-5 times. The Positron Emission Tomography (PET) detector may be a hundred fold more sensitive than a conventional gamma camera. For peptides, receptor expression may be increased 500- 10,000 times and antigen expression per cell for monoclonal antibodies between 5000 and 50,000 times. As well as the uptake, the residence time of the radiopharmaceutical is important so that what is taken up stays a sufficient length of time for imaging and/or for therapy. A radioactive pinhead is identifiable if it has enough radioactivity on it and a detector sensitive enough to detect it. For tumours less than 1.5 cm in diameter, size is not the determinant of detection

  17. A structured approach to individual plant evaluation and accident management

    International Nuclear Information System (INIS)

    Klopp, G.T.

    1991-01-01

    The current requirements for the performance of individual plant evaluations (IPE's) include the derivation of accident management insights as and if they occur in the course of finalizing an IPE. The development of formal, structured accident management programs is, however, explicitly excluded from current IPE requirements. The Nuclear Regulatory Commission is following the Nuclear Management and Resources Council (NUMARC) efforts to establish the framework(s) for accident management program development and plants to issue requirements on such development at a later date. The Commonwealth Edison program consists of comprehensive level 2 PRA's which address the requirements for IPE's and which go beyond those requirements. From the start of the IPE efforts, it was firmly held, within Edison, that the best way to fully and economically extract a viable accident management program from an IPE was to integrate the two efforts from the start and include the accident management program development as a required IPE product

  18. Methods of Improving Water Treatment Systems for Individual Residential Houses

    Directory of Open Access Journals (Sweden)

    Pavlov Sergey

    2016-01-01

    Full Text Available One of hot topics for ecological management is sewage treatment today in places where there is no sewerage. The volume of country construction in territories, which are not connected to the public sewage system increasing nowadays. Therefore, problem of wastewater treatment take place. Currently, there are a lot of different designs of local waste treatment plants is offered to consumers. However, a large number of negative reviews indicate serious shortcomings in most of the local plants offered in the market. The purpose of this paper is the proposal of improvement of the most common local treatment plants in Russia.

  19. Individual differences in approach motivation, resting-state frontal cortical activity and attentional scope

    NARCIS (Netherlands)

    Boksem, M.A.S.; Kostermans, E.; Tops, M.; de Cremer, D.

    2012-01-01

    Recent research has demonstrated that individual differences in approach motivation modulate attentional scope. In turn, approach and inhibition have been related to different neural systems that are associated with asymmetries in relative frontal activity (RFA). Here, we investigated whether such

  20. Physical treatment planning by several approaches

    International Nuclear Information System (INIS)

    Burger, G.; Morhart, A.; Wittmann, A.

    1985-01-01

    Neutron isodose planning may be performed by commercial treatment planning systems for photons, providing that certain modifications are applied. All geometry-related corrections such as for nonregular surfaces and oblique incidence remain unchanged. The main modifications concern the tissue-air-ratio, containing essentially the attenuation correction function. We have as a first step applied this modified commercial system to a few regular exposure situations in a homogenious water phantom and compared the generated isodose charts with those derived by direct Monte Carlo calculations of the neutron transport for the corresponding fields. As expected the commercial methods do not incorporate the necessary corrections for the change of scatter conditions in case of oblique incidence or wedged fields. For this reason we developed another approach, based upon the numerical superposition of dose matrices for pencil beams. These matrices were again Monte Carlo calculated. From it build-up functions can be derived by partial radial integration. The isodose charts generated by superposition of pencil beam dose distributions agree much better with directly Monte Carlo calculated ones, than those from the commercial treatment planning system. Based upon these results the method was finally applied to real patients cross sections, as derived from CT or MR-tomography. In the latter case one can even perform a pixelwise attenuation correction, if spin density images are available

  1. Individual Learning in Construction Projects: Professions and their Approaches

    Directory of Open Access Journals (Sweden)

    Ingeborg Wasif

    2010-10-01

    Full Text Available New materials, use of sophisticated technologies and increased customer demands, in combination with growing competition among construction companies, have led to a high organizational boundaries. The results indicate that personal networks are the most common source of learning for all professions. While clients, architects, and designers also engage in reading and attending courses, site managers and workers are less engaged in these activities. Experimenting and organizing for learning appear to be underutilized strategies by all professions. This leads to the conclusion that attempts to increase learning have to address the differences in learning behaviours of the various groups. Further, focus on experimenting and organizing for learning is a possibility to change the learning behaviour from learning as a consequence of problems to learning for future improvement.degree of specialization. For successful integration of the different professional specialists, there is a need for shared learning between project co-workers. Based on twenty eight interviews in six different Swedish construction projects, this paper illustrates strategies for individual and shared learning, among different actors and across various

  2. Enzyme replacement therapy in Fabry disease, towards individualized treatment

    NARCIS (Netherlands)

    Arends, M.

    2017-01-01

    Fabry disease is a very heterogeneous disorder for which expensive enzyme replacement therapy is available since more than 15 years. Because of the variety of symptoms and disease course, individual choices need to be made to improve the appropriate use of therapy. Supported by ZONWM, we have been

  3. Clinical approach in treatment of resistant hypertension

    Directory of Open Access Journals (Sweden)

    Jennifer Frank

    2009-07-01

    Full Text Available Jennifer Frank, David SommerfeldUniversity of Wisconsin School of Medicine and Public Health, Department of Family Medicine, Appleton, WI, USAAbstract: Resistant hypertension, defined as failure to achieve target blood pressure despite the use of optimal or maximum doses of at least 3 agents, one of which is a diuretic, or requiring 4 or more medications to achieve blood pressure goal, is likely to affect up to 20% of all patients with hypertension. Apparent resistant hypertension may be caused by medication nonadherence, substances that either interfere with antihypertensive mediations or cause blood pressure elevation, and under- or inappropriate medication treatment. Certain patient characteristics are associated with the presence of resistant hypertension and include chronic kidney disease, diabetes, obesity, and presence of end-organ damage (microalbuminuria, retinopathy, left-ventricular hypertrophy. Secondary causes of resistant hypertension are not uncommon and include obstructive sleep apnea, chronic kidney disease, primary aldosteronism, renal artery stenosis, pheochromocytoma, and Cushing’s disease. Initial medication management usually includes adding or increasing the dose of a diuretic, which is effective in lowering the blood pressure of a large number of patients with resistant hypertension. Additional management options include maximizing lifestyle modification, combination therapy of antihypertensive agents depending on individual patient characteristics, adding less-commonly used fourth- or fifth-line antihypertensive agents, and referral to a hypertension specialist.Keywords: resistant hypertension, blood pressure, diuretic

  4. Treatment approaches for interoceptive dysfunctions in drug addiction.

    Science.gov (United States)

    Paulus, Martin P; Stewart, Jennifer L; Haase, Lori

    2013-10-18

    There is emerging evidence that individuals with drug addiction have dysfunctions in brain systems that are important for interoceptive processing, which include, among others, the insular and the anterior cingulate cortices. These individuals may not be expending sufficient neural resources to process perturbations of the interoceptive state but may exert over-activation of these systems when processing drug-related stimuli. As a consequence, insufficient detection and processing of interoceptive state changes may result in inadequate anticipation and preparation to adapt to environmental challenges, e.g., adapt to abstinence in the presence of withdrawal symptoms. Here, we integrate interoceptive dysfunction in drug-addicted individuals, with the neural basis for meditation and exercise to develop a heuristic to target the interoceptive system as potential treatments for drug addiction. First, it is suggested that mindfulness-based approaches can modulate both interoceptive function and insular activation patterns. Second, there is an emerging literature showing that the regulation of physical exercise in the brain involves the insula and anterior cingulate cortex and that intense physical exercise is associated with a insula changes that may provide a window to attenuate the increased interoceptive response to drug-related stimuli. It is concluded that the conceptual framework of interoceptive dysfunctions in drug addiction and the experimental findings in meditation and exercise provide a useful approach to develop new interventions for drug addiction.

  5. Treatment Approaches for Interoceptive Dysfunctions in Drug Addiction

    Directory of Open Access Journals (Sweden)

    Martin P Paulus

    2013-10-01

    Full Text Available There is emerging evidence that individuals with drug addiction have dysfunctions in brain systems that are important for interoceptive processing, which include, among others, the insular and the anterior cingulate cortices. These individuals may not be expending sufficient neural resources to process perturbations of the interoceptive state but may exert over-activation of these systems when processing drug-related stimuli. As a consequence, insufficient detection and processing of interoceptive state changes may result in inadequate anticipation and preparation to adapt to environmental challenges, e.g. adapt to abstinence in the presence of withdrawal symptoms. Here, we integrate interoceptive dysfunction in drug-addicted individuals, with the neural basis for meditation and exercise to develop a heuristic to target the interoceptive system as potential treatments for drug addiction. First, it is suggested that mindfulness-based approaches can modulate both interoceptive function and insular activation patterns. Second, there is an emerging literature that the regulation of physical exercise in the brain involves the insula and anterior cingulate cortex and that intense physical exercise is associated with a state-dependent activation difference in the insula that may provide a window to attenuate the increased interoceptive response drug related stimuli. It is concluded that the conceptual framework of interoceptive dysfunctions in drug addiction and the experimental findings in meditation and exercise provide a useful approach to develop new interventions for drug addiction.

  6. A neurogenetics approach to understanding individual differences in brain, behavior, and risk for psychopathology.

    Science.gov (United States)

    Bogdan, R; Hyde, L W; Hariri, A R

    2013-03-01

    Neurogenetics research has begun to advance our understanding of how genetic variation gives rise to individual differences in brain function, which, in turn, shapes behavior and risk for psychopathology. Despite these advancements, neurogenetics research is currently confronted by three major challenges: (1) conducting research on individual variables with small effects, (2) absence of detailed mechanisms, and (3) a need to translate findings toward greater clinical relevance. In this review, we showcase techniques and developments that address these challenges and highlight the benefits of a neurogenetics approach to understanding brain, behavior and psychopathology. To address the challenge of small effects, we explore approaches including incorporating the environment, modeling epistatic relationships and using multilocus profiles. To address the challenge of mechanism, we explore how non-human animal research, epigenetics research and genome-wide association studies can inform our mechanistic understanding of behaviorally relevant brain function. Finally, to address the challenge of clinical relevance, we examine how neurogenetics research can identify novel therapeutic targets and for whom treatments work best. By addressing these challenges, neurogenetics research is poised to exponentially increase our understanding of how genetic variation interacts with the environment to shape the brain, behavior and risk for psychopathology.

  7. Advanced-stage III/IV follicular lymphoma. Treatment strategies for individual patients

    Energy Technology Data Exchange (ETDEWEB)

    Heinzelmann, Frank; Bamberg, Michael; Weinmann, Martin [Dept. of Radiation Oncology, Univ. of Tuebingen (Germany); Ottinger, Hellmut [Dept. of Bone Marrow Transplantation, Univ. of Essen (Germany); Engelhard, Marianne [Dept. of Radiation Oncology, Univ. of Essen (Germany); Soekler, Martin [Dept. of Internal Medicine II, Univ. of Tuebingen (Germany)

    2010-05-15

    Background: in patients with advanced-stage III/IV follicular lymphoma (FL), there are many treatment options available. The current challenge is to choose the optimal strategy for the individual patient. Methods: the literature was reviewed with respect to treatment strategies in patients with advanced FL by screening the PubMed databank. Results: in advanced-stage III/IV FL, median survival may approach 8-10 years. Treatment strategies include a watch-and-wait strategy, chemoimmunotherapy, monotherapy with rituximab, and - as an experimental approach so far - radioimmunotherapy. The use of autologous hematopoietic stem cell transplantation (HSCT) for patients in first remission or chemosensitive relapse prolongs progression-free survival while the effect on overall survival remains unclear compared to standard chemotherapy. However, long-term results are flawed by high relapse rates and risk of secondary malignancies. In patients with relapsed/chemoresistant disease, allogeneic HSCT constitutes the only curative approach but is associated with high treatment-related mortality. In the palliative setting, low-dose involved-field irradiation constitutes an effective treatment option in order to control local symptoms with potential long-lasting response. Conclusion: in case of advanced-disease FL, asymptomatic patients can be managed expectantly. In symptomatic patients, chemoimmunotherapy is regarded as standard therapy. In symptomatic elderly patients with relevant comorbidities, rituximab {+-} single-agent chemotherapy, or low-dose involved-field radiotherapy might be appropriate. For younger patients with chemoresistant/relapsed disease, allogeneic HSCT might be considered, since advances in supportive care and better patient selection have resulted in improved outcomes. (orig.)

  8. Random forests of interaction trees for estimating individualized treatment effects in randomized trials.

    Science.gov (United States)

    Su, Xiaogang; Peña, Annette T; Liu, Lei; Levine, Richard A

    2018-04-29

    Assessing heterogeneous treatment effects is a growing interest in advancing precision medicine. Individualized treatment effects (ITEs) play a critical role in such an endeavor. Concerning experimental data collected from randomized trials, we put forward a method, termed random forests of interaction trees (RFIT), for estimating ITE on the basis of interaction trees. To this end, we propose a smooth sigmoid surrogate method, as an alternative to greedy search, to speed up tree construction. The RFIT outperforms the "separate regression" approach in estimating ITE. Furthermore, standard errors for the estimated ITE via RFIT are obtained with the infinitesimal jackknife method. We assess and illustrate the use of RFIT via both simulation and the analysis of data from an acupuncture headache trial. Copyright © 2018 John Wiley & Sons, Ltd.

  9. Models of Alcohol and Other Drug Treatment for Consideration When Working with Deaf and Hard of Hearing Individuals.

    Science.gov (United States)

    Guthmann, Debra

    This paper discusses several models for treating chemical dependency in individuals who are deaf or hard of hearing. It begins by describing the 12-step model, a comprehensive, multi-disciplinary approach to the treatment of addiction which is abstinence oriented and based on the principles of Alcoholics Anonymous. This model includes group…

  10. Individual negative symptoms and domains - Relevance for assessment, pathomechanisms and treatment.

    Science.gov (United States)

    Kaiser, Stefan; Lyne, John; Agartz, Ingrid; Clarke, Mary; Mørch-Johnsen, Lynn; Faerden, Ann

    2017-08-01

    The negative symptoms of schizophrenia can be divided into two domains. Avolition/apathy includes the individual symptoms of avolition, asociality and anhedonia. Diminished expression includes blunted affect and alogia. Until now, causes and treatment of negative symptoms have remained a major challenge, which is partially related to the focus on negative symptoms as a broad entity. Here, we propose that negative symptoms may become more tractable when the different domains and individual symptoms are taken into account. There is now increasing evidence that the relationship with clinical variables - in particular outcome - differs between the domains of avolition/apathy and diminished expression. Regarding models of negative symptom formation, those relevant to avolition/apathy are now converging on processes underlying goal-directed behavior and dysfunctions of the reward system. In contrast, models of the diminished expression domains are only beginning to emerge. The aim of this article is to review the specific clinical, behavioral and neural correlates of individual symptoms and domains as a better understanding of these areas may facilitate specific treatment approaches. Copyright © 2016 Elsevier B.V. All rights reserved.

  11. Model-Based Individualized Treatment of Chemotherapeutics: Bayesian Population Modeling and Dose Optimization.

    Directory of Open Access Journals (Sweden)

    Devaraj Jayachandran

    Full Text Available 6-Mercaptopurine (6-MP is one of the key drugs in the treatment of many pediatric cancers, auto immune diseases and inflammatory bowel disease. 6-MP is a prodrug, converted to an active metabolite 6-thioguanine nucleotide (6-TGN through enzymatic reaction involving thiopurine methyltransferase (TPMT. Pharmacogenomic variation observed in the TPMT enzyme produces a significant variation in drug response among the patient population. Despite 6-MP's widespread use and observed variation in treatment response, efforts at quantitative optimization of dose regimens for individual patients are limited. In addition, research efforts devoted on pharmacogenomics to predict clinical responses are proving far from ideal. In this work, we present a Bayesian population modeling approach to develop a pharmacological model for 6-MP metabolism in humans. In the face of scarcity of data in clinical settings, a global sensitivity analysis based model reduction approach is used to minimize the parameter space. For accurate estimation of sensitive parameters, robust optimal experimental design based on D-optimality criteria was exploited. With the patient-specific model, a model predictive control algorithm is used to optimize the dose scheduling with the objective of maintaining the 6-TGN concentration within its therapeutic window. More importantly, for the first time, we show how the incorporation of information from different levels of biological chain-of response (i.e. gene expression-enzyme phenotype-drug phenotype plays a critical role in determining the uncertainty in predicting therapeutic target. The model and the control approach can be utilized in the clinical setting to individualize 6-MP dosing based on the patient's ability to metabolize the drug instead of the traditional standard-dose-for-all approach.

  12. Model-Based Individualized Treatment of Chemotherapeutics: Bayesian Population Modeling and Dose Optimization

    Science.gov (United States)

    Jayachandran, Devaraj; Laínez-Aguirre, José; Rundell, Ann; Vik, Terry; Hannemann, Robert; Reklaitis, Gintaras; Ramkrishna, Doraiswami

    2015-01-01

    6-Mercaptopurine (6-MP) is one of the key drugs in the treatment of many pediatric cancers, auto immune diseases and inflammatory bowel disease. 6-MP is a prodrug, converted to an active metabolite 6-thioguanine nucleotide (6-TGN) through enzymatic reaction involving thiopurine methyltransferase (TPMT). Pharmacogenomic variation observed in the TPMT enzyme produces a significant variation in drug response among the patient population. Despite 6-MP’s widespread use and observed variation in treatment response, efforts at quantitative optimization of dose regimens for individual patients are limited. In addition, research efforts devoted on pharmacogenomics to predict clinical responses are proving far from ideal. In this work, we present a Bayesian population modeling approach to develop a pharmacological model for 6-MP metabolism in humans. In the face of scarcity of data in clinical settings, a global sensitivity analysis based model reduction approach is used to minimize the parameter space. For accurate estimation of sensitive parameters, robust optimal experimental design based on D-optimality criteria was exploited. With the patient-specific model, a model predictive control algorithm is used to optimize the dose scheduling with the objective of maintaining the 6-TGN concentration within its therapeutic window. More importantly, for the first time, we show how the incorporation of information from different levels of biological chain-of response (i.e. gene expression-enzyme phenotype-drug phenotype) plays a critical role in determining the uncertainty in predicting therapeutic target. The model and the control approach can be utilized in the clinical setting to individualize 6-MP dosing based on the patient’s ability to metabolize the drug instead of the traditional standard-dose-for-all approach. PMID:26226448

  13. [Treatment of generalized anxiety: new pharmacologic approaches].

    Science.gov (United States)

    Boulenger, J P

    1995-01-01

    . However, it will also be important to know if wether or not the efficacy of these new drugs, like that of buspirone, is associated with some effects on depressive symptomatology, develops only progressively over time and is different in previous BZD users compared to GAD patients who did not receive BZD before the new drug. Among these drugs in development for GAD, the most likely to reach the market in a near future are a BZD partial agonist (abecarnil), 5-HT1A agonists like ipsapirone and 5-HT3 antagonists like ondansetron. However, another area of new developments concerning the drug treatment of GAD is the use of antidepressants, which have demonstrated efficacy in this indication even in patients without depressive features or panic attacks symptoms. Considering the chronic nature of GAD, these drugs, like those acting on the 5-HT-system, would be more adapted than BZD for the long-term management of this condition. If confirmed by clinical trials involving antidepressants other than tricyclics, the efficacy of these drugs in GAD may suggest that common neurobiological mechanisms are involved in the pathogenesis of both anxiety and depressive disorders. Despite the potential interest of these new treatments of GAD, recent years have shown that the development of new anxiolytic drugs often appears limited by high-rates of placebo response in numerous clinical trials. This phenomenon may be related--in part--to the increasingly sophisticated designs used in such trials, such as extensive diagnostic workups, repeated evaluations and inclusion criteria selecting the less severe types of anxiety. As emphasized by other authors, much more research needs to be done to establish what effects various ways of conducting a trial have on the trial's results in order to facilitate the emergence of new psychopharmacological approaches in the treatment of GAD.

  14. Systematic Desensitization Of Test Anxiety: A Comparison Of Group And Individual Treatment

    Science.gov (United States)

    Scissons, Edward H.; Njaa, Lloyd J.

    1973-01-01

    The results indicate the effectiveness of both individual desensitization and group desensitization in the treatment of high test anxiety. More research is needed in comparing the effectiveness of group desensitization and individual desensitization with intratreatment variables. (Author)

  15. Convergence of biomarkers, bioinformatics and nanotechnology for individualized cancer treatment

    Science.gov (United States)

    Phan, John H.; Moffitt, Richard A.; Stokes, Todd H.; Liu, Jian; Young, Andrew N.; Nie, Shuming; Wang, May D.

    2013-01-01

    Recent advances in biomarker discovery, biocomputing, and nanotechnology have raised new opportunities for the emerging field of personalized medicine in which disease detection, diagnosis, and therapy are tailored to each individual’s molecular profile, and also for predictive medicine that uses genetic/molecular information to predict disease development, progression, and clinical outcome. Here we discuss advanced biocomputing tools for cancer biomarker discovery and multiplexed nanoparticle probes for cancer biomarker profiling, together with prospects and challenges in correlating biomolecular signatures with clinical outcome. This bio-nano-info convergence holds great promise for molecular diagnosis and individualized therapy of cancer and other human diseases. PMID:19409634

  16. Predicting Retrograde Autobiographical Memory Changes Following Electroconvulsive Therapy: Relationships between Individual, Treatment, and Early Clinical Factors.

    Science.gov (United States)

    Martin, Donel M; Gálvez, Verònica; Loo, Colleen K

    2015-06-19

    Loss of personal memories experienced prior to receiving electroconvulsive therapy is common and distressing and in some patients can persist for many months following treatment. Improved understanding of the relationships between individual patient factors, electroconvulsive therapy treatment factors, and clinical indicators measured early in the electroconvulsive therapy course may help clinicians minimize these side effects through better management of the electroconvulsive therapy treatment approach. In this study we examined the associations between the above factors for predicting retrograde autobiographical memory changes following electroconvulsive therapy. Seventy-four depressed participants with major depressive disorder were administered electroconvulsive therapy 3 times per week using either a right unilateral or bitemporal electrode placement and brief or ultrabrief pulse width. Verbal fluency and retrograde autobiographical memory (assessed using the Columbia Autobiographical Memory Interview - Short Form) were tested at baseline and after the last electroconvulsive therapy treatment. Time to reorientation was measured immediately following the third and sixth electroconvulsive therapy treatments. Results confirmed the utility of measuring time to reorientation early during the electroconvulsive therapy treatment course as a predictor of greater retrograde amnesia and the importance of assessing baseline cognitive status for identifying patients at greater risk for developing later side effects. With increased number of electroconvulsive therapy treatments, older age was associated with increased time to reorientation. Consistency of verbal fluency performance was moderately correlated with change in Columbia Autobiographical Memory Interview - Short Form scores following right unilateral electroconvulsive therapy. Electroconvulsive therapy treatment techniques associated with lesser cognitive side effects should be particularly considered for

  17. Integrated and Holistic Treatment Approach to PTSD and SUD: A Synergy

    Science.gov (United States)

    Weis, Melanie

    2010-01-01

    Individuals living with posttraumatic stress disorder (PTSD) and addiction experience a complex and dynamic interaction of symptoms from both diagnoses. However, heretofore, each diagnosis has been approached as if it were a separate treatment consideration. Therefore, an individual may be treated for either a substance use disorder (SUD) or PTSD,…

  18. Osteopetroses, emphasizing potential approaches to treatment.

    Science.gov (United States)

    Teti, Anna; Econs, Michael J

    2017-09-01

    interfering RNA approach and novel pharmacologic treatments. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Gender-related differences in individuals seeking treatment for kleptomania.

    Science.gov (United States)

    Grant, Jon E; Potenza, Marc N

    2008-03-01

    Understanding variations in disease presentation in men and women is clinically important as differences may reflect biological and sociocultural factors and have implications for prevention and treatment strategies. Few empirical investigations have been performed in kleptomania, particularly with respect to gender-related influences. From 2001--2007, 95 adult subjects (n=27 [28.4%] males) with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-defined kleptomania were assessed on sociodemographics and clinical characteristics, including symptom severity, comorbidity, and functional impairment, to identify gender-related differences. Men and women showed substantial symptom severity and functional impairment. Compared with affected men, women with kleptomania were more likely to be married (47.1% vs 25.9%; P=.039), have a later age at shoplifting onset (20.9 vs 14 years of age; P=.001), steal household items (PKleptomania is similarly associated with significant impairment in women and men. Gender-related differences in clinical features and co-occurring disorders suggest that prevention and treatment strategies incorporate gender considerations.

  20. An algorithmic approach for the treatment of severe uncontrolled asthma

    Science.gov (United States)

    Zervas, Eleftherios; Samitas, Konstantinos; Papaioannou, Andriana I.; Bakakos, Petros; Loukides, Stelios; Gaga, Mina

    2018-01-01

    A small subgroup of patients with asthma suffers from severe disease that is either partially controlled or uncontrolled despite intensive, guideline-based treatment. These patients have significantly impaired quality of life and although they constitute asthma patients, they are responsible for more than half of asthma-related healthcare costs. Here, we review a definition for severe asthma and present all therapeutic options currently available for these severe asthma patients. Moreover, we suggest a specific algorithmic treatment approach for the management of severe, difficult-to-treat asthma based on specific phenotype characteristics and biomarkers. The diagnosis and management of severe asthma requires specialised experience, time and effort to comprehend the needs and expectations of each individual patient and incorporate those as well as his/her specific phenotype characteristics into the management planning. Although some new treatment options are currently available for these patients, there is still a need for further research into severe asthma and yet more treatment options. PMID:29531957

  1. Group or Individual treatment: What is More Effective in Childhood and Juvenile Obesity?

    Directory of Open Access Journals (Sweden)

    Rita de Cássia Garcia Pereira

    2015-01-01

    Full Text Available Objective: the objective was to compare the efficacy of individual treatment (consulting and group treatment combined with individualized care, in childhood and juvenile obesity situations. Methodology: The study was carried out in 2 different places: in the Nutrition Clinic of the Integrated Health Clinic of UNIARA and in another clinical school. In both places there was a treatment with individual consultations, however, in the Integrated Health Clinic of UNIARA treatment was also done in group care. The target individuals were composed of children and adolescents of both sexes who participated in the consultations, however, only patients who were above the 85th percentile for BMI, according to the international reference population (NCHS, 2000, were included in the sample which was composed of 58 individuals. The choice of clinical records occurred at random in both places. Results: the most effective program in the positive change in dietary habits was group together with individual treatment, where 20 patients (68.96% showed some change in eating behavior. In individual treatment, 11 patients (37.93% showed some change in dietary habits existing before treatment. There was a reduction in the rate of obesity of 24% for patients in groups, however, both types of treatment were favorable to changes in dietary habits and weight reduction. The findings showed that the strategy of individualized care together with group care is an alternative for the treatment of overweight.

  2. The metabolic vascular syndrome - guide to an individualized treatment.

    Science.gov (United States)

    Hanefeld, Markolf; Pistrosch, Frank; Bornstein, Stefan R; Birkenfeld, Andreas L

    2016-03-01

    In ancient Greek medicine the concept of a distinct syndrome (going together) was used to label 'a group of signs and symptoms' that occur together and 'characterize a particular abnormality and condition'. The (dys)metabolic syndrome is a common cluster of five pre-morbid metabolic-vascular risk factors or diseases associated with increased cardiovascular morbidity, fatty liver disease and risk of cancer. The risk for major complications such as cardiovascular diseases, NASH and some cancers develops along a continuum of risk factors into clinical diseases. Therefore we still include hyperglycemia, visceral obesity, dyslipidemia and hypertension as diagnostic traits in the definition according to the term 'deadly quartet'. From the beginning elevated blood pressure and hyperglycemia were core traits of the metabolic syndrome associated with endothelial dysfunction and increased risk of cardiovascular disease. Thus metabolic and vascular abnormalities are in extricable linked. Therefore it seems reasonable to extend the term to metabolic-vascular syndrome (MVS) to signal the clinical relevance and related risk of multimorbidity. This has important implications for integrated diagnostics and therapeutic approach. According to the definition of a syndrome the rapid global rise in the prevalence of all traits and comorbidities of the MVS is mainly caused by rapid changes in life-style and sociocultural transition resp. with over- and malnutrition, low physical activity and social stress as a common soil.

  3. Alcoholism and its treatment approach from a citizen perspective.

    Science.gov (United States)

    Gual, Antoni; Arbesú, José Ángel; Zarco, José; López Pelayo, Hugo; Miquel, Laia; Bobes, Julio

    2016-06-14

    The main objective of the study is to describe alcohol consumption in the general Spanish population, to discover citizens' opinion on their alcohol consumption, on alcoholism and on treatment approaches.   In 2015 a cross-sectional study was carried out by means of a telephone survey. A representative sample was selected. Participants were asked about their alcohol consumption, their perception of risk regarding their pattern of alcohol consumption, about their opinion on alcoholism, alcohol consequences and the treatment approach. A questionnaire was designed. The Alcohol Use Disorders Identification Test-C was used to define the pattern of alcohol intake. A descriptive and an statistical inference analysis were done. 22.1% were classified as risky drinkers, with a higher proportion in young males. The majority of individuals think that alcoholism is an illness, and more than 75% agree that alcohol has negative consequences on health, social functioning, occupational functioning and family relationships. Furthermore, the perception of risk that citizens have regarding their own drinking pattern is high (37.6%). 67.7% considered that the general practitioner can manage alcoholism, with females and older people believing this most strongly. Alcohol consumption is very prevalent in the Spanish population, especially in young people (31.8%). The perception of alcohol risk is high. The majority agree with the fact that general practitioners are well prepared for treating alcohol problems.

  4. Individualized rituximab treatment for relapsing neuromyelitis optica: a pediatric case report.

    Science.gov (United States)

    He, Dian; Yu, YunLi; Yan, WeiBo; Dai, QingQing; Xu, Zhu; Chu, Lan

    2014-08-01

    Neuromyelitis optica is an autoimmune inflammatory disorder of the central nervous system. Current therapeutic approaches are based on small uncontrolled trials, case series, or case reports. There are only a few case reports describing rituximab for pediatric neuromyelitis optica. A 7-year-old girl with neuromyelitis optica had high disease activity with recurrent myelitis and steroid dependence. A remarkable increase of CD19(+) B-cell count in the peripheral blood mononuclear cells and seropositivity for anti-aquaporin 4 antibody were detected at each attack. After induction therapy with rituximab, the CD19(+) B-cell number was significantly reduced and sustained at low levels. The level of serum anti-aquaporin 4 antibody normalized. She was relapse-free over 1-year follow-up period. An individualized maintenance therapy scheme is underway. Treatment with rituximab for relapsing neuromyelitis optica requires an individualized regimen to optimize the frequency and dosage of administration to maximize efficacy yet minimize overtreatment and cost. Personal levels of CD19(+) B cells in peripheral blood mononuclear cells at previous attacks and responsiveness to rituximab in induction therapy may be two useful indicators in establishing individualized maintenance therapy schemes for relapsing neuromyelitis optica. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Current approaches to treatments for schizophrenia spectrum disorders, part I: an overview and medical treatments

    Directory of Open Access Journals (Sweden)

    Chien WT

    2013-09-01

    Full Text Available Wai Tong Chien, Annie LK Yip School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong Abstract: During the last three decades, an increasing understanding of the etiology, psychopathology, and clinical manifestations of schizophrenia spectrum disorders, in addition to the introduction of second-generation antipsychotics, has optimized the potential for recovery from the illness. Continued development of various models of psychosocial intervention promotes the goal of schizophrenia treatment from one of symptom control and social adaptation to an optimal restoration of functioning and/or recovery. However, it is still questionable whether these new treatment approaches can address the patients' needs for treatment and services and contribute to better patient outcomes. This article provides an overview of different treatment approaches currently used in schizophrenia spectrum disorders to address complex health problems and a wide range of abnormalities and impairments resulting from the illness. There are different treatment strategies and targets for patients at different stages of the illness, ranging from prophylactic antipsychotics and cognitive–behavioral therapy in the premorbid stage to various psychosocial interventions in addition to antipsychotics for relapse prevention and rehabilitation in the later stages of the illness. The use of antipsychotics alone as the main treatment modality may be limited not only in being unable to tackle the frequently occurring negative symptoms and cognitive impairments but also in producing a wide variety of adverse effects to the body or organ functioning. Because of varied pharmacokinetics and treatment responsiveness across agents, the medication regimen should be determined on an individual basis to ensure an optimal effect in its long-term use. This review also highlights that the recent practice guidelines and standards have

  6. An Investigation on Individual Students' Perceptions of Interest Utilizing a Blended Learning Approach

    Science.gov (United States)

    Shroff, Ronnie H.; Vogel, Douglas R.

    2010-01-01

    Research has established that individual student interest has a positive effect on learning and academic achievement. However, little is known about the impact of a blended learning approach on individual student interest and whether combinations of online and face-to-face learning activities significantly enhance student interest. This paper…

  7. Acne Scar Treatment: A Multimodality Approach Tailored to Scar Type.

    Science.gov (United States)

    Zaleski-Larsen, Lisa A; Fabi, Sabrina G; McGraw, Timothy; Taylor, Mark

    2016-05-01

    Acne scarring can be classified into atrophic icepick, boxcar, and rolling scars in addition to keloidal and hypertrophic scars. Additionally, these scars can be erythematous, hyperpigmented, and/or hypopigmented. Each scar type has a different structural cause warranting a customized approach. Many cosmetic options exist to address these changes individually, but little literature exists about the safety and efficacy of combining such procedures and devices. A Medline search was performed on combination treatments because it relates to facial acne scarring, and results are summarized. Practical applications for these combinations of procedures are also discussed. Studies examining the efficacy and safety of ablative, nonablative, fractionated, and nonfractionated lasers, dermabrasion, chemical peels, needling, subcision, radiofrequency, stem cell therapy, fat transplantation, platelet-rich plasma, and hyaluronic acid dermal fillers for acne scars were found. The authors review their experience in combining these techniques. Review of the literature revealed multiple single options for facial acne scarring treatment with minimal evidence in the literature found on the safety and efficacy of combining such procedures and devices. The authors' experience is that combining acne scar treatment techniques can be performed safely and synergistically with optimal patient outcomes.

  8. Current approach to the treatment of chronic myeloid leukaemia.

    Science.gov (United States)

    Pasic, Ivan; Lipton, Jeffrey H

    2017-04-01

    Of all the cancers, chronic myeloid leukaemia (CML) has witnessed the most rapid evolution of the therapeutic milieu in recent decades. The introduction of tyrosine kinase inhibitors (TKIs) as a therapeutic option has profoundly changed patient experience and outcome. The availability of multiple new highly effective therapies has increasingly underscored the importance of a good understanding of the underlying pathophysiological basis in CML, as well as patient-specific factors in choosing the right treatment for every individual. The treatment of CML has migrated in many jurisdictions from the office of a highly specialized malignant hematologist to the general hematologist or even a general practitioner. The goal of this review is to offer an overview of the modern approach to the treatment of CML, with an emphasis on chronic phase (CP) CML, including both TKI-based therapies such as imatinib, dasatinib, nilotinib, bosutinib and ponatinib, and non-TKI medications, such as omacetaxine. We discuss evidence behind each drug, most common and material adverse reactions and outline how this information can be used in selecting the right drug for the right patient. We also discuss evidence as it relates to other therapies, including stem cell transplant (SCT), and patients in accelerated (AP) and blastic phase (BP). Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Current treatment approach of bone metastases

    International Nuclear Information System (INIS)

    Gómez Cabrera, Erasmo Pablo

    2016-01-01

    The document deals with the cancer situation in Cuba; the factors that produce and causes destruction of bone metastases. It also describes osteoblastic and osteolytic lesions; and details the different treatments for bone metastases

  10. Vasculitis : Clinical approach, pathophysiology and treatment

    NARCIS (Netherlands)

    Kallenberg, GGM

    2000-01-01

    Systemic vasculitides constitute a heterogeneous group of diseases characterized by inflammation of blood vessels. Classification of the disease is mandatory for the assessment of prognosis and the institution of treatment. Secondary forms of vasculitis should be distinguished from primary

  11. [Clinical laboratory approaches to parodontitis treatment optimization].

    Science.gov (United States)

    Soboleva, L A; Shul'diakov, A A; Oseeva, A O; Aleksandrova, E A

    2010-01-01

    In order to determine cycloferon liniment clinical-pathogenetic efficacy in comprehensive parodontitis therapy examination and treatment of 80 patients was done. It was determined that the cycloferon liniment use in comprehensive treatment of patients with parodontitis let to reduce infectious load in parodontal pockets and local inflammation intensity, to normalize the secretory immunoglobulin level and immune status indices that provided speed up of healing process and reduction relapse frequency.

  12. Breast cancer patients' satisfaction with individual therapy goals and treatment in a standardized integrative medicine consultancy service.

    Science.gov (United States)

    Hack, Carolin C; Antoniadis, Sophia; Hackl, Janina; Langemann, Hanna; Schwitulla, Judith; Fasching, Peter A; Beckmann, Matthias W; Theuser, Anna-Katharin

    2018-04-27

    Complementary medicine services are nowadays usually quite heterogeneous, and little information is available on standards for running an integrative medicine consultancy service. This study aimed to assess patients' satisfaction with a standardized treatment service on integrative medicine. Using a cross-sectional design, 75 breast cancer patients from the integrative medicine consultancy service at the University Breast Center for Franconia were evaluated between January 2016 and March 2017. At primary consultation, patients answered a standardized questionnaire on their medical history and treatment goals regarding integrative medicine. In a subsequent interview, patients evaluated their satisfaction with the treatment service and individual treatment goals. 72% of the patients (n = 54) reported high satisfaction with the overall approach of the treatment service. 76% of the patients (n = 57) were very satisfied or satisfied with their individual treatment plans. The most frequently reported goals were to slow tumor progression (n = 64, 85.3%), reducing the side effects of conventional cancer treatments (n = 60, 80%), and a desire to participate actively in the treatment of breast cancer (n = 64, 85.3%). Using a standardized procedure in integrative medicine allows a high quality level to be offered to patients. Overall, breast cancer patients report very high satisfaction with the integrative medicine consultancy service and state long-term treatment goals. Hence, long-term treatment with integrative medicine methods should be taken into consideration.

  13. Structural redundancy of data from wastewater treatment systems. Determination of individual balance equations.

    Science.gov (United States)

    Spindler, A

    2014-06-15

    Although data reconciliation is intensely applied in process engineering, almost none of its powerful methods are employed for validation of operational data from wastewater treatment plants. This is partly due to some prerequisites that are difficult to meet including steady state, known variances of process variables and absence of gross errors. However, an algorithm can be derived from the classical approaches to data reconciliation that allows to find a comprehensive set of equations describing redundancy in the data when measured and unmeasured variables (flows and concentrations) are defined. This is a precondition for methods of data validation based on individual mass balances such as CUSUM charts. The procedure can also be applied to verify the necessity of existing or additional measurements with respect to the improvement of the data's redundancy. Results are given for a large wastewater treatment plant. The introduction aims at establishing a link between methods known from data reconciliation in process engineering and their application in wastewater treatment. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. A critical review of treatment approaches for gambling disorders.

    Science.gov (United States)

    Stea, Jonathan N; Hodgins, David C

    2011-06-01

    This review presents the theoretical model, evidence base, and theoretical and methodological issues for seven treatment approaches to gambling disorders: 1) psychoanalytic and psychodynamic treatments, 2) Gamblers Anonymous, 3) behavioural treatments, 4) cognitive and cognitive-behavioural therapies, 5) brief, motivational, and self-directed interventions, 6) pharmacotherapies, and 7) family therapy approaches. Throughout the review, broader clinical and research issues are also discussed, including barriers to treatment-seeking, controlled gambling versus abstinence as a treatment goal, comorbidity, and the evaluation of treatment efficacy and effectiveness.

  15. Predicting Optimal Outcomes in Cognitive Therapy or Interpersonal Psychotherapy for Depressed Individuals Using the Personalized Advantage Index Approach.

    Directory of Open Access Journals (Sweden)

    Marcus J H Huibers

    Full Text Available Although psychotherapies for depression produce equivalent outcomes, individual patients respond differently to different therapies. Predictors of outcome have been identified in the context of randomized trials, but this information has not been used to predict which treatment works best for the depressed individual. In this paper, we aim to replicate a recently developed treatment selection method, using data from an RCT comparing the effects of cognitive therapy (CT and interpersonal psychotherapy (IPT.134 depressed patients completed the pre- and post-treatment BDI-II assessment. First, we identified baseline predictors and moderators. Second, individual treatment recommendations were generated by combining the identified predictors and moderators in an algorithm that produces the Personalized Advantage Index (PAI, a measure of the predicted advantage in one therapy compared to the other, using standard regression analyses and the leave-one-out cross-validation approach.We found five predictors (gender, employment status, anxiety, personality disorder and quality of life and six moderators (somatic complaints, cognitive problems, paranoid symptoms, interpersonal self-sacrificing, attributional style and number of life events of treatment outcome. The mean average PAI value was 8.9 BDI points, and 63% of the sample was predicted to have a clinically meaningful advantage in one of the therapies. Those who were randomized to their predicted optimal treatment (either CT or IPT had an observed mean end-BDI of 11.8, while those who received their predicted non-optimal treatment had an end-BDI of 17.8 (effect size for the difference = 0.51.Depressed patients who were randomized to their predicted optimal treatment fared much better than those randomized to their predicted non-optimal treatment. The PAI provides a great opportunity for formal decision-making to improve individual patient outcomes in depression. Although the utility of the PAI

  16. Whole body dosimetry for treatment individualized neuroblastoma with 131I-MIBG

    International Nuclear Information System (INIS)

    Ferrer Gracia, C.; Luquero Llopis, N.; Sanchez Munoz, F.; Plaza Aparicio, R.; Huerga Cabrerizo, C.; Corredoira Silva, E.; Serrada Hierro, A.

    2013-01-01

    It according to in this study, that in therapy with 1 31I-MIBG for the treatment of neuroblastoma, it can prescribe and manage dose whole body accurately, allowing individualized treatments and major activities that in the treatments based on a fixed activity according to weight management. (Author)

  17. Couple Discord and Depression in Couples during Couple Therapy and in Depressed Individuals during Depression Treatment

    Science.gov (United States)

    Atkins, David C.; Dimidjian, Sona; Bedics, Jamie D.; Christensen, Andrew

    2009-01-01

    The association between depression and relationship distress as well as the impact of treatment for the one on the other was examined across 2 treatment-seeking samples: individuals seeking treatment for depression (N = 120) and couples seeking marital therapy (N = 134 couples). Although there was a baseline association between depression and…

  18. An Integrated, Multidimensional Treatment Model for Individuals Living with HIV, Mental Illness, and Substance Abuse

    Science.gov (United States)

    Bouis, Stephanie; Reif, Susan; Whetten, Kathryn; Scovil, Janet; Murray, Andrea; Swartz, Marvin

    2007-01-01

    The challenge of providing effective treatment services for the growing population of HIV-positive individuals who are also dually diagnosed with substance use and mental disorders has only recently been recognized as an important public health concern affecting both HIV treatment and prevention. This article describes a treatment model that was…

  19. Nanotechnology-Based Approach in Tuberculosis Treatment

    Directory of Open Access Journals (Sweden)

    Mohammad Nasiruddin

    2017-01-01

    Full Text Available Tuberculosis, commonly known as TB, is the second most fatal infectious disease after AIDS, caused by bacterium called Mycobacterium tuberculosis. Prolonged treatment, high pill burden, low compliance, and stiff administration schedules are factors that are responsible for emergence of MDR and XDR cases of tuberculosis. Till date, only BCG vaccine is available which is ineffective against adult pulmonary TB, which is the most common form of disease. Various unique antibodies have been developed to overcome drug resistance, reduce the treatment regimen, and elevate the compliance to treatment. Therefore, we need an effective and robust system to subdue technological drawbacks and improve the effectiveness of therapeutic drugs which still remains a major challenge for pharmaceutical technology. Nanoparticle-based ideology has shown convincing treatment and promising outcomes for chronic infectious diseases. Different types of nanocarriers have been evaluated as promising drug delivery systems for various administration routes. Controlled and sustained release of drugs is one of the advantages of nanoparticle-based antituberculosis drugs over free drug. It also reduces the dosage frequency and resolves the difficulty of low poor compliance. This paper reviews various nanotechnology-based therapies which can be used for the treatment of TB.

  20. Juvenile Fibromyalgia: A Multidisciplinary Approach to Treatment.

    Science.gov (United States)

    Tesher, Melissa S

    2015-06-01

    A 14-year-old boy presented with months of severe widespread musculoskeletal pain. He was profoundly fatigued and unable to attend school. Laboratory evaluation, including complete blood count, comprehensive metabolic panel, inflammatory markers, and thyroid function, was unrevealing. Physical examination was also normal except for multiple tender points. The patient was diagnosed with juvenile primary fibromyalgia syndrome and referred for multidisciplinary treatment including physical therapy, exercise, and counseling, and his daily functioning gradually improves. Juvenile fibromyalgia is a complex syndrome that often severely limits patients' activities and can impede normal adolescent development. Effective treatment requires an understanding of the biologic, psychologic, and social factors contributing to the perpetuation of chronic pain. The author reviews the diagnostic criteria, pathophysiology, and treatment of juvenile fibromyalgia. Medications, particularly antidepressants and anticonvulsants, can be useful adjuncts to therapy. However, multimodal pain management including intensive physical therapy, exercise, counseling, and sleep hygiene is most effective in treating fibromyalgia. Copyright 2015, SLACK Incorporated.

  1. Current approaches in atrial fibrillation treatment

    Directory of Open Access Journals (Sweden)

    Cenk Sarı

    2014-09-01

    Full Text Available Atrial fibrillation (AF is the most common sustained arrhythmia encountered in clinical practice. Its incidence increases with age. AF is classified into subtypes according to the duration and/or able to provide sinus rhytym. İnitially, patients should be evaluated for rhythm or rate control for appropriate treatment. Second stage of strategy aimed to investigate the feasibility of anticoagulation therapy. Recently, due to the progress made in treatment with rhythm control and anticoagulation therapy, either American or European guidelines have been renovated. These developments have taken place in the newly published guide. In this article, the current change in the management of AF is discussed.

  2. Radiotherapy treatments using Tsallis entropy statistical approach

    International Nuclear Information System (INIS)

    Rodríguez-Pérez D; Sotolongo-Grau O; Sotolongo-Costa O; Antoranz J C

    2014-01-01

    Several radiobiological models mimic the biologic effect of one single radiation dose on a living tissue. However, the actual fractionated radiotherapy requires accounting for a new magnitude, i.e., time. Here, we explore the biological consequences posed by the mathematical prolongation of a previous single radiation model to fractionated treatment. The survival fraction is obtained, together with the equivalent physical dose, in terms of a time dependent factor (similar to a repair coefficient) describing the tissue trend to recovering its radioresistance. The model describes how dose fractions add up to obtain the equivalent dose and how the repair coefficient poses a limit to reach an equivalent dose equal to the critical one that would completely annihilate the tumor. On the other hand, the surrounding healthy tissue is a limiting factor to treatment planning. This tissue has its own repair coefficient and thus should limit the equivalent dose of a treatment. Depending on the repair coefficient and the critical dose of each tissue, unexpected results (failure to fully remove the tumor) can be obtained. To illustrate these results and predictions, some realistic example calculations will be performed using parameter values within actual clinical ranges. In conclusion, the model warns about treatment limitations and proposes ways to overcome them

  3. A comprehensive iterative approach is highly effective in diagnosing individuals who are exome negative.

    Science.gov (United States)

    Shashi, Vandana; Schoch, Kelly; Spillmann, Rebecca; Cope, Heidi; Tan, Queenie K-G; Walley, Nicole; Pena, Loren; McConkie-Rosell, Allyn; Jiang, Yong-Hui; Stong, Nicholas; Need, Anna C; Goldstein, David B

    2018-06-15

    Sixty to seventy-five percent of individuals with rare and undiagnosed phenotypes remain undiagnosed after exome sequencing (ES). With standard ES reanalysis resolving 10-15% of the ES negatives, further approaches are necessary to maximize diagnoses in these individuals. In 38 ES negative patients an individualized genomic-phenotypic approach was employed utilizing (1) phenotyping; (2) reanalyses of FASTQ files, with innovative bioinformatics; (3) targeted molecular testing; (4) genome sequencing (GS); and (5) conferring of clinical diagnoses when pathognomonic clinical findings occurred. Certain and highly likely diagnoses were made in 18/38 (47%) individuals, including identifying two new developmental disorders. The majority of diagnoses (>70%) were due to our bioinformatics, phenotyping, and targeted testing identifying variants that were undetected or not prioritized on prior ES. GS diagnosed 3/18 individuals with structural variants not amenable to ES. Additionally, tentative diagnoses were made in 3 (8%), and in 5 individuals (13%) candidate genes were identified. Overall, diagnoses/potential leads were identified in 26/38 (68%). Our comprehensive approach to ES negatives maximizes the ES and clinical data for both diagnoses and candidate gene identification, without GS in the majority. This iterative approach is cost-effective and is pertinent to the current conundrum of ES negatives.

  4. The relationship of gender and gender identity to treatment adherence among individuals with bipolar disorder.

    Science.gov (United States)

    Sajatovic, Martha; Micula-Gondek, Weronika; Tatsuoka, Curtis; Bialko, Christopher

    2011-08-01

    It has been demonstrated that 46% to 48% of individuals with bipolar disorder (BD) are at least partially nonadherent with prescribed medication. Reports of whether male gender is a predictor of treatment nonadherence in BD have been inconsistent. The construct of gender may also be a matter of cultural orientation, and psychological gender, as a component of self-perception, may affect the experience of mental illness. Gender identity is the subjective experience of one's individuality as male or female. This cross-sectional study evaluated gender and gender identity among men and women with BD as they relate to self-reported medication treatment adherence. This secondary analysis of a larger study on treatment adherence evaluated men and women with BD being treated with mood-stabilizing medications in a community mental health clinic. Gender identity and treatment adherence were evaluated using the Bem Sex Role Inventory (BSRI) and the Tablets Routine Questionnaire, respectively. Other measures included assessing BD symptoms using the Hamilton Depression Rating Scale and mania symptoms using the Young Mania Rating Scale, as well as psychosocial support with the Interpersonal Support Evaluation List and locus of control with the Multidimensional Health Locus of Control Scale. Mean age of the 70 men and 70 women with type I BD was 43.1 years for adherent patients and 40.8 years for nonadherent patients. Women with BD had mean scores on the BSRI consistent with general population norms, whereas men with BD had scores suggesting lower levels of self-perceived masculinity than population norms. There were no differences between men and women on adherence; however, men with high BSRI masculinity scores had less adherence than other men in the sample (P = 0.04). Lower scores on the "powerful others" dimension of locus of control were associated with lower adherence. For women, there was no relationship between BSRI masculinity scores and adherence. Gender identity in

  5. [Supra-aortic trunks occlusive disease: three different treatment approaches].

    Science.gov (United States)

    Dias, P; Almeida, P; Sampaio, S; Silva, A; Leite-Moreira, A; Pinho, P; Roncon de Albuquerque, R

    2010-01-01

    Unlike carotid bifurcation atherosclerotic stenosis, supra-aortic trunks (SAT) occlusive disease is rare and its revascularization uncommon, accouting for less than 10% of the operations performed on the extracranial brain-irrigating arteries. There are three different treatment approaches: transthoracic, extra-anatomic cervical and endovascular. Endovascular repair is gaining popularity as first-line therapy for proximal lesions with favorable anatomy because of its low morbidity and rare mortality. Extra-anatomic bypass is a safe and durable reconstruction and should be considered in patients with single vessel disease, with cardiopulmonary high-risk or with limited life expectancy. If cardiac surgery is needed, central transthoracic reconstruction is preferable, and the two procedures should be combined. The long-term patency of bypasses with aortic origin, specially when multiple vessels are involved, is superior to other repair techniques. We present three clinical cases that illustrate each of these therapeutic strategies: central brachiocephalic revascularization and synchronous cardiac surgery in a patient with complex SAT atherosclerosis disease; subclavian-carotid transposition for disabling upper limb claudication; and subclavian artery stenting for subclavian-steal syndrome. Surgical approach selection should be based on the individual patient's anatomy and operative risk.

  6. Standardized Approach to Quantitatively Measure Residual Limb Skin Health in Individuals with Lower Limb Amputation.

    Science.gov (United States)

    Rink, Cameron L; Wernke, Matthew M; Powell, Heather M; Tornero, Mark; Gnyawali, Surya C; Schroeder, Ryan M; Kim, Jayne Y; Denune, Jeffrey A; Albury, Alexander W; Gordillo, Gayle M; Colvin, James M; Sen, Chandan K

    2017-07-01

    Objective: (1) Develop a standardized approach to quantitatively measure residual limb skin health. (2) Report reference residual limb skin health values in people with transtibial and transfemoral amputation. Approach: Residual limb health outcomes in individuals with transtibial ( n  = 5) and transfemoral ( n  = 5) amputation were compared to able-limb controls ( n  = 4) using noninvasive imaging (hyperspectral imaging and laser speckle flowmetry) and probe-based approaches (laser doppler flowmetry, transcutaneous oxygen, transepidermal water loss, surface electrical capacitance). Results: A standardized methodology that employs noninvasive imaging and probe-based approaches to measure residual limb skin health are described. Compared to able-limb controls, individuals with transtibial and transfemoral amputation have significantly lower transcutaneous oxygen tension, higher transepidermal water loss, and higher surface electrical capacitance in the residual limb. Innovation: Residual limb health as a critical component of prosthesis rehabilitation for individuals with lower limb amputation is understudied in part due to a lack of clinical measures. Here, we present a standardized approach to measure residual limb health in people with transtibial and transfemoral amputation. Conclusion: Technology advances in noninvasive imaging and probe-based measures are leveraged to develop a standardized approach to quantitatively measure residual limb health in individuals with lower limb loss. Compared to able-limb controls, resting residual limb physiology in people that have had transfemoral or transtibial amputation is characterized by lower transcutaneous oxygen tension and poorer skin barrier function.

  7. Comorbidities and treatment of trichotillomania systemic approach

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    Maričić Mina

    2016-01-01

    Full Text Available Introduction: Trichotillomania is a type of traumatic alopecia and is defined as the irresistible urge to pull out the hair. It is classified as impulse control disorder. This chronic, recurrent disorder with dermatologic expression has specific symptomatology, affects daily activities and leads to social isolation. Goal: The aim of the study was to investigate mannerism between symptoms in population with trichotillomania and to determine connection with other habits and disorders as well as treatment differences and efficiency. Material and methods: This prospective research was conducted within 880 people with trichotillomania from all around the world in a period from November 5th to December 15th, 2016. The data were collected by using a standardized internet questionnaire. Results: Symptoms of trichotillomania usually start between 9 and 13 years. 48,5% respondents localize their disorder on one specific body region. The most involved are scalp, eyebrows and eyelashes. 56,5% of the patients pull their hairs everyday, 61,6% even in company. Oral habits are present in 20,9%. Trichotillomania is associated with dermatillomania in 42.0%, nail biting habit in 37.0%, alcohol (21.7% and drug abuse (12.3%, anxiety (60.6%, affective (55.3%, obsessive-compulsive (19.4% and sleep disorders (11.3%. The most effective treatment seem to be combination of psychotherapy, antipsychotic and antidepressant. Conclusion: Trichotillomania shows diverse psychiatric appearance in most cases, so there is not specific treatment for this condition. It is necessary to treat trichotillomania with their comorbidities, especially the ones with oral habits, who present potential surgical patients.

  8. Smartphone and Mobile Application Utilization Prior to and Following Treatment Among Individuals Enrolled in Residential Substance Use Treatment

    Science.gov (United States)

    Dahne, Jennifer; Lejuez, C. W.

    2015-01-01

    Background Following completion of substance use treatment, it is crucial for patients to continue to utilize skills learned in treatment for optimal treatment outcomes. Mobile applications (apps) on smartphones offer a unique platform to promote utilization of evidence-based skills following completion of substance use treatment. Despite the promise of mobile apps and smartphones for treatment delivery, it remains unknown whether patients in substance use treatment in the United States have access to smartphones and utilize mobile apps on smartphones. The present study sought to determine smartphone utilization among individuals enrolled in one residential substance use treatment center in the U.S catering specifically to low-income adults. Methods Participants included 251 individuals at a residential substance use treatment center in Washington DC admitted to the center between March, 2014 and January, 2015. During the intake process, participants completed interviewer-administered demographics and psychiatric questionnaires as well as a self-report of technology utilization. Results Results indicated that the majority of patients in this residential substance use treatment center owned mobile phones prior to treatment entry (86.9%) and expected to own mobile phones after leaving treatment (92.6%). Moreover, the majority of these phones were (68.5%) or will be smartphones (72.4%) on which patients reported utilizing mobile applications (Prior to treatment: 61.3%; Post treatment: 64.3%) and accessing the internet (Prior to treatment: 61.3%; Post treatment: 65.9%). Conclusions Mobile phone and smartphone ownership among this sample were comparable to ownership among U.S. adults broadly. Findings suggest that smartphones and mobile apps may hold clinical utility for fostering continued use of treatment skills following substance use treatment completion. PMID:26231698

  9. Treatment of Proper Name Retrieval Deficits in an Individual with Temporal Lobe Epilepsy

    Science.gov (United States)

    Minkina, Irene; Ojemann, Jeffrey G.; Grabowski, Thomas J.; Silkes, JoAnn P.; Phatak, Vaishali; Kendall, Diane L.

    2013-01-01

    Purpose: Studies investigating language deficits in individuals with left temporal-lobe epilepsy have consistently demonstrated impairments in proper name retrieval. The aim of this Phase I rehabilitation study was to investigate the effects of a linguistically distributed word retrieval treatment on proper name retrieval in an individual with…

  10. A Cognitive-Behavioral Treatment Approach for Body Dysmorphic Disorder

    Science.gov (United States)

    Wilhelm, Sabine; Buhlmann, Ulrike; Hayward, Laura C.; Greenberg, Jennifer L.; Dimaite, Ruta

    2010-01-01

    Although body dysmorphic disorder (BDD) has been described in the literature for more than a century, there has been only a limited focus on the development of cognitive behavioral treatments for BDD. Our case report provides a detailed description of a course of cognitive behavioral treatment (CBT) for an individual with BDD. The patient was…

  11. Linking Individual Learning Styles to Approach-Avoidance Motivational Traits and Computational Aspects of Reinforcement Learning.

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    Kristoffer Carl Aberg

    Full Text Available Learning how to gain rewards (approach learning and avoid punishments (avoidance learning is fundamental for everyday life. While individual differences in approach and avoidance learning styles have been related to genetics and aging, the contribution of personality factors, such as traits, remains undetermined. Moreover, little is known about the computational mechanisms mediating differences in learning styles. Here, we used a probabilistic selection task with positive and negative feedbacks, in combination with computational modelling, to show that individuals displaying better approach (vs. avoidance learning scored higher on measures of approach (vs. avoidance trait motivation, but, paradoxically, also displayed reduced learning speed following positive (vs. negative outcomes. These data suggest that learning different types of information depend on associated reward values and internal motivational drives, possibly determined by personality traits.

  12. Linking Individual Learning Styles to Approach-Avoidance Motivational Traits and Computational Aspects of Reinforcement Learning

    Science.gov (United States)

    Carl Aberg, Kristoffer; Doell, Kimberly C.; Schwartz, Sophie

    2016-01-01

    Learning how to gain rewards (approach learning) and avoid punishments (avoidance learning) is fundamental for everyday life. While individual differences in approach and avoidance learning styles have been related to genetics and aging, the contribution of personality factors, such as traits, remains undetermined. Moreover, little is known about the computational mechanisms mediating differences in learning styles. Here, we used a probabilistic selection task with positive and negative feedbacks, in combination with computational modelling, to show that individuals displaying better approach (vs. avoidance) learning scored higher on measures of approach (vs. avoidance) trait motivation, but, paradoxically, also displayed reduced learning speed following positive (vs. negative) outcomes. These data suggest that learning different types of information depend on associated reward values and internal motivational drives, possibly determined by personality traits. PMID:27851807

  13. [Application of individually designed trans-fissure approach in brain surgery: analysis of 90 cases].

    Science.gov (United States)

    Zhao, Ji-Zong; Wang, Shuo; Zhang, Mao-Zhi; Wang, Lei; Wang, Rong; Tang, Ya-Juan

    2009-01-06

    To explore the feasibility and value of trans-fissure approaches in brain surgery through individually designed craniotomy. Ninety patients with intracranial space-occupying lesions, 47 males and 58 females, aged (43 +/- 14) (1 - 68), were treated by individualized trans-fissure approach surgeries. Linear scalp incision or "horseshoe shape" scalp incision were designed to perform the operation, with a bone flap 3 - 4 cm in diameter. The shortest approach to reach the lesion was decided under the guidance of neuro-navigation and real-time B-mode ultrasonography. Then the lesions were removed through natural cortical fissures. Another 79 patients with intracranial space-occupying lesions, 53 males and 51 females, aged (42 +/- 11) (15 -73), undergoing classical surgeries in the same period were used as control group. The average operation time, size of bone flap, amount of blood loss, hospitalization time, and hospitalization cost were compared between these 2 groups. The operation time of the individually designed trans-fissure approach group was (3.1 +/- 1.6) hours (1.33 - 10.83 hours), significantly shorter than that of the control group [(4.8 +/- 1.9) hrs, P trans-fissure approach group was (173 +/- 168) ml (20 m - 500 ml), significantly less than that of the control group [(410 +/- 61) ml, P trans-fissure approach group was (12 +/- 5) cm2 [(1 - 25) cm2], significantly smaller than that of the control group [(20. +/- 9) cm2, P trans-fissure approach group received retransfusion, compared to 15 in the control group, during operation. No infection or other significant complications occurred after operation in the individually designed trans-fissure approach group. The hospitalization time of the individually designed trans-fissure approach group was (20 +/- 6) days (9 - 39 days), significantly shorter than that of the control group [(24 +/- 7) days, P trans-fissure approach group was (23171 +/- 7280) yuan RMB; significantly lower than that of the control group

  14. Evaluating a Bayesian approach to improve accuracy of individual photographic identification methods using ecological distribution data

    Directory of Open Access Journals (Sweden)

    Richard Stafford

    2011-04-01

    Full Text Available Photographic identification of individual organisms can be possible from natural body markings. Data from photo-ID can be used to estimate important ecological and conservation metrics such as population sizes, home ranges or territories. However, poor quality photographs or less well-studied individuals can result in a non-unique ID, potentially confounding several similar looking individuals. Here we present a Bayesian approach that uses known data about previous sightings of individuals at specific sites as priors to help assess the problems of obtaining a non-unique ID. Using a simulation of individuals with different confidence of correct ID we evaluate the accuracy of Bayesian modified (posterior probabilities. However, in most cases, the accuracy of identification decreases. Although this technique is unsuccessful, it does demonstrate the importance of computer simulations in testing such hypotheses in ecology.

  15. An individual-based approach to SIR epidemics in contact networks.

    Science.gov (United States)

    Youssef, Mina; Scoglio, Caterina

    2011-08-21

    Many approaches have recently been proposed to model the spread of epidemics on networks. For instance, the Susceptible/Infected/Recovered (SIR) compartmental model has successfully been applied to different types of diseases that spread out among humans and animals. When this model is applied on a contact network, the centrality characteristics of the network plays an important role in the spreading process. However, current approaches only consider an aggregate representation of the network structure, which can result in inaccurate analysis. In this paper, we propose a new individual-based SIR approach, which considers the whole description of the network structure. The individual-based approach is built on a continuous time Markov chain, and it is capable of evaluating the state probability for every individual in the network. Through mathematical analysis, we rigorously confirm the existence of an epidemic threshold below which an epidemic does not propagate in the network. We also show that the epidemic threshold is inversely proportional to the maximum eigenvalue of the network. Additionally, we study the role of the whole spectrum of the network, and determine the relationship between the maximum number of infected individuals and the set of eigenvalues and eigenvectors. To validate our approach, we analytically study the deviation with respect to the continuous time Markov chain model, and we show that the new approach is accurate for a large range of infection strength. Furthermore, we compare the new approach with the well-known heterogeneous mean field approach in the literature. Ultimately, we support our theoretical results through extensive numerical evaluations and Monte Carlo simulations. Published by Elsevier Ltd.

  16. Group vs. Individual Treatment for Acute Insomnia: A Pilot Study Evaluating a “One-Shot” Treatment Strategy

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    Pam Boullin

    2016-12-01

    Full Text Available Background: Despite undeniable evidence for the efficacy and effectiveness of Cognitive Behaviour Therapy for Insomnia (CBT-I, the potential for its widespread dissemination and implementation has yet to be realised. A suggested reason for this is that traditional CBT-I is considered too burdensome for deployment, in its current form, within the context of where it would be most beneficial—Primary Care. One strategy, aimed to address this, has been to develop briefer versions of CBT-I, whilst another has been to deliver CBT-I in a group format. An alternative has been to attempt to address insomnia during its acute phase with a view to circumventing its progression to chronic insomnia. The aim of the present study was to compare a brief version of CBT-I (one-shot when delivered individually or in groups to those with acute insomnia. Method: Twenty-eight individuals with acute insomnia (i.e., meeting full DSM-5 criteria for insomnia disorder for less than three months self-assigned to either a group or individual treatment arm. Treatment consisted of a single one-hour session accompanied by a self-help pamphlet. Subjects completed measures of insomnia severity, anxiety and depression pre-treatment and at one-month post-treatment. Additionally, daily sleep diaries were compared between pre-treatment and at the one-month follow up. Results: There were no significant between group differences in treatment outcome on any sleep or mood measures although those in the group treatment arm were less adherent than those who received individual treatment. Furthermore, the combined (group and individual treatment arms pre-post test effect size on insomnia symptoms, using the Insomnia Severity Index, was large (d = 2.27. Discussion: It appears that group treatment is as efficacious as individual treatment within the context of a “one shot” intervention for individuals with acute insomnia. The results are discussed with a view to integrating one-shot CBT

  17. Oral Health Condition and Treatment Needs of a Group of Nigerian Individuals with Down Syndrome

    Science.gov (United States)

    Oredugba, Folakemi A.

    2007-01-01

    Objective: This study was carried out to determine the oral health condition and treatment needs of a group of individuals with Down syndrome in Nigeria. Method: Participants were examined for oral hygiene status, dental caries, malocclusion, hypoplasia, missing teeth, crowding and treatment needs. Findings were compared with controls across age…

  18. Identifying Empirically Supported Treatments for Pica in Individuals with Intellectual Disabilities

    Science.gov (United States)

    Hagopian, Louis P.; Rooker, Griffin W.; Rolider, Natalie U.

    2011-01-01

    The purpose of the current study was to critically examine the existing literature on the treatment of pica displayed by individuals with intellectual disabilities. Criteria for empirically supported treatments as described by Divisions 12 and 16 of APA, and adapted for studies employing single-case designs were used to review this body of…

  19. Individualized treatment of multidrug-resistant tuberculosis using therapeutic drug monitoring

    Directory of Open Access Journals (Sweden)

    Mathieu S Bolhuis

    2016-01-01

    Conclusion: TDM is highly valuable to individualize and optimize treatment of complex MDR-TB patients. TDM is routinely applied in Tuberculosis Center Beatrixoord, and high success rates for treatment of MDR-TB patients have been achieved. DBS and LSS make implementation of TDM feasible, even in low- and middle-income countries.

  20. Treatment Adherence, Competence, and Outcome in Individual and Family Therapy for Adolescent Behavior Problems

    Science.gov (United States)

    Hogue, Aaron; Henderson, Craig E.; Dauber, Sarah; Barajas, Priscilla C.; Fried, Adam; Liddle, Howard A.

    2008-01-01

    This study examined the impact of treatment adherence and therapist competence on treatment outcome in a controlled trial of individual cognitive-behavioral therapy (CBT) and multidimensional family therapy (MDFT) for adolescent substance use and related behavior problems. Participants included 136 adolescents (62 CBT, 74 MDFT) assessed at intake,…

  1. An Evidence-Based Systematic Review on Communication Treatments for Individuals with Right Hemisphere Brain Damage

    Science.gov (United States)

    Blake, Margaret Lehman; Frymark, Tobi; Venedictov, Rebecca

    2013-01-01

    Purpose: The purpose of this review is to evaluate and summarize the research evidence related to the treatment of individuals with right hemisphere communication disorders. Method: A comprehensive search of the literature using key words related to right hemisphere brain damage and communication treatment was conducted in 27 databases (e.g.,…

  2. Breast cancer treatment by nanophotolysis approach

    Science.gov (United States)

    Ashiq, Muhammad Gul Bahar

    2018-06-01

    In this work, gold nanoparticles irradiated with nanosecond short pulse laser for breast cancer treatment is studied theoretically. Nanophotolysis is involved for selective damaging of breast cancer cells. Results shows that laser fluence of 1.5 J/cm2 interact with gold nanoparticles and generates a maximum number of ions. Laser light in the visible region interacts with the gold foil. At 700 nm, 12 × 1012 ions are produced for the laser intensity of 8.89 × 107 W/cm2. Slow increase in the Coulomb explosion pressure from 0.6 × 106 Pa to 2 × 106 Pa is observed for a cluster size of range 10 nm to 20 nm. Penetration of nanobullets in tumor increases with the increase of temperature from 39.83 °C to 62.20 °C. Number of cell damaged increases by increasing the number of ions (6 × 1016 cells are damaged by 9.59 × 1020 gold ions). Findings are compared with the other experimental results and are found in excellent agreement. It is concluded from current work that nanophotolysis therapy is may be useful in future for selective damaging of breast cancer cells.

  3. Mialgias: Approaches to differential diagnosis, treatment

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    Nadezhda Aleksandrovna Shostak

    2013-01-01

    Full Text Available Differential diagnosis in muscle pains often presents great difficulties so all existing signs of the disease should be carefully considered to make its diagnosis and to prescribe adequate therapy. The paper considers the causes of muscle pains, laboratory and instrumental studies (immunological tests, determination of the level of specific muscular enzymes, primarily creatine phosphokinase – CPK, etc., and the main reasons for enhanced plasma CPK activity. It also describes acute and chronic mialgias associated with enhanced plasma CPK activity, as well as diseases in which mialgias are related to the normal level of CPK, myofascial syndrome (MFS and fibromyalgia (FM in particular. The characteristic features of MFS are given in its diagnostic criteria. It is stated that a differential diagnosis should be made between MFS and major muscle pain-associated abnormalities, such as polymyalgia rheumatica, FM, etc. Diagnosticcriteria for polymyalgia rheumatica are given. A MFS treatment algorithm is presented. Local exposure methods applied to altered musculoligamentous structures in combination with myorelaxants and non-steroidal anti-inflammatory drugs assume paramount importance in MFS.

  4. [Treatment approaches for synthetic drug addiction].

    Science.gov (United States)

    Kobayashi, Ohji

    2015-09-01

    In Japan, synthetic drugs have emerged since late 2000s, and cases of emergency visits and fatal traffic accidents due to acute intoxication have rapidly increased. The synthetic drugs gained popularity mainly because they were cheap and thought to be "legal". The Japanese government restricted not only production and distribution, but also its possession and use in April 2014. As the synthetic drug dependent patients have better social profiles compared to methamphetamine abusers, this legal sanction may have triggered the decrease in the number of synthetic drug dependent patient visits observed at Kanagawa Psychiatric Center since July 2014. Treatment of the synthetic drug dependent patients should begin with empathic inquiry into the motives and positive psychological effects of the drug use. In the maintenance phase, training patients to trust others and express their hidden negative emotions through verbal communications is essential. The recovery is a process of understanding the relationship between psychological isolation and drug abuse, and gaining trust in others to cope with negative emotions that the patients inevitably would face in their subsequent lives.

  5. Identifying functional reorganization of spelling networks: an individual peak probability comparison approach

    Science.gov (United States)

    Purcell, Jeremy J.; Rapp, Brenda

    2013-01-01

    Previous research has shown that damage to the neural substrates of orthographic processing can lead to functional reorganization during reading (Tsapkini et al., 2011); in this research we ask if the same is true for spelling. To examine the functional reorganization of spelling networks we present a novel three-stage Individual Peak Probability Comparison (IPPC) analysis approach for comparing the activation patterns obtained during fMRI of spelling in a single brain-damaged individual with dysgraphia to those obtained in a set of non-impaired control participants. The first analysis stage characterizes the convergence in activations across non-impaired control participants by applying a technique typically used for characterizing activations across studies: Activation Likelihood Estimate (ALE) (Turkeltaub et al., 2002). This method was used to identify locations that have a high likelihood of yielding activation peaks in the non-impaired participants. The second stage provides a characterization of the degree to which the brain-damaged individual's activations correspond to the group pattern identified in Stage 1. This involves performing a Mahalanobis distance statistics analysis (Tsapkini et al., 2011) that compares each of a control group's peak activation locations to the nearest peak generated by the brain-damaged individual. The third stage evaluates the extent to which the brain-damaged individual's peaks are atypical relative to the range of individual variation among the control participants. This IPPC analysis allows for a quantifiable, statistically sound method for comparing an individual's activation pattern to the patterns observed in a control group and, thus, provides a valuable tool for identifying functional reorganization in a brain-damaged individual with impaired spelling. Furthermore, this approach can be applied more generally to compare any individual's activation pattern with that of a set of other individuals. PMID:24399981

  6. Adaptive brachytherapy of cervical cancer, comparison of conventional point A and CT based individual treatment planning

    International Nuclear Information System (INIS)

    Wanderaas, Anne D.; Langdal, Ingrid; Danielsen, Signe; Frykholm, Gunilla; Marthinsen, Anne B. L; Sundset, Marit

    2012-01-01

    Background. Locally advanced cervical cancer is commonly treated with external radiation therapy combined with local brachytherapy. The brachytherapy is traditionally given based on standard dose planning with prescription of dose to point A. Dosimetric aspects when changing from former standard treatment to individualized treatment plans based on computed tomography (CT) images are here investigated. Material and methods. Brachytherapy data from 19 patients with a total of 72 individual treatment fractions were retrospectively reviewed. Standard library plans were analyzed with respect to doses to organs at risk (OARs), and the result was compared to corresponding delivered individualized plans. The theoretical potential of further optimization based on prescription to target volumes was investigated. The treatments were performed with a Fletcher applicator. Results. For standard treatment planning, the tolerance dose limits were exceeded in the bladder, rectum and sigmoid in 26%, 4% and 15% of the plans, respectively. This was observed most often for the smallest target volumes. The individualized planning of the delivered treatment gave the possibility of controlling the dose to critical organs to below certain limits. The dose was still prescribed to point A. An increase in target dose coverage was achieved when additional individual optimization was performed, while still keeping the dose to the OARs below predefined limits. Relatively low average target coverage, especially for the largest volumes was however seen. Conclusion. The individualized delivered treatment plans ensured that doses to OARs were within acceptable limits. This was not the case in 42% of the corresponding standard plans. Further optimized treatment plans were found to give an overall better dose coverage. In lack of MR capacity, it may be favorable to use CT for planning due to possible protection of OARs. The CT based target volumes were, however, not equivalent to the volumes described

  7. A Holistic Treatment Approach to Male Erectile Disorder.

    Science.gov (United States)

    Millner, Vaughn S.; Ullery, Elizabeth K.

    2002-01-01

    This article offers information about erectile functioning, provides a DSM-IV-TR interpretation of erectile dysfunction, and discusses a biophysical approach to erectile dysfunction treatment. (Contains 36 references.) (GCP)

  8. IINTESTINAL COLIC IN INFANTS: APPROACHES TO THE COMPLEX TREATMENT

    Directory of Open Access Journals (Sweden)

    Yu. V. Rovenskaya

    2013-01-01

    Full Text Available The authors describe the causes and mechanisms of development of intestinal colic syndrome in infants and give the approaches to treatment of this condition with modern anti-foaming agents on the base of simethicone. 

  9. Treatment Adherence, Competence, and Outcome in Individual and Family Therapy for Adolescent Behavior Problems

    OpenAIRE

    Hogue, Aaron; Henderson, Craig E.; Dauber, Sarah; Barajas, Priscilla C.; Fried, Adam; Liddle, Howard A.

    2008-01-01

    This study examined the impact of treatment adherence and therapist competence on treatment outcome in a controlled trial of individual cognitive–behavioral therapy (CBT) and multidimensional family therapy (MDFT) for adolescent substance use and related behavior problems. Participants included 136 adolescents (62 CBT, 74 MDFT) assessed at intake, discharge, and 6-month follow-up. Observational ratings of adherence and competence were collected on early and later phases of treatment (192 CBT ...

  10. Individual capacity-building approaches in a global pharmaceutical systems strengthening program: a selected review.

    Science.gov (United States)

    Konduri, Niranjan; Rauscher, Megan; Wang, Shiou-Chu Judy; Malpica-Llanos, Tanya

    2017-01-01

    Medicines use related challenges such as inadequate adherence, high levels of antimicrobial resistance and preventable adverse drug reactions have underscored the need to incorporate pharmaceutical services to help achieve desired treatment outcomes, and protect patients from inappropriate use of medicines. This situation is further constrained by insufficient numbers of pharmaceutical personnel and inappropriate skill mix. Studies have addressed individual capacity building approaches of logistics, supply chain or disease specific interventions but few have documented those involving such pharmacy assistants/professionals, or health workers/professionals charged with improving access and provision of pharmaceutical services. We examined how different training modalities have been employed and adapted to meet country-specific context and needs by a global pharmaceutical systems strengthening program in collaboration with a country's Ministry of Health and local stakeholders. Structured, content analysis of training approaches from twelve selected countries and a survey among conveniently selected trainees in Bangladesh and Ethiopia. Case-based learning, practice and feedback, and repetitive interventions such as post-training action plan, supportive supervision and mentoring approaches are effective, evidence-based training techniques. In Ethiopia and Bangladesh, over 94% of respondents indicated that they have improved or developed skills or competencies as a result of the program's training activities. Supportive supervision structures and mentorship have been institutionalized with appropriate management structures. National authorities have been sensitized to secure funding from domestic resources or from the global fund grants for post-training follow-up initiatives. The Pharmaceutical Leadership Development Program is an effective, case-based training modality that motivates staff to develop quality-improvement interventions and solve specific challenges

  11. Individual Information-Centered Approach for Handling Physical Activity Missing Data

    Science.gov (United States)

    Kang, Minsoo; Rowe, David A.; Barreira, Tiago V.; Robinson, Terrance S.; Mahar, Matthew T.

    2009-01-01

    The purpose of this study was to validate individual information (II)-centered methods for handling missing data, using data samples of 118 middle-aged adults and 91 older adults equipped with Yamax SW-200 pedometers and Actigraph accelerometers for 7 days. We used a semisimulation approach to create six data sets: three physical activity outcome…

  12. Contract Learning as an Approach to Individualizing EFL Education in the Context of Assessment for Learning

    Science.gov (United States)

    Zandi, Hamed; Kaivanpanah, Shiva; Alavi, Sayyed Mohammad

    2015-01-01

    Contract learning as an approach to individualizing education in the context of assessment for learning is relatively underexplored in English as a Foreign Language instruction. The present study used a mixed-methods design to investigate its efficacy to provide feedback to students and improve self-directed learning. Furthermore, it studied…

  13. Gait quality is improved by locomotor training in individuals with SCI regardless of training approach

    NARCIS (Netherlands)

    Nooijen, C.F.J.; ter Hoeve, N.; Field-Fote, E.C.

    2009-01-01

    Background: While various body weight supported locomotor training (BWSLT) approaches are reported in the literature for individuals with spinal cord injury (SCI), none have evaluated outcomes in terms of gait quality. The purpose of this study was to compare changes in measures of gait quality

  14. Predictors of treatment utilization and barriers to treatment utilization among individuals with lifetime cannabis use disorder in the United States.

    Science.gov (United States)

    Kerridge, Bradley T; Mauro, Pia M; Chou, S Patricia; Saha, Tulshi D; Pickering, Roger P; Fan, Amy Z; Grant, Bridget F; Hasin, Deborah S

    2017-12-01

    To present information on predictors of treatment utilization and barriers to treatment utilization among individuals with lifetime DSM-5 cannabis use disorder (CUD). Face-to-face survey of a representative sample of the adult US general population (n=36,309). Treatment rates for CUD were low in this general population survey (13.7%). Severity of CUD and comorbidity of other lifetime drug use disorders were significant predictors of lifetime treatment utilization for CUD. Preference for self-reliance, minimizing problems, fear of stigma, and financial and structural issues were among the most frequently endorsed reasons for respondents not seeking treatment when they perceived the need for treatment among individuals with lifetime CUD, regardless of whether they eventually utilized treatment at some time in their lives. Given the rising prevalence of CUD in the US over the past decade and currently low treatment rates for CUD, increased provision for services for CUD appears critically needed, especially those that screen for and treat, when present, other drug use disorders. Programs to reduce stigma and financial barriers are needed, as well as programs to increase awareness among the general public, health care professionals about the nature and seriousness of CUD, and the availability and effectiveness of treatment for this disorder. Copyright © 2017. Published by Elsevier B.V.

  15. Systems approach to studying animal sociality: individual position versus group organization in dynamic social network models.

    Directory of Open Access Journals (Sweden)

    Karlo Hock

    2010-12-01

    Full Text Available Social networks can be used to represent group structure as a network of interacting components, and also to quantify both the position of each individual and the global properties of a group. In a series of simulation experiments based on dynamic social networks, we test the prediction that social behaviors that help individuals reach prominence within their social group may conflict with their potential to benefit from their social environment. In addition to cases where individuals were able to benefit from improving both their personal relative importance and group organization, using only simple rules of social affiliation we were able to obtain results in which individuals would face a trade-off between these factors. While selection would favor (or work against social behaviors that concordantly increase (or decrease, respectively fitness at both individual and group level, when these factors conflict with each other the eventual selective pressure would depend on the relative returns individuals get from their social environment and their position within it. The presented results highlight the importance of a systems approach to studying animal sociality, in which the effects of social behaviors should be viewed not only through the benefits that those provide to individuals, but also in terms of how they affect broader social environment and how in turn this is reflected back on an individual's fitness.

  16. The effects of an individual, multistep intervention on adherence to treatment in hemodialysis patients.

    Science.gov (United States)

    Rafiee Vardanjani, Leila; Parvin, Neda; Mahmoodi Shan, Gholamreza

    2015-07-01

    The present study was conducted to investigate the effect of individual, multistep intervention on adherence to treatment in hemodialysis patients referred to a hemodialysis center in Shahrekord, Iran. In this interventional study, hemodialysis patients referring the center of the study were randomly assigned into two control and intervention groups (each 33). The control group received routine treatment, recommended dietary and fluid restrictions. The intervention group participated in eight individual interventional sessions accompanied routine treatment. At the beginning and the end of the study, routine laboratory tests and end-stage renal disease-adherence questionnaire were filled out for patients in both groups. The data were analyzed using Mann-Whitney and Wilcoxon tests. At the end of the study, the two groups showed a significant difference in all domains of adherence except adherence to diet and adherence was better in the intervention group (p adherence to dialysis program (p = 0.04, r = 0.254). After intervention, serum phosphorus decreased significantly in the intervention group (p Adherence to treatment is one of the major problems in hemodialysis patients; however, comprehensive interventions are required in view of individual condition. Implications for Rehabilitation Adherence to treatment means that all patients' behaviors (diet, fluids and drugs intake) should be in line with the recommendations given by healthcare professionals. There is evidence on the association between adherence to treatment and decreased risk of hospitalization in dialysis patients. Individual structured programs are most likely to be successful in encouraging adherence to treatment.

  17. DEVOTION IN NICHOLAS SPARKS’ THE NOTEBOOK (1996: AN INDIVIDUAL PSYCHOLOGICAL APPROACH

    Directory of Open Access Journals (Sweden)

    Yuli Andria Fajarini

    2017-08-01

    Full Text Available The study described the devotion of Noah Calhoun, the main character in Nicholas Sparks’ The Notebook. It focused on its structural elements and the devotion of Noah to deal with inferiority feeling and compensation, striving for superiority, fictional finalism, style of life, social interest, and creative self that were explored through an individual psychological approach. This research was qualitative research with the primary data source of the novel entitled The Notebook written by Nicholas Sparks in 1996. While the secondary data were other related sources. The data were collected through library research. The results showed that based on individual psychology analysis the major character, Noah Calhoun is psychologically affected. Noah fights hard to get his true love and shows her his devotion. He dedicates all of his life for Allie.     Keywords: Devotion, The Notebook, Individual Psychological Approach.

  18. Delineating Individual Trees from Lidar Data: A Comparison of Vector- and Raster-based Segmentation Approaches

    Directory of Open Access Journals (Sweden)

    Maggi Kelly

    2013-08-01

    Full Text Available Light detection and ranging (lidar data is increasingly being used for ecosystem monitoring across geographic scales. This work concentrates on delineating individual trees in topographically-complex, mixed conifer forest across the California’s Sierra Nevada. We delineated individual trees using vector data and a 3D lidar point cloud segmentation algorithm, and using raster data with an object-based image analysis (OBIA of a canopy height model (CHM. The two approaches are compared to each other and to ground reference data. We used high density (9 pulses/m2, discreet lidar data and WorldView-2 imagery to delineate individual trees, and to classify them by species or species types. We also identified a new method to correct artifacts in a high-resolution CHM. Our main focus was to determine the difference between the two types of approaches and to identify the one that produces more realistic results. We compared the delineations via tree detection, tree heights, and the shape of the generated polygons. The tree height agreement was high between the two approaches and the ground data (r2: 0.93–0.96. Tree detection rates increased for more dominant trees (8–100 percent. The two approaches delineated tree boundaries that differed in shape: the lidar-approach produced fewer, more complex, and larger polygons that more closely resembled real forest structure.

  19. Personalizing Type 2 Diabetes Management: Use of a Patient-Centered Approach to Individualizing A1C Goals and Pharmacological Regimens.

    Science.gov (United States)

    Lahiri, Sharon W

    2017-12-01

    IN BRIEF Caring for people with type 2 diabetes requires a patient-centered approach to treatment targets and medication regimens. Focusing on patients' individual characteristics, needs, and treatment responses can improve compliance and clinical outcomes. Medication selection can be guided by the mechanisms of action, advantages, disadvantages, and costs of available options; patients' behavioral and psychological variables, personal preferences, and socioeconomic status also should be taken into account. This article provides an overview of patient-centered and individualized diabetes management, offers pharmacological recommendations for specific clinical scenarios, and describes a complicated case illustrating the patient-centered approach in clinical practice.

  20. The Experience of Couples in the Process of Treatment of Pathological Gambling: Couple vs. Individual Therapy

    Science.gov (United States)

    Tremblay, Joël; Dufour, Magali; Bertrand, Karine; Blanchette-Martin, Nadine; Ferland, Francine; Savard, Annie-Claude; Saint-Jacques, Marianne; Côté, Mélissa

    2018-01-01

    Context: Couple treatment for pathological gambling is an innovative strategy. There are some results supporting its potential effectiveness, but little is known about the subjective experiences of the participants. Objective: The aim of this article is to document the experiences of gamblers and their partners participating in one of two treatments, namely individual or couple. Method: In a study aiming to evaluate the efficacy of the Integrative Couple Treatment for Pathological Gambling (ICT-PG), couples who were entering specialized treatment for the addiction of one member who was a pathological gambler were randomly assigned to individual or ICT-PG. Nine months after their admission to treatment, gamblers and partners (n = 21 couples; n = 13 ICT-PG; n = 8 individual treatment) were interviewed in semi-structured interviews. A sequenced thematization method was used to extract the major themes. Results: This study highlighted five major themes in the therapeutic process noted by the gamblers and their partners mainly after the couple treatment but also partly through the individual therapy. These were: (1) the gamblers' anxiety about having to reveal their gambling problems in couple therapy; (2) the wish to develop a mutually beneficial understanding of gambling and its effects on the partners in the two types of treatments; (3) the transformation of negative attributions through a more effective intra-couple communication fostered by the couple therapy; (4) the partners' contribution to changes in gambling behavior and prevention of relapses, which were both better supported in couple therapy; and (5) the interpersonal nature of gambling and its connections with the couples' relationship. However, gamblers who were in individual treatment were more likely to mention that their partners' involvement was not necessary. Participants likewise made a few recommendations about the conditions underlying the choice of one treatment method or the other. Discussion

  1. The Experience of Couples in the Process of Treatment of Pathological Gambling: Couple vs. Individual Therapy

    Directory of Open Access Journals (Sweden)

    Joël Tremblay

    2018-01-01

    Full Text Available Context: Couple treatment for pathological gambling is an innovative strategy. There are some results supporting its potential effectiveness, but little is known about the subjective experiences of the participants.Objective: The aim of this article is to document the experiences of gamblers and their partners participating in one of two treatments, namely individual or couple.Method: In a study aiming to evaluate the efficacy of the Integrative Couple Treatment for Pathological Gambling (ICT-PG, couples who were entering specialized treatment for the addiction of one member who was a pathological gambler were randomly assigned to individual or ICT-PG. Nine months after their admission to treatment, gamblers and partners (n = 21 couples; n = 13 ICT-PG; n = 8 individual treatment were interviewed in semi-structured interviews. A sequenced thematization method was used to extract the major themes.Results: This study highlighted five major themes in the therapeutic process noted by the gamblers and their partners mainly after the couple treatment but also partly through the individual therapy. These were: (1 the gamblers' anxiety about having to reveal their gambling problems in couple therapy; (2 the wish to develop a mutually beneficial understanding of gambling and its effects on the partners in the two types of treatments; (3 the transformation of negative attributions through a more effective intra-couple communication fostered by the couple therapy; (4 the partners' contribution to changes in gambling behavior and prevention of relapses, which were both better supported in couple therapy; and (5 the interpersonal nature of gambling and its connections with the couples' relationship. However, gamblers who were in individual treatment were more likely to mention that their partners' involvement was not necessary. Participants likewise made a few recommendations about the conditions underlying the choice of one treatment method or the other

  2. Biomarkers for Success: Using Neuroimaging to Predict Relapse and Develop Brain Stimulation Treatments for Cocaine-Dependent Individuals.

    Science.gov (United States)

    Hanlon, C A; Dowdle, L T; Jones, J L

    2016-01-01

    Cocaine dependence is one of the most difficult substance use disorders to treat. While the powerful effects of cocaine use on behavior were documented in the 19th century, it was not until the late 20th century that we realized cocaine use was affecting brain tissue and function. Following a brief introduction (Section 1), this chapter will summarize our current knowledge regarding alterations in neural circuit function typically observed in chronic cocaine users (Section 2) and highlight an emerging body of literature which suggests that pretreatment limbic circuit activity may be a reliable predictor of clinical outcomes among individuals seeking treatment for cocaine (Section 3). Finally, as the field of addiction research strives to translate this neuroimaging data into something clinically meaningful, we will highlight several new brain stimulation approaches which utilize functional brain imaging data to design noninvasive brain stimulation interventions for individuals seeking treatment for substance dependence disorders (Section 4). © 2016 Elsevier Inc. All rights reserved.

  3. Approach to osteomyelitis treatment with antibiotic loaded PMMA.

    Science.gov (United States)

    Wentao, Zhang; Lei, Guangyu; Liu, Yang; Wang, Wei; Song, Tao; Fan, Jinzhu

    2017-01-01

    To reduce the incidence of osteomyelitis infection, local antibiotic impregnated delivery systems are commonly used as a promising and effective approach to deliver high antibiotic concentrations at the infection site. The objective of this review was to provide a literature review regarding approach to osteomyelitis treatment with antibiotic loaded PMMA. Literature study regarding osteomyelitis treatment with antibiotic loaded carriers using key terms Antibiotic, osteomyelitis, biodegradable PMMA through published articles. Hands searching of bibliographies of identified articles were also undertaken. We concluded that Antibiotic-impregnated PMMA beads are useful options for the treatment of osteomyelitis for prolonged drug therapy. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Accounting for linkage disequilibrium in genome scans for selection without individual genotypes: The local score approach.

    Science.gov (United States)

    Fariello, María Inés; Boitard, Simon; Mercier, Sabine; Robelin, David; Faraut, Thomas; Arnould, Cécile; Recoquillay, Julien; Bouchez, Olivier; Salin, Gérald; Dehais, Patrice; Gourichon, David; Leroux, Sophie; Pitel, Frédérique; Leterrier, Christine; SanCristobal, Magali

    2017-07-01

    Detecting genomic footprints of selection is an important step in the understanding of evolution. Accounting for linkage disequilibrium in genome scans increases detection power, but haplotype-based methods require individual genotypes and are not applicable on pool-sequenced samples. We propose to take advantage of the local score approach to account for linkage disequilibrium in genome scans for selection, cumulating (possibly small) signals from single markers over a genomic segment, to clearly pinpoint a selection signal. Using computer simulations, we demonstrate that this approach detects selection with higher power than several state-of-the-art single-marker, windowing or haplotype-based approaches. We illustrate this on two benchmark data sets including individual genotypes, for which we obtain similar results with the local score and one haplotype-based approach. Finally, we apply the local score approach to Pool-Seq data obtained from a divergent selection experiment on behaviour in quail and obtain precise and biologically coherent selection signals: while competing methods fail to highlight any clear selection signature, our method detects several regions involving genes known to act on social responsiveness or autistic traits. Although we focus here on the detection of positive selection from multiple population data, the local score approach is general and can be applied to other genome scans for selection or other genomewide analyses such as GWAS. © 2017 John Wiley & Sons Ltd.

  5. Integrating Estimates of the Social and Individual Costs of Caregiving into Dementia Treatment Trials

    Directory of Open Access Journals (Sweden)

    Charles D. Phillips

    2016-01-01

    Full Text Available A variety of new treatments for dementia are awaiting or undergoing randomized clinical trails. These trials focus on outcomes such as changes in cognitive function, physical function, or amyloid plaques. What is quite important and is too often missing from these trials are estimates of the impact of these treatments on the social and individual costs of providing care for those facing dementia. Until outcomes such as family caregiver time and caregiver burden are included in trails of dementia treatments, the picture of how well these treatments work will be distressingly incomplete.

  6. Individualized treatment of craniovertebral junction malformation guided by intraoperative computed tomography.

    Science.gov (United States)

    Li, Lianfeng; Wang, Peng; Chen, LiFeng; Ma, Xiaodong; Bu, Bo; Yu, Xinguang

    2012-04-01

    This study was designed to report our preliminary experience of intraoperative computed tomography (iCT) using a mobile scanner with integrated neuronavigation system (NNS). The objective of this study was to assess the feasibility and potential utility of iCT with integrated NNS in individualized treatment of craniovertebral junction malformation (CVJM). The surgical management of congenital craniovertebral anomalies is complex due to the relative difficulty in accessing the region, critical relationships of neurovascular structures, and the intricate biomechanical issues involved. We reported our first 19 complex CVJM cases including 11 male and 8 female patients from January, 2009 to June, 2009 (mean age, 33.9 y; age range, 13 to 58 y). A sliding gantry 40-slice CT scanner was installed in a preexisting operating room. Image data was transferred directly from the scanner into the NNS using an automated registration system. We applied this technology to transoral odontoidectomy in 17 patients. Moreover, with the extra help of iCT integrated with NNS, odontoidectomy through posterior midline approach, and transoral atlantal lateral mass resection were, for the first time, performed for treatment of complex CVJM. NNS was found to correlate well with the intraoperative findings, and the recalibration was uneven in all cases with an accuracy of 1.6 mm (1.6: 1.2 to 2.0). All patients were clinically evaluated by Nurick grade criteria, and neurological deficits were monitored after 3 months of surgery. Fifteen patients (79%) were improved by at least 1 Nurick grade, whereas the grade did not change in 4 patients (21%). iCT scanning with integrated NNS was both feasible and beneficial for the surgical management of complex CVJM. In this unusual patient population, the technique seemed to be valuable in negotiating complex anatomy and achieving a safe and predictable decompression.

  7. Current suicidal ideation in treatment-seeking individuals in the United Kingdom with gambling problems.

    Science.gov (United States)

    Ronzitti, Silvia; Soldini, Emiliano; Smith, Neil; Potenza, Marc N; Clerici, Massimo; Bowden-Jones, Henrietta

    2017-11-01

    Studies show higher lifetime prevalence of suicidality in individuals with pathological gambling. However, less is known about the relationship between pathological gambling and current suicidal ideation. We investigated socio-demographic, clinical and gambling-related variables associated with suicidality in treatment-seeking individuals. Bivariate analyses and logistic regression models were generated on data from 903 individuals to identify measures associated with aspects of suicidality. Forty-six percent of patients reported current suicidal ideation. People with current suicidal thoughts were more likely to report greater problem-gambling severity (psuicidality. Logistic regression models suggested that past suicidal ideation (psuicidality. Our findings suggest that the severity of anxiety disorder, along with a lifetime history of suicidal ideation, may help to identify treatment-seeking individuals with pathological gambling with a higher risk of suicidality, highlighting the importance of assessing suicidal ideation in clinical settings. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. 47 CFR 65.102 - Petitions for exclusion from unitary treatment and for individual treatment in determining...

    Science.gov (United States)

    2010-10-01

    ... granted for a period of two years if the cost of capital for interstate exchange service is so low as to... required rate of return for interstate exchange access services. (b) A petition for exclusion from unitary... and for individual treatment in determining authorized return for interstate exchange access service...

  9. Individualized Surgical Approach Planning for Petroclival Tumors Using a 3D Printer.

    Science.gov (United States)

    Muelleman, Thomas John; Peterson, Jeremy; Chowdhury, Naweed Iffat; Gorup, Jason; Camarata, Paul; Lin, James

    2016-06-01

    Objectives To determine the utility of three-dimensional (3D) printed models in individualized petroclival tumor resection planning by measuring the fidelity of printed anatomical structures and comparing tumor exposure afforded by different approaches. Design Case series and review of the literature. Setting Tertiary care center. Participants Three patients with petroclival lesions. Main Outcome Measures Subjective opinion of access by neuro-otologists and neurosurgeons as well as surface area of tumor exposure. Results Surgeons found the 3D models of each patient's skull and tumor useful for preoperative planning. Limitations of individual surgical approaches not identified through preoperative imaging were apparent after 3D models were evaluated. Significant variability in exposure was noted between models for similar or identical approaches. A notable drawback is that our printing process did not replicate mastoid air cells. Conclusions We found that 3D modeling is useful for individualized preoperative planning for approaching petroclival tumors. Our printing techniques did produce authentic replicas of the tumors in relation to bony structures.

  10. Measuring health outcomes of a multidisciplinary care approach in individuals with chronic environmental conditions using an abbreviated symptoms questionnaire

    Directory of Open Access Journals (Sweden)

    Roy Fox

    2008-12-01

    Full Text Available Roy Fox1, Tara Sampalli1, Jonathan Fox11Nova Scotia Environmental Health Centre, Fall River, NS, CanadaAbstract: The Nova Scotia Environmental Health Centre is a treatment facility for individuals with chronic environmental conditions such as multiple chemical sensitivity, chronic fatigue syndrome, fibromyalgia, chronic respiratory conditions and in some cases chronic pain. The premise of care is to provide a patient-centred multidisciplinary care approach leading to self-management strategies. In order to measure the outcome of the treatment in these complex problems, with overlapping diagnoses, symptoms in many body systems and suspected environmental triggers, a detailed symptoms questionnaire was developed specifically for this patient population and validated. Results from a pilot study in which an abbreviated symptoms questionnaire based on the top reported symptoms captured in previous research was used to measure the efficacy of a multidisciplinary care approach in individuals with multiple chemical sensitivity are presented in this paper. The purpose of this study was to examine the extent, type and patterns of changes over time in the top reported symptoms with treatment measured using the abbreviated symptoms questionnaire. A total of 183 active and 109 discharged patients participated in the study where the health status was measured at different time periods of follow up since the commencement of treatment at the Centre. The findings from this study were successful in generating an initial picture of the nature and type of changes in these symptoms. For instance, symptoms such as difficulty concentrating, sinus conditions and tiredness showed early improvement, within the first 6 months of being in treatment, while others, such as fatigue, hoarseness or loss of voice, took longer while others showed inconsistent changes warranting further enquiry. A controlled longitudinal study is planned to confirm the findings of the pilot study

  11. A rethink of how policy and social science approach changing individuals' actions on greenhouse gas emissions

    International Nuclear Information System (INIS)

    Young, William; Middlemiss, Lucie

    2012-01-01

    Social scientists from all areas are developing theories and testing practical approaches to change individuals' actions to lower greenhouse gas emissions. In the UK context, policy-makers, local authorities, companies and organisations are using these theories to invest resources to change individual's actions. The problem is that social scientists are delivering fragmented science based on narrow disciplinary views and those using this science are cherry picking whatever theory suits their agenda. We argue that with substantial GHG emission reduction targets to be achieved, a multidisciplinary application and view of social science are urgently needed.

  12. PECULIARITIES OF AN INDIVIDUAL APPROACH TO HIGH SCHOOL STUDENTS MAJORING IN TECHNOLOGY

    Directory of Open Access Journals (Sweden)

    Andriy Uruskyi

    2016-05-01

    Full Text Available The features of the methodology of the implementation of an individual approach to high school students majoring in technology are analysed. The main stages of the implementation have been defined as the analysis of the individual student characteristics; grouping 10–11 grade students; usage of the modern informational and communicational techniques and a set of facilities of differentiated studying. The examples of the differentiated tasks for different phases of the high school training such as providing training material by teachers; academic progress monitoring; self-studying materials; fulfilling tasks of practical (laboratory and practical works; goods manufacturing; carrying out creative projects have been provided.

  13. Low-energy coupling of individual and collective degrees of freedom: a general microscopic approach

    International Nuclear Information System (INIS)

    Quentin, P.; Meyer, M.

    1988-01-01

    A general microscopic approach of low energy coupling of individual and collective degrees of freedom is presented. The ingredients of a Bohr-Mottelson unified model description are determined consistently from the Skyrme SIII effective interaction, through the adiabatic limit of the time-dependent Hartree-Fock-Bogoliubov approximation. Three specific aspects will be mostly developed: i) the effect of pairing correlations on adiabatic mass parameters and collective dynamics; ii) a consistent coupling of collective and individual degrees of freedom to describe odd nuclei; iii) a study of spectroscopic data in odd-odd nuclei as a test of effective nucleon-nucleon interactions. (author)

  14. Behavioral facilitation: a cognitive model of individual differences in approach motivation.

    Science.gov (United States)

    Robinson, Michael D; Meier, Brian P; Tamir, Maya; Wilkowski, Benjamin M; Ode, Scott

    2009-02-01

    Approach motivation consists of the active, engaged pursuit of one's goals. The purpose of the present three studies (N = 258) was to examine whether approach motivation could be cognitively modeled, thereby providing process-based insights into personality functioning. Behavioral facilitation was assessed in terms of faster (or facilitated) reaction time with practice. As hypothesized, such tendencies predicted higher levels of approach motivation, higher levels of positive affect, and lower levels of depressive symptoms and did so across cognitive, behavioral, self-reported, and peer-reported outcomes. Tendencies toward behavioral facilitation, on the other hand, did not correlate with self-reported traits (Study 1) and did not predict avoidance motivation or negative affect (all studies). The results indicate a systematic relationship between behavioral facilitation in cognitive tasks and approach motivation in daily life. Results are discussed in terms of the benefits of modeling the cognitive processes hypothesized to underlie individual differences motivation, affect, and depression. (c) 2009 APA, all rights reserved

  15. A computational approach to characterizing the impact of social influence on individuals' vaccination decision making.

    Science.gov (United States)

    Xia, Shang; Liu, Jiming

    2013-01-01

    In modeling individuals vaccination decision making, existing studies have typically used the payoff-based (e.g., game-theoretical) approaches that evaluate the risks and benefits of vaccination. In reality, whether an individual takes vaccine or not is also influenced by the decisions of others, i.e., due to the impact of social influence. In this regard, we present a dual-perspective view on individuals decision making that incorporates both the cost analysis of vaccination and the impact of social influence. In doing so, we consider a group of individuals making their vaccination decisions by both minimizing the associated costs and evaluating the decisions of others. We apply social impact theory (SIT) to characterize the impact of social influence with respect to individuals interaction relationships. By doing so, we propose a novel modeling framework that integrates an extended SIT-based characterization of social influence with a game-theoretical analysis of cost minimization. We consider the scenario of voluntary vaccination against an influenza-like disease through a series of simulations. We investigate the steady state of individuals' decision making, and thus, assess the impact of social influence by evaluating the coverage of vaccination for infectious diseases control. Our simulation results suggest that individuals high conformity to social influence will increase the vaccination coverage if the cost of vaccination is low, and conversely, will decrease it if the cost is high. Interestingly, if individuals are social followers, the resulting vaccination coverage would converge to a certain level, depending on individuals' initial level of vaccination willingness rather than the associated costs. We conclude that social influence will have an impact on the control of an infectious disease as they can affect the vaccination coverage. In this respect, our work can provide a means for modeling the impact of social influence as well as for estimating the

  16. Understanding the individual to implement the ecosystem approach to fisheries management.

    Science.gov (United States)

    Ward, Taylor D; Algera, Dirk A; Gallagher, Austin J; Hawkins, Emily; Horodysky, Andrij; Jørgensen, Christian; Killen, Shaun S; McKenzie, David J; Metcalfe, Julian D; Peck, Myron A; Vu, Maria; Cooke, Steven J

    2016-01-01

    Ecosystem-based approaches to fisheries management (EAFMs) have emerged as requisite for sustainable use of fisheries resources. At the same time, however, there is a growing recognition of the degree of variation among individuals within a population, as well as the ecological consequences of this variation. Managing resources at an ecosystem level calls on practitioners to consider evolutionary processes, and ample evidence from the realm of fisheries science indicates that anthropogenic disturbance can drive changes in predominant character traits (e.g. size at maturity). Eco-evolutionary theory suggests that human-induced trait change and the modification of selective regimens might contribute to ecosystem dynamics at a similar magnitude to species extirpation, extinction and ecological dysfunction. Given the dynamic interaction between fisheries and target species via harvest and subsequent ecosystem consequences, we argue that individual diversity in genetic, physiological and behavioural traits are important considerations under EAFMs. Here, we examine the role of individual variation in a number of contexts relevant to fisheries management, including the potential ecological effects of rapid trait change. Using select examples, we highlight the extent of phenotypic diversity of individuals, as well as the ecological constraints on such diversity. We conclude that individual phenotypic diversity is a complex phenomenon that needs to be considered in EAFMs, with the ultimate realization that maintaining or increasing individual trait diversity may afford not only species, but also entire ecosystems, with enhanced resilience to environmental perturbations. Put simply, individuals are the foundation from which population- and ecosystem-level traits emerge and are therefore of central importance for the ecosystem-based approaches to fisheries management.

  17. Endoscopic graduated multiangle, multicorridor resection of juvenile nasopharyngeal angiofibroma: an individualized, tailored, multicorridor skull base approach.

    Science.gov (United States)

    Liu, James K; Husain, Qasim; Kanumuri, Vivek; Khan, Mohemmed N; Mendelson, Zachary S; Eloy, Jean Anderson

    2016-05-01

    endoscopically. There were no vascular complications. CONCLUSIONS An individualized, multiangle, multicorridor approach allows for safe and effective surgical customization of access for resection of JNAs depending on the size and exact location of the tumor. Combining the endoscopic endonasal approach with a transcranial approach via an orbitozygomatic, extradural, transcavernous approach may be considered in giant extensive JNAs that have intracranial extension and intimate involvement of the cavernous sinus.

  18. An Individualized and Everyday Life Approach to Cognitive Rehabilitation in Schizophrenia: A Case Illustration

    Directory of Open Access Journals (Sweden)

    M.-N. Levaux

    2012-01-01

    Full Text Available Objective. The effectiveness of an individualized and everyday approach to cognitive rehabilitation for schizophrenia was examined in a case study. Method. After cognitive and functional assessment, concrete objectives were targeted for the person’s everyday complaints. Strategies were constructed based on an analysis of the cognitive profile, daily life functioning, and processes involved in activities. They included a memory strategy for reading, a diary to compensate memory difficulties, and working memory exercises to improve immediate processing of information when reading and following conversations. Efficacy was assessed with outcome measures. Results. The program had beneficial effects on the person’s cognitive and everyday functioning, which persisted at a 3-year follow-up. Conclusion. Findings provide suggestive evidence that an individualized and everyday approach may be a useful alternative in order to obtain a meaningfully lasting transfer of training to daily life, compared to the nomothetic ones which dominate the field.

  19. Psychosocial Aspects of Adolescent Dysphonia: An Approach to Treatment.

    Science.gov (United States)

    Beery, Quinter C.

    1991-01-01

    This paper presents an approach to voice therapy with adolescents, emphasizing the importance of psychosocial and family influences as they relate to vocal behavior. The goals of therapy for the adolescent with dysphonia usually follow an orderly sequence, first dealing with individual behavior and later with family and peer group influences. (JDD)

  20. Training Approach-Avoidance of Smiling Faces Affects Emotional Vulnerability in Socially Anxious Individuals

    Directory of Open Access Journals (Sweden)

    Mike eRinck

    2013-08-01

    Full Text Available Previous research revealed an automatic behavioral bias in high socially anxious individuals (HSAs: Although their explicit evaluations of smiling faces are positive, they show automatic avoidance of these faces. This is reflected by faster pushing than pulling of smiling faces in an Approach-Avoidance Task (AAT; Heuer, Rinck, & Becker, 2007. The current study addressed the causal role of this avoidance bias for social anxiety. To this end, we used the AAT to train HSAs, either to approach smiling faces or to avoid them. We examined whether such an AAT training could change HSAs’ automatic avoidance tendencies, and if yes, whether AAT effects would generalize to a new approach task with new facial stimuli, and to mood and anxiety in a social threat situation (a video-recorded self-presentation. We found that HSAs trained to approach smiling faces did indeed approach female faces faster after the training than HSAs trained to avoid smiling faces. Moreover, approach-faces training reduced emotional vulnerability: It led to more positive mood and lower anxiety after the self-presentation than avoid-faces training. These results suggest that automatic approach-avoidance tendencies have a causal role in social anxiety, and that they can be modified by a simple computerized training. This may open new avenues in the therapy of social phobia.

  1. Training approach-avoidance of smiling faces affects emotional vulnerability in socially anxious individuals

    Science.gov (United States)

    Rinck, Mike; Telli, Sibel; Kampmann, Isabel L.; Woud, Marcella L.; Kerstholt, Merel; te Velthuis, Sarai; Wittkowski, Matthias; Becker, Eni S.

    2013-01-01

    Previous research revealed an automatic behavioral bias in high socially anxious individuals (HSAs): although their explicit evaluations of smiling faces are positive, they show automatic avoidance of these faces. This is reflected by faster pushing than pulling of smiling faces in an Approach-Avoidance Task (AAT; Heuer et al., 2007). The current study addressed the causal role of this avoidance bias for social anxiety. To this end, we used the AAT to train HSAs, either to approach smiling faces or to avoid them. We examined whether such an AAT training could change HSAs' automatic avoidance tendencies, and if yes, whether AAT effects would generalize to a new approach task with new facial stimuli, and to mood and anxiety in a social threat situation (a video-recorded self-presentation). We found that HSAs trained to approach smiling faces did indeed approach female faces faster after the training than HSAs trained to avoid smiling faces. Moreover, approach-faces training reduced emotional vulnerability: it led to more positive mood and lower anxiety after the self-presentation than avoid-faces training. These results suggest that automatic approach-avoidance tendencies have a causal role in social anxiety, and that they can be modified by a simple computerized training. This may open new avenues in the therapy of social phobia. PMID:23970862

  2. Dental Treatment in a State-Funded Primary Dental Care Facility: Contextual and Individual Predictors of Treatment Need?

    Science.gov (United States)

    Wanyonyi, Kristina L; Radford, David R; Gallagher, Jennifer E

    2017-01-01

    This study examined individual and contextual factors which predict the dental care received by patients in a state-funded primary dental care training facility in England. Routine clinical and demographic data were extracted from a live dental patient management system in a state-funded facility using novel methods. The data, spanning a four-year period [2008-2012] were cleaned, validated, linked by means of postcode to deprivation status, and analysed to identify factors which predict dental treatment need. The predictive relationship between patients' individual characteristics (demography, smoking, payment status) and contextual experience (deprivation based on area of residence), with common dental treatments received was examined using unadjusted analysis and adjusted logistic regression. Additionally, multilevel modelling was used to establish the isolated influence of area of residence on treatments. Data on 6,351 dental patients extracted comprised of 147,417 treatment procedures delivered across 10,371 courses of care. Individual level factors associated with the treatments were age, sex, payment exemption and smoking status and deprivation associated with area of residence was a contextual predictor of treatment. More than 50% of children (care in the form of 'instruction and advice', compared with 46% of working age adults (18-64 years); p = 0.001. The odds of receiving treatment increased with each increasing year of age amongst adults (p = 0.001): 'partial dentures' (7%); 'scale and polish' (3.7%); 'tooth extraction' (3%; p = 0.001), and 'instruction and advice' (3%; p = 0.001). Smokers had a higher likelihood of receiving all treatments; and were notably over four times more likely to receive 'instruction and advice' than non-smokers (OR 4.124; 95% CI: 3.088-5.508; p = 0.01). A further new finding from the multilevel models was a significant difference in treatment related to area of residence; adults from the most deprived quintile were more likely

  3. Dental Treatment in a State-Funded Primary Dental Care Facility: Contextual and Individual Predictors of Treatment Need?

    Directory of Open Access Journals (Sweden)

    Kristina L Wanyonyi

    Full Text Available This study examined individual and contextual factors which predict the dental care received by patients in a state-funded primary dental care training facility in England.Routine clinical and demographic data were extracted from a live dental patient management system in a state-funded facility using novel methods. The data, spanning a four-year period [2008-2012] were cleaned, validated, linked by means of postcode to deprivation status, and analysed to identify factors which predict dental treatment need. The predictive relationship between patients' individual characteristics (demography, smoking, payment status and contextual experience (deprivation based on area of residence, with common dental treatments received was examined using unadjusted analysis and adjusted logistic regression. Additionally, multilevel modelling was used to establish the isolated influence of area of residence on treatments.Data on 6,351 dental patients extracted comprised of 147,417 treatment procedures delivered across 10,371 courses of care. Individual level factors associated with the treatments were age, sex, payment exemption and smoking status and deprivation associated with area of residence was a contextual predictor of treatment. More than 50% of children (<18 years and older adults (≥65 years received preventive care in the form of 'instruction and advice', compared with 46% of working age adults (18-64 years; p = 0.001. The odds of receiving treatment increased with each increasing year of age amongst adults (p = 0.001: 'partial dentures' (7%; 'scale and polish' (3.7%; 'tooth extraction' (3%; p = 0.001, and 'instruction and advice' (3%; p = 0.001. Smokers had a higher likelihood of receiving all treatments; and were notably over four times more likely to receive 'instruction and advice' than non-smokers (OR 4.124; 95% CI: 3.088-5.508; p = 0.01. A further new finding from the multilevel models was a significant difference in treatment related to area

  4. Individualized cost-effective conventional ovulation induction treatment in normogonadotrophic anovulatory infertility (WHO group 2).

    Science.gov (United States)

    Eijkemans, Marinus J C; Polinder, Suzanne; Mulders, Annemarie G M G J; Laven, Joop S E; Habbema, J Dik F; Fauser, Bart C J M

    2005-10-01

    Conventional treatment in normogonadotrophic anovulatory infertility (WHO 2) consists of clomiphene citrate (CC), followed by exogenous gonadotrophins (FSH) and IVF. Response to these treatments may be predicted on the basis of individual patient characteristics. We aimed to devise a patient-tailored, cost-effective treatment algorithm involving the above-mentioned treatment modalities, based on individual patient characteristics. Sixteen prognostic groups are defined, according to the presence or absence of: age >30 years, amenorrhea, elevated androgen levels and obesity. The chances of response with each of the three treatments were calculated using prediction models. Treatment costs were based on the data of 240 patients visiting a specialist academic fertility unit. Outcome was an ongoing pregnancy within 12 months after initiation of treatment. The costs per pregnancy of three different strategies were compared, with a threshold for cost-effectiveness of 10 000. The strategy CC + FSH + IVF compared with FSH + IVF generated more pregnancies against lower costs. Compared with CC + IVF, it also produced more pregnancies, but at higher costs. For costs per pregnancy were less than 10 000. For women >30 years old, costs per pregnancy were 25 000 and over 200 000, when presenting with normal or elevated androgen levels, respectively. The conventional treatment protocol is efficient for women aged 30 years old with elevated androgen levels, FSH may be skipped.

  5. Concept for individualized patient allocation: ReCompare—remote comparison of particle and photon treatment plans

    International Nuclear Information System (INIS)

    Lühr, Armin; Baumann, Michael; Löck, Steffen; Roth, Klaus; Helmbrecht, Stephan; Jakobi, Annika; Petersen, Jørgen B; Just, Uwe; Krause, Mechthild; Enghardt, Wolfgang

    2014-01-01

    Identifying those patients who have a higher chance to be cured with fewer side effects by particle beam therapy than by state-of-the-art photon therapy is essential to guarantee a fair and sufficient access to specialized radiotherapy. The individualized identification requires initiatives by particle as well as non-particle radiotherapy centers to form networks, to establish procedures for the decision process, and to implement means for the remote exchange of relevant patient information. In this work, we want to contribute a practical concept that addresses these requirements. We proposed a concept for individualized patient allocation to photon or particle beam therapy at a non-particle radiotherapy institution that bases on remote treatment plan comparison. We translated this concept into the web-based software tool ReCompare (REmote COMparison of PARticlE and photon treatment plans). We substantiated the feasibility of the proposed concept by demonstrating remote exchange of treatment plans between radiotherapy institutions and the direct comparison of photon and particle treatment plans in photon treatment planning systems. ReCompare worked with several tested standard treatment planning systems, ensured patient data protection, and integrated in the clinical workflow. Our concept supports non-particle radiotherapy institutions with the patient-specific treatment decision on the optimal irradiation modality by providing expertise from a particle therapy center. The software tool ReCompare may help to improve and standardize this personalized treatment decision. It will be available from our website when proton therapy is operational at our facility

  6. Factor-Analytic and Individualized Approaches to Constructing Brief Measures of ADHD Behaviors

    Science.gov (United States)

    Volpe, Robert J.; Gadow, Kenneth D.; Blom-Hoffman, Jessica; Feinberg, Adam B.

    2009-01-01

    Two studies were performed to examine a factor-analytic and an individualized approach to creating short progress-monitoring measures from the longer "ADHD-Symptom Checklist-4" (ADHD-SC4). In Study 1, teacher ratings on items of the ADHD:Inattentive (IA) and ADHD:Hyperactive-Impulsive (HI) scales of the ADHD-SC4 were factor analyzed in a normative…

  7. An approach to routine individual internal dose monitoring at the object 'Shelter' personnel considering uncertainties

    International Nuclear Information System (INIS)

    Mel'nichuk, D.V.; Bondarenko, O.O.; Medvedjev, S.Yu.

    2002-01-01

    An approach to organisation of routine individual internal dose monitoring of the personnel of the Object 'Shelter' is presented in the work, that considers individualised uncertainties. In this aspect two methods of effective dose assessment based on bioassay are considered in the work: (1) traditional indirect method at which application results of workplace monitoring are not taken into account, and (2) a combined method in which both results of bioassay measurements and workplace monitoring are considered

  8. Reliability and Validity of a Treatment Barriers Scale for Individuals With Alcohol Use Disorder.

    Science.gov (United States)

    Possemato, Kyle; Funderburk, Jennifer; Spinola, Suzanne; Hutchison, Dezarie; Maisto, Stephen A; Lantinga, Larry J; Oslin, David W

    2016-01-01

    Few studies have measured addiction-specific barriers to treatment. A measurement of barriers with psychometric support that has been tested in diverse samples and that assesses multiple components of addiction treatment barriers is needed to inform providers and treatment programs. This paper aims to provide an initial psychometric investigation of a measure of barriers to seeking addictions treatment. Data were collected from 196 Veterans Affairs primary care patients with Alcohol Use Disorder that participated in a randomized clinical trial. A Principal Components Analysis revealed that the 32-item Treatment Barriers Scale (TBS) can be reduced to 14 items, measuring 4 factors: stigma, dislike of the treatment process, alcohol problem identification, and logistical concerns. Acceptable internal consistent reliability (α = .64-.76) and excellent precision of alpha (α = 0.001-0.009) was found for each subscale. Support for the measure's concurrent validity was found, for example, participants who reported more motivation to reduce their drinking perceived significantly fewer barriers to care. Support for the measure's predictive validity was also found, including that more barriers were related to future drinking among all participants and less mental health and addictions treatment visits among participants in one treatment condition. Conclusions/ Importance: Our results provide initial support for the utility of the TBS-14 among primary care patients with Alcohol Use Disorder. Use of the TBS-14 could enable healthcare providers to better understand patient-specific treatment barriers, provide corrective information on treatment misconceptions, and inform individualized treatment plans that increase patient engagement in addiction services.

  9. Individuals Are Continents; or, Why It's Time to Retire the Island Approach to Addiction.

    Science.gov (United States)

    Tootle, William; Ziegler, James; Singer, Merrill

    2015-01-01

    Individuals are not island isolates. This is an old insight that finds expression in indigenous worldviews, ancient philosophies, religious doctrine, and modern social theories. Even so, science remains encumbered by the false dichotomies and reductionism inherited from the capitalist revolution and reinforced by the fragmentation of modern life. This same heritage encumbers addiction research and efforts to devise effective interventions. It does so because the island concept at its core filters out the most decisive factors contributing to addiction. We therefore recommend its replacement with what we call the continental concept of the individual, which conceives of society and the natural environment as extensions of individual corporeal bodies. Such a theoretical reorientation has significant implications for intervention research and practice. More specifically, it radically expands the scope of what constitutes a valid intervention in the first place. We call this reorientation the continental approach to drug addiction.

  10. Repetitive model predictive approach to individual pitch control of wind turbines

    DEFF Research Database (Denmark)

    Adegas, Fabiano Daher; Stoustrup, Jakob; Odgaard, Peter Fogh

    2011-01-01

    prediction. As a consequence, individual pitch feed-forward control action is generated by the controller, taking ”future” wind disturbance into account. Information about the estimated wind spatial distribution one blade experience can be used in the prediction model to better control the next passing blade......Wind turbines are inherently exposed to nonuniform wind fields with of wind shear, tower shadow, and possible wake contributions. Asymmetrical aerodynamic rotor loads are a consequence of such periodic, repetitive wind disturbances experienced by the blades. A controller may estimate and use...... this peculiar disturbance pattern to better attenuate loads and regulate power by controlling the blade pitch angles individually. A novel model predictive (MPC) approach for individual pitch control of wind turbines is proposed in this paper. A repetitive wind disturbance model is incorporated into the MPC...

  11. Risk, individual differences, and environment: an Agent-Based Modeling approach to sexual risk-taking.

    Science.gov (United States)

    Nagoski, Emily; Janssen, Erick; Lohrmann, David; Nichols, Eric

    2012-08-01

    Risky sexual behaviors, including the decision to have unprotected sex, result from interactions between individuals and their environment. The current study explored the use of Agent-Based Modeling (ABM)-a methodological approach in which computer-generated artificial societies simulate human sexual networks-to assess the influence of heterogeneity of sexual motivation on the risk of contracting HIV. The models successfully simulated some characteristics of human sexual systems, such as the relationship between individual differences in sexual motivation (sexual excitation and inhibition) and sexual risk, but failed to reproduce the scale-free distribution of number of partners observed in the real world. ABM has the potential to inform intervention strategies that target the interaction between an individual and his or her social environment.

  12. Humanistic Approaches to the Understanding and Treatment of Anorexia Nervosa.

    Science.gov (United States)

    Dittmar, Helga; Bates, Brian

    1987-01-01

    Summarizes some attempts to understand the causes and consequent treatments of anorexia nervosa from the viewpoints of psychoanalytically informed, family, existential and feminist psychology. These perspectives, which focus on the individual experience of the anorexic, leave many questions unanswered, but provide fresh frameworks from which to…

  13. Towards personalized treatment in cardiovascular disease : a molecular epidemiological approach

    NARCIS (Netherlands)

    Regieli, J.J.

    2009-01-01

    Patients who have experienced cardiovascular disease each differ in terms of their future risk, yet currently we have no ways to predict individual prognosis. Mass preventive treatment is therefore currently recommended for the group as a whole whereas in fact this group is highly heterogeneous and

  14. Individual aircraft life monitoring: An engineering approach for fatigue damage evaluation

    Directory of Open Access Journals (Sweden)

    Rui JIAO

    2018-04-01

    Full Text Available Individual aircraft life monitoring is required to ensure safety and economy of aircraft structure, and fatigue damage evaluation based on collected operational data of aircraft is an integral part of it. To improve the accuracy and facilitate the application, this paper proposes an engineering approach to evaluate fatigue damage and predict fatigue life for critical structures in fatigue monitoring. In this approach, traditional nominal stress method is applied to back calculate the S-N curve parameters of the realistic structure details based on full-scale fatigue test data. Then the S-N curve and Miner’s rule are adopted in damage estimation and fatigue life analysis for critical locations under individual load spectra. The relationship between relative small crack length and fatigue life can also be predicted with this approach. Specimens of 7B04-T74 aluminum alloy and TA15M titanium alloy are fatigue tested under two types of load spectra, and there is a good agreement between the experimental results and analysis results. Furthermore, the issue concerning scatter factor in individual aircraft damage estimation is also discussed. Keywords: Fatigue damage, Fatigue monitoring, Fatigue test, Scatter factor, S-N curve

  15. Omics approaches to individual variation: modeling networks and the virtual patient

    OpenAIRE

    Lehrach, Hans

    2016-01-01

    Every human is unique. We differ in our genomes, environment, behavior, disease history, and past and current medical treatment?a complex catalog of differences that often leads to variations in the way each of us responds to a particular therapy. We argue here that true personalization of drug therapies will rely on ?virtual patient? models based on a detailed characterization of the individual patient by molecular, imaging, and sensor techniques. The models will be based, wherever possible,...

  16. A person-centered approach to individualizing a school-based universal preventive intervention.

    Science.gov (United States)

    Caldwell, Linda L; Bradley, Stephanie; Coffman, Donna

    2009-01-01

    This manuscript focuses on how individualized components may be embedded within a universal preventive intervention (TimeWise: Taking Charge of Leisure Time) to make program delivery more effective. Leisure related variables (motivation, boredom/interest and peer and parental influence) were used to suggest ways to individualize the program. Latent Class Analysis was used to develop individualized risk and strength profiles of adolescents (N = 617). Comparisons were made between a treatment and control group. Four classes were identified: undifferentiated high, intrinsic motivation, extrinsic motivation/amotivation, undifferentiated low. These classes were related to substance use. Membership in the intrinsic class was associated with intervention group while the extrinsic class was related to the control group. Results were useful in suggesting ways to tailor a universal prevention program.

  17. Individual psychological therapy in the outpatient treatment of adults with anorexia nervosa.

    Science.gov (United States)

    Hay, Phillipa J; Claudino, Angélica M; Touyz, Stephen; Abd Elbaky, Ghada

    2015-07-27

    therapies and comparability was poor. Risks of bias were mostly evident through lack of blinded outcome assessments (in 60% of studies) and incomplete data reporting (attrition bias).The results suggest that treatment as usual (TAU) when delivered by a non-eating-disorder specialist or similar may be less efficacious than focal psychodynamic therapy. This was suggested for a primary outcome of recovery by achievement of a good or intermediate outcome on the Morgan and Russell Scale (RR 0.70, 95% confidence interval (CI) 0.51 to 0.97; 1 RCT, 40 participants; very low-quality evidence). However there were no differences between cognitive analytic therapy and TAU for this outcome (RR 0.78, 95% CI 0.61 to 1.00; 2 RCTs, 71 participants; very low-quality evidence), nor for body mass index (BMI). There were no differences in overall dropout rates between individual psychological therapies and TAU.Two trials found a non-specific specialist therapy (Specialist Supportive Clinical Management) or an Optimised TAU delivered by therapists with eating disorder expertise was similar in outcomes to cognitive behaviour therapy (BMI MD -0.00, 95% CI -0.91 to 0.91; 197 participants, low-quality evidence). When comparing individual psychological therapies with each other, no specific treatment was consistently superior to any other specific approach. Dietary advice as a control arm had a 100% non-completion rate in one trial (35 participants). None of the trials identified any adverse effects. Insufficient power was problematic for the majority of trials. There was a suggestion in one trial that focal psychodynamic therapy might be superior to TAU, but this is in the context of TAU performing poorly. An alternative control condition of dietary advice alone appeared to be unacceptable, but again this is based on just one trial. Owing to the risk of bias and limitations of studies, notably small sample sizes, we can draw no specific conclusions about the effects of specific individual

  18. An Investigation of the Differential Effects of Group versus Individual Treatment on Vocational Indecision and Indecisiveness.

    Science.gov (United States)

    Cooper, Stewart E.; Van Matre, Gene

    The differential effects of individual versus group treatment on career indecision and general indecisiveness among career counseling clients were investigated. Data were obtained from 24 career-undecided students seeking vocational counseling through the counseling center of a midwestern state university. Twelve subjects participated in the group…

  19. Early Therapeutic Alliance and Treatment Outcome in Individual and Family Therapy for Adolescent Behavior Problems

    Science.gov (United States)

    Hogue, Aaron; Dauber, Sarah; Stambaugh, Leyla Faw; Cecero, John J.; Liddle, Howard A.

    2006-01-01

    The impact of early therapeutic alliance was examined in 100 clients receiving either individual cognitive-behavioral therapy (CBT) or family therapy for adolescent substance abuse. Observational ratings of adolescent alliance in CBT and adolescent and parent alliance in family therapy were used to predict treatment retention (in CBT only) and…

  20. Treatment of Bruxism in Individuals with Developmental Disabilities: A Systematic Review

    Science.gov (United States)

    Lang, Russell; White, Pamela J.; Machalicek, Wendy; Rispoli, Mandy; Kang, Soyeon; Aquilar, Jeannie; O'Reilly, Mark; Sigafoos, Jeff; Lancioni, Giulio; Didden, Robert

    2009-01-01

    We reviewed studies involving the treatment of bruxism (i.e., teeth clenching or teeth grinding) in individuals with developmental disabilities. Systematic searches of electronic databases, journals, and reference lists identified 11 studies meeting the inclusion criteria. These studies were evaluated in terms of: (a) participants, (b) procedures…

  1. A Randomized Trial of Individual and Couple Behavioral Alcohol Treatment for Women

    Science.gov (United States)

    Mccrady, Barbara S.; Epstein, Elizabeth E.; Cook, Sharon; Jensen, Noelle; Hildebrandt, Thomas

    2009-01-01

    Although alcohol use disorders (AUDs) adversely affect women, research on efficacious treatments for women is limited. In this randomized efficacy trial of 102 heterosexual women with AUDs, the authors compared alcohol behavioral couple therapy (ABCT) and alcohol behavioral individual therapy (ABIT) on percentage of days abstinent (PDA) and…

  2. Surgery as an Adjunctive Treatment for Multidrug-Resistant Tuberculosis : An Individual Patient Data Metaanalysis

    NARCIS (Netherlands)

    Fox, Gregory J.; Mitnick, Carole D.; Benedetti, Andrea; Chan, Edward D.; Becerra, Mercedes; Chiang, Chen-Yuan; Keshavjee, Salmaan; Koh, Won-Jung; Shiraishi, Yuji; Viiklepp, Piret; Yim, Jae-Joon; Pasvol, Geoffrey; Robert, Jerome; Shim, Tae Sun; Shin, Sonya S.; Menzies, Dick; van der Werf, Tjip S.

    2016-01-01

    Background. Medical treatment for multidrug-resistant (MDR)-tuberculosis is complex, toxic, and associated with poor outcomes. Surgical lung resection may be used as an adjunct to medical therapy, with the intent of reducing bacterial burden and improving cure rates. We conducted an individual

  3. 5 CFR 307.104 - Treatment of individuals serving under VRAs.

    Science.gov (United States)

    2010-01-01

    ... REGULATIONS VETERANS RECRUITMENT APPOINTMENTS § 307.104 Treatment of individuals serving under VRAs. (a... service employees, may be reassigned, promoted, demoted, or transferred in accordance with the provisions... disqualifies a person for a VRA. (d) The Veterans Recruitment Appointment date for a recently separated veteran...

  4. A mindful eating group as an adjunct to individual treatment for eating disorders: a pilot study.

    Science.gov (United States)

    Hepworth, Natasha S

    2011-01-01

    The objective of this study was to investigate potential benefits of a Mindful Eating Group as an adjunct to long-term treatment for a variety of eating disorders. Individuals (N = 33) attending treatment at an outpatient treatment facility participated in the 10-week intervention designed to enhance awareness around hunger and satiety cues. Disordered eating symptoms were assessed pre- and post-intervention using the EAT-26. Significant reductions were found on all subscales of the EAT-26 with large effect sizes. No significant differences were identified between eating disorder diagnoses. Results suggest potential benefits of an adjunct mindfulness group intervention when treating a variety of eating disorders. Limitations are discussed.

  5. Rapid detox: understanding new treatment approaches for the addicted patient.

    Science.gov (United States)

    McCabe, S

    2000-01-01

    Despite substantive advances in understanding of genetic and biochemical basis of substance abuse and addiction in the last decade, little information has been translated into alternative treatment models for the addicted patient. Rapid detox, an alternative form of detox treatment, is gaining in both acceptance and popularity. To increase readers' understanding of the neurobiology of addiction and the mode of action of new detox approaches for patients addicted to opiate drugs. A review of the current literature pertaining to rapid detox. Rapid detox is a viable alternative for selected patients attempting to detox from opiate agents of abuse. Increasing knowledge of new treatment approaches allows nurses working to assist addicted patients in planning and receiving treatment based on new awareness of the neurobiology of addiction.

  6. Towards personalized therapy for multiple sclerosis: prediction of individual treatment response.

    Science.gov (United States)

    Kalincik, Tomas; Manouchehrinia, Ali; Sobisek, Lukas; Jokubaitis, Vilija; Spelman, Tim; Horakova, Dana; Havrdova, Eva; Trojano, Maria; Izquierdo, Guillermo; Lugaresi, Alessandra; Girard, Marc; Prat, Alexandre; Duquette, Pierre; Grammond, Pierre; Sola, Patrizia; Hupperts, Raymond; Grand'Maison, Francois; Pucci, Eugenio; Boz, Cavit; Alroughani, Raed; Van Pesch, Vincent; Lechner-Scott, Jeannette; Terzi, Murat; Bergamaschi, Roberto; Iuliano, Gerardo; Granella, Franco; Spitaleri, Daniele; Shaygannejad, Vahid; Oreja-Guevara, Celia; Slee, Mark; Ampapa, Radek; Verheul, Freek; McCombe, Pamela; Olascoaga, Javier; Amato, Maria Pia; Vucic, Steve; Hodgkinson, Suzanne; Ramo-Tello, Cristina; Flechter, Shlomo; Cristiano, Edgardo; Rozsa, Csilla; Moore, Fraser; Luis Sanchez-Menoyo, Jose; Laura Saladino, Maria; Barnett, Michael; Hillert, Jan; Butzkueven, Helmut

    2017-09-01

    Timely initiation of effective therapy is crucial for preventing disability in multiple sclerosis; however, treatment response varies greatly among patients. Comprehensive predictive models of individual treatment response are lacking. Our aims were: (i) to develop predictive algorithms for individual treatment response using demographic, clinical and paraclinical predictors in patients with multiple sclerosis; and (ii) to evaluate accuracy, and internal and external validity of these algorithms. This study evaluated 27 demographic, clinical and paraclinical predictors of individual response to seven disease-modifying therapies in MSBase, a large global cohort study. Treatment response was analysed separately for disability progression, disability regression, relapse frequency, conversion to secondary progressive disease, change in the cumulative disease burden, and the probability of treatment discontinuation. Multivariable survival and generalized linear models were used, together with the principal component analysis to reduce model dimensionality and prevent overparameterization. Accuracy of the individual prediction was tested and its internal validity was evaluated in a separate, non-overlapping cohort. External validity was evaluated in a geographically distinct cohort, the Swedish Multiple Sclerosis Registry. In the training cohort (n = 8513), the most prominent modifiers of treatment response comprised age, disease duration, disease course, previous relapse activity, disability, predominant relapse phenotype and previous therapy. Importantly, the magnitude and direction of the associations varied among therapies and disease outcomes. Higher probability of disability progression during treatment with injectable therapies was predominantly associated with a greater disability at treatment start and the previous therapy. For fingolimod, natalizumab or mitoxantrone, it was mainly associated with lower pretreatment relapse activity. The probability of

  7. Holistic approach to treatment of intractable central neuropathic itch.

    Science.gov (United States)

    Curtis, Ashley R; Tegeler, Charles; Burdette, Jonathan; Yosipovitch, Gil

    2011-05-01

    Central neuropathic itch can be a lifelong debilitating condition and treatment challenge. We report a patient with a traumatic brain injury with severe intractable pruritus who failed extensive pharmacologic and nonpharmacologic treatment but responded to a holistic approach using healing touch. We discuss the complexity of this type of neuropathic itch and present a holistic approach as an adjunct to therapy in reducing itch intensity. This case presentation along with the literature discussed suggests a therapeutic strategy for the management of complicated central neuropathic itch. Copyright © 2010 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  8. Evidence to practice: treatment of anxiety in individuals with autism spectrum disorders.

    Science.gov (United States)

    Lang, Russell; Mahoney, Richard; El Zein, Farah; Delaune, Elizabeth; Amidon, Megan

    2011-01-25

    What treatment improves social interactions and reduces reports of anxiety symptoms in individuals with autism spectrum disorders (ASD) and a co-occurring anxiety disorder? Systematic reviews and randomized clinical trials suggest that cognitive behavior therapy in tandem with direct instruction of social skills using applied behavior analysis intervention components may be effective for treating anxiety in individuals with high functioning ASD. For individuals with ASD, an anxiety disorder, and an intellectual disability, systematic desensitization may be effective. Intervention should emphasize teaching social skills. Reinforcers (ie, rewards based upon the client's interests) should be used to encourage participation in therapy. Treatment should incorporate visual aides and family involvement. Intervention components involving abstract concepts, visualization, and discussions of emotions are less useful given difficulties in abstract reasoning and communication inherent to ASD.

  9. Combination antiretroviral therapy improves cognitive performance and functional connectivity in treatment-naïve HIV-infected individuals.

    Science.gov (United States)

    Zhuang, Yuchuan; Qiu, Xing; Wang, Lu; Ma, Qing; Mapstone, Mark; Luque, Amneris; Weber, Miriam; Tivarus, Madalina; Miller, Eric; Arduino, Roberto C; Zhong, Jianhui; Schifitto, Giovanni

    2017-10-01

    Our study aimed to investigate the short-term effect of combination antiretroviral therapy (cART) on cognitive performance and functional and structural connectivity and their relationship to plasma levels of antiretroviral (ARV) drugs. Seventeen ARV treatment-naïve HIV-infected individuals (baseline mean CD4 cell count, 479 ± 48 cells/mm 3 ) were age matched with 17 HIV-uninfected individuals. All subjects underwent a detailed neurocognitive and functional assessment and magnetic resonance imaging. HIV-infected subjects were scanned before starting cART and 12 weeks after initiation of treatment. Uninfected subjects were assessed once at baseline. Functional connectivity (FC) was assessed within the default mode network while structural connectivity was assessed by voxel-wise analysis using tract-based spatial statistics (TBSS) and probabilistic tractography within the DMN. Tenofovir and emtricitabine blood concentration were measured at week 12 of cART. Prior to cART, HIV-infected individuals had significantly lower cognitive performance than control subjects as measured by the total Z-score from the neuropsychological tests assessing six cognitive domains (p = 0.020). After 12 weeks of cART treatment, there remained only a weak cognitive difference between HIV-infected and HIV-uninfected subjects (p = 0.057). Mean FC was lower in HIV-infected individuals compared with those uninfected (p = 0.008), but FC differences became non-significant after treatment (p = 0.197). There were no differences in DTI metrics between HIV-infected and HIV-uninfected individuals using the TBSS approach and limited evidence of decreased structural connectivity within the DMN in HIV-infected individuals. Tenofovir and emtricitabine plasma concentrations did not correlate with either cognitive performance or imaging metrics. Twelve weeks of cART improves cognitive performance and functional connectivity in ARV treatment-naïve HIV-infected individuals with relatively

  10. Islam - Science Integration Approach in Developing Chemistry Individualized Education Program (IEP for Students with Disabilities

    Directory of Open Access Journals (Sweden)

    Jamil Suprihatiningrum

    2017-11-01

    Full Text Available The paper is based on a research which tries to explore, explain and describe Islam - science integration approach to develop an Individualized Education Program (IEP for students with disabilities in chemistry lesson. As a qualitative case study, this paper is aimed at investigating how Islam - science integration approach can be underpinned for developing the IEP for Chemistry. Participants were recruited purposively and data were collected by interviews; documents’ analysis; and experts’ assessment (i.e. material experts, inclusive education experts, media experts, chemistry teachers and support teachers, then analyzed using content-analysis. The result shows Islam - science integration approach can be a foundation to develop the chemistry IEP by seeking support for the verses of the Qur'an and corresponding hadiths. Even although almost all the subject matter in chemistry can be integrated with Islamic values, this study only developed two contents, namely Periodic System of Elements and Reaction Rate.

  11. Vocal individuality cues in the African penguin (Spheniscus demersus): a source-filter theory approach.

    Science.gov (United States)

    Favaro, Livio; Gamba, Marco; Alfieri, Chiara; Pessani, Daniela; McElligott, Alan G

    2015-11-25

    The African penguin is a nesting seabird endemic to southern Africa. In penguins of the genus Spheniscus vocalisations are important for social recognition. However, it is not clear which acoustic features of calls can encode individual identity information. We recorded contact calls and ecstatic display songs of 12 adult birds from a captive colony. For each vocalisation, we measured 31 spectral and temporal acoustic parameters related to both source and filter components of calls. For each parameter, we calculated the Potential of Individual Coding (PIC). The acoustic parameters showing PIC ≥ 1.1 were used to perform a stepwise cross-validated discriminant function analysis (DFA). The DFA correctly classified 66.1% of the contact calls and 62.5% of display songs to the correct individual. The DFA also resulted in the further selection of 10 acoustic features for contact calls and 9 for display songs that were important for vocal individuality. Our results suggest that studying the anatomical constraints that influence nesting penguin vocalisations from a source-filter perspective, can lead to a much better understanding of the acoustic cues of individuality contained in their calls. This approach could be further extended to study and understand vocal communication in other bird species.

  12. Oral cavity infection: an adverse effect after the treatment of oral cancer in aged individuals.

    Science.gov (United States)

    Pan, Jie; Zhao, Jun; Jiang, Ning

    2014-01-01

    The immune compromised patients after treatment of oral cancer may have a chance of infection by drug-resistant opportunistic microbes. We investigated the occurrence of opportunistic microorganisms in aged individuals receiving follow-up examinations after treatment of oral cancer in China. These patients were used as test group and the respective age grouped healthy individuals as control group. In this study, the oral cavity microorganisms such as bacteria and yeast were taken for the analysis. After the screening of representative microorganisms, their aptitude of pervasiveness against drugs was studied. Here, we used antimicrobial agents which are common in clinical practice. We also performed studies to investigate the presence of toxin genes in methicillin-resistant S. aureus (MRSA). The results indicate that the prevalence of drug-resistant microbes was more pronounced in oral cancer patients after initial treatment above 70 years old. The oxacillin resistance of S. aureus isolate confirms that the prevalence of MRSA is increasing in accordance to age-factor and immune compromise in elderly patients. This study reveals the occurrence of drug-resistant opportunistic microorganisms in oral cavity after treatment for oral cancer in aged individuals. Special attention should be directed to MRSA during the treatment of oral cancer, and to realize the fact of immune compromise in elderly patients.

  13. Use of conventional, complementary, and alternative treatments for pain among individuals seeking primary care treatment with buprenorphine-naloxone

    Science.gov (United States)

    Barry, Declan T.; Savant, Jonathan D.; Beitel, Mark; Cutter, Christopher J.; Moore, Brent A.; Schottenfeld, Richard S.; Fiellin, David A.

    2012-01-01

    Previous studies have not examined patterns of pain treatment use among patients seeking office-based buprenorphine-naloxone treatment (BNT) for opioid dependence. Objectives To examine, among individuals with pain seeking BNT for opioid dependence, the use of pain treatment modalities, perceived efficacy of prior pain treatment, and interest in pursuing pain treatment while in BNT. Methods 244 patients seeking office-based BNT for opioid dependence completed measures of demographics, pain status (i.e. “chronic pain (CP)” [pain lasting at least 3 months] vs. “some pain (SP)” [pain in the past week not meeting the duration criteria for chronic pain]), pain treatment use, perceived efficacy of prior pain treatment, and interest in receiving pain treatment while in BNT. Results In comparison to the SP group (N = 87), the CP group (N = 88) was more likely to report past-week medical use of opioid medication (AOR 3.2, 95% CI 1.2–8.4), lifetime medical use of non-opioid prescribed medication (AOR 2.2, 95% CI 1.1–4.7), and lifetime use of prayer (AOR 2.8, 95% CI 1.2–6.5), and was less likely to report lifetime use of yoga (AOR 0.2, 95% CI 0.1–0.7) to treat pain. While the two pain groups did not differ on levels of perceived efficacy of prior lifetime pain treatments, in comparison to the SP group, the CP group was more likely to report interest in receiving pain treatment while in BNT (P pain seeking BNT for opioid dependence report a wide range of conventional, complementary, and alternative pain-related treatments and are interested (especially those with CP) in receiving pain management services along with BNT. PMID:23041680

  14. [Evaluated treatment approaches in child and adolescent psychiatry I].

    Science.gov (United States)

    Baving, L; Schmidt, M H

    2001-08-01

    The principle of evidence-based medicine is to integrate data concerning the efficacy of interventions into clinical practice. This article assesses the level of evaluation of psychosocial, psychopharmacological and combined interventions for mental disorders in childhood and adolescence (autistic disorders, hyperkinetic disorders, conduct disorders, tic disorders, enuresis, and encopresis). Three different levels of evaluation were defined for both psychosocial and psychopharmacological interventions: A (> or = 2 randomized controlled studies), B (1 randomized controlled study), and C (open studies and case studies). The level of evaluation was judged on the basis of original papers found in a comprehensive literature search. For most disorders presented in this article there are several A-level treatments. The efficacy of both psychosocial and psychopharmacological interventions that target specific problem behaviors or symptoms, respectively, has been repeatedly demonstrated with regard to autistic disorders. Many studies have evaluated treatment approaches for hyperkinetic disorders and conduct disorders. With regard to the treatment of tic disorders in children and adolescents, far more studies evaluated the efficacy of pharmacotherapy than of psychotherapy. Further research should compare the efficacy of different treatment approaches, examine specific and differential treatment effects and investigate combined treatment approaches.

  15. Goal setting in psychotherapy: the relevance of approach and avoidance goals for treatment outcome.

    Science.gov (United States)

    Wollburg, Eileen; Braukhaus, Christoph

    2010-07-01

    The present study is the first aimed at investigating the influence of goal definition on treatment outcome in a sample of depressed patients. Data from 657 inpatients admitted to a psychosomatic clinic in Germany being treated in a cognitive-behavioral therapy program were analyzed. Treatment goals were identified as either approach or avoidance, and the sample was classified accordingly. Patients who identified approach goals only were placed in the approach group, and those who identified at least one avoidance goal were placed in the avoidance group. Results showed that framing goals using avoidance terms was associated with less symptomatic improvement but did not affect goal attainment. Findings from this research should be utilized in practice not only for process management such as individual treatment planning but also to control outcome quality. Furthermore, goal definition should be considered as a control variable in research on depression.

  16. Behavioral treatment of insomnia: a proposal for a stepped-care approach to promote public health

    Directory of Open Access Journals (Sweden)

    Mack L

    2011-07-01

    Full Text Available Laurin J Mack, Bruce D RybarczykClinical Psychology Program, Department of Psychology, Virginia Commonwealth University, Richmond, VA, USAAbstract: Chronic insomnia is a highly prevalent condition that has psychological and medical consequences for those who suffer from it and financial consequences for both the individual and society. In spite of the fact that nonpharmacologic treatment methods have been developed and shown to be as or more effective than medication for chronic insomnia, these methods remain greatly underutilized due to an absence of properly trained therapists and a general failure in dissemination. A stepped-care model implemented in a primary-care setting offers a public health solution to the problem of treatment accessibility and delivery of behavioral treatments for insomnia. Such a model would provide graduated levels of cognitive behavioral intervention, with corresponding increases in intensity and cost, including self-help, manualized group treatment, brief individual treatment, and finally, individualized behavioral treatment provided by a specialist. To provide such a systematic approach, future research would need to confirm several aspects of the model, and a cadre of professionals would need to be trained to administer manualized care in both group and individualized formats.Keywords: cognitive behavioral therapy, chronic insomnia, stepped care, primary care

  17. From Genes to Ecosystems in Microbiology: Modeling Approaches and the Importance of Individuality

    Directory of Open Access Journals (Sweden)

    Jan-Ulrich Kreft

    2017-11-01

    Full Text Available Models are important tools in microbial ecology. They can be used to advance understanding by helping to interpret observations and test hypotheses, and to predict the effects of ecosystem management actions or a different climate. Over the past decades, biological knowledge and ecosystem observations have advanced to the molecular and in particular gene level. However, microbial ecology models have changed less and a current challenge is to make them utilize the knowledge and observations at the genetic level. We review published models that explicitly consider genes and make predictions at the population or ecosystem level. The models can be grouped into three general approaches, i.e., metabolic flux, gene-centric and agent-based. We describe and contrast these approaches by applying them to a hypothetical ecosystem and discuss their strengths and weaknesses. An important distinguishing feature is how variation between individual cells (individuality is handled. In microbial ecosystems, individual heterogeneity is generated by a number of mechanisms including stochastic interactions of molecules (e.g., gene expression, stochastic and deterministic cell division asymmetry, small-scale environmental heterogeneity, and differential transport in a heterogeneous environment. This heterogeneity can then be amplified and transferred to other cell properties by several mechanisms, including nutrient uptake, metabolism and growth, cell cycle asynchronicity and the effects of age and damage. For example, stochastic gene expression may lead to heterogeneity in nutrient uptake enzyme levels, which in turn results in heterogeneity in intracellular nutrient levels. Individuality can have important ecological consequences, including division of labor, bet hedging, aging and sub-optimality. Understanding the importance of individuality and the mechanism(s underlying it for the specific microbial system and question investigated is essential for selecting the

  18. Current approaches to the treatment of Parkinson’s disease

    Directory of Open Access Journals (Sweden)

    Joseph Jankovic

    2008-09-01

    Full Text Available Joseph Jankovic, L Giselle AguilarParkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of MedicineAbstract: Enormous progress has been made in the treatment of Parkinson’s disease (PD. As a result of advances in experimental therapeutics, many promising therapies for PD are emerging. Levodopa remains the most potent drug for controlling PD symptoms, yet is associated with significant complications such as the “wearing off” effect, levodopa-induced dyskinesias and other motor complications. Catechol-o-methyl-transferase inhibitors, dopamine agonists and nondopaminergic therapy are alternative modalities in the management of PD and may be used concomitantly with levodopa or one another. The neurosurgical treatment, focusing on deep brain stimulation, is reviewed briefly. Although this review has attempted to highlight the most recent advances in the treatment of PD, it is important to note that new treatments are not necessarily better than the established conventional therapy and that the treatment options must be individualized and tailored to the needs of each individual patient.Keywords: Parkinson’s disease, levodopa, medical treatment, pallidotomy, deep brain stimulation

  19. Innovative approaches to support smoking cessation for individuals with mental illness and co-occurring substance use disorders.

    Science.gov (United States)

    Das, Smita; Prochaska, Judith J

    2017-10-01

    Tobacco remains the leading preventable cause of death in the US, accounting for over 520,000 deaths annually. While the smoking prevalence has declined over the past 50 years, those with mental illness and addictive disorders continue to smoke at high levels and with significant tobacco-related health problems. Areas covered: This review highlights the epidemiology, contributing factors, and evidence-base for intervening upon tobacco use in those with mental illness and addictive disorders. Historically underprioritized, a growing body of literature supports treating tobacco within mental health and addiction treatment settings. Critically, treating tobacco use appears to support, and not harm, mental health recovery and sobriety. This review also summarizes novel, emerging approaches to mitigate the harms of cigarette smoking. Expert commentary: People with mental illness and addictive disorders have a high prevalence of tobacco use with serious health harms. Treating tobacco use is essential. Evidence-based strategies include individual treatments that are stage-matched to readiness to quit and combine cessation medications with behavioral therapies, supported by smoke-free policies in treatment settings and residential environments. Emerging approaches, with a focus on harm reduction, are electronic nicotine delivery systems and tobacco regulatory efforts to reduce the nicotine content in cigarettes, thereby reducing their addiction potential.

  20. New concepts in the management of diffuse low-grade glioma: Proposal of a multistage and individualized therapeutic approach.

    Science.gov (United States)

    Duffau, Hugues; Taillandier, Luc

    2015-03-01

    Diffuse low-grade glioma grows, migrates along white matter tracts, and progresses to high-grade glioma. Rather than a "wait and see" policy, an aggressive attitude is now recommended, with early surgery as the first therapy. Intraoperative mapping, with maximal resection according to functional boundaries, is associated with a longer overall survival (OS) while minimizing morbidity. However, most studies have investigated the role of only one specific treatment (surgery, radiotherapy, chemotherapy) without taking a global view of managing the cumulative time while preserving quality of life (QoL) versus time to anaplastic transformation. Our aim is to switch towards a more holistic concept based upon the anticipation of a personalized and long-term multistage therapeutic approach, with online adaptation of the strategy over the years using feedback from clinical, radiological, and histomolecular monitoring. This dynamic strategy challenges the traditional approach by proposing earlier therapy, by repeating treatments, and by reversing the classical order of therapies (eg, neoadjuvant chemotherapy when maximal resection is impossible, no early radiotherapy) to improve OS and QoL. New individualized management strategies should deal with the interactions between the course of this chronic disease, reaction brain remapping, and oncofunctional modulation elicited by serial treatments. This philosophy supports a personalized, functional, and preventive neuro-oncology. © The Author(s) 2014. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  1. Systemic multimodal approach to speech therapy treatment in autistic children.

    Science.gov (United States)

    Tamas, Daniela; Marković, Slavica; Milankov, Vesela

    2013-01-01

    Conditions in which speech therapy treatment is applied in autistic children are often not in accordance with characteristics of opinions and learning of people with autism. A systemic multimodal approach means motivating autistic people to develop their language speech skill through the procedure which allows reliving of their personal experience according to the contents that are presented in the their natural social environment. This research was aimed at evaluating the efficiency of speech treatment based on the systemic multimodal approach to the work with autistic children. The study sample consisted of 34 children, aged from 8 to 16 years, diagnosed to have different autistic disorders, whose results showed a moderate and severe clinical picture of autism on the Childhood Autism Rating Scale. The applied instruments for the evaluation of ability were the Childhood Autism Rating Scale and Ganzberg II test. The study subjects were divided into two groups according to the type of treatment: children who were covered by the continuing treatment and systemic multimodal approach in the treatment, and children who were covered by classical speech treatment. It is shown that the systemic multimodal approach in teaching autistic children affects the stimulation of communication, socialization, self-service and work as well as that the progress achieved in these areas of functioning was retainable after long time, too. By applying the systemic multimodal approach when dealing with autistic children and by comparing their achievements on tests applied before, during and after the application of this mode, it has been concluded that certain improvement has been achieved in the functionality within the diagnosed category. The results point to a possible direction in the creation of new methods, plans and programs in dealing with autistic children based on empirical and interactive learning.

  2. MULTIDISCIPLINARY APPROACH TO SUPPORTING TREATMENT COMPLIANCE IN TUBERCULOSIS PATIENTS

    Directory of Open Access Journals (Sweden)

    T. V. Sherstneva

    2017-01-01

    Full Text Available The article presents the algorithm for working with tuberculosis patients in TB hospital, providing implementation of multidisciplinary patient-centered activities for early diagnostics of psychiatric and social disorders, therapy and rehabilitation of concurrent psychiatric disorders and addictions. Multidisciplinary approach to activities within TB unit is aimed at improvement of treatment compliance of tuberculosis patients. The training programme has been developed in order to improve competency of medical personnel on the issue of treatment interruption prevention and motivating patients to undergo the continuous treatment.

  3. Breast cancer treatment: historical review and current approaches

    International Nuclear Information System (INIS)

    Kulakowski, A.

    1994-01-01

    The evolution and development of opinions on the diagnosis and treatment of breast cancer since Galen to present time is presented. The concept of breast cancer as a local disease has been replaced by the understanding of its systemic character. On this background described are the methods of surgical treatment beginning from early - supraradical, to present -conservative approaches. The ''milestones'' in diagnosis and treatment of breast cancer of the last 40 years are presented. Current methods of breast cancer management include correct diagnosis (clinical examination, mammography, ultrasound, fine needle aspiration biopsy), TNM staging, adequate loco-regional therapy, systemic therapy, rehabilitation, reconstruction and careful follow-up. (author)

  4. An individual-based modelling approach to estimate landscape connectivity for bighorn sheep (Ovis canadensis

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    Corrie H. Allen

    2016-05-01

    Full Text Available Background. Preserving connectivity, or the ability of a landscape to support species movement, is among the most commonly recommended strategies to reduce the negative effects of climate change and human land use development on species. Connectivity analyses have traditionally used a corridor-based approach and rely heavily on least cost path modeling and circuit theory to delineate corridors. Individual-based models are gaining popularity as a potentially more ecologically realistic method of estimating landscape connectivity. However, this remains a relatively unexplored approach. We sought to explore the utility of a simple, individual-based model as a land-use management support tool in identifying and implementing landscape connectivity. Methods. We created an individual-based model of bighorn sheep (Ovis canadensis that simulates a bighorn sheep traversing a landscape by following simple movement rules. The model was calibrated for bighorn sheep in the Okanagan Valley, British Columbia, Canada, a region containing isolated herds that are vital to conservation of the species in its northern range. Simulations were run to determine baseline connectivity between subpopulations in the study area. We then applied the model to explore two land management scenarios on simulated connectivity: restoring natural fire regimes and identifying appropriate sites for interventions that would increase road permeability for bighorn sheep. Results. This model suggests there are no continuous areas of good habitat between current subpopulations of sheep in the study area; however, a series of stepping-stones or circuitous routes could facilitate movement between subpopulations and into currently unoccupied, yet suitable, bighorn habitat. Restoring natural fire regimes or mimicking fire with prescribed burns and tree removal could considerably increase bighorn connectivity in this area. Moreover, several key road crossing sites that could benefit from

  5. Spontaneous harm reduction: a barrier for substance-dependent individuals seeking treatment?

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    Fontanella Bruno José Barcellos

    2005-01-01

    Full Text Available OBJETIVE: Greater information regarding motivations and treatment barriers faced by substance-dependent individuals has clinical and public health implications. This study aimed to formulate hypotheses regarding psychological, social and family variables that can be constructed as motivations or subjective barriers for the early seeking of formal treatment. METHODS: A qualitative study was conducted in an intentional sample (selected through saturation and variety of types of 13 substance-dependent individuals who sought treatment. In-depth, semi-structured interviews were conducted using open questions, and the transcribed data were subjected to qualitative analysis. RESULTS: Four types of spontaneous harm reduction measures were identified, according to the subjective logic of each participant: having some periods at rest (not using and recovering from adverse effects; caretaking by close acquaintances (relatives, partners, drug dealers and alcoholic beverage sellers; selectivity regarding substance source, type and means of administration; establishing "healthy" limits of ingestion. CONCLUSIONS: The measures identified might represent barriers to the early seeking of treatment but might also represent spontaneous learning of abilities beneficial to future treatment. Health care professionals should take into consideration their existence and should address them in clinical settings. Issues representative of the formulated categories should be presented in structured questionnaires used in future quantitative studies of barriers to treatment in this population.

  6. Spontaneous harm reduction: a barrier for substance-dependent individuals seeking treatment?

    Directory of Open Access Journals (Sweden)

    Bruno José Barcellos Fontanella

    2005-12-01

    Full Text Available OBJETIVE: Greater information regarding motivations and treatment barriers faced by substance-dependent individuals has clinical and public health implications. This study aimed to formulate hypotheses regarding psychological, social and family variables that can be constructed as motivations or subjective barriers for the early seeking of formal treatment. METHODS: A qualitative study was conducted in an intentional sample (selected through saturation and variety of types of 13 substance-dependent individuals who sought treatment. In-depth, semi-structured interviews were conducted using open questions, and the transcribed data were subjected to qualitative analysis. RESULTS: Four types of spontaneous harm reduction measures were identified, according to the subjective logic of each participant: having some periods at rest (not using and recovering from adverse effects; caretaking by close acquaintances (relatives, partners, drug dealers and alcoholic beverage sellers; selectivity regarding substance source, type and means of administration; establishing "healthy" limits of ingestion. CONCLUSIONS: The measures identified might represent barriers to the early seeking of treatment but might also represent spontaneous learning of abilities beneficial to future treatment. Health care professionals should take into consideration their existence and should address them in clinical settings. Issues representative of the formulated categories should be presented in structured questionnaires used in future quantitative studies of barriers to treatment in this population.

  7. Cancer treatment disparities in HIV-infected individuals in the United States.

    Science.gov (United States)

    Suneja, Gita; Shiels, Meredith S; Angulo, Rory; Copeland, Glenn E; Gonsalves, Lou; Hakenewerth, Anne M; Macomber, Kathryn E; Melville, Sharon K; Engels, Eric A

    2014-08-01

    HIV-infected individuals with cancer have worse survival rates compared with their HIV-uninfected counterparts. One explanation may be differing cancer treatment; however, few studies have examined this. We used HIV and cancer registry data from Connecticut, Michigan, and Texas to study adults diagnosed with non-Hodgkin's lymphoma, Hodgkin's lymphoma, or cervical, lung, anal, prostate, colorectal, or breast cancers from 1996 to 2010. We used logistic regression to examine associations between HIV status and cancer treatment, adjusted for cancer stage and demographic covariates. For a subset of local-stage cancers, we used logistic regression to assess the relationship between HIV status and standard treatment modality. We identified predictors of cancer treatment among individuals with both HIV and cancer. We evaluated 3,045 HIV-infected patients with cancer and 1,087,648 patients with cancer without HIV infection. A significantly higher proportion of HIV-infected individuals did not receive cancer treatment for diffuse large B-cell lymphoma (DLBCL; adjusted odds ratio [aOR], 1.67; 95% CI, 1.41 to 1.99), lung cancer (aOR, 2.18; 95% CI, 1.80 to 2.64), Hodgkin's lymphoma (aOR, 1.77; 95% CI, 1.33 to 2.37), prostate cancer (aOR, 1.79; 95% CI, 1.31 to 2.46), and colorectal cancer (aOR, 2.27; 95% CI, 1.38 to 3.72). HIV infection was associated with a lack of standard treatment modality for local-stage DLBCL (aOR, 2.02; 95% CI, 1.50 to 2.72), non-small-cell lung cancer (aOR, 2.43; 95% CI, 1.46 to 4.03), and colon cancer (aOR, 4.77; 95% CI, 1.76 to 12.96). Among HIV-infected individuals, factors independently associated with lack of cancer treatment included low CD4 count, male sex with injection drug use as mode of HIV exposure, age 45 to 64 years, black race, and distant or unknown cancer stage. HIV-infected individuals are less likely to receive treatment for some cancers than uninfected people, which may affect survival rates. © 2014 by American Society of Clinical

  8. Meseron Therapy: An African Approach To Psychological Treatment ...

    African Journals Online (AJOL)

    Meseron therapy is a psychological treatment approach of African origin that consists of a direct and holistic counter-attack on undesirable conditions. It derives from an African custom of rejecting the negative while accepting the positive circumstances of life. Based on the philosophy of “I can”, and the concept of man as a ...

  9. How does dialectical behavior therapy facilitate treatment retention among individuals with comorbid borderline personality disorder and substance use disorders?

    Science.gov (United States)

    Bornovalova, Marina A; Daughters, Stacey B

    2007-12-01

    For individuals presenting with comorbid borderline personality disorder (BPD) and substance use disorders (SUD), rates of treatment dropout from combined mental health and substance abuse treatment centers approach 80%, rendering dropout the rule rather than the exception. Several studies indicate that utilizing a more comprehensive treatment such as Dialectical Behavior Therapy (DBT) may be useful for client retention; however, given the scope and effort required to conduct this treatment, it may be more practical to determine which specific components within DBT are useful in retaining clients in substance use treatment. Thus, the purpose of the current paper is first to determine what exact deficits underlie treatment dropout among the BPD-SUD comorbidity. Second, we review and evaluate effectiveness of DBT retention-enhancing strategies by assembling work from other samples and literatures that also tests retention-enhancing strategies discussed in DBT. As a last step, the paper will conclude with a discussion on methodological limitations and potential future directions in this line of research.

  10. Beyond price: individuals' accounts of deciding to pay for private healthcare treatment in the UK.

    Science.gov (United States)

    Exley, Catherine; Rousseau, Nikki; Donaldson, Cam; Steele, Jimmy G

    2012-03-07

    Delivering appropriate and affordable healthcare is a concern across the globe. As countries grapple with the issue of delivering healthcare with finite resources and populations continue to age, more health-related care services or treatments may become an optional 'extra' to be purchased privately. It is timely to consider how, and to what extent, the individual can act as both a 'patient' and a 'consumer'. In the UK the majority of healthcare treatments are free at the point of delivery. However, increasingly some healthcare treatments are being made available via the private healthcare market. Drawing from insights from healthcare policy and social sciences, this paper uses the exemplar of private dental implant treatment provision in the UK to examine what factors people considered when deciding whether or not to pay for a costly healthcare treatment for a non-fatal condition. Qualitative interviews with people (n = 27) who considered paying for dental implants treatments in the UK. Data collection and analysis processes followed the principles of the constant comparative methods, and thematic analysis was facilitated through the use of NVivo qualitative data software. Decisions to pay for private healthcare treatments are not simply determined by price. Decisions are mediated by: the perceived 'status' of the healthcare treatment as either functional or aesthetic; how the individual determines and values their 'need' for the treatment; and, the impact the expenditure may have on themselves and others. Choosing a private healthcare provider is sometimes determined simply by personal rapport or extant clinical relationship, or based on the recommendation of others. As private healthcare markets expand to provide more 'non-essential' services, patients need to develop new skills and to be supported in their new role as consumers.

  11. The stochastic system approach for estimating dynamic treatments effect.

    Science.gov (United States)

    Commenges, Daniel; Gégout-Petit, Anne

    2015-10-01

    The problem of assessing the effect of a treatment on a marker in observational studies raises the difficulty that attribution of the treatment may depend on the observed marker values. As an example, we focus on the analysis of the effect of a HAART on CD4 counts, where attribution of the treatment may depend on the observed marker values. This problem has been treated using marginal structural models relying on the counterfactual/potential response formalism. Another approach to causality is based on dynamical models, and causal influence has been formalized in the framework of the Doob-Meyer decomposition of stochastic processes. Causal inference however needs assumptions that we detail in this paper and we call this approach to causality the "stochastic system" approach. First we treat this problem in discrete time, then in continuous time. This approach allows incorporating biological knowledge naturally. When working in continuous time, the mechanistic approach involves distinguishing the model for the system and the model for the observations. Indeed, biological systems live in continuous time, and mechanisms can be expressed in the form of a system of differential equations, while observations are taken at discrete times. Inference in mechanistic models is challenging, particularly from a numerical point of view, but these models can yield much richer and reliable results.

  12. Individual differences in aversion to ambiguity regarding medical tests and treatments: association with cancer screening cognitions.

    Science.gov (United States)

    Han, Paul K J; Williams, Andrew E; Haskins, Amy; Gutheil, Caitlin; Lucas, F Lee; Klein, William M P; Mazor, Kathleen M

    2014-12-01

    Aversion to "ambiguity"-uncertainty about the reliability, credibility, or adequacy of information-about medical tests and treatments is an important psychological response that varies among individuals, but little is known about its nature and extent. The purpose of this study was to examine how individual-level ambiguity aversion relates to important health cognitions related to different cancer screening tests. A survey of 1,074 adults, ages 40 to 70 years, was conducted in four integrated U.S. healthcare systems. The Ambiguity Aversion in Medicine (AA-Med) scale, a measure of individual differences in aversion to ambiguity (AA) about medical tests and treatments, was administered along with measures of several cancer screening-related cognitions: perceived benefits and harms of colonoscopy, mammography, and PSA screening, and ambivalence and future intentions regarding these tests. Multivariable analyses were conducted to assess the associations between AA-Med scores and cancer screening cognitions. Individual-level AA as assessed by the AA-Med scale was significantly associated (P ambiguity. Individual-level AA constitutes a measurable, wide-ranging cognitive bias against medical intervention, and more research is needed to elucidate its mechanisms and effects. ©2014 American Association for Cancer Research.

  13. Clinical Significance: a Therapeutic Approach Topsychological Assessment in Treatment Planning

    Directory of Open Access Journals (Sweden)

    Afolabi Olusegun Emmanuel

    2015-06-01

    Full Text Available Psychological assessment has long been reported as a key component of clinical psychology. This paper examines the complexities surrounding the clinical significance of therapeutic approach to treatment planning. To achieve this objective, the paper searched and used the PsycINFO and PubMed databases and the reference sections of chapters and journal articles to analysed, 1 a strong basis for the usage of therapeutic approach to psychological assessment in treatment plans, 2 explained the conceptual meaning of clinical significant change in therapeutic assessment, 3 answered some of the questions regarding practicability and the clinical significance of therapeutic approach to treatment plans, particularly during or before treatment, 4 linked therapeutic assessment to change in clients’ clinical impression, functioning and therapeutic needs 5 analysed the empirically documenting clinically significant change in therapeutic assessment. Finally, the study suggested that though therapeutic assessment is not sufficient for the systematic study of psychotherapy outcome and process, it is still consistent with both the layman and professional expectations regarding treatment outcome and also provides a precise method for classifying clients as ‘changed’ or ‘unchanged’ on the basis of clinical significance criteria.

  14. An Approach of Estimating Individual Growth Curves for Young Thoroughbred Horses Based on Their Birthdays

    Science.gov (United States)

    ONODA, Tomoaki; YAMAMOTO, Ryuta; SAWAMURA, Kyohei; MURASE, Harutaka; NAMBO, Yasuo; INOUE, Yoshinobu; MATSUI, Akira; MIYAKE, Takeshi; HIRAI, Nobuhiro

    2014-01-01

    ABSTRACT We propose an approach of estimating individual growth curves based on the birthday information of Japanese Thoroughbred horses, with considerations of the seasonal compensatory growth that is a typical characteristic of seasonal breeding animals. The compensatory growth patterns appear during only the winter and spring seasons in the life of growing horses, and the meeting point between winter and spring depends on the birthday of each horse. We previously developed new growth curve equations for Japanese Thoroughbreds adjusting for compensatory growth. Based on the equations, a parameter denoting the birthday information was added for the modeling of the individual growth curves for each horse by shifting the meeting points in the compensatory growth periods. A total of 5,594 and 5,680 body weight and age measurements of Thoroughbred colts and fillies, respectively, and 3,770 withers height and age measurements of both sexes were used in the analyses. The results of predicted error difference and Akaike Information Criterion showed that the individual growth curves using birthday information better fit to the body weight and withers height data than not using them. The individual growth curve for each horse would be a useful tool for the feeding managements of young Japanese Thoroughbreds in compensatory growth periods. PMID:25013356

  15. Muscle relaxation for individuals having tattoos removed through laser treatment: possible effects regarding anxiety and pain.

    Science.gov (United States)

    Huang, Faye; Chou, Wen-Jiun; Chen, Tien-Hsing; Chen, Ching; Hsieh, Yu-Lian; Chong, Mian-Yoon; Hung, Chi-Fa; Lin, Shu-Ching; Tsai, Hsiu-Huang; Wang, Liang-Jen

    2016-08-01

    Effectively managing pain is vital for the well-being and satisfaction of patients undergoing dermatologic treatments involving lasers. This study investigates the potential outcome of using muscle relaxation techniques to reduce pain among people having their tattoos removed with laser treatment. This study consists of 56 participants (mean age 18.1 ± 2.1 years) that had tattoos removed using the principle of selective photothermolysis. These participants underwent muscle relaxation before receiving the laser treatment. Their peripheral skin temperatures (PST) were measured both at the beginning and the end of the muscle relaxation period. Then, the Beck Anxiety Inventory was applied to evaluate anxiety levels. Once the laser treatment was completed, pain levels were measured using a visual analogue scale. A total of 125 person-sessions of laser treatment and psychometric assessments were performed in this study. The muscle relaxation method significantly increased the PST of the participants while reducing the levels of anxiety and pain throughout the course of the laser treatment procedure. The PST, anxiety scores, and pain scores all showed significant correlations with one another. According to the results obtained, this study proposes that muscle relaxation techniques be considered possibly auxiliary treatment options for individuals having tattoos removed through laser treatment. Additional studies with a comparison group and a larger sample size are required in the future to confirm the effectiveness of such intervention.

  16. Anglo-Saxon experience in the implementation of correctional treatment and the Polish individual rehabilitation program

    Directory of Open Access Journals (Sweden)

    Maciej Bernasiewicz

    2012-12-01

    Full Text Available The authors cite American and British research on the effectiveness of correctional treatment. On that basis, they describe several crucial factors that affect the success of rehabilitation (e.g., educators’ skills, working with families of juvenile offenders. The article broadly discusses the specific juvenile residential treatment program that has been implemented in Florida. The conclusions of this program are drawn from the research conducted through interviews with juvenile offenders (young adults who have effectively completed the process of rehabilitation in correctional facilities. Furthermore, the authors discuss an individual program of rehabilitation (IPR implemented in Polish correctional facilities. Using the experience and the impact of correctional treatment in the West, it is proposed to introduce certain modifications in the planning and implementation of Polish correctional treatment programs (IPR s.

  17. Effectiveness of prenatal treatment for congenital toxoplasmosis: a meta-analysis of individual patients' data

    DEFF Research Database (Denmark)

    Thiébaut, Rodolphe; Leproust, Sandy; Chêne, Geneviève

    2007-01-01

    BACKGROUND: Despite three decades of prenatal screening for congenital toxoplasmosis in some European countries, uncertainty remains about the effectiveness of prenatal treatment. METHODS: We did a systematic review of cohort studies based on universal screening for congenital toxoplasmosis. We did...... a meta-analysis using individual patients' data to assess the effect of timing and type of prenatal treatment on mother-to-child transmission of infection and clinical manifestations before age 1 year. Analyses were adjusted for gestational age at maternal seroconversion and other covariates. FINDINGS......: We included 26 cohorts in the review. In 1438 treated mothers identified by prenatal screening, we found weak evidence that treatment started within 3 weeks of seroconversion reduced mother-to-child transmission compared with treatment started after 8 or more weeks (adjusted odds ratio [OR] 0.48, 95...

  18. Cow-specific treatment of clinical mastitis: an economic approach.

    Science.gov (United States)

    Steeneveld, W; van Werven, T; Barkema, H W; Hogeveen, H

    2011-01-01

    Under Dutch circumstances, most clinical mastitis (CM) cases of cows on dairy farms are treated with a standard intramammary antimicrobial treatment. Several antimicrobial treatments are available for CM, differing in antimicrobial compound, route of application, duration, and cost. Because cow factors (e.g., parity, stage of lactation, and somatic cell count history) and the causal pathogen influence the probability of cure, cow-specific treatment of CM is often recommended. The objective of this study was to determine if cow-specific treatment of CM is economically beneficial. Using a stochastic Monte Carlo simulation model, 20,000 CM cases were simulated. These CM cases were caused by Streptococcus uberis and Streptococcus dysgalactiae (40%), Staphylococcus aureus (30%), or Escherichia coli (30%). For each simulated CM case, the consequences of using different antimicrobial treatment regimens (standard 3-d intramammary, extended 5-d intramammary, combination 3-d intramammary+systemic, combination 3-d intramammary+systemic+1-d nonsteroidal antiinflammatory drugs, and combination extended 5-d intramammary+systemic) were simulated simultaneously. Finally, total costs of the 5 antimicrobial treatment regimens were compared. Some inputs for the model were based on literature information and assumptions made by the authors were used if no information was available. Bacteriological cure for each individual cow depended on the antimicrobial treatment regimen, the causal pathogen, and the cow factors parity, stage of lactation, somatic cell count history, CM history, and whether the cow was systemically ill. Total costs for each case depended on treatment costs for the initial CM case (including costs for antibiotics, milk withdrawal, and labor), treatment costs for follow-up CM cases, costs for milk production losses, and costs for culling. Average total costs for CM using the 5 treatments were (US) $224, $247, $253, $260, and $275, respectively. Average probabilities

  19. Habitual biting of oral mucosa: A conservative treatment approach

    Directory of Open Access Journals (Sweden)

    Sarabjot Kaur Bhatia

    2013-01-01

    Full Text Available Chronic biting of oral mucosa is an innocuous self inflicted injury, commonly seen in children suffering from developmental and psychological problems and has rarely been reported in normal unaffected individuals. The management strategies vary from counseling, prescription of sedatives to different prosthetic shields. The paper highlights the efficacy of a simple approach using soft mouth guard in the management of self inflicted lesions due to habitual biting of oral mucosa in two normal healthy children.

  20. Placebo treatment facilitates social trust and approach behavior.

    Science.gov (United States)

    Yan, Xinyuan; Yong, Xue; Huang, Wenhao; Ma, Yina

    2018-05-29

    Placebo effect refers to beneficial changes induced by the use of inert treatment, such as placebo-induced relief of physical pain and attenuation of negative affect. To date, we know little about whether placebo treatment could facilitate social functioning, a crucial aspect for well-being of a social species. In the present study, we develop and validate a paradigm to induce placebo effects on social trust and approach behavior (social placebo effect), and show robust evidence that placebo treatment promotes trust in others and increases preference for a closer interpersonal distance. We further examine placebo effects in real-life social interaction and show that placebo treatment makes single, but not pair-bonded, males keep closer to an attractive first-met female and perceive less social anxiety in the female. Finally, we show evidence that the effects of placebo treatment on social trust and approach behavior can be as strong as the effect of intranasal administration of oxytocin, a neuropeptide known for its function in facilitating social cognition and behavior. The finding of the social placebo effect extends our understanding of placebo effects on improvement of physical, mental, and social well-being and suggests clinical potentials in the treatment of social dysfunction.

  1. Differential approach to treatment of primary nocturnal enuresis in children

    Directory of Open Access Journals (Sweden)

    Nesterenko O.V.

    2011-09-01

    Full Text Available The aim of the work is to develop an algorithm of differentiated therapy in children with PNE. 234 children aged 5-15 years were studied. Results of treatment of children with primary nocturnal enuresis using the traditional therapeutic scheme and the algorithm of differential therapy based on identification of individual pathology were analyzed. The best clinical effect (recovery— in 73,1%, improvement— in 19,4% of cases was obtained in children undergone the complex of recommended measures: psychological consultation, rational and family psychotherapy, medication correction, physical and physiotherapy, alarm-monitoring; the complex was used differentially, i.e. depending on the identified pathology. In conclusion the article stated that individual treatment program with the obligatory inclusion of alarm-control for child with PNE should be selected after performing the recommended set of diagnostic measures

  2. Self-monitoring of blood glucose in diabetes mellitus: arguments for an individualized approach.

    Science.gov (United States)

    Nauck, Michael A; El-Ouaghlidi, Andrea; Vardarli, Irfan

    2009-09-01

    The utility of glucose self-monitoring in different types and stages of diabetes is controversial, as there is only sparse relevant evidence from randomized controlled clinical trials. In this analysis, the authors aim to develop individualized recommendations based on clinical needs and the available literature. The PubMed database was searched for articles that appeared up to 30 September 2008 containing the terms "measurement," "control","monitoring," and "hypoglycemia"; the retrieved articles were supplemented by other articles that were cited in them. A directed search was also made for the recommendations of the German, European, American, and international diabetological societies. Conclusions were then drawn about the useful modalities and extent of glucose self-monitoring on the basis of the clinical features of the major types of diabetes and the main treatment strategies for them. With the exception of intensified treatment strategies (which rely on blood-sugar regulation with insulin), only a few evidence-based recommendations can be derived from randomized clinical trials and meta-analyses. Nonetheless, a strategy for self-monitoring according to the patient's individual needs can be derived from the characteristics of therapeutic regimens: depending on the type of diabetes from which the patient suffers, the predicted number of glucometer strips required for self-monitoring will vary from almost none to roughly 400 per month. The decision to use glucose self-monitoring, as well as the type and extent of self-monitoring that will be used, should be based on the individual patient's type of diabetes, treatment regimen, and clinical characteristics. Like any other type of therapeutic intervention, self-monitoring should have a well-documented, rational justification.

  3. What factors predict individual subjects' re-learning of words during anomia treatment?

    Directory of Open Access Journals (Sweden)

    William Hayward

    2014-04-01

    Full Text Available A growing number of studies are addressing methodological approaches to treating anomia in persons with aphasia. What is missing from these studies are validated procedures for determining which words have the greatest potential for recovery. The current study evaluates the usefulness of several word-specific variables and one subject-specific measure in predicting success in re-learning problematic words. Methods: Two participants, YPR and ODH, presented with fluent aphasia and marked anomia. YPR’s Aphasia Quotient on the Western Aphasia Battery was 58.8; ODH’s AQ was 79.5. Stimuli were 96 pictures chosen individually for each participant from among those that they named incorrectly on multiple baselines. Subsequently, participants were presented with each picture and asked to indicate whether they could name it covertly, or “in their head.” Each subject completed a biweekly anomia treatment for these pictures. We performed separate statistical analyses for each subject. Dependent variables included whether each word was learned during treatment (Acquisition and the number of sessions required to learn each word (#Sessions. We used logistic regression models to evaluate the association of (self-reported covert naming success with Acquisition, and linear regression models to assess the relationship between (self-reported covert naming success and #Sessions. Starting with the predictors of covert naming accuracy, number of syllables (#syllables, number of phonemes (#phonemes, and frequency, we used backwards elimination methods to select the final regression models. Results: By the end of 25 treatment sessions, YPR had learned 90.2% (37/41 of the covertly correct words but only 70.4% (38/54 of the covertly incorrect words. In the unadjusted analysis, covert naming was significantly associated with Acquisition, OR=3.89, 95% CI: (1.19, 12.74, p=0.025. The result remained significant after adjustment for #phonemes (the only other predictor

  4. THE IMPORTANCE OF INDIVIDUAL APPROACH IN TEACHING HIGHER MATHEMATICS AT TECHNICAL UNIVERSITIES

    Directory of Open Access Journals (Sweden)

    Medvedeva Natal'ya Aleksandrovna

    2015-12-01

    Full Text Available The article discusses the importance of an individual approach when considering the time needed for learning basic technical courses of a technical University (such as higher mathematics, physics, etc. to motivate a student to obtain 100% standard of mastering the educational material using the experience of the Department of mathematics. In the modern conditions of the world of information technologies it is extremely important to teach people how to handle information independently and, what is the most important, to assess it. As you know, universities set a certain studying time for each academic subject fixed by curriculum. But time should not be a constant component. Obviously, such a new approach will require innovation in the methodological literature. Using the experience of the Department of Mathematics of MGSU the author offers methodical developments and research works for studying under the direction of a teacher along with standard digestion of the curriculum.

  5. A multidisciplinary approach for the treatment of complication of hematogenous osteomyelitis in children

    Directory of Open Access Journals (Sweden)

    Yury Garkavenko Garkavenko

    2016-06-01

    The modern concept of comprehensive medical rehabilitation of children with complications of osteomyelitis should include an interdisciplinary approach involving orthopedic and maxillofacial surgeons. Early diagnosis in children ensures the timely formation of individualized rehabilitation programs, designed to improve the anatomical and functional characteristics of the affected bones. Along with comprehensive orthopedic treatment, bone-reconstructive surgery of the facial bones of the skull should be focused on restoration of chewing function, external respiration, speech, and facial esthetics.

  6. Modelling individual differences in the form of Pavlovian conditioned approach responses: a dual learning systems approach with factored representations.

    Directory of Open Access Journals (Sweden)

    Florian Lesaint

    2014-02-01

    Full Text Available Reinforcement Learning has greatly influenced models of conditioning, providing powerful explanations of acquired behaviour and underlying physiological observations. However, in recent autoshaping experiments in rats, variation in the form of Pavlovian conditioned responses (CRs and associated dopamine activity, have questioned the classical hypothesis that phasic dopamine activity corresponds to a reward prediction error-like signal arising from a classical Model-Free system, necessary for Pavlovian conditioning. Over the course of Pavlovian conditioning using food as the unconditioned stimulus (US, some rats (sign-trackers come to approach and engage the conditioned stimulus (CS itself - a lever - more and more avidly, whereas other rats (goal-trackers learn to approach the location of food delivery upon CS presentation. Importantly, although both sign-trackers and goal-trackers learn the CS-US association equally well, only in sign-trackers does phasic dopamine activity show classical reward prediction error-like bursts. Furthermore, neither the acquisition nor the expression of a goal-tracking CR is dopamine-dependent. Here we present a computational model that can account for such individual variations. We show that a combination of a Model-Based system and a revised Model-Free system can account for the development of distinct CRs in rats. Moreover, we show that revising a classical Model-Free system to individually process stimuli by using factored representations can explain why classical dopaminergic patterns may be observed for some rats and not for others depending on the CR they develop. In addition, the model can account for other behavioural and pharmacological results obtained using the same, or similar, autoshaping procedures. Finally, the model makes it possible to draw a set of experimental predictions that may be verified in a modified experimental protocol. We suggest that further investigation of factored representations in

  7. Modelling Individual Differences in the Form of Pavlovian Conditioned Approach Responses: A Dual Learning Systems Approach with Factored Representations

    Science.gov (United States)

    Lesaint, Florian; Sigaud, Olivier; Flagel, Shelly B.; Robinson, Terry E.; Khamassi, Mehdi

    2014-01-01

    Reinforcement Learning has greatly influenced models of conditioning, providing powerful explanations of acquired behaviour and underlying physiological observations. However, in recent autoshaping experiments in rats, variation in the form of Pavlovian conditioned responses (CRs) and associated dopamine activity, have questioned the classical hypothesis that phasic dopamine activity corresponds to a reward prediction error-like signal arising from a classical Model-Free system, necessary for Pavlovian conditioning. Over the course of Pavlovian conditioning using food as the unconditioned stimulus (US), some rats (sign-trackers) come to approach and engage the conditioned stimulus (CS) itself – a lever – more and more avidly, whereas other rats (goal-trackers) learn to approach the location of food delivery upon CS presentation. Importantly, although both sign-trackers and goal-trackers learn the CS-US association equally well, only in sign-trackers does phasic dopamine activity show classical reward prediction error-like bursts. Furthermore, neither the acquisition nor the expression of a goal-tracking CR is dopamine-dependent. Here we present a computational model that can account for such individual variations. We show that a combination of a Model-Based system and a revised Model-Free system can account for the development of distinct CRs in rats. Moreover, we show that revising a classical Model-Free system to individually process stimuli by using factored representations can explain why classical dopaminergic patterns may be observed for some rats and not for others depending on the CR they develop. In addition, the model can account for other behavioural and pharmacological results obtained using the same, or similar, autoshaping procedures. Finally, the model makes it possible to draw a set of experimental predictions that may be verified in a modified experimental protocol. We suggest that further investigation of factored representations in

  8. Modelling individual differences in the form of Pavlovian conditioned approach responses: a dual learning systems approach with factored representations.

    Science.gov (United States)

    Lesaint, Florian; Sigaud, Olivier; Flagel, Shelly B; Robinson, Terry E; Khamassi, Mehdi

    2014-02-01

    Reinforcement Learning has greatly influenced models of conditioning, providing powerful explanations of acquired behaviour and underlying physiological observations. However, in recent autoshaping experiments in rats, variation in the form of Pavlovian conditioned responses (CRs) and associated dopamine activity, have questioned the classical hypothesis that phasic dopamine activity corresponds to a reward prediction error-like signal arising from a classical Model-Free system, necessary for Pavlovian conditioning. Over the course of Pavlovian conditioning using food as the unconditioned stimulus (US), some rats (sign-trackers) come to approach and engage the conditioned stimulus (CS) itself - a lever - more and more avidly, whereas other rats (goal-trackers) learn to approach the location of food delivery upon CS presentation. Importantly, although both sign-trackers and goal-trackers learn the CS-US association equally well, only in sign-trackers does phasic dopamine activity show classical reward prediction error-like bursts. Furthermore, neither the acquisition nor the expression of a goal-tracking CR is dopamine-dependent. Here we present a computational model that can account for such individual variations. We show that a combination of a Model-Based system and a revised Model-Free system can account for the development of distinct CRs in rats. Moreover, we show that revising a classical Model-Free system to individually process stimuli by using factored representations can explain why classical dopaminergic patterns may be observed for some rats and not for others depending on the CR they develop. In addition, the model can account for other behavioural and pharmacological results obtained using the same, or similar, autoshaping procedures. Finally, the model makes it possible to draw a set of experimental predictions that may be verified in a modified experimental protocol. We suggest that further investigation of factored representations in computational

  9. Individual Differences in Approach-Avoidance Aptitude: Some Clues from Research on Parkinson’s Disease

    Directory of Open Access Journals (Sweden)

    Alberto eCosta

    2015-03-01

    Full Text Available Approach and avoidance are two basic behavioral aptitudes of humans whose correct balance is critical for successful adaptation to the environment. As the expression of approach and avoidance tendencies may differ significantly between healthy individuals, different psychobiological factors have been posited to account for such variability. In this regard, two main issues are still open that refers to i the role played by dopamine neurotransmission and ii the possible influence of cognitive characteristics, particularly executive functioning. The aim of the present paper was to highlight the contribution of research on Parkinson’s disease (PD to our understanding of the above issues. In particular, we here reviewed PD literature to clarify whether neurobiological and neuropsychological modifications due to PD are associated to changes in approach-avoidance related personality features. Available data indicate that PD patients may show and approach-avoidance imbalance as documented by lower novelty-seeking and higher harm-avoidance behaviors, possibly suggesting a relationship with neurobiological and neurocognitive PD-related changes. However, the literature that directly investigated this issue is still sparse and much more work is needed to better clarify it.

  10. Combined endoscopic approaches to the cardiac sphincter achalasia treatment

    Directory of Open Access Journals (Sweden)

    V. N. Klimenko

    2015-12-01

    Full Text Available Aim. To assess combined endoscopic approaches to the cardiac sphincter achalasia treatment. Results. There are preliminary results of treatment and methods of carrying out of combined endoscopic pneumocardiodilatation and injections of botulotoxin type A ‘Disport’ at achalasia cardia are described in the article. Aethio-pathogenetic aspects in the development of achalasia cardia, action of botulotoxin type A and balloon pneumocardiodilatation of the esophagus, were described. And modern roentgen-endoscopic classification of achalasia cardia was given. Prognostic estimation scale of possibility to implement further combined endoscopic or surgical treatment is defined and is being in subsequent working out. Conclusion. Described clinical cases most brightly demonstrate variety of clinical achalasia cardia manifestations and also determine of the earlier display of surgical treatment.

  11. Treatment for spasmodic dysphonia: limitations of current approaches

    Science.gov (United States)

    Ludlow, Christy L.

    2009-01-01

    Purpose of review Although botulinum toxin injection is the gold standard for treatment of spasmodic dysphonia, surgical approaches aimed at providing long-term symptom control have been advancing over recent years. Recent findings When surgical approaches provide greater long-term benefits to symptom control, they also increase the initial period of side effects of breathiness and swallowing difficulties. However, recent analyses of quality-of-life questionnaires in patients undergoing regular injections of botulinum toxin demonstrate that a large proportion of patients have limited relief for relatively short periods due to early breathiness and loss-of-benefit before reinjection. Summary Most medical and surgical approaches to the treatment of spasmodic dysphonia have been aimed at denervation of the laryngeal muscles to block symptom expression in the voice, and have both adverse effects as well as treatment benefits. Research is needed to identify the central neuropathophysiology responsible for the laryngeal muscle spasms in order target treatment towards the central neurological abnormality responsible for producing symptoms. PMID:19337127

  12. Evidence to practice: treatment of anxiety in individuals with autism spectrum disorders

    OpenAIRE

    Russell Lang; Richard Mahoney; Farah El Zein; et al

    2011-01-01

    Russell Lang, Richard Mahoney, Farah El Zein, Elizabeth Delaune, Megan AmidonTexas State University-San Marcos, TX, USADate of preparation: 23rd December 2010 Conflict of interest: None declaredClinical question: What treatment improves social interactions and reduces reports of anxiety symptoms in individuals with autism spectrum disorders (ASD) and a co-occurring anxiety disorder? Results: Systematic reviews and randomized clinical trials suggest that cognitive behavior therapy in tandem wi...

  13. Deliverable navigation for multicriteria IMRT treatment planning by combining shared and individual apertures

    International Nuclear Information System (INIS)

    Fredriksson, Albin; Bokrantz, Rasmus

    2013-01-01

    We consider the problem of deliverable Pareto surface navigation for step-and-shoot intensity-modulated radiation therapy. This problem amounts to calculation of a collection of treatment plans with the property that convex combinations of plans are directly deliverable. Previous methods for deliverable navigation impose restrictions on the number of apertures of the individual plans, or require that all treatment plans have identical apertures. We introduce simultaneous direct step-and-shoot optimization of multiple plans subject to constraints that some of the apertures must be identical across all plans. This method generalizes previous methods for deliverable navigation to allow for treatment plans with some apertures from a collective pool and some apertures that are individual. The method can also be used as a post-processing step to previous methods for deliverable navigation in order to improve upon their plans. By applying the method to subsets of plans in the collection representing the Pareto set, we show how it can enable convergence toward the unrestricted (non-navigable) Pareto set where all apertures are individual. (paper)

  14. Surgery as an Adjunctive Treatment for Multidrug-Resistant Tuberculosis: An Individual Patient Data Metaanalysis.

    Science.gov (United States)

    Fox, Gregory J; Mitnick, Carole D; Benedetti, Andrea; Chan, Edward D; Becerra, Mercedes; Chiang, Chen-Yuan; Keshavjee, Salmaan; Koh, Won-Jung; Shiraishi, Yuji; Viiklepp, Piret; Yim, Jae-Joon; Pasvol, Geoffrey; Robert, Jerome; Shim, Tae Sun; Shin, Sonya S; Menzies, Dick; Ahuja, S; Ashkin, D; Avendaño, M; Banerjee, R; Bauer, M; Burgos, M; Centis, R; Cobelens, F; Cox, H; D'Ambrosio, L; de Lange, W C M; DeRiemer, K; Enarson, D; Falzon, D; Flanagan, K; Flood, J; Gandhi, N; Garcia-Garcia, L; Granich, R M; Hollm-Delgado, M G; Holtz, T H; Hopewell, P; Iseman, M; Jarlsberg, L G; Kim, H R; Lancaster, J; Lange, C; Leimane, V; Leung, C C; Li, J; Menzies, D; Migliori, G B; Narita, M; Nathanson, E; Odendaal, R; O'Riordan, P; Pai, M; Palmero, D; Park, S K; Pena, J; Pérez-Guzmán, C; Ponce-de-Leon, A; Quelapio, M I D; Quy, H T; Riekstina, V; Royce, S; Salim, M; Schaaf, H S; Seung, K J; Shah, L; Shean, K; Sifuentes-Osornio, J; Sotgiu, G; Strand, M J; Sung, S W; Tabarsi, P; Tupasi, T E; Vargas, M H; van Altena, R; van der Walt, M; van der Werf, T S; Westenhouse, J; Yew, W W

    2016-04-01

    Medical treatment for multidrug-resistant (MDR)-tuberculosis is complex, toxic, and associated with poor outcomes. Surgical lung resection may be used as an adjunct to medical therapy, with the intent of reducing bacterial burden and improving cure rates. We conducted an individual patient data metaanalysis to evaluate the effectiveness of surgery as adjunctive therapy for MDR-tuberculosis. Individual patient data, was obtained from the authors of 26 cohort studies, identified from 3 systematic reviews of MDR-tuberculosis treatment. Data included the clinical characteristics and medical and surgical therapy of each patient. Primary analyses compared treatment success (cure and completion) to a combined outcome of failure, relapse, or death. The effects of all forms of resection surgery, pneumonectomy, and partial lung resection were evaluated. A total of 4238 patients from 18 surgical studies and 2193 patients from 8 nonsurgical studies were included. Pulmonary resection surgery was performed on 478 patients. Partial lung resection surgery was associated with improved treatment success (adjusted odds ratio [aOR], 3.0; 95% confidence interval [CI], 1.5-5.9; I(2)R, 11.8%), but pneumonectomy was not (aOR, 1.1; 95% CI, .6-2.3; I(2)R, 13.2%). Treatment success was more likely when surgery was performed after culture conversion than before conversion (aOR, 2.6; 95% CI, 0.9-7.1; I(2)R, 0.2%). Partial lung resection, but not pneumonectomy, was associated with improved treatment success among patients with MDR-tuberculosis. Although improved outcomes may reflect patient selection, partial lung resection surgery after culture conversion may improve treatment outcomes in patients who receive optimal medical therapy. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  15. Disparities in the treatment and outcomes of lung cancer among HIV-infected individuals

    Science.gov (United States)

    Suneja, Gita; Shiels, Meredith S.; Melville, Sharon K.; Williams, Melanie A.; Rengan, Ramesh; Engels, Eric A.

    2013-01-01

    Objectives HIV-infected people have elevated risk for lung cancer and higher mortality following cancer diagnosis than HIV-uninfected individuals. It is unclear whether HIV-infected individuals with lung cancer receive similar cancer treatment as HIV-uninfected individuals. Design/methods We studied adults more than 18 years of age with lung cancer reported to the Texas Cancer Registry (N = 156 930) from 1995 to 2009. HIV status was determined by linkage with the Texas enhanced HIV/AIDS Reporting System. For nonsmall cell lung cancer (NSCLC) cases, we identified predictors of cancer treatment using logistic regression. We used Cox regression to evaluate effects of HIV and cancer treatment on mortality. Results Compared with HIV-uninfected lung cancer patients (N = 156 593), HIV-infected lung cancer patients (N = 337) were more frequently young, black, men, and with non-Hispanic distant stage disease. HIV-infected NSCLC patients less frequently received cancer treatment than HIV-uninfected patients [60.3 vs. 77.5%; odds ratio 0.39, 95% confidence interval (CI) 0.30–0.52, after adjustment for diagnosis year, age, sex, race, stage, and histologic subtype]. HIV infection was associated with higher lung cancer-specific mortality (hazard ratio 1.34, 95% CI 1.15–1.56, adjusted for demographics and tumor characteristics). Inclusion of cancer treatment in adjusted models slightly attenuated the effect of HIV on lung cancer-specific mortality (hazard ratio 1.25; 95% CI 1.06–1.47). Also, there was a suggestion that HIV was more strongly associated with mortality among untreated than among treated patients (adjusted hazard ratio 1.32 vs. 1.16, P-interaction = 0.34). Conclusion HIV-infected NSCLC patients were less frequently treated for lung cancer than HIV-uninfected patients, which may have affected survival. PMID:23079809

  16. Experiences of the individual placement and support approach in persons with severe mental illness.

    Science.gov (United States)

    Areberg, Cecilia; Björkman, Tommy; Bejerholm, Ulrika

    2013-09-01

    Across several research studies comparing the individual placement and support (IPS) approach to traditional vocational services, the approach has achieved employment outcomes superior to comparison conditions. However, to understand the efficacy of IPS, it is equally important to consider what is more or less effective as viewed by the IPS participants. To investigate participants' experiences of IPS participation and their experiences of receiving support from an employment specialist (ES). Interviews were conducted with 17 persons with severe mental illness. The interviews were subjected to qualitative content analysis. The principles of informed consent and the voluntary nature of participation were included as ethical considerations. Participation in IPS was associated with hope, meaning and an individualized support provided by the ES. The skills of the ES facilitated the relationship with the participant and the contact with the labour market. However, to make a change happen, everybody involved in IPS had to contribute. These findings have endorsed the guiding principles of IPS and emphasized the ES's role and skills during IPS as well as the participant's motivation. © 2012 The Authors. Scandinavian Journal of Caring Sciences © 2012 Nordic College of Caring Science.

  17. Are individual based models a suitable approach to estimate population vulnerability? - a case study

    Directory of Open Access Journals (Sweden)

    Eva Maria Griebeler

    2011-04-01

    Full Text Available European populations of the Large Blue Butterfly Maculinea arion have experienced severe declines in the last decades, especially in the northern part of the species range. This endangered lycaenid butterfly needs two resources for development: flower buds of specific plants (Thymus spp., Origanum vulgare, on which young caterpillars briefly feed, and red ants of the genus Myrmica, whose nests support caterpillars during a prolonged final instar. I present an analytically solvable deterministic model to estimate the vulnerability of populations of M. arion. Results obtained from the sensitivity analysis of this mathematical model (MM are contrasted to the respective results that had been derived from a spatially explicit individual based model (IBM for this butterfly. I demonstrate that details in landscape configuration which are neglected by the MM but are easily taken into consideration by the IBM result in a different degree of intraspecific competition of caterpillars on flower buds and within host ant nests. The resulting differences in mortalities of caterpillars lead to erroneous estimates of the extinction risk of a butterfly population living in habitat with low food plant coverage and low abundance in host ant nests. This observation favors the use of an individual based modeling approach over the deterministic approach at least for the management of this threatened butterfly.

  18. Bridging the gap between biologic, individual, and macroenvironmental factors in cancer: a multilevel approach.

    Science.gov (United States)

    Lynch, Shannon M; Rebbeck, Timothy R

    2013-04-01

    To address the complex nature of cancer occurrence and outcomes, approaches have been developed to simultaneously assess the role of two or more etiologic agents within hierarchical levels including the: (i) macroenvironment level (e.g., health care policy, neighborhood, or family structure); (ii) individual level (e.g., behaviors, carcinogenic exposures, socioeconomic factors, and psychologic responses); and (iii) biologic level (e.g., cellular biomarkers and inherited susceptibility variants). Prior multilevel approaches tend to focus on social and environmental hypotheses, and are thus limited in their ability to integrate biologic factors into a multilevel framework. This limited integration may be related to the limited translation of research findings into the clinic. We propose a "Multi-level Biologic and Social Integrative Construct" (MBASIC) to integrate macroenvironment and individual factors with biology. The goal of this framework is to help researchers identify relationships among factors that may be involved in the multifactorial, complex nature of cancer etiology, to aid in appropriate study design, to guide the development of statistical or mechanistic models to study these relationships, and to position the results of these studies for improved intervention, translation, and implementation. MBASIC allows researchers from diverse fields to develop hypotheses of interest under a common conceptual framework, to guide transdisciplinary collaborations, and to optimize the value of multilevel studies for clinical and public health activities.

  19. NEW APPROACH TO TREATMENT OF CHRONIC CONSTIPATION IN CHILDREN

    Directory of Open Access Journals (Sweden)

    A.V. Gorelov

    2009-01-01

    Full Text Available Authors discuss the problem of constipation in children and modern approach to treatment and prophylaxis of this disorder in children of different age group. Stimulating effectiveness of laxative agents and spasmolytics are analyzed. Effectiveness of sodium picosulfate (Guttalax in monotherapy was compared with combined treatment with sodium picosulfate and spasmolytic (Buscopan in children with chronic constipation.Key words: children, chronic constipation, sodium picosulfate, hyoscine butylbromide.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2009;8(1:85-89

  20. Volume measurements of individual muscles in human quadriceps femoris using atlas-based segmentation approaches.

    Science.gov (United States)

    Le Troter, Arnaud; Fouré, Alexandre; Guye, Maxime; Confort-Gouny, Sylviane; Mattei, Jean-Pierre; Gondin, Julien; Salort-Campana, Emmanuelle; Bendahan, David

    2016-04-01

    Atlas-based segmentation is a powerful method for automatic structural segmentation of several sub-structures in many organs. However, such an approach has been very scarcely used in the context of muscle segmentation, and so far no study has assessed such a method for the automatic delineation of individual muscles of the quadriceps femoris (QF). In the present study, we have evaluated a fully automated multi-atlas method and a semi-automated single-atlas method for the segmentation and volume quantification of the four muscles of the QF and for the QF as a whole. The study was conducted in 32 young healthy males, using high-resolution magnetic resonance images (MRI) of the thigh. The multi-atlas-based segmentation method was conducted in 25 subjects. Different non-linear registration approaches based on free-form deformable (FFD) and symmetric diffeomorphic normalization algorithms (SyN) were assessed. Optimal parameters of two fusion methods, i.e., STAPLE and STEPS, were determined on the basis of the highest Dice similarity index (DSI) considering manual segmentation (MSeg) as the ground truth. Validation and reproducibility of this pipeline were determined using another MRI dataset recorded in seven healthy male subjects on the basis of additional metrics such as the muscle volume similarity values, intraclass coefficient, and coefficient of variation. Both non-linear registration methods (FFD and SyN) were also evaluated as part of a single-atlas strategy in order to assess longitudinal muscle volume measurements. The multi- and the single-atlas approaches were compared for the segmentation and the volume quantification of the four muscles of the QF and for the QF as a whole. Considering each muscle of the QF, the DSI of the multi-atlas-based approach was high 0.87 ± 0.11 and the best results were obtained with the combination of two deformation fields resulting from the SyN registration method and the STEPS fusion algorithm. The optimal variables for FFD

  1. High throughput generation and trapping of individual agarose microgel using microfluidic approach

    KAUST Repository

    Shi, Yang; Gao, Xinghua; Chen, Longqing; Zhang, Min; Ma, Jingyun; Zhang, Xixiang; Qin, Jianhua

    2013-01-01

    Microgel is a kind of biocompatible polymeric material, which has been widely used as micro-carriers in materials synthesis, drug delivery and cell biology applications. However, high-throughput generation of individual microgel for on-site analysis in a microdevice still remains a challenge. Here, we presented a simple and stable droplet microfluidic system to realize high-throughput generation and trapping of individual agarose microgels based on the synergetic effect of surface tension and hydrodynamic forces in microchannels and used it for 3-D cell culture in real-time. The established system was mainly composed of droplet generators with flow focusing T-junction and a series of array individual trap structures. The whole process including the independent agarose microgel formation, immobilization in trapping array and gelation in situ via temperature cooling could be realized on the integrated microdevice completely. The performance of this system was demonstrated by successfully encapsulating and culturing adenoid cystic carcinoma (ACCM) cells in the gelated agarose microgels. This established approach is simple, easy to operate, which can not only generate the micro-carriers with different components in parallel, but also monitor the cell behavior in 3D matrix in real-time. It can also be extended for applications in the area of material synthesis and tissue engineering. © 2013 Springer-Verlag Berlin Heidelberg.

  2. High throughput generation and trapping of individual agarose microgel using microfluidic approach

    KAUST Repository

    Shi, Yang

    2013-02-28

    Microgel is a kind of biocompatible polymeric material, which has been widely used as micro-carriers in materials synthesis, drug delivery and cell biology applications. However, high-throughput generation of individual microgel for on-site analysis in a microdevice still remains a challenge. Here, we presented a simple and stable droplet microfluidic system to realize high-throughput generation and trapping of individual agarose microgels based on the synergetic effect of surface tension and hydrodynamic forces in microchannels and used it for 3-D cell culture in real-time. The established system was mainly composed of droplet generators with flow focusing T-junction and a series of array individual trap structures. The whole process including the independent agarose microgel formation, immobilization in trapping array and gelation in situ via temperature cooling could be realized on the integrated microdevice completely. The performance of this system was demonstrated by successfully encapsulating and culturing adenoid cystic carcinoma (ACCM) cells in the gelated agarose microgels. This established approach is simple, easy to operate, which can not only generate the micro-carriers with different components in parallel, but also monitor the cell behavior in 3D matrix in real-time. It can also be extended for applications in the area of material synthesis and tissue engineering. © 2013 Springer-Verlag Berlin Heidelberg.

  3. Neuropsychological assessment of individuals with brain tumor: Comparison of approaches used in the classification of impairment

    Directory of Open Access Journals (Sweden)

    Toni Maree Dwan

    2015-03-01

    Full Text Available Approaches to classifying neuropsychological impairment after brain tumor vary according to testing level (individual tests, domains or global index and source of reference (i.e., norms, controls and premorbid functioning. This study aimed to compare rates of impairment according to different classification approaches. Participants were 44 individuals (57% female with a primary brain tumor diagnosis (mean age = 45.6 years and 44 matched control participants (59% female, mean age = 44.5 years. All participants completed a test battery that assesses premorbid IQ (Wechsler Adult Reading Test, attention/processing speed (Digit Span, Trail Making Test A, memory (Hopkins Verbal Learning Test – Revised, Rey-Osterrieth Complex Figure-recall and executive function (Trail Making Test B, Rey-Osterrieth Complex Figure copy, Controlled Oral Word Association Test. Results indicated that across the different sources of reference, 86-93% of participants were classified as impaired at a test-specific level, 61-73% were classified as impaired at a domain-specific level, and 32-50% were classified as impaired at a global level. Rates of impairment did not significantly differ according to source of reference (p>.05; however, at the individual participant level, classification based on estimated premorbid IQ was often inconsistent with classification based on the norms or controls. Participants with brain tumor performed significantly poorer than matched controls on tests of neuropsychological functioning, including executive function (p=.001 and memory (p.05. These results highlight the need to examine individuals’ performance across a multi-faceted neuropsychological test battery to avoid over- or under-estimation of impairment.

  4. Effectiveness of individualized, integrative outpatient treatment for females with anorexia nervosa and bulimia nervosa.

    Science.gov (United States)

    Freudenberg, Cara; Jones, Rebecca A; Livingston, Genvieve; Goetsch, Virginia; Schaffner, Angela; Buchanan, Linda

    2016-01-01

    The effectiveness of an individualized outpatient program was investigated in the treatment of bulimia nervosa (BN) and anorexia nervosa (AN). Participants included 151 females who received outpatient eating disorder treatment in the partial hospitalization program, the intensive outpatient program, or a combination of the two programs. Outcome measures included the Eating Disorder Inventory (EDI-2), Beck Depression Inventory (BDI-II), frequency of binge eating and purging, and mean body weight. Findings included significant increases in weight for the AN group, reductions in binge eating frequency for the BN group, and reductions in EDI-2 and BDI-II scores and purging frequency for both groups. This study provides preliminary support for the efficacy of a multimodal program for the treatment of both anorexia nervosa and bulimia nervosa.

  5. Investing in Obesity Treatment: Kaiser Permanente's Approach to Chronic Disease Management.

    Science.gov (United States)

    Tsai, Adam G; Histon, Trina; Donahoo, W Troy; Hashmi, Shahid; Murali, Sameer; Latare, Peggy; Oliver, Lajune; Slovis, Jennifer; Grall, Sarah; Fisher, David; Solomon, Loel

    2016-09-01

    Kaiser Permanente, an integrated health care delivery system in the USA, takes a "whole systems" approach to the chronic disease of obesity that begins with efforts to prevent it by modifying the environment in communities and schools. Aggressive case-finding and substantial investment in intensive lifestyle modification programs target individuals at high risk of diabetes and other weight-related conditions. Kaiser Permanente regions are increasingly standardizing their approach when patients with obesity require treatment intensification using medically supervised diets, prescription medication to treat obesity, or weight loss surgery.

  6. Determination of hemispheric emotional valence in individual subjects: A new approach with research and therapeutic implications

    Directory of Open Access Journals (Sweden)

    Polcari Ann

    2007-03-01

    Full Text Available Abstract Background Much has been theorized about the emotional properties of the hemispheres. Our review of the dominant hypotheses put forth by Schore, Joseph, Davidson, and Harmon-Jones on hemispheric emotional valences (HEV shows that none are supported by robust data. Instead, we propose that individual's hemispheres are organized to have differing HEVs that can be lateralized in either direction. Methods Probe auditory evoked potentials (AEP recorded during a neutral and an upsetting memory were used to assess HEV in 28 (20 F right-handed subjects who were either victims of childhood maltreatment (N = 12 or healthy controls. In a sub-population, we determined HEV by emotional response to lateral visual field stimulation (LVFS, in which vision is limited to one, then the other hemifield. We compare a number of morphometric and functional brain measures between individuals who have right-negative versus left-negative HEV. Results Using AEPs to determine HEV, we found 62% of controls and 67% of maltreated subjects had right negative HEV. There was a strong interaction between HEV-laterality and gender, which together accounted for 60% of individual variability in total grey matter volume (GMV. HEV-laterality was associated with differences in hippocampal volume, amygdala/hippocampal ratios, and measures of verbal, visual and global memory. HEV-laterality was associated also with different constellations of symptoms comparing maltreated subjects to controls. Emotional response to LVFS provided a convenient and complementary measure of HEV-laterality that correlated significantly with the HEVs determined by AEPs. Conclusion Our findings suggest that HEV-laterality, like handedness or gender, is an important individual difference with significant implications for brain and behavioral research, and for guiding lateralized treatments such as rTMS.

  7. Determination of hemispheric emotional valence in individual subjects: a new approach with research and therapeutic implications.

    Science.gov (United States)

    Schiffer, Fredric; Teicher, Martin H; Anderson, Carl; Tomoda, Akemi; Polcari, Ann; Navalta, Carryl P; Andersen, Susan L

    2007-03-06

    Much has been theorized about the emotional properties of the hemispheres. Our review of the dominant hypotheses put forth by Schore, Joseph, Davidson, and Harmon-Jones on hemispheric emotional valences (HEV) shows that none are supported by robust data. Instead, we propose that individual's hemispheres are organized to have differing HEVs that can be lateralized in either direction. Probe auditory evoked potentials (AEP) recorded during a neutral and an upsetting memory were used to assess HEV in 28 (20 F) right-handed subjects who were either victims of childhood maltreatment (N = 12) or healthy controls. In a sub-population, we determined HEV by emotional response to lateral visual field stimulation (LVFS), in which vision is limited to one, then the other hemifield. We compare a number of morphometric and functional brain measures between individuals who have right-negative versus left-negative HEV. Using AEPs to determine HEV, we found 62% of controls and 67% of maltreated subjects had right negative HEV. There was a strong interaction between HEV-laterality and gender, which together accounted for 60% of individual variability in total grey matter volume (GMV). HEV-laterality was associated with differences in hippocampal volume, amygdala/hippocampal ratios, and measures of verbal, visual and global memory. HEV-laterality was associated also with different constellations of symptoms comparing maltreated subjects to controls. Emotional response to LVFS provided a convenient and complementary measure of HEV-laterality that correlated significantly with the HEVs determined by AEPs. Our findings suggest that HEV-laterality, like handedness or gender, is an important individual difference with significant implications for brain and behavioral research, and for guiding lateralized treatments such as rTMS.

  8. Cross-sex hormonal treatment and body uneasiness in individuals with gender dysphoria.

    Science.gov (United States)

    Fisher, Alessandra D; Castellini, Giovanni; Bandini, Elisa; Casale, Helen; Fanni, Egidia; Benni, Laura; Ferruccio, Naika; Meriggiola, Maria Cristina; Manieri, Chiara; Gualerzi, Anna; Jannini, Emmanuele; Oppo, Alessandro; Ricca, Valdo; Maggi, Mario; Rellini, Alessandra H

    2014-03-01

    Cross-sex hormonal treatment (CHT) used for gender dysphoria (GD) could by itself affect well-being without the use of genital surgery; however, to date, there is a paucity of studies investigating the effects of CHT alone. This study aimed to assess differences in body uneasiness and psychiatric symptoms between GD clients taking CHT and those not taking hormones (no CHT). A second aim was to assess whether length of CHT treatment and daily dose provided an explanation for levels of body uneasiness and psychiatric symptoms. A consecutive series of 125 subjects meeting the criteria for GD who not had genital reassignment surgery were considered. Subjects were asked to complete the Body Uneasiness Test (BUT) to explore different areas of body-related psychopathology and the Symptom Checklist-90 Revised (SCL-90-R) to measure psychological state. In addition, data on daily hormone dose and length of hormonal treatment (androgens, estrogens, and/or antiandrogens) were collected through an analysis of medical records. Among the male-to-female (MtF) individuals, those using CHT reported less body uneasiness compared with individuals in the no-CHT group. No significant differences were observed between CHT and no-CHT groups in the female-to-male (FtM) sample. Also, no significant differences in SCL score were observed with regard to gender (MtF vs. FtM), hormone treatment (CHT vs. no-CHT), or the interaction of these two variables. Moreover, a two-step hierarchical regression showed that cumulative dose of estradiol (daily dose of estradiol times days of treatment) and cumulative dose of androgen blockers (daily dose of androgen blockers times days of treatment) predicted BUT score even after controlling for age, gender role, cosmetic surgery, and BMI. The differences observed between MtF and FtM individuals suggest that body-related uneasiness associated with GD may be effectively diminished with the administration of CHT even without the use of genital surgery for Mt

  9. New approaches to addiction treatment based on learning and memory.

    Science.gov (United States)

    Kiefer, Falk; Dinter, Christina

    2013-01-01

    Preclinical studies suggest that physiological learning processes are similar to changes observed in addicts at the molecular, neuronal, and structural levels. Based on the importance of classical and instrumental conditioning in the development and maintenance of addictive disorders, many have suggested cue-exposure-based extinction training of conditioned, drug-related responses as a potential new treatment of addiction. It may also be possible to facilitate this extinction training with pharmacological compounds that strengthen memory consolidation during cue exposure. Another potential therapeutic intervention would be based on the so-called reconsolidation theory. According to this hypothesis, already-consolidated memories return to a labile state when reactivated, allowing them to undergo another phase of consolidation-reconsolidation, which can be pharmacologically manipulated. These approaches suggest that the extinction of drug-related memories may represent a viable treatment strategy in the future treatment of addiction.

  10. Evidence to practice: treatment of anxiety in individuals with autism spectrum disorders

    Directory of Open Access Journals (Sweden)

    Russell Lang

    2011-01-01

    Full Text Available Russell Lang, Richard Mahoney, Farah El Zein, Elizabeth Delaune, Megan AmidonTexas State University-San Marcos, TX, USADate of preparation: 23rd December 2010 Conflict of interest: None declaredClinical question: What treatment improves social interactions and reduces reports of anxiety symptoms in individuals with autism spectrum disorders (ASD and a co-occurring anxiety disorder? Results: Systematic reviews and randomized clinical trials suggest that cognitive behavior therapy in tandem with direct instruction of social skills using applied behavior analysis intervention components may be effective for treating anxiety in individuals with high functioning ASD. For individuals with ASD, an anxiety disorder, and an intellectual disability, systematic desensitization may be effective.Implementation: Intervention should emphasize teaching social skills. Reinforcers (ie, rewards based upon the client's interests should be used to encourage participation in therapy. Treatment should incorporate visual aides and family involvement. Intervention components involving abstract concepts, visualization, and discussions of emotions are less useful given difficulties in abstract reasoning and communication inherent to ASD.Keywords: autism, ASD, Asperger's, anxiety, cognitive behavior therapy, applied behavior analysis

  11. Treatment decision-making among Canadian youth with severe haemophilia: a qualitative approach.

    Science.gov (United States)

    Lane, S J; Walker, I; Chan, A K; Heddle, N M; Poon, M-C; Minuk, L; Jardine, L; Arnold, E; Sholapur, N; Webert, K E

    2015-03-01

    The first generation of young men using primary prophylaxis is coming of age. Important questions regarding the management of severe haemophilia with prophylaxis persist: Can prophylaxis be stopped? At what age? To what effect? Can the regimen be individualized? The reasons why some individuals discontinue or poorly comply with prophylaxis are not well understood. These issues have been explored using predominantly quantitative research approaches, yielding little insight into treatment decision-making from the perspectives of persons with haemophilia (PWH). Positioning the PWH as a source of expertise about their condition and its management, we undertook a qualitative study: (i) to explore and understand the lived experience of young men with severe haemophilia A or B and (ii) to identify the factors and inter-relationships between factors that affect young men's treatment decision-making. This manuscript reports primarily on the second objective. A modified Straussian, grounded theory methodology was used for data collection (interviews) and preliminary analysis. The study sample, youth aged 15-29, with severe haemophilia A or B, was chosen selectively and recruited through three Canadian Haemophilia Treatment Centres. We found treatment decision-making to be multi-factorial and used the Framework method to analyze the inter-relationships between factors. A typology of four distinct approaches to treatment was identified: lifestyle routine prophylaxis, situational prophylaxis, strict routine prophylaxis and no prophylaxis. Standardized treatment definitions (i.e.: 'primary' and 'secondary', 'prophylaxis') do not adequately describe the ways participants treat. Naming the variation of approaches documented in this study can improve PWH/provider communication, treatment planning and education. © 2014 John Wiley & Sons Ltd.

  12. Acoustic Wave Treatment For Cellulite—A New Approach

    Science.gov (United States)

    Russe-Wilflingseder, Katharina; Russe, Elisabeth

    2010-05-01

    Background and Objectives: Cellulite is a biological caused modification of the female connective tissue. In extracorporeal shockwave therapy (ESWT) pulses are penetrating into the tissue without causing a thermal effect or micro lesions, but leading to a stimulation of tissue metabolism and blood circulation, inducing a natural repair process with cell activation and stem cells proliferation. Recently ESWT treatment showed evidence of remodelling collagen within the dermis and of stimulating microcirculation in fatty tissue. Study Design and Methods: The study was designed to assess acoustic wave treatment for cellulite by comparison treated vs. untreated side (upper-leg and buttock). Each individual served as its own control. 11 females with a BMI less then 30 and an age over 18 years were included. 6 treatments were given weekly with radial acoustic waves. Documentation was done before and 1, 4, 12 weeks after last treatment by standardized photo documentation, relaxed and with muscle contraction, measurement of body weight and circumference of the thigh, pinch test, and evaluation of hormonal status and lifestyle. The efficacy of AWT/EPAT was evaluated before and 1, 4, 12 weeks after last treatment. Patients rated the improvement of cellulite, overall satisfaction and acceptance. The therapist assessed improvement of cellulite, side effects and photo documentation treated vs. untreated side, before vs. after treatment. The blinded investigator evaluated the results using photo documentation right vs. left leg, before vs. after treatment in a frontal, lateral and dorsal view, relaxed and with muscle contraction. Results: The improvement of cellulite at the treated side was rated by patients with 27,3% at week 4 and 12, by the therapist with 34,1% at week 4 and 31,2% at week 12 after the last treatment The blinded investigator could verify an improvement of cellulite in an increasing number of patients with increasing time interval after treatment. No side

  13. Integrated ecotechnology approach towards treatment of complex wastewater with simultaneous bioenergy production.

    Science.gov (United States)

    Hemalatha, Manupati; Sravan, J Shanthi; Yeruva, Dileep Kumar; Venkata Mohan, S

    2017-10-01

    Sequential integration of three stage diverse biological processes was studied by exploiting the individual process advantage towards enhanced treatment of complex chemical based wastewater. A successful attempt to integrate sequence batch reactor (SBR) with bioelectrochemical treatment (BET) and finally with microalgae treatment was studied. The sequential integration has showed individual substrate degradation (COD) of 55% in SBR, 49% in BET and 56% in microalgae, accounting for a consolidated treatment efficiency of 90%. Nitrates removal efficiency of 25% was observed in SBR, 31% in BET and 44% in microalgae, with a total efficiency of 72%. The SBR treated effluents fed to BET with the electrode intervention showed TDS removal. BET exhibited relatively higher process performance than SBR. The integration approach significantly overcame the individual process limitations along with value addition as biomass (1.75g/L), carbohydrates (640mg/g), lipids (15%) and bioelectricity. The study resulted in providing a strategy of combining SBR as pretreatment step to BET process and finally polishing with microalgae cultivation achieving the benefits of enhanced wastewater treatment along with value addition. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Radioembolization of hepatocarcinoma with (90)Y glass microspheres: development of an individualized treatment planning strategy based on dosimetry and radiobiology.

    Science.gov (United States)

    Chiesa, C; Mira, M; Maccauro, M; Spreafico, C; Romito, R; Morosi, C; Camerini, T; Carrara, M; Pellizzari, S; Negri, A; Aliberti, G; Sposito, C; Bhoori, S; Facciorusso, A; Civelli, E; Lanocita, R; Padovano, B; Migliorisi, M; De Nile, M C; Seregni, E; Marchianò, A; Crippa, F; Mazzaferro, V

    2015-10-01

    The aim of this study was to optimize the dosimetric approach and to review the absorbed doses delivered, taking into account radiobiology, in order to identify the optimal methodology for an individualized treatment planning strategy based on (99m)Tc-macroaggregated albumin (MAA) single photon emission computed tomography (SPECT) images. We performed retrospective dosimetry of the standard TheraSphere® treatment on 52 intermediate (n = 17) and advanced (i.e. portal vein thrombosis, n = 35) hepatocarcinoma patients with tumour burden 10 cc). Apparent radiosensitivity values from TCP were around 0.003/Gy, a factor of 3-5 lower than in EBRT, as found by other authors. The dose-rate effect was negligible: a purely linear model can be applied. Toxicity incidence was significantly larger for Child B7 patients (89 vs 14%, p < 0.0001), who were therefore excluded from dose-toxicity analysis. Child A toxic vs non-toxic treatments were significantly separated in terms of dose averaged on whole non-tumoural parenchyma (including non-irradiated regions) with AUC from 0.73 to 0.94. TD50 was ≈ 100 Gy. No methodology was superior to parenchyma mean dose, which therefore can be used for planning, with a limit of TD15 ≈ 75 Gy. A dosimetric treatment planning criterion for Child A patients without complete obstruction of the portal vein was developed.

  15. Meta-STEPP: subpopulation treatment effect pattern plot for individual patient data meta-analysis.

    Science.gov (United States)

    Wang, Xin Victoria; Cole, Bernard; Bonetti, Marco; Gelber, Richard D

    2016-09-20

    We have developed a method, called Meta-STEPP (subpopulation treatment effect pattern plot for meta-analysis), to explore treatment effect heterogeneity across covariate values in the meta-analysis setting for time-to-event data when the covariate of interest is continuous. Meta-STEPP forms overlapping subpopulations from individual patient data containing similar numbers of events with increasing covariate values, estimates subpopulation treatment effects using standard fixed-effects meta-analysis methodology, displays the estimated subpopulation treatment effect as a function of the covariate values, and provides a statistical test to detect possibly complex treatment-covariate interactions. Simulation studies show that this test has adequate type-I error rate recovery as well as power when reasonable window sizes are chosen. When applied to eight breast cancer trials, Meta-STEPP suggests that chemotherapy is less effective for tumors with high estrogen receptor expression compared with those with low expression. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  16. A muscle-driven approach to restore stepping with an exoskeleton for individuals with paraplegia.

    Science.gov (United States)

    Chang, Sarah R; Nandor, Mark J; Li, Lu; Kobetic, Rudi; Foglyano, Kevin M; Schnellenberger, John R; Audu, Musa L; Pinault, Gilles; Quinn, Roger D; Triolo, Ronald J

    2017-05-30

    Functional neuromuscular stimulation, lower limb orthosis, powered lower limb exoskeleton, and hybrid neuroprosthesis (HNP) technologies can restore stepping in individuals with paraplegia due to spinal cord injury (SCI). However, a self-contained muscle-driven controllable exoskeleton approach based on an implanted neural stimulator to restore walking has not been previously demonstrated, which could potentially result in system use outside the laboratory and viable for long term use or clinical testing. In this work, we designed and evaluated an untethered muscle-driven controllable exoskeleton to restore stepping in three individuals with paralysis from SCI. The self-contained HNP combined neural stimulation to activate the paralyzed muscles and generate joint torques for limb movements with a controllable lower limb exoskeleton to stabilize and support the user. An onboard controller processed exoskeleton sensor signals, determined appropriate exoskeletal constraints and stimulation commands for a finite state machine (FSM), and transmitted data over Bluetooth to an off-board computer for real-time monitoring and data recording. The FSM coordinated stimulation and exoskeletal constraints to enable functions, selected with a wireless finger switch user interface, for standing up, standing, stepping, or sitting down. In the stepping function, the FSM used a sensor-based gait event detector to determine transitions between gait phases of double stance, early swing, late swing, and weight acceptance. The HNP restored stepping in three individuals with motor complete paralysis due to SCI. The controller appropriately coordinated stimulation and exoskeletal constraints using the sensor-based FSM for subjects with different stimulation systems. The average range of motion at hip and knee joints during walking were 8.5°-20.8° and 14.0°-43.6°, respectively. Walking speeds varied from 0.03 to 0.06 m/s, and cadences from 10 to 20 steps/min. A self-contained muscle

  17. Individual perception and cultural development: Foucault's 1954 approach to mental illness and its history.

    Science.gov (United States)

    Joranger, Line

    2016-02-01

    In his 1954 book Mental Illness and Personality Foucault combines the subjective experience of the mentally ill person with a sociocultural historical approach to mental illness and suggests that there exists a reciprocal connection between individual perception and sociocultural development. This article examines the ramifications of these connections in Foucault's 1954 works and the connection with his later historical works. The article also examines the similarities between Foucault's 1954 thoughts and contemporary intellectual thought, such as those outlined in Maurice Merleau-Ponty's existential phenomenology and in Gaston Bachelard and Georges Canguilhem's historical epistemology. In sum, my study shows that Foucault's historical analysis began long before his 1961 dissertation History of Madness. It also shows that, more than announcing the "death" of the subject, Foucault's historical analysis may have contributed to saving it. (c) 2016 APA, all rights reserved).

  18. Part-time sick leave as a treatment method for individuals with musculoskeletal disorders.

    Science.gov (United States)

    Andrén, Daniela; Svensson, Mikael

    2012-09-01

    There is increasing evidence that staying active is an important part of a recovery process for individuals on sick leave due to musculoskeletal disorders (MSDs). It has been suggested that using part-time sick-leave rather than full-time sick leave will enhance the possibility of full recovery to the workforce, and several countries actively favor this policy. The aim of this paper is to examine if it is beneficial for individuals on sick leave due to MSDs to be on part-time sick leave compared to full-time sick leave. A sample of 1,170 employees from the RFV-LS (register) database of the Social Insurance Agency of Sweden is used. The effect of being on part-time sick leave compared to full-time sick leave is estimated for the probability of returning to work with full recovery of lost work capacity. A two-stage recursive bivariate probit model is used to deal with the endogeneity problem. The results indicate that employees assigned to part-time sick leave do recover to full work capacity with a higher probability than those assigned to full-time sick leave. The average treatment effect of part-time sick leave is 25 percentage points. Considering that part-time sick leave may also be less expensive than assigning individuals to full-time sick leave, this would imply efficiency improvements from assigning individuals, when possible, to part-time sick leave.

  19. Understanding the role of individual consumer-provider relationships within assertive community treatment.

    Science.gov (United States)

    Stanhope, Victoria; Matejkowski, Jason

    2010-08-01

    The widespread adoption of assertive community treatment has resulted in a shift from an individual model to a team model of case management. The shift has had implications for individual relationships between case managers and consumers, but still little is known about how these relationships develop in teams. This exploratory mixed methods study looked at how case managers and consumers negotiate individual relationships within a team model. Quantitative methods identified high and low service intensity relationships between consumers and case managers and qualitative methods explored and compared these relationships. Consumers in high service intensity relationships described a preference for certain case managers and the burden of working with multiple people. Case managers invested high service intensity relationships with special therapeutic value, articulated the challenges of coordinating care across the team, and utilized team limit setting techniques. In contrast, low service intensity relationships were more likely to reflect integration with the entire team. Findings suggest that teams need to consider how individual relationships enhance care for their consumers and how to nurture these relationships while maintaining the support necessary for case managers and consumers.

  20. Forensic individual age estimation with DNA: From initial approaches to methylation tests.

    Science.gov (United States)

    Freire-Aradas, A; Phillips, C; Lareu, M V

    2017-07-01

    Individual age estimation is a key factor in forensic science analysis that can provide very useful information applicable to criminal, legal, and anthropological investigations. Forensic age inference was initially based on morphological inspection or radiography and only later began to adopt molecular approaches. However, a lack of accuracy or technical problems hampered the introduction of these DNA-based methodologies in casework analysis. A turning point occurred when the epigenetic signature of DNA methylation was observed to gradually change during an individual´s lifespan. In the last four years, the number of publications reporting DNA methylation age-correlated changes has gradually risen and the forensic community now has a range of age methylation tests applicable to forensic casework. Most forensic age predictor models have been developed based on blood DNA samples, but additional tissues are now also being explored. This review assesses the most widely adopted genes harboring methylation sites, detection technologies, statistical age-predictive analyses, and potential causes of variation in age estimates. Despite the need for further work to improve predictive accuracy and establishing a broader range of tissues for which tests can analyze the most appropriate methylation sites, several forensic age predictors have now been reported that provide consistency in their prediction accuracies (predictive error of ±4 years); this makes them compelling tools with the potential to contribute key information to help guide criminal investigations. Copyright © 2017 Central Police University.

  1. The need for affect: individual differences in the motivation to approach or avoid emotions.

    Science.gov (United States)

    Maio, G R; Esses, V M

    2001-08-01

    The present research developed and tested a new individual-difference measure of the need for affect, which is the motivation to approach or avoid emotion-inducing situations. The first phase of the research developed the need for affect scale. The second phase revealed that the need for affect is related to a number of individual differences in cognitive processes (e.g., need for cognition, need for closure), emotional processes (e.g., affect intensity, repression-sensitization), behavioral inhibition and activation (e.g., sensation seeking), and aspects of personality (Big Five dimensions) in the expected directions, while not being redundant with them. The third phase of the research indicated that, compared to people low in the need for affect, people high in the need for affect are more likely to (a) possess extreme attitudes across a variety of issues, (b) choose to view emotional movies, and (c) become involved in an emotion-inducing event (the death of Princess Diana). Overall, the results indicate that the need for affect is an important construct in understanding emotion-related processes.

  2. Contemporary diagnostic imaging approaches in treatment of urolithiasis

    International Nuclear Information System (INIS)

    Velichkov, B.; Naoumov, N.

    2004-01-01

    Based on an extensive review of the literature and on their own clinical experience, authors attempts to present clear guidelines for the management of urolithiasis. Ninety-eight per cent of stones can be successfully fragmented by the application of shock-waves, but the ability of the kidney and ureter to clear the resulting fragments is far more important in terms of successful treatment outcome. Extracorporeal shock-waves lithotripsy (ESWL) is a safe procedure for the treatment of urolithiasis; nevertheless some problems remain. In ureteric stones, ureteroscopy (rigid or flexible device) allows a rate of stone-free patients better than ESWL. For treatment of large staghorn calculi combined approach of Percutaneous Nephrolithotripsy (PCNL) and ESWL is preferred. For stones located at lower calyx, the stone-free rate in patients treated by ESWL fell to 50%, when unfavourable anatomy is present. Ultimate goal of treating stones by whatever means is to get the patient stone-free and prevent recurrence. The good technique of performing and interpretation of diagnostic imaging modalities is of critical importance in terms of diagnosing, successful treatment and follow up of results of treatment of urolithiasis

  3. Determining the optimal approach to identifying individuals with chronic obstructive pulmonary disease: The DOC study.

    Science.gov (United States)

    Ronaldson, Sarah J; Dyson, Lisa; Clark, Laura; Hewitt, Catherine E; Torgerson, David J; Cooper, Brendan G; Kearney, Matt; Laughey, William; Raghunath, Raghu; Steele, Lisa; Rhodes, Rebecca; Adamson, Joy

    2018-06-01

    Early identification of chronic obstructive pulmonary disease (COPD) results in patients receiving appropriate management for their condition at an earlier stage in their disease. The determining the optimal approach to identifying individuals with chronic obstructive pulmonary disease (DOC) study was a case-finding study to enhance early identification of COPD in primary care, which evaluated the diagnostic accuracy of a series of simple lung function tests and symptom-based case-finding questionnaires. Current smokers aged 35 or more were invited to undertake a series of case-finding tools, which comprised lung function tests (specifically, spirometry, microspirometry, peak flow meter, and WheezoMeter) and several case-finding questionnaires. The effectiveness of these tests, individually or in combination, to identify small airways obstruction was evaluated against the gold standard of spirometry, with the quality of spirometry tests assessed by independent overreaders. The study was conducted with general practices in the Yorkshire and Humberside area, in the UK. Six hundred eighty-one individuals met the inclusion criteria, with 444 participants completing their study appointments. A total of 216 (49%) with good-quality spirometry readings were included in the analysis. The most effective case-finding tools were found to be the peak flow meter alone, the peak flow meter plus WheezoMeter, and microspirometry alone. In addition to the main analysis, where the severity of airflow obstruction was based on fixed ratios and percent of predicted values, sensitivity analyses were conducted by using lower limit of normal values. This research informs the choice of test for COPD identification; case-finding by use of the peak flow meter or microspirometer could be used routinely in primary care for suspected COPD patients. Only those testing positive to these tests would move on to full spirometry, thereby reducing unnecessary spirometric testing. © 2018 John Wiley

  4. Supporting culturally and linguistically diverse children with speech, language and communication needs: Overarching principles, individual approaches.

    Science.gov (United States)

    Verdon, Sarah; McLeod, Sharynne; Wong, Sandie

    2015-01-01

    Speech-language pathologists (SLPs) are working with an increasing number of families from culturally and linguistically diverse backgrounds as the world's population continues to become more internationally mobile. The heterogeneity of these diverse populations makes it impossible to identify and document a one size fits all strategy for working with culturally and linguistically diverse families. This paper explores approaches to practice by SLPs identified as specialising in multilingual and multicultural practice in culturally and linguistically diverse contexts from around the world. Data were obtained from ethnographic observation of 14 sites in 5 countries on 4 continents. The sites included hospital settings, university clinics, school-based settings, private practices and Indigenous community-based services. There were 652 individual artefacts collected from the sites which included interview transcripts, photographs, videos, narrative reflections, informal and formal field notes. The data were analysed using Cultural-Historical Activity Theory (Engeström, 1987). From the analysis six overarching Principles of Culturally Competent Practice (PCCP) were identified. These were: (1) identification of culturally appropriate and mutually motivating therapy goals, (2) knowledge of languages and culture, (3) use of culturally appropriate resources, (4) consideration of the cultural, social and political context, (5) consultation with families and communities, and (6) collaboration between professionals. These overarching principles align with the six position statements developed by the International Expert Panel on Multilingual Children's Speech (2012) which aim to enhance the cultural competence of speech pathologists and their practice. The international examples provided in the current study demonstrate the individualised ways that these overarching principles are enacted in a range of different organisational, social, cultural and political contexts

  5. Association between community pharmacy loyalty and persistence and implementation of antipsychotic treatment among individuals with schizophrenia.

    Science.gov (United States)

    Zongo, Frank E; Moisan, Jocelyne; Grégoire, Jean-Pierre; Lesage, Alain; Dossa, Anara Richi; Lauzier, Sophie

    2018-01-01

    Non-adherence is a major obstacle to optimal treatment of schizophrenia. Community pharmacists are in a key position to detect non-adherence and put in place interventions. Their role is likely to be more efficient when individuals are loyal to a single pharmacy. To assess the association between the level of community pharmacy loyalty and persistence with and implementation of antipsychotic drug treatment among individuals with schizophrenia. A cohort study using databases from the Quebec health insurance board (Canada) was conducted among new antipsychotic users insured by Quebec's public drug plan. Level of community pharmacy loyalty was assessed as the number of pharmacies visited in the year after antipsychotics initiation. Persistence was defined as having an antipsychotic supply in the user's possession on the 730 th day after its initiation and implementation as having antipsychotics in the user's possession for ≥80% of the days in the second year after antipsychotics initiation (among persistent only). Generalized linear models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (95%CI). 6,251 individuals were included in the cohort and 54.1% had their drug prescriptions filled in >1 pharmacy. When compared to those who had their prescriptions filled in a single pharmacy, those who had their prescriptions filled in ≥4 different pharmacies were 22% more likely to be non-persistent (aPR = 1.22; 95%CI = 1.10-1.37) and 49% more likely to have an antipsychotic for loyalty in the context of severe mental illness indicates that this healthcare organisation factor might be associated with antipsychotics persistence and implementation. Identification of individuals with low community pharmacy loyalty and initiatives to optimize community pharmacy loyalty could contribute to enhanced persistence and implementation. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Skin care education and individual counselling versus treatment as usual in healthcare workers with hand eczema

    DEFF Research Database (Denmark)

    Ibler, K.S.; Jemec, G.B.E.; Thomsen, S.F.

    2012-01-01

    Objective: To evaluate the effect of a secondary prevention programme with education on skin care and individual counselling versus treatment as usual in healthcare workers with hand eczema. Design: Randomised, observer blinded parallel group superiority clinical trial. Setting: Three hospitals...... in Denmark. Participants: 255 healthcare workers with self reported hand eczema within the past year randomised centrally and stratified by profession, severity of eczema, and hospital. 123 were allocated to the intervention group and 132 to the control group. Interventions: Education in skin care...

  7. Current pharmacotherapeutic approaches for the treatment of Tourette syndrome.

    Science.gov (United States)

    Egolf, A; Coffey, B J

    2014-02-01

    Tourette syndrome is a childhood onset neurodevelopmental disorder characterized by multiple motor and vocal tics. Although many youth experience attenuation or even remission of tics in adolescence and young adulthood, some individuals experience persistent tics which can be debilitating or disabling. The majority of patients also have one or more psychiatric comorbid disorders, such as attention deficit hyperactivity disorder and/or obsessive-compulsive disorder. Treatment is multimodal, including both pharmacotherapy and cognitive behavioral treatment, and requires disentanglement of tics and the comorbid symptoms. Although the only two formally approved medications in the United States are haloperidol and pimozide, these treatments are generally not used as first-line interventions due to their significant potential for adverse effects. The α-adrenoceptor agonists guanfacine and clonidine have an established evidence base for both efficacy and tolerability, and are usually recommended as initial pharmacotherapy. Atypical neuroleptics, such as aripiprazole or risperidone, are typically used if the α-adrenoceptor agonists are ineffective or intolerable. However, many other pharmacological agents reviewed in this manuscript have been studied as treatment alternatives. Copyright 2014 Prous Science, S.A.U. or its licensors. All rights reserved.

  8. Oral nanomedicine approaches for the treatment of psychiatric illnesses.

    Science.gov (United States)

    Dening, Tahnee J; Rao, Shasha; Thomas, Nicky; Prestidge, Clive A

    2016-02-10

    Psychiatric illnesses are a leading cause of disability and morbidity globally. However, the preferred orally dosed pharmacological treatment options available for depression, anxiety and schizophrenia are often limited by factors such as low drug aqueous solubility, food effects, high hepatic first-pass metabolism effects and short half-lives. Furthermore, the discovery and development of more effective psychotropic agents has stalled in recent times, with the majority of new drugs reaching the market offering similar efficacy, but suffering from the same oral delivery concerns. As such, the application of nanomedicine formulation approaches to currently available drugs is a viable option for optimizing oral drug delivery and maximizing treatment efficacy. This review focuses on the various delivery challenges encountered by psychotropic drugs, and the ability of nanomedicine formulation strategies to overcome these. Specifically, we critically review proof of concept in vitro and in vivo studies of nanoemulsions/microemulsions, solid lipid nanoparticles, dendrimers, polymeric micelles, nanoparticles of biodegradable polymers and nanosuspensions, and provide new insight into the various mechanisms for improved drug performance. The advantages and limitations of current oral nanomedicine approaches for psychotropic drugs are discussed, which will provide guidance for future research directions and assist in fostering the translation of such delivery systems to the clinical setting. Accordingly, emphasis has been placed on correlating the in vitro/in vivo performance of these nanomedicine approaches with their potential clinical outcomes and benefits for patients. Copyright © 2016 Elsevier B.V. All rights reserved.

  9. Post-fundoplication symptoms and complications: Diagnostic approach and treatment.

    Science.gov (United States)

    Sobrino-Cossío, S; Soto-Pérez, J C; Coss-Adame, E; Mateos-Pérez, G; Teramoto Matsubara, O; Tawil, J; Vallejo-Soto, M; Sáez-Ríos, A; Vargas-Romero, J A; Zárate-Guzmán, A M; Galvis-García, E S; Morales-Arámbula, M; Quiroz-Castro, O; Carrasco-Rojas, A; Remes-Troche, J M

    Laparoscopic Nissen fundoplication is currently considered the surgical treatment of choice for gastroesophageal reflux disease (GERD) and its long-term effectiveness is above 90%. Adequate patient selection and the experience of the surgeon are among the predictive factors of good clinical response. However, there can be new, persistent, and recurrent symptoms after the antireflux procedure in up to 30% of the cases. There are numerous causes, but in general, they are due to one or more anatomic abnormalities and esophageal and gastric function alterations. When there are persistent symptoms after the surgical procedure, the surgery should be described as "failed". In the case of a patient that initially manifests symptom control, but the symptoms then reappear, the term "dysfunction" could be used. When symptoms worsen, or when symptoms or clinical situations appear that did not exist before the surgery, this should be considered a "complication". Postoperative dysphagia and dyspeptic symptoms are very frequent and require an integrated approach to determine the best possible treatment. This review details the pathophysiologic aspects, diagnostic approach, and treatment of the symptoms and complications after fundoplication for the management of GERD. Copyright © 2016 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

  10. Nutrient supplementation approaches in the treatment of ADHD.

    Science.gov (United States)

    Rucklidge, Julia J; Johnstone, Jeanette; Kaplan, Bonnie J

    2009-04-01

    Attention-deficit/hyperactivity disorder (ADHD) is a chronic, debilitating psychiatric illness that often co-occurs with other common psychiatric problems. Although empirical evidence supports pharmacological and behavioral treatments, side effects, concerns regarding safety and fears about long-term use all contribute to families searching for alternative methods of treating the symptoms of ADHD. This review presents the published evidence on supplementation, including single ingredients (e.g., minerals, vitamins, amino acids and essential fatty acids), botanicals and multi-ingredient formulas in the treatment of ADHD symptoms. In most cases, evidence is sparse, mixed and lacking information. Of those supplements where we found published studies, the evidence is best for zinc (two positive randomized, controlled trials); there is mixed evidence for carnitine, pycnogenol and essential fatty acids, and more research is needed before drawing conclusions about vitamins, magnesium, iron, SAM-e, tryptophan and Ginkgo biloba with ginseng. To date, there is no evidence to support the use of St John's wort, tyrosine or phenylalanine in the treatment of ADHD symptoms. Multi-ingredient approaches are an intriguing yet under-researched area; we discuss the benefits of this approach considering the heterogeneous nature of ADHD.

  11. An approach to combining parallel and cross-over trials with and without run-in periods using individual patient data.

    Science.gov (United States)

    Tvete, Ingunn F; Olsen, Inge C; Fagerland, Morten W; Meland, Nils; Aldrin, Magne; Smerud, Knut T; Holden, Lars

    2012-04-01

    In active run-in trials, where patients may be excluded after a run-in period based on their response to the treatment, it is implicitly assumed that patients have individual treatment effects. If individual patient data are available, active run-in trials can be modelled using patient-specific random effects. With more than one trial on the same medication available, one can obtain a more precise overall treatment effect estimate. We present a model for joint analysis of a two-sequence, four-period cross-over trial (AABB/BBAA) and a three-sequence, two-period active run-in trial (AB/AA/A), where the aim is to investigate the effect of a new treatment for patients with pain due to osteoarthritis. Our approach enables us to separately estimate the direct treatment effect for all patients, for the patients excluded after the active run-in trial prior to randomisation, and for the patients who completed the active run-in trial. A similar model approach can be used to analyse other types of run-in trials, but this depends on the data and type of other trials available. We assume equality of the various carry-over effects over time. The proposed approach is flexible and can be modified to handle other designs. Our results should be encouraging for those responsible for planning cost-efficient clinical development programmes.

  12. Predicting optimal outcomes in cognitive therapy or interpersonal psychotherapy for depressed individuals using the personalized advantage index approach

    NARCIS (Netherlands)

    Huibers, M.J.H.; Cohen, Z.D.; Lemmens, L.H.J.M.; Arntz, A.; Peeters, F.P.M.L.; Cuijpers, P.; DeRubeis, R.J.

    2015-01-01

    Introduction: Although psychotherapies for depression produce equivalent outcomes, individual patients respond differently to different therapies. Predictors of outcome have been identified in the context of randomized trials, but this information has not been used to predict which treatment works

  13. Predicting optimal outcomes in cognitive therapy or interpersonal psychotherapy for depressed individuals using the personalized advantage index approach

    NARCIS (Netherlands)

    Huibers, M.J.H.; Cohen, Z.D.; Lemmens, L.H.J.M.; Arntz, A.; Peeters, F.P.M.L.; Cuijpers, P.; DeRubeis, R.J.

    2015-01-01

    Introduction Although psychotherapies for depression produce equivalent outcomes, individual patients respond differently to different therapies. Predictors of outcome have been identified in the context of randomized trials, but this information has not been used to predict which treatment works

  14. TOBACCO SMOKING AND LUNG DISEASES: EFFICIENCY OF TREATMENT APPROACHES

    Directory of Open Access Journals (Sweden)

    V. A. Nikitin

    2016-01-01

    Full Text Available The review presents data on the significant increase of tobacco smoking prevalence and its harmful effect on the development and course of chronic respiratory diseases: tuberculosis, pneumonia, lung cancer, chronic obstructive pulmonary disease and asthma. Negative consequences of tobacco smoking are caused by chronic intoxication of the host by the components of tobacco smoke providing impact on various organs and cells of the host, thus causing a big variety of diseases. Both active and passive smoking deteriorates their course and increase the risk of exacerbation, hinders taking control over the disease and interferes with adequate response to drugs.Current approaches to treatment of tobacco addiction have been presented. There are several ways to overcome nicotine addiction – drug therapy and the other forms of therapy. Integrated approach to tobacco smoking management allows achieving success in 30% of cases within short period of time with continuous and quality remissions. 

  15. Metal chaperones: a holistic approach to the treatment of AD

    Directory of Open Access Journals (Sweden)

    Paul Anthony Adlard

    2012-03-01

    Full Text Available As the burden of proof for the role of metal ion dysregulation in the pathogenesis of multiple CNS disorders grows, it has become important to more precisely identify and differentiate the biological effects of various pharmacological modulators of metal ion homeostasis. This is particularly evident in disorders such as Alzheimer’s disease, where the use of metal chaperones (that transport metals, as opposed to chelators (which exclude metals from biological interactions, may prove to be the first truly disease modifying approach for this condition. The purpose of this mini-review is to highlight the emerging notion that metal chaperones, such as PBT2 (Prana Biotechnology, modulate a variety of critical pathways affecting key aspects of the AD cascade to provide a more holistic approach to the treatment of this disease.

  16. Nalmefene: a new approach to the treatment of alcohol dependence

    Directory of Open Access Journals (Sweden)

    Paille F

    2014-08-01

    Full Text Available François Paille, Hervé Martini Department of Addiction Treatment, University Hospital, Vandœuvre-lès-Nancy, France Abstract: Reduction of alcohol consumption is not yet a widely accepted treatment objective for alcohol-dependent patients, as abstinence is often considered to be the only possible objective in this situation. However, various studies have demonstrated the value of proposing these two options to such patients. Firstly, reduction of alcohol consumption very significantly reduces the risk of alcohol-related damage, and also modifies the patient's and the doctor's perception of the disease, resulting in improved access to care and better patient adherence with the proposed treatment objective and consequently better clinical results. Recent studies have shown that some medicinal products can help patients reduce their alcohol consumption. One such product, nalmefene, has been granted European marketing authorization and is now being released onto the market in various countries. The ESENSE 1 and 2 studies in alcohol-dependent patients showed that, in combination with BRENDA, a psychosocial intervention focusing on reinforcement of motivation and treatment adherence, nalmefene significantly reduced the number of heavy drinking days and mean daily total alcohol consumption versus placebo. This reduction was more marked in the marketing authorization target population, ie, patients with a high or very high drinking risk level according to World Health Organization criteria. Another original feature of this molecule is that it can be used as needed if the patient perceives a risk of drinking, which is a more flexible approach and more likely to ensure the patient's active involvement in the treatment of his/her disease. This molecule opens up interesting and original therapeutic prospects in the treatment of alcohol dependence. Keywords: alcohol dependence, reduction, consumption, damage reduction, drug therapy, nalmefene

  17. Insomnia in the elderly: cause, approach, and treatment.

    Science.gov (United States)

    Kamel, Nabil S; Gammack, Julie K

    2006-06-01

    Insomnia is a prevalent problem in late life. Sleep problems in the elderly are often mistakenly considered a normal part of aging. Insomnia, the most common sleep disorder, is a subjective report of insufficient or nonrestorative sleep despite adequate opportunity to sleep. Despite the fact that more than 50% of elderly people have insomnia, it is typically undertreated, and nonpharmacologic interventions are underused by health care practitioners. This article will review the causes of insomnia in the elderly, the approach to patient evaluation, and the nonpharmacologic and pharmacologic treatment of insomnia.

  18. Treatment Approaches to Urinary Stones Caused by Forgotten DJ Stents

    Directory of Open Access Journals (Sweden)

    Ergun Alma

    2015-03-01

    Full Text Available Ureteral DJ stents have been used widely for years in urology practice. With increased use, complications have been increased and forgotton stents have started to cause problems. The most common complications are early pain and irritative symptoms. Late complications are bacterial colonization and stone formation because of the biofilm covering the stents. Treatment for a forgotten stent varies on many factors, such as stent localization and stone formation. In this article, we aimed to discuss our clinic approach on two different cases in light to current literature. [Cukurova Med J 2015; 40(Suppl 1: 58-63

  19. Novel Approaches to the Treatment of Cancer in London UK

    Directory of Open Access Journals (Sweden)

    Judith Black

    2015-03-01

    Full Text Available An intensive and in-depth two-day conference providing an advanced level updateKEY TOPICS TO BE COVERED:New paradigms for targeted therapiesNew anti-cancer agents ~ industry viewpointNovel approaches to the treatment of breast cancer, melanoma and pancreatic cancerDrug development and precision radiotherapyEuropean drug development initiativesMarket access to novel cancer drugsRegulatory issues in marketing authorisation of anti-cancer productsGene and cell therapies and trial endpointsDeveloping cancer vaccinesCLICK HERE for more information 

  20. Individual treatment of hotel and restaurant waste water in rural areas.

    Science.gov (United States)

    Van Hulle, S W H; Ghyselbrecht, N; Vermeiren, T J L; Depuydt, V; Boeckaert, C

    2012-01-01

    About 25 hotels, restaurants and pubs in the rural community Heuvelland are situated in the area designated for individual water treatment. In order to meet the legislation by the end of 2015, each business needs to install an individual waste water treatment system (IWTS). To study this situation, three catering businesses were selected for further research. The aim of the study was to quantify the effluent quality and to assess IWTS performance for these catering businesses. First of all, the influence of discharging untreated waste water on the receiving surface water was examined. The results showed a decrease in water quality after the discharge point at every business. With the collected data, simulations with the software WEST were performed. With this software two types of IWTSs with different (buffer) volumes were modelled and tested for each catering business. The first type is a completely mixed activated sludge reactor and the second type is a submerged aerobic fixed-bed reactor. The results of these simulations demonstrate that purification with an IWTS is possible if the capacity is large enough and if an adequate buffer volume is installed and if regular maintenance is performed.

  1. Non-pharmachological approaches to the treatment of chronic insomnia

    Directory of Open Access Journals (Sweden)

    Vita Štukovnik

    2013-05-01

    Full Text Available Sleep disorders have a negative impact on the quality of life and contribute to physical and mental health problems. Insomnia is a pervasive condition with various causes, manifestations, and health consequences. Even though it can be triggered by a variety of precipitating events, psychological and behavioral factors are almost always involved in perpetuating or exacerbating it over time, and lead to chronic condition. This article reviews some basic models and mechanisms of chronic insomnia as well as the rationale and objectives of cognitive-behavioral therapy (CBT in its management. CBT is a safe and effective treatment that may be used either as a monotherapy or to augment therapy with drugs. Evidence from controlled clinical trials indicates that the majority of patients (70 % to 80 % with persistent insomnia respond to this treatment, which is comparable to medication treatment. Aside from the clinically measurable changes, this therapy system enables patients to regain a feeling of control over their sleep, thereby reducing the emotional distress that sleep disorders cause. But despite the evidence for effectiveness and efficacy of these therapies and also the preference for non-pharmacological treatments expressed by many patients, psychological and behavioral approaches still remain underutilized by health care practitioners. Thus, an important challenge for the future is to disseminate these evidence-based therapies more effectively and increase their routine use in clinical practice.

  2. Using Symbolic Interactionism Insights as an Approach to Helping the Individual with Asperger's Syndrome Overcome Barriers to Social Inclusion

    Science.gov (United States)

    Hughes, Paul

    2016-01-01

    This article outlines a case for using symbolic interactionism as a tool to help individuals with Asperger's syndrome reconcile situations in which communication might prove challenging. This study builds on previous work carried out by the author which describes an autoethnographical approach to help the individual with Asperger's syndrome gain…

  3. Central nervous system histoplasmosis: Multicenter retrospective study on clinical features, diagnostic approach and outcome of treatment.

    Science.gov (United States)

    Wheat, Joseph; Myint, Thein; Guo, Ying; Kemmer, Phebe; Hage, Chadi; Terry, Colin; Azar, Marwan M; Riddell, James; Ender, Peter; Chen, Sharon; Shehab, Kareem; Cleveland, Kerry; Esguerra, Eden; Johnson, James; Wright, Patty; Douglas, Vanja; Vergidis, Pascalis; Ooi, Winnie; Baddley, John; Bamberger, David; Khairy, Raed; Vikram, Holenarasipur R; Jenny-Avital, Elizabeth; Sivasubramanian, Geetha; Bowlware, Karen; Pahud, Barbara; Sarria, Juan; Tsai, Townson; Assi, Maha; Mocherla, Satish; Prakash, Vidhya; Allen, David; Passaretti, Catherine; Huprikar, Shirish; Anderson, Albert

    2018-03-01

    Central nervous system (CNS) involvement occurs in 5 to 10% of individuals with disseminated histoplasmosis. Most experience has been derived from small single center case series, or case report literature reviews. Therefore, a larger study of central nervous system (CNS) histoplasmosis is needed in order to guide the approach to diagnosis, and treatment.A convenience sample of 77 patients with histoplasmosis infection of the CNS was evaluated. Data was collected that focused on recognition of infection, diagnostic techniques, and outcomes of treatment.Twenty nine percent of patients were not immunosuppressed. Histoplasma antigen, or anti-Histoplasma antibodies were detected in the cerebrospinal fluid (CSF) in 75% of patients. One year survival was 75% among patients treated initially with amphotericin B, and was highest with liposomal, or deoxycholate formulations. Mortality was higher in immunocompromised patients, and patients 54 years of age, or older. Six percent of patients relapsed, all of whom had the acquired immunodeficiency syndrome (AIDS), and were poorly adherent with treatment.While CNS histoplasmosis occurred most often in immunocompromised individuals, a significant proportion of patients were previously, healthy. The diagnosis can be established by antigen, and antibody testing of the CSF, and serum, and antigen testing of the urine in most patients. Treatment with liposomal amphotericin B (AMB-L) for at least 1 month; followed by itraconazole for at least 1 year, results in survival among the majority of individuals. Patients should be followed for relapse for at least 1 year, after stopping therapy.

  4. Bothersome Tics in Patients with Chronic Tic Disorders: Characteristics and Individualized Treatment Response to Behavior Therapy

    Science.gov (United States)

    McGuire, Joseph F.; Piacentini, John; Scahill, Lawrence; Woods, Douglas W.; Villarreal, Robert; Wilhelm, Sabine; Walkup, John T.; Peterson, Alan L.

    2015-01-01

    This report examined the most frequently reported bothersome tics among individuals with chronic tic disorders and evaluated the improvement and remission of tics and their associated characteristics. Youths and adults (N = 240) were randomly assigned to receive the comprehensive behavioral intervention for tics (CBIT) or psychoeducation and supportive therapy (PST). At baseline, motor tics and tics with an urge were rated as more bothersome relative to vocal tics and tics without premonitory urges. The five most common bothersome tics included eye blinking, head jerks, sniffing, throat clearing, and other complex motor tics. While CBIT outperformed PST across tic type and urge presence, tics preceded by premonitory urges at baseline had higher severity at posttreatment across treatment condition. Six individual tic types had lower severity at posttreatment following CBIT relative to PST. Baseline urge presence was associated with tic remission for CBIT but not PST. Specific bothersome tics were more likely to remit with CBIT relative to PST. Findings suggest that individual tics respond and remit differently to CBIT relative to PST, with implications highlighting the negative reinforcement hypothesis in tic symptom maintenance. PMID:25988365

  5. Bothersome tics in patients with chronic tic disorders: Characteristics and individualized treatment response to behavior therapy.

    Science.gov (United States)

    McGuire, Joseph F; Piacentini, John; Scahill, Lawrence; Woods, Douglas W; Villarreal, Robert; Wilhelm, Sabine; Walkup, John T; Peterson, Alan L

    2015-07-01

    This report examined the most frequently reported bothersome tics among individuals with chronic tic disorders and evaluated the improvement and remission of tics and their associated characteristics. Youths and adults (N = 240) were randomly assigned to receive the comprehensive behavioral intervention for tics (CBIT) or psychoeducation and supportive therapy (PST). At baseline, motor tics and tics with an urge were rated as more bothersome relative to vocal tics and tics without premonitory urges. The five most common bothersome tics included eye blinking, head jerks, sniffing, throat clearing, and other complex motor tics. While CBIT outperformed PST across tic type and urge presence, tics preceded by premonitory urges at baseline had higher severity at posttreatment across treatment condition. Six individual tic types had lower severity at posttreatment following CBIT relative to PST. Baseline urge presence was associated with tic remission for CBIT but not PST. Specific bothersome tics were more likely to remit with CBIT relative to PST. Findings suggest that individual tics respond and remit differently to CBIT relative to PST, with implications highlighting the negative reinforcement hypothesis in tic symptom maintenance. CLINICALTRIALS. NCT00218777; NCT00231985. Published by Elsevier Ltd.

  6. MIGRAINE AND TENSION-TYPE HEADACHE IN CHILDREN: THE APPROACH TO EFFECTIVE TREATMENT. PART 2

    Directory of Open Access Journals (Sweden)

    A. V. Sergeev

    2012-01-01

    Full Text Available Pediatric neurologists often have to prescribe drugs off-label in children, according to individual approach to every patient and weighing possible benefits and risk of side-effects. Multidisciplinary approach to migraine and tension-type headache treatment in children, including correction of comorbid psychiatric and somatic disorders, is a critical point in decrease of frequency and severity of headaches and normalization of everyday children’s activity. In the second part of the article the authors discuss the problems of symptomatic (episodic drugs taking in order to arrest a headache attack and preventive (regular prolonged drug taking directed on decrease of frequency and severity of headaches medical treatment of migraine and tension-type headaches in pediatric practice.

  7. Exploring the perceived usefulness of practical food groups in day treatment for individuals with eating disorders.

    Science.gov (United States)

    Biddiscombe, Rachel J; Scanlan, Justin Newton; Ross, Jessica; Horsfield, Sarah; Aradas, Jessica; Hart, Susan

    2018-04-01

    Recovery from eating disorders is a challenging process. Emerging literature suggests that occupational therapists may provide a useful contribution in delivering purposeful eating-related interventions as a potential treatment to support sustained cognitive and behavioural changes for individuals with eating disorders. This study aimed to evaluate participants' perceptions of the contribution of occupational therapy practical food groups (food based outings and cooking groups) in supporting their functional recovery. Individuals attended practical food groups as part of standard treatment at an outpatient eating disorders day program. Ninety-nine participants completed questionnaires at discharge and up to three follow-up points (6, 12 and 24 months). Questions related to practical food groups were analysed, exploring participants' experiences and perceived usefulness of groups using rating-scale and open-ended questions. Open-ended responses were analysed using thematic analysis. Descriptive statistics were calculated for responses to rating-scale questions. At discharge, participants rated the importance and usefulness of practical food groups as high (4.73 and 4.43 on 5-point scales, respectively), but tended to rate their enjoyment of the groups lower (3.50 on a 5-point scale). Some skill transfer was typically reported by participants at discharge (3.92 on a 5-point scale). One core theme, 'success through participation', emerged from qualitative comments. Six subthemes were also identified: helpful components of practical food groups; perceived benefit of exposure; impact of applying cognitive and behavioural skills; challenges affecting participation; facilitating adaptation; and influence of eating disorders on challenging feared foods. This study highlights that participation in practical food groups was perceived as useful in assisting individuals to improve eating behaviours and, in some circumstances, transfer these skills into their lives outside of

  8. Rapprochement in Late Adolescent Separation-Individuation: A Structural Equations Approach.

    Science.gov (United States)

    Quintana, Stephen M.; Lapsley, Daniel K.

    1990-01-01

    Attempted to integrate indices of connection and individuality into a single, positively related construct. College students (n=101) responded to measures of parenting style, individuation, and ego identity. Results suggest that parental control restricts successful individuation but that adjustment on individuation indices predicts advanced…

  9. Predictors of residential treatment retention among individuals with co-occurring substance abuse and mental health disorders.

    Science.gov (United States)

    Choi, Sam; Adams, Susie M; MacMaster, Samuel A; Seiters, John

    2013-01-01

    A significant number of individuals with co-occurring substance abuse and mental health disorders do not engage, stay, and/or complete residential treatment. The purpose of this study is to identify factors during the initial phase of treatment which predict retention in private residential treatment for individuals with co-occurring substance use and mental health disorders. The participants were 1,317 individuals with co-occurring substance abuse and mental health disorders receiving treatment at three residential treatment centers located in Memphis, TN, Malibu, CA, and Palm Springs, CA. Bivariate analysis and logistic regression were utilized to identify factors that predict treatment retention at 30 days. The findings indicate a variety of factors including age, gender, types of drug, Addiction Severity Index Medical and Psychiatric scores, and readiness to change. These identified factors could be incorporated into pretreatment assessments, so that programs can initiate preventive measures to decrease attrition and improve treatment outcomes.

  10. Testing two principles of the Health Action Process Approach in individuals with type 2 diabetes.

    Science.gov (United States)

    Lippke, Sonia; Plotnikoff, Ronald C

    2014-01-01

    The Health Action Process Approach (HAPA) proposes principles that can be translated into testable hypotheses. This is one of the first studies to have explicitly tested HAPA's first 2 principles, which are (1) health behavior change process can be subdivided into motivation and volition, and (2) volition can be grouped into intentional and action stages. The 3 stage groups are labeled preintenders, intenders, and actors. The hypotheses of the HAPA model were investigated in a sample of 1,193 individuals with Type 2 diabetes. Study participants completed a questionnaire assessing the HAPA variables. The hypotheses were evaluated by examining mean differences of test variables and by the use of multigroup structural equation modeling (MSEM). Findings support the HAPA's 2 principles and 3 distinct stages. The 3 HAPA stages were significantly different in several stage-specific variables, and discontinuity patterns were found in terms of nonlinear trends across means. In terms of predicting goals, action planning, and behavior, differences transpired between the 2 motivational stages (preintenders and intenders), and between the 2 volitional stages (intenders and actors). Results indicate implications for supporting behavior change processes, depending on in which stage a person is at: All individuals should be helped to increase self-efficacy. Preintenders and intenders require interventions targeting outcome expectancies. Actors benefit from an improvement in action planning to maintain and increase their previous behavior. Overall, the first 2 principles of the HAPA were supported and some evidence for the other principles was found. Future research should experimentally test these conclusions. 2014 APA, all rights reserved

  11. Satisfactory patient-based outcomes after surgical treatment for idiopathic clubfoot: includes surgeon's individualized technique.

    Science.gov (United States)

    Mahan, Susan T; Spencer, Samantha A; Kasser, James R

    2014-09-01

    Treatment of idiopathic clubfoot has shifted towards Ponseti technique, but previously surgical management was standard. Outcomes of surgery have varied, with many authors reporting discouraging results. Our purpose was to evaluate a single surgeon's series of children with idiopathic clubfoot treated with a la carte posteromedial and lateral releases using the Pediatric Outcomes Data Collection Instrument (PODCI) with a minimum of 2-year follow-up. A total of 148 patients with idiopathic clubfoot treated surgically by a single surgeon over 15 years were identified, and mailed PODCI questionnaires. Fifty percent of the patients were located and responded, resulting in 74 complete questionnaires. Median age at surgery was 10 months (range, 5.3 to 84.7 mo), male sex 53/74 (71.6%), bilateral surgery 31/74 (41.9%), and average follow-up of 9.7 years. PODCI responses were compared with previously published normal healthy controls using t test for each separate category. Included in the methods is the individual surgeon's operative technique. In PODCIs where a parent reports for their child or adolescent, there was no difference between our data and the healthy controls in any of the 5 categories. In PODCI where an adolescent self-reports, there was no difference in 4 of 5 categories; significant difference was only found between our data (mean = 95.2; SD = 7.427) and normal controls (mean = 86.3; SD = 12.5) in Happiness Scale (P = 0.0031). In this group of idiopathic clubfoot patients, treated with judicious posteromedial release by a single surgeon, primarily when surgery was treatment of choice for clubfoot, patient-based outcomes are not different from their normal healthy peers through childhood and adolescence. While Ponseti treatment has since become the treatment of choice for clubfoot, surgical treatment, in some hands, has led to satisfactory results. Level III.

  12. Motivational assessment of non-treatment buprenorphine research participation in heroin dependent individuals.

    Science.gov (United States)

    Papke, Gina; Greenwald, Mark K

    2012-06-01

    Heroin abuse remains an important public health problem, particularly in economically disadvantaged areas. Insight into this problem is gained from interviewing addicted individuals. However, we lack systematic data on factors that motivate heroin users to participate in non-treatment research that offers both financial incentives (compensation) and non-financial incentives (e.g., short-term medication). To better understand the relative importance of several types of personal motivations to participate in non-treatment buprenorphine research, and to relate self-motivations to social, economic, demographic and drug use factors. Heroin dependent volunteers (N=235 total; 57 female and 178 male; 136 African American, 86 Caucasian, and 13 Other) applied for non-therapeutic buprenorphine research in an urban outpatient setting from 2004 to 2008. We conducted a semi-structured behavioral economic interview, after which participants ranked 11 possible motivations for research participation. Although the study was repeatedly described as non-treatment research involving buprenorphine, participants often ranked some treatment-related motivations as important (wanting to reduce/stop heroin use, needing a medication to get stabilized/detoxify). Some motivations correlated with income, heroin use, and years since marketing of buprenorphine. Two dimensions emerged from principal component analysis of motivation rankings: (1) treatment motivation vs. greater immediate needs and (2) commitment to trying alternatives vs. a more accepting attitude toward traditional interventions. In summary, heroin addicts' self-motivations to engage in non-therapeutic research are complex--they value economic gain but not exclusively or primarily--and relate to variables such as socioeconomic factors and drug use. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  13. Current treatment options with immunoglobulin G for the individualization of care in patients with primary immunodeficiency disease.

    Science.gov (United States)

    Jolles, S; Orange, J S; Gardulf, A; Stein, M R; Shapiro, R; Borte, M; Berger, M

    2015-02-01

    Primary antibody deficiencies require lifelong replacement therapy with immunoglobulin (Ig)G to reduce the incidence and severity of infections. Both subcutaneous and intravenous routes of administering IgG can be effective and well tolerated. Treatment regimens can be individualized to provide optimal medical and quality-of-life outcomes in infants, children, adults and elderly people. Frequency, dose, route of administration, home or infusion-centre administration, and the use of self- or health-professional-administered infusion can be tailored to suit individual patient needs and circumstances. Patient education is needed to understand the disease and the importance of continuous therapy. Both the subcutaneous and intravenous routes have advantages and disadvantages, which should be considered in selecting each patient's treatment regimen. The subcutaneous route is attractive to many patients because of a reduced incidence of systemic adverse events, flexibility in scheduling and its comparative ease of administration, at home or in a clinic. Self-infusion regimens, however, require independence and self-reliance, good compliance on the part of the patient/parent and the confidence of the physician and the nurse. Intravenous administration in a clinic setting may be more appropriate in patients with reduced manual dexterity, reluctance to self-administer or a lack of self-reliance, and intravenous administration at home for those with good venous access who prefer less frequent treatments. Both therapy approaches have been demonstrated to provide protection from infections and improve health-related quality of life. Data supporting current options in IgG replacement are presented, and considerations in choosing between the two routes of therapy are discussed. © 2014 British Society for Immunology.

  14. [SURGICAL HIP DISLOCATION APPROACH FOR TREATMENT OF FEMORAL HEAD FRACTURE].

    Science.gov (United States)

    Tang, Yanfeng; Liu, Youwen; Zhu, Yingjie; Li, Jianming; Li, Wuyin; Li, Qiyi; Jia, Yudong

    2015-11-01

    To discuss the value of surgical hip dislocation approach in the treatment of femoral head fracture. A retrospectively analysis was made on the clinical data of 15 patients with femoral head fractures treated through surgical hip dislocation approach between January 2010 and February 2013. There were 11 men and 4 women with an average age of 30.8 years (range, 15-63 years). The causes included traffic accident injury in 9 cases, falling injury from height in 5 cases, and sports injury in 1 case. According to Pipkin typing, 2 cases were rated as type I, 7 cases as type II, 1 case as type III, and 5 cases as type IV. The interval of injury and operation was 2-10 days (mean, 4.1 days). Reduction was performed in 10 patients within 6 hours after injury, and then bone traction was given for 4-6 weeks except 5 patients who received reduction in the other hospital. Primary healing of incision was obtained in all patients after surgery without complications of dislocation and lower limbs deep venous thrombosis. The mean follow-up time was 29.9 months (range, 25-36 months). During follow-up, there was no infection, breakage of internal fixation, or nonunion of femoral greater trochanter fracture. In 3 patients having necrosis of the femoral head, 2 had no obvious symptoms [staging as IIa and IIb respectively according to Association Research Circulation Osseous (ARCO) staging system], and 1 (stage IIIb) had nonunion of the femoral neck fracture, who underwent total hip arthroplasty (THA). In 4 patients having myositis ossificans (2 cases of grade I, 1 case of grade II, and 1 case of grade III based on Brooker grading), no treatment was given in 3 cases and the focus was removed during THA in 1 case. According to the Thompson-Epstein scale at last follow-up, the results were excellent in 9 cases, good in 3 cases, fair in 1 case, and poor in 2 cases, and the excellent and good rate was 80%. Surgical hip dislocation approach can not only protect the residual vessels of the

  15. Influence of Psychiatric and Personality Disorders on Smoking Cessation Among Individuals in Opiate Dependence Treatment.

    Science.gov (United States)

    Cooperman, Nina A; Lu, Shou-En; Richter, Kimber P; Bernstein, Steven L; Williams, Jill M

    2016-01-01

    attempt or not (C-statistic of .79, 95% CI [0.70, 0.88]). Compared to existing treatments, smoking cessation treatments that can be tailored to address the individual needs of people with specific psychiatric disorders or personality disorder traits may better help those in opiate dependence treatment to set a cessation goal, attempt to quit, and eventually quit smoking.

  16. Influence of Psychiatric and Personality Disorders on Smoking Cessation among Individuals in Opiate Dependence Treatment

    Science.gov (United States)

    Cooperman, Nina A.; Lu, Shou-En; Richter, Kimber P.; Bernstein, Steven L.; Williams, Jill M.

    2016-01-01

    .85]) and ever making a quit attempt or not (C-statistic of .79, 95% CI[0.70, 0.88]). Conclusions Compared to existing treatments, smoking cessation treatments that can be tailored to address the individual needs of people with specific psychiatric disorders or personality disorder traits may better help those in opiate dependence treatment to set a cessation goal, attempt to quit, and eventually quit smoking. PMID:27064523

  17. Evaluation of Average Life Expectancy of Exposed Individuals and their offspring: Population Genetic Approach

    International Nuclear Information System (INIS)

    Telnov, V. I.; Sotnik, N. V.

    2004-01-01

    Average life expectancy (ALE) is a significant integrating indicator of the population health. It can be affected by many factors such as radiation and hereditary ones. A population-genetic analysis of the average life expectancy (ALE) was performed for nuclear workers at the Mayak Production. Association exposed to external and internal radiation over a wide dose range and their offspring. A methodical approach was proposed to determine ALE for individuals with different genotypes and estimate ALE in the population based on genotype distribution. The analysis of a number of genetic markers revealed significant changes in the age-specific pattern of the Hp types in workers over 60 years. Such changes were caused by both radiation and non-radiation (cardiovascular pathology) factors. In the first case ALE decreased as Hp 1-1 > Hp 2-2> Hp2-1 (radiation). In the second case, it decreased as Hp 1-1> Hp-2-1> Hp2-2 (non-radiation). analysis of genetic markers in the workers offspring indicated significant shifts in distribution of the Hp types, especially an increase in the proportion of Hp 2-2 at doses from external γ-rays over 200 cGy to parents by the time of conception. Based on the non-radiation genotype differences in ALE in this group of offspring, the preliminary calculation of ALE was carried out, which indicated its reduction by 0.52 years in comparison with the control. (Author) 21 refs

  18. Novel approaches to diagnosis and treatment of Juvenile Myelomonocytic Leukemia.

    Science.gov (United States)

    Locatelli, Franco; Algeri, Mattia; Merli, Pietro; Strocchio, Luisa

    2018-02-01

    Juvenile myelomonocytic leukemia (JMML) is a clonal hematopoietic disorder of infancy/early childhood, resulting from oncogenic mutations in genes involved in the Ras pathway. As JMML often exhibits an aggressive course, the timing of diagnosis and treatment is critical to outcome. Areas covered: This review summarizes current approaches to diagnosis and treatment of JMML, highlighting most recent insights into genetic and epigenetic mechanisms underlying the disease, and providing an overview of novel potential therapeutic strategies. Expert commentary: At present, allogeneic HSCT remains the only potentially effective therapy, being able to cure more than 50% of patients, relapse representing the main cause of treatment failure. Prompt HSCT is recommended for all children with NF1, somatic PTPN11 and KRAS mutations, and for most children with somatic NRAS mutations. Conversely, a 'watch and wait' strategy should be adopted in children with germline CBL mutations, specific somatic NRAS mutation, and in Noonan syndrome patients, since spontaneous resolution has been reported to occur. Novel drugs targeting relevant nodes of JMML leukemogenesis have been explored in pre-HSCT window or at relapse. The use of 5-azacytidine, a DNA-hypomethylating agent reported to induce hematologic and molecular remission in some JMML children, is currently being investigated in clinical trials.

  19. Omics approaches to individual variation: modeling networks and the virtual patient.

    Science.gov (United States)

    Lehrach, Hans

    2016-09-01

    Every human is unique. We differ in our genomes, environment, behavior, disease history, and past and current medical treatment-a complex catalog of differences that often leads to variations in the way each of us responds to a particular therapy. We argue here that true personalization of drug therapies will rely on "virtual patient" models based on a detailed characterization of the individual patient by molecular, imaging, and sensor techniques. The models will be based, wherever possible, on the molecular mechanisms of disease processes and drug action but can also expand to hybrid models including statistics/machine learning/artificial intelligence-based elements trained on available data to address therapeutic areas or therapies for which insufficient information on mechanisms is available. Depending on the disease, its mechanisms, and the therapy, virtual patient models can be implemented at a fairly high level of abstraction, with molecular models representing cells, cell types, or organs relevant to the clinical question, interacting not only with each other but also the environment. In the future, "virtual patient/in-silico self" models may not only become a central element of our health care system, reducing otherwise unavoidable mistakes and unnecessary costs, but also act as "guardian angels" accompanying us through life to protect us against dangers and to help us to deal intelligently with our own health and wellness.

  20. Public-health and individual approaches to antiretroviral therapy: township South Africa and Switzerland compared.

    Directory of Open Access Journals (Sweden)

    Olivia Keiser

    2008-07-01

    Full Text Available The provision of highly active antiretroviral therapy (HAART in resource-limited settings follows a public health approach, which is characterised by a limited number of regimens and the standardisation of clinical and laboratory monitoring. In industrialized countries doctors prescribe from the full range of available antiretroviral drugs, supported by resistance testing and frequent laboratory monitoring. We compared virologic response, changes to first-line regimens, and mortality in HIV-infected patients starting HAART in South Africa and Switzerland.We analysed data from the Swiss HIV Cohort Study and two HAART programmes in townships of Cape Town, South Africa. We included treatment-naïve patients aged 16 y or older who had started treatment with at least three drugs since 2001, and excluded intravenous drug users. Data from a total of 2,348 patients from South Africa and 1,016 patients from the Swiss HIV Cohort Study were analysed. Median baseline CD4+ T cell counts were 80 cells/mul in South Africa and 204 cells/mul in Switzerland. In South Africa, patients started with one of four first-line regimens, which was subsequently changed in 514 patients (22%. In Switzerland, 36 first-line regimens were used initially, and these were changed in 539 patients (53%. In most patients HIV-1 RNA was suppressed to 500 copies/ml or less within one year: 96% (95% confidence interval [CI] 95%-97% in South Africa and 96% (94%-97% in Switzerland, and 26% (22%-29% and 27% (24%-31%, respectively, developed viral rebound within two years. Mortality was higher in South Africa than in Switzerland during the first months of HAART: adjusted hazard ratios were 5.90 (95% CI 1.81-19.2 during months 1-3 and 1.77 (0.90-3.50 during months 4-24.Compared to the highly individualised approach in Switzerland, programmatic HAART in South Africa resulted in similar virologic outcomes, with relatively few changes to initial regimens. Further innovation and resources are

  1. Serological Response to Treatment of Syphilis with Doxycycline Compared with Penicillin in HIV-infected Individuals

    DEFF Research Database (Denmark)

    Salado-Rasmussen, Kirsten; Hoffmann, Steen; Cowan, Susan

    2016-01-01

    Serological response to treatment of syphilis with orally administered doxycycline or intramuscularly administered penicillin was assessed in patients with concurrent HIV. All HIV-infected individuals diagnosed with syphilis attending 3 hospitals in Copenhagen, Denmark were included. Odds ratios...... (ORs) with 95% confidence intervals (CI) associated with serological outcome were modelled using propensity-score-adjusted logistic regression analysis. In total, 202 cases were treated with doxycycline or intramuscular penicillin. At 12 months, serological failure was observed in 12 cases (15......%) treated with doxycycline and in 8 cases (17%) treated with penicillin (OR 0.78 (95% CI 0.16-3.88), p = 0.76). The serological cure rate at 12 months was highest in patients with primary syphilis (100%), followed by patients with secondary (89%), early latent (71%) and late latent (67%) syphilis (p = 0...

  2. [Leukotriene antagonists: a new approach in the treatment of asthma].

    Science.gov (United States)

    Devillier, P; Bessard, G; Advenier, C

    1997-06-01

    Inflammation plays an essential role in the genesis of airflow obstruction and bronchial hyper-reactivity in the early stages of clinical asthma. The treatment of bronchial inflammation has become an essential element in the therapeutic strategy and principally rests on inhaled glucocorticoids. Amongst a number of inflammatory mediators leukotrienes occupy a privileged place by the power of their inflammatory and constrictor effects on bronchial smooth muscles. These properties have justified the clinical development of inhibitors of their synthesis and of specific antagonists to their receptors. Leukotriene antagonists are specific for a sub type of leukotriene receptors C4, D4 and E4 which is implicated in the majority of the bronchial constrictor and inflammatory effects of leukotrienes. The antagonists of Cys-LT1 receptor but also the inhibitors of the leukotriene synthesis exert an additive bronchodilator effect to those of B2 stimulants confirming an efficacious protection vis a vis bronchial provocation tests and above all they improve the clinical scores, lung function and also enable a decrease in the consumption of beta 2 agonists. The marketing of these products represents a major event because it corresponds to the advent of a new therapeutic class. The ease of administration by the oral route, their demonstrated efficacy and their good tolerance profile (in particular for ICI 204.219, and antagonists to Cys-LT1 receptors) are elements which foresee a success for this new asthmatic treatment. However numerous studies, notably comparative studies vis a vis reference treatments will be necessary to define their place in the strategic approach to the treatment of asthma.

  3. Clinician identification of elevated symptoms of depression among individuals seeking treatment for substance misuse.

    Science.gov (United States)

    Hobden, Breanne; Carey, Mariko; Bryant, Jamie; Sanson-Fisher, Rob; Oldmeadow, Christopher

    2017-12-01

    Depression is common among those experiencing alcohol and other drug (AOD) disorders. It has been suggested that identifying depressive symptoms among this group is important for case management. Despite this, there is a lack of research examining how well clinicians perform this task within this setting. To determine the: (i) accuracy of clinician identified elevated symptoms of depression among clients seeking treatment for AOD misuse as compared to a standardized self-report psychiatric screening tool; and (ii) clinician and client characteristics associated with accurate identification of elevated symptoms of depression. The study used a descriptive cohort design. Participants from two Australian AOD outpatient clinics reported demographic data and completed the Patient Health Questionnaire (PHQ-9) to identify elevated symptoms of depression. Clinicians were asked to indicate the presence or absence of depression for individual clients. Client and clinician data were compared. Sensitivity of clinician identified elevated symptoms of depression, compared with the PHQ-9, was moderate at 73.0% (95% CI=63.7, 81.0) and specificity was low with 49.5% (95% CI=39.9, 61.2) accurately identified as not having elevated symptoms of depression. AOD clinicians' years' of experience, clients' main substance and length of treatment were associated with accuracy of identification. Clinicians identify elevated symptoms of depression with moderate accuracy amongst individuals with AOD disorders. There is a tendency to over-identify which may contribute to inaccuracies. Routine screening may assist in improving identification of depressive symptoms and place greater focus on mental health comorbidities. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  4. Pica and rumination behavior among individuals seeking treatment for eating disorders or obesity.

    Science.gov (United States)

    Delaney, Charlotte B; Eddy, Kamryn T; Hartmann, Andrea S; Becker, Anne E; Murray, Helen B; Thomas, Jennifer J

    2015-03-01

    Pica and rumination disorder (RD)-formerly classified within DSM-IV Feeding and Eating Disorders of Infancy or Early Childhood-are now classified within DSM-5 Feeding and Eating Disorders. Though pica and RD have been studied in select populations (e.g., pregnant women, intellectually disabled persons), their typical features and overall prevalence remain unknown. This study examined the clinical characteristics and frequency of DSM-5 pica and RD among individuals seeking treatment for eating disorders and obesity. We conducted structured interviews with adolescent and young adult females from a residential eating disorder center (N = 149), and adult males and females with overweight or obesity from an outpatient weight-loss clinic (N = 100). Several participants reported ingesting non-nutritive substances (e.g., ice) for weight-control purposes. However, only 1.3% (n = 2; 95% CI: .06% to 5.1%) at the residential eating disorder center and 0% at the weight-loss clinic met DSM-5 criteria for pica, consuming gum and plastic. Although no eating disorder participants were eligible for an RD diagnosis due to DSM-5 trumping rules, 7.4% (n = 11; 95% CI: 4.0% to 12.9%) endorsed rumination behavior under varying degrees of volitional control. At the weight-loss clinic, 2.0% (n = 2; 95% CI: 0.1% to 7.4%) had RD. DSM-5 pica and RD were rare in our sample of individuals seeking treatment for eating disorders and obesity, but related behaviors were more common. The wide range of pica and rumination presentations highlights the challenges of differential diagnosis with other forms of disordered eating. © 2014 Wiley Periodicals, Inc.

  5. Maintaining Professional Relationships in an Interdisciplinary Setting: Strategies for Navigating Nonbehavioral Treatment Recommendations for Individuals with Autism.

    Science.gov (United States)

    Brodhead, Matthew T

    2015-05-01

    Due to an increase in research and clinical application of behavior analysis with individuals with autism spectrum disorder (ASD), one setting a Board Certified Behavior Analyst (BCBA) may work within is an interdisciplinary setting, where multiple disciplines collaborate to improve the outcomes of individuals with ASD. In some cases, nonbehavioral colleagues could recommend nonbehavioral treatments, setting the occasion for the BCBA to offer an alternative treatment to or question the nonbehavioral treatment. However, excessive questioning or critiques of nonbehavioral treatments by the BCBA may unintentionally erode professional relationships between the BCBA and their nonbehavioral colleagues. Because an erosion of professional relationships may occur when a BCBA questions a nonbehavioral treatment, a decision-making model for determining whether or not the proposed nonbehavioral treatment is worth addressing may be useful. The purpose of this paper is to outline such a decision-making model in order to assist the BCBA in assessing nonbehavioral treatments while maintaining an ethical balance between professional relationships and the well-being and safety of the individual with ASD. Such a model could assist the BCBA in becoming familiar with the proposed treatment, understanding the perspective of the nonbehavioral colleague and assessing the negative impacts the treatment could have on the individual with ASD. With this information, the BCBA will be in a better position to decide whether or not addressing the nonbehavioral treatment is worth the possibility of eroding a professional relationship.

  6. Treatment approaches and antibiotic use for emergency dental treatment in Turkey

    Directory of Open Access Journals (Sweden)

    Kaptan RF

    2013-11-01

    Full Text Available Rabia Figen Kaptan,1 Faruk Haznedaroglu,2 Fatima Betul Basturk,3 Mehmet Baybora Kayahan11Department of Endodontics, Yeditepe University, 2Department of Endodontics, Istanbul University, 3Department of Endodontics, Marmara University, Istanbul, TurkeyAbstract: The purpose of this study was to gather information about Turkish general dental practitioners' treatment approaches towards endodontic emergencies, antibiotic-prescribing habits, and their participation in lifelong learning programs. Questionnaires were given to dentists who attended the 16th National Congress organized by the Turkish Dental Association. From 1,400 questionnaires distributed, 589 (43% were deemed usable in this study. This survey dealt with questions that were subdivided into two main topics: dental emergency treatment approaches, and antibiotic prescription and information on lifelong learning program participation. The statistical analysis was conducted with a Χ2 test at a significance level of P<0.05. For irreversible pulpitis cases in vital teeth, most of the dental practitioners (65.3% preferred single-visit root canal treatments. For teeth presenting a periapical lesion, the preferred treatment approach was root canal treatment (91.5%. The rate of prescription of analgesics and antibiotics was 21.7% in untreated acute apical periodontitis cases and 41% in acute apical abscess cases. Frequently prescribed antibiotics were amoxicillin–clavulanate (61.8% and amoxicillin (46.5%. There was a tendency for practitioners to attend congresses as their years of professional practice increased (P<0.0001. There have been discrepancies between taught and observed practice. Educational initiatives are needed to prevent inappropriate prescription of antibiotics.Keywords: antibiotic prescription, endodontic emergency, survey, Turkey

  7. Technical progress, the concept of individualized cancer treatment and the innovation of computer-assisted radiotherapy planning

    International Nuclear Information System (INIS)

    Merkle, K.; Tanneberger, S.; Matschke, S.

    1985-01-01

    After a first step of cancerogenesis, the further development of the tumor is an individual process. At the end of this process the tumor is formed as an individual in the individual. The individuality of cancer exists on the level of organs, tissues and cells and includes an individual tumor-host relationship. Today, optimized cancer treatment requires a most precise biological characterization possible of the tumor and of the tumor-host relationship, which will provide objective information about the individual character of every tumor. Routine analysis and strict therapeutic consideration of the clinical and biological individuality of human cancer can offer real chances for the improvement of cancer treatment. A routine acquisition of individual tumor characteristics will be possible only if methods and equipment are available for the registration of suitable parameters. In this context technical innovations have an essential influence on the realization of the concept of individualized cancer treatment. With the method of flow cytophotometry and other techniques examples are given in how far the ideas of individual cancer management can be realized by introduction of new technical solutions into medical research and clinical practice. Unfortunately there is still a lack of methodology in individualizing cancer treatment. The individualization of radiotherapy is connected to an extremely high degree of technical innovations. Particularly this refers to the topometrical description of the target volume in relation to the adjacent anatomical structures and the body contour as well as the fitting of isodoses to the shape and size of the target volume. As an example of innovation of a technical solution for individual radiotherapy planning the computer-assisted radiotherapy planning system DOPSY is described. (author)

  8. A structural model of treatment program and individual counselor leadership in innovation transfer.

    Science.gov (United States)

    Joe, George W; Becan, Jennifer E; Knight, Danica K; Flynn, Patrick M

    2017-03-23

    A number of program-level and counselor-level factors are known to impact the adoption of treatment innovations. While program leadership is considered a primary factor, the importance of leadership among clinical staff to innovation transfer is less known. Objectives included explore (1) the influence of two leadership roles, program director and individual counselor, on recent training activity and (2) the relationship of counselor attributes on training endorsement. The sample included 301 clinical staff in 49 treatment programs. A structural equation model was evaluated for key hypothesized relationships between exogenous and endogenous variables related to the two leadership roles. The importance of organizational leadership, climate, and counselor attributes (particularly counseling innovation interest and influence) to recent training activity was supported. In a subset of 68 counselors who attended a developer-led training on a new intervention, it was found that training endorsement was higher among those with high innovation interest and influence. The findings suggest that each leadership level impacts the organization in different ways, yet both can promote or impede technology transfer.

  9. New therapeutic approaches for treatment of tularaemia: a review

    Directory of Open Access Journals (Sweden)

    Sandrine eBOISSET

    2014-03-01

    Full Text Available Antibiotic treatment of tularaemia is based on a few drugs, including the fluoroquinolones, the tetracyclines and the aminoglycosides. Because no effective and safe vaccine is currently available, tularaemia prophylaxis following proven exposure to F. tularensis also relies on administration of antibiotics. A number of reasons make it necessary to search for new therapeutic alternatives: the potential toxicity of first-line drugs, especially in children and pregnant women; a high rate of treatment relapses and failures, especially for severe and/or suppurated forms of the disease; and the possible use of antibiotic-resistant strains in the context of a biological threat. This review presents novel therapeutic approaches that have been explored in recent years to improve tularaemia patients’ management and prognosis. First, the activities of newly available antibiotic compounds were evaluated against F. tularensis, including tigecycline (a glycylcycline, ketolides (telithromycin and cethromycin and fluoroquinolones (moxifloxacin, gatifloxacin, trovafloxacin and grepafloxacin. The liposome delivery of some antibiotics was evaluated. The effect of antimicrobial peptides against F. tularensis was also considered. Other drugs were evaluated for their ability to suppress the intracellular multiplication of F. tularensis. The effects of the modulation of the innate immune response (especially via TLR receptors on the course of F. tularensis infection were characterized. Another approach was the administration of specific antibodies to induce passive resistance to F. tularensis infection. All of these studies highlight the need to develop new therapeutic strategies to improve the management of patients with tularaemia. Many possibilities exist, some unexplored. Moreover, it is likely that new therapeutic alternatives that are effective against this intracellular pathogen could be, at least partially, extrapolated to other human pathogens.

  10. Family Connections versus optimised treatment-as-usual for family members of individuals with borderline personality disorder: non-randomised controlled study.

    LENUS (Irish Health Repository)

    Flynn, Daniel

    2017-01-01

    Borderline personality disorder (BPD) is challenging for family members who are often required to fulfil multiple roles such as those of advocate, caregiver, coach and guardian. To date, two uncontrolled studies by the treatment developers suggest that Family Connections (FC) is an effective programme to support, educate and teach skills to family members of individuals with BPD. However, such studies have been limited by lack of comparison to other treatment approaches. This study aimed to compare the effectiveness of FC with an optimised treatment-as-usual (OTAU) programme for family members of individuals with BPD. A secondary aim was to introduce a long term follow-up to investigate if positive gains from the intervention would be maintained following programme completion.

  11. Cerebral 18F-FDG PET in macrophagic myofasciitis: An individual SVM-based approach.

    Science.gov (United States)

    Blanc-Durand, Paul; Van Der Gucht, Axel; Guedj, Eric; Abulizi, Mukedaisi; Aoun-Sebaiti, Mehdi; Lerman, Lionel; Verger, Antoine; Authier, François-Jérôme; Itti, Emmanuel

    2017-01-01

    Macrophagic myofasciitis (MMF) is an emerging condition with highly specific myopathological alterations. A peculiar spatial pattern of a cerebral glucose hypometabolism involving occipito-temporal cortex and cerebellum have been reported in patients with MMF; however, the full pattern is not systematically present in routine interpretation of scans, and with varying degrees of severity depending on the cognitive profile of patients. Aim was to generate and evaluate a support vector machine (SVM) procedure to classify patients between healthy or MMF 18F-FDG brain profiles. 18F-FDG PET brain images of 119 patients with MMF and 64 healthy subjects were retrospectively analyzed. The whole-population was divided into two groups; a training set (100 MMF, 44 healthy subjects) and a testing set (19 MMF, 20 healthy subjects). Dimensionality reduction was performed using a t-map from statistical parametric mapping (SPM) and a SVM with a linear kernel was trained on the training set. To evaluate the performance of the SVM classifier, values of sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and accuracy (Acc) were calculated. The SPM12 analysis on the training set exhibited the already reported hypometabolism pattern involving occipito-temporal and fronto-parietal cortices, limbic system and cerebellum. The SVM procedure, based on the t-test mask generated from the training set, correctly classified MMF patients of the testing set with following Se, Sp, PPV, NPV and Acc: 89%, 85%, 85%, 89%, and 87%. We developed an original and individual approach including a SVM to classify patients between healthy or MMF metabolic brain profiles using 18F-FDG-PET. Machine learning algorithms are promising for computer-aided diagnosis but will need further validation in prospective cohorts.

  12. Choice between delayed food and immediate opioids in rats: treatment effects and individual differences.

    Science.gov (United States)

    Panlilio, Leigh V; Secci, Maria E; Schindler, Charles W; Bradberry, Charles W

    2017-11-01

    Addiction involves maladaptive choice behavior in which immediate drug effects are valued more than delayed nondrug rewards. To model this behavior and extend our earlier work with the prescription opioid oxycodone, we allowed rats to choose between immediate intravenous delivery of the short-acting opioid remifentanil and delayed delivery of highly palatable food pellets. Treatment drugs were tested on a baseline where remifentanil was preferred over food. Treatment with a high dose of the opioid antagonist naltrexone decreased but did not reverse the preference for remifentanil. Treatment with the serotonin 5-HT 2C agonist lorcaserin decreased remifentanil and food self-administration nonselectively. Across conditions in which the alternative to delayed food was either a moderate dose of oxycodone, a moderate or high dose of remifentanil, a smaller more immediate delivery of food, or timeout with no primary reinforcement, choice was determined by both the length of the delay and the nature of the alternative option. Delayed food was discounted most steeply when the alternative was a high dose of remifentanil, which was preferred over food when food was delayed by 30 s or more. Within-subject comparisons showed no evidence for trait-like impulsivity or sensitivity to delay across these conditions. Choice was determined more by the current contingencies of reinforcement than by innate individual differences. This finding suggests that people might develop steep delay-discounting functions because of the contingencies in their environment, and it supports the use of contingency management to enhance the relative value of delayed nondrug reinforcers.

  13. Treatment of cyanide containing wastewater using cavitation based approach.

    Science.gov (United States)

    Jawale, Rajashree H; Gogate, Parag R; Pandit, Aniruddha B

    2014-07-01

    Industrial wastewater streams containing high concentrations of biorefractory materials like cyanides should ideally be treated at source. In the present work, degradation of potassium ferrocyanide (K4Fe(CN)6) as a model pollutant has been investigated using cavitational reactors with possible intensification studies using different approaches. Effect of different operating parameters such as initial concentration, temperature and pH on the extent of degradation using acoustic cavitation has been investigated. For the case of hydrodynamic cavitation, flow characteristics of cavitating device (venturi) have been established initially followed by the effect of inlet pressure and pH on the extent of degradation. Under the optimized set of operating parameters, the addition of hydrogen peroxide (ratio of K4Fe(CN)6:H2O2 varied from 1:1 to 1:30 mol basis) as process intensifying approach has been investigated. The present work has conclusively established that under the set of optimized operating parameters, cavitation can be effectively used for degradation of potassium ferrocyanide. The comparative study of hydrodynamic cavitation and acoustic cavitation suggested that hydrodynamic cavitation is more energy efficient and gives higher degradation as compared to acoustic cavitation for equivalent power/energy dissipation. The present work is the first one to report comparison of cavitation based treatment schemes for degradation of cyanide containing wastewaters. Copyright © 2014 Elsevier B.V. All rights reserved.

  14. A Novel Approach for Pathogen Reduction in Wastewater Treatment

    Directory of Open Access Journals (Sweden)

    Dhevagi Periasamy

    2013-06-01

    Full Text Available Many sewage waste treatment systems are aiming for complete pathogen removal which necessitates search for novel approaches that does not harm the environment. One such novel approach is exploring the possibilities of bacteriophages for pathogen removal. Hospital wastewater was collected from different locations of Tamil Nadu and used for the study. The total heterotroph and total coliform population ranged from 1.6 × 105 to 8.3 × 106 per mL and from 1.2 × 103 to 1.6 × 103/ 100 mL of sample respectively. Higher frequency of antibiotic resistant E. coli, Pseudomonas sp. Streptococcus sp and Bacillus spp were observed in all the places, which clearly indicated the extent of pollution. All the samples had specific phages against E. coli and none of the samples had phages against MTCC culture. E. coli specific phage was isolated and the population of phage required for effective killing of E. coli has been standardized as 3 × 104 pfu / mL of lysate. The inoculation resulted in 100% removal of pathogen from sewage water within 14 hours of incubation.

  15. Integrated approach in the treatment of metabolic syndrome

    Directory of Open Access Journals (Sweden)

    2014-03-01

    Full Text Available The Goal of this study was to investigate the efficacy of the integrated approach for the treatment of metabolic syndrome (MS aiming to correct all of its components versus standard therapy using clinical outcomes (BMI, waist circumference, blood pressure, lipid levels, assessment of psychological status (Beck Depression Inventory, and quality of life (SF-36. Methods: A total of 60 patients with MS were included in the study. The study group (30 subjects mean age 41.0±11 years, women - 23 (76.7%, men - 7 (23.3% received the complex therapy of MS - pharmacotherapy of obesity (orlistat and insulin resistance (metformin, lipid-lowering therapy (statins or fibrates, antihypertensive therapy. Control group (30 patients mean age 43.4±9.5 years, women - 26 (86.7%, men - 4 (13.3% was treated with statins or fibrates and received antihypertensive therapy when needed. At the inclusion in the study and after 6 months of therapy all patients underwent clinical and laboratory investigation, assessment of depression and quality of life. Results: We found a more significant reduction of all clinical outcomes (body weight, blood pressure, improvement in glucose and lipid metabolism, a significant decrease in the prevalence and severity of the depression, and an improvement in the quality of life in patients of study group compared with standard therapy. Conclusion: Complex treatment of the MS, including pharmacotherapy of obesity (orlistat, Xenical and insulin resistance (metformin, Glucophage is characterized by a greater clinical efficacy compared with standard therapy.

  16. Polymer Therapeutics: Biomarkers and New Approaches for Personalized Cancer Treatment.

    Science.gov (United States)

    Atkinson, Stuart P; Andreu, Zoraida; Vicent, María J

    2018-01-23

    Polymer therapeutics (PTs) provides a potentially exciting approach for the treatment of many diseases by enhancing aqueous solubility and altering drug pharmacokinetics at both the whole organism and subcellular level leading to improved therapeutic outcomes. However, the failure of many polymer-drug conjugates in clinical trials suggests that we may need to stratify patients in order to match each patient to the right PT. In this concise review, we hope to assess potential PT-specific biomarkers for cancer treatment, with a focus on new studies, detection methods, new models and the opportunities this knowledge will bring for the development of novel PT-based anti-cancer strategies. We discuss the various "hurdles" that a given PT faces on its passage from the syringe to the tumor (and beyond), including the passage through the bloodstream, tumor targeting, tumor uptake and the intracellular release of the active agent. However, we also discuss other relevant concepts and new considerations in the field, which we hope will provide new insight into the possible applications of PT-related biomarkers.

  17. Minimally invasive approaches for the treatment of inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Marco Zoccali; Alessandro Fichera

    2012-01-01

    Despite significant improvements in medical management of inflammatory bowel disease,many of these patients still require surgery at some point in the course of their disease.Their young age and poor general conditions,worsened by the aggressive medical treatments,make minimally invasive approaches particularly enticing to this patient population.However,the typical inflammatory changes that characterize these diseases have hindered wide diffusion of laparoscopy in this setting,currently mostly pursued in high-volume referral centers,despite accumulating evidences in the literature supporting the benefits of minimally invasive surgery.The largest body of evidence currently available for terminal ileal Crohn's disease shows improved short term outcomes after laparoscopic surgery,with prolonged operative times.For Crohn's colitis,high quality evidence supporting laparoscopic surgery is lacking.Encouraging preliminary results have been obtained with the adoption of laparoscopic restorative total proctocolectomy for the treatment of ulcerative colitis.A consensus about patients' selection and the need for staging has not been reached yet.Despite the lack of conclusive evidence,a wave of enthusiasm is pushing towards less invasive strategies,to further minimize surgical trauma,with single incision laparoscopic surgery being the most realistic future development.

  18. The Laparoscopic Approach in the Treatment of Diverticular Colon Disease

    Science.gov (United States)

    del Olmo, J. C. Martin; Blanco, J. I.; de la Cuesta, C.; Atienza, R.

    1998-01-01

    Background and Objectives: The experience with treatment of diverticular colon disease (DCD) by the laparoscopic method is analyzed. Methods: Between January 1994 and July 1997, a group of 22 patients with criteria for symptomatic diverticular disease in the descending and sigmoid colon underwent laparoscopy with average resections of 40 cm. Intra-abdominal mechanical anastomosis completed the procedure. Results: The operative morbidity was 28%. Two cases, in acute diverticulitis phase, were reconverted to open surgery, and three cases presented postoperative rectorrhagia which ceased spontaneously. No long-term complications have been found. Postoperative hospitalization was 4-8 days (mean 5.5) and mean operative time was 165 minutes (range 120-240). Conclusions: Nevertheless, the learning curve precise to practice this type of surgery, the acceptable morbity-mortality rates which the laparoscopic method presents, especially with these high-risk groups of patients (age > 65, high blood pressure, etc), encouraged us to modified the criteria indicating surgery for the disease, offering first choice operative treatment with efficiency and safety. However, we feel that those patients with acute complications of diverticular colon disease must be excluded initially for laparoscopic approach. PMID:9876730

  19. Selection of treatment and surgical approach for vestibular schwannomas

    International Nuclear Information System (INIS)

    Eguchi, Kuniki; Yamaguchi, Satoshi; Sakoda, Eiichiro

    2007-01-01

    Described are the present state of selection of stereotactic radiotherapy or surgical treatment and their combination for schwannomas in the title, and authors' policy of surgery as a first choice treatment. The policy stands on the concept that surgery is useful for the controllability thereafter of the tumor, of which size is at first larger than 25 mm diameter, and radiotherapy like a gamma-knife is applicable to the residual tissue grown after operation and to the tissue with less than the size before surgery because the smaller the size, the better is thought the control by the knife (reportedly 100% for the tissue of <14 mm diameter). The basis of authors' selection of two surgical approaches of through-lower lateral occiput and trans-labyrinthine, and their outcomes like hearing loss are described and discussed in details for 24 patients (two underwent radiotherapy before surgery) during the period Sep. 2003-Aug. 2006 of authors' hospital. Radiotherapy is thought essentially useful for the control of the tumor with a small or surgically reduced size. (R.T.)

  20. A meta-analysis of the effectiveness of individually oriented Cognitive Behavioral Treatment (CBT) for severe agressive behavior in adolescents

    NARCIS (Netherlands)

    Hoogsteder, L.M.; Stams, G.J.J.M.; Figge, M.A.; Changoe, K.; van Horn, J.E.; Hendriks, J.; Wissink, I.B.

    2015-01-01

    This meta-analysis, including six studies (13 effect sizes) and 164 adolescents, examined the effectiveness of individually oriented treatment (which means that the intervention contained at least an individual component, possibly in combination with group and/or family therapy) with CBT-elements

  1. Measuring the individual benefit of a medical or behavioral treatment using generalized linear mixed-effects models.

    Science.gov (United States)

    Diaz, Francisco J

    2016-10-15

    We propose statistical definitions of the individual benefit of a medical or behavioral treatment and of the severity of a chronic illness. These definitions are used to develop a graphical method that can be used by statisticians and clinicians in the data analysis of clinical trials from the perspective of personalized medicine. The method focuses on assessing and comparing individual effects of treatments rather than average effects and can be used with continuous and discrete responses, including dichotomous and count responses. The method is based on new developments in generalized linear mixed-effects models, which are introduced in this article. To illustrate, analyses of data from the Sequenced Treatment Alternatives to Relieve Depression clinical trial of sequences of treatments for depression and data from a clinical trial of respiratory treatments are presented. The estimation of individual benefits is also explained. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  2. Addressing Social Anxiety Concurrently With Prison-Based Sex Offender Treatment: A Case of Individual Needs in an Era of Manualized Treatment.

    Science.gov (United States)

    Lasher, Michael P; Webb, Jon R; Stinson, Jill D; Cantrell, Peggy J

    2017-07-01

    Emotional regulation may be an underaddressed therapeutic target in sex offender treatment. This article presents a case report of "Adam," a Caucasian male referred to a prison-based sex offender treatment program. Adam's social anxiety was recognized as an antecendent to his sexual offending, and treatment of such, as a critical adjunct to sex offender treatment, is discussed herein. Adam's individualized treatment included aspects of rational emotive behavior therapy and time-limited dynamic psychotherapy. Adam showed an increased understanding of his anxiety and improvement in his social interactions, both in the context of treatment groups and with female staff, and was willing to continue follow-up care in the community. This case provides support for the individualized treatment of incarcerated offenders as opposed to exclusively utilizing manualized psychoeducational interventions.

  3. [Individual parameters of general low-frequency magnetic therapy as a possibility for improving the clinical efficacy of the combined treatment of patients with essential arterial hypertension].

    Science.gov (United States)

    Fedotov, V D; Maslov, A G; Lobkaeva, E P; Krylov, V N; Obukhova, E O

    2012-01-01

    A new approach is proposed for the choice of low-frequency magnetic therapy on an individual basis using the results of analysis of heart rhythm variability. The clinical efficiency of low-frequency magnetic therapy incorporated in the combined treatment of 65 patients aged between 25 and 45 years with essential arterial hypertension was estimated. The statistically significant positive effects of the treatment included normalization of blood pressure and characteristics of heart rhythm variability as well as resolution of clinical symptoms of vegetative dysregulation.

  4. New approach for validating the segmentation of 3D data applied to individual fibre extraction

    DEFF Research Database (Denmark)

    Emerson, Monica Jane; Dahl, Anders Bjorholm; Dahl, Vedrana Andersen

    2017-01-01

    We present two approaches for validating the segmentation of 3D data. The first approach consists on comparing the amount of estimated material to a value provided by the manufacturer. The second approach consists on comparing the segmented results to those obtained from imaging modalities...

  5. Parental cancer: Characteristics of users of child-centred counselling versus individual psycho-oncological treatment.

    Science.gov (United States)

    Inhestern, Laura; Geertz, Wiebke; Schulz-Kindermann, Frank; Bergelt, Corinna

    2018-03-01

    The aims of this study were to investigate the characteristics of users of a specific child-centred counselling service (COSIP) and to compare those to parents using an individual psycho-oncological treatment (PO). We conducted a retrospective analysis on data of users of COSIP and users of PO. Database was the routine assessment (demographic and disease-related characteristics, GAD-7, PHQ-9, EORTC QLQ-C30, and current concerns) of an outpatient psycho-oncological clinic with additional child-centred counselling. A total of 151 patients and 49 partners with children ≤21 years were included. We conducted descriptive analyses and group comparisons. Fifty-nine patients and partners used COSIP only or additionally to individual psycho-oncological service. PO users were more depressed and were more anxious than COSIP users. Patients using PO reported worse emotional functioning than patients using COSIP. Partners using PO reported worse global quality of life and more symptoms of fatigue than partners using COSIP. With regard to current concerns, patients using COSIP reported child-related issues more frequently than PO users. PO users reported symptoms of anxiety, depressive symptoms, or exhaustion more frequently than COSIP users. The findings demonstrate that patients and partners self-referring to PO or COSIP are highly burdened. COSIP users experience different psychosocial burden than PO users. As poor mental state of parents is a risk factor for the development of mental problems in children, parents using only PO may benefit from additional child-centred support. Accordingly, the need for COSIP should be assessed continuously during PO of patients with children ≤21 years. Copyright © 2017 John Wiley & Sons, Ltd.

  6. Individualized Selection of Beam Angles and Treatment Isocenter in Tangential Breast Intensity Modulated Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Penninkhof, Joan, E-mail: j.penninkhof@erasmusmc.nl [Department of Radiation Oncology, Erasmus M.C. Cancer Institute, Rotterdam (Netherlands); Spadola, Sara [Department of Radiation Oncology, Erasmus M.C. Cancer Institute, Rotterdam (Netherlands); Department of Physics and Astronomy, Alma Mater Studiorum, University of Bologna, Bologna (Italy); Breedveld, Sebastiaan; Baaijens, Margreet [Department of Radiation Oncology, Erasmus M.C. Cancer Institute, Rotterdam (Netherlands); Lanconelli, Nico [Department of Physics and Astronomy, Alma Mater Studiorum, University of Bologna, Bologna (Italy); Heijmen, Ben [Department of Radiation Oncology, Erasmus M.C. Cancer Institute, Rotterdam (Netherlands)

    2017-06-01

    Purpose and Objective: Propose a novel method for individualized selection of beam angles and treatment isocenter in tangential breast intensity modulated radiation therapy (IMRT). Methods and Materials: For each patient, beam and isocenter selection starts with the fully automatic generation of a large database of IMRT plans (up to 847 in this study); each of these plans belongs to a unique combination of isocenter position, lateral beam angle, and medial beam angle. The imposed hard planning constraint on patient maximum dose may result in plans with unacceptable target dose delivery. Such plans are excluded from further analyses. Owing to differences in beam setup, database plans differ in mean doses to organs at risk (OARs). These mean doses are used to construct 2-dimensional graphs, showing relationships between: (1) contralateral breast dose and ipsilateral lung dose; and (2) contralateral breast dose and heart dose (analyzed only for left-sided). The graphs can be used for selection of the isocenter and beam angles with the optimal, patient-specific tradeoffs between the mean OAR doses. For 30 previously treated patients (15 left-sided and 15 right-sided tumors), graphs were generated considering only the clinically applied isocenter with 121 tangential beam angle pairs. For 20 of the 30 patients, 6 alternative isocenters were also investigated. Results: Computation time for automatic generation of 121 IMRT plans took on average 30 minutes. The generated graphs demonstrated large variations in tradeoffs between conflicting OAR objectives, depending on beam angles and patient anatomy. For patients with isocenter optimization, 847 IMRT plans were considered. Adding isocenter position optimization next to beam angle optimization had a small impact on the final plan quality. Conclusion: A method is proposed for individualized selection of beam angles in tangential breast IMRT. This may be especially important for patients with cardiac risk factors or an

  7. The Multidisciplinary Conservative Approach in Treatment of TOS

    Directory of Open Access Journals (Sweden)

    F. Layeghi

    2010-10-01

    Full Text Available Objectives: The aims of this study were to evaluate the efficacy of conservative treatment in patients with and without cervical ribs and Thoracic Outlet Syndrome (TOS. From so many kinds of conservative treatment in literature, we used a multidisciplinary approach (correction of posture, maximizing muscle endurance and power, stretch shorten muscles, massage for trigger points and maximize thoracic span with stomach breathing to get more effective treatment and a longer time of relief with less duration and more long-term relief. Methods: Twenty six female patients with or without cervical ribs, pain and numbness were included in this study. They were assessed in terms of posture, muscle testing and shortness in muscles in all part of the body. Initial pain status were recorded and after eight weeks treatment including posture correction, their pain were assessed again with visual analogue scale that 0 was no pain and 10 was intolerable pain. Results: In 100 % of patients initial pain score were more than 5 in visual analogue scale. 23.1% of cases showed reduced pain scores to lower than 5 scales. Age was not a significant factor (P=0.93 on pain reducing. Type of posture was independent from pain and pain diminishing (0.004. Cervical rib was effective in initial pain (P=0.08 and degree of diminishing pain (P=0.236. Initial pain of 57.1% of patients with cervical rib was 10 due to visual analogue scale (VAS. In 33.3% of the persons with bilateral cervical rib we saw more than 5 degree in diminishing pain. In the 85.7% patients with unilateral cervical rib, we had more than 5 degree diminishing pain and we saw this in all of the non cervical rib TOS. Dicussion: Faulty posture can cause narrowing of the thoracic outlet space and may lead to pain and numbness, and some other symptoms. Correction of posture despite of cervical rib can widen the space and reduces pressure on vessels and nerves. Postural correction and long time follow up must be

  8. Universal Approach to Estimate Perfluorocarbons Emissions During Individual High-Voltage Anode Effect for Prebaked Cell Technologies

    Science.gov (United States)

    Dion, Lukas; Gaboury, Simon; Picard, Frédéric; Kiss, Laszlo I.; Poncsak, Sandor; Morais, Nadia

    2018-04-01

    Recent investigations on aluminum electrolysis cell demonstrated limitations to the commonly used tier-3 slope methodology to estimate perfluorocarbon (PFC) emissions from high-voltage anode effects (HVAEs). These limitations are greater for smelters with a reduced HVAE frequency. A novel approach is proposed to estimate the specific emissions using a tier 2 model resulting from individual HVAE instead of estimating monthly emissions for pot lines with the slope methodology. This approach considers the nonlinear behavior of PFC emissions as a function of the polarized anode effect duration but also integrates the change in behavior attributed to cell productivity. Validation was performed by comparing the new approach and the slope methodology with measurement campaigns from different smelters. The results demonstrate a good agreement between measured and estimated emissions as well as more accurately reflect individual HVAE dynamics occurring over time. Finally, the possible impact of this approach for the aluminum industry is discussed.

  9. Immunological changes in human immunodeficiency virus (HIV)-infected individuals during HIV-specific protease inhibitor treatment

    DEFF Research Database (Denmark)

    Ullum, H; Katzenstein, T; Aladdin, H

    1999-01-01

    The present study examines the influence of effective anti-retroviral treatment on immune function, evaluated by a broad array of immunological tests. We followed 12 individuals infected with human immunodeficiency virus (HIV) for 6 months after initiation of combination anti-retroviral treatment...

  10. Attitudes and preferences towards exercise training in individuals with alcohol use disorders in a residential treatment setting.

    Science.gov (United States)

    Stoutenberg, Mark; Warne, James; Vidot, Denise; Jimenez, Erika; Read, Jennifer P

    2015-02-01

    Alcohol use disorders (AUD) are a major public health concern due to their association with several acute and chronic health conditions. Exercise training offers a myriad of physical and mental health benefits, and may be a promising adjunct intervention for those in AUD treatment. The purpose of this study was to explore the possible role of exercise training as a treatment strategy by examining the attitudes, beliefs, and preferences of individuals entering residential AUD treatment. Surveys were administered to eligible individuals with AUD within 2days of intake to one of two residential treatment centers. The survey asked respondents about their attitudes, beliefs, and preferences towards exercise training as a part of their residential treatment. Respondents were in favor of receiving exercise counseling as part of their treatment (70.6%), in a face-to-face format (90.0%), and from an exercise counselor at the treatment center (55.5%). The top reported benefits included: improved health, feeling good about oneself, and feeling more confident. The most commonly reported barriers to exercise training included transportation issues, lack of motivation, knowledge, and proper equipment, and cost. Our study supports previous work in individuals with substance abuse disorders and suggests that exercise training would be widely accepted as a part of residential treatment for AUD. This study also identified several strategies that can be used to individualize exercise training programs to better meet the needs of AUD patients and maximize their participation in future interventions. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Emerging targets and therapeutic approaches for the treatment of osteoarthritis pain.

    Science.gov (United States)

    Rahman, Wahida; Dickenson, Anthony H

    2015-06-01

    Osteoarthritis is a complex and often painful disease that is inadequately controlled with current analgesics. This review discusses emerging targets and therapeutic approaches that may lead to the development of better analgesics. Aberrant excitability in peripheral and central pain pathways drives osteoarthritis pain, reversing this via modulation of nerve growth factor, voltage-gated sodium channel, voltage-gated calcium channel and transient receptor potential vanilloid one activity, and increasing inhibitory mechanisms through modulation of cannabinoid and descending modulatory systems hold promise for osteoarthritis pain therapy. Somatosensory phenotyping of chronic pain patients, as a surrogate of putative pain generating mechanisms, may predict patient response to treatment. Identification of new targets will inform and guide future research, aiding the development of more effective analgesics. Future clinical trial designs should implement sensory phenotyping of patients, as an inclusion or stratification criterion, in order to establish an individualized, mechanism-based treatment of osteoarthritis pain.

  12. Pharyngeal electrical stimulation for treatment of poststroke dysphagia: individual patient data meta-analysis of randomised controlled trials

    OpenAIRE

    Scutt, Polly; Lee, Han S.; Hamdy, Shaheen; Bath, Philip M.W.

    2015-01-01

    Background. Dysphagia after stroke is common, associated independently with poor outcome, and has limited treatment options. Pharyngeal electrical stimulation (PES) is a novel treatment being evaluated for treatment of poststroke dysphagia. Methods. We searched electronically for randomised controlled trials of PES in dysphagic patients within 3 months of stroke. Individual patient data were analysed using regression, adjusted for trial, age, severity, and baseline score. The coprimary outcom...

  13. Novel electrophysiological approaches to clinical epilepsy. Diagnosis and treatment

    International Nuclear Information System (INIS)

    Kanazawa, Kyoko; Matsumoto, Riki; Ikeda, Akio; Kinoshita, Masako

    2011-01-01

    Seizure onset zone (SOZ) is currently defined by ictal epileptiform discharges, which are most commonly recorded as regional low-voltage fast waves or repetitive spikes. Interictal epileptiform discharges, on the other hand, are not specific enough for SOZ as they are recorded at zones other than the SOZ; they are also recorded from areas that do not generate the ictal pattern and from areas to which ictal discharges propagate. Besides spikes and sharp waves, a novel index of human epileptogenicity has been investigated in association with wide-band electroencephalography (EEG) analysis. We primarily noted the following during clinical neurophysiological analysis for clinical epilepsy. Recent development of digital EEG technology enabled us to record wide-band EEG in a clinical setting. Thus, high frequency (>200 Hz) and low frequency (<1 Hz) components can be reliably recorded using subdural electrodes. Direct current shift, slow shift, ripple, and fast ripple can be well delineated, and they will be potentially useful in the diagnosis and management of epileptic patients. Fiber tractography (morphological parameter) and cortico-cortical-evoked potentials with single cortical stimulation (electrophysiological parameter) elucidated cortico-cortical connections in human brain. The data thus obtained can help us understand the mechanism of seizure propagation and normal cortical functional connectivity. Non-invasive simultaneous recording of EEG and functional magnetic resonance imaging (fMRI) provided information on the roles of deep brain structures associated with scalp-recorded epileptiform discharges. Interventional neurophysiology can shed light on the non-pharmacological treatment of epilepsy. In this report, we discuss these novel electrophysiological approaches to the diagnosis and treatment of clinical epilepsy. (author)

  14. A novel Antibody based approach to Cancer Treatment

    Directory of Open Access Journals (Sweden)

    Yoshikazu Kurosawa

    2010-01-01

    Full Text Available Cancer is one of the leading causes of death among the human race. No valid modalities of treatment other than surgical treatment have been established for this disease. We aimed to identify and to characterize cancer using large number of human monoclonal antibodies (mAbs which are specific against their surface for new molecular targeted immunotherapy. In order to find proper targets for therapeutic antibodies against cancers we developed a screening strategy. We used a huge phage library of human antibodies. At the first step we comprehensively isolated many monoclonal antibodies (mAbs that specifically bound to surface of cancer cells. Development of ICOS (Isolation of antigen/antibody complexes through organic solvent method allowed us to succeed in isolation of a huge number of mAbs with various characteristics (Y Akahori et al. 2009. At the next step we selected clones that showed tumor-specific staining patterns in immunohistochemical (IHC analysis by using many fresh cancer tissues reseted. Many surgeons took part in this project. Finally the antigens recognized by these clones were identified by immunoprecipitation (IP followed by analysis with mass (MS spectrometry (G Kurosawa et al. 2009. We have succeeded in identification of 29 tumor-associated antigens (TAAs and in isolation of 441 human mAbs that specifically bound to one of the 29 TAAs (G Kurosawa et al. 2008. In these screenings of the library, rounds of the selection process, mixing of cells and phage particles centrifugation growth of phages, were repeated three to four times in each screening. Therefore, numbers of phages of the clones whose antigens were abundantly present on the cell surface increased during the screenings. Recently we developed a new method for isolation of clones whose antigens were less abundantly present on the cell surface. Hence, we would like to talk on these methodology and discuss regarding this “A novel antibody based approach to Cancer

  15. Individual trajectories in stress covary with immunity during recovery from cancer diagnosis and treatments.

    Science.gov (United States)

    Thornton, Lisa M; Andersen, Barbara L; Crespin, Timothy R; Carson, William E

    2007-02-01

    Research connects stressful events with altered immune regulation, but the role of subjective stress is uncertain. Using a longitudinal design, we provide a statistically powerful test of the relationship between subjective stress (perceived stress, emotional distress) and immunity (T cell blastogenesis, natural killer cell cytotoxicity, [NKCC]) as individuals adjust to a severe stressor, a cancer diagnosis and its treatments. Women with regional breast cancer (N=113) were assessed at diagnosis/surgery and reassessed 4, 8, 12, and 18 months later. Latent growth curve analysis tested two hypotheses: (1) initial levels of subjective stress will correlate inversely with initial levels of immunity, and (2) rate of change in subjective stress will correlate inversely with rate of change in immunity. As predicted by Hypothesis 1, participants with high initial subjective stress showed poor initial blastogenesis. As predicted by Hypothesis 2, participants exhibiting an early, rapid decline in subjective stress also showed rapid improvement in NKCC. Follow-up analyses revealed perceived stress to be strongly related to immune function, while emotional distress was not. This is the first study to investigate trajectories in stress and immunity during recovery from a major stressor. Results imply that NK and T cells are sensitive to different aspects of the stress response. While T cell blastogenesis correlated with initial (peak) subjective stress, NKCC correlated with change (improvement) in subjective stress. These data highlight the importance of subjective stress, particularly stress appraisals, in the immune response to a major stressor.

  16. Comparison of craving for opioid in opioid-dependent individuals and people under methadone maintenance treatment

    Directory of Open Access Journals (Sweden)

    Azita Chehri

    2014-02-01

    Full Text Available Background: Methadone Maintenance Therapy (MMT is the most important treatment for opioid -dependency recurrence. The aim of this study was to compare the craving level in opioid-dependent individuals and people under methadone maintenance therapy. Methods: In this case – control study, 120 men with opioid dependency were selected through cluster sampling method. They were divided into two groups, 60 people in opioid-dependent group and 60 people in MMT group. Both groups were matched for age, sex, marital status, education, duration of opioid dependency and method of consumption. Then, they completed INCAS Substance Abuse Profile (ISAP, opiate withdrawal symptoms checklist, self–report of craving, Desire for Drug Questionnaire (DDQ, Obsessive Compulsive Drug Use Scale (OCDUS and visual cue-induced craving questionnaire. Data were analyzed by SPSS 15 using t-test and ANOVA. Results: Mean craving for drug significantly was lower in MMT group comparing opioid-dependent group (P<0.01. Conclusion: Methadone Maintenance Therapy decreased the craving for drugs and substances This can have an important role in relapse prevention.

  17. Individual Savings Accounts and the Life-Cycle Approach to Social Insurance

    DEFF Research Database (Denmark)

    Sørensen, Peter Birch; Hansen, Martin Ino; Bovenberg, A. Lans

    Using Danish data, we find that about three fourths of the taxes levied to finance public transfers actually finance benefits that do not redistribute between people but redistribute income over the life cycle of individual taxpayers. This provides a rationale for financing part of social insurance...... via mandatory individual savings accounts. An account system that offers liquidity insurance and a lifetime income guarantee helps to alleviate the dilemma between insurance and incentives. To illustrate this, we analyse a specific proposal for reform of the Danish system of social insurance......, involving the use of individual accounts. We estimate how the reform would affect the distribution of lifetime incomes, the public budget, and economic efficiency...

  18. Investigating DIF and extensions using an LLTM approach and also an individual differences approach: an international testing context

    Directory of Open Access Journals (Sweden)

    YIYU XIE

    2008-09-01

    Full Text Available This study intends to investigate two ways to generalise differential item functioning (DIF by grouping of items that share a common feature, or an item property as in the Linear Logistic Test Model (LLTM. An item “facet” refers to this type of grouping, and DIF can be expressed in terms of more fundamental parameters that relate to the facet of items. Hence the differential facet functioning (DFF model, a particular version of the LLTM, helps to explain the DIF effects more substantively. Using the mathematics data from the Program for International Student Assessment (PISA 2003, this study shows that modeling the DFF effect through an interaction of the group-by-facet parameter rather than DIF effect on the individual item level can be handled easily with the NLMIXED procedure of SAS. We found that the results are more interpretable when the bias is interpreted on the facet level rather than the item level. Analogous to the multidimensional DIF model, one natural extension of the DFF model is to make the model multidimensional when DFF facets (i.e., LLTM facets are considered as dimensions. This extension, multidimensional DFF (MDFF, is also investigated. The MDFF model allows individual differences to be modeled on the dimension that exhibits a DFF effect. However, it is always recommended to check the individual DIF estimates and construct a substantive analysis first before conducting DFF and MDFF analysis.

  19. New Approaches to Treatment of Severe Intrauterine Growth Restriction

    Directory of Open Access Journals (Sweden)

    Zhanar Kurmangali

    2014-12-01

    Full Text Available Introduction. Intrauterine growth restriction (IUGR is a leading cause of perinatal morbidity and mortality due to placental insufficiency. Currently, one of the new approaches to treating this disease is the injection of nutrients to the fetus through intravascular port-systems (catheters.Objective. To assess the impact of nutrient injections as treatment to fetuses with severe growth retardation.Materials and methods. Pregnant women with IUGR (abdominal circumference (AC < 5th percentile with the absence of diastolic flow in the umbilical artery and a fetal gestational age of less than 30 weeks were randomly divided into two groups. The treatment group included six pregnant women who had an intravascular port-system for the infusion of nutrients (amino acids and glucose in the umbilical vein of the fetus for 14 ± 3 days. The control group consisted of eight patients who received only traditional dynamic monitoring and delivery at the optimum time of pregnancy. Fetal status was assessed using ultrasound equipment Accuvix V20 (Medison, South Korea by examining indicators of biometry and Doppler study of blood flow in utero, umbilical arteries, middle cerebral artery, and ductus venosus with fetal vascular resistance index calculation - pulsatility index (PI. Criteria for blood flow disturbances in the vessels were considered PI values above normal values for their gestational age, which were defined as absence or reverse blood flow in a diastole in the umbilical artery.Results. In a comparative analysis of the two groups, the treatment led to a 44.7% increase in AC of the fetus (121.0 ± 11.5 mm and 219.3 ± 18.3 mm, respectively, p ˂ 0.001. In all cases, the profile of blood flow in the umbilical artery had a positive diastolic component. As a result, there was a 45.3% decrease in PI in the umbilical artery (2.14 ± 0.54 and 1.17 ± 0.15, respectively, p < 0.05. Average fetal weight in the study group was not significantly higher than the

  20. Improving efficiency and safety in external beam radiation therapy treatment delivery using a Kaizen approach.

    Science.gov (United States)

    Kapur, Ajay; Adair, Nilda; O'Brien, Mildred; Naparstek, Nikoleta; Cangelosi, Thomas; Zuvic, Petrina; Joseph, Sherin; Meier, Jason; Bloom, Beatrice; Potters, Louis

    Modern external beam radiation therapy treatment delivery processes potentially increase the number of tasks to be performed by therapists and thus opportunities for errors, yet the need to treat a large number of patients daily requires a balanced allocation of time per treatment slot. The goal of this work was to streamline the underlying workflow in such time-interval constrained processes to enhance both execution efficiency and active safety surveillance using a Kaizen approach. A Kaizen project was initiated by mapping the workflow within each treatment slot for 3 Varian TrueBeam linear accelerators. More than 90 steps were identified, and average execution times for each were measured. The time-consuming steps were stratified into a 2 × 2 matrix arranged by potential workflow improvement versus the level of corrective effort required. A work plan was created to launch initiatives with high potential for workflow improvement but modest effort to implement. Time spent on safety surveillance and average durations of treatment slots were used to assess corresponding workflow improvements. Three initiatives were implemented to mitigate unnecessary therapist motion, overprocessing of data, and wait time for data transfer defects, respectively. A fourth initiative was implemented to make the division of labor by treating therapists as well as peer review more explicit. The average duration of treatment slots reduced by 6.7% in the 9 months following implementation of the initiatives (P = .001). A reduction of 21% in duration of treatment slots was observed on 1 of the machines (P Kaizen approach has the potential to improve operational efficiency and safety with quick turnaround in radiation therapy practice by addressing non-value-adding steps characteristic of individual department workflows. Higher effort opportunities are identified to guide continual downstream quality improvements. Copyright © 2017 American Society for Radiation Oncology. Published by

  1. Perception of individualism and collectivism in Dutch society: A developmental approach.

    NARCIS (Netherlands)

    Oppenheimer, L.J.T.

    2004-01-01

    Within Triandis's (1994) theoretical framework, two studies are reported that deal with the developmental course for subjective perceptions of cultural dimensions in Dutch society (i.e., vertical and horizontal individualism and collectivism). While perceptions of society are always subjectively

  2. METHODOLOGICAL APPROACH TO THE PHENOMENON OF SOCIAL RESPONSIBILITY OF THE INDIVIDUAL

    OpenAIRE

    L. A. Saenko; E. I. Zritneva

    2016-01-01

    The authors present an analysis of the phenomenon of "social responsibility of the individual" research from various perspectives. Based on the research of domestic and foreign scientists, as well as the experience of the authors own activities build mechanisms of socially responsible behavior of the person. Emphasis is based on the research of R. Selman, a conductive connection between social responsibility and social intelligence of the individual. In the article are described results of F....

  3. Experimental Determination of Effectiveness of an Individual Information-Centered Approach in Recovering Step-Count Missing Data

    Science.gov (United States)

    Kang, Minsoo; Zhu, Weimo; Tudor-Locke, Catrine; Ainsworth, Barbara

    2005-01-01

    Missing values are a common phenomenon in physical activity research, which has a negative impact on the quality of the data collected. The purpose of this study was to determine empirically the effectiveness of an individual information-centered (II-centered) approach in recovering step-count missing values by comparing the performance of the…

  4. A Cross-Cultural Approach to the Negotiation of Individual and Group Identities: Parliamentary Debates and Editorial Meetings

    Science.gov (United States)

    Stewart, Miranda

    2012-01-01

    This article draws on interactional pragmatics and a cross-cultural approach (UK, France, Spain) to investigate the negotiation of individual and group identities in two different speech events, parliamentary debates and editorial meetings. The cross-cultural examination of the use of linguistic resources for signalling "social role,…

  5. Treatment Approach for Infection of Healed Fractures After Internal Fixation.

    Science.gov (United States)

    Lawrenz, Joshua M; Frangiamore, Salvatore J; Rane, Ajinkya A; Cantrell, William Alex; Vallier, Heather A

    2017-11-01

    To review the efficacy of a treatment approach for patients with infection and colonized implants after open reduction and internal fixation of fractures. Retrospective case series. Level one trauma center. Twenty patients were treated for wound infection with colonized implants after open reduction and internal fixation. Surgical debridement, removal of implants, and a short postoperative oral antibiotic course. The course of patients after surgical debridement and removal of implants, including culture results, antibiotic administration, and presence of recurrent clinical infection and radiographic union. Twenty patients had clinical presentations, including skin breakdown, serous drainage, purulent drainage and/or exposed implants, most commonly of the tibia (15 of 20). Mean time from index procedure to debridement with implant removal was 19.7 months. At the time of debridement and implant removal, 18 of 20 (90%) patients had a positive intraoperative culture (16 routine cultures and 2 broth cultures). The most common bacteria were Enterobacter cloacae (5/17) and methicillin-sensitive Staphylococcus aureus (4/17). All patients had soft tissue healing without signs of recurrent infection after mean follow up of 40 months after implant removal. Surgical debridement with implant removal plus a short oral antibiotic course is effective to resolve wound infection with a colonized implant in the setting of healed fracture after internal fixation. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  6. Post-fundoplication symptoms and complications: Diagnostic approach and treatment

    Directory of Open Access Journals (Sweden)

    S. Sobrino-Cossío

    2017-07-01

    Full Text Available Laparoscopic Nissen fundoplication is currently considered the surgical treatment of choice for gastroesophageal reflux disease (GERD and its long-term effectiveness is above 90%. Adequate patient selection and the experience of the surgeon are among the predictive factors of good clinical response. However, there can be new, persistent, and recurrent symptoms after the antireflux procedure in up to 30% of the cases. There are numerous causes, but in general, they are due to one or more anatomic abnormalities and esophageal and gastric function alterations. When there are persistent symptoms after the surgical procedure, the surgery should be described as “failed”. In the case of a patient that initially manifests symptom control, but the symptoms then reappear, the term “dysfunction” could be used. When symptoms worsen, or when symptoms or clinical situations appear that did not exist before the surgery, this should be considered a “complication”. Postoperative dysphagia and dyspeptic symptoms are very frequent and require an integrated approach to determine the best possible treatment. This review details the pathophysiologic aspects, diagnostic approach, and treatment of the symptoms and complications after fundoplication for the management of GERD. Resumen: En la actualidad la funduplicatura laparoscópica tipo Nissen se considera el tratamiento quirúrgico de elección para la enfermedad por reflujo gastroesofágico (ERGE y su efectividad a largo plazo es mayor del 90%. Dentro de los factores predictores de buena respuesta clínica están la adecuada selección del paciente y la experiencia del cirujano. Sin embargo, la prevalencia de síntomas nuevos, persistentes y recurrentes posteriores al procedimiento antirreflujo puede ser de hasta un 30%. Las causas son múltiples pero en general se deben a una o más alteraciones en la anatomía y en la función esofagogástrica. Ante la

  7. Underlying motivation in the approach and avoidance goals of depressed and non-depressed individuals.

    Science.gov (United States)

    Sherratt, Katherine A L; MacLeod, Andrew K

    2013-01-01

    Neurobiological theories predict decreased approach motivation and increased avoidance motivation in depression, but the results of previous studies have been equivocal. This study addressed a key limitation of previous research by assessing participants' underlying motivation for adopting their goals. Depressed (N=26) and non-depressed (N=33) participants listed approach and avoidance goals and wrote down their underlying reasons for adopting those goals. The groups did not differ on either the number of goals or underlying reasons but when underlying reasons were coded for approach or avoidance motivation depressed participants, compared to controls, showed less approach motivation and more avoidance motivation in relation to their approach goals. There were no effects related to avoidance goals. The results suggest that while the goals of depressed persons appear to be similar to those who are not depressed there are important differences at the level of underlying motivation.

  8. Failure after Success: Correlates of Recidivism among Individuals Who Successfully Completed Coerced Drug Treatment

    Science.gov (United States)

    Sung, Hung-En; Belenko, Steven

    2005-01-01

    A subset of criminal offenders diverted from prison to treatment return to crime after successful completion of treatment. Identifying correlates of recidivism among treatment completers will improve our ability to help treated offenders to better capitalize on their treatment experiences. Data from 156 mandated clients of long-term residential…

  9. Headache after traumatic brain injury: a national survey of clinical practices and treatment approaches.

    Science.gov (United States)

    Brown, Allen W; Watanabe, Thomas K; Hoffman, Jeanne M; Bell, Kathleen R; Lucas, Sylvia; Dikmen, Sureyya

    2015-01-01

    Individuals with headache after traumatic brain injury (TBI) receive care in a wide variety of clinical locations by physicians trained in multiple specialties. To understand current practice patterns and perceptions of treatment issues among clinicians managing headache after TBI. National survey of current clinical practice using a 20-item questionnaire developed by the authors. Survey respondents were members of the Central Nervous System Council list survey of the American Academy of Physical Medicine and Rehabilitation (N = 1782) and the American Headache Society membership (N = 1260). The survey was sent electronically to potential participants and was followed by 2 biweekly reminders. The survey queried the physicians' clinical setting; their use of headache classification systems, headache diaries, checklists, and diagnostic procedures; the pharmacologic and nonpharmacologic treatments prescribed; and headache chronicity and associated symptoms and disorders among their patients with TBI. Completed surveys were received from 193 respondents. The use of standardized classification systems and checklists was commonly reported. Respondents used nonpharmacologic and pharmacologic treatment approaches with similar frequency and modest perceived success rates. A high frequency of headache-associated new sleep and mood disorders was reported. When response differences occurred between practice settings, they reflected a focus on headache diagnosis, classification, and pharmacologic treatment among neurology and specialty headache clinics, whereas a nonpharmacologic approach to management among TBI specialty and general rehabilitation clinicians was more commonly reported. Management strategies for treating headache after TBI vary widely among general and specialty clinical practices. This suggests that additional research is needed that would lead to an increase in the use of established headache classification and the development of standardized management

  10. Effectiveness of integrating individualized and generic complementary medicine treatments with standard care versus standard care alone for reducing preoperative anxiety.

    Science.gov (United States)

    Attias, Samuel; Keinan Boker, Lital; Arnon, Zahi; Ben-Arye, Eran; Bar'am, Ayala; Sroka, Gideon; Matter, Ibrahim; Somri, Mostafa; Schiff, Elad

    2016-03-01

    Preoperative anxiety is commonly reported by people undergoing surgery. A significant number of studies have found a correlation between preoperative anxiety and post-operative morbidity. Various methods of complementary and alternative medicine (CAM) were found to be effective in alleviating preoperative anxiety. This study examined the relative effectiveness of various individual and generic CAM methods combined with standard treatment (ST) in relieving preoperative anxiety, in comparison with ST alone. Randomized controlled trial. Holding room area Three hundred sixty patients. Patients were randomly divided into 6 equal-sized groups. Group 1 received the standard treatment (ST) for anxiety alleviation with anxiolytics. The five other groups received the following, together with ST (anxiolytics): Compact Disk Recording of Guided Imagery (CDRGI); acupuncture; individual guided imagery; reflexology; and individual guided imagery combined with reflexology, based on medical staff availability. Assessment of anxiety was taken upon entering the holding room area (surgery preparation room) ('pre-treatment assessment'), and following the treatment, shortly before transfer to the operating room ('post-treatment assessment'), based on the Visual Analogue Scale (VAS) questionnaire. Data processing included comparison of VAS averages in the 'pre' and 'post' stages among the various groups. Preoperatively, CAM treatments were associated with significant reduction of anxiety level (5.54-2.32, peffective than individualized CAM (Peffective than generic CDRGI. In light of the scope of preoperative anxiety and its implications for public health, integration of CAM therapies with ST should be considered for reducing preoperative anxiety. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Influence of ROI selection on Resting Functional Connectivity: An Individualized Approach for Resting fMRI Analysis

    Directory of Open Access Journals (Sweden)

    William Seunghyun Sohn

    2015-08-01

    Full Text Available The differences in how our brain is connected are often thought to reflect the differences in our individual personalities and cognitive abilities. Individual differences in brain connectivity has long been recognized in the neuroscience community however it has yet to manifest itself in the methodology of resting state analysis. This is evident as previous studies use the same region of interest (ROIs for all subjects. In this paper we demonstrate that the use of ROIs which are standardized across individuals leads to inaccurate calculations of functional connectivity. We also show that this problem can be addressed by taking an individualized approach by using subject-specific ROIs. Finally we show that ROI selection can affect the way we interpret our data by showing different changes in functional connectivity with ageing.

  12. Eculizumab treatment: stochastic occurrence of C3 binding to individual PNH erythrocytes

    Directory of Open Access Journals (Sweden)

    Michela Sica

    2017-06-01

    Full Text Available Abstract Background C5 blockade by eculizumab prevents complement-mediated intravascular hemolysis in paroxysmal nocturnal hemoglobinuria (PNH. However, C3-bound PNH red blood cells (RBCs, arising in almost all treated patients, may undergo extravascular hemolysis reducing clinical benefits. Despite the uniform deficiency of CD55 and of CD59, there are always two distinct populations of PNH RBCs, with (C3+ and without (C3− C3 binding. Methods To investigate this paradox, the phenomenon has been modeled in vitro by incubating RBCs from eculizumab untreated PNH patients with compatible sera containing eculizumab, and by assessing the C3 binding after activation of complement alternative pathway. Results When RBCs from untreated patients were exposed in vitro to activated complement in the context of C5-blockade, there was the prompt appearance of a distinct C3+ PNH RBC population whose size increased with time and also with the rate of complement activation. Eventually, all PNH RBCs become C3+ to the same extent, without differences between old and young (reticulocytes PNH RBCs. Conclusions This study indicates that the distinct (C3+ and C3− PNH RBC populations are not intrinsically different; rather, they result from a stochastic all-or-nothing phenomenon linked to the time-dependent cumulative probability of each individual PNH red cell to be exposed to levels of complement activation able to trigger C3 binding. These findings may envision novel approaches to reduce C3 opsonization and the subsequent extravascular hemolysis in PNH patients on eculizumab.

  13. The effect of cross-sex hormonal treatment on gender dysphoria individuals' mental health: a systematic review.

    Science.gov (United States)

    Costa, Rosalia; Colizzi, Marco

    2016-01-01

    Cross-sex hormonal treatment represents a main aspect of gender dysphoria health care pathway. However, it is still debated whether this intervention translates into a better mental well-being for the individual and which mechanisms may underlie this association. Although sex reassignment surgery has been the subject of extensive investigation, few studies have specifically focused on hormonal treatment in recent years. Here, we systematically review all studies examining the effect of cross-sex hormonal treatment on mental health and well-being in gender dysphoria. Research tends to support the evidence that hormone therapy reduces symptoms of anxiety and dissociation, lowering perceived and social distress and improving quality of life and self-esteem in both male-to-female and female-to-male individuals. Instead, compared to female-to-male individuals, hormone-treated male-to-female individuals seem to benefit more in terms of a reduction in their body uneasiness and personality-related psychopathology and an amelioration of their emotional functioning. Less consistent findings support an association between hormonal treatment and other mental health-related dimensions. In particular, depression, global psychopathology, and psychosocial functioning difficulties appear to reduce only in some studies, while others do not suggest any improvement in these domains. Results from longitudinal studies support more consistently the association between hormonal treatment and improved mental health. On the contrary, a number of cross-sectional studies do not support this evidence. This review provides possible biological explanation vs psychological explanation (direct effect vs indirect effect) for the hormonal treatment-induced better mental well-being. In conclusion, this review indicates that gender dysphoria-related mental distress may benefit from hormonal treatment intervention, suggesting a transient reaction to the nonsatisfaction connected to the incongruent body

  14. Age determination in roe deer - a new approach to tooth wear evaluated on known age individuals

    DEFF Research Database (Denmark)

    Høye, Toke Thomas

    2006-01-01

    A novel, simple, and objective method is presented for ageing roe deer Capreolus capreolus (Linnaeus, 1758) evaluated on 471 lower jaws from roe deer of known age (351 with permanent premolars). It is based on tooth eruption patterns and presence/absence of wear characters in jaws from roe deer...... integrated in a scoring system. Permanent cheek teeth emerge in May-July in the year after birth, which enables precise age determination of individuals with deciduous premolars. For individuals with permanent cheek teeth, the method provides the correct age for all individuals younger than 13 months...... originate from two separated Danish roe deer populations exposed to contrasting habitats, but no difference in wear rate is found between populations. Thus, previous concern about the validity of age determination methods based on tooth wear may have been overstated. The findings demonstrate that objective...

  15. Concept and approaches used in assessing individual and collective doses from releases of radioactive effluents

    International Nuclear Information System (INIS)

    1988-06-01

    To guide on the applications of the principles for limiting radioactive releases contained in Safety Series 77, the Agency is in the process of preparing a number of safety guides. The first one is this present document which deals with the principal aspects of the methods for the assessment of the individual and collective dose. It aims at giving a general guidance to those responsible for establishing programmes for the determination of individual doses as well as collective doses in connection with licensing a site for a nuclear installation. The document is concerned with the principles applied for calculating individual and collective doses from routine releases of radionuclides to the atmosphere and hydrosphere but not releases directly to the geosphere, as in waste management. These areas will be covered by other Agency publications. 75 refs, figs and tabs

  16. Recent Advances of Individual BODIPY and BODIPY-Based Functional Materials in Medical Diagnostics and Treatment.

    Science.gov (United States)

    Marfin, Yuriy S; Solomonov, Alexey V; Timin, Alexander S; Rumyantsev, Evgeniy V

    2017-01-01

    The group of fluorophores on boron dipyrrin platform (4,4- difluoro-4-bora3a,4a-diaza-s-indacene, also known as BODIPY) has attracted much attention in the field of molecular sensorics, including sensing of biomolecules and bioprocesses. Structural diversity of existing BODIPY with ample opportunities of directed modification of compounds makes this class of fluorophores attractive for medical and biological purposes. The recent progress in the design and functionalization of BODIPY allows using them for modification of drug micro- and nanocarriers in order to improve their therapeutic effect in cancer treatment. At the same time, integration of BODIPY into drug carriers provides the possibility of in vitro and in vivo real time imaging of used drug carriers. The high fluorescent intensity and low toxicity of BODIPY granted for conjugation with different biomolecules. The present review focuses on the recent advances for application of individual BODIPY in medical diagnostics, antimicrobial activity, as well as establishing the role of BODIPY in labeling of biomolecules (e.g. proteins, hormones and DNA). Also the review highlights the potential of BODIPY in functionalization of drug micro- and nanocarriers in order to achieve better therapeutic efficiency compared with non-modified materials. The advantages derived from the use of BODIPY for preparation and modification of drug carriers are critically evaluated and potential for future challenges, especially concerning the design of innovative multi-functional BODIPY-based nanocarriers, is discussed in detail using representative examples from literature. Our objective was to show that BODIPY are powerful tools for bioimaging, labeling of biomolecules and construction of new multifunctional drug carriers. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  17. Adherence to Follow-up Recommendations Among Individuals in the Philadelphia Glaucoma Detection and Treatment Project.

    Science.gov (United States)

    Hark, Lisa A; Leiby, Benjamin E; Waisbourd, Michael; Myers, Jonathan S; Fudemberg, Scott J; Mantravadi, Anand V; Dai, Yang; Gilligan, John P; Resende, Arthur F; Katz, L Jay

    2017-08-01

    To evaluate rates of adherence to free follow-up eye exam appointments among participants in the Philadelphia Glaucoma Detection and Treatment Project. Ophthalmologists and testing equipment were brought directly to participants at risk for glaucoma at 43 community sites in Philadelphia. Those diagnosed with glaucoma-related pathology were recommended to return for follow-up to be reexamined on site. Rates of adherence and clinical and demographic risk factors for adherence were evaluated. Five hundred thirty-one participants were diagnosed with glaucoma-related conditions and recommended to attend community-based follow-up exams. Follow-up adherence rate was 61.2% (n=325/531). Significant factors associated with greater eye exam appointment adherence, based on our univariable analysis, included final diagnosis of glaucoma (risk ratio [RR]=1.33; 95% confidence interval [CI], 1.13-1.57), male sex (RR=1.19; 95% CI, 1.04-1.36), white race (RR=1.26; 95% CI, 1.08-1.48), age (RR=1.17; 95% CI, 1.00-1.37) recommendation for glaucoma medication (RR=1.52; 95% CI, 1.35-1.71), recommendation for laser peripheral iridotomy (RR=1.18; 95% CI, 1.02-1.35), diagnosis of age-related macular degeneration (RR=1.42; 95% CI, 1.13-1.77) and an increased intraocular pressure (>22 mm Hg in the worse eye) (RR=1.23; 95% CI, 1.06-1.42). On the basis of our multivariable model, diagnosis, sex, and recommended glaucoma medications were significantly associated with follow-up adherence. This study demonstrates that individuals living in underserved urban communities would take advantage of free eye exams in community sites and return for follow-up eye exams in these same settings. Future studies could investigate interventions to improve eye exam appointment adherence in community-based settings to detect glaucoma-eye conditions.

  18. Comparing barriers to mental health treatment and substance use disorder treatment among individuals with comorbid major depression and substance use disorders.

    Science.gov (United States)

    Mojtabai, Ramin; Chen, Lian-Yu; Kaufmann, Christopher N; Crum, Rosa M

    2014-02-01

    Barriers to both mental health and substance use disorder treatments have rarely been examined among individuals with comorbid mental health and substance use disorders. In a sample of 393 adults with 12-month major depressive episodes and substance use disorders, we compared perceived barriers to these two types of treatments. Data were drawn from the 2005-2011 U.S. National Surveys on Drug Use and Health. Overall, the same individuals experienced different barriers to mental health treatment versus substance use disorder treatment. Concerns about negative views of the community, effects on job, and inconvenience of services were more commonly reported as reasons for not receiving substance use disorder treatment. Not affording the cost of care was the most common barrier to both types of treatments, but more commonly reported as a barrier to mental health treatment. Improved financial access through the Affordable Care Act and parity legislation and integration of mental health and substance use disorder services may help to reduce treatment barriers among individuals with comorbid mental health and substance disorders. © 2013.

  19. A Multi-Objective Approach to Visualize Proportions and Similarities Between Individuals by Rectangular Maps

    DEFF Research Database (Denmark)

    Carrizosa, Emilio; Guerrero, Vanesa; Morales, Dolores Romero

    In this paper we address the problem of visualizing the proportions and the similarities attached to a set of individuals. We represent this information using a rectangular map, i.e., a subdivision of a rectangle into rectangular portions so that each portion is associated with one individual...... area and adjacency requirements, this visualization problem is formulated as a three-objective Mixed Integer Nonlinear Problem. The first objective seeks to maximize the number of true adjacencies that the rectangular map is able to reproduce, the second one is to minimize the number of false...

  20. A bioenergetic approach to model and reconstruct individual life traits from fish otoliths

    DEFF Research Database (Denmark)

    Fablet, Ronan; Pecquerie, Laure; Høie, Hans

    2012-01-01

    Otoliths are biocalcified bodies connected to the sensory system in the inner ears of fish. Their layered, biorhythm‐following formation provides individual records of the age, the individual history, and the natural environment of extinct and living fish species. Such data are critical for ecosy...... observations of otolith formation. It represents a unique simulation tool to improve otolith interpretation and applications, and, beyond, to address the effects of both climate change and ocean acidification on other biomineralizing organisms such as corals and bivalves...

  1. An individual-based approach to explain plasmid invasion in bacterial populations

    DEFF Research Database (Denmark)

    Seoane, Jose Miguel; Yankelevich, Tatiana; Dechesne, Arnaud

    2011-01-01

    We present an individual-based experimental framework to identify and estimate the main parameters governing bacterial conjugation at the individual cell scale. From this analysis, we have established that transient periods of unregulated plasmid transfer within newly formed transconjugant cells...... of the growth cycle and that nongrowing cells, even when exposed to high nutrient concentrations, do not display conjugal activity. These results do not support previous hypotheses relating conjugation decay in the deeper cell layers of bacterial biofilms to nutrient depletion and low physiological activity. We...

  2. Cow-specific treatment of clinical mastitis: an economic approach

    NARCIS (Netherlands)

    Steeneveld, W.; Werven, van T.; Barkema, H.W.; Hogeveen, H.

    2011-01-01

    Under Dutch circumstances, most clinical mastitis (CM) cases of cows on dairy farms are treated with a standard intramammary antimicrobial treatment. Several antimicrobial treatments are available for CM, differing in antimicrobial compound, route of application, duration, and cost. Because cow

  3. Diagnosis and management of neuropathic pain: a balanced approach to treatment.

    Science.gov (United States)

    Nicholson, Bruce D

    2003-12-01

    To provide nurse practitioners with a conceptual framework from which to diagnose and manage chronic neuropathic pain, specifically postherpetic neuralgia (PHN). A current review of the available treatment options for the management of neuropathic pain and PHN is provided. A comprehensive literature review was conducted. Clinical articles, meta-analyses, and reviews were selected for their relevance to the diagnosis and management of chronic neuropathic pain and PHN. Managing patients with chronic neuropathic pain is a common clinical challenge due to variability in individual symptoms, mechanisms, and treatment responses. In patients with PHN, a balanced treatment approach focusing on efficacy, safety, and tolerability is recommended. With appropriate treatment, most patients are able to achieve clinically significant relief from neuropathic pain. Diagnosis and management of neuropathic pain syndromes is challenging. Because of the complexity of chronic pain, successful long-term treatment can be especially difficult (Nicholson, 2003b). While most acute pain is nociceptive (i.e., a response to noxious stimuli), chronic pain can be nociceptive, neuropathic, or of mixed origin. PHN is a chronic pain syndrome that can last for years, causing physical and social disability and psychological distress (Kanazi, 2000). Despite major recent advances in the treatment of PHN, many patients remain refractory to current therapy (Dworkin, 2003). For practicing clinicians, including nurse practitioners, viewing pain as a disease rather than a symptom is the first step towards its successful management. Understanding the pathophysiology of chronic pain and emerging treatment paradigms for the management of neuropathic pain and PHN is critical to optimal care.

  4. Determinants of Success in Native and Non-Native Listening Comprehension: An Individual Differences Approach

    Science.gov (United States)

    Andringa, Sible; Olsthoorn, Nomi; van Beuningen, Catherine; Schoonen, Rob; Hulstijn, Jan

    2012-01-01

    The goal of this study was to explain individual differences in both native and non-native listening comprehension; 121 native and 113 non-native speakers of Dutch were tested on various linguistic and nonlinguistic cognitive skills thought to underlie listening comprehension. Structural equation modeling was used to identify the predictors of…

  5. Determinants of success in native and non-native listening comprehension: an individual differences approach

    NARCIS (Netherlands)

    Andringa, S.; Olsthoorn, N.; van Beuningen, C.; Schoonen, R.; Hulstijn, J.

    2012-01-01

    The goal of this study was to explain individual differences in both native and non-native listening comprehension; 121 native and 113 non-native speakers of Dutch were tested on various linguistic and nonlinguistic cognitive skills thought to underlie listening comprehension. Structural equation

  6. Diet, risk of obesity and socioeconomic circumstances of individuals in the UK: A seemingly unrelated approach

    Directory of Open Access Journals (Sweden)

    Damilola Olajide

    2012-01-01

    Full Text Available Normal 0 false false false EN-GB X-NONE X-NONE Understanding the link between diet, risk of obesity and the underlying socioeconomic circumstances of the individual is useful for health promotion and improvement interventions. In this study, we examined the socioeconomic factors that jointly affect food consumption choices and risk of obesity. We analyse the National Dietary and Nutrition Survey (2000/01 of adults aged 19-64 years living in private households in the UK, using a health production framework. We used information on the complete food history on individuals in the previous week to create eight common food groups. We estimated a system of linear risk of obesity (as measured by Body Mass Index and eight diet equations with error terms that are correlated across equations for a given individual, but are uncorrelated across individuals, using the seemingly unrelated regression method. Our findings indicate that the socioeconomic factors (e.g. income and education associated with sources of healthy eating differ. While increasing household purchasing power may be more effective for increasing consumption of healthier foods such as fruit and vegetables, more knowledge and information about healthy eating may be more effective for cutting down on consumption of less healthy foods (e.g. preserves and savoury foods. An understanding of these different healthy eating contexts is essential for the development of effective targeted food based policies aimed at reducing the risk of obesity. Link to Appendix

  7. Perception of Individualism and Collectivism in Dutch Society: A Developmental Approach

    Science.gov (United States)

    Oppenheimer, Louis

    2004-01-01

    Within Triandis's (1994) theoretical framework, two studies are reported that deal with the developmental course for subjective perceptions of cultural dimensions in Dutch society (i.e., vertical and horizontal individualism and collectivism). While perceptions of society are always subjectively determined, the perceived dimensions that are…

  8. Analyzing Individual Differences in Vocational, Leisure, and Family Interests: A Multitrait-Multimethod Approach

    Science.gov (United States)

    Gaudron, Jean-Philippe; Vautier, Stephane

    2007-01-01

    This study investigates the latent structure of individual differences in vocational, leisure, and family interests. The participants consisted of 302 French adults who rated their like or dislike for activities based on Holland's RIASEC typology and presented in three life domains: work, family and leisure. The multitrait-multimethod model…

  9. An individual-centered approach to multidimensional poverty: The cases of Chile, Colombia, Ecuador and Peru

    NARCIS (Netherlands)

    Franco-Correa, A.

    2014-01-01

    This paper deals with the problem of selecting the unit of analysis in multidimensional poverty analyses, which is a central decision to take, both from academic and normative points of view. The paper compares the results of an individual-level Multidimensional Poverty Index for Chile, Colombia,

  10. Why Individuals Hike the Appalachian Trail: A Qualitative Approach to Benefits

    Science.gov (United States)

    Goldenberg, Marni; Hill, Eddie; Freidt, Barbara

    2008-01-01

    The Appalachian Trail (AT) is a 2,175 mile-long National Scenic Trail extending from Maine to Georgia. Since its inception in the early 1920s, individuals, families, schools, and other organizations, just to name a few, have used the AT. Approximately 3 to 4 million visitors hike a portion of the AT each year (ATC, 2006). Throughout its 80-year…

  11. Quantitative Approach to Collaborative Learning: Performance Prediction, Individual Assessment, and Group Composition

    Science.gov (United States)

    Cen, Ling; Ruta, Dymitr; Powell, Leigh; Hirsch, Benjamin; Ng, Jason

    2016-01-01

    The benefits of collaborative learning, although widely reported, lack the quantitative rigor and detailed insight into the dynamics of interactions within the group, while individual contributions and their impacts on group members and their collaborative work remain hidden behind joint group assessment. To bridge this gap we intend to address…

  12. The Relation between Navigation Strategy and Associative Memory: An Individual Differences Approach

    Science.gov (United States)

    Ngo, Chi T.; Weisberg, Steven M.; Newcombe, Nora S.; Olson, Ingrid R.

    2016-01-01

    Although the hippocampus is implicated in both spatial navigation and associative memory, very little is known about whether individual differences in the 2 domains covary. People who prefer to navigate using a hippocampal-dependent place strategy may show better performance on associative memory tasks than those who prefer a caudate-dependent…

  13. An individual differences approach to temporal integration and order reversals in the attentional blink task

    NARCIS (Netherlands)

    Willems, Charlotte; Saija, Jefta D.; Akyurek, Elkan G.; Martens, Sander

    2016-01-01

    Background The reduced ability to identify a second target when it is presented in close temporal succession of a first target is called the attentional blink (AB). Studies have shown large individual differences in AB task performance, where lower task performance has been associated with more

  14. Individual and contextual factors related to binge drinking among adolescents in Spain: a multilevel approach.

    Science.gov (United States)

    Teixidó-Compañó, Ester; Sordo, Luis; Bosque-Prous, Marina; Puigcorbé, Susanna; Barrio, Gregorio; Brugal, M Teresa; Belza, María José J; Espelt, Albert

    2018-01-15

    The aim of this study was to estimate the prevalence of binge drinking by regions in Spain and assess the effect of individual and contextual factors related to this drinking pattern in adolescents. A cross-sectional study was performed with data from the 2014 Spanish School Survey on Drug Use (ESTUDES) in students aged 14-18 years (N = 34,259). The outcome was binge drinking in adolescents during the last 30 days. Individual independent variables were socioeconomic variables and variables related to access to alcohol and its availability. Contextual variables consisted of adult alcohol consumption, public policies on alcohol, and socioeconomic factors. Multilevel Poisson regression models with robust variance were estimated, obtaining prevalence ratios (PR) and their 95% confidence intervals.  The results showed that the prevalence of youth binge drinking by region of residence was similar for both sexes (r = 0.72). At the individual level, binge drinking was mainly associated with the perception of easy access to alcohol (PR: 1.38; 95% CI: 1.23-1.55), consumption in open areas [(PR: 3.82; 95% CI: 3.44-4.24) < once a month and (PR: 6.57; 95% CI: 5.85-7.37) ≥ once a month], at least one parent allowing alcohol consumption (PR: 1.42; 95% CI: 1.37-1.47), and receiving >30 euros weekly (PR :1.51; 95% CI: 1.37-1.67). Contextual variables were not associated with youth binge drinking when individual variables were considered. In conclusion, youth binge drinking was associated with individual variables related to high alcohol accessibility and availability, regardless of contextual variables. These variables explained the variability in binge drinking among Spanish regions.

  15. Correction of glutathione deficiency in the lower respiratory tract of HIV seropositive individuals by glutathione aerosol treatment.

    Science.gov (United States)

    Holroyd, K J; Buhl, R; Borok, Z; Roum, J H; Bokser, A D; Grimes, G J; Czerski, D; Cantin, A M; Crystal, R G

    1993-10-01

    Concentrations of glutathione, a ubiquitous tripeptide with immune enhancing and antioxidant properties, are decreased in the blood and lung epithelial lining fluid of human immunodeficiency virus (HIV) seropositive individuals. Since the lung is the most common site of infection in those who progress to AIDS it is rational to consider whether it is possible to safely augment glutathione levels in the epithelial lining fluid of HIV seropositive individuals, thus potentially improving local host defence. Purified reduced glutathione was delivered by aerosol to HIV seropositive individuals (n = 14) and the glutathione levels in lung epithelial lining fluid were compared before and at one, two, and three hours after aerosol administration. Before treatment total glutathione concentrations in the epithelial lining fluid were approximately 60% of controls. After three days of twice daily doses each of 600 mg reduced glutathione, total glutathione levels in the epithelial lining fluid increased and remained in the normal range for at least three hours after treatment. Strikingly, even though > 95% of the glutathione in the aerosol was in its reduced form, the percentage of oxidised glutathione in epithelial lining fluid increased from 5% before treatment to about 40% three hours after treatment, probably reflecting the use of glutathione as an antioxidant in vivo. No adverse effects were observed. It is feasible and safe to use aerosolised reduced glutathione to augment the deficient glutathione levels of the lower respiratory tract of HIV seropositive individuals. It is rational to evaluate further the efficacy of this tripeptide in improving host defence in HIV seropositive individuals.

  16. Analysis of pairwise correlations in multi-parametric PET/MR data for biological tumor characterization and treatment individualization strategies

    Energy Technology Data Exchange (ETDEWEB)

    Leibfarth, Sara; Moennich, David; Thorwarth, Daniela [University Hospital Tuebingen, Section for Biomedical Physics, Department of Radiation Oncology, Tuebingen (Germany); Simoncic, Urban [University Hospital Tuebingen, Section for Biomedical Physics, Department of Radiation Oncology, Tuebingen (Germany); University of Ljubljana, Faculty of Mathematics and Physics, Ljubljana (Slovenia); Jozef Stefan Institute, Ljubljana (Slovenia); Welz, Stefan; Zips, Daniel [University Hospital Tuebingen, Department of Radiation Oncology, Tuebingen (Germany); Schmidt, Holger; Schwenzer, Nina [University Hospital Tuebingen, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany)

    2016-07-15

    The aim of this pilot study was to explore simultaneous functional PET/MR for biological characterization of tumors and potential future treatment adaptations. To investigate the extent of complementarity between different PET/MR-based functional datasets, a pairwise correlation analysis was performed. Functional datasets of N=15 head and neck (HN) cancer patients were evaluated. For patients of group A (N=7), combined PET/MR datasets including FDG-PET and ADC maps were available. Patients of group B (N=8) had FMISO-PET, DCE-MRI and ADC maps from combined PET/MRI, an additional dynamic FMISO-PET/CT acquired directly after FMISO tracer injection as well as an FDG-PET/CT acquired a few days earlier. From DCE-MR, parameter maps K{sup trans}, v{sub e} and v{sub p} were obtained with the extended Tofts model. Moreover, parameter maps of mean DCE enhancement, ΔS{sub DCE}, and mean FMISO signal 0-4 min p.i., anti A{sub FMISO}, were derived. Pairwise correlations were quantified using the Spearman correlation coefficient (r) on both a voxel and a regional level within the gross tumor volume. Between some pairs of functional imaging modalities moderate correlations were observed with respect to the median over all patient datasets, whereas distinct correlations were only present on an individual basis. Highest inter-modality median correlations on the voxel level were obtained for FDG/FMISO (r = 0.56), FDG/ anti A{sub FMISO} (r = 0.55), anti A{sub FMISO}/ΔS{sub DCE} (r = 0.46), and FDG/ADC (r = -0.39). Correlations on the regional level showed comparable results. The results of this study suggest that the examined functional datasets provide complementary information. However, only pairwise correlations were examined, and correlations could still exist between combinations of three or more datasets. These results might contribute to the future design of individually adapted treatment approaches based on multiparametric functional imaging.

  17. Developing a dependable approach for evaluating waste treatment data

    International Nuclear Information System (INIS)

    Gering, K.L.

    1997-01-01

    Decision makers involved with hazardous waste treatment issues are faced with the challenge of making objective evaluations concerning treatment formulations. This work utilizes an effectiveness factor (denoted as η) as the basis for waste treatment evaluations, which was recently developed for application to mixed waste treatability studies involving solidification and stabilization at the Idaho National Engineering and Environmental Laboratory. The effectiveness factor incorporates an arbitrary treatment criterion Φ, which in practice could be the Toxicity Characteristic Leaching Procedure, Unconfined Compressive Strength, Leachability Index, or any other criterion used to judge treatment performance. Three values for Φ are utilized when assessing a given treatment formulation: before treatment, after treatment, and a reference value (typically a treatment standard). The expression for η also incorporates the waste loading as the prime experimental parameter, and accounts for the contribution that each hazard has upon the overall treatment performance. Also discussed are general guidelines for numerical boundaries and statistical interpretations of treatment data. Case studies are presented that demonstrate the usefulness of the effectiveness factor and related numerical methods, where the typical hazards encountered are toxic metals within mixed waste

  18. Who seeks care where? Utilization of mental health and substance use disorder treatment in two national samples of individuals with alcohol use disorders.

    Science.gov (United States)

    Edlund, Mark J; Booth, Brenda M; Han, Xiaotong

    2012-07-01

    Only a fraction of individuals with alcohol use disorders (AUDs) receive any AUD treatment during a given year. If a substantial proportion of individuals with unmet need for AUD treatment are receiving mental health treatment, accessibility of AUD treatment could potentially be improved by implementing strategies to ensure that individuals receiving mental health care are referred to the AUD sector or by increasing rates of AUD treatment in individuals receiving mental health treatment. We assessed patterns and predictors of mental health treatment and AUD treatment among individuals with 12-month AUDs, using secondary data analyses from two national surveys, the National Survey on Drug Use and Health (NSDUH; n = 4,545 individuals with AUDs) and the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; n = 3,327 individuals with AUDs). In both NSDUH and NESARC, 8% of individuals with AUDs reported past-year AUD treatment. Among individuals with AUDs, mental health treatment was more common than AUD treatment, with 20% of NSDUH respondents and 11% of NESARC respondents reporting receiving mental health treatment. Greater mental health morbidity increased the odds of mental health treatment, and AUD severity increased the odds of AUD treatment. Mental health morbidity also increased the odds of AUD treatment, mainly by increasing the odds of receiving the category of both AUD and mental health treatment. Because individuals with AUDs are more likely to receive mental health treatment than AUD treatment, a key opportunity to improve the overall accessibility of treatment for AUDs may be to focus on improving AUD treatment among individuals receiving mental health treatment.

  19. Evolution of Applied Behavior Analysis in the Treatment of Individuals With Autism

    Science.gov (United States)

    Wolery, Mark; Barton, Erin E.; Hine, Jeffrey F.

    2005-01-01

    Two issues of each volume of the Journal of Applied Behavior Analysis were reviewed to identify research reports focusing on individuals with autism. The identified articles were analyzed to describe the ages of individuals with autism, the settings in which the research occurred, the nature of the behaviors targeted for intervention, and the…

  20. 26 CFR 1.408-4 - Treatment of distributions from individual retirement arrangements.

    Science.gov (United States)

    2010-04-01

    ... transfer incident to divorce), be deemed a distribution to such individual from such account or annuity of... an individual retirement account by reason of the application of section 408(e)(2), paragraph (a)(1... section 408(f) shall not apply to such amount. (g) Transfer incident to divorce—(1) General rule. The...

  1. From individual statements to market maps : a geomarketing approach to public transport Planning

    Directory of Open Access Journals (Sweden)

    Arnaud Banos

    2002-07-01

    Full Text Available Since several decades, French urbanisation evolves in a way that can hardly be seen favourable to public transportation. Innovation is needed in this field, if the individual automobile is to be faced on its own territories. This need for innovation concerns the miscellaneous stages of the public transport production, including the preliminary analysis ones. Indeed, many work remains to be done to understand mobility behaviour, what is more if we are to propose versatile and viable alternatives to current trends. Geomarketing based surveys, combining revealed and stated preferences, are a powerful way of acquiring such an accurate information. From a qualitative point of view, this kind of information allows to calibrate public transport services adapted as much as possible to the targeted customers. However, the major problem of the spatial generalisation of this individual information remains often unsolved. In this context, a strategy is proposed, based on the combination of miscellaneous methods.

  2. An investigation of the differential effectiveness of bibliotherapy and self-regulatory treatments in individuals with panic attacks

    OpenAIRE

    Febbraro, Gregorio A. R.

    1997-01-01

    Several studies targeting individuals with panic disorder have demonstrated that Cognitive-behavioral treatment (CST) is the psychological treatment of choice. CST interventions that include exposure to panic symptoms, along with cognitive restructuring. breathing retraining, and relaxation training are more effective than any of these components administered alone. Past studies have demonstrated the efficacy of imparting the above CBT components in the form of bibliotherapy (BT) ...

  3. The Profile of Functional Emotional Development of Children with Autism Spectrum Disorders from the Perspective of Developmental, Individual Differences(DIR, Relationship-based Approach

    Directory of Open Access Journals (Sweden)

    Shahrbanoo Aali

    2014-10-01

    Full Text Available Introduction: The dominant approach in the etiology and treatment of autism spectrum disorder (ASD is a behavioral approach. Proponents of the behavioral model believe that children with autism in access to capabilities in achieving love, empathy, language and creative thinking, have significant fundamental defects.  Instead model-based development of individual differences relationship offers a new approach in the etiology and treatment of autism spectrum disorders. According to this approach, early signs of autism and the major differences between these children with normal children, is the difference in capability development , nor behavioral symptoms. Methods and Materials:This study was a descriptive survey. Our research society were Children 4 to 6 years with ASD at official training centers for autism in Mashhad-Iran and  among them 40 children with available sampling, were selected according to the study entry criteria. 40 normal children that were matched with autistic children in sample group were selected as a comparison group. Data were analyzed using of spss16 with descriptive statistics, ANOVA and  chi square test. Results: Autistic Children at the ability to regulate attention, attraction and interest in human relations; exchange of desires, intentions and thoughts with others, shaping ideas and the ability to think logically, have a lower mean  and no significant difference was observed between the two groups (P

  4. Individual approach to the development of graphomotor skills by child with diparetic form of cerebral palsy.

    OpenAIRE

    ŠMOLÍKOVÁ, Anežka

    2014-01-01

    The thesis deals with the development of graphomotoric skills in a child with diparetic form DMO in the form of cerebral palsy. Describes the DMO, its causes, manifestations and classification of interventions. A case study is focused on the development of graphomotoric skills by using the individual program, created for the nursery school, as well as for parents and their work with the child at home.

  5. Healthcare Expenditures Associated with Depression Among Individuals with Osteoarthritis: Post-Regression Linear Decomposition Approach.

    Science.gov (United States)

    Agarwal, Parul; Sambamoorthi, Usha

    2015-12-01

    Depression is common among individuals with osteoarthritis and leads to increased healthcare burden. The objective of this study was to examine excess total healthcare expenditures associated with depression among individuals with osteoarthritis in the US. Adults with self-reported osteoarthritis (n = 1881) were identified using data from the 2010 Medical Expenditure Panel Survey (MEPS). Among those with osteoarthritis, chi-square tests and ordinary least square regressions (OLS) were used to examine differences in healthcare expenditures between those with and without depression. Post-regression linear decomposition technique was used to estimate the relative contribution of different constructs of the Anderson's behavioral model, i.e., predisposing, enabling, need, personal healthcare practices, and external environment factors, to the excess expenditures associated with depression among individuals with osteoarthritis. All analysis accounted for the complex survey design of MEPS. Depression coexisted among 20.6 % of adults with osteoarthritis. The average total healthcare expenditures were $13,684 among adults with depression compared to $9284 among those without depression. Multivariable OLS regression revealed that adults with depression had 38.8 % higher healthcare expenditures (p regression linear decomposition analysis indicated that 50 % of differences in expenditures among adults with and without depression can be explained by differences in need factors. Among individuals with coexisting osteoarthritis and depression, excess healthcare expenditures associated with depression were mainly due to comorbid anxiety, chronic conditions and poor health status. These expenditures may potentially be reduced by providing timely intervention for need factors or by providing care under a collaborative care model.

  6. Determination of hemispheric emotional valence in individual subjects: A new approach with research and therapeutic implications

    OpenAIRE

    Schiffer, Fredric; Teicher, Martin H; Anderson, Carl; Tomoda, Akemi; Polcari, Ann; Navalta, Carryl P; Andersen, Susan L

    2007-01-01

    Abstract Background Much has been theorized about the emotional properties of the hemispheres. Our review of the dominant hypotheses put forth by Schore, Joseph, Davidson, and Harmon-Jones on hemispheric emotional valences (HEV) shows that none are supported by robust data. Instead, we propose that individual's hemispheres are organized to have differing HEVs that can be lateralized in either direction. Methods Probe auditory evoked potentials (AEP) recorded during a neutral and an upsetting ...

  7. Radioembolization of hepatocarcinoma with 90Y glass microspheres: development of an individualized treatment planning strategy based on dosimetry and radiobiology

    International Nuclear Information System (INIS)

    Chiesa, C.; Maccauro, M.; Aliberti, G.; Padovano, B.; Seregni, E.; Crippa, F.; Mira, M.; Negri, A.; Spreafico, C.; Morosi, C.; Civelli, E.; Lanocita, R.; Marchiano, A.; Romito, R.; Sposito, C.; Bhoori, S.; Facciorusso, A.; Mazzaferro, V.; Camerini, T.; Carrara, M.; Pellizzari, S.; Migliorisi, M.; De Nile, M.C.

    2015-01-01

    The aim of this study was to optimize the dosimetric approach and to review the absorbed doses delivered, taking into account radiobiology, in order to identify the optimal methodology for an individualized treatment planning strategy based on 99m Tc-macroaggregated albumin (MAA) single photon emission computed tomography (SPECT) images. We performed retrospective dosimetry of the standard TheraSphere registered treatment on 52 intermediate (n = 17) and advanced (i.e. portal vein thrombosis, n = 35) hepatocarcinoma patients with tumour burden < 50 % and without obstruction of the main portal vein trunk. Response was monitored with the densitometric radiological criterion (European Association for the Study of the Liver) and treatment-related liver decompensation was defined ad hoc with a time cut-off of 6 months. Adverse events clearly attributable to disease progression or other causes were not attributed to treatment. Voxel dosimetry was performed with the local deposition method on 99m Tc-MAA SPECT images. The reconstruction protocol was optimized. Concordance of 99m Tc-MAA and 90 Y bremsstrahlung microsphere biodistributions was studied in 35 sequential patients. Two segmentation methods were used, based on SPECT alone (home-made code) or on coregistered SPECT/CT images (IMALYTICS trademark by Philips). STRATOS trademark absorbed dose calculation was validated for 90 Y with a single time point. Radiobiology was used introducing other dosimetric variables besides the mean absorbed dose D: equivalent uniform dose (EUD), biologically effective dose averaged over voxel values (BED ave ) and equivalent uniform biologically effective dose (EUBED). Two sets of radiobiological parameters, the first derived from microsphere irradiation and the second from external beam radiotherapy (EBRT), were used. A total of 16 possible methodologies were compared. Tumour control probability (TCP) and normal tissue complication probability (NTCP) were derived. The area under the

  8. Individual Differences in Working Memory Capacity and Attention, and Their Relationship with Students' Approaches to Learning

    Science.gov (United States)

    Kyndt, Eva; Cascallar, Eduardo; Dochy, Filip

    2012-01-01

    Past research has shown that working memory capacity, attention and students' approaches to learning are all important predictors for educational achievement. In this study the interrelations between these three variables are investigated. Participants were 128 university students. Results show a negative relationship between attention and deep…

  9. Group Dynamics and Individual Roles: A Differentiated Approach to Social-Emotional Learning

    Science.gov (United States)

    Dugas, Daryl

    2017-01-01

    Differentiated instruction is a set of strategies to help teachers meet each child where he or she is in order to improve students' engagement, lead them to do their best work, and maximize their success. This article describes a differentiated classroom management approach based in group dynamics which focuses on the development of group norms…

  10. Territorial community: a systematic approach to advance functions of individual elements

    Directory of Open Access Journals (Sweden)

    T. V. Serohina

    2017-03-01

    It is established that in conditions of the administrative-territorial reform, is the need to change in the approach to the basic concepts, in particular, of the territorial communities category as well as of a new category of amalgamated territorial community. New categories need to be identifyed and be enshrined in the legal framework.

  11. Differential expression among tissues in morbidly obese individuals using a finite mixture model under BLUP approach

    DEFF Research Database (Denmark)

    Kogelman, Lisette; Trabzuni, Daniah; Bonder, Marc Jan

    effects of the interactions between tissues and probes using BLUP (Best Linear Unbiased Prediction) linear models correcting for gender, which were subsequently used in a finite mixture model to detect DE genes in each tissue. This approach evades the multiple-testing problem and is able to detect...

  12. Individualized Nonadaptive and Online-Adaptive Intensity-Modulated Radiotherapy Treatment Strategies for Cervical Cancer Patients Based on Pretreatment Acquired Variable Bladder Filling Computed Tomography Scans

    International Nuclear Information System (INIS)

    Bondar, M.L.; Hoogeman, M.S.; Mens, J.W.; Quint, S.; Ahmad, R.; Dhawtal, G.; Heijmen, B.J.

    2012-01-01

    Purpose: To design and evaluate individualized nonadaptive and online-adaptive strategies based on a pretreatment established motion model for the highly deformable target volume in cervical cancer patients. Methods and Materials: For 14 patients, nine to ten variable bladder filling computed tomography (CT) scans were acquired at pretreatment and after 40 Gy. Individualized model-based internal target volumes (mbITVs) accounting for the cervix and uterus motion due to bladder volume changes were generated by using a motion-model constructed from two pretreatment CT scans (full and empty bladder). Two individualized strategies were designed: a nonadaptive strategy, using an mbITV accounting for the full-range of bladder volume changes throughout the treatment; and an online-adaptive strategy, using mbITVs of bladder volume subranges to construct a library of plans. The latter adapts the treatment online by selecting the plan-of-the-day from the library based on the measured bladder volume. The individualized strategies were evaluated by the seven to eight CT scans not used for mbITVs construction, and compared with a population-based approach. Geometric uniform margins around planning cervix–uterus and mbITVs were determined to ensure adequate coverage. For each strategy, the percentage of the cervix–uterus, bladder, and rectum volumes inside the planning target volume (PTV), and the clinical target volume (CTV)-to-PTV volume (volume difference between PTV and CTV) were calculated. Results: The margin for the population-based approach was 38 mm and for the individualized strategies was 7 to 10 mm. Compared with the population-based approach, the individualized nonadaptive strategy decreased the CTV-to-PTV volume by 48% ± 6% and the percentage of bladder and rectum inside the PTV by 5% to 45% and 26% to 74% (p < 0.001), respectively. Replacing the individualized nonadaptive strategy by an online-adaptive, two-plan library further decreased the percentage of

  13. Current approaches and future directions in the treatment of leprosy

    Directory of Open Access Journals (Sweden)

    Worobec SM

    2012-08-01

    Full Text Available Sophie M WorobecDepartment of Dermatology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USAAbstract: This review surveys current treatments and future treatment trends in leprosy from a clinical perspective. The World Health Organization provides a multidrug treatment regimen that targets the Mycobacterium leprae bacillus which causes leprosy. Several investigational drugs are available for the treatment of drug-resistant M. leprae. Future directions in leprosy treatment will focus on: the molecular signaling mechanism M. leprae uses to avoid triggering an immune response; prospective studies of the side effects experienced during multiple-drug therapy; recognition of relapse rates post-completion of designated treatments; combating multidrug resistance; vaccine development; development of new diagnostic tests; and the implications of the recent discovery of a genetically distinct leprosy-causing bacillus, Mycobacterium lepromatosis.Keywords: epidemiology, leprosy, Hansen’s disease, multidrug resistance, multidrug therapy

  14. [Malnutrition in anorexia nervosa: psychosomatic approach and multidisciplinary treatment].

    Science.gov (United States)

    Cabetas Hernández, I

    2004-01-01

    image, tend to undervalue their own, unable to withstand the development of the body or the internal tension this entails. Controlled exercise, improved nutrition and hormone treatment are currently the combined therapies applied in AN, with agreement being reached with patients on a specific personal diet of low volume, attempting to ensure the necessary minimum of fat and carbohydrates. With simultaneous psychological attention through an integral multidisciplinary approach in order to reduce the high prevalence of partially treated cases that accumulate over time.

  15. Water Supply Treatment Sustainability of Semambu Water Supply Treatment Process - Water Footprint Approach

    Science.gov (United States)

    Aziz, Edriyana A.; Malek, Marlinda Abdul; Moni, Syazwan N.; Hadi, Iqmal H.; Zulkifli, Nabil F.

    2018-03-01

    In this study, the assessment by using Water Footprint (WF) approach was conducted to assess water consumption within the water supply treatment process (WSTP) services of Semambu Water Treatment Plant (WTP). Identification of the type of WF at each stage of WSTP was carried out and later the WF accounting for the period 2010 – 2016 was calculated. Several factors that might influence the accounting such as population, and land use. The increasing value of total WF per year was due to the increasing water demand from population and land use activities. However, the pattern of rainfall intensity from the monsoonal changes was not majorly affected the total amount of WF per year. As a conclusion, if the value of WF per year keeps increasing due to unregulated development in addition to the occurrences of climate changing, the intake river water will be insufficient and may lead to water scarcity. The findings in this study suggest actions to reduce the WF will likely have a great impact on freshwater resources availability and sustainability.

  16. Treatment for primary hypothyroidism: current approaches and future possibilities

    Science.gov (United States)

    Chakera, Ali J; Pearce, Simon HS; Vaidya, Bijay

    2012-01-01

    Primary hypothyroidism is the most common endocrine disease. Although the diagnosis and treatment of hypothyroidism is often considered simple, there are large numbers of people with this condition who are suboptimally treated. Even in those people with hypothyroidism who are biochemically euthyroid on levothyroxine replacement there is a significant proportion who report poorer quality of life. This review explores the historical and current treatment options for hypothyroidism, reasons for and potential solutions to suboptimal treatment, and future possibilities in the treatment of hypothyroidism. PMID:22291465

  17. Detection of consensuses and treatment principles of diabetic nephropathy in traditional Chinese medicine: A new approach

    Directory of Open Access Journals (Sweden)

    Xu Tong

    2015-10-01

    Conclusion: The results suggest that the community detection-based approach is useful and feasible for uncovering consensuses and treatment principles of DN treatment in TCM, and could be used to address other similar problems in TCM.

  18. The Intersystem Model of Psychotherapy: An Integrated Systems Treatment Approach

    Science.gov (United States)

    Weeks, Gerald R.; Cross, Chad L.

    2004-01-01

    This article introduces the intersystem model of psychotherapy and discusses its utility as a truly integrative and comprehensive approach. The foundation of this conceptually complex approach comes from dialectic metatheory; hence, its derivation requires an understanding of both foundational and integrational constructs. The article provides a…

  19. An assessment of individual-level factors associated with alcohol treatment utilization among Mexican Americans.

    Science.gov (United States)

    Reingle Gonzalez, Jennifer M; Caetano, Raul; Mills, Britain A; Vaeth, Patrice A C

    2014-01-01

    The purpose of this study is to identify enabling factors for treatment utilization for alcohol-related problems, and to evaluate how enabling factors vary by need for treatment, among two samples of Mexican American adults. These two distinct samples included 2,595 current and former drinkers (one sample included 787 U.S./Mexico border residents; the other sample included 740 Mexican Americans living in U.S. cities not proximal to the border). Need for treatment (alcohol disorder severity) and (male) gender were the primary correlates of treatment utilization; and there was no moderation in the enabling factors by need for treatment as "enablers" of utilization. Further theoretical and empirical research is necessary to determine which mechanisms are driving disparities in treatment utilization across racial/ethnic groups generally, and Hispanic national groups specifically. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Individual differences in the propensity to approach signals vs goals promote different adaptations in the dopamine system of rats.

    Science.gov (United States)

    Flagel, Shelly B; Watson, Stanley J; Robinson, Terry E; Akil, Huda

    2007-04-01

    The way an individual responds to cues associated with rewards may be a key determinant of vulnerability to compulsive behavioral disorders. We studied individual differences in Pavlovian conditioned approach behavior and examined the expression of neurobiological markers associated with the dopaminergic system, the same neural system implicated in incentive motivational processes. Pavlovian autoshaping procedures consisted of the brief presentation of an illuminated retractable lever (conditioned stimulus) followed by the response-independent delivery of a food pellet (unconditioned stimulus), which lead to a Pavlovian conditioned response. In situ hybridization was performed on brains obtained either following the first or last (fifth) day of training. Two phenotypes emerged. Sign-trackers (ST) exhibited behavior that seemed to be largely controlled by the cue that signaled impending reward delivery; whereas goal-trackers (GT) preferentially approached the location where the reward was delivered. Following a single training session, ST showed greater expression of dopamine D1 receptor mRNA relative to GT. After 5 days of training, GT exhibited greater expression levels of tyrosine hydroxylase, dopamine transporter, and dopamine D2 receptor mRNA relative to ST. These findings suggest that the development of approach behavior towards signals vs goal leads to distinct adaptations in the dopamine system. The sign-tracker vs goal-tracker phenotype may prove to be a valuable animal model to investigate individual differences in the way incentive salience is attributed to environmental stimuli, which may contribute to the development of addiction and other compulsive behavioral disorders.

  1. The third spatial dimension risk approach for individual risk and group risk in multiple use of space

    International Nuclear Information System (INIS)

    Suddle, Shahid; Ale, Ben

    2005-01-01

    Buildings above roads and railways are examples of multiple use of space. Safety is one of the critical issues for such projects. Risk analyses can be undertaken to investigate what safety measures that are required to realise these projects. The results of these analyses can also be compared to risk acceptance criteria, if they are applicable. In The Netherlands, there are explicit criteria for acceptability of individual risk and societal risk. Traditionally calculations of individual risk result in contours of equal risk on a map and thus are considered in two-dimensional space only. However, when different functions are layered the third spatial dimension, height, becomes an important parameter. The various activities and structures above and below each other impose mutual risks. There are no explicit norms or policies about how to deal with the individual or group risk approach in the third dimension. This paper proposes an approach for these problems and gives some examples. Finally, the third dimension risk approach is applied in a case study of Bos en Lommer, Amsterdam

  2. 20 CFR 416.936 - Treatment required for individuals whose drug addiction or alcoholism is a contributing factor...

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Treatment required for individuals whose drug addiction or alcoholism is a contributing factor material to the determination of disability. 416.936 Section 416.936 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Determining...

  3. 20 CFR 404.1536 - Treatment required for individuals whose drug addiction or alcoholism is a contributing factor...

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Treatment required for individuals whose drug addiction or alcoholism is a contributing factor material to the determination of disability. 404.1536 Section 404.1536 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Determining...

  4. Impact of cancer diagnosis and treatment on glycaemic control among individuals with colorectal cancer using glucose lowering drugs

    NARCIS (Netherlands)

    Zanders, M.M.J.; van Herk-Sukel, M.P.P.; Herings, R.M.C.; van de Poll-Franse, L.V.; Haak, H.

    2016-01-01

    Aims This study aims to evaluate the impact of cancer and its treatment on HbA1c values among individuals with colorectal cancer (CRC) using glucose-lowering drugs (GLDs). Methods Patients with primary CRC (1998–2011) were selected from the Eindhoven Cancer Registry and linked to the PHARMO Database

  5. Contamination and Harm Relevant UCS-Expectancy Bias in Spider Phobic Individuals : Influence of Treatment

    NARCIS (Netherlands)

    van Overveld, Mark; de Jong, Peter J.; Huijding, Jorg; Peters, Madelon L.

    2010-01-01

    Phobic individuals expect aversive UCS's following encounters with phobic stimuli. Previous research using a thought-experiment procedure showed that contamination rather than harm-related outcome expectancies differentiated best between high and low spider fearful undergraduates. This study

  6. Treatment of Conduct Disorder with a Multisystemic and Multimodal Approach

    Science.gov (United States)

    Ubinger, Nicole

    2006-01-01

    Conduct disorder is a childhood disorder that is often resistant to treatment. Current treatment methods often focus on separate interventions for each environment that the child or adolescent is exhibiting antisocial behavior. Additionally the focus is on the behavior of the child and often does not focus on the family unit or the biology behind…

  7. Novel immunotherapeutic approaches for the treatment of acute leukemia (myeloid and lymphoblastic)

    Science.gov (United States)

    Ishii, Kazusa; Barrett, Austin J.

    2016-01-01

    There have been major advances in our understanding of the multiple interactions between malignant cells and the innate and adaptive immune system. While the attention of immunologists has hitherto focused on solid tumors, the specific immunobiology of acute leukemias is now becoming defined. These discoveries have pointed the way to immune interventions building on the established graft-versus-leukemia (GVL) effect from hematopoietic stem-cell transplant (HSCT) and extending immunotherapy beyond HSCT to individuals with acute leukemia with a diversity of immune manipulations early in the course of the leukemia. At present, clinical results are in their infancy. In the coming years larger studies will better define the place of immunotherapy in the management of acute leukemias and lead to treatment approaches that combine conventional chemotherapy, immunotherapy and HSCT to achieve durable cures. PMID:26834952

  8. Psychological approaches in the treatment of specific phobias: A meta-analysis

    NARCIS (Netherlands)

    Wolitzky-Taylor, K.B.; Horowitz, J.D.; Powers, M.B.; Telch, M.J.

    2008-01-01

    Data from 33 randomized treatment studies were subjected to a meta-analysis to address questions surrounding the efficacy of psychological approaches in the treatment of specific phobia. As expected, exposure-based treatment produced large effects sizes relative to no treatment. They also

  9. A Fuzzy PROMETHEE Approach for Breast Cancer Treatment Techniques

    Directory of Open Access Journals (Sweden)

    Dilber Uzun Ozsahin

    2018-05-01

    Full Text Available Breast tumor is a growth that occur in the healthy breast tissue, whereby abnormal cells undergo division in an uncontrolled manner. It comes in different types and stages and the ability to metastasize and infect distant tissues. Several studies have showed that one in eight women in the US have develop breast cancer during their life time. Therefore, early diagnosis and treatment is widely approved as being essential to effectively alleviate the disease. The aim of this study is to comparatively analyze certain breast cancer treatment procedures which include surgery, hormone therapy, chemotherapy, and radiation therapy. Fuzzy PROMETHEE (preference ranking organization method for enrichment of evaluations a multi-criteria decision-making process was used to evaluate the treatments on factors that include side effects, overall survival rate, cost of treatment and treatment time.

  10. Approach for measuring the chemistry of individual particles in the size range critical for cloud formation.

    Science.gov (United States)

    Zauscher, Melanie D; Moore, Meagan J K; Lewis, Gregory S; Hering, Susanne V; Prather, Kimberly A

    2011-03-15

    Aerosol particles, especially those ranging from 50 to 200 nm, strongly impact climate by serving as nuclei upon which water condenses and cloud droplets form. However, the small number of analytical methods capable of measuring the composition of particles in this size range, particularly at the individual particle level, has limited our knowledge of cloud condensation nuclei (CCN) composition and hence our understanding of aerosols effect on climate. To obtain more insight into particles in this size range, we developed a method which couples a growth tube (GT) to an ultrafine aerosol time-of-flight mass spectrometer (UF-ATOFMS), a combination that allows in situ measurements of the composition of individual particles as small as 38 nm. The growth tube uses water to grow particles to larger sizes so they can be optically detected by the UF-ATOFMS, extending the size range to below 100 nm with no discernible changes in particle composition. To gain further insight into the temporal variability of aerosol chemistry and sources, the GT-UF-ATOFMS was used for online continuous measurements over a period of 3 days.

  11. An Integrated, Multifactorial Approach to Periodization for Optimal Performance in Individual and Team Sports.

    Science.gov (United States)

    Mujika, Iñigo; Halson, Shona; Burke, Louise M; Balagué, Gloria; Farrow, Damian

    2018-05-01

    Sports periodization has traditionally focused on the exercise aspect of athletic preparation, while neglecting the integration of other elements that can impact an athlete's readiness for peak competition performances. Integrated periodization allows the coordinated inclusion of multiple training components best suited for a given training phase into an athlete's program. The aim of this article is to review the available evidence underpinning integrated periodization, focusing on exercise training, recovery, nutrition, psychological skills, and skill acquisition as key factors by which athletic preparation can be periodized. The periodization of heat and altitude adaptation, body composition, and physical therapy is also considered. Despite recent criticism, various methods of exercise training periodization can contribute to performance enhancement in a variety of elite individual and team sports, such as soccer. In the latter, both physical and strategic periodization are useful tools for managing the heavy travel schedule, fatigue, and injuries that occur throughout a competitive season. Recovery interventions should be periodized (ie, withheld or emphasized) to influence acute and chronic training adaptation and performance. Nutrient intake and timing in relation to exercise and as part of the periodization of an athlete's training and competition calendar can also promote physiological adaptations and performance capacity. Psychological skills are a central component of athletic performance, and their periodization should cater to each athlete's individual needs and the needs of the team. Skill acquisition can also be integrated into an athlete's periodized training program to make a significant contribution to competition performance.

  12. Assimilation and Individual Differences in Emotion: The Dynamics of Anger and Approach Motivation.

    Science.gov (United States)

    Lechuga, Julia; Fernandez, Norma P

    2011-03-01

    Individuals who cross cultural boundaries face many challenges when trying to adapt to a receiving culture. Adaptation challenges such as learning to maneuver across societal domains may become increasingly complex if structural level factors such as discrimination are present. Researchers have conceptualized acculturation as a relatively autonomous decision indicating that four acculturation strategies exist: assimilation, separation, integration, and marginalization. Moreover, researchers have also long debated the link between acculturation strategy, adaptation hassles and negative health outcomes. However, models seeking to explain how individual difference and structural level variables may influence each other and subsequently influence acculturation and adaptation are needed. The purpose of this study is to lay the foundation for the conceptualization of such a model. We propose that temperamental predispositions to negative emotionality, anger, and impulsivity may highlight discrimination which in turn may lead to increases in acculturative stress and negative markers of psychosocial well-being. We used SEM to test our hypothesized model. Results supported a modified model. Implications for the measurement of adaptation and interventions are discussed.

  13. Assessing vocational outcome expectancy in individuals with serious mental illness: a factor-analytic approach.

    Science.gov (United States)

    Iwanaga, Kanako; Umucu, Emre; Wu, Jia-Rung; Yaghmaian, Rana; Lee, Hui-Ling; Fitzgerald, Sandra; Chan, Fong

    2017-07-04

    Self-determination theory (SDT) and self-efficacy theory (SET) can be used to conceptualize self-determined motivation to engage in mental health and vocational rehabilitation (VR) services and to predict recovery. To incorporate SDT and SET as a framework for vocational recovery, developing and validating SDT/SET measures in vocational rehabilitation is warranted. Outcome expectancy is an important SDT/SET variable affecting rehabilitation engagement and recovery. The purpose of this study was to validate the Vocational Outcome Expectancy Scale (VOES) for use within the SDT/SET vocational recovery framework. One hundred and twenty-four individuals with serious mental illness (SMI) participated in this study. Measurement structure of the VOES was evaluated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Both EFA and CFA results supported a two-factor structure: (a) positive outcome expectancy, and (b) negative outcome expectancy. The internal consistency reliability coefficients for both factors were acceptable. In addition, positive outcome expectancy correlated stronger than negative outcome expectancy with other SDT/SET constructs in the expected directions. The VOES is a brief, reliable and valid instrument for assessing vocational outcome expectancy in individuals with SMI that can be integrated into SDT/SET as a vocational rehabilitation engagement and recovery model in psychiatric rehabilitation.

  14. Relative Age in School and Suicide among Young Individuals in Japan: A Regression Discontinuity Approach.

    Directory of Open Access Journals (Sweden)

    Tetsuya Matsubayashi

    Full Text Available Evidence collected in many parts of the world suggests that, compared to older students, students who are relatively younger at school entry tend to have worse academic performance and lower levels of income. This study examined how relative age in a grade affects suicide rates of adolescents and young adults between 15 and 25 years of age using data from Japan.We examined individual death records in the Vital Statistics of Japan from 1989 to 2010. In contrast to other countries, late entry to primary school is not allowed in Japan. We took advantage of the school entry cutoff date to implement a regression discontinuity (RD design, assuming that the timing of births around the school entry cutoff date was randomly determined and therefore that individuals who were born just before and after the cutoff date have similar baseline characteristics.We found that those who were born right before the school cutoff day and thus youngest in their cohort have higher mortality rates by suicide, compared to their peers who were born right after the cutoff date and thus older. We also found that those with relative age disadvantage tend to follow a different career path than those with relative age advantage, which may explain their higher suicide mortality rates.Relative age effects have broader consequences than was previously supposed. This study suggests that policy intervention that alleviates the relative age effect can be important.

  15. On the Comparison of Cognitive Function in Substance Abusers and Addicts under Methadone Treatment with Normal Individuals

    Directory of Open Access Journals (Sweden)

    reza mohammadzadeghan

    2015-09-01

    Full Text Available Objective: This study was an attempt to compare cognitive functioning in substance abusers and addicts under methadone treatment with normal individuals. Method: The current study was a causal-comparative one. The statistical population of this research consisted of all male substance abusers who had referred to addiction treatment centers of Khoy city in 2013. The total of 40 addicts under methadone treatment, 40 active drug users, and 40 non-addicts were selected as the participants of this study via convenience sampling method. Wisconsin Card Sorting Test and Wechsler Memory Scale were administered to the three groups for data collection purposes. Results: The results showed that the substance abusers’ scores in Wisconsin card sorting test and Wechsler memory scale were significantly different from those of addicts under methadone treatment and normal individuals. In the same way, there was a significant difference between addicts under methadone treatment and normal individuals in terms of cognitive function however, there was no significant difference between these two groups in terms of perseveration error. Conclusion: It can be concluded that chronic use of psychoactive substances causes damage to multiple brain regions such as prefrontal cortex and hippocampus and, thereby, it leads to cognitive malfunctioning in these areas.

  16. Behavioral Treatments and Pharmacotherapy: Acceptability Ratings by Elderly Individuals in Residential Settings.

    Science.gov (United States)

    Burgio, Louis D.; Sinnott, Jan

    1990-01-01

    Presented residents of life care community and nursing homes with scenarios of older woman. Client varied by cognitive capacity and behavior problem (aggression, verbal abuse, noncompliance). Participants rated three treatments: differential reinforcement of incompatible behavior (DRI), time-out, and haloperidol. All treatments were acceptable;…

  17. Pharmacogenetics and individual responses to treatment of hyperglycemia in type 2 diabetes

    DEFF Research Database (Denmark)

    Engelbrechtsen, Line; Galijatovic, Ehm Astrid Andersson; Roepstorff, Søren

    2015-01-01

    The aim of this study was to summarize current knowledge and provide perspectives on the relationships between human genetic variants, type 2 diabetes, antidiabetic treatment, and disease progression. Type 2 diabetes is a complex disease with clear-cut diagnostic criteria and treatment guidelines...

  18. Guide for health professionals addressing oral care for individuals in oncological treatment based on scientific evidence.

    Science.gov (United States)

    Carvalho, Caroline Gomes; Medeiros-Filho, João Batista; Ferreira, Meire Coelho

    2018-02-22

    Oncological treatment can cause changes in the oral cavity compromising oral functions. The aim of the study was, based on a systematic review, to draft a guide directed at the team of health professionals involved in the oral care of oncological patients. A systematic search of the literature was performed for articles published between 2000 and April 2017. Searches were made of electronic databases and hand search. The inclusion criteria were systematic reviews of randomized clinical trials (RCTs) and RCTs published in English, involving pediatric and adult oncological patients and focused on the prevention and treatment of oral complications as well as studies addressing the maintenance of oral health. Among the 1237 studies identified, 129 were pre-selected and 54 were selected to form the basis for the clinical guide. The studies analyzed stress the need for oral assessments as well as preventive and curative actions prior to oncological treatment. To minimize the severity of oral problems, the studies emphasize daily oral care, the treatment of xerostomia with saliva substitute and hydration, and low-level laser therapy, nystatin, acyclovir, respectively, for the prevention and treatment of oral mucositis, oral candidiasis, and infection by herpes simplex virus. Thus, the guide produced addresses oral assessments and professional and home care before, during, and after oncological treatment. The guide drafted has the function of assisting health professionals involved in the oral care of patients with cancer, enabling the prevention or treatment of oral complications stemming from oncological treatment.

  19. Gender-related clinical and neurocognitive differences in individuals seeking treatment for pathological gambling

    DEFF Research Database (Denmark)

    Grant, Jon E; Chamberlain, Samuel R; Schreiber, Liana R N

    2012-01-01

    Understanding variations in disease presentation in men and women is clinically important as differences may reflect biological and sociocultural factors and have implications for selecting appropriate prevention and treatment strategies. The aim of this study was to investigate clinical and cogn...... and cognitive differences in treatment-seeking people with pathological gambling as a function of gender....

  20. Psychotherapeutic Treatment of a Gastrointestinal Disorder: Individual and Family Systems Perspectives.

    Science.gov (United States)

    Bauknight, S. Terry

    A 17-year-old boy presented for treatment with chronic diarrhea that had proven refractory to medical treatment for a period of five years. The problem was sufficiently debilitating to cause highly erratic school attendance. Anamnesis revealed no precipitating event, though it was discovered that the patient's mother was a moderately compensated,…

  1. Early Magnesium Treatment After Aneurysmal Subarachnoid Hemorrhage Individual Patient Data Meta-Analysis

    NARCIS (Netherlands)

    Mees, Sanne M. Dorhout; Algra, Ale; Wong, George K. C.; Poon, Wai S.; Bradford, Celia M.; Saver, Jeffrey L.; Starkman, Sidney; Rinkel, Gabriel J. E.; van den Bergh, Walter M.

    2015-01-01

    Background and Purpose—Delayed cerebral ischemia (DCI) is an important cause of poor outcome after aneurysmal subarachnoid hemorrhage (SAH). Trials of magnesium treatment starting <4 days after symptom onset found no effect on poor outcome or DCI in SAH. Earlier installment of treatment might be

  2. Early Magnesium Treatment After Aneurysmal Subarachnoid Hemorrhage Individual Patient Data Meta-Analysis

    NARCIS (Netherlands)

    Dorhout Mees, Sanne M.; Algra, Ale; Wong, George K. C.; Poon, Wai S.; Bradford, Celia M.; Saver, Jeffrey L.; Starkman, Sidney; Rinkel, Gabriel J. E.; van den Bergh, Walter M.; van Kooten, F.; Dirven, C. M.; van Gijn, J.; Vermeulen, M.; Rinkel, G. J. E.; Boet, R.; Chan, M. T. V.; Gin, T.; Ng, S. C. P.; Zee, B. C. Y.; Al-Shahi Salman, R.; Boiten, J.; Kuijsten, H.; Lavados, P. M.; van Oostenbrugge, R. J.; Vandertop, W. P.; Finfer, S.; O'Connor, A.; Yarad, E.; Firth, R.; McCallister, R.; Harrington, T.; Steinfort, B.; Faulder, K.; Assaad, N.; Morgan, M.; Starkman, S.; Eckstein, M.; Stratton, S. J.; Pratt, F. D.; Hamilton, S.; Conwit, R.; Liebeskind, D. S.; Sung, G.; Kramer, I.; Moreau, G.; Goldweber, R.; Sanossian, N.

    2015-01-01

    Delayed cerebral ischemia (DCI) is an important cause of poor outcome after aneurysmal subarachnoid hemorrhage (SAH). Trials of magnesium treatment starting <4 days after symptom onset found no effect on poor outcome or DCI in SAH. Earlier installment of treatment might be more effective, but

  3. Early Magnesium Treatment after Aneurysmal Subarachnoid Hemorrhage : Individual Patient Data Meta-Analysis

    NARCIS (Netherlands)

    Dorhout Mees, Sanne M.; Algra, Ale; Wong, George K C; Poon, Wai S.; Bradford, Celia M.; Saver, Jeffrey L.; Starkman, Sidney; Rinkel, Gabriel J E; Van Den Bergh, Walter M.

    2015-01-01

    Background and Purpose-Delayed cerebral ischemia (DCI) is an important cause of poor outcome after aneurysmal subarachnoid hemorrhage (SAH). Trials of magnesium treatment starting <4 days after symptom onset found no effect on poor outcome or DCI in SAH. Earlier installment of treatment might be

  4. Past-Year Treatment Utilization Among Individuals Meeting DSM-5 PTSD Criteria: Results From a Nationally Representative Sample.

    Science.gov (United States)

    Hale, Andrew C; Sripada, Rebecca K; Bohnert, Kipling M

    2018-03-01

    Little is known regarding treatment utilization among individuals meeting DSM-5 criteria for posttraumatic stress disorder (PTSD). Data were analyzed from the third wave of the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative sample using DSM-5 criteria. Factors related to increased odds of PTSD treatment utilization for individuals meeting lifetime criteria included some college education versus less than a high school degree (odds ratio [OR]=3.17), having health insurance versus no insurance (OR=2.86), having a comorbid phobia disorder versus not having a phobia disorder (OR=1.36), and greater PTSD symptom count (OR=1.11). Older age (OR=.40), identifying as black or Asian versus white non-Hispanic (OR=.70 and OR=.28, respectively), and greater social functioning (OR=.98) were associated with decreased odds of PTSD treatment utilization. Results highlight factors that may be useful in identifying population subgroups with PTSD that are at risk for underutilization of services.

  5. Neuropsychological consequences of chronic drug use: relevance to treatment approaches

    Directory of Open Access Journals (Sweden)

    Jean Lud eCadet

    2016-01-01

    Full Text Available Heavy use of drugs impacts of the daily activities of individuals in these activities. Several groups of investigators have indeed documented changes in cognitive performance by individuals who have a long history of chronic drug use. In the case of marijuana, a wealth of information suggests that heavy long-term use of the drug may have neurobehavioral consequences in some individuals. In humans, heavy cocaine use is accompanied by neuropathological changes that might serve as substrates for cognitive dysfunctions. Similarly, methamphetamine users suffer from cognitive abnormalities that may be consequent to alterations in structures and functions. Here, we detail the evidence for these neuropsychological consequences. The review suggests that improving the care of our patients will necessarily depend on the better characterization of drug-induced cognitive phenotypes because they might inform the development of better pharmacological and behavioral interventions, with the goal of improving cognitive functions in these subsets of drug users.

  6. Thermodynamic approach to improving solubility prediction of co-crystals in comparison with individual poorly soluble components

    International Nuclear Information System (INIS)

    Perlovich, German L.

    2014-01-01

    Highlights: • Thermodynamic approach for solubility improvement of co-crystal was developed. • The graphical technique for estimation of co-crystal solubility was elaborated. • Hydration enthalpies of some drugs and amino acids were calculated. • Applicability/operability of the approach was exemplified by some drugs and amino acids. - Abstract: A novel thermodynamic approach to compare poorly soluble components (active pharmaceutical ingredient (API)) both in co-crystals and individual compounds was developed. An algorithm of choosing potential co-crystals with improved solubility characteristics on the basis of the known solvation/hydration API and co-former enthalpies is described. The applicability and operability of the algorithm were tested exemplified by some drugs and amino acids

  7. Individual differences in response to positive and negative stimuli: endocannabinoid-based insight on approach and avoidance behaviors

    Directory of Open Access Journals (Sweden)

    Daniela eLaricchiuta

    2014-12-01

    Full Text Available Approach and avoidance behaviors - the primary responses to the environmental stimuli of danger, novelty and reward - are associated with the brain structures that mediate cognitive functionality, reward sensitivity and emotional expression. Individual differences in approach and avoidance behaviors are modulated by the functioning of amygdaloid-hypothalamic-striatal and striatal-cerebellar networks implicated in action and reaction to salient stimuli. The nodes of these networks are strongly interconnected and by acting on them the endocannabinoid and dopaminergic systems increase the intensity of appetitive or defensive motivation. This review analyzes the approach and avoidance behaviors in humans and rodents, addresses neurobiological and neurochemical aspects of these behaviors, and proposes a possible synaptic plasticity mechanism, related to endocannabinoid-dependent long-term potentiation and depression that allows responding to salient positive and negative stimuli.

  8. Prediction of the period of psychotic episode in individual schizophrenics by simulation-data construction approach.

    Science.gov (United States)

    Huang, Chun-Jung; Wang, Hsiao-Fan; Chiu, Hsien-Jane; Lan, Tsuo-Hung; Hu, Tsung-Ming; Loh, El-Wui

    2010-10-01

    Although schizophrenia can be treated, most patients still experience inevitable psychotic episodes from time to time. Precautious actions can be taken if the next onset can be predicted. However, sufficient information is always lacking in the clinical scenario. A possible solution is to use the virtual data generated from limited of original data. Data construction method (DCM) has been shown to generate the virtual felt earthquake data effectively and used in the prediction of further events. Here we investigated the performance of DCM in deriving the membership functions and discrete-event simulations (DES) in predicting the period embracing the initiation and termination time-points of the next psychotic episode of 35 individual schizophrenic patients. The results showed that 21 subjects had a success of simulations (RSS) ≥70%. Further analysis demonstrated that the co-morbidity of coronary heart diseases (CHD), risks of CHD, and the frequency of previous psychotic episodes increased the RSS.

  9. Evaluating the status of individuals and populations: Advantages of multiple approaches and time scales: Chapter 6

    Science.gov (United States)

    Monson, Daniel H.; Bowen, Lizabeth

    2015-01-01

    The assessment of population status is a central goal of applied wildlife research and essential to the field of wildlife conservation. “Population status” has a number of definitions, the most widely used having to do with the current trajectory of the population (i.e., growing, stable, or declining), or the probability of persistence (i.e., extinction risk), perhaps without any specific knowledge as to the factors driving a population’s dynamics. In contrast, a population’s status relative to the carrying capacity of the environment (K) is an ecologically-based definition that explicitly provides information about a major mechanism of population control. That is, it relates to the relative per capita availability of resources to individuals in a population, which can also be used to infer the state of the environment itself.

  10. A novel approach for individual tree crown delineation using lidar data

    Science.gov (United States)

    Liu, Tao

    Individual tree crown delineation (ITCD) is an important technique to support precision forestry. ITCD is particularly difficult for deciduous forests where the existence of multiple branches can lead to false tree top detection. This thesis focused on developing a new ITCD model, which consists of two components: (1) boundary refinement using a novel algorithm called Fishing Net Dragging (FiND), and (2) segment merging using boundary classification. The proposed ITCD model was tested in both deciduous and mixed forests, attaining an overall accuracy of 74% and 78%, respectively. This compared favorably to an ITCD method commonly cited in the literature, which attained 41% and 51% on the same plots. To facilitate comparison of research in the ITCD community, this thesis also developed a new accuracy assessment scheme for ITCD. This new accuracy assessment is easy to interpret and convenient to implement while comprehensively evaluating ITCD accuracy.

  11. The Master's program in Advanced Optical Technologies: an interdisciplinary, international and individual approach

    Science.gov (United States)

    Großmann, Jürgen; Schmauss, Bernhard

    2017-08-01

    The Master's Program in Advanced Optical Technologies (MAOT) was established at the Friedrich-Alexander Universität Erlangen-Nürnberg in 2007 as part of the Elite Network of Bavaria (ENB), an initiative by the Bavarian State Government comprising about 40 elite Master's programs and doctoral programs. MAOT can be studied after a Bachelor in physics or an engineering subject. The Master's program realizes an innovative concept combining three core elements: (1) Interdisciplinarity: The program integrates courses and researchers from five engineering subjects and from physics. The degree of interdisciplinarity goes far beyond traditional programs. (2) Internationality: The program is taught entirely in English and special support is given to international students. (3). Individuality: The course curriculum was adapted at several points based on the experience in the initial years. The same is true for the way in which international students are supported and the type of support they need. The students are given an unusually high degree of freedom to develop an individual curriculum and to pursue research projects. Crucial experience and lessons learned are: (1) Lecturers and researchers have to be coordinated and the perspectives of the different disciplines have to be integrated within one program. Students must be guided in order to deal with the demands and challenges of the different disciplines. (2) International students need support with settling in Germany and with learning and working in a German cultural environment. They need support with administrative issues. Furthermore, they need to analyze and understand cultural differences and how they impact on the cooperation between lecturers and students and on the work in research groups. (3) Students must be helped to develop their own curriculum. They must learn how to combine their first-degree qualification with the specialized qualification which they gain after completing their Master's program. They

  12. Uniting statistical and individual-based approaches for animal movement modelling.

    Science.gov (United States)

    Latombe, Guillaume; Parrott, Lael; Basille, Mathieu; Fortin, Daniel

    2014-01-01

    The dynamic nature of their internal states and the environment directly shape animals' spatial behaviours and give rise to emergent properties at broader scales in natural systems. However, integrating these dynamic features into habitat selection studies remains challenging, due to practically impossible field work to access internal states and the inability of current statistical models to produce dynamic outputs. To address these issues, we developed a robust method, which combines statistical and individual-based modelling. Using a statistical technique for forward modelling of the IBM has the advantage of being faster for parameterization than a pure inverse modelling technique and allows for robust selection of parameters. Using GPS locations from caribou monitored in Québec, caribou movements were modelled based on generative mechanisms accounting for dynamic variables at a low level of emergence. These variables were accessed by replicating real individuals' movements in parallel sub-models, and movement parameters were then empirically parameterized using Step Selection Functions. The final IBM model was validated using both k-fold cross-validation and emergent patterns validation and was tested for two different scenarios, with varying hardwood encroachment. Our results highlighted a functional response in habitat selection, which suggests that our method was able to capture the complexity of the natural system, and adequately provided projections on future possible states of the system in response to different management plans. This is especially relevant for testing the long-term impact of scenarios corresponding to environmental configurations that have yet to be observed in real systems.

  13. Investigation into the Individualized Treatment of Traditional Chinese Medicine through a Series of N-of-1 Trials

    Science.gov (United States)

    Yang, Peilan; Wang, Jie; Wu, Yingen; Zi, Suna; Tang, Jie; Wang, Zhenwei

    2018-01-01

    Purpose To compare the efficacy of individualized herbal decoction with standard decoction for patients with stable bronchiectasis through N-of-1 trials. Methods We conducted a single center N-of-1 trials in 17 patients with stable bronchiectasis. Each N-of-1 trial contains three cycles. Each cycle is divided into two 4-week intervention including individualized decoction and fixed decoction (control). The primary outcome was patient self-reported symptoms scores on a 1–7 point Likert scale. Secondary outcomes were 24-hour sputum volume and CAT scores. Results Among 14 completed trials, five showed that the individualized decoction was statistically better than the control decoction on symptom scores (P traditional Chinese medicine individual diagnosis and treatment. PMID:29552084

  14. Delay discounting, treatment motivation and treatment retention among substance-dependent individuals attending an in inpatient detoxification program

    NARCIS (Netherlands)

    Stevens, Laura; Verdejo-García, Antonio; Roeyers, Herbert; Goudriaan, Anna E.; Vanderplasschen, Wouter

    2015-01-01

    Recent studies consistently indicate high rates of delay discounting in drug users, which refers to a strong tendency to devaluate delayed rewards. Many addiction treatment programs however, place high demands on the ability to postpone immediate gratification. Therefore, these programs may be

  15. Patients’ perception regarding the influence of individual and social vulnerabilities on the adherence to tuberculosis treatment: a qualitative study

    Directory of Open Access Journals (Sweden)

    Rosiane Davina da Silva

    2017-09-01

    Full Text Available Abstract Background Tuberculosis remains an important disease which mainly affects the majority of vulnerable individuals in society, who are subjected to poor living conditions and difficulties to access the services of public health. Under these circumstances, the present study aims to understand patients’ perception in relation to the influence of individual and social vulnerabilities on the adherence to tuberculosis treatment. Methods A qualitative descriptive cross sectional study was conducted in one large municipality at the state of Paraíba, Northeast of Brazil. The study subjects, who were residents of the study site, covered all tuberculosis cases diagnosed between March and June 2015. The sample was defined by the criteria of response saturation. All interviews were audio recorded, and data analysis was developed through the hermeneutic dialectic method and the theory of Generative Route Sense. The project was approved by the Research Ethics Committee of the University of São Paulo (USP. Results A total of 13 individuals were interviewed and the responses were identified into two analytical categories: the difficulties they had and the enabling factors they could mention during their tuberculosis treatment. Patients brought up social exclusion as an obstacle to treatment adherence, which, along with stigmatization, weakened their link with family members and health professionals. Moreover, economic precariousness was a major hindrance to the maintenance of a proper diet and transportation access to health centers. However, social support and directly observed treatment helped to break down barriers of prejudice and to promote individual and family empowerment. Finally, patients also reported that their will to live and faith gave them the strength to continue with the treatment. Conclusions According to patients in this study, social support and the strengthening of links with family members and health professionals may reduce

  16. Patients' perception regarding the influence of individual and social vulnerabilities on the adherence to tuberculosis treatment: a qualitative study.

    Science.gov (United States)

    da Silva, Rosiane Davina; de Luna, Fernanda Darliane Tavares; de Araújo, Aguinaldo José; Camêlo, Edwirde Luiz Silva; Bertolozzi, Maria Rita; Hino, Paula; Lacerda, Sheylla Nadjane Batista; Fook, Sayonara Maria Lia; de Figueiredo, Tânia Maria Ribeiro Monteiro

    2017-09-19

    Tuberculosis remains an important disease which mainly affects the majority of vulnerable individuals in society, who are subjected to poor living conditions and difficulties to access the services of public health. Under these circumstances, the present study aims to understand patients' perception in relation to the influence of individual and social vulnerabilities on the adherence to tuberculosis treatment. A qualitative descriptive cross sectional study was conducted in one large municipality at the state of Paraíba, Northeast of Brazil. The study subjects, who were residents of the study site, covered all tuberculosis cases diagnosed between March and June 2015. The sample was defined by the criteria of response saturation. All interviews were audio recorded, and data analysis was developed through the hermeneutic dialectic method and the theory of Generative Route Sense. The project was approved by the Research Ethics Committee of the University of São Paulo (USP). A total of 13 individuals were interviewed and the responses were identified into two analytical categories: the difficulties they had and the enabling factors they could mention during their tuberculosis treatment. Patients brought up social exclusion as an obstacle to treatment adherence, which, along with stigmatization, weakened their link with family members and health professionals. Moreover, economic precariousness was a major hindrance to the maintenance of a proper diet and transportation access to health centers. However, social support and directly observed treatment helped to break down barriers of prejudice and to promote individual and family empowerment. Finally, patients also reported that their will to live and faith gave them the strength to continue with the treatment. According to patients in this study, social support and the strengthening of links with family members and health professionals may reduce social exclusion and other difficulties they face, thus encouraging them

  17. Conditional random slope: A new approach for estimating individual child growth velocity in epidemiological research.

    Science.gov (United States)

    Leung, Michael; Bassani, Diego G; Racine-Poon, Amy; Goldenberg, Anna; Ali, Syed Asad; Kang, Gagandeep; Premkumar, Prasanna S; Roth, Daniel E

    2017-09-10

    Conditioning child growth measures on baseline accounts for regression to the mean (RTM). Here, we present the "conditional random slope" (CRS) model, based on a linear-mixed effects model that incorporates a baseline-time interaction term that can accommodate multiple data points for a child while also directly accounting for RTM. In two birth cohorts, we applied five approaches to estimate child growth velocities from 0 to 12 months to assess the effect of increasing data density (number of measures per child) on the magnitude of RTM of unconditional estimates, and the correlation and concordance between the CRS and four alternative metrics. Further, we demonstrated the differential effect of the choice of velocity metric on the magnitude of the association between infant growth and stunting at 2 years. RTM was minimally attenuated by increasing data density for unconditional growth modeling approaches. CRS and classical conditional models gave nearly identical estimates with two measures per child. Compared to the CRS estimates, unconditional metrics had moderate correlation (r = 0.65-0.91), but poor agreement in the classification of infants with relatively slow growth (kappa = 0.38-0.78). Estimates of the velocity-stunting association were the same for CRS and classical conditional models but differed substantially between conditional versus unconditional metrics. The CRS can leverage the flexibility of linear mixed models while addressing RTM in longitudinal analyses. © 2017 The Authors American Journal of Human Biology Published by Wiley Periodicals, Inc.

  18. Pharmacological Approaches for Treatment-resistant Bipolar Disorder

    Science.gov (United States)

    Poon, Shi Hui; Sim, Kang; Baldessarini, Ross J.

    2015-01-01

    Bipolar disorder is prevalent, with high risks of disability, substance abuse and premature mortality. Treatment responses typically are incomplete, especially for depressive components, so that many cases can be considered “treatment resistant.” We reviewed reports on experimental treatments for such patients: there is a striking paucity of such research, mainly involving small incompletely controlled trials of add-on treatment, and findings remain preliminary. Encouraging results have been reported by adding aripiprazole, bupropion, clozapine, ketamine, memantine, pramipexole, pregabalin, and perhaps tri-iodothyronine in resistant manic or depressive phases. The urgency of incomplete responses in such a severe illness underscores the need for more systematic, simpler, and better controlled studies in more homogeneous samples of patients. PMID:26467409

  19. Emerging nanotechnology approaches for HIV/AIDS treatment and prevention

    Science.gov (United States)

    Mamo, Tewodros; Moseman, E Ashley; Kolishetti, Nagesh; Salvador-Morales, Carolina; Shi, Jinjun; Kuritzkes, Daniel R; Langer, Robert; von Andrian, Ulrich

    2010-01-01

    Currently, there is no cure and no preventive vaccine for HIV/AIDS. Combination antiretroviral therapy has dramatically improved treatment, but it has to be taken for a lifetime, has major side effects and is ineffective in patients in whom the virus develops resistance. Nanotechnology is an emerging multidisciplinary field that is revolutionizing medicine in the 21st century. It has a vast potential to radically advance the treatment and prevention of HIV/AIDS. In this review, we discuss the challenges with the current treatment of the disease and shed light on the remarkable potential of nanotechnology to provide more effective treatment and prevention for HIV/AIDS by advancing antiretroviral therapy, gene therapy, immunotherapy, vaccinology and microbicides. PMID:20148638

  20. Green Walls as an Approach in Grey Water Treatment

    Science.gov (United States)

    Rysulova, Martina; Kaposztasova, Daniela; Vranayova, Zuzana

    2017-10-01

    Grey water contributes significantly to waste water parameters such as biochemical oxygen demand (BOD), chemical oxygen demand (COD), total suspended solids (TSS), total phosphorus (Ptotal), total nitrogen (Ntotal), ammonium, boron, metals, salts, surfactants, synthetic chemicals, oils and greases, xenobiotic substances and microorganisms. Concentration of these pollutants and the water quality highlights the importance of treatment process in grey water systems. Treatment technologies operating under low energy and maintenance are usually preferred, since they are more cost effective for users. Treatment technologies based on natural processes represent an example of such technology including vegetated wall. Main aim of this paper is to introduce the proposal of vegetated wall managing grey water and brief characteristic of proposed system. Is expected that prepared experiment will establish the purifying ability and the potential of green wall application as an efficient treatment technology.

  1. Treatment of premature ejaculation: a new combined approach

    Directory of Open Access Journals (Sweden)

    Adel Kurkar

    2015-01-01

    Causes of PE differ considerably. In this paper, we compared the outcomes of two single treatment lines together with a combination of both. The combination therapy was more effective than either line alone.

  2. Current treatment approaches in patients with ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    Bilal Elbey

    2015-03-01

    Full Text Available Ankylosing spondylitis (AS is a chronic, inflammatory, rheumatic disease that mainly affects sacroiliac joints and spine. AS predominantly occurs more often in males and typically begins in the second or third decade. The mainstay of therapy in AS are nonsteroidal anti-inflammatory drugs, which reduce inflammation and pain. Disease modifying antirheumatic drugs (DMARD did not have enough evidence to prove their effect in AS treatment. The use of DMARD may not sufficient to improve the treatment and symptoms. Currently, TNF-blockers such as, Golimumab Etanersept Adalimumab İnfliksimab have promising results in the treatment of AS. TNF-blockers improve the clinical signs and symptoms, and improve the patients’ physical function and quality of life. This manuscript is focused that Current pharmacological treatments in patients with ankylosing spondylitis.

  3. Lupus nephritis: An approach to diagnosis and treatment in South ...

    African Journals Online (AJOL)

    In all patients, treatment should include adjunctive therapies such as renin angiotensin aldosterone system .... Switching to an alternative agent is recommended for ... gastritis, cataracts, avascular necrosis of femur, cushingoid appearance.

  4. FUNCTIONAL FECAL INCONTINENCE IN CHILDREN (DIFFERENTIAL DIAGNOSTICS AND TREATMENT APPROACHES

    Directory of Open Access Journals (Sweden)

    V.N. Kopeikin

    2009-01-01

    Full Text Available Impairment of the intestinal content continence, a common clinical situation with various pathogenetic mechanisms. Disease proceeds with the child’s maladjustment events. 33 cases of encopresis have been analyzed. This condition has various clinical and instrumental diagnostic criteria depending on the origin which simplifies differential diagnostics. Using a differential diagnostics table helps expedite the process of making a diagnosis and hence start an adequate treatment in a timely manner.Key words: encopresis, differential diagnostics, treatment, children.

  5. Radiographic structural findings in the mandibular condyles of young individuals receiving orthodontic treatment

    International Nuclear Information System (INIS)

    Peltola, J.S.; Nystroem, M.; Koenoenen, M.; Wolf, J.

    1995-01-01

    Radiographic findings in mandibular condyles were studied from the pre- and post-treatment panoramic radiographs of 625 orthodontic patients. The subjects' mean age was 11 years at the start and 14 years at the end of active orthodontic treatment. Radiographic condylar findings were seen in 14 subjects before treatment and in 54 subjects after treatment. In age-related controls condylar findings were seen in 3%. The condylar findings was ''flattening only'' in half of the patients and in one-third of the controls with condylar findings. Activator treatment was associated with condylar findings. Condylar findings increased with age in the orthodontically treated subjects, but not in the unselected population controls. This may mean that condyles become more sensitive with age in children. Increase with age may be partly due to the radiographic interpretation, since minor condylar findings are difficult to observe in young children, and partly due to differences in treatment modalities and the duration of treatment. 44 refs., 1 fig., 3 tabs

  6. Ulipristal acetate: a novel pharmacological approach for the treatment of uterine fibroids

    Directory of Open Access Journals (Sweden)

    Biglia N

    2014-02-01

    Full Text Available Nicoletta Biglia,1 Silvestro Carinelli,2 Antonio Maiorana,3 Marta D'Alonzo,1 Giuseppe Lo Monte,4 Roberto Marci4 1Department of Obstetrics and Gynaecology, Mauriziano "Umberto I" Hospital, University of Turin, Turin, 2Department of Pathology, European Institute of Oncology, Milan, 3Department of Obstetrics and Gynecology, ARNAS Civico Hospital, Palermo, 4Department of Morphology, Surgery and Experimental Medicine, Section of Obstetrics and Gynecology, Infertility Unit, University of Ferrara, Ferrara, Italy Abstract: Uterine fibroids are the most common benign tumors of the female genital tract. The management of symptomatic fibroids has traditionally been surgical; however, alternative pharmacological approaches have been proposed to control symptoms. To date, gonadotropin-releasing hormone analogs are the only available drugs for the preoperative treatment of fibroids. However, the US Food and Drug Administration recently authorized ulipristal acetate (UPA, an oral selective progesterone-receptor modulator, for the same indication. UPA is a new, effective, and well-tolerated option for the preoperative treatment of moderate and severe symptoms of uterine fibroids in women of reproductive age. According to clinical data, UPA shows several advantages: it is faster than leuprolide in reducing the fibroid-associated bleeding, it significantly improves hemoglobin and hematocrit levels in anemic patients, and it grants a significant reduction in the size of fibroids, which lasts for at least 6 months after the end of the treatment. Furthermore, UPA displays a better tolerability profile when compared to leuprolide; in fact, it keeps estradiol levels at mid follicular phase range, thereby reducing the incidence of hot flushes and exerting no impact on bone turnover. On the grounds of this evidence, the administration of 5 mg/day ulipristal acetate for 3 months is suggested for different patient categories and allows for planning a treatment strategy

  7. Approaches for assessment of terrestrial vertebrate responses to contaminants: moving beyond individual organisms

    Science.gov (United States)

    Albers, P.H.; Heinz, G.H.; Hall, R.J.; Albers, Peter H.; Heinz, Gary H.; Ohlendorf, Harry M.

    2000-01-01

    Conclusions: A need for a broader range ofinformation on effects of contaminants on individuals exists among the 4 classes of terrestrial vertebrates, especially mammals, reptiles, and amphibians. Separation of contaminant effects from other effects and reduction of speculative extrapolation within and among species requires information that can be produced only by combined field and laboratory investigations that incorporate seasonal or annual cycles and important spatial and interaction conditions. Assessments of contaminant effects at the population level and higher are frequently dependent on extrapolations from a lower organizational level. Actual measurements of the effects of contaminants on populations or communities, possibly in conjunction with case studies that establish relations between effects on individuals and effects on populations, are needed to reduce the uncertainty associated with these extrapolations. Associated with these assessment levels is the need for acceptable definitions of what we mean when we refer to a 'meaningful population change' or an 'effect on communities or ecosystems.' At these higher levels of organization we are also confronted with the need for procedures useful for separating contaminant effects from effects caused by other environmental conditions. Although the bulk of literature surveyed was of the focused cause-and-effect type that is necessary for proving relations between contaminants and wildlife, community or ecosystem field assessments, as sometimes performed with reptiles and amphibians, might be a useful alternative for estimating the potential of a contaminant to cause environmental harm. Assumptions about the special usefulness of reptiles and amphibians as environmental indicators ought to be tested with comparisons to mammals and birds. Information on the effects of contaminants above the individual level is needed to generate accurate estimates of the potential consequences of anthropogenic pollution (e

  8. An MPC approach to individual pitch control of wind turbines using uncertain LIDAR measurements

    DEFF Research Database (Denmark)

    Mirzaei, Mahmood; Soltani, Mohsen; Poulsen, Niels Kjølstad

    2013-01-01

    wind turbine in the full load region is considered. Model predictive control (MPC) is used to solve the problem. A new approach is proposed to simplify the optimization problem of MPC. We linearize the obtained nonlinear model for different operating points which are determined by the effective wind...... speed on the rotor disc and take the wind speed as a scheduling variable. The wind speed is measurable ahead of the turbine using LIDARs, therefore the scheduling variable is known for the entire prediction horizon. We consider uncertainty in the wind propagation, which is the traveling time of wind...... from the LIDAR measurement point to the rotor. An algorithm based on wind speed estimation and measurements from the LIDAR is devised to find an estimate of the delay and compensate for it before it is used in the controller. Comparisons between the MPC with error compensation, without error...

  9. Intelligent systems approach for automated identification of individual control behavior of a human operator

    Science.gov (United States)

    Zaychik, Kirill B.

    Acceptable results have been obtained using conventional techniques to model the generic human operator's control behavior. However, little research has been done in an attempt to identify an individual based on his/her control behavior. The main hypothesis investigated in this dissertation is that different operators exhibit different control behavior when performing a given control task. Furthermore, inter-person differences are manifested in the amplitude and frequency content of the non-linear component of the control behavior. Two enhancements to the existing models of the human operator, which allow personalization of the modeled control behavior, are presented in this dissertation. One of the proposed enhancements accounts for the "testing" control signals, which are introduced by an operator for more accurate control of the system and/or to adjust his/her control strategy. Such enhancement uses the Artificial Neural Network (ANN), which can be fine-tuned to model the "testing" control behavior of a given individual. The other model enhancement took the form of an equiripple filter (EF), which conditions the power spectrum of the control signal before it is passed through the plant dynamics block. The filter design technique uses Parks-McClellan algorithm, which allows parameterization of the desired levels of power at certain frequencies. A novel automated parameter identification technique (APID) was developed to facilitate the identification process of the parameters of the selected models of the human operator. APID utilizes a Genetic Algorithm (GA) based optimization engine called the Bit-climbing Algorithm (BCA). Proposed model enhancements were validated using the experimental data obtained at three different sources: the Manual Control Laboratory software experiments, Unmanned Aerial Vehicle simulation, and NASA Langley Research Center Visual Motion Simulator studies. Validation analysis involves comparison of the actual and simulated control

  10. Who's adopting the smarter lunchroom approach? Individual characteristics of innovative food service directors.

    Science.gov (United States)

    Gabrielyan, Gnel; Hanks, Drew S; Hoy, Kathryn; Just, David R; Wansink, Brian

    2017-02-01

    School cafeterias and, subsequently, food service directors (FSDs) play a vital role in feeding children in the U.S. This study investigates which FSDs with different characteristics and organizational affiliations are most willing to embrace and implement new programs in their cafeterias. In 2014 we surveyed a representative sample of 8143 school FSDs across the U.S. regarding their knowledge and use of innovative methods that encourage children to select healthy food options. Nearly all of the surveyed FSDs (93%) are aware of behavioral strategies to promote healthier eating in school lunchrooms, and nearly 93% report having made at least one change in their lunchroom. Male FSDs are more likely to be aware of new programs, though they are less likely to adopt them relative to female FSDs. In addition, membership in a professional organization increases awareness as well as the number of changes made by 0.14 (p<0.01). Finally, 22% of all respondents say they know about the Smarter Lunchrooms approach, a set of research-based lunchroom behavioral strategies that positively influence children to select healthy foods. The findings highlight the importance of participation in professional associations which provide career-building activities for school FSDs increasing awareness and adoption of innovative approaches to motivate children to eat the nutritious foods. Given these findings, there is reason for policy makers and school districts to consider allocating funds to encourage FSDs to engage more fully in professional association meetings and activities. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. Hypnosis Attitudes: Treatment Effects and Associations With Symptoms in Individuals With Cancer.

    Science.gov (United States)

    Mendoza, Maria Elena; Capafons, Antonio; Jensen, Mark P

    2017-07-01

    Attitudes about hypnosis are associated with hypnotic responsiveness. However, little is known about how hypnosis attitudes change with treatment and if those changes are associated with better outcomes. This study examined whether an intervention based on the Valencia Model of Waking Hypnosis combined with Cognitive-Behavioral Therapy changed attitudes about hypnosis in a sample of patients with a history of cancer. The results indicated that the intervention improved attitudes toward hypnosis, relative to a control intervention, and the improvements remained stable at 3-month follow-up. Analyses also showed that changes in some attitudes were associated with treatment-related improvements. The findings are consistent with the idea that attitudes about hypnosis play a role in hypnosis treatment outcome, supporting the importance of addressing such beliefs at the onset of and throughout treatment.

  12. Experienced and anticipated discrimination reported by individuals in treatment for substance use disorders within the Netherlands

    NARCIS (Netherlands)

    van Boekel, L.C.; Brouwers, E.P.M.; van Weeghel, J.; Garretsen, H.F.L.

    2016-01-01

    Experiences and expectations of discrimination (anticipated discrimination) may delay treatment seeking among people with substance use disorders. In addition, experienced and anticipated discrimination can be a barrier to successful recovery and rehabilitation. The aim of this study was to study

  13. Perceived Stigma and Treatment-Seeking Behavior in Individuals with Substance Use Disorder in Baghdad

    Directory of Open Access Journals (Sweden)

    Qahtan Q. Mohammed

    2016-12-01

    Conclusions The study concluded that perceived stigma among substance abusers has no impact upon their treatment-seeking behavior, and also, perceived stigma among substance abusers is insignificantly correlated with their socio-demographic variables.

  14. The efficacy of individual treatment of subjective tinnitus with cognitive behavioural therapy.

    Science.gov (United States)

    Canals, Pascual; Pérez Del Valle, Belén; Lopez, Francisco; Marco, Amparo

    2016-01-01

    It has been a long time since subjective tinnitus cases were described for the first time but they still lack a treatment with proven effectiveness. The main goal of this study was to evaluate the effectiveness of cognitive behavioural therapy in these patients. Between 2012 and 2013, 310 patients that suffered from subjective tinnitus were studied. Of these, 267 were included in treatment based on cognitive behavioural therapy. The monitoring period lasted 18 months for most cases, while it lasted 21 months for 11 patients. Considering patients that interrupted their treatment as failures, the percentage of recovery was 95.7%. Cognitive behavioural therapy should always be included in the treatment of people suffering from tinnitus. Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  15. Topical analgesic added to paraffin enhances paraffin bath treatment of individuals with hand osteoarthritis.

    Science.gov (United States)

    Myrer, Joseph William; Johnson, Aaron Wayne; Mitchell, Ulrike H; Measom, Gary J; Fellingham, Gilbert W

    2011-01-01

    To compare treating patients with symptomatic hand osteoarthritis (OA) with paraffin baths only (PO) (100% wax) or paraffin baths 80% wax with 20% topical analgesic (PTA). Subjects met criteria of the American College of Rheumatology for classifying symptomatic hand OA and had a Dreiser's index score >5 points. Current and average pain at rest and with movement was assessed with visual analogue scales. Hand function was assessed by the functional index for hand OA (FIHOA). Both groups had a significant reduction in their 'current' pain 15 min after the first and twelfth treatments compared to pre-treatment but there was no difference between groups (t = 0.10, p > 0.05). The PTA group had greater improvement over the 12 treatment sessions for their pain at rest (t = 2.92, p paraffin produced significantly greater pain relief at rest and during movement than paraffin baths alone after 12 treatments. Additionally, the PTA group experienced greater improved hand function.

  16. The effects of an individualized exercise intervention on body composition in breast cancer patients undergoing treatment

    OpenAIRE

    Battaglini,Claudio; Bottaro,Martim; Dennehy,Carolyn; Rae,Logan; Shields,Edgar; Kirk,David; Hackney,Anthony

    2007-01-01

    CONTEXT AND OBJECTIVE: Changes in metabolism have been reported in the majority of patients undergoing cancer treatment, and these are usually characterized by progressive change in body composition. The effects of aerobic exercise programs to combat the cancer and cancer treatment-related side effects, which include the negative changes in body composition, have been extensively reported in the literature. However, few resistance exercise intervention studies have hypothesized that breast ca...

  17. Schistosomiasis and HIV in rural Zimbabwe: efficacy of treatment of schistosomiasis in individuals with HIV coinfection

    DEFF Research Database (Denmark)

    Kallestrup, Per; Zinyama, Rutendo; Gomo, Exnevia

    2006-01-01

    There is evidence from experimental models that the praziquantel-induced clearance of schistosomiasis is dependent on the host's immune response. Consequently, human immunodeficiency virus (HIV)-related immunodeficiency may impair the effect of praziquantel treatment.......There is evidence from experimental models that the praziquantel-induced clearance of schistosomiasis is dependent on the host's immune response. Consequently, human immunodeficiency virus (HIV)-related immunodeficiency may impair the effect of praziquantel treatment....

  18. Intelligent Systems Approach for Automated Identification of Individual Control Behavior of a Human Operator

    Science.gov (United States)

    Zaychik, Kirill B.; Cardullo, Frank M.

    2012-01-01

    Results have been obtained using conventional techniques to model the generic human operator?s control behavior, however little research has been done to identify an individual based on control behavior. The hypothesis investigated is that different operators exhibit different control behavior when performing a given control task. Two enhancements to existing human operator models, which allow personalization of the modeled control behavior, are presented. One enhancement accounts for the testing control signals, which are introduced by an operator for more accurate control of the system and/or to adjust the control strategy. This uses the Artificial Neural Network which can be fine-tuned to model the testing control. Another enhancement takes the form of an equiripple filter which conditions the control system power spectrum. A novel automated parameter identification technique was developed to facilitate the identification process of the parameters of the selected models. This utilizes a Genetic Algorithm based optimization engine called the Bit-Climbing Algorithm. Enhancements were validated using experimental data obtained from three different sources: the Manual Control Laboratory software experiments, Unmanned Aerial Vehicle simulation, and NASA Langley Research Center Visual Motion Simulator studies. This manuscript also addresses applying human operator models to evaluate the effectiveness of motion feedback when simulating actual pilot control behavior in a flight simulator.

  19. Thermodynamic optimization of individual steel database by means of systematic DSC measurements according the CALPHAD approach

    International Nuclear Information System (INIS)

    Presoly, P; Bernhard, C; Six, J

    2016-01-01

    Reliable thermodynamic data are essential information required for the design of new steel types and are a prerequisite to effective process optimization and simulation. Moreover, it is important to know the exact temperatures at which the high-temperature phase transformations (T Liquid , T Solid , T Perit , T γ→δ ) occur in order to describe the solidification sequence and to describe further processing parameters. By utilizing DTA/DSC measurements, our earlier experimental studies of selected commercial DP, TRIP and high-Mn TWIP steels, have indicated that currently commercially available databases can often not be utilised to reliably describe the behaviour and microstructural development in such complex alloy systems. Because of these ostensible deficiencies, an experimental study was undertaken in an attempt to determine the pertaining thermodynamic data to analyse the behaviour of the important five- component Fe-C-Si-Mn-Al alloy system. High purity model alloys with systematic alloy variations were prepared and utilized in order to determine the influence of individual alloying elements in this complex, but industrially important alloy system. The present study provides new validated experimental thermodynamic data and analysis of the five-component Fe-C-Si- Mn-Al system, which will allow the construction of new phase diagrams, prediction of solidification sequences and the assessment of micro-segregation. (paper)

  20. Thermodynamic optimization of individual steel database by means of systematic DSC measurements according the CALPHAD approach

    Science.gov (United States)

    Presoly, P.; Six, J.; Bernhard, C.

    2016-03-01

    Reliable thermodynamic data are essential information required for the design of new steel types and are a prerequisite to effective process optimization and simulation. Moreover, it is important to know the exact temperatures at which the high-temperature phase transformations (TLiquid, TSolid, TPerit, Tγ→δ) occur in order to describe the solidification sequence and to describe further processing parameters. By utilizing DTA/DSC measurements, our earlier experimental studies of selected commercial DP, TRIP and high-Mn TWIP steels, have indicated that currently commercially available databases can often not be utilised to reliably describe the behaviour and microstructural development in such complex alloy systems. Because of these ostensible deficiencies, an experimental study was undertaken in an attempt to determine the pertaining thermodynamic data to analyse the behaviour of the important five- component Fe-C-Si-Mn-Al alloy system. High purity model alloys with systematic alloy variations were prepared and utilized in order to determine the influence of individual alloying elements in this complex, but industrially important alloy system. The present study provides new validated experimental thermodynamic data and analysis of the five-component Fe-C-Si- Mn-Al system, which will allow the construction of new phase diagrams, prediction of solidification sequences and the assessment of micro-segregation.

  1. An epigenomics approach to individual differences and its translation to neuropsychiatric conditions.

    Science.gov (United States)

    Sweatt, J David; Tamminga, Carol A

    2016-09-01

    This review concerns epigenetic mechanisms and their roles in conferring interindividual differences, especially as related to experientially acquired and genetically driven changes in central nervous system (CNS) function. In addition, the review contains commentary regarding the possible ways in which epigenomic changes may contribute to neuropsychiatric conditions and disorders and ways in which epigenotyping might be cross-correlated with clinical phenotyping in the context of precision medicine. The review begins with a basic description of epigenetic marking in the CNS and how these changes are powerful regulators of gene readout. Means for characterizing the individual epigenotype are briefly described, with a focus on DNA cytosine methylation as a readily measurable, stable epigenetic mark. This background enables a discussion of how "epigenotyping" might be integrated along with genotyping and deep phenotyping as a means of implementing advanced precision medicine. Finally, the commentary addresses two exemplars when considering how epigenotype may correlate with and modulate cognitive and behavioral phenotype: schizophrenia and Rett syndrome. These two disorders provide an interesting compare-and-contrast example regarding possible epigenotypic regulation of behavior: whereas Rett syndrome is clearly established as being caused by disruption of the function of an epigenetic "reader" of the DNA cytosine methylome-methyl-CpG-binding protein 2 (MeCP2)-the case for a role for epigenetic mechanisms in schizophrenia is still quite speculative.

  2. A cytogenetic approach to the effects of low levels of ionizing radiations on occupationally exposed individuals

    Energy Technology Data Exchange (ETDEWEB)

    Zakeri, Farideh [National Radiation Protection Department, Iranian Nuclear Regulatory Authority, Nuclear Science and Research Institute-Agriculture, Medicine and Industry Research School, Tehran (Iran, Islamic Republic of); Graduate School of Science and Technology, Chiba University, Inage-ku, Chiba 263-8522 (Japan)], E-mail: fzakeri@aeoi.org.ir; Hirobe, Tomohisa [Graduate School of Science and Technology, Chiba University, Inage-ku, Chiba 263-8522 (Japan); Radiation Effect Mechanism Research Group, National Institute of Radiological Sciences, Inage-ku, Chiba 263-8555 (Japan)

    2010-01-15

    The aim of the present study was to assess occupationally induced chromosomal damage in hospital workers exposed to low levels of ionizing radiation. Thirty-two interventional cardiologists, 36 nuclear medicine physicians and 33 conventional radiologists were included in this study, along with 35 healthy age- and sex-matched individuals as the control group. We used conventional metaphase chromosome aberration (CA) analysis, cytokinesis-block micronucleus (MN) assay as important biological indicators of ionizing radiation exposure. Occupational dosimetry records were collected over the last year (ranged from 0.25 to 48 mSv) and their whole life exposure (ranged from 1.5 to 147 mSv). The results showed significantly higher frequencies of dicentric and acentric CAs (p < 0.001) and MN (p < 0.01) in all exposed groups than in the controls. Taking all the confounding factors into account, no obvious trend of increased chromosomal damages as a function of either duration of employment, exposed dose, sex or age was observed. Interventional cardiologists had the highest rates of CA and MN frequencies between the worker groups, though the differences were not significant. These results indicate that long term exposure to low dose ionizing radiation could result in DNA damage. Hence, the personnel who work in the hospitals should carefully apply the radiation protection procedures.

  3. A STRUGGLE FOR LOVE OF BELLA SWAN REFLECTED IN NEW MOON MOVIE: AN INDIVIDUAL PSYCHOLOGICAL APPROACH

    Directory of Open Access Journals (Sweden)

    Ayu Riska Lestari

    2012-12-01

    Full Text Available This paper described the struggle for love of Bella Swan reflected in New Moon movie by using Alfred Adler’s individual psychology and analyzed the plot of the movie. It used qualitative research method and the object of this study was a major character named Bella Swan. Primary data sources were the New Moon movie directed by Christopher Weitz and the script of the movie, while secondary data sources were collected from many sources such as dictionary, articles from internet, and books related to this study. Methods of data collecting were observation and library research. The method of data analysis was descriptive analysis. Based on the analysis, It reflected the condition of a person who had a goal and struggle to get it. It concluded that Bella had high struggles to reach her goals. The plot of New Moon movie is complicated and stimulating, therefore it made the story was not flat and boring. By analyzing the plot, the viewers could easily understand the story and the message of the movie and catch up the moral lesson of it.

  4. Novel pharmacological approaches for the treatment of acne vulgaris.

    Science.gov (United States)

    Valente Duarte de Sousa, Isabel Cristina

    2014-10-01

    Acne vulgaris is the most common skin disease worldwide; yet, current treatment options, although effective, are associated with unwanted side effects, chronicity, relapses and recurrences. The adequate control of the four pathogenic mechanisms, involved in the appearance of acne lesions, is paramount to treatment success. The authors discuss and evaluate the pathogenic pathways related to the mechanisms of action of novel molecules, which are currently under investigation for the treatment of acne vulgaris. The manuscript is based on comprehensive searches made through PubMed, GoogleScholar and ClinicalTrial.gov, using different combination of key words, which include acne vulgaris, pathogenesis, treatment, sebogenesis and Propionibacterium acnes. In the near future, more effective treatments with fewer side effects are expected. The use of topical antiandrogens, acetylcholine inhibitors and PPAR modulators seem to be promising options for controlling sebum production. Retinoic acid metabolism-blocking agents and IL-1α inhibitors have the potential to become legitimate alternative options to retinoid therapy in the management of infundibular dyskeratosis. Indeed, the authors believe that there will likely be a decline in the use of antibiotics for controlling P. acnes colonization and targeting the inflammation cascade.

  5. An Approach for Practical Multiobjective IMRT Treatment Planning

    International Nuclear Information System (INIS)

    Craft, David; Halabi, Tarek; Shih, Helen A.; Bortfeld, Thomas

    2007-01-01

    Purpose: To introduce and demonstrate a practical multiobjective treatment planning procedure for intensity-modulated radiation therapy (IMRT) planning. Methods and Materials: The creation of a database of Pareto optimal treatment plans proceeds in two steps. The first step solves an optimization problem that finds a single treatment plan which is close to a set of clinical aspirations. This plan provides an example of what is feasible, and is then used to determine mutually satisfiable hard constraints for the subsequent generation of the plan database. All optimizations are done using linear programming. Results: The two-step procedure is applied to a brain, a prostate, and a lung case. The plan databases created allow for the selection of a final treatment plan based on the observed tradeoffs between the various organs involved. Conclusions: The proposed method reduces the human iteration time common in IMRT treatment planning. Additionally, the database of plans, when properly viewed, allows the decision maker to make an informed final plan selection

  6. Evaluation of patient involvement in a systematic review and meta-analysis of individual patient data in cervical cancer treatment

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    Vale Claire L

    2012-05-01

    Full Text Available Abstract Background In April 2005, researchers based at the Medical Research Council Clinical Trials Unit, set out to involve women affected by cervical cancer in a systematic review and meta-analysis of individual patient data to evaluate treatments for this disease. Each of the women had previously been treated for cervical cancer. Following completion of the meta-analysis, we aimed to evaluate the process of involvement from the researcher and research partner perspective. Methods An advisory group was first established to give advice on recruiting, supporting and involving women and led to efforts to recruit women to take part in the systematic review using different approaches. Evaluation of the process and outcomes of the partnership between the systematic reviewers and the patients, in respect to what the partnership achieved; what worked well and what were the difficulties; what was learned and the resource requirements, took place during the conduct of the meta-analysis and again after completion of the project. Results Six women, each of whom had received treatments for cervical cancer, were recruited as Patient Research Partners and five of these women subsequently took part in a variety of activities around the systematic review. They attended progress meetings and all but one attended a meeting at which the first results of the review were presented to all collaborators and gave feedback. Three of the women also became involved in a further related research project which led to an editorial publication from the patient perspective and also participated, along with two lead researchers, in the evaluation of the process and outcomes. While they were generally positive about the experience, one Patient Research Partner questioned the extent of the impact patients could make to the systematic review process. Conclusions In general, researchers and patient research partners felt that they had learned a lot from the process and considered

  7. Individualization of treatments with drugs metabolized by CES1: combining genetics and metabolomics

    DEFF Research Database (Denmark)

    Rasmussen, Henrik B.; Bjerre, Ditte; Linnet, Kristian

    2015-01-01

    CES1 is involved in the hydrolysis of ester group-containing xenobiotic and endobiotic compounds including several essential and commonly used drugs. The individual variation in the efficacy and tolerability of many drugs metabolized by CES1 is considerable. Hence, there is a large interest in in...

  8. The effects of physiotherapy for female urinary incontinence: individual compared with group treatment

    NARCIS (Netherlands)

    Janssen, C.C.M.; Lagro-Janssen, A.L.M.; Felling, A.J.A.

    2001-01-01

    OBJECTIVES: To compare, in a randomized trial, the effects of individual and group physiotherapy for urinary incontinence in women referred by their general practitioner (GP). PATIENTS AND METHODS: The study included women of all ages (mean 47.8 years) with stress, urge or mixed incontinence; 126

  9. The effects of physiotherapy for female urinary incontinence: individual compared with group treatment.

    NARCIS (Netherlands)

    Janssen, C.C.M.; Lagro-Janssen, A.L.M.; Felling, A.J.A.

    2001-01-01

    OBJECTIVES: To compare, in a randomized trial, the effects of individual and group physiotherapy for urinary incontinence in women referred by their general practitioner (GP). PATIENTS AND METHODS: The study included women of all ages (mean 47.8 years) with stress, urge or mixed incontinence; 126

  10. No differences between group versus individual treatment of childhood anxiety disorders in a randomised clinical trial

    NARCIS (Netherlands)

    Liber, Juliette M.; van Widenfelt, Brigit M.; Utens, Elisabeth M. W. J.; Ferdinand, Robert F.; van der Leeden, Adelinde J. M.; van Gastel, Willemijn; Treffers, Philip D. A.

    2008-01-01

    The present study compares an individual versus a group format in the delivery of manualised cognitive-behavioural therapy (FRIENDS) for children with anxiety disorders. Clinically referred children (aged 8 to 12) diagnosed with Separation Anxiety Disorder (n = 52), Generalised Anxiety Disorder (n =

  11. Predicting and preventing ovarian hyperstimulation syndrome (OHSS: the need for individualized not standardized treatment

    Directory of Open Access Journals (Sweden)

    Fiedler Klaus

    2012-04-01

    Full Text Available Abstract Ovarian hyperstimulation syndrome (OHSS is the most serious complication of controlled ovarian stimulation (COS as part of assisted reproductive technologies (ART. While the safety and efficacy of ART is well established, physicians should always be aware of the risk of OHSS in patients undergoing COS, as it can be fatal. This article will briefly present the pathophysiology of OHSS, including the key role of vascular endothelial growth factor (VEGF, to provide the foundation for an overview of current techniques for the prevention of OHSS. Risk factors and predictive factors for OHSS will be presented, as recognizing these risk factors and individualizing the COS protocol appropriately is the key to the primary prevention of OHSS, as the benefits and risks of each COS strategy vary among individuals. Individualized COS (iCOS could effectively eradicate OHSS, and the identification of hormonal, functional and genetic markers of ovarian response will facilitate iCOS. However, if iCOS is not properly applied, various preventive measures can be instituted once COS has begun, including cancelling the cycle, coasting, individualizing the human chorionic gonadotropin trigger dose or using a gonadotropin-releasing hormone (GnRH agonist (for those using a GnRH antagonist protocol, the use of intravenous fluids at the time of oocyte retrieval, and cryopreserving/vitrifying all embryos for subsequent transfer in an unstimulated cycle. Some of these techniques have been widely adopted, despite the scarcity of data from randomized clinical trials to support their use.

  12. A new methodological approach for PET implementation in radiotherapy treatment planning.

    Science.gov (United States)

    Bellan, Elena; Ferretti, Alice; Capirci, Carlo; Grassetto, Gaia; Gava, Marcello; Chondrogiannis, Sotirios; Virdis, Graziella; Marzola, Maria Cristina; Massaro, Arianna; Rubello, Domenico; Nibale, Otello

    2012-05-01

    In this paper, a new methodological approach to using PET information in radiotherapy treatment planning has been discussed. Computed tomography (CT) represents the primary modality to plan personalized radiation treatment, because it provides the basic electron density map for correct dose calculation. If PET scanning is also performed it is typically coregistered with the CT study. This operation can be executed automatically by a hybrid PET/CT scanner or, if the PET and CT imaging sets have been acquired through different equipment, by a dedicated module of the radiotherapy treatment planning system. Both approaches have some disadvantages: in the first case, the bore of a PET/CT system generally used in clinical practice often does not allow the use of certain bulky devices for patient immobilization in radiotherapy, whereas in the second case the result could be affected by limitations in window/level visualization of two different image modalities, and the displayed PET volumes can appear not to be related to the actual uptake into the patient. To overcome these problems, at our centre a specific procedure has been studied and tested in 30 patients, allowing good results of precision in the target contouring to be obtained. The process consists of segmentation of the biological target volume by a dedicated PET/CT console and its export to a dedicated radiotherapy system, where an image registration between the CT images acquired by the PET/CT scanner and a large-bore CT is performed. The planning target volume is contoured only on the large-bore CT and is used for virtual simulation, to individuate permanent skin markers on the patient.

  13. Pressure sores--a multifaceted approach to prevention and treatment.

    Science.gov (United States)

    Staas, W. E.; Cioschi, H. M.

    1991-01-01

    The incidence and effect of pressure sores on the disabled and elderly population have created a challenge to physicians and health care professionals, from emergency departments to rehabilitation units, and in the community. If not prevented, the morbidity and mortality of patients and the direct and indirect costs to both patients and the health care system are radically increased. In this article we define the impact on our health care system of pressure sores, provide an overview of a multifaceted approach to their prevention and management, and introduce successful behavioral and educational approaches for patients with chronic, recurrent sores. A coordinated approach with patients as informed participants and their care givers enhances the chances for success. PMID:1830985

  14. BACK PAIN ASSOCIATED WITH OSTEOPOROSIS — TREATMENT PATTERNS, APPROACHES TO THERAPY

    Directory of Open Access Journals (Sweden)

    N. A. Shostak

    2014-07-01

    Full Text Available The article highlights current approaches to diagnosis and treatment of back pain, associated with osteoporosis. An algorithm for management of patients with vertebral compression fracture, complicated by pain, the main approaches to drug treatment of back pain and osteoporosis are described.

  15. [Our current approach in the treatment of sigmoid colon volvulus].

    Science.gov (United States)

    Taviloğlu, Korhan; Aydin, Erol; Ertekin, Cemalettin; Güloğlu, Recep; Kurtoğlu, Mehmet

    2002-04-01

    Our aim was to emphasize the role of endoscopic detorsion in the treatment of sigmoid colon volvulus, which we currently apply in the majority of our cases. The data of 37 patients were analyzed in a retrospective manner, during a 86-month period, between May 1994 and July 2001. The patients were classified into three groups. The first group consisted of 9 patients with resection and anastomosis, the second group consisted of 20 patients with Hartmann's procedure, and the third group consisted of 8 patients with endoscopic detorsion. Complications were encountered in 7 patients (19%), and 3 patients (8%) died following treatment. We favor colonic resection following endoscopic treatment. Resection should be preferred, if endoscopic detorsion is not successful or in the presence of a complication.

  16. Plasma Onco-Immunotherapy: Novel Approach to Cancer Treatment

    Science.gov (United States)

    Fridman, Alexander

    2015-09-01

    Presentation is reviewing the newest results obtained by researchers of A.J. Drexel Plasma Institute on direct application of non-thermal plasma for direct treatment of different types of cancer by means of specific stimulation of immune system in the frameworks of the so-called onco-immunotherapy. Especial attention is paid to analysis of depth of penetration of different plasma-medical effects, from ROS, RNS, and ions to special biological signaling and immune system related processes. General aspects of the plasma-stimulation of immune system are discussed, pointing out specific medical applications. Most of experiments have been carried out using nanosecond pulsed DBD at low power and relatively low level of treatment doses, guaranteeing non-damage no-toxicity treatment regime. The nanosecond pulsed DBD physics is discussed mostly regarding its space uniformity and control of plasma parameters relevant to plasma medical treatment, and especially relevant to depth of penetration of different plasma medical effects. Detailed mechanism of the plasma-induced onco-immunotherapy has been suggested based upon preliminary in-vitro experiments with DBD treatment of different cancer cells. Sub-elements of this mechanism related to activation of macrophages and dendritic cells, specific stressing of cancer cells and the immunogenic cell death (ICD) are to be discussed based on results of corresponding in-vitro experiments. In-vivo experiments focused on the plasma-induced onco-immunotherapy were carried out in collaboration with medical doctors from Jefferson University hospital of Philadelphia. Todays achievements and nearest future prospective of clinical test focused on plasma-controlled cancer treatment are discussed in conclusion.

  17. A New Model to Facilitate Individualized Case Conceptualization and Treatment of Social Phobia: An Examination and Reaction to Moscovitch's Model

    Science.gov (United States)

    Heimberg, Richard G.

    2009-01-01

    Moscovitch's (2009) model of social phobia is put forth as an integration and extension of previous cognitive-behavioral models. The author asserts that his approach overcomes a number of shortcomings of previous models and will serve to better guide case conceptualization, treatment planning, and intervention implementation for clients with…

  18. Automation and Intensity Modulated Radiation Therapy for Individualized High-Quality Tangent Breast Treatment Plans

    International Nuclear Information System (INIS)

    Purdie, Thomas G.; Dinniwell, Robert E.; Fyles, Anthony; Sharpe, Michael B.

    2014-01-01

    Purpose: To demonstrate the large-scale clinical implementation and performance of an automated treatment planning methodology for tangential breast intensity modulated radiation therapy (IMRT). Methods and Materials: Automated planning was used to prospectively plan tangential breast IMRT treatment for 1661 patients between June 2009 and November 2012. The automated planning method emulates the manual steps performed by the user during treatment planning, including anatomical segmentation, beam placement, optimization, dose calculation, and plan documentation. The user specifies clinical requirements of the plan to be generated through a user interface embedded in the planning system. The automated method uses heuristic algorithms to define and simplify the technical aspects of the treatment planning process. Results: Automated planning was used in 1661 of 1708 patients receiving tangential breast IMRT during the time interval studied. Therefore, automated planning was applicable in greater than 97% of cases. The time for treatment planning using the automated process is routinely 5 to 6 minutes on standard commercially available planning hardware. We have shown a consistent reduction in plan rejections from plan reviews through the standard quality control process or weekly quality review multidisciplinary breast rounds as we have automated the planning process for tangential breast IMRT. Clinical plan acceptance increased from 97.3% using our previous semiautomated inverse method to 98.9% using the fully automated method. Conclusions: Automation has become the routine standard method for treatment planning of tangential breast IMRT at our institution and is clinically feasible on a large scale. The method has wide clinical applicability and can add tremendous efficiency, standardization, and quality to the current treatment planning process. The use of automated methods can allow centers to more rapidly adopt IMRT and enhance access to the documented

  19. The tradition algorithm approach underestimates the prevalence of serodiagnosis of syphilis in HIV-infected individuals.

    Directory of Open Access Journals (Sweden)

    Bin Chen

    2017-07-01

    Full Text Available Currently, there are three algorithms for screening of syphilis: traditional algorithm, reverse algorithm and European Centre for Disease Prevention and Control (ECDC algorithm. To date, there is not a generally recognized diagnostic algorithm. When syphilis meets HIV, the situation is even more complex. To evaluate their screening performance and impact on the seroprevalence of syphilis in HIV-infected individuals, we conducted a cross-sectional study included 865 serum samples from HIV-infected patients in a tertiary hospital. Every sample (one per patient was tested with toluidine red unheated serum test (TRUST, T. pallidum particle agglutination assay (TPPA, and Treponema pallidum enzyme immunoassay (TP-EIA according to the manufacturer's instructions. The results of syphilis serological testing were interpreted following different algorithms respectively. We directly compared the traditional syphilis screening algorithm with the reverse syphilis screening algorithm in this unique population. The reverse algorithm achieved remarkable higher seroprevalence of syphilis than the traditional algorithm (24.9% vs. 14.2%, p < 0.0001. Compared to the reverse algorithm, the traditional algorithm also had a missed serodiagnosis rate of 42.8%. The total percentages of agreement and corresponding kappa values of tradition and ECDC algorithm compared with those of reverse algorithm were as follows: 89.4%,0.668; 99.8%, 0.994. There was a very good strength of agreement between the reverse and the ECDC algorithm. Our results supported the reverse (or ECDC algorithm in screening of syphilis in HIV-infected populations. In addition, our study demonstrated that screening of HIV-populations using different algorithms may result in a statistically different seroprevalence of syphilis.

  20. The tradition algorithm approach underestimates the prevalence of serodiagnosis of syphilis in HIV-infected individuals.

    Science.gov (United States)

    Chen, Bin; Peng, Xiuming; Xie, Tiansheng; Jin, Changzhong; Liu, Fumin; Wu, Nanping

    2017-07-01

    Currently, there are three algorithms for screening of syphilis: traditional algorithm, reverse algorithm and European Centre for Disease Prevention and Control (ECDC) algorithm. To date, there is not a generally recognized diagnostic algorithm. When syphilis meets HIV, the situation is even more complex. To evaluate their screening performance and impact on the seroprevalence of syphilis in HIV-infected individuals, we conducted a cross-sectional study included 865 serum samples from HIV-infected patients in a tertiary hospital. Every sample (one per patient) was tested with toluidine red unheated serum test (TRUST), T. pallidum particle agglutination assay (TPPA), and Treponema pallidum enzyme immunoassay (TP-EIA) according to the manufacturer's instructions. The results of syphilis serological testing were interpreted following different algorithms respectively. We directly compared the traditional syphilis screening algorithm with the reverse syphilis screening algorithm in this unique population. The reverse algorithm achieved remarkable higher seroprevalence of syphilis than the traditional algorithm (24.9% vs. 14.2%, p algorithm, the traditional algorithm also had a missed serodiagnosis rate of 42.8%. The total percentages of agreement and corresponding kappa values of tradition and ECDC algorithm compared with those of reverse algorithm were as follows: 89.4%,0.668; 99.8%, 0.994. There was a very good strength of agreement between the reverse and the ECDC algorithm. Our results supported the reverse (or ECDC) algorithm in screening of syphilis in HIV-infected populations. In addition, our study demonstrated that screening of HIV-populations using different algorithms may result in a statistically different seroprevalence of syphilis.