A multifaceted workplace intervention for low back pain in nurses' aides

DEFF Research Database (Denmark)

Nørregaard Rasmussen, Charlotte Diana; Holtermann, Andreas; Bay, Hans

2015-01-01

The present study established the effectiveness of a workplace multi-faceted intervention consisting of participatory ergonomics, physical training and cognitive behavioural training for low back pain. Between November 2012 and May 2014, we conducted a pragmatic stepped-wedge cluster-randomized c......The present study established the effectiveness of a workplace multi-faceted intervention consisting of participatory ergonomics, physical training and cognitive behavioural training for low back pain. Between November 2012 and May 2014, we conducted a pragmatic stepped-wedge cluster......-randomized controlled trial with 594 workers from eldercare workplaces (nursing homes and home care) randomized to four successive time periods, three months apart. The intervention lasted 12 weeks and consisted of 19 sessions in total (physical training (12 sessions), cognitive behavioural training (2 sessions...... pain among workers in eldercare. Thus, multi-faceted interventions may be relevant for improving low back pain in a working population.This is an open access article distributed under the terms of the Creative Commons Attribution-Noncommercial No Derivatives 3.0 License, which permits downloading...

A multifaceted hospital-wide intervention increases hand hygiene ...

African Journals Online (AJOL)

A multifaceted hospital-wide intervention increases hand hygiene compliance. B Patel, H Engelbrecht, H McDonald, V Morris, W Smythe. Abstract. Background. Hand hygiene is an important and basic practice that should be used by all healthcare staff to protect both themselves and their patients against infection.

A Framework for a Multi-Faceted, Educational, Knowledge-Based Recommender System

Directory of Open Access Journals (Sweden)

John W. Coffey

2016-08-01

Full Text Available The literature on intelligent or adaptive tutoring systems generally has a focus on how to determine what resources to present to students as they make their way through a course of study. The idea of multi-faceted student modeling is that a variety of measures, both academic and non-academic, might be represented in student models in service of a broader educational context. This paper contains a framework for a multi-faceted, educational, knowledge-based recommender system, including a basic set of descriptors that the model contains, and a taxonomy of inferences that might be made over such models.

Effect of personalised citizen assistance for social participation (APIC) on older adults' health and social participation: study protocol for a pragmatic multicentre randomised controlled trial (RCT).

Science.gov (United States)

Levasseur, Mélanie; Dubois, Marie-France; Filliatrault, Johanne; Vasiliadis, Helen-Maria; Lacasse-Bédard, Joanie; Tourigny, André; Levert, Marie-Josée; Gabaude, Catherine; Lefebvre, Hélène; Berger, Valérie; Eymard, Chantal

2018-03-31

The challenges of global ageing and the growing burden of chronic diseases require innovative interventions acting on health determinants like social participation. Many older adults do not have equitable opportunities to achieve full social participation, and interventions might underempower their personal and environmental resources and only reach a minority. To optimise current practices, the Accompagnement-citoyen Personnalisé d'Intégration Communautaire (APIC), an intervention demonstrated as being feasible and having positive impacts, needs further evaluation. A pragmatic multicentre, prospective, two-armed, randomised controlled trial will evaluate: (1) the short-term and long-term effects of the APIC on older adults' health, social participation, life satisfaction and healthcare services utilisation and (2) its cost-effectiveness. A total of 376 participants restricted in at least one instrumental activity of daily living and living in three large cities in the province of Quebec, Canada, will be randomly assigned to the experimental or control group using a centralised computer-generated random number sequence procedure. The experimental group will receive weekly 3-hour personalised stimulation sessions given by a trained volunteer over the first 12 months. Sessions will encourage empowerment, gradual mobilisation of personal and environmental resources and community integration. The control group will receive the publicly funded universal healthcare services available to all Quebecers. Over 2 years (baseline and 12, 18 and 24 months later), self-administered questionnaires will assess physical and mental health (primary outcome; version 2 of the 36-item Short-Form Health Survey, converted to SF-6D utility scores for quality-adjusted life years), social participation (Social Participation Scale) and life satisfaction (Life Satisfaction Index-Z). Healthcare services utilisation will be recorded and costs of each intervention calculated. The Research

Evaluation of an effective multifaceted implementation strategy for elective single-embryo transfer after in vitro fertilization

NARCIS (Netherlands)

Kreuwel, I.A.M.; Peperstraten, A.M. van; Hulscher, M.E.J.L.; Kremer, J.A.M.; Grol, R.P.T.M.; Nelen, W.L.D.M.; Hermens, R.P.M.G.

2013-01-01

STUDY QUESTION: What is the relationship between the rate of elective single-embryo transfer (eSET) and couples' exposure to different elements of a multifaceted implementation strategy? SUMMARY ANSWER: Additional elements in a multifaceted implementation strategy do not result in an increased eSET

Multicentric Giant Cell Tumor of Bone: Synchronous and Metachronous Presentation

Directory of Open Access Journals (Sweden)

Reiner Wirbel

2013-01-01

Full Text Available A 27-year-old man treated 2.5 years ago for synchronous multicentric giant cell tumor of bone located at the right proximal humerus and the right 5th finger presented now with complaints of pain in his right hip and wrist of two-month duration. Radiology and magnetic resonance revealed multicentric giant cell tumor lesions of the right proximal femur, the left ileum, the right distal radius, and the left distal tibia. The patient has an eighteen-year history of a healed osteosarcoma of the right tibia that was treated with chemotherapy, resection, and allograft reconstruction. A literature review establishes this as the first reported case of a patient with synchronous and metachronous multicentric giant cell tumor who also has a history of osteosarcoma.

Theoretical Underpinnings of the Other Social Effects Account

National Research Council Canada - National Science Library

Dunning, C. M; Durden, Susan

2007-01-01

...) account, well-being is a multi-faceted concept grounded in human needs that include distributive justice, social connectedness, equality, and health and safety considerations, in addition to economic well-being factors...

Computational Investigation of the Thermochemistry and Kinetics of Steam Methane Reforming Over a Multi-Faceted Nickel Catalyst

KAUST Repository

Blaylock, D. Wayne; Zhu, Yi-An; Green, William H.

2011-01-01

A microkinetic model of steam methane reforming over a multi-faceted nickel surface using planewave, periodic boundary condition density functional theory is presented. The multi-faceted model consists of a Ni(111) surface, a Ni(100) surface

The REFORM study protocol: a cohort randomised controlled trial of a multifaceted podiatry intervention for the prevention of falls in older people.

Science.gov (United States)

Cockayne, Sarah; Adamson, Joy; Corbacho Martin, Belen; Fairhurst, Caroline; Hewitt, Catherine; Hicks, Kate; Hull, Robin; Keenan, Anne Maree; Lamb, Sarah E; Loughrey, Lorraine; McIntosh, Caroline; Menz, Hylton B; Redmond, Anthony C; Rodgers, Sara; Vernon, Wesley; Watson, Judith; Torgerson, David

2014-12-17

Falls and fall-related injuries are a serious cause of morbidity and cost to society. Foot problems and inappropriate footwear may increase the risk of falls; therefore podiatric interventions may play a role in reducing falls. Two Cochrane systematic reviews identified only one study of a podiatry intervention aimed to reduce falls, which was undertaken in Australia. The REFORM trial aims to evaluate the clinical and cost-effectiveness of a multifaceted podiatry intervention in reducing falls in people aged 65 years and over in a UK and Irish setting. This multicentre, cohort randomised controlled trial will recruit 2600 participants from routine podiatry clinics in the UK and Ireland to the REFORM cohort. In order to detect a 10% point reduction in falls from 50% to 40%, with 80% power 890 participants will be randomised to receive routine podiatry care and a falls prevention leaflet or routine podiatry care, a falls prevention leaflet and a multifaceted podiatry intervention. The primary outcome is rate of falls (falls/person/time) over 12 months assessed by patient self-report falls diary. Secondary self-report outcome measures include: the proportion of single and multiple fallers and time to first fall over a 12-month period; Short Falls Efficacy Scale-International; fear of falling in the past 4 weeks; Frenchay Activities Index; fracture rate; Geriatric Depression Scale; EuroQoL-five dimensional scale 3-L; health service utilisation at 6 and 12 months. A qualitative study will examine the acceptability of the package of care to participants and podiatrists. The trial has received a favourable opinion from the East of England-Cambridge East Research Ethics Committee and Galway Research Ethics Committee. The trial results will be published in peer-reviewed journals and at conference presentations. Current Controlled Trials ISRCTN68240461 assigned 01/07/2011. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a

Baseline Patient Characteristics Predicting Outcome and Attrition in Cognitive Therapy for Social Phobia: Results from a Large Multicentre Trial.

Science.gov (United States)

Hoyer, Juergen; Wiltink, Joerg; Hiller, Wolfgang; Miller, Robert; Salzer, Simone; Sarnowsky, Stephan; Stangier, Ulrich; Strauss, Bernhard; Willutzki, Ulrike; Leibing, Eric

2016-01-01

We examined the role of baseline patient characteristics as predictors of outcome (end-state functioning, response and remission) and attrition for cognitive therapy (CT) in social anxiety disorder (SAD). Beyond socio-demographic and clinical variables such as symptom severity and comorbidity status, previously neglected patient characteristics (e.g., personality, self-esteem, shame, interpersonal problems and attachment style) were analysed. Data came from the CT arm of a multicentre RCT with n = 244 patients having DSM-IV SAD. CT was conducted according to the manual by Clark and Wells. Severity of SAD was assessed at baseline and end of treatment with the Liebowitz Social Anxiety Scale (LSAS). Multiple linear regression analyses and logistic regression analyses were applied. Up to 37% of the post-treatment variance (LSAS) could be explained by all pre-treatment variables combined. Symptom severity (baseline LSAS) was consistently negatively associated with end-state functioning and remission, but not with response. Number of comorbid diagnoses was negatively associated with end-state functioning and response, but not with remission. Self-esteem was positively associated with higher end-state functioning and more shame with better response. Attrition could not be significantly predicted. The results indicate that the initial probability for treatment success mainly depends on severity of disorder and comorbid conditions while other psychological variables are of minor importance, at least on a nomothetic level. This stands in contrast with efforts to arrive at an empirical-based foundation for differential indication and argues to search for more potent moderators of therapeutic change rather on the process level. Personality, self-esteem, shame, attachment style and interpersonal problems do not or only marginally moderate the effects of interventions in CT of social phobia. Symptom severity and comorbid diagnoses might affect treatment outcome negatively

Implementation of a clinical dementia guideline. A controlled study on the effect of a multifaceted strategy

DEFF Research Database (Denmark)

Waldorff, Frans Boch; Almind, Gert; Mäkelä, Marjukka

2003-01-01

OBJECTIVE: To assess the impact of a multifaceted implementation strategy aiming to improve GP adherence to a clinical guideline on dementia. DESIGN: Controlled before and after study using data records from regional laboratories. The guideline was mailed to all GPs. The multifaceted implementation...... strategy was planned with local GPs, and consisted of seminars, outreach visits, reminders and continuing medical education (CME) small group training. SETTING: Primary health care. SUBJECTS: 535 GP practices with 727 physicians in Denmark. MAIN OUTCOME MEASURES: The diffusion and use of the guideline...... of dementia in general practice. CONCLUSION: Although GPs regarded the guideline applicable in primary care, no change in practice adherence to guideline recommendations was detected after a multifaceted implementation....

HRM implementation in multinational companies : the dynamics of multifaceted scenarios

NARCIS (Netherlands)

Bos-Nehles, Anna; Bondarouk, Tanya; Labrenz, Soren

2017-01-01

This study explores why the subsidiary line managers of multinational companies (MNCs) implement HRM practices differently than intended by headquarters. HRM implementation is understood as a process in which one has to differentiate between a range of multifaceted HRM implementation scenarios. We

Uncharted Territory: Can Social Innovation Revitalize Literacy and Essential Skills Programs?

Science.gov (United States)

MacLaughlin, John; Samson, Ron

2013-01-01

The concept of social innovation has recently emerged as an influential approach to address intractable social problems. Increasingly discussed in academia and policy circles, the concept draws on multifaceted practices and ideas from many disciplines. Yet despite widespread discussion and promotion, there is still limited understanding of…

Health Promotion by Social Cognitive Means

Science.gov (United States)

Bandura, Albert

2004-01-01

This article examines health promotion and disease prevention from the perspective of social cognitive theory. This theory posits a multifaceted causal structure in which self-efficacy beliefs operate together with goals, outcome expectations, and perceived environmental impediments and facilitators in the regulation of human motivation, behavior,…

Evaluation of a multifaceted intervention to limit excessive antipsychotic co-prescribing in schizophrenia out-patients

DEFF Research Database (Denmark)

Baandrup, Lone; Allerup, Peter; Lublin, H

2010-01-01

OBJECTIVE: To evaluate the effect of a multifaceted educational intervention on the frequency of antipsychotic co-prescribing in adult schizophrenia out-patients. METHOD: Controlled quasi-experimental study performed in two Danish municipalities matched for baseline prevalence of antipsychotic po...... for differences in case-mix (P = 0.07). CONCLUSION: This multifaceted educational intervention failed to reduce the frequency of antipsychotic co-prescribing, but it suggested that future efforts to improve prescribing practice should address organizational barriers to implementation....

Breast Cancer a Multifaceted Phenomenon in Older Women in Nigeria

African Journals Online (AJOL)

The paper takes a look at Breast Cancer a Multifaceted Phenomenon in Older Women. The risk factors, screening, therapy and diagnosis, some forms of modern treatment were mentioned and described, their effects on victims enumerated and possible remedies spelt out for the management, reduction or eradication of the ...

The Fate of the World is in your hands: computer gaming for multi-faceted climate change education

Science.gov (United States)

Bedford, D. P.

2015-12-01

Climate change is a multi-faceted (or 'wicked') problem. True climate literacy therefore requires understanding not only the workings of the climate system, but also the current and potential future impacts of climate change and sea level rise on individuals, communities and countries around the world, as noted in the US Global Change Research Program's (2009) Climate Literacy: The Essential Principles of Climate Sciences. The asymmetric nature of climate change impacts, whereby the world's poorest countries have done the least to cause the problem but will suffer disproportionate consequences, has also been widely noted. Education in climate literacy therefore requires an element of ethics in addition to physical and social sciences. As if addressing these multiple aspects of climate change were not challenging enough, polling data has repeatedly shown that many members of the public tend to see climate change as a far away problem affecting people remote from them at a point in the future, but not themselves. This perspective is likely shared by many students. Computer gaming provides a possible solution to the combined problems of, on the one hand, addressing the multi-faceted nature of climate change, and, on the other hand, making the issue real to students. Fate of the World, a game produced by the company Red Redemption, has been used on several occasions in a small (20-30 students) introductory level general education course on global warming at Weber State University. Players are required to balance difficult decisions about energy investment while managing regional political disputes and attempting to maintain minimum levels of development in the world's poorer countries. By providing a realistic "total immersion" experience, the game has the potential to make climate change issues more immediate to players, and presents them with the ethical dilemmas inherent in climate change. This presentation reports on the use of Fate of the World in an educational

Measuring the Multifaceted Nature of Infant and Toddler Care Quality

Science.gov (United States)

Mangione, Peter L.; Kriener-Althen, Kerry; Marcella, Jennifer

2016-01-01

Research Findings: The quality of group care infants and toddlers experience relates to their concurrent and later development. Recent quality improvement initiatives point to the need for ecologically valid measures that assess the multifaceted nature of child care quality. In this article, we present the psychometric properties of an infant and…

Globalization: A Multi-Faceted Terrain | Jotia | Lwati: A Journal of ...

African Journals Online (AJOL)

This paper registers that globalization is a multifaceted phenomenon that can be viewed from the socio-economic, political and cultural perspectives. The paper explore the globalization theory which calls for the unification of one global village and also looks at forces driving globalization such as international free trade and ...

One Iota Fills the Quota: A Paradox in Multifacet Reliability Coefficients.

Science.gov (United States)

Conger, Anthony J.

1983-01-01

A paradoxical phenomenon of decreases in reliability as the number of elements averaged over increases is shown to be possible in multifacet reliability procedures (intraclass correlations or generalizability coefficients). Conditions governing this phenomenon are presented along with implications and cautions. (Author)

Multicentre structural and functional MRI

OpenAIRE

Gountouna, Viktoria-Eleni

2014-01-01

Neuroimaging techniques are likely to continue to improve our understanding of the brain in health and disease, but studies tend to be small, based in one imaging centre and of uncertain generalisability. Multicentre imaging studies therefore have great appeal but it is not yet clear under which circumstances data from different scanners can be combined. The successful harmonisation of multiple Magnetic Resonance Imaging (MRI) machines will increase study power, flexibility and...

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 th...

[Social inequalities in health, missions of a regional healthcare agency].

Science.gov (United States)

Ginot, Luc

The presence of social inequalities in health requires a multi-faceted intervention, focusing on the social determinants as well as the provision of care and prevention strategies. Regional health agencies have important levers at their disposal, as illustrated by the example of the Île-de-France region. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Infection or allergy? The multifaceted nature of vulvar dermatoses

Directory of Open Access Journals (Sweden)

Alok Vij, MD

2015-12-01

Full Text Available Chronic dermatitis or pruritus affecting the female genital and perianal skin can be challenging to properly diagnose and manage. The differential diagnosis generally includes allergic, inflammatory, infectious, and neoplastic conditions. We report the case of a 52-year-old woman with a 6-month history of a progressive, debilitating vulvar and perianal rash that highlights the multifaceted nature of female genital dermatoses.

Quality control and data-handling in multicentre studies: the case of the Multicentre Project for Tuberculosis Research

Directory of Open Access Journals (Sweden)

Caloto Teresa

2001-12-01

Full Text Available Abstract Background The Multicentre Project for Tuberculosis Research (MPTR was a clinical-epidemiological study on tuberculosis carried out in Spain from 1996 to 1998. In total, 96 centres scattered all over the country participated in the project, 19935 "possible cases" of tuberculosis were examined and 10053 finally included. Data-handling and quality control procedures implemented in the MPTR are described. Methods The study was divided in three phases: 1 preliminary phase, 2 field work 3 final phase. Quality control procedures during the three phases are described. Results: Preliminary phase: a organisation of the research team; b design of epidemiological tools; training of researchers. Field work: a data collection; b data computerisation; c data transmission; d data cleaning; e quality control audits; f confidentiality. Final phase: a final data cleaning; b final analysis. Conclusion The undertaking of a multicentre project implies the need to work with a heterogeneous research team and yet at the same time attain a common goal by following a homogeneous methodology. This demands an additional effort on quality control.

Effectiveness of a community-based multifaceted fall-prevention intervention in active and independent older Chinese adults

OpenAIRE

Xia, Q H; Jiang, Y; Niu, C J; Tang, C X; Xia, Z L

2009-01-01

Objective: To evaluate the effectiveness of an 18-month multifaceted intervention designed to reduce the incidence of falls in community-living older adults in China. Methods: A population-based community trial evaluated by before-and-after cross-sectional surveys. Four residential communities were randomised to either a multifaceted intervention or a control condition. Baseline information was collected from a sample of older adults in each community. A 1-year annual fall rate was calculated...

Differential effects of MDMA and methylphenidate on social cognition.

Science.gov (United States)

Schmid, Yasmin; Hysek, Cédric M; Simmler, Linda D; Crockett, Molly J; Quednow, Boris B; Liechti, Matthias E

2014-09-01

Social cognition is important in everyday-life social interactions. The social cognitive effects of 3,4-methylenedioxymethamphetamine (MDMA, 'ecstasy') and methylphenidate (both used for neuroenhancement and as party drugs) are largely unknown. We investigated the acute effects of MDMA (75 mg), methylphenidate (40 mg) and placebo using the Facial Emotion Recognition Task, Multifaceted Empathy Test, Movie for the Assessment of Social Cognition, Social Value Orientation Test and the Moral Judgment Task in a cross-over study in 30 healthy subjects. Additionally, subjective, autonomic, pharmacokinetic, endocrine and adverse drug effects were measured. MDMA enhanced emotional empathy for positive emotionally charged situations in the MET and tended to reduce the recognition of sad faces in the Facial Emotion Recognition Task. MDMA had no effects on cognitive empathy in the Multifaceted Empathy Test or social cognitive inferences in the Movie for the Assessment of Social Cognition. MDMA produced subjective 'empathogenic' effects, such as drug liking, closeness to others, openness and trust. In contrast, methylphenidate lacked such subjective effects and did not alter emotional processing, empathy or mental perspective-taking. MDMA but not methylphenidate increased the plasma levels of oxytocin and prolactin. None of the drugs influenced moral judgment. Effects on emotion recognition and emotional empathy were evident at a low dose of MDMA and likely contribute to the popularity of the drug. © The Author(s) 2014.

Authorship issues in multi-centre clinical trials

DEFF Research Database (Denmark)

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

2015-01-01

to qualify for authorship as defined by the International Committee of Medical Journal Editors. Therefore, rules for authorship in multi-centre trials are strongly recommended. We propose two contracts to prevent conflicts regarding authorship; both are freely available for use without pay but with reference...... to the original source....

Impact of a multifaceted community-based falls prevention program on balance-related psychologic factors.

Science.gov (United States)

Filiatrault, Johanne; Gauvin, Lise; Richard, Lucie; Robitaille, Yvonne; Laforest, Sophie; Fournier, Michel; Corriveau, Hélène

2008-10-01

To assess the impact of a multifaceted falls prevention program including exercise and educational components on perceived balance and balance confidence among community-dwelling seniors. Quasi-experimental design. Community-based organizations. Two hundred community-dwelling adults aged 60 years and over recruited by community-based organizations. A 12-week multifaceted falls prevention program including 3 components (a 1-hour group exercise class held twice a week, a 30-minute home exercise module to be performed at least once a week, a 30-minute educational class held once a week). Perceived balance and balance confidence. Multivariate analysis showed that the program was successful in increasing perceived balance in experimental participants. However, balance confidence was not improved by program participation. A multifaceted community-based falls prevention program that was successful in improving balance performance among community-dwelling seniors also had a positive impact on perceived balance. However, the program did not improve participants' balance confidence. These results suggest that balance confidence has determinants other than balance and that new components and/or modifications of existing components of the program are required to achieve maximal benefits for seniors in terms of physical and psychologic outcomes.

Multicentric Castleman's disease & HIV infection.

LENUS (Irish Health Repository)

Cotter, A

2009-10-01

We report the case of a 35 year patient from Nigeria who presented with fever and splenomegaly. The initial diagnosis was Salmonellosis. However, relapsing symptoms lead to a re-evaluation and ultimately a diagnosis of Multicentric Castleman\\'s Disease (MCD). There is no gold standard treatment but our patient responded to Rituximab and Highly active anti-retroviral therapy. MCD is a rare, aggressive disease that should be considered in a HIV positive patient presenting with fever and significant lymphadenopathy.

Effect of a multifaceted social franchising model on quality and coverage of maternal, newborn, and reproductive health-care services in Uttar Pradesh, India: a quasi-experimental study.

Science.gov (United States)

Tougher, Sarah; Dutt, Varun; Pereira, Shreya; Haldar, Kaveri; Shukla, Vasudha; Singh, Kultar; Kumar, Paresh; Goodman, Catherine; Powell-Jackson, Timothy

2018-02-01

How to harness the private sector to improve population health in low-income and middle-income countries is heavily debated and one prominent strategy is social franchising. We aimed to evaluate whether the Matrika social franchising model-a multifaceted intervention that established a network of private providers and strengthened the skills of both public and private sector clinicians-could improve the quality and coverage of health services along the continuum of care for maternal, newborn, and reproductive health. We did a quasi-experimental study, which combined matching with difference-in-differences methods. We matched 60 intervention clusters (wards or villages) with a social franchisee to 120 comparison clusters in six districts of Uttar Pradesh, India. The intervention was implemented by two not-for-profit organisations from September, 2013, to May, 2016. We did two rounds (January, 2015, and May, 2016) of a household survey for women who had given birth up to 2 years previously. The primary outcome was the proportion of women who gave birth in a health-care facility. An additional 56 prespecified outcomes measured maternal health-care use, content of care, patient experience, and other dimensions of care. We organised conceptually similar outcomes into 14 families to create summary indices. We used multivariate difference-in-differences methods for the analyses and accounted for multiple inference. The introduction of Matrika was not significantly associated with the change in facility births (4 percentage points, 95% CI -1 to 9; p=0·100). Effects for any of the other individual outcomes or for any of the 14 summary indices were not significant. Evidence was weak for an increase of 0·13 SD (95% CI 0·00 to 0·27; p=0·053) in recommended delivery care practices. The Matrika social franchise model was not effective in improving the quality and coverage of maternal health services at the population level. Several key reasons identified for the absence of

A Multifaceted Approach to Teamwork Assessment in an Undergraduate Business Program

Science.gov (United States)

Kemery, Edward R.; Stickney, Lisa T.

2014-01-01

We describe a multifaceted, multilevel approach to teamwork learning and assessment. It includes teamwork knowledge, peer and self-appraisal of teamwork behavior, and individual and team performance on objective tests for teaching and assessing teamwork in an undergraduate business program. At the beginning of this semester-long process, students…

Social Learning Theory: A Vanishing or Expanding Presence?

Science.gov (United States)

Stuart, Richard B.

1989-01-01

Reviews history and current status of social learning theory (SLT) including present conflict between "cognitive behaviorists" within the movement. Makes suggestions on how to resolve conflict in a way that will further secure the future role of SLT. Offers prescription for adoption of a multifaceted "indirect" approach to…

Social Pedagogy and Social Work: An analysis of their Relationship from a Socio-pedagogical Perspective

Directory of Open Access Journals (Sweden)

Ewa Marynowicz-Hetka

2016-04-01

Full Text Available A proposal for the relationship between social pedagogy and social work will be made in this manuscript. It is assumed that social work is a certain type of practice cultivated by representatives of the social professions. Social pedagogy can provide an analysis of the field of social work, helping to orient activities within the field and to determine the proper selection of ways of conduct, a kind of a meta-theory. Such an approach enables interaction and cooperation between representatives of multiple disciplines within the humanities and social sciences who are engaged in social work. It also has consequences for the acceptance of multi-faceted and multi-dimensional approaches to activities in the field of social work, which is recognized as an important field for social pedagogues, allowing them to carry out social actions from various perspectives, socio-pedagogical among them. The socio-pedagogical perspective on social work will be analyzed in this article.

A practical scale for Multi-Faceted Organizational Health Climate Assessment.

Science.gov (United States)

Zweber, Zandra M; Henning, Robert A; Magley, Vicki J

2016-04-01

The current study sought to develop a practical scale to measure 3 facets of workplace health climate from the employee perspective as an important component of a healthy organization. The goal was to create a short, usable yet comprehensive scale that organizations and occupational health professionals could use to determine if workplace health interventions were needed. The proposed Multi-faceted Organizational Health Climate Assessment (MOHCA) scale assesses facets that correspond to 3 organizational levels: (a) workgroup, (b) supervisor, and (c) organization. Ten items were developed and tested on 2 distinct samples, 1 cross-organization and 1 within-organization. Exploratory and confirmatory factor analyses yielded a 9-item, hierarchical 3-factor structure. Tests confirmed MOHCA has convergent validity with related constructs, such as perceived organizational support and supervisor support, as well as discriminant validity with safety climate. Lastly, criterion-related validity was found between MOHCA and health-related outcomes. The multi-faceted nature of MOHCA provides a scale that has face validity and can be easily translated into practice, offering a means for diagnosing the shortcomings of an organization or workgroup's health climate to better plan health and well-being interventions. (c) 2016 APA, all rights reserved).

What Difference Does It Make? Implicit, Explicit and Complex Social Cognition in Autism Spectrum Disorders

Science.gov (United States)

Schaller, Ulrich M.; Rauh, Reinhold

2017-01-01

We tested social cognition abilities of adolescents with autism spectrum disorders (ASD) and neurotypically developed peers (NTD). A multi-faceted test-battery including facial emotion categorization (FEC), classical false belief tasks (FBT), and complex social cognition (SC), yielded significantly lower accuracy rates for FEC and complex SC tasks…

Evaluation of a multifaceted social marketing campaign to increase awareness of and screening for oral cancer in African Americans.

Science.gov (United States)

Jedele, J M; Ismail, A I

2010-08-01

newspaper ads were printed; and 242 education sessions were conducted. The hotline received 1783 calls. The majority of callers reported that their call was prompted by a radio ad (57%). The clinic screened 1020 adults and referred 78 for further examination. Three cancers, two precancers, and 12 benign tumors were detected. The total cost associated with the campaign and toll-free hotline was $795,898. A multifaceted social marketing campaign including radio ads, billboards, and education sessions can effectively target a high-risk population and that given an outlet could result in a significant number of people getting screened at a relatively low cost.

Multifaceted Approach to Personality Assessment in Cheetahs (Acinonyx jubatus

Directory of Open Access Journals (Sweden)

Catherine B. Razal

2016-02-01

Full Text Available The purpose of this study was to assess the personality of 17 South African cheetahs at the San Diego Zoo Safari Park. A multifaceted approach of observer ratings (rating method, behavioral data (coding method and hormone monitoring was used to examine individual differences. Knowledge of these individual differences, i.e., personality, is essential to better husbandry and management in a zoological facility. Principal Components Analysis yielded five personality components: Insecure, Aggressive, Interactive, Active, and Unsociable. Comparing the personality components with gender, reproductive success, and hand-rearing history of the individuals revealed significant associations. The components Aggressive and Interactive had a positive correlation with behavioral diversity, and the component Unsociable had a positive correlation with self-maintenance. There was a significant gender difference, with males scoring higher on Aggressive and Interactive. Individuals who scored higher on these components also had higher levels of behavioral diversity, and males displayed higher levels of behavioral diversity than females. In addition, individuals that were reproductively successful scored higher on the component Unsociable, as well as displayed higher FGM levels. This study demonstrates the value of using a multifaceted approach to further understand and assess animal personality. Information gained from this study can ultimately help zoological facilities manage and assist with reproductive efforts in populations that are not currently self-sustaining, such as the cheetah.

Student learning for social relevance: the case of Melkhoutfontein ...

African Journals Online (AJOL)

... tourism as a vehicle for multi-faceted learning in a community setting. The article contextualises the project, highlights its aims and goals, describes its research approach and analyses its outcomes and results. Findings suggest that student contextualisation of learning tasks and their increased levels of social awareness ...

Social Support and Physical Health: The Importance of Belonging.

Science.gov (United States)

Hale, Cara J.; Hannum, James W.; Espelage, Dorothy L.

2005-01-01

Social support is a multifaceted construct recognized as a significant predictor of physical health. In this study, the authors examined several support domains simultaneously in a sample of 247 college students to determine their unique prediction of physical health perceptions and physical symptoms. They also examined gender differences across…

Treatment of unicentric and multicentric Castleman disease and the role of radiotherapy.

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Chronowski, G M; Ha, C S; Wilder, R B; Cabanillas, F; Manning, J; Cox, J D

2001-08-01

Although surgery is considered standard therapy for unicentric Castleman disease, favorable responses to radiotherapy also have been documented. The authors undertook this study to analyze the clinical factors, treatment approaches, and outcomes of patients with unicentric or multicentric Castleman disease, and to report the outcomes of patients with unicentric Castleman disease treated with radiotherapy. The authors reviewed the medical records of 22 patients who had received a histologic diagnosis of Castleman disease at the University of Texas M. D. Anderson Cancer Center between 1988 and 1999. One patient with a concurrent histopathologic diagnosis of nonsecretory multiple myeloma was excluded from the study. In all patients, the diagnosis of Castleman disease was based on the results of lymph node biopsies. Disease was categorized as being either unicentric or multicentric and further subdivided into hyaline vascular, plasma cell, or mixed variant histologic types. Clinical variables and outcomes were analyzed according to treatment, which consisted of surgery, chemotherapy, or radiotherapy. Records from 21 patients were analyzed: 12 had unicentric disease, and 9 had multicentric disease. The mean follow-up time for the entire series was 51 months (median, 40 months). Four patients with unicentric disease were treated with radiotherapy alone: 2 remain alive and symptom free, 2 died of causes unrelated to Castleman disease and had no evidence of disease at last follow-up. Eight patients with unicentric disease were treated with complete or partial surgical resection, and all are alive and asymptomatic. All nine patients with multicentric disease were treated with combination chemotherapy: five are alive with no evidence of disease, and four are alive with progressive disease. Surgery results in excellent rates of cure in patients with unicentric Castleman disease; radiotherapy can also achieve clinical response and cure in selected patients. Multicentric

Revisiting the Robustness of PET-Based Textural Features in the Context of Multi-Centric Trials.

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Bailly, Clément; Bodet-Milin, Caroline; Couespel, Solène; Necib, Hatem; Kraeber-Bodéré, Françoise; Ansquer, Catherine; Carlier, Thomas

2016-01-01

This study aimed to investigate the variability of textural features (TF) as a function of acquisition and reconstruction parameters within the context of multi-centric trials. The robustness of 15 selected TFs were studied as a function of the number of iterations, the post-filtering level, input data noise, the reconstruction algorithm and the matrix size. A combination of several reconstruction and acquisition settings was devised to mimic multi-centric conditions. We retrospectively studied data from 26 patients enrolled in a diagnostic study that aimed to evaluate the performance of PET/CT 68Ga-DOTANOC in gastro-entero-pancreatic neuroendocrine tumors. Forty-one tumors were extracted and served as the database. The coefficient of variation (COV) or the absolute deviation (for the noise study) was derived and compared statistically with SUVmax and SUVmean results. The majority of investigated TFs can be used in a multi-centric context when each parameter is considered individually. The impact of voxel size and noise in the input data were predominant as only 4 TFs presented a high/intermediate robustness against SUV-based metrics (Entropy, Homogeneity, RP and ZP). When combining several reconstruction settings to mimic multi-centric conditions, most of the investigated TFs were robust enough against SUVmax except Correlation, Contrast, LGRE, LGZE and LZLGE. Considering previously published results on either reproducibility or sensitivity against delineation approach and our findings, it is feasible to consider Homogeneity, Entropy, Dissimilarity, HGRE, HGZE and ZP as relevant for being used in multi-centric trials.

Playful mediation and virtual sociality

Directory of Open Access Journals (Sweden)

Sihem NAJJAR

2010-01-01

Full Text Available As a space of sociability, virtual games, especially online role playing games, allow us to capture the interest of the playfulness in social life, but they are means by which users are able to experiment their relationship to others. The virtual games as a mediation device, constitute a "pretext" to forge friendships, develop love relationships, improve language skills, discover other cultures, etc. Based on a sociological survey of Tunisian Internet users (both sexes fans of virtual games we try to show how playful mediation is producing a multifaceted virtual sociality inherent in our contemporary societies.

EOSINOPHILS: MULTIFACETED BIOLOGIC PROPERTIES AND ROLES IN HEALTH AND DISEASE

Science.gov (United States)

Kita, Hirohito

2011-01-01

Summary Eosinophils are leukocytes resident in mucosal tissues. During Th2-type inflammation, eosinophils are recruited from bone marrow and blood to the sites of immune response. While eosinophils have been considered end-stage cells involved in host protection against parasite infection and immunopathology in hypersensitivity disease, recent studies changed this perspective. Eosinophils are now considered multifunctional leukocytes involved in tissue homeostasis, modulation of adaptive immune responses, and innate immunity to certain microbes. Eosinophils are capable of producing immunoregulatory cytokines and are actively involved in regulation of Th2-type immune responses. However, such new information does not preclude earlier observations showing that eosinophils, in particular human eosinophils, are also effector cells with pro-inflammatory and destructive capabilities. Eosinophils with activation phenotypes are observed in biological specimens from patients with disease, and deposition of eosinophil products is readily seen in the affected tissues from these patients. Therefore, it would be reasonable to consider the eosinophil a multifaceted leukocyte that contributes to various physiological and pathological processes depending on their location and activation status. This review summarizes the emerging concept of the multifaceted immunobiology of eosinophils and discusses the roles of eosinophils in health and disease and the challenges and perspectives in the field. PMID:21682744

A multifaceted intervention model can give a lasting improvement of older peoples' nutritional status.

Science.gov (United States)

Lorefält, B; Wilhelmsson, S

2012-04-01

The purpose of this study was with a multifaceted intervention model improve the nutritional status of elderly people living in residential homes to increase their energy intake and to maintain improvements over time. Three different municipal residential homes in the south-east of Sweden. The study population consisted of 67 elderly people. A within-subjects design was used which means that the participants were their own controls. A multifaceted intervention model was chosen, which included education on both theoretical and practical issues, training and support for staff, and individualized snacks to the residents. Nutritional status was measured by Mini Nutritional Assessment (MNA), the consumption of food was recorded by the staff using a food record method for 3 consecutive days. The length of night-time fasting has been calculated from the food records. Nutritional status improved after 3 months of intervention and was maintained after 9 months. Weight increased during the whole study period. Night-time fasting decreased but not to the recommended level. This study shows that it is possible by a multifaceted intervention model to increase energy intake including expanding snacks and thereby improve and maintain nutritional status over a longer period in the elderly living in residential homes. This result was possible to achieve because staff received education and training in nutritional issues and by provision of support during a period when new routines were introduced.

Revisiting the Robustness of PET-Based Textural Features in the Context of Multi-Centric Trials.

Directory of Open Access Journals (Sweden)

Clément Bailly

Full Text Available This study aimed to investigate the variability of textural features (TF as a function of acquisition and reconstruction parameters within the context of multi-centric trials.The robustness of 15 selected TFs were studied as a function of the number of iterations, the post-filtering level, input data noise, the reconstruction algorithm and the matrix size. A combination of several reconstruction and acquisition settings was devised to mimic multi-centric conditions. We retrospectively studied data from 26 patients enrolled in a diagnostic study that aimed to evaluate the performance of PET/CT 68Ga-DOTANOC in gastro-entero-pancreatic neuroendocrine tumors. Forty-one tumors were extracted and served as the database. The coefficient of variation (COV or the absolute deviation (for the noise study was derived and compared statistically with SUVmax and SUVmean results.The majority of investigated TFs can be used in a multi-centric context when each parameter is considered individually. The impact of voxel size and noise in the input data were predominant as only 4 TFs presented a high/intermediate robustness against SUV-based metrics (Entropy, Homogeneity, RP and ZP. When combining several reconstruction settings to mimic multi-centric conditions, most of the investigated TFs were robust enough against SUVmax except Correlation, Contrast, LGRE, LGZE and LZLGE.Considering previously published results on either reproducibility or sensitivity against delineation approach and our findings, it is feasible to consider Homogeneity, Entropy, Dissimilarity, HGRE, HGZE and ZP as relevant for being used in multi-centric trials.

Multicentric primary extramammary Paget disease: a Toker cell disorder?

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Hashemi, Pantea; Kao, Grace F; Konia, Thomas; Kauffman, Lisa C; Tam, Christine C; Sina, Bahram

2014-07-01

Toker cells are epithelial clear cells found in the areolar and nipple areas of the breast, vulvar region, and other apocrine gland-bearing areas of the skin. Toker cells have been implicated in the pathogenesis of clear cell papulosis, cutaneous hamartoma with pagetoid cells, and rare cases of primary extramammary Paget disease (EMPD) but not in secondary EMPD with underlying adenocarcinoma. The pathogenesis of primary EMPD is not well defined. We report a case of multicentric primary EMPD with evidence of Toker cell proliferation and nonaggressive biologic behavior in a 63-year-old white man. A detailed description of the morphologic and biologic features of Toker cells and their possible carcinogenetic links also are discussed. Based on the observation and follow-up of our patient, we hypothesize that multicentric primary EMPD starts with Toker cell hyperplasia and can potentially evolve to carcinoma in the genital region.

Evaluation of an effective multifaceted implementation strategy for elective single-embryo transfer after in vitro fertilization.

Science.gov (United States)

Kreuwel, I A M; van Peperstraten, A M; Hulscher, M E J L; Kremer, J A M; Grol, R P T M; Nelen, W L D M; Hermens, R P M G

2013-02-01

What is the relationship between the rate of elective single-embryo transfer (eSET) and couples' exposure to different elements of a multifaceted implementation strategy? Additional elements in a multifaceted implementation strategy do not result in an increased eSET rate. A multifaceted eSET implementation strategy with four different elements is effective in increasing the eSET rate by 11%. It is unclear whether every strategy element contributes equally to the strategy's effectiveness. An observational study was performed among 222 subfertile couples included in a previously performed randomized controlled trial. Of the 222 subfertile couples included, 109 couples received the implementation strategy and 113 couples received standard IVF care. A multivariate regression analysis assessed the effectiveness of four different strategy elements on the decision about the number embryos to be transferred. Questionnaires evaluated the experiences of couples with the different elements. Of the couples who received the implementation strategy, almost 50% (52/109) were exposed to all the four elements of the strategy. The remaining 57 couples who received two or three elements of the strategy could be divided into two further classes of exposure. Our analysis demonstrated that additional elements do not result in an increased eSET rate. In addition to the physician's advice, couples rated a decision aid and a counselling session as more important for their decision to transfer one or two embryos, compared with a phone call and a reimbursement offer (P implementation strategy does not always result in an increased effectiveness, which is in concordance with recent literature. This in-depth evaluation of a multifaceted intervention strategy could therefore help to modify strategies, by making them more effective and less expensive.

Introducing a multifaceted exercise intervention particular to older adults diagnosed with Parkinson's disease: a preliminary study.

Science.gov (United States)

Peacock, Corey A; Sanders, Gabriel J; Wilson, Kayla A; Fickes-Ryan, Emily J; Corbett, Duane B; von Carlowitz, Kyle-Patrick A; Ridgel, Angela L

2014-08-01

With a substantial increase in diagnosed Parkinson's disease, it is of great importance to examine tolerance and physical measures of evolving exercise interventions. Of particular importance, a multifaceted exercise intervention combining active-assisted cycling and resistance training to older adults diagnosed with Parkinson's disease is being assessed. Fourteen older adults diagnosed with Parkinson's disease and ten healthy older adults (67.5 ± 7.9 years of age) engaged in an 8-week, 24-session, multifaceted exercise protocol. The protocol consisted of both active-assisted cycling and resistance training. Tolerance was measured, as well as multiple indicators of health-related physical fitness. These indicators examined improvements in cardiovascular performance, muscular strength, muscular endurance, and flexibility. Twenty-two older adults and older adults diagnosed with Parkinson's disease tolerated the intervention by completing all 24 sessions. Repeated-measures analysis of variance demonstrated significant (P ≤ 0.003) improvements in cardiovascular performance, muscular strength, muscular endurance, and flexibility for both groups of individuals. The multifaceted intervention is the first to combine both active-assisted cycling and resistance training. The older adult and the older adult diagnosed with Parkinson's disease exhibited both tolerance and health-related improvements in physical fitness following the intervention.

Data collection using open access technology in multicentre operational research involving patient interviews.

Science.gov (United States)

Shewade, H D; Chadha, S S; Gupta, V; Tripathy, J P; Satyanarayana, S; Sagili, K; Mohanty, S; Bera, O P; Pandey, P; Rajeswaran, P; Jayaraman, G; Santhappan, A; Bajpai, U N; Mamatha, A M; Maiser, R; Naqvi, A J; Pandurangan, S; Nath, S; Ghule, V H; Das, A; Prasad, B M; Biswas, M; Singh, G; Mallick, G; Jeyakumar Jaisingh, A J; Rao, R; Kumar, A M V

2017-03-21

Conducting multicentre operational research is challenging due to issues related to the logistics of travel, training, supervision, monitoring and troubleshooting support. This is even more burdensome in resource-constrained settings and if the research includes patient interviews. In this article, we describe an innovative model that uses open access tools such as Dropbox, TeamViewer and CamScanner for efficient, quality-assured data collection in an ongoing multicentre operational research study involving record review and patient interviews. The tools used for data collection have been shared for adaptation and use by other researchers.

Moral imperialism and multi-centric clinical trials in peripheral countries.

Science.gov (United States)

Garrafa, Volnei; Lorenzo, Claudio

2008-10-01

Moral imperialism is expressed in attempts to impose moral standards from one particular culture, geopolitical region or culture onto other cultures, regions or countries. Examples of Direct Moral Imperialism can be seen in various recurrent events involving multi-centric clinical trials promoted by developed (central) countries in poor and developing (peripheral) countries, particularly projects related to the theory of double standards in research. After the WMA General Assembly refused to change the Helsinki Declaration - which would have given moral recognition to the above mentioned theory - the USA abandoned the declaration and began to promote regional seminars in peripheral countries with the aim of "training" researchers on ethical perspectives that reflect America's best interests. Individuals who received such training became transmitters of these central countries' ideas across the peripheral countries, representing a form of Indirect Moral Imperialism. The paper proposes the establishment of regulatory and social control systems for clinical trials implemented in peripheral countries, through the formulation of ethical norms that reflect the specific contexts of these countries, along with the drawing up and validation of their own national norms.

Nurse case-manager vs multifaceted intervention to improve quality of osteoporosis care after wrist fracture: randomized controlled pilot study.

Science.gov (United States)

Majumdar, S R; Johnson, J A; Bellerose, D; McAlister, F A; Russell, A S; Hanley, D A; Garg, S; Lier, D A; Maksymowych, W P; Morrish, D W; Rowe, B H

2011-01-01

Few outpatients with fractures are treated for osteoporosis in the years following fracture. In a randomized pilot study, we found a nurse case-manager could double rates of osteoporosis testing and treatment compared with a proven efficacious quality improvement strategy directed at patients and physicians (57% vs 28% rates of appropriate care). Few patients with fractures are treated for osteoporosis. An intervention directed at wrist fracture patients (education) and physicians (guidelines, reminders) tripled osteoporosis treatment rates compared to controls (22% vs 7% within 6 months of fracture). More effective strategies are needed. We undertook a pilot study that compared a nurse case-manager to the multifaceted intervention using a randomized trial design. The case-manager counseled patients, arranged bone mineral density (BMD) tests, and prescribed treatments. We included controls from our first trial who remained untreated for osteoporosis 1-year post-fracture. Primary outcome was bisphosphonate treatment and secondary outcomes were BMD testing, appropriate care (BMD test-treatment if bone mass low), and costs. Forty six patients untreated 1-year after wrist fracture were randomized to case-manager (n = 21) or multifaceted intervention (n = 25). Median age was 60 years and 68% were female. Six months post-randomization, 9 (43%) case-managed patients were treated with bisphosphonates compared with 3 (12%) multifaceted intervention patients (relative risk [RR] 3.6, 95% confidence intervals [CI] 1.1-11.5, p = 0.019). Case-managed patients were more likely than multifaceted intervention patients to undergo BMD tests (81% vs 52%, RR 1.6, 95%CI 1.1-2.4, p = 0.042) and receive appropriate care (57% vs 28%, RR 2.0, 95%CI 1.0-4.2, p = 0.048). Case-management cost was $44 (CDN) per patient vs $12 for the multifaceted intervention. A nurse case-manager substantially increased rates of appropriate testing and treatment for osteoporosis in

[Multicentric hyaline vascular Castleman's disease. A POEMS type variant].

Science.gov (United States)

Gracia-Ramos, Abraham Edgar; Cruz-Domínguez, María del Pilar; Vera-Lastra, Olga Lidia

2013-01-01

Castleman's disease is an atypical lymphoproliferative disorder which may be compatible with paraneoplastic manifestations of POEMS syndrome. a 53 year old man with a history of type 2 diabetes, hypothyroidism and Addison's disease presented with numbness and weakness in limbs, dyspnea, skin hardening, Raynaud's phenomenon, weight loss and fatigue. A physical exam showed tachypnea, generalized cutaneous hyperpigmentation and skin hardening of extremities, muscle weakness, hypoesthesia and hyporeflexia. Laboratory showed hyperprolactinemia, low testosterone, hypothyroidism and Addison's disease. Electrophoresis of proteins showed polyclonal hypergammaglobulinemia. Somatosensory evoked potentials reported peripheral neuropathy and severe axonal polyneuropathy by electromyography. Chest X-rays showed bilateral reticular infiltrates and mediastinal widening. An echocardiogram displayed moderate pulmonary hypertension. Skin biopsy had no evidence of scleroderma. CT reported axillar, mediastinal and retroperitoneal nodes. The mediastinal lesion biopsy reported hyaline vascular Castleman's disease, multicentric variety. He was treated with rituximab. the case meet criteria for multicentric hyaline vascular Castleman's disease, POEMS variant, treated with rituximab.

Patient satisfaction in out-of-hospital emergency care: a multicentre survey.

Science.gov (United States)

Neumayr, Agnes; Gnirke, André; Schaeuble, Joerg C; Ganter, Michael T; Sparr, Harald; Zoll, Adolf; Schinnerl, Adolf; Nuebling, Matthias; Heidegger, Thomas; Baubin, Michael

2016-10-01

There is only limited information on patient satisfaction with emergency medical services (EMS). The aim of this multicentre survey was to evaluate patient satisfaction in five out-of-hospital physician-based EMS in Austria and Switzerland. The psychometrically tested and standardized questionnaire 'patient satisfaction in out-of-hospital emergency care' was used for this survey. The recruitment of the patients was carried out on the basis of inclusion and exclusion criteria. All questionnaires were sent together with an invitation letter and a prepaid return envelope, followed by a reminder 2 weeks later. The descriptive statistical analysis was carried out by an external organization to maintain anonymity. The response rate of all EMS was 46.7%. High satisfaction rates were achieved for the four quality scales 'emergency call, emergency treatment, transport and hospital admission'. A significant difference was found between the Swiss and the Austrian dispatch centres in the judgement of the call takers' social skills. Patient satisfaction with the emergency treatment, for example, reduction of pain, was high in all EMS, independent of whether the EMS is physician (Austria) or physician and emergency medical assistant based (Switzerland). Lowest satisfaction rates were found for items of social skills. Patient satisfaction in out-of-hospital physician-based EMS is generally high. There is room for improvement in areas such as the social skills of dispatchers and EMS-team members and the comfort of the patients during transport. A checklist should be developed for basic articles that patients should take along to hospital and for questions on responsibilities for children, dependent people or pets.

EL FORO SOCIAL MUNDIAL ANTE EL RETO DE LA EMANCIPACIÓN

OpenAIRE

Cartaya Fabregat, Raúl

2012-01-01

The current challenge of initiating processes of emancipation, confronted with the multifaceted capitalist reality extended throughout the globe and the strong depoliticization of our present day societies, appears to be an impossible task. Biopolitics and technologies of control are finding more and more fine-tuned and sophisticated mechanisms to both administrate and depoliticize. The World Social Forum, which presents itself as a social politicization model, emerged out of the rise in prot...

Synchronous multicentric osteosarcoma: the case for metastases

International Nuclear Information System (INIS)

Daffner, R.H.; Kennedy, S.L.; Fox, K.R.; Crowley, J.J.; Sauser, D.D.; Cooperstein, L.A.

1997-01-01

Objective. There is a current debate whether multicentric osteosarcoma represents synchronous multiple primary osteosarcomas or metastatic disease. The purpose of this report is to evaluate the etiology, presentation, and classification of this entity. Design and patients. Six patients ranging in age from 7 to 29 years were studied. The clinical, radiographic, and pathologic findings are reported. In addition, a review of the literature was undertaken. Results. The clinical courses of our six patients as well as a review of the literature suggest that multicentric osteosarcoma represent one extreme of a continuous scale of metastatic osteosarcoma rather than multiple synchronous primary tumors. The presentation is unusual and the clinical behavior distinctive, but the mechanism of spread remains the same: blood-borne and lymphatic-borne. Conclusions. Our experience with these six patients supports the concept in the recent literature that synchronous osteosarcoma is one extreme of the spectrum of metastatic osteosarcoma. Its unique features are: (1) multiple radiodense lesions that present simultaneously with or without pulmonary metastases; (2) a single ''dominant'' lesion with multiple smaller lesions; and (3) a uniformly rapid, fatal prognosis. Osteosarcoma should be regarded as a metastatic disease, even when only a single primary lesion is found at the initial presentation. (orig.)

A multicomponent approach to identify predictors of hospital outcomes in older in-patients: a multicentre, observational study.

Directory of Open Access Journals (Sweden)

Stefanie L De Buyser

Full Text Available BACKGROUND: The identification of older patients at risk of poor hospital outcomes (e.g. longer hospital stay, in-hospital mortality, and institutionalisation is important to provide an effective healthcare service. OBJECTIVE: To identify factors related to older patients' clinical, nutritional, functional and socio-demographic profiles at admission to an acute care ward that can predict poor hospital outcomes. DESIGN AND SETTING: The CRiteria to assess appropriate Medication use among Elderly complex patients project was a multicentre, observational study performed in geriatric and internal medicine acute care wards of seven Italian hospitals. SUBJECTS: One thousand one hundred twenty-three consecutively admitted patients aged 65 years or older. METHODS: Hospital outcomes were length of stay, in-hospital mortality, and institutionalisation. RESULTS: Mean age of participants was 81 years, 56% were women. Median length of stay was 10 (7-14 days, 41 patients died during hospital stay and 37 were newly institutionalised. Number of drugs before admission, metastasized cancer, renal failure or dialysis, infection, falls at home during the last year, pain, and walking speed were independent predictors of LoS. Total dependency in activities of daily living and inability to perform grip strength test were independent predictors of in-hospital mortality. Malnutrition and total dependency in activities of daily living were independent predictors of institutionalisation. CONCLUSIONS: Our results confirm that not only diseases, but also multifaceted aspects of ageing such as physical function and malnutrition are strong predictors of hospital outcomes and suggest that these variables should be systematically recorded.

[Sentinel node biopsy in patients with multifocal and multicentric breast cancer: A 5-year follow-up].

Science.gov (United States)

Blanco Saiz, I; López Carballo, M T; Martínez Fernández, J; Carrión Maldonado, J; Cabrera Pereira, A; Moral Alvarez, S; Santamaría Girón, L; Cantero Cerquella, F; López Secades, A; Díaz González, D; Llaneza Folgueras, A; Aira Delgado, F J

2014-01-01

Sentinel lymph node biopsy (SLNB) as a staging procedure in multiple breast cancer is a controversial issue. We have aimed to evaluate the efficacy of sentinel node (SN) detection in patients with multifocal or multicentric breast cancer as well as the safety of its clinical application after a long follow-up. A prospective descriptive study was performed. Eighty-nine patients diagnosed of multiple breast cancer (73 multifocal; 16 multicentric) underwent SLNB. These patients were compared to those with unifocal neoplasia. Periareolar radiocolloid administration was performed in most of the patients. Evaluation was made at an average of 67.2 months of follow-up (32-126 months). Scintigraphic and surgical SN localization in patients with multiple breast cancer were 95.5% and 92.1%, respectively. A higher percentage of extra-axillary nodes was observed than in the unifocal group (11.7% vs 5.4%) as well as a significantly higher number of SN per patient (1.70 vs 1.38). The rate of SN localization in multicentric cancer was slightly lower than in multifocal cancer (87.5% vs 93.1%), and the finding of extra-axillary drainages was higher (20% vs 10%). Number of SN per patient was significantly higher in multicentric breast cancer (2.33 vs 1.57). No axillary relapses have been demonstrated in the follow-up in multiple breast cancer patients group. SLNB performed by periareolar injection is a reliable and accurate staging procedure of patients with multiple breast cancer, including those with multicentric processes. Copyright © 2013 Elsevier España, S.L. and SEMNIM. All rights reserved.

Synchronous Multicentric Giant Cell Tumour of Distal Radius and Sacrum with Pulmonary Metastases

Directory of Open Access Journals (Sweden)

Varun Sharma Tandra

2015-01-01

Full Text Available Giant cell tumour (GCT is an uncommon primary bone tumour, and its multicentric presentation is exceedingly rare. We report a case of a 45-year-old female who presented to us with GCT of left distal radius. On the skeletal survey, osteolytic lesion was noted in her right sacral ala. Biopsy confirmed both lesions as GCT. Pulmonary metastasis was also present. Resection-reconstruction arthroplasty for distal radius and thorough curettage and bone grafting of the sacral lesion were done. Multicentric GCT involving distal radius and sacrum with primary sacral involvement is not reported so far to our knowledge.

Understanding Parkinson Disease: A Complex and Multifaceted Illness.

Science.gov (United States)

Gopalakrishna, Apoorva; Alexander, Sheila A

2015-12-01

Parkinson disease is an incredibly complex and multifaceted illness affecting millions of people in the United States. Parkinson disease is characterized by progressive dopaminergic neuronal dysfunction and loss, leading to debilitating motor, cognitive, and behavioral symptoms. Parkinson disease is an enigmatic illness that is still extensively researched today to search for a better understanding of the disease, develop therapeutic interventions to halt or slow progression of the disease, and optimize patient outcomes. This article aims to examine in detail the normal function of the basal ganglia and dopaminergic neurons in the central nervous system, the etiology and pathophysiology of Parkinson disease, related signs and symptoms, current treatment, and finally, the profound impact of understanding the disease on nursing care.

Artful and multifaceted applications of carbon dot in biomedicine.

Science.gov (United States)

Jaleel, Jumana Abdul; Pramod, K

2018-01-10

Carbon dots (C-dots) are luminescent carbon nanomaterial having good biocompatibility and low toxicity. The characteristic fluorescence emission property of C-dots establishes their role in optical imaging. C-dots which are superior to fluorescent dyes and semiconductor quantum dots act as a safer in vivo imaging probe. Apart from their bioimaging application, other applications in biomedicine such as drug delivery, cancer therapy, and gene delivery were studied. In this review, we present multifaceted applications of C-dots along with their synthesis, surface passivation, doping, and toxicity profile. Copyright © 2017 Elsevier B.V. All rights reserved.

Improving patient-centeredness of fertility care using a multifaceted approach: study protocol for a randomized controlled trial

Directory of Open Access Journals (Sweden)

Huppelschoten Aleida G

2012-09-01

Full Text Available Abstract Background Beside traditional outcomes of safety and (cost-effectiveness, the Institute of Medicine states patient-centeredness as an independent outcome indicator to evaluate the quality of healthcare. Providing patient-centered care is important because patients want to be heard for their ideas and concerns. Healthcare areas associated with high emotions and intensive treatment periods could especially benefit from patient-centered care. How care can become optimally improved in patient-centeredness is unknown. Therefore, we will conduct a study in the context of Dutch fertility care to determine the effects of a multifaceted approach on patient-centeredness, patients’ quality of life (QoL and levels of distress. Our aims are to investigate the effectiveness of a multifaceted approach and to identify determinants of a change in the level of patient-centeredness, patients’ QoL and distress levels. This paper presents the study protocol. Methods/Design In a cluster-randomized trial in 32 Dutch fertility clinics the effects of a multifaceted approach will be determined on the level of patient-centeredness (Patient-centredness Questionnaire – Infertility, patients’ QoL (FertiQoL and levels of distress (SCREENIVF. The multifaceted approach includes audit and feedback, educational outreach visits and patient-mediated interventions. Potential determinants of a change in patient-centeredness, patients’ QoL and levels of distress will be collected by an addendum to the patients’ questionnaire and a professionals’ questionnaire. The latter includes the Organizational Culture Assessment Instrument about the clinic’s culture as a possible determinant of an increase in patient-centered care. Discussion The study is expected to yield important new evidence about the effects of a multifaceted approach on levels of patient-centeredness, patients’ QoL and distress in fertility care. Furthermore, determinants associated with a change

Exploring the relationship between a multidimensional and multifaceted burnout concept and self-rated performance

NARCIS (Netherlands)

Demerouti, E.; Verbeke, W.J.M.I.; Bakker, A.B.

2005-01-01

This study examines the relationship between burnout and performance among three samples of account managers. Using a multidimensional and multifaceted burnout instrument, the authors tried to uncover meaningful configurations based on the basic symptoms of burnout and the role members to whom these

Toward a Multifaceted Model of Internet Access for Understanding Digital Divides: An Empirical Investigation

NARCIS (Netherlands)

van Deursen, Alexander Johannes Aloysius Maria; van Dijk, Johannes A.G.M.

2015-01-01

In this investigation, a multifaceted model of Internet appropriation that encompasses four types of access—motivational, material, skills, and usage—is tested with a representative sample of the Dutch population. The analysis indicates that while the digital divide policies' focus has moved to

The effect of a multifaceted educational intervention on medication preparation and administration errors in neonatal intensive care.

Science.gov (United States)

Chedoe, Indra; Molendijk, Harry; Hospes, Wobbe; Van den Heuvel, Edwin R; Taxis, Katja

2012-11-01

To examine the effect of a multifaceted educational intervention on the incidence of medication preparation and administration errors in a neonatal intensive care unit (NICU). Prospective study with a preintervention and postintervention measurement using direct observation. NICU in a tertiary hospital in the Netherlands. A multifaceted educational intervention including teaching and self-study. The incidence of medication preparation and administration errors. Clinical importance was assessed by three experts. The incidence of errors decreased from 49% (43-54%) (151 medications with one or more errors of 311 observations) to 31% (87 of 284) (25-36%). Preintervention, 0.3% (0-2%) medications contained severe errors, 26% (21-31%) moderate and 23% (18-28%) minor errors; postintervention, none 0% (0-2%) was severe, 23% (18-28%) moderate and 8% (5-12%) minor. A generalised estimating equations analysis provided an OR of 0.49 (0.29-0.84) for period (p=0.032), (route of administration (p=0.001), observer within period (p=0.036)). The multifaceted educational intervention seemed to have contributed to a significant reduction of the preparation and administration error rate, but other measures are needed to improve medication safety further.

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

Science.gov (United States)

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

2015-02-01

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

Building a Multi-centre Clinical Research Facilitation Network: The ARC Experience

Directory of Open Access Journals (Sweden)

Ian Nicholson

2017-06-01

Full Text Available Introduction: In order to practice evidence-based veterinary medicine, good quality clinical evidence needs to be produced, in order that it can be apprasied systematically by the EBVM network, and used by vets. There is very little good-quality veterinary evidence for most of the veterinary procedures carried out every day across the world. Very few, if any, individuals have all the necessary qualities (case-load, time, research expertise, financial support to be able to systematically produce good-quality, and relevant, clinical research on their own, in a timely manner. The Association for Veterinary Soft Tissue Surgery (AVSTS www.avsts.org.uk is an affiliate group with the British Small Animal Veterinary Association (BSAVA, and functions as a clinical network of like-minded individuals. In 2013 AVSTS sought to create a role for itself in facilitating the production (by its members of multi-centre clinical research of relevance to its members.Materials and methods: Members of AVSTS were asked to join the AVSTS Research Cooperative (ARC, with a veterinary epidemiologist and an experienced multi-centre veterinary clinical researcher (to help with study design and statistical planning, and the Animal Health Trust clinical research ethics committee. An email list was established, and a page was set up on the AVSTS website, to allow information to be disseminated. The AVSTS spring and autumn meetings were used as a regular forum by ARC, to discuss its direction, to generate interest, to create and promote specific studies (in order to widen participation amongst different centres, and to update members about previous studies.Results: Membership of ARC has grown to 224 people, although the epidemiologist left. One multi-centre study has been published, two have been presented and await publication, one has been accepted for presentation, two other studies are gathering data at present, and further studies are in the pipeline. There has been

Infinity as a Multi-Faceted Concept in History and in the Mathematics Classroom

Science.gov (United States)

Arzarello, Ferdinando; Bussi, Maria G., Bartolini; Robutti, Ornella

2004-01-01

This paper presents the conceptualisation of infinity as a multi-faceted concept, discussing two examples. The first is from history and illustrates the work of Euler, when using infinity in an algebraic context. The second sketches an activity in a school context, namely students who approach the definite integral with symbolic-graphic…

Factors contributing to the longitudinal development of social participation in individuals with cerebral palsy

NARCIS (Netherlands)

Tan, Siok Swan; van der Slot, Wilma M A; Ketelaar, Marjolijn; Becher, Jules G.; Dallmeijer, Annet J.; Smits, Dirk Wouter; Roebroeck, Marij E.

2016-01-01

Aims We aimed to determine factors associated with the longitudinal development of social participation in a Dutch population of individuals with Cerebral Palsy (CP) aged 1–24 years. Methods and procedures For this multicentre prospective longitudinal study, 424 individuals with CP aged 1–24 years

A multifaceted rehabilitation program for women with cancer.

Science.gov (United States)

Johnson, J B; Kelly, A W

1990-01-01

A multifaceted rehabilitation program for women diagnosed with cancer includes a personal fitness plan, aerobic exercise classes, journaling, and a six-day environmental wilderness experience. The program's purpose is for participants to learn how to cope with uncertainties in life and to promote a wellness concept for living with cancer. This is achieved through successfully meeting the challenges of the program. A descriptive study, using journal entries of the pilot group's 12 women with breast cancer, provides insight into participants' views of the program. Their responses described: personal growth through succeeding at new and difficult experiences; normalization engendered by communicating with others having cancer; exhilaration at focusing on challenging events external to personal health problems; and courage that overrode their fears of facing what seemed impossible.

Joys and challenges of relationships in Scotland and New Zealand rural midwifery: A multicentre study.

Science.gov (United States)

Crowther, Susan; Deery, Ruth; Daellenbach, Rea; Davies, Lorna; Gilkison, Andrea; Kensington, Mary; Rankin, Jean

2018-04-21

Globally there are challenges meeting the recruitment and retention needs for rural midwifery. Rural practice is not usually recognised as important and feelings of marginalisation amongst this workforce are apparent. Relationships are interwoven throughout midwifery and are particularly evident in rural settings. However, how these relationships are developed and sustained in rural areas is unclear. To study the significance of relationships in rural midwifery and provide insights to inform midwifery education. Multi-centre study using online surveys and discussion groups across New Zealand and Scotland. Descriptive and template analysis were used to organise, examine and analyse the qualitative data. Rural midwives highlighted how relationships with health organisations, each other and women and their families were both a joy and a challenge. Social capital was a principal theme. Subthemes were (a) working relationships, (b) respectful communication, (c) partnerships, (d) interface tensions, (e) gift of time facilitates relationships. To meet the challenges of rural practice the importance of relationship needs acknowledging. Relationships are created, built and sustained at a distance with others who have little appreciation of the rural context. Social capital for rural midwives is thus characterised by social trust, community solidarity, shared values and working together for mutual benefit. Rural communities generally exhibit high levels of social capital and this is key to sustainable rural midwifery practice. Midwives, educationalists and researchers need to address the skills required for building social capital in rural midwifery practice. These skills are important in midwifery pre- and post-registration curricula. Copyright © 2018 Australian College of Midwives. All rights reserved.

EBV+ HHV-8+ Multicentric Castleman Disease With Plasmablastic Aggregates in an HIV+ Man: An Evolving Clinicopathologic Entity.

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Shivane, Aditya; Pearce, Amy; Khatib, Nadia; Smith, Mark E F

2018-06-01

We report a case of EBV+ and HHV-8+ multicentric Castleman disease with plasmablastic aggregates in an HIV-positive individual. A 41-year-old man presented in early 2015 with fevers, sweats, weight loss, intractable itching, and on subsequent testing was found to be HIV positive. Investigations showed cervical lymphadenopathy and splenomegaly. He was treated for HIV and his symptoms resolved. His symptoms recurred in January 2016, and a provisional diagnosis of multicentric Castleman disease was entertained. The HHV-8 (human herpesvirus-8) and EBV (Epstein-Barr virus) viral load was elevated. A left supraclavicular lymph node core biopsy was performed, which showed features of multicentric Castleman disease with plasmablastic aggregates that are EBV (EBER) and HHV-8 positive. He responded well to rituximab treatment and remains well with no symptoms at recent follow-up.

Multifaceted Modelling of Complex Business Enterprises.

Science.gov (United States)

Chakraborty, Subrata; Mengersen, Kerrie; Fidge, Colin; Ma, Lin; Lassen, David

2015-01-01

We formalise and present a new generic multifaceted complex system approach for modelling complex business enterprises. Our method has a strong focus on integrating the various data types available in an enterprise which represent the diverse perspectives of various stakeholders. We explain the challenges faced and define a novel approach to converting diverse data types into usable Bayesian probability forms. The data types that can be integrated include historic data, survey data, and management planning data, expert knowledge and incomplete data. The structural complexities of the complex system modelling process, based on various decision contexts, are also explained along with a solution. This new application of complex system models as a management tool for decision making is demonstrated using a railway transport case study. The case study demonstrates how the new approach can be utilised to develop a customised decision support model for a specific enterprise. Various decision scenarios are also provided to illustrate the versatility of the decision model at different phases of enterprise operations such as planning and control.

Multifaceted Modelling of Complex Business Enterprises

Science.gov (United States)

2015-01-01

We formalise and present a new generic multifaceted complex system approach for modelling complex business enterprises. Our method has a strong focus on integrating the various data types available in an enterprise which represent the diverse perspectives of various stakeholders. We explain the challenges faced and define a novel approach to converting diverse data types into usable Bayesian probability forms. The data types that can be integrated include historic data, survey data, and management planning data, expert knowledge and incomplete data. The structural complexities of the complex system modelling process, based on various decision contexts, are also explained along with a solution. This new application of complex system models as a management tool for decision making is demonstrated using a railway transport case study. The case study demonstrates how the new approach can be utilised to develop a customised decision support model for a specific enterprise. Various decision scenarios are also provided to illustrate the versatility of the decision model at different phases of enterprise operations such as planning and control. PMID:26247591

HIV-associated multicentric Castleman’s disease

Directory of Open Access Journals (Sweden)

Fauzia de Fátima Naime

2012-09-01

Full Text Available Multicentric Castleman’s disease (MCD is a rare lymphoproliferative disorder. It is found with higher frequency in patients with HIV infection, with systemic symptoms and poor prognosis. We present the case of a 32-year old man with HIV disease, Kaposi’s sarcoma, lymphadenopathy, fever and hemolytic anemia. A diagnosis of Castleman’s disease is confirmed through biopsy and treatment is often based only on published case reports. Systemic treatments for MCD have included chemotherapy, anti-herpes virus, highly active antiretroviral therapy and, more recently, monoclonal antibodies against both IL6 and CD20.

Loss to follow-up in an international, multicentre observational study

DEFF Research Database (Denmark)

Mocroft, A; Kirk, O; Aldins, P

2008-01-01

OBJECTIVE: The aim of this work was to assess loss to follow-up (LTFU) in EuroSIDA, an international multicentre observational cohort study. METHODS: LTFU was defined as no follow-up visit, CD4 cell count measurement or viral load measurement after 1 January 2006. Poisson regression was used...

Implementation of a clinical dementia guideline. A controlled study on the effect of a multifaceted strategy

DEFF Research Database (Denmark)

Waldorff, Frans Boch; Almind, Gert; Mäkelä, Marjukka

2003-01-01

OBJECTIVE: To assess the impact of a multifaceted implementation strategy aiming to improve GP adherence to a clinical guideline on dementia. DESIGN: Controlled before and after study using data records from regional laboratories. The guideline was mailed to all GPs. The multifaceted implementation...... strategy was planned with local GPs, and consisted of seminars, outreach visits, reminders and continuing medical education (CME) small group training. SETTING: Primary health care. SUBJECTS: 535 GP practices with 727 physicians in Denmark. MAIN OUTCOME MEASURES: The diffusion and use of the guideline...... was measured by a mailed survey. Adherence to guideline recommendations was monitored by data on laboratory tests from general practice in patient's > or = 65 years: thyroid stimulating hormone requested with vitamin B12 or methylmalonate. The use of these tests as part of a diagnostic evaluation of dementia...

Unilateral pallidotomy in Parkinson's disease : a randomised, single-blind, multicentre trial

NARCIS (Netherlands)

de Bie, RMA; de Haan, RJ; Nijssen, PCG; Rutgers, AWF; Beute, GN; Haaxma, R; Schmand, B; Staal, MJ; Speelman, J.D.

1999-01-01

Background The results of several cohort studies suggest that patients with advanced Parkinson's disease would benefit from unilateral pallidotomy. We have assessed the efficacy of unilateral pallidotomy in a randomised, single-blind, multicentre trial. Methods We enrolled 37 patients with advanced

Evaluation of web-based annotation of ophthalmic images for multicentric clinical trials.

