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Sample records for multi-centre european study

  1. One year follow-up of the multi-centre European PARTNER transcatheter heart valve study

    Science.gov (United States)

    Lefèvre, Thierry; Kappetein, Ari Pieter; Wolner, Ernst; Nataf, Patrick; Thomas, Martyn; Schächinger, Volker; De Bruyne, Bernard; Eltchaninoff, Hélène; Thielmann, Matthias; Himbert, Dominique; Romano, Mauro; Serruys, Patrick; Wimmer-Greinecker, Gerhard

    2011-01-01

    Background Transcatheter aortic valve implantation (TAVI) has emerged as a new therapeutic option in high-risk patients with severe aortic stenosis. Aims PARTNER EU is the first study to evaluate prospectively the procedural and mid-term outcomes of transfemoral (TF) or transapical (TA) implantation of the Edwards SAPIEN® valve involving a multi-disciplinary approach. Methods and results Primary safety endpoints were 30 days and 6 months mortality. Primary efficacy endpoints were haemodynamic and functional improvement at 12 months. One hundred and thirty patients (61 TF, 69 TA), aged 82.1 ± 5.5 years were included. TA patients had higher logistic EuroSCORE (33.8 vs. 25.7%, P = 0.0005) and more peripheral disease (49.3 vs. 16.4%, P< 0.0001). Procedures were aborted in four TA (5.8%) and six TF cases (9.8%). Valve implantation was successful in the remaining patients in 95.4 and 96.4%, respectively. Thirty days and 6 months survival were 81.2 and 58.0% (TA) and 91.8 and 90.2% (TF). In both groups, mean aortic gradient decreased from 46.9 ± 18.1 to 10.9 ± 5.4 mmHg 6 months post-TAVI. In total, 78.1 and 84.8% of patients experienced significant improvement in New York Heart Association (NYHA) class, whereas 73.9 and 72.7% had improved Kansas City Cardiomyopathy Questionnaire (KCCQ) scores in TA and TF cohorts, respectively. Conclusion This first team-based multi-centre European TAVI registry shows promising results in high-risk patients treated by TF or TA delivery. Survival rates differ significantly between TF and TA groups and probably reflect the higher risk profile of the TA cohort. Optimal patient screening, approach selection, and device refinement may improve outcomes. PMID:21075775

  2. Role of capsule endoscopy in suspected celiac disease: A European multi-centre study

    Science.gov (United States)

    Luján-Sanchis, Marisol; Pérez-Cuadrado-Robles, Enrique; García-Lledó, Javier; Juanmartiñena Fernández, José-Francisco; Elli, Luca; Jiménez-García, Victoria-Alejandra; Egea-Valenzuela, Juan; Valle-Muñoz, Julio; Carretero-Ribón, Cristina; Fernández-Urién-Sainz, Ignacio; López-Higueras, Antonio; Alonso-Lázaro, Noelia; Sanjuan-Acosta, Mileidis; Sánchez-Ceballos, Francisco; Rosa, Bruno; González-Vázquez, Santiago; Branchi, Federica; Ruano-Díaz, Lucía; Prieto-de-Frías, César; Pons-Beltrán, Vicente; Borque-Barrera, Pilar; González-Suárez, Begoña; Xavier, Sofía; Argüelles-Arias, Federico; Herrerías-Gutiérrez, Juan-Manuel; Pérez-Cuadrado-Martínez, Enrique; Sempere-García-Argüelles, Javier

    2017-01-01

    AIM To analyze the diagnostic yield (DY), therapeutic impact (TI) and safety of capsule endoscopy (CE). METHODS This is a multi-centre, observational, analytical, retrospective study. A total of 163 patients with suspicion of celiac disease (CD) (mean age = 46.4 ± 17.3 years, 68.1% women) who underwent CE from 2003 to 2015 were included. Patients were divided into four groups: seronegative CD with atrophy (Group-I, n = 19), seropositive CD without atrophy (Group-II, n = 39), contraindication to gastroscopy (Group-III, n = 6), seronegative CD without atrophy, but with a compatible context (Group-IV, n = 99). DY, TI and the safety of CE were analysed. RESULTS The overall DY was 54% and the final diagnosis was villous atrophy (n = 65, 39.9%), complicated CD (n = 12, 7.4%) and other enteropathies (n = 11, 6.8%; 8 Crohn’s). DY for groups I to IV was 73.7%, 69.2%, 50% and 44.4%, respectively. Atrophy was located in duodenum in 24 cases (36.9%), diffuse in 19 (29.2%), jejunal in 11 (16.9%), and patchy in 10 cases (15.4%). Factors associated with a greater DY were positive serology (68.3% vs 49.2%, P = 0.034) and older age (P = 0.008). On the other hand, neither sex nor clinical presentation, family background, positive histology or HLA status were associated with DY. CE results changed the therapeutic approach in 71.8% of the cases. Atrophy was associated with a greater TI (92.3% vs 45.3%, P disease. CE is safe procedure with a high degree of concordance with histology and it helps in the differential diagnosis of CD. PMID:28216978

  3. Predictors of participation of adolescents with cerebral palsy: A European multi-centre longitudinal study.

    Science.gov (United States)

    Dang, Van Mô; Colver, Allan; Dickinson, Heather O; Marcelli, Marco; Michelsen, Susan I; Parkes, Jackie; Parkinson, Kathryn; Rapp, Marion; Arnaud, Catherine; Nystrand, Malin; Fauconnier, Jérôme

    2014-11-14

    We investigated whether childhood factors that are amenable to intervention (parenting stress, child psychological problems and pain) predicted participation in daily activities and social roles of adolescents with cerebral palsy (CP). We randomly selected 1174 children aged 8-12 years from eight population-based registers of children with CP in six European countries; 743 (63%) agreed to participate. One further region recruited 75 children from multiple sources. These 818 children were visited at home at age 8-12 years, 594 (73%) agreed to follow-up at age 13-17 years. We used the following measures: parent reported stress (Parenting Stress Index Short Form), their child's psychological difficulties (Strength and Difficulties Questionnaire) and frequency and severity of pain; either child or parent reported the child's participation (LIFE Habits questionnaire). We fitted a structural equation model to each of the participation domains, regressing participation in childhood and adolescence on parenting stress, child psychological problems and pain, and regressing adolescent factors on the corresponding childhood factors; models were adjusted for impairment, region, age and gender. Pain in childhood predicted restricted adolescent participation in all domains except Mealtimes and Communication (standardized total indirect effects β -0.05 to -0.18, 0.01

  4. Study protocol: SPARCLE – a multi-centre European study of the relationship of environment to participation and quality of life in children with cerebral palsy

    Directory of Open Access Journals (Sweden)

    Colver Allan

    2006-04-01

    Full Text Available Abstract Background SPARCLE is a nine-centre European epidemiological research study examining the relationship of participation and quality of life to impairment and environment (physical, social and attitudinal in 8–12 year old children with cerebral palsy. Concepts are adopted from the International Classification of Functioning, Disability and Health which bridges the medical and social models of disability. Methods/Design A cross sectional study of children with cerebral palsy sampled from total population databases in 9 European regions. Children were visited by research associates in each country who had been trained together. The main instruments used were KIDSCREEN, Life-H, Strength and Difficulties Questionnaire, Parenting Stress Index. A measure of environment was developed within the study. All instruments were translated according to international guidelines. The potential for bias due to non response and missing data will be examined. After initial analysis using multivariate regression of how the data captured by each instrument relate to impairment and socio-economic characteristics, relationships between the latent traits captured by the instruments will then be analysed using structural equation modelling. Discussion This study is original in its methods by directly engaging children themselves, ensuring those with learning or communication difficulty are not excluded, and by studying in quantitative terms the crucial outcomes of participation and quality of life. Specification and publication of this protocol prior to analysis, which is not common in epidemiology but well established for randomised controlled trials and systematic reviews, should avoid the pitfalls of data dredging and post hoc analyses.

  5. Final results of a European, multi-centre, prospective, observational Study of Permacol™ collagen paste injection for the treatment of anal fistula

    DEFF Research Database (Denmark)

    Giordano, Pasquale; Sileri, Pierpaolo; Buntzen, Steen

    2017-01-01

    AIM: Permacol(™) collagen paste (Permacol(™) paste) is an acellular cross-linked porcine dermal collagen matrix suspension for use in soft tissue repair. The use of Permacol(™) paste in the filling of anorectal fistula tract is a new sphincter-preserving method for fistula repair. The MASERATI100...... study was a prospective, observational clinical study with the objective to assess the efficacy of Permacol(™) collagen paste for anal fistula repair in 100 patients. METHOD: Patients (N=100) with anal fistula were treated at ten European surgical sites with a sphincter-preserving technique using...... Permacol(™) paste. Fistula healing was assessed at 1, 3, 6, and 12 months post-treatment, with the primary endpoint being healing at 6 months. Faecal continence and patient satisfaction were surveyed at each follow-up; adverse events (AEs) were monitored throughout the follow-up. RESULTS: At 6 months post...

  6. The detection of microbial DNA but not cultured bacteria is associated with increased mortality in patients with suspected sepsis-a prospective multi-centre European observational study.

    Science.gov (United States)

    O'Dwyer, M J; Starczewska, M H; Schrenzel, J; Zacharowski, K; Ecker, D J; Sampath, R; Brealey, D; Singer, M; Libert, N; Wilks, M; Vincent, J-L

    2017-03-01

    Blood culture results inadequately stratify the mortality risk in critically ill patients with sepsis. We sought to establish the prognostic significance of the presence of microbial DNA in the bloodstream of patients hospitalized with suspected sepsis. We analysed the data collected during the Rapid Diagnosis of Infections in the Critically Ill (RADICAL) study, which compared a novel culture-independent PCR/electrospray ionization-mass spectrometry (ESI-MS) assay with standard microbiological testing. Patients were eligible for the study if they had suspected sepsis and were either hospitalized or were referred to one of nine intensive care units from six European countries. The blood specimen for PCR/ESI-MS assay was taken along with initial blood culture taken for clinical indications. Of the 616 patients recruited to the RADICAL study, 439 patients had data on outcome, results of the blood culture and PCR/ESI-MS assay available for analysis. Positive blood culture and PCR/ESI-MSI result was found in 13% (56/439) and 40% (177/439) of patients, respectively. Either a positive blood culture (p 0.01) or a positive PCR/ESI-MS (p 0.005) was associated with higher SOFA scores on enrolment to the study. There was no difference in 28-day mortality observed in patients who had either positive or negative blood cultures (35% versus 32%, p 0.74). However, in patients with a positive PCR/ESI-MS assay, mortality was significantly higher in comparison to those with a negative result (42% versus 26%, p 0.001). Presence of microbial DNA in patients with suspected sepsis might define a patient group at higher risk of death. Copyright © 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  7. Final results of a European, multi-centre, prospective, observational Study of Permacol(™) collagen paste injection for the treatment of anal fistula.

    Science.gov (United States)

    Giordano, Pasquale; Sileri, Pierpaolo; Buntzen, Steen; Stuto, Angelo; Nunoo-Mensah, Joseph; Lenisa, Leonardo; Singh, Baljit; Thorlacius-Ussing, Ole; Griffiths, Ben; Ziyaie, Dorin

    2017-05-11

    Permacol(™) collagen paste (Permacol(™) paste) is an acellular cross-linked porcine dermal collagen matrix suspension for use in soft tissue repair. The use of Permacol(™) paste in the filling of anorectal fistula tract is a new sphincter-preserving method for fistula repair. The MASERATI100 study was a prospective, observational clinical study with the objective to assess the efficacy of Permacol(™) collagen paste for anal fistula repair in 100 patients. Patients (N=100) with anal fistula were treated at ten European surgical sites with a sphincter-preserving technique using Permacol(™) paste. Fistula healing was assessed at 1, 3, 6, and 12 months post-treatment, with the primary endpoint being healing at 6 months. Faecal continence and patient satisfaction were surveyed at each follow-up; adverse events (AEs) were monitored throughout the follow-up. At 6 months post-surgery, 56.7% of patients were healed, and the percentage healed was largely maintained, with 53.5% healed at 12 months. 29.0% of patients had at least one AE, and 16.0% of patients had one or more procedure-related AE. Most AEs reported were minor and similar to those commonly observed after fistula treatment, and the incidence of serious adverse events was low (4.0% of patients). Regardless of treatment outcome, 73.0% of patients were satisfied or very satisfied with the procedure. Permacol(™) paste provides a promising sphincter-preserving treatment for anal fistulas with minimal adverse side-effects. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  8. A large multi-centre European study validates high-sensitivity C-reactive protein (hsCRP) as a clinical biomarker for the diagnosis of diabetes subtypes

    DEFF Research Database (Denmark)

    Thanabalasingham, G.; Shah, N.; Vaxillaire, M.;

    2011-01-01

    . High-sensitivity CRP levels were analysed in individuals with HNF1A-MODY (n = 457), glucokinase (GCK)-MODY (n = 404), hepatocyte nuclear factor 4 alpha (HNF4A)-MODY (n = 54) and type 2 diabetes (n = 582) from seven European centres. Three common assays for hsCRP analysis were evaluated. We excluded 121...

  9. Obstetric risk indicators for labour dystocia in nulliparous women: a multi-centre cohort study

    DEFF Research Database (Denmark)

    Kjaergaard, H.; Olsen, J.; Ottesen, Bent Smedegaard

    2008-01-01

    BACKGROUND: In nulliparous women dystocia is the most common obstetric problem and its etiology is largely unknown. The frequency of augmentation and cesarean delivery related to dystocia is high although it is not clear if a slow progress justifies the interventions. Studies of risk factors...... for dystocia often do not provide diagnostic criteria for the diagnosis. The aim of the present study was to identify obstetric and clinical risk indicators of dystocia defined by strict and explicit criteria. METHODS: A multi-centre population based cohort study with prospectively collected data from 2810......: The following characteristics, present at admission to hospital, were associated with dystocia during labour (OR, 95% CI): dilatation of cervix

  10. Contact sensitisation in hand eczema patients-relation to subdiagnosis, severity and quality of life: a multi-centre study

    DEFF Research Database (Denmark)

    Agner, Tove; Andersen, Klaus Ejner; Brandao, Francisco M;

    2009-01-01

    BACKGROUND: Contact sensitisation has been identified as a factor associated with poor prognosis for patients with hand eczema. OBJECTIVES: To study implications of contact sensitisation with respect to severity, quality of life (QoL) and subdiagnosis of hand eczema. METHODS: The study...... was performed as a multi-centre, cross-sectional study from 10 European clinics. All patients were patch tested, and severity of hand eczema assessed by Hand Eczema Severity Index. A multi-variate analysis was performed to explore which factors influenced severity, QoL and sick leave. RESULTS: A total 416...... eczema and presence of contact sensitisation were independent risk factors for increased severity as measured by Hand Eczema Severity Index. Furthermore, the severity of hand eczema increased by the number of contact sensitisations detected (P = 0.023). High age and personal history of atopic eczema were...

  11. Contact sensitisation in hand eczema patients-relation to subdiagnosis, severity and quality of life: a multi-centre study

    DEFF Research Database (Denmark)

    Agner, T.; Andersen, K.E.; Brandao, F.M.

    2009-01-01

    Background Contact sensitisation has been identified as a factor associated with poor prognosis for patients with hand eczema. Objectives To study implications of contact sensitisation with respect to severity, quality of life (QoL) and subdiagnosis of hand eczema. Methods The study was performed...... as a multi-centre, cross-sectional study from 10 European clinics. All patients were patch tested, and severity of hand eczema assessed by Hand Eczema Severity Index. A multi-variate analysis was performed to explore which factors influenced severity, QoL and sick leave. Results A total 416 patients were...... and presence of contact sensitisation were independent risk factors for increased severity as measured by Hand Eczema Severity Index. Furthermore, the severity of hand eczema increased by the number of contact sensitisations detected (P = 0.023). High age and personal history of atopic eczema were independent...

  12. Harmonization process and reliability assessment of anthropometric measurements in the elderly EXERNET multi-centre study.

    Directory of Open Access Journals (Sweden)

    Alba Gómez-Cabello

    Full Text Available BACKGROUND: The elderly EXERNET multi-centre study aims to collect normative anthropometric data for old functionally independent adults living in Spain. PURPOSE: To describe the standardization process and reliability of the anthropometric measurements carried out in the pilot study and during the final workshop, examining both intra- and inter-rater errors for measurements. MATERIALS AND METHODS: A total of 98 elderly from five different regions participated in the intra-rater error assessment, and 10 different seniors living in the city of Toledo (Spain participated in the inter-rater assessment. We examined both intra- and inter-rater errors for heights and circumferences. RESULTS: For height, intra-rater technical errors of measurement (TEMs were smaller than 0.25 cm. For circumferences and knee height, TEMs were smaller than 1 cm, except for waist circumference in the city of Cáceres. Reliability for heights and circumferences was greater than 98% in all cases. Inter-rater TEMs were 0.61 cm for height, 0.75 cm for knee-height and ranged between 2.70 and 3.09 cm for the circumferences measured. Inter-rater reliabilities for anthropometric measurements were always higher than 90%. CONCLUSION: The harmonization process, including the workshop and pilot study, guarantee the quality of the anthropometric measurements in the elderly EXERNET multi-centre study. High reliability and low TEM may be expected when assessing anthropometry in elderly population.

  13. A human post-mortem brain model for the standardization of multi-centre MRI studies.

    Science.gov (United States)

    Droby, Amgad; Lukas, Carsten; Schänzer, Anne; Spiwoks-Becker, Isabella; Giorgio, Antonio; Gold, Ralf; De Stefano, Nicola; Kugel, Harald; Deppe, Michael; Wiendl, Heinz; Meuth, Sven G; Acker, Till; Zipp, Frauke; Deichmann, Ralf

    2015-04-15

    Multi-centre MRI studies of the brain are essential for enrolling large and diverse patient cohorts, as required for the investigation of heterogeneous neurological and psychiatric diseases. However, the multi-site comparison of standard MRI data sets that are weighted with respect to tissue parameters such as the relaxation times (T1, T2) and proton density (PD) may be problematic, as signal intensities and image contrasts depend on site-specific details such as the sequences used, imaging parameters, and sensitivity profiles of the radiofrequency (RF) coils. Water or gel phantoms are frequently used for long-term and/or inter-site quality assessment. However, these phantoms hardly mimic the structure, shape, size or tissue distribution of the human brain. The goals of this study were: (1) to validate the long-term stability of a human post-mortem brain phantom, performing quantitative mapping of T1, T2, and PD, and the magnetization transfer ratio (MTR) over a period of 18months; (2) to acquire and analyse data for this phantom and the brain of a healthy control (HC) in a multi-centre study for MRI protocol standardization in four centres, while conducting a voxel-wise as well as whole brain grey (GM) and white matter (WM) tissue volume comparison. MTR, T2, and the quotient of PD in WM and GM were stable in the post-mortem brain with no significant changes. T1 was found to decrease from 267/236ms (GM/WM) to 234/216ms between 5 and 17weeks post embedment, stabilizing during an 18-month period following the first scan at about 215/190ms. The volumetric measures, based on T1-weighted MP-RAGE images obtained at all participating centres, revealed inter- and intra-centre variations in the evaluated GM and WM volumes that displayed similar trends in both the post-mortem brain as well as the HC. At a confidence level of 95%, brain regions such as the brainstem, deep GM structures as well as boundaries between GM and WM tissues were found to be less reproducible than

  14. Retrospective exposure assessment and quality control in an international multi-centre case-control study

    DEFF Research Database (Denmark)

    Tinnerberg, H; Heikkilä, P; Huici-Montagud, A;

    2003-01-01

    The paper presents the exposure assessment method and quality control procedure used in an international, multi-centre case-control study within a joint Nordic and Italian cohort. This study was conducted to evaluate whether occupational exposure to carcinogens influenced the predictivity of high...... frequency of chromosomal aberrations (CA) in peripheral lymphocytes for increased cancer risk. Occupational hygienists assessed exposures in each participating country: Denmark, Finland, Italy, Norway and Sweden. The exposure status to a carcinogen or a clastogen was coded in the cohort according...... country-specific differences, differences in information available to the home assessor and the others and misunderstandings or difficulties in translation of information. To ensure the consistency of exposure assessments in international retrospective case-control studies it is important to have a well...

  15. Obstetric risk indicators for labour dystocia in nulliparous women: A multi-centre cohort study

    Directory of Open Access Journals (Sweden)

    Ottesen Bent

    2008-10-01

    Full Text Available Abstract Background In nulliparous women dystocia is the most common obstetric problem and its etiology is largely unknown. The frequency of augmentation and cesarean delivery related to dystocia is high although it is not clear if a slow progress justifies the interventions. Studies of risk factors for dystocia often do not provide diagnostic criteria for the diagnosis. The aim of the present study was to identify obstetric and clinical risk indicators of dystocia defined by strict and explicit criteria. Methods A multi-centre population based cohort study with prospectively collected data from 2810 nulliparous women in term spontaneous labour with a singleton infant in cephalic presentation. Data were collected by self-administered questionnaires and clinical data-records. Logistic regression analyses were used to estimate adjusted Odds Ratios (OR and 95% confidence intervals (CI are given. Results The following characteristics, present at admission to hospital, were associated with dystocia during labour (OR, 95% CI: dilatation of cervix Conclusion Vaginal examinations at admission provide useful information on risk indicators for dystocia. The strongest risk indicator was use of epidural analgesia and if part of that is causal, it is of concern.

  16. Current management of intracerebral haemorrhage in China: a national, multi-centre, hospital register study

    Directory of Open Access Journals (Sweden)

    Heeley Emma L

    2011-01-01

    Full Text Available Abstract Background We aimed to examine current practice of the management and secondary prevention of intracerebral haemorrhage (ICH in China where the disease is more common than in Western populations. Methods Data on baseline characteristics, management in-hospital and post-stroke, and outcome of ICH patients are from the ChinaQUEST (QUality Evaluation of Stroke Care and Treatment study, a multi-centre, prospective, 62 hospital registry in China during 2006-07. Results Nearly all ICH patients (n = 1572 received an intravenous haemodiluting agent such as mannitol (96% or a neuroprotectant (72%, and there was high use of intravenous traditional Chinese medicine (TCM (42%. Neurosurgery was undertaken in 137 (9% patients; being overweight, having a low Glasgow Coma Scale (GCS score on admission, and Total Anterior Circulation Syndrome (TACS clinical pattern on admission, were the only baseline factors associated with this intervention in multivariate analyses. Neurosurgery was associated with nearly three times higher risk of death/disability at 3 months post-stroke (odd ratio [OR] 2.60, p Conclusions The management of ICH in China is characterised by high rates of use of intravenous haemodiluting agents, neuroprotectants, and TCM, and of antihypertensives for secondary prevention. The controversial efficacy of these therapies, coupled with the current lack of treatments of proven benefit, is a call for action for more outcomes based research in ICH.

  17. First episode psychosis and outcome : Findings from a swedish multi-centre study

    OpenAIRE

    Mattsson, Maria

    2007-01-01

    The Parachute Project was a Swedish multi-centre project that included 175 First Episode Psychosis patients who were followed over five years. The aim was to provide need adapted care with low medication and based on out-patient support in order to positively affect long-term outcome. One historical and one prospective treatment-as-usual group provided comparison follow-up data. The aim of this thesis is to describe outcome from various perspectives in FEP patients. Stud...

  18. The impact of study design and diagnostic approach in a large multi-centre ADHD study: Part 2: Dimensional measures of psychopathology and intelligence

    NARCIS (Netherlands)

    Muller, U.C.; Asherson, P.; Banaschewski, T.; Buitelaar, J.K.; Ebstein, R.P.; Eisenberg, J.; Gill, M.; Manor, I.; Miranda, A.; Oades, R.D.; Roeyers, H.; Rothenberger, A.; Sergeant, J.A.; Sonuga-Barke, E.J.S.; Thompson, M.; Faraone, S.V.; Steinhausen, H.C.

    2011-01-01

    BACKGROUND: The International Multi-centre ADHD Genetics (IMAGE) project with 11 participating centres from 7 European countries and Israel has collected a large behavioural and genetic database for present and future research. Behavioural data were collected from 1068 probands with ADHD and 1446 un

  19. The impact of study design and diagnostic approach in a large multi-centre ADHD study. Part 1: ADHD symptom patterns

    NARCIS (Netherlands)

    Muller, U.C.; Asherson, P.; Banaschewski, T.; Buitelaar, J.K.; Ebstein, R.P.; Eisenberg, J.; Gill, M.; Manor, I.; Miranda, A.; Oades, R.D.; Roeyers, H.; Rothenberger, A.; Sergeant, J.A.; Sonuga-Barke, E.J.S.; Thompson, M.; Faraone, S.V.; Steinhausen, H.C.

    2011-01-01

    BACKGROUND: The International Multi-centre ADHD Genetics (IMAGE) project with 11 participating centres from 7 European countries and Israel has collected a large behavioural and genetic database for present and future research. Behavioural data were collected from 1068 probands with the combined typ

  20. Posttraumatic stress among women after induced abortion: a Swedish multi-centre cohort study

    Science.gov (United States)

    2013-01-01

    Background Induced abortion is a common medical intervention. Whether psychological sequelae might follow induced abortion has long been a subject of concern among researchers and little is known about the relationship between posttraumatic stress disorder (PTSD) and induced abortion. Thus, the aim of the study was to assess the prevalence of PTSD and posttraumatic stress symptoms (PTSS) before and at three and six months after induced abortion, and to describe the characteristics of the women who developed PTSD or PTSS after the abortion. Methods This multi-centre cohort study included six departments of Obstetrics and Gynaecology in Sweden. The study included 1457 women who requested an induced abortion, among whom 742 women responded at the three-month follow-up and 641 women at the six-month follow-up. The Screen Questionnaire-Posttraumatic Stress Disorder (SQ-PTSD) was used for research diagnoses of PTSD and PTSS, and anxiety and depressive symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS). Measurements were made at the first visit and at three and six months after the abortion. The 95% confidence intervals for the prevalence of lifetime or ongoing PTSD and PTSS were calculated using the normal approximation. The chi-square test and the Student’s t-test were used to compare data between groups. Results The prevalence of ongoing PTSD and PTSS before the abortion was 4.3% and 23.5%, respectively, concomitant with high levels of anxiety and depression. At three months the corresponding rates were 2.0% and 4.6%, at six months 1.9% and 6.1%, respectively. Dropouts had higher rates of PTSD and PTSS. Fifty-one women developed PTSD or PTSS during the observation period. They were young, less well educated, needed counselling, and had high levels of anxiety and depressive symptoms. During the observation period 57 women had trauma experiences, among whom 11 developed PTSD or PTSS and reported a traumatic experience in relation to the

  1. Attachment Styles of Dermatological Patients in Europe: A Multi-centre Study in 13 Countries.

    Science.gov (United States)

    Szabó, Csanád; Altmayer, Anita; Lien, Lars; Poot, Françoise; Gieler, Uwe; Tomas-Aragones, Lucía; Kupfer, Jörg; Jemec, Gregor B E; Misery, Laurent; Linder, M Dennis; Sampogna, Francesca; Middendorp, Henriët van; Halvorsen, Jon Anders; Balieva, Flora; Szepietowski, Jacek C; Romanov, Dmitry; Marron, Servando E; Altunay, Ilknur K; Finlay, Andrew Y; Salek, Sam S; Dalgard, Florence

    2017-01-25

    Attachment styles of dermatological outpatients and satisfaction with their dermatologists were investigated within the framework of a multicentre study conducted in 13 European countries, organized by the European Society for Dermatology and Psychiatry. Attachment style was assessed with the Adult Attachment Scale. Patient satisfaction with the dermatologist was assessed with an 11-degree scale. A total of 3,635 adult outpatients and 1,359 controls participated in the study. Dermatological outpatients were less able to depend on others, were less comfortable with closeness and intimacy, and experienced similar rates of anxiety in relationships as did the controls. Participants who had secure attachment styles reported stressful life events during the last 6 months significantly less often than those who had insecure attachment styles. Patients with secure attachment styles tended to be more satisfied with their dermatologist than did insecure patients. These results suggest that secure attachment of dermatological outpatients may be a protective factor in the management of stress.

  2. Reappraisal of known malaria resistance loci in a large multi-centre study

    Science.gov (United States)

    Rockett, Kirk A.; Clarke, Geraldine M.; Fitzpatrick, Kathryn; Hubbart, Christina; Jeffreys, Anna E.; Rowlands, Kate; Craik, Rachel; Jallow, Muminatou; Conway, David J.; Bojang, Kalifa A.; Pinder, Margaret; Usen, Stanley; Sisay-Joof, Fatoumatta; Sirugo, Giorgio; Toure, Ousmane; Thera, Mahamadou A.; Konate, Salimata; Sissoko, Sibiry; Niangaly, Amadou; Poudiougou, Belco; Mangano, Valentina D.; Bougouma, Edith C.; Sirima, Sodiomon B.; Modiano, David; Amenga-Etego, Lucas N.; Ghansah, Anita; Koram, Kwadwo A.; Wilson, Michael D.; Enimil, Anthony; Evans, Jennifer; Amodu, Olukemi; Olaniyan, Subulade; Apinjoh, Tobias; Mugri, Regina; Ndi, Andre; Ndila, Carolyne M.; Uyoga, Sophie; Macharia, Alexander; Peshu, Norbert; Williams, Thomas N.; Manjurano, Alphaxard; Riley, Eleanor; Drakeley, Chris; Reyburn, Hugh; Nyirongo, Vysaul; Kachala, David; Molyneux, Malcolm; Dunstan, Sarah J.; Phu, Nguyen Hoan; Ngoc Quyen, Nguyen Thi; Thai, Cao Quang; Hien, Tran Tinh; Manning, Laurens; Laman, Moses; Siba, Peter; Karunajeewa, Harin; Allen, Steve; Allen, Angela; Davis, Timothy M. E.; Michon, Pascal; Mueller, Ivo; Green, Angie; Molloy, Sile; Johnson, Kimberly J.; Kerasidou, Angeliki; Cornelius, Victoria; Hart, Lee; Vanderwal, Aaron; SanJoaquin, Miguel; Band, Gavin; Le, Si Quang; Pirinen, Matti; Sepúlveda, Nuno; Spencer, Chris C.A.; Clark, Taane G.; Agbenyega, Tsiri; Achidi, Eric; Doumbo, Ogobara; Farrar, Jeremy; Marsh, Kevin; Taylor, Terrie; Kwiatkowski, Dominic P.

    2015-01-01

    Many human genetic associations with resistance to malaria have been reported but few have been reliably replicated. We collected data on 11,890 cases of severe malaria due to Plasmodium falciparum and 17,441 controls from 12 locations in Africa, Asia and Oceania. There was strong evidence of association with the HBB, ABO, ATP2B4, G6PD and CD40LG loci but previously reported associations at 22 other loci did not replicate in the multi-centre analysis. The large sample size made it possible to identify authentic genetic effects that are heterogeneous across populations or phenotypes, a striking example being the main African form of G6PD deficiency, which reduced the risk of cerebral malaria but increased the risk of severe malarial anaemia. The finding that G6PD deficiency has opposing effects on different fatal complications of P. falciparum infection indicates that the evolutionary origins of this common human genetic disorder are more complex than previously supposed. PMID:25261933

  3. A controlled multi-centre study of herbal versus synthetic secretolytic drugs for acute bronchitis.

    Science.gov (United States)

    Ernst, E; März, R; Sieder, C

    1997-12-01

    Herbal expectorants and secretolytic drugs hold a sizeable share of the European market. Therefore it is essential to test their clinical effectiveness and safety. The aim of the present study was to compare the herbal medication Bronchipret(®) with various other pharmacotherapeutical options for acute bronchitis. The study was designed as a matched-pair comparison of 7783 patients. Clinical outcomes of bronchitis and adverse reactions were documented. The data were evaluated by comparing the treatment success of the test medication and 3 control groups using ordinal regression. The results suggest that clinical effectiveness of Bronchipret(®) was not less than with synthetic drugs. There was a tendency for better results with Bronchipret(®), particularly in the treatment of adults. Similar results were obtained with respect to adverse reactions. Particularly in the adult sub-group, these were markedly less with herbals as compared to synthetic drugs. These findings imply that a risk/benefit evaluation would favour Bronchipret(®) over synthetic drugs for acute bronchitis. Their interpretation is limited through the fact that this study could not be randomised nor blinded. The results therefore require confirmation through randomised, double-blind trials.

  4. Coerced hospital admission and symptom change--a prospective observational multi-centre study.

    Directory of Open Access Journals (Sweden)

    Thomas W Kallert

    Full Text Available INTRODUCTION: Coerced admission to psychiatric hospitals, defined by legal status or patient's subjective experience, is common. Evidence on clinical outcomes however is limited. This study aimed to assess symptom change over a three month period following coerced admission and identify patient characteristics associated with outcomes. METHOD: At study sites in 11 European countries consecutive legally involuntary patients and patients with a legally voluntary admission who however felt coerced, were recruited and assessed by independent researchers within the first week after admission. Symptoms were assessed on the Brief Psychiatric Rating Scale. Patients were re-assessed after one and three months. RESULTS: The total sample consisted of 2326 legally coerced patients and 764 patients with a legally voluntary admission who felt coerced. Symptom levels significantly improved over time. In a multivariable analysis, higher baseline symptoms, being unemployed, living alone, repeated hospitalisation, being legally a voluntary patient but feeling coerced, and being initially less satisfied with treatment were all associated with less symptom improvement after one month and, other than initial treatment satisfaction, also after three months. The diagnostic group was not linked with outcomes. DISCUSSION: On average patients show significant but limited symptom improvements after coerced hospital admission, possibly reflecting the severity of the underlying illnesses. Social factors, but not the psychiatric diagnosis, appear important predictors of outcomes. Legally voluntary patients who feel coerced may have a poorer prognosis than legally involuntary patients and deserve attention in research and clinical practice.

  5. The impact of study design and diagnostic approach in a large multi-centre ADHD study. Part 1: ADHD symptom patterns.

    LENUS (Irish Health Repository)

    Muller, Ueli C

    2011-04-07

    Abstract Background The International Multi-centre ADHD Genetics (IMAGE) project with 11 participating centres from 7 European countries and Israel has collected a large behavioural and genetic database for present and future research. Behavioural data were collected from 1068 probands with the combined type of attention deficit\\/hyperactivity disorder (ADHD-CT) and 1446 \\'unselected\\' siblings. The aim was to analyse the IMAGE sample with respect to demographic features (gender, age, family status, and recruiting centres) and psychopathological characteristics (diagnostic subtype, symptom frequencies, age at symptom detection, and comorbidities). A particular focus was on the effects of the study design and the diagnostic procedure on the homogeneity of the sample in terms of symptom-based behavioural data, and potential consequences for further analyses based on these data. Methods Diagnosis was based on the Parental Account of Childhood Symptoms (PACS) interview and the DSM-IV items of the Conners\\' teacher questionnaire. Demographics of the full sample and the homogeneity of a subsample (all probands) were analysed by using robust statistical procedures which were adjusted for unequal sample sizes and skewed distributions. These procedures included multi-way analyses based on trimmed means and winsorised variances as well as bootstrapping. Results Age and proband\\/sibling ratios differed between participating centres. There was no significant difference in the distribution of gender between centres. There was a significant interaction between age and centre for number of inattentive, but not number of hyperactive symptoms. Higher ADHD symptom frequencies were reported by parents than teachers. The diagnostic symptoms differed from each other in their frequencies. The face-to-face interview was more sensitive than the questionnaire. The differentiation between ADHD-CT probands and unaffected siblings was mainly due to differences in hyperactive

  6. The impact of study design and diagnostic approach in a large multi-centre ADHD study. Part 1: ADHD symptom patterns

    Directory of Open Access Journals (Sweden)

    Roeyers Herbert

    2011-04-01

    Full Text Available Abstract Background The International Multi-centre ADHD Genetics (IMAGE project with 11 participating centres from 7 European countries and Israel has collected a large behavioural and genetic database for present and future research. Behavioural data were collected from 1068 probands with the combined type of attention deficit/hyperactivity disorder (ADHD-CT and 1446 'unselected' siblings. The aim was to analyse the IMAGE sample with respect to demographic features (gender, age, family status, and recruiting centres and psychopathological characteristics (diagnostic subtype, symptom frequencies, age at symptom detection, and comorbidities. A particular focus was on the effects of the study design and the diagnostic procedure on the homogeneity of the sample in terms of symptom-based behavioural data, and potential consequences for further analyses based on these data. Methods Diagnosis was based on the Parental Account of Childhood Symptoms (PACS interview and the DSM-IV items of the Conners' teacher questionnaire. Demographics of the full sample and the homogeneity of a subsample (all probands were analysed by using robust statistical procedures which were adjusted for unequal sample sizes and skewed distributions. These procedures included multi-way analyses based on trimmed means and winsorised variances as well as bootstrapping. Results Age and proband/sibling ratios differed between participating centres. There was no significant difference in the distribution of gender between centres. There was a significant interaction between age and centre for number of inattentive, but not number of hyperactive symptoms. Higher ADHD symptom frequencies were reported by parents than teachers. The diagnostic symptoms differed from each other in their frequencies. The face-to-face interview was more sensitive than the questionnaire. The differentiation between ADHD-CT probands and unaffected siblings was mainly due to differences in hyperactive

  7. Species distribution and susceptibility profile to fluconazole, voriconazole and MXP-4509 of 551 clinical yeast isolates from a Romanian multi-centre study

    NARCIS (Netherlands)

    Minea, B; Nastasa, V; Moraru, R F; Kolecka, A; Flonta, M M; Marincu, I; Man, A; Toma, F; Lupse, M; Doroftei, B; Marangoci, N; Pinteala, M; Boekhout, T; Mares, M

    2015-01-01

    This is the first multi-centre study regarding yeast infections in Romania. The aim was to determine the aetiological spectrum and susceptibility pattern to fluconazole, voriconazole and the novel compound MXP-4509. The 551 isolates were identified using routine laboratory methods, matrix-assisted l

  8. Antibiotic resistance and population structure of cystic fibrosis Pseudomonas aeruginosa isolates from a Spanish multi-centre study.

    Science.gov (United States)

    López-Causapé, Carla; de Dios-Caballero, Juan; Cobo, Marta; Escribano, Amparo; Asensio, Óscar; Oliver, Antonio; Del Campo, Rosa; Cantón, Rafael; Solé, Amparó; Cortell, Isidoro; Asensio, Oscar; García, Gloria; Martínez, María Teresa; Cols, María; Salcedo, Antonio; Vázquez, Carlos; Baranda, Félix; Girón, Rosa; Quintana, Esther; Delgado, Isabel; de Miguel, María Ángeles; García, Marta; Oliva, Concepción; Prados, María Concepción; Barrio, María Isabel; Pastor, María Dolores; Olveira, Casilda; de Gracia, Javier; Álvarez, Antonio; Escribano, Amparo; Castillo, Silvia; Figuerola, Joan; Togores, Bernat; Oliver, Antonio; López, Carla; de Dios Caballero, Juan; Tato, Marta; Máiz, Luis; Suárez, Lucrecia; Cantón, Rafael

    2017-07-20

    The first Spanish multi-centre study on the microbiology of cystic fibrosis (CF) was conducted from 2013 to 2014. The study involved 24 CF units from 17 hospitals, and recruited 341 patients. The aim of this study was to characterise Pseudomonas aeruginosa isolates, 79 of which were recovered from 75 (22%) patients. The study determined the population structure, antibiotic susceptibility profile and genetic background of the strains. Fifty-five percent of the isolates were multi-drug-resistant, and 16% were extensively-drug-resistant. Defective mutS and mutL genes were observed in mutator isolates (15.2%). Considerable genetic diversity was observed by pulsed-field gel electrophoresis (70 patterns) and multi-locus sequence typing (72 sequence types). International epidemic clones were not detected. Fifty-one new and 14 previously described array tube (AT) genotypes were detected by AT technology. This study found a genetically unrelated and highly diverse CF P. aeruginosa population in Spain, not represented by the epidemic clones widely distributed across Europe, with multiple combinations of virulence factors and high antimicrobial resistance rates (except for colistin). Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

  9. Obstacles to Gaining Ethical Approval for a Multi-Centre Study of Family Support

    Science.gov (United States)

    MacPherson, Kristen; Lattin-Rawstrone, Rebekah; Senior, Rob; Barnes, Jacqueline

    2005-01-01

    The NHS has emphasised the need for rigorous evaluations of preventative home-visiting support (Bull and others, 2004) in building a public health evidence base. Interdisciplinary studies involving the NHS in any capacity are subject to ethical review by NHS Research Ethics Committees. However, the current process of ethical review does not…

  10. Adherence to MRI protocol consensus guidelines in multiple sclerosis: an Australian multi-centre study.

    Science.gov (United States)

    Curley, Michael; Josey, Lawrence; Lucas, Robyn; Dear, Keith; Taylor, Bruce V; Coulthard, Alan; Chapman, Caron; Coulthard, Alan; Dear, Keith; Dwyer, Terry; Kilpatrick, Trevor; Lucas, Robyn; McMichael, Tony; Pender, Michael P; Ponsonby, Anne-Louise; Taylor, Bruce; Valery, Patricia; van der Mei, Ingrid; Williams, David

    2012-12-01

    Multiple sclerosis (MS) is a debilitating disease that causes significant morbidity within a young demographic. Diagnostic guidelines for MS have evolved, and imaging has played an increasingly important role in diagnosis over the last two decades. For imaging to contribute to diagnosis in a meaningful way, it must be reproducible. Consensus guidelines for MRI in MS exist to define correct sequence type and imaging technique, but it is not clear to what extent they are followed. This study reviewed MRI studies performed on Australian individuals presenting with a first clinical diagnosis of central nervous system demyelination (FCD) for adherence to published guidelines and discussed practical implementation of MS guidelines in light of recent updates. The Ausimmune study was a prospective case control study of Australian participants presenting with FCD from 2003 to 2006. Baseline cranial and spinal cord MRI studies of 226 case participants from four separate Australian regions were reviewed. MRI sequences were classified according to anatomical location, slice plane, tissue weighting and use of gadolinium-containing contrast media. Results were compared with the 2003 Consortium of Multiple Sclerosis Centres MRI protocol for the diagnosis of MS. The composition of core cranial MRI sequences performed varied across the 226 scans. Of the studies, 91% included sagittal fluid attenuated inversion recovery (FLAIR) sequences. Cranial axial T2-weighted, axial FLAIR and axial proton density-weighted sequences were performed in 88%, 60% and 16% (respectively) of scans. Only 25% of the studies included a T1-weighted contrast-enhanced sequence. Concordance with the guidelines in all sequences was very low (2). Only a small number of MRI investigations performed included all of the sequences stipulated by consensus guidelines. This is likely due to poor awareness in the imaging community of the guidelines and the rationale behind certain sequences. Radiologists with a sub

  11. Multi-centred mixed-methods PEPFAR HIV care & support public health evaluation: study protocol

    Directory of Open Access Journals (Sweden)

    Fayers Peter

    2010-09-01

    Full Text Available Abstract Background A public health response is essential to meet the multidimensional needs of patients and families affected by HIV disease in sub-Saharan Africa. In order to appraise curret provision of HIV care and support in East Africa, and to provide evidence-based direction to future care programming, and Public Health Evaluation was commissioned by the PEPFAR programme of the US Government. Methods/Design This paper described the 2-Phase international mixed methods study protocol utilising longitudinal outcome measurement, surveys, patient and family qualitative interviews and focus groups, staff qualitative interviews, health economics and document analysis. Aim 1 To describe the nature and scope of HIV care and support in two African countries, including the types of facilities available, clients seen, and availability of specific components of care [Study Phase 1]. Aim 2 To determine patient health outcomes over time and principle cost drivers [Study Phase 2]. The study objectives are as follows. 1 To undertake a cross-sectional survey of service configuration and activity by sampling 10% of the facilities being funded by PEPFAR to provide HIV care and support in Kenya and Uganda (Phase 1 in order to describe care currently provided, including pharmacy drug reviews to determine availability and supply of essential drugs in HIV management. 2 To conduct patient focus group discussions at each of these (Phase 1 to determine care received. 3 To undertake a longitudinal prospective study of 1200 patients who are newly diagnosed with HIV or patients with HIV who present with a new problem attending PEPFAR care and support services. Data collection includes self-reported quality of life, core palliative outcomes and components of care received (Phase 2. 4 To conduct qualitative interviews with staff, patients and carers in order to explore and understand service issues and care provision in more depth (Phase 2. 5 To undertake document

  12. Phenylketonuria patients' and their parents' knowledge and attitudes to the daily diet - multi-centre study.

    Science.gov (United States)

    Witalis, Ewa; Mikoluc, Bozena; Motkowski, Radoslaw; Sawicka-Powierza, Jolanta; Chrobot, Agnieszka; Didycz, Bozena; Lange, Agata; Mozrzymas, Renata; Milanowski, Andrzej; Nowacka, Maria; Piotrowska-Depta, Mariola; Romanowska, Hanna; Starostecka, Ewa; Wierzba, Jolanta; Skorniewska, Magdalena; Wojcicka-Bartlomiejczyk, Barbara Iwona; Gizewska, Maria; Car, Halina

    2017-01-01

    The aim of the study was to assess both patients' and their parents' knowledge of phenylketonuria (PKU) treatment and compliance with PKU diet. The study included 173 PKU patients aged 10-19 and 110 parents of PKU children who were enrolled in the study on the basis of questionnaire data. The study also included 45 patients aged ≥20. Our study demonstrated that only 45% (n = 74) of PKU patients knew daily Phe intake recommendations, 27% of patients (n = 41) knew the Phe content in a minimum of three out of four researched food products. Patients' knowledge concerning Phe intake (p = 0.0181) and the knowledge of selected food products (p = 0.041819) improved with age. We did not establish such a correlation in the group of PKU children's parents. Approximately 31% of patients and 22% of parents reported helplessness, which increased with the child's age, associated with the necessity to adhere to the diet; 30% of patients reported feeling ashamed of the fact that they could not eat all food products. Regardless of age, children were more likely than parents to report helplessness (p = 0.032005). Among patients, 41.40% declared that they would wish to select products unassisted but their parents did not permit them to do so. The question of whether parents teach children self-reliance in meal preparation was answered affirmatively by 98% of parents and only 81% of children (p = 0.0001). Our data demonstrated that parents' and children's knowledge concerning treatment recommendations and food products does not have a direct impact on attitude to the PKU diet. Limiting children's independence in meal selection, growing helplessness in the face of dietary adherence and shame resulting from the necessity to follow a different diet observed in PKU families are responsible for shaping and perpetuating a consistently negative attitude to the diet. The care of PKU paediatric patients requires consistent, long-term family and individual therapy which may

  13. Azithromycin for Indigenous children with bronchiectasis: study protocol for a multi-centre randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Valery Patricia C

    2012-08-01

    Full Text Available Abstract Background The prevalence of chronic suppurative lung disease (CSLD and bronchiectasis unrelated to cystic fibrosis (CF among Indigenous children in Australia, New Zealand and Alaska is very high. Antibiotics are a major component of treatment and are used both on a short or long-term basis. One aim of long-term or maintenance antibiotics is to reduce the frequency of acute pulmonary exacerbations and symptoms. However, there are few studies investigating the efficacy of long-term antibiotic use for CSLD and non-CF bronchiectasis among children. This study tests the hypothesis that azithromycin administered once a week as maintenance antibiotic treatment will reduce the rate of pulmonary exacerbations in Indigenous children with bronchiectasis. Methods/design We are conducting a multicentre, randomised, double-blind, placebo controlled clinical trial in Australia and New Zealand. Inclusion criteria are: Aboriginal, Torres Strait Islander, Maori or Pacific Island children aged 1 to 8 years, diagnosed with bronchiectasis (or probable bronchiectasis with no underlying disease identified (such as CF or primary immunodeficiency, and having had at least one episode of pulmonary exacerbation in the last 12 months. After informed consent, children are randomised to receive either azithromycin (30 mg/kg once a week or placebo (once a week for 12–24 months from study entry. Primary outcomes are the rate of pulmonary exacerbations and time to pulmonary exacerbation determined by review of patient medical records. Secondary outcomes include length and severity of pulmonary exacerbation episodes, changes in growth, school loss, respiratory symptoms, forced expiratory volume in 1-second (FEV1; for children ≥6 years, and sputum characteristics. Safety endpoints include serious adverse events. Antibiotic resistance in respiratory bacterial pathogens colonising the nasopharynx is monitored. Data derived from medical records and clinical

  14. Genetic determinants of anti-malarial acquired immunity in a large multi-centre study.

    Science.gov (United States)

    Shelton, Jennifer M G; Corran, Patrick; Risley, Paul; Silva, Nilupa; Hubbart, Christina; Jeffreys, Anna; Rowlands, Kate; Craik, Rachel; Cornelius, Victoria; Hensmann, Meike; Molloy, Sile; Sepulveda, Nuno; Clark, Taane G; Band, Gavin; Clarke, Geraldine M; Spencer, Christopher C A; Kerasidou, Angeliki; Campino, Susana; Auburn, Sarah; Tall, Adama; Ly, Alioune Badara; Mercereau-Puijalon, Odile; Sakuntabhai, Anavaj; Djimdé, Abdoulaye; Maiga, Boubacar; Touré, Ousmane; Doumbo, Ogobara K; Dolo, Amagana; Troye-Blomberg, Marita; Mangano, Valentina D; Verra, Frederica; Modiano, David; Bougouma, Edith; Sirima, Sodiomon B; Ibrahim, Muntaser; Hussain, Ayman; Eid, Nahid; Elzein, Abier; Mohammed, Hiba; Elhassan, Ahmed; Elhassan, Ibrahim; Williams, Thomas N; Ndila, Carolyne; Macharia, Alexander; Marsh, Kevin; Manjurano, Alphaxard; Reyburn, Hugh; Lemnge, Martha; Ishengoma, Deus; Carter, Richard; Karunaweera, Nadira; Fernando, Deepika; Dewasurendra, Rajika; Drakeley, Christopher J; Riley, Eleanor M; Kwiatkowski, Dominic P; Rockett, Kirk A

    2015-08-28

    Many studies report associations between human genetic factors and immunity to malaria but few have been reliably replicated. These studies are usually country-specific, use small sample sizes and are not directly comparable due to differences in methodologies. This study brings together samples and data collected from multiple sites across Africa and Asia to use standardized methods to look for consistent genetic effects on anti-malarial antibody levels. Sera, DNA samples and clinical data were collected from 13,299 individuals from ten sites in Senegal, Mali, Burkina Faso, Sudan, Kenya, Tanzania, and Sri Lanka using standardized methods. DNA was extracted and typed for 202 Single Nucleotide Polymorphisms with known associations to malaria or antibody production, and antibody levels to four clinical grade malarial antigens [AMA1, MSP1, MSP2, and (NANP)4] plus total IgE were measured by ELISA techniques. Regression models were used to investigate the associations of clinical and genetic factors with antibody levels. Malaria infection increased levels of antibodies to malaria antigens and, as expected, stable predictors of anti-malarial antibody levels included age, seasonality, location, and ethnicity. Correlations between antibodies to blood-stage antigens AMA1, MSP1 and MSP2 were higher between themselves than with antibodies to the (NANP)4 epitope of the pre-erythrocytic circumsporozoite protein, while there was little or no correlation with total IgE levels. Individuals with sickle cell trait had significantly lower antibody levels to all blood-stage antigens, and recessive homozygotes for CD36 (rs321198) had significantly lower anti-malarial antibody levels to MSP2. Although the most significant finding with a consistent effect across sites was for sickle cell trait, its effect is likely to be via reducing a microscopically positive parasitaemia rather than directly on antibody levels. However, this study does demonstrate a framework for the feasibility of

  15. Multiple myeloma in Nigeria: a multi-centre epidemiological and biomedical study

    Science.gov (United States)

    Nnonyelum, Odunukwe Nkiruka; Anazoeze, Madu Jude; Eunice, Nnodu Obigeli; Emmanuel, Okocha Onyichide; Stella, Akingbola Titilola; Marcus, Asuquo Inyama; Taiwo, Balogun Modupe; Olufela, Kalejaiye Olufunto; Chinawaeze, Aneke John; Orkuma, Joseph Aondowase; Dalhat, Gwarzo Gwarzo; Otobo, Ujah Innocent

    2015-01-01

    Introduction Myelomatosis is a malignant proliferation of plasma cells in the bone marrow, with relatively high prevalence in African populations. Variation in genetic mutations has been observed in individual patients and may be responsible for differences in disease pattern and treatment outcomes. This study described the presentations and treatment outcomes of multiple myeloma in nigerian. Methods The data was obtained retrospectively from the case notes of 135 patients diagnosed with multiple myeloma from eight tertiary health institutions across the six geopolitical zones of Nigeria from 2005 to 2014. Data analysis was carried out using SPSS 17.0. Results The predominant presentations were bone pain in 97 (74%), nephropathy in 47 (35.9%) and pathological fractures in 58 (44.3%). Sixty-seven percent (67%) of the patients were less than 60 years, and 35% had Bence Jones proteinuria. The overall survival beyond 6 months was 91.3%, mean duration of survival rate was 7.4 months. Majority (66.2%) were on Melphalan alone or on melphalan-containing combinations. A higher packed cell volume (PCV) and total serum protein levels at presentation were associated with increased survival, p=0.033 and 0.036, respectively. Conclusion This study portrayed the importance of detail investigation on the causes of bone pain and anaemia in person's aged 40 years and above. There is a high prevalence of nephropathy in this cohort of patients which needs to be further investigated. Majority of the patients, though < 65 years of age were placed on melphalan-containing combinations, which foreclosed chances of future autologous bone marrow transplantation. PMID:26966488

  16. Faculty perspective on competency-based research education: A multi-centre study from Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Hamza Naji

    2017-01-01

    Full Text Available Introduction: Research is becoming indispensable in today's medical education and clinical practice. Engaging medical students in research activities and producing clinically competent and research-oriented medical students are essential demands of today's modern medicine. Incorporating research-based competencies and designing research-oriented medical curricula are challenging and need more attention, especially in developing countries. The aim of this study was to identify research competencies for medical students and the best instructional modality for their integration in the medical curricula. Methodology: A list of research competencies needed to be acquired by medical students during their undergraduate level have been proposed and classified under the following categories: general research skills, biostatistics, basic biomedical research and clinical research and epidemiology. The competencies were further reviewed by academicians of different fields. Afterwards, a questionnaire was prepared targeting researchers who have mentored undergraduate medical students in Riyadh, Saudi Arabia. Research mentors were asked to rate the importance of the competencies listed using a 5-point Likert scale and to determine how they should be delivered into the medical curricula. Results: Results showed that Likert scale mean score ranged from 3.44 to 4.71, illustrating mentors' agreement to the importance of the competencies listed. Around 52% and 58% of mentors choose 'compulsory component' in case of 'general research skills' and 'biostatistics', respectively. On the other hand, 75% and 66% of mentors choose 'non-compulsory component' in case of 'basic research' and 'clinical research and epidemiology', respectively. Conclusion: Standardisation of competencies might help to better integrate research competencies in medical curricula.

  17. Suboptimal management of central nervous system infections in children: a multi-centre retrospective study

    Directory of Open Access Journals (Sweden)

    Kelly Christine

    2012-09-01

    Full Text Available Abstract Objective We aimed to audit the regional management of central nervous system (CNS infection in children. Methods The study was undertaken in five district general hospitals and one tertiary paediatric hospital in the Mersey region of the UK. Children admitted to hospital with a suspected CNS infection over a three month period were identified. Children were aged between 4 weeks and 16 years old. Details were recorded from the case notes and electronic records. We measured the appropriateness of management pathways as outlined by national and local guidelines. Results Sixty-five children were identified with a median age of 6 months (range 1 month to 15 years. Ten had a CNS infection: 4 aseptic meningitis, 3 purulent meningitis, 3 encephalitis [2 with herpes simplex virus (HSV type 1]. A lumbar puncture (LP was attempted in 50 (77% cases but only 43 had cerebrospinal fluid (CSF available for analysis. Of these 24 (57% had a complete standard set of tests performed. Fifty eight (89% received a third generation cephalosporin. Seventeen (26% also received aciclovir with no obvious indication in 9 (53%. Only 11 (65% of those receiving aciclovir had CSF herpes virus PCR. Seventeen had cranial imaging and it was the first management step in 14. Treatment lengths of both antibiotics and aciclovir were highly variable: one child with HSV encephalitis was only treated with aciclovir for 7 days. Conclusions The clinical management of children with suspected CNS infections across the Mersey region is heterogeneous and often sub-optimal, particularly for the investigation and treatment of viral encephalitis. National guidelines for the management of viral encephalitis are needed.

  18. Validity and reliability of the braden scale and the influence of other risk factors: a multi-centre prospective study.

    Science.gov (United States)

    Halfens, R J; Van Achterberg, T; Bal, R M

    2000-08-01

    The Braden scale is one of the most intensively studied risk assessment scales used in identifying the risk of developing pressure sores. However, not all studies show that the sensitivity and specificity of this scale is sufficient. This study, therefore, investigated whether adding new risk factors can enhance the sensitivity and specificity of the Braden scale. The Braden scale was tested in a prospective multi-centre design. The nurses of 11 wards filled in the Braden scale every 5 days for each patient who was admitted without pressure sores and who had a probable stay of at least 10 days. Based on a literature study and in-depth interviews with experts, the Braden scale was extended by the risk factor blood circulation. In addition, other risk factors, which are more or less stable patient characteristics, were measured during the admission of the patient. Independent research assistants measured the presence of pressure sores twice a week. As the external criterion for the risk of developing pressure sores, the presence of pressure sores and/or the use of preventive activities was used. Results showed that the original Braden scale was a reliable instrument and that the sensitivity and specificity was sufficient. However, reformulating the factors moisture and nutrition, and adding the risk factor age could enhance the sensitivity and specificity. Furthermore, results showed that the factors sensory perception, and friction and shear were especially important risk factors for the Braden scale. In fact, using only the factors sensory perception, friction and shear, moisture (a reformulated factor) and age give the highest explained variance of the risk of developing pressure sores. The added risk factor blood circulation, did not enhance the sensitivity and specificity of the original Braden scale. Suggestions are given on how to use risk assessment scales in practice.

  19. A multi-centre cohort study shows no association between experienced violence and labour dystocia in nulliparous women at term

    Directory of Open Access Journals (Sweden)

    Dykes Anna-Karin

    2011-02-01

    Full Text Available Abstract Background Although both labour dystocia and domestic violence during pregnancy are associated with adverse maternal and fetal outcome, evidence in support of a possible association between experiences of domestic violence and labour dystocia is sparse. The aim of this study was to investigate whether self-reported history of violence or experienced violence during pregnancy is associated with increased risk of labour dystocia in nulliparous women at term. Methods A population-based multi-centre cohort study. A self-administrated questionnaire collected at 37 weeks of gestation from nine obstetric departments in Denmark. The total cohort comprised 2652 nulliparous women, among whom 985 (37.1% met the protocol criteria for dystocia. Results Among the total cohort, 940 (35.4% women reported experience of violence, and among these, 66 (2.5% women reported exposure to violence during their first pregnancy. Further, 39.5% (n = 26 of those had never been exposed to violence before. Univariate logistic regression analysis showed no association between history of violence or experienced violence during pregnancy and labour dystocia at term, crude OR 0.91, 95% CI (0.77-1.08, OR 0.90, 95% CI (0.54-1.50, respectively. However, violence exposed women consuming alcoholic beverages during late pregnancy had increased odds of labour dystocia, crude OR 1.45, 95% CI (1.07-1.96. Conclusions Our findings indicate that nulliparous women who have a history of violence or experienced violence during pregnancy do not appear to have a higher risk of labour dystocia at term, according to the definition of labour dystocia in this study. Additional research on this topic would be beneficial, including further evaluation of the criteria for labour dystocia.

  20. Screening for diabetes mellitus among tuberculosis patients in Southern Nigeria: a multi-centre implementation study under programme settings

    Science.gov (United States)

    Ekeke, Ngozi; Ukwaja, Kingsley N.; Chukwu, Joseph N.; Nwafor, Charles C.; Meka, Anthony O.; Egbagbe, Eruke E.; Soyinka, Festus O.; Alobu, Isaac; Agujiobi, Ifeanyi; Akingbesote, Samuel; Igbinigie, Osagie; Offor, Job B.; Madichie, Nelson O.; Alphonsus, Chukwuka; Anyim, Moses C.; Mbah, Obinna K.; Oshi, Daniel C.

    2017-01-01

    Implementation studies are recommended to assess the feasibility and effectiveness of programmes. In Nigeria, little is known about the burden of diabetes mellitus (DM) among tuberculosis (TB) patients. The objective of this study was to determine screening efficacy, prevalence of DM and determinants of DM among TB patients. We report on a multi-centre implementation study carried-out in 13 health facilities in six States of Southern Nigeria. All newly diagnosed TB patients registered from March to October 2015 were screened for DM using current World Health Organisation guidelines. Overall, 2094 TB patients were evaluated, 196 (9.4%) were found to have DM. The prevalence of newly diagnosed DM was 5.5% (115/2094). DM prevalence varied according to age group; occurring in 2.2% of patients aged ≤ 25 years and 16.9% in patients aged (56–65) years. The additional yield of DM was 59% while the number needed to screen to detect a new case of DM was 18. Factors associated with DM were; age >40 years (aOR2.8, CI 2.1–3.9), rural residence (aOR2.3, 1.6–3.2), private health facility care (aOR2.0, 1.4–2.7), and having an occupation that engages in vigorous activity (aOR0.6, 0.4–0.9). The burden of DM among TB patients is high. Prioritization of DM screening for TB patients is indicated. PMID:28281682

  1. Efficacy and safety of acupuncture for chronic pain caused by gonarthrosis: A study protocol of an ongoing multi-centre randomised controlled clinical trial [ISRCTN27450856

    Directory of Open Access Journals (Sweden)

    Krämer Jürgen

    2004-03-01

    Full Text Available Abstract Background Controlled clinical trials produced contradictory results with respect to a specific analgesic effect of acupuncture. There is a lack of large multi-centre acupuncture trials. The German Acupuncture Trial represents the largest multi-centre study of acupuncture in the treatment of chronic pain caused by gonarthrosis up to now. Methods 900 patients will be randomised to three treatment arms. One group receives verum acupuncture, the second sham acupuncture, and the third conservative standard therapy. The trial protocol is described with eligibility criteria, detailed information on the treatment definition, blinding, endpoints, safety evaluation, statistical methods, sample size determination, monitoring, legal aspects, and the current status of the trial. Discussion A critical discussion is given regarding the considerations about standardisation of the acupuncture treatment, the choice of the control group, and the blinding of patients and observers.

  2. Does cataract surgery alleviate poverty? Evidence from a multi-centre intervention study conducted in Kenya, the Philippines and Bangladesh.

    Directory of Open Access Journals (Sweden)

    Hannah Kuper

    Full Text Available BACKGROUND: Poverty and blindness are believed to be intimately linked, but empirical data supporting this purported relationship are sparse. The objective of this study is to assess whether there is a reduction in poverty after cataract surgery among visually impaired cases. METHODOLOGY/PRINCIPAL FINDINGS: A multi-centre intervention study was conducted in three countries (Kenya, Philippines, Bangladesh. Poverty data (household per capita expenditure--PCE, asset ownership and self-rated wealth were collected from cases aged ≥50 years who were visually impaired due to cataract (visual acuity<6/24 in the better eye and age-sex matched controls with normal vision. Cases were offered free/subsidised cataract surgery. Approximately one year later participants were re-interviewed about poverty. 466 cases and 436 controls were examined at both baseline and follow-up (Follow up rate: 78% for cases, 81% for controls, of which 263 cases had undergone cataract surgery ("operated cases". At baseline, operated cases were poorer compared to controls in terms of PCE (Kenya: $22 versus £35 p = 0.02, Bangladesh: $16 vs $24 p = 0.004, Philippines: $24 vs 32 p = 0.0007, assets and self-rated wealth. By follow-up PCE had increased significantly among operated cases in each of the three settings to the level of controls (Kenya: $30 versus £36 p = 0.49, Bangladesh: $23 vs $23 p = 0.20, Philippines: $45 vs $36 p = 0.68. There were smaller increases in self-rated wealth and no changes in assets. Changes in PCE were apparent in different socio-demographic and ocular groups. The largest PCE increases were apparent among the cases that were poorest at baseline. CONCLUSIONS/SIGNIFICANCE: This study showed that cataract surgery can contribute to poverty alleviation, particularly among the most vulnerable members of society. This study highlights the need for increased provision of cataract surgery to poor people and shows that a focus on blindness may help to alleviate

  3. A multi-centre study of interactional style in nurse specialist- and physician-led Rheumatology clinics in the UK.

    Science.gov (United States)

    Vinall-Collier, Karen; Madill, Anna; Firth, Jill

    2016-07-01

    Nurse-led care is well established in Rheumatology in the UK and provides follow-up care to people with inflammatory arthritis including treatment, monitoring, patient education and psychosocial support. The aim of this study is to compare and contrast interactional style with patients in physician-led and nurse-led Rheumatology clinics. A multi-centre mixed methods approach was adopted. Nine UK Rheumatology out-patient clinics were observed and audio-recorded May 2009-April 2010. Eighteen practitioners agreed to participate in clinic audio-recordings, researcher observations, and note-taking. Of 9 nurse specialists, 8 were female and 5 of 9 physicians were female. Eight practitioners in each group took part in audio-recorded post-clinic interviews. All patients on the clinic list for those practitioners were invited to participate and 107 were consented and observed. In the nurse specialist cohort 46% were female; 71% had a diagnosis of Rheumatoid Arthritis (RA). The physician cohort comprised 31% female; 40% with RA and 16% unconfirmed diagnosis. Nineteen (18%) of the patients observed were approached for an audio-recorded telephone interview and 15 participated (4 male, 11 female). Forty-four nurse specialist and 63 physician consultations with patients were recorded. Roter's Interactional Analysis System (RIAS) was used to code this data. Thirty-one semi-structured interviews were conducted (16 practitioner, 15 patients) within 24h of observed consultations and were analyzed using thematic analysis. RIAS results illuminated differences between practitioners that can be classified as 'socio-emotional' versus 'task-focussed'. Specifically, nurse specialists and their patients engaged significantly more in the socio-emotional activity of 'building a relationship'. Across practitioners, the greatest proportion of 'patient initiations' were in 'giving medical information' and reflected what patients wanted the practitioner to know rather than giving insight into

  4. Species distribution and susceptibility profile to fluconazole, voriconazole and MXP-4509 of 551 clinical yeast isolates from a Romanian multi-centre study.

    Science.gov (United States)

    Minea, B; Nastasa, V; Moraru, R F; Kolecka, A; Flonta, M M; Marincu, I; Man, A; Toma, F; Lupse, M; Doroftei, B; Marangoci, N; Pinteala, M; Boekhout, T; Mares, M

    2015-02-01

    This is the first multi-centre study regarding yeast infections in Romania. The aim was to determine the aetiological spectrum and susceptibility pattern to fluconazole, voriconazole and the novel compound MXP-4509. The 551 isolates were identified using routine laboratory methods, matrix-assisted laser desorption ionisation time-of-flight mass spectrometry (MALDI-TOF MS) and DNA sequence analysis. Susceptibility testing was performed using the European Committee for Antimicrobial Susceptibility Testing (EUCAST) method and breakpoints. The yeasts originated from superficial infections (SUP, 51.5 %), bloodstream infections (BSI, 31.6 %) and deep-seated infections (DEEP, 16.9 %), from patients of all ages. Nine genera and 30 species were identified. The 20 Candida species accounted for 94.6 % of all isolates. C. albicans was the overall leading pathogen (50.5 %). Lodderomyces elongisporus is reported for the first time as a fungaemia cause in Europe. C. glabrata and Saccharomyces cerevisiae, as well as the non-Candida spp. and non-albicans Candida spp. groups, showed decreased fluconazole susceptibility (fluconazole resistance was 10.2 %. C. krusei accounted for 27 of the 56 fluconazole-resistant isolates. The overall voriconazole resistance was 2.5 % and was due mainly to C. glabrata and C. tropicalis isolates. Fluconazole resistance rates for the three categories of infection were similar to the overall value; voriconazole resistance rates differed: 4 % for BSI, 3.2 % for DEEP and 1.4 % for SUP. The antifungal activity of MXP-4509 was superior to voriconazole against C. glabrata and many fluconazole-resistant isolates. There was a large percentage of non-albicans Candida isolates. A large part of the high fluconazole resistance was not acquired but intrinsic, resulting from the high percentage of C. krusei.

  5. Prospective multi-centre study on a composite ceramic femoral component in total knee arthroplasty: Five-year clinical and radiological outcomes.

    Science.gov (United States)

    Bergschmidt, Philipp; Bader, Rainer; Ganzer, Dirk; Hauzeur, Christian; Lohmann, Christoph H; Krüger, Alexander; Rüther, Wolfgang; Tigani, Domenico; Rani, Nicola; Esteve, José Luis; Prats, Fernando Lopez; Zorzi, Claudio; Madonna, Vincenzo; Rigotti, Stefano; Benazzo, Francesco; Rossi, Stefano Marco Paolo; Mittelmeier, Wolfram

    2015-06-01

    Enhanced wear resistance of ceramics in general and improved mechanical characteristics of composite ceramics in terms of strength and resistance meet the demands for application in TKA. The aim of this prospective international multi-centre study was to evaluate the 5-year clinical and radiological outcomes of an unconstrained TKA with a composite ceramic femoral component. A total of 107 patients (109 knees) underwent TKA with the MULTIGEN-PLUS Ceramic Knee at seven centres in three European countries. Clinical and radiological assessments were performed preoperatively and postoperatively at 3, 12, 24 and 60 months, using HSS, WOMAC, SF-36 and standardised radiographs. Mean HSS and WOMAC increased significantly from 55.1±11.5 (21-83) and 48.1±16.6 (3-90) preoperatively to 85.6±9.6 (49-98) and 73.3±20.4 (17-100) at 60 months. Mean SF-36 showed significant improvements in patients' quality of life (49.1±17.6 (12-96) preoperatively versus 67.7±23.1 (12-100) at 60 months). Non-progressive radiolucent lines (ceramic knee is comparable to other metallic and ceramic unconstrained TKA systems. Although the assessment of long-term implant survivorship is still pending, the ceramic implants represent a promising solution for patients with allergies against metallic components and furthermore for the general osteoarthritis population due to enhanced wear resistance. Copyright © 2015 Elsevier B.V. All rights reserved.

  6. The impact of study design and diagnostic approach in a large multi-centre ADHD study: Part 2: Dimensional measures of psychopathology and intelligence

    Directory of Open Access Journals (Sweden)

    Roeyers Herbert

    2011-04-01

    Full Text Available Abstract Background The International Multi-centre ADHD Genetics (IMAGE project with 11 participating centres from 7 European countries and Israel has collected a large behavioural and genetic database for present and future research. Behavioural data were collected from 1068 probands with ADHD and 1446 unselected siblings. The aim was to describe and analyse questionnaire data and IQ measures from all probands and siblings. In particular, to investigate the influence of age, gender, family status (proband vs. sibling, informant, and centres on sample homogeneity in psychopathological measures. Methods Conners' Questionnaires, Strengths and Difficulties Questionnaires, and Wechsler Intelligence Scores were used to describe the phenotype of the sample. Data were analysed by use of robust statistical multi-way procedures. Results Besides main effects of age, gender, informant, and centre, there were considerable interaction effects on questionnaire data. The larger differences between probands and siblings at home than at school may reflect contrast effects in the parents. Furthermore, there were marked gender by status effects on the ADHD symptom ratings with girls scoring one standard deviation higher than boys in the proband sample but lower than boys in the siblings sample. The multi-centre design is another important source of heterogeneity, particularly in the interaction with the family status. To a large extent the centres differed from each other with regard to differences between proband and sibling scores. Conclusions When ADHD probands are diagnosed by use of fixed symptom counts, the severity of the disorder in the proband sample may markedly differ between boys and girls and across age, particularly in samples with a large age range. A multi-centre design carries the risk of considerable phenotypic differences between centres and, consequently, of additional heterogeneity of the sample even if standardized diagnostic procedures are

  7. The impact of study design and diagnostic approach in a large multi-centre ADHD study: Part 2: Dimensional measures of psychopathology and intelligence.

    LENUS (Irish Health Repository)

    Muller, Ueli C

    2011-04-07

    Abstract Background The International Multi-centre ADHD Genetics (IMAGE) project with 11 participating centres from 7 European countries and Israel has collected a large behavioural and genetic database for present and future research. Behavioural data were collected from 1068 probands with ADHD and 1446 unselected siblings. The aim was to describe and analyse questionnaire data and IQ measures from all probands and siblings. In particular, to investigate the influence of age, gender, family status (proband vs. sibling), informant, and centres on sample homogeneity in psychopathological measures. Methods Conners\\' Questionnaires, Strengths and Difficulties Questionnaires, and Wechsler Intelligence Scores were used to describe the phenotype of the sample. Data were analysed by use of robust statistical multi-way procedures. Results Besides main effects of age, gender, informant, and centre, there were considerable interaction effects on questionnaire data. The larger differences between probands and siblings at home than at school may reflect contrast effects in the parents. Furthermore, there were marked gender by status effects on the ADHD symptom ratings with girls scoring one standard deviation higher than boys in the proband sample but lower than boys in the siblings sample. The multi-centre design is another important source of heterogeneity, particularly in the interaction with the family status. To a large extent the centres differed from each other with regard to differences between proband and sibling scores. Conclusions When ADHD probands are diagnosed by use of fixed symptom counts, the severity of the disorder in the proband sample may markedly differ between boys and girls and across age, particularly in samples with a large age range. A multi-centre design carries the risk of considerable phenotypic differences between centres and, consequently, of additional heterogeneity of the sample even if standardized diagnostic procedures are used. These

  8. In vitro predictions of skin absorption of caffeine, testosterone, and benzoic acid: A multi-centre comparison study

    NARCIS (Netherlands)

    Sandt, J.J.M. van de; Burgsteden, J.A. van; Cage, S.; Carmichael, P.L.; Dick, I.; Kenyon, S.; Korinth, G.; Larese, F.; Limasset, J.C.; Maas, W.J.M.; Montomoli, L.; Nielsen, J.B.; Payan, J.-P.; Robinson, E.; Sartorelli, P.; Schaller, K.H.; Wilkinson, S.C.; Williams, F.M.

    2004-01-01

    To obtain better insight into the robustness of in vitro percutaneous absorption methodology, the intra- and inter-laboratory variation in this type of study was investigated in 10 European laboratories. To this purpose, the in vitro absorption of three compounds through human skin (9 laboratories)

  9. In vitro predictions of skin absorption of caffeine, testosterone, and benzoic acid: A multi-centre comparison study

    NARCIS (Netherlands)

    Sandt, J.J.M. van de; Burgsteden, J.A. van; Cage, S.; Carmichael, P.L.; Dick, I.; Kenyon, S.; Korinth, G.; Larese, F.; Limasset, J.C.; Maas, W.J.M.; Montomoli, L.; Nielsen, J.B.; Payan, J.-P.; Robinson, E.; Sartorelli, P.; Schaller, K.H.; Wilkinson, S.C.; Williams, F.M.

    2004-01-01

    To obtain better insight into the robustness of in vitro percutaneous absorption methodology, the intra- and inter-laboratory variation in this type of study was investigated in 10 European laboratories. To this purpose, the in vitro absorption of three compounds through human skin (9 laboratories)

  10. I-MOVE multi-centre case control study 2010-11: overall and stratified estimates of influenza vaccine effectiveness in Europe.

    Directory of Open Access Journals (Sweden)

    Esther Kissling

    Full Text Available BACKGROUND: In the third season of I-MOVE (Influenza Monitoring Vaccine Effectiveness in Europe, we undertook a multicentre case-control study based on sentinel practitioner surveillance networks in eight European Union (EU member states to estimate 2010/11 influenza vaccine effectiveness (VE against medically-attended influenza-like illness (ILI laboratory-confirmed as influenza. METHODS: Using systematic sampling, practitioners swabbed ILI/ARI patients within seven days of symptom onset. We compared influenza-positive to influenza laboratory-negative patients among those meeting the EU ILI case definition. A valid vaccination corresponded to > 14 days between receiving a dose of vaccine and symptom onset. We used multiple imputation with chained equations to estimate missing values. Using logistic regression with study as fixed effect we calculated influenza VE adjusting for potential confounders. We estimated influenza VE overall, by influenza type, age group and among the target group for vaccination. RESULTS: We included 2019 cases and 2391 controls in the analysis. Adjusted VE was 52% (95% CI 30-67 overall (N = 4410, 55% (95% CI 29-72 against A(H1N1 and 50% (95% CI 14-71 against influenza B. Adjusted VE against all influenza subtypes was 66% (95% CI 15-86, 41% (95% CI -3-66 and 60% (95% CI 17-81 among those aged 0-14, 15-59 and ≥60 respectively. Among target groups for vaccination (N = 1004, VE was 56% (95% CI 34-71 overall, 59% (95% CI 32-75 against A(H1N1 and 63% (95% CI 31-81 against influenza B. CONCLUSIONS: Results suggest moderate protection from 2010-11 trivalent influenza vaccines against medically-attended ILI laboratory-confirmed as influenza across Europe. Adjusted and stratified influenza VE estimates are possible with the large sample size of this multi-centre case-control. I-MOVE shows how a network can provide precise summary VE measures across Europe.

  11. I-MOVE Multi-Centre Case Control Study 2010-11: Overall and Stratified Estimates of Influenza Vaccine Effectiveness in Europe

    Science.gov (United States)

    Kissling, Esther; Valenciano, Marta; Cohen, Jean Marie; Oroszi, Beatrix; Barret, Anne-Sophie; Rizzo, Caterina; Stefanoff, Pawel; Nunes, Baltazar; Pitigoi, Daniela; Larrauri, Amparo; Daviaud, Isabelle; Horvath, Judit Krisztina; O'Donnell, Joan; Seyler, Thomas; Paradowska-Stankiewicz, Iwona Anna; Pechirra, Pedro; Ivanciuc, Alina Elena; Jiménez-Jorge, Silvia; Savulescu, Camelia; Ciancio, Bruno Christian; Moren, Alain

    2011-01-01

    Background In the third season of I-MOVE (Influenza Monitoring Vaccine Effectiveness in Europe), we undertook a multicentre case-control study based on sentinel practitioner surveillance networks in eight European Union (EU) member states to estimate 2010/11 influenza vaccine effectiveness (VE) against medically-attended influenza-like illness (ILI) laboratory-confirmed as influenza. Methods Using systematic sampling, practitioners swabbed ILI/ARI patients within seven days of symptom onset. We compared influenza-positive to influenza laboratory-negative patients among those meeting the EU ILI case definition. A valid vaccination corresponded to > 14 days between receiving a dose of vaccine and symptom onset. We used multiple imputation with chained equations to estimate missing values. Using logistic regression with study as fixed effect we calculated influenza VE adjusting for potential confounders. We estimated influenza VE overall, by influenza type, age group and among the target group for vaccination. Results We included 2019 cases and 2391 controls in the analysis. Adjusted VE was 52% (95% CI 30-67) overall (N = 4410), 55% (95% CI 29-72) against A(H1N1) and 50% (95% CI 14-71) against influenza B. Adjusted VE against all influenza subtypes was 66% (95% CI 15-86), 41% (95% CI -3-66) and 60% (95% CI 17-81) among those aged 0-14, 15-59 and ≥60 respectively. Among target groups for vaccination (N = 1004), VE was 56% (95% CI 34-71) overall, 59% (95% CI 32-75) against A(H1N1) and 63% (95% CI 31-81) against influenza B. Conclusions Results suggest moderate protection from 2010-11 trivalent influenza vaccines against medically-attended ILI laboratory-confirmed as influenza across Europe. Adjusted and stratified influenza VE estimates are possible with the large sample size of this multi-centre case-control. I-MOVE shows how a network can provide precise summary VE measures across Europe. PMID:22110695

  12. Collaborative Depression Trial (CADET: multi-centre randomised controlled trial of collaborative care for depression - study protocol

    Directory of Open Access Journals (Sweden)

    Kessler David

    2009-10-01

    Full Text Available Abstract Background Comprising of both organisational and patient level components, collaborative care is a potentially powerful intervention for improving depression treatment in UK primary Care. However, as previous models have been developed and evaluated in the United States, it is necessary to establish the effect of collaborative care in the UK in order to determine whether this innovative treatment model can replicate benefits for patients outside the US. This Phase III trial was preceded by a Phase II patient level RCT, following the MRC Complex Intervention Framework. Methods/Design A multi-centre controlled trial with cluster-randomised allocation of GP practices. GP practices will be randomised to usual care control or to "collaborative care" - a combination of case manager coordinated support and brief psychological treatment, enhanced specialist and GP communication. The primary outcome will be symptoms of depression as assessed by the PHQ-9. Discussion If collaborative care is demonstrated to be effective we will have evidence to enable the NHS to substantially improve the organisation of depressed patients in primary care, and to assist primary care providers to deliver a model of enhanced depression care which is both effective and acceptable to patients. Trial Registration Number ISRCTN32829227

  13. Increased incidence of hypotension in elderly patients who underwent emergency airway management: an analysis of a multi-centre prospective observational study.

    Science.gov (United States)

    Hasegawa, Kohei; Hagiwara, Yusuke; Imamura, Taichi; Chiba, Takuyo; Watase, Hiroko; Brown, Calvin A; Brown, David Fm

    2013-01-01

    Although the number of elderly increases disproportionately throughout the industrialised nations and intubation-related cardiovascular compromise is associated with hospital mortality, no emergency medicine literature has reported the direction and magnitude of effect of advanced age on post-intubation hypotension. We seek to determine whether advanced age is associated with an increased rate of hypotension at airway management in emergency departments (EDs). We conducted an analysis of a multi-centre prospective observational study of 13 Japanese EDs from April 2010 to March 2012. Inclusion criteria were all adult non-cardiac-arrest patients who underwent emergency intubation. We excluded patients in whom airway management was performed for shock or status asthmaticus as the principal indication. Patients were divided into two groups defined a priori: age ≥ 65 years old (elderly group) and age airway management at 13 EDs. Among these, the database recorded 3,872 intubations (capture rate 96%). Of 1,903 eligible patients, 975 patients were age ≥ 65 years (51%) and 928 patients were age advanced age had an adjusted OR for post-intubation hypotension of 2.6 (95% CI, 1.3-5.6; P = 0.01). In this large multi-centre study of ED patients who underwent emergent airway management, we found that elderly patients have a significantly higher risk of post-intubation hypotension. These data provide implications for the education and practice of ED airway management that may lead to better clinical outcomes and improved patient safety.

  14. European multi-centre study of the Nucleus Hybrid L24 cochlear implant

    NARCIS (Netherlands)

    Lenarz, T.; James, C.; Cuda, D.; O'Connor, A.; Frachet, B.; Frijns, J.H.; Klenzner, T.; Laszig, R.; Manrique, M.; Marx, M.; Merkus, P.; Mylanus, E.A.M.; Offeciers, E.; Pesch, J.; Ramos-Macias, A.; Robier, A.; Sterkers, O.; Uziel, A.

    2013-01-01

    OBJECTIVES: To investigate the preservation of residual hearing in subjects who received the Nucleus Hybrid L24 cochlear implant. To investigate the performance benefits up to one year post-implantation in terms of speech recognition, sound quality, and quality of life. DESIGN: Prospective, with seq

  15. European multi-centre study of the Nucleus Hybrid L24 cochlear implant

    NARCIS (Netherlands)

    Lenarz, T.; James, C.; Cuda, D.; O'Connor, A.; Frachet, B.; Frijns, J.H.; Klenzner, T.; Laszig, R.; Manrique, M.; Marx, M.; Merkus, P.; Mylanus, E.A.M.; Offeciers, E.; Pesch, J.; Ramos-Macias, A.; Robier, A.; Sterkers, O.; Uziel, A.

    2013-01-01

    OBJECTIVES: To investigate the preservation of residual hearing in subjects who received the Nucleus Hybrid L24 cochlear implant. To investigate the performance benefits up to one year post-implantation in terms of speech recognition, sound quality, and quality of life. DESIGN: Prospective, with

  16. The importance of dietary change for men diagnosed with and at risk of prostate cancer: a multi-centre interview study with men, their partners and health professionals.

    Science.gov (United States)

    Avery, Kerry N L; Donovan, Jenny L; Horwood, Jeremy; Neal, David E; Hamdy, Freddie C; Parker, Chris; Wade, Julia; Lane, Athene

    2014-05-03

    The diagnosis of prostate cancer (PC) can provide a trigger for dietary change, and there is evidence that healthier diets may improve quality of life and clinical outcomes. However, men's views about dietary change in PC survivorship are largely unknown. This multi-centre qualitative interview study explored men's views about dietary change in PC survivorship, to better understand motivations for, and barriers to, achieving desired changes. The role of radical and active surveillance treatments on dietary change and the influence of men's partners were examined. Focus groups also evaluated stakeholder opinion, including healthcare professionals, about the provision of dietary advice to PC patients. A multi-centre interview study explored views about diet and motivations for, and barriers to, dietary change in men at elevated risk or diagnosed with PC following prostate specific antigen (PSA) testing. 58 men and 11 partners were interviewed. Interviews and focus groups were undertaken with 11 healthcare professionals, 5 patients and 4 partners to evaluate stakeholders' opinions about the feasibility and acceptability of providing dietary advice to PC patients. Data were analysed using methods of constant comparison and thematic analysis. Over half of diagnosed men reported making dietary changes, primarily to promote general or prostate health or facilitate coping, despite their uncertainty about diet-PC links. Interest in dietary advice was high. Information needs varied depending on treatment received, with men on active surveillance more frequently modifying their diet and regarding this as an adjunct therapy. Men considered their partners integral to implementing changes. Provision of dietary advice to men diagnosed with PC was considered by healthcare professionals and men to be feasible and appropriate in the context of a holistic 'care package'. Many men make positive dietary changes after PC diagnosis, which are perceived by men and their partners to bring

  17. Closing the gender leadership gap: a multi-centre cross-country comparison of women in management and leadership in academic health centres in the European Union.

    Science.gov (United States)

    Kuhlmann, Ellen; Ovseiko, Pavel V; Kurmeyer, Christine; Gutiérrez-Lobos, Karin; Steinböck, Sandra; von Knorring, Mia; Buchan, Alastair M; Brommels, Mats

    2017-01-06

    Women's participation in medicine and the need for gender equality in healthcare are increasingly recognised, yet little attention is paid to leadership and management positions in large publicly funded academic health centres. This study illustrates such a need, taking the case of four large European centres: Charité - Universitätsmedizin Berlin (Germany), Karolinska Institutet (Sweden), Medizinische Universität Wien (Austria), and Oxford Academic Health Science Centre (United Kingdom). The percentage of female medical students and doctors in all four countries is now well within the 40-60% gender balance zone. Women are less well represented among specialists and remain significantly under-represented among senior doctors and full professors. All four centres have made progress in closing the gender leadership gap on boards and other top-level decision-making bodies, but a gender leadership gap remains relevant. The level of achieved gender balance varies significantly between the centres and largely mirrors country-specific welfare state models, with more equal gender relations in Sweden than in the other countries. Notably, there are also similar trends across countries and centres: gender inequality is stronger within academic enterprises than within hospital enterprises and stronger in middle management than at the top level. These novel findings reveal fissures in the 'glass ceiling' effects at top-level management, while the barriers for women shift to middle-level management and remain strong in academic positions. The uneven shifts in the leadership gap are highly relevant and have policy implications. Setting gender balance objectives exclusively for top-level decision-making bodies may not effectively promote a wider goal of gender equality. Academic health centres should pay greater attention to gender equality as an issue of organisational performance and good leadership at all levels of management, with particular attention to academic enterprises

  18. DALI: Defining Antibiotic Levels in Intensive care unit patients: a multi-centre point of prevalence study to determine whether contemporary antibiotic dosing for critically ill patients is therapeutic

    Directory of Open Access Journals (Sweden)

    Roberts Jason A

    2012-07-01

    Full Text Available Abstract Background The clinical effects of varying pharmacokinetic exposures of antibiotics (antibacterials and antifungals on outcome in infected critically ill patients are poorly described. A large-scale multi-centre study (DALI Study is currently underway describing the clinical outcomes of patients achieving pre-defined antibiotic exposures. This report describes the protocol. Methods DALI will recruit over 500 patients administered a wide range of either beta-lactam or glycopeptide antibiotics or triazole or echinocandin antifungals in a pharmacokinetic point-prevalence study. It is anticipated that over 60 European intensive care units (ICUs will participate. The primary aim will be to determine whether contemporary antibiotic dosing for critically ill patients achieves plasma concentrations associated with maximal activity. Secondary aims will compare antibiotic pharmacokinetic exposures with patient outcome and will describe the population pharmacokinetics of the antibiotics included. Various subgroup analyses will be conducted to determine patient groups that may be at risk of very low or very high concentrations of antibiotics. Discussion The DALI study should inform clinicians of the potential clinical advantages of achieving certain antibiotic pharmacokinetic exposures in infected critically ill patients.

  19. First step to facilitate long-term and multi-centre studies of shear wave elastography in solid breast lesions using a computer-assisted algorithm.

    Science.gov (United States)

    Skerl, Katrin; Cochran, Sandy; Evans, Andrew

    2017-05-06

    Shear wave elastography (SWE) visualises the elasticity of tissue. As malignant tissue is generally stiffer than benign tissue, SWE is helpful to diagnose solid breast lesions. Until now, quantitative measurements of elasticity parameters have been possible only, while the images were still saved on the ultrasound imaging device. This work aims to overcome this issue and introduces an algorithm allowing fast offline evaluation of SWE images. The algorithm was applied to a commercial phantom comprising three lesions of various elasticities and 207 in vivo solid breast lesions. All images were saved in DICOM, JPG and QDE (quantitative data export; for research only) format and evaluated according to our clinical routine using a computer-aided diagnosis algorithm. The results were compared to the manual evaluation (experienced radiologist and trained engineer) regarding their numerical discrepancies and their diagnostic performance using ROC and ICC analysis. ICCs of the elasticity parameters in all formats were nearly perfect (0.861-0.990). AUC for all formats was nearly identical for [Formula: see text] and [Formula: see text] (0.863-0.888). The diagnostic performance of SD using DICOM or JPG estimations was lower than the manual or QDE estimation (AUC 0.673 vs. 0.844). The algorithm introduced in this study is suitable for the estimation of the elasticity parameters offline from the ultrasound system to include images taken at different times and sites. This facilitates the performance of long-term and multi-centre studies.

  20. The effect of two cognitive aid designs on team functioning during intra-operative anaphylaxis emergencies: a multi-centre simulation study.

    Science.gov (United States)

    Marshall, S D; Sanderson, P; McIntosh, C A; Kolawole, H

    2016-04-01

    This multi-centre repeated measures study was undertaken to determine how contrasting designs of cognitive aids affect team performance during simulated intra-operative anaphylaxis crises. A total of 24 teams consisting of a consultant anaesthetist, an anaesthetic trainee and anaesthetic assistant managed three simulated intra-operative anaphylaxis emergencies. Each team was assigned at random to a counterbalanced order of: no cognitive aid; a linear cognitive aid; and a branched cognitive aid, and scored for team functioning. Scores were significantly higher with a linear compared with either a branched version of the cognitive aid or no cognitive aid for 'Team Overall Behavioural Performance', difference between study groups (F-value) 5.8, p = 0.01. Aggregate scores were higher with the linear compared with the branched aid design (p = 0.03). Cognitive aids improve co-ordination of the team's activities and support team members to verbalise their actions. A linear design of cognitive aid improves team functioning more than a branched design.

  1. The influence of sample volume applied to the Makler sperm counting chamber upon the measured concentration of latex beads:A multi-centre study

    Institute of Scientific and Technical Information of China (English)

    Melanie Walls; Cherise Mooy; Patrick Mohan; Sally Catt; Matthew Wiltshire; Hassan W Bakos; Mary Whyte; Phillip Matson; Emily Zuvela; Cheryl Ayres; Deborah Sherrin; Asma Chhotani; Liz Butler; Kelli Peirce; Jenny Krapez; Renae Parker

    2012-01-01

    Objective:To undertake a multi-centre study to maximize the number ofMakler chambers used.Methods:A total of15 laboratories participated with31Makler chambers.A suspension of latex beads was prepared to a concentration of20 millions per milliliter, and0.5 mL aliquots distributed to each participating laboratory.They measured the concentration on theirMakler chamber(s) used for routine semen analysis by adding3,4,5,7 and10µL volumes of bead suspension to the chamber.Results:There was no difference in within-chamber analysis of the bead concentration according to the volume of bead suspension applied within the range of 3-10µL(F4,14=2.634,P=0.056).However, the between-chamber effects were significantly different (F30,124=4.937,P=0.000), and24/31(77.5%) chambers tested had an average bias>10% compared to the target bead concentration.Conclusions:A volume of3-10µL added toMakler counting chambers does not influence the concentration measured of latex beads, but the between-chamber variability and positive bias seen would suggest that other sources of error are present which are yet to be identified.

  2. An international multi-centre prospective study on the efficacy of an intraarticular polyacrylamide hydrogel in horses with osteoarthritis

    DEFF Research Database (Denmark)

    Tnibar, Aziz; Schougaard, Hans; Camitz, Linus

    2015-01-01

    Background: Polyacrylamide hydrogel (PAAG) was evaluated recently to treat osteoarthritis (OA) in horses with highly encouraging results; however no long term field-study was done to explore its clinical efficacy and lasting effect. The objective of this study was to evaluate the efficacy of PAAG...

  3. The PneuCarriage Project: A Multi-Centre Comparative Study to Identify the Best Serotyping Methods for Examining Pneumococcal Carriage in Vaccine Evaluation Studies

    Science.gov (United States)

    Satzke, Catherine; Dunne, Eileen M.; Porter, Barbara D.; Klugman, Keith P.; Mulholland, E. Kim

    2015-01-01

    Background The pneumococcus is a diverse pathogen whose primary niche is the nasopharynx. Over 90 different serotypes exist, and nasopharyngeal carriage of multiple serotypes is common. Understanding pneumococcal carriage is essential for evaluating the impact of pneumococcal vaccines. Traditional serotyping methods are cumbersome and insufficient for detecting multiple serotype carriage, and there are few data comparing the new methods that have been developed over the past decade. We established the PneuCarriage project, a large, international multi-centre study dedicated to the identification of the best pneumococcal serotyping methods for carriage studies. Methods and Findings Reference sample sets were distributed to 15 research groups for blinded testing. Twenty pneumococcal serotyping methods were used to test 81 laboratory-prepared (spiked) samples. The five top-performing methods were used to test 260 nasopharyngeal (field) samples collected from children in six high-burden countries. Sensitivity and positive predictive value (PPV) were determined for the test methods and the reference method (traditional serotyping of >100 colonies from each sample). For the alternate serotyping methods, the overall sensitivity ranged from 1% to 99% (reference method 98%), and PPV from 8% to 100% (reference method 100%), when testing the spiked samples. Fifteen methods had ≥70% sensitivity to detect the dominant (major) serotype, whilst only eight methods had ≥70% sensitivity to detect minor serotypes. For the field samples, the overall sensitivity ranged from 74.2% to 95.8% (reference method 93.8%), and PPV from 82.2% to 96.4% (reference method 99.6%). The microarray had the highest sensitivity (95.8%) and high PPV (93.7%). The major limitation of this study is that not all of the available alternative serotyping methods were included. Conclusions Most methods were able to detect the dominant serotype in a sample, but many performed poorly in detecting the minor

  4. ENLIST 1: An International Multi-centre Cross-sectional Study of the Clinical Features of Erythema Nodosum Leprosum.

    Directory of Open Access Journals (Sweden)

    Stephen L Walker

    Full Text Available Erythema nodosum leprosum (ENL is a severe multisystem immune mediated complication of borderline lepromatous leprosy and lepromatous leprosy. ENL is associated with skin lesions, neuritis, arthritis, dactylitis, eye inflammation, osteitis, orchitis, lymphadenitis and nephritis. The treatment of ENL requires immunosuppression, which is often required for prolonged periods of time and may lead to serious adverse effects. ENL and its treatment is associated with increased mortality and economic hardship. Improved, evidence-based treatments for ENL are needed; however, defining the severity of ENL and outcome measures for treatment studies is difficult because of the multiple organ systems involved. A cross-sectional study was performed, by the members of the Erythema Nodosum Leprosum International STudy (ENLIST Group, of patients with ENL attending seven leprosy referral centres in Brazil, Ethiopia, India, Nepal, the Philippines and the United Kingdom. We systematically documented the clinical features and type of ENL, its severity and the drugs used to treat it. Patients with chronic ENL were more likely to be assessed as having severe ENL. Pain, the most frequent symptom, assessed using a semi-quantitative scale was significantly worse in individuals with "severe" ENL. Our findings will determine the items to be included in a severity scale of ENL which we are developing and validating. The study also provides data on the clinical features of ENL, which can be incorporated into a definition of ENL and used for outcome measures in treatment studies.

  5. A multi-centre cohort study shows no association between experienced violence and labour dystocia in nulliparous women at term

    OpenAIRE

    Dykes Anna-Karin; Dejin-Karlsson Elisabeth; Finnbogadóttir Hafrún

    2011-01-01

    Abstract Background Although both labour dystocia and domestic violence during pregnancy are associated with adverse maternal and fetal outcome, evidence in support of a possible association between experiences of domestic violence and labour dystocia is sparse. The aim of this study was to investigate whether self-reported history of violence or experienced violence during pregnancy is associated with increased risk of labour dystocia in nulliparous women at term. Methods A population-based ...

  6. Early childhood feeding practices and dental caries in preschool children: a multi-centre birth cohort study

    Directory of Open Access Journals (Sweden)

    Schwarz Eli

    2011-01-01

    Full Text Available Abstract Background Dental caries (decay is an international public health challenge, especially amongst young children. Early Childhood Caries is a rapidly progressing disease leading to severe pain, anxiety, sepsis and sleep loss, and is a major health problem particularly for disadvantaged populations. There is currently a lack of research exploring the interactions between risk and protective factors in the development of early childhood caries, in particular the effects of infant feeding practises. Methods/Design This is an observational cohort study and involves the recruitment of a birth cohort from disadvantaged communities in South Western Sydney. Mothers will be invited to join the study soon after the birth of their child at the time of the first home visit by Child and Family Health Nurses. Data on feeding practices and dental health behaviours will be gathered utilizing a telephone interview at 4, 8 and 12 months, and thereafter at 6 monthly intervals until the child is aged 5 years. Information collected will include a initiation and duration of breastfeeding, b introduction of solid food, c intake of cariogenic and non-cariogenic foods, d fluoride exposure, and e oral hygiene practices. Children will have a dental and anthropometric examination at 2 and 5 years of age and the main outcome measures will be oral health quality of life, caries prevalence and caries incidence. Discussion This study will provide evidence of the association of early childhood feeding practices and the oral health of preschool children. In addition, information will be collected on breastfeeding practices and the oral health concerns of mothers living in disadvantaged areas in South Western Sydney.

  7. Financial considerations in the conduct of multi-centre randomised controlled trials: evidence from a qualitative study

    Directory of Open Access Journals (Sweden)

    Grant Adrian M

    2006-12-01

    Full Text Available Abstract Background Securing and managing finances for multicentre randomised controlled trials is a highly complex activity which is rarely considered in the research literature. This paper describes the process of financial negotiation and the impact of financial considerations in four UK multicentre trials. These trials had met, or were on schedule to meet, recruitment targets agreed with their public-sector funders. The trials were considered within a larger study examining factors which might be associated with trial recruitment (STEPS. Methods In-depth semi-structured telephone interviews were conducted in 2003–04 with 45 individuals with various responsibilities to one of the four trials. Interviewees were recruited through purposive and then snowball sampling. Interview transcripts were analysed with the assistance of the qualitative package Atlas-ti. Results The data suggest that the UK system of dividing funds into research, treatment and NHS support costs brought the trial teams into complicated negotiations with multiple funders. The divisions were somewhat malleable and the funding system was used differently in each trial. The fact that all funders had the potential to influence and shape the trials considered here was an important issue as the perspectives of applicants and funders could diverge. The extent and range of industry involvement in non-industry-led trials was striking. Three broad periods of financial work (foundation, maintenance, and resourcing completion were identified. From development to completion of a trial, the trialists had to be resourceful and flexible, adapting to changing internal and external circumstances. In each period, trialists and collaborators could face changing costs and challenges. Each trial extended the recruitment period; three required funding extensions from MRC or HTA. Conclusion This study highlights complex financial aspects of planning and conducting trials, especially where multiple

  8. Clinical tolerability of perioperative tenoxicam in 1001 patients--a prospective, controlled, double-blind, multi-centre study.

    Science.gov (United States)

    Merry, Alan F; Webster, Craig S; Holland, Robin L; Middleton, Neil G; Schug, Stephan A; James, Margaret; McGrath, Ken A

    2004-10-01

    We investigated adverse events (AEs) associated with perioperative tenoxicam in a double-blind, prospective, randomised study. Patients undergoing surgery, screened for contraindications to non-steroidal anti-inflammatory drug, received tenoxicam (n=750) on 2843 days or placebo (n=251) on 988 days, in courses of 1-12 days. There was no increase in the overall incidence of side effects with tenoxicam (33 vs 38% with placebo: P=0.15), or in major side effects (3.9 vs 2.0% with placebo: P=0.11). Of major side effects possibly or probably related to tenoxicam (2.1 vs 1.2% with placebo: P=0.26), all but one involved post-operative surgical site bleeding. However, in the subgroup of patients undergoing otorhinolaryngology surgery, surgical site bleeding occurred in 18 of 171 (10.5%) patients on tenoxicam and one of 57 (1.8%) on placebo (P=0.026); of these, nine in the tenoxicam group and 0 in the placebo were classified as major (P=0.07). One patient on tenoxicam experienced endoscopically proven duodenal ulceration with malaena. In conclusion, perioperative tenoxicam is well tolerated in comparison with placebo and the incidence of drug-related major AEs (other than post-operative bleeding) is no greater than 1 in 150 in low risk patients, but in patients undergoing otorhinolaryngological surgery there may be an increased risk of post-operative bleeding.

  9. Assessment of coeliac disease prevalence in patients with Down syndrome in Poland - a multi-centre study.

    Science.gov (United States)

    Szaflarska-Popławska, Anna; Soroczyńska-Wrzyszcz, Anetta; Barg, Ewa; Józefczuk, Jan; Korczowski, Bartosz; Grzybowska-Chlebowczyk, Urszula; Więcek, Sabina; Cukrowska, Bożena

    2016-01-01

    The results of studies assessing whether patients with Down syndrome have increased risk of coeliac disease are contradictory. The prevalence of coeliac disease in patients with Down syndrome is estimated at a wide range between 1% to as much as 18.6%. To assess coeliac disease prevalence in patients with Down syndrome in Poland. The study enrolled 301 patients with Down syndrome from six centres in Poland (Wroclaw, Sandomierz, Rzeszow, Grudziadz, Katowice, and Bydgoszcz). We measured the concentration of anti-tissue transglutaminase IgA antibodies and anti-deamidated gliadin peptide IgG antibodies in all patients. Patients with abnormal positive (> 10 U/ml) or inconclusive (7-10 U/ml) result of the serological test were offered endoscopic biopsy of the small intestine in the main centre. In 31 (10.3%) patients increased concentrations of the investigated antibodies were found, including 19 (6.3%) patients with increased tTg-IgA concentration, 27 (8.97%) patients with increased concentration of DGP-IgG, and 15 (4.98%) patients with increased concentration of both types of antibodies. Endoscopic biopsy of the small intestine was planned for all 31 patients with abnormal results of at least one antibody test and for 2 patients with inconclusive results. One of them suffered from previously diagnosed and histologically confirmed coeliac disease. Biopsy was not conducted in 9 patients due to contraindications, lack of their consent, or introduction of a gluten-free diet by the parents before the examination. In a group of 23 patients who underwent endoscopic biopsy of the small intestine, in 15 patients the histopathological picture of the small intestinal mucosa was typical for coeliac disease, 2 patients were diagnosed with lesions of grade 1 according to the classification by Marsh-Oberhuber, 1 patient was diagnosed with focal shortening of villi and hypertrophy of the crypts with no intraepithelial lymphocytosis (remains under gastrological observation), 2 patients

  10. Natural history of mesenteric venous thrombosis in patients treated with vitamin K antagonists: a multi-centre, retrospective cohort study.

    Science.gov (United States)

    Dentali, Francesco; Ageno, Walter; Witt, Dan; Malato, Alessandra; Clark, Nathan; Garcia, David; McCool, Kathleen; Siragusa, Sergio; Dyke, Shannon; Crowther, Mark

    2009-09-01

    Knowledge on the natural history of mesenteric vein thrombosis (MVT) and of the efficacy and safety of long-term oral anticoagulant therapy (OAT) in this setting is based on small uncontrolled series of patients with a limited follow-up. It was the aim of the study to assess the natural history of MVT in a cohort of patients treated with OAT. The charts of all MVT patients currently attending or who have attended four anticoagulation clinics were reviewed. Information on risk factors, treatment, recurrence, major bleeding and mortality was collected. Seventy-seven patients (mean age 49.2 years; 45 males) were included with a median follow-up of 36 months (range 2-204 months). Forty-six patients were treated with long-term OAT. Seven patients had venous thromboembolism (VTE) recurrence (5 splanchnic vein thromboses and two pulmonary emboli) for an incidence rate of 23.4 events /1,000 year patients. In two patients recurrent VTE occurred during OAT, for an incidence rate of 10.5 events /1,000 year patient. Five patients had VTE recurrence when OAT was suspened for an incidence rate of 45.9 events /1,000 year patient. Two patients (2.6%) had a major bleeding event. 97.3% of patients were alive at one year, and seven patients (9.1%) died during follow up. In conclusion, patients with MTV seem to have a low risk of recurrent VTE while receiving OAT. This risk appears increased after treatment is stopped.

  11. Multi-centre evaluation of accuracy and reproducibility of planar and SPECT image quantification. An IAEA phantom study

    Energy Technology Data Exchange (ETDEWEB)

    Zimmermann, Brian E. [National Institute of Standards and Technology, Gaithersburg, MD (United States); Grosev, Darko [Univ. Hospital Centre Zagreb (Croatia); Buvat, Irene [Service Hospitalier Frederic Joliot, Paris (France); and others

    2017-08-01

    Accurate quantitation of activity provides the basis for internal dosimetry of targeted radionuclide therapies. This study investigated quantitative imaging capabilities at sites with a variety of experience and equipment and assessed levels of errors in activity quantitation in Single-Photon Emission Computed Tomography (SPECT) and planar imaging. Participants from 9 countries took part in a comparison in which planar, SPECT and SPECT with X ray computed tomography (SPECT-CT) imaging were used to quantify activities of four epoxy-filled cylinders containing {sup 133}Ba, which was chosen as a surrogate for {sup 131}I. The sources, with nominal volumes of 2, 4, 6 and 23 mL, were calibrated for {sup 133}Ba activity by the National Institute of Standards and Technology, but the activity was initially unknown to the participants. Imaging was performed in a cylindrical phantom filled with water. Two trials were carried out in which the participants first estimated the activities using their local standard protocols, and then repeated the measurements using a standardized acquisition and analysis protocol. Finally, processing of the imaging data from the second trial was repeated by a single centre using a fixed protocol. In the first trial, the activities were underestimated by about 15% with planar imaging. SPECT with Chang's first order attenuation correction (Chang-AC) and SPECT-CT overestimated the activity by about 10%. The second trial showed moderate improvements in accuracy and variability. Planar imaging was subject to methodological errors, e.g., in the use of a transmission scan for attenuation correction. The use of Chang-AC was subject to variability from the definition of phantom contours. The project demonstrated the need for training and standardized protocols to achieve good levels of quantitative accuracy and precision in a multicentre setting. Absolute quantification of simple objects with no background was possible with the strictest protocol to

  12. Rehabilitation Profiles of Older Adult Stroke Survivors Admitted to Intermediate Care Units: A Multi-Centre Study

    Science.gov (United States)

    Inzitari, Marco; Quinn, Terence J.; Montaner, Joan; Gavaldà, Ricard; Duarte, Esther; Coll-Planas, Laura; Cerdà, Mercè; Santaeugenia, Sebastià; Closa, Conxita; Gallofré, Miquel

    2016-01-01

    Background Stroke is a major cause of disability in older adults, but the evidence around post-acute treatment is limited and heterogeneous. We aimed to identify profiles of older adult stroke survivors admitted to intermediate care geriatric rehabilitation units. Methods We performed a cohort study, enrolling stroke survivors aged 65 years or older, admitted to 9 intermediate care units in Catalonia-Spain. To identify potential profiles, we included age, caregiver presence, comorbidity, pre-stroke and post-stroke disability, cognitive impairment and stroke severity in a cluster analysis. We also proposed a practical decision tree for patient’s classification in clinical practice. We analyzed differences between profiles in functional improvement (Barthel index), relative functional gain (Montebello index), length of hospital stay (LOS), rehabilitation efficiency (functional improvement by LOS), and new institutionalization using multivariable regression models (for continuous and dichotomous outcomes). Results Among 384 patients (79.1±7.9 years, 50.8% women), we identified 3 complexity profiles: a) Lower Complexity with Caregiver (LCC), b) Moderate Complexity without Caregiver (MCN), and c) Higher Complexity with Caregiver (HCC). The decision tree showed high agreement with cluster analysis (96.6%). Using either linear (continuous outcomes) or logistic regression, both LCC and MCN, compared to HCC, showed statistically significant higher chances of functional improvement (OR = 4.68, 95%CI = 2.54–8.63 and OR = 3.0, 95%CI = 1.52–5.87, respectively, for Barthel index improvement ≥20), relative functional gain (OR = 4.41, 95%CI = 1.81–10.75 and OR = 3.45, 95%CI = 1.31–9.04, respectively, for top Vs lower tertiles), and rehabilitation efficiency (OR = 7.88, 95%CI = 3.65–17.03 and OR = 3.87, 95%CI = 1.69–8.89, respectively, for top Vs lower tertiles). In relation to LOS, MCN cluster had lower chance of shorter LOS than LCC (OR = 0.41, 95%CI = 0.23–0

  13. Rehabilitation Profiles of Older Adult Stroke Survivors Admitted to Intermediate Care Units: A Multi-Centre Study.

    Science.gov (United States)

    Pérez, Laura M; Inzitari, Marco; Quinn, Terence J; Montaner, Joan; Gavaldà, Ricard; Duarte, Esther; Coll-Planas, Laura; Cerdà, Mercè; Santaeugenia, Sebastià; Closa, Conxita; Gallofré, Miquel

    2016-01-01

    Stroke is a major cause of disability in older adults, but the evidence around post-acute treatment is limited and heterogeneous. We aimed to identify profiles of older adult stroke survivors admitted to intermediate care geriatric rehabilitation units. We performed a cohort study, enrolling stroke survivors aged 65 years or older, admitted to 9 intermediate care units in Catalonia-Spain. To identify potential profiles, we included age, caregiver presence, comorbidity, pre-stroke and post-stroke disability, cognitive impairment and stroke severity in a cluster analysis. We also proposed a practical decision tree for patient's classification in clinical practice. We analyzed differences between profiles in functional improvement (Barthel index), relative functional gain (Montebello index), length of hospital stay (LOS), rehabilitation efficiency (functional improvement by LOS), and new institutionalization using multivariable regression models (for continuous and dichotomous outcomes). Among 384 patients (79.1±7.9 years, 50.8% women), we identified 3 complexity profiles: a) Lower Complexity with Caregiver (LCC), b) Moderate Complexity without Caregiver (MCN), and c) Higher Complexity with Caregiver (HCC). The decision tree showed high agreement with cluster analysis (96.6%). Using either linear (continuous outcomes) or logistic regression, both LCC and MCN, compared to HCC, showed statistically significant higher chances of functional improvement (OR = 4.68, 95%CI = 2.54-8.63 and OR = 3.0, 95%CI = 1.52-5.87, respectively, for Barthel index improvement ≥20), relative functional gain (OR = 4.41, 95%CI = 1.81-10.75 and OR = 3.45, 95%CI = 1.31-9.04, respectively, for top Vs lower tertiles), and rehabilitation efficiency (OR = 7.88, 95%CI = 3.65-17.03 and OR = 3.87, 95%CI = 1.69-8.89, respectively, for top Vs lower tertiles). In relation to LOS, MCN cluster had lower chance of shorter LOS than LCC (OR = 0.41, 95%CI = 0.23-0.75) and HCC (OR = 0.37, 95%CI = 0

  14. India-Based Knee Osteoarthritis Evaluation (iKare): A Multi-Centre Cross-Sectional Study on the Management of Knee Pain and Early Osteoarthritis in India.

    Science.gov (United States)

    Sancheti, Parag; Shetty, Vijay D; Dhillon, Mandeep S; Sprague, Sheila A; Bhandari, Mohit

    2017-09-01

    Access to early knee osteoarthritis treatment in low and middle income nations is often believed to be limited. We conducted a cross-sectional study in India to assess prior access to treatment among patients presenting with knee pain to specialist orthopaedic clinics. The multi-centre, cross-sectional study included patients presenting with knee pain at 3 hospitals in India. Patients who met the inclusion criteria and provided informed consent completed a questionnaire designed to assess patient demographics, socioeconomic status, knee pain, treatment method, and patient's knowledge on osteoarthritis (OA). Their orthopaedic surgeons also completed a questionnaire on the severity of patient's OA and their recommended treatments. The impact of demographic characteristics on the prescription of treatment options was analyzed using logistic regression. A total of 714 patients met the eligibility criteria and participated in this study. The majority of patients had been experiencing pain for less than 1 year (64.8%) and had previously been prescribed medications (91.6%), supplements (68.6%), and nonpharmacological (81.9%) treatments to manage their knee OA. Current treatment recommendations included oral medications (83.3%), intra-articular injections (29.8%), and surgical intervention (12.7%). Prescription of oral medications was related to younger age, lack of deformities, and lower Kellgren-Lawrence grades (p < 0.01). Patients treated in private hospital settings were more likely to have been previously treated with medications (range, 84.3% to 92.6%; p < 0.01) and physical treatments (range, 61.8% to 84.8%; p < 0.01) than patients treated at government hospitals. Contrary to the perception, our findings suggest a similar proportion of early knee OA treatment between India and North America.

  15. The effect of core stability training on balance and mobility in ambulant individuals with multiple sclerosis: a multi-centre series of single case studies.

    Science.gov (United States)

    Freeman, J A; Gear, M; Pauli, A; Cowan, P; Finnigan, C; Hunter, H; Mobberley, C; Nock, A; Sims, R; Thain, J

    2010-11-01

    Core stability training is popular in the management of people with multiple sclerosis (MS); however, scientific evidence to support its effectiveness is scarce. To explore the effectiveness of core stability training on balance and mobility. A multi-centre series of eight single case studies was undertaken. Eight ambulant individuals with stable MS participated in 16 face-to-face core stability training sessions, delivered by a neurophysiotherapist, plus a daily home exercise programme. A range of outcomes were measured: 10-m timed walk, 12-item MS walking scale, timed get up and go, functional reach tests, timed single leg stance, visual analogue scales of two activities, and the Activities-specific Balance Confidence Scale. Visual analysis of trend, level and slope demonstrated improvement in five subjects (62%) in seven measures. This was confirmed by the two standard deviation band method of analysis for six measures. Analysis of group data (repeated measures within subjects analysis of variance) indicated significant improvement between baseline and intervention phases for timed walk (p = 0.019), MSWS-12 Scale (p = 0.041), forward (p = 0.015) and lateral reach (p = 0.012). In general, no further improvements were made following withdrawal of the intervention. This study provides preliminary evidence of the effectiveness of an 8-week core stability training programme in improving balance and mobility in ambulant people with MS. Variations in response to intervention are evident. Assessor-blinded randomized controlled studies are required to confirm these findings and determine patient characteristics which identify those who benefit most from this intervention.

  16. SHECTS multi-centre Spanish study: liver situation of patients with chronic hepatitis from HCV on renal replacement therapy with haemodialysis.

    Science.gov (United States)

    García-Agudo, Rebeca; Aoufi-Rabih, Sami; Barril-Cuadrado, Guillermina

    2013-01-01

    The SHECTS study, approved by the Spanish Society of Nephrology, has the goal of analysing the level of examination and follow-up of patients with chronic hepatitis C virus (HCV) infections on haemodialysis, and to determine the current prevalence of these patients. A national, multi-centre, cohort study carried out between September 2010 and September 2011. We sent a data collection folder to all Spanish haemodialysis units to include information regarding each centre and the nephrological/hepatological situation of their HCV-positive patients. A total of 187 haemodialysis units (71 hospital-based) participated in the study. The global prevalence of HCV was estimated at 5.6%. The most common cause of chronic kidney disease was glomerular (25%); of the 72.1% of patients who had undergone a renal biopsy, 23.2% had glomerulonephritis that could have been associated with HCV. Genotyping had not been carried out in 64%, liver ultrasound had not been applied in 61.3%, and liver biopsies were not performed in 87.7%. One-third of all patients received care from a gastroenterologist. Antiviral treatment was administered to 26.6% of patients, with a sustained viral response in 35.3% and suspension of treatment in 67.4%. The prevalence of HCV in patients on haemodialysis in Spain has decreased to the point of reaching similar rates to those of neighbouring countries. These patients receive incomplete analyses of liver condition, and individuals who receive antiviral treatment and untreated patients constitute a large proportion, despite having low viral loads and being candidates for kidney transplants.

  17. Visceral leishmaniasis on the Indian sub-continent: a multi-centre study of the costs of three interventions for the control of the sandfly vector, Phlebotomus argentipes.

    Science.gov (United States)

    Das, M; Banjara, M; Chowdhury, R; Kumar, V; Rijal, S; Joshi, A; Akhter, S; Das, P; Kroeger, A

    2008-12-01

    The sandflies that transmit the parasites causing human visceral leishmaniasis (VL) can be controlled by several methods, including indoor residual spraying (IRS), the use of long-lasting insecticidal nets (LLIN) and ecological vector management (EVM). The financial costs of each of these three methods of sandfly control have recently been assessed and compared, in a multi-centre study based on the Indian sub-continent. In each of the four study sites (two in Nepal and one each in India and Bangladesh), 24 neighbourhoods were randomly selected in districts with high incidences of VL. The costs of the three interventions were then prospectively assessed in each study neighbourhood, in the local currency, and then converted to U.S. dollars at the prevailing exchange rate in the country concerned. The costs of IRS, which ranged from U.S.$2.4-11.7 (mean = U.S.$5.9) per household-year, were greater than those of LLIN (U.S.$3.5-5.1/household-year, with a mean of U. S.$4.5) but less than those of EVM (U. S.$5.0- 14.0/household-year, with a mean of U.S.$8.7). These results indicate that LLIN and IRS may be the cheaper options for the control of sandflies on the Indian sub-continent, and that EVM should perhaps only be taken up as a complimentary and voluntary method. Various combinations of these interventions (based on country-specific social and economic factors) may, however, be the best and most cost-effective choice.

  18. The most commonly used disease severity scores are inappropriate for risk stratification of older emergency department sepsis patients: an observational multi-centre study.

    Science.gov (United States)

    de Groot, Bas; Stolwijk, Frank; Warmerdam, Mats; Lucke, Jacinta A; Singh, Gurpreet K; Abbas, Mo; Mooijaart, Simon P; Ansems, Annemieke; Esteve Cuevas, Laura; Rijpsma, Douwe

    2017-09-11

    Sepsis recognition in older emergency department (ED) patients is difficult due to atypical symptom presentation. We therefore investigated whether the prognostic and discriminative performance of the five most commonly used disease severity scores were appropriate for risk stratification of older ED sepsis patients (≥70 years) compared to a younger control group (<70 years). This was an observational multi-centre study using an existing database in which ED patients who were hospitalized with a suspected infection were prospectively included. Patients were stratified by age < 70 and ≥70 years. We assessed the association with in-hospital mortality (primary outcome) and the area under the curve (AUC) with receiver operator characteristics of the Predisposition, Infection, Response, Organ dysfunction (PIRO), quick Sequential Organ Failure Assessment (qSOFA), Mortality in ED Sepsis (MEDS), and the Modified and National Early Warning (MEWS and NEWS) scores. In-hospital mortality was 9.5% ((95%-CI); 7.4-11.5) in the 783 included older patients, and 4.6% (3.6-5.7) in the 1497 included younger patients. In contrast to younger patients, disease severity scores in older patients associated poorly with mortality. The AUCs of all disease severity scores were poor and ranged from 0.56 to 0.64 in older patients, significantly lower than the good AUC range from 0.72 to 0.86 in younger patients. The MEDS had the best AUC (0.64 (0.57-0.71)) in older patients. In older and younger patients, the newly proposed qSOFA score (Sepsis 3.0) had a lower AUC than the PIRO score (sepsis 2.0). The prognostic and discriminative performance of the five most commonly used disease severity scores was poor and less useful for risk stratification of older ED sepsis patients.

  19. Preventing hospital admissions by reviewing medication (PHARM in primary care: design of the cluster randomised, controlled, multi-centre PHARM-study

    Directory of Open Access Journals (Sweden)

    van den Bogert Sander CA

    2011-01-01

    Full Text Available Abstract Background Medication can be effective but can also be harmful and even cause hospital admissions. Medication review or pharmacotherapy review has often been proposed as a solution to prevent these admissions and to improve the effectiveness and safety of pharmacotherapy. However, most published randomised controlled trials on pharmacotherapy reviews showed no or little effect on morbidity and mortality. Therefore we designed the PHARM (Preventing Hospital Admissions by Reviewing Medication-study with the objective to study the effect of the total pharmaceutical care process on medication related hospital admissions and on adverse drug events, survival and quality of life. Methods/Design The PHARM-study is designed as a cluster randomised, controlled, multi-centre study in an integrated primary care setting. Patients with a high risk of a medication related hospital admission are included in the study with randomisation at GP (general practitioner level. We aim to include 14200 patients, 7100 in each arm, from at least 142 pharmacy practices. The intervention consists of a patient-centred, structured, pharmaceutical care process. This process consists of several steps, is continuous and occurrs over multiple encounters of patients and clinicians. The steps of this pharmaceutical care process are a pharmaceutical anamnesis, a review of the patient's pharmacotherapy, the formulation and execution of a pharmaceutical care plan combined with the monitoring and follow up evaluation of the care plan and pharmacotherapy. The patient's own pharmacist and GP carry out the intervention. The control group receives usual care. The primary outcome of the study is the frequency of hospital admissions related to medication within the study period of 12 months of each patient. The secondary outcomes are survival, quality of life, adverse drug events and severe adverse drug events. The outcomes will be analysed by using mixed-effects Cox models

  20. Preventing hospital admissions by reviewing medication (PHARM) in primary care: design of the cluster randomised, controlled, multi-centre PHARM-study.

    Science.gov (United States)

    Leendertse, Anne J; de Koning, Fred H P; Goudswaard, Alex N; Jonkhoff, Andries R; van den Bogert, Sander C A; de Gier, Han J; Egberts, Toine C G; van den Bemt, Patricia M L A

    2011-01-07

    Medication can be effective but can also be harmful and even cause hospital admissions. Medication review or pharmacotherapy review has often been proposed as a solution to prevent these admissions and to improve the effectiveness and safety of pharmacotherapy. However, most published randomised controlled trials on pharmacotherapy reviews showed no or little effect on morbidity and mortality. Therefore we designed the PHARM (Preventing Hospital Admissions by Reviewing Medication)-study with the objective to study the effect of the total pharmaceutical care process on medication related hospital admissions and on adverse drug events, survival and quality of life. The PHARM-study is designed as a cluster randomised, controlled, multi-centre study in an integrated primary care setting. Patients with a high risk of a medication related hospital admission are included in the study with randomisation at GP (general practitioner) level. We aim to include 14200 patients, 7100 in each arm, from at least 142 pharmacy practices.The intervention consists of a patient-centred, structured, pharmaceutical care process. This process consists of several steps, is continuous and occurs over multiple encounters of patients and clinicians. The steps of this pharmaceutical care process are a pharmaceutical anamnesis, a review of the patient's pharmacotherapy, the formulation and execution of a pharmaceutical care plan combined with the monitoring and follow up evaluation of the care plan and pharmacotherapy. The patient's own pharmacist and GP carry out the intervention. The control group receives usual care.The primary outcome of the study is the frequency of hospital admissions related to medication within the study period of 12 months of each patient. The secondary outcomes are survival, quality of life, adverse drug events and severe adverse drug events. The outcomes will be analysed by using mixed-effects Cox models. The PHARM-study is one of the largest controlled trials to

  1. Virtual patients design and its effect on clinical reasoning and student experience: a protocol for a randomised factorial multi-centre study

    Directory of Open Access Journals (Sweden)

    Bateman James

    2012-08-01

    Full Text Available Abstract Background Virtual Patients (VPs are web-based representations of realistic clinical cases. They are proposed as being an optimal method for teaching clinical reasoning skills. International standards exist which define precisely what constitutes a VP. There are multiple design possibilities for VPs, however there is little formal evidence to support individual design features. The purpose of this trial is to explore the effect of two different potentially important design features on clinical reasoning skills and the student experience. These are the branching case pathways (present or absent and structured clinical reasoning feedback (present or absent. Methods/Design This is a multi-centre randomised 2x2 factorial design study evaluating two independent variables of VP design, branching (present or absent, and structured clinical reasoning feedback (present or absent.The study will be carried out in medical student volunteers in one year group from three university medical schools in the United Kingdom, Warwick, Keele and Birmingham. There are four core musculoskeletal topics. Each case can be designed in four different ways, equating to 16 VPs required for the research. Students will be randomised to four groups, completing the four VP topics in the same order, but with each group exposed to a different VP design sequentially. All students will be exposed to the four designs. Primary outcomes are performance for each case design in a standardized fifteen item clinical reasoning assessment, integrated into each VP, which is identical for each topic. Additionally a 15-item self-reported evaluation is completed for each VP, based on a widely used EViP tool. Student patterns of use of the VPs will be recorded. In one centre, formative clinical and examination performance will be recorded, along with a self reported pre and post-intervention reasoning score, the DTI. Our power calculations indicate a sample size of 112 is required for

  2. A multi-centre randomised controlled trial of rehabilitation aimed at improving outdoor mobility for people after stroke: Study protocol for a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Logan Pip A

    2012-06-01

    Full Text Available Abstract Background Up to 42% of all stroke patients do not get out of the house as much as they would like. This can impede a person’s quality of life. This study is testing the clinical effectiveness and cost effectiveness of a new outdoor mobility rehabilitation intervention by comparing it to usual care. Methods/design This is a multi-centre parallel group individually randomised, controlled trial. At least 506 participants will be recruited through 15 primary and secondary care settings and will be eligible if they are over 18 years of age, have had a stroke and wish to get out of the house more often. Participants are being randomly allocated to either the intervention group or the control group. Intervention group participants receive up to 12 rehabilitation outdoor mobility sessions over up to four months. The main component of the intervention is repeated practice of outdoor mobility with a therapist. Control group participants are receiving the usual intervention for outdoor mobility limitations: verbal advice and provision of leaflets provided over one session. Outcome measures are being collected using postal questionnaires, travel calendars and by independent assessors. The primary outcome measure is the Social Function domain of the SF36v2 quality of life assessment six months after recruitment. The secondary outcome measures include: functional ability, mobility, the number of journeys (monthly travel diaries, satisfaction with outdoor mobility, mood, health-related quality of life, resource use of health and social care. Carer mood information is also being collected. The mean Social Function score of the SF-36v2 will be compared between treatment arms using a multiple membership form of mixed effects multiple regression analysis adjusting for centre (as a fixed effect, age and baseline Social Function score as covariates and therapist as a multiple membership random effect. Regression coefficients and 95% confidence

  3. A multi-centre, randomised controlled trial of the effectiveness of PDSAFE to prevent falls among people with Parkinson's: study protocol.

    Science.gov (United States)

    Goodwin, Victoria A; Pickering, Ruth; Ballinger, Claire; Roberts, Helen; McIntosh, Emma; Lamb, Sarah; Nieuwboer, Alice; Rochester, Lynn; Ashburn, Ann

    2015-05-15

    Falls amongst people with Parkinson's (PwP) result in significant disability and reduced quality of life. There is emerging evidence that exercise-based and physiotherapeutic interventions are of benefit for improving fall risk factors, such as balance. However, the benefit, in terms of preventing falls, is mixed. The development of effective interventions has been identified as the highest research priority for this population. The aim of this trial is to establish the effectiveness and cost-effectiveness of a novel, home-based physiotherapy programme, compared with usual care, on falls amongst PwP. A UK multi-centre, community-based, single blind, randomised controlled trial with twelve month follow-up, and nested economic evaluation and qualitative studies will be undertaken. Six hundred PwP who live in their own home, have had one or more falls in the previous year and an MMSE score of ≥24 will be recruited. Those living in care homes and those needing assistance from another person to walk indoors will not be eligible. The intervention is a physiotherapist delivered, individually tailored and progressive, home-based programme (PDSAFE) comprising task orientated movement strategy training, functional lower limb strengthening and balance training, of six months duration. Unsupervised daily home exercises and strategies will be practised and supported using technology. Control participants will receive usual care. Data collection will include falls, cognitive state, balance and mobility, fear of falling, freezing of gait, mood, quality of life, carer quality of life and resource use. Data will be collected at baseline, three, six and twelve months. Longitudinal semi-structured interviews will be undertaken with forty participants to explore the expectations and experiences of participants. The primary outcome is risk of repeat falling at six months post-randomisation. The aims of this trial are to establish the effectiveness and cost-effectiveness of a novel

  4. Implementation of preventive strength training in residential geriatric care: a multi-centre study protocol with one year of interventions on multiple levels

    Directory of Open Access Journals (Sweden)

    Nieder Ulrike

    2009-11-01

    Full Text Available Abstract Background There is scientific evidence that preventive physical exercise is effective even in high age. In contrast, there are few opportunities of preventive exercise for highly aged people endangered by or actually in need of care. For example, they would not be able to easily go to training facilities; standard exercises may be too intensive and therefore be harmful to them; orientation disorders like dementia would exacerbate individuals and groups in following instructions and keeping exercises going. In order to develop appropriate interventions, these and other issues were assigned to different levels: the individual-social level (ISL, the organisational-institutional level (OIL and the political-cultural level (PCL. Consequently, this conceptional framework was utilised for development, implementation and evaluation of a new strength and balance exercise programme for old people endangered by or actually in need of daily care. The present paper contains the development of this programme labeled "fit for 100", and a study protocol of an interventional single-arm multi-centre trial. Methods The intervention consisted of (a two group training sessions every week over one year, mainly resistance exercises, accompanied by sensorimotor and communicative group exercises and games (ISL, (b a sustainable implementation concept, starting new groups by instructors belonging to the project, followed by training and supervision of local staff, who stepwise take over the group (OIL, (c informing and convincing activities in professional, administrative and governmental contexts, public relation activities, and establishing an advisory council with renowned experts and public figures (PCL. Participating institutions of geriatric care were selected through several steps of quality criteria assessment. Primary outcome measures were continuous documentation of individual participation (ISL, number of groups continued without external financial

  5. Field efficacy of a new mosaic long-lasting mosquito net (PermaNet (R) 3.0) against pyrethroid-resistant malaria vectors : a multi centre study in Western and Central Africa

    OpenAIRE

    Corbel, Vincent; Chabi, Joseph; Dabiré, R. K.; Etang, J.; Nwane, P.; Pigeon, O.; Akogbeto, M.; Hougard, Jean-Marc

    2010-01-01

    Background: Due to the spread of pyrethroid-resistance in malaria vectors in Africa, new strategies and tools are urgently needed to better control malaria transmission. The aim of this study was to evaluate the performances of a new mosaic long-lasting insecticidal net (LLIN), i.e. PermaNet (R) 3.0, against wild pyrethroid-resistant Anopheles gambiae s.l. in West and Central Africa. Methods: A multi centre experimental hut trial was conducted in Malanville (Benin), Vallee du Kou (Burkina Fas...

  6. Field efficacy of a new mosaic long-lasting mosquito net (PermaNet® 3.0) against pyrethroid-resistant malaria vectors: a multi centre study in Western and Central Africa

    OpenAIRE

    Pigeon Olivier; Nwane Philippe; Etang Josiane; Dabiré Roch K; Chabi Joseph; Corbel Vincent; Akogbeto Martin; Hougard Jean-Marc

    2010-01-01

    Abstract Background Due to the spread of pyrethroid-resistance in malaria vectors in Africa, new strategies and tools are urgently needed to better control malaria transmission. The aim of this study was to evaluate the performances of a new mosaic long-lasting insecticidal net (LLIN), i.e. PermaNet® 3.0, against wild pyrethroid-resistant Anopheles gambiae s.l. in West and Central Africa. Methods A multi centre experimental hut trial was conducted in Malanville (Benin), Vallée du Kou (Burkina...

  7. Multi-centre European study of breakthrough cancer pain: pain characteristics and patient perceptions of current and potential management strategies

    DEFF Research Database (Denmark)

    Davies, Andrew; Zeppetella, Giovambattista; Andersen, Steen

    2011-01-01

    took rescue medication every time they experienced breakthrough pain. Sixty-five percent patients would definitely consider using an oral transmucosal product; patients from Denmark were less likely to answer positively, and a positive response was associated with previous use of the route...... for breakthrough pain. Seventy-three percent patients reported regular oral problems. Forty-two percent patients would definitely consider using an intranasal product, with 26% patients stating they would definitely not use such a preparation; patients from Denmark and Sweden were less likely to answer positively......, and a positive response was associated with male gender, and previous use of the route. Forty-four percent patients reported regular nasal problems. Sixty percent patients would definitely consider using a subcutaneous product, and 44% patients would definitely consider using an intrapulmonary product....

  8. Influence of quality of care and individual patient characteristics on quality of life and return to work in survivors of the acute respiratory distress syndrome: protocol for a prospective, observational, multi-centre patient cohort study (DACAPO).

    Science.gov (United States)

    Brandstetter, Susanne; Dodoo-Schittko, Frank; Blecha, Sebastian; Sebök, Philipp; Thomann-Hackner, Kathrin; Quintel, Michael; Weber-Carstens, Steffen; Bein, Thomas; Apfelbacher, Christian

    2015-12-17

    Health-related quality of life (HRQoL) and return to work are important outcomes in critical care medicine, reaching beyond mortality. Little is known on factors predictive of HRQoL and return to work in critical illness, including the acute respiratory distress syndrome (ARDS), and no evidence exists on the role of quality of care (QoC) for outcomes in survivors of ARDS. It is the aim of the DACAPO study ("Surviving ARDS: the influence of QoC and individual patient characteristics on quality of life") to investigate the role of QoC and individual patient characteristics on quality of life and return to work. A prospective, observational, multi-centre patient cohort study will be performed in Germany, using hospitals from the "ARDS Network Germany" as the main recruiting centres. It is envisaged to recruit 2400 patients into the DACAPO study and to analyse a study population of 1500 survivors. They will be followed up until 12 months after discharge from hospital. QoC will be assessed as process quality, structural quality and volume at the institutional level. The main outcomes (HRQoL and return to work) will be assessed by self-report questionnaires. Further data collection includes general medical and ARDS-related characteristics of patients as well as sociodemographic and psycho-social parameters. Multilevel hierarchical modelling will be performed to analyse the effects of QoC and individual patient characteristics on outcomes, taking the cluster structure of the data into account. By obtaining comprehensive data at patient and hospital level using a prospective multi-centre design, the DACAPO-study is the first study investigating the influence of QoC on individual outcomes of ARDS survivors.

  9. The group-based social skills training SOSTA-FRA in children and adolescents with high functioning autism spectrum disorder - study protocol of the randomised, multi-centre controlled SOSTA - net trial

    Directory of Open Access Journals (Sweden)

    Freitag Christine M

    2013-01-01

    Full Text Available Abstract Background Group-based social skills training (SST has repeatedly been recommended as treatment of choice in high-functioning autism spectrum disorder (HFASD. To date, no sufficiently powered randomised controlled trial has been performed to establish efficacy and safety of SST in children and adolescents with HFASD. In this randomised, multi-centre, controlled trial with 220 children and adolescents with HFASD it is hypothesized, that add-on group-based SST using the 12 weeks manualised SOSTA–FRA program will result in improved social responsiveness (measured by the parent rated social responsiveness scale, SRS compared to treatment as usual (TAU. It is further expected, that parent and self reported anxiety and depressive symptoms will decline and pro-social behaviour will increase in the treatment group. A neurophysiological study in the Frankfurt HFASD subgroup will be performed pre- and post treatment to assess changes in neural function induced by SST versus TAU. Methods/design The SOSTA – net trial is designed as a prospective, randomised, multi-centre, controlled trial with two parallel groups. The primary outcome is change in SRS score directly after the intervention and at 3 months follow-up. Several secondary outcome measures are also obtained. The target sample consists of 220 individuals with ASD, included at the six study centres. Discussion This study is currently one of the largest trials on SST in children and adolescents with HFASD worldwide. Compared to recent randomised controlled studies, our study shows several advantages with regard to in- and exclusion criteria, study methods, and the therapeutic approach chosen, which can be easily implemented in non-university-based clinical settings. Trial registration ISRCTN94863788 – SOSTA – net: Group-based social skills training in children and adolescents with high functioning autism spectrum disorder.

  10. The group-based social skills training SOSTA-FRA in children and adolescents with high functioning autism spectrum disorder--study protocol of the randomised, multi-centre controlled SOSTA--net trial.

    Science.gov (United States)

    Freitag, Christine M; Cholemkery, Hannah; Elsuni, Leyla; Kroeger, Anne K; Bender, Stephan; Kunz, Cornelia Ursula; Kieser, Meinhard

    2013-01-07

    Group-based social skills training (SST) has repeatedly been recommended as treatment of choice in high-functioning autism spectrum disorder (HFASD). To date, no sufficiently powered randomised controlled trial has been performed to establish efficacy and safety of SST in children and adolescents with HFASD. In this randomised, multi-centre, controlled trial with 220 children and adolescents with HFASD it is hypothesized, that add-on group-based SST using the 12 weeks manualised SOSTA-FRA program will result in improved social responsiveness (measured by the parent rated social responsiveness scale, SRS) compared to treatment as usual (TAU). It is further expected, that parent and self reported anxiety and depressive symptoms will decline and pro-social behaviour will increase in the treatment group. A neurophysiological study in the Frankfurt HFASD subgroup will be performed pre- and post treatment to assess changes in neural function induced by SST versus TAU. The SOSTA - net trial is designed as a prospective, randomised, multi-centre, controlled trial with two parallel groups. The primary outcome is change in SRS score directly after the intervention and at 3 months follow-up. Several secondary outcome measures are also obtained. The target sample consists of 220 individuals with ASD, included at the six study centres. This study is currently one of the largest trials on SST in children and adolescents with HFASD worldwide. Compared to recent randomised controlled studies, our study shows several advantages with regard to in- and exclusion criteria, study methods, and the therapeutic approach chosen, which can be easily implemented in non-university-based clinical settings. ISRCTN94863788--SOSTA--net: Group-based social skills training in children and adolescents with high functioning autism spectrum disorder.

  11. Assessment of data quality in a multi-centre cross-sectional study of participation and quality of life of children with cerebral palsy

    Directory of Open Access Journals (Sweden)

    Parkes Jackie

    2006-11-01

    Full Text Available Abstract Background SPARCLE is a cross-sectional survey in nine European regions, examining the relationship of the environment of children with cerebral palsy to their participation and quality of life. The objective of this report is to assess data quality, in particular heterogeneity between regions, family and item non-response and potential for bias. Methods 1,174 children aged 8–12 years were selected from eight population-based registers of children with cerebral palsy; one further centre recruited 75 children from multiple sources. Families were visited by trained researchers who administered psychometric questionnaires. Logistic regression was used to assess factors related to family non-response and self-completion of questionnaires by children. Results 431/1,174 (37% families identified from registers did not respond: 146 (12% were not traced; of the 1,028 traced families, 250 (24% declined to participate and 35 (3% were not approached. Families whose disabled children could walk unaided were more likely to decline to participate. 818 children entered the study of which 500 (61% self-reported their quality of life; children with low IQ, seizures or inability to walk were less likely to self-report. There was substantial heterogeneity between regions in response rates and socio-demographic characteristics of families but not in age or gender of children. Item non-response was 2% for children and ranged from 0.4% to 5% for questionnaires completed by parents. Conclusion While the proportion of untraced families was higher than in similar surveys, the refusal rate was comparable. To reduce bias, all analyses should allow for region, walking ability, age and socio-demographic characteristics. The 75 children in the region without a population based register are unlikely to introduce bias.

  12. Predictors of drop-out in a multi-centre longitudinal study of participation and quality of life of children with cerebral palsy

    Directory of Open Access Journals (Sweden)

    Dickinson Heather O

    2012-06-01

    Full Text Available Abstract Background SPARCLE is a study across nine European regions which examines the predictors of participation and quality of life of children with cerebral palsy. Children and their families were initially interviewed in 2004/2005 when the children were aged 8–12 years (SPARCLE1; they were approached again in 2009/2010 at age 13–17 years (SPARCLE2. The objective of this report is to assess potential for bias due to family non-response in SPARCLE2. Logistic regression was used to assess whether socio-demographic factors, parental stress and child impairment were related to non-response, both overall and by category (failure to trace families, death of child, traced families declining to participate. Results Of the 818 families who participated in SPARCLE1, 224/818 (27% did not participate in SPARCLE2. 51/818 (6% were not traced. Among the 767 traced families, 32/767 (4% children with cerebral palsy had died, seven children had been incorrectly diagnosed as having cerebral palsy, thirteen families had moved out of the region and one family had language problems. Of the remaining 714 families, 120/714 (17% declined to participate. Drop-out between SPARCLE1 and SPARCLE2 varied significantly between regions; families were more difficult to trace and more likely to decline to participate if the parents’ educational qualifications, as recorded in SPARCLE1, were lower; they were also more likely to decline to participate if SPARCLE1 recorded that they were more stressed or if they had not completed a SPARCLE1 stress questionnaire. Conclusions To reduce the risk of bias, all SPARCLE2 analyses should allow for factors (region and walking ability which determined the sampling strategy, either by adjusting for these factors or by using sampling weights. Further analyses should be performed, adjusting for additional factors that were associated with non-response: parents' educational qualifications, family structure and parental stress. To allow

  13. HIV testing in non-traditional settings--the HINTS study: a multi-centre observational study of feasibility and acceptability.

    Directory of Open Access Journals (Sweden)

    Michael Rayment

    Full Text Available BACKGROUND: UK guidelines recommend routine HIV testing in healthcare settings if the local diagnosed HIV prevalence >2/1000 persons. This prospective study assessed the feasibility and acceptability, to patients and staff, of routinely offering HIV tests in four settings: Emergency Department, Acute Care Unit, Dermatology Outpatients and Primary Care. Modelling suggested the estimated prevalence of undiagnosed HIV infection in attendees would exceed 1/1000 persons. The prevalence identified prospectively was not a primary outcome. METHODS: Permanent staff completed questionnaires assessing attitudes towards routine HIV testing in their workplace before testing began. Subsequently, over a three-month period, patients aged 16-65 were offered an HIV test by study staff. Demographics, uptake, results, and departmental activity were collected. Subsets of patients completed questionnaires. Analyses were conducted to identify factors associated with test uptake. FINDINGS: Questionnaires were received from 144 staff. 96% supported the expansion of HIV testing, but only 54% stated that they would feel comfortable delivering testing themselves, with 72% identifying a need for training. Of 6194 patients offered a test, 4105 (66·8% accepted (61·8-75·4% across sites. Eight individuals were diagnosed with HIV (0-10/1000 across sites and all transferred to care. Younger people, and males, were more likely to accept an HIV test. No significant associations were found between uptake and ethnicity, or clinical site. Questionnaires were returned from 1003 patients. The offer of an HIV test was acceptable to 92%. Of respondents, individuals who had never tested for HIV before were more likely to accept a test, but no association was found between test uptake and sexual orientation. CONCLUSIONS: HIV testing in these settings is acceptable, and operationally feasible. The strategy successfully identified, and transferred to care, HIV-positive individuals. However

  14. Comparative efficacy of a recombinant feline interferon omega in refractory cases of calicivirus-positive cats with caudal stomatitis: a randomised, multi-centre, controlled, double-blind study in 39 cats.

    Science.gov (United States)

    Hennet, Philippe R; Camy, Guy A L; McGahie, David M; Albouy, Maxime V

    2011-08-01

    Chronic caudal stomatitis with alveolar/buccal mucositis in calicivirus-positive cats is the most severe presentation of feline chronic gingivostomatitis. Refractory cases are helped by antibiotic and anti-inflammatory treatments often including glucocorticoids. In order to evaluate the comparative efficacy of oromucosal administration of recombinant feline interferon omega (rFeIFN-ω) versus oral administration of glucocorticoids, a randomised, multi-centre, controlled, double-blind study was performed in 39 cats. The progression of behavioural, clinical and lesional scores was assessed over 90 days. Daily oromucosal treatment with 0.1 MU of rFeIFN-ω was associated with a significant improvement of clinical lesions (caudal stomatitis and alveolar/buccal mucositis) and a decrease of pain scores from D0 to D90. Although no such statistical improvement was noticed in the prednisolone group, there was, however, no significant difference between the two groups for most of the parameters, except pain at D60 and D90.

  15. Skin autofluorescence and risk of micro- and macrovascular complications in patients with Type 2 diabetes mellitus-a multi-centre study

    NARCIS (Netherlands)

    Noordzij, M J; Mulder, D.J.; Oomen, P H N; Brouwer, T; Jager, J; Castro Cabezas, M; Lefrandt, J D; Smit, Andries

    2012-01-01

    AIMS: Skin autofluorescence is a non-invasive marker of advanced glycation end product accumulation. In a previous study, skin autofluorescence correlated with and predicted micro- and macrovascular complications in Type 2 diabetes in a primary care setting. The present cross-sectional study aims to

  16. Skin autofluorescence and risk of micro- and macrovascular complications in patients with Type 2 diabetes mellitus-a multi-centre study

    NARCIS (Netherlands)

    Noordzij, M J; Mulder, D.J.; Oomen, P H N; Brouwer, T; Jager, J; Castro Cabezas, M; Lefrandt, J D; Smit, Andries

    2012-01-01

    AIMS: Skin autofluorescence is a non-invasive marker of advanced glycation end product accumulation. In a previous study, skin autofluorescence correlated with and predicted micro- and macrovascular complications in Type 2 diabetes in a primary care setting. The present cross-sectional study aims to

  17. Determinants of rehabilitation outcome in geriatric patients admitted to skilled nursing facilities after stroke : a Dutch multi-centre cohort study

    NARCIS (Netherlands)

    Spruit-van Eijk, Monica; Zuidema, Sytse U.; Buijck, Bianca I.; Koopmans, Raymond T. C. M.; Geurts, Alexander C. H.

    2012-01-01

    Objective: to identify important demographic, clinical and functional determinants of successful discharge of geriatric patients from skilled nursing facilities (SNFs), particularly the role of multi-morbidity. Design: prospective cohort study with data collection at baseline and at discharge. Setti

  18. Determinants of rehabilitation outcome in geriatric patients admitted to skilled nursing facilities after stroke: a Dutch multi-centre cohort study

    NARCIS (Netherlands)

    Spruit-van Eijk, M.; Zuidema, S.U.; Buijck, B.I.; Koopmans, R.T.C.M.; Geurts, A.C.H.

    2012-01-01

    OBJECTIVE: to identify important demographic, clinical and functional determinants of successful discharge of geriatric patients from skilled nursing facilities (SNFs), particularly the role of multi-morbidity. DESIGN: prospective cohort study with data collection at baseline and at discharge. SETTI

  19. Pulmonary infection control window in treatment of severe respiratory failure of chronic obstructive pulmonary diseases: a prospective, randomized controlled, multi-centred study

    Institute of Scientific and Technical Information of China (English)

    Collaborating Research Group for Noninvasive Mecha

    2005-01-01

    Background Early withdraw from invasive mechanical ventilation (MV) followed by noninvasive MV is a new strategy for changing modes of treatment. This study was conducted to estimate the feasibility and the efficacy of early extubation and sequential noninvasive MV commenced at beginning of pulmonary infection control window in patients with exacerbated hypercapnic respiratory failure caused by chronic obstructive pulmonary diseases (COPD). Methods A prospective, randomized controlled study was conducted in eleven teaching hospitals' respiratory or medical intensive care units in China. Ninety intubated COPD patients with severe hypercapnic respiratory failure triggered by pulmonary infection (pneumonia or purulent bronchitis) were involved in the study. When the pulmonary infection had been controlled by antibiotics and comprehensive therapy, the "pulmonary infection control window (PIC window)" has been reached. Each case was randomly assigned to study group (extubation and noninvasive MV via facial mask immediately) or control group (invasive MV was received continuously after PIC window by using conventional weaning technique).Results Study group (n=47) and control group (n=43) had similar clinical characteristics initially and at the time of PIC window. Compared with control group, study group had shorter duration of invasive MV [(6.4±4.4) days vs (11.3±6.2) days, P=0.000], lower rate of ventilator associated pneumonia (VAP) (3/47 vs 12/43, P=0.014), fewer days in ICU [(12±8) days vs (16±11) days, P=0.047] and lower hospital mortality (1/47 vs 7/43, P=0.025).Conclusions In COPD patients requiring intubation and invasive MV for hypercapnic respiratory failure, which is exacerbated by pulmonary infection, early extubation followed by noninvasive MV initiated at the start of PIC window may decrease significantly the duration of invasive MV, the risk of VAP and hospital mortality.

  20. Assessment of data quality in a multi-centre cross-sectional study of participation and quality of life of children with cerebral palsy

    DEFF Research Database (Denmark)

    Dickinson, Heather; Parkinson, Kathryn; McManus, Vicki

    2006-01-01

    to participate and 35 (3%) were not approached. Families whose disabled children could walk unaided were more likely to decline to participate. 818 children entered the study of which 500 (61%) self-reported their quality of life; children with low IQ, seizures or inability to walk were less likely to self...

  1. Protocol of a randomised delayed-start double-blind placebo-controlled multi-centre trial for Levodopa in EArly Parkinson's disease: the LEAP-study

    NARCIS (Netherlands)

    Verschuur, C.V.; Suwijn, S.R.; Post, B.; Dijkgraaf, M.; Bloem, B.R.; Hilten, J.J. van; Laar, T. van; Tissingh, G.; Deuschl, G.; Lang, A.E.; Haan, R.J. de; Bie, R.M. de

    2015-01-01

    BACKGROUND: The aim of this study is to investigate if early treatment with levodopa has a beneficial disease modifying effect on Parkinson's disease (PD) symptoms and functional health, improves the ability to (maintain) work, and reduces the use of (informal) care, caregiver burden, and costs. Add

  2. MonitorNet: the Italian multi-centre observational study aimed at estimating the risk/benefit profile of biologic agents in real-world rheumatology practice.

    Science.gov (United States)

    Sfriso, P; Salaffi, F; Montecucco, C M; Bombardieri, S; Todesco, S

    2009-01-01

    MonitorNet is a database established by the Italian Society of Rheumatology (SIR) in January 2007 and funded by the Italian Medicines Agency (AIFA), for the active long-term follow-up of patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis treated with biologic agents. All hospital Rheumatology Units in Italy were invited to participate in a non-interventional, observational, epidemiological study. The study is conducted in a routine clinical setting (real-world practice) where biologics are prescribed on the basis of current recommendations. In this report we describe the design, methodology, and present preliminary data of the study. At the time of the analysis (April 2009) the database included 3510 patients: 2469 (70.3%) with established RA, 675 (19.2%) with PsA and 366 (10.4%) with AS. The cumulative follow up period was 8,787 patient-years (RA: 8,388, PsA: 157; AS: 242). There were 1,538 adverse events in 938 (26.7%) patients. Infections were recorded in 630 patients, skin-related adverse events in 142 and post-infusion reactions in 90. A total of 30 malignancies were reported. An interim analysis of efficacy was conducted on 2,148 RA patients. Seven hundred and thirty-one patients (35.8%) achieved EULAR remission (defined as DAS28<2.4). When assessed with the more restrictive CDAI and SDAI criteria, the frequency of remission was lower (17.9% and 14.7% respectively). Availability of funding for this study provided an opportunity to organize a collaborative national network of rheumatology clinics to develop a large multicentre observational study.

  3. A multi-centre phase 3 study comparing efficacy and safety of Bemfola® versus Gonal-f® in women undergoing ovarian stimulation for IVF

    DEFF Research Database (Denmark)

    Rettenbacher, M; Andersen, A N; Garcia-Velasco, J A

    2015-01-01

    injection (n = 372) showed Bemfola yielding similar efficacy and safety profiles to Gonal-f. Women aged 20-38 years of age were randomized 2:1 to receive a single, daily, subcutaneous 150 IU dose of either Bemfola or Gonal-f. This study tested equivalence in the number of retrieved oocytes using a pre...... pregnancy rate per embryo transfer in first and second cycles (Bemfola: 40.2% and 38.5%, respectively; Gonal-f: 48.2% and 27.8%, respectively). No difference in severe ovarian hyperstimulation syndrome was observed between treatment groups (Bemfola: 0.8%; Gonal-f: 0.8%). This study demonstrates similar...... clinical efficacy and safety profiles between Bemfola and Gonal-f, and suggests that Bemfola can be an appropriate alternative in ovarian stimulation protocols....

  4. The prevalence and management of heart failure in Dutch nursing homes; design of a multi-centre cross-sectional study

    Directory of Open Access Journals (Sweden)

    Daamen Mariëlle AMJ

    2012-06-01

    Full Text Available Abstract Background Heart failure is likely to be particularly prevalent in the nursing home population, but reliable data about the prevalence of heart failure in nursing homes are lacking. Therefore the aims of this study are to investigate (a the prevalence and management of heart failure in nursing home residents and (b the relation between heart failure and care dependency as well as heart failure and quality of life in nursing home residents. Methods/design Nursing home residents in the southern part of the Netherlands, aged over 65 years and receiving long-term somatic or psychogeriatric care will be included in the study. A panel of two cardiologists and a geriatrician will diagnose heart failure based on data collected from actual clinical examinations (including history, physical examination, ECG, cardiac markers and echocardiography, patient records and questionnaires. Care dependency will be measured using the Care Dependency Scale. To measure the quality of life of the participating residents, the Qualidem will be used for psychogeriatric residents and the SF-12 and VAS for somatic residents. Conclusion The study will provide an insight into the actual prevalence and management of heart failure in nursing home residents as well as their quality of life and care dependency. Trial registration Dutch trial register NTR2663

  5. Development of a competency-based formative progress test with student-generated MCQs: Results from a multi-centre pilot study

    Directory of Open Access Journals (Sweden)

    Wagener, Stefan

    2015-10-01

    Full Text Available Introduction: Progress tests provide students feedback on their level of proficiency over the course of their medical studies. Peer-assisted learning and competency-based education have become increasingly important in medical education. Although progress tests have been proven to be useful as a longitudinal feedback instrument, there are currently no progress tests that have been created in cooperation with students or that focus on competency in medical education.In this study, we investigated the extent to which students can be included in the development of a progress test and demonstrated that aspects of knowledge related to competency can be represented on a competency-based progress test.Methods: A two-dimensional blueprint for 144 multiple-choice questions (MCQs covering groups of medical subjects and groups of competency areas was generated by three expert groups for developing the competency-based progress test. A total of 31 students from seven medical schools in Germany actively participated in this exercise. After completing an intensive and comprehensive training programme, the students generated and reviewed the test questions for the competency-based progress test using a separate platform of the ItemManagementSystem (IMS. This test was administered as a formative test to 469 students in a pilot study in November 2013 at eight medical schools in Germany. The scores were analysed for the overall test and differentiated according to the subject groups and competency areas.Results: A pool of more than 200 MCQs was compiled by the students for pilot use, of which 118 student-generated MCQs were used in the progress test. University instructors supplemented this pool with 26 MCQs, which primarily addressed the area of scientific skills. The post-review showed that student-generated MCQs were of high quality with regard to test statistic criteria and content. Overall, the progress test displayed a very high reliability. When the

  6. A multi-centre retrospective study of mandibular fractures: do occlusal support and the mandibular third molar affect mandibular angle and condylar fractures?

    Science.gov (United States)

    Hasegawa, T; Sadakane, H; Kobayashi, M; Tachibana, A; Oko, T; Ishida, Y; Fujita, T; Takenono, I; Komatsubara, H; Takeuchi, J; Ichiki, K; Miyai, D; Komori, T

    2016-09-01

    This retrospective study was performed to investigate the influence of occlusal support and the presence, state, and position of mandibular third molars on the incidence of mandibular angle and condylar fractures. The following variables were investigated: age, sex, cause of fracture, presence and state (impaction, angulation, and the number of roots) of the mandibular third molars, site of the mandibular fracture, presence of occlusal support, duration of intermaxillary fixation, and postoperative complications. Various risk factors for mandibular angle and condylar fractures were investigated by univariate analysis. The risk of mandibular angle fracture was significantly higher in patients with occlusal support and mandibular third molars. The risk of condylar fracture was significantly higher in patients without occlusal support or mandibular third molars. The position and angulation of the mandibular third molars were not significant risk factors in mandibular angle and condylar fractures. This study demonstrated the influence of occlusal support and the presence of mandibular third molars on the incidence of mandibular angle and condylar fractures. The presence of occlusal support may be a more important factor affecting mandibular angle or condylar fractures than the position of the mandibular third molars.

  7. Factors associated with intimate partner violence against women in a mega city of South-Asia: multi-centre cross-sectional study.

    Science.gov (United States)

    Ali, Niloufer S; Ali, Farzana N; Khuwaja, Ali K; Nanji, Kashmira

    2014-08-01

    OBJECTIVES. To assess the proportion of women subjected to intimate partner violence and the associated factors, and to identify the attitudes of women towards the use of violence by their husbands. DESIGN. Cross-sectional study. SETTING. Family practice clinics at a teaching hospital in Karachi, Pakistan. PARTICIPANTS. A total of 520 women aged between 16 and 60 years were consecutively approached to participate in the study and interviewed by trained data collectors. Overall, 401 completed questionnaires were available for analysis. Multivariate logistic regression analysis was used to identify the association of various factors of interest. RESULTS. In all, 35% of the women reported being physically abused by their husbands in the last 12 months. Multivariate analysis showed that experiences of violence were independently associated with women's illiteracy (adjusted odds ratio=5.9; 95% confidence interval, 1.8-19.6), husband's illiteracy (3.9; 1.4-10.7), smoking habit of husbands (3.3; 1.9-5.8), and substance use (3.1; 1.7-5.7). CONCLUSION. It is imperative that intimate partner violence be considered a major public health concern. It can be prevented through comprehensive, multifaceted, and integrated approaches. The role of education is greatly emphasised in changing the perspectives of individuals and societies against intimate partner violence.

  8. The Prevalence and Characteristics of Primary Headache and Dream-Enacting Behaviour in Japanese Patients with Narcolepsy or Idiopathic Hypersomnia: A Multi-Centre Cross-Sectional Study.

    Science.gov (United States)

    Suzuki, Keisuke; Miyamoto, Masayuki; Miyamoto, Tomoyuki; Inoue, Yuichi; Matsui, Kentaro; Nishida, Shingo; Hayashida, Kenichi; Usui, Akira; Ueki, Yoichiro; Nakamura, Masaki; Murata, Momoyo; Numao, Ayaka; Watanabe, Yuji; Suzuki, Shiho; Hirata, Koichi

    2015-01-01

    Because the prevalence and characteristics of primary headache have yet to be thoroughly studied in patients with hypersomnia disorders, including narcolepsy and idiopathic hypersomnia, we examined these parameters in the Japanese population. In a multicentre cross-sectional survey, among 576 consecutive outpatients with sleep disorders, 68 narcolepsy patients and 35 idiopathic hypersomnia patients were included. Additionally, 61 healthy control subjects participated. Semi-structured headache questionnaires were administered to all participants. The patients with narcolepsy (52.9%) and idiopathic hypersomnia (77.1%) more frequently experienced headache than the healthy controls (24.6%; pnarcolepsy patients, the idiopathic hypersomnia patients and the control subjects, respectively. Those who experienced migraine more frequently experienced excessive daytime sleepiness, defined as an Epworth Sleepiness Scale score of ≥10, than those who did not experience headache among the patients with narcolepsy (93.8% vs. 65.6%, p = 0.040) and idiopathic hypersomnia (86.7% vs. 37.5%, p = 0.026). Dream-enacting behaviour (DEB), as evaluated by the rapid eye movement sleep disorders questionnaire, was more frequently observed in the narcolepsy patients than in the idiopathic hypersomnia patients and the control subjects. An increased DEB frequency was observed in the narcolepsy patients with migraines compared to those without headache. Migraines were frequently observed in patients with narcolepsy and idiopathic hypersomnia. DEB is a characteristic of narcolepsy patients. Further studies are required to assess the factors that contribute to migraines in narcolepsy and idiopathic hypersomnia patients.

  9. The effects of living distantly from peritoneal dialysis units on peritonitis risk, microbiology, treatment and outcomes: a multi-centre registry study

    Directory of Open Access Journals (Sweden)

    Cho Yeoungjee

    2012-06-01

    Full Text Available Abstract Background The aim of the study was to determine whether distance between residence and peritoneal dialysis (PD unit influenced peritonitis occurrence, microbiology, treatment and outcomes. Methods The study included all patients receiving PD between 1/10/2003 and 31/12/2008, using ANZDATA Registry data. Results 365 (6% patients lived ≥100 km from their nearest PD unit (distant group, while 6183 (94% lived S. aureus peritonitis (adjusted odds ratio [OR] 1.64, 95% CI 1.09-2.47. Distant patients with first peritonitis episodes were less likely to be hospitalised (64% vs 73%, p = 0.008 and receive antifungal prophylaxis (4% vs 10%, p = 0.01, but more likely to receive vancomycin-based antibiotic regimens (52% vs 42%, p  Conclusions Living ≥100 km away from a PD unit was associated with increased risk of S. aureus peritonitis, modified approaches to peritonitis treatment and peritonitis outcomes that were comparable to, or better than patients living closer to a PD unit. Staphylococcal decolonisation should receive particular consideration in remote living patients.

  10. The effects of living distantly from peritoneal dialysis units on peritonitis risk, microbiology, treatment and outcomes: a multi-centre registry study

    Science.gov (United States)

    2012-01-01

    Background The aim of the study was to determine whether distance between residence and peritoneal dialysis (PD) unit influenced peritonitis occurrence, microbiology, treatment and outcomes. Methods The study included all patients receiving PD between 1/10/2003 and 31/12/2008, using ANZDATA Registry data. Results 365 (6%) patients lived ≥100 km from their nearest PD unit (distant group), while 6183 (94%) lived peritonitis in distant patients (1.34 years, 95% CI 1.07-1.61) was significantly shorter than in local patients (1.68 years, 95% CI 1.59-1.77, p = 0.001), whilst overall peritonitis rates were higher in distant patients (incidence rate ratio 1.32, 95% CI 1.20-1.46). Living ≥100 km away from a PD unit was independently associated with a higher risk of S. aureus peritonitis (adjusted odds ratio [OR] 1.64, 95% CI 1.09-2.47). Distant patients with first peritonitis episodes were less likely to be hospitalised (64% vs 73%, p = 0.008) and receive antifungal prophylaxis (4% vs 10%, p = 0.01), but more likely to receive vancomycin-based antibiotic regimens (52% vs 42%, p peritonitis outcomes, distant patients were more likely to be cured with antibiotics alone (OR 1.55, 95% CI 1.03-2.24). All other outcomes were comparable between the two groups. Conclusions Living ≥100 km away from a PD unit was associated with increased risk of S. aureus peritonitis, modified approaches to peritonitis treatment and peritonitis outcomes that were comparable to, or better than patients living closer to a PD unit. Staphylococcal decolonisation should receive particular consideration in remote living patients. PMID:22702659

  11. The effect of using NHS number as the unique identifier for patients who self-harm: a multi-centre descriptive study

    Directory of Open Access Journals (Sweden)

    Lilley Rachael

    2007-09-01

    Full Text Available Abstract Background Processing personal data for research purposes and the requirement of anonymity has been the subject of recent debate. We aimed to determine the proportion of individuals who present to emergency departments with non-fatal suicidal behavior where an NHS number has been successfully traced and to investigate the characteristics of patients associated with non-capture. Method This was a descriptive study of people attending after self-harm using allocation of NHS numbers as main outcome measurement. Data from the Multicentre Monitoring of Self-Harm Project from 3 centres in England were used to identify consecutive patients (N = 3000 who were treated in six emergency departments in Oxford, Manchester and Leeds in 2004 and 2005 following self-harm. Results NHS number was available between 55–73% of individuals across centres. Characteristics associated with non-recording of NHS number in more than one centre included those from ethnic minority groups (Oxford: chi-squared statistic = 13.6, df = 3, p = 0.004; Manchester: chi-squared statistic = 13.6, df = 3, p ≤0.001 and the homeless or living in a hostel or other institution (Oxford: chi-squared statistic = 40.9, df = 7, p = Conclusion Basing research studies on NHS number as the unique identifier, as suggested by the Data Protection Act 1998 and the Patient Information Advisory Group, would exclude some of the most vulnerable groups for further self-harm or suicide. This bias may also affect other research registers.

  12. Tumor biology in older breast cancer patients--what is the impact on survival stratified for guideline adherence? A retrospective multi-centre cohort study of 5378 patients.

    Science.gov (United States)

    Ebner, Florian; van Ewijk, Reyn; Wöckel, Achim; Hancke, Katharina; Schwentner, Lukas; Fink, Visnja; Kreienberg, Rolf; Janni, Wolfgang; Blettner, Maria

    2015-06-01

    The tumor biology of older breast cancer patients (oBCP) is usually less aggressive, however applied adjuvant treatment is often less potent resulting in an impaired disease free survival and overall survival in this group. This study tries to answer the following questions for the biological subtypes of oBCP (70+ y): Between 1992 and 2008 the BRENDA ('BRENDA' = quality of BREast caNcer care unDer evidence-bAsed guidelines) study group recorded medical data of 17 participating certified breast cancer centers in Germany. We performed a retrospective multi-center database analysis of 5632 patient records. Guideline-adherent-treatment (GL+) of oBCP(n = 1918) was compared to GL+ of yBCP(n = 3714). OBCP were more likely to have hormone receptor positive (HR+) and HER2neu negative (HER2-) breast cancer (77.5% vs 74.5%). The rate of GL- was significantly different (p < 0.001) between the age groups and the biological subgroups (yBCP vs oBCP: 21.8%vs38.8% (HR+/HER2-); 30.6%vs49.7% (HR+/HER2+); 23.6%vs69.5% (HR-/HER2+); 31.4%vs67.8% (TNBC)). The survival parameters for HR+/HER2- and TNBC were significantly worse in case of GL- regarding chemotherapy, and if applicable endocrine therapy. A similar association only existed in HR-/HER2+ tumors for GL- for radiotherapy and in HR+/HER2+ tumors for chemotherapy. Beside the significantly different distribution of biological subtypes in the age groups there is an association between biological subtype, and GL+ influencing survival parameters in oBCP. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. The Prevalence and Characteristics of Primary Headache and Dream-Enacting Behaviour in Japanese Patients with Narcolepsy or Idiopathic Hypersomnia: A Multi-Centre Cross-Sectional Study.

    Directory of Open Access Journals (Sweden)

    Keisuke Suzuki

    Full Text Available Because the prevalence and characteristics of primary headache have yet to be thoroughly studied in patients with hypersomnia disorders, including narcolepsy and idiopathic hypersomnia, we examined these parameters in the Japanese population.In a multicentre cross-sectional survey, among 576 consecutive outpatients with sleep disorders, 68 narcolepsy patients and 35 idiopathic hypersomnia patients were included. Additionally, 61 healthy control subjects participated. Semi-structured headache questionnaires were administered to all participants.The patients with narcolepsy (52.9% and idiopathic hypersomnia (77.1% more frequently experienced headache than the healthy controls (24.6%; p<0.0001. The prevalence rates were 23.5%, 41.2% and 4.9% for migraine (p<0.0001 and 16.2%, 23.5% and 14.8% (p = 0.58 for tension-type headache among the narcolepsy patients, the idiopathic hypersomnia patients and the control subjects, respectively. Those who experienced migraine more frequently experienced excessive daytime sleepiness, defined as an Epworth Sleepiness Scale score of ≥10, than those who did not experience headache among the patients with narcolepsy (93.8% vs. 65.6%, p = 0.040 and idiopathic hypersomnia (86.7% vs. 37.5%, p = 0.026. Dream-enacting behaviour (DEB, as evaluated by the rapid eye movement sleep disorders questionnaire, was more frequently observed in the narcolepsy patients than in the idiopathic hypersomnia patients and the control subjects. An increased DEB frequency was observed in the narcolepsy patients with migraines compared to those without headache.Migraines were frequently observed in patients with narcolepsy and idiopathic hypersomnia. DEB is a characteristic of narcolepsy patients. Further studies are required to assess the factors that contribute to migraines in narcolepsy and idiopathic hypersomnia patients.

  14. A comparative evaluation of dimensional stability of three types of interocclusal recording materials-an in-vitro multi-centre study

    Directory of Open Access Journals (Sweden)

    Tejo Sampath

    2012-10-01

    Full Text Available Abstract Background The introduction of different interocclusal recording materials has put clinicians in dilemma that which material should be used in routine clinical practice for precise recording and transferring of accurate existing occlusal records for articulation of patient’s diagnostic or working casts in the fabrication of good satisfactory prosthesis. In the era of developing world of dentistry the different materials are introduced for interocclusal record with different brand names because of this; the utility of the material is confusing for successful delivery of prosthesis with lack of in vitro or in vivo studies which will predict the property of the material with utility recommendations. Purpose of the study The aim of this multicenter research is to evaluate the time dependent linear dimensional stability of three types of interocclusal recording materials; which gives very clear idea to clinicians in regard to its usage in routine practice and recommendations for usage of the different materials. Also to find out ideal time for articulation of three types of interocclusal recording materials with accuracy. Materials and method Commercially available and ADA approved Polyether bite registration paste (Ramitec, Poly vinyl siloxane bite registration paste (Jetbite and Zinc oxide eugenol (ZOE bite registration paste (Super bite were used in the study. A stainless steel die was made according to modified American dental Associations (ADA specification no. 19. Each one of the tested materials were manipulated according to manufacturers’ instructions. The materials separated from die, 3-mins after their respective setting time, resulted in disks of standard diameter. Two parallel lines and three perpendicular lines reproduced on the surface. The distance between two parallel lines was measured at different time intervals i.e. 1 hour, 24, 48 and 72 hours by using travelling microscope (magnus and compared with standard die

  15. The Effect of Vaginal Oestriol Cream on Subjective and Objective Symptoms of Stress Urinary Incontinence and Vaginal Atrophy: An International Multi-Centre Pilot Study.

    Science.gov (United States)

    Weber, Maaike A; Lim, Veronica; Oryszczyn, Josephine; Te West, Nevine; Souget, Judith; Jeffery, Stephen; Roovers, Jan Paul W R; Moore, Kate H

    2017-01-01

    Subjectively and objectively assess stress urinary incontinence (SUI) symptoms before and after topical oestrogen therapy. A prospective study was performed in 3 centres in South-Africa, Australia and the Netherlands. Postmenopausal women with SUI were treated with topical oestriol cream for 6 weeks. The primary subjective outcome was the Patient's Global Impression of Improvement (PGI-I) scale. The primary objective outcome was vaginal pH. Secondary subjective outcomes were: the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form, the Incontinence Impact Questionnaire, the Urogenital Distress Inventory (UDI-6) and the most bothersome symptom approach. Secondary objective outcome was the erect cough pad test. Compliance was scored. A total of 68 women were enrolled. Half of the participants reported improvement on the PGI-I scale after treatment. Vaginal pH was significantly lower after treatment (median 5.3 (interquartile range (IQR) 4.5-6.0) vs. 5.0 (4.4-5.4), p = 0.002). Improvement on the UDI stress domain was observed (p = 0.01). No statistically significant differences were found in the other subjective outcomes. Baseline and repeat cough pad tests demonstrated a wide variation with no significant difference. Compliance was high (median 100 (IQR 83-100%)). Topical oestriol cream during 6 weeks improved quality of life and vaginal pH but no other objective measures of incontinence. © 2016 The Author(s) Published by S. Karger AG, Basel.

  16. A comparative evaluation of dimensional stability of three types of interocclusal recording materials-an in-vitro multi-centre study.

    Science.gov (United States)

    Tejo, Sampath Kumar; Kumar, Anil G; Kattimani, Vivekanand S; Desai, Priti D; Nalla, Sandeep; Chaitanya K, Krishna

    2012-10-05

    The introduction of different interocclusal recording materials has put clinicians in dilemma that which material should be used in routine clinical practice for precise recording and transferring of accurate existing occlusal records for articulation of patient's diagnostic or working casts in the fabrication of good satisfactory prosthesis. In the era of developing world of dentistry the different materials are introduced for interocclusal record with different brand names because of this; the utility of the material is confusing for successful delivery of prosthesis with lack of in vitro or in vivo studies which will predict the property of the material with utility recommendations. The aim of this multicenter research is to evaluate the time dependent linear dimensional stability of three types of interocclusal recording materials; which gives very clear idea to clinicians in regard to its usage in routine practice and recommendations for usage of the different materials. Also to find out ideal time for articulation of three types of interocclusal recording materials with accuracy. Commercially available and ADA approved Polyether bite registration paste (Ramitec), Poly vinyl siloxane bite registration paste (Jetbite) and Zinc oxide eugenol (ZOE) bite registration paste (Super bite) were used in the study.A stainless steel die was made according to modified American dental Associations (ADA) specification no. 19. Each one of the tested materials were manipulated according to manufacturers' instructions. The materials separated from die, 3-mins after their respective setting time, resulted in disks of standard diameter. Two parallel lines and three perpendicular lines reproduced on the surface. The distance between two parallel lines was measured at different time intervals i.e. 1 hour, 24, 48 and 72 hours by using travelling microscope (magnus) and compared with standard die measurements made according to ADA specification no.19 to find out the dimensional

  17. Determinants of microvascular damage recovery after acute myocardial infarction: results from the acute myocardial infarction contrast imaging (AMICI) multi-centre study.

    Science.gov (United States)

    Funaro, Stefania; Galiuto, Leonarda; Boccalini, Francesca; Cimino, Sara; Canali, Emanuele; Evangelio, Francesca; DeLuca, Laura; Paraggio, Lazzaro; Mattatelli, Antonella; Gnessi, Lucio; Agati, Luciano

    2011-04-01

    Microvascular damage (MD) occurring soon after primary percutaneous coronary intervention (PPCI) may reverse or remain sustained within the first week after ST-elevation myocardial infarction (STEMI). We investigated the incidence, determinants, and long-term clinical relevance of MD reversal after PPCI. Serial two-dimensional echocardiograms (2DE) and a myocardial contrast study were obtained within 24 h of PPCI (T1) and at pre-discharge (T2) in 110 successfully re-perfused STEMI patients. Six months 2DE and 2-year clinical follow-up were obtained. After PPCI myocardial re-perfusion was normal at T1 only in 40 patients (36%, 'normal reflow'), recovered at T2 in 33 (30%, 'reversible MD'), and remained abnormal in 37 (34%, 'sustained MD'). At follow-up, normal reflow and reversible MD were coupled with a significant reduction in the infarct area, decrease in cardiac volumes, and a slight non-significant improvement in systolic function. Conversely, in the sustained MD group, the infarct area did not change and cardiac volumes significantly increased with a parallel worsening in systolic function. By multivariate analysis, independent predictors of reversible MD were: absence of family history of coronary artery disease (CAD), younger age, shorter time to re-perfusion, and absence of diabetes. The 2-year combined events rate was significantly lower in reversible MD (log-rank test P= 0.03) compared with sustained MD patients. In STEMI patients treated according to the current guidelines, MD frequently occurs soon after re-perfusion but it is reversible in ~50% of cases and it is associated with a favourable functional and clinical outcome. Family history of CAD, aging, time to re-perfusion, and diabetes are independent predictors of MD reversibility.

  18. Clinical profile and predictors of mortality of severe pandemic (H1N1 2009 virus infection needing intensive care: A multi-centre prospective study from South India

    Directory of Open Access Journals (Sweden)

    Kartik Ramakrishna

    2012-01-01

    Full Text Available Background: This multi-center study from India details the profile and outcomes of patients admitted to the intensive care unit (ICU with pandemic Influenza A (H1N1 2009 virus [P(H1N12009v] infection. Materials and Methods: Over 4 months, adult patients diagnosed to have P(H1N12009v infection by real-time RT-PCR of respiratory specimens and requiring ICU admission were followed up until death or hospital discharge. Sequential organ failure assessment (SOFA scores were calculated daily. Results: Of the 1902 patients screened, 464 (24.4% tested positive for P(H1N12009v; 106 (22.8% patients aged 35±11.9 (mean±SD years required ICU admission 5.8±2.7 days after onset of illness. Common symptoms were fever (96.2%, cough (88.7%, and breathlessness (85.9%. The admission APACHE-II and SOFA scores were 14.4±6.5 and 5.5±3.1, respectively. Ninety-six (90.6% patients required ventilation for 10.1±7.5 days. Of these, 34/96 (35.4% were non-invasively ventilated; 16/34 were weaned successfully whilst 18/34 required intubation. Sixteen patients (15.1% needed dialysis. The duration of hospitalization was 14.0±8.0 days. Hospital mortality was 49%. Mortality in pregnant/puerperal women was 52.6% (10/19. Patients requiring invasive ventilation at admission had a higher mortality than those managed with non-invasive ventilation and those not requiring ventilation (44/62 vs. 8/44, P<0.001. Need for dialysis was independently associated with mortality (P=0.019. Although admission APACHE-II and SOFA scores were significantly (P<0.02 higher in non-survivors compared with survivors on univariate analysis, individually, neither were predictive on multivariate analysis. Conclusions: In our setting, a high mortality was observed in patients admitted to ICU with severe P(H1N12009v infection. The need for invasive ventilation and dialysis were associated with a poor outcome.

  19. Robust Reference Intervals for Serum Kappa and Lambda Free Light Chains from a Multi Centre Study Population from Hyderabad, India: Myeloma Diagnostic Implications.

    Science.gov (United States)

    Mohammed, Noorjahan; Chandran, Priscilla Abraham; Kandregula, Madhavi; Mattaparthi, Ratna Deepika; Gundeti, Sadasivudu; Volturi, Jyotsna; Darapuneni, Radhika; Raju, Sree Bhushan; Dattatreya, Palanki Satya

    2016-01-01

    The International Myeloma Working Group considers the serum free light chain (SFLC) assay to be an adjunct to traditional tests. Apart from the FLC ratio, the absolute values of individual free light chains also are gaining importance as they appear to be more relevant in certain clinical settings. Automated assays are available for their determination. As laboratories put new test systems into use catering to different disease populations, they are required by accreditation and certification bodies to verify or establish performance specifications, including reference intervals (RIs) representative of their population. Our aim was to establish local RIs for SFLC in a multicentre representative healthy population using a robust method. There was no significant relationship between SFLC levels and age, gender and creatinine levels. The 95% RI for κSFLC was 4.81 to 33.86mg/L, for ? SFLC was 5.19 to 23.67mg/L and for κ/?SFLC was 0.36 to 2.33, significantly higher than the values given by the manufacturer. The κ/? SFLC ratio at 2.23, covering 100% of the data, showed 72% sensitivity (95% CI=39.0 - 94.0), 100% specificity (95% CI=71.5 - 100.0), 100% PPV (95% CI=21.5 - 100.0), 95% NPV (95% CI=75.4 - 99.9), and 79% accuracy (95% CI=56.0 - 93.0). In the patient group, kit RI for κ /? SFLC ratio classified 45.5% (n=5) as positive vs 9.1% (n=1) positive by the study RI, while the kit RI for kappa FLC classified 90.9% (n=10) as positive vs 54.5% (n=6) , indicating increased probability of false positive test results with the kit RI when applied to our patient population. Appropriate and specific reference intervals and criteria values result in fewer false-positive and false-negative results which means fewer wrong or missed diagnoses.

  20. The social and economic burden of stroke survivors in Italy: a prospective, incidence-based, multi-centre cost of illness study

    Directory of Open Access Journals (Sweden)

    Fattore Giovanni

    2012-11-01

    Full Text Available Abstract Background The aim of this study was to estimate the one-year societal costs due to a stroke event in Italy and to investigate variables associated with costs in different phases following hospital admission. Methods The patients were enrolled in 44 hospitals across the country and data on socio-demographic, clinical variables and resource consumption were prospectively surveyed for 411 stroke survivors at admission, discharge and 3, 6 and 12 months post the event. We adopted a micro-costing procedure to identify cost generating components and the attribution of appropriate unit costs for three cost categories: direct healthcare, direct non-healthcare (including informal care costs and productivity losses. The relation between costs of stroke management and socio-demographic and clinical characteristics as well as disability levels was evaluated in a series of bivariate analyses using non parametric tests (Mann Whitney and Kruskal-Wallis. Multiple linear regression analyses were performed to determine predictors of costs incurred by stroke patients during the acute phase and follow-up of 1 year. Results On average, one-year healthcare and societal costs amounted to €11,747 and € 19,953 per stroke survivor, respectively. The major cost component of societal costs was informal care accounting for € 6,656 (33.4% of total, followed by the initial hospitalisation, (€ 5,573; 27.9% of total, rehabilitation during follow up (€ 4,112; 20.6 %, readmissions (€ 439 and specialist and general practioner visits (€ 326. Mean drug costs per patient over the follow-up period was about € 50 per month. Costs associated to the provision of paid and informal care followed different pattern and were persistent over time (ranging from € 639 to € 597 per month in the first and the second part of the year, respectively. Clinical variables (presence of diabetes mellitus and hemorrhagic stroke were significant predictors of total healthcare

  1. Prevalence and correlates of achieving recommended physical activity levels among children living in rural South Asia-A multi-centre study.

    Science.gov (United States)

    Shridhar, Krithiga; Millett, Christopher; Laverty, Anthony A; Alam, Dewan; Dias, Amit; Williams, Joseph; Dhillon, Preet K

    2016-08-02

    We report the prevalence of recommended physical activity levels (RPALs) and examine the correlates of achieving RPALs in rural South Asian children and analyse its association with anthropometric outcomes. This analysis on rural South Asian children aged 5-14 years (n = 564) is a part of the Chronic Disease Risk Factor study conducted at three sites in India (Chennai n = 146; Goa n = 218) and Bangladesh (Matlab; n = 200). Data on socio-demographic and lifestyle factors (physical activity (PA); diet) were collected using an interviewer-administered questionnaires, along with objective anthropometric measurements. Multivariate logistic regression models were used to examine whether RPALs (active travel to school (yes/no); leisure-time PA ≥ 1 h/day; sedentary-activity ≤ 2 h/day) were associated with socio-demographic factors, diet and other forms of PA. Multivariate linear regression models were used to investigate associations between RPALs and anthropometrics (BMI- and waist z-scores). The majority of children (71.8 %) belonged to households where a parent had at least a secondary education. Two-thirds (66.7 %) actively travelled to school; 74.6 % reported ≥1 h/day of leisure-time PA and 55.7 % had ≤2 h/day of sedentary-activity; 25.2 % of children reported RPALs in all three dimensions. Older (10-14 years, OR = 2.0; 95 % CI: 1.3, 3.0) and female (OR = 1.7; 95 % CI: 1.1, 2.5) children were more likely to travel actively to school. Leisure-time PA ≥ 1 h/day was more common among boys (OR = 2.5; 95 % CI: 1.5, 4.0), children in Matlab, Bangladesh (OR = 3.0; 95 % CI: 1.6, 5.5), and those with higher processed-food consumption (OR = 2.3; 95 % CI: 1.2, 4.1). Sedentary activity ≤ 2 h/day was associated with younger children (5-9 years, OR = 1.6; 95 % CI: 1.1, 2.4), children of Goa (OR = 3.5; 95 % CI: 2.1, 6.1) and Chennai (OR = 2.5; 95 % CI: 1.5, 4.3) and low household education

  2. Study Protocol. IDUS – Instrumental delivery & ultrasound. A multi-centre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at instrumental delivery

    Science.gov (United States)

    2012-01-01

    Background Instrumental deliveries are commonly performed in the United Kingdom and Ireland, with rates of 12 – 17% in most centres. Knowing the exact position of the fetal head is a pre-requisite for safe instrumental delivery. Traditionally, diagnosis of the fetal head position is made on transvaginal digital examination by delineating the suture lines of the fetal skull and the fontanelles. However, the accuracy of transvaginal digital examination can be unreliable and varies between 20% and 75%. Failure to identify the correct fetal head position increases the likelihood of failed instrumental delivery with the additional morbidity of sequential use of instruments or second stage caesarean section. The use of ultrasound in determining the position of the fetal head has been explored but is not part of routine clinical practice. Methods/Design A multi-centre randomised controlled trial is proposed. The study will take place in two large maternity units in Ireland with a combined annual birth rate of 13,500 deliveries. It will involve 450 nulliparous women undergoing instrumental delivery after 37 weeks gestation. The main outcome measure will be incorrect diagnosis of the fetal head position. A study involving 450 women will have 80% power to detect a 10% difference in the incidence of inaccurate diagnosis of the fetal head position with two-sided 5% alpha. Discussion It is both important and timely to evaluate the use of ultrasound to diagnose the fetal head position prior to instrumental delivery before routine use can be advocated. The overall aim is to reduce the incidence of incorrect diagnosis of the fetal head position prior to instrumental delivery and improve the safety of instrumental deliveries. Trial registration Current Controlled Trials ISRCTN72230496 PMID:22970933

  3. Study Protocol. IDUS – Instrumental delivery & ultrasound. A multi-centre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at instrumental delivery

    Directory of Open Access Journals (Sweden)

    Murphy Deirdre J

    2012-09-01

    Full Text Available Abstract Background Instrumental deliveries are commonly performed in the United Kingdom and Ireland, with rates of 12 – 17% in most centres. Knowing the exact position of the fetal head is a pre-requisite for safe instrumental delivery. Traditionally, diagnosis of the fetal head position is made on transvaginal digital examination by delineating the suture lines of the fetal skull and the fontanelles. However, the accuracy of transvaginal digital examination can be unreliable and varies between 20% and 75%. Failure to identify the correct fetal head position increases the likelihood of failed instrumental delivery with the additional morbidity of sequential use of instruments or second stage caesarean section. The use of ultrasound in determining the position of the fetal head has been explored but is not part of routine clinical practice. Methods/Design A multi-centre randomised controlled trial is proposed. The study will take place in two large maternity units in Ireland with a combined annual birth rate of 13,500 deliveries. It will involve 450 nulliparous women undergoing instrumental delivery after 37 weeks gestation. The main outcome measure will be incorrect diagnosis of the fetal head position. A study involving 450 women will have 80% power to detect a 10% difference in the incidence of inaccurate diagnosis of the fetal head position with two-sided 5% alpha. Discussion It is both important and timely to evaluate the use of ultrasound to diagnose the fetal head position prior to instrumental delivery before routine use can be advocated. The overall aim is to reduce the incidence of incorrect diagnosis of the fetal head position prior to instrumental delivery and improve the safety of instrumental deliveries. Trial registration Current Controlled Trials ISRCTN72230496

  4. Study Protocol. IDUS -- Instrumental delivery & ultrasound. A multi-centre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at instrumental delivery

    LENUS (Irish Health Repository)

    Murphy, Deirdre J

    2012-09-13

    AbstractBackgroundInstrumental deliveries are commonly performed in the United Kingdom and Ireland, with rates of 12 – 17% in most centres. Knowing the exact position of the fetal head is a pre-requisite for safe instrumental delivery. Traditionally, diagnosis of the fetal head position is made on transvaginal digital examination by delineating the suture lines of the fetal skull and the fontanelles. However, the accuracy of transvaginal digital examination can be unreliable and varies between 20% and 75%. Failure to identify the correct fetal head position increases the likelihood of failed instrumental delivery with the additional morbidity of sequential use of instruments or second stage caesarean section. The use of ultrasound in determining the position of the fetal head has been explored but is not part of routine clinical practice.Methods\\/DesignA multi-centre randomised controlled trial is proposed. The study will take place in two large maternity units in Ireland with a combined annual birth rate of 13,500 deliveries. It will involve 450 nulliparous women undergoing instrumental delivery after 37 weeks gestation. The main outcome measure will be incorrect diagnosis of the fetal head position. A study involving 450 women will have 80% power to detect a 10% difference in the incidence of inaccurate diagnosis of the fetal head position with two-sided 5% alpha.DiscussionIt is both important and timely to evaluate the use of ultrasound to diagnose the fetal head position prior to instrumental delivery before routine use can be advocated. The overall aim is to reduce the incidence of incorrect diagnosis of the fetal head position prior to instrumental delivery and improve the safety of instrumental deliveries.Trial registrationCurrent Controlled Trials ISRCTN72230496

  5. Cost-effectiveness of the Australian Medical Sheepskin for the prevention of pressure ulcers in somatic nursing home patients: study protocol for a prospective multi-centre randomised controlled trial (ISRCTN17553857

    Directory of Open Access Journals (Sweden)

    Montgomery Ken

    2008-01-01

    Full Text Available Abstract Background Pressure ulcers are a major problem, especially in nursing home patients, although they are regarded as preventable and there are many pressure relieving methods and materials. One such pressure relieving material is the recently developed Australian Medical Sheepskin, which has been shown in two randomized controlled trials 12 to be an effective intervention in the prevention of sacral pressure ulcers in hospital patients. However, the use of sheepskins has been debated and in general discouraged by most pressure ulcer working groups and pressure ulcer guidelines, but these debates were based on old forms of sheepskins. Furthermore, nothing is yet known about the (cost-effectiveness of the Australian Medical sheepskin in nursing home patients. The objective of this study is to assess the effects and costs of the use of the Australian Medical Sheepskin combined with usual care with regard to the prevention of sacral pressure ulcers in somatic nursing home patients, versus usual care only. Methods/Design In a multi-centre randomised controlled trial 750 patients admitted for a primarily somatic reason to one of the five participating nursing homes, and not having pressure ulcers on the sacrum at admission, will be randomized to either usual care only or usual care plus the use of the Australian Medical Sheepskin as an overlay on the mattress. Outcome measures are: incidence of sacral pressure ulcers in the first month after admission; sacrum pressure ulcer free days; costs; patient comfort; and ease of use. The skin of all the patients will be observed once a day from admission on for 30 days. Patient characteristics and pressure risk scores are assessed at admission and at day 30 after it. Additional to the empirical phase, systematic reviews will be performed in order to obtain data for economic weighting and modelling. The protocol is registered in the Controlled Trial Register as ISRCTN17553857.

  6. Field efficacy of a new mosaic long-lasting mosquito net (PermaNet® 3.0 against pyrethroid-resistant malaria vectors: a multi centre study in Western and Central Africa

    Directory of Open Access Journals (Sweden)

    Pigeon Olivier

    2010-04-01

    Full Text Available Abstract Background Due to the spread of pyrethroid-resistance in malaria vectors in Africa, new strategies and tools are urgently needed to better control malaria transmission. The aim of this study was to evaluate the performances of a new mosaic long-lasting insecticidal net (LLIN, i.e. PermaNet® 3.0, against wild pyrethroid-resistant Anopheles gambiae s.l. in West and Central Africa. Methods A multi centre experimental hut trial was conducted in Malanville (Benin, Vallée du Kou (Burkina Faso and Pitoa (Cameroon to investigate the exophily, blood feeding inhibition and mortality induced by PermaNet® 3.0 (i.e. a mosaic net containing piperonyl butoxide and deltamethrin on the roof comparatively to the WHO recommended PermaNet® 2.0 (unwashed and washed 20-times and a conventionally deltamethrin-treated net (CTN. Results The personal protection and insecticidal activity of PermaNet 3.0 and PermaNet® 2.0 were excellent (>80% in the "pyrethroid-tolerant" area of Malanville. In the pyrethroid-resistance areas of Pitoa (metabolic resistance and Vallée du Kou (presence of the L1014F kdr mutation, PermaNet® 3.0 showed equal or better performances than PermaNet® 2.0. It should be noted however that the deltamethrin content on PermaNet® 3.0 was up to twice higher than that of PermaNet® 2.0. Significant reduction of efficacy of both LLIN was noted after 20 washes although PermaNet® 3.0 still fulfilled the WHO requirement for LLIN. Conclusion The use of combination nets for malaria control offers promising prospects. However, further investigations are needed to demonstrate the benefits of using PermaNet® 3.0 for the control of pyrethroid resistant mosquito populations in Africa.

  7. A person-centred and thriving-promoting intervention in nursing homes - study protocol for the U-Age nursing home multi-centre, non-equivalent controlled group before-after trial.

    Science.gov (United States)

    Edvardsson, David; Sjögren, Karin; Lood, Qarin; Bergland, Ådel; Kirkevold, Marit; Sandman, Per-Olof

    2017-01-17

    The literature suggests that person-centred care can contribute to quality of life and wellbeing of nursing home residents, relatives and staff. However, there is sparse research evidence on how person-centred care can be operationalised and implemented in practice, and the extent to which it may promote wellbeing and satisfaction. Therefore, the U-Age nursing home study was initiated to deepen the understanding of how to integrate person-centred care into daily practice and to explore the effects and meanings of this. The study aims to evaluate effects and meanings of a person-centred and thriving-promoting intervention in nursing homes through a multi-centre, non-equivalent controlled group before-after trial design. Three nursing homes across three international sites have been allocated to a person-centred and thriving-promoting intervention group, and three nursing homes have been allocated to an inert control group. Staff at intervention sites will participate in a 12-month interactive educational programme that operationalises thriving-promoting and person-centred care three dimensions: 1) Doing a little extra, 2) Developing a caring environment, and 3) Assessing and meeting highly prioritised psychosocial needs. A pedagogical framework will guide the intervention. The primary study endpoints are; residents' thriving, relatives' satisfaction with care and staff job satisfaction. Secondary endpoints are; resident, relative and staff experiences of the caring environment, relatives' experience of visiting their relative and the nursing home, as well as staff stress of conscience and perceived person-centredness of care. Data on study endpoints will be collected pre-intervention, post-intervention, and at a six-month follow up. Interviews will be conducted with relatives and staff to explore experiences and meanings of the intervention. The study is expected to provide evidence that can inform further research, policy and practice development on if and how

  8. Anger management for people with mild to moderate learning disabilities: Study protocol for a multi-centre cluster randomized controlled trial of a manualized intervention delivered by day-service staff

    Directory of Open Access Journals (Sweden)

    Nuttall Jacqueline

    2011-02-01

    Full Text Available Abstract Background Cognitive behaviour therapy (CBT is the treatment of choice for common mental health problems, but this approach has only recently been adapted for people with learning disabilities, and there is a limited evidence base for the use of CBT with this client group. Anger treatment is the one area where there exists a reasonable number of small controlled trials. This study will evaluate the effectiveness of a manualized 12-week CBT intervention for anger. The intervention will be delivered by staff working in the day services that the participants attend, following training to act as 'lay therapists' by a Clinical Psychologist, who will also provide supervision. Methods/Design This is a multi-centre cluster randomized controlled trial of a group intervention versus a 'support as usual' waiting-list control group, with randomization at the level of the group. Outcomes will be assessed at the end of the intervention and again 6-months later. After completion of the 6-month follow-up assessments, the intervention will also be delivered to the waiting-list groups. The study will include a range of anger/aggression and mental health measures, some of which will be completed by service users and also by their day service key-workers and by home carers. Qualitative data will be collected to assess the impact of the intervention on participants, lay therapists, and services, and the study will also include a service-utilization cost and consequences analysis. Discussion This will be the first trial to investigate formally how effectively staff working in services providing day activities for people with learning disabilities are able to use a therapy manual to deliver a CBT based anger management intervention, following brief training by a Clinical Psychologist. The demonstration that service staff can successfully deliver anger management to people with learning disabilities, by widening the pool of potential therapists, would have

  9. Anger management for people with mild to moderate learning disabilities: study protocol for a multi-centre cluster randomized controlled trial of a manualized intervention delivered by day-service staff.

    Science.gov (United States)

    Willner, Paul; Jahoda, Andrew; Rose, John; Stenfert-Kroese, Biza; Hood, Kerenza; Townson, Julia K; Nuttall, Jacqueline; Gillespie, David; Felce, David

    2011-02-09

    Cognitive behaviour therapy (CBT) is the treatment of choice for common mental health problems, but this approach has only recently been adapted for people with learning disabilities, and there is a limited evidence base for the use of CBT with this client group. Anger treatment is the one area where there exists a reasonable number of small controlled trials. This study will evaluate the effectiveness of a manualized 12-week CBT intervention for anger. The intervention will be delivered by staff working in the day services that the participants attend, following training to act as 'lay therapists' by a Clinical Psychologist, who will also provide supervision. This is a multi-centre cluster randomized controlled trial of a group intervention versus a 'support as usual' waiting-list control group, with randomization at the level of the group. Outcomes will be assessed at the end of the intervention and again 6-months later. After completion of the 6-month follow-up assessments, the intervention will also be delivered to the waiting-list groups. The study will include a range of anger/aggression and mental health measures, some of which will be completed by service users and also by their day service key-workers and by home carers. Qualitative data will be collected to assess the impact of the intervention on participants, lay therapists, and services, and the study will also include a service-utilization cost and consequences analysis. This will be the first trial to investigate formally how effectively staff working in services providing day activities for people with learning disabilities are able to use a therapy manual to deliver a CBT based anger management intervention, following brief training by a Clinical Psychologist. The demonstration that service staff can successfully deliver anger management to people with learning disabilities, by widening the pool of potential therapists, would have very significant benefits in relation to the current policy of

  10. RADAR – A randomised, multi-centre, prospective study comparing best medical treatment versus best medical treatment plus renal artery stenting in patients with haemodynamically relevant atherosclerotic renal artery stenosis

    Directory of Open Access Journals (Sweden)

    Hauk Michael

    2009-07-01

    Full Text Available Abstract Background Prospective, international, multi-centre, randomised (1:1 trial to evaluate the clinical impact of percutaneous transluminal renal artery stenting (PTRAS on the impaired renal function measured by the estimated glomerular filtration rate (eGFR in patients with haemodynamically significant atherosclerotic renal artery stenosis. Methods Patients will be randomised to receive either PTRAS using the Dynamic Renal Stent system plus best medical treatment or best medical treatment. Renal stenting will be performed under angiographic imaging. For patients randomised to best medical treatment the degree of stenosis measured by renal duplex sonography (RDS will be confirmed by MR angio or multi-slice CT where possible. Best medical treatment will be initiated at randomisation or post procedure (for PTRAS arm only, and adjusted as needed at all visits. Best medical treatment is defined as optimal drug therapy for control of the major risk factors (blood pressure ≤ 125/80 mmHg, LDL cholesterol ≤ 100 mg/dL, HbA1c ≤ 6.5%. Data recordings include serum creatinine values, eGFR, brain natriuretic peptide, patients' medical history and concomitant medication, clinical events, quality of life questionnaire (SF-12v2™, 24 hour ambulatory blood pressure measurement, renal artery duplex ultrasound and echocardiography. Follow-up intervals are at 2, 6, 12 and 36 months following randomisation. The primary endpoint is the difference between treatments in change of eGFR over 12 months. Major secondary endpoints are technical success, change of renal function based on the eGFR slope change between pre-treatment and post-treatment (i.e. improvement, stabilisation, failure, clinical events overall such as renal or cardiac death, stroke, myocardial infarction, hospitalisation for congestive heart failure, progressive renal insufficiency (i.e. need for dialysis, need of target vessel revascularisation or target lesion revascularisation, change in

  11. European Prospective Investigation into Cancer and Nutrition (EPIC): study populations and data collection

    DEFF Research Database (Denmark)

    Riboli, E.; Hunt, K.J.; Slimani, N.

    2002-01-01

    The European Prospective Investigation into Cancer and Nutrition (EPIC) is an ongoing multi-centre prospective cohort study designed to investigate the relationship between nutrition and cancer, with the potential for studying other diseases as well. The study currently includes 519 978...... participants (366 521 women and 153 457 men, mostly aged 35-70 years) in 23 centres located in 10 European countries, to be followed for cancer incidence and cause-specific mortality for several decades. At enrollment, which took place between 1992 and 2000 at each of the different centres, information...

  12. Authorship issues in multi-centre clinical trials

    DEFF Research Database (Denmark)

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

    2015-01-01

    Discussions about authorship often arise in multi-centre clinical trials. Such trials may involve up to hundreds of contributors of whom some will eventually co-author the final publication. It is, however, often impossible to involve all contributors in the manuscript process sufficiently for them...

  13. Estudio multicéntrico de prevalencia de infección tuberculosa latente en los internados en prisiones españolas Multi-centre study of the prevalance of latent tuberculosis infection amongst inmates in spanish prisons

    Directory of Open Access Journals (Sweden)

    J. García-Guerrero

    2010-02-01

    Full Text Available Objetivo: Estudiar la prevalencia de infección tuberculosa latente (ITL entre los presos internados en las prisiones españolas. Material y Método: Estudio multicéntrico, observacional y transversal; muestreo por conglomerado bietápico. Se recogieron variables sociodemográficas, penitenciarias y clínico-serológicas. Se realizó análisis univariante, bivariante y multivariante mediante regresión logística con las variables que mostraron significación estadística. Se calculó la odds ratio con intervalo de confianza del 95%. Resultados: 378 pacientes. Se dispuso de intradermorreacción de Mantoux (IDRM valorable en el 90,2%. 91,2% hombres, 37,8% extranjeros con edad media de 35,9±10,3 años. Mediana de estancia en prisión: 2 años y el 28,7% había estado > 5 años en prisión. El 49,6% ingresó en prisión en 2006 o antes. El 24,5% tenía antecedentes de uso de drogas intravenosas (UDI. El 50,4% presentaba ITL que se asoció a: edad > 40 años (63,2 vs 43,8%; IC: 1,39-3,49; OR: 2,20; p=0,001; haber estado > 5 años en prisión (71,2 vs 41,3%; IC: 2,13-5,75; OR: 3,50; p 40 años (OR:1,76; IC: 1,08-2,87; p=0,024; y b estancia > 5 años en prisión (OR: 2,50; IC: 1,41-4,43; p=0,002. Conclusiones: La prevalencia de ITL en prisión es muy alta, sobre todo en los mayores de 40 años y los que están más de cinco años en prisión. Para evitar el riesgo de progresión a tuberculosis, se recomienda tratar a los infectados que lo precisen y mantener los programas de control de esta patología.Aims: To study the prevalence of latent tuberculosis infection (LTBI amongst inmates in Spanish prisons. Materials and Methods: Multi-centre, cross-sectional study; two stage sampling. Socio-demographic, prison and clinical variables were gathered. A univariate, bivariate and multivariate analysis was carried out using logistic regression with the variables that showed statistical significance. The odds ratio was calculated with a confidence interval

  14. Frequency of participation of 8-12-year-old children with cerebral palsy: a multi-centre cross-sectional European study

    DEFF Research Database (Denmark)

    Michelsen, Susan I; Flachs, Esben M; Uldall, Peter;

    2009-01-01

    Participation in home, school and community is important for all children; and little is known about the frequency of participation of disabled children. Frequency of participation is a valuable outcome measure for evaluating habilitation programmes for disabled children and for planning social...... and health services. We investigated how frequency of participation varied between children with cerebral palsy and the general population; and examined variation across countries to understand better how the environmental factors such as legislation, public attitudes and regulation in different countries...... how this regional variation might be explained by the different environments in which children live. Attending a special school or class was not associated with further reduction in participation in most areas of everyday life....

  15. Pirating European Studies

    Directory of Open Access Journals (Sweden)

    Natalia Timus

    2016-08-01

    Full Text Available Open Science has gained a lot of attention not only within the academic community but also among policy-makers. Some international publishers have been active in moving towards open access publications and research data, but, overall, modest results have been achieved so far. In this context, the digital piracy engines emerge as vital actors in disseminating and determining the impact of research. This study examines the Sci-Hub downloads data in order to uncover patterns of piracy in European Studies research. We identify journals and the subjects of articles that have been pirated the most. We also study the geographical distribution of download requests. The analysis reveals that the readers are mostly interested in subjects reflecting the current major European challenges, specifically populism and the economic crisis. Both developing countries as well as the ‘old’ EU members are active in illegal downloads.

  16. Neonatal Procalcitonin Intervention Study (NeoPInS): Effect of Procalcitonin-guided decision making on duration of antibiotic therapy in suspected neonatal early-onset sepsis: A multi-centre randomized superiority and non-inferiority Intervention Study.

    Science.gov (United States)

    Stocker, Martin; Hop, Wim C J; van Rossum, Annemarie M C

    2010-12-08

    Early diagnosis and treatment of the newborn infant with suspected sepsis are essential to prevent severe and life threatening complications. Diagnosis of neonatal sepsis is difficult because of the variable and nonspecific clinical presentation. Therefore, many newborns with nonspecific symptoms are started on antibiotic treatment before the presence of sepsis has been proven. With our recently published single-centre intervention study we were able to show that Procalcitonin determinations allowed to shorten the duration of antibiotic therapy in newborns with suspected early-onset sepsis. The study is designed as randomized controlled international multicenter intervention trial on the efficacy and safety of Procalcitonin guided treatment. Term and near-term infants (gestational age ≥ 34 0/7 weeks) with suspected sepsis in the first 3 days of life requiring empiric antibiotic therapy will be included. The duration of antibiotic therapy in the standard group is based on the attending physician's assessment of the likelihood of infection (infection unlikely, possible, probable or proven). In the Procalcitonin group, if infection is considered to be unlikely or possible, antibiotic therapy is discontinued when two consecutive Procalcitonin values are within the normal range. Co-primary outcome measures are the duration of antibiotic therapy (superiority aspect of the trial) and the proportion of infants with a recurrence of infection requiring additional courses of antibiotic therapy and/or death in the first month of life (safety of study intervention, non-inferiority aspect of the trial). The number of infants to be included equals 800 per arm. With these numbers the power of the study to demonstrate superiority for duration of antibiotic therapy as well as non-inferiority regarding safety, i.e. excluding a disadvantage difference larger than 2% for the experimental arm, will both be greater than 80%. Benefit of the study is a possible limitation of unnecessary

  17. Prescription errors in Brazilian hospitals: a multi-centre exploratory survey.

    Science.gov (United States)

    Miasso, Adriana Inocenti; Oliveira, Regina Célia de; Silva, Ana Elisa Bauer de Camargo; Lyra Junior, Divaldo Pereira de; Gimenes, Fernanda Raphael Escobar; Fakih, Flávio Trevisan; Cassiani, Sílvia Helena De Bortoli

    2009-02-01

    In Brazil, millions of prescriptions do not follow the legal requirements necessary to guarantee the correct dispensing and administration of medication. This multi-centre exploratory study aimed to analyze the appropriateness of prescriptions at four Brazilian hospitals and to identify possible errors caused by inadequacies. The sample consisted of 864 prescriptions obtained at hospital medical clinics in January 2003. Data was collected by three nurse researchers during one week using a standard data sheet that included items about: the type of prescription; legibility; completeness; use of abbreviations; existence of changes and erasures. There were statistically significant differences between incomplete electronic prescriptions at hospital A, and handwritten ones from hospitals C (C2 = 12.703 and p system at the hospitals. Physicians, pharmacists and nurses should therefore jointly propose strategies to avoid these prescription errors.

  18. Multi-centre validation of an automatic algorithm for fast 4D myocardial segmentation in cine CMR datasets.

    Science.gov (United States)

    Queirós, Sandro; Barbosa, Daniel; Engvall, Jan; Ebbers, Tino; Nagel, Eike; Sarvari, Sebastian I; Claus, Piet; Fonseca, Jaime C; Vilaça, João L; D'hooge, Jan

    2016-10-01

    Quantitative analysis of cine cardiac magnetic resonance (CMR) images for the assessment of global left ventricular morphology and function remains a routine task in clinical cardiology practice. To date, this process requires user interaction and therefore prolongs the examination (i.e. cost) and introduces observer variability. In this study, we sought to validate the feasibility, accuracy, and time efficiency of a novel framework for automatic quantification of left ventricular global function in a clinical setting. Analyses of 318 CMR studies, acquired at the enrolment of patients in a multi-centre imaging trial (DOPPLER-CIP), were performed automatically, as well as manually. For comparative purposes, intra- and inter-observer variability was also assessed in a subset of patients. The extracted morphological and functional parameters were compared between both analyses, and time efficiency was evaluated. The automatic analysis was feasible in 95% of the cases (302/318) and showed a good agreement with manually derived reference measurements, with small biases and narrow limits of agreement particularly for end-diastolic volume (-4.08 ± 8.98 mL), end-systolic volume (1.18 ± 9.74 mL), and ejection fraction (-1.53 ± 4.93%). These results were comparable with the agreement between two independent observers. A complete automatic analysis took 5.61 ± 1.22 s, which is nearly 150 times faster than manual contouring (14 ± 2 min, P cine CMR images. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  19. The Scandinavian Propaten(®) trial - 1-year patency of PTFE vascular prostheses with heparin-bonded luminal surfaces compared to ordinary pure PTFE vascular prostheses - a randomised clinical controlled multi-centre trial

    DEFF Research Database (Denmark)

    Lindholt, J S; Gottschalksen, B; Johannesen, N

    2011-01-01

    To compare 1-year potencies' of heparin-bonded PTFE [(Hb-PTFE) (Propaten(®))] grafts with those of ordinary polytetraflouroethylene (PTFE) grafts in a blinded, randomised, clinically controlled, multi-centre study.......To compare 1-year potencies' of heparin-bonded PTFE [(Hb-PTFE) (Propaten(®))] grafts with those of ordinary polytetraflouroethylene (PTFE) grafts in a blinded, randomised, clinically controlled, multi-centre study....

  20. Use of metformin before and during assisted reproductive technology in non-obese young infertile women with polycystic ovary syndrome: a prospective, randomized, double-blind, multi-centre study

    DEFF Research Database (Denmark)

    Kjøtrød, S B; Carlsen, S M; Rasmussen, P E

    2011-01-01

    To study the effect of metformin before and during assisted reproductive technology (ART) on the clinical pregnancy rate (CPR) in non-obese women with polycystic ovary syndrome (PCOS).......To study the effect of metformin before and during assisted reproductive technology (ART) on the clinical pregnancy rate (CPR) in non-obese women with polycystic ovary syndrome (PCOS)....

  1. Making the Most of Mealtimes (M3): protocol of a multi-centre cross-sectional study of food intake and its determinants in older adults living in long term care homes.

    Science.gov (United States)

    Keller, Heather H; Carrier, Natalie; Slaughter, Susan; Lengyel, Christina; Steele, Catriona M; Duizer, Lisa; Brown, K Steve; Chaudhury, Habib; Yoon, Minn N; Duncan, Alison M; Boscart, Veronique M; Heckman, George; Villalon, Lita

    2017-01-13

    Older adults living in long term care (LTC) homes are nutritionally vulnerable, often consuming insufficient energy, macro- and micronutrients to sustain their health and function. Multiple factors are proposed to influence food intake, yet our understanding of these diverse factors and their interactions are limited. The purpose of this paper is to fully describe the protocol used to examine determinants of food and fluid intake among older adults participating in the Making the Most of Mealtimes (M3) study. A conceptual framework that considers multi-level influences on mealtime experience, meal quality and meal access was used to design this multi-site cross-sectional study. Data were collected from 639 participants residing in 32 LTC homes in four Canadian provinces by trained researchers. Food intake was assessed with three-days of weighed food intake (main plate items), as well as estimations of side dishes, beverages and snacks and compared to the Dietary Reference Intake. Resident-level measures included: nutritional status, nutritional risk; disease conditions, medication, and diet prescriptions; oral health exam, signs of swallowing difficulty and olfactory ability; observed eating behaviours, type and number of staff assisting with eating; and food and foodservice satisfaction. Function, cognition, depression and pain were assessed using interRAI LTCF with selected items completed by researchers with care staff. Care staff completed a standardized person-directed care questionnaire. Researchers assessed dining rooms for physical and psychosocial aspects that could influence food intake. Management from each site completed a questionnaire that described the home, menu development, food production, out-sourcing of food, staffing levels, and staff training. Hierarchical regression models, accounting for clustering within province, home and dining room will be used to determine factors independently associated with energy and protein intake, as proxies for

  2. Pregnancy, chimerism and lupus nephritis: a multi-centre study.

    NARCIS (Netherlands)

    Hovinga, I.C. Kremer; Koopmans, M.; Grootscholten, C.; Wal, A.M. van der; Bijl, M. van der; Derksen, R.H.; Voskuyl, A.E.; Heer, E. de; Bruijn, J.A.; Berden, J.H.M.; Bajema, I.M.

    2008-01-01

    Chimerism occurs twice as often in the kidneys of women with lupus nephritis as in normal kidneys and may be involved in the pathogenesis of systemic lupus erythematosus. Pregnancy is considered the most important source of chimerism, but the exact relationship between pregnancy, the persistence of

  3. Pregnancy, chimerism and lupus nephritis : a multi-centre study

    NARCIS (Netherlands)

    Hovinga, I. C. L. Kremer; Koopmans, M.; Grootscholten, C.; van der Wal, A. M.; Bijl, M.; Derksen, R. H. W. M.; Voslcuyl, A. E.; de Heer, E.; Bruijn, J. A.; Berden, J. H. M.; Rajema, I. M.

    2008-01-01

    Chimerism occurs twice as often in the kidneys of women with lupus nephritis as in normal kidneys and may he involved in the pathogenesis of systemic lupus erythematosus. Pregnancy is considered the most important source of chimerism, but the exact relationship between pregnancy, the persistence of

  4. Multi-centre, multi-database studies with common protocols

    DEFF Research Database (Denmark)

    Klungel, Olaf H; Kurz, Xavier; de Groot, Mark C H

    2016-01-01

    Purpose: To assess the impact of a variety of methodological parameters on the association between six drug classes and five key adverse events in multiple databases. Methods: The selection of Drug-Adverse Event pairs was based on public health impact, regulatory relevance, and the possibility to...

  5. Study protocol. ECSSIT - Elective Caesarean Section Syntocinon Infusion Trial. A multi-centre randomised controlled trial of oxytocin (Syntocinon) 5 IU bolus and placebo infusion versus oxytocin 5 IU bolus and 40 IU infusion for the control of blood loss at elective caesarean section.

    LENUS (Irish Health Repository)

    Murphy, Deirdre J

    2009-01-01

    BACKGROUND: Caesarean section is one of the most commonly performed major operations in women throughout the world. Rates are escalating, with studies from the United States of America, the United Kingdom, China and the Republic of Ireland reporting rates between 20% and 25%. Operative morbidity includes haemorrhage, anaemia, blood transfusion and in severe cases, maternal death. The value of routine oxytocics in the third stage of vaginal birth has been well established and it has been assumed that these benefits apply to caesarean delivery as well. A slow bolus dose of oxytocin is recommended following delivery of the baby at caesarean section. Some clinicians use an additional infusion of oxytocin for a further period following the procedure. Intravenous oxytocin has a very short half-life (4-10 minutes) therefore the potential advantage of an oxytocin infusion is that it maintains uterine contractility throughout the surgical procedure and immediate postpartum period, when most primary haemorrhages occur. The few trials to date addressing the optimal approach to preventing haemorrhage at caesarean section have been under-powered to evaluate clinically important outcomes. There has been no trial to date comparing the use of an intravenous slow bolus of oxytocin versus an oxytocin bolus and infusion. METHODS AND DESIGN: A multi-centre randomised controlled trial is proposed. The study will take place in five large maternity units in Ireland with collaboration between academics and clinicians in the disciplines of obstetrics and anaesthetics. It will involve 2000 women undergoing elective caesarean section after 36 weeks gestation. The main outcome measure will be major haemorrhage (blood loss >1000 ml). A study involving 2000 women will have 80% power to detect a 36% relative change in the risk of major haemorrhage with two-sided 5% alpha. DISCUSSION: It is both important and timely that we evaluate the optimal approach to the management of the third stage at

  6. Study protocol. ECSSIT - Elective Caesarean Section Syntocinon Infusion Trial. A multi-centre randomised controlled trial of oxytocin (Syntocinon) 5 IU bolus and placebo infusion versus oxytocin 5 IU bolus and 40 IU infusion for the control of blood loss at elective caesarean section.

    LENUS (Irish Health Repository)

    Murphy, Deirdre J

    2012-02-01

    BACKGROUND: Caesarean section is one of the most commonly performed major operations in women throughout the world. Rates are escalating, with studies from the United States of America, the United Kingdom, China and the Republic of Ireland reporting rates between 20% and 25%. Operative morbidity includes haemorrhage, anaemia, blood transfusion and in severe cases, maternal death. The value of routine oxytocics in the third stage of vaginal birth has been well established and it has been assumed that these benefits apply to caesarean delivery as well. A slow bolus dose of oxytocin is recommended following delivery of the baby at caesarean section. Some clinicians use an additional infusion of oxytocin for a further period following the procedure. Intravenous oxytocin has a very short half-life (4-10 minutes) therefore the potential advantage of an oxytocin infusion is that it maintains uterine contractility throughout the surgical procedure and immediate postpartum period, when most primary haemorrhages occur. The few trials to date addressing the optimal approach to preventing haemorrhage at caesarean section have been under-powered to evaluate clinically important outcomes. There has been no trial to date comparing the use of an intravenous slow bolus of oxytocin versus an oxytocin bolus and infusion. METHODS AND DESIGN: A multi-centre randomised controlled trial is proposed. The study will take place in five large maternity units in Ireland with collaboration between academics and clinicians in the disciplines of obstetrics and anaesthetics. It will involve 2000 women undergoing elective caesarean section after 36 weeks gestation. The main outcome measure will be major haemorrhage (blood loss >1000 ml). A study involving 2000 women will have 80% power to detect a 36% relative change in the risk of major haemorrhage with two-sided 5% alpha. DISCUSSION: It is both important and timely that we evaluate the optimal approach to the management of the third stage at

  7. Cardiac phantom measurement validating the methodology for a cardiac multi-centre trial with positron emission tomography.

    Science.gov (United States)

    Nuyts, Johan; Mortelmans, Luc; Van de Werf, Frans; Djian, Jacques; Sambuceti, Gianmario; Schwaiger, Marcus; Touboul, Paul; Maes, Alex

    2002-12-01

    In an ongoing international multi-centre trial, positron emission tomography (PET) is being used to evaluate the effect of a new P-selectin antagonist on the infarct size in patients with acute myocardial infarction, treated with thrombolysis. Although it is possible to correct for site-dependent factors, it is desirable to reduce these factors to a minimum. Therefore, acquisition and reconstruction protocols have been defined that can be closely followed by all participating centres. The resulting reconstructed images are transferred to the core centre for central processing with semi-automatic software. This paper reports on the multi-centre phantom experiment that was carried out to assess the inter-centre reproducibility of defect size determination with this protocol. Also, the spatial resolution of the short axis slices was examined. In addition, the analysis procedure was applied to normal PET studies to evaluate the specificity of perfusion defect detection. The transmural cold defect in the phantom occupied 14.8% of the left ventricular area. The automated analysis was applied to the phantom measurements from the 14 participating PET cameras. It yielded an accurate estimate of 15.1% with a standard deviation of 0.6%, indicating excellent reproducibility. The spatial resolution in the short axis slices was similar for all PET systems: 9.6+/-0.8 mm. The same procedure produced a defect size of zero in the studies of normal volunteers. This study indicates that cardiac studies from multiple PET systems can be pooled for statistical analysis.

  8. Cardiac phantom measurement validating the methodology for a cardiac multi-centre trial with positron emission tomography

    Energy Technology Data Exchange (ETDEWEB)

    Nuyts, Johan; Mortelmans, Luc; Maes, Alex [Nuclear Medicine, UZ Gasthuisberg, K.U. Leuven, Herestraat 49, 3000 Leuven (Belgium); Van de Werf, Frans [Cardiology, UZ Gasthuisberg, K.U. Leuven, Leuven (Belgium); Djian, Jacques [Wyeth Research, Paris la Defense Cedex (France); Sambuceti, Gianmario [Instituto di Fisiologia Clinica CNR, Pisa (Italy); Schwaiger, Marcus [Nuklearmedizinische Klinik und Poliklinik, TU Muenchen, Muenchen (Germany); Touboul, Paul [Hopital Cardio-Vasculaire et Pneumologique, Lyon (France)

    2002-12-01

    In an ongoing international multi-centre trial, positron emission tomography (PET) is being used to evaluate the effect of a new P-selectin antagonist on the infarct size in patients with acute myocardial infarction, treated with thrombolysis. Although it is possible to correct for site-dependent factors, it is desirable to reduce these factors to a minimum. Therefore, acquisition and reconstruction protocols have been defined that can be closely followed by all participating centres. The resulting reconstructed images are transferred to the core centre for central processing with semi-automatic software. This paper reports on the multi-centre phantom experiment that was carried out to assess the inter-centre reproducibility of defect size determination with this protocol. Also, the spatial resolution of the short axis slices was examined. In addition, the analysis procedure was applied to normal PET studies to evaluate the specificity of perfusion defect detection. The transmural cold defect in the phantom occupied 14.8% of the left ventricular area. The automated analysis was applied to the phantom measurements from the 14 participating PET cameras. It yielded an accurate estimate of 15.1% with a standard deviation of 0.6%, indicating excellent reproducibility. The spatial resolution in the short axis slices was similar for all PET systems: 9.6{+-}0.8 mm. The same procedure produced a defect size of zero in the studies of normal volunteers. This study indicates that cardiac studies from multiple PET systems can be pooled for statistical analysis. (orig.)

  9. How to improve walking, balance and social participation following stroke: a comparison of the long term effects of two walking aids--canes and an orthosis TheraTogs--on the recovery of gait following acute stroke. A study protocol for a multi-centre, single blind, randomised control trial

    Directory of Open Access Journals (Sweden)

    Maguire Clare

    2012-03-01

    Full Text Available Abstract Background Annually, some 9000 people in Switzerland suffer a first time stroke. Of these 60% are left with moderate to severe walking disability. Evidence shows that rehabilitation techniques which emphasise activity of the hemiplegic side increase ipsilesional cortical plasticity and improve functional outcomes. Canes are commonly used in gait rehabilitation although they significantly reduce hemiplegic muscle activity. We have shown that an orthosis "TheraTogs" (a corset with elasticated strapping significantly increases hemiplegic muscle activity during gait. The aim of the present study is to investigate the long term effects on the recovery of gait, balance and social participation of gait rehabilitation with TheraTogs compared to gait rehabilitation with a cane following first time acute stroke. Methods/Design Multi-centre, single blind, randomised trial with 120 patients after first stroke. When subjects have reached Functional Ambulation Category 3 they will be randomly allocated into TheraTogs or cane group. TheraTogs will be applied to support hip extensor and abductor musculature according to a standardised procedure. Cane walking held at the level of the radial styloid of the sound wrist. Subjects will walk throughout the day with only the assigned walking aid. Standard therapy treatments and usual care will remain unchanged and documented. The intervention will continue for five weeks or until patients have reached Functional Ambulation category 5. Outcome measures will be assessed the day before begin of intervention, the day after completion, 3 months, 6 months and 2 years. Primary outcome: Timed "up and go" test, secondary outcomes: peak surface EMG of gluteus maximus and gluteus medius, activation patterns of hemiplegic leg musculature, temporo-spatial gait parameters, hemiplegic hip kinematics in the frontal and sagittal planes, dynamic balance, daily activity measured by accelerometry, Stroke Impact Scale

  10. Effects of unstratified and centre-stratified randomization in multi-centre clinical trials.

    Science.gov (United States)

    Anisimov, Vladimir V

    2011-01-01

    This paper deals with the analysis of randomization effects in multi-centre clinical trials. The two randomization schemes most often used in clinical trials are considered: unstratified and centre-stratified block-permuted randomization. The prediction of the number of patients randomized to different treatment arms in different regions during the recruitment period accounting for the stochastic nature of the recruitment and effects of multiple centres is investigated. A new analytic approach using a Poisson-gamma patient recruitment model (patients arrive at different centres according to Poisson processes with rates sampled from a gamma distributed population) and its further extensions is proposed. Closed-form expressions for corresponding distributions of the predicted number of the patients randomized in different regions are derived. In the case of two treatments, the properties of the total imbalance in the number of patients on treatment arms caused by using centre-stratified randomization are investigated and for a large number of centres a normal approximation of imbalance is proved. The impact of imbalance on the power of the study is considered. It is shown that the loss of statistical power is practically negligible and can be compensated by a minor increase in sample size. The influence of patient dropout is also investigated. The impact of randomization on predicted drug supply overage is discussed.

  11. Proposal for the standardisation of multi-centre trials in nuclear medicine imaging

    DEFF Research Database (Denmark)

    Dickson, John Caddell; Tossici-Bolt, Livia; Sera, Terez;

    2012-01-01

    Multi-centre trials are an important part of proving the efficacy of procedures, drugs and interventions. Imaging components in such trials are becoming increasingly common; however, without sufficient control measures the usefulness of these data can be compromised. This paper describes a framew...

  12. Assessment of data quality in an international multi-centre randomised trial of coronary artery surgery

    Directory of Open Access Journals (Sweden)

    Bochenek Andrzej

    2011-09-01

    Full Text Available Abstract Background ART is a multi-centre randomised trial of cardiac surgery which provided a unique opportunity to evaluate the data from a large number of centres from a variety of countries. We attempted to assess data quality, including recruitment rates, timeliness and completeness of the data obtained from the centres in different socio-economic strata. Methods The analysis was based on the 2-page CRF completed at the 6 week follow-up. CRF pages were categorised into "clean" (no edit query and "dirty" (any incomplete, inconsistent or illegible data. The timelines were assessed on the basis of the time interval from the visit and receipt of complete CRF. Data quality was defined as the number of data queries (in percent and time delay (in days between visit and receipt of correct data. Analyses were stratified according to the World Bank definitions into: "Developing" countries (Poland, Brazil and India and "Developed" (Italy, UK, Austria and Australia. Results There were 18 centres in the "Developed" and 10 centres in the "Developing" countries. The rate of enrolment did not differ significantly by economic level ("Developing":4.1 persons/month, "Developed":3.7 persons/month. The time interval for the receipt of data was longer for "Developing" countries (median:37 days compared to "Developed" ones (median:11 days (p Conclusions In this study we showed that data quality was comparable between centres from "Developed" and "Developing" countries. Data was received in a less timely fashion from Developing countries and appropriate systems should be instigated to minimize any delays. Close attention should be paid to the training of centres and to the central management of data quality. Trial registration ISRCTN46552265

  13. Acupuncture for persistent allergic rhinitis: a multi-centre, randomised, controlled trial protocol

    Directory of Open Access Journals (Sweden)

    Kang Kyung-Won

    2009-07-01

    Full Text Available Abstract Background Allergic rhinitis is one of the most common health complaints worldwide. Complementary and alternative medical approaches have been employed to relieve allergic rhinitis symptoms and to avoid the side effects of conventional medication. Acupuncture has been widely used to treat patients with allergic rhinitis, but the available evidence of its effectiveness is insufficient. Our objective is to evaluate the effectiveness of acupuncture in patients in Korea and China with persistent allergic rhinitis compared to sham acupuncture treatment or waitlist control. Methods This study consists of a multi-centre (two centres in Korea and two centres in China, randomised, controlled trial with three parallel arms (active acupuncture, sham acupuncture, and waitlist group. The active acupuncture and sham acupuncture groups will receive real or sham acupuncture treatment, respectively, three times per week for a total of 12 sessions over four weeks. Post-treatment follow-up will be performed a month later to complement these 12 acupuncture sessions. Participants in the waitlist group will not receive real or sham acupuncture treatments during this period but will only be required to keep recording their symptoms in a daily diary. After four weeks, the same treatment given to the active acupuncture group will be provided to the waitlist group. Discussion This trial will provide evidence for the effectiveness of acupuncture as a treatment for persistent allergic rhinitis. The primary outcome between groups is a change in the self-reported total nasal symptom score (i.e., nasal obstruction, rhinorrhea, sneezing, and itching from baseline at the fourth week. Secondary outcome measures include the Rhinitis Quality of Life Questionnaire score and total non-nasal symptom score (i.e., headache, itching, pain, eye-dropping. The quantity of conventional relief medication used during the follow-up period is another secondary outcome measure. Trial

  14. Modified Uvulopalatopharyngoplasty and Coblation Channeling of the Tongue for Obstructive Sleep Apnea: A Multi-Centre Australian Trial

    Science.gov (United States)

    MacKay, Stuart G.; Carney, A. Simon; Woods, Charmaine; Antic, Nick; McEvoy, R. Doug; Chia, Michael; Sands, Terry; Jones, Andrew; Hobson, Jonathan; Robinson, Samuel

    2013-01-01

    Study Objectives: To investigate the surgical outcomes and efficacy of modified uvulopalatopharyngoplasty (mod UPPP) and Coblation channelling of the tongue (CCT) as a treatment for obstructive sleep apnea (OSA). Methods: Adult patients with simple snoring or obstructive sleep apnea were treated with combined modified UPPP, bilateral tonsillectomy, and CCT (N = 48). Full polysomnography was performed preoperatively and 3 months postoperatively. Postoperative clinical assessment, sleep questionnaires, and patient demographics including body mass index were compared to preoperative data. All polysomnograms were re-scored to AASM recommended criteria by 2 sleep professionals. Results: The preoperative AHI (median and interquartile range) of 23.1 (10.4 to 36.6) was lowered to a postoperative AHI of 5.6 (1.9 to 10.4) (p coblation channeling of the tongue for obstructive sleep apnea: a multi-centre australian trial. J Clin Sleep Med 2013;9(2):117–124. PMID:23372463

  15. Study protocol, rationale and recruitment in a European multi-centre randomized controlled trial to determine the efficacy and safety of azithromycin maintenance therapy for 6 months in primary ciliary dyskinesia

    DEFF Research Database (Denmark)

    Kobbernagel, Helene E; Buchvald, Frederik F; Haarman, Eric G

    2016-01-01

    BACKGROUND: Clinical management of primary ciliary dyskinesia (PCD) respiratory disease is currently based on improving mucociliary clearance and controlling respiratory infections, through the administration of antibiotics. Treatment practices in PCD are largely extrapolated from more common chr...

  16. Multi-centre reproducibility of diffusion MRI parameters for clinical sequences in the brain.

    Science.gov (United States)

    Grech-Sollars, Matthew; Hales, Patrick W; Miyazaki, Keiko; Raschke, Felix; Rodriguez, Daniel; Wilson, Martin; Gill, Simrandip K; Banks, Tina; Saunders, Dawn E; Clayden, Jonathan D; Gwilliam, Matt N; Barrick, Thomas R; Morgan, Paul S; Davies, Nigel P; Rossiter, James; Auer, Dorothee P; Grundy, Richard; Leach, Martin O; Howe, Franklyn A; Peet, Andrew C; Clark, Chris A

    2015-04-01

    The purpose of this work was to assess the reproducibility of diffusion imaging, and in particular the apparent diffusion coefficient (ADC), intra-voxel incoherent motion (IVIM) parameters and diffusion tensor imaging (DTI) parameters, across multiple centres using clinically available protocols with limited harmonization between sequences. An ice-water phantom and nine healthy volunteers were scanned across fives centres on eight scanners (four Siemens 1.5T, four Philips 3T). The mean ADC, IVIM parameters (diffusion coefficient D and perfusion fraction f) and DTI parameters (mean diffusivity MD and fractional anisotropy FA), were measured in grey matter, white matter and specific brain sub-regions. A mixed effect model was used to measure the intra- and inter-scanner coefficient of variation (CV) for each of the five parameters. ADC, D, MD and FA had a good intra- and inter-scanner reproducibility in both grey and white matter, with a CV ranging between 1% and 7.4%; mean 2.6%. Other brain regions also showed high levels of reproducibility except for small structures such as the choroid plexus. The IVIM parameter f had a higher intra-scanner CV of 8.4% and inter-scanner CV of 24.8%. No major difference in the inter-scanner CV for ADC, D, MD and FA was observed when analysing the 1.5T and 3T scanners separately. ADC, D, MD and FA all showed good intra-scanner reproducibility, with the inter-scanner reproducibility being comparable or faring slightly worse, suggesting that using data from multiple scanners does not have an adverse effect compared with using data from the same scanner. The IVIM parameter f had a poorer inter-scanner CV when scanners of different field strengths were combined, and the parameter was also affected by the scan acquisition resolution. This study shows that the majority of diffusion MRI derived parameters are robust across 1.5T and 3T scanners and suitable for use in multi-centre clinical studies and trials.

  17. Multi-centre reproducibility of diffusion MRI parameters for clinical sequences in the brain

    Science.gov (United States)

    Grech-Sollars, Matthew; Hales, Patrick W; Miyazaki, Keiko; Raschke, Felix; Rodriguez, Daniel; Wilson, Martin; Gill, Simrandip K; Banks, Tina; Saunders, Dawn E; Clayden, Jonathan D; Gwilliam, Matt N; Barrick, Thomas R; Morgan, Paul S; Davies, Nigel P; Rossiter, James; Auer, Dorothee P; Grundy, Richard; Leach, Martin O; Howe, Franklyn A; Peet, Andrew C; Clark, Chris A

    2015-01-01

    The purpose of this work was to assess the reproducibility of diffusion imaging, and in particular the apparent diffusion coefficient (ADC), intra-voxel incoherent motion (IVIM) parameters and diffusion tensor imaging (DTI) parameters, across multiple centres using clinically available protocols with limited harmonization between sequences. An ice–water phantom and nine healthy volunteers were scanned across fives centres on eight scanners (four Siemens 1.5T, four Philips 3T). The mean ADC, IVIM parameters (diffusion coefficient D and perfusion fraction f) and DTI parameters (mean diffusivity MD and fractional anisotropy FA), were measured in grey matter, white matter and specific brain sub-regions. A mixed effect model was used to measure the intra- and inter-scanner coefficient of variation (CV) for each of the five parameters. ADC, D, MD and FA had a good intra- and inter-scanner reproducibility in both grey and white matter, with a CV ranging between 1% and 7.4%; mean 2.6%. Other brain regions also showed high levels of reproducibility except for small structures such as the choroid plexus. The IVIM parameter f had a higher intra-scanner CV of 8.4% and inter-scanner CV of 24.8%. No major difference in the inter-scanner CV for ADC, D, MD and FA was observed when analysing the 1.5T and 3T scanners separately. ADC, D, MD and FA all showed good intra-scanner reproducibility, with the inter-scanner reproducibility being comparable or faring slightly worse, suggesting that using data from multiple scanners does not have an adverse effect compared with using data from the same scanner. The IVIM parameter f had a poorer inter-scanner CV when scanners of different field strengths were combined, and the parameter was also affected by the scan acquisition resolution. This study shows that the majority of diffusion MRI derived parameters are robust across 1.5T and 3T scanners and suitable for use in multi-centre clinical studies and trials. © 2015 The Authors NMR in

  18. Observing Huntington’s Disease: the European Huntington’s Disease Network’s REGISTRY

    OpenAIRE

    2011-01-01

    Background: Huntington’s disease (HD) is a rare triplet repeat (CAG) disorder. Advanced, multi-centre, multi-national research frameworks are needed to study simultaneously multiple complementary aspects of HD. This includes the natural history of HD, its management and the collection of clinical information and biosamples for research. Methods: We report on cross-sectional data of the first 1766 participants in REGISTRY, the European Huntington’s Disease Network’s (EHDN), multi-lingual, mult...

  19. UDRIVE : the European naturalistic driving study.

    NARCIS (Netherlands)

    Eenink, R.G. Barnard, Y. Baumann, M. Augros, X. & Utesch, F.

    2014-01-01

    UDRIVE is the first large-scale European Naturalistic Driving Study on cars, trucks and powered two wheelers. The acronym stands for “European naturalistic Driving and Riding for Infrastructure & Vehicle safety and Environment”. Naturalistic driving can be defined as a study undertaken to provide in

  20. UDRIVE : the European naturalistic driving study.

    NARCIS (Netherlands)

    Eenink, R.G. Barnard, Y. Baumann, M. Augros, X. & Utesch, F.

    2014-01-01

    UDRIVE is the first large-scale European Naturalistic Driving Study on cars, trucks and powered two wheelers. The acronym stands for “European naturalistic Driving and Riding for Infrastructure & Vehicle safety and Environment”. Naturalistic driving can be defined as a study undertaken to provide in

  1. A multi-centre open-label randomised non-inferiority trial comparing watchful waiting to antibiotic treatment for acute otitis media without perforation in low-risk urban Aboriginal and Torres Strait Islander children (the WATCH trial): study protocol for a randomised controlled trial.

    Science.gov (United States)

    Abbott, Penelope; Gunasekera, Hasantha; Leach, Amanda Jane; Askew, Deborah; Walsh, Robyn; Kong, Kelvin; Girosi, Federico; Bond, Chelsea; Morris, Peter; Lujic, Sanja; Hu, Wendy; Usherwood, Tim; Tyson, Sissy; Spurling, Geoffrey; Douglas, Markeeta; Schubert, Kira; Chapman, Shavaun; Siddiqui, Nadeem; Murray, Reeion; Rabbitt, Keitha; Porykali, Bobby; Woodall, Cheryl; Newman, Tina; Reath, Jennifer

    2016-03-03

    Treatment guidelines recommend watchful waiting for children older than 2 years with acute otitis media (AOM) without perforation, unless they are at high risk of complications. The high prevalence of chronic suppurative otitis media (CSOM) in remote Aboriginal and Torres Strait Islander communities leads these children to be classified as high risk. Urban Aboriginal and Torres Strait Islander children are at lower risk of complications, but evidence to support the subsequent recommendation for watchful waiting in this population is lacking. This non-inferiority multi-centre randomised controlled trial will determine whether watchful waiting is non-inferior to immediate antibiotics for urban Aboriginal and Torres Strait Islander children with AOM without perforation. Children aged 2 - 16 years with AOM who are considered at low risk for complications will be recruited from six participating urban primary health care services across Australia. We will obtain informed consent from each participant or their guardian. The primary outcome is clinical resolution on day 7 (no pain, no fever of at least 38 °C, no bulging eardrum and no complications of AOM such as perforation or mastoiditis) as assessed by general practitioners or nurse practitioners. Participants and outcome assessors will not be blinded to treatment. With a sample size of 198 children in each arm, we have 80 % power to detect a non-inferiority margin of up to 10 % at a significance level of 5 %, assuming clinical improvement of at least 80 % in both groups. Allowing for a 20 % dropout rate, we aim to recruit 495 children. We will analyse both by intention-to-treat and per protocol. We will assess the cost- effectiveness of watchful waiting compared to immediate antibiotic prescription. We will also report on the implementation of the trial from the perspectives of parents/carers, health professionals and researchers. The trial will provide evidence for the safety and effectiveness of watchful waiting

  2. Use of platelet rich plasma to treat plantar fasciitis: design of a multi centre randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Peerbooms Joost C

    2010-04-01

    Full Text Available Abstract Background If conservative treatment for chronic plantar fasciitis fails, often a corticosteroid injection is given. Corticosteroid injection gives temporarily pain reduction, but no healing. Blood platelets initiate the natural healing rate. GPS® gives an eightfold concentrate platelets of patients own blood. Injection of these platelets in the attachment of the fascia to the os calcis might induce a healing rate. Methods and design A randomized controlled multi centre trial will be performed. The study population consists of 120 patients of 18 years and older. Patients with chronic plantar fasciitis will be allocated randomly to have a steroid injection or an autologous platelet concentrate injections. Data will be collected before the procedure, 4,8,12,26 weeks and 1 year after the procedure. The main outcome measures of this study are pain and function measured with questionnaires. Conclusion Recent literature show positive effects for the treatment of tendinosis with autologous platelet injections. The forthcoming trial will compare treatment for chronic plantar fasciitis with a steroid injection versus an autologous platelet injection. Our results will be published as soon as they become available. Trial Registration Trial registration number: http://www.clinicaltrials.gov NCT00758641.

  3. Design and baseline characteristics of the Food4Me study: a web-based randomised controlled trial of personalised nutrition in seven European countries.

    Science.gov (United States)

    Celis-Morales, Carlos; Livingstone, Katherine M; Marsaux, Cyril F M; Forster, Hannah; O'Donovan, Clare B; Woolhead, Clara; Macready, Anna L; Fallaize, Rosalind; Navas-Carretero, Santiago; San-Cristobal, Rodrigo; Kolossa, Silvia; Hartwig, Kai; Tsirigoti, Lydia; Lambrinou, Christina P; Moschonis, George; Godlewska, Magdalena; Surwiłło, Agnieszka; Grimaldi, Keith; Bouwman, Jildau; Daly, E J; Akujobi, Victor; O'Riordan, Rick; Hoonhout, Jettie; Claassen, Arjan; Hoeller, Ulrich; Gundersen, Thomas E; Kaland, Siv E; Matthews, John N S; Manios, Yannis; Traczyk, Iwona; Drevon, Christian A; Gibney, Eileen R; Brennan, Lorraine; Walsh, Marianne C; Lovegrove, Julie A; Alfredo Martinez, J; Saris, Wim H M; Daniel, Hannelore; Gibney, Mike; Mathers, John C

    2015-01-01

    Improving lifestyle behaviours has considerable potential for reducing the global burden of non-communicable diseases, promoting better health across the life-course and increasing well-being. However, realising this potential will require the development, testing and implementation of much more effective behaviour change interventions than are used conventionally. Therefore, the aim of this study was to conduct a multi-centre, web-based, proof-of-principle study of personalised nutrition (PN) to determine whether providing more personalised dietary advice leads to greater improvements in eating patterns and health outcomes compared to conventional population-based advice. A total of 5,562 volunteers were screened across seven European countries; the first 1,607 participants who fulfilled the inclusion criteria were recruited into the trial. Participants were randomly assigned to one of the following intervention groups for a 6-month period: Level 0-control group-receiving conventional, non-PN advice; Level 1-receiving PN advice based on dietary intake data alone; Level 2-receiving PN advice based on dietary intake and phenotypic data; and Level 3-receiving PN advice based on dietary intake, phenotypic and genotypic data. A total of 1,607 participants had a mean age of 39.8 years (ranging from 18 to 79 years). Of these participants, 60.9 % were women and 96.7 % were from white-European background. The mean BMI for all randomised participants was 25.5 kg m(-2), and 44.8 % of the participants had a BMI ≥ 25.0 kg m(-2). Food4Me is the first large multi-centre RCT of web-based PN. The main outcomes from the Food4Me study will be submitted for publication during 2015.

  4. Evidence - competence - discourse: the theoretical framework of the multi-centre clinical ethics support project METAP.

    Science.gov (United States)

    Reiter-Theil, Stella; Mertz, Marcel; Schürmann, Jan; Stingelin Giles, Nicola; Meyer-Zehnder, Barbara

    2011-09-01

    In this paper we assume that 'theory' is important for Clinical Ethics Support Services (CESS). We will argue that the underlying implicit theory should be reflected. Moreover, we suggest that the theoretical components on which any clinical ethics support (CES) relies should be explicitly articulated in order to enhance the quality of CES. A theoretical framework appropriate for CES will be necessarily complex and should include ethical (both descriptive and normative), metaethical and organizational components. The various forms of CES that exist in North-America and in Europe show their underlying theory more or less explicitly, with most of them referring to some kind of theoretical components including 'how-to' questions (methodology), organizational issues (implementation), problem analysis (phenomenology or typology of problems), and related ethical issues such as end-of-life decisions (major ethical topics). In order to illustrate and explain the theoretical framework that we are suggesting for our own CES project METAP, we will outline this project which has been established in a multi-centre context in several healthcare institutions. We conceptualize three 'pillars' as the major components of our theoretical framework: (1) evidence, (2) competence, and (3) discourse. As a whole, the framework is aimed at developing a foundation of our CES project METAP. We conclude that this specific integration of theoretical components is a promising model for the fruitful further development of CES. © 2011 Blackwell Publishing Ltd.

  5. Assessment of data quality in an international multi-centre randomised trial of coronary artery surgery.

    Science.gov (United States)

    Krzych, Lukasz J; Lees, Belinda; Nugara, Fiona; Banya, Winston; Bochenek, Andrzej; Cook, Jo; Taggart, David; Flather, Marcus D

    2011-09-26

    ART is a multi-centre randomised trial of cardiac surgery which provided a unique opportunity to evaluate the data from a large number of centres from a variety of countries. We attempted to assess data quality, including recruitment rates, timeliness and completeness of the data obtained from the centres in different socio-economic strata. The analysis was based on the 2-page CRF completed at the 6 week follow-up. CRF pages were categorised into "clean" (no edit query) and "dirty" (any incomplete, inconsistent or illegible data). The timelines were assessed on the basis of the time interval from the visit and receipt of complete CRF. Data quality was defined as the number of data queries (in percent) and time delay (in days) between visit and receipt of correct data. Analyses were stratified according to the World Bank definitions into: "Developing" countries (Poland, Brazil and India) and "Developed" (Italy, UK, Austria and Australia). There were 18 centres in the "Developed" and 10 centres in the "Developing" countries. The rate of enrolment did not differ significantly by economic level ("Developing":4.1 persons/month, "Developed":3.7 persons/month). The time interval for the receipt of data was longer for "Developing" countries (median:37 days) compared to "Developed" ones (median:11 days) (p central management of data quality. ISRCTN46552265.

  6. Splinting after contracture release for Dupuytren's contracture (SCoRD: protocol of a pragmatic, multi-centre, randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Chojnowski Adrian J

    2008-04-01

    Full Text Available Abstract Background Splinting as part of the overall post-surgical management of patients after release of Dupuytren's contracture has been widely reported, though there is variation in practice and criteria for using it. The evidence on its effectiveness is sparse, of poor quality and contradictory with studies reporting negative and positive effects. Methods/Design A multi-centre, pragmatic, randomized, controlled trial is being conducted to evaluate the effect of static night splinting for six months on hand function, range of movement, patient satisfaction and recurrence at 1 year after fasciectomy or dermofasciectomy. Using a centrally administered computer randomization system consented patients will be allocated to one of two groups: i splint group who will be given a static splint at approximately 10 to 14 days after surgery to be worn for 6 months at night time only as well as hand therapy; ii non-splint group, who will receive hand therapy only. The primary outcome measure is the patient-reported Disabilities of the Arm, Hand and Shoulder Questionnaire (DASH. Secondary outcomes are total active flexion and extension of fingers, patient satisfaction and recurrence of contracture. Outcome measures will be collected prior to surgery, 3 months, 6 months and 1 year after surgery. Using the DASH as the primary outcome measure, where a difference of 15 points is considered to be a clinically important difference a total of 51 patients will be needed in each group for a power of 90%. An intention-to-treat analysis will be used. Discussion This pragmatic randomized controlled trial will provide much needed evidence on the clinical effectiveness of post-operative night splinting in patients who have undergone fasciectomy or dermofasciectomy for Dupuytren's contracture of the hand. Trial Registration Current Controlled Trials ISRCTN 57079614

  7. Relationship between risk factors and QUS in a European Population: The OPUS study.

    Science.gov (United States)

    Stewart, A; Felsenberg, D; Eastell, R; Roux, C; Glüer, C C; Reid, D M

    2006-09-01

    There are many risk factors associated with low bone mineral density. Quantitative ultrasound (QUS) is a generally accepted method for measurement of bone and has been shown to be strongly associated with future fracture risk. The Osteoporosis and Ultrasound Study (OPUS) is a multi-centre European wide study examining 5 different QUS scanners (4 calcaneal, 1 finger device). The aim of this paper was to examine the relationship between risk factors (as assessed by questionnaire) and QUS measurements. 449 younger women (aged 20 to 39 years) and 2283 older women (aged 55 to 79 years) were included in this analysis. As expected, those with a self-reported previous fracture had lower QUS measurements than those without (P < 0.001). However, no significant difference was seen between those reporting a maternal hip fracture and those who did not report such an event. Differences were found for smokers vs. non-smokers for SOS but not for BUA measurements. Weight was positively correlated with all BUA variables but only with some SOS variables. We determined which risk factors were most strongly associated with QUS measurements by using step-wise multiple regression. Models for each QUS measurement were calculated, and the R2 values ranged from 0.18 to 0.28 for SOS, 0.27 to 0.32 for BUA and 0.31 to 0.42 for the finger QUS device. The most common risk factors across all models were age, use of hormone replacement therapy, self-reported previous fracture, self-reported diagnosis of osteoporosis, current weight, pulse rate and self-reported estimated height at age 20 years. We analysed relationships across the 5 centres and detected some geographical differences in the prevalence of the risk factors. In conclusion, similar relationships are seen with QUS measurements as are found for bone mineral density. However, the strength of the association is dependent on the type of QUS device and variable measured.

  8. Crossroads in European Union Studies

    DEFF Research Database (Denmark)

    Lynggaard, Kennet; Löfgren, Karl; Manners, Ian James

    2015-01-01

    Over the past two decades the educational practices within EU studies have been challenged by the lack of comprehensive texts on research strategy, design and method useful for study programmes. Since the ‘comparative turn’ of the 1990s, where we saw a shift towards applying theories, analytical ...

  9. Crossroads in European Union Studies

    DEFF Research Database (Denmark)

    Lynggaard, Kennet; Löfgren, Karl; Manners, Ian James

    2015-01-01

    Over the past two decades the educational practices within EU studies have been challenged by the lack of comprehensive texts on research strategy, design and method useful for study programmes. Since the ‘comparative turn’ of the 1990s, where we saw a shift towards applying theories, analytical ...... the past weaknesses of methodology meet the future challenges of a new research agenda on Europe....

  10. Computerized detection of breast lesions in multi-centre and multi-instrument DCE-MR data using 3D principal component maps and template matching.

    Science.gov (United States)

    Ertas, Gokhan; Doran, Simon; Leach, Martin O

    2011-12-21

    In this study, we introduce a novel, robust and accurate computerized algorithm based on volumetric principal component maps and template matching that facilitates lesion detection on dynamic contrast-enhanced MR. The study dataset comprises 24,204 contrast-enhanced breast MR images corresponding to 4034 axial slices from 47 women in the UK multi-centre study of MRI screening for breast cancer and categorized as high risk. The scans analysed here were performed on six different models of scanner from three commercial vendors, sited in 13 clinics around the UK. 1952 slices from this dataset, containing 15 benign and 13 malignant lesions, were used for training. The remaining 2082 slices, with 14 benign and 12 malignant lesions, were used for test purposes. To prevent false positives being detected from other tissues and regions of the body, breast volumes are segmented from pre-contrast images using a fast semi-automated algorithm. Principal component analysis is applied to the centred intensity vectors formed from the dynamic contrast-enhanced T1-weighted images of the segmented breasts, followed by automatic thresholding to eliminate fatty tissues and slowly enhancing normal parenchyma and a convolution and filtering process to minimize artefacts from moderately enhanced normal parenchyma and blood vessels. Finally, suspicious lesions are identified through a volumetric sixfold neighbourhood connectivity search and calculation of two morphological features: volume and volumetric eccentricity, to exclude highly enhanced blood vessels, nipples and normal parenchyma and to localize lesions. This provides satisfactory lesion localization. For a detection sensitivity of 100%, the overall false-positive detection rate of the system is 1.02/lesion, 1.17/case and 0.08/slice, comparing favourably with previous studies. This approach may facilitate detection of lesions in multi-centre and multi-instrument dynamic contrast-enhanced breast MR data.

  11. Meeting the privacy requirements for the development of a multi-centre patient registry in Canada: the Rick Hansen Spinal Cord Injury Registry.

    Science.gov (United States)

    Noonan, Vanessa K; Thorogood, Nancy P; Joshi, Phalgun B; Fehlings, Michael G; Craven, B Catharine; Linassi, Gary; Fourney, Daryl R; Kwon, Brian K; Bailey, Christopher S; Tsai, Eve C; Drew, Brian M; Ahn, Henry; Tsui, Deborah; Dvorak, Marcel F

    2013-05-01

    Privacy legislation addresses concerns regarding the privacy of personal information; however, its interpretation by research ethics boards has resulted in significant challenges to the collection, management, use and disclosure of personal health information for multi-centre research studies. This paper describes the strategy used to develop the national Rick Hansen Spinal Cord Injury Registry (RHSCIR) in accordance with privacy statutes and benchmarked against best practices. An analysis of the regional and national privacy legislation was conducted to determine the requirements for each of the 31 local RHSCIR sites and the national RHSCIR office. A national privacy and security framework was created for RHSCIR that includes a governance structure, standard operating procedures, training processes, physical and technical security and privacy impact assessments. The framework meets a high-water mark in ensuring privacy and security of personal health information nationally and may assist in the development of other national or international research initiatives.

  12. Meeting the Privacy Requirements for the Development of a Multi-Centre Patient Registry in Canada: The Rick Hansen Spinal Cord Injury Registry

    Science.gov (United States)

    Noonan, Vanessa K.; Thorogood, Nancy P.; Joshi, Phalgun B.; Fehlings, Michael G.; Craven, B. Catharine; Linassi, Gary; Fourney, Daryl R.; Kwon, Brian K.; Bailey, Christopher S.; Tsai, Eve C.; Drew, Brian M.; Ahn, Henry; Tsui, Deborah; Dvorak, Marcel F.

    2013-01-01

    Privacy legislation addresses concerns regarding the privacy of personal information; however, its interpretation by research ethics boards has resulted in significant challenges to the collection, management, use and disclosure of personal health information for multi-centre research studies. This paper describes the strategy used to develop the national Rick Hansen Spinal Cord Injury Registry (RHSCIR) in accordance with privacy statutes and benchmarked against best practices. An analysis of the regional and national privacy legislation was conducted to determine the requirements for each of the 31 local RHSCIR sites and the national RHSCIR office. A national privacy and security framework was created for RHSCIR that includes a governance structure, standard operating procedures, training processes, physical and technical security and privacy impact assessments. The framework meets a high-water mark in ensuring privacy and security of personal health information nationally and may assist in the development of other national or international research initiatives. PMID:23968640

  13. A prospective, multi centre, randomized clinical study to compare the efficacy and safety of Ertapenem 3 days versus Ampicillin - Sulbactam 3 days in the treatment of localized community acquired intra-abdominal infection. (T.E.A. Study: Three days Ertapenem vs three days Ampicillin-sulbactam

    Directory of Open Access Journals (Sweden)

    Gazzotti Filippo

    2011-04-01

    Full Text Available Abstract Background The recommendations outlined in the latest guidelines published by the Surgical Infection Society (SIS and the Infectious Disease Society of America (IDSA regarding the proper duration of antibiotic therapy in patients with intra-abdominal infections are limited and non-specific. This ambiguity is due mainly to the lack of clinical trials on the topic of optimal duration of therapy. It is well known that the overuse of antibiotics has several important consequences such as increased treatment costs, reduced clinical efficacy, and above all, the increased emergence of antibiotic-resistant pathogens. Ampicillin-Sulbactam is a commonly used "first line" antibiotic for intra-abdominal infections. Ertapenem and Ampicillin-sulbactam are recommended as primary treatment agents for localized peritonitis by both the SIS and IDSA guidelines. Methods/Design This study is a prospective multi-center randomized investigation. The study will be performed in the Departments of General, Emergency, and Transplant Surgery of Sant'Orsola-Malpighi University Hospital in Bologna, Italy, in the General Surgery Department of the Ospedali Riuniti of Bergamo, Italy, and in the Trauma and Emergency Surgery Department of Maggiore Hospital in Bologna, Italy, and will be conducted by all surgeons willing to participate in the study. The inclusion period of the study will take approximately two years before the planned number of 142 enrolled patients is reached. Discussion Ertapenem and Ampicillin-sulbactam are recommended both as primary treatment agents for localized peritonitis by both the SIS and IDSA guidelines. As one of the discussed topic is the optimal duration of the antibiotic therapy and this ambiguity is due mainly to the lack of clinical trials on the topic, the present study aims for obtain precise data. Trial Registration ClinicalTrials.gov: NCT00630513

  14. Pilates based core stability training in ambulant individuals with multiple sclerosis: protocol for a multi-centre randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Freeman Jennifer

    2012-04-01

    Full Text Available Abstract Background People with Multiple Sclerosis (MS frequently experience balance and mobility impairments, including reduced trunk stability. Pilates-based core stability training, which is aimed at improving control of the body's stabilising muscles, is popular as a form of exercise with people with MS and therapists. A replicated single case series study facilitated by the Therapists in MS Group in the United Kingdom (UK provides preliminary evidence that this approach can improve balance and mobility in ambulant people with MS; further evidence is needed to substantiate these findings to ensure that limited time, energy, finances and resources are used to best effect. This study builds upon the pilot work undertaken in the case series study by implementing a powered randomised controlled study, with the aims of: 1 Establishing the effectiveness of core stability training 2 Comparing core stability training with standardised physiotherapy exercise 3 Exploring underlying mechanisms of change associated with this intervention Methods This is a multi-centre, double blind, block randomised, controlled trial. Eligible participants will be recruited from 4 UK centres. Participants will be randomly allocated to one of three groups: Pilates based core stability training, standardised physiotherapy exercise or contract-relax relaxation sessions (placebo control. All will receive face to face training sessions over a 12 week period; together with a 15 minute daily home programme. All will be assessed by a blinded assessor before training, at the end of the 12 week programme and at 4 week follow-up. The primary outcome measure is the 10 metre timed walk. Secondary outcome measures are the MS walking Scale (MSWS-12, the Functional Reach (forwards and lateral, a 10 point Numerical Rating Scale to determine "Difficulty in carrying a drink when walking", and the Activities-specific Balance Confidence (ABC Scale. In addition, ultrasound imaging of the

  15. Multi-centre evaluation of the speed-oligo Mycobacteria assay for differentiation of Mycobacterium spp. in clinical isolates

    Directory of Open Access Journals (Sweden)

    Hofmann-Thiel Sabine

    2011-12-01

    Full Text Available Abstract Background A new DNA line probe assay (Speed-oligo Mycobacteria, Vircell has been launched for rapid differentiation of Mycobacterium spp. from cultures. Compared to other line-probe assays, Speed-oligo Mycobacteria covers a relatively limited spectrum of species but uses a simpler and faster dip-stick technique. The present multi-centre, multi-country study aimed at evaluating the utility and usability of Speed-oligo Mycobacteria in routine mycobacteriology diagnostics. Results from Speed-oligo Myobacteria were compared to those from Genotype CM (HAIN lifescience, Nehren, Germany, another line-probe assay. Methods Speed-oligo Mycobacteria assay was performed in three main steps: 1 DNA extraction from cultured material 2 PCR amplification of the target gene and an internal control and 3 hybridization of the PCR products to specific probes by means of a dip-stick. Results Two hundred forty-two clinical isolates were recovered from consecutive positive mycobacterial cultures at two German (IML Gauting, Bioscientia Ingelheim, one Czech (KLINLAB Prague, and at a Sudanese (Khartoum laboratory. All Mycobacterium species covered by the assay were reliably recognized. The rate of false positive results was 1.2% and concerned only the species M. marinum and M. peregrinum. The identification rate, i.e. the proportion of isolates which was correctly differentiated to the level of species or complex by the assay, differed significantly among laboratories being 94.9%, 90.7%, and 75.0% at the study sites IML Gauting, KLINLAB Prague and Bioscientia Ingelheim, respectively. This difference was caused by different spectra of NTM species encountered by the laboratory centres in daily routine diagnostics. Conclusions Speed-oligo Mycobacteria assay was proved a rapid and easy-to-perform alternative to conventional line-probe assays. The assay showed excellent sensitivity with regard to identification of genus Mycobacterium and species/complexes covered by

  16. Effectiveness of a hospital-based work support intervention for female cancer patients - a multi-centre randomised controlled trial.

    Directory of Open Access Journals (Sweden)

    Sietske J Tamminga

    Full Text Available OBJECTIVE: One key aspect of cancer survivorship is return-to-work. Unfortunately, many cancer survivors face problems upon their return-to-work. For that reason, we developed a hospital-based work support intervention aimed at enhancing return-to-work. We studied effectiveness of the intervention compared to usual care for female cancer patients in a multi-centre randomised controlled trial. METHODS: Breast and gynaecological cancer patients who were treated with curative intent and had paid work were randomised to the intervention group (n = 65 or control group (n = 68. The intervention involved patient education and support at the hospital and improvement of communication between treating and occupational physicians. In addition, we asked patient's occupational physician to organise a meeting with the patient and the supervisor to make a concrete gradual return-to-work plan. Outcomes at 12 months of follow-up included rate and time until return-to-work (full or partial, quality of life, work ability, work functioning, and lost productivity costs. Time until return-to-work was analyzed with Kaplan-Meier survival analysis. RESULTS: Return-to-work rates were 86% and 83% (p = 0.6 for the intervention group and control group when excluding 8 patients who died or with a life expectancy of months at follow-up. Median time from initial sick leave to partial return-to-work was 194 days (range 14-435 versus 192 days (range 82-465 (p = 0.90 with a hazard ratio of 1.03 (95% CI 0.64-1.6. Quality of life and work ability improved statistically over time but did not differ statistically between groups. Work functioning and costs did not differ statistically between groups. CONCLUSION: The intervention was easily implemented into usual psycho-oncological care and showed high return-to-work rates. We failed to show any differences between groups on return-to-work outcomes and quality of life scores. Further research is needed to study which

  17. Presentations to the Emergency Department Following Cannabis use--a Multi-Centre Case Series from Ten European Countries.

    Science.gov (United States)

    Dines, Alison M; Wood, David M; Galicia, Miguel; Yates, Christopher M; Heyerdahl, Fridtjof; Hovda, Knut Erik; Giraudon, Isabelle; Sedefov, Roumen; Dargan, Paul I

    2015-12-01

    Cannabis is the most commonly used illicit drug in Europe, and is generally regarded as having low acute toxicity. We present the findings of the first 6 months of data collection from the Euro-DEN project on presentations related to cannabis use to further understand the acute toxicity related to the use of cannabis. Data was extracted on clinical features, treatment and outcome from the Euro-DEN minimum dataset for all cases of acute recreational drug toxicity reported 1st October 2013 to 31st March 2014 for all cannabis-related presentations. Of 2198 presentations reported by 14 of the 16 Euro-DEN centres, 356 (16.2 %) involved cannabis either alone or together with other drugs/alcohol. There were 36 that involved lone use of cannabis (1.6 % of all presentations). Of the 35 non-fatal lone cannabis presentations, the most commonly reported features were neuro-behavioural (agitation/aggression 8 (22.9 %), psychosis 7 (20.0 %), anxiety 7 (20.0 %)) and vomiting 6 (17.1 %). Most patients (25, 71.4 %) received no treatment and 30 (85.7 %) were discharged/self-discharged from the ED. There was one fatality amongst these lone-cannabis cases: an 18-year-old male collapsed with an asystolic cardiac arrest whilst smoking cannabis and suffered hypoxic brain injury related to prolonged cardiac arrest. THC was detected in a urine sample taken at ED arrival; no other drugs were detected. Lone acute cannabis toxicity was typically associated with neuro-behavioural symptoms and vomiting. Although uncommon, severe toxicity including cardiovascular toxicity and death may be under-recognised, and it is important that Emergency Physicians are aware of this.

  18. Report on the use of sampling frames in European studies

    NARCIS (Netherlands)

    Scherpenzeel, A.; Maineri, Angelica; Bristle, Johanna; Pflüger, Senta-Melissa; Mindarova, Ilziya; Butt, Sarah; Zins, Stefan; Emery, Tom; Luijkx, R.

    2017-01-01

    Obtaining good probability samples is a key challenge for European cross-national studies in order to represent the population. This report gives an overview of the sampling frames which are used in countries participating in the four cross-European surveys cooperating in SERISS: the European Social

  19. Outcome of implantable cardioverter defibrillators in adults with congenital heart disease : a multi-centre study

    NARCIS (Netherlands)

    Yap, Sing-Chien; Roos-Hesselink, Jolien W.; Hoendermis, Elke S.; Budts, Werner; Vliegen, Hubert W.; Mulder, Barbara J. M.; van Dijk, Arie P. J.; Schalij, Martin J.; Drenthen, Willem

    2007-01-01

    Aims To investigate outcome and complications of implantable cardioverter defibrillators (ICDs) in adults with congenital heart disease (CHD) and to identify predictors of (in-) appropriate shocks. Methods and results Sixty-four CHD patients >= 18 years at first ICD implantation [63% tetralogy of Fa

  20. [Personality traits in patients with migraine: a multi-centre study using the Salamanca screening questionnaire].

    Science.gov (United States)

    Munoz, Irene; Toribio-Díaz, M Elena; Carod-Artal, Francisco J; Peñas-Martínez, M Luz; Ruiz, Lara; Domínguez, Elena; Pedraza, M Isabel; Molina, Vicente; Guerrero-Peral, Angel L; Uribe, Fernando

    2013-12-16

    Introduccion. La comorbilidad psiquiatrica en migraña es frecuente, y se ha estudiado mas la relacionada con trastornos afectivos y ansiedad que los rasgos de personalidad. Objetivo. Estudiar la presencia de rasgos de personalidad en personas con migraña y su relacion con la presencia de migraña cronica o abuso de medicacion. Pacientes y metodos. Se evaluan pacientes atendidos consecutivamente en cinco centros. Se exploran, mediante las 22 preguntas del cuestionario de cribado Salamanca, 11 rasgos de personalidad agrupados en tres grupos. Se obtuvieron datos referentes a las caracteristicas demograficas e impacto de la migraña. Resultados. Se incluyeron en el estudio 164 pacientes (134 mujeres, 30 varones), con una edad media de 36,6 ± 12,5 años (rango: 18-78 años). En la mayoria de los pacientes, el impacto de la migraña fue elevado. Los rasgos de personalidad que aparecieron mas frecuentemente fueron: ansioso (53,7%), anancastico (44,5%), histrionico (40,9%) y dependiente (32,9%). El riesgo de migraña cronica fue superior en pacientes con el rasgo anancastico (riesgo relativo = 2,06; intervalo de confianza al 95% = 1,07-3,94; p = 0,027). Conclusiones. Hay rasgos de personalidad detectables con el cuestionario Salamanca muy frecuentes en pacientes migrañosos. En nuestra serie, el rasgo anancastico se relaciona con la presencia de migraña cronica.

  1. Alarm Variables for Dengue Outbreaks: A Multi-Centre Study in Asia and Latin America.

    Directory of Open Access Journals (Sweden)

    Leigh R Bowman

    Full Text Available Worldwide, dengue is an unrelenting economic and health burden. Dengue outbreaks have become increasingly common, which place great strain on health infrastructure and services. Early warning models could allow health systems and vector control programmes to respond more cost-effectively and efficiently.The Shewhart method and Endemic Channel were used to identify alarm variables that may predict dengue outbreaks. Five country datasets were compiled by epidemiological week over the years 2007-2013. These data were split between the years 2007-2011 (historic period and 2012-2013 (evaluation period. Associations between alarm/ outbreak variables were analysed using logistic regression during the historic period while alarm and outbreak signals were captured during the evaluation period. These signals were combined to form alarm/ outbreak periods, where 2 signals were equal to 1 period. Alarm periods were quantified and used to predict subsequent outbreak periods. Across Mexico and Dominican Republic, an increase in probable cases predicted outbreaks of hospitalised cases with sensitivities and positive predictive values (PPV of 93%/ 83% and 97%/ 86% respectively, at a lag of 1-12 weeks. An increase in mean temperature ably predicted outbreaks of hospitalised cases in Mexico and Brazil, with sensitivities and PPVs of 79%/ 73% and 81%/ 46% respectively, also at a lag of 1-12 weeks. Mean age was predictive of hospitalised cases at sensitivities and PPVs of 72%/ 74% and 96%/ 45% in Mexico and Malaysia respectively, at a lag of 4-16 weeks.An increase in probable cases was predictive of outbreaks, while meteorological variables, particularly mean temperature, demonstrated predictive potential in some countries, but not all. While it is difficult to define uniform variables applicable in every country context, the use of probable cases and meteorological variables in tailored early warning systems could be used to highlight the occurrence of dengue outbreaks or indicate increased risk of dengue transmission.

  2. A multi-centre phase IIa clinical study of predictive testing for preeclampsia

    DEFF Research Database (Denmark)

    Navaratnam, Kate; Alfirevic, Zarko; Baker, Philip N;

    2013-01-01

    5% of first time pregnancies are complicated by pre-eclampsia, the leading cause of maternal death in Europe. No clinically useful screening test exists; consequentially clinicians are unable to offer targeted surveillance or preventative strategies. IMPROvED Consortium members have pioneered...... a personalised medicine approach to identifying blood-borne biomarkers through recent technological advancements, involving mapping of the blood metabolome and proteome. The key objective is to develop a sensitive, specific, high-throughput and economically viable early pregnancy screening test for pre-eclampsia....

  3. Health status of children with cerebral palsy living in Europe: a multi-centre study

    DEFF Research Database (Denmark)

    Beckung, E; White-Koning, M; Marcelli, M

    2008-01-01

    AIM: The aim of this report is to describe the health status of 8-12-year-old children with cerebral palsy (CP) of all severities in Europe using the Child Health Questionnaire (CHQ). METHOD: A total of 818 children with CP from nine centres in defined geographical areas participated. CP type......, gross and fine motor function, additional impairments were classified and family data were obtained. The CHQ was used to measure the parent's perception of their child's physical (PHY) and psychosocial (PSY) health. RESULTS: PHY scores were lower than the reference samples with a median of 46......, parental education and employment revealed gross motor function, cognitive level and type of school attended were significant prognostic factors. CONCLUSION: This report is based on the largest sample to date of children with CP. Health status as measured using the CHQ was affected in all children...

  4. [Electrical status epilepticus during sleep: a retrospective multi-centre study of 29 cases].

    Science.gov (United States)

    Lorenzo-Ruiz, María; Miguel-Martin, Beatriz; García-Pérez, Asunción; Martínez-Granero, Miguel A; Aguilera-Albesa, Sergio; Yoldi-Petri, M Eugenia; Sánchez-Ruiz de Gordoa, Javier; Castro-De Castro, Pedro; Sánchez-Carpintero, Rocío

    2015-02-01

    Introduccion. El estado epileptico electrico durante el sueño (ESES) es un sindrome epileptico caracterizado por la presencia de descargas epilepticas tipo punta-onda lenta de manera muy persistente durante el sueño no REM. En la actualidad, el manejo de esta patologia es heterogeneo y no hay estudios controlados con los tratamientos utilizados, ni se ha comprobado si estos mejoran la evolucion cognitiva de los pacientes. Pacientes y metodos. Se revisan los pacientes diagnosticados de ESES durante 15 años en cuatro centros hospitalarios, se recoge la presentacion clinica, el manejo terapeutico y la evolucion clinica, y se compara con la bibliografia. Resultados. Se seleccionaron 29 pacientes con ESES, 20 de ellos idiopatico y 26 de ellos generalizado. Los farmacos con los que se consiguio mayor control de la actividad electrica fueron los corticoides/hormona adrenocorticotropa (ACTH), el clobazam y el levetiracetam. La mediana de duracion del ESES en los casos primarios fue de seis meses, y en los secundarios, el doble. El 45% de los pacientes mantuvo un cociente intelectual normal y un 40% presento en la evolucion discapacidad cognitiva de diferente grado. Conclusiones. El pronostico neuropsicologico evolutivo suele ser desfavorable y la evolucion cognitiva parece estar en relacion con la duracion del ESES y el area donde este concentrada la actividad epileptica, lo que sugiere que el mal pronostico, si se trata precozmente, se puede evitar. Los antiepilepticos mas frecuentemente utilizados son el acido valproico, la etosuximida y el levetiracetam, y en nuestra muestra tambien se utilizaron con frecuencia el clobazam y la lamotrigina. Los farmacos mas eficaces para el control del ESES fueron los corticoides/ACTH, el clobazam y el levetiracetam.

  5. Understanding resident ratings of teaching in the workplace: a multi-centre study

    NARCIS (Netherlands)

    Fluit, C.R.M.G.; Feskens, R.; Bolhuis, S.; Grol, R.; Wensing, M.; Laan, R.

    2015-01-01

    Providing clinical teachers with feedback about their teaching skills is a powerful tool to improve teaching. Evaluations are mostly based on questionnaires completed by residents. We investigated to what extent characteristics of residents, clinical teachers, and the clinical environment influenced

  6. A web-based intervention (RESTORE) to support self-management of cancer-related fatigue following primary cancer treatment: a multi-centre proof of concept randomised controlled trial

    OpenAIRE

    Foster, Claire; Grimmett, Chloe; May, Christine M.; Ewings, Sean; Myall, Michelle; Hulme, Claire; Smith, Peter W.; Powers, Cassandra; Calman, Lynn; Armes, Jo; Breckons, Matthew; Corner, Jessica; Fenlon, Deborah; Batehup, Lynn; Lennan, Elaine

    2015-01-01

    Purpose: Cancer-related fatigue (CRF) is a frequent and distressing symptom experienced after cancer treatment. RESTORE is the first web-based resource designed to enhance self-efficacy to manage CRF following curative-intent treatment. The aim of this study is to test the proof of concept and inform the design of an effectiveness trial.\\ud \\ud Methods: A multi-centre parallel-group two-armed (1:1) exploratory randomised controlled trial (RCT) with qualitative process evaluation was employed ...

  7. Design and performance of a multi-centre randomised controlled trial and economic evaluation of joint tele-consultations [ISRCTN54264250

    Directory of Open Access Journals (Sweden)

    Thompson Simon

    2002-01-01

    Full Text Available Abstract Background Appropriate information flow is crucial to the care of patients, particularly at the interface between primary and secondary care. Communication problems can result from inadequate organisation and training, There is a major expectation that information and communication technologies may offer solutions, but little reliable evidence. This paper reports the design and performance of a multi-centre randomised controlled trial (RCT, unparalleled in telemedicine research in either scale or range of outcomes. The study investigated the effectiveness and cost implications in rural and inner-city settings of using videoconferencing to perform joint tele-consultations as an alternative to general practitioner referral to the hospital specialist in the outpatient clinic. Methods Joint tele-consultation services were established in both the Royal Free Hampstead NHS Trust in inner London, and the Royal Shrewsbury Hospitals Trust, in Shropshire. All the patients who gave consent to participate were randomised either to joint tele-consultation or to a routine outpatients appointment. The principal outcome measures included the frequency of decision by the specialist to offer a follow-up outpatient appointment, patient satisfaction (Ware Specific Questionnaire, wellbeing (SF12 and enablement (PEI, numbers of tests, investigations, procedures and treatments. Results A total of 134 general practitioners operating from 29 practices participated in the trial, referring a total of 3170 patients to 20 specialists in ENT medicine, general medicine (including endocrinology, and rheumatology, gastroenterology, orthopaedics, neurology and urology. Of these, 2094 patients consented to participate in the study and were correctly randomised. There was a 91% response rate to the initial assessment questionnaires, and analysis showed equivalence for all key characteristics between the treatment and control groups. Conclusion We have designed and

  8. A multi-centre investigation towards reaching a consensus on the immunohistochemical detection of ERbeta in archival formalin-fixed paraffin embedded human breast tissue.

    Science.gov (United States)

    Carder, Pauline J; Murphy, Claire E; Dervan, Peter; Kennedy, Maria; McCann, Amanda; Saunders, Philippa T K; Shaaban, Abeer M; Foster, Christopher S; Witton, Caroline J; Bartlett, John M S; Walker, Rosemary A; Speirs, Valerie

    2005-08-01

    Estrogen receptor (ER) alpha is a well-established independent prognostic factor in breast cancer whose presence determines the clinical implications of adjuvant endocrine therapy. A second receptor, ERb has been described, and a number of studies have examined its expression in breast tissue. However elucidation of the role played by ERb has been hampered by published immunohistochemical studies employing a variety of protocols and scoring systems such that inter-laboratory comparisons are difficult. Here we present a multi-centre study designed to critically evaluate inter-laboratory differences in methodology. Six UK and Irish centres participated in this study. A small series of breast cancers were stained using centre-specific laboratory protocols and scored using both centrespecific and standard scoring protocols. There was generally poor agreement as to what constituted a positive or negative case when centre-specific scoring systems were used with less than half of all cases in agreement. Concordance was improved when a standard scoring system was used but varied according to threshold for positivity employed and primary antibody. Our results emphasise the need for further studies addressing the role of ERb to be based on a wider consensus on criteria for positivity. Ideally this should be based on calibration against clinical outcome.

  9. A multi-centre, prospective, clinical in-market evaluation to assess the performance of Opsite™ Post-Op Visible dressings.

    LENUS (Irish Health Repository)

    O'Brien, Gillian

    2010-10-01

    The aim of this study was to assess the performance of Opsite™ Post-Op Visible as a post-surgical dressing in a typical clinical setting. In this multi-centre clinical evaluation, patients who underwent clean surgery were treated with Opsite Post-Op Visible dressing. Duration of dressing wear, visibility through the dressing and ability to handle exudate were assessed and the product was rated in comparison with those normally used. A total of 64 patients were recruited. Mean wear time was 4·5 days. Exudate management was rated very good or good at 96% of assessments. Visibility of the incision site was rated as very good or good at 72%, and as acceptable at 24%, of assessments. Patient comfort was rated very comfortable (63%) or comfortable (37%) at all assessments. Dressings were generally rated as satisfactory or exceeding expectations with clinicians stating that the Opsite Post-Op Visible dressing was better than the dressing they routinely used for 92% of patients. Opsite Post-Op Visible dressing is an innovative dressing combining good visibility with exudate management and patient comfort. It was found to have adequate wear time, visibility and exudate management properties making it suitable for use on a variety of surgical incision sites.

  10. European contribution to the study of ROS

    DEFF Research Database (Denmark)

    Egea, Javier; Fabregat, Isabel; Frapart, Yves M

    2017-01-01

    The European Cooperation in Science and Technology (COST) provides an ideal framework to establish multi-disciplinary research networks. COST Action BM1203 (EU-ROS) represents a consortium of researchers from different disciplines who are dedicated to providing new insights and tools for better u...

  11. Linking Public Administration and Law Studies within European Union

    Directory of Open Access Journals (Sweden)

    Mihaela V. Cărăuşan

    2012-05-01

    Full Text Available The year 1987 represented for us, scholars, the turning point for the Europeanization of highdegree studies. The European Region Action Scheme for the Mobility of University Students (ERASMUS isa European Union student exchange program which has proved its utility in the last two decade. The publicadministration and law studies are two of the fields of studies which have benefited from the ERASMUSProgramme. In this respect we will try to learn the lesson of internationalization from the European contactthrough ERASMUS programme. The ‘win win’ for students is not just in the increase of knowledge in thearea of administrative sciences and law, but also in the share of cultures. The ERASMUS gives students abetter sense of what it means to be a European citizen. In addition, many employers highly value such aperiod abroad, which increases the students’ employability and job prospects.

  12. Geometries of low spin states of multi-centre transition metal complexes through extended broken symmetry variational Monte Carlo

    Science.gov (United States)

    Barborini, Matteo; Guidoni, Leonardo

    2016-09-01

    The correct description of the ground state electronic and geometrical properties of multi-centre transition metal complexes necessitates of a high-level description of both dynamical and static correlation effects. In di-metallic complexes, the ground state low spin properties can be computed starting from single-determinants High-Spin (HS) and Broken Symmetry (BS) states by reconstructing an approximated low spin potential energy surface through the extended broken symmetry approach, based on the Heisenberg Hamiltonian. In the present work, we first apply this approach within the variational Monte Carlo method to tackle the geometry optimization of a Fe2S2(SH)42- model complex. To describe the HS and BS wavefunctions, we use a fully optimized unrestricted single determinant with a correlated Jastrow factor able to recover a large amount of dynamical correlation. We compared our results with those obtained by density functional theory and other multiconfigurational approaches, discussing the role of the nodal surface on the structural parameters.

  13. Protocol for the combined immunosuppression & radiotherapy in thyroid eye disease (CIRTED trial: A multi-centre, double-masked, factorial randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Kingston Laura

    2008-01-01

    Full Text Available Abstract Background Medical management of thyroid eye disease remains controversial due to a paucity of high quality evidence on long-term treatment outcomes. Glucocorticoids are known to be effective initially but have significant side-effects with long-term use and recrudescence can occur on cessation. Current evidence is conflicting on the efficacy of radiotherapy and non-steroid systemic immunosuppression, and the majority of previous studies have been retrospective, uncontrolled, small or poorly designed. The Combined Immunosuppression and Radiotherapy in Thyroid Eye Disease (CIRTED trial was designed to investigate the efficacy of radiotherapy and azathioprine in combination with a standard course of oral prednisolone in patients with active thyroid eye disease. Methods/design Patients with active thyroid eye disease will be randomised to receive (i azathioprine or oral placebo and (ii radiotherapy or sham-radiotherapy in this multi-centre, factorial randomised control trial. The primary outcome is improvement in disease severity (assessed using a composite binary measure at 12 months and secondary end-points include quality of life scores and health economic measures. Discussion The CIRTED trial is the first study to evaluate the role of radiotherapy and azathioprine as part of a long-term, combination immunosuppressive treatment regime for Thyroid Eye Disease. It will provide evidence for the role of radiotherapy and prolonged immunosuppression in the management of this condition, as well as pilot data on their use in combination. We have paid particular attention in the trial design to establishing (a robust placebo controls and masking protocols which are effective and safe for both radiotherapy and the systemic administration of an antiproliferative drug; (b constructing effective inclusion and exclusion criteria to select for active disease; and (c selecting pragmatic outcome measures. Trial registration Current controlled trials

  14. Design and baseline characteristics of the Food4Me study: a web-based randomised controlled trial of personalised nutrition in seven European countries

    OpenAIRE

    Celis-Morales, Carlos; Livingstone, Katherine M.; Marsaux, Cyril F. M.; Forster, Hannah; O’Donovan, Clare B; Woolhead, Clara; Macready, Anna L.; Fallaize, Rosalind; Navas-Carretero, Santiago; San-Cristobal, Rodrigo; Kolossa, Silvia; Hartwig, Kai; Tsirigoti, Lydia; Lambrinou, Christina P.; Moschonis, George

    2014-01-01

    Improving lifestyle behaviours has considerable potential for reducing the global burden of non-communicable diseases, promoting better health across the life-course and increasing well-being. However, realising this potential will require the development, testing and implementation of much more effective behaviour change interventions than are used conventionally. Therefore, the aim of this study was to conduct a multi-centre, web-based, proof-of-principle study of personalised nutrition (PN...

  15. European birth cohort studies on asthma and atopic diseases

    DEFF Research Database (Denmark)

    Keil, T; Kulig, M; Simpson, A;

    2006-01-01

    BACKGROUND: The Global Allergy and Asthma European Network (GA2LEN) is a consortium of 26 leading European research centres committed to establish a European research area of excellence in the field of allergy and asthma. AIM: One of the GA2LEN work packages was designed to identify and compare...... asthma and atopic diseases. Data were collected by visiting most of the participating research teams and interviewing all relevant study personnel. For each study, the type of objective/subjective outcome parameters and potentially influential factors were recorded precisely for every time point during...... the existing European birth cohort studies on asthma and atopic diseases. The present review compares their subjective and objective outcomes as well as exposure variables. METHODS: A common database was established to assess study characteristics of observational birth cohort studies designed to examine...

  16. Safety of intramuscular influenza vaccine in patients receiving oral anticoagulation therapy: a single blinded multi-centre randomized controlled clinical trial

    Directory of Open Access Journals (Sweden)

    Benítez Mència

    2008-05-01

    Full Text Available Abstract Background Influenza vaccines are recommended for administration by the intramuscular route. However, many physicians use the subcutaneous route for patients receiving an oral anticoagulant because this route is thought to induce fewer hemorrhagic side effects. Our aim is to assess the safety of intramuscular administration of influenza vaccine in patients on oral anticoagulation therapy. Methods Design: Randomised, controlled, single blinded, multi-centre clinical trial. Setting: 4 primary care practices in Barcelona, Spain. Participants: 229 patients on oral anticoagulation therapy eligible for influenza vaccine during the 2003–2004 season. Interventions: intramuscular administration of influenza vaccine in the experimental group (129 patients compared to subcutaneous administration in the control group (100 patients. Primary outcome: change in the circumference of the arm at the site of injection at 24 hours. Secondary outcomes: appearance of local reactions and pain at 24 hours and at 10 days; change in INR (International Normalized Ratio at 24 hours and at 10 days. Analysis was by intention to treat using the 95% confidence intervals of the proportions or mean differences. Results Baseline variables in the two groups were similar. No major side effects or major haemorrhage during the follow-up period were reported. No significant differences were observed in the primary outcome between the two groups. The appearance of local adverse reactions was more frequent in the subcutaneous administration group (37,4% vs. 17,4%, 95% confidence interval of the difference 8,2% to 31,8%. Conclusion This study shows that the intramuscular administration route of influenza vaccine in patients on anticoagulant therapy does not have more side effects than the subcutaneous administration route. Registration number NCT00137579 at clinicaltrials.gov

  17. Fraser syndrome : epidemiological study in a European population

    NARCIS (Netherlands)

    Barisic, Ingeborg; Odak, Ljubica; Loane, Maria; Garne, Ester; Wellesley, Diana; Calzolari, Elisa; Dolk, Helen; Addor, Marie-Claude; Arriola, Larraitz; Bergman, Jorieke; Bianca, Sebastiano; Boyd, Patricia A; Draper, Elizabeth S; Gatt, Miriam; Haeusler, Martin; Khoshnood, Babak; Latos-Bielenska, Anna; McDonnell, Bob; Pierini, Anna; Rankin, Judith; Rissmann, Anke; Queisser-Luft, Annette; Verellen-Dumoulin, Christine; Stone, David; Tenconi, Romano

    2013-01-01

    Fraser syndrome is a rare autosomal recessive disorder characterized by cryptophthalmos, cutaneous syndactyly, laryngeal, and urogenital malformations. We present a population-based epidemiological study using data provided by the European Surveillance of Congenital Anomalies (EUROCAT) network of bi

  18. European Liaisons? A study on European bi-national marriages in Belgium

    NARCIS (Netherlands)

    Koelet, S.; de Valk, H.A.G.

    2014-01-01

    European bi-national marriages as a special case of interethnic unions have received relatively little attention in research. Existing studies on interethnic marriage mainly orient on union formation among non-western migrants and in particular intermarriages between the majority group and non-weste

  19. Work related musculoskeletal disorders among hospital nurses in rural Maharashtra, India: a multi centre survey

    Directory of Open Access Journals (Sweden)

    Deepak B. Anap

    2013-04-01

    Full Text Available Nurses have one of the highest rates of MSD of any occupation. Although en number of studies were done to find out prevalence of Work related musculoskeletal disorders (WMSDs among nurses across the world, there is limited information on its prevalence in Rural Maharashtra. This study investigated prevalence of WMSDs, job risk factors and the coping strategies towards reducing the risk of development of WMSDs among nurses from selected hospitals in rural Maharashtra, India. Validated questionnaires were distributed to 250 nurses working rural hospitals across Maharashtra but only 228 questionnaires were returned and 212 complete questionnaires were included for study. On Analysis we found that 89.1% nurses had experienced work-related musculoskeletal pain or discomfort at sometime in their occupational lives. WMSDs was highest in the low back (48.2%, followed by the shoulder (34.6%, neck (33.1 and knee (29 %. Other regions with less prevalence were Thoracic (10.5%, Feet and ankle (7.6%, Elbow ( 1.88% and Hip (1.6 %. Priority was given to getting help to handle heavy patients ( 57.1 %, nursing procedure modification in order to avoid stress injury ( 50.2 % coping strategies. Our study Concluded that high prevalence of LBP, Shoulder, neck and Knee pain over a 12-month period among nurses working in Rural hospitals in Maharashtra state , and certain risk factors like working in same position for long time, bending, twisting, lifting and treating excessive number of patients were strongly associated with WMSDs. [Int J Res Med Sci 2013; 1(2.000: 101-107

  20. Multi-centre testing and validation of current protocols for the identification of Gyrodactylus salaris (Monogenea).

    Science.gov (United States)

    Shinn, A P; Collins, C; García-Vásquez, A; Snow, M; Matejusová, I; Paladini, G; Longshaw, M; Lindenstrøm, T; Stone, D M; Turnbull, J F; Picon-Camacho, S M; Rivera, C Vázquez; Duguid, R A; Mo, T A; Hansen, H; Olstad, K; Cable, J; Harris, P D; Kerr, R; Graham, D; Monaghan, S J; Yoon, G H; Buchmann, K; Taylor, N G H; Bakke, T A; Raynard, R; Irving, S; Bron, J E

    2010-10-01

    Despite routine screening requirements for the notifiable fish pathogen Gyrodactylus salaris, no standard operating procedure exists for its rapid identification and discrimination from other species of Gyrodactylus. This study assessed screening and identification efficiencies under real-world conditions for the most commonly employed identification methodologies: visual, morphometric and molecular analyses. Obtained data were used to design a best-practice processing and decision-making protocol allowing rapid specimen throughput and maximal classification accuracy. True specimen identities were established using a consensus from all three identification methods, coupled with the use of host and location information. The most experienced salmonid gyrodactylid expert correctly identified 95.1% of G. salaris specimens. Statistical methods of classification identified 66.7% of the G. salaris, demonstrating the need for much wider training. Molecular techniques (internal transcribed spacer region-restriction fragment length polymorphism (ITS-RFLP)/cytochrome c oxidase I (COI) sequencing) conducted in the diagnostic laboratory most experienced in the analysis of gyrodactylid material, identified 100% of the true G. salaris specimens. Taking into account causes of potential specimen loss, the probabilities of a specimen being accurately identified were 95%, 87% and 92% for visual, morphometric and molecular techniques, respectively, and the probabilities of correctly identifying a specimen of G. salaris by each method were 81%, 58% and 92%. Inter-analyst agreement for 189 gyrodactylids assessed by all three methods using Fleiss' Kappa suggested substantial agreement in identification between the methods. During routine surveillance periods when low numbers of specimens are analysed, we recommend that specimens be analysed using the ITS-RFLP approach followed by sequencing of specimens with a "G. salaris-like" (i.e. G. salaris, Gyrodactylus thymalli) banding pattern

  1. Reflecting on the methodological challenges of recruiting to a United Kingdom-wide, multi-centre, randomised controlled trial in gynaecology outpatient settings

    OpenAIRE

    2013-01-01

    Background Successful recruitment of participants to any trial is central to its success. Trial results are routinely published, and recruitment is often cited to be slower and more difficult than anticipated. This article reflects on the methodological challenges of recruiting women with prolapse attending United Kingdom (UK) gynaecology outpatient clinics to a multi-centre randomised controlled trial (RCT) of physiotherapy, and the systems put in place in an attempt to address them. Methods...

  2. European Studies and Public Engagement: A Conceptual Toolbox

    Directory of Open Access Journals (Sweden)

    Andreas Müllerleile

    2014-11-01

    Full Text Available Journal of Contemporary European Research User Username Password Remember me Subscribe... Sign up for issue alerts Follow JCER on Twitter Font Size Make font size smaller Make font size default Make font size larger Journal Content Search Search Scope Browse By Issue By Author By Title Information For Readers For Authors For Librarians Journal Help Keywords CFSP Communication ESDP EU EU enlargement EU trade policy Energy, EU, External Policy Europe European Commission European Parliament European Union European integration Europeanisation First Enlargement Germany Liberty Lisbon Treaty Poland Russia Security teaching European studies The UACES Blog The Commission after the 2014 EP... Power shift? The EU’s pivot to Asia 100 Books on Europe to be Remembered For a Global European Studies? EU Member State Building in the... Open Journal Systems Home About Login Register Search Current Archives Announcements UACES Home > Vol 10, No 4 (2014 > Müllerleile European Studies and Public Engagement: A Conceptual Toolbox Andreas Müllerleile Abstract This article examines public engagement strategies for academics working in the field of European Studies. Should academics engage with the public? What are the most effective outreach strategies? And what are the implications for universities and departments? The article argues that engaging with the public should be considered an integral part for academics working on topics that relate to the European Union or European politics. The article has a theoretical and a practical dimension. The first part of the paper deals with the nature of public engagement, explaining why it is an important issue and how it differs from the mainstream understanding of public engagement. The practical part of the paper presents the idea of building an online presence through which academics can engage with the public debate both during periods of low issue salience and high issue salience. The final section includes a toolbox

  3. Early Life Factors and Inter-Country Heterogeneity in BMI Growth Trajectories of European Children: The IDEFICS Study.

    Directory of Open Access Journals (Sweden)

    Claudia Börnhorst

    Full Text Available Starting from birth, this explorative study aimed to investigate between-country differences in body mass index (BMI trajectories and whether early life factors explain these differences.The sample included 7,644 children from seven European countries (Belgium, Cyprus, Germany, Hungary, Italy, Spain, Sweden participating in the multi-centre IDEFICS study. Information on early life factors and in total 53,409 repeated measurements of height and weight from 0 to <12 years of age were collected during the baseline (2007/2008 and follow-up examination (2009/2010 supplemented by records of routine child health visits. Country-specific BMI growth curves were estimated using fractional polynomial mixed effects models. Several covariates focussing on early life factors were added to the models to investigate their role in the between-countries differences.Large between-country differences were observed with Italian children showing significantly higher mean BMI values at all ages ≥ 3 years compared to the other countries. For instance, at age 11 years mean BMI values in Italian boys and girls were 22.3 [21.9;22.8; 99% confidence interval] and 22.0 [21.5;22.4], respectively, compared to a range of 18.4 [18.1;18.8] to 20.3 [19.8;20.7] in boys and 18.2 [17.8;18.6] to 20.3 [19.8;20.7] in girls in the other countries. After adjustment for early life factors, differences between country-specific BMI curves became smaller. Maternal BMI was the factor being most strongly associated with BMI growth (p<0.01 in all countries with associations increasing during childhood. Gestational weight gain (GWG was weakly associated with BMI at birth in all countries. In some countries, positive associations between BMI growth and children not being breastfed, mothers' smoking during pregnancy and low educational level of parents were found.Early life factors seem to explain only some of the inter-country variation in growth. Maternal BMI showed the strongest association

  4. SU-C-BRD-01: Multi-Centre Collaborative Quality Assurance Program for IMRT Planning and Delivery: Year 3 Results

    Energy Technology Data Exchange (ETDEWEB)

    McNiven, A; Jaffray, D; Letourneau, D [Princess Margaret Cancer Centre and Department of Radiation Oncology, University of Toronto, Toronto, ON (Canada)

    2015-06-15

    Purpose: A multi-centre quality assurance program was developed to enable quality improvement by coupling measurement of intensity modulated radiotherapy (IMRT) planning and delivery performance for site-specific planning exercises with diagnostic testing. The third year of the program specifically assessed the quality of spine stereotactic body radiotherapy (SBRT) planning and delivery amongst the participating centres. Methods: A spine SBRT planning exercise (24 Gy in 2 fractions) was created and completed by participants prior to an on-site visit. The delivery portion of the on-site visit included spine SBRT plan delivery and diagnostic testing, which included portal image acquisition for quantification of phantom positioning error and multi-leaf collimator (MLC) calibration accuracy. The measured dose was compared to that calculated in the treatment planning system (TPS) using 3%/2mm composite analysis and 3%/3mm gamma analysis. Results: Fourteen institutions participated, creating 17 spine SBRT plans (15 VMAT and 2 IMRT). Three different TPS, two beam energies (6 MV and 6 MV FFF), and four MLC designs from two linac vendors were tested. Large variation in total monitor units (MU) per plan (2494–6462 MU) and dose-volume parameters was observed. The maximum point dose in the plans ranged from 116–149% and was dependent upon the TPS used. Pass rates for measured to planned dose comparison ranged from 89.4–100% and 97.3–100% for 3%/2mm and 3%/3mm criteria respectively. The largest measured MLC error did Result in one of the poorer pass rates. No direct correlation between phantom positioning error and pass rates overall. Conclusion: Significant differences were observed in the planning exercise for some plan and dose-volume parameters based on the TPS used. Standard evaluation criteria showed good agreement between planned and measured dose for all participants, however on an individual plan basis, diagnostic tests were able to identify contributing

  5. Are Teachers Ready for CLIL? Evidence from a European Study

    Science.gov (United States)

    Pérez Cañado, María Luisa

    2016-01-01

    This article presents the outcomes of a European study on the main training needs which pre- and in-service teachers, teacher trainers, and coordinators consider they have in order to adapt to a bilingual education model. The macro-study has designed, validated and administered four sets of questionnaires to 706 informants across the whole of…

  6. Are Teachers Ready for CLIL? Evidence from a European Study

    Science.gov (United States)

    Pérez Cañado, María Luisa

    2016-01-01

    This article presents the outcomes of a European study on the main training needs which pre- and in-service teachers, teacher trainers, and coordinators consider they have in order to adapt to a bilingual education model. The macro-study has designed, validated and administered four sets of questionnaires to 706 informants across the whole of…

  7. Research Strategies in European Union Studies

    DEFF Research Database (Denmark)

    Manners, Ian James; Lynggaard, Kennet; Löfgren, Karl

    2015-01-01

    The contributing chapters of this book all illustrate the richness and diversity of problem-driven research in EU studies. This concluding chapter draws together the insights of this rich diversity in order to move the study of research strategies beyond the dichotomies of the past towards a new ...... of demonstrating the methods and evidence used. A new agenda for research on Europe needs to acknowledge these weaknesses of the past and move beyond dichotomies towards greater awareness and openesss of the importance of research strategies, designs and methods.......The contributing chapters of this book all illustrate the richness and diversity of problem-driven research in EU studies. This concluding chapter draws together the insights of this rich diversity in order to move the study of research strategies beyond the dichotomies of the past towards a new...

  8. Research Methods in European Union Studies

    DEFF Research Database (Denmark)

    Research methods and designs from the social sciences and beyond can, and should, be applied in research directed at EU affairs. The purpose of this edited collection is twofold: (1) to provide a state-of-the-art examination of social science research methods in EU studies and (2) to provide...... innovative guidelines to the advancement of more inclusive and empirically sensitive research methods in EU studies....

  9. Case study: Teaching European Active Citizenship (TEACh)-course, EU

    DEFF Research Database (Denmark)

    Milana, Marcella; Bernt Sorensen, Tore

    2007-01-01

    education. Among these projects, the Teaching European Active Citizenship (TEACh)-course was considered worth of a closer examination due to several reasons. Firstly, the course constitutes a follow-up of a Socrates research project which was co-financed by the European Commission within the same action....... The case study presented here is based on results from desk research and field work carried out over 9 months (autumn 2006-summer 2007). Data was collected by a combination of qualitative methods. The main source of information was participant observation at the TEACh course held in Milan (Italy...

  10. Research Strategies in European Union Studies

    DEFF Research Database (Denmark)

    Manners, Ian James; Lynggaard, Kennet; Löfgren, Karl

    2015-01-01

    The contributing chapters of this book all illustrate the richness and diversity of problem-driven research in EU studies. This concluding chapter draws together the insights of this rich diversity in order to move the study of research strategies beyond the dichotomies of the past towards a new...... of demonstrating the methods and evidence used. A new agenda for research on Europe needs to acknowledge these weaknesses of the past and move beyond dichotomies towards greater awareness and openesss of the importance of research strategies, designs and methods....... agenda for research on Europe. The crisis gripping the EU in the 21st century is not just an economic crisis, it is a crisis of belief in the EU. Research on the EU is deeply implicated in this crisis, not least because of the questions it does not ask, but also because of the pereceived weakness...

  11. Calibration test of PET scanners in a multi-centre clinical trial on breast cancer therapy monitoring using 18F-FLT.

    Directory of Open Access Journals (Sweden)

    Francis Bouchet

    Full Text Available UNLABELLED: A multi-centre trial using PET requires the analysis of images acquired on different systems We designed a multi-centre trial to estimate the value of 18F-FLT-PET to predict response to neoadjuvant chemotherapy in patients with newly diagnosed breast cancer. A calibration check of each PET-CT and of its peripheral devices was performed to evaluate the reliability of the results. MATERIAL AND METHODS: 11 centres were investigated. Dose calibrators were assessed by repeated measurements of a 68Ge certified source. The differences between the clocks associated with the dose calibrators and inherent to the PET systems were registered. The calibration of PET-CT was assessed with an homogeneous cylindrical phantom by comparing the activities per unit of volume calculated from the dose calibrator measurements with that measured on 15 Regions of Interest (ROIs drawn on 15 consecutive slices of reconstructed filtered back-projection (FBP images. Both repeatability of activity concentration based upon the 15 ROIs (ANOVA-test and its accuracy were evaluated. RESULTS: There was no significant difference for dose calibrator measurements (median of difference -0.04%; min = -4.65%; max = +5.63%. Mismatches between the clocks were less than 2 min in all sites and thus did not require any correction, regarding the half life of 18F. For all the PET systems, ANOVA revealed no significant difference between the activity concentrations estimated from the 15 ROIs (median of difference -0.69%; min = -9.97%; max = +9.60%. CONCLUSION: No major difference between the 11 centres with respect to calibration and cross-calibration was observed. The reliability of our 18F-FLT multi-centre clinical trial was therefore confirmed from the physical point of view. This type of procedure may be useful for any clinical trial involving different PET systems.

  12. Teacher Behavior and Student Outcomes : Results of a European Study

    NARCIS (Netherlands)

    Panayiotou, A.; Kyriakides, L.; Creemers, B.P.M.; McMahon, L.; Vanlaar, G.; Pfeifer, M.; Rekalidou, G.; Bren, M.

    2014-01-01

    This study investigates the extent to which the factors included in the dynamic model of educational effectiveness are associated with student achievement gains in six different European countries. At classroom level, the dynamic model refers to eight factors relating to teacher behavior in the clas

  13. Neonatal bleeding in haemophilia : a European cohort study

    NARCIS (Netherlands)

    Richards, M.; Lissalde, G. Lavigne; Combescure, C.; Batorova, A.; Dolan, G.; Fischer, K.; Klamroth, R.; Lambert, T.; Lopez-Fernandez, M.; Perez, R.; Rocino, A.; Fijnvandraat, K.

    2012-01-01

    Birth is the first haemostatic challenge for a child with haemophilia. Our aim was to examine the association between perinatal risk factors and major neonatal bleeding in infants with haemophilia. This observational cohort study in 12 European haemophilia treatment centres (HTC) incorporated 508 ch

  14. European Union Students Studying in English Higher Education Institutions

    Science.gov (United States)

    Morris, Marian; Rutt, Simon

    2008-01-01

    This study aimed to identify the pathways, intentions and relevant perceptions of (non-UK) European Union (EU) students entering English higher education. It sought to identify why students wished to obtain an English HE qualification, their attitudes towards the uptake and repayment of tuition fee loans and their future career plans. Drawing on…

  15. European Maxillofacial Trauma (EURMAT) project: a multicentre and prospective study

    NARCIS (Netherlands)

    Boffano, P.; Roccia, F.; Zavattero, E.; Dediol, E.; Uglešić, V.; Kovačič, Ž.; Vesnaver, A.; Konstantinović, V.S.; Petrović, M.; Stephens, M.; Kanzaria, A.; Bhatti, N.; Holmes, S.; Pechalova, P.F.; Bakardjiev, A.G.; Malanchuk, V.A.; Kopchak, A.V.; Galteland, P.; Mjøen, E.; Skjelbred, P.; Koudougou, C.; Mouallem, G.; Corre, P.; Løes, S.; Lekven, N.; Laverick, S.; Gordon, P.; Tamme, T.; Akermann, S.; Karagozoglu, K.H.; Kommers, S.C.; Forouzanfar, T.

    2015-01-01

    The purpose of this study was to analyse the demographics, causes and characteristics of maxillofacial fractures managed at several European departments of oral and maxillofacial surgery over one year. The following data were recorded: gender, age, aetiology, site of facial fractures, facial injury

  16. 32nd European Study Group with Industry, Final Report

    DEFF Research Database (Denmark)

    ESGI (European Study Group with Industry) is Europe's leading workshop for interaction between mathematicians and industry. These workshops have taken place in Great Britain for a number of years, going back to 1968 when Prof. Alan Tayler initiated the so-called Oxford Study Group with Industry....... The coordiantion of the study groups is now done by the European Consortium for Mathematics in Industry (ECMI).This is the final report for the first study group in Denmark, (and the first ESGI outside Great Britain). Six Danish companies brought problems to the Study Group, requiring a wide range of mathematical...... a model describing the chlorination of swimming pools.LEGO wanted an algorithm for building an arbitrary model with LEGO bricks in stable manner.SCANtechnology wanted an algorithm to identify features in an image from a 3D laser scanning....

  17. Prevalence of age-related maculopathy in older Europeans: The European Eye Study (EUREYE)

    NARCIS (Netherlands)

    C. Augood (Cristina); J.R. Vingerling (Hans); P.T.V.M. de Jong (Paulus); U. Chakravarthy (Usha); J.H. Seland (Johan ); G. Soubrane; L. Tomazzoli (Laura); F. Topouzis (Fotis); G.C. Bentham (Graham ); M. Rahu; J. Vioque (Jesus); I.S. Young (Ian ); A.E. Fletcher (Astrid E.)

    2006-01-01

    textabstractObjective: To estimate the prevalence of age-related maculopathy in an older population from 7 European countries. Methods: Randomly sampled people 65 years and older were invited to an eye examination in centers across 7 European countries (Norway, Estonia, United Kingdom, France, Italy

  18. Managing Pan-European mammography images and data using a service oriented architecture

    CERN Document Server

    Amendolia, S R; McClatchey, R; Rogulin, D; Solomonides, T

    2004-01-01

    Medical conditions such as breast cancer, and mammograms as images, are extremely complex with many degrees of variability across the population. An effective solution for the management of disparate mammogram data sources that provides sufficient statistics for complex epidemiological study is a federation of autonomous multi- centre sites which transcends national boundaries. Grid-based technologies are emerging as open-source standards-based solutions for managing and collaborating distributed resources. In the light of these new computing solutions, the MammoGrid project, as one example of a HealthGrid, is developing a Grid-aware medical application which manages a European-wide database of mammograms. The MammoGrid solution utilizes the grid technologies in seamlessly integrating distributed data sets and is investigating the potential of the Grid to support effective co-working among mammogram analysts throughout the EU.

  19. A multi-centre retrospective study of rituximab use in the treatment of relapsed or resistant warm autoimmune haemolytic anaemia.

    LENUS (Irish Health Repository)

    Maung, Su W

    2013-10-01

    This retrospective analysis assessed the response, safety and duration of response to standard dose rituximab 375 mg\\/m(2) weekly for four weeks as therapy for patients with primary or secondary warm autoimmune haemolytic anaemia (WAIHA), who had failed initial treatment. Thirty-four patients received rituximab for WAIHA in seven centres in the Republic of Ireland. The overall response rate was 70·6% (24\\/34) with 26·5% (9\\/34) achieving a complete response (CR). The time to response was 1 month post-initiation of rituximab in 87·5% (21\\/24) and 3 months in 12·5% (3\\/24) of patients. The median duration of follow-up was 36 months (range 6-90 months). Of the patients who responded, 50% (12\\/24) relapsed during follow up with a median time to next treatment of 16·5 months (range 6-60 months). Three patients were re-treated with rituximab 375 mg\\/m2 weekly for four weeks at relapse and responded. There was a single episode of neutropenic sepsis. Rituximab is an effective and safe treatment for WAIHA but a significant number of patients will relapse in the first two years post treatment. Re-treatment was effective in a small number of patients, suggesting that intermittent pulse treatment or maintenance treatment may improve long-term response.

  20. Multi-centre, multi-database studies with common protocols: Lessons learnt from the IMI PROTECT project

    NARCIS (Netherlands)

    Klungel, Olaf H.; Kurz, Xavier; de Groot, Mark C. H.; Schlienger, Raymond G.; Tcherny-Lessenot, Stephanie; Grimaldi, Lamiae; Ibáñez, Luisa; Groenwold, Rolf H. H.; Reynolds, Robert F.; Alvarez, Y.; Candore, G.; Durand, J.; Slattery, J.; Hasford, J.; Rottenkolber, M.; Schmiedl, S.; de Abajo Iglesias, F.; Gil, M.; Gonzalez, R.; Huerta Alvarez, C.; Martin, E.; Oliva, B.; Requena, G.; Amelio, J.; Brauer, R.; Downey, G.; Feudjo-Tepie, M.; Schoonen, M.; Johansson, S.; Robinson, J.; Schuerch, M.; Tatt, I.; Petri, H.; Garcia, L.A.; Ruigomez, A.; Campbell, J.; Gallagher, A.; Ng, E.; van Staa, T.P.; Demol, O.; Boudiaf, N.; Davis, K.; Logie, J.; Pimenta, J.; Beau-Lejdstrom, R.; Grimaldi-Bensouda, L.; Abenhaim, L.; Grimaldi-Bensouda, L.; Rossignol, M.; Hesse, U.; Rønn, P.F.; Miret, M.; Fortuny, J.; Primatesta, P.; Rivero, E.; Schlienger, R.; Bate, A.; Gatto, N.; Ballarin, E.; Ferrer, P.; Ibañez, L.; Laporte, J.R.; Sabaté, M.; Abbing-Karahagopian, V.; Ali, S.; de Bakker, D.; Belitser, S.; de Boer, Anthonius; De Bruin, M.L.; Egberts, A.C.G.; van Dijk, L.; Gardarsdottir, H.; Hoes, A.W.; Leufkens, H.G.M.; Pestman, W.; Roes, K.C.B.; Souverein, P.; Rutten, F.; Uddin, J.; van den Ham, H.A.; Voogd, E.; de Vries, Frank; De Bruin, M.L.; Udo, R.; Auclert, L.; Juhaeri, J.; Mazuranok, L.; Wise, L.; Irvine, D.; Dolin, P.; Gasse, C.

    2016-01-01

    Purpose: To assess the impact of a variety of methodological parameters on the association between six drug classes and five key adverse events in multiple databases. Methods: The selection of Drug-Adverse Event pairs was based on public health impact, regulatory relevance, and the possibility to st

  1. [Fingolimod: effectiveness and safety in routine clinical practice. An observational, retrospective, multi-centre study in Galicia].

    Science.gov (United States)

    Pato-Pato, A; Midaglia, L; Costa-Arpin, E; Rodriguez-Regal, A; Puy-Nunez, A; Rodriguez-Rodriguez, M; Lopez-Real, A; Llaneza-Gonzalez, M A; Garcia-Estevez, D A; Moreno-Carretero, M J; Escriche-Jaime, D; Aguado-Valcarcel, M L; Munoz, D; Prieto, J M; Lorenzo-Gonzalez, J R; Amigo-Jorrin, M C

    2016-09-05

    Introduccion. La efectividad y seguridad del fingolimod en pacientes con esclerosis multiple remitente recurrente (EMRR) se demostro en ensayos clinicos. Sin embargo, por las limitaciones de estos, es importante saber como se comporta en condiciones de practica clinica habitual. Asi, el objetivo de este estudio es evaluar la efectividad y seguridad del fingolimod despues de 12 meses de uso en la practica clinica en Galicia. Pacientes y metodos. Estudio retrospectivo y multicentrico (n = 8) de pacientes con EMRR y tratados con una o mas dosis de fingolimod, 0,5 mg/dia. Se evaluo la efectividad –tasa anualizada de brotes (TAB), cambio en la puntuacion de la escala expandida del estado de discapacidad (EDSS), porcentaje de pacientes libres de brotes, libres de progresion de discapacidad y libres de actividad en resonancia– para el total de pacientes y segun tratamiento previo. Se evaluo la seguridad a partir del porcentaje de pacientes que discontinuaron y que presentaron efectos adversos. Resultados. Despues de 12 meses de uso, el fingolimod redujo un 87% la TAB (de 1,7 a 0,23; p < 0,0001) y, en consecuencia, un 81% de pacientes estuvo libre de brotes. La puntuacion de la EDSS disminuyo un 9%. Un 91% de pacientes estuvo libre de progresion de discapacidad y un 72%, libre de actividad en resonancia. En el 43% de los pacientes no se evidenciaron signos de la actividad de la enfermedad. La mayoria de los beneficios del fingolimod difirieron segun el tratamiento previo. Alrededor de un tercio de los pacientes comunicaron efectos adversos, pero solo el 2% discontinuo debido a ellos. Conclusiones. La mayoria de los resultados de efectividad de los ensayos clinicos del fingolimod se observa durante los 12 primeros meses de tratamiento en la practica clinica. Se observo un mejor perfil de seguridad al comunicado en los ensayos clinicos.

  2. [Fingolimod: effectiveness and safety in routine clinical practice. An observational, retrospective, multi-centre study in Asturias and Cantabria].

    Science.gov (United States)

    Oterino, A; Uria, D F; Pena, J; Solar, D; Villafani, J; Oliva-Nacarino, P; Suarez-Moro, R; Quintanilla, V G

    2016-09-05

    Objetivo. Evaluar la efectividad y seguridad del fingolimod en la practica clinica habitual en la region de Asturias y Cantabria (España). Pacientes y metodos. Estudio retrospectivo y multicentrico de pacientes con esclerosis multiple recurrente remitente tratados con fingolimod, segun la ficha tecnica. La efectividad se evaluo en los pacientes con al menos un año de tratamiento. Se calculo la tasa anualizada de brotes (TAB), el porcentaje de pacientes libres de brotes y libres de lesiones captantes de gadolinio, y los que mejoraron/mantuvieron la puntuacion en la escala expandida del estado de discapacidad (EDSS). Se analizo la poblacion total y segun el tratamiento previo: inmunomodulador (interferon beta-1 o acetato de glatiramero) o natalizumab. Resultados. Un total de 138 pacientes iniciaron tratamiento con fingolimod; el 60% recibio previamente inmunomodulador; el 28%, natalizumab; y el 9%, ningun tratamiento. Noventa y nueve pacientes estuvieron al menos un año en tratamiento con fingolimod. Despues de un año de tratamiento, el fingolimod disminuyo la TAB en un 67% (1,26 a 0,42; p < 0,0001), aumento el porcentaje de pacientes libres de brotes de un 24% a un 69% (p < 0,0001), y el porcentaje de pacientes libres de lesiones captantes de gadolinio de un 70% a un 85% (p < 0,0106). El 77% de los pacientes mejoro/mantuvo la puntuacion en la EDSS. Resultados similares se observaron en pacientes tratados previamente con inmunomodulador. La efectividad de los pacientes tratados previamente con natalizumab se mantuvo tras el tratamiento con fingolimod. Conclusiones. La practica clinica habitual en las regiones de Asturias y Cantabria muestra que el fingolimod tiene resultados similares a los observados en los ensayos clinicos, al comparar las variables clinicorradiologicas utilizadas en estos ultimos.

  3. [Fingolimod: effectiveness and safety in routine clinical practice. An observational, retrospective, multi-centre study in the province of Alicante].

    Science.gov (United States)

    Mallada, J; Perez-Carmona, N; Berenguer-Ruiz, L; Sanchez-Perez, R; Martin-Gonzalez, R; Sola-Martinez, D; Mola, S; Lopez-Arlandis, J M; Vela-Yebra, R; Gabaldon-Torres, L; Freire-Alvarez, E; Garcia-Escriva, A; Sempere, A P

    2016-09-05

    Introduccion. Los estudios postautorizacion son importantes para confirmar si los resultados de los ensayos clinicos se reproducen en la practica clinica habitual. Objetivo. Evaluar la efectividad y seguridad del fingolimod en la practica clinica en la provincia de Alicante. Pacientes y metodos. Estudio multicentrico retrospectivo de pacientes con esclerosis multiple remitente tratados con fingolimod. Se recogen las caracteristicas demograficas, clinicas y farmacologicas. Se describe la efectividad del farmaco –tasa anualizada de brotes (TAB) y porcentaje de pacientes libres de brotes– al año y a los dos años de tratamiento en relacion con el año previo y datos de efectos secundarios. Resultados. Se incluyo a 89 pacientes. El tratamiento previo fue inmunomodulador (interferon beta o acetato de glatiramero) en 54 pacientes y natalizumab en 32. Cincuenta pacientes cambiaron por fracaso con el inmunomodulador y 31 por serologia positiva del virus JC (VJC+). La TAB global disminuyo el 67,3% el primer año (p < 0,0001) y el 84,1% el segundo (p = 0,0078). Disminuyo en los pacientes con fracaso del inmunomodulador (el 85,6% el primer año, p < 0,0001; el 88,9% el segundo año, p = 0,0039) y aumento de forma no significativa en los pacientes VJC+ en el primer año. El porcentaje de pacientes libres de brotes en la poblacion global aumento del 32,6 al 68,1% en el primer año (p < 0,0019) y al 82,6% en el segundo (p = 0,0215). Este aumento no se observo en los pacientes VJC+. Trece pacientes tuvieron efectos secundarios, que obligaron a la retirada del farmaco en dos de ellos. Conclusion. En la practica clinica de la provincia de Alicante, el fingolimod mostro una efectividad y una seguridad ligeramente superiores a las de los ensayos clinicos.

  4. Pharmacological treatment of the pathogenetic defects in Type 2 Diabetes. The randomized multi-centre South Danish Diabetes study (SDDS)

    DEFF Research Database (Denmark)

    Gram, Jeppe; Henriksen, Jan Erik; Grodum, Ellen

    2011-01-01

    AbstractObjective: To determine the effect of treatment with insulin Aspart as compared to NPH insulin, together with metformin/placebo and rosiglitazone/placebo. The hypothesis was that combined correction of major pathogenetic defects in type 2 diabetes would result in optimal glycemic control....

  5. Multi-centre, multi-database studies with common protocols : lessons learnt from the IMI PROTECT project

    NARCIS (Netherlands)

    Klungel, Olaf H; Kurz, Xavier; de Groot, Mark C H; Schlienger, Raymond G; Tcherny-Lessenot, Stephanie; Grimaldi, Lamiae; Ibáñez, Luisa; Groenwold, Rolf H H; Reynolds, Robert F

    2016-01-01

    PURPOSE: To assess the impact of a variety of methodological parameters on the association between six drug classes and five key adverse events in multiple databases. METHODS: The selection of Drug-Adverse Event pairs was based on public health impact, regulatory relevance, and the possibility to st

  6. Catheter-related infection in Irish intensive care units diagnosed with HELICS criteria: a multi-centre surveillance study.

    LENUS (Irish Health Repository)

    Conrick-Martin, I

    2013-03-01

    Catheter-related infection (CRI) surveillance is advocated as a healthcare quality indicator. However, there is no national CRI surveillance programme or standardized CRI definitions in Irish intensive care units (ICUs).

  7. Convergence to the European Energy Policy in European countries: case studies and comparison

    Directory of Open Access Journals (Sweden)

    César Teixeira

    2014-10-01

    Full Text Available Purpose – Our paper aims at analyzing how different European countries cope with the European Energy Policy, which proposes a set of measures (free energy market, smart meters, energy certificates to improve energy utilization and management in Europe.Design/methodology/approach – The paper first reports the general vision, regulations and goals set up by Europe to implement the European Energy Policy. Later on, it performs an analysis of how some European countries are coping with the goals, with financial, legal, economical and regulatory measures. Finally, the paper draws a comparison between the countries to present a view on how Europe is responding to the emerging energy emergency of the modern world.Findings – Our analysis on different use cases (countries showed that European countries are converging to a common energy policy, even though some countries appear to be later than others In particular, Southern European countries were slowed down by the world financial and economical crisis. Still, it appears that contingency plans were put into action, and Europe as a whole is proceeding steadily towards the common vision.Research limitations/implications – European countries are applying yet more cuts to financing green technologies, and it is not possible to predict clearly how each country will evolve its support to the European energy policy.Practical implications – Different countries applied the concepts and measures in different ways. The implementation of the European energy policy has to cope with the resulting plethora of regulations, and a company proposing enhancement regarding energy management still has to possess robust knowledge of the single country, before being able to export experience and know-how between European countries.Originality/Value – Even though a few surveys on energy measures in Europe are already part of the state-of-the-art, organic analysis diagonal to the different topics of the European

  8. Psychological Problems in Children with Cerebral Palsy: A Cross-Sectional European Study

    Science.gov (United States)

    Parkes, Jackie; White-Koning, Melanie; Dickinson, Heather O.; Thyen, Ute; Arnaud, Catherine; Beckung, Eva; Fauconnier, Jerome; Marcelli, Marco; McManus, Vicki; Michelsen, Susan I.; Parkinson, Kathryn; Colver, Allan

    2008-01-01

    Objectives: To describe psychological symptoms in 8-12-year-old children with cerebral palsy; to investigate predictors of these symptoms and their impact on the child and family. Design: A cross-sectional multi-centre survey. Participants: Eight hundred and eighteen children with cerebral palsy, aged 8-12 years, identified from population-based…

  9. Surface-induced intramolecular electron transfer in multi-centre redox metalloproteins: the di-haem protein cytochrome c4 in homogeneous solution and at electrochemical surfaces

    Science.gov (United States)

    Chi, Qijin; Zhang, Jingdong; Jensen, Palle S.; Nazmudtinov, Renat R.; Ulstrup, Jens

    2008-09-01

    Intramolecular electron transfer (ET) between transition metal centres is a core feature of biological ET and redox enzyme function. The number of microscopic redox potentials and ET rate constants is, however, mostly prohibitive for experimental mapping, but two-centre proteins offer simple enough communication networks for complete mapping to be within reach. At the same time, multi-centre redox proteins operate in a membrane environment where conformational dynamics and ET patterns are quite different from the conditions in a homogeneous solution. The bacterial respiratory di-haem protein Pseudomonas stutzeri cytochrome c4 offers a prototype target for environmental gating of intra-haem ET. ET between P. stutzeri cyt c4 and small molecular reaction partners in solution appears completely dominated by intermolecular ET of each haem group/protein domain, with no competing intra-haem ET, for which accompanying propionate-mediated proton transfer is a further barrier. The protein can, however, be immobilized on single-crystal, modified Au(111) electrode surfaces with either the low-potential N terminal or the high-potential C terminal domain facing the surface, clearly with fast intramolecular ET as a key feature in the electrochemical two-ET process. This dual behaviour suggests a pattern for multi-centre redox metalloprotein function. In a homogeneous solution, which is not the natural environment of cyt c4, the two haem group domains operate largely independently with conformations prohibitive for intramolecular ET. Binding to a membrane or electrochemical surface, however, triggers conformational opening of intramolecular ET channels. The haem group orientation in P. stutzeri cyt c4 is finally noted to offer a case for orientation dependent electronic rectification between a substrate and a tip in electrochemical in situ scanning tunnelling microscopy or nanoscale electrode configurations.

  10. In-Depth Study Of European Union Fiscal Approximation

    Directory of Open Access Journals (Sweden)

    Andreea Roxana TOMI

    2011-05-01

    Full Text Available The current study presents a viewpoint on the EU fiscal policy contents, advocating the need for an in-depth understanding and acceleration of the 27 national fiscal system components and the creation of the EU Tax System that would enable the Single Market operation and the enforcement of the four fundamental liberties within the European Union. In the author’s opinion, the extant common fiscal policy elements are only marginal, while the actions aimed at an in-depth understanding of a broad fiscal policy are essential to the extent they point at both direct and indirect taxation aspects whose approximation is a priority.

  11. Network of European studies of genes in growth (NESTEGG).

    Science.gov (United States)

    Johnston, Linda B; Ester, Wiestske; Caliebe, Janina; Molinas, Catherine; Wollmann, Hartmut; Fryklund, Linda; Clark, Adrian J; Ranke, Michael B; Tauber, Maithe; Hokken Koelega, Anita; Savage, Martin O

    2009-04-01

    The network of European studies of genes in growth (NESTEGG) is an international growth genomics project, focusing on the birth size phenotypes of small for gestational age (SGA) and idiopathic short stature. Seven hundred controls and 1,275 cases with their parents have been recruited. Detailed clinical histories and auxological measurements are recorded in a clinical database. Candidate gene studies are being undertaken with the study DNA samples. These genetic data will be used to explore associations with the clinical phenotypes of short stature and SGA birth size, and, in a subset, response to growth hormone (GH) therapy. This article describes the study methodology and reviews the association of the exon 3-deleted genotype of the GH receptor with GH responsiveness in GH-treated children born SGA. Copyright 2009 S. Karger AG, Basel.

  12. Research Design in the study of the European Neighbourhood Policy

    DEFF Research Database (Denmark)

    Exadaktylos, Theofanis; Lynggaard, Kennet

    2017-01-01

    This chapter deals with the pitfalls and pathways of research design aimed at the study of the European Neighbourhood Policy (ENP) and maps out the literature on questions of knowledge ambition, research ontology and epistemology, and choices of approaches to the research object. We include...... a review of traditional research designs in ENP research, through a systematic meta-analysis of a selection of the most-cited articles on the ENP. Inspired by earlier work on awareness of research design in EU studies, ENP research is categorised according to typical choices of research design in the form...... of dichotomous trade-offs. The chapter then discusses how individual contributions to this volume deal with research design challenges of the past and present innovative ways of studying the revised ENP....

  13. Ethics teaching in European veterinary schools: a qualitative case study.

    Science.gov (United States)

    Magalhães-Sant'Ana, M

    2014-12-13

    Veterinary ethics is recognised as a relevant topic in the undergraduate veterinary curriculum. However, there appears to be no widely agreed view on which contents are best suited for veterinary ethics teaching and there is limited information on the teaching approaches adopted by veterinary schools. This paper provides an inside perspective on the diversity of veterinary ethics teaching topics, based on an in-depth analysis of three European veterinary schools: Copenhagen, Lisbon and Nottingham. The case study approach integrated information from the analysis of syllabi contents and interviews with educators (curricular year 2010-2011). These results show that the curriculum of veterinary ethics is multidimensional and can combine a wide range of scientific, regulatory, professional and philosophical subjects, some of which may not be explicitly set out in the course descriptors. A conceptual model for veterinary ethics teaching is proposed comprising prominent topics included within four overarching concepts: animal welfare science, laws/regulations, professionalism, and theories/concepts. It is intended that this work should inform future curriculum development of veterinary ethics in European schools and assist ethical deliberation in veterinary practice.

  14. The Study of a European Neutrino Factory Complex

    CERN Document Server

    Gruber, P; Amand, J F; Autin, Bruno; Baldy, J L; Benedikt, Michael; Benett, R; Bernardon, A; Blondel, A; Bongardt, K; Cappi, R; Castellano, M G; Chiaveri, Enrico; Delahaye, J P; Densham, C J; Drumm, P V; Edgecocka, R; Fabich, A; Franchetti, Giuliano; Gareyte, Jacques; Garoby, R; Gastaldi, Ugo; Gerigk, F; Gilardoni, S S; Giovannozzi, Massimo; Hancock, S; Hanke, K; Haseroth, H; Hill, C; Hoffman, I; Holzer, B; Hübner, K; Jansson, A; Johnson, C D; Johnston, C; Küchler, D; Lettry, Jacques; Lindroos, M; Lombardi, A M; Martini, M; Migliorati, M; Méot, F; Métral, Elias; Möhl, D; Müller, A S; Neuffer, David V; Palumbo, L; Pasternak, J; Perrin, A; Pirkl, Werner; Poehler, M; Prior, C R; Ravn, H L; Rees, G; Riche, A; Russenschuck, Stephan; Ryne, Robert D; Schindl, Karlheinz; Schriber, Stanley O; Schönauer, Horst Otto; Scrivens, R; Senichev, Yu V; Sievers, P; Silari, Marco; Tazzioli, F; Ullrich, H M; Vassilopoulos, N; Verdier, A; Vretenar, Maurizio; Wenander, F; Wilson, Edmund J N; Wyss, C; Zimmermann, M F; Zisman, M S; Zucchelli, P

    2004-01-01

    The Neutrino Factory is a new concept for an accelerator that produces a high-intensity, high-energy beam of electron and muon neutrinos - the ultimate tool for neutrino oscillation studies and the only machine conceived up today that could help detect CP violation of leptons. The basic concept of the Neutrino Factory is the production of neutrinos from the decay of high-energy muons. Due to their short lifetime, these muons have to be accelerated very fast. Several new accelerator techniques, like a high-intenstiy proton linac, high-power targets, ionization cooling or recirculating muon linacs are required. This paper presents a snapshot of the accelerator design at CERN. Although some aspects of this European Neutrino Factory Scheme have been optimised for the CERN site, the basic principle is site-independent.

  15. A comparative study of European nuclear energy programs

    Energy Technology Data Exchange (ETDEWEB)

    Presas i Puig, Albert (ed.)

    2011-07-01

    The report includes the following contributions: Comparative study of European Nuclear Energy Programs. From international cooperation to the failure of a national program: the Austrian case. The ''go-and-stop'' of the Italian civil nuclear programs, among improvisations, ambitions and conspiracy. Nuclear energy in Spain - a research agenda for economic historians. The Portuguese nuclear program: a peripheral experience under dictatorship (1945-1973). The nuclear energy programs in Switzerland. The rise and decline of an independent nuclear power industry in Sweden, 1945-1970. The German fast breeder program, a historical review. Fast reactors as future visions - the case of Sweden. Transnational flows of nuclear knowledge between the U.S. and the U.K. and continental Europe in the 1950/60s. The Carter administration and its non-proliferation policies: the road to INFCE.

  16. Variability of fish consumption within the 10 European countries participating in the European Investigation into Cancer and Nutrition (EPIC) study

    DEFF Research Database (Denmark)

    Welch, A.A.; Lund, E.; Amiano, P.;

    2002-01-01

    OBJECTIVE: To describe and compare the consumption of total fish (marine foods) and the fish sub-groups - white fish, fatty fish, very fatty fish, fish products and crustacea, in participants from the European Investigation into Cancer and Nutrition (EPIC) study. DESIGN: Cross-sectional analysis ...

  17. EUropean prospective cohort study on Enterobacteriaceae showing REsistance to CArbapenems (EURECA): a protocol of a European multicentre observational study

    Science.gov (United States)

    Gutiérrez-Gutiérrez, Belén; Sojo-Dorado, Jesús; Bravo-Ferrer, José; Cuperus, Nienke; de Kraker, Marlieke; Kostyanev, Tomislav; Raka, Lul; Daikos, George; Feifel, Jan; Folgori, Laura; Pascual, Alvaro; Goossens, Herman; O'Brien, Seamus; Bonten, Marc J M; Rodríguez-Baño, Jesús

    2017-01-01

    Introduction The rapid worldwide spread of carbapenem-resistant Enterobacteriaceae (CRE) constitutes a major challenge. The aim of the EUropean prospective cohort study on Enterobacteriaceae showing REsistance to CArbapenems (EURECA), which is part of the Innovative Medicines Initiative Joint Undertaking (IMI JU) funded COMBACTE-CARE project, is to investigate risk factors for and outcome determinants of CRE infections to inform randomised clinical trial designs and to provide a historical cohort that could eventually be used for future comparisons with new drugs targeting CRE. Methods A multicentre (50 sites), multinational (11 European countries), analytical observational project was designed, comprising 3 studies. The aims of study 1 (a prospective cohort study) include characterising the features, clinical management and outcomes of hospitalised patients with intra-abdominal infection, pneumonia, complicated urinary tract infections and bloodstream infections caused by CRE (202 patients in each group). The main outcomes will be 30-day all-cause mortality and clinical response. Study 2 (a nested case–control study) will identify the risk factors for target infections caused by CRE; 248 selected patients from study 1 will be matched with patients with carbapenem-susceptible Enterobacteriaceae (1:1) and with hospitalised patients (1:3) and will provide a historical cohort of patients with CRE infections. Study 3 (a matched cohort study) will follow patients in study 2 in order to assess mortality, length of stay and hospital costs associated with CRE. All patients will be followed for 30 days. Different, up-to-date statistical methods will be applied to come to unbiased estimates for all 3 studies. Ethics and dissemination Before-study sites will be initiated, approval will be sought from appropriate regulatory agencies and local Ethics Committees of Research or Institutional Review Boards (IRBs) to conduct the study in accordance with regulatory requirements

  18. How to study the history of European law?

    DEFF Research Database (Denmark)

    Rasmussen, Morten

    This paper has a double purpose. On the one hand, it offers a new history, based on recently discovered primary sources, of the driving forces behind the so-called ‘constitutionalisation’ of European law taking place in 1963-64. On the other hand, it uses the lessons of this new history to reflect...... with direct effect and supremacy vis-à-vis national law, this coalition legitimised what had happened and contributed crucially to what would amount to a rather slow acceptance of the new ‘constitutional’ doctrines by national governments and courts. A key feature of these processes was the extent to which...... on how a general history of European law should be written and in particular how to avoid the pitfalls that characterises mainstream research on European law. In the first part it is argued that the ‘constitutionalisation’ of European law was promoted by a broad coalition beyond the Court of Justice...

  19. Recruiting Hard-to-Reach Subjects for Exercise Interventions: A Multi-Centre and Multi-Stage Approach Targeting General Practitioners and Their Community-Dwelling and Mobility-Limited Patients

    Directory of Open Access Journals (Sweden)

    Michael Brach

    2013-12-01

    Full Text Available The general practitioner (GP’s practice appears to be an ideal venue for recruiting community-dwelling older adults with limited mobility. This study (Current Controlled Trials ISRCTN17727272 aimed at evaluating the recruiting process used for a multi-centre exercise intervention (HOMEfit. Each of six steps resulted in an absolute number of patients (N1–N6. Sex and age (for N4–N6 and reasons for dropping out were assessed. Patient database screening (N1–N3 at 15 GP practices yielded N1 = 5,990 patients aged 70 and above who had visited their GP within the past 6 months, N2 = 5,467 after exclusion of institutionalised patients, N3 = 1,545 patients eligible. Using a pre-defined limitation algorithm in order to conserve the practices’ resources resulted in N4 = 1,214 patients (80.3 ± 5.6 years, 68% female, who were then officially invited to the final assessment of eligibility at the GP’s practice. N5 = 434 patients (79.5 ± 5.4 years, 69% female attended the practice screening (n = 13 of whom had not received an official invitation. Finally, N6 = 209 (79.8 ± 5.2 years, 74% female were randomised after they were judged eligible and had given their written informed consent to participate in the randomised controlled trial (overall recruitment rate: 4.4%. The general strategy of utilising a GP’s practice to recruit the target group proved beneficial. The data and experiences presented here can help planners of future exercise-intervention studies.

  20. Academic partnership in NLS resource design: a European case study.

    Directory of Open Access Journals (Sweden)

    Jo Pye

    1997-01-01

    Full Text Available This paper describes the library work package of the European Union’s Telematics for Teacher Training project, which links the Libraries and Education and Training sectors. Its two major deliverables, a user needs analysis report addressing networked learner support in European partner institutions and development of an online course for librarians, are discussed in terms of professional development opportunities for partnership between academic and information staff.

  1. Spaceflight studies of tropisms in the European Modular Cultivation System

    Science.gov (United States)

    Kiss, J. Z.; Correll, M. J.; Edelmann, R. E.

    Phototropism and gravitropism play key roles in the oriented growth of roots in flowering plants. In blue or white light, roots exhibit negative phototropism, but red light induces positive phototropism in Arabidopsis roots. The blue-light response is controlled by the phototropins while the red-light response is mediated by the phytochrome family of photoreceptors. In order to better characterize root phototropism, we plan to perform experiments in microgravity so that this tropism can be more effectively studied without the interactions with the gravity response. Our experiments are to be performed on the European Modular Cultivation System (EMCS), which provides an incubator, lighting system, and high resolution video that are on a centrifuge palette. These experiments will be performed at μ g, 1g (control) and fractional g-levels. In order to ensure success of this mission on the International Space Station (ISS), we have been performing ground-based studies on growth, phototropism, and gravitropism in experimental unique equipment (EUE) that was designed for our experiments that will use Arabidopsis seedlings. Currently, the EMCS and our EUE are scheduled for launch on space shuttle mission STS-121. This project should provide insight into how the blue-light and red-light signaling systems interact with each other, and also with the gravisensing system.

  2. A multi-centre pilot proficiency programme to assess the quality of molecular detection of respiratory viruses

    NARCIS (Netherlands)

    Templeton, K E; Forde, C B; Loon, A M van; Claas, E C J; Niesters, H G M; Wallace, P; Carman, W F

    2006-01-01

    OBJECTIVES: To assess the quality of molecular detection of respiratory viruses in clinical diagnostic laboratories. STUDY DESIGN: Respiratory virus proficiency panels were produced from diluted stocks of respiratory viruses provided and tested by four reference laboratories. The panels consisted of

  3. HELIAS stellarator reactor studies and related European technology studies

    Energy Technology Data Exchange (ETDEWEB)

    Grieger, G. (Max-Planck-Institut fuer Plasmaphysik, EURATOM-Association, D-85748 Garching (Germany)); Nuehrenberg, J. (Max-Planck-Institut fuer Plasmaphysik, EURATOM-Association, D-85748 Garching (Germany)); Renner, H. (Max-Planck-Institut fuer Plasmaphysik, EURATOM-Association, D-85748 Garching (Germany)); Sapper, J. (Max-Planck-Institut fuer Plasmaphysik, EURATOM-Association, D-85748 Garching (Germany)); Wobig, H. (Max-Planck-Institut fuer Plasmaphysik, EURATOM-Association, D-85748 Garching (Germany))

    1994-08-01

    Research on stellarators has been carried out in Europe since the early years of the fusion programme. Early studies of this reactor concept were done at the Culham Laboratory of the UK Atomic Energy Authority. Such classical stellarators, however, have poor reactor prospects in spite of the significant advantage of not needing a large toroidal plasma current. It seemed to be just this large toroidal plasma current which has led to intrinsic deficiencies with respect to reactor potential of the tokamak. Expecting that these deficiencies would disappear for a concept without such a current, the Institut fuer Plasmaphysik developed, in a roll-back fashion, i.e. by starting from reactor considerations, the concept of the helical axis advanced stellarator (HELIAS). The results achieved look very promising indeed. Since tokamaks and stellarators show many similarities, there appeared no need as yet for a new stand-alone stellarator reactor study. The work was rather concentrated on the few but decisive differences between the two concepts and on evaluation of their relative importance. Studies on the coil system, the stress distribution in the supporting material, the space needed for an efficient blanket system, the properties of the exhaust system, etc. have been done. Applying contemporary scaling laws, it turns out that although the aspect ratio of such advanced stellarators is larger than that of tokamaks, the plasma volume is about the same. The magnetic energy needed for plasma confinement is considerably lower and the mass utilization tends to be larger than for comparable tokamaks. It also follows that a number of reactor components needed for tokamak operation (e.g. current drive, feedback stabilization, disruption prevention) are not needed in stellarators, making this type of reactor and its operation simpler. Such results would have a large influence on selection of the final concept and the further evolution of the fusion programme.

  4. A pragmatic multi-centred randomised controlled trial of yoga for chronic low back pain: Trial protocol

    OpenAIRE

    Cox, Helen; Tilbrook, Helen; Aplin, John; Chuang, Ling-Hsiang; Hewitt, Catherine; Jayakody, Shalmini; Semlyen, Anna; Soares, Marta O; Torgerson, David; Trewhela, Alison; Watt, Ian; Worthy, Gill

    2010-01-01

    A systematic review revealed three small randomised controlled trials of yoga for low back pain, all of which showed effects on back pain that favoured the yoga group. To build on these studies a larger trial, with longer term follow-up, and a number of different yoga teachers delivering the intervention is required. This study protocol describes the details of a randomised controlled trial (RCT) to determine the effectiveness and cost-effectiveness of Yoga for chronic Low Back Pain, which is...

  5. Development of a disease-specific quality of life questionnaire for adult patients with hereditary angioedema due to C1 inhibitor deficiency (HAE-QoL: Spanish multi-centre research project

    Directory of Open Access Journals (Sweden)

    Prior Nieves

    2012-07-01

    Full Text Available Abstract Background There is a need for a disease-specific instrument for assessing health-related quality of life in adults with hereditary angioedema due to C1 inhibitor deficiency, a rare, disabling and life-threatening disease. In this paper we report the protocol for the development and validation of a specific questionnaire, with details on the results of the process of item generation, domain selection, and the expert and patient rating phase. Methods/Design Semi-structured interviews were completed by 45 patients with hereditary angioedema and 8 experts from 8 regions in Spain. A qualitative content analysis of the responses was carried out. Issues raised by respondents were grouped into categories. Content analysis identified 240 different responses, which were grouped into 10 conceptual domains. Sixty- four items were generated. A total of 8 experts and 16 patients assessed the items for clarity, relevance to the disease, and correct dimension assignment. The preliminary version of the specific health-related quality of life questionnaire for hereditary angioedema (HAE-QoL v 1.1 contained 44 items grouped into 9 domains. Discussion To the best of our knowledge, this is the first multi-centre research project that aims to develop a specific health-related quality of life questionnaire for adult patients with hereditary angioedema due to C1 inhibitor deficiency. A preliminary version of the specific HAE-QoL questionnaire was obtained. The qualitative analysis of interviews together with the expert and patient rating phase helped to ensure content validity. A pilot study will be performed to assess the psychometric properties of the questionnaire and to decide on the final version.

  6. Competencies of specialised wound care nurses: a European Delphi study.

    Science.gov (United States)

    Eskes, Anne M; Maaskant, Jolanda M; Holloway, Samantha; van Dijk, Nynke; Alves, Paulo; Legemate, Dink A; Ubbink, Dirk T; Vermeulen, Hester

    2014-12-01

    Health care professionals responsible for patients with complex wounds need a particular level of expertise and education to ensure optimum wound care. However, uniform education for those working as wound care nurses is lacking. We aimed to reach consensus among experts from six European countries as to the competencies for specialised wound care nurses that meet international professional expectations and educational systems. Wound care experts including doctors, wound care nurses, lecturers, managers and head nurses were invited to contribute to an e-Delphi study. They completed online questionnaires based on the Canadian Medical Education Directives for Specialists framework. Suggested competencies were rated on a 9-point Likert scale. Consensus was defined as an agreement of at least 75% for each competence. Response rates ranged from 62% (round 1) to 86% (rounds 2 and 3). The experts reached consensus on 77 (80%) competences. Most competencies chosen belonged to the domain 'scholar' (n = 19), whereas few addressed those associated with being a 'health advocate' (n = 7). Competencies related to professional knowledge and expertise, ethical integrity and patient commitment were considered most important. This consensus on core competencies for specialised wound care nurses may help achieve a more uniform definition and education for specialised wound care nurses.

  7. Tobacco smoking in Poland in 2003-2014. Multi-centre National Population Health Examination Survey (WOBASZ).

    Science.gov (United States)

    Polakowska, Maria; Kaleta, Dorota; Piotrowski, Walerian; Topór-Mądry, Roman; Puch-Walczak, Aleksandra; Niklas, Arkadiusz; Bielecki, Wojciech; Kozakiewicz, Krystyna; Pająk, Andrzej; Tykarski, Andrzej; Zdrojewski, Tomasz; Drygas, Wojciech

    2017-01-17

    INTRODUCTION    The reduction of tobacco smoking is a challenging problem of public health. OBJECTIVES    The main purpose of this work was to evaluate the prevalence and tobacco use patterns in the adult population of Poles and its changes in a period between year 2003 and 2014. Furthermore, changes in the smoking addiction, the declared reasons for smoking as well as readiness and motivation to stop smoking has been assessed.  PATIENTS AND METHODS    Based on data from the Polish studies - WOBASZ and WOBASZ II, the analysis covered a population of 14576 persons from the 1st study (6906 men and 7670 women) and 5696 persons from the 2nd study (2578 men and 3118 women), aged 20 - 74. RESULTS    According to the WOBASZ II study, in Poland 30% of men and 21% of women smoked,  the shares being 9 and 4 % lower for men and women respectively in comparison with the WOBASZ (p<0.001). The average number of cigarettes smoked daily per smoker significantly decreased in the period of observation among men (from 17.9 to 15.8 cigarettes/day) and women (from 13.7 to 12.1). The percentage of never smoking men rose from 29.8% to 36.1% (p<0.0001). The proportion of never smoking women no changed. However, the percentage of those expressing unwillingness to quit tobacco smoking nearly doubled in WOBASZ II vs WOBASZ. CONCLUSIONS    Although we found smoking rates in Poland have declined over the past decade, smoking remains prevalent among men and women. Therefore it is necessary to optimize the tobacco control in Poland including fiscal policy, counseling and tobacco addiction treatment, promotional and educational activities, with a special emphasis on the female population.

  8. Prognostic factors for survival in patients with amyotrophic lateral sclerosis: analysis of a multi-centre clinical trial.

    Science.gov (United States)

    Yates, Emma; Rafiq, Muhammad K

    2016-10-01

    Information regarding factors influencing prognosis and quality of life (QoL) in patients with amyotrophic lateral sclerosis (ALS) is useful for clinicians and also for patients and their carers. The aims of this study are to identify prognostic factors for survival in ALS and to determine the physical factors influencing QoL. This study is a retrospective analysis of a cohort of 512 patients who participated in a phase II/III clinical trial of olesoxime. Cox multivariate regression analysis found older age, bulbar onset disease, low baseline forced vital capacity, low baseline manual muscle test (MMT) scores and a shorter diagnostic delay to be independently associated with poor survival outcome. Physical factors shown to have the strongest correlation with poor QoL were low weight and a reduced ability to climb stairs. Therapeutic interventions including gastrostomy and non-invasive ventilation had no positive impact on QoL in this cohort. The prognostic factors for survival identified here are consistent with other studies of ALS patients, with the additional identification of baseline MMT score as another predictor of prognosis. Furthermore, the correlation between both weight and poor lower limb function with QoL is novel and underlines the importance of careful nutritional management in this hypercatabolic condition.

  9. Gram-negative bacteraemia; a multi-centre prospective evaluation of empiric antibiotic therapy and outcome in English acute hospitals.

    Science.gov (United States)

    Fitzpatrick, J M; Biswas, J S; Edgeworth, J D; Islam, J; Jenkins, N; Judge, R; Lavery, A J; Melzer, M; Morris-Jones, S; Nsutebu, E F; Peters, J; Pillay, D G; Pink, F; Price, J R; Scarborough, M; Thwaites, G E; Tilley, R; Walker, A S; Llewelyn, M J

    2016-03-01

    Increasing antibiotic resistance makes choosing antibiotics for suspected Gram-negative infection challenging. This study set out to identify key determinants of mortality among patients with Gram-negative bacteraemia, focusing particularly on the importance of appropriate empiric antibiotic treatment. We conducted a prospective observational study of 679 unselected adults with Gram-negative bacteraemia at ten acute english hospitals between October 2013 and March 2014. Appropriate empiric antibiotic treatment was defined as intravenous treatment on the day of blood culture collection with an antibiotic to which the cultured organism was sensitive in vitro. Mortality analyses were adjusted for patient demographics, co-morbidities and illness severity. The majority of bacteraemias were community-onset (70%); most were caused by Escherichia coli (65%), Klebsiella spp. (15%) or Pseudomonas spp. (7%). Main foci of infection were urinary tract (51%), abdomen/biliary tract (20%) and lower respiratory tract (14%). The main antibiotics used were co-amoxiclav (32%) and piperacillin-tazobactam (30%) with 34% receiving combination therapy (predominantly aminoglycosides). Empiric treatment was inappropriate in 34%. All-cause mortality was 8% at 7 days and 15% at 30 days. Independent predictors of mortality (p antibiotic therapy was not associated with mortality at either time-point (adjusted OR 0.82; 95% CI 0.35-1.94 and adjusted OR 0.92; 95% CI 0.50-1.66, respectively). Although our study does not exclude an impact of empiric antibiotic choice on survival in Gram-negative bacteraemia, outcome is determined primarily by patient and disease factors.

  10. Site Selection for the European ELT: working package included in the European FP6 ``ELT design study'' contract

    Science.gov (United States)

    Muñoz-Tuñón, C.; Sarazin, M.; Vernin, J.

    2007-10-01

    The site selection for the future European Large Telescope (E-ELT) is a key issue within the European proposal funded by the European Union (EU), within the ``ELT design study'' proposal. The organization, working scheme and baseline frameworks are reviewed. For the definition of the working package WP12000 ``Site Characterization'', important use has been done of previous work in the definition of techniques and tools for the study of the atmosphere above observing sites. We have also taken advantage of the number of data already available which have naturally defined a ranking among the known places which have also been taken as a base line for pre-selecting the candidate sites. The work will last 4 years, it started in 2005 and is organized in subtasks, working packages WP, whose main objectives are the following: WP12100: to characterize two top astronomical sites (ORM and North-Paranal) and to explore three other alternatives (Macon in Argentina, Izaña in Spain and Aklim in Morocco) suitable to install an ELT under the best conditions (Dome C is been currently under investigation, and no particular effort will be put in this site, but rather its atmospheric properties will be compared to the above mentioned sites). WP12200 is dedicated to design, build and operate a set of standard equipment in all the sites and to perform long term campaign. WP12300 will investigate wavefront properties over large baselines (50-100 m) corresponding to the size of the future ELT, as well as the fine characterization of the optical turbulence within the boundary layer. A similar plan is being carried out by the Thirty Meter Telescope (TMT) site selection team. For the sake of saving resources (budget and people), the TMT preselected sites (all in the American Continent) are not included in our European study.

  11. Methylhexanamine is not detectable in Pelargonium or Geranium species and their essential oils: A multi-centre investigation.

    Science.gov (United States)

    ElSohly, Mahmoud A; Gul, Waseem; Tolbert, Candice; ElSohly, Kareem M; Murphy, Timothy P; Avula, Bharathi; Chittiboyina, Amar G; Wang, Mei; Khan, Ikhlas A; Yang, Min; Guo, Dean; Zhang, Wei-Dong; Su, Juan

    2015-07-01

    In an earlier study, we developed two sensitive and reliable procedures for gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis of methylhexaneamine (MHA) in P. graveolens plant materials and volatile oils. None of the analyzed plant materials or oils showed any detectable levels of MHA which was further substantiated by high resolution liquid chromatography-quantum time of flight-mass spectrometry (LC-QTOF-MS) analysis with a limit of detection of 10 ppb. However, other laboratories (two studies) reported the presence of MHA in some samples of P. graveolens and pelargonium oil acquired by the investigators from China. Because of the controversy of whether Pelargonium species or pelargonium oil contains MHA, it was recommended that splits of multiple samples be analyzed by different laboratories. In this investigation, multiple plant materials and oil samples were collected from around the world. These samples were submitted to four different sites for analysis. All sites adopted a similar extraction method. All the analysis sites used LC-MS/MS or LC-QTOF-MS and detection limit was set close to the 10 ng/mL as previously reported. A total of 18 plant samples belonging to 6 different Pelargonium species and 9 oils from different locations around the world were split among 4 different analytical laboratories for analysis (each lab received the same samples). None of the laboratories detected MHA in any of the samples at or around the 10 ppb detection level of the procedure used.

  12. Efficacy of artesunate-amodiaquine for treating uncomplicated falciparum malaria in sub-Saharan Africa: a multi-centre analysis

    Directory of Open Access Journals (Sweden)

    Same-Ekobo Albert

    2009-08-01

    Full Text Available Abstract Background Artesunate and amodiaquine (AS&AQ is at present the world's second most widely used artemisinin-based combination therapy (ACT. It was necessary to evaluate the efficacy of ACT, recently adopted by the World Health Organization (WHO and deployed over 80 countries, in order to make an evidence-based drug policy. Methods An individual patient data (IPD analysis was conducted on efficacy outcomes in 26 clinical studies in sub-Saharan Africa using the WHO protocol with similar primary and secondary endpoints. Results A total of 11,700 patients (75% under 5 years old, from 33 different sites in 16 countries were followed for 28 days. Loss to follow-up was 4.9% (575/11,700. AS&AQ was given to 5,897 patients. Of these, 82% (4,826/5,897 were included in randomized comparative trials with polymerase chain reaction (PCR genotyping results and compared to 5,413 patients (half receiving an ACT. AS&AQ and other ACT comparators resulted in rapid clearance of fever and parasitaemia, superior to non-ACT. Using survival analysis on a modified intent-to-treat population, the Day 28 PCR-adjusted efficacy of AS&AQ was greater than 90% (the WHO cut-off in 11/16 countries. In randomized comparative trials (n = 22, the crude efficacy of AS&AQ was 75.9% (95% CI 74.6–77.1 and the PCR-adjusted efficacy was 93.9% (95% CI 93.2–94.5. The risk (weighted by site of failure PCR-adjusted of AS&AQ was significantly inferior to non-ACT, superior to dihydroartemisinin-piperaquine (DP, in one Ugandan site, and not different from AS+SP or AL (artemether-lumefantrine. The risk of gametocyte appearance and the carriage rate of AS&AQ was only greater in one Ugandan site compared to AL and DP, and lower compared to non-ACT (p = 0.001, for all comparisons. Anaemia recovery was not different than comparator groups, except in one site in Rwanda where the patients in the DP group had a slower recovery. Conclusion AS&AQ compares well to other treatments and meets the

  13. [Effect of acupuncture on early cerebral palsy infants with parafunctional sitting position: a multi-centre, randomized, control research].

    Science.gov (United States)

    Zhang, Hong-yun; Sun, Qun-ying; Yang, Kun-peng; Chen, Yu-xia; Wang, Qi; Wang, Xi; Liu, Yuan

    2015-02-01

    To study the clinical effect of development theory based acupuncture on early cerebral palsy (CP) infants with parafunctional sitting position. Totally 120 early CP infants were randomly assigned to two groups equally, the treatment group and the control group. All received acupuncture combined with training rehabilitation. Patients in the treatment group adopted acupuncture based on infants development theory, while those in the control group were treated by head acupuncture. Sitting functional points in Gross motor function measure (GMFM) 88 were observed in different groups and infant patients of various types before and after treatment. Root mean square (RMS) signals of sitting correlated muscles (latissimus dorsi, erector spinae, rectus abdominis) were recorded by surface electromyography (sEMG). The effective rate was evaluated by Nimodipine method. Compared with before treatment, sitting functional points were significantly improved in the two groups (Ptreatment, it was higher in the treatment group than in the control group (Ptreatment group after treatment (all Ptreatment group than in the control group (89.29% vs. 77.78%, P<0.05). Infants development theory based acupuncture could effectively elevate dorsi-extensor muscles force, improve sitting position of 8 months to 1 year old CP infants with parafunctional sitting position.

  14. Polyp measurement and size categorisation by CT colonography: effect of observer experience in a multi-centre setting

    Energy Technology Data Exchange (ETDEWEB)

    Burling, David; Bartram, Clive; De Villiers, Melinda; Honeyfield, Lesley [St. Marks Hospital, Intestinal Imaging Centre, London (United Kingdom); Halligan, Steve; Taylor, Stuart [University College Hospital, Specialist Radiology, Level 2 Podium, London (United Kingdom); Altman, Douglas G. [Centre for Medical Statistics, Oxford (United Kingdom); Atkin, Wendy [St Mark' s Hospital, Cancer Research UK, London (United Kingdom); Fenlon, Helen; Foley, Shane; O' Hare, Alan [Mater Misericordiae, Dublin (Ireland); Laghi, Andrea; Iannaccone, Riccardo; Mangiapane, Filipo; Ori, Sante [La Sapienza, Rome (Italy); Stoker, Jaap; Florie, Jasper; Poulus, Martin; Hulst, Victor van der [Amersterdam Medican Centre, Amsterdam (Netherlands); Frost, Roger [Salisbury District Hospital, Salisbury (United Kingdom); Dessey, Guido; Lefere, Philippe; Marrannes, Jesse [Stedelijk Ziekenhuis, Roeselare (Belgium); Gallo, Teresa; Nieddu, Giulia; Regge, Daniele; Signoretta, Saverio [Candiolo Oncologic Hospital, Turin (Italy); Kay, Clive; Lowe, Andrew; Williams-Butt, Jane [Bradford Royal Infirmary, Bradford (United Kingdom); Neri, Emmanuele; Politi, Benedetta; Vagli, Paola [University of Pisa, Pisa (Italy); Nicholson, David; Renaut, Lisa; Rudralingham, Velauthan [Hope Hospital, Salford (United Kingdom)

    2006-08-15

    The extent measurement error on CT colonography influences polyp categorisation according to established management guidelines is studied using twenty-eight observers of varying experience to classify polyps seen at CT colonography as either 'medium' (maximal diameter 6-9 mm) or 'large' (maximal diameter 10 mm or larger). Comparison was then made with the reference diameter obtained in each patient via colonoscopy. The Bland-Altman method was used to assess agreement between observer measurements and colonoscopy, and differences in measurement and categorisation was assessed using Kruskal-Wallis and Chi-squared test statistics respectively. Observer measurements on average underestimated the diameter of polyps when compared to the reference value, by approximately 2-3 mm, irrespective of observer experience. Ninety-five percent limits of agreement were relatively wide for all observer groups, and had sufficient span to encompass different size categories for polyps. There were 167 polyp observations and 135 (81%) were correctly categorised. Of the 32 observations that were miscategorised, 5 (16%) were overestimations and 27 (84%) were underestimations (i.e. large polyps misclassified as medium). Caution should be exercised for polyps whose colonographic diameter is below but close to the 1-cm boundary threshold in order to avoid potential miscategorisation of advanced adenomas. (orig.)

  15. CT colonography interpretation times: effect of reader experience, fatigue, and scan findings in a multi-centre setting

    Energy Technology Data Exchange (ETDEWEB)

    Burling, David; Bartram, Clive; De Villiers, Melinda; Honeyfield, Lesley [St. Marks Hospital, Intestinal Imaging Centre, London (United Kingdom); Halligan, Steve; Taylor, Stuart [University College Hospital, Specialist Radiology, Level 2 Podium, London (United Kingdom); Altman, Douglas G. [Centre for Medical Statistics, Oxford (United Kingdom); Atkin, Wendy [St Mark' s Hospital, Cancer Research UK, London (United Kingdom); Fenlon, Helen; Foley, Shane; O' Hare, Alan [Mater Misericordiae, Dublin (Ireland); Laghi, Andrea; Iannaccone, Riccardo; Mangiapane, Filipo; Ori, Sante [La Sapienza, Rome (Italy); Stoker, Jaap; Florie, Jasper; Poulus, Martin; Hulst, Victor van der [Amsterdam Medical Centre, Amsterdam (Netherlands); Frost, Roger [Salisbury District Hospital, Salisbury (United Kingdom); Dessey, Guido; Lefere, Philippe; Marrannes, Jesse [Stedelijk Ziekenhuis, Roeselare (Belgium); Gallo, Teresa; Nieddu, Giulia; Regge, Daniele; Signoretta, Saverio [Candiolo Oncologic Hospital, Turin (Italy); Kay, Clive; Lowe, Andrew; Williams-Butt, Jane [Bradford Royal Infirmary, Bradford (United Kingdom); Neri, Emmanuele; Politi, Benedetta; Vagli, Paola [University of Pisa, Pisa (Italy); Nicholson, David; Renaut, Lisa; Rudralingham, Velauthan [Hope Hospital, Salford (United Kingdom)

    2006-08-15

    Our purpose was to assess the effect of reader experience, fatigue, and scan findings on interpretation time for CT colonography. Nine radiologists (experienced in CT colonography); nine radiologists and ten technicians (both groups trained using 50 validated examinations) read 40 cases (50% abnormal) under controlled conditions. Individual interpretation times for each case were recorded, and differences between groups determined. Multi-level linear regression was used to investigate effect of scan category (normal or abnormal) and observer fatigue on interpretation times. Experienced radiologists (mean time 10.9 min, SD 5.2) reported significantly faster than less experienced radiologists and technicians; odds ratios of reporting times 1.4 (CI 1.1, 1.8) and 1.6 (1.3, 2.0), respectively (P{<=}0.001). Experienced and less-experienced radiologists took longer to report abnormal cases; ratio 1.2 (CI 1.1,1.4, P<0.001) and 1.2 (1.0, 1.3, P=0.03), respectively. All groups took 70% as long to report the final five cases as they did with an initial five; ratio 0.7 (CI 0.6 to 0.8), P<0.001. For technicians only, accuracy increased with longer reporting times (P=0.04). Experienced radiologists report faster than do less-experienced observers and proportionally spend less time interpreting normal cases. Technicians who report more slowly are more accurate. All groups reported faster as the study period progressed. (orig.)

  16. BariSurg trial: Sleeve gastrectomy versus Roux-en-Y gastric bypass in obese patients with BMI 35–60 kg/m2 – a multi-centre randomized patient and observer blind non-inferiority trial

    OpenAIRE

    2015-01-01

    Background: Roux-en-Ygastric bypass (RYGB) and sleeve gastrectomy (SG) rank among the most frequently applied bariatric procedures worldwide due to their positive risk/benefit correlation. A systematic review revealed a similar excess weight loss (EWL) 2 years postoperatively between SG and RYGB. However, there is a lack of randomized controlled multi-centre trials comparing SG and RYGB, not only concerning EWL, but also in terms of remission of obesity-related co-morbidities, gastroesophagea...

  17. Quality control for diagnostic oral microbiology laboratories in European countries

    Directory of Open Access Journals (Sweden)

    Andrew J. Smith

    2011-11-01

    Full Text Available Participation in diagnostic microbiology internal and external quality control (QC processes is good laboratory practice and an essential component of a quality management system. However, no QC scheme for diagnostic oral microbiology existed until 2009 when the Clinical Oral Microbiology (COMB Network was created. At the European Oral Microbiology Workshop in 2008, 12 laboratories processing clinical oral microbiological samples were identified. All these were recruited to participate into the study and six laboratories from six European countries completed both the online survey and the first QC round. Three additional laboratories participated in the second round. Based on the survey, European oral microbiology laboratories process a significant (mean per laboratory 4,135 number of diagnostic samples from the oral cavity annually. A majority of the laboratories did not participate in any internal or external QC programme and nearly half of the laboratories did not have standard operating procedures for the tests they performed. In both QC rounds, there was a large variation in the results, interpretation and reporting of antibiotic susceptibility testing among the laboratories. In conclusion, the results of this study demonstrate the need for harmonisation of laboratory processing methods and interpretation of results for oral microbiology specimens. The QC rounds highlighted the value of external QC in evaluating the efficacy and safety of processes, materials and methods used in the laboratory. The use of standardised methods is also a prerequisite for multi-centre epidemiological studies that can provide important information on emerging microbes and trends in anti-microbial susceptibility for empirical prescribing in oro-facial infections.

  18. Red list assessment of European habitat types. A feasibility study

    NARCIS (Netherlands)

    Rodwell, J.S.; Janssen, J.A.M.; Gubbay, S.; Schaminee, J.H.J.

    2013-01-01

    This report presents an achievable methodology for the Red List assessment of European habitats in terrestrial, freshwater and marine realms, outlines a process that will deliver such evaluations and gives an indication of resources needed. It shows how the EUNIS habitat classification can be employ

  19. Reading and Spelling Acquisition in European Portuguese: A Preliminary Study

    Science.gov (United States)

    Fernandes, Sandra; Ventura, Paulo; Querido, Luis; Morais, Jose

    2008-01-01

    We investigated the initial development of reading and spelling in European Portuguese. First-graders, tested in February and June, had to read and spell words and pseudowords. In February there were regularity and graphemic complexity effects, indicating that these children relied on grapheme-phoneme conversion. The lexicality effect found in…

  20. CRASH - Community Road Accident System Homepage : feasibility study on a European Road Safety Information System, financially supported by the European Commission.

    NARCIS (Netherlands)

    Brouwer, M. Poppe, F. Blokpoel, A. & Kars, V.

    2000-01-01

    This report is the result of a feasibility study, financially supported by the European Commission. The study investigated the possibilities for the development and maintenance of a European Road Safety Information System with relevant and internationally comparable information. Recommendations on h

  1. Progression of Alzheimer Disease in Europe: Data from the European ICTUS Study

    NARCIS (Netherlands)

    Vellas, B.; Hausner, L.; Frolich, L.; Cantet, C.; Gardette, V.; Reynish, E.; Gillette, S.; Aguera-Morales, E.; Auriacombe, S.; Boada, M.; Bullock, R.; Byrne, J.; Camus, V.; Cherubini, A.; Eriksdotter-Jonhagen, M.; Frisoni, G.B.; Hasselbalch, S.; Jones, R.W.; Martinez-Lage, P.; Olde Rikkert, M.G.; Tsolaki, M.; Ousset, P.J.; Pasquier, F.; Ribera-Casado, J.M.; Rigaud, A.S.; Robert, P.; Rodriguez, G.; Salmon, E.; Salva, A.; Scheltens, P.; Schneider, A.; Sinclair, A.; Spiru, L.; Touchon, J.; Zekry, D.; Winblad, B.; Andrieu, S.

    2012-01-01

    The clinical progression of Alzheimer disease (AD) was studied in European subjects under treatment with AChE inhibitors (AChE-I) in relation to geographical location over a 2-years period. One thousand three hundred and six subjects from 11 European countries were clustered into 3 regions (North,

  2. Consultation-Liaison psychiatric service delivery : results from a European study

    NARCIS (Netherlands)

    Huyse, FJ; Herzog, T; Lobo, A; Malt, UF; Opmeer, BC; Stein, B; de Jonge, P; van Dijck, R; Creed, F; Crespo, MD; Cardoso, G; Guimaraes-Lopes, R; Mayou, R; van Moffaert, M; Rigatelli, M; Sakkas, P; Tienari, P

    2001-01-01

    The reported Endings of the European Consultation-Liaison Workgroup (ECLW) Collaborative Study describe consultation-liaison service delivery by 56 services from ZI European countries aggregated on a C-L service level. During the period of 1 year (1991), the participants applied a standardized, reli

  3. Coproducing European Integration Studies: Infrastructures and Epistemic Movements in an Interdisciplinary Field

    Science.gov (United States)

    Pfister, Thomas

    2015-01-01

    This paper is interested in the interdisciplinary characteristics of European integration studies. It explores how the institutional and intellectual, internal and external boundaries of this interdisciplinary field are shaped. For this purpose, it discusses two interlocking dynamics that are most important: on the one hand, the European Union…

  4. STUDY ON EUROPEAN FUNDS ABSORPTION IN ROMANIA FOR MEASURE 313

    Directory of Open Access Journals (Sweden)

    Florentina D. MATEI

    2014-06-01

    Full Text Available In this paper we wish to highlight the main causes of regional disparities in Romania in terms of absorption of European funds through Measure 313: Encouragement of tourism activities. The post-accession of Romania shows a major deficiency in attracting funds from the European Union, this situation is generated, in particular, by the lack of a coherent long-term vision of the authorities, insufficient resources for co-financing projects, low administrative capacity at central and local level, lack of inter-institutional coordination, public-private partnerships failures and insufficient skilled human resources . We will analyze the number of projects approved and implemented in each region of Romania (2007-2013 to establish the real possibilities of expansion of rural tourism.

  5. Case study: Teaching European Active Citizenship (TEACh)-course, EU

    DEFF Research Database (Denmark)

    Milana, Marcella; Bernt Sorensen, Tore

    2007-01-01

    Learning for democratic citizenship has been the object of several projects supported by the European Commission, under the Socrates / Grundtvig 1.1. Action. Nonetheless only very few had the specific aim of exploring the relations between learning for democratic citizenship and non-formal adult...... for different professionals in education. Thirdly, the course is to be considered on the edge of non-formal and formal learning activities, as it is organized accordingly to the European Credit Transfer System (ECTS). Participants are awarded 3 ECTS points to be spent in a variety of learning and working...... as capacity building in linking research and supply in adult education. Secondly, the course addresses a very special audience: Adult educators in a variety of learning contexts - i.e. including lower and upper secondary school teachers. Thus it falls within the broader category of in-service training...

  6. European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study: rationale, design and population characteristics

    DEFF Research Database (Denmark)

    Slimani, N.; Kaaks, R.; Ferrari, P.

    2002-01-01

    The European Prospective Investigation into Cancer and Nutrition (EPIC), which covers a large cohort of half a million men and women from 23 European centres in 10 Western European countries, was designed to study the relationship between diet and the risk of chronic diseases, particularly cancer...... a stratified random sample of 36 900 subjects from the entire EPIC cohort, using a software program (EPIC-SOFT) specifically designed to standardise the dietary measurements across study populations. This paper describes the design and populations of the calibration sub-studies set up in the EPIC centres...

  7. Night-time splinting after fasciectomy or dermo-fasciectomy for Dupuytren's contracture: a pragmatic, multi-centre, randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Larson Debbie

    2011-06-01

    Full Text Available Abstract Background Dupuytren's disease is a progressive fibroproliferative disorder which can result in fixed flexion contractures of digits and impaired hand function. Standard treatment involves surgical release or excision followed by post-operative hand therapy and splinting, however the evidence supporting night splinting is of low quality and equivocal. Methods A multi-centre, pragmatic, open, randomised controlled trial was conducted to evaluate the effect of night splinting on self-reported function, finger extension and satisfaction in patients undergoing fasciectomy or dermofasciectomy. 154 patients from 5 regional hospitals were randomised after surgery to receive hand therapy only (n = 77 or hand therapy with night-splinting (n = 77. Primary outcome was self-reported function using the Disabilities of the Arm, Shoulder and Hand (DASH questionnaire. Secondary outcomes were finger range of motion and patient satisfaction. Primary analysis was by intention to treat. Results 148 (96% patients completed follow-up at 12 months. No statistically significant differences were observed on the DASH questionnaire (0-100 scale: adjusted mean diff. 0.66, 95%CI - 2.79 to 4.11, p = 0.703, total extension deficit of operated digits (degrees: adjusted mean diff 5.11, 95%CI -2.33 to 12.55, p = 0.172 or patient satisfaction (0-10 numerical rating scale: adjusted mean diff -0.35, 95%CI -1.04 to 0.34, p = 0.315 at 1 year post surgery. Similarly, in a secondary per protocol analysis no statistically significant differences were observed between the groups in any of the outcomes. Conclusions No differences were observed in self-reported upper limb disability or active range of motion between a group of patients who were all routinely splinted after surgery and a group of patients receiving hand therapy and only splinted if and when contractures occurred. Given the added expense of therapists' time, thermoplastic materials and the potential inconvenience to

  8. European adults’ physical activity socio-demographic correlates: a cross-sectional study from the European Social Survey

    Science.gov (United States)

    Martins, João; Peralta, Miguel; Catunda, Ricardo; Nunes, Luís Saboga

    2016-01-01

    Background. From a public health perspective, the study of socio-demographic factors related to physical activity is important in order to identify subgroups for intervention programs. Objective. This study aimed to identify the prevalence of, and the socio-demographic correlates related to, the achievement of recommended physical activity levels. Methods. Using data from the European Social Survey round 6, physical activity and socio-demographic characteristics were collected, in 2012, from 39,278 European adults (18,272 men, 21,006 women), aged 18–65 years, from 28 countries. The question of meeting physical activity guidelines was assessed using World Health Organization criteria. Results. A total of 64.50% (63.36% men, 66.49% women) attained physical activity recommended levels. The likelihood of attaining physical activity recommendations was higher in the 55–64 years age group (men: OR = 1.22, p socio-demographic factors are important to consider when planning the increase of physical activity. PMID:27280072

  9. Merchant electricity transmission expansion: A European case study

    Energy Technology Data Exchange (ETDEWEB)

    Kristiansen, T. [RBS Sempra Commodities, 155 Bishopsgate, London EC2M3TZ (United Kingdom); Rosellon, J. [Centro de Investigacion y Docencia Economicas (CIDE), Division de Economia, Carretera Mexico-Toluca 3655, Lomas de Santa Fe, 01210 Mexico D.F. (Mexico); German Institute for Economic Research (DIW Berlin), Mohrenstrasse 58, 10117, Berlin (Germany)

    2010-10-15

    We apply a merchant transmission model to the trilateral market coupling (TLC) arrangement among the Netherlands, Belgium and France as an example, and note that it could further be applied to other market splitting or coupling of Europe's different national power markets. In this merchant framework the system operator allocates financial transmission rights (FTRs) to investors in transmission expansion based upon their preferences, and revenue adequacy. The independent system operator (ISO) preserves some proxy FTRs to manage potential negative externalities that may result from expansion projects. This scheme could help European market coupling arrangements attract additional investment. (author)

  10. Response from the European Organization for Nuclear Research (CERN) to the consultation on the European Commission study on scientific publishing

    CERN Document Server

    Rolandi, Luigi

    2006-01-01

    CERN welcomes the EC study on the economic and technical evolution of the scientific publication markets in Europe. In general the report accurately reflects the overall situation in scientific publishing. Most of the findings in the study accord with data collected and analyzed by our scientific information officers. The report has the potential to serve as a reference document for scientific information policy makers in the ongoing reform of the publishing model. The recommendations presented by the authoring consortium of the study deserve the European Commission's full attention. We support the recommendations made and we take the opportunity to encourage the Commission to take all appropriate steps to contribute to adapt the framework for scientific publishing to a fast changing world with new paradigms.

  11. Genomic study in Mexicans identifies a new locus for triglycerides and refines European lipid loci

    Science.gov (United States)

    Weissglas-Volkov, Daphna; Aguilar-Salinas, Carlos A.; Nikkola, Elina; Deere, Kerry A.; Cruz-Bautista, Ivette; Arellano-Campos, Olimpia; Muñoz-Hernandez, Linda Liliana; Gomez-Munguia, Lizeth; Ordoñez-Sánchez, Maria Luisa; Reddy, Prasad MV Linga; Lusis, Aldons J.; Matikainen, Niina; Taskinen, Marja-Riitta; Riba, Laura; Cantor, Rita M.; Sinsheimer, Janet S.; Tusie-Luna, Teresa; Pajukanta, Päivi

    2013-01-01

    Background The Mexican population and others with Amerindian heritage exhibit a substantial predisposition to dyslipidemias and coronary heart disease. Yet, these populations remain underinvestigated by genomic studies, and to date, no genome-wide association (GWA) studies have been reported for lipids in these rapidly expanding populations. Methods and Findings We performed a two-stage GWA study for hypertriglyceridemia and low high-density lipoprotein cholesterol (HDL-C) in Mexicans (n=4,361) and identified a novel Mexican-specific genome-wide significant locus for serum triglycerides (TGs) near the Niemann-Pick type C1 protein (NPC1) gene (P=2.43×10−08). Furthermore, three European loci for TGs (APOA5, GCKR, and LPL) and four loci for HDL-C (ABCA1, CETP, LIPC and LOC55908) reached genome-wide significance in Mexicans. We utilized cross-ethnic mapping to narrow three European TG GWA loci, APOA5, MLXIPL, and CILP2 that were wide and contained multiple candidate variants in the European scan. At the APOA5 locus, this reduced the most likely susceptibility variants to one, rs964184. Importantly, our functional analysis demonstrated a direct link between rs964184 and postprandial serum apoAV protein levels, supporting rs964184 as the causative variant underlying the European and Mexican GWA signal. Overall, 52 of the 100 reported associations from European lipid GWA meta-analysis generalized to Mexicans. However, in 82 of the 100 European GWA loci, a different variant other than the European lead/best-proxy variant had the strongest regional evidence of association in Mexicans. Conclusions This first Mexican GWA study of lipids identified a novel GWA locus for high TG levels; utilized the inter-population heterogeneity to significantly restrict three previously known European GWA signals; and surveyed whether the European lipid GWA SNPs extend to the Mexican population. PMID:23505323

  12. Status of infection control policies and organisation in European hospitals, 2001: the ARPAC study.

    NARCIS (Netherlands)

    Struelens, M.J.; Wagner, D.; Bruce, J.; MacKenzie, F.M.; Cookson, B.; Voss, A.; Broek, P.J.J.A. van den; Gould, I.

    2006-01-01

    Patient safety in hospital care depends on effective infection control (IC) programmes. The Antimicrobial Resistance Prevention and Control (ARPAC) study assessed the organisation, components and human resources of IC programmes in European hospitals. A questionnaire survey of policies and procedure

  13. The EMBARC European bronchiectasis registry: Protocol for an international observational study

    NARCIS (Netherlands)

    Chalmers, J.D. (James D.); S. Aliberti (Stefano); Polverino, E. (Eva); Vendrell, M. (Montserrat); Crichton, M. (Megan); Loebinger, M. (Michael); Dimakou, K. (Katerina); Clifton, I. (Ian); M. van der Eerden (Menno); G. Rohde (Gernot); Murris-Espin, M. (Marlene); Masefield, S. (Sarah); Gerada, E. (Eleanor); Shteinberg, M. (Michal); F.C. Ringshausen (Felix C.); Haworth, C. (Charles); W.G. Boersma (Wim); Rademacher, J. (Jessica); Hill, A.T. (Adam T.); Aksamit, T. (Timothy); O’Donnell, A. (Anne); Morgan, L. (Lucy); B. Milenkovic (Branislava); Tramma, L. (Leandro); Neves, J. (Joao); Menendez, R. (Rosario); Paggiaro, P. (Perluigi); Botnaru, V. (Victor); Skrgat, S. (Sabina); R. Wilson (Richard); Goeminne, P. (Pieter); De Soyza, A. (Anthony); T. Welte; Torres, A. (Antoni); S. Elborn (Stuart); Blasi, F. (Francesco)

    2016-01-01

    textabstractBronchiectasis is one of the most neglected diseases in respiratory medicine. There are no approved therapies and few large-scale, representative epidemiological studies. The EMBARC (European Multicentre Bronchiectasis Audit and Research Collaboration) registry is a prospective,

  14. Energy efficiency in the European water industry. A compendium of best practices and case studies

    Energy Technology Data Exchange (ETDEWEB)

    Frijns, J. [Watercycle Research Institute KWR, Nieuwegein (Netherlands); Uijterlinde, C. [Foundation for Applied Water Research STOWA, Amersfoort (Netherlands)

    2010-02-15

    This European report on best practices of energy efficiency in the water industry showcases 23 energy efficiency initiatives which were collected as case studies from European water utilities. The 25 case studies presented in this report will be submitted to UKWIR and Black and Veatch, for potential inclusion in the Global Water Research Coalition (GWRC) global compendium of best practice case studies. The aim of the GWRC-compendium is to identify the promising developments and future opportunities to help deliver incremental improvements in energy efficiency through optimisation of existing assets and operations. But also more substantial improvements in energy efficiency from the adoption of novel (but proven at full scale) technologies. The European report describes case studies from: Belgium, Denmark, France, Germany, Hungary, Netherlands, Norway, Spain and Switzerland. Black and Veatch has gathered furthermore information on 47 cases from the UK. These are reported separately and are not included in this European overview.

  15. Prescription errors in Brazilian hospitals: a multi-centre exploratory survey Erros de prescrição em hospitais brasileiros: um estudo exploratório multicêntrico

    Directory of Open Access Journals (Sweden)

    Adriana Inocenti Miasso

    2009-02-01

    Full Text Available In Brazil, millions of prescriptions do not follow the legal requirements necessary to guarantee the correct dispensing and administration of medication. This multi-centre exploratory study aimed to analyze the appropriateness of prescriptions at four Brazilian hospitals and to identify possible errors caused by inadequacies. The sample consisted of 864 prescriptions obtained at hospital medical clinics in January 2003. Data was collected by three nurse researchers during one week using a standard data sheet that included items about: the type of prescription; legibility; completeness; use of abbreviations; existence of changes and erasures. There were statistically significant differences between incomplete electronic prescriptions at hospital A, and handwritten ones from hospitals C (Ç2 = 12.703 and p No Brasil, milhões de prescrições não apresentam os requisitos legais necessários para garantir a correta dispensação e administração dos medicamentos. Este estudo multicêntrico exploratório objetivou analisar a adequação das prescrições em quatro hospitais brasileiros e identificar eventuais erros causados pelas inadequações. A amostra consistiu de 864 prescrições obtidas nas clínicas médicas dos hospitais em janeiro de 2003. Os dados foram coletados por três enfermeiras durante uma semana através de instrumento estruturado com variáveis sobre: tipo de prescrição; legibilidade; completude; presença de abreviações, alterações e rasuras. Houve diferenças estatisticamente significativas entre prescrição eletrônica no hospital A e manuscritas nos C (Ç2 = 12,703 e p < 0,001 e D (Ç2 = 14,074 e p < 0,001. Abreviações foram usadas em mais de 80% das receitas nos hospitais B, C e D. Alterações foram encontradas em prescrições de todos os hospitais, com níveis mais elevados no B (35,2% e A (25,3%. Este estudo identificou uma série de pontos vulneráveis na fase prescrição dos sistemas de medicação dos

  16. Moxibustion Treatment for Knee Osteoarthritis: A Multi-Centre, Non-Blinded, Randomised Controlled Trial on the Effectiveness and Safety of the Moxibustion Treatment versus Usual Care in Knee Osteoarthritis Patients

    Science.gov (United States)

    Kang, Jung Won; Lee, MinHee; Kang, Kyung-Won; Kim, Jung Eun; Kim, Joo-Hee; Lee, Seunghoon; Shin, Mi-Suk; Jung, So-Young; Kim, Ae-Ran; Park, Hyo-Ju; Jung, Hee-Jung; Song, Ho Sueb; Kim, Hyeong Jun; Choi, Jin-Bong; Hong, Kwon Eui; Choi, Sun-Mi

    2014-01-01

    Introduction This study tested the effectiveness of moxibustion on pain and function in chronic knee osteoarthritis (KOA) and evaluated safety. Methods A multi-centre, non-blinded, parallel-group, randomised controlled trial compared moxibustion with usual care (UC) in KOA. 212 South Korean patients aged 40–70 were recruited from 2011–12, stratified by mild (Kellgren/Lawrence scale grades 0/1) and moderate-severe KOA (grades 2/3/4), and randomly allocated to moxibustion or UC for four weeks. Moxibustion involved burning mugwort devices over acupuncture and Ashi points in affected knee(s). UC was allowed. Korean Western Ontario and McMaster Universities Questionnaire (K-WOMAC), Short Form 36 Health Survey (SF-36v2), Beck Depression Inventory (BDI), physical performance test, pain numeric rating scale (NRS) and adverse events were evaluated at 5 and 13 weeks. K-WOMAC global score at 5 weeks was the primary outcome. Results 102 patients (73 mild, 29 moderate-severe) were allocated to moxibustion, 110 (77 mild, 33 moderate-severe) to UC. K-WOMAC global score (moxibustion 25.42+/−SD 19.26, UC 33.60+/−17.91, p<0.01, effect size  = 0.0477), NRS (moxibustion 44.77+/−22.73, UC 56.23+/−17.71, p<0.01, effect size  = 0.0073) and timed-stand test (moxibustion 24.79+/−9.76, UC 25.24+/−8.84, p = 0.0486, effect size  = 0.0021) were improved by moxibustion at 5 weeks. The primary outcome improved for mild but not moderate-severe KOA. At 13 weeks, moxibustion significantly improved the K-WOMAC global score and NRS. Moxibustion improved SF-36 physical component summary (p = 0.0299), bodily pain (p = 0.0003), physical functioning (p = 0.0025) and social functioning (p = 0.0418) at 5 weeks, with no difference in mental component summary at 5 and 13 weeks. BDI showed no difference (p = 0.34) at 5 weeks. After 1158 moxibustion treatments, 121 adverse events included first (n = 6) and second degree (n = 113) burns, pruritus and

  17. Development of Vocational Secondary School Students Competitiveness for Studies in the European Area of Higher Education

    OpenAIRE

    Olga Dementjeva

    2012-01-01

    ABSTRACT OF THE PROMOTION THESIS DEVELOPMENT OF VOCATIONAL SECONDARY SCHOOL STUDENTS’ COMPETITIVENESS FOR STUDIES IN THE EUROPEAN AREA OF HIGHER EDUCATION The promotion thesis „Development of Vocational Secondary School Students’ Competitiveness for Studies in the European Area of Higher Education” in the field of general pedagogy of pedagogical science has been worked out by Olga Dementjeva under the supervision of Dr. chem. Professor Andrejs Rauhvargers at the Depart...

  18. Association of STAT4 with rheumatoid arthritis - A replication study in three European populations : a replication study in three European populations

    NARCIS (Netherlands)

    Orozco, Gisela; Alizadeh, Behrooz Z.; Delgado-Vega, Angelica M.; Gonzalez-Gay, Miguel A.; Balsa, Alejandro; Pascual-Salcedo, Dora; Fernandez-Gutierrez, Benjamin; Gonzalez-Escribano, Maria F.; Petersson, Ingemar F.; van Riel, Piet L. C. M.; Barrera, Pilar; Coenen, Marieke J. H.; Radstake, Timothy R. D. J.; van Leeuwen, Miek A.; Wijmenga, Cisca; Koeleman, Bobby P. C.; Alarcon-Riquelme, Marta; Martin, Javier

    Objective. This study was undertaken to investigate the previously reported association of the STAT4 polymorphism rs7574865 with rheumatoid arthritis (RA) in 3 different European populations from Spain, Sweden, and The Netherlands, comprising a total of 2,072 patients and 2,474 controls. Methods.

  19. Association of STAT4 with rheumatoid arthritis - A replication study in three European populations : a replication study in three European populations

    NARCIS (Netherlands)

    Orozco, Gisela; Alizadeh, Behrooz Z.; Delgado-Vega, Angelica M.; Gonzalez-Gay, Miguel A.; Balsa, Alejandro; Pascual-Salcedo, Dora; Fernandez-Gutierrez, Benjamin; Gonzalez-Escribano, Maria F.; Petersson, Ingemar F.; van Riel, Piet L. C. M.; Barrera, Pilar; Coenen, Marieke J. H.; Radstake, Timothy R. D. J.; van Leeuwen, Miek A.; Wijmenga, Cisca; Koeleman, Bobby P. C.; Alarcon-Riquelme, Marta; Martin, Javier

    2008-01-01

    Objective. This study was undertaken to investigate the previously reported association of the STAT4 polymorphism rs7574865 with rheumatoid arthritis (RA) in 3 different European populations from Spain, Sweden, and The Netherlands, comprising a total of 2,072 patients and 2,474 controls. Methods. Th

  20. European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study: rationale, design and population characteristics

    DEFF Research Database (Denmark)

    Slimani, N.; Kaaks, R.; Ferrari, P.

    2002-01-01

    The European Prospective Investigation into Cancer and Nutrition (EPIC), which covers a large cohort of half a million men and women from 23 European centres in 10 Western European countries, was designed to study the relationship between diet and the risk of chronic diseases, particularly cancer...... population differed slightly from the overall cohort but the differences were small for most characteristics and centres. The overall results suggest that, after adjustment for age, dietary intakes estimated from calibration samples can reasonably be interpreted as representative of the main cohorts in most...

  1. European Whiteness?

    DEFF Research Database (Denmark)

    Blaagaard, Bolette

    2008-01-01

    Born out of the United States’ (U.S.) history of slavery and segregation and intertwined with gender studies and feminism, the field of critical whiteness studies does not fit easily into a European setting and the particular historical context that entails. In order for a field of European...

  2. European Whiteness?

    DEFF Research Database (Denmark)

    Blaagaard, Bolette

    2008-01-01

    Born out of the United States’ (U.S.) history of slavery and segregation and intertwined with gender studies and feminism, the field of critical whiteness studies does not fit easily into a European setting and the particular historical context that entails. In order for a field of European...

  3. Stakeholders' Views on Factors Influencing Nutrition Policy: a Qualitative Study Across Ten European Countries

    OpenAIRE

    Jeruszka-Bielak Marta; Sicińska Ewa; Wit Liesbeth de; Ruprich Jiří; Řehůřková Irena; Brown Kerry A.; Timotijevic Lada; Sonne Anne-Mette; Haugaard Pernille; Guzzon Antonella; Garcia Noé Brito; Alevritou Eleni; Hermoso Maria; Sarmant Yuliya; Lähteenmäki Liisa

    2015-01-01

    The objective was to identify the main factors infl uencing micronutrient policies in the opinion of policy actors in ten European countries. Study was carried out during Jan-Nov 2010 in European countries: the Czech Republic, Denmark, England, Germany, Greece, Italy, the Netherlands, Norway, Poland and Spain. Semi-structured qualitative interviews were conducted with representatives of stakeholders involved in the vitamin D, folate and iodine policy making process. Fifty eight key informants...

  4. A European-wide 222Radon and 222Radon progeny comparison study

    OpenAIRE

    Schmithüsen, Dominik; Chambers, Scott; Fischer, Bernd; Gilge, Stefan; Hatakka, Juha; Kazan, Victor; Neubert, Rolf; Paatero, Jussi; Ramonet, Michel; Schlosser, Clemens; Schmid, Sabine; Vermeulen, Alex; Levin, Ingeborg

    2016-01-01

    A European-wide 222Radon/222Radon progeny comparison study has been conducted in order to determine correction factors that could be applied to existing atmospheric 222Radon data sets for quantitative use of this tracer in atmospheric transport model validation. Two compact and easy-to-transport Heidelberg Radon Monitors (HRM) were moved around to run for at least one month at each of the nine European measurement stations that were included in the comparison. Linear regressions between paral...

  5. European structuralism

    OpenAIRE

    Willems, Klaas

    2014-01-01

    European structuralism is a paradigm for the study of language developed by prominent European linguists during the inter-war period and the first decades after World War II that radically rejected the prevailing atomism of 19th century (particularly neo-grammarian) linguistics and language psychology.

  6. Voluntary agreements, implementation and efficiency. European relevance of case study results. Reflections on transferability to voluntary agreement schemes at the European level

    Energy Technology Data Exchange (ETDEWEB)

    Helby, Peter

    2000-04-01

    As a policy instrument, voluntary agreements often fascinate policy-makers.This is fuelled by a number of assumed advantages, such as the opportunity for co-operation rather than confrontation, speed and flexibility and the cost-effectiveness. Some advantages might even be accentuated at the European level: Co-operation has added advantage at the European level where the culture of consensus decision is strong. Flexibility is extra attractive for policy makers dealing with an economy less homogeneous than the average national economy. Speed is certainly welcomed by policy-makers otherwise faced with the slow-winding European legislative process. Cost-effectiveness is eagerly sought by European policy makers facing tight administrative budgets and staff limits. This report examines lessons from the VAIE case studies that may be useful to policy makers engaged in the development of voluntary approaches at the European level. These case studies are about voluntary agreement schemes for industrial energy efficiency deployed in Denmark, France, Germany, Netherlands, and Sweden. For a summary of these case studies, please refer to the the VAIE final report. More detailed information is available in the VAIE national reports. It needs to be emphasised that the empirical base is very narrow. The 'lessons' presented can only be hypotheses, based on an inductive leap from a very narrow experience. The reader will need to check these hypotheses against her own broader experience and personal judgement. According to the principle of subsidiarity, voluntary agreements should be implemented at the European level only if that would have significant advantage over national action. Action at the European level, rather than the national level, would have these potential advantages: Being more consistent with the development of the single market; Allowing higher demands on energy efficiency without negative effect on competitiveness and employment; Stimulating company

  7. Long-term particulate matter exposure and mortality: a review of European epidemiological studies

    Directory of Open Access Journals (Sweden)

    Boffetta Paolo

    2009-12-01

    Full Text Available Abstract Background Several studies considered the relation between long-term exposure to particulate matter (PM and total mortality, as well as mortality from cardiovascular and respiratory diseases. Our aim was to provide a comprehensive review of European epidemiological studies on the issue. Methods We searched the Medline database for epidemiological studies on air pollution and health outcomes published between January 2002 and December 2007. We also examined the reference lists of individual papers and reviews. Two independent reviewers classified the studies according to type of air pollutant, duration of exposure and health outcome considered. Among European investigations that examined long-term PM exposure we found 4 cohort studies (considering total and cardiopulmonary mortality, 1 case-control study (considering mortality from myocardial infarction, and 4 ecologic studies (2 studies considering total and cardiopulmonary mortality and 2 studies focused on cardiovascular mortality. Results Measurement indicators of PM exposure used in European studies, including PM10, PM2.5, total suspended particulate and black smoke, were heterogeneous. This notwithstanding, in all analytic studies total mortality was directly associated with long-term exposure to PM. The excesses in mortality were mainly due to cardiovascular and respiratory causes. Three out of 4 ecologic studies found significant direct associations between PM indexes and mortality. Conclusion European studies on long-term exposure to PM indicate a direct association with mortality, particularly from cardiovascular and respiratory diseases.

  8. Rehabilitation robotics in robotics for healthcare ; a roadmap study for the European Commission

    NARCIS (Netherlands)

    Gelderblom, G.J.; Wilt, M.de; Cremers, G.; Rensma, A.R.

    2009-01-01

    To gain understanding in the current status of Robotics in healthcare the European Commission issued a roadmap study into this domain. This paper reports on the main characteristics and results of this study. The study covered the wide domain of Healthcare and in this paper the domains relevant for

  9. European Maxillofacial Trauma (EURMAT) in children: a multicenter and prospective study

    NARCIS (Netherlands)

    Boffano, P.; Roccia, F.; Zavattero, E.; Dediol, E.; Uglešić, V.; Kovačič, Ž.; Vesnaver, A.; Konstantinović, V.S.; Petrović, M.; Stephens, J.; Kanzaria, A.; Bhatti, N.; Holmes, S.; Pechalova, P.F.; Bakardjiev, A.G.; Malanchuk, V.A.; Kopchak, A.V.; Galteland, P.; Mjøen, E.; Skjelbred, P.; Grimaud, F.; Fauvel, F.; Longis, J.; Corre, P.; Løes, S.; Lekven, N.; Laverick, S.; Gordon, P.; Tamme, T.; Akermann, S.; Karagozoglu, K.H.; Kommers, S.C.; Meijer, B.; Forouzanfar, T.

    2015-01-01

    Objective The aim of this study is to present and discuss the results of a European multicentre prospective study about pediatric maxillofacial trauma epidemiology during a year. Study Design The following data were recorded: gender, age, etiology, site of fracture, date of injury. Of the 3396 patie

  10. Rehabilitation robotics in robotics for healthcare ; a roadmap study for the European Commission

    NARCIS (Netherlands)

    Gelderblom, G.J.; Wilt, M.de; Cremers, G.; Rensma, A.R.

    2009-01-01

    To gain understanding in the current status of Robotics in healthcare the European Commission issued a roadmap study into this domain. This paper reports on the main characteristics and results of this study. The study covered the wide domain of Healthcare and in this paper the domains relevant for

  11. Media Literacy in the European Union: Tendencies Observed in the Regulations and the Studies

    Directory of Open Access Journals (Sweden)

    Ayşen AKKOR GÜL

    2013-02-01

    Full Text Available This study is about the European Union’s Media Literacy Policy and its main concern is to observe the leading tendencies in the media literacy studies and regulations. Therefore the recent literature is examined in order to find out the development and the goals of the European Union’s media literacy policy. Some the findings are: Media literacy is becoming a priority for policy-makers recently.The move from a communication to a recommendation is a sign that progress is being made. However looking at the regulations and studies it is seen that the goals of the media literacy is not clear. The European Commission considers media literacy an essential factor of democratic participation, active citizenship and social cohesion. So the goals are rather grandiose and the Euopean Union has to limit the requirements of media literacy. Otherwise media literacy will never achieve its ends.

  12. European birth cohort studies on asthma and atopic diseases

    DEFF Research Database (Denmark)

    Keil, T; Kulig, M; Simpson, A;

    2006-01-01

    BACKGROUND: The reasons for the rise in asthma and allergies remain unclear. To identify risk or protective factors, it is essential to carry out longitudinal epidemiological studies, preferably birth cohort studies. In Europe, several birth cohort studies on asthma and atopic diseases have been ...

  13. Media Literacy in the European Union: Tendencies Observed in the Regulations and the Studies

    OpenAIRE

    2013-01-01

    This study is about the European Union’s Media Literacy Policy and its main concern is to observe the leading tendencies in the media literacy studies and regulations. Therefore the recent literature is examined in order to find out the development and the goals of the European Union’s media literacy policy. Some the findings are: Media literacy is becoming a priority for policy-makers recently.The move from a communication to a recommendation is a sign that progress is being made. However lo...

  14. EURailNoise: a study of European priorities and strategies for railway noise abatement

    Science.gov (United States)

    Kalivoda, M.; Danneskiold-Samsøe, U.; Krüger, F.; Barsikow, B.

    2003-10-01

    The European Union is developing its noise policy by using a number of expert groups on specific noise issues. One of the most relevant noise problems is railway traffic which is dealt with by Working Group 6 (WG 6). The Commission of the European Union appointed a consortium of six consultants and experts in railway noise to prepare a study on European priorities and strategies for railway noise abatement. The main purpose of this study was to support the work within WG 6 and to create an inventory of measures for future railway noise abatement policy of the European Union. The EURailNoise study was to be completed in autumn 2001. The countries included the European Union member states, together with Norway, and Switzerland, and three prospective members (Hungary, the Czech Republic, and Poland). The EURailNoise study consisted of three main parts. The baseline was a review of current European legislation on railway noise generation as well as noise perception. In parallel a documentation of cases, where technical measures against railway noise had been successfully applied, was prepared using a classification of "good practice", "promising new technology", and "promising research results". The second part covered the potential for further noise reduction demonstrated for High Speed Passenger Traffic, S-Trains, Locomotives, Trams, Freight Traffic, Track Design and finally Wheels and Track Monitoring and Maintenance. Thirdly, a strategy for future activities of the Commission concerning the reduction of rail noise was to be proposed including a proposal for noise emission limits. This paper summarizes the results of the EURailNoise study.

  15. The Effect of Using Assessment Instruments on Substance-abuse Outpatients' Adherence to Treatment: a Multi-centre Randomised Controlled Trial

    Directory of Open Access Journals (Sweden)

    Broekaert Eric

    2011-05-01

    Full Text Available Abstract Background Drop-out is an important problem in the treatment of substance use disorder. The focus of this study was to investigate the effectiveness of within treatment assessment with feedback directly to patients with multiple substance use disorder on outpatient individual treatment adherence. Feedback consisted of personal resources' and readiness to change status and progress that facilitate or hinder change, thereby using graphical representation. Methods Informed consent was obtained from both the control and experimental groups to be involved in research and follow-up. Following Zelen's single consent design, baseline participants (n = 280 were randomised (sample-size-estimation: 80%power, p=.05, 2-sided and treatment consent was obtained from those allocated to the experiment (n = 142. In both groups, equal numbers of patients did not attend sessions after allocation. So, 227 persons were analyzed according to intention-to-treat analysis (ITT: experiment n = 116;control n = 111. Excluding refusals 211 participants remained for per-protocol analysis (PP: experiment n = 100; control n = 111, The study was conducted in five outpatient treatment-centres of a large network (De Sleutel in Belgium. Participants were people with multiple substance use disorder -abuse and dependence- who had asked for treatment and who had been advised to start individual treatment after a standardised admission assessment with the European Addiction Severity Index. The experimental condition consisted of informing the patient about the intervention and of subsequent assessments plus feedback following a protocol within the first seven sessions. Assessments were made with the Readiness to Change Questionnaire and the Personal Resources Diagnostic System. The control group received the usual treatment without within treatment assessment with feedback. The most important outcome measure in this analysis of the study was the level of adherence to treatment

  16. European Wind Farm Project Costs History and Projections 2008 Study

    Energy Technology Data Exchange (ETDEWEB)

    2008-10-15

    At the request of Enova (the 'Client'), Garrad Hassan and Partners Limited ('GH') has provided technical advice on capital cost expectations for wind farm developments. In summary, the work provides a survey of the present and future 5-year prognosis for costs and conditions facing developers and suppliers in the European wind power market. The report will be used as a benchmark to support tendering for future Norwegian projects. As such, it will also provide discussion of how project characteristics can influence project cost. Data Used in the Analysis GH has obtained data on the investment costs for 35 projects developed or in development in Europe. The projects represent to the extent possible the characteristics representative of potential Norwegian projects. The data used in this analysis are from actual projects in: France, Germany, Hungary, Ireland, Italy, Northern Ireland, Portugal, Scotland, Spain and Wales. The turbine capacities represented in the data are typically 2 MW or above, except in one case where a mix of turbines sizes was used at the project. GH highlights that because of high demand for turbines, the main manufacturers have recently been offering to meet delivery schedules for new orders from late 2010. For new tenders it is likely that delivery time frames offered will now be for 2011 deliveries. As a result of the current 'Seller's Market', production capacity typically relates directly to the number of turbines sold in the year; therefore for 2007 the annual production capacity was approximately 22 GW. GH is aware that turbine suppliers across the market are working to increase their production capacity in order to ease the pressure on the market, however, there are bottlenecks through the supply chain at the sub component level. As a result, increases in production capacity will likely remain at a relatively steady state in the short term. Energy Assessment The energy assessment of a project is the area

  17. European Wind Farm Project Costs History and Projections 2008 Study

    Energy Technology Data Exchange (ETDEWEB)

    2008-10-15

    At the request of Enova (the 'Client'), Garrad Hassan and Partners Limited ('GH') has provided technical advice on capital cost expectations for wind farm developments. In summary, the work provides a survey of the present and future 5-year prognosis for costs and conditions facing developers and suppliers in the European wind power market. The report will be used as a benchmark to support tendering for future Norwegian projects. As such, it will also provide discussion of how project characteristics can influence project cost. Data Used in the Analysis GH has obtained data on the investment costs for 35 projects developed or in development in Europe. The projects represent to the extent possible the characteristics representative of potential Norwegian projects. The data used in this analysis are from actual projects in: France, Germany, Hungary, Ireland, Italy, Northern Ireland, Portugal, Scotland, Spain and Wales. The turbine capacities represented in the data are typically 2 MW or above, except in one case where a mix of turbines sizes was used at the project. GH highlights that because of high demand for turbines, the main manufacturers have recently been offering to meet delivery schedules for new orders from late 2010. For new tenders it is likely that delivery time frames offered will now be for 2011 deliveries. As a result of the current 'Seller's Market', production capacity typically relates directly to the number of turbines sold in the year; therefore for 2007 the annual production capacity was approximately 22 GW. GH is aware that turbine suppliers across the market are working to increase their production capacity in order to ease the pressure on the market, however, there are bottlenecks through the supply chain at the sub component level. As a result, increases in production capacity will likely remain at a relatively steady state in the short term. Energy Assessment The energy assessment of a project is the area

  18. Anterolateral thigh skinfold thickness and the European head and neck cancer patient: a prospective study.

    Science.gov (United States)

    Achal, Kulraj S; Farrell, C; Smith, Adam B; Mücke, T; Mitchell, David A; Kanatas, Anastasios N

    2011-03-01

    The purpose of this study was to objectively assess this widely recognised problem of the bulky adipocutaneous Anterolateral thigh flap in the European population that may have implications in the reconstruction of head and neck cancer patients. We report 50 cases that underwent specific prospective thigh skinfold thickness assessment as part of assessment of suitability for ALT flap reconstruction following cancer ablation. The null hypothesis was that thigh skinfold thickness and circumference in an oral cancer population do not differ significantly from published sino-Asian norms. This study confirms anthropometrically the suspicion that European thigh skinfold thickness in a head and neck cancer population is greater than sino-Asian comparators. Copyright © 2010 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  19. Executive Coaching: Study of the Evolution of the Program at a Top European Business School

    Science.gov (United States)

    Kim, Hyun Jung

    2011-01-01

    To understand how tensions caused by the multidisciplinary nature of executive coaching are perceived and overcome, this modified ethnographic study was conducted at an executive coaching program and leadership center at a prestigious European business school. This study is built on prolonged discussions on the role of psychology in executive…

  20. Multiple case study in seven European countries regarding culture-sensitive classroom quality assessment

    NARCIS (Netherlands)

    Slot, P.L.; Cadima, Joana; Salminen, Jenni; Pastori, Giulia; Lerkkanen, Marja-Kristiina

    2016-01-01

    This report presents the findings of a multiple case study, conducted in seven European countries to examine common and culturally differing aspects of curriculum, pedagogy, and quality of Early Childhood Education and Care (ECEC) provisions in Europe. This multiple case study involved intensive dat

  1. Executive Coaching: Study of the Evolution of the Program at a Top European Business School

    Science.gov (United States)

    Kim, Hyun Jung

    2011-01-01

    To understand how tensions caused by the multidisciplinary nature of executive coaching are perceived and overcome, this modified ethnographic study was conducted at an executive coaching program and leadership center at a prestigious European business school. This study is built on prolonged discussions on the role of psychology in executive…

  2. Multiple case study in seven European countries regarding culture-sensitive classroom quality assessment

    NARCIS (Netherlands)

    Slot, P.L.|info:eu-repo/dai/nl/328192694; Cadima, Joana; Salminen, Jenni; Pastori, Giulia; Lerkkanen, Marja-Kristiina

    This report presents the findings of a multiple case study, conducted in seven European countries to examine common and culturally differing aspects of curriculum, pedagogy, and quality of Early Childhood Education and Care (ECEC) provisions in Europe. This multiple case study involved intensive

  3. P03-34 - First European studies on acupuncture and schizophrenia: first results

    NARCIS (Netherlands)

    Bosch, M.P.C.; Ronan, P.; Quinton, N.; Harbinson, D.; Noort, M.W.M.L. van den

    2010-01-01

    Objectives - This presentation will compare preliminary results from the first two European studies being carried out on acupuncture and schizophrenia, one in the UK and one in Germany. Statistical comment will be made on comparable study outcomes and there will be discussion on the methodological

  4. P03-34 - First European studies on acupuncture and schizophrenia: first results

    NARCIS (Netherlands)

    Bosch, M.P.C.; Ronan, P.; Quinton, N.; Harbinson, D.; Noort, M.W.M.L. van den

    2010-01-01

    Objectives - This presentation will compare preliminary results from the first two European studies being carried out on acupuncture and schizophrenia, one in the UK and one in Germany. Statistical comment will be made on comparable study outcomes and there will be discussion on the methodological s

  5. Multiple case study in seven European countries regarding culture-sensitive classroom quality assessment

    NARCIS (Netherlands)

    Slot, P.L.|info:eu-repo/dai/nl/328192694; Cadima, Joana; Salminen, Jenni; Pastori, Giulia; Lerkkanen, Marja-Kristiina

    2016-01-01

    This report presents the findings of a multiple case study, conducted in seven European countries to examine common and culturally differing aspects of curriculum, pedagogy, and quality of Early Childhood Education and Care (ECEC) provisions in Europe. This multiple case study involved intensive dat

  6. Smoking in Movies and Adolescent Smoking Initiation Longitudinal Study in Six European Countries

    NARCIS (Netherlands)

    Morgenstern, M.; Sargent, J.D.; Engels, R.C.M.E.; Scholte, R.H.J.; Florek, E.; Hunt, K.; Sweeting, H.; Mathis, F.; Faggiano, F.; Hanewinkel, R.

    2013-01-01

    Background: Longitudinal studies from the U.S. suggest a causal relationship between exposure to images of smoking in movies and adolescent smoking onset. Purpose: This study investigates whether adolescent smoking onset is predicted by the amount of exposure to smoking in movies across six European

  7. Study review : The European Nutrient Database (ENDB) for Nutritional Epidemiology

    NARCIS (Netherlands)

    Charrondiere, U.R.; Vignat, J.; Moller, A.; Ireland, J.; Becker, W.; Church, S.; Farran, A.; Holden, J.; Klemm, C.; Linardou, A.; Mueller, D.; Staveren, van W.A.

    2002-01-01

    Food composition databases (FCDB), as well as standardized calculation procedures are required for international studies on nutrition and disease to calculate nutrient intakes across countries. Comparisons of national FCDBs have shown that major improvements are needed in standardization and documen

  8. Emotional politics on Facebook. An exploratory study of Podemos’ discourse during the European election campaign 2014

    Directory of Open Access Journals (Sweden)

    Agnese Sampietro

    2015-10-01

    Full Text Available The results of the European elections 2014 in Spain were characterized by the outstanding rise of a new party, Podemos, which obtained five seats in the European Parliament, despite being founded few months before the elections. The present study analyzes both the content and the presence of emotions in Podemos’ discourse on Facebook during the European electoral campaign. In particular, the affective content of both the party’s discourse and the comments of its followers will be analyzed through a pragmatic linguistic approach applied to a corpus of 163 posts and 215 followers’ comments. Results show an insistence on positive emotions in the party’s discourse and a prevalence of negative emotions in the comments of the citizens.

  9. A Theoretical and Empirical Study of Corporate Lobbying in the European Parliament

    Directory of Open Access Journals (Sweden)

    Pieter Bouwen

    2003-12-01

    Full Text Available This paper is an attempt to empirically test a theory of access that investigates the logic behind the apparent ad hoc lobbying behavior of business interests in the European Parliament. The theoretical framework tries to explain the degree of access of different organizational forms of business interest representation (companies, associations and consultants to the European Parliament in terms of a theory of the supply and demand of "access goods". The generated hypotheses are analyzed in an empirical study of the EU financial services sector. On the basis of 14 exploratory and 27 semi-structured interviews the hypotheses are checked in the Committee on Economic and Monetary Affairs of the European Parliament.

  10. Study on the Future of Mutual Recognition in Criminal Matters in the European Union

    DEFF Research Database (Denmark)

    Vestergaard, Jørn; Adamo, Silvia

    2008-01-01

    Practitioners in the criminal justice system are fairly content with the European Arrest Warrant and other schemes based on the principle of mutual recognition of judicial decisions. This is the result of a survey published by Professor of Criminal Law Jørn Vestergaard and research asststant Silvia...... Adamo from The Faculty of Law, University of Copenhagen. In recent years, the principle  of mutual recognition has become a cornerstone in police and criminal law cooperation between Member States. In particular, the European Arrest Warrant has come to play an important role. The pivotal point....... As part of a comprehensive European study, a national survey has been conducted on the perception among leading representatives for the police, the prosecution service, defenders and judiciary regarding the new rules....

  11. European Union News Themes in Romanian Radio Stations. Case Study: Europa FM and Radio Romania Actualitati

    Directory of Open Access Journals (Sweden)

    Antonia-Ioana Matei

    2013-05-01

    Full Text Available With Romania’s integration in the European Union, the media content related to the member states has acquired growing importance. The themes of journalism were enriched with new approaches towards national image in the European context and vice versa. At a first level, the study aims to conduct a quantitative analysis on the news topics broadcasted by Radio Romania Actualitati and Europa FM, for the duration of 32 days. The qualitative component focuses on the topics addressed in radio news in order to see what is the media content which reflects the image of the European Union. The findings show, beyond the numbers, that the editorial policy of the Romanian media is not concerned with the interests of the citizens - from the perspective of common themes - but rather with how can the EU, as a unified body, help member countries solve their problems.

  12. A comprehensive review of European epidemiological studies on particulate matter exposure and health

    Energy Technology Data Exchange (ETDEWEB)

    Negri, E.; Gallus, S. [Department of Epidemiology, Mario Negri Institute, Milan (Italy); Boffetta, P. [International Agency for Research on Cancer, Lyon (France); McLaughlin, J.K. [International Epidemiology Institute, Rockville, MD (United States); La Vecchia, C. [Institute of Medical Statistics and Biometry, University of Milan (Italy)

    2011-06-15

    There are a limited number of papers on the long term effect of air pollution on morbidity and mortality in Europe, particularly with reference to small particles with aerodynamic diameters less than 2.5 microns (PM2.5). Most information comes from US cohort studies, including the American Cancer Society Cancer Prevention Study II, the Harvard Six Cities Study, the Adventists' Health Study of Smog, and the Veterans' Cohort Mortality Study. Ambient levels of several relevant pollutants are more variable within Europe than in the USA, and are in several areas comparably high. Selected European cohort studies, including the Netherlands Cohort Study on Diet and Cancer and the European Prospective Investigation on Cancer and Nutrition study found some association between indicators of air pollution such as PM10 or NO2 and lung cancer risk, but the results were inconsistent and inadequate to address the health effects of exposure to PM2.5. In addition to the effect on mortality, there are open issues on the potential impact of air pollution on childhood asthma, allergy and airway disease. In consideration of the difficulties in estimating the prevalence of the conditions in various populations, these issues require additional focus. In order to provide an indication on possible further analyses of existing European datasets, and on future new studies, a critical review of existing literature (with a focus on European data) was performed. The project resulted in a detailed report (see Appendix 1) and in a paper published in the European Journal of Cancer Prevention.

  13. The perspective of European researchers of national occupational safety and health institutes for contributing to a European research agenda: a modified Delphi study.

    Science.gov (United States)

    Gagliardi, Diana; Rondinone, Bruna M; Mirabile, Marco; Buresti, Giuliana; Ellwood, Peter; Hery, Michel; Paszkiewicz, Peter; Valenti, Antonio; Iavicoli, Sergio

    2017-06-23

    This study, developed within the frame of the Partnership for European Research on Occupational Safety and Health joint research activities and based on the frame designed by the 2013 European Agency for Safety and Health at Work (EU-OSHA) study, is the first example of using the points of view of European occupational safety and health (OSH) researchers.The objective is to identify priorities for OSH research that may contribute to the achievement of present and future sustainable growth objectives set by the European strategies. The study was carried out using a modified Delphi method with a two-round survey. Each round involved a panel of about 110 researchers representing the network member institutes was selected according to specific criteria, including the ownership of research expertise in at least one of the four macroareas identified by the reference report developed by EU-OSHA in 2013. The study identified some innovative research topics (for example, 'Emerging technological devices' and 'OSH consequences of markets integration') and research priorities (ie, crowdsourcing, e-work, zero-hours contracts) that are not reflected in previous studies of this nature.The absence of any reference to violence and harassment at work among the researchers' proposals is a major difference from previous similar studies, while topics related to gender issues and electromagnetic fields show a lower importance. The innovative design of a research priorities identification process, which takes advantage of a large, representative and qualified panel of European researchers allowed the definition of a number of research priorities able to support the inclusion of innovative OSH research issues in the scope of the next European research agenda. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  14. Captopril radionuclide test in renovascular hypertension: a European multicentre study

    Energy Technology Data Exchange (ETDEWEB)

    Fommei, E. (Inst. of Clinical Physiology, C.N.R., Multicentre Study Central Office, Pisa (Italy)); Ghione, S. (Inst. of Clinical Physiology, C.N.R., Multicentre Study Central Office, Pisa (Italy)); Hilson, A.J.W. (Inst. of Clinical Physiology, C.N.R., Multicentre Study Central Office, Pisa (Italy)); Mezzasalma, L. (Inst. of Clinical Physiology, C.N.R., Multicentre Study Central Office, Pisa (Italy)); Oei, H.Y. (Inst. of Clinical Physiology, C.N.R., Multicentre Study Central Office, Pisa (Italy)); Piepsz, A. (Inst. of Clinical Physiology, C.N.R., Multicentre Study Central Office, Pisa (Italy)); Volterrani, D. (Inst. of Clinical Physiology, C.N.R., Multicentre Study Central Office, Pisa (Italy)); European Multicentre Study Group

    1993-07-01

    The efficacy of renal scintigraphy with technetium-99m DTPA before and after captopril was evaluated in a multicentre study. All 380 hypertensive patients in the study underwent renal arteriography; 125 had renal arterial stenosis [>=]70%, and 54 had a technically successful intervention to correct the stenosis. The post-captopril study had a sensitivity of 93% and a specificity of 100% for predicting blood pressure response to intervention, if renal function was normal and a combination of quantitative parameters was applied. In the entire population renal artery stenosis [>=]70% was detected with a sensitivity of 83% and a specificity of 93% if renal function was normal. In patients with abnormal renal function the performance of the test was worse, owing to a lower specificity which could be increased by using only time parameters. The performance of the test was optimal when the post-captopril findings were examined; no improvement was achieved by evaluation of the changes induced by captopril from the baseline. The test can thus be simplified by performing only a post-captopril study for routine use: a negative test would exclude a curable form of renovascular hypertension in right angle 80% and a positive test would predict it in right angle 90% of the patients selected for suspicion of the disease. Usefulness of the scintigraphic test for monitoring the clinical results of intervention is suggested by correlating post-intervention outcome with pre- and post-intervention scintigraphic results. (orig./MG)

  15. Effectiveness study of atropine for progressive myopia in Europeans

    NARCIS (Netherlands)

    Polling, J.R.; Kok, R.G.; Tideman, J.W.; Meskat, B.; Klaver, C.C.W.

    2016-01-01

    PurposeRandomized controlled trials have shown the efficacy of atropine for progressive myopia, and this treatment has become the preferred pattern for this condition in Taiwan. This study explores the effectiveness of atropine 0.5% treatment for progressive high myopia and adherence to therapy in a

  16. Familial aggregation of tinnitus: a European multicentre study.

    NARCIS (Netherlands)

    Hendrickx, J.J.; Demeester, K.; Topsakal, V.; Eyken, E. van; Fransen, E.; Maki-Torkko, E.; Hannula, S.; Jensen, M.; Tropitzsch, A.; Bonaconsa, A.; Mazzoli, M.; Espeso, A.; Verbruggen, K.; Huyghe, J.; Huygen, P.L.M.; Kremer, H.; Kunst, S.J.W.; Manninen, M.; Diaz-Lacava, A.N.; Steffens, M.; Parving, A.; Pyykko, I.; Dhooge, I.J.; Stephens, D.; Orzan, E.; Pfister, M.H.; Bille, M.; Sorri, M.; Cremers, C.W.R.J.; Laer, L. van; Camp, G. van; Wienker, T.F.; Heyning, P. van de

    2007-01-01

    INTRODUCTION AND AIM: Tinnitus is a common condition affecting approximately 20% of the older population. There is increasing evidence that changes in the central auditory system following cochlear malfunctioning are responsible for tinnitus. To date, few investigators have studied the influence of

  17. EUROPEAN FUNDS MANAGEMENT ANALYSIS—A CASE STUDY OF EUROPEAN SOCIAL FUNDS IN ROMANIA FROM 2007 TO 2013

    Directory of Open Access Journals (Sweden)

    Tiberiu Foris

    2014-07-01

    Full Text Available This article focuses on fund financing management of one of the utmost important European Union funds, the European Social Fund (ESF, and its implementation in Romania in its post adherence period (2007-2013.  In this respect, the main aspects regarding the management and implementation of this program in Romania, as compared to other European countries, are analyzed taking into consideration the declared objectives at its launching moment. Through a defective management, these objectives have not reached their target, whereas the educational market of continuous adult education has been strongly distorted from the competitive point of view. Moreover, due to inadequate financial management, many of the involved agencies—private companies, schools, constitutive parts of the civil society, have gone bankrupted—the fact that would lead to a serious social imbalance.The research part of this article, being implied in the management of the most important strategic projects of this program (projects in qualifications for the spa tourism, agro-tourism, and food industry, presents a critical point of view on ESF management at a national level and highlights a set of proposals and recommendations, so that, between 2014 and 2020, Romania should be aligned with the European standards regarding the performance in implementing programs with non-reimbursable financing.

  18. Evidence-based practice: reflections from five European case studies.

    Science.gov (United States)

    Baeza, Juan I; Fraser, Alec; Boaz, Annette

    2014-01-01

    Background Evidence-based practice (EBP) is now the accepted orthodoxy in clinical practice and developed from evidence-based medicine. EBP is based on a specific type of evidence that is derived from studies based on randomised controlled trials (RCT). This type of evidence is suited to acute medical care and is more problematic for other clinicians such as nurses and therapists, particularly when they are situated within community or primary care settings. Setting Five stroke care services in England (2), Sweden (2) and Poland (1). Aims To reflect on the evidence gained from these case studies to shed light on various aspects of EBP. This paper focuses on three key issues: (1) the importance of context for evidence, (2) the nature of knowledge, and (3) professional hierarchies. Methods Five qualitative case studies into stroke care were carried out in England, Sweden and Poland. One hundred and twenty semi-structured interviews were carried out with a range of healthcare staff who provided specialised and non-specialised stroke care in acute, community and primary care between October 2010 and September 2011. Medical doctors, nurses and different therapists were included in the samples in all five case studies. For this paper, we reflect on some aspects of this work to illuminate the different interprofessional perspectives relating to EBP in stroke care. Results The lack of RCT-based evidence in the community and primary care sectors can lead to the clinicians working in these sectors being perceived as having a lower status. Clinicians use both tacit and encoded knowledge to guide their practice and there existed both intraand interprofessional tensions in these two types of knowledge. The professional hierarchy of stroke teams varies with national context and the role of the non-specialists is less valued in stroke care.

  19. Functional independence and health-related functional status following spinal cord injury : a prospective study of the association with physical capacity

    NARCIS (Netherlands)

    Haisma, Janneke A.; Post, Marcel W.; van der Woude, Lucas H.; Stam, Henk J.; Bergen, Michael P.; Sluis, Tebbe A.; van den Berg-Emons, Hendrika J.; Bussmann, Johannes B.

    2008-01-01

    Objective: To determine changes in functional independence following spinal cord injury and to evaluate the association between functional independence and physical capacity. Design: Multi-centre prospective cohort study. Subjects: Patients with spinal cord injury admitted for initial rehabilitation

  20. Dyssynchrony by speckle-tracking echocardiography and response to cardiac resynchronization therapy: results of the Speckle Tracking and Resynchronization (STAR) study

    National Research Council Canada - National Science Library

    Tanaka, Hidekazu; Nesser, Hans-Joachim; Buck, Thomas; Oyenuga, Olusegun; Jánosi, Rolf Alexander; Winter, Siegmund; Saba, Samir; Gorcsan, 3rd, John

    2010-01-01

    The Speckle Tracking and Resynchronization (STAR) study used a prospective multi-centre design to test the hypothesis that speckle-tracking echocardiography can predict response to cardiac resynchronization therapy (CRT...

  1. European surveillance study on antimicrobial susceptibility of Gram-positive anaerobic cocci

    DEFF Research Database (Denmark)

    Brazier, J; Chmelar, D; Dubreuil, L

    2008-01-01

    Gram-positive anaerobic cocci (GPAC) are a heterogeneous group of microorganisms frequently isolated from local and systemic infections. In this study, the antimicrobial susceptibilities of clinical strains isolated in 10 European countries were investigated. After identification of 299 GPAC to s...

  2. Chronological Age, Cognitions, and Practices in European American Mothers: A Multivariate Study of Parenting

    Science.gov (United States)

    Bornstein, Marc H.; Putnick, Diane L.

    2007-01-01

    The authors studied multiple parenting cognitions and practices in European American mothers (N=262) who ranged from 15 to 47 years of age. All were 1st-time parents of 20-month-old children. Some age effects were 0; others were linear or nonlinear. Nonlinear age effects determined by spline regression showed significant associations to a "knot"…

  3. Association of STAT4 with rheumatoid arthritis: a replication study in three European populations.

    NARCIS (Netherlands)

    Orozco, G.; Alizadeh, B.Z.; Delgado-Vega, A.M.; Gonzalez-Gay, M.A.; Balsa, A.; Pascual-Salcedo, D.; Fernandez-Gutierrez, B.; Gonzalez-Escribano, M.F.; Petersson, I.F.; Riel, P.L.C.M. van; Barrera, P.; Coenen, M.J.; Radstake, T.R.D.J.; Leeuwen, M.A. van; Wijmenga, C.; Koeleman, B.P.; Alarcon-Riquelme, M.; Martin, J.

    2008-01-01

    OBJECTIVE: This study was undertaken to investigate the previously reported association of the STAT4 polymorphism rs7574865 with rheumatoid arthritis (RA) in 3 different European populations from Spain, Sweden, and The Netherlands, comprising a total of 2,072 patients and 2,474 controls. METHODS:

  4. Excellent survival after liver transplantation for isolated polycystic liver disease : an European Liver Transplant Registry study

    NARCIS (Netherlands)

    van Keimpema, Loes; Nevens, Frederik; Adam, Rene; Porte, Robert J.; Fikatas, Panagiotis; Becker, Thomas; Kirkegaard, Preben; Metselaar, Herold J.; Drenth, Joost P. H.

    2011-01-01

    Patients with end-stage isolated polycystic liver disease (PCLD) suffer from incapacitating symptoms because of very large liver volumes. Liver transplantation (LT) is the only curative option. This study assesses the feasibility of LT in PCLD. We used the European Liver Transplant Registry (ELTR) d

  5. Student mobility and European identity: Erasmus study as a civic experience?

    Directory of Open Access Journals (Sweden)

    Kristine Mitchell

    2012-12-01

    Full Text Available From its inception, the Erasmus student exchange programme has been promoted by the European Commission as a “civic experience” that instils or enhances a European consciousness among participants. Recent scholarship on European identity has made similar claims about the civic significance of foreign study, yet the empirical basis for these claims remains a subject of debate. This article unpacks the logic of the civic view of Erasmus and submits the individual assumptions to empirical investigation. Based on a survey of more than 2000 respondents from 25 EU countries, this study has the advantage of being both larger and more multinational in composition than the major previous studies. The data largely support the logic of the civic view of Erasmus, demonstrating the intercultural nature of the sojourn abroad, providing compelling evidence that the Erasmus experience contributes to attitudinal changes about Europe among participants, and highlighting significant differences between the Erasmus students and those who do not study abroad when it comes to levels of support for the EU and extent of identifying as European.

  6. Excellent survival after liver transplantation for isolated polycystic liver disease: an European Liver Transplant Registry study

    DEFF Research Database (Denmark)

    van Keimpema, Loes; Nevens, Frederik; Adam, René

    2011-01-01

    Patients with end-stage isolated polycystic liver disease (PCLD) suffer from incapacitating symptoms because of very large liver volumes. Liver transplantation (LT) is the only curative option. This study assesses the feasibility of LT in PCLD. We used the European Liver Transplant Registry (ELTR...

  7. Direct access in primary care and patient satisfaction: a European study.

    NARCIS (Netherlands)

    Kroneman, M.W.; Maarse, H.; Zee, J. van der

    2006-01-01

    Objective: This study addressed the question to what extent gate-keeping or direct access to health care services influences the satisfaction with GP-services by the population in 18 European countries ("old" EU-countries plus Norway, Iceland and Switzerland). METHODS: Two datasets were collected. F

  8. Excellent survival after liver transplantation for isolated polycystic liver disease : an European Liver Transplant Registry study

    NARCIS (Netherlands)

    van Keimpema, Loes; Nevens, Frederik; Adam, Rene; Porte, Robert J.; Fikatas, Panagiotis; Becker, Thomas; Kirkegaard, Preben; Metselaar, Herold J.; Drenth, Joost P. H.

    2011-01-01

    Patients with end-stage isolated polycystic liver disease (PCLD) suffer from incapacitating symptoms because of very large liver volumes. Liver transplantation (LT) is the only curative option. This study assesses the feasibility of LT in PCLD. We used the European Liver Transplant Registry (ELTR)

  9. Association of STAT4 with rheumatoid arthritis : a replication study in three European populations

    NARCIS (Netherlands)

    Orozco, Gisela; Alizadeh, Behrooz Z; Delgado-Vega, Angélica M; González-Gay, Miguel A; Balsa, Alejandro; Pascual-Salcedo, Dora; Fernández-Gutierrez, Benjamín; González-Escribano, María F; Petersson, Ingemar F; van Riel, Piet L C M; Barrera, Pilar; Coenen, Marieke J H; Radstake, Timothy R D J; van Leeuwen, Miek A; Wijmenga, Cisca; Koeleman, Bobby P C; Alarcón-Riquelme, Marta; Martín, Javier

    2008-01-01

    OBJECTIVE: This study was undertaken to investigate the previously reported association of the STAT4 polymorphism rs7574865 with rheumatoid arthritis (RA) in 3 different European populations from Spain, Sweden, and The Netherlands, comprising a total of 2,072 patients and 2,474 controls. METHODS: Th

  10. Attitudes, beliefs and knowledge concerning antibiotic use and self-medication : a comparative European study

    NARCIS (Netherlands)

    Grigoryan, Larissa; Burgerhof, Johannes G. M.; Degener, John E.; Deschepper, Reginald; Lundborg, Cecilia Stalsby; Monnet, Dominique L.; Scicluna, Elizabeth A.; Birkin, Joan; Haaijer-Ruskamp, Flora M.

    2007-01-01

    Purpose Although the relevance of cultural factors for antibiotic use has been recognized, few studies exist in Europe. We compared public attitudes, beliefs and knowledge concerning antibiotic use and self-medication between 11 European countries. Methods In total, 1101 respondents were interviewed

  11. Use of dietary supplements in the European Prospective Investigation into Cancer and Nutrition calibration study

    NARCIS (Netherlands)

    Skeie, G.; Braaten, T.; Hjartaker, A.; Lentjes, M.; Amiano, P.; Jakszyn, P.; Pala, V.; Palanca, A.; Niekerk, E. M.; Verhagen, H.; Avloniti, K.; Psaltopoulou, T.; Niravong, M.; Touvier, M.; Nimptsch, K.; Haubrock, J.; Walker, L.; Spencer, E. A.; Roswall, N.; Olsen, A.; Wallstrom, P.; Nilsson, S.; Casagrande, C.; Deharveng, G.; Hellstrom, V.; Boutron-Ruault, M. C.; Tjonneland, A.; Joensen, A. M.; Clavel-Chapelon, F.; Trichopoulou, A.; Martinez, C.; Rodriguez, L.; Frasca, G.; Sacerdote, C.; Peeters, P. H. M.; Linseisen, J.; Schienkiewitz, A.; Welch, A. A.; Manjer, J.; Ferrari, P.; Riboli, E.; Bingham, S.; Engeset, D.; Lund, E.; Slimani, N.

    2009-01-01

    Background: Dietary supplement use is increasing, but there are few comparable data on supplement intakes and how they affect the nutrition and health of European consumers. The aim of this study was to describe the use of dietary supplements in subsamples of the 10 countries participating in the

  12. Determinants of health policy impact: comparative results of a European policymaker study.

    NARCIS (Netherlands)

    Rütten, A.; Lüschen, G.; Lengerke, T. von; Abel, T.; Kannas, L.; Rodríguez Diaz, J.A.; Vinck, J.; Zee, J. van der

    2003-01-01

    OBJECTIVES: This article will use a new theoretical framework for the analysis of health policy impact introduced by Rutten et al. (2003). In particular, it will report on a comparative European study of policymakers' perception and evaluation of specific determinants of the policy impact, both in

  13. Multicenter European Prevalence Study of Neurocognitive Impairment and Associated Factors in HIV Positive Patients

    DEFF Research Database (Denmark)

    Haddow, Lewis J; Laverick, Rosanna; Daskalopoulou, Marina

    2017-01-01

    We conducted a cross-sectional study in 448 HIV positive patients attending five European outpatient clinics to determine prevalence of and factors associated with neurocognitive impairment (NCI) using computerized and pen-and-paper neuropsychological tests. NCI was defined as a normalized Z score...

  14. Exposure assessment for a nested case-control study of lung cancer among European asphalt workers.

    NARCIS (Netherlands)

    Agostini, M.; Ferro, G.; Olsson, A.; Burstyn, I.; de Vocht, F.; Hansen, J.; Funch Lassen, C.; Johansen, C.; Kjaerheim, K.; Langard, S.; Stucker, I.; Ahrens, W.; Behrens, T.; Lindbohm, M-J.; Heikkila, P.; Heederik, D.; Portengen, L.; Shaham, J.; Boffetta, P.; Kromhout, H.

    2010-01-01

    OBJECTIVE: Development of a method for retrospective assessment of exposure to bitumen fume, bitumen condensate, organic vapour, polycyclic aromatic hydrocarbons, and co-exposures to known or suspected lung carcinogens for a nested case-control study of lung cancer mortality among European asphalt

  15. European and Japanese Logistics Paradigms: An Explorative and comparative study of the dynamics of logistics management

    NARCIS (Netherlands)

    M. Shinohara

    2006-01-01

    textabstractThis dissertation explores a new field of study in the paradigms of logistics management and their evolution. General observations detected the existence of large differences of logistics practices between Europe and Japan, and that Japanese are apparently trying to tread the European pa

  16. The European Union's Role in International Economic Fora: The G20 : Study for the ECON Committee

    NARCIS (Netherlands)

    F. Amtenbrink (Fabian); Blocker, (Niels); S. Van Den Bogaert (Stefaan); A. Cuyvers (Armin); K. Heine (Klaus); Hilion, (Christophe); J. Kantorowicz (Jarosław); Lenk, (Hannes); Repasi, (René)

    2015-01-01

    markdownabstractThis study provides factual background information about the G20, the European Union's role and representation therein, its accountability as well as the coordination and impact thereof. The G20 has played a key role in measure taken to overcome the economic and financial crisis a

  17. Bringing a European perspective to the health human resources debate: a scoping study.

    NARCIS (Netherlands)

    Kuhlmann, E.; Batenburg, R.; Groenewegen, P.P.; Larsen, C.

    2013-01-01

    Healthcare systems across the world are increasingly challenged by workforce shortages and misdistribution of skills. Yet, no comprehensive European approach to health human resources (HHR) policy exists and action remains fragmented. This scoping study seeks to contribute to the debates by providin

  18. Adjunctive corticosteroid therapy for Pneumocystis carinii pneumonia in AIDS: a randomized European multicenter open label study

    DEFF Research Database (Denmark)

    Nielsen, T L; Eeftinck Schattenkerk, J K; Jensen, B N

    1992-01-01

    Fifty-nine human immunodeficiency virus type-1-infected patients with a microscopically proven first episode of moderate to severe Pneumocystis carinii pneumonia (PCP) were enrolled into a randomized European multicenter study. The effect of adjunctive corticosteroid (CS) therapy was assessed on (a...

  19. Attitudes, beliefs and knowledge concerning antibiotic use and self-medication : a comparative European study

    NARCIS (Netherlands)

    Grigoryan, Larissa; Burgerhof, Johannes G. M.; Degener, John E.; Deschepper, Reginald; Lundborg, Cecilia Stalsby; Monnet, Dominique L.; Scicluna, Elizabeth A.; Birkin, Joan; Haaijer-Ruskamp, Flora M.

    2007-01-01

    Purpose Although the relevance of cultural factors for antibiotic use has been recognized, few studies exist in Europe. We compared public attitudes, beliefs and knowledge concerning antibiotic use and self-medication between 11 European countries. Methods In total, 1101 respondents were interviewed

  20. European Union Students Studying in English Higher Education Institutions. DIUS Research Report 08-09

    Science.gov (United States)

    Morris, Marian; Rutt, Simon

    2008-01-01

    This study aimed to identify the pathways, intentions and relevant perceptions of (non-UK) European Union (EU) students entering English higher education. It sought to identify why students wished to obtain an English HE qualification, their attitudes towards the uptake and repayment of tuition fee loans and their future career plans. Drawing on…

  1. Association of STAT4 with rheumatoid arthritis: a replication study in three European populations.

    NARCIS (Netherlands)

    Orozco, G.; Alizadeh, B.Z.; Delgado-Vega, A.M.; Gonzalez-Gay, M.A.; Balsa, A.; Pascual-Salcedo, D.; Fernandez-Gutierrez, B.; Gonzalez-Escribano, M.F.; Petersson, I.F.; Riel, P.L.C.M. van; Barrera, P.; Coenen, M.J.; Radstake, T.R.D.J.; Leeuwen, M.A. van; Wijmenga, C.; Koeleman, B.P.; Alarcon-Riquelme, M.; Martin, J.

    2008-01-01

    OBJECTIVE: This study was undertaken to investigate the previously reported association of the STAT4 polymorphism rs7574865 with rheumatoid arthritis (RA) in 3 different European populations from Spain, Sweden, and The Netherlands, comprising a total of 2,072 patients and 2,474 controls. METHODS: Th

  2. Structural influences on involvement in European homegrown jihadism : A case study

    NARCIS (Netherlands)

    Schuurman, B.W.; Bakker, E.; Eijkman, Q.A.M.

    2016-01-01

    his article empirically assesses the applicability of structural-level hypotheses for involvement in terrorism within the context of European homegrown jihadism. It uses these hypotheses to study how structural factors influenced involvement in the Dutch “Hofstadgroup.” Structural factors enabled th

  3. Endotoxin levels in settled airborne dust in European schools: the HITEA school study.

    NARCIS (Netherlands)

    Jacobs, J.H.; Krop, E.J.M.; Borràs-Santos, A.; Zock, J.P.; Täubel, M.; Hyvärinen, A.; Pekkanen, J.; Doekes, G.; Heederik, D.J.J.

    2014-01-01

    Indoor exposure to microbial agents is known to influence respiratory health. Besides home exposure, exposure in schools can affect respiratory health. In this study, we measured endotoxin in settled dust in primary schools in three European countries from three different geographical regions with d

  4. Asthma medication prescribing before, during and after pregnancy : A study in seven European regions

    NARCIS (Netherlands)

    Charlton, Rachel A; Pierini, Anna; Klungsøyr, Kari; Neville, Amanda J; Jordan, Susan; Jong-van den Berg, de Lolkje; Thayer, Daniel; Bos, H Jens; Puccini, Aurora; Hansen, Anne V; Gini, Rosa; Engeland, Anders; Nybo Andersen, Anne-Marie; Dolk, Helen; Garne, Ester

    2016-01-01

    OBJECTIVES: To explore utilisation patterns of asthma medication before, during and after pregnancy as recorded in seven European population-based databases. DESIGN: A descriptive drug utilisation study. SETTING: 7 electronic healthcare databases in Denmark, Norway, the Netherlands, Italy (Emilia Ro

  5. Trans fatty acids in French fries, soups, and snacks from 14 European countries : the TRANSFAIR study

    NARCIS (Netherlands)

    Aro, A.; Amaral, E.; Kestesloot, H.; Rimestad, A.; Thamm, M.; Poppel, G. van

    1998-01-01

    In the TRANSFAIR study, foods contributing to 95% of total fat intake were collected in 14 European countries. In addition to edible fats, dairy, meat, and bakery products some specific food items with relatively high amounts oftransfatty acids were found. French fried potatoes, both those from fast

  6. Intercultural Education in the European Context: Key Remarks from a Comparative Study

    Science.gov (United States)

    Catarci, Marco

    2014-01-01

    The article focuses on some findings of a comparative study carried out by a network of scholars and researchers who are active in the field of intercultural education in the European context in the main "old immigration countries" (United Kingdom, France and Germany), "new immigration countries" (Italy, Spain and Greece) and…

  7. Trans fatty acids in French fries, soups, and snacks from 14 European countries : the TRANSFAIR study

    NARCIS (Netherlands)

    Aro, A.; Amaral, E.; Kestesloot, H.; Rimestad, A.; Thamm, M.; Poppel, G. van

    1998-01-01

    In the TRANSFAIR study, foods contributing to 95% of total fat intake were collected in 14 European countries. In addition to edible fats, dairy, meat, and bakery products some specific food items with relatively high amounts oftransfatty acids were found. French fried potatoes, both those from

  8. Genome-wide association study of kidney function decline in individuals of European descent

    NARCIS (Netherlands)

    Gorski, Mathias; Tin, Adrienne; Garnaas, Maija; McMahon, Gearoid M.; Chu, Audrey Y.; Tayo, Bamidele O.; Pattaro, Cristian; Teumer, Alexander; Chasman, Daniel I.; Chalmers, John; Hamet, Pavel; Tremblay, Johanne; Woodward, Marc; Aspelund, Thor; Eiriksdottir, Gudny; Gudnason, Vilmundur; Harris, Tamara B.; Launer, Lenore J.; Smith, Albert V.; Mitchell, Braxton D.; O'Connell, Jeffrey R.; Shuldiner, Alan R.; Coresh, Josef; Li, Man; Freudenberger, Paul; Hofer, Edith; Schmidt, Helena; Schmidt, Reinhold; Holliday, Elizabeth G.; Mitchell, Paul; Wang, Jie Jin; de Boer, Ian H.; Li, Guo; Siscovick, David S.; Kutalik, Zoltan; Corre, Tanguy; Vollenweider, Peter; Waeber, Gerard; Gupta, Jayanta; Kanetsky, Peter A.; Hwang, Shih-Jen; Olden, Matthias; Yang, Qiong; de Andrade, Mariza; Atkinson, Elizabeth J.; Kardia, Sharon L. R.; Turner, Stephen T.; Stafford, Jeanette M.; Ding, Jingzhong; Liu, Yongmei; Barlassina, Cristina; Cusi, Daniele; Salvi, Erika; Staessen, Jan A.; Ridker, Paul M.; Grallert, Harald; Meisinger, Christa; Mueller-Nurasyid, Martina; Kraemer, Bernhard K.; Kramer, Holly; Rosas, Sylvia E.; Nolte, Ilja M.; Penninx, Brenda W.; Snieder, Harold; Del Greco, M. Fabiola; Franke, Andre; Noethlings, Ute; Lieb, Wolfgang; Bakker, Stephan J. L.; Gansevoort, Ron T.; van der Harst, Pim; Dehghan, Abbas; Franco, Oscar H.; Hofman, Albert; Rivadeneira, Fernando; Sedaghat, Sanaz; Uitterlinden, Andre G.; Coassin, Stefan; Haun, Margot; Kollerits, Barbara; Kronenberg, Florian; Paulweber, Bernhard; Aumann, Nicole; Endlich, Karlhans; Pietzner, Mike; Voelker, Uwe; Rettig, Rainer; Chouraki, Vincent; Helmer, Catherine; Lambert, Jean-Charles; Metzger, Marie; Stengel, Benedicte; Lehtimaki, Terho; Lyytikainen, Leo-Pekka; Raitakari, Olli; Johnson, Andrew; Parsa, Afshin; Bochud, Murielle; Heid, Iris M.; Goessling, Wolfram; Kottgen, Anna; Kao, W. H. Linda; Fox, Caroline S.; Boeger, Carsten A.

    2015-01-01

    Genome-wide association studies (GWASs) have identified multiple loci associated with cross-sectional eGFR, but a systematic genetic analysis of kidney function decline over time is missing. Here we conducted a GWAS meta-analysis among 63,558 participants of European descent, initially from 16 cohor

  9. Genome-wide association study of kidney function decline in individuals of European descent

    NARCIS (Netherlands)

    M. Gorski (Mathias); A. Tin (Adrienne); M. Garnaas (Maija); G.M. McMahon (Gearoid M.); A.Y. Chu (Audrey Y.); B. Tayo (Bamidele); C. Pattaro (Cristian); A. Teumer (Alexander); D.I. Chasman (Daniel); J. Chalmers (John); P. Hamet (Pavel); J. Tremblay (Johanne); M. Woodward (Mark); T. Aspelund (Thor); G. Eiriksdottir (Gudny); V. Gudnason (Vilmundur); T.B. Harris (Tamara); L.J. Launer (Lenore); A.V. Smith (Albert V.); B.D. Mitchell (Braxton); J.R. O´Connell; A.R. Shuldiner (Alan); J. Coresh (Josef); M. Li (Man); P. Freudenberger (Paul); E. Hofer (Edith); R. Schmidt (Reinhold); R. Schmidt (Reinhold); E.G. Holliday (Elizabeth); P. Mitchell (Paul); J.J. Wang (Jie Jin); I.H. de Boer (Ian); G. Li (Guo); D.S. Siscovick (David); Z. Kutalik; T. Corre (Tanguy); P. Vollenweider (Peter); G. Waeber (Gérard); J. Gupta (Jayanta); P.P. Kanetsky (Peter P.); S.J. Hwang; M. Olden (Matthias); Q. Yang (Qiong Fang); M. de Andrade (Mariza); E.J. Atkinson (Elizabeth J.); S.L.R. Kardia (Sharon); S.T. Turner (Stephen); J.M. Stafford (Jeanette M.); J. Ding (Jinhui); Y. Liu; C. Barlassina (Christina); D. Cusi (Daniele); E. Salvi (Erika); J.A. Staessen (Jan); P.M. Ridker (Paul); H. Grallert (Harald); C. Meisinger (Christa); M. Müller-Nurasyid (Martina); B.K. Krämer (Bernhard K.); H. Kramer (Holly); S.E. Rosas (Sylvia E.); I.M. Nolte (Ilja M.); B.W.J.H. Penninx (Brenda); H. Snieder (Harold); M. Fabiola Del Greco; A. Franke (Andre); U. Nöthlings (Ute); W. Lieb (Wolfgang); S.J.L. Bakker (Stephan J L); R.T. Gansevoort (Ron); P. Van Der Harst (Pim); A. Dehghan (Abbas); O.H. Franco (Oscar); A. Hofman (Albert); F. Rivadeneira Ramirez (Fernando); S. Sedaghat (Sanaz); A.G. Uitterlinden (André); S. Coassin (Stefan); M. Haun (Margot); B. Kollerits (Barbara); F. Kronenberg (Florian); B. Paulweber (Bernhard); N. Aumann (Nicole); K. Endlich (Karlhans); M. Pietzner (Mike); U. Völker (Uwe); R. Rettig (Rainer); V. Chouraki (Vincent); C. Helmer (Catherine); J.-C. Lambert (Jean-Charles); M. Metzger (Marie); B. Stengel (Benedicte); T. Lehtimäki (Terho); L.-P. Lyytikäinen (Leo-Pekka); O. Raitakari (Olli); A.D. Johnson (Andrew); A. Parsa (Afshin); M. Bochud (Murielle); I.M. Heid (Iris); W. Goessling (Wolfram); A. K̈ttgen (Anna); W.H.L. Kao (Wen); C.S. Fox (Caroline S.); C.A. Böger (Carsten)

    2015-01-01

    textabstractGenome-wide association studies (GWASs) have identified multiple loci associated with cross-sectional eGFR, but a systematic genetic analysis of kidney function decline over time is missing. Here we conducted a GWAS meta-analysis among 63,558 participants of European descent, initially f

  10. Design studies for ECO, the European Gamma-ray Observatory

    CERN Document Server

    Baixeras, C

    2004-01-01

    We discuss preliminary studies concerning a large-diameter gamma-ray telescope, to be part of an array of telescopes installed at the existing observation site on the Canary island of La Palma. One of the telescopes in the array will be MAGIC, presently the largest existing gamma ray telescope and the most performant world wide at low energy. A second telescope of the same class is under construction. Eventually, we will want to install one or more devices giving access to even lower gamma-ray energy; they will be larger than MAGIC by roughly a linear factor two, and are code-named here ECO-1000 (for a mirror surface of 1000 m$^2$).

  11. Age-dependent decline of beta-cell function in type 1 diabetes after diagnosis: a multi-centre longitudinal study

    DEFF Research Database (Denmark)

    Barker, A.; Lauria, A.; Schloot, N.

    2014-01-01

    C-peptide secretion is currently the only available clinical biomarker to measure residual β-cell function in type 1 diabetes. However, the natural history of C-peptide decline after diagnosis can vary considerably dependent upon several variables. We investigated the shape of C-peptide decline...... over time from type 1 diabetes onset in relation to age at diagnosis, HbA1c levels and insulin dose....

  12. [Fingolimod: effectiveness and safety in routine clinical practice. An observational, retrospective, multi-centre study in Navarra, Gipuzkoa and La Rioja].

    Science.gov (United States)

    Ayuso, T; Marzo-Sola, M E; Castillo-Trivino, T; Soriano, G; Otano, M A; Lopez, M A; Croitoru, I M; Olascoaga, J

    2016-09-05

    Objetivo. Evaluar la efectividad y seguridad del fingolimod en la practica clinica en las regiones de Navarra, Gipuzkoa y La Rioja. Pacientes y metodos. Estudio retrospectivo y multicentrico de pacientes con esclerosis multiple recurrente tratados con fingolimod, siguiendo la ficha tecnica. Se evaluo la tasa anualizada de brotes (TAB), el porcentaje de pacientes libres de brotes, la discapacidad usando la escala expandida del estado de discapacidad (EDSS) y el porcentaje de pacientes sin lesiones captantes de gadolinio. Resultados. Un total de 113 pacientes fueron tratados con fingolimod: el 6%, naive, y el 58% y 35%, pacientes tratados previamente con inmunomodulador y natalizumab, respectivamente. El fingolimod disminuyo la TAB tras el primer (67%; 1 a 0,3; p < 0,0001) y segundo (89%; 1 a 0,1; p < 0,0001) año de tratamiento, y aumento asi el porcentaje de pacientes libres de brotes durante el tratamiento. La EDSS basal fue 3 y despues del tratamiento con fingolimod fue 2,5 en ambos años. El porcentaje de pacientes sin lesiones captantes de gadolinio tras el primer año de tratamiento fue del 77%. Resultados similares se observaron en los pacientes naive y en los tratados previamente con inmunomodulador. En los pacientes tratados previamente con natalizumab no se observaron cambios tras el tratamiento. Conclusiones. El uso del fingolimod en la practica clinica mostro una efectividad similar a la eficacia observada en ensayos clinicos. No hubo cambios en la TAB al cambiar desde natalizumab, y solo un paciente tras suspender el natalizumab presento 'rebrote'. El fingolimod se comporta como un farmaco seguro, con escasos efectos adversos y con un bajo porcentaje de abandonos.

  13. Preventing hospital admissions by reviewing medication (PHARM) in primary care: Design of the cluster randomised, controlled, multi-centre PHARM-study

    NARCIS (Netherlands)

    A.J. Leendertse (Anne); F.H.P. de Koning (Fred); A.N. Goudswaard (Alex); A.R. Jonkhoff (Andries); S.C.A. van den Bogert; H.J. de Gier (Han); T.C.G. Egberts (Toine); P.M.L.A. van den Bemt (Patricia)

    2011-01-01

    textabstractBackground: Medication can be effective but can also be harmful and even cause hospital admissions. Medication review or pharmacotherapy review has often been proposed as a solution to prevent these admissions and to improve the effectiveness and safety of pharmacotherapy. However, most

  14. Preventing hospital admissions by reviewing medication (PHARM) in primary care : design of the cluster randomised, controlled, multi-centre PHARM-study

    NARCIS (Netherlands)

    Leendertse, Anne J.; de Koning, Fred H. P.; Goudswaard, Alex N.; Jonkhoff, Andries R.; van den Bogert, Sander C. A.; de Gier, Han J.; Egberts, Toine C. G.; van den Bemt, Patricia M. L. A.

    2011-01-01

    Background: Medication can be effective but can also be harmful and even cause hospital admissions. Medication review or pharmacotherapy review has often been proposed as a solution to prevent these admissions and to improve the effectiveness and safety of pharmacotherapy. However, most published

  15. A Multi-centre Study to Assess the Long-term Performance of the Pinnacle™ Cup With a Polyethylene-on-metal Bearing in Primary Total Hip Replacement

    Science.gov (United States)

    2017-06-27

    Rheumatoid Arthritis; Osteoarthritis; Post-traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis

  16. A Randomised Multi-centre Study to Compare the Long-term Performance of the Future Hip to 3 Other Implants in Primary Total Hip Replacement

    Science.gov (United States)

    2016-10-06

    Osteoarthritis; Post-traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis; Perthes Disease

  17. The tryptophan hydroxylase 1 (TPH1) gene, schizophrenia susceptibility, and suicidal behavior: a multi-centre case-control study and meta-analysis

    DEFF Research Database (Denmark)

    Saetre, Peter; Lundmark, Per; Wang, August;

    2010-01-01

    associated with schizophrenia. The minor allele (A) of this polymorphism (A218C) is also more frequent in patients who have attempted suicide and individuals who died by suicide, than in healthy control individuals. In an attempt to replicate previous findings, five single nucleotide polymorphisms (SNPs....../A779 locus increases the susceptibility of schizophrenia in Caucasian and Asian populations. In addition, the data at hand suggest that the locus contributes to the liability of psychiatric disorders characterized by elevated suicidal rates, rather than affecting suicidal behavior of individuals...

  18. Quantification of FDG PET studies using standardised uptake values in multi-centre trials : effects of image reconstruction, resolution and ROI definition parameters

    NARCIS (Netherlands)

    Westerterp, Marinke; Pruim, Jan; Oyen, Wim; Hoekstra, Otto; Paans, Anne; Visser, Eric; van Lanschot, Jan; Sloof, Gerrit; Boellaard, Ronald

    2007-01-01

    Purpose: Standardised uptake values (SUVs) depend on acquisition, reconstruction and region of interest (ROI) parameters. SUV quantification in multicentre trials therefore requires standardisation of acquisition and analysis protocols. However, standardisation is difficult owing to the use of diffe

  19. Adverse events of interferon beta-1a: a prospective multi-centre international ICH-GCP-based CRO-supported external validation study in daily practice.

    NARCIS (Netherlands)

    Jongen, P.J.H.; Sindic, C.; Sanders, E.; Hawkins, S.; Linssen, W.; Munster, E. van; Frequin, S.T.F.M.; Borm, G.F.

    2011-01-01

    BACKGROUND: Due to methodological shortcomings the available post-registration data on the adverse events (AEs) occurring in interferon beta-1a (INFb-1a)-treated patients fail to adequately validate phase III data and only partially inform on safety in daily practice. We assessed AEs in relapsing

  20. The LIPPSMAck POP (Lung Infection Prevention Post Surgery - Major Abdominal - with Pre-Operative Physiotherapy) trial: study protocol for a multi-centre randomised controlled trial

    OpenAIRE

    Boden, Ianthe; Browning, Laura; Elizabeth H Skinner; Reeve, Julie; El-Ansary, Doa; Robertson, Iain K.; Denehy, Linda

    2015-01-01

    Background Post-operative pulmonary complications are a significant problem following open upper abdominal surgery. Preliminary evidence suggests that a single pre-operative physiotherapy education and preparatory lung expansion training session alone may prevent respiratory complications more effectively than supervised post-operative breathing and coughing exercises. However, the evidence is inconclusive due to methodological limitations. No well-designed, adequately powered, randomised con...

  1. The tryptophan hydroxylase 1 (TPH1) gene, schizophrenia susceptibility, and suicidal behavior: a multi-centre case-control study and meta-analysis

    DEFF Research Database (Denmark)

    Saetre, Peter; Lundmark, Per; Wang, August

    2010-01-01

    affected individuals having attempted suicide at least once and patients with no history of suicide attempts (P = 0.84). A systematic literature review and meta-analysis support the A218C polymorphism as a susceptibility locus for schizophrenia (odds ratio 1.17, 95% confidence interval 1......Serotonin (5-hydroxytryptamin; 5-HT) alternations has since long been suspected in the pathophysiology of schizophrenia. Tryptophan hydroxylase (tryptophan 5-monooxygenase; TPH) is the rate-limiting enzyme in the biosynthesis of 5-HT, and sequence variation in intron 6 of the TPH1 gene has been...... associated with schizophrenia. The minor allele (A) of this polymorphism (A218C) is also more frequent in patients who have attempted suicide and individuals who died by suicide, than in healthy control individuals. In an attempt to replicate previous findings, five single nucleotide polymorphisms (SNPs...

  2. The EMBARC European Bronchiectasis Registry: protocol for an international observational study

    Directory of Open Access Journals (Sweden)

    James D. Chalmers

    2016-01-01

    Full Text Available Bronchiectasis is one of the most neglected diseases in respiratory medicine. There are no approved therapies and few large-scale, representative epidemiological studies. The EMBARC (European Multicentre Bronchiectasis Audit and Research Collaboration registry is a prospective, pan-European observational study of patients with bronchiectasis. The inclusion criterion is a primary clinical diagnosis of bronchiectasis consisting of: 1 a clinical history consistent with bronchiectasis; and 2 computed tomography demonstrating bronchiectasis. Core exclusion criteria are: 1 bronchiectasis due to known cystic fibrosis; 2 age <18 years; and 3 patients who are unable or unwilling to provide informed consent. The study aims to enrol 1000 patients by April 2016 across at least 20 European countries, and 10 000 patients by March 2020. Patients will undergo a comprehensive baseline assessment and will be followed up annually for up to 5 years with the goal of providing high-quality longitudinal data on outcomes, treatment patterns and quality of life. Data from the registry will be available in the form of annual reports. and will be disseminated in conference presentations and peer-reviewed publications. The European Bronchiectasis Registry aims to make a major contribution to understanding the natural history of the disease, as well as guiding evidence-based decision making and facilitating large randomised controlled trials.

  3. The EMBARC European Bronchiectasis Registry: protocol for an international observational study

    Science.gov (United States)

    Aliberti, Stefano; Polverino, Eva; Vendrell, Montserrat; Crichton, Megan; Loebinger, Michael; Dimakou, Katerina; Clifton, Ian; van der Eerden, Menno; Rohde, Gernot; Murris-Espin, Marlene; Masefield, Sarah; Gerada, Eleanor; Shteinberg, Michal; Ringshausen, Felix; Haworth, Charles; Boersma, Wim; Rademacher, Jessica; Hill, Adam T.; Aksamit, Timothy; O'Donnell, Anne; Morgan, Lucy; Milenkovic, Branislava; Tramma, Leandro; Neves, Joao; Menendez, Rosario; Paggiaro, Perluigi; Botnaru, Victor; Skrgat, Sabina; Wilson, Robert; Goeminne, Pieter; De Soyza, Anthony; Welte, Tobias; Torres, Antoni; Elborn, J. Stuart; Blasi, Francesco

    2016-01-01

    Bronchiectasis is one of the most neglected diseases in respiratory medicine. There are no approved therapies and few large-scale, representative epidemiological studies. The EMBARC (European Multicentre Bronchiectasis Audit and Research Collaboration) registry is a prospective, pan-European observational study of patients with bronchiectasis. The inclusion criterion is a primary clinical diagnosis of bronchiectasis consisting of: 1) a clinical history consistent with bronchiectasis; and 2) computed tomography demonstrating bronchiectasis. Core exclusion criteria are: 1) bronchiectasis due to known cystic fibrosis; 2) age <18 years; and 3) patients who are unable or unwilling to provide informed consent. The study aims to enrol 1000 patients by April 2016 across at least 20 European countries, and 10 000 patients by March 2020. Patients will undergo a comprehensive baseline assessment and will be followed up annually for up to 5 years with the goal of providing high-quality longitudinal data on outcomes, treatment patterns and quality of life. Data from the registry will be available in the form of annual reports. and will be disseminated in conference presentations and peer-reviewed publications. The European Bronchiectasis Registry aims to make a major contribution to understanding the natural history of the disease, as well as guiding evidence-based decision making and facilitating large randomised controlled trials. PMID:27730179

  4. Surface-induced intramolecular electron transfer in multi-centre redox metalloproteins: the di-haem protein cytochrome c{sub 4} in homogeneous solution and at electrochemical surfaces

    Energy Technology Data Exchange (ETDEWEB)

    Chi Qijin; Zhang Jingdong; Jensen, Palle S; Ulstrup, Jens [Department of Chemistry, Technical University of Denmark, Building 207, DK-2800 Kongens Lyngby (Denmark); Nazmudtinov, Renat R [Kazan State Technological University, 420015 Kazan, Republic of Tatarstan (Russian Federation)

    2008-09-17

    Intramolecular electron transfer (ET) between transition metal centres is a core feature of biological ET and redox enzyme function. The number of microscopic redox potentials and ET rate constants is, however, mostly prohibitive for experimental mapping, but two-centre proteins offer simple enough communication networks for complete mapping to be within reach. At the same time, multi-centre redox proteins operate in a membrane environment where conformational dynamics and ET patterns are quite different from the conditions in a homogeneous solution. The bacterial respiratory di-haem protein Pseudomonas stutzeri cytochrome c{sub 4} offers a prototype target for environmental gating of intra-haem ET. ET between P. stutzeri cyt c{sub 4} and small molecular reaction partners in solution appears completely dominated by intermolecular ET of each haem group/protein domain, with no competing intra-haem ET, for which accompanying propionate-mediated proton transfer is a further barrier. The protein can, however, be immobilized on single-crystal, modified Au(111) electrode surfaces with either the low-potential N terminal or the high-potential C terminal domain facing the surface, clearly with fast intramolecular ET as a key feature in the electrochemical two-ET process. This dual behaviour suggests a pattern for multi-centre redox metalloprotein function. In a homogeneous solution, which is not the natural environment of cyt c{sub 4}, the two haem group domains operate largely independently with conformations prohibitive for intramolecular ET. Binding to a membrane or electrochemical surface, however, triggers conformational opening of intramolecular ET channels. The haem group orientation in P. stutzeri cyt c{sub 4} is finally noted to offer a case for orientation dependent electronic rectification between a substrate and a tip in electrochemical in situ scanning tunnelling microscopy or nanoscale electrode configurations.

  5. European wine policy and perceptions of Moravian winemakers: a pilot study in the Czech Republic

    Directory of Open Access Journals (Sweden)

    Petr Koráb

    2012-01-01

    Full Text Available European wine policy is a significant factor influencing winemakers in the European Union. This paper examines perception of this policy by winemakers and other persons working in Czech wine sector on the sample of respondents. Methodological triangulation consisting of non-structured interview and semantic differential was chosen. Field research was carried out, therefore the study uses primary data. Application of the methodology along with the method of evaluation of data creates an original approach which may be applied on several other research questions. General perception of European Wine Policy is complemented with its impact on competitiveness, practical running of vineyards and winery and on future development of winery. Data is statistically evaluated within categories of respondents. Special emphasis is placed on direct payments as a controversial factor of the policy. The policy is perceived as bureaucratic (“all respondents” x = 4.56, and among micro winemakers discriminating (x = 4.5, selfish (x = 4.5 and malfunctioning (x = 3.5. “Professional” winemakers perceive the impact on competitiveness in the Czech market as rather positive (x = 2.67. This study represents pilot research on perception of European Wine Policy by owners of wineries, viticulturists, micro winemakers, a sommelier and a representative of marketing-supporting institution, conducted in the Czech Republic. The author also outlines further direction of research, as the topic is not paid enough scientific attention.

  6. A comparative study of psychophysical judgment of color reproductions on mobile displays between Europeans and Asians

    Science.gov (United States)

    Choi, Kyungah; Suk, Hyeon-Jeong

    2015-01-01

    The purpose of this study is to investigate the differences in the psychophysical judgment of mobile display color appearances between Europeans and Asians. A total of 50 participants, comprising 20 Europeans (9 French, 6 Swedish, 3 Norwegians, and 2 Germans) and 30 Asians (30 Koreans) participated in this experiment. A total of 18 display stimuli with different correlated color temperatures were presented, varying from 2,470 to 18,330 K. Each stimulus was viewed under 11 illuminants ranging from 2,530 to 19,760 K, while their illuminance was consistent around 500 lux. The subjects were asked to assess the optimal level of the display stimuli under different illuminants. In general, confirming the previous studies on color reproduction, we found a positive correlation in the correlated color temperatures between the illuminants and optimal displays. However, Europeans preferred a lower color temperature compared to Asians along the entire range of the illuminants. Two regression equations were derived to predict the optimal display color temperature (y) under varying illuminants (x) as follows: y = α + β*log(x), where α = -8770.37 and β = 4279.29 for European (R2 = 0.95, p < .05), and α = -16076.35 and β = 6388.41 for Asian (R2 = 0.85, p < .05). The findings provide the theoretical basis from which manufacturers can take a cultural-sensitive approach to enhancing their products' appeal in the global markets.

  7. Drinking behaviours and blood alcohol concentration in four European drinking environments: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Hughes Karen

    2011-12-01

    Full Text Available Abstract Background Reducing harm in drinking environments is a growing priority for European alcohol policy yet few studies have explored nightlife drinking behaviours. This study examines alcohol consumption and blood alcohol concentration (BAC in drinking environments in four European cities. Methods A short questionnaire was implemented among 838 drinkers aged 16-35 in drinking environments in four European cities, in the Netherlands, Slovenia, Spain and the UK. Questions included self-reported alcohol use before interview and expected consumption over the remainder of the night. Breathalyser tests were used to measured breath alcohol concentration (converted to BAC at interview. Results Most participants in the Dutch (56.2%, Spanish (59.6% and British (61.4% samples had preloaded (cf Slovenia 34.8%. In those drinking 5 h. In other nationalities, BAC increases were less pronounced or absent. High BAC (> 0.08% was associated with being male, aged > 19, British and having consumed spirits. In all cities most participants intended to drink enough alcohol to constitute binge drinking. Conclusions Different models of drinking behaviour are seen in different nightlife settings. Here, the UK sample was typified by continued increases in inebriation compared with steady, more moderate intoxication elsewhere. With the former being associated with higher health risks, European alcohol policy must work to deter this form of nightlife.

  8. European Medicines Agency Perspective on Oncology Study Design for Marketing Authorization and Beyond.

    Science.gov (United States)

    Jonsson, B; Martinalbo, J; Pignatti, F

    2017-05-01

    In the development of highly active anticancer drugs, the European situation may be viewed as paradoxical. Limited data may support marketing authorization, but may be insufficient for the health economic appraisal needed for reimbursement and market uptake. To achieve this, conventional confirmatory studies may be needed. For products of special interest, studies aimed at optimizing cost-effectiveness may be warranted. Efficient designs of studies to meet these objectives constitute challenges to all stakeholders. © 2017 ASCPT.

  9. Variation in population levels of physical activity in European adults according to cross-European studies: a systematic literature review within DEDIPAC

    NARCIS (Netherlands)

    Loyen, A.; Hecke, L. van; Verloigne, M.; Hendriksen, I.; Lakerveld, J.; Steene-Johannessen, J.; Vuillemin, A.; Koster, A.; Donnelly, A.; Ekelund, U.; Deforche, B.; Bourdeaudhuij, I. de; Brug, J.; Ploeg, H.P. van der

    2016-01-01

    Background: Physical inactivity is a well-known public health risk that should be monitored at the population level. Physical activity levels are often surveyed across Europe. This systematic literature review aims to provide an overview of all existing cross-European studies that assess physical ac

  10. Cancer in inflammatory bowel disease 15 years after diagnosis in a population-based European Collaborative follow-up study

    DEFF Research Database (Denmark)

    Katsanos, Konstantinos H; Tatsioni, Athina; Pedersen, Natalia;

    2011-01-01

    To determine the occurrence of intestinal and extraintestinal cancers in the 1993-2009 prospective European Collaborative Inflammatory Bowel Disease (EC-IBD) Study Group cohort.......To determine the occurrence of intestinal and extraintestinal cancers in the 1993-2009 prospective European Collaborative Inflammatory Bowel Disease (EC-IBD) Study Group cohort....

  11. Promoting and Financing Cultural Tourism in Europe through European Capitals of Culture: A Case Study of Košice, European Capital of Culture 2013

    Directory of Open Access Journals (Sweden)

    Miriam Šebová

    2014-05-01

    Full Text Available The paper highlights the link between the European Capital of Culture (ECoC designation and the development of cultural tourism in Europe. Cultural tourism is the fastest growing segment of tourism in the world and is the desirable objective of new defined cultural policies in European cities. According to the European Commission (2012, it is estimated that cultural tourism accounts for around 40% of all European tourism. In general, the European Commission confirms the significant role of cultural tourism in the development of tourism in Europe and one of the most visible tools of this strategy is the designation of the ECoC. Cultural policy has also become an important tool of urban regeneration and in the rebranding of European cities. The case study of Košice ECoC 2013 presents part of the results from the Košice ECoC evaluation project. The Košice ECoC 2013 project was designed as a community led project which was targeted at increasing the cultural consumption of residents rather than the number of foreign cultural tourists. However, the biggest events such as White night attracted a lot of tourists from the wider region. More than 70 million EUR was dedicated to investments, which have significantly improved the culture infrastructure in Košice. The ECoC designation supported the local cultural buzz and led to new local production of modern culture, art and the creative industries. Other visible effects have already been seen in the advantages gained by the decentralization of the cultural infrastructure and events in the neighbourhoods. The involvement of people outside the city centre has avoided gentrification in the city. From this point of view the project Košice ECoC 2013 has had the prerequisite to sustainable cultural tourism in Košice

  12. European Non-Communicable Respiratory Disease Research, 2002-13: Bibliometric Study of Outputs and Funding.

    Directory of Open Access Journals (Sweden)

    Mursheda Begum

    Full Text Available This study was conducted in order to map European research in chronic respiratory diseases (CRDs. It was intended to assist the European Commission and other research funders to identify gaps and overlaps in their portfolios, and to suggest ways in which they could improve the effectiveness of their support and increase the impact of the research on patient care and on the reduction of the incidence of the CRDs. Articles and reviews were identified in the Web of Science on research in six non-communicable respiratory diseases that were published in 2002-13 from 31 European countries. They represented only 0.8% of biomedical research output but these diseases accounted for 4.7% of the European disease burden, as measured by Disability-Adjusted Life Years (DALYs, so the sub-field is seriously under-researched. Europe is prominent in the sub-field and published 56% of the world total, with the UK the most productive and publishing more than France and Italy, the next two countries, combined. Asthma and Chronic Obstructive Pulmonary Disease (COPD were the diseases with the most publications and the highest citation rates. They also received the most funding, with around two acknowledgments per paper (in 2009-13, whereas cystic fibrosis and emphysema averaged only one. Just over 37% of papers had no specific funding and depended on institutional support from universities and hospitals.

  13. Competencies in European gerontological higher education. An explorative study on core elements.

    Science.gov (United States)

    Schoenmakers, Eric C; Damron-Rodriguez, Joann; Frank, Janet C; Pianosi, Birgit; Jukema, Jan S

    2017-01-01

    This study explores whether there is a common core of competencies in European gerontology education programs by doing a cross-comparison of five undergraduate-level programs. Content analysis of competency profile documents at the five European educational programs were studied using thematic analysis. Study results document that there indeed is a common core of elements in gerontological educational programs. Three clusters which included a total of 15 categories were identified. The clusters were labeled professional attitude, communication skills, and service provision. Clusters and categories varied across the five programs. One program in particular included fewer clusters and categories. This may reflect a difference in focus in the program but could also reflect a less elaborately formulated competency profile document. The results of this study show that, at least at the level of formulating competencies, there is a strong agreement on the major components that are important for a gerontologist at the undergraduate level.

  14. Evaluating with a portfolio in the European Higher Education Framework: an example from English Studies

    OpenAIRE

    Martínez Lirola, María

    2012-01-01

    The European Higher Education Area (EHEA) requests that universities introduce changes in the teaching-learning process. This paper is focused on evaluation as one of the key elements that the new educational model demands. This article offers a proposal of assessment in the core subject English Grammar in English Studies at the University of Alicante (Spain) as an illustrative example of how to evaluate large classes following the model proposed in Bologna. This study will concentrate specif...

  15. Changes in mortality inequalities over two decades: register based study of European countries

    OpenAIRE

    Mackenbach, Johan P; Kulhánová, Ivana; Artnik, Barbara; Bopp, Matthias; Borrell, Carme; Strand, Bjørn Heine

    2016-01-01

    Objective To determine whether government efforts in reducing inequalities in health in European countries have actually made a difference to mortality inequalities by socioeconomic group. Design Register based study. Data source Mortality data by level of education and occupational class in the period 1990-2010, usually collected in a census linked longitudinal study design. We compared changes in mortality between the lowest and highest socioeconomic groups, and calculated their effect on a...

  16. Study of the respiratory health of employees in seven European plants that manufacture ceramic fibres.

    OpenAIRE

    Trethowan, W N; Burge, P S; Rossiter, C E; Harrington, J M; Calvert, I A

    1995-01-01

    OBJECTIVES--To study the relation between occupational exposure to ceramic fibres during manufacture and respiratory health. METHODS--The respiratory health of 628 current employees in the manufacture of ceramic fibres in seven European plants in three countries was studied with a respiratory questionnaire, lung function tests, and chest radiography. Simultaneous plant hygiene surveys measured subjects' current exposure to airborne ceramic fibres from personal samples with optical microscopy ...

  17. Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED).

    Science.gov (United States)

    Dinis-Ribeiro, M; Areia, M; de Vries, A C; Marcos-Pinto, R; Monteiro-Soares, M; O'Connor, A; Pereira, C; Pimentel-Nunes, P; Correia, R; Ensari, A; Dumonceau, J M; Machado, J C; Macedo, G; Malfertheiner, P; Matysiak-Budnik, T; Megraud, F; Miki, K; O'Morain, C; Peek, R M; Ponchon, T; Ristimaki, A; Rembacken, B; Carneiro, F; Kuipers, E J

    2012-01-01

    Atrophic gastritis, intestinal metaplasia, and epithelial dysplasia of the stomach are common and are associated with an increased risk for gastric cancer. In the absence of guidelines, there is wide disparity in the management of patients with these premalignant conditions. The European Society of Gastrointestinal Endoscopy (ESGE), the European Helicobacter Study Group (EHSG), the European Society of Pathology (ESP) and the Sociedade Portuguesa de Endoscopia Digestiva (SPED) have therefore combined efforts to develop evidence-based guidelines on the management of patients with precancerous conditions and lesions of the stomach (termed MAPS). A multidisciplinary group of 63 experts from 24 countries developed these recommendations by means of repeat online voting and a meeting in June 2011 in Porto, Portugal. The recommendations emphasize the increased cancer risk in patients with gastric atrophy and metaplasia, and the need for adequate staging in the case of high grade dysplasia, and they focus on treatment and surveillance indications and methods.

  18. Use of national and international growth charts for studying height in European children: development of up-to-date European height-for-age charts.

    Directory of Open Access Journals (Sweden)

    Marjolein Bonthuis

    Full Text Available BACKGROUND: Growth charts based on data collected in different populations and time periods are key tools to assess children's linear growth. We analyzed the impact of geographic factors and the secular trend on height-for-age charts currently used in European populations, developed up-to-date European growth charts, and studied the effect of using different charts in a sample of growth retarded children. METHODS AND FINDINGS: In an international survey we obtained 18 unique national height-for-age charts from 28 European countries and compared them with charts from the World Health Organization (WHO, Euro-Growth reference, and Centers of Disease Control and Prevention (CDC. As an example, we obtained height data from 3,534 children with end-stage renal disease (ESRD from 13 countries via the ESPN/ERA-EDTA registry, a patient group generally suffering from growth retardation. National growth charts showed a clear secular trend in height (mean height increased on average 0.6 cm/decade and a North-South height gradient in Europe. For countries without a recent (>1990 national growth chart novel European growth charts were constructed from Northern and Southern European reference populations, reflecting geographic height differences in mean final height of 3.9 cm in boys and 3.8 cm in girls. Mean height SDS of 2- to 17-year-old ESRD patients calculated from recent national or derived European growth charts (-1.91, 95% CI: -1.97 to -1.85 was significantly lower than when using CDC or WHO growth charts (-1.55, 95% CI: -1.61 to -1.49 (P<0.0001. CONCLUSION: Differences between height-for-age charts may reflect true population differences, but are also strongly affected by the secular trend in height. The choice of reference charts substantially affects the clinical decision whether a child is considered short-for-age. Therefore, we advocate using recent national or European height-for-age charts derived from recent national data when monitoring growth

  19. The convergence process of dramatic art and dance studies in the European Higher Education Area

    Directory of Open Access Journals (Sweden)

    María Matilde Pérez García

    2011-11-01

    Full Text Available In light of the reform of Spanish higher education in order to achieve higher education European convergence, art studies face a new and twofold challenge. On the one hand, the design and structure of an organizational and operational framework is necessary to allow for the development of art studies in higher education. On the other hand, the design and implementation of curricula is required which have to be evaluated and accredited by agencies to ensure sufficient quality of education. From the analysis of this twofold challenge, the paper suggests some proposals that the administration, the schools and the staff could consider with regard to the special situation that these studies are going through in the process of European convergence.

  20. The Certificate Program in Western European Area and in Latin American Area Studies as Incentives to Study French and Spanish.

    Science.gov (United States)

    Deblauwe, Claude

    The University of San Francisco developed a certificate program in Western European area studies covering French-speaking countries, and subsequently a Latin American area studies program for Spanish-speaking countries, in response to uneven language enrollments and as a means of increasing intermediate-level enrollment. The French program begins…

  1. Building Evaluation Capacity in Spain: A Case Study of Rural Development and Empowerment in the European Union

    Science.gov (United States)

    Diaz-Puente, Jose M.; Yague, Jose L.; Afonso, Ana

    2008-01-01

    The development of European Community administrative authority has greatly influenced the development of an evaluation culture among the southern and central member states of the European Union. The present case study from Spain provides an example of this diffusion through the use of an empowerment evaluation approach to build evaluation capacity…

  2. Access point analysis in smoking and nonsmoking adolescents: Findings from the European Smoking Prevention Framework Approach study

    NARCIS (Netherlands)

    Vries, H. de; Riet, J.P. van 't; Panday, S.; Reubsaet, A.

    2007-01-01

    This study analyzed possibilities to access European adolescents for tobacco control activities in out-of-school settings as part of comprehensive tobacco control programs. Data on leisure time behaviors of secondary school students were gathered during three waves from six European Union countries

  3. Study of Vertical Movements of the European Crust Using Tide Gauge and Gnss Observations

    Directory of Open Access Journals (Sweden)

    Tretyak Kornyliy

    2015-02-01

    Full Text Available This research is devoted to the study of vertical movements of the European crust on the basis of two independent methods, namely tide gauge and GNSS observations results. The description and classification of factors affecting sea level change has been made. The precision with which the movement of the earth's crust according to the results of tide gauge observations can be explored has been calculated . A methodology to identify the duration of tide gauge observations required for studies of vertical movements of the earth 's crust has been presented. Approximation of tide gauge time series with the help of Fourier series has been implemented, the need for long-term observations in certain areas has been explained. The diagram of the velocities of the vertical movements of the European crust on the basis of the tide gauge data and GNSS observations has been built and the anomalous areas where the observations do not coincide have been identified.

  4. European wood pellet market integration - A study of the residential sector

    Energy Technology Data Exchange (ETDEWEB)

    Olsson, Olle; Hillring, Bengt; Vinterbaeck, Johan [Swedish University of Agricultural Sciences, Department of Energy and Technology P.O. Box 7032 SE-750 07 Uppsala (Sweden)

    2011-01-15

    The integration of European energy markets is a key goal of EU energy policy, and has also been the focal point of many scientific studies in recent years. International markets for coal, oil, natural gas and electricity have previously been investigated in order to determine the extent of the respective markets. This study enhances this field of research to bioenergy markets. Price series data and time series econometrics are used to determine whether residential sector wood pellet markets of Austria, Germany and Sweden are integrated. The results of the econometric tests show that the German and Austrian markets can be considered to be integrated, whereas the Swedish market is separate from the other two countries. Although increased internationalization of wood pellet markets is likely to contribute to European price convergence and market integration, this process is far from completed. (author)

  5. The Georgian-Abkhaz Conflict / Chapter 5 of Europeanization and Conflict Resolution: Case Studies from the European Periphery

    Directory of Open Access Journals (Sweden)

    Bruno Coppieters

    2004-07-01

    Full Text Available This chapter analyses the historical background to the secessionist conflict in Abkhazia and the prospect of a settlement. The Georgian-Abkhaz conflict, driven by a need for identity and security, is one that failed to be resolved within the hierarchical federal framework of the Soviet state. Abkhazia seceded from Georgia as a result of the 1992-93 war. UN mediation has so far failed to bring a political settlement closer. The chapter describes the solutions proposed and political actions taken both by the parties to the conflict and by the external mediators. It assesses the way in which the conflicting parties perceive the process of Europeanization in their region, the role of the European Union in the conflict on Abkhazia, and possible future outcomes. The UN proposals for a settlement make it possible to envisage the future of Abkhazia either as part of a federation with Georgia or as an associated state with Georgia, but as long as the external powers are unable to devise a common approach to overcoming the present deadlock in the political negotiations, it remains difficult to predict the precise outcome of the conflict.

  6. Suicidality in primary care patients who present with sadness and anhedonia: a prospective European study

    OpenAIRE

    Moreno-Küstner, Berta; Jones, Rebeca; Švab, Igor; Maaroos, Heidi; Xavier, Miguel; Geerlings, Mirjam; TORRES-GONZÁLEZ, FRANCISCO; Nazareth, Irwin; Motrico-Martínez, Emma; Montón-Franco, Carmen; Gil-de-Gómez, María José; Sánchez-Celaya, Marta; Díaz-Barreiros, Miguel Ángel; Vicens-Caldentey, Catalina; King, Michael

    2016-01-01

    Background Sadness and anhedonia (loss of interest in activities) are central symptoms of major depression. However, not all people with these symptoms meet diagnostic criteria for major depression. We aimed to assess the importance of suicidality in the outcomes for primary care patients who present with sadness and anhedonia. Method Cohort study of 2,599 unselected primary care attenders in six European countries followed up at 6 and 12 months. Results 1) In patients with sadness and/or anh...

  7. Association Study for 26 Candidate Loci in Idiopathic Pulmonary Fibrosis Patients from Four European Populations

    Directory of Open Access Journals (Sweden)

    Amit Kishore

    2016-07-01

    Full Text Available Idiopathic pulmonary fibrosis (IPF affects lung parenchyma with progressing fibrosis. In this study, we aimed to replicate MUC5B rs35705950 variants and determine new plausible candidate variants for IPF among four different European populations. We genotyped 26 IPF candidate loci in 165 IPF patients from four European countries: Czech Republic (n = 41, Germany (n = 33, Greece (n = 40, France (n = 51 and performed association study comparing observed variant distribution with this obtained in a genetically similar Czech healthy control population (n = 96 described in our earlier data report. A highly significant association for a promoter variant (rs35705950 of mucin encoding MUC5B gene was observed in all IPF populations, individually and combined [OR (95% CI; p-value as 5.23 (8.94-3.06; 1.80x10-11. Another non-coding variant, rs7934606 in MUC2 was significant among German patients [2.85 (5.05-1.60; 4.03x10-4] and combined European IPF cases [2.18 (3.16-1.50; 3.73x10-5]. The network analysis for these variants indicated gene-gene and gene-phenotype interactions in IPF and lung biology. With replication of MUC5B rs35705950 previously reported in U.S. populations of European descent and indicating other plausible polymorphic variants relevant for IPF, we provide additional reference information for future extended functional and population studies aimed, ideally with inclusion of clinical parameters, at identification of IPF genetic markers.

  8. Patterns of Long Term Care in 29 European countries: evidence from an exploratory study

    Directory of Open Access Journals (Sweden)

    Damiani Gianfranco

    2011-11-01

    Full Text Available Abstract Background The challenges posed by the rapidly ageing population, and the increased preponderance of disabled people in this group, coupled with the rising level of public expenditure required to service the complex organization of long term care (LTC delivery are causing increased pressure on LTC systems in Europe. A pan-European survey was carried out to evaluate whether patterns of LTC can be identified across Europe and what are the trends of the countries along them. Methods An ecological study was conducted on the 27 EU Member States plus Norway and Iceland, referring to the period 2003-2007. Several variables related to organizational features, elderly needs and expenditure were drawn from OECD Health Data and the Eurostat Statistics database and combined using Multiple Factor Analysis (MFA. Results Two global Principal Components were taken into consideration given that their expressed total variance was greater than 60%. They were interpreted according to the higher (more than 0.5 positive or negative correlation coefficients between them and the original variables; thus patterns of LTC were identified. High alignment between old age related expenditure and elderly needs characterizes Nordic and Western European countries, the former also having a higher level of formal care than the latter. Mediterranean as well as Central and South Eastern European countries show lower alignment between old age related expenditure and elderly needs, coupled with a level of provision of formal care that is around or slightly above the average European level. In the dynamic comparison, linear, stable or unclear trends were shown for the studied countries. Conclusions The analysis carried out is an explorative and descriptive study, which is an attempt to reveal patterns and trends of LTC in Europe, allowing comparisons between countries. It also stimulates further researches with lower aggregated data useful to gain meaningful policy

  9. Self-regulation and the new challenges in journalism: Comparative study across European countries

    Directory of Open Access Journals (Sweden)

    Matthias Karmasin

    2011-01-01

    Full Text Available The objective of this article is to compare the self-regulatory systems of the journalistic profession in Austria, Germany, Denmark, Estonia, Spain, France and Poland. Based on the analysis of the different cases and situations in these seven countries, we offer a comparative analysis of the existence of: ethical codes, pro-consumers associations, print and audiovisual press councils, level of organization and unionism among journalists. The results reveal deficiencies in the European systems as well as progressions in the implementation of self-regulation tools in the journalistic profession, mainly in the field of print and audiovisual media. In most European countries under study, online newspapers lack self-regulatory tools, except for the regulation coming from their parent print or broadcast media companies.

  10. Sustaining International Partnerships: The European Master of Science Program In Occupational Therapy: A Case Study

    DEFF Research Database (Denmark)

    Ilott, Irene; Kottorp, Anders; la Cour, Karen

    2013-01-01

    Abstract International partnerships are a mechanism for supporting the academic development of occupational therapy and promoting cultural competence. This case study describes the factors that have helped to sustain a post-qualifying programme implemented by five higher education institutions...... in Denmark, the Netherlands, Sweden, Switzerland and the UK since 1999. Data collection methods were documentary analysis and the reflections of a purposive sample of six key informants. Cohort and outcome data, from 193 students from 31 countries who enrolled between 1999 and 2011, are reported. Each cohort...... comprises students from an average of eight countries to optimize inter-cultural dialogue. Four factors support sustainability. These are 1) supportive professional European networks; 2) timeliness and alignment with European higher education policy; 3) partnership structures and processes that emphasize...

  11. Benchmark Study and Characterization of European Rad-Hard Power MOSFEts for Space Applications

    Science.gov (United States)

    Becherer, J.; Dittrich, R.; Muschitiello, M.; Constantino, A.

    2014-08-01

    Power Field Effect Transistors are an integral part of the electronic equipment of every space vehicle. In order to survive the harsh conditions of space, the transistors have to fulfill rigorous conditions. A number one in the list of space qualification criteria is the guarantee of radiation hardness. Today several radiation hard Power MOSFETs are available from a variety of companies all over the world. A benchmark study of the available Power MOSFETs for space applications has been compiled in this paper. The newly developed European Superjunction Technologies Power MOSFETs from Infineon show the best performance. Therefore, a total ionizing dose characterization of the 250 V and 150 V European MOSFETs have been performed.

  12. Participants' perspective on maintaining behaviour change: a qualitative study within the European Diabetes Prevention Study

    Directory of Open Access Journals (Sweden)

    White Martin

    2008-07-01

    Full Text Available Abstract Background The European Diabetes Prevention Study (EDIPS is an RCT of diet and exercise interventions in people with impaired glucose tolerance. We undertook a qualitative study, nested within the EDIPS in Newcastle-upon-Tyne, UK, aiming to understand the experience of participants who maintained behaviour change, in order to inform future interventions. Methods Participants were purposively sampled, according to success criteria for diet and physical activity change maintenance, and invited to attend individual semi-structured interviews. Fifteen participants completed an interview and reflected on their experience over three to five years. We used the Framework method to analyse the transcribed data. Results Main themes were identified as factors that help (props and those that hinder (burdens behaviour change maintenance at different organisational levels: individual (both physical and psychological, social and environmental. Pre-existing physical conditions (such as arthritis and social demands (such as caring for an ageing relative hindered, whereas the benefits of becoming fitter and of having social and professional support helped, participants in maintaining behaviour change. Participants' long term experiences highlighted the salience of the continuous change in their physical, social and environmental conditions over time. Conclusion The construct of props and burdens facilitates a holistic view of participants' behaviour. Efforts to encourage behaviour change maintenance should take account of context and the way this changes over time, and should include strategies to address these issues. The experience of participants who maintain behaviour change highlights the challenges for the wider implementation of diabetes prevention strategies. Trial Registration (ISRCTN 15670600

  13. Observing Huntington’s Disease: the European Huntington’s Disease Network’s REGISTRY

    Science.gov (United States)

    Orth, Michael; Handley, Olivia J; Schwenke, Carsten; Dunnett, Stephen B.; Craufurd, David; Ho, Aileen K; Wild, Edward; Tabrizi, Sarah J; Landwehrmeyer, G. Bernhard; Bonelli, Raphael M.; Herranhof, Brigitte; Hödl, Anna; Koppitz, Michael; Magnet, Markus; Otti, Daniela; Painold, Annamaria; Reisinger, Karin; Flamez, Anja; Morez, Vera; de Raedt, Sylvie; Ribaï, Pascale; Verellen-Dumoulin, Christine; Vandenberghe, Wim; van Reijen, Dimphna; Hasholt, Lis; Hjermind, Lena E.; Jakobsen, Oda; Nørremølle, Anne; Sørensen, Sven Asger; Stokholm, Jette; Peippo, Maarit; Sipponen, Marjatta; Hiivola, Heli; Martikainen, Kirsti; Tuuha, Katri; Kosinski, Christoph Michael; Probst, Daniela; Sass, Christian; Schiefer, Johannes; Schlangen, Christiane; Werner, Cornelius J.; Priller, Josef; Prüß, Harald; Andrich, Jürgen; Hoffmann, Rainer; Kraus, Peter; Prehn, Christian; Saft, Carsten; Salmen, Stephan; Straßburger, Katrin; Lange, Herwig; Hunger, Ulrike; Löhle, Matthias; Schmidt, Simone; Storch, Alexander; Wolz, Anett; Wolz, Martin; Lammbeck, Johann; Zucker, Birgit; Hidding, Ute; Münchau, Alexander; Orth, Michael; Stubbe, Lars; Heinicke, Walburgis; Orth, Michael; Longinus, Bernhard; Möller, Jens Carsten; Rissling, Ida; Peinemann, Alexander; Städtler, Michael; Weindl, Adolf; Bohlen, Stefan; Lange, Herwig; Reilmann, Ralf; Beister, Antonie; Dose, Matthias; Leythaeuser, Gabriele; Marquard, Ralf; Schrenk, Caroline; Schuierer, Michele; Wiedemann, Alexandra; Ecker, Daniel; Landwehrmeyer, Bernhard; Lezius, Franziska; Trautmann, Sonja; Bertini, Elisabetta; Mechi, Claudia; Paganini, Marco; Piacentini, Sivia; Romoli, Maria; Sorbi, Sandro; Abbruzzese, Giovanni; di Poggio, Monica Bandettini; Di Maria, Emilio; Ferrandes, Giovanna; Mandich, Paola; Marchese, Roberta; Albanese, Alberto; Di Donato, Stefano; Mariotti, Caterina; Soliveri, Paola; Carlo, Rinaldi; Luigi, Di Maio; De Michele, Giuseppe; Rinaldi, Carlo; Salvatore, Elena; Tucci, Tecla; Ciarmiello, Andrea; Martino, Tiziana; Simonelli, Maria; Squitieri, Ferdinando; Bentivoglio, Anna Rita; Fasano, Alfonso; Frontali, Marina; Guidubaldi, Arianna; Ialongo, Tamara; Jacopini, Gioia; Loria, Giovanna; Piano, Carla; Romano, Silvia; Soleti, Francesco; Spadaro, Maria; Zinzi, Paola; Heiberg, Arvid; van Walsem, Marleen R; Bjørgo, Kathrine; Fannemel, Madelein; Lars Retterstøl, Per Gørvell.; Bjørnevoll, Inga; Sando, Sigrid Botne; Sitek, Emilia Jadwiga; Slawek, Jaroslaw; Soltan, Witold; Boczarska-Jedynak, Magdalena; Jasinska-Myga, Barbara; Opala, Gregorz; Rudzińska, Monika; Szczudlik, Andrzej; Wójcik, Magdalena; Banaszkiewicz, Krzysztof; Bryl, Anna; Ciesielska, Anna; Klimberg, Aneta; Kozubski, Wojciech; Marcinkowski, Jerzy; Sempołowicz, Pani Justyna; Zielonka, Daniel; Janik, Piotr; Kalbarczyk, Anna; Kwiecinski, Hubert; Jamrozik, Zygmunt; Antczak, Jakub; Witkowski, Grzegorz; Rakowicz, Maryla; Richter, Przemyslaw; Ryglewicz, Danuta; Zaremba, Jacek; Zdzienicka, Elzbieta; Costa, Christina; Coelho, Miguel; Ferreira, Joaquim J; Mestre, Tiago; Rosa, Mário M; Valadas, Anabela; Gago, Miguel; Garrett, Carolina; Guerra, Maria Rosalia; Bas, Jordi; Calopa, Matilde; Barberà, Miquel Aguilar; Badenes, Dolores; Casas, Laura; Arroyo, Sonia Escalante; Vara, Jorge Hernández; Krupinski, Jerzy; López, Judith; Obdulia, Marta; Ferrer, Pilar Quilez; Sebastián, Ana Rojo; Contreras, Silvia Romero; Carruesco, Gemma Tome; Cubo, Esther; Mariscal, Natividad; Sánchez, Jesús; Barrero, Francisco J; Morales, Blas; López-Sendón Moreno, José Luis; García, Rocío García-Ramos; Quiroga, Purificacion Pin; Villanueva, Clara; Ruíz-Espiga, Pedro-José García; Martínez, Asunción; Artiga, María José Saiz; Sánchez, Vicenta; Bascuñana, Mónica; Fatas, Marta; Ribas, Guillermo García; de Yébenes, Justo García; López Moreno, José Luis; Schwarz, Christine; Cubillo, Patricia Trigo; Arques, Penelope Navas; Gorospe, Aranzazú; Legarda, Inés; Torres Rodríguez, María José; Gaston, Itziar; Ramos-Arroyo, Maria A.; del Val, Javier López; Martinez, Laura; Burgunder, Jean-Marc; Romero, Irene; Schüpbach, Michael; Zaugg, Sabine Weber; van Hout, Monique S.E.; van Vugt, Jeroen P.P.; de Weert, A. Marit; Bolwijn, J.J.W.; Dekker, Meike; Leenders, K.L.; van Oostrom, Joost.C.H.; Bos, Reineke; Dumas, Eve; Jurgens, Caroline K.; Roos, Raymund A.C.; Witjes-Ané, Marie-Noëlle; Matheson, Kirsty; Rae, Daniela; Simpson, Sheila; Summers, Fiona; Ure, Alexandra; Curtis, Adrienne; Keylock, Jenny; Rickards, Hugh; Wright, Jan; Barker, Roger A.; Fisher, Kate; Goodman, Anna Olivia Goyder; Hill, Susan; Kershaw, Ann; Mason, Sarah; Paterson, Nicole; Raymond, Lucy; Bisson, Jon; Busse, Monica; Ellison-Rose, Lynda; Handley, Olivia; Dunnett, SB; Naji, Jenny; Price, Kathy; Rosser, Anne; Edwards, Maureen; De Sousa, Paul A.; Hughes, Teresa; McGill, Marie; Pearson, Pauline; Porteous, Mary; Zema, Adam; Brockie, Peter; Foster, Jillian; Johns, Nicola; McKenzie, Sue; Thomas, Gareth; Burrows, Liz; Fletcher, Amy; Laver, Fiona; Silva, Mark; Thomson, Aileen; Chu, Carol; Hobson, Emma; Jamieson, Stuart; Toscano, Jean; Wild, Sue; Yardumian, Pam; Bourne, Colin; Clayton, Carole; Dipple, Heather; Grant, Janet; Gross, Diana; Hallam, Caroline; Middleton, Julia; Murch, Ann; Andrews, Thomasin; Dougherty, Andrew; Kavalier, Fred; Golding, Charlotte; Lashwood, Alison; Robertson, Dene; Ruddy, Deborah; Whaite, Anna; Andrews, Thomasin; Bruno, Stefania; Golding, Charlotte; Henley, Susie; Novak, Marianne; O'Driscoll, Christine; Patel, Aakta; Rosser, Elisabeth; Tabrizi, Sarah; Taylor, Rachel; Warner, Thomas; Wild, Edward; Arran, Natalie; Craufurd, David; Fullam, Ruth; Howard, Liz; Huson, Susan; Partington-Jones, Lucy; Ritchie, Nichola; Snowden, Julie; Solom, Annie; Stopford, Cheryl; Thompson, Jennifer; Westmoreland, Leann; Nemeth, Andrea H; Siuda, Gill; Bandmann, Oliver; Bradbury, Alyson; Fillingham, Kay; Foustanos, Isabella; Quarrell, Oliver; Reynders, Hazel; Robertson, Lisa; Tidswell, Katharine

    2011-01-01

    Background: Huntington’s disease (HD) is a rare triplet repeat (CAG) disorder. Advanced, multi-centre, multi-national research frameworks are needed to study simultaneously multiple complementary aspects of HD. This includes the natural history of HD, its management and the collection of clinical information and biosamples for research. Methods: We report on cross-sectional data of the first 1766 participants in REGISTRY, the European Huntington’s Disease Network’s (EHDN), multi-lingual, multi-national prospective observational study of HD in Europe. Data collection (demographics, phenotype, genotype, medication, co-morbidities, biosamples) followed a standard protocol. Results: Phenotype, and the HD genotype, of manifest HD participants across different European regions was similar. Motor onset was most common (48%) with a non-motor onset in more than a third of participants. Motor signs increased, and cognitive abilities and functional capacity declined as the disease burden (CAGn-35.5) X age) increased. A life-time history of behavioural symptoms was common, but the behavioural score was not related to disease burden. One fifth of participants had severe psychiatric problems, e.g. suicidal ideation and attempts, and/or irritability/aggression, with psychosis being less common. Participants on anti-dyskinetic medication had a higher motor and lower cognitive score, were older, and more prone to physical trauma. A higher motor and a lower cognitive score predicted more advanced disease. Conclusions: The unparalleled collection of clinical data and biomaterials within the EHDN’s REGISTRY can expedite the search for disease modifiers (genetic and environmental) of age at onset and disease progression that could be harnessed for the development of novel treatments. PMID:20890398

  14. Qualitative Research Methods in Visual Communication. Case Study: Visual Networks in the Promotional Videos of the European Year of Volunteering

    Directory of Open Access Journals (Sweden)

    Camelia Cmeciu

    2013-05-01

    Full Text Available European Years are a means of promoting European issues at a macro and micro-level. The objective of this paper is to provide the visual differences in the framing of the issue of volunteering at a European and national level. The approach focuses on a blending of two qualitative research methods in visual communication: ATLAS.ti (computer assisted/ aided qualitative data analysis software and social semiotics. The results of our analysis highlight two network views on volunteering promoted through videos, a salience of transactional processes in the implementation of volunteering at a European and national level, and a classification of various types of social practices specific to Romania. This study provides an insight into the way in which two different qualitative methods may be combined in order to provide a visual representation and interpretation to a European issue.

  15. Protocol for the ProFHER (PROximal Fracture of the Humerus: Evaluation by Randomisation trial: a pragmatic multi-centre randomised controlled trial of surgical versus non-surgical treatment for proximal fracture of the humerus in adults

    Directory of Open Access Journals (Sweden)

    Maffulli Nicola

    2009-11-01

    Full Text Available Abstract Background Proximal humeral fractures, which occur mainly in older adults, account for approximately 4 to 5% of all fractures. Approximately 40% of these fractures are displaced fractures involving the surgical neck. Management of this group of fractures is often challenging and the outcome is frequently unsatisfactory. In particular it is not clear whether surgery gives better outcomes than non-surgical management. Currently there is much variation in the use of surgery and a lack of good quality evidence to inform this decision. Methods/Design We aim to undertake a pragmatic UK-based multi-centre randomised controlled trial evaluating the effectiveness and cost-effectiveness of surgical versus standard non-surgical treatment for adults with an acute closed displaced fracture of the proximal humerus with involvement of the surgical neck. The choice of surgical intervention is left to the surgeon, who must use techniques that they are fully experienced with. This will avoid 'learning curve' problems. We will promote good standards of non-surgical care, similarly insisting on care-provider competence, and emphasize the need for comparable provision of rehabilitation for both groups of patients. We aim to recruit 250 patients from a minimum of 18 NHS trauma centres throughout the UK. These patients will be followed-up for 2 years. The primary outcome is the Oxford Shoulder Score, which will be collected via questionnaires completed by the trial participants at 6, 12 and 24 months. This is a 12-item condition-specific questionnaire providing a total score based on the person's subjective assessment of pain and activities of daily living impairment. We will also collect data for other outcomes, including general health measures and complications, and for an economic evaluation. Additionally, we plan a systematic collection of reasons for non-inclusion of eligible patients who were not recruited into the trial, and their baseline

  16. Standing up in multiple sclerosis (SUMS): protocol for a multi-centre randomised controlled trial evaluating the clinical and cost effectiveness of a home-based self-management standing frame programme in people with progressive multiple sclerosis.

    Science.gov (United States)

    Freeman, J A; Hendrie, W; Creanor, S; Jarrett, L; Barton, A; Green, C; Marsden, J; Rogers, E; Zajicek, J

    2016-05-05

    Multiple sclerosis (MS) is an incurable, unpredictable but typically progressive neurological condition. It is the most common cause of neurological disability in young adults. Within 15 years of diagnosis, approximately 50 % of affected people are unable to walk unaided, and over time an estimated 25 % depend on a wheelchair. Typically, people with such limited mobility are excluded from clinical trials. Severely impaired people with MS spend much of their day sitting, often with limited ability to change position. In response, secondary complications can occur including: muscle wasting, pain, reduced skin integrity, spasms, limb stiffness, constipation, and associated psychosocial problems such as depression and lowered self-esteem. Effective self-management strategies, which can be implemented relatively easily and cheaply within people's homes, are needed to improve or maintain mobility and reduce sedentary behaviour. However this is challenging, particularly in the latter stages of disease. Regular supported standing using standing frames is one potential option. SUMS is a pragmatic multi-centre randomised controlled trial evaluating use of Oswestry standing frames with blinded outcome assessment and full economic evaluation. Participants will be randomly allocated (1:1) to either a home-based, self-management standing programme (with advice and support) along with their usual care or to usual care alone. Those in the intervention group will be asked to stand for a minimum of 30 min three times weekly over 20 weeks. Each participant will be followed-up at 20 and 36 weeks post baseline. The primary clinical outcome is motor function, assessed using the Amended Motor Club Assessment. The primary economic endpoint is quality-adjusted life years. The secondary outcomes include measures of explanatory physical impairments, key clinical outcomes, and health-related quality of life. An embedded qualitative component will explore participant's and carer

  17. The Multidimensionality of Welfare State Attitudes: A European Cross-National Study.

    Science.gov (United States)

    Roosma, Femke; Gelissen, John; van Oorschot, Wim

    2013-08-01

    When evaluating the various aspects of the welfare state, people assess some aspects more positively than others. Following a multidimensional approach, this study systematically argues for a framework composed of seven dimensions of the welfare state, which are subject to the opinions of the public. Using confirmatory factor analyses, this conceptual framework of multidimensional welfare attitudes was tested on cross-national data from 22 countries participating in the 2008 European Social Survey. According to our empirical analysis, attitudes towards the welfare state are multidimensional; in general, people are very positive about the welfare state's goals and range, while simultaneously being critical of its efficiency, effectiveness and policy outcomes. We found that these dimensions relate to each other differently in different countries. Eastern/Southern Europeans combine a positive attitude towards the goals and role of government with a more critical attitude towards the welfare state's efficiency and policy outcomes. In contrast, Western/Northern Europeans' attitudes towards the various welfare state dimensions are based partly on a fundamentally positive or negative stance towards the welfare state.

  18. Health, Well-Being and Energy Poverty in Europe: A Comparative Study of 32 European Countries

    Science.gov (United States)

    Thomson, Harriet; Snell, Carolyn; Bouzarovski, Stefan

    2017-01-01

    Despite growing pan-European interest in and awareness of the wide-ranging health and well-being impacts of energy poverty—which is characterised by an inability to secure adequate levels of energy services in the home—the knowledge base is largely British-centric and dominated by single-country studies. In response, this paper investigates the relationship between energy poverty, health and well-being across 32 European countries, using 2012 data from the European Quality of Life Survey. We find an uneven concentration of energy poverty, poor health, and poor well-being across Europe, with Eastern and Central Europe worst affected. At the intersection of energy poverty and health, there is a higher incidence of poor health (both physical and mental) amongst the energy poor populations of most countries, compared to non-energy poor households. Interestingly, we find the largest disparities in health and well-being levels between energy poor and non-energy poor households occur within relatively equal societies, such as Sweden and Slovenia. As well as the unique challenges brought about by rapidly changing energy landscapes in these countries, we also suggest the relative deprivation theory and processes of social comparison hold some value in explaining these findings. PMID:28561767

  19. Health, Well-Being and Energy Poverty in Europe: A Comparative Study of 32 European Countries

    Directory of Open Access Journals (Sweden)

    Harriet Thomson

    2017-05-01

    Full Text Available Despite growing pan-European interest in and awareness of the wide-ranging health and well-being impacts of energy poverty—which is characterised by an inability to secure adequate levels of energy services in the home—the knowledge base is largely British-centric and dominated by single-country studies. In response, this paper investigates the relationship between energy poverty, health and well-being across 32 European countries, using 2012 data from the European Quality of Life Survey. We find an uneven concentration of energy poverty, poor health, and poor well-being across Europe, with Eastern and Central Europe worst affected. At the intersection of energy poverty and health, there is a higher incidence of poor health (both physical and mental amongst the energy poor populations of most countries, compared to non-energy poor households. Interestingly, we find the largest disparities in health and well-being levels between energy poor and non-energy poor households occur within relatively equal societies, such as Sweden and Slovenia. As well as the unique challenges brought about by rapidly changing energy landscapes in these countries, we also suggest the relative deprivation theory and processes of social comparison hold some value in explaining these findings.

  20. Coffee Drinking and Mortality in 10 European Countries: A Multinational Cohort Study.

    Science.gov (United States)

    Gunter, Marc J; Murphy, Neil; Cross, Amanda J; Dossus, Laure; Dartois, Laureen; Fagherazzi, Guy; Kaaks, Rudolf; Kühn, Tilman; Boeing, Heiner; Aleksandrova, Krasimira; Tjønneland, Anne; Olsen, Anja; Overvad, Kim; Larsen, Sofus Christian; Redondo Cornejo, Maria Luisa; Agudo, Antonio; Sánchez Pérez, María José; Altzibar, Jone M; Navarro, Carmen; Ardanaz, Eva; Khaw, Kay-Tee; Butterworth, Adam; Bradbury, Kathryn E; Trichopoulou, Antonia; Lagiou, Pagona; Trichopoulos, Dimitrios; Palli, Domenico; Grioni, Sara; Vineis, Paolo; Panico, Salvatore; Tumino, Rosario; Bueno-de-Mesquita, Bas; Siersema, Peter; Leenders, Max; Beulens, Joline W J; Uiterwaal, Cuno U; Wallström, Peter; Nilsson, Lena Maria; Landberg, Rikard; Weiderpass, Elisabete; Skeie, Guri; Braaten, Tonje; Brennan, Paul; Licaj, Idlir; Muller, David C; Sinha, Rashmi; Wareham, Nick; Riboli, Elio

    2017-08-15

    The relationship between coffee consumption and mortality in diverse European populations with variable coffee preparation methods is unclear. To examine whether coffee consumption is associated with all-cause and cause-specific mortality. Prospective cohort study. 10 European countries. 521 330 persons enrolled in EPIC (European Prospective Investigation into Cancer and Nutrition). Hazard ratios (HRs) and 95% CIs estimated using multivariable Cox proportional hazards models. The association of coffee consumption with serum biomarkers of liver function, inflammation, and metabolic health was evaluated in the EPIC Biomarkers subcohort (n = 14 800). During a mean follow-up of 16.4 years, 41 693 deaths occurred. Compared with nonconsumers, participants in the highest quartile of coffee consumption had statistically significantly lower all-cause mortality (men: HR, 0.88 [95% CI, 0.82 to 0.95]; P for trend coffee drinking with circulatory disease mortality (HR, 0.78 [CI, 0.68 to 0.90]; P for trend coffee consumption was associated with lower serum alkaline phosphatase; alanine aminotransferase; aspartate aminotransferase; γ-glutamyltransferase; and, in women, C-reactive protein, lipoprotein(a), and glycated hemoglobin levels. Reverse causality may have biased the findings; however, results did not differ after exclusion of participants who died within 8 years of baseline. Coffee-drinking habits were assessed only once. Coffee drinking was associated with reduced risk for death from various causes. This relationship did not vary by country. European Commission Directorate-General for Health and Consumers and International Agency for Research on Cancer.

  1. European active surveillance study of women taking HRT (EURAS-HRT: study protocol [NCT00214903

    Directory of Open Access Journals (Sweden)

    Heinemann Lothar AJ

    2006-01-01

    Full Text Available Abstract Background The post marketing safety surveillance program for a drug containing a new chemical entity should assess both, the safety outcomes that relate specifically to the targeted population, as well as those that could potentially be related to special pharmacological characteristics of the drug. Active safety surveillance using valid epidemiological study designs has been proven to be a pertinent and reliable method to approach this endeavor. Methods/design The primary objective of the study is to compare incidence rates of serious adverse events in users of all types of newly prescribed oral HRT products. This active surveillance study will assess pertinent cardiovascular outcomes - in particular venous and arterial thromboembolism - and other serious adverse events (SAEs in new HRT users over a period of several years. One product under surveillance is Angeliq®, which contains the novel progestagen drospirenone (DRSP combined with estradiol. In addition, all other oral combined HRT products with a novel progestagen or estrogen that will be newly marketed during the study period will be studied. These new HRT products will be compared with established HRT products. The combined cohort will include at least 30,000 women recruited in several European countries. At least 90,000 years of observation are expected from the field work which started in early 2002 and will end around 2008. The participating women will complete a baseline survey using a self-administered questionnaire to describe the baseline risk. After 6 months, 12 months, and then on an annual basis, they will fill out a questionnaire in which they record complaints and events during the use of the prescribed HRTs. All adverse outcomes occurring during the observational period will be evaluated. Discussion A complete lifetime medical history, individually validated SAEs over time, and a low loss to follow-up rate are essential for a robust safety assessment. Therefore

  2. Invasive mucormycosis in children: an epidemiologic study in European and non-European countries based on two registries.

    Science.gov (United States)

    Pana, Zoi Dorothea; Seidel, Danila; Skiada, Anna; Groll, Andreas H; Petrikkos, Georgios; Cornely, Oliver A; Roilides, Emmanuel

    2016-11-10

    Mucormycosis has emerged as a rare but frequently fatal invasive fungal disease. Current knowledge on paediatric mucormycosis is based on case reports and small series reported over several decades. Contemporary data on a large cohort of patients is lacking. Two large international registries (Zygomyco.net and FungiScope™) were searched for mucormycosis cases in ≤19 year-old patients. Cases enrolled between 2005 and 2014 were extracted, and dual entries in the two databases merged. Epidemiology, clinical characteristics, diagnostic procedures, therapeutic management and final outcome were recorded and analysed with SPSS v.12. Sixty-three unique cases (44 proven and 19 probable) were enrolled from 15 countries (54 in European and 9 in non-European countries). Median age was 13 years [Interquartile Range (IQR) 7.7] with a slight predominance (54.1 %) of females. Underlying conditions were haematological malignancies (46 %), other malignancies (6.3 %), haematopoietic stem cell transplantation (15.9 %), solid organ transplantation, trauma/surgery and diabetes mellitus (4.8 % each) and a variety of other diseases (7.9 %); in 9.5%, no underlying medical condition was found. Neutropenia was recorded in 46 % of the patients. The main sites of infection were lungs (19 %), skin and soft tissues (19 %), paranasal sinus/sino-orbital region (15.8 %) and rhino-cerebral region (7.9 %). Disseminated infection was present in 38.1 %. Mucormycosis diagnosis was based on several combinations of methods; culture combined with histology was performed in 31 cases (49.2 %). Fungal isolates included Rhizopus spp. (39.7 %), Lichtheimia spp. (17.5 %), Mucor spp. (12.7 %), Cunninghamella bertholletiae (6.3 %) and unspecified (23.8 %). Treatment comprised amphotericin B (AmB) monotherapy in 31.7 % or AmB in combination with other antifungals in 47.7 % of the cases, while 14.3 % received no antifungals. Surgery alone was performed in 6.3 %, and combined with antifungal therapy in 47

  3. Gaps in EU Foreign Policy: the Role of Concepts in European Studies

    DEFF Research Database (Denmark)

    Larsen, Henrik

    of Capability-Expectations Gap in the study of European foreign policy. Through examples from the literature, it is shown that the concept sets up standards for the EU as a foreign policy actor that are not met by most other international actors and that this curtails analysis of EU foreign policy....... It then demonstrates that the widespread use of the concept of ‘gap’ in different forms affects the way in which EU foreign policy has been studied and that it always produces the same result: the EU is an unfulfilled actor outside the realm of “normal” actors in IR....

  4. Predicting sickness impact profile at six months after stroke: further results from the European multi-center CERISE study

    NARCIS (Netherlands)

    Stummer, C.A.; Verheyden, G.; Putman, K.; Jenni, W.; Schupp, W.; Wit, L. De

    2015-01-01

    PURPOSE: To develop prognostic models and equations for predicting participation at six months after stroke. METHODS: This European prospective cohort study recruited 532 consecutive patients from four rehabilitation centers. Participation was assessed at six months after stroke with the Sickness

  5. Clinical, polysomnographic and genome-wide association analyses of narcolepsy with cataplexy: a European Narcolepsy Network study

    National Research Council Canada - National Science Library

    Luca, G. De; Haba-Rubio, J; Dauvilliers, Y; Lammers, G.J; Overeem, S; Donjacour, C.E; Mayer, G; Javidi, S; Iranzo, A; Santamaria, J; Peraita-Aados, R; Hor, H; Kutalik, Z; Plazzi, G; Poli, F; Pizza, F; Arnulf, I; Leceneux, M; Bassetti, C; Mathis, J; Heinzer, R; Jennum, P; Knudsen, S; Geisler, P; Wierzbicka, A; Feketeova, E; Pfister, C; Khatami, R; Baumann, C; Tafti, M

    2013-01-01

    The aim of this study was to describe the clinical and PSG characteristics of narcolepsy with cataplexy and their genetic predisposition by using the retrospective patient database of the European Narcolepsy Network (EU-NN...

  6. Effect of osteosynthesis, primary hemiarthroplasty, and non-surgical management for displaced four-part fractures of the proximal humerus in elderly: a multi-centre, randomised clinical trial

    Directory of Open Access Journals (Sweden)

    Johannsen Hans

    2009-07-01

    Full Text Available Abstract Background Fractures of the proximal humerus are common injuries and account for 4–5 percent of all fractures, second only to hip and wrist fractures. The incidence is positively correlated with age and osteoporosis, and is likely to increase. Displaced four-part fractures are among the most severe injuries, accounting for 2–10 percent of proximal humeral fractures. The optimal intervention is disputed. Two previous randomised trials were very small and involved a noticeable risk of bias, and systematic reviews consequently conclude that there is inadequate basis for evidence-based treatment decisions. We aim to compare the effect of osteosynthesis with angle-stable plate with non-surgical management, and the effect of primary hemiarthroplasty with both osteosynthesis and non-surgical management. Methods/Design We will conduct a randomised, multi-centre, clinical trial including patients from ten national shoulder units within a two-year period. We plan to include 162 patients. A central randomisation unit will allocate patients. All patients will receive a standardised three-month rehabilitation program of supervised physiotherapy regardless of treatment allocation. Patients will be followed at least one year. The primary outcomes will be the overall score on the Constant Disability Scale, and its pain subscale, measured at 12 months. A blinded physiotherapist will carry out the assessments. Other secondary outcomes are Oxford Shoulder Score, and general health status (Short Form-36.

  7. Eliminating Language Barriers Online at European Prisons (ELBEP): A Case-Study

    Science.gov (United States)

    Barkan, M.; Toprak, E.; Kumtepe, A. T.; Kumtepe, E. Genc; Ataizi, M.; Pilanci, H.; Mutlu, M. E.; Kayabas, I.; Kayabas, B. Kip

    2011-01-01

    ELBEP (Eliminating Language Barriers in European Prisons Through Open and Distance Education Technology) is a multilateral project funded by the European Union (EU) Lifelong Learning, Grundtvig (Adult Education) Programme. It aims to overcome language/communication problems between prison staff and foreign inmates at European prisons via online…

  8. Eliminating Language Barriers Online at European Prisons (ELBEP): A Case-Study

    Science.gov (United States)

    Barkan, M.; Toprak, E.; Kumtepe, A. T.; Kumtepe, E. Genc; Ataizi, M.; Pilanci, H.; Mutlu, M. E.; Kayabas, I.; Kayabas, B. Kip

    2011-01-01

    ELBEP (Eliminating Language Barriers in European Prisons Through Open and Distance Education Technology) is a multilateral project funded by the European Union (EU) Lifelong Learning, Grundtvig (Adult Education) Programme. It aims to overcome language/communication problems between prison staff and foreign inmates at European prisons via online…

  9. A longitudinal, multi-level comparative study of quality and safety in European hospitals

    DEFF Research Database (Denmark)

    Robert, Glenn B; Anderson, Janet E; Burnett, Susan J

    2011-01-01

    these impact on the quality of health care; the findings will be designed to help policy makers, payers and hospital managers understand the factors and processes that enable hospitals in Europe to achieve-and sustain-high quality services for their patients. METHODS/DESIGN: in-depth multi-level (macro, meso...... and micro-system) analysis of healthcare quality policies and practices in 5 European countries, including longitudinal case studies in a purposive sample of 10 hospitals. The project design has three major features: • a working definition of quality comprising three components: clinical effectiveness...

  10. Opportunities, constraints and constrained opportunities - A study on mothers' working time patterns in 22 European countries

    OpenAIRE

    Milla Salin

    2014-01-01

    The aim of this study was to analyze mothers’ working time patters across 22 European countries. The focu was on three questions: how much mothers prefer to work, how much they actually work, and to what degree their preferred and actual working times are (in)consistent with each other. The focus was on cross-national differences in mothers’ working time patterns, comparison of mothers’ working times to that of childless women and fathers, as well as on individual- and country-level factors t...

  11. Inspiring Lecturers: Sharing E-Learning Practice through European Case Studies

    DEFF Research Database (Denmark)

    Hayes, Sarah; Godsk, Mikkel; Andersen, Majbrit Vandsø

    2009-01-01

    a consistent approach to transferring knowledge that might be followed and developed by others. We will outline a methodology for sharing best practices of e-learning. We will explain how these cases, rather like short stories, were identified, gathered and communicated by the EUNIS ELearning Task Force......Sharing best practice in e-learning, when undertaken as an active process, can provide valuable insights, with a real capacity to inspire. This has been our experience in collecting European university e-learning case studies. How this was achieved is the focus of this paper, which discusses...

  12. Characteristics of event tourism marketing. Case study: the European youth Olympic festival, Brasov 2013

    Directory of Open Access Journals (Sweden)

    Herţanu, A.

    2011-01-01

    Full Text Available Event tourism is a very important branch of tourism, not only from the economic point of view, but also as the cultural and social development of a tourism destination. Organizing sporting events is considered, by the managers of tourism destinations, as an improvement strategy regarding the destination image, and as a competitive advantage. This article brings forward the features of event tourism concerning the marketing mix policies and the importance of events in the development of an area. The chosen study case is Brasov County area, which will host, in 201,3 the winter edition of the European Youth Olympic Festival.

  13. Assessment of marine ecosystem services indicators: Experiences and lessons learned from 14 European case studies.

    Science.gov (United States)

    Lillebø, Ana I; Somma, Francesca; Norén, Katja; Gonçalves, Jorge; Alves, M Fátima; Ballarini, Elisabetta; Bentes, Luis; Bielecka, Malgorzata; Chubarenko, Boris V; Heise, Susanne; Khokhlov, Valeriy; Klaoudatos, Dimitris; Lloret, Javier; Margonski, Piotr; Marín, Atucha; Matczak, Magdalena; Oen, Amy Mp; Palmieri, Maria G; Przedrzymirska, Joanna; Różyński, Grzegorz; Sousa, Ana I; Sousa, Lisa P; Tuchkovenko, Yurii; Zaucha, Jacek

    2016-10-01

    This article shares the experiences, observations, and discussions that occurred during the completing of an ecosystem services (ES) indicator framework to be used at European Union (EU) and Member States' level. The experience base was drawn from 3 European research projects and 14 associated case study sites that include 13 transitional-water bodies (specifically 8 coastal lagoons, 4 riverine estuaries, and 1 fjord) and 1 coastal-water ecosystem. The ES pertinent to each case study site were identified along with indicators of these ES and data sources that could be used for mapping. During the process, several questions and uncertainties arose, followed by discussion, leading to these main lessons learned: 1) ES identification: Some ES that do not seem important at the European scale emerge as relevant at regional or local scales; 2) ES indicators: When direct indicators are not available, proxies for indicators (indirect indicators) might be used, including combined data on monitoring requirements imposed by EU legislation and international agreements; 3) ES mapping: Boundaries and appropriate data spatial resolution must be established because ES can be mapped at different temporal and spatial scales. We also acknowledge that mapping and assessment of ES supports the dialogue between human well-being and ecological status. From an evidence-based marine planning-process point of view, mapping and assessment of marine ES are of paramount importance to sustainable use of marine natural capital and to halt the loss of marine biodiversity. Integr Environ Assess Manag 2016;12:726-734. © 2016 SETAC. © 2016 SETAC.

  14. From the Stereotypification of the Non-European Other to the Prototypification of the European Self: A Case Study of Turkey’s Membership to the European Union from the French Perspective.

    Directory of Open Access Journals (Sweden)

    Ariane Bogain

    2008-02-01

    Full Text Available In an era of increased globalisation, the need for a sense of belonging and an identity is becoming more pressing. The way nations form images of others and, conversely, conscious or unconscious images of themselves is becoming increasingly important as these images impact on public opinion and on political and decision-making discourse. With the development of supranationalism in Europe, the age-old notion of European identity has come more and more to the fore. Conflicting interpretations and a general disinclination to consider the matter leave the notion of European identity as polysemic as ever. Furthermore, the expansion of the EU has contributed to blurring this notion, so much so that in the collective psyche, it has become closely linked to the membership of the European Union and it is proving sometimes difficult to dissociate one from the other. In this context, the debate surrounding Turkey’s membership of the EU gives an insight into prototypical and stereotypical representations of Europe. As the controversy has been particularly salient in France, the aim of this study is to explore the European self-conceptions and images of the other through the example of France’s opposition to Turkey’s membership of the EU. For this purpose, opinion polls and the Press will be used as forms of narrative in order to highlight these representations and how they have evolved in time. The first part of the study will concentrate on the arguments put forward to justify the opposition to Turkey joining the EU. The second part will then evaluate how the image of the other contributes to the prototypical representation French citizens have of Europe.

  15. Disclosure patterns of mode of conception among mothers and fathers-5-year follow-up of the Copenhagen Multi-centre Psychosocial Infertility (COMPI) cohort

    DEFF Research Database (Denmark)

    Rosholm, Rikke; Lund, Rikke; Molbo, Drude

    2010-01-01

    BACKGROUND: Most studies on disclosure of mode of conception after fertility treatment have focused on donor insemination. We present a large, longitudinal cohort study of fertility patients who conceived through a variety of fertility treatments, including both non-donor and donor techniques. ME...

  16. Polymorphisms associated with ventricular tachyarrhythmias: rationale, design, and endpoints of the 'diagnostic data influence on disease management and relation of genomics to ventricular tachyarrhythmias in implantable cardioverter/defibrillator patients (DISCOVERY)' study

    DEFF Research Database (Denmark)

    Garcia, Javier; Wieneke, Heinrich; Spencker, Sebastian;

    2010-01-01

    (SNPs) are DNA sequence variations occurring when a single nucleotide in the genome differs among members of a species. A novel concept has emerged being that these common genetic variations might modify the susceptibility of a certain population to specific diseases. Thus, genetic factors may also...... modulate the risk for arrhythmias and sudden cardiac death, and identification of common variants could help to better identify patients at risk. The DISCOVERY study is an interventional, longitudinal, prospective, multi-centre diagnostic study that will enrol 1287 patients in approximately 80 European...... centres. In the genetic part of the DISCOVERY study, candidate gene polymorphisms involved in coding of the G-protein subunits will be correlated with the occurrence of ventricular arrhythmias in patients receiving an ICD for primary prevention. Furthermore, in order to search for additional sequence...

  17. A Case Study of Personal Experiences of Undocumented Eastern European Immigrants Living in the United States

    Directory of Open Access Journals (Sweden)

    Titanilla KISS

    2015-11-01

    Full Text Available Existing research on undocumented migration has focused predominantly on Latin American and Mexican immigrants and largely overlooked the experiences of immigrants originating from other parts of the world. As such, very few studies have considered how the lack of legal residency status can influence life opportunities of undocumented immigrants from Eastern Europe. The overarching aim of the present study was to explore the personal experiences of unauthorized Eastern European immigrants in the United States in order to: (a augment research on undocumented migration, and (b highlight the experiences of undocumented Eastern Europeans who remain an understudied group of the undocumented immigrants. Comprehensive personal interviews were conducted with a small group of unauthorized immigrants to explore: (1 reasons for immigration and prior expectations, and (2 psychosocial experiences (i.e., status related anxiety, experience with prejudice and discrimination, job satisfaction, sense of belonging, family relations, and future plans. Some of the results are presented in terms of similarity and differences between the current study's sample and the undocumented immigrants from other regions of the world, namely, Mexico and Latin America.

  18. Correlations between cutaneous malignant melanoma and other cancers: An ecological study in forty European countries

    Directory of Open Access Journals (Sweden)

    Pablo Fernandez-Crehuet Serrano

    2016-01-01

    Full Text Available Background: The presence of noncutaneous neoplasms does not seem to increase the risk of cutaneous malignant melanoma; however, it seems to be associated with the development of other hematological, brain, breast, uterine, and prostatic neoplasms. An ecological transversal study was conducted to study the geographic association between cutaneous malignant melanoma and 24 localizations of cancer in forty European countries. Methods: Cancer incidence rates were extracted from GLOBOCAN database of the International Agency for Research on Cancer. We analyzed the age-adjusted and gender-stratified incidence rates for different localizations of cancer in forty European countries and calculated their correlation using Pearson′s correlation test. Results: In males, significant correlations were found between cutaneous malignant melanoma with testicular cancer (r = 0.83 [95% confidence interval (CI: 0.68-0.89], myeloma (r = 0.68 [95% CI: 0.46-0.81], prostatic carcinoma (r = 0.66 [95% CI: 0.43-0.80], and non-Hodgkin lymphoma (NHL (r = 0.63 [95% CI: 0.39-0.78]. In females, significant correlations were found between cutaneous malignant melanoma with breast cancer (r = 0.80 [95% CI: 0.64-0.88], colorectal cancer (r = 0.72 [95% CI: 0.52-0.83], and NHL (r = 0.71 [95% CI: 0.50-0.83]. Conclusions: These correlations call to conduct new studies about the epidemiology of cancer in general and cutaneous malignant melanoma risk factors in particular.

  19. Prevention of central venous catheter-associated bloodstream infections in paediatric oncology patients using 70% ethanol locks : A randomised controlled multi-centre trial

    NARCIS (Netherlands)

    Schoot, Reineke A.; van Ommen, C. Heleen; Stijnen, Theo; Tissing, Wim J. E.; Michiels, Erna; Abbink, Floor C. H.; Raphael, Martine F.; Heij, Hugo A.; Lieverst, Jan A.; Spanjaard, Lodewijk; Zwaan, C. Michel; Caron, Huib N.; van de Wetering, Marianne D.

    Background: The prevention of central venous catheter (CVC) associated bloodstream infections (CABSIs) in paediatric oncology patients is essential. Ethanol locks can eliminate pathogens colonising CVCs and microbial resistance is rare. Aim of this study was to determine whether two hour 70% ethanol

  20. Patients' attitudes to medical and psychosocial aspects of care in fertility clinics: Findings from the Copenhagen Multi-centre Psychosocial Infertility (COMPI) Research Programme

    DEFF Research Database (Denmark)

    Schmidt, L; Holstein, B E; Boivin, J

    2003-01-01

    among infertile people. METHODS: We conducted an epidemiological study based on questionnaires among all new couples attending five fertility clinics with a response rate of 80.0% and a total of 2250 patients. RESULTS: The vast majority of both men and women considered a high level of medical...

  1. The effect of using assessment instruments on substance-abuse outpatients' adherence to treatment: A multi-centre randomised controlled trial

    NARCIS (Netherlands)

    Raes, V.; Jong, C.A.J. de; Bacquer, D. De; Broekaert, E.; Maeseneer, J. De

    2011-01-01

    Background: Drop-out is an important problem in the treatment of substance use disorder. The focus of this study was to investigate the effectiveness of within treatment assessment with feedback directly to patients with multiple substance use disorder on outpatient individual treatment adherence. F

  2. The effect of using assessment instruments on substance-abuse outpatients' adherence to treatment: a multi-centre randomised controlled trial.

    NARCIS (Netherlands)

    Raes, V.; Jong, C.A.J. de; Bacquer, D. De; Broekaert, E.; Maeseneer, J. De

    2011-01-01

    BACKGROUND: Drop-out is an important problem in the treatment of substance use disorder. The focus of this study was to investigate the effectiveness of within treatment assessment with feedback directly to patients with multiple substance use disorder on outpatient individual treatment adherence. F

  3. European Energy Security and Nord Stream: A Case Study of the Nord Stream Pipeline, Its Opportunities and Risks for Europe, and Its Impact on European Energy Security

    Science.gov (United States)

    2011-06-01

    System of Gas Supplies xiii ACKNOWLEDGMENTS I would like to thank my co-advisors, Professor Robert Looney and COL (G.S.) (GAF) Dirk Rogalski...74 European Commission, Green Paper. 75 European Union, A secure Europe in a better world: European Security Strategy. 76 European Union, Europa ...online, 13 September 2010, http://www.zeit.de/wirtschaft/2010-09/wachstum-deutschland- europa (accessed 3 February 2011). 277 Deutscher Bundestag, Basic

  4. Comparative Study of the Local Collectivity in the European Administrative Space

    Directory of Open Access Journals (Sweden)

    Dana Georgeta ALEXANDRU

    2012-11-01

    Full Text Available In this paper we examine the need of an unitary research on the local collectivity issue with the objective of highlightening the necesity for standardization and adjustment to social and economic realities inside the european administrative space. The paper will be structured into three parts so that the study will begin to clarify the notion of competece, then determining the place and role of local communities-we will identify common features and criteria for their differentiation.Given this objective we propose to realise a comparative study of local collectivities skills in Europe, to identify their relationship with the State. The conducted research continues others concerning the timeliness of this research in the theoretical plan, therefore the following are necesary: establishing the place and role, definition and identification of its legal nature, emphasizing key features of the functions and criteria in relation with the State. The work may be useful to the Romanian authorities involved in the enforcement of local collectivities in the context of decentralization. The results and the essential contribution of the work, its originality, consist of the general examination of the categories of local collectivities elected for representation and the diversity of european experiences, regarding the local administrative device -organizatoric forms, in federal states, decentralized unitary states and unitary states partial or non-centralized.

  5. Consumer perceptions of beef healthiness: results from a qualitative study in four European countries

    Directory of Open Access Journals (Sweden)

    de Barcellos Marcia D

    2010-06-01

    Full Text Available Abstract Background Consumer perception of the healthiness of beef is an important determinant of beef consumption. However, little is known about how consumers perceive the healthiness of beef. The aim of this study is to shed light on the associations between beef and health. Methods Eight focus group discussions were conducted in four European countries (France, UK, Germany, Spain, each consisting of seven to nine participants. A content analysis was performed on the transcripts of these discussions. Results Although beef was generally perceived as healthful, focus group participants expected positive as well as negative effects of beef consumption on their health. Labelled, branded, fresh and lean beef were perceived as signalling healthful beef, in contrast with further processed and packaged beef. Consumers felt that their individual choices could make a difference with respect to the healthiness of beef consumed. Focus group participants were not in favour of improving beef healthiness during processing, but rather focussed on appropriate consumption behaviour and preparation methods. Conclusions The individual responsibility for health implies that consumers should be able to make correct judgements about how healthful their food is. However, the results of this study indicate that an accurate assessment of beef healthiness is not always straightforward. The presented results on consumer perceptions of beef healthiness provide insights into consumer decision making processes, which are important for the innovation and product differentiation in the European beef sector, as well as for public health policy decisions related to meat consumption in general and beef consumption in particular.

  6. Detecting Genetic Isolation in Human Populations: A Study of European Language Minorities

    Science.gov (United States)

    Capocasa, Marco; Battaggia, Cinzia; Anagnostou, Paolo; Montinaro, Francesco; Boschi, Ilaria; Ferri, Gianmarco; Alù, Milena; Coia, Valentina; Crivellaro, Federica; Bisol, Giovanni Destro

    2013-01-01

    The identification of isolation signatures is fundamental to better understand the genetic structure of human populations and to test the relations between cultural factors and genetic variation. However, with current approaches, it is not possible to distinguish between the consequences of long-term isolation and the effects of reduced sample size, selection and differential gene flow. To overcome these limitations, we have integrated the analysis of classical genetic diversity measures with a Bayesian method to estimate gene flow and have carried out simulations based on the coalescent. Combining these approaches, we first tested whether the relatively short history of cultural and geographical isolation of four “linguistic islands” of the Eastern Alps (Lessinia, Sauris, Sappada and Timau) had left detectable signatures in their genetic structure. We then compared our findings to previous studies of European population isolates. Finally, we explored the importance of demographic and cultural factors in shaping genetic diversity among the groups under study. A combination of small initial effective size and continued genetic isolation from surrounding populations seems to provide a coherent explanation for the diversity observed among Sauris, Sappada and Timau, which was found to be substantially greater than in other groups of European isolated populations. Simulations of micro-evolutionary scenarios indicate that ethnicity might have been important in increasing genetic diversity among these culturally related and spatially close populations. PMID:23418562

  7. Sustaining international partnerships: the European Master of Science Programme in Occupational Therapy, a case study.

    Science.gov (United States)

    Ilott, Irene; Kottorp, Anders; la Cour, Karen; van Nes, Fenna; Jonsson, Hans; Sadlo, Gaynor

    2013-06-01

    International partnerships are a mechanism for supporting the academic development of occupational therapy and promoting cultural competence. This case study describes the factors that have helped to sustain a post-qualifying programme implemented by five higher education institutions in Denmark, the Netherlands, Sweden, Switzerland and the UK since 1999. Data collection methods were documentary analysis and the reflections of a purposive sample of six key informants. Cohort and outcome data, from 193 students from 31 countries who enrolled between 1999 and 2011, are reported. Each cohort comprises students from an average of eight countries to optimize inter-cultural dialogue. Four factors support sustainability. These are 1) supportive professional European networks; 2) timeliness and alignment with European higher education policy; 3) partnership structures and processes that emphasize joint decision making and accountability; and 4) the stimulus and satisfaction associated with internationalization. The main limitations are considering the OT-EuroMaster as an intrinsic case study and using opportunistic data collection that undermines the rigor and transferability of the findings. Future opportunities include doctoral networks, transnational research and sharing our curricula design with other Regions to spread the collaborative, capacity building endeavours more widely.

  8. An exploratory study of barriers to inclusion in the European workplace.

    Science.gov (United States)

    Moody, Louise; Saunders, Janet; Leber, Marjan; Wójcik-Augustyniak, Marzena; Szajczyk, Marek; Rebernik, Nataša

    2017-10-01

    The European Disability Strategy (2010-2020) seeks to significantly raise the proportion of people with disabilities working in the open labour market. The ERGO WORK project is a collaboration of academic and industrial partners in six European countries, focused on understanding and tackling barriers to workplace inclusion for workers with disabilities. This study sought to explore the perceptions and needs of stakeholders in terms of workplace adaptation to the needs of employees with disabilities. An exploratory online survey was completed by 480 participants across six countries. The analysis suggests that workplaces could be further improved to meet the needs of employees with considerable scope for training within companies to raise awareness about employees' needs, employers' obligations and workplace adaptation. This snapshot suggests there is still a gap between intent and reality in workplace inclusion and further strategies are needed to improve the opportunities for employees with disabilities. The paper argues that ergonomics may have a key role to play in tackling these challenges and adapting the workplace environment and job design to suit the needs of individual employees. Implications for rehabilitation This study suggests there is considerable scope for workplace adaptation and improvements to meet the needs of employees with disabilities. Employers need and want further specialist practitioner guidance to facilitate workplace inclusion and support adaptation to individual needs. Organisations would benefit from training to raise awareness about potential solutions and approaches that would support more widespread employment of people with disabilities.

  9. Example of the application the microsatellite DNA fragments in the study of farmed European catfish (Silurus glanis, L. broodstock

    Directory of Open Access Journals (Sweden)

    Kuciñski Marcin

    2015-06-01

    Full Text Available European catfish, Silurus glanis L., is the second largest freshwater fish in Europe. The species is very popular among the farmers, as it is one of the most promising European aquaculture species. Despite the growing importance of European catfish in freshwater aquaculture, the genetic data available on this species are still limited. The main purpose of the present study was to develop a reliable, feasible genetic protocol for future studies on European catfish populations and broodstocks in Poland. The genetic characteristics of the tested fish group were based on genetic parameters such as the polymorphism information content (PIC, the effective population size (Ne, the inbreeding coefficient (Fis, and the Garza-Williamson index (M, among others. Additionally, the potential effects of a genetic bottleneck on the genetic variation of the broodstock were examined. The genetic analysis protocol described in this study can be used to establish genetic-based records for European catfish broodstocks, including for sperm cryobanking. This approach will be useful for elaborating the selection procedures that allow for optimal assemblages of spawning pairs in artificial reproduction. The application of the genetic analysis protocol in practice will permit maintaining high quality in European catfish broodstocks.

  10. Design of COSMIC: a randomized, multi-centre controlled trial comparing conservative or early surgical management of incomplete cervical cord syndrome without spinal instability

    Directory of Open Access Journals (Sweden)

    Bartels Ronald HMA

    2013-01-01

    Full Text Available Abstract Background Incomplete cervical cord syndrome without spinal instability is a very devastating event for the patient and the family. It is estimated that up to 25% of all traumatic spinal cord lesions belong to this category. The treatment for this type of spinal cord lesion is still subject of discussion. From a biological point of view early surgery could prevent secondary damage due to ongoing compression of the already damaged spinal cord. Historically, however, conservative treatment was propagated with good clinical results. Proponents for early surgery as well those favoring conservative treatment are still in debate. The proposed trial will contribute to the discussion and hopefully also to a decrease in the variability of clinical practice. Methods/Design A randomized controlled trial is designed to compare the clinical outcome of early surgical strategy versus a conservative approach. The primary outcome is clinical outcome according to mJOA. This also measured by ASIA score, DASH score and SCIM III score. Other endpoints are duration of the stay at a high care department (medium care, intensive care, duration of the stay at the hospital, complication rate, mortality rate, sort of rehabilitation, and quality of life. A sample size of 36 patients per group was calculated to reach a power of 95%. The data will be analyzed as intention-to-treat at regular intervals, but the end evaluation will take place at two years post-injury. Discussion At the end of the study, clinical outcomes between treatments attitudes can be compared. Efficacy, but also efficiency can be determined. A goal of the study is to determine which treatment will result in the best quality of life for the patients. This study will certainly contribute to more uniformity of treatment offered to patients with a special sort of spinal cord injury. Trial Registration Gov: NCT01367405

  11. Facilitating needs based cancer care for people with a chronic disease: Evaluation of an intervention using a multi-centre interrupted time series design

    Directory of Open Access Journals (Sweden)

    Sibbritt David

    2010-01-01

    Full Text Available Abstract Background Palliative care should be provided according to the individual needs of the patient, caregiver and family, so that the type and level of care provided, as well as the setting in which it is delivered, are dependent on the complexity and severity of individual needs, rather than prognosis or diagnosis 1. This paper presents a study designed to assess the feasibility and efficacy of an intervention to assist in the allocation of palliative care resources according to need, within the context of a population of people with advanced cancer. Methods/design People with advanced cancer and their caregivers completed bi-monthly telephone interviews over a period of up to 18 months to assess unmet needs, anxiety and depression, quality of life, satisfaction with care and service utilisation. The intervention, introduced after at least two baseline phone interviews, involved a training medical, nursing and allied health professionals at each recruitment site on the use of the Palliative Care Needs Assessment Guidelines and the Needs Assessment Tool: Progressive Disease - Cancer (NAT: PD-C; b health professionals completing the NAT: PD-C with participating patients approximately monthly for the rest of the study period. Changes in outcomes will be compared pre-and post-intervention. Discussion The study will determine whether the routine, systematic and regular use of the Guidelines and NAT: PD-C in a range of clinical settings is a feasible and effective strategy for facilitating the timely provision of needs based care. Trials registration ISRCTN21699701

  12. Dietary fibre and incidence of type 2 diabetes in eight European countries: the EPIC-InterAct Study and a meta-analysis of prospective studies

    NARCIS (Netherlands)

    Kuijsten, A.

    2015-01-01

    Aims/hypothesis Intake of dietary fibre has been associated with a reduced risk of type 2 diabetes, but few European studies have been published on this. We evaluated the association between intake of dietary fibre and type 2 diabetes in the European Prospective Investigation into Cancer and

  13. Dietary fibre and incidence of type 2 diabetes in eight European countries : the EPIC-InterAct Study and a meta-analysis of prospective studies

    NARCIS (Netherlands)

    Kuijsten, Anneleen; Aune, Dagfinn; Schulze, Matthias B.; Norat, Teresa; van Woudenbergh, Geertruida J.; Beulens, Joline W J; Sluijs, Ivonne; Spijkerman, Annemieke M W; van der A, Daphne L.; Palli, Domenico; Kühn, Tilman; Wendt, Andrea; Buijsse, Brian; Boeing, Heiner; Pala, Valeria; Amiano, Pilar; Buckland, Genevieve; Huerta Castaño, José María; Tjønneland, Anne; Kyrø, Cecilie; Redondo, Maria Luisa; Sacerdote, Carlotta; Sánchez, María José; Fagherazzi, Guy; Balkau, Beverley; Lajous, Martin; Panico, Salvatore; Franks, Paul W.; Rolandsson, Olov; Nilsson, Peter; Orho-Melander, Marju; Overvad, Kim; Huybrechts, Inge; Slimani, Nadia; Tumino, Rosario; Barricarte, Aurelio; Key, Timothy J.; Feskens, Edith J M; Langenberg, Claudia; Sharp, Stephen; Forouhi, Nita G.; Riboli, Elio; Wareham, Nicholas J.

    2015-01-01

    Aims/hypothesis: Intake of dietary fibre has been associated with a reduced risk of type 2 diabetes, but few European studies have been published on this. We evaluated the association between intake of dietary fibre and type 2 diabetes in the European Prospective Investigation into Cancer and

  14. The EULAR Study Group for Registers and Observational Drug Studies: comparability of the patient case mix in the European biologic disease modifying anti-rheumatic drug registers

    NARCIS (Netherlands)

    Kearsley-Fleet, Lianne; Zavada, Jakub; Lund Hetland, Merete; Nordstrom, Dan C.; Aaltonen, Kalle J.; Listing, Joachim; Zink, Angela; Gati, Tamas; Rojkovich, Bernadette; Iannone, Florenzo; Gremese, Elisa; van Riel, Piet L.C.M.; van de Laar, Mart A F J; Lie, Elisabeth; Kvien, Tore K.; Canhao, Helena; Fonseca, Joao E.; Rotar, Ziga; Loza, Estibaliz; Carmona, Loretto; Askling, Johan; Johansson, Kari; Finckh, Axel; Dixon, William G.; Hyrich, Kimme L.

    2015-01-01

    Objective. Under the auspices of the European League Against Rheumatism (EULAR), a study group of investigators representing European biologic DMARD (bDMARD) registers was convened. The purpose of this initial assessment was to collect and compare a cross section of patient characteristics and

  15. Radiation dose in coronary angiography and intervention: initial results from the establishment of a multi-centre diagnostic reference level in Queensland public hospitals

    Energy Technology Data Exchange (ETDEWEB)

    Crowhurst, James A, E-mail: jimcrowhurst@hotmail.com [The Prince Charles Hospital, Chermside, Queensland (Australia); School of Medicine, University of Queensland, St. Lucia, Brisbane, Queensland (Australia); Whitby, Mark [The Prince Charles Hospital, Chermside, Queensland (Australia); Biomedical Technology Services, Health Services Support Agency, Queensland Health, Herston, Queensland (Australia); Thiele, David [Biomedical Technology Services, Health Services Support Agency, Queensland Health, Herston, Queensland (Australia); Halligan, Toni [Allied Health Professions' Office of Queensland, Brisbane, Queensland (Australia); Westerink, Adam [Royal Brisbane and Women' s Hospital, Herston, Queensland (Australia); Crown, Suzanne [Princess Alexandra Hospital, Woolloongabba, Queensland (Australia); Milne, Jillian [Cardiac Clinical Informatics Unit - Queensland Health, Herston, Queensland (Australia); The Prince Charles Hospital, Chermside, Queensland (Australia)

    2014-09-15

    Radiation dose to patients undergoing invasive coronary angiography (ICA) is relatively high. Guidelines suggest that a local benchmark or diagnostic reference level (DRL) be established for these procedures. This study sought to create a DRL for ICA procedures in Queensland public hospitals. Data were collected for all Cardiac Catheter Laboratories in Queensland public hospitals. Data were collected for diagnostic coronary angiography (CA) and single-vessel percutaneous intervention (PCI) procedures. Dose area product (P{sub KA}), skin surface entrance dose (K{sub AR}), fluoroscopy time (FT), and patient height and weight were collected for 3 months. The DRL was set from the 75th percentile of the P{sub KA.} 2590 patients were included in the CA group where the median FT was 3.5 min (inter-quartile range = 2.3–6.1). Median K{sub AR} = 581 mGy (374–876). Median P{sub KA} = 3908 uGym{sup 2} (2489–5865) DRL = 5865 uGym{sup 2}. 947 patients were included in the PCI group where median FT was 11.2 min (7.7–17.4). Median K{sub AR} = 1501 mGy (928–2224). Median P{sub KA} = 8736 uGym{sup 2} (5449–12,900) DRL = 12,900 uGym{sup 2}. This study established a benchmark for radiation dose for diagnostic and interventional coronary angiography in Queensland public facilities.

  16. Topical tea tree oil effective in canine localised pruritic dermatitis--a multi-centre randomised double-blind controlled clinical trial in the veterinary practice.

    Science.gov (United States)

    Reichling, J; Fitzi, J; Hellmann, K; Wegener, T; Bucher, S; Saller, R

    2004-10-01

    Tea tree oil, a volatile oil, is well known for its broad antibacterial and antifungal activity. A standardised and stabilised 10% tea tree oil cream was tested against a commercial skin care cream (control cream) in the management of canine localised acute and chronic dermatitis. Fifty-seven dogs with clinical manifestations of mostly pruritic skin lesions or alterations, skin fold pyodermas and other forms of dermatitis, corroborated by predominantly positive fungal and bacterial skin isolates, were enrolled by seven practising veterinarians and randomly allocated to two study groups (28:29) and were treated twice daily with a blinded topical preparation. After 10 days of treatment, success rates of 71% for the tea tree oil cream and 41% for the control cream (over-all efficacy documented by the veterinary investigator) differed significantly (p = 0.04), favouring tea tree oil cream treatment. Accordingly on day 10, the tea tree oil cream caused significantly faster relief than the control cream (p = 0.04) for two common clinical dermatitis signs, pruritus (occurring in 84 % of dogs) and alopecia. Only one adverse event was reported in the tea tree oil group (suspected not to be causally related to the study drug) and none in the control cream group. The tested herbal cream appears to be a fast-acting safe alternative to conventional therapy for symptomatic treatment of canine localised dermatitis with pruritus.

  17. Multifactorial day hospital intervention to reduce falls in high risk older people in primary care: a multi-centre randomised controlled trial [ISRCTN46584556

    Directory of Open Access Journals (Sweden)

    Morris Rob

    2006-02-01

    Full Text Available Abstract Falls in older people are a major public health concern in terms of morbidity, mortality and cost. Previous studies suggest that multifactorial interventions can reduce falls, and many geriatric day hospitals are now offering falls intervention programmes. However, no studies have investigated whether these programmes, based in the day hospital are effective, nor whether they can be successfully applied to high-risk older people screened in primary care. The hypothesis is that a multidisciplinary falls assessment and intervention at Day hospitals can reduce the incidence of falls in older people identified within primary care as being at high risk of falling. This will be tested by a pragmatic parallel-group randomised controlled trial in which the participants, identified as at high risk of falling, will be randomised into either the intervention Day hospital arm or to a control (current practice arm. Those participants preferring not to enter the full randomised study will be offered the opportunity to complete brief diaries only at monthly intervals. This data will be used to validate the screening questionnaire. Three day hospitals (2 Nottingham, 1 Derby will provide the interventions, and the University of Nottingham's Departments of Primary Care, the Division of Rehabilitation and Ageing Unit, and the Trent Institute for Health Service Research will provide the methodological and statistical expertise. Four hundred subjects will be randomised into the two arms. The primary outcome measure will be the rate of falls over one year. Secondary outcome measures will include the proportion of people experiencing at least one fall, the proportion of people experiencing recurrent falls (>1, injuries, fear of falling, quality of life, institutionalisation rates, and use of health services. Cost-effectiveness analyses will be performed to inform health commissioners about resource allocation issues. The importance of this trial is that the

  18. Community support and participation among persons with disabilities. A study in three European countries

    Directory of Open Access Journals (Sweden)

    Jean-Pierre Wilken

    2014-09-01

    Full Text Available Community support and participation among persons with disabilities. A study in three European countriesThis article describes a European project which was aimed at improving the situation of persons with psychiatric or learning disabilities with regard to social participation and citizenship. The project took place in three countries (Estonia, Hungary and the Netherlands and four cities (Tallinn, Budapest, Amersfoort and Maastricht. The project included research and actions at the policy level, the organizational level and the practice level. At the policy level, the framework of the United Nations Convention on the Rights of Persons with Disabilities (United Nations, 2006 and the European Disability Strategy (European Commission, 2010 were used to look at national and local policies, at the reality of the lives of those with disabilities and at the support that professional services offer with regard to participation and inclusion. The project generated a number of insights, recommendations and methods by which to improve the quality of service and increase the number of opportunities for community engagement. In this article, we present some of the lessons learned from the meta-analysis. Although the circumstances in each country are quite different with regard to policy, culture and service systems, it is remarkable that people with disabilities face many of the same problems.The study shows that in all three countries, access to services could be improved. Barriers include bureaucratic procedures and a lack of services. The research identified that in every country and city there are considerable barriers regarding equal participation in the field of housing, work and leisure activities. In addition to financial barriers, there are the barriers of stigma and self-stigmatization. Marginalization keeps people in an unequal position and hinders their recovery and participation. In all countries, professionals need to develop a stronger focus

  19. Statistical methodology for the evaluation of vaccine efficacy in a phase III multi-centre trial of the RTS,S/AS01 malaria vaccine in African children

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    Lievens Marc

    2011-08-01

    Full Text Available Abstract Background There has been much debate about the appropriate statistical methodology for the evaluation of malaria field studies and the challenges in interpreting data arising from these trials. Methods The present paper describes, for a pivotal phase III efficacy of the RTS, S/AS01 malaria vaccine, the methods of the statistical analysis and the rationale for their selection. The methods used to estimate efficacy of the primary course of vaccination, and of a booster dose, in preventing clinical episodes of uncomplicated and severe malaria, and to determine the duration of protection, are described. The interpretation of various measures of efficacy in terms of the potential public health impact of the vaccine is discussed. Conclusions The methodology selected to analyse the clinical trial must be scientifically sound, acceptable to regulatory authorities and meaningful to those responsible for malaria control and public health policy. Trial registration Clinicaltrials.gov NCT00866619

  20. Routine Use of Fluoroscopic-Guided Femoral Arterial Puncture to Minimise Vascular Complication Rates in CTO Intervention: Multi-centre UK Experience.

    Science.gov (United States)

    Fairley, Sarah L; Lucking, Andrew J; McEntegart, Margaret; Shaukat, Aadil; Smith, David; Chase, Alexander; Hanratty, Colm G; Spratt, James C; Walsh, Simon J

    2016-12-01

    Chronic total occlusion (CTO) revascularisation has a crucial role in contemporary percutaneous coronary intervention (PCI). Procedural success is influenced by disease complexity, calcific burden and patient characteristics but has substantially improved with the implementation of novel hybrid strategies. However, vascular-access related complications remain a cause of morbidity and mortality. This study aimed to assess the effectiveness of fluoroscopic-guided femoral arterial puncture to minimise this risk during CTO PCI. Standardised data were retrospectively collected from four high-volume UK CTO centres between September 2011 and November 2013. Demographic, clinical and procedural data (vascular access site, sheath size, anticoagulation use) was collated. The anatomical location of the femoral puncture in relation to the femoral bifurcation, femoral head position and inferior epigastric artery were recorded. Adverse events related to vascular access were documented. A total of 528 patients were included (676 femoral punctures) with the majority being male (n=432, 81.8%). Large sheaths (8F) were used in 81.2% of cases. Fluoroscopy-enabled punctures were made in the 'safe zone' in over > 93% of cases. Vascular closure devices (VCD) were used in 88.3% of cases. The adverse event rate per puncture was 0.89%. This study demonstrates an extremely low incidence of vascular-access complications in CTO PCI when fluoroscopic guidance is used to obtain femoral arterial access by default radial operators. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  1. Radiation dose in coronary angiography and intervention: initial results from the establishment of a multi-centre diagnostic reference level in Queensland public hospitals

    Science.gov (United States)

    Crowhurst, James A; Whitby, Mark; Thiele, David; Halligan, Toni; Westerink, Adam; Crown, Suzanne; Milne, Jillian

    2014-01-01

    Introduction Radiation dose to patients undergoing invasive coronary angiography (ICA) is relatively high. Guidelines suggest that a local benchmark or diagnostic reference level (DRL) be established for these procedures. This study sought to create a DRL for ICA procedures in Queensland public hospitals. Methods Data were collected for all Cardiac Catheter Laboratories in Queensland public hospitals. Data were collected for diagnostic coronary angiography (CA) and single-vessel percutaneous intervention (PCI) procedures. Dose area product (PKA), skin surface entrance dose (KAR), fluoroscopy time (FT), and patient height and weight were collected for 3 months. The DRL was set from the 75th percentile of the PKA. Results 2590 patients were included in the CA group where the median FT was 3.5 min (inter-quartile range = 2.3–6.1). Median KAR = 581 mGy (374–876). Median PKA = 3908 uGym2 (2489–5865) DRL = 5865 uGym2. 947 patients were included in the PCI group where median FT was 11.2 min (7.7–17.4). Median KAR = 1501 mGy (928–2224). Median PKA = 8736 uGym2 (5449–12,900) DRL = 12,900 uGym2. Conclusion This study established a benchmark for radiation dose for diagnostic and interventional coronary angiography in Queensland public facilities. PMID:26229649

  2. Developmental and epilepsy outcomes at age 4 years in the UKISS trial comparing hormonal treatments to vigabatrin for infantile spasms: a multi-centre randomised trial.

    Science.gov (United States)

    Darke, Katrina; Edwards, Stuart W; Hancock, Eleanor; Johnson, Anthony L; Kennedy, Colin R; Lux, Andrew L; Newton, Richard W; O'Callaghan, Finbar J K; Verity, Christopher M; Osborne, John P

    2010-05-01

    Infantile spasms is the name given to a difficult to treat, severe infantile epilepsy with high morbidity. The United Kingdom Infantile Spasms Study (UKISS) showed that absence of spasms on days 13 and 14 after randomisation was more common in infants allocated hormonal treatments than vigabatrin. At 12-14 months, those with no identified aetiology allocated hormonal treatment had better development. However, epilepsy outcome was not affected by treatment allocated. It is not known if the difference in development persists as the infants grow. Infants in UKISS were followed up blind to treatment allocation by telephone at a mean age of 4 years using the Vineland Adaptive Behaviour Scales (VABS) and an epilepsy questionnaire. 9 of 107 enrolled infants had died. 77 were traced and consented to take part. The median (quartile) VABS scores were 60 (42, 97) for the 39 allocated hormonal treatment and 50 (36, 67) for the 38 allocated vigabatrin (Mann-Whitney U=575; p=0.091; median difference (95% CI): 8 (-1 to 19)). For those with no identified aetiology, VABS scores were 96 (52, 102) for the 21 allocated hormonal treatment and 63 (37, 92) for the 16 allocated vigabatrin (U=98.5; p=0.033; median difference (95% CI): 14 (1 to 42)).The proportions in each treatment group with epilepsy were similar. For all 77 infants, development and epilepsy outcomes were not significantly different between the two treatment groups. The better development seen at 14 months in those with no identified aetiology allocated hormonal treatment was seen again at 4 years in this study.

  3. European model of satisfaction: a case study with students from a Higher Education Instituition

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    Everton Anger Cavalheiro

    2014-06-01

    Full Text Available This study aimed to evaluate the overall satisfaction determinants of the student’s body of a higher education institution in the northwest of Rio Grande do Sul/Brasil. To do so, a descriptive quantitative research was performed, which used a model based on a Survey with 402 students, being the instrument used to conduct the survey based on the European model of satisfaction. Represented by a structural equation (PASWAN YOUNG, 2002, apud VIEIRA et al., 2008, the ECSI (European Customer Satisfaction Model, focuses on: (i evaluating the influence of perceived quality, the expectation of quality, image and perceived value in the overall student satisfaction; (II evaluating the influence of the general satisfaction of students in the level of loyalty and retention of students in the educational institution, and (III pointing key areas as well as a set of indicators for the management and maintenance of the students’ satisfaction from the institution being analyzed. Thus, with the application of the instrument, three factors able to explain 78% of student’s satisfaction towards the university were found: the first and most representative factor was called the student perceived value, which is the perceived value or level of teaching quality for the price paid by the students, the second factor is the image of the university, and the third factor are the expectations of the student.

  4. Molecular cytogenetic study of the European bitterling Rhodeus amarus (Teleostei: Cyprinidae: Acheilognathinae).

    Science.gov (United States)

    Kirtiklis, Lech; Ocalewicz, Konrad; Wiechowska, Marzena; Boroń, Alicja; Hliwa, Piotr

    2014-04-01

    The European bitterlings (Rhodeus amarus) from the Eastern locations were cytogenetically examined by conventional and molecular techniques. All analyzed individuals presented invariably the same chromosomal constitution of 2n = 48, with 8 metacentrics + 20 submetacentrics + 20 subtelo-acrocentrics and C-banding positive heterochromatin at the pericentromeric regions in most of the chromosomes. Moreover, some of the chromosomes had short arms entirely built with heterochromatin. GC-rich Ag-NORs (nucleolus organizer regions) were located at the short arms of two submetacentric chromosomes, and the length polymorphism of these regions was found. Multiple location of 28S rDNA sequences with fluorescence in situ hybridization signals was observed on the long and/or short arms of three submetacentric chromosomes including NOR regions and short arms of three to five acrocentric chromosomes in the studied fish. 5S rDNA sites were found on the short arms of two subtelocentric chromosomes, and telomeric repeats were localized at the ends of all chromosomes. Provided results have expanded our knowledge concerning genetic characteristics of the European bitterlings that may be profitable in the conservation programs of this endangered species.

  5. Mechanical studies of the multi-gap spoke cavity for European project HIPPI

    Science.gov (United States)

    Gassot, H.; Blivet, S.; Junquera, T.; Olry, G.; Zaplatine, E.

    2006-07-01

    Within the HIPPI (high intensity pulsed proton injector) project, supported by the 6th PCRD (framework programme for research and development) of the European Union, the German research centre Forschungszentrum Jülich proposed a multi-spoke H-cavity for the intermediate energy section ( β = 0.5) of high power proton linear accelerators. The IPN Orsay is associated with FZ Jülich for the prototype design, and before that, all preliminary mechanical studies. A triple-spoke superconducting cavity has a more complicated geometry, compared to the same beta elliptical cavity. As a consequence the design requires some sophisticated tools, like the CAD (computer aided design) code CATIA. In addition, in order to solve the specific mechanical problems imposed by external constraints, a sophisticated mechanical simulation tool CAST3M (Calcul et Analyse de Structure et Thermique par la méthode des Eléments Finis) is used [H. Gassot, in: Proceedings of the 8th European Particle Accelerator Conference, June 2002, Paris, [1

  6. Life cycle assessment of European pilchard (Sardina pilchardus) consumption. A case study for Galicia (NW Spain).

    Science.gov (United States)

    Vázquez-Rowe, Ian; Villanueva-Rey, Pedro; Hospido, Almudena; Moreira, María Teresa; Feijoo, Gumersindo

    2014-03-15

    European pilchard or sardines (Sardina pilchardus) are an attractive raw material to extract from Iberian waters, since they constitute a cheap source of protein and they are a popular product among consumers. This has led to a wide range of final products available for consumers to purchase based on this single raw material. Therefore, this study presents a cross-product environmental assessment using life cycle assessment of three different final products based on sardine landings: canned sardines, fresh sardines and European hake caught by using sardine as bait. In addition, the products were followed throughout their entire life cycle, considering different cooking methods for each final product. Results showed high variability in environmental impacts, not only between the three final products, but also when one single product was cooked in different ways, highlighting the importance that the consumption phase and other post-landing stages may have on the final environmental profile of seafood. Results are then analysed regarding relevant limitations and uncertainties, as well as in terms of the consumer and policy implications. Copyright © 2013 Elsevier B.V. All rights reserved.

  7. An exploratory study of the cost-effectiveness of orthodontic care in seven European countries

    Science.gov (United States)

    Deans, Jamie; Playle, Rebecca; Durning, Peter

    2009-01-01

    This study investigated the orthodontic treatment of 429 consecutive patients [172 male (40.1 per cent) and 257 female (59.9 per cent)] carried out by 10 orthodontic specialist practitioners in seven European countries [two in the Czech Republic (A and B), two in Germany (A and B), Italy, Latvia, Lithuania, and Netherlands, and two in Slovenia (A and B)]. The median age of the patients at the start of treatment was 13.0 years (minimum 7.3 years maximum 50.3 years). The patients had a range of malocclusions and the majority (97 per cent) were treated with upper and lower fixed appliances. Real exchange rates were calculated using purchasing power parity (PPP) indicators to allow cross-border comparisons of costs. The Index of Complexity, Outcome and Need (ICON) was used to measure the effectiveness of treatment and cost per ICON point reduction to compare cost-effectiveness of orthodontic treatment between practitioners in different European countries. The median cost per ICON point reduction for all the cases treated was €57.69. The median cost per ICON point reduction varied greatly between practitioners from €21.70 (Lithuania) to €116.62 (Slovenia A). Analysis of variance and Tukey post hoc tests showed the differences in cost-effectiveness between the practitioners to be statistically significant (P < 0.001). The cost per ICON point reduction is a simple and effective method of comparing cost-effectiveness between orthodontic practitioners in different countries. PMID:18854553

  8. The Cataract National Dataset electronic multi-centre audit of 55,567 operations: variation in posterior capsule rupture rates between surgeons.

    Science.gov (United States)

    Johnston, R L; Taylor, H; Smith, R; Sparrow, J M

    2010-05-01

    To demonstrate variations in posterior capsule rupture (PCR) rate between surgeons of the same and different grades as a by-product of routine clinical care. NHS departments using electronic medical record (EMR) systems to collect the Cataract National Dataset (CND) were invited to submit data. Data were remotely extracted, anonymised, assessed for conformity and completeness, and analysed for rates of PCR for individual surgeons within each of the three grades. Data were extracted on 55,567 cataract operations performed at 12 NHS trusts by 406 surgeons between November 2001 and July 2006. Data on the grade of 404 of the 406 surgeons who contributed to the study were available for 55,515 cases (99.9%) and were used for this analysis. Variation in PCR rate between surgeons was highest for the most junior grade of surgeon and between those surgeons contributing relatively few cases to the data set. Variation in PCR was lowest among experienced surgeons contributing large numbers of cases to the data set. Considerable variation in PCR rate exists both between and within surgical grades. Routine electronic collection of the CND allows detailed analysis of variations in PCR rates between individual surgeons. To define acceptable limits for this benchmark complication of cataract surgery, further work is needed to adjust surgeons' outcomes for the case mix complexity.

  9. Multi-centre evaluation of real-time multiplex PCR for detection of carbapenemase genes OXA-48, VIM, IMP, NDM and KPC.

    Science.gov (United States)

    van der Zee, Anneke; Roorda, Lieuwe; Bosman, Gerda; Fluit, Ad C; Hermans, Mirjam; Smits, Paul H M; van der Zanden, Adri G M; Te Witt, René; Bruijnesteijn van Coppenraet, Lesla E S; Cohen Stuart, James; Ossewaarde, Jacobus M

    2014-01-14

    Resistance to carbapenem antibiotics is emerging worldwide among Enterobacteriaceae. To prevent hospital transmission due to unnoticed carriage of carbapenemase producing micro-organisms in newly admitted patients, or follow-up of patients in an outbreak setting, a molecular screening method was developed for detection of the most prevalent carbapenemase genes; blaOXA-48, blaVIM, blaIMP, blaNDM and blaKPC. A real-time multiplex PCR assay was evaluated using a collection of 86 Gram negative isolates, including 62 carbapenemase producers. Seven different laboratories carried out this method and used the assay for detection of the carbapenemase genes on a selection of 20 isolates. Both sensitivity and specificity of the multiplex PCR assay was 100%, as established by results on the strain collection and the inter-laboratory comparisons. In this study, we present a multiplex real-time PCR that is a robust, reliable and rapid method for the detection of the most prevalent carbapenemases blaOXA-48, blaVIM, blaIMP, blaNDM and blaKPC, and is suitable for screening of broth cultured rectal swabs and for identification of carbapenemase genes in cultures.

  10. Effectiveness and cost-effectiveness of body psychotherapy in the treatment of negative symptoms of schizophrenia – a multi-centre randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Priebe Stefan

    2013-01-01

    Full Text Available Abstract Background Negative symptoms of schizophrenia are frequently associated with poor long term outcomes. Established interventions have little, if any, positive effects on negative symptoms. Arts Therapies such as Body Psychotherapy (BPT have been suggested to reduce negative symptoms, but the existing evidence is limited. In a small exploratory trial a manualised form of group BPT led to significantly lower negative symptom levels both at the end of treatment and at 4 months follow-up as compared to supportive counseling. We designed a large multi-site trial to assess the effectiveness of a manualised BPT intervention in reducing negative symptoms, compared to an active control. Methods/Design In a randomised controlled trial, 256 schizophrenic outpatients with negative symptoms will be randomly allocated either to BPT or Pilates groups. In both conditions, patients will be offered two 90 minutes sessions per week in groups of about 8 patients over a period of 10 weeks. Outcomes are assessed at the end of treatment and at six months follow-up. The primary outcome is severity of negative symptoms, as measured by the Positive and Negative Symptom Scale (PANSS, whilst a range of secondary outcome measures include general psychopathology, social contacts, and quality of life. We will also assess the cost-effectiveness of the intervention. Discussion The study aims to evaluate the effectiveness of a promising form of group therapy which may help alleviate negative symptoms that are associated with unfavourable long-term outcomes and have so far been difficult to treat. If the trial is successful, it will add a new and effective option in the treatment of negative symptoms. Group BPT is manualised, might be attractive to many patients because of its unusual approach, and could potentially be rolled out to services at relatively little additional cost. Trial registration Current Controlled Trials ISRCTN84216587

  11. The Sigma-trial protocol: a prospective double-blind multi-centre comparison of laparoscopic versus open elective sigmoid resection in patients with symptomatic diverticulitis

    Directory of Open Access Journals (Sweden)

    Lacy Antonio M

    2007-08-01

    Full Text Available Abstract Backround Diverticulosis is a common disease in the western society with an incidence of 33–66%. 10–25% of these patients will develop diverticulitis. In order to prevent a high-risk acute operation it is advised to perform elective sigmoid resection after two episodes of diverticulitis in the elderly patient or after one episode in the younger ( Method Indication for elective resection is one episode of diverticulitis in patients 50 years or in case of progressive abdominal complaints due to strictures caused by a previous episode of diverticulits. The diagnosis is confirmed by CT-scan, barium enema and/or coloscopy. It is required that the participating surgeons have performed at least 15 laparoscopic and open sigmoid resections. Open resection is performed by median laparotomy, laparoscopic resection is approached by 4 or 5 cannula. Sigmoid and colon which contain serosal changes or induration are removed and a tension free anastomosis is created. After completion of either surgical procedure an opaque dressing will be used, covering from 10 cm above the umbilicus to the pubic bone. Surgery details will be kept separate from the patient's notes. Primary endpoints are the postoperative morbidity and mortality. We divided morbidity in minor (e.g. wound infection, major (e.g. anastomotic leakage and late (e.g. incisional hernias complications, data will be collected during hospital stay and after six weeks and six months postoperative. Secondary endpoints are the operative and the postoperative recovery data. Operative data include duration of the operation, blood loss and conversion to laparotomy. Post operative recovery consists of return to normal diet, pain, analgesics, general health (SF-36 questionnaire and duration of hospital stay. Discussion The Sigma-trial is a prospective, multi-center, double-blind, randomized study to define the role of laparoscopic sigmoid resection in patients with symptomatic diverticulitis.

  12. A multi-centre evaluation of eleven clinically feasible brain PET/MRI attenuation correction techniques using a large cohort of patients.

    Science.gov (United States)

    Ladefoged, Claes N; Law, Ian; Anazodo, Udunna; St Lawrence, Keith; Izquierdo-Garcia, David; Catana, Ciprian; Burgos, Ninon; Cardoso, M Jorge; Ourselin, Sebastien; Hutton, Brian; Mérida, Inés; Costes, Nicolas; Hammers, Alexander; Benoit, Didier; Holm, Søren; Juttukonda, Meher; An, Hongyu; Cabello, Jorge; Lukas, Mathias; Nekolla, Stephan; Ziegler, Sibylle; Fenchel, Matthias; Jakoby, Bjoern; Casey, Michael E; Benzinger, Tammie; Højgaard, Liselotte; Hansen, Adam E; Andersen, Flemming L

    2017-02-15

    To accurately quantify the radioactivity concentration measured by PET, emission data need to be corrected for photon attenuation; however, the MRI signal cannot easily be converted into attenuation values, making attenuation correction (AC) in PET/MRI challenging. In order to further improve the current vendor-implemented MR-AC methods for absolute quantification, a number of prototype methods have been proposed in the literature. These can be categorized into three types: template/atlas-based, segmentation-based, and reconstruction-based. These proposed methods in general demonstrated improvements compared to vendor-implemented AC, and many studies report deviations in PET uptake after AC of only a few percent from a gold standard CT-AC. Using a unified quantitative evaluation with identical metrics, subject cohort, and common CT-based reference, the aims of this study were to evaluate a selection of novel methods proposed in the literature, and identify the ones suitable for clinical use. In total, 11 AC methods were evaluated: two vendor-implemented (MR-ACDIXON and MR-ACUTE), five based on template/atlas information (MR-ACSEGBONE (Koesters et al., 2016), MR-ACONTARIO (Anazodo et al., 2014), MR-ACBOSTON (Izquierdo-Garcia et al., 2014), MR-ACUCL (Burgos et al., 2014), and MR-ACMAXPROB (Merida et al., 2015)), one based on simultaneous reconstruction of attenuation and emission (MR-ACMLAA (Benoit et al., 2015)), and three based on image-segmentation (MR-ACMUNICH (Cabello et al., 2015), MR-ACCAR-RiDR (Juttukonda et al., 2015), and MR-ACRESOLUTE (Ladefoged et al., 2015)). We selected 359 subjects who were scanned using one of the following radiotracers: [(18)F]FDG (210), [(11)C]PiB (51), and [(18)F]florbetapir (98). The comparison to AC with a gold standard CT was performed both globally and regionally, with a special focus on robustness and outlier analysis. The average performance in PET tracer uptake was within ±5% of CT for all of the proposed methods, with the

  13. Chewing gum vs. ibuprofen in the management of orthodontic pain, a multi-centre randomised controlled trial - the effect of anxiety.

    Science.gov (United States)

    Ireland, Anthony J; Ellis, Pamela; Jordan, Abbie; Bradley, Rebecca; Ewings, Paul; Atack, Nicola E; Griffiths, Helen; House, Kate; Moore, Matthew B; Deacon, Scott; Wenger, Nicholas; Worth, Victoria; Scaysbrook, Emma; Williams, Julie C; Sandy, Jonathan R

    2017-03-01

    Pain is a common side effect of orthodontic treatment. An objective of this study, part of a large previously reported RCT on pain and analgesic use, was to determine the effect of anxiety on perceived pain and use of analgesia. 1000 patients aged 11-17 years, undergoing upper and lower fixed appliance treatment in nine hospital departments were recruited into this two-arm parallel design randomised controlled trial. One arm was given sugar-free chewing gum and the other arm ibuprofen for pain relief. Neither the clinicians nor patients were blinded to assignment. In addition to recording pain experience and analgesic use for 3 days following appliance placement and first archwire change, each patient recorded their level of anxiety immediately following the fitting of the appliance and the first archwire change. 419 chewing gum group (84%) and 407 ibuprofen group (83%) questionnaires were returned following appliance placement, and 343 chewing gum group (70%) and 341 ibuprofen group (71%) questionnaires were returned following the first archwire change. The mean anxiety scores following fitting of the appliance and first archwire change were 2.7 (SD 2.1) and 1.6 (SD 1.8), respectively. There were weak but significant positive associations between anxiety scores and pain scores. Multi-level modelling produced a coefficient for anxiety of 0.23 (95% CI 0.17-0.28) for appliance placement, suggesting a small rise (0.23) on the 11-point pain scale for a one-point increase on the corresponding anxiety scale. Following archwire change, the corresponding coefficient was 0.32 (0.24-0.39). For ibuprofen use, again simple analyses suggested a relationship with anxiety. Multi-level logistic modelling produced an odds ratio for ibuprofen use of 1.11 (95% CI 1.07-1.15) at appliance placement and 1.21 (1.10-1.33) at the first archwire change. There was a 10-20% increase in the odds of using ibuprofen for each one-point increase on the anxiety scale. No such relationship was found

  14. Ideal cardiovascular health and inflammation in European adolescents: The HELENA study.

    Science.gov (United States)

    González-Gil, E M; Santabárbara, J; Ruiz, J R; Bel-Serrat, S; Huybrechts, I; Pedrero-Chamizo, R; de la O, A; Gottrand, F; Kafatos, A; Widhalm, K; Manios, Y; Molnar, D; De Henauw, S; Plada, M; Ferrari, M; Palacios Le Blé, G; Siani, A; González-Gross, M; Gómez-Martínez, S; Marcos, A; Moreno Aznar, L A

    2017-05-01

    Inflammation plays a key role in atherosclerosis and this process seems to appear in childhood. The ideal cardiovascular health index (ICHI) has been inversely related to atherosclerotic plaque in adults. However, evidence regarding inflammation and ICHI in adolescents is scarce. The aim is to assess the association between ICHI and inflammation in European adolescents. As many as 543 adolescents (251 boys and 292 girls) from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study, a cross-sectional multi-center study including 9 European countries, were measured. C-reactive protein (CRP), complement factors C3 and C4, leptin and white blood cell counts were used to compute an inflammatory score. Multilevel linear models and multilevel logistic regression were used to assess the association between ICHI and inflammation controlling by covariates. Higher ICHI was associated with a lower inflammatory score, as well as with several individual components, both in boys and girls (p < 0.01). In addition, adolescents with at least 4 ideal components of the ICHI had significantly lower inflammatory score and lower levels of the study biomarkers, except CRP. Finally, the multilevel logistic regression showed that for every unit increase in the ICHI, the probability of having an inflammatory profile decreased by 28.1% in girls. Results from this study suggest that a better ICHI is associated with a lower inflammatory profile already in adolescence. Improving these health behaviors, and health factors included in the ICHI, could play an important role in CVD prevention. Copyright © 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

  15. The european FAZIA initiative: a high-performance digital telescope array for heavy-ion studies

    CERN Document Server

    Casini, G; Pasquali, G; Pastore, G; Bini, M; Carboni, S; Olmi, A; Piantelli, S; Poggi, G; Stefanini, A; Valdre', S; Bonnet, E; Borderie, B; Bougault, R; Bruno, M; Chbihi, A; Cinausero, M; Degerlier, M; Edelbruck, P; Frankland, J D; Gramegna, F; Gruyer, D; Guerzoni, M; Kordjasz, A; Kozik, T; Neindre, N Le; Lopez, O; Marchi, T; Marini, P; Morelli, L; Ordine, A; Parlog, M; Rivet, M F; Rosato, E; Salomon, F; Spadaccini, G; Twarog, T; Vient, E; Vigilante, M

    2013-01-01

    The european Fazia collaboration aims at building a new modular array for charged product identification to be employed for heavy-ion studies. The elementary module of the array is a Silicon-Silicon-CsI telescope, optimized for ion identification also via pulse shape analysis. The achievement of top performances imposes specific electronics which has been developed by FAZIA and features high quality charge and current preamplifiers, coupled to fully digital front-end. During the initial R&D phase, original and novel solutions have been tested in prototypes, obtaining unprecedented ion identification capabilities. FAZIA is now constructing a demonstrator array consisting of about two hundreds telescopes arranged in a compact and transportable configuration. In this contribution, we mainly summarize some aspects studied by FAZIA to improve the ion identification. Then we will briefly discuss the FAZIA program centered on experiments to be done with the demonstrator. First results on the isospin dynamics obt...

  16. The fate of nitrate in riparian wetlands: results from a pan-European study

    Science.gov (United States)

    Burt, T.; Pinay, G.

    2001-12-01

    Subsurface flow through the soil and deeper sediments of the riparian zone is known to be of crucial importance to denitrification and other nitrogen cycling processes. Since denitrification potential generally increases towards the soil surface, water table elevation can control the degree to which nitrate reduction is optimised. This paper presents data collected as part of a pan-European study of nitrate buffer zones, the NICOLAS project (Nitrogen Control by Landscape Structures in Agricultural Environments). An identical experimental design was employed at each site, allowing climatic controls on hydrology and nitrogen cycling processes to be explored. Nitrate elimination occurred at most of the 13 study sites spread out within Europe (between latitude 40\\deg and 55\\deg N) with an efficiency ranging from 5 to 30% of N concentration abatement per metre. This elimination usually occurred within the first few tens of metres at the upland-wetland interface depending on local geomorphological and hydrological conditions.

  17. Nosocomial rotavirus infection: An up to date evaluation of European studies

    Science.gov (United States)

    Gervasi, G.; Capanna, A.; Mita, V.; Zaratti, L.; Franco, E.

    2016-01-01

    ABSTRACT Rotavirus (RV) is worldwide considered as the most important viral agent of acute gastroenteritis in children less than 5 y. Since 2006, the availability of anti-RV vaccines has deeply modified the incidence and economic burden of RV infection. In Europe, some countries have introduced an anti-RV vaccination program in the last 10 y. Although community acquired RV (CARV) disease is the most studied condition of RV infection, recently some authors have highlighted the importance of nosocomial RV (nRV) disease as an emerging public health issue. The aim of this review is to summarize the epidemiology of both CARV and nRV, in order to discuss the difficulty of a clear evaluation of the burden of the disease in absence of comparable data. In particular, we focused our attention to European studies regarding nRV in terms of divergences related to definition, report of incidence rate and methodological issues. PMID:27185183

  18. Inspiring Lecturers: Sharing E-Learning Practice through European Case Studies

    DEFF Research Database (Denmark)

    Hayes, Sarah; Godsk, Mikkel; Andersen, Majbrit Vandsø

    2009-01-01

    Sharing best practice in e-learning, when undertaken as an active process, can provide valuable insights, with a real capacity to inspire. This has been our experience in collecting European university e-learning case studies. How this was achieved is the focus of this paper, which discusses...... a consistent approach to transferring knowledge that might be followed and developed by others. We will outline a methodology for sharing best practices of e-learning. We will explain how these cases, rather like short stories, were identified, gathered and communicated by the EUNIS ELearning Task Force...... collaboration, using a database and a weblog (EUNIC, 2008). Some examples of the case studies are provided, with suggestions of ways to develop this process further....

  19. Nosocomial rotavirus infection: An up to date evaluation of European studies.

    Science.gov (United States)

    Gervasi, G; Capanna, A; Mita, V; Zaratti, L; Franco, E

    2016-09-01

    Rotavirus (RV) is worldwide considered as the most important viral agent of acute gastroenteritis in children less than 5 y. Since 2006, the availability of anti-RV vaccines has deeply modified the incidence and economic burden of RV infection. In Europe, some countries have introduced an anti-RV vaccination program in the last 10 y. Although community acquired RV (CARV) disease is the most studied condition of RV infection, recently some authors have highlighted the importance of nosocomial RV (nRV) disease as an emerging public health issue. The aim of this review is to summarize the epidemiology of both CARV and nRV, in order to discuss the difficulty of a clear evaluation of the burden of the disease in absence of comparable data. In particular, we focused our attention to European studies regarding nRV in terms of divergences related to definition, report of incidence rate and methodological issues.

  20. Promoting the health of Europeans in a rapidly changing world: a historical study of the implementation of World Health Organisation policies by the Nursing and Midwifery Unit, European Regional Office, 1970-2003

    DEFF Research Database (Denmark)

    Hallett, Christine; Wagner, Lis

    2011-01-01

    HALLETT C and WAGNER L. Nursing Inquiry 2011; 18: 359-368 Promoting the health of Europeans in a rapidly changing world: a historical study of the implementation of World Health Organisation policies by the Nursing and Midwifery Unit, European Regional Office, 1970-2003 The World Health...... Organisation (WHO) was inaugurated in 1948. Formed in a period of post-war devastation, WHO aimed to develop and meet goals that would rebuild the health of shattered populations. The historical study reported here examined the work of the Nursing and Midwifery Unit (NMU) of WHO's European Regional Office...... in the work of the NMU of the European Regional Office of WHO. One of the strongest of these was a drive to develop and promote the nursing profession within the countries of the European Region. The second was the promulgation and implementation of the positive public health strategies of WHO, particularly...

  1. Chinese Journal of European Studies Vol. 30 No.5 October 2012

    Institute of Scientific and Technical Information of China (English)

    2012-01-01

    Changes in Germany's European Policy: An Analysis Based on the Per- formances of Germany in the European Debt Crisis After some initial hesitation, Germany turned out to be more assertive in the European debt crisis. This shift is not only closely linked with Germany' s idea of economic gov- ernance, but a result from the competition between the domestic veto players. Al- though a "European Germany" still serves as the basic framework for Germany' s ac- tions in Europe, its performances in the European debt crisis have clearly told us a number of changes in its European policy. In particular, domestic affairs are playing an increasingly decisive role in directing Germany' s European policy with a weakened sense of Euopean identiry, and it seems that Germany is becoming a geo-economic power. These changes further exacerbate the existing tension between external expecta- tions towards Germany from the other EU member states and internal constraints from the German society and aggravate the unpredictability of Germany' s European policy and the uncertainty of the future of European integration.

  2. Determinants in the uptake of the Human Papillomavirus vaccine: a systematic review based on European studies

    Directory of Open Access Journals (Sweden)

    Victoria eFernández de Casadevante

    2015-06-01

    Full Text Available Background Cervical cancer is the fourth most common cancer affecting women worldwide. Since 2006, two Human Papillomavirus vaccines (HPVV have been licensed to protect women against the virus that causes cervical cancer. However, worldwide coverage remains unequal. Studies from the USA found strong evidence for differences in HPVV uptake by ethnicity and healthcare coverage. As the profile of ethnic groups and the healthcare system in the USA differ from countries in Europe where HPVV is free in most of the countries, we conducted a systematic review in order to analyze the determinants of HPVV uptake in Europe.Methods We performed a systematic Pubmed, Scopus and Science Direct search to find articles published from HPVV availability in European countries until April 2014. No age restriction was applied. We included all studies assessing factors associated with HPVV uptake. Uptake refers to either initiation and/or completion of the three dose vaccination program. Results Out of the 23 eligible studies, 14 were retrospective reviews of data, six were cross-sectional surveys and three were prospective cohort studies. Higher HPVV uptake was associated with ethnic majority populations, higher socio-economic status, regular cervical screening participation by the mother and having received previous childhood vaccinations.Conclusions Since the vaccine is offered for free in most of the European countries, the findings suggest that ethno-cultural and educational factors play an important role when it comes to HPVV uptake. Girls who were undervaccinated had also a lower uptake of standard childhood vaccines and mothers who were less likely to attend cervical cancer screening. This may indicate, that only few parents have specific concerns with HPVV, and that preventive health care should seek ways to target these vulnerable groups.

  3. Associations of Adiponectin with Individual European Ancestry in African Americans: the Jackson Heart Study

    Directory of Open Access Journals (Sweden)

    Aurelian eBidulescu

    2014-02-01

    Full Text Available Background: Compared with European Americans, African Americans (AA exhibit lower levels of the cardio-metabolically protective adiponectin even after accounting for adiposity measures. Because few studies have examined in AA the association between adiponectin and genetic admixture, a dense panel of ancestry informative markers (AIMs was used to estimate the individual proportions of European ancestry (PEA for the African Americans enrolled in a large community-based cohort, the Jackson Heart Study (JHS. We tested the hypothesis that plasma adiponectin and PEA are directly associated and assessed the interaction with a series of cardio-metabolic risk factors.Methods: Plasma specimens from 1,439 JHS participants were analyzed by ELISA for adiponectin levels. Using pseudo-ancestral population genotype data from the HapMap Consortium, PEA was estimated with a panel of up to 1,447 genome-wide preselected AIMs by a maximum likelihood approach. Interaction assessment, stepwise linear and cubic multivariable-adjusted regression models were used to analyze the cross-sectional association between adiponectin and PEA.Results: Among the study participants (62% women; mean age 48 ± 12 years, the median (interquartile range of PEA was 15.8 (9.3%. Body mass index (p = 0.04 and insulin resistance (p = 0.0001 modified the association between adiponectin and PEA. Adiponectin was directly and linearly associated with PEA (β = 0.62 ± 0.28, p = 0.03 among non-obese (n = 673 and insulin sensitive participants (n = 1,141; β = 0.74 ± 0.23, p = 0.001, but not among those obese or with insulin resistance. No threshold effect was detected for non-obese participants.Conclusions: In a large African American population, the individual proportion of European ancestry was linearly and directly associated with plasma adiponectin among non-obese and non insulin-resistant participants, pointing to the interaction of genetic and metabolic factors influencing adiponectin

  4. Differences in energy balance-related behaviours in European preschool children: the ToyBox-study.

    Directory of Open Access Journals (Sweden)

    Marieke De Craemer

    Full Text Available The aim of the current study was to compare levels of energy balance-related behaviours (physical activity, sedentary behaviour, and dietary behaviours (more specifically water consumption, sugar-sweetened beverage consumption and unhealthy snacking in four- to six-year-old preschoolers from six European countries (Belgium, Bulgaria, Germany, Greece, Poland, and Spain within the ToyBox cross-sectional study.A sample of 4,045 preschoolers (4.77 ± 0.43 years; 52.2% boys had valid physical activity data (steps per day, parents of 8,117 preschoolers (4.78 ± 0.46 years; 53.0% boys completed a parental questionnaire with questions on sedentary behaviours (television viewing, computer use, and quiet play, and parents of 7,244 preschoolers (4.77 ± 0.44 years; 52.0% boys completed a food frequency questionnaire with questions on water consumption, sugar-sweetened beverage consumption and unhealthy snacking.The highest levels of physical activity were found in Spain (12,669 steps/day on weekdays, while the lowest levels were found in Bulgaria and Greece (9,777 and 9,656 steps/day on weekdays, respectively. German preschoolers spent the least amount of time in television viewing (43.3 min/day on weekdays, while Greek preschoolers spent the most time in television viewing (88.5 min/day on weekdays. A considerable amount of time was spent in quiet play in all countries, with the highest levels in Poland (104.9 min/day on weekdays, and the lowest levels in Spain (60.4 min/day on weekdays. Belgian, German, and Polish preschoolers had the lowest intakes of water and the highest intakes of sugar-sweetened beverages. The intake of snacks was the highest in Belgian preschoolers (73.1 g/day and the lowest in Greek preschoolers (53.3 g/day.Across six European countries, differences in preschoolers' energy balance-related behaviours were found. Future interventions should target European preschoolers' energy balance-related behaviours simultaneously, but should

  5. Joint statement of the European Association for the Study of Obesity and the European Society of Hypertension: obesity and heart failure.

    Science.gov (United States)

    Jordan, Jens; Toplak, Hermann; Grassi, Guido; Yumuk, Volkan; Kotsis, Vasilios; Engeli, Stefan; Cuspidi, Cesare; Nilsson, Peter M; Finer, Nick; Doehner, Wolfram

    2016-09-01

    Obese individuals are more likely to develop heart failure. Yet, once heart failure is established, the impact of overweight and obesity on prognosis and survival is unclear. The purpose of this joint scientific statement of the European Association for the Study of Obesity and the European Society of Hypertension is to provide an overview on the current scientific literature on obesity and heart failure in terms of prognosis, mechanisms, and clinical management implications. Moreover, the document identifies open questions that ought to be addressed. The need for more tailored weight management recommendations in heart failure will be emphasized and, in line with the emerging evidence, aims to distinguish between primary disease and secondary outcome prevention. In the primary prevention of heart failure, it appears prudent advising obese individuals to lose or achieve a healthy body weight, especially in those with risk factors such as hypertension or type 2 diabetes. However, there is no evidence from clinical trials to guide weight management in overweight or obese patients with established heart failure. Prospective clinical trials are strongly encouraged.

  6. A validation of the first genome-wide association study of calcaneus ultrasound parameters in the European Male Ageing Study

    Directory of Open Access Journals (Sweden)

    Han Thang S

    2011-01-01

    Full Text Available Abstract Background A number of single nucleotide polymorphisms (SNPs have been associated with broadband ultrasound attenuation (BUA and speed of sound (SOS as measured by quantitative ultrasound (QUS at the calcaneus in the Framingham 100K genome-wide association study (GWAS but have not been validated in independent studies. The aim of this analysis was to determine if these SNPs are associated with QUS measurements assessed in a large independent population of European middle-aged and elderly men. The association between these SNPs and bone mineral density (BMD measured using dual-energy X-ray absorptiometry (DXA was also tested. Methods Men aged 40-79 years (N = 2960 were recruited from population registers in seven European centres for participation in an observational study of male ageing, the European Male Ageing Study (EMAS. QUS at the calcaneus was measured in all subjects and blood was taken for genetic analysis. Lumbar spine (LS, femoral neck (FN and total hip (TH BMD were measured by DXA in a subsample of 620 men in two centres. SNPs associated with BUA or SOS in the Framingham study with p -4 were selected and genotyped using SEQUENOM technology. Linear regression was used to test for the association between SNPs and standardised (SD bone outcomes under an additive genetic model adjusting for centre. The same direction of effect and p Results Thirty-four of 38 selected SNPs were successfully genotyped in 2377 men. Suggestive evidence of replication was observed for a single SNP, rs3754032, which was associated with a higher SOS (β(SD = 0.07, p = 0.032 but not BUA (β(SD = 0.02, p = 0.505 and is located in the 3'UTR of WDR77 (WD repeat domain 77 also known as androgen receptor cofactor p44. A single SNP, rs238358, was associated with BMD at the LS (β(SD = -0.22, p = 0.014, FN (β(SD = -0.31,p = 0.001 and TH (β(SD = -0.36, p = 0.002 in a locus previously associated with LS BMD in large-scale GWAS, incorporating AKAP11 and RANKL

  7. Diffuse and bi-directional reflectance spectrometry to study European volcanic soils

    Directory of Open Access Journals (Sweden)

    Roberto Salzano

    2008-01-01

    Full Text Available Diffuse and bi-directional reflectance spectroscopy were applied in this research in order to characterize chemical and mineralogical properties in volcanic soils. The study was conducted on 77 volcanic soil profiles from several European countries. Diffuse reflectance spectroscopy was used in conjunction with parameterization using the second derivative of the Kubelka-Munk function and colour calculation. From derivative curves, one band of interest was characterized and identified around 450 nm. Using correlation analysis, significant relationships were observed between amplitude of this band and Fed (r = 0.6. In addition, the data showed that soil organic matter content, Ald and Fep were moderately correlated with reflectance values centered at 546, 579 and 2048 nm.

  8. Investigating the effects of ICT on innovation and performance of European hospitals: an exploratory study.

    Science.gov (United States)

    Arvanitis, Spyros; Loukis, Euripidis N

    2016-05-01

    Hospitals are making big investments in various types of ICT, so it is important to investigate their effects on innovation and performance. This paper presents an empirical study in this direction, based on data for 743 hospitals from 18 European countries. We specified and estimated econometrically five equations: one for product innovation, one for process innovation and three equations for the three different dimensions of (ICT-enabled) hospital performance. All five equations included various ICT-related variables reflecting ICT infrastructure and a series of important ICT applications, some of them hospital-specific, and some others of general business use, and also ICT personnel (viewed as a kind of 'soft' ICT investment), while the performance equations also included the two innovation measures.

  9. What can be learned from practical cases of green economy? - studies from five European countries

    DEFF Research Database (Denmark)

    Pitkänen, Kati; Antikainen, Riina; Droste, Nils

    2016-01-01

    The transition to green economies has been mediated by concrete cases and experiments in a variety of different industrial and social sectors. What is lacking, is research that would synthesize key findings and “lessons learned” across a variety of cases. In this study, we explore ten cases...... of green economy of different sectors and approaches from five European countries and identify factors that have had critical importance for the success or failure of the cases. Our paper reveals similarities across small and large scale cases and different approaches for implementing green economy. We...... negotiation between potential trade-offs among multiple goals, and interests of various stakeholders. The mutual benefits can be communicated through valid impact assessments and the integration of R&D into the practical implementation. Securing the continuity of funding and leadership is crucial...

  10. What can be learned from practical cases of green economy? - studies from five European countries

    DEFF Research Database (Denmark)

    Pitkänen, Kati; Antikainen, Riina; Droste, Nils;

    2016-01-01

    The transition to green economies has been mediated by concrete cases and experiments in a variety of different industrial and social sectors. What is lacking, is research that would synthesize key findings and “lessons learned” across a variety of cases. In this study, we explore ten cases...... of green economy of different sectors and approaches from five European countries and identify factors that have had critical importance for the success or failure of the cases. Our paper reveals similarities across small and large scale cases and different approaches for implementing green economy. We...... identified critical factors related to economic viability, public funding, technological development, impact assessments, public policies and regulation, social capital, leadership and coordination as well as public acceptability and image. According to our results, transition to green economies requires...

  11. VSI@ESS: Case study for a vibrational spectroscopy instrument at the european spallation source

    Science.gov (United States)

    Zoppi, Marco; Fedrigo, Anna; Celli, Milva; Colognesi, Daniele

    2015-01-01

    Neutron Vibrational Spectroscopy is a well-established experimental technique where elementary excitations at relatively high frequency are detected via inelastic neutron scattering. This technique attracts a high interest in a large fraction of the scientific community in the fields of chemistry, materials science, physics, and biology, since one of its main applications exploits the large incoherent scattering cross section of the proton with respect to all the other elements, whose dynamics can be spectroscopically detected, even if dissolved in very low concentration in materials composed of much heavier atoms. We have proposed a feasibility study for a Vibrational Spectroscopy Instrument (VSI) at the European Spallation Source ESS. Here, we will summarize the preliminary design calculations and the corresponding McStas simulation results for a possible ToF, Inverted Geometry, VSI beamline.

  12. VSI@ESS: Case study for a vibrational spectroscopy instrument at the european spallation source

    Directory of Open Access Journals (Sweden)

    Zoppi Marco

    2015-01-01

    Full Text Available Neutron Vibrational Spectroscopy is a well-established experimental technique where elementary excitations at relatively high frequency are detected via inelastic neutron scattering. This technique attracts a high interest in a large fraction of the scientific community in the fields of chemistry, materials science, physics, and biology, since one of its main applications exploits the large incoherent scattering cross section of the proton with respect to all the other elements, whose dynamics can be spectroscopically detected, even if dissolved in very low concentration in materials composed of much heavier atoms. We have proposed a feasibility study for a Vibrational Spectroscopy Instrument (VSI at the European Spallation Source ESS. Here, we will summarize the preliminary design calculations and the corresponding McStas simulation results for a possible ToF, Inverted Geometry, VSI beamline.

  13. Stakeholders’ Views on Factors Influencing Nutrition Policy: a Qualitative Study Across Ten European Countries

    Directory of Open Access Journals (Sweden)

    Jeruszka-Bielak Marta

    2015-12-01

    Full Text Available The objective was to identify the main factors influencing micronutrient policies in the opinion of policy actors in ten European countries. Study was carried out during Jan-Nov 2010 in European countries: the Czech Republic, Denmark, England, Germany, Greece, Italy, the Netherlands, Norway, Poland and Spain. Semi-structured qualitative interviews were conducted with representatives of stakeholders involved in the vitamin D, folate and iodine policy making process. Fifty eight key informants representing mainly scientific advisory bodies (n=24 and governmental organisations (n=19 participated in the study. The remaining interviewees represented non-governmental organisations (n=6, industry (n=4 or were independent academic or health professional experts (n=5. Data were analysed by theoretical interpretative thematic analysis. Insights from interviewees on the development of micronutrient policies were grouped using the Public Health Nutrition Policy-making model. The main factors influencing the micronutrient policies were: systematic monitoring of nutrition and health, causal relationships between consumers’ diet-related behaviours and health outcomes, scientific recommendations from national bodies (Science area; scientific recommendations from international authorities and experiences of other countries, EU legislation, cultural factors (Wider context and political environment, national capacity to deal with the problem, national legislation, economics, stakeholder engagement, relationships between stakeholders (Policy and institutions area. The spectrum and weight of the factors influencing nutritional policy depends on nutrient, country and degree of its “advanced status” within nutrition policy, political environment, culture and socio-economic conditions as well as the point of view (who is expressing the opinion.

  14. European adolescents' level of perceived stress and its relationship with body adiposity--the HELENA Study.

    Science.gov (United States)

    De Vriendt, Tineke; Clays, Els; Maes, Lea; De Bourdeaudhuij, Ilse; Vicente-Rodriguez, Germàn; Moreno, Luis A; Nagy, Eniko; Molnár, Dénes; Ortega, Francisco B; Dietrich, Sabine; Manios, Yannis; De Henauw, Stefaan

    2012-08-01

    Since stress is hypothesized to be involved in the aetiology of obesity, the present study examined the current perception of stress in European adolescents and the association between adolescent perceived stress and their adiposity. Observational data from 1121 adolescents aged 12.5-17.5 years from six European cities involved in the Healthy Lifestyle in Europe by Nutrition in Adolescence cross-sectional study, was investigated. The adolescents completed the adolescent stress questionnaire, comprising 10 different stress dimensions. Anthropometric measurements (weight, height, skinfold thicknesses and circumferences) and bioelectrical impedance analysis were performed, and personal characteristics (age, pubertal stage and parental education) were collected. The measures of perceived stress were described for boys and girls separately and gender differences were investigated. Associations between the adolescents' perceived stress and indicators of general (body mass index z-score, sum of skinfold thicknesses and body fat%) and abdominal (waist and hip circumference, and waist/height ratio) adiposity were examined using hierarchical linear models. While girls reported systematically higher levels of stress compared with boys, their stress profiles were similar, with highest levels for school-related stress followed by future uncertainty. Only in girls, perceived stress was significantly associated with increased measures of general and abdominal adiposity. In boys, no relationship between perceived stress and adiposity measures was observed. School is reported to be an important source of adolescent stress and should be the focus of stress management campaigns. Only in girls, the hypothesis that stress might be involved in the aetiology of obesity during adolescence was supported.

  15. Multi-sectoral action for child safety-a European study exploring implicated sectors.

    Science.gov (United States)

    Scholtes, Beatrice; Schröder-Bäck, Peter; Förster, Katharina; MacKay, Morag; Vincenten, Joanne; Brand, Helmut

    2017-06-01

    Injury to children in Europe, resulting in both death and disability, constitutes a significant burden on individuals, families and society. Inequalities between high and low-income countries are growing. The World Health Organisation Health 2020 strategy calls for inter-sectoral collaboration to address injury in Europe and advocates the whole of government and whole of society approaches to wicked problems. In this study we explore which sectors (e.g. health, transport, education) are relevant for four domains of child safety (intentional injury, water, road and home safety). We used the organigraph methodology, originally developed to demonstrate how organizations work, to describe the governance of child safety interventions. Members of the European Child Safety Alliance, working in the field of child safety in 24 European countries, drew organigraphs of evidence-based interventions. They included the different actors involved and the processes between them. We analyzed the organigraphs by counting the actors presented and categorizing them into sectors using a pre-defined analysis framework. We received 44 organigraphs from participants in 24 countries. Twenty-seven sectors were identified across the four domains. Nine of the 27 identified sectors were classified as 'core sectors' (education, health, home affairs, justice, media, recreation, research, social/welfare services and consumers). This study reveals the multi-sectoral nature of child safety in practice. It provides information for stakeholders working in child safety to help them implement inter-sectoral child safety interventions taking a whole-of-government and whole-of-society approach to health governance.

  16. STUDY REGARDING THE LEGISLATIVE CONDITIONS IN THE EUROPEAN UNION IMPORT FOR FRESH MEAT AND MEAT PRODUCTS

    Directory of Open Access Journals (Sweden)

    S. STANCIU

    2013-12-01

    Full Text Available The European Union is by far the biggest importer of food worldwide. Import rulesfor meat and meat products are fully harmonized and the European Commissionacts as the competent authority on behalf of the 25 Member States. The EUCommission is the sole negotiating partner for all non-EU countries in questionsrelated to import conditions for meat and meat products.

  17. Fostering Self-Regulated Learning through the European Language Portfolio: An Embedded Mixed Methods Study

    Science.gov (United States)

    Ziegler, Nicholas Allan

    2014-01-01

    The European Language Portfolio (ELP) is an alternative assessment used in foreign language classes throughout Europe to support and record language learning. Directly linked to the Common European Framework of Reference for Languages (Council of Europe, 2001) proficiency guidelines, it is designed to achieve an ambitious dual goal: document…

  18. Nurses' intention to leave their profession: a cross sectional observational study in 10 European countries

    NARCIS (Netherlands)

    Heinen, M.M.; Achterberg, T. van; Schwendimann, R.; Zander, B.; Matthews, A.; Kozka, M.; Ensio, A.; Sjetne, I.S.; Moreno Casbas, T.; Ball, J.; Schoonhoven, L.

    2013-01-01

    BACKGROUND: As the European population ages, the demand for nursing care increases. Yet, a shortage of nurses at the labour market exists or is predicted for most European countries. There are no adequate solutions for this shortage yet, and recruitment of future nurses is difficult. Therefore, reta

  19. Studies in Business Administration in the European Higher Education Area: A Comparative Analysis in Europe

    Science.gov (United States)

    Cavero Rubio, José Antonio; Mullor, Javier Reig; Martín, Agustín Pérez

    2015-01-01

    On signing the Bologna declaration in 1999, European countries committed themselves to addressing the reforms necessary for adapting their university education to the European Higher Education Area. This modification process culminated in 2010, and this research aims to analyse the degree of divergence that currently exists in each course subject…

  20. Nurses' intention to leave their profession: a cross sectional observational study in 10 European countries

    NARCIS (Netherlands)

    Heinen, M.M.; Achterberg, T. van; Schwendimann, R.; Zander, B.; Matthews, A.; Kozka, M.; Ensio, A.; Sjetne, I.S.; Moreno Casbas, T.; Ball, J.; Schoonhoven, L.

    2013-01-01

    BACKGROUND: As the European population ages, the demand for nursing care increases. Yet, a shortage of nurses at the labour market exists or is predicted for most European countries. There are no adequate solutions for this shortage yet, and recruitment of future nurses is difficult. Therefore,

  1. Macronutrient-specific effect of FTO rs9939609 in response to a 10-week randomized hypo-energetic diet among obese Europeans

    DEFF Research Database (Denmark)

    Grau, K; Hansen, Torben; Holst, C;

    2009-01-01

    BACKGROUND: The A risk allele of rs9939609 of the fat mass- and obesity-associated gene (FTO) increases body fat mass. OBJECTIVE: To examine whether FTO rs9939609 affects obese individuals' response to a high-fat, low-carbohydrate (CHO) (HF) or low-fat, high-CHO (LF), hypo-energetic diet...... and whether the effect of the FTO variant depends on dietary fat and CHO content. DESIGN: In a 10-week, European, multi-centre dietary intervention study 771 obese women and men were randomized to either LF (20-25% of energy (%E) from fat, 60-65%E from CHO) or HF (40-45%E from fat, 40-45%E from CHO), hypo......-energetic diet (measured resting metabolic rate multiplied by 1.3-600 kcal day(-1)). Body weight, fat mass (FM), fat-free mass (FFM), waist circumference (WC), resting energy expenditure (REE), fasting fat oxidation as % of REE (FatOx), insulin release (HOMA-beta) and a surrogate measure of insulin resistance...

  2. Cross-species amplification of 41 microsatellites in European cyprinids: A tool for evolutionary, population genetics and hybridization studies

    Directory of Open Access Journals (Sweden)

    Gilles André

    2010-05-01

    Full Text Available Abstract Background Cyprinids display the most abundant and widespread species among the European freshwater Teleostei and are known to hybridize quite commonly. Nevertheless, a limited number of markers for conducting comparative differentiation, evolutionary and hybridization dynamics studies are available to date. Findings Five multiplex PCR sets were optimized in order to assay 41 cyprinid-specific polymorphic microsatellite loci (including 10 novel loci isolated from Chondrostoma nasus nasus, Chondrostoma toxostoma toxostoma and Leuciscus leuciscus for 503 individuals (440 purebred specimens and 63 hybrids from 15 European cyprinid species. The level of genetic diversity was assessed in Alburnus alburnus, Alburnoides bipunctatus, C. genei, C. n. nasus, C. soetta, C. t. toxostoma, L. idus, L. leuciscus, Pachychilon pictum, Rutilus rutilus, Squalius cephalus and Telestes souffia. The applicability of the markers was also tested on Abramis brama, Blicca bjoerkna and Scardinius erythrophtalmus specimens. Overall, between 24 and 37 of these markers revealed polymorphic for the investigated species and 23 markers amplified for all the 15 European cyprinid species. Conclusions The developed set of markers demonstrated its performance in discriminating European cyprinid species. Furthermore, it allowed detecting and characterizing hybrid individuals. These microsatellites will therefore be useful to perform comparative evolutionary and population genetics studies dealing with European cyprinids, what is of particular interest in conservation issues and constitutes a tool of choice to conduct hybridization studies.

  3. The European Portuguese WHOQOL-OLD module and the new facet Family/Family life: reliability and validity studies.

    Science.gov (United States)

    Vilar, Manuela; Sousa, Liliana B; Simões, Mário R

    2016-09-01

    The aim of this study was to examine the psychometric properties of the European Portuguese version of the World Health Organization Quality of Life-Older Adults Module (WHOQOL-OLD). The European Portuguese WHOQOL-OLD includes a new identified facet, Family/Family life. A convenience sample of older adults was recruited (N = 921). The assessment protocol included demographics, self-perceived health, depressive symptoms (GDS-30), cognitive function (ACE-R), daily life activities (IAFAI), health status (SF-12) and QoL (WHOQOL-Bref, EUROHIS-QOL-8 and WHOQOL-OLD). The internal consistency was excellent for the total 24-item WHOQOL-OLD original version and also for the final 28-item European Portuguese WHOQOL-OLD version. The test-retest reliability for total scores was good. The construct validity of the European Portuguese WHOQOL-OLD was supported in the correlation matrix analysis. The results indicated good convergent/divergent validity. The WHOQOL-OLD scores differentiated groups of older adults who were healthy/unhealthy and without/mild/severe depressive symptoms. The new facet, Family/Family life, presented evidence of good reliability and validity parameters. Comparatively to international studies, the European Portuguese WHOQOL-OLD version showed similar and/or better psychometric properties. The new facet, Family/Family life, introduces cross-cultural specificity to the study of QoL of older adults and generally improves the psychometric robustness of the WHOQOL-OLD.

  4. Chinese Journal of European Studies Vol. 29 No. 5 October 2011 ARTICLES

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    Russia's European Complex and Its Westward Strategy Russia owns a special complex towards Europe. At every critical point of historical transformations, Russia would take Europe as a reference for rethinking its own strategy and destiny. After the end of the Cold War, the realistic geopolitical context forced Russia to face the "European knot" once again. As a response to this situation, President Medvedev and PM Putin successively put forward a " Pan-European security pact" and a "new European economic architecture", which constitutes the general concept of Russia' s new European strategy. However, great difficulties still lie ahead for Russia to return to Europe in its own way

  5. Pilot study testing a European human biomonitoring framework for biomarkers of chemical exposure in children and their mothers

    DEFF Research Database (Denmark)

    Exley, Karen; Aerts, Dominique; Biot, Pierre;

    2015-01-01

    Exposure to a number of environmental chemicals in UK mothers and children has been assessed as part of the European biomonitoring pilot study, Demonstration of a Study to Coordinate and Perform Human Biomonitoring on a European Scale (DEMOCOPHES). For the European-funded project, 17 countries...... tested the biomonitoring guidelines and protocols developed by COPHES. The results from the pilot study in the UK are presented; 21 school children aged 6-11 years old and their mothers provided hair samples to measure mercury and urine samples, to measure cadmium, cotinine and several phthalate...... on environment, health and lifestyle. Mercury in hair was higher in children who reported frequent consumption of fish (geometric mean 0.35 μg/g) compared to those that ate fish less frequently (0.13 μg/g, p = 0.002). Cadmium accumulates with age as demonstrated by higher levels of urinary cadmium in the mothers...

  6. Perceived Indoor Environment and Occupants’ Comfort in European “Modern” Office Buildings: The OFFICAIR Study

    Science.gov (United States)

    Sakellaris, Ioannis A.; Saraga, Dikaia E.; Mandin, Corinne; Roda,