Science.gov (United States)

Chalam, K V; Jain, P; Shah, V A; Shah, Gaurav Y

2006-06-01

An Internet browser-based annotation system can be used to identify and describe features in digitalized retinal images, in multicentric clinical trials, in real time. In this web-based annotation system, the user employs a mouse to draw and create annotations on a transparent layer, that encapsulates the observations and interpretations of a specific image. Multiple annotation layers may be overlaid on a single image. These layers may correspond to annotations by different users on the same image or annotations of a temporal sequence of images of a disease process, over a period of time. In addition, geometrical properties of annotated figures may be computed and measured. The annotations are stored in a central repository database on a server, which can be retrieved by multiple users in real time. This system facilitates objective evaluation of digital images and comparison of double-blind readings of digital photographs, with an identifiable audit trail. Annotation of ophthalmic images allowed clinically feasible and useful interpretation to track properties of an area of fundus pathology. This provided an objective method to monitor properties of pathologies over time, an essential component of multicentric clinical trials. The annotation system also allowed users to view stereoscopic images that are stereo pairs. This web-based annotation system is useful and valuable in monitoring patient care, in multicentric clinical trials, telemedicine, teaching and routine clinical settings.

Shifting social identities as a strategy for deflecting threatening social comparisons.

Science.gov (United States)

Mussweiler, T; Gabriel, S; Bodenhausen, G V

2000-09-01

Results of three studies suggest that the multifaceted nature of identity provides a strategic basis for reducing the threat involved in upward social comparisons. After performing worse than a comparison standard, people may strategically emphasize aspects of their identity that differentiate them from the standard, thereby making the standard less relevant for self-evaluation. On the basis of previous research showing that persons low in self-esteem are less likely to make effective use of self-protection strategies, we hypothesized that this strategy of deflecting the threat involved in upward comparison (i.e., decreasing perceived comparability by emphasizing an unshared social identity) would be used primarily by persons who are characteristically high in self-esteem. This pattern was confirmed in three studies. Moreover, use of the strategy was associated with relatively more positive affect following threatening upward comparisons.

The multifaceted influence of gender in career progress in nursing.

Science.gov (United States)

Tracey, Catherine; Nicholl, Honor

2007-10-01

The complex web of gender influence in the workplace results from a multifaceted interplay of factors [Walby et al. (1994) Medicine and Nursing. Sage Publications, London]. Literature reports that in nursing men's success compared with that of women is disproportionate and substantial evidence of gender-based disadvantage is found [Women in Management Review13 (1998) 184]. However, studies have not addressed the specific reasons for this and little is known of how or what influences nurses' career decisions and developments [Journal of Advanced Nursing25 (1997) 602]. Those studies which examine career developments and patterns are mainly found in the private business sector.

The Impact of Multifaceted Osteoporosis Group Education on Patients’ Decision-Making regarding Treatment Options and Lifestyle Changes

DEFF Research Database (Denmark)

Jensen, Annesofie L.; Wind, Gitte; Langdahl, Bente Lomholt

2018-01-01

-based knowledge and personal experiences and preferences, respectively, leading to a two-way exchange of information and deliberation about recommendations. Though teachers and patients explored the implications of the decisions and shared their preferences, teachers stressed that the patients ultimately had......Patients with chronic diseases like osteoporosis constantly have to make decisions related to their disease. Multifaceted osteoporosis group education (GE) may support patients’ decision-making. This study investigated multifaceted osteoporosis GE focusing on the impact of GE on patients’ decision....... Results. Attending GE had an impact on the patients’ decision-making in all educational themes. Patients decided on new ways to manage osteoporosis and made decisions regarding bone health and how to implement a lifestyle ensuring bone health. During GE, teachers and patients shared evidence...

Design and baseline characteristics of the ParkFit study, a randomized controlled trial evaluating the effectiveness of a multifaceted behavioral program to increase physical activity in Parkinson patients

Directory of Open Access Journals (Sweden)

van Nimwegen Marlies

2010-08-01

Full Text Available Abstract Background Many patients with Parkinson's disease (PD lead a sedentary lifestyle. Promotion of physical activities may beneficially affect the clinical presentation of PD, and perhaps even modify the course of PD. However, because of physical and cognitive impairments, patients with PD require specific support to increase their level of physical activity. Methods We developed the ParkFit Program: a PD-specific and multifaceted behavioral program to promote physical activity. The emphasis is on creating a behavioral change, using a combination of accepted behavioral motivation techniques. In addition, we designed a multicentre randomized clinical trial to investigate whether this ParkFit Program increases physical activity levels over two years in sedentary PD patients. We intended to include 700 sedentary patients. Primary endpoint is the time spent on physical activities per week, which will be measured every six months using an interview-based 7-day recall. Results In total 3453 PD patients were invited to participate. Ultimately, 586 patients - with a mean (SD age of 64.1 (7.6 years and disease duration of 5.3 (4.5 years - entered the study. Study participants were younger, had a shorter disease duration and were less sedentary compared with eligible PD patients not willing to participate. Discussion The ParkFit trial is expected to yield important new evidence about behavioral interventions to promote physical activity in sedentary patients with PD. The results of the trial are expected in 2012. Trial registration http://clinicaltrials.gov (nr NCT00748488.

Pressure sores--a multifaceted approach to prevention and treatment.

Science.gov (United States)

Staas, W. E.; Cioschi, H. M.

1991-01-01

The incidence and effect of pressure sores on the disabled and elderly population have created a challenge to physicians and health care professionals, from emergency departments to rehabilitation units, and in the community. If not prevented, the morbidity and mortality of patients and the direct and indirect costs to both patients and the health care system are radically increased. In this article we define the impact on our health care system of pressure sores, provide an overview of a multifaceted approach to their prevention and management, and introduce successful behavioral and educational approaches for patients with chronic, recurrent sores. A coordinated approach with patients as informed participants and their care givers enhances the chances for success. PMID:1830985

Global aspirations, local realities: the role of social science research in controlling neglected tropical diseases.

Science.gov (United States)

Bardosh, Kevin

2014-01-01

Neglected Tropical Diseases (NTDs) are both drivers and manifestations of poverty and social inequality. Increased advocacy efforts since the mid-2000s have led to ambitious new control and elimination targets set for 2020 by the World Health Organisation. While these global aspirations represent significant policy momentum, there are multifaceted challenges in controlling infectious diseases in resource-poor local contexts that need to be acknowledged, understood and engaged. However a number of recent publications have emphasised the "neglected" status of applied social science research on NTDs. In light of the 2020 targets, this paper explores the social science/NTD literature and unpacks some of the ways in which social inquiry can help support effective and sustainable interventions. Five priority areas are discussed, including on policy processes, health systems capacity, compliance and resistance to interventions, education and behaviour change, and community participation. The paper shows that despite the multifaceted value of having anthropological and sociological perspectives integrated into NTD programmes, contemporary efforts underutilise this potential. This is reflective of the dominance of top-down information flows and technocratic approaches in global health. To counter this tendency, social research needs to be more than an afterthought; integrating social inquiry into the planning, monitoring and evaluating process will help ensure that flexibility and adaptability to local realities are built into interventions. More emphasis on social science perspectives can also help link NTD control to broader social determinants of health, especially important given the major social and economic inequalities that continue to underpin transmission in endemic countries.

Multifaceted medication adherence intervention for patients with hypertension in secondary care

DEFF Research Database (Denmark)

Hedegaard, Ulla; Hallas, Jesper; Nielsen, Lene Ravn-Vestergaard

study was to describe the content and process outcomes of an adherence program developed for hypertensive patients in a hospital setting. Methods The intervention development was based on adherence and behavioral theories, and evidence of effective interventions. The intervention was pharmacist...... action (60%) and was exercised in 94% of the patients. All participants gave informed consent and the study was approved by The Regional Scientific Ethical Committee for Southern Denmark and the Danish Registry Board Conclusions A pharmacist-led multifaceted tailored adherence intervention has been...

Case report 375: Multicentric reticulohistiocytosis

International Nuclear Information System (INIS)

Scutellari, P.N.; Orzincolo, C.; Trotta, F.

1986-01-01

In summary, a case of multicentric reticulohistiocytosis in an 18-year-old girl is presented, with dramatic demonstration of the progressive lesions of the hands demonstrated in xeroradiographs. The association of nodules in the skin, particularly around the distal interphalangeal joints of the hands is stressed and the generally progressive nature of the disorder is emphasized and illustrated in this patient. The end result in most instances is that of an 'arthritis mutilans', with extensive deformities, particularly of the distal phalanges of the hands. The clinical, radiological and pathological aspects of the disorder are discussed and a review of the literature is included. The differential diagnosis, particularly including rheumatoid arthritis, is described in detail. The pathogenesis of the disorder is considered. (orig./SHA)

Multifaceted diversity-area relationships reveal global hotspots of mammalian species, trait and lineage diversity.

Science.gov (United States)

Mazel, Florent; Guilhaumon, François; Mouquet, Nicolas; Devictor, Vincent; Gravel, Dominique; Renaud, Julien; Cianciaruso, Marcus Vinicius; Loyola, Rafael Dias; Diniz-Filho, José Alexandre Felizola; Mouillot, David; Thuiller, Wilfried

2014-08-01

To define biome-scale hotspots of phylogenetic and functional mammalian biodiversity (PD and FD, respectively) and compare them to 'classical' hotspots based on species richness (SR) only. Global. SR, PD & FD were computed for 782 terrestrial ecoregions using distribution ranges of 4616 mammalian species. We used a set of comprehensive diversity indices unified by a recent framework that incorporates the species relative coverage in each ecoregion. We build large-scale multifaceted diversity-area relationships to rank ecoregions according to their levels of biodiversity while accounting for the effect of area on each diversity facet. Finally we defined hotspots as the top-ranked ecoregions. While ignoring species relative coverage led to a relative good congruence between biome top ranked SR, PD and FD hotspots, ecoregions harboring a rich and abundantly represented evolutionary history and functional diversity did not match with top ranked ecoregions defined by species richness. More importantly PD and FD hotspots showed important spatial mismatches. We also found that FD and PD generally reached their maximum values faster than species richness as a function of area. The fact that PD/FD reach faster their maximal value than SR may suggest that the two former facets might be less vulnerable to habitat loss than the latter. While this point is expected, it is the first time that it is quantified at global scale and should have important consequences in conservation. Incorporating species relative coverage into the delineation of multifaceted hotspots of diversity lead to weak congruence between SR, PD and FD hotspots. This means that maximizing species number may fail at preserving those nodes (in the phylogenetic or functional tree) that are relatively abundant in the ecoregion. As a consequence it may be of prime importance to adopt a multifaceted biodiversity perspective to inform conservation strategies at global scale.

Multicentre European study of thalamic stimulation in parkinsonian and essential tremor

NARCIS (Netherlands)

Limousin, P.; Speelman, J. D.; Gielen, F.; Janssens, M.

1999-01-01

Thalamic stimulation has been proposed to treat disabling tremor. The aims of this multicentre study were to evaluate the efficacy and the morbidity of thalamic stimulation in a large number of patients with parkinsonian or essential tremor. One hundred and eleven patients were included in the study

The multifaceted roles of Leptospira enolase.

Science.gov (United States)

Salazar, Natália; Souza, Matilde Costa Lima de; Biasioli, Amanda Gameiro; Silva, Ludmila Bezerra da; Barbosa, Angela Silva

A previous study had demonstrated that Leptospira enolase is secreted extracellularly by a yet unknown mechanism and reassociates with the bacterial membrane. Surface-anchored leptospiral enolase displays plasminogen binding activity. In this work, we explored the consequences of this interaction and also assessed whether Leptospira enolase might display additional moonlighting functions by interacting with other host effector proteins. We first demonstrated that enolase-bound plasminogen is converted to its active form, plasmin. The protease plasmin targets human fibrinogen and vitronectin, but not the complement proteins C3b and C5. Leptospira enolase also acts as an immune evasion protein by interacting with the negative complement regulators C4b binding protein and factor H. Once bound to enolase, both regulators remain functional as cofactors of factor I, mediating cleavage of C4b and C3b. In conclusion, enolase may facilitate leptospiral survival and dissemination, thus contributing to bacterial virulence. The identification and characterization of moonlighting proteins is a growing field of bacterial pathogenesis, as these multifaceted proteins may represent potential future therapeutic targets to fight bacterial infections. Copyright © 2016 Institut Pasteur. Published by Elsevier Masson SAS. All rights reserved.

Coronary CT angiography using 64 detector rows: methods and design of the multi-centre trial CORE-64

Energy Technology Data Exchange (ETDEWEB)

Miller, Julie M.; Vavere, Andrea L.; Arbab-Zadeh, Armin; Bush, David E.; Lardo, Albert C.; Texter, John; Brinker, Jeffery; Lima, Joao A.C. [Johns Hopkins Hospital, Johns Hopkins University, Department of Medicine, Division of Cardiology, Baltimore, MD (United States); Dewey, Marc [Charite - Universitaetsmedizin Berlin, Medical School, Humboldt-Universitaet und Freie Universitaet zu Berlin, Department of Radiology, Berlin, PO Box 10098 (Germany); Rochitte, Carlos E.; Lemos, Pedro A. [University of Sao Paulo Medical School, Heart Institute (InCor), Sao Paulo (Brazil); Niinuma, Hiroyuki [Iwate Medical University, Department of Cardiology, Morioka (Japan); Paul, Narinder [Toronto General Hospital, Department of Medical Imaging, Toronto (Canada); Hoe, John [Medi-Rad Associates Ltd, CT Centre, Mt Elizabeth Hospital, Singapore (Singapore); Roos, Albert de [Leiden University Medical Center, Department of Radiology, Leiden (Netherlands); Yoshioka, Kunihiro [Iwate Medical University, Department of Radiology, Morioka (Japan); Cox, Christopher [Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD (United States); Clouse, Melvin E. [Harvard University, Department of Radiology, Beth Israel Deaconess, Boston, MA (United States)

2009-04-15

Multislice computed tomography (MSCT) for the noninvasive detection of coronary artery stenoses is a promising candidate for widespread clinical application because of its non-invasive nature and high sensitivity and negative predictive value as found in several previous studies using 16 to 64 simultaneous detector rows. A multi-centre study of CT coronary angiography using 16 simultaneous detector rows has shown that 16-slice CT is limited by a high number of nondiagnostic cases and a high false-positive rate. A recent meta-analysis indicated a significant interaction between the size of the study sample and the diagnostic odds ratios suggestive of small study bias, highlighting the importance of evaluating MSCT using 64 simultaneous detector rows in a multi-centre approach with a larger sample size. In this manuscript we detail the objectives and methods of the prospective ''CORE-64'' trial (''Coronary Evaluation Using Multidetector Spiral Computed Tomography Angiography using 64 Detectors''). This multi-centre trial was unique in that it assessed the diagnostic performance of 64-slice CT coronary angiography in nine centres worldwide in comparison to conventional coronary angiography. In conclusion, the multi-centre, multi-institutional and multi-continental trial CORE-64 has great potential to ultimately assess the per-patient diagnostic performance of coronary CT angiography using 64 simultaneous detector rows. (orig.)

Best Friends’ Discussions of Social Dilemmas

Science.gov (United States)

McDonald, Kristina L.; Malti, Tina; Killen, Melanie; Rubin, Kenneth H.

2013-01-01

Peer relationships, particularly friendships, have been theorized to contribute to how children and adolescents think about social and moral issues. The current study examined how young adolescent best friends (191 dyads; 53.4% female) reason together about multifaceted social dilemmas and how their reasoning is related to friendship quality. Mutually-recognized friendship dyads were videotaped discussing dilemmas entailing moral, social-conventional and prudential/pragmatic issues. Both dyad members completed a self-report measure of friendship quality. Dyadic data analyses guided by the Actor-Partner Interdependence Model indicated that adolescent and friend's reports of friendship qualities were related to the forms of reasoning used during discussion. Friends who both reported that they could resolve conflicts in a constructive way were more likely to use moral reasoning than friends who reported that their conflict resolution was poor or disagreed on the quality of their conflict resolution. The findings provide evidence for the important role that friendship interaction may play in adolescents’ social and moral development. PMID:23666555

Best friends' discussions of social dilemmas.

Science.gov (United States)

McDonald, Kristina L; Malti, Tina; Killen, Melanie; Rubin, Kenneth H

2014-02-01

Peer relationships, particularly friendships, have been theorized to contribute to how children and adolescents think about social and moral issues. The current study examined how young adolescent best friends (191 dyads; 53.4% female) reason together about multifaceted social dilemmas and how their reasoning is related to friendship quality. Mutually-recognized friendship dyads were videotaped discussing dilemmas entailing moral, social-conventional and prudential/pragmatic issues. Both dyad members completed a self-report measure of friendship quality. Dyadic data analyses guided by the Actor-Partner Interdependence Model indicated that adolescent and friend reports of friendship qualities were related to the forms of reasoning used during discussion. Friends who both reported that they could resolve conflicts in a constructive way were more likely to use moral reasoning than friends who reported that their conflict resolution was poor or disagreed on the quality of their conflict resolution. The findings provide evidence for the important role that friendship interaction may play in adolescents' social and moral development.

Multifaceted Roles of Connexin 43 in Stem Cell Niches.

Science.gov (United States)

Genet, Nafiisha; Bhatt, Neha; Bourdieu, Antonin; Hirschi, Karen K

2018-01-01

Considerable progress has been made in the field of stem cell research; nonetheless, the use of stem cells for regenerative medicine therapies, for either endogenous tissue repair or cellular grafts post injury, remains a challenge. To better understand how to maintain stem cell potential in vivo and promote differentiation ex vivo, it is fundamentally important to elucidate the interactions between stem cells and their surrounding partners within their distinct niches. Among the vast array of proteins depicted as mediators for cell-to-cell interactions, connexin-comprised gap junctions play pivotal roles in the regulation of stem cell fate both in vivo and in vitro. This review summarizes and illustrates the current knowledge regarding the multifaceted roles of Cx43, specifically, in various stem cell niches.

The effectiveness of 2-implant overdentures: a pragmatic international multicentre study

NARCIS (Netherlands)

Rashid, F.; Awad, M.A.; Thomason, J.M.; Piovano, A.; Spielberg, G.P.; Scilingo, E.; Mojon, P.; Müller, F.; Spielberg, M.; Heydecke, G.; Stoker, G.; Wismeijer, D.; Allen, F.; Feine, J.S.

2011-01-01

The purpose of this multicentre observational study was to determine patient satisfaction with either conventional dentures or mandibular 2-implant overdentures in a 'real world' setting. Two hundred and three edentulous patients (mean age 68·8 ± 10·4 years) were recruited at eight centres located

Multicentre quality assurance of intensity-modulated radiation therapy plans: a precursor to clinical trials

International Nuclear Information System (INIS)

Williams, M. J.; Bailey, M. J.; Forstner, D.; Metcalfe, P. E

2007-01-01

Full text: A multicentre planning study comparing intensity-modulated radiation therapy (IMRT) plans for the treatment of a head and neck cancer has been carried out. Three Australian radiotherapy centres, each with a different planning system, were supplied a fully contoured CT dataset and requested to generate an IMRT plan in accordance with the requirements of an IMRT-based radiation therapy oncology group clinical trial. Plan analysis was carried out using software developed specifically for reviewing multicentre clinical trial data. Two out of the three plans failed to meet the prescription requirements with one misinterpreting the prescription and the third failed to meet one of the constraints. Only one plan achieved all of the dose objectives for the critical structures and normal tissues. Although each centre used very similar planning parameters and beam arrangements the resulting plans were quite different. The subjective interpretation and application of the prescription and planning objectives emphasize one of the many difficulties in carrying out multicentre IMRT planning studies. The treatment prescription protocol in a clinical trial must be both lucid and unequivocally stated to avoid misinterpretation. Australian radiotherapy centres must show that they can produce a quality IMRT plan and that they can adhere to protocols for IMRT planning before using it in a clinical trial

Acceptance and Commitment Therapy for Psychological and Physiological Illnesses: A Systematic Review for Social Workers

Science.gov (United States)

Montgomery, Katherine L.; Kim, Johnny S.; Franklin, Cynthia

2011-01-01

Social workers provide services to a variety of clients and are challenged with finding interventions that meet the multifaceted needs of diverse populations. Acceptance and commitment therapy (ACT) is becoming an increasingly popular therapy that offers flexibility and effectiveness in treating challenging cases. The purpose of this review is to…

[Establishment and Management of Multicentral Collection Bio-sample Banks of Malignant Tumors from Digestive System].

Science.gov (United States)

Shen, Si; Shen, Junwei; Zhu, Liang; Wu, Chaoqun; Li, Dongliang; Yu, Hongyu; Qiu, Yuanyuan; Zhou, Yi

2015-11-01

To establish and manage of multicentral collection bio-sample banks of malignant tumors from digestive system, the paper designed a multicentral management system, established the standard operation procedures (SOPs) and leaded ten hospitals nationwide to collect tumor samples. The biobank has been established for half a year, and has collected 695 samples from patients with digestive system malignant tumor. The clinical data is full and complete, labeled in a unified way and classified to be managed. The clinical and molecular biology researches were based on the biobank, and obtained achievements. The biobank provides a research platform for malignant tumor of digestive system from different regions and of different types.

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...

Violent women : A multicentre study into gender differences in forensic psychiatric patients

NARCIS (Netherlands)

de Vogel, Vivienne; Stam, Jeantine; Bouman, Yvonne H. A.; Ter Horst, P.R.M.; Lancel, Marike

2016-01-01

To gain insight into the relatively small, but increasing group of women in forensic psychiatry, a retrospective multicentre study was started gathering information from the files of 275 female patients of four Dutch forensic psychiatric hospitals on characteristics and violence risk factors.

The effect of a multifaceted educational intervention on medication preparation and administration errors in neonatal intensive care

NARCIS (Netherlands)

Chedoe, Indra; Molendijk, Harry; Hospes, Wobbe; Van den Heuvel, Edwin B.; Taxis, Katja

Objective To examine the effect of a multifaceted educational intervention on the incidence of medication preparation and administration errors in a neonatal intensive care unit (NICU). Design Prospective study with a preintervention and postintervention measurement using direct observation. Setting

Description of a multifaceted rehabilitation program including overground gait training for a child with cerebral palsy: A case report.

Science.gov (United States)

Farrell, Elizabeth; Naber, Erin; Geigle, Paula

2010-01-01

This case describes the outcomes of a multifaceted rehabilitation program including body weight-supported overground gait training (BWSOGT) in a nonambulatory child with cerebral palsy (CP) and the impact of this treatment on the child's functional mobility. The patient is a nonambulatory 10-year-old female with CP who during an inpatient rehabilitation stay participated in direct, physical therapy 6 days per week for 5 weeks. Physical therapy interventions included stretching of her bilateral lower extremities, transfer training, bed mobility training, balance training, kinesiotaping, supported standing in a prone stander, two trials of partial weight-supported treadmill training, and for 4 weeks, three to five times per week, engaged in 30 minutes of BWSOGT using the Up n' go gait trainer, Lite Gait Walkable, and Rifton Pacer gait trainer. Following the multifaceted rehabilitation program, the patient demonstrated increased step initiation, increased weight bearing through bilateral lower extremities, improved bed mobility, and increased participation in transfers. The child's Gross Motor Functional Measure (GMFM) scores increased across four dimensions and her Physical Abilities and Mobility Scale (PAMS) increased significantly. This case report illustrates that a multifaceted rehabilitation program including BWSOGT was an effective intervention strategy to improve functional mobility in this nonambulatory child with CP.

Perinatal complications in patients with unisutural craniosynostosis: An international multicentre retrospective cohort study

NARCIS (Netherlands)

Cornelissen, Martijn J.; Softeland, Madiha; Apon, Inge; Ladfors, Lars; Mathijssen, Irene M. J.; Cohen-Overbeek, Titia E.; Bonsel, Gouke J.; Kolby, Lars

2017-01-01

Purpose Craniosynostosis may lead to hampered fetal head molding and birth complications. To study the interaction between single suture craniosynostosis and delivery complications, an international, multicentre, retrospective cohort study was performed. Materials and methods All infants born

Effect of an in-hospital multifaceted clinical pharmacist intervention on the risk of readmission a randomized clinical trial

DEFF Research Database (Denmark)

Ravn-Nielsen, Lene Vestergaard; Duckert, Marie Louise; Lund, Mia Lolk

2018-01-01

IMPORTANCE Hospital readmissions are common among patients receiving multiple medications, with considerable costs to the patients and society. OBJECTIVE To determine whether a multifaceted pharmacist intervention based on medication review, patient interview, and follow-up can reduce the number...... of readmissions and emergency department (ED) visits. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical multicenter study (Odense Pharmacist Trial Investigating Medication Interventions at Sector Transfer [OPTIMIST]) enrolled patients from September 1, 2013, through April 23, 2015, with a follow-up of 6...... days (HR, 0.80; 95% CI, 0.59-1.08) after inclusion and in deaths (HR, 0.83; 95% CI, 0.22-3.11). The number needed to treat to achieve the primary composite outcome for the extended intervention (vs usual care) was 12. CONCLUSIONS AND RELEVANCE A multifaceted clinical pharmacist intervention may reduce...

Effects of Video Feedback on Social Behaviour of Young People with Mild Intellectual Disability and Staff Responses.

Science.gov (United States)

Embregts, Petri J. C. M.

2002-01-01

A study evaluated effects of a multifaceted training procedure on the inappropriate and appropriate social behavior of five adolescents with mild intellectual disability and on staff responses. The training included video feedback and self-management procedures and staff training with video and graphic feedback. Results indicated increases in…

Multifaceted intervention including education, rounding checklist implementation, cost feedback, and financial incentives reduces inpatient laboratory costs.

Science.gov (United States)

Yarbrough, Peter M; Kukhareva, Polina V; Horton, Devin; Edholm, Karli; Kawamoto, Kensaku

2016-05-01

Inappropriate laboratory testing is a contributor to waste in healthcare. To evaluate the impact of a multifaceted laboratory reduction intervention on laboratory costs. A retrospective, controlled, interrupted time series (ITS) study. University of Utah Health Care, a 500-bed academic medical center in Salt Lake City, Utah. All patients 18 years or older admitted to the hospital to a service other than obstetrics, rehabilitation, or psychiatry. Multifaceted quality-improvement initiative in a hospitalist service including education, process change, cost feedback, and financial incentive. Primary outcomes of lab cost per day and per visit. Secondary outcomes of number of basic metabolic panel (BMP), comprehensive metabolic panel (CMP), complete blood count (CBC), and prothrombin time/international normalized ratio tests per day; length of stay (LOS); and 30-day readmissions. A total of 6310 hospitalist patient visits (intervention group) were compared to 25,586 nonhospitalist visits (control group). Among the intervention group, the unadjusted mean cost per day was reduced from $138 before the intervention to $123 after the intervention (P analysis showed significant reductions in cost per day, cost per visit, and the number of BMP, CMP, and CBC tests per day (P = 0.034, 0.02, <0.001, 0.004, and <0.001). LOS was unchanged and 30-day readmissions decreased in the intervention group. A multifaceted approach to laboratory reduction demonstrated a significant reduction in laboratory cost per day and per visit, as well as common tests per day at a major academic medical center. Journal of Hospital Medicine 2016;11:348-354. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

Assessing social-emotional development in children from a longitudinal perspective.

Science.gov (United States)

Denham, S A; Wyatt, T M; Bassett, H H; Echeverria, D; Knox, S S

2009-01-01

This paper provides an overview of methodological challenges related to the epidemiological assessment of social-emotional development in children. Because population-based studies involve large cohorts and are usually multicentre in structure, they have cost, participant burden and other specific issues that affect the feasibility of the types of measures that can be administered. Despite these challenges, accurate in-depth assessment of social-emotional functioning is crucial, based on its importance to child outcomes like mental health, academic performance, delinquency and substance abuse. Five dimensions of social-emotional development in children are defined: (1) social competence; (2) attachment; (3) emotional competence; (4) self-perceived competence; and (5) temperament/personality. Their measurement in a longitudinal study and associated challenges are discussed. Means of making valid, reliable assessments while at the same time minimising the multiple challenges posed in the epidemiological assessment of social-emotional development in children are reviewed.

The Social Strategy Game

Science.gov (United States)

Gurven, Michael; Kaplan, Hillard; Winking, Jeffrey

2010-01-01

This paper examines social determinants of resource competition among Tsimane Amerindian women of Bolivia. We introduce a semi-anonymous experiment (the Social Strategy Game) designed to simulate resource competition among women. Information concerning dyadic social relationships and demographic data were collected to identify variables influencing resource competition intensity, as measured by the number of beads one woman took from another. Relationship variables are used to test how the affiliative or competitive aspects of dyads affect the extent of prosociality in the game. Using a mixed-modeling procedure, we find that women compete with those with whom they are quarreling over accusations of meat theft, mate competition, and rumor spreading. They also compete with members of their social network and with those who were designated as cooperative helpers or as close kin. Women take fewer beads from desired friends, neighbors, and from those viewed as enemies. We interpret favoritism toward enemies as resulting from fear of retribution. Our results suggest that social relations among women are multifaceted and often cannot be simplified by exclusive focus on genetic relatedness, physical proximity, or reciprocity. We argue that a complex understanding of cooperation and competition among women may require important contextual information concerning relationship history in addition to typical features of resource ecology. PMID:20526460

Prophylactic antibiotic regimens in tumour surgery (PARITY) : a pilot multicentre randomised controlled trial

NARCIS (Netherlands)

Ghert, M.; Bhandari, M.; Deheshi, B.; Guyatt, G.; Holt, G.; O'Shea, T.; Randall, R. L.; Thabane, L.; Wunder, J.; Evaniew, N.; McKay, P.; Schneider, P.; Turcotte, R.; Madden, K.; Scott, T.; Sprague, S.; Simunovic, N.; Swinton, M.; Racano, A.; Heels-Ansdell, D.; Buckingham, L.; Rose, P.; Brigman, B.; Pullenayegum, E.; Ghert, M.; Evaniew, N.; Mckay, P.; Schneider, P.; Sobhi, G.; Chan, R.; Biljan, M.; Ferguson, P.; Wunder, J.; Griffin, A.; Mantas, I.; Wylie, A.; Han, A.; Grewal, G.; Turcotte, R.; Goulding, K.; Dandachli, F.; Matte, G.; Werier, J.; Abdelbary, H.; Paquin, K.; Cosgrove, H.; Dugal, A-M.; Jutte, P.; Ploegmakers, J. J. W.; Stevens, M.

2015-01-01

Objective Clinical studies of patients with bone sarcomas have been challenged by insufficient numbers at individual centres to draw valid conclusions. Our objective was to assess the feasibility of conducting a definitive multi-centre randomised controlled trial (RCT) to determine whether a

Patient controlled analgesia with remifentanil versus epidural analgesia in labour : randomised multicentre equivalence trial

NARCIS (Netherlands)

Freeman, Liv M; Bloemenkamp, Kitty W; Franssen, Maureen T; Papatsonis, Dimitri N; Hajenius, Petra J; Hollmann, Markus W; Woiski, Mallory D; Porath, Martina; van den Berg, Hans J; van Beek, Erik; Borchert, Odette W H M; Schuitemaker, Nico; Sikkema, J Marko; Kuipers, A H M; Logtenberg, Sabine L M; van der Salm, Paulien C M; Oude Rengerink, Katrien; Lopriore, Enrico; van den Akker-van Marle, M Elske; le Cessie, Saskia; van Lith, Jan M; Struys, Michel M; Mol, Ben Willem J; Dahan, Albert; Middeldorp, Johanna M; Oude Rengerink, K

2015-01-01

OBJECTIVE: To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. DESIGN: Multicentre randomised controlled equivalence trial. SETTING: 15 hospitals in the Netherlands. PARTICIPANTS: Women with an

Patient controlled analgesia with remifentanil versus epidural analgesia in labour : randomised multicentre equivalence trial

NARCIS (Netherlands)

Freeman, Liv M.; Bloemenkamp, Kitty W.; Franssen, Maureen T.; Papatsonis, Dimitri N.; Hajenius, Petra J.; Hollmann, Markus W.; Woiski, Mallory D.; Porath, Martina; van den Berg, Hans J.; van Beek, Erik; Borchert, Odette W. H. M.; Schuitemaker, Nico; Sikkema, J. Marko; Kuipers, A. H. M.; Logtenberg, Sabine L. M.; van der Salm, Paulien C. M.; Rengerink, Katrien Oude; Lopriore, Enrico; van den Akker-van Marle, M. Elske; le Cessie, Saskia; van Lith, Jan M.; Struys, Michel M.; Mol, Ben Willem J.; Dahan, Albert; Middeldorp, Johanna M.

2015-01-01

Objective To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. Design Multicentre randomised controlled equivalence trial. Setting 15 hospitals in the Netherlands. Participants Women with an

Patient controlled analgesia with remifentanil versus epidural analgesia in labour: randomised multicentre equivalence trial

NARCIS (Netherlands)

Freeman, L.M.; Bloemenkamp, K.W.; Franssen, M.T.; Papatsonis, D.N.; Hajenius, P.J.; Hollmann, M.W.; Woiski, M.D.; Porath, M.; Berg, H.J. van den; Beek, E. van; Borchert, O.W.; Schuitemaker, N.; Sikkema, J.M.; Kuipers, A.H.; Logtenberg, S.L.; Salm, P.C. van der; Oude Rengerink, K.; Lopriore, E.; Akker-van Marle, M.E. van den; Cessie, S. le; Lith, J.M. van; Struys, M.M.; Mol, B.W.; Dahan, A; Middeldorp, J.M.

2015-01-01

OBJECTIVE: To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. DESIGN: Multicentre randomised controlled equivalence trial. SETTING: 15 hospitals in the Netherlands. PARTICIPANTS: Women with an

Enabling multi-faceted measures of success for protected area management in Trinidad and Tobago.

Science.gov (United States)

Granderson, Ainka A

2011-08-01

A key challenge has been to define and measure "success" in managing protected areas. A case study was conducted of efforts to evaluate the new protected area management system in Trinidad and Tobago using a participatory approach. The aim of the case study was to (1) examine whether stakeholder involvement better captures the multi-faceted nature of success and (2) identify the role and influence of various stakeholder groups in this process. An holistic and systematic framework was developed with stakeholder input that facilitated the integration of expert and lay knowledge, a broad emphasis on ecological, socio-economic, and institutional aspects, and the use of both quantitative and qualitative data allowing the evaluation to capture the multi-faceted nature and impacts of protected area management. Input from primary stakeholders, such as local communities, was critical as they have a high stake in protected area outcomes. Secondary and external stakeholders, including government agencies, non-governmental organizations, academia and the private sector, were also important in providing valuable technical assistance and serving as mediators. However, a lack of consensus over priorities, politics, and limited stakeholder capacity and data access pose significant barriers to engaging stakeholders to effectively measure the management success of protected areas. Copyright © 2011 Elsevier Ltd. All rights reserved.

Iohexol in investigations of the spinal canal. Multicentre study

International Nuclear Information System (INIS)

Bories, J.

1988-01-01

The author presents the results of a multicentric study of Iohexol in investigation of the spinal canal undertaken at the request of Winthrop Laboratories in 32 Radiological departments. The study involved 329 adults of both sexes. It confirmed the excellent quality of results obtained with this preparation in the literature and its excellent tolerance. On the basis of these results Iohexol may be considered to be definitely one of the best currently available preparations for investigation of the spinal canal [fr

Predictors of adherence to a multifaceted podiatry intervention for the prevention of falls in older people.

Science.gov (United States)

Spink, Martin J; Fotoohabadi, Mohammad R; Wee, Elin; Landorf, Karl B; Hill, Keith D; Lord, Stephen R; Menz, Hylton B

2011-08-26

Despite emerging evidence that foot problems and inappropriate footwear increase the risk of falls, there is little evidence as to whether foot-related intervention strategies can be successfully implemented. The aim of this study was to evaluate adherence rates, barriers to adherence, and the predictors of adherence to a multifaceted podiatry intervention for the prevention of falls in older people. The intervention group (n = 153, mean age 74.2 years) of a randomised trial that investigated the effectiveness of a multifaceted podiatry intervention to prevent falls was assessed for adherence to the three components of the intervention: (i) foot orthoses, (ii) footwear advice and footwear cost subsidy, and (iii) a home-based foot and ankle exercise program. Adherence to each component and the barriers to adherence were documented, and separate discriminant function analyses were undertaken to identify factors that were significantly and independently associated with adherence to the three intervention components. Adherence to the three components of the intervention was as follows: foot orthoses (69%), footwear (54%) and home-based exercise (72%). Discriminant function analyses identified that being younger was the best predictor of orthoses use, higher physical health status and lower fear of falling were independent predictors of footwear adherence, and higher physical health status was the best predictor of exercise adherence. The predictive accuracy of these models was only modest, with 62 to 71% of participants correctly classified. Adherence to a multifaceted podiatry intervention in this trial ranged from 54 to 72%. People with better physical health, less fear of falling and a younger age exhibited greater adherence, suggesting that strategies need to be developed to enhance adherence in frailer older people who are most at risk of falling. Australian New Zealand Clinical Trials Registry ACTRN12608000065392.

Low sodium diet and pregnancy-induced hypertension: a multi-centre randomised controlled trial

NARCIS (Netherlands)

Knuist, M.; Bonsel, G. J.; Zondervan, H. A.; Treffers, P. E.

1998-01-01

To examine the effectiveness of the standard policy in the Netherlands to prescribe a sodium restricted diet to prevent or to treat mild pregnancy-induced hypertension. Multi-centre randomised controlled trial between April 1992 and April 1994. Seven practices of independent midwives and one

Employees' Perceptions of Social Norms as a Result of Implementing the Participatory Approach at Supervisor Level : Results of a Randomized Controlled Trial

NARCIS (Netherlands)

Ketelaar, S M; Schaafsma, F G; Geldof, M F; Boot, C R L; Kraaijeveld, R A; Shaw, W S; Bültmann, U; Twisk, J; Anema, J R

Purpose A multifaceted implementation strategy was targeted at supervisors to encourage them to apply a participatory approach (PA) in dealing with employees' work functioning problems due to health concerns. This paper assesses the effect on employees' perceived social norms regarding the use of

A new Gauss quadrature for multicentre integrals over STOs in the Gaussian integral transform approach

International Nuclear Information System (INIS)

Bouferguene, Ahmed

2005-01-01

When computing multicentre integrals over Slater-type orbitals (STOs) by means of the Shavitt and Karplus Gaussian integral transforms (Shavitt and Karplus 1962 J. Chem. Phys. 36 550), one usually ends up with a multiple integral of the form ∫ 0 1 du ∫ 0 1 dv ...∫ 0 ∞ dz F(u, v, ..., z) (Shavitt and Karplus 1965 J. Chem. Phys. 43 398) in which all the integrals are inter-related. The most widely used approach for computing such an integral is to apply a product of Gauss-Legendre quadratures for the integrals over [0, 1] while the semi-infinite term is evaluated by a special procedure. Although numerous approaches have been developed to accurately perform the integration over [0, ∞) efficiently, it is the aim of this work to add a new tool that could be of some benefit in carrying out the hard task of multicentre integrals over STOs. The new approach relies on a special Gauss quadrature referred to as Gauss-Bessel to accurately evaluate the semi-infinite integral of interest. In this work, emphasis is put on accuracy rather than efficiency since its aim is essentially to bring a proof of concept showing that Gauss-Bessel quadrature can successfully be applied in the context of multicentre integrals over STOs. The obtained accuracy is comparable to that obtained with other methods available in the literature

Patient controlled analgesia with remifentanil versus epidural analgesia in labour: randomised multicentre equivalence trial

NARCIS (Netherlands)

Freeman, Liv M.; Bloemenkamp, Kitty W.; Franssen, Maureen T.; Papatsonis, Dimitri N.; Hajenius, Petra J.; Hollmann, Markus W.; Woiski, Mallory D.; Porath, Martina; van den Berg, Hans J.; van Beek, Erik; Borchert, Odette W. H. M.; Schuitemaker, Nico; Sikkema, J. Marko; Kuipers, A. H. M.; Logtenberg, Sabine L. M.; van der Salm, Paulien C. M.; Oude Rengerink, Katrien; Lopriore, Enrico; van den Akker-van Marle, M. Elske; le Cessie, Saskia; van Lith, Jan M.; Struys, Michel M.; Mol, Ben Willem J.; Dahan, Albert; Middeldorp, Johanna M.

2015-01-01

To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. Multicentre randomised controlled equivalence trial. 15 hospitals in the Netherlands. Women with an intermediate to high obstetric risk with an

Evaluation of the preliminary auditory profile test battery in an international multi-centre study

NARCIS (Netherlands)

van Esch, T.E.M.; Kollmeier, B.; Vormann, M.; Lijzenga, J.; Houtgast, T.; Hallgren, M.; Larsby, B.; Athalye, S.P.; Lutman, M.E.; Dreschler, W.A.

2013-01-01

Objective: This paper describes the composition and international multi-centre evaluation of a battery of tests termed the preliminary auditory profile. It includes measures of loudness perception, listening effort, speech perception, spectral and temporal resolution, spatial hearing, self-reported

Implementing diffusion-weighted MRI for body imaging in prospective multicentre trials. Current considerations and future perspectives

Energy Technology Data Exchange (ETDEWEB)

DeSouza, N.M.; Winfield, J.M.; Weller, A.; Papoutsaki, M.V.; Doran, S.J.; Collins, D.J. [Institute of Cancer Research and Royal Marsden NHS Foundation Trust, CRUK Cancer Imaging Centre, Surrey (United Kingdom); Waterton, J.C.; Jackson, A. [University of Manchester, Manchester Academic Health Sciences Institute, Manchester (United Kingdom); Fournier, L. [Universite Paris Descartes Sorbonne Paris Cite, Assistance Publique-Hopitaux de Paris, Hopital Europeen Georges Pompidou, Radiology Department, Paris (France); Sullivan, D. [Duke Comprehensive Cancer Institute, Durham, NC (United States); Chenevert, T. [University of Michigan Health System, Department of Radiology, Ann Arbor, MI (United States); Boss, M. [National Institute of Standards and Technology (NIST), Applied Physics Division, Boulder, CO (United States); Trattnig, S. [Medical University of Vienna, Department of Biomedical Imaging and Image Guided Therapy, Vienna (Austria); Liu, Y. [European Organisation for Research and Treatment of Cancer, Brussels (Belgium)

2018-03-15

For body imaging, diffusion-weighted MRI may be used for tumour detection, staging, prognostic information, assessing response and follow-up. Disease detection and staging involve qualitative, subjective assessment of images, whereas for prognosis, progression or response, quantitative evaluation of the apparent diffusion coefficient (ADC) is required. Validation and qualification of ADC in multicentre trials involves examination of i) technical performance to determine biomarker bias and reproducibility and ii) biological performance to interrogate a specific aspect of biology or to forecast outcome. Unfortunately, the variety of acquisition and analysis methodologies employed at different centres make ADC values non-comparable between them. This invalidates implementation in multicentre trials and limits utility of ADC as a biomarker. This article reviews the factors contributing to ADC variability in terms of data acquisition and analysis. Hardware and software considerations are discussed when implementing standardised protocols across multi-vendor platforms together with methods for quality assurance and quality control. Processes of data collection, archiving, curation, analysis, central reading and handling incidental findings are considered in the conduct of multicentre trials. Data protection and good clinical practice are essential prerequisites. Developing international consensus of procedures is critical to successful validation if ADC is to become a useful biomarker in oncology. (orig.)

A Big Social Media Data Study of the 2017 German Federal Election Based on Social Set Analysis of Political Party Facebook Pages with SoSeVi

DEFF Research Database (Denmark)

Flesch, Benjamin; Vatrapu, Ravi; Mukkamala, Raghava Rao

2017-01-01

We present a big social media data study that comprises of 1 million individuals who interact with Facebook pages of the seven major political parties CDU, CSU, SPD, FDP, Greens, Die Linke and AfD during the 2017 German federal election. Our study uses the Social Set Analysis (SSA) approach, which...... is based on the sociology of associations, mathematics of set theory, and advanced visual analytics of event studies. We illustrate the capabilities of SSA through the most recent version of our Social Set Analysis (SoSeVi) tool, which enables us to deep dive into Facebook activity concerning the election....... We explore a significant gender-based difference between female and male interactions with political party Facebook pages. Furthermore, we perform a multi-faceted analysis of social media interactions using gender detection, user segmentation and retention analysis, and visualize our findings...

Ethical dilemmas of a large national multi-centre study in Australia: time for some consistency.

Science.gov (United States)

Driscoll, Andrea; Currey, Judy; Worrall-Carter, Linda; Stewart, Simon

2008-08-01

To examine the impact and obstacles that individual Institutional Research Ethics Committee (IRECs) had on a large-scale national multi-centre clinical audit called the National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes Study. Multi-centre research is commonplace in the health care system. However, IRECs continue to fail to differentiate between research and quality audit projects. The National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes study used an investigator-developed questionnaire concerning a clinical audit for heart failure programmes throughout Australia. Ethical guidelines developed by the National governing body of health and medical research in Australia classified the National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes Study as a low risk clinical audit not requiring ethical approval by IREC. Fifteen of 27 IRECs stipulated that the research proposal undergo full ethical review. None of the IRECs acknowledged: national quality assurance guidelines and recommendations nor ethics approval from other IRECs. Twelve of the 15 IRECs used different ethics application forms. Variability in the type of amendments was prolific. Lack of uniformity in ethical review processes resulted in a six- to eight-month delay in commencing the national study. Development of a national ethics application form with full ethical review by the first IREC and compulsory expedited review by subsequent IRECs would resolve issues raised in this paper. IRECs must change their ethics approval processes to one that enhances facilitation of multi-centre research which is now normative process for health services. The findings of this study highlight inconsistent ethical requirements between different IRECs. Also highlighted are the obstacles and delays that IRECs create when undertaking multi-centre clinical audits

The Social Strategy Game: Resource Competition within Female Social Networks among Small-scale Forager-Horticulturalists.

Science.gov (United States)

Rucas, Stacey L; Gurven, Michael; Kaplan, Hillard; Winking, Jeffrey

2010-03-10

This paper examines social determinants of resource competition among Tsimane Amerindian women of Bolivia. We introduce a semi-anonymous experiment (the Social Strategy Game) designed to simulate resource competition among women. Information concerning dyadic social relationships and demographic data were collected to identify variables influencing resource competition intensity, as measured by the number of beads one woman took from another. Relationship variables are used to test how the affiliative or competitive aspects of dyads affect the extent of prosociality in the game. Using a mixed-modeling procedure, we find that women compete with those with whom they are quarreling over accusations of meat theft, mate competition, and rumor spreading. They also compete with members of their social network and with those who were designated as cooperative helpers or as close kin. Women take fewer beads from desired friends, neighbors, and from those viewed as enemies. We interpret favoritism toward enemies as resulting from fear of retribution. Our results suggest that social relations among women are multifaceted and often cannot be simplified by exclusive focus on genetic relatedness, physical proximity, or reciprocity. We argue that a complex understanding of cooperation and competition among women may require important contextual information concerning relationship history in addition to typical features of resource ecology.

School Social Workers as Response to Intervention Change Champions

Directory of Open Access Journals (Sweden)

Deneca Winfrey Avant

2016-02-01

Full Text Available School social workers (SSWs are known for serving students with social, emotional, and academic needs. Implementing Response to Intervention (RTI/Multi-Tiered System of Supports (MTSS is one avenue in which SSWs play an integral role by guiding the development and implementation of student interventions. RTI/MTSS requires substantive and multifaceted system changes that involve more than simply adopting new approaches. This paradigm shift brings change which may not be desired or easily accepted by school systems. However, developing collaborative relationships and using effective leadership strategies throughout the RTI/MTSS transformation can be a pathway to success. A survey of 192 SSWs in Illinois revealed the challenges that SSWs experienced as the process of implementing RTI/MTSS transformed them into change leaders. This revelation was viewed as an opportunity to closely align social and emotional practices with students’ academic achievement.

Teaching Tree Thinking in an Upper Level Organismal Biology Course: Testing the Effectiveness of a Multifaceted Curriculum

Science.gov (United States)

Novick, Laura R.; Catley, Kefyn M.

2018-01-01

The ability to interpret and reason from Tree of Life diagrams is a key component of twenty-first century science literacy. This article reports on the authors' continued development of a multifaceted research-based curriculum--including an instructional booklet, lectures, laboratories and a field activity--to teach such tree thinking to biology…

Lung volume reduction coil treatment for patients with severe emphysema : a European multicentre trial

NARCIS (Netherlands)

Deslee, Gaetan; Klooster, Karin; Hetzel, Martin; Stanzel, Franz; Kessler, Romain; Marquette, Charles-Hugo; Witt, Christian; Blaas, Stefan; Gesierich, Wolfgang; Herth, Felix J. F.; Hetzel, Juergen; van Rikxoort, Eva M.; Slebos, Dirk-Jan

2014-01-01

Background The lung volume reduction (LVR) coil is a minimally invasive bronchoscopic nitinol device designed to reduce hyperinflation and improve elastic recoil in severe emphysema. We investigated the feasibility, safety and efficacy of LVR coil treatment in a prospective multicentre cohort trial

A multifaceted approach to education, observation, and feedback in a successful hand hygiene campaign.

Science.gov (United States)

Doron, Shira I; Kifuji, Kayoko; Hynes, Brooke Tyson; Dunlop, Dan; Lemon, Tricia; Hansjosten, Karen; Cheung, Teresa; Curley, Barbara; Snydman, David R; Fairchild, David G

2011-01-01

Prevention of health care-associated infections starts with scrupulous hand hygiene (HH). Improving HH compliance is a major target for the World Health Organization Patient Safety Challenge and is one of The Joint Commission's National Patient Safety Goals. Yet, adherence to HH protocols is generally poor for health care professionals, despite interventions designed to improve compliance. At Tufts Medical Center (Boston), HH compliance rates were consistently low despite the presence of a traditional HH campaign that used communication and education. A comprehensive program incorporated strong commitment by hospital leadership-who were actively involved in responsibilities previously only performed by infection preventionists and quality and patient safety staff-dedication of financial resources, including securing a grant; collaborating with a private advertising firm in a marketing campaign; and employing a multifaceted approach to education, observation, and feedback. This campaign resulted in a rapid and sustained improvement in HH compliance: Compared with the mean HH compliance rate for the six months before the campaign (72%), postcampaign HH compliance (mean = 94%) was significantly greater (p marketing campaign to fit this academic medical center's particular culture, strong support from the medical center leadership, a multifaceted educational approach, and monthly feedback on HH compliance. A comprehensive campaign resulted in rapid and sustained improvement in HH compliance at an academic medical center after traditional communication and education strategies failed to improve HH performance.

Hands4U: the effectiveness of a multifaceted implementation strategy on behaviour related to the prevention of hand eczema-a randomised controlled trial among healthcare workers.

Science.gov (United States)

van der Meer, Esther W C; Boot, Cécile R L; Twisk, Jos W R; Coenraads, Pieter Jan; Jungbauer, Frank H W; van der Gulden, Joost W J; Anema, Johannes R

2014-07-01

To investigate the effects of a multifaceted implementation strategy on behaviour, behavioural determinants, knowledge and awareness of healthcare workers regarding the use of recommendations to prevent hand eczema. The Hands4U study is a randomised controlled trial. A total of 48 departments (n=1649 workers) were randomly allocated to the multifaceted implementation strategy or the control group (minimal implementation strategy). Within the departments designated to the multifaceted implementation strategy, participatory working groups were set up to enhance the implementation of the recommendations for hand eczema. In addition, working group members were trained to become role models, and an education session was given within the department. Outcome measures were awareness, knowledge, receiving information, behaviour and behavioural determinants. Data were collected at baseline, with a 3- and 6-month follow-up. Statistically significant effects were found after 6 months for awareness (OR 6.30; 95% CI 3.41 to 11.63), knowledge (B 0.74; 95% CI 0.54 to 0.95), receiving information (OR 9.81; 95% CI 5.60 to 17.18), washing hands (B -0.40; 95% -0.51 to -0.29), use of moisturiser (B 0.29; 95% CI 0.20 to 0.38), cotton under gloves (OR 3.94; 95% CI 2.04 to 7.60) and the overall compliance measure (B 0.14; 95% CI 0.02 to 0.26), as a result of the multifaceted implementation strategy. No effects were found for behavioural determinants. The multifaceted implementation strategy can be used in healthcare settings to enhance the implementation of recommendations for the prevention of hand eczema. NTR2812. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Converging biology, economics and social science in fisheries research –lessons learned

DEFF Research Database (Denmark)

Haapasaari, Päivi Elisabet; Kulmala, Soile; Kuikka, Sakari

2011-01-01

of the Baltic salmon stocks, using the Bayesian networks. It enabled the analysis of the outcomes of different management measures from biological, social and economic perspectives. The synthesis was the final output of a learning process of eight years. We reflect how and what kind of interdisciplinarity...... between natural scientists, economists and social scientists grew from the need to better understand complexity related to the salmon fisheries in the Baltic Sea, what we learned about the fishery, and what we learned about interdisciplinary collaboration.......It has been acknowledged that natural sciences cannot provide an adequate basis for the management of complex environmental problems. The scientific knowledge base has to be expanded towards a more holistic direction by incorporating social and economic issues. Besides this, the multifaceted...

An Examination of the Multi-Faceted Motivation System in Healthy Young Adults

Directory of Open Access Journals (Sweden)

Susana Da Silva

2018-05-01

Full Text Available Background: Amotivation is a prevalent symptom in schizophrenia (SZ and depression (MDD, and is linked to poor functional outcomes in affected individuals. Conceptualizations of motivation have outlined a multi-faceted construct comprised of reward responsiveness, reward expectancy, reward valuation, effort valuation, and action selection/preference-based decision making. To date, findings from studies utilizing variable-centered approaches to examining isolated facets of motivation in SZ and MDD have been inconsistent. Thus, the present study adopted a person-centered approach, and comprehensively examined the reward system in a non-clinical sample in an attempt to explore potential subtypes of motivation impairments, while minimizing the effects of illness-related confounds.Methods: Ninety-six healthy undergraduate students were evaluated for amotivation, schizotypal traits, depressive symptoms, and cognition, and administered objective computerized tasks to measure the different facets of motivation. Cluster analysis was performed to explore subgroups of individuals based on similar motivation task performance. Additionally, correlational analyses were conducted in order to examine inter-relationships between motivation facets, and relations between clinical measures and facets of motivation.Results: Cluster analysis identified two subgroups of individuals with differential motivation performance profiles. Correlational analyses revealed that reward responsiveness was associated with amotivation, depressive symptoms, and negative schizotypy. Further, significant inter-correlations were found between reward responsiveness and reward expectancy, as well as between reward valuation and effort valuation.Conclusions: Our results mark important steps forward in understanding motivation in a non-clinical sample, and guide future dimensional and comprehensive analyses of the multi-faceted reward system. It remains to be seen whether these patterns of

An Examination of the Multi-Faceted Motivation System in Healthy Young Adults.

Science.gov (United States)

Da Silva, Susana; Apatsidou, Areti; Saperia, Sarah; Siddiqui, Ishraq; Jeffay, Eliyas; Voineskos, Aristotle N; Daskalakis, Zafiris J; Remington, Gary; Zakzanis, Konstantine K; Foussias, George

2018-01-01

Background: Amotivation is a prevalent symptom in schizophrenia (SZ) and depression (MDD), and is linked to poor functional outcomes in affected individuals. Conceptualizations of motivation have outlined a multi-faceted construct comprised of reward responsiveness, reward expectancy, reward valuation, effort valuation, and action selection/preference-based decision making. To date, findings from studies utilizing variable-centered approaches to examining isolated facets of motivation in SZ and MDD have been inconsistent. Thus, the present study adopted a person-centered approach, and comprehensively examined the reward system in a non-clinical sample in an attempt to explore potential subtypes of motivation impairments, while minimizing the effects of illness-related confounds. Methods: Ninety-six healthy undergraduate students were evaluated for amotivation, schizotypal traits, depressive symptoms, and cognition, and administered objective computerized tasks to measure the different facets of motivation. Cluster analysis was performed to explore subgroups of individuals based on similar motivation task performance. Additionally, correlational analyses were conducted in order to examine inter-relationships between motivation facets, and relations between clinical measures and facets of motivation. Results: Cluster analysis identified two subgroups of individuals with differential motivation performance profiles. Correlational analyses revealed that reward responsiveness was associated with amotivation, depressive symptoms, and negative schizotypy. Further, significant inter-correlations were found between reward responsiveness and reward expectancy, as well as between reward valuation and effort valuation. Conclusions: Our results mark important steps forward in understanding motivation in a non-clinical sample, and guide future dimensional and comprehensive analyses of the multi-faceted reward system. It remains to be seen whether these patterns of results will

The multifaceted therapeutic potential of benfotiamine.

Science.gov (United States)

Balakumar, Pitchai; Rohilla, Ankur; Krishan, Pawan; Solairaj, Ponnu; Thangathirupathi, Arunachalam

2010-06-01

Thiamine, known as vitamin B(1), plays an essential role in energy metabolism. Benfotiamine (S-benzoylthiamine O-monophoshate) is a synthetic S-acyl derivative of thiamine. Once absorbed, benfotiamine is dephosphorylated by ecto-alkaline phosphatase to lipid-soluble S-benzoylthiamine. Transketolase is an enzyme that directs the precursors of advanced glycation end products (AGEs) to pentose phosphate pathway. Benfotiamine administration increases the levels of intracellular thiamine diphosphate, a cofactor necessary for the activation transketolase, resulting in the reduction of tissue level of AGEs. The elevated level of AGEs has been implicated in the induction and progression of diabetes-associated complications. Chronic hyperglycemia accelerates the reaction between glucose and proteins leading to the formation of AGEs, which form irreversible cross-links with many macromolecules such as collagen. In diabetes, AGEs accumulate in tissues at an accelerated rate. Experimental studies have elucidated that binding of AGEs to their specific receptors (RAGE) activates mainly monocytes and endothelial cells and consequently induces various inflammatory events. Moreover, AGEs exaggerate the status of oxidative stress in diabetes that may additionally contribute to functional changes in vascular tone control observed in diabetes. The anti-AGE property of benfotiamine certainly makes it effective for the treatment of diabetic neuropathy, nephropathy and retinopathy. Interestingly, few recent studies demonstrated additional non-AGE-dependent pharmacological actions of benfotiamine. The present review critically analyzed the multifaceted therapeutic potential of benfotiamine. (c) 2010 Elsevier Ltd. All rights reserved.

Multicentre evaluation of a novel vaginal dose reporting method in 153 cervical cancer patients

DEFF Research Database (Denmark)

Westerveld, Henrike; de Leeuw, Astrid; Kirchheiner, Kathrin

2016-01-01

Background and purpose Recently, a vaginal dose reporting method for combined EBRT and BT in cervical cancer patients was proposed. The current study was to evaluate vaginal doses with this method in a multicentre setting, wherein different applicators, dose rates and protocols were used. Materia...

Multicentre Double-Blind Placebo-Controlled Food Challenge Study in Children Sensitised to Cashew Nut

NARCIS (Netherlands)

van der Valk, Johanna P. M.; van Wijk, Roy Gerth; Dubois, Anthony E. J.; de Groot, Hans; Reitsma, Marit; Vlieg-Boerstra, Berber; Savelkoul, Huub F. J.; Wichers, Harry J.; de Jong, Nicolette W.

2016-01-01

Background Few studies with a limited number of patients have provided indications that cashew-allergic patients may experience severe allergic reactions to minimal amounts of cashew nut. The objectives of this multicentre study were to assess the clinical relevance of cashew nut sensitisation, to

Social justice and religious participation: a qualitative investigation of Christian perspectives.

Science.gov (United States)

Todd, Nathan R; Rufa, Anne K

2013-06-01

This investigation examines how self-identified Christians in the Midwest U.S. understand and work for social justice, with a focus on their process of social justice development and the role of religious congregations in promoting social justice. Using a grounded theory analysis of 15 in-depth interviews, results indicated multiple understandings of social justice such as meeting basic needs, fixing social structures and systems to create equal distributions of resources, promoting human rights and dignity, and as a religious responsibility. Participants also described a process of social justice development facilitated by exposure to injustice, mentors, educating others, and the importance of finding a social justice community. Distinct personal barriers to social justice engagement were identified such as resources and negative emotions, whereas congregational leadership was important for congregational involvement. General frustration with congregations was expressed regarding low social justice engagement; however, participants balanced this frustration with hope for the positive potential of congregations to promote social justice. Together these findings show multifaceted understandings of social justice and a dynamic process of social justice development for these self-identified Christians. Implications for future research and partnership with religious individuals and congregations also are discussed.

Multifaceted nutritional intervention among nursing-home residents has a positive influence on nutrition and function

DEFF Research Database (Denmark)

Beck, Anne Marie; Damkjær, Karin; Beyer, Nina

2008-01-01

intervention study with nutrition (chocolate and homemade oral supplements), group exercise twice a week (45-60 min, moderate intensity), and oral care intervention one to two times a week, with the aim of improving nutritional status and function in elderly nursing-home residents. A follow-up visit was made 4......-home residents by means of a multifaceted intervention consisting of chocolate, homemade supplements, group exercise, and oral care. (C) 2008 Elsevier Inc. All rights reserved....

Involvement as inclusion? Shared decision-making in social work practice in Israel: a qualitative account.

Science.gov (United States)

Levin, Lia

2015-03-01

Shared decision-making (SDM), a representation of shared knowledge and power between social workers and their clients, is gaining popularity and prevalence in social services around the world. In many senses, SDM reflects values traditionally associated with social work and service provision, such as equality and anti-discrimination. In the complex context of social problem-solving, however, the relationship between SDM, social workers and their clients is multi-faceted and deserves particular attention. The current study examined SDM and the dilemmas it entails through interviews conducted in 2012 with 77 Israeli social workers and policy makers whose responses were analysed according to the guiding principles of descriptive phenomenological content analysis and dialogical commonality. Participants' responses represent notions of hope, change, identity and choice. Findings are discussed in correspondence with current and recent trends in Israeli social services, and the social work profession in Israel. © 2014 John Wiley & Sons Ltd.

ECSPECT prospective multicentre registry for single-port laparoscopic colorectal procedures

DEFF Research Database (Denmark)

Weiss, Helmut; Zorron, R; Vestweber, K-H

2017-01-01

BACKGROUND: The international multicentre registry ECSPECT (European Consensus of Single Port Expertise in Colorectal Treatment) was established to evaluate the general feasibility and safety of single-port colorectal surgery with regard to preoperative risk assessment. METHODS: Consecutive...... patients undergoing single-port colorectal surgery were enrolled from 11 European centres between March 2010 and March 2014. Data were analysed to assess patient-, technique- and procedure-dependent parameters. A validated sex-adjusted risk chart was developed for prediction of single-port colorectal...

Social media and internet driven study recruitment: evaluating a new model for promoting collaborator engagement and participation.

Science.gov (United States)

Khatri, Chetan; Chapman, Stephen J; Glasbey, James; Kelly, Michael; Nepogodiev, Dmitri; Bhangu, Aneel; Fitzgerald, J Edward

2015-01-01

A substantial challenge facing multicentre audit and research projects is timely recruitment of collaborators and their study centres. Cost-effective strategies are required and fee-free social media has previously been identified as a potential conduit. We investigated and evaluated the effectiveness of a novel multi-format social media and Internet strategy for targeted recruitment to a national multicentre cohort study. Interventions involved a new Twitter account, including weekly live question-and-answer sessions, a new Facebook group page, online YouTube presentations and an information page on a national association website. Link tracking analysis was undertaken using Google Analytics, which was then related to subsequent registration. Social influence was calculated using the proprietary Klout score. Internet traffic analysis identified a total of 1562 unique registration site views, of which 285 originated from social media (18.2%). Some 528 unique registrations were received, with 96 via social media platforms (18.2%). Traffic source analysis identified a separate national association webpage as resulting in the majority of registration page views (15.8%), followed by Facebook (11.9%), Twitter (4.8%) and YouTube (1.5%). A combination of publicity through Facebook, Twitter and the dedicated national association webpage contributed to the greatest rise in registration traffic and accounted for 312 (48%) of the total registrations within a 2-week period. A Twitter 'social influence' (Klout) score of 42/100 was obtained during this period. Targeted social media substantially aided study dissemination and collaborator recruitment. It acted as an adjunct to traditional methods, accounting for 18.2% of collaborator registration in a short time period with no associated financial costs. We provide a practical model for designing future recruitment campaigns, and recommend Facebook, Twitter and targeted websites as the most effective adjuncts for maximising cost

Social Media and Internet Driven Study Recruitment: Evaluating a New Model for Promoting Collaborator Engagement and Participation

Science.gov (United States)

Khatri, Chetan; Chapman, Stephen J.; Glasbey, James; Kelly, Michael; Nepogodiev, Dmitri; Bhangu, Aneel; Fitzgerald, J. Edward

2015-01-01

Aims A substantial challenge facing multicentre audit and research projects is timely recruitment of collaborators and their study centres. Cost-effective strategies are required and fee-free social media has previously been identified as a potential conduit. We investigated and evaluated the effectiveness of a novel multi-format social media and Internet strategy for targeted recruitment to a national multicentre cohort study. Methods Interventions involved a new Twitter account, including weekly live question-and-answer sessions, a new Facebook group page, online YouTube presentations and an information page on a national association website. Link tracking analysis was undertaken using Google Analytics, which was then related to subsequent registration. Social influence was calculated using the proprietary Klout score. Results Internet traffic analysis identified a total of 1562 unique registration site views, of which 285 originated from social media (18.2%). Some 528 unique registrations were received, with 96 via social media platforms (18.2%). Traffic source analysis identified a separate national association webpage as resulting in the majority of registration page views (15.8%), followed by Facebook (11.9%), Twitter (4.8%) and YouTube (1.5%). A combination of publicity through Facebook, Twitter and the dedicated national association webpage contributed to the greatest rise in registration traffic and accounted for 312 (48%) of the total registrations within a 2-week period. A Twitter ‘social influence’ (Klout) score of 42/100 was obtained during this period. Conclusions Targeted social media substantially aided study dissemination and collaborator recruitment. It acted as an adjunct to traditional methods, accounting for 18.2% of collaborator registration in a short time period with no associated financial costs. We provide a practical model for designing future recruitment campaigns, and recommend Facebook, Twitter and targeted websites as the most

Social media and internet driven study recruitment: evaluating a new model for promoting collaborator engagement and participation.

Directory of Open Access Journals (Sweden)

Chetan Khatri

Full Text Available A substantial challenge facing multicentre audit and research projects is timely recruitment of collaborators and their study centres. Cost-effective strategies are required and fee-free social media has previously been identified as a potential conduit. We investigated and evaluated the effectiveness of a novel multi-format social media and Internet strategy for targeted recruitment to a national multicentre cohort study.Interventions involved a new Twitter account, including weekly live question-and-answer sessions, a new Facebook group page, online YouTube presentations and an information page on a national association website. Link tracking analysis was undertaken using Google Analytics, which was then related to subsequent registration. Social influence was calculated using the proprietary Klout score.Internet traffic analysis identified a total of 1562 unique registration site views, of which 285 originated from social media (18.2%. Some 528 unique registrations were received, with 96 via social media platforms (18.2%. Traffic source analysis identified a separate national association webpage as resulting in the majority of registration page views (15.8%, followed by Facebook (11.9%, Twitter (4.8% and YouTube (1.5%. A combination of publicity through Facebook, Twitter and the dedicated national association webpage contributed to the greatest rise in registration traffic and accounted for 312 (48% of the total registrations within a 2-week period. A Twitter 'social influence' (Klout score of 42/100 was obtained during this period.Targeted social media substantially aided study dissemination and collaborator recruitment. It acted as an adjunct to traditional methods, accounting for 18.2% of collaborator registration in a short time period with no associated financial costs. We provide a practical model for designing future recruitment campaigns, and recommend Facebook, Twitter and targeted websites as the most effective adjuncts for

Effectiveness of a Treatment for Impairments in Social Cognition and Emotion Regulation (T-ScEmo) After Traumatic Brain Injury : A Randomized Controlled Trial

NARCIS (Netherlands)

Westerhof-Evers, Herma J.; Visser-Keizer, Annemarie C.; Fasotti, Luciano; Schonherr, Marleen C.; Vink, Martie; van der Naalt, Joukje; Spikman, Jacoba M.

Objective: To evaluate the effects of a multifaceted Treatment for Social cognition and Emotion regulation (T-ScEmo) in patients with a traumatic brain injury.  Participants: Sixty-one patients with moderate to severe traumatic brain injury randomly assigned to an experimental T-ScEmo intervention

Developing and actualizing a multifaceted approach to fighting corruption

Directory of Open Access Journals (Sweden)

Alexandra V. Orlova

2017-12-01

Full Text Available Objective to analyze the main practices of corruption counteraction in the modern society with a view of elaborating the key directions of such counteraction. Methods dialectic method of cognition and general scientific methods based on it analysis synthesis induction deduction. Results the work presents the basic models of corruption counteraction in the modern society. The phenomenon of corruption is frequently discussed and debated in a variety of contexts. Corruption is often difficult to identify as it occurs in secret away from the public eye and records. Moreover anticorruption measures repeatedly fail in part because corruption is a multifaceted social phenomenon that penetrates horizontally and vertically through many areas of society. Despite a high degree of informality within many industries and the prevalence of corrupt practices most anticorruption efforts have so far involved reforming the formal legal rules. However the discussion of formal rules and institutions cannot be neatly divorced from the examination of informal norms and vice versa. These two spheres of norms and rules operate side by side each dependent on the other. Hence any conversation about reform has to include discussions of both formal and informal rules and institutions and the intersection between the two. It is also crucial to examine the fora where informal rules and norms are practiced enforced and replicated. Part of this examination revolves around socalled organizational or corporate culture. In order to start overcoming the formal laws vs. informal rules divide government regulators have to work with industry professionals labour groups and consumers when designing various industry and health and safety regulations. This partnership if it were to be a true one would improve the likelihood of compliance and reduce opportunities for corrupt practices. Ultimately any meaningful anticorruption reform will have to address not only the intertwined nature of

The vascularised fibular graft for limb salvage after bone tumour surgery A MULTICENTRE STUDY

NARCIS (Netherlands)

Hilven, P. H.; Bayliss, L.; Cosker, T.; Dijkstra, P. D. S.; Jutte, P. C.; Lahoda, L. U.; Schaap, G. R.; Bramer, J. A. M.; van Drunen, G. K.; Strackee, S. D.; van Vooren, J.; Gibbons, M.; Giele, H.; van de Sande, M. A. J.

2015-01-01

Vascularised fibular grafts (VFGs) are a valuable surgical technique in limb salvage after resection of a tumour. The primary objective of this multicentre study was to assess the risk factors for failure and complications for using a VFG after resection of a tumour. The study involved 74

Social Cognition and Interaction in Chronic Users of 3,4-Methylenedioxymethamphetamine (MDMA, "Ecstasy").

Science.gov (United States)

Wunderli, Michael D; Vonmoos, Matthias; Treichler, Lorena; Zeller, Carmen; Dziobek, Isabel; Kraemer, Thomas; Baumgartner, Markus R; Seifritz, Erich; Quednow, Boris B

2018-04-01

The empathogen 3,4-methylenedioxymethamphetamine (MDMA) is the prototypical prosocial club drug inducing emotional openness to others. It has recently been shown that acutely applied 3,4-MDMA in fact enhances emotional empathy and prosocial behavior, while it simultaneously decreases cognitive empathy. However, the long-term effects of 3,4-MDMA use on socio-cognitive functions and social interactions have not been investigated yet. Therefore, we examined emotional and cognitive empathy, social decision-making, and oxytocin plasma levels in chronic 3,4-MDMA users. We tested 38 regular but recently abstinent 3,4-MDMA users and 56 3,4-MDMA-naïve controls with the Movie for the Assessment of Social Cognition, the Multifaceted Empathy Test, and the Distribution Game and the Dictator Game. Drug use was objectively quantified by 6-month hair analyses. Furthermore, oxytocin plasma levels were determined in smaller subgroups (24 3,4-MDMA users, 9 controls). 3,4-MDMA users showed superior cognitive empathy compared with controls in the Multifaceted Empathy Test (Cohen's d=.39) and in the Movie for the Assessment of Social Cognition (d=.50), but they did not differ from controls in emotional empathy. Moreover, 3,4-MDMA users acted less self-serving in the Distribution Game. However, within 3,4-MDMA users, multiple regression analyses showed that higher 3,4-MDMA concentrations in hair were associated with lower cognitive empathy (βMDMA=-.34, t=-2.12, P<.05). Oxytocin plasma concentrations did not significantly differ between both groups. We conclude that people with high cognitive empathy abilities and pronounced social motivations might be more prone to 3,4-MDMA consumption. In contrast, long-term 3,4-MDMA use might nevertheless have a detrimental effect on cognitive empathy capacity.

Knowledge and Awareness among Parents and General Dental Practitioners regarding Rehabilitation with Full Coverage Restoration in Children: A Multi-centric Trial.

Science.gov (United States)

Moda, Aman; Saroj, Gyanendra; Sharma, Swati; Gupta, Basant

2016-01-01

The aim of this study was to evaluate the knowledge and awareness among parents and general dental practitioners regarding rehabilitation with full coverage restoration in children following pulp therapy. A multiple choice questionnaire was given to 1,000 parents and 400 general practitioners in this multicentric trial. The questionnaire assessed their beliefs, knowledge regarding care of primary teeth, assessment of treating children, and knowledge regarding importance of primary teeth. All the questionnaires were then compiled and statistically analyzed using Statistical Package for Social Sciences (SPSS) software. 53% parents did not know the importance of primary teeth and 73% parents also thought that no treatment is possible for pulpally involved primary teeth. 20% parents believed that root canal treatment can be possible for children and only 10% knew about full coverage restorations. 40% of the general dentists felt that the best treatment in the case of primary necrotic teeth is extraction and only 13% knew about stainless steel crowns. 62% of general dental practitioners pointed out patients' noninterest in providing crowns whereas 68% parents reported non-information by dentists. Both parents and general dental practitioners have incomplete and inadequate knowledge regarding full coverage restorations, and we need to improve the knowledge and dental awareness of the parents and the general dental practitioners. How to cite this article: Moda A, Saroj G, Sharma S, Gupta B. Knowledge and Awareness among Parents and General Dental Practitioners regarding Rehabilitation with Full Coverage Restoration in Children: A Multi-centric Trial. Int J Clin Pediatr Dent 2016;9(2):177-180.

MULTICENTRIC T-CELL LYMPHOMA AND CUTANEOUS HEMANGIOSARCOMA IN A CAPTIVE CHEETAH (ACINONYX JUBATUS).

Science.gov (United States)

Lindemann, Dana M; Carpenter, James W; Nietfeld, Jerome C; Gonzalez, Estehela; Hallman, Mackenzie; Hause, Ben M

2015-12-01

A 13-yr-old intact male cheetah (Acinonyx jubatus) presented for evaluation after a 4-mo history of intermittent lethargy and increased expiratory effort. The clinical signs were initially noted after the diagnosis and death of its 13-yr-old male sibling with solitary hepatic T-cell lymphoma. Physical examination findings included thin body condition, harsh lung sounds, peripheral lymphadenopathy, and a cutaneous mass on the right medial tarsus and scrotum. Excisional biopsies diagnosed well-differentiated cutaneous hemangiosarcomas. Thoracic radiographs revealed a cranial mediastinal mass. Complete blood count and serum biochemical analyses showed a leukocytosis with persistent lymphocytosis, progressive azotemia, and markedly elevated alkaline phosphatase. Because of the cheetah's declining quality of life, euthanasia was elected. Postmortem examination, histopathology, and immunohistochemical staining revealed multicentric T-cell lymphoma. Feline leukemia virus (FeLV) enzyme-linked immunosorbent assay, FeLV polymerase chain reaction (whole blood), and viral metagenomic analysis were negative. This is the first case of cutaneous hemangiosarcoma and multicentric T-cell lymphoma reported in a FeLV-negative cheetah.

Imaging features of multicentric Castleman's disease in HIV infection

International Nuclear Information System (INIS)

Hillier, J.C.; Shaw, P.; Miller, R.F.; Cartledge, J.D.; Nelson, M.; Bower, M.; Francis, N.; Padley, S.P.

2004-01-01

AIM: To describe the computed tomography (CT) features of human immunodeficiency virus (HIV)-associated Castleman's disease. MATERIALS AND METHODS: Nine HIV-positive patients with biopsy-proven Castleman's disease were studied. Clinical and demographic data, CD4 count, histological diagnosis and human herpes type 8 (HHV8) serology or immunostaining results were recorded. CT images were reviewed independently by two radiologists. RESULTS: CT findings included splenomegaly (n=7) and peripheral lymph node enlargement (axillary n=8, inguinal n=4). All nodes displayed mild to avid enhancement after intravenous administration of contrast material. Hepatomegaly was evident in seven patients. Other features included abdominal (n=6) and mediastinal (n=5) lymph node enlargement and pulmonary abnormalities (n=4). Patterns of parenchymal abnormality included bronchovascular nodularity (n=2), consolidation (n=1) and pleural effusion (n=2). On histological examination eight patients (spleen n=3, lymph node n=9, lung n=1 bone marrow n=1) had the plasma cell variant and one had mixed hyaline-vascular/plasma cell variant. The majority had either positive immunostaining for HHV8 or positive serology (n=8). CONCLUSION: Common imaging features of multicentric Castleman's disease in HIV infection are hepatosplenomegaly and peripheral lymph node enlargement. Although these imaging features may suggest the diagnosis in the appropriate clinical context, they lack specificity and so biopsy is needed for diagnosis. In distinction from multicentric Castleman's disease in other populations the plasma cell variant is most commonly encountered, splenomegaly is a universal feature and there is a strong association with Kaposi's sarcoma

Multifaceted intervention to enhance the screening and care of hospitalised malnourished children: study protocol for the PREDIRE cluster randomized controlled trial

Science.gov (United States)

2013-01-01

Background Hospital malnutrition is an underestimated problem and as many as half of malnourished patients do not receive appropriate treatment. In order to extend the management of malnutrition in health care facilities, multidisciplinary teams focusing on clinical nutrition were established in France. The establishment of such teams within hospital facilities remains nonetheless difficult. We have consequently developed a multifaceted intervention coordinated by a Nutritional Support Team (NST). Our study aims to evaluate the impact of this multifaceted intervention coordinated by a NST, in adherence to recommended practices for the care of malnourished children, among health care workers of a paediatric university hospital. Methods/design We carried out 1) a six-month observational phase focusing on the medical care procedures relative to malnourished children followed by 2) a cluster randomised controlled trial phase to evaluate the impact of a multidisciplinary nutrition team over an 18 month time frame. Based on power analyses and assuming a conservative intracluster correlation coefficient, 1289 children were needed to detect a 25% difference in rates between the two groups of the cluster trial. The implementation of our intervention was coordinated by the NST and had three major components: a) access to a computerised malnutrition screening system associated with an automatic alert system, b) an awareness campaign directed toward the health care workers and c) a leadership based strategy. Main outcomes included the number of daily weighings during hospitalisation, the investigation of malnutrition etiology and the management of malnutrition by a dietician and/or the NST. Due to the clustered nature of the data with children nested in departments, a generalized estimated equations approach will be used to analyse the impact of the multifaceted intervention on primary and secondary outcomes. Discussion Our results will provide an overall response regarding

Multicentre European study of thalamic stimulation for parkinsonian tremor: a 6 year follow-up

NARCIS (Netherlands)

Hariz, M. I.; Krack, P.; Alesch, F.; Augustinsson, L.-E.; Bosch, A.; Ekberg, R.; Johansson, F.; Johnels, B.; Meyerson, B. A.; N'Guyen, J.-P.; Pinter, M.; Pollak, P.; von Raison, F.; Rehncrona, S.; Speelman, J. D.; Sydow, O.; Benabid, A.-L.

2008-01-01

To evaluate the results of ventral intermediate (Vim) thalamic deep brain stimulation (DBS) in patients with tremor predominant Parkinson's disease (PD) at 6 years post surgery. This was a prolonged follow-up study of 38 patients from eight centres who participated in a multicentre study, the 1 year

Multicentric malignant gastrointestinal stromal tumor

International Nuclear Information System (INIS)

Shukla, Shailaja; Singh, Sanjeet K; Pujani, Mukta

2009-01-01

Malignant gastrointestinal stromal tumor (GIST) is a rare type of sarcoma that is found in the digestive system, most often in the wall of the stomach. Multiple GISTs are extremely rare and usually associated with type 1 neurofibromatosis and familial GIST. We report here a case of a 70-year-old woman who reported pain in the abdomen, loss of appetite, and weight loss for six months. Ultrasound examination showed a small bowel mass along with multiple peritoneal deposits and a mass within the liver. Barium studies were suggestive of a neoplastic pathology of the distal ileum. A differential diagnosis of adenocarcinoma/lymphoma with metastases was entertained. Perioperative findings showed two large growths arising from the jejunum and the distal ileum, along with multiple smaller nodules on the serosal surface and adjoining mesentery of the involved bowel segments. Segmental resection of the involved portions of the intestine was performed. Histopathological features were consistent with those of multicentric malignant GIST-not otherwise specified (GIST-NOS). Follow-up examination three months after surgery showed no evidence of recurrence. (author)

Cognitive functioning and social problem-solving skills in schizophrenia.

Science.gov (United States)

Hatashita-Wong, Michi; Smith, Thomas E; Silverstein, Steven M; Hull, James W; Willson, Deborah F

2002-05-01

This study examined the relationships between symptoms, cognitive functioning, and social skill deficits in schizophrenia. Few studies have incorporated measures of cognitive functioning and symptoms in predictive models for social problem solving. For our study, 44 participants were recruited from consecutive outpatient admissions. Neuropsychological tests were given to assess cognitive function, and social problem solving was assessed using structured vignettes designed to evoke the participant's ability to generate, evaluate, and apply solutions to social problems. A sequential model-fitting method of analysis was used to incorporate social problem solving, symptom presentation, and cognitive impairment into linear regression models. Predictor variables were drawn from demographic, cognitive, and symptom domains. Because this method of analysis was exploratory and not intended as hierarchical modelling, no a priori hypotheses were proposed. Participants with higher scores on tests of cognitive flexibility were better able to generate accurate, appropriate, and relevant responses to the social problem-solving vignettes. The results suggest that cognitive flexibility is a potentially important mediating factor in social problem-solving competence. While other factors are related to social problem-solving skill, this study supports the importance of cognition and understanding how it relates to the complex and multifaceted nature of social functioning.

Effectiveness of multifaceted implementation strategies for the implementation of back and neck pain guidelines in health care : A systematic review

NARCIS (Netherlands)

Suman, Arnela; Dikkers, Marije F.; Schaafsma, Frederieke G.; van Tulder, Maurits W.; Anema, Johannes R.

2016-01-01

Background: For the optimal use of clinical guidelines in daily practice, mere distribution of guidelines and materials is not enough, and active implementation is needed. This review investigated the effectiveness of multifaceted implementation strategies compared to minimal, single, or no

CSP: A Multifaceted Hybrid Architecture for Space Computing

Science.gov (United States)

Rudolph, Dylan; Wilson, Christopher; Stewart, Jacob; Gauvin, Patrick; George, Alan; Lam, Herman; Crum, Gary Alex; Wirthlin, Mike; Wilson, Alex; Stoddard, Aaron

2014-01-01

Research on the CHREC Space Processor (CSP) takes a multifaceted hybrid approach to embedded space computing. Working closely with the NASA Goddard SpaceCube team, researchers at the National Science Foundation (NSF) Center for High-Performance Reconfigurable Computing (CHREC) at the University of Florida and Brigham Young University are developing hybrid space computers that feature an innovative combination of three technologies: commercial-off-the-shelf (COTS) devices, radiation-hardened (RadHard) devices, and fault-tolerant computing. Modern COTS processors provide the utmost in performance and energy-efficiency but are susceptible to ionizing radiation in space, whereas RadHard processors are virtually immune to this radiation but are more expensive, larger, less energy-efficient, and generations behind in speed and functionality. By featuring COTS devices to perform the critical data processing, supported by simpler RadHard devices that monitor and manage the COTS devices, and augmented with novel uses of fault-tolerant hardware, software, information, and networking within and between COTS devices, the resulting system can maximize performance and reliability while minimizing energy consumption and cost. NASA Goddard has adopted the CSP concept and technology with plans underway to feature flight-ready CSP boards on two upcoming space missions.

The multifaceted nature of access to compounded progesterone: a cross-sectional study from Australia.

Science.gov (United States)

Spark, M Joy; Willis, Jon; Byrne, Graeme; Iacono, Teresa

2014-02-01

To explore the influences on accessibility of compounded progesterone therapy for Australian women. A cross-sectional survey of a stratified sample of Australian women who use progesterone only products using the 'Perspectives on Progesterone' questionnaire. Principle components analysis (PCA) to determine components of access to progesterone treatment and multi-way analysis of variance to compare groups. Women using compounded progesterone were likely to have made at least one lifestyle adaptation (73%), and to have tried and stopped using at least one complementary and alternative medicine therapy (63%) or conventional hormone therapy (41%). PCA revealed six components of access to progesterone treatment: affordable, values natural treatments and is concerned about other treatments, conventionally available, perceived knowledge, values information gathered from a variety of sources, and rural & disadvantaged. The multifaceted nature of progesterone use illustrates that there are multiple aspects to use of non-conventional medicines. Women looking for non-conventional treatment are neither stupid nor uninformed, their understandings, based on experience and research, need to be addressed by health professionals while assessing their condition prior to discussing the risks and benefits of non-conventional medicines. Access to compounded progesterone is multifaceted, and many of the women who use it have tried other treatments first. Despite the clinical ambivalence towards progesterone as an alternative for women who may have tried and rejected other treatments, including conventional hormone therapy, the women described in this paper are using it. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Maltese Antibiotic Stewardship Programme in the Community (MASPIC): protocol of a prospective quasiexperimental social marketing intervention

OpenAIRE

Saliba-Gustafsson, Erika A; Borg, Michael A; Rosales-Klintz, Senia; Nyberg, Anna; StålsbyLundborg, Cecilia

2017-01-01

Introduction Antibiotic misuse is a key driver of antibiotic resistance. In 2015/2016, Maltese respondents reported the highest proportions of antibiotic consumption in Europe. Since antibiotics are prescription-only medicines in Malta, research on effective strategies targeting general practitioners’ (GPs) knowledge and behaviour is needed. Multifaceted behaviour change (BC) interventions are likely to be effective. Social marketing (SM) can provide the tools to promote sustained BC; however...

A Multifaceted Mentoring Program for Junior Faculty in Academic Pediatrics.

Science.gov (United States)

Chen, Mary M; Sandborg, Christy I; Hudgins, Louanne; Sanford, Rania; Bachrach, Laura K

2016-01-01

The departure of physician-scientists from education and research into clinical practice is a growing challenge for the future of academic medicine. Junior faculty face competing demands for clinical productivity, teaching, research, and work-life integration, which can undermine confidence in the value of an academic career. Mentorship is important to foster career development and satisfaction in junior faculty. The goals of this academic pediatrics department were to develop, implement, and evaluate a multifaceted pediatric mentoring program to promote retention and satisfaction of junior faculty. Program elements included one-on-one mentor-mentee meetings, didactic workshops, grant review assistance, and facilitated peer-group mentoring. Program effectiveness was assessed using annual surveys of mentees and structured mentee exit interviews, as well as retention data for assistant professors. The mentees were instructors and assistant professors in the department of pediatrics. Seventy-nine mentees participated in the program from 2007 through 2014. The response rate from seven annual surveys was 84%. Sixty-nine percent of mentees felt more prepared to advance their careers, 81% had a better understanding of the criteria for advancement, 84% were satisfied with the program, and 95% found mentors accessible. Mentees who exited the program reported they most valued the one-on-one mentoring and viewed the experience positively regardless of promotion. Retention of assistant professors improved after initiation of the program; four of 13 hired from 2002 to 2006 left the institution, whereas 18 of 18 hired from 2007 to 2014 were retained. This multifaceted mentoring program appeared to bolster satisfaction and enhance retention of junior pediatric faculty. Mentees reported increased understanding of the criteria for promotion and viewed the program as a positive experience regardless of career path. Individual mentor-mentee meetings were needed at least twice yearly

Witkop′s tooth and nail syndrome: A multifaceted approach to dental management

Directory of Open Access Journals (Sweden)

Subramaniam P

2008-03-01

Full Text Available Witkop′s tooth and nail syndrome is a rare autosomal dominant disorder of ectodermal dysplasia characterized by hypodontia and nail dysplasia. Mutations in MSX-1 have been shown to be associated with this syndrome. There is failure of development and eruption of the dentition. Tooth shape may vary; the most common forms are conical and narrow crowns. The nails may be spoon shaped and slow growing and affect both finger and toe nails. The nail involvement is more severe in childhood. The present case describes a 14-year-old boy who showed the characteristic features of Witkop′s syndrome. A multifaceted approach to the dental management of the patient is discussed.

The DanCavas Pilot Study of Multifaceted Screening for Subclinical Cardiovascular Disease in Men and Women Aged 65-74 Years

DEFF Research Database (Denmark)

Kvist, T V; Lindholt, Jes Sanddal; Rasmussen, L M

2017-01-01

OBJECTIVE/BACKGROUND: This pilot study of a large population based randomised screening trial investigated feasibility, acceptability, and relevance (prevalence of clinical and subclinical cardiovascular disease [CVD] and proportion receiving insufficient prevention) of a multifaceted screening f...

Assessment of multifaceted environmental issues and model development of an Indo-Burma hotspot region.

Science.gov (United States)

Rai, Prabhat Kumar

2012-01-01

The present article provides a multifaceted critical research review on environmental issues intimately related with the socio-economy of North East India (NE), a part of Indo-Burma hotspot. Further, the article addresses the issue of sustainable development of NE India through diverse ecological practices inextricably linked with traditional ecological knowledge (TEK). The biodiversity of NE India comprises endemic floral diversity, particularly medicinal plants of importance to pharmaceutical industry, and unique faunal diversity. Nevertheless, it is very unfortunate that this great land of biodiversity is least explored taxonomically as well as biotechnologically, probably due to geographical and political constraints. Different anthropogenic and socio-economic factors have perturbed the pristine ecology of this region, leading to environmental degradation. Also, the practice of unregulated shifting cultivation (jhooming), bamboo flowering, biological invasions and anthropogenic perturbations to biodiversity exacerbate the gloomy situation. Instead of a plethora of policies, the TEK of NE people may be integrated with modern scientific knowledge in order to conserve the environment which is the strong pillar for socio-economic sector here. The aforesaid approach can be practiced in NE India through the broad implementation and extension of agroforestry practices. Further, case studies on Apatanis, ethnomedicinal plants use by indigenous tribal groups and sacred forests are particularly relevant in the context of conservation of environmental health in totality while addressing the socioeconomic impact as well. In context with the prevailing scenarios in this region, we developed an eco-sustainable model for natural resource management through agroforestry practices in order to uplift the social as well as environmental framework.

Necrotizing soft tissue infections - a multicentre, prospective observational study (INFECT)

DEFF Research Database (Denmark)

Madsen, M. B.; Skrede, S.; Bruun, T.

2018-01-01

these to patient-important outcomes. With this protocol and statistical analysis plan we describe the methods used to obtain data and the details of the planned analyses. Methods: The INFECT study is a multicentre, prospective observational cohort study. Patients with NSTIs are enrolled in five Scandinavian......Background: The INFECT project aims to advance our understanding of the pathophysiological mechanisms in necrotizing soft tissue infections (NSTIs). The INFECT observational study is part of the INFECT project with the aim of studying the clinical profile of patients with NSTIs and correlating...

Multicentric osteoid osteoma with a nidus located in the epiphysis

International Nuclear Information System (INIS)

Tamam, Cueneyt; Yildirim, Duezguen; Tamam, Muge

2009-01-01

We present a 13-year-old girl who was referred to our clinic with a 5-month history of right leg pain relieved by salicylates. Initial CT examination demonstrated a lesion in the posterior tibial cortex in keeping with an osteoid osteoma. This was resected and the diagnosis confirmed by histology. However, her pain recurred 2 weeks after the operation and further imaging identified a further nidus in the epiphysis. We present the imaging findings in this unique case of multicentric osteoid osteoma with one nidus located in the epiphysis. (orig.)

Social disadvantages associated with myasthenia gravis and its treatment: a multicentre cross-sectional study.

Science.gov (United States)

Nagane, Yuriko; Murai, Hiroyuki; Imai, Tomihiro; Yamamoto, Daisuke; Tsuda, Emiko; Minami, Naoya; Suzuki, Yasushi; Kanai, Tetsuya; Uzawa, Akiyuki; Kawaguchi, Naoki; Masuda, Masayuki; Konno, Shingo; Suzuki, Hidekazu; Aoki, Masashi; Utsugisawa, Kimiaki

2017-02-23

To clarify the social disadvantages associated with myasthenia gravis (MG) and examine associations with its disease and treatment. Cross-sectional study. We evaluated 917 consecutive cases of established MG seen at 13 neurological centres in Japan over a short duration. All patients completed a questionnaire on social disadvantages resulting from MG and its treatment and a 15-item MG-specific quality of life scale at study entry. Clinical severity at the worst condition was graded according to the MG Foundation of America classification, and that at the current condition was determined according to the quantitative MG score and MG composite. Maximum dose and duration of dose ≥20 mg/day of oral prednisolone during the disease course were obtained from the patients' medical records. Achievement of the treatment target (minimal manifestation status with prednisolone at ≤5 mg/day) was determined at 1, 2 and 4 years after starting treatment and at study entry. We found that 27.2% of the patients had experienced unemployment, 4.1% had been unwillingly transferred and 35.9% had experienced a decrease in income, 47.1% of whom reported that the decrease was ≥50% of their previous total income. In addition, 49.0% of the patients reported feeling reduced social positivity. Factors promoting social disadvantages were severity of illness, dose and duration of prednisolone, long-term treatment, and a depressive state and change in appearance after treatment with oral steroids. Early achievement of the treatment target was a major inhibiting factor. Patients with MG often experience unemployment, unwilling job transfers and a decrease in income. In addition, many patients report feeling reduced social positivity. To inhibit the social disadvantages associated with MG and its treatment, greater focus needs to be placed on helping patients with MG resume a normal lifestyle as soon as possible by achieving the treatment target. Published by the BMJ Publishing Group

Case report 558: Multicentric Klebsiella pneumoniae (Friedlaenders bacillus) osteomyelitis in sickle cell anemia

International Nuclear Information System (INIS)

Malpani, A.R.; Sundaram, M.; Ramani, S.K.

1989-01-01

This patient represents a unique combination of multicentric osteomyelitis due to Klebsiella pneumoniae, lesions in the skull, pathological fracture of a long bone and no evidence of pulmonary disease. That Klebsiella pneumoniae osteomyelitis can occur in sickle cell anemia should be considered when such bone changes are seen. The remarkable resolution on conservative management also needs to be noted. (orig./GDG)

Managing acute alcohol withdrawal with Homoeopathy: A prospective, observational, multicentre exploratory study

Directory of Open Access Journals (Sweden)

Debadatta Nayak

2014-01-01

Full Text Available Background: Alcohol dependence is a common social problem which may be associated with other risk factors and co-morbidities. Abrupt cessation of alcohol intake may provoke an acute alcohol withdrawal phase with varying degrees of signs and symptoms. In conventional medical system, specific pharmacological interventions are used for management of Acute Alcohol Withdrawal (AAW. There exists a need to explore safe and holistic treatment of AAW. The present work reports the results of a prospective, observational, exploratory, multicentre trial (2008-2011 to assess the role of Homoeopathy in AAW. Materials and Methods: Individualised Homoeopathy was given to 112 patients reporting with AAW. The clinical assessment was done for 05 days using Clinical Institute Withdrawal Assessment Scale of Alcohol-Revised (CIWA-Ar. Post-withdrawal phase, quality of life of patients was assessed at end of 01 st , 03 rd and 06 th month using World Health Organisation quality of life (WHOQOL- BREF. Results and Analysis: There was a significant decrease in CIWA-Ar mean scores and increase in quality of life score (P < 0.001. The most common remedies used were Arsenicum album, Lycopodium clavatum, Belladonna, Nux vomica and Pulsatilla. Conclusion: The results of current observational pilot study suggest the promising use of Homoeopathy in the management of acute alcohol withdrawal. Further studies with large sample size and rigorous design are warranted.

Problematic internet use as an age-related multifaceted problem: Evidence from a two-site survey.

Science.gov (United States)

Ioannidis, Konstantinos; Treder, Matthias S; Chamberlain, Samuel R; Kiraly, Franz; Redden, Sarah A; Stein, Dan J; Lochner, Christine; Grant, Jon E

2018-06-01

Problematic internet use (PIU; otherwise known as Internet Addiction) is a growing problem in modern societies. There is scarce knowledge of the demographic variables and specific internet activities associated with PIU and a limited understanding of how PIU should be conceptualized. Our aim was to identify specific internet activities associated with PIU and explore the moderating role of age and gender in those associations. We recruited 1749 participants aged 18 and above via media advertisements in an Internet-based survey at two sites, one in the US, and one in South Africa; we utilized Lasso regression for the analysis. Specific internet activities were associated with higher problematic internet use scores, including general surfing (lasso β: 2.1), internet gaming (β: 0.6), online shopping (β: 1.4), use of online auction websites (β: 0.027), social networking (β: 0.46) and use of online pornography (β: 1.0). Age moderated the relationship between PIU and role-playing-games (β: 0.33), online gambling (β: 0.15), use of auction websites (β: 0.35) and streaming media (β: 0.35), with older age associated with higher levels of PIU. There was inconclusive evidence for gender and gender × internet activities being associated with problematic internet use scores. Attention-deficit hyperactivity disorder (ADHD) and social anxiety disorder were associated with high PIU scores in young participants (age ≤ 25, β: 0.35 and 0.65 respectively), whereas generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD) were associated with high PIU scores in the older participants (age > 55, β: 6.4 and 4.3 respectively). Many types of online behavior (e.g. shopping, pornography, general surfing) bear a stronger relationship with maladaptive use of the internet than gaming supporting the diagnostic classification of problematic internet use as a multifaceted disorder. Furthermore, internet activities and psychiatric diagnoses associated with

Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial

NARCIS (Netherlands)

Nauth, A. (Aaron); Creek, A.T. (Aaron T.); Zellar, A. (Abby); Lawendy, A.-R. (Abdel-Rahman); Dowrick, A. (Adam); Gupta, A. (Ajay); Dadi, A. (Akhil); A. van Kampen (A.); Yee, A. (Albert); A.C. de Vries (Alexander); de Mol van Otterloo, A. (Alexander); Garibaldi, A. (Alisha); Liew, A. (Allen); McIntyre, A.W. (Allison W.); Prasad, A.S. (Amal Shankar); Romero, A.W. (Amanda W.); Rangan, A. (Amar); Oatt, A. (Amber); Sanghavi, A. (Amir); Foley, A.L. (Amy L.); Karlsten, A. (Anders); Dolenc, A. (Andrea); Bucknill, A. (Andrew); Chia, A. (Andrew); Evans, A. (Andrew); Gong, A. (Andrew); Schmidt, A.H. (Andrew H.); Marcantonio, A.J. (Andrew J.); Jennings, A. (Andrew); Ward, A. (Angela); Khanna, A. (Angshuman); Rai, A. (Anil); Smits, A.B. (Anke B.); Horan, A.D. (Annamarie D.); Brekke, A.C. (Anne Christine); Flynn, A. (Annette); Duraikannan, A. (Aravin); Stødle, A. (Are); van Vugt, A.B. (Arie B.); Luther, A. (Arlene); Zurcher, A.W. (Arthur W.); Jain, A. (Arvind); Amundsen, A. (Asgeir); Moaveni, A. (Ash); Carr, A. (Ashley); Sharma, A. (Ateet); Hill, A.D. (Austin D.); Trommer, A. (Axel); Rai, B.S. (B. Sachidananda); Hileman, B. (Barbara); Schreurs, B. (Bart); Verhoeven, B. (Bart); Barden, B.B. (Benjamin B.); Flatøy, B. (Bernhard); B.I. Cleffken (Berry); Bøe, B. (Berthe); Perey, B. (Bertrand); Hanusch, B.C. (Birgit C.); Weening, B. (Brad); B. Fioole (Bram); Rijbroek, B. (Bram); Crist, B.D. (Brett D.); Halliday, B. (Brett); Peterson, B. (Brett); Mullis, B. (Brian); Richardson, C.G. (C. Glen); Clark, C. (Callum); Sagebien, C.A. (Carlos A.); C. van der Pol (Carmen); Bowler, C. (Carol); Humphrey, C.A. (Catherine A.); Coady, C. (Catherine); Koppert, C.L. (Cees L.); Coles, C. (Chad); Tannoury, C. (Chadi); DePaolo, C.J. (Charles J.); Gayton, C. (Chris); Herriott, C. (Chris); Reeves, C. (Christina); Tieszer, C. (Christina); Dobb, C. (Christine); Anderson, C.G. (Christopher G.); Sage, C. (Claire); Cuento, C. (Claudine); Jones, C.B. (Clifford B.); Bosman, C.H.R. (Coks H.R.); Linehan, C. (Colleen); C.P. van der Hart (Cor P.); Henderson, C. (Corey); Lewis, C.G. (Courtland G.); Davis, C.A. (Craig A.); Donohue, C. (Craig); Mauffrey, C. (Cyril); Sundaresh, D.C. (D. C.); Farrell, D.J. (Dana J.); Whelan, D.B. (Daniel B.); Horwitz, D. (Daniel); Stinner, D. (Daniel); Viskontas, D. (Darius); Roffey, D.M. (Darren M.); Alexander, D. (David); Karges, D.E. (David E.); Hak, D. (David); Johnston, D. (David); Love, D. (David); Wright, D.M. (David M.); Zamorano, D.P. (David P.); Goetz, D.R. (David R.); Sanders, D. (David); Stephen, D. (David); Yen, D. (David); Bardana, D. (Davide); Olakkengil, D.J. (Davy J); Lawson, D. (Deanna); Maddock, D. (Deborah); Sietsema, D.L. (Debra L.); Pourmand, D. (Deeba); D. den Hartog (Dennis); Donegan, D. (Derek); D. Heels-Ansdell (Diane); Nam, D. (Diane); Inman, D. (Dominic); Boyer, D. (Dory); Li, D. (Doug); Gibula, D. (Douglas); Price, D.M. (Dustin M.); Watson, D.J. (Dylan J.); Hammerberg, E.M. (E. Mark); Tan, E.T.C.H. (Edward T.C.H.); E.J.R. de Graaf (Eelco); Vesterhus, E.B. (Elise Berg); Roper, E. (Elizabeth); Edwards, E. (Elton); E.H. Schemitsch (Emil); E.R. Hammacher (Eric); Henderson, E.R. (Eric R.); Whatley, E. (Erica); Torres, E.T. (Erick T.); Vermeulen, E.G.J. (Erik G.J.); Finn, E. (Erin); E.M.M. van Lieshout (Esther); Wai, E.K. (Eugene K.); Bannister, E.R. (Evan R.); Kile, E. (Evelyn); Theunissen, E.B.M. (Evert B.M.); Ritchie, E.D. (Ewan D.); Khan, F. (Farah); Moola, F. (Farhad); Howells, F. (Fiona); F. de Nies (Frank); F.H.W.M. van der Heijden (Frank); de Meulemeester, F.R.A.J. (Frank R.A.J.); F. Frihagen (Frede); Nilsen, F. (Fredrik); Schmidt, G.B. (G. Ben); Albers, G.H.R. (G.H. Robert); Gudger, G.K. (Garland K.); Johnson, G. (Garth); Gruen, G. (Gary); Zohman, G. (Gary); Sharma, G. (Gaurav); Wood, G. (Gavin); G.W.M. Tetteroo (Geert); Hjorthaug, G. (Geir); Jomaas, G. (Geir); Donald, G. (Geoff); Rieser, G.R. (Geoffrey Ryan); Reardon, G. (Gerald); Slobogean, G.P. (Gerard P.); G.R. Roukema (Gert); Visser, G.A. (Gijs A.); Moatshe, G. (Gilbert); Horner, G. (Gillian); Rose, G. (Glynis); Guyatt, G. (Gordon); Chuter, G. (Graham); Etherington, G. (Greg); Rocca, G.J.D. (Gregory J. Della); Ekås, G. (Guri); Dobbin, G. (Gwendolyn); Lemke, H.M. (H. Michael); Curry, H. (Hamish); H. Boxma (Han); Gissel, H. (Hannah); Kreder, H. (Hans); Kuiken, H. (Hans); H.L.F. Brom; Pape, H.-C. (Hans-Christoph); H.M. van der Vis (Harm); Bedi, H. (Harvinder); Vallier, H.A. (Heather A.); Brien, H. (Heather); Silva, H. (Heather); Newman, H. (Heike); H. Viveiros (Helena); van der Hoeven, H. (Henk); Ahn, H. (Henry); Johal, H. (Herman); H. Rijna; Stockmann, H. (Heyn); Josaputra, H.A. (Hong A.); Carlisle, H. (Hope); van der Brand, I. (Igor); I. Dawson (Imro); Tarkin, I. (Ivan); Wong, I. (Ivan); Parr, J.A. (J. Andrew); Trenholm, J.A. (J. Andrew); J.C. Goslings (Carel); Amirault, J.D. (J. David); Broderick, J.S. (J. Scott); Snellen, J.P. (Jaap P.); Zijl, J.A.C. (Jacco A.C.); Ahn, J. (Jaimo); Ficke, J. (James); Irrgang, J. (James); Powell, J. (James); Ringler, J.R. (James R.); Shaer, J. (James); Monica, J.T. (James T.); J. Biert (Jan); Bosma, J. (Jan); Brattgjerd, J.E. (Jan Egil); J.P.M. Frölke (Jan Paul); J.C. Wille (Jan); Rajakumar, J. (Janakiraman); Walker, J.E. (Jane E.); Baker, J.K. (Janell K.); Ertl, J.P. (Janos P.); de Vries, J.P.P.M. (Jean Paul P.M.); Gardeniers, J.W.M. (Jean W.M.); May, J. (Jedediah); Yach, J. (Jeff); Hidy, J.T. (Jennifer T.); Westberg, J.R. (Jerald R.); Hall, J.A. (Jeremy A.); van Mulken, J. (Jeroen); McBeth, J.C. (Jessica Cooper); Hoogendoorn, J. (Jochem); Hoffman, J.M. (Jodi M.); Cherian, J.J. (Joe Joseph); Tanksley, J.A. (John A.); Clarke-Jenssen, J. (John); Adams, J.D. (John D.); Esterhai, J. (John); Tilzey, J.F. (John F.); Murnaghan, J. (John); Ketz, J.P. (John P.); Garfi, J.S. (John S.); Schwappach, J. (John); Gorczyca, J.T. (John T.); Wyrick, J. (John); Rydinge, J. (Jonas); Foret, J.L. (Jonathan L.); Gross, J.M. (Jonathan M.); Keeve, J.P. (Jonathan P.); Meijer, J. (Joost); J.J. Scheepers (Joris J.); Baele, J. (Joseph); O'Neil, J. (Joseph); Cass, J.R. (Joseph R.); Hsu, J.R. (Joseph R.); Dumais, J. (Jules); Lee, J. (Julia); Switzer, J.A. (Julie A.); Agel, J. (Julie); Richards, J.E. (Justin E.); Langan, J.W. (Justin W.); Turckan, K. (Kahn); Pecorella, K. (Kaili); Rai, K. (Kamal); Aurang, K. (Kamran); Shively, K. (Karl); K.J.P. van Wessem; Moon, K. (Karyn); Eke, K. (Kate); Erwin, K. (Katie); Milner, K. (Katrine); K.J. Ponsen (Kees-jan); Mills, K. (Kelli); Apostle, K. (Kelly); Johnston, K. (Kelly); Trask, K. (Kelly); Strohecker, K. (Kent); Stringfellow, K. (Kenya); Kruse, K.K. (Kevin K.); Tetsworth, K. (Kevin); Mitchell, K. (Khalis); Browner, K. (Kieran); Hemlock, K. (Kim); Carcary, K. (Kimberly); Jørgen Haug, K. (Knut); Noble, K. (Krista); Robbins, K. (Kristin); Payton, K. (Krystal); Jeray, K.J. (Kyle J.); Rubino, L.J. (L. Joseph); Nastoff, L.A. (Lauren A.); Leffler, L.C. (Lauren C.); L.P. Stassen (Laurents); O'Malley, L.K. (Lawrence K.); Specht, L.M. (Lawrence M.); L. Thabane (Lehana); Geeraedts, L.M.G. (Leo M.G.); Shell, L.E. (Leslie E.); Anderson, L.K. (Linda K.); Eickhoff, L.S. (Linda S.); Lyle, L. (Lindsey); Pilling, L. (Lindsey); Buckingham, L. (Lisa); Cannada, L.K. (Lisa K.); Wild, L.M. (Lisa M.); Dulaney-Cripe, L. (Liz); L.M.S.J. Poelhekke; Govaert, L. (Lonneke); Ton, L. (Lu); Kottam, L. (Lucksy); L.P.H. Leenen (Luke); Clipper, L. (Lydia); Jackson, L.T. (Lyle T.); Hampton, L. (Lynne); de Waal Malefijt, M.C. (Maarten C.); M.P. Simons; M. van der Elst (Maarten); M.W.G.A. Bronkhorst (Maarten); Bhatia, M. (Mahesh); M.F. Swiontkowski (Marc ); Lobo, M.J. (Margaret J.); Swinton, M. (Marilyn); Pirpiris, M. (Marinis); Molund, M. (Marius); Gichuru, M. (Mark); Glazebrook, M. (Mark); Harrison, M. (Mark); Jenkins, M. (Mark); MacLeod, M. (Mark); M.R. de Vries (Mark); Butler, M.S. (Mark S.); Nousiainen, M. (Markku); van ‘t Riet, M. (Martijne); Tynan, M.C. (Martin C.); Campo, M. (Martin); M.G. Eversdijk (Martin); M.J. Heetveld (Martin); Richardson, M. (Martin); Breslin, M. (Mary); Fan, M. (Mary); Edison, M. (Matt); Napierala, M. (Matthew); Knobe, M. (Matthias); Russ, M. (Matthias); Zomar, M. (Mauri); de Brauw, M. (Maurits); Esser, M. (Max); Hurley, M. (Meghan); Peters, M.E. (Melissa E.); Lorenzo, M. (Melissa); Li, M. (Mengnai); Archdeacon, M. (Michael); Biddulph, M. (Michael); Charlton, M. (Michael); McDonald, M.D. (Michael D.); McKee, M.D. (Michael D.); Dunbar, M. (Michael); Torchia, M.E. (Michael E.); Gross, M. (Michael); Hewitt, M. (Michael); Holt, M. (Michael); Prayson, M.J. (Michael J.); M.J.R. Edwards (Michael); Beckish, M.L. (Michael L.); Brennan, M.L. (Michael L.); Dohm, M.P. (Michael P.); Kain, M.S.H. (Michael S.H.); Vogt, M. (Michelle); Yu, M. (Michelle); M.H.J. Verhofstad (Michiel); Segers, M.J.M. (Michiel J.M.); M.J.M. Segers (Michiel); Siroen, M.P.C. (Michiel P.C.); M.R. Reed (Mike); Vicente, M.R. (Milena R.); M.M.M. Bruijninckx (Milko); Trivedi, M. (Mittal); M. Bhandari (Mohit); Moore, M.M. (Molly M.); Kunz, M. (Monica); Smedsrud, M. (Morten); Palla, N. (Naveen); Jain, N. (Neeraj); Out, N.J.M. (Nico J.M.); Simunovic, N. (Nicole); Simunovic, N. (Nicole); N.W.L. Schep (Niels); Müller, O. (Oliver); Guicherit, O.R. (Onno R.); O.J.F. van Waes (Oscar); Wang, O. (Otis); P. Doornebosch (Pascal); Seuffert, P. (Patricia); Hesketh, P.J. (Patrick J.); Weinrauch, P. (Patrick); Duffy, P. (Paul); Keller, P. (Paul); Lafferty, P.M. (Paul M.); Pincus, P. (Paul); P. Tornetta III (Paul); Zalzal, P. (Paul); McKay, P. (Paula); Cole, P.A. (Peter A.); de Rooij, P.D. (Peter D.); Hull, P. (Peter); Go, P.M.N.Y.M. (Peter M.N.Y.M.); P. Patka (Peter); Siska, P. (Peter); Weingarten, P. (Peter); Kregor, P. (Philip); Stahel, P. (Philip); Stull, P. (Philip); P. Wittich (Philippe); P.A.R. Rijcke (Piet); P.P. Oprel (Pim); Devereaux, P.J. (P. J.); Zhou, Q. (Qi); Lee Murphy, R. (R.); Alosky, R. (Rachel); Clarkson, R. (Rachel); Moon, R. (Raely); Logishetty, R. (Rajanikanth); Nanda, R. (Rajesh); Sullivan, R.J. (Raymond J.); Snider, R.G. (Rebecca G.); Buckley, R.E. (Richard E.); Iorio, R. (Richard); Farrugia, R.J. (Richard J); Jenkinson, R. (Richard); Laughlin, R. (Richard); R.P.R. Groenendijk (Richard); Gurich, R.W. (Richard W.); Worman, R. (Ripley); Silvis, R. (Rob); R. Haverlag (Robert); Teasdall, R.J. (Robert J.); Korley, R. (Robert); McCormack, R. (Robert); Probe, R. (Robert); Cantu, R.V. (Robert V.); Huff, R.B. (Roger B.); R.K.J. Simmermacher; Peters, R. (Rolf); Pfeifer, R. (Roman); Liem, R. (Ronald); Wessel, R.N. (Ronald N.); Verhagen, R. (Ronald); Vuylsteke, R. (Ronald); Leighton, R. (Ross); McKercher, R. (Ross); R.W. Poolman (Rudolf); Miller, R. (Russell); Bicknell, R. (Ryan); Finnan, R. (Ryan); Khan, R.M. (Ryan M.); Mehta, S. (Samir); Vang, S. (Sandy); Singh, S. (Sanjay); Anand, S. (Sanjeev); Anderson, S.A. (Sarah A.); Dawson, S.A. (Sarah A.); Marston, S.B. (Scott B.); Porter, S.E. (Scott E.); Watson, S.T. (Scott T.); S. Festen (Sebastiaan); Lieberman, S. (Shane); Puloski, S. (Shannon); Bielby, S.A. (Shea A.); Sprague, S. (Sheila); Hess, S. (Shelley); MacDonald, S. (Shelley); Evans, S. (Simone); Bzovsky, S. (Sofia); Hasselund, S. (Sondre); Lewis, S. (Sophie); Ugland, S. (Stein); Caminiti, S. (Stephanie); Tanner, S.L. (Stephanie L.); S.M. Zielinski (Stephanie); Shepard, S. (Stephanie); Sems, S.A. (Stephen A.); Walter, S.D. (Stephen D.); Doig, S. (Stephen); Finley, S.H. (Stephen H.); Kates, S. (Stephen); Lindenbaum, S. (Stephen); Kingwell, S.P. (Stephen P.); Csongvay, S. (Steve); Papp, S. (Steve); Buijk, S.E. (Steven E.); S. Rhemrev (Steven); Hollenbeck, S.M. (Steven M.); van Gaalen, S.M. (Steven M.); Yang, S. (Steven); Weinerman, S. (Stuart); Subash, (); Lambert, S. (Sue); Liew, S. (Susan); S.A.G. Meylaerts (Sven); Blokhuis, T.J. (Taco J.); de Vries Reilingh, T.S. (Tammo S.); Lona, T. (Tarjei); Scott, T. (Taryn); Swenson, T.K. (Teresa K.); Endres, T.J. (Terrence J.); Axelrod, T. (Terry); van Egmond, T. (Teun); Pace, T.B. (Thomas B.); Kibsgård, T. (Thomas); Schaller, T.M. (Thomas M.); Ly, T.V. (Thuan V.); Miller, T.J. (Timothy J.); Weber, T. (Timothy); Le, T. (Toan); Oliver, T.M. (Todd M.); T.M. Karsten (Thomas); Borch, T. (Tor); Hoseth, T.M. (Tor Magne); Nicolaisen, T. (Tor); Ianssen, T. (Torben); Rutherford, T. (Tori); Nanney, T. (Tracy); Gervais, T. (Trevor); Stone, T. (Trevor); Schrickel, T. (Tyson); Scrabeck, T. (Tyson); Ganguly, U. (Utsav); Naumetz, V. (V.); Frizzell, V. (Valda); Wadey, V. (Veronica); Jones, V. (Vicki); Avram, V. (Victoria); Mishra, V. (Vimlesh); Yadav, V. (Vineet); Arora, V. (Vinod); Tyagi, V. (Vivek); Borsella, V. (Vivian); W.J. Willems (Jaap); Hoffman, W.H. (W. H.); Gofton, W.T. (Wade T.); Lackey, W.G. (Wesley G.); Ghent, W. (Wesley); Obremskey, W. (William); Oxner, W. (William); Cross, W.W. (William W.); Murtha, Y.M. (Yvonne M.); Murdoch, Z. (Zoe)

2017-01-01

textabstractBackground Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled

Masquerade Syndrome of Multicentre Primary Central Nervous System Lymphoma

Directory of Open Access Journals (Sweden)

Silvana Guerriero

2011-01-01

Full Text Available Purpose. In Italy we say that the most unlucky things can happen to physicians when they get sick, despite the attention of colleagues. To confirm this rumor, we report the sad story of a surgeon with bilateral vitreitis and glaucoma unresponsive to traditional therapies. Methods/Design. Case report. Results. After one year of steroidal and immunosuppressive therapy, a vitrectomy, and a trabeculectomy for unresponsive bilateral vitreitis and glaucoma, MRI showed a multicentre primary central nervous system lymphoma, which was the underlying cause of the masquerade syndrome. Conclusions. All ophthalmologists and clinicians must be aware of masquerade syndromes, in order to avoid delays in diagnosis.

Hypercalcaemic multicentric lymphoma in a dog presenting as clitoromegaly

Directory of Open Access Journals (Sweden)

Anthony B. Zambelli

2013-12-01

Full Text Available Clitoromegaly is a clinical manifestation of various local and systemic conditions in all species. The external genitalia are a very rare site of primary or metastatic lymphoma in canines, with only one previously-reported case in a dog and only sparse reports in the medical literature. Lymphoma is also very rare in dogs less than four years of age. This account reports on a T-cell multicentric lymphoma in a 16-month-old Basset hound presented primarily for clitoromegaly. The patient survived for 68 days with cyclophosphamide-vincristine-prednisolone therapy. The causes of clitoromegaly in all species, including humans, are tabulated with references.

Standardised multicentre procedure for plasma gonadotrophin radioimmunoassay

Energy Technology Data Exchange (ETDEWEB)

Ferguson, K M; Hayes, M; Jeffcoate, S L [Chelsea Hospital for Women, London (UK)

1982-09-01

A radioimmunoassay method for the assay of luteinising hormone (LH) and follicle-stimulating hormone (FSH) in serum/plasma has been designed for use in laboratories of varying expertise in the United Kingdom. The major sources of experimental error leading to poor within-laboratory performance and between-laboratory comparability were identified: quality of tracer, use of calibration standards, and separation procedure. A simple rugged kit was designed which was extensively tested first in our laboratory and then in a small multi-centre field trial before being made available. It is now used routinely by 26 health service and research laboratories. The working range of the assays is 1-50 IU/l (LH) and 0.3-16 IU/l (FSH). The between-batch reproducibility was 5-11% (CV) over the dose range 4.8-18 IU/l (LH) and 1.6-15 IU/l (FSH).

Factors influencing social distance toward people with mental illness.

Science.gov (United States)

Lauber, Christoph; Nordt, Carlos; Falcato, Luis; Rössler, Wulf

2004-06-01

When identifying ways to reduce stigmatization because of mental illness it is crucial to understand contributing factors. Social distance-the willingness to engage in relationships of varying intimacy with a person--is an indicator of public attitudes toward persons with mental illness. Multiple linear regression analysis of the results of a vignette-based opinion survey conducted on a representative population sample in Switzerland (n = 594). The level of social distance increases if situations imply 'social closeness.' The vignette describing a person with schizophrenia, attitudes to general aspects of mental health (lay helping, community psychiatry), emotions toward those affected, and the attitude toward consequences of mental illness (medical treatment, medication side effects, negative sanctions, e.g. withdrawal of the driver license) were found to predict social distance. Demographic factors such as age, gender, and the cultural background influence social distance. The explained variance (R2) is 44.8%. Social distance is a multifaceted concept influenced by, e.g., socio-economic and cultural factors, but also by the respondent's general attitude toward (mental) health issues. These results suggest that more knowledge about mental illnesses, especially schizophrenia, may increase social distance. The findings presented here may help to focus anti-stigma campaigns not only on transmission of knowledge, but on integrating different approaches.

The evaluation of a multifaceted intervention to promote "speaking up" and strengthen interprofessional teamwork climate perceptions.

Science.gov (United States)

Ginsburg, Liane; Bain, Lorna

2017-03-01

Communication failure is a leading cause of error and is often due to inhibition of individuals to speak up in interprofessional healthcare environments. The present study sought to evaluate the impact of a multifaceted intervention designed to promote speaking up on teamwork climate in one clinical department of a large community hospital based in Canada. The multifaceted intervention included a role-playing simulation workshop, teamwork climate data feedback and facilitated discussion with the interprofessional team (discussion briefings), and other department-led initiatives to promote trust, teamwork, and speaking up among interprofessional team members. A quasi-experiment (pretest-posttest control group design, using two posttests several months apart) was used to evaluate the impact of the complete intervention on individual teamwork climate perceptions. The intervention was implemented with an intact interprofessional team (the Emergency Department-ED) in 2014. The intensive care unit (ICU) was used as the control unit. Survey response rates were the highest at time 1 (83/102 = 81% for the ED and 29/31 = 94% for the ICU) and the lowest at time 3 (38/105 = 36% for the ED and 14/30 = 47% for the ICU). The results obtained from paired and unpaired analyses suggest that this type of multifaceted approach can improve staff perceptions of teamwork climate. The teamwork climate score in the ED was significantly higher at follow-up (Mt2 = 3.42, SD = 0.66) compared to baseline (Mt1 = 3.13, SD = 0.72), (F(1, 34) = 12.2, p = .001, eta 2 p = .263), while baseline and follow-up scores were not significantly different between baseline and follow-up for the ICU group (Mt1 = 4.12, SD = 0.60; Mt2 = 4.15, SD = 0.56; F(1, 34) = 0.06, p = .806, eta 2 p = .002). Sustaining high levels of participation in interprofessional initiatives and engaging physicians remain challenging when interventions are used in context. Improving team

Multicentre study with activity meters launched by PTB

International Nuclear Information System (INIS)

Rodloff, G.

1992-01-01

The German Pharmacopeia tolerates for most radionuclides deviations of up to 10% from the actual activity value. The evaluation of a multicentre study launched by the PTB (Federal Physicotechnical Institute) during the period between 1982 and 1987 revealed, however, that not all producers paid attention to these tolerance limits. Occasional values were reported to differ by more than 50% or even a factor of 2 from the PTB value. In order that those deviations are kept to a minimum it is necessary for both manufacturers and users to meet the requirements of the DIN 6852 industrial standard. Activity determinations for 99 Tc m eluates must additionally be carried out in accordance with the recommendations contained in DIN 6854. (orig./DG) [de

Fracture fixation in the operative management of hip fractures (FAITH) : an international, multicentre, randomised controlled trial

NARCIS (Netherlands)

Nauth, Aaron; Creek, Aaron T.; Zellar, Abby; Lawendy, Abdel Rahman; Dowrick, Adam; Gupta, Ajay; Dadi, Akhil; van Kampen, Albert; Yee, Albert; de Vries, Alexander C.; de Mol van Otterloo, Alexander; Garibaldi, Alisha; Liew, Allen; McIntyre, Allison W.; Prasad, Amal Shankar; Romero, Amanda W.; Rangan, Amar; Oatt, Amber; Sanghavi, Amir; Foley, Amy L.; Karlsten, Anders; Dolenc, Andrea; Bucknill, Andrew; Chia, Andrew; Evans, Andrew; Gong, Andrew; Schmidt, Andrew H.; Marcantonio, Andrew J.; Jennings, Andrew; Ward, Angela; Khanna, Angshuman; Rai, Anil; Smits, Anke B; Horan, Annamarie D.; Brekke, Anne Christine; Flynn, Annette; Duraikannan, Aravin; Stødle, Are; van Vugt, Arie B.; Luther, Arlene; Zurcher, Arthur W.; Jain, Arvind; Amundsen, Asgeir; Moaveni, Ash; Carr, Ashley; Sharma, Ateet; Hill, Austin D.; Trommer, Axel; Rai, B. Sachidananda; Hileman, Barbara; Schreurs, Bart; Verhoeven, Bart A N; Barden, Benjamin B.; Flatøy, Bernhard; Cleffken, Berry I.; Bøe, Berthe; Perey, Bertrand; Hanusch, Birgit C.; Weening, Brad; Fioole, Bram; Rijbroek, Bram; Crist, Brett D.; Halliday, Brett; Peterson, Brett; Mullis, Brian; Richardson, C. Glen; Clark, Callum; Sagebien, Carlos A.; van der Pol, Carmen C.; Bowler, Carol; Humphrey, Catherine A.; Coady, Catherine; Koppert, Cees L.; Coles, Chad; Tannoury, Chadi; DePaolo, Charles J.; Gayton, Chris; Herriott, Chris; Reeves, Christina; Tieszer, Christina; Dobb, Christine; Anderson, Christopher G.; Sage, Claire; Cuento, Claudine; Jones, Clifford B.; Bosman, Coks H.R.; Linehan, Colleen; van der Hart, Cor P.; Henderson, Corey; Lewis, Courtland G.; Davis, Craig A.; Donohue, Craig; Mauffrey, Cyril; Sundaresh, D. C.; Farrell, Dana J.; Whelan, Daniel B.; Horwitz, Daniel; Stinner, Daniel; Viskontas, Darius; Roffey, Darren M.; Alexander, David; Karges, David E.; Hak, David; Johnston, David; Love, David; Wright, David M.; Zamorano, David P.; Goetz, David R.; Sanders, David; Stephen, David; Yen, David; Bardana, Davide; Olakkengil, Davy J.; Lawson, Deanna; Maddock, Deborah; Sietsema, Debra L.; Pourmand, Deeba; Den Hartog, Dennis; Donegan, Derek; Heels-Ansdell, Diane; Nam, Diane; Inman, Dominic; Boyer, Dory; Li, Doug; Gibula, Douglas; Price, Dustin M.; Watson, Dylan J.; Hammerberg, E. Mark; Tan, Edward C T H; de Graaf, Eelco J.R.; Vesterhus, Elise Berg; Roper, Elizabeth; Edwards, Elton; Schemitsch, Emil H.; Hammacher, Eric R.; Henderson, Eric R.; Whatley, Erica; Torres, Erick T.; Vermeulen, Erik G.J.; Finn, Erin; Van Lieshout, Esther M M; Wai, Eugene K.; Bannister, Evan R.; Kile, Evelyn; Theunissen, Evert B.M.; Ritchie, Ewan D.; Khan, Farah; Moola, Farhad; Howells, Fiona; de Nies, Frank; van der Heijden, Frank H.W.M.; de Meulemeester, Frank R.A.J.; Frihagen, Frede; Nilsen, Fredrik; Schmidt, G. Ben; Albers, G. H.Robert; Gudger, Garland K.; Johnson, Garth; Gruen, Gary; Zohman, Gary; Sharma, Gaurav; Wood, Gavin; Tetteroo, Geert W.M.; Hjorthaug, Geir; Jomaas, Geir; Donald, Geoff; Rieser, Geoffrey Ryan; Reardon, Gerald; Slobogean, Gerard P.; Roukema, Gert R.; Visser, Gijs A.; Moatshe, Gilbert; Horner, Gillian; Rose, Glynis; Guyatt, Gordon; Chuter, Graham; Etherington, Greg; Rocca, Gregory J.Della; Ekås, Guri; Dobbin, Gwendolyn; Lemke, H. Michael; Curry, Hamish; Boxma, Han; Gissel, Hannah; Kreder, Hans; Kuiken, Hans; Brom, Hans L.F.; Pape, Hans Christoph; van der Vis, Harm M.; Bedi, Harvinder; Vallier, Heather A.; Brien, Heather; Silva, Heather; Newman, Heike; Viveiros, Helena; van der Hoeven, Henk; Ahn, Henry; Johal, Herman; Rijna, Herman; Stockmann, Heyn; Josaputra, Hong A.; Carlisle, Hope; van der Brand, Igor; Dawson, Imro; Tarkin, Ivan; Wong, Ivan; Parr, J. Andrew; Trenholm, J. Andrew; Goslings, J Carel; Amirault, J. David; Broderick, J. Scott; Snellen, Jaap P.; Zijl, Jacco A.C.; Ahn, Jaimo; Ficke, James; Irrgang, James; Powell, James; Ringler, James R.; Shaer, James; Monica, James T.; Biert, Jan; Bosma, Jan; Brattgjerd, Jan Egil; Frölke, Jan Paul M.; Wille, Jan; Rajakumar, Janakiraman; Walker, Jane E.; Baker, Janell K.; Ertl, Janos P.; De Vries, Jean-Paul P. M.; Gardeniers, Jean W.M.; May, Jedediah; Yach, Jeff; Hidy, Jennifer T.; Westberg, Jerald R.; Hall, Jeremy A.; van Mulken, Jeroen; McBeth, Jessica Cooper; Hoogendoorn, Jochem M; Hoffman, Jodi M.; Cherian, Joe Joseph; Tanksley, John A.; Clarke-Jenssen, John; Adams, John D.; Esterhai, John; Tilzey, John F.; Murnaghan, John; Ketz, John P.; Garfi, John S.; Schwappach, John; Gorczyca, John T.; Wyrick, John; Rydinge, Jonas; Foret, Jonathan L.; Gross, Jonathan M.; Keeve, Jonathan P.; Meijer, Joost; Scheepers, Joris J.G.; Baele, Joseph; O'Neil, Joseph; Cass, Joseph R.; Hsu, Joseph R.; Dumais, Jules; Lee, Julia; Switzer, Julie A.; Agel, Julie; Richards, Justin E.; Langan, Justin W.; Turckan, Kahn; Pecorella, Kaili; Rai, Kamal; Aurang, Kamran; Shively, Karl; van Wessem, Karlijn; Moon, Karyn; Eke, Kate; Erwin, Katie; Milner, Katrine; Ponsen, Kees Jan; Mills, Kelli; Apostle, Kelly; Johnston, Kelly; Trask, Kelly; Strohecker, Kent; Stringfellow, Kenya; Kruse, Kevin K.; Tetsworth, Kevin; Mitchell, Khalis; Browner, Kieran; Hemlock, Kim; Carcary, Kimberly; Jørgen Haug, Knut; Noble, Krista; Robbins, Kristin; Payton, Krystal; Jeray, Kyle J.; Rubino, L. Joseph; Nastoff, Lauren A.; Leffler, Lauren C.; Stassen, Laurents P.S.; O'Malley, Lawrence K.; Specht, Lawrence M.; Thabane, Lehana; Geeraedts, Leo M.G.; Shell, Leslie E.; Anderson, Linda K.; Eickhoff, Linda S.; Lyle, Lindsey; Pilling, Lindsey; Buckingham, Lisa; Cannada, Lisa K.; Wild, Lisa M.; Dulaney-Cripe, Liz; Poelhekke, Lodewijk M.S.J.; Govaert, Lonneke; Ton, Lu; Kottam, Lucksy; Leenen, Luke P.H.; Clipper, Lydia; Jackson, Lyle T.; Hampton, Lynne; de Waal Malefijt, Maarten C.; Simons, Maarten P.; van der Elst, Maarten; Bronkhorst, Maarten W.G.A.; Bhatia, Mahesh; Swiontkowski, Marc; Lobo, Margaret J.; Swinton, Marilyn; Pirpiris, Marinis; Molund, Marius; Gichuru, Mark; Glazebrook, Mark; Harrison, Mark; Jenkins, Mark; MacLeod, Mark; de Vries, Mark R.; Butler, Mark S.; Nousiainen, Markku; van ‘t Riet, Martijne; Tynan, Martin C.; Campo, Martin; Eversdijk, Martin G.; Heetveld, Martin J.; Richardson, Martin; Breslin, Mary; Fan, Mary; Edison, Matt; Napierala, Matthew; Knobe, Matthias; Russ, Matthias; Zomar, Mauri; de Brauw, Maurits; Esser, Max; Hurley, Meghan; Peters, Melissa E.; Lorenzo, Melissa; Li, Mengnai; Archdeacon, Michael; Biddulph, Michael; Charlton, Michael R; McDonald, Michael D.; McKee, Michael D.; Dunbar, Michael; Torchia, Michael E.; Gross, Michael; Hewitt, Michael; Holt, Michael; Prayson, Michael J.; Edwards, Michael J R; Beckish, Michael L.; Brennan, Michael L.; Dohm, Michael P.; Kain, Michael S.H.; Vogt, Michelle; Yu, Michelle; Verhofstad, Michiel H J; Segers, Michiel J M; Segers, Michiel J M; Siroen, Michiel P.C.; Reed, Mike; Vicente, Milena R.; Bruijninckx, Milko M.M.; Trivedi, Mittal; Bhandari, Mohit; Moore, Molly M.; Kunz, Monica; Smedsrud, Morten; Palla, Naveen; Jain, Neeraj; Out, Nico J.M.; Simunovic, Nicole; Simunovic, Nicole; Schep, Niels W. L.; Müller, Oliver; Guicherit, Onno R.; Van Waes, Oscar J.F.; Wang, Otis; Doornebosch, Pascal G.; Seuffert, Patricia; Hesketh, Patrick J.; Weinrauch, Patrick; Duffy, Paul; Keller, Paul; Lafferty, Paul M.; Pincus, Paul; Tornetta, Paul; Zalzal, Paul; McKay, Paula; Cole, Peter A.; de Rooij, Peter D.; Hull, Peter; Go, Peter M.N.Y.M.; Patka, Peter; Siska, Peter; Weingarten, Peter; Kregor, Philip; Stahel, Philip; Stull, Philip; Wittich, Philippe; de Rijcke, Piet A.R.; Oprel, Pim; Devereaux, P. J.; Zhou, Qi; Lee Murphy, R.; Alosky, Rachel; Clarkson, Rachel; Moon, Raely; Logishetty, Rajanikanth; Nanda, Rajesh; Sullivan, Raymond J.; Snider, Rebecca G.; Buckley, Richard E.; Iorio, Richard; Farrugia, Richard J.; Jenkinson, Richard; Laughlin, Richard; Groenendijk, Richard P R; Gurich, Richard W.; Worman, Ripley; Silvis, Rob; Haverlag, Robert; Teasdall, Robert J.; Korley, Robert; McCormack, Robert; Probe, Robert; Cantu, Robert V.; Huff, Roger B.; Simmermacher, Rogier K J; Peters, Rolf; Pfeifer, Roman; Liem, Ronald; Wessel, Ronald N.; Verhagen, Ronald; Vuylsteke, Ronald J C L M; Leighton, Ross; McKercher, Ross; Poolman, Rudolf W; Miller, Russell; Bicknell, Ryan; Finnan, Ryan; Khan, Ryan M.; Mehta, Samir; Vang, Sandy; Singh, Sanjay; Anand, Sanjeev; Anderson, Sarah A.; Dawson, Sarah A.; Marston, Scott B.; Porter, Scott E.; Watson, Scott T.; Festen, Sebastiaan; Lieberman, Shane; Puloski, Shannon; Bielby, Shea A.; Sprague, Sheila; Hess, Shelley; MacDonald, Shelley; Evans, Simone; Bzovsky, Sofia; Hasselund, Sondre; Lewis, Sophie; Ugland, Stein; Caminiti, Stephanie; Tanner, Stephanie L.; Zielinski, Stephanie M.; Shepard, Stephanie; Sems, Stephen A.; Walter, Stephen D.; Doig, Stephen; Finley, Stephen H.; Kates, Stephen; Lindenbaum, Stephen; Kingwell, Stephen P.; Csongvay, Steve; Papp, Steve; Buijk, Steven E.; Rhemrev, Steven J.; Hollenbeck, Steven M.; van Gaalen, Steven M.; Yang, Steven; Weinerman, Stuart; Lambert, Sue; Liew, Susan; Meylaerts, Sven A.G.; Blokhuis, Taco J.; de Vries Reilingh, Tammo S.; Lona, Tarjei; Scott, Taryn; Swenson, Teresa K.; Endres, Terrence J.; Axelrod, Terry; van Egmond, Teun; Pace, Thomas B.; Kibsgård, Thomas; Schaller, Thomas M.; Ly, Thuan V.; Miller, Timothy J.; Weber, Timothy; Le, Toan; Oliver, Todd M.; Karsten, Tom M.; Borch, Tor; Hoseth, Tor Magne; Nicolaisen, Tor; Ianssen, Torben; Rutherford, Tori; Nanney, Tracy; Gervais, Trevor; Stone, Trevor; Schrickel, Tyson; Scrabeck, Tyson; Ganguly, Utsav; Naumetz, V.; Frizzell, Valda; Wadey, Veronica; Jones, Vicki; Avram, Victoria; Mishra, Vimlesh; Yadav, Vineet; Arora, Vinod; Tyagi, Vivek; Borsella, Vivian; Willems, W. Jaap; Hoffman, W. H.; Gofton, Wade T.; Lackey, Wesley G.; Ghent, Wesley; Obremskey, William; Oxner, William; Cross, William W.; Murtha, Yvonne M.; Murdoch, Zoe

2017-01-01

Background Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled trial, we

Homeless Women and Shelter Regimes : A Glimpse of Everyday Practice through Social Workers´Narratives

OpenAIRE

Phiri, Cynthia

2016-01-01

Homelessness in South Africa is a multi-faceted issue with enormous dimensions; an issue which is deeply interrelated with questions of power, human dignity and social justice. In South Africa, women have been frequently neglected and marginalized with regard to contemporary housing policy and practice. In seeking to understand the nature of this marginalization, this paper focuses on structural disadvantages faced by homeless women in relation to the shelter regimes. To illustrate the latter...

Towards informed and multi-faceted wildlife trade interventions

Directory of Open Access Journals (Sweden)

Daniel W.S. Challender

2015-01-01

Full Text Available International trade in wildlife is a key threat to biodiversity conservation. CITES, the Convention on International Trade in Endangered Species of Wild Fauna and Flora, seeks to ensure international wildlife trade is sustainable, relying on trade bans and controls. However, there has been little comprehensive review of its effectiveness and here we review approaches taken to regulate wildlife trade in CITES. Although assessing its effectiveness is problematic, we assert that CITES boasts few measurable conservation successes. We attribute this to: non-compliance, an over reliance on regulation, lack of knowledge and monitoring of listed species, ignorance of market forces, and influence among CITES actors. To more effectively manage trade we argue that interventions should go beyond regulation and should be multi-faceted, reflecting the complexity of wildlife trade. To inform these interventions we assert an intensive research effort is needed around six key areas: (1 factors undermining wildlife trade governance at the national level, (2 determining sustainable harvest rates for, and adaptive management of CITES species, (3 gaining the buy-in of local communities in implementing CITES, (4 supply and demand based market interventions, (5 means of quantifying illicit trade, and (6 political processes and influence within CITES.

A PERSONAL NARRATIVE ON THE ROLE OF MICROLEVEL PROFESSIONAL SOCIAL WORK PRACTICE CALLING FOR ITS APPLICATION IN SRI LANKA

Directory of Open Access Journals (Sweden)

Sarathchandra Gamlath

2015-10-01

Full Text Available This paper is a personal reflection on social work and what constitutes a social worker, with special reference to Sri Lanka. Drawing from global literature, it observes that the field of social work has evolved to become a package of knowledge, skills, competencies, code of ethics, and accreditation standards. Therefore, qualified social workers today possess a set of practical as well as academic competencies that is designed to address issues not only at the macro and mezzo level, but also at the individual and family levels. The paper argues that Sri Lanka has yet to adopt a multi-faceted social work approach like this, and explores the possibility of enhancing the institutional capacity of the National Institute for Social Development (the country’s only institute of higher education that offers professional social work education to deliver such approach.

Advantages of the modified double ring areolar incision over the traditional areolar incision in multicentric breast fibroadenoma surgery.

Science.gov (United States)

Zhang, Mingliang; Shen, Gongjin; Zhang, Song; Cui, Zhen; Qian, Jun

2017-09-01

This study was conducted to investigate the clinical advantages of modified double ring areola incision (MDRAI) compared to ordinary areola incision (OAI) in multicentric breast fibroadenoma in women. Sixty cases of multicentric benign breast tumor were recruited from the First Affiliated Hospital of Bengbu Medical College from January to December 2016. The cases were divided into two groups according to surgical approach: MDRAI (n = 20) and OAI (n = 40). The operation duration, intraoperative blood loss, drainage time, and postoperative recurrence rate in the first six months were compared. The mean age and tumor locations were not statistically different between the groups (P > 0.05). However, more lesions and larger tumor diameter were found in the MDRAI group than in the OAI group, with statistical difference (P  0.05). However, the intraoperative blood loss was statistically different between the two groups (P < 0.05). All 60 cases received six months of follow-up. Eight recurrent cases were found in the OAI group, but none in the MDRAI group. The recurrence rate was significantly different (χ 2  = 4.62, P < 0.05). Compared with OAI, MDRAI offers greater advantages in the aspects of blood loss and recurrence for the treatment of breast benign tumor, especially for multicentric larger lesions. © 2017 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

Case report 446: Multicentric, metachronous, low-grade, sclerosing osteogenic sarcoma

International Nuclear Information System (INIS)

McCarthy, E.F.; Tolo, V.T.; Dorfman, H.D.

1987-01-01

This case of multicentric osteosarcoma has overlying features of the clinical subgroups described by Amstutz and Mahoney. This 38-year-old woman has survived 6 years with metachronous multifocal osteosarcomas. She presently has at least seven sites of involvement. The lesions are all densely sclerotic and are confined to the axial skeleton. She has had no treatment except for release of compression syndromes. She has no evidence of pulmonary or other visceral metastases. The low grade nature of this type of multifocal osteosarcoma is confirmed by a six year survival in the absence of ablative surgery, radiotherapy or chemotherapy. (orig.)

Computational Investigation of the Thermochemistry and Kinetics of Steam Methane Reforming Over a Multi-Faceted Nickel Catalyst

KAUST Repository

Blaylock, D. Wayne

2011-08-20

A microkinetic model of steam methane reforming over a multi-faceted nickel surface using planewave, periodic boundary condition density functional theory is presented. The multi-faceted model consists of a Ni(111) surface, a Ni(100) surface, and nickel step edge sites that are modeled as a Ni(211) surface. Flux and sensitivity analysis are combined to gain an increased understanding of the important reactions, intermediates, and surface facets in SMR. Statistical thermodynamics are applied to allow for the investigation of SMR under industrially-relevant conditions (e.g., temperatures in excess of 500 °C and pressures in excess of 1 bar). The most important surface reactions are found to occur at the under-coordinated step edge sites modeled using the Ni(211) surface as well as on the Ni(100) surface. The primary reforming pathway is predicted to be through C*+ O*→ CO*at high temperatures; however, hydrogen-mediated reactions such as C*+ OH*→ COH*and C.H.*+ O*→ CHO*are predicted to become more important at low temperatures. The rate-limiting reactions are predicted to be dissociative chemisorption of methane in addition to the aforementioned C-O addition reactions. © 2011 Springer Science+Business Media, LLC.

Daily variations in air pollution and respiratory health in a multicentre study: the PEACE project.

NARCIS (Netherlands)

Roemer, W.; Hoek, G.; Brunekreef, B.; Haluszka, J.; Kalandidi, A.; Pekkanen, J.

1998-01-01

The Pollution Effects on Asthmatic Children in Europe (PEACE) study is a multicentre study of the acute effects of particles with a 50% cut-off aerodynamic diameter of 10 μm (PM10), black smoke (BS), sulphur dioxide (SO2) and nitrogen dioxide (NO2) on the respiratory health of children with chronic

Dosimetry audit for a multi-centre IMRT head and neck trial

International Nuclear Information System (INIS)

Clark, Catharine H.; Hansen, Vibeke Nordmark; Chantler, Hannah; Edwards, Craig; James, Hayley V.; Webster, Gareth; Miles, Elizabeth A.; Guerrero Urbano, M. Teresa; Bhide, Shree A.; Bidmead, A. Margaret; Nutting, Christoper M.

2009-01-01

Background and purpose: PARSPORT was a multi-centre randomised trial in the UK which compared Intensity-Modulated Radiotherapy (IMRT) and conventional radiotherapy (CRT) for patients with head and neck cancer. The dosimetry audit goals were to verify the plan delivery in participating centres, ascertain what tolerances were suitable for head and neck IMRT trials and develop an IMRT credentialing program. Materials and methods: Centres enrolling patients underwent rigorous quality assurance before joining the trial. Following this each centre was visited for a dosimetry audit, which consisted of treatment planning system tests, fluence verification films, combined field films and dose point measurements. Results: Mean dose point measurements were made at six centres. For the primary planning target volume (PTV) the differences with the planned values for the IMRT and CRT arms were -0.6% (1.8% to -2.4%) and 0.7% (2.0% to -0.9%), respectively. Ninety-four percent of the IMRT fluence films for individual fields passed gamma criterion of 3%/3 mm and 75% of the films for combined fields passed gamma criterion 4%/3 mm (no significant difference between dynamic delivery and step and shoot delivery). Conclusions: This audit suggests that a 3% tolerance could be applied for PTV point doses. For dose distributions tolerances of 3%/3 mm on individual fields and 4%/3 mm for combined fields are proposed for multi-centre head and neck IMRT trials.

A Multi-faceted Mentoring Program for Junior Faculty in Academic Pediatrics

Science.gov (United States)

Chen, Mary M.; Sandborg, Christy I.; Hudgins, Louanne; Sanford, Rania; Bachrach, Laura K.

2016-01-01

Problem The departure of physician-scientists from education and research into clinical practice is a growing challenge for the future of academic medicine. Junior faculty face competing demands for clinical productivity, teaching, research and work-life integration which can undermine confidence in the value of an academic career. Mentorship is important to foster career development and satisfaction in junior faculty. Intervention The goals of this academic pediatrics department were to develop, implement, and evaluate a multi-faceted pediatric mentoring program to promote retention and satisfaction of junior faculty. Program elements included one-on-one mentor-mentee meetings, didactic workshops, grant review assistance, and facilitated peer-group mentoring. Program effectiveness was assessed using annual surveys of mentees, structured mentee exit interviews as well as retention data for assistant professors. Context The mentees were Instructors and Assistant Professors in the department of pediatrics Outcome Seventy-nine mentees participated in the program from 2007 through 2014. The response rate from seven annual surveys was 84%. Sixty-nine percent of mentees felt more prepared to advance their careers, 81% had a better understanding of the criteria for advancement, 84% were satisfied with the program, and 95% found mentors accessible. Mentees who exited the program reported they most valued the one-on-one mentoring and viewed the experience positively regardless of promotion. Retention of Assistant Professors improved after initiation of the program; 4 of 13 hired from 2002–2006 left the institution whereas 18 of 18 hired from 2007–2014 were retained. Lessons Learned This multi-faceted mentoring program appeared to bolster satisfaction and enhance retention of junior pediatric faculty. Mentees reported increased understanding of the criteria for promotion and viewed the program as a positive experience regardless of career path. Individual mentor

A multi-centre dosimetry audit on advanced radiotherapy in lung as part of the Isotoxic IMRT study

Directory of Open Access Journals (Sweden)

Yat Tsang

2017-10-01

Conclusion: This multi-centre dosimetry audit of complex IMRT/VMAT delivery provides confidence in the accuracy of modern planning and delivery systems in inhomogeneous tissues. The findings from this study can be used as a reference for future dosimetry audits.

A multicentre study to improve clinical interpretation of proteinase-3 and myeloperoxidase anti-neutrophil cytoplasmic antibodies

DEFF Research Database (Denmark)

Bossuyt, Xavier; Rasmussen, Niels; van Paassen, Pieter

2017-01-01

Objective: The objective of this multicentre study was to improve the clinical interpretation of PR3- and MPO-ANCAs as an adjunct for the diagnosis of ANCA-associated vasculitis (AAV) by defining thresholds and test result intervals based on predefined specificities and by calculating test result...

StreamExplorer: A Multi-Stage System for Visually Exploring Events in Social Streams.

Science.gov (United States)

Wu, Yingcai; Chen, Zhutian; Sun, Guodao; Xie, Xiao; Cao, Nan; Liu, Shixia; Cui, Weiwei

2017-10-18

Analyzing social streams is important for many applications, such as crisis management. However, the considerable diversity, increasing volume, and high dynamics of social streams of large events continue to be significant challenges that must be overcome to ensure effective exploration. We propose a novel framework by which to handle complex social streams on a budget PC. This framework features two components: 1) an online method to detect important time periods (i.e., subevents), and 2) a tailored GPU-assisted Self-Organizing Map (SOM) method, which clusters the tweets of subevents stably and efficiently. Based on the framework, we present StreamExplorer to facilitate the visual analysis, tracking, and comparison of a social stream at three levels. At a macroscopic level, StreamExplorer uses a new glyph-based timeline visualization, which presents a quick multi-faceted overview of the ebb and flow of a social stream. At a mesoscopic level, a map visualization is employed to visually summarize the social stream from either a topical or geographical aspect. At a microscopic level, users can employ interactive lenses to visually examine and explore the social stream from different perspectives. Two case studies and a task-based evaluation are used to demonstrate the effectiveness and usefulness of StreamExplorer.Analyzing social streams is important for many applications, such as crisis management. However, the considerable diversity, increasing volume, and high dynamics of social streams of large events continue to be significant challenges that must be overcome to ensure effective exploration. We propose a novel framework by which to handle complex social streams on a budget PC. This framework features two components: 1) an online method to detect important time periods (i.e., subevents), and 2) a tailored GPU-assisted Self-Organizing Map (SOM) method, which clusters the tweets of subevents stably and efficiently. Based on the framework, we present Stream

The foundation of NCVD PCI Registry: the Malaysia's first multi-centre interventional cardiology project.

Science.gov (United States)

Liew, H B; Rosli, M A; Wan Azman, W A; Robaayah, Z; Sim, K H

2008-09-01

The National Cardiovascular Database for Percutaneous Coronary Intervention (NCVD PCI) Registry is the first multicentre interventional cardiology project, involving the main cardiac centres in the country. The ultimate goal of NCVD PCI is to provide a contemporary appraisal of PCI in Malaysia. This article introduces the foundation, the aims, methodology, database collection and preliminary results of the first six-month database.

YadA, the multifaceted Yersinia adhesin.

Science.gov (United States)

El Tahir, Y; Skurnik, M

2001-08-01

The adhesion protein YadA is encoded by the yadA gene located in the 70-kb virulence plasmid of Yersinia (pYV) that is common to the pathogenic Yersinia species (Y. pestis, Y. pseudotuberculosis and Y. enterocolitica). YadA is a virulence factor of Y. enterocolitica, however, YadA seems to be dispensable for the virulence of Y. pseudotuberculosis, and in wild-type Y. pestis the yadA gene has a frameshift mutation silencing the gene. Expression of the Y. pseudotuberculosis YadA in Y. pestis reduces its virulence. YadA is a homotrimer of ca. 45-kDa subunits that are anchored to the outer membrane via their C-termini, while their N-termini form a globular head on top of a stalk; the 'lollipop'-shaped YadA structure covers the entire bacterial surface giving it hydrophobic properties. The yadA gene expression is induced at 37 degrees C by the temperature-dependent transcriptional activator LcrF. YadA is a multifaceted protein as revealed by its different biological properties. YadA+ bacteria bind to collagens, laminin, fibronectin, intestinal submucosa, mucus, and to hydrophobic surfaces like polystyrene. YadA+ bacteria autoagglutinate in stationary culture and also specifically agglutinate guinea pig red blood cells. YadA is also a potent serum resistance factor as it inhibits the classical pathway of complement. As invasin, it mediates low rate invasion to tissue culture cells. In a rat model of reactive arthritis YadA and specifically YadA-mediated collagen binding is necessary for Y. enterocolitica to induce the disease. Despite of this wealth of information or perhaps because of it, the in vivo role of YadA during infection remains still largely unresolved.

A new social-family model for eating disorders: A European multicentre project using a case-control design.

Science.gov (United States)

Krug, Isabel; Fuller-Tyszkiewicz, Matthew; Anderluh, Marija; Bellodi, Laura; Bagnoli, Silvia; Collier, David; Fernandez-Aranda, Fernando; Karwautz, Andreas; Mitchell, Sarah; Nacmias, Benedetta; Ricca, Valdo; Sorbi, Sandro; Tchanuria, Kate; Wagner, Gudrun; Treasure, Janet; Micali, Nadia

2015-12-01

To examine a new socio-family risk model of Eating Disorders (EDs) using path-analyses. The sample comprised 1264 (ED patients = 653; Healthy Controls = 611) participants, recruited into a multicentre European project. Socio-family factors assessed included: perceived maternal and parental parenting styles, family, peer and media influences, and body dissatisfaction. Two types of path-analyses were run to assess the socio-family model: 1.) a multinomial logistic path-model including ED sub-types [Anorexia Nervosa-Restrictive (AN-R), AN-Binge-Purging (AN-BP), Bulimia Nervosa (BN) and EDNOS)] as the key polychotomous categorical outcome and 2.) a path-model assessing whether the socio-family model differed across ED sub-types and healthy controls using body dissatisfaction as the outcome variable. The first path-analyses suggested that family and media (but not peers) were directly and indirectly associated (through body dissatisfaction) with all ED sub-types. There was a weak effect of perceived parenting directly on ED sub-types and indirectly through family influences and body dissatisfaction. For the second path-analyses, the socio-family model varied substantially across ED sub-types. Family and media influences were related to body dissatisfaction in the EDNOS and control sample, whereas perceived abusive parenting was related to AN-BP and BN. This is the first study providing support for this new socio-family model, which differed across ED sub-types. This suggests that prevention and early intervention might need to be tailored to diagnosis-specific ED profiles. Copyright © 2015 Elsevier Ltd. All rights reserved.

Improving surgical site infection prevention practices through a multifaceted educational intervention.

LENUS (Irish Health Repository)

Owens, P

2015-03-01

As part of the National Clinical Programme on healthcare-associated infection prevention, a Royal College of Surgeons in Ireland (RCSI) and Royal College of Physicians of Ireland (RCPI) working group developed a quality improvement tool for prevention of surgical site infection (SS). We aimed to validate the effectiveness of an educational campaign, which utilises this quality improvement tool to prevent SSI in a tertiary hospital. Prior to the SSI educational campaign, surgical patients were prospectively audited and details of antibiotic administration recorded. Prophylactic antibiotic administration recommendations were delivered via poster and educational presentations. Post-intervention, the audit was repeated. 50 patients were audited pre-intervention, 45 post-intervention. Post-intervention, prophylaxis within 60 minutes prior to incision increased from 54% to 68% (p = 0.266). Appropriate postoperative prescribing improved from 71% to 92% (p = 0.075). A multifaceted educational program may be effective in changing SSI prevention practices.

Predictors of subjective quality of life in schizophrenic patients living in the community. A Nordic multicentre study.

Science.gov (United States)

Hansson, L; Middelboe, T; Merinder, L; Bjarnason, O; Bengtsson-Tops, A; Nilsson, L; Sandlund, M; Sourander, A; Sørgaard, K W; Vinding, H

1999-01-01

As part of a Nordic multi-centre study investigating the life and care situation of community samples of schizophrenic patients the aim of the present part of the study was to examine the relationship between global subjective quality of life and objective life conditions, clinical characteristics including psychopathology and number of needs for care, subjective factors such as satisfaction with different life domains, social network, and self-esteem. A sample of 418 persons with schizophrenia from 10 sites was used. The results of a final multiple regression analysis, explaining 52.3% of the variance, showed that five subjective factors were significantly associated with global subjective quality of life, together with one objective indicator, to have a close friend. No clinical characteristics were associated with global subjective quality of life. The largest part of the variance was explained by satisfaction with health, 36.3% of the variance, and self-esteem, 7.3% of the variance. It is concluded that the actual relationship between objective life conditions and subjectively experienced quality of life still remains unclear. Furthermore, it seems obvious that personality related factors such as self-esteem, mastery and sense of autonomy also play a role in the appraisal of subjective quality of life, which implies that factors like these are important to consider in clinical and social interventions for patients with schizophrenia in order to improve quality of life for these persons.

Mapping the social impacts of small dams: The case of Thailand's Ing River basin.

Science.gov (United States)

Fung, Zali; Pomun, Teerapong; Charles, Katrina J; Kirchherr, Julian

2018-05-24

The social impacts of large dams have been studied extensively. However, small dams' social impacts have been largely neglected by the academic community. Our paper addresses this gap. We examine the social impacts of multiple small dams in one upstream and one downstream village in Thailand's Ing River basin. Our research is based on semi-structured interviews with beneficiaries, government and NGOs. We argue that small dams' social impacts are multi-faceted and unequal. The dams were perceived to reduce fish abundance and provide flood mitigation benefits. Furthermore, the dams enabled increased access to irrigation water for upstream farmers, who re-appropriated water via the dams at the expense of those downstream. The small dams thus engendered water allocation conflicts. Many scholars, practitioners and environmentalists argue that small dams are a benign alternative to large dams. However, the results of our research mandate caution regarding this claim.

How social cognition deficits affect psychopathology: A neuroscientific approach

Directory of Open Access Journals (Sweden)

Andrić Sanja

2015-01-01

Full Text Available Humans are substantially a social species. Effective mental treatment cannot be obtained without addressing social behavior. Social cognition refers to the mental processes underlying social interactions, which allow individuals to make sense of the other peoples' behavior, to decipher emotions on their faces, and to draw conclusions about their intentions. The core domains of this multifaceted concept are theory of mind, social cue perception, attributional style and emotion perception/ processing. The amygdala, orbital frontal cortex and temporal cortex areas are typically activated during the processing of information within social-emotional context. The aforementioned brain areas are recognized as the major components of the so-called 'social brain'- specialized for the social interactions in humans. Adequate perceiving and processing of the social information is essential for an effective social functioning, which becomes obvious when it goes awry. Various psychiatric disorders are characterized by social cognitive deficits, among which schizophrenias, depression-anxiety and autism spectrum disorders were most broadly studied to date. Growing evidence suggest that these deficits underlie poor functional outcomes in patients with mental health impairments and have an important role in the initiation and maintenance of the disorders' symptoms. One of the most important goals of social neuroscience research is to provide a treatment intervention that will improve patients' social cognitive skills and the functional outcome. All together, the present review aims to provide a contemporary overview of the concept of social cognition, to outline its relation to psychopathology, and to discuss the implications for clinical practice and treatment.

A multicentre ‘end to end’ dosimetry audit for cervix HDR brachytherapy treatment

International Nuclear Information System (INIS)

Palmer, Antony L.; Diez, Patricia; Gandon, Laura; Wynn-Jones, Andrea; Bownes, Peter; Lee, Chris; Aird, Edwin; Bidmead, Margaret; Lowe, Gerry; Bradley, David; Nisbet, Andrew

2015-01-01

Purpose: To undertake the first multicentre fully ‘end to end’ dosimetry audit for HDR cervix brachytherapy, comparing planned and delivered dose distributions around clinical treatment applicators, with review of local procedures. Materials and methods: A film-dosimetry audit was performed at 46 centres, including imaging, applicator reconstruction, treatment planning and delivery. Film dose maps were calculated using triple-channel dosimetry and compared to RTDose data from treatment planning systems. Deviations between plan and measurement were quantified at prescription Point A and using gamma analysis. Local procedures were also discussed. Results: The mean difference between planned and measured dose at Point A was −0.6% for plastic applicators and −3.0% for metal applicators, at standard uncertainty 3.0% (k = 1). Isodose distributions agreed within 1 mm over a dose range 2–16 Gy. Mean gamma passing rates exceeded 97% for plastic and metal applicators at 3% (local) 2 mm criteria. Two errors were found: one dose normalisation error and one applicator library misaligned with the imaged applicator. Suggestions for quality improvement were also made. Conclusions: The concept of ‘end to end’ dosimetry audit for HDR brachytherapy has been successfully implemented in a multicentre environment, providing evidence that a high level of accuracy in brachytherapy dosimetry can be achieved

More than addiction: Examining the role of anonymity, endless narrative, and socialization in prolonged gaming and instant messaging practices

Directory of Open Access Journals (Sweden)

Kishonna Gray

2015-06-01

Full Text Available This ethnographic study explores a user’s prolonged engagement within virtual gaming communities. Likening prolonged engagement with addiction, this research provides an alternative perspective into virtual addiction focusing on three interrelated themes: 1 anonymity, 2 endless narrative, and 3 socialization. By employing narrative interviews and virtual observations, the researchers examine two different cultural, racial and age groups’ user experience within console and computer-based multiplayer environments. More specifically, they explore how the three factors (i.e., anonymity; endless narrative; socialization relate to the prolonged and extended use within these virtual communities and highlight the multifaceted uses of traditional chat services, social media, and the convergence of media existing within these chat communities.

Impact of a multifaceted educational intervention including serious games to improve the management of invasive candidiasis in critically ill patients.

Science.gov (United States)

Ferrer, R; Zaragoza, R; Llinares, P; Maseda, E; Rodríguez, A; Quindós, G

Infections caused by Candida species are common in critically ill patients and contribute to significant morbidity and mortality. The EPICO Project (Epico 1 and Epico 2.0 studies) recently used a Delphi approach to elaborate guidelines for the diagnosis and treatment of this condition in critically ill adult patients. We aimed to evaluate the impact of a multifaceted educational intervention based on the Epico 1 and Epico 2.0 recommendations. Specialists anonymously responded to two online surveys before and after a multifaceted educational intervention consisting of 60-min educational sessions, the distribution of slide kits and pocket guides with the recommendations, and an interactive virtual case presented at a teleconference and available for online consultation. A total of 74 Spanish hospitals. Specialists of the Intensive Care Units in the participating hospitals. Specialist knowledge and reported practices evaluated using a survey. The McNemar test was used to compare the responses in the pre- and post-intervention surveys. A total of 255 and 248 specialists completed both surveys, in both periods, respectively. The pre-intervention surveys showed many specialists to be unaware of the best approach for managing invasive candidiasis. After both educational interventions, specialist knowledge and reported practices were found to be more in line with nearly all the recommendations of the Epico 1 and Epico 2.0 guidelines, except as regards de-escalation from echinocandins to fluconazole in Candida glabrata infections (p=0.055), and the duration of antifungal treatment in both candidemia and peritoneal candidiasis. This multifaceted educational intervention based on the Epico Project recommendations improved specialist knowledge of the management of invasive candidiasis in critically ill patients. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

Effectiveness of Multifaceted Care Approach on Adverse Clinical Outcomes in Nondiabetic CKD: A Systematic Review and Meta-analysis

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Aminu K. Bello

2017-07-01

Discussion: Multifaceted interventions targeting multiple risk factors tended to reduce the risk of all-cause mortality and reduced the risk to progress to end-stage kidney failure in patients with CKD. There is a need for high-quality studies that can rigorously evaluate a set of interventions targeting multiple domains of CKD management in the population with nondiabetic CKD due to paucity of data in the current published literature.

Multi-faceted implementation strategy to increase use of a clinical guideline for the diagnosis of deep venous thrombosis in primary care.

Science.gov (United States)

Kingma, Anna E C; van Stel, Henk F; Oudega, Ruud; Moons, Karel G M; Geersing, Geert-Jan

2017-08-01

A clinical decision rule (CDR), combined with a negative D-dimer test, can safely rule out deep venous thrombosis (DVT) in primary care. This strategy is recommended by guidelines, yet uptake by GPs is low. To evaluate a multi-faceted implementation strategy aimed at increased use of the guideline recommended CDR plus D-dimer test in primary care patients with suspected DVT. This multi-faceted implementation strategy consisted of educational outreach visits, financial reimbursements and periodical newsletters. 217 Dutch GPs (implementation group) received this strategy and included patients. Effectiveness was measured through the following patient-level outcomes: (i) proportion of non-referred patients, (ii) proportion of missed DVT cases within this group and (iii) the proportion of patients in whom the guideline was applied incorrectly. Implementation outcomes ('acceptability', 'feasibility', 'fidelity' and 'sustainability') were assessed with an online questionnaire. Patient-level outcomes were compared with those of patients included by 450 GPs, uninformed about the study's purposes providing information about usual care. 336 (54%) of 619 analyzable implementation group patients were not referred, missing 6 [1.8% (95% confidence interval 0.7% to 3.9%)] DVT cases. Incorrect guideline use was observed in 199 patients (32%). Self-reported acceptability, feasibility and expected sustainability were high. Guideline use increased from 42% to an expected continuation of use of 91%. Only 32 usual care GPs included 62 patients, making formal comparison unreliable. This multi-faceted implementation strategy safely reduced patient referral to secondary care, despite frequently incorrect application of the guideline and resulted in high acceptability, feasibility and expected sustainability. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Multifaceted intervention to curb in-hospital over-prescription of proton pump inhibitors: A longitudinal multicenter quasi-experimental before-and-after study.

Science.gov (United States)

Del Giorno, Rosaria; Ceschi, Alessandro; Pironi, Michela; Zasa, Anna; Greco, Angela; Gabutti, Luca

2018-04-01

Proton pump inhibitors (PPIs) are indicated for a restricted number of clinical conditions, and their misuse can lead to several adverse effects. Despite that, the proportion of overuse is alarmingly high. To test the efficacy of a multifaceted strategy in order to achieve a significant reduction of new PPI prescriptions at discharge in hospitalized patients. Multicenter longitudinal quasi-experimental before-and-after study conducted from July 1st, 2014 to June 30th, 2017. 44,973 admissions in a network of 5 public teaching hospitals of the Italian-speaking region of Switzerland. Multifaceted strategy consisting in a continuous transparent monitoring-benchmarking and in capillary educational interventions applied in the internal medicine departments. To confirm the causality of the results we monitored the trend of new PPI prescriptions in the, not exposed to the intervention, surgery departments of the same hospital network. New PPI prescriptions at hospital discharge. Over the 36month study period 44,973 patient files were analyzed. At admission, comparing internal medicine vs. surgery departments, 44.9% vs. 23.3% of patients were already being treated with a PPI. The annual rate of new PPI prescriptions, for internal medicine showed a decreasing trend: 19, 19, 18, 16% in years 2014, 2015, 2016, 2017, respectively (pintroduction of a multifaceted intervention significantly reduced the time trend of PPI prescriptions at hospital discharge in internal medicine departments. Further studies are needed to confirm whether the strategy proposed could contribute to optimize the in-hospital drug prescription behavior in other healthcare settings as well. Copyright © 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

An Investigational Analysis of Problem Drinking among a Commuter College Population.

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Bebo, Joseph A.

2003-01-01

Previous literature has identified a number of variables that lead to substance abuse behavior. Studies that take a multifaceted, theoretical approach are limited. This study proposes the integration of differential association, social learning, social bonding, seduction and self-control theories. Proposes that a multifaceted approach contributes…

Association between the older adults' social relationships and functional status in Japan.

Science.gov (United States)

Watanabe, Kumi; Tanaka, Emiko; Watanabe, Taeko; Chen, Wencan; Wu, Bailiang; Ito, Sumio; Okumura, Rika; Anme, Tokie

2017-10-01

Previous studies have shown that social relationships positively contribute to the functioning of older adults. However, the particular aspects of social relationships that are most predictive remain unknown. Consequently, the current study aimed to clarify what elements of social relationships impacted the maintenance of functioning among older adults. The present study used baseline data collected in 2011, and follow-up surveys were carried out 3 years later. Participants included individuals aged 65 years or older who lived in a suburban community in Japan. A total of 434 participants met inclusion criteria for the study and were included in analysis. The Index of Social Interaction measure consists of five subscales (independence, social curiosity, interaction, participation and feeling of safety), and was used to assess the multiple elements of social relationships. After controlling for age, sex, disease status and mobility in 2011, the results showed that the social curiosity subscale was significantly associated with functional status after 3 years (OR 1.29, 95% CI 1.02-1.63). Other Index of Social Interaction subscales were non-significant. The current study suggests that interaction with environment and multifaceted social relationships have the strongest impact on functional ability for older adults in Japan. Geriatr Gerontol Int 2017; 17: 1522-1526. © 2016 Japan Geriatrics Society.

Effectiveness of a multifaceted podiatry intervention to prevent falls in community dwelling older people with disabling foot pain: randomised controlled trial.

Science.gov (United States)

Spink, Martin J; Menz, Hylton B; Fotoohabadi, Mohammad R; Wee, Elin; Landorf, Karl B; Hill, Keith D; Lord, Stephen R

2011-06-16

To determine the effectiveness of a multifaceted podiatry intervention in preventing falls in community dwelling older people with disabling foot pain. Parallel group randomised controlled trial. University health sciences clinic in Melbourne, Australia. 305 community dwelling men and women (mean age 74 (SD 6) years) with disabling foot pain and an increased risk of falling. 153 were allocated to a multifaceted podiatry intervention and 152 to routine podiatry care, with 12 months' follow-up. Multifaceted podiatry intervention consisting of foot orthoses, advice on footwear, subsidy for footwear ($A100 voucher; £65; €74), a home based programme of foot and ankle exercises, a falls prevention education booklet, and routine podiatry care for 12 months. The control group received routine podiatry care for 12 months. Proportion of fallers and multiple fallers, falling rate, and injuries resulting from falls during follow-up. Overall, 264 falls occurred during the study. 296 participants returned all 12 calendars: 147 (96%) in the intervention group and 149 (98%) in the control group. Adherence was good, with 52% of the participants completing 75% or more of the requested three exercise sessions weekly, and 55% of those issued orthoses reporting wearing them most of the time. Participants in the intervention group (n=153) experienced 36% fewer falls than participants in the control group (incidence rate ratio 0.64, 95% confidence interval 0.45 to 0.91, P=0.01). The proportion of fallers and multiple fallers did not differ significantly between the groups (relative risk 0.85, 0.66 to 1.08, P=0.19 and 0.63, 0.38 to 1.04, P=0.07). One fracture occurred in the intervention group and seven in the control group (0.14, 0.02 to 1.15, P=0.07). Significant improvements in the intervention group compared with the control group were found for the domains of strength (ankle eversion), range of motion (ankle dorsiflexion and inversion/eversion), and balance (postural sway on the

The Multifaceted Role of the Ventromedial Prefrontal Cortex in Emotion, Decision Making, Social Cognition, and Psychopathology.

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Hiser, Jaryd; Koenigs, Michael

2018-04-15

The ventromedial prefrontal cortex (vmPFC) has been implicated in a variety of social, cognitive, and affective functions that are commonly disrupted in mental illness. In this review, we summarize data from a diverse array of human and animal studies demonstrating that the vmPFC is a key node of cortical and subcortical networks that subserve at least three broad domains of psychological function linked to psychopathology. One track of research indicates that the vmPFC is critical for the representation of reward- and value-based decision making, through interactions with the ventral striatum and amygdala. A second track of research demonstrates that the vmPFC is critical for the generation and regulation of negative emotion, through its interactions with the amygdala, bed nucleus of the stria terminalis, periaqueductal gray, hippocampus, and dorsal anterior cingulate cortex. A third track of research shows the importance of the vmPFC in multiple aspects of social cognition, such as facial emotion recognition, theory-of-mind ability, and processing self-relevant information, through its interactions with the posterior cingulate cortex, precuneus, dorsomedial PFC, and amygdala. We then present meta-analytic data revealing distinct subregions within the vmPFC that correspond to each of these three functions, as well as the associations between these subregions and specific psychiatric disorders (depression, posttraumatic stress disorder, addiction, social anxiety disorder, bipolar disorder, schizophrenia, and attention-deficit/hyperactivity disorder). We conclude by describing several translational possibilities for clinical studies of vmPFC-based circuits, including neuropsychological assessment of transdiagnostic functions, anatomical targets for intervention, predictors of treatment response, markers of treatment efficacy, and subtyping within disorders. Copyright © 2017 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

Cybersecurity vulnerabilities in medical devices: a complex environment and multifaceted problem.

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Williams, Patricia Ah; Woodward, Andrew J

2015-01-01

The increased connectivity to existing computer networks has exposed medical devices to cybersecurity vulnerabilities from which they were previously shielded. For the prevention of cybersecurity incidents, it is important to recognize the complexity of the operational environment as well as to catalog the technical vulnerabilities. Cybersecurity protection is not just a technical issue; it is a richer and more intricate problem to solve. A review of the factors that contribute to such a potentially insecure environment, together with the identification of the vulnerabilities, is important for understanding why these vulnerabilities persist and what the solution space should look like. This multifaceted problem must be viewed from a systemic perspective if adequate protection is to be put in place and patient safety concerns addressed. This requires technical controls, governance, resilience measures, consolidated reporting, context expertise, regulation, and standards. It is evident that a coordinated, proactive approach to address this complex challenge is essential. In the interim, patient safety is under threat.

Cybersecurity vulnerabilities in medical devices: a complex environment and multifaceted problem

Science.gov (United States)

Williams, Patricia AH; Woodward, Andrew J

2015-01-01

The increased connectivity to existing computer networks has exposed medical devices to cybersecurity vulnerabilities from which they were previously shielded. For the prevention of cybersecurity incidents, it is important to recognize the complexity of the operational environment as well as to catalog the technical vulnerabilities. Cybersecurity protection is not just a technical issue; it is a richer and more intricate problem to solve. A review of the factors that contribute to such a potentially insecure environment, together with the identification of the vulnerabilities, is important for understanding why these vulnerabilities persist and what the solution space should look like. This multifaceted problem must be viewed from a systemic perspective if adequate protection is to be put in place and patient safety concerns addressed. This requires technical controls, governance, resilience measures, consolidated reporting, context expertise, regulation, and standards. It is evident that a coordinated, proactive approach to address this complex challenge is essential. In the interim, patient safety is under threat. PMID:26229513

Examining Motivation in Online Distance Learning Environments: Complex, Multifaceted, and Situation-Dependent

Directory of Open Access Journals (Sweden)

Maggie Hartnett

2011-10-01

Full Text Available Existing research into motivation in online environments has tended to use one of two approaches. The first adopts a trait-like model that views motivation as a relatively stable, personal characteristic of the learner. Research from this perspective has contributed to the notion that online learners are, on the whole, intrinsically motivated. The alternative view concentrates on the design of online learning environments to encourage optimal learner motivation. Neither approach acknowledges a contemporary view of motivation that emphasises the situated, mutually constitutive relationship of the learner and the learning environment. Using self-determination theory (SDT as a framework, this paper explores the motivation to learn of preservice teachers in two online distance-learning contexts. In this study, learners were found to be not primarily intrinsically motivated. Instead, student motivation was found to be complex, multifaceted, and sensitive to situational conditions.

Growing into interdisciplinarity: how to converge biology, economics and social science in fisheries research?

DEFF Research Database (Denmark)

Haapasaari, Päivi Elisabet; Kulmala, Soile; Kuikka, Sakari

2012-01-01

It has been acknowledged that natural sciences alone cannot provide an adequate basis for the management of complex environmental problems. The scientific knowledge base has to be expanded in a more holistic direction by incorporating social and economic issues. As well, the multifaceted knowledge...... science-based decision making. The empirical findings suggest that interdisciplinarity is an extensive learning process that takes place on three levels: between individuals, between disciplines, and between types of knowledge. Such a learning process is facilitated by agreeing to a methodological epoch...

Effectiveness of a multifaceted implementation strategy on physicians' referral behavior to an evidence-based psychosocial intervention in dementia: a cluster randomized controlled trial

NARCIS (Netherlands)

Dopp, C.M.E.; Graff, M.J.L.; Teerenstra, S.; Nijhuis-Van der Sanden, M.W.; Olde Rikkert, M.G.M.; Vernooij-Dassen, M.J.F.J.

2013-01-01

BACKGROUND: To evaluate the effectiveness of a multifaceted implementation strategy on physicians' referral rate to and knowledge on the community occupational therapy in dementia program (COTiD program). METHODS: A cluster randomized controlled trial with 28 experimental and 17 control clusters was

The effect of a multifaceted empowerment strategy on decision making about the number of embryos transferred in in vitro fertilisation: randomised controlled trial.

NARCIS (Netherlands)

Peperstraten, A.M. van; Nelen, W.L.D.M.; Grol, R.P.T.M.; Zielhuis, G.A.; Adang, E.M.M.; Stalmeier, P.F.M.; Hermens, R.P.M.G.; Kremer, J.A.M.

2010-01-01

OBJECTIVE: To evaluate the effects of a multifaceted empowerment strategy on the actual use of single embryo transfer after in vitro fertilisation. DESIGN: Randomised controlled trial. SETTING: Five in vitro fertilisation clinics in the Netherlands. PARTICIPANTS: 308 couples (women aged <40) on the

A multifaceted hospital-wide intervention increases hand hygiene compliance.

Science.gov (United States)

Patel, B; Engelbrecht, H; McDonald, H; Morris, V; Smythe, W

2016-03-07

Hand hygiene is an important and basic practice that should be used by all healthcare staff to protect both themselves and their patients against infection. Unfortunately hand hygiene compliance remains poor. To show an improvement in hand hygiene compliance using a multifaceted approach. This was a quasiexperimental pre-post intervention study design with a number of standardised interventions to promote hand hygiene. The World Health Organization hand hygiene multimodal (five-step) intervention approach was used. The study ran from June 2015 to August 2015 in 11 selected wards of a 975-bed tertiary and quaternary care public hospital (Groote Schuur Hospital, Cape Town, South Africa). The outcome was to assess improvement in hand hygiene compliance monthly over the 3 months, compared with non-intervention wards and compared with the wards' own performance measured in 2014. The study included both descriptive and analytical components. Post intervention, hand hygiene compliance showed a statistically significant improvement for before patient contact from 34% in 2014 to 76% in 2015 (p<0.05) and for after patient contact from 47% in 2014 to 82% in 2015 (p<0.05). The intervention improved hand hygiene compliance and can easily be replicated in other wards, resulting in sustaining a culture of hand hygiene improvement and behavioural change throughout the hospital.

Fructose and NAFLD: The Multifaceted Aspects of Fructose Metabolism

Science.gov (United States)

Jegatheesan, Prasanthi; De Bandt, Jean-Pascal

2017-01-01

Among various factors, such as an unhealthy diet or a sedentarity lifestyle, excessive fructose consumption is known to favor nonalcoholic fatty liver disease (NAFLD), as fructose is both a substrate and an inducer of hepatic de novo lipogenesis. The present review presents some well-established mechanisms and new clues to better understand the pathophysiology of fructose-induced NAFLD. Beyond its lipogenic effect, fructose intake is also at the onset of hepatic inflammation and cellular stress, such as oxidative and endoplasmic stress, that are key factors contributing to the progression of simple steatosis to nonalcoholic steatohepatitis (NASH). Beyond its hepatic effects, this carbohydrate may exert direct and indirect effects at the peripheral level. Excessive fructose consumption is associated, for example, with the release by the liver of several key mediators leading to alterations in the communication between the liver and the gut, muscles, and adipose tissue and to disease aggravation. These multifaceted aspects of fructose properties are in part specific to fructose, but are also shared in part with sucrose and glucose present in energy–dense beverages and foods. All these aspects must be taken into account in the development of new therapeutic strategies and thereby to better prevent NAFLD. PMID:28273805

Precision of 3.0 Tesla quantitative magnetic resonance imaging of cartilage morphology in a multicentre clinical trial.

Science.gov (United States)

Eckstein, F; Buck, R J; Burstein, D; Charles, H C; Crim, J; Hudelmaier, M; Hunter, D J; Hutchins, G; Jackson, C; Kraus, V Byers; Lane, N E; Link, T M; Majumdar, L S; Mazzuca, S; Prasad, P V; Schnitzer, T J; Taljanovic, M S; Vaz, A; Wyman, B; Le Graverand, M-P Hellio

2008-12-01

Quantitative MRI (qMRI) of cartilage morphology is a promising tool for disease-modifying osteoarthritis drug (DMOAD) development. Recent studies at single sites have indicated that measurements at 3.0 Tesla (T) are more reproducible (precise) than those at 1.5 T. Precision errors and stability in multicentre studies with imaging equipment from various vendors have, however, not yet been evaluated. A total of 158 female participants (97 Kellgren and Lawrence grade (KLG) 0, 31 KLG 2 and 30 KLG 3) were imaged at 7 clinical centres using Siemens Magnetom Trio and GE Signa Excite magnets. Double oblique coronal acquisitions were obtained at baseline and at 3 months, using water excitation spoiled gradient echo sequences (1.0x0.31x0.31 mm3 resolution). Segmentation of femorotibial cartilage morphology was performed using proprietary software (Chondrometrics GmbH, Ainring, Germany). The precision error (root mean square coefficient of variation (RMS CV)%) for cartilage thickness/volume measurements ranged from 2.1%/2.4% (medial tibia) to 2.9%/3.3% (lateral weight-bearing femoral condyle) across all participants. No significant differences in precision errors were observed between KLGs, imaging sites, or scanner manufacturers/types. Mean differences between baseline and 3 months ranged from <0.1% (non-significant) in the medial to 0.94% (p<0.01) in the lateral femorotibial compartment, and were 0.33% (p<0.02) for the total femorotibial subchondral bone area. qMRI performed at 3.0 T provides highly reproducible measurements of cartilage morphology in multicentre clinical trials with equipment from different vendors. The technology thus appears sufficiently robust to be recommended for large-scale multicentre trials.

Ethics review as a component of institutional approval for a multicentre continuous quality improvement project: the investigator's perspective

Directory of Open Access Journals (Sweden)

von Dadelszen Peter

2010-07-01

Full Text Available Abstract Background For ethical approval of a multicentre study in Canada, investigators must apply separately to individual Research Ethics Boards (REBs. In principle, the protection of human research subjects is of utmost importance. However, in practice, the process of multicentre ethics review can be time consuming and costly, requiring duplication of effort for researchers and REBs. We used our experience with ethical review of The Canadian Perinatal Network (CPN, to gain insight into the Canadian system. Methods The applications forms of 16 different REBs were abstracted for a list of standardized items. The application process across sites was compared. Correspondence between the REB and the investigators was documented in order to construct a timeline to approval, identify the specific issues raised by each board, and describe how they were resolved. Results Each REB had a different application form. Most (n = 9 had a two or three step application process. Overall, it took a median of 31 days (range 2-174 days to receive an initial response from the REB. Approval took a median of 42 days (range 4-443 days. Privacy and consent were the two major issues raised. Several additional minor or administrative issues were raised which delayed approval. Conclusions For CPN, the Canadian REB process of ethical review proved challenging. REBs acted independently and without unified application forms or submission procedures. We call for a critical examination of the ethical, privacy and institutional review processes in Canada, to determine the best way to undertake multicentre review.

Electrophysiological indices of response inhibition in a Go/NoGo task predict self-control in a social context.

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Kyle Nash

Full Text Available Recent research demonstrates that response inhibition-a core executive function-may subserve self-regulation and self-control. However, it is unclear whether response inhibition also predicts self-control in the multifaceted, high-level phenomena of social decision-making. Here we examined whether electrophysiological indices of response inhibition would predict self-control in a social context. Electroencephalography was recorded as participants completed a widely used Go/NoGo task (the cued Continuous Performance Test. Participants then interacted with a partner in an economic exchange game that requires self-control. Results demonstrated that greater NoGo-Anteriorization and larger NoGo-P300 peak amplitudes-two established electrophysiological indices of response inhibition-both predicted more self-control in this social game. These findings support continued integration of executive function and self-regulation and help extend prior research into social decision-making processes.

A structural multidisciplinary approach to depression management in nursing-home residents: a multicentre, stepped-wedge cluster-randomised trial

NARCIS (Netherlands)

Leontjevas, R.; Gerritsen, D.L.; Smalbrugge, M.; Teerenstra, S.; Vernooij-Dassen, M.J.F.J.; Koopmans, R.T.C.M.

2013-01-01

BACKGROUND: Depression in nursing-home residents is often under-recognised. We aimed to establish the effectiveness of a structural approach to its management. METHODS: Between May 15, 2009, and April 30, 2011, we undertook a multicentre, stepped-wedge cluster-randomised trial in four provinces of

Misoprostol for cervical priming prior to hysteroscopy in postmenopausal and premenopausal nulliparous women; a multicentre randomised placebo controlled trial

NARCIS (Netherlands)

Tasma, M L; Louwerse, M D; Hehenkamp, W J; Geomini, P M; Bongers, M Y; Veersema, S; van Kesteren, P J; Tromp, E; Huirne, J A; Graziosi, G C

OBJECTIVE: To evaluate the reduction of pain by misoprostol compared with placebo prior to hysteroscopy in postmenopausal and premenopausal nulliparous women. DESIGN: Randomised multicentre double-blind placebo controlled trial. SETTING: Two Dutch teaching hospitals and one Dutch university medical

Multifaceted Material Substitution: The Case of NdFeB Magnets, 2010-2015

Science.gov (United States)

Smith, Braeton J.; Eggert, Roderick G.

2016-07-01

Substitution is an important response for material users when faced with disruption to the availability or price of an essential material. In economic terms, substitution refers to the ability of firms to alter their patterns of material use in response to exogenous market shocks. Substitution comes in different forms which vary from situation to situation. This paper uses expert opinion to identify the specific forms of substitution that occurred in permanent magnets, specifically neodymium-iron-boron magnets, following the significant increase in rare earth prices in 2010-2011. The paper provides a framework for understanding the multifaceted nature of substitution and assesses the relative importance of five different types of substitution. Technology-for-element, grade-for-grade, and system-for-system substitution appear to have been more important than element-for-element and magnet-for-magnet substitution. Cost pass-through and absorption were also important responses.

Social Cognitive Mediators of Sociodemographic Differences in Colorectal Cancer Screening Uptake

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Siu Hing Lo

2015-01-01

Full Text Available Background. This study examined if and how sociodemographic differences in colorectal cancer (CRC screening uptake can be explained by social cognitive factors. Methods. Face-to-face interviews were conducted with individuals aged 60–70 years (n=1309 living in England as part of a population-based omnibus survey. Results. There were differences in screening uptake by SES, marital status, ethnicity, and age but not by gender. Perceived barriers (stand. b=-0.40, p<0.001, social norms (stand. b=0.33, p<0.001, and screening knowledge (stand. b=0.17, p<0.001 had independent associations with uptake. SES differences in uptake were mediated through knowledge, social norms, and perceived barriers. Ethnic differences were mediated through knowledge. Differences in uptake by marital status were primarily mediated through social norms and to a lesser extent through knowledge. Age differences were largely unmediated, except for a small mediated effect via social norms. Conclusions. Sociodemographic differences in CRC screening uptake were largely mediated through social cognitive factors. Impact. Our findings suggest that multifaceted interventions might be needed to reduce socioeconomic inequalities. Ethnic differences might be reduced through improved screening knowledge. Normative interventions could emphasise screening as an activity endorsed by important others outside the immediate family to appeal to a wider audience.

Multicentre prospective cohort study of body mass index and postoperative complications following gastrointestinal surgery

OpenAIRE

Drake, T. M.; Nepogodiev, D.; Chapman, S. J.; Glasbey, J. C.; Khatri, C.; Kong, C. Y.; Claireaux, H. A.; Bath, M. F.; Mohan, M.; McNamee, L.; Kelly, M.; Mitchell, H.; Fitzgerald, J. E.; Harrison, E. M.; Bhangu, A.

2016-01-01

BackgroundThere is currently conflicting evidence surrounding the effects of obesity on postoperative outcomes. Previous studies have found obesity to be associated with adverse events, but others have found no association. The aim of this study was to determine whether increasing body mass index (BMI) is an independent risk factor for development of major postoperative complications.MethodsThis was a multicentre prospective cohort study across the UK and Republic of Ireland. Consecutive pati...

ZOOM or Non-ZOOM? Assessing Spinal Cord Diffusion Tensor Imaging Protocols for Multi-Centre Studies.

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Rebecca S Samson

Full Text Available The purpose of this study was to develop and evaluate two spinal cord (SC diffusion tensor imaging (DTI protocols, implemented at multiple sites (using scanners from two different manufacturers, one available on any clinical scanner, and one using more advanced options currently available in the research setting, and to use an automated processing method for unbiased quantification. DTI parameters are sensitive to changes in the diseased SC. However, imaging the cord can be technically challenging due to various factors including its small size, patient-related and physiological motion, and field inhomogeneities. Rapid acquisition sequences such as Echo Planar Imaging (EPI are desirable but may suffer from image distortions. We present a multi-centre comparison of two acquisition protocols implemented on scanners from two different vendors (Siemens and Philips, one using a reduced field-of-view (rFOV EPI sequence, and one only using options available on standard clinical scanners such as outer volume suppression (OVS. Automatic analysis was performed with the Spinal Cord Toolbox for unbiased and reproducible quantification of DTI metrics in the white matter. Images acquired using the rFOV sequence appear less distorted than those acquired using OVS alone. SC DTI parameter values obtained using both sequences at all sites were consistent with previous measurements made at 3T. For the same scanner manufacturer, DTI parameter inter-site SDs were smaller for the rFOV sequence compared to the OVS sequence. The higher inter-site reproducibility (for the same manufacturer and acquisition details, i.e. ZOOM data acquired at the two Philips sites of rFOV compared to the OVS sequence supports the idea that making research options such as rFOV more widely available would improve accuracy of measurements obtained in multi-centre clinical trials. Future multi-centre studies should also aim to match the rFOV technique and signal-to-noise ratios in all

Social Disadvantage, Severe Child Abuse, and Biological Profiles in Adulthood.

Science.gov (United States)

Lee, Chioun; Coe, Christopher L; Ryff, Carol D

2017-09-01

Guided by the stress process model and the life course perspective, we hypothesize: (1) that childhood abuse is concentrated, in terms of type and intensity, among socially disadvantaged individuals, and (2) that experiencing serious abuse contributes to poor biological profiles in multiple body systems in adulthood. Data came from the Biomarker subsample of Midlife in the United States (2004-2006). We used latent class analysis to identify distinct profiles of childhood abuse, each reflecting a combination of type and severity. Results indicate that disadvantaged groups, women, and those from disadvantaged families are at greater risk of experiencing more severe and multiple types of abuse. Those with more severe and multifaceted childhood abuse show greater physiological dysregulation. Childhood abuse experiences partially accounted for the social status differences in physiological profiles. Our findings underscore that differential exposure to serious childhood stressors plays a significant role in gender and class inequalities in adult health.

Health in All Social Work Programs: Findings From a US National Analysis

Science.gov (United States)

Wachman, Madeline K.; Marshall, Jamie W.; Backman, Allison R.; Harrington, Calla B.; Schultz, Neena S.; Ouimet, Kaitlyn J.

2017-01-01

Objectives. To establish a baseline of health content in 4 domains of US social work education—baccalaureate, master’s, doctoral, and continuing education programs—and to introduce the Social Work Health Impact Model, illustrating social work’s multifaceted health services, from clinical to wide-lens population health approaches. Methods. We analyzed US social work programs’ Web site content to determine amount and types of health content in mission statements, courses, and specializations. Coding criterion determined if content was (1) health or health-related (HHR) and (2) had wide-lens health (WLH) emphasis. A second iteration categorized HHR and WLH courses into health topics. Results. We reviewed 4831 courses. We found broad HHR content in baccalaureate, master’s, and continuing education curricula; doctoral programs had limited health content. We identified minimal WLH content across all domains. Topical analysis indicated that more than 50% of courses concentrated on 3 areas: mental and behavioral health, abuse and violence, and substance use and addictions. Conclusions. As a core health profession, social work must strengthen its health and wide-lens content to better prepare graduates for integrated practice and collaboration in the changing health environment. PMID:29236538

Marriage Migration as a Multifaceted System: The Intersectionality of Intimate Partner Violence in Cross-Border Marriages.

Science.gov (United States)

Chiu, Tuen Yi

2016-08-18

This article addresses the intersectional nature of intimate partner violence (IPV) against female marriage migrants in Mainland China-Hong Kong cross-border marriages. The author analyzes data from 15 battered female marriage migrants who share the same ethnicity as their husbands to illustrate how the immigration of female marriage migrants intricately intersects with gender, class, and culture to form a multifaceted system that traps battered marriage migrants in abusive marriages. It is proposed that marriage migration, as a distinct form of migration, involves certain intrinsic risk factors that make marriage migrants particularly vulnerable to IPV. © The Author(s) 2016.

NILVAD protocol: a European multicentre double-blind placebo-controlled trial of nilvadipine in mild-to-moderate Alzheimer's disease

NARCIS (Netherlands)

Lawlor, B.; Kennelly, S.; O'Dwyer, S.; Cregg, F.; Walsh, C.; Coen, R.; Kenny, R.A.; Howard, R.; Murphy, C.; Adams, J.; Daly, L.; Segurado, R.; Gaynor, S.; Crawford, F.; Mullan, M.; Lucca, U.; Banzi, R.; Pasquier, F.; Breuilh, L.; Riepe, M.; Kalman, J.; Wallin, A.; Borjesson, A.; Molloy, W.; Tsolaki, M.; Olde Rikkert, M.G.M.

2014-01-01

INTRODUCTION: This study is a European multicentre, randomised, double-blind, placebo-controlled trial investigating the efficacy and safety of nilvadipine as a disease course modifying treatment for mild-to-moderate Alzheimer's disease (AD) in a phase III study that will run for a period of 82

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....

Recruiting ENT and Audiology patients into pharmaceutical trials: evaluating the multi-centre experience in the UK and USA.

Science.gov (United States)

Sanchez, Victoria A; Hall, Deborah A; Millar, Bonnie; Escabi, Celia D; Sharman, Alice; Watson, Jeannette; Thasma, Sornaraja; Harris, Peter

2018-01-21

Recruiting into clinical trials on time and on target is a major challenge and yet often goes unreported. This study evaluated the adjustment to procedures, recruitment and screening methods in two multi-centre pharmaceutical randomised controlled trials (RCTs) for hearing-related problems in adults. Recruitment monitoring and subsequent adjustment of various study procedures (e.g. eligibility criteria, increasing recruiting sites and recruitment methods) are reported. Participants were recruited through eight overarching methods: trial registration, posters/flyers, print publications, Internet, social media, radio, databases and referrals. The efficiency of the recruitment was measured by determining the number of people: (1) eligible for screening as a percentage of those who underwent telephone pre-screening and (2) randomised as a percentage of those screened. A total of 584 participants completed the pre-screening steps, 491 screened and 169 participants were randomised. Both RCTs completed adjustments to the participant eligibility, added new study sites and additional recruitment methods. No single recruitment method was efficient enough to serve as the only route to enrolment. A diverse portfolio of methods, continuous monitoring, mitigation strategy and adequate resourcing were essential for achieving our recruitment goals.

Implementing a multifaceted intervention to decrease central line-associated bloodstream infections in SEHA (Abu Dhabi Health Services Company) intensive care units: the Abu Dhabi experience.

Science.gov (United States)

Latif, Asad; Kelly, Bernadette; Edrees, Hanan; Kent, Paula S; Weaver, Sallie J; Jovanovic, Branislava; Attallah, Hadeel; de Grouchy, Kristin K; Al-Obaidli, Ali; Goeschel, Christine A; Berenholtz, Sean M

2015-07-01

OBJECTIVE To determine whether implementation of a multifaceted intervention would significantly reduce the incidence of central line-associated bloodstream infections. DESIGN Prospective cohort collaborative. SETTING AND PARTICIPANTS Intensive care units of the Abu Dhabi Health Services Company hospitals in the Emirate of Abu Dhabi. INTERVENTIONS A bundled intervention consisting of 3 components was implemented as part of the program. It consisted of a multifaceted approach that targeted clinician use of evidence-based infection prevention recommendations, tools that supported the identification of local barriers to these practices, and implementation ideas to help ensure patients received the practices. Comprehensive unit-based safety teams were created to improve safety culture and teamwork. Finally, the measurement and feedback of monthly infection rate data to safety teams, senior leaders, and staff in participating intensive care units was encouraged. The main outcome measure was the quarterly rate of central line-associated bloodstream infections. RESULTS Eighteen intensive care units from 7 hospitals in Abu Dhabi implemented the program and achieved an overall 38% reduction in their central line-associated bloodstream infection rate, adjusted at the hospital and unit level. The number of units with a quarterly central line-associated bloodstream infection rate of less than 1 infection per 1,000 catheter-days increased by almost 40% between the baseline and postintervention periods. CONCLUSION A significant reduction in the global morbidity and mortality associated with central line-associated bloodstream infections is possible across intensive care units in disparate settings using a multifaceted intervention.

Heterogeneous FDG-guided dose-escalation for locally advanced NSCLC (the NARLAL2 trial): Design and early dosimetric results of a randomized, multi-centre phase-III study

DEFF Research Database (Denmark)

Møller, Ditte Sloth; Nielsen, Tine Bjørn; Brink, Carsten

2017-01-01

Background and purpose: Local recurrence is frequent in locally advanced NSCLC and is primarily located in FDG-avid parts of tumour and lymph nodes. Aiming at improving local control without increasing toxicity, we designed a multi-centre phase-III trial delivering inhomogeneous dose-escalation d......Background and purpose: Local recurrence is frequent in locally advanced NSCLC and is primarily located in FDG-avid parts of tumour and lymph nodes. Aiming at improving local control without increasing toxicity, we designed a multi-centre phase-III trial delivering inhomogeneous dose...

The cost-benefit of federal investment in preventing Clostridium difficile infections through the use of a multifaceted infection control and antimicrobial stewardship program.

Science.gov (United States)

Slayton, Rachel B; Scott, R Douglas; Baggs, James; Lessa, Fernanda C; McDonald, L Clifford; Jernigan, John A

2015-06-01

To determine the potential epidemiologic and economic value of the implementation of a multifaceted Clostridium difficile infection (CDI) control program at US acute care hospitals Markov model with a 5-year time horizon Patients whose data were used in our simulations were limited to hospitalized Medicare beneficiaries ≥65 years old. CDI is an important public health problem with substantial associated morbidity, mortality, and cost. Multifaceted national prevention efforts in the United Kingdom, including antimicrobial stewardship, patient isolation, hand hygiene, environmental cleaning and disinfection, and audit, resulted in a 59% reduction in CDI cases reported from 2008 to 2012. Our analysis was conducted from the federal perspective. The intervention we modeled included the following components: antimicrobial stewardship utilizing the Antimicrobial Use and Resistance module of the National Healthcare Safety Network (NHSN), use of contact precautions, and enhanced environmental cleaning. We parameterized our model using data from CDC surveillance systems, the AHRQ Healthcare Cost and Utilization Project, and literature reviews. To address uncertainty in our parameter estimates, we conducted sensitivity analyses for intervention effectiveness and cost, expenditures by other federal partners, and discount rate. Each simulation represented a cohort of 1,000 hospitalized patients over 1,000 trials. RESULTS In our base case scenario with 50% intervention effectiveness, we estimated that 509,000 CDI cases and 82,000 CDI-attributable deaths would be prevented over a 5-year time horizon. Nationally, the cost savings across all hospitalizations would be $2.5 billion (95% credible interval: $1.2 billion to $4.0 billion). The potential benefits of a multifaceted national CDI prevention program are sizeable from the federal perspective.

A multi-centre evaluation of oral cancer in Southern and Western Nigeria: an African oral pathology research consortium initiative.

Science.gov (United States)

Omitola, Olufemi Gbenga; Soyele, Olujide Oladele; Sigbeku, Opeyemi; Okoh, Dickson; Akinshipo, Abdulwarith Olaitan; Butali, Azeez; Adeola, Henry Ademola

2017-01-01

Oral cancer is a leading cause of cancer deaths among African populations. Lack of standard cancer registries and under-reporting has inaccurately depicted its magnitude in Nigeria. Development of multi-centre collaborative oral pathology networks such as the African Oral Pathology Research Consortium (AOPRC) facilitates skill and expertise exchange and fosters a robust and systematic investigation of oral diseases across Africa. In this descriptive cross-sectional study, we have leveraged the auspices of the AOPRC to examine the burden of oral cancer in Nigeria, using a multi-centre approach. Data from 4 major tertiary health institutions in Western and Southern Nigeria was generated using a standardized data extraction format and analysed using the SPSS data analysis software (version 20.0; SPSS Inc. Chicago, IL). Of the 162 cases examined across the 4 centres, we observed that oral squamous cell carcinomas (OSCC) occurred mostly in the 6 th and 7 th decades of life and maxillary were more frequent than mandibular OSCC lesions. Regional variations were observed both for location, age group and gender distribution. Significant regional differences was found between poorly, moderately and well differentiated OSCC (p value = 0.0071). A multi-centre collaborative oral pathology research approach is an effective way to achieve better insight into the patterns and distribution of various oral diseases in men of African descent. The wider outlook for AOPRC is to employ similar approaches to drive intensive oral pathology research targeted at addressing the current morbidity and mortality of various oral diseases across Africa.

Multi-faceted Rasch measurement and bias patterns in EFL writing performance assessment.

Science.gov (United States)

He, Tung-Hsien; Gou, Wen Johnny; Chien, Ya-Chen; Chen, I-Shan Jenny; Chang, Shan-Mao

2013-04-01

This study applied multi-faceted Rasch measurement to examine rater bias in the assessment of essays written by college students learning English as a foreign language. Four raters who had received different academic training from four distinctive disciplines applied a six-category rating scale to analytically rate essays on an argumentative topic and on a descriptive topic. FACETS, a Rasch computer program, was utilized to pinpoint bias patterns by analyzing the rater-topic, rater-category, and topic-category interactions. Results showed: argumentative essays were rated more severely than were descriptive essays; the linguistics-major rater was the most lenient rater, while the literature-major rater was the severest one; and the category of language use received the severest ratings, whereas content was given the most lenient ratings. The severity hierarchies for raters, essay topics, and rating categories suggested that raters' academic training and their perceptions of the importance of categories were associated with their bias patterns. Implications for rater training are discussed.

Multicentric lymphoma in a giant anteater (Myrmecophaga tridactyla).

Science.gov (United States)

Sanches, Adrien W D; Werner, Pedro R; Margarido, Tereza C C; Pachaly, Jose R

2013-03-01

Neoplastic disease is not well documented in giant anteaters. This report describes a disseminated lymphoma in an adult male giant anteater (Myrmecophaga tridactyla) from the City Zoo of Curitiba, State of Paraná, Brazil. No clinical signs were noticed before its death, except for a slight inappetence. At postmortem examination, pale white to yellow, variably sized nodules infiltrated the heart, liver, and intestinal lymph nodes. Histologically, two distinct cell populations were present in the nodular lesions: one characterized by smaller cells, primarily lymphocytic in nature, and another characterized by larger rounded cells with loose chromatin and frequently indented nuclei resembling histiocytes. Giant binucleated cells were occasionally observed. Mitotic figures numbered 2-3 mitotic figures/x400 field. Both cellular populations presented with moderate pleomorphism, large nuclei, a high nucleus-to-cytoplasm ratio, distinct nucleoli, and coarse nuclear chromatin. The neoplasia was classified as a form of multicentric lymphohistiocytic lymphoma (Rappaport Classification) and as an intermediate grade lymphoma (National Cancer Institute Working Formulation).

Social support and the intimate partner violence victimization among adults from six European countries.

Science.gov (United States)

Dias, Nicole Geovana; Costa, Diogo; Soares, Joaquim; Hatzidimitriadou, Eleni; Ioannidi-Kapolou, Elisabeth; Lindert, Jutta; Sundin, Örjan; Toth, Olga; Barros, Henrique; Fraga, Silvia

2018-05-21

Social support may buffer the negative effects of violence on physical and mental health. Family medicine providers play an essential role in identifying the available social support and intervening in intimate partner violence (IPV). This study aimed at assessing the association between social support and the IPV victimization among adults from six European countries. This is a cross-sectional multi-centre study that included individuals from Athens (Greece), Budapest (Hungary), London (UK), Östersund (Sweden), Porto (Portugal) and Stuttgart (Germany). Data collection was carried out between September 2010 and May 2011. The sample consisted of 3496 adults aged 18-64 years randomly selected from the general population in each city. The revised Conflict Tactics Scales was used to assess IPV victimization. Social support was assessed with the Multidimensional Scale of Perceived Social Support. Participants reporting physical assault victimization experienced lower social support (mean ± SD) than their counterparts, 66.1 ± 13.96 versus 71.7 ± 12.90, P social support among participants reporting lifetime and past year victimization, independent of demographic, social and health-related factors. Results showed a statistically significant association between low social support and IPV victimization. Although the specific mechanisms linking social support with experiences of violence need further investigation, it seems that both informal and formal networks may be associated with lower levels of abusive situations.

Simulation-based team training for multi-professional obstetric care teams to improve patient outcome : a multicentre, cluster randomised controlled trial

NARCIS (Netherlands)

Fransen, A F; van de Ven, J; Schuit, E; van Tetering, Aac; Mol, B W; Oei, S G

OBJECTIVE: To investigate whether simulation-based obstetric team training in a simulation centre improves patient outcome. DESIGN: Multicentre, open, cluster randomised controlled trial. SETTING: Obstetric units in the Netherlands. POPULATION: Women with a singleton pregnancy beyond 24 weeks of

Social marketing analysis of 20 [corrected] years of hand hygiene promotion.

Science.gov (United States)

Mah, Manuel W; Tam, Yat Cho; Deshpande, Sameer

2008-03-01

To assess published hand hygiene behavioral interventions that employed a social marketing framework and to recommend improvements to future interventions. We performed a systematic literature review by searching the PubMed database and the Cumulative Index to Nursing and Allied Health Literature for published articles about hand hygiene behavioral interventions in healthcare facilities, schools, and community settings. Our analysis included articles that describe multifaceted interventions and evaluated them with predefined social marketing benchmark criteria. Of 53 interventions analyzed in this review, 16 (30.2%) employed primary formative audience research, 5 (9.4%) incorporated social or behavioral theories, 27 (50.9%) employed segmentation and targeting of the audience, 44 (83.0%) used components of the "marketing mix," 3 (5.7%) considered the influence of competing behaviors, 7 (13.2%) cultivated relationships with the target audience, and 15 (28.3%) provided simple behavioral messages. Thirty-five (66.0%) of the interventions demonstrated a significant improvement in performance, but only 21 (39.6%) were considered to have a strong evaluative design. The median duration of the interventions was 8.0 months. From a social marketing perspective, the promotion of hand hygiene could be improved in several ways. The effectiveness of social marketing in hand hygiene promotion should be tested in future interventions.

Economic and social activities on ancient Cypriot terraced landscapes.

Science.gov (United States)

Ridder, Elizabeth; Galletti, Christopher S; Fall, Patricia L; Falconer, Steven E

2017-11-01

We investigate ancient agricultural terraces and their associated social and economic activities across the site complex consisting of the village at Politiko-Troullia and its more extensive associated taskscape. Surface artifact distributions mapped over 12 ha are integrated with evidence excavated from this Bronze Age settlement in central Cyprus. Contrary to expectations, artifact densities do not diminish with distance from the village architecture. In particular, concentrations of Prehistoric Bronze Age ceramics and ground stone artifacts are most pronounced on nearby terraced hillsides. These terraces were not utilized for domestic structures, but for extensive processing of agricultural crops and copper ore. Bronze Age excavated plant remains indicate cultivation of olives, grapes and figs, with wood resources dominated by olive and pine. Larger, non-portable ground stones and gaming stones are associated with communal social and economic activities in open courtyard settings in Politiko-Troullia. This category of ground stone also is particularly common on the terraced hillsides around Troullia, suggesting that similar behaviors occurred beyond village structures. The terraced landscape of Politiko-Troullia exemplifies a multi-faceted taskscape with a range of agricultural, metallurgical and social activities. Copyright © 2016 Elsevier Ltd. All rights reserved.

Assessment of Diet, Physical Activity and Biological, Social and Environmental Factors in a Multi-centre European Project on Diet- and Lifestyle-related Disorders in Children (IDEFICS)

DEFF Research Database (Denmark)

Bammann, Karin; Peplies, Jenny; Sjöström, Michael

2006-01-01

Obesity is a major public health problem in developed countries. We present a European project, called Identification and Prevention of Dietary and Lifestyle-induced Health Effects in Children and Infants (IDEFICS), that focuses on diet- and lifestyle-related diseases in children. This paper...... outlines methodological aspects and means of quality control in IDEFICS. IDEFICS will use a multicentre survey design of a population-based cohort of about 17,000 2- to 10-year-old children in nine European countries (Belgium, Cyprus, Estonia, Germany, Greece, Hungary, Italy, Spain and Sweden). The project...... will investigate the impact of dietary factors such as food intake and food preferences, lifestyle factors such as physical activity, psychosocial factors and genetic factors on the development of obesity and other selected diet- and lifestyle-related disorders. An intervention study will be set up in pre...

Effect of perioperative beta blockade in patients with diabetes undergoing major non-cardiac surgery: randomised placebo controlled, blinded multicentre trial

DEFF Research Database (Denmark)

Juul, Anne Benedicte; Wetterslev, Jørn; Gluud, Christian

2006-01-01

Objectives To evaluate the long term effects of perioperative blockade on mortality and cardiac morbidity in patients with diabetes undergoing major non-cardiac surgery. Design Randomised placebo controlled and blinded multicentre trial. Analyses were by intention to treat. Setting University...

Job stress, absenteeism and coronary heart disease European cooperative study (the JACE study): Design of a multicentre prospective study

NARCIS (Netherlands)

Houtman, I.; Kornitzer, M.; Smet, P. de; Koyuncu, R.; Backer, G. de; Pelfrene, E.; Romon, M.; Boulenguez, C.; Ferrario, M.; Origgi, G.; Sans, S.; Perez, I.; Wilhelmsen, L.; Rosengren, A.; Isacsson, S.-O.; Östergren, P.-O.

1999-01-01

Background: The motives, objectives and design of a multicentre prospective study on job stress, absenteeism and coronary heart disease in Europe (the JACE study) is presented in this paper. Some specific gaps in the reviewed literature are explicitly tapped into by the JACE study. Its objectives

Impaired emotional empathy and related social network deficits in cocaine users.

Science.gov (United States)

Preller, Katrin H; Hulka, Lea M; Vonmoos, Matthias; Jenni, Daniela; Baumgartner, Markus R; Seifritz, Erich; Dziobek, Isabel; Quednow, Boris B

2014-05-01

Chronic cocaine users consistently display neurochemical and functional alterations in brain areas involved in social cognition (e.g. medial and orbitofrontal cortex). Although social functioning plays a crucial role in the development and treatment of drug dependence, studies investigating social cognition in cocaine users are lacking. Therefore, we investigated mental perspective taking ('theory of mind') and emotional and cognitive empathy in recreational (RCU) and dependent (DCU) cocaine users. Furthermore, we related these measures to real-life indicators of social functioning. One-hundred cocaine users (69 RCU, 31 DCU) and 68 stimulant-naïve healthy controls were tested with the Multifaceted Empathy Test (MET), Movie for the Assessment of Social Cognition (MASC) and Reading the Mind in the Eyes Test (RMET). The Social Network Questionnaire was conducted to assess social network size. Furthermore, participants provided information on committed criminal offenses. RCU and DCU showed less emotional empathy compared to controls (MET), whereas cognitive empathy was not impaired (MET, RMET). Additionally, DCU made more errors in mental perspective taking (MASC). Notably, cocaine users committed more criminal offenses and displayed a smaller social network and higher cocaine use was correlated with less social contacts. Diminished mental perspective taking was tentatively correlated with more intense cocaine use as well. Finally, younger age of onset of cocaine use was associated with more pronounced empathy impairment. In conclusion, social cognition impairments in cocaine users were related to real-life social functioning and should therefore be considered in therapy and prevention strategies. © 2013 Society for the Study of Addiction.

Social Norms and Adolescents' Sexual Health: An Introduction for Practitioners Working in Low and Mid-income African countries.

Science.gov (United States)

Cislaghi, Beniamino; Shakya, Holly

2018-03-01

Donors, practitioners and scholars are increasingly interested in harnessing the potential of social norms theory to improve adolescents' sexual and reproductive health outcomes. However, social norms theory is multifaceted, and its application in field interventions is complex. An introduction to social norms that will be beneficial for those who intend to integrate a social norms perspective in their work to improve adolescents' sexual health in Africa is presented. First three main schools of thought on social norms, looking at the theoretical standpoint of each, are discussed. Next, the difference between two important types of social norms (descriptive and injunctive) is explained and then the concept of a -reference group‖ is examined. The difference between social and gender norms are then considered, highlighting how this difference is motivated by existing yet contrasting approaches to norms (in social psychology and gender theory). In the last section, existing evidence on the role that social norms play in influencing adolescents' sexual and reproductive health are reviewed. Conclusions call for further research and action to understand how norms affecting adolescents' sexual and reproductive health and rights (SRHR) can be changed in sub-Saharan Africa.

How to help depressed older people living in residential care: a multifaceted shared-care intervention for late-life depression.

Science.gov (United States)

Llewellyn-Jones, R H; Baikie, K A; Castell, S; Andrews, C L; Baikie, A; Pond, C D; Willcock, S M; Snowdon, J; Tennant, C C

2001-12-01

To describe a population-based, multifaceted shared-care intervention for late-life depression in residential care as a new model of geriatric practice, to outline its development and implementation, and to describe the lessons learned during the implementation process. A large continuing-care retirement community in Sydney, Australia, providing three levels of care (independent living units, assisted-living complexes, and nursing homes). The intervention was implemented for the entire non-nursing home population (residents in independent and assisted living: N = 1,466) of the facility and their health care providers. Of the 1,036 residents whowere eligible and agreed to be interviewed, 281 (27.1%) were classified as depressed according to the Geriatric Depression Scale. INTERVENTION DESCRIPTION: The intervention included: (a) multidisciplinary collaboration between primary care physicians, facility health care providers, and the local psychogeriatric service; (b) training for primary care physicians and other facility health care providers about detecting and managing depression; and (c) depression-related health education/promotion programs for residents. The intervention was widely accepted by residents and their health care providers, and was sustained and enhanced by the facility after the completion of the study. It is possible to implement and sustain a multifaceted shared-care intervention for late-life depression in a residential care facility where local psychogeriatric services are scarce, staff-to-resident ratios are low, and the needs of depressed residents are substantial.

Efficacy of a multifaceted podiatry intervention to improve balance and prevent falls in older people: study protocol for a randomised trial.

Science.gov (United States)

Spink, Martin J; Menz, Hylton B; Lord, Stephen R

2008-11-25

Falls in older people are a major public health problem, with at least one in three people aged over 65 years falling each year. There is increasing evidence that foot problems and inappropriate footwear increase the risk of falls, however no studies have been undertaken to determine whether modifying these risk factors decreases the risk of falling. This article describes the design of a randomised trial to evaluate the efficacy of a multifaceted podiatry intervention to reduce foot pain, improve balance, and reduce falls in older people. Three hundred community-dwelling men and women aged 65 years and over with current foot pain and an increased risk of falling will be randomly allocated to a control or intervention group. The "usual cae" control group will receive routine podiatry (i.e. nail care and callus debridement). The intervention group will receive usual care plus a multifaceted podiatry intervention consisting of: (i) prefabricated insoles customised to accommodate plantar lesions; (ii) footwear advice and assistance with the purchase of new footwear if current footwear is inappropriate; (iii) a home-based exercise program to strengthen foot and ankle muscles; and (iv) a falls prevention education booklet. Primary outcome measures will be the number of fallers, number of multiple fallers and the falls rate recorded by a falls diary over a 12 month period. Secondary outcome measures assessed six months after baseline will include the Medical Outcomes Study Short Form 12 (SF-12), the Manchester Foot Pain and Disability Index, the Falls Efficacy Scale International, and a series of balance and functional tests. Data will be analysed using the intention to treat principle. This study is the first randomised trial to evaluate the efficacy of podiatry in improving balance and preventing falls. The trial has been pragmatically designed to ensure that the findings can be generalised to clinical practice. If found to be effective, the multifaceted podiatry

Efficacy of a multifaceted podiatry intervention to improve balance and prevent falls in older people: study protocol for a randomised trial

Directory of Open Access Journals (Sweden)

Menz Hylton B

2008-11-01

Full Text Available Abstract Background Falls in older people are a major public health problem, with at least one in three people aged over 65 years falling each year. There is increasing evidence that foot problems and inappropriate footwear increase the risk of falls, however no studies have been undertaken to determine whether modifying these risk factors decreases the risk of falling. This article describes the design of a randomised trial to evaluate the efficacy of a multifaceted podiatry intervention to reduce foot pain, improve balance, and reduce falls in older people. Methods Three hundred community-dwelling men and women aged 65 years and over with current foot pain and an increased risk of falling will be randomly allocated to a control or intervention group. The "usual cae" control group will receive routine podiatry (i.e. nail care and callus debridement. The intervention group will receive usual care plus a multifaceted podiatry intervention consisting of: (i prefabricated insoles customised to accommodate plantar lesions; (ii footwear advice and assistance with the purchase of new footwear if current footwear is inappropriate; (iii a home-based exercise program to strengthen foot and ankle muscles; and (iv a falls prevention education booklet. Primary outcome measures will be the number of fallers, number of multiple fallers and the falls rate recorded by a falls diary over a 12 month period. Secondary outcome measures assessed six months after baseline will include the Medical Outcomes Study Short Form 12 (SF-12, the Manchester Foot Pain and Disability Index, the Falls Efficacy Scale International, and a series of balance and functional tests. Data will be analysed using the intention to treat principle. Discussion This study is the first randomised trial to evaluate the efficacy of podiatry in improving balance and preventing falls. The trial has been pragmatically designed to ensure that the findings can be generalised to clinical practice. If

A multifaceted community-based asthma intervention in Chicago: effects of trigger reduction and self-management education on asthma morbidity.

Science.gov (United States)

Turyk, Mary; Banda, Elizabeth; Chisum, Gay; Weems, Dolores; Liu, Yangyang; Damitz, Maureen; Williams, Rhonda; Persky, Victoria

2013-09-01

Home-based, multifaceted interventions have been effective in reducing asthma morbidity in children. However, identification of independent components that contribute to outcomes and delineating effectiveness by level of asthma symptoms would help to refine the intervention and target appropriate populations. A community health educator led asthma intervention implemented in a low-income African-American neighborhood included asthma management education, individually tailored low-cost asthma home trigger remediation, and referrals to social and medical agencies, when appropriate. Changes in asthma morbidity measures were assessed in relation to implementation of individual intervention components using multivariable logistic regression. Among the 218 children who completed the year-long program, there were significant reductions in measures of asthma morbidity, including symptoms, urgent care visits, emergency department (ED) visits, hospitalizations, missed school days, and missed work days for caretakers. We also found significant decreases in the prevalence of many home asthma triggers and improvements in asthma management practices. Improvement in caretaker's ability to manage the child's asthma was associated with reduction in ED visits for asthma and uncontrolled asthma. Specific home interventions, such as repair of water leaks and reduced exposure to plants, dust, clutter and stuffed toys, may be related to reduction in asthma morbidity. This program was effective in reducing asthma morbidity in low-income African-American children and identified specific interventions as possible areas to target in future projects. Furthermore, the intervention was useful in children with persistent asthma symptoms as well as those with less frequent asthma exacerbations.

Image acquisition and interpretation criteria for Tc-99m-HMPAO-labelled white blood cell scintigraphy : results of a multicentre study

NARCIS (Netherlands)

Erba, Paola A.; Glaudemans, Andor W. J. M.; Veltman, Niels C.; Sollini, Martina; Pacilio, Marta; Galli, Filippo; Dierckx, Rudi A. J. O.; Signore, Alberto

Purpose There is no consensus yet on the best protocol for planar image acquisition and interpretation of radiolabelled white blood cell (WBC) scintigraphy. This may account for differences in reported diagnostic accuracy amongst different centres. Methods This was a multicentre retrospective study

A multifaceted approach to maximize erectile function and vascular health.

Science.gov (United States)

Meldrum, David R; Gambone, Joseph C; Morris, Marge A; Ignarro, Louis J

2010-12-01

To review the role of various factors influencing vascular nitric oxide (NO) and cyclic GMP, and consequently, erectile function and vascular health. Pertinent publications are reviewed. Daily moderate exercise stimulates vascular NO production. Maintenance of normal body weight and waist/hip ratio allows NO stimulation by insulin. Decreased intake of fat, sugar, and simple carbohydrates rapidly converted to sugar reduces the adverse effects of fatty acids and sugar on endothelial NO production. Omega-3 fatty acids stimulate endothelial NO release. Antioxidants boost NO production and prevent NO breakdown. Folic acid, calcium, vitamin C, and vitamin E support the biochemical pathways leading to NO release. Cessation of smoking and avoidance of excessive alcohol preserve normal endothelial function. Moderate use of alcohol and certain proprietary supplements may favorably influence erectile and vascular function. Treatment of any remaining testosterone deficit will both increase erectile function and reduce any associated metabolic syndrome. After production of NO and cyclic GMP are improved, use of phosphodiesterase-5 inhibitors should result in greater success in treating remaining erectile dysfunction. Recent studies have also suggested positive effects of phosphodiesterase-5 inhibitors on vascular function. A multifaceted approach will maximize both erectile function and vascular health. Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

The multifacet graphically contracted function method. I. Formulation and implementation

International Nuclear Information System (INIS)

Shepard, Ron; Brozell, Scott R.; Gidofalvi, Gergely

2014-01-01

The basic formulation for the multifacet generalization of the graphically contracted function (MFGCF) electronic structure method is presented. The analysis includes the discussion of linear dependency and redundancy of the arc factor parameters, the computation of reduced density matrices, Hamiltonian matrix construction, spin-density matrix construction, the computation of optimization gradients for single-state and state-averaged calculations, graphical wave function analysis, and the efficient computation of configuration state function and Slater determinant expansion coefficients. Timings are given for Hamiltonian matrix element and analytic optimization gradient computations for a range of model problems for full-CI Shavitt graphs, and it is observed that both the energy and the gradient computation scale as O(N 2 n 4 ) for N electrons and n orbitals. The important arithmetic operations are within dense matrix-matrix product computational kernels, resulting in a computationally efficient procedure. An initial implementation of the method is used to present applications to several challenging chemical systems, including N 2 dissociation, cubic H 8 dissociation, the symmetric dissociation of H 2 O, and the insertion of Be into H 2 . The results are compared to the exact full-CI values and also to those of the previous single-facet GCF expansion form

The multifacet graphically contracted function method. I. Formulation and implementation

Science.gov (United States)

Shepard, Ron; Gidofalvi, Gergely; Brozell, Scott R.

2014-08-01

The basic formulation for the multifacet generalization of the graphically contracted function (MFGCF) electronic structure method is presented. The analysis includes the discussion of linear dependency and redundancy of the arc factor parameters, the computation of reduced density matrices, Hamiltonian matrix construction, spin-density matrix construction, the computation of optimization gradients for single-state and state-averaged calculations, graphical wave function analysis, and the efficient computation of configuration state function and Slater determinant expansion coefficients. Timings are given for Hamiltonian matrix element and analytic optimization gradient computations for a range of model problems for full-CI Shavitt graphs, and it is observed that both the energy and the gradient computation scale as O(N2n4) for N electrons and n orbitals. The important arithmetic operations are within dense matrix-matrix product computational kernels, resulting in a computationally efficient procedure. An initial implementation of the method is used to present applications to several challenging chemical systems, including N2 dissociation, cubic H8 dissociation, the symmetric dissociation of H2O, and the insertion of Be into H2. The results are compared to the exact full-CI values and also to those of the previous single-facet GCF expansion form.

Four-week parenteral nutrition using a third generation lipid emulsion (SMOFlipid)--a double-blind, randomised, multicentre study in adults

DEFF Research Database (Denmark)

Klek, Stanislaw; Chambrier, Cecile; Singer, Pierre

2013-01-01

The aim of this study was to evaluate the safety and tolerance of a soybean/MCT/olive/fish oil emulsion in intestinal failure patients on long-term parenteral nutrition. 73 patients took part in a randomized, double-blind, multi-centre study. The study demonstrates that the lipid emulsion...

Elderly complete denture wearers: a social approach to tooth loss.

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Papadaki, Eftychia; Anastassiadou, Vassiliki

2012-06-01

To correlate emotional reactions to tooth loss with denture satisfaction attributes in elderly complete denture wearers. Total tooth loss is a serious life event, and poor oral health has an impact on daily life. Edentulism treated by rehabilitation with dentures can have a positive effect on patients' self-image and social behaviour. A group of 80 edentulous subjects undergoing routine prosthetic care in a Greek Department of Prosthetic Dentistry were interviewed using two structured questionnaires. The first questionnaire explored reactions to tooth loss, whereas the second measured their subjective experience of complete dentures. The responses to both questionnaires were compared using the statistical package SPSS v.17. The results showed significant correlation between aspects of tooth loss experience and complete denture satisfaction. Despite the fact that a substantial proportion of patients were satisfied with their complete dentures, some patients experienced increased social and psychological problems related to their edentulousness and the wearing of complete dentures. The aesthetic and functional aspects of complete dentures affected both patients' social behaviour and self-confidence. Total tooth loss was not only reflected in patient's social behaviour and self-image, but it had a complex and multifaceted impact on satisfaction from complete dentures. © 2011 The Gerodontology Society and John Wiley & Sons A/S.

MANAGEMENT AND OUTCOMES FROM APPENDECTOMY: AN INTERNATIONAL, PROSPECTIVE, MULTICENTRE STUDY.

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Camilleri-Brennan, J; Drake, T; Spence, R; Bhangu, A; Harrison, E

2017-09-01

To identify variation in surgical management and outcomes of appendicitis across low, middle and high Human Development Index (HDI) country groups. Multi-centre, international prospective cohort study of consecutive patients undergoing emergency appendectomy over a 6-month period. Follow-up lasted 30 days. Primary outcome measure was overall complication rate. 4546 patients from 52 countries underwent appendectomy (2499 high, 1540 middle and 507 low HDI groups). Complications were more frequent in low-HDI (OR 3.81, 95% CI 2.78 to 5.19, p accounting for case-mix, laparoscopy was still associated with fewer complications (OR 0.55, 95% CI 0.42 to 0.71, pintroduction of laparoscopy that if overcome, could result in significantly improved outcomes for patients in low-resource environments, with potential for wider health-system benefits.

The role played by social-ecological resilience as a method of integration in interdisciplinary research

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Simone A. Beichler

2014-09-01

Full Text Available Today's multifaceted environmental problems, including climate change, necessitate interdisciplinary research. It is however difficult to combine disciplines to study such complex phenomena. We analyzed the experience we gained in applying a particular method of interdisciplinary integration, the 'bridging concept.' We outlined the entire process of developing, utilizing, and adapting social-ecological resilience as a bridging concept in a research project involving seven different disciplines. We focused on the tensions and opportunities arising from interdisciplinary dialogue and the understandings and manifestations of resilience in the disciplines involved. By evaluating the specific cognitive and social functions of resilience as a method of integration, we call for placing greater emphasis on the quality and value of the actual interdisciplinary process, rather than concentrating solely on the output of interdisciplinary work.

Social networks of older adults living with HIV in Finland.

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Nobre, Nuno Ribeiro; Kylmä, Jari; Kirsi, Tapio; Pereira, Marco

2016-01-01

The aim of this study was to explore the social networks of older adults living with HIV. Interviews were conducted with nine individuals aged 50 or older living with HIV in Helsinki, Finland. Analysis of transcripts was analysed by inductive qualitative content analysis. Results indicated that these participants' networks tended to be large, including those both aware and unaware of the participants' health status. Analysis identified three main themes: large multifaceted social networks, importance of a support group, and downsizing of social networks. Support received appeared to be of great importance in coping with their health condition, especially since the time of diagnosis. Friends and family were the primary source of informal support. The majority of participants relied mostly on friends, some of whom were HIV-positive. Formal support came primarily from the HIV organisation's support group. In this study group, non-disclosure did not impact participants' well-being. In years to come, social networks of older adults living with HIV may shrink due to personal reasons other than HIV-disclosure. What is of primary importance is that healthcare professionals become knowledgeable about psychosocial issues of older adults living with HIV, identifying latent problems and developing adequate interventions in the early stages of the disease; this would help prevent social isolation and foster successful ageing with HIV.

Screening prior to biological therapy in Crohn's disease: adherence to guidelines and prevalence of infections. Results from a multicentre retrospective study

NARCIS (Netherlands)

van der Have, Mike; Belderbos, Tim D. G.; Fidder, Herma H.; Leenders, Max; Dijkstra, Gerard; Peters, Charlotte P.; Eshuis, Emma J.; Ponsioen, Cyriel Y.; Siersema, Peter D.; van Oijen, Martijn G. H.; Oldenburg, Bas

2014-01-01

Screening for opportunistic infections prior to starting biological therapy in patients with inflammatory bowel disease is recommended. To assess adherence to screening for opportunistic infections prior to starting biological therapy in Crohn's disease patients and its yield. A multicentre

The Limpopo Project: Empirical support for the concept of emotional–social giftedness

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Kobus Maree

2011-10-01

Full Text Available In this article, I report on a project that commenced in 2003. A number of gifted black youths were recruited to study at the University of Pretoria in a project that sought to address the challenges faced by so many children from South Africa who daily face adverse conditions in their struggle to gain education so that they can earn a living and contribute to the development of the country. I reflect on the multifaceted challenges at a South African university signified by diversity and attempt to determine the role of emotional–social intelligence in the success of students who persevered despite many odds. My hope is to contribute to the current debate about developing a counselling mode giving recognition to social groups belonging to the middle and lower ends of society’s power structure – especially as played out in the realm of education and psychology.

Social representations elaborated by nurses about climacteric women in primary health care

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Smithanny Barros da Silva

2016-01-01

Full Text Available Objective : to understand the social representations elaborated by nurses from the family health strategy concerning the assistance to climacteric women. Methods : qualitative research conducted with 28 nurses. One adopted the reference of procedural approach of the theory of social representations. The interviews were recorded and transcribed completely and processed by the Software of Lexical Analysis of co-occurrence in simple statements of a text, version 4.7. Results: nurses recognize the menopause as a phase of women’s life that needs to be assisted in its entirety, however, they showed difficulty in helping them, as they just carry out the cytological examination collection, request laboratory tests and forward them to a doctor. Conclusion: the climacteric period is a multifaceted phenomenon and the assistance to those people should be systematized from a qualified listening, in an approach that respects its uniqueness and autonomy.

Multifaceted Prospective Memory Intervention to Improve Medication Adherence.

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Insel, Kathie C; Einstein, Gilles O; Morrow, Daniel G; Koerner, Kari M; Hepworth, Joseph T

2016-03-01

To test whether a multifaceted prospective memory intervention improved adherence to antihypertensive medications and to assess whether executive function and working memory processes moderated the intervention effects. Two-group longitudinal randomized control trial. Community. Individuals aged 65 and older without signs of dementia or symptoms of severe depression who were self-managing prescribed medication. After 4 weeks of initial adherence monitoring using a medication event monitoring system, individuals with 90% or less adherence were randomly assigned to groups. The prospective memory intervention was designed to provide strategies that switch older adults from relying on executive function and working memory processes (that show effects of cognitive aging) to mostly automatic associative processes (that are relatively spared with normal aging) for remembering to take medications. Strategies included establishing a routine, establishing cues strongly associated with medication taking actions, performing the action immediately upon thinking about it, using a medication organizer, and imagining medication taking to enhance encoding and improve cuing. There was significant improvement in adherence in the intervention group (57% at baseline to 78% after the intervention), but most of these gains were lost after 5 months. The control condition started at 68% and was stable during the intervention, but dropped to 62%. Executive function and working memory moderated the intervention effect, with the intervention producing greater benefit for those with lower executive function and working memory. The intervention improved adherence, but the benefits were not sustained. Further research is needed to determine how to sustain the substantial initial benefits. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Comparison of Basic Psychological Needs, Social Support and Stressful events in Addicts and Non-addicts: gender differences

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Rahele Mohammadi

2017-05-01

Full Text Available The aim of this study was to compare basic psychological needs, stressful life events, and social support in addicts and non-addicts. The study was a causal-comparative research. Two hundreds residents of Khorramabad were chosen by available sampling (130 healthy and 70 addicts and were asked to respond to Basic Psychological Need Scale La Guardia, Ryan, Couchman & Deci, Multi-facet Perceived Social Support Scale Zimet, Powell, Farley, Werkman, & Berkoff, Addiction Acceptance Scale Weed, Butcher, McKenna, & Ben-Porath, and Weekly Stress Inventory Brantley, Jones & Boudreaux. Results of analysis of variance and and discriminant analysis showed singnificant differences between men and women. The results also showed significant differences  competency and friend social support in the two groups of men, and autonomy, competency and family social support in the two groups of women. Discriminant analysis revealed that stressful life events and competency predict addiction in men. and relationship and family social support predict addiction in women.Results were discussed according to different protecting factors in men and women and possible reciprocal relationships between addiction and protecting factors.

Cybersecurity vulnerabilities in medical devices: a complex environment and multifaceted problem

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Williams PAH

2015-07-01

Full Text Available Patricia AH Williams, Andrew J Woodward eHealth Research Group and Security Research Institute, Edith Cowan University, Perth, WA, Australia Abstract: The increased connectivity to existing computer networks has exposed medical devices to cybersecurity vulnerabilities from which they were previously shielded. For the prevention of cybersecurity incidents, it is important to recognize the complexity of the operational environment as well as to catalog the technical vulnerabilities. Cybersecurity protection is not just a technical issue; it is a richer and more intricate problem to solve. A review of the factors that contribute to such a potentially insecure environment, together with the identification of the vulnerabilities, is important for understanding why these vulnerabilities persist and what the solution space should look like. This multifaceted problem must be viewed from a systemic perspective if adequate protection is to be put in place and patient safety concerns addressed. This requires technical controls, governance, resilience measures, consolidated reporting, context expertise, regulation, and standards. It is evident that a coordinated, proactive approach to address this complex challenge is essential. In the interim, patient safety is under threat. Keywords: cybersecurity, security, safety, wireless, risk, medical devices

When high pressure, system constraints, and a social justice mission collide: A socio-structural analysis of emergency department social work services.

Science.gov (United States)

Moore, Megan; Cristofalo, Margaret; Dotolo, Danae; Torres, Nicole; Lahdya, Alexandra; Ho, Leyna; Vogel, Mia; Forrester, Mollie; Conley, Bonnie; Fouts, Susan

2017-04-01

The emergency department (ED) can be a critical intervention point for many patients with multifaceted needs. Social workers have long been part of interdisciplinary ED teams. This study aimed to contribute to the limited understanding of social worker-patient interactions and factors influencing social work services in this setting. This paper reports a qualitative content analysis of social work medical record notes (N = 1509) of services provided to trauma patients in an urban, public, level 1 trauma center and an in-depth analysis of semi-structured interviews with ED social workers (N = 10). Eight major social work roles were identified: investigator, gatekeeper, resource broker, care coordinator, problem solver, crisis manager, advocate, discharge planner. Analyses revealed a complex interplay between ED social work services and multi-layered contexts. Using a social-ecological framework, we identified the interactions between micro or individual level factors, mezzo or local system level factors and macro environmental and systemic factors that play a role in ED interactions and patient services. Macro-level contextual influences were socio-structural forces including socioeconomic barriers to health, social hierarchies that reflected power differentials between providers and patients, and distrust or bias. Mezzo-level forces were limited resources, lack of healthcare system coordination, a challenging hierarchy within the medical model and the pressure to discharge patients quickly. Micro-level factors included characteristics of patients and social workers, complexity of patient stressors, empathic strain, lack of closure and compassion. All of these forces were at play in patient-social worker interactions and impacted service provision. Social workers were at times able to successfully navigate these forces, yet at other times these challenges were insurmountable. A conceptual model of ED social work and the influences on the patient-social worker

Complete en bloc urinary exenteration for synchronous multicentric transitional cell carcinoma with sarcomatoid features in a hemodialysis patient

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Tiberio M. Siqueira Jr

2006-10-01

Full Text Available The incidence of transitional cell carcinoma (TCC in patients submitted to hemodialysis is low. The presence of TCC with sarcomatoid features in this cohort is even scarcer. Herein, we describe a very rare case of synchronous multicentric muscle invasive bladder carcinoma with prostate invasion in a hemodialysis patient, submitted to complete en bloc urinary exenteration.

The multi-faceted assessment of independence in patients with rheumatoid arthritis: preliminary validation from the ATTAIN study.

Science.gov (United States)

Hassett, Afton L; Li, Tracy; Buyske, Steven; Savage, Shantal V; Gignac, Monique A M

2008-05-01

To consider the feasibility of assessing multiple facets of independence in rheumatoid arthritis (RA) using a measure developed from existing items and examining its face validity, construct validity and responsiveness to change. The ATTAIN (Abatacept Trial in Treatment of Anti-tumor necrosis factor [TNF] Inadequate responders) database was used. Patients with RA were randomized 2:1, abatacept (n = 258) and placebo (n = 133). A multi-faceted scale to measure physical and psychosocial independence was constructed using items from the Health Assessment Questionnaire (HAQ) and Short Form 36 Health Survey (SF-36). Questions assessing activity limitations and need for outside caregiver help were also examined. Interviews with 20 RA patients assessed face validity. Item Response Theory analysis yielded two traits - 'Psychosocial Independence', derived from the number of days with activity limitations plus the Role Emotional, Social Functioning and Role Physical subscale items from the SF-36; and 'Physical Independence', derived from 15 HAQ items assessing need for help from another. The two traits showed no significant differential item functioning for age or gender and demonstrated good face validity. Changes over 169 days on Psychosocial Independence were greater (mean 0.46 units, 95% confidence interval [CI]: 0.17-0.75) for the abatacept group than for placebo (p = 0.002). Changes in Physical Independence were greater (mean 0.59 units, 95% CI: 0.35-0.82) for the abatacept group than for placebo (p anti-TNF therapy. However, we caution against an interpretation that these data suggest that abatacept improves independence because the component parts of this assessment came from instruments used in the ATTAIN trial where data had been previously analyzed.

Understanding the effects of different social data on selecting priority conservation areas.

Science.gov (United States)

Karimi, Azadeh; Tulloch, Ayesha I T; Brown, Greg; Hockings, Marc

2017-12-01

Conservation success is contingent on assessing social and environmental factors so that cost-effective implementation of strategies and actions can be placed in a broad social-ecological context. Until now, the focus has been on how to include spatially explicit social data in conservation planning, whereas the value of different kinds of social data has received limited attention. In a regional systematic conservation planning case study in Australia, we examined the spatial concurrence of a range of spatially explicit social values and land-use preferences collected using a public participation geographic information system and biological data. We used Zonation to integrate the social data with the biological data in a series of spatial-prioritization scenarios to determine the effect of the different types of social data on spatial prioritization compared with biological data alone. The type of social data (i.e., conservation opportunities or constraints) significantly affected spatial prioritization outcomes. The integration of social values and land-use preferences under different scenarios was highly variable and generated spatial prioritizations 1.2-51% different from those based on biological data alone. The inclusion of conservation-compatible values and preferences added relatively few new areas to conservation priorities, whereas including noncompatible economic values and development preferences as costs significantly changed conservation priority areas (48.2% and 47.4%, respectively). Based on our results, a multifaceted conservation prioritization approach that combines spatially explicit social data with biological data can help conservation planners identify the type of social data to collect for more effective and feasible conservation actions. © 2017 Society for Conservation Biology.

Benefit of particle therapy in re-irradiation of head and neck patients. Results of a multicentric in silico ROCOCO trial

NARCIS (Netherlands)

Eekers, D.B.; Roelofs, E.; Jelen, U.; Kirk, M.; Granzier, M.; Ammazzalorso, F.; Ahn, P.H.; Janssens, G.O.; Hoebers, F.J.; Friedmann, T.; Solberg, T.; Walsh, S.; Troost, E.G.; Kaanders, J.H.A.M.; Lambin, P.

2016-01-01

BACKGROUND AND PURPOSE: In this multicentric in silico trial we compared photon, proton, and carbon-ion radiotherapy plans for re-irradiation of patients with squamous cell carcinoma of the head and neck (HNSCC) regarding dose to tumour and doses to surrounding organs at risk (OARs). MATERIAL AND

[Insomnia Between Neuro- and Social Sciences - A Psycho-Socio-Somatic Outview].

Science.gov (United States)

Cohrs, S; Hacker, T; Marx, I; Goerke, M

2016-10-01

Insomnia is one of the most prevalent neuropsychiatric disorders throughout Europe. It is associated with a number of health-relevant problems including an increased risk of psychiatric and organic disorders. A variety of organic, social and psychological risk factors takes part in the genesis of these sleep disturbances. A key component of the pathophysiology is the multifaceted hyperarousal that is expressed in the cognitive, emotional, neuronal, neuroendocrine, the hypothalamo-pituitary-adrenal axis, and further neurovegetative domains. Recent studies document in addition to identified risk factors for insomnia a number of protective factors that are relevant for the individual as well as society. © Georg Thieme Verlag KG Stuttgart · New York.

The utility of e-Learning to support training for a multicentre bladder online adaptive radiotherapy trial (TROG 10.01-BOLART).

Science.gov (United States)

Foroudi, Farshad; Pham, Daniel; Bressel, Mathias; Tongs, David; Rolfo, Aldo; Styles, Colin; Gill, Suki; Kron, Tomas

2013-10-01

An e-Learning programme appeared useful for providing training and information regarding a multi-centre image guided radiotherapy trial. The aim of this study is to demonstrate the utility of this e-Learning programme. Modules were created on relevant pelvic anatomy, Cone Beam CT soft tissue recognition and trial details. Radiation therapist participants' knowledge and confidence were evaluated before, at the end of, and after at least 6 weeks of e-Learning (long term). One hundred and eighty-five participants were recruited from 12 centres, with 118 in the first, and 67 in the second cohort. One hundred and forty-six participants had two tests (pre and post e-Learning) and 39 of these had three tests (pre, post, and long term). There was an increase confidence after completion of modules (pe-Learning for a multi-centre clinical trial was feasible and improved confidence and knowledge. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

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

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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.

A Japanese cross-sectional multicentre study of biomarkers associated with cardiovascular disease in smokers and non-smokers

OpenAIRE

L?dicke, Frank; Magnette, John; Baker, Gizelle; Weitkunat, Rolf

2015-01-01

Abstract We performed a cross-sectional, multicentre study in Japan to detect the differences in biomarkers of exposure and cardiovascular biomarkers between smokers and non-smokers. Several clinically relevant cardiovascular biomarkers differed significantly between smokers and non-smokers, including lipid metabolism (high-density lipoprotein cholesterol concentrations ? lower in smokers), inflammation (fibrinogen and white blood cell count ? both higher in smokers), oxidative stress (8-epi-...

A person-centered approach to the multifaceted nature of young adult sexual behavior.

Science.gov (United States)

McGuire, Jenifer K; Barber, Bonnie L

2010-07-01

Young adult sexual relationships were examined using a multifaceted, person-centered approach with data from Wave 7 (aged 20-21; N = 1,126) of the Michigan Study of Adolescent Life Transitions. The study utilized hierarchical cluster analyses based on the following measured variables: frequency of sex, importance of regularly having sex, satisfaction with sex life, experience of coercion for sex, and sexual risk reduction. Five distinct clusters emerged for females (Satisfied, Moderate, Active Unprotected, Pressured, and Inactive) and represented patterns such as more partners paired with less risk reduction (Active Unprotected), high satisfaction paired with frequent sex and high-risk reduction (Satisfied), or higher levels of coercion paired with low satisfaction and low-risk reduction (Pressured). Similar clusters emerged for males, with one additional cluster: the Dissatisfied cluster. Clusters differed with respect to relationship status, marital status, and psychological well-being (both males and females) and parental divorce, living situation, and sexual orientation (females only).

Salmeterol versus slow-release theophylline combined with ketotifen in nocturnal asthma: a multicentre trial. French Multicentre Study Group.

Science.gov (United States)

Muir, J F; Bertin, L; Georges, D

1992-11-01

We wished to assess the efficacy of inhaled salmeterol (SML; 50 micrograms b.i.d.) compared to a combination of slow-release theophylline and ketotifen p.o. (TK; T 300 mg+K 1 mg b.i.d.) for the treatment of nocturnal asthma. Ninety six patients with nocturnal asthma, (forced expiratory volume in one second (FEV1) 60-90% of predicted value, reversibility > or = 15%, at least two nocturnal awakenings per week) were eligible for a multicentre, double-blind, double-dummy cross-over study (14-day run-in, two successive 28-day treatment periods). Efficacy was assessed as success/failure, success being defined as the complete disappearance of nocturnal symptoms/awakening during the last week of each treatment period. There was a statistically significant difference between SML and TK for this criterion: 46% and 39% success with SML during periods I (first 28-day period) and II (following the cross-over), compared to only 15% and 26% with TK, respectively (p < 0.01). SML was also significantly better for the other criteria (lung function, rescue salbutamol intake during day and night). Side-effects were five times less frequent in SML-treated patients (p < 0.004). Efficacy and tolerance of SML were obviously far better than those of TK in patients with nocturnal asthma.

Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial

OpenAIRE

Nauth, A. (Aaron); Creek, A.T. (Aaron T.); Zellar, A. (Abby); Lawendy, A.-R. (Abdel-Rahman); Dowrick, A. (Adam); Gupta, A. (Ajay); Dadi, A. (Akhil); Kampen, A.; Yee, A. (Albert); Vries, Alexander; de Mol van Otterloo, A. (Alexander); Garibaldi, A. (Alisha); Liew, A. (Allen); McIntyre, A.W. (Allison W.); Prasad, A.S. (Amal Shankar)

2017-01-01

textabstractBackground Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries. Patients were assigned by minimisation with a...

TAFRO syndrome: New subtype of idiopathic multicentric Castleman disease

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Gordan Srkalovic

2017-05-01

Full Text Available Castleman disease (CD describes a group of three rare and poorly understood lymphoproliferative disorders that have heterogeneous clinical symptoms and common lymph node histopathological features. Unicentric CD (UCD involves a single region of enlarged nodes. Multicentric CD (MCD involves multiple regions of enlarged lymph nodes, constitutional symptoms, and organ dysfunction due to a cytokine storm often including interleukin 6. MCD is further divided into Human Herpes Virus-8 (HHV-8-associated MCD, which occurs in immunocompromised individuals, and HHV-8-negative/idiopathic MCD (iMCD. Recently, iMCD has been further sub-divided into patients with TAFRO syndrome, which involves thrombocytopenia (T, anasarca (A, fevers (F, reticulin myelofibrosis (R, organomegaly (O, and normal or only slightly elevated immunoglobulin levels, and those who do not have TAFRO syndrome. Non-TAFRO iMCD patients typically have thrombocytosis, less severe fluid accumulation, and hypergammaglobulinemia. iMCD patients with TAFRO syndrome may have a worse prognosis, but more research is needed.

'Away Days' in multi-centre randomised controlled trials: a questionnaire survey of their use and a case study on the effect of one Away Day on patient recruitment.

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Jefferson, Laura; Cook, Liz; Keding, Ada; Brealey, Stephen; Handoll, Helen; Rangan, Amar

2015-11-06

'Away Days' (trial promotion and training events for trial site personnel) are a well-established method used by trialists to encourage engagement of research sites in the recruitment of patients to multi-centre randomised controlled trials (RCTs). We explored the use of Away Days in multi-centre RCTs and analysed the effect on patient recruitment in a case study. Members of the United Kingdom Trial Managers' Network were surveyed in June 2013 to investigate their experiences in the design and conduct of Away Days in RCTs. We used data from a multi-centre pragmatic surgical trial to explore the effects of an Away Day on the screening and recruitment of patients. A total of 94 people responded to the survey. The majority (78%), who confirmed had organised an Away Day previously, found them to be useful. This is despite their costs.. There was no evidence, however, from the analysis of data from a surgical trial that attendance at an Away Day increased the number of patients screened or recruited at participating sites. Although those responsible for managing RCTs in the UK tend to believe that trial Away Days are beneficial, evidence from a multi-centre surgical trial shows no improvement on a key indicator of trial success. This points to the need to carefully consider the aims, design and conduct of Away Days. Further more rigorous research nested within RCTs would be valuable to evaluate the design and conduct of Away Days. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Multifaceted catalytic hydrogenation of amides via diverse activation of a sterically confined bipyridine-ruthenium framework.

Science.gov (United States)

Miura, Takashi; Naruto, Masayuki; Toda, Katsuaki; Shimomura, Taiki; Saito, Susumu

2017-05-16

Amides are ubiquitous and abundant in nature and our society, but are very stable and reluctant to salt-free, catalytic chemical transformations. Through the activation of a "sterically confined bipyridine-ruthenium (Ru) framework (molecularly well-designed site to confine adsorbed H 2 in)" of a precatalyst, catalytic hydrogenation of formamides through polyamide is achieved under a wide range of reaction conditions. Both C=O bond and C-N bond cleavage of a lactam became also possible using a single precatalyst. That is, catalyst diversity is induced by activation and stepwise multiple hydrogenation of a single precatalyst when the conditions are varied. The versatile catalysts have different structures and different resting states for multifaceted amide hydrogenation, but the common structure produced upon reaction with H 2 , which catalyzes hydrogenation, seems to be "H-Ru-N-H."

A comprehensive assessment of maternal deaths in Argentina: translating multicentre collaborative research into action.

Science.gov (United States)

Ramos, Silvina; Karolinski, Ariel; Romero, Mariana; Mercer, Raúl

2007-08-01

To perform a comprehensive assessment of maternal mortality in Argentina, the ultimate purpose being to strengthen the surveillance system and reorient reproductive health policies to prevent maternal deaths. Our multicentre population-based study combining qualitative and quantitative methodologies included a descriptive analysis of under-registration and distribution of causes of death, a case-control study to identify risk factors in health-care delivery and verbal autopsies to analyse social determinants associated with maternal deaths. A total of 121 maternal deaths occurred during 2002. The most common causes were abortion complications (27.4%), haemorrhage (22.1%), infection/sepsis (9.5%), hypertensive disorders (8.4%) and other causes (32.6%). Under-registration was 9.5% for maternal deaths (n = 95) and 15.4% for late maternal deaths (n = 26). The probability of dying was 10 times greater in the absence of essential obstetric care, active emergency care and qualified staff, and doubled with every 10-year increase in age. Other contributing factors included delays in recognizing "alarm signals"; reluctance in seeking care owing to desire to hide an induced abortion; delays in receiving timely treatment due to misdiagnosis or lack of supplies; and delays in referral/transportation in rural areas. A combination of methodologies is required to improve research on and understanding of maternal mortality via the systematic collection of health surveillance data. There is an urgent need for a comprehensive intervention to address public health and human rights issues in maternal mortality, and our results contribute to the consensus-building necessary to improve the existing surveillance system and prevention strategies.

The role of dosimetry audit in lung SBRT multi-centre clinical trials.

Science.gov (United States)

Clark, Catharine H; Hurkmans, Coen W; Kry, Stephen F

2017-12-01

Stereotactic Body Radiotherapy (SBRT) in the lung is a challenging technique which requires high quality clinical trials to answer the un-resolved clinical questions. Quality assurance of these clinical trials not only ensures the safety of the treatment of the participating patients but also minimises the variation in treatment, thus allowing the lowest number of patient treatments to answer the trial question. This review addresses the role of dosimetry audits in the quality assurance process and considers what can be done to ensure the highest accuracy of dose calculation and delivery and it's assessment in multi-centre trials. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Multicentre epidemiological survey on the incidence of Streptococcus agalactiae in pregnancy

Directory of Open Access Journals (Sweden)

Leonardo Lodolo

2010-03-01

Full Text Available ß-hemolytic streptococci group B (GBS cause infections of the urinary tract, endometrium, amnion, and superinfection of wounds, with complications in 2% -4% of cases in pregnant woman.The infection transmitted to newborns is a cause of sepsis and meningitis with high incidence of mortality.A recent report on a multicentric study of the ISS, showed that detection of S. agalactiae in pregnant women in different realities of healthcare, ranging from 3.9% to 19.4%. This survey covers a sample of 29607 women screened in a total of 36852 childbirths, with a positivity of 4183 subjects equal to 14.1%. Thanks to the GBS Study Group of Piemonte and Valle d’Aosta microbiology laboratories, with the support of 42 study centres have been involved. Collection techniques, types of medium, environmental of incubation of the culture, possible enrichment in broth, of the swabs of 28491 women during 2006/2007 have been considered. 24.36% were vaginal swab while 75.64% vagino/rectal. According to data collected at 31 centers with eligible data (22,175 pregnant GBS positivity was 12.7% (CI [Confidence Interval] + / -95%: 13.1% -12.2% with wide variability between individual centers (2% -22.6%. The enrichment broth is used by 6 out of 9 centers with positivity> 15% (M: 20.05%, from 6 to 14 with positivity between 10-15% (M: 12.61%, from none to 8 centers with less than 10% positivity (M: 4.95%.This multicentre survey underlined the preference for vagino/rectal swab, as recommended by the literature. The frequency of GBS positivity of pregnant women on the whole samples is similar to that found in other national surveys, even if with large differences between the different centers.The sensitivity tends to increase with the use of enrichment techniques, whose use is uneven between the centers, perhaps indicating the need for greater uniformity of protocols based on the results of microbiological analysis EBM (Evidence Based Medicine.

The Youth Empowered for Success Program: A Multi-faceted Approach to Youth Leadership Development and School Culture Change in Southern Arizona

OpenAIRE

Pam Parrish; Mari Wilhelm; Yvette Florez-Urcadez; Daniel A. Jeffrey; James Roebuck; Bill B. Burnett

2008-01-01

Arizona’s first Teen Institute (TI) program, Youth Empowered for Success, began in July 2004. It is the first TI-based project to focus on nurturing resilience via Health Realization (Pransky, 2007). The YES program’s design to “create conditions for success” in high schools is discussed. YES utilizes a strengths-based, multi-faceted approach of (1) teaching participants how to access their innate resilience and common sense (Health Realization), (2) training them in community development fo...

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

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

Stress Prevention@Work : A study protocol for the evaluation of a multifaceted integral stress prevention strategy to prevent employee stress in a healthcare organization: a cluster controlled trial

NARCIS (Netherlands)

Hoek, R.J.A.; Havermans, B.M.; Houtman, I.L.D.; Brouwers, E.P.M.; Heerkens, Y.F.; Zijlstra-vlasveld, M.C.; Anema, J.R.; van der Beek, A.J.; Boot, C.R.L.

2018-01-01

Adequate implementation of work-related stress management interventions can reduce or prevent work-related stress and sick leave in organizations. We developed a multifaceted integral stress-prevention strategy for organizations from several sectors that includes a digital platform and collaborative

Stress Prevention@Work: a study protocol for the evaluation of a multifaceted integral stress prevention strategy to prevent employee stress in a healthcare organization: a cluster controlled trial

NARCIS (Netherlands)

Hoek, R.J.A.; Havermans, B.M.; Houtman, I.L.D.; Brouwers, E.P.M.; Heerkens, Y.F.; Zijlstra-Vlasveld, M.C.; Anema, J.R.; Beek, A.J. van der; Boot, C.R.L.

2017-01-01

Background. Adequate implementation of work-related stress management interventions can reduce or prevent work-related stress and sick leave in organizations. We developed a multifaceted integral stress-prevention strategy for organizations from several sectors that includes a digital platform and

Video games as a multifaceted medium: a review of quantitative social science research on video games and a typology of video game research approaches

OpenAIRE

Ivory, James D.

2013-01-01

Although there is a vast and useful body of quantitative social science research dealing with the social role and impact of video games, it is difficult to compare studies dealing with various dimensions of video games because they are informed by different perspectives and assumptions, employ different methodologies, and address different problems. Studies focusing on different social dimensions of video games can produce varied findings about games' social function that are often difficult...

Multifaceted academic detailing program to increase pharmacotherapy for alcohol use disorder: interrupted time series evaluation of effectiveness.

Science.gov (United States)

Harris, Alex H S; Bowe, Thomas; Hagedorn, Hildi; Nevedal, Andrea; Finlay, Andrea K; Gidwani, Risha; Rosen, Craig; Kay, Chad; Christopher, Melissa

2016-09-15

Active consideration of effective medications to treat alcohol use disorder (AUD) is a consensus standard of care, yet knowledge and use of these medications are very low across diverse settings. This study evaluated the overall effectiveness a multifaceted academic detailing program to address this persistent quality problem in the US Veterans Health Administration (VHA), as well as the context and process factors that explained variation in effectiveness across sites. An interrupted time series design, analyzed with mixed-effects segmented logistic regression, was used to evaluate changes in level and rate of change in the monthly percent of patients with a clinically documented AUD who received naltrexone, acamprosate, disulfiram, or topiramate. Using data from a 20 month post-implementation period, intervention sites (n = 37) were compared to their own 16 month pre-implementation performance and separately to the rest of VHA. From immediately pre-intervention to the end of the observation period, the percent of patients in the intervention sites with AUD who received medication increased over 3.4 % in absolute terms and 68 % in relative terms (i.e., 4.9-8.3 %). This change was significant compared to the pre-implementation period in the intervention sites and secular trends in control sites. Sites with lower pre-implementation adoption, more person hours of detailing, but fewer people detailed, had larger immediate increases in medication receipt after implementation. The average number of detailing encounters per person was associated with steeper increases in slope over time. This study found empirical support for a multifaceted quality improvement strategy aimed at increasing access to and utilization of pharmacotherapy for AUD. Future studies should focus on determining how to enhance the programs effects, especially in non-responsive locations.

Psychological and psychosocial functioning of children with burn scarring using cosmetic camouflage: a multi-centre prospective randomised controlled trial.

Science.gov (United States)

Maskell, Jessica; Newcombe, Peter; Martin, Graham; Kimble, Roy

2014-02-01

Burns leave patients with long-term physical scarring. Children with scarring are required to face challenges of reintegration into their community, including acceptance of an altered appearance and acceptance by others. This can be difficult given society's preoccupation with physical appearance. Limited research exists investigating validity of cosmetic camouflage as a psychosocial intervention for children with scarring. This study investigated whether using cosmetic camouflage (Microskin™) had a positive impact on health-related quality of life, self-concept and psychopathology for children and adolescents (8-17 years) with burn scarring. A prospective multi-centre randomised controlled trial was conducted across Australian and New Zealand paediatric hospitals. 63 participants (49 females, mean age 12.7 ± 2.1 years) were enrolled. Data points were baseline (Time 1) and at 8 weeks (Time 2) using reliable and valid psychometric measures. Findings indicate there were significant improvements in socialisation, school and appearance scales on the Paediatric Quality of Life Inventory and psychopathology scores particularly peer problems decreased. However self-concept remained stable from baseline throughout intervention use. Cosmetic camouflage appears to have a positive impact on quality of life particularly socialisation. Cosmetic camouflage is a valid tool to assist children with scarring to actively participate socially within their communities. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

Perceived information needs and social support of Chinese-Australian breast cancer survivors.

Science.gov (United States)

Kwok, C; White, K

2014-10-01

Both informational and social support are vital components in achieving a high quality of life as a cancer survivor. The study aims to explore the perceptions of information needs and social support among Chinese-Australian breast cancer survivors and how these resources impacted their cancer experience. Three focus groups were conducted with 23 Chinese-Australian women diagnosed with breast cancer in their native language (Mandarin and Cantonese). Each interview was translated and transcribed. Content analysis was used to uncover the major themes. Themes for information needs were identified as (1) using linguistically appropriate information, (2) the need for culturally sensitive information for the management of expected side effect and promotion of recovery and (3) the need for information on signs and symptoms of recurrence. Families were described as a primary source of multifaceted social support, although it was challenging to obtain. Support groups were also an important support source, but health care professionals were not identified as a source of support. Our study has provided practical insight into the information needs and social support of Chinese women with breast cancer. These findings can be used to inform the development of linguistically and culturally tailored support and survivorship interventions for this vulnerable population.

Social Identities in a Globalized World: Challenges and Opportunities for Collective Action.

Science.gov (United States)

Rosenmann, Amir; Reese, Gerhard; Cameron, James E

2016-03-01

Globalization-the increasing interconnectedness of societies, economies, and cultures-is a defining feature of contemporary social life. Paradoxically, it underlies both the dynamics of global crises (e.g., rising inequality, climate change) and the possibilities for ameliorating them. In this review, we introduce globalization as a multifaceted process and elaborate its psychological effects with respect to identity, culture, and collective action. Using a social identity approach, we discuss three foci of identification: local culture, globalized Western culture, and humanity in its entirety. Each source of identification is analyzed in terms of its psychological meaning and position vis-à-vis the global power structure. Globalized Western culture forms the basis for an exclusive globalized identity, which privileges only some cultures and ways of life. We conceptualize reactions to its core values in terms of cultural identification and rejection and acceptance of, or opposition to, its global social order. Opposition to this inequitable global order is central to inclusive globalized identities (e.g., identification with humanity). These identities may encourage globally minded collective action, even as more research is needed to address their potential caveats. We consider possibilities for social change and action and conclude that a focused application of psychological science to the study of these issues is overdue. © The Author(s) 2016.

Disease-related social situation in family of children with chronic kidney disease--parents` assessment. A multicentre study.

Science.gov (United States)

Kiliś-Pstrusińska, Katarzyna; Medyńska, Anna; Adamczyk, Piotr; Bałasz-Chmielewska, Irena; Grenda, Ryszard; Kluska-Jóźwiak, Agnieszka; Leszczyńska, Beata; Olszak-Szot, Ilona; Miklaszewska, Monika; Szczepańska, Maria; Tkaczyk, Marcin; Wasilewska, Anna; Zachwieja, Katarzyna; Zajączkowska, Maria; Ziółkowska, Helena; Zagożdżon, Ilona; Zwolińska, Danuta

2014-01-01

Chronic kidney disease (CKD) in children burdens life of patients and their families. Little is known about parents` assessment of families' social situation. However, the knowledge of the details of a patient's and his family's life standards might influence modification and optimization of applied therapy. Therefore, the main goal of the present study was to explore the selected elements of life situation of patients suffering with CKD as well as their parents, depending on the CKD stage and appropriate treatment. Cross-sectional national study was conducted. A total of 203 children with CKD and 388 their parent-proxies (196 women and 192 men) were enrolled into this study. Patient data and questionnaires filled by both parents, concerning social-demographic parameters and assessment of changes in families after CKD diagnosis in the child, were analysed. CKD children are being brought up in proper families whose financial situation is not good. Children need help in process of education. Perception of current situation differed between both parents in the change of the income source, taking care of CKD child, change in social relations and evaluating relations with medical staff. Parents do not obtain proper support from social workers. Families of CKD children require support in area of financial and educational help for school children. The discrepancies in evaluation of family situation between mothers and fathers of ill children might be the source of conflicts possibly resulting in worsening the outcome for CKD children.

Parental social status and intrasexual competitiveness among adolescents.

Science.gov (United States)

Buunk, Abraham P; Stulp, Gert; Ormel, Johan

2014-11-17

A study among 1,881 adolescents (52.3% girls) with a mean age of 19.1 years examined the effects of parental social status upon intrasexual competitiveness. Whereas females were consistently more intrasexually competitive the higher the socio-economic status of their parents, males with parents of the lowest socio-economic status tended to be more intrasexually competitive than those with parents of medium socio-economic status, and nearly as intrasexually competitive as those with parents of high socio-economic status. Only among adolescents with parents of low socio-economic status were males more intrasexually competitive than females. Among males and females, higher levels of intrasexual competitiveness were related to a higher family income, to a higher occupational status of the father as well as of the mother, and to a higher educational level of the mother. Only among females were higher levels of intrasexual competitiveness associated with a higher educational level of the father. Males whose fathers had only elementary education had a relatively high level of intrasexual competitiveness. The results are discussed in the context of the multifaceted nature of human status, and the potential relevance of intrasexual competitiveness for individuals of high versus low social status.

Transport Policy and Social Inclusion

Directory of Open Access Journals (Sweden)

Miriam Ricci

2016-06-01

Full Text Available ‘Transport-related Social inclusion’ is a specific naming of the complex set of interrelationships within which accessibility plays an important role in whether a citizen achieves the level of participation in socioeconomic life that he or she seeks. It has its origins in the United Kingdom of the early 2000s, but the diversity of theoretical perspectives, research methods and practical focus shown by the contributions to the present issue on this theme bears witness to the evolution and translation this concept and term has undergone over more than a decade. Nine papers are presented, concerning applications of the concept in three continents, and including some of the poorest and richest per capita income countries on the globe. As well as developing and applying the multi-faceted theories of the processes of exclusion and techniques for the quantitative identification of inclusion, they consider important topics such as the treatment of the less abled and more frail members of society when on the move and the potential for new technological design methods and practical solutions either to enhance inclusion or deepen inequality in our societies. Collectively their conclusions reinforce the message that social exclusion remains multi-dimensional, relational and dynamic, located both in the circumstances of the excluded individual as well as in the processes, institutions and structures that permeate wider society.

Cerebral sinus venous thromboses in children with acute lymphoblastic leukaemia - a multicentre study from the Nordic Society of Paediatric Haematology and Oncology

DEFF Research Database (Denmark)

Ranta, Susanna; Tuckuviene, Ruta; Mäkipernaa, Anne

2014-01-01

We present a prospective multicentre cohort of 20 children with acute lymphoblastic leukaemia (ALL) and cerebral sinus venous thrombosis (CSVT). The study covers a period of 5 years and comprises 1038 children treated according to the Nordic Society of Paediatric Haematology and Oncology (NOPHO...

Improving the well-being of elderly patients via community pharmacy-based provision of pharmaceutical care - A multicentre study in seven European countries

NARCIS (Netherlands)

Bernsten, C; Bjorkman, [No Value; Caramona, M; Crealey, G; Frokjaer, B; Grundberger, E; Gustafsson, T; Henman, M; Herborg, H; Hughes, C; McElnay, J; Magner, M; van Mil, F; Schaeffer, M; Silva, S; Sondergaard, B; Sturgess, [No Value; Tromp, D; Vivero, L; Winterstein, A

2001-01-01

Objective: This study aimed to measure the outcomes of a harmonised, structured pharmaceutical care programme provided to elderly patients: (greater than or equal to 65 years of age) by community pharmacists in a multicentre international study performed in 7 European countries. Design and setting:

Dust in fusion devices-a multi-faceted problem connecting high- and low-temperature plasma physics

International Nuclear Information System (INIS)

Winter, J

2004-01-01

Small particles with sizes between a few nanometers and a few 10 μm (dust) are formed in fusion devices by plasma-surface interaction processes. Though it is not a major problem today, dust is considered a problem that could arise in future long pulse fusion devices. This is primarily due to its radioactivity and due to its very high chemical reactivity. Dust formation is particularly pronounced when carbonaceous wall materials are used. Dust particles can be transported in the tokamak over significant distances. Radioactivity leads to electrical charging of dust and to its interaction with plasmas and electric fields. This may cause interference with the discharge but may also result in options for particle removal. This paper discusses some of the multi-faceted problems using information both from fusion research and from low-temperature dusty plasma work

Cumulative Effects Assessment: Linking Social, Ecological, and Governance Dimensions

Directory of Open Access Journals (Sweden)

Marian Weber

2012-06-01

Full Text Available Setting social, economic, and ecological objectives is ultimately a process of social choice informed by science. In this special feature we provide a multidisciplinary framework for the use of cumulative effects assessment in land use planning. Forest ecosystems are facing considerable challenges driven by population growth and increasing demands for resources. In a suite of case studies that span the boreal forest of Western Canada to the interior Atlantic forest of Paraguay we show how transparent and defensible methods for scenario analysis can be applied in data-limited regions and how social dimensions of land use change can be incorporated in these methods, particularly in aboriginal communities that have lived in these ecosystems for generations. The case studies explore how scenario analysis can be used to evaluate various land use options and highlight specific challenges with identifying social and ecological responses, determining thresholds and targets for land use, and integrating local and traditional knowledge in land use planning. Given that land use planning is ultimately a value-laden and often politically charged process we also provide some perspective on various collective and expert-based processes for identifying cumulative impacts and thresholds. The need for good science to inform and be informed by culturally appropriate democratic processes calls for well-planned and multifaceted approaches both to achieve an informed understanding of both residents and governments of the interactive and additive changes caused by development, and to design action agendas to influence such change at the ecological and social level.

BAG3: a multifaceted protein that regulates major cell pathways

Science.gov (United States)

Rosati, A; Graziano, V; De Laurenzi, V; Pascale, M; Turco, M C

2011-01-01

Bcl2-associated athanogene 3 (BAG3) protein is a member of BAG family of co-chaperones that interacts with the ATPase domain of the heat shock protein (Hsp) 70 through BAG domain (110–124 amino acids). BAG3 is the only member of the family to be induced by stressful stimuli, mainly through the activity of heat shock factor 1 on bag3 gene promoter. In addition to the BAG domain, BAG3 contains also a WW domain and a proline-rich (PXXP) repeat, that mediate binding to partners different from Hsp70. These multifaceted interactions underlie BAG3 ability to modulate major biological processes, that is, apoptosis, development, cytoskeleton organization and autophagy, thereby mediating cell adaptive responses to stressful stimuli. In normal cells, BAG3 is constitutively present in a very few cell types, including cardiomyocytes and skeletal muscle cells, in which the protein appears to contribute to cell resistance to mechanical stress. A growing body of evidence indicate that BAG3 is instead expressed in several tumor types. In different tumor contexts, BAG3 protein was reported to sustain cell survival, resistance to therapy, and/or motility and metastatization. In some tumor types, down-modulation of BAG3 levels was shown, as a proof-of-principle, to inhibit neoplastic cell growth in animal models. This review attempts to outline the emerging mechanisms that can underlie some of the biological activities of the protein, focusing on implications in tumor progression. PMID:21472004

The Mosque and Social Networks: The Case of Muslim Youth in Brisbane

Directory of Open Access Journals (Sweden)

Ameera Karimshah

2014-08-01

Full Text Available Much of the existing public discourse surrounding Muslim youth in Western societies is framed through a simplistic and static understanding of the role of the Mosque in their everyday life. Mosques are often seen as places for the development of Muslim conservatism where membership is gender and ethno-specific and activities are socially restrictive (Spalek & Imtoual, 2007, p. 195; Spalek & Lambert, 2008; Poynting & Mason, 2008, p. 237. This contributes to an ongoing public preoccupation with the idea that it is necessary to integrate Muslim youth into “mainstream society” as a counter measure to anti-social behaviour and attributed outcomes (i.e. terrorism. This paper, building on the work of Dialmy (2007, p. 70 and Jamal (2005, p. 523, offers an account of how young Muslims network and socialise around the Mosque in Brisbane, Australia. We show that contrary to popular public conception, the role of the Mosque in the lives of Muslim youth is multifaceted and serves as the centrepiece from which the majority of socialisation, across variety formal and informal networks, occurs. This paper also explores the reasons underpinning Muslim youth’s social participation, emphasizing the socio-cultural factors (both within and beyond the place of worship that facilitate and hinder participation across a range of social settings. We argue that discussions on Muslim youth and social engagement must be positioned within an informed understanding of the nuanced role of the Mosque in the generation of social networks within Western contexts.

Early pregnancy ultrasound and management – effect of a multifaceted training on physician knowledge

LENUS (Irish Health Repository)

O’Leary, B

2016-02-01

Vaginal bleeding is a common event in early pregnancy, with 20-40% of pregnancies affected. Prompt diagnosis and management of bleeding is important, both to reduce morbidity and to avoid excessive emotional distress. This was a prospective study of an educational programme aimed at Obstetrics and Gynaecology BST trainees in the National Maternity Hospital, Dublin. The educational programme consisted of didactic lectures, and simulation and practical sessions. A questionnaire reviewing early pregnancy complications was used to assess participant knowledge. Six trainees participated in the programme, with five (83%) answering the questionnaire. The pre-education questionnaire showed a generally poor level of knowledge of early pregnancy complications with 8\\/50 (16%) questions answered correctly. Following the educational intervention there was a statistically significant increase in participant knowledge with 45\\/50 (90%) questions answered correctly. A significant increase in participant knowledge of early pregnancy complications followed our multifaceted educational programme. Study limitations exist, however we have shown the potential value of our educational programme.

The Multifaceted Roles of STAT3 Signaling in the Progression of Prostate Cancer

International Nuclear Information System (INIS)

Bishop, Jennifer L.; Thaper, Daksh; Zoubeidi, Amina

2014-01-01

The signal transducer and activator of transcription (STAT)3 governs essential functions of epithelial and hematopoietic cells that are often dysregulated in cancer. While the role for STAT3 in promoting the progression of many solid and hematopoietic malignancies is well established, this review will focus on the importance of STAT3 in prostate cancer progression to the incurable metastatic castration-resistant prostate cancer (mCRPC). Indeed, STAT3 integrates different signaling pathways involved in the reactivation of androgen receptor pathway, stem like cells and the epithelial to mesenchymal transition that drive progression to mCRPC. As equally important, STAT3 regulates interactions between tumor cells and the microenvironment as well as immune cell activation. This makes it a major factor in facilitating prostate cancer escape from detection of the immune response, promoting an immunosuppressive environment that allows growth and metastasis. Based on the multifaceted nature of STAT3 signaling in the progression to mCRPC, the promise of STAT3 as a therapeutic target to prevent prostate cancer progression and the variety of STAT3 inhibitors used in cancer therapies is discussed

Pushing the Limits: Cognitive, Affective, & Neural Plasticity Revealed by an Intensive Multifaceted Intervention

Directory of Open Access Journals (Sweden)

Michael David Mrazek

2016-03-01

Full Text Available Scientific understanding of how much the adult brain can be shaped by experience requires examination of how multiple influences combine to elicit cognitive, affective, and neural plasticity. Using an intensive multifaceted intervention, we discovered that substantial and enduring improvements can occur in parallel across multiple cognitive and neuroimaging measures in healthy young adults. The intervention elicited substantial improvements in physical health, working memory, standardized test performance, mood, self-esteem, self-efficacy, mindfulness, and life satisfaction. Improvements in mindfulness were associated with increased degree centrality of the insula, greater functional connectivity between insula and somatosensory cortex, and reduced functional connectivity between posterior cingulate cortex and somatosensory cortex. Improvements in working memory and reading comprehension were associated with increased degree centrality of a region within the middle temporal gyrus that was extensively and predominately integrated with the executive control network. The scope and magnitude of the observed improvements represent the most extensive demonstration to date of the considerable human capacity for change. These findings point to higher limits for rapid and concurrent cognitive, affective, and neural plasticity than is widely assumed.

Effectiveness of a multifaceted implementation strategy on physicians? referral behavior to an evidence-based psychosocial intervention in dementia: a cluster randomized controlled trial

OpenAIRE

D?pp, Carola ME; Graff, Maud JL; Teerenstra, Steven; Nijhuis-van der Sanden, Maria WG; Olde Rikkert, Marcel GM; Vernooij-Dassen, Myrra JFJ

2013-01-01

BACKGROUND: To evaluate the effectiveness of a multifaceted implementation strategy on physicians' referral rate to and knowledge on the community occupational therapy in dementia program (COTiD program). METHODS: A cluster randomized controlled trial with 28 experimental and 17 control clusters was conducted. Cluster included a minimum of one physician, one manager, and two occupational therapists. In the control group physicians and managers received no interventions and occupational therap...

USING A MULTIFACETED APPROACH TO IMPROVE THE FOLLOW-UP OF POSITIVE FECAL OCCULT BLOOD TEST RESULTS

Science.gov (United States)

Singh, Hardeep; Kadiyala, Himabindu; Bhagwath, Gayathri; Shethia, Anila; El-Serag, Hashem; Walder, Annette; Velez, Maria; Petersen, Laura A.

2010-01-01

Background Inadequate follow-up of abnormal fecal occult blood test (FOBT) results occurs in several types of practice settings. Our institution implemented multifaceted quality improvement (QI) activities in 2004–2005 to improve follow-up of FOBT positive results. Activities addressed pre-colonoscopy referral processes and system-level factors such as electronic communication and provider education and feedback. We evaluated their effects on timeliness and appropriateness of positive FOBT follow-up and identified factors that affect colonoscopy performance. Methods Retrospective electronic medical record (EMR) review was used to determine outcomes pre- and post-QI activities in a multi-specialty ambulatory clinic of a tertiary care Veterans Affairs facility and its affiliated satellite clinics. From 1869 FOBT positive cases, 800 were randomly selected from time periods before and after QI activities. Two reviewers used a pretested standardized data collection form to determine whether colonoscopy was appropriate or indicated based on pre-determined criteria and if so, the timeliness of colonoscopy referral and performance pre- and post-QI activities. Results In cases where a colonoscopy was indicated, the proportion of patients who received a timely colonoscopy referral and performance were significantly higher post implementation (60.5% vs. 31.7%, pperformance (6 vs. 19 days pperformance of an indicated colonoscopy included performance of a non-colonoscopy procedure such as barium enema or flexible sigmoidoscopy (OR=16.9; 95% CI 1.9–145.1), patient non-adherence (OR=33.9; 95% CI 17.3–66.6), not providing an appropriate provisional diagnosis on the consultation (OR= 17.9; 95% CI 11.3–28.1) and gastroenterology service not rescheduling colonoscopies after an initial cancellation (OR= 11.0; 95% CI 5.1–23.7) Conclusions Multifaceted QI activities improved rates of timely colonoscopy referral and performance in an EMR system. However, colonoscopy was not

Economic Evaluation of a Multifaceted Implementation Strategy for the Prevention of Hand Eczema Among Healthcare Workers in Comparison with a Control Group: The Hands4U Study.

NARCIS (Netherlands)

Van Der Meer, Esther W C; van Dongen, J.M.; Boot, C.R.; van der Gulden, J.W.; Bosmans, J.E.; Anema, J.R.

2016-01-01

The aim of this study was to evaluate the cost-effectiveness of a multifaceted implementation strategy for the prevention of hand eczema in comparison with a control group among healthcare workers. A total of 48 departments (n=1,649) were randomly allocated to the implementation strategy or the

Economic Evaluation of a Multifaceted Implementation Strategy for the Prevention of Hand Eczema Among Healthcare Workers in Comparison with a Control Group: The Hands4U Study

NARCIS (Netherlands)

Meer, E.W. van der; Dongen, J.M. van; Boot, C.R.; Gulden, J.W.J. van der; Bosmans, J.E.; Anema, J.R.

2016-01-01

The aim of this study was to evaluate the cost-effectiveness of a multifaceted implementation strategy for the prevention of hand eczema in comparison with a control group among healthcare workers. A total of 48 departments (n=1,649) were randomly allocated to the implementation strategy or the

Health Alliance for prudent antibiotic prescribing in patients with respiratory tract infections (HAPPY AUDIT -impact of a non-randomised multifaceted intervention programme

Directory of Open Access Journals (Sweden)

Reutskiy Anatoliy

2011-06-01

Full Text Available Abstract Background Excessive use of antibiotics is worldwide the most important reason for development of antimicrobial resistance. As antibiotic resistance may spread across borders, high prevalence countries may serve as a source of bacterial resistance for countries with a low prevalence. Therefore, bacterial resistance is an important issue with a potential serious impact on all countries. Initiatives have been taken to improve the quality of antibiotic prescribing in primary care, but only few studies have been designed to determine the effectiveness of multifaceted strategies across countries with different practice setting. The aim of this study was to evaluate the impact of a multifaceted intervention targeting general practitioners (GPs and patients in six countries with different health organization and different prevalence of antibiotic resistance. Methods GPs from two Nordic countries, two Baltic Countries and two Hispano-American countries registered patients with respiratory tract infections (RTIs in 2008 and 2009. After first registration they received individual prescriber feedback and they were offered an intervention programme that included training courses, clinical guidelines, posters for waiting rooms, patient brochures and access to point of care tests (Strep A and C-Reactive Protein. Antibiotic prescribing rates were compared before and after the intervention. Results A total of 440 GPs registered 47011 consultations; 24436 before the intervention (2008 and 22575 after the intervention (2009. After the intervention, the GPs significantly reduced the percentage of consultations resulting in an antibiotic prescription. In patients with lower RTI the GPs in Lithuania reduced the prescribing rate by 42%, in Russia by 25%, in Spain by 25%, and in Argentina by 9%. In patients with upper RTIs, the corresponding reductions in the antibiotic prescribing rates were in Lithania 20%, in Russia 15%, in Spain 9%, and in Argentina 5

Tissue-Based MRI Intensity Standardization: Application to Multicentric Datasets

Directory of Open Access Journals (Sweden)

Nicolas Robitaille

2012-01-01

Full Text Available Intensity standardization in MRI aims at correcting scanner-dependent intensity variations. Existing simple and robust techniques aim at matching the input image histogram onto a standard, while we think that standardization should aim at matching spatially corresponding tissue intensities. In this study, we present a novel automatic technique, called STI for STandardization of Intensities, which not only shares the simplicity and robustness of histogram-matching techniques, but also incorporates tissue spatial intensity information. STI uses joint intensity histograms to determine intensity correspondence in each tissue between the input and standard images. We compared STI to an existing histogram-matching technique on two multicentric datasets, Pilot E-ADNI and ADNI, by measuring the intensity error with respect to the standard image after performing nonlinear registration. The Pilot E-ADNI dataset consisted in 3 subjects each scanned in 7 different sites. The ADNI dataset consisted in 795 subjects scanned in more than 50 different sites. STI was superior to the histogram-matching technique, showing significantly better intensity matching for the brain white matter with respect to the standard image.

Tolerability of the capsaicin 8% patch following pretreatment with lidocaine or tramadol in patients with peripheral neuropathic pain: A multicentre, randomized, assessor-blinded study

NARCIS (Netherlands)

Jensen, T.S.; Hoye, K.; Fricova, J.; Vanelderen, P.J.L.; Ernault, E.; Siciliano, T.; Marques, S.

2014-01-01

BACKGROUND: Application of the capsaicin 8% patch is associated with treatment-related discomfort. Consequently, pretreatment for 60 min with anaesthetic cream is recommended; however, this may be uncomfortable and time consuming. METHODS: We conducted a multicentre, randomized (1:1),

Using social marketing principles to guide the development of a nutrition education initiative for preschool-aged children.

Science.gov (United States)

Young, Laura; Anderson, Jennifer; Beckstrom, Leslie; Bellows, Laura; Johnson, Susan L

2004-01-01

Within the field of nutrition education, social marketing has become a promising framework to systematically approach problems related to nutrition behavior. In 1997, the Colorado Nutrition Network began developing a social marketing campaign to promote healthful food choices among low-income Coloradans. A multifaceted formative evaluation plan that included focus groups, campaign concept pretesting, and a food frequency questionnaire was used to segment and scrutinize the target audience. The resulting pilot program was a blend of educational and marketing strategies targeting preschoolers that was implemented in Head Start classrooms. The 12-week intervention contained a narrow, behavior-based "try new foods" message, multiple nutrition education activities, and repeated opportunities to taste 13 novel foods. Key strategies used and findings from the formative evaluation process are presented herein in an effort to provide insight for nutrition educators interested in developing similar interventions.

A successful strategy for increasing the influenza vaccination rate of healthcare workers without a mandatory policy outside of the United States: a multifaceted intervention in a Japanese tertiary care center.

Science.gov (United States)

Honda, Hitoshi; Sato, Yumiko; Yamazaki, Akinori; Padival, Simi; Kumagai, Akira; Babcock, Hilary

2013-11-01

Although mandatory vaccination programs have been effective in improving the vaccination rate among healthcare workers, implementing this type of program can be challenging because of varied reasons for vaccine refusal. The purpose of our study is to measure improvement in the influenza vaccination rate from a multifaceted intervention at a Japanese tertiary care center where implementing a mandatory vaccination program is difficult. Before-and-after trial. Healthcare workers at a 550-bed, tertiary care, academic medical center in Sapporo, Japan. We performed a multifaceted intervention including (1) use of a declination form, (2) free vaccination, (3) hospital-wide announcements during the vaccination period, (4) prospective audit and real-time telephone interview for healthcare workers who did not receive the vaccine, (5) medical interview with the hospital executive for noncompliant (no vaccine, no declination form) healthcare workers during the vaccination period, and (6) mandatory submission of a vaccination document if vaccinated outside of the study institution. With the new multifaceted intervention, the vaccination rate in the 2012-2013 season increased substantially, up to 97%. This rate is similar to that reported in studies with a mandatory vaccination program. Improved vaccination acceptance, particularly among physicians, likely contributed to the overall increase in the vaccination rate reported in the study. Implementation of comprehensive strategies with strong leadership can lead to substantial improvements in vaccine uptake among healthcare workers even without a mandatory vaccination policy. The concept is especially important for institutions where implementing mandatory vaccination programs is challenging.

Sensitivity of imaging for multifocal-multicentric breast carcinoma

Directory of Open Access Journals (Sweden)

Viale Giuseppe

2008-09-01

Full Text Available Abstract Background This retrospective study aims to determine: 1 the sensitivity of preoperative mammography (Mx and ultrasound (US, and re-reviewed Mx to detect multifocal multicentric breast carcinoma (MMBC, defined by pathology on surgical specimens, and 2 to analyze the characteristics of both detected and undetected foci on Mx and US. Methods Three experienced breast radiologists re-reviewed, independently, digital mammography of 97 women with MMBC pathologically diagnosed on surgical specimens. The radiologists were informed of all neoplastic foci, and blinded to the original mammograms and US reports. With regards to Mx, they considered the breast density, number of foci, the Mx characteristics of the lesions and their BI-RADS classification. For US, they considered size of the lesions, BI-RADS classification and US pattern and lesion characteristics. According to the histological size, the lesions were classified as: index cancer, 2nd lesion, 3rd lesion, and 4th lesion. Any pathologically identified malignant foci not previously described in the original imaging reports, were defined as undetected or missed lesions. Sensitivity was calculated for Mx, US and re-reviewed Mx for detecting the presence of the index cancer as well as additional satellite lesions. Results Pathological examination revealed 13 multifocal and 84 multicentric cancers with a total of 303 malignant foci (282 invasive and 21 non invasive. Original Mx and US reports had an overall sensitivity of 45.5% and 52.9%, respectively. Mx detected 83/97 index cancers with a sensitivity of 85.6%. The number of lesions undetected by original Mx was 165/303. The Mx pattern of breasts with undetected lesions were: fatty in 3 (1.8%; scattered fibroglandular density in 40 (24.3%, heterogeneously dense in 91 (55.1% and dense in 31 (18.8% cases. In breasts with an almost entirely fatty pattern, Mx sensitivity was 100%, while in fibroglandular or dense pattern it was reduced to 45

Data-Driven Engineering of Social Dynamics: Pattern Matching and Profit Maximization.

Science.gov (United States)

Peng, Huan-Kai; Lee, Hao-Chih; Pan, Jia-Yu; Marculescu, Radu

2016-01-01

In this paper, we define a new problem related to social media, namely, the data-driven engineering of social dynamics. More precisely, given a set of observations from the past, we aim at finding the best short-term intervention that can lead to predefined long-term outcomes. Toward this end, we propose a general formulation that covers two useful engineering tasks as special cases, namely, pattern matching and profit maximization. By incorporating a deep learning model, we derive a solution using convex relaxation and quadratic-programming transformation. Moreover, we propose a data-driven evaluation method in place of the expensive field experiments. Using a Twitter dataset, we demonstrate the effectiveness of our dynamics engineering approach for both pattern matching and profit maximization, and study the multifaceted interplay among several important factors of dynamics engineering, such as solution validity, pattern-matching accuracy, and intervention cost. Finally, the method we propose is general enough to work with multi-dimensional time series, so it can potentially be used in many other applications.

EL FORO SOCIAL MUNDIAL ANTE EL RETO DE LA EMANCIPACIÓN

Directory of Open Access Journals (Sweden)

Raúl Cartaya Fabregat

2012-12-01

Full Text Available The current challenge of initiating processes of emancipation, confronted with the multifaceted capitalist reality extended throughout the globe and the strong depoliticization of our present day societies, appears to be an impossible task. Biopolitics and technologies of control are finding more and more fine-tuned and sophisticated mechanisms to both administrate and depoliticize.The World  Social Forum, which presents itself as a social politicization model, emerged out of the rise in protests and criticisms that during the 90’s were made against despotism and the hegemony of the corporate and financial world. Since the beginning of the 21stCentury, the WSF has proposed the creation of a space for the counter-powers, a place to exchange, reflect and create a counter-hegemonic support network. However, even though the strong point of the Forum is found in its original structure, this appears  to be threatened by its global character, which in turn translates into its weakness.

Data-Driven Engineering of Social Dynamics: Pattern Matching and Profit Maximization.

Directory of Open Access Journals (Sweden)

Huan-Kai Peng

Full Text Available In this paper, we define a new problem related to social media, namely, the data-driven engineering of social dynamics. More precisely, given a set of observations from the past, we aim at finding the best short-term intervention that can lead to predefined long-term outcomes. Toward this end, we propose a general formulation that covers two useful engineering tasks as special cases, namely, pattern matching and profit maximization. By incorporating a deep learning model, we derive a solution using convex relaxation and quadratic-programming transformation. Moreover, we propose a data-driven evaluation method in place of the expensive field experiments. Using a Twitter dataset, we demonstrate the effectiveness of our dynamics engineering approach for both pattern matching and profit maximization, and study the multifaceted interplay among several important factors of dynamics engineering, such as solution validity, pattern-matching accuracy, and intervention cost. Finally, the method we propose is general enough to work with multi-dimensional time series, so it can potentially be used in many other applications.

Data-Driven Engineering of Social Dynamics: Pattern Matching and Profit Maximization

Science.gov (United States)

Peng, Huan-Kai; Lee, Hao-Chih; Pan, Jia-Yu; Marculescu, Radu

2016-01-01

In this paper, we define a new problem related to social media, namely, the data-driven engineering of social dynamics. More precisely, given a set of observations from the past, we aim at finding the best short-term intervention that can lead to predefined long-term outcomes. Toward this end, we propose a general formulation that covers two useful engineering tasks as special cases, namely, pattern matching and profit maximization. By incorporating a deep learning model, we derive a solution using convex relaxation and quadratic-programming transformation. Moreover, we propose a data-driven evaluation method in place of the expensive field experiments. Using a Twitter dataset, we demonstrate the effectiveness of our dynamics engineering approach for both pattern matching and profit maximization, and study the multifaceted interplay among several important factors of dynamics engineering, such as solution validity, pattern-matching accuracy, and intervention cost. Finally, the method we propose is general enough to work with multi-dimensional time series, so it can potentially be used in many other applications. PMID:26771830

The efficacy of Femal in women with premenstrual syndrome: a randomised, double-blind, parallel-group, placebo-controlled, multicentre study

DEFF Research Database (Denmark)

Gerhardsen, G.; Hansen, A.V.; Killi, M.

2008-01-01

Introduction: A double-blind, placebo-controlled, randomised, parallel-group, multicentre study was conducted to evaluate the effect of a pollen-based herbal medicinal product, Femal (R) (Sea-Band Ltd, Leicestershire, UK), on premenstrual sleep disturbances (PSD) in women with premenstrual syndrome...... as the main symptom cluster makes this herbal medicinal product a promising addition to the therapeutic arsenal for women with PMS Udgivelsesdato: 2008/6...

Comparative activity of tigecycline and tetracycline on Gram-negative and Gram-positive bacteria revealed by a multicentre study in four North European countries

DEFF Research Database (Denmark)

Nilsson, Lennart E; Frimodt-Møller, Niels; Vaara, Martti

2011-01-01

This study involves a multicentre surveillance of tigecycline and tetracycline activity against Gram-negative and Gram-positive bacteria from primary care centres (PCCs), general hospital wards (GHWs) and intensive care units (ICUs) in Denmark (n = 9), Finland (n = 10), Norway (n = 7) and Sweden (n...

Non conventional psychiatric rehabilitation in schizophrenia using therapeutic riding: the FISE multicentre Pindar project

Directory of Open Access Journals (Sweden)

Stefania Cerino

2011-12-01

Full Text Available The FISE (Federazione Italiana Sport Equestri Pindar is a multicentre research project aimed at testing the potential effects of therapeutic riding on schizophrenic patients. Twenty-four subjects with a diagnosis of schizophrenia were enrolled for a 1 year-treatment involving therapeutic riding sessions. All subjects were tested at the beginning and at the end of treatment with a series of validated test batteries (BPRS and 8 items-PANSS. The results discussed in this paper point out an improvement in negative symptoms, a constant disease remission in both early onset and chronic disease subjects, as well as a reduced rate of hospitalization.

Video Games as a Multifaceted Medium: A Review of Quantitative Social Science Research on Video Games and a Typology of Video Game Research Approaches

Directory of Open Access Journals (Sweden)

James D. Ivory

2013-01-01

Full Text Available Although there is a vast and useful body of quantitative social science research dealing with the social role and impact of video games, it is difficult to compare studies dealing with various dimensions of video games because they are informed by different perspectives and assumptions, employ different methodologies, and address different problems. Studies focusing on different social dimensions of video games can produce varied findings about games’ social function that are often difficult to reconcile— or even contradictory. Research is also often categorized by topic area, rendering a comprehensive view of video games’ social role across topic areas difficult. This interpretive review presents a novel typology of four identified approaches that categorize much of the quantitative social science video game research conducted to date: “video games as stimulus,” “video games as avocation,” “video games as skill,” and “video games as social environment.” This typology is useful because it provides an organizational structure within which the large and growing number of studies on video games can be categorized, guiding comparisons between studies on different research topics and aiding a more comprehensive understanding of video games’ social role. Categorizing the different approaches to video game research provides a useful heuristic for those critiquing and expanding that research, as well as an understandable entry point for scholars new to video game research. Further, and perhaps more importantly, the typology indicates when topics should be explored using different approaches than usual to shed new light on the topic areas. Lastly, the typology exposes the conceptual disconnects between the different approaches to video game research, allowing researchers to consider new ways to bridge gaps between the different approaches’ strengths and limitations with novel methods.

Italian multicentre study on intrathecal fluorescein for craniosinusal fistulae.

Science.gov (United States)

Felisati, G; Bianchi, A; Lozza, P; Portaleone, S

2008-08-01

derives from frequent reports of complications, often related to the intrathecal administration; such complications are, however, always due to an incorrect dosage. In order to perform correct monitoring of any complication related to the use of intrathecal fluorescein and to investigate in a strictly scientific fashion, the legal problem related to the off label use (intrathecal administration) of an authorised substance, the Authors coordinated an Italian multicentre study aimed at establishig the tolerability of the lumbar intrathecal administration of fluorescein. Aim of the study was to review the literature focusing on CSF leaks, to set up to date diagnostic and therapeutic indications of fluorescein and to report the preliminary results of the Italian multicentre study.

LSD Acutely Impairs Fear Recognition and Enhances Emotional Empathy and Sociality.

Science.gov (United States)

Dolder, Patrick C; Schmid, Yasmin; Müller, Felix; Borgwardt, Stefan; Liechti, Matthias E

2016-10-01

Lysergic acid diethylamide (LSD) is used recreationally and has been evaluated as an adjunct to psychotherapy to treat anxiety in patients with life-threatening illness. LSD is well-known to induce perceptual alterations, but unknown is whether LSD alters emotional processing in ways that can support psychotherapy. We investigated the acute effects of LSD on emotional processing using the Face Emotion Recognition Task (FERT) and Multifaceted Empathy Test (MET). The effects of LSD on social behavior were tested using the Social Value Orientation (SVO) test. Two similar placebo-controlled, double-blind, random-order, crossover studies were conducted using 100 μg LSD in 24 subjects and 200 μg LSD in 16 subjects. All of the subjects were healthy and mostly hallucinogen-naive 25- to 65-year-old volunteers (20 men, 20 women). LSD produced feelings of happiness, trust, closeness to others, enhanced explicit and implicit emotional empathy on the MET, and impaired the recognition of sad and fearful faces on the FERT. LSD enhanced the participants' desire to be with other people and increased their prosocial behavior on the SVO test. These effects of LSD on emotion processing and sociality may be useful for LSD-assisted psychotherapy.

The European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC: experiences from a successful ERS Clinical Research Collaboration

Directory of Open Access Journals (Sweden)

James D. Chalmers

2017-09-01

To understand the role of Clinical Research Collaborations as the major way in which the European Respiratory Society can stimulate clinical research in different disease areas To understand some of the key features of successful disease registries To review key epidemiological, clinical and translational studies of bronchiectasis contributed by the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC project in the past 5 years To understand the key research priorities identified by EMBARC for the next 5 years

Mesenchymal stem cells for the treatment of systemic lupus erythematosus: is the cure for connective tissue diseases within connective tissue?

Science.gov (United States)

Carrion, Flavio A; Figueroa, Fernando E

2011-05-11

Mesenchymal stem cells (MSCs) are now known to display not only adult stem cell multipotency but also robust anti-inflammatory and regenerative properties. After widespread in vitro and in vivo preclinical testing in several autoimmune disease models, allogenic MSCs have been successfully applied in patients with severe treatment-refractory systemic lupus erythematosus. The impressive results of these uncontrolled phase I and II trials - mostly in patients with non-responding renal disease - point to the need to perform controlled multicentric trials. In addition, they suggest that there is much to be learned from the basic and clinical science of MSCs in order to reap the full potential of these multifaceted progenitor cells in the treatment of autoimmune diseases.

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.

Impact of Context-Rich, Multifaceted Problems on Students' Attitudes Towards Problem-Solving

Science.gov (United States)

Ogilvie, Craig

2008-04-01

Young scientists and engineers need strong problem-solving skills to enable them to address the broad challenges they will face in their careers. These challenges will likely be ill-defined and open-ended with either unclear goals, insufficient constraints, multiple possible solutions, and different criteria for evaluating solutions so that our young scientists and engineers must be able to make judgments and defend their proposed solutions. In contrast, many students believe that problem-solving is being able to apply set procedures or algorithms to tasks and that their job as students is to master an ever-increasing list of procedures. This gap between students' beliefs and the broader, deeper approaches of experts is a strong barrier to the educational challenge of preparing students to succeed in their future careers. To start to address this gap, we have used multi-faceted, context-rich problems in a sophomore calculus-based physics course. To assess whether there was any change in students' attitudes or beliefs towards problem-solving, students were asked to reflect on their problem-solving at the beginning and at the end of the semester. These reflections were coded as containing one or more problem-solving ideas. The change in students' beliefs will be shown in this talk.

Multicentric Evaluation of New Commercial Enzyme Immunoassays for the Detection of Immunoglobulin M and Total Antibodies against Hepatitis A Virus▿

Science.gov (United States)

Arcangeletti, M. C.; Dussaix, E.; Ferraglia, F.; Roque-Afonso, A. M.; Graube, A.; Chezzi, C.

2011-01-01

A multicentric clinical study was conducted on representative sera from 1,738 European and U.S. subjects for the evaluation of new anti-hepatitis A virus enzyme immunoassays from Bio-Rad Laboratories. Comparison with reference DiaSorin S.p.A. tests confirmed the good performance of Bio-Rad assays (99.85% and 99.47% overall agreement in detecting total antibodies and IgM, respectively). PMID:21653739

International multicentre randomised controlled trial of improvisational music therapy for children with autism spectrum disorder: TIME-A study.

Science.gov (United States)

Crawford, Mike J; Gold, Christian; Odell-Miller, Helen; Thana, Lavanya; Faber, Sarah; Assmus, Jörg; Bieleninik, Łucja; Geretsegger, Monika; Grant, Claire; Maratos, Anna; Sandford, Stephan; Claringbold, Amy; McConachie, Helen; Maskey, Morag; Mössler, Karin Antonia; Ramchandani, Paul; Hassiotis, Angela

2017-10-01

Preliminary studies have indicated that music therapy may benefit children with autism spectrum disorders (ASD). To examine the effects of improvisational music therapy (IMT) on social affect and responsiveness of children with ASD. International, multicentre, three-arm, single-masked randomised controlled trial, including a National Institute for Health Research (NIHR)-funded centre that recruited in London and the east of England. Randomisation was via a remote service using permuted blocks, stratified by study site. Schools and private, voluntary and state-funded health-care services. Children aged between 4 and 7 years with a confirmed diagnosis of ASD and a parent or guardian who provided written informed consent. We excluded children with serious sensory disorder and those who had received music therapy within the past 12 months. All parents and children received enhanced standard care (ESC), which involved three 60-minute sessions of advice and support in addition to treatment as usual. In addition, they were randomised to either one (low-frequency) or three (high-frequency) sessions of IMT per week, or to ESC alone, over 5 months in a ratio of 1 : 1 : 2. The primary outcome was measured using the social affect score derived from the Autism Diagnostic Observation Schedule (ADOS) at 5 months: higher scores indicated greater impairment. Secondary outcomes included social affect at 12 months and parent-rated social responsiveness at 5 and 12 months (higher scores indicated greater impairment). A total of 364 participants were randomised between 2011 and 2015. A total of 182 children were allocated to IMT (90 to high-frequency sessions and 92 to low-frequency sessions), and 182 were allocated to ESC alone. A total of 314 (86.3%) of the total sample were followed up at 5 months [165 (90.7%) in the intervention group and 149 (81.9%) in the control group]. Among those randomised to IMT, 171 (94.0%) received it. From baseline to 5 months, mean scores of ADOS

Unified analytical treatment of multicentre electron attraction, electric field and electric field gradient integrals over Slater orbitals

International Nuclear Information System (INIS)

Guseinov, I I

2004-01-01

The new central and noncentral potential functions (CPFs and NCPFs) of a molecule depending on the coordinates of the nuclei are introduced. Using complete orthonormal sets of Ψ α -exponential-type orbitals (Ψ α -ETOs) introduced by the author, the series expansion formulae for the multicentre electronic attraction (EA), electric field (EF) and electric field gradient (EFG) integrals over Slater-type orbitals (STOs) in terms of CPFs and NCPFs are derived. The relationships obtained are valid for the arbitrary location, quantum numbers and screening constants of STOs

Utilizing Multifaceted Rasch Measurement through Facets to Evaluate Science Education Data Sets Composed of Judges, Respondents, and Rating Scale Items: An Exemplar Utilizing the Elementary Science Teaching Analysis Matrix Instrument

Science.gov (United States)

Boone, William J.; Townsend, J. Scott; Staver, John R.

2016-01-01

When collecting data, science education researchers frequently have multiple respondents evaluate multiple artifacts using multiple criteria. Herein, the authors introduce Multifaceted Rasch Measurement (MFRM) analysis and explain why MFRM must be used when "judges'" data are collected. The authors use data from elementary science…

Measurement of HbA1c in multicentre diabetes trials - should blood samples be tested locally or sent to a central laboratory: an agreement analysis.

Science.gov (United States)

Arch, Barbara N; Blair, Joanne; McKay, Andrew; Gregory, John W; Newland, Paul; Gamble, Carrol

2016-10-24

Glycated haemoglobin (HbA1c) is an important outcome measure in diabetes clinical trials. For multicentre designs, HbA1c can be measured locally at participating centres or by sending blood samples to a central laboratory. This study analyses the agreement between local and central measurements, using 1-year follow-up data collected in a multicentre randomised controlled trial (RCT) of newly diagnosed children with type I diabetes. HbA1c measurements were routinely analysed both locally and centrally at baseline and then at 3, 6, 9 and 12 months and the data reported in mmol/mol. Agreement was assessed by calculating the bias and 95 % limits of agreement, using the Bland-Altman analysis method. A predetermined benchmark for clinically acceptable margin of error between measurements was subjectively set as ±10 % for HbA1c. The percentage of pairs of measurements that were classified as clinically acceptable was calculated. Descriptive statistics were used to examine the agreement within centres. Treatment group was not considered. Five hundred and ninety pairs of measurement, representing 255 children and 15 trial centres across four follow-up time points, were compared. There was no significant bias: local measurements were an average of 0.16 mmol/mol (SD = 4.5, 95 % CI -0.2 to 0.5) higher than central. The 95 % limits of agreement were -8.6 to 9.0 mmol/mol (local minus central). Eighty percent of local measurements were within ±10 % of corresponding central measurements. Some trial centres were more varied in the differences observed between local and central measurements: IQRs ranging from 3 to 9 mmol/mol; none indicated systematic bias. Variation in agreement between HbA1c measurements was greater than had been expected although no overall bias was detected and standard deviations were similar. Discrepancies were present across all participating centres. These findings have implications for the comparison of standards of clinical care between centres

Rationale and design of the BUDAPEST-CRT Upgrade Study: a prospective, randomized, multicentre clinical trial.

Science.gov (United States)

Merkely, Bela; Kosztin, Annamaria; Roka, Attila; Geller, Laszlo; Zima, Endre; Kovacs, Attila; Boros, Andras Mihaly; Klein, Helmut; Wranicz, Jerzy K; Hindricks, Gerhard; Clemens, Marcell; Duray, Gabor Z; Moss, Arthur J; Goldenberg, Ilan; Kutyifa, Valentina

2017-09-01

There is lack of conclusive evidence from randomized clinical trials on the efficacy and safety of upgrade to cardiac resynchronization therapy (CRT) in patients with implanted pacemakers (PM) or defibrillators (ICD) with reduced left ventricular ejection fraction (LVEF) and chronic heart failure (HF). The BUDAPEST-CRT Upgrade Study was designed to compare the efficacy and safety of CRT upgrade from conventional PM or ICD therapy in patients with intermittent or permanent right ventricular (RV) septal/apical pacing, reduced LVEF, and symptomatic HF. The BUDAPEST-CRT study is a prospective, randomized, multicentre, investigator-sponsored clinical trial. A total of 360 subjects will be enrolled with LVEF ≤ 35%, NYHA functional classes II-IVa, paced QRS ≥ 150 ms, and a RV pacing ≥ 20%. Patients will be followed for 12 months. Randomization is performed in a 3:2 ratio (CRT-D vs. ICD). The primary composite endpoint is all-cause mortality, a first HF event, or less than 15% reduction in left ventricular (LV) end-systolic volume at 12 months. Secondary endpoints are all-cause mortality, all-cause mortality or HF event, and LV volume reduction at 12 months. Tertiary endpoints include changes in quality of life, NYHA functional class, 6 min walk test, natriuretic peptides, and safety outcomes. The results of our prospective, randomized, multicentre clinical trial will provide important information on the role of cardiac resynchronization therapy with defibrillator (CRT-D) upgrade in patients with symptomatic HF, reduced LVEF, and wide-paced QRS with intermittent or permanent RV pacing. NCT02270840. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Cardiology.

Prophylactic efficacy of lithium administered every second day: a WHO multicentre study

DEFF Research Database (Denmark)

Plenge, P; Amin, M; Agarwal, A K

1999-01-01

OBJECTIVES: To study the prophylactic efficacy of lithium administered every second day to patients with bipolar disorder or recurrent unipolar depressive disorder. METHODS: The study was carried out as a WHO multicentre study in five different psychiatric clinics: Russia (Moscow), Canada (Montreal......), India (Lucknow), Germany (Munich) and South Korea (Pusan), with the lithium tablets being supplied from Denmark (Copenhagen). Participation in the study was conditional on the patient having been in prophylactic lithium treatment for the preceding 2-year period and having been free of depressive...... of bipolar disorder and five with a diagnosis of recurrent unipolar depressive disorder, participated in the study. The number of patients from each centre ranged from six to 11. The mean lithium dose every second day was 36 mmol lithium, leading to a mean 12-h standard serum lithium concentration during...

MEVA--An Interactive Visualization Application for Validation of Multifaceted Meteorological Data with Multiple 3D Devices.

Directory of Open Access Journals (Sweden)

Carolin Helbig

Full Text Available To achieve more realistic simulations, meteorologists develop and use models with increasing spatial and temporal resolution. The analyzing, comparing, and visualizing of resulting simulations becomes more and more challenging due to the growing amounts and multifaceted character of the data. Various data sources, numerous variables and multiple simulations lead to a complex database. Although a variety of software exists suited for the visualization of meteorological data, none of them fulfills all of the typical domain-specific requirements: support for quasi-standard data formats and different grid types, standard visualization techniques for scalar and vector data, visualization of the context (e.g., topography and other static data, support for multiple presentation devices used in modern sciences (e.g., virtual reality, a user-friendly interface, and suitability for cooperative work.Instead of attempting to develop yet another new visualization system to fulfill all possible needs in this application domain, our approach is to provide a flexible workflow that combines different existing state-of-the-art visualization software components in order to hide the complexity of 3D data visualization tools from the end user. To complete the workflow and to enable the domain scientists to interactively visualize their data without advanced skills in 3D visualization systems, we developed a lightweight custom visualization application (MEVA - multifaceted environmental data visualization application that supports the most relevant visualization and interaction techniques and can be easily deployed. Specifically, our workflow combines a variety of different data abstraction methods provided by a state-of-the-art 3D visualization application with the interaction and presentation features of a computer-games engine. Our customized application includes solutions for the analysis of multirun data, specifically with respect to data uncertainty and

Getting evidence-based pressure ulcer prevention into practice: a process evaluation of a multifaceted intervention in a hospital setting.

Science.gov (United States)

Sving, Eva; Fredriksson, Lennart; Gunningberg, Lena; Mamhidir, Anna-Greta

2017-10-01

To describe registered nurses', assistant nurses' and first-line managers' experiences and perceptions of a multifaceted hospital setting intervention focused on implementing evidence-based pressure ulcer prevention. Pressure ulcer prevention is deficient. Different models exist to support implementation of evidence-based care. Little is known about implementation processes. A descriptive qualitative approach. Five focus-group nurse interviews and five individual first-line manager interviews were conducted at five Swedish hospital units. Qualitative content analysis was used. The findings support that the intervention and the implementation process changed the understanding and way of working with pressure ulcer prevention: from treating to preventing. This became possible as 'Changed understanding enables changed actions - through one's own performance and reflection on pressure ulcer prevention'. Having a common outlook on pressure ulcer prevention, easy access to pressure-reducing equipment, and external and internal facilitator support were described as important factors for changed practices. Bedside support, feedback and discussions on current results increased the awareness of needed improvements. The multifaceted intervention approach and the participants' positive attitudes seemed to be crucial for changing understanding and working more preventatively. The strategies used and the skills of the facilitators need to be tailored to the problems surrounding the context. Feedback discussions among the staff regarding the results of the care provided also appear to be vital. It is crucial that dedicated facilitators are involved to promote the implementation process. A preventative mindset should be strived for. Creating an implementation plan with an outcome and a process evaluation should be emphasised. It is important to give the staff regular feedback on the quality of care and on those occasions allocate time for discussion and reflection. © 2016 John

Questing for circadian dependence in ST-segment-elevation acute myocardial infarction: A multicentric and multiethnic study

KAUST Repository

Ammirati, Enrico

2013-05-09

Rationale: Four monocentric studies reported that circadian rhythms can affect left ventricular infarct size after ST-segment-elevation acute myocardial infarction (STEMI). Objective: To further validate the circadian dependence of infarct size after STEMI in a multicentric and multiethnic population. Methods and Results: We analyzed a prospective cohort of subjects with first STEMI from the First Acute Myocardial Infarction study that enrolled 1099 patients (ischemic time <6 hours) in Italy, Scotland, and China. We confirmed a circadian variation of STEMI incidence with an increased morning incidence (from 6:00 am till noon). We investigated the presence of circadian dependence of infarct size plotting the peak creatine kinase against time onset of ischemia. In addition, we studied the patients from the 3 countries separately, including 624 Italians; all patients were treated with percutaneous coronary intervention. We adopted several levels of analysis with different inclusion criteria consistent with previous studies. In all the analyses, we did not find a clear-cut circadian dependence of infarct size after STEMI. Conclusions: Although the circadian dependence of infarct size supported by previous studies poses an intriguing hypothesis, we were unable to converge toward their conclusions in a multicentric and multiethnic setting. Parameters that vary as a function of latitude could potentially obscure the circadian variations observed in monocentric studies. We believe that, to assess whether circadian rhythms can affect the infarct size, future study design should not only include larger samples but also aim to untangle the molecular time-dynamic mechanisms underlying such a relation. © 2013 American Heart Association, Inc.

The mental representation of social connections: generalizability extended to Beijing adults.

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Louise C Hawkley

Full Text Available Social connections are essential for the survival of a social species like humans. People differ in the degree to which they are sensitive to perceived deficits in their social connections, but evidence suggests that they nevertheless construe the nature of their social connections similarly. This construal can be thought of as a mental representation of a multi-faceted social experience. A three-dimensional mental representation has been identified with the UCLA Loneliness Scale and consists of Intimate, Relational, and Collective Connectedness reflecting beliefs about one's individual, dyadic, and collective (group social value, respectively. Moreover, this mental representation has been replicated with other scales and validated across age, gender, and racial/ethnic lines in U.S. samples. The purpose of this study is to evaluate the extent to which this three-dimensional representation applies to people whose social lives are experienced in a collectivistic rather than individualistic culture. To that end, we used confirmatory factor analyses to assess the fit of the three-dimensional mental structure to data collected from Chinese people living in China. Two hundred sixty-seven young adults (16-25 yrs and 250 older adults (50-65 yrs in Beijing completed the revised UCLA Loneliness Scale and demographic and social activity questionnaires. Results revealed adequate fit of the structure to data from young and older Chinese adults. Moreover, the structure exhibited equivalent fit in young and older Chinese adults despite changes in the Chinese culture that exposed these two generations to different cultural experiences. Social activity variables that discriminated among the three dimensions in the Chinese samples corresponded well with variables that discriminated among the three dimensions in the U.S.-based samples, indicating cultural commonalities in the factors predicting dimensions of people's representations of their social connections

The mental representation of social connections: generalizability extended to Beijing adults.

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Hawkley, Louise C; Gu, Yuanyuan; Luo, Yue-Jia; Cacioppo, John T

2012-01-01

Social connections are essential for the survival of a social species like humans. People differ in the degree to which they are sensitive to perceived deficits in their social connections, but evidence suggests that they nevertheless construe the nature of their social connections similarly. This construal can be thought of as a mental representation of a multi-faceted social experience. A three-dimensional mental representation has been identified with the UCLA Loneliness Scale and consists of Intimate, Relational, and Collective Connectedness reflecting beliefs about one's individual, dyadic, and collective (group) social value, respectively. Moreover, this mental representation has been replicated with other scales and validated across age, gender, and racial/ethnic lines in U.S. samples. The purpose of this study is to evaluate the extent to which this three-dimensional representation applies to people whose social lives are experienced in a collectivistic rather than individualistic culture. To that end, we used confirmatory factor analyses to assess the fit of the three-dimensional mental structure to data collected from Chinese people living in China. Two hundred sixty-seven young adults (16-25 yrs) and 250 older adults (50-65 yrs) in Beijing completed the revised UCLA Loneliness Scale and demographic and social activity questionnaires. Results revealed adequate fit of the structure to data from young and older Chinese adults. Moreover, the structure exhibited equivalent fit in young and older Chinese adults despite changes in the Chinese culture that exposed these two generations to different cultural experiences. Social activity variables that discriminated among the three dimensions in the Chinese samples corresponded well with variables that discriminated among the three dimensions in the U.S.-based samples, indicating cultural commonalities in the factors predicting dimensions of people's representations of their social connections. Equivalence of the

Catholic social teaching and America's suboptimal breastfeeding rate: Where faith and policy should meet to combat injustice.

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Stark, Grace Emily

2017-11-01

Despite the numerous health benefits of breastfeeding, few American women breastfeed for the optimal duration of time. Reasons given for not following national and global institutional breastfeeding recommendations are various and multi-faceted. However, for many American women who would like to breastfeed, unjust historical, social, economic, cultural, and environmental factors negatively impact their ability to breastfeed. Catholic social teaching seeks to protect the poor and the vulnerable by working for social and economic justice, encourages stewardship of the environment, and uplifts the family as the most important unit in society. As such, Catholic social teaching has clear implications for individuals and institutions seeking to make breastfeeding a more widespread, accepted practice. In response to the crisis in American rates of breastfeeding, American Catholic healthcare institutions should work to promote the just economic and social conditions necessary for American women to breastfeed their children, starting by implementing breastfeeding-friendly policies for patients and employees in their own institutions. For many American women who would like to breastfeed, unjust historical, social, economic, cultural, and environmental factors negatively impact their ability to breastfeed. Catholic social teaching has clear implications for individuals and institutions seeking to make breastfeeding a more widespread, accepted practice. Therefore, American Catholic healthcare institutions should work particularly hard to promote the just economic and social conditions necessary for American women to breastfeed their children, starting by implementing breastfeeding-friendly policies for patients and employees in their own institutions.

Danazol treatment of benign breast disease: a survey of U.S.A. multi-centre studies.

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Brookshaw, J D

1979-01-01

514 patients with benign breast disease provided records from multicentre studies in the U.S.A. Results showed that a high proportion responded with either decrease or elimination of symptoms, response usually being apparent 15 to 45 days after commencing treatment. Dosage schedules varied between 50 and 400 mg danazol daily and length of treatment between 15 and 196 days. There was a tendency for patients with more severe symptoms to respond better to the higher dosages, and for the elimination rate for all grades of severity to improve with time. Side effects were not severe, and of the expected type including weight gain, oiliness of skin and hair, and acne.

Possible Association of Multicentric Castleman's Disease with Autoimmune Lymphoproliferative Syndrome

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Hiroyuki Minemura

2018-04-01

Full Text Available Multicentric Castleman's disease (MCD is lymphoproliferative disorder characterized by systemic inflammatory symptoms such as fever and weight loss. Human herpes virus-8 (HHV-8 is thought to be a causable pathogen in all HIV-positive and some HIV-negative MCD patients. Furthermore, the term idiopathic MCD (iMCD was recently proposed to represent a group of HIV-negative and HHV-8-negative patients with unknown etiologies. Although the international diagnostic criteria for iMCD require exclusion of infection-related disorders, autoimmune/autoinflammatory diseases and malignant/lymphoproliferative disorders to make an iMCD diagnosis, the relationships and differences between these disorders and MCD have not yet been clarified. We recently reported the first case of MCD with autoimmune lymphoproliferative syndrome (ALPS. Although ALPS was included in the iMCD exclusion criteria as an autoimmune/autoinflammatory disease according to the international diagnostic criteria, there is a lack of evidence on the association between MCD and ALPS. In this study, we review the recent understanding of MCD and discuss the possible association between MCD with ALPS.

The effectiveness of 2-implant overdentures - a pragmatic international multicentre study.

LENUS (Irish Health Repository)

Rashid, F

2011-03-01

The purpose of this multicentre observational study was to determine patient satisfaction with either conventional dentures or mandibular 2-implant overdentures in a \\'real world\\' setting. Two hundred and three edentulous patients (mean age 68·8 ± 10·4 years) were recruited at eight centres located in North America, South America and Europe. The patients were provided with new mandibular conventional dentures or implant overdentures supported by two implants and ball attachments. At baseline and at 6 months post-treatment, they rated their satisfaction with their mandibular prostheses on 100-mm visual analogue scale questionnaires. One hundred and two (50·2%) participants had valid baseline and 6-month satisfaction data. Although both groups reported improvements, the implant overdenture group reported significantly higher ratings of overall satisfaction, comfort, stability, ability to speak and ability to chew. These results suggest that edentulous patients who choose mandibular implant overdentures have significantly greater improvements in satisfaction, despite their relatively higher cost, than those who choose new conventional dentures.

Using multifaceted education to improve management in acute viral bronchiolitis.

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Murch, Hannah; Oakley, Juliette; Pierrepoint, Marcus; Powell, Colin

2015-07-01

To establish current bronchiolitis management across hospitals in Wales, improve compliance with national guidelines and standardise evidence-based clinical practice. A complete audit cycle with implementation of a multifaceted education bundle prior to the follow-up audit. Twelve acute paediatric departments between 1 November and 31 December in 2012 and 2013. All infants under 12 months with a clinical diagnosis of bronchiolitis. The first audit assessed management of bronchiolitis with reference to both the Scottish Intercollegiate Guideline Network (SIGN) guidelines and local hospital guidelines. Following analysis and dissemination of these results, an education bundle was implemented nationwide, with completion of the audit cycle to assess change. Compliance with SIGN recommendations for investigation, treatment and discharge. Compliance with the education bundle requirements also assessed in 2013. Data were collected for 1599 infants. The education bundle was delivered in all hospitals. The level of severity, defined by oxygen saturations in air at presentation, length of stay and paediatric intensive care unit transfers, was equivalent for both years. Mean compliance percentage (95% CI) across Wales significantly improved between 2012 and 2013, with compliance with investigations increasing from 50% (46% to 53%) to 71% (68% to 74%), with management increasing from 65% (61% to 68%) to 74% (71% to 77%), and overall compliance improving from 38% (37% to 39%) to 59% (56% to 62%) in 2013. This audit demonstrated a significant improvement in compliance following implementation of our educational bundle. This has enabled improvement in standardised and evidence-based patient care across Wales. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Cost-effectiveness of a multifaceted implementation strategy for the Dutch multidisciplinary guideline for nonspecific low back pain: design of a stepped-wedge cluster randomised controlled trial.

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Suman, Arnela; Schaafsma, Frederieke G; Elders, Petra J M; van Tulder, Maurits W; Anema, Johannes R

2015-05-31

Low back pain (LBP) is one of the most prevalent and expensive health care problems in industrialised countries. LBP leads to high health care utility and productivity losses; leaving the individual, the employer, and society with substantial costs. To improve the care for LBP patients and reduce the high societal and financial burden of LBP, in 2010 the 'Multidisciplinary care guideline for nonspecific low back pain' was developed in the Netherlands. The current paper describes the design of a study aiming to evaluate the (cost-) effectiveness of a multifaceted strategy to implement this guideline. In a cluster-randomised controlled trial, the (cost-) effectiveness of a multifaceted implementation strategy will be compared to passive guideline dissemination. Using a stepped-wedge approach, participating general practitioners, physiotherapists, and occupational physicians are allocated into clusters and will attend a multidisciplinary continuing medical education training session. The timing these clusters receive the training is the unit of randomisation. LBP patients visiting the participating health care providers are invited to participate in the trial and will receive access to a multimedia intervention aimed at improving beliefs, cognitions, and self-management. The primary outcome measure of this study is patient back beliefs. Secondary outcome measures on patient level include pain, functional status, quality of life, health care utility, and productivity losses. Outcome measures on professional level include knowledge and attitude towards the guideline, and guideline adherence. A process evaluation for the implementation strategy will be performed among the health care providers and the patients. Furthermore, a qualitative subgroup analysis among patients with various ethnic backgrounds will be performed. This study will give insight into the (cost-) effectiveness of a multifaceted implementation strategy for the Dutch multidisciplinary guideline for non

Risk as a social phenomenon.

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Jamison, Wesley V

2003-01-01

What do nuclear power, smoking, and eating beef have in common? The answer is multifaceted. They all share aspects of mass production and consumption, and therefore consumer confidence comes into play in evaluating each of the products' merits. They all produce some level of anxiety--be it in response to adverse media coverage, or the successes of adversarial interest groups in publicizing those products' weaknesses--among consumers who wonder what if any level of the product should be consumed. Finally, nuclear power, smoking, and eating beef all share risk; that is, the perceived and real detriments of producing and consuming those products. Whether or not the associated risks--from increased cancer to increased heart disease--are real is beside the point. When talking about risk, scientific education must deal with the perception of risk as much as its reality. Risk is a socially defined phenomenon, and as such, the successful scientists/communicator must understand the social evaluations of it. While many scientists take a rational view of risk evaluation and consumers often make rational decisions about technological and scientific risk based upon the costs and benefits of that technology, this approach is problematic for three reasons. First, the nature of modern risks has changed in that risk is complex, incomprehensible and uncontrollable to the average person. Second, the rational approach assumes that all costs and benefits of a technology, both real and potential, both current and future, can be known and therefore rationally evaluated. This is not the case. Third, evidence from Europe indicates that trust in information sources about risk has fallen, and thus classic scientific education campaigns that rely upon increasing public knowledge and acceptance of technological and scientific risk are problematic. Because of these factors we argue that effective scientific response must begin to understand the social components of risk if campaigns to shape

Social skills programmes for schizophrenia.

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Almerie, Muhammad Qutayba; Okba Al Marhi, Muhammad; Jawoosh, Muhammad; Alsabbagh, Mohamad; Matar, Hosam E; Maayan, Nicola; Bergman, Hanna

2015-06-09

. Global state was measured in one trial by numbers not experiencing a clinical improvement, results favoured social skills (1 RCT, n = 67, RR 0.29 CI 0.12 to 0.68, very low quality evidence). Quality of life was also improved in the social skills programme compared to standard care (1 RCT, n = 112, MD -7.60 CI -12.18 to -3.02, very low quality evidence). However, when social skills programmes were compared to a discussion group control, we found no significant differences in the participants social functioning, relapse rates, mental state or quality of life, again the quality of evidence for these outcomes was very low. Compared to standard care, social skills training may improve the social skills of people with schizophrenia and reduce relapse rates, but at present, the evidence is very limited with data rated as very low quality. When social skills training was compared to discussion there was no difference on patients outcomes. Cultural differences might limit the applicability of the current results, as most reported studies were conducted in China. Whether social skills training can improve social functioning of people with schizophrenia in different settings remains unclear and should be investigated in a large multi-centre randomised controlled trial.

Treatment of bipolar disorder: a complex treatment for a multi-faceted disorder

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Fresno David

2007-10-01

Full Text Available Abstract Background Manic-depression or bipolar disorder (BD is a multi-faceted illness with an inevitably complex treatment. Methods This article summarizes the current status of our knowledge and practice of its treatment. Results It is widely accepted that lithium is moderately useful during all phases of bipolar illness and it might possess a specific effectiveness on suicidal prevention. Both first and second generation antipsychotics are widely used and the FDA has approved olanzapine, risperidone, quetiapine, ziprasidone and aripiprazole for the treatment of acute mania. These could also be useful in the treatment of bipolar depression, but only limited data exists so far to support the use of quetiapine monotherapy or the olanzapine-fluoxetine combination. Some, but not all, anticonvulsants possess a broad spectrum of effectiveness, including mixed dysphoric and rapid-cycling forms. Lamotrigine may be effective in the treatment of depression but not mania. Antidepressant use is controversial. Guidelines suggest their cautious use in combination with an antimanic agent, because they are supposed to induce switching to mania or hypomania, mixed episodes and rapid cycling. Conclusion The first-line psychosocial intervention in BD is psychoeducation, followed by cognitive-behavioral therapy. Other treatment options include Electroconvulsive therapy and transcranial magnetic stimulation. There is a gap between the evidence base, which comes mostly from monotherapy trials, and clinical practice, where complex treatment regimens are the rule.

The Fort McMurray Demonstration Project in Social Marketing: theory, design, and evaluation.

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Guidotti, T L; Ford, L; Wheeler, M

2000-02-01

The Fort McMurray Demonstration Project in Social Marketing is a multifaceted program that applies the techniques of social marketing to health and safety. This paper describes the origins of the project and the principles on which it was based. VENUE: Fort McMurray, in the province of Alberta, Canada, was selected because the community had several community initiatives already underway and the project had the opportunity to demonstrate "value added." The project is distinguished from others by a model that attempts to achieve mutually reinforcing effects from social marketing in the community as a whole and from workplace safety promotion in particular. Specific interventions sponsored by the project include a media campaign on cable television, public activities in local schools, a community safety audit, and media appearance by a mascot that provides visual identity to the project, a dinosaur named "Safetysaurus." The project integrated its activities with other community initiatives. The evaluation component emphasizes outcome measures. A final evaluation based on injury rates and attitudinal surveys is underway. Baseline data from the first round of surveys have been compiled and published. In 1995, Fort McMurray became the first city in North America to be given membership in the World Health Organization's Safe Community Network.

Social capital and frequent attenders in general practice: a register-based cohort study.

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Pasgaard, Alexander A; Mæhlisen, Maiken H; Overgaard, Charlotte; Ejlskov, Linda; Torp-Pedersen, Christian; Bøggild, Henrik

2018-03-02

Frequent attendance to primary care constitutes a large use of resources for the health care system. The association between frequent attendance and illness-related factors has been examined in several studies, but little is known about the association between frequent attendance and individual social capital. The aim of this study is to explore this association. The analysis is conducted on responders to the North Denmark Region Health Profile 2010 (n = 23,384), individually linked with information from administrative registers. Social capital is operationalized at the individual level, and includes cognitive (interpersonal trust and norms of reciprocity) as well as structural (social network and civic engagement) dimensions. Frequent attendance is defined as the upper-quartile of the total number of measured consultations with a general practitioner over a period of 148 weeks. Using multiple logistic regression, we found that frequent attendance was associated with a lower score in interpersonal trust [OR 0.86 (0.79-0.94)] and social network [OR 0.88 (0.79-0.98)] for women, when adjusted for age, education, income and SF12 health scores. Norms of reciprocity and civic engagement were not significantly associated with frequent attendance for women [OR 1.05 (0.99-1.11) and OR 1.01 (0.92-1.11) respectively]. None of the associations were statistically significant for men. This study suggests that for women, some aspects of social capital are associated with frequent attendance in general practice, and the statistically significant dimensions belonged to both cognitive and structural aspects of social capital. This association was not seen for men. This indicates a multifaceted and heterogeneous relationship between social capital and frequent attendance among genders.

Effects of Peers and Social Environment on Adolescent Psychological Well-Being

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Andrew J. Hussey

2013-07-01

Full Text Available We use data from Add Health to estimate models of peer effects and effects of social environment on adolescent psychological well-being. Past literature has focused mostly on the role of peers on adolescents, notably on schooling (GPA, high school graduation, etc. and risk behavioral (smoking, drinking, drug use, etc. outcomes. Our study’s core innovation lies in the conceptual testing of the hypothesis that an enlarged adolescent social environment encompasses support from peers, school, parents, and the neighborhood. In this paper, we isolate the effects of each of these groups on adolescent psychological well-being and find significant effects of support from schools and parents. However, peer effects are insignificant except for the baseline Ordinary Least Squares (OLS model. Separate models for males and females and different age groups are also estimated and similar results are found, although the effects are greatest during late adolescence. Given the likely endogeneity of peer group formation, we also use an instrumental variables (IV approach. The IV results indicate that peer effects are not statistically significant, but otherwise mimic OLS estimates, supporting the presence of a multi-faceted social network influencing adolescent health. These results, reinforced by further statistical testing, suggest that past work limiting influence on adolescent behavior or outcome to only the peers tends to be incomplete.

A comparison of functional outcome in patients sustaining major trauma: a multicentre, prospective, international study.

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Timothy H Rainer

Full Text Available OBJECTIVES: To compare 6 month and 12 month health status and functional outcomes between regional major trauma registries in Hong Kong and Victoria, Australia. SUMMARY BACKGROUND DATA: Multicentres from trauma registries in Hong Kong and the Victorian State Trauma Registry (VSTR. METHODS: Multicentre, prospective cohort study. Major trauma patients and aged ≥18 years were included. The main outcome measures were Extended Glasgow Outcome Scale (GOSE functional outcome and risk-adjusted Short-Form 12 (SF-12 health status at 6 and 12 months after injury. RESULTS: 261 cases from Hong Kong and 1955 cases from VSTR were included. Adjusting for age, sex, ISS, comorbid status, injury mechanism and GCS group, the odds of a better functional outcome for Hong Kong patients relative to Victorian patients at six months was 0.88 (95% CI: 0.66, 1.17, and at 12 months was 0.83 (95% CI: 0.60, 1.12. Adjusting for age, gender, ISS, GCS, injury mechanism and comorbid status, Hong Kong patients demonstrated comparable mean PCS-12 scores at 6-months (adjusted mean difference: 1.2, 95% CI: -1.2, 3.6 and 12-months (adjusted mean difference: -0.4, 95% CI: -3.2, 2.4 compared to Victorian patients. Keeping age, gender, ISS, GCS, injury mechanism and comorbid status, there was no difference in the MCS-12 scores of Hong Kong patients compared to Victorian patients at 6-months (adjusted mean difference: 0.4, 95% CI: -2.1, 2.8 or 12-months (adjusted mean difference: 1.8, 95% CI: -0.8, 4.5. CONCLUSION: The unadjusted analyses showed better outcomes for Victorian cases compared to Hong Kong but after adjusting for key confounders, there was no difference in 6-month or 12-month functional outcomes between the jurisdictions.

A Comparison of Functional Outcome in Patients Sustaining Major Trauma: A Multicentre, Prospective, International Study

Science.gov (United States)

Rainer, Timothy H.; Yeung, Hiu Hung; Gabbe, Belinda J.; Yuen, Kai Y.; Ho, Hiu F.; Kam, Chak W.; Chang, Annice; Poon, Wai S.; Cameron, Peter A.; Graham, Colin A.

2014-01-01

Objectives To compare 6 month and 12 month health status and functional outcomes between regional major trauma registries in Hong Kong and Victoria, Australia. Summary Background Data Multicentres from trauma registries in Hong Kong and the Victorian State Trauma Registry (VSTR). Methods Multicentre, prospective cohort study. Major trauma patients and aged ≥18 years were included. The main outcome measures were Extended Glasgow Outcome Scale (GOSE) functional outcome and risk-adjusted Short-Form 12 (SF-12) health status at 6 and 12 months after injury. Results 261 cases from Hong Kong and 1955 cases from VSTR were included. Adjusting for age, sex, ISS, comorbid status, injury mechanism and GCS group, the odds of a better functional outcome for Hong Kong patients relative to Victorian patients at six months was 0.88 (95% CI: 0.66, 1.17), and at 12 months was 0.83 (95% CI: 0.60, 1.12). Adjusting for age, gender, ISS, GCS, injury mechanism and comorbid status, Hong Kong patients demonstrated comparable mean PCS-12 scores at 6-months (adjusted mean difference: 1.2, 95% CI: −1.2, 3.6) and 12-months (adjusted mean difference: −0.4, 95% CI: −3.2, 2.4) compared to Victorian patients. Keeping age, gender, ISS, GCS, injury mechanism and comorbid status, there was no difference in the MCS-12 scores of Hong Kong patients compared to Victorian patients at 6-months (adjusted mean difference: 0.4, 95% CI: −2.1, 2.8) or 12-months (adjusted mean difference: 1.8, 95% CI: −0.8, 4.5). Conclusion The unadjusted analyses showed better outcomes for Victorian cases compared to Hong Kong but after adjusting for key confounders, there was no difference in 6-month or 12-month functional outcomes between the jurisdictions. PMID:25157522

The multifaceted origin of taurine cattle reflected by the mitochondrial genome.

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Alessandro Achilli

Full Text Available A Neolithic domestication of taurine cattle in the Fertile Crescent from local aurochsen (Bos primigenius is generally accepted, but a genetic contribution from European aurochsen has been proposed. Here we performed a survey of a large number of taurine cattle mitochondrial DNA (mtDNA control regions from numerous European breeds confirming the overall clustering within haplogroups (T1, T2 and T3 of Near Eastern ancestry, but also identifying eight mtDNAs (1.3% that did not fit in haplogroup T. Sequencing of the entire mitochondrial genome showed that four mtDNAs formed a novel branch (haplogroup R which, after the deep bifurcation that gave rise to the taurine and zebuine lineages, constitutes the earliest known split in the mtDNA phylogeny of B. primigenius. The remaining four mtDNAs were members of the recently discovered haplogroup Q. Phylogeographic data indicate that R mtDNAs were derived from female European aurochsen, possibly in the Italian Peninsula, and sporadically included in domestic herds. In contrast, the available data suggest that Q mtDNAs and T subclades were involved in the same Neolithic event of domestication in the Near East. Thus, the existence of novel (and rare taurine haplogroups highlights a multifaceted genetic legacy from distinct B. primigenius populations. Taking into account that the maternally transmitted mtDNA tends to underestimate the extent of gene flow from European aurochsen, the detection of the R mtDNAs in autochthonous breeds, some of which are endangered, identifies an unexpected reservoir of genetic variation that should be carefully preserved.

Comparison of manual and semi-automatic measuring techniques in MSCT scans of patients with lymphoma: a multicentre study

Energy Technology Data Exchange (ETDEWEB)

Hoeink, A.J.; Wessling, J.; Schuelke, C.; Kohlhase, N.; Wassenaar, L.; Heindel, W.; Buerke, B. [University Hospital Muenster, Department of Clinical Radiology, Muenster (Germany); Koch, R. [University of Muenster, Institute of Biostatistics and Clinical Research (IBKF), Muenster (Germany); Mesters, R.M. [University Hospital Muenster, Department of Haematology and Oncology, Muenster (Germany); D' Anastasi, M.; Graser, A.; Karpitschka, M. [University Hospital Muenchen (LMU), Institute of Clinical Radiology, Muenchen (Germany); Fabel, M.; Wulff, A. [University Hospital Kiel, Department of Clinical Radiology, Kiel (Germany); Pinto dos Santos, D. [University Hospital Mainz, Department of Diagnostic and Interventional Radiology, Mainz (Germany); Kiessling, A. [University Hospital Marburg, Department of Diagnostic and Interventional Radiology, Marburg (Germany); Dicken, V.; Bornemann, L. [Institute of Medical Imaging Computing, Fraunhofer MeVis, Bremen (Germany)

2014-11-15

Multicentre evaluation of the precision of semi-automatic 2D/3D measurements in comparison to manual, linear measurements of lymph nodes regarding their inter-observer variability in multi-slice CT (MSCT) of patients with lymphoma. MSCT data of 63 patients were interpreted before and after chemotherapy by one/tworadiologists in five university hospitals. In 307 lymph nodes, short (SAD)/long (LAD) axis diameter and WHO area were determined manually and semi-automatically. Volume was solely calculated semi-automatically. To determine the precision of the individual parameters, a mean was calculated for every lymph node/parameter. Deviation of the measured parameters from this mean was evaluated separately. Statistical analysis entailed intraclass correlation coefficients (ICC) and Kruskal-Wallis tests. Median relative deviations of semi-automatic parameters were smaller than deviations of manually assessed parameters, e.g. semi-automatic SAD 5.3 vs. manual 6.5 %. Median variations among different study sites were smaller if the measurement was conducted semi-automatically, e. g. manual LAD 5.7/4.2 % vs. semi-automatic 3.4/3.4 %. Semi-automatic volumetry was superior to the other parameters (2.8 %). Semi-automatic determination of different lymph node parameters is (compared to manually assessed parameters) associated with a slightly greater precision and a marginally lower inter-observer variability. These results are with regard to the increasing mobility of patients among different medical centres and in relation to the quality management of multicentre trials of importance. (orig.)

Developing, implementing, and evaluating a multifaceted quality improvement intervention to promote sleep in an ICU.

Science.gov (United States)

Kamdar, Biren B; Yang, Jessica; King, Lauren M; Neufeld, Karin J; Bienvenu, O Joseph; Rowden, Annette M; Brower, Roy G; Collop, Nancy A; Needham, Dale M

2014-01-01

Critically ill patients commonly experience poor sleep quality in the intensive care unit (ICU) because of various modifiable factors. To address this issue, an ICU-wide, multifaceted quality improvement (QI) project was undertaken to promote sleep in the Johns Hopkins Hospital Medical ICU (MICU). To supplement previously published results of this QI intervention, the present article describes the specific QI framework used to develop and implement this intervention, which consists of 4 steps: (a) summarizing the evidence to create a list of sleep-promoting interventions, (b) identifying and addressing local barriers to implementation, (c) selecting performance measures to assess intervention adherence and patient outcomes, and (d) ensuring that all patients receive the interventions through staff engagement and education and regular project evaluation. Measures of performance included daily completion rates of daytime and nighttime sleep improvement checklists and completion rates of individual interventions. Although long-term adherence and sustainability pose ongoing challenges, this model provides a foundation for future ICU sleep promotion initiatives. © 2013 by the American College of Medical Quality.

On the theory of improved confinement due to stationary multifaceted asymmetric radiation from the edge

International Nuclear Information System (INIS)

Herrera, J.J.E.

2002-01-01

Multifaceted asymmetric radiation from the edge (MARFE's) are toroidally symmetric and poloidally asymmetric radiation bands that occur in tokamaks as a result of a thermal instability, originated by radiation losses. It was observed in TFTR and TEXTOR that they formed as density was increased, and impurities concentrated on the edge. Under certain circumstances, they could evolve into weakly poloidal symmetric structures that cooled the edge of the plasma to a few tens of eV, thus leading to detachment from the limiter. Although non-stationary MARFE's are often precursors of disruptions, the use of a stochastic divertor in TORE-SUPRA, and of feedback controlled gas-puff in HT-7 have proved the existence of stationary MARFE's. Their appearance has been found to depend strongly on the impurity content of the plasma. They trigger internal transport barriers, observed in the electron temperature profiles. The purpose of this work is: to take into account the edge control in order to understand the sustainment of stationary MARFE's, and to propose non-local mechanisms that can explain the formation of internal transport barriers. (author)

On the theory of improved confinement due to stationary multifaceted asymmetric radiation from the edge

International Nuclear Information System (INIS)

Herrera, J.J.E.; Martinell, J.J.; Morozov, D.Kh.

2003-01-01

Multifaceted asymmetric radiation from the edge (MARFE's) are toroidally symmetric and poloidally asymmetric radiation bands that occur in tokamaks as a result of a thermal instability, originated by radiation losses. It was observed in TFfR and TEXTOR that they formed as density was increased, and impurities concentrated on the edge. Under certain circumstances, they could evolve into weakly poloidal symmetric structures that cooled the edge of the plasma to a few tens of eV, thus leading to detachment from the limiter. Although non-stationary MARFE's are often precursors of disruptions, the use of a stochastic divertor in TORESUPRA, and of feedback controlled gas-puff in HT- 7 have proved the existence of stationary MARFE' s. Their appearance has been found to depend strongly on the impurity content of the plasma. They trigger internal transport barriers, observed in the electron temperature profiles. The purpose of this work is to review the evidence of the existence of stationary MARFEs, and whether they can actually lead to improved confinement regimes, through non-local mechanisms. (author)

The European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC): experiences from a successful ERS Clinical Research Collaboration.

Science.gov (United States)

Chalmers, James D; Crichton, Megan; Goeminne, Pieter C; Loebinger, Michael R; Haworth, Charles; Almagro, Marta; Vendrell, Montse; De Soyza, Anthony; Dhar, Raja; Morgan, Lucy; Blasi, Francesco; Aliberti, Stefano; Boyd, Jeanette; Polverino, Eva

2017-09-01

In contrast to airway diseases like chronic obstructive pulmonary disease or asthma, and rare diseases such as cystic fibrosis, there has been little research and few clinical trials in bronchiectasis. Guidelines are primarily based on expert opinion and treatment is challenging because of the heterogeneous nature of the disease. In an effort to address decades of underinvestment in bronchiectasis research, education and clinical care, the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) was established in 2012 as a collaborative pan-European network to bring together bronchiectasis researchers. The European Respiratory Society officially funded EMBARC in 2013 as a Clinical Research Collaboration, providing support and infrastructure to allow the project to grow. EMBARC has now established an international bronchiectasis registry that is active in more than 30 countries both within and outside Europe. Beyond the registry, the network participates in designing and facilitating clinical trials, has set international research priorities, promotes education and has participated in producing the first international bronchiectasis guidelines. This manuscript article the development, structure and achievements of EMBARC from 2012 to 2017. To understand the role of Clinical Research Collaborations as the major way in which the European Respiratory Society can stimulate clinical research in different disease areasTo understand some of the key features of successful disease registriesTo review key epidemiological, clinical and translational studies of bronchiectasis contributed by the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) project in the past 5 yearsTo understand the key research priorities identified by EMBARC for the next 5 years.

Erectile dysfunction and quality of life in men receiving methadone or buprenorphine maintenance treatment. A cross-sectional multicentre study.

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Fabio Lugoboni

Full Text Available Erectile dysfunction (ED is common among men on opioid replacement therapy (ORT, but most previous studies exploring its prevalence and determinants yielded contrasting findings. Moreover, the impact of ED on patients' quality of life (QoL has been seldom explored.To explore the prevalence and determinants of ED in men on ORT, and the impact on QoL.In a multicentre cross-sectional study, we recruited 797 consecutive male patients on methadone and buprenorphine treatment, collected data on demographic, clinical, and psychopathological factors, and explored their role as predictors of ED and QoL through univariate and multivariate analysis. ED severity was assessed with a self-assessment questionnaire.Nearly half of patients in our sample were sexually inactive or reported some degree of ED. Some demographic, clinical and psychopathological variables significantly differed according to the presence or absence of ED. Multivariate regression analysis indicated that age, employment, smoke, psychoactive drugs, opioid maintenance dosage, and severity of psychopathological factors significantly influenced the risk and severity of ED. QoL was worse in patients with ED and significantly correlated with ED severity. Age, education, employment, opioid maintenance dosage, ED score, and severity of psychopathology significantly influenced QoL in the multivariate analysis.ED complaints can be explored in male opioid users on ORT through a simple and quick self-assessment tool. ED may have important effects on emotional and social well-being, and may affect outcome.

The construction of the Øresund link between Denmark and Sweden: the effect of a multi-faceted safety campaign

DEFF Research Database (Denmark)

Kines, Peter; Spangenberg, S.; Mikkelsen, K.L.

2002-01-01

The purpose of the present study was to evaluate the effect of a safety campaign implemented midway during the construction of the railway and road link across the Sound, Oresund, between Denmark and Sweden. The safety campaign was multi-faceted and aimed both at promoting positive attitudes...... of type of work before and after the campaign was taken into account. The modest effect of the safety campaign might be explained by the fact that the site, like any construction site, was a temporary workplace, where several contractors' had short-term project assignments. Apparently, the contractors...... working routines were not sufficiently affected by the safety campaign. Other factors, that might affect a safety campaign at a construction site, are discussed. (C) 2002 Elsevier Science Ltd. All rights reserved....

The Reciprocal Relationship between Bipolar Disorder and Social Interaction: A Qualitative Investigation.

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Owen, Rebecca; Gooding, Patricia; Dempsey, Robert; Jones, Steven

2017-07-01

Evidence suggests that social support can influence relapse rates, functioning and various clinical outcomes in people with bipolar disorder. Yet 'social support' is a poorly defined construct, and the mechanisms by which it affects illness course in bipolar disorder remain largely unknown. Key aims of this study were to ascertain which facets of social interaction affect mood management in bipolar disorder, and how symptoms of bipolar disorder can influence the level of support received. Semi-structured qualitative interviews were conducted with 20 individuals with bipolar disorder. Questions were designed to elicit: the effects of social interaction upon the management and course of bipolar disorder; and the impact of bipolar disorder upon social relationships. An inductive thematic analysis was used to analyse the data. Empathy and understanding from another person can make it easier to cope with bipolar disorder. Social interaction can also provide opportunities to challenge negative ruminative thoughts and prevent the onset of a major mood episode. The loss of social support, particularly through bereavement, creates a loss of control and can trigger mania or depression. Hypomanic symptoms can facilitate new social connections, whereas disinhibited and risky behaviour exhibited during mania can cause the breakdown of vital relationships. An in-depth clinical formulation of an individual's perceptions of how their illness affects and is affected by social interaction is crucial to understanding psychosocial factors which influence mood management. These results have clear application in interventions which aim to promote improved wellbeing and social functioning in bipolar disorder. Copyright © 2016 John Wiley & Sons, Ltd. The relationship between bipolar-related experiences and social interaction is complex and multi-faceted. Bipolar disorder can damage social relationships and create a loss of social control via extreme mood states, but it can also offer a

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).

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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.

Effects of surgery on ischaemic mitral regurgitation: a prospective multicentre registry (SIMRAM registry)

DEFF Research Database (Denmark)

Lancellotti, P.; Donal, E.; Cosyns, B.

2008-01-01

at rest. Exercise echocardiography may help identify a subset of patients at higher risk of cardiovascular events by revealing the dynamic component of IMR. METHODS: A large prospective, multicentre, non-randomized registry is designed to evaluate the effects of surgery on IMR at rest and on its dynamic......AIMS: Functional ischaemic mitral regurgitation (IMR) is common in patients with ischaemic left ventricular dysfunction undergoing coronary artery bypass surgery. Although the presence of IMR negatively affects prognosis, the additional benefit of valve repair is debated, particularly with mild IMR...... component at exercise (z). SIMRAM will enrol approximately 550 patients with IMR in up to 17 centres with clinical and exercise follow-up for 1 year. Three sets of outcomes will be prospectively assessed and several hypotheses will be tested including determinants of adverse outcome and progressive left...

An international multicentre study on the allergenic activity of air-oxidized R-limonene

DEFF Research Database (Denmark)

Bråred Christensson, Johanna; Andersen, Klaus Ejner; Bruze, Magnus

2013-01-01

Background. Limonene is a common fragrance terpene that, in its pure form, is not allergenic or is a very weak allergen. However, limonene autoxidizes on air exposure, and the oxidation products can cause contact allergy. Oxidized R-limonene has previously been patch tested in multicentre studies......, giving 2-3% positive patch test reactions in consecutive patients. Objectives. To investigate whether oxidized R-limonene 3.0% in petrolatum, with a stable concentration of the main haptens, limonene hydroperoxides (Lim-OOHs), could be a useful tool for the detection of contact allergy...... in an international setting. Methods. Oxidized R-limonene 3.0% (Lim-OOHs 0.33%) pet. was tested in 2900 consecutive dermatitis patients in Denmark, the United Kingdom, Singapore, Spain, Sweden, and Australia. Results. Overall, 5.2% (range 2.3-12.1%) of the patients showed a positive patch test reaction to oxidized R...

SOCIAL FRANCHISING IN CONTEXT OF MARKETING LONG-TERM AND REVERSIBLE CONTRACEPTIVES (LARCS IN UGANDA: ANALYSIS OF PACE SOCIAL FRANCHISE MODEL

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Simon SENSALIRE

2015-02-01

Full Text Available Background: Uganda is TFR is among the world’s highest at six children per woman, and contributes to the rising rate of poverty and maternal and infant mortality across the country. A social franchise model was adopted in Uganda to market and scale up contraceptive prevalence through the private sector. In 2008 PACE launched the Women’s Health Project, a core component of their reproductive health strategy to increase access to and demand for affordable, quality long‐term Family Planning (FP services, through the setup of a network of private healthcare providers, branded as “ProFam” social franchise health facilities. The program expanded and included services aimed to offer and improve reproductive health services, limiting births through increased use of IUDs and implants as well change negative perceptions to FP. Until 2014, this network consisted of 189 private facilities spread out in 56 districts, following a business model of social franchising. Methods: The multifaceted effect of the social franchise intervention under PACE was then measured through a longitudinal cross sectional survey on perceptions towards Long-Term and Reversible Contraceptives (LARCs use among the target population through a cross-sectional studies over two periods. The studies covered 53 districts hosting 194 privately owned health facilities branded Profam. Multi-stage cluster sampling approaches was used to draw a representative sample of women of reproductive age group. However, for Kampala (capital city, given its population size, the catchment area was restricted to a parish/Ward. Findings: There is an evident rise in current use of FP methods among WRA. Availability of LARCs particularly IUCDs significantly increased over the two time periods. Use of FP services among WRA is a socially sanctioned behavior/practice. There was reported increase in social support for FP services. There were high levels of correct knowledge about FP services and

L-Carnitine-supplementation in advanced pancreatic cancer (CARPAN - a randomized multicentre trial

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Kraft Matthias

2012-07-01

Full Text Available Abstract Background Cachexia, a >10% loss of body-weight, is one factor determining the poor prognosis of pancreatic cancer. Deficiency of L-Carnitine has been proposed to cause cancer cachexia. Findings We screened 152 and enrolled 72 patients suffering from advanced pancreatic cancer in a prospective, multi-centre, placebo-controlled, randomized and double-blinded trial to receive oral L-Carnitine (4 g or placebo for 12 weeks. At entry patients reported a mean weight loss of 12 ± 2,5 (SEM kg. During treatment body-mass-index increased by 3,4 ± 1,4% under L-Carnitine and decreased (−1,5 ± 1,4% in controls (p  Conclusion While these data are preliminary and need confirmation they indicate that patients with pancreatic cancer may have a clinically relevant benefit from the inexpensive and well tolerated oral supplementation of L-Carnitine.

Mitochondrial multifaceted dysfunction in schizophrenia; complex I as a possible pathological target.

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Ben-Shachar, Dorit

2017-09-01

Mitochondria are key players in various essential cellular processes beyond being the main energy supplier of the cell. Accordingly, they are involved in neuronal synaptic transmission, neuronal growth and sprouting and consequently neuronal plasticity and connectivity. In addition, mitochondria participate in the modulation of gene transcription and inflammation as well in physiological responses in health and disease. Schizophrenia is currently regarded as a neurodevelopmental disorder associated with impaired immune system, aberrant neuronal differentiation and abnormalities in various neurotransmitter systems mainly the dopaminergic, glutaminergic and GABAergic. Ample evidence has been accumulated over the last decade indicating a multifaceted dysfunction of mitochondria in schizophrenia. Indeed, mitochondrial deficit can be of relevance for the majority of the pathologies observed in this disease. In the present article, we overview specific deficits of the mitochondria in schizophrenia, with a focus on the first complex (complex I) of the mitochondrial electron transport chain (ETC). We argue that complex I, being a major factor in the regulation of mitochondrial ETC, is a possible key modulator of various functions of the mitochondria. We review biochemical, molecular, cellular and functional evidence for mitochondrial impairments and their possible convergence to impact in-vitro neuronal differentiation efficiency in schizophrenia. Mitochondrial function in schizophrenia may advance our knowledge of the disease pathophysiology and open the road for new treatment targets for the benefit of the patients. Copyright © 2016 Elsevier B.V. All rights reserved.

Inherited multicentric osteolysis: case report of three siblings treated with bisphosphonate

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Whitewood Colin

2010-04-01

Full Text Available Abstract Inherited Multicentric Osteolysis (IMO is an uncommon familial condition of idiopathic pathophysiology causing bone osteolysis and dysplasia. These patients present with common rheumatologic complaints of pain, dysfunction and disability, and are often initially misdiagnosed as a chronic rheumatic disease of childhood such as juvenile idiopathic arthritis. We report a case of three siblings diagnosed with IMO. Diagnosis was made during childhood, with each sibling having different manifestations and course of disease. One had a previous history of bilateral hip dysplasia. Two had osteolysis of the foot, distal tibia and femur (lower limb bones, whilst one had osteolysis of the rib and unusual clavicular fractures. Unusually, all siblings appear to experience decreased pain sensation compared to norms. All siblings were treated with bisphosphonates and experienced a rapid improvement in pain symptoms, decreased analgesic requirements. Two had bone mineral density testing performed and both had increases post-bisphosphonate. In all three, there was subjective evidence of stabilisation of bone disease. Testing for matrix metalloproteinase-2 (MMP2 gene was negative.

Decoupling social status and status certainty effects on health in macaques: a network approach

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Jessica J. Vandeleest

2016-09-01

Full Text Available Background Although a wealth of literature points to the importance of social factors on health, a detailed understanding of the complex interplay between social and biological systems is lacking. Social status is one aspect of social life that is made up of multiple structural (humans: income, education; animals: mating system, dominance rank and relational components (perceived social status, dominance interactions. In a nonhuman primate model we use novel network techniques to decouple two components of social status, dominance rank (a commonly used measure of social status in animal models and dominance certainty (the relative certainty vs. ambiguity of an individual’s status, allowing for a more complex examination of how social status impacts health. Methods Behavioral observations were conducted on three outdoor captive groups of rhesus macaques (N = 252 subjects. Subjects’ general physical health (diarrhea was assessed twice weekly, and blood was drawn once to assess biomarkers of inflammation (interleukin-6 (IL-6, tumor necrosis factor-alpha (TNF-α, and C-reactive protein (CRP. Results Dominance rank alone did not fully account for the complex way that social status exerted its effect on health. Instead, dominance certainty modified the impact of rank on biomarkers of inflammation. Specifically, high-ranked animals with more ambiguous status relationships had higher levels of inflammation than low-ranked animals, whereas little effect of rank was seen for animals with more certain status relationships. The impact of status on physical health was more straightforward: individuals with more ambiguous status relationships had more frequent diarrhea; there was marginal evidence that high-ranked animals had less frequent diarrhea. Discussion Social status has a complex and multi-faceted impact on individual health. Our work suggests an important role of uncertainty in one’s social status in status-health research. This work also

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...... was higher among the original assessors (the assessor from the same country as the subject) than the average prevalence assessed by the other four in the quality control round. The original assessors classified more job situations as exposed than the others. Several reasons for this are plausible: real...... 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...

Hands4U: the effects of a multifaceted implementation strategy on hand eczema prevalence in a healthcare setting. Results of a randomized controlled trial.

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van der Meer, Esther W C; Boot, Cécile R L; van der Gulden, Joost W J; Knol, Dirk L; Jungbauer, Frank H W; Coenraads, Pieter Jan; Anema, Johannes R

2015-05-01

Healthcare workers have an increased risk of developing hand eczema. A multifaceted implementation strategy was developed to implement a guideline to prevent hand eczema among healthcare workers. To investigate the effects of the implementation strategy on self-reported hand eczema and preventive behaviour. A randomized controlled trial was performed. A total of 48 departments (n = 1649) were randomly allocated to the multifaceted implementation strategy or the control group. The strategy consisted of education, participatory working groups, and role models. Outcome measures were self-reported hand eczema and preventive behaviour. Data were collected at baseline, and 3, 6, 9 and 12 months of follow-up. Participants in the intervention group were significantly more likely to report hand eczema [odds ratio (OR) 1.45; 95% confidence interval (CI) 1.03-2.04], and they reported significantly less hand washing (B, - 0.38; 95%CI: - 0.48 to - 0.27), reported significantly more frequent use of a moisturizer (B, 0.30; 95%CI: 0.22-0.39) and were more likely to report wearing cotton undergloves (OR 6.33; 95%CI: 3.23-12.41) than participants in the control group 12 months after baseline. The strategy implemented can be used in practice, as it showed positive effects on preventive behaviour. More research is needed to investigate the unexpected effects on hand eczema. © 2014 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.

Social vulnerabilities and health conditions of arrestees in the Greater Paris area, France, in 2013: a multicentre cross-sectional study.

Science.gov (United States)

Verdier, Emilie; Denis, Céline; Bourokba, Nacer; Chauvin, Pierre; Chariot, Patrick

2018-05-01

The aim of this study was to describe the health and social conditions of arrestees, as compared to the general population. We studied a sample of 600 adult arrestees in three locations in the Greater Paris area, prospectively included (February-May 2013). A descriptive analysis has been performed, then prevalence was estimated using an indirect standardisation according to age, based on data from a population-based, representative survey in the same area. Arrestees had a median age of 31 years; 92% were males. As compared to the general population, arrestees had a lower level of education (8.6 vs. 7.6%, p analysis of male arrestees and males from the general population showed that the former had worse social and health conditions. These results argue for widespread medical interventions on all arrestees. Medical examination during detention could act as a gateway to health care and social support.

Beneficial impacts of a national smokefree environments law on an indigenous population: a multifaceted evaluation

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Thomson George

2009-04-01

Full Text Available Abstract Background Smokefree environments legislation is increasingly being implemented around the world. Evaluations largely find that the legislation is popular, compliance is high and report improved air quality and reduced exposure to secondhand smoke (SHS. The impact of the legislation on disadvantaged groups, including indigenous peoples has not been explored. We present findings from a multifaceted evaluation of the impact of the smokefree workplace provisions of the New Zealand Smokefree Environments Amendment Act on Māori people in New Zealand. Māori are the indigenous people of New Zealand. The Smokefree Environments Amendment Act extended existing smokefree legislation to almost all indoor workplaces in December 2004 (including restaurants and pubs/bars. Methods Review of existing data and commissioned studies to identify evidence for the evaluation of the new legislation: including attitudes and support for the legislation; stakeholders views about the Act and the implementation process; impact on SHS exposure in workplaces and other settings; and impact on smoking-related behaviours. Results Support for the legislation was strong among Māori and reached 90% for smokefree restaurants and 84% for smokefree bars by 2006. Māori stakeholders interviewed were mostly supportive of the way the legislation had been introduced. Reported exposure to SHS in workplaces decreased similarly in Māori and non-Māori with 27% of employed adult Māori reporting SHS exposure indoors at work during the previous week in 2003 and 9% in 2006. Exposure to SHS in the home declined, and may have decreased more in Māori households containing one or more smokers. For example, the proportion of 14–15 year old Māori children reporting that smoking occurred in their home fell from 47% in 2001 to 37% in 2007. Similar reductions in socially-cued smoking occurred among Māori and non-Māori. Evidence for the effect on smoking prevalence was mixed. M�

Beneficial impacts of a national smokefree environments law on an indigenous population: a multifaceted evaluation

Science.gov (United States)

Edwards, Richard; Gifford, Heather; Waa, Andrew; Glover, Marewa; Thomson, George; Wilson, Nick

2009-01-01

Background Smokefree environments legislation is increasingly being implemented around the world. Evaluations largely find that the legislation is popular, compliance is high and report improved air quality and reduced exposure to secondhand smoke (SHS). The impact of the legislation on disadvantaged groups, including indigenous peoples has not been explored. We present findings from a multifaceted evaluation of the impact of the smokefree workplace provisions of the New Zealand Smokefree Environments Amendment Act on Māori people in New Zealand. Māori are the indigenous people of New Zealand. The Smokefree Environments Amendment Act extended existing smokefree legislation to almost all indoor workplaces in December 2004 (including restaurants and pubs/bars). Methods Review of existing data and commissioned studies to identify evidence for the evaluation of the new legislation: including attitudes and support for the legislation; stakeholders views about the Act and the implementation process; impact on SHS exposure in workplaces and other settings; and impact on smoking-related behaviours. Results Support for the legislation was strong among Māori and reached 90% for smokefree restaurants and 84% for smokefree bars by 2006. Māori stakeholders interviewed were mostly supportive of the way the legislation had been introduced. Reported exposure to SHS in workplaces decreased similarly in Māori and non-Māori with 27% of employed adult Māori reporting SHS exposure indoors at work during the previous week in 2003 and 9% in 2006. Exposure to SHS in the home declined, and may have decreased more in Māori households containing one or more smokers. For example, the proportion of 14–15 year old Māori children reporting that smoking occurred in their home fell from 47% in 2001 to 37% in 2007. Similar reductions in socially-cued smoking occurred among Māori and non-Māori. Evidence for the effect on smoking prevalence was mixed. Māori responded to the new law with

Beneficial impacts of a national smokefree environments law on an indigenous population: a multifaceted evaluation.

Science.gov (United States)

Edwards, Richard; Gifford, Heather; Waa, Andrew; Glover, Marewa; Thomson, George; Wilson, Nick

2009-04-30

Smokefree environments legislation is increasingly being implemented around the world. Evaluations largely find that the legislation is popular, compliance is high and report improved air quality and reduced exposure to secondhand smoke (SHS). The impact of the legislation on disadvantaged groups, including indigenous peoples has not been explored. We present findings from a multifaceted evaluation of the impact of the smokefree workplace provisions of the New Zealand Smokefree Environments Amendment Act on Māori people in New Zealand. Māori are the indigenous people of New Zealand. The Smokefree Environments Amendment Act extended existing smokefree legislation to almost all indoor workplaces in December 2004 (including restaurants and pubs/bars). Review of existing data and commissioned studies to identify evidence for the evaluation of the new legislation: including attitudes and support for the legislation; stakeholders views about the Act and the implementation process; impact on SHS exposure in workplaces and other settings; and impact on smoking-related behaviours. Support for the legislation was strong among Māori and reached 90% for smokefree restaurants and 84% for smokefree bars by 2006. Māori stakeholders interviewed were mostly supportive of the way the legislation had been introduced. Reported exposure to SHS in workplaces decreased similarly in Māori and non-Māori with 27% of employed adult Māori reporting SHS exposure indoors at work during the previous week in 2003 and 9% in 2006. Exposure to SHS in the home declined, and may have decreased more in Māori households containing one or more smokers. For example, the proportion of 14-15 year old Māori children reporting that smoking occurred in their home fell from 47% in 2001 to 37% in 2007. Similar reductions in socially-cued smoking occurred among Māori and non-Māori. Evidence for the effect on smoking prevalence was mixed. Māori responded to the new law with increased calls to the

Multifaceted regulation of V(D)J recombination

Science.gov (United States)

Wang, Guannan

V(D)J recombination is responsible for generating an enormous repertoire of immunoglobulins and T cell receptors, therefore it is a centerpiece to the formation of the adaptive immune system. The V(D)J recombination process proceeds through two steps, site-specific cleavage at RSS (Recombination Signal Sequence) site mediated by the RAG recombinase (RAG1/2) and the subsequent imprecise resolution of the DNA ends, which is carried out by the ubiquitous non-homologous end joining pathway (NHEJ). The V(D)J recombination reaction is obliged to be tightly controlled under all circumstances, as it involves generations of DNA double strand breaks, which are considered the most dangerous lesion to a cell. Multifaceted regulatory mechanisms have been evolved to create great diversity of the antigen receptor repertoire while ensuring genome stability. The RAG-mediated cleavage reaction is stringently regulated at both the pre-cleavage stage and the post-cleavage stage. Specifically, RAG1/2 first forms a pre-cleavage complex assembled at the boarder of RSS and coding flank, which ensures the appropriate DNA targeting. Subsequently, this complex initiates site-specific cleavage, generating two types of double stranded DNA breaks, hairpin-ended coding ends (HP-CEs) and blunt signal ends (SEs). After the cleavage, RAG1/2 proteins bind and retain the recombination ends to form post-cleavage complexes (PCC), which collaborates with the NHEJ machinery for appropriate transfer of recombination ends to NHEJ for proper end resolution. However, little is known about the molecular basis of this collaboration, partly attributed to the lack of sensitive assays to reveal the interaction of PCC with HP-CEs. Here, for the first time, by using two complementary fluorescence-based techniques, fluorescence anisotropy and fluorescence resonance energy transfer (FRET), I managed to monitor the RAG1/2-catalyzed cleavage reaction in real time, from the pre-cleavage to the post-cleavage stages. By

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

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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

Comparison between repaglinide and glipizide in Type 2 diabetes mellitus: a 1-year multicentre study

DEFF Research Database (Denmark)

Madsbad, Sten; Kilhovd, B; Lager, I

2001-01-01

AIMS: To evaluate the long-term effectiveness and safety of repaglinide, a novel prandial glucose regulator, in comparison with glipizide in the treatment of patients with Type 2 diabetes. METHODS: Diet or tablet-treated patients with Type 2 diabetes (n = 256; age 40-75 years, body mass index (BMI...... with Type 2 diabetes, and is better than glipizide in controlling HbA1c and FBG levels, overall, and in OHA-naive patients.......) 20-35 kg/m2, HbA1c 4.2-12.8%), without signs of severe microvascular or macrovascular complications, were included in this double-blind, multicentre, parallel-group comparative trial. Patients were randomized at a 2:1 ratio to repaglinide, 1-4 mg at mealtimes, or glipizide, 5-15 mg daily. RESULTS...

Diversity of what? Multifaceted Boards and Directors

OpenAIRE

A. Hillman; S. Nielsen; A. Zattoni

2012-01-01

Board diversity has long intrigued practitioners and scholars. Constituents encourage companies to vary of director characteristics, but companies often resist. Academics debate whether diversity is beneficial for board decision-making and the empirical evidence is mixed, partly because “diversity” is treated as a singular construct despite representing many different forms (e.g. demographic, human capital and social capital). We propose a theoretical model of board diversit...

Effects of combined exercise training and electromyostimulation treatments in chronic heart failure: A prospective multicentre study.

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Iliou, Marie C; Vergès-Patois, Bénédicte; Pavy, Bruno; Charles-Nelson, Anais; Monpère, Catherine; Richard, Rudy; Verdier, Jean C

2017-08-01

Background Exercise training as part of a comprehensive cardiac rehabilitation is recommended for patients with cardiac heart failure. It is a valuable method for the improvement of exercise tolerance. Some studies reported a similar improvement with quadricipital electrical myostimulation, but the effect of combined exercise training and electrical myostimulation in cardiac heart failure has not been yet evaluated in a large prospective multicentre study. Purpose The aim of this study was to determine whether the addition of low frequency electrical myostimulation to exercise training may improve exercise capacity and/or muscular strength in cardiac heart failure patients. Methods Ninety-one patients were included (mean age: 58 ± 9 years; New York Heart Association II/III: 52/48%, left ventricular ejection fraction: 30 ± 7%) in a prospective French study. The patients were randomised into two groups: 41 patients in exercise training and 50 in exercise training + electrical myostimulation. All patients underwent 20 exercise training sessions. In addition, in the exercise training + electrical myostimulation group, patients underwent 20 low frequency (10 Hz) quadricipital electrical myostimulation sessions. Each patient underwent a cardiopulmonary exercise test, a six-minute walk test, a muscular function evaluation and a quality of life questionnaire, before and at the end of the study. Results A significant improvement of exercise capacity (Δ peak oxygen uptake+15% in exercise training group and +14% in exercise training + electrical myostimulation group) and of quality of life was observed in both groups without statistically significant differences between the two groups. Mean creatine kinase level increased in the exercise training group whereas it remained stable in the combined group. Conclusions This prospective multicentre study shows that electrical myostimulation on top of exercise training does not demonstrate any significant

Primary adrenal insufficiency in adult population: a Portuguese Multicentre Study by the Adrenal Tumours Study Group.

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Ferreira, Lia; Silva, João; Garrido, Susana; Bello, Carlos; Oliveira, Diana; Simões, Hélder; Paiva, Isabel; Guimarães, Joana; Ferreira, Marta; Pereira, Teresa; Bettencourt-Silva, Rita; Martins, Ana Filipa; Silva, Tiago; Fernandes, Vera; Pereira, Maria Lopes

2017-11-01

Primary adrenal insufficiency (PAI) is a rare but severe and potentially life-threatening condition. No previous studies have characterized Portuguese patients with PAI. To characterize the clinical presentation, diagnostic workup, treatment and follow-up of Portuguese patients with confirmed PAI. This multicentre retrospective study examined PAI patients in 12 Portuguese hospitals. We investigated 278 patients with PAI (55.8% were females), with a mean age of 33.6 ± 19.3 years at diagnosis. The most frequent presenting clinical features were asthenia (60.1%), mucocutaneous hyperpigmentation (55.0%) and weight loss (43.2%); 29.1% of the patients presented with adrenal crisis. Diagnosis was established by high plasma ACTH and low serum cortisol in most patients (43.9%). The most common aetiology of PAI was autoimmune adrenalitis (61.0%). There were 38 idiopathic cases. Autoimmune comorbidities were found in 70% of the patients, the most frequent being autoimmune thyroiditis (60.7%) and type 1 diabetes mellitus (17.3%). Seventy-nine percent were treated with hydrocortisone (mean dose 26.3 ± 8.3 mg/day) mostly in three (57.5%) or two (37.4%) daily doses. The remaining patients were treated with prednisolone (10.1%), dexamethasone (6.2%) and methylprednisolone (0.7%); 66.2% were also on fludrocortisone (median dose of 100 µg/day). Since diagnosis, 33.5% of patients were hospitalized for disease decompensation. In the last appointment, 17.2% of patients had complaints (7.6% asthenia and 6.5% depression) and 9.7% had electrolyte disturbances. This is the first multicentre Portuguese study regarding PAI. The results emphasize the need for standardization in diagnostic tests and etiological investigation and provide a framework for improving treatment. © 2017 The authors.

A call for a multifaceted approach to language learning motivation research: Combining complexity, humanistic, and critical perspectives

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Julian Pigott

2012-10-01

Full Text Available In this paper I give an overview of recent developments in the L2 motivation field, in particular the movement away from quantitative, questionnaire-based methodologies toward smaller-scale qualitative studies incorporating concepts from complexity theory. While complexity theory provides useful concepts for exploring motivation in new ways, it has nothing to say about ethics, morality, ideology, politics, power or educational purpose. Furthermore, calls for its use come primarily from researchers from the quantitative tradition whose aim in importing this paradigm from the physical sciences appears to be to conceptualize and model motivation more accurately. The endeavor therefore remains a fundamentally positivist one. Rather than being embraced as a self-contained methodology, I argue that complexity theory should be used cautiously and prudently alongside methods grounded in other philosophical traditions. Possibilities abound, but here I suggest one possible multifaceted approach combining complexity theory, a humanisticconception of motivation, and a critical perspective.

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

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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

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

99mTc-DTPA aerosol for same-day post-perfusion ventilation imaging: Results of a multicentre study

International Nuclear Information System (INIS)

Koehn, H.; Koenig, B.; Bachmayr, S.; Markt, B.; Eber, O.; Lind, P.; Galvan, G.; Rettenbacher, L.; Holm, C.; Ogris, E.

1993-01-01

A multicentre study was performed in an attempt to evaluate a submicronic technetium-99m diethylene triamine penta-acetic acid aerosol generated by a newly developed delivery system, the aerosol production equipment (APE nebulizer), for same-day post-perfusion ventilation imaging in patients with clinically suspected pulmonary embolism. Quantitative comparison between the DTPA aerosol and krypton gas demonstrated a close correlation with respect to regional pulmonary distribution of activity and peripheral lung penetration (n=14, r=0.94, P 99m Tc-labelled DTPA aerosol is well suited for fast same-day post-perfusion ventilation imaging in patients with clinical suspicion of pulmonary embolism. (orig.)

The economic and clinical impact of an inpatient palliative care consultation service: a multifaceted approach.

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Ciemins, Elizabeth L; Blum, Linda; Nunley, Marsha; Lasher, Andrew; Newman, Jeffrey M

2007-12-01

While there has been a rapid increase of inpatient palliative care (PC) programs, the financial and clinical benefits have not been well established. Determine the effect of an inpatient PC consultation service on costs and clinical outcomes. Multifaceted study included: (1) interrupted time-series design utilizing mean daily costs preintervention and postintervention; (2) matched cohort analysis comparing PC to usual care patients; and (3) analysis of symptom control after consultation. Large private, not-for-profit, academic medical center in San Francisco, California, 2004-2006. Time series analysis included 282 PC patients; matched cohorts included 27 PC with 128 usual care patients; clinical outcome analysis of 48 PC patients. Mean daily patient costs and length of stay (LOS); pain, dyspnea, and secretions assessment scores. Mean daily costs were reduced 33% (p reduction in mean daily costs and LOS resulted in an estimated annual savings of $2.2 million in the study hospital. Our results extend the evidence base of financial and clinical benefits associated with inpatient PC programs. We recommend additional study of best practices for identifying patients and providing consultation services, in addition to progressive management support and reimbursement policy.

Social motivation and implicit theory of mind in children with autism spectrum disorder.

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Burnside, Kimberly; Wright, Kristyn; Poulin-Dubois, Diane

2017-11-01

According to the social motivation theory of autism, children who develop Autism Spectrum Disorder (ASD) have early deficits in social motivation, which is expressed by decreased attention to social information. These deficits are said to lead to impaired socio-cognitive development, such as theory of mind (ToM). There is little research focused on the relation between social motivation and ToM in this population. The goal of the present study was to investigate the link between one aspect of social motivation, social orienting, and ToM in preschoolers with ASD. It was expected that, in contrast to typically developing (TD) children, children with ASD would show impaired performance on tasks measuring social orienting and ToM. It was also expected that children's performance on the social orienting tasks would be correlated with their performance on the ToM task. A total of 17 children with ASD and 16 TD children participated in this study. Participants completed two social orienting tasks, a face preference task and a biological motion preference task, as well an implicit false belief task. Results reveal that TD children, but not children with ASD, exhibited social preference as measured by a preference for faces and biological motion. Furthermore, children with ASD tended to perform worse on the ToM task compared to their TD counterparts. Performance on the social motivation tasks and the ToM task tended to be related but only for the TD children. These findings suggest that ToM is multifaceted and that motivational deficits might have downstream effects even on implicit ToM. Autism Res 2017, 10: 1834-1844. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. The goal of the present study was to examine the link between poor attention to social information and mindreading abilities in children with autism spectrum disorder (ASD). Results demonstrated that children with ASD tended to perform worse than neurotypical children on both social

Prevalence and predictors of alcohol use during pregnancy: findings from international multicentre cohort studies.

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O'Keeffe, Linda M; Kearney, Patricia M; McCarthy, Fergus P; Khashan, Ali S; Greene, Richard A; North, Robyn A; Poston, Lucilla; McCowan, Lesley M E; Baker, Philip N; Dekker, Gus A; Walker, James J; Taylor, Rennae; Kenny, Louise C

2015-07-06

To compare the prevalence and predictors of alcohol use in multiple cohorts. Cross-cohort comparison of retrospective and prospective studies. Population-based studies in Ireland, the UK, Australia and New Zealand. 17,244 women of predominantly Caucasian origin from two Irish retrospective studies (Growing up in Ireland (GUI) and Pregnancy Risk Assessment Monitoring System Ireland (PRAMS Ireland)), and one multicentre prospective international cohort, Screening for Pregnancy Endpoints (SCOPE) study. Prevalence of alcohol use pre-pregnancy and during pregnancy across cohorts. Sociodemographic factors associated with alcohol consumption in each cohort. Alcohol consumption during pregnancy in Ireland ranged from 20% in GUI to 80% in SCOPE, and from 40% to 80% in Australia, New Zealand and the UK. Levels of exposure also varied substantially among drinkers in each cohort ranging from 70% consuming more than 1-2 units/week in the first trimester in SCOPE Ireland, to 46% and 15% in the retrospective studies. Smoking during pregnancy was the most consistent predictor of gestational alcohol use in all three cohorts, and smokers were 17% more likely to drink during pregnancy in SCOPE, relative risk (RR)=1.17 (95% CI 1.12 to 1.22), 50% more likely to drink during pregnancy in GUI, RR=1.50 (95% CI 1.36 to 1.65), and 42% more likely to drink in PRAMS, RR=1.42 (95% CI 1.18 to 1.70). Our data suggest that alcohol use during pregnancy is prevalent and socially pervasive in the UK, Ireland, New Zealand and Australia. New policy and interventions are required to reduce alcohol prevalence both prior to and during pregnancy. Further research on biological markers and conventions for measuring alcohol use in pregnancy is required to improve the validity and reliability of prevalence estimates. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Multifaceted Glance on Childhood Sexual Abuse and Incest

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Aslihan Okan Ibiloglu

2018-03-01

Full Text Available An experience of domestic violence can lead to permanent physical, mental, and psychological harms, whether the child is a direct victim or a witness. Although having no standard definition, it is generally agreed that childhood sexual abuse and incest are underreported. The majority of sexual abuse happens in childhood, with incest being the most common form. Incest is a sexual activity or assault between family members or close relatives and can be defined as the sexual abuse of the child, as well. On the other hand, pedophilic disorder is defined as having recurrent, intense sexual urges or behaviors involving sexual activity with a preadolescent child, over a period of at least 6 months. In this article, clinical, social, and legal effects from the sexual abuse of results are investigated. Results of our research will be hopefully helpful in informing social policy and guiding mental health practice.

Does the effect of one-day simulation team training in obstetric emergencies decline within one year? A post-hoc analysis of a multicentre cluster randomised controlled trial

NARCIS (Netherlands)

van de Ven, J.; Fransen, A F; Schuit, E.; van Runnard Heimel, P.J.; Mol, Ben W.; Oei, Swan G.

2017-01-01

Does the effect of one-day simulation team training in obstetric emergencies decline within one year? A post-hoc analysis of a multicentre cluster randomised controlled trial. J van de Ven, AF Fransen, E Schuit, PJ van Runnard Heimel, BW Mol, SG Oei Objective To investigate whether the effect of a

ChroPac-Trial: Duodenum-preserving pancreatic head resection versus pancreatoduodenectomy for chronic pancreatitis. Trial protocol of a randomised controlled multicentre trial

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Schlitt Hans

2010-04-01

Full Text Available Abstract Background A recently published systematic review indicated superiority of duodenum-preserving techniques when compared with pancreatoduodenectomy, for the treatment of patients with chronic pancreatitis in the head of the gland. A multicentre randomised trial to confirm these results is needed. Methods/Design ChroPac aims to investigate differences in quality of life, mortality and morbidity during 24 months after surgery (duodenum-preserving pancreatic head resection versus pancreatoduodenectomy in patients with chronic pancreatitis of the pancreatic head. ChroPac is a randomised, controlled, observer and patient blinded multicentre surgical trial with two parallel comparison groups. The primary outcome measure will be the average quality of life during 24 months after surgery. Statistical analysis is based on the intention-to-treat population. Analysis of covariance will be applied for the intervention group comparison adjusting for age, centre and quality of life before surgery. Level of significance is set at 5% (two-sided and sample size (n = 100 per group is determined to assure a power of 90%. Discussion The ChroPac trial will explore important outcomes from different perspectives (e.g. surgeon, patient, health care system. Its pragmatic approach promises high external validity allowing a comprehensive evaluation of the surgical strategy for treatment of patients with chronic pancreatitis. Trial registration Controlled-trials.com ISRCTN38973832

Of 'disgrace' and 'pain'--corticolimbic interaction patterns for disorder-relevant and emotional words in social phobia.

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Laeger, Inga; Dobel, Christian; Radenz, Britta; Kugel, Harald; Keuper, Kati; Eden, Annuschka; Arolt, Volker; Zwitserlood, Pienie; Dannlowski, Udo; Zwanzger, Peter

2014-01-01

Limbic hyperactivation and an impaired functional interplay between the amygdala and the prefrontal cortex are discussed to go along with, or even cause, pathological anxiety. Within the multi-faceted group of anxiety disorders, the highly prevalent social phobia (SP) is characterized by excessive fear of being negatively evaluated. Although there is widespread evidence for amygdala hypersensitivity to emotional faces in SP, verbal material has rarely been used in imaging studies, in particular with an eye on disorder-specificity. Using functional magnetic resonance imaging (fMRI) and a block design consisting of (1) overall negative, (2) social-phobia related, (3) positive, and (4) neutral words, we studied 25 female patients with social phobia and 25 healthy female control subjects (HC). Results demonstrated amygdala hyperactivation to disorder-relevant but not to generally negative words in SP patients, with a positive correlation to symptom severity. A functional connectivity analysis revealed a weaker coupling between the amygdala and the left middle frontal gyrus in patients. Symptom severity was negatively related to connectivity strength between the amygdala and the ventromedial prefrontal and orbitofrontal cortex (Brodmann Area 10 and 11). The findings clearly support the view of a hypersensitive threat-detection system, combined with disorder-related alterations in amygdala-prefrontal cortex connectivity in pathological anxiety.

Hydropower, social priorities and the rural–urban development divide: The case of large dams in Cambodia

International Nuclear Information System (INIS)

Siciliano, Giuseppina; Urban, Frauke; Kim, Sour; Dara Lonn, Pich

2015-01-01

Hydropower investment is a priority in many developing countries, as a means to increase electrification rates and promote national development. However, neglect of dam-affected people's needs, can make them vulnerable to the multifaceted impacts of such projects. Using the case of Cambodia's first large dam, the Kamchay dam, this paper reveals social priorities of affected communities and institutional actors linked to environmental and social implications of large hydropower projects using a preference ranking method. Qualitative research revealed concerns among dam-affected communities which included energy access, livelihood changes, environmental impacts, access to natural resources and compensation. Results also reveal divergence between national and local priorities, which in turn brings about an unequal distribution of costs and benefits of the Kamchay Dam between urban and rural areas. The paper provides recommendations to policy-makers, NGOs and international organizations regarding governance issues, consultation processes and mitigation measures. - Highlights: • We assess social priorities linked to the impacts of a large dam in Cambodia. • We examine differences between local actors in the prioritization of the impacts. • Findings show divergences between national and local priorities of dam construction. • Distribution of cost and benefit is spatially unequal between rural and urban areas.

Adverse events associated with acupuncture: three multicentre randomized controlled trials of 1968 cases in China.

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Zhao, Ling; Zhang, Fu-wen; Li, Ying; Wu, Xi; Zheng, Hui; Cheng, Lin-hao; Liang, Fan-rong

2011-03-24

In order to evaluate the safety of acupuncture in China objectively, we investigated the adverse events associated with acupuncture based on three multicentre randomized controlled trials (RCTs) to assess the safety of acupuncture, identifying the common types of acupuncture adverse events, and analysing the related risk factors for their occurrence. This observational study included patients who received acupuncture from three multicentre RCTs respectively for migraine, functional dyspepsia and Bell's palsy. The 1968 patients and their acupuncturists documented adverse events associated with acupuncture after treatment. We collected data about adverse events due to acupuncture treatment from their case report forms. We analysed the incidence and details of the adverse effects, and studied the risk factors for acupuncture adverse events with non-conditional logistic regression analysis. Among the 1968 patients, 74 patients (3.76%) suffered at least one adverse event throughout the treatment period. We did not observe the occurrence of serious adverse events. 73 patients with adverse events recovered within 2 weeks through effective treatment such as physiotherapy or self-treatment. A total of 3 patients withdrew because of adverse events. There were 9 types of adverse events related to acupuncture, including subcutaneous haematoma, bleeding, skin bruising and needle site pain. Subcutaneous haematoma and haemorrhage in the needling points were the most common adverse events. Age and gender were related to the occurrence of acupuncture adverse events. The older the patients were, the higher the risk of adverse events was. In addition, male patients had slightly higher risk of an adverse event than female patients. Acupuncture is a safe therapy with low risk of adverse events in clinical practice. The risk factors for adverse events (AEs) were related to the patients' gender and age and the local anatomical structure of the acupoints. AEs could be reduced and

Class and comparison: subjective social location and lay experiences of constraint and mobility.

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Irwin, Sarah

2015-06-01

Lay perceptions and experiences of social location have been commonly framed with reference to social class. However, complex responses to, and ambivalence over, class categories have raised interesting analytic questions relating to how sociological concepts are operationalized in empirical research. For example, prior researchers have argued that processes of class dis-identification signify moral unease with the nature of classed inequalities, yet dis-identification may also in part reflect a poor fit between 'social class' as a category and the ways in which people accord meaning to, and evaluate, their related experiences of socio-economic inequality. Differently framed questions about social comparison, aligned more closely with people's own terms of reference, offer an interesting alternative avenue for exploring subjective experiences of inequality. This paper explores some of these questions through an analysis of new empirical data, generated in the context of recession. In the analysis reported here, class identification was common. Nevertheless, whether or not people self identified in class terms, class relevant issues were perceived and described in highly diverse ways, and lay views on class revealed it to be a very aggregated as well as multifaceted construct. It is argued that it enables a particular, not general, perspective on social comparison. The paper therefore goes on to examine how study participants compared themselves with familiar others, identified by themselves. The evidence illuminates social positioning in terms of constraint, agency and (for some) movement, and offers insight into very diverse experiences of inequality, through the comparisons that people made. Their comparisons are situated, and pragmatic, accounts of the material contexts in which people live their lives. Linked evaluations are circumscribed and strongly tied to these proximate material contexts.The paper draws out implications for theorizing lay perspectives on

Multifaceted antibiotic treatment analysis of methicillin-sensitive Staphylococcus aureus bloodstream infections.

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Weber, Zhanni; Ariano, Robert; Lagacé-Wiens, Philippe; Zelenitsky, Sheryl

2016-12-01

Given the overall prevalence and poor prognosis of Staphylococcus aureus bloodstream infections (BSIs), the study of treatment strategies to improve patient outcomes is important. The aim of this study was to conduct a multifaceted antibiotic treatment analysis of methicillin-sensitive S. aureus (MSSA) BSI and to characterise optimal early antibiotic therapy (within the first 7 days of drawing the index blood culture) for this serious infection. Antibiotic selection was categorised as optimal targeted (intravenous cloxacillin or cefazolin), optimal broad (piperacillin/tazobactam or meropenem), adequate (vancomycin) or inadequate (other antibiotics or oral therapy). A TSE (timing, selection, exposure) score was developed to comprehensively characterise early antibiotic therapy, where higher points corresponded to prompt initiation, optimal antibiotic selection and longer exposure (duration). Amongst 71 cases of complicated MSSA-BSI, end-of-treatment (EOT) response (i.e. clinical cure) was improved when at least adequate antibiotic therapy was initiated within 24 h [71.7% (33/46) vs. 48.0% (12/25); P = 0.047]. Clinical cure was also more likely when therapy included ≥4 days of optimal targeted antibiotics within the first 7 days [74.4% (29/39) vs. 50.0% (16/32); P = 0.03]. The TSE score was an informative index of early antibiotic therapy, with EOT cure documented in 72.0% (36/50) compared with 42.9% (9/21) of cases with scores above and below 15.2, respectively (P = 0.02). In multivariable analysis, lower Charlson comorbidity index, presence of BSI on admission, and optimising early antibiotic therapy, as described above, were associated with clinical cure in patients with MSSA-BSI. Copyright © 2016 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

The utility of e-Learning to support training for a multicentre bladder online adaptive radiotherapy trial (TROG 10.01-BOLART)

International Nuclear Information System (INIS)

Foroudi, Farshad; Pham, Daniel; Bressel, Mathias; Tongs, David; Rolfo, Aldo; Styles, Colin; Gill, Suki; Kron, Tomas

2013-01-01

Background and purpose: An e-Learning programme appeared useful for providing training and information regarding a multi-centre image guided radiotherapy trial. The aim of this study is to demonstrate the utility of this e-Learning programme. Materials and methods: Modules were created on relevant pelvic anatomy, Cone Beam CT soft tissue recognition and trial details. Radiation therapist participants’ knowledge and confidence were evaluated before, at the end of, and after at least 6 weeks of e-Learning (long term). Results: One hundred and eighty-five participants were recruited from 12 centres, with 118 in the first, and 67 in the second cohort. One hundred and forty-six participants had two tests (pre and post e-Learning) and 39 of these had three tests (pre, post, and long term). There was an increase confidence after completion of modules (p < 0.001). The first cohort pre scores increased from 67 ± 11 to 79 ± 8 (p < 0.001) post. The long term same question score was 73 ± 14 (p = 0.025, comparing to pre-test), and different questions’ score was 77 ± 13 (p = 0.014). In the second cohort, pre-test scores were 64 ± 10, post-test same question score 78 ± 9 (p < 0.001) and different questions’ score 81 ± 11 (p < 0.001). Conclusions: e-Learning for a multi-centre clinical trial was feasible and improved confidence and knowledge

Structural and functional social network attributes moderate the association of self-rated health with mental health in midlife and older adults.

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Windsor, Tim D; Rioseco, Pilar; Fiori, Katherine L; Curtis, Rachel G; Booth, Heather

2016-01-01

Social relationships are multifaceted, and different social network components can operate via different processes to influence well-being. This study examined associations of social network structure and relationship quality (positive and negative social exchanges) with mental health in midlife and older adults. The focus was on both direct associations of network structure and relationship quality with mental health, and whether these social network attributes moderated the association of self-rated health (SRH) with mental health. Analyses were based on survey data provided by 2001 (Mean age = 65, SD = 8.07) midlife and older adults. We used Latent Class Analysis (LCA) to classify participants into network types based on network structure (partner status, network size, contact frequency, and activity engagement), and used continuous measures of positive and negative social exchanges to operationalize relationship quality. Regression analysis was used to test moderation. LCA revealed network types generally consistent with those reported in previous studies. Participants in more diverse networks reported better mental health than those categorized into a restricted network type after adjustment for age, sex, education, and employment status. Analysis of moderation indicated that those with poorer SRH were less likely to report poorer mental health if they were classified into more diverse networks. A similar moderation effect was also evident for positive exchanges. The findings suggest that both quantity and quality of social relationships can play a role in buffering against the negative implications of physical health decline for mental health.

Multicentric epitheliotropic T-cell lymphoma in an African hedgehog (Atelerix albiventris).

Science.gov (United States)

Chung, Tae-Ho; Kim, Hyo-Jin; Choi, Ul-Soo

2014-12-01

A 2-year-old female African hedgehog was presented with a 5-month history of pruritus, and diffuse spine and hair loss. A dermatologic examination revealed erythema, excoriation, scales, and crusting affecting the face, flanks, forelimbs, hindlimbs, and dorsal and ventral abdomen. Fine-needle aspiration was performed and skin biopsies were taken from several lesions for cytologic and histologic evaluation. The aspirates yielded smears characterized by a monomorphic population of medium-sized to large lymphocytes with scant to moderate amounts of clear to moderately basophilic cytoplasm and distinct nucleoli along with a low number of cytoplasmic fragments. On histopathologic examination, there were dense dermal lymphoid infiltrates invading the dermis and a monomorphic population of round cells that had infiltrated the overlying epidermis. Epitheliotropic cutaneous lymphoma was diagnosed based on morphologic features. Additional immunochemical analysis using anti-CD3 and anti-CD79a antibodies revealed strong CD3 expression by the tumor cells, which confirmed epitheliotropic cutaneous T-cell lymphoma. This is the first description of a multicentric pattern of epitheliotropic cutaneous T-cell lymphoma in an African hedgehog. © 2014 American Society for Veterinary Clinical Pathology.

Designing a multifaceted quality improvement intervention in primary care in a country where general practice is seeking recognition: the case of Cyprus

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Stoffers Henri E

2008-08-01

Full Text Available Abstract Background Quality Improvement Interventions require significant financial investments, and therefore demand careful consideration in their design in order to maximize potential benefits. In this correspondence we present the methodological approach of a multifaceted quality improvement intervention aiming to improve quality of care in primary care, properly tailored for a country such as Cyprus where general practice is currently seeking recognition. Methods Our methodological approach was focused on the design of an open label, community-based intervention controlled trial using all patients from two urban and two rural public primary care centers diagnosed with hypertension and type II diabetes mellitus. The design of our intervention was grounded on a strong theoretical framework that included the Unified Theory of Acceptance and Use of Technology, and the Chronic Care Model, which synthesize evidence-based system changes in accordance with the Theory of Planned Behavior and the Theory of Reasoned Action. The primary outcome measure was improvement in the quality of care for two chronic diseases evaluated through specific clinical indicators, as well as the patient satisfaction assessed by the EUROPEP questionnaire and additional personal interviews. Results We designed a multifaceted quality improvement intervention model, supported by a varying degree of scientific evidence, tailored to local needs and specific country characteristics. Overall, the main components of the intervention were the development and adoption of an electronic medical record and the introduction of clinical guidelines for the management of the targeted chronic diseases facilitated by the necessary model of organizational changes. Conclusion Health planners and policy makers need to be aware of the potential use of certain theoretical models and applied methodology as well as inexpensive tools that may be suitably tailored to the local needs, in order to

Designing a multifaceted quality improvement intervention in primary care in a country where general practice is seeking recognition: the case of Cyprus.

Science.gov (United States)

Samoutis, George A; Soteriades, Elpidoforos S; Stoffers, Henri E; Zachariadou, Theodora; Philalithis, Anastasios; Lionis, Christos

2008-08-27

Quality Improvement Interventions require significant financial investments, and therefore demand careful consideration in their design in order to maximize potential benefits. In this correspondence we present the methodological approach of a multifaceted quality improvement intervention aiming to improve quality of care in primary care, properly tailored for a country such as Cyprus where general practice is currently seeking recognition. Our methodological approach was focused on the design of an open label, community-based intervention controlled trial using all patients from two urban and two rural public primary care centers diagnosed with hypertension and type II diabetes mellitus. The design of our intervention was grounded on a strong theoretical framework that included the Unified Theory of Acceptance and Use of Technology, and the Chronic Care Model, which synthesize evidence-based system changes in accordance with the Theory of Planned Behavior and the Theory of Reasoned Action. The primary outcome measure was improvement in the quality of care for two chronic diseases evaluated through specific clinical indicators, as well as the patient satisfaction assessed by the EUROPEP questionnaire and additional personal interviews. We designed a multifaceted quality improvement intervention model, supported by a varying degree of scientific evidence, tailored to local needs and specific country characteristics. Overall, the main components of the intervention were the development and adoption of an electronic medical record and the introduction of clinical guidelines for the management of the targeted chronic diseases facilitated by the necessary model of organizational changes. Health planners and policy makers need to be aware of the potential use of certain theoretical models and applied methodology as well as inexpensive tools that may be suitably tailored to the local needs, in order to effectively design quality improvement interventions in primary care

Intra- and interobserver analysis in the morphological assessment of early stage embryos during an IVF procedure: a multicentre study

Directory of Open Access Journals (Sweden)

Devroe Johanna

2011-09-01

Full Text Available Abstract Background Quality control programs are necessary to maintain good clinical practice. Embryo grading has been described as one of the external quality assurance schemes. Although the evaluation of embryos is based on the assessment of morphological characteristics, considerable intra- and inter-observer variability has been described. In this multicentre study, the variability in the embryo evaluation has been evaluated using morphological characteristics on day 1, day 2 and day 3 of embryo development. Methods Five embryologists of four different IVF centers participated in this study. Multilevel images of embryos were presented on a website at different time points to evaluate intra-and inter-observer agreement in the assessment of embryo morphology. The embryos were evaluated on day 1, day 2 and day 3 of their development and each embryologist had to decide if the embryo had to be transferred, cryopreserved or discarded. Results Both intra-observer agreement and inter-observer agreement were good to excellent for the position of the pronuclei on day 1, the number of blastomeres on day 2 and day 3 and the clinical decision (transfer, cryopreservation, discard. For all other characteristics (size of pronuclei, presence of cytoplasomic halo, degree of fragmentation and size of blastomeres the intra- and inter-observer agreement was moderate to very poor. Conclusions Mono- or multicentre quality control on embryo scoring by morphological assessment can easily be performed through the design of a simple website. In the future the website design can be adapted to generate statistical feedback upon scoring and can even include a training module.

Whiplash – en usynlig lidelse

DEFF Research Database (Denmark)

Lauritzen, Jette

2005-01-01

A disease such as whiplash presents a large number of complex social problems. With the help of medical anthropology it is possible to look at whiplash as a multifaceted concept influenced by the social and cultural norms in Western society. In this way whiplash can be considered to be a socially...

Cognition and bimanual performance in children with unilateral cerebral palsy: protocol for a multicentre, cross-sectional study.

Science.gov (United States)

Hoare, Brian; Ditchfield, Michael; Thorley, Megan; Wallen, Margaret; Bracken, Jenny; Harvey, Adrienne; Elliott, Catherine; Novak, Iona; Crichton, Ali

2018-05-08

Motor outcomes of children with unilateral cerebral palsy are clearly documented and well understood, yet few studies describe the cognitive functioning in this population, and the associations between the two is poorly understood. Using two hands together in daily life involves complex motor and cognitive processes. Impairment in either domain may contribute to difficulties with bimanual performance. Research is yet to derive whether, and how, cognition affects a child's ability to use their two hands to perform bimanual tasks. This study will use a prospective, cross-sectional multi-centre observational design. Children (aged 6-12 years) with unilateral cerebral palsy will be recruited from one of five Australian treatment centres. We will examine associations between cognition, bimanual performance and brain neuropathology (lesion type and severity) in a sample of 131 children. The primary outcomes are: Motor - the Assisting Hand Assessment; Cognitive - Executive Function; and Brain - lesion location on structural MRI. Secondary data collected will include: Motor - Box and Blocks, ABILHAND- Kids, Sword Test; Cognitive - standard neuropsychological measures of intelligence. We will use generalized linear modelling and structural equation modelling techniques to investigate relationships between bimanual performance, executive function and brain lesion location. This large multi-centre study will examine how cognition affects bimanual performance in children with unilateral cerebral palsy. First, it is anticipated that distinct relationships between bimanual performance and cognition (executive function) will be identified. Second, it is anticipated that interrelationships between bimanual performance and cognition will be associated with common underlying neuropathology. Findings have the potential to improve the specificity of existing upper limb interventions by providing more targeted treatments and influence the development of novel methods to improve both

Laser in Glaucoma and Ocular Hypertension (LiGHT) trial. A multicentre, randomised controlled trial: design and methodology.

Science.gov (United States)

Gazzard, Gus; Konstantakopoulou, Evgenia; Garway-Heath, David; Barton, Keith; Wormald, Richard; Morris, Stephen; Hunter, Rachael; Rubin, Gary; Buszewicz, Marta; Ambler, Gareth; Bunce, Catey

2018-05-01

The Laser in Glaucoma and Ocular Hypertension (LiGHT) Trial aims to establish whether initial treatment with selective laser trabeculoplasty (SLT) is superior to initial treatment with topical medication for primary open-angle glaucoma (POAG) or ocular hypertension (OHT). The LiGHT Trial is a prospective, unmasked, multicentre, pragmatic, randomised controlled trial. 718 previously untreated patients with POAG or OHT were recruited at six collaborating centres in the UK between 2012 and 2014. The trial comprises two treatment arms: initial SLT followed by conventional medical therapy as required, and medical therapy without laser therapy. Randomisation was provided online by a web-based randomisation service. Participants will be monitored for 3 years, according to routine clinical practice. The target intraocular pressure (IOP) was set at baseline according to an algorithm, based on disease severity and lifetime risk of loss of vision at recruitment, and subsequently adjusted on the basis of IOP control, optic disc and visual field. The primary outcome measure is health-related quality of life (HRQL) (EQ-5D five-level). Secondary outcomes are treatment pathway cost and cost-effectiveness, Glaucoma Utility Index, Glaucoma Symptom Scale, Glaucoma Quality of Life, objective measures of pathway effectiveness, visual function and safety profiles and concordance. A single main analysis will be performed at the end of the trial on an intention-to-treat basis. The LiGHT Trial is a multicentre, pragmatic, randomised clinical trial that will provide valuable data on the relative HRQL, clinical effectiveness and cost-effectiveness of SLT and topical IOP-lowering medication. ISRCTN32038223, Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Burnout, psychological morbidity and use of coping mechanisms among palliative care practitioners: A multi-centre cross-sectional study.

Science.gov (United States)

Koh, Mervyn Yong Hwang; Chong, Poh Heng; Neo, Patricia Soek Hui; Ong, Yew Jin; Yong, Woon Chai; Ong, Wah Ying; Shen, Mira Li Juan; Hum, Allyn Yin Mei

2015-07-01

The prevalence of burnout, psychological morbidity and the use of coping mechanisms among palliative care practitioners in Singapore have not been studied. We aimed to study the prevalence of burnout and psychological morbidity among palliative care practitioners in Singapore and its associations with demographic and workplace factors as well as the use of coping mechanisms. This was a multi-centre, cross-sectional study of all the palliative care providers within the public healthcare sector in Singapore. The study was conducted in hospital palliative care services, home hospice and inpatient hospices in Singapore. The participants were doctors, nurses and social workers. The prevalence of burnout among respondents in our study was 91 of 273 (33.3%) and psychological morbidity was 77 (28.2%). Working >60 h per week was significantly associated with burnout (odds ratio: 9.02, 95% confidence interval: 2.3-35.8, p = 0.002) and psychological morbidity (odds ratio: 7.21, 95% confidence interval: 1.8-28.8, p = 0.005). Home hospice care practitioners (41.5%) were more at risk of developing psychological morbidity compared to hospital-based palliative care (17.5%) or hospice inpatient care (26.0%) (p = 0.007). Coping mechanisms like physical well-being, clinical variety, setting boundaries, transcendental (meditation and quiet reflection), passion for one's work, realistic expectations, remembering patients and organisational activities were associated with less burnout. Our results reveal that burnout and psychological morbidity are significant in the palliative care community and demonstrate a need to look at managing long working hours and promoting the use of coping mechanisms to reduce burnout and psychological morbidity. © The Author(s) 2015.

A multicentre study of 513 Danish patients with systemic lupus erythematosus. II. Disease mortality and clinical factors of prognostic value

DEFF Research Database (Denmark)

Jacobsen, S; Petersen, J; Ullman, S

1998-01-01

influence on survival related to mortality caused by infections. Diffuse central nervous system disease and myocarditis were related to increased SLE-related mortality, whereas photosensitivity predicted a decreased mortality. Non-fatal infections and thrombotic events predicted a decreased overall survival......In this Danish multicentre study, predictive clinical factors of mortality and survival were calculated for 513 patients with systemic lupus erythematosus (SLE), 122 of whom died within a mean observation period of 8.2 years equalling a mortality rate of 2.9% per year. Survival rates were 97%, 91...

One-year multicentre outcomes of transapical aortic valve implantation using the SAPIEN XT™ valve: the PREVAIL transapical study.

Science.gov (United States)

Walther, Thomas; Thielmann, Matthias; Kempfert, Joerg; Schroefel, Holger; Wimmer-Greinecker, Gerhard; Treede, Hendrik; Wahlers, Thorsten; Wendler, Olaf

2013-05-01

The study aimed to evaluate 1-year outcomes of the multicentre PREVAIL transapical (TA) study of TA-aortic valve implantation (AVI) in high-risk patients. From September 2009 to August 2010, a total of 150 patients, aged 81.6 ± 5.8 years, 40.7% female, were included at 12 European TA-AVI experienced sites. Patients received 23 (n = 36), 26 (n = 57) and 29 mm (n = 57) second-generation SAPIEN XT™ (Edwards Lifesciences, Irvine, CA, USA) valves. The mean logistic EuroSCORE was 24.3 ± 7.0, and mean Society Thoracic Surgeons score was 7.5 ± 4.4%. Survival was 91.3% at 30 days and 77.9% at 1 year. Subgroup analysis revealed survivals of 91.7/88.9, 86.0/70.2, 96.55/91.2% for patients receiving 23-, 26- and 29-mm valves at 30 days and at 1 year, respectively. Transthoracic echocardiography revealed preserved left ventricular ejection fraction and low gradients. Aortic incompetence was none in 41/48, trace 30/36, mild 22/12 and moderate in 7/4% at discharge and 1 year. Walking distance increased from 221 (postimplant) to 284 m (at 1 year, P = 0.0004). Three patients required reoperation due to increasing aortic incompetence during follow-up. Causes of mortality at 1 year were cardiac (n = 7), stroke (n = 1) and others (n = 5). The European PREVAIL multicentre trial demonstrates good functionality and good outcomes for TA-AVI using the second-generation SAPIEN XT prosthesis and the ASCENDRA-II delivery system. The 29-mm SAPIEN XT valve was successfully introduced and showed excellent results.

Clinical and echocardiographic assessment of the Medtronic Advantage aortic valve prosthesis: the Scandinavian multicentre, prospective study

DEFF Research Database (Denmark)

Haaverstad, Rune; Vitale, Nicola; Karevold, Asbjørn

2006-01-01

OBJECTIVE: The aim of this report is the prospective, multicentre evaluation of clinical results and haemodynamic performance of the Medtronic Advantage aortic valve prosthesis. METHODS: From April 2001 to June 2003, 166 patients (male:female 125:41; mean (SD) age 61.8 (11.8) years) received...... an aortic advantage valve prosthesis. Complete cumulative follow-up was 242.7 patient-years (maximum 3.2; mean 1.6 years). Postoperatively, patients underwent early (within 30 days) and 1 year transthoracic echocardiography. RESULTS: 30 day mortality was 2.4% (n = 4). Kaplan-Meier estimates of freedom from...... echocardiography. CONCLUSIONS: Haemodynamic performance and early clinical results of Medtronic advantage in the aortic position were satisfactory and comparable with those of other bileaflet valves in current clinical use....

Association of invasive breast carcinoma and multicentric high grade astrocytoma: a case report with a review.

Science.gov (United States)

Pour, P Hossein; Forouzandeh, M; Beni, A Naderi; Beni, Z Naderi; Hoseinpour, P

2011-03-01

Breast cancer is the most common cancer in women. Multicentric gliomas are uncommon lesions of the central nervous system (CNS) with an unprecise rate of occurrence that diffusely infiltrate large portions of the brain. High grade astrocytoma is the most agressive form of gliomas and often has a distinct neuroimaging pattern with a poor prognosis. We report a case of a 29-year-old woman patient with primary breast carcinoma and high grade astrocytoma subsequently developed. The woman was treated by mastectomy and 20 months post-diagnosis of the cancer she exhibited a transient facial paralysis. Magnetic resonance imaging (MRI) revealed two cranial masses suspicious of metastasis. A complete tumor removal from the brain was performed. On histological examination, this tumor was a high grade astrocytoma.

Fast neutrons in the treatment of head and neck cancers: the results of a multi-centre randomly controlled trial

International Nuclear Information System (INIS)

Duncan, W.; Arnott, S.J.; Orr, J.A.; Kerr, G.R.; Schmitt, G.

1984-01-01

The results are presented of a multi-centre randomly controlled trial of fast neutron irradiation and mega-voltage X-rays in the treatment of patients with locally advanced squamous cell carcinoma of the head and neck region. No significant difference was observed in local tumour control rates. Salvage surgery was performed in a similar number of patients in the two groups. Late morbidity was also similar in the two treatment groups. Patients in a subgroup with cancer of the larynx treated by photons had a significantly better survival than those in the neutron treated group. (Auth.)

Religion, a social determinant of mortality? A 10-year follow-up of the Health and Retirement Study.

Science.gov (United States)

Idler, Ellen; Blevins, John; Kiser, Mimi; Hogue, Carol

2017-01-01

The social determinants of health framework has brought a recognition of the primary importance of social forces in determining population health. Research using this framework to understand the health and mortality impact of social, economic, and political conditions, however, has rarely included religious institutions and ties. We investigate a well-measured set of social and economic determinants along with several measures of religious participation as predictors of adult mortality. Respondents (N = 18,370) aged 50 and older to the Health and Retirement Study were interviewed in 2004 and followed for all-cause mortality to 2014. Exposure variables were religious attendance, importance, and affiliation. Other social determinants of health included gender, race/ethnicity, education, household income, and net worth measured at baseline. Confounders included physical and mental health. Health behaviors and social ties were included as potential explanatory variables. Cox proportional hazards regressions were adjusted for complex sample design. After adjustment for confounders, attendance at religious services had a dose-response relationship with mortality, such that respondents who attended frequently had a 40% lower hazard of mortality (HR = 0.60, 95% CI 0.53-0.68) compared with those who never attended. Those for whom religion was "very important" had a 4% higher hazard (HR = 1.04, 95% CI 1.01-1.07); religious affiliation was not associated with risk of mortality. Higher income and net worth were associated with a reduced hazard of mortality as were female gender, Latino ethnicity, and native birth. Religious participation is multi-faceted and shows both lower and higher hazards of mortality in an adult US sample in the context of a comprehensive set of other social and economic determinants of health.

Stylistic Diversity in Children's Communication with Mothers at 30 Months

Science.gov (United States)

Verissimo, Manuela; Blicharski, Teresa; Strayer, F. Francis

2012-01-01

Although developmental researchers endorse a multifaceted view of early communication, where language, non-verbal behaviour and socio-affective exchange contribute concurrently to the social construction of shared meanings, past studies of social development usually focused on component parts of interpersonal communication. This research…

Repeatability and response to therapy of dynamic contrast-enhanced magnetic resonance imaging biomarkers in rheumatoid arthritis in a large multicentre trial setting

Energy Technology Data Exchange (ETDEWEB)

Waterton, John C. [University of Manchester, Stopford Building, Manchester Academic Health Sciences Centre, Manchester (United Kingdom); Personalised Healthcare and Biomarkers, AstraZeneca, Macclesfield (United Kingdom); Ho, Meilien [AstraZeneca, Global Medicines Development, Macclesfield (United Kingdom); Nordenmark, Lars H. [AstraZeneca, Global Medicines Development, Moelndal (Sweden); Jenkins, Martin [AstraZeneca, Global Medicines Development, Cambridge (United Kingdom); DiCarlo, Julie; Peterfy, Charles [Spire Sciences Inc, Boca Raton, FL (United States); Guillard, Gwenael; Bowes, Michael A. [Imorphics, Manchester (United Kingdom); Roberts, Caleb; Buonaccorsi, Giovanni [Bioxydyn, Manchester (United Kingdom); Parker, Geoffrey J.M. [University of Manchester, Stopford Building, Manchester Academic Health Sciences Centre, Manchester (United Kingdom); Bioxydyn, Manchester (United Kingdom); Kellner, Herbert [Private Practice and Division of Rheumatology KHI Neuwittelsbach, Muenchen (Germany); Taylor, Peter C. [University of Oxford, Kennedy Institute, Oxford (United Kingdom)

2017-09-15

To determine the repeatability and response to therapy of dynamic contrast-enhanced (DCE) MRI biomarkers of synovitis in the hand and wrist of rheumatoid arthritis (RA) patients, and in particular the performance of the transfer constant K{sup trans}, in a multicentre trial setting. DCE-MRI and RA MRI scoring (RAMRIS) were performed with meticulous standardisation at baseline and 6 and 24 weeks in a substudy of fostamatinib monotherapy in reducing synovitis compared with placebo or adalimumab. Analysis employed statistical shape modelling to avoid biased regions-of-interest, kinetic modelling and heuristic analyses. Repeatability was also evaluated. At early study termination, DCE-MRI data had been acquired from 58 patients in 19 imaging centres. K{sup trans} intra-subject coefficient of variation (N = 14) was 30%. K{sup trans} change demonstrated inferiority of fostamatinib (N = 11) relative to adalimumab (N = 10) after 6 weeks (treatment ratio = 1.92, p = 0.003), and failed to distinguish fostamatinib from placebo (N = 10, p = 0.79). RAMRIS showed superiority of fostamatinib relative to placebo at 6 weeks (p = 0.023), and did not distinguish fostamatinib from adalimumab at either 6 (p = 0.175) or 24 (p = 0.230) weeks. This demonstrated repeatability of K{sup trans} and its ability to distinguish treatment groups show that DCE-MRI biomarkers are suitable for use in multicentre RA trials. (orig.)

[Candidemias: multicentre analysis in 16 hospitals in Andalusia (Spain)].

Science.gov (United States)

Rodríguez-Hernández, M Jesús; Ruiz-Pérez de Pipaon, Maite; Márquez-Solero, Manuel; Martín-Rico, Patricia; Castón-Osorio, Juan José; Guerrero-Sánchez, Francisca M; Vidal-Verdú, Elisa; García-Figueras, Carolina; Del Arco-Jiménez, Alfonso; Rodríguez-Baño, Jesús; Martín-Mazuelos, Estrella; Cisneros-Herreros, José Miguel

2011-05-01

Candidemia is a nosocomial infection with high associated mortality. There have been changes in microbiology, epidemiology and treatment over the last few years, which has led us to analyse our own situation. Prospective, multicentre and observational study. All episodes of candidemia in adult patients seen in 17 Andalusian hospitals from 1 October 2005 to 30 September 2006 were included. Were detected 220 cases, the incidence was 0.58 cases/1,000 hospital discharges. Candida albicans was the most frecuent species (53% of cases). The majority of isolates (89%) was susceptibility to fluconazole. Sepsis was the most frequent clinical manifestation (65.7%). The treatment was inadequate in 38.7% of cases. Overall mortality was 40%. On univarite analysis death was found to be significantly associated with: aged > 60 years, unknown candidemia focus, Pitt score ≥ 2, APACHE II, shock at onset, persistents positive second blood cultures, non-removal of the central venous catheter and Candida species different of C. parasilopsis, among others. In the multivariate analysis death was found to be significantly associated with: aged > 60 years, Pitt score ≥ 2, Candida species different of C.parasilopsis and inadequate treatment. The candidemia clinical epidemiology in our region is similar to other areas and receiving inadequate treatment is the only modifiable risk factor associated with higher odds of mortality. Therefore, this modifiable factor needs to be improved to reduce the mortality. Copyright © 2010 Elsevier España, S.L. All rights reserved.

Multifaceted shared care intervention for late life depression in residential care: randomised controlled trial.

Science.gov (United States)

Llewellyn-Jones, R H; Baikie, K A; Smithers, H; Cohen, J; Snowdon, J; Tennant, C C

1999-09-11

To evaluate the effectiveness of a population based, multifaceted shared care intervention for late life depression in residential care. Randomised controlled trial, with control and intervention groups studied one after the other and blind follow up after 9.5 months. Population of residential facility in Sydney living in self care units and hostels. 220 depressed residents aged >/=65 without severe cognitive impairment. The shared care intervention included: (a) multidisciplinary consultation and collaboration, (b) training of general practitioners and carers in detection and management of depression, and (c) depression related health education and activity programmes for residents. The control group received routine care. Geriatric depression scale. Intention to treat analysis was used. There was significantly more movement to "less depressed" levels of depression at follow up in the intervention than control group (Mantel-Haenszel stratification test, P=0.0125). Multiple linear regression analysis found a significant intervention effect after controlling for possible confounders, with the intervention group showing an average improvement of 1.87 points on the geriatric depression scale compared with the control group (95% confidence interval 0.76 to 2.97, P=0.0011). The outcome of depression among elderly people in residential care can be improved by multidisciplinary collaboration, by enhancing the clinical skills of general practitioners and care staff, and by providing depression related health education and activity programmes for residents.

Rhenium-188 Lipiodol Therapy of Hepatocellular Carcinoma: Results of a multicentre-multinational study

International Nuclear Information System (INIS)

Padhy, A.K.; Bernal, P.; Buscombe, R.J.

2007-01-01

Full text: A multi-centre study was sponsored by the IAEA to assess the safety and efficacy of trans-arterial Rhenium-188 HDD Lipiodol in the treatment of inoperable Hepatocellular Carcinoma. The radioconjugate was prepared by using an HDD kit and Lipiodol. Over three years, 185 patients received at least one treatment. The dose administered was based on radiation absorbed dose to critical normal organs, calculated following a ''scout'' dose (approximately 4 mCi) of radioconjugate. The organs at greatest risk for radiation toxicity are the liver, the lung and the bone marrow. An Excel spreadsheet was used to determine maximum tolerated activity, defined as the amount of radioactivity calculated to deliver no more than 12 Gy to lungs, 30 Gy to liver, or 1.5 Gy to bone marrow. A single treatment was given to 134 patients, 42 patients received two doses, 8 received three and one patient received four treatments. The total injected activity including the scout dose during the first treatment ranged from 21 to 364 mCi (average 108 mCi). Patients were followed for at least l2 weeks after therapy. The clinical parameters evaluated included toxicity, response as determined objectively by contrast enhanced computed tomography, palliation of symptoms, overall survival, performance status (Karnofsky), and hepatic function (Child's classification). Liver function tests, serum alpha-fetoprotein (AFP) levels and complete blood counts were done at each follow-up visit. Side effects were minimal and usually presented as loss of appetite, right hypochondrial discomfort and low-grade fever. Liver function tests at 24 and 72 hours showed no significant changes and complete blood counts at 1 week, 4 weeks and 12 weeks showed no changes (no bone marrow suppression). Data on largest tumour diameter after therapy and/or tumour response as evaluated from CT scans are available for 88 patients. Complete disappearance of tumour was recorded in 3 (3%), partial response in 19 (22%), stable

Multifaceted Health Benefits of Mangifera indica L. (Mango): The Inestimable Value of Orchards Recently Planted in Sicilian Rural Areas.

Science.gov (United States)

Lauricella, Marianna; Emanuele, Sonia; Calvaruso, Giuseppe; Giuliano, Michela; D'Anneo, Antonella

2017-05-20

Historically, Mangifera indica L. cultivations have been widely planted in tropical areas of India, Africa, Asia, and Central America. However, at least 20 years ago its spreading allowed the development of some cultivars in Sicily, an island to the south of Italy, where the favourable subtropical climate and adapted soils represent the perfect field to create new sources of production for the Sicilian agricultural supply chain. Currently, cultivations of Kensington Pride, Keitt, Glenn, Maya, and Tommy Atkins varieties are active in Sicily and their products meet the requirements of local and European markets. Mango plants produce fleshy stone fruits rich in phytochemicals with an undisputed nutritional value for its high content of polyphenolics and vitamins. This review provides an overview of the antioxidant, anti-inflammatory, and anticancer properties of mango, a fruit that should be included in everyone's diet for its multifaceted biochemical actions and health-enhancing properties.

Mainstream Media and Social Media Reactions to the Discovery of Extraterrestrial Life

Science.gov (United States)

Jones, Morris

The rise of online social media (such as Facebook and Twitter) has overturned traditional top-down and stovepiped channels for mass communications. As social media have risen, traditional media sources have been steadily crippled by economic problems, resulting in a loss of capabilities and credibility. Information can propagate rapidly without the inclusion of traditional editorial checks and controls. Mass communications strategies for any type of major announcement must account for this new media landscape. Scientists announcing the discovery of extraterrestrial life will trigger a multifaceted and unpredictable percolation of the story through the public sphere. They will also potentially struggle with misinformation, rumours and hoaxes. The interplay of official announcements with the discussions of an extraterrestrial discovery on social media has parallels with traditional theories of mass communications. A wide spectrum of different messages is likely to be received by different segments of the community, based on their usage patterns of various media and online communications. The presentation and interpretation of a discovery will be hotly debated and contested within online media environments. In extreme cases, this could lead to "editorial wars" on collaborative media projects as well as cyber-attacks on certain online services and individuals. It is unlikely that a clear and coherent message can be propagated to a near-universal level. This has the potential to contribute to inappropriate reactions in some sectors of the community. Preventing unnecessary panic will be a priority. In turn, the monitoring of online and social media will provide a useful tool for assessing public reactions to a discovery of extraterrestrial life. This will help to calibrate public communications strategies following in the wake of an initial announcement.

Sense of agency and mentalizing: dissociation of subdomains of social cognition in patients with schizophrenia.

Science.gov (United States)

Schimansky, Jenny; David, Nicole; Rössler, Wulf; Haker, Helene

2010-06-30

The sense of agency, i.e., the sense that "I am the one who is causing an action", and mentalizing, the ability to understand the mental states of other individuals, are key domains of social cognition. It has been hypothesized that an intact sense of agency is an important precondition for higher-level mentalizing abilities. A substantial body of evidence shows that both processes rely on similar brain areas and are severely impaired in schizophrenia, suggesting a close link between agency and mentalizing. Yet this relationship has not been explicitly tested. We investigated 40 individuals with schizophrenia and 40 healthy controls on an agency and mentalizing task. On the agency task, participants carried out simple mouse movements and judged the partially manipulated visual feedback as either self- or other-generated. On the mentalizing task, participants inferred mental states from pictures that depicted others' eyes ("Reading the mind in the eyes test"). Neuropsychological, psychopathological and social functioning levels were also evaluated. Both sense of agency and mentalizing were impaired in schizophrenia patients compared to healthy controls. However, testing for a relationship revealed no significant correlations between the two processes, either in the schizophrenia or the control group. The present findings demonstrate a dissociation of agency and mentalizing deficits in schizophrenia, suggesting that the multifaceted construct of social cognition consists of independent subdomains in healthy and psychiatrically ill individuals.

A multicentre molecular analysis of hepatitis B and blood-borne virus coinfections in Viet Nam.

Science.gov (United States)

Dunford, Linda; Carr, Michael J; Dean, Jonathan; Nguyen, Linh Thuy; Ta Thi, Thu Hong; Nguyen, Binh Thanh; Connell, Jeff; Coughlan, Suzie; Nguyen, Hien Tran; Hall, William W; Thi, Lan Anh Nguyen

2012-01-01

Hepatitis B (HBV) infection is endemic in Viet Nam, with up to 8.4 million individuals estimated to be chronically infected. We describe results of a large, multicentre seroepidemiological and molecular study of the prevalence of HBV infection and blood-borne viral coinfections in Viet Nam. Individuals with varying risk factors for infection (n = 8654) were recruited from five centres; Ha Noi, Hai Phong, Da Nang, Khanh Hoa and Can Tho. A mean prevalence rate of 10.7% was observed and levels of HBsAg were significantly higher in injecting drug users (IDUs) (17.4%, n = 174/1000) and dialysis patients (14.3%, n = 82/575) than in lower-risk groups (9.4%; pViet Nam and also highlights the significant levels of blood-borne virus coinfections, which have important implications for hepatitis-related morbidity and development of effective management strategies.

Role of the internet as an information resource before anaesthesia consultation: A French prospective multicentre survey.

Science.gov (United States)

Nucci, Bastian; Claret, Pierre-Geraud; Leclerc, Gilles; Chaumeron, Arnaud; Grillo, Philippe; Buleon, Clément; Leprince, Vincent; Raux, Mathieu; Minville, Vincent; Futier, Emmanuel; Lefrant, Jean-Yves; Cuvillon, Philippe

2017-12-01

Use of the internet as an information search tool has increased dramatically. Our study assessed preoperative use of the internet by patients to search for information regarding anaesthesia, surgery, pain or outcomes. The aim of this study was to test whether patients used the internet prior to surgery and what kinds of information they looked for (anaesthetic technique, pain, adverse events, outcomes and surgery). Correlation between patient age and information sought about surgery from the internet was also explored. A prospective multicentre observational study. In total, 14 French private and public institutions from May 2015 to January 2016. In total, 3161 adult patients scheduled for elective surgery under regional or general anaesthesia. An anonymous questionnaire was presented to adult patients scheduled for elective surgery under regional or general anaesthesia for completion before the first meeting with the anaesthesiologist. The investigator at each centre completed specific items that the patient could not complete. We defined the primary endpoint as the number of patients who searched for information about their anaesthesia or surgery on the internet by the time of the their preanaesthetic consultation. Of the 3234 questionnaires distributed, responses were received from 3161 patients. Within this respondent sample, 1304 (45%) were professionally active and 1664 (59%) used the internet at least once per day. Among 3098 (98%) patients who answered the question concerning the primary endpoint, 1506 (48%) had searched the internet for information about their health. In total, 784 (25%) used the internet to find information about their surgery and 113 (3.5%) looked for specific information about anaesthesia. Of the 3161, 52% reported difficulty searching for appropriate information about anaesthesia on the internet. 'Daily use of the web' [odds ratio (OR) 2.0; (95% CI: 1.65 to 2.55) P internet was not widely used by patients scheduled for elective

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

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

Science.gov (United States)

Snowdon, Claire; Elbourne, Diana R; Garcia, Jo; Campbell, Marion K; Entwistle, Vikki A; Francis, David; Grant, Adrian M; Knight, Rosemary C; McDonald, Alison M; Roberts, Ian

2006-12-21

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). 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. 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. This study highlights complex financial aspects of planning and conducting trials, especially where multiple funders are involved. Recognition of the importance of financial

Correction to white-johnson, ford, and sellers (2010).

Science.gov (United States)

2015-01-01

Reports an error in "Parental racial socialization profiles: Association with demographic factors, racial discrimination, childhood socialization, and racial identity" by Rhonda L. White-Johnson, Kahlil R. Ford and Robert M. Sellers (Cultural Diversity and Ethnic Minority Psychology, 2010[Apr], Vol 16[2], 237-247). In the article, there was an error in the Measures subsection. The following citation should have been included in the third paragraph " Mothers' childhood racial socialization experiences. Prior racial socialization messages were assessed using four items adapted from the Comprehensive Race Socialization Inventory (Lesane- Brown, Brown, Caldwell, & Sellers, 2005)." Additionally, the included reference should have been included in the Reference section. (The following abstract of the original article appeared in record 2010-07475-016.) The authors examined patterns of racial socialization practices in a sample of 212 African American mothers. They investigated the relation between parent profiles of racial socialization messages with child and parent demographic factors and race-related experiences, as well as parent racial identity attitudes. Using latent class analyses, the authors identified 3 patterns of parent-reported racial socialization experiences: multifaceted, low race salience, and unengaged. In general, findings indicate that mothers in the multifaceted profile were more educated, experienced more racial discrimination, and talked about race during their childhood more than mothers in the unengaged profile. The multifaceted profile also differed from the low race salience and unengaged profiles on several racial identity dimensions. Although the patterned approach used in this study lends itself to a more complex study of racial socialization in future research, it also highlights the associations between parent's race-relevant experiences and the messages they communicate to their children about race. (PsycINFO Database Record (c) 2015 APA

Serum C-reactive protein concentration as an indicator of remission status in dogs with multicentric lymphoma

DEFF Research Database (Denmark)

Nielsen, Lise; Toft, Nils; Eckersall, David

2007-01-01

Background: The acute-phase protein C-reactive protein (CRP) is used as a diagnostic and prognostic marker in humans with various neoplasias, including non-Hodgkin's lymphoma. Objective: To evaluate if CRP could be used to detect different remission states in dogs with lymphoma. Animals: Twenty......-two dogs with untreated multicentric lymphoma. Methods: Prospective observational study. Blood samples were collected at the time of diagnosis, before each chemotherapy session, and at follow-up visits, resulting in 287 serum samples. Results: Before therapy, a statistically significant majority...... of the dogs (P = .0019) had CRP concentrations above the reference range (68%, 15/22). After achieving complete remission 90% (18/20) of the dogs had CRP concentrations within the reference range, and the difference in values before and after treatment was statistically significant (P

Associations of Sexual Victimization, Depression, and Sexual Assertiveness with Unprotected Sex: A Test of the Multifaceted Model of HIV Risk Across Gender

Science.gov (United States)

Morokoff, Patricia J.; Redding, Colleen A.; Harlow, Lisa L.; Cho, Sookhyun; Rossi, Joseph S.; Meier, Kathryn S.; Mayer, Kenneth H.; Koblin, Beryl; Brown-Peterside, Pamela

2014-01-01

This study examined whether the Multifaceted Model of HIV Risk (MMOHR) would predict unprotected sex based on predictors including gender, childhood sexual abuse (CSA), sexual victimization (SV), depression, and sexual assertiveness for condom use. A community-based sample of 473 heterosexually active men and women, aged 18–46 years completed survey measures of model variables. Gender predicted several variables significantly. A separate model for women demonstrated excellent fit, while the model for men demonstrated reasonable fit. Multiple sample model testing supported the use of MMOHR in both men and women, while simultaneously highlighting areas of gender difference. Prevention interventions should focus on sexual assertiveness, especially for CSA and SV survivors, as well as targeting depression, especially among men. PMID:25018617

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; van Middendorp, Henriët; Halvorsen, Jon Anders; Balieva, Flora; Szepietowski, Jacek C; Romanov, Dmitry; Marron, Servando E; Altunay, Ilknur K; Finlay, Andrew Y; Salek, Sam S; Dalgard, Florence

2017-07-06

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.

Multi-faceted case management: reducing compensation costs of musculoskeletal work injuries in Australia.

Science.gov (United States)

Iles, Ross Anthony; Wyatt, M; Pransky, G

2012-12-01

This study aimed to determine whether a multi-faceted model of management of work related musculoskeletal disorders reduced compensation claim costs and days of compensation for injured workers. An intervention including early reporting, employee centred case management and removal of barriers to return to work was instituted in 16 selected companies with a combined remuneration over $337 million. Outcomes were evaluated by an administrative dataset from the Victorian WorkCover Authority database. A 'quasi experimental' pre-post design was employed with 492 matched companies without the intervention used as a control group and an average of 21 months of post-intervention follow-up. Primary outcomes were average number of days of compensation and average cost of claims. Secondary outcomes were total medical costs and weekly benefits paid. Information on 3,312 claims was analysed. In companies where the intervention was introduced the average cost of claims was reduced from $6,019 to $3,913 (estimated difference $2,329, 95 % CI $1,318-$3,340) and the number of days of compensation decreased from 33.5 to 14.1 (HR 0.77, 95 % CI 0.67-0.88). Medical costs and weekly benefits costs were also lower after the intervention (p costs were noted across industry types, injury location and most employer sizes. The model of claims management investigated was effective in reducing the number of days of compensation, total claim costs, total medical costs and the amount paid in weekly benefits. Further research should investigate whether the intervention improves non-financial outcomes in the return to work process.

Evaluating Patient Activation Measure (PAM) Scores and Readmission Rates Following Implementation of a Nurse-Initiated Multi-Faceted Strategy for Patients on a U.S. Navy Inpatient Oncology Unit: A Quality Improvement Project

Science.gov (United States)

2016-06-30

5b. GRANT NUMBER N/A of a Nurse-Initiated Multi-Faceted Strategy for Patients on a U.S. Navy Inpatient Oncology Unit: A Quality...13. SUPPLEMENTARY NOTES N/A 14. ABSTRACT Background: Chronically ill patients often experience multiple hospitalizations. Oncology patients...have been shown to have more readmissions to the hospital than non- oncology patients. Recent reports estimate a $17.4 billion cost burden is

Can Health 2.0 Address Critical Healthcare Challenges? Insights from the Case of How Online Social Networks Can Assist in Combatting the Obesity Epidemic

Directory of Open Access Journals (Sweden)

Janine Hacker

2017-03-01

Full Text Available One of the serious concerns in healthcare in this 21st century is obesity. While the causes of obesity are multifaceted, social networks have been identified as one of the most important dimensions of people's social environment that may influence the adoption of many behaviours, including health-promoting behaviours. In this article, we examine the possibility of harnessing the appeal of online social networks to address the obesity epidemic currently plaguing society. Specifically, a design science research methodology is adopted to design, implement and test the Health 2.0 application called “Calorie Cruncher”. The application is designed specifically to explore the influence of online social networks on individual’s health-related behaviour. In this regard, pilot data collected based on qualitative interviews indicate that online social networks may influence health-related behaviours in several ways. Firstly, they can influence people’s norms and value system that have an impact on their health-related behaviours. Secondly, social control and pressure of social connections may also shape health-related behaviours, and operate implicitly when people make food selection decisions. Thirdly, social relationships may provide emotional support. Our study has implications for research and practice. From a theoretical perspective, the article inductively identifies three factors that influence specific types of health outcomes in the context of obesity. From a practical perspective, the study underscores the benefits of adopting a design science methodology to design and implement a technology solution for a healthcare issue as well as the key role for online social media to assist with health and wellness management and maintenance.

The onset and offset of psychosis--and what happens in between--a commentary on ‘Reappraising the long-term course and outcome of psychotic disorders: the AESOP-10 Study’ by Morgan et al. (2014).

Science.gov (United States)

McGrath, J J; Miettunen, J; Jääskeläinen, E; Dark, F

2014-10-01

As one would expect for a heterogeneous syndrome like schizophrenia, at the individual level the course of symptoms and disability vary widely. Mindful that the definition of recovery/remission varies widely between studies, a recent systematic review and meta-analysis reported that the proportion of those with schizophrenia who recover on both symptom and functional outcome is modest (approximately 14%). A 10-year follow-up of the English multicentre AESOP incidence study provides more 'fine-grained' insights into the time course of symptom fluctuation for schizophrenia and other psychotic disorders. We highlight selected findings from the new study and speculate on the role of different outcome domains for future study (e.g., symptom, occupational/functional, cognition, physical health, patient-nominated outcomes). Because recovery is a multifaceted process, we need to develop a panel of practical and operationalizable criteria for remission and recovery.

A pragmatic multi-centre randomised controlled trial of fluid loading and level of dependency in high-risk surgical patients undergoing major elective surgery: trial protocol

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Norrie John

2010-04-01

Full Text Available Abstract Background Patients undergoing major elective or urgent surgery are at high risk of death or significant morbidity. Measures to reduce this morbidity and mortality include pre-operative optimisation and use of higher levels of dependency care after surgery. We propose a pragmatic multi-centre randomised controlled trial of level of dependency and pre-operative fluid therapy in high-risk surgical patients undergoing major elective surgery. Methods/Design A multi-centre randomised controlled trial with a 2 * 2 factorial design. The first randomisation is to pre-operative fluid therapy or standard regimen and the second randomisation is to routine intensive care versus high dependency care during the early post-operative period. We intend to recruit 204 patients undergoing major elective and urgent abdominal and thoraco-abdominal surgery who fulfil high-risk surgical criteria. The primary outcome for the comparison of level of care is cost-effectiveness at six months and for the comparison of fluid optimisation is the number of hospital days after surgery. Discussion We believe that the results of this study will be invaluable in determining the future care and clinical resource utilisation for this group of patients and thus will have a major impact on clinical practice. Trial Registration Trial registration number - ISRCTN32188676

European multicentre double-blind placebo-controlled trial of Nilvadipine in mild-to-moderate Alzheimer's disease-the substudy protocols: NILVAD frailty; NILVAD blood and genetic biomarkers; NILVAD cerebrospinal fluid biomarkers; NILVAD cerebral blood flow

NARCIS (Netherlands)

Meulenbroek, O.V.; O'Dwyer, S.; Jong, D. de; Spijker, G.J. van; Kennelly, S.; Cregg, F.; Olde Rikkert, M.G.M.; Abdullah, L.; Wallin, A.; Walsh, C.; Coen, R.; Kenny, R.A.; Daly, L.; Segurado, R.; Borjesson-Hanson, A.; Crawford, F.; Mullan, M.; Lucca, U.; Banzi, R.; Pasquier, F.; Breuilh, L.; Riepe, M.; Kalman, J.; Molloy, W.; Tsolaki, M.; Howard, R.; Adams, J.; Gaynor, S.; Lawlor, B.

2016-01-01

INTRODUCTION: In conjunction with the NILVAD trial, a European Multicentre Double-Blind Placebo Controlled trial of Nilvadipine in Mild-to-Moderate Alzheimer's disease (AD), there are four NILVAD substudies in which eligible NILVAD patients are also invited to participate. The main NILVAD protocol

A multi-centre clinical follow-up database as a systematic approach to the evaluation of mid- and long-term health consequences in Chernobyl acute radiation syndrome patients

International Nuclear Information System (INIS)

Fischer, B.; Weiss, M.; Fliedner, T.M.; Belyi, D.A.; Kovalenko, A.N.; Bebeshko, V.G.; Nadejina, N.M.; Galstian, I.A.

1996-01-01

This paper describes scope, design and first results of a multi-centre follow-up database that has been established for the evaluation of mid- and long-term health consequences of acute radiation syndrome (ARS) survivors. After the Chernobyl accident on 26 April 1986, 237 cases with suspected acute radiation syndrome have been reported. For 134 of these cases the diagnosis of ARS was confirmed in a consensus conference three years after the accident. Nearly all survivors underwent regular follow-up examinations in two specialized centres in Kiev and in Moscow. In collaboration with these centres we established a multi-centre clinical follow-up database that records the results of the follow-up examinations in a standardized schema. This database is an integral part of a five step approach to patient evaluation and aims at a comprehensive base for scientific analysis of the mid- and long-term consequences of accidental ionizing radiation. It will allow for a dynamic view on the development of the health status of individuals and groups of patients as well as the identification of critical organ systems that need early support, and an improvement of acute and follow-up treatment protocols for radiation accident victims

Design of an international multicentre RCT on group schema therapy for borderline personality disorder.

Science.gov (United States)

Wetzelaer, Pim; Farrell, Joan; Evers, Silvia M A A; Jacob, Gitta A; Lee, Christopher W; Brand, Odette; van Breukelen, Gerard; Fassbinder, Eva; Fretwell, Heather; Harper, R Patrick; Lavender, Anna; Lockwood, George; Malogiannis, Ioannis A; Schweiger, Ulrich; Startup, Helen; Stevenson, Teresa; Zarbock, Gerhard; Arntz, Arnoud

2014-11-18

Borderline personality disorder (BPD) is a severe and highly prevalent mental disorder. Schema therapy (ST) has been found effective in the treatment of BPD and is commonly delivered through an individual format. A group format (group schema therapy, GST) has also been developed. GST has been found to speed up and amplify the treatment effects found for individual ST. Delivery in a group format may lead to improved cost-effectiveness. An important question is how GST compares to treatment as usual (TAU) and what format for delivery of schema therapy (format A; intensive group therapy only, or format B; a combination of group and individual therapy) produces the best outcomes. An international, multicentre randomized controlled trial (RCT) will be conducted with a minimum of fourteen participating centres. Each centre will recruit multiple cohorts of at least sixteen patients. GST formats as well as the orders in which they are delivered to successive cohorts will be balanced. Within countries that contribute an uneven number of sites, the orders of GST formats will be balanced within a difference of one. The RCT is designed to include a minimum of 448 patients with BPD. The primary clinical outcome measure will be BPD severity. Secondary clinical outcome measures will include measures of BPD and general psychiatric symptoms, schemas and schema modes, social functioning and quality of life. Furthermore, an economic evaluation that consists of cost-effectiveness and cost-utility analyses will be performed using a societal perspective. Lastly, additional investigations will be carried out that include an assessment of the integrity of GST, a qualitative study on patients' and therapists' experiences with GST, and studies on variables that might influence the effectiveness of GST. This trial will compare GST to TAU for patients with BPD as well as two different formats for the delivery of GST. By combining an evaluation of clinical effectiveness, an economic evaluation

Ocular and multicentric T-cell lymphoma in horse

Directory of Open Access Journals (Sweden)

Mariana C. Oliveira

2016-11-01

Full Text Available ABSTRACT. Oliveira M.C., Faleiro R.D., Santos C.C.A., Oliveira G.F., Daoualibi Y., Sonne L., Brito M.F. & Ubiali D.G. [Ocular and multicentric T-cell lymphoma in horse.] Linfoma de células T multicêntrico e ocular em equino. Revista Brasileira de Medicina Veterinária, 38(Supl.2:147-151, 2016. Setor de Anatomia Patológica, Departamento Epidemiologia e Saúde Pública, Universidade Federal Rural do Rio de Janeiro, BR 465 Km 7, Seropédica, RJ 23890-000, Brasil. E-mail: danielubiali@hotmail.com A 10-year-old gelding, mixed breed had body score condition 3 (1-10, with reluctance to move due to the loss of visual acuity in both eyes, right eye swelling and marked dyspnea. The ophthalmic examination showed no response to threat of reflection, objects test or direct reflection and consensus of both eyes. Examination with visor magnifier and Finoff transilluminator revealed buftalmia, hyphema, aqueous flare, corneal neovascularization and posterior synechiae with irregular bulging of the iris in the right eye and aqueous flare, central anterior synechiae and mature cataract in the left eye. It was found corneal integrity in both eyes with the fluorescein test. Urine sample submitted for PCR to Leptospira sp. resulted negative. Euthanasia was performed after unsuccessful treatment attempts. At necropsy there was a mass in the right eyeball, the pleural surface of the diaphragm and the mesentery. There was multifocal to coalescing whitish nodules between 1 and 4 cm in diameter in the lung, filling about 80% of the lungs’ surface, mainly in the ventral region. Morphology of masses was histopathologically compatible with lymphoma. Anti-CD3 antibody resulted positive in all samples analyzed characterizing immunophenotypic T-cell lymphoma.

Multicentre prospective evaluation of implant-assisted mandibular removable partial dentures: surgical and prosthodontic outcomes.

Science.gov (United States)

Payne, Alan G T; Tawse-Smith, Andrew; Wismeijer, Daniel; De Silva, Rohana K; Ma, Sunyoung

2017-01-01

To determine implant survival and prosthodontic maintenance of implant-assisted mandibular removable partial dentures in a multicentre prospective study up to 10 years. Forty-eight participants with mandibular distal extension partial dentures were selected. A control group of 12 New Zealand participants had new conventional mandibular partial dentures made. Three test groups of 36 participants in New Zealand (n = 12), the Netherlands (n = 12) and Colombia (n = 12) had bilateral distal implants placed. Surgical and prosthodontic outcomes were documented with only healing caps placed (Stage 1) and with an attachment system (Stage 2). No implants failed after 3 years. Four late implant failures in three participants occurred in New Zealand (two unilateral implant failures after 5 and 8 years and two bilateral implant failures in the same participant after 6 and 10 years); two unilateral late implant failures occurred in the Netherlands and no late failures in Colombia. Implant survival rate was 92% by 10 years. Resonance frequency measurements were taken at surgery implant stability quotient (ISQ) 62.44 ± 7.46; range 40 - 79), baseline (ISQ 63.22 ± 6.17; range 50 - 74) and after 3 years (ISQ 66.38 ± 6.77; range 55 - 83). In New Zealand and Colombia, measured crestal bone levels were 2.03 ± 0.71 mm and 2.20 ± 0.81 mm, respectively, at baseline and 3 years. For Stage I, principal prosthodontic maintenance issues were loose healing caps among 10 New Zealand participants, four Colombian participants and one Netherlands participant. For Stage 2, matrix activation and overdenture puncture fractures resulted in 41 events (25 participants) in New Zealand over 10 years, whilst over 3 years, there were 14 events in nine Colombian participants and six events in five Netherlands participants. This clinical multicentre research complements previous case reports, case series, retrospective and prospective studies on the notion of implant

Physical and social functional abilities seem to be maintained by a multifaceted randomized controlled nutritional intervention among old (> 65 years) Danish nursing home residents

DEFF Research Database (Denmark)

Beck, Anne Marie; Damkjær, K.; Sorbye, L. W.

2010-01-01

of nutrition (chocolate, homemade oral supplements), group exercise (moderate intensity) and oral care. Measurements taken were weight, body mass index (BMI), energy and protein intake, and functional abilities (activities of daily living = ADL, cognitive performance, and social engagement). The results showed...

Multifaceted Impact of Self-Efficacy Beliefs on Academic Functioning.

Science.gov (United States)

Bandura, Albert; And Others

1996-01-01

Analyzed the psychosocial influences through which efficacy beliefs affect academic achievement. Found that parents' sense of academic efficacy and aspirations for their children, children's beliefs in their efficacy to regulate their own learning and academic attainments, children's perceived social efficacy and ability to manage peer pressure,…

The outcome of a multi-centre feasibility study of online adaptive radiotherapy for muscle-invasive bladder cancer TROG 10.01 BOLART

International Nuclear Information System (INIS)

Foroudi, Farshad; Pham, Daniel; Rolfo, Aldo; Bressel, Mathias; Tang, Colin I.; Tan, Alex; Turner, Sandra; Hruby, George; Williams, Stephen; Hayne, Dickon; Lehman, Margot; Skala, Marketa; Jose, Chakiath C.; Gogna, Kumar; Kron, Tomas

2014-01-01

Purpose: To assess whether online adaptive radiotherapy for bladder cancer is feasible across multiple Radiation Oncology departments using different imaging, delivery and recording technology. Materials and methods: A multi-centre feasibility study of online adaptive radiotherapy, using a choice of three “plan of the day”, was conducted at 12 departments. Patients with muscle-invasive bladder cancer were included. Departments were activated if part of the pilot study or after a site-credentialing visit. There was real time review of the first two cases from each department. Results: 54 patients were recruited, with 50 proceeding to radiotherapy. There were 43 males and 7 females with a mean age of 78 years. The tumour stages treated included T1 (1 patient), T2 (35), T3 (10) and T4 (4). One patient died of an unrelated cause during radiotherapy. The three adaptive plans were created before the 10th fraction in all cases. In 8 (16%) of the patients, a conventional plan using a ‘standard’ CTV to PTV margin of 1.5 cm was used for one or more fractions where the pre-treatment bladder CTV was larger than any of the three adaptive plans. The bladder CTV extended beyond the PTV on post treatment imaging in 9 (18%) of the 49 patients. Conclusions: From a technical perspective an online adaptive radiotherapy technique can be instituted in a multi-centre setting. However, without further bladder filling control or imaging, a CTV to PTV margin of 7 mm is insufficient

Building a Foundation against Violence: Impact of a School-Based Prevention Program on Elementary Students

Science.gov (United States)

Hall, Bruce W.; Bacon, Tina P.

2005-01-01

This study examined the effectiveness of the Too Good for Violence Prevention Program (TGFV), a multifaceted interactive intervention. Grounded in Bandura's Social Learning Theory, the TGFV curricula focus on developing personal and interpersonal skills to solve conflict non-violently and resist social influences that lead to violence.…

Resilience research and policy/practice discourse in health, social, behavioral, and environmental sciences over the last ten years.

Science.gov (United States)

Almedom, Astier M

2008-12-01

Resilience research has gained increased scientific interest and political currency over the last ten years. To set this volume in the wider context of scholarly debate conducted in previous special theme issue and/or special section publications of refereed journals on resilience and related concepts (1998-2008). Peer reviewed journals of health, social, behavioral, and environmental sciences were searched systematically for articles on resilience and/or related themes published as a set. Non-English language publications were included, while those involving non-human subjects were excluded. A total of fifteen journal special issues and/or special sections (including a debate and a roundtable discussion) on resilience and/or related themes were retrieved and examined with the aim of teasing out salient points of direct relevance to African social policy and health care systems. Viewed chronologically, this series of public discussions and debates charts a progressive paradigm shift from the pathogenic perspectives on risk and vulnerability to a clear turn of attention to health-centered approaches to building resilience to disasters and preventing vulnerability to disease, social dysfunction, human and environmental resource depletion. Resilience is a dynamic and multi-dimensional process of adaptation to adverse and/or turbulent changes in human, institutional, and ecological systems across scales, and thus requires a composite, multi-faceted Resilience Index (RI), in order to be meaningfully gauged. Collaborative links between interdisciplinary research institutions, policy makers and practitioners involved in promoting sustainable social and health care systems are called for, particularly in Africa.

The Youth Empowered for Success Program: A Multi-faceted Approach to Youth Leadership Development and School Culture Change in Southern Arizona

Directory of Open Access Journals (Sweden)

Pam Parrish

2008-09-01

Full Text Available Arizona’s first Teen Institute (TI program, Youth Empowered for Success, began in July 2004. It is the first TI-based project to focus on nurturing resilience via Health Realization (Pransky, 2007. The YES program’s design to “create conditions for success” in high schools is discussed. YES utilizes a strengths-based, multi-faceted approach of (1 teaching participants how to access their innate resilience and common sense (Health Realization, (2 training them in community development for school culture change and (3 helping them develop meaningful partnerships with adults. YES also expands upon the TI model by providing staff support for community development throughout the academic year. It is hypothesized that these efforts ultimately will increase overall well-being and reduce the incidence of alcohol, tobacco and other drug use (ATOD as well as depression and suicide among youth.

Ten-year decrease of acquired methicillin-resistant Staphylococcus aureus (MRSA bacteremia at a single institution: the result of a multifaceted program combining cross-transmission prevention and antimicrobial stewardship

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Chalfine Annie

2012-05-01

Full Text Available Abstract Background In France, the proportion of MRSA has been over 25% since 2000. Prevention of hospital-acquired (HA MRSA spread is based on isolation precautions and antibiotic stewardship. At our institution, before 2000, the Infection Disease and the Infection Control teams had failed to reduce HA-MRSA rates. Objectives and methods We implemented a multifaceted hospital-wide prevention program and measured the effects on HA-MRSA colonization and bacteremia rates between 2000 and 2009. From 2000 to 2003, active screening and decontamination of ICU patients, hospital wide alcohol based hand rubs (ABHR use, control of specific classes of antibiotics, compliance audits, and feed-backs to the care providers were successively implemented. The efficacy of the program was assessed by HA-MRSA colonized and bacteremic patient rates per 1000 patient-days in patients hospitalized for more than twenty-four hours. Results Compliance with the isolation practices increased between 2000 and 2009. Consumption of ABHR increased from 6.8 L to 27.5 L per 1000 patient-days. The use of antibiotic Defined Daily Doses (DDD per 1000 patient-days decreased by 31%. HA-MRSA colonization decreased by 84% from 1.09 to 0.17 per 1000 patient-days and HA-MRSA bacteremia by 93%, from 0.15 to 0.01 per 1000 patient-days (p −7 for each rate. Conclusions In an area highly endemic for MRSA, a multifaceted prevention program allows for sustainable reduction in HA-MRSA bacteremia rates.

A multicentre audit of HDR/PDR brachytherapy absolute dosimetry in association with the INTERLACE trial (NCT015662405)

Science.gov (United States)

Díez, P.; Aird, E. G. A.; Sander, T.; Gouldstone, C. A.; Sharpe, P. H. G.; Lee, C. D.; Lowe, G.; Thomas, R. A. S.; Simnor, T.; Bownes, P.; Bidmead, M.; Gandon, L.; Eaton, D.; Palmer, A. L.

2017-12-01

A UK multicentre audit to evaluate HDR and PDR brachytherapy has been performed using alanine absolute dosimetry. This is the first national UK audit performing an absolute dose measurement at a clinically relevant distance (20 mm) from the source. It was performed in both INTERLACE (a phase III multicentre trial in cervical cancer) and non-INTERLACE brachytherapy centres treating gynaecological tumours. Forty-seven UK centres (including the National Physical Laboratory) were visited. A simulated line source was generated within each centre’s treatment planning system and dwell times calculated to deliver 10 Gy at 20 mm from the midpoint of the central dwell (representative of Point A of the Manchester system). The line source was delivered in a water-equivalent plastic phantom (Barts Solid Water) encased in blocks of PMMA (polymethyl methacrylate) and charge measured with an ion chamber at 3 positions (120° apart, 20 mm from the source). Absorbed dose was then measured with alanine at the same positions and averaged to reduce source positional uncertainties. Charge was also measured at 50 mm from the source (representative of Point B of the Manchester system). Source types included 46 HDR and PDR 192Ir sources, (7 Flexisource, 24 mHDR-v2, 12 GammaMed HDR Plus, 2 GammaMed PDR Plus, 1 VS2000) and 1 HDR 60Co source, (Co0.A86). Alanine measurements when compared to the centres’ calculated dose showed a mean difference (±SD) of  +1.1% (±1.4%) at 20 mm. Differences were also observed between source types and dose calculation algorithm. Ion chamber measurements demonstrated significant discrepancies between the three holes mainly due to positional variation of the source within the catheter (0.4%-4.9% maximum difference between two holes). This comprehensive audit of absolute dose to water from a simulated line source showed all centres could deliver the prescribed dose to within 5% maximum difference between measurement and calculation.

Growth optimization and characterization of GaN epilayers on multifaceted (111) surfaces etched on Si(100) substrates

Energy Technology Data Exchange (ETDEWEB)

Ansah-Antwi, KwaDwo Konadu, E-mail: kakadee@gmail.com; Chua, Soo Jin [Institute of Materials Research and Engineering (IMRE), A*STAR (Agency for Science, Technology and Research), 2 Fusionopolis Way, Innovis # 08-03, Singapore 138634 (Singapore); Department of Electrical and Computer Engineering, National University of Singapore, E4-5-45, 4 Engineering Drive 3, Singapore 117576 (Singapore); Soh, Chew Beng [Singapore Institute of Technology, 10 Dover Drive, Singapore 138683 (Singapore); Liu, Hongfei [Institute of Materials Research and Engineering (IMRE), A*STAR (Agency for Science, Technology and Research), 2 Fusionopolis Way, Innovis # 08-03, Singapore 138634 (Singapore)

2015-11-15

The four nearest Si(111) multifaceted sidewalls were exposed inside an array of 3 μm-wide square holes patterned on an Si(100) substrate, and this patterned Si(100) substrate was used as a substrate for the deposition of a gallium nitride (GaN) epilayer. Subsequently the effect that the growth pressure, the etched-hole profiles, and the etched-hole arrangement had upon the quality of the as-grown GaN was investigated. The coalescence of the as-grown GaN epilayer on the exposed Si(111) facets was observed to be enhanced with reduced growth pressure from 120 to 90 Torr. A larger Si(001) plane area at the bottom of the etched holes resulted in bidirectional GaN domains, which resulted in poor material quality. The bidirectional GaN domains were observed as two sets of six peaks via a high-resolution x-ray diffraction phi scan of the GaN(10-11) reflection. It was also shown that a triangular array of etched holes was more desirable than square arrays of etched holes for the growth high-quality and continuous GaN films.

Fructose and NAFLD: The Multifaceted Aspects of  Fructose Metabolism.

Science.gov (United States)

Jegatheesan, Prasanthi; De Bandt, Jean-Pascal

2017-03-03

Among various factors, such as an unhealthy diet or a sedentarity lifestyle, excessive fructose consumption is known to favor nonalcoholic fatty liver disease (NAFLD), as fructose is both a substrate and an inducer of hepatic de novo lipogenesis. The present review presents some well-established mechanisms and new clues to better understand the pathophysiology of fructose-induced NAFLD. Beyond its lipogenic effect, fructose intake is also at the onset of hepatic inflammation and cellular stress, such as oxidative and endoplasmic stress, that are key factors contributing to the progression of simple steatosis to nonalcoholic steatohepatitis (NASH). Beyond its hepatic effects, this carbohydrate may exert direct and indirect effects at the peripheral level. Excessive fructose consumption is associated, for example, with the release by the liver of several key mediators leading to alterations in the communication between the liver and the gut, muscles, and adipose tissue and to disease aggravation. These multifaceted aspects of fructose properties are in part specific to fructose, but are also shared in part with sucrose and glucose present in energy- dense beverages and foods. All these aspects must be taken into account in the development of new therapeutic strategies and thereby to better prevent NAFLD.

Meeting the challenges of recruitment to multicentre, community-based, lifestyle-change trials: a case study of the BeWEL trial.

Science.gov (United States)

Treweek, Shaun; Wilkie, Erna; Craigie, Angela M; Caswell, Stephen; Thompson, Joyce; Steele, Robert J C; Stead, Martine; Anderson, Annie S

2013-12-18

Recruiting participants to multicentre, community-based trials is a challenge. This case study describes how this challenge was met for the BeWEL trial, which evaluated the impact of a diet and physical activity intervention on body weight in people who had had pre-cancerous bowel polyps. The BeWEL trial was a community-based trial, involving centres linked to the Scottish National Health Service (NHS) colorectal cancer screening programme. BeWEL had a recruitment target of 316 and its primary recruitment route was the colonoscopy clinics of the Scottish Bowel Screening Programme. BeWEL exceeded its recruitment target but needed a 6-month no-cost extension from the funder to achieve this. The major causes of delay were lower consent rates (49% as opposed to 70% estimated from earlier work), the time taken for NHS research and development department approvals and the inclusion of two additional sites to increase recruitment, for which there were substantial bureaucratic delays. A range of specific interventions to increase recruitment, for example, telephone reminders and a shorter participant information leaflet, helped to increase the proportion of eligible individuals consenting and being randomized. Recruitment to multicentre trials is a challenge but can be successfully achieved with a committed team. In a UK context, NHS research and development approval can be a substantial source of delay. Investigators should be cautious when estimating consent rates. If consent rates are less than expected, qualitative analysis might be beneficial, to try and identify the reason. Finally, investigators should select trial sites on the basis of a formal assessment of a site's past performance and the likelihood of success in the trial being planned. Current Controlled Trials ISRCTN53033856.

Elective frozen elephant trunk procedure using the E-Vita Open Plus prosthesis in 94 patients: a multicentre French registry.

Science.gov (United States)

Verhoye, Jean-Philippe; Belhaj Soulami, Reda; Fouquet, Olivier; Ruggieri, Vito Giovanni; Kaladji, Adrien; Tomasi, Jacques; Sellin, Michel; Farhat, Fadi; Anselmi, Amedeo

2017-10-01

Our goal was to evaluate the operative outcomes of the frozen elephant trunk technique using the E-Vita Open Plus® hybrid prosthesis in chronic aortic arch diseases and report clinical and radiological outcomes at the 1-year follow-up. As determined from a prospective multicentre registry, 94 patients underwent frozen elephant trunk procedures using the E-Vita Open Plus hybrid device for the treatment of chronic aortic conditions, including 50% chronic aortic dissections, 40% degenerative aneurysms and 10% miscellaneous indications. Fifty percent of the cases were reoperations. The perioperative mortality rate was 11.7%. Spinal cord ischaemia and stroke rates were 4% and 9.6%, respectively. The mean cardiopulmonary bypass time was 252 ± 97 min, cardiac ischaemia time was 152 ± 53 min and cerebral perfusion time was 82 ± 22 min. Concomitant procedures were observed in 15% of patients. Among the 83 surviving patients, the survival rate after the 1-year follow-up was 98%. Eleven percent of patients underwent endovascular completion, whereas 4% of patients required aortic reintervention at 1 year. The E-Vita Open Plus hybrid device confirms the favourable short- and mid-term outcomes offered by its predecessor in frozen elephant trunk procedures in patients with chronic aortic arch disease. Implantation of the E-Vita Open Plus is associated with good 1-year survival rates, good rates of favourable aortic remodelling in both chronic dissection and degenerative aneurysms and a reproducible technique in a multicentre registry. Continued follow-up is required due to the risk of evolution at the downstream aorta. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Homeopathy in chronic sinusitis: a prospective multi-centric observational study.

Science.gov (United States)

Nayak, Chaturbhuja; Singh, Vikram; Singh, V P; Oberai, Praveen; Roja, Varanasi; Shitanshu, Shashi Shekhar; Sinha, M N; Deewan, Deepti; Lakhera, B C; Ramteke, Sunil; Kaushik, Subhash; Sarkar, Sarabjit; Mandal, N R; Mohanan, P G; Singh, J R; Biswas, Sabyasachi; Mathew, Georgekutty

2012-04-01

The primary objective was to ascertain the therapeutic usefulness of homeopathic medicine in the management of chronic sinusitis (CS). Multicentre observational study at Institutes and Units of the Central Council for Research in Homoeopathy, India. Symptoms were assessed using the chronic sinusitis assessment score (CSAS). 17 pre-defined homeopathic medicines were shortlisted for prescription on the basis of repertorisation for the pathological symptoms of CS. Regimes and adjustment of regimes in the event of a change of symptoms were pre-defined. The follow-up period was for 6 months. Statistical analysis was done using SPSS version 16. 628 patients suffering from CS confirmed on X-ray were enrolled from eight Institutes and Units of the Central Council for Research in Homoeopathy. All 550 patients with at least one follow-up assessment were analyzed. There was a statistically significant reduction in CSAS (P = 0.0001, Friedman test) after 3 and 6 months of treatment. Radiological appearances also improved. A total of 13 out of 17 pre-defined medicines were prescribed in 550 patients, Sil. (55.2% of 210), Calc. (62.5% of 98), Lyc. (69% of 55), Phos. (66.7% of 45) and Kali iod. (65% of 40) were found to be most useful having marked improvement. 4/17 medicines were never prescribed. No complications were observed during treatment. Homeopathic treatment may be effective for CS patients. Controlled trials are required for further validation. Copyright © 2012 Elsevier Ltd. All rights reserved.

Captopril radionuclide test in renovascular hypertension: a European multicentre study

International Nuclear Information System (INIS)

Fommei, E.; Ghione, S.; Hilson, A.J.W.; Mezzasalma, L.; Oei, H.Y.; Piepsz, A.; Volterrani, D.

1993-01-01

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)

Associations between recent gay-related stressful events, emotional distress, social support and unprotected anal intercourse behavior among Chinese men who have sex with men.

Science.gov (United States)

Yunyong, Liu; Zhe, Wang; Junting, Xu; Yan, Zhou; Xiaoxia, An; Li, Zhao; Yuan, Gu; Chao, Jiang

2016-07-01

This study was designed to assess the levels of and associations between gay-related stressful events, social support, emotional distress and the number of unprotected anal intercourse partners among Chinese men who have sex with men. Using a respondent-driven sampling method, 807 men who have sex with men were recruited in urban areas of northeast China and data were collected via face-to-face interviews. Gay-related stressful events were measured using the Gay-Related Stressful Life Events Scale; levels of depression, anxiety symptoms and social support were measured using the Self-Rating Depression Scale, the Self-Rating Anxiety Scale and the Social Support Rating Scale, respectively. Over a quarter of study participants experienced gay-related stressful events during the preceding 3 months. Their average Self-Rating Depression Scale, Self-Rating Anxiety Scale and Social Support scores differed significantly from the national norm. Gay-related stressful events significantly correlated with anxiety (r = 0.167, p Gay-related stressful events are common and are significantly associated with emotional distress, lack of social support and high-risk sexual behaviors among Chinese men who have sex with men. Multifaceted approaches are warranted to increase social support and reduce intolerance toward homosexual behaviors and to reduce risky sexual behaviors related to the rapid HIV epidemic among men who have sex with men population in China. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Low social interactions in eating disorder patients in childhood and adulthood: a multi-centre European case control study.

Science.gov (United States)

Krug, Isabel; Penelo, Eva; Fernandez-Aranda, Fernando; Anderluh, Marija; Bellodi, Laura; Cellini, Elena; di Bernardo, Milena; Granero, Roser; Karwautz, Andreas; Nacmias, Benedetta; Ricca, Valdo; Sorbi, Sandro; Tchanturia, Kate; Wagner, Gudrun; Collier, David; Treasure, Janet

2013-01-01

The objective of this article was to examine lifestyle behaviours in eating disorder (ED) patients and healthy controls. A total of 801 ED patients and 727 healthy controls from five European countries completed the questions related to lifestyle behaviours of the Cross-Cultural Questionnaire (CCQ). For children, the ED sample exhibited more solitary activities (rigorously doing homework [psocializing with friends [pgroup and this continued in adulthood. There were minimal differences across ED sub-diagnoses and various cross-cultural differences emerged. Reduced social activities may be an important risk and maintaining factor for ED symptomatology.

Our Health Is in Our Hands: A Social Marketing Campaign to Combat Obesity and Diabetes.

Science.gov (United States)

George, Kimberly S; Roberts, Calpurnyia B; Beasley, Stephen; Fox, Margaretta; Rashied-Henry, Kweli

2016-03-01

Design, implement, and evaluate a 6-week social marketing campaign (SMC) to raise awareness of obesity and increase involvement in type 2 diabetes prevention, nutrition, and fitness programs offered by the Brooklyn Partnership to Drive Down Diabetes (BP3D) in two low-income, urban communities. This was a nonexperimental, formative research, mixed-methods study. The study took place in Central Brooklyn and East New York, two of the most impoverished, high-need communities in New York City. Participants were black and Hispanic adults, who were 18+ years of age and residing in the priority communities. Advertisements in English and Spanish encouraging healthier eating habits and advocating for better food options were displayed on New York City bus shelters, buses, and subway cars operating in the priority communities. Social media, Web sites, and print material were used to promote the campaign message. Social media metrics and a street intercept postsurvey informed the campaign's success. Quantitative data were analyzed using descriptive statistics. One hundred advertisements in English and Spanish were posted. After an 18-month followup, there were over 11,000 visits to the Facebook page. Results from the postsurvey (n = 171) suggest the SMC motivated participants who recognized the advertisements to improve their health behaviors. A multifaceted SMC that coincides with prevention programs can effectively raise attention to health issues and activities in a high-risk population at a relatively low cost. © The Author(s) 2016.

Attention to Faces in Williams Syndrome

Science.gov (United States)

Riby, Deborah M.; Jones, Nicola; Brown, Philippa H.; Robinson, Lucy J.; Langton, Stephen R. H.; Bruce, Vicki; Riby, Leigh M.

2011-01-01

Williams syndrome (WS) is associated with distinct social behaviours. One component of the WS social phenotype is atypically prolonged face fixation. This behaviour co-exists with attention difficulties. Attention is multi-faceted and may impact on gaze behaviour in several ways. Four experiments assessed (i) attention capture by faces, (ii)…

Wilson loops from multicentre and rotating branes, mass gaps and phase structure in gauge theories

CERN Document Server

Brandhuber, A.

1999-01-01

Within the AdS/CFT correspondence we use multicentre D3-brane metrics to investigate Wilson loops and compute the associated heavy quark-antiquark potentials for the strongly coupled SU(N) super-Yang-Mills gauge theory, when the gauge symmetry is broken by the expectation values of the scalar fields. For the case of a uniform distribution of D3-branes over a disc, we find that there exists a maximum separation beyond which there is no force between the quark and the antiquark, i.e. the screening is complete. We associate this phenomenon with the possible existence of a mass gap in the strongly coupled gauge theory. In the finite-temperature case, when the corresponding supergravity solution is a rotating D3-brane solution, there is a class of potentials interpolating between a Coulombic and a confining behaviour. However, above a certain critical value of the mass parameter, the potentials exhibit a behaviour characteristic of statistical systems undergoing phase transitions. The physical path preserves the c...

Sensitivity of enhanced MRI for the detection of breast cancer: new, multicentric, residual, and recurrent

International Nuclear Information System (INIS)

Davis, P.L.; McCarty, K.S. Jr.

1997-01-01

Magnetic resonance imaging (MRI) of the breast brings the advantages of high resolution cross-sectional imaging to breast cancer diagnosis, treatment and research: improved cancer detection, staging, selection of therapy, evaluation of therapeutic response in vivo, detection of recurrence, and even the development of new therapies. Until now breast cancer treatment and research has been impeded by the limited means of evaluating the breast cancer in vivo: primarily clinical palpation and mammography of the breast tumor. A review of the initial studies shows that with the use of paramagnetic contrast agents, MRI has a sensitivity of 96 % for detecting breast cancers. MRI detects multicentric disease with a sensitivity of 98 %, superior to any other modality. The ability of MRI to detect recurrent local breast cancer in the conservatively treated breast is nearly 100 %. MRI is capable of monitoring tumor response to chemotherapy and actually guiding therapeutic interventions such as interstitial laser photocoagulation. (orig.)

Prevention and treatment of long-term social disability amongst young people with emerging severe mental illness with social recovery therapy (The PRODIGY Trial): study protocol for a randomised controlled trial.

Science.gov (United States)

Fowler, David; French, Paul; Banerjee, Robin; Barton, Garry; Berry, Clio; Byrne, Rory; Clarke, Timothy; Fraser, Rick; Gee, Brioney; Greenwood, Kathryn; Notley, Caitlin; Parker, Sophie; Shepstone, Lee; Wilson, Jon; Yung, Alison R; Hodgekins, Joanne

2017-07-11

Young people who have social disability associated with severe and complex mental health problems are an important group in need of early intervention. Their problems often date back to childhood and become chronic at an early age. Without intervention, the long-term prognosis is often poor and the economic costs very large. There is a major gap in the provision of evidence-based interventions for this group, and therefore new approaches to detection and intervention are needed. This trial provides a definitive evaluation of a new approach to early intervention with young people with social disability and severe and complex mental health problems using social recovery therapy (SRT) over a period of 9 months to improve mental health and social recovery outcomes. This is a pragmatic, multi-centre, single blind, superiority randomised controlled trial. It is conducted in three sites in the UK: Sussex, Manchester and East Anglia. Participants are aged 16 to 25 and have both persistent and severe social disability (defined as engaged in less than 30 hours per week of structured activity) and severe and complex mental health problems. The target sample size is 270 participants, providing 135 participants in each trial arm. Participants are randomised 1:1 using a web-based randomisation system and allocated to either SRT plus optimised treatment as usual (enhanced standard care) or enhanced standard care alone. The primary outcome is time use, namely hours spent in structured activity per week at 15 months post-randomisation. Secondary outcomes assess typical mental health problems of the group, including subthreshold psychotic symptoms, negative symptoms, depression and anxiety. Time use, secondary outcomes and health economic measures are assessed at 9, 15 and 24 months post-randomisation. This definitive trial will be the first to evaluate a novel psychological treatment for social disability and mental health problems in young people presenting with social

Measuring Peer Socialization for Adolescent Substance Use: A Comparison of Perceived and Actual Friends’ Substance Use Effects

Science.gov (United States)

Deutsch, Arielle R.; Chernyavskiy, Pavel; Steinley, Douglas; Slutske, Wendy S.

2015-01-01

Objective: There has been an increase in the use of social network analysis in studies of peer socialization effects on adolescent substance use. Some researchers argue that social network analyses provide more accurate measures of peer substance use, that the alternate strategy of assessing perceptions of friends’ drug use is biased, and that perceptions of peer use and actual peer use represent different constructs. However, there has been little research directly comparing the two effects, and little is known about the extent to which the measures differ in the magnitude of their influence on adolescent substance use, as well as how these two effects may be redundant or separate constructs. Method: Using Waves I and II of the National Longitudinal Study of Adolescent Health (Add Health) saturated subsample, we directly compared effects of perception of friends’ use (PFU) and actual friends’ use (AFU) on alcohol, cigarette, and marijuana initiation and persistence of use 1 year later. We also examined potential moderating effects of friendship quality and individual use on the relationship between perceived and actual friends’ substance use and outcomes. Results: Results indicated that, overall, PFU effects were larger than AFU effects; however, these effects did not significantly differ in magnitude for most models. In addition, interaction effects differed for different substances and usage outcomes, indicating the meaning of PFU and AFU constructs (and thus, different types of peer socialization) may change based on substance and type of use. Conclusions: These results highlight the multifaceted nature of peer influence on substance use and the importance of assessing multiple aspects of peer socialization while accounting for distinct contexts related to specific substances and use outcomes. PMID:25785802

A multicentre randomised controlled trial of day hospital-based falls prevention programme for a screened population of community-dwelling older people at high risk of falls

OpenAIRE

Conroy, Simon; Kendrick, Denise; Harwood, Rowan; Gladman, John; Coupland, Carol; Sach, Tracey; Drummond, Avril; Youde, Jane; Edmans, Judi; Masud, Tahir

2010-01-01

Objective: to determine the clinical effectiveness of a day hospital-delivered multifactorial falls prevention programme, for community-dwelling older people at high risk of future falls identified through a screening process. Design: multicentre randomised controlled trial. Setting: eight general practices and three day hospitals based in the East Midlands, UK. Participants: three hundred and sixty-four participants, mean age 79 years, with a median of three falls risk factors per person at ...

Associations between individual and environmental factors and habitual physical activity among older Chinese adults:A social-ecological perspective

Institute of Scientific and Technical Information of China (English)

Xiangren Yi; Rui Wang; Zachary Pope; Zan Gao; Shumei Wang; Fang Pan; Jingpeng Yan; Meng Liu; Peipei Wu; Jingjing Xu

2016-01-01

Purpose: To examine, within a social–ecological framework, associations between multifaceted individual and environmental factors and habitual physical activity (HPA) among older Chinese adults. Methods: Through a mix of qualitative and quantitative methods, a survey instrument assessing various factors underlying 3 social–ecological dimensions of intrapersonal, interpersonal, and community and environmental resources was developed. Using a cross-sectional design, older adults (n=1580, aged 67 ± 7 years) recruited from 10 communities in Shandong province completed the social–ecological survey of HPA. Data were analyzed using Partial Least Squares Path Modeling. Results: Factors related to intrapersonal (medical knowledge, motivation, physical function, sport skills, socioeconomic status, and education), interpersonal (social support, social activity, and social norms), and community and physical environmental resources (safety, capacity, availability of and access to physical activity facilities) were found to be significantly associated with older adults’ participation in HPA. Conclusion: The findings provide an initial validation of a social–ecological approach to the study of HPA in China, suggesting that strategies aimed at promoting physical activity in older adults should address multiple levels of factors that may contribute to the likelihood of older Chinese adults being physically active. © 2016 Production and hosting by Elsevier B.V. on behalf of Shanghai University of Sport. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Capacity Building for Social Innovation: A Collective Impact Approach

Science.gov (United States)

Szarleta, Ellen J.

2017-01-01

Business, nonprofit, and government institutions generally agree that a vibrant economy is critical to addressing the multi-faceted, complex issues faced by urban communities. Yet, despite significant targeted efforts aimed at revitalizing economic activity over the past few decades, the state of many communities remains unchanged. A collective…

Culturally grounded indicators of resilience in social-ecological systems

Science.gov (United States)

Eleanor Sterling; Tamara Ticktin; Tē Kipa Kepa Morgan; Georgina Cullman; Diana Alvira; Pelika Andrade; Nadia Bergamini; Erin Betley; Kate Burrows; Sophie Caillon; Joachim Claudet; Rachel Dacks; Pablo Eyzaguirre; Chris Filardi; Nadav Gazit; Christian Giardina; Stacy Jupiter; Kealohanuiopuna Kinney; Joe McCarter; Manuel Mejia; Kanoe Morishige; Jennifer Newell; Lihla Noori; John Parks; Pua‘ala Pascua; Ashwin Ravikumar; Jamie Tanguay; Amanda Sigouin; Tina Stege; Mark Stege; Alaka Wali

2017-01-01

Measuring progress toward sustainability goals is a multifaceted task. International, regional, and national organizations and agencies seek to promote resilience and capacity for adaptation at local levels. However, their measurement systems may be poorly aligned with local contexts, cultures, and needs. Understanding how to build effective, culturally grounded...

A teaching intervention in a contouring dummy run improved target volume delineation in locally advanced non-small cell lung cancer: Reducing the interobserver variability in multicentre clinical studies.

Science.gov (United States)

Schimek-Jasch, Tanja; Troost, Esther G C; Rücker, Gerta; Prokic, Vesna; Avlar, Melanie; Duncker-Rohr, Viola; Mix, Michael; Doll, Christian; Grosu, Anca-Ligia; Nestle, Ursula

2015-06-01

Interobserver variability in the definition of target volumes (TVs) is a well-known confounding factor in (multicentre) clinical studies employing radiotherapy. Therefore, detailed contouring guidelines are provided in the prospective randomised multicentre PET-Plan (NCT00697333) clinical trial protocol. This trial compares strictly FDG-PET-based TV delineation with conventional TV delineation in patients with locally advanced non-small cell lung cancer (NSCLC). Despite detailed contouring guidelines, their interpretation by different radiation oncologists can vary considerably, leading to undesirable discrepancies in TV delineation. Considering this, as part of the PET-Plan study quality assurance (QA), a contouring dummy run (DR) consisting of two phases was performed to analyse the interobserver variability before and after teaching. In the first phase of the DR (DR1), radiation oncologists from 14 study centres were asked to delineate TVs as defined by the study protocol (gross TV, GTV; and two clinical TVs, CTV-A and CTV-B) in a test patient. A teaching session was held at a study group meeting, including a discussion of the results focussing on discordances in comparison to the per-protocol solution. Subsequently, the second phase of the DR (DR2) was performed in order to evaluate the impact of teaching. Teaching after DR1 resulted in a reduction of absolute TVs in DR2, as well as in better concordance of TVs. The Overall Kappa(κ) indices increased from 0.63 to 0.71 (GTV), 0.60 to 0.65 (CTV-A) and from 0.59 to 0.63 (CTV-B), demonstrating improvements in overall interobserver agreement. Contouring DRs and study group meetings as part of QA in multicentre clinical trials help to identify misinterpretations of per-protocol TV delineation. Teaching the correct interpretation of protocol contouring guidelines leads to a reduction in interobserver variability and to more consistent contouring, which should consequently improve the validity of the overall study

A teaching intervention in a contouring dummy run improved target volume delineation in locally advanced non-small cell lung cancer. Reducing the interobserver variability in multicentre clinical studies

International Nuclear Information System (INIS)

Schimek-Jasch, Tanja; Prokic, Vesna; Doll, Christian; Grosu, Anca-Ligia; Nestle, Ursula; Troost, Esther G.C.; Ruecker, Gerta; Avlar, Melanie; Duncker-Rohr, Viola; Mix, Michael

2015-01-01

Interobserver variability in the definition of target volumes (TVs) is a well-known confounding factor in (multicentre) clinical studies employing radiotherapy. Therefore, detailed contouring guidelines are provided in the prospective randomised multicentre PET-Plan (NCT00697333) clinical trial protocol. This trial compares strictly FDG-PET-based TV delineation with conventional TV delineation in patients with locally advanced non-small cell lung cancer (NSCLC). Despite detailed contouring guidelines, their interpretation by different radiation oncologists can vary considerably, leading to undesirable discrepancies in TV delineation. Considering this, as part of the PET-Plan study quality assurance (QA), a contouring dummy run (DR) consisting of two phases was performed to analyse the interobserver variability before and after teaching. In the first phase of the DR (DR1), radiation oncologists from 14 study centres were asked to delineate TVs as defined by the study protocol (gross TV, GTV; and two clinical TVs, CTV-A and CTV-B) in a test patient. A teaching session was held at a study group meeting, including a discussion of the results focussing on discordances in comparison to the per-protocol solution. Subsequently, the second phase of the DR (DR2) was performed in order to evaluate the impact of teaching. Teaching after DR1 resulted in a reduction of absolute TVs in DR2, as well as in better concordance of TVs. The Overall Kappa(κ) indices increased from 0.63 to 0.71 (GTV), 0.60 to 0.65 (CTV-A) and from 0.59 to 0.63 (CTV-B), demonstrating improvements in overall interobserver agreement. Contouring DRs and study group meetings as part of QA in multicentre clinical trials help to identify misinterpretations of per-protocol TV delineation. Teaching the correct interpretation of protocol contouring guidelines leads to a reduction in interobserver variability and to more consistent contouring, which should consequently improve the validity of the overall study

Atypical presentation of multicentric Castleman disease in a pediatric patient: pleural and pericardial effusion.

Science.gov (United States)

Akman, Alkim Oden; Basaran, Ozge; Ozyoruk, Derya; Han, Unsal; Sayli, Tulin; Cakar, Nilgun

2016-06-01

Castleman disease (CD) is a rare poorly understood lymphoproliferative disorder. Pediatric onset CD has been reported before. However, most of them have benign unicentric pattern. Multicentric CD (MCD) is quite rare in children. Herein, we report a 13-year-old adolescent boy with MCD of the hyaline vascular variant presenting with pleural and pericardial effusion, which is an uncommon presentation. MCD should be considered in the differential diagnosis of pleural and/or pericardial effusion with unexplained lymph nodes in children. What is Known •Pediatric Castleman disease (CD) most commonly occurs in the unicentric form, which typically is asymptomatic and cured by lymph node excision. •The diagnosis of MCD can be difficult owing to the heterogeneity of presentation and potential for nonspecific multisystem involvement. What is New •A 13-year-old adolescent boy was diagnosed with MCD of the hyaline vascular variant presenting with pleural and pericardial effusion, which is an uncommon presentation. •In a pediatric patient with fever, pleural-pericardial effusion and multiple lymph nodes, MCD should be considered in differantial diagnosis.

Perspectives of Cosmesis following Breast Conservation for Multifocal and Multicentric Breast Cancers

Directory of Open Access Journals (Sweden)

Mona P. Tan

2015-01-01

Full Text Available Background. Contemporary data suggest that breast conservation treatment (BCT for multifocal and multicentric breast cancer (MFMCBC may be appropriate with noninferior local control rates. However, there is a paucity of data to evaluate patient’s satisfaction with cosmetic outcomes after BCT for MFMCBC. This study was performed to bridge this information gap. Methods. All patients treated at the authors’ healthcare facility were included in the study. Patients with MFMCBC who were assessed to be eligible for BCT underwent tumour resection using standard surgical techniques with direct parenchymal closure through a single incision. After at least three years of follow-up, they were invited to participate in a survey regarding their cosmetic outcomes. Results. Of a total of 160 patients, 40 had MFMCBC, of whom 34 (85% underwent successful BCT. Five-year cancer-specific survival and disease-free survival were 95.7%. Twenty of the 34 patients responded to the survey. No patient rated her cosmetic outcome as “poor.” Analysis indicated low agreement between patients’ self-assessment and clinician-directed evaluation of aesthetic results. Conclusion. BCT for MFMCBC is feasible with acceptable survival and cosmetic outcomes. However, there appears to be a disparity between patient and clinician-directed evaluation of cosmetic results which warrant further research.

Multicentric evaluation of the impact of central tumour location when comparing rates of N1 upstaging in patients undergoing video-assisted and open surgery for clinical Stage I non-small-cell lung cancer

DEFF Research Database (Denmark)

Decaluwé, Herbert; Petersen, René Horsleben; Brunelli, Alex

2018-01-01

OBJECTIVES: Large retrospective series have indicated lower rates of cN0 to pN1 nodal upstaging after video-assisted thoracic surgery (VATS) compared with open resections for Stage I non-small-cell lung cancer (NSCLC). The objective of our multicentre study was to investigate whether the presumed...

Analysis of Daily Laboratory Orders at a Large Urban Academic Center: A Multifaceted Approach to Changing Test Ordering Patterns.

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Rudolf, Joseph W; Dighe, Anand S; Coley, Christopher M; Kamis, Irina K; Wertheim, Bradley M; Wright, Douglas E; Lewandrowski, Kent B; Baron, Jason M

2017-08-01

We sought to address concerns regarding recurring inpatient laboratory test order practices (daily laboratory tests) through a multifaceted approach to changing ordering patterns. We engaged in an interdepartmental collaboration to foster mindful test ordering through clinical policy creation, electronic clinical decision support, and continuous auditing and feedback. Annualized daily order volumes decreased from approximately 25,000 to 10,000 during a 33-month postintervention review. This represented a significant change from preintervention order volumes (95% confidence interval, 0.61-0.64; P < 10-16). Total inpatient test volumes were not affected. Durable changes to inpatient order practices can be achieved through a collaborative approach to utilization management that includes shared responsibility for establishing clinical guidelines and electronic decision support. Our experience suggests auditing and continued feedback are additional crucial components to changing ordering behavior. Curtailing daily orders alone may not be a sufficient strategy to reduce in-laboratory costs. © American Society for Clinical Pathology, 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Efficacy and Safety of the Biosimilar Infliximab CT-P13 Treatment in Inflammatory Bowel Diseases: A Prospective, Multicentre, Nationwide Cohort.

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Gecse, Krisztina B; Lovász, Barbara D; Farkas, Klaudia; Banai, János; Bene, László; Gasztonyi, Beáta; Golovics, Petra Anna; Kristóf, Tünde; Lakatos, László; Csontos, Ágnes Anna; Juhász, Márk; Nagy, Ferenc; Palatka, Károly; Papp, Mária; Patai, Árpád; Lakner, Lilla; Salamon, Ágnes; Szamosi, Tamás; Szepes, Zoltán; Tóth, Gábor T; Vincze, Áron; Szalay, Balázs; Molnár, Tamás; Lakatos, Péter L

2016-02-01

Biosimilar infliximab CT-P13 is approved for all indications of the originator product in Europe. Prospective data on its efficacy, safety, and immunogenicity in inflammatory bowel diseases are lacking. A prospective, nationwide, multicentre, observational cohort was designed to examine the efficacy, safety, and immunogenicity of CT-P13 infliximab biosimilar in the induction treatment of Crohn's disease [CD] and ulcerative colitis [UC]. Demographic data were collected and a harmonised monitoring strategy was applied. Early clinical remission, response, and early biochemical response were evaluated at Week 14, steroid-free clinical remission was evaluated at Week 30. Therapeutic drug level was monitored using a conventional enzyme-linked immunosorbent assay. In all, 210 consecutive inflammatory bowel disease [126 CD and 84 UC] patients were included in the present cohort. At Week 14, 81.4% of CD and 77.6% of UC patients showed clinical response and 53.6% of CD and 58.6% of UC patients were in clinical remission. Clinical remission rates at Week 14 were significantly higher in CD and UC patients who were infliximab naïve, compared with those with previous exposure to the originator compound [p < 0.05]. Until Week 30, adverse events were experienced in 17.1% of all patients. Infusion reactions and infectious adverse events occurred in 6.6% and 5.7% of all patients, respectively. This prospective multicentre cohort shows that CT-P13 is safe and effective in the induction of clinical remission and response in both CD and UC. Patients with previous infliximab exposure exhibited decreased response rates and were more likely to develop allergic reactions. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Factors secreted from dental pulp stem cells show multifaceted benefits for treating experimental rheumatoid arthritis.

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Ishikawa, Jun; Takahashi, Nobunori; Matsumoto, Takuya; Yoshioka, Yutaka; Yamamoto, Noriyuki; Nishikawa, Masaya; Hibi, Hideharu; Ishigro, Naoki; Ueda, Minoru; Furukawa, Koichi; Yamamoto, Akihito

2016-02-01

Rheumatoid arthritis (RA) is an autoimmune disease characterized by synovial hyperplasia and chronic inflammation, which lead to the progressive destruction of cartilage and bone in the joints. Numerous studies have reported that administrations of various types of MSCs improve arthritis symptoms in animal models, by paracrine mechanisms. However, the therapeutic effects of the secreted factors alone, without the cell graft, have been uncertain. Here, we show that a single intravenous administration of serum-free conditioned medium (CM) from human deciduous dental pulp stem cells (SHED-CM) into anti-collagen type II antibody-induced arthritis (CAIA), a mouse model of rheumatoid arthritis (RA), markedly improved the arthritis symptoms and joint destruction. The therapeutic efficacy of SHED-CM was associated with an induction of anti-inflammatory M2 macrophages in the CAIA joints and the abrogation of RANKL expression. SHED-CM specifically depleted of an M2 macrophage inducer, the secreted ectodomain of sialic acid-binding Ig-like lectin-9 (ED-Siglec-9), exhibited a reduced ability to induce M2-related gene expression and attenuate CAIA. SHED-CM also inhibited the RANKL-induced osteoclastogenesis in vitro. Collectively, our findings suggest that SHED-CM provides multifaceted therapeutic effects for treating CAIA, including the ED-Siglec-9-dependent induction of M2 macrophage polarization and inhibition of osteoclastogenesis. Thus, SHED-CM may represent a novel anti-inflammatory and reparative therapy for RA. Copyright © 2015 Elsevier Inc. All rights reserved.

Improving understanding, promoting social inclusion, and fostering empowerment related to epilepsy: Epilepsy Foundation public awareness campaigns--2001 through 2013.

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Price, P; Kobau, R; Buelow, J; Austin, J; Lowenberg, K

2015-03-01

It is a significant public health concern that epilepsy, the fourth most common neurological disorder in the United States, is generally poorly understood by both the public and those living with the condition. Lack of understanding may magnify the challenges faced by those with epilepsy, including limiting treatment opportunities, effective management of symptoms, and full participation in daily life activities. Insufficient awareness of epilepsy and appropriate seizure first aid among the public and professionals can result in insufficient treatment, inappropriate seizure response, physical restraint, social exclusion, or other negative consequences. To address the need for increased public education and awareness about epilepsy, the national Epilepsy Foundation, supported by the Centers for Disease Control and Prevention, has conducted yearly multifaceted public education and awareness campaigns designed to reach the broad population and targeted segments of the population including youth, young adults, racial/ethnic groups (i.e., African-, Hispanic-, and Asian-Americans), and people with epilepsy and their caregivers. Campaign channels have included traditional media, social media, and community opinion leaders and celebrity spokespersons. The key activities of these campaigns, conducted from 2001 to 2013, are summarized in this report. Published by Elsevier Inc.

Multi-centre audit of VMAT planning and pre-treatment verification.

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Jurado-Bruggeman, Diego; Hernández, Victor; Sáez, Jordi; Navarro, David; Pino, Francisco; Martínez, Tatiana; Alayrach, Maria-Elena; Ailleres, Norbert; Melero, Alejandro; Jornet, Núria

2017-08-01

We performed a multi-centre intercomparison of VMAT dose planning and pre-treatment verification. The aims were to analyse the dose plans in terms of dosimetric quality and deliverability, and to validate whether in-house pre-treatment verification results agreed with those of an external audit. The nine participating centres encompassed different machines, equipment, and methodologies. Two mock cases (prostate and head and neck) were planned using one and two arcs. A plan quality index was defined to compare the plans and different complexity indices were calculated to check their deliverability. We compared gamma index pass rates using the centre's equipment and methodology to those of an external audit (global 3D gamma, absolute dose differences, 10% of maximum dose threshold). Log-file analysis was performed to look for delivery errors. All centres fulfilled the dosimetric goals but plan quality and delivery complexity were heterogeneous and uncorrelated, depending on the manufacturer and the planner's methodology. Pre-treatment verifications results were within tolerance in all cases for gamma 3%-3mm evaluation. Nevertheless, differences between the external audit and in-house measurements arose due to different equipment or methodology, especially for 2%-2mm criteria with differences up to 20%. No correlation was found between complexity indices and verification results amongst centres. All plans fulfilled dosimetric constraints, but plan quality and complexity did not correlate and were strongly dependent on the planner and the vendor. In-house measurements cannot completely replace external audits for credentialing. Copyright © 2017 Elsevier B.V. All rights reserved.

A Multifaceted Mass Spectrometric Method to Probe Feeding Related Neuropeptide Changes in Callinectes sapidus and Carcinus maenas

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Zhang, Yuzhuo; DeLaney, Kellen; Hui, Limei; Wang, Junhua; Sturm, Robert M.; Li, Lingjun

2018-05-01

Food intake is regulated by various neuromodulators, including numerous neuropeptides. However, it remains elusive at the molecular and cellular level as to how these important chemicals regulate internal processes and which regions of the neuronal organs are responsible for regulating the behavior. Here we report a comparative neuropeptidomic analysis of the brain and pericardial organ (PO) in response to feeding in two well-studied crustacean physiology model organisms, Callinectes sapidus and Carcinus maenas, using mass spectrometry (MS) techniques. A multifaceted MS-based approach has been developed to obtain complementary information on the expression changes of a large array of neuropeptides in the brain and PO. The method employs stable isotope labeling of brain and PO extracts for relative MS quantitation, capillary electrophoresis (CE)-MS for fractionation and high-specificity analysis, and mass spectrometric imaging (MSI) for in-situ molecular mapping of peptides. A number of neuropeptides, including RFamides, B-type allatostatins (AST-B), RYamides, and orcokinins exhibit significant changes in abundance after feeding in this investigation. Peptides from the AST-B family found in PO tissue were shown to have both altered expression and localization changes after feeding, indicating that they may be a class of vital neuropeptide regulators involved in feeding behavior. [Figure not available: see fulltext.

A Multifaceted Mass Spectrometric Method to Probe Feeding Related Neuropeptide Changes in Callinectes sapidus and Carcinus maenas

Science.gov (United States)

Zhang, Yuzhuo; DeLaney, Kellen; Hui, Limei; Wang, Junhua; Sturm, Robert M.; Li, Lingjun

2018-02-01

Food intake is regulated by various neuromodulators, including numerous neuropeptides. However, it remains elusive at the molecular and cellular level as to how these important chemicals regulate internal processes and which regions of the neuronal organs are responsible for regulating the behavior. Here we report a comparative neuropeptidomic analysis of the brain and pericardial organ (PO) in response to feeding in two well-studied crustacean physiology model organisms, Callinectes sapidus and Carcinus maenas, using mass spectrometry (MS) techniques. A multifaceted MS-based approach has been developed to obtain complementary information on the expression changes of a large array of neuropeptides in the brain and PO. The method employs stable isotope labeling of brain and PO extracts for relative MS quantitation, capillary electrophoresis (CE)-MS for fractionation and high-specificity analysis, and mass spectrometric imaging (MSI) for in-situ molecular mapping of peptides. A number of neuropeptides, including RFamides, B-type allatostatins (AST-B), RYamides, and orcokinins exhibit significant changes in abundance after feeding in this investigation. Peptides from the AST-B family found in PO tissue were shown to have both altered expression and localization changes after feeding, indicating that they may be a class of vital neuropeptide regulators involved in feeding behavior. [Figure not available: see fulltext.

Fructose and NAFLD: The Multifaceted Aspects of  Fructose Metabolism

Directory of Open Access Journals (Sweden)

Prasanthi Jegatheesan

2017-03-01

Full Text Available Among various factors, such as an unhealthy diet or a sedentarity lifestyle, excessive fructose consumption is known to favor nonalcoholic fatty liver disease (NAFLD, as fructose is both a substrate and an inducer of hepatic de novo lipogenesis. The present review presents some well‐established mechanisms and new clues to better understand the pathophysiology of fructose‐induced NAFLD. Beyond its lipogenic effect, fructose intake is also at the onset of hepatic inflammation and cellular stress, such as oxidative and endoplasmic stress, that are key factors contributing to the progression of simple steatosis to nonalcoholic steatohepatitis (NASH. Beyond its hepatic effects, this carbohydrate may exert direct and indirect effects at the peripheral level. Excessive fructose consumption is associated, for example, with the release by the liver of several key mediators leading to alterations in the communication between the liver and the gut, muscles, and adipose tissue and to disease aggravation. These multifaceted aspects of fructose properties are in part specific to fructose, but are also shared in part with sucrose and glucose present in energy– dense beverages and foods. All these aspects must be taken into account in the development of new therapeutic strategies and thereby to better prevent NAFLD.

Maltese Antibiotic Stewardship Programme in the Community (MASPIC): protocol of a prospective quasiexperimental social marketing intervention

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Saliba-Gustafsson, Erika A; Borg, Michael A; Rosales-Klintz, Senia; Nyberg, Anna; StålsbyLundborg, Cecilia

2017-01-01

Introduction Antibiotic misuse is a key driver of antibiotic resistance. In 2015/2016, Maltese respondents reported the highest proportions of antibiotic consumption in Europe. Since antibiotics are prescription-only medicines in Malta, research on effective strategies targeting general practitioners’ (GPs) knowledge and behaviour is needed. Multifaceted behaviour change (BC) interventions are likely to be effective. Social marketing (SM) can provide the tools to promote sustained BC; however, its utilisation in Europe is limited. This paper aims to describe the design and methods of a multifaceted SM intervention aimed at changing Maltese GPs’ antibiotic prescribing behaviour for patients with acute respiratory tract infections (aRTIs). Methods and analysis This 4-year quasiexperimental intervention study will be carried out in Malta and includes three phases: preintervention, intervention and postintervention. The preintervention phase intends to gain insight into the practices and attitudes of GPs, pharmacists and parents through interviews, focus group discussions and antibiotic prescribing surveillance. A 6-month intervention targeting GPs will be implemented following assessment of their prescribing intention and readiness for BC. The intervention will likely comprise: prescribing guidelines, patient educational materials, delayed antibiotic prescriptions and GP education. Outcomes will be evaluated in the postintervention phase through questionnaires based on the theory of planned behaviour and stages-of-change theory, as well as postintervention surveillance. The primary outcome will be the antibiotic prescribing rate for all patients with aRTIs. Secondary outcomes will include the proportion of diagnosis-specific antibiotic prescription and symptomatic relief medication prescribed, and the change in GPs stage-of-change and their intention to prescribe antibiotics. Ethics and dissemination The project received ethical approval from the University of

Dasatinib first-line: Multicentric Italian experience outside clinical trials.

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Breccia, Massimo; Stagno, Fabio; Luciano, Luigiana; Abruzzese, Elisabetta; Annunziata, Mario; D'Adda, Mariella; Maggi, Alessandro; Sgherza, Nicola; Russo-Rossi, Antonella; Pregno, Patrizia; Castagnetti, Fausto; Iurlo, Alessandra; Latagliata, Roberto; Cedrone, Michele; Di Renzo, Nicola; Sorà, Federica; Rege-Cambrin, Giovanna; La Nasa, Giorgio; Scortechini, Anna Rita; Greco, Giovanna; Franceschini, Luca; Sica, Simona; Bocchia, Monica; Crugnola, Monica; Orlandi, Esther; Guarini, Attilio; Specchia, Giorgina; Rosti, Gianantonio; Saglio, Giuseppe; Alimena, Giuliana

2016-01-01

Dasatinib was approved for the treatment of chronic phase (CP) chronic myeloid leukemia (CML) patients in first line therapy based on the demonstration of efficacy and safety reported in patients enrolled in clinical trials. We describe a multicentric Italian "real-life" experience of dasatinib used as frontline treatment outside clinical trials. One hundred and nine patients (median age 54 years) were treated from January 2012 to December 2013. Increased incidence of high risk patients were detected according to stratification (26% according to Sokal score, 19% according to Euro score and 16% according to EUTOS) when compared to company sponsored studies. Median time from diagnosis to start of dasatinib was 18 days. Ten patients received unscheduled starting dose (6 patients 50mg and 4 patients 80 mg QD), whereas 99 patients started with 100mg QD. At 3 months, 92% of patients achieved a BCR-ABL ratio less than 10%. At 6 months, the rate of CCyR was 91% and the rate of MR3 was 40%, with 8% of the patients reaching MR4.5. Ninety-three patients were evaluable at 12 months: the rate of MR3 was 62%, with MR4.5 being achieved by 19% of the patients. At a median follow-up of 12 months, 27 patients (24.7%) were receiving the drug at reduced dose. Two patients (1.8%) experienced a lymphoid blast crisis and the overall incidence of resistance was 8%. As regards safety, the major side effects recorded were thrombocytopenia, neutropenia and pleural effusions, which occurred in 22%, 10% and 8% of patients, respectively. Present results, achieved in a large cohort of patients treated outside clinical trials, further confirm the efficacy and safety of dasatinib as firstline treatment in CML. Copyright © 2015 Elsevier Ltd. All rights reserved.

The EULAR Scleroderma Trials and Research Group (EUSTAR): an international framework for accelerating scleroderma research.

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Tyndall, Alan; Ladner, Ulf M; Matucci-Cerinic, Marco

2008-11-01

Systemic sclerosis has a complex pathogenesis and a multifaceted clinical spectrum without a specific treatment. Under the auspices of the European League Against Rheumatism, the European League Against Rheumatism Scleroderma Trials And Research group (EUSTAR) has been founded in Europe to foster the study of systemic sclerosis with the aim of achieving equality of assessment and care of systemic sclerosis patients throughout the world according to evidence-based principles. EUSTAR created the minimal essential data set, a simple two-page form with basic demographics and mostly yes/no answers to clinical and laboratory parameters, to track patients throughout Europe. Currently, over 7000 patients are registered from 150 centres in four continents, and several articles have been published with the data generated by the minimal essential data set. A commitment of EUSTAR is also to teaching and educating, and for this reason there are two teaching courses and a third is planned for early in 2009. These courses have built international networks among young investigators improving the quality of multicentre clinical trials. EUSTAR has organized several rounds of 'teach the teachers' to further standardize the skin scoring. EUSTAR activities have extended beyond European borders, and EUSTAR now includes experts from several nations. The growth of data and biomaterial might ensure many further fruitful multicentre studies, but the financial sustainability of EUSTAR remains an issue that may jeopardize the existence of this group as well as that of other organizations in the world.

Doxycycline in the treatment of respiratory tract infections. Results of a pan-European multi-centre trial.

Science.gov (United States)

Pestel, M

1975-01-01

In the winter of 1973-4, general practitioners from seven European countries took part in a multi-centre trial of doxycycline in the treatment of infections of the respiratory tract. The carefully designed protocol was observed by all participants. A total of 1,747 patients were admitted to the trial; their ages ranged from 6 years to over 80. The commonest diagnoses (50%) were acute bronchitis and acute exacerbations of chronic bronchitis. On the recommended dosage of 200 mg doxycycline on the first day, followed by 100 mg daily thereafter (though 200 mg could be continued daily in severe cases), 87% of patients achieved good or very good results. Both subjective (pain) and objective (sputum volume and viscosity, temperature, cough) measures showed rapid improvement, usually by the third to fifth days. Side-effects were minimal and mainly gastrointestinal and caused only 4 patients to discontinue treatment. Overall, doxycycline proved its effectiveness and rapidity of action.

'Get Your Life Back': process and impact evaluation of an asthma social marketing campaign targeting older adults.

Science.gov (United States)

Evers, Uwana; Jones, Sandra C; Iverson, Don; Caputi, Peter

2013-08-15

Asthma in older adults is underdiagnosed and poorly self-managed. This population has little knowledge about the key symptoms, the prevalence among older adults, and the serious consequences of untreated asthma. The purpose of this study was to undertake a multifaceted evaluation of a social marketing campaign to increase asthma awareness among older adults in a regional Australian community. A cohort of older adults in an intervention region (n = 316) and a control region (n = 394) were surveyed immediately prior to and following the social marketing campaign. Campaign awareness, message recall, materials recognition, and actions taken as a result of the campaign were assessed in both regions. Asthma knowledge and perceptions, experience of asthma symptoms, and general health were also assessed in both regions at baseline and follow-up. Analyses were conducted to explore the effects of the campaign in the intervention region, and to examine outcomes among different audience segments. The survey data showed that those in the target segments (Wheezers and Strugglers) had better message recall, and were more likely to report having taken action to control their respiratory symptoms. The campaign significantly increased the number of calls to an asthma information line from the target audience in the intervention community. A theory-based social marketing campaign conducted over 3-months increased the asthma information seeking behaviours of older adults in the intervention community compared to the control community. Recommendations are outlined for future community health promotion campaigns targeting older adults